Prunus persica crop management as step toward AMF diversity conservation for the sustainable soil management

NASA Astrophysics Data System (ADS)

Alguacil, M. M.; Torrecillas, E.; Lozano, Z.; Garcia-Orenes, F.; Roldan, A.

2012-04-01

We investigated the diversity of arbuscular mycorrhizal fungi (AMF) in roots of Prunus persica under two fertilization treatments (CF: consisted of application of chicken manure (1400 kg.ha-1), urea (140 kg.ha-1), complex fertilizer 12-12-17/2 (280 kg.ha-1), and potassium sulfate (40 kg.ha-1) and IF: consisted of application of urea (140 kg.ha-1), complex fertilizer 12-12-17/2 (400 kg.ha-1) and potassium sulfate (70 kg.ha-1)) combined with integrated pest management (IM) or chemical pest management (CM), in a tropical agroecosystem in the north of Venezuela. Our goal was to ascertain how different fertilizers/pest management can modify the AMF diversity colonizing P. persica roots as an important step towards sustainable soil use and therefore protection of biodiversity. The AM fungal small-subunit (SSU) rRNA genes were subjected to PCR, cloning, sequencing and phylogenetic analyses. Twenty-one different phylotypes were identified, which were grouped in five families: Glomeraceae, Paraglomeraceae, Acaulosporaceae, Gigasporaceae and Archaeosporaceae. Sixteen of these sequence groups belonged to the genus Glomus, two to Paraglomus, one to Acaulospora, one to Scutellospora and one to Archaeospora. A different distribution of the AMF phylotypes as consequence of the difference between treatments was observed. Thus, the AMF communities of tree roots in the (IF+CM) treatment had the lowest diversity (H'=1.78) with the lowest total number of AMF sequence types (9). The trees from both (CF+IM) and (IF+IM) treatments had similar AMF diversity (H'?2.00); while the treatment (CF+CM) yielded the highest number of different AMF sequence types (17) and showed the highest diversity index (H'=2.69). In conclusion, the crop management including combination of organic and inorganic fertilization and chemical pest control appears to be the most suitable strategy with respect to reactivate the AMF diversity in the roots of this crop and thus, the agricultural and environmental sustainability in the agroecosystem.

Project Management Meets Change Management - A Success Story. Focus Area: Tech Perspectives TI012SN

NASA Technical Reports Server (NTRS)

Hall, Wayne

2011-01-01

Utilizing the concepts and terminology from Project Management, the process of planning and executing a Change Management (CM) Infrastructure improvement project is described. The primary audience for this presentation includes both experienced and relatively new CM administrators and their managers. It also includes anyone with an interest in the application of project management knowledge to CM administration. There are several benefits: the complexity of the CM tool technology is more manageable, CM administrators get to use project management knowledge to complete a project (not "firefighting"), improve relations with your customers (that means developers and managers), and get the opportunity to do it again.

Effectiveness of Motivational Incentives for Adolescent Marijuana Users in a School-Based Intervention.

PubMed

Stewart, David G; Felleman, Benjamin I; Arger, Christopher A

2015-11-01

This study examined whether adolescents receiving Motivational Interviewing (MI) intervention have different outcomes compared to those receiving Motivational Incentives (Motivational Interviewing combined with Contingency Management; MI+CM). A total of 136 adolescents (from a parent study of 220 adolescents) with problematic substance use were recruited from 8 high schools in Washington State, where they completed either 8-weeks of MI or MI+CM. Frequency of marijuana use was assessed at baseline, at the end-of-treatment, and at 16-week follow-up. A balanced and matched sample was created using propensity scores, then analyzed using Hierarchical Linear Modeling (HLM). Multilevel regression analyses revealed that adolescents who received MI+CM exhibited a greater reduction in use across time (p<.05). Reductions at the end-of-treatment were greater for the MI+CM condition (Cohen's d=-.82) compared to MI alone (Cohen's d=-.33), but did not differ at 16-week follow-up. Adolescents receiving MI+CM showed significantly fewer negative consequences of marijuana use at the end-of-treatment (t1, 124=2.26, p<.05), higher use of coping strategies (t1, 124=3.01, p<.01), and increased likelihood to attend additional treatment for substance use (χ2 1, 124=4.12 p<.05), though hypothesized improvements in motivation and school attendance were not found. Use of coping strategies at the end-of-treatment had a significant indirect effect on the relationship between the intervention condition and marijuana use at the end-of-treatment (F3, 121=10.20, R2=.20, p<.01). These results suggest that the inclusion of contingencies into adolescent marijuana treatment decreases the end-of-treatment frequency of marijuana use and related consequences while increasing the use of coping strategies and the pursuit of additional treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

Spatial Analysis of Soil Subsidence in Peat Meadow Areas in Friesland in Relation to Land and Water Management, Climate Change, and Adaptation

NASA Astrophysics Data System (ADS)

Brouns, Karlijn; Eikelboom, Tessa; Jansen, Peter C.; Janssen, Ron; Kwakernaak, Cees; van den Akker, Jan J. H.; Verhoeven, Jos T. A.

2015-02-01

Dutch peatlands have been subsiding due to peat decomposition, shrinkage and compression, since their reclamation in the 11th century. Currently, subsidence amounts to 1-2 cm/year. Water management in these areas is complex and costly, greenhouse gases are being emitted, and surface water quality is relatively poor. Regional and local authorities and landowners responsible for peatland management have recognized these problems. In addition, the Netherlands Royal Meteorological Institute predicts higher temperatures and drier summers, which both are expected to enhance peat decomposition. Stakeholder workshops have been organized in three case study areas in the province of Friesland to exchange knowledge on subsidence and explore future subsidence rates and the effects of land use and management changes on subsidence rates. Subsidence rates were up to 3 cm/year in deeply drained parcels and increased when we included climate change in the modeling exercises. This means that the relatively thin peat layers in this province (ca 1 m) would shrink or even disappear by the end of the century when current practices continue. Adaptation measures were explored, such as extensive dairy farming and the production of new crops in wetter conditions, but little experience has been gained on best practices. The workshops have resulted in useful exchange of ideas on possible measures and their consequences for land use and water management in the three case study areas. The province and the regional water board will use the results to develop land use and water management policies for the next decades.

Nitrate accumulation and leaching potential reduced by coupled water and nitrogen management in the Huang-Huai-Hai Plain.

PubMed

Huang, Ping; Zhang, Jiabao; Zhu, Anning; Li, Xiaopeng; Ma, Donghao; Xin, Xiuli; Zhang, Congzhi; Wu, Shengjun; Garland, Gina; Pereira, Engil Isadora Pujol

2018-01-01

Irrigation and nitrogen (N) fertilization in excess of crop requirements are responsible for substantial nitrate accumulation in the soil profile and contamination of groundwater by nitrate leaching during intensive agricultural production. In this on-farm field trial, we compared 16 different water and N treatments on nitrate accumulation and its distribution in the soil profile (0-180cm), nitrate leaching potential, and groundwater nitrate concentration within a summer-maize (Zea mays L.) and winter-wheat (Triticum aestivum L.) rotation system in the Huang-Huai-Hai Plain over five cropping cycles (2006-2010). The results indicated that nitrate remaining in the soil profile after crop harvest and nitrate concentration of soil solutions at two depths (80cm and 180cm) declined with increasing irrigation amounts and increased greatly with increasing N application rates, especially for seasonal N application rates higher than 190kgNha -1 . During the experimental period, continuous torrential rainfall was the main cause for nitrate leaching beyond the root zone (180cm), which could pose potential risks for contamination of groundwater. Nitrate concentration of groundwater varied from 0.2 to 2.9mgL -1 , which was lower than the limit of 10mgL -1 as the maximum safe level for drinking water. In view of the balance between grain production and environmental consequences, seasonal N application rates of 190kgNha -1 and 150kgNha -1 were recommended for winter wheat and summer maize, respectively. Irrigation to the field capacity of 0-40cm and 0-60cm soil depth could be appropriate for maize and wheat, respectively. Therefore, taking grain yields, mineral N accumulation in the soil profile, nitrate leaching potential, and groundwater quality into account, coupled water and N management could provide an opportunity to promote grain production while reducing negative environmental impacts in this region. Copyright © 2017 Elsevier B.V. All rights reserved.

Is estimated bullet trajectory a reliable predictor of severe injury? Case report of a thoraco-abdominal gunshot with a protracted trajectory managed nonoperatively.

PubMed

Khan, Muhammad Sohaib; Khan, Bilal Masood; Naz, Sumbul; Pirzada, Muhammad Taqi

2013-02-15

Operative management of all gunshot's traumas carries a high rate of unwarranted interventions that are known to cause serious complications. Selective nonoperative management is thus being increasingly practiced which has reduced these avoidable interventions. Physical examination and computed tomography scans are most sensitive in assessing need of laparotomy. Assessment of internal injuries on the basis of an estimated bullet trajectory is often practiced but has seldom been studied. We report a case of conservative management of a thoraco abdominal gun shot patient where an estimated bullet trajectory was indicative of serious injuries. To the best of our knowledge this is the first report of a thoraco abdominal gunshot that, despite of a protracted trajectory, had no sequelae and was thus managed nonoperatively. A 30 year old male patient having height of 180 cm and weight of 70 kg (Body Mass Index 21.6) presented with complaint of a penetrating injury at left side of upper torso. The patient had no symptoms or obvious bleeding and was vitally stable. On examination a 1 cm × 1 cm entry wound at the left 3rd intercostal space in the mid clavicular line was identified. The chest and abdomen were otherwise unremarkable on examination. The chest radiograph displayed clear lung fields. The abdominal radiographs displayed a bullet in the upper left quadrant of the abdomen lateral to the spine. The bullets estimated trajectory from 3rd intercostal space and its lodgment in the abdomen lateral to the spine indicated severe visceral injury. The computed tomography scan showed that the bullet was lodged postero-medially to the left kidney. All thoracic, intra peritoneal and retroperitoneal visceral structures were identified to be normal. The patient remained clinically and vitally stable, hence was managed nonoperatively being discharged after 48 h of observation. From this case we conclude that decision for managing gun shot patients should be based on objective clinical and diagnostic findings. We recommend further investigation of the predictability of estimated trajectory for visceral injuries and consequent operative intervention as we found it to be misleading in this case.

Land surface water cycles observed with satellite sensors

NASA Technical Reports Server (NTRS)

Nghiem, Son V.; Njoku, E. G.; Brakenridge, G. R.; Kim, Y.

2005-01-01

Acceleration of the global water cycle may lead to increased global precipitation, faster evaporation and a consequent exacerbation of hydrologic extreme. In the U.S. national assessment of the potential consequences of climate variability and change, two GCMs (CGCM1 and HadCM2) show a large increase in precipitation in the future over the southwestern U.S. particularly during winter (Felzer and Heard, 1999). Increased precipitation potentially has important impacts on agricultural and water use in the southeast U.S. (Hatch et al., 1999) and in the central Great Plains (Nielsen, 1997). A hurricane model predicts a 40% precipitation increase for severe hurricanes affecting southeastern Florida, which provokes substantially greater flooding that could negate most of the benefits of present water-management practices in this basin (Gutowski et al., 1994). Thus, it is important to observe the hydroclimate on a continuous longterm basis to address the question of increased precipitation in the enhanced water cycle.

[Case management process identified from experience of nurse case managers].

PubMed

Park, Eun-Jun; Kim, Chunmi

2008-12-01

The purpose of this study was to develop a substantive theory of case management (CM) practice by investigating the experience of nurse case managers caring for Medical Aid enrollees in Korea. A total of 12 nurses were interviewed regarding their own experience in CM practice. Data were recorded and analyzed using grounded theory. Empowerment was the core category of CM for Medical Aid enrollees. The case managers engaged in five phases as follows, phase of inquiring in advance, building a relationship with the client, giving the client critical mind, facilitating positive changes in the client's use of healthcare services, and maintaining relationship bonds. These phases moved gradually and were circular if necessary. Also, they were accelerated or slowed depending on factors including clients' characteristics, case managers' competency level, families' support level, and availability of community resources. This study helps understand what CM practice is and how nurses are performing this innovative CM role. It is recommended that nurse leaders and policy makers integrate empowerment as a core category and the five critical CM phases into future CM programs.

An epidemiologic perspective on a case management program.

PubMed

Kahler, Deborah; Salber, Patricia; Wilson, Thomas

2010-01-01

to improve a case management (CM) program using the principles and tools of epidemiology. Specifically, to use epidemiology to describe the population being managed, to analyze factors influencing outcomes, to assess the degree to which the CM process (or intervention) is related to those outcomes, to utilize the findings in order to make recommendations (to take action) for both better evaluation and improved and more efficient CM process, to provide an estimate of the impact of the CM program based on the comparison of pre-CM and post-CM interventions, and finally to discuss the caveat that pre-CM period probably does not provide a prediction of patterns to be expected in the post-CM period had CM not been present (an ideal, but difficult-to-find referent population for this kind of effectiveness analysis). a Medicare Advantage health plan. there were a total of 12,185 individuals who met the continuous enrollment requirement of 6 months (28 days) prior to initial contact with the CM department and 6 months after the contact date: 53% were female; the average age was 73.9 (standard deviation = ± 9.5). There was a linear relationship between the average "dose" of CM-as measured by the number of times a case manager had contact with a case-and the risk profile of the case-as measured by a standard risk assessment tool provided by the Centers for Medicare & Medicaid Services. The month-to-month costs for the study population prior to CM showed a sharp rise in the month prior to the initial contact with CM and a sharp decline beginning before the contact. This pattern was consistent across different risk profiles and our operational definition of CM "dose."The average costs 6 months prior to CM were higher than the average costs 6 months after the CM. The difference in cost varied by "dose" category. When coupled with the number of cases per dosage category, the greatest value for the CM program was in the management of moderate risk cases called two to four times.However, some of the overall decline that begins prior to the initial CM contact is likely attributed to "regression to the mean" (i.e., costs may have shown a decline in spite of CM) but not all. Subsequent studies will be designed to assess the degree to which this is the case by including an equivalent referent; ideally, one that has not experienced CM or, in the absence of that, one that experienced a different kind of CM so that a valid "comparative effectiveness" study can be conducted. the "dose" of CM to its cases was in synch with an independent assessment of risk of the cases. This implies that case managers were directing their resources to those in need. However, case managers and CM processes are a limited resource and it is of interest for management to allocate those CM resources in the most efficient way possible. Methods of assessment based on individual experiences of case managers can be improved with structured, population-based assessment. These population-based tools, according to the principles of epidemiology, will be used to better allocate CM resources for optimized impact on patient populations in the future.

Micro and macroscopic investigation to quantify tillage impact on soil hydrodynamic behaviour

NASA Astrophysics Data System (ADS)

Beckers, E.; Roisin, C.; Plougonven, E.; Deraedt, D.; Léonard, A.; Degré, A.

2012-04-01

Nowadays, tillage simplification is an increasing practice. Many advantages are cited in the literature, such as energy saving, soil conservation etc. Agricultural management practices influence soil structure, but consequent changes in soil hydrodynamic behaviour at the field scale are still not well understood. Many studies focus only on macroscopic measurements which do not provide mechanistic explanations. Moreover, research shows divergent conclusions over structure modification. The aim of this work is to fill this gap by quantifying soil structure modification depending on tillage intensity through both macroscopic and microscopic measurements, the latter improving our comprehension of the fundamental mechanisms involved. Our experiment takes place in Gentinnes (Walloon Brabant, Belgium), on a field organized in a Latin square scheme. Since 2004, plots have been cultivated in conventional tillage (CT) or in reduced tillage (RT). The latter consists in sowing after stubble ploughing of about 10cm. The crop rotation is sugar beet followed by winter wheat. The soil is mainly composed of silt loam and can be classified as a Luvisol. Macroscopic investigations consist in establishing pF and K(h) curves and 3D soil strength profiles. At the microscale, 3D morphologic parameters are measured using X-ray microtomography. Because of the variation of working depth between management practices (10cm for RT vs. 25cm for CT), two horizons were investigated: H1 between 0-10cm and H2 between 12-25cm. 3D soil strength profiles were established thanks to a fully automated penetrometer (30° angle cone with a base area of 10mm2) which covered a 160 × 80cm2 area with 5cm spacing between neighbouring points. At each node, penetration was performed and soil strength measurements were collected every 1cm from 5 to 55cm depth. K(h) curves were provided by 20cm diameter tension-infiltrometer measurements (Eijkelkamp Agrisearch Equipment). Undisturbed soil samples were removed from H1 and H2 for both management practices: 100cm3 samples were used to establish pF curves with the Richards procedure, and 35cm3 samples were used for X-ray microtomography investigation. Samples for microtomography were air-dried at 40°C in order to empty meso- and macroporosity and then scanned using a Skyscan-1172 high-resolution desktop micro-CT system (Skyscan, Kontich, Belgium). Macroscopic measurements show consistent results: penetrometry profiles confirm the presence of two different horizons for RT, with a permeable superficial horizon between 0 and 10cm and a compacted subjacent horizon. Despite the long-term experiment, the old plough pan is still observed. The superficial horizon is equivalent in terms of pF curves to CT. The second horizon in RT shows significant differences with CT: porosity and especially effective porosity are greater for CT than RT. Infiltration tests confirm these reports with a higher conductivity for CT than RT. In fact, the first permeable horizon for RT is thin and the second horizon impacts vertical infiltration. These observations will be completed with microtomograms analysis. Pore size distribution, but particularly morphological parameters like eccentricity, orientation, connectivity and anisotropy of the pore network will be quantified and connected with macroscopic measurements.

Developing a toolbox for analysis of warrior wound biopsies: vibrational spectroscopy

NASA Astrophysics Data System (ADS)

Crane, Nicole J.; O'Brien, Frederick P.; Forsberg, Jonathan A.; Potter, Benjamin K.; Elster, Eric A.

2011-03-01

The management of modern traumatic war wounds remains a significant challenge for clinicians. This is a reflection of the extensive osseous and soft-tissue damage caused by blasts and high-energy projectiles. The ensuing inflammatory response ultimately dictates the pace of wound healing and tissue regeneration. Consequently, the eventual timing of wound closure or definitive coverage is often subjectively based. Some wounds require an extended period of time to close or fail to remain closed, despite the use and application of novel wound-specific treatment modalities. Aside from impaired wound healing, additional wound complications include wound infection, biofilm formation, and heterotopic ossification (the pathological mineralization of soft tissues). An understanding of the molecular environment of acute wounds throughout the debridement process can provide valuable insight into the mechanisms associated with the eventual wound outcome. The analysis of Raman spectra of ex vivo wound biopsy tissue obtained from serial traumatic wound debridements reveals a decreased 1665 cm-1/1445 cm-1 band area ratio in impaired healing wounds, indicative of an impaired remodeling process, in addition to a decreased 1240 cm-1/1270cm-1. The examination of debrided tissue exhibits mineralization during the early development of heterotopic ossification. Finally, preliminary results suggest that Fourier transform infrared (FT-IR) images of wound effluent may be able to provide early microbiological information about the wound.

Expecting the holistic regulation from Chinese medicine based on the "solar system" hypothesis of ischemic heart disease.

PubMed

Luo, Jing; Wang, An-Lu; Xu, Hao; Shi, Da-Zhuo; Chen, Ke-Ji

2016-11-01

Stenosis of the coronary artery has been considered as an essential component of ischemic heart disease (IHD). Consequently, revascularization [e.g., percutaneous coronary intervention (PCI) and coronary artery bypass] has been the primary therapeutic approach to IHD. Such strategy has indeed revolutionized the management of IHD patients. However, not all patients with myocardial ischemia have visible coronary stenosis. Moreover, cardiovascular events occur in nearly 20% patients with stable coronary artery disease who have undergone PCI. The recently proposed "solar system" hypothesis of IHD postulates that coronary stenosis is only one (albeit important) of its features. Mechanistic contribution and clinical implication of multiple pathophysiological processes beyond coronary stenosis are highlighted in this hypothesis. On the basis of a holistic regulation and individualized medicine, Chinese medicine (CM) has been used in the real-world setting to manage a variety of diseases, including IHD, for more than two thousands years. In this article, we summarize the evidence of CM that supports the "solar system" IHD hypothesis, and argue for a comprehensive approach to IHD. At the theoretical level, the central features of this approach include a holistic view of disease and human subjects, as well as individualized medicine. At the practical level, this approach emphasizes anoxia-tolerance and self-healing.

Frequency, outcome, and risk factors of contrast media extravasation in 142,651 intravenous contrast-enhanced CT scans.

PubMed

Hwang, Eui Jin; Shin, Cheong-Il; Choi, Young Hun; Park, Chang Min

2018-06-06

To evaluate the frequency, outcome, and risk factors of intravenous contrast media (CM) extravasation during contrast-enhanced CT scans in a large population. After institutional review board approval, 142,651 patients (72,976 males and 69,675 females; mean age, 59.9 ± 13.0 years) who underwent contrast-enhanced CT scans with intravenous CM between January 2015 and April 2017 were retrospectively included. The frequency of CM extravasations and their clinical outcomes were investigated. Risk factors of CM extravasation were evaluated using logistic regression with generalized estimating equation analyses. In addition, the frequency and risk factors of large-volume (≥100 ml) CM extravasation were also investigated. CM extravasation occurred in 0.23% (321/142,651) of patients, all of which were of mild degree and resolved without any sequelae through conservative management. Multivariate analysis revealed that female gender [odds ratio (OR) = 1.61; p < 0.001], 60 < age ≤ 70 years (OR = 1.71; p = 0.004) or age > 70 years (OR = 2.49; p < 0.001), patients in general wards (OR = 2.71; p < 0.001) or ICUs (OR = 4.76; p < 0.001), 9.4 < CM viscosity ≤ 10.0 (OR = 1.65; p = 0.015), 10.0 < CM viscosity ≤ 10.6 (OR = 1.60; p = 0.002), and CM viscosity > 16.0 (OR = 2.55, p < 0.001) were independent risk factors for CM extravasation. CM extravasation during contrast-enhanced CT scans was uncommon with no substantial clinical consequences. Several risk factors that may have the potential to reduce the occurrence of CM extravasation were identified. • The observed frequency of contrast media extravasation during contrast-enhanced CT scans was 0.23% (321/142,651). • Significant risk factors for contrast media extravasation were female gender, age older than 60 years, patients in general wards or ICUs, and the viscosity of contrast media greater than 9.4 mPa∙s. • The main preventive action for contrast media extravasation would be to lower the viscosity of contrast media.

Chemical, Biological, Radiological, and Nuclear Consequence Management: Ways to Improve Fixed-Site Decontamination Capability

DTIC Science & Technology

2007-05-10

objective is achieved through consequence management and fixed-site decontamination operations. The effectiveness of CBRN consequence management...decontamination operations. The effectiveness of CBRN consequence management and fixed-site decontamination executed in the Joint Security Area can be...when faced with Chemical, Biological, Radiological, or Nuclear (CBRN) contaminated ports of debarkation. The effectiveness of CBRN consequence

Fuel-reduction management alters plant composition, carbon and nitrogen pools, and soil thaw in Alaskan boreal forest

USGS Publications Warehouse

Melvin, April M.; Celis, Gerardo; Johnstone, Jill F.; McGuire, A. David; Genet, Helene; Schuur, Edward A.G.; Rupp, T. Scott; Mack, Michelle C.

2018-01-01

Increasing wildfire activity in Alaska's boreal forests has led to greater fuel-reduction management. Management has been implemented to reduce wildfire spread, but the ecological impacts of these practices are poorly known. We quantified the effects of hand-thinning and shearblading on above- and belowground stand characteristics, plant species composition, carbon (C) and nitrogen (N) pools, and soil thaw across 19 black spruce (Picea mariana) dominated sites in interior Alaska treated 2-12 years prior to sampling. The density of deciduous tree seedlings was significantly higher in shearbladed areas compared to unmanaged forest (6.4 vs. 0.1 stems m−2), and unmanaged stands exhibited the highest mean density of conifer seedlings and layers (1.4 stems m−2). Understory plant community composition was most similar between unmanaged and thinned stands. Shearblading resulted in a near complete loss of aboveground tree biomass C pools while thinning approximately halved the C pool size (1.2 kg C m−2 compared to 3.1 kg C m−2 in unmanaged forest). Significantly smaller soil organic layer (SOL) C and N pools were observed in shearbladed stands (3.2 kg C m−2 and 116.8 g N m−2) relative to thinned (6.0 kg C m−2 and 192.2 g N m−2) and unmanaged (5.9 kg C m−2 and 178.7 g N m−2) stands. No difference in C and N pool sizes in the uppermost 10 cm of mineral soil was observed among stand types. Total C stocks for measured pools was 2.6 kg C m−2 smaller in thinned stands and 5.8 kg C m−2smaller in shearbladed stands when compared to unmanaged forest. Soil thaw depth averaged 13 cm deeper in thinned areas and 46 cm deeper in shearbladed areas relative to adjacent unmanaged stands, although variability was high across sites. Deeper soil thaw was linked to shallower SOL depth for unmanaged stands and both management types, however for any given SOL depth, thaw tended to be deeper in shearbladed areas compared to unmanaged forest. These findings indicate that fuel-reduction management alters plant community composition, C and N pools, and soil thaw depth, with consequences for ecosystem structure and function beyond those intended for fire management.

Configuration Management File Manager Developed for Numerical Propulsion System Simulation

NASA Technical Reports Server (NTRS)

Follen, Gregory J.

1997-01-01

One of the objectives of the High Performance Computing and Communication Project's (HPCCP) Numerical Propulsion System Simulation (NPSS) is to provide a common and consistent way to manage applications, data, and engine simulations. The NPSS Configuration Management (CM) File Manager integrated with the Common Desktop Environment (CDE) window management system provides a common look and feel for the configuration management of data, applications, and engine simulations for U.S. engine companies. In addition, CM File Manager provides tools to manage a simulation. Features include managing input files, output files, textual notes, and any other material normally associated with simulation. The CM File Manager includes a generic configuration management Application Program Interface (API) that can be adapted for the configuration management repositories of any U.S. engine company.

49 CFR 195.452 - Pipeline integrity management in high consequence areas.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 3 2013-10-01 2013-10-01 false Pipeline integrity management in high consequence... Management § 195.452 Pipeline integrity management in high consequence areas. (a) Which pipelines are covered... by this section must: (1) Develop a written integrity management program that addresses the risks on...

49 CFR 195.452 - Pipeline integrity management in high consequence areas.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 3 2012-10-01 2012-10-01 false Pipeline integrity management in high consequence... Management § 195.452 Pipeline integrity management in high consequence areas. (a) Which pipelines are covered... by this section must: (1) Develop a written integrity management program that addresses the risks on...

49 CFR 195.452 - Pipeline integrity management in high consequence areas.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 3 2014-10-01 2014-10-01 false Pipeline integrity management in high consequence... Management § 195.452 Pipeline integrity management in high consequence areas. (a) Which pipelines are covered... by this section must: (1) Develop a written integrity management program that addresses the risks on...

Initiatives and Challenges in Consequence Management after a WMD Attack

DTIC Science & Technology

2004-08-01

Challenges in Consequence Management people to seek shelter or other protection when possible, to avoid exposure to weapons of mass destruction effects . The...Potential Effects .........................................9 V. Methods for Managing the Consequences of WMD Use.................14 VI. Toward a...mass destruction (WMD). Consequence management1 is a process to mitigate the effects of the use of weapons of mass destruction, including

Homeland Biological Warfare Consequence Management: Capabilities and Needs Assessment

DTIC Science & Technology

2001-04-01

AU/ACSC/105/2001-04 AIR COMMAND AND STAFF COLLEGE AIR UNIVERSITY HOMELAND BIOLOGICAL WARFARE CONSEQUENCE MANAGEMENT: CAPABILITIES AND NEEDS...Dates Covered (from... to) - Title and Subtitle Homeland biological Warfare Consequence Management: Capabilities and Needs Assessment Contract...FEMA, DoJ, DoD, HHS, etc.) make a comprehensive, organized solution to the problem difficult. Focusing on the consequence management functions

Impact of land management on soil structure and soil hydraulic properties

NASA Astrophysics Data System (ADS)

Kodesova, Radka; Jirku, Veronika; Nikodem, Antonin; Muhlhanselova, Marcela; Zigova, Anna

2010-05-01

Study is focused on a comparison of a soil structure and soil hydraulic properties within soil profiles of a same soil type under different land management. Study was performed in Haplic Luvisol in Hnevceves the Czech Republic. Two soil profiles, which were in close distance from each other, were chosen: 1. under the conventional tillage, 2. under the permanent (30 years) grass cover. Soil sampling and field experiments were carried out immediately after the harvest of winter barley in 2008. The micromorphological images were used to evaluate the soil structure of all Ap, Bt1, Bt2 and C diagnostic horizons. The hydraulic properties of the diagnostic horizons were studied in the laboratory using multistep outflow experiments performed on the undisturbed 100-cm3 soil samples. A tension disc infiltrometer (with a disc radius of 10 cm) and minidisc tension infiltrometers (with a disc radius of 2.2 cm) were used to measure cumulative water infiltration under unsaturated conditions created using a pressure head of -2 cm. Measurements were performed at a depths of 5, 45, 75 and 110 cm, which corresponded to the Ap, Bt1, Bt2 and C horizons of studied Haplic Luvisol at both locations. The Guelph permeameter was used to measure cumulative water flux under surface ponding conditions. The depth of the drilled well was 10, 50, 80 and 115 cm, the well radius was 3 cm, and the well ponding depth was 5 cm. Both tests were used to evaluate hydraulic conductivity (K for h=-2cm, and Ks) values. Results showed, that while properties in the Bt2 and C horizons of both soil profiles were relatively similar, properties in the Ap and Bt1 horizons were different. The fraction of gravitational pores (which may cause preferential flow) in the Ap and Bt1 horizons of the soil profile under the convectional tillage was large than those in the Ap and Bt1 horizons of the soil profile under the permanent grass. This influenced for instance the Ks values measured using the Guelph permeametr. The Ks values were higher and more variable in the soil profile under the convectional tillage than those in the soil profile under the permanent grass. On the other hand, due to the periodical tillage and consequent soil structure breakdown, the fraction of the large capillary pores were smaller in the Ap horizon of the soil profile under the convectional tillage than that in the Ap horizon of the soil profile under the permanent grass. As result the K (h=-2cm) values measured using the tension infiltrometer in the soil profile under the permanent grass was higher than those in the soil profile under the convectional tillage. However, the fraction of the large capillary pores and K (h=-2cm) values were similar in the Bt1 horizons of both soil profiles. Thus the land management impacted both macropores and matrix pores in the Ap horizon and macropores (prismatic structure and biopores) in the Bt1 horizon. Acknowledgement: Authors acknowledge the financial support of the Grant Agency of the Czech Republic (grant No. GA CR 526/08/0434) and the Ministry of Education, Youth and Sports of the Czech Republic (grant No. MSM 6046070901).

NCCDS configuration management process improvement

NASA Technical Reports Server (NTRS)

Shay, Kathy

1993-01-01

By concentrating on defining and improving specific Configuration Management (CM) functions, processes, procedures, personnel selection/development, and tools, internal and external customers received improved CM services. Job performance within the section increased in both satisfaction and output. Participation in achieving major improvements has led to the delivery of consistent quality CM products as well as significant decreases in every measured CM metrics category.

How Configuration Management (CM) Can Help Project Teams To Innovate and Communicate

NASA Technical Reports Server (NTRS)

Cioletti, Louis

2009-01-01

Traditionally, CM is relegated to a support role in project management activities. CM s traditional functions of identification, change control, status accounting, and audits/verification are still necessary and play a vital role. However, this presentation proposes CM s role in a new and innovative manner that will significantly improve communication throughout the organization and, in turn, augment the project s success. CM s new role is elevated to the project management level, above the engineering or sub-project level in the Work Breakdown Structure (WBS), where it can more effectively accommodate changes, reduce corrective actions, and ensure that requirements are clear, concise, and valid, and that results conform to the requirements. By elevating CM s role in project management and orchestrating new measures, a new communication will emerge that will improve information integrity, structured baselines, interchangeability/traceability, metrics, conformance to standards, and standardize the best practices in the organization. Overall project performance (schedule, quality, and cost) can be no better than the ability to communicate requirements which, in turn, is no better than the CM process to communicate project decisions and the correct requirements.

Tropical stormwater floods: a sustainable solution

NASA Astrophysics Data System (ADS)

Molinie, Jack; Bade, Francois; Nagau, Jimmy; Nuiro, Paul

2017-04-01

Stormwater management is one of the most difficult problem of urban and suburban area. The urban runoff volume related to rain intensity and surfaces properties can lead to flood. Thereby, urban flooding creates considerable infrastructure problem, economics and human damages. In tropical countries, burgeoning human population coupled with unplanned urbanization altered the natural drainage. Consequently, classical intense rain around 100 cm/h produces frequent street flooding. In our case, we study the management of intense tropical rain, by using a network of individual rain storage tanks. The study area is economical and industrial zone installed in a coastal plain , with seventy per cent of impermeable surface (roads, parking lots, building roof, …) and thirty per cent of wetland (mangrove, …). Our solution is to delay the routes and parking lots runoff to the roof one. We propose sustainable individual water storage and a real time dynamical management, which permit to control the roof water arrival in the stormwater culvert. During the remaining time, the stored rainwater can be used for domestic activities instead of the use of drinking water.

Seeing the Elephant -- Consequence Management Policy for the Department of Defense

DTIC Science & Technology

2001-05-01

required for effective Consequence Management. The three response tiers allows the DoD to provide a predesignated level of support to the appropriate Federal...recommendation is the creation of a tiered response capability that balances time and tasks required for effective Consequence Management. The three...the response required for toxic chemical events. The third tier is reserved for the actions required for the Consequence Management for a biological

Examining Maternal Weight Gain During Contingency-Management Treatment for Smoking Cessation Among Pregnant Women

PubMed Central

Washio, Yukiko; Higgins, Stephen T.; Heil, Sarah H.; Badger, Gary J.; Skelly, Joan; Bernstein, Ira M.; Solomon, Laura J.; Higgins, Tara M.; Lynch, Mary Ellen; Hanson, Jennifer D.

2010-01-01

Excessive maternal weight gain during pregnancy can result in serious adverse maternal and neonatal health consequences making it an important outcome to monitor in developing smoking-cessation interventions for pregnant women. Maternal weight gain was investigated in the present study with 154 pregnant participants in controlled trials investigating the efficacy of contingency management (CM) for smoking cessation. Women were assigned to either an abstinence-contingent condition wherein they earned vouchers exchangeable for retail items by abstaining from smoking or to a control condition where they received comparable vouchers independent of smoking status. Mean percent of negative smoking status tests throughout antepartum was greater in the incentive than control condition (45.2±4.6 vs. 15.5±2.4, p < .001) as was late-pregnancy point-prevalence abstinence (36% vs. 8%, p < .001) but maternal weight gain did not differ significantly between treatment conditions (15.0 ± 0.8 kg vs. 15.0 ± 0.9 kg, p = .97). In a comparison of women classified by smoking status rather than treatment condition, a greater percent of negative smoking status tests predicted significantly more weight gain (0.34 kg per 10% increase in negative tests), an effect that appeared to be attributable to women with greater abstinence having larger infants. This study shows no evidence of excessive maternal weight gain among pregnant women receiving a CM intervention for smoking cessation. PMID:20870365

Raman spectroscopy and electron-phonon coupling in Eu3+ doped Gd2Zr2O7 nanopowders

NASA Astrophysics Data System (ADS)

Krizan, G.; Gilic, M.; Ristic-Djurovic, J. L.; Trajic, J.; Romcevic, M.; Krizan, J.; Hadzic, B.; Vasic, B.; Romcevic, N.

2017-11-01

The Raman spectra of Eu3+ doped Gd2Zr2O7 nanopowders were measured. We registered three phonons at 177 cm-1, 268 cm-1, and 592 cm-1, as well as their overtones at 354 cm-1, 445 cm-1, 708 cm-1, 1062 cm-1, 1184 cm-1, ∼1530 cm-1, and ∼1720 cm-1. The phonon at 592 cm-1 is known to be characteristic for Gd2Zr2O7 fluorite-type structure; however, the other two have not been registered so far. We found that the position of the newly detected phonons agrees well with the observed electron-phonon interaction. On the other hand, the registered multiphonon processes were a consequence of miniaturization that further induced changes in electronic structure of Eu3+ doped Gd2Zr2O7 nanopowders.

Critical factors in case management: practical lessons from a cardiac case management program.

PubMed

Stafford, Randall S; Berra, Kathy

2007-08-01

Case management (CM) is an important strategy for chronic disease care. By utilizing non-physician providers for conditions requiring ongoing care and follow-up, CM can facilitate guideline-concordant care, patient empowerment, and improvement in quality of life. We identify a series of critical factors required for successful CM implementation. Heart to Heart is a clinical trial evaluating CM for coronary heart disease (CHD) risk reduction in a multiethnic, low-income population. Patients at elevated cardiac risk were randomized to CM plus primary care (212 patients) or to primary care alone (207). Over a mean follow-up of 17 months, patients received face-to-face nurse and dietitian visits. Mean contact time was 14 hours provided at an estimated cost of $1250 per patient for the 341 (81%) patients completing follow-up. Visits emphasized behavior change, risk-factor monitoring, self-management skills, and guideline-based pharmacotherapy. A statistically significant reduction in mean Framingham risk probability occurred in CM plus primary care relative to primary care alone (1.6% decrease in 10-year CHD risk, p = 0.007). Favorable changes were noted across individual risk factors. Our findings suggest that successful CM implementation relies on choosing appropriate case managers and investing in training, integrating CM into existing care systems, delineating the scope and appropriate levels of clinical decision making, using information systems, and monitoring outcomes and costs. While our population, setting, and intervention model are unique, these insights are broadly relevant. If implemented with attention to critical factors, CM has great potential to improve the process and outcomes of chronic disease care.

A Randomized Trial of Contingency Management Delivered by Community Therapists

ERIC Educational Resources Information Center

Petry, Nancy M.; Alessi, Sheila M.; Ledgerwood, David M.

2012-01-01

Objective: Contingency management (CM) is an evidence-based treatment, but few clinicians deliver this intervention in community-based settings. Method: Twenty-three clinicians from 3 methadone maintenance clinics received training in CM. Following a didactics seminar and a training and supervision period in which clinicians delivered CM to pilot…

Consequence Management - Ready or Not?

DTIC Science & Technology

2003-04-07

Defense will have sufficient capability and be ready to respond to a Weapons of Mass Destruction/ Effects attack. An effective consequence management...Defense adopts the National Military Strategy and its consequence management approach, it must identify Weapons of Mass Destruction/ Effects threats...that the Department of Defense: develop Weapons of Mass Destruction/ Effects performance standards for response assets; implement a consequence

Motivation and Contingency Management Treatments for Substance Use Disorders.

PubMed

Walter, Kimberly N; Petry, Nancy M

2016-01-01

Contingency management (CM) is a highly efficacious psychosocial treatment for substance use disorders based on the principles of behavioral analysis. CM involves delivering a tangible positive reinforcer following objective evidence of submission of a drug-negative urine sample. Although CM interventions primarily involve applying extrinsic rewards, a patient's intrinsic motivation to change substance use behavior may also be impacted by CM. This chapter provides an introduction to CM interventions for substance use disorders and examines the impact of CM on intrinsic motivation . It also addresses applications of this intervention to other conditions and patient populations.

RASA1 analysis guides management in a family with capillary malformation-arteriovenous malformation

PubMed Central

Flore, Leigh Anne; Leon, Eyby; Maher, Tom A.; Milunsky, Jeff M.

2012-01-01

Capillary malformation-arteriovenous malformation (CM-AVM; MIM 60354) is an autosomal dominant disorder characterized by multifocal cutaneous capillary malformations, often in association with fast-flow vascular lesions, which may be cutaneous, subcutaneous, intramuscular, intraosseus, or cerebral arteriovenous malformations or arteriovenous fistulas. CM-AVM results from heterozygous mutations in the RASA1 gene. Capillary malformations of the skin are common, and clinical examination alone may not be able to definitively diagnose-or exclude- CM-AVM. We report a family in which the proband was initially referred for a genetic evaluation in the neonatal period because of the presence of a cardiac murmur and minor dysmorphic features. Both he and his mother were noted to have multiple capillary malformations on the face, head, and extremities. Echocardiography revealed dilated head and neck vessels and magnetic resonance imaging and angiography of the brain revealed a large infratentorial arteriovenous fistula, for which he has had two embolization procedures. RASA1 sequence analysis revealed a heterozygous mutation, confirming his diagnosis of CM-AVM. We established targeted mutation analysis for the proband's mother and sister, the latter of whom is a healthy 3-year-old whose only cutaneous finding is a facial capillary malformation. This revealed that the proband's mother is also heterozygous for the RASA1 mutation, but his sister is negative. Consequently, his mother will undergo magnetic resonance imaging and angiography screening for intracranial and spinal fast-flow lesions, while his sister will require no imaging or serial evaluations. Targeted mutation analysis has been offered to additional maternal family members. This case illustrates the benefit of molecular testing in diagnosis and making screening recommendations for families with CM-AVM. PMID:27625812

RASA1 analysis guides management in a family with capillary malformation-arteriovenous malformation.

PubMed

Flore, Leigh Anne; Leon, Eyby; Maher, Tom A; Milunsky, Jeff M

2012-06-01

Capillary malformation-arteriovenous malformation (CM-AVM; MIM 60354) is an autosomal dominant disorder characterized by multifocal cutaneous capillary malformations, often in association with fast-flow vascular lesions, which may be cutaneous, subcutaneous, intramuscular, intraosseus, or cerebral arteriovenous malformations or arteriovenous fistulas. CM-AVM results from heterozygous mutations in the RASA1 gene. Capillary malformations of the skin are common, and clinical examination alone may not be able to definitively diagnose-or exclude- CM-AVM. We report a family in which the proband was initially referred for a genetic evaluation in the neonatal period because of the presence of a cardiac murmur and minor dysmorphic features. Both he and his mother were noted to have multiple capillary malformations on the face, head, and extremities. Echocardiography revealed dilated head and neck vessels and magnetic resonance imaging and angiography of the brain revealed a large infratentorial arteriovenous fistula, for which he has had two embolization procedures. RASA1 sequence analysis revealed a heterozygous mutation, confirming his diagnosis of CM-AVM. We established targeted mutation analysis for the proband's mother and sister, the latter of whom is a healthy 3-year-old whose only cutaneous finding is a facial capillary malformation. This revealed that the proband's mother is also heterozygous for the RASA1 mutation, but his sister is negative. Consequently, his mother will undergo magnetic resonance imaging and angiography screening for intracranial and spinal fast-flow lesions, while his sister will require no imaging or serial evaluations. Targeted mutation analysis has been offered to additional maternal family members. This case illustrates the benefit of molecular testing in diagnosis and making screening recommendations for families with CM-AVM.

Sexual size dimorphism in three North Sea gadoids.

PubMed

Keyl, F; Kempf, A J; Sell, A F

2015-01-01

Existing biological data on whiting Merlangius merlangus, cod Gadus morhua and haddock Melanogrammus aeglefinus from a long-term international survey were analysed to address sexual size dimorphism (SSD) and its effect on their ecology and management. Results show that SSD, with larger females of the same age as males, is a result of higher growth rates in females. A direct consequence of SSD is the pronounced length-dependent female ratio that was found in all three gadoids in the North Sea. Female ratios of the three species changed from equality to female dominance at specific dominance transition lengths of c. 30, 35 and 60 cm for M. merlangus, G. morhua and M. aeglefinus, respectively. An analysis by area for M. merlangus also revealed length dependence of female ratios. SSD and length-dependent female ratios under most circumstances are inseparable. Higher overall energy demand as well as a higher energy uptake rate must result from the observed SSD and dimorphism in growth rates. Potential processes related to feeding, locomotion and physiology are proposed that could balance the increased energy investment of females. Potential consequences of SSD and length dependency of female ratios are the reduction of the reproductive potential of a stock due to size-selective fishing and biased assessment of the true size of the female spawning stock that could distort decisions in fisheries management. © 2014 The Fisheries Society of the British Isles.

Fluctuations in episodic and chronic migraine status over the course of 1 year: implications for diagnosis, treatment and clinical trial design.

PubMed

Serrano, Daniel; Lipton, Richard B; Scher, Ann I; Reed, Michael L; Stewart, Walter Buzz F; Adams, Aubrey Manack; Buse, Dawn C

2017-10-04

Relatively little is known about the stability of a diagnosis of episodic migraine (EM) or chronic migraine (CM) over time. This study examines natural fluctuations in self-reported headache frequency as well as the stability and variation in migraine type among individuals meeting criteria for EM and CM at baseline. The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study was a longitudinal survey of US adults with EM and CM identified by a web-questionnaire. A validated questionnaire was used to classify respondents with EM (<15 headache days/month) or CM (≥15 headache days/month) every three months for a total of five assessments. We described longitudinal persistence of baseline EM and CM classifications. In addition, we modelled longitudinal variation in headache day frequency per month using negative binomial repeated measures regression models (NBRMR). Among the 5464 respondents with EM at baseline providing four or five waves of data, 5048 (92.4%) had EM in all waves and 416 (7.6%) had CM in at least one wave. Among 526 respondents with CM at baseline providing four or five waves of data, 140 (26.6%) had CM in every wave and 386 (73.4%) had EM for at least one wave. Individual plots revealed striking within-person variations in headache days per month. The NBRMR model revealed that the rate of headache days increased across waves of observation 19% more per wave for CM compared to EM (rate ratio [RR], 1.19; 95% CI, 1.13-1.26). After adjustment for covariates, the relative difference changed to a 26% increase per wave (RR, 1.26; 95% CI, 1.2-1.33). Follow-up at three-month intervals reveals a high level of short-term variability in headache days per month. As a consequence, many individuals cross the CM diagnostic boundary of ≥15 headache days per month.Nearly three quarters of persons with CM at baseline drop below this diagnostic boundary at least once over the course of a year. These findings are of interest in the consideration of headache classification and diagnosis, the design and interpretation of epidemiologic and clinical studies, and clinical management.

[A strategy of constructing the technological system for quality control of Chinese medicine based on process control and management].

PubMed

Cheng, Yi-Yu; Qian, Zhong-Zhi; Zhang, Bo-Li

2017-01-01

The current situation, bottleneck problems and severe challenges in quality control technology of Chinese Medicine (CM) are briefly described. It is presented to change the phenomenon related to the post-test as the main means and contempt for process control in drug regulation, reverse the situation of neglecting the development of process control and management technology for pharmaceutical manufacture and reconstruct the technological system for quality control of CM products. The regulation and technology system based on process control and management for controlling CM quality should be established to solve weighty realistic problems of CM industry from the root causes, including backwardness of quality control technology, weakness of quality risk control measures, poor reputation of product quality and so on. By this way, the obstacles from poor controllability of CM product quality could be broken. Concentrating on those difficult problems and weak links in the technical field of CM quality control, it is proposed to build CMC (Chemistry, Manufacturing and Controls) regulation for CM products with Chinese characteristics and promote the regulation international recognition as soon as possible. The CMC technical framework, which is clinical efficacy-oriented, manufacturing manner-centered and process control-focused, was designed. To address the clinical characteristics of traditional Chinese medicine (TCM) and the production feature of CM manufacture, it is suggested to establish quality control engineering for CM manufacturing by integrating pharmaceutical analysis, TCM chemistry, TCM pharmacology, pharmaceutical engineering, control engineering, management engineering and other disciplines. Further, a theoretical model of quality control engineering for CM manufacturing and the methodology of digital pharmaceutical engineering are proposed. A technology pathway for promoting CM standard and realizing the strategic goal of CM internationalization is elaborated. Copyright© by the Chinese Pharmaceutical Association.

Is estimated bullet trajectory a reliable predictor of severe injury? Case report of a thoraco-abdominal gunshot with a protracted trajectory managed nonoperatively

PubMed Central

2013-01-01

Background Operative management of all gunshot’s traumas carries a high rate of unwarranted interventions that are known to cause serious complications. Selective nonoperative management is thus being increasingly practiced which has reduced these avoidable interventions. Physical examination and computed tomography scans are most sensitive in assessing need of laparotomy. Assessment of internal injuries on the basis of an estimated bullet trajectory is often practiced but has seldom been studied. We report a case of conservative management of a thoraco abdominal gun shot patient where an estimated bullet trajectory was indicative of serious injuries. To the best of our knowledge this is the first report of a thoraco abdominal gunshot that, despite of a protracted trajectory, had no sequelae and was thus managed nonoperatively. Case presentation A 30 year old male patient having height of 180 cm and weight of 70 kg (Body Mass Index 21.6) presented with complaint of a penetrating injury at left side of upper torso. The patient had no symptoms or obvious bleeding and was vitally stable. On examination a 1 cm × 1 cm entry wound at the left 3rd intercostal space in the mid clavicular line was identified. The chest and abdomen were otherwise unremarkable on examination. The chest radiograph displayed clear lung fields. The abdominal radiographs displayed a bullet in the upper left quadrant of the abdomen lateral to the spine. The bullets estimated trajectory from 3rd intercostal space and its lodgment in the abdomen lateral to the spine indicated severe visceral injury. The computed tomography scan showed that the bullet was lodged postero-medially to the left kidney. All thoracic, intra peritoneal and retroperitoneal visceral structures were identified to be normal. The patient remained clinically and vitally stable, hence was managed nonoperatively being discharged after 48 h of observation. Conclusion From this case we conclude that decision for managing gun shot patients should be based on objective clinical and diagnostic findings. We recommend further investigation of the predictability of estimated trajectory for visceral injuries and consequent operative intervention as we found it to be misleading in this case. PMID:23414905

Key factors of case management interventions for frequent users of healthcare services: a thematic analysis review

PubMed Central

Hudon, Catherine; Chouinard, Maud-Christine; Lambert, Mireille; Diadiou, Fatoumata; Bouliane, Danielle; Beaudin, Jérémie

2017-01-01

Objective The aim of this paper was to identify the key factors of case management (CM) interventions among frequent users of healthcare services found in empirical studies of effectiveness. Design Thematic analysis review of CM studies. Methods We built on a previously published review that aimed to report the effectiveness of CM interventions for frequent users of healthcare services, using the Medline, Scopus and CINAHL databases covering the January 2004–December 2015 period, then updated to July 2017, with the keywords ‘CM’ and ‘frequent use’. We extracted factors of successful (n=7) and unsuccessful (n=6) CM interventions and conducted a mixed thematic analysis to synthesise findings. Chaudoir’s implementation of health innovations framework was used to organise results into four broad levels of factors: (1) environmental/organisational level, (2) practitioner level, (3) patient level and (4) programme level. Results Access to, and close partnerships with, healthcare providers and community services resources were key factors of successful CM interventions that should target patients with the greatest needs and promote frequent contacts with the healthcare team. The selection and training of the case manager was also an important factor to foster patient engagement in CM. Coordination of care, self-management support and assistance with care navigation were key CM activities. The main issues reported by unsuccessful CM interventions were problems with case finding or lack of care integration. Conclusions CM interventions for frequent users of healthcare services should ensure adequate case finding processes, rigorous selection and training of the case manager, sufficient intensity of the intervention, as well as good care integration among all partners. Other studies could further evaluate the influence of contextual factors on intervention impacts. PMID:29061623

Case managers for older persons with multi-morbidity and their everyday work – a focused ethnography

PubMed Central

2013-01-01

Background Modern-day health systems are complex, making it difficult to assure continuity of care for older persons with multi-morbidity. One way of intervening in a health system that is leading to fragmented care is by utilising Case Management (CM). CM aims to improve co-ordination of healthcare and social services. To better understand and advance the development of CM, there is a need for additional research that provides rich descriptions of CM in practice. This knowledge is important as there could be unknown mechanisms, contextual or interpersonal, that contribute to the success or failure of a CM intervention. Furthermore, the CM intervention in this study is conducted in the context of the Swedish health system, which prior to this intervention was unfamiliar with this kind of coordinative service. The aim of this study was to explore the everyday work undertaken by case managers within a CM intervention, with a focus on their experiences. Methods The study design was qualitative and inductive, utilising a focused ethnographic approach. Data collection consisted of participant observations with field notes as well as a group interview and individual interviews with nine case managers, conducted in 2012/2013. The interviews were recorded, transcribed verbatim and subjected to thematic analysis. Results An overarching theme emerged from the data: Challenging current professional identity, with three sub-themes. The sub-themes were 1) Adjusting to familiar work in an unfamiliar role; 2) Striving to improve the health system through a new role; 3) Trust is vital to advocacy. Conclusions Findings from this study shed some light on the complexity of CM for older persons with multi-morbidity, as seen from the perspective of case managers. The findings illustrate how their everyday work as case managers represents a challenge to their current professional identity. These findings could help to understand and promote the development of CM models aimed at a population of older persons with complex health needs. PMID:24279695

Child maltreatment and psychological symptoms in a Portuguese adult community sample: the harmful effects of emotional abuse.

PubMed

Dias, Aida; Sales, Luísa; Hessen, David J; Kleber, Rolf J

2015-07-01

Child maltreatment (CM) is associated with poor long-term health outcomes. However, knowledge about CM prevalence and related consequences is scarce among adults in South European countries. We examined the self-reported prevalence of five different forms of CM in a community sample of 1,200 Portuguese adults; we compared the results with similar samples from three other countries, using the same instrument. We also explored the relationship between CM and psychological symptoms. Cross-sectional data using the Childhood Trauma Questionnaire-Short Form and the Brief Symptom Inventory were analyzed. Moderate or severe CM exposure was self-reported by 14.7% of the sample, and 67% was exposed to more than one form of CM. Emotional neglect was the most endorsed experience, with women reporting greater emotional abuse and men reporting larger physical abuse. Physical and sexual abuse was less self-reported by Portuguese than by American or German subjects. CM exposure predicted 12.8% of the psychological distress. Emotional abuse was the strongest predictor for psychological symptoms, namely for paranoid ideation, depression, and interpersonal sensitivity. Emotional abuse overlapped with the exposure to all other CM forms, and interacted with physical abuse, physical neglect, and emotional neglect to predict psychological distress. Low exposure to emotional abuse was directly associated with the effects of physical abuse, physical neglect, and emotional neglect to predict adult psychological distress. Verbal abuse experiences were frequently reported and had the highest correlations with adult psychological distress. Our results underline the potential hurtful effects of child emotional abuse among Portuguese adults in the community. They also highlight the need to improve prevention and intervention actions to reduce exposure and consequences of CM, particularly emotional abuse.

76 FR 60497 - Agency Forms Undergoing Paperwork Reduction Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-29

... child maltreatment (CM) using a quantitative, preference-based approach. The U.S. Department of Health... research on the consequences of CM in adults, few studies have utilized standard HRQoL techniques and none... preferences over a series of comparisons that will be shown to survey respondents. The online survey will be...

Cognitive Functioning in Chiari Malformation Type I Without Posterior Fossa Surgery.

PubMed

García, Maitane; Lázaro, Esther; López-Paz, Juan Francisco; Martínez, Oscar; Pérez, Manuel; Berrocoso, Sarah; Al-Rashaida, Mohammad; Amayra, Imanol

2018-05-15

Chiari Malformation type I (CM-I) is a neurological disorder characterized by a displacement of the cerebellar tonsils through the foramen magnum into the spinal canal. Most research has focused on physical symptomatology but few studies include neuropsychological examinations. Moreover, although current research highlights the involvement of the cerebellum on higher cognitive functions, little is known about cognitive consequences associated with CM-I. The aim of this study is to analyze cognitive functioning between 39 CM-I patients and 39 healthy controls, matched by gender, age and years of education. Participants have been examined on a large battery of neuropsychological tests, including executive functioning, verbal fluency, spatial cognition, language, verbal memory, processing speed, facial recognition and theory of mind. Results show a poorer performance of the clinical group compared to the control group, even after controlling the effect of physical pain and anxious-depressive symptomatology. The findings suggest the presence of a generalized cognitive deficit associated with CM-I, which makes it necessary to focus attention not only on physical consequences, but also on cognitive ones.

Methodological approach for evaluating the response of soil hydrological behavior to irrigation with treated municipal wastewater

NASA Astrophysics Data System (ADS)

Coppola, A.; Santini, A.; Botti, P.; Vacca, S.; Comegna, V.; Severino, G.

2004-06-01

This paper aims mainly to provide experimental evidence of the consequences of urban wastewater reuse in irrigation practices on the hydrological behavior of soils. The effects on both the hydraulic and dispersive properties of representative soils in southern Sardinia are illustrated. Ten undisturbed soil monoliths, 120 cm in height and 40 cm in diameter, were collected from plots previously selected through a soil survey. Soil hydraulic and solute transport properties were determined before and after application of wastewater using transient water infiltration and steady state-solute transport column experiments. Detailed spatial-temporal information on the propagation of water and solute through the soil profiles were obtained by monitoring soil water contents, θ, pressure heads, h, and solute concentrations, C, measured by a network of time domain reflectometry probes, tensiometers and solution samplers horizontally inserted in each column at different depths. A disturbed layer at the soil surface, which expands in depth with time, was observed, characterized by reduced soil porosity, translation of pore size distribution towards narrower pores and consequent decrease in water retention, hydraulic conductivity and hydrodynamic dispersion. It is shown that these changes occurring in the disturbed soil layer, although local by nature, affect the hydrological behavior of the whole soil profile. Due to the disturbed layer formation, the soil beneath never saturates. Such behavior has important consequences on the solute transport in soils, as unsaturated conditions mean higher residence times of solutes, even of those normally characterized by considerable mobility (e.g. boron), which may accumulate along the profile. The results mainly provide experimental evidence that knowledge of the chemical and microbiological composition of the water is not sufficient to evaluate its suitability for irrigation. Other factors, mainly soil physical and hydrological characteristics, should be considered in order to define appropriate guidelines for wastewater management.

Clinical Case Management versus Case Management with Problem-Solving Therapy in Low-Income, Disabled Elders with Major Depression: A Randomized Clinical Trial

PubMed Central

Alexopoulos, George S.; Raue, Patrick J.; McCulloch, Charles; Kanellopoulos, Dora; Seirup, Joanna K.; Sirey, Jo Anne; Banerjee, Samprit; Kiosses, Dimitris N.; Areán, Patricia A.

2015-01-01

Objective To test the hypotheses that (1) clinical case management integrated with problem-solving therapy (CM-PST) is more effective than clinical case management alone (CM) in reducing depressive symptoms of depressed, disabled, impoverished patients and that (2) development of problem-solving skills mediates improvement of depression. Methods This randomized clinical trial with a parallel design allocated participants to CM or CM-PST at 1:1 ratio. Raters were blind to patients’ assignments. Two hundred seventy-one individuals were screened and 171 were randomized to 12 weekly sessions of either CM or CM-PST. Participants were at least 60 years old with major depression measured with the 24-item Hamilton Depression Rating Scale (HAM-D), had at least one disability, were eligible for home-based meals services, and had income no more than 30% of their counties’ median. Results CM and CM-PST led to similar declines in HAM-D over 12 weeks (t = 0.37, df = 547, p = 0.71); CM was noninferior to CM-PST. The entire study group (CM plus CM-PST) had a 9.6-point decline in HAM-D (t = 18.7, df = 547, p <0.0001). The response (42.5% versus 33.3%) and remission (37.9% versus 31.0%) rates were similar (χ2 = 1.5, df = 1, p = 0.22 and χ2 = 0.9, df = 1, p = 0.34, respectively). Development of problem-solving skills did not mediate treatment outcomes. There was no significant increase in depression between the end of interventions and 12 weeks later (0.7 HAM-D point increase) (t = 1.36, df = 719, p = 0.17). Conclusion Organizations offering CM are available across the nation. With training in CM, their social workers can serve the many depressed, disabled, low-income patients, most of whom have poor response to antidepressants even when combined with psychotherapy. PMID:25794636

Vulval elephantiasis as a result of tubercular lymphadenitis: two case reports and a review of the literature

PubMed Central

2010-01-01

Introduction Elephantiasis as a result of chronic lymphedema is characterized by gross enlargement of the arms, legs or genitalia, and occurs due to a variety of obstructive diseases of the lymphatic system. Genital elephantiasis usually follows common filariasis and lymphogranuloma venereum. It may follow granuloma inguinale, carcinomas, lymph node dissection or irradiation and tuberculosis but this happens rarely. Vulval elephantiasis as a consequence of extensive lymph node destruction by tuberculosis is very rare. We present two very unusual cases of vulval elephantiasis due to tuberculous destruction of the inguinal lymph nodes. Case presentation Two Indian women - one aged 40 years and the other aged 27 years, with progressively increasing vulval swellings over a period of five and four years respectively - presented to our hospital. In both cases, there was a significant history on presentation. Both women had previously taken a complete course of anti-tubercular treatment for generalized lymphadenopathy. The vulval swellings were extremely large: in the first case report, measuring 35 × 25 cm on the right side and 45 × 30 cm on the left side, weighing 20 lb and 16 lb respectively. Both cases were managed by surgical excision with reconstruction and the outcome was positive. Satisfactory results have been maintained during a follow-up period of six years in both cases. Conclusions Elephantiasis of the female genitalia is unusual and it has rarely been reported following tuberculosis. We report two cases of vulval elephantiasis as a consequence of extensive lymph node destruction by tuberculosis, in order to highlight this very rare clinical scenario. PMID:21092075

[Seasonal distribution of clinical case codes (DOC study)].

PubMed

von Dercks, N; Melz, R; Hepp, P; Theopold, J; Marquass, B; Josten, C

2017-02-01

The German diagnosis-related groups remuneration system (G-DRG) was implemented in 2004 and patient-related diagnoses and procedures lead to allocation to specific DRGs. This system includes several codes, such as case mix (CM), case mix index (CMI) and number of cases. Seasonal distribution of these codes as well as distribution of diagnoses and DRGs may lead to logistical consequences for clinical management. From 2004 to 2013 all the main diagnoses and DRGs for inpatients were recorded. Monthly and seasonal distributions were analyzed using ANOVA. The average monthly number of cases was 265 ± 25 cases, the average CM was 388.50 ± 51.75 and the average CMI was 1.46 ± 0.15 with no significant seasonal differences (p > 0.1). Concussion was the most frequently occurring main diagnosis (3739 cases) followed by fractures of the humeral head (699). Significant distribution differences could be shown for humeral head fractures in monthly (p = 0.018) and seasonal comparisons (p = 0.006) with a maximum in winter. Radius (p = 0.01) and ankle fractures (p ≤ 0.001) also occurred most frequently in winter. Non-bony lesions of the shoulder were significantly less in spring (p = 0.04). The DRGs showed no evidence of a monthly or seasonal clustering (p > 0.1). The significant clustering of injuries in specific months and seasons should lead to logistic consequences (e.g. operating room slots, availability of nursing and anesthesia staff). For a needs assessment the analysis of main diagnoses is more appropriate than DRGs.

A Randomized Trial Adapting Contingency Management Targets Based on Initial Abstinence Status of Cocaine-Dependent Patients

ERIC Educational Resources Information Center

Petry, Nancy M.; Barry, Danielle; Alessi, Sheila M.; Rounsaville, Bruce J.; Carroll, Kathleen M.

2012-01-01

Objective: Contingency management (CM) reduces drug use, but questions remain regarding optimal targets and magnitudes of reinforcement. We evaluated the efficacy of CM reinforcing attendance in patients who initiated treatment with cocaine-negative samples, and of higher magnitude abstinence-based CM in patients who began treatment positive.…

Costs of unnecessary admissions and treatments for "threatened preterm labor".

PubMed

Lucovnik, Miha; Chambliss, Linda R; Garfield, Robert E

2013-09-01

Cervical length (CL) of 3 cm or greater has been shown to have a 97-99% negative predictive value for preterm delivery in women with threatened preterm labor. Consequently, hospitalization and treatment are not indicated in these patients. We analyzed how often patients with a CL of 3 cm or greater are still being admitted and treated for preterm labor and how much this contributes to the economic burden of preterm labor hospitalizations. Twelve month hospitalizations for preterm labor at less than 34 weeks at a single institution were reviewed and patients with a CL of 3 cm or greater were identified. We chose to use patients' hospital charges as a surrogate for health care costs, recognizing that charges are not synonymous with the final patient bill and also do not reflect additional costs such as the cost of treatment at the referring facility, transportation, physician fees, and other such costs as lost wages, need for additional child care, etc. Between July 2009 and June 2010, 139 patients were admitted and treated for preterm labor at our level III center. Fifty of these patients (36%) had a CL of 3 cm or greater. None of them delivered preterm. Total hospital charges for the management of these patients were $1,018 589 (mean, $20,372; median, $14,444). Unnecessary admissions and treatments for threatened preterm labor are part of clinical practice and contribute to exploding health care costs. Using currently available diagnostics, these costs could be lowered significantly without jeopardizing outcome. Copyright © 2013 Mosby, Inc. All rights reserved.

Contingency management adapted for African-American adolescents with obesity enhances youth weight loss with caregiver participation: a multiple baseline pilot study.

PubMed

Hartlieb, Kathryn Brogan; Naar, Sylvie; Ledgerwood, David M; Templin, Thomas N; Ellis, Deborah A; Donohue, Bradley; Cunningham, Phillippe B

2015-12-07

Contingency management (CM) interventions, which use operant conditioning principles to encourage completion of target behavioral goals, may be useful for improving adherence to behavioral skills training (BST). Research-to-date has yet to explore CM for weight loss in minority adolescents. To examine the effects of CM in improving adolescent weight loss when added to BST. The study utilized an innovative experimental design that builds upon multiple baseline approaches as recommended by the National Institutes of Health. Six obese African-American youth and their primary caregivers living in Detroit, Michigan, USA. Adolescents received between 4 and 12 weeks of BST during a baseline period and subsequently received CM targeting weight loss. Youth weight. Linear mixed effects modeling was used in the analysis. CM did not directly affect adolescent weight loss above that of BST (p=0.053). However, when caregivers were involved in CM session treatment, contingency management had a positive effect on adolescent weight loss. The estimated weight loss due to CM when caregivers also attended was 0.66 kg/week (p<0.001, [95% CI; -1.96, -0.97]) relative to the baseline trajectory. This study demonstrates application of a novel experimental approach to intervention development and demonstrated the importance of parent involvement when delivering contingency management for minority youth weight loss. Lessons learned from contingency management program implementation are also discussed in order to inform practice.

How Configuration Management Helps Projects Innovate and Communicate

NASA Technical Reports Server (NTRS)

Cioletti, Louis A.; Guidry, Carla F.

2009-01-01

This slide presentation reviews the concept of Configuration Management (CM) and compares it to the standard view of Project management (PM). It presents two PM models: (1) Kepner-Tregoe,, and the Deming models, describes why projects fail, and presents methods of how CM helps projects innovate and communicate.

Key factors of case management interventions for frequent users of healthcare services: a thematic analysis review.

PubMed

Hudon, Catherine; Chouinard, Maud-Christine; Lambert, Mireille; Diadiou, Fatoumata; Bouliane, Danielle; Beaudin, Jérémie

2017-10-22

The aim of this paper was to identify the key factors of case management (CM) interventions among frequent users of healthcare services found in empirical studies of effectiveness. Thematic analysis review of CM studies. We built on a previously published review that aimed to report the effectiveness of CM interventions for frequent users of healthcare services, using the Medline, Scopus and CINAHL databases covering the January 2004-December 2015 period, then updated to July 2017, with the keywords 'CM' and 'frequent use'. We extracted factors of successful (n=7) and unsuccessful (n=6) CM interventions and conducted a mixed thematic analysis to synthesise findings. Chaudoir's implementation of health innovations framework was used to organise results into four broad levels of factors: (1) ,environmental/organisational level, (2) practitioner level, (3) patient level and (4) programme level. Access to, and close partnerships with, healthcare providers and community services resources were key factors of successful CM interventions that should target patients with the greatest needs and promote frequent contacts with the healthcare team. The selection and training of the case manager was also an important factor to foster patient engagement in CM. Coordination of care, self-management support and assistance with care navigation were key CM activities. The main issues reported by unsuccessful CM interventions were problems with case finding or lack of care integration. CM interventions for frequent users of healthcare services should ensure adequate case finding processes, rigorous selection and training of the case manager, sufficient intensity of the intervention, as well as good care integration among all partners. Other studies could further evaluate the influence of contextual factors on intervention impacts. © 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.

THE ROLE OF THE CONSEQUENCE MANAGEMENT HOME TEAM IN THE FUKUSHIMA DAIICHI RESPONSE

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

Pemberton, Wendy; Mena, RaJah; Beal, William

The Consequence Management Home Team is a U.S. Department of Energy/National Nuclear Security Administration asset. It assists a variety of response organizations with modeling; radiological operations planning; field monitoring techniques; and the analysis, interpretation, and distribution of radiological data. These reach-back capabilities are activated quickly to support public safety and minimize the social and economic impact of a nuclear or radiological incident. In the Fukushima Daiichi response, the Consequence Management Home Team grew to include a more broad range of support than was historically planned. From the early days of the response to the continuing involvement in supporting late phasemore » efforts, each stage of the Consequence Management Home Team support had distinct characteristics in terms of management of incoming data streams as well as creation of products. Regardless of stage, the Consequence Management Home Team played a critical role in the Fukushima Daiichi response effort.« less

41 CFR 302-15.13 - What are the income tax consequences when my agency pays for my property management services?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false What are the income tax consequences when my agency pays for my property management services? 302-15.13 Section 302-15.13 Public....13 What are the income tax consequences when my agency pays for my property management services? When...

41 CFR 302-3.421 - What are the income tax consequences when my agency pays for property management services?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false What are the income tax consequences when my agency pays for property management services? 302-3.421 Section 302-3.421 Public Contracts... § 302-3.421 What are the income tax consequences when my agency pays for property management services...

TWRS configuration management requirement source document

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

Vann, J.M.

The TWRS Configuration Management (CM) Requirement Source document prescribes CM as a basic product life-cycle function by which work and activities are conducted or accomplished. This document serves as the requirements basis for the TWRS CM program. The objective of the TWRS CM program is to establish consistency among requirements, physical/functional configuration, information, and documentation for TWRS and TWRS products, and to maintain this consistency throughout the life-cycle of TWRS and the product, particularly as changes are being made.

Influence of agricultural management on chemical quality of a clay soil of semi-arid Morocco

NASA Astrophysics Data System (ADS)

Ibno Namr, Khalid; Mrabet, Rachid

2004-06-01

Morocco's semi-arid lands are characterized by unique challenges. The most important obstacles to the development of durable agriculture are (1) limited and unpredictable supply of soil moisture and (2) low soil quality. Intensive use of soil throughout history has led to depletion in soil quality, leading in return to reduced yields because of the consequent reduced organic matter. Recognizing the need to recover soil quality and production decline, INRA scientists began, in the early 1980s, research on the effects of crop rotations, tillage and residue management on the productivity and quality of cropped soils. The present study concerns the short-term effect of rotation, tillage and residue management on selected quality indices of a calcixeroll (organic matter, nitrogen, particulate organic carbon (Cpom), particulate organic nitrogen (Npom) and pH). Hence, three rotations (wheat-wheat, WW; fallow-wheat, FW; and fallow-wheat-barley, FWB), two tillage systems (conventional offset disking, CT and no-tillage, NT), and three levels of residue in the NT system (NT 0 = no-residue cover, NT 50 = half surface residue cover, NT 100 = full surface residue cover) were selected. Three surface horizons were sampled (0-2.5, 2.5-7 and 7-20 cm). The study results showed an improvement of measured soil chemical properties under NT compared to CT, at the surface layer. No-tillage system helped sequestration of carbon and nitrogen, build-up of particulate organic carbon and nitrogen and sensible reduction of pH only at the surface layer. Continuous wheat permitted a slight improvement of soil quality, mainly at the 0-2.5 cm depth. Effects of rotation, tillage and residue level were reduced with depth of measurements.

Roosting habitat of Merriam's turkeys in the Black Hills, South Dakota

Treesearch

Mark A. Rumble

1992-01-01

Lack of roost habitat (trees >40 cm diameter breast height [dbh] and >18 m2/ha basal area) can limit populations of Merriam’s turkeys (Meleagris gallopavo merriami). The Black Hills region has relatively large populations of Merriam’s turkeys, yet trees >40 cm dbh are uncommon. Consequently, I studied...

Contingency Management for Attendance to Group Substance Abuse Treatment Administered by Clinicians in Community Clinics

ERIC Educational Resources Information Center

Ledgerwood, David M.; Alessi, Sheila M.; Hanson, Tressa; Godley, Mark D.; Petry, Nancy M.

2008-01-01

Contingency management (CM) is effective in enhancing retention in therapy. After an 8-week baseline, four community-based substance abuse treatment clinics were exposed in random order to 16 weeks of standard care with CM followed by 16 weeks of standard care without CM or vice versa. In total, 75 outpatients participated. Patients who were…

Configuration Management Process Assessment Strategy

NASA Technical Reports Server (NTRS)

Henry, Thad

2014-01-01

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

Family Physician–Case Manager Collaboration and Needs of Patients With Dementia and Their Caregivers: A Systematic Mixed Studies Review

PubMed Central

Khanassov, Vladimir; Vedel, Isabelle

2016-01-01

PURPOSE Dementia case management (CM) in primary care is a complex intervention aimed at identifying the various needs of patients with dementia and their caregivers, as well as the organization and coordination of care. A key element of CM is the collaboration of family physicians with case managers. We conducted a systematic mixed-studies review to identify the needs of the patient-caregiver dyad and the effects of CM. METHODS We searched MEDLINE, PsycINFO, and EMBASE up to October 2014, regardless of the study design. Our main outcomes were needs of patients and their caregivers and the effects of CM on these needs. We used narrative syntheses to develop a taxonomy of needs and to describe the effects of CM on those needs. We used meta-analysis to calculate the prevalence of needs and the standardized mean differences to evaluate the effects of CM on the needs identified. RESULTS Fifty-four studies were included. We identified needs of the patient-caregiver dyad and needs of the patient and caregiver individually. CM addressed the majority of the identified needs. Still, some very common needs (eg, early diagnosis) are overlooked while other needs (eg, education on the disease) are well addressed. Fully establishing the value of CM is difficult given the small number of studies of CM in primary care. CONCLUSIONS There is good evidence that case managers, in collaboration with family physicians, have a pivotal role in addressing the needs of the patient-caregiver dyad. PMID:26951593

Family Physician-Case Manager Collaboration and Needs of Patients With Dementia and Their Caregivers: A Systematic Mixed Studies Review.

PubMed

Khanassov, Vladimir; Vedel, Isabelle

2016-03-01

Dementia case management (CM) in primary care is a complex intervention aimed at identifying the various needs of patients with dementia and their caregivers, as well as the organization and coordination of care. A key element of CM is the collaboration of family physicians with case managers. We conducted a systematic mixed-studies review to identify the needs of the patient-caregiver dyad and the effects of CM. We searched MEDLINE, PsycINFO, and EMBASE up to October 2014, regardless of the study design. Our main outcomes were needs of patients and their caregivers and the effects of CM on these needs. We used narrative syntheses to develop a taxonomy of needs and to describe the effects of CM on those needs. We used meta-analysis to calculate the prevalence of needs and the standardized mean differences to evaluate the effects of CM on the needs identified. Fifty-four studies were included. We identified needs of the patient-caregiver dyad and needs of the patient and caregiver individually. CM addressed the majority of the identified needs. Still, some very common needs (eg, early diagnosis) are overlooked while other needs (eg, education on the disease) are well addressed. Fully establishing the value of CM is difficult given the small number of studies of CM in primary care. There is good evidence that case managers, in collaboration with family physicians, have a pivotal role in addressing the needs of the patient-caregiver dyad. © 2016 Annals of Family Medicine, Inc.

InSAR Time Series Analysis and Geophysical Modeling of City Uplift Associated with Geothermal Drillings in Staufen im Breisgau, Germany

NASA Astrophysics Data System (ADS)

Motagh, M.; Lubitz, C.

2014-12-01

Geothermal energy is of increasing importance as alternative, environmentally friendly technology for heat management. Direct interaction with the subsurface requires careful implementation, in particular in geological complex regions. The historical city Staufen im Breisgau, SW Germany, has attracted national attention as a case of implementation failure with severe consequences, causing debates on the applicability and security of this sustainable technique. Located at the eastern transition zone of the Upper Rhine Graben and the Schwarzwald massif, the geothermal potential is high at Staufen due to strong temperature gradients. In September 2007, seven boreholes for geothermal probes were drilled up to a depth of 140 m to provide a new heat management for the city hall. Within five years an uplift phenomenon has been observed in Staufen reaching more than 40 cm in places and 269 buildings were damaged. Hydro-chemical driven anhydrite-gypsum transformation in the subsurface was identified as the cause leading to volume increase that is observable as surface uplift. This process is associated with the geothermal drilling activities that have crossed several groundwater levels. In this work, we summarize and present the findings of spaceborne Synthetic Aperture Radar Interferometry (InSAR) analysis of the uplift in Staufen over the last five years from July 2008 through July 2013. By applying the Small Baseline Subset (SBAS) method, we find a localized elliptical-shaped deformation field in NE-SW orientation. Area of maximum uplift is located 50 m NNE of the drilling zone. At this location, we observe a cumulative uplift of approx. 13.7 cm ± 0.34 cm (mean value within an area of 30 m by 30 m) from July 2008 to July 2009, which reduced to cumulative uplift of 3 cm ± 0.25 cm from July 2012 to July 2013. The deceleration can be related to applied countermeasures as borehole sealing and groundwater pumping. The observed ground surface response was compared to regularly performed leveling measurements and shows indications of significant symmetric horizontal motions, which were further investigated by a combined analysis of SAR imagery from ascending and descending orbits. Moreover, InSAR observations were inverted using geophysical models to derive first order characteristics of deformation source at depth.

Case Report: A Case of Severe Cerebral Malaria Managed with Therapeutic Hypothermia and Other Modalities for Brain Edema.

PubMed

Gad, AbdAllah; Ali, Sajjad; Zahoor, Talal; Azarov, Nick

2018-04-01

Malarial infections are uncommon in the United States and almost all reported cases stem from recent travelers coming from endemic countries. Cerebral malaria (CM) is a severe form of the disease usually affecting children and individuals with limited immunity. Despite proper management, mortality from CM can reach up to 25%, especially when it is associated with brain edema. Inefficient management of the edema may result in brain herniation and death. Uniform guidelines for management of CM-associated brain edema are lacking. In this report, we present a case of CM with associated severe brain edema that was successfully managed using a unique combination of therapeutic hypothermia, hypertonic saline, mannitol, and hyperventilation along with the antimalarial drugs quinidine and doxycycline. Our use of hypothermia was based on its proven benefit for improving neurological outcomes in post-cardiac arrest patients and previous in vitro research, suggesting its potential inhibitory role on malaria growth.

[Clinical management of adrenal incidentalomas: results of a survey].

PubMed

Moreno-Fernández, Jesús; García-Manzanares, Alvaro; Sánchez-Covisa, Miguel Aguirre; García, E Inés Rosa Gómez

2009-12-01

Incidentalomas are clinically silent adrenal masses that are discovered incidentally during diagnostic testing for clinical conditions unrelated to suspicion of adrenal disease. Several decision algorithms are used in the management of adrenal masses. We evaluated the routine use of these algorithms through a clinical activity questionnaire. The questionnaire included data on the work center, initial hormonal and radiological study, imaging and hormonal tests performed to complete the study, surgical indications and clinical follow-up. Thirty-three endocrinologists (79%) attending the annual congress of the Castilla-La Mancha Society of Endocrinology, Nutrition and Diabetes completed the questionnaire. Forty-six percent considered tumoral size to be the most important factor suggesting malignancy in the initial evaluation of adrenal incidentalomas, the limit being 4 cm for 78% of the endocrinologists. Imaging study was completed by magnetic resonance imaging by 39%. All the physicians always performed screening for hypercortisolism and pheochromocytoma. Other assessments always conducted in all incidentalomas included hyperaldosteronism (76%), sex hormone-producing tumor (51%) and congenital adrenal hyperplasia (30%). Seventy-nine percent of respondents began to refer incidentalomas larger than 4 cm for surgical treatment, and 46% referred all tumors larger than 6 cm for surgical treatment. With regard to hormonal function, patients with pheochromocytoma, Cushing's syndrome, hyperaldosteronism with poorly controlled blood pressure or sex hormoneproducing tumors were more frequently referred for surgery. Seventy-six percent of endocrinologists performed clinical follow-up in adrenal incidentalomas larger than 4 cm, preferably through computerized tomography (81%), and repeated studies for hormonal hypercortisolism (97%), primary hyperaldosteronism (42%) and pheochromocytoma (76%) over a 4-5 year period (67%). Clinical practice varied among the endocrinologists surveyed, although a certain uniformity in relation to the main guidelines was observed. A tendency to request a greater number of diagnostic tests for initial hormone assessment and clinical follow-up was detected. Assessment, decision-making and medical monitoring in adrenal incidentalomas remain unclear and consequently further studies are required. Copyright 2009 Sociedad Española de Endocrinología y Nutrición. Published by Elsevier Espana. All rights reserved.

Unified-planning, graded-administration, and centralized-controlling: a management modality for treating acquired immune deficiency syndrome with Chinese medicine in Henan Province of China.

PubMed

Xu, Li-Ran; Guo, Hui-jun; Liu, Zhi-bin; Li, Qiang; Yang, Ji-ping; He, Ying

2015-04-01

Henan Province in China has a major epidemic of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Chinese medicine (CM) has been used throughout the last decade, and a management modality was developed, which can be described by unified-planning, graded-administration, and centralized-controlling (UGC). The UGC modality has one primary concept (patient-centered medicine from CM theory), four basic foundations (classifying administrative region, characteristics of CM on disease treatment, health resource conditions, and distribution of patients living with HIV), six important relationships (the "three uniformities and three combinations," and the six relationships therein guide the treatment of AIDS with CM), and four key sections (management, operation, records, and evaluation). In this article, the authors introduce the UGC modality, which could be beneficial to developing countries or resource-limited areas for the management of chronic infectious disease.

12 CFR 225.83 - What are the consequences of failing to continue to meet applicable capital and management...

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 3 2012-01-01 2012-01-01 false What are the consequences of failing to continue to meet applicable capital and management requirements? 225.83 Section 225.83 Banks and Banking... the consequences of failing to continue to meet applicable capital and management requirements? (a...

12 CFR 225.83 - What are the consequences of failing to continue to meet applicable capital and management...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 3 2010-01-01 2010-01-01 false What are the consequences of failing to continue to meet applicable capital and management requirements? 225.83 Section 225.83 Banks and Banking... the consequences of failing to continue to meet applicable capital and management requirements? (a...

The effect of chestnut coppice forests abandon on slope stability: a case study

NASA Astrophysics Data System (ADS)

Vergani, Chiara; Bassanelli, Chiara; Rossi, Lorenzo; Chiaradia, Enrico Antonio; Battista Bischetti, Gian

2013-04-01

Sweet chestnut has been fundamental for Italian mountainous economies for many centuries. This kind of forest was traditionally managed by coppicing in shortly rotation (15-20 years) to rapidly produce wood biomass until half of XX century. In the last decades these forests were in large part abandoned due to change in economy which made coppiced forest management unprofitable, especially in steeper slopes and where forest viability is scarce. As a consequence most of them are over aged and very dense, leading to an observed increasing in localized slope instability, primary because of the uprooting of stools (Vogt et al., 2006). In this work the effect of the abandon of chestnut coppice on slope stability was analyzed, focusing on shallow landslides triggering. The mechanical contribution to soil shear strength of differently managed chestnut stand was estimated and compared in terms of additional root cohesion. The study area is located in the Valcuvia Valley (Lombardy Prealps - Northern Italy) at an elevation about 600 m a.s.l., where two different stands, one managed and the other abandoned (over 40 year aged), were chosen. The two sampling stands are on cohesionless slopes (quaternary moraine deposits) and are homogeneous with regard to the substrate, exposure and elevation. Slope steepness influences heavily forestry practices and steeper stands are more frequently abandoned than stands on gentler terrain: in fact in the abandoned coppice the slope was higher (35 degrees against 13 in the managed stand) and no stands completely homogeneous can be found. In each site the main characteristics of the stand were surveyed and a trench in each stand was excavated to analyze root diameter and number distribution with depth; root specimens were also collected for the tensile force determination through laboratory tensile tests. Root distribution and force were then used to estimate root cohesion values through a Fiber Boundle Model (Pollen and Simon, 2005). Results, as expected, show that management didn't affect root mechanical properties, whereas root distribution within the soil profile did. In terms of additional root cohesion, values are higher in the managed stand, and lower in the abandoned one, at least in the first 50 cm of soil. In the abandoned stand, in fact, roots reach deeper layers of soil (100 cm) than the managed one (50 cm), mainly because of an unexpected greater soil depth. To assess the implication of such results in terms of slope stability, a simple infinite slope model was applied to the two conditions. The results showed that the abandoned stand is prone to instability also with a low level of saturation. On the contrary, by applying the additional root cohesion profile obtained in the managed stand to the steeper slopes, stability should be guaranteed, except in the case of total saturation. In conclusion, although more investigations are required especially to extend the number of stands, coppicing practice seem to be fundamental to prevent shallow landsliding in sweet chestnut forests over cohesionless slopes.

A mechanical, thermal and electrical packaging design for a prototype power management and control system for the 30 cm mercury ion thruster

NASA Technical Reports Server (NTRS)

Sharp, G. R.; Gedeon, L.; Oglebay, J. C.; Shaker, F. S.; Siegert, C. E.

1978-01-01

A prototype electric power management and thruster control system for a 30 cm ion thruster is described. The system meets all of the requirements necessary to operate a thruster in a fully automatic mode. Power input to the system can vary over a full two to one dynamic range (200 to 400 V) for the solar array or other power source. The power management and control system is designed to protect the thruster, the flight system and itself from arcs and is fully compatible with standard spacecraft electronics. The system is easily integrated into flight systems which can operate over a thermal environment ranging from 0.3 to 5 AU. The complete power management and control system measures 45.7 cm (18 in.) x 15.2 cm (6 in.) x 114.8 cm (45.2 in.) and weighs 36.2 kg (79.7 lb). At full power the overall efficiency of the system is estimated to be 87.4 percent. Three systems are currently being built and a full schedule of environmental and electrical testing is planned.

Facilitating the Adoption of Contingency Management for the Treatment of Substance Use Disorders

PubMed Central

Roll, John M; Madden, Gregory J; Rawson, Richard; Petry, Nancy M

2009-01-01

Contingency management (CM) is an effective treatment strategy for addressing many types of substance abuse disorders and associated problems. Nonetheless, CM protocols have not been widely embraced by community-based treatment providers. Exploration of the viability of CM outside of a research context remains largely an academic pursuit. In this paper, we outline several areas that may hinder the transfer of CM technology into community-based practice settings, review the literature that may address these barriers, and offer suggestions to researchers for overcoming them. PMID:22477692

The cost and management of different types of clinical mastitis in dairy cows estimated by dynamic programming.

PubMed

Cha, E; Bar, D; Hertl, J A; Tauer, L W; Bennett, G; González, R N; Schukken, Y H; Welcome, F L; Gröhn, Y T

2011-09-01

The objective of this study was to estimate the cost of 3 different types of clinical mastitis (CM) (caused by gram-positive bacteria, gram-negative bacteria, and other organisms) at the individual cow level and thereby identify the economically optimal management decision for each type of mastitis. We made modifications to an existing dynamic optimization and simulation model, studying the effects of various factors (incidence of CM, milk loss, pregnancy rate, and treatment cost) on the cost of different types of CM. The average costs per case (US$) of gram-positive, gram-negative, and other CM were $133.73, $211.03, and $95.31, respectively. This model provided a more informed decision-making process in CM management for optimal economic profitability and determined that 93.1% of gram-positive CM cases, 93.1% of gram-negative CM cases, and 94.6% of other CM cases should be treated. The main contributor to the total cost per case was treatment cost for gram-positive CM (51.5% of the total cost per case), milk loss for gram-negative CM (72.4%), and treatment cost for other CM (49.2%). The model affords versatility as it allows for parameters such as production costs, economic values, and disease frequencies to be altered. Therefore, cost estimates are the direct outcome of the farm-specific parameters entered into the model. Thus, this model can provide farmers economically optimal guidelines specific to their individual cows suffering from different types of CM. Copyright © 2011 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Management of soft tissue tumors of the musculoskeletal system.

PubMed

Rochwerger, A; Mattei, J-C

2018-02-01

A palpable mass in the musculoskeletal system is a common reason for consultation. The main issue is that a malignant tumor must not be missed. Inappropriate initial treatment can have direct consequences on the risk of local recurrence, the patient's future function and life expectancy. A mass more than 5cm in diameter, a subfascial location and a recent increase in size are signs that should lead the physician to question whether the lesion is truly benign and to carry out diagnostic examinations. MRI is the gold standard imaging exam. Biopsy, which is now mainly percutaneous and imaging-guided, must be performed for any subfascial mass more than 5cm long or a smaller mass with a high risk of postoperative functional sequelae. Referring the patient to a specialized cancer center has direct benefits on the patient's recurrence-free survival and reduces time lost during the diagnostic and treatment phases. For malignant tumors, surgical treatment requires resection margins that comply with cancer guidelines. Preservation of the limb and its function may require multidisciplinary reconstruction techniques. Pre- or post-operative radiation therapy or chemotherapy should be proposed only after discussion in a multidisciplinary team meeting. Copyright © 2017. Published by Elsevier Masson SAS.

12 CFR 225.83 - What are the consequences of failing to continue to meet applicable capital and management...

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 3 2014-01-01 2014-01-01 false What are the consequences of failing to continue to meet applicable capital and management requirements? 225.83 Section 225.83 Banks and Banking....83 What are the consequences of failing to continue to meet applicable capital and management...

The Feasibility of Interventions to Reduce HIV Risk and Drug Use among Heterosexual Methamphetamine Users.

PubMed

Corsi, Karen F; Lehman, Wayne E; Min, Sung-Joon; Lance, Shannon P; Speer, Nicole; Booth, Robert E; Shoptaw, Steve

2012-06-04

This paper reports on a feasibility study that examined contingency management among out-of-treatment, heterosexual methamphetamine users and the reduction of drug use and HIV risk. Fifty-eight meth users were recruited through street outreach in Denver from November 2006 through March 2007. The low sample size reflects that this was a pilot study to see if CM is feasible in an out-of-treatment, street-recruited population of meth users. Secondary aims were to examine if reductions and drug use and risk behavior could be found. Subjects were randomly assigned to contingency management (CM) or CM plus strengths-based case management (CM/SBCM), with follow-up at 4 and 8 months. Participants were primarily White (90%), 52% male and averaged 38 years old. Eighty-three percent attended at least one CM session, with 29% attending at least fifteen. All participants reduced meth use significantly at follow-up. Those who attended more sessions submitted more stimulant-free urines than those who attended fewer sessions. Participants assigned to CM/SBCM attended more sessions and earned more vouchers than clients in CM. Similarly, participants reported reduced needle-sharing and sex risk. Findings demonstrate that CM and SBCM may help meth users reduce drug use and HIV risk.

The Feasibility of Interventions to Reduce HIV Risk and Drug Use among Heterosexual Methamphetamine Users

PubMed Central

Corsi, Karen F.; Lehman, Wayne E.; Min, Sung-Joon; Lance, Shannon P.; Speer, Nicole; Booth, Robert E.; Shoptaw, Steve

2013-01-01

This paper reports on a feasibility study that examined contingency management among out-of-treatment, heterosexual methamphetamine users and the reduction of drug use and HIV risk. Fifty-eight meth users were recruited through street outreach in Denver from November 2006 through March 2007. The low sample size reflects that this was a pilot study to see if CM is feasible in an out-of-treatment, street-recruited population of meth users. Secondary aims were to examine if reductions and drug use and risk behavior could be found. Subjects were randomly assigned to contingency management (CM) or CM plus strengths-based case management (CM/SBCM), with follow-up at 4 and 8 months. Participants were primarily White (90%), 52% male and averaged 38 years old. Eighty-three percent attended at least one CM session, with 29% attending at least fifteen. All participants reduced meth use significantly at follow-up. Those who attended more sessions submitted more stimulant-free urines than those who attended fewer sessions. Participants assigned to CM/SBCM attended more sessions and earned more vouchers than clients in CM. Similarly, participants reported reduced needle-sharing and sex risk. Findings demonstrate that CM and SBCM may help meth users reduce drug use and HIV risk. PMID:23493796

Configuration Management (CM) Support for KM Processes at NASA/Johnson Space Center (JSC)

NASA Technical Reports Server (NTRS)

Cioletti, Louis

2010-01-01

Collection and processing of information are critical aspects of every business activity from raw data to information to an executable decision. Configuration Management (CM) supports KM practices through its automated business practices and its integrated operations within the organization. This presentation delivers an overview of JSC/Space Life Sciences Directorate (SLSD) and its methods to encourage innovation through collaboration and participation. Specifically, this presentation will illustrate how SLSD CM creates an embedded KM activity with an established IT platform to control and update baselines, requirements, documents, schedules, budgets, while tracking changes essentially managing critical knowledge elements.

Treatment of impulsive aggression in correctional settings.

PubMed

Shelton, Deborah; Sampl, Susan; Kesten, Karen L; Zhang, Wanli; Trestman, Robert L

2009-01-01

This article reports the implementation of Dialectical Behavioral Therapy-Corrections Modified (DBT-CM) for difficult to manage, impulsive and/or aggressive correctional populations. Participants were English-speaking women (n = 18) and men (n = 45) of diverse cultural backgrounds between the ages of 16 and 59 years old retained in state-run prisons in Connecticut. Following consent, and a psychological assessment battery, twice-weekly DBT-CM groups were held over 16 weeks followed by random assignment to DBT coaching or case management condition, with sessions taking place individually for eight weeks. Data analysis. A mixed effects regression model was used to test the hypotheses: participants will show decreased aggression, impulsivity, and psychopathology, as well as improved coping, after completing the DBT-CM groups; and will show greater reduction in targeted behaviors than those receiving case management at the six month and 12 month follow-up assessment periods. Significant reduction in targeted behavior was found from baseline to following the 16 week DBT-CM skills treatment groups. Both case management and DBT coaching were significant at 12 month follow-up. A significant difference was found for adult men and women. The study supports the value of DBT-CM for management of aggressive behaviors in prison settings. (c) 2009 John Wiley & Sons, Ltd.

Anti-aliasing filters for deriving high-accuracy DEMs from TLS data: A case study from Freeport, Texas

NASA Astrophysics Data System (ADS)

Xiong, Lin.; Wang, Guoquan; Wessel, Paul

2017-03-01

Terrestrial laser scanning (TLS), also known as ground-based Light Detection and Ranging (LiDAR), has been frequently applied to build bare-earth digital elevation models (DEMs) for high-accuracy geomorphology studies. The point clouds acquired from TLS often achieve a spatial resolution at fingerprint (e.g., 3 cm×3 cm) to handprint (e.g., 10 cm×10 cm) level. A downsampling process has to be applied to decimate the massive point clouds and obtain manageable DEMs. It is well known that downsampling can result in aliasing that causes different signal components to become indistinguishable when the signal is reconstructed from the datasets with a lower sampling rate. Conventional DEMs are mainly the results of upsampling of sparse elevation measurements from land surveying, satellite remote sensing, and aerial photography. As a consequence, the effects of aliasing caused by downsampling have not been fully investigated in the open literature of DEMs. This study aims to investigate the spatial aliasing problem of regridding dense TLS data. The TLS data collected from the beach and dune area near Freeport, Texas in the summer of 2015 are used for this study. The core idea of the anti-aliasing procedure is to apply a low-pass spatial filter prior to conducting downsampling. This article describes the successful use of a fourth-order Butterworth low-pass spatial filter employed in the Generic Mapping Tools (GMT) software package as an anti-aliasing filter. The filter can be applied as an isotropic filter with a single cutoff wavelength or as an anisotropic filter with two different cutoff wavelengths in the X and Y directions. The cutoff wavelength for the isotropic filter is recommended to be three times the grid size of the target DEM.

REASONS AND CONSEQUENCES OF APPLIED LEADERSHIP STYLES IN ETHICAL DILEMMAS WHEN NURSE MANAGERS MAKE DECISIONS.

PubMed

Zydziunaite, V; Suominen, T

2014-09-21

Abstract Background: Understanding the reasons and consequences of leadership styles in ethical dilemmas is fundamental to exploring nurse managers' abilities to influence outcomes for patients and nursing personnel. Purpose: To explain the associations between different leadership styles, reasons for their application and its consequences when nurse managers make decisions in ethical dilemmas. Methods: The data were collected between 15 October 2011 and 30 April 2012 by statistically validated questionnaire. The respondents (n=278) were nurse managers. The data were analyzed using SPSS 20.0, calculating Spearman's correlations, the Stepwise Regression and ANOVA. Results: The reasons for applying different leadership styles in ethical dilemmas include personal characteristics, years in work position, institutional factors, and the professional authority of nurse managers. The applied leadership styles in ethical dilemmas are associated with the consequences regarding the satisfaction of patients', relatives' and nurse managers' needs. Conclusions: Nurse managers exhibited leadership styles oriented to maintenance, focusing more on the "doing the job" than on managing the decision-making in ethical dilemmas.

Leadership styles of nurse managers in ethical dilemmas: Reasons and consequences.

PubMed

Zydziunaite, Vilma; Suominen, Tarja

2014-01-01

Abstract Background: Understanding the reasons and consequences of leadership styles in ethical dilemmas is fundamental to exploring nurse managers' abilities to influence outcomes for patients and nursing personnel. To explain the associations between different leadership styles, reasons for their application and its consequences when nurse managers make decisions in ethical dilemmas. The data were collected between 15 October 2011 and 30 April 2012 by statistically validated questionnaire. The respondents (N = 278) were nurse managers. The data were analysed using SPSS 20.0, calculating Spearman's correlations, the Stepwise Regression and ANOVA. The reasons for applying different leadership styles in ethical dilemmas include personal characteristics, years in work position, institutional factors, and the professional authority of nurse managers. The applied leadership styles in ethical dilemmas are associated with the consequences regarding the satisfaction of patients,' relatives' and nurse managers' needs. Nurse managers exhibited leadership styles oriented to maintenance, focussing more on the 'doing the job' than on managing the decision-making in ethical dilemmas.

Elevated soil nitrogen pools after conversion of turfgrass to water-efficient residential landscapes

NASA Astrophysics Data System (ADS)

Heavenrich, Hannah; Hall, Sharon J.

2016-08-01

As a result of uncertain resource availability and growing populations, city managers are implementing conservation plans that aim to provide services for people while reducing household resource use. For example, in the US, municipalities are incentivizing homeowners to replace their water-intensive turfgrass lawns with water-efficient landscapes consisting of interspersed drought-tolerant shrubs and trees with rock or mulch groundcover (e.g. xeriscapes, rain gardens, water-wise landscapes). While these strategies are likely to reduce water demand, the consequences for other ecosystem services are unclear. Previous studies in controlled, experimental landscapes have shown that conversion from turfgrass to shrubs may lead to high rates of nutrient leaching from soils. However, little is known about the long-term biogeochemical consequences of this increasingly common land cover change across diverse homeowner management practices. We explored the fate of soil nitrogen (N) across a chronosequence of land cover change from turfgrass to water-efficient landscapes in privately owned yards in metropolitan Phoenix, Arizona, in the arid US Southwest. Soil nitrate ({{{{NO}}}3}--N) pools were four times larger in water-efficient landscapes (25 ± 4 kg {{{{NO}}}3}--N/ha 0-45 cm depth) compared to turfgrass lawns (6 ± 7 kg {{{{NO}}}3}--N/ha). Soil {{{{NO}}}3}--N also varied significantly with time since landscape conversion; the largest pools occurred at 9-13 years after turfgrass removal and declined to levels comparable to turfgrass thereafter. Variation in soil {{{{NO}}}3}--N with landscape age was strongly influenced by management practices related to soil water availability, including shrub cover, sub-surface plastic sheeting, and irrigation frequency. Our findings show that transitioning from turfgrass to water-efficient residential landscaping can lead to an accumulation of {{{{NO}}}3}--N that may be lost from the plant rooting zone over time following irrigation or rainfall. These results have implications for best management practices to optimize the benefits of water-conserving landscapes while protecting water quality.

Risk Management of Jettisoned Objects in LEO

NASA Technical Reports Server (NTRS)

Bacon, John B.; Gray, Charles

2011-01-01

The construction and maintenance of the International Space Station (ISS) has led to the release of many objects into its orbital plane, usually during the course of an extra-vehicular activity (EVA). Such releases are often unintentional, but in a growing number of cases, the jettison has been intentional, conducted after a careful assessment of the net risk to the partnership and to other objects in space. Since its launch in 1998 the ISS has contributed on average at least one additional debris object that is simultaneously in orbit with the station, although the number varies widely from zero to eight at any one moment. All of these objects present potential risks to other objects in orbit. Whether it comes from known and tracked orbiting objects or from unknown or untrackable objects, collision with orbital debris can have disastrous consequences. Objects greater than 10cm are generally well documented and tracked, allowing orbiting spacecraft or satellites opportunities to perform evasive maneuvers (commonly known as Debris Avoidance Maneuvers, or DAMs) in the event that imminent collision is predicted. The issue with smaller debris; however, is that it is too numerous to be tracked effectively and yet still poses disastrous consequences if it intercepts a larger object. Due to the immense kinetic energy of any item in orbit, collision with debris as small as 1cm can have catastrophic consequences for many orbiting satellites or spacecraft. Faced with the growing orbital debris threat and the potentially catastrophic consequences of a collision-generated debris shower originating in an orbit crossing the ISS altitude band, in 2007 the ISS program manger asked program specialists to coordinate a multilateral jettison policy amongst the ISS partners. This policy would define the acceptable risk trade rationale for intentional release of a debris object, and other mandatory constraints on such jettisons to minimize the residual risks whenever a jettison was accepted. Although ISS-related debris often presents untenable risks to the EVA crew, IVA crew, or to a departing cargo vehicle for a controlled disposal, such released objects also present a ballistic nuisance to the visiting vehicle traffic, and a potential fragmentation threat to the hundreds of other functional and debris objects whose perigees lie below the ISS orbital altitude. Thus, every such jettison decision is a conscious risk trade.

Clinical case management for patients with schizophrenia with high care needs.

PubMed

Mas-Expósito, Laia; Amador-Campos, Juan Antonio; Gómez-Benito, Juana; Mauri-Mas, Lluís; Lalucat-Jo, Lluís

2015-02-01

The aim of this study is to establish the effectiveness of a clinical case management (CM) programme compared to a standard treatment programme (STP) in patients with schizophrenia. Patients for the CM programme were consecutively selected among patients in the STP with schizophrenia who had poor functioning. Seventy-five patients were admitted to the CM programme and were matched to 75 patients in the STP. Patients were evaluated at baseline and at 1 year follow-up. At baseline, patients in the CM programme showed lower levels of clinical and psychosocial functioning and more care needs than patients in the STP. Both treatment programmes were effective in maintaining contact with services but the CM programme did not show advantages over the STP on outcomes. Differences between groups at baseline may be masking the effects of CM at one year follow-up. A longer follow-up may be required to evaluate the real CM practices effects.

Flowering phenology and its implications for management of big-leaf mahogany Swietenia macrophylla in Brazilian Amazonia.

PubMed

Grogan, James; Loveless, Marilyn D

2013-11-01

Flowering phenology is a crucial determinant of reproductive success and offspring genetic diversity in plants. We measure the flowering phenology of big-leaf mahogany (Swietenia macrophylla, Meliaceae), a widely distributed neotropical tree, and explore how disturbance from logging impacts its reproductive biology. We use a crown scoring system to estimate the timing and duration of population-level flowering at three forest sites in the Brazilian Amazon over a five-year period. We combine this information with data on population structure and spatial distribution to consider the implications of logging for population flowering patterns and reproductive success. Mahogany trees as small as 14 cm diam flowered, but only trees > 30 cm diam flowered annually or supra-annually. Mean observed flowering periods by focal trees ranged from 18-34 d, and trees flowered sequentially during 3-4 mo beginning in the dry season. Focal trees demonstrated significant interannual correlation in flowering order. Estimated population-level flowering schedules resembled that of the focal trees, with temporal isolation between early and late flowering trees. At the principal study site, conventional logging practices eliminated 87% of mahogany trees > 30 cm diam and an estimated 94% of annual pre-logging floral effort. Consistent interannual patterns of sequential flowering among trees create incompletely isolated subpopulations, constraining pollen flow. After harvests, surviving subcommercial trees will have fewer, more distant, and smaller potential partners, with probable consequences for post-logging regeneration. These results have important implications for the sustainability of harvesting systems for tropical timber species.

SSE software test management STM capability: Using STM in the Ground Systems Development Environment (GSDE)

NASA Technical Reports Server (NTRS)

Church, Victor E.; Long, D.; Hartenstein, Ray; Perez-Davila, Alfredo

1992-01-01

This report is one of a series discussing configuration management (CM) topics for Space Station ground systems software development. It provides a description of the Software Support Environment (SSE)-developed Software Test Management (STM) capability, and discusses the possible use of this capability for management of developed software during testing performed on target platforms. This is intended to supplement the formal documentation of STM provided by the SEE Project. How STM can be used to integrate contractor CM and formal CM for software before delivery to operations is described. STM provides a level of control that is flexible enough to support integration and debugging, but sufficiently rigorous to insure the integrity of the testing process.

Cryptococcal meningitis management in Tanzania with strict schedule of serial lumber punctures using intravenous tubing sets: an operational research study.

PubMed

Meda, John; Kalluvya, Samuel; Downs, Jennifer A; Chofle, Awilly A; Seni, Jeremiah; Kidenya, Benson; Fitzgerald, Daniel W; Peck, Robert N

2014-06-01

Cryptococcal meningitis (CM) has a mortality rate of ∼70% among HIV-infected adults in low-income countries. Controlling intracranial pressure (ICP) is essential in CM, but it is difficult in low-income countries because manometers and practical ICP management protocols are lacking. As part of a continuous quality improvement project, our Tanzanian hospital initiated a new protocol for ICP management for CM. All adult inpatients with CM are included in a prospective patient registry. At the time of analysis, this registry included data from 2 years before the initiation of this new ICP management protocol and for a 9-month period after. ICP was measured at baseline and at days 3, 7, and 14 by both manometer and intravenous (IV) tubing set. All patients were given IV fluconazole according to Tanzanian treatment guidelines and were followed until 30 days after admission. Among adult inpatients with CM, 32 of 35 patients (91%) had elevated ICP on admission. Cerebrospinal fluid pressure measurements using the improvised IV tubing set demonstrated excellent agreement (r = 0.96) with manometer measurements. Compared with historical controls, the new ICP management protocol was associated with a significant reduction in 30-day mortality (16/35 [46%] vs. 48/64 [75%] in historical controls; hazard ratio = 2.1 [95% CI: 1.1 to 3.8]; P = 0.018]. Increased ICP is almost universal among HIV-infected adults admitted with CM in Tanzania. Intensive ICP management with a strict schedule of serial lumbar punctures reduced in-hospital mortality compared with historical controls. ICP measurement with IV tubing sets may be a good alternative in resource-limited health facilities where manometers are not available.

Performance measurement for case management: principles and objectives for developing standard measures.

PubMed

Howe, Rufus

2005-01-01

Developing standardized performance measurements for case management (CM) has become the holy grail of the field. The Council for Case Management Accountability (CCMA), a leadership committee of the Case Management Society of America (CMSA), has been grappling with the concept since early 2003. This article lays out a theoretical framework for performance measurement and then outlines the progress on a specific initiative begun by CCMA to correlate CM practices with improved outcome measures.

Essential activities and knowledge domains of case management: new insights from the CCMC role and functions study.

PubMed

Tahan, Hussein

2006-01-01

The Commission for Case Manager Certification (CCMC) defines case management (CM) as "a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual's health needs. [Case management] uses communication and available resources to promote quality, cost-effective outcomes." The practice of CM spans the entire health-care spectrum, including pre-acute, acute, and post-acute settings, and the involvement of varied care providers, such as nurses, social workers, rehabilitation counselors, physicians, and other allied health professionals. So what does it mean to practice as a case manager? What roles and job functions are performed and what knowledge is required of a professional in the field for effective practice? These highly relevant questions reflect the thinking of the CCMC commissioners when the latest Case Manager Role and Functions study was undertaken. The primary purpose of this research, which is conducted every 5 years by the CCMC, is to capture the current state of CM practice. This type of in-depth research is required to support an evidence-based certification examination such as the one offered by CCMC-the certified case manager (CCM) credential. Moreover, as the first and largest nationally accredited organization to certify US case managers, the CCMC recognizes its responsibility to undertake and promote scientifically conducted research in the field of CM.

Agricultural management impact on physical and chemical functions of European peat soils.

NASA Astrophysics Data System (ADS)

Piayda, Arndt; Tiemeyer, Bärbel; Dettmann, Ullrich; Bechtold, Michel; Buschmann, Christoph

2017-04-01

Peat soils offer numerous functions from the global to the local scale: they constitute the biggest terrestrial carbon storage on the globe, form important nutrient filters for catchments and provide hydrological buffer capacities for local ecosystems. Peat soils represent a large share of soils suitable for agriculture in temperate and boreal Europe, pressurized by increasing demands for production. Cultivated peat soils, however, show extreme mineralization rates of the organic substance and turn into hotspots for green house gas emissions, are highly vulnerable to land surface subsidence, soil and water quality deterioration and thus crop failure. The aim of this study is to analyse the impact of past agricultural management on soil physical and chemical functions of peat soils in six European countries. We conducted standardized soil mapping, soil physical/chemical analysis, ground water table monitoring and farm business surveys across 7 to 10 sites in Germany, The Netherlands, Denmark, Estonia, Finland and Sweden. The results show a strong impact of past agricultural management on peat soil functions across Europe. Peat soil under intensive arable land use consistently offer lowest bearing capacities in the upper 10 cm compared to extensive and intensive grassland use, which is a major limiting factor for successful agricultural practice on peat soils. The difference can be explained by root mat stabilization solely, since soil compaction in the upper 25cm is highest under arable land use. A strong decrease of available water capacity and saturated hydraulic conductivity is consequently observed under arable land use, further intensifying hydrological problems like ponding, drought stress and reductions of hydrological buffer capacities frequently present on cultivated peat soils. Soil carbon stocks clearly decrease with increasing land use intensity, showing highest carbon stocks on extensive grassland. This is supported by the degree of decomposition, which is lowest for extensive grass land. Both findings indicate a strong impact of land use intensity and management on soil carbon losses and peat conservation on the European scale. This study provides evidence how functions of peat soils, valuable for successful agricultural production and relevant for climate change mitigation, are impacted by agricultural management.

Technology transfer through performance management: the effects of graphical feedback and positive reinforcement on drug treatment counselors' behavior.

PubMed

Andrzejewski, M E; Kirby, K C; Morral, A R; Iguchi, M Y

2001-07-01

After drug treatment counselors at a community-based methadone treatment clinic were trained in implementing a contingency management (CM) intervention, baseline measures of performance revealed that, on average, counselors were meeting the performance criteria specified by the treatment protocol about 42% of the time. Counselors were exposed to graphical feedback and a drawing for cash prizes in an additive within-subjects design to assess the effectiveness of these interventions in improving protocol adherence. Counselor performance measures increased to 71% during the graphical feedback condition, and to 81% during the drawing. Each counselor's performance improved during the intervention conditions. Additional analyses suggested that counselors did not have skill deficits that hindered implementation. Rather, protocol implementation occurred more frequently when consequences were added, thereby increasing the overall proportion of criteria met. Generalizations, however, may be limited due to a small sample size and possible confounding of time and intervention effects. Nonetheless, present results show promise that feedback and positive reinforcement could be used to improve technology transfer of behavioral interventions into community clinic settings.

Advanced consequence management program: challenges and recent real-world implementations

NASA Astrophysics Data System (ADS)

Graser, Tom; Barber, K. S.; Williams, Bob; Saghir, Feras; Henry, Kurt A.

2002-08-01

The Enhanced Consequence Management, Planning and Support System (ENCOMPASS) was developed under DARPA's Advanced Consequence Management program to assist decision-makers operating in crisis situations such as terrorist attacks using conventional and unconventional weapons and natural disasters. ENCOMPASS provides the tools for first responders, incident commanders, and officials at all levels to share vital information and consequently, plan and execute a coordinated response to incidents of varying complexity and size. ENCOMPASS offers custom configuration of components with capabilities ranging from map-based situation assessment, situation-based response checklists, casualty tracking, and epidemiological surveillance. Developing and deploying such a comprehensive system posed significant challenges for DARPA program management, due to an inherently complex domain, a broad spectrum of customer sites and skill sets, an often inhospitable runtime environment, demanding development-to-deployment transition requirements, and a technically diverse and geographically distributed development team. This paper introduces ENCOMPASS and explores these challenges, followed by an outline of selected ENCOMPASS deployments, demonstrating how ENCOMPASS can enhance consequence management in a variety real world contexts.

Impact of a Dialectic Behavior Therapy - Corrections Modified (DBT-CM) Upon Behaviorally Challenged Incarcerated Male Adolescents

PubMed Central

Shelton, Deborah; Kesten, Karen; Zhang, Wanli; Trestman, Robert

2011-01-01

Purpose This article reports the findings of a Dialectical Behavioral Therapy- Corrections Modified (DBT-CM) intervention upon difficult to manage, impulsive and/or aggressive incarcerated male adolescents. Methods A secondary analysis of a sub-sample of 38 male adolescents who participated in the study was conducted. A one-group pretest-posttest design was used; descriptive statistics and t-tests were conducted. Results Significant changes were found in physical aggression, distancing coping methods and number of disciplinary tickets for behavior. Conclusion The study supports the value of DBT-CM for management of incarcerated male adolescents with difficult to manage aggressive behaviors. PMID:21501287

A conceptual modeling framework for discrete event simulation using hierarchical control structures.

PubMed

Furian, N; O'Sullivan, M; Walker, C; Vössner, S; Neubacher, D

2015-08-01

Conceptual Modeling (CM) is a fundamental step in a simulation project. Nevertheless, it is only recently that structured approaches towards the definition and formulation of conceptual models have gained importance in the Discrete Event Simulation (DES) community. As a consequence, frameworks and guidelines for applying CM to DES have emerged and discussion of CM for DES is increasing. However, both the organization of model-components and the identification of behavior and system control from standard CM approaches have shortcomings that limit CM's applicability to DES. Therefore, we discuss the different aspects of previous CM frameworks and identify their limitations. Further, we present the Hierarchical Control Conceptual Modeling framework that pays more attention to the identification of a models' system behavior, control policies and dispatching routines and their structured representation within a conceptual model. The framework guides the user step-by-step through the modeling process and is illustrated by a worked example.

Disease severity is associated with the use of complementary medicine to treat or manage type-2 diabetes: data from the 2002 and 2007 National Health Interview Survey.

PubMed

Nahin, Richard L; Byrd-Clark, Danita; Stussman, Barbara J; Kalyanaraman, Nilesh

2012-10-22

The overall prevalence of complementary medicine (CM) use among adults in the United States with diabetes has been examined both in representative national samples and in more restricted populations. However, none of these earlier studies attempted to identify predictors of CM use to treat diabetes among the populations sampled, nor looked for a relationship between CM use and diabetes severity. Combining data from the 2002 and 2007 National Health Interview Survey (NHIS), we constructed a nationally representative sample of 3,978 U.S. adults aged ≥18 years with self-reported diabetes. Both the 2002 and 2007 NHIS contained extensive questions on the use of CM. We used logistic regression to examine the association between diabetes severity and overall CM use, as well as the use of specific categories of CM. In adults with type-2 diabetes, 30.9% used CM for any reason, but only 3.4% used CM to treat or manage their type-2 diabetes versus 7.1% of those with type-1 diabetes. Among those using CM to treat/manage their type-2 diabetes, 77% used both CM and conventional prescription medicine for their diabetes. The most prevalent types of CM therapies used were diet-based interventions (35.19%, S.E. 5.11) and non-vitamin/non-mineral dietary supplements (33.74%, S.E. 5.07). After controlling for sociodemographic factors, we found that, based on a count of measures of diabetes severity, persons with the most severe diabetes had nearly twice the odds of using CM as those with less severe disease (OR=1.9, 95%CI 1.2-3.01). Persons who had diabetes 10 years or more (OR=1.66, 95%CI 1.04-3.66) and those that had a functional limitation resulting from their diabetes (OR=1.74, 95%CI 1.09-2.8) had greater odds of using CM than those not reporting these measures. No significant associations were observed between overall CM use and other individual measures of diabetes severity: use of diabetic medications, weak or failing kidneys, coronary heart disease, or severe vision problems. Our results demonstrate that individuals with more severe diabetes are more likely to use CM independent of sociodemographic factors. Further studies are essential to determine if CM therapies actually improve clinical outcomes when used to treat/manage diabetes.

Disease severity is associated with the use of complementary medicine to treat or manage type-2 diabetes: data from the 2002 and 2007 National Health Interview Survey

PubMed Central

2012-01-01

Background The overall prevalence of complementary medicine (CM) use among adults in the United States with diabetes has been examined both in representative national samples and in more restricted populations. However, none of these earlier studies attempted to identify predictors of CM use to treat diabetes among the populations sampled, nor looked for a relationship between CM use and diabetes severity. Methods Combining data from the 2002 and 2007 National Health Interview Survey (NHIS), we constructed a nationally representative sample of 3,978 U.S. adults aged ≥18 years with self-reported diabetes. Both the 2002 and 2007 NHIS contained extensive questions on the use of CM. We used logistic regression to examine the association between diabetes severity and overall CM use, as well as the use of specific categories of CM. Results In adults with type-2 diabetes, 30.9% used CM for any reason, but only 3.4% used CM to treat or manage their type-2 diabetes versus 7.1% of those with type-1 diabetes. Among those using CM to treat/manage their type-2 diabetes, 77% used both CM and conventional prescription medicine for their diabetes. The most prevalent types of CM therapies used were diet-based interventions (35.19%, S.E. 5.11) and non-vitamin/non-mineral dietary supplements (33.74%, S.E. 5.07). After controlling for sociodemographic factors, we found that, based on a count of measures of diabetes severity, persons with the most severe diabetes had nearly twice the odds of using CM as those with less severe disease (OR=1.9, 95%CI 1.2-3.01). Persons who had diabetes 10 years or more (OR=1.66, 95%CI 1.04-3.66) and those that had a functional limitation resulting from their diabetes (OR=1.74, 95%CI 1.09-2.8) had greater odds of using CM than those not reporting these measures. No significant associations were observed between overall CM use and other individual measures of diabetes severity: use of diabetic medications, weak or failing kidneys, coronary heart disease, or severe vision problems. Conclusions Our results demonstrate that individuals with more severe diabetes are more likely to use CM independent of sociodemographic factors. Further studies are essential to determine if CM therapies actually improve clinical outcomes when used to treat/manage diabetes. PMID:23088705

Outpatient case management in low-income epilepsy patients.

PubMed

Tatum, William O; Al-Saadi, Sam; Orth, Thomas L

2008-12-01

Case management (CM) has been shown to improve the medical care of patients in several paradigms of general medicine. This study was undertaken to assess the impact of CM on low-income patients with epilepsy. From 2002 to 2003, 737 epilepsy patients had CM provided by a non-profit, state-supported, epilepsy service subserving a four county region in southeastern Florida. Standardized survey forms distributed by the Florida Department of Health were completed by 159 consecutive patients at program admission. Follow-up information regarding seizure frequency, antiepileptic drugs, and quality of life self-rating was performed after 1 year of CM. The patients evaluated were composed of 58.5% men, with a mean age of 41.0 years. After CM, an increase in self-reported seizure control was seen in 40.2% of patients (p<0.0001, Fisher's exact test), in addition to a shift in the principal utilization of the older to the newer antiepileptic drugs. Furthermore, the total number of emergency department (ED) visits was reduced by 90% with a mean reduction of ED visits per patient from 1.83 per patient per year before CM to 0.14 per patient per year after CM (p<0.0001, Wilcoxon matched-pairs test). Following CM, fewer patients reported difficulty with friends, employers, problems socializing, and feelings of anger (p<0.05, Fisher's exact test). CM of low-income patients with epilepsy resulted in self-reported improvement in seizure control, QoL, and significantly reduced ED visitation. CM in epilepsy is feasible and represents a cost-effective improvement in outpatient epilepsy management.

No shift to a deeper water uptake depth in response to summer drought of two lowland and sub-alpine C₃-grasslands in Switzerland.

PubMed

Prechsl, Ulrich E; Burri, Susanne; Gilgen, Anna K; Kahmen, Ansgar; Buchmann, Nina

2015-01-01

Temperate C3-grasslands are of high agricultural and ecological importance in Central Europe. Plant growth and consequently grassland yields depend strongly on water supply during the growing season, which is projected to change in the future. We therefore investigated the effect of summer drought on the water uptake of an intensively managed lowland and an extensively managed sub-alpine grassland in Switzerland. Summer drought was simulated by using transparent shelters. Standing above- and belowground biomass was sampled during three growing seasons. Soil and plant xylem waters were analyzed for oxygen (and hydrogen) stable isotope ratios, and the depths of plant water uptake were estimated by two different approaches: (1) linear interpolation method and (2) Bayesian calibrated mixing model. Relative to the control, aboveground biomass was reduced under drought conditions. In contrast to our expectations, lowland grassland plants subjected to summer drought were more likely (43-68%) to rely on water in the topsoil (0-10 cm), whereas control plants relied less on the topsoil (4-37%) and shifted to deeper soil layers (20-35 cm) during the drought period (29-48%). Sub-alpine grassland plants did not differ significantly in uptake depth between drought and control plots during the drought period. Both approaches yielded similar results and showed that the drought treatment in the two grasslands did not induce a shift to deeper uptake depths, but rather continued or shifted water uptake to even more shallower soil depths. These findings illustrate the importance of shallow soil depths for plant performance under drought conditions.

Better management of cow's milk allergy using a very low dose food challenge test: a retrospective study.

PubMed

Okada, Yu; Yanagida, Noriyuki; Sato, Sakura; Ebisawa, Motohiro

2015-07-01

Low dose reactive cow's milk (CM) allergic children are at high risk of persistent CM allergy and a positive oral food challenge (OFC). The present study aimed to evaluate if the results of a very low dose (VL) OFC with these children contributes to better management of CM allergy. We retrospectively reviewed subjects with CM allergy who underwent a VL OFC with 3 mL heated CM and had a previous allergic reaction to <25 mL heated CM in the 2 years before the OFC. Subjects who passed the OFC were defined as VL tolerant, and subjects who failed were defined as VL reactive. VL tolerant subjects increased the dose to 25 mL heated CM either during an OFC in our hospital or gradually at home. Of the 83 subjects (median age, 4.3 years; range, 1.0-12.9 years) who were included, 41 (49.4%) were VL tolerant, and 42 (51.6%) were VL reactive. Thirty-nine VL reactive subjects had skin and/or respiratory symptoms during the OFC. Most reactions could be treated with an antihistamine and/or a nebulized β2 agonist. The VL tolerant subjects consumed 3 mL heated CM or 10 g butter. Within the year following the OFC, 18 VL tolerant subjects (45.0%), but none of the VL reactive subjects, were able to consume 25 mL heated CM (p < 0.001). A VL OFC allows the management of some low dose reactive CM allergic children to change from complete avoidance to partial intake of CM. Copyright © 2015 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.

Combating Terrorism: Issues in Managing Counterterrorist Programs

DTIC Science & Technology

2000-04-06

major effort to develop a national strategy, to date the strategy does not include a clear desired outcome to be achieved. Resources to combat...Federal exercises, in contrast to earlier years, are now practicing crisis and consequence management simultaneously and including state and local...categories—crisis management and consequence management. Crisis management includes efforts to stop a terrorist attack, arrest terrorists, and gather

Acceptability of contingency management among clinicians and clients within a co-occurring mental health and substance use treatment program.

PubMed

Srebnik, Debra; Sugar, Andrea; Coblentz, Patrick; McDonell, Michael G; Angelo, Frank; Lowe, Jessica M; Ries, Richard K; Roll, John

2013-01-01

Emerging evidence supports the effectiveness of contingency management (CM) for addictions treatment among individuals with co-occurring serious mental illness (SMI). Addiction treatment for people with SMI generally occurs within community mental health centers (CMHCs) and it is not known whether CM is acceptable within this context. Client views regarding CM are also unknown. This study is the first to describe CM acceptability among CMHC clinicians, and the first to explore client views. Clinician-level predictors of CM acceptability are also examined. This study examined views about CM among 80 clinicians and 29 clients within a CMHC within the context of a concurrent CM study. Three-quarters of clinicians reported they would use CM if funding were available. Clinicians and clients affirmed that incentives enhance abstinence motivation. Clinician CM acceptability was related to greater years of experience, and identifying as an addictions or co-occurring disorders counselor, more than a mental health clinician. The findings provide preliminary evidence that CMHC clinicians, serving clients with addictions and complicating SMI, and client participants in CM, view CM as motivating and a positive tool to facilitate recovery. As an evidence-based intervention, CM warrants further efforts toward funding and dissemination in CMHCs. Copyright © American Academy of Addiction Psychiatry.

Environmental Security Cooperation USARPAC’s: Defense Environmental and International Cooperation (DEIC) Conference (Center of Strategic Leadeship Issue Paper, Volume 07-03, September 2003)

DTIC Science & Technology

2003-09-01

infrastructure, and providing consequence management and mitigation of man-made and natural disasters. The United States Army, Pacifi c (USARPAC), the Offi...Terrorism, Disaster Response and Consequence Management , and Medical Aspects of Environmental Security. The conference brought together military and...consequence management in maintaining governmental legitimacy, and examine salient military roles in preventing, responding to, and mitigating natural

Interdependent Group Contingency Management for Cocaine-Dependent Methadone Maintenance Patients

ERIC Educational Resources Information Center

Kirby, Kimberly C.; Kerwin, MaryLouise E.; Carpenedo, Carolyn M.; Rosenwasser, Beth J.; Gardner, Robert S.

2008-01-01

Contingency management (CM) for drug abstinence has been applied to individuals independently even when delivered in groups. We developed a group CM intervention in which the behavior of a single, randomly selected, anonymous individual determined reinforcement delivery for the entire group. We also compared contingencies placed only on cocaine…

Managing an invasive corallimorph at Palmyra Atoll National Wildlife Refuge, Line Islands, Central Pacific

USGS Publications Warehouse

Work, Thierry M.; Aeby, Greta S.; Neal, Benjamin P.; Price, Nichole N.; Conklin, Eric; Pollock, Amanda

2018-01-01

In 2007, a phase shift from corals to corallimorpharians (CM) centered around a shipwreck was documented at Palmyra Atoll, Line Islands. Subsequent surveys revealed CM to be overgrowing the reef benthos, including corals and coralline algae, potentially placing coral ecosystems in the atoll at risk. This prompted the U.S. Fish and Wildlife Service, the lead management agency of the atoll, to remove the shipwreck. Subsequent surveys showed reductions in CM around the ship impact site. We explain patterns of spread of the CM in terms of both life history and local currents and show with a pilot study that pulverized bleach may be an effective tool to eradicate CM on a local scale. If applied strategically, particularly in heavily infested (> 66% cover) areas, active intervention such as this could be an effective management tool to reduce CM impact on localized areas and decrease colonization rate of remaining reefs. This is the first documentation of the response of an invasive cnidarian to shipwreck removal. While this was a singular event in Palmyra, the spatial and temporal patterns of this invasion and the eradications lessons described herein, are useful for anticipating and controlling similar situations elsewhere.

An economic analysis of conservative management versus active treatment for men with localized prostate cancer.

PubMed

Perlroth, Daniella J; Bhattacharya, Jay; Goldman, Dana P; Garber, Alan M

2012-12-01

Comparative effectiveness research suggests that conservative management (CM) strategies are no less effective than active initial treatment for many men with localized prostate cancer. We estimate longer-term costs of initial management strategies and potential US health expenditure savings by increased use of conservative management for men with localized prostate cancer. Five-year total health expenditures attributed to initial management strategies for localized prostate cancer were calculated using commercial claims data from 1998 to 2006, and savings were estimated from a US population health-care expenditure model. Our analysis finds that patients receiving combinations of active treatments have the highest additional costs over conservative management at $63 500, followed by $48 550 for intensity-modulated radiation therapy, $37 500 for primary androgen deprivation therapy, and $28 600 for brachytherapy. Radical prostatectomy ($15 200) and external beam radiation therapy ($18 900) were associated with the lowest costs. The population model estimated that US health expenditures could be lowered by 1) use of initial CM over all active treatment ($2.9-3.25 billion annual savings), 2) shifting patients receiving intensity-modulated radiation therapy to CM ($680-930 million), 3) foregoing primary androgen deprivation therapy($555 million), 4) reducing the use of adjuvant androgen deprivation in addition to local therapies ($630 million), and 5) using single treatments rather than combination local treatment ($620-655 million). In conclusion, we find that all active treatments are associated with higher longer-term costs than CM. Substantial savings, representing up to 30% of total costs, could be realized by adopting CM strategies, including active surveillance, for initial management of men with localized prostate cancer.

Challenges in diagnosis and management of Cryptococcal immune reconstitution inflammatory syndrome (IRIS) in resource limited settings.

PubMed

Musubire, A K; Meya, B D; Mayanja-Kizza, H; Lukande, R; Wiesner, L D; Bohjanen, P; R Boulware, R D

2012-06-01

In many resource-limited settings, cryptococcal meningitis (CM) contributes up to 20% of all deaths with further complications due to Immune Reconstitution Inflammatory Syndrome (IRIS). We present a case report on a patient who developed CM-IRIS and then subsequent CM-relapse with a fluconazole-resistant organism and then later CM-IRIS once again, manifesting as cystic cryptococcomas, hydrocephalus, and sterile CSF. In this case we, demonstrate that CM-IRIS and persistent low level cryptococcal infection are not mutually exclusive phenomena. The management of IRIS with corticosteroids may increase the risk of culture positive CM-relapse which may further increase the risk of recurrent IRIS and resulting complications including death. We also highlight the role of imaging and fluconazole resistance testing in patients with recurrent meningitis and the importance of CSF cultures in guiding treatment decisions.

Ubiquitous CM and DM

NASA Technical Reports Server (NTRS)

Crowley, Sandra L.

2000-01-01

Ubiquitous is a real word. I thank a former Total Quality Coach for my first exposure some years ago to its existence. My version of Webster's dictionary defines ubiquitous as "present, or seeming to be present, everywhere at the same time; omnipresent." While I believe that God is omnipresent, I have come to discover that CM and DM are present everywhere. Oh, yes; I define CM as Configuration Management and DM as either Data or Document Management. Ten years ago, I had my first introduction to the CM world. I had an opportunity to do CM for the Space Station effort at the NASA Lewis Research Center. I learned that CM was a discipline that had four areas of focus: identification, control, status accounting, and verification. I was certified as a CMIl graduate and was indoctrinated about clear, concise, and valid. Off I went into a world of entirely new experiences. I was exposed to change requests and change boards first hand. I also learned about implementation of changes, and then of technical and CM requirements.

The selective conservative management of small traumatic pneumothoraces following stab injuries is safe: experience from a high-volume trauma service in South Africa.

PubMed

Kong, V Y; Oosthuizen, G V; Clarke, D L

2015-02-01

The selective conservative management of small pneumothoraces (PTXs) following stab injuries is controversial. We reviewed a cohort of patients managed conservatively in a high volume trauma service in South Africa. A retrospective review over a 2-year period identified 125 asymptomatic patients with small PTXs measuring <2 cm on chest radiograph who were managed conservatively. Of the 125 patients included in the study, 92% were male (115/125), and the median age for all patients was 21 years (19-24). Ninety-seven per cent (121/125) of the weapons involved were knives, and 3% (4/125) were screwdrivers. Sixty-one per cent of all injuries were on the left side. Eighty-two per cent (102/125) sustained a single stab, and 18% (23/125) had multiple stabs. Thirty-nine per cent (49/125) had a PTX <0.5 cm (Group A), 26% (32/125) were ≥ 0.5 to <1 cm (Group B), 19% (24/125) were ≥ 1 to <1.5 cm (Group C) and 15% (20/125) were ≥ 1.5 to <2 cm (Group D). Three per cent of all patients (4/125) eventually required ICDs (one in Group C, three in Group D). All four patients had ICDs in situ for 24 h. The remaining 97% (121/125) were all managed successfully by active clinical observation alone. There were no subsequent readmissions, morbidity or mortality as a direct result of our conservative approach. The selective conservative management of asymptomatic small PTXs from stab injuries is safe if undertaken in the appropriate setting.

Cognitive Learning Theory Takes a Backseat: Consequences of a Management Development Program for Work Practice

ERIC Educational Resources Information Center

Moesby-Jensen, Cecilie K.

2008-01-01

This paper describes the consequences of a cognitive management development program for middle managers in a public organization. The objective was to teach transformational leadership and teamwork but it occasioned a very limited improved articulation of transformational leadership and teamwork and only a modest change in the managers' actions in…

Development of a Multi-Target Contingency Management Intervention for HIV Positive Substance Users.

PubMed

Stitzer, Maxine; Calsyn, Donald; Matheson, Timothy; Sorensen, James; Gooden, Lauren; Metsch, Lisa

2017-01-01

Contingency management (CM) interventions generally target a single behavior such as attendance or drug use. However, disease outcomes are mediated by complex chains of both healthy and interfering behaviors enacted over extended periods of time. This paper describes a novel multi-target contingency management (CM) program developed for use with HIV positive substance users enrolled in a CTN multi-site study (0049 Project HOPE). Participants were randomly assigned to usual care (referral to health care and SUD treatment) or 6-months strength-based patient navigation interventions with (PN+CM) or without (PN only) the CM program. Primary outcome of the trial was viral load suppression at 12-months post-randomization. Up to $1160 could be earned over 6 months under escalating schedules of reinforcement. Earnings were divided among eight CM targets; two PN-related (PN visits; paperwork completion; 26% of possible earnings), four health-related (HIV care visits, lab blood draw visits, medication check, viral load suppression; 47% of possible earnings) and two drug-use abatement (treatment entry; submission of drug negative UAs; 27% of earnings). The paper describes rationale for selection of targets, pay amounts and pay schedules. The CM program was compatible with and fully integrated into the PN intervention. The study design will allow comparison of behavioral and health outcomes for participants receiving PN with and without CM; results will inform future multi-target CM development. Copyright © 2016 Elsevier Inc. All rights reserved.

[Psychiatric case management. Chronic Disease Management application experience in a public Mental Health Service].

PubMed

Pompili, Enrico; Silvestrini, Cristiana; Nicolò, Giuseppe; Pitino, Annalisa; Bernabei, Laura

2014-01-01

Aim of this study is to investigate the possible effectiveness of a specific program management needs of patients at high impact health care, case management (CM). The welfare impact is evaluated in terms of the severity of the presented disorder or to other characteristic factors of the individual patient, such as: adherence to the proposed treatments, possible resistance to drug treatment, cognitive structure, the presence of comorbid medical pathologies, abuse/addiction and, more generally, all bio-psycho-social functioning variables that can complicate the treatment of the patient. Twenty five outpatients with chronic schizophrenia (age mean 49,5 yrs) were evaluated through the Camberwell Assessment of Need (CAN20) and Life Skill Profile (LSP) before and after 1 year of CM treatment. General psychopathology was assessed by the Clinical Global Impression (CGI) and the Brief Psychiatric Rating Scale (BPRS). Demographic data were collected, as well as data related to the severity of the disorder: number of hospitalizations and number of switch in drug treatment in the year before the study. Between T0 and T1 there is a significant improvement on CGI-G, BPRS (total and HOST factor), LSP and CAN TOT in patients treated with CM. Moreover, in CM treated patients a 58% reduction of hospitalizations is noted in the year of study. There is a possible effectiveness of CM in improving patient's clinical and social needs in chronic psychiatric diseases. The CM reduces the number of hospitalizations.

School Asthma Screening and Case Management: Attendance and Learning Outcomes

ERIC Educational Resources Information Center

Moricca, Michelle L.; Grasska, Merry A.; BMarthaler, Marcia; Morphew, Tricia; Weismuller, Penny C.; Galant, Stanley P.

2013-01-01

Asthma is related to school absenteeism and underperformance in elementary students. This pilot study assessed whether school nurse case management (CM) in children identified with asthma impacts academic performance and school absenteeism in one school. A validated questionnaire was used to identify children at risk for asthma and CM was provided…

Contingency Management Improves Abstinence and Quality of Life in Cocaine Abusers

ERIC Educational Resources Information Center

Petry, Nancy M.; Alessi, Sheila M.; Hanson, Tressa

2007-01-01

Contingency management (CM) treatments enhance drug abstinence. This study evaluated whether CM also improves quality of life and if these effects are mediated by abstinence. Across 3 independent trials, cocaine abusers in intensive outpatient treatment (n = 387) were randomly assigned to 12 weeks of standard treatment as usual or standard…

A Randomized Trial of Contingency Management Delivered in the Context of Group Counseling

ERIC Educational Resources Information Center

Petry, Nancy M.; Weinstock, Jeremiah; Alessi, Sheila M.

2011-01-01

Objective: Contingency management (CM) is efficacious in reducing drug use. Typically, reinforcers are provided on an individual basis to patients for submitting drug-negative samples. However, most treatment is provided in a group context, and poor attendance is a substantial concern. This study evaluated whether adding CM to group-based…

Preliminary Examination of Adolescent Spending in a Contingency Management-Based Smoking-Cessation Program

ERIC Educational Resources Information Center

Cavallo, Dana A.; Nich, Charla; Schepis, Ty S.; Smith, Anne E.; Liss, Thomas B.; McFetridge, Amanda K.; Krishnan-Sarin, Suchitra

2010-01-01

Contingency management (CM) utilizing monetary incentives is efficacious in enhancing abstinence in an adolescent smoking-cessation program, but how adolescents spend their money has not been examined. We assessed spending habits of 38 adolescent smokers in a CM-based smoking-cessation project prior to quitting and during treatment using a…

Application of gaseous core reactors for transmutation of nuclear waste

NASA Technical Reports Server (NTRS)

Schnitzler, B. G.; Paternoster, R. R.; Schneider, R. T.

1976-01-01

An acceptable management scheme for high-level radioactive waste is vital to the nuclear industry. The hazard potential of the trans-uranic actinides and of key fission products is high due to their nuclear activity and/or chemical toxicity. Of particular concern are the very long-lived nuclides whose hazard potential remains high for hundreds of thousands of years. Neutron induced transmutation offers a promising technique for the treatment of problem wastes. Transmutation is unique as a waste management scheme in that it offers the potential for "destruction" of the hazardous nuclides by conversion to non-hazardous or more manageable nuclides. The transmutation potential of a thermal spectrum uranium hexafluoride fueled cavity reactor was examined. Initial studies focused on a heavy water moderated cavity reactor fueled with 5% enriched U-235-F6 and operating with an average thermal flux of 6 times 10 to the 14th power neutrons/sq cm-sec. The isotopes considered for transmutation were I-129, Am-241, Am-242m, Am-243, Cm-243, Cm-244, Cm-245, and Cm-246.

Conservative management of CIN2: National Audit of British Society for Colposcopy and Cervical Pathology members' opinion.

PubMed

Macdonald, Madeleine; Smith, John H F; Tidy, John A; Palmer, Julia E

2018-04-01

There is no doubt that organised cervical screening programmes have significantly reduced the rates of cervical cancer by detection and treatment of high-grade cervical intraepithelial neoplasia (CIN2, CIN3). National UK guidelines do not differentiate between CIN2 and CIN3 as separate entities and recommend treatment for both, although a degree of uncertainty exists regarding the natural history of CIN2. This national survey of British Society for Colposcopy and Cervical Pathology members aimed to assess attitudes towards conservative management (CM) of CIN2 in the UK and identify potential selection criteria. In total, 511 members responded (response rate 32%); 55.6% offered CM for selective cases; 12.4% for all cases; 16.4% had formal guidelines. Most agreed age group was >40yrs (83%), HPV 16/18 positive (51.4%), smoking (60%), immuno-compromise (74.2%), and large lesion size (80.8%) were relative contraindications for CM. 75.9% favoured six-monthly monitoring, with 80.2% preferring excisional treatment for persistent high-grade disease. Many UK colposcopists manage CIN2 conservatively without formal guidelines. Potential selection criteria should be investigated by a multicentre study. Impact statement Although anecdotally some colposcopists manage many women with CIN2 conservatively, this National Audit of British Society for Colposcopy and Cytopathology members, we believe, is the first time this has been formally recorded. The survey assesses current attitudes towards conservative management (CM) of CIN2 and seeks to identify potential selection criteria that could be used to identify suitable women. It received over 500 responses and significantly, identified many colposcopists recommending CM of CIN2 for patients despite the lack of any formal guidance regarding this approach. The greater majority of respondents were keen to consider participating in a multicentre trial on CM of CIN2 targeting the UK screening population (25-64 years). The paper has international relevance as ACOG and ASCCP have recently changed their guidance for the management of CIN2 in younger women and now recommend CM with monitoring rather than first line ablative or excisional treatment due to concerns regarding overtreatment, especially in women who have not yet completed their family.

[Multiple colonic anastomoses in the surgical treatment of short bowel syndrome. A new technique].

PubMed

Robledo-Ogazón, Felipe; Becerril-Martínez, Guillermo; Hernández-Saldaña, Víctor; Zavala-Aznar, Marí Luisa; Bojalil-Durán, Luis

2008-01-01

Some surgical pathologies eventually require intestinal resection. This may lead to an extended procedure such as leaving 30 cm of proximal jejunum and left and sigmoid colon. One of the most important consequences of this type of resection is "intestinal failure" or short bowel syndrome. This complex syndrome leads to different metabolic and water and acid/base imbalances, as well as nutritional and immunological challenges along with the problem accompanying an abdomen subjected to many surgical procedures and high mortality. Many surgical techniques have been developed to improve quality of life of patients. We designed a non-transplant surgical approach and performed the procedure on two patients with postoperative short bowel syndrome with <40 cm of proximal jejunum and left colon. There are a variety of non-transplant surgical procedures that, due to their complex technique or high mortality rate, have not resolved this important problem. However, the technique we present in this work can be performed by a large number of surgeons. The procedure has a low morbimortality rate and offers the opportunity for better control of metabolic and acid/base balance, intestinal transit and proper nutrition. We consider that this technique offers a new alternative for the complex management required by patients with short bowel syndrome and facilitates their long-term nutritional control.

Trail impact monitoring in Rocky Mountain National Park, USA

NASA Astrophysics Data System (ADS)

Svajda, J.; Korony, S.; Brighton, I.; Esser, S.; Ciapala, S.

2016-01-01

This paper examines impacts of increased visitation leading to human trampling of vegetation and soil along several trails in Rocky Mountain National Park (RMNP) to understand how abiotic factors and level of use can influence trail conditions. RMNP is one of the most visited national parks in the USA, with 3.3 million visitors in 2012 across 1075 km2 and 571 km of hiking trails. 95 % of the park is designated wilderness, making the balance between preservation and visitor use challenging. This research involves the application of trail condition assessments to 56 km of trails to determine prevailing factors and what, if any, connection between them exist. The study looked at a variety of inventory and impact indicators and standards to determine their importance and to develop a baseline condition of trails. The data can be used for future comparison and evaluation of development trends. We found that trail widening (mean trail width 88.9 cm) and soil loss (cross-sectional area 172.7 cm2) are the most visible effects of trail degradation. Further statistical analyses of data identified the role and influence of various factors (e.g., use level and topography). Insights into the influence of these factors can lead to the selection of appropriate management measures to avoid or minimize negative consequences from increased visitation.

Trail impact monitoring in Rocky Mountain National Park, USA

NASA Astrophysics Data System (ADS)

Svajda, J.; Korony, S.; Brighton, I.; Esser, S.; Ciapala, S.

2015-11-01

This paper examines impacts of increased visitation leading to human trampling of vegetation and soil along several trails in Rocky Mountain National Park (RMNP) to understand how abiotic factors and level of use can influence trail conditions. RMNP is one of the most visited national parks in the USA with 3.3 million visitors in 2012 across 1075 km2 and 571 km of hiking trails. 95 % of the park is designated wilderness making the balance between preservation and visitor use challenging. This research involves the application of trail condition assessments to 56 km of trails to determine prevailing factors and what, if any, connection between them exist. The study looked at a variety of inventory and impact indicators and standards to determine their importance and to develop a baseline condition of trails. The data can be used for future comparison and evaluation of development trends. We found that trail widening (mean trail width 88.9 cm) and soil loss (cross sectional area 172.7 cm2) are the most visible effects of trail degradation. Further statistical analyses of data identified the role and influence of various factors (e.g. use level and topography). Insights into the influence of these factors can lead to the selection of appropriate management measures to avoid or minimize negative consequences from increased visitation.

A conceptual modeling framework for discrete event simulation using hierarchical control structures

PubMed Central

Furian, N.; O’Sullivan, M.; Walker, C.; Vössner, S.; Neubacher, D.

2015-01-01

Conceptual Modeling (CM) is a fundamental step in a simulation project. Nevertheless, it is only recently that structured approaches towards the definition and formulation of conceptual models have gained importance in the Discrete Event Simulation (DES) community. As a consequence, frameworks and guidelines for applying CM to DES have emerged and discussion of CM for DES is increasing. However, both the organization of model-components and the identification of behavior and system control from standard CM approaches have shortcomings that limit CM’s applicability to DES. Therefore, we discuss the different aspects of previous CM frameworks and identify their limitations. Further, we present the Hierarchical Control Conceptual Modeling framework that pays more attention to the identification of a models’ system behavior, control policies and dispatching routines and their structured representation within a conceptual model. The framework guides the user step-by-step through the modeling process and is illustrated by a worked example. PMID:26778940

Using the Experience Sampling Method in the Context of Contingency Management for Substance Abuse Treatment

ERIC Educational Resources Information Center

Husky, Mathilde M.; Mazure, Carolyn M.; Carroll, Kathleen M.; Barry, Danielle; Petry, Nancy M.

2008-01-01

Contingency management (CM) treatments have been shown to be effective in reducing substance use. This manuscript illustrates how the experience sampling method (ESM) can depict behavior and behavior change and can be used to explore CM treatment mechanisms. ESM characterizes idiosyncratic patterns of behavior and offers the potential to determine…

Compositional Homogeneity of CM Parent Bodies

NASA Astrophysics Data System (ADS)

Vernazza, P.; Marsset, M.; Beck, P.; Binzel, R. P.; Birlan, M.; Cloutis, E. A.; DeMeo, F. E.; Dumas, C.; Hiroi, T.

2016-09-01

CM chondrites are the most common type of hydrated meteorites, making up ˜1.5% of all falls. Whereas most CM chondrites experienced only low-temperature (˜0°C-120°C) aqueous alteration, the existence of a small fraction of CM chondrites that suffered both hydration and heating complicates our understanding of the early thermal evolution of the CM parent body(ies). Here, we provide new constraints on the collisional and thermal history of CM-like bodies from a comparison between newly acquired spectral measurements of main-belt Ch/Cgh-type asteroids (70 objects) and existing laboratory spectral measurements of CM chondrites. It first appears that the spectral variation observed among CM-like bodies is essentially due to variations in the average regolith grain size. Second, the spectral properties of the vast majority (unheated) of CM chondrites resemble both the surfaces and the interiors of CM-like bodies, implying a “low” temperature (<300°C) thermal evolution of the CM parent body(ies). It follows that an impact origin is the likely explanation for the existence of heated CM chondrites. Finally, similarly to S-type asteroids and (2) Pallas, the surfaces of large (D > 100 km)—supposedly primordial—Ch/Cgh-type main-belt asteroids likely expose the interiors of the primordial CM parent bodies, a possible consequence of impacts by small asteroids (D < 10 km) in the early solar system.

Finite Element Stress Analysis of Spent Nuclear Fuel Disposal Canister in a Deep Geological Repository

NASA Astrophysics Data System (ADS)

Kwon, Young Joo; Choi, Jong Won

This paper presents the finite element stress analysis of a spent nuclear fuel disposal canister to provide basic information for dimensioning the canister and configuration of canister components and consequently to suggest the structural analysis methodology for the disposal canister in a deep geological repository which is nowadays very important in the environmental waste treatment technology. Because of big differences in the pressurized water reactor (PWR) and the Canadian deuterium and uranium reactor (CANDU) fuel properties, two types of canisters are conceived. For manufacturing, operational reasons and standardization, however, both canisters have the same outer diameter and length. The construction type of canisters introduced here is a solid structure with a cast insert and a corrosion resistant overpack. The structural stress analysis is carried out using a finite element analysis code, NISA, and focused on the structural strength of the canister against the expected external pressures due to the swelling of the bentonite buffer and the hydrostatic head. The canister must withstand these large pressure loads. Consequently, canisters presented here contain 4 PWR fuel assemblies and 33×9 CANDU fuel bundles. The outside diameter of the canister for both fuels is 122cm and the cast insert diameter is 112cm. The total length of the canister is 483cm with the lid/bottom and the outer shell of 5cm.

The Efficacy of All-Positive Management as a Function of the Prior Use of Negative Consequences.

ERIC Educational Resources Information Center

Pfiffner, Linda J.; O'Leary, Susan G.

1987-01-01

The study found that in the absence of a history of negative consequences, an all-positive management system for eight first- through third-grade children with academic and/or classroom behavioral problems was not sufficient to maintain on-task rates of academic accuracy. The addition of negative consequences immediately improved on-task behavior…

Temperature, illumination, and fluence dependence of current and voltage in electron irradiated solar cells

NASA Technical Reports Server (NTRS)

Faith, T. J.; Obenschain, A. F.

1974-01-01

Empirical equations have been derived from measurements of solar cell photovoltaic characteristics relating light-generated current and open circuit voltage to cell temperature, intensity of illumination and 1-MeV electron fluence. Both 2-ohm-cm and 10-ohm-cm cells were tested over the temperature range from 120 to 470 K, the illumination intensity range from 5 to 1830 mW/sq cm, and the electron fluence range from 1 x 10 to the 13th to 1 x 10 to the 16th electrons/sq cm. The normalized temperature coefficient of the light generated current varies as the 0.18 power of the fluence for temperatures above approximately 273 K and is independent of fluence at lower temperatures. At 140 mW/sq cm, a power law expression was derived which shows that the light-generated current decreases at a rate proportional to the 0.153 power of the fluence for both resistivities. The coefficient of the expression is larger for 2-ohm-cm cells; consequently, the advantage for 10-ohm-cm cells increased with increasing fluence.

Establishment of an Italian chronic migraine database: a multicenter pilot study.

PubMed

Barbanti, Piero; Fofi, L; Cevoli, S; Torelli, P; Aurilia, C; Egeo, G; Grazzi, L; D'Amico, D; Manzoni, G C; Cortelli, P; Infarinato, F; Vanacore, N

2018-05-01

To optimize chronic migraine (CM) ascertainment and phenotype definition, provide adequate clinical management and health care procedures, and rationalize economic resources allocation, we performed an exploratory multicenter pilot study aimed at establishing a CM database, the first step for developing a future Italian CM registry. We enrolled 63 consecutive CM patients in four tertiary headache centers screened with face-to-face interviews using an ad hoc dedicated semi-structured questionnaire gathering detailed information on life-style, behavioral and socio-demographic factors, comorbidities, and migraine features before and after chronicization and healthcare resource use. Our pilot study provided useful insights revealing that CM patients (1) presented in most cases symptoms of peripheral trigeminal sensitization, a relatively unexpected feature which could be useful to unravel different CM endophenotypes and to predict trigeminal-targeted treatments' responsiveness; (2) had been frequently admitted to emergency departments; (3) had undergone, sometime repeatedly, unnecessary or inappropriate investigations; (4) got rarely illness benefit exemption or disability allowance only. We deem that the expansion of the database-shortly including many other Italian headache centers-will contribute to more precisely outline CM endophenotypes, hence improving management, treatment, and economic resource allocation, ultimately reducing CM burden on both patients and health system.

Comments on Contingency Management and Conditional Cash Transfers

PubMed Central

Higgins, Stephen T.

2009-01-01

This essay discusses research on incentive-based interventions to promote healthy behavior change, contingency management (CM) and conditional cash transfers (CCT). The overarching point of the essay is that CM and CCT are often treated as distinct areas of inquiry when at their core they represent a common approach. Some potential bi-directional benefits of recognizing this commonality are discussed. Distinct intellectual traditions probably account for the separate paths of CM and CCT to date, with the former being rooted in behavioral psychology and the latter in microeconomics. It is concluded that the emerging field of behavioral economics, which is informed by and integrates principles of each of those disciplines, may provide the proper conceptual framework for integrating CM and CCT. PMID:19670269

Comments on contingency management and conditional cash transfers.

PubMed

Higgins, Stephen T

2010-10-01

This essay discusses research on incentive-based interventions to promote healthy behavior change, contingency management (CM) and conditional cash transfers (CCT). The overarching point of the essay is that CM and CCT are often treated as distinct areas of inquiry when at their core they represent a common approach. Some potential bi-directional benefits of recognizing this commonality are discussed. Distinct intellectual traditions probably account for the separate paths of CM and CCT to date, with the former being rooted in behavioral psychology and the latter in microeconomics. It is concluded that the emerging field of behavioral economics, which is informed by and integrates principles of each of those disciplines, may provide the proper conceptual framework for integrating CM and CCT.

Effect of PTSD diagnosis and contingency management procedures on cocaine use in dually cocaine and opioid-dependent individuals maintained on LAAM: A retrospective analysis

PubMed Central

Mancino, M.; McGaugh, J.; Feldman, Z.; Poling, J.; Oliveto, A.

2012-01-01

This randomized clinical trial retrospectively examined the effect of Post Traumatic Stress Disorder (PTSD) and contingency management (CM) on cocaine use in opioid and cocaine dependent individuals maintained on high or low-dose LAAM randomly assigned to CM or a yoked-control condition. Cocaine-positive urines decreased more rapidly over time in those without PTSD versus those with PTSD in the non-contingency condition. In participants with PTSD, CM resulted in fewer cocaine positive urines compared to the non-contingent condition. This suggests that CM may help improve the potentially worse outcomes in opioid-and cocaine dependent individuals with PTSD compared to those without PTSD. PMID:20163389

How development and manufacturing will need to be structured--heads of development/manufacturing. May 20-21, 2014 Continuous Manufacturing Symposium.

PubMed

Nepveux, Kevin; Sherlock, Jon-Paul; Futran, Mauricio; Thien, Michael; Krumme, Markus

2015-03-01

Continuous manufacturing (CM) is a process technology that has been used in the chemical industry for large-scale mass production of chemicals in single-purpose plants with benefit for many years. Recent interest has been raised to expand CM into the low-volume, high-value pharmaceutical business with its unique requirements regarding readiness for human use and the required quality, supply chain, and liability constraints in this business context. Using a fairly abstract set of definitions, this paper derives technical consequences of CM in different scenarios along the development-launch-supply axis in different business models and how they compare to batch processes. Impact of CM on functions in development is discussed and several operational models suitable for originators and other business models are discussed and specific aspects of CM are deduced from CM's technical characteristics. Organizational structures of current operations typically can support CM implementations with just minor refinements if the CM technology is limited to single steps or small sequences (bin-to-bin approach) and if the appropriate technical skill set is available. In such cases, a small, dedicated group focused on CM is recommended. The manufacturing strategy, as centralized versus decentralized in light of CM processes, is discussed and the potential impact of significantly shortened supply lead times on the organization that runs these processes. The ultimate CM implementation may be seen by some as a totally integrated monolithic plant, one that unifies chemistry and pharmaceutical operations into one plant. The organization supporting this approach will have to reflect this change in scope and responsibility. The other extreme, admittedly futuristic at this point, would be a highly decentralized approach with multiple smaller hubs; this would require a new and different organizational structure. This processing approach would open up new opportunities for products that, because of stability constraints or individualization to patients, do not allow centralized manufacturing approaches at all. Again, the entire enterprise needs to be restructured accordingly. The situation of CM in an outsourced operation business model is discussed. Next steps for the industry are recommended. In summary, opportunistic implementation of isolated steps in existing portfolios can be implemented with minimal organizational changes; the availability of the appropriate skills is the determining factor. The implementation of more substantial sequences requires business processes that consider the portfolio, not just single products. Exploration and implementation of complete process chains with consequences for quality decisions do require appropriate organizational support. © 2015 Wiley Periodicals, Inc. and the American Pharmacists Association.

Linking meteorological drivers of spring-summer drought regimes to agricultural drought risk in China

NASA Astrophysics Data System (ADS)

Dai, L.; Wright, J. S.; Yu, C.; Huang, W. Y.

2017-12-01

As a drought prone country, China has experienced frequent severe droughts in recent decades. Drought frequency and severity are projected to increase in China under climate change. An understanding of the physical processes that contribute to extreme droughts is essential for seasonal forecasting, but the dominant physical mechanisms responsible for droughts in most parts of China are still unclear. Moreover, despite numerous studies on droughts in China, there are few clear connections between the meteorological and climatological drivers of extreme droughts and the associated agricultural consequences. This knowledge gap limits the capacity for decision-making support in drought management. The objectives of this study are (1) to identify robust spring-summer drought regimes over China, (2) to investigate the physical mechanisms associated with each regime, and (3) to better clarify connections between meteorological drought regimes and agricultural drought risk. First, we identify six drought regimes over China by applying an area-weighted k-means clustering technique to spatial patterns of spring-summer Standardized Precipitation Index (SPI) obtained from the ten-member ERA-20CM ensemble for 1900-2010. Second, we project these drought regimes onto agricultural drought risk maps for the three major cereal crops (rice, maize, and wheat) in China. Taking into account historical harvest areas for these crops, we then evaluate the potential impact of each drought regime on agricultural production. Third, the physical mechanisms and meteorological context behind each drought regimes are investigated based on monthly outputs from ERA20CM. We analyze the preceding and concurrent atmospheric circulation anomalies associated with each regime, and propose mechanistic explanations for drought development. This work provides a new perspective on diagnosing the physical mechanisms behind seasonal droughts, and lays a foundation for improving seasonal drought prediction and water management practices in China.

Weed management and cotton yield under two row spacings, conventional and conservation tillage systems utilizing conventional, glufosinate-, and glyphosate-based weed management systems

USDA-ARS?s Scientific Manuscript database

A field experiment was conducted in 2005 and 2006, to evaluate weed control in conventional, Liberty Link® (LL), and Roundup Ready® (RR) herbicide systems under standard [102 cm (40 inch)] and narrow [38 cm (15 inch)] row-spacings utilizing conventional and high-residue conservation tillage systems....

Case Studies to Deepen Understanding and Enhance Classroom Management Skills in Preschool Teacher Training

ERIC Educational Resources Information Center

Tal, Clodie

2010-01-01

This article adds to the existing body of data that demonstrates how the use of in-depth case studies that include social episode analysis can deepen the teaching students' and researchers' understanding of the perceptions and skills needed for Classroom Management (CM). In this article, CM is defined as a meta-skill that integrates cognitive…

School asthma screening and case management: attendance and learning outcomes.

PubMed

Moricca, Michelle L; Grasska, Merry A; BMarthaler, Marcia; Morphew, Tricia; Weismuller, Penny C; Galant, Stanley P

2013-04-01

Asthma is related to school absenteeism and underperformance in elementary students. This pilot study assessed whether school nurse case management (CM) in children identified with asthma impacts academic performance and school absenteeism in one school. A validated questionnaire was used to identify children at risk for asthma and CM was provided to link these students to medical care and assure asthma action plans at school. In the 40 children with confirmed diagnosis who received CM, academic performance on standardized testing postintervention was similar to the 76 children who were low risk for asthma. Average days absent due to illness in the CM group were reduced from 5.8 to 3.7 days in the postintervention school year. School nurse screening, CM, and collaboration with a medical provider resulted in early identification, referral, and subsequent treatment of students at risk for asthma and may have contributed to reduced illness absences.

Indicated Prevention of Fetal Alcohol Spectrum Disorders in South Africa: Effectiveness of Case Management

PubMed Central

de Vries, Marlene M.; Joubert, Belinda; Cloete, Marise; Roux, Sumien; Baca, Beth A.; Hasken, Julie M.; Barnard, Ronel; Buckley, David; Kalberg, Wendy O.; Snell, Cudore L.; Marais, Anna-Susan; Seedat, Soraya; Parry, Charles D. H.; May, Philip A.

2015-01-01

In the Western Cape Province of South Africa (ZA) a subculture of binge drinking produces the highest global documented prevalence of fetal alcohol spectrum disorders (FASD). FASD prevention research activities in ZA use the Comprehensive Prevention approach from the United States Institute of Medicine. Case management (CM) was delivered as a method of indicated prevention to empower heavy drinking pregnant women to achieve cessation or a reduction in drinking. CM activities incorporated life management, Motivational Interviewing (MI) techniques and the Community Reinforcement Approach (CRA). Data were collected at baseline, 6, 12 and 18 months. Mean drinking decreases 6 months into CM; but overall alcohol consumption rose significantly over time to levels higher than baseline at 12 and 18 months. Alcohol consumption drops significantly from before pregnancy to the second and third trimesters. AUDIT scores indicate that problematic drinking decreases significantly even after the vulnerable fetus/baby was born. CM significantly increases client happiness, which correlates with reduced weekend drinking. CM was successful for women with high-risk drinking behaviour, and was effective in helping women stop drinking, or drink less, while pregnant, reducing the risk of FASD. PMID:26703708

General RMP Guidance - Chapter 7: Prevention Program (Program 3)

EPA Pesticide Factsheets

Many Program 3 processes are already addressed by the OSHA Process Safety Management Program, which covers on-site consequences. So for compliance with the risk management program, process hazard analysis teams must consider potential offsite consequences.

Long-term monitoring of streambed sedimentation and scour in a dynamic stream based on streambed temperature time series.

PubMed

Sebok, Eva; Engesgaard, Peter; Duque, Carlos

2017-08-24

This study presented the monitoring and quantification of streambed sedimentation and scour in a stream with dynamically changing streambed based on measured phase and amplitude of the diurnal signal of sediment temperature time series. With the applied method, changes in streambed elevation were estimated on a sub-daily scale with 2-h intervals without continuous maintenance of the measurement system, thus making both high temporal resolution and long-term monitoring of streambed elevations possible. Estimates of streambed elevation showed that during base flow conditions streambed elevation fluctuates by 2-3 cm. Following high stream stages, scouring of 2-5 cm can be observed even at areas with low stream flow and weak currents. Our results demonstrate that weather variability can induce significant changes in the stream water and consequently sediment temperatures influencing the diurnal temperature signal in such an extent that the sediment thickness between paired temperature sensors were overestimated by up to 8 cm. These observations have significant consequences on the design of vertical sensor spacing in high-flux environments and in climates with reduced diurnal variations in air temperature.

Contrast Media Viscosity versus Osmolality in Kidney Injury: Lessons from Animal Studies

PubMed Central

Seeliger, Erdmann; Lenhard, Diana C.; Persson, Pontus B.

2014-01-01

Iodinated contrast media (CM) can induce acute kidney injury (AKI). CM share common iodine-related cytotoxic features but differ considerably with regard to osmolality and viscosity. Meta-analyses of clinical trials generally failed to reveal renal safety differences of modern CM with regard to these physicochemical properties. While most trials' reliance on serum creatinine as outcome measure contributes to this lack of clinical evidence, it largely relies on the nature of prospective clinical trials: effective prophylaxis by ample hydration must be employed. In everyday life, patients are often not well hydrated; here we lack clinical data. However, preclinical studies that directly measured glomerular filtration rate, intrarenal perfusion and oxygenation, and various markers of AKI have shown that the viscosity of CM is of vast importance. In the renal tubules, CM become enriched, as water is reabsorbed, but CM are not. In consequence, tubular fluid viscosity increases exponentially. This hinders glomerular filtration and tubular flow and, thereby, prolongs intrarenal retention of cytotoxic CM. Renal cells become injured, which triggers hypoperfusion and hypoxia, finally leading to AKI. Comparisons between modern CM reveal that moderately elevated osmolality has a renoprotective effect, in particular, in the dehydrated state, because it prevents excessive tubular fluid viscosity. PMID:24707482

Consequence Maps: A Novel Behavior Management Tool for Educators

ERIC Educational Resources Information Center

Tobin, Catherine E.; Simpson, Richard

2012-01-01

Behavior management remains one of the most significant challenges faced by classroom personnel. One relatively novel and promising management approach involves the use of "Consequence Maps". In this article we discuss the use of this method, including its application and evaluation. A case study of a six-year-old boy in a self-contained special…

North Korean Paradoxes. Circumstances, Costs, and Consequences of Korean Unification

DTIC Science & Technology

2005-01-01

consequences of Korean unification / Charles Wolf, Jr., Kamil Akramov. p. cm. "MG-333." Includes bibliographical references. ISBN 0-8330-3762-5 (pbk. : alk ...Institute of Technology NBER National Bureau for Economic Research OECD Organization for Economic Cooperation and Develoment OSD Office of the Secretary of...opment ( OECD ) with a per capita income over $10,000 and the other a "lights-out" but nuclear-capable dynastic state-is the riddle; how to link economic

First, keep it safe: Integration of a complementary medicine service within a hospital.

PubMed

Schiff, Elad; Levy, Ilana; Arnon, Zahi; Ben-Arye, Eran; Attias, Samuel

2018-05-01

This paper sought to explore risk/safety considerations associated with the integration of a complementary medicine (CM) service within a public academic medical centre in Israel. We reviewed various sources pertaining to the CM service (interviews with CM staff, patients' electronic charts, service guidelines, correspondence with hospital administration) and conducted a thematic analysis to evaluate safety-related incidents during the 7 years of operation. In addition, we systematically assessed the charts for reports of treatment-associated adverse effects, which were documented in an obligatory field on treatment reports. After reviewing transcripts of interviews with 12 CM practitioners and with the director and vice-director of the CM service as well as transcripts of 8560 consultations that included 7383 treatments, we categorised 3 major domains of CM safety management: (i) prevention of safety-related incidents by appropriate selection of CM practitioners and modalities, (ii) actual adverse incidents and (iii) prevention of their recurrence using both hospital and CM service safety protocols. CM staff reported 5 categories of adverse incidents, most of which were minor. Twenty-nine adverse incidents were documented in the 7383 treatment sessions (0.4%). Safety management needs to be addressed both before introducing CM services in hospitals and throughout their integration. Important considerations for the safe integration of CM practices in the hospital include communication between CM and conventional practitioners, adherence to hospital safety rules, implementing a systematic approach for detecting and reporting safety-related incidents and continuous adaptation of the CM service safety protocols. © 2018 John Wiley & Sons Ltd.

Mitral valve resistance determines hemodynamic consequences of severe rheumatic mitral stenosis and immediate outcomes of percutaneous valvuloplasty.

PubMed

Sanati, Hamidreza; Zolfaghari, Reza; Samiei, Niloufar; Rezaei, Yousef; Chitsazan, Mitra; Zahedmehr, Ali; Shakerian, Farshad; Kiani, Reza; Firouzi, Ata; Rezaei Tabrizi, Reza

2017-02-01

The mitral valve area (MVA) poorly reflects the hemodynamic status of (MS). In this study, we compared the MVA with mitral valve resistance (MVR) with regard to the determination of hemodynamic consequences of MS and the immediate outcomes of percutaneous balloon mitral valvuloplasty (PBMV). In a prospective study, 36 patients with severe rheumatic MS with left ventricular ejection fraction (LVEF) >50% were evaluated. They underwent transthoracic echocardiography (TTE) and catheterization. The MVA was measured by two-dimensional planimetry and pressure half-time (PHT), and the MVR was calculated using the equation: 1333 × transmitral pressure gradient mean transmitral diastolic flow rate. The patients' mean age was 47.8±10.5 years. MVR ≥140.6 dynes·s/cm 5 detected systolic pulmonary arterial pressure (sPAP) >55 mm Hg with a sensitivity of 100% and a specificity of 74%. The sensitivity and specificity of MVA<0.75 cm 2 to discriminate elevated sPAP were 81% and 89%, respectively. PHT ≥323.5 mseconds had a sensitivity of 78% and a specificity of 96% to detect an elevated sPAP. To predict a successful PBMV, preprocedural MVR ≥106.1 dynes·s/cm 5 had a sensitivity of 100% and a specificity of 67% (area under the curve [AUC]=0.763; 95% confidence interval [CI]=0.520-1.006; P=.034); preprocedural MVA <0.95 cm 2 had a sensitivity of 78% and a specificity of 73% (AUC=0.730; 95% CI=0.503-0.956; P=.065); and preprocedural PHT ≥210.5 mseconds had a sensitivity of 73% and a specificity of 78% (AUC=0.707; 95% CI=0.474-0.941; P=.095). MVR seems to be more accurate than MVA in determining the hemodynamic consequences of severe MS as determined by sPAP. In addition, preprocedural MVR detected successful PBMVs. © 2017, Wiley Periodicals, Inc.

Randomized Trial Comparing Two Treatment Strategies Using Prize-Based Reinforcement of Abstinence in Cocaine and Opiate Users

ERIC Educational Resources Information Center

Preston, Kenzie L.; Ghitza, Udi E.; Schmittner, John P.; Schroeder, Jennifer R.; Epstein, David H.

2008-01-01

We compared two strategies of prize-based contingency management (CM) in methadone-maintained outpatients. Urine was tested thrice weekly for 5 weeks pre-CM, 12 weeks CM, and 8 weeks post-CM. Participants were randomly assigned to a cocaine contingency (four prize draws for each cocaine-negative urine, N = 29) or an opiate-cocaine contingency (one…

Surgical management of pediatric urolithiasis

PubMed Central

Mishra, Shashi K.; Ganpule, A.; Manohar, T.; Desai, Mahesh R.

2007-01-01

Pediatric urolithiasis poses a technical challenge to the urologist. A review of the recent literature on the subject was performed to highlight the various treatment modalities in the management of pediatric stones. A Medline search was used to identify manuscripts dealing with management options such as percutaneous nephrolithotomy, shock wave lithotripsy, ureteroscopy and cystolithotripsy in pediatric stone diseases. We also share our experience on the subject. Shock wave lithotripsy should be the treatment modality for renal stone less than 1cm or < 150 mm2 and proximal non-impacted ureteric stone less than 1 cm with normal renal function, no infection and favorable anatomy. Indications for PCNL in children are large burden stone more than 2cm or more than 150mm2 with or without hydronephrosis, urosepsis and renal insufficiency, more than 1cm impacted upper ureteric stone, failure of SWL and significant volume of residual stones after open surgery. Shock wave lithotripsy can be offered for more soft (< 900 HU on CT scan) renal stones between 1-2cm. Primary vesical stone more than 1cm can be tackled with percutaneous cystolithomy or open cystolithotomy. Open renal stone surgery can be done for renal stones with associated structural abnormalities, large burden infective and staghorn stones, large impacted proximal ureteric stone. The role of laparoscopic surgery for stone disease in children still needs to be explored. PMID:19718300

Early Postoperative FDG-PET-CT Imaging Results in a Relevant Upstaging in the pN2 Subgroup of Stage III Colorectal Cancer Patients.

PubMed

Fehr, Martin; Müller, Joachim; Knitel, Meinhard; Fornaro, Jürgen; Horber, Daniel; Koeberle, Dieter; Cerny, Thomas; Güller, Ulrich

2017-12-01

Clinical practice guidelines regarding follow-up in patients after curative resection of colorectal cancer (CRC) vary widely. Current follow-up recommendations do not include additional postoperative imaging before starting adjuvant treatment in any patients. We evaluated the potential benefit of our institutional approach, recommending 18 fluor-deoxy-glucose (FDG)-positron emission tomography (PET)-computed tomography (CT) imaging in CRC stage III patients with ≥4 locoregional lymph node metastases (pN2). Our study included all patients from a single center with complete resection of a pT1-4, pN2, cM0 CRC. All patients were considered free of distant metastases on the basis of preoperative CT imaging of the chest, abdomen, and pelvis. The main objective of the present study was to assess the proportion of patients with changes of therapeutic management (defined as any other treatment than the preplanned adjuvant chemotherapy) because of the results of additional postoperative FDG-PET-CT imaging. Fifty patients (22 female/28 male) were included; the median age was 64 years (range, 37-78 years). Previously undiagnosed metastatic disease resulting in a change of the therapeutic management was detected using postoperative FDG-PET-CT imaging in 7 patients (14.0%; 95% confidence interval, 5.8%-26.7%). The number needed to screen to detect new or previously occult metastases was 7 (7 of 50). To our knowledge, this is the first study to evaluate the role of an additional postoperative FDG-PET-CT scan before adjuvant treatment in patients with completely resected CRC with ≥4 lymph node metastases (pT1-4, pN2) and without distant metastases on preoperative CT imaging (cM0). Postoperative FDG-PET-CT imaging represents a valuable tool for the detection of new macrometastases in the subgroup of pN2 cM0 CRC patients. The low number needed to screen for consequent therapeutic changes is clinically relevant and should be further evaluated. Copyright © 2017 Elsevier Inc. All rights reserved.

Patient-Physician Discordance in Global Assessment in Rheumatoid Arthritis: A Systematic Literature Review With Meta-Analysis.

PubMed

Desthieux, Carole; Hermet, Aurore; Granger, Benjamin; Fautrel, Bruno; Gossec, Laure

2016-12-01

The integration of the patient in therapeutic decision-making is important in the management of rheumatoid arthritis (RA), but the patient opinion regarding disease status may differ from the physician's opinion. The aim of this study was to assess in the published literature the frequency and drivers of patient-physician discordance in global assessment in RA. A systematic literature review of all articles published up to January 2015 in Medline or Embase, reporting discordance in RA, was conducted by 2 investigators. Discordance was defined based on the absolute difference of patient global (PGA) and physician global assessments (PhGA) on 0-10-cm scales. The frequency of discordance and its predictors were collected in each study. Frequencies of discordance were pooled by meta-analysis using random effect. In all, 12 studies were selected (i.e., 11,879 patients): weighted mean ± SD age was 55.1 ± 13.9 years, weighted mean ± SD disease duration was 10.4 ± 9.3 years, and 80.7% were women. The value of the difference |PGA - PhGA| defining discordance varied between ≥0.5 cm (n = 2 studies) to ≥3 cm (n = 5 studies); the weighted mean value was 2.7 cm. The pooled percentage of patients with discordance was 43% (95% confidence interval 36%-51%; range 25%-76%). PGA was usually higher than PhGA. The drivers of PGA were pain and functional incapacity, whereas drivers of PhGA were joint counts and acute-phase reactants. Discordance in global assessment was most frequently defined as a difference of 3 points or more; even with such a stringent definition, up to half the patients were found to be discordant. The long-term consequences of this discordance remain to be determined. © 2016, American College of Rheumatology.

Obesometric factors associated with increased skin-to-stone distances in renal stone patients.

PubMed

Allard, Christopher B; Shuster, Anatoly; Pinthus, Jehonathan H; Farrokhyar, Forough; Raees, A; Patlas, Michael; Matsumoto, Edward D; Whelan, J Paul

2012-12-01

Obese patients are at increased risk for renal stones as well as treatment failures due to increased skin-to-stone distances (SSD) and harder stone compositions. We investigated the relationships between obesometric parameters (body mass index [BMI], body fat distribution and obesity-related hormone levels) with SSD and stone hardness. We prospectively enrolled patients undergoing stone interventions at our institution. Computed tomography (CT) scans were analyzed; adipose tissue was identified according to Hounsfield units (HU) and separated into subcutaneous (SAT) and visceral (VAT) components. The pixels were averaged at three levels to calculate fat distribution: %VAT = (VAT)/(VAT + SAT). SSD was measured and HU were used as a surrogate for stone hardness. Obesity-related hormones leptin and adiponectin were measured by ELISA. Seventy-nine patients were prospectively enrolled. Mean BMI and %VAT were 30.02 kg/m2 and 40.13 kg/m2. Mean leptin and adiponectin levels were 17.5 ng/mL and 7.67 mcg/mL indicating high risk for metabolic consequences of obesity. Females had greater proportions of subcutaneous fat than males (%VAT 28.4 versus 46.94, p < 0.001) and greater SSD (11.26 cm versus 9.86 cm, p = 0.025). Among obese patients, subcutaneous fat correlated with SSD independently of BMI (r = 0.454, p = 0.008). Obese patients with %VAT > 40 versus < 40 had SSD of 11.35 cm versus 13.7 cm (p = 0.005). Diabetics had harder stone compositions as measured by HU than non-diabetics (982.86 versus 648.86, p = 0.001). Obesometric parameters such as BMI, body fat distribution, and the presence of diabetes mellitus are important considerations in the management of renal stone disease. A large proportion of subcutaneous fat, which can be estimated by physical examination, predicts SSD among obese patients and may aid treatment decisions in patients, particularly those without pre-treatment CT scans. Further studies are needed to refine the role of obesometrics in personalizing treatment decisions.

Effects of Different Tillage and Straw Return on Soil Organic Carbon in a Rice-Wheat Rotation System

PubMed Central

Zhu, Liqun; Hu, Naijuan; Yang, Minfang; Zhan, Xinhua; Zhang, Zhengwen

2014-01-01

Soil management practices, such as tillage method or straw return, could alter soil organic carbon (C) contents. However, the effects of tillage method or straw return on soil organic C (SOC) have showed inconsistent results in different soil/climate/cropping systems. The Yangtze River Delta of China is the main production region of rice and wheat, and rice-wheat rotation is the most important cropping system in this region. However, few studies in this region have been conducted to assess the effects of different tillage methods combined with straw return on soil labile C fractions in the rice-wheat rotation system. In this study, a field experiment was used to evaluate the effects of different tillage methods, straw return and their interaction on soil total organic C (TOC) and labile organic C fractions at three soil depths (0–7, 7–14 and 14–21 cm) for a rice-wheat rotation in Yangzhong of the Yangtze River Delta of China. Soil TOC, easily oxidizable C (EOC), dissolved organic C (DOC) and microbial biomass C (MBC) contents were measured in this study. Soil TOC and labile organic C fractions contents were significantly affected by straw returns, and were higher under straw return treatments than non-straw return at three depths. At 0–7 cm depth, soil MBC was significantly higher under plowing tillage than rotary tillage, but EOC was just opposite. Rotary tillage had significantly higher soil TOC than plowing tillage at 7–14 cm depth. However, at 14–21 cm depth, TOC, DOC and MBC were significantly higher under plowing tillage than rotary tillage except for EOC. Consequently, under short-term condition, rice and wheat straw both return in rice-wheat rotation system could increase SOC content and improve soil quality in the Yangtze River Delta. PMID:24586434

Consequence of oxidant concentration on XPS properties of chemically synthesized polythiophene thin films

NASA Astrophysics Data System (ADS)

Kamat, Sandip V.; Chhabra, Jasvinder; Patil, V. S.; Yadav, J. B.; Puri, R. K.; Puri, Vijaya

2018-05-01

The polythiophene thin films were prepared by a wellknown chemical bath deposition technique. The deposited thin films were characterized for structural morphological properties and the adhesion of these thin films were measured by direct pull off (DPO) method, the effect of oxidant concentration on these thin films also studied. The FTIR spectra of chemically deposited polythiophene thin films shows the absorption peak at 836 cm-1 which represents c-s stretching vibrations, shifts to 869 cm-1 as the oxidant concentration increases. The band at 666 cm-1 representing c-s-c ring deformation becomes sharper and appears with a shoulder peak due to increase in oxidant concentration.

Cost-effective way to reduce stimulant-abuse among gay/bisexual men and transgender women: a randomized clinical trial with a cost comparison.

PubMed

Zhang, S X; Shoptaw, S; Reback, C J; Yadav, K; Nyamathi, A M

2018-01-01

A randomized controlled study was conducted with 422 homeless, stimulant-using gay/bisexual (G/B) men and 29 transgender women (n = 451) to assess two community-based interventions to reduce substance abuse and improve health: (a) a nurse case-managed program combined with contingency management (NCM + CM) versus (b) standard education plus contingency management (SE + CM). Hypotheses tested included: a) completion of hepatitis A/B vaccination series; b) reduction in stimulant use; and c) reduction in number of sexual partners. A deconstructive cost analysis approach was utilized to capture direct costs associated with the delivery of both interventions. Based on an analysis of activity logs and staff interviews, specific activities and the time required to complete each were analyzed as follows: a) NCM + CM only; b) SE + CM only; c) time to administer/record vaccines; and d) time to receive and record CM visits. Cost comparison of the interventions included only staffing costs and direct cash expenditures. The study outcomes showed significant over time reductions in all measures of drug use and multiple sex partners, compared to baseline, although no significant between-group differences were detected. Cost analysis favored the simpler SE + CM intervention over the more labor-intensive NCM + CM approach. Because of the high levels of staffing required for the NCM relative to SE, costs associated with it were significantly higher. Findings suggest that while both intervention strategies were equally effective in achieving desired health outcomes, the brief SE + CM appeared less expensive to deliver. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Mapping of accumulated nitrogen in the sediment pore water of a eutrophic lake in Iowa, USA

USGS Publications Warehouse

Iqbal, M.Z.; Fields, C.L.

2009-01-01

A large pool of nitrogen in the sediment pore fluid of a eutrophic lake in Iowa, USA, was mapped in this study. Previously, the lake had supported fishing and boating, but today it no longer supports its designated uses as a recreational water body. In the top 5 cm of the lake bottom, the pore water nitrogen ranges between 3.1 and 1,250 ??g/cm3 of sediments, with an average of 160.3 ??g/cm3. Vertically, nitrate concentrations were measured as 153 ??g/cm3 at 0-10 cm, 162 ??g/cm3 at 10-20 cm, and 32 ??g/cm3 at 20-30 cm. Nitrate mass distribution was quantified as 3.67 ?? 103 kg (65%) in the bottom sediments, 172 kg (3%) in suspended particulates, and 1.83 ?? 103 kg (32%) in the dissolved phase. Soil runoff nutrients arrive at the lake from the heavily fertilized lands in the watershed. Upon sedimentation, a large mass of nitrogen desorbs from mineral particles to the relatively immobile pore fluid. Under favorable conditions, this nitrogen diffuses back into the water column, thereby dramatically limiting the lake's capability to process incoming nutrients from farmlands. Consequently, a condition of oxygen deficiency disrupts the post-season biological activities in the lake. ?? 2008 Springer-Verlag.

[Study on incorporation of "management and guidance of home-visiting by a pharmacist" into a care plan -observation based on a survey of care managers-].

PubMed

Nanaumi, Yoko; Onda, Mitsuko; Sakurai, Hidehiko; Tanaka, Rie; Tsubota, Kenichi; Matoba, Shunya; Mukai, Yusuke; Arakawa, Yukio; Hayase, Yukitoshi

2010-11-01

A survey of care managers ("CMs") was conducted to identify top priority issues in promoting the management and guidance of home-visiting by a pharmacist ("management and guidance") by focusing on the experience in incorporating the management and guidance into a care plan and its relevant factors. Major survey items included (1) number of years working as a CM, (2) basic occupation, (3) experience in incorporating the management and guidance into care plans, (4) understanding the management and guidance content, and (5) an awareness of the need for pharmacists' involvement in care plans. A χ² test was conducted to determine if the experience in incorporating the management and guidance into care plans caused a difference in the distribution of the number of years as a CM, the basic occupation, understanding of the management and guidance content, and an awareness of the need for pharmacists' involvement in care plans. A regression analysis was conducted to determine the degree of association between the incorporation experience and each item. The numbers of years working as a CM, the basic occupation, understanding of the management and guidance content, and an awareness of the need for pharmacists' involvement in care plans, were found to be associated with the experience in incorporating the management and guidance into care plans. Understanding of the management and guidance content was most closely associated. To promote pharmacists' management and guidance for home-based care, CMs need to deepen their understanding of this service.

An Effectiveness Trial of Contingency Management in a Felony Preadjudication Drug Court

PubMed Central

Marlowe, Douglas B; Festinger, David S; Dugosh, Karen L; Arabia, Patricia L; Kirby, Kimberly C

2008-01-01

This study evaluated a contingency management (CM) program in a drug court. Gift certificates for compliance were delivered at 4- to 6-week intervals (total value  =  $390.00). Participants in one condition earned gift certificates that escalated by $5.00 increments. Participants in a second condition began earning higher magnitude gift certificates, and the density of reinforcement was gradually decreased. No main effects of CM were detected, which appears to be attributable to a ceiling effect from the intensive contingencies already delivered in the drug court and the low density of reinforcement. Preplanned interaction analyses suggested that participants with more serious criminal backgrounds might have performed better in the CM conditions. This suggests that CM programs may be best suited for more incorrigible drug offenders. PMID:19192860

Management and diagnosis of gallbladder polyps: a systematic review.

PubMed

Babu, Benoy I; Dennison, Ashley R; Garcea, Giuseppe

2015-05-01

Recommendation for management of gallbladder polyps (GBPs) >1 cm is cholecystectomy. No consensus exists on management of GBPs <1 cm. This systematic review examines current evidence on management of GBPs. MEDLINE, EMBASE and Cochrane library databases were searched from January 1991 to June 2013 using specified terms. A predefined protocol for data extraction was used to retrieve specified end points. Literature search yielded 43 manuscripts with a dataset of 11,685 patients with GBPs. M:F ratio was 1.3:1. Average age (range) was 49 years (32-83). Patients with malignant GBPs had an average (range) age of 58 (50-66) years with M:F ratio of 0.78:1. Cholesterol polyps constituted 60.5% of GBPs followed by adenomas (15.2%) and cancer (11.6%). Malignant GBPs ≥1 cm, <1 cm and <5 mm constituted 8.5, 1.2 and 0% of GBPs, respectively. Majority of patients requiring surgical intervention had laparoscopic cholecystectomy. Presently employed policy of cholecystectomy for GBPs >1 cm is appropriate. For GBPs <1 cm, the authors propose (accepting existence of differing proposals) the following: 1. Surveillance may not be needed for GBPs <5 mm. 2. For GBPs between 5 and 10 mm, two scans at six monthly intervals is suggested and after that, tailor surveillance to age, growth and ethnicity. In the non-Asian population, if GBP remains the same size or number, discontinuation of surveillance may be considered. In the Asian population, if GBPs remain the same, yearly surveillance is continued for a suggested period of 3 years. 3. Discontinue surveillance if GBPs is/are smaller/ disappeared. Cholecystectomy is advised where size increases to >10 mm.

Reduction of stand density as a management tool to mitigate the effect of drought

NASA Astrophysics Data System (ADS)

Giuggiola, A.; Rigling, A.; Dobbertin, M.

2012-04-01

An increasing frequency and severity of drought combined with increased competition due to reduced forest management practices are putting many Scots pine forest (Pinus sylvestris) under increased drought pressure. Declining pines are already been observed in many drought exposed regions as in southern Europe or in the dry inner Alpine valleys. Thus, forest management practices oriented at reducing competition for water should increase pines tolerance to climate change and thus enhancing their long-term mitigation potential. In this study, we are testing the beneficial effect of thinning and understory removal as possible management practices. As a first study object we selected a trial with 3 thinning intensities (basal area reduction of 15%, 46% and 70%) and one control (unmanaged forest). The second experiment consisted in removing the understory layer in a radius of 5 meter from 6 mature pine trees. Water-related indicators, such as soil water content, sapflow, point dendrometer and ring width measurements over the growing season were then compared with control trees. Both objects belongs to the pine forests from the dry Rhone valley. Our results indicates that over the 10 years following the thinning performed in 1965 (when the stand was 45 years old) doubled and quadrupled the basal area increment in the medium and heavy treatments compared to the control. The annual mortality rates for the period 1978-1990 ranged between 2.9% for the control and 0.8% for the heavy thinned stand. An increasing mortality rates during the period 1991-2009 (up to 3.3%), with consequent decline in basal area and carbon sequestration, has been observed in relation to high remaining stand density. The removal of understory performed in April 2010 increased soil water content at 30 cm and 65 cm depth reducing trees drought stress. The transpiration and the predawn leaf water potential of overstory trees were higher in the trees with removal of the understory vegetation. The same trees also showed delayed stomata closure during drought periods. This advantage eventually resulted in a significant increase in tree growth, which was observed in the second year after removal. This combining approach highlight the positive effect of competition removal of growth and vitality of Scots pine trees. Our results suggest that in dry forests of the inner-Alps or the Mediterranean region, a strong reduction of basal area (15-25 m2/ha) is suitable to preserve enough water availability to maintain and healthy state. If thinning lead to a major increase of the understory layer, understory removal would prolong the initial positive effect of thinning. Thinning and understory removal enhance tree vitality and increase tree resistance against drought, insects and pathogens. These results simultaneously suggests that pine decline is not driven only by the increase of temperature, but is also a consequence of a change of forest use, specifically for the Valais, to a reduction of goat grazing pressure and wood harvesting.

Prevention of primary caesarean delivery: comprehensive management of dystocia in nulliparous patients at term.

PubMed

Ragusa, Antonio; Gizzo, Salvatore; Noventa, Marco; Ferrazzi, Enrico; Deiana, Sara; Svelato, Alessandro

2016-10-01

Dystocia is the leading indication for primary caesarean sections. Our aim is to compare two approaches in the management of dystocia in labor in nulliparous women with a singleton fetus in cephalic presentation at term in spontaneous or induced labor. Prospective cohort study. Four hundred and nineteen consecutive patients were divided into two groups: the standard management group (SM), in acceleration of labor was commenced at the "action line" in the case of arrested or protracted labor, and the comprehensive management group (CM) in which arrested or protracted labor was considered as a warning sign promoting further diagnostic assessment prior to considering intervention. Caesarean sections rate was 22.2 % in the SM group (216 patients) and 10.3 % in the CM group (203 patients) (p = 0.001). The rate of oxytocin use decreased from 33.3 % in SM group to 13.8 % in the CM group (p < 0.0005). The rate of amniotomy decreased from 41.7 % in the SM group to 7.4 % in the CM group (p < 0.0005). The percentage of newborns with 5-min Apgar score <7 and/or umbilical cord arterial pH ≤ 7.00 decreased from 2.3 % in SM cohort to 0.5 % in CM cohort (p = ns). The average length of labor did not differ between the two groups of patients (264 vs 277 min; p = ns). Comprehensive management of dystocia enabled us to achieve a reduction in iatrogenic interventions in labor while maintaining good neonatal outcomes.

Is Exposure to an Effective Contingency Management Intervention Associated with More Positive Provider Beliefs?

PubMed Central

Kirby, Kimberly C.; Carpenedo, Carolyn M.; Stitzer, Maxine L.; Dugosh, Karen L.; Petry, Nancy M.; Roll, John M.; Saladin, Michael E.; Cohen, Allan J.; Hamilton, John; Reese, Karen; Sillo, Gina R.; Stabile, Patricia Quinn; Sterling, Robert C.

2011-01-01

This study empirically examined opinions of treatment providers regarding Contingency Management (CM) programs while controlling for experience with a specific efficacious CM program. In addition to empirically describing provider opinions, we examined whether the opinions of providers at the sites that implemented the CM program were more positive than those of matched providers at sites that did not implement it. Participants from 7 CM treatment sites (n = 76) and 7 matched non-participating sites (n = 69) within the same nodes of NIDA's Clinical Trials Network completed the Provider Survey of Incentives (PSI), which assesses positive and negative beliefs about incentive programs. An intent-to-treat analysis found no differences in the PSI summary scores of providers in CM program vs. matched sites, but correcting for experience with tangible incentives showed significant differences, with providers from CM sites reporting more positive opinions than those from matched sites. Some differences were found in opinions regarding costs of incentives and these generally indicated that participants from CM sites were more likely to see the costs as worthwhile. The results from the study suggest that exposing community treatment providers to incentive programs may itself be an effective strategy in prompting the dissemination of CM interventions. PMID:22116009

A randomized placebo-blind study of the effect of low power laser on pain caused by irreversible pulpitis.

PubMed

Ramalho, Karen Müller; de Souza, Lárissa Marcondes Paladini; Tortamano, Isabel Peixoto; Adde, Carlos Alberto; Rocha, Rodney Garcia; de Paula Eduardo, Carlos

2016-12-01

This randomized placebo-blind study aimed to evaluate the effect of laser phototherapy (LPT) on pain caused by symptomatic irreversible pulpitis (SIP). Sixty patients diagnosed with SIP were randomly assigned to treatment groups (n = 15): G1 (control), G2 (laser placebo-sham irradiation), G3 (laser irradiation at 780 nm, 40 mW, 4 J/cm 2 ), and G4 (laser irradiation at 780 nm, 40 mW, 40 J/cm 2 ). Spontaneous pain was recorded using a VAS score before (T0), immediately after (T1), and 15 min after treatment (T2). Local anesthetics failure during emergency endodontic treatment was also assessed. There was no pain difference in T1 and T2 between the experimental laser groups (G3 and G4) and the placebo group (G2). The 4-J/cm 2 (G3) irradiation resulted in significant increase in the local anesthetics failure in lower jar teeth. This effect could be suggested as consequence of the LPT improvement in local circulation and vasodilatation that would result in the increase of local anesthetic agent absorption. The application of 780-nm diode laser irradiation, at 4 and 40 J/cm 2 , showed no effect in reducing the pain in SIP in comparison to the placebo group. The fluence of 4 J/cm 2 showed a negative effect in local anesthetics, resulting in significant increase of complimentary local anesthesia during emergency endodontic treatment. This work provides evidence of the consequence of LPT application on teeth with symptomatic irreversible pulpitis. LPT should be avoided in teeth with pain due to irreversible pulpitis.

Group-Based Randomized Trial of Contingencies for Health and Abstinence in HIV Patients

ERIC Educational Resources Information Center

Petry, Nancy M.; Weinstock, Jeremiah; Alessi, Sheila M.; Lewis, Marilyn W.; Dieckhaus, Kevin

2010-01-01

Objective: Contingency management (CM) treatments are usually applied individually for drug abstinence, but CM can also be targeted toward health behaviors and implemented in groups. This study evaluated effects of a group-based CM intervention that focused on reinforcing health behaviors. Method: HIV-positive patients with cocaine or opioid use…

Transport and fate of methyl iodide a its pest control in soils

USDA-ARS?s Scientific Manuscript database

For fumigants, information on transport and fate, as well as pest control, is needed to develop management practices with the fewest human and environmental health risks while offering sufficient pest control efficacy. For this purpose, a 2-D soil chamber (60 cm wide, 60 cm long, and 6 cm thick) wit...

Ground Systems Development Environment (GSDE) software configuration management

NASA Technical Reports Server (NTRS)

Church, Victor E.; Long, D.; Hartenstein, Ray; Perez-Davila, Alfredo

1992-01-01

This report presents a review of the software configuration management (CM) plans developed for the Space Station Training Facility (SSTF) and the Space Station Control Center. The scope of the CM assessed in this report is the Systems Integration and Testing Phase of the Ground Systems development life cycle. This is the period following coding and unit test and preceding delivery to operational use. This report is one of a series from a study of the interfaces among the Ground Systems Development Environment (GSDE), the development systems for the SSTF and the SSCC, and the target systems for SSCC and SSTF. This is the last report in the series. The focus of this report is on the CM plans developed by the contractors for the Mission Systems Contract (MSC) and the Training Systems Contract (TSC). CM requirements are summarized and described in terms of operational software development. The software workflows proposed in the TSC and MSC plans are reviewed in this context, and evaluated against the CM requirements defined in earlier study reports. Recommendations are made to improve the effectiveness of CM while minimizing its impact on the developers.

Using a randomized controlled trial to test whether modifications to contingency management improve outcomes for heavy drinkers with serious mental illness.

PubMed

Oluwoye, Oladunni; Skalisky, Jordan; Burduli, Ekaterina; Chaytor, Naomi S; McPherson, Sterling; Murphy, Sean M; Herron, Jalene; Hirchak, Katherine; Burley, Mason; Ries, Richard K; Roll, John M; McDonell, Michael G

2018-06-01

In contingency management (CM), individuals receive rewards for alcohol abstinence. CM is associated with reduced alcohol use in adults with co-occurring serious mental illnesses (SMI). Pre-treatment urine ethyl glucuronide (uEtG) levels equivalent to daily heavy drinking (uEtG >349ng/mL) are associated with poor response to CM. Modifications to CM are needed to improve outcomes for non-responders. To determine if pre-treatment heavy drinkers, defined by uEtG, with SMI achieve higher levels of alcohol abstinence when they receive an increased magnitude of reinforcement for abstinence (High-Magnitude CM) or reinforcers for reduced drinking, prior to receiving reinforcers for abstinence (Shaping CM), relative to those who receive typical low-magnitude abstinence based CM (Usual CM). Additionally, variables in the Addictions Neuroclinical Assessment model will be examined as treatment response moderators. Participants (N=400) will be recruited from two urban mental health organizations and complete a 4-week induction period where they will be reinforced for submitting samples for uEtG testing. Participants who attain a mean uEtG >349mg/mL will be randomized to receive either Usual CM, High-Magnitude CM, or Shaping CM for 16weeks. Differences in abstinence, assessed by uEtG, will be examined during treatment and during a 12-month follow-up. Measures of negative emotionality, alcohol reinforcer salience, and executive functioning will be gathered at study intake and used to predict treatment outcomes. This novel approach to CM will use an alcohol biomarker to identify those at risk for treatment non-response and determine if adaptations to CM might improve outcomes for this group. Copyright © 2018 Elsevier Inc. All rights reserved.

An overview of the catalog manager

NASA Technical Reports Server (NTRS)

Irani, Frederick M.

1986-01-01

The Catalog Manager (CM) is being used at the Goddard Space Flight Center in conjunction with the Land Analysis System (LAS) running under the Transportable Applications Executive (TAE). CM maintains a catalog of file names for all users of the LAS system. The catalog provides a cross-reference between TAE user file names and fully qualified host-file names. It also maintains information about the content and status of each file. A brief history of CM development is given and a description of naming conventions, catalog structure and file attributes, and archive/retrieve capabilities is presented. General user operation and the LAS user scenario are also discussed.

Contingency management: New directions and remaining challenges for an evidence-based intervention

PubMed Central

Rash, Carla J.; Stitzer, Maxine; Weinstock, Jeremiah

2016-01-01

This article introduces the special issue on contingency management (CM), an efficacious intervention for the treatment of substance use disorders with low uptake in clinical settings that is not commensurate with evidence for efficacy. In this special issue of the Journal of Substance Abuse Treatment, we present 16 articles representing the latest research in efficacy, implementation, and technological advances related to CM. Combined, this collection of articles highlights the diverse populations, settings, and applications of CM in the treatment of substance use disorders. We conclude by highlighting directions for future research, particularly those that may increase CM’s appeal and uptake in routine clinical care. PMID:27746057

Amount of earnings during prize contingency management treatment is associated with posttreatment abstinence outcomes.

PubMed

Petry, Nancy M; Roll, John M

2011-12-01

Contingency management (CM) treatments that provide patients with the opportunity to earn chances of winning prizes of varying magnitudes are becoming increasingly popular. In the CM literature, magnitude of reinforcement is linked with effect sizes, such that CM treatments that provide larger magnitude reinforcement are more efficacious than those that provide lower magnitude reinforcement. With prize CM, even when magnitudes of overall expected prize earnings are constant, some patients win more prizes than others. Thus, patients who win larger overall amounts of prizes during treatment may have better outcomes than those who win fewer prizes. This study evaluated the impact of overall amounts of prizes won on long-term abstinence outcomes. The dollar amount of prizes won during prize CM treatments was determined from 78 cocaine-abusing methadone-maintenance patients who were randomized to prize CM treatments in three clinical trials. Abstinence three months following the end of the CM intervention was the primary dependent variable. The dollar amount of prizes won during CM treatment was a significant predictor of submission of cocaine-negative urine samples and self-reports of cocaine abstinence at the follow-up evaluation, even after controlling for other variables associated with long-term abstinence, such as pretreatment urinalysis results and longest duration of abstinence achieved during treatment. These results suggest that magnitudes of earnings during prize CM may impact outcomes and call for further experimentation of parameters related to the efficacy of prize CM.

Management of Iatrogenic Pseudoaneurysms in Patients Undergoing Coronary Artery Bypass Grafting.

PubMed

Stone, Patrick A; Thompson, Stephanie N; Hanson, Brent; Masinter, David

2016-05-01

A plethora of papers have been written regarding postcatheterization femoral pseudoaneurysms. However, literature is lacking on pseudoaneurysmal management in patients undergoing coronary artery bypass grafting (CABG). Thus, we examined if pseudoaneurysms with subsequent CABG can be managed with the same strategies as those not exposed to the intense anticoagulation accompanying CABGs. During a 14-year study period, we retrospectively examined femoral iatrogenic pseudoaneurysms (IPSAs) diagnosed postheart catheterization in patients having a subsequent CABG. Patient information was obtained from electronic medical records and included pseudoaneurysm characteristics, treatment, and resolution. Outcomes of interest included the occurrence of IPSA treatment failures and complications. In the 66 patients (mean age, 66 ± 11 years, 46% male) meeting inclusion criteria, mean dose of heparin received during the CABG procedure was 34 000 ± 23 000 units. The IPSA size distribution was the following: 17% of IPSAs measured <1 cm, 55% between 1 and 3 cm, and 21% measured >3 cm. Pseudoaneurysms were managed with compression, duplex-guided thrombin injection, and surgical repair (1%, 27%, and 26% of cases, respectively). Thrombin injection and surgical repair were 100% effective at treating pseudoaneurysms, with 1 patient experiencing a surgical site infection postsurgical repair. Observation-only management was employed in 30 (45%) patients. Nine of 30 patients with no intervention beyond observation had duplex documented resolution/thrombosis during follow-up. One patient initially managed by observation required readmission and surgical repair of an enlarging pseudoaneurysm (6 cm growth) following CABG. Management of pseudoaneurysms in patients prior to CABG should be similar to those patients not undergoing intense anticoagulation. In appropriate cases, small aneurysms can be safely observed, while thrombin injections are effective and safe as well. Thus, routine open surgical repair is not routinely required in patients with femoral pseudoaneurysms at time of CABG. © The Author(s) 2016.

Outcomes after primary chemoradiotherapy for N3 (>6 cm) head and neck squamous cell carcinoma after an FDG-PET--guided neck management policy.

PubMed

Adams, Gerard; Porceddu, Sandro V; Pryor, David I; Panizza, Benedict; Foote, Matthew; Rowan, Ann; Burmeister, Bryan

2014-08-01

The purpose of this study was to assess whether a positron emission tomography (PET)-directed policy remains appropriate for managing neck nodes (N3; >6 cm) in head and neck squamous cell carcinoma (HNSCC). All patients with N3 (>6 cm) HNSCC treated with definitive chemoradiotherapy (CRT) at our institution between 2005 and 2012 were included in the analysis. Patients underwent PET assessment before and 12 weeks after CRT. Neck dissections were performed for PET-avid residual nodal abnormalities after complete response at the primary site. Rate of isolated nodal failure (INF) was the primary outcome. Median follow-up from diagnosis for 33 patients was 30 months (range, 6-76 months). INF occurred in 2 patients (6%) with neck dissections performed in 4 cases (12%). First failure was predominantly distant metastatic (10; 30%). The rate of INF remains low when following a PET-directed neck management policy after definitive CRT for N3 (>6 cm) HNSCC. Copyright © 2013 Wiley Periodicals, Inc.

Case management of individuals with long-term conditions by community matrons: report of qualitative findings of a mixed method evaluation.

PubMed

Randall, Sue; Daly, Guy; Thunhurst, Colin; Mills, Natalie; Guest, David A; Barker, Annette

2014-01-01

To consider findings from a study that evaluated case management of individuals with long-term conditions (LTCs) by a community matron (CM) service. The paper highlights issues related to the implementation of a new role and the impact this had on the experience of care across hospital and community settings for patients and their carers. The introduction of the role of CM was intended to increase effective management of patients with complex comorbid LTCs through the introduction of case management, thereby reducing unplanned hospital admissions. The overall methodological approach was one of mixed methods. This paper reports the qualitative findings from CMs (n = 15); patients (n = 13); family carers (n = 8); and secondary care staff who interface with the CM service (n = 7). Data were collected between October 2009 and May 2010. A thematic analysis resulted in the identification of four themes: (1) visibility; (2) interpersonal relationships; (3) leadership; and (4) systems/professional boundaries. Patients enjoyed being seen as a whole and family carers appreciated the coordination aspect of the role. Difficulties arose from the limited understanding of the CM role and from a lack of a shared vision across healthcare professionals concerning the role and its goals.

[Size structure, selectivity and specific composition of the catch in traps for marine fish in the Gulf of California].

PubMed

Nevárez-Martínez, Manuel O; Balmori-Ramírez, Alejandro; Miranda-Mier, Everardo; Santos-Molina, J Pablo; Méndez-Tenorio, Francisco J; Cervantes-Valle, Celio

2008-09-01

We analyzed the performance of three traps for marine fish between October 2005 and August 2006 in the Gulf of California, Mexico. The performance was measured as difference in selectivity, fish diversity, size structure and yield. The samples were collected with quadrangular traps 90 cm wide, 120 cm long and 50 cm high. Trap type 1 had a 5 x 5 cm mesh (type 2: 5 x 5 cm including a rear panel of 5 x 10 cm; trap 3: 5 x 10 cm). Most abundant in our traps were: Goldspotted sand bass (Paralabrax auroguttatus), Ocean whitefish (Caulolatilus princeps), Spotted sand bass (P. maculatofaciatus) and Bighead tilefish (C. affinis); there was no bycatch. The number offish per trap per haul decreased when mesh size was increased. We also observed a direct relationship between mesh size and average fish length. By comparing our traps with the authorized fishing gear (hooks-and-line) we found that the size structure is larger in traps. Traps with larger mesh size were more selective. Consequently, we recommend adding traps to hooks-and-line as authorized fishing gear in the small scale fisheries of the Sonora coast, Mexico.

Simulation of the consequences of different fire regimes to support wildland fire use decisions

Treesearch

Carol Miller

2007-01-01

The strategy known as wildland fire use, in which lightning-ignited fires are allowed to burn, is rapidly gaining momentum in the fire management community. Managers need to know the consequences of an increase in area burned that might result from an increase in wildland fire use. One concern of land managers as they consider implementing wildland fire use is whether...

5 CFR 250.103 - Consequences of improper agency actions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Consequences of improper agency actions. 250.103 Section 250.103 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERSONNEL MANAGEMENT IN AGENCIES Authority for Personnel Actions in Agencies § 250.103...

Fire Regime and Ecosystem Effects of Climate-driven Changes in Rocky Mountains Hydrology

NASA Astrophysics Data System (ADS)

Westerling, A. L.; Das, T.; Lubetkin, K.; Romme, W.; Ryan, M. G.; Smithwick, E. A.; Turner, M.

2009-12-01

Western US Forest managers face more wildfires than ever before, and it is increasingly imperative to anticipate the consequences of this trend. Large fires in the northern Rocky Mountains have increased in association with warmer temperatures, earlier snowmelt, and longer fire seasons (1), and this trend is likely to continue with global warming (2). Increased wildfire occurrence is already a concern shared by managers from many federal land-management agencies (3). However, new analyses for the western US suggest that future climate could diverge even more rapidly from past climate than previously suggested. Current model projections suggest end-of-century hydroclimatic conditions like those of 1988 (the year of the well-known Yellowstone Fires) may represent close to the average year rather than an extreme year. The consequences of a shift of this magnitude for the fire regime, post-fire succession and carbon (C) balance of western forest ecosystems are well beyond what scientists have explored to date, and may fundamentally change the potential of western forests to sequester atmospheric C. We link hydroclimatic extremes (spring and summer temperature and cumulative water-year moisture deficit) to extreme fire years in northern Rockies forests, using large forest fire histories and 1/8-degree gridded historical hydrologic simulations (1950 - 2005) (4) forced with historical gridded temperature and precipitation (5). The frequency of extremes in hydroclimate associated with historic severe fire years in the northern Rocky Mountains is compared to those projected under a range of climate change projections, using global climate model runs for the A2 and B1 emissions pathways for three global climate models (NCAR PCM1, GFDL CM2.1, CNRM CM3). Coarse-scale climatic variables are downscaled to a 1/8 degree grid and used to force hydrologic simulations (6, 7). We will present preliminary results using these hydrologic simulations to model spatially explicit annual wildfire occurrence historically and under the above-cited future climate scenarios, and discuss how these results are being integrated with process-based ecosystem models and field data to model changes in carbon flux across the Greater Yellowstone Ecosystem landscape (8). 1. Westerling, Hidalgo, Cayan, Swetnam, Science 313, 940 (2006). 2. Tymstra, Flannigan, Armitage, Logan, Int’l J. Wildland Fire 16, 153 (2007). 3. U. S. G. A. O. GAO. (2007). 4. Liang, Lettenmaier, Wood, Burges. J. Geophys. Res. 99(D7), 14,415 (1994). 5. Maurer, Wood, Adam, Lettenmaier, Nijssen. J. Climate 15:3237 (2002). 6. Cayan, Maurer, Dettinger, Tyree, Hayhoe. Climatic Change 87(Suppl. 1) 21 (2008). 7. Hidalgo, Dettinger Cayan, CEC Report CEC-500-2007-123 (2008). 8. We acknowledge support from the Joint Fire Science Program (Project ID 09-3-01-47), the NOAA RISA program for California, and the US Forest Service.

Forecasting domestic water demand in the Haihe river basin under changing environment

NASA Astrophysics Data System (ADS)

Wang, Xiao-Jun; Zhang, Jian-Yun; Shahid, Shamsuddin; Xie, Yu-Xuan; Zhang, Xu

2018-02-01

A statistical model has been developed for forecasting domestic water demand in Haihe river basin of China due to population growth, technological advances and climate change. Historical records of domestic water use, climate, population and urbanization are used for the development of model. An ensemble of seven general circulation models (GCMs) namely, BCC-CSM1-1, BNU-ESM, CNRM-CM5, GISS-E2-R, MIROC-ESM, PI-ESM-LR, MRI-CGCM3 were used for the projection of climate and the changes in water demand in the Haihe River basin under Representative Concentration Pathways (RCPs) 4.5. The results showed that domestic water demand in different sub-basins of the Haihe river basin will gradually increase due to continuous increase of population and rise in temperature. It is projected to increase maximum 136.22 × 108 m3 by GCM BNU-ESM and the minimum 107.25 × 108 m3 by CNRM-CM5 in 2030. In spite of uncertainty in projection, it can be remarked that climate change and population growth would cause increase in water demand and consequently, reduce the gap between water supply and demand, which eventually aggravate the condition of existing water stress in the basin. Water demand management should be emphasized for adaptation to ever increasing water demand and mitigation of the impacts of environmental changes.

Targeted Treatment Options in Mastocytosis

PubMed Central

Vaes, Mélanie; Benghiat, Fleur Samantha; Hermine, Olivier

2017-01-01

Mastocytosis refers to a heterogeneous group of disorders resulting from the clonal proliferation of abnormal mast cells and their accumulation in the skin (cutaneous mastocytosis when only in the skin, CM) or in various organs (systemic mastocytosis, SM). This leads to a wide variety of clinical manifestations resulting from excessive mediator release in CM and benign forms of SM (indolent SM, ISM) and from tissue mast cell infiltration causing multiorgan dysfunction and failure in more aggressive subtypes (aggressive SM, ASM, or mast cell leukemia). In addition, SM may be associated with hematological neoplasms (AHN). While treatment of ISM primarily aims at symptom management with anti-mediator therapies, cytoreductive and targeted therapies are needed to control the expansion of neoplastic mast cells in advanced forms of SM, in order to improve overall survival. Mast cell accumulation results from a gain-of-function mutation (mostly the D816V mutation) within the KIT tyrosine kinase domain expressed by mast cells and additional genetic and epigenetic mutations may further determine the features of the disease (ASM and AHN). Consequently, tyrosine kinase inhibitors and targeted therapies directed against the oncogenic signaling machinery downstream of KIT are attractive therapeutic approaches. A better understanding of the relative contribution of these genetic and epigenetic events to the molecular pathogenesis of mastocytosis is of particular interest for the development of targeted therapies and therefore to better choose patient subgroups that would best benefit from a given therapeutic strategy. PMID:28775983

Adapting the helpful responses questionnaire to assess communication skills involved in delivering contingency management: preliminary psychometrics.

PubMed

Hartzler, Bryan

2015-08-01

A paper/pencil instrument, adapted from Miller and colleagues' (1991) Helpful Responses Questionnaire (HRQ), was developed to assess clinician skill with core communicative aspects involved in delivering contingency management (CM). The instrument presents a single vignette consisting of six points of client dialogue to which respondents write 'what they would say next.' In the context of an implementation/effectiveness hybrid trial, 19 staff clinicians at an opiate treatment program completed serial training outcome assessments before, following, and three months after CM training. Assessments included this adaptation of the HRQ, a multiple-choice CM knowledge test, and a recorded standardized patient encounter scored for CM skillfulness. Study results reveal promising psychometric properties for the instrument, including strong scoring reliability, internal consistency, concurrent and predictive validity, test-retest reliability and sensitivity to training effects. These preliminary findings suggest the instrument is a viable, practical method to assess clinician skill in communicative aspects of CM delivery. Copyright © 2015 Elsevier Inc. All rights reserved.

40 CFR 1400.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... OFF-SITE CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION... analysis (OCA) information means sections 2 through 5 of a risk management plan (consisting of an... consequence analysis (OCA) data elements means the results of the off-site consequence analysis conducted by a...

40 CFR 1400.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... OFF-SITE CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION... analysis (OCA) information means sections 2 through 5 of a risk management plan (consisting of an... consequence analysis (OCA) data elements means the results of the off-site consequence analysis conducted by a...

40 CFR 1400.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... OFF-SITE CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION... analysis (OCA) information means sections 2 through 5 of a risk management plan (consisting of an... consequence analysis (OCA) data elements means the results of the off-site consequence analysis conducted by a...

40 CFR 1400.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... OFF-SITE CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION... analysis (OCA) information means sections 2 through 5 of a risk management plan (consisting of an... consequence analysis (OCA) data elements means the results of the off-site consequence analysis conducted by a...

A Randomized Trial of Contingency Management for Smoking Cessation During Intensive Outpatient Alcohol Treatment.

PubMed

Cooney, Judith L; Cooper, Sharon; Grant, Christoffer; Sevarino, Kevin; Krishnan-Sarin, Suchitra; Gutierrez, Ian A; Cooney, Ned L

2017-01-01

This randomized clinical trial was designed to evaluate the efficacy of contingency management (CM) for smoking cessation for smokers with alcohol abuse or dependence delivered concurrently with intensive outpatient alcohol treatment. The study also explored the indirect effects of CM smoking treatment and smoking cessation on alcohol and drug use outcomes. Alcohol abuse/dependent smokers were randomized to cognitive behavioral therapy plus nicotine replacement therapy plus contingency management (CBT+NRT+CM) or to cognitive behavior therapy plus nicotine replacement therapy (CBT+NRT) delivered concurrent with a three-week intensive outpatient alcohol treatment program. Participants in the CBT+NRT+CM condition were significantly more likely to be cigarette abstinent at the end of treatment (χ 2 (1)=8.48, p=.004) with approximately double the carbon monoxide confirmed quit rate (60%) compared with the CBT+NRT condition (29%). At the one-month and six-month time-points there were nonsignificant differences in smoking abstinence outcomes by condition. Smoking treatment condition did not directly affect alcohol abstinence outcomes, but we observed an indirect effect of smoking treatment on alcohol and drug abstinence at one-month follow-up that was mediated by smoking cessation at the end of treatment. Adding CM to an evidence-based smoking cessation treatment that included medication and behavioral counseling doubled the quit rate at the end of treatment. This finding provides strong evidence for the efficacy of CM for helping alcohol dependent smokers reach the milestone of initial smoking abstinence. Published by Elsevier Inc.

How Development and Manufacturing Will Need to Be Structured-Heads of Development/Manufacturing May 20-21, 2014 Continuous Manufacturing Symposium.

PubMed

Nepveux, Kevin; Sherlock, Jon-Paul; Futran, Mauricio; Thien, Michael; Krumme, Markus

2015-03-01

Continuous manufacturing (CM) is a process technology that has been used in the chemical industry for large-scale mass production of chemicals in single-purpose plants with benefit for many years. Recent interest has been raised to expand CM into the low-volume, high-value pharmaceutical business with its unique requirements regarding readiness for human use and the required quality, supply chain, and liability constraints in this business context. Using a fairly abstract set of definitions, this paper derives technical consequences of CM in different scenarios along the development-launch-supply axis in different business models and how they compare to batch processes. Impact of CM on functions in development is discussed and several operational models suitable for originators and other business models are discussed and specific aspects of CM are deduced from CM's technical characteristics. Organizational structures of current operations typically can support CM implementations with just minor refinements if the CM technology is limited to single steps or small sequences (bin-to-bin approach) and if the appropriate technical skill set is available. In such cases, a small, dedicated group focused on CM is recommended. The manufacturing strategy, as centralized versus decentralized in light of CM processes, is discussed and the potential impact of significantly shortened supply lead times on the organization that runs these processes. The ultimate CM implementation may be seen by some as a totally integrated monolithic plant, one that unifies chemistry and pharmaceutical operations into one plant. The organization supporting this approach will have to reflect this change in scope and responsibility. The other extreme, admittedly futuristic at this point, would be a highly decentralized approach with multiple smaller hubs; this would require a new and different organizational structure. This processing approach would open up new opportunities for products that, because of stability constraints or individualization to patients, do not allow centralized manufacturing approaches at all. Again, the entire enterprise needs to be restructured accordingly. The situation of CM in an outsourced operation business model is discussed. Next steps for the industry are recommended. In summary, opportunistic implementation of isolated steps in existing portfolios can be implemented with minimal organizational changes; the availability of the appropriate skills is the determining factor. The implementation of more substantial sequences requires business processes that consider the portfolio, not just single products. Exploration and implementation of complete process chains with consequences for quality decisions do require appropriate organizational support. © 2015 Wiley Periodicals, Inc. and the American Pharmacists Association. © 2014 Wiley Periodicals, Inc. and the American Pharmacists Association.

Legal Aspects: Civilians/Contractors in the War Zone And Disaster Relief Support Joint Center for Operational Analysis Journal, Volume 10, Issue 2, June 2008

DTIC Science & Technology

2008-06-01

operations . The JSC, however, has analyzed the new legislation and their JCOA Journal, June 2008 13 recommendations for managing how these cases are...CBRNE) consequence management operations . 4 While the Department of Homeland Security’s (DHS) Federal Emergency Management Agency (FEMA) 5 is...affect the Department of Defense’s consequence management operations in support of a primary federal agency. Although the U.S. Constitution’s Supremacy

Exosomes derived from human umbilical cord blood mesenchymal stem cells stimulates rejuvenation of human skin.

PubMed

Kim, Yoon-Jin; Yoo, Sae Mi; Park, Hwan Hee; Lim, Hye Jin; Kim, Yu-Lee; Lee, Seunghee; Seo, Kwang-Won; Kang, Kyung-Sun

2017-11-18

Human umbilical cord blood-derived mesenchymal stem cells (UCB-MSCs) play an important role in cutaneous wound healing, and recent studies suggested that MSC-derived exosomes activate several signaling pathways, which are conducive in wound healing and cell growth. In this study, we investigated the roles of exosomes that are derived from USC-CM (USC-CM Exos) in cutaneous collagen synthesis and permeation. We found that USC-CM has various growth factors associated with skin rejuvenation. Our in vitro results showed that USC-CM Exos integrate in Human Dermal Fibroblasts (HDFs) and consequently promote cell migration and collagen synthesis of HDFs. Moreover, we evaluated skin permeation of USC-CM Exos by using human skin tissues. Results showed that Exo-Green labeled USC-CM Exos approached the outermost layer of the epidermis after 3 h and gradually approached the epidermis after 18 h. Moreover, increased expressions of Collagen I and Elastin were found after 3 days of treatment on human skin. The results showed that USC-CM Exos is absorbed into human skin, it promotes Collagen I and Elastin synthesis in the skin, which are essential to skin rejuvenation and shows the potential of USC-CM integration with the cosmetics or therapeutics. Copyright © 2017 Elsevier Inc. All rights reserved.

Constraining Cosmic Dawn and Cosmological Reionization via the global redshifted 21-cm signal

NASA Astrophysics Data System (ADS)

Singh, Saurabh

2018-01-01

The formation of first stars and consequent thermal evolution in baryons during Cosmic Dawn and the Epoch of Reionization (EoR) is poorly constrained. The 21-cm line transition of neutral hydrogen is one of the richest probes of the astrophysics during this era. The signal has the potential to reveal the nature and timing of the emergence of first stars, first light, and the consequent evolution in thermal and ionization state of the baryons.The detection of the global redshifted 21-cm signal, which represents the mean thermal history of the gas, is challenging since it is extremely faint and seen through orders of magnitude stronger contributions from Galactic and extragalactic foregrounds. Man-made terrestrial Radio Frequency Interference (RFI) and the exacting tolerances required on instrument systematics make the detection even more daunting.The design considerations for a precision spectral radiometer are first listed, and a comparison is made of different radiometer configurations, including short and zero baseline interferometers along with methods to enhance the response. We discuss the relative merits of different methods.We then describe SARAS 2, a spectral radiometer custom-designed for precision measurement of the global 21-cm signal. SARAS 2 has been designed to have a system transfer function and internal systematics – both multiplicative and additive – to be spectrally smooth so as to allow a separation of foregrounds and systematics from plausible and predicted global cosmological 21-cm signals. The algorithms for calibration and RFI mitigation are carefully developed so that they do not introduce spectral features that may confuse the detection of the 21-cm signal.We present the outcomes for cosmology from analysis of 60 hr observing with the radiometer deployed at the Timbaktu Collective in Southern India. The detailed analysis of the data reveals an RMS noise level of 11 mK, without being limited by systematic structures. The likelihood ratios are computed from the data for plausible 21-cm signals predicted by theoretical models. First light with SARAS 2 disfavors the scenario of rapid reionization and also the models in which the first X-ray sources have poor heating efficiency.

Degenerate p-type conductivity in wide-gap LaCuOS1-xSex (x=0-1) epitaxial films

NASA Astrophysics Data System (ADS)

Hiramatsu, Hidenori; Ueda, Kazushige; Ohta, Hiromichi; Hirano, Masahiro; Kamiya, Toshio; Hosono, Hideo

2003-02-01

Epitaxial films of LaCuOS1-xSex (x=0-1) solid solution were grown on MgO (001) substrates and their electrical and optical properties were examined. Sharp emission due to room-temperature exciton with binding energy of ˜50 meV is observed for all x values. Hall mobility becomes large with an increase in the Se content and it reaches 8.0 cm2V-1s-1 in LaCuOSe, a comparable value to that of p-type GaN:Mg. Doping of Mg2+ ions at La3+ sites enhances a hole concentration up to 2.2×1020 cm-3, while maintaining the Hall mobility as large as 4.0 cm2V-1s-1. Consequently, a degenerate p-type electrical conduction with a conductivity of 140 S cm-1 was achieved.

Consequence Management: A Disconnect Between National Security Policy and Force Structure?

DTIC Science & Technology

2001-03-15

effects or the consequences of a detonated and/or released weapon(s) has only recently been given much attention. Despite several warnings of the...with the exposure ? Second, the time required to establish and field a regional JTF would prevent the force from having a strong positive effect on the... outcome of the situation. One of the critical missions of a successful consequence management force is its ability to provide a strong deterrent

Impacts of 25 years of groundwater extraction on subsidence ...

EPA Pesticide Factsheets

Many major river deltas in the world are subsiding and consequently become increasingly vulnerable to flooding and storm surges, salinization and permanent inundation. For the Mekong Delta, annual subsidence rates up to several centimetres have been reported. Excessive groundwater extraction is suggested as the main driver. As groundwater levels drop, subsidence is induced through aquifer compaction. Over the past 25 years, groundwater exploitation has increased dramatically, transforming the delta from an almost undisturbed hydrogeological state to a situation with increasing aquifer depletion. Yet the exact contribution of groundwater exploitation to subsidence in the Mekong delta has remained unknown. In this study we deployed a delta-wide modelling approach, comprising a 3D hydrogeological model with an integrated subsidence module. This provides a quantitative spatially-explicit assessment of groundwater extraction-induced subsidence for the entire Mekong delta since the start of widespread overexploitation of the groundwater reserves. We find that subsidence related to groundwater extraction has gradually increased in the past decades with highest sinking rates at present. During the past 25 years, the delta sank on average ~18 cm as a consequence of groundwater withdrawal. Current average subsidence rates due to groundwater extraction in our best estimate model amount to 1.1 cm yr−1, with areas subsiding over 2.5 cm yr−1, outpacing global sea level ri

Motion of the center of gravity of the body in clinical evaluation of gait.

PubMed

Tesio, L; Civaschi, P; Tessari, L

1985-04-01

The motion of the center of gravity during walking was analyzed in five hemiplegic subjects and eleven subjects affected by unilateral hip arthritis. In the hemiplegic subjects and 6 subjects with hip arthritis the transfer between kinetic and potential energy (with a passive pendular motion) was found to be 9-95% greater during the step performed on the affected limb ("pathological" step); as a consequence, the muscular work done during this step was 7-81% of the work done during the step performed on the second limb ("normal" step). Qualitatively similar gait anomalies were recorded in all hemiplegic subjects with hypertonus of the paretic limb: these subjects had to lift the spastic limb as a whole during the normal step, with the consequence that the center of gravity was lifted 0.6-3 cm more than during the pathological step. In contrast, various motor patterns were found in patients with hip arthritis. During the pathological step the center of gravity reached a height 0.5-3 cm greater in 7 subjects, 1 cm smaller in one subject, and about the same height reached during the normal step in 3 subjects. This was consistent with the various motor deficits caused by hip arthritis.

CM Process Improvement and the International Space Station Program (ISSP)

NASA Technical Reports Server (NTRS)

Stephenson, Ginny

2007-01-01

This viewgraph presentation reviews the Configuration Management (CM) process improvements planned and undertaken for the International Space Station Program (ISSP). It reviews the 2004 findings and recommendations and the progress towards their implementation.

Impact of Water Level on Carbon Sequestration at a Sub-tropical Peat Marsh

NASA Astrophysics Data System (ADS)

Sumner, D.; Hinkle, C.; Li, J.

2012-12-01

The impact of water level on sub-tropical peat marsh atmospheric/landscape carbon exchange was explored through eddy-covariance measurement of carbon dioxide and methane fluxes over a site at Blue Cypress Conservation Area in Florida. This site is vegetated with tall, dense sawgrass (Cladium jamaicense) and a thick accumulation of peat (over 3 m) suggesting a historically high primary productivity and carbon sequestration. Water managers are particularly interested in understanding how water-level controls can be directed to maintain topography through avoidance of excessive drought-induced oxidative losses of peat soil, as well as to minimize releases of greenhouse gases to the atmosphere. Comparison of net ecosystem productivity (NEP) during a wet year of continuous inundation and a drier year with a 9-month hydroperiod (NEP of 710 and 180 g C/m2/yr, respectively) suggests the positive impact of inundation on sequestration of carbon dioxide. These results are counter to previous research in short stature (1 m or less) sawgrass marshes in the Florida Everglades which indicate suppression of productivity during inundation. This seeming contradiction is probably best explained by the tall stature (over 2 m) of sawgrass at the study site in which inundation still does not cover a substantial fraction of the green leaves and the lower canopy is largely composed of brown and decaying leaves. Gross ecosystem productivity (GEP) was suppressed during the dry year (GEP = 1380 and 1030 g C/m2/yr for wet and dry years, respectively), probably as a consequence of canopy moisture stress. Respiration (R) was enhanced the year when water levels were farthest below land surface (R = 670 and 850 g C/m2/yr for wet and dry years, respectively) as a result of soil oxidation. GEP remained suppressed during the dry year even after re-flooding, probably because of relatively low photosynthetic leaf area that was the legacy of reduced canopy growth rates during the drought. Over a seven-month measurement period spanning a dry-to-inundated transition in the marsh, methane flux was negligible during non-inundated periods, but was substantial (averaging 80 g C/m2/yr) during wet periods. The results of this study suggest that water level is a critical control on atmospheric carbon exchanges at this peat marsh with implications for water management and strategic planning under potentially drier conditions that might occur in response to climate change.

Impact of Water Level on Carbon Sequestration at a Sub-tropical Peat Marsh

NASA Astrophysics Data System (ADS)

Sumner, D.; Hinkle, C.; Graham, S.; Li, J.

2013-12-01

The impact of water level on sub-tropical peat marsh atmospheric/landscape carbon exchange was explored through eddy-covariance measurement of carbon dioxide and methane fluxes over a site at Blue Cypress Conservation Area in Florida. This site is vegetated with tall, dense sawgrass (Cladium jamaicense) and a thick accumulation of peat (over 3 m) suggesting a historically high primary productivity and carbon sequestration. Water managers are particularly interested in understanding how water-level controls can be directed to maintain topography through avoidance of excessive drought-induced oxidative losses of peat soil, as well as to minimize releases of greenhouse gases to the atmosphere. Comparison of net ecosystem productivity (NEP) during a wet year of continuous inundation and a drier year with a 9-month hydroperiod (NEP of 710 and 180 g C/m2/yr, respectively) suggests the positive impact of inundation on sequestration of carbon dioxide. These results are counter to previous research in short stature (1 m or less) sawgrass marshes in the Florida Everglades which indicate suppression of productivity during inundation. This seeming contradiction is probably best explained by the tall stature (over 2 m) of sawgrass at the study site in which inundation still does not cover a substantial fraction of the green leaves and the lower canopy is largely composed of brown and decaying leaves. Gross ecosystem productivity (GEP) was suppressed during the dry year (GEP = 1380 and 1030 g C/m2/yr for wet and dry years, respectively), probably as a consequence of canopy moisture stress. Respiration (R) was enhanced the year when water levels were farthest below land surface (R = 670 and 850 g C/m2/yr for wet and dry years, respectively) as a result of soil oxidation. GEP remained suppressed during the dry year even after re-flooding, probably because of relatively low photosynthetic leaf area that was the legacy of reduced canopy growth rates during the drought. Over a seven-month measurement period spanning a dry-to-inundated transition in the marsh, methane flux was negligible during non-inundated periods, but was substantial (averaging 80 g C/m2/yr) during wet periods. The results of this study suggest that water level is a critical control on atmospheric carbon exchanges at this peat marsh with implications for water management and strategic planning under potentially drier conditions that might occur in response to climate change.

Beech vs. Pine - how different tree species manage their water demands

NASA Astrophysics Data System (ADS)

Heidbüchel, Ingo; Dreibrodt, Janek; Simard, Sonia; Güntner, Andreas; Blume, Theresa

2016-04-01

In north-eastern Germany large parts of the landscape are covered by pine trees. Although beech used to be one of the typical species for the region, today it makes up only a small fraction of the forested area. In order to reinstate a more natural forest composition an effort is made to decrease the coniferous forest in the next 30 years from 70% to 40% while increasing the deciduous forest from 20% to 40%. This will have consequences for the forest water balance that we would like to understand better. In an attempt to capture the complete tree water balance for both species we monitored all relevant hydrologic fluxes in four stands of pure beech and pine (both young and old stands) as well as in eight mixed stands (as part of the TERENO observatory). Extensive measurements of throughfall and stemflow were conducted with 35 rain trough systems, 50 stemflow collectors and tipping buckets. Soil moisture was monitored in 70 depth profiles with a total of 450 sensors ranging from 10 cm down to 200 cm. In combination with soil water potential measurements at 5 depths root water uptake from different depths and hydraulic redistribution between depths could be determined. Sapflux sensors recorded tree water use for 16 trees and groundwater level was monitored at 16 locations. We found that soil moisture conditions under beech were more variable than under pine, especially in the upper 100 cm. This was due to the higher influx of water from stemflow on the one hand and to the more intensive/effective use of soil water by the beech on the other hand. Our sap flux measurements show that beech was able to sustain steady rates of sapflux even under extremely dry soil conditions. While annual average sapflow was twice as high for pines compared to beeches, pine trees were less effective in taking up water from the soil and reduced sap flow considerably during dry phases. We still found the upper 100 cm of soil under pine to be generally wetter than under beech and considered this as an indication that pine had access to a second water source - possibly the groundwater reached by its deep tap roots. These differences in how tree species organize and optimize their water use and adapt to potential changes in trends in precipitation patterns and amounts have important ramifications for groundwater recharge and we should continue considering them when making decisions on future forest management.

Behavior Management: Examining the Functions of Behavior

ERIC Educational Resources Information Center

Alstot, Andrew E.; Alstot, Crystal D.

2015-01-01

Appropriate student behavior is essential for the success of a physical education lesson. Despite using effective proactive management strategies, teachers may need to also use reactive techniques to reduce problem behaviors by applying suitable consequences. For these consequences to be effective, they must be aligned with the function, or cause,…

Cyber-Victimization and Its Psychosocial Consequences: Relationships with Behavior Management and Traditional Bullying

ERIC Educational Resources Information Center

Mindrila, Diana; Moore, Lori; Davis, Pamela

2015-01-01

The current study investigated the relationship between behavior management, traditional bullying, cyber-victimization, and several psychosocial consequences of cyber-victimization. Findings from previous research were used to specify a complex path model, which allowed the simultaneous estimation of multiple direct and indirect effects. Data were…

Manual vs. automatic capture management in implantable cardioverter defibrillators and cardiac resynchronization therapy defibrillators.

PubMed

Murgatroyd, Francis D; Helmling, Erhard; Lemke, Bernd; Eber, Bernd; Mewis, Christian; van der Meer-Hensgens, Judith; Chang, Yanping; Khalameizer, Vladimir; Katz, Amos

2010-06-01

The Secura ICD and Consulta CRT-D are the first defibrillators to have automatic right atrial (RA), right ventricular (RV), and left ventricular (LV) capture management (CM). Complete CM was evaluated in an implantable cardioverter defibrillator (ICD) population. Two prospective clinical studies were conducted in 28 centres in Europe and Israel. Automatic CM data were compared with manual threshold measurements, the CM applicability was determined, and adjustments to pacing outputs were analysed. In total, 160 patients [age 64.6 +/- 10.4 years, 77% male, 80 ICD and 80 cardiac resynchronization therapy defibrillator (CRT-D)] were included. The differences between automatic and manual measurements were 2.5 V) due to raised RA threshold in seven (4.4%), high RV threshold in nine (5.6%), and high LV threshold in three patients (3.8%). All high threshold detections and all automatic modulations of pacing output were adjudicated appropriate. Complete CM adjusts pacing output appropriately, permitting a reduction in office visits while it may maximize device longevity. The study was registered at ClinicalTrials.gov identifiers: NCT00526227 and NCT00526162.

Laparoendoscopic Management of Midureteral Strictures

PubMed Central

Komninos, Christos; Koo, Kyo Chul

2014-01-01

The incidence of ureteral strictures has increased worldwide owing to the widespread use of laparoscopic and endourologic procedures. Midureteral strictures can be managed by either an endoscopic approach or surgical reconstruction, including open or minimally invasive (laparoscopic/robotic) techniques. Minimally invasive surgical ureteral reconstruction is gaining in popularity in the management of midureteral strictures. However, only a few studies have been published so far regarding the safety and efficacy of laparoscopic and robotic ureteral reconstruction procedures. Nevertheless, most of the studies have reported at least equivalent outcomes with the open approach. In general, strictures more than 2 cm, injury strictures, and strictures associated either with radiation or with reduced renal function of less than 25% may be managed more appropriately by minimally invasive surgical reconstruction, although the evidence to establish these recommendations is not yet adequate. Defects of 2 to 3 cm in length may be treated with laparoscopic or robot-assisted uretero-ureterostomy, whereas defects of 12 to 15 cm may be managed either via ureteral reimplantation with a Boari flap or via transuretero-ureterostomy in case of low bladder capacity. Cases with more extended defects can be reconstructed with the incorporation of the ileum in ureteral repair. PMID:24466390

The Systematic Use of Positive and Negative Consequences in Managing Classroom Encopresis

ERIC Educational Resources Information Center

George, Thomas W.; And Others

1977-01-01

This study reports a successful classroom intervention program which was designed to curb encopresis. It used positive consequences in combination with negative consequences, rather than negative consequences alone. Also it utilized a reversal strategy to evalulate the efficacy of the treatment variables. (Author)

A randomized factorial trial of disulfiram and contingency management to enhance cognitive behavioral therapy for cocaine dependence.

PubMed

Carroll, Kathleen M; Nich, Charla; Petry, Nancy M; Eagan, Dorothy A; Shi, Julia M; Ball, Samuel A

2016-03-01

This study evaluated the extent to which the addition of disulfiram and contingency management for adherence and abstinence (CM), alone and in combination, might enhance the effects of cognitive behavioral therapy (CBT) for cocaine use disorders. Factorial randomized double blind (for medication condition) clinical trial where CBT served as the platform and was delivered in weekly individual sessions in a community-based outpatient clinic. 99 outpatients who met DSM-IV criteria for current cocaine dependence were assigned to receive either disulfiram or placebo, and either CM or no CM. Cocaine and other substance use was assessed via a daily calendar with thrice weekly urine sample testing for 12 weeks with a one-year follow-up (80% interviewed at one year). The primary hypothesis that CM and disulfiram would produce the best cocaine outcomes was not confirmed, nor was there a main effect for disulfiram. For the primary outcome (percent days of abstinence, self report), there was a significant interaction, with the best cocaine outcomes were seen for the combination of CM and placebo, with the two groups assigned to disulfiram associated with intermediate outcomes, and poorest cocaine outcome among those assigned to placebo and no CM. The secondary outcome (urinalysis) indicated a significant effect favoring CM over no CM but the interaction effect was not significant. One year follow-up data indicated sustained treatment effects across conditions. CM enhances outcomes for CBT treatment of cocaine dependence, but disulfiram provided no added benefit to the combination of CM and CBT. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Management implications from routine needle biopsy of hyperfunctioning thyroid nodules.

PubMed

Walfish, P G; Strawbridge, H T; Rosen, I B

1985-12-01

To evaluate the diagnostic and treatment consequences of using a routine needle biopsy procedure on all thyroid nodules without a radioisotopic scintigraphic study, 12 patients with documented hyperfunctioning thyroid nodules were retrospectively evaluated regarding the physical and cytologic observations obtained after a fine-needle (22 to 27-gauge) aspiration biopsy (FNB) procedure. Among the seven solid lesions, features of marked cellularity and nuclear pleomorphism were present in three and moderate sheets of epithelium in four raising the suspicion of underlying malignancy, while five mixed (cystic and solid) lesions were larger than 3 cm, hemorrhagic, and recurrent, with two having detectable sheets of epithelium. Evidence for concomitant lymphocytic thyroiditis was seen in five of 12 (42%) patients, and nine had positive serum antithyroid antibody titers as well. In conclusion, total reliance on FNB without scintigraphy could lead to operations on hyperfunctioning thyroid adenomas for suspected malignancy, of whom the vast majority would be benign, and could expose some unprepared patients with thyrotoxicosis to surgical morbidity. Routine thyroid hormone suppression therapy for apparently benign inflammatory or cystic degenerative lesions could also induce hyperthyroidism in patients with hyperfunctional or autonomous (nonsuppressible) nodules. When using an initial FNB approach, the need for thyroid function studies and scintigraphy before undertaking surgery or thyroid hormone feeding, as well as the consequences of omitting such studies, should be considered.

Taking out violence.

PubMed

Loafmann, B

2001-01-01

An analysis of how consequences impact your company from inside or outside will enable you to prevent the situations that can build up until they explode into violence. Specific skill enhancement on the use of feedback and consequences will broaden the base of involvement and foster early intervention opportunities before things get out of control. Understanding how consequences influence behavior also can improve self-management efforts. When these strategies are coupled with security hardware and appropriate policies, we can once again help our managers and employees work without fear of violence.

Duration effects in contingency management treatment of methamphetamine disorders.

PubMed

Roll, John M; Chudzynski, Joy; Cameron, Jennifer M; Howell, Donelle N; McPherson, Sterling

2013-09-01

The primary aim of this study was to determine whether different durations of contingency management (CM) in conjunction with psychosocial treatment produced different rates of abstinence among methamphetamine dependent individuals. Participants were randomized to one of the four 16-week treatment conditions: standard psychosocial treatment or psychosocial treatment plus one of the three durations of CM (one-month, two-month, or four-month). A total of 118 participants were randomized to the four treatment conditions. There were significant differences across treatment conditions for number of consecutive days of methamphetamine abstinence (p<0.05). These differences were in the hypothesized direction, as participants were more likely to remain abstinent through the 16-week trial as CM duration increased. A significant effect of treatment condition (p<0.05) and time (p<0.05) on abstinence over time was also found. Longer durations of CM were more effective for maintaining methamphetamine abstinence. Copyright © 2013 Elsevier Ltd. All rights reserved.

Duration Effects in Contingency Management Treatment of Methamphetamine Disorders

PubMed Central

Roll, John M.; Chudzynski, Joy; Cameron, Jennifer M.; Howell, Donelle N.; McPherson, Sterling

2013-01-01

The primary aim of this study was to determine whether different durations of contingency management (CM) in conjunction with psychosocial treatment produced different rates of abstinence among methamphetamine dependent individuals. Participants were randomized to one of four 16-week treatment conditions: standard psychosocial treatment or psychosocial treatment plus one of three durations of CM (one-month, two-month, or four-month). A total of 118 participants were randomized to the four treatment conditions. There were significant differences across treatment conditions for number of consecutive days of methamphetamine abstinence (p < 0.05). These differences were in the hypothesized direction, as participants were more likely to remain abstinent through the 16-week trial as CM duration increased. A significant effect of treatment condition (p < 0.05) and time (p < 0.05) on abstinence over time was also found. Longer durations of CM were more effective for maintaining methamphetamine abstinence. PMID:23708468

The evolution of capture myopathy in hooved mammals: a model for human stress cardiomyopathy?

PubMed

Blumstein, Daniel T; Buckner, Janet; Shah, Sajan; Patel, Shane; Alfaro, Michael E; Natterson-Horowitz, Barbara

2015-07-21

Capture myopathy (CM) syndromes in wildlife may be a model for human stress cardiomyopathy, including Takotsubo cardiomyopathy. Emotional stress or grief may trigger heart attack-like symptoms, and occasionally, sudden death in some humans. Similarly, wildlife exposed to predatory stresses, chase, or capture occasionally results in sudden death. To better understand the nature of vulnerability to stress-induced sudden death, we studied cases of CM in hooved mammals-ungulates-and hypothesized that CM would be associated with a syndrome of longevity-related traits. We reconstructed the evolution of CM in ungulates then determined how a set of life history traits explained variation in the likelihood that CM was reported. CM is broadly reported, but not in all genera, and phylogenetic analyses suggest that it is an evolutionarily labile trait. We found that the following traits were significantly associated with reports of CM: greater brain mass, faster maximum running speed, greater minimum group size and greater maximum longevity. CM may be an unavoidable consequence of adaptations to reduce predation risk that include increased running speed, sociality and having larger brains. Moreover, longer-lived species seem to be more likely to be susceptible to CM. Exploring variable susceptibility to CM highlights the evolutionary origins of the disorder, potential basic mechanisms that underlie vulnerability to the phenomenon, and the potential for reduction of risk through modification of life history trajectory. © The Author(s) 2015. Published by Oxford University Press on behalf of the Foundation for Evolution, Medicine, and Public Health.

Population Dynamics and Flight Phenology Model of Codling Moth Differ between Commercial and Abandoned Apple Orchard Ecosystems.

PubMed

Joshi, Neelendra K; Rajotte, Edwin G; Naithani, Kusum J; Krawczyk, Greg; Hull, Larry A

2016-01-01

Apple orchard management practices may affect development and phenology of arthropod pests, such as the codling moth (CM), Cydia pomonella (L.) (Lepidoptera: Tortricidae), which is a serious internal fruit-feeding pest of apples worldwide. Estimating population dynamics and accurately predicting the timing of CM development and phenology events (for instance, adult flight, and egg-hatch) allows growers to understand and control local populations of CM. Studies were conducted to compare the CM flight phenology in commercial and abandoned apple orchard ecosystems using a logistic function model based on degree-days accumulation. The flight models for these orchards were derived from the cumulative percent moth capture using two types of commercially available CM lure baited traps. Models from both types of orchards were also compared to another model known as PETE (prediction extension timing estimator) that was developed in 1970s to predict life cycle events for many fruit pests including CM across different fruit growing regions of the United States. We found that the flight phenology of CM was significantly different in commercial and abandoned orchards. CM male flight patterns for first and second generations as predicted by the constrained and unconstrained PCM (Pennsylvania Codling Moth) models in commercial and abandoned orchards were different than the flight patterns predicted by the currently used CM model (i.e., PETE model). In commercial orchards, during the first and second generations, the PCM unconstrained model predicted delays in moth emergence compared to current model. In addition, the flight patterns of females were different between commercial and abandoned orchards. Such differences in CM flight phenology between commercial and abandoned orchard ecosystems suggest potential impact of orchard environment and crop management practices on CM biology.

Contingency management improves smoking cessation treatment outcomes among highly impulsive adolescent smokers relative to cognitive behavioral therapy.

PubMed

Morean, Meghan E; Kong, Grace; Camenga, Deepa R; Cavallo, Dana A; Carroll, Kathleen M; Pittman, Brian; Krishnan-Sarin, Suchitra

2015-03-01

Impulsive adolescents have difficulty quitting smoking. We examined if treatments that provide behavioral incentives for abstinence improve treatment outcomes among impulsive adolescent smokers, who have been shown to be highly sensitive to reward. We ran secondary data analyses on 64 teen smokers (mean age=16.36 [1.44]; cigarettes/day=13.97 [6.61]; 53.1% female; 90.6% Caucasian) who completed a four-week smoking cessation trial to determine whether impulsive adolescents differentially benefit from receiving cognitive behavioral therapy (CBT), contingency management (CM), or the combination of the two (CM/CBT). Indices of treatment efficacy included self-report percent days abstinent and end of treatment biochemically-confirmed 7-day point prevalence abstinence (EOT abstinence). We assessed self-reported impulsivity using the Brief Barratt Impulsiveness Scale. We used univariate Generalized Linear Modeling to examine main effects and interactions of impulsivity and treatment condition as predictors of self-reported abstinence, and exact logistic regression to examine EOT abstinence. CM/CBT and CM were comparably effective in promoting abstinence, so analyses were conducted comparing the efficacy of CBT to treatments with a CM component (i.e., CM and CM/CBT). CBT and deficient self-regulation predicted lower self-reported abstinence rates within the total analytic sample. Treatments containing CM were more effective than CBT in predicting 1) self-reported abstinence among behaviorally impulsive adolescents (% days abstinent: CM 77%; CM/CBT 81%; CBT 30%) and 2) EOT point prevalence abstinence among behaviorally impulsive adolescents and adolescents with significant deficits in self-regulation. CM-based interventions may improve the low smoking cessation rates previously observed among impulsive adolescent smokers. Copyright © 2014 Elsevier Ltd. All rights reserved.

Population Dynamics and Flight Phenology Model of Codling Moth Differ between Commercial and Abandoned Apple Orchard Ecosystems

PubMed Central

Joshi, Neelendra K.; Rajotte, Edwin G.; Naithani, Kusum J.; Krawczyk, Greg; Hull, Larry A.

2016-01-01

Apple orchard management practices may affect development and phenology of arthropod pests, such as the codling moth (CM), Cydia pomonella (L.) (Lepidoptera: Tortricidae), which is a serious internal fruit-feeding pest of apples worldwide. Estimating population dynamics and accurately predicting the timing of CM development and phenology events (for instance, adult flight, and egg-hatch) allows growers to understand and control local populations of CM. Studies were conducted to compare the CM flight phenology in commercial and abandoned apple orchard ecosystems using a logistic function model based on degree-days accumulation. The flight models for these orchards were derived from the cumulative percent moth capture using two types of commercially available CM lure baited traps. Models from both types of orchards were also compared to another model known as PETE (prediction extension timing estimator) that was developed in 1970s to predict life cycle events for many fruit pests including CM across different fruit growing regions of the United States. We found that the flight phenology of CM was significantly different in commercial and abandoned orchards. CM male flight patterns for first and second generations as predicted by the constrained and unconstrained PCM (Pennsylvania Codling Moth) models in commercial and abandoned orchards were different than the flight patterns predicted by the currently used CM model (i.e., PETE model). In commercial orchards, during the first and second generations, the PCM unconstrained model predicted delays in moth emergence compared to current model. In addition, the flight patterns of females were different between commercial and abandoned orchards. Such differences in CM flight phenology between commercial and abandoned orchard ecosystems suggest potential impact of orchard environment and crop management practices on CM biology. PMID:27713702

Misalignment of disposable pulse oximeter probes results in false saturation readings that influence anesthetic management.

PubMed

Guan, Zhonghui; Baker, Keith; Sandberg, Warren S

2009-11-01

We report a small case series in which misaligned disposable pulse oximeter sensors gave falsely low saturation readings. In each instance, the sensor performed well during preinduction oxygen administration and the early part of the case, most notably by producing a plethysmographic trace rated as high quality by the oximeter software. The reported pulse oximeter oxygen saturation eventually decreased to concerning levels in each instance, but the anesthesiologists, relying on the reported high-quality signal, initially sought other causes for apparent hypoxia. They undertook maneuvers and diagnostic procedures later deemed unnecessary. When the malpositioned sensors were discovered and repositioned, the apparent hypoxia was quickly relieved in each case. We then undertook a survey of disposable oximeter sensors as patients entered the recovery room, and discovered malposition of more than 1 cm in approximately 20% of all sensors, without apparent consequence. We conclude that the technology is quite robust, but that the diagnosis of apparent hypoxia should include a quick check of oximeter position early on.

Rare case of losartan-induced cough complicated by rectus sheath haematoma: in a patient on rivaroxaban therapy.

PubMed

Talari, Goutham; Talari, Preetham; Sweigart, Joseph; Ahmed, Sadiq

2016-12-23

Spontaneous rectus sheath haematomas and cough secondary to losartan are individually rare conditions. Abdominal wall haematomas present with abdominal pain and abdominal mass. Most patients are managed conservatively; Surgery or embolisation is indicated for shock, infection, rupture into the peritoneum or intractable pain. This is a man aged 65 years presented with dry cough and right-sided abdominal pain. He started losartan a few weeks prior to the onset of cough and had been on rivaroxaban for prior deep venous thrombosis. The right side of his abdomen was distended, bruised and tender. His haemoglobin dropped from 13.3to 9.5 g/dL. CT abdomen/pelvis showed a large 14.5×9.1×4.5 cm haematoma within the right lateral rectus muscle. His only risk factor for developing rectus sheath haematoma was cough in the setting of anticoagulation. Dry cough due to angiotensin receptor blockers is rare, but can have very serious consequences. 2016 BMJ Publishing Group Ltd.

Scale-Up of an Human Papillomavirus Testing Implementation Program in El Salvador.

PubMed

Cremer, Miriam; Maza, Mauricio; Alfaro, Karla; Morales Velado, Mario; Felix, Juan; Castle, Philip E; Kim, Jane; Gage, Julia C

2017-01-01

The Cervical Cancer Prevention in El Salvador is a demonstration project to introduce a lower-cost human papillomavirus (HPV)-DNA test into a public sector project. Started in October 2012, The Cervical Cancer Prevention in El Salvador consists of 3 phases and will ultimately screen 30,000 women. Results of phase 2 of the project are presented. The objective of this project was to compare colposcopy and noncolposcopy-based management for HPV-positive women. In phase 2, a total of 8,050 women, aged 30 to 49 years, were screened; 6,761 provided both self- and provider-collected specimens and 1,289 provided only provider-testing specimens. HPV results from self-collected specimens were not used in clinical management decisions. Women with provider-collected HPV-positive results were treated based on the strategy assigned to their community; the strategy was colposcopy management (CM) or screen-and-treat (ST) management if they were cryotherapy eligible or colposcopy if not eligible. Outcomes were assessed 6 months after screening. Overall, 489 (12.3%) of 3,963 women receiving CM and 465 (11.4%) of 4,087 women receiving ST tested HPV positive. In the CM cohort, 216 (44.2%) of 489 completed their intervention (203 treated, 11 diagnosed negative, 2 pregnant). In the ST cohort, 411 (88.4%) of 465 completed their intervention (407 treated, 2 diagnosed negative, 1 pregnant). Overall agreement between HPV test results from self-collected and provider-collected specimens was 93.7%, with a κ value of 0.70 (95% CI = 0.68-0.73). Human papillomavirus testing with ST management resulted in an approximately twice completion rate compared with CM management. Agreement between self- and provider-based sampling was good and might be used to extend screening to women in areas that are more difficult to reach.

A randomized controlled trial to examine the effectiveness of case management model for community dwelling older persons with mild dementia in Hong Kong.

PubMed

Lam, Linda C W; Lee, Jenny S W; Chung, Jenny C C; Lau, Anna; Woo, Jean; Kwok, Timothy C Y

2010-04-01

To evaluate a case management (CM) model for people with mild dementia, whereby resources within the family and in the community were mobilized and optimally used. Community dwelling psychiatric and geriatrics outpatients with mild dementia were randomized to receive CM by a trained occupational therapist for 4 months (CM group, N = 59) or usual care only (control group, N = 43). Primary outcome indicators included the Zarit Burden Scale (ZBI), General Health Questionnaire (GHQ), and Personal Well-Being Index for Adult (PWI-A) of the family caregivers. Secondary outcome indicators included the Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), and Personal Well-Being Index for Intellectually Disabled (PWI-ID) of the demented subjects as measured at fourth and twelfth months. CSDDis reduced in the CM group at fourth month, but not at twelfth month. The changes in outcome variables of persons with dementia did not differ between the groups (Mann-Whitney U-test, p > 0.05). At follow-up, CM group used more day care and domestic helpers than control group (chi (2), p > 0.05). Case management for Chinese persons with mild dementia outpatients did not show significant effects in reducing caregiver burden, but encouraged family caregivers to seek external support.

DNA fragmentation and nuclear phenotype in tendons exposed to low-intensity infrared laser

NASA Astrophysics Data System (ADS)

de Paoli, Flavia; Ramos Cerqueira, Larissa; Martins Ramos, Mayara; Campos, Vera M.; Ferreira-Machado, Samara C.; Geller, Mauro; de Souza da Fonseca, Adenilson

2015-03-01

Clinical protocols are recommended in device guidelines outlined for treating many diseases on empirical basis. However, effects of low-intensity infrared lasers at fluences used in clinical protocols on DNA are controversial. Excitation of endogenous chromophores in tissues and free radicals generation could be described as a consequence of laser used. DNA lesions induced by free radicals cause changes in DNA structure, chromatin organization, ploidy degrees and cell death. In this work, we investigated whether low-intensity infrared laser therapy could alter the fibroblasts nuclei characteristics and induce DNA fragmentation. Tendons of Wistar rats were exposed to low-intensity infrared laser (830 nm), at different fluences (1, 5 and 10 J/cm2), in continuous wave (power output of 10mW, power density of 79.6 mW/cm2). Different frequencies were analyzed for the higher fluence (10 J/cm2), at pulsed emission mode (2.5, 250 and 2500 Hz), with the laser source at surface of skin. Geometric, densitometric and textural parameters obtained for Feulgen-stained nuclei by image analysis were used to define nuclear phenotypes. Significant differences were observed on the nuclear phenotype of tendons after exposure to laser, as well as, high cell death percentages was observed for all fluences and frequencies analyzed here, exception 1 J/cm2 fluence. Our results indicate that low-intensity infrared laser can alter geometric, densitometric and textural parameters in tendon fibroblasts nuclei. Laser can also induce DNA fragmentation, chromatin lost and consequently cell death, using fluences, frequencies and emission modes took out from clinical protocols.

Contingency management for college student smokers: The role of drinking as a moderator and mediator of smoking abstinence during treatment.

PubMed

Cassidy, Rachel N; Jackson, Kristina M; Rohsenow, Damaris J; Tidey, Jennifer W; Tevyaw, Tracy O' L; Barnett, Nancy P; Monti, Peter M; Miller, Mollie E; Colby, Suzanne M

2018-05-01

Contingency management (CM) is effective for promoting smoking abstinence; however, moderators and mediators of CM treatment efficacy in young adult populations are under-explored. We leveraged fine-grained data from a large randomized controlled trial: 1) to determine whether early attainment of sustained abstinence mediated the effect of treatment on abstinence; 2) to test whether heavy drinking moderated the effect of treatment on abstinence; and 3) to test a serial mediation model of the effects of drinking during early treatment on sustained smoking abstinence. College student smokers (N=110) were randomized to receive either CM treatment or noncontingent reinforcement (NR) over a 21-day treatment period. All participants received $5 for providing twice-daily breath carbon monoxide (CO) samples. In CM, additional money was provided for samples that indicated smoking reduction (Initial Phase; first 7days), and for samples ≤5ppm (Abstinence Phase; following 14days). CM treatment led to greater sustained abstinence relative to NR. Longer sustained abstinence in the Initial Phase partially mediated the effect of treatment on sustained abstinence in the Abstinence Phase. Heavier pretreatment drinkers had shorter periods of sustained abstinence in the Abstinence Phase; this effect was greater in CM. A serial mediation model determined that increased drinking during the Initial Phase led to decreased sustained abstinence, which then led to decreased sustained abstinence in the Abstinence Phase. These data provide a greater understanding of how heavy drinking and early sustained abstinence may affect success during treatment in young adults undergoing contingency management treatment for smoking. Copyright © 2018. Published by Elsevier Ltd.

Miscanthus Establishment and Overwintering in the Midwest USA: A Regional Modeling Study of Crop Residue Management on Critical Minimum Soil Temperatures

PubMed Central

Kucharik, Christopher J.; VanLoocke, Andy; Lenters, John D.; Motew, Melissa M.

2013-01-01

Miscanthus is an intriguing cellulosic bioenergy feedstock because its aboveground productivity is high for low amounts of agrochemical inputs, but soil temperatures below −3.5°C could threaten successful cultivation in temperate regions. We used a combination of observed soil temperatures and the Agro-IBIS model to investigate how strategic residue management could reduce the risk of rhizome threatening soil temperatures. This objective was addressed using a historical (1978–2007) reconstruction of extreme minimum 10 cm soil temperatures experienced across the Midwest US and model sensitivity studies that quantified the impact of crop residue on soil temperatures. At observation sites and for simulations that had bare soil, two critical soil temperature thresholds (50% rhizome winterkill at −3.5°C and −6.0°C for different Miscanthus genotypes) were reached at rhizome planting depth (10 cm) over large geographic areas. The coldest average annual extreme 10 cm soil temperatures were between −8°C to −11°C across North Dakota, South Dakota, and Minnesota. Large portions of the region experienced 10 cm soil temperatures below −3.5°C in 75% or greater for all years, and portions of North and South Dakota, Minnesota, and Wisconsin experienced soil temperatures below −6.0°C in 50–60% of all years. For simulated management options that established varied thicknesses (1–5 cm) of miscanthus straw following harvest, extreme minimum soil temperatures increased by 2.5°C to 6°C compared to bare soil, with the greatest warming associated with thicker residue layers. While the likelihood of 10 cm soil temperatures reaching −3.5°C was greatly reduced with 2–5 cm of surface residue, portions of the Dakotas, Nebraska, Minnesota, and Wisconsin still experienced temperatures colder than −3.5°C in 50–80% of all years. Nonetheless, strategic residue management could help increase the likelihood of overwintering of miscanthus rhizomes in the first few years after establishment, although low productivity and biomass availability during these early stages could hamper such efforts. PMID:23844244

Consequence Management Symposium

DTIC Science & Technology

2001-09-01

AND SUBTITLE Consequence Management Symposium 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e...log i cal agents and their effects was deemed essen tial for “first respond ers,” includ ing emer gency medi cal and hospi tal prac ti tio ners

Contemporary occurrence of hydrocephalus and Chiari I malformation in sagittal craniosynostosis. Case report and review of the literature.

PubMed

Sgulò, Francesco Giovanni; Spennato, Pietro; Aliberti, Ferdinando; Di Martino, Giuliana; Cascone, Daniele; Cinalli, Giuseppe

2017-01-01

Chiari malformation type I (CM-I) and hydrocephalus are often associated with complex craniosynostosis. On the contrary, their simultaneous occurrence in monosutural synostosis is extremely rare. The pathophysiological hypothesis is that they may alter posterior fossa growth and lead to cerebellar tonsil herniation also without skull base primary involvement. Hydrocephalus is multifactorial and may be secondary to fourth ventricle outlet obstruction. The management of these cases is quite complex and not well defined. Cranial vault remodeling should be the only treatment when CM-I is asymptomatic and not related to syringomyelia. Suboccipital decompression should be reserved only in complicated CM-I, usually as a second surgical step following the correction of the supratentorial deformity. In our opinion, the associated hydrocephalus should be treated first in order to normalize intracranial hypertension before opening the cranial sutures. We report the case of a 26-month-old child that presented with sagittal craniosynostosis, hydrocephalus, and CM-I. He was managed by performing endoscopic third ventriculostomy (ETV) first and cranial vault remodeling thereafter. Clinico-radiological outcome was very satisfying. Concerning literature is reviewed; physiopathology and surgical management are discussed.

File format for normalizing radiological concentration exposure rate and dose rate data for the effects of radioactive decay and weathering processes

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

Kraus, Terrence D.

2017-04-01

This report specifies the electronic file format that was agreed upon to be used as the file format for normalized radiological data produced by the software tool developed under this TI project. The NA-84 Technology Integration (TI) Program project (SNL17-CM-635, Normalizing Radiological Data for Analysis and Integration into Models) investigators held a teleconference on December 7, 2017 to discuss the tasks to be completed under the TI program project. During this teleconference, the TI project investigators determined that the comma-separated values (CSV) file format is the most suitable file format for the normalized radiological data that will be outputted frommore » the normalizing tool developed under this TI project. The CSV file format was selected because it provides the requisite flexibility to manage different types of radiological data (i.e., activity concentration, exposure rate, dose rate) from other sources [e.g., Radiological Assessment and Monitoring System (RAMS), Aerial Measuring System (AMS), Monitoring and Sampling). The CSV file format also is suitable for the file format of the normalized radiological data because this normalized data can then be ingested by other software [e.g., RAMS, Visual Sampling Plan (VSP)] used by the NA-84’s Consequence Management Program.« less

Wait time management strategies for total joint replacement surgery: sustainability and unintended consequences.

PubMed

Pomey, Marie-Pascale; Clavel, Nathalie; Amar, Claudia; Sabogale-Olarte, Juan Carlos; Sanmartin, Claudia; De Coster, Carolyn; Noseworthy, Tom

2017-09-07

In Canada, long waiting times for core specialized services have consistently been identified as a key barrier to access. Governments and organizations have responded with strategies for better access management, notably for total joint replacement (TJR) of the hip and knee. While wait time management strategies (WTMS) are promising, the factors which influence their sustainable implementation at the organizational level are understudied. Consequently, this study examined organizational and systemic factors that made it possible to sustain waiting times for TJR within federally established limits and for at least 18 months or more. The research design is a multiple case study of WTMS implementation. Five cases were selected across five Canadian provinces. Three success levels were pre-defined: 1) the WTMS maintained compliance with requirements for more than 18 months; 2) the WTMS met requirements for 18 months but could not sustain the level thereafter; 3) the WTMS never met requirements. For each case, we collected documents and interviewed key informants. We analyzed systemic and organizational factors, with particular attention to governance and leadership, culture, resources, methods, and tools. We found that successful organizations had specific characteristics: 1) management of the whole care continuum, 2) strong clinical leadership; 3) dedicated committees to coordinate and sustain strategy; 4) a culture based on trust and innovation. All strategies led to relatively similar unintended consequences. The main negative consequence was an initial increase in waiting times for TJR and the main positive consequence was operational enhancement of other areas of specialization based on the TJR model. This study highlights important differences in factors which help to achieve and sustain waiting times. To be sustainable, a WTMS needs to generate greater synergies between contextual-level strategy (provincial or regional) and organizational objectives and constraints. Managers at the organizational level should be vigilant with regard to unintended consequences that a WTMS in one area can have for other areas of care. A more systemic approach to sustainability can help avoid or mitigate undesirable unintended consequences.

Multilayer gyroid cubic membrane organization in green alga Zygnema.

PubMed

Zhan, Ting; Lv, Wenhua; Deng, Yuru

2017-09-01

Biological cubic membranes (CM), which are fluid membranes draped onto the 3D periodic parallel surface geometries with cubic symmetry, have been observed within subcellular organelles, including mitochondria, endoplasmic reticulum, and thylakoids. CM transition tends to occur under various stress conditions; however, multilayer CM organizations often appear associated with light stress conditions. This report is about the characterization of a projected gyroid CM in a transmission electron microscopy study of the chloroplast membranes within green alga Zygnema (LB923) whose lamellar form of thylakoid membrane started to fold into multilayer gyroid CM in the culture at the end of log phase of cell growth. Using the techniques of computer simulation of transmission electron microscopy (TEM) and a direct template matching method, we show that these CM are based on the gyroid parallel surfaces. The single, double, and multilayer gyroid CM morphologies are observed in which space is continuously divided into two, three, and more subvolumes by either one, two, or several parallel membranes. The gyroid CM are continuous with varying amount of pseudo-grana with lamellar-like morphology. The relative amount and order of these two membrane morphologies seem to vary with the age of cell culture and are insensitive to ambient light condition. In addition, thylakoid gyroid CM continuously interpenetrates the pyrenoid body through stalk, bundle-like, morphologies. Inside the pyrenoid body, the membranes re-folded into gyroid CM. The appearance of these CM rearrangements due to the consequence of Zygnema cell response to various types of environmental stresses will be discussed. These stresses include nutrient limitation, temperature fluctuation, and ultraviolet (UV) exposure.

Life-stages, exploitation status and habitat use of Lutjanus goreensis (Perciformes: Lutjanidae) in coastal marine environments of Lagos, SW Nigeria.

PubMed

Kafayat, A Fakoya; Martins, A Anetekhai; Shehu, L Akintola; Abdulwakil, O Sabal; Abass, Mikhail A

2015-03-01

The Gorean snapper, Lutanus goreensis is an important component of artisanal fisheries and trawl landings in the Gulf of Guinea. Despite its economic importance, there is a dearth of information on size structure and life history strategies of the species. Therefore, the objectives of this study were to provide baseline data on the life stages, exploitation status and habitat use for the species in Nigeria. Monthly samples were obtained from artisanal and trawl catches in Five Cowrie Creek and Lagos coastal waters between December 2008 and December 2010, respectively. Length-frequency distributions of the fishes caught were analysed to provide preliminary information on mean and modal lengths at capture and life-history strategies based on habitat use and estuarine-dependency for L. goreensis. A total of 822 specimens of L. goreensis were collected from Five Cowrie Creek while 377 specimens were collected from Lagos coastal waters. Total length varied between 7.90-34.90 cm for creek samples and from 21.90-56.10 cm for marine samples. Length-frequency histograms showed polymodal size distributions in creek and marine samples. Length-frequency distributions of L. goreensis showed a high abundance ofjuveniles (<20 cm) and sub-adults (20-35 cm) which accounted for 84.1% and 68.4% of creek and marine samples examined, respectively. For the creek samples, fish in modal length class of 13.00-13.99 cm were the most exploited while in the marine samples, length classes of 29.00-30.99 cm and 31.00-32.99cm constituted the most frequently exploited fishes. Increase in total lengths from the creek (mean +/- SD; 16.19 +/- 3.73 cm) to the marine habitat samples (32.89 +/- 6.14 cm) indicated ontogenetic shift in habitat use. Occurrence of a predominant juvenile population in Five Cowrie Creek by L. goreensis suggests estuarine-dependency and is indicative of a temporary juvenile habitat or a migratory corridor. In conclusion, data from the presently reported study and previous studies demonstrated that juvenile L. goreensis displays estuarine dependency and habitat flexibility. Hence, this underscores the importance of preserving estuarine environments as essential fish habitats to prevent overfishing. The study also concludes that the species is vulnerable to recruitment overfishing in the marine environment especially as a consequence of shrimping. Consequently, it advocates for ban on all fishing activities during peak spawning periods in breeding grounds and shrimp ground assemblage.

Contingency Management Requirements Document: Preliminary Version. Revision F

NASA Technical Reports Server (NTRS)

2005-01-01

This is the High Altitude, Long Endurance (HALE) Remotely Operated Aircraft (ROA) Contingency Management (CM) Functional Requirements document. This document applies to HALE ROA operating within the National Airspace System (NAS) limited at this time to enroute operations above 43,000 feet (defined as Step 1 of the Access 5 project, sponsored by the National Aeronautics and Space Administration). A contingency is an unforeseen event requiring a response. The unforeseen event may be an emergency, an incident, a deviation, or an observation. Contingency Management (CM) is the process of evaluating the event, deciding on the proper course of action (a plan), and successfully executing the plan.

75 FR 67092 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-01

... (CM) using a quantitative, preference-based approach. The US Department of Health and Human Services... substantial long-term physical and psychological consequences. Despite considerable research on the... these decrements, based on respondent preferences over a series of comparisons that will be shown to...

A risk-based approach to sanitary sewer pipe asset management.

PubMed

Baah, Kelly; Dubey, Brajesh; Harvey, Richard; McBean, Edward

2015-02-01

Wastewater collection systems are an important component of proper management of wastewater to prevent environmental and human health implications from mismanagement of anthropogenic waste. Due to aging and inadequate asset management practices, the wastewater collection assets of many cities around the globe are in a state of rapid decline and in need of urgent attention. Risk management is a tool which can help prioritize resources to better manage and rehabilitate wastewater collection systems. In this study, a risk matrix and a weighted sum multi-criteria decision-matrix are used to assess the consequence and risk of sewer pipe failure for a mid-sized city, using ArcGIS. The methodology shows that six percent of the uninspected sewer pipe assets of the case study have a high consequence of failure while four percent of the assets have a high risk of failure and hence provide priorities for inspection. A map incorporating risk of sewer pipe failure and consequence is developed to facilitate future planning, rehabilitation and maintenance programs. The consequence of failure assessment also includes a novel failure impact factor which captures the effect of structurally defective stormwater pipes on the failure assessment. The methodology recommended in this study can serve as a basis for future planning and decision making and has the potential to be universally applied by municipal sewer pipe asset managers globally to effectively manage the sanitary sewer pipe infrastructure within their jurisdiction. Copyright © 2014 Elsevier B.V. All rights reserved.

Large-scale performance and design for construction activity erosion control best management practices.

PubMed

Faucette, L B; Scholl, B; Beighley, R E; Governo, J

2009-01-01

The National Pollutant Discharge Elimination System (NPDES) Phase II requires construction activities to have erosion and sediment control best management practices (BMPs) designed and installed for site storm water management. Although BMPs are specified on storm water pollution prevention plans (SWPPPs) as part of the construction general permit (GP), there is little evidence in the research literature as to how BMPs perform or should be designed. The objectives of this study were to: (i) comparatively evaluate the performance of common construction activity erosion control BMPs under a standardized test method, (ii) evaluate the performance of compost erosion control blanket thickness, (iii) evaluate the performance of compost erosion control blankets (CECBs) on a variety of slope angles, and (iv) determine Universal Soil Loss Equation (USLE) cover management factors (C factors) for these BMPs to assist site designers and engineers. Twenty-three erosion control BMPs were evaluated using American Society of Testing and Materials (ASTM) D-6459, standard test method for determination of ECB performance in protecting hill slopes from rainfall induced erosion, on 4:1 (H:V), 3:1, and 2:1 slopes. Soil loss reduction for treatments exposed to 5 cm of rainfall on a 2:1 slope ranged from-7 to 99%. For rainfall exposure of 10 cm, treatment soil loss reduction ranged from 8 to 99%. The 2.5 and 5 cm CECBs significantly reduced erosion on slopes up to 2:1, while CECBs < 2.5 cm are not recommended on slopes >or= 4:1 when rainfall totals reach 5 cm. Based on the soil loss results, USLE C factors ranged from 0.01 to 0.9. These performance and design criteria should aid site planners and designers in decision-making processes.

Flexible micro supercapacitors based on laser-scribed graphene/ZnO nanocomposite

NASA Astrophysics Data System (ADS)

Amiri, Morteza Hassanpour; Namdar, Naser; Mashayekhi, Alireza; Ghasemi, Foad; Sanaee, Zeinab; Mohajerzadeh, Shams

2016-08-01

We report on the fabrication of graphene/Zno nanocomposite supercapacitor electrodes. Laser-scribing process was implemented in order to reduce the graphene oxide (GO)/ZnO mixture on a DVD disk. With reduced graphene oxide (rGO)/ZnO composite prepared by a mass ratio of 1:25 of Zn(NO3)2·6H2O to GO constituents, nanoparticles of ZnO with sizes ranging from 20 to 50 nm are obtained. Consequently, 12 times improvement in the specific capacitance was achieved at a current density of 0.1 mA/cm2 compared with pristine rGO electrodes. In addition, flexible microsupercapacitor was fabricated by spin coating of the gel electrolyte, showing high stack capacitance of 9 F/cm3 at a current density of 150 mA/cm2. This microsupercapacitor delivers power density of 70 mW/cm3 and energy density of 1.2 mWh/cm3. Furthermore, the performance of device was investigated at different bending angles. The resulted characteristics demonstrate that LSG/ZnO nanocomposite is a promising electrode material for high-performance supercapacitors.

Heat-treated stainless steel felt as scalable anode material for bioelectrochemical systems.

PubMed

Guo, Kun; Soeriyadi, Alexander H; Feng, Huajun; Prévoteau, Antonin; Patil, Sunil A; Gooding, J Justin; Rabaey, Korneel

2015-11-01

This work reports a simple and scalable method to convert stainless steel (SS) felt into an effective anode for bioelectrochemical systems (BESs) by means of heat treatment. X-ray photoelectron spectroscopy and cyclic voltammetry elucidated that the heat treatment generated an iron oxide rich layer on the SS felt surface. The iron oxide layer dramatically enhanced the electroactive biofilm formation on SS felt surface in BESs. Consequently, the sustained current densities achieved on the treated electrodes (1 cm(2)) were around 1.5±0.13 mA/cm(2), which was seven times higher than the untreated electrodes (0.22±0.04 mA/cm(2)). To test the scalability of this material, the heat-treated SS felt was scaled up to 150 cm(2) and similar current density (1.5 mA/cm(2)) was achieved on the larger electrode. The low cost, straightforwardness of the treatment, high conductivity and high bioelectrocatalytic performance make heat-treated SS felt a scalable anodic material for BESs. Copyright © 2015 Elsevier Ltd. All rights reserved.

41 CFR 105-55.024 - Consideration of tax consequences to the Government.

Code of Federal Regulations, 2010 CFR

2010-07-01

... consequences to the Government. 105-55.024 Section 105-55.024 Public Contracts and Property Management Federal... consequences to the Government. In negotiating a compromise, the General Services Administration (GSA) may consider the tax consequences to the Government. In particular, GSA may consider requiring a waiver of tax...

Spatio-Temporal Variation in Length-Weight Relationships and Condition of the Ribbonfish Trichiurus lepturus (Linnaeus, 1758): Implications for Fisheries Management

PubMed Central

Garcia de Leaniz, Carlos; King, Andrew J.

2016-01-01

Knowledge of length-weight relationships for commercially exploited fish is an important tool for assessing and managing of fish stocks. However, analyses of length-weight relationship fisheries data typically do not consider the inherent differences in length-weight relationships for fish caught from different habitats, seasons, or years, and this can affect the utility of these data for developing condition indices or calculating fisheries biomass. Here, we investigated length-weight relationships for ribbonfish Trichiurus lepturus in the waters of the Arabian Sea off Oman collected during three periods (2001–02, 2007–08, and 2014–15) and showed that a multivariate modelling approach that considers the areas and seasons in which ribbonfish were caught improved estimation of length-weight relationships. We used the outputs of these models to explore spatio-temporal variations in condition indices and relative weights among ribbonfish, revealing fish of 85–125 cm were in the best overall condition. We also found that condition differed according to where and when fish were caught, with condition lowest during spring and pre-south-west monsoon periods and highest during and after the south-west monsoons. We interpret these differences to be a consequence of variability in temperature and food availability. Based on our findings, we suggest fishing during seasons that have the lowest impact on fish condition and which are commercially most viable; such fishery management would enhance fisheries conservation and economic revenue in the region. PMID:27579485

Evaluating water management scenarios to support habitat management for the Cape Sable seaside sparrow

USGS Publications Warehouse

Beerens, James M.; Romañach, Stephanie S.; McKelvy, Mark

2016-06-22

The endangered Cape Sable seaside sparrow (Ammodramus maritimus mirabilis) is endemic to south Florida and a key indicator species of marl prairie, a highly diverse freshwater community in the Florida Everglades. Maintenance and creation of suitable habitat is seen as the most important pathway to the persistence of the six existing sparrow subpopulations; however, major uncertainties remain in how to increase suitable habitat within and surrounding these subpopulations, which are vulnerable to environmental stochasticity. Currently, consistently suitable conditions for the Cape Sable seaside sparrow are only present in two of these subpopulations (B and E). The water management scenarios evaluated herein were intended to lower water levels and improve habitat conditions in subpopulation A and D, raise water levels to improve habitat conditions in subpopulations C and F, and minimize impacts to subpopulations B and E. Our objective in this analysis was to compare these scenarios utilizing a set of metrics (short- to long-time scales) that relate habitat suitability to hydrologic conditions. Although hydrologic outputs are similar across scenarios in subpopulation A, scenario R2H reaches the hydroperiod and depth suitability targets more than the other scenarios relative to ECB, while minimizing negative consequences to subpopulation E. However, although R2H hydroperiods are longer than those for ECB during the wet season in subpopulations C and F, depths during the breeding season are predicted to decrease in suitability (less than -50 cm) relative to existing conditions.

Exercise, appetite and weight management: understanding the compensatory responses in eating behaviour and how they contribute to variability in exercise-induced weight loss.

PubMed

King, N A; Horner, K; Hills, A P; Byrne, N M; Wood, R E; Bryant, E; Caudwell, P; Finlayson, G; Gibbons, C; Hopkins, M; Martins, C; Blundell, J E

2012-04-01

Does exercise promote weight loss? One of the key problems with studies assessing the efficacy of exercise as a method of weight management and obesity is that mean data are presented and the individual variability in response is overlooked. Recent data have highlighted the need to demonstrate and characterise the individual variability in response to exercise. Do people who exercise compensate for the increase in energy expenditure via compensatory increases in hunger and food intake? The authors address the physiological, psychological and behavioural factors potentially involved in the relationship between exercise and appetite, and identify the research questions that remain unanswered. A negative consequence of the phenomena of individual variability and compensatory responses has been the focus on those who lose little weight in response to exercise; this has been used unreasonably as evidence to suggest that exercise is a futile method of controlling weight and managing obesity. Most of the evidence suggests that exercise is useful for improving body composition and health. For example, when exercise-induced mean weight loss is <1.0 kg, significant improvements in aerobic capacity (+6.3 ml/kg/min), systolic (-6.00 mm Hg) and diastolic (-3.9 mm Hg) blood pressure, waist circumference (-3.7 cm) and positive mood still occur. However, people will vary in their responses to exercise; understanding and characterising this variability will help tailor weight loss strategies to suit individuals.

Spatio-Temporal Variation in Length-Weight Relationships and Condition of the Ribbonfish Trichiurus lepturus (Linnaeus, 1758): Implications for Fisheries Management.

PubMed

Al Nahdi, Abdullah; Garcia de Leaniz, Carlos; King, Andrew J

2016-01-01

Knowledge of length-weight relationships for commercially exploited fish is an important tool for assessing and managing of fish stocks. However, analyses of length-weight relationship fisheries data typically do not consider the inherent differences in length-weight relationships for fish caught from different habitats, seasons, or years, and this can affect the utility of these data for developing condition indices or calculating fisheries biomass. Here, we investigated length-weight relationships for ribbonfish Trichiurus lepturus in the waters of the Arabian Sea off Oman collected during three periods (2001-02, 2007-08, and 2014-15) and showed that a multivariate modelling approach that considers the areas and seasons in which ribbonfish were caught improved estimation of length-weight relationships. We used the outputs of these models to explore spatio-temporal variations in condition indices and relative weights among ribbonfish, revealing fish of 85-125 cm were in the best overall condition. We also found that condition differed according to where and when fish were caught, with condition lowest during spring and pre-south-west monsoon periods and highest during and after the south-west monsoons. We interpret these differences to be a consequence of variability in temperature and food availability. Based on our findings, we suggest fishing during seasons that have the lowest impact on fish condition and which are commercially most viable; such fishery management would enhance fisheries conservation and economic revenue in the region.

Biodiversity management of organic orchard enhances both ecological and economic profitability.

PubMed

Meng, Jie; Li, Lijun; Liu, Haitao; Li, Yong; Li, Caihong; Wu, Guanglei; Yu, Xiaofan; Guo, Liyue; Cheng, Da; Muminov, Mahmud A; Liang, Xiaotian; Jiang, Gaoming

2016-01-01

Organic farming has been regarded as an alternative solution for both agricultural sustainability and human health maintenance. Few researches have concentrated on the differences of biodiversity and eco-economic benefits between organic and conventional orchards. Organic management (OM) of orchards mainly includes taking advantage of natural enemies and beneficial weeds as well as soil organisms and controlling harmful pests. Here we conducted a three-year experiment on the effects of managing biodiversity in an organic apple orchard, using cattle manure to enrich soil biota, propagating native plant to suppress weeds and applying ecological pest management to control pests. The effect was assessed against the conventional management (CM) model. We found that OM enhanced soil organic carbon, total nitrogen, microbial biomass carbon and nitrogen. The 16S rDNA high-throughput sequencing results indicated that the dominant bacterial phyla of the top soil were Proteobacteria and Actinobacteria, and OM had richer bacteria diversity with a 7% higher Shannon's index than the CM. In particular, the relative abundance of rhizobium in the OM was higher than that of the CM. For OM, Duchesnea indica was an ideal ground-cover plant to control weeds through winning the niche competition and thus decreased weeds' Simpson, Shannon-Wiener and Pielou index by 38.2%, 53.8% and 16.9% separately. The phototactic pests' weight and scarab beetle's population were effectively decreased by 35% and 86% respectively through long time control and prevention. OM had an average of 20 times more earthworms than CM, and the maximum density had reached 369 m(-2) (0-20 cm soil). The dominant earthworm species of the OM were detritivores which preferring soil with high organic matter content. Due to no synthetic chemicals being used, the OM produced much safer apple fruits which were sold at high prices. Economically, up to a 103% increase of output-input ratio had been achieved in the OM. Our study clearly demonstrated that biodiversity management without chemical pollution increased the biodiversity of beneficial organisms, reduced antagonists of the fruit tree, and enhanced economic benefits of the apple orchard.

Biodiversity management of organic orchard enhances both ecological and economic profitability

PubMed Central

Meng, Jie; Li, Lijun; Liu, Haitao; Li, Yong; Li, Caihong; Wu, Guanglei; Yu, Xiaofan; Guo, Liyue; Cheng, Da; Muminov, Mahmud A.; Liang, Xiaotian

2016-01-01

Organic farming has been regarded as an alternative solution for both agricultural sustainability and human health maintenance. Few researches have concentrated on the differences of biodiversity and eco-economic benefits between organic and conventional orchards. Organic management (OM) of orchards mainly includes taking advantage of natural enemies and beneficial weeds as well as soil organisms and controlling harmful pests. Here we conducted a three-year experiment on the effects of managing biodiversity in an organic apple orchard, using cattle manure to enrich soil biota, propagating native plant to suppress weeds and applying ecological pest management to control pests. The effect was assessed against the conventional management (CM) model. We found that OM enhanced soil organic carbon, total nitrogen, microbial biomass carbon and nitrogen. The 16S rDNA high-throughput sequencing results indicated that the dominant bacterial phyla of the top soil were Proteobacteria and Actinobacteria, and OM had richer bacteria diversity with a 7% higher Shannon’s index than the CM. In particular, the relative abundance of rhizobium in the OM was higher than that of the CM. For OM, Duchesnea indica was an ideal ground-cover plant to control weeds through winning the niche competition and thus decreased weeds’ Simpson, Shannon–Wiener and Pielou index by 38.2%, 53.8% and 16.9% separately. The phototactic pests’ weight and scarab beetle’s population were effectively decreased by 35% and 86% respectively through long time control and prevention. OM had an average of 20 times more earthworms than CM, and the maximum density had reached 369 m−2 (0–20 cm soil). The dominant earthworm species of the OM were detritivores which preferring soil with high organic matter content. Due to no synthetic chemicals being used, the OM produced much safer apple fruits which were sold at high prices. Economically, up to a 103% increase of output–input ratio had been achieved in the OM. Our study clearly demonstrated that biodiversity management without chemical pollution increased the biodiversity of beneficial organisms, reduced antagonists of the fruit tree, and enhanced economic benefits of the apple orchard. PMID:27366643

Contingency management for substance use disorders in Spain: Implications for research and practice.

PubMed

Secades-Villa, Roberto; García-Rodríguez, Olaya; Fernández-Hermida, José R

2015-11-01

We provide a narrative review of published studies evaluating voucher-based contingency management (CM) treatment for cocaine, nicotine and cannabis use disorders in Spain and discuss the concerns and future challenges. Published studies between 2008 and 2015 that evaluated the impact of incentives for SUD in Spain and included an appropriate control or comparison condition were identified and reviewed. Adding voucher-based CM to standard treatments obtained better treatment retention and cocaine abstinence than standard care alone. CM also improved psychosocial functioning. Economic status or depressive symptoms did not affect the results of CM treatment for cocaine dependence. The addition of a CM protocol to cognitive behavioral treatment (CBT) also improved treatment effectiveness for smoking cessation. Available data on the effect of CM on cannabis use disorders (CUD) with young people did not allow confirmation of its superiority to date. The research conducted to date in Spain confirms and expands the findings of studies conducted in the US supporting the effectiveness of CM in the context of community settings with cocaine- and nicotine-dependents. However, CM has not yet been readily adopted into general clinical practice in Spain or the rest of Europe. The limited effectiveness of CM for CUD is likely due to the scarcity of data and may change with more studies, taking into account recent research on this topic in the US. Continued efforts are warranted to further develop and disseminate incentive-based treatments for SUD across clinical settings and populations in Spain. Copyright © 2015 Elsevier Inc. All rights reserved.

Clinician-delivered contingency management increases engagement and attendance in drug and alcohol treatment.

PubMed

Fitzsimons, Heather; Tuten, Michelle; Borsuk, Courtney; Lookatch, Samantha; Hanks, Lisa

2015-07-01

This study examined the impact of a low-cost contingency management (CM) delivered by program clinicians on treatment attendance and utilization for patients enrolled in outpatient psychosocial substance abuse treatment. The study used a pre-posttest design to compare substance abuse patients who received Reinforcement-Based Treatment (RBT) plus low cost CM (n=130; RBT+CM) to patients who received RBT only (n=132, RBT). RBT+CM participants received a $10 incentive for returning to treatment the day following intake assessment (day one), and a $15 incentive for attending treatment on day five following admission. RBT clients received standard care intervention without the addition of the CM procedures. Groups were compared on proportion of participants who returned to treatment on day one, mean days of treatment attendance, individual sessions attended, and treatment utilization during the first week and the first month following treatment admission. Both the RBT+CM and RBT group participants returned to the clinic on day one at high rates (95% versus 89%, respectively). However, the RBT group participants were more likely to attend the intake assessment only (i.e., never return to treatment) compared to the RBT+CM participants. Additionally, the RBT+CM participants attended significantly more treatment days, attended more individual counseling sessions, and had higher rates of overall treatment utilization compared to the RBT participants during the one week and one month following treatment admission. Findings support the feasibility and effectiveness of a CM intervention delivered by clinicians for increasing treatment attendance and utilization in a community substance abuse program. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Complementary Medicine and the Role of Oncology Nurses in an Acute Care Hospital: The Gap Between Attitudes and Practice.

PubMed

Admi, Hanna; Eilon-Moshe, Yael; Ben-Arye, Eran

2017-09-01

To describe hospital nurses' knowledge, attitudes, and practices regarding complementary medicine (CM); to compare the knowledge and attitudes of nurse managers to staff nurses with diverse oncology experience; and to assess attitudes toward integrating CM into the role of the hospital oncology nurse. 
. Descriptive, cross-sectional study.
. Rambam Health Care Campus in northern Israel.
. A convenience sample of 434 hospital nurses with varied oncology experience.
. Nurses completed a knowledge and attitude questionnaire developed for the current study. Data were analyzed using parametric and nonparametric statistical tests. 
. Hospital nurses' knowledge of and attitudes toward CM, and attitudes toward integrating CM into the role of the hospital oncology nurse.
. Nurses lack knowledge and are unaware of the risks associated with CM. However, they believe this approach can improve the quality of life of patients with cancer; 51% expressed an interest in receiving training. Oncology nurses were ambivalent about the feasibility of applying an integrative approach, whereas nurse managers expressed significantly more positive attitudes toward integrating CM within the scope of nursing practices.
. A large discrepancy remains between nurses' strong interest in CM and awareness of associated benefits, and their ambivalence toward its integration in their nursing practice. 
. Although improving nurses' knowledge should be mandatory, it remains insufficient; a shift in the approach to integrating CM into conventional health care is needed, from practitioners' responsibility to healthcare policymakers' responsibility. Legislations and policies are necessary, along with providing respectable infrastructures.

A Perfect Platform: Combining Contingency Management with Medications for Drug Abuse

PubMed Central

Carroll, Kathleen M.; Rounsaville, Bruce J.

2008-01-01

Contingency management (CM) procedures, which provide concrete reinforcers or rewards contingent on verification of discrete targeted behaviors, such as drug-free urines, have been demonstrated to be effective in a number of clinical trials. However, to date there have been only a few that have capitalized on the unique strengths and capabilities of CM as an ideal platform to improve response to or address weaknesses of many pharmacotherapies used in the treatment of drug abuse. In this review, we describe the multiple potential uses of CM as a platform for pharmacotherapy, including reducing illicit drug use in the context of agonist therapies; fostering medication compliance with antagonists, aversive agents and HIV medications; fostering a period of abstinence prior to initiation of agents used to treat comorbid psychiatric conditions or in the context of vaccines to foster adequate periods of abstinence while titer levels are building; and to enhance the effectiveness of anticraving agents through additive or synergistic effects. Although its multiple strengths render it an almost perfect platform, CM does have some weaknesses that have limited its use to date, including cost, the short-term nature of its effects, and need for training. Future treatment development of CM as a medication platform needs to counter these issues by focusing on CM applications with large potential benefit, developing simple or automated methods for CM delivery and placing greater emphasis on the process of transitioning away from formal CM treatment. PMID:17613963

A review of the literature on contingency management in the treatment of substance use disorders, 2009–2014

PubMed Central

Davis, Danielle R.; Kurti, Allison N.; Skelly, Joan M.; Redner, Ryan; White, Thomas J.; Higgins, Stephen T.

2017-01-01

This report describes a systematic literature review of voucher and related monetary-based contingency management (CM) interventions for substance use disorders (SUDs) over 5.2 years (November 2009 through December 2014). Reports were identified using the search engine PubMed, expert consultations, and published bibliographies. For inclusion, reports had to (a) involve monetary-based CM; (b) appear in a peer-reviewed journal; (c) include an experimental comparison condition; (d) describe an original study; (e) assess efficacy using inferential statistics; (f) use a research design allowing treatment effects to be attributed to CM. Sixty-nine reports met inclusion criteria and were categorized into 7 research trends: (1) extending CM to special populations, (2) parametric studies, (3) extending CM to community clinics, (4) combining CM with pharmacotherapies, (5) incorporating technology into CM, (6) investigating longer-term outcomes, (7) using CM as a research tool. The vast majority (59/69, 86%) of studies reported significant (p < 0.05) during-treatment effects. Twenty-eight (28/59, 47%) of those studies included at least one follow-up visit after CM was discontinued, with eight (8/28, 29%) reporting significant (p < 0.05) effects. Average effect size (Cohen’s d) during treatment was 0.62 (95% CI: 0.54, 0.70) and post-treatment it was 0.26 (95% CI: 0.11, 0.41). Overall, the literature on voucher-based CM over the past 5 years documents sustained growth, high treatment efficacy, moderate to large effect sizes during treatment that weaken but remain evident following treatment termination, and breadth across a diverse set of SUDs, populations, and settings consistent with and extending results from prior reviews. PMID:27514250

Performance mapping of a 30 cm engineering model thruster

NASA Technical Reports Server (NTRS)

Poeschel, R. L.; Vahrenkamp, R. P.

1975-01-01

A 30 cm thruster representative of the engineering model design has been tested over a wide range of operating parameters to document performance characteristics such as electrical and propellant efficiencies, double ion and beam divergence thrust loss, component equilibrium temperatures, operational stability, etc. Data obtained show that optimum power throttling, in terms of maximum thruster efficiency, is not highly sensitive to parameter selection. Consequently, considerations of stability, discharge chamber erosion, thrust losses, etc. can be made the determining factors for parameter selection in power throttling operations. Options in parameter selection based on these considerations are discussed.

Muon collider interaction region design

DOE PAGES

Alexahin, Y. I.; Gianfelice-Wendt, E.; Kashikhin, V. V.; ...

2011-06-02

Design of a muon collider interaction region (IR) presents a number of challenges arising from low β* < 1 cm, correspondingly large beta-function values and beam sizes at IR magnets, as well as the necessity to protect superconducting magnets and collider detectors from muon decay products. As a consequence, the designs of the IR optics, magnets and machine-detector interface are strongly interlaced and iterative. A consistent solution for the 1.5 TeV center-of-mass muon collider IR is presented. It can too provide an average luminosity of 10 34 cm -2s -1 with an adequate protection of magnet and detector components.

41 CFR 302-14.7 - Are there tax consequences when I receive a home marketing incentive payment?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false Are there tax consequences when I receive a home marketing incentive payment? 302-14.7 Section 302-14.7 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES...

Effect of case management on glycemic control and behavioral outcomes for chinese people with type 2 diabetes: A 2-year study.

PubMed

Yuan, Xiaodan; Wang, Fengmei; Fish, Anne Folta; Xue, Cunyi; Chen, Tao; Liu, Chao; Lou, Qingqing

2016-08-01

To examine the effect of case management on glycemic control and behavioral outcomes in adults with Type 2 diabetes in China. Participants were randomly assigned to a 1-year case management (CM) group (n=60) or control group (n=60). Monthly case management visits included identifying individuals' diabetes-related problems, setting goals, planning self-care, and evaluating progress. During a 1-year follow-up, all participants attended visits every 3 months without intervention. In the CM vs. the control group, HbA1c was reduced at 6 months compared to baseline (P=0.034), with trends at 12 and 24 months, and empowerment ability improved (P<0.05). Also in the CM vs. controls, total self-care behaviors, the frequency of exercise, blood glucose testing, and foot care were higher (P<0.001) at 12 months, and the percentage of individuals with HbA1c ≤7.0% was higher (P=0.035) at 24 months. The case management intervention in China was effective at 6 months and, based on trends in HbA1c at 12 and 24 months and results for behavioral outcomes, the intervention shows promise and warrants more research. A case management approach can enhance behavior change and glycemic control in Chinese with diabetes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Action errors, error management, and learning in organizations.

PubMed

Frese, Michael; Keith, Nina

2015-01-03

Every organization is confronted with errors. Most errors are corrected easily, but some may lead to negative consequences. Organizations often focus on error prevention as a single strategy for dealing with errors. Our review suggests that error prevention needs to be supplemented by error management--an approach directed at effectively dealing with errors after they have occurred, with the goal of minimizing negative and maximizing positive error consequences (examples of the latter are learning and innovations). After defining errors and related concepts, we review research on error-related processes affected by error management (error detection, damage control). Empirical evidence on positive effects of error management in individuals and organizations is then discussed, along with emotional, motivational, cognitive, and behavioral pathways of these effects. Learning from errors is central, but like other positive consequences, learning occurs under certain circumstances--one being the development of a mind-set of acceptance of human error.

40 CFR 68.165 - Offsite consequence analysis.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 15 2011-07-01 2011-07-01 false Offsite consequence analysis. 68.165 Section 68.165 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.165 Offsite consequence...

40 CFR 68.165 - Offsite consequence analysis.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Offsite consequence analysis. 68.165 Section 68.165 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.165 Offsite consequence...

A novel symbiotic organisms search algorithm for congestion management in deregulated environment

NASA Astrophysics Data System (ADS)

Verma, Sumit; Saha, Subhodip; Mukherjee, V.

2017-01-01

In today's competitive electricity market, managing transmission congestion in deregulated power system has created challenges for independent system operators to operate the transmission lines reliably within the limits. This paper proposes a new meta-heuristic algorithm, called as symbiotic organisms search (SOS) algorithm, for congestion management (CM) problem in pool based electricity market by real power rescheduling of generators. Inspired by interactions among organisms in ecosystem, SOS algorithm is a recent population based algorithm which does not require any algorithm specific control parameters unlike other algorithms. Various security constraints such as load bus voltage and line loading are taken into account while dealing with the CM problem. In this paper, the proposed SOS algorithm is applied on modified IEEE 30- and 57-bus test power system for the solution of CM problem. The results, thus, obtained are compared to those reported in the recent state-of-the-art literature. The efficacy of the proposed SOS algorithm for obtaining the higher quality solution is also established.

A novel symbiotic organisms search algorithm for congestion management in deregulated environment

NASA Astrophysics Data System (ADS)

Verma, Sumit; Saha, Subhodip; Mukherjee, V.

2017-01-01

In today's competitive electricity market, managing transmission congestion in deregulated power system has created challenges for independent system operators to operate the transmission lines reliably within the limits. This paper proposes a new meta-heuristic algorithm, called as symbiotic organisms search (SOS) algorithm, for congestion management (CM) problem in pool-based electricity market by real power rescheduling of generators. Inspired by interactions among organisms in ecosystem, SOS algorithm is a recent population-based algorithm which does not require any algorithm specific control parameters unlike other algorithms. Various security constraints such as load bus voltage and line loading are taken into account while dealing with the CM problem. In this paper, the proposed SOS algorithm is applied on modified IEEE 30- and 57-bus test power system for the solution of CM problem. The results, thus, obtained are compared to those reported in the recent state-of-the-art literature. The efficacy of the proposed SOS algorithm for obtaining the higher quality solution is also established.

Adaptability of contingency management in justice settings: survey findings on attitudes toward using rewards.

PubMed

Murphy, Amy; Rhodes, Anne Giuranna; Taxman, Faye S

2012-09-01

Contingency management (CM) is widely recognized as an evidence-based practice, but it is not widely used in either treatment settings or justice settings. CM is perceived as adaptable in justice settings given the natural inclination to use contingencies to improve compliance to desired behaviors. In the Justice Steps implementation study, 5 federal district court jurisdictions agreed to consider implementing CM in specialized problem-solving courts or probation settings. A baseline survey (N = 186) examined the acceptance and feasibility of using rewards as a tool to manage offender compliance. The results of the survey revealed that most of the respondents believe that rewards are acceptable, with little difference between social and material rewards. Survey findings also showed that female justice workers and those who were not probation officers were more accepting of material rewards than their counterparts. Findings are consistent with prior research in drug treatment settings where there is little concern about using rewards. Copyright © 2012 Elsevier Inc. All rights reserved.

Adaptability of Contingency Management in Justice Settings: Survey Findings on Attitudes Towards Using Rewards

PubMed Central

Murphy, Amy; Rhodes, Anne Giuranna; Taxman, Faye S.

2011-01-01

Contingency management (CM) is widely recognized as an evidence-based practice, but it is not widely used in either treatment settings or justice settings. CM is perceived as adaptable in justice settings given the natural inclination to use contingencies to improve compliance to desired behaviors. In the Justice Steps implementation study, five federal district court jurisdictions agreed to consider implementing CM in specialized problem-solving courts or probation settings. A baseline survey (n=186) examined the acceptance and feasibility of using rewards as a tool to manage offender compliance. The results of the survey revealed that the majority of respondents believe that rewards are acceptable, with little difference between social and material rewards. Survey findings also showed that female justice workers and those who were not Probation Officers were more accepting of material rewards than their counterparts. Findings are consistent with prior research in drug treatment settings where there is little concern about using rewards. PMID:22209658

Contribution of the AIRS Shortwave Sounding Channels to Retrieval Accuracy

NASA Technical Reports Server (NTRS)

Susskind, Joel; Kouvaris, Louis

2006-01-01

AIRS contains 2376 high spectral resolution channels between 650/cm and 2665/cm, including channels in both the 15 micron (near 667/cm) and 4.2 micron (near 2400/cm) COP sounding bands. Use of temperature sounding channels in the 15 micron CO2 band has considerable heritage in infra-red remote sensing. Channels in the 4.2 micron CO2 band have potential advantages for temperature sounding purposes because they are essentially insensitive to absorption by water vapor and ozone, and also have considerably sharper lower tropospheric temperature sounding weighting functions than do the 15 micron temperature sounding channels. Potential drawbacks with regard to use of 4.2 micron channels arise from effects on the observed radiances of solar radiation reflected by the surface and clouds, as well as effects of non-local thermodynamic equilibrium on shortwave observations during the day. These are of no practical consequences, however, when properly accounted for. We show results of experiments performed utilizing different spectral regions of AIRS, conducted with the AIRS Science Team candidate Version 5 algorithm. Experiments were performed using temperature sounding channels within the entire AIRS spectral coverage, within only the spectral region 650/cm to 1614 /cm; and within only the spectral region 1000/cm-2665/cm. These show the relative importance of utilizing only 15 micron temperature sounding channels, only the 4.2 micron temperature sounding channels, and both, with regards to sounding accuracy. The spectral region 2380/cm to 2400/cm is shown to contribute significantly to improve sounding accuracy in the lower troposphere, both day and night.

The Effects of More Extreme Rainfall Patterns on Infiltration and Nutrient Losses in Agricultural Soils

NASA Astrophysics Data System (ADS)

Hess, L.; Basso, B.; Hinckley, E. L. S.; Robertson, G. P.; Matson, P. A.

2015-12-01

In the coming century, the proportion of total rainfall that falls in heavy storm events is expected to increase in many areas, especially in the US Midwest, a major agricultural region. These changes in rainfall patterns may have consequences for hydrologic flow and nutrient losses, especially in agricultural soils, with potentially negative consequences for receiving ground- and surface waters. We used a tracer experiment to examine how more extreme rainfall patterns may affect the movement of water and solutes through an agricultural soil profile in the upper Midwest, and to what extent tillage may moderate these effects. Two rainfall patterns were created with 5m x 5m rainout shelters at the Kellogg Biological Station LTER site in replicated plots with either conventional tillage or no-till management. Control rainfall treatments received water 3x per week, and extreme rainfall treatments received the same total amount of water but once every two weeks, to simulate less frequent but larger storms. In April 2015, potassium bromide (KBr) was added as a conservative tracer of water flow to all plots, and Br- concentrations in soil water at 1.2m depth were measured weekly from April through July. Soil water Br- concentrations increased and peaked more quickly under the extreme rainfall treatment, suggesting increased infiltration and solute transfer to depth compared to soils exposed to control rainfall patterns. Soil water Br- also increased and peaked more quickly in no-till than in conventional tillage treatments, indicating differences in flow paths between management systems. Soil moisture measured every 15 minutes at 10, 40, and 100cm depths corroborates tracer experiment results: rainfall events simulated in extreme rainfall treatments led to large increases in deep soil moisture, while the smaller rainfall events simulated under control conditions did not. Deep soil moisture in no-till treatments also increased sooner after water application as compared to in conventional soils. Our results suggest that exposure to more extreme rainfall patterns will likely increase infiltration depth and nutrient losses in agricultural soils. In particular, soils under no-till management, which leads to development of preferential flow paths, may be particularly vulnerable to vertical nutrient losses.

Quality in translation: case management in the international marketplace.

PubMed

Beichl, Lisa; Craig, Kathy

2009-01-01

This article identifies three categories of case management (CM), in-country, international, and micro, that are poised to serve as the quality proxy for the international medical patient in the rapidly emerging globalized healthcare marketplace. The content concentrates on describing in-country CM and international CM (ICM). Because CM professionals are the providers of patient-centered quality and safety improvements, they are capable of filling the chasm between the travel industry and the regulators who specialize in accrediting hospital systems. In-country and ICM case managers are equipped to perform surveillance and intervention at the level of the international patient's bedside, activate network connections, and use culture-sensitive communication skills to safeguard patients in their individual sojourns abroad. The article discusses useful concepts and sources, including an algorithmic tool under development that is geared to identify and quantify risks for lay and business individuals who seek to engage the global medical market. The article's information is provided for front-line and front-office healthcare practitioners to understand or enter the worldwide medical marketplace. Content is targeted to CM generalists, specialists, and business developers interested in learning about safeguarding the patients who travel internationally to receive medical care. It can also be applied by those within and outside the healthcare practice arena, particularly those interested in the development of quality initiatives. All research and syntheses were executed by the authors. Sources included scholarly treatises, business correspondence, medical tourism literature, corporate Internet profiles, news releases, and healthcare industry investigative and monitoring agencies. International health insurance, economics, and financing expertise stems from one author (L.B.). Clinical competencies stem from the international practice experiences of one author (K.C.). This article identifies Web sites and sources that constitute high-quality resources for ongoing reference by ICM practitioners. Two strategic tools are introduced: one for assessing the readiness of the regional marketplace for CM and the Beichl-Craig Medical Travel Risk Evaluator for international medical consumer risk identification. The emerging global healthcare marketplace is certain to change the way case managers anticipate and respond to care delivery concerns in different regional systems. A systematic structure for analyzing specific country and CM "readiness" is introduced. For case managers who assist clients to receive care internationally, the application of these concepts will help them know where a range of potential obstacles lie and how to calibrate risks and set realistic expectations. For healthcare product developers and quality analysts, the information will help stimulate discourse regarding innovative strategies, tools, and metrics geared to identify, measure, and mitigate risks for patients in the global medical marketplace.

Effect of solute lipophilicity on penetration through canine skin.

PubMed

Mills, P C; Magnusson, B M; Cross, S E

2003-12-01

To investigate the effect of lipophilicity on the percutaneous penetration of a homologous series of alcohols through canine skin. Skin harvested from Greyhound thorax was placed in Franz-type diffusion cells and the in vitro passage of radiolabelled (14C) alcohols (ethanol, butanol, hexanol and octanol (Log P 0.19-3.0)) through separate skin sections was measured in replicates of five. Permeability coefficient (kP, cm/h), maximum flux (Jmax, mol/cm2/h) and residue remaining within the skin were determined. The kP increased with increasing lipophilicity (6.2 x 10(-4) +/- 1.6 x 10(-4) cm/h for ethanol to 1.8 x 10(-2) +/- 3.6 x 10(-3) cm/h for octanol). Alcohol residues remaining within each skin sample followed a similar pattern. An exponential decrease in Jmax with increasing lipophilicity was observed. Changes in canine skin permeability occur with increasing alcohol lipophilicity. This finding has practical consequences for the design of topical formulations and optimisation of drug delivery through animal skin.

Predicting use of case management support services for adolescents and adults living in community following brain injury: A longitudinal Canadian database study with implications for life care planning.

PubMed

Baptiste, B; Dawson, D R; Streiner, D

2015-01-01

To determine factors associated with case management (CM) service use in people with traumatic brain injury (TBI), using a published model for service use. A retrospective cohort, with nested case-control design. Correlational and logistic regression analyses of questionnaires from a longitudinal community data base. Questionnaires of 203 users of CM services and 273 non-users, complete for all outcome and predictor variables. Individuals with TBI, 15 years of age and older. Out of a dataset of 1,960 questionnaires, 476 met the inclusion criteria. Eight predictor variables and one outcome variable (use or non-use of the service). Predictor variables considered the framework of the Behaviour Model of Health Service Use (BMHSU); specifically, pre-disposing, need and enabling factor groups as these relate to health service use and access. Analyses revealed significant differences between users and non-users of CM services. In particular, users were significantly younger than non-users as the older the person the less likely to use the service. Also, users had less education and more severe activity limitations and lower community integration. Persons living alone are less likely to use case management. Funding groups also significantly impact users. This study advances an empirical understanding of equity of access to health services usage in the practice of CM for persons living with TBI as a fairly new area of research, and considers direct relevance to Life Care Planning (LCP). Many life care planers are CM and the genesis of LCP is CM. The findings relate to health service use and access, rather than health outcomes. These findings may assist with development of a modified model for prediction of use to advance future cost of care predictions.

[Payment by performance to improve the nutritional status of children: impact of budget support agreements in three peruvian regions with a high prevalence of chronic malnutrition in children in 2010-2014].

PubMed

Cruzado de la Vega, Viviana

2017-01-01

To estimate the impact of a payment scheme by performance, known as a budget support agreement, applied by the government in three regions in Peru with the highest rates of chronic malnutrition (CM) in children in 2008-Apurimac, Ayacucho, and Huancavelica-on indicators of health service coverage (immunization, childhood growth and development, and iron supplementation) and the nutritional status of children (malnutrition, anemia, and diarrhea). These agreements were used to transfer resources to the budgets of these regions with the condition of fulfilling management commitments and coverage goals with a view toward improving the nutritional status of children. Based on data from the Demographic and Family Health Survey conducted from 2008 to 2014, evolution of the indicators in a sample of children residing in the areas where the support programs were signed was compared to that of a control sample in the period in which the agreements were in force and in the subsequent years to estimate differences in the impact of this support strategy. There was a positive impact of the programs on the increase in vaccination coverage provided by the basic health system and rotavirus vaccination, which consequently reduced the rates of diarrhea and malnutrition. The scheme was effective in increasing the vaccination coverage and reducing CM but did not seem to improve the coverage of other benefits, including childhood growth and iron supplementation to children and mothers.

Effects of poultry manure, compost, and biochar amendments on soil nitrogen dynamics in maize production systems

NASA Astrophysics Data System (ADS)

Ryals, R.; Tang, J.; Hastings, M. G.; Dell, C. J.; Sims, T.

2013-12-01

Intensification of animal agriculture has profound impacts on the global and local biogeochemistry of nitrogen (N), resulting in consequences to environmental and human health. In the Chesapeake Bay watershed, intensive agriculture is the primary contributor to N pollution, with animal manure comprising more than half of N from agriculture. Management interventions may play an important role in mitigating reactive N pollution in the Bay watershed. The objective of our research was to test management strategies that maximize benefits of poultry manure as an agricultural resource while minimizing it as a source of reactive nitrogen to the atmosphere and ground and surface waters. We conducted field experiments in two agricultural regions of the Chesapeake Bay watershed (Georgetown, Delaware and State College, Pennsylvania) to explore the effects of poultry manure amendments on gaseous N losses and soil N transformations. Treatments were applied at rates needed to meet the plant N demand at each site and included unfertilized controls, fertilizer N (urea), and raw, composted, or and biocharred poultry manure. The fate of the N from all sources was followed throughout the growing season. Global greenhouse gases emitted from soil (nitrous oxide [N2O] and carbon dioxide [CO2]) and regional air pollutants (nitrogen oxides [NOx] and ammonia [NH3]) were measured. Gas measurements were coupled with data on treatment effects on temperature, moisture, and concentrations of nitrate (NO3¬-) and ammonium (NH4+) in surface soils (0-10 cm). Soil NO3- and NH4+ were also measured approximately monthly in the soil profile (0-10, 10-30, 30-50, 50-70, and 70-100 cm) as an index of leaching potential. Plant N uptake and grain production were also quantified to quantify crop N use efficiency and compare measured N losses for each N source. Our results suggest that the form of poultry manure amendments can affect the magnitude of reactive N losses to the environment.

Occupational Stress in Secondary Education in Cyprus: Causes, Symptoms, Consequences and Stress Management

ERIC Educational Resources Information Center

Hadjisymeou, Georgia

2010-01-01

The survey attempted to look into the causes, symptoms and consequences that occupational stress has on teachers in Secondary Education in Cyprus and find ways to manage it. Thirty eight schools with 553 teachers participated in the survey. The sample chosen is a result of a simple random sampling and it is representative of the country's…

Changes in quantity and spectroscopic properties of water-extractable organic matter during soil aquifer treatment.

PubMed

Xue, S; Zhao, Q L; Wei, L L; Ma, X P; Tie, M

2013-01-01

The aim of this study was to identify qualitative and quantitative changes in the character of water-extractable organic matter (WEOM) in soils as a consequence of soil aquifer treatment (SAT). Soil samples were obtained from a soil-column system with a 2-year operation, and divided into seven layers from top to bottom: CS1 (0-12.5 cm), CS2 (12.5-25 cm), CS3 (25-50 cm), CS4 (50-75 cm), CS5 (75-100 cm), CS6 (100-125 cm) and CS7 (125-150 cm). A sample of the original soil used to pack the columns was also analysed to determine the effects of SAT. Following 2 years of SAT operation, both soil organic carbon and water-extractable organic carbon were shown to accumulate in the top soil layer (0-12.5 cm), and to decrease in soil layers deeper than 12.5 cm. The WEOM in the top soil layer was characterized by low aromaticity index (AI), low emission humification index (HIX) and low fluorescence efficiency index (F(eff)). On the other hand, the WEOM in soil layers deeper than 12.5 cm had increased values of HIX and F(eff), as well as decreased AI values relative to the original soil before SAT. In all soil layers, the percentage of hydrophobic and transphilic fractions decreased, while that of the hydrophilic fraction increased, as a result of SAT. The production of the amide-2 functional groups was observed in the top soil layer. SAT operation also led to the enrichment of hydrocarbon and amide-1 functional groups, as well as the depletion of oxygen-containing functional groups in soil layers deeper than 12.5 cm.

Managing complex, high-output, enterocutaneous fistulas: a case study.

PubMed

Hahler, Barbara; Schassberger, Debra; Novakovic, Rachel; Lang, Stephanie

2009-10-15

Gastrointestinal (GI) fistulas are an uncommon but serious complication. Following diagnosis, management strategies may have to be adapted frequently to address changes in fistula output, surrounding skin or wound condition, overall patient clinical and nutritional status, mobility level, and body contours. Following a motor vehicle accident, a 49-year-old man with a body mass index of 36.8 and a history of multiple previous surgeries, including gastric bypass, experienced excessive output from a fistula within a large open abdominal wound measuring 45 cm x 40 cm x 5 cm. Abdominal creases and the need to protect a split-thickness skin graft of the wound surrounding his fistula complicated wound management. During his prolonged 4-month hospital stay, the patient underwent several surgical procedures, repeated wound debridement, and various nutritional support interventions; a wide variety of wound and fistula management systems were utilized. One year after the initial trauma, the fistula was surgically closed. One week later, the patient died from a cardiac event. This case study confirms that GI fistulas increase costs of care and hospital length of stay and require the experience and expertise of a wide array of patient support staff members and clinicians.

Tailored minimally invasive management of complex calculi in horseshoe kidney.

PubMed

Ding, Jie; Zhang, Yuanyuan; Cao, Qifeng; Huang, Tao; Xu, Wei; Huang, Kai; Fang, Jing; Bai, Qiang; Qi, Jun; Huang, Yunteng

2015-01-01

Complex calculi in horseshoe kidney (HK) present a significant management challenge. Here, we report the clinical efficacy of extracorporeal shock wave lithotripsy (ESWL), minimally invasive percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy (FURS), combined with holmium laser lithotripsy, in the treatment of calculi in HK. From January 2005 to May 2014, 62 HK patients with renal calculi were reviewed in terms of medical history, treatment modality and therapeutic outcome in a single tertiary care hospital. Among the patients, 11 with a solitary stone ≤ 1.5 cm in diameter received ESWL, leading to overall stone-free rate of 72.7%; 18 with stone diameter ≤ 2-3 cm received retrograde flexible ureteroscopy, with a recorded mean digitized surface area (DSA) of 339.6 ± 103.9 mm2, mean operation time of 93.1 ± 11.5 minutes and overall stone-free rate of 88.9%; and 33 with staghorn or complex calculi (d ≥ 2 cm) had MPCNL or MPCNL-FURS, with a recorded mean DSA of 691.0 ± 329.9 vs. 802.9 ± 333.3 mm2, mean operation time of 106.4 ± 16.6 vs. 124.4 ± 15.1 min and overall stone-free rate of 89.5% vs. 92.9%. For complex calculi (d ≥ 2 cm), MPCNL combined with antegrade FURS was superior in terms of reducing number of tracts, controlling mean hemoglobin drop, but required longer operation time, comparing with MPCNL alone. As minimally invasive treatments, a combination of MPCNL and antegrade FURS provides a safe and effective modality in the management of staghorn or complex calculi (d ≥ 2 cm) in HK with significantly reduced blood loss comparing to MPCNL alone, and retrograde FURS alone is favorable for stones with a diameter ≤ 2-3 cm. ESWL is effective for viable small solitary stones (d ≤ 1.5 cm). Treatment modality should be tailored based on individual condition.

Preventive medicine for von Hippel-Lindau disease-associated pancreatic neuroendocrine tumors.

PubMed

Krauss, Tobias; Ferrara, Alfonso Massimiliano; Links, Thera P; Wellner, Ulrich; Bancos, Irina; Kvachenyuk, Andrey; Villar Gómez de Las Heras, Karina; Yukina, Marina; Petrov, Roman; Bullivant, Garrett; von Duecker, Laura; Jadhav, Swati S; Ploeckinger, Ursula; Welin, Staffan; Schalin-Jantti, Camilla; Gimm, Oliver; Pfeifer, Marija; Ngeow, Joanne; Hasse-Lazar, Kornelia; Sanso, Gabriela; Qi, Xiao-Ping; Ugurlu, Umit; Diaz, Rene Eduardo; Wohllk, Nelson; Peczkowska, Mariola; Aberle, Jens; Lourenço, Delmar Muniz; Pereira, Maria Adelaide; Fragoso, Maria Candida Barisson Villares; Hoff, Ana O; Almeida, Madson Queiroz; Violante, Alice H D; Quidute, Ana R P; Zhang, Zheiwei; Recasens, Monica; Robles Diaz, Luis; Kunavisarut, Tada; Wannachalee, Taweesak; Sirinvaravong, Sirinart; Jonasch, Eric; Grozinsky-Glasberg, Simona; Fraenkel, Merav; Beltsevich, Dmitry; Egorov, Viacheslav I; Bausch, Dirk; Schott, Matthias; Tiling, Nikolaus; Pennelli, Gianmaria; Zschiedrich, Stefan; Därr, Roland; Ruf, Juri; Denecke, Timm; Link, Karl-Heinrich; Zovato, Stefania; von Dobschuetz, Ernst; Yaremchuk, Svetlana; Amthauer, Holger; Makay, Ozer; Patocs, Attila; Walz, Martin K; Huber, Tobias B; Seufert, Jochen; Hellman, Per; Kim, Raymond H; Kuchinskaya, Ekaterina; Schiavi, Francesca; Malinoc, Angelica; Reisch, Nicole; Jarzab, Barbara; Barontini, Marta; Januszewicz, Andrzej; Shah, Nalini; Young, William; Opocher, Giuseppe; Eng, Charis; Neumann, Hartmut P H; Bausch, Birke

2018-05-10

Pancreatic neuroendocrine tumors (PanNETs) are rare in von Hippel-Lindau disease (VHL) but cause serious morbidity and mortality. Management guidelines for VHL-PanNETs continue to be based on limited evidence, and survival data to guide surgical management are lacking. We established the European-American-Asian-VHL-PanNET-Registry to assess data for risks for metastases, survival and long-term outcomes to provide best management recommendations. Of 2,330 VHL patients, 273 had a total of 484 PanNETs. Median age at diagnosis of PanNET was 35 years (range 10-75). Fifty-five (20%) patients had metastatic PanNETs. Metastatic PanNETs were significantly larger (median size 5 vs 2 cm; P<0.001) and tumor volume doubling time (TVDT) was faster (22 vs 126 months; P=0.001). All metastatic tumors were ≥2.8 cm. Codons 161 and 167 were hotspots for VHL germline mutations with enhanced risk for metastatic PanNETs. Multivariate prediction modeling disclosed maximum tumor diameter and TVDT as significant predictors for metastatic disease (positive and negative predictive values of 51% and 100% for diameter cutoff ≥2.8 cm, 44% and 91% for TVDT cutoff of ≤24 months). In 117/273 patients, PanNETs >1.5 cm in diameter were operated. Ten-year survival was significantly longer in operated vs non-operated patients, in particular for PanNETs <2.8cm vs ≥2.8 cm (94% vs 85% by 10 years; P=0.020; 80% vs 50% at 10 years; P=0.030). This study demonstrates that patients with PanNET approaching the cut-off diameter of 2.8 cm should be operated. Mutations in exon 3, especially of codons 161/167 are at enhanced risk for metastatic PanNETs. Survival is significantly longer in operated non-metastatic VHL-PanNETs.

Quality assurance planning for lunar Mars exploration

NASA Technical Reports Server (NTRS)

Myers, Kay

1991-01-01

A review is presented of the tools and techniques required to meet the challenge of total quality in the goal of traveling to Mars and returning to the moon. One program used by NASA to ensure the integrity of baselined requirements documents is configuration management (CM). CM is defined as an integrated management process that documents and identifies the functional and physical characteristics of a facility's systems, structures, computer software, and components. It also ensures that changes to these characteristics are properly assessed, developed, approved, implemented, verified, recorded, and incorporated into the facility's documentation. Three principal areas are discussed that will realize significant efficiencies and enhanced effectiveness, change assessment, change avoidance, and requirements management.

Obesity Cardiometabolic Comorbidity Prevalence in Children in a Rural Weight-Management Program.

PubMed

O'Hara, Valerie; Browne, Nancy; Fathima, Samreen; Sorondo, Barbara; Bayleran, Janet; Johnston, Starr; Hastey, Kathrin

2017-01-01

This descriptive study examines the prevalence of obesity-related cardiometabolic (CM) risk factors using CM laboratory metrics, in 3 to 19 year olds presenting to a rural American Academy of Pediatrics stage 3 multidisciplinary weight management clinic based on gender, age ranges, and obesity classes. From 2009 to 2016, 382 children (body mass index ≥85th percentile) enrolled. Multiple logistic regression determined the effects of age, gender, or obesity class on CM risk factors. Odds of elevated insulin were more significant in 15 to 19 year olds than in 3 to 5 year olds, or in 6 to 11 year olds. Obesity class III had higher odds than class II, class I, and overweight in having elevated insulin; twice likely than class II for having low high-density lipoprotein; and twice as likely than class I for high triglycerides. Adolescents and obesity class III categories have significant CM risk but the burden in younger and less severe obesity cohorts cannot be underestimated.

Sedimentation rates in the marshes of Sand Lake National Wildlife Refuge

USGS Publications Warehouse

Gleason, R.A.; Euliss, N.H.; Holmes, C.W.

2003-01-01

Impoundments located within river systems in the Northern Great Plains are vulnerable to sediment inputs because intensive agriculture in watersheds has increased soil erosion and sediments in rivers. At the request of the U.S. Fish and Wildlife Service (FWS), we evaluated the vertical accretion of sediment in the Mud Lake impoundment of Sand Lake National Wildlife Refuge (NWR), Brown County, South Dakota. The Mud Lake impoundment was created in 1936 by constructing a low-head dam across the James River. We collected sediment cores from the Mud Lake impoundment during August 2000 for determination of vertical accretion rates. Accretion rates were estimated using cesium-13 7 and lead-210 isotopic dating techniques to estimate sediment accretion over the past 100 years. Accretion rates were greatest near the dam (1.3 cm yr-1) with less accretion (0.2 cm yr-1) occurring in the upper reaches of Mud Lake. As expected, accretion was highest near the dam where water velocities and greater water depth facilitates sediment deposition. Higher rates of sedimentation (accretion> 2.0 cm year-1) occurred during the 1990s when river flows were especially high. Since 1959, sediment accretion has reduced maximum pool depth of Mud Lake near the dam by 55 cm. Assuming that sediment accretion rates remain the same in the future, we project Mud Lake will have a maximum pool depth of 77 and 51 cm by 2020 and 2040, respectively. Over this same time frame, water depths in the upper reaches of Mud Lake would be reduced to< 2 cm. Projected future loss of water depth will severely limit the ability of managers to manipulate pool levels in Mud Lake to cycle vegetation and create interspersion of cover and water to meet current wildlife habitat management objectives. As predicted for major dams constructed on rivers throughout the world, Mud Lake will have a finite life span. Our data suggests that the functional life span of Mud Lake since construction will be < 100 years. We anticipate that over the next 20 years, sediments entering Mud Lake will reduce water depths to the point that current wildlife management objectives cannot be achieved through customary water-level manipulations. Sedimentation impacts are not unique to the Sand Lake NWR. It is widely accepted that impoundments trap sediments and shallow impoundments, such as those managed by the FWS, are especially vulnerable. Given the ecological impacts associated with loss of water depths, we recommend that managers begin evaluating the long-term wildlife management goals for the refuge relative to associated costs and feasibility of options available to enhance and maximize the life span of existing impoundments, including upper watershed management.

Healthcare managers in negative media focus: a qualitative study of personification processes and their personal consequences

PubMed Central

2014-01-01

Background Over the last decade healthcare management and managers have increasingly been in focus in public debate. The purpose of the present study was to gain a deeper understanding of how prolonged, unfavorable media focus can influence both the individual as a person and his or her managerial practice in the healthcare organization. Methods In-depth interviews (n = 49) with 24 managers and their superiors, or subordinate human resources/information professionals, and partners were analyzed using a grounded theory approach. Results The conceptual model explains how perceived uncertainties related to the managerial role influence personification and its negative consequences. The role ambiguities comprised challenges regarding the separation of individual identity from the professional function, the interaction with intra-organizational support and political play, and the understanding and acceptance of roles in society. A higher degree of uncertainty in role ambiguity increased both personification and the personal reaction to intense media pressure. Three types of reactions were related to the feeling of being infringed: avoidance and narrow-mindedness; being hard on self, on subordinates, and/or family members; and resignation and dejection. The results are discussed so as to elucidate the importance of support from others within the organization when under media scrutiny. Conclusions The degree of personification seems to determine the personal consequences as well as the consequences for their managerial practice. Organizational support for managers appearing in the media would probably be beneficial for both the manager and the organization. PMID:24397306

A Method for Dynamic Risk Assessment and Management of Rockbursts in Drill and Blast Tunnels

NASA Astrophysics Data System (ADS)

Liu, Guo-Feng; Feng, Xia-Ting; Feng, Guang-Liang; Chen, Bing-Rui; Chen, Dong-Fang; Duan, Shu-Qian

2016-08-01

Focusing on the problems caused by rockburst hazards in deep tunnels, such as casualties, damage to construction equipment and facilities, construction schedule delays, and project cost increase, this research attempts to present a methodology for dynamic risk assessment and management of rockbursts in D&B tunnels. The basic idea of dynamic risk assessment and management of rockbursts is determined, and methods associated with each step in the rockburst risk assessment and management process are given, respectively. Among them, the main parts include a microseismic method for early warning the occurrence probability of rockburst risk, an estimation method that aims to assess potential consequences of rockburst risk, an evaluation method that utilizes a new quantitative index considering both occurrence probability and consequences for determining the level of rockburst risk, and the dynamic updating. Specifically, this research briefly describes the referenced microseismic method of warning rockburst, but focuses on the analysis of consequences and associated risk assessment and management of rockburst. Using the proposed method of risk assessment and management of rockburst, the occurrence probability, potential consequences, and the level of rockburst risk can be obtained in real-time during tunnel excavation, which contributes to the dynamic optimisation of risk mitigation measures and their application. The applicability of the proposed method has been verified by those cases from the Jinping II deep headrace and water drainage tunnels at depths of 1900-2525 m (with a length of 11.6 km in total for D&B tunnels).

Configuration management and software measurement in the Ground Systems Development Environment (GSDE)

NASA Technical Reports Server (NTRS)

Church, Victor E.; Long, D.; Hartenstein, Ray; Perez-Davila, Alfredo

1992-01-01

A set of functional requirements for software configuration management (CM) and metrics reporting for Space Station Freedom ground systems software are described. This report is one of a series from a study of the interfaces among the Ground Systems Development Environment (GSDE), the development systems for the Space Station Training Facility (SSTF) and the Space Station Control Center (SSCC), and the target systems for SSCC and SSTF. The focus is on the CM of the software following delivery to NASA and on the software metrics that relate to the quality and maintainability of the delivered software. The CM and metrics requirements address specific problems that occur in large-scale software development. Mechanisms to assist in the continuing improvement of mission operations software development are described.

Evaluation of adverse reactions to contrast media in the hospital

PubMed Central

Ryu, J-H; Kim, E-Y

2013-01-01

Objective: To determine and analyse the characteristics of contrast media adverse reactions (CM-ARs) reported in a hospital. Methods: A retrospective review of CM-ARs from the electronic spontaneous adverse drug reaction (ADR) report system between January 2011 and August 2012 was conducted. CM-ARs were evaluated in terms of causality, severity, preventability and affected organs. Also, agreement and correlation among the tools used to evaluate CM-ARs were analysed. Results: The overall reaction rate was 1.5% (n = 286). In total, 269 CM-ARs were identified. For ADR causality, 96.7% (n = 260) and 98.5% (n = 265) were evaluated as “probable” ADR using the Naranjo probability scale and the World Health Organization–Uppsala Monitoring Centre causality categories, whereas 98.1% (n = 264) were evaluated as “certain” with Korean algorithm v. II. Of these, 91.4% (n = 246) were mild in severity and 96.7% (n = 260) were unpreventable. Most patients (n = 233, 86.7%) could be managed with observation and/or simple treatment. The most frequent reaction (n = 383, 79.5%) was dermatological. Spearman's correlation coefficient was 0.667 (p < 0.01), and the agreement was 98.1% between the Naranjo scale and the World Health Organization–Uppsala Monitoring Centre categories. No relationship was seen between CM-AR severity and gender or between in- and outpatients. Conclusion: In our study, most CM-ARs were mild and managed with simple treatment. However, as the number of patients undergoing CT procedures continues to increase, it is essential to identify and observe patients at risk for CM-ARs to prevent severe ADRs. Advances in knowledge: Continuous careful review of reporting and treatment protocols of CM-ARs is needed to prevent morbidity and mortality. PMID:24191123

The discriminatory cost of ICD-10-CM transition between clinical specialties: metrics, case study, and mitigating tools

PubMed Central

Boyd, Andrew D; Li, Jianrong ‘John’; Burton, Mike D; Jonen, Michael; Gardeux, Vincent; Achour, Ikbel; Luo, Roger Q; Zenku, Ilir; Bahroos, Neil; Brown, Stephen B; Vanden Hoek, Terry; Lussier, Yves A

2013-01-01

Objective Applying the science of networks to quantify the discriminatory impact of the ICD-9-CM to ICD-10-CM transition between clinical specialties. Materials and Methods Datasets were the Center for Medicaid and Medicare Services ICD-9-CM to ICD-10-CM mapping files, general equivalence mappings, and statewide Medicaid emergency department billing. Diagnoses were represented as nodes and their mappings as directional relationships. The complex network was synthesized as an aggregate of simpler motifs and tabulation per clinical specialty. Results We identified five mapping motif categories: identity, class-to-subclass, subclass-to-class, convoluted, and no mapping. Convoluted mappings indicate that multiple ICD-9-CM and ICD-10-CM codes share complex, entangled, and non-reciprocal mappings. The proportions of convoluted diagnoses mappings (36% overall) range from 5% (hematology) to 60% (obstetrics and injuries). In a case study of 24 008 patient visits in 217 emergency departments, 27% of the costs are associated with convoluted diagnoses, with ‘abdominal pain’ and ‘gastroenteritis’ accounting for approximately 3.5%. Discussion Previous qualitative studies report that administrators and clinicians are likely to be challenged in understanding and managing their practice because of the ICD-10-CM transition. We substantiate the complexity of this transition with a thorough quantitative summary per clinical specialty, a case study, and the tools to apply this methodology easily to any clinical practice in the form of a web portal and analytic tables. Conclusions Post-transition, successful management of frequent diseases with convoluted mapping network patterns is critical. The http://lussierlab.org/transition-to-ICD10CM web portal provides insight in linking onerous diseases to the ICD-10 transition. PMID:23645552

Sudden unexpected nocturnal death in Chiari type 1 malformation and potential role of opioid analgesics

PubMed Central

Roohi, Fereydoon; Gropen, Toby; Kula, Roger W.

2014-01-01

Background: Chiari malformation type 1 (CM1) is a common congenital anomaly of the craniocervical junction. CM1 is reported to run a usually benign course and patients typically experience no symptoms or chronic, slowly progressive symptoms. However, recent reports indicate that a subset of patients with CM1 may present with acute deterioration and sudden unexpected death (SUD). We report a case of SUD during sleep in a young man with CM1, which we believe was related to the administration of common and therapeutic doses of narcotic analgesics for the management of pain. We will clarify the pathophysiology of acute deterioration and SUD in CM1 and the possibility that the adverse effects of opiate analgesics likely were the leading cause of death in our patient. Case Description: In this review, we present a 29-year-old male with worsening headache secondary to previously diagnosed CM1. The patient died suddenly and unexpectedly after administration of common and therapeutic doses of narcotic analgesics for the management of pain. Conclusion: The mechanism(s) of acute neurological deterioration and sudden death in patients with CM1 remains poorly understood. We believe the rapid fatal deterioration in our patient following administration of opioids suggests that this category of medication may cause sudden unexpected “neurogenic” cardiac death in CM1 patients by inducing sleep-related breathing difficulties and associated hypercapnia. Hypercapnia by further increasing intracranial pressure can result in a sudden pressure-induced decompensation of the cardiopulmonary control centers in the brain stem and cause instantaneous cardiorespiratory arrest. PMID:24778905

Department of Defense In-House RDT and E Activities: Management Analysis Report for Fiscal Year 1993

DTIC Science & Technology

1994-11-01

A worldwide unique lab because it houses a high - speed modeling and simulation system, a prototype...E Division, San Diego, CA: High Performance Computing Laboratory providing a wide range of advanced computer systems for the scientific investigation...Machines CM-200 and a 256-node Thinking Machines CM-S. The CM-5 is in a very large memory, ( high performance 32 Gbytes, >4 0 OFlop) coafiguration,

The Effects of Manure and Nitrogen Fertilizer Applications on Soil Organic Carbon and Nitrogen in a High-Input Cropping System

PubMed Central

Ren, Tao; Wang, Jingguo; Chen, Qing; Zhang, Fusuo; Lu, Shuchang

2014-01-01

With the goal of improving N fertilizer management to maximize soil organic carbon (SOC) storage and minimize N losses in high-intensity cropping system, a 6-years greenhouse vegetable experiment was conducted from 2004 to 2010 in Shouguang, northern China. Treatment tested the effects of organic manure and N fertilizer on SOC, total N (TN) pool and annual apparent N losses. The results demonstrated that SOC and TN concentrations in the 0-10cm soil layer decreased significantly without organic manure and mineral N applications, primarily because of the decomposition of stable C. Increasing C inputs through wheat straw and chicken manure incorporation couldn't increase SOC pools over the 4 year duration of the experiment. In contrast to the organic manure treatment, the SOC and TN pools were not increased with the combination of organic manure and N fertilizer. However, the soil labile carbon fractions increased significantly when both chicken manure and N fertilizer were applied together. Additionally, lower optimized N fertilizer inputs did not decrease SOC and TN accumulation compared with conventional N applications. Despite the annual apparent N losses for the optimized N treatment were significantly lower than that for the conventional N treatment, the unchanged SOC over the past 6 years might limit N storage in the soil and more surplus N were lost to the environment. Consequently, optimized N fertilizer inputs according to root-zone N management did not influence the accumulation of SOC and TN in soil; but beneficial in reducing apparent N losses. N fertilizer management in a greenhouse cropping system should not only identify how to reduce N fertilizer input but should also be more attentive to improving soil fertility with better management of organic manure. PMID:24830463

Shaping Smoking Cessation in Hard-to-Treat Smokers

ERIC Educational Resources Information Center

Lamb, R. J.; Kirby, Kimberly C.; Morral, Andrew R.; Galbicka, Greg; Iguchi, Martin Y.

2010-01-01

Objective: Contingency management (CM) effectively treats addictions by providing abstinence incentives. However, CM fails for many who do not readily become abstinent and earn incentives. Shaping may improve outcomes in these hard-to-treat (HTT) individuals. Shaping sets intermediate criteria for incentive delivery between the present behavior…

A simple procedure for estimating soil porosity

NASA Astrophysics Data System (ADS)

Emmet-Booth, Jeremy; Forristal, Dermot; Fenton, Owen; Holden, Nick

2016-04-01

Soil degradation from mismanagement is of international concern. Simple, accessible tools for rapidly assessing impacts of soil management are required. Soil structure is a key component of soil quality and porosity is a useful indicator of structure. We outline a version of a procedure described by Piwowarczyk et al. (2011) used to estimate porosity of samples taken during a soil quality survey of 38 sites across Ireland as part of the Government funded SQUARE (Soil Quality Assessment Research) project. This required intact core (r = 2.5 cm, H = 5cm) samples taken at 5-10 cm and 10-20 cm depth, to be covered with muslin cloth at one end and secured with a jubilee clip. Samples were saturated in sealable water tanks for ≈ 64 hours, then allowed to drain by gravity for 24 hours, at which point Field Capacity (F.C.) was assumed to have been reached, followed by oven drying with weight determined at each stage. This allowed the calculation of bulk density and the estimation of water content at saturation and following gravitational drainage, thus total and functional porosity. The assumption that F.C. was reached following 24 hours of gravitational drainage was based on the Soil Moisture Deficit model used in Ireland to predict when soils are potentially vulnerable to structural damage and used nationally as a management tool. Preliminary results indicate moderately strong, negative correlations between estimated total porosity at 5-10 cm and 10-20 cm depth (rs = -0.7, P < 0.01 in both cases) and soil quality scores of the Visual Evaluation of Soil Structure (VESS) method which was conducted at each survey site. Estimated functional porosity at 5-10 cm depth was found to moderately, negatively correlate with VESS scores (rs = - 0.5, P < 0.05). This simple procedure requires inexpensive equipment and appears useful in indicating porosity of a large quantity of samples taken at numerous sites or if done periodically, temporal changes in porosity at a field scale, indicating the impacts of soil management. Reference Piwowarczyk, A., Giuliani, G. & Holden, N.M. 2011. Can soil moisture deficit be used to forecast when soils are at high risk of damage owing to grazing animals? Soil Use and Management, 27, 255-263.

Contingency management treatment in cocaine using methadone maintained patients with and without legal problems.

PubMed

Ginley, Meredith K; Rash, Carla J; Olmstead, Todd A; Petry, Nancy M

2017-11-01

Legal difficulties and cocaine use are prevalent in methadone maintenance patients, and they are related to one another, as well as to poor response to methadone treatment. Contingency management (CM) is efficacious for decreasing cocaine use, but the relation of CM treatment to criminal activities has rarely been studied. This study evaluated whether baseline legal problems are related to subsequent substance use and illegal activities for cocaine using methadone maintained patients and whether CM differentially improves outcomes depending on baseline legal problems. Using data from four randomized CM trials (N=323), we compared methadone maintained patients with legal problems at the start of study participation to those without initial legal problems. Overall, the addition of CM to standard methadone care improved substance use outcomes regardless of initial legal problems. Endorsement of legal problems within 30days of study initiation was associated with reduced proportion of negative samples submitted during the 12-week treatment period. A significant interaction effect of baseline legal problems and treatment condition was present for subsequent self-reports of illegal activities. Those with baseline legal problems who were assigned to CM had reduced self-reports of reengagement in illegal activity throughout a six month follow-up compared to their counterparts randomized to standard care. Adding CM to methadone treatment improves substance use outcomes and reduces subsequent illegal activity in cocaine-using methadone patients with legal problems. Copyright © 2017 Elsevier B.V. All rights reserved.

Scale-Up of an Human Papillomavirus Testing Implementation Program in El Salvador

PubMed Central

Cremer, Miriam; Maza, Mauricio; Alfaro, Karla; Morales Velado, Mario; Felix, Juan; Castle, Philip E.; Kim, Jane; Gage, Julia C.

2017-01-01

Objective The Cervical Cancer Prevention in El Salvador is a demonstration project to introduce a lower-cost human papillomavirus (HPV)-DNA test into a public sector project. Started in October 2012, The Cervical Cancer Prevention in El Salvador consists of 3 phases and will ultimately screen 30,000 women. Results of phase 2 of the project are presented. The objective of this project was to compare colposcopy and noncolposcopy-based management for HPV-positive women. Material and Methods In phase 2, a total of 8,050 women, aged 30 to 49 years, were screened; 6,761 provided both self- and provider-collected specimens and 1,289 provided only provider-testing specimens. HPV results from self-collected specimens were not used in clinical management decisions. Women with provider-collected HPV-positive results were treated based on the strategy assigned to their community; the strategy was colposcopy management (CM) or screen-and-treat (ST) management if they were cryotherapy eligible or colposcopy if not eligible. Outcomes were assessed 6 months after screening. Results Overall, 489 (12.3%) of 3,963 women receiving CM and 465 (11.4%) of 4,087 women receiving ST tested HPV positive. In the CM cohort, 216 (44.2%) of 489 completed their intervention (203 treated, 11 diagnosed negative, 2 pregnant). In the ST cohort, 411 (88.4%) of 465 completed their intervention (407 treated, 2 diagnosed negative, 1 pregnant). Overall agreement between HPV test results from self-collected and provider-collected specimens was 93.7%, with a κ value of 0.70 (95% CI = 0.68–0.73). Conclusions Human papillomavirus testing with ST management resulted in an approximately twice completion rate compared with CM management. Agreement between self- and provider-based sampling was good and might be used to extend screening to women in areas that are more difficult to reach. PMID:27922905

Giant spigelian hernia due to abdominal wall injury: a case report.

PubMed

Topal, Ersun; Kaya, Ekrem; Topal, Naile Bolca; Sahin, Ilker

2007-02-01

Spigelian hernia is a rare clinical entity. It is difficult to diagnose due to its location. In this article we report the case of a giant spigelian hernia consequent to abdominal wall injury. The neck of the hernia was 10 cm in diameter. We repaired this hernia with a polypropylene mesh.

Organic matter evolution throughout a 100-cm ombrotrophic profile from an Italian floating mire

NASA Astrophysics Data System (ADS)

Zaccone, Claudio; D'Orazio, Valeria; Lobianco, Daniela; Miano, Teodoro M.

2015-04-01

The curious sight of an island floating and moving on a lake naturally, already described by Pliny the Elder in his Naturalis historia (AD 77-79), fascinated people from time immemorial. Floating mires are defined by the occurrence of emergent vegetation rooted in highly organic buoyant mats that rise and fall with changes in water level. Peat-forming floating mires could provide an exceptional tool for environmental studies, since much of their evolution, as well as the changes of the surrounding areas, is recorded in their peat deposits. A complete, 4-m deep peat core was collected in July 2012 from the floating island of Posta Fibreno, a relic mire in the Central Italy. This floating island has a diameter of ca. 30 m, a submerged thickness of about 3 m, and the vegetation is organized in concentric belts, from the Carex paniculata palisade to the Sphagnum centre. Here, some of the southernmost Italian populations of Sphagnum palustre occur. The 14C age dating of macrofossils removed from the sample at 360 cm of depth revealed that the island probably formed more than 500 yrs ago (435±20 yr BP). In the present work, we show preliminary results regarding the evolution of the organic matter along the first, ombrotrophic 100 cm of depth, hoping also to provide some insight into the possible mechanism of the evolution of this floating island. The 100 cm monolith was collected using a Wardenaar corer and cut frozen in 1-cm layers. It consists almost exclusively of Sphagnum mosses, often spaced out, in the top 20-30 cm, by leaves of Populus tremula that annually fell off. This section shows a very low bulk density, ranging from 0.017 and 0.059 g cm-3 (avg. value, 0.03±0.01 g cm-3), an average water content of 96.1±1.1%, and a gravimetric water content ranging between 14.3 and 41.5 gwater gdrypeat-1. The pH of porewaters was in the range 5-5.5. The C content along the profile ranged between 35 and 47% (avg., 41±1%), whereas the N between 0.3 and 0.9% (avg., 0.6±0.1%). Main atomic ratios seem to confirm what found during the visual inspection of the core, i.e., Sphagnum material so well preserved that it is hard to classify it as 'peat'. In fact, the F14C age dating suggests that the first 95 cm of Sphagnum material accumulate in less than 55 yrs, thus resulting in an average growing rate of ca. 1.7-1.8 cm yr-1. At the same time, C/N, H/C and O/C ratios show their lowest values between 20 and 55 cm of depth, corresponding to the section with highest bulk density (0.025-0.059 g cm-3). This seems to suggest a slightly more decomposed material. Consequently, the depth of 55-60 cm could represent the emerged (i.e., less anaerobic) section of this floating mire. Finally, the first 100 cm of the core show a great potential to be used as archive of environmental changes, especially considering their high resolution (1 cm = 0.5 yr ca.), although the short time-space covered could be a limiting factor. The Authors thank the Municipality of Posta Fibreno (FR), Managing Authority of the Regional Natural Reserve of Lake Posta Fibreno, for allowing peat cores sampling. C.Z. is indebted to the Staff of the Regional Natural Reserve for the help during samplings and for their continuous feedbacks.

Preparing for the Unthinkable: DOD Support to Foreign Consequence Management

DTIC Science & Technology

2010-05-03

Nuclear Disaster ” (research paper, Maxwell Air Force Base, AL: Air University, 2001), 23. 17 Department of Defense Consequence Management...States Government Response to an Overseas Chemical, Biological, Radiological, or Nuclear Disaster ” (research paper, Maxwell Air Force Base, AL: Air...Government Response to an Overseas Chemical, Biological, Radiological, or Nuclear Disaster .” Research paper, Maxwell Air Force Base, AL: Air University

An in vitro study of magnetic particle targeting in small blood vessels

NASA Astrophysics Data System (ADS)

Udrea, Laura Elena; Strachan, Norval J. C.; Bădescu, Vasile; Rotariu, Ovidiu

2006-10-01

The magnetic guidance and capture of particles inside the human body, via the circulatory system, is a novel method for the targeted delivery of drugs. This experimental study confirms in vitro that a dipolar capturing device, based on high-energy magnets with an active space of 8.7 cm × 10 cm × 10 cm, retains colloidal magnetic particles (MPs) (<30 nm) injected in the capillary tubes, where flow velocities are comparable to that encountered in the capillary beds of tumours (<0.5 cm s-1). The build-up of the deposition of the MPs was investigated using video imaging techniques that enabled continuous monitoring of the blocking of the vessel whilst simultaneously recording the colloid's flow rate. The parameters of practical importance (length of MP deposit, time of capillary blocking) were estimated and were found to be dependent on the initial fluid velocity, the MP concentration and the distance between the capillary tube and the polar magnetic pieces. Although the tube used in this experiment is larger (diameter = 0.75 mm, length = 100 mm) than that of real capillaries (diameter = 0.01 mm, length ~1.5 mm), the flow velocities chosen were similar to those encountered in the capillary beds of tumours and the length/diameter ratio was approximately equal (133 for the present set-up, 100-150 for real capillaries). In these circumstances and using the same magnetic field conditions (intensity, gradient) and MPs, there is close similarity with magnetic capture in a microscopic capillary system. Moreover, the macroscopic system permits analysis of the distribution of MPs in the active magnetic space, and consequently the maximum targetable volume. This study revealed that the capture of particles within the active space was strongly influenced by the gradient of the magnetic field and the flow velocity. Thus, when the magnetic field gradient had medium values (0.1-0.3 T cm-1) and the fluid velocity was small (0.15 cm s-1), the particles were captured in small, compact and stable deposits (L < 4 cm) and the time necessary for blocking of the capillary was <150 s. Doubling the value for the flow velocity did not influence significantly either the length of MP deposits nor the blocking time. However, lower gradients (<0.1 T cm-1) and larger velocities (0.3-0.9 cm s-1) result in the formation of larger deposits (4 cm < L < 10 cm) that are unstable at the beginning of the capture process. These large deposits do become stable given sufficient time for the deposition process to take place in conjunction with a decrease in the flow rate. As a consequence, the time necessary for blocking of the capillary increased up to 450 s. Decreasing the MP concentration from 0.02 g cm-3 to 0.005 g cm-3 decreased the deposit lengths by approximately 20% and doubled the values of the blocking time. The maximum targetable volume obtained by the present method is ~350 cm3, which corresponds to medium-sized tumours. The capillary vessels were blocked only for the situation that occurs for microcirculation within a tumour. This reduces the concentration of MPs trapped within the normal tissues, which occurs when using particles of micrometre size. This work showed the potential of using colloidal MPs and dipolar magnetic devices for treatment of human patients, when the affected sites are positioned at medium distances from the surface of the body (e.g. head, neck, breast, hands and legs).

A new risk stratification algorithm for the management of patients with adrenal incidentalomas.

PubMed

Birsen, Onur; Akyuz, Muhammet; Dural, Cem; Aksoy, Erol; Aliyev, Shamil; Mitchell, Jamie; Siperstein, Allan; Berber, Eren

2014-10-01

Although adrenal incidentalomas (AI) are detected in ≤5% of patients undergoing chest and abdominal computed tomography (CT), their management is challenging. The current guidelines include recommendations from the National Institutes of Health, the American Association of Endocrine Surgeons (AAES), and the American Association for Cancer Education (AACE). The aim of this study was to develop a new risk stratification model and compare its performance against the existing guidelines for managing AI. A risk stratification model was designed by assigning points for adrenal size (1, 2, or 3 points for tumors <4, 4-6, or >6 cm, respectively) and Hounsfield unit (HU) density on noncontrast CT (1, 2, or 3 points for HU <10, 10-20, or >20, respectively). This model was applied retrospectively to 157 patients with AI managed in an endocrine surgery clinic to assign a score to each tumor. The utility of this model versus the AAES/AACE guidelines was assessed. Of the 157 patients, 54 (34%), had tumors <4 cm with HU <10 (a score of 2). One third of these were hormonally active on biochemical workup and underwent adrenalectomy. The remaining two thirds were nonsecretory lesions and have been followed conservatively with annual testing. In 103 patients (66%), the adrenal mass was >4 cm and/or had indeterminate features on noncontrast CT (HU >10, irregular borders, heterogeneity), and adrenalectomy was performed after hormonal evaluation was completed (10 were hormonally active on biochemical testing). Seven of these patients (7%) had adrenocortical cancer on final pathology with tumor size <4 cm in 0, 4-6 cm in 1, and >6 cm in 5 patients. Of the hormonally inactive patients, 32% had a score of 3, 38% 4, and 30% 5 or 6. The incidence of adrenocortical cancer in these subgroups was 0, 0, and 25%, respectively. This study shows that an algorithm that utilizes the hormonal activity at the first decision step followed by a consolidated risk stratification, based on tumor size and HU density, has a potential to spare a substantial number of patients from unnecessary "diagnostic" surgery for AI. Copyright © 2014 Elsevier Inc. All rights reserved.

808-nm laser therapy with a flat-top handpiece photobiomodulates mitochondria activities of Paramecium primaurelia (Protozoa).

PubMed

Amaroli, Andrea; Ravera, Silvia; Parker, Steven; Panfoli, Isabella; Benedicenti, Alberico; Benedicenti, Stefano

2016-05-01

Photobiomodulation is proposed as a non-linear process, and only low-level laser therapy (LLLT) is assumed to stimulate exposed cells, whereas high powered laser and fluences can cause negative effects, exhausting the cell's energy reserve as a consequence of excessive photon-based stimulation. In our work, we investigated and compared the effects of 808-nm diode laser (CW) with a new flat-top handpiece. To this purpose, we tested the photobiomodulation effects of 1 and 3 J/cm(2) fluence, both generated by 100 mW or 1 W of laser power and of 64 J/cm(2) of fluence generated by 100 mW, 1 W, 1.5 W or 2 W, as expressed through oxygen consumption and ATP synthesis of Paramecium. Data collected indicates the incremental consumption of oxygen through irradiation with 3 J/cm(2)-100 mW or 64 J/cm(2)-1 W correlates with an increase in Paramecium ATP synthesis. The Paramecium respiration was inhibited by fluences 64 J/cm(2)-100 mW or 64 J/cm(2)-2 W and was followed by a decrease in the endogenous ATP concentration. The 1 J/cm(2)-100 mW or 1 W and 3 J/cm(2)-1 W did not affect mitochondrial activity. The results show that the fluence of 64 J/cm(2)-1 W more than the 3 J/cm(2)-100 mW causes greater efficiency in Paramecium mitochondria respiratory chain activity. Our results suggest that thanks to flat-top handpiece we used, high fluences by high-powered laser have to be reconsidered as an effective and non-invasive therapy. Possible associated benefits of deeper tissue penetration would increase treatment effectiveness and reduced irradiation time.

Forest fire management to avoid unintended consequences: a case study of Portugal using system dynamics.

PubMed

Collins, Ross D; de Neufville, Richard; Claro, João; Oliveira, Tiago; Pacheco, Abílio P

2013-11-30

Forest fires are a serious management challenge in many regions, complicating the appropriate allocation to suppression and prevention efforts. Using a System Dynamics (SD) model, this paper explores how interactions between physical and political systems in forest fire management impact the effectiveness of different allocations. A core issue is that apparently sound management can have unintended consequences. An instinctive management response to periods of worsening fire severity is to increase fire suppression capacity, an approach with immediate appeal as it directly treats the symptom of devastating fires and appeases the public. However, the SD analysis indicates that a policy emphasizing suppression can degrade the long-run effectiveness of forest fire management. By crowding out efforts to preventative fuel removal, it exacerbates fuel loads and leads to greater fires, which further balloon suppression budgets. The business management literature refers to this problem as the firefighting trap, wherein focus on fixing problems diverts attention from preventing them, and thus leads to inferior outcomes. The paper illustrates these phenomena through a case study of Portugal, showing that a balanced approach to suppression and prevention efforts can mitigate the self-reinforcing consequences of this trap, and better manage long-term fire damages. These insights can help policymakers and fire managers better appreciate the interconnected systems in which their authorities reside and the dynamics that may undermine seemingly rational management decisions. Copyright © 2013 Elsevier Ltd. All rights reserved.

(Fe II) emission from high-density regions in the Orion Nebula

NASA Technical Reports Server (NTRS)

Bautista, Manuel A.; Pradhan, Anil K.; Osterbrock, Donald E.

1994-01-01

Direct spectroscopic evidence of high-density regions in the Orion Nebula, N(sub e) approximately equals 10(exp 5)-10(exp 7)/cu cm, is obtained from the forbidden optical and near-IR (Fe II) emission lines, using new atomic data. Calculations for level populations and line ratios are carried out using 16, 35, and 142 level collisional-radiative models for Fe II. Estimates of Fe(+) abundances derived from the near-infrared and the optical line intensities are consistent with a high density of 10(exp 6)/cu cm in the (Fe II) emitting regions. Important consequences for abundance determinations in the nebula are pointed out.

Anatomy of the obturator region: relations to a trans-obturator sling.

PubMed

Whiteside, James L; Walters, Mark D

2004-01-01

Our objective was to determine the relationships between a trans-obturator sling and anatomic structures within the obturator region. The obturator regions of six cadavers were dissected and distances from the mid-point of the ischiopubic ramus to the muscles, nerves, and vessels of the region were measured. A trans-obturator sling was placed and distances from the device to the same anatomic structures were determined. Four additional cadavers were dissected to determine the device route of passage. The obturator canal is on average 4.4 cm from the midpoint of the ischiopubic rami. The trans-obturator sling passes on average 2.4 cm inferior-medial to the obturator canal. The anterior and posterior divisions of the obturator nerve are on average 3.4 and 2.8 cm, respectively, from a passed trans-obturator device. The device passed on average 1.1 cm from the most medial branch of the obturator vessels. Vascular and nerve structures are within 1-3 cm of the path of any device passed through the obturator foramen. A trans-obturator sling risks injury to these structures, although the small caliber of the vessels and the confined space in which they would bleed make the consequences of injury uncertain.

Composition of Apollo 17 core 76001

NASA Technical Reports Server (NTRS)

Korotev, Randy L.; Bishop, Kaylynn M.

1993-01-01

Core 76001 is a single drive tube containing a column of regolith taken at the base of the North Massif, station 6, Apollo 17. The core material is believed to have accumulated through slow downslope mass wasting from the massif. As a consequence, the core soil is mature throughout its length. Results of INAA for samples taken every half centimeter along the length of the core indicate that there is only minor systematic compositional variation with depth. Concentrations of elements primarily associated with mare basalt (Sc, Fe) and noritic impact melt breccia (Sm) decrease slightly with depth, particularly between 20 cm and the bottom of the core at 32 cm depth. This is consistent with petrographic studies that indicate a greater proportion of basalt and melt breccia in the top part of the core. However, Sm/Sc and La/Sm ratios are remarkably constant with depth, indicating no variation in the ratio of mare material to Sm-rich highlands material with depth. Other than these subtle changes, there is no compositional evidence for the two stratigraphic units (0-20 cm and 20-32 cm) defined on the basis of modal petrography, although all samples with anomalously high Ni concentrations (Fe-Ni metal nuggets) occur above 20 cm depth.

Preliminary studies of the effects of psychological stress on circulating lymphocytes analyzed by synchrotron radiation based-Fourier transform infrared microspectroscopy

NASA Astrophysics Data System (ADS)

Vargas-Caraveo, Alejandra; Castillo-Michel, Hiram; Mejia-Carmona, Gloria Erika; Pérez-Ishiwara, David Guillermo; Cotte, Marine; Martínez-Martínez, Alejandro

2014-07-01

Psychological stress is a condition that not only generates behavioral disorders but also disrupts homeostasis and immune activity that can exacerbate or lead to inflammatory diseases. The aim of this work was to study biochemical changes in circulating immune cells from rats under psychological stress by using vibrational spectroscopy. A stress model was used, where exposure to a stressor was repeated for 5 days. Subsequently, circulating lymphocytes were examined for their biomolecular vibrational fingerprints with synchrotron radiation based-Fourier transform infrared microspectroscopy. The results showed an increased absorption at the ester lipid region (1720-1755 cm-1) in lymphocytes from stressed rats, suggesting lipid peroxidation. Statistical significant changes in wavenumber peak position and absorbance in the nucleic acid region were also observed (915-950 cm-1 Z-DNA, 1090-1150 cm-1 symmetric stretching of Psbnd Osbnd C, 1200-1260 cm-1 asymmetric PO2 and 1570-1510 cm-1 methylated nucleotides) which suggest a reduction of transcriptional activity in lymphocytes from stressed rat. These results unravel part of the mechanisms by which psychological stress may affect the immune system leading to systemic consequences.

Edema index-guided disease management improves 6-month outcomes of patients with acute heart failure.

PubMed

Liu, Min-Hui; Wang, Chao-Hung; Huang, Yu-Yen; Tung, Tao-Hsin; Lee, Chii-Ming; Yang, Ning-I; Wang, Jong-Shyan; Kuo, Li-Tang; Cherng, Wen-Jin

2012-01-01

The efficacy of heart failure (HF) management programs is compromised by the challenge of early identification of patients at imminent risk. Segmental multifrequency bioelectrical impedance analysis can generate an "edema index" (EI) as a surrogate for the body fluid status. In this study, we tested whether integration of EI-guided management improved the 6-month outcomes of HF patients under multidisciplinary care. In total, 159 patients with acute HF were randomized into control, case management (CM), and EI-guided CM (EI) groups (n = 53 in each group). In the EI group, a management algorithm was designed based on the measured EI. The analyzed endpoints included HF-related and all cause-related events during the 6-month follow-up period. In the 6 months, there were 11 (6.9%) deaths, 19 (11.9%) HF-related rehospitalizations, and 45 (28.3%) all-cause-related rehospitalizations. Compared to the control (26.4%) and CM groups (15.1%), the EI group had a lower rate of HF-related death and rehospitalization (3.8%, P = 0.004). Multivariate analysis revealed that EI-guided management was an independent predictor of a lower HF-related event rate (hazard ratio = 0.15, 95%CI = 0.03~0.66, P = 0.012). Patients with a higher pre-discharge EI were older, had lower blood albumin and hemoglobin levels, and had a higher functional class and incidences of diabetes mellitus and chronic kidney disease. An increase in the pre-discharge EI by 0.001 increased the HF-related event rate by 6% (P = 0.002). Use of EI-guided management lowered this risk (P = 0.03). In conclusion, an EI-based HF management program demonstrated an event-lowering effect superior to traditional nurse-led multidisciplinary care in 6 months after an acute HF episode.

5 CFR 250.103 - Consequences of improper agency actions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Consequences of improper agency actions. 250.103 Section 250.103 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE... Consequences of improper agency actions. If OPM finds that an agency has taken an action contrary to a law...

Introducing a High-Risk HPV DNA Test Into a Public Sector Screening Program in El Salvador.

PubMed

Cremer, Miriam L; Maza, Mauricio; Alfaro, Karla M; Kim, Jane J; Ditzian, Lauren R; Villalta, Sofia; Alonzo, Todd A; Felix, Juan C; Castle, Philip E; Gage, Julia C

2016-04-01

In a primary human papillomavirus (HPV) screening program, we compared the 6-month follow-up among colposcopy and noncolposcopy-based management strategies for screen-positive women. Women aged 30 to 49 years were screened with HPV DNA tests using both self-collection and provider collection of samples. Women testing positive received either (1) colposcopy management (CM) consisting of colposcopy and management per local guidelines or (2) screen-and-treat (ST) management using visual inspection with acetic acid to determine cryotherapy eligibility, with eligible women undergoing immediate cryotherapy. One thousand women were recruited in each cohort. Of these, 368 (18.4%) of 2000 women were recruited using a more intensive outreach strategy. Demographics, HPV positivity, and treatment compliance were compared across recruitment and management strategies. More women in the ST cohort received treatment within 6 months compared with those in the CM cohort (117/119 [98.3%] vs 64/93 [68.8%]; p < .001). Women recruited through more intensive outreach were more likely to be HPV positive, lived in urban areas, were more educated, and had higher numbers of lifetime sexual partners and fewer children. Women in the CM arm were less likely to complete care than women in the ST arm. Targeted outreach to underscreened women successfully identified women with higher prevalence of HPV and possibly higher disease burden.

Analysis of flood modeling through innovative geomatic methods

NASA Astrophysics Data System (ADS)

Zazo, Santiago; Molina, José-Luis; Rodríguez-Gonzálvez, Pablo

2015-05-01

A suitable assessment and management of the exposure level to natural flood risks necessarily requires an exhaustive knowledge of the terrain. This study, primarily aimed to evaluate flood risk, firstly assesses the suitability of an innovative technique, called Reduced Cost Aerial Precision Photogrammetry (RC-APP), based on a motorized technology ultra-light aircraft ULM (Ultra-Light Motor), together with the hybridization of reduced costs sensors, for the acquisition of geospatial information. Consequently, this research generates the RC-APP technique which is found to be a more accurate-precise, economical and less time consuming geomatic product. This technique is applied in river engineering for the geometric modeling and risk assessment to floods. Through the application of RC-APP, a high spatial resolution image (orthophoto of 2.5 cm), and a Digital Elevation Model (DEM) of 0.10 m mesh size and high density points (about 100 points/m2), with altimetric accuracy of -0.02 ± 0.03 m have been obtained. These products have provided a detailed knowledge of the terrain, afterward used for the hydraulic simulation which has allowed a better definition of the inundated area, with important implications for flood risk assessment and management. In this sense, it should be noted that the achieved spatial resolution of DEM is 0.10 m which is especially interesting and useful in hydraulic simulations through 2D software. According to the results, the developed methodology and technology allows for a more accurate riverbed representation, compared with other traditional techniques such as Light Detection and Ranging (LiDAR), with a Root-Mean-Square Error (RMSE ± 0.50 m). This comparison has revealed that RC-APP has one lower magnitude order of error than the LiDAR method. Consequently, this technique arises as an efficient and appropriate tool, especially in areas with high exposure to risk of flooding. In hydraulic terms, the degree of detail achieved in the 3D model, has allowed reaching a significant increase in the knowledge of hydraulic variables in natural waterways.

Theories of lean management: an empirical evaluation.

PubMed

Handel, Michael J

2014-03-01

Debates within organization theory traditionally argued the relative merits of bureaucracy but today there is broad agreement across different perspectives that bureaucratic organization is inefficient and outmoded. Despite their differences, post-bureaucratic and neo-liberal theories argue that organizations with relatively flat hierarchies and low management overhead are better adapted to current market requirements. Post-bureaucratic theory also argues that employees, as well as firms, benefit from leaner management structures. This paper investigates trends in managerial leanness, proposed explanations for such trends, and the consequences of leanness for firms and employees. Although there is a trend toward flatter management hierarchies, there is only weak support for current claims regarding both the causes and consequences of lean management. Copyright © 2013 Elsevier Inc. All rights reserved.

Assessment of a Bayesian Belief Network-GIS framework as a practical tool to support marine planning.

PubMed

Stelzenmüller, V; Lee, J; Garnacho, E; Rogers, S I

2010-10-01

For the UK continental shelf we developed a Bayesian Belief Network-GIS framework to visualise relationships between cumulative human pressures, sensitive marine landscapes and landscape vulnerability, to assess the consequences of potential marine planning objectives, and to map uncertainty-related changes in management measures. Results revealed that the spatial assessment of footprints and intensities of human activities had more influence on landscape vulnerabilities than the type of landscape sensitivity measure used. We addressed questions regarding consequences of potential planning targets, and necessary management measures with spatially-explicit assessment of their consequences. We conclude that the BN-GIS framework is a practical tool allowing for the visualisation of relationships, the spatial assessment of uncertainty related to spatial management scenarios, the engagement of different stakeholder views, and enables a quick update of new spatial data and relationships. Ultimately, such BN-GIS based tools can support the decision-making process used in adaptive marine management. Copyright © 2010 Elsevier Ltd. All rights reserved.

How change management can prevent the failure of information systems implementation among Malaysian government hospitals?

NASA Astrophysics Data System (ADS)

ChePa, Noraziah; Jasin, Noorhayati Md; Bakar, Nur Azzah Abu

2017-10-01

Fail to prevent or control challenges of Information System (IS) implementation have led to the failure of its implementation. Successful implementation of IS has been a challenging task to any organization including government hospitals. Government has invested a big amount of money on information system (IS) projects to improve service delivery in healthcare. However, several of them failed to be implemented successfully due to several factors. This article proposes a prevention model which incorporated Change Management (CM) concepts to avoid the failure of IS implementation, hence ensuring the success of it. Challenges of IS implementation in government hospitals have been discovered. Extensive literature review and deep interview approaches were employed to discover these challenges. A prevention model has been designed to cater the challenges. The model caters three main phases of implementation; pre-implementation, during implementation, and post-implementation by adopting CM practices of Lewin's, Kotter's and Prosci's CM model. Six elements of CM comprising thirteen sub-elements adopted from the three CM models have been used to handle CFFs of Human and Support issues; guiding team, resistance avoidance, IS adoption, enforcement, monitoring, and IS sustainability. Successful practice of the proposed mapping is expected to prevent CFFs to occur, hence ensuring a successful implementation of IS in the hospitals. The proposed model has been presented and successfully evaluated by the domain experts from the selected hospitals. The proposed model is believed to be beneficial for top management, IT practitioners and medical practitioners in preventing IS implementation failure among government hospitals towards ensuring the success implementation.

40 CFR 68.165 - Offsite consequence analysis.

Code of Federal Regulations, 2013 CFR

2013-07-01

... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.165 Offsite consequence... released in pounds; (7) Release rate; (8) Release duration; (9) Wind speed and atmospheric stability class...

40 CFR 68.165 - Offsite consequence analysis.

Code of Federal Regulations, 2012 CFR

2012-07-01

... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.165 Offsite consequence... released in pounds; (7) Release rate; (8) Release duration; (9) Wind speed and atmospheric stability class...

40 CFR 68.165 - Offsite consequence analysis.

Code of Federal Regulations, 2014 CFR

2014-07-01

... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.165 Offsite consequence... released in pounds; (7) Release rate; (8) Release duration; (9) Wind speed and atmospheric stability class...

Thirty-Eight Years of Autogenic, Woody Understory Dynamics in a Mature, Temperate Pine-Oak Forest

Treesearch

Michael D. Cain; Michael G. Shelton

1997-01-01

In 1935, 32 ha of a pine-hardwood forest were set aside from future timber management in southern Arkansas, U.S.A. Old-growth timber had been cut to a 36-cm stump diameter before 1915. Between 1952 and 1993, four inventories were made of the overstory and midstory components (number of live trees 29 cm in diameter breast height (DBH) taken at 1.37 m, by 2.54-cm DBH...

Chiari Malformation Type 1: A Systematic Review of Natural History and Conservative Management.

PubMed

Langridge, Benjamin; Phillips, Edward; Choi, David

2017-08-01

Chiari malformation type 1 (CM-1) is a variation of hindbrain development that can sometimes occur in asymptomatic individuals. Conventional treatment is surgical decompression, but little is known about the natural history of patients who do not undergo surgical management. This information is critical to determine how these patients should be managed. We conducted a systematic literature review to determine the natural history of CM-1, particularly in patients who did not undergo surgery and in asymptomatic individuals, to help patients and physicians determine when surgery is likely to be beneficial. The literature search was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the electronic databases PubMed, Scopus, Cochrane Library, and Web of Science. Inclusion and exclusion criteria were predefined. In symptomatic patients who did not undergo surgery, headaches and nausea often improved, whereas ataxia and sensory disturbance tended not to improve spontaneously. Of patients, 27%-47% had an improvement in symptoms after 15 months, and 37%-40% with cough headache and 89% with nausea who were managed nonoperatively improved at follow-up. Most asymptomatic individuals with CM-1 remained asymptomatic (93.3%) even in the presence of syringomyelia. The natural history of mild symptomatic and asymptomatic CM-1 in adults is relatively benign and nonprogressive; the decision to perform surgical decompression should be based on severity and duration of a patient's symptoms at presentation. It is reasonable to observe a patient with mild or asymptomatic symptoms even in the presence of significant tonsillar descent or syringomyelia. Copyright © 2017 Elsevier Inc. All rights reserved.

Beliefs About Dysmenorrhea and Their Relationship to Self-Management.

PubMed

Chen, Chen X; Kwekkeboom, Kristine L; Ward, Sandra E

2016-08-01

Dysmenorrhea is highly prevalent and is the leading cause of work and school absences among women of reproductive age. However, self-management of dysmenorrhea is not well understood in the US, and little evidence is available on factors that influence dysmenorrhea self-management. Guided by the Common Sense Model, we examined women's representations of dysmenorrhea (beliefs about causes, symptoms, consequences, timeline, controllability, coherence, and emotional responses), described their dysmenorrhea self-management behaviors, and investigated the relationship between representations and self-management behaviors. We conducted a cross-sectional, web-based survey of 762 adult women who had dysmenorrhea symptoms in the last six months. Participants had varied beliefs about the causes of their dysmenorrhea symptoms, which were perceived as a normal part of life. Dysmenorrhea symptoms were reported as moderately severe, with consequences that moderately affected daily life. Women believed they understood their symptoms moderately well and perceived them as moderately controllable but them to continue through menopause. Most women did not seek professional care but rather used a variety of pharmacologic and complementary health approaches. Care-seeking and use of self-management strategies were associated with common sense beliefs about dysmenorrhea cause, consequences, timeline, and controllability. The findings may inform development and testing of self-management interventions that address dysmenorrhea representations and facilitate evidence-based management. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Factors associated with contingency management adoption among opioid treatment providers receiving a comprehensive implementation strategy.

PubMed

Becker, Sara J; Kelly, Lourah M; Kang, Augustine W; Escobar, Katherine I; Squires, Daniel D

2018-03-29

Contingency management (CM) is an evidence-based behavioral intervention for opioid use disorders (OUDs); however, CM adoption in OUD treatment centers remains low due to barriers at patient, provider, and organizational levels. In a recent trial, OUD treatment providers who received the Science to Service Laboratory (SSL), a multilevel implementation strategy developed by a federally funded addiction training center, had significantly greater odds of CM adoption than providers who received training as usual. This study examined whether CM adoption frequency varied as a function of provider sociodemographic characteristics (i.e., age, race/ethnicity, licensure) and perceived barriers to adoption (i.e., patient-, provider-, organization-level) among providers receiving the SSL in an opioid treatment program. Thirty-nine providers (67% female, 77% non-Hispanic white, 72% with specialty licensure, M age = 42 [SD = 11.46]) received the SSL, which consisted of didactic training, performance feedback, specialized training of internal change champions, and external coaching. Providers completed a comprehensive baseline assessment and reported on their adoption of CM biweekly for 52 weeks. Providers reported using CM an average of nine 2-week intervals (SD = 6.35). Hierarchical multiple regression found that providers identifying as younger, non-Hispanic white, and without addiction-related licensure all had higher levels of CM adoption frequency. Higher perceived patient-level barriers predicted lower levels of CM adoption frequency, whereas provider- and organization-level barriers were not significant predictors. The significant effect of age on CM adoption frequency was consistent with prior research on predictors of evidence-based practice adoption, whereas the effect of licensure was counter to prior research. The finding that CM adoption frequency was lower among racially/ethnically diverse providers was not expected and suggests that the SSL may require adaptation to meet the needs of diverse opioid treatment providers. Entities using the SSL may also wish to incorporate a more explicit focus on patient-level barriers.

The Role of CMR and Others in Project Implementation using the CM Method to Support the Government

NASA Astrophysics Data System (ADS)

Tada, Hiroshi; Miyatake, Ichiro; Mouri, Junji; Endo, Kenji; Fueta, Toshiharu

In Japan, the construction management (CM) method has been introduced as a measure to support the governmental agencies, in developing and maintaining local infrastructures, or in executing public works projects in an appropriate manner, etc. The scope of work of the Construction Manager (CMR) of the CM method is specified as work items, in the special specification document for CM services contained in the contract documents, as a reflection of the client's expectations towards the performance of CMR. However, the CM services has been conducted as required on a case-by-case basis, because it is not possible to anticipate the actual construction status in advance, and thus the special specification document does not provide full detail of the scope of work of CMR. In such case, there may be a difference in the way the scope of work in the special specification document is recognized between the client and the CMR, which could make the CM method less effective. Moreover, there is a case in which the role sharing between the client and the CMR is not clearly defined, and both parties may engage in the same task in such case, causing an obstacle for smooth project implementation. For this reason, it is required to prepare the special specification document which clearly defines the scope of work of CMR, by examining the status of application of the CM method in actual project cases, and to improve the practices of the CM method as necessary. In view of this background, this study looks in to the actual project cases using the CM method, for the purpose of clarifying the actual scope of work of CMR for each task item defined in the special specification document, and the role sharing between the client and CMR, in the aim of contributing the promotion of the use and the effective application of the CM method.

Large-volume iodinated contrast medium extravasation: low frequency and good outcome after conservative management in a single-centre cohort of more than 67,000 patients.

PubMed

Ko, Chih-Hsiang; Tay, Shee Yen; Chang, Hsiu-Chin; Chan, Wing P

2018-06-12

Our aim was to retrospectively investigate the frequency and outcome of large-volume iodinated contrast medium (CM) extravasation in our institution and to compare our management protocol to current practice. Institutional review board approval was obtained, and informed consent was waived because the study was retrospective. From January 2008 to September 2016, radiological examinations with intravenous non-ionic iodinated CM administration were performed in 67,129 patients. Contrast medium extravasation events on CT scans and intravenous pyelograms but not on angiograms were included. All data were collected prospectively and stratified according to age, injection method (manual vs auto-injection), prevention of extravasation by various means (including intercom alarm), management of extravasation (routine application of silver sulfadiazine ointment, clobetasol propionate cream, and damp gauze at room temperature), etc. RESULTS: The incidence of large-volume CM extravasation was very low (0.04% [27/67,129] overall; 0.03% related to manual injection [age range, 59-92 years; mean, 75.4 years], and 0.045% related to auto-injection [age range, 36-86 years; mean, 65.8 years]). The CM extravasation volume in majority of patients was 20-40 ml in 5 of 9 patients (55.6%) in the manual injection group and 14 of 18 (77.8%) in the auto-injection group. Swelling and pain were the most common symptoms. No patient developed severe signs or needed surgical intervention. Results show a very low incidence of large-volume CM extravasation without severe complications or sequelae. The casual effect between our protocols and good outcome cannot be scrutinised thoroughly because the study lacks a control group and is retrospective. • The incidence of large-volume contrast medium extravasation (≥20 ml) was 0.04%. • No patient needed surgical intervention, and most recovered within 7 days. • Each element of our management protocol contributed to good outcome.

Aeropropulsion facilities configuration control: Procedures manual

NASA Technical Reports Server (NTRS)

Lavelle, James J.

1990-01-01

Lewis Research Center senior management directed that the aeropropulsion facilities be put under configuration control. A Configuration Management (CM) program was established by the Facilities Management Branch of the Aeropropulsion Facilities and Experiments Division. Under the CM program, a support service contractor was engaged to staff and implement the program. The Aeronautics Directorate has over 30 facilities at Lewis of various sizes and complexities. Under the program, a Facility Baseline List (FBL) was established for each facility, listing which systems and their documents were to be placed under configuration control. A Change Control System (CCS) was established requiring that any proposed changes to FBL systems or their documents were to be processed as per the CCS. Limited access control of the FBL master drawings was implemented and an audit system established to ensure all facility changes are properly processed. This procedures manual sets forth the policy and responsibilities to ensure all key documents constituting a facilities configuration are kept current, modified as needed, and verified to reflect any proposed change. This is the essence of the CM program.

Conceptual Model of Weight Management in Overweight and Obese African-American Females.

PubMed

Sutton, Suzanne M; Magwood, Gayenell S; Nemeth, Lynne S; Jenkins, Carolyn M

2017-04-01

Weight management of overweight and obese (OWO) African-American females (AAFs) is a poorly defined concept, leading to ineffective treatment of overweight and obesity, prevention of health sequelae, and risk reduction. A conceptual model of the phenomenon of weight management in OWO AAFs was developed through dimensional analysis of the literature. Constructs were identified and sorted into the dimensions of perspective, context, conditions, process, and consequences and integrated into an explanatory matrix. Through dimensional analysis, weight management in OWO AAFs was characterized as a multidimensional concept, defined from the perspective of weight loss in community-dwelling AAFs. Behaviors associated with weight management are strongly influenced by intrinsic factors and extrinsic conditions, which influence engagement in the processes and consequences of weight management. The resulting conceptual model of weight management in OWO AAFs provides a framework for research interventions applicable in a variety of settings. © 2016 Wiley Periodicals, Inc.

The Effectiveness of Ultra-Low Magnitude Reinforcers: Findings From a "Real-World" Application of Contingency Management.

PubMed

Kropp, Frankie; Lewis, Daniel; Winhusen, Theresa

2017-01-01

Research has consistently found contingency management (CM) to be an effective tool in increasing desired patient behaviors in substance use disorder (SUD) treatment. Despite the strong evidence for the effectiveness of this intervention, practical issues and the cost of implementing CM in treatment programs have been significant barriers to adoption. To evaluate the impact of a CM program designed and implemented by university-affiliated methadone clinic staff to increase patient group attendance. The CM program consisted of a weekly raffle for patients attending clinician-led group counseling and/or in-clinic Methadone Anonymous (MA) groups in which slips with patient ID#s were entered and one ID slip was drawn per week with a fee credit for a dose of methadone ($15) as the prize. The CM program continued for 12 months. Group attendance was tracked before, during, and after CM implementation as part of ongoing clinic service utilization monitoring. Following the implementation of CM, attendance at any clinician-led or MA groups increased significantly from baseline to month 1 (X 2 =5.78, p<0.05) but this increase was not sustained beyond month 6. Analysis of attendance by type of group revealed that clinician-led group attendance did not increase significantly but there was a significant increase in in-clinic MA group attendance from baseline to month 1 (X 2 =20.27, p<0.001), which was sustained through the 12-month implementation period (X 2 =11.21, p<0.001) and through 3 months post-implementation (X 2 =14.73; p<0.001). A low-cost, simple CM intervention implemented by clinic staff was associated with significant increases in the target behavior of increasing group attendance. Copyright © 2016 Elsevier Inc. All rights reserved.

In modern linacs monitor units should be defined in water at 10 cm depth rather than at dmax.

PubMed

Van den Heuvel, Frank; Wu, Qiuwen; Cai, Jing

2018-05-28

Thanks to the widely adopted guidelines such as AAPM TG-51 1 and IAEA TRS-398 2 , linac calibration has become more consistent and accurate around the globe than previously. Modern linac photon beams are often calibrated in water at 10 cm depth, and configured such that 1 monitor unit (MU) corresponds to 1 cGy at the depth of maximum dose, (d max) . However, such configuration is not without limitations. Some think it is unnecessarily complex and prone to errors, and believe that defining MU at 10 cm is more appropriate. Others think that change of MU definition can cause confusion and possibly serious consequences without any real benefit. This is the premise debated in this month's Point/Counterpoint. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Added Value of Reliability to a Microgrid: Simulations of Three California Buildings

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

Marnay, Chris; Lai, Judy; Stadler, Michael

The Distributed Energy Resources Customer Adoption Model is used to estimate the value an Oakland nursing home, a Riverside high school, and a Sunnyvale data center would need to put on higher electricity service reliability for them to adopt a Consortium for Electric Reliability Technology Solutions Microgrid (CM) based on economics alone. A fraction of each building's load is deemed critical based on its mission, and the added cost of CM capability to meet it added to on-site generation options. The three sites are analyzed with various resources available as microgrid components. Results show that the value placed on highermore » reliability often does not have to be significant for CM to appear attractive, about 25 $/kWcdota and up, but the carbon footprint consequences are mixed because storage is often used to shift cheaper off-peak electricity to use during afternoon hours in competition with the solar sources.« less

The colonial context of Filipino American immigrants' psychological experiences.

PubMed

David, E J R; Nadal, Kevin L

2013-07-01

Because of the long colonial history of Filipinos and the highly Americanized climate of postcolonial Philippines, many scholars from various disciplines have speculated that colonialism and its legacies may play major roles in Filipino emigration to the United States. However, there are no known empirical studies in psychology that specifically investigate whether colonialism and its effects have influenced the psychological experiences of Filipino American immigrants prior to their arrival in the United States. Further, there is no existing empirical study that specifically investigates the extent to which colonialism and its legacies continue to influence Filipino American immigrants' mental health. Thus, using interviews (N = 6) and surveys (N = 219) with Filipino American immigrants, two studies found that colonialism and its consequences are important factors to consider when conceptualizing the psychological experiences of Filipino American immigrants. Specifically, the findings suggest that (a) Filipino American immigrants experienced ethnic and cultural denigration in the Philippines prior to their U.S. arrival, (b) ethnic and cultural denigration in the Philippines and in the United States may lead to the development of colonial mentality (CM), and (c) that CM may have negative mental health consequences among Filipino American immigrants. The two studies' findings suggest that the Filipino American immigration experience cannot be completely captured by the voluntary immigrant narrative, as they provide empirical support to the notion that the Filipino American immigration experience needs to be understood in the context of colonialism and its most insidious psychological legacy- CM. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Soil management practice in Croatian vineyard affect CO2 fluxes and soil degradation in trafficking zones. First results

NASA Astrophysics Data System (ADS)

Bogunovic, Igor; Bilandzija, Darija; Andabaka, Zeljko; Stupic, Domagoj; Cacic, Marija; Brezinscak, Luka; Maletic, Edi; Pereira, Paulo; Kisic, Ivica

2017-04-01

Vineyards represent one of the most degradation prone types of intensively managed land on Earth. Steep slopes encourage grape producers to adopt environmental friendly soil management like mulching or continuous no-tillage. In this context, producers have concerns about efficient fertilisation practices and water competitions between vine and grasses in continuous no-tillage inter rows. Vineyards in semi-humid areas like Continental Croatia mostly not suffer from water deficit during growth. Nevertheless, lack of research of different soil management practices open dilemma about soil compaction concerns in intensively trafficked soils in vineyard of semi-humid areas. Soil compaction, determined by bulk density (BD), soil water content (SWC) and CO2 fluxes from trafficked inter row positions were recorded in 2016 in an experiment in which four different soil management systems were compared in a vineyard raised on a silty clay loam soil, near Zagreb, Croatia: No-tillage (NT) system, continuous tillage (CT) and yearly inversed grass covered (INV-GC) and tillage managed (INV-T) inter rows are subjected to intensive traffic. Grape yield and must quality of grape variety Chardonnay was also monitored. Tractor traffic increased the soil BD at 0-10 and 10-20 cm, but especially at the 0-10 cm depth. CT treatment record lowest compaction at 0-10 cm because of tillage. Soil water content showed better conservation possibilities of INV-GC in drier period. In wet period SWC possibilities are similar between treatments. The results of soil compaction under different management indicate that vineyard soil differently response to traffic intensity and impact on microfauna activity and CO2 emissions. INV-GC and NT managed soils record lower CO2 fluxes from vineyard soil compared to CT and INV-T treatments. Management treatments did not statistically influenced on grape yields. Several years of investigation is needed to confirm the overall impact of different management treatments on the proportion of degradation process and their response to proportion of tractor circulation impacts.

The Advanced Communication Technology Satellite and ISDN

NASA Technical Reports Server (NTRS)

Lowry, Peter A.

1996-01-01

This paper depicts the Advanced Communication Technology Satellite (ACTS) system as a global central office switch. The ground portion of the system is the collection of earth stations or T1-VSAT's (T1 very small aperture terminals). The control software for the T1-VSAT's resides in a single CPU. The software consists of two modules, the modem manager and the call manager. The modem manager (MM) controls the RF modem portion of the T1-VSAT. It processes the orderwires from the satellite or from signaling generated by the call manager (CM). The CM controls the Recom Laboratories MSPs by receiving signaling messages from the stacked MSP shelves ro units and sending appropriate setup commands to them. There are two methods used to setup and process calls in the CM; first by dialing up a circuit using a standard telephone handset or, secondly by using an external processor connected to the CPU's second COM port, by sending and receiving signaling orderwires. It is the use of the external processor which permits the ISDN (Integrated Services Digital Network) Signaling Processor to implement ISDN calls. In August 1993, the initial testing of the ISDN Signaling Processor was carried out at ACTS System Test at Lockheed Marietta, Princeton, NJ using the spacecraft in its test configuration on the ground.

Managing Appalachian hardwood stands using four management practices: 60-year results

Treesearch

Thomas M. Schuler; Melissa Thomas-Van Gundy; John P. Brown; Jan Wiedenbeck

2017-01-01

A long-term forest management case study on the Fernow Experimental Forest in West Virginia referred to as the Cutting Practice Level study is evaluated after 60 years. Treatments include a commercial clearcut (one time application), a 39 cm diameter-limit (applied 4 times), uneven-aged management using two variations of single-tree selection (applied 7 and 8 times,...

Treatment of the neglected Achilles tendon rupture.

PubMed

Bevilacqua, Nicholas J

2012-04-01

Achilles tendon ruptures are best managed acutely. Neglected Achilles tendon ruptures are debilitating injuries and the increased complexity of the situation must be appreciated. Surgical management is recommended, and only in the poorest surgical candidate is conservative treatment entertained. Numerous treatment algorithms and surgical techniques have been described. A V-Y advancement flap and flexor halluces longus tendon transfer have been found to be reliable and achieve good clinical outcomes for defects ranging from 2 cm to 8 cm. This article focuses on the treatment options for the neglected Achilles tendon rupture. Copyright © 2012 Elsevier Inc. All rights reserved.

Optimizing Soft Tissue Management and Spacer Design in Segmental Bone Defects

DTIC Science & Technology

2016-12-01

proximal and distal bone segments. 3. Debride 10 grams of tibialis anterior and gastrocnemius muscles. 4. Place an interlocking intramedullary nail ...using a custom spacer to maintain 5-cm defect length. 5. Place a pre-molded 5 cm long x 2 cm diameter PMMA spacer around the nail in the defect. 6...tibia. 3. Open the IM surrounding the PMMA spacer using a “bomb bay door opening”. 4. Remove the spacer without damaging the membrane or nail . 5

[Effect of psychotherapeutic interventions on weight reduction and personality development of a 13-year-old boy with Prader-Willi syndrome].

PubMed

Wurst, E; Möslinger, D; Widhalm, K

1992-01-01

A 12.10-year old boy (actual weight 88.8 kg, actual height 131.2 cm; 228% overweight) with Prader-Willi-syndrome achieved, after repeated ineffective therapy attempts over a period of 10 years, a weight reduction of 11.8 kg (185% overweight) during a 9-week in-patient treatment. In the following out-patient phase of therapy a further weight reduction of 20 kg (109% overweight) was achieved over a period of 16 months. Apart from the usual modes of action of therapy (reduced energy intake, physical exercise, behaviour modification), family therapeutic and special education interventions were used. These achieved an improvement of the patient's self-esteem, an increase in his competence to act and in his autonomy concerning his diet management, as well as a positive experience of his own abilities and social acceptance by other children and the stabilisation of the dysfunctional family system. It may be assumed that this therapeutic success is dependent on consequent compliance with the system model.

A high risk critical mitral valve stenosis with emergency management at Apollo Hospitals Dhaka.

PubMed

Zahangir, N M; Hoque, K Z; Khan, M H; Haque, M A; Haider, M Z

2013-10-01

Heart valve surgery in high-risk patients with severe jaundice, congestive hepatomegaly and renal impairment is associated with considerable morbidity and mortality. Without operation the consequences are invariably grave. A 35 years old gentleman with congestive cardiac failure was initially treated in coronary care unit (CCU). Mitral valve area was 0.5cm², pulmonary arterial systolic pressure (PASP) was 110mmHg, serum bilirubin was 20mg/dl, SGPT & SGOT were 1024iu/l and 1027iu/l respectively. Serum creatinine was 3.35mmol/l. Serum bilirubin gradually diminished to 3.1mg/dl after 12 days treatment in Coronary Care Unit but next day it increased to 3.6mg/dl. Mitral valve was replaced on an emergency basis. Echocardiogram on the 5th post operative day showed well functioning prosthetic mitral valve in situ. Serum bilirubin decreased to 2.2mg/dl, SGPT, SGOT and serum creatinine to 43iu/l, 40iu/l and 1.34mmol/l respectively. After 8 weeks of postoperative follow up his serum bilirubin decreased to 0.8mg/dl.

A Modern Bréguet-Type Galvanometer

ERIC Educational Resources Information Center

Daffron, John A.; Greenslade, Thomas B., Jr.

2015-01-01

Recently the handsome little galvanometer (only 10 cm high) in Fig. 1 came into the Greenslade Collection. This is a design without a moving coil and, consequently, is very rugged. At the same time, John Daffron independently sent Tom Greenslade the picture of a similar galvanometer that he had made some years back and has been using for…

What do we get for our money? Cost-effectiveness of adding contingency management.

PubMed

Sindelar, Jody; Elbel, Brian; Petry, Nancy M

2007-02-01

To assess the relative cost-effectiveness of lower versus higher cost prize-based contingency management (CM) treatments for cocaine abuse. Cost-effectiveness analyses based on resource utilization, unit costs and outcomes from a previous CM efficacy trial. Two community-based treatment centers. Patients (n = 120) enrolled in out-patient treatment for cocaine abuse. Random assignment to one of three 12-week treatment conditions: standard treatment (STD) alone or two variants of STD combined with prize based CM. In CM, drawing for prizes was available to those submitting drug-free urine samples and completing goal-related activities. There were two levels of pay-out (referred to as $80 versus $240) based on the potential value of prizes won. Costs per participant associated with counseling utilization, urine and breathalyzer testing, and operation of the prize-drawing procedure were derived from a survey conducted at 16 clinics that had participated in CM studies. The three measures of effectiveness were: (1) longest duration of consecutive abstinence; (2) percentage completing treatment; and (3) percentage of samples drug-free. The higher magnitude CM produced outcomes at a lower per unit cost than did the lower magnitude prize CM treatment. This was the case for all three outcome measures examined and held across various assumptions in the sensitivity analysis. Cost-effectiveness analyses can inform policy decisions regarding selection of one treatment model over another. Decisions on adoption of new evidence-based treatments would be aided by more information on society's willingness to pay for incremental gains in effectiveness.

[Drug shortage: determinants, consequences and management].

PubMed

Reis, Adriano Max Moreira; Perini, Edson

2008-04-01

The present study analyzes drug shortage as a problem reaching beyond the logistic aspect of the health field and discusses its consequences with respect to quality, safety and cost of health care delivery. The pharmaceutical supply chain and the factors that determine the distribution and availability of drugs are discussed. The contribution of the Pharmacy and Therapeutics Committee in preventing and managing drug shortage in health institutions is stressed and measures for drug shortage management are suggested. Finally it is emphasized that drugs should be considered health products rather than consumer goods and as such be given a different treatment by the supply chain.

Supported self-management for cancer survivors to address long-term biopsychosocial consequences of cancer and treatment to optimize living well.

PubMed

Howell, Doris D

2018-03-01

As individuals are living longer with cancer as a chronic disease, they face new health challenges that require the application of self-management behaviors and skills that may not be in their usual repertoire of self-regulatory health behaviors. Increasing attention is focused on supported self-management (SSM) programs to enable survivors in managing the long-term biopsychosocial consequences and health challenges of survivorship. This review explores current directions and evidence for SSM programs that enable survivors to manage these consequences and optimize health. Cancer survivors face complex health challenges that affect daily functioning and well being. Multiple systematic reviews show that SSM programs have positive effects on health outcomes in typical chronic diseases. However, the efficacy of these approaches in cancer survivors are in their infancy; and the 'one-size' fits all approach for chronic disease self-management may not be adequate for cancer as a complex chronic illness. This review suggests that SSM has promising potential for improving health and well being of cancer survivors, but there is a need for standardizing SSM for future research. Although there is increasing enthusiasm for SSM programs tailored to cancer survivors, there is a need for further research of their efficacy on long-term health outcomes.

Anhedonia Is Associated with Poorer Outcomes in Contingency Management for Cocaine Use Disorder

PubMed Central

Wardle, Margaret C.; Vincent, Jessica N.; Suchting, Robert; Green, Charles E.; Lane, Scott D.; Schmitz, Joy M.

2016-01-01

This study explored anhedonia (lack of interest or pleasure in non-drug rewards) as a potentially modifiable individual difference associated with the effectiveness of Contingency Management (CM). It also tested the hypothesis that a dopaminergic drug, levodopa (L-DOPA), would improve the effectiveness of CM, particularly in individuals high in anhedonia. The study was a single-site, randomized, double-blind, parallel group, 12-week trial comparing L-DOPA with placebo, with both medication groups receiving voucher-based CM targeting cocaine-negative urines. Participants were N = 85 treatment-seeking adults with CUD. Anhedonia was measured at baseline using a validated self-report measure and a progressive ratio behavioral measure. Treatment Effectiveness Score (TES) was defined as the total number of cocaine-negative urines submitted. Analyses based on Frequentist general linear models were not significant, but Bayesian analyses indicated a high probability (92.6%) that self-reported anhedonia was associated with poor treatment outcomes (lower TES). L-DOPA did not significantly improve outcomes, nor was the effect of L-DOPA moderated by anhedonia. While the study failed to replicate positive findings from previous studies of L-DOPA in combination with CM, it does provide preliminary evidence that anhedonia may be a modifiable individual difference associated with poorer CM outcomes. PMID:27646197

Short-term effects of prescribed fire for pasture management on soil water repellency in the Central Pyrenees (NE-Spain)

NASA Astrophysics Data System (ADS)

Girona García, Antonio; María Armas-Herrera, Cecilia; Martí-Dalmau, Clara; Badía-Villas, David; Ortiz-Perpiñán, Oriol

2016-04-01

The decrease of livestock grazing during the last decades in the Central Pyrenees has led to a regression of grasslands in favour of shrublands, mainly composed by Echinospartum horridum. Prescribed burning might be a suitable tool for the control of this species that limits pastures development and therefore, the reclamation of grasslands; although, its effects on soil properties are still uncertain [1]. Controlled burnings are usually performed in spring or autumn, when soil moisture is high and temperature low, being easier to control and also reducing its effects on soil properties. However, burning during the wet seasons can increase the risk of soil erosion as the vegetation cover is partially destroyed. In this sense, soil water repellency (SWR) plays an important role reducing the infiltration rates and, thus, increasing runoff and soil erosion [2]. Then, it is of special interest to study parameters that influence SWR such as soil moisture, soil organic carbon (SOC) content and soil biological activity [3]. The aim of this work is, to analyse the effects of controlled burning on SWR as well as some of the influencing factors on this parameter. To achieve this, soil sampling was carried out in two prescribed fire events that took place in the Central Pyrenees: Tella (April, 2015) and Buisán (November, 2015). Temperature was simultaneously recorded during the fire via thermocouples placed at the surface level and at 1 cm, 2 cm and 3 cm depth. In each event, topsoil was scrapped and sampled from 0-1 cm, 1-2 cm and 2-3 cm depth in each sampling point (3 for Tella and 4 for Buisán) just before and immediately after burning. We analysed SWR persistence (Water Drop Penetration Time, WDPT) and intensity (Ethanol Percentage Test, EPT) as well as total C and N, microbial C, β-glucosidase activity, soil moisture and pH. Temperature measurements indicated a higher fire intensity in Tella than in Buisán burning. Surface unburned samples presented extreme SWR values for Tella (2726 s) and strong values for Buisán (191 s) according to the WDPT test, significantly decreasing with depth. Preliminary results showed that burning affected SWR, significantly reducing WDPT down to 3 cm in Tella (from extreme to strong) and 2 cm depth in Buisán (from strong to slight). EPT results indicated a significant decrease in SWR intensity down to 2 cm in Tella and 1 cm in Buisán with burning. On the other hand, no differences were observed regarding soil moisture between burned and unburned samples, although a trend to decreasing was observed with fire. Further analyses will allow us to explain and support in detail the variations observed in SWR with prescribed burning. [1] Shakesby, R.A. et al. (2015). Impacts of prescribed fire on soil loss and soil quality: An assessment based on an experimentally-burned catchment in central Portugal. Catena 128: 278-293. [2] Bodí, M.B. et al. (2013). Spatial and temporal variations of water repellency and probability of its occurrence in calcareous Mediterranean rangeland soils affected by fire. Catena 108: 14-25. [3] Jordán, A. et al. (2013). Soil water repellency: Origin, assessment and geomorphological consequences. Catena 108: 1-5.

Predicting use of case management support services for adolescents and adults living in community following brain injury: A longitudinal Canadian database study with implications for life care planning

PubMed Central

Baptiste, B.; Dawson, D.R.; Streiner, D.

2015-01-01

Abstract OBJECTIVE: To determine factors associated with case management (CM) service use in people with traumatic brain injury (TBI), using a published model for service use. DESIGN: A retrospective cohort, with nested case-control design. Correlational and logistic regression analyses of questionnaires from a longitudinal community data base. STUDY SAMPLE: Questionnaires of 203 users of CM services and 273 non-users, complete for all outcome and predictor variables. Individuals with TBI, 15 years of age and older. Out of a dataset of 1,960 questionnaires, 476 met the inclusion criteria. METHODOLOGY: Eight predictor variables and one outcome variable (use or non-use of the service). Predictor variables considered the framework of the Behaviour Model of Health Service Use (BMHSU); specifically, pre-disposing, need and enabling factor groups as these relate to health service use and access. RESULTS: Analyses revealed significant differences between users and non-users of CM services. In particular, users were significantly younger than non-users as the older the person the less likely to use the service. Also, users had less education and more severe activity limitations and lower community integration. Persons living alone are less likely to use case management. Funding groups also significantly impact users. CONCLUSIONS: This study advances an empirical understanding of equity of access to health services usage in the practice of CM for persons living with TBI as a fairly new area of research, and considers direct relevance to Life Care Planning (LCP). Many life care planers are CM and the genesis of LCP is CM. The findings relate to health service use and access, rather than health outcomes. These findings may assist with development of a modified model for prediction of use to advance future cost of care predictions. PMID:26409333

Configuration and Data Management Process and the System Safety Professional

NASA Technical Reports Server (NTRS)

Shivers, Charles Herbert; Parker, Nelson C. (Technical Monitor)

2001-01-01

This article presents a discussion of the configuration management (CM) and the Data Management (DM) functions and provides a perspective of the importance of configuration and data management processes to the success of system safety activities. The article addresses the basic requirements of configuration and data management generally based on NASA configuration and data management policies and practices, although the concepts are likely to represent processes of any public or private organization's well-designed configuration and data management program.

Psychosocial Risk Factors for Child Welfare among Postpartum Mothers with a History of Childhood Maltreatment and Neglect.

PubMed

Koenig, A M; Schury, K; Reister, F; Köhler-Dauner, F; Schauer, M; Ruf-Leuschner, M; Gündel, H; Ziegenhain, U; Fegert, J M; Kolassa, I-T

2016-03-01

Background: Childhood maltreatment (CM) can increase the risk of psychosocial risk factors in adulthood (e. g. intimate partner violence, financial problems, substance abuse or medical problems). The transition to parenthood presents those affected by CM with particular challenges, in addition to usual birth-related stressors. Methods: In this cross-sectional study a total of 240 women were interviewed in the puerperium with respect to CM experiences, using the German version of the Childhood Trauma Questionnaire (CTQ). Current psychosocial risk factors (e. g. financial concerns, maternal mental illness, single parent) were assessed using the Constance Index (KINDEX) for early childhood risk factors. Associations between CM experience and psychosocial risk factors were calculated using simple correlation. Results: The average age of participants was 33 years. On the CTQ 13.8 % of participants reported emotional abuse, 6.7 % physical abuse and 12.5 % sexual abuse, while 32.1 % reported emotional neglect and 7.5 % physical neglect during childhood. With rising severity of CM, more psychosocial risk factors (KINDEX) were present. Conclusions: This study shows a clear association between experiences of maltreatment during childhood and the presence of psychosocial stressors among women in the puerperium. Regular screening for a history of CM and parental psychosocial stressors should be conducted early, i.e. during pregnancy, to avoid negative consequences for the child.

Wireless Power Transfer for Autonomous Wearable Neurotransmitter Sensors.

PubMed

Nguyen, Cuong M; Kota, Pavan Kumar; Nguyen, Minh Q; Dubey, Souvik; Rao, Smitha; Mays, Jeffrey; Chiao, J-C

2015-09-23

In this paper, we report a power management system for autonomous and real-time monitoring of the neurotransmitter L-glutamate (L-Glu). A low-power, low-noise, and high-gain recording module was designed to acquire signal from an implantable flexible L-Glu sensor fabricated by micro-electro-mechanical system (MEMS)-based processes. The wearable recording module was wirelessly powered through inductive coupling transmitter antennas. Lateral and angular misalignments of the receiver antennas were resolved by using a multi-transmitter antenna configuration. The effective coverage, over which the recording module functioned properly, was improved with the use of in-phase transmitter antennas. Experimental results showed that the recording system was capable of operating continuously at distances of 4 cm, 7 cm and 10 cm. The wireless power management system reduced the weight of the recording module, eliminated human intervention and enabled animal experimentation for extended durations.

Organizational Factors Associated with the Use of Contingency Management in Publicly Funded Substance Abuse Treatment Centers

PubMed Central

Bride, Brian E.; Abraham, Amanda J.; Roman, Paul M.

2010-01-01

A promising area within technology transfer studies is the identification of organizational factors that influence the adoption of treatment innovations. While studies have identified organizational factors associated with the adoption of pharmacological innovations, few studies have examined organizational factors in the adoption of psychosocial innovations, among which contingency management (CM) is a significant practice. Using data from a sample (n = 318) drawn from the population of publicly funded treatment centers in the U.S., this study modeled organizational factors falling in the domains of structural characteristics, workforce variables, values and norms, and patient characteristics associated with the use of CM. Organizations were more likely to use CM if they: embrace a supportive therapeutic approach, are research-friendly, offer only outpatient levels of care, or serve drug-court patients. Implications for studying the diffusion and implementation of evidence-based psychosocial interventions are discussed. PMID:20850259

Wireless Power Transfer for Autonomous Wearable Neurotransmitter Sensors

PubMed Central

Nguyen, Cuong M.; Kota, Pavan Kumar; Nguyen, Minh Q.; Dubey, Souvik; Rao, Smitha; Mays, Jeffrey; Chiao, J.-C.

2015-01-01

In this paper, we report a power management system for autonomous and real-time monitoring of the neurotransmitter L-glutamate (L-Glu). A low-power, low-noise, and high-gain recording module was designed to acquire signal from an implantable flexible L-Glu sensor fabricated by micro-electro-mechanical system (MEMS)-based processes. The wearable recording module was wirelessly powered through inductive coupling transmitter antennas. Lateral and angular misalignments of the receiver antennas were resolved by using a multi-transmitter antenna configuration. The effective coverage, over which the recording module functioned properly, was improved with the use of in-phase transmitter antennas. Experimental results showed that the recording system was capable of operating continuously at distances of 4 cm, 7 cm and 10 cm. The wireless power management system reduced the weight of the recording module, eliminated human intervention and enabled animal experimentation for extended durations. PMID:26404311

Configuration Management at NASA

NASA Technical Reports Server (NTRS)

Doreswamy, Rajiv

2013-01-01

NASA programs are characterized by complexity, harsh environments and the fact that we usually have one chance to get it right. Programs last decades and need to accept new hardware and technology as it is developed. We have multiple suppliers and international partners Our challenges are many, our costs are high and our failures are highly visible. CM systems need to be scalable, adaptable to new technology and span the life cycle of the program (30+ years). Multiple Systems, Contractors and Countries added major levels of complexity to the ISS program and CM/DM and Requirements management systems center dot CM Systems need to be designed for long design life center dot Space Station Design started in 1984 center dot Assembly Complete in 2012 center dot Systems were developed on a task basis without an overall system perspective center dot Technology moves faster than a large project office, try to make sure you have a system that can adapt

Medical and surgical management of subperiosteal orbital abscess secondary to acute sinusitis in children.

PubMed

Oxford, Lance E; McClay, John

2006-11-01

To evaluate the presentations and outcomes of pediatric subperiosteal orbital abscesses (SPOA) secondary to acute sinusitis. Case series Tertiary children's hospital. Forty-three admissions diagnosed with SPOA by clinical presentation and contrast enhanced computed tomography (CECT) were retrospectively reviewed. Clinical presentations, CECT dimensions, treatment, outcomes, and microbiology. Eighteen/43 (42%) patients resolved their infection with medical management only, including five children older than nine. Twenty-five/43 (58%) children underwent surgical drainage. Purulence was identified in 22 of 25 surgical patients, and the most common organism was Streptococcus milleri (7 patients). Compared to 22 patients with drained purulence, the 18 patients with abscesses managed medically had significant differences for: chemosis in 2/18 (11.1%) versus 14/22 (63.6%, p=0.001), proptosis in 10/18 (55.6%) versus 20/22 (90.9%, p=0.025), elevated intraocular pressure (IOP) in 0/18 (0%) versus 11/22 (50%, p<0.001), severe restriction of extraocular movements in 1/18 (5.6%) versus 12/22 (54.5%, p=0.002), and length of stay (4.3 versus 5.8 days, p=0.038). The dimensions of medial SPOA managed medically were significantly smaller on CECT compared to surgically drained purulent SPOA: width (0.25 versus 1.46cm, p<0.001), height (0.73 versus 1.35cm, p=0.002), and length (1.1 versus 1.86cm, p=0.004). Persistent morbidities occurred in no patients managed medically and in 2/25 (8%) managed surgically. Children with small medial SPOA without significant ocular signs may be managed medically with favorable outcomes. Proposed criteria for medical management of medial SPOA include: (1) normal vision, pupil, and retina; (2) no ophthalmoplegia; (3) IOP<20mmHg; (4) proptosis of 5mm or less; and (5) abscess width of 4mm or less. In contrast to prior series, older children with SPOA were managed successfully with medical therapy.

Satellite Estimation of Fractional Cover in Several California Specialty Crops

NASA Technical Reports Server (NTRS)

Johnson, Lee; Cahn, Michael; Rosevelt, Carolyn; Guzman, Alberto; Farrara, Barry; Melton, Forrest S.

2016-01-01

Past research in California and elsewhere has revealed strong relationships between satellite NDVI, photosynthetically active vegetation fraction (Fc), and crop evapotranspiration (ETc). Estimation of ETc can support efficiency of irrigation practice, which enhances water security and may mitigate nitrate leaching. The U.C. Cooperative Extension previously developed the CropManage (CM) web application for evaluation of crop water requirement and irrigation scheduling for several high-value specialty crops. CM currently uses empirical equations to predict daily Fc as a function of crop type, planting date and expected harvest date. The Fc prediction is transformed to fraction of reference ET and combined with reference data from the California Irrigation Management Information System to estimate daily ETc. In the current study, atmospherically-corrected Landsat NDVI data were compared with in-situ Fc estimates on several crops in the Salinas Valley during 2011-2014. The satellite data were observed on day of ground collection or were linearly interpolated across no more than an 8-day revisit period. Results will be presented for lettuce, spinach, celery, broccoli, cauliflower, cabbage, peppers, and strawberry. An application programming interface (API) allows CM and other clients to automatically retrieve NDVI and associated data from NASA's Satellite Irrigation Management Support (SIMS) web service. The SIMS API allows for queries both by individual points or user-defined polygons, and provides data for individual days or annual timeseries. Updates to the CM web app will convert these NDVI data to Fc on a crop-specific basis. The satellite observations are expected to play a support role in Salinas Valley, and may eventually serve as a primary data source as CM is extended to crop systems or regions where Fc is less predictable.

Satellite Estimation of Fractional Cover in Several California Specialty Crops

NASA Astrophysics Data System (ADS)

Johnson, L.; Cahn, M.; Rosevelt, C.; Guzman, A.; Lockhart, T.; Farrara, B.; Melton, F. S.

2016-12-01

Past research in California and elsewhere has revealed strong relationships between satellite NDVI, photosynthetically active vegetation fraction (Fc), and crop evapotranspiration (ETc). Estimation of ETc can support efficiency of irrigation practice, which enhances water security and may mitigate nitrate leaching. The U.C. Cooperative Extension previously developed the CropManage (CM) web application for evaluation of crop water requirement and irrigation scheduling for several high-value specialty crops. CM currently uses empirical equations to predict daily Fc as a function of crop type, planting date and expected harvest date. The Fc prediction is transformed to fraction of reference ET and combined with reference data from the California Irrigation Management Information System to estimate daily ETc. In the current study, atmospherically-corrected Landsat NDVI data were compared with in-situ Fc estimates on several crops in the Salinas Valley during 2011-2014. The satellite data were observed on day of ground collection or were linearly interpolated across no more than an 8-day revisit period. Results will be presented for lettuce, spinach, celery, broccoli, cauliflower, cabbage, peppers, and strawberry. An application programming interface (API) allows CM and other clients to automatically retrieve NDVI and associated data from NASA's Satellite Irrigation Management Support (SIMS) web service. The SIMS API allows for queries both by individual points or user-defined polygons, and provides data for individual days or annual timeseries. Updates to the CM web app will convert these NDVI data to Fc on a crop-specific basis. The satellite observations are expected to play a support role in Salinas Valley, and may eventually serve as a primary data source as CM is extended to crop systems or regions where Fc is less predictable.

The Efficacy of Contingency Management on Cocaine Craving, using Prize-based Reinforcement of Abstinence in Cocaine Users.

PubMed

Pirnia, Bijan; Tabatabaei, Seyed Kazem Rasoulzadeh; Tavallaii, Abbas; Soleimani, Ali Akbar; Pirnia, Kambiz

2016-11-01

Contingency management (CM) is one of the most common therapies in the domain of drug addiction. This study has been carried out with the purpose of evaluating the efficacy of contingency management intervention. In an experimental design, between December 15, 2014 and November 20, 2015, fifty men (between 18 and 31 with an average age of 24.6) with a history of cocaine use, were selected voluntarily and were randomly assigned into two groups of CM and control group. The CM group were awarded coupons for negative urine tests, over a period of twelve weeks. The urine tests were taken from the participants twice per week, with cutoff concentrations for positive set at 300 ng/ml and self-reporting index of cocaine craving (response rate = 96%) were evaluated in two phase, through pretest and posttest measures. The data were analyzed by parametric covariance test. Additionally, the qualitative data, resulted from demographic measures, were coded and were analyzed with the help of an analysis instrument of qualitative data i.e. ATLAS.ti-5.2. The primary outcome was the number of negative urine tests and the secondary outcome included the cocaine usage craving index over twelve weeks. The mean of (95% of confidence) number of negative cocaine urine tests was 15.4 (13.1-17.8) in the CM group and 19.7 (17.7-21.6) in the control group (P = 0.049). Also, results showed that CM has a significant effect on reducing craving (p<0.01). The findings of this study, while having practical aspects in this domain, can be valuable in planning remedial procedures.

[Normal pressure hydrocephalus: prognostic value of height in patients treated with an identical shunt system].

PubMed

Aguas, Jesús; Rodrigo, Victor; Estupiñan, Francisco; Nogues, Pere; Villalba, Gloria; Villagrasa, Javier; Caral, Luis

2013-01-01

Normal pressure hydrocephalus (NPH) is a clinical entity frequently managed by means of a cerebrospinal fluid shunt. Hydrodynamic hypotheses consider hydrostatic pressure (as well as height) a very important variable for shunt system function. However, we did not find empirical studies supporting the influence of height on clinical response in the literature. Our objective was to study the prognostic value of height, as a variable related to hydrostatic pressure, when an identical shunt system is used. A prospective series of 61 idiopathic NPH cases was analyzed. All cases were shunted by means of a ventricle-peritoneal system with a 100mmH2O opening pressure valve. Anthropometric, clinical, radiological and pressure variables were registered, as well as delay for treatment, improvement and complications. 78.7% of cases improved after shunting. This group of patients was significantly taller (P=.005) than the group without response (median value 165cm versus 152cm). There was also a significant correlation between height and ventricular size decrease after the shunt. In our series opening valve pressure was a constant (100mmHg) and we could consequently focus on the effect of hydrostatic pressure (height). Moreover, we found a positive predictive value for taller patients, probably because we had selected an opening pressure especially suitable for them. Current gravitational valve shunt systems also recommend considering patient height when customising the system. Our study empirically supports this idea. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

Our ultrasonographic experience in the management of symptomatic hydronephrosis during pregnancy.

PubMed

Dell'Atti, Lucio

2016-03-01

The aim of the present study was to document the role of ultrasound in the diagnosis and management of symptomatic hydronephrosis during pregnancy. In this study, we reviewed 36 consecutive cases of pregnant women whose pregnancy was complicated by symptomatic hydronephrosis. In all patients, management was initially conservative (analgesics and fluids) after hospitalization. The following criteria were used to indicate double-J stent placement under US guidance rather than a conservative treatment: persistent pain with no improvement after conservative treatment, progressive hydronephrosis (>2 cm dilatation of the renal pelvis) or presence of uterine contractions. The mean patient's age was 25 years (17-35) and gestational age at clinical presentation was 24 weeks (13-37). 81 % of cases had a renal pelvis dilatation >2 cm, while in only 19 % of cases there was a hydronephrosis between 1 and 2 cm in diameter; however, calculi were confirmed only in 25 patients. 28 patients required an invasive management with double-J stent insertion under US guidance. The sensitivity and specificity of US in the etiological diagnosis of hydronephrosis during pregnancy was 83 and 91 %, respectively. Conservative management with medical therapy and observation should be the first-line treatment approach. In our opinion a rapid ureteral decompression with the insertion of a ureteral double-J stent, under US visualization, is the safest method in the treatment of pregnant women with obstructed renal systems.

A Threshold Concept in Managing: What Students in Introductory Management Courses Must Know

ERIC Educational Resources Information Center

Donovan, Paul

2017-01-01

In the field of management, a practice--theory gap has developed and consequently, management education has been criticized for being irrelevant to the needs of stakeholders. This article argues that introduction to management courses in higher education perpetuate this gap by not teaching what managers do. These courses fail to communicate well…

Crop residue incorporation for increasing SOC stock. Is it worth it?

NASA Astrophysics Data System (ADS)

Pituello, Chiara; Berti, Antonio; Morari, Francesco

2015-04-01

In the last fifty years, soil organic carbon (SOC) in North-Eastern Italy decreased at rates ranging from 0.02 to 0.58 t ha/year as a consequence of the intensification and simplification of cropping systems. Most recently, the removal of crop residue for bioenergy production raises concerns about its potential impact on SOC evolution. Crop residue incorporation has been included in the Recommended Management Practices (RMPs) for climate change mitigation, however, several doubts still remain on its actual effectiveness. Indeed, long term effects of residue incorporation on SOC stocks have been studied by many authors with apparently contrasting findings. Thus, given the pivotal role played by SOC on ecosystem services, investigating the effects of residues incorporation on soil quality constitutes a key step towards understanding soil processes and will help establish a rationale bioenergy production policy. For this purpose, soil samples were taken from a long-term field experiment started in 1970, with three types of soil: sand, silt-loam and clay. The experiment design adopted implied a crop rotation including maize, wheat, and potatoes with only two types of residues management: incorporation and removal. The levels of nitrogen application were six (0, 50, 100, 200, 300, 400 kg ha-1) with a factorial combination with the residues management. Residue incorporation affected significantly the carbon stock within the profile (0-70cm), with an average increase in carbon content from 60 to 67 t C ha-1 in 42 years (0.16 t C ha-1 y-1). In clay and silt-loam soils the C stock varied within the whole profile, with an increase in the upper layer (0-20 cm) ranging from 29% (silt-loam) to 60% (clay soil) of the total increment. Conversely, in sand soil the effect was found only in the upper horizon, where the incorporation of residues increased SOC of only 1.9 t ha-1. This indicates that in sand soil the increase of C is mainly attributable to the direct effect of residues input, while in the other two soils the accumulation depends both on direct effect and root-C input due to the enhancement of crop growth. The effectiveness of residue incorporation strongly depends on the type of soil, a factor which should be considered by the future bioenergy production policy.

Clear cell sarcoma: the Roswell Park experience.

PubMed

Finley, J W; Hanypsiak, B; McGrath, B; Kraybill, W; Gibbs, J F

2001-05-01

Clear cell sarcoma of the tendons and aponeuroses (CCSTA) is an aggressive, rare soft-tissue tumor with approximately 300 reported cases. Although it appears to be histogenetically related to melanoma, its clinical behavior resembles soft tissue sarcoma with a propensity for lymph node metastases. We report our experience at a tertiary cancer center. Eight cases of CCSTA evaluated at Roswell Park Cancer Institute between 1970 and 1998 were reviewed retrospectively. Patient data analyzed included patient age, gender, anatomic location, size of tumor, development of local, regional and distant recurrence, and patient status at last follow up. Six of eight patients were alive at 2 years, while three of seven patients were alive at 5 years. Of the patients alive with no evidence of recurrence, two had tumors of less than 2 cm, and the remaining patient had incomplete information regarding tumor size. Five patients recurred within 2 years of definitive surgical management. Four had tumors > 5 cm. All five patients progressed to metastatic disease at a median follow up of 20 months (range 1-108 months) following definitive surgical management and all eventually died of their disease at a median of 3 months (range 0-24 months) from presentation with metastatic disease. Four of five patients with lesions > 5 cm received adjuvant chemotherapy with intent to cure, but all eventually died of disease at 4, 22, 34, and 41 months from initial presentation. CCSTA is an aggressive tumor of the soft tissues. Early recognition and management are associated with an excellent long-term prognosis. Tumors greater than 5 cm warrant aggressive surgical management and treatment, and are at high risk of the development of distant disease. Aggressive multiagent chemotherapy appeared to have no impact on outcome. Other adjuvant therapeutic options including immunotherapy should be investigated. Copyright 2001 Wiley-Liss, Inc.

Management considerations to minimize environmental impacts of arsenic following monosodium methylarsenate (MSMA) applications to turfgrass.

PubMed

Mahoney, Denis J; Gannon, Travis W; Jeffries, Matthew D; Matteson, Audrey R; Polizzotto, Matthew L

2015-03-01

Monosodium methylarsenate (MSMA) is an organic arsenical herbicide currently utilized in turfgrass and cotton systems. In recent years, concerns over adverse impacts of arsenic (As) from MSMA applications have emerged; however, little research has been conducted in controlled field experiments using typical management practices. To address this knowledge gap, a field lysimeter experiment was conducted during 2012-2013 to determine the fate of As following MSMA applications to a bareground and an established turfgrass system. Arsenic concentrations in soil, porewater, and aboveground vegetation, were measured through one yr after treatment. Aboveground vegetation As concentration was increased compared to nontreated through 120 d after initial treatment (DAIT). In both systems, increased soil As concentrations were observed at 0-4 cm at 30 and 120 DAIT and 0-8 cm at 60 and 365 DAIT, suggesting that As was bound in shallow soil depths. Porewater As concentrations in MSMA-treated lysimeters from a 30-cm depth (22.0-83.8 μg L(-1)) were greater than those at 76-cm depth (0.4-5.1 μg L(-1)). These results were combined with previous research to devise management considerations in systems where MSMA is utilized. MSMA should not be applied if rainfall is forecasted within 7 DAIT and/or in areas with shallow water tables. Further, disposing of MSMA-treated turfgrass aboveground vegetation in a confined area - a common management practice for turfgrass clippings - may be of concern due to As release to surface water or groundwater as the vegetation decomposes. Finally, long-term MSMA use may cause soil As accumulation and thus downward migration of As over time; therefore, MSMA should be used in rotation with other herbicides. Copyright © 2014 Elsevier Ltd. All rights reserved.

Retrograde Ureteroscopic Management of Large Renal Calculi: A Single Institutional Experience and Concise Literature Review.

PubMed

Scotland, Kymora B; Rudnick, Benjamin; Healy, Kelly A; Hubosky, Scott G; Bagley, Demetrius H

2018-06-06

Advances in flexible ureteroscope design and accessory instrumentation have allowed for more challenging cases to be treated ureteroscopically. Here, we evaluate our experience with ureteroscopy (URS) for the management of large renal calculi (≥2 cm) and provide a concise review of recent reports. A retrospective review was undertaken of all URS cases between 2004 and 2014 performed by the endourologic team at a single academic tertiary care institution. We identified patients with at least one stone ≥2 cm managed with retrograde URS. Stone size was defined as the largest linear diameter of the index stone. Small diameter flexible ureteroscopes were used primarily with holmium laser. Patient demographics, intraoperative data, and postoperative outcomes were evaluated. We evaluated 167 consecutive patients who underwent URS for large renal stones ≥2 cm. The initial reason for choosing URS included patient preference (29.5%), failure of other therapies (8.2%), anatomic considerations/body habitus (30.3%), and comorbidities (28.8%). Mean patient age was 55.5 years (22-84). The mean stone size was 2.75 cm with mean number of procedures per patient of 1.65 (1-6). The single session stone-free rate was 57.1%, two-stage procedure stone-free rate was 90.2% and three-stage stone-free rate was 94.0%. Access sheaths were used in 47% of patients. An association was identified between stone size and patient outcomes; smaller stones correlated with decreased number of procedures. Postoperative complications were minor. Single or multi-stage retrograde ureteroscopic lithotripsy is a safe and effective mode of surgical management of large renal calculi. Total stone burden is a reliable predictor of the need for a staged procedure and of stone-free rate.

Diversity of arbuscular mycorrhiza in the rhizosphere of Cajeput in agroforestry system with different fertilizer management of maize

NASA Astrophysics Data System (ADS)

Parwi; Pudjiasmanto, B.; Purnomo, D.; Cahyani, VR

2017-11-01

This study investigated the diversity of arbuscular mycorrhiza in rhizosphere of cajeput with different fertilizer management of maize. This research was conducted by observation on cajeput agroforestry system in Ponorogo that have different fertilizer management of maize: conventional management (CM), universal management (UM) and alternative management (AM1, AM2, and AM3). The result showed that the highest infection of arbuscular mycorrhiza was observed in the plot of AM3, while the lowest colonization was observed in the plot of CM. Infection of arbuscular mycorrhiza in roots cajeput from five fertilizer management, ranging from 32.64% - 63.33%. In all fertilizer management, there were eight species of arbuscular mycorrhiza which five species were Glomus genus, one species was Acaulospora genus and two species were Gigaspora genus. Glomus constrictum was the dominant species in all fertilizer management. Acaulospora favoeta was found only in the plot of AM3. Spore density varies between 150-594 / 100g of soil. The highest spore density was observed in the plot of AM3, while the lowest spore density was observed in the plot of AM1. The highest diversity index value of arbuscular mycorrhiza (Species richness and Shannon-Wiener) was observed in the plot of AM3.

Initial abstinence status and contingency management treatment outcomes: does race matter?

PubMed

Montgomery, LaTrice; Carroll, Kathleen M; Petry, Nancy M

2015-06-01

Limited research has evaluated African American substance users' response to evidence-based treatments. This study examined the efficacy of contingency management (CM) in African American and White cocaine users. A secondary analysis evaluated effects of race, treatment condition, and baseline cocaine urine sample results on treatment outcomes of African American (n = 444) and White (n = 403) cocaine abusers participating in one of six randomized clinical trials comparing CM to standard care. African American and White patients who initiated treatment with a cocaine-negative urine sample remained in treatment for similar durations and submitted a comparable proportion of negative samples during treatment regardless of treatment type; CM was efficacious in both races in terms of engendering longer durations of abstinence in patients who began treatment abstinent. Whites who began treatment with a cocaine positive sample remained in treatment longer and submitted a higher proportion of negative samples when assigned to CM than standard care. African Americans who initiated treatment with a cocaine positive sample, however, did not remain in treatment longer with CM compared with standard care, and gains in terms of drug use outcomes were muted in nature relative to Whites. This interaction effect persisted through the 9-month follow-up period. CM is not equally effective in reducing drug use among all subgroups, specifically African American patients who are using cocaine upon treatment entry. Future research on improving treatment outcomes in this population is needed. (c) 2015 APA, all rights reserved).

Income received during treatment does not affect response to contingency management treatments in cocaine-dependent outpatients

PubMed Central

Andrade, Leonardo F.; Petry, Nancy M.

2013-01-01

Background Prior studies find no effect of baseline income on response to contingency management (CM) interventions. However, income among substance disordered patients is variable, particularly at treatment entry. This study investigated the impact of during-treatment income, a more proximal estimate of economic resources at the time that CM is in effect, on response to standard treatment or the standard treatment plus CM. Method These secondary analyses included 418 cocaine dependent participants initiating community intensive outpatient treatment. We examined whether differences were present in pretreatment and during-treatment overall income, as well as specific income sources. We then conducted a series of regression models to investigate the impact of during-treatment income on treatment outcome. Results Participants’ during-treatment income was significantly lower compared to pretreatment income, and this difference was largely attributable to decreases in earned income, illegal income, and support from friends and family. Neither the main effect of income, nor the interaction of income and treatment condition, was significantly associated with treatment outcome. CM, however, was a significant predictor of improved treatment outcome relative to standard treatment. Income sources and some demographic characteristics were also significant predictors of outcomes; public assistance income was associated with improved outcomes and illegal income was associated with poorer outcomes. Conclusions These results suggest that substance abusers benefit from CM regardless of their income level, and these data add to the growing literature supporting the generalizability of CM across a variety of patient characteristics. PMID:23631869

Management of refractory esophageal stenosis in the pediatric age.

PubMed

Alberca de Las Parras, Fernando; Navalón Rubio, María; Egea Valenzuela, Juan

2016-10-01

Refractory esophageal stenosis (RES) is a major health problem in the pediatric population. Several techniques such as stent placement or C-mitomycin (CM) have been described as alternative treatments. We present our experience with both techniques, in our case with biodegradable stents (BS) and sometimes the association with stents and CM. Six patients have been included: 2 post-operative fistulas in patients with type I esophageal atresia; 1 operated atresia without fistula; and 3 caustic strictures. 5 BS were placed in 4 children: 3 of them in cases of atresia (2 prosthesis in one case) and the other one in a case of stricture. CM was used in 5 cases: in 2 of them from the beginning, and in the other 3 cases after failure of the stent. When placed in fistulas, BS were fully covered. One of them successfully treated the fistula, but the other one was not effective. One stenosis was successfully treated with SB (in the case of persistent fistula), but recurrence was observed in the other 2 cases. One of these was solved with CM, and the other one needed a second stent. In the remaining 2 cases (one atresia and one caustic stricture) CM was effective after 1 and 2 sessions respectively. Overall, 5 out of 6 stenosis have been successfully treated (83.3%), and 1 out of 2 fistulas (50%). Association of BS and CM has been effective in the management of RES in children.

High-grade carotid artery stenosis: A forgotten area in cardiovascular risk management.

PubMed

Good, Elin; Länne, Toste; Wilhelm, Elisabeth; Perk, Joep; Jaarsma, Tiny; de Muinck, Ebo

2016-09-01

Patients with high-grade (≥70%) carotid artery stenosis (CAS) rank in the highest risk category for future cardiovascular (CV) events, but the quality of cardiovascular risk management in this patient group is unknown. Cross-sectional retrospective study. Data were collected for all patients diagnosed with high-grade CAS in Östergötland county, Sweden between 1 January 2009 and 31 July 2012 regarding the quality of cardiovascular risk management, co-morbidity and outcomes during the 2-year follow-up period after a diagnosis of CAS with a carotid ultrasound scan. Patients were included regardless of whether they underwent carotid endarterectomy (CEA). A total of 393 patients with CAS were included in the study; 133 (33.8%) underwent CEA and 260 (66.2%) were assigned to a conservative management (CM) group. In both groups of patients the prescription of platelet inhibitors, statins and antihypertensive drugs increased significantly (p < 0.001) after diagnosis. However treatment targets were not met in the majority of patients and the low-density lipoprotein level was on target in only 13.5% of patients. During follow-up, low-density lipoprotein levels were not measured in 19.8% of patients who underwent CEA and 44.2% of patients in the CM group (p < 0.001); HbA1c was not measured in 24.4% of patients with diabetes in the CEA group and in 18.8% of patients in the CM group (p = 0.560). There was no documentation of counselling on diet, exercise, smoking cessation or adherence to medication. The combined clinical event rate (all-cause mortality, cardiovascular mortality and non-fatal cardiovascular events) was high in both groups (CEA 36.8% and CM 36.9%; p = 1.00) with no difference in the occurrence of ipsilateral ischaemic stroke. The clinical event rate was high in patients with high-grade CAS and the management of cardiovascular risk was deficient in all aspects. © The European Society of Cardiology 2016.

[Book Review] Building Models for Conservation and Wildlife Management, by A. M. Starfield and A. L. Bleloch

USGS Publications Warehouse

Johnson, D.H.

1988-01-01

Review of: Building Models for Conservation and Wildlife Management. By Anthony Starfield and A. L. Bleloch. New York: Macmillan; London: Collier Macmillan, 1986. ISBN: 002948040X. xi, 253 p.: ill.; 25 cm.

Management of Pregnant Women with Type 2 Diabetes Mellitus and the Consequences of Fetal Programming in Their Offspring.

PubMed

Berry, Diane C; Boggess, Kim; Johnson, Quinetta B

2016-05-01

The obesity epidemic has fueled an epidemic of prediabetes and type 2 diabetes mellitus in women of childbearing age. This paper examines the state of the science on preconception and pregnancy management of women with type 2 diabetes to optimize outcomes for the women and their infants. In addition, the consequence of fetal programming as a result of suboptimal maternal glycemic control is discussed. The paper focuses on type 2 diabetes, not type 1 diabetes or gestational diabetes. Management of women with type 2 diabetes includes preconception counseling, preconception weight management and weight loss, proper weight gain during pregnancy, self-monitoring of blood glucose levels, medication, medical nutrition therapy, and exercise.

UK report on waste management

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

Ferguson, J.

1995-09-01

Arising jointly from the National and European Union requirements for more intensive attention to be paid to the environment, the United Kingdom (UK) has taken many strides forward in protecting the environment from pollution and preventing harm to human health arising from the handling, transport and disposal of wastes. Major adjustments are taking place in Europe following the opening up of the Eastern European countries. The consequences of the illegal movement of wastes and its mistreatment and disposal are now recognised within the European Union. The UK as a member State is well aware of the consequences which arise frommore » the lack of proper waste management. This paper discusses waste management and legislation pertaining to waste management in the United Kingdom.« less

[Principles of management of All-Russia Disaster Medicine Services].

PubMed

Sakhno, I I

2000-11-01

Experience of liquidation of earthquake consequences in Armenia (1988) has shown that it is extremely necessary to create the system of management in regions of natural disaster, large accident or catastrophe before arrival of main forces in order to provide reconnaissance, to receive the arriving units. It will help to make well-grounded decisions, to set tasks in time, to organize and conduct emergency-and-rescue works. The article contains general material concerning the structure of All-Russia service of disaster medicine (ARSDM), organization of management at all levels and interaction between the components of ARSDM and other subsystems of Russian Service of Extreme Situations. It is recommended how to organize management of ARSDM during liquidation of medical-and-sanitary consequences of large-scale extreme situations.

Chief Executive Officers: Academic Leaders or Business Managers?

ERIC Educational Resources Information Center

Doring, Allan

This paper explores the role and preparation of academics for senior management and executive positions in colleges and universities, particularly in Australia. A background section cites trends in higher education management and recent critiques of that management and the consequent scrutiny of leadership effectiveness. There follows an…

Gamma Knife radiosurgery for large vestibular schwannomas greater than 3 cm in diameter.

PubMed

Huang, Cheng-Wei; Tu, Hsien-Tang; Chuang, Chun-Yi; Chang, Cheng-Siu; Chou, Hsi-Hsien; Lee, Ming-Tsung; Huang, Chuan-Fu

2018-05-01

OBJECTIVE Stereotactic radiosurgery (SRS) is an important alternative management option for patients with small- and medium-sized vestibular schwannomas (VSs). Its use in the treatment of large tumors, however, is still being debated. The authors reviewed their recent experience to assess the potential role of SRS in larger-sized VSs. METHODS Between 2000 and 2014, 35 patients with large VSs, defined as having both a single dimension > 3 cm and a volume > 10 cm 3 , underwent Gamma Knife radiosurgery (GKRS). Nine patients (25.7%) had previously undergone resection. The median total volume covered in this group of patients was 14.8 cm 3 (range 10.3-24.5 cm 3 ). The median tumor margin dose was 11 Gy (range 10-12 Gy). RESULTS The median follow-up duration was 48 months (range 6-156 months). All 35 patients had regular MRI follow-up examinations. Twenty tumors (57.1%) had a volume reduction of greater than 50%, 5 (14.3%) had a volume reduction of 15%-50%, 5 (14.3%) were stable in size (volume change < 15%), and 5 (14.3%) had larger volumes (all of these lesions were eventually resected). Four patients (11.4%) underwent resection within 9 months to 6 years because of progressive symptoms. One patient (2.9%) had open surgery for new-onset intractable trigeminal neuralgia at 48 months after GKRS. Two patients (5.7%) who developed a symptomatic cyst underwent placement of a cystoperitoneal shunt. Eight (66%) of 12 patients with pre-GKRS trigeminal sensory dysfunction had hypoesthesia relief. One hemifacial spasm completely resolved 3 years after treatment. Seven patients with facial weakness experienced no deterioration after GKRS. Two of 3 patients with serviceable hearing before GKRS deteriorated while 1 patient retained the same level of hearing. Two patients improved from severe hearing loss to pure tone audiometry less than 50 dB. The authors found borderline statistical significance for post-GKRS tumor enlargement for later resection (p = 0.05, HR 9.97, CI 0.99-100.00). A tumor volume ≥ 15 cm 3 was a significant factor predictive of GKRS failure (p = 0.005). No difference in outcome was observed based on indication for GKRS (p = 0.0761). CONCLUSIONS Although microsurgical resection remains the primary management choice in patients with VSs, most VSs that are defined as having both a single dimension > 3 cm and a volume > 10 cm 3 and tolerable mass effect can be managed satisfactorily with GKRS. Tumor volume ≥ 15 cm 3 is a significant factor predicting poor tumor control following GKRS.

The effects of combining Web-based eHealth with telephone nurse case management for pediatric asthma control: a randomized controlled trial.

PubMed

Gustafson, David; Wise, Meg; Bhattacharya, Abhik; Pulvermacher, Alice; Shanovich, Kathleen; Phillips, Brenda; Lehman, Erik; Chinchilli, Vernon; Hawkins, Robert; Kim, Jee-Seon

2012-07-26

Asthma is the most common pediatric illness in the United States, burdening low-income and minority families disproportionately and contributing to high health care costs. Clinic-based asthma education and telephone case management have had mixed results on asthma control, as have eHealth programs and online games. To test the effects of (1) CHESS+CM, a system for parents and children ages 4-12 years with poorly controlled asthma, on asthma control and medication adherence, and (2) competence, self-efficacy, and social support as mediators. CHESS+CM included a fully automated eHealth component (Comprehensive Health Enhancement Support System [CHESS]) plus monthly nurse case management (CM) via phone. CHESS, based on self-determination theory, was designed to improve competence, social support, and intrinsic motivation of parents and children. We identified eligible parent-child dyads from files of managed care organizations in Madison and Milwaukee, Wisconsin, USA, sent them recruitment letters, and randomly assigned them (unblinded) to a control group of treatment as usual plus asthma information or to CHESS+CM. Asthma control was measured by the Asthma Control Questionnaire (ACQ) and self-reported symptom-free days. Medication adherence was a composite of pharmacy refill data and medication taking. Social support, information competence, and self-efficacy were self-assessed in questionnaires. All data were collected at 0, 3, 6, 9, and 12 months. Asthma diaries kept during a 3-week run-in period before randomization provided baseline data. Of 305 parent-child dyads enrolled, 301 were randomly assigned, 153 to the control group and 148 to CHESS+CM. Most parents were female (283/301, 94%), African American (150/301, 49.8%), and had a low income as indicated by child's Medicaid status (154/301, 51.2%); 146 (48.5%) were single and 96 of 301 (31.9%) had a high school education or less. Completion rates were 127 of 153 control group dyads (83.0%) and 132 of 148 CHESS+CM group dyads (89.2%). CHESS+CM group children had significantly better asthma control on the ACQ (d = -0.31, 95% confidence limits [CL] -0.56, -0.06, P = .011), but not as measured by symptom-free days (d = 0.18, 95% CL -0.88, 1.60, P = 1.00). The composite adherence scores did not differ significantly between groups (d = 1.48%, 95% CL -8.15, 11.11, P = .76). Social support was a significant mediator for CHESS+CM's effect on asthma control (alpha = .200, P = .01; beta = .210, P = .03). Self-efficacy was not significant (alpha = .080, P = .14; beta = .476, P = .01); neither was information competence (alpha = .079, P = .09; beta = .063, P = .64). Integrating telephone case management with eHealth benefited pediatric asthma control, though not medication adherence. Improved methods of measuring medication adherence are needed. Social support appears to be more effective than information in improving pediatric asthma control. Clinicaltrials.gov NCT00214383; http://clinicaltrials.gov/ct2/show/NCT00214383 (Archived by WebCite at http://www.webcitation.org/68OVwqMPz).

Immediate and delayed cutaneous reactions to radiocontrast media.

PubMed

Brockow, Knut

2012-01-01

Hypersensitivity reactions to contrast media (CM) are frequent causes of anaphylaxis and drug exanthemas. Adverse events after CM exposure are classified into immediate (≤1 h) and non-immediate reactions (>1 h), with differing mechanisms. In the majority of patients with immediate reactions, IgE-mediated allergy cannot be demonstrated, and the underlying mechanism remains unknown. However, recent data have provided evidence for skin test positivity and/or specific IgE in some patients. T cell-mediated hypersensitivity is the responsible mechanism for the majority of non-immediate skin eruptions. These insights have consequences for diagnosis and prevention. Skin testing evolves to be a useful tool for diagnosis of CM allergy. Skin tests have been employed to confirm this hypersensitivity. Previous reactors have an increased risk to develop new reactions upon repeated exposure; however, other risk factors are poorly defined. The use of skin tests for the selection of a 'safe' CM is under investigation with promising results. In vitro tests to search for CM-specific cell activation include flow cytometric approaches, lymphocyte cultures and construction of cell lines and hybridomas. Premedication of previous reactors is common practice among radiologists; however, breakthrough reactions are a concern, and physicians should not rely on the efficacy of pharmacological premedication. Copyright © 2012 S. Karger AG, Basel.

Reduced graphene oxide hydrogels deposited in nickel foam for supercapacitor applications: Toward high volumetric capacitance

DOE PAGES

Pham, Viet Hung; Dickerson, James H.

2016-02-21

Graphene hydrogels have been considered as ideal materials for high-performance supercapacitors. However, their low volumetric capacitance significantly limits its real application. In this study, we report an environment-friendly and scalable method to prepare high packing density, electrochemically reduced graphene oxide hydrogels (ERGO) for supercapacitor application by the electrophoretic deposition of graphene oxide onto nickel foam, followed by the electrochemical reduction and hydraulic compression of the deposited materials. The as-prepared ERGO on nickel foam was hydraulic compressed up to 20 tons, resulting in an increase of the packing density of ERGO from 0.0098 to 1.32 g cm –3. Consequently, the volumetricmore » capacitance and volumetric energy density of ERGOs greatly increased from 1.58 F cm –3 and 0.053 Wh cm –3 (as-prepared ERGO) to 176.5 F cm –3 and 6.02 Wh cm –3 (ERGO compressed at 20 tons), respectively. The ERGOs also exhibited long-term electrochemical stability with a capacitance retention in the range of approximately 79–90% after 10 000 cycles. Lastly, we believe that these high packing density ERGOs are promising for real-world energy storage devices for which scalable, cost-effective manufacturing is of significance and for which space constraints are paramount.« less

Reduced graphene oxide hydrogels deposited in nickel foam for supercapacitor applications: Toward high volumetric capacitance

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

Pham, Viet Hung; Dickerson, James H.

Graphene hydrogels have been considered as ideal materials for high-performance supercapacitors. However, their low volumetric capacitance significantly limits its real application. In this study, we report an environment-friendly and scalable method to prepare high packing density, electrochemically reduced graphene oxide hydrogels (ERGO) for supercapacitor application by the electrophoretic deposition of graphene oxide onto nickel foam, followed by the electrochemical reduction and hydraulic compression of the deposited materials. The as-prepared ERGO on nickel foam was hydraulic compressed up to 20 tons, resulting in an increase of the packing density of ERGO from 0.0098 to 1.32 g cm –3. Consequently, the volumetricmore » capacitance and volumetric energy density of ERGOs greatly increased from 1.58 F cm –3 and 0.053 Wh cm –3 (as-prepared ERGO) to 176.5 F cm –3 and 6.02 Wh cm –3 (ERGO compressed at 20 tons), respectively. The ERGOs also exhibited long-term electrochemical stability with a capacitance retention in the range of approximately 79–90% after 10 000 cycles. Lastly, we believe that these high packing density ERGOs are promising for real-world energy storage devices for which scalable, cost-effective manufacturing is of significance and for which space constraints are paramount.« less

A Primer on Risks, Issues and Opportunities

DTIC Science & Technology

2016-08-01

likelihood or consequence. A risk has three main parts: a future root cause, a likelihood and a consequence. The future root cause is determined...through root cause analysis, which is the most important part of any risk management effort. SPECIAL SECTION: RISK MANAGEMENT Defense AT&L: July-August...2016 10 Root cause analysis gets to the heart of the risk. Why does the risk exist? What is its nature? How will the risk occur? What should be

Risk Management and Critical Infrastructure Protection: Assessing, Integrating, and Managing Threats, Vulnerabilities and Consequences

DTIC Science & Technology

2004-09-02

Consequences 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7...OSLGCP now administers the grants programs. 30According to the guidance, threat assessment determines the relative likelihood of a known potential...information on critical infrastructure assets. The Office of State and Local Government Coordination and Preparedness (OSLGCP) administers two grant

Risk Management and Critical Infrastructure Protection: Assessing, Integrating, and Managing Threats, Vulnerabilities and Consequences

DTIC Science & Technology

2005-02-04

Consequences 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7...OSLGCP). The OSLGCP now administers the grants programs. 37 According to the guidance, threat assessment determines the relative likelihood of a...Preparedness (OSLGCP) administers two grant programs that give states the opportunity to identify critical infrastructure assets: the State Homeland Security

The indigenous Somba cattle of the hilly Atacora region in North-West Benin: threats and opportunities for its sustainable use.

PubMed

Dossa, Luc Hippolyte; Vanvanhossou, Fridaïus Ulrich Sèyi

2016-02-01

The objective of this study was to characterize the declining Somba cattle population in its production system context. Two-hundred-twenty-four (224) cattle farm-households were surveyed in the Boukombe district, the natural habitat of the breed in North-West Benin. Information on their socioeconomic characteristics and on their herd management practices were recorded using a semi-structured questionnaire. In addition, 15 body measurements were recorded from 102 adult cattle. Three types of breeders were distinguished: the owners-herders (54.0 %); the absentee owners (40.2 %) and the professional herders (5.8 %). The average cattle herd sizes were 4.7 ± 3.70 and 58.6 ± 22.83 heads for owner-managed and entrusted herds, respectively. Offtakes were more associated with sociocultural purposes (75.5 %) than market. While crop farming was the main occupation and income source of their owners, the Somba cattle were used for ploughing during the rainy season. In contrast to the widely accepted belief that this indigenous genetic resource is mainly threatened by crossbreeding and/or replacement, our findings suggest high mortalities due to diseases, feed and water shortages and poor reproduction management as the main causes of the decline of this cattle population. Somba cattle generally have short horns and a small body size. However, bulls have significantly (P ≤ 0.05) longer horns (21.2 ± 16.44 cm against 13.9 ± 7.21 cm), higher height at withers (99.7 ± 6.97 cm against 95.9 ± 5.76 cm) and body length (149.7 ± 12.87 cm against 146.8 ± 11.01 cm) than cows. All surveyed farmers expressed their willingness and readiness to participate in and contribute materially or financially to any program towards a sustainable use and preservation of this breed which they perceived as hardy and embedded in their culture. We therefore argue that strategies for its sustainable use and conservation should consist of simultaneously improving general herd management practices, organizing farmers and involving them in participatory breed improvement programs.

40 CFR 1400.8 - Access to off-site consequence analysis information by Federal government officials.

Code of Federal Regulations, 2010 CFR

2010-07-01

... ENVIRONMENTAL PROTECTION AGENCY AND DEPARTMENT OF JUSTICE ACCIDENTAL RELEASE PREVENTION REQUIREMENTS; RISK MANAGEMENT PROGRAMS UNDER THE CLEAN AIR ACT SECTION 112(r)(7); DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS...

Unintended consequences and trade-offs of fish passage

USGS Publications Warehouse

McLaughlin, Robert L.; Smyth, Eric R.; Castro-Santos, Theodore; Jones, Michael L.; Koops, Marten A.; Pratt, Thomas C.; Vélez-Espino, Luis-Antonio

2012-01-01

We synthesized evidence for unintended consequences and trade-offs associated with the passage of fishes. Provisioning of fish passageways at dams and dam removals are being carried out increasingly as resource managers seek ways to reduce fragmentation of migratory fish populations and restore biodiversity and nature-like ecosystem services in tributaries altered by dams. The benefits of provisioning upstream passage are highlighted widely. Possible unwanted consequences and trade-offs of upstream passage are coming to light, but remain poorly examined and underappreciated. Unintended consequences arise when passage of native and desirable introduced fishes is delayed, undone (fallback), results in patterns of movement and habitat use that reduce Darwinian fitness (e.g. ecological traps), or is highly selective taxonomically and numerically. Trade-offs arise when passage decisions intended to benefit native species interfere with management decisions intended to control the unwanted spread of non-native fishes and aquatic invertebrates, or genes, diseases and contaminants carried by hatchery and wild fishes. These consequences and trade-offs will vary in importance from system to system and can result in large economic and environmental costs. For some river systems, decisions about how to manage fish passage involve substantial risks and could benefit from use of a formal, structured process that allows transparent, objective and, where possible, quantitative evaluation of these risks. Such a process can also facilitate the design of an adaptive framework that provides valuable insights into future decisions.

QTLs associated with agronomic traits in the Attila × CDC Go spring wheat population evaluated under conventional management

PubMed Central

Zou, Jun; Iqbal, Muhammad; Chen, Hua; Asif, Mohammad; N’Diaye, Amidou; Navabi, Alireza; Perez-Lara, Enid; Pozniak, Curtis; Yang, Rong-Cai; Randhawa, Harpinder; Spaner, Dean

2017-01-01

Recently, we investigated the effect of the wheat 90K single nucleotide polymorphic (SNP) array and three gene-specific (Ppd-D1, Vrn-A1 and Rht-B1) markers on quantitative trait loci (QTL) detection in a recombinant inbred lines (RILs) population derived from a cross between two spring wheat (Triticum aestivum L.) cultivars, ‘Attila’ and ‘CDC Go’, and evaluated for eight agronomic traits at three environments under organic management. The objectives of the present study were to investigate the effect of conventional management on QTL detection in the same mapping population using the same set of markers as the organic management and compare the results with organic management. Here, we evaluated 167 RILs for number of tillers (tillering), flowering time, maturity, plant height, test weight (grain volume weight), 1000 kernel weight, grain yield, and grain protein content at seven conventionally managed environments from 2008 to 2014. Using inclusive composite interval mapping (ICIM) on phenotypic data averaged across seven environments and a subset of 1203 informative markers (1200 SNPs and 3 gene specific markers), we identified a total of 14 QTLs associated with flowering time (1), maturity (2), plant height (1), grain yield (1), test weight (2), kernel weight (4), tillering (1) and grain protein content (2). Each QTL individually explained from 6.1 to 18.4% of the phenotypic variance. Overall, the QTLs associated with each trait explained from 9.7 to 35.4% of the phenotypic and from 22.1 to 90.8% of the genetic variance. Three chromosomal regions on chromosomes 2D (61–66 cM), 4B (80–82 cM) and 5A (296–297 cM) harbored clusters of QTLs associated with two to three traits. The coincidental region on chromosome 5A harbored QTL clusters for both flowering and maturity time, and mapped about 2 cM proximal to the Vrn-A1 gene, which was in high linkage disequilibrium (0.70 ≤ r2 ≤ 0.75) with SNP markers that mapped within the QTL confidence interval. Six of the 14 QTLs (one for flowering time and plant height each, and two for maturity and kernel weight each) were common between the conventional and organic management systems, which suggests issues in directly utilizing gene discovery results based on conventional management to make in detail selection (decision) for organic management. PMID:28158253

Patch burn grazing management in a semiarid grassland: Consequences for pronghorn, plains pricklypear and wind erosion

USDA-ARS?s Scientific Manuscript database

Rangeland management strategies that allow for spatial and temporal interactions between fire and herbivores can achieve multiple management goals related to livestock production and wildlife conservation in mesic grasslands and savannas. Less is known about integrated management of herbivores and f...

Earth Observing System (EOS)/Advanced Microwave Sounding Unit A (AMSU-A) configuration management plan

NASA Technical Reports Server (NTRS)

Cavanaugh, J.

1994-01-01

This plan describes methods and procedures Aerojet will follow in the implementation of configuration control for each established baseline. The plan is written in response to the GSFC EOS CM Plan 420-02-02, dated January 1990, and also meets he requirements specified in DOD-STD-480, DOD-D 1000B, MIL-STD-483A, and MIL-STD-490B. The plan establishes the configuration management process to be used for the deliverable hardware, software, and firmware of the EOS/AMSU-A during development, design, fabrication, test, and delivery. This revision includes minor updates to reflect Aerojet's CM policies.

Care manager to control cardiovascular risk factors in primary care: the Raffaello cluster randomized trial.

PubMed

Deales, A; Fratini, M; Romano, S; Rappelli, A; Penco, M; Perna, G Piero; Beccaceci, G; Borgia, R; Palumbo, W; Magi, M; Vespasiani, G; Bronzini, M; Musilli, A; Nocciolini, M; Mezzetti, A; Manzoli, L

2014-05-01

This cluster randomized trial evaluated the efficacy of a disease and care management (D&CM) model in cardiovascular (CVD) prevention in primary care. Eligible subjects had ≥ 1 among: blood pressure ≥ 140/90 mmHg; glycated hemoglobin ≥ 7%; LDL-cholesterol ≥ 160 or ≥ 100 mg/dL (primary or secondary prevention, respectively); BMI ≥ 30; current smoking. The D&CM intervention included a teamwork including nurses as care managers for the implementation of tailored care plans. Control group was allocated to usual-care. The main outcome was the proportion of subjects achieving recommended clinical targets for ≥ 1 of uncontrolled CVD risk factors at 12-month. During 2008-2009 we enrolled 920 subjects in the Abruzzo/Marche regions, Italy. Following the exclusion of L'Aquila due to 2009 earthquake, final analyses included 762 subjects. The primary outcome was achieved by 39.1% (95%CI: 34.2-44.2) and 25.2% (95%CI: 20.9-29.9) of subjects in the intervention and usual-care group, respectively (p < 0.001). The D&CM intervention significantly increased the proportion of subjects who achieved clinical targets for both diabetes and hypertension, with no differences in hypercholesterolemia, smoking status and obesity. The D&CM intervention was effective in controlling cardiovascular risk factors, in particular hypertension and diabetes. Numbers needed to treat were small. Such intervention may deserve further consideration in clinical practice. ACTRN12611000813987. Copyright © 2013 Elsevier B.V. All rights reserved.

Conservative management of cesarean scar pregnancies: a prospective randomized controlled trial at a single center.

PubMed

Wang, Mingyi; Yang, Zhiling; Li, Yunming; Chen, Biliang; Wang, Jian; Ma, Xiangdong; Wang, Yu

2015-01-01

To assess clinical outcomes related to conservative management of women with cesarean scar pregnancies (CSPs), specifically through uterine artery embolization (UAE) with local and systemic methotrexate (MTX) treatment (UAE-MTX), or ultrasound-guided local and systemic MTX treatment (USG-MTX). Forty-five patients with CSP were randomly allocated to receive UAE-MTX (n = 24) or USG-MTX (n = 21). Participants' clinical outcomes were compared, and clinical characteristics of failed cases were evaluated relative to successful cases. The 2 groups were similar in clinical characteristics, success rate (83.3% cf. 80.9%), time to normalization of serum beta (β) human chorionic gonadotropin (β-hCG), and percentage of patients receiving multiple doses of systemic MTX. However, within the failed cases, the percentages of patients with gestational sac > 5 cm (87.5%), or type II CSP (75.0%) was significantly higher than in the successful cases (13.5% and 18.9%, respectively; P < 0.001, both), without regard to treatment group. According to the logistic regression model, a gestational sac diameter > 5 cm or type II CSP were independent risk factors for failed CSP management (gestational sac > 5 cm: OR 51.87, 95% CI 3.48-775.91, P < 0.01; type II CSP: OR 15.54, 95% CI 1.25-193.36, P < 0.05). The conservative treatments UAE-MTX and USG-MTX were similarly effective in treating CSP patients. Either treatment was likely to fail for CSP patients with gestational sac > 5 cm or type II CSP.

Effects of Contingency Management and Bupropion on Cigarette Smoking in Smokers with Schizophrenia

PubMed Central

Tidey, Jennifer W.; Rohsenow, Damaris J.; Kaplan, Gary B.; Swift, Robert M; Reid, Netesha

2013-01-01

Rationale Individuals with schizophrenia have high smoking-related morbidity and mortality rates and need powerful and innovative smoking cessation interventions. Objectives This proof-of-concept study investigated the feasibility and initial efficacy of combining a contingency management intervention with bupropion to reduce smoking in people with schizophrenia. Methods Using a double-blind, placebo-controlled, between-groups design, 57 non-treatment seeking participants were randomized to receive 300 mg/day bupropion or placebo. One week later, participants were randomized to a contingency management (CM) intervention in which reductions in urinary cotinine levels were reinforced, or a non-contingent reinforcement (NR) condition in which session attendance was reinforced, regardless of cotinine level. Over the 22-day study period, participants visited the laboratory approximately three times per week to provide urine samples for analysis of cotinine levels, to give breath samples for analysis of carbon monoxide (CO) levels, and to report number of cigarettes smoked per day, nicotine withdrawal symptoms, cigarette craving and psychiatric symptoms. Results Cotinine and CO levels significantly decreased during the study period in participants randomized to the CM condition, but not the NR condition. Bupropion did not reduce cotinine levels or increase the efficacy of CM. Cigarette craving and psychiatric symptom levels significantly decreased during the study in all groups. Conclusions The results of this study indicate the efficacy and feasibility of this CM intervention for reducing smoking in individuals with schizophrenia. PMID:21475970

Using causal maps to support ex-post assessment of social impacts of dams

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

Aledo, Antonio, E-mail: Antonio.Aledo@ua.es; García-Andreu, Hugo, E-mail: Hugo.Andreu@ua.es; Pinese, José, E-mail: pinese@uel.br

- Highlights: • We defend the usefulness of causal maps (CM) for ex-post impact assessment of dams. • Political decisions are presented as unavoidable technical measures. • CM enable the identification of multiple causes involved in the dam impacts. • An alternative management of the dams is shown from the precise tracking of the causes. • Participatory CM better the quality of information and the governance of the research. This paper presents the results of an ex-post assessment of two important dams in Brazil. The study follows the principles of Social Impact Management, which offer a suitable framework for analyzingmore » the complex social transformations triggered by hydroelectric dams. In the implementation of this approach, participative causal maps were used to identify the ex-post social impacts of the Porto Primavera and Rosana dams on the community of Porto Rico, located along the High Paraná River. We found that in the operation of dams there are intermediate causes of a political nature, stemming from decisions based on values and interests not determined by neutral, exclusively technical reasons; and this insight opens up an area of action for managing the negative impacts of dams.« less

Woody debris in north Iberian streams: influence of geomorphology, vegetation, and management.

PubMed

Diez, J R; Elosegi, A; Pozo, J

2001-11-01

The effect of stream geomorphology, maturity, and management of riparian forests on abundance, role, and mobility of wood was evaluated in 20 contrasting reaches in the Agüera stream catchment (northern Iberian Peninsula). During 1 year the volume of woody debris exceeding 1 cm in diameter was measured in all reaches. All large woody debris (phi > 5 cm) pieces were tagged, their positions mapped, and their subsequent changes noted. Volume of woody debris was in general low and ranged from 40 to 22,000 cm3 m-2; the abundance of debris dams ranged from 0 to 5.5 per 100 m of channel. Wood was especially rare and unstable in downstream reaches, or under harvested forests (both natural or plantations). Results stress that woody debris in north Iberian streams has been severely reduced by forestry and log removal. Because of the important influence of woody debris on structure and function of stream systems, this reduction has likely impacted stream communities. Therefore, efforts to restore north Iberian streams should include in-channel and riparian management practices that promote greater abundance and stability of large woody debris whenever possible.

A meta-analysis of the effect of hospital-based case management on hospital length-of-stay and readmission.

PubMed

Kim, Young-Ju; Soeken, Karen L

2005-01-01

Although many hospital-based case management (CM) interventions have been studied, there is little work summarizing the effectiveness of these studies. The purpose of this study was to investigate the effect of hospital-based CM compared with usual care on length of hospital stay and readmission rate. A meta-analytic method was employed to analyze the effect sizes of CM intervention on outcomes. Eligible studies were retrieved using computerized database searches, footnote chasing, and contact with content experts. The authors reviewed the final 12 studies, and the effect size, 95% confidence interval (CI), sensitivity, homogeneity, and publication bias were analyzed. The overall average weighted effect size on length of stay (LOS) was 0.094 with a 95% CI of -0.032 to 0.220. The overall odds ratio for readmission was 0.87 with a 95% CI of 0.69 to 1.04. Overall, hospital-based CM interventions were not significantly effective in reducing LOS and readmissions. However, CM for patients with heart failure (effect size of 0.241 with a 95% CI of 0.012 to 0.470) was significantly effective in reducing LOS, although it was not effective for stroke patients (effect size of -0.226 with a 95% CI of -0.542 to 0.089) and frail elders (effect size of 0.126 with a 95% CI of -0.073 to 0.324). Analysis indicated that in this meta-analysis publication bias was unlikely. The findings of this meta-analysis demonstrate a 6% decrease in readmission rate for patients who received hospital-based CM interventions. Further meta-analytic studies are needed to investigate the effectiveness of CM on other outcomes.

A Developmental Perspective on Neuroeconomic Mechanisms of Contingency Management

PubMed Central

Stanger, Catherine; Budney, Alan J.; Bickel, Warren K.

2012-01-01

This paper provides a developmental overview of relevant theory and research on delay discounting and neuroeconomics, and their implications for CM approaches to treatment. Recent advances in neuroscience, and in particular the neuroscience of decision making, have the potential to inform treatment development for adolescent substance use in general, and contingency management (CM) treatments in particular. CM utilizes abstinence-based reinforcement to enhance motivation to engage in treatment and engender abstinence. CM interventions may be informed by research on delay discounting, a type of decision making that reflects how individuals value immediate vs. delayed rewards. Delay discounting reliably distinguishes substance abusers from non abusers and is a significant predictor of individual differences in response to substance use treatments. Delay discounting is also of high potential importance in the development of substance use problems in adolescence. Discounting may also be important in predicting response to CM, as CM attempts to directly influence this decision making process, shifting the preference from the immediate rewards of use to delayed rewards for choosing not to use. Multiple neural processes underlie decision making, and those processes have implications for adolescent substance abuse. There are significant neurodevelopmental processes that differentiate adolescents from adults. These processes are implicated in delay discounting, suggesting that adolescence may reflect a period of plasticity in temporal decision making. Understanding the neural mechanisms of delay discounting has led to promising working memory interventions directly targeting the executive functions that underlie individual choices. These interventions may be particularly helpful in combination with CM interventions that offer immediate rewards for brief periods of abstinence, and may show particular benefit in adolescence due to the heightened neural plasticity of systems that underlie temporal discounting in adolescence. PMID:22663343

Performance-Based Contingency Management in Cognitive Remediation Training: A Pilot Study.

PubMed

Kiluk, Brian D; Buck, Matthew B; Devore, Kathleen A; Babuscio, Theresa A; Nich, Charla; Carroll, Kathleen M

2017-01-01

Impairments in attention, working memory, and executive function are common among substance users and may adversely affect SUD treatment outcomes. The ability of cognitive remediation (CR) interventions to improve these deficits is hindered in part because levels of engagement in CR training may be inadequate to achieve benefit. This pilot study aimed to increase CR engagement and improve outcome by implementing contingency management (CM) procedures that reinforce performance improvements on CR tasks. Participants were forty individuals (50% male; 65% African American) in an outpatient substance use treatment facility with mild cognitive impairment who had ≥30-days of abstinence from alcohol and drugs. They were randomized to standard (CR-S; n=21) or CM-enhanced (CR-CM; n=19) cognitive remediation training. CR consisted of 1-hour sessions, three times per week for four weeks (12 sessions). A neuropsychological assessment battery was administered prior to and after the four-week intervention. Both groups had high rates of CR session attendance (mean CR-S=11.7, CR-CM=10.9 sessions). Performance on 8 of the 9 CR tasks significantly improved over time for both conditions, with the CR-CM condition demonstrating greater improvement on a CR Sequenced Recall task [F(1,37)=5.81, p<.05]. Significant improvement was also evident on 4 of 9 neuropsychological assessment measures, with the CR-CM condition showing differential improvement on the Trail Making Test - Part B [F (1,37)=5.34, p<.05]. These findings support the feasibility of using CM procedures to enhance substance users' engagement with CR training and suggest the potential value of more research in this area. Copyright © 2016 Elsevier Inc. All rights reserved.

A randomized trial of assertive continuing care and contingency management for adolescents with substance use disorders.

PubMed

Godley, Mark D; Godley, Susan H; Dennis, Michael L; Funk, Rodney R; Passetti, Lora L; Petry, Nancy M

2014-02-01

Most adolescents relapse within 90 days of discharge from residential substance use treatment. We hypothesized that contingency management (CM), assertive continuing care (ACC), and their combination (CM + ACC) would each be more effective than usual continuing care (UCC). Following residential treatment, 337 adolescents were randomized to 4 continuing care conditions: UCC alone, CM, ACC, or CM + ACC. UCC was available across all conditions. Outcome measures over 12 months included percentage of days abstinent from alcohol, heavy alcohol, marijuana, and any alcohol or other drugs (AOD) using self-reports and toxicology testing and remission status at 12 months. CM had significantly higher rates of abstinence than UCC for heavy alcohol use, t(297) = 2.50, p < .01, d = 0.34; any alcohol use, t(297) = 2.58, p < .01, d = 0.36; or any AOD use, t(297) = 2.12, p = .01, d = 0.41; and had a higher rate in remission, odds ratio (OR) = 2.45, 90% confidence interval (CI) [1.18, 5.08], p = .02. ACC had significantly higher rates of abstinence than UCC from heavy alcohol use, t(297) = 2.66, p < .01, d = 0.31; any alcohol use, t(297) = 2.63, p < .01, d = 0.30; any marijuana use, t(297) = 1.95, p = .02, d = 0.28; or any AOD use, t(297) = 1.88, p = .02, d = 0.30; and had higher rates in remission, OR = 2.31, 90% CI [1.10, 4.85], p = .03. The ACC + CM condition was not significantly different from UCC on any outcomes. CM and ACC are promising continuing care approaches after residential treatment. Future research should seek to further improve their effectiveness. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Environmental Impact Research Program and Defense Natural Resources Program: Section 7.5.7, US Army Corps of Engineers Wildlife Resources Management Manual

DTIC Science & Technology

1992-02-01

throated sparrow (Z. albicollis) X X Song sparrow (Melospiza melodia) X X Fox sparrow (Passerella iliaca) X X Mammals Opossum (Didelphis virginiana ) X...cm) and should not be less than 0.38 in. (0.4 cm). When Ellagood is pruned severely, an abundance of new shoots are produced (SCS, undated). Planting...Holes for the plants should be deep enough to take the full root without bending. Unusually long roots and tops may be pruned to 6 in. (15.2 cm) if

Fire Management/Suppression Systems/Concepts Relating to Aircraft Cabin Fire Safety.

DTIC Science & Technology

1982-07-01

polyamide- cm; cell size, cm; paper honeycomb; paper honeycomb; density, kg/cm 3 ; filler 2.413;0.31; 48.06; 2.413;0.31; 48.06; no core filler no core...0 4’ 14 ~ 1 4 44 N4 El4 (36M -11 - 0 0 N4 8A 0o N. 0 04 0n 0m C,0 0 44 . . 000040 -t 0 0 880 -8 ,0 04 0 C, 0 C4 4-0 OD -CD0C, m. g G - C4 A - 40 a

Optimization of Soft Tissue Management, Spacer Design, and Grafting Strategies for Large Segmental Bone Defects using the Chronic Caprine Tibial Defect Model

DTIC Science & Technology

2016-12-01

gastrocnemius muscles. 4. Place an interlocking intramedullary nail using a custom spacer to maintain 5-cm defect length. 5. Place a pre-molded 5 cm long x...2 cm diameter PMMA spacer around the nail in the defect. 6. Irrigate the wound with normal (0.9 %) saline and close the wound. The Treatment...PMMA spacer using a “bomb bay door opening”. 4. Remove the spacer without damaging the membrane or nail . 5. Collect appropriate IM samples as

Effects of organic and conventional management of sugar cane crop on soil physicochemical characteristics and phosphomonoesterase activity.

PubMed

Purcena, Luiza L A; Di Medeiros, Maria Carolina B; Leandro, Wilson M; Fernandes, Kátia F

2014-02-19

Soil enzymes play an important role in agriculture and particularly in nutrient cycling. They are also involved in the degradation, transformation, and mineralization of organic matter and availability of nutrients in soil. It is believed that organic agriculture causes fewer losses to soil quality and is less aggressive to the environment than conventional management. In this study, the effects of conventional (CM) and organic management (OM) on phosphomonoesterases, an important enzyme for soil fertility, were evaluated and compared to those results from native Cerrado (Brazilian Savanna) soil (NS), because they are the most common phosphatases in soils. The results showed that there were both acid (AcP) and alkaline (AkP) phosphatases in all soils tested and that AcP activity was higher than that of AkP. In contrast to AkP, AcP had its activity affected by land use. In the cultivated areas there was a reduction of almost 50% of AcP activity respect to native unexploited soils and there was no significant difference between organic and CM, demonstrating that independent of the management chosen, there was an impact of land use on AcP activity. Principal component analysis indicated that characteristics related to pH such as alkali saturation (V%), aluminum saturation (M%), Al(3+), soil total acidity (H+Al), and Ca(2+) are the main factors that permit distinguishing NS from OM and CM.

Analysis and identification of two reconstituted tobacco sheets by three-level infrared spectroscopy

NASA Astrophysics Data System (ADS)

Wu, Xian-xue; Xu, Chang-hua; Li, Ming; Sun, Su-qin; Li, Jin-ming; Dong, Wei

2014-07-01

Two kinds of reconstituted tobacco (RT) from France (RTF) and China (RTC) were analyzed and identified by a three-level infrared spectroscopy method (Fourier-transform infrared spectroscopy (FT-IR) coupled with second derivative infrared spectroscopy (SD-IR) and two-dimensional infrared correlation spectroscopy (2D-IR)). The conventional IR spectra of RTF parallel samples were more consistent than those of RTC according to their overlapped parallel spectra and IR spectra correlation coefficients. FT-IR spectra of both two RTs were similar in holistic spectral profile except for small differences around 1430 cm-1, indicating that they have similar chemical constituents. By analysis of SD-IR spectra of RTFs and RTCs, more distinct fingerprint features, especially peaks at 1106 (1110), 1054 (1059) and 877 (874) cm-1, were disclosed. Even better reproducibility of five SD-IR spectra of RTF in 1750-1400 cm-1 could be seen intuitively from their stacked spectra and could be confirmed by further similarity evaluation of SD-IR spectra. Existence of calcium carbonate and calcium oxalate could be easily observed in two RTs by comparing their spectra with references. Furthermore, the 2D-IR spectra provided obvious, vivid and intuitive differences of RTF and RTC. Both two RTs had a pair of strong positive auto-peaks in 1600-1400 cm-1. Specifically, the autopeak at 1586 cm-1 in RTF was stronger than the one around 1421 cm-1, whereas the one at 1587 cm-1 in RTC was weaker than that at 1458 cm-1. Consequently, the RTs of two different brands were analyzed and identified thoroughly and RTF had better homogeneity than RTC. As a result, three-level infrared spectroscopy method has proved to be a simple, convenient and efficient method for rapid discrimination and homogeneousness estimation of RT.

Child abuse and neglect in institutional settings, cumulative lifetime traumatization, and psychopathological long-term correlates in adult survivors: The Vienna Institutional Abuse Study.

PubMed

Lueger-Schuster, Brigitte; Knefel, Matthias; Glück, Tobias M; Jagsch, Reinhold; Kantor, Viktoria; Weindl, Dina

2018-02-01

Child maltreatment (CM) in foster care settings (i.e., institutional abuse, IA) is known to have negative effects on adult survivor's mental health. This study examines and compares the extent of CM (physical, emotional, and sexual abuse; physical and emotional neglect) and lifetime traumatization with regard to current adult mental health in a group of survivors of IA and a comparison group from the community. Participants in the foster care group (n = 220) were adult survivors of IA in Viennese foster care institutions, the comparison group (n = 234) consisted of persons from the Viennese population. The comparison group included persons who were exposed to CM within their families. Participants completed the Childhood Trauma Questionnaire, the Life Events Checklist for DSM-5, the PTSD Checklist for DSM-5, the International Trauma Questionnaire for ICD-11, and the Brief Symptom Inventory-18 and completed a structured clinical interview. Participants in the foster care group showed higher scores in all types of CM than the comparison group and 57.7% reported exposure to all types of CM. The foster care group had significantly higher prevalence rates in almost all mental disorders including personality disorders and suffered from higher symptom distress in all dimensional measures of psychopathology including depression, anxiety, somatization, dissociation, and the symptom dimensions of PTSD. In both groups, adult life events and some but not all forms of CM predicted PTSD and adult life events partly mediated the association of PTSD and CM. Explanations for the severe consequences of CM and IA are discussed. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Bangladeshi school-age children's experiences and perceptions on child maltreatment: A qualitative interview study.

PubMed

Atiqul Haque, M; Janson, S; Moniruzzaman, S; Rahman, A K M F; Mashreky, S R; Eriksson, U-B

2017-11-01

Child maltreatment (CM) is a public health problem and is recognized as a huge barrier for child development. Most of the research and definitions on CM are from the perspective of high-income western countries. Because no major studies have been conducted on CM in Bangladesh, the aim of the current study was to explore the experiences of and perceptions on CM in school-age children in rural and urban Bangladesh in order to understand maltreatment in a local context and from a child perspective. Semistructured individual interviews with 24 children (13 boys and 11 girls), between the ages of 9 and 13 years of which 11 were schoolgoing and 13 non-schoolgoing, were conducted during July 2013 and analysed according to qualitative content analysis. CM was a common and painful experience with serious physical and emotional consequences but highly accepted by the society. Vulnerable groups were especially young children, girls, and poor children. The children's voices were not heard due to their low status and low position in their families, schools, and working places. The main theme that emerged in the analysis was children's subordination, which permeated the five categories: (a) perception of children's situation in society, (b) understanding children's development and needs, (c) CM associated to school achievement, (d) negative impact of CM, and (e) emotional responses. Different kinds of abuse are obviously common in Bangladesh, and the schools do not follow the law from 2011 prohibiting corporal punishment at school. The society has to take further steps to live up to the UN Convention on the Rights of the Child, which was ratified already in 1990, to protect the Bangladeshi children from CM. © 2017 John Wiley & Sons Ltd.

Counselor attitudes toward contingency management for substance use disorder: effectiveness, acceptability, and endorsement of incentives for treatment attendance and abstinence☆

PubMed Central

Aletraris, Lydia; Shelton, Jeff S.; Roman, Paul M.

2015-01-01

Despite research demonstrating its effectiveness, use of contingency management (CM) in substance use disorder treatment has been limited. Given the vital role that counselors play as arbiters in the use of therapies, examination of their attitudes can provide insight into how further use of CM might be effectively promoted. In this paper, we examine 731 counselors' attitudes toward the effectiveness and acceptability of CM in treatment, as well as their specific attitudes toward both unspecified and tangible incentives for treatment attendance and abstinence. Compared to cognitive behavioral therapy, motivational interviewing, and community reinforcement approach, counselors rated CM as the least effective and least acceptable psychosocial intervention. Exposure through the use of CM in a counselor's employing organization was positively associated with perceptions of acceptability, agreement that incentives have a positive effect on the client–counselor relationship, and endorsement of tangible incentives for abstinence. Endorsement of tangible incentives for treatment attendance was significantly greater among counselors with more years in the treatment field, and counselors who held at least a master's degree. Counselors' adaptability or openness to innovations was also positively associated with attitudes toward CM. Further, female counselors and counsellors with a greater 12-step philosophy were less likely to endorse the use of incentives. A highlight of our study is that it offers the first specific assessment of the impact of “Promoting Awareness of Motivational Incentives” (PAMI), a Web-based tool based on findings of CM protocols tested within the Clinical Trials Network (CTN), on counselors employed outside the CTN. We found that 10% of counselors had accessed PAMI, and those who had accessed PAMI were more likely to report a higher degree of perceived effectiveness of CM than those who had not. This study lays the groundwork for vital research on the impact of multiple Web-based educational strategies. Given the barriers to CM adoption, identifying predictors of positive attitudes among counselors can help diffuse CM into routine clinical practice. PMID:26001821

First analysis of the 2ν1 + 3ν3 band of NO2 at 7192.159 cm-1

NASA Astrophysics Data System (ADS)

Raghunandan, R.; Perrin, A.; Ruth, A. A.; Orphal, J.

2014-03-01

The first investigation of the very weak 2ν1 + 3ν3 absorption band of nitrogen dioxide, 14N16O2, located at 7192.1587(1) cm-1 was performed using Fourier-transform incoherent broadband cavity-enhanced absorption spectroscopy (FT-IBBCEAS) in the 7080-7210 cm-1 spectral range. The assigned 2ν1 + 3ν3 lines involve energy levels of the (2 0 3) vibrational state with rotational quantum numbers up to Ka = 7 and N = 47. Furthermore, due to local resonances involving energy levels from the (2,2,2)⇔(2,0,3) and (5,1,0)⇔(2,0,3) states, several transitions were also observed for the 2ν1 + 2ν2 + 2ν3 and 5ν1 + ν3 dark bands, respectively. The energy levels were satisfactorily reproduced within their experimental uncertainty using a theoretical model which takes explicitly into account the Coriolis interactions between the levels of the (2, 0, 3) vibrational state and those of (2, 2, 2) and of (5, 1, 0). As a consequence, precise vibrational energies, rotational, and coupling constants were achieved for the triad {(5, 0, 1), (2, 2, 2), (2, 0, 3)} of interacting states of 14N16O2. This theoretical model also accounts for the electron spin-rotation resonances within the (2, 0, 3), (2, 2, 2) and (5, 1, 0) vibrational states. However, owing to the limited experimental resolution (˜0.075 cm-1), it was not possible to observe the spin-rotation doublet structure. As a consequence, the spin-rotation constants in the {(2, 2, 2), (2, 0, 3), (5, 1, 0)} excited states were maintained fixed to their ground state values in this study. Using these parameters a comprehensive list of line positions and line intensities was generated for the 2ν1 + 3ν3 band of NO2.

Intramolecular Vibrational Energy Redistribution (ivr) in Selected S_{1} Levels above 1000 cm^{-1} in Para-Fluorotoluene

NASA Astrophysics Data System (ADS)

Whalley, Laura E.; Gardner, Adrian M.; Tuttle, William Duncan; Davies, Julia A.; Reid, Katharine L.; Wright, Timothy G.

2017-06-01

With increasing vibrational wavenumber, the density of states of a molecule is expected to rise dramatically, especially so when low wavenumber torsions (internal rotations) are present, as in the case of para-fluorotoluene (pFT). This in turn is expected to lead to more opportunities for coupling between vibrational modes, which is the driving force for intramolecular vibrational energy redistribution (IVR). Previous studies at higher energies have focussed on the two close lying vibrational levels at 1200 cm^{-1} in the S_{1} electronic state of pFT which were assigned to two zero-order bright states (ZOBSs), whose characters predominantly involve C-CH_{3} and C-F stretching modes. A surprising result of these studies was that the photoelectron spectra showed evidence that IVR is more extensive following excitation of the C-F mode than it is following excitation of the C-CH_{3} mode, despite these levels being separated by only 35 cm^{-1}. This observation provides evidence that the IVR dynamics are mode-specific, which in turn may be a consequence of the IVR route being dependent on couplings to nearby states that are only available to the C-F mode. In this work, in order to further investigate this behaviour, we have employed resonance-enhanced multiphoton ionisation (REMPI) spectroscopy and zero-kinetic-energy (ZEKE) spectroscopy to probe S_{1} levels above 1000 cm^{-1} in pFT. Such ZEKE spectra have been recorded via a number of S_{1} intermediate levels allowing the character and coupling between vibrations to be unravelled; the consequence of this coupling will be discussed with a view to understanding any IVR dynamics seen. C. J. Hammond, V. L. Ayles, D. E. Bergeron, K. L. Reid and T. G. Wright, J. Chem. Phys., 125, 124308 (2006) J. A. Davies, A. M. Green, A. M. Gardner, C. D. Withers, T. G. Wright and K. L. Reid, Phys. Chem. Chem. Phys., 16, 430 (2014)

Self-Management Patient Education and Weight Loss

ERIC Educational Resources Information Center

Stombaugh, Angela M.

2010-01-01

Self-management of a disease is defined as "having or being able to obtain, the skills and resources necessary to best accommodate to the chronic disease and its consequences" (Holman & Lorig, 1992, p. 309). Self-management has been used in the management of several chronic conditions and this model may be useful in the management of weight loss.…

Increasing the visibility of watershed management as a land management profession

Treesearch

Daniel G. Neary; Peter F. Ffolliott; Kenneth N. Brooks

2000-01-01

Population increases will continue to severely pressure water resources in the 21st century. Consequently, the importance of watershed management will increase. The potential demand in the next century for information on, and individuals skilled in, watershed management raises several important issues: the need for watershed management to have a central voice to gain...

Large-scale interdisciplinary experiments inform current and future forestry management options in the U.S

Treesearch

C.E. Peterson; P.D. Anderson

2009-01-01

Over the last 20 years, changing public values and increased ecological understanding have led to a paradigm shift in forestry from timber management to sustainable ecosystem management on U.S. federal lands. Forest managers are now seeking alternative management approaches that simultaneously meet socio-cultural, ecological and economic goals. Consequently, many field...

Evaluation of fleet management techniques for timber highway bridges

Treesearch

Brent M. Phares; Travis K. Hosteng; Justin Dahlberg; Michael A. Ritter

2011-01-01

The general condition of the nation's bridges presents a complex management issue when considering cost, safety, and time. Consequently, the management of those bridges can become an overwhelming task. The need for a management system that is specific to rural systems may help to improve the management of this significant number of bridges. Although individual...

Six-month Outcomes of Mobile Phone Application-based Self-management in a Patient with Type 2 Diabetes.

PubMed

Hong, Mi Kyeong; Cho, Young Yun; Rha, Mi Yong; Kim, Jae Hyeon; Lee, Moon-Kyu

2015-07-01

We report the case in order to examine the effect of a mobile application program ("Diabetes & Nutrition") developed in 2011-2012 for self-management in patients with type 2 diabetes and to recommend important considerations when the mobile application program is developed. A 46-year-old man was newly diagnosed with type 2 diabetes in 2013 and had no complications. The height of the patient was 168 cm and the body weight was 75.6 kg. Nutrition education was conducted according to a medical prescription, and follow-up nutrition education was conducted after 3 and 6 months. After nutrition education, the patient was engaged in self-management using "Diabetes & Nutrition" program during 3 months. At 3 months, the body weight had decreased by 4.4 kg (from 75.6 to 71.2 kg), waist circumference by 5 cm (from 88 to 83 cm) and HbA1c level from 7.9% to 6.1%. Also at 3 months, the medication was reduced from from the dose of 850 mg to the dose of 500 mg metformin per twice a day. Since then, the patient did not continue to use the "Diabetes & Nutrition" because the level of blood glucose had stabilized, and the patient felt inconvenient and annoying to use the program. At 6 months, no significant change in the body weight and body composition was observed in comparison with those at 3 months. The present case demonstrates that the early use of "Diabetes & Nutrition" could be helpful for self-management of glycemic control in patients with type 2 diabetes. Developing self-management mobile application programs in the future will require strategies of how to promote continuous use of application program and self-management of type 2 diabetes.

NONINVASIVE FOLLICULAR TUMOR WITH PAPILLARY-LIKE NUCLEAR FEATURES: NOT A TEMPEST IN A TEAPOT.

PubMed

Agrawal, Nidhi; Abbott, Collette E; Liu, Cheng; Kang, Stella; Tipton, Laura; Patel, Kepal; Persky, Mark; King, Lizabeth; Deng, Fang-Ming; Bannan, Michael; Ogilvie, Jennifer B; Heller, Keith; Hodak, Steven P

2017-04-02

Encapsulated non-invasive follicular variant papillary thyroid cancer (ENIFVPTC) has recently been retermed noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This designation specifically omits the word "cancer" to encourage conservative treatment since patients with NIFTP tumors have been shown to derive no benefit from completion thyroidectomy or adjuvant radio-active iodine (RAI) therapy. This was a retrospective study of consecutive cases of tumors from 2007 to 2015 that met pathologic criteria for NIFTP. The conservative management (CM) group included patients managed with lobectomy alone or appropriately indicated total thyroidectomy. Those included in the aggressive management (AM) group received either completion thyroidectomy or RAI or both. From 100 consecutive cases of ENIFVPTC reviewed, 40 NIFTP were included for the final analysis. Of these, 10 (27%) patients treated with initial lobectomy received completion thyroidectomy and 6 of 40 (16%) also received postsurgical adjuvant RAI. The mean per-patient cost of care in the AM group was $17,629 ± 2,865, nearly twice the $8,637 ± 309 costs in the CM group, and was largely driven by the cost of completion thyroidectomy and RAI. The term NIFTP has been recently promulgated to identify a type of thyroid neoplasm, formerly identified as a low-grade cancer, for which initial surgery represents adequate treatment. We believe that since the new NIFTP nomenclature intentionally omits the word "cancer," the clinical indolence of these tumors will be better appreciated, and cost savings will result from more conservative and appropriate clinical management. AM = aggressive management CM = conservative management ENIFVPTC = encapsulated noninvasive form of FVPTC FVPTC = follicular variant of papillary thyroid carcinoma NIFTP = noninvasive follicular thyroid neoplasm with papillary-like nuclear features PTC = papillary thyroid carcinoma PTMC = papillary thyroid microcarcinoma RAI = radio-active iodine US = ultrasound.

Dosimetric verification of small fields in the lung using lung-equivalent polymer gel and Monte Carlo simulation.

PubMed

Gharehaghaji, Nahideh; Dadgar, Habib Alah

2018-01-01

The main purpose of this study was evaluate a polymer-gel-dosimeter (PGD) for three-dimensional verification of dose distributions in the lung that is called lung-equivalent gel (LEG) and then to compare its result with Monte Carlo (MC) method. In the present study, to achieve a lung density for PGD, gel is beaten until foam is obtained, and then sodium dodecyl sulfate is added as a surfactant to increase the surface tension of the gel. The foam gel was irradiated with 1 cm × 1 cm field size in the 6 MV photon beams of ONCOR SIEMENS LINAC, along the central axis of the gel. The LEG was then scanned on a 1.5 Tesla magnetic resonance imaging scanner after irradiation using a multiple-spin echo sequence. Least-square fitting the pixel values from 32 consecutive images using a single exponential decay function derived the R2 relaxation rates. Moreover, 6 and 18 MV photon beams of ONCOR SIEMENS LINAC are simulated using MCNPX MC Code. The MC model is used to calculate the depth dose water and low-density water resembling the soft tissue and lung, respectively. Percentages of dose reduction in the lung region relative to homogeneous phantom for 6 MV photon beam were 44.6%, 39%, 13%, and 7% for 0.5 cm × 0.5 cm, 1 cm × 1 cm, 2 cm × 2 cm, and 3 cm × 3 cm fields, respectively. For 18 MV photon beam, the results were found to be 82%, 69%, 46%, and 25.8% for the same field sizes, respectively. Preliminary results show good agreement between depth dose measured with the LEG and the depth dose calculated using MCNP code. Our study showed that the dose reduction with small fields in the lung was very high. Thus, inaccurate prediction of absorbed dose inside the lung and also lung/soft-tissue interfaces with small photon beams may lead to critical consequences for treatment outcome.

41 CFR 302-12.108 - What are the income tax consequences that we must consider when offering relocation services?

Code of Federal Regulations, 2011 CFR

2011-07-01

... Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE... Constitution Avenue, NW., Room 5501, Washington, DC 20224, for information on the income tax consequences of...

41 CFR 302-12.115 - What are the income tax consequences that we must consider when offering relocation services?

Code of Federal Regulations, 2013 CFR

2013-07-01

... Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE... Constitution Avenue, NW., Room 5501, Washington, DC 20224, for information on the income tax consequences of...

41 CFR 302-12.115 - What are the income tax consequences that we must consider when offering relocation services?

Code of Federal Regulations, 2014 CFR

2014-07-01

... Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE... Constitution Avenue, NW., Room 5501, Washington, DC 20224, for information on the income tax consequences of...

Thermo-mechanical improvement of Inconel 718 using ex situ boron nitride-reinforced composites processed by laser powder bed fusion.

PubMed

Kim, Sang Hoon; Shin, Gi-Hun; Kim, Byoung-Kee; Kim, Kyung Tae; Yang, Dong-Yeol; Aranas, Clodualdo; Choi, Joon-Phil; Yu, Ji-Hun

2017-10-30

Hexagonal boron nitride-reinforced Inconel 718 (h-BN/IN718) composites were fabricated using a laser powder bed fusion (LPBF) technique to treat a nanosheet-micropowder precursor mixture prepared in a mechanical blending process. Tailoring the BN in IN718 enhanced the thermal resistance of the composites, thereby dampening the sharpness of the melting temperature peak at 1364 °C. This is because the presence of the BN reinforcement, which has a low coefficient of thermal expansion (CTE), resulted in a heat-blocking effect within the matrix. Following this lead, we found that the BN (2.29 g/cm 3 ) was uniformly distributed and strongly embedded in the IN718 (8.12 g/cm 3 ), with the lowest alloy density value (7.03 g/cm 3 ) being obtained after the addition of 12 vol% BN. Consequently, its specific hardness and compressive strength rose to 41.7 Hv 0.5 ·cm 3 /g and 92.4 MPa·cm 3 /g, respectively, compared to the unreinforced IN718 alloy with 38.7 Hv 0.5 ·cm 3 /g and 89.4 MPa·cm 3 /g, respectively. Most importantly, we discovered that the wear resistance of the composite improved compared to the unreinforced IN718, indicated by a decrease in the coefficient of friction (COF) from 0.43 to 0.31 at 2400 s. This is because the BN has an exfoliated surface and intrinsically high sliding and lubricating characteristics.

Significant Admixture Linkage Disequilibrium across 30 cM around the FY Locus in African Americans

PubMed Central

Lautenberger, James A.; Stephens, J. Claiborne; O'Brien, Stephen J.; Smith, Michael W.

2000-01-01

Scientists, to understand the importance of allelic polymorphisms on phenotypes that are quantitative and environmentally interacting, are now turning to population-association screens, especially in instances in which pedigree analysis is difficult. Because association screens require linkage disequilibrium between markers and disease loci, maximizing the degree of linkage disequilibrium increases the chances of discovering functional gene-marker associations. One theoretically valid approach—mapping by admixture linkage disequilibrium (MALD), using recently admixed African Americans—is empirically evaluated here by measurement of marker associations with 15 short tandem repeats (STRs) and an insertion/deletion polymorphism of the AT3 locus in a 70-cM segment at 1q22-23, around the FY (Duffy) locus. The FY polymorphism (−46T→C) disrupts the GATA promoter motif, specifically blocking FY erythroid expression and has a nearly fixed allele-frequency difference between European Americans and native Africans that is likely a consequence of a selective advantage of FY−/− in malaria infections. Analysis of linkage disequilibrium around the FY gene has indicated that there is strong and consistent linkage disequilibrium between FY and three flanking loci (D1S303, SPTA1, and D1S484) spanning 8 cM. We observed significant linkage-disequilibrium signals over a 30-cM region from −4.4 to 16.3 cM (from D1S2777 to D1S196) for STRs and at 26.4 cM (AT3), which provided quantitative estimates of centimorgan limits, by MALD assessment in African American population-association analyses, of 5–10 cM. PMID:10712211

Effect of Capacitive Radiofrequency on the Fibrosis of Patients with Cellulite

PubMed Central

Valentim da Silva, Rodrigo Marcel; Barichello, Priscila Arend; Medeiros, Melyssa Lima; de Mendonça, Waléria Cristina Miranda; Dantas, Jung Siung Camel; Ronzio, Oscar Ariel; Froes, Patricia Meyer

2013-01-01

Background. Cellulite is a type of lipodystrophy that develops primarily from an alteration in blood circulation or of the lymphatic system that causes structural changes in subcutaneous adipose tissue, collagen, and adjacent proteoglycans. The radiofrequency devices used for cutaneous applications have shown different physiological treatment effects, but there is controversy about the suitable parameters for this type of treatment. Objectives. The aim of this study was to evaluate the effects of low-temperature radiofrequency to confirm the thinning of the collagen tissue and interlobular septa and consequent improvement of cellulite. Methods. A sample of eight women was used to collect ultrasonographic data with a 12 MHz probe that measured collagen fiber thickness. The Vip Electromedicina (Argentina) device, frequency of 0.55 MHz and active electrode 3.5 cm in diameter (area = 9.61 cm2), was applied to a 10 cm2 region of the gluteal region for 2 minutes per area of active electrode, during 10 biweekly sessions. Results. The Wilcoxon matched paired test was applied using GraphPad InStat 3.01 for Win95-NT software. Pre- and posttreatment mean collagen fiber thickness showed a 24.66% reduction from 1.01 to 0.67 mm. Statistical analysis using the Wilcoxon matched paired test obtained a significant two-tailed P value of 0.0391. Conclusion. It was concluded that the use of more comfortable temperatures favored a reduction in fibrous septum thickness and consequent cellulite improvement, evidenced by the lower degree of severity and decrease in interlobular septal thickness. PMID:24223586

A Stand-Alone Demography and Landscape Structure Module for Earth System Models: Integration with Inventory Data from Temperate and Boreal Forests

NASA Astrophysics Data System (ADS)

Hess, L.; Basso, B.; Hinckley, E. L. S.; Robertson, G. P.; Matson, P. A.

2014-12-01

In the coming century, the proportion of total rainfall that falls in heavy storm events is expected to increase in many areas, especially in the US Midwest, a major agricultural region. These changes in rainfall patterns may have consequences for hydrologic flow and nutrient losses, especially in agricultural soils, with potentially negative consequences for receiving ground- and surface waters. We used a tracer experiment to examine how more extreme rainfall patterns may affect the movement of water and solutes through an agricultural soil profile in the upper Midwest, and to what extent tillage may moderate these effects. Two rainfall patterns were created with 5m x 5m rainout shelters at the Kellogg Biological Station LTER site in replicated plots with either conventional tillage or no-till management. Control rainfall treatments received water 3x per week, and extreme rainfall treatments received the same total amount of water but once every two weeks, to simulate less frequent but larger storms. In April 2015, potassium bromide (KBr) was added as a conservative tracer of water flow to all plots, and Br- concentrations in soil water at 1.2m depth were measured weekly from April through July. Soil water Br- concentrations increased and peaked more quickly under the extreme rainfall treatment, suggesting increased infiltration and solute transfer to depth compared to soils exposed to control rainfall patterns. Soil water Br- also increased and peaked more quickly in no-till than in conventional tillage treatments, indicating differences in flow paths between management systems. Soil moisture measured every 15 minutes at 10, 40, and 100cm depths corroborates tracer experiment results: rainfall events simulated in extreme rainfall treatments led to large increases in deep soil moisture, while the smaller rainfall events simulated under control conditions did not. Deep soil moisture in no-till treatments also increased sooner after water application as compared to in conventional soils. Our results suggest that exposure to more extreme rainfall patterns will likely increase infiltration depth and nutrient losses in agricultural soils. In particular, soils under no-till management, which leads to development of preferential flow paths, may be particularly vulnerable to vertical nutrient losses.

Dose evaluation of Grid Therapy using a 6 MV flattening filter-free (FFF) photon beam: A Monte Carlo study.

PubMed

Martínez-Rovira, Immaculada; Puxeu-Vaqué, Josep; Prezado, Yolanda

2017-10-01

Spatially fractionated radiotherapy is a strategy to overcome the main limitation of radiotherapy, i.e., the restrained normal tissue tolerances. A well-known example is Grid Therapy, which is currently performed at some hospitals using megavoltage photon beams delivered by Linacs. Grid Therapy has been successfully used in the management of bulky abdominal tumors with low toxicity. The aim of this work was to evaluate whether an improvement in therapeutic index in Grid Therapy can be obtained by implementing it in a flattening filter-free (FFF) Linac. The rationale behind is that the removal of the flattening filter shifts the beam energy spectrum towards lower energies and increase the photon fluence. Lower energies result in a reduction of lateral scattering and thus, to higher peak-to-valley dose ratios (PVDR) in normal tissues. In addition, the gain in fluence might allow using smaller beams leading a more efficient exploitation of dose-volume effects, and consequently, a better normal tissue sparing. Monte Carlo simulations were used to evaluate realistic dose distributions considering a 6 MV FFF photon beam from a standard medical Linac and a cerrobend mechanical collimator in different configurations: grid sizes of 0.3 × 0.3 cm 2 , 0.5 × 0.5 cm 2 , and 1 × 1 cm 2 and a corresponding center-to-center (ctc) distance of 0.6, 1, and 2 cm, respectively (total field size of 10 × 10 cm 2 ). As figure of merit, peak doses in depth, PVDR, output factors (OF), and penumbra values were assessed. Dose at the entrance is slightly higher than in conventional Grid Therapy. However, it is compensated by the large PVDR obtained at the entrance, reaching a maximum of 35 for a grid size of 1 × 1 cm 2 . Indeed, this grid size leads to very high PVDR values at all depths (≥ 10), which are much higher than in standard Grid Therapy. This may be beneficial for normal tissues but detrimental for tumor control, where a lower PVDR might be requested. In that case, higher valley doses in the tumor could be achieved by using an interlaced approach and/or adapting the ctc distance. The smallest grid size (0.3 × 0.3 cm 2 ) leads to low PVDR at all depths, comparable to standard Grid Therapy. However, the use of very thin beams might increase the normal tissue tolerances with respect to the grid size commonly used (1 × 1 cm 2 ). The gain in fluence provided by FFF implies that the important OF reduction (0.6) will not increase treatment time. Finally, the intermediate configuration (0.5 × 0.5 cm 2 ) provides high PVDR in the first 5 cm, and comparable PVDR to previous Grid Therapy works at depth. Therefore, this configuration might allow increasing the normal tissue tolerances with respect to Grid Therapy thanks to the higher PVDR and thinner beams, while a similar tumor control could be expected. The implementation of Grid Therapy in an FFF photon beam from medical Linac might lead to an improvement of the therapeutic index. Among the cases evaluated, a grid size of 0.5 × 0.5 cm 2 (1-cm-ctc) is the most advantageous configuration from the physics point of view. Radiobiological experiments are needed to fully explore this new avenue and to confirm our results. © 2017 American Association of Physicists in Medicine.

Sediment accretion and carbon storage in constructed wetlands receiving water treated with metal-based coagulants

USGS Publications Warehouse

Stumpner, Elizabeth; Kraus, Tamara; Liang, Yan; Bachand, Sandra M.; Horwath, William R.; Bachand, Philip A.M.

2018-01-01

In many regions of the world, subsidence of organic rich soils threatens levee stability and freshwater supply, and continued oxidative loss of organic matter contributes to greenhouse gas production. To counter subsidence in the Sacramento-San Joaquin Delta of northern California, we examined the feasibility of using constructed wetlands receiving drainage water treated with metal-based coagulants to accrete mineral material along with wetland biomass, while also sequestering carbon in wetland sediment. Nine field-scale wetlands were constructed which received local drainage water that was either untreated (control), or treated with polyaluminum chloride (PAC) or iron sulfate (FeSO4) coagulants. After 23 months of flooding and coagulant treatment, sediment samples were collected near the inlet, middle, and outlet of each wetland to determine vertical accretion rates, bulk density, sediment composition, and carbon sequestration rates. Wetlands treated with PAC had the highest and most spatially consistent vertical accretion rates (~6 cm year-1), while the FeSO4 wetlands had similarly high accretion rates near the inlet but rates similar to the untreated wetland (~1.5 cm year-1) at the middle and outlet sites. The composition of the newly accreted sediment in the PAC and FeSO4 treatments was high in the added metal (aluminum and iron, respectively), but the percent metal by weight was similar to native soils of California. As has been observed in other constructed wetlands, the newly accreted sediment material had lower bulk densities than the native soil material (0.04-0.10 g cm-3 versus 0.2-0.3 g cm-3), suggesting these materials will consolidate over time. Finally, this technology accelerated carbon burial, with rates in PAC treated wetland (0.63 kg C m-2 yr-1) over 2-fold greater than the untreated control (0.28 kg C m-2 yr-1). This study demonstrates the feasibility of using constructed wetlands treated with coagulants to reverse subsidence by accreting the resulting organo-metal flocculent and storing carbon at rates exceeding untreated wetlands. Management and design questions remain for how to best integrate this technology into heavily subsided land to lower the risks and consequences associated with levee failure, improve water quality, and ultimately restore these lands to tidal wetlands.

Minimally Invasive Sacroiliac Joint Fusion, Radiofrequency Denervation, and Conservative Management for Sacroiliac Joint Pain: 6-Year Comparative Case Series.

PubMed

Vanaclocha, Vicente; Herrera, Juan Manuel; Sáiz-Sapena, Nieves; Rivera-Paz, Marlon; Verdú-López, Francisco

2018-01-01

Sacroiliac joint (SIJ) pain is an under-recognized condition. Substantial information supports the safety and effectiveness of SIJ fusion (SIJF). Long-term follow-up after SIJF has not been reported. To determine responses to conservative management (CM), SIJ denervation, and SIJF in patients with SIJ pain unresponsive to CM. Retrospective study with long-term (up to 6 yr) follow-up of 137 patients with SIJ pain seen in an outpatient neurosurgery clinic who received either CM (n = 63), sacroiliac denervation (n = 47), or minimally invasive SIJF (n = 27). At each routine clinic visit, patients completed pain scores and Oswestry Disability Index. Additional data were extracted from medical charts. Patients treated with continued CM had no long-term improvement in pain (mean worsening of 1 point) or disability (mean Oswestry Disability Index worsened by 4-6 points), increased their use of opioids, and had poor long-term work status. SIJF patients had large improvements in SIJ pain (mean 6 points), large improvements in disability (mean 25 points), a decrease in opioid use, and good final work status. Sacroiliac denervation patients had intermediate responses (0-1 and 1-2 points, respectively). In patients with SIJ pain unresponsive to CM, SIJF resulted in excellent long-term clinical responses, with low opioid use and better work status compared to other treatments. Copyright © 2017 by the Congress of Neurological Surgeons

Income Levels and Response to Contingency Management for Smoking Cessation.

PubMed

López-Núñez, Carla; Secades-Villa, Roberto; Peña-Suárez, Elsa; Fernández-Artamendi, Sergio; Weidberg, Sara

2017-06-07

Contingency management (CM) has demonstrated its efficacy in treating many drug addictions, including nicotine. However, one of the most commonly perceived limitations with regard to its dissemination into community settings is whether this protocol could be equally effective for treating patients across different income levels. This study aimed to examine whether individuals' income levels affect treatment success in a cognitive behavioral treatment (CBT) that included a voucher-based CM protocol for smoking cessation. A total of 92 treatment-seeking smokers in a community setting were randomly assigned to a CBT group (N = 49) or to a CBT plus CM group (N = 43). The CM procedure included a voucher program through which smoking abstinence was reinforced on a schedule of escalating magnitude of reinforcement with a reset contingency. We analyzed the impact of self-reported monthly income, alone and in combination with treatment condition, on short-term (treatment retention) and long-term (self-reported number of days of continuous smoking abstinence at 6-month follow-up) results. Income had no effect on treatment retention and continuous abstinence outcomes at 6-month follow-up in either treatment condition. Treatment modality emerged as the only significant predictor of treatment success. Our findings suggest that treatment-seeking smokers from the general population respond equally well to CM regardless of their income levels. The results of this randomized controlled trial support the generalizability of this evidenced-based program into community settings.

Proceedings of the Strategy Meeting for the Development of an International Consortium for Chinese Medicine and Cancer

PubMed Central

White, Jeffrey D.; Lin, Hongsheng; Wu, Roy S.; Lam, Stephen; Li, Jie; Dou, Jinhui; Kumar, Nagi; Lin, Lizhu; Lao, Lixing

2017-01-01

On November 3, 2014, in Bethesda, MD, the Office of Cancer Complementary and Alternative Medicine of the National Cancer Institute held a meeting to examine the potential utility and feasibility of establishing an international consortium for Chinese medicine and cancer. There is significant interest in the West in using components of Chinese medicine (CM) —such as botanicals and herbal medicines, acupuncture and acupressure, and qigong—in the field of oncology, as potential anticancer agents, for symptom management, and to improve quality of life. The proposal for a consortium on CM came from the Chinese Academy of Chinese Medical Sciences, with the aims of improving scientific communications and collaborations and modernizing the studies of CM for cancer. The US National Cancer Institute’s Office of Cancer Complementary and Alternative Medicine agreed to work with Chinese Academy of Chinese Medical Sciences to explore the feasibility of establishing an international consortium for Chinese medicine and cancer. At the meeting, participants from the United States, China, Canada, Australia, and Korea discussed issues in CM and cancer research, treatment, and management, including potential mechanisms of action, proof of efficacy, adverse effects, regulatory issues, and the need for improving the quality of randomized clinical trials of CM treatments and supportive care interventions. Presented in these proceedings are some of the main issues and opportunities discussed by workshop participants. PMID:29244995

Dissolved organic C and N pools in soils amended with composted and thermally-dried sludge as affected by soil tillage systems and sampling depth

NASA Astrophysics Data System (ADS)

García-Gil, Juan Carlos; Soler-Rovira, Pedro Angel; García López de Sa, Esther; Polo, Alfredo

2013-04-01

Soil tillage practices exert a significant influence on the dynamic of soluble organic C and N pools, affecting nutrient cycling in agricultural systems by enhancing its mineralization through microbial activities or stabilization in soil microaggregates, which contribute to mitigate greenhouse gases emissions. The objective of the present research was to determine the influence of three different soil management systems (moldboard plowing, chisel and no-tillage) and the application of composted sludge (CS) and thermally-dried sewage sludge (TSS) obtained from wastewater treatment processes on dissolved organic C (water-soluble organic C -WSOC-, carbohydrates, phenolic compounds) and soluble N (total-N, NH4+, NO3-) pools in a long-term field experiment (27 years) conducted on a sandy-loam soil at the experimental station "La Higueruela" (40° 03'N, 4° 24'W) under semi-arid conditions. Both organic amendments were applied at a rate of 30 tonnes per hectare prior to tillage practices. Unamended soils were used as control for each tillage system. Soil sampling was performed two months after tillage practices at the following depths for each treatment: 0-10 cm, 10-20 cm and 20-30 cm. Results obtained for unamended soils showed that no-tillage management increased total-N, NH4+ and NO3- contents at the 0-10 cm depth samples, meanwhile WSC and carbohydrates contents were larger at 20-30 cm depth samples in both moldboard and no-tillage plots. CS and TSS-amended soils presented a general increase in soluble C and N compounds, being significantly higher in TSS-amended soils, as TSS contains a great amount of labile organic C and N substrates due to the lack of stabilization treatment. TSS-amended soils under no-tillage and chisel plowing showed larger N, NH4+ and NO3- content at the 0-10 cm samples, meanwhile moldboard management exhibited larger NH4+ and NO3- content at 10-20 and 20-30 cm samples, possibly due to the incorporation of TSS at deeper depths (20-40 cm). CS and TSS-amended soils in no-tillage system showed the largest content of organic C pools at 0-10 cm depth samples due to less soil disturbance and the input of organic substrates with CS and TSS on soil surface. CS and TSS-amended soils under chisel plowing exhibited similar contents of soluble organic C pools at 10-20 and 20-30 cm depth samples and only TSS-amended soils increased significantly WSOC content at 0-10 cm samples. Similarly, contents of WSOC and carbohydrates in moldboard plowing were distributed more uniformly throughout the soil profile due to the turnover of soil and CS and TSS amendments into the plow layer. Acknowledgements: this research was supported by the Spanish CICYT, Project no. CTM2011-25557.

Diurnal roosts of male evening bats (Nycticeius humeralis) in diversely managed pine-hardwood forests

Treesearch

Roger W. Perry; Ronald E. Thill

2008-01-01

We examined attributes of 45 roost sites used by 17 adult male evening bats (Nycticeius humeralis) in a diverse forested landscape within the Ouachita Mountains, Arkansas. Bats roosted in a diverse array of substrates, including live or dead Pinus echinata $15 cm diam at breast height (29% of roosts) and small (,10 cm) understory or midstory...

Randomized Trial of Continuing Care Enhancements for Cocaine-Dependent Patients following Initial Engagement

ERIC Educational Resources Information Center

McKay, James R.; Lynch, Kevin G.; Coviello, Donna; Morrison, Rebecca; Cary, Mark S.; Skalina, Lauren; Plebani, Jennifer

2010-01-01

Objective: The effects of cognitive-behavioral relapse prevention (RP), contingency management (CM), and their combination (CM + RP) were evaluated in a randomized trial with 100 cocaine-dependent patients (58% female, 89% African American) who were engaged in treatment for at least 2 weeks and had an average of 44 days of abstinence at baseline.…

Software Process Automation: Experiences from the Trenches.

DTIC Science & Technology

1996-07-01

Integration of problem database Weaver tions) J Process WordPerfect, All-in-One, Oracle, CM Integration of tools Weaver System K Process Framemaker , CM...handle change requests and problem reports. * Autoplan, a project management tool * Framemaker , a document processing system * Worldview, a document...Cadre, Team Work, FrameMaker , some- thing for requirements traceability, their own homegrown scheduling tool, and their own homegrown tool integrator

Chiari Type I Malformations in Young Adults: Implications for the College Health Practitioner

ERIC Educational Resources Information Center

Elam, Mary Jane; Vaughn, John A.

2011-01-01

In this article, the authors describe 2 cases of Chiari type I malformation (CM-I) in students presenting to a college health center within a 6-month period. A review of CM-I, including epidemiology, typical presentation, evaluation, and management, is followed by a discussion of the clinical and functional implications of the disorder in an…

Urethral calculi in young-adult Nigerian males: a case series.

PubMed

Gali, B M; Ali, N; Agbese, G O; Garba, I I; Musa, K

2011-01-01

Urethral calculi are rare and usually encountered in males with urethral pathology. To present our experience managing urethral calculi in a resource limited centre and review the literature. We did a chart review of management of patients with urethral calculi between January and April 2009, at Federal Medical Centre (FMC) Azare, Nigeria. We also reviewed the literature on this rare condition. Four young adult male Nigerians between the ages of 17 and 27 years presented with varying degrees of urethral pain and palpable calculi in the anterior urethra. Two presented with acute retention of urine, but none had haematuria. The calculi were radio-opaque, located in the anterior urethra with no associated urethral pathology. Three were solitary and one multiple. The composition of the urethral calculi was a mixture of calcium oxalate calcium carbonate, magnesium phosphate, one has additional cystine but none had struvite or uric acid. Their sizes ranged between 1cm ×1.5cm and 1.5cm × 5.5cm. External urethrotomy was the method of treatment. Urethral calculi are rare in our setting, with no clear identifiable aetiological factors which suggests urinary schistosomiasisbeing associsted. The occurrence of urethral calculi appears to have a relationship with childhood urinary schistosomasis.

Computer-assisted Behavioral Therapy and Contingency Management for Cannabis Use Disorder

PubMed Central

Budney, Alan J.; Stanger, Catherine; Tilford, J. Mick; Scherer, Emily; Brown, Pamela C.; Li, Zhongze; Li, Zhigang; Walker, Denise

2015-01-01

Computer-assisted behavioral treatments hold promise for enhancing access to and reducing costs of treatments for substance use disorders. This study assessed the efficacy of a computer-assisted version of an efficacious, multicomponent treatment for cannabis use disorders (CUD), i.e., motivational enhancement therapy, cognitive-behavioral therapy, and abstinence-based contingency-management (MET/CBT/CM). An initial cost comparison was also performed. Seventy-five adult participants, 59% African Americans, seeking treatment for CUD received either, MET only (BRIEF), therapist-delivered MET/CBT/CM (THERAPIST), or computer-delivered MET/CBT/CM (COMPUTER). During treatment, the THERAPIST and COMPUTER conditions engendered longer durations of continuous cannabis abstinence than BRIEF (p < .05), but did not differ from each other. Abstinence rates and reduction in days of use over time were maintained in COMPUTER at least as well as in THERAPIST. COMPUTER averaged approximately $130 (p < .05) less per case than THERAPIST in therapist costs, which offset most of the costs of CM. Results add to promising findings that illustrate potential for computer-assisted delivery methods to enhance access to evidence-based care, reduce costs, and possibly improve outcomes. The observed maintenance effects and the cost findings require replication in larger clinical trials. PMID:25938629

Variations of deep soil moisture under different vegetation types and influencing factors in a watershed of the Loess Plateau, China

NASA Astrophysics Data System (ADS)

Fang, Xuening; Zhao, Wenwu; Wang, Lixin; Feng, Qiang; Ding, Jingyi; Liu, Yuanxin; Zhang, Xiao

2016-08-01

Soil moisture in deep soil layers is a relatively stable water resource for vegetation growth in the semi-arid Loess Plateau of China. Characterizing the variations in deep soil moisture and its influencing factors at a moderate watershed scale is important to ensure the sustainability of vegetation restoration efforts. In this study, we focus on analyzing the variations and factors that influence the deep soil moisture (DSM) in 80-500 cm soil layers based on a soil moisture survey of the Ansai watershed in Yan'an in Shanxi Province. Our results can be divided into four main findings. (1) At the watershed scale, higher variations in the DSM occurred at 120-140 and 480-500 cm in the vertical direction. At the comparable depths, the variation in the DSM under native vegetation was much lower than that in human-managed vegetation and introduced vegetation. (2) The DSM in native vegetation and human-managed vegetation was significantly higher than that in introduced vegetation, and different degrees of soil desiccation occurred under all the introduced vegetation types. Caragana korshinskii and black locust caused the most serious desiccation. (3) Taking the DSM conditions of native vegetation as a reference, the DSM in this watershed could be divided into three layers: (i) a rainfall transpiration layer (80-220 cm); (ii) a transition layer (220-400 cm); and (iii) a stable layer (400-500 cm). (4) The factors influencing DSM at the watershed scale varied with vegetation types. The main local controls of the DSM variations were the soil particle composition and mean annual rainfall; human agricultural management measures can alter the soil bulk density, which contributes to higher DSM in farmland and apple orchards. The plant growth conditions, planting density, and litter water holding capacity of introduced vegetation showed significant relationships with the DSM. The results of this study are of practical significance for vegetation restoration strategies, especially for the choice of vegetation types, planting zones, and proper human management measures.

Vapor feed direct methanol fuel cells with passive thermal-fluids management system

NASA Astrophysics Data System (ADS)

Guo, Zhen; Faghri, Amir

The present paper describes a novel technology that can be used to manage methanol and water in miniature direct methanol fuel cells (DMFCs) without the need for a complex micro-fluidics subsystem. At the core of this new technology is a unique passive fuel delivery system that allows for fuel delivery at an adjustable rate from a reservoir to the anode. Furthermore, the fuel cell is designed for both passive water management and effective carbon dioxide removal. The innovative thermal management mechanism is the key for effective operation of the fuel cell system. The vapor feed DMFC reached a power density of 16.5 mW cm -2 at current density of 60 mA cm -2. A series of fuel cell prototypes in the 0.5 W range have been successfully developed. The prototypes have demonstrated long-term stable operation, easy fuel delivery control and are scalable to larger power systems. A two-cell stack has successfully operated for 6 months with negligible degradation.

Critical analysis of procurement techniques in construction management sectors

NASA Astrophysics Data System (ADS)

Tiwari, Suman Tiwari Suresh; Chan, Shiau Wei; Faraz Mubarak, Muhammad

2018-04-01

Over the last three decades, numerous procurement techniques have been one of the highlights of the Construction Management (CM) for ventures, administration contracting, venture management as well as design and construct. Due to the development and utilization of those techniques, various researchers have explored the criteria for their choice and their execution in terms of time, cost and quality. Nevertheless, there is a lack of giving an account on the relationship between the procurement techniques and the progressed related issues, for example, supply chain, sustainability, innovation and technology development, lean construction, constructability, value management, Building Information Modelling (BIM) as well as e-procurement. Through chosen papers from the reputable CM-related academic journals, the specified scopes of these issues are methodically assessed with the objective to explore the status and trend in procurement related research. The result of this paper contributes theoretically as well as practically to the researchers and industrialist in order to be aware and appreciate the development of procurement techniques.

Risk analysis of urban gas pipeline network based on improved bow-tie model

NASA Astrophysics Data System (ADS)

Hao, M. J.; You, Q. J.; Yue, Z.

2017-11-01

Gas pipeline network is a major hazard source in urban areas. In the event of an accident, there could be grave consequences. In order to understand more clearly the causes and consequences of gas pipeline network accidents, and to develop prevention and mitigation measures, the author puts forward the application of improved bow-tie model to analyze risks of urban gas pipeline network. The improved bow-tie model analyzes accident causes from four aspects: human, materials, environment and management; it also analyzes the consequences from four aspects: casualty, property loss, environment and society. Then it quantifies the causes and consequences. Risk identification, risk analysis, risk assessment, risk control, and risk management will be clearly shown in the model figures. Then it can suggest prevention and mitigation measures accordingly to help reduce accident rate of gas pipeline network. The results show that the whole process of an accident can be visually investigated using the bow-tie model. It can also provide reasons for and predict consequences of an unfortunate event. It is of great significance in order to analyze leakage failure of gas pipeline network.

Technical note: Examining ozone deposition over seawater

NASA Astrophysics Data System (ADS)

Sarwar, Golam; Kang, Daiwen; Foley, Kristen; Schwede, Donna; Gantt, Brett; Mathur, Rohit

2016-09-01

Surface layer resistance plays an important role in determining ozone deposition velocity over sea-water and can be influenced by chemical interactions at the air-water interface. Here, we examine the effect of chemical interactions of iodide, dimethylsulfide, dissolved organic carbon, and bromide in seawater on ozone deposition. We perform a series of simulations using the hemispheric Community Multiscale Air Quality model for summer months in the Northern Hemisphere. Our results suggest that each chemical interaction enhances the ozone deposition velocity and decreases the atmospheric ozone mixing ratio over seawater. Iodide enhances the median deposition velocity over seawater by 0.023 cm s-1, dissolved organic carbon by 0.021 cm s-1, dimethylsulfide by 0.002 cm s-1, and bromide by ∼0.0006 cm s-1. Consequently, iodide decreases the median atmospheric ozone mixing ratio over seawater by 0.7 ppb, dissolved organic carbon by 0.8 ppb, dimethylsulfide by 0.1 ppb, and bromide by 0.02 ppb. In a separate model simulation, we account for the effect of dissolved salts in seawater on the Henry's law constant for ozone and find that it reduces the median deposition velocity by 0.007 cm s-1 and increases surface ozone mixing ratio by 0.2 ppb. The combined effect of these processes increases the median ozone deposition velocity over seawater by 0.040 cm s-1, lowers the atmospheric ozone mixing ratio by 5%, and slightly improves model performance relative to observations.

Follow-up treatment effects of contingency management and motivational interviewing on substance use: A meta-analysis.

PubMed

Sayegh, Caitlin S; Huey, Stanley J; Zara, Erica J; Jhaveri, Kinnari

2017-06-01

Motivation is an integral factor in substance use treatment and long-term recovery. However, it is unclear what role intrinsic and extrinsic motivation play across different treatment modalities. A meta-analysis (N = 84) was performed to estimate the pooled effect size of Motivational Interviewing (MI; primarily targeting intrinsic motivation) and contingency management (CM; primarily targeting extrinsic motivation) at different follow-up periods. Collapsed across all substance types, CM had a significant effect at 3-month follow-up, only. In contrast, MI had a significant effect at 6-month follow-up, only. CM had small and medium effects on multiple substances at 3-month follow-up (i.e., tobacco, marijuana, stimulants, polysubstances), but not at 6-month follow-up. MI had 1 significant medium effect at 3-month follow-up (i.e., marijuana), but several significant small effects at 6-month follow-up (i.e., alcohol, tobacco, polysubstances). This meta-analysis suggests that both CM and MI promote reductions in a range of substances, even several months after the intervention concludes. Further, these results provide some evidence that extrinsically focused CM may produce medium follow-up effects in the short run, but intrinsically focused MI may produce small but durable follow-up effects. However, this interpretation is complicated by the differences between the MI and CM studies that preclude statistical tests comparing effect sizes, and few studies assessed motivation itself. Future researchers should investigate how motivational dynamics impact lasting outcomes in substance use treatment. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

RMP Guidance for Chemical Distributors - Chapter 7: Prevention Program (Program 3)

EPA Pesticide Factsheets

The OSHA Process Safety Management program has legal authority for on-site consequences, EPA's Prevention Program for offsite consequences, so your process hazard analysis (PHA) team may have to assess new hazards to the public and offsite environment.

40 CFR 1400.1 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-07-01

... OFF-SITE CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION... chemical accidents and submit the results of their analyses to the U.S. Environmental Protection Agency as... the portions of risk management plans containing the results of those analyses and certain related...

40 CFR 1400.1 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-07-01

... OFF-SITE CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION... chemical accidents and submit the results of their analyses to the U.S. Environmental Protection Agency as... the portions of risk management plans containing the results of those analyses and certain related...

40 CFR 1400.1 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-07-01

... OFF-SITE CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION... chemical accidents and submit the results of their analyses to the U.S. Environmental Protection Agency as... the portions of risk management plans containing the results of those analyses and certain related...

40 CFR 1400.1 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-07-01

... OFF-SITE CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION... chemical accidents and submit the results of their analyses to the U.S. Environmental Protection Agency as... the portions of risk management plans containing the results of those analyses and certain related...

Management of thinned Emory oak coppice for multiple resource benefits

Treesearch

D. Catlow Shipek; Peter F. Ffolliott

2005-01-01

Managers are increasingly moving toward an ecosystem-based, multiple-use approach in managing Emory oak woodlands in the Southwestern United States. Often of particular interest is managing the coppice that evolves from earlier fuelwood harvesting activities. Emory oak (Quercus emoryi) is a prolific sprouting species and, as a consequence, post-...

41 CFR 302-12.9 - What are the income tax consequences if I use a relocation services company?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false What are the income tax consequences if I use a relocation services company? 302-12.9 Section 302-12.9 Public Contracts and Property... the income tax consequences if I use a relocation services company? You may incur income taxes on...

Adaptive social impact management for conservation and environmental management.

PubMed

Kaplan-Hallam, Maery; Bennett, Nathan J

2018-04-01

Concerns about the social consequences of conservation have spurred increased attention the monitoring and evaluation of the social impacts of conservation projects. This has resulted in a growing body of research that demonstrates how conservation can produce both positive and negative social, economic, cultural, health, and governance consequences for local communities. Yet, the results of social monitoring efforts are seldom applied to adaptively manage conservation projects. Greater attention is needed to incorporating the results of social impact assessments in long-term conservation management to minimize negative social consequences and maximize social benefits. We bring together insights from social impact assessment, adaptive management, social learning, knowledge coproduction, cross-scale governance, and environmental planning to propose a definition and framework for adaptive social impact management (ASIM). We define ASIM as the cyclical process of monitoring and adaptively managing social impacts over the life-span of an initiative through the 4 stages of profiling, learning, planning, and implementing. We outline 14 steps associated with the 4 stages of the ASIM cycle and provide guidance and potential methods for social-indicator development, predictive assessments of social impacts, monitoring and evaluation, communication of results, and identification and prioritization of management responses. Successful ASIM will be aided by engaging with best practices - including local engagement and collaboration in the process, transparent communication of results to stakeholders, collective deliberation on and choice of interventions, documentation of shared learning at the site level, and the scaling up of insights to inform higher-level conservation policies-to increase accountability, trust, and perceived legitimacy among stakeholders. The ASIM process is broadly applicable to conservation, environmental management, and development initiatives at various scales and in different contexts. © 2017 Society for Conservation Biology.

Chronic Obstructive Pulmonary Disease heterogeneity: challenges for health risk assessment, stratification and management.

PubMed

Roca, Josep; Vargas, Claudia; Cano, Isaac; Selivanov, Vitaly; Barreiro, Esther; Maier, Dieter; Falciani, Francesco; Wagner, Peter; Cascante, Marta; Garcia-Aymerich, Judith; Kalko, Susana; De Mas, Igor; Tegnér, Jesper; Escarrabill, Joan; Agustí, Alvar; Gomez-Cabrero, David

2014-11-28

Heterogeneity in clinical manifestations and disease progression in Chronic Obstructive Pulmonary Disease (COPD) lead to consequences for patient health risk assessment, stratification and management. Implicit with the classical "spill over" hypothesis is that COPD heterogeneity is driven by the pulmonary events of the disease. Alternatively, we hypothesized that COPD heterogeneities result from the interplay of mechanisms governing three conceptually different phenomena: 1) pulmonary disease, 2) systemic effects of COPD and 3) co-morbidity clustering, each of them with their own dynamics. To explore the potential of a systems analysis of COPD heterogeneity focused on skeletal muscle dysfunction and on co-morbidity clustering aiming at generating predictive modeling with impact on patient management. To this end, strategies combining deterministic modeling and network medicine analyses of the Biobridge dataset were used to investigate the mechanisms of skeletal muscle dysfunction. An independent data driven analysis of co-morbidity clustering examining associated genes and pathways was performed using a large dataset (ICD9-CM data from Medicare, 13 million people). Finally, a targeted network analysis using the outcomes of the two approaches (skeletal muscle dysfunction and co-morbidity clustering) explored shared pathways between these phenomena. (1) Evidence of abnormal regulation of skeletal muscle bioenergetics and skeletal muscle remodeling showing a significant association with nitroso-redox disequilibrium was observed in COPD; (2) COPD patients presented higher risk for co-morbidity clustering than non-COPD patients increasing with ageing; and, (3) the on-going targeted network analyses suggests shared pathways between skeletal muscle dysfunction and co-morbidity clustering. The results indicate the high potential of a systems approach to address COPD heterogeneity. Significant knowledge gaps were identified that are relevant to shape strategies aiming at fostering 4P Medicine for patients with COPD.

Thermal Lens Measurement in Diode-Pumped Nd:YAG Zig-Zag Slab

NASA Technical Reports Server (NTRS)

Smoak, M. C.; Kay, R. B.; Coyle, D. B.; Hopf, D.

1998-01-01

A major advantage that solid state zig-zag slab lasers have over conventional rod-based designs is that a much weaker thermal lens is produced in the slab when side-pumped with Quasi-CW laser diode arrays, particularly if the pump radiation is kept well away from the Brewster-cut ends. This paper reports on a rather strong thermal lens produced when diode pump radiation is collimated into a narrow portion of the zig-zag slab. The collimation of multi-bar pump packages to increase brightness and improve overlap is a direct consequence of designs which seek to maximize performance and efficiency. Our slab design employed a 8.1 cm x 2.5 mm x 5 mm slab with opposing Brewster end faces. It was pumped through the 2.5 mm direction by seven laser diode array packages, each housing four 6OW diode bars, 1 cm in width. The pump face, anti-reflection (AR) coated at 809 nm, was 6.8 cm in width and the 8.1 cm opposing side, high-reflection (HR) coated at 809 nm, reflected the unabsorbed pump beam for a second pass through the slab.

Heavily doped n-type a-IGZO by F plasma treatment and its thermal stability up to 600 °C

NASA Astrophysics Data System (ADS)

Um, Jae Gwang; Jang, Jin

2018-04-01

We report the electrical properties and thermal stability of heavily doped, amorphous indium-gallium-zinc-oxide (a-IGZO) treated with fluorine (F) plasma. When the F doping concentration in a-IGZO is 17.51 × 1021/cm-3, the a-IGZO exhibits a carrier concentration of 6 × 1019 cm-3, a resistivity of 3 × 10-3 Ω cm, and a Hall mobility of 20 cm2/V s. This indicates that F is a suitable n-type dopant in a-IGZO. The similarity of the ionic radius of F to that of oxygen (O) allows substitutional doping by replacing O with F or the occupation of the oxygen vacancy (VO) site by F and consequent reduction in defect density. The semiconducting property of a-IGZO can change into metallic behavior by F doping. The defect passivation by F incorporation is confirmed by the XPS depth profile, which reveals the significant reduction in the VO concentration due to the formation of In-F bonds. The heavily doped a-IGZO exhibits thermally stable conductivity up to 600 °C annealing and thus can be widely used for the ohmic contact of a-IGZO devices.

Seasonally frozen layer in natural and drained peatlands at the South of West Siberia, Russia

NASA Astrophysics Data System (ADS)

Dyukarev, Egor; Kiselev, Maxim; Voropay, Nadezhda; Preis, Yulia

2017-04-01

The temperature regime of soils in natural and drained peatlands at Bakchar bog located in the South Taiga zone of West Siberia is studied. Soil temperature for depths up to 320 cm was registered using autonomous temperature profile recorder during the period from August 2010 to September 2016. Maximal and minimal temperatures were registered at surface in July and February, consequently. Extreme soil temperatures at 320 cm depth shifts to December (maximum) and July (minimum) reducing absolute values. Annual peat soil temperature amplitude decrease with depth from 21,8 °C on surface to 1,1 °C at 320 cm. The analysis of daily, month and annual mean data of temperature in peat soil has shown that seasonally frozen layer was registered up to 20-60 cm depth. The duration of seasonally freeze layer existence varies from 130 to 180 days. Drained peatlands with the lowest water table have highest freeze depth. Soil at water-logged sedge-sphagnum fen in winter is warmer than soil in ryam ecosystem and mineral soil at upland. Maximal freezing depth in peatlands is up to 3 times lower than at drain areas.

Thermoelectric properties of sintered type-II clathrates (K, Ba)24(Ga, Sn)136 with various carrier concentrations

NASA Astrophysics Data System (ADS)

Kishimoto, Kengo; Koda, Shota; Akai, Koji; Koyanagi, Tsuyoshi

2015-09-01

We reported the thermoelectric properties of the sintered type-II clathrate K8Ba16Ga40Sn96 in a previous paper [S. Koda et al., J. Appl. Phys. 116, 023710 (2014)]. The clathrate had a high dimensionless figure of merit ZT, namely, 0.93. In this study, we optimized the carrier concentration n by modifying the chemical compositions of (K, Ba)24(Ga, Sn)136 samples, and heat treated the sintered samples. The carrier mobilities μ were improved because of the reduction in potential barrier scattering at grain boundaries. The room-temperature (RT) n values varied from 7.7 × 1017 to 3.7 × 1019 cm-3; the maximum RT μ value was 170 cm2V-1s-1. Consequently, we obtained a high ZT value of 1.19 at 630 K for n = 2.5 × 1019 cm-3. This material therefore has good thermoelectric properties.

The importance of carbon nanotube wire density, structural uniformity, and purity for fabricating homogeneous carbon nanotube-copper wire composites by copper electrodeposition

NASA Astrophysics Data System (ADS)

Sundaram, Rajyashree; Yamada, Takeo; Hata, Kenji; Sekiguchi, Atsuko

2018-04-01

We present the influence of density, structural regularity, and purity of carbon nanotube wires (CNTWs) used as Cu electrodeposition templates on fabricating homogeneous high-electrical performance CNT-Cu wires lighter than Cu. We show that low-density CNTWs (<0.6 g/cm3 for multiwall nanotube wires) with regular macro- and microstructures and high CNT content (>90 wt %) are essential for making homogeneous CNT-Cu wires. These homogeneous CNT-Cu wires show a continuous Cu matrix with evenly mixed nanotubes of high volume fractions (˜45 vol %) throughout the wire-length. Consequently, the composite wires show densities ˜5.1 g/cm3 (33% lower than Cu) and electrical conductivities ˜6.1 × 104 S/cm (>100 × CNTW conductivity). However, composite wires from templates with higher densities or structural inconsistencies are non-uniform with discontinuous Cu matrices and poor CNT/Cu mixing. These non-uniform CNT-Cu wires show conductivities 2-6 times lower than the homogeneous composite wires.

Inkjet printing of metal-oxide-based transparent thin-film capacitors

NASA Astrophysics Data System (ADS)

Matavž, A.; Malič, B.; Bobnar, V.

2017-12-01

We report on the inkjet printing of transparent, thin-film capacitors (TTFCs) composed of indium-zinc-oxide electrodes and a tantalum-oxide-based dielectric on glass substrates. The printing parameters were adapted for the sequential deposition of functional layers, resulting in approximately 100-nm-thick transparent capacitors with a uniform thickness. The relatively high electrical resistivity of the electrodes is reflected in the frequency dispersive dielectric behaviour, which is explained in terms of an equivalent circuit. The resistivity of the electrode strongly decreases with the number of printing passes; consequently, any misalignment of the printed layers is detected in the measured response. At low frequency, the TTFCs show a stable intrinsic dielectric response and a high capacitance density of ˜280 nF/cm2. The good dielectric performance as well as the low leakage-current density (8 × 10-7 A/cm2 at 1 MV cm-1) of our capacitors indicates that inkjet printing can be used to produce all-printed, high-quality electrical devices.

Large-scale interdisciplinary experiments inform current and future forestry management options in the U.S. Pacific Northwest

Treesearch

Charles E. Peterson; Paul D. Anderson

2009-01-01

Over the last 20 years, changing public values and increased ecological understanding have led to a paradigm shift in forestry from timber management to sustainable ecosystem management on U.S. federal lands. Forest managers are now seeking alternative management approaches that simultaneously meet socio-cultural, ecological and economic goals. Consequently, many field...

The effect of soil biodiversity on soil quality after agricultural reclamation at the eastern coast of China

NASA Astrophysics Data System (ADS)

Wang, Xiaohan; Yang, Jianghua; Pu, Lijie; Chen, Xinjian

2017-04-01

Large area of tidal flats in Chinese coast has been reclaimed to support agriculture and urban development because of rapid population and economic growth. Knowledge of soil development mechanisms is essential for efficient management of land resources in coastal zone. So far, most studies have focused on consequences of soil physico-chemical properties on soil quality evolution after tideland reclamation for cultivation; yet a large part of soil bioprocess drives many soil processes. The effect of organism composition on the performance of soil development remains unclear. The purpose of our work was to reveal the organism composition change and its influence on soil quality impotent. In this study, we choose seven reclamation districts along a chronosequence in eastern coast of China, which were respectively reclaimed in 1956, 1971, 1980, 1997, 2009, 2013 and unenclosed tidal flat. The latest districts reclaimed in 2013 were left to succession fallow which were covered with halophytic vegetation and the rest districts were agriculturally managed. Soil samples at 0-20 cm were collected in each district. Soil physical, chemical and biological properties and wheat yields were measured. The result showed after the transformation from tidal flat to cropland, longer tillage time (>5 year) lead to higher soil clay and silt, SOC contents and lower bulk density, while soil clay and C contents declined within the first 5 years after reclamation. Agricultural reclamation significantly improved SOC contents of 0-20 cm depth form 0.11±0.05% to 0.77±0.10%. It needs about 35 years to achieve stable yield level after reclamation. Meanwhile, the soil community composition changed strongly over time. More significant relationships were found among soil physicochemical properties and bacteria community. And the variation trend of soil community richness (chao1) is similar to soil C contents, dropped at first 5 years and then significantly increased. Our results indicate that the soil biodiversity growth promotes the soil quality recovery after crop cultivation. Both the soil physical environment and fertility were improved.

Assessing the variation in bund structure design and its impact on soil physical properties and hydrology in Koga catchment, Highlands of Ethiopia

NASA Astrophysics Data System (ADS)

Lakew, Walle; Baartman, Jantiene; Fleskens, Luuk; Selassie, Yihenew; Ritsema, Coen

2017-04-01

Prolonged soil drying and severe moisture stress during the dry season, and soil saturation and erosion during the short rainy season are critical problems in the Ethiopian highlands. Large-scale implementation of bund structures has been used as soil and water management (SWM) strategy to fight these problems and establish a sustainable land management (SLM) system. However, many SWM practices are implemented with design flaws or without proper design and maintenance, and do not match conservation requirements. The quality of implementation and effects of bund structures on soil physical properties is not yet documented. Therefore, in this study, field investigations and laboratory analysis were carried out to evaluate the variation in bund structure design and its impact on soil-water retention, bulk density, porosity and soil depth. Results show that the dimensions and stability of bund structures, and consequently, the impacts of bunds varied widely. The widths and heights of bunds, and slope gradients were significantly correlated with infiltration rate and available soil-water content. Water holding capacity was 24% higher compared to that on untreated farms. Bunds with larger dimensions of top width (>85 cm) and height (>75 cm) showed 17 and 18% higher water holding capacity compared to fields with bunds having lower dimensions. In addition, results exhibited that the porosity and soil depth were significantly affected by the dimensions of bund structures and increased with increasing widths and heights of bunds. A 14.2% increase in porosity; a 41.2% increase in infiltration rate; and a 17.5% decrease in bulk density was found in soils of treated farms compared to those of untreated farm plots. Differences in particle size distribution and soil erodibility among widths of the bunds were low. It can be concluded that bund structure design varied substantially throughout the study area, which had impacted soil-water storage and soil physical properties. Bund structure design should be adapted to local biophysical settings at catchment level to enhance on- and offsite impacts.

Mature and immature pediatric head and neck teratomas: A 15-year review at a large tertiary center.

PubMed

Dharmarajan, Harish; Rouillard-Bazinet, Noémie; Chandy, Binoy M

2018-02-01

Pediatric head and neck teratomas account for less than 4% of congenital teratomas. The distinct presentations and outcomes of mature and immature head and neck teratomas have not been well established. To review the management and outcomes of pediatric head and neck teratomas. To distinguish differences between mature and immature tumors with respect to the age at presentation and surgery, tumor size and location, alpha fetoprotein (AFP) levels, airway management, and recurrence. A 15-year retrospective chart review of patients treated for head and neck teratomas at Texas Children's Hospital was performed. A total of 20 patients were included. Wilcoxon rank and Fisher's exact tests were used for statistical analysis. Immature teratomas were associated with both higher AFP levels (80800 ng/ml, p = 0.02) and maximum tumor dimensions (14.4 cm, p = 0.0034) than mature teratomas (24400 ng/ml and 6.44 cm). Patients with immature tumors were younger at the time of surgical resection (19.8 days, p = 0.025) compared to those with mature tumors (348 days). 89% of immature teratomas involved anterior neck localization compared to 27% for mature teratomas (p = 0.0098); 88% of the immature teratomas required an EXIT (Ex Utero Intrapartum Treatment) procedure compared with 40% of the mature teratomas (p = 0.0656). Recurrence was noted in only two cases: an immature teratoma 51 months after incomplete resection and a mature teratoma 33 months after complete resection. Long-term consequences of surgical resection included cleft palate (38.9%), dysphagia (33.3%), facial nerve paresis/paralysis (16.7%) and tracheotomy (16.7%). Immature teratomas had higher AFP levels, tumor dimensions, frequency of anterior neck localization, and requirement of EXIT than mature teratomas. Given that there was no significant difference between the recurrence rates of immature and mature teratomas, follow-up vigilance should be maintained equally regardless of tumor maturity. Copyright © 2017. Published by Elsevier B.V.

Managing Physical Education Lessons: An Interactional Approach

ERIC Educational Resources Information Center

Barker, Dean; Annerstedt, Claes

2016-01-01

Physical education (PE) lessons involve complex and dynamic interactive sequences between students, equipment and teacher. The potential for unexpected and/or unintended events is relatively large, a point reflected in an increasing amount of scholarship dealing with classroom management (CM). This scholarship further suggests that unexpected and…

Critical Essay: Building new management theories on sound data? The case of neuroscience

PubMed Central

Lindebaum, Dirk

2015-01-01

In this critical essay, I contend that accelerating demands for novel theories in management studies imply that new methodologies and data are sometimes accepted prematurely as supply of these novel theories. This point is illustrated with reference to how neuroscience can inform management research. I propose two demand forces that foster the increased focus on neuroscience in management studies, these being (i) the direction of public research funding, and (ii) publication bias as a boost for journal impact factor. Looking at the supply side, I note that (i) the statistical power of studies using functional magnetic resonance imaging (or fMRI, the ‘gold’ standard) is unacceptably low, (ii) the use of imprecise ‘motherhood’ statements, and (iii) the dismissal of ethical concerns in the formulation of management theories and practice informed by neuroscience. I then briefly outline the bad consequences of this for management theory and practice, emphasize why it is important to prevent these consequences, and offer some methodological suggestions for future research. PMID:27041766

Linking Indicators: Key Research Questions to Guide Decisions on What to Measure, Map and Model

EPA Science Inventory

Public policy increasingly demands insight into the social consequences of environmental policy and drivers of human behaviors that affect the environment. Social consequences can provide potent justifications for environmental protection and management, and human preferences and...

Leaving moss and litter layers undisturbed reduces the short-term environmental consequences of heathland managed burns.

PubMed

Grau-Andrés, Roger; Davies, G Matt; Waldron, Susan; Scott, E Marian; Gray, Alan

2017-12-15

Variation in the structure of ground fuels, i.e. the moss and litter (M/L) layer, may be an important control on fire severity in heather moorlands and thus influence vegetation regeneration and soil carbon dynamics. We completed experimental fires in a Calluna vulgaris-dominated heathland to study the role of the M/L layer in determining (i) fire-induced temperature pulses into the soil and (ii) post-fire soil thermal dynamics. Manually removing the M/L layer before burning increased fire-induced soil heating, both at the soil surface and 2 cm below. Burnt plots where the M/L layer was removed simulated the fuel structure after high severity fires where ground fuels are consumed but the soil does not ignite. Where the M/L layer was manually removed, either before or after the fire, post-fire soil thermal dynamics showed larger diurnal and seasonal variation, as well as similar patterns to those observed after wildfires, compared to burnt plots where the M/L layer was not manipulated. We used soil temperatures to explore potential changes in post-fire soil respiration. Simulated high fire severity (where the M/L layer was manually removed) increased estimates of soil respiration in warm months. With projected fire regimes shifting towards higher severity fires, our results can help land managers develop strategies to balance ecosystem services in Calluna-dominated habitats. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Sexual Difficulties after Pelvic Radiotherapy: Improving Clinical Management.

PubMed

White, I D

2015-11-01

Modern multimodality cancer treatment has led to more than 2 million people living with and beyond cancer in the UK, an impressive survival statistic on which clinicians and services continue to build. However, what is less readily acknowledged by health professionals and patients alike are the 500,000 people whose daily lives are adversely affected by the longer term consequences of cancer treatment. Macmillan Cancer Support estimate as many as 350,000 people in the UK experience sexual consequences of cancer and its treatment, an aspect of survivorship and rehabilitation that receives relatively scant attention in service provision, policy development and research terms. This overview addresses the sexual impact of radical pelvic radiotherapy for the more common (prostate, ano-rectal, cervical and endometrial) adult malignancies. Through discussion of the clinical assessment and management of desire, arousal, orgasmic and sexual pain difficulties that arise after pelvic radiotherapy, this overview offers an integrated biopsychosocial model of practice that incorporates the physical, psychological and relationship elements of these treatment sequelae. It is important that clinicians raise the profile of the sexual consequences of cancer treatment as a legitimate aspect of survivorship and service provision. Only in this way can the identification and management of treatment-induced sexual difficulties, frequently experienced by patients and their partners, be better understood and managed. Increased focus on the sexual consequences of treatment and cancer survivorship more broadly may, in time, lead to greater clinical recognition, service development and, most importantly, increased research devoted to the effective management of what remains a neglected aspect of cancer care. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Contingency Management Voucher Redemption as an Indicator of Delayed Gratification

PubMed Central

Fletcher, Jesse B.; Dierst-Davies, Rhodri; Reback, Cathy J.

2014-01-01

This prospective analysis tested whether frequency of voucher redemptions during a contingency management (CM) substance use intervention was significantly associated with participants’ ongoing substance use. Homeless, substance-dependent men who have sex with men (N=131) were randomized into either a “full” or “lite” voucher-based CM intervention. All participants earned vouchers for attendance and participation; participants in the CM-full condition also received vouchers for substance abstinence and enactment of prosocial and/or health-promoting behaviors. Multivariate longitudinal negative binomial regression analyses (n = 118) assessed the association between substance use during the intervention and frequency of voucher redemptions. Participants who used methamphetamine (IRR = 0.66; 95% CI=0.44–0.99) and/or opiates (IRR=0.60; 95% CI=0.40–0.99) during the intervention exhibited less time between voucher redemptions than individuals who achieved abstinence from these substances. Voucher redemption logs can be cost-effective and unobtrusive tools for measuring study participants’ tendency to delay gratification. PMID:24674235

Successful management of trachea stenosis with massive substernal goiter via thacheobronchial stent

PubMed Central

2013-01-01

A case of 65 year-old Chinese male patient with severe tracheal stenosis due to a massive substernal goiter, is presented. MRI and CT scan revealed that the massive substernal goiter was 9.3 × 6.1 × 4.7 cm in size, displacing the trachea and adjacent large vessels to the patient’s right contributing to severe intrathoracic trachea compression up to 6 cm in length and the narrowest caliber of the trachea only 3.0 mm in diameter. To the best of our knowledge, optimal airway management for the massive substernal goiter resection was considered to be temporary tracheobronchial stent placement pre-operation. PMID:24228633

Ground-layer plant community responses to even-age and uneven-age silvicultural treatments in Wisconsin northern hardwood forests

Treesearch

Cristel C. Kern; Brian J. Palik; Terry F. Strong

2006-01-01

We evaluated ground-layer plant diversity and community composition in northern hardwood forests among uncut controls and stands managed with even-age or uneven-age silvicultural systems. Even-age treatments included diameter-limit cuttings (20-cm diameter at 30-cm stem height) in 1952 and shelterwood removals in 1964. Uneven-age treatments included three intensities...

Phosphorous fractions in soils of rubber-based agroforestry systems: Influence of season, management and stand age.

PubMed

Liu, Chenggang; Jin, Yanqiang; Liu, Changan; Tang, Jianwei; Wang, Qingwei; Xu, Mingxi

2018-03-01

Rubber-based agroforestry system is a vital management practice and its productivity is often controlled by soil phosphorus (P) nutrient, but little information is available on P fractions dynamics in such system. The aim of this study was to examine the seasonal, management and stand age effects on P fractions, acid phosphatase activity, microbial biomass P, other physical-chemical properties and litter and roots in four systems: 10-year-old rubber mono- (YM) and intercropping (YI) with N-fixing species (NFS), 22-year-old mono- (MM) and intercropping (MI) in Xishuangbanna, Southwestern China. Most P fractions varied seasonally at different depths, with highest values in the fog-cool season (i.e. labile P at 5-60cm, non-labile P and total P at 30-60cm). By contrast, moderately labile P varied little over time, except in MI that had lower values in the rainy season. Compared with their monoculture counterparts, YI doubled resin-P i concentration but decreased NaHCO 3 -extractable P, HCl-P i and residual-P o at the 0-30cm depth, whereas MI had hardly any changes in P species at the 60-cm depth. Surprisingly, residual-P o was enriched down to the deepest soil (30-60cm) in both YI and MI in the fog-cool season. All P fractions, except NaOH 0.1 -P i , were greatly reduced with increasing stand age. In addition to plants uptake, these changes can be explained by seasonality in soil environments (e.g. moisture, temperature, pH and microbial activity) and decomposition of litter and roots. Moreover, YI decreased labile P o stock, but MI increased moderately labile P i at the 60-cm depth across seasons. The results imply that a large amount of residual-P o exists in acidic Oxisol from China and that they can be reasonably exploited to reduce the application of P fertilizers, highlighting the importance of P o pool. Taken together, intercropping mature rubber plantation with NFS appears to be an effective way to enhance productivity while maintaining adequate soil P concentration over the long run. Copyright © 2017 Elsevier B.V. All rights reserved.

Acta Oncologica Lecture. Gastrointestinal consequences of cancer treatment and the wider context: a bad gut feeling.

PubMed

Muls, Ann Cecile

2014-03-01

The percentage of people living with a diagnosis of cancer is rising globally. Between 20% and 25% of people treated for cancer experience a consequence of cancer which has an adverse impact on the quality of their life. Gastrointestinal (GI) symptoms are the most common of all consequences of cancer treatment and have the greatest impact on daily activity. PATHOPHYSIOLOGY OF LONG-TERM BOWEL DAMAGE AFTER PELVIC RADIOTHERAPY: Long-term damage to the bowel after radiotherapy is mediated by ischaemic changes and fibrosis. Each fraction of radiotherapy causes a series of repetitive injuries to the intestinal tissue resulting in an altered healing process, which affects the integrity of the repair and changes the architecture of the bowel wall. THE NATURE OF GI SYMPTOMS THAT DEVELOP: Patient-reported outcome measures show that diarrhoea, urgency, increased bowel frequency, tenesmus and flatulence are the five most prevalent GI symptoms with a moderate or severe impact on patients' daily lives after treatment with pelvic radiotherapy. Many patients also experience fatigue, urinary problems and have sexual concerns. SYSTEMATIC ASSESSMENT AND MANAGEMENT: The complex nature of those symptoms warrants systematic assessment and management. The use of a tested algorithm can assist in achieving this. The most common contributing factors to ongoing bowel problems after pelvic radiotherapy are small intestinal bacterial overgrowth, bile acid malabsorption, pancreatic insufficiency, rectal bleeding and its impact on bone health. Symptom burden, socio-psychosocial impact, memory and cognitive function, fatigue, urinary problems and sexual concerns need to be taken into account when thinking about consequences of cancer treatment. As our understanding of consequences of cancer treatments continues to emerge and encompass a wide variety of specialties, a holistic, multifaceted and multidisciplinary approach is required to manage those consequences long-term.

A Markov decision process for managing habitat for Florida scrub-jays

USGS Publications Warehouse

Johnson, Fred A.; Breininger, David R.; Duncan, Brean W.; Nichols, James D.; Runge, Michael C.; Williams, B. Ken

2011-01-01

Florida scrub-jays Aphelocoma coerulescens are listed as threatened under the Endangered Species Act due to loss and degradation of scrub habitat. This study concerned the development of an optimal strategy for the restoration and management of scrub habitat at Merritt Island National Wildlife Refuge, which contains one of the few remaining large populations of scrub-jays in Florida. There are documented differences in the reproductive and survival rates of scrubjays among discrete classes of scrub height (<120 cm or "short"; 120-170 cm or "optimal"; .170 cm or "tall"; and a combination of tall and optimal or "mixed"), and our objective was to calculate a state-dependent management strategy that would maximize the long-term growth rate of the resident scrub-jay population. We used aerial imagery with multistate Markov models to estimate annual transition probabilities among the four scrub-height classes under three possible management actions: scrub restoration (mechanical cutting followed by burning), a prescribed burn, or no intervention. A strategy prescribing the optimal management action for management units exhibiting different proportions of scrub-height classes was derived using dynamic programming. Scrub restoration was the optimal management action only in units dominated by mixed and tall scrub, and burning tended to be the optimal action for intermediate levels of short scrub. The optimal action was to do nothing when the amount of short scrub was greater than 30%, because short scrub mostly transitions to optimal height scrub (i.e., that state with the highest demographic success of scrub-jays) in the absence of intervention. Monte Carlo simulation of the optimal policy suggested that some form of management would be required every year. We note, however, that estimates of scrub-height transition probabilities were subject to several sources of uncertainty, and so we explored the management implications of alternative sets of transition probabilities. Generally, our analysis demonstrated the difficulty of managing for a species that requires midsuccessional habitat, and suggests that innovative management tools may be needed to help ensure the persistence of scrub-jays at Merritt Island National Wildlife Refuge. The development of a tailored monitoring program as a component of adaptive management could help reduce uncertainty about controlled and uncontrolled variation in transition probabilities of scrub-height and thus lead to improved decision making.

Impacts of Center of Mass Shifts on Messenger Spacecraft Operations

NASA Technical Reports Server (NTRS)

O'Shaughnessy, D. J.; Vaughan, R. M.; Chouinard, T. L., III; Jaekle, D. E.

2007-01-01

The MESSENGER (MErcury Surface, Space ENvironment, GEochemistry, and Ranging) has successfully completed its first three years of flight operations following launch on August 3, 2004. As part of NASA s Discovery Program, MESSENGER will observe Mercury during flybys in 2008 and 2009, as well as from orbit beginning in March 2011. This paper discusses the impact that center of mass (CM) location changes have had on many mission activities, particularly angular momentum management and maneuver execution. Momentum trends were altered significantly following the first deep-space maneuver, and these changes were related to a change in the CM. The CM location also impacts maneuver execution, and uncertainties in its location led to the significant direction errors experienced at trajectory correction maneuver 11. Because of the spacecraft sensitivity to CM location, efforts to estimate its position are important to momentum and maneuver prediction. This paper summarizes efforts to estimate the CM from flight data, as well as the operational strategy to handle CM uncertainties and their impact on momentum trends and maneuver execution accuracy.

Are Herniated Cerebellar Tonsils the Main Culprit of Chiari Malformation Type I Symptoms? The Brainstem Compression Hypothesis seems to be Re-Elucidated and Revised.

PubMed

Selcuki, Mehmet; Mete, Mesut; Selcuki, Deniz

2018-01-01

The Chiari Malformation I (CM I) and the tethered cord syndrome (TCS) are both congenital abnormalities whose mechanisms are still not fully understood. The association of CM I and TCS has been reported only a few times previously. This retrospective study included 7 patients who were diagnosed with CM I and TCS, managed by cutting of the filum terminale. The mean follow-up period was 21 months and 28 days. Although all patients underwent an untethering surgical procedure by cutting the filum terminale only, all patients reported significant early postsurgical resolution of CM I symptoms and symptoms related to TCS as well. Patients with symptomatic CM I, even if lumbar MRI is normal and the patient asymptomatic for TCS, may have tethered spinal cord at the same time. It seems it would be worthwhile to investigate CM I patients for occult TCS with spinal somatosensory evoked potentials.

Physicians’ Outlook on ICD-10-CM/PCS and Its Effect on Their Practice

PubMed Central

Watzlaf, Valerie; Alkarwi, Zahraa; Meyers, Sandy; Sheridan, Patty

2015-01-01

Background The United States is one of the last countries to change from ICD-9-CM to ICD-10-CM/PCS. The compliance date for implementation of ICD-10-CM/PCS is expected to fall on October 1, 2015. Objectives Evaluate physicians’ perceptions on the change from ICD-9-CM to ICD-10-CM/PCS and its effect on their practice, determine how HIM professionals can assist in this transition, and assess what resources are needed to aid in the transition. Results Twenty physicians were asked to participate in one of three focus groups. Twelve physicians (60 percent) agreed to participate. Top concerns included electronic health record software readiness, increase in documentation specificity and time, ability of healthcare professionals to learn a new language, and inadequacy of current training methods and content. Conclusion Physicians expressed that advantages of ICD-10-CM/PCS were effective data analytics and complexity of patient cases with more specific codes. Health information management professionals were touted as needed during the transition to create simple, clear specialty guides and crosswalks as well as education and training tools specific for physicians. PMID:26807074

Governing University Strategy: Perceptions and Practice of Governance and Management Roles

ERIC Educational Resources Information Center

Rytmeister, Catherine

2009-01-01

Intertwined trends of massification, internationalisation and marketisation constitute and drive change in higher education at all levels. Consequences at the institutional level include: increased competition, adoption of corporate management forms, accrual of power to executive management, and greater emphasis on strategy. As Government policy…

Rationalizing Management Information System Costs.

ERIC Educational Resources Information Center

Parden, Robert J.

This paper examines the proposition that management information systems (MIS) for colleges and universities are not achieving their original objectives of supporting better management decisions by providing more and better information in a more timely manner. As a consequence, the MIS activity should be reduced in scope, and standardized to…

Experienced dilemmas of everyday life in chronic neuropathic pain patients--results from a critical incident study.

PubMed

Hensing, Gunnel K E; Sverker, Annette M; Leijon, Göran S

2007-06-01

Neuropathic pain is a disabling chronic condition with limited therapeutic options. Few studies have addressed patient's experience and strategies. The aim of this study was to explore dilemmas experienced in order to improve care and rehabilitation. An interview study with 39 patients suffering from neuropathic pain of different origin was performed. We used the critical incident technique to collect data. Questions on occasions when patients had been hindered by or reminded of their neuropathic pain were included, and the self-perceived consequences and management of such occasions. The interviews were transcribed verbatim and analysed qualitatively. A broad range of experiences categorised into dilemmas, disturbances, consequences and managements from most parts of everyday life was identified. The dilemmas were 'housework', 'sitting', 'physical activity', 'personal hygiene', 'sleeping difficulties', 'hypersensitivity to external stimuli', 'social relationships', 'transportation' and 'leisure time'. Disturbances were 'failures', 'inabilities' and 'restrictions'. Consequences were 'increased pain', 'psychological reactions' and 'physical symptoms'. The majority of the patients used activity-oriented strategies to manage their pain such as alternative ways of performing the task, a cognitive approach or simply ignoring the pain. This is one of the first studies presenting detailed data on everyday dilemmas, disturbances and consequences of patients with chronic neuropathic pain. Such information is important in clinical settings to improve care and rehabilitation.

Space Geodesy Project Information and Configuration Management Procedure

NASA Technical Reports Server (NTRS)

Merkowitz, Stephen M.

2016-01-01

This plan defines the Space Geodesy Project (SGP) policies, procedures, and requirements for Information and Configuration Management (CM). This procedure describes a process that is intended to ensure that all proposed and approved technical and programmatic baselines and changes to the SGP hardware, software, support systems, and equipment are documented.

Coordinated Traffic Incident and Congestion Management (TIM-CM) : Mitigating Regional Impacts of Major Traffic Incidents in the Seattle I-5 Corridor

DOT National Transportation Integrated Search

2018-02-02

Within the Seattle metropolitan area, traffic incident management (TIM) operations provide a multi-jurisdictional and coordinated strategy to detect, respond to, and clear traffic incidents so that traffic flow can be restored quickly and safely. The...

The effect of substrate properties, size, position, sheltering and shading on dew: An experimental approach in the Negev Desert

NASA Astrophysics Data System (ADS)

Kidron, Giora J.

2010-11-01

Affected by the interrelationships between the air mass and the substrate properties, dew measurements entail numerous difficulties. Inattentiveness to the complexities involved may result in inconsistent and consequently unreliable data and thus in misleading conclusions. This is especially important in dew deserts such as the Negev where dew may be regarded as an important water source. In an attempt to highlight some of the factors that may affect dew condensation, an experimental approach was adapted during which dew condensation at different surfaces (smooth and ragged Plexiglas, bright limestone and dark flint cobbles), at various size substrata with identical axes (of 2.5, 5, 10, 20, 30 and 40 cm) or different size axes (of 10 × 20, 10 × 30 and 10 × 40 cm), and substrata at different heights and settings was measured. Some of the settings explored were also sheltered by a shrub, a cave, an 80-cm-tall cliff and neighboring cobbles. No significant differences were found in the dew amounts condensing on the limestone and the flint cobbles. Smooth Plexiglas surfaces yielded significantly higher amounts than a ragged Plexiglas surface. As for the substratum height and size, the dew amounts increased with height (from 0.7 to 10.0 cm) and size (from 2.5 × 2.5 cm to 40 × 40 cm). However, an increase in the long axis (a-axis) to 20, 30 and 40 cm while leaving the b-axis constant (at 10 cm) resulted in only a slight increase in the dew amounts in comparison to a 10 × 10 cm substratum. While confined to non-sheltered habitats, dew at partially sheltered habitats (such as the margin of a shrub or a cave, the vicinity of a cliff and on 7-cm-high cobble surrounded by 15-cm-high cobbles) was significantly lower than at the exposed habitats. The differences in dew amounts coincided with minute differences in the surface temperatures, explained as resulting from differences in the outgoing nocturnal longwave radiational cooling. The findings may shed light on the dew regime of lithobionts at different microhabitats and upon inconsistent values reported in the literature.

Referring Physicians' Tendency to Collaborate With Radiologists in Managing Contrast Media-Related Risk Factors.

PubMed

İmamoğlu, Hakan; Doğan, Serap; Erdoğan, Nuri

2018-02-01

The aim of this study was to investigate the tendency of referring physicians to collaborate with radiologists in managing contrast media (CM)-related risk factors. The study was conducted at a single academic hospital. Among 150 referring physicians from various specialties, 51 referring physicians (34%) responded to the invitation letter asking for an interview with a radiologist. During the interview, a modified form of the Control Preferences Scale was administered, in which there were five preferences (each displayed on a separate card) that ranged from the fully active to fully passive involvement of referring physicians in managing CM-related risk factors. A descriptive analysis was performed through categorization of the results depending on the respondents' two most preferred roles. Thirty-six referring physicians (70.5%) preferred a collaborative role, and 15 (29.4%) preferred a noncollaborative role (i.e., remained on either the fully active or fully passive side). Among the referring physicians who preferred a collaborative role, the most common response (n = 15 [29.4%]) was collaborative-active. Referring physicians at the authors' institution have basic cognitive and motivational-affective tone toward collaboration in future teamwork aimed at the management of CM-related risk factors. A modified form of the Control Preferences Scale, as in this study, can be used to investigate the tendency of referring physicians to collaborate with radiologists. The results are discussed from ethical and legal perspectives. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Laparoscopic Management of Large Ovarian Cysts at a Rural Hospital

PubMed Central

Shindholimath, Vishwanath V; Jyoti, S G; Patil, K V; Ammanagi, A S

2009-01-01

Objective: To assess the feasibility and outcome of laparoscopic surgery for the management of large ovarian cysts at a rural hospital. Materials and Methods: Fifteen patients from March 2004 to February 2007, with large ovarian cysts, with diameter >10 cm, were managed laparoscopically. The masses were cystic and were not associated with ascites or enlarged lymph nodes on ultrasound. Serum CA-125 levels were within the normal range (35 U/ml). Preoperative evaluation included history, clinical examination, sonographic images and serum markers. The management of these ovarian cysts included aspiration, cystectomy or salphingo-oophorectomy, depending on the patient’s age, obstetric history and desire of future fertility. In large, solid, fixed or irregular adnexal masses, suspicious of malignancy, laparotomy was done. Results: Five patients presented with pain in the abdomen and 10 patients with abdominal distension and discomfort. The average maximum diameter of the ovarian cysts was 16.75 cm (range 10–24 cm). The mean duration of the operation was 80 min. The postoperative hospital stay was from 4 to 6 days. No intraoperative complications occurred and the hospital course of all patients was uncomplicated. In one case, laparoscopy was converted to laparotomy. One patient had minor wound infection at umbilical port site. The patients did not report any complaints during follow up and the clinical examination findings were normal in all, up to 9 months after discharge. Conclusion: With proper patient selection, the size of an ovarian cyst is not necessarily a contraindication for laparoscopic surgery. PMID:22442520

Controversies in the diagnosis and treatment of early cutaneous melanoma

PubMed Central

Orzan, OA; Șandru, A; Jecan, CR

2015-01-01

Cutaneous melanoma (CM) is a disease with an unpredictable evolution mainly due to its high metastatic ability. The steadily increasing incidence and the poor outcome in advanced stages made this cancer an interesting field for many research groups. Given that CM is a curable disease in early stages, efforts have been made to detect it as soon as possible, which led to the diversification and refining of diagnosis methods and therapies. But, as the data from trials have been published, doubts about the indications and efficacy of established treatments have arisen. In fact, there is probably no single aspect of early CM that has not given birth to controversy. This article intends to present the current disputes regarding the early detection, diagnosis, treatment and postoperative follow-up of patients with localized CM. After analyzing both pros and cons, several conclusions were drawn, that reflect our experience in managing patients with early CM. PMID:25866567

Phobias, other psychiatric comorbidities and chronic migraine.

PubMed

Corchs, Felipe; Mercante, Juliane P P; Guendler, Vera Z; Vieira, Domingos S; Masruha, Marcelo R; Moreira, Frederico R; Bernik, Marcio; Zukerman, Eliova; Peres, Mario F P

2006-12-01

Comorbidity of chronic migraine (CM) with psychiatric disorders, mostly anxiety and mood disorders, is a well-recognized phenomenon. Phobias are one of the most common anxiety disorders in the general population. Phobias are more common in migraineurs than non-migraineurs. The clinical profile of phobias in CM has never been studied. We investigated the psychiatric profile in 56 patients with CM using the SCID I/P interview. Lifetime criteria for at least one mental disorder was found in 87.5% of the sample; 75% met criteria for at least one lifetime anxiety disorder and 60.7% of our sample fulfilled DSM-IV criteria for lifetime phobic avoidant disorders. Mood and anxiety scores were higher in phobic patients than in non-phobic CM controls. Number of phobias correlated with higher levels of anxiety and depression. Phobias are common in CM. Its recognition may influence its management. Early treatment may lead to better prognosis.

Adolescent and parent diabetes distress in type 1 diabetes: the role of self-efficacy, perceived consequences, family responsibility and adolescent-parent discrepancies.

PubMed

Law, G Urquhart; Walsh, Jennifer; Queralt, Victoria; Nouwen, Arie

2013-04-01

To examine the association of adolescent and parent diabetes distress with perceived consequences, dietary self-efficacy, and discrepancies in diabetes family responsibility, in type 1 diabetes (T1D). 203 adolescents with T1D, aged 12-18, and their parents completed self-report questionnaires cross-sectionally. Higher HbA1c, greater perceived negative consequences of diabetes, and reduced self-efficacy predicted adolescent diabetes distress. Higher HbA1c predicted parental diabetes distress, as did diabetes family responsibility disagreements when both family members claimed responsibility, and parents' perception of reduced adolescent self-efficacy. Dietary self-efficacy and perceived negative consequences of diabetes are important factors to consider in assessing and managing adolescent diabetes distress. Perceptions of family responsibility for self-care tasks and parental confidence in adolescents' self-management have implications for parental diabetes distress. Clinical implications support long-held recommendations of taking a family-perspective of T1D care. Copyright © 2012 Elsevier Inc. All rights reserved.

Five potential consequences of climate change for invasive species.

PubMed

Hellmann, Jessica J; Byers, James E; Bierwagen, Britta G; Dukes, Jeffrey S

2008-06-01

Scientific and societal unknowns make it difficult to predict how global environmental changes such as climate change and biological invasions will affect ecological systems. In the long term, these changes may have interacting effects and compound the uncertainty associated with each individual driver. Nonetheless, invasive species are likely to respond in ways that should be qualitatively predictable, and some of these responses will be distinct from those of native counterparts. We used the stages of invasion known as the "invasion pathway" to identify 5 nonexclusive consequences of climate change for invasive species: (1) altered transport and introduction mechanisms, (2) establishment of new invasive species, (3) altered impact of existing invasive species, (4) altered distribution of existing invasive species, and (5) altered effectiveness of control strategies. We then used these consequences to identify testable hypotheses about the responses of invasive species to climate change and provide suggestions for invasive-species management plans. The 5 consequences also emphasize the need for enhanced environmental monitoring and expanded coordination among entities involved in invasive-species management.

Management Impacts on Carbon Dynamics in a Sierra Nevada Mixed Conifer Forest

PubMed Central

Dore, Sabina; Fry, Danny L.; Collins, Brandon M.; Vargas, Rodrigo; York, Robert A.; Stephens, Scott L.

2016-01-01

Forest ecosystems can act as sinks of carbon and thus mitigate anthropogenic carbon emissions. When forests are actively managed, treatments can alter forests carbon dynamics, reducing their sink strength and switching them from sinks to sources of carbon. These effects are generally characterized by fast temporal dynamics. Hence this study monitored for over a decade the impacts of management practices commonly used to reduce fire hazards on the carbon dynamics of mixed-conifer forests in the Sierra Nevada, California, USA. Soil CO2 efflux, carbon pools (i.e. soil carbon, litter, fine roots, tree biomass), and radial tree growth were compared among un-manipulated controls, prescribed fire, thinning, thinning followed by fire, and two clear-cut harvested sites. Soil CO2 efflux was reduced by both fire and harvesting (ca. 15%). Soil carbon content (upper 15 cm) was not significantly changed by harvest or fire treatments. Fine root biomass was reduced by clear-cut harvest (60–70%) but not by fire, and the litter layer was reduced 80% by clear-cut harvest and 40% by fire. Thinning effects on tree growth and biomass were concentrated in the first year after treatments, whereas fire effects persisted over the seven-year post-treatment period. Over this period, tree radial growth was increased (25%) by thinning and reduced (12%) by fire. After seven years, tree biomass returned to pre-treatment levels in both fire and thinning treatments; however, biomass and productivity decreased 30%-40% compared to controls when thinning was combined with fire. The clear-cut treatment had the strongest impact, reducing ecosystem carbon stocks and delaying the capacity for carbon uptake. We conclude that post-treatment carbon dynamics and ecosystem recovery time varied with intensity and type of treatments. Consequently, management practices can be selected to minimize ecosystem carbon losses while increasing future carbon uptake, resilience to high severity fire, and climate related stresses. PMID:26918460

CAD/CAM and scientific data management at Dassault

NASA Technical Reports Server (NTRS)

Bohn, P.

1984-01-01

The history of CAD/CAM and scientific data management at Dassault are presented. Emphasis is put on the targets of the now commercially available software CATIA. The links with scientific computations such as aerodynamics and structural analysis are presented. Comments are made on the principles followed within the company. The consequences of the approximative nature of scientific data are examined. Consequence of the new history function is mainly its protection against copy or alteration. Future plans at Dassault for scientific data appear to be in opposite directions compared to some general tendencies.

A fuzzy model for assessing risk of occupational safety in the processing industry.

PubMed

Tadic, Danijela; Djapan, Marko; Misita, Mirjana; Stefanovic, Miladin; Milanovic, Dragan D

2012-01-01

Managing occupational safety in any kind of industry, especially in processing, is very important and complex. This paper develops a new method for occupational risk assessment in the presence of uncertainties. Uncertain values of hazardous factors and consequence frequencies are described with linguistic expressions defined by a safety management team. They are modeled with fuzzy sets. Consequence severities depend on current hazardous factors, and their values are calculated with the proposed procedure. The proposed model is tested with real-life data from fruit processing firms in Central Serbia.

The anal canal as a risk organ in cervical cancer patients with hemorrhoids undergoing whole pelvic radiotherapy.

PubMed

Jang, Hyunsoo; Baek, Jong Geun; Jo, Sunmi

2015-01-01

Tolerance of the anal canal tends to be ignored in patients with cervical cancer undergoing whole pelvic radiotherapy. However, patients with hemorrhoids may be troubled with low radiation dose. We tried to analyze the dose-volume statistics of the anal canal in patients undergoing whole pelvic radiotherapy. The records of 31 patients with cervical cancer who received definite or postoperative radiotherapy at one institution were reviewed. Acute anal symptoms, such as anal pain and bleeding, were evaluated from radiotherapy start to 1 month after radiotherapy completion. Various clinical and dosimetric factors were analyzed to characterize relations with acute anal complications. The anal verge was located an average of 1.2 cm (range -0.6~3.9) below the lower border of the ischial tuberosity and an average of 2.7 cm (range -0.6~5.7) behind the sacral promontory level. The presence of hemorrhoids before radiotherapy was found to be significantly associated with acute radiation-induced anal symptoms (p = 0.001), and the mean induction dose for anal symptoms was 36.9 Gy. No patient without hemorrhoids developed an anal symptom during radiotherapy. Dosimetric analyses of V30 and V40 showed marginal correlations with anal symptoms (p = 0.07). The present study suggests a relation between acute anal symptoms following radiotherapy and acute hemorrhoid aggravation. Furthermore, the location of the anal verge was found to be variable, and consequently doses administered to the anal canal also varied substantially. Our results caution careful radiation treatment planning for whole pelvic radiotherapy, and that proper clinical management be afforded patients with hemorrhoids during radiotherapy.

Wrist Circumference and Frame Size Percentiles in 6-17-Year-Old Turkish Children and Adolescents in Kayseri.

PubMed

Öztürk, Ahmet; Çiçek, Betül; Mazıcıoğlu, M Mümtaz; Zararsız, Gökmen; Kurtoğlu, Selim

2017-12-15

The aim of the current study was to provide wrist circumference (WrC) and body frame size (height/WrC) percentile values in Turkish children and adolescents aged 6-17 years. In this cross-sectional study, the data of "Determination of Anthropometric Measures of Turkish Children and Adolescents" (DAMTCA II) study in Kayseri/Turkey were used. A total of 4330 observations were recorded (1931 boys, 2399 girls). The WrC and frame size reference values were produced with generalized additive models for location, scale and shape. The WrC percentiles (3rd-97th) were calculated. The frame size (height/WrC) was estimated as small, medium, and large (<15 th , 15-85 th , and ≥85 th percentiles, respectively). For both genders, WrC linearly increased with age (13.0-16.8 cm for boys and 12.5-15.5 cm for girls). In boys and girls, the mean ± standard deviation of WrC is 13.00±0.89 cm and 12.48±0.93 cm (6 years) and increases to 16.83±1.16 and 15.58±0.86 cm (17 years), respectively. The WrC values in all age groups were higher in boys compared with girls. The increment in frame size from 6 to 17 years were 1.25 cm in boys and 0.85 cm in girls. WrC is a simple, easy-to-detect anthropometric index which is not subject to measurement errors. Additionally, WrC can be used both to decide about frame size and to determine metabolic risks related to obesity. We consider that this easy-to-get anthropometric index can be used both in screening procedures and clinical assessment procedure for obesity-related metabolic consequences.

Current conduction mechanism and electrical break-down in InN grown on GaN

NASA Astrophysics Data System (ADS)

Kuzmik, J.; Fleury, C.; Adikimenakis, A.; Gregušová, D.; Ťapajna, M.; Dobročka, E.; Haščík, Š.; Kučera, M.; Kúdela, R.; Androulidaki, M.; Pogany, D.; Georgakilas, A.

2017-06-01

Current conduction mechanism, including electron mobility, electron drift velocity (vd) and electrical break-down have been investigated in a 0.5 μm-thick (0001) InN layer grown by molecular-beam epitaxy on a GaN/sapphire template. Electron mobility (μ) of 1040 cm2/Vs and a free electron concentration (n) of 2.1 × 1018 cm-3 were measured at room temperature with only a limited change down to 20 K, suggesting scattering on dislocations and ionized impurities. Photoluminescence spectra and high-resolution X-ray diffraction correlated with the Hall experiment showing an emission peak at 0.69 eV, a full-width half-maximum of 30 meV, and a dislocation density Ndis ˜ 5.6 × 1010 cm-2. Current-voltage (I-V) characterization was done in a pulsed (10 ns-width) mode on InN resistors prepared by plasma processing and Ohmic contacts evaporation. Resistors with a different channel length ranging from 4 to 15.8 μm obeyed the Ohm law up to an electric field intensity Eknee ˜ 22 kV/cm, when vd ≥ 2.5 × 105 m/s. For higher E, I-V curves were nonlinear and evolved with time. Light emission with a photon energy > 0.7 eV has been observed already at modest Erad of ˜ 8.3 kV/cm and consequently, a trap-assisted interband tunneling was suggested to play a role. At Eknee ˜ 22 kV/cm, we assumed electron emission from traps, with a positive feed-back for the current enhancement. Catastrophic break-down appeared at E ˜ 25 kV/cm. Reduction of Ndis was suggested to fully exploit InN unique prospects for future high-frequency devices.

Baked milk- and egg-containing diet in the management of milk and egg allergy.

PubMed

Leonard, Stephanie A; Caubet, Jean-Christoph; Kim, Jennifer S; Groetch, Marion; Nowak-Węgrzyn, Anna

2015-01-01

Cow's milk (CM) and hen's egg allergies are among the most common food allergies in children. With evidence of increasing food allergy prevalence and more persistent disease, it has become vital to improve the management of CM and egg allergies. The ability to tolerate baked milk or egg, such as in a cake or muffin, has been associated with an increased chance of tolerance development. Studies report that about 70% of CM- and egg-allergic children can tolerate baked milk or egg and that incorporating baked milk or egg into the diet is well tolerated. Being able to add baked milk or egg into the diet can also increase quality of life by expanding the diet, boosting nutrition, and promoting inclusion in social activities. There is some debate over how baked milk and egg should be introduced, at home or in a supervised setting. Anaphylaxis and treatment with epinephrine during baked milk or egg challenges have been reported. Study of potential biomarkers to predict tolerability of baked milk and egg, such as serum specific IgE levels and skin prick test wheal diameters, is ongoing. Many parents can reliably report that their CM- or egg-allergic child is already consuming baked goods without symptoms. However, for those who cannot report such tolerance, the most prudent approach is to perform a supervised oral food challenge to determine the tolerability of baked milk and egg. The purpose of this article was to review the pathophysiology, clinical data, and safety of baked milk and egg and provide a practical guide to managing CM allergy and/or egg allergy. Recipes for baked milk and egg challenges and guidance on how to add baked milk and egg if tolerated to the child's regular diet are provided. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

General anesthesia

MedlinePlus

... Miller's Anesthesia . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 3. Hernandez A, Sherwood ER. Anesthesiology principles, pain management, and conscious sedation. In: Townsend CM Jr, Beauchamp ...

Efficacy of cocaine contingency management in heroin-assisted treatment: Results of a randomized controlled trial.

PubMed

Blanken, Peter; Hendriks, Vincent M; Huijsman, Ineke A; van Ree, Jan M; van den Brink, Wim

2016-07-01

To determine the efficacy of contingency management (CM), targeting cocaine use, as an add-on intervention for heroin dependent patients in supervised heroin-assisted treatment (HAT) with frequent cocaine use. Multi-center, open-label, parallel group, randomized controlled trial. Twelve specialized addiction treatment centers for HAT in The Netherlands; April 2006-January 2011. 214 chronic, treatment-refractory heroin dependent patients in HAT, with frequent cocaine use. Routine, daily supervised diacetylmorphine treatment, co-prescribed with oral methadone (HAT), with and without 6 months contingency management for cocaine use as an add-on intervention; HAT+CM and HAT-only, respectively. Primary outcome was the longest, uninterrupted duration of cocaine abstinence, based upon laboratory urinalysis. Secondary outcome measures included other cocaine-related measures, treatment retention in HAT, and multi-domain health-related treatment response. In an intention-to-treat analysis, HAT+CM was more effective than HAT-only in promoting longer, uninterrupted duration of cocaine abstinence (3.7 weeks versus 1.6 weeks; negative binomial regression: Exp(B)=2.34, 95%-CI: 1.70-3.23; p<0.001). This result remained significant in sensitivity analyses and was supported by all secondary, cocaine-related outcome measures. Treatment retention in HAT was high (91.6%) with no difference between the groups. The improvement in multi-domain health-related treatment response during the trial was numerically higher in HAT+CM (from 37.4% to 53.1%; +15.7%) than in HAT-only (from 44.5% to 46.5%; +2.0%), but this difference was statistically not significant. Contingency management is an effective add-on intervention to promote longer, uninterrupted periods of cocaine abstinence in chronic, treatment-refractory heroin dependent patients in heroin-assisted treatment with frequent cocaine use. The trial has been registered in The Netherlands National Trial Register under clinical trial registration number NTR4728. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

European Paediatric Surgeons' Association Survey on the Management of Hirschsprung Disease.

PubMed

Zani, Augusto; Eaton, Simon; Morini, Francesco; Puri, Prem; Rintala, Risto; Heurn, Ernest van; Lukac, Marija; Bagolan, Pietro; Kuebler, Joachim F; Friedmacher, Florian; Wijnen, Rene; Tovar, Juan A; Hoellwarth, Michael E; Pierro, Agostino

2017-02-01

Aim  This study aims to define patterns of Hirschsprung disease (HD) management. Methods  An online questionnaire was sent to all European Paediatric Surgeons' Association (EUPSA) members. Results  A total of 294 members (61 countries) answered (response rate: 61%). All respondents perform rectal biopsies (61% rectal suction [RSBs], 39% open full-thickness), 96% contrast enema, and 31% anorectal manometry. At RSB, 17% take the most distal biopsy 1 cm above the dentate line, 34% take 2 cm, 30% take 3 cm, and 19% take > 3 cm. Rectal biopsy staining's are hematoxylin/eosin (77%), acetylcholinesterase (74%), calretinin (31%), S100 (2%), nicotinamide adenine dinucleotide-tetrazolium reductase (2%), succinate dehydrogenase (1%), and neuron-specific enolase (1%). A total of 85% respondents recognize entities including hypoganglionosis (69%), intestinal neuronal dysplasia (55%), and ultrashort segment HD (50%). Pull-through (PT) is performed at diagnosis by 33% or delayed by 67% (4 months or > 5 kg). Awaiting definitive surgery, 77% perform rectal irrigations, 22% rectal dilatation/stimulations, and 33% perform a stoma. The preferred type of PT is the Soave approach (65%), performed with transanal technique by 70% respondents. If symptoms persist after PT, most opt for conservative approach (enemas/laxatives = 76%; botulinum toxin = 27%), 30% would redo the PT. Total colonic aganglionosis: PT is performed in neonates (4%), at 1 to 6 months (29%), 6 to 12 months (37%) or older (30%). If required, a stoma is sited in the ileum (31%), according to intraoperative biopsies (54%), macroscopic impression (13%), and radiology (2%). Duhamel PT is performed by 52%, Soave by 31%, and Swenson by 17%. Overall, 31% would perform a J-pouch. Conclusions  Most aspects of HD management lack consensus with wide variations in obtaining a diagnosis. Transanal Soave PT is the most common technique in standard segment HD. Guidelines should be developed to avoid such variability in management and to facilitate research studies. Georg Thieme Verlag KG Stuttgart · New York.

Testing an Irrigation Decision Support Tool for California Specialty Crops

NASA Astrophysics Data System (ADS)

Johnson, L.; Cahn, M.; Benzen, S.; Zaragoza, I.; Murphy, L.; Melton, F. S.; Martin, F.; Quackenbush, A.; Lockhart, T.

2015-12-01

Estimation of crop evapotranspiration supports efficiency of irrigation water management, which in turn can mitigate nitrate leaching, groundwater depletion, and provide energy savings. Past research in California and elsewhere has revealed strong relationships between photosynthetically active vegetation fraction (Fc) and crop evapotranspiration (ETc). Additional research has shown the potential of monitoring Fc by satellite remote sensing. The U.C. Cooperative Extension developed and operates CropManage (CM) as on-line database irrigation (and nitrogen) scheduling tool. CM accounts for the rapid growth and typically brief cycle of cool-season vegetables, where Fc and fraction of reference ET can change daily during canopy development. The model automates crop water requirement calculations based on reference ET data collected by California Dept. Water Resources. Empirically-derived equations are used to estimate daily Fc time-series for a given crop type primarily as a function of planting date and expected harvest date. An application programming interface (API) is under development to provide a check on modeled Fc of current crops and facilitate CM expansion to new crops. The API will enable CM to extract field scale Fc observations from NASA's Satellite Irrigation Management Support (SIMS). SIMS is mainly Landsat based and currently monitors Fc over about 8 million irrigation acres statewide, with potential for adding data from ESA/Sentinel for improved temporal resolution. In the current study, a replicated irrigation trial was performed on romaine lettuce at the USDA Agricultural Research Station in Salinas, CA. CropManage recommendations were used to guide water treatments by drip irrigation at 50%, 75%, 100% ETc replacement levels, with an added treatment at 150% ET representing grower standard practice. Experimental results indicate that yields from the 100% and 150% treatments were not significantly different and were in-line with industry average, while yields from the 75% and 50% treatments were significantly lower. Additional results will be presented with respect to a subsequent cabbage trial harvested October 2015.

Updated evidence-based clinical practice guidelines for the diagnosis and management of melanoma: definitive excision margins for primary cutaneous melanoma.

PubMed

Sladden, Michael J; Nieweg, Omgo E; Howle, Julie; Coventry, Brendon J; Thompson, John F

2018-02-19

Definitive management of primary cutaneous melanoma consists of surgical excision of the melanoma with the aim of curing the patient. The melanoma is widely excised together with a safety margin of surrounding skin and subcutaneous tissue, after the diagnosis and Breslow thickness have been established by histological assessment of the initial excision biopsy specimen. Sentinel lymph node biopsy should be discussed for melanomas ≥ 1 mm thickness (≥ 0.8 mm if other high risk features) in which case lymphoscintigraphy must be performed before wider excision of the primary melanoma site. The 2008 evidence-based clinical practice guidelines for the management of melanoma (http://www.cancer.org.au/content/pdf/HealthProfessionals/ClinicalGuidelines/ClinicalPracticeGuidelines-ManagementofMelanoma.pdf) are currently being revised and updated in a staged process by a multidisciplinary working party established by Cancer Council Australia. The guidelines for definitive excision margins for primary melanomas have been revised as part of this process. Main recommendations: The recommendations for definitive wide local excision of primary cutaneous melanoma are: melanoma in situ: 5-10 mm margins invasive melanoma (pT1) ≤ 1.0 mm thick: 1 cm margins invasive melanoma (pT2) 1.01-2.00 mm thick: 1-2 cm margins invasive melanoma (pT3) 2.01-4.00 mm thick: 1-2 cm margins invasive melanoma (pT4) > 4.0 mm thick: 2 cm margins Changes in management as a result of the guideline: Based on currently available evidence, excision margins for invasive melanoma have been left unchanged compared with the 2008 guidelines. However, melanoma in situ should be excised with 5-10 mm margins, with the aim of achieving complete histological clearance. Minimum clearances from all margins should be assessed and stated. Consideration should be given to further excision if necessary; positive or close histological margins are unacceptable.

Beyond wilderness: Broadening the applicability of limits of acceptable change

Treesearch

Mark W. Brunson

1977-01-01

The Limits of Acceptable Change (LAC) process helps managers preserve wilderness attributes along with recreation opportunities. Ecosystem management likewise requires managers to balance societal and ecosystem needs. Both are more likely to succeed through collaborative planning. Consequently, LAC can offer a conceptual framework for achieving sustainable solutions...

77 FR 30320 - General Management Plan/Environmental Impact Statement, Ross Lake National Recreation Area, North...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-22

... Management Plan/Environmental Impact Statement, Ross Lake National Recreation Area, North Cascades National... Impact Statement for the new General Management Plan (GMP) for Ross Lake National Recreation Area, part... Wilderness Act of 1988. The full range of foreseeable environmental consequences from implementing the...

Congruent Knowledge Management Behaviors as Discriminate Sources of Competitive Advantage

ERIC Educational Resources Information Center

Magnier-Watanabe, Remy; Senoo, Dai

2009-01-01

Purpose: While knowledge management has been shown to be a strategic source of competitive advantage, processes designed to enhance the productivity of knowledge do not, however, equally contribute to the organization's capabilities. Consequently, this research aims to focus on the relationship between each mode of the knowledge management process…

Broad-scale consequences of land management: Columbia basin example.

Treesearch

Richard W. Haynes; Thomas M. Quigley

2001-01-01

Integrating management actions to consistently achieve broad ecological and socioeconomic goals is a challenge largely unmet. The presumed or real conflict between these goals establishes a forum for debate. Broad measures are needed to describe tradeoffs, trends in conditions under varying management scenarios, and a transparent science underpinning. The Interior...

Visual Inspection of Water Leakage from Ground Penetrating Radar Radargram

NASA Astrophysics Data System (ADS)

Halimshah, N. N.; Yusup, A.; Mat Amin, Z.; Ghazalli, M. D.

2015-10-01

Water loss in town and suburban is currently a significant issue which reflect the performance of water supply management in Malaysia. Consequently, water supply distribution system has to be maintained in order to prevent shortage of water supply in an area. Various techniques for detecting a mains water leaks are available but mostly are time-consuming, disruptive and expensive. In this paper, the potential of Ground Penetrating Radar (GPR) as a non-destructive method to correctly and efficiently detect mains water leaks has been examined. Several experiments were designed and conducted to prove that GPR can be used as tool for water leakage detection. These include instrument validation test and soil compaction test to clarify the maximum dry density (MDD) of soil and simulation studies on water leakage at a test bed consisting of PVC pipe burying in sand to a depth of 40 cm. Data from GPR detection are processed using the Reflex 2D software. Identification of water leakage was visually inspected from the anomalies in the radargram based on GPR reflection coefficients. The results have ascertained the capability and effectiveness of the GPR in detecting water leakage which could help avoiding difficulties with other leak detection methods.

Deterioration of soil quality and pasture production linked to overgrazing in rangelands of Extremadura (SW Spain)

NASA Astrophysics Data System (ADS)

Pulido-Fernández, Manuel; Schnabel, Susanne; Francisco Lavado Contador, Joaquín; Lozano-Parra, Javier; González López, Francisco

2015-04-01

Soil degradation phenomena include water erosion and physical and biological processes have been already reported in rangelands of southwestern Spain. The increasing of the number of domestic animals since 1986 has been highlighted as one of the key causes. The main goal of this work is to analyze the effects of the excessive number of animals on soil quality and pasture production in privately-owned farms dedicated to extensive ranching. Soil properties, soil surface cover, erosion features, pasture production and composition, rainfall and land management variables such as livestock density were analyzed during a period of 3 years (2008-2011). The study was carried out in 22 fenced units belonging to 10 farms distributed throughout the Spanish region of Extremadura. The occurrence of bare soil patches, and consequently water erosion processes, as well as an increasing in the mean values of bulk density from 5 to 10 cm in depth were observed in the fenced units with animal stocking rates exceeding 1 AU ha-1 (AU: animal cattle equivalent unit). Some indications which may serve to confirm the negative effect of increased bulk density on pasture production and quality were also found.

Rationale, design and pilot feasibility results of a smartphone-assisted, mindfulness-based intervention for smokers with mood disorders: Project mSMART MIND.

PubMed

Minami, Haruka; Brinkman, Hannah R; Nahvi, Shadi; Arnsten, Julia H; Rivera-Mindt, Monica; Wetter, David W; Bloom, Erika Litvin; Price, Lawrence H; Vieira, Carlos; Donnelly, Remington; McClain, Lauren M; Kennedy, Katherine A; D'Aquila, Erica; Fine, Micki; McCarthy, Danielle E; Graham Thomas, J; Hecht, Jacki; Brown, Richard A

2018-03-01

Although individuals with psychiatric disorders are disproportionately affected by cigarette smoking, few outpatient mental health treatment facilities offer smoking cessation services. In this paper, we describe the development of a smartphone-assisted mindfulness smoking cessation intervention with contingency management (SMI-CM), as well as the design and methods of an ongoing pilot randomized controlled trial (RCT) targeting smokers receiving outpatient psychiatric treatment. We also report the results of an open-label pilot feasibility study. In phase 1, we developed and pilot-tested SMI-CM, which includes a smartphone intervention app that prompts participants to practice mindfulness, complete ecological momentary assessment (EMA) reports 5 times per day, and submit carbon monoxide (CO) videos twice per day. Participants earned incentives if submitted videos showed CO≤6ppm. In phase 2, smokers receiving outpatient treatment for mood disorders are randomized to receive SMI-CM or enhanced standard treatment plus non-contingent CM (EST). The results from the pilot feasibility study (N=8) showed that participants practiced mindfulness an average of 3.4times/day (≥3min), completed 72.3% of prompted EMA reports, and submitted 68.0% of requested CO videos. Participants reported that the program was helpful overall (M=4.85/5) and that daily mindfulness practice was helpful for both managing mood and quitting smoking (Ms=4.50/5). The results from the feasibility study indicated high levels of acceptability and satisfaction with SMI-CM. The ongoing RCT will allow evaluation of the efficacy and mechanisms of action underlying SMI-CM for improving cessation rates among smokers with mood disorders. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparison of physician referral and insurance claims data-based risk prediction as approaches to identify patients for care management in primary care: an observational study.

PubMed

Freund, Tobias; Gondan, Matthias; Rochon, Justine; Peters-Klimm, Frank; Campbell, Stephen; Wensing, Michel; Szecsenyi, Joachim

2013-10-20

Primary care-based care management (CM) could reduce hospital admissions in high-risk patients. Identification of patients most likely to benefit is needed as resources for CM are limited. This study aimed to compare hospitalization and mortality rates of patients identified for CM either by treating primary care physicians (PCPs) or predictive modelling software for hospitalization risk (PM). In 2009, a cohort of 6,026 beneficiaries of a German statutory health insurance served as a sample for patient identification for CM by PCPs or commercial PM (CSSG 0.8, Verisk Health). The resulting samples were compared regarding hospitalization and mortality rates in 2010 and in the two year period before patient selection. No CM-intervention was delivered until the end of 2010 and PCPs were blinded for the assessment of hospitalization rates. In 2010, hospitalization rates of PM-identified patients were 80% higher compared to PCP-identified patients. Mortality rates were also 8% higher in PM-identified patients if compared to PCP-identified patients (10% vs. 2%). The hospitalization rate of patients independently identified by both PM and PCPs was numerically between PM- and PCP-identified patients. Time trend between 2007 and 2010 showed decreasing hospitalization rates in PM-identified patients (-15% per year) compared to increasing rates in PCP-identified patients (+34% per year). PM identified patients with higher hospitalization and mortality rates compared to PCP-referred patients. But the latter showed increasing hospitalization rates over time thereby suggesting that PCPs may be able to predict future deterioration in patients with relatively good current health status. These patients may most likely benefit from preventive services like CM.