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Sample records for current management strategy

  1. Radiation Proctitis: Current Strategies in Management

    PubMed Central

    Do, Nhue L.; Nagle, Deborah; Poylin, Vitaliy Y.

    2011-01-01

    Radiation proctitis is a known complication following radiation therapy for pelvic malignancy. The majority of cases are treated nonsurgically, and an understanding of the available modalities is crucial in the management of these patients. In this paper, we focus on the current treatments of radiation proctitis. PMID:22144997

  2. Current Models and Innovative Strategies in Management Education in China.

    ERIC Educational Resources Information Center

    Wang, Zhong-Ming

    1999-01-01

    Current models of management education in China include national training, on-the-job technical training, and the national master's of business administration supervisory committee. Effective strategies being used include teamwork, process skills, action learning, cross-cultural management learning, and competency-based management development. (SK)

  3. Sports-related concussions: diagnosis, complications, and current management strategies.

    PubMed

    Hobbs, Jonathan G; Young, Jacob S; Bailes, Julian E

    2016-04-01

    Sports-related concussions (SRCs) are traumatic events that affect up to 3.8 million athletes per year. The initial diagnosis and management is often instituted on the field of play by coaches, athletic trainers, and team physicians. SRCs are usually transient episodes of neurological dysfunction following a traumatic impact, with most symptoms resolving in 7-10 days; however, a small percentage of patients will suffer protracted symptoms for years after the event and may develop chronic neurodegenerative disease. Rarely, SRCs are associated with complications, such as skull fractures, epidural or subdural hematomas, and edema requiring neurosurgical evaluation. Current standards of care are based on a paradigm of rest and gradual return to play, with decisions driven by subjective and objective information gleaned from a detailed history and physical examination. Advanced imaging techniques such as functional MRI, and detailed understanding of the complex pathophysiological process underlying SRCs and how they affect the athletes acutely and long-term, may change the way physicians treat athletes who suffer a concussion. It is hoped that these advances will allow a more accurate assessment of when an athlete is truly safe to return to play, decreasing the risk of secondary impact injuries, and provide avenues for therapeutic strategies targeting the complex biochemical cascade that results from a traumatic injury to the brain.

  4. Risk definition and management strategies in retinoblastoma: current perspectives

    PubMed Central

    Ghassemi, Fariba; Khodabande, Alireza

    2015-01-01

    This manuscript focuses on high-risk factors of metastatic disease in retinoblastoma and evaluation of the current treatments of retinoblastoma. Presence of histopathologic high-risk factors is associated with a higher risk of local recurrence and systemic metastasis. Currently, globe-sparing therapies, including systemic chemotherapy, intra-arterial chemoreduction, intravitreal chemotherapy, focal consolidation, and combination therapies, are being used and investigated actively. Major advances are being made in the diagnosis and management of retinoblastoma that will lead to improved morbidity and mortality rates in patients with retinoblastoma. By saving the globes, fronting with some high-risk factors for metastasis would be inevitable. International multi-institutional prospective studies could resolve current uncertainties regarding the main tumor treatment regimens for each patient and indications for chemoprophylaxis for high-risk-factor-bearing retinoblastoma cases. PMID:26089630

  5. Current therapeutics and practical management strategies for pulmonary arterial hypertension.

    PubMed

    Agarwal, Richa; Gomberg-Maitland, Mardi

    2011-08-01

    Pulmonary arterial hypertension (PAH) develops from an abnormal interaction between the endothelium and smooth muscle cells in the pulmonary vasculature and is characterized by a progressive rise in pulmonary vascular resistance resulting from vascular remodeling, vasoconstriction, and cellular proliferation. Currently, 3 classes of drugs are approved for the treatment of PAH based on results from small short-term clinical trials-prostacyclin analogues, endothelin receptor antagonists, and phosphodiesterase type 5 inhibitors. The pharmacologic management of PAH is rapidly evolving as newer therapeutic targets that stabilize or reverse pulmonary vascular disease and target right ventricular function are being sought and as clinical practice patterns shift in favor of earlier diagnosis and aggressive treatment. This manuscript will review the practical management aspects of currently approved PAH treatments and briefly discuss combination therapy and novel pharmacologic targets. In addition, the treatment of acute right ventricular failure and evidence (or lack thereof) for therapies in non-PAH pulmonary hypertension, such as pulmonary hypertension from left side of the heart disease, are addressed.

  6. Caries management by risk assessment: A review on current strategies for caries prevention and management

    PubMed Central

    Maheswari, S. Uma; Raja, Jacob; Kumar, Arvind; Seelan, R. Gnana

    2015-01-01

    The current trend in treating dental caries is using nondestructive risk-based caries management strategies rather than focusing on the restorative treatment alone. Currently, there have been many changes in understanding of the multifaceted nature of caries process and its management. Caries Management by Risk Assessment (CAMBRA) which is an evidence-based approach focuses on determining many factors causing the expression of disease and take corrective action. The clinicians can ascertain what behaviors are increasing a patient's risk for disease and disease progression by evaluating the current caries risk of a patient. With this modern CAMBRA protocol, a novel treatment plan can be designed to arrest dental caries thereby decreasing the chance of cavitation. After the recognition of the multi factorial nature of caries involving the biofilm, the contemporary approaches focused mainly on the various options to cope with the locally out-of-balance oral biofilm and stop the progression of the disease. The initial caries lesions can be diagnosed with modern diagnostic aids and with the help of CAMBRA, reestablishment of the integrity of the tooth surface early on in the caries process will bring great rewards for patients. This review focuses on the repair of hard tooth tissues using noninvasive strategies. PMID:26538870

  7. Water Utility Management Strategies in Turkey: The current situation and the challenges

    NASA Astrophysics Data System (ADS)

    Alp, E.; Aksoy, M. N.; Koçer, B.

    2013-12-01

    As the effects of climate change becomes more prominent, current challenges related to water and wastewater management is becoming more serious. Providing water that satisfies environmental and safety standards in terms of quantity and quality is needed to maintain human life without compromising the need of future generations. Besides providing safe and affordable water, necessary treatment should be achieved according to several important factors such as receiving body standards, discharge standards, water reuse options. Therefore, management of water becomes more crucial than ever that states have to provide accessibility of safe water with affordable cost to its citizens with the means of effective utility management, including water treatment facilities, wastewater treatment facilities, water supply facilities and water distribution systems. Water utilities encounter with several challenges related to cost, infrastructure, population, legislation, workforce and resource. This study aims to determine the current situation and the necessary strategies to improve utility management in Turkish municipalities in a sustainable manner. US Environment Protection Agency (EPA) has formed a tool on effective utility management that assists utilities to provide a solution for both current and future challenges. In this study, we used EPA's guidelines and developed a survey consists of 60 questions under 10 sub-topics (Product Quality, Employee & Leadership Development, Stakeholder Understanding & Support, Operational Optimization, Infrastructure Stability, Financial Viability, Community Sustainability, Customer Satisfaction, Operational Resiliency, and Water Resource Adequacy). This survey was sent to the managers of 25 metropolitan municipalities in Turkey to assess the current condition of municipalities. After the evaluation of the survey results for each topic, including the importance given by managers, facilities were rated according to their level of achievement

  8. Pulmonary hypertension in adults with congenital heart disease and Eisenmenger syndrome: current advanced management strategies.

    PubMed

    D'Alto, Michele; Diller, Gerhard-Paul

    2014-09-01

    The presence of pulmonary arterial hypertension (PAH) increases morbidity and reduces survival in patients with congenital heart disease (CHD). PAH-CHD is a heterogeneous condition, depending on the type of the underlying defect and previous repair strategies. There is growing evidence of the benefits of PAH-specific therapy in the PAH-CHD population, but despite recent advances mortality rates remain relatively high. In the last years, an increasing focus has been placed on patients with PAH-CHD and net left-to-right shunt. Currently, there are limited data to guide the management of these patients and uncertainty on the cut-off values for eventual defect closure. Pregnancy conveys significant risks in PAH-CHD patients: appropriate counselling and care, including psychological support and a multidisciplinary team, should be part of the routine management of women with PAH-CHD of reproductive age. Some subgroups, such as patients with Down's syndrome, Fontan circulation and 'segmental' pulmonary hypertension, present particular challenges in terms of management and therapy. The current review focuses on contemporary treatment strategies in PAH-CHD patients with particular emphasis on challenging patient groups and conditions.

  9. Antimicrobial resistance in Helicobacter pylori: current situation and management strategy in Vietnam.

    PubMed

    Phan, Trung Nam; Tran, Van Huy; Tran, Thi Nhu Hoa; Le, Van An; Santona, Antonella; Rubino, Salvatore; Paglietti, Bianca

    2015-07-04

    Increasing antimicrobial resistance to key antibiotics in Helicobacter pylori has become a main cause of treatment failures in many countries, including Vietnam. For this reason it is advisable to perform antimicrobial sensitivity tests to provide more focused regimens for H. pylori eradication. However, this approach is generally unavailable for H. pylori in Vietnam and the selection of treatment regimens is mainly based on the trend of antibiotic use in the population, resistance development in the region, and history of H. pylori eradication of patients. The aim of this review is to examine the current situation of antimicrobial resistance in Vietnam and suggest management strategies for treatment selection.

  10. Soil environmental quality in greenhouse vegetable production systems in eastern China: Current status and management strategies.

    PubMed

    Hu, Wenyou; Zhang, Yanxia; Huang, Biao; Teng, Ying

    2017-03-01

    Greenhouse vegetable production (GVP) has become an important source of public vegetable consumption and farmers' income in China. However, various pollutants can be accumulated in GVP soils due to the high cropping index, large agricultural input, and closed environment. Ecological toxicity caused by excessive pollutants' accumulation can then lead to serious health risks. This paper was aimed to systematically review the current status of soil environmental quality, analyze their impact factors, and consequently to propose integrated management strategies for GVP systems. Results indicated a decrease in soil pH, soil salinization, and nutrients imbalance in GVP soils. Fungicides, remaining nutrients, antibiotics, heavy metals, and phthalate esters were main pollutants accumulating in GVP soils comparing to surrounding open field soils. Degradation of soil ecological function, accumulation of major pollutants in vegetables, deterioration of neighboring water bodies, and potential human health risks has occurred due to the changes of soil properties and accumulation of pollutants such as heavy metals and fungicides in soils. Four dominant factors were identified leading to the above-mentioned issues including heavy application of agricultural inputs, outmoded planting styles with poor environmental protection awareness, old-fashion regulations, unreasonable standards, and ineffective supervisory management. To guarantee a sustainable GVP development, several strategies were suggested to protect and improve soil environmental quality. Implementation of various strategies not only requires the concerted efforts among different stakeholders, but also the whole lifecycle assessment throughout the GVP processes as well as effective enforcement of policies, laws, and regulations.

  11. Current strategies for the prevention and management of central line-associated bloodstream infections

    PubMed Central

    Han, Zhuolin; Liang, Stephen Y; Marschall, Jonas

    2010-01-01

    Central venous catheters are an invaluable tool for diagnostic and therapeutic purposes in today’s medicine, but their use can be complicated by bloodstream infections (BSIs). While evidence-based preventive measures are disseminated by infection control associations, the optimal management of established central line-associated BSIs has been summarized in infectious diseases guidelines. We prepared an overview of the state-of-the-art of prevention and management of central line-associated BSIs and included topics such as the role of antibiotic-coated catheters, the role of catheter removal in the management, and a review of currently used antibiotic compounds and the duration of treatment. PMID:21694903

  12. Current and emerging strategies in the management of venous thromboembolism: benefit-risk assessment of dabigatran.

    PubMed

    Fanola, Christina L

    2015-01-01

    Venous thromboembolism (VTE) is a disease state that carries significant morbidity and mortality, and is a known cause of preventable death in hospitalized and orthopedic surgical patients. There are many identifiable risk factors for VTE, yet up to half of VTE incident cases have no identifiable risk factor and carry a high likelihood of recurrence, which may warrant extended therapy. For many years, parenteral unfractionated heparin, low-molecular weight heparin, fondaparinux, and oral vitamin K antagonists (VKAs) have been the standard of care in VTE management. However, limitations in current drug therapy options have led to suboptimal treatment, so there has been a need for rapid-onset, fixed-dosing novel oral anticoagulants in both VTE treatment and prophylaxis. Oral VKAs have historically been challenging to use in clinical practice, with their narrow therapeutic range, unpredictable dose responsiveness, and many drug-drug and drug-food interactions. As such, there has also been a need for novel anticoagulant therapies with fewer limitations, which has recently been met. Dabigatran etexilate is a fixed-dose oral direct thrombin inhibitor available for use in acute and extended treatment of VTE, as well as prophylaxis in high-risk orthopedic surgical patients. In this review, the risks and overall benefits of dabigatran in VTE management are addressed, with special emphasis on clinical trial data and their application to general clinical practice and special patient populations. Current and emerging therapies in the management of VTE and monitoring of dabigatran anticoagulant-effect reversal are also discussed.

  13. Mycotoxin problem in Africa: current status, implications to food safety and health and possible management strategies.

    PubMed

    Wagacha, J M; Muthomi, J W

    2008-05-10

    Mycotoxins are toxic secondary metabolites of fungal origin and contaminate agricultural commodities before or under post-harvest conditions. They are mainly produced by fungi in the Aspergillus, Penicillium and Fusarium genera. When ingested, inhaled or absorbed through the skin, mycotoxins will cause lowered performance, sickness or death on humans and animals. Factors that contribute to mycotoxin contamination of food and feed in Africa include environmental, socio-economic and food production. Environmental conditions especially high humidity and temperatures favour fungal proliferation resulting in contamination of food and feed. The socio-economic status of majority of inhabitants of sub-Saharan Africa predisposes them to consumption of mycotoxin contaminated products either directly or at various points in the food chain. The resulting implications include immuno-suppression, impaired growth, various cancers and death depending on the type, period and amount of exposure. A synergistic effect between mycotoxin exposure and some important diseases in the continent such as malaria, kwashiorkor and HIV/AIDS have been suggested. Mycotoxin concerns have grown during the last few decades because of their implications to human and animal health, productivity, economics of their management and trade. This has led to development of maximum tolerated limits for mycotoxins in various countries. Even with the standards in place, the greatest recorded fatal mycotoxin-poisoning outbreak caused by contamination of maize with aflatoxins occurred in Africa in 2004. Pre-harvest practices; time of harvesting; handling of produce during harvesting; moisture levels at harvesting, transportation, marketing and processing; insect damage all contribute to mycotoxin contamination. Possible intervention strategies include good agricultural practices such as early harvesting, proper drying, sanitation, proper storage and insect management among others. Other possible interventions

  14. Non-alcoholic fatty liver disease in obese adults: clinical aspects and current management strategies.

    PubMed

    Pallayova, M; Taheri, S

    2014-10-01

    Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder whose prevalence is strongly linked to the current epidemic of obesity in many western countries. The prevalence of NAFLD is two to four times higher in populations with pre-existing metabolic comorbidities than in the general population. The diagnosis of primary NAFLD involves establishing the presence of hepatic steatosis or steatohepatitis by imaging or histology, along with establishing the non-alcoholic nature of the disease process and excluding competing aetiologies for hepatic steatosis. Among the indirect serum biomarkers, the NAFLD fibrosis score can help to identify patients with NAFLD and with higher likelihood of having fibrosis or cirrhosis. A liver biopsy should be considered in NAFLD patients at increased risk for steatohepatitis/advanced fibrosis and in cases where a liver biopsy is necessary to exclude co-existing chronic liver diseases and other aetiologies for hepatic steatosis. The treatment and management recommendations for obesity-associated NAFLD are aimed towards weight reduction. The currently available interventions employed to promote weight loss and improve the metabolic responses in NAFLD include lifestyle modification, pharmacotherapy and bariatric surgery.

  15. HTLV-1 in solid-organ transplantation: current challenges and future management strategies.

    PubMed

    Armstrong, Matthew J; Corbett, Christopher; Rowe, Ian A; Taylor, Graham P; Neuberger, James M

    2012-12-15

    Human T-cell lymphotrophic virus (HTLV)-1 has been reported after solid-organ transplantation, with a related fatal outcome in less than five cases. The natural history of HTLV-1 transmission from donor to recipient is unknown in this setting, because available screening platforms are suboptimal in low-prevalence areas and there is a lack of long-term follow-up. Minimizing organ wastage due to false-positive screening and avoiding donor-derived HTLV-associated diseases remain the goal. To date, only six HTLV-naive organ recipients from four donors (only one had confirmed HTLV) have developed HTLV-associated disease after transplantation. All of these cases were described in countries or from donors from HTLV-endemic regions. To the best of our knowledge, there have been no reported cases of donor-derived HTLV-1-associated death after organ transplantation in the world. Based on data from low-prevalence countries (Europe and the United States) and the current shortage of donor organs, it appears plausible to authorize the decision to transplant an organ without the prior knowledge of the donor's HTLV-1 status. Currently, it is not possible to exclude such transmission and recipients should be informed of the possible inadvertent transmission of this (and other) infections at the time of consent. In those cases where HTLV-1 transmission does occur, there may be a therapeutic window in which use of antiviral agents (i.e., zidovudine and raltegravir) may be of benefit. The development of national/international registries should allow a greater understanding of the extent and consequences of transmission risk and so allow a more evidence-based approach to management.

  16. Current strategies for reproductive management of gilts and sows in North America.

    PubMed

    Kraeling, Robert R; Webel, Stephen K

    2015-01-01

    Many advances in genetic selection, nutrition, housing and disease control have been incorporated into modern pork production since the 1950s resulting in highly prolific females and practices and technologies, which significantly increased efficiency of reproduction in the breeding herd. The objective of this manuscript is to review the literature and current industry practices employed for reproductive management. In particular the authors focus on assisted reproduction technologies and their application for enhanced productivity. Modern maternal line genotypes have lower appetites and exceptional lean growth potential compared to females of 20 yr ago. Thus, nutrient requirements and management techniques and technologies, which affect gilt development and sow longevity, require continuous updating. Failure to detect estrus accurately has the greatest impact on farrowing rate and litter size. Yet, even accurate estrus detection will not compensate for the variability in the interval between onset of estrus and actual time of ovulation. However, administration of GnRH analogs in weaned sows and in gilts after withdrawal of altrenogest do overcome this variability and thereby synchronize ovulation, which makes fixed-time AI practical. Seasonal infertility, mediated by temperature and photoperiod, is a persistent problem. Training workers in the art of stockmanship is of increasing importance as consumers become more interested in humane animal care. Altrenogest, is used to synchronize the estrous cycle of gilts, to prolong gestation for 2-3 d to synchronize farrowing and to postpone post-weaning estrus. P.G. 600® is used for induction of estrus in pre-pubertal gilts and as a treatment to overcome seasonal anestrous. Sperm cell numbers/dose of semen is significantly less for post cervical AI than for cervical AI. Real-time ultrasonography is used to determine pregnancy during wk 3-5. PGF2α effectively induces farrowing when administered within two d of normal

  17. [Hyperkalemia - current therapuetic strategies].

    PubMed

    Głogowski, Tomasz; Wojtaszek, Ewa

    Hyperkalemia is a medical emergency that requires immediate therapy, followed by interventions aimed at preventing its recurrence. Hyperkalemia occurs especially frequently in patients with chronic kidney disease (CKD), in part because of impaired kidney function and in part due to coexisting comorbidities such as diabetes or heart failure and the medications used to treat them, first of all the inhibitors of renin-angiotensin-aldosterone system (RAASi). Both acute and chronic management of hyperkalemia are equally important, though, with currently available therapeutic possibilities, the effective restoration of potassium homeostasis are in fact limited to the correction of its triggers. The emergence of new medications (patiromer and ZS-9) could lead to a therapeutic paradigm shift from intermittent treatment of incidentally discovered hyperkalemia toward preventive measures preventing fluctuations in serum potassium levels and enabling the continuation of beneficial, but hyperkalemia inducing agents.

  18. Current strategies for the long-term assessment, monitoring, and management of cystic fibrosis patients treated with CFTR modulator therapy.

    PubMed

    Elborn, J Stuart; Davies, Jane; Mall, Marcus A; Flume, Patrick A; Plant, Barry

    2017-01-01

    The content for this activity is based on the satellite symposium, "Current Strategies for the Long-term Assessment, Monitoring, and Management for Cystic Fibrosis Patients Treated with CFTR Modulator Therapy" that was presented at the 39th European Cystic Fibrosis Society Conference on June 10, 2016 (Online access: http://courses.elseviercme.com/ecfs2016e/619e). The emergence of novel targeted agents, that directly correct CFTR loss function alleles, has created new treatment opportunities for patients with cystic fibrosis with advanced disease. Knowledge of the role of these agents in the clinical setting is quickly evolving and will require physicians to stay acquainted with the latest data as well as evidence-based treatment guidelines in order to achieve optimized cystic fibrosis patient care. Ideally, after diagnosis, a personalized approach would be adapted and tailored to the patient through genome-informed medicine. However, due to the relative recentness of genomic-based therapeutics, physicians may have a limited knowledge base regarding these new treatment options and how to best incorporate these agents into patient management plans. Although cystic fibrosis is still largely regarded as a pediatric disease, the median survival for patients is 35years of age. Consequently, pediatric-to-adult cystic fibrosis care programs would allow suitable preparation time for this transition and develop a standardized group of self-care and management skills.

  19. Management of Chyle Leak after Head and Neck Surgery: Review of Current Treatment Strategies

    PubMed Central

    Shi, Haoran; Sinha, Uttam K.

    2017-01-01

    Chyle leak formation is an uncommon but serious sequela of head and neck surgery when the thoracic duct is inadvertently injured, particularly with the resection of malignancy low in the neck. The thoracic duct is the primary structure that returns lymph and chyle from the entire left and right lower half of the body. Chyle extravasation can result in delayed wound healing, dehydration, malnutrition, electrolyte disturbances, and immunosuppression. Prompt identification and treatment of a chyle leak are essential for optimal surgical outcome. In this article we will review the current treatment options for iatrogenic cervical chyle leaks. PMID:28203252

  20. Human capital strategy: talent management.

    PubMed

    Nagra, Michael

    2011-01-01

    Large organizations, including the US Army Medical Department and the Army Nurse Corps, are people-based organizations. Consequently, effective and efficient management of the human capital within these organizations is a strategic goal for the leadership. Over time, the Department of Defense has used many different systems and strategies to manage people throughout their service life-cycle. The current system in use is called Human Capital Management. In the near future, the Army's human capital will be managed based on skills, knowledge, and behaviors through various measurement tools. This article elaborates the human capital management strategy within the Army Nurse Corps, which identifies, develops, and implements key talent management strategies under the umbrella of the Corps' human capital goals. The talent management strategy solutions are aligned under the Nurse Corps business strategy captured by the 2008 Army Nurse Corps Campaign Plan, and are implemented within the context of the culture and core values of the organization.

  1. Narrative review of current context of malaria and management strategies in Uganda (Part I).

    PubMed

    Kassam, Rosemin; Collins, John B; Liow, Eric; Rasool, Nabeela

    2015-12-01

    In accordance with international targets, the Uganda National Malaria Control Strategic Plan established specific targets to be achieved by 2010. For children under five, this included increasing the number of children sleeping under mosquito nets and those receiving a first-line antimalarial to 85%, and decreasing case fatality to 2%. This narrative review offers contextual information relevant to malaria management in Uganda since the advent of artemisinin combination therapy (ACT) as first-line antimalarial treatment in 2004. A comprehensive search using key words and phrases was conducted using the web search engines Google and Google Scholar, as well as the databases of PubMed, ERIC, EMBASE, CINAHL, OvidSP (MEDLINE), PSYC Info, Springer Link, Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews were searched. A total of 147 relevant international and Ugandan literature sources meeting the inclusion criteria were included. This review provides an insightful understanding on six topic areas: global and local priorities, malarial pathology, disease burden, malaria control, treatment guidelines for uncomplicated malaria, and role of the health system in accessing antimalarial medicines. Plasmodium falciparum remains the most common cause of malaria in Uganda, with children under five being most vulnerable due to their underdeveloped immunity. While international efforts to scale up malaria control measures have resulted in considerable decline in malaria incidence and mortality in several regions of sub-Saharan Africa, this benefit has yet to be substantiated for Uganda. At the local level, key initiatives have included implementation of a new antimalarial drug policy in 2004 and strengthening of government health systems and programs. Examples of such programs include removal of user fees, training of frontline health workers, providing free ACT from government systems and subsidized ACT from licensed private

  2. Clinical management of sleep disturbances in Alzheimer’s disease: current and emerging strategies

    PubMed Central

    Urrestarazu, Elena; Iriarte, Jorge

    2016-01-01

    Sleep and circadian disorders in Alzheimer’s disease (AD) are more frequent than in the general population and appear early in the course of the disease. Quality of sleep and quality of life are parallel in these patients, and such disorders also represent a heavy burden for caregivers. Although alterations in melatonin and hypocretins (orexins) seem to play a key role in the origin of these disturbances, the etiology of these disorders is multifactorial, including many factors such as environment, behavior, treatments, and comorbidities, among others. A comprehensive evaluation of sleep in each patient is essential in the design of the treatment that includes nonpharmacological and pharmacological approaches. One particularly interesting point is the possibility of a role of sleep disorders in the pathogenesis of AD, raising the possibility that treating the sleep disorder may alter the course of the disease. In this review, we present an update on the role of sleep disorders in AD, the bidirectional influence of sleep problems and AD, and treatment options. Behavioral measures, bright light therapy (BLT), melatonin, and other drugs are likely well known and correctly managed by the physicians in charge of these patients. In spite of the multiple treatments used, evidence of efficacy is scarce and more randomized double-blind placebo-controlled studies are needed. Future directions for treatment are the establishment of BLT protocols and the development of drugs with new mechanisms of action, especially hypocretin receptor antagonists, melatonin receptor agonists, and molecules that modulate the circadian clock. PMID:26834500

  3. Cost-effectiveness in the management of Dupuytren's contracture. A Canadian cost-utility analysis of current and future management strategies.

    PubMed

    Baltzer, H; Binhammer, P A

    2013-08-01

    In Canada, Dupuytren's contracture is managed with partial fasciectomy or percutaneous needle aponeurotomy (PNA). Injectable collagenase will soon be available. The optimal management of Dupuytren's contracture is controversial and trade-offs exist between the different methods. Using a cost-utility analysis approach, our aim was to identify the most cost-effective form of treatment for managing Dupuytren's contracture it and the threshold at which collagenase is cost-effective. We developed an expected-value decision analysis model for Dupuytren's contracture affecting a single finger, comparing the cost-effectiveness of fasciectomy, aponeurotomy and collagenase from a societal perspective. Cost-effectiveness, one-way sensitivity and variability analyses were performed using standard thresholds for cost effective treatment ($50 000 to $100 000/QALY gained). Percutaneous needle aponeurotomy was the preferred strategy for managing contractures affecting a single finger. The cost-effectiveness of primary aponeurotomy improved when repeated to treat recurrence. Fasciectomy was not cost-effective. Collagenase was cost-effective relative to and preferred over aponeurotomy at $875 and $470 per course of treatment, respectively. In summary, our model supports the trend towards non-surgical interventions for managing Dupuytren's contracture affecting a single finger. Injectable collagenase will only be feasible in our publicly funded healthcare system if it costs significantly less than current United States pricing.

  4. The need to clot: a review of current management strategies for adverse bleeding events with new oral anticoagulants.

    PubMed

    Whalley, D; Skappak, C; Lang, E S

    2014-07-01

    The new factor Xa inhibitors and direct thrombin inhibitors have offered alternatives to traditional anticoagulants, with benefits of no routine monitoring, less drug interactions, and oral administration. Current approved uses of these agents include prophylaxis of stroke in non-valvular atrial fibrillation and prevention of venous thromboembolism (VTE) following hip and knee arthroplasty. However, concern over bleeding risk in the context of having no specific antidotes available is a topic of focus for many physicians in an acute care setting. This manuscript examines the recent literature in the management of acute bleeding and the various methods of reversing anticoagulation in this setting. Literature published over the last 18 months (2011/07/01-present) was gathered from PubMed, Ovid, and Medline under a combined search strategy covering bleeding, reversal, and new oral anticoagulants, both factor Xa and direct thrombin inhibitors. The use of prothrombin complex concentrate, fresh frozen plasma, activated recombinant factor VII, activated prothrombin complex concentrate, as well as adjuncts of charcoal, hemodialysis, and antifibrinolytics are discussed. Recommendations are based on the determination of the severity of the bleed and physiological markers of anticoagulation, and involve the use of prothrombin complex concentrate, activated recombinant factor VII, and adjunctive therapy as appropriate.

  5. Determining heavy metals in spent compact fluorescent lamps (CFLs) and their waste management challenges: Some strategies for improving current conditions

    SciTech Connect

    Taghipour, Hassan; Amjad, Zahra; Jafarabadi, Mohamad Asghari; Gholampour, Akbar; Norouz, Prviz

    2014-07-15

    Highlights: • Heavy metals in spent compact fluorescent lamps (CFLs) determined. • Current waste management condition of CFLs in Iran assessed. • Currently, waste of CFLs is disposed by municipal waste stream in waste landfills. • We propose extended producer responsibility (EPR) for CFLs waste management. - Abstract: From environmental viewpoint, the most important advantage of compact fluorescent lamps (CFLs) is reduction of green house gas emissions. But their significant disadvantage is disposal of spent lamps because of containing a few milligrams of toxic metals, especially mercury and lead. For a successful implementation of any waste management plan, availability of sufficient and accurate information on quantities and compositions of the generated waste and current management conditions is a fundamental prerequisite. In this study, CFLs were selected among 20 different brands in Iran. Content of heavy metals including mercury, lead, nickel, arsenic and chromium was determined by inductive coupled plasma (ICP). Two cities, Tehran and Tabriz, were selected for assessing the current waste management condition of CFLs. The study found that waste generation amount of CFLs in the country was about 159.80, 183.82 and 153.75 million per year in 2010, 2011 and 2012, respectively. Waste generation rate of CFLs in Iran was determined to be 2.05 per person in 2012. The average amount of mercury, lead, nickel, arsenic and chromium was 0.417, 2.33, 0.064, 0.056 and 0.012 mg per lamp, respectively. Currently, waste of CFLs is disposed by municipal waste stream in waste landfills. For improving the current conditions, we propose by considering the successful experience of extended producer responsibility (EPR) in other electronic waste management. The EPR program with advanced recycling fee (ARF) is implemented for collecting and then recycling CFLs. For encouraging consumers to take the spent CFLs back at the end of the products’ useful life, a proportion of

  6. Anomalous aortic origin of a coronary artery with an interarterial course: understanding current management strategies in children and young adults.

    PubMed

    Brothers, Julie; Gaynor, J William; Paridon, Stephen; Lorber, Richard; Jacobs, Marshall

    2009-10-01

    Anomalous aortic origin of a coronary artery from the opposite sinus of Valsalva with an interarterial course (AAOCA) is a rare congenital anomaly that is the second leading cardiovascular cause of sudden death in children and adolescents. Management practices with respect to this lesion vary among clinicians. We surveyed practitioners' opinions on treatment and management strategies for patients with AAOCA. A 17-question "Patient Management Questionnaire" was sent to all Congenital Heart Surgeons' Society (CHSS) members (n = 90), who were asked to respond and to distribute the questionnaire to pediatric cardiologists and nurse practitioners at their institutions. Questions addressed patient presentation, diagnostic modalities, therapeutic intervention, complications to therapy, follow-up visits, and type and frequency of follow-up testing. Descriptive statistics were used for analyses. We received 113 responses. Almost all respondents agree that ischemia at presentation or with provocative testing warrants surgical repair, whereas the majority believes that any patient with symptoms but no evidence of ischemia should have surgery. Approximately one-half and one-third of the respondents manage patients who are awaiting surgery or not having surgery by completely restricting exercise or not allowing competitive athletics, respectively. In asymptomatic patients, patient age determines timing of surgical repair but almost one-quarter did not believe that an asymptomatic child should undergo surgery. Among patients managed medically, there were six sudden deaths; there were two deaths in those who had surgical repair. There is marked heterogeneity in physician opinions regarding AAOCA treatment and management. A multicenter registry would facilitate the development of evidence-based treatment and management guidelines for children and young adults with AAOCA.

  7. Current Management of NAFLD

    PubMed Central

    MUNTEANU, MIHAI ALEXANDRU; NAGY, GEORGIANA ANCA; MIRCEA, PETRU ADRIAN

    2016-01-01

    Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in Western countries. It affects about 1 billion individuals worldwide. While people with simple steatosis have no higher risk of death than the general population, people with non-alcoholic steatohepatitis are at increased risk of death compared to general population. Current management for NAFLD includes diet and lifestyle changes, management of underlying metabolic risk factors and pharmacological therapies. The objective of therapy is to prevent the complications. The problem with dietary and lifestyle interventions is that they are hard to implement. Compliance is the key. Until now, there is still no approved drug for the treatment of NAFLD. Insulin resistance is the main target of pharmacological therapy, but the question that we ask ourselves as physicians is who should receive medical treatment among NAFLD patients and for how long. PMID:27004021

  8. Fault Management Design Strategies

    NASA Technical Reports Server (NTRS)

    Day, John C.; Johnson, Stephen B.

    2014-01-01

    Development of dependable systems relies on the ability of the system to determine and respond to off-nominal system behavior. Specification and development of these fault management capabilities must be done in a structured and principled manner to improve our understanding of these systems, and to make significant gains in dependability (safety, reliability and availability). Prior work has described a fundamental taxonomy and theory of System Health Management (SHM), and of its operational subset, Fault Management (FM). This conceptual foundation provides a basis to develop framework to design and implement FM design strategies that protect mission objectives and account for system design limitations. Selection of an SHM strategy has implications for the functions required to perform the strategy, and it places constraints on the set of possible design solutions. The framework developed in this paper provides a rigorous and principled approach to classifying SHM strategies, as well as methods for determination and implementation of SHM strategies. An illustrative example is used to describe the application of the framework and the resulting benefits to system and FM design and dependability.

  9. Medical equipment management strategies.

    PubMed

    Wang, Binseng; Furst, Emanuel; Cohen, Ted; Keil, Ode R; Ridgway, Malcolm; Stiefel, Robert

    2006-01-01

    Clinical engineering professionals need to continually review and improve their management strategies in order to keep up with improvements in equipment technology, as well as with increasing expectations of health care organizations. In the last 20 years, management strategies have evolved from the initial obsession with electrical safety to flexible criteria that fit the individual institution's needs. Few hospitals, however, are taking full advantage of the paradigm shift offered by the evolution of joint Commission standards. The focus should be on risks caused by equipment failure, rather than on equipment with highest maintenance demands. Furthermore, it is not enough to consider risks posed by individual pieces of equipment to individual patients. It is critical to anticipate the impact of an equipment failure on larger groups of patients, especially when dealing with one of a kind, sophisticated pieces of equipment that are required to provide timely and accurate diagnoses for immediate therapeutic decisions or surgical interventions. A strategy for incorporating multiple criteria to formulate appropriate management strategies is provided in this article.

  10. Diffuse low-grade glioma: a review on the new molecular classification, natural history and current management strategies.

    PubMed

    Delgado-López, P D; Corrales-García, E M; Martino, J; Lastra-Aras, E; Dueñas-Polo, M T

    2017-03-02

    The management of diffuse supratentorial WHO grade II glioma remains a challenge because of the infiltrative nature of the tumor, which precludes curative therapy after total or even supratotal resection. When possible, functional-guided resection is the preferred initial treatment. Total and subtotal resections correlate with increased overall survival. High-risk patients (age >40, partial resection), especially IDH-mutated and 1p19q-codeleted oligodendroglial lesions, benefit from surgery plus adjuvant chemoradiation. Under the new 2016 WHO brain tumor classification, which now incorporates molecular parameters, all diffusely infiltrating gliomas are grouped together since they share specific genetic mutations and prognostic factors. Although low-grade gliomas cannot be regarded as benign tumors, large observational studies have shown that median survival can actually be doubled if an early, aggressive, multi-stage and personalized therapy is applied, as compared to prior wait-and-see policy series. Patients need an honest long-term therapeutic strategy that should ideally anticipate neurological, cognitive and histopathologic worsening.

  11. Fanconi anemia: current management.

    PubMed

    Kook, Hoon

    2005-01-01

    Fanconi anemia (FA) is an autosomal recessive chromosomal instability disorder, characterized by congenital anomalies, defective hematopoiesis and a high risk of developing acute myeloid leukemia and certain solid tumors. All racial and ethnic groups are at risk, and at least 11 complementation groups have been identified and the genes defective in eight of these have been identified (FANCA, C, D2, E, F, G, L and BRCA2). FA-A is the most common complementation group, accounting for approximately 65% of all affected individuals. The gold-standard screening test for FA is based on the characteristic hypersensitivity of FA cells to the crosslinking agents, such as mitomicin C or diepoxybutane. Recent progress has been made in identifying the genes bearing pathogenetically relevant mutations, but slower progress has been made in defining the precise functions of the proteins in normal cells, in part because that the proteins are multifunctional. Molecular studies have established that a common pathway exist, both between the FA proteins and other proteins involved in DNA repair such as NBS1, ATM, BRCA1 and BRCA2. Stem cell transplantation (SCT) is the only option for establishing normal hematopoiesis. To reduce undue toxicities due to inherent hypersensitivity, nonmyeloablative conditioning for transplants has been advocated. This review summarizes the general clinical and hematologic features and the current management of FA. Fanconi anemia (FA) is the commonest type of inherited bone marrow failure syndrome with the birth incidence of around three per million. The inheritance pattern is autosomal recessive with the estimated heterozygote frequency being one in 300 in Europe and the US.

  12. Using Rewards and Sanctions in the Classroom: Pupils' Perceptions of Their Own Responses to Current Behaviour Management Strategies

    ERIC Educational Resources Information Center

    Payne, Ruth

    2015-01-01

    The use of systems of rewards and sanctions within behaviour policies has now been adopted formally in UK schools. Such systems potentially represent competing theoretical ideas when considered alongside current approaches to teaching and learning. There is also opportunity for inconsistent use of rewards and sanctions resulting from the absence…

  13. Combination strategies for pain management.

    PubMed

    Raffa, Robert B; Clark-Vetri, Rachel; Tallarida, Ronald J; Wertheimer, Albert I

    2003-10-01

    At least two factors relating to pain management using oral analgesics suggest that combination strategies merit consideration: many pains arise from more than one physiological cause and current analgesics have adverse effect profiles that might be reduced by combination with another agent in smaller doses or with less frequent dosing. In addition to increased convenience, combinations sometimes also result in the unexpected benefit of synergy. But not all pains, clinical settings or combinations merit the extra expense or other potential negative features of fixed-ratio products. This review examines the multiple basic science, clinical and pharmacoeconomic issues relating to analgesic combinations and the methodologies available for assessing these issues.

  14. Relapsed Hodgkin Lymphoma: Management Strategies

    PubMed Central

    Montanari, Francesca; Diefenbach, Catherine

    2016-01-01

    Although Hodgkin lymphoma (HL) is largely curable with first-line therapy, approximately one-third of patients will not have a complete response to frontline treatment or will subsequently relapse. Only 50 % of these patients will be effectively salvaged with conventional therapies. The prognosis is particularly poor for those patients with chemotherapy refractory disease, who are unable to obtain even transient disease control, and for patients who relapse following high dose chemotherapy and autologous stem cell transplant. In this review, we summarize the most recent updates on the management of patients with relapsed HL, the role of novel therapies such as brentuximab vedotin, and an overview of promising new agents currently under investigation. We also discuss the role of consolidation strategies such as high-dose chemotherapy and autologous stem cell transplant, and reduced-intensity allogeneic hematopoietic stem cell transplant, and the need for new strategies in the elderly patient population. PMID:24942298

  15. Alcoholic hepatitis: current management.

    PubMed

    Spengler, Erin K J; Dunkelberg, Jeffrey; Schey, Ron

    2014-10-01

    Alcoholic hepatitis is an acute manifestation of alcoholic liver disease with mortality as high as 40-50% in severe cases. Patients usually have a history of prolonged alcohol abuse with or without a known history of liver disease. Although there is significant range in severity at presentation, patients with severe alcoholic hepatitis typically present with anorexia, fatigue, fever, jaundice, and ascites. The use of either pentoxifylline or corticosteroids in those with severe disease (Maddrey's discriminate function >32) has significant mortality benefit. The addition of N-acetylcysteine to corticosteroids decreases the incidences of hepatorenal syndrome, infection, and short-term mortality, but does not appear to significantly affect 6-month mortality. Nutritional support with high-calorie, high-protein diet is recommended in all patients screening positive for malnutrition. Liver transplantation for a highly selected group of patients with severe alcoholic hepatitis may be an option in the future, but is not currently recommended or available at most transplant institutions.

  16. Current and emerging strategies for the treatment and management of systemic lupus erythematosus based on molecular signatures of acute and chronic inflammation

    PubMed Central

    Das, Undurti N

    2010-01-01

    Lupus is a chronic, systemic inflammatory condition in which eicosanoids, cytokines, nitric oxide (NO), a deranged immune system, and genetics play a significant role. Our studies revealed that an imbalance in the pro- and antioxidants and NO and an alteration in the metabolism of essential fatty acids exist in lupus. The current strategy of management includes administration of nonsteroidal anti-inflammatory drugs such as hydroxychloroquine and immunosuppressive drugs such as corticosteroids. Investigational drugs include the following: 1) belimumab, a fully human monoclonal antibody that specifically recognizes and inhibits the biological activity of B-lymphocyte stimulator, also known as B-cell-activation factor of the TNF family; 2) stem cell transplantation; 3) rituximab, a chimeric monoclonal antibody against CD20, which is primarily found on the surface of B-cells and can therefore destroy B-cells; and 4) IL-27, which has potent anti-inflammatory actions. Our studies showed that a regimen of corticosteroids and cyclophosphamide, and methods designed to enhance endothelial NO synthesis and augment antioxidant defenses, led to induction of long-lasting remission of the disease. These results suggest that methods designed to modulate molecular signatures of the disease process and suppress inflammation could be of significant benefit in lupus. Some of these strategies could be vagal nerve stimulation, glucose–insulin infusion, and administration of lipoxins, resolvins, protectins, and nitrolipids by themselves or their stable synthetic analogs that are known to suppress inflammation and help in the resolution and healing of the inflammation-induced damage. These strategies are likely to be useful not only in lupus but also in other conditions, such as rheumatoid arthritis, scleroderma, ischemia-reperfusion injury to the myocardium, ischemic heart disease, and sepsis. PMID:22096364

  17. [Constipation and cancer: Current strategies].

    PubMed

    Gervais, Claire; Ducrotté, Philippe; Piche, Thierry; Di Palma, Mario; Jovenin, Nicolas; Scotté, Florian

    2016-09-01

    Digestive disorders, in particular constipation, are symptoms very often reported by cancer patients as having a major impact on their quality of life. An accurate diagnosis of bowel delayed transit and defecation disorders is required to best adapt therapeutic management. Constipation associated with cancer may be related to several causes, which can be placed in three nosological categories that sometimes overlap: chronic constipation prior to cancer and having its own evolution; constipation related to the cancer condition, in particular the occlusive syndrome, and constipation induced by cancer therapies. The stricter application of diet and lifestyle measures is often necessary and sometimes sufficient. Laxative drug treatments come under various galenic forms and administration routes and must be selected according to the clinical features of constipation. Surgical management can be indicated in case of ileus or pelvic static disorders. In the case of refractory constipation induced by opioids and within the framework of palliative care to treat an advanced pathology, a peripheral morphinic antagonist can offer fast symptom relief. A way forward to improve the patients' quality of life could be to identify the contributing factors (in particular, genetic factors) to determine which patients are the more at risk and anticipate their management.

  18. Knowledge management: an innovative risk management strategy.

    PubMed

    Zipperer, Lorri; Amori, Geri

    2011-01-01

    Knowledge management effectively lends itself to the enterprise risk process. The authors introduce the concept of knowledge management as a strategy to drive innovation and support risk management. They align this work with organizational efforts to improve patient safety and quality through the effective sharing of experience and lessons learned. The article closes with suggestions on how to develop a knowledge management initiative at an organization, who should be on the team, and how to sustain this effort and build the culture it requires to drive success.

  19. The office of strategy management.

    PubMed

    Kaplan, Robert S; Norton, David P

    2005-10-01

    There is a disconnect in most companies between strategy formulation and strategy execution. On average, 95% of a company's employees are unaware of, or do not understand, its strategy. If employees are unaware of the strategy, they surely cannot help the organization implement it effectively. It doesn't have to be like this. For the past 15 years, the authors have studied companies that achieved performance breakthroughs by adopting the Balanced Scorecard and its associated tools to help them better communicate strategy to their employees and to guide and monitor the execution of that strategy. Some companies, of course, have achieved better, longer-lasting improvements than others. The organizations that have managed to sustain their strategic focus have typically established a new corporate-level unit to oversee all activities related to strategy: an office of strategy management (OS M). The OSM, in effect, acts as the CEO's chief of staff. It coordinates an array of tasks: communicating corporate strategy; ensuring that enterprise-level plans are translated into the plans of the various units and departments; executing strategic initiatives to deliver on the grand design; aligning employees' plans for competency development with strategic objectives; and testing and adapting the strategy to stay abreast of the competition. The OSM does not do all the work, but it facilitates the processes so that strategy is executed in an integrated fashion across the enterprise. Although the companies that Kaplan and Norton studied use the Balanced Scorecard as the framework for their strategy management systems, the authors say the lessons of the OSM are applicable even to companies that do not use it.

  20. Management Strategies for Clopidogrel Hypersensitivity.

    PubMed

    Beavers, Craig J; Carris, Nicolas W; Ruf, Kathryn M

    2015-06-01

    Clopidogrel is a cornerstone of dual antiplatelet therapy. Hypersensitivity reactions potentially limit the use of this treatment and present a significant clinical challenge. The authors have developed recommendations for the management of clopidogrel hypersensitivity with consideration for the etiology, pathophysiology, and critical evaluation of potential management strategies. The clopidogrel hypersensitivity reaction is complex in mechanism and presents generally around day 5 of treatment. Generalized reactions are most common, but the reaction may also be localized or systemic. Screening patients for hypersensitivity is not always possible because the type IV delayed reaction is not detected reliably by conventional skin prick, intradermal challenge, or patch testing. Proposed strategies for management of clopidogrel hypersensitivity include treatment of the reaction with corticosteroids, clopidogrel desensitization, substituting an alternative P2Y12 inhibitor, or clopidogrel avoidance. The safety, efficacy, and cost of each potential strategy must be considered when managing a patient with clopidogrel hypersensitivity.

  1. Health management education: current alternatives.

    PubMed

    Weil, Thomas P

    2014-01-01

    The past several decades have witnessed a significant increase in the number of graduate programs in health management, either on campus or online. The alternative for a health professional to attending a graduate program on campus is to receive an MBA or MHA degree online. The current cost ranges from $13,600 to $78,000, with the more expensive online programs tied to graduate programs that are accredited by the Commission on the Accreditation of Healthcare Management Education and provide the names and qualifications of their faculty. The for-profit online programs have not been forthcoming to this author concerning their health management faculty or their curriculum. For the individual desiring more health management education who is unable to enroll, for family or financial reasons, in an on-campus program, the top-tier online programs seem like a worthwhile but is a relatively expensive option.

  2. Crisis management strategies.

    PubMed

    Koster, Maria C; Politis-Norton, Helen

    2004-01-01

    This paper discusses the different facets of crisis as experienced within the pharmaceutical industry but which are also prevalent throughout other industries. It highlights the importance of early identification and management of crises and issues, which in return are strongly intertwined with a fundamental positive internal corporate climate. A corporate philosophy should always embrace crisis management with the attitude of 'when' and not 'if'; therefore, a company should act today and not tomorrow once a crisis is on its doorstep. Preparation is of utmost importance and there are several items that can be addressed even before a crisis has arisen. Further, this paper also provides guidance on how to deal with the media, what to do and what not to do, and how to appoint the appropriate spokesperson. In this era of fast exchange of information, crisis, which previously may have stayed behind corporate doors, may not do so any longer. Image is very important and should therefore not be risked. Crisis and issue management should therefore be integrated in every company's philosophy and standard operating procedures.

  3. Current management of paediatric urolithiasis.

    PubMed

    Gnessin, Ehud; Chertin, Leonid; Chertin, Boris

    2012-07-01

    We aimed to review a current management of paediatric nephrolithiasis. The current literature, including our own experience on the treatment of paediatric nephrolithiasis was reviewed by MEDLINE/PubMed search. We have used in our search following keywords: urolithiasis, nephrolithiasis, paediatrics, surgical treatment, conservative management, ESWL, ureteroscopy, and open renal surgery. The search was limited to the English language literature during the period of time from 1990 to 2011. All papers were reviewed independently by all co-authors and only the manuscripts directly related to the reviewed subjects were included into the current review. Due to the high incidence of predisposing factors for urolithiasis in children and high stone recurrence rates, every child with urinary stone should be given a complete metabolic evaluation. Most stones in children can be managed by ESWL and endoscopic techniques. Paediatric stone disease is an important clinical problem in paediatric urology practice. Because of its recurrent nature, every effort should be made to discover the underlying metabolic abnormality so that it can be treated appropriately. Obtaining a stone-free state with interventional management and close follow-up are of utmost importance.

  4. Current management of immune thrombocytopenia.

    PubMed

    Neunert, Cindy E

    2013-01-01

    Immune thrombocytopenia (ITP) is an autoimmune-mediated condition that results from antibody-mediated destruction of platelets and impaired megakaryocyte platelet production. ITP patients exhibit severe thrombocytopenia and are at risk for significant hemorrhage. Few randomized trials exist to guide management of patients with ITP. Ultimately, each patient requires an individualized treatment plan that takes into consideration the platelet count, bleeding symptoms, health-related quality of life, and medication side effects. This article provides an up-to-date review of management strategies drawing on links between the expanding amounts of clinical trial data and associated biology studies to enhance understanding of the disease heterogeneity with regard to the complex pathogenesis and response to treatment.

  5. [Current management of hepatitis C].

    PubMed

    Lange, Christian M

    2015-09-01

    During the last decade, the therapeutic management of hepatitis C virus (HCV) infection has changed dramatically. Due to the recent approval of several directly acting antiviral agents (DAAs) such as sofosbuvir, daclatasvir, or ledipasvir, HCV eradication is possible in the vast majority of HCV infected individuals by DAA combinations with or without pegylated interferon-α. This review summarized these exciting developments with a focus on current recommendations for the treatment of chronic hepatitis C.

  6. Managing incontinence: women's normalizing strategies.

    PubMed

    Skoner, M M; Haylor, M J

    1993-01-01

    Women's strategies for managing urinary incontinence were examined in a grounded-theory study. The women's basic social concern was dealing with incontinence in a manner that enabled them to feel normal. Feeling normal meant being able to do what they wanted to do and needed to do to have a normal life-style as they perceived it. This goal was accomplished by normalizing incontinence and its management. Normalization was achieved by directing its course through self-management, accounting for it in terms of personal history and life experiences, and delaying medical counsel. These strategies are described. The findings provide fresh insights about women's response to incontinence and their practice of self-managing its consequences.

  7. Management of Current Psychiatric Disorders

    PubMed Central

    Carbonnel, François; David, Michel; Norton, Joanna; Bourrel, Gérard; Boulenger, Jean-Philippe; Capdevielle, Delphine

    2016-01-01

    Objective: Describe and analyse the experience of family physicians in managing current psychiatric disorders to obtain a better understanding of the underlying reasons of under-detection and inadequate prescribing identified in studies. Methods: A qualitative study using in-depth interviews. Sample of 15 practicing family physicians, recruited by telephone from a precedent cohort (Sesame1) with a maximum variation: sex, age, single or group practice, urban or rural. Qualitative method is inspired by the completed grounded theory of a verbatim semiopragmatic analysis from 2 experts in this approach. Results: Family physicians found that current psychiatric disorders were related to psychological symptoms in reaction to life events. Their role was to make patients aware of a psychiatric symptom rather than establish a diagnosis. Their management responsibility was considered in contrasting ways: it was claimed or endured. They defined their position as facilitating compliance to psychiatrist consultations, while assuring a complementary psychotherapeutic approach. Prescribing medication was not a priority for them. Conclusions: The identified under-detection is essentially due to inherent frontline conditions and complexity of clinical forms. The family physician role, facilitating compliance to psychiatrist consultations while assuring a support psychotherapy is the main result of this study. More studies should be conducted to define more accurately the clinical reality, management and course of current psychiatric disorders in primary care.

  8. Management strategies for encouraging creativity.

    PubMed

    Preston, P

    1998-01-01

    Change, chaos, and uncertainty touch every part of every institution. The laboratory is not immune. Managers content to continue on their familiar path soon will find themselves bypassed. To meet today's challenges, directors of technical operations, laboratory directors, team leaders, and coordinators need plenty of creativity--from everyone on their staff. It is no longer just "nice" to improve group output and problem-solving skills while staying within a "shoestring" budget. It is absolutely necessary. In this article, we explore strategies laboratory managers can use to tap the creative potential and commitment of their people. These strategies work. Whether it involves using humor, creating "idea centers," or "deconstructing the bureaucracy," the goal is the same: to encourage clinical managers to think beyond their technical and managerial experience. The examples in this article may not suit the needs, situations, or tastes of all laboratory managers. They are "food for thought." The concepts and strategies these examples illustrate are every laboratory manager's keys to adapting successfully to future challenges.

  9. Current penile-rehabilitation strategies: Clinical evidence

    PubMed Central

    Segal, Robert L.; Bivalacqua, Trinity J.; Burnett, Arthur L.

    2013-01-01

    We review the current strategies used for penile rehabilitation (PR) after a radical prostatectomy, where PR is defined as the attempt to restore spontaneous erectile function so that the patient can generate erections with no need for erectile aids. We searched PubMed for relevant reports, using the keywords ‘radical prostatectomy’, ‘penile rehabilitation’, ‘phosphodiesterase inhibitors’, ‘vacuum erection device’, ‘injection therapy’, ‘urethral suppository’, and ‘erectile dysfunction’. In all, 155 articles were identified and reviewed, and had a level of evidence ranging from 1b-4. The use of PR strategies should be based on the patient’s goals after a thorough explanation of realistic expectations, and the risks and consequences of the various treatment options. While a multitude of studies suggest a benefit with PR strategies, there are no established, proven regimens. Further research is needed to establish the optimal approaches to PR. PMID:26558087

  10. Current penile-rehabilitation strategies: Clinical evidence.

    PubMed

    Segal, Robert L; Bivalacqua, Trinity J; Burnett, Arthur L

    2013-09-01

    We review the current strategies used for penile rehabilitation (PR) after a radical prostatectomy, where PR is defined as the attempt to restore spontaneous erectile function so that the patient can generate erections with no need for erectile aids. We searched PubMed for relevant reports, using the keywords 'radical prostatectomy', 'penile rehabilitation', 'phosphodiesterase inhibitors', 'vacuum erection device', 'injection therapy', 'urethral suppository', and 'erectile dysfunction'. In all, 155 articles were identified and reviewed, and had a level of evidence ranging from 1b-4. The use of PR strategies should be based on the patient's goals after a thorough explanation of realistic expectations, and the risks and consequences of the various treatment options. While a multitude of studies suggest a benefit with PR strategies, there are no established, proven regimens. Further research is needed to establish the optimal approaches to PR.

  11. Sleep bruxism: Current knowledge and contemporary management.

    PubMed

    Yap, Adrian U; Chua, Ai Ping

    2016-01-01

    Bruxism is defined as the repetitive jaw muscle activity characterized by the clenching or grinding of teeth. It can be categorized into awake and sleep bruxism (SB). Frequent SB occurs in about 13% of adults. The exact etiology of SB is still unknown and probably multifactorial in nature. Current literature suggests that SB is regulated centrally (pathophysiological and psychosocial factors) and not peripherally (morphological factors). Cited consequences of SB include temporomandibular disorders, headaches, tooth wear/fracture, implant, and other restoration failure. Chairside recognition of SB involves the use of subjective reports, clinical examinations, and trial oral splints. Definitive diagnosis of SB can only be achieved using electrophysiological tools. Pharmacological, psychological, and dental strategies had been employed to manage SB. There is at present, no effective treatment that "cures" or "stops" SB permanently. Management is usually directed toward tooth/restoration protection, reduction of bruxism activity, and pain relief.

  12. Sleep bruxism: Current knowledge and contemporary management

    PubMed Central

    Yap, Adrian U.; Chua, Ai Ping

    2016-01-01

    Bruxism is defined as the repetitive jaw muscle activity characterized by the clenching or grinding of teeth. It can be categorized into awake and sleep bruxism (SB). Frequent SB occurs in about 13% of adults. The exact etiology of SB is still unknown and probably multifactorial in nature. Current literature suggests that SB is regulated centrally (pathophysiological and psychosocial factors) and not peripherally (morphological factors). Cited consequences of SB include temporomandibular disorders, headaches, tooth wear/fracture, implant, and other restoration failure. Chairside recognition of SB involves the use of subjective reports, clinical examinations, and trial oral splints. Definitive diagnosis of SB can only be achieved using electrophysiological tools. Pharmacological, psychological, and dental strategies had been employed to manage SB. There is at present, no effective treatment that “cures” or “stops” SB permanently. Management is usually directed toward tooth/restoration protection, reduction of bruxism activity, and pain relief. PMID:27656052

  13. Disease management strategies for wildlife.

    PubMed

    Wobeser, G

    2002-04-01

    Three basic forms of management strategies exist for wildlife disease, as follows: prevention of introduction of disease, control of existing disease or eradication. Management may be directed at the disease agent, host population, habitat or be focused on human activities. Disease agents may be dealt with in the environment through disinfection or in the host through treatment. Disinfection and pesticides used to destroy agents or vectors are limited to local situations, may have serious environmental effects and may result in acquired resistance. Difficulty in delivering treatment limits chemotherapy to local situations. Host populations may be managed by immunisation, by altering their distribution or density, or by extirpation. Immunisation is best suited for microparasitic exogenous infections with a low reproductive rate and in populations which have a low turnover. Mass immunisation with oral baits has been effective, but this strategy is limited to a few serious diseases. It is difficult to move wild animals and techniques to discourage animals from entering an area become ineffective rapidly. The setting up of fences is feasible only in local situations. Selective culling is limited to situations in which affected individuals are readily identifiable. General population reduction has had little success in disease control but reducing populations surrounding a focus or creating a barrier to disease movement have been successful. Population reduction is a temporary measure. Eradication of a wildlife population has not been attempted for disease management. Habitat modification may be used to reduce exposure to disease agents, or to alter host distribution or density. Management of diseases of wild animals usually requires a change in human activities. The most important method is by restricting translocation of wild animals to prevent movement of disease.

  14. Population communication management training strategy.

    PubMed

    Bayan Salas, E

    1985-01-01

    The discussion presents some thoughts on a general training strategy in information/education/communication (IEC) management which might meet the needs of 3rd world countries. Management by objectives (MBO) has emerged as the central doctrine in management theory and practice since its initial formulation in 1954. Yet, little evidence exists to date of its successful application in IEC activities. Population IEC activities, being staff activities in a nonprofit, public sector program, are in the "twilight zone" of MBO where hasty efforts to comply with the form if not the substance of this management technique can lead to lower levels of performance and achievement than before the goal setting system was implemented. Yet, clearly, IEC managers need the benefits that management by objectives can bring if done properly. It is essential that IEC managers and workers stop looking at IEC materials as end products in themselves but rather as inputs to be combined with other inputs in realizing the desired output of voluntary behavioral change on a mass level. To overcome tendencies toward provincialism, all IEC managers should initially spend time working in other areas of the population program. The experience of using IEC materials and approaches in face-to-face transactions with potential acceptors is a prerequisite to the successful formulation of such materials and approaches. Training programs for IEC managers and supervisors should emphasize development of consensual decision making skills. The success or failure of the program depends on the ability of its workers to resolve potential conflicts between an individual's priorities and national priorities in a noncoercive manner. The social dynamics approach that seeks a conscious, voluntary, nonmanipulated shift of shared attitudes, opinions, feelings, and actions is the approach underlying the most successful population programs. All IEC managers and supervisors should be systematically trained in norm shifting

  15. Current imaging strategies in rheumatoid arthritis

    PubMed Central

    Zeman, Merissa N; Scott, Peter JH

    2012-01-01

    As remission has now become a realistic therapeutic goal in the clinical management of RA due to the introduction and widespread adoption of biologic agents, there is a greater need for earlier diagnoses and objective methods for evaluating disease activity and response to treatment. In this capacity, advanced imaging strategies are assuming an expansive clinical role, particularly as they take advantage of newer imaging technologies and the shift toward imaging at the molecular level. Molecular imaging utilizes target-specific probes to non-invasively visualize molecular, cellular, and physiological perturbations in response to the underlying pathology. Probes for nuclear and MR imaging have been and are being developed that react with discrete aspects of inflammatory and destructive pathways specific to RA. These probes in addition to new MR sequences and contrast agents have the potential to provide an earlier and more reliable assessment of clinical outcome, disease activity, severity, and location, and therapeutic response. Furthermore, these imaging strategies may enable a more fundamental understanding of critical pathophysiological processes and the advent of new molecular therapies. This review will discuss these advances in both nuclear medicine and MRI strategies for imaging RA with a particular emphasis on molecular imaging. PMID:23133812

  16. Current data and strategy in glioblastoma multiforme

    PubMed Central

    Dinca, EB

    2009-01-01

    Glioblastoma multiforme (GBM) or astrocytoma grade Ⅳ on WHO classification is the most aggressive and the most frequent of all primary brain tumors. Glioblastoma is multiforme , resistant to therapeutic interventions illustrating the heterogeneity exhibited by this tumor in its every aspect, including clinical presentation, pathology, genetic signature. Current data and treatment strategy in GBM are presented focusing on basic science data and key clinical aspects like surgery, including personal experience; adjuvant modalities: radiotherapy, chemotherapy, but also for experimental approaches. Therapeutic attitude in recurrent GBM is also widely discussed. PMID:20108752

  17. Quality management under current conditions

    NASA Astrophysics Data System (ADS)

    Vasiliev, V. A.; Aleksandrova, S. V.

    2015-12-01

    The diversity of the concept of quality is defined. Modern quality management methods and tools are considered. The global components of quality management and quality management system ISO 9000 are discussed. Education requirements for specialists in the field of quality are formulated.

  18. Molecular Imaging: Current Status and Emerging Strategies

    PubMed Central

    Pysz, Marybeth A.; Gambhir, Sanjiv S.; Willmann, Jürgen K.

    2011-01-01

    In vivo molecular imaging has a great potential to impact medicine by detecting diseases in early stages (screening), identifying extent of disease, selecting disease- and patient-specific therapeutic treatment (personalized medicine), applying a directed or targeted therapy, and measuring molecular-specific effects of treatment. Current clinical molecular imaging approaches primarily use PET- or SPECT-based techniques. In ongoing preclinical research novel molecular targets of different diseases are identified and, sophisticated and multifunctional contrast agents for imaging these molecular targets are developed along with new technologies and instrumentation for multimodality molecular imaging. Contrast-enhanced molecular ultrasound with molecularly-targeted contrast microbubbles is explored as a clinically translatable molecular imaging strategy for screening, diagnosing, and monitoring diseases at the molecular level. Optical imaging with fluorescent molecular probes and ultrasound imaging with molecularly-targeted microbubbles are attractive strategies since they provide real-time imaging, are relatively inexpensive, produce images with high spatial resolution, and do not involve exposure to ionizing irradiation. Raman spectroscopy/microscopy has emerged as a molecular optical imaging strategy for ultrasensitive detection of multiple biomolecules/biochemicals with both in vivo and ex vivo versatility. Photoacoustic imaging is a hybrid of optical and ultrasound modalities involving optically-excitable molecularly-targeted contrast agents and quantitative detection of resulting oscillatory contrast agent movement with ultrasound. Current preclinical findings and advances in instrumentation such as endoscopes and microcatheters suggest that these molecular imaging modalities have numerous clinical applications and will be translated into clinical use in the near future. PMID:20541650

  19. Current Management of Undescended Testes

    PubMed Central

    Kurz, David

    2016-01-01

    Opinion Statement Undescended testes (UDTs) are a relatively common finding in newborn males, especially in those born prematurely. Upon discovering a non-intrascrotal testis, it is important to determine whether the testis is palpable or non-palpable and whether the finding is unilateral or bilateral. Imaging should not be used in this workup, as no current modality has been shown to be adequately sensitive or specific to aid in management decisions. Patients with UDTs diagnosed after 6 months of age should be referred to a specialist for correction so that surgery may be performed within 1 year thereafter. This allows testes to descend spontaneously if they are to do so while facilitating early intervention to decrease the risk of subfertility and testicular malignancy for those patients in whom spontaneous descent does not occur. The surgical approach is often dependent on the location of the testis on physical exam. Most orchiopexies for palpable testes are performed through an inguinal incision, although a scrotal approach can be safely utilized depending on the testis position. Diagnostic laparoscopy is most often used for non-palpable testes, as it not only allows for the identification of an atrophic or absent testicle, but it also provides an opportunity to perform an orchiopexy simultaneously should a viable testis be found. Hormonal therapy is not recommended for treatment of UDTs due to its low success rate, the incidence of secondary re-ascent, and the possible detrimental effects on spermatogenesis. Finally, patients with bilateral non-palpable UDTs require a more extensive preliminary evaluation to rule out congenital adrenal hyperplasia (CAH) and disorders of sexual development (DSD). This involves serum electrolytes, karyotype analysis and hormonal testing including a serum müllerian inhibiting substance (MIS), in order to determine if testicular tissue is present and functional. PMID:27158583

  20. Overview of current immunotherapeutic strategies for glioma

    PubMed Central

    Calinescu, Anda-Alexandra; Kamran, Neha; Baker, Gregory; Mineharu, Yohei; Lowenstein, Pedro Ricardo; Castro, Maria Graciela

    2015-01-01

    In the last decade, numerous studies of immunotherapy for malignant glioma (glioblastoma multiforme) have brought new knowledge and new hope for improving the prognosis of this incurable disease. Some clinical trials have reached Phase III, following positive outcomes in Phase I and II, with respect to safety and immunological end points. Results are encouraging especially when considering the promise of sustained efficacy by inducing antitumor immunological memory. Progress in understanding the mechanisms of tumor-induced immune suppression led to the development of drugs targeting immunosuppressive checkpoints, which are used in active clinical trials for glioblastoma multiforme. Insights related to the heterogeneity of the disease bring new challenges for the management of glioma and underscore a likely cause of therapeutic failure. An emerging therapeutic strategy is represented by a combinatorial, personalized approach, including the standard of care: surgery, radiation, chemotherapy with added active immunotherapy and multiagent targeting of immunosuppressive checkpoints. PMID:26598957

  1. 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.*

  2. DETERMINANTS OF NETWORK OUTCOMES: THE IMPACT OF MANAGEMENT STRATEGIES

    PubMed Central

    YSA, TAMYKO; SIERRA, VICENTA; ESTEVE, MARC

    2014-01-01

    The literature on network management is extensive. However, it generally explores network structures, neglecting the impact of management strategies. In this article we assess the effect of management strategies on network outcomes, providing empirical evidence from 119 urban revitalization networks. We go beyond current work by testing a path model for the determinants of network outcomes and considering the interactions between the constructs: management strategies, trust, complexity, and facilitative leadership. Our results suggest that management strategies have a strong effect on network outcomes and that they enhance the level of trust. We also found that facilitative leadership has a positive impact on network management as well as on trust in the network. Our findings also show that complexity has a negative impact on trust. A key finding of our research is that managers may wield more influence on network dynamics than previously theorized. PMID:25520529

  3. Homosexuality in Turkey: strategies for managing heterosexism.

    PubMed

    Bakacak, Ayça Gelgeç; Oktem, Pinar

    2014-01-01

    The goal of this study was to identify the strategies used by young homosexuals to manage their sexual minority status in Turkey. In-depth interviews were conducted with 15 self-identified homosexual university students. The data on the strategies employed by homosexuals suggested a categorization of these strategies into four interrelated areas: strategies employed in the process of self-acceptance; strategies to manage sexual stigma and prejudice; strategies specific to the coming-out process; and the strategies used while openly expressing their sexual identities.

  4. Novel strategies for managing pancreatic cancer

    PubMed Central

    Loc, Welley S; Smith, Jill P; Matters, Gail; Kester, Mark; Adair, James H

    2014-01-01

    With the incidence reports of pancreatic cancer increasing every year, research over the last several decades has been focused on the means to achieve early diagnosis in patients that are at a high risk of developing the malignancy. This review covers current strategies for managing pancreatic cancer and further discusses efforts in understanding the role of early onset symptoms leading to tumor progression. Recent investigations in this discussion include type 3c diabetes, selected biomarkers and pathways related to pancreatic intraepithelial neoplasia lesions, drug resistance, and advances in nanomedicine which may provide significant solutions for improving early detection and treatments in future medicine. PMID:25356034

  5. Disease management strategies: managing care giving in managed care.

    PubMed

    Nesse, R E; Hagedorn, S D; Scheitel, S M; Nyman, M A; Broers, J K

    2000-01-01

    The rapid rate of change in health care delivery systems has challenged and troubled health care providers. Some new health care delivery systems primarily emphasize the economics of medical care and leave providers with a sense that their profession has strayed from its mission. In addition, there is an increasing demand by payers and the public for public accountability for the quality and expense of clinical services. One response to these changes in health care is the use of disease management strategies. There is a growing body of knowledge regarding disease management strategies and practice guidelines in the literature. This article discusses how a provider group can implement improvement in the clinical process successfully by applying techniques of disease management.

  6. Neurocysticercosis: Diagnostic problems & current therapeutic strategies

    PubMed Central

    Rajshekhar, Vedantam

    2016-01-01

    Neurocysticercosis (NCC) is the most common single cause of seizures/epilepsy in India and several other endemic countries throughout the world. It is also the most common parasitic disease of the brain caused by the cestode Taenia solium or pork tapeworm. The diagnosis of NCC and the tapeworm carrier (taeniasis) can be relatively inaccessible and expensive for most of the patients. In spite of the introduction of several new immunological tests, neuroimaging remains the main diagnostic test for NCC. The treatment of NCC is also mired in controversy although, there is emerging evidence that albendazole (a cysticidal drug) may be beneficial for patients by reducing the number of seizures and hastening the resolution of live cysts. Currently, there are several diagnostic and management issues which remain unresolved. This review will highlight some of these issues. PMID:28139530

  7. Diabetes benefit management: evolving strategies for payers.

    PubMed

    Tzeel, Albert L

    2011-11-01

    Over the next quarter century, the burden of type 2 diabetes mellitus (T2DM) is expected to at least double. Currently, 1 in every 10 healthcare dollars is spent on diabetes management; by 2050, it has been projected that the annual costs of managing T2DM will rise to $336 billion. Without substantial, systemic changes, T2DM management costs will lead to a potentially untenable strain on the healthcare system. However, the appropriate management of diabetes can reduce associated mortality and delay comorbidities. In addition, adequate glycemic control can improve patient outcomes and significantly reduce diabetes-related complications. This article provides an overview of key concepts associated with a value-based insurance design (VBID) approach to T2DM coverage. By promoting the use of services or treatments that provide high benefits relative to cost, and by alternatively discouraging patients from utilizing services whose benefits do not justify their cost, VBID improves the quality of healthcare while simultaneously reining in spending. VBID initiatives tend to focus on chronic disease management and generally target prescription drug use. However, some programs have expanded their scope by incorporating services traditionally offered by wellness and disease management programs. The concept of VBID is growing, and it is increasingly being implemented by a diverse and growing number of public and private entities, including pharmacy benefit managers, health plans, and employers. This article provides key background on VBID strategies, with a focus on T2DM management. It also provides a road map for health plans seeking to implement VBID as part of their programs.

  8. Current Management of Fecal Incontinence

    PubMed Central

    Wang, Jennifer Y; Abbas, Maher A

    2013-01-01

    Objective: To review the management of fecal incontinence, which affects more than 1 in 10 people and can have a substantial negative impact on quality of life. Methods: The medical literature between 1980 and April 2012 was reviewed for the evaluation and management of fecal incontinence. Results: A comprehensive history and physical examination are required to help understand the severity and type of symptoms and the cause of incontinence. Treatment options range from medical therapy and minimally invasive interventions to more invasive procedures with varying degrees of morbidity. The treatment approach must be tailored to each patient. Many patients can have substantial improvement in symptoms with dietary management and biofeedback therapy. For younger patients with large sphincter defects, sphincter repair can be helpful. For patients in whom biofeedback has failed, other options include injectable medications, radiofrequency ablation, or sacral nerve stimulation. Patients with postdefecation fecal incontinence and a rectocele can benefit from rectocele repair. An artificial bowel sphincter is reserved for patients with more severe fecal incontinence. Conclusion: The treatment algorithm for fecal incontinence will continue to evolve as additional data become available on newer technologies. PMID:24355892

  9. [Global brain metastases management strategy: a multidisciplinary-based approach].

    PubMed

    Métellus, P; Tallet, A; Dhermain, F; Reyns, N; Carpentier, A; Spano, J-P; Azria, D; Noël, G; Barlési, F; Taillibert, S; Le Rhun, É

    2015-02-01

    Brain metastases management has evolved over the last fifteen years and may use varying strategies, including more or less aggressive treatments, sometimes combined, leading to an improvement in patient's survival and quality of life. The therapeutic decision is subject to a multidisciplinary analysis, taking into account established prognostic factors including patient's general condition, extracerebral disease status and clinical and radiological presentation of lesions. In this article, we propose a management strategy based on the state of current knowledge and available therapeutic resources.

  10. Current management of molar pregnancy.

    PubMed

    Hancock, Barry W; Tidy, John A

    2002-05-01

    Molar pregnancy remains an uncommon and still not fully understood disorder. The clinical presentation has changed over recent decades. In developed countries complete moles are now usually diagnosed early (on clinical and/or ultrasound scan criteria) so that the more severe clinical presentations are much less commonly seen. The important differences between complete and partial moles and their risk factors are now well recognized. Common protocols for managing persistent gestational trophoblastic disease are being derived, and molecular genetic studies are advancing our understanding of molar pregnancy and its sequelae. Cure rates approaching 100% should now be the rule rather than the exception. There is a strong case for formal registration and monitoring of all cases through specialist centers.

  11. Current management of wound healing.

    PubMed

    Gottrup, F; Karlsmark, T

    2009-06-01

    While the understanding of wound pathophysiology has progressed considerably over the past decades the improvements in clinical treatment has occurred to a minor degree. During the last years, however, new trends and initiatives have been launched, and we will continue to attain new information in the next decade. It is the hope that increasing parts of the new knowledge from basic wound healing research will be implemented in daily clinical practice. The development of new treatment products will also continue, and especially new technologies with combined types of dressing materials or dressing containing active substances will be accentuated. Further developments in the management structure and education will also continue and consensus of treatment guidelines, recommendations and organization models will hopefully be achieved.

  12. [Current strategies for the prevention of malaria].

    PubMed

    Gentilini, M; Danis, M; Mouchet, J

    1990-01-01

    Two billion of persons live in regions where endemic malaria prevails or has reappeared. An estimated on hundred million infected individuals per year have been reported around the world. In front of this alarming situation, the diversity and even the incoherence of the currently proposed prophylactic regimens confuses the therapists and renders difficult the adoption of an efficacious strategy. The extension and gravity of drug resistance of P. falciparum and the withdrawal of anti-vectorial campaign constitute two reasons for the present recrudescence of malaria. The preventive strategies in 1990 are based on: rehabilitation of anti-vectorial campaign particularly against nocturnal mosquito bites, applicable to all, everywhere and at all times, by the means of individual and collective measures and mostly by impregnated nets; chemoprophylaxis for which two situations should be distinguished: the non immune traveler leaving for a short period (inferior or equal to 3 months) to an endemic area: individuals living permanently or for long periods in tropical regions. Prevention for short stays In low risk transmission zone (North Africa, Mexico, large cities of South East Asia) whatever the duration, suppression of chemoprophylaxis is acceptable. In high risk transmission zone, three strategies exist according to the intensity and frequency of drug resistance: zone 1 (P. vivax or drug sensitive P. falciparum): chloroquine at a dose of 100 mg/day for adults (1.5 mg/kg/day for children) 6 days out of 7, from the day of departure trough the whole stay and for one month after the return, is still efficacious; zone 2 (moderate frequency of drug resistance): protection is again ensured by chloroquine only, as in zone 1, or better than that by the association of chloroquine 300 mg once a week and proguanil 200 mg/day (3 mg/kg/day for children). The side effects of mefloquine and the risk of generation drug resistance argue against its general use in this zone particularly

  13. Orofacial pain management: current perspectives

    PubMed Central

    Romero-Reyes, Marcela; Uyanik, James M

    2014-01-01

    Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). Orofacial pain (OFP) can arise from different regions and etiologies. Temporomandibular disorders (TMD) are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities. PMID:24591846

  14. Orofacial pain management: current perspectives.

    PubMed

    Romero-Reyes, Marcela; Uyanik, James M

    2014-01-01

    Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). Orofacial pain (OFP) can arise from different regions and etiologies. Temporomandibular disorders (TMD) are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities.

  15. Stereotactic body radiotherapy: current strategies and future development

    PubMed Central

    2016-01-01

    Stereotactic body radiotherapy (SBRT) has emerged as the standard treatment for medically inoperable early-staged non-small cell lung cancer (NSCLC). The local control rate after SBRT is over 90%. Some forms of tumour motion management and image-guided radiation delivery techniques are the prerequisites for fulfilment of its goal to deliver a high radiation dose to the tumour target without overdosing surrounding normal tissues. In this review, the current strategies of tumour motion management will be discussed, followed by an overview of various image-guided radiotherapy (RT) systems and devices available for clinical practice. Besides medically inoperable stage I NSCLC, SBRT has also been widely adopted for treatment of oligometastasis involving the lungs. Its possible applications in various other cancer illnesses are under extensive exploration. The progress of SBRT is critically technology-dependent. With advancement of technology, the ideal of personalised, effective and yet safe SBRT is already on the horizon. PMID:27606082

  16. Current perioperative management of pheochromocytomas

    PubMed Central

    Ramachandran, Rashmi; Rewari, Vimi

    2017-01-01

    Neuroendocrine tumors which have the potential to secrete catecholamines are either associated with sympathetic adrenal (pheochromocytoma) or nonadrenal (paraganglioma) tissue. Surgical removal of these tumors is always indicated to cure and prevent cardiovascular and other organ system complications associated with catecholamine excess. Some of these tumors have malignant potential as well. The diagnosis, localization and anatomical delineation of these tumors involve measurement of catecholamines and their metabolic end products in plasma and urine, 123I-metaiodobenzylguanidine scintigraphy, computed tomography, and/or magnetic resonance imaging. Before surgical removal of the tumors, the optimization of blood pressure, as well as intravascular volume, is an important measure to avoid and suppress perioperative adverse hemodynamic events. Preoperative preparation includes the use of alpha-adrenergic antagonists, beta-adrenergic antagonists with or without other antihypertensive agents, fluid therapy as well as insulin therapy for hyperglycemia if required. Due attention should be given to type and dose of alpha-receptor antagonists to be used and the duration of this therapy to achieve an optimal level of preoperative “alpha-blockade.” Despite this preoperative preparation, many patients will have hypertensive crises intraoperatively which need to be promptly and carefully managed by the anesthesia team which requires intensive and advanced monitoring techniques. The most common complication after tumor removal is hypotension which may require fluid therapy and vasopressor support for a few hours. With advancement in surgical and anesthetic techniques, the incidence of severe morbidity and mortality associated with the surgery is low in high volume centers. PMID:28197025

  17. Anthelmintic treatment strategies: current status and future.

    PubMed

    Williams, J C

    1997-11-01

    Despite the array of anthelmintics and endectocides and delivery systems available for use in the prevention and control of nematode parasites of ruminants, the number of highly effective control programs that have been developed and even the number of such programs that have been successfully implemented in commercial animal production, there have been no recent innovations or discoveries in regard to strategies, new anthelmintics, or systems for controlling nematode parasites through anthelmintic use. In the traditional sense of chemotherapy-chemoprophylaxis, we have probably achieved the maximum effect of what is possible from excellent anthelmintics developed by the pharmaceutical industry over the last 35 years, i.e. from thiabendazole through levamisole and morantel tartrate, to more advanced benzimidazoles and to the avermectins and milbemycins. At the core of all anthelmintic treatment-related problems is the lingering conception among a large body of animal producers that anthelmintic treatment is the only effort needed to control parasitism and its effects on host animals. This concept has given rise to the long-standing difficulty of drug resistance in sheep nematodes and the not remote possibility of its development in nematodes of cattle. Along with this are serious concerns over environmental toxicity, tissue residues and enormous financial investment to develop new and novel anthelmintic compounds. Progress is being made in current and intensive searches for development and testing of control approaches alternative to anthelmintics, e.g. helminth vaccines, biological control agents such as fungi, selection of resistant sires, alternative chemicals and nematode growth regulators. A timetable for when alternative controls can be developed fully and put into practical use cannot be predicted. It is universally acknowledged among parasitologists that existing anthelmintics must be preserved and utilized judiciously to ensure continued effectiveness. A

  18. Disease management as a performance improvement strategy.

    PubMed

    McClatchey, S

    2001-11-01

    Disease management is a strategy of organizing care and services for a patient population across the continuum. It is characterized by a population database, interdisciplinary and interagency collaboration, and evidence-based clinical information. The effectiveness of a disease management program has been measured by a combination of clinical, financial, and quality of life outcomes. In early 1997, driven by a strategic planning process that established three Centers of Excellence (COE), we implemented disease management as the foundation for a new approach to performance improvement utilizing five key strategies. The five implementation strategies are outlined, in addition to a review of the key elements in outcome achievement.

  19. Time management strategies for research productivity.

    PubMed

    Chase, Jo-Ana D; Topp, Robert; Smith, Carol E; Cohen, Marlene Z; Fahrenwald, Nancy; Zerwic, Julie J; Benefield, Lazelle E; Anderson, Cindy M; Conn, Vicki S

    2013-02-01

    Researchers function in a complex environment and carry multiple role responsibilities. This environment is prone to various distractions that can derail productivity and decrease efficiency. Effective time management allows researchers to maintain focus on their work, contributing to research productivity. Thus, improving time management skills is essential to developing and sustaining a successful program of research. This article presents time management strategies addressing behaviors surrounding time assessment, planning, and monitoring. Herein, the Western Journal of Nursing Research editorial board recommends strategies to enhance time management, including setting realistic goals, prioritizing, and optimizing planning. Involving a team, problem-solving barriers, and early management of potential distractions can facilitate maintaining focus on a research program. Continually evaluating the effectiveness of time management strategies allows researchers to identify areas of improvement and recognize progress.

  20. Speed Management Strategies; A Systematic Review

    PubMed Central

    Sadeghi-Bazargani, Homayoun; Saadati, Mohammad

    2016-01-01

    Objective: To systematically identify the various methods of speed management and their effects. Methods: A systematic search was performed in Science Direct, Ovid Medline, Scopus, PubMed and ProQuest databases from April to June 2015. Hand searching and reference of selected articles were used to improve article identification. Articles published after 1990 which had reported on efficacy/effectiveness of speed management strategies were included. Data were extracted using pre-defined extraction table. Results: Of the 803 retrieved articles, 22 articles were included in this review. Most of the included articles (63%) had before-after design and were done in European countries. Speed cameras, engineering schemes, intelligent speed adaption (ISA), speed limits and zones, vehicle activated sign and integrated strategies were the most common strategies reported in the literature. Various strategies had different effects on mean speed of the vehicles ranging from 1.6 to 10 km/h. Moreover, 8-65% and 11-71% reduction was reported in person injured accidents and fatal accidents, respectively as a result of employing various strategies. Conclusion: Literature revealed positive effects of various speed management strategies. Using various strategies was mostly dependent on road characteristics, driver’s attitude about the strategy as well as economic and technological capabilities of the country. Political support is considered as a main determinant in selecting speed management strategies. PMID:27540546

  1. Pharmacological and psychosocial management of mental, neurological and substance use disorders in low- and middle-income countries: issues and current strategies.

    PubMed

    de Jesus Mari, Jair; Tófoli, Luís Fernando; Noto, Cristiano; Li, Li M; Diehl, Alessandra; Claudino, Angélica M; Juruena, Mario F

    2013-09-01

    Mental, neurological, and substance use disorders (MNS) are among the largest sources of medical disability in the world, surpassing both cardiovascular disease and cancer. The picture is not different in low- and middle-income countries (LAMIC) where the relative morbidity associated with MNS is increasing, as a consequence of improvement in general health indicators and longevity. However, 80 % of individuals with MNS live in LAMIC but only close to 20 % of cases receive some sort of treatment. The main aim of this article is to provide non-specialist health workers in LAMIC with an accessible guide to the affordable essential psychotropics and psychosocial interventions which are proven to be cost effective for treating the main MNS. The MNS discussed in this article were selected on the basis of burden, following the key priority conditions selected by the Mental Health Action Programme (mhGAP) developed by the World Health Organization (WHO) (anxiety, stress-related and bodily distress disorders; depression and bipolar disorder; schizophrenia; alcohol and drug addiction; and epilepsy), with the addition of eating disorders, because of their emergent trend in middle-income countries. We review best evidence-based clinical practice in these areas, with a focus on drugs from the WHO Model List of Essential Medicines and the psychosocial interventions available in LAMIC for the management of these conditions in primary care. We do this by reviewing guidelines developed by prestigious professional associations and government agencies, clinical trials conducted in LAMIC and systematic reviews (including Cochrane reviews) identified from the main international literature databases (MEDLINE, EMBASE and PsycINFO). In summary, it can be concluded that the availability and use of the psychotropics on the WHO Model List of Essential Medicines in LAMIC, plus an array of psychosocial interventions, can represent a cost-effective way to expand treatment of most MNS. The

  2. Multiple Strategies for Teaching Current Events.

    ERIC Educational Resources Information Center

    Haas, Mary E.; Laughlin, Margaret A.

    Teacher members of the National Council for the Social Studies (NCSS) describe the study of current events as essential or very important to the social studies curriculum. Most teachers indicated using current events to provide contemporary examples of abstract historical, social, economic, and political concepts or to illustrate the continuity of…

  3. Epidemiology of MRSA and current strategies in Europe and Japan

    PubMed Central

    Kramer, Axel; Wagenvoort, Hans; Åhrén, Christina; Daniels-Haardt, Inka; Hartemann, Philippe; Kobayashi, Hiro; Kurcz, Andrea; Picazo, Juan; Privitera, Gaetano; Assadian, Ojan

    2010-01-01

    The prevalence of health-care associated infections caused by multi-drug resistant organisms has significantly increased over the past decade. Among these organisms, Methicillin-resistant Staphylococcus aureus (MRSA) plays a prominent and increasing role. Because of consequences for patients and the economic burden in course of prolonged treatment following MRSA infections and additional indirect costs for e.g. isolation or antiseptic treatment, this trend will further damage European health-care systems. In 2006, a workshop was initiated at the 8th International Congress of the German Society of Hospital Hygiene held in Berlin. The aim of this workshop was to give an overview of the current situation of MRSA in selected European countries and to elaborate on potential strategies to prevent MRSA-infections and dissemination. A questionnaire encompassing 20 questions addressed topics such as epidemiology, current measures and future prospects was distributed to representatives from various European countries and Japan. A variety of widely different answers was obtained. It was shown that in all countries prevalence of MRSA is on a rising tide. This trend is observable in all European countries, albeit less strong in The Netherlands, Slovenia, France, Austria and Scandinavian countries. It was conclude that prevention strategies in a united and expanding European Community will become of utmost importance and that rapid screening strategies, e.g. PCR, might be of assistance in such an approach. A potential strategy to improve infection control measures could be the requirement of health-insurance providers to sign contracts only with hospitals able to proof having an infection control management in place. PMID:20204100

  4. 15 Strategies for Managing Attention Problems

    ERIC Educational Resources Information Center

    Thorne, Glenda; Thomas, Alice; Lawson, Candy

    2005-01-01

    In this document, 15 strategies are offered for enhancing attention and managing attention problems. This listing is by no means exhaustive, but rather is meant as a place to begin. The best resources for strategies are the creative, inventive minds of enlightened assessment professionals, teachers and parents, in partnership with the students…

  5. Optimizing diabetes management: managed care strategies.

    PubMed

    Tzeel, E Albert

    2013-06-01

    Both the prevalence of type 2 diabetes mellitus (DM) and its associated costs have been rising over time and are projected to continue to escalate. Therefore, type 2 DM (T2DM) management costs represent a potentially untenable strain on the healthcare system unless substantial, systemic changes are made. Managed care organizations (MCOs) are uniquely positioned to attempt to make the changes necessary to reduce the burdens associated with T2DM by developing policies that align with evidence-based DM management guidelines and other resources. For example, MCOs can encourage members to implement healthy lifestyle choices, which have been shown to reduce DM-associated mortality and delay comorbidities. In addition, MCOs are exploring the strengths and weaknesses of several different benefit plan designs. Value-based insurance designs, sometimes referred to as value-based benefit designs, use both direct and indirect data to invest in incentives that change behaviors through health information technologies, communications, and services to improve health, productivity, quality, and financial trends. Provider incentive programs, sometimes referred to as "pay for performance," represent a payment/delivery paradigm that places emphasis on rewarding value instead of volume to align financial incentives and quality of care. Accountable care organizations emphasize an alignment between reimbursement and implementation of best practices through the use of disease management and/ or clinical pathways and health information technologies. Consumer-directed health plans, or high-deductible health plans, combine lower premiums with high annual deductibles to encourage members to seek better value for health expenditures. Studies conducted to date on these different designs have produced mixed results.

  6. Winning Strategies for Classroom Management.

    ERIC Educational Resources Information Center

    Cummings, Carol

    This book offers advice on arranging classrooms, diagnosing student behavior, and responding to students' emotional needs, examining intellectual, emotional, and physical challenges students face and providing strategies which help teachers create communities of learners, design classrooms, diagnose student behavior, and respond to student needs.…

  7. Strategies for Management of Colorectal Endometriosis.

    PubMed

    Abrão, Mauricio Simões; Borrelli, Giuliano Moysés; Clarizia, Roberto; Kho, Rosanne Marie; Ceccaroni, Marcello

    2017-01-01

    Endometriosis has clearly three distinct clinical presentations and deep endometriosis, especially compromising the rectosigmoid is probably the most concerning one for both patients and surgeons. Currently, with the available tools, it is mandatory to have a precise diagnostic of this type of disease prior to indication of treatment. Strategies to manage this form of endometriosis will take into account several involved aspects, such as age of the patient, reproductive desire or infertility, clinical symptoms, as well as the extension and localization of the disease. Treatment could vary from more conservative to more radical depending on those aspects. As we pointed out in this article, the key to manage colorectal endometriosis is to start with a good diagnosis. Knowing exactly what is the extension and localization of the disease and knowing the patient's wishes as well as the clinical complaints, surgeons are able to define the best option for each patient. Critical points should always be discussed; for example, patients chosen to have clinical treatment should be aware of important issues regarding the follow-up, while patients undergoing surgery must be advised about all surgical possibilities and related complications.

  8. Selecting habitat management strategies on refuges

    USGS Publications Warehouse

    Schroeder, Richard L.; King, Wayne J.; Cornely, John E.

    1998-01-01

    This report is a joint effort of the Biological Resources Division, U.S. Geological Survey and the U.S. Fish and Wildlife Service (FWS) to provide National Wildlife Refuge (NWR) managers guidance on the selection and evaluation of habitat management strategies to meet stated objectives. The FWS recently completed a handbook on writing refuge management goals and objectives (U.S. Fish and Wildlife Service 1996a). the National Wildlife Refuge System Improvement Act of 1997 requires that National Wildlife Refuge System (NWRS) lands be managed according to approved Comprehensive Conservation Plans to guide management decisions and devise strategies for achieving refuge unit purposes and meeting the NWRS mission. It is expected that over the next several years most refuges will develop new or revised refuge goals and objectives for directing their habitat management strategies. This paper outlines the steps we recommend in selecting and evaluating habitat management strategies to meet specific refuge habitat objectives. We selected two examples to illustrate the process. Although each refuge is unique and will require specific information and solutions, these two examples can be used as guidance when selecting and evaluating habitat management strategies for other refuge resources: Example 1. Management of floodplain woods habitat for forest interior birds. The biological recourse of concern is the quality and quantity of floodplain woods habitat for eastern forest interior birds in the Cypress Creek NWR (U.S. Fish and Wildlife Service 1996b). Example 2. Management of habitat for biodiversity: Historical landscape proportions. The biological resource of concern is the change in diversity associated with man-induced changes in the distribution and abundance of habitat types at the Minnesota Valley NWR (U.S. Fish and Wildlife Service 1996c).

  9. Internationalisation Strategies for Management Education.

    ERIC Educational Resources Information Center

    Howe, W. Stewart; Martin, Graeme

    1998-01-01

    A literature review and case study of a British business school examined these areas: (1) competing rationales for internationalizing management education; (2) transfer of best practice from the west; and (3) problems that parent and host countries face in joint ventures. (SK)

  10. Current guidelines in defining therapeutic strategies.

    PubMed

    Ferrajoli, Alessandra; Keating, Michael J

    2004-08-01

    The past three decades have brought major changes in the approach toward chronic lymphocytic leukemia (CLL). This disease was considered a simple form of leukemia for which the only goal of treatment was control of the leukocytosis and of the symptoms related to disease expansion. Many biologic discoveries have increased our understanding of the disease process. New prognostic markers have been identified and are being incorporated into clinical practice. Now, CLL is considered a complex and challenging leukemia for which multiple treatment options are emerging, from chemotherapy to monoclonal antibodies, from vaccines to immunomodulatory strategies. The evaluation of treatment results also has been revolutionized: clones carrying genetic aberrations are monitored, and patients who have had a response are assessed for the presence of minimal residual disease.

  11. Evolution in clinical knowledge management strategy at Intermountain Healthcare.

    PubMed

    Hulse, Nathan C; Galland, Joel; Borsato, Emerson P

    2012-01-01

    In this manuscript, we present an overview of the clinical knowledge management strategy at Intermountain Healthcare in support of our electronic medical record systems. Intermountain first initiated efforts in developing a centralized enterprise knowledge repository in 2001. Applications developed, areas of emphasis served, and key areas of focus are presented. We also detail historical and current areas of emphasis, in response to business needs.

  12. Managing Work and Family: Do Control Strategies Help?

    ERIC Educational Resources Information Center

    Versey, H. Shellae

    2015-01-01

    How can we effectively manage competing obligations from work and family without becoming overwhelmed? This question inspires the current study by examining control strategies that may facilitate better work-life balance, with a specific focus on the role of lowered aspirations and positive reappraisals, attitudes that underlie adaptive coping…

  13. Current strategies of blood doping detection.

    PubMed

    Pottgiesser, Torben; Schumacher, Yorck Olaf

    2013-12-01

    During the last 30 years, the artificial increase of red blood cell volume ("blood doping") has changed the level of performance in all endurance sports. Many doping scandals have shown the extent of the problem. The detection of blood doping relies on two different approaches: the direct detection of exogenous manipulating substances (erythropoietic stimulants) or red cells (homologous transfusion) and the indirect detection, where not the doping substance or technique itself, but its effect on certain biomarkers is measured. Whereas direct detection using standard laboratory procedures such as isoelectric focusing can identify erythropoietic stimulants, homologous blood transfusion is identified through mismatches in minor blood group antigens by flow cytometry. Indirect methods such as the athlete biological passport are the only means to detect autologous transfusion and may also be used for the detection of erythropoietic stimulants or homologous transfusion. New techniques to unmask blood doping include the use of high-throughput 'omics' technologies (proteomics/metabolomics) and the combination of different biomarkers with the help of mathematical approaches. Future strategies should aim at improving the use of the available data and resources by applying pattern recognition algorithms to recognize suspicious athletes and, on the basis of these findings, use the appropriate testing method. Different types of information should be combined in the quest for a forensic approach to anti-doping.

  14. Cancer pain management-current status

    PubMed Central

    Thapa, Deepak; Rastogi, V; Ahuja, Vanita

    2011-01-01

    Cancer pain is still one of the most feared entities in cancer and about 75% of these patients require treatment with opioids for severe pain.The cancer pain relief is difficult to manage in patients with episodic or incidental pain, neuropathic pain, substance abuse and with impaired cognitive or communication skills. This non-systematic review article aims to discuss reasons for under treatment, tools of pain assessment, cancer pain and anxiety and possibly carve new approaches for cancer pain management in future. The current status of World Health Organization analgesic ladder has also been reviewed. A thorough literature search was carried out from 1998 to 2010 for current status in cancer pain management in MEDLINE, WHO guidelines and published literature and relevant articles have been included. PMID:21772673

  15. Current drug discovery strategies against arenavirus infections.

    PubMed

    Pasquato, Antonella; Burri, Dominique J; Kunz, Stefan

    2012-11-01

    Arenaviruses are a large group of emerging viruses including several causative agents of severe hemorrhagic fevers with high mortality in man. Considering the number of people affected and the currently limited therapeutic options, novel efficacious therapeutics against arenaviruses are urgently needed. Over the past decade, significant advances in knowledge about the basic virology of arenaviruses have been accompanied by the development of novel therapeutics targeting different steps of the arenaviral life cycle. High-throughput, small-molecule screens identified potent and broadly active inhibitors of arenavirus entry that were instrumental for the dissection of unique features of arenavirus fusion. Novel inhibitors of arenavirus replication have been successfully tested in animal models and hold promise for application in humans. Late in the arenavirus life cycle, the proteolytic processing of the arenavirus envelope glycoprotein precursor and cellular factors critically involved virion assembly and budding provide further promising 'druggable' targets for novel therapeutics to combat human arenavirus infection.

  16. Current and Future Parts Management at NASA

    NASA Technical Reports Server (NTRS)

    Sampson, Michael J.

    2011-01-01

    This presentation provides a high level view of current and future electronic parts management at NASA. It describes a current perspective of the new human space flight direction that NASA is beginning to take and how that could influence parts management in the future. It provides an overview of current NASA electronic parts policy and how that is implemented at the NASA flight Centers. It also describes some of the technical challenges that lie ahead and suggests approaches for their mitigation. These challenges include: advanced packaging, obsolescence and counterfeits, the global supply chain and Commercial Crew, a new direction by which NASA will utilize commercial launch vehicles to get astronauts to the International Space Station.

  17. Tissue Engineering: Current Strategies and Future Directions

    PubMed Central

    Olson, Jennifer L.; Atala, Anthony

    2011-01-01

    Novel therapies resulting from regenerative medicine and tissue engineering technology may offer new hope for patients with injuries, end-stage organ failure, or other clinical issues. Currently, patients with diseased and injured organs are often treated with transplanted organs. However, there is a shortage of donor organs that is worsening yearly as the population ages and as the number of new cases of organ failure increases. Scientists in the field of regenerative medicine and tissue engineering are now applying the principles of cell transplantation, material science, and bioengineering to construct biological substitutes that can restore and maintain normal function in diseased and injured tissues. In addition, the stem cell field is a rapidly advancing part of regenerative medicine, and new discoveries in this field create new options for this type of therapy. For example, new types of stem cells, such as amniotic fluid and placental stem cells that can circumvent the ethical issues associated with embryonic stem cells, have been discovered. The process of therapeutic cloning and the creation of induced pluripotent cells provide still other potential sources of stem cells for cell-based tissue engineering applications. Although stem cells are still in the research phase, some therapies arising from tissue engineering endeavors that make use of autologous, adult cells have already entered the clinical setting, indicating that regenerative medicine holds much promise for the future. PMID:22111050

  18. Atrial fibrillation: review of current treatment strategies.

    PubMed

    Xu, Joshua; Luc, Jessica G Y; Phan, Kevin

    2016-09-01

    Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in modern clinical practice, with an estimated prevalence of 1.5-2%. The prevalence of AF is expected to double in the next decades, progressing with age and increasingly becoming a global medical challenge. The first-line treatment for AF is often medical treatment with either rate control or anti-arrhythmic agents for rhythm control, in addition to anti-coagulants such as warfarin for stroke prevention in patient at risk. Catheter ablation has emerged as an alternative for AF treatment, which involves myocardial tissue lesions to disrupt the underlying triggers and substrates for AF. Surgical approaches have also been developed for treatment of AF, particularly for patients requiring concomitant cardiac surgery or those refractory to medical and catheter ablation treatments. Since the introduction of the Cox-Maze III, this procedure has evolved into several modern variations, including the use of alternative energy sources (Cox-Maze IV) such as radiofrequency, cryo-energy and microwave, as well as minimally invasive thoracoscopic epicardial approaches. Another recently introduced technique is the hybrid ablation approach, where in a single setting both epicardial thoracoscopic ablation lesions and endocardial catheter ablation lesions are performed by the cardiothoracic surgeon and cardiologist. There remains controversy surrounding the optimal approach for AF ablation, energy sources, and lesion sets employed. The goal of this article is review the history, classifications, pathophysiology and current treatment options for AF.

  19. Atrial fibrillation: review of current treatment strategies

    PubMed Central

    Xu, Joshua; Luc, Jessica G. Y.

    2016-01-01

    Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in modern clinical practice, with an estimated prevalence of 1.5–2%. The prevalence of AF is expected to double in the next decades, progressing with age and increasingly becoming a global medical challenge. The first-line treatment for AF is often medical treatment with either rate control or anti-arrhythmic agents for rhythm control, in addition to anti-coagulants such as warfarin for stroke prevention in patient at risk. Catheter ablation has emerged as an alternative for AF treatment, which involves myocardial tissue lesions to disrupt the underlying triggers and substrates for AF. Surgical approaches have also been developed for treatment of AF, particularly for patients requiring concomitant cardiac surgery or those refractory to medical and catheter ablation treatments. Since the introduction of the Cox-Maze III, this procedure has evolved into several modern variations, including the use of alternative energy sources (Cox-Maze IV) such as radiofrequency, cryo-energy and microwave, as well as minimally invasive thoracoscopic epicardial approaches. Another recently introduced technique is the hybrid ablation approach, where in a single setting both epicardial thoracoscopic ablation lesions and endocardial catheter ablation lesions are performed by the cardiothoracic surgeon and cardiologist. There remains controversy surrounding the optimal approach for AF ablation, energy sources, and lesion sets employed. The goal of this article is review the history, classifications, pathophysiology and current treatment options for AF. PMID:27747025

  20. Nonpharmacologic strategies for managing hypertension.

    PubMed

    Wexler, Randy; Aukerman, Glen

    2006-06-01

    The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends lifestyle modification for all patients with hypertension or prehypertension. Modifications include reducing dietary sodium to less than 2.4 g per day; increasing exercise to at least 30 minutes per day, four days per week; limiting alcohol consumption to two drinks or less per day for men and one drink or less per day for women; following the Dietary Approaches to Stop Hypertension eating plan (high in fruits, vegetables, potassium, calcium, and magnesium; low in fat and salt); and achieving a weight loss goal of 10 lb (4.5 kg) or more. Alternative treatments such as vitamin C, coenzyme Q10, magnesium, and omega-3 fatty acids have been suggested for managing hypertension, but evidence for their effectiveness is lacking.

  1. Current concepts in management of slipped capital femoral epiphysis.

    PubMed

    Bittersohl, Bernd; Hosalkar, Harish S; Zilkens, Christoph; Krauspe, Rüdiger

    2015-01-01

    Slipped capital femoral epiphysis (SCFE) is a common hip condition that can be disabling. In this review, we provide an orientation on current trends in the clinical management of SCFE including conventional procedures and specialised surgical developments. Different methods of fixation of the epiphysis, risks of complications, and the rationale of addressing deformity, primarily or secondarily, are presented. Although improved understanding of the anatomy, vascularity and implications of residual deformity have changed management strategies, the best modality of treatment that would restore complete vascularity to the femoral head and prevent any residual deformity, impingement and early osteoarthritis remains elusive.

  2. Ocular onchocerciasis: current management and future prospects

    PubMed Central

    Babalola, Olufemi Emmanuel

    2011-01-01

    This paper reviews the current management of onchocerciasis and its future prospects. Onchocerciasis is a disease affecting millions of people in Africa, South and Central America, and Yemen. It is spread by the blackfly as a vector and caused by the filarial nematode, Onchocerca volvulus. A serious attempt was made by the Onchocerciasis Control Program between 1975 and 2002 to eliminate the vector in eleven of the endemic countries in West Africa, and with remarkable success. Formerly, the treatment was with diethyl carbamazine for the microfilaria and suramin for the adult worm. These drugs are now known to be toxic and unsuitable for mass distribution. In particular, they precipitate optic nerve disease. With the discovery of ivermectin, a much safer microfilaricide, and the decision of Merck to distribute the drug free of charge for as long as needed, the strategy of control switched to mass drug administration through community-directed treatment with ivermectin. So far, millions have received this annual or biannual treatment through the African Program for Onchocerciasis Control and the Onchocerciasis Elimination Program for the Americas. However, the problem with ivermectin is that it is a monotherapy microfilaricide which has limited effect on the adult worm, and thus will need to be continued for the life span of the adult worm, which may last up to 15 years. There are also early reports of resistance. Serious encephalopathy and death may occur when ivermectin is used in subjects heavily infested with loiasis. It seems unlikely that a break in transmission will occur with community-directed treatment with ivermectin in Africa because of population migrations and the highly efficient vector, but in the Americas some countries such as Columbia and the Oaxaca focus in Mexico have reported eradication. Vector control is only now applicable in selected situations, and particularly to control the nuisance value of the blackfly. Trials are ongoing for

  3. Strategies for Managing a Multigenerational Workforce

    NASA Astrophysics Data System (ADS)

    Iden, Ronald

    The multigenerational workforce presents a critical challenge for business managers, and each generation has different expectations. A human resource management study of organizations with more than 500 employees reported 58% of the managers experiencing conflict between younger and older workers. The purpose of this single case study was to explore the multigenerational strategies used by 3 managers from a Franklin County, Ohio manufacturing facility with a population size of 6 participants. The conceptual framework for this study was built upon generational theory and cohort group theory. The data were collected through face-to-face semistructured interviews, company documents, and a reflexive journal. Member checking was completed to strengthen the credibility and trustworthiness of the interpretation of participants' responses. A modified van Kaam method enabled separation of themes following the coding of data. Four themes emerged from the data: (a) required multigenerational managerial skills, (b) generational cohort differences, (c) most effective multigenerational management strategies, and (d) least effective multigenerational management strategies. Findings from this study may contribute to social change through better understanding, acceptance, and appreciation of the primary generations in the workforce, and, in turn, improve community relationships.

  4. Evolutionary space station fluids management strategies

    NASA Technical Reports Server (NTRS)

    1989-01-01

    Results are summarized for an 11-month study to define fluid storage and handling strategies and requirements for various specific mission case studies and their associated design impacts on the Space Station. There are a variety of fluid users which require a variety of fluids and use rates. Also, the cryogenic propellants required for NASA's STV, Planetary, and Code Z missions are enormous. The storage methods must accommodate fluids ranging from a high pressure gas or supercritical state fluid to a sub-cooled liquid (and superfluid helium). These requirements begin in the year 1994, reach a maximum of nearly 1800 metric tons in the year 2004, and trail off to the year 2018, as currently planned. It is conceivable that the cryogenic propellant needs for the STV and/or Lunar mission models will be met by LTCSF LH2/LO2 tanksets attached to the SS truss structure. Concepts and corresponding transfer and delivery operations have been presented for STV propellant provisioning from the SS. A growth orbit maneuvering vehicle (OMV) and associated servicing capability will be required to move tanksets from delivery launch vehicles to the SS or co-orbiting platforms. Also, appropriate changes to the software used for OMV operation are necessary to allow for the combined operation of the growth OMV. To support fluid management activities at the Space Station for the experimental payloads and propellant provisioning, there must be truss structure space allocated for fluid carriers and propellant tanksets, and substantial beam strengthening may be required. The Station must have two Mobile Remote Manipulator Systems (MRMS) and the growth OMV propellant handling operations for the STV at the SS. Propellant needs for the Planetary Initiatives and Code Z mission models will most likely be provided by co-orbiting propellant platform(s). Space Station impacts for Code Z mission fluid management activities will be minimal.

  5. Current management of coarctation of the aorta

    PubMed Central

    Suradi, Hussam; Hijazi, Ziyad M.

    2015-01-01

    Coarctation of the aorta (C) is the sixth most common lesion in congenital heart disease and represents a spectrum of aortic narrowing that varies from a discrete entity to tubular hypoplasia. This condition was once thought to be a relatively simple lesion that would be “cured” upon repair of the narrowing, however, despite relief of the anatomical obstruction the subsequent risk of early morbidity and death persists. This review outlines the optimal management strategy of this disease from neonatal to adult life and provides insights to approach this straightforward but challenging condition. PMID:26779519

  6. Classroom Management Strategies for Students with Autism

    ERIC Educational Resources Information Center

    Valdivia, Joe S.

    2007-01-01

    Classroom management strategies designed to improve problem behavior directly affect student achievement. Researchers have demonstrated positive behavior supports (PBS) can reduce problem behavior. However, researchers have also found evidence that PBS may not always be successful and further studies are needed to improve the use of PBS as a…

  7. Management Strategies for Promoting Teacher Collective Learning

    ERIC Educational Resources Information Center

    Cheng, Eric C. K.

    2011-01-01

    This paper aims to validate a theoretical model for developing teacher collective learning by using a quasi-experimental design, and explores the management strategies that would provide a school administrator practical steps to effectively promote collective learning in the school organization. Twenty aided secondary schools in Hong Kong were…

  8. Seeking sustainability: Israel's evolving water management strategy.

    PubMed

    Tal, Alon

    2006-08-25

    The water management policies adopted to address Israel's chronic scarcity have not been without environmental consequences. Yet, through a trial-and-error process, a combined strategy of water transport, rainwater harvesting, and wastewater reuse and desalination, along with a variety of water conservation measures, have put the country on a more sustainable path for the future.

  9. Group-Oriented Behavior Management Strategies.

    ERIC Educational Resources Information Center

    Salend, Spencer J.

    1987-01-01

    A variety of group oriented behavior management strategies to modify classroom behavior problems is suggested. Advantages, disadvantages, and implementation guidelines for the group response cost system, the good behavior game, the group timeout ribbon, hero method, peer-mediated extinction, and peer confrontation. (DB)

  10. Practical management strategies for diaper dermatitis.

    PubMed

    Humphrey, S; Bergman, J N; Au, S

    2006-09-01

    Common diaper dermatitis is an irritant contact diaper dermatitis (IDD) created by the combined influence of moisture, warmth, urine, feces, friction, and secondary infection. It is difficult to completely eradicate these predisposing factors in a diapered child. Thus, IDD presents an ongoing therapeutic challenge for parents, family physicians, pediatricians, and dermatologists. This article will focus on practical management strategies for IDD.

  11. Assessment of two BWR accident management strategies

    SciTech Connect

    Hodge, S.A.; Petek, M.

    1991-01-01

    Candidate mitigative strategies for management of in-vessel events during the late phase (after core degradation has occurred) of postulated BWR severe accidents were considered at Oak Ridge National Laboratory (ORNL) during 1990. The identification of new strategies was subject to the constraint that they should, to the maximum extent possible, make use of the existing equipment and water resources of the BWR facilities and not require major equipment modifications or additions. As a result of this effort, two of these candidate strategies were recommended for additional assessment. The first is a strategy for containment flooding to maintain the core and structural debris within the reactor vessel in the event that vessel injection cannot be restored to terminate a severe accident sequence. The second strategy pertains to the opposite case, for which vessel injection would be restored after control blade melting had begun; its purpose is to provide an injection source of borated water at the concentration necessary to preclude criticality upon recovering a damaged BWR core. Assessments of these two strategies have been performed during 1991 under the auspices of the Detailed Assessment of BWR In-Vessel Strategies Program. This paper provides a discussion of the motivation for and purpose of these strategies and the potential for their success. 33 refs., 9 figs.

  12. Assessing Fishers' Support of Striped Bass Management Strategies.

    PubMed

    Murphy, Robert D; Scyphers, Steven B; Grabowski, Jonathan H

    2015-01-01

    Incorporating the perspectives and insights of stakeholders is an essential component of ecosystem-based fisheries management, such that policy strategies should account for the diverse interests of various groups of anglers to enhance their efficacy. Here we assessed fishing stakeholders' perceptions on the management of Atlantic striped bass (Morone saxatilis) and receptiveness to potential future regulations using an online survey of recreational and commercial fishers in Massachusetts and Connecticut (USA). Our results indicate that most fishers harbored adequate to positive perceptions of current striped bass management policies when asked to grade their state's management regime. Yet, subtle differences in perceptions existed between recreational and commercial fishers, as well as across individuals with differing levels of fishing experience, resource dependency, and tournament participation. Recreational fishers in both states were generally supportive or neutral towards potential management actions including slot limits (71%) and mandated circle hooks to reduce mortality of released fish (74%), but less supportive of reduced recreational bag limits (51%). Although commercial anglers were typically less supportive of management changes than their recreational counterparts, the majority were still supportive of slot limits (54%) and mandated use of circle hooks (56%). Our study suggests that both recreational and commercial fishers are generally supportive of additional management strategies aimed at sustaining healthy striped bass populations and agree on a variety of strategies. However, both stakeholder groups were less supportive of harvest reductions, which is the most direct measure of reducing mortality available to fisheries managers. By revealing factors that influence stakeholders' support or willingness to comply with management strategies, studies such as ours can help managers identify potential stakeholder support for or conflicts that may

  13. Irritable bowel syndrome: contemporary nutrition management strategies.

    PubMed

    Mullin, Gerard E; Shepherd, Sue J; Chander Roland, Bani; Ireton-Jones, Carol; Matarese, Laura E

    2014-09-01

    Irritable bowel syndrome is a complex disorder whose pathophysiology involves alterations in the enteric microbiota, visceral hypersensitivity, gut immune/barrier function, hypothalamic-pituitary-adrenal axis regulation, neurotransmitters, stress response, psychological factors, and more. The importance of diet in the management of irritable bowel syndrome has taken center stage in recent times as the literature validates the relationship of certain foods with the provocation of symptoms. Likewise, a number of elimination dietary programs have been successful in alleviating irritable bowel syndrome symptoms. Knowledge of the dietary management strategies for irritable bowel syndrome will help guide nutritionists and healthcare practitioners to deliver optimal outcomes. This tutorial reviews the nutrition management strategies for irritable bowel syndrome.

  14. A Synthesis of Language Learning Strategies: Current Issues, Problems and Claims Made in Learner Strategy Research

    ERIC Educational Resources Information Center

    Barjesteh, Hamed; Mukundan, Jayakaran; Vaseghi, Reza

    2014-01-01

    The current paper presented theoretical assumptions behind language learning strategies (LLS) and an overview of methods used to identify learners' strategies, first, and then summarized what have been reported from large number of descriptive studies of strategies by language learners. Moreover, the paper tried to present the variety of…

  15. Soil contamination in China: current status and mitigation strategies.

    PubMed

    Zhao, Fang-Jie; Ma, Yibing; Zhu, Yong-Guan; Tang, Zhong; McGrath, Steve P

    2015-01-20

    China faces great challenges in protecting its soil from contamination caused by rapid industrialization and urbanization over the last three decades. Recent nationwide surveys show that 16% of the soil samples, 19% for the agricultural soils, are contaminated based on China’s soil environmental quality limits, mainly with heavy metals and metalloids. Comparisons with other regions of the world show that the current status of soil contamination, based on the total contaminant concentrations, is not worse in China. However, the concentrations of some heavy metals in Chinese soils appear to be increasing at much greater rates. Exceedance of the contaminant limits in food crops is widespread in some areas, especially southern China, due to elevated inputs of contaminants, acidic nature of the soil and crop species or cultivars prone to heavy metal accumulation. Minimizing the transfer of contaminants from soil to the food chain is a top priority. A number of options are proposed, including identification of the sources of contaminants to agricultural systems, minimization of contaminant inputs, reduction of heavy metal phytoavailability in soil with liming or other immobilizing materials, selection and breeding of low accumulating crop cultivars, adoption of appropriate water and fertilizer management, bioremediation, and change of land use to grow nonfood crops. Implementation of these strategies requires not only technological advances, but also social-economic evaluation and effective enforcement of environmental protection law.

  16. The problem of current toxic chemicals management.

    PubMed

    Tickner, Joel; Geiser, Ken

    2004-01-01

    In this article, we explore the limitations of current chemicals management policies worldwide and the evolution of new European, International and U.S. policies to address the problem of toxic chemicals control. It is becoming increasingly apparent that current chemicals management policies in Europe and the United States are inadequate. There is a general lack of toxicity and exposure information on chemicals in commerce and the vast majority of chemicals were considered safe until proven guilty in legislation. Governments must then prove each chemical is dangerous through a slow and resource-intensive risk assessment process. For more than a decade, Nordic countries, such as Denmark and Sweden, have actively promoted integrated chemicals policies to address contamination of critical waterways. They have successfully used a variety of voluntary and mandatory policy tools, such as education, procurement, lists of chemicals of concern, eco-labeling, research and development on safer substitutes, and chemical phase-out requirements, to encourage companies using chemicals to reduce their reliance on harmful substances and to develop safer substitutes. While previously isolated to particular countries, innovative and exciting European-wide policies to promote sustainable chemicals management are now moving forward, including the recently published draft Registration, Evaluation and Authorization of CHemicals (REACH) policy of the European Union. A sweeping change in chemicals management policies in Europe is inevitable and it will ultimately affect manufacturers in the U.S. and globally. The European movement provides an opportunity to initiate a discussion on integrated chemicals policy in the U.S. where some innovative initiatives already are underway.

  17. Chordoma: current concepts, management, and future directions.

    PubMed

    Walcott, Brian P; Nahed, Brian V; Mohyeldin, Ahmed; Coumans, Jean-Valery; Kahle, Kristopher T; Ferreira, Manuel J

    2012-02-01

    Chordoma is a rare bone cancer that is aggressive, locally invasive, and has a poor prognosis. Chordomas are thought to arise from transformed remnants of notochord and have a predilection for the axial skeleton, with the most common sites being the sacrum, skull base, and spine. The gold standard treatment for chordomas of the mobile spine and sacrum is en-bloc excision with wide margins and postoperative external-beam radiation therapy. Treatment of clival chordomas is unique from other locations with an enhanced emphasis on preservation of neurological function, typified by a general paradigm of maximally safe cytoreductive surgery and advanced radiation delivery techniques. In this Review, we highlight current standards in diagnosis, clinical management, and molecular characterisation of chordomas, and discuss current research.

  18. Current management of allergic rhinitis in children.

    PubMed

    Georgalas, Christos; Terreehorst, Ingrid; Fokkens, Wytske

    2010-02-01

    Over the last 20 years, there has been significant progress in our understanding of the pathophysiology of allergic rhinitis, including the discovery of new inflammatory mediators, the link between asthma and allergic rhinitis ('one airway-one disease' concept) and the introduction of novel therapeutic modalities. These new insights have been documented in the Allergic Rhinitis and its Impact on Asthma guidelines and have led to the creation of evidence-based management algorithms. We now understand the importance of a common strategy for treating allergic inflammation of the upper and lower airway as a way of improving outcome, reducing hospital admissions, providing better quality of life and perhaps, altering the natural course of the 'allergic march'. A therapeutic ladder is suggested: Whereas for mild intermittent allergic rhinitis, allergen avoidance should be the first line of treatment with subsequent addition of a second generation topical or oral antihistamine, nasal saline or cromoglycate, in cases of moderate to severe allergic rhinitis, a nasal steroid is the treatment of choice. If a patient with moderate/severe persistent allergic rhinitis fails to improve after 4 wk of adequate treatment, patient compliance or the diagnosis must be re-assessed. In such cases, when the diagnosis is in doubt, a careful clinical examination including nasal endoscopy is mandatory to assess for other potential causes of nasal obstruction. In children who suffer from concomitant allergic rhinitis and asthma, a management algorithm that addresses concurrently asthma and allergic rhinitis is vital, both from a theoretical and from a practical point of view: Parents overwhelmingly prefer a single strategy for the treatment of their child's upper and lower airway symptoms; however, the overall quality of life in children with severe asthma can be significantly improved if rhinitis is adequately addressed.

  19. Environmental Management Strategy: Four Forces Analysis

    NASA Astrophysics Data System (ADS)

    Doyle, Martin W.; Von Windheim, Jesko

    2015-01-01

    We develop an analytical approach for more systematically analyzing environmental management problems in order to develop strategic plans. This approach can be deployed by agencies, non-profit organizations, corporations, or other organizations and institutions tasked with improving environmental quality. The analysis relies on assessing the underlying natural processes followed by articulation of the relevant societal forces causing environmental change: (1) science and technology, (2) governance, (3) markets and the economy, and (4) public behavior. The four forces analysis is then used to strategize which types of actions might be most effective at influencing environmental quality. Such strategy has been under-used and under-valued in environmental management outside of the corporate sector, and we suggest that this four forces analysis is a useful analytic to begin developing such strategy.

  20. Evolution in Clinical Knowledge Management Strategy at Intermountain Healthcare

    PubMed Central

    Hulse, Nathan C.; Galland, Joel; Borsato, Emerson P.

    2012-01-01

    In this manuscript, we present an overview of the clinical knowledge management strategy at Intermountain Healthcare in support of our electronic medical record systems. Intermountain first initiated efforts in developing a centralized enterprise knowledge repository in 2001. Applications developed, areas of emphasis served, and key areas of focus are presented. We also detail historical and current areas of emphasis, in response to business needs. PMID:23304309

  1. Management strategies for promoting successful breastfeeding.

    PubMed

    Bear, K; Tigges, B B

    1993-06-01

    Clinicians can promote a successful breastfeeding experience by providing support, anticipatory guidance and practical information. This article presents the components of early follow-up and guidelines for assessment. Management strategies for common problems are discussed, such as nipple soreness, cracked nipples, plugged ducts and mastitis, insufficient infant weight gain, perceived inadequacy of milk supply, breast-milk jaundice, sexual adjustment and failure at breastfeeding. Breastfeeding guidelines for employed mothers and adoptive mothers are indicated.

  2. Status epilepticus. Current concepts and management.

    PubMed Central

    Starreveld, E.; Starreveld, A. A.

    2000-01-01

    OBJECTIVE: To inform primary care physicians about current issues around generalized convulsive status epilepticus (GCSE) emphasizing definition, pathophysiology, treatment, and prognosis. QUALITY OF EVIDENCE: MEDLINE (1994 to 1999) provided 479 references using the MeSH terms "status epilepticus" and "treatment." From these we selected 30 English-language articles covering clinical aspects, treatment, and animal research. Key source documents from previous years and information from modern textbooks and recent symposia were also included. MAIN MESSAGE: Generalized convulsive status epilepticus continues to be a medical emergency with high morbidity and mortality. It must be managed promptly and effectively. The operational definition of GCSE is a seizure that lasts longer than 5 minutes or two or more seizures between which patients do not recover. Main differential diagnosis is nonepileptic status. Intravenous therapy with combined lorazepam and phenytoin is the initial treatment of choice. Other preferred medications are diazepam, midazolam, and propofol. Some of these medications should be considered before arrival at hospital. Prognosis of GCSE is determined by underlying cause, delay in adequate treatment, and comorbidity. Patients with GCSE lasting longer than 30 minutes require intensive care and electroencephalogram monitoring. CONCLUSION: Intravenous lorazepam and phenytoin are currently the most effective drugs for initial management of GCSE. Timely administration of antiepileptic medication can prevent development of GCSE in some patients with known epilepsy. Main differential diagnosis is nonepileptic status. PMID:11013800

  3. Strategies for Management of Synchronous Colorectal Metastases.

    PubMed

    Castellanos, Jason A; Merchant, Nipun B

    2014-06-01

    The management of synchronous presentation of colorectal cancer and liver metastases has long been a topic of debate and discussion for surgeons due to the unique dilemma of balancing operative timing along with treatment strategy. Operative strategies for resection include staged resection with colon first approach, "reverse" staged resection with liver metastases resected first, and one-stage, or simultaneous, resection of both the primary tumor and liver metastases approach. These operative strategies can be further augmented with perioperative chemotherapy and other novel approaches that may improve resectability and patient survival. The decision on operative timing and approach, however, remains largely dependent on the surgeon's determination of disease resectability, patient fitness, and the need for neoadjuvant chemotherapy.

  4. Managing hyperthyroidism in pregnancy: current perspectives

    PubMed Central

    Andersen, Stine Linding; Laurberg, Peter

    2016-01-01

    Hyperthyroidism in women who are of childbearing age is predominantly of autoimmune origin and caused by Graves’ disease. The physiological changes in the maternal immune system during a pregnancy may influence the development of this and other autoimmune diseases. Furthermore, pregnancy-associated physiological changes influence the synthesis and metabolism of thyroid hormones and challenge the interpretation of thyroid function tests in pregnancy. Thyroid hormones are crucial regulators of early development and play an important role in the maintenance of a normal pregnancy and in the development of the fetus, particularly the fetal brain. Untreated or inadequately treated hyperthyroidism is associated with pregnancy complications and may even program the fetus to long-term development of disease. Thus, hyperthyroidism in pregnant women should be carefully managed and controlled, and proper management involves different medical specialties. The treatment of choice in pregnancy is antithyroid drugs (ATDs). These drugs are effective in the control of maternal hyperthyroidism, but they all cross the placenta, and so need careful management and control during the second half of pregnancy considering the risk of fetal hyper- or hypothyroidism. An important aspect in the early pregnancy is that the predominant side effect to the use of ATDs in weeks 6–10 of pregnancy is birth defects that may develop after exposure to available types of ATDs and may be severe. This review focuses on four current perspectives in the management of overt hyperthyroidism in pregnancy, including the etiology and incidence of the disease, how the diagnosis is made, the consequences of untreated or inadequately treated disease, and finally how to treat overt hyperthyroidism in pregnancy. PMID:27698567

  5. Fluid management strategies in heart failure.

    PubMed

    Albert, Nancy M

    2012-04-01

    In patients with chronic heart failure, fluid retention (or hypervolemia) is often the stimulus for acute decompensated heart failure that requires hospitalization. The pathophysiology of fluid retention is complex and involves both hemodynamic and clinical congestion. Signs and symptoms of both hemodynamic and clinical congestion should be assessed serially during hospitalization. Core heart failure drug and cardiac device therapies should be provided, and ultrafiltration may be warranted. Critical care, intermediate care, and telemetry nurses have roles in both assessment and management of patients hospitalized with acute decompensated heart failure and fluid retention. Nurse administrators and managers have heightened their attention to fluid retention because the Medicare performance measure known as the risk-standardized 30-day all-cause readmission rate after heart failure hospitalization can be attenuated by fluid management strategies initiated by nurses during a patient's hospitalization.

  6. Opt-in medical management strategies.

    PubMed

    Fetterolf, Donald; Olson, Marty

    2008-02-01

    Historically, health plans and disease management companies have employed "opt-out" strategies for evaluating medical management outcomes across larger populations, targeting the entire population of eligible individuals and allowing those not interested to opt out. Recent observations that the predominant effort of these programs is on high-risk patients has lead some managers to suggest that the focus be on only those individuals with an anticipated higher effectiveness and lower cost to the payers of such services. They believe such "opt-in" models, in which only higher risk participants are targeted and enrolled, will deliver higher value. The use of common opt-in models, however, is not only methodologically unsound, but experience in the field suggests there may be less overall effect as well. Calculation methods for developing impact remain extremely sensitive to methodology

  7. Contemporary Strategies in the Management of Hepatocellular Carcinoma

    PubMed Central

    Khorsandi, Shirin Elizabeth; Heaton, Nigel

    2012-01-01

    Liver transplantation is the treatment of choice for selected patients with hepatocellular carcinoma (HCC) on a background of chronic liver disease. Liver resection or locoregional ablative therapies may be indicated for patients with preserved synthetic function without significant portal hypertension. Milan criteria were introduced to select suitable patients for liver transplant with low risk of tumor recurrence and 5-year survival in excess of 70%. Currently the incidence of HCC is climbing rapidly and in a current climate of organ shortage has led to the re-evaluation of locoregional therapies and resectional surgery to manage the case load. The introduction of biological therapies has had a new dimension to care, adding to the complexities of multidisciplinary team working in the management of HCC. The aim of this paper is to give a brief overview of present day management strategies and decision making. PMID:23197879

  8. Forest management strategies for reducing carbon emissions, the French case

    NASA Astrophysics Data System (ADS)

    Valade, Aude; Luyssaert, Sebastiaan; Bellassen, Valentin; Vallet, Patrick; Martin, Manuel

    2015-04-01

    International agreements now recognize the role of forest in the mitigation of climate change through the levers of in-situ sequestration, storage in products and energy and product substitution. These three strategies of carbon management are often antagonistic and it is still not clear which strategy would have the most significant impact on atmospheric carbon concentrations. With a focus on France, this study compares several scenarios of forest management in terms of their effect on the overall carbon budget from trees to wood-products. We elaborated four scenarios of forest management that target different wood production objectives. One scenario is 'Business as usual' and reproduces the current forest management and wood production levels. Two scenarios target an increase in bioenergy wood production, with either long-term or short-term goals. One scenario aims at increasing the production of timber for construction. For this, an empirical regression model was developed building on the rich French inventory database. The model can project the current forest resource at a time horizon of 20 years for characteristic variables diameter, standing volume, above-ground biomass, stand age. A simplified life-cycle analysis provides a full carbon budget for each scenario from forest management to wood use and allows the identification of the scenario that most reduces carbon emissions.

  9. Optimal management of familial hypercholesterolemia: treatment and management strategies

    PubMed Central

    Nemati, Mohammad Hassan; Astaneh, Behrooz

    2010-01-01

    Familial hypercholesterolemia is an autosomally dominant disorder caused by various mutations in low-density lipoprotein receptor genes. This will lead to elevated levels of total and low-density lipoprotein cholesterol, which may in turn lead to premature coronary atherosclerosis and cardiac-related death. The symptoms are more severe in the homozygous type of the disease. Different options for the treatment of affected patients are now available. Diet therapy, pharmacologic therapy, lipid apheresis, and liver transplantation are among the various treatments. We clinically review the treatment and management strategies for the disease in order to shed light on the optimal management of familial hypercholesterolemia. PMID:21191428

  10. Optimal management of genital herpes: current perspectives

    PubMed Central

    Sauerbrei, Andreas

    2016-01-01

    As one of the most common sexually transmitted diseases, genital herpes is a global medical problem with significant physical and psychological morbidity. Genital herpes is caused by herpes simplex virus type 1 or type 2 and can manifest as primary and/or recurrent infection. This manuscript provides an overview about the fundamental knowledge on the virus, its epidemiology, and infection. Furthermore, the current possibilities of antiviral therapeutic interventions and laboratory diagnosis of genital herpes as well as the present situation and perspectives for the treatment by novel antivirals and prevention of disease by vaccination are presented. Since the medical management of patients with genital herpes simplex virus infection is often unsatisfactory, this review aims at all physicians and health professionals who are involved in the care of patients with genital herpes. The information provided would help to improve the counseling of affected patients and to optimize the diagnosis, treatment, and prevention of this particular disease. PMID:27358569

  11. Optimal management of genital herpes: current perspectives.

    PubMed

    Sauerbrei, Andreas

    2016-01-01

    As one of the most common sexually transmitted diseases, genital herpes is a global medical problem with significant physical and psychological morbidity. Genital herpes is caused by herpes simplex virus type 1 or type 2 and can manifest as primary and/or recurrent infection. This manuscript provides an overview about the fundamental knowledge on the virus, its epidemiology, and infection. Furthermore, the current possibilities of antiviral therapeutic interventions and laboratory diagnosis of genital herpes as well as the present situation and perspectives for the treatment by novel antivirals and prevention of disease by vaccination are presented. Since the medical management of patients with genital herpes simplex virus infection is often unsatisfactory, this review aims at all physicians and health professionals who are involved in the care of patients with genital herpes. The information provided would help to improve the counseling of affected patients and to optimize the diagnosis, treatment, and prevention of this particular disease.

  12. HRD Strategies for Expatriate Development: Review of Current Strategies and Potentials of Expatriate Mentoring

    ERIC Educational Resources Information Center

    Kim, Eunok Alice

    2007-01-01

    Expatriates are critical human resources and means of global organizations. Through review of literature, this paper examines HRD strategies that have been utilized to develop expatriates for international assignments, identifies gaps in current HRD strategies, and investigates unique potentials of expatriate mentoring contributing expatriate…

  13. [Current recommendations for the management of TTTS].

    PubMed

    Ropacka-Lesiak, Mariola; Breborowicz, Grzegorz H

    2014-08-01

    The paper presents current views and recommendations for pregnancy complicated by TTTS. The symptoms that should attract our attention during the first-trimester ultrasound, i.e. CRL asymmetry NT > 95th percentile, or 20% or more of the NT difference between the fetuses, absent or reversed A wave in DV, and TV regurgitation, are discussed and presented. Similarly symptoms that should attract our attention in the second trimester such as amniotic fluid volume imbalance, asymmetry in the size of the urinary bladders, abdominal circumferences discordance, inter-twin membrane folding, membranous attachment of the donor's umbilical cord, different placental echogenicity and abnormal Doppler measurements, are listed. The paper presents the principle of monitoring based on ultrasound examination, including Doppler studies. The necessity and usefulness of echocardiography is underlined. It is also stressed that the frequency of monitoring depends on the severity of hemodynamic changes and the check-up rate varies from once a week to daily monitoring in extreme cases. This paper presents a variety of therapeutic options, including conservative management, septostomy amnioreduction, laser and selective fetoreduction. Taking into account the level of disease severity stages I and V can be managed conservatively. Fetoscopic laser coagulation of anastomoses, which can be used almost in all stages of TTTS (I-IV), remains to be the treatment of choice. However the current level of evidence does not yet allow us to determine whether laser coagulation increases or reduces the risk of neurodevelopmental delay and mental retardation in children, as compared to other types of therapy. Amnioreduction may be recommended in cases when laser therapy is unavailable or as first-line therapy before transporting the patient to the intrauterine therapy center.

  14. Peripartum cardiomyopathy: current management and future perspectives

    PubMed Central

    Hilfiker-Kleiner, Denise; Haghikia, Arash; Nonhoff, Justus; Bauersachs, Johann

    2015-01-01

    Pregnancy is associated with marked physiological changes challenging the cardiovascular system. Among the more severe pregnancy associated cardiovascular complications, peripartum cardiomyopathy (PPCM) is a potentially life-threatening heart disease emerging towards the end of pregnancy or in the first postpartal months in previously healthy women. A major challenge is to distinguish the peripartum discomforts in healthy women (fatigue, shortness of breath, and oedema) from the pathological symptoms of PPCM. Moreover, pregnancy-related pathologies such as preeclampsia, myocarditis, or underlying genetic disease show overlapping symptoms with PPCM. Difficulties in diagnosis and the discrimination from other pathological conditions in pregnancy may explain why PPCM is still underestimated. Additionally, underlying pathophysiologies are poorly understood, biomarkers are scarce and treatment options in general limited. Experience in long-term prognosis and management including subsequent pregnancies is just beginning to emerge. This review focuses on novel aspects of physiological and pathophysiological changes of the maternal cardiovascular system by comparing normal conditions, hypertensive complications, genetic aspects, and infectious disease in PPCM-pregnancies. It also presents clinical and basic science data on the current state of knowledge on PPCM and brings them in context thereby highlighting promising new insights in diagnostic tools and therapeutic approaches and management. PMID:25636745

  15. Multiple system atrophy: current and future approaches to management

    PubMed Central

    Flabeau, Olivier; Meissner, Wassilios G.; Tison, François

    2010-01-01

    Multiple system atrophy (MSA) is a rare neurodegenerative disorder without any effective treatment in slowing or stopping disease progression. It is characterized by poor levodopa responsive Parkinsonism, cerebellar ataxia, pyramidal signs and autonomic failure in any combination. Current therapeutic strategies are primarily based on dopamine replacement and improvement of autonomic failure. However, symptomatic management remains disappointing and no curative treatment is yet available. Recent experimental evidence has confirmed the key role of alpha-synuclein aggregation in the pathogenesis of MSA. Referring to this hypothesis, transgenic and toxic animal models have been developed to assess candidate drugs for MSA. The standardization of diagnosis criteria and assessment procedures will allow large multicentre clinical trials to be conducted. In this article we review the available symptomatic treatment, recent results of studies investigating potential neuroprotective drugs, and future approaches for the management in MSA. PMID:21179616

  16. Blood Management Strategies in Total Knee Arthroplasty

    PubMed Central

    Dan, Michael; Martinez Martos, Sara; Beller, Elaine

    2016-01-01

    A perioperative blood management program is one of a number of important elements for successful patient care in total knee arthroplasty (TKA) and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risk of blood transfusion whilst at the same time maximizing hemoglobin (Hb) in the postoperative period, leading to a positive effect on outcome and cost. An individualized strategy based on patient specific risk factors, anticipated blood loss and comorbidities are useful in achieving this aim. Multiple blood conservation strategies are available in the preoperative, intraoperative and postoperative periods and can be employed in various combinations. Recent literature has highlighted the importance of preoperative Hb optimization, minimizing blood loss and evidence-based transfusion guidelines. Given TKA is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal. PMID:27595070

  17. It's magic: a unique practice management strategy.

    PubMed

    Schwartz, Steven

    2003-11-15

    For thousands of years prior to the advent of modern dentistry, magic has been used to entertain, impress, and motivate individuals. Today's dental professionals are using the concept of The Magic of a Healthy Smile through their use of modern clinical techniques and as a means for practice marketing, patient education, and the reduction of patient stress and fear. This article describes how dentists/magicians have incorporated magic into their practices and the benefits of this useful patient management strategy. A script of the "Happy Tooth Magic Show" and resources for dentists to create their own dental magic show are provided.

  18. Suicide Gene Therapy for Cancer – Current Strategies

    PubMed Central

    Zarogoulidis, Paul; Darwiche, Kaid; Sakkas, Antonios; Yarmus, Lonny; Huang, Haidong; Li, Qiang; Freitag, Lutz; Zarogoulidis, Konstantinos; Malecki, Marek

    2013-01-01

    Current cancer treatments may create profound iatrogenic outcomes. The adverse effects of these treatments still remain, as the serious problems that practicing physicians have to cope with in clinical practice. Although, non-specific cytotoxic agents constitute an effective treatment modality against cancer cells, they also tend to kill normal, quickly dividing cells. On the other hand, therapies targeting the genome of the tumors are both under investigation, and some others are already streamlined to clinical practice. Several approaches have been investigated in order to find a treatment targeting the cancer cells, while not affecting the normal cells. Suicide gene therapy is a therapeutic strategy, in which cell suicide inducing transgenes are introduced into cancer cells. The two major suicide gene therapeutic strategies currently pursued are: cytosine deaminase/5-fluorocytosine and the herpes simplex virus/ganciclovir. The novel strategies include silencing gene expression, expression of intracellular antibodies blocking cells’ vital pathways, and transgenic expression of caspases and DNases. We analyze various elements of cancer cells’ suicide inducing strategies including: targets, vectors, and mechanisms. These strategies have been extensively investigated in various types of cancers, while exploring multiple delivery routes including viruses, non-viral vectors, liposomes, nanoparticles, and stem cells. We discuss various stages of streamlining of the suicide gene therapy into clinical oncology as applied to different types of cancer. Moreover, suicide gene therapy is in the center of attention as a strategy preventing cancer from developing in patients participating in the clinical trials of regenerative medicine. In oncology, these clinical trials are aimed at regenerating, with the aid of stem cells, of the patients’ organs damaged by pathologic and/or iatrogenic factors. However, the stem cells carry the risk of neoplasmic transformation. We

  19. Invasive mycoses: strategies for effective management.

    PubMed

    Kontoyiannis, Dimitrios P

    2012-01-01

    Effective management of invasive fungal infections (IFIs) depends on early individualized therapy that optimizes efficacy and safety. Considering the negative consequences of IFI, for some high-risk patients the potential benefits of prophylactic therapy may outweigh the risks. When using a prophylactic, empiric, or preemptive therapeutic approach, clinicians must take into account the local epidemiology, spectrum of activity, pharmacokinetic and pharmacodynamic parameters, and safety profile of different antifungal agents, together with unique host-related factors that may affect antifungal efficacy or safety. Therapeutic drug monitoring is increasingly recognized as important or necessary when employing lipophilic triazoles (itraconazole, voriconazole, posaconazole) or flucytosine. Because early diagnostics remain limited for uncommon, yet emerging opportunistic molds (e.g., Mucorales), and treatment delay is associated with increased mortality, early effective management often depends on a high index of suspicion, taking into account predisposing factors, host cues favoring mucormycosis, and local epidemiology. Antifungal options for mucormycosis are limited, and optimal management depends on a multimodal approach that includes early diagnosis/clinical suspicion, correction of underlying predisposing factors, radical debridement of affected tissues, and extended antifungal therapy. This article discusses strategies for the effective management of invasive mycoses, with a particular focus on antifungal hepatotoxicity.

  20. Managing work and family: Do control strategies help?

    PubMed

    Versey, H Shellae

    2015-11-01

    How can we effectively manage competing obligations from work and family without becoming overwhelmed? This question inspires the current study by examining control strategies that may facilitate better work-life balance, with a specific focus on the role of lowered aspirations and positive reappraisals, attitudes that underlie adaptive coping behaviors. Data from the Midlife in the United States Survey (MIDUS II) were used to explore the relationship between negative spillover, control strategies, and well-being among full-time working men and women (N = 2,091). In this nationally representative sample, findings indicate that while positive reappraisals function as a protective buffer, lowering aspirations exacerbate the relationship between work-family spillover and well-being, with moderating effects stronger among women. This study extends prior research tying work-life conflict to health and mental health, and suggests further investigation is needed to consider types of resources that may be effective coping strategies in balancing work and family.

  1. Present and New Treatment Strategies in the Management of Glaucoma

    PubMed Central

    Kolko, M.

    2015-01-01

    Glaucoma is a neurodegenerative disease characterized by retinal ganglion cell (RGC) death and axonal loss. It remains a major cause of blindness worldwide. All current modalities of treatment are focused on lowering intraocular pressure (IOP), and it is evident that increased IOP is an important risk factor for progression of the disease. However, it is clear that a significant number of glaucoma patients show disease progression despite of pressure lowering treatments. Much attention has been given to the development of neuroprotective treatment strategies, but the identification of such has been hampered by lack of understanding of the etiology of glaucoma. Hence, in spite of many attempts no neuroprotective drug has yet been clinically approved. Even though neuroprotection is without doubt an important treatment strategy, many glaucoma subjects are diagnosed after substantial loss of RGCs. In this matter, recent approaches aim to rescue RGCs and regenerate axons in order to restore visual function in glaucoma. The present review seeks to provide an overview of the present and new treatment strategies in the management of glaucoma. The treatment strategies are divided into current available glaucoma medications, new pressure lowering targets, prospective neuroprotective interventions, and finally possible neuroregenrative strategies. PMID:26069521

  2. Peritoneal mesothelioma: current understanding and management

    PubMed Central

    Chua, Terence C.; Yan, Tristan D.; Morris, David L.

    2009-01-01

    Mesothelioma is an asbestos-related tumour. Mesothelioma in the thorax occurs on the pleura and is known as pleural mesothelioma. It is the more common form of mesothelioma, accounting for 70% of cases. The other form occurs in the abdomen. It accounts for much of the remaining 30% and is known as peritoneal mesothelioma. Early diagnosis of peritoneal mesothelioma is often difficult because the early symptoms are often overlooked as being a benign ailment of the gastrointestinal tract. Therefore, diagnosis often occurs at an advanced stage when disease is widespread throughout the peritoneal cavity. Treatment approaches have evolved in the last decade from systemic chemotherapy and palliative surgery to aggressive cytoreductive surgery and perioperative intraperitoneal chemotherapy. This has led to a marked increase in survival among patients who were once classified as “preterminal.” We update on the current understanding of peritoneal mesothelioma from a clinical perspective in hope that greater clinician awareness will promote best practice management of this condition. PMID:19234654

  3. Why Leading Consumer Product Companies Develop Proactive Chemical Management Strategies.

    PubMed

    Scruggs, Caroline E; Van Buren, Harry J

    2016-05-01

    Scholars have studied the various pressures that companies face related to socially responsible behavior when stakeholders know the particular social issues under consideration. Many have examined social responsibility in the context of environmental responsibility and the general approaches companies take regarding environmental management. The issue of currently unregulated, but potentially hazardous, chemicals in consumer products is not well understood by the general public, but a number of proactive consumer product companies have voluntarily adopted strategies to minimize use of such chemicals. These companies are exceeding regulatory requirements by restricting from their products chemicals that could harm human or environmental health, despite the fact that these actions are costly. They do not usually advertise the details of their strategies to end consumers. This article uses interviews with senior environmental directors of 20 multinational consumer product companies to investigate why these companies engage in voluntary chemicals management. The authors conclude that the most significant reasons are to achieve a competitive advantage and stay ahead of regulations, manage relationships and maintain legitimacy with stakeholders, and put managerial values into practice. Many of the characteristics related to the case of chemicals management are extendable to other areas of stakeholder management in which risks to stakeholders are either unknown or poorly understood.

  4. Why Leading Consumer Product Companies Develop Proactive Chemical Management Strategies

    PubMed Central

    Scruggs, Caroline E.; Van Buren, Harry J.

    2014-01-01

    Scholars have studied the various pressures that companies face related to socially responsible behavior when stakeholders know the particular social issues under consideration. Many have examined social responsibility in the context of environmental responsibility and the general approaches companies take regarding environmental management. The issue of currently unregulated, but potentially hazardous, chemicals in consumer products is not well understood by the general public, but a number of proactive consumer product companies have voluntarily adopted strategies to minimize use of such chemicals. These companies are exceeding regulatory requirements by restricting from their products chemicals that could harm human or environmental health, despite the fact that these actions are costly. They do not usually advertise the details of their strategies to end consumers. This article uses interviews with senior environmental directors of 20 multinational consumer product companies to investigate why these companies engage in voluntary chemicals management. The authors conclude that the most significant reasons are to achieve a competitive advantage and stay ahead of regulations, manage relationships and maintain legitimacy with stakeholders, and put managerial values into practice. Many of the characteristics related to the case of chemicals management are extendable to other areas of stakeholder management in which risks to stakeholders are either unknown or poorly understood. PMID:27471326

  5. Part 2 -- current program integrating strategies and lubrication technology

    SciTech Connect

    Johnson, B.

    1996-12-01

    This paper is the second of two that describe the Predictive Maintenance Program for rotating machinery at the Palo Verde Nuclear Generating Station. The Predictive Maintenance program has been enhanced through organizational changes and improved interdisciplinary usage of technology. This paper will discuss current program strategies that have improved the interaction between the Vibration and Lube Oil programs. The {open_quotes}Lube Oil{close_quotes} view of the combined program along with case studies will then be presented.

  6. Regional economic effects of current and proposed management alternatives for Arrowwood National Wildlife Refuge

    USGS Publications Warehouse

    Koontz, Lynne; Lambert, Heather

    2005-01-01

    This report first provides a description of the local community and economy near the Refuge. An analysis of current and proposed management strategies that could affect the local economy is then presented. The Refuge management activities of economic concern in this analysis are Refuge personnel staffing and Refuge spending within the local community, and spending in the local community by Refuge visitors.

  7. Regional economic effects of current and proposed management alternatives for Sand Lake National Wildlife Refuge

    USGS Publications Warehouse

    Koontz, Lynne; Lambert, Heather

    2005-01-01

    This report first provides a description of the local community and economy near the Refuge. An analysis of current and proposed management strategies that could affect the local economy is then presented. The Refuge management activities of economic concern in this analysis are Refuge personnel staffing and Refuge spending within the local community, and spending in the local community by Refuge visitors.

  8. Health plans' strategies for managing outpatient specialty pharmaceuticals.

    PubMed

    Mullins, C Daniel; Lavallee, Danielle Chauncey; Pradel, Françoise G; DeVries, Andrea R; Caputo, Nadine

    2006-01-01

    Balancing increased spending for specialty pharmaceuticals while providing affordable and equitable coverage for consumers is a key issue for public and private payers. Health plans rely on an array of strategies, including both medical management and those used for more traditional pharmaceuticals. To explore specific management strategies for outpatient specialty pharmaceuticals, a survey was administered to thirty-eight Blue Cross and Blue Shield plans, focused on identifying core strategies. Prior authorization was the most commonly used strategy, implemented by 83.3 percent of respondents. Other frequently implemented management strategies included claims review (82.8 percent), formulary management (76.7 percent), and utilization review (70 percent).

  9. Relationship-Driven Classroom Management: Strategies That Promote Student Motivation.

    ERIC Educational Resources Information Center

    Vitto, John M.

    This book combines information about resiliency, classroom management, and discipline into a user-friendly discussion suitable for all teachers. The material covers both preventive strategies and reactive strategies. The chapters of part 1, "Reinventive Strategies," are: (1) "Relationship-Driven Classroom Management and Resilience"; (2)…

  10. Epilepsy during pregnancy: focus on management strategies

    PubMed Central

    Borgelt, Laura M; Hart, Felecia M; Bainbridge, Jacquelyn L

    2016-01-01

    In the US, more than one million women with epilepsy are of childbearing age and have over 20,000 babies each year. Patients with epilepsy who become pregnant are at risk of complications, including changes in seizure frequency, maternal morbidity and mortality, and congenital anomalies due to antiepileptic drug exposure. Appropriate management of epilepsy during pregnancy may involve frequent monitoring of antiepileptic drug serum concentrations, potential preconception switching of antiepileptic medications, making dose adjustments, minimizing peak drug concentration with more frequent dosing, and avoiding potentially teratogenic medications. Ideally, preconception planning will be done to minimize risks to both the mother and fetus during pregnancy. It is important to recognize benefits and risks of current and emerging therapies, especially with revised pregnancy labeling in prescription drug product information. This review will outline risks for epilepsy during pregnancy, review various recommendations from leading organizations, and provide an evidence-based approach for managing patients with epilepsy before, during, and after pregnancy. PMID:27703396

  11. Ulcerative colitis: current treatment strategies and future prospects.

    PubMed

    Garud, Sagar; Peppercorn, Mark A

    2009-03-01

    Ulcerative colitis (UC) is a disease of unknown etiology characterized by inflammation of the mucosa and occasionally the submucosa of the colon. Conventional drug therapy for UC involves use of aminosalicylates, corticosteroids, azathioprine/6-mercaptopurine, cyclosporine and anti-tumor necrosis factor therapy. Alternative therapies include probiotics, nicotine and fish oil. Drugs like tacrolimus, rosiglitazone and Trichuris suis ova are being evaluated for use in UC patients. With the new biologic agents, new treatment options for UC continue to evolve. In this article we will discuss the conventional drugs, the alternative therapies and the management strategies according to the severity and extent of UC.

  12. Ulcerative Colitis: Current Treatment Strategies and Future Prospects

    PubMed Central

    Peppercorn, Mark A.

    2009-01-01

    Ulcerative colitis (UC) is a disease of unknown etiology characterized by inflammation of the mucosa and occasionally the submucosa of the colon. Conventional drug therapy for UC involves use of aminosalicylates, corticosteroids, azathioprine/6-mercaptopurine, cyclosporine and anti-tumor necrosis factor therapy. Alternative therapies include probiotics, nicotine and fish oil. Drugs like tacrolimus, rosiglitazone and Trichuris suis ova are being evaluated for use in UC patients. With the new biologic agents, new treatment options for UC continue to evolve. In this article we will discuss the conventional drugs, the alternative therapies and the management strategies according to the severity and extent of UC. PMID:21180538

  13. Preparing Future Leaders: Project Management Strategies for Service Learning

    ERIC Educational Resources Information Center

    Munger, Roger; Gutowski, Amanda

    2008-01-01

    This article makes a case for teaching project management strategies in service-learning courses. The authors describe three specific documents students can create to help them manage a service-learning project and then present strategies that can help students manage their project teams. Such skills, the authors argue, provide the tools students…

  14. Preservice Teachers' Knowledge and Perceptions of Effective Behavior Management Strategies

    ERIC Educational Resources Information Center

    Nields, Allison N.

    2014-01-01

    This study examined student teachers' perceptions and knowledge of behavior management strategies. A questionnaire that included questions about broad behavior management techniques, behavioral learning theory, and behavior management strategies related to behavioral learning theory was given to sixty-one student teacher candidates at a large…

  15. National launch strategy vehicle data management system

    NASA Technical Reports Server (NTRS)

    Cordes, David

    1990-01-01

    The national launch strategy vehicle data management system (NLS/VDMS) was developed as part of the 1990 NASA Summer Faculty Fellowship Program. The system was developed under the guidance of the Engineering Systems Branch of the Information Systems Office, and is intended for use within the Program Development Branch PD34. The NLS/VDMS is an on-line database system that permits the tracking of various launch vehicle configurations within the program development office. The system is designed to permit the definition of new launch vehicles, as well as the ability to display and edit existing launch vehicles. Vehicles can be grouped in logical architectures within the system. Reports generated from this package include vehicle data sheets, architecture data sheets, and vehicle flight rate reports. The topics covered include: (1) system overview; (2) initial system development; (3) supercard hypermedia authoring system; (4) the ORACLE database; and (5) system evaluation.

  16. Current and Potential Therapeutic Strategies for Hemodynamic Cardiorenal Syndrome

    PubMed Central

    Obi, Yoshitsugu; Kim, Taehee; Kovesdy, Csaba P.; Amin, Alpesh N.; Kalantar-Zadeh, Kamyar

    2016-01-01

    Background Cardiorenal syndrome (CRS) encompasses conditions in which cardiac and renal disorders co-exist and are pathophysiologically related. The newest classification of CRS into seven etiologically and clinically distinct types for direct patient management purposes includes hemodynamic, uremic, vascular, neurohumoral, anemia- and/or iron metabolism-related, mineral metabolism-related and protein-energy wasting-related CRS. This classification also emphasizes the pathophysiologic pathways. The leading CRS category remains hemodynamic CRS, which is the most commonly encountered type in patient care settings and in which acute or chronic heart failure leads to renal impairment. Summary This review focuses on selected therapeutic strategies for the clinical management of hemodynamic CRS. This is often characterized by an exceptionally high ratio of serum urea to creatinine concentrations. Loop diuretics, positive inotropic agents including dopamine and dobutamine, vasopressin antagonists including vasopressin receptor antagonists such as tolvaptan, nesiritide and angiotensin-neprilysin inhibitors are among the pharmacologic agents used. Additional therapies include ultrafiltration (UF) via hemofiltration or dialysis. The beneficial versus unfavorable effects of these therapies on cardiac decongestion versus renal blood flow may act in opposite directions. Some of the most interesting options for the outpatient setting that deserve revisiting include portable continuous dobutamine infusion, peritoneal dialysis and outpatient UF via hemodialysis or hemofiltration. Key Messages The new clinically oriented CRS classification system is helpful in identifying therapeutic targets and offers a systematic approach to an optimal management algorithm with better understanding of etiologies. Most interventions including UF have not shown a favorable impact on outcomes. Outpatient portable dobutamine infusion is underutilized and not well studied. Revisiting traditional and

  17. Current Antiplatelet Treatment Strategy in Patients with Diabetes Mellitus

    PubMed Central

    Jung, Jung Hwa; Tantry, Udaya S.; Gurbel, Paul A.

    2015-01-01

    Patients with diabetes mellitus (DM) have accelerated atherosclerosis with an increased risk for atherothrombotic cardiovascular complications. A state of high platelet reactivity and activation, hypercoagulability (prothrombotic state) and a subdued response to standard antiplatelet agents may explain high rate of adverse cardiovascular events in patients with DM. Several antithrombotic treatment strategies have been developed to control the prothrombotic state in patients with DM: dose modification of commonly used agents; use of potent agents; and addition of a third antithrombotic drug (triple therapy) to commonly prescribed dual antiplatelet therapy of aspirin and a P2Y12 inhibitor. The present review aims to provide an overview of the current knowledge on platelet abnormalities in patients with DM, focusing on the challenges and perspectives of antiplatelet treatment strategies in this population. PMID:25922803

  18. Nanomedicinal strategies to treat multidrug-resistant tumors: current progress

    PubMed Central

    Dong, Xiaowei; Mumper, Russell J

    2010-01-01

    Multidrug resistance (MDR) is a major impediment to the success of cancer chemotherapy. P-glycoprotein is an important and the best-known membrane transporter involved in MDR. Several strategies have been used to address MDR, especially P-glycoprotein-mediated drug resistance in tumors. However, clinical success has been limited, largely due to issues regarding lack of efficacy and/or safety. Nanoparticles have shown the ability to target tumors based on their unique physical and biological properties. To date, nanoparticles have been investigated primarily to address P-glycoprotein and the observed improved anticancer efficacy suggests that nanomedicinal strategies provide a new opportunity to overcome MDR. This article focuses on nanotechnology-based formulations and current nanomedicine approaches to address MDR in tumors and discusses the proposed mechanisms of action. PMID:20528455

  19. Improving Recall Using Database Management Systems: A Learning Strategy.

    ERIC Educational Resources Information Center

    Jonassen, David H.

    1986-01-01

    Describes the use of microcomputer database management systems to facilitate the instructional uses of learning strategies relating to information processing skills, especially recall. Two learning strategies, cross-classification matrixing and node acquisition and integration, are highlighted. (Author/LRW)

  20. Current Concepts in the Management of the Rheumatoid Hand

    PubMed Central

    Chung, Kevin C; Pushman, Allison G

    2011-01-01

    Hand surgeons are an integral part of the management team for patients with rheumatoid arthritis. There is now a greater understanding of the national utilization of rheumatoid hand surgery, which highlights the differences between hand surgeons and rheumatologists regarding the treatment of the rheumatoid hand. Advances in medical treatments have also decreased the prevalence of hand deformities caused by this disease. Hand surgeons today have less exposure to treating rheumatoid hand, but despite more effective medical options, surgery may still offer patients hope for improvement of hand function and appearance. This article will summarize the current state of rheumatoid hand surgery and discuss the surgical treatment strategies for optimizing outcomes for patients suffering from rheumatoid arthritis. PMID:21463736

  1. Current Status of On-Site Wastewater Management

    ERIC Educational Resources Information Center

    Senn, Charles L.

    1978-01-01

    Wastewater management is becoming an important environmental issue nationally. This article reports the history and current status of wastewater management. Regulatory programs are discussed with specific state examples. Needs assessment is also included. (MA)

  2. A holistic strategy for adaptive land management

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Adaptive management is widely applied to natural resources management. Adaptive management can be generally defined as an iterative decision-making process that incorporates formulation of management objectives, actions designed to address these objectives, monitoring of results, and repeated adapta...

  3. 2013 update on current vaccination strategies in puppies and kittens.

    PubMed

    Davis-Wurzler, Gina M

    2014-03-01

    Vaccines remain one of the practitioner's greatest tools in preventing disease and maintaining individual and population health. This article is an update to "Current Vaccination Strategies in Puppies and Kittens" published in Veterinary Clinics of North America, Small Animal Practitioner, in May 2006. There are now comprehensive guidelines readily available for small animal practitioners regarding canine and feline pediatric (and adult) vaccination recommendations. Perhaps more importantly, there is an increased dialogue regarding all aspects of preventive medicine, of which vaccination is only a small, yet significant portion; and an increased drive to provide scientific evidence for developing vaccination recommendations.

  4. Current therapeutic strategies for inflammation following traumatic spinal cord injury☆

    PubMed Central

    Singh, Priyanka L.; Agarwal, Nitin; Barrese, James C.; Heary, Robert F.

    2012-01-01

    Damage from spinal cord injury occurs in two phases – the trauma of the initial mechanical insult and a secondary injury to nervous tissue spared by the primary insult. Apart from damage sustained as a result of direct trauma to the spinal cord, the post-traumatic inflammatory response contributes significantly to functional motor deficits exacerbated by the secondary injury. Attenuating the detrimental aspects of the inflammatory response is a promising strategy to potentially ameliorate the secondary injury, and promote significant functional recovery. This review details how the inflammatory component of secondary injury to the spinal cord can be treated currently and in the foreseeable future. PMID:25624806

  5. Pharmacological treatment for Alzheimer's disease: current approaches and future strategies.

    PubMed

    Fan, Ling-Yun; Chiu, Ming-Jang

    2010-12-01

    More than a decade after the first approval of the use of acetylcholine esterase inhibitor on patients with Alzheimer's disease, we still not have a single treatment or combination therapy that can effectively stop or reverse the relentless progression of such neurodegenerative disease. Recently therapeutics targeting amyloid hypothesis have undergone scrutiny by many clinical trials. These include gamma secretase inhibitor for reducing beta amyloid formation, agents for preventing aggregation of amyloid oligomers, and immunotherapy for enhancing clearance of amyloid and plaque. Therapies targeting hyperphosphorylated tau is another promising mechanism to be tackled with. Other agents enforcing mitochondria functions, enhancing serotonin receptors, modulating advanced glycation end products, and neurotrophic factors, as well as other therapies are also emerging. We review current treatments and therapeutic strategies already undergone different stage of clinical trails in this report. We propose that therapeutics of various combination composed of symptomatic treatments and disease modifying therapies will become standard regimens of AD treatment with much better efficacy than current approaches.

  6. Therapeutic strategies for Leber's hereditary optic neuropathy: A current update.

    PubMed

    Gueven, Nuri; Faldu, Dharmesh

    2013-11-01

    Leber's hereditary optic neuropathy (LHON) is a rare mitochondrial retinopathy, caused by mutations in subunits of complex I of the respiratory chain, which leads to elevated levels of oxidative stress and an insufficient energy supply. This molecular pathology is thought to be responsible for the dysfunction and eventual apoptotic loss of retinal ganglion cells in the eye, which ultimately results in blindness. Many strategies, ranging from neuroprotectants, antioxidants, anti-apoptotic- and anti-inflammatory compounds have been tested with mixed results. Currently, the most promising compounds are short-chain quinones that have been shown to protect the vision of LHON patients during the early stages of the disease. This commentary gives a brief overview on the current status of tested therapeutics and also addresses future developments such as the use of gene therapy that hopefully will provide safe and efficient therapy options for all LHON patients.

  7. Current therapeutic strategies for premature ejaculation and future perspectives

    PubMed Central

    Xin, Zhong-Cheng; Zhu, Yi-Chen; Yuan, Yi-Ming; Cui, Wan-Shou; Jin, Zhe; Li, Wei-Ren; Liu, Tao

    2011-01-01

    Premature ejaculation (PE) is a common sexual disorder in men that is mediated by disturbances in the peripheral and central nervous systems. Although all pharmaceutical treatments for PE are currently used ‘off-label', some novel oral agents and some newer methods of drug administration now provide important relief to PE patients. However, the aetiology of this condition has still not been unified, primarily because of the lack of a standard animal model for basic research and the absence of a widely accepted definition and assessment tool for evidence-based clinical studies in patients with PE. In this review, we focus on the current therapeutic strategies and future treatment perspectives for PE. PMID:21532601

  8. A review of current treatment strategies for gestational diabetes mellitus

    PubMed Central

    Kelley, Kristi W; Carroll, Dana G; Meyer, Allison

    2015-01-01

    Approximately 90% of diabetes cases in pregnant women are considered gestational diabetes mellitus (GDM). It is well known that uncontrolled glucose results in poor pregnancy outcomes in both the mother and fetus. Worldwide there are many guidelines with recommendations for appropriate management strategies for GDM once lifestyle modifications have been instituted and failed to achieve control. The efficacy and particularly the safety of other treatment modalities for GDM has been the source of much debate in recent years. Studies that have demonstrated the safety and efficacy of both glyburide and metformin in the management of patients with GDM will be reviewed. There is a lack of evidence with other oral and injectable non-insulin agents to control blood glucose in GDM. The role of insulin will be discussed, with emphasis on insulin analogs. Ideal patient characteristics for each treatment modality will be reviewed. In addition, recommendations for postpartum screening of patients will be described as well as recommendations for use of agents to manage subsequent type 2 diabetes in patients who are breastfeeding. PMID:26213555

  9. SUSTAINABLE MSW MANAGEMENT STRATEGIES IN THE UNITED STATES

    EPA Science Inventory

    Under increasing pressure to minimize potential environmental burdens and costs for municipal solid waste (MSW) management, state and local governments often must modify programs and adopt more efficient integrated MSW management strategies that reflect dynamic shifts in MSW mana...

  10. Liquid Acquisition Strategies for Exploration Missions: Current Status 2010

    NASA Technical Reports Server (NTRS)

    Chato, David J.

    2010-01-01

    NASA is currently developing the propulsion system concepts for human exploration missions to the lunar surface. The propulsion concepts being investigated are considering the use of cryogenic propellants for the low gravity portion of the mission, that is, the lunar transit, lunar orbit insertion, lunar descent and the rendezvous in lunar orbit with a service module after ascent from the lunar surface. These propulsion concepts will require the vapor free delivery of the cryogenic propellants stored in the propulsion tanks to the exploration vehicles main propulsion system (MPS) engines and reaction control system (RCS) engines. Propellant management devices (PMD s) such as screen channel capillary liquid acquisition devices (LAD s), vanes and sponges currently are used for earth storable propellants in the Space Shuttle Orbiter OMS and RCS applications and spacecraft propulsion applications but only very limited propellant management capability exists for cryogenic propellants. NASA has begun a technology program to develop LAD cryogenic fluid management (CFM) technology through a government in-house ground test program of accurately measuring the bubble point delta-pressure for typical screen samples using LO2, LN2, LH2 and LCH4 as test fluids at various fluid temperatures and pressures. This presentation will document the CFM project s progress to date in concept designs, as well ground testing results.

  11. Evidence-based Management Strategies for Treatment of Chronic Wounds

    PubMed Central

    Werdin, Frank; Tennenhaus, Mayer; Schaller, Hans-Eberhardt; Rennekampff, Hans-Oliver

    2009-01-01

    The care and management of patients with chronic wounds and their far-reaching effects challenge both the patient and the practitioner. Further complicating this situation is the paucity of evidence-based treatment strategies for chronic wound care. After searching both MEDLINE and Cochrane databases, we reviewed currently available articles concerning chronic wound care. Utilizing this information, we have outlined a review of current, evidence-based concepts as they pertain to the treatment of chronic wounds, focusing on fundamental treatment principles for the management of venous, arterial, diabetic, and pressure ulcers. Individualized treatment options as well as general wound management principles applicable to all varieties of chronic wounds are described. Classification and treatment guidelines as well as the adoption of the TIME acronym facilitate an organized conceptional approach to wound care. In so doing, individual aspects of generalized wound care such as debridement, infection, and moisture control as well as attention to the qualities of the wound edge are comprehensively evaluated, communicated, and addressed. Effective adjuvant agents for the therapy of chronic wounds including nutritional and social support measures are listed, as is a brief review of strategies helpful for preventing recurrence. An appreciation of evidence-based treatment pathways and an understanding of the pathophysiology of chronic wounds are important elements in the management of patients with chronic wounds. To achieve effective and long-lasting results, a multidisciplinary approach to patient care, focused on the education and coordination of patient, family as well as medical and support staff can prove invaluable. PMID:19578487

  12. Library and Learning Resources Management: Current Trends.

    ERIC Educational Resources Information Center

    Armsby, Allen; And Others

    1987-01-01

    The seven papers that make up this report focus on the impact of new information technology on curriculum and resource management at the college level in England and Wales. A brief preface, an introduction, and a foreword provide background information on the report and introduce the following papers: (1) "Curriculum Developments in Further…

  13. Strategies for sustainable management of renewable resources during environmental change.

    PubMed

    Lindkvist, Emilie; Ekeberg, Örjan; Norberg, Jon

    2017-03-15

    As a consequence of global environmental change, management strategies that can deal with unexpected change in resource dynamics are becoming increasingly important. In this paper we undertake a novel approach to studying resource growth problems using a computational form of adaptive management to find optimal strategies for prevalent natural resource management dilemmas. We scrutinize adaptive management, or learning-by-doing, to better understand how to simultaneously manage and learn about a system when its dynamics are unknown. We study important trade-offs in decision-making with respect to choosing optimal actions (harvest efforts) for sustainable management during change. This is operationalized through an artificially intelligent model where we analyze how different trends and fluctuations in growth rates of a renewable resource affect the performance of different management strategies. Our results show that the optimal strategy for managing resources with declining growth is capable of managing resources with fluctuating or increasing growth at a negligible cost, creating in a management strategy that is both efficient and robust towards future unknown changes. To obtain this strategy, adaptive management should strive for: high learning rates to new knowledge, high valuation of future outcomes and modest exploration around what is perceived as the optimal action.

  14. Anaplastic glioma: current treatment and management.

    PubMed

    Le Rhun, Emilie; Taillibert, Sophie; Chamberlain, Marc C

    2015-06-01

    Anaplastic glioma (AG) is divided into three morphology-based groups (anaplastic astrocytoma, anaplastic oligodendroglioma, anaplastic oligoastrocytoma) as well as three molecular groups (glioma-CpG island methylation phenotype [G-CIMP] negative, G-CIMP positive non-1p19q codeleted tumors and G-CIMP positive codeleted tumors). The RTOG 9402 and EORTC 26951 trials established radiotherapy plus (procarbazine, lomustine, vincristine) chemotherapy as the standard of care in 1p/19q codeleted AG. Uni- or non-codeleted AG are currently best treated with radiotherapy only or alkylator-based chemotherapy only as determined by the NOA-04 trial. Maturation of NOA-04 and results of the currently accruing studies, CODEL (for codeleted AG) and CATNON (for uni or non-codeleted AG), will likely refine current up-front treatment recommendations for AG.

  15. Pediatric papillary thyroid cancer: current management challenges

    PubMed Central

    Verburg, Frederik A; Van Santen, Hanneke M; Luster, Markus

    2017-01-01

    Although with a standardized incidence of 0.54 cases per 100,000 persons, differentiated thyroid cancer (DTC) is a rare disease in children and adolescents, it nonetheless concerns ~1.4% of all pediatric malignancies. Furthermore, its incidence is rising. Due to the rarity and long survival of pediatric DTC patients, in most areas of treatment little evidence exists. Treatment of pediatric DTC is therefore littered with controversies, many questions therefore remain open regarding the optimal management of pediatric papillary thyroid cancer (PTC), and many challenges remain unsolved. In the present review, we aim to provide an overview of these challenging areas of patient and disease management in pediatric PTC patients. Data on diagnosis, surgery, radionuclide, and endocrine therapy are discussed, and the controversies therein are highlighted. PMID:28096684

  16. Current Management of Sickle Cell Anemia

    PubMed Central

    McGann, Patrick T.; Nero, Alecia C.; Ware, Russell E.

    2013-01-01

    Proper management of sickle cell anemia (SCA) begins with establishing the correct diagnosis early in life, ideally during the newborn period. The identification of affected infants by neonatal screening programs allows early initiation of prophylactic penicillin and pneumococcal immunizations, which help prevent overwhelming sepsis. Ongoing education of families promotes the early recognition of disease-released complications, which allows prompt and appropriate medical evaluation and therapeutic intervention. Periodic evaluation by trained specialists helps provide comprehensive care, including transcranial Doppler examinations to identify children at risk for primary stroke, plus assessments for other parenchymal organ damage as patients become teens and adults. Treatment approaches that previously highlighted acute vaso-occlusive events are now evolving to the concept of preventive therapy. Liberalized use of blood transfusions and early consideration of hydroxyurea treatment represent a new treatment paradigm for SCA management. PMID:23709685

  17. MANAGEMENT OF VARICEAL HEMORRHAGE: CURRENT CONCEPTS

    PubMed Central

    COELHO, Fabricio Ferreira; PERINI, Marcos Vinícius; KRUGER, Jaime Arthur Pirola; FONSECA, Gilton Marques; de ARAÚJO, Raphael Leonardo Cunha; MAKDISSI, Fábio Ferrari; LUPINACCI, Renato Micelli; HERMAN, Paulo

    2014-01-01

    Introduction The treatment of portal hypertension is complex and the the best strategy depends on the underlying disease (cirrhosis vs. schistosomiasis), patient's clinical condition and time on it is performed (during an acute episode of variceal bleeding or electively, as pre-primary, primary or secondary prophylaxis). With the advent of new pharmacological options and technical development of endoscopy and interventional radiology treatment of portal hypertension has changed in recent decades. Aim To review the strategies employed in elective and emergency treatment of variceal bleeding in cirrhotic and schistosomotic patients. Methods Survey of publications in PubMed, Embase, Lilacs, SciELO and Cochrane databases through June 2013, using the headings: portal hypertension, esophageal and gastric varices, variceal bleeding, liver cirrhosis, schistosomiasis mansoni, surgical treatment, pharmacological treatment, secondary prophylaxis, primary prophylaxis, pre-primary prophylaxis. Conclusion Pre-primary prophylaxis doesn't have specific treatment strategies; the best recommendation is treatment of the underlying disease. Primary prophylaxis should be performed in cirrhotic patients with beta-blockers or endoscopic variceal ligation. There is controversy regarding the effectiveness of primary prophylaxis in patients with schistosomiasis; when indicated, it is done with beta-blockers or endoscopic therapy in high-risk varices. Treatment of acute variceal bleeding is systematized in the literature, combination of vasoconstrictor drugs and endoscopic therapy, provided significant decline in mortality over the last decades. TIPS and surgical treatment are options as rescue therapy. Secondary prophylaxis plays a fundamental role in the reduction of recurrent bleeding, the best option in cirrhotic patients is the combination of pharmacological therapy with beta-blockers and endoscopic band ligation. TIPS or surgical treatment, are options for controlling rebleeding on

  18. Current management of the short bowel syndrome.

    PubMed

    Thompson, Jon S; Weseman, Rebecca; Rochling, Fedja A; Mercer, David F

    2011-06-01

    Short bowel syndrome is a challenging clinical problem that benefits from a multidisciplinary approach. Much progress has recently been made in all aspects of management. Medical intestinal rehabilitation should be the initial treatment focus, and several new potential pharmacologic agents are being investigated. Surgical rehabilitation using nontransplant procedures in selected patients may further improve intestinal function. Intestinal lengthening procedures are particularly promising. Intestinal transplantation has increasingly been used with improving success in patients with life-threatening complications of intestinal failure.

  19. Current Medical Management of Peptic Ulcer Disease

    PubMed Central

    Lukie, Bryan E.

    1989-01-01

    Peptic ulceration occurs when the digestive action of gastric secretions overcomes gastroduodenal mucosal defences. The therapeutic strategy used to correct this imbalance uses drugs that either reduce gastric secretion or increase mucosal resistance. Traditional therapies of dietary manipulation and antacid administration no longer play major roles in peptic ulcer therapy. Uncomplicated peptic ulcers respond quite well to drug treatment, although recurrences are common and may require long-term maintenance therapy. Drug-induced gastric ulcers have represented a challenging problem, for which effective therapy is now available. PMID:21249091

  20. Management of polycythaemia vera: a critical review of current data.

    PubMed

    McMullin, Mary F; Wilkins, Bridget S; Harrison, Claire N

    2016-02-01

    Polycythaemia vera (PV) is a chronic blood cancer; its clinical features are dominated by myeloproliferation (erythrocytosis, often leucocytosis and/or thrombocytosis) and a tendency for thrombosis and transformation to myelofibrosis or acute myeloid leukaemia. In the past 10 years the pathophysiology of this condition has been defined as JAK/STAT pathway activation, almost always due to mutations in JAK2 exons 12 or 14 (JAK2 V617F). In the same time period our understanding of the optimal management of PV has expanded, most recently culminating in the approval of JAK inhibitors for the treatment of PV patients who are resistant or intolerant to therapy with hydroxycarbamide. It has also been demonstrated that life expectancy for many patients with PV is not normal, nor is their quality of life. We critically explore these findings and discuss their impact. In addition, we highlight persisting gaps in our current management strategy; for example, what is the optimal first line cytoreductive therapy and, indeed, which patients need cytoreductive drugs.

  1. Current management of talar osteochondral lesions

    PubMed Central

    Gianakos, Arianna L; Yasui, Youichi; Hannon, Charles P; Kennedy, John G

    2017-01-01

    Osteochondral lesions of the talus (OLT) occur in up to 70% of acute ankle sprains and fractures. OLT have become increasingly recognized with the advancements in cartilage-sensitive diagnostic imaging modalities. Although OLT may be treated nonoperatively, a number of surgical techniques have been described for patients whom surgery is indicated. Traditionally, treatment of symptomatic OLT have included either reparative procedures, such as bone marrow stimulation (BMS), or replacement procedures, such as autologous osteochondral transplantation (AOT). Reparative procedures are generally indicated for OLT < 150 mm2 in area. Replacement strategies are used for large lesions or after failed primary repair procedures. Although short- and medium-term results have been reported, long-term studies on OLT treatment strategies are lacking. Biological augmentation including platelet-rich plasma and concentrated bone marrow aspirate is becoming increasingly popular for the treatment of OLT to enhance the biological environment during healing. In this review, we describe the most up-to-date clinical evidence of surgical outcomes, as well as both the mechanical and biological concerns associated with BMS and AOT. In addition, we will review the recent evidence for biological adjunct therapies that aim to improve outcomes and longevity of both BMS and AOT procedures. PMID:28144574

  2. Strategy Maps in University Management: A Comparative Study

    ERIC Educational Resources Information Center

    Han, Shuangmiao; Zhong, Zhou

    2015-01-01

    In this study, the conceptual use of the strategy map approach and the strategy map which it produces have been adapted from the business sector and introduced as tools for achieving more effective strategic planning and management in higher education institutions (HEIs). This study discusses the development of strategy maps as transformational…

  3. Steam generator degradation: Current mitigation strategies for controlling corrosion

    SciTech Connect

    Millett, P.

    1997-02-01

    Steam Generator degradation has caused substantial losses of power generation, resulted in large repair and maintenance costs, and contributed to significant personnel radiation exposures in Pressurized Water Reactors (PWRs) operating throughout the world. EPRI has just published the revised Steam Generator Reference Book, which reviews all of the major forms of SG degradation. This paper discusses the types of SG degradation that have been experienced with emphasis on the mitigation strategies that have been developed and implemented in the field. SG degradation is presented from a world wide perspective as all countries operating PWRs have been effected to one degree or another. The paper is written from a US. perspective where the utility industry is currently undergoing tremendous change as a result of deregulation of the electricity marketplace. Competitive pressures are causing utilities to strive to reduce Operations and Maintenance (O&M) and capital costs. SG corrosion is a major contributor to the O&M costs of PWR plants, and therefore US utilities are evaluating and implementing the most cost effective solutions to their corrosion problems. Mitigation strategies developed over the past few years reflect a trend towards plant specific solutions to SG corrosion problems. Since SG degradation is in most cases an economic problem and not a safety problem, utilities can focus their mitigation strategies on their unique financial situation. Accordingly, the focus of R&D has shifted from the development of more expensive, prescriptive solutions (e.g. reduced impurity limits) to corrosion problems to providing the utilities with a number of cost effective mitigation options (e.g. molar ratio control, boric acid treatment).

  4. [Current operative techniques and strategies in endocrine surgery].

    PubMed

    Gürtler, Thomas; Weber, Markus

    2011-06-01

    Technical advances and focusing on subsets modified endocrine surgery in the last ten years tremendously. There is on one side a clear trend towards minimal invasive approaches, first of all in the surgery of the adrenal glands, where the transperitoneal or retroperitoneal laparoscopic adrenalectomy has become the gold standard for tumors up to a size of 10 cm in diameter. But also in pancreatic endocrine surgery for small tumors localized in the pancreas tail and up to a certain extend in thyroid and parathyroid surgery, laparoscopic or video assisted techniques are used. On the other side more precise techniques allow a more complete and radical removal of endocrine tissue, especially in thyroid surgery. This article presents a summary of current operative techniques and strategies in endocrine surgery.

  5. Cell sheet engineering for regenerative medicine: current challenges and strategies.

    PubMed

    Owaki, Toshiyuki; Shimizu, Tatsuya; Yamato, Masayuki; Okano, Teruo

    2014-07-01

    Substantial progress made in the areas of stem cell research and regenerative medicine has provided a number of innovative methods to repair or regenerate defective tissues and organs. Although previous studies regarding regenerative medicine, especially those involving induced pluripotent stem cells, have been actively promoted in the past decade, there remain some challenges that need to be addressed in order to enable clinical applications. Designed for use in clinical applications, cell sheet engineering has been developed as a unique, scaffold-free method of cell processing utilizing temperature-responsive cell culture vessels. Clinical studies using cell sheets have shown positive outcomes and will be translated into clinical practice in the near future. However, several challenges stand in the way of the industrialization of cell sheet products and the widespread acceptance of regenerative medicine based on cell sheet engineering. This review describes current strategies geared towards the realization of the regenerative medicine approach.

  6. TRALI risk reduction: donor and component management strategies.

    PubMed

    Eder, Anne F; Benjamin, Richard J

    2009-01-01

    Transfusion-related lung injury (TRALI) occurs in approximately 1 in 5,000 transfusions and may cause considerably more morbidity and mortality that is not recognized in clinical practice. Based on the current understanding of the etiology of TRALI, blood centers have implemented or are evaluating various donor and component management strategies in an effort to mitigate the risk of TRALI. Many cases of TRALI are likely caused by antibodies to leukocyte antigens (HLA or HNA) in blood components. Approximately 10 to 20% of female blood donors with a history of pregnancy and 1 to 5% of male blood donors harbor these antibodies. Alternatively, TRALI may be mediated by other bioactive lipids or substances that accumulate during storage and cause a reaction when transfused to susceptible patients. The complex interplay among various donor-, component-, and patient-related factors underlying TRALI guarantees that effective prevention will not be a single or simple intervention but rather will require a multifaceted approach. Perhaps, the most important risk reduction strategy is the effort to ensure appropriate use of blood products and eliminate unnecessary transfusions. Blood collection agencies, however, have more proximate control over donor selection and component management than transfusion practice. AABB has provided some guidance on deferring donors implicated in TRALI and minimizing the preparation of high plasma volume components from donors who have anti-leukocyte antibodies or are at increased risk of leukocyte alloimmunization. Blood centers have taken various approaches to mitigate the risk of TRALI, and the possible benefit and the inherent limitations of the current strategies will be reviewed.

  7. Determining management strategies for the Sarikum Nature Protection Area.

    PubMed

    Öztürk, Sevgi

    2015-03-01

    In recent years, many environmental problems have become important factors in promoting the economic need to develop tourist activity: climate change such as energy wars, increasing hunger and aridity, population increases in urban areas, excessive and unthinking use of natural resources, difficult international relations, economic competition, and increasing environmental stress. Trends in global tourism have changed with changes in culture and our attitude to nature. Changes in both the profile and consumption patterns of tourists have called for the need to balance the use of natural and cultural assets with the need to adequately protect them. In this study, the Sarikum Nature Protection Area (SNPA) was selected as a case study because of its significance as a Turkish wetland area and the variety of different ecosystems coexisting within it. The study focussed on management strategies, but also provides a broader strategy for an area that currently has no management plan. Strengths and weaknesses, opportunities and threats (SWOT) analyses of the area were gathered and analyzed using R'WOT analysis (ranking + SWOT), a multi-criteria assessment method, in order to determine strategies, obtain the participation of interest groups, and assess their opinions and attitudes. The analysis showed the following: the rich biological diversity and the existence of endemic species were the reserve's most significant strength; the presence of natural areas in surrounding regions was the most significant opportunity; the shortage of infrastructure and lack of legal regulation of ecotourism was the most significant weakness; and the lack of a management plan was the most immediate threat.

  8. Current Approaches to the Management of Pediatric Overweight and Obesity

    PubMed Central

    Ridolfi, Danielle R.; Hayes, Jacqueline F.; St Paul, Michelle; Wilfley, Denise E.

    2015-01-01

    Opinion Statement Family-based behavioral intervention has been demonstrated to be an effective and safe treatment for childhood obesity and should be considered a first-line treatment option. However, access to such intensive evidence-based treatment is limited and, currently, obesity care is dominated by high intensity behavioral treatment implemented in specialty clinics or less effective, low intensity treatments implemented in primary care. However, capitalizing on the established and ongoing relationship between primary care providers and families, primary care providers hold an invaluable role in early identification of overweight and obesity, and subsequent referral to an evidence-based treatment. key aspects of effective treatment include: early intervention, moderate- to high-intensity intervention of sufficient duration, multi-component intervention targeting dietary modification, physical activity and behavioral strategies, family involvement and goals targeting family members, and follow-up contact during maintenance. The purpose of this review is to present the current empirically supported treatment options for pediatric obesity including primary care-based interventions and diagnostic tools, multi-component behavioral intervention with a focus on family-based behavioral intervention, immersion treatment, and pharmacologic and surgical management. PMID:25205083

  9. Current Management for Improved Railgun Performance

    DTIC Science & Technology

    1989-08-01

    studs" deserve special recognition. Although there has been no significance to the order in which I previously mentioned people or organizations, I have...milliseconds. This dictates that useful railguns operate as pulsed current devices, driven by pulsed power supplies. Maximization of projectile...how to control it to maximize railgun acceleration capabilities. 0 1.2 The Present State of Railgun Technology Although there was some interest in

  10. Oligometastatic non-small-cell lung cancer: current treatment strategies

    PubMed Central

    Richard, Patrick J; Rengan, Ramesh

    2016-01-01

    The oligometastatic disease theory was initially described in 1995 by Heilman and Weichselbaum. Since then, much work has been performed to investigate its existence in many solid tumors. This has led to subclassifications of stage IV cancer, which could redefine our treatment approaches and the therapeutic outcomes for this historically “incurable” entity. With a high incidence of stage IV disease, non-small-cell lung cancer (NSCLC) remains a difficult cancer to treat and cure. Recent work has proven the existence of an oligometastatic state in NSCLC in terms of properly selecting patients who may benefit from aggressive therapy and experience long-term overall survival. This review discusses the current treatment approaches used in oligometastatic NSCLC and provides the evidence and rationale for each approach. The prognostic factors of many trials are discussed, which can be used to properly select patients for aggressive treatment regimens. Future advances in both molecular profiling of NSCLC to find targetable mutations and investigating patient selection may increase the number of patients diagnosed with oligometastatic NSCLC. As this disease entity increases, it is of utmost importance for oncologists treating NSCLC to be aware of the current treatment strategies that exist and the potential advantages/disadvantages of each. PMID:28210169

  11. Current challenges in the management of hemophilia.

    PubMed

    Bauer, Kenneth A

    2015-03-01

    Hemophilia is characterized by genetic mutations resulting in the deficiency of factors critical to the normal process of coagulation, sometimes resulting in spontaneous bleeding into soft tissue, joints, and internal organs. The 2 most common subtypes are hemophilia A, or factor VIII deficiency, and hemophilia B, or factor IX deficiency. Hemophilia affects an estimated 20,000 individuals in the United States. The diagnosis and management of patients with severe hemophilia is complex, and requires preventive treatment (prophylaxis) to avoid bleeding episodes and related complications and the use of replacement therapy with coagulation factors during acute bleeding episodes. To achieve optimal long-term results, the treatment of patients with hemophilia requires a comprehensive approach coordinated by a multidisciplinary team of specialists. Hemophilia imposes a substantial burden from economic, societal, and patient perspectives.

  12. Upper extremity trauma: current trends in management.

    PubMed

    Stone, W M; Fowl, R J; Money, S R

    2007-10-01

    Upper extremity trauma can be penetrating or blunt in etiology. The close proximity of vein, artery and nerve makes for a complicated presentation and potentially complicated reconstruction. Orthopedic and neurologic injuries can cause the more long term disability of these patients, but vascular injuries are initially more life threatening. Control of vascular injuries can be particularly difficult due to anatomic issues in the upper extremities. The intervention carried significant morbidity until evolution to endovascular approaches occurred. By reconstructing the injury from a more ''remote'' access site, less concomitant injury to the extremity can be encountered. However, although control of vascular injuries may result in greater survival rates with less morbidity from the procedure, long term outcome remains dependent upon concomitant injuries. This review will encompass both vascular and neurologic injuries secondary to trauma to the upper extremity and outline some of the trends in management.

  13. The 'Toolbox' of strategies for managing Haemonchus contortus in goats: What's in and what's out.

    PubMed

    Kearney, P E; Murray, P J; Hoy, J M; Hohenhaus, M; Kotze, A

    2016-04-15

    A dynamic and innovative approach to managing the blood-consuming nematode Haemonchus contortus in goats is critical to crack dependence on veterinary anthelmintics. H. contortus management strategies have been the subject of intense research for decades, and must be selected to create a tailored, individualized program for goat farms. Through the selection and combination of strategies from the Toolbox, an effective management program for H. contortus can be designed according to the unique conditions of each particular farm. This Toolbox investigates strategies including vaccines, bioactive forages, pasture/grazing management, behavioural management, natural immunity, FAMACHA, Refugia and strategic drenching, mineral/vitamin supplementation, copper Oxide Wire Particles (COWPs), breeding and selection/selecting resistant and resilient individuals, biological control and anthelmintic drugs. Barbervax(®), the ground-breaking Haemonchus vaccine developed and currently commercially available on a pilot scale for sheep, is prime for trialling in goats and would be an invaluable inclusion to this Toolbox. The specialised behaviours of goats, specifically their preferences to browse a variety of plants and accompanying physiological adaptations to the consumption of secondary compounds contained in browse, have long been unappreciated and thus overlooked as a valuable, sustainable strategy for Haemonchus management. These strategies are discussed in this review as to their value for inclusion into the 'Toolbox' currently, and the future implications of ongoing research for goat producers. Combining and manipulating strategies such as browsing behaviour, pasture management, bioactive forages and identifying and treating individual animals for haemonchosis, in addition to continuous evaluation of strategy effectiveness, is conducted using a model farm scenario. Selecting strategies from the Toolbox, with regard to their current availability, feasibility, economical cost

  14. Current surgical strategies for total arthroplasty in valgus knee

    PubMed Central

    Nikolopoulos, Dimitrios; Michos, Ioannis; Safos, George; Safos, Petros

    2015-01-01

    The majority of orthopaedic surgeons even currently agree that primary total arthroplasty in valgus knees with a deformity of more than ten degrees may prove challenging. The unique sets of bone and soft tissue abnormalities that must be addressed at the time of the operation make accurate axis restoration, component orientation and joint stability attainment a difficult task. Understanding the specific pathologic anatomic changes associated with the valgus knee is a prerequisite so as to select the proper surgical method, to optimize component position and restore soft-tissue balance. The purpose of this article is to review the valgus knee anatomical variations, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. It will also be underlying the up-to-date main approaches and surgical techniques be proposed in the English literature both for bone cuts and soft tissue management of valgus knees. PMID:26191494

  15. Giant cell arteritis: Current treatment and management

    PubMed Central

    Ponte, Cristina; Rodrigues, Ana Filipa; O’Neill, Lorraine; Luqmani, Raashid Ahmed

    2015-01-01

    Glucocorticoids remain the cornerstone of medical therapy in giant cell arteritis (GCA) and should be started immediately to prevent severe consequences of the disease, such as blindness. However, glucocorticoid therapy leads to significant toxicity in over 80% of the patients. Various steroid-sparing agents have been tried, but robust scientific evidence of their efficacy and safety is still lacking. Tocilizumab, a monoclonal IL-6 receptor blocker, has shown promising results in a number of case series and is now being tested in a multi-centre randomized controlled trial. Other targeted treatments, such as the use of abatacept, are also now under investigation in GCA. The need for surgical treatment is rare and should ideally be performed in a quiescent phase of the disease. Not all patients follow the same course, but there are no valid biomarkers to assess therapy response. Monitoring of disease progress still relies on assessing clinical features and measuring inflammatory markers (C-reactive protein and erythrocyte sedimentation rate). Imaging techniques (e.g., ultrasound) are clearly important screening tools for aortic aneurysms and assessing patients with large-vessel involvement, but may also have an important role as biomarkers of disease activity over time or in response to therapy. Although GCA is the most common form of primary vasculitis, the optimal strategies for treatment and monitoring remain uncertain. PMID:26090367

  16. Recent Advances in Nanosystems and Strategies for Managing Leishmaniasis.

    PubMed

    Vaghela, Rudra; Kulkarni, Parthasarathi K; Osmani, Riyaz Ali M; Bhosale, Rohit R; Naga Sravan Kumar Varma, V

    2016-04-01

    Parasitic infection such as Leishmaniasis, a neglected tropical disease, presents a significant global burden which is responsible for high mortality rate especially in less developed countries. Its intracellular nature and disseminated locations of parasite, limited number of chemotherapeutic agents, increasing incidences of resistance to first line drugs and toxicities, poses a great challenge to formulation scientists that have necessitated effective management of leishmanial infection by modulating the delivery of existing drugs. Over the past decade, research on development of alternative treatments such as nanotechnology-based drug delivery systems (nanoparticles, nanosuspensions, liposomes etc.), use of natural products as well as development of antileishmanial vaccine have been extensively investigated. The present review focuses on different facets of therapeutic strategies, existing miscellaneous drug delivery systems and approaches intended for management, as well as treatment of the infection, with an aim to summarize the current trends and strategies adopted for antileishmanial therapy in a systematic manner. Moreover, the article encloses an eclectic collection of patents allied to new-fangled chemotherapeutics for antileishmanial therapy.

  17. Open Source for Knowledge and Learning Management: Strategies beyond Tools

    ERIC Educational Resources Information Center

    Lytras, Miltiadis, Ed.; Naeve, Ambjorn, Ed.

    2007-01-01

    In the last years, knowledge and learning management have made a significant impact on the IT research community. "Open Source for Knowledge and Learning Management: Strategies Beyond Tools" presents learning and knowledge management from a point of view where the basic tools and applications are provided by open source technologies.…

  18. Survival strategies in the era of managed care.

    PubMed

    Rudomin, M L; Spirakes, A S

    1996-02-01

    The era of managed care has forced an unprecedented restructuring of the health care environment. As hospitals downsize in response, materiel managers should consider adopting strategies that may help ensure their survival, including innovative approaches to supply management and the development of individual responses that will best position them to succeed in this new reality.

  19. Strategies for Managing a Multigenerational Workforce

    ERIC Educational Resources Information Center

    Iden, Ronald

    2016-01-01

    The multigenerational workforce presents a critical challenge for business managers, and each generation has different expectations. A human resource management study of organizations with more than 500 employees reported 58% of the managers experiencing conflict between younger and older workers. The purpose of this single case study was to…

  20. Current management of heparin-induced thrombocytopenia.

    PubMed

    Cosmi, Benilde

    2015-12-01

    Heparin-induced thrombocytopenia (HIT) is an immune adverse reaction to heparin (both unfractionated and low-molecular-weight), which is mediated by the formation of IgG antibodies against platelet factor 4-heparin complexes. The IgG/platelet factor 4 immunocomplexes activate platelets with resulting thrombocytopenia, which is not associated with bleeding, but with paradoxical life-threatening thrombotic complications, for coagulation activation. HIT diagnosis requires the assessment of pre-test clinical probability in combination with the measurement of platelet activating antibodies against platelet factor 4-heparin complexes with immunological and functional assays. When HIT is diagnosed, any form of heparin should be stopped and a non-heparin alternative anticoagulant should be started. Argatroban and danaparoid are currently the only drugs licensed for HIT, with different country availability. Bivalirudin is an option in cardiac surgery and procedures in HIT patients.

  1. Current concepts in acute pain management.

    PubMed

    Huynh, Mai-Phuong; Yagiela, John A

    2003-05-01

    Analgesics most commonly prescribed in dentistry for acute pain relief include the nonsteroidal anti-inflammatory drug, acetaminophen, and various opioid-containing analgesic combinations. The NSAIDs and presumably acetaminophen act by inhibiting cyclooxgenase enzymes responsible for the formation of prostaglandins that promote pain and inflammation. Opioids such as codeine, hydrocodone, and oxycodone stimulate endogenous opioid receptors to bring about analgesic and other effects. Numerous clinical studies have confirmed that moderate to severe pain of dental origin is best managed through the use of ibuprofen or another NSAID whose maximum analgesic effect is at least equal to that of standard doses of acetaminophen-opioid combinations. If an NSAID cannot be prescribed because of patient intolerance, analgesic preparations that combine effective doses of an orally active opioid with 600 to 1,000 mg of acetaminophen are preferred in the healthy adult. On occasion, prescribing both an NSAID and an acetaminophen-opioid combination may be helpful in patients not responding to a single product. In all cases, however, the primary analgesic should be taken on a fixed schedule, not on a "prn" (or as needed) basis, which only guarantees the patient will experience pain.

  2. Current management of urethral stricture disease

    PubMed Central

    Smith, Thomas G.

    2016-01-01

    Introduction: Broadly defined, urethral strictures are narrowing of the urethral lumen that is surrounded by corpus spongiosum, i.e., urethral meatus through the bulbar urethra. Urethral stenosis is narrowing of the posterior urethra, i.e., membranous urethra through bladder neck/prostate junction, which is not enveloped by corpus spongiosum. The disease has significant quality of life ramifications because many times younger patients are affected by this compared to many other urological diseases. Methods: A review of the scientific literature concerning urethral stricture, stenosis, treatment, and outcomes was performed using Medline and PubMed (U.S. National Library of Medicine and the National Institutes of Health). Abstracts from scientific meetings were included in this review. Results: There is level 3 evidence regarding the etiology and epidemiology of urethral strictures, stenoses, and pelvic fracture urethral injuries. Outcomes data from literature regarding intervention for urethral stricture are largely limited to level 3 evidence and expert opinion. There is a single level 1 study comparing urethral dilation and direct vision internal urethrotomy. Urethroplasty outcomes data are limited to level 3 case series. Conclusions: Progress is being made toward consistent terminology, and nomenclature which will, in turn, help to standardize treatment within the field of urology. Treatment for urethral stricture and stenosis remains inconsistent between reconstructive and nonreconstructive urologists due to varying treatment algorithms and approaches to disease management. Tissue engineering appears to be future for reconstructive urethral surgery with reports demonstrating feasibility in the use of different tissue substitutes and grafts. PMID:26941491

  3. Management of asthma in adults: current therapy and future directions

    PubMed Central

    Green, R; Brightling, C; Pavord, I; Wardlaw, A

    2003-01-01

    Asthma is increasing in prevalence worldwide and results in significant use of healthcare resources. Although most patients with asthma can be adequately treated with inhaled corticosteroids, an important number of patients require additional therapy and an increasing number of options are available. A further minority of patients develop severe persistent asthma which remains difficult to manage despite current pharmacological therapies. This review discusses the various treatment options currently available for each stage of asthma severity, highlights some of the limitations of current management, and outlines directions which may improve the management of asthma in the future. PMID:12782771

  4. [Electronic health strategies in The Americas: current situation and perspectives].

    PubMed

    D Agostino, Marcelo

    2015-01-01

    The main objective of the Strategy and Plan of Action on eHealth (2012-2017) is to contribute to sustainable development of health systems of member states. Its adoption aims to improve quality and access to health services through the use of information and communication technologies (ICT), the implementation of digital literacy programs and access to quality information to advance towards more informed, equitable, competitive and democratic societies. PAHO/WHO considers that in society, free and equal access to health information should be a fundamental right of individuals. Access to information, knowledge sharing and use of information and communication technology in the health sector continues to grow and is driving significant changes in the way people interact with health services and among themselves in social networks and through the use of mobile devices (mHealth). This hyper-connected society, or information society, brings new challenges and opportunities related to the use of massive data (Big Data) that forces us to rethink our relationship with reality and the traditional ways of managing health information.

  5. Osteochondral tissue engineering with biphasic scaffold: current strategies and techniques.

    PubMed

    Shimomura, Kazunori; Moriguchi, Yu; Murawski, Christopher D; Yoshikawa, Hideki; Nakamura, Norimasa

    2014-10-01

    The management of osteoarthritis (OA) remains challenging and controversial. Although several clinical options exist for the treatment of OA, regeneration of the damaged articular cartilage has proved difficult due to the limited healing capacity. With the advancements in tissue engineering and cell-based technologies over the past decade, new therapeutic options for patients with osteochondral lesions potentially exist. This review will focus on the feasibility of tissue-engineered biphasic scaffolds, which can mimic the native osteochondral complex, for osteochondral repair and highlight the recent development of these techniques toward tissue regeneration. Moreover, basic anatomy, strategy for osteochondral repair, the design and fabrication methods of scaffolds, as well as the choice of cells, growth factor, and materials will be discussed. Specifically, we focus on the latest preclinical animal studies using large animals and clinical trials with high clinical relevance. In turn, this will facilitate an understanding of the latest trends in osteochondral repair and contribute to the future application of such clinical therapies in patients with OA.

  6. Current Strategies for the Treatment of Aneurysmal Bone Cysts

    PubMed Central

    Brosjö, Otte

    2015-01-01

    Aneurysmal bone cysts are benign bone tumors that usually present in childhood and early adulthood. They usually manifest as expansile osteolytic lesions with a varying potential to be locally aggressive. Since their first description in 1942, a variety of treatment methods has been proposed. Traditionally, these tumors were treated with open surgery. Either intralesional surgical procedures or en bloc excisions have been described. Furthermore, a variety of chemical or physical adjuvants has been utilized in order to reduce the risk for local recurrence after excision. Currently, there is a shift to more minimally invasive procedures in order to avoid the complications of open surgical excision. Good results have been reported during percutaneous surgery, or the use of embolization. Recently, sclerotherapy has emerged as a promising treatment, showing effective consolidation of the lesions and functional results that appear to be superior to the ones of open surgery. Lastly, non-invasive treatment, such as pharmaceutical intervention with denosumab or bisphosphonates has been reported to be effective in the management of the disease. Radiotherapy has also been shown to confer good local control, either alone or in conjunction to other treatment modalities, but is associated with serious adverse effects. Here, we review the current literature on the methods of treatment of aneurysmal bone cysts. The indication for each type of treatment along reported outcome of the intervention, as well as potential complications are systematically presented. Our review aims to increase awareness of the different treatment modalities and facilitate decision-making regarding each individual patient. PMID:26793296

  7. A holistic strategy for adaptive land management

    USGS Publications Warehouse

    Herrick, Jeffrey E.; Duniway, Michael C.; Pyke, David A.; Bestelmeyer, Brandon T.; Wills, Skye A.; Brown, Joel R.; Karl, Jason W.; Havstad, Kris M.

    2012-01-01

    Adaptive management is widely applied to natural resources management (Holling 1973; Walters and Holling 1990). Adaptive management can be generally defined as an iterative decision-making process that incorporates formulation of management objectives, actions designed to address these objectives, monitoring of results, and repeated adaptation of management until desired results are achieved (Brown and MacLeod 1996; Savory and Butterfield 1999). However, adaptive management is often criticized because very few projects ever complete more than one cycle, resulting in little adaptation and little knowledge gain (Lee 1999; Walters 2007). One significant criticism is that adaptive management is often used as a justification for undertaking actions with uncertain outcomes or as a surrogate for the development of specific, measurable indicators and monitoring programs (Lee 1999; Ruhl 2007).

  8. Evidence-Based Classroom Behaviour Management Strategies

    ERIC Educational Resources Information Center

    Parsonson, Barry S.

    2012-01-01

    This paper reviews a range of evidence-based strategies for application by teachers to reduce disruptive and challenging behaviours in their classrooms. These include a number of antecedent strategies intended to help minimise the emergence of problematic behaviours and a range of those which provide positive consequences for appropriate student…

  9. Use of single large or several small policies as strategies to manage people-park interactions.

    PubMed

    Mackenzie, Catrina A; Baird, Timothy D; Hartter, Joel

    2014-12-01

    Biodiversity conservation has been criticized for undermining or ignoring social well-being. Currently efforts to mutually promote social justice, rural development, and biodiversity conservation, which have been contentious and yielded mixed results, continue to spread despite a general dearth of effective management strategies. We contend that social and economic concerns should be integral to conservation planning and propose that the scale of these phenomena is also critical. To evaluate the merit of this proposal, we adopted and expanded a conservation management strategy framework developed by Joel Heinen and examined how population density, economic disparity, and ethnic heterogeneity vary spatially surrounding 2 contrasting protected areas in East Africa: Kibale National Park in Uganda and Tarangire National Park in Tanzania. Analyses of demographic, wealth, and ethnicity data from regional censuses and household surveys conducted in 2009 and 2010 indicated that choice of scale (landscape or community) changed the management strategies recommended by the model. Therefore, "several small" people-park management strategies varying around a given protected area may be more appropriate than a "single large" people-park strategy applied across an entire protected area. Correspondingly, scale adjusted Heinen recommendations offered new strategies for effective conservation management within these human landscapes not incorporated in current in situ management plans.

  10. Current Pharmacological Management of Gastroesophageal Reflux Disease

    PubMed Central

    Wang, Yao-Kuang; Hsu, Wen-Hung; Wang, Sophie S. W.; Lu, Chien-Yu; Kuo, Fu-Chen; Su, Yu-Chung; Yang, Sheau-Fang; Chen, Chiao-Yun; Wu, Deng-Chyang

    2013-01-01

    Gastroesophageal reflux disease (GERD), a common disorder with troublesome symptoms caused by reflux of gastric contents into the esophagus, has adverse impact on quality of life. A variety of medications have been used in GERD treatment, and acid suppression therapy is the mainstay of treatment for GERD. Although proton pump inhibitor is the most potent acid suppressant and provides good efficacy in esophagitis healing and symptom relief, about one-third of patients with GERD still have persistent symptoms with poor response to standard dose PPI. Antacids, alginate, histamine type-2 receptor antagonists, and prokinetic agents are usually used as add-on therapy to PPI in clinical practice. Development of novel therapeutic agents has focused on the underlying mechanisms of GERD, such as transient lower esophageal sphincter relaxation, motility disorder, mucosal protection, and esophageal hypersensitivity. Newer formulations of PPI with faster and longer duration of action and potassium-competitive acid blocker, a newer acid suppressant, have also been investigated in clinical trials. In this review, we summarize the current and developing therapeutic agents for GERD treatment. PMID:23878534

  11. French consensus. Management of patients with hypersomnia: Which strategy?

    PubMed

    Lopez, R; Arnulf, I; Drouot, X; Lecendreux, M; Dauvilliers, Y

    Central hypersomnias principally involves type 1 narcolepsy (NT1), type 2 narcolepsy (NT2) and idiopathic hypersomnia (IH). Despite great progress made in understanding the physiopathology of NT1 with low cerebrospinal fluid hypocretin-1 levels, current treatment remains symptomatic. The same applies to NT2 and IH, for which the physiopathology is still largely unknown. Controlling excessive daytime sleepiness (EDS), cataplexy, hypnagogic hallucinations, sleep paralysis and disturbed night-time sleep are key therapeutic targets in NT1. For IH and NT2, reducing EDS is the main objective. Based on European and American directives for the treatment of narcolepsy, we propose French recommendations for managing central hypersomnias as well as strategies in the case of drug-resistance. Stimulating treatments target EDS, and Modafinil is the first-line treatment. Other stimulants such as methylphenidate, pitolisant, and exceptionally dextro-amphetamine can be prescribed. Selective serotonin and noradrenaline reuptake inhibitor antidepressants are effective for the management of cataplexy in NT1. Sodium oxybate is an effective treatment for several symptoms, including EDS, cataplexy and disturbed night-time sleep. Treatment of central hypersomnia must also take into consideration frequent cardiovascular, metabolic and psychiatric comorbidities, particularly in NT1. New therapies are currently under study with the development of new stimulants and anti-cataplectics. The next few years will see innovative emerging therapies, based on a physiopathological approach, aiming to restore hypocretinergic transmission or to interrupt the autoimmune processes causing the loss of hypocretin neurons.

  12. Current management of differentiated thyroid carcinoma.

    PubMed

    Lupoli, Gelsy Arianna; Fonderico, Francesco; Colarusso, Sara; Panico, Annalisa; Cavallo, Annalisa; Di Micco, Lucia; Paglione, Angela; Costa, Luisa; Lupoli, Giovanni

    2005-12-01

    Papillary and follicular thyroid cancers, together termed differentiated thyroid cancers (DTC), comprise the majority of thyroid carcinomas and have an optimal prognosis. Most DTCs appear as asymptomatic thyroid nodules. Fine-needle aspiration (FNA) cytology is the first diagnostic test for a thyroid nodule in a euthyroid patient. Surgery is the primary treatment for thyroid cancers. Most clinicians recommend near-total or total thyroidectomy, and then 131I ablation therapy, since its consequences are minimal and follow-up is facilitated. A total body scan (TBS) is performed 4 to 7 days after 131I treatment. At a later stage, all patients should be treated with L-tiroxine so as to suppress TSH, and must undergo a periodic evaluation of TSH and thyroglobulin (Tg), the most sensitive and specific marker of DTC. After 6-12 months, TBS with 131I is performed, a technique complementary to serum Tg evaluation. For this technique, it is also necessary to have a high serum TSH concentration, obtained by withdrawing thyroxine therapy for 4 to 6 weeks. This standard method induces hypothyroidism. An alternative method to the withdrawal of thyroid hormones in the follow-up of DTC patients is to administer recombinant human TSH (rh-TSH). After the dose of rhTSH, 131I is administered, and then TBS can be performed 48-72 hours later. Currently, several authors have explored the possibility that rh-TSH-stimulated Tg levels may represent the only necessary test to differentiate patients with persistent disease from disease-free patients, without performing a diagnostic TBS.

  13. Conservation values and management strategies of coastal windbreaks

    NASA Astrophysics Data System (ADS)

    Lee, M. J.; Song, G. Z. M.

    2015-12-01

    Taiwan is surrounded by oceans, so that the citizens' daily lives and the industrial activities in coast areas are exposed to and affected by strong winds and dust storms caused by the winter monsoon. Tree windbreaks present the functions of windproof, dust inhibition, damp-proof, and climate moderation. However, in recent years, the construction of roads, establishment industrial districts, development of recreation areas, building of wind turbines, and the cultivation of local citizens have greatly changed the width and integrity of tree windbreak belts, and in turn affected their functionality. Our study focus on tree windbreaks right next to the estuary of the Zhoushui River in Taiwan. Through environmental investigations, questionnaire surveys for local citizens, and vegetation sureys, the current functions of windbreaks and impacts of human disturbances on windbreaks will be evaluated. The conservation values and management strategies of tree windbreaks will be proposed after all.

  14. Estonian National Security Strategy: Current and Future Challenges

    DTIC Science & Technology

    2013-03-01

    2013 2 . REPORT TYPE STRATEGY RESEARCH PROJECT .33 3. DATES COVERED (From - To) 4. TITLE AND SUBTITLE Estonian National Security Strategy...the existing Estonian Security Strategy and offers recommendations. 2 1. Estonian Security Environment: International Relations...Copenhagen School is understood in wider terms than the political-military and state-centered view of traditional security studies. 2 According to Buzan

  15. Prostate biopsy strategies: current state of the art.

    PubMed

    Mian, Badar M

    2004-05-01

    Prostate-specific antigen testing and prostate biopsy have revolutionized our ability to detect prostate cancer at an early stage. The transrectal ultrasound-guided biopsy procedure has undergone a number of modifications over the past 10 years to meet our goal of early detection of cancer at a curable stage. Biopsy schemes have evolved from lesion-directed biopsies to systematic mapping of the peripheral zone of the prostate, which harbors almost all of the significant tumor foci. An increase in the number of biopsy cores from 6 to 10 (or 12) has resulted in a significant improvement in the detection of clinically localized cancer, without any appreciable increase in the number of indolent cancers. Current biopsy schemes also have enhanced our ability to determine the true prognostic value of pathologic lesions such as high-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation which have been associated with cancer detection in repeat biopsies. I discuss the rationale behind, and the outcomes of, various biopsy strategies. More than 15 years after PSA testing was popularized for early detection, a number of men are presenting for evaluation regarding repeat prostate biopsy for various clinical indications. The indications, biopsy scheme, and cancer detection rates for repeat prostate biopsy are discussed in detail.

  16. Current Research Therapeutic Strategies for Alzheimer's Disease Treatment

    PubMed Central

    Folch, Jaume; Petrov, Dmitry; Ettcheto, Miren; Abad, Sonia; Sánchez-López, Elena; García, M. Luisa; Olloquequi, Jordi; Beas-Zarate, Carlos; Auladell, Carme; Camins, Antoni

    2016-01-01

    Alzheimer's disease (AD) currently presents one of the biggest healthcare issues in the developed countries. There is no effective treatment capable of slowing down disease progression. In recent years the main focus of research on novel pharmacotherapies was based on the amyloidogenic hypothesis of AD, which posits that the beta amyloid (Aβ) peptide is chiefly responsible for cognitive impairment and neuronal death. The goal of such treatments is (a) to reduce Aβ production through the inhibition of β and γ secretase enzymes and (b) to promote dissolution of existing cerebral Aβ plaques. However, this approach has proven to be only modestly effective. Recent studies suggest an alternative strategy centred on the inhibition of the downstream Aβ signalling, particularly at the synapse. Aβ oligomers may cause aberrant N-methyl-D-aspartate receptor (NMDAR) activation postsynaptically by forming complexes with the cell-surface prion protein (PrPC). PrPC is enriched at the neuronal postsynaptic density, where it interacts with Fyn tyrosine kinase. Fyn activation occurs when Aβ is bound to PrPC-Fyn complex. Fyn causes tyrosine phosphorylation of the NR2B subunit of metabotropic glutamate receptor 5 (mGluR5). Fyn kinase blockers masitinib and saracatinib have proven to be efficacious in treating AD symptoms in experimental mouse models of the disease. PMID:26881137

  17. Soil Contamination and Remediation Strategies. Current research and future challenge

    NASA Astrophysics Data System (ADS)

    Petruzzelli, G.

    2012-04-01

    eliminating the source of pollution, but also on blocking the pathways from contaminants to receptors or reducing the exposure to contaminants,. Future challenge integration of sustainability into remediation decision-making. Soil is not a waste! There is a growing interest in the clean up approaches that maintain soil quality after remediation treatments. This issue is of great importance in the U.S.A. where the EPA from 2009 is promoting innovative clean-up strategies (Green Remediation). Green remediation is defined as the practice of considering all environmental effects of remedy and incorporating options to maximize environmental benefit of cleanup actions . These remediation strategies restore contaminated sites to productive use with a great attention to the global environmental quality, including the preservation of soil functionality according to the following principles: use minimally invasive technologies; use passive energy technologies such as bioremediation and phytoremediation as primary remedies or finishing steps where possible and effective; minimize soil and habitat disturbance; minimize bioavailability of contaminants trough adequate contaminant source and plume control If we move from the current definition of remedial targets based on total concentrations, technologies with low impact on the environment can be utilized reducing the wrong choice to disposal soil in landfill destroying quickly a not renewable essential resource.

  18. Unique strategies for technical information management at Johnson Space Center

    NASA Technical Reports Server (NTRS)

    Krishen, Vijay

    1994-01-01

    In addition to the current NASA manned programs, the maturation of Space Station and the introduction of the Space Exploration programs are anticipated to add substantially to the number and variety of data and documentation at NASA Johnson Space Center (JSC). This growth in the next decade has been estimated at five to ten fold compared to the current numbers. There will be an increased requirement for the tracking and currency of space program data and documents with National pressures to realize economic benefits from the research and technological developments of space programs. From a global perspective the demand for NASA's technical data and documentation is anticipated to increase at local, national, and international levels. The primary users will be government, industry, and academia. In our present national strategy, NASA's research and technology will assume a great role in the revitalization of the economy and gaining international competitiveness. Thus, greater demand will be placed on NASA's data and documentation resources. In this paper the strategies and procedures developed by DDMS, Inc., to accommodate the present and future information utilization needs are presented. The DDMS, Inc., strategies and procedures rely on understanding user requirements, library management issues, and technological applications for acquiring, searching, storing, and retrieving specific information accurately and quickly. The proposed approach responds to changing customer requirements and product deliveries. The unique features of the proposed strategy include: (1) To establish customer driven data and documentation management through an innovative and unique methods to identify needs and requirements. (2) To implement a structured process which responds to user needs, aimed at minimizing costs and maximizing services, resulting in increased productivity. (3) To provide a process of standardization of services and procedures. This standardization is the central

  19. A Comparison of Current Guidelines of Five International Societies on Clostridium difficile Infection Management.

    PubMed

    Fehér, Csaba; Mensa, Josep

    2016-09-01

    Clostridium difficile infection (CDI) is increasingly recognized as an emerging healthcare problem of elevated importance. Prevention and treatment strategies are constantly evolving along with the apperance of new scientific evidence and novel treatment methods, which is well-reflected in the differences among consecutive international guidelines. In this article, we summarize and compare current guidelines of five international medical societies on CDI management, and discuss some of the controversial and currently unresolved aspects which should be addressed by future research.

  20. Current approaches to the management of early active diffuse scleroderma skin disease.

    PubMed

    Nihtyanova, Svetlana I; Denton, Christopher P

    2008-02-01

    Skin sclerosis is a clinical hallmark of systemic sclerosis (SSc) and provides a means to classify and evaluate patients. In the diffuse cutaneous subset, skin involvement is often extensive and warrants direct therapy. Currently, broad spectrum immunosuppressive strategies are used, but more targeted specific approaches are now emerging. This article reviews the evidence for efficacy of current treatment approaches and future developments for managing skin disease in early diffuse cutaneous SSc.

  1. Strategies and algorithms for management of the difficult airway.

    PubMed

    Heidegger, Thomas; Gerig, Hans J; Henderson, John J

    2005-12-01

    Management of the difficult airway is the most important patient safety issue in the practice of anaesthesia. Many national societies have developed algorithms and guidelines for management of the difficult airway. The key issues of this chapter are definition of terms, the advantages and disadvantages of the use of guidelines, and a comparison of different algorithms and guidelines for management of the most important clinical airway scenarios. Although there is no strong evidence of benefit for any specific strategy or algorithm for management of the difficult airway, there is strong agreement that a pre-planned strategy may lead to improved outcome.

  2. Current Issues for Higher Education Information Resources Management.

    ERIC Educational Resources Information Center

    CAUSE/EFFECT, 1995

    1995-01-01

    Current issues that are important for the future of information resources management in higher education are presented. They include: integrating planning for information resources within institution-wide strategic planning; reengineering fundamental services; change management; distributed computing support; networking; the changing communication…

  3. 10 Budget-Savvy Content Management Strategies

    ERIC Educational Resources Information Center

    Hillis, David J.

    2004-01-01

    Facing an overall budget reduction of 10 percent, most colleges or universities would postpone investing in a Web content management system. However, for California State University Monterey Bay (CSUMB), a large budget cut made Web content management even more important. CSUMB found an innovative way to purchase and implement a new Content…

  4. Osteoarthritis 2: pain management and treatment strategies.

    PubMed

    Swift, Amelia

    Osteoarthritis (OA) is a painful, progressive joint disorder. This article discusses pharmacological management of OA, such as non-steroidal anti-inflammatory drugs and opioids, and non-pharmacological management, including weight reduction, acupuncture and joint replacement surgery. The third part, to be published online, will cover the physical, psychological and social impact of OA.

  5. Teaching Self-Management Strategies to Adolescents.

    ERIC Educational Resources Information Center

    Young, K. Richard; And Others

    This book presents a behavioral program to teach adolescents basic self-management skills; two chapters provide the theoretical basis for the program and four chapters supply sample lesson plans. The first chapter is an introduction to behavioral self-management. It proposes a behavior change model with four major components: assessment,…

  6. Spatial strategies for managing visitor impacts in National Parks

    USGS Publications Warehouse

    Leung, Y.-F.; Marion, J.L.

    1999-01-01

    Resource and social impacts caused by recreationists and tourists have become a management concern in national parks and equivalent protected areas. The need to contain visitor impacts within acceptable limits has prompted park and protected area managers to implement a wide variety of strategies and actions, many of which are spatial in nature. This paper classifies and illustrates the basic spatial strategies for managing visitor impacts in parks and protected areas. A typology of four spatial strategies was proposed based on the recreation and park management literature. Spatial segregation is a common strategy for shielding sensitive resources from visitor impacts or for separating potentially conflicting types of use. Two forms of spatial segregation are zoning and closure. A spatial containment strategy is intended to minimize the aggregate extent of visitor impacts by confining use to limited designated or established Iocations. In contrast, a spatial dispersal strategy seeks to spread visitor use, reducing the frequency of use to levels that avoid or minimize permanent resource impacts or visitor crowding and conflict. Finally, a spatial configuration strategy minimizes impacting visitor behavior though the judicious spatial arrangement of facilities. These four spatial strategics can be implemented separately or in combination at varying spatial scales within a single park. A survey of national park managers provides an empirical example of the diversity of implemented spatial strategies in managing visitor impacts. Spatial segregation is frequently applied in the form of camping restrictions or closures to protect sensitive natural or cultural resources and to separate incompatible visitor activities. Spatial containment is the most widely applied strategy for minimizing the areal extent of resource impacts. Spatial dispersal is commonly applied to reduce visitor crowding or conflicts in popular destination areas but is less frequently applied or

  7. Adaptive Management as an Effective Strategy: Interdisciplinary Perceptions for Natural Resources Management

    NASA Astrophysics Data System (ADS)

    Dreiss, Lindsay M.; Hessenauer, Jan-Michael; Nathan, Lucas R.; O'Connor, Kelly M.; Liberati, Marjorie R.; Kloster, Danielle P.; Barclay, Janet R.; Vokoun, Jason C.; Morzillo, Anita T.

    2017-02-01

    Adaptive management is a well-established approach to managing natural resources, but there is little evidence demonstrating effectiveness of adaptive management over traditional management techniques. Peer-reviewed literature attempts to draw conclusions about adaptive management effectiveness using social perceptions, but those studies are largely restricted to employees of US federal organizations. To gain a more comprehensive insight into perceived adaptive management effectiveness, this study aimed to broaden the suite of disciplines, professional affiliations, and geographic backgrounds represented by both practitioners and scholars. A questionnaire contained a series of questions concerning factors that lead to or inhibit effective management, followed by another set of questions focused on adaptive management. Using a continuum representing strategies of both adaptive management and traditional management, respondents selected those strategies that they perceived as being effective. Overall, characteristics (i.e., strategies, stakeholders, and barriers) identified by respondents as contributing to effective management closely aligned with adaptive management. Responses were correlated to the type of adaptive management experience rather than an individual's discipline, occupational, or regional affiliation. In particular, perceptions of characteristics contributing to adaptive management effectiveness varied between respondents who identified as adaptive management scholars (i.e., no implementation experience) and adaptive management practitioners. Together, these results supported two concepts that make adaptive management effective: practitioners emphasized adaptive management's value as a long-term approach and scholars noted the importance of stakeholder involvement. Even so, more communication between practitioners and scholars regarding adaptive management effectiveness could promote interdisciplinary learning and problem solving for improved

  8. [Waste management strategy and the role of the environmental protection and energy efficiency fund].

    PubMed

    Kalambura, Sanja

    2006-09-01

    On 14 October 2005, the Croatian Parliament adopted the National Strategy of Waste Management pursuant to Article 8 of the Waste Act. This strategy defines its objectives and the means to reach them, and gives an overview of the current situation in waste management. It seeks to provide a realistic framework for the effective reduction of national waste load and for a sustainable waste management. This Strategy defines 15 major waste flows which are in concordance with the EU practice. It also defines waste management buildings and plants, and looks into the remediation of municipal waste landfills. According to the Strategy, waste management will be present on all levels of administration: from national to local, and will include all areas of production, consumption, and everyday life. Founded on the EU's general principles of waste management, this Strategy provides the ideal framework for a sustained waste management in Croatia by the year 2025. Environmental Protection and Energy Efficiency Fund is one of the key administration bodies within the waste management system. It collects taxes for motor vehicles, for sulphur and nitrogen oxide pollution sources, for environmental hazardous and non-hazardous industrial waste load, and for the use of the environment. The Fund participates in the ongoing municipal landfill remediation projects and programmes all over Croatia (currently 161 landfills are being remedied) and helps to establish new regional and county waste management centres. It co-finances clean production technology projects, projects whose aim is to reduce the emission of harmful gases, projects for reusable energy sources and for more efficient use of energy, projects for remediation of unregulated municipal landfills, projects for primary recycling, and projects for biodiversity landscapes. According to an estimate, the implementation of the National Strategy of Waste Management will cost over 24 billion Croatian kunas (about 3.3 billion Euros

  9. Current imaging strategies for the evaluation of uterine cervical cancer

    PubMed Central

    Bourgioti, Charis; Chatoupis, Konstantinos; Moulopoulos, Lia Angela

    2016-01-01

    Uterine cervical cancer still remains an important socioeconomic issue because it largely affects women of reproductive age. Prognosis is highly depended on extent of the disease at diagnosis and, therefore, accurate staging is crucial for optimal management. Cervical cancer is clinically staged, according to International Federation of Gynecology and Obstetrics guidelines, but, currently, there is increased use of cross sectional imaging modalities [computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-CT (PET-CT)] for the study of important prognostic factors like tumor size, parametrial invasion, endocervical extension, pelvic side wall or adjacent/distal organs involvement and lymph node status. Imaging indications also include cervical cancer follow-up, evaluation of tumor response to treatment and selection of suitable candidates for less radical surgeries like radical trachelectomy for fertility preservation. The preferred imaging method for local cervical cancer evaluation is MRI; CT is equally effective for evaluation of extrauterine spread of the disease. PET-CT shows high diagnostic performance for the detection of tumor relapse and metastatic lymph nodes. The aim of this review is to familiarize radiologists with the MRI appearance of cervical carcinoma and to discuss the indications of cross sectional imaging during the course of the disease in patients with cervical carcinoma. PMID:27158421

  10. Current treatment strategies for brain metastasis and complications from therapeutic techniques: a review of current literature.

    PubMed

    Platta, Christopher S; Khuntia, Deepak; Mehta, Minesh P; Suh, John H

    2010-08-01

    Each year approximately 170,000 patients are diagnosed with brain metastasis in the United States, making this the most common intracranial tumor in adults. Historically, treatment strategies focused on the use of whole brain radiation therapy (WBRT) for palliation, yielding a median survival time of only 3 to 6 months. The possible effect of WBRT on cognitive function has generated much concern and debate regarding the use of this modality. Thus, the use of WBRT alone, or in conjunction with other treatment modalities should take into account both risks and benefits, to ensure the best patient outcome with regard to disease state and functional status. The advent of technologies permitting local dose-escalation have clearly increased local control rates, and in select patients, even survival, thereby, further intensifying the debate regarding the use of WBRT. Here, we review the use of WBRT, radiosurgery, and resection for the treatment of brain metastases. Further, we will review the use of radiation sensitizers and blood-brain barrier penetrating cytotoxics such as temozolomide. Finally, we will discuss current treatment strategies for possibly maintaining and improving cognitive function for these patients.

  11. Analysis of Human Resources Management Strategy in China Electronic Commerce Enterprises

    NASA Astrophysics Data System (ADS)

    Shao, Fang

    The paper discussed electronic-commerce's influence on enterprise human resources management, proposed and proved the human resources management strategy which electronic commerce enterprise should adopt from recruitment strategy to training strategy, keeping talent strategy and other ways.

  12. Anesthesia information management systems marketplace and current vendors.

    PubMed

    Stonemetz, Jerry

    2011-09-01

    This article addresses the brief history of anesthesia information management systems (AIMS) and discusses the vendors that currently market AIMS. The current market penetration based on the information provided by these vendors is presented and the rationale for the purchase of AIMS is discussed. The considerations to be evaluated when making a vendor selection are also discussed.

  13. Knowledge Management and the Competitive Strategy of the Firm

    ERIC Educational Resources Information Center

    Halawi, Leila A.; McCarthy, Richard V.; Aronson, Jay E.

    2006-01-01

    Purpose: Knowledge management (KM) has emerged as a strategy to improve organizational competitiveness. Our purpose is to identify the relationship between KM and the firm's competitive advantage. Design/methodology/approach: We review the existing literature on KM and strategy formulation. We utilize the resource-based view approach as a lens for…

  14. Emphysematous pyelonephritis with calculus: Management strategies

    PubMed Central

    Goel, Tanmaya; Reddy, Sreedhar; Thomas, Joseph

    2007-01-01

    Objective: Emphysematous pyelonephritis (EPN) with calculus is well recognized but with very few reports on its treatment. Our aim is to elucidate our experience in its successful management. Materials and Methods: Over four years, we diagnosed seven cases (eight renal units) of EPN, out of which two patients (three renal units) had EPN with urinary calculi. After the initial conservative management of EPN, the stones were tackled appropriately. Results: EPN was initially managed effectively with antibiotics and supportive care. Once the patient was stable, the stones were cleared in a step-wise fashion. The associated postoperative complications were also tackled efficiently with preservation of renal function. Conclusion: In EPN with stones, nephrectomy is not the sole option available and they can be effectively managed with open / endoscopic measures. PMID:19718324

  15. Current and emerging treatment strategies for Duchenne muscular dystrophy

    PubMed Central

    Mah, Jean K

    2016-01-01

    Duchenne muscular dystrophy (DMD) is the most common form of muscular dystrophy in childhood. It is caused by mutations of the DMD gene, leading to progressive muscle weakness, loss of independent ambulation by early teens, and premature death due to cardiorespiratory complications. The diagnosis can usually be made after careful review of the history and examination of affected boys presenting with developmental delay, proximal weakness, and elevated serum creatine kinase, plus confirmation by muscle biopsy or genetic testing. Precise characterization of the DMD mutation is important for genetic counseling and individualized treatment. Current standard of care includes the use of corticosteroids to prolong ambulation and to delay the onset of secondary complications. Early use of cardioprotective agents, noninvasive positive pressure ventilation, and other supportive strategies has improved the life expectancy and health-related quality of life for many young adults with DMD. New emerging treatment includes viral-mediated microdystrophin gene replacement, exon skipping to restore the reading frame, and nonsense suppression therapy to allow translation and production of a modified dystrophin protein. Other potential therapeutic targets involve upregulation of compensatory proteins, reduction of the inflammatory cascade, and enhancement of muscle regeneration. So far, data from DMD clinical trials have shown limited success in delaying disease progression; unforeseen obstacles included immune response against the generated mini-dystrophin, inconsistent evidence of dystrophin production in muscle biopsies, and failure to demonstrate a significant improvement in the primary outcome measure, as defined by the 6-minute walk test in some studies. The long-term safety and efficacy of emerging treatments will depend on the selection of appropriate clinical end points and sensitive biomarkers to detect meaningful changes in disease progression. Correction of the underlying

  16. Managing organizational change: strategies for the female health care supervisor.

    PubMed

    Davies, G

    1990-07-01

    In responding to resistance to change in the current health care organization, the new female supervisor can learn to support her staff in encountering and accepting these changes. The strategies and skills discussed above are characteristic of a supervisory style that may naturally occur for women, but also can be incorporated into the leadership style of men in health care management today. Health care leaders of tomorrow must work from an androgynous framework in which the behavior patterns and responses of each gender are learned and used appropriately by both men and women. Sargent suggests that the best managers are androgynous and that this is the inevitable wave of the future. Whether man or woman, a supervisor should learn, accept, and use methods that are characteristic of both sexes to be successful in managing people. Women and men must learn from each other's strengths and share these diverse skills. Given that women now outnumber men in health care management positions and organizations are changing to a more nurturing environment, the androgynous supervisor will be the successful leader of the future. Finally, women in health care supervisory positions have the potential to bring change where it is badly needed. Women in these roles often have a system wide view of health care policy issues that recognizes less federal commitment to social programs. Many women in health care positions believe that the issues of children, women, the elderly, the poor, and the homeless need focused attention. The growing number of women in health care supervisory and leadership roles is an important factor in changing national health policy for the benefit of these groups.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Classroom Management Strategies and Behavioral Interventions to Support Academic Achievement

    ERIC Educational Resources Information Center

    Gilpatrick, Robin Sue Holzworth

    2010-01-01

    This mixed method project study identified the need for effective classroom management strategies to dissuade student noncompliant behavior and to ensure academic success for all students. Enhancing classroom management practices is vital to improved student achievement and teacher self-efficacy. Within a constructivist framework, it is critical…

  18. A Policy Change Strategy for Head Lice Management

    ERIC Educational Resources Information Center

    Andresen, Kathleen; McCarthy, Ann Marie

    2009-01-01

    The purpose of this project was to formulate an effective change strategy for head lice management in a group of five separate school districts within one county. Despite a desire to use evidence to support their practice, school nurses often encounter educational system barriers that prevent independent management of health conditions. The use of…

  19. A Strategy for Optimizing Item-Pool Management

    ERIC Educational Resources Information Center

    Ariel, Adelaide; van der Linden, Wim J.; Veldkamp, Bernard P.

    2006-01-01

    Item-pool management requires a balancing act between the input of new items into the pool and the output of tests assembled from it. A strategy for optimizing item-pool management is presented that is based on the idea of a periodic update of an optimal blueprint for the item pool to tune item production to test assembly. A simulation study with…

  20. Ecological principles underpinning invasive plant management tools and strategies

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The broad focus of ecologically-based invasive plant management is to identify and repair the ecological processes facilitating plant invasion. To be useful, however, EBIPM requires that our application of management tools and strategies be based on ecological principles that determine the rate and ...

  1. Strategies for managing impressions of racial identity in the workplace.

    PubMed

    Roberts, Laura Morgan; Cha, Sandra E; Kim, Sung Soo

    2014-10-01

    This article deepens understanding of the workplace experiences of racial minorities by investigating racial identity-based impression management (RIM) by Asian American journalists. Racial centrality, directly or indirectly, predicted the use of 4 RIM strategies (avoidance, enhancement, affiliation, and racial humor). Professional centrality also predicted strategy use, which was related to life satisfaction and perceived career success. By shedding light on proactive strategies that individuals use to influence colleagues' impressions of their racial identity, we contribute to research on diversity in organizations, impression management, and racial identity.

  2. Management Strategies for Mycosis Fungoides in India

    PubMed Central

    Raychaudhury, Tanumay

    2017-01-01

    Mycosis fungoides is the most common primary cutaneous T-cell lymphoma. The approach to diagnosis and further follow-up is outlined. Evidence for interventions is based classically on a Tumor Node Metastasis Blood TNMB “stage-based” approach. The treatment options in India are limited. The options as per risk stratification and prognostic index are discussed. Early stages and low-risk patients can be managed with expectant policy or skin-directed therapies including topical steroids and phototherapy; intermediate-risk patients can be opted for interferons or retinoids or low dose methotrexate along with radiotherapy including total skin electron beam therapy while high-risk patients are managed most often with single agent or multiagent palliative chemotherapy. Patients who are intermediate- or high-risk need management by a multispecialty team at tertiary care centers.

  3. Municipal solid waste management strategies in Turkey.

    PubMed

    Turan, N Gamze; Coruh, Semra; Akdemir, Andaç; Ergun, Osman Nuri

    2009-01-01

    Municipal solid waste (MSW) is a major environmental problem in Turkey, as in many developing countries. Problems associated with municipal solid waste are difficult to address, but efforts towards more efficient collection and transportation and environmentally acceptable waste disposal continue in Turkey. Although strict regulations on the management of solid waste are in place, primitive disposal methods such as open dumping and discharge into surface water have been used in various parts of Turkey. This study presents a brief history of the legislative trends in Turkey for MSW management. The study also presents the MSW responsibility and management structure together with the present situation of generation, composition, recycling, and treatment. The results show that approximately 25 million ton of MSW are generated annually in Turkey. About 77% of the population receives MSW services. In spite of efforts to change open dumping areas into sanitary landfills and to build modern recycling and composting facilities, Turkey still has over 2000 open dumps.

  4. Multigeneration employees: strategies for effective management.

    PubMed

    Kupperschmidt, B R

    2000-09-01

    Today's health care workforce comprises Traditional, Baby Boomer, and Generation X employees. Effective managers must understand the times and generational characteristics of these employees and they must assure that employees understand and respect one another's differences. They must foster open discussion of how generational differences influence attitudes toward work and organizations. They must provide opportunities for multigeneration employees to contribute their best concurrent with meeting organizational goals. Employees must be offered a conditional security based upon value-added results and collaboration. Managers must use leadership practices that encourage the hearts of dispirited employees.

  5. Alertness Management Strategies for Operational Contexts

    DTIC Science & Technology

    2008-08-01

    or reproductive disorders. In addition, there is evidence from some studies that night work is associated with increased accide’nts. In fact, Folkard...behaviorally based strategies for avoiding insomnia in many situations, but in some cases, hypnotic medications or so- called "sleeping pills" may be necessary...preferable to being sleep deprived. Choosing the best hypnotic for each situation requires consideration of a variety of factors. From a strictly

  6. Does Business Strategy Affect Personnel Management Practices?

    DTIC Science & Technology

    1987-04-01

    the SIPM membership variable, two interactions with strategy were significant. Search firms - were used more often by prospectors and analysers than by...defenders (as originally predicted), but only when the highest ranking personel officer was not a member of SIPM . When an SIPM member was present...analyzers (as originally 5, hypothesized) when the highest personnel officer was not a member of SIPM . When an SIPM member was present, aC 21 prospectors

  7. Change in MSW characteristics under recent management strategies in Taiwan.

    PubMed

    Chang, Yu-Min; Liu, Chien-Chung; Hung, Chao-Yang; Hu, Allen; Chen, Shiao-Shing

    2008-12-01

    Reduction and recycling initiatives such as producer responsibility and pay-as-you-throw are being implemented in Taiwan. This paper presents a study assessing the impact of recently implemented municipal solid waste (MSW) reduction and recycling management strategies on the characteristics of waste feedstock for incineration in Taiwan. Through the periodic sampling of two typical MSW incineration plants, proximate and ultimate analyses were conducted according to standard methods to explore the influence of MSW reduction and recycling management strategies on incineration feed waste characteristics. It was observed that the annual amount of MSW generated in 2005 decreased by about 10% compared to 2003 and that the characteristics of MSW have changed significantly due to recent management strategies. The heating value of the MSW generated in Taiwan increased yearly by about 5% after program implementation. A comparison of the monthly variations in chemical concentrations indicated that the chlorine content in MSW has changed. This change results from usage reduction of PVC plastic due to the recycling fund management (RFM) program, and the food waste as well as salt content reduction due to the total recycling for kitchen garbage program. This achievement will improve the reduction of dioxin emissions from MSW incineration. In summary, management strategies must be conducted in tandem with the global trend to achieve a zero-waste-discharge country. When implementing these strategies and planning for future MSW management systems, it is important to consider the changes that may occur in the composition and characteristics of MSW over time.

  8. Classroom Strategies: Classroom Management Systems. Volume 3.

    ERIC Educational Resources Information Center

    Speiss, Madeleine F.; And Others

    Classroom management is defined as procedures for arranging the classroom environment so that children learn what the teacher wants to teach them in the healthiest and most effective way possible. The Southwestern Cooperative Educational Laboratory presents a discussion of these procedures as they relate to social controls and components of…

  9. Evaluation and experimentation with duck management strategies

    USGS Publications Warehouse

    Nichols, J.D.; Johnson, F.A.

    1989-01-01

    Our knowledge of the effects of hunting regulations on duck populations has been based largely on retrospective studies of historical data. We have reached the limits of what can be learned in this way. Future knowledge gains will likely come about only through experimentation and adaptive management.

  10. Reservoir management strategy for East Randolph Field, Randolph Township, Portage County, Ohio

    SciTech Connect

    Safley, L.E.; Salamy, S.P.; Young, M.A.; Fowler, M.L.; Wing, J.L.; Thomas, J.B.; Mills, J.; Wood, D.

    1998-07-01

    The primary objective of the Reservoir Management Field Demonstration Program is to demonstrate that multidisciplinary reservoir management teams using appropriate software and methodologies with efforts scaled to the size of the resource are a cost-effective method for: Increasing current profitability of field operations; Forestalling abandonment of the reservoir; and Improving long-term economic recovery for the company. The primary objective of the Reservoir Management Demonstration Project with Belden and Blake Corporation is to develop a comprehensive reservoir management strategy to improve the operational economics and optimize oil production from East Randolph field, Randolph Township, Portage County, Ohio. This strategy identifies the viable improved recovery process options and defines related operational and facility requirements. In addition, strategies are addressed for field operation problems, such as paraffin buildup, hydraulic fracture stimulation, pumping system optimization, and production treatment requirements, with the goal of reducing operating costs and improving oil recovery.

  11. Mistakes to avoid when planning managed care strategies.

    PubMed

    Scheur, B S

    1997-06-01

    Hospital executives, steeped in hospital business traditions, sometimes fall victim to those traditions when planning their managed care strategies. They may fail to sufficiently evaluate their hospitals' market position or set appropriate priorities for their various business strategies. They may not recruit individuals with managed care expertise, develop effective marketing plans, or construct realistic physician networks. Some hospital executives may be ill-equipped to deal with cultural clashes and reluctant to share control of their managed care organizations with physicians. Or, they may not always understand the true nature of the arrangement they have entered into, the information and technology needs of the arrangement, and their own strategic advantages. Today's hospital executives must plan their managed care strategies carefully and execute them intelligently to ensure success.

  12. A conflict of strategies: Medicaid managed care and Medicaid maximization.

    PubMed Central

    Coughlin, T A; Zuckerman, S; Wallin, S; Holahan, J

    1999-01-01

    OBJECTIVE: To examine the influence of state strategies aimed at increasing federal Medicaid matching dollars on the design of states' Medicaid managed care programs. STUDY DESIGN: Data obtained from the 1996-1997 case studies of 13 states to examine how states have adapted the design of their Medicaid managed care programs in part because of maximization strategies, to accommodate the many roles and responsibilities that Medicaid has assumed over the years. PRINCIPAL FINDINGS: Our study showed that as states made the shift to managed care, some found that the responsibilities undertaken in part through maximization strategies proved to be in conflict with their Medicaid managed care initiatives. Among other things, the study revealed that most states included provisions that preserved the health care safety net, such as adapting the managed care benefit package and promoting the participation of safety net providers in managed care programs. In addition, most of the study states continued to pay special subsidies to safety net providers, including hospitals and clinics. CONCLUSIONS: States have made real progress in moving a large number of Medicaid beneficiaries into managed care. At the same time, many states have specially crafted their managed care programs to accommodate safety net providers and existing funding mechanisms. By making these adaptations states, in the long run, may compromise the central goals of managed care: controlling costs and improving Medicaid beneficiaries' access to and quality of care. PMID:10199675

  13. Current Events and the International Relations Curriculum: Instructional Strategies.

    ERIC Educational Resources Information Center

    Chernotsky, Harry I.

    One of the most significant challenges confronting college instructors who teach international politics survey courses is the coverage of current events issues and how to stimulate student interest about the issues. This paper describes two techniques, a current events sweepstakes and a Great Decisions roundtable, designed to infuse current events…

  14. Understanding beef-cattle farming management strategies by identifying motivations behind farmers' priorities.

    PubMed

    Magne, M A; Cerf, M; Ingrand, S

    2012-06-01

    This study aimed to identify and better understand management strategies that help livestock farmers adapt to changes in their production contexts, a fundamental challenge. A total of nine beef-cattle farmers were interviewed three times over 1 year to discuss 13 dimensions of livestock farming (e.g. reproduction, feeding, sales, etc.). Characterisation of management strategies rested on three main factors: (i) ranking of the dimensions according to the degree to which farmers desired to control them, (ii) reasons for the ranking and (iii) management guidelines. Although farmers agreed upon the rank of certain dimensions, such as herd management, they differed on that of others, such as sales and administration/regulations. Four motivation categories were identified: risk, pleasure, efficiency and ability to control the dimension. Three management guidelines were identified, which indicated that farmers managed for future survival of their farms at different scales (animal/herd v. whole-farm), involving different resources (biological v. financial) and based on different animal categories (reproductive cows v. animals sold). These results improve understanding of individual livestock farmers and their current management strategies by integrating the motivations behind their strategies. For this reason, they constitute methodological elements that agricultural advisors can use to provide relevant information to farmers while accommodating differences in farm management.

  15. Electronic mail communication--management strategies.

    PubMed

    Strasser, Patricia B

    2003-12-01

    Electronic communication has come a long way in the past 30 years. It will no doubt continue to improve and remain the primary communication vehicle for businesses. Occupational health nurses, like other business professionals, must use email to their advantage to improve their practice. However, electronic mail communication must be managed in the same manner as records and documents produced in any form or media.

  16. Power Management Based Current Control Technique for Photovoltaic-Battery Assisted Wind-Hydro Hybrid System

    NASA Astrophysics Data System (ADS)

    Ram Prabhakar, J.; Ragavan, K.

    2013-07-01

    This article proposes new power management based current control strategy for integrated wind-solar-hydro system equipped with battery storage mechanism. In this control technique, an indirect estimation of load current is done, through energy balance model, DC-link voltage control and droop control. This system features simpler energy management strategy and necessitates few power electronic converters, thereby minimizing the cost of the system. The generation-demand (G-D) management diagram is formulated based on the stochastic weather conditions and demand, which would likely moderate the gap between both. The features of management strategy deploying energy balance model include (1) regulating DC-link voltage within specified tolerances, (2) isolated operation without relying on external electric power transmission network, (3) indirect current control of hydro turbine driven induction generator and (4) seamless transition between grid-connected and off-grid operation modes. Furthermore, structuring of the hybrid system with appropriate selection of control variables enables power sharing among each energy conversion systems and battery storage mechanism. By addressing these intricacies, it is viable to regulate the frequency and voltage of the remote network at load end. The performance of the proposed composite scheme is demonstrated through time-domain simulation in MATLAB/Simulink environment.

  17. Current treatments and advances in pain and anxiety management.

    PubMed

    Huang, David; Wun, Edmund; Stern, Avichai

    2011-07-01

    In light of preoperative and postoperative mortality and morbidity, continued advancement in pain and anxiety management would benefit millions. Although significant strides have been made in the past few decades, it is imperative that research and development continue. This article discusses types of pain and anxiety, the relationship between pain and anxiety, the physiology of pain and anxiety, and current trends in pain and anxiety management.

  18. Improved control strategy for PI-R current of DFIG considering voltage and current harmonics compensation

    NASA Astrophysics Data System (ADS)

    Song, S. Y.; Liu, Q. H.; Zhao, Y. N.; Liu, S. Y.

    2016-08-01

    With the rapid development of wind power generation, the related research of wind power control and integration issues has attracted much attention, and the focus of the research are shifting away from the ideal power grid environment to the actual power grid environment. As the main stream wind turbine generator, a doubly-fed induction generator (DFIG) is connected to the power grid directly by its stator, so it is particularly sensitive to the power grid. This paper studies the improvement of DFIG control technology in the power grid harmonic environment. Based on the DFIG dynamic model considering the power grid harmonic environment, this paper introduces the shortcomings of the common control strategy of DFIG, and puts forward the enhanced method. The decoupling control of the system is realized by compensating the coupling between the rotor harmonic voltage and harmonic current, improving the control performance. In addition, the simulation experiments on PSCAD/EMTDC are carried out to verify the correctness and effectiveness of the improved scheme.

  19. Regional economic impacts of current and proposed management alternatives for Don Edwards National Wildlife Refuge

    USGS Publications Warehouse

    Richardson, Leslie; Huber, Chris; Koontz, Lynne

    2012-01-01

    The National Wildlife Refuge System Improvement Act of 1997 requires all units of the National Wildlife Refuge System to be managed under a Comprehensive Conservation Plan. The Comprehensive Conservation Plan must describe the desired future conditions of a Refuge and provide long-range guidance and management direction to achieve refuge purposes. The Don Edwards San Francisco Bay National Wildlife Refuge, located at the south end of California's San Francisco Bay and one of seven refuges in the San Francisco Bay National Wildlife Refuge Complex, is in the process of developing a range of management goals, objectives, and strategies for the Comprehensive Conservation Plan. The Comprehensive Conservation Plan must contain an analysis of expected effects associated with current and proposed Refuge management strategies. For Refuge Comprehensive Conservation Plan planning, a regional economic analysis provides a means of estimating how current management (No Action Alternative) and proposed management activities (alternatives) affect the local economy. This type of analysis provides two critical pieces of information: (1) it illustrates the Don Edwards San Francisco Bay National Wildlife Refuge's contribution to the local community, and (2) it can help in determining whether economic effects are or are not a real concern in choosing among management alternatives. This report first presents a description of the local community and economy near the Don Edwards San Francisco Bay National Wildlife Refuge. Next, the methods used to conduct a regional economic impact analysis are described. An analysis of the final Comprehensive Conservation Plan management strategies that could affect stakeholders, residents, and the local economy is then presented. The management activities of economic concern in this analysis are: * Spending in the local community by Refuge visitors; * Refuge personnel salary spending; and * Refuge purchases of goods and services within the local

  20. Nurses' strategies for managing pain in the postoperative setting.

    PubMed

    Manias, Elizabeth; Bucknall, Tracey; Botti, Mari

    2005-03-01

    Acute pain is a significant problem in the postoperative setting. Patients report a lack of information about pain-control measures and ineffective pain control. Nurses continue to rely on pharmacologic measures and tend to under-administer analgesics. The purpose of this study was to determine the strategies nurses used to manage patients' pain in the postoperative setting. It also sought to examine the effect of context, including organization of care, nurses' prioritization of work activities, and pressures during a working shift, on their pain-management strategies. An observational design was used in two surgical units of a metropolitan teaching hospital in Melbourne, Australia. Six fixed observation times were identified as key periods for pain activities, each comprising a 2-hour duration. An observation period was examined at least 12 times, resulting in the completion of 74 observations and the identification of 316 pain cases. Fifty-two nurses were observed during their normal day's work with postoperative patients. Six themes were identified: managing pain effectively; prioritizing pain experiences for pain management; missing pain cues for pain management; regulators and enforcers of pain management; preventing pain; and reactive management of pain. The findings highlighted the critical nature of communication between clinicians and patients and among clinicians. It also demonstrated the influence of time on management strategies and the relative importance that nurses place on nonpharmacologic measures in actual practice. This research, which portrays what happens in actual clinical practice, has facilitated the identification of new data that were not evident from other research studies.

  1. Budd-Chiari syndrome: illustrated review of current management.

    PubMed

    Horton, John D; San Miguel, Francisco L; Membreno, Fernando; Wright, Francis; Paima, Juan; Foster, Preston; Ortiz, Jorge A

    2008-04-01

    Budd-Chiari syndrome (BCS) is characterized by hepatic venous outflow obstruction at any level from the small hepatic veins to the atriocaval junction. BCS is a complex disease with a wide spectrum of aetiologies and presentations. This article reviews the current literature with respect to presentation, management and prognosis of the disease. Medical, interventional and surgical management of BCS is discussed. Particular attention is paid to interventional and surgical aspects of management. The review is augmented by images, which provide a clinical corollary to the text.

  2. Management strategies in hospitals: scenario planning.

    PubMed

    Ghanem, Mohamed; Schnoor, Jörg; Heyde, Christoph-Eckhard; Kuwatsch, Sandra; Bohn, Marco; Josten, Christoph

    2015-01-01

    Hintergrund: Das Krankenhausmanagement ist stets Herausforderungen ausgesetzt. Anstatt auf die Herausforderungen zu warten, sollten Ärzte und Manager im Voraus handeln, um ein optimiertes und nachhaltig wertorientiertes Gesundheitswesen zu sichern. Diese Arbeit unterstreicht die Bedeutung der Szenarienplanung in Krankenhäusern, schlägt eine ausgearbeitete Definition der Stakeholder eines Krankenhauses vor und definiert die Einflussfaktoren, denen Krankenhäuser ausgesetzt sind.Methodik: Basierend auf einer Literaturanalyse sowie auf persönlichen Interviews mit Stakeholdern eines Krankenhauses schlagen wir eine ausgearbeitete Definition von Stakeholdern vor und erarbeiteten einen Fragebogen. Dieser Fragebogen berücksichtigt folgende Einflussfaktoren, die entsprechende Auswirkungen auf das Krankenhaus-Management haben: politische/rechtliche, wirtschaftliche, soziale, technologische und Umweltkräfte.Diese Einflussfaktoren werden untersucht, um die so genannten kritischen Unsicherheiten zu entwickeln. Die gründliche Identifizierung von Unsicherheiten basierte auf „Stakeholder Feedback“.Ergebnisse: Zwei Haupt-Unsicherheiten wurden identifiziert und in dieser Studie berücksichtigt:die Entwicklung der Arbeitsbelastung für das medizinische Personaldie gewinnorientierte Leistung des medizinischen Personals.Entsprechend der entwickelten Szenarien konnten wir folgende Kernstrategie empfehlen: komplementäre Ausbildung sowohl des medizinischen Personals als auch der nicht-medizinischen Top-Führungskräfte und Manager von Krankenhäusern. Ergänzende szenariospezifische strategische Optionen sollen, falls erforderlich, in Betracht gezogen werden, um eine bestimmte zukünftige Entwicklung des medizinischen Umfeldes zu optimieren.Schlussfolgerung: Strategische Planung in Krankenhäusern ist wichtig, um nachhaltigen Erfolg zu gewährleisten. Diese Planung soll mehrere Situationen berücksichtigen und integriert interne und externe Ein- und Ausblicke. Darüber hinaus

  3. [Behavioral and cognitive strategies in stress management].

    PubMed

    Légeron, P

    1993-03-01

    Stress is a specific response of the individual to all nonspecific demands. However, this process of adaptation is very complex and varies considerably from person to person. The stress response or "stress reactivity" is triggered by various stressors, ranging from live events to daily hassles and including chronic stressors. These stressors need to be identified. The stress response is not univocal: it has physiological, cognitive and behavioral components. Most of the time, physiological, cognitive and behavioral responses are maladaptive and harmful for the individual. Stress management is directed at teaching individuals specific skills to modify parts of these responses in order to reduce stress. Relaxation therapies are the cornerstone of any stress management program. They mostly include autogenic training and progressive relaxation training, sometimes biofeedback. The relaxation response is a learned response. There are a variety of different methods of inducing this response. They share the common goal of countering the physiological aspects of the stress reaction. All the relaxation techniques involve long and exacting training. But proper training leads to a gradual reduction in time and effort required to relax. When properly pursued, these techniques produce a state of relaxation quickly and on demand. Cognitive approaches to stress management derive from the constatation that the individual's interpretation of events or situations which have been labeled stressful, the individual's anticipation of the consequences of the stressor and the individual's view of his or her ability to cope with the stressor or the stress reaction are fundamental in the stress process. There are a variety of cognitive theories and techniques, ranging from Beck's cognitive therapy to Ellis' Rational-Emotive Therapy. Initial phases of these therapies are directed at teaching the individual to recognize, record, analyse and modify maladaptive cognitions. The second phase is

  4. Complexity Science Applications to Dynamic Trajectory Management: Research Strategies

    NASA Technical Reports Server (NTRS)

    Sawhill, Bruce; Herriot, James; Holmes, Bruce J.; Alexandrov, Natalia

    2009-01-01

    The promise of the Next Generation Air Transportation System (NextGen) is strongly tied to the concept of trajectory-based operations in the national airspace system. Existing efforts to develop trajectory management concepts are largely focused on individual trajectories, optimized independently, then de-conflicted among each other, and individually re-optimized, as possible. The benefits in capacity, fuel, and time are valuable, though perhaps could be greater through alternative strategies. The concept of agent-based trajectories offers a strategy for automation of simultaneous multiple trajectory management. The anticipated result of the strategy would be dynamic management of multiple trajectories with interacting and interdependent outcomes that satisfy multiple, conflicting constraints. These constraints would include the business case for operators, the capacity case for the Air Navigation Service Provider (ANSP), and the environmental case for noise and emissions. The benefits in capacity, fuel, and time might be improved over those possible under individual trajectory management approaches. The proposed approach relies on computational agent-based modeling (ABM), combinatorial mathematics, as well as application of "traffic physics" concepts to the challenge, and modeling and simulation capabilities. The proposed strategy could support transforming air traffic control from managing individual aircraft behaviors to managing systemic behavior of air traffic in the NAS. A system built on the approach could provide the ability to know when regions of airspace approach being "full," that is, having non-viable local solution space for optimizing trajectories in advance.

  5. Solubility and dissolution enhancement strategies: current understanding and recent trends.

    PubMed

    Jain, Shashank; Patel, Niketkumar; Lin, Senshang

    2015-06-01

    Identification of lead compounds with higher molecular weight and lower aqueous solubility has become increasingly prevalent with the advent of high throughput screening. Poor aqueous solubility of these lipophilic compounds can drastically affect the dissolution rate and subsequently the drug absorbed in the systemic circulation, imposing a significant burden of time and money during drug development process. Various pre-formulation and formulation strategies have been applied in the past that can improve the aqueous solubility of lipophilic compounds by manipulating either the crystal lattice properties or the activity coefficient of a solute in solution or both, if possible. However, despite various strategies available in the armor of formulation scientist, solubility issue still remains an overriding problem in the drug development process. It is perhaps due to the insufficient conceptual understanding of solubility and dissolution phenomenon that hinders the judgment in selecting suitable strategy for improving aqueous solubility and/or dissolution rate. This article, therefore, focuses on (i) revisiting the theoretical and mathematical concepts associated with solubility and dissolution, (ii) their application in making rationale decision for selecting suitable pre-formulation and formulation strategies and (iii) the relevant research performed in this field in past decade.

  6. Result Merging Strategies for a Current News Metasearcher.

    ERIC Educational Resources Information Center

    Rasolofo, Yves; Hawking, David; Savoy, Jacques

    2003-01-01

    Metasearching of online current news services is a potentially useful Web application of distributed information retrieval techniques. Reports experiences in building a metasearcher designed to provide up-to-date searching over a significant number of rapidly changing current news sites, focusing on how to merge results from the search engines at…

  7. A framework for the assessment of severe accident management strategies

    SciTech Connect

    Kastenberg, W.E.; Apostolakis, G.; Dhir, V.K.

    1993-09-01

    Severe accident management can be defined as the use of existing and/or altemative resources, systems and actors to prevent or mitigate a core-melt accident. For each accident sequence and each combination of severe accident management strategies, there may be several options available to the operator, and each involves phenomenological and operational considerations regarding uncertainty. Operational uncertainties include operator, system and instrumentation behavior during an accident. A framework based on decision trees and influence diagrams has been developed which incorporates such criteria as feasibility, effectiveness, and adverse effects, for evaluating potential severe accident management strategies. The framework is also capable of propagating both data and model uncertainty. It is applied to several potential strategies including PWR cavity flooding, BWR drywell flooding, PWR depressurization and PWR feed and bleed.

  8. New Management Strategies for Ectopia Lentis.

    PubMed

    Simon, Melissa A; Origlieri, Catherine A; Dinallo, Anthony M; Forbes, Brian J; Wagner, Rudolph S; Guo, Suqin

    2015-01-01

    Ectopia lentis refers to displacement of the crystalline lens in the setting of various systemic and metabolic disorders. A literature review was conducted to investigate the management of non-traumatic ectopia lentis in the pediatric population, particularly focusing on surgical intervention. Both limbal and pars plana approaches for lensectomy are well established in the literature. Surgical options for intraocular lens implantation in pediatric eyes with ectopia lentis include anterior chamber intraocular lenses and iris-fixated or scleral-fixated posterior chamber intraocular lenses. Recently, the use of capsular tension rings has also been described with promising results. Visual rehabilitation and treatment of amblyopia are essential for patients within the amblyogenic age group following surgical intervention.

  9. Current concepts in wound management and wound healing products.

    PubMed

    Davidson, Jacqueline R

    2015-05-01

    Current concepts in wound management are summarized. The emphasis is on selection of the contact layer of the bandage to promote a moist wound environment. Selection of an appropriate contact layer is based on the stage of wound healing and the amount of wound exudate. The contact layer can be used to promote autolytic debridement and enhance wound healing.

  10. Tinnitus--Current Concepts in Diagnosis and Management.

    ERIC Educational Resources Information Center

    Epstein, Stephen

    1997-01-01

    This article discusses the causes of tinnitus, sound or noise in the ears or head without any external stimulation. Classification of tinnitus, the essentials of medical evaluation of a patient with tinnitus, essential test procedures, and current concepts in the management of tinnitus are addressed. (CR)

  11. Amyloid beta (Aβ) peptide modulators and other current treatment strategies for Alzheimer’s disease (AD)

    PubMed Central

    Lukiw, Walter J.

    2012-01-01

    Introduction Alzheimer’s disease (AD) is a common, progressive neurological disorder whose incidence is reaching epidemic proportions. The prevailing ‘amyloid cascade hypothesis’, which maintains that the aberrant proteolysis of beta-amyloid precursor protein (βAPP) into neurotoxic amyloid beta (Aβ)-peptides is central to the etiopathology of AD, continues to dominate pharmacological approaches to the clinical management of this insidious disorder. This review is a compilation and update on current pharmacological strategies designed to down-regulate Aβ42-peptide generation in an effort to ameliorate the tragedy of AD. Areas Covered This review utilized on-line data searches at various open online-access websites including the Alzheimer Association, Alzheimer Research Forum; individual drug company databases; the National Institutes of Health (NIH) Medline; Pharmaprojects database; Scopus; inter-University research communications and unpublished research data. Expert Opinion Aβ immunization-, anti-acetylcholinesterase-, β-secretase-, chelation-, γ-secretase-, N-methyl D-aspartate (NMDA) receptor antagonist-, statin-based and other strategies to modulate βAPP processing have dominated pharmacological approaches directed against AD-type neurodegenerative pathology. Cumulative clinical results of these efforts remain extremely disappointing, and have had little overall impact on the clinical management of AD. While a number of novel approaches are in consideration and development, to date there is still no effective treatment or cure for this expanding healthcare concern. PMID:22439907

  12. SECONDARY WASTE MANAGEMENT STRATEGY FOR EARLY LOW ACTIVITY WASTE TREATMENT

    SciTech Connect

    TW, CRAWFORD

    2008-07-17

    This study evaluates parameters relevant to River Protection Project secondary waste streams generated during Early Low Activity Waste operations and recommends a strategy for secondary waste management that considers groundwater impact, cost, and programmatic risk. The recommended strategy for managing River Protection Project secondary waste is focused on improvements in the Effiuent Treatment Facility. Baseline plans to build a Solidification Treatment Unit adjacent to Effluent Treatment Facility should be enhanced to improve solid waste performance and mitigate corrosion of tanks and piping supporting the Effiuent Treatment Facility evaporator. This approach provides a life-cycle benefit to solid waste performance and reduction of groundwater contaminants.

  13. Current Strategies to Improve the Bioactivity of PEEK

    PubMed Central

    Ma, Rui; Tang, Tingting

    2014-01-01

    The synthetic thermoplastic polymer polyetheretherketone (PEEK) is becoming a popular component of clinical orthopedic and spinal applications, but its practical use suffers from several limitations. Although PEEK is biocompatible, chemically stable, radiolucent and has an elastic modulus similar to that of normal human bone, it is biologically inert, preventing good integration with adjacent bone tissues upon implantation. Recent efforts have focused on increasing the bioactivity of PEEK to improve the bone-implant interface. Two main strategies have been used to overcome the inert character of PEEK. One approach is surface modification to activate PEEK through surface treatment alone or in combination with a surface coating. Another strategy is to prepare bioactive PEEK composites by impregnating bioactive materials into PEEK substrate. Researchers believe that modified bioactive PEEK will have a wide range of orthopedic applications. PMID:24686515

  14. MicroRNA Detection: Current Technology and Research Strategies

    NASA Astrophysics Data System (ADS)

    Hunt, Eric A.; Broyles, David; Head, Trajen; Deo, Sapna K.

    2015-07-01

    The relatively new field of microRNA (miR) has experienced rapid growth in methodology associated with its detection and bioanalysis as well as with its role in -omics research, clinical diagnostics, and new therapeutic strategies. The breadth of this area of research and the seemingly exponential increase in number of publications on the subject can present scientists new to the field with a daunting amount of information to evaluate. This review aims to provide a collective overview of miR detection methods by relating conventional, established techniques [such as quantitative reverse transcription polymerase chain reaction (RT-qPCR), microarray, and Northern blotting (NB)] and relatively recent advancements [such as next-generation sequencing (NGS), highly sensitive biosensors, and computational prediction of microRNA/targets] to common miR research strategies. This should guide interested readers toward a more focused study of miR research and the surrounding technology.

  15. CURRENT METHODS AND RESEARCH STRATEGIES FOR MODELING ATMOSPHERIC MERCURY

    EPA Science Inventory

    The atmospheric pathway of the global mercury cycle is known to be the primary source of mercury contamination to most threatened aquatic ecosystems. Current efforts toward numerical modeling of atmospheric mercury are hindered by an incomplete understanding of emissions, atmosp...

  16. Caries Management Strategies for Primary Molars

    PubMed Central

    Santamaria, R.M.; Innes, N.P.T.; Machiulskiene, V.; Evans, D.J.P.; Splieth, C.H.

    2014-01-01

    Minimal invasive approaches to managing caries, such as partial caries removal techniques, are showing increasing evidence of improved outcomes over the conventional complete caries removal. There is also increasing interest in techniques where no caries is removed. We present the 1-yr results of clinical efficacy for 3 caries management options for occlusoproximal cavitated lesions in primary molars: conventional restorations (CR; complete caries removal and compomer restoration), Hall technique (HT; no caries removal, sealing in with stainless steel crowns), and nonrestorative caries treatment (NRCT; no caries removal, opening up the cavity, teaching brushing and fluoride application). In sum, 169 children (3-8 yr old; mean, 5.56 ± 1.45 yr) were enrolled in this secondary care–based, 3-arm, parallel-group, randomized clinical trial. Treatments were carried out by specialist pediatric dentists or postgraduate trainees. One lesion per child received CR, HT, or NRCT. Outcome measures were clinical failure rates, grouped as minor failure (restoration loss/need for replacement, reversible pulpitis, caries progression, etc.) and major failure (irreversible pulpitis, abscess, etc.). There were 148 children (87.6%) with a minimum follow-up of 11 mo (mean, 12.23 ± 0.98 mo). Twenty teeth were recorded as having at least 1 minor failure: NRCT, n = 8 (5%); CR, n = 11 (7%); HT, n = 1 (1%) (p = .002, 95% CI = 0.001 to 0.003). Only the comparison between NRCT and CR showed no significant difference (p = .79, 95% CI = 0.78 to 0.80). Nine (6%) experienced at least 1 major failure: NRCT, n = 4 (2%); CR, n = 5 (3%); HT, n = 0 (0%) (p = .002, 95% CI = 0.001 to 0.003). Individual comparison of NRCT and CR showed no statistically significant difference in major failures (p = .75, 95% CI = 0.73 to 0.76). Success and failure rates were not significantly affected by pediatric dentists’ level of experience (p = .13, 95% CI = 0.12 to 0.14). The HT was significantly more successful

  17. Model predictive control power management strategies for HEVs: A review

    NASA Astrophysics Data System (ADS)

    Huang, Yanjun; Wang, Hong; Khajepour, Amir; He, Hongwen; Ji, Jie

    2017-02-01

    This paper presents a comprehensive review of power management strategy (PMS) utilized in hybrid electric vehicles (HEVs) with an emphasis on model predictive control (MPC) based strategies for the first time. Research on MPC-based power management systems for HEVs has intensified recently due to its many inherent merits. The categories of the existing PMSs are identified from the latest literature, and a brief study of each type is conducted. Then, the MPC approach is introduced and its advantages are discussed. Based on the acquisition method of driver behavior used for state prediction and the dynamic model used, the MPC is classified and elaborated. Factors that affect the performance of the MPC are put forward, including prediction accuracy, design parameters, and solvers. Finally, several important issues in the application of MPC-based power management strategies and latest developing trends are discussed. This paper not only provides a comprehensive analysis of MPC-based power management strategies for HEVs but also puts forward the future and emphasis of future study, which will promote the development of energy management controller with high performance and low cost for HEVs.

  18. Technology and Current Reading/Literacy Assessment Strategies

    ERIC Educational Resources Information Center

    Balajthy, Ernest

    2007-01-01

    Computer-based technologies offer promise as a means to assess students and provide teachers with better understandings of their students' achievement. This article describes recent developments in computer-based and web-based reading and literacy assessment, focusing on assessment administration, information management, and report creation. In…

  19. Strategies for searching and managing evidence-based practice resources.

    PubMed

    Robb, Meigan; Shellenbarger, Teresa

    2014-10-01

    Evidence-based nursing practice requires the use of effective search strategies to locate relevant resources to guide practice change. Continuing education and staff development professionals can assist nurses to conduct effective literature searches. This article provides suggestions for strategies to aid in identifying search terms. Strategies also are recommended for refining searches by using controlled vocabulary, truncation, Boolean operators, PICOT (Population/Patient Problem, Intervention, Comparison, Outcome, Time) searching, and search limits. Suggestions for methods of managing resources also are identified. Using these approaches will assist in more effective literature searches and may help evidence-based practice decisions.

  20. Exploring strategies used following a group-based fatigue management programme for people with multiple sclerosis (FACETS) via the Fatigue Management Strategies Questionnaire (FMSQ)

    PubMed Central

    Thomas, S; Kersten, P; Thomas, P W; Slingsby, V; Nock, A; Jones, R; Davies Smith, A; Galvin, K T; Baker, R; Hillier, C

    2015-01-01

    Objectives To explore cross-sectional patterns of use of fatigue management strategies in people with multiple sclerosis (MS) who had attended a group-based fatigue management programme, Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle (‘FACETS’). In a multicentre randomised controlled trial (RCT) the FACETS programme was shown to reduce fatigue severity and improve self-efficacy and quality of life. Design A questionnaire substudy within a RCT involving the self-completed Fatigue Management Strategies Questionnaire (FMSQ). The FMSQ includes: (1) closed questions about the use and helpfulness of fatigue management strategies taught in FACETS and (2) open items about changes to lifestyle, attitudes or expectations, barriers or difficulties encountered and helpful strategies not covered in FACETS. Participants All had a clinical diagnosis of MS, significant fatigue, were ambulatory and had attended at least 4 of 6 scheduled FACETS sessions. Methods Participants (n=72) were posted the FMSQ with a prepaid return envelope 4 months after the end of the FACETS programme. Results 82% (59/72) of participants returned the FMSQ. The fatigue management strategies most frequently used since attending FACETS were prioritisation (80%), pacing (78%), saying no to others (78%), grading tasks (75%) and challenging unhelpful thoughts (71%). Adding in those participants who were already using the respective strategies prior to FACETS, the three most used strategies at 4 months were prioritisation (55/59), grading (54/59) and pacing (53/58). Free-text comments illustrated the complex interplay between attitudes/expectations, behaviours, emotions and the environment. Issues related to expectations featured strongly in participants’ comments. Expectations (from self and others) were both facilitators and barriers to effective fatigue management. Conclusions Individuals’ comments highlighted the complex, multifaceted nature of fatigue

  1. Current Controversies in Diagnosis and Management of Cleft Palate and Velopharyngeal Insufficiency

    PubMed Central

    Ysunza, Pablo Antonio; Repetto, Gabriela M.; Pamplona, Maria Carmen; Calderon, Juan F.; Shaheen, Kenneth; Chaiyasate, Konkgrit; Rontal, Matthew

    2015-01-01

    Background. One of the most controversial topics concerning cleft palate is the diagnosis and treatment of velopharyngeal insufficiency (VPI). Objective. This paper reviews current genetic aspects of cleft palate, imaging diagnosis of VPI, the planning of operations for restoring velopharyngeal function during speech, and strategies for speech pathology treatment of articulation disorders in patients with cleft palate. Materials and Methods. An updated review of the scientific literature concerning genetic aspects of cleft palate was carried out. Current strategies for assessing and treating articulation disorders associated with cleft palate were analyzed. Imaging procedures for assessing velopharyngeal closure during speech were reviewed, including a recent method for performing intraoperative videonasopharyngoscopy. Results. Conclusions from the analysis of genetic aspects of syndromic and nonsyndromic cleft palate and their use in its diagnosis and management are presented. Strategies for classifying and treating articulation disorders in patients with cleft palate are presented. Preliminary results of the use of multiplanar videofluoroscopy as an outpatient procedure and intraoperative endoscopy for the planning of operations which aimed to correct VPI are presented. Conclusion. This paper presents current aspects of the diagnosis and management of patients with cleft palate and VPI including 3 main aspects: genetics and genomics, speech pathology and imaging diagnosis, and surgical management. PMID:26273595

  2. Psychosomatic pain: new insights and management strategies.

    PubMed

    Rubin, Jay J

    2005-11-01

    insight about the relationship between abuse and their current symptoms leads to decreased health care utilization. Practical guidelines are provided for identifying psychopathology, communicating effectively, and achieving better treatment outcomes for these unfortunate patients.

  3. Current Cell-Based Strategies for Whole Kidney Regeneration.

    PubMed

    Poornejad, Nafiseh; Schaumann, Lara B; Buckmiller, Evan M; Roeder, Beverly L; Cook, Alonzo D

    2016-10-01

    Chronic kidney diseases affect thousands of people worldwide. Although hemodialysis alleviates the situation by filtering the patient's blood, it does not replace other kidney functions such as hormone release or homeostasis regulation. Consequently, orthotopic transplantation of donor organs is the ultimate treatment for patients suffering from end-stage renal failure. Unfortunately, the number of patients on the waiting list far exceeds the number of donors. In addition, recipients must remain on immunosuppressive medications for the remainder of their lives, which increases the risk of morbidity due to their weakened immune system. Despite recent advancements in whole organ transplantation, 40% of recipients will face rejection of implanted organs with a life expectancy of only 10 years. Bioengineered patient-specific kidneys could be an inexhaustible source of healthy kidneys without the risk of immune rejection. The purpose of this article is to review the pros and cons of several bioengineering strategies used in recent years and their unresolved issues. These strategies include repopulation of natural scaffolds with a patient's cells, de-novo generation of kidneys using patient-induced pluripotent stem cells combined with stepwise differentiation, and the creation of a patient's kidney in the embryos of other mammalian species.

  4. How Managers' everyday decisions create or destroy your company's strategy.

    PubMed

    Bower, Joseph L; Gilbert, Clark G

    2007-02-01

    Senior executives have long been frustrated by the disconnection between the plans and strategies they devise and the actual behavior of the managers throughout the company. This article approaches the problem from the ground up, recognizing that every time a manager allocates resources, that decision moves the company either into or out of alignment with its announced strategy. A well-known story--Intel's exit from the memory business--illustrates this point. When discussing what businesses Intel should be in, Andy Grove asked Gordon Moore what they would do if Intel were a company that they had just acquired. When Moore answered, "Get out of memory," they decided to do just that. It turned out, though, that Intel's revenues from memory were by this time only 4% of total sales. Intel's lower-level managers had already exited the business. What Intel hadn't done was to shut down the flow of research funding into memory (which was still eating up one-third of all research expenditures); nor had the company announced its exit to the outside world. Because divisional and operating managers-as well as customers and capital markets-have such a powerful impact on the realized strategy of the firm, senior management might consider focusing less on the company's formal strategy and more on the processes by which the company allocates resources. Top managers must know the track record of the people who are making resource allocation proposals; recognize the strategic issues at stake; reach down to operational managers to work across division lines; frame resource questions to reflect the corporate perspective, especially when large sums of money are involved and conditions are highly uncertain; and create a new context that allows top executives to circumvent the regular resource allocation process when necessary.

  5. Coping Strategies for Managing Acculturative Stress among Asian International Students

    ERIC Educational Resources Information Center

    Ra, Young-An; Trusty, Jerry

    2015-01-01

    This article examines the effects of specific coping strategies on managing acculturative stress and acculturation of Asian international students, based on a sample of 220 Asian international students in the U.S. The data were analyzed with hierarchical multiple regression using Baron and Kenny's (1986) mediation procedure. The results supported…

  6. Board and Senior Management Alignment on School Strategy

    ERIC Educational Resources Information Center

    Sarros, James C.; Sarros, Anne M.; Cooper, Brian K.; Santora, Joseph C.; Baker, Robin

    2016-01-01

    This study examines the degree to which senior executive members of a school's decision-making team (senior management team and board of directors) are aligned on fundamental principles of school strategy. Our study is based on a conceptual framework of strategic leadership as it applies in an Australian independent school context. We also examine…

  7. Designs, Management Tactics, and Strategies in Asynchronous Learning Discussions.

    ERIC Educational Resources Information Center

    Tu, Chih-Hsiung; Corry, Michael

    2003-01-01

    Discusses effective designs, management tactics, and strategies to produce ideal asynchronous network discussions that allow contemplation and encourage the development of critical thinking. A model of an online collaborative learning community is applied to implement the designs. A sample of online collaborative moderation guidelines is…

  8. Sources of Faculty Stress and Strategies for Its Management.

    ERIC Educational Resources Information Center

    Larkin, Paul; Clagett, Craig

    Views on sources of stress on college faculty and strategies for its management were obtained at small-group sessions in the 1980 faculty orientation at Prince George's Community College, Maryland. Sixteen faculty groups generated 218 responses expressing sources of job stress, a complete listing of which is appended. The responses were aggregated…

  9. Strategies for Talent Management: Greater Philadelphia Companies in Action

    ERIC Educational Resources Information Center

    Council for Adult and Experiential Learning (NJ1), 2008

    2008-01-01

    Human capital is one of the critical issues that impacts the Greater Philadelphia region's ability to grow and prosper. The CEO Council for Growth (CEO Council) is committed to ensuring a steady and talented supply of quality workers for this region. "Strategies for Talent Management: Greater Philadelphia Companies in Action" provides…

  10. The creative process in biomedical visualization: strategies and management.

    PubMed

    Anderson, P A

    1990-01-01

    The phases of the creative process (identification, preparation, incubation, insight, and elaboration/verification) are related to strategies for management of biomedical illustration projects. The idea that creativity is a mystery--and is unpredictable and uncontrollable--is not accepted. This article presents a practical way to encourage creative thinking in the biomedical visualization studio.

  11. Role Management Strategies of Beginning Teachers in Hong Kong

    ERIC Educational Resources Information Center

    Choi, Pik Lin; Tang, Sylvia Yee Fan

    2005-01-01

    Beginning teachers encounter new challenges as the role system in contemporary society has become more and more demanding. By means of the life history method, role management strategies of four Hong Kong beginning teachers employed to cope with role demands and intra-role conflicts were located in their biographical, workplace and wider…

  12. Management Strategies for Transition to Sustainable Agricultural Irrigation

    NASA Astrophysics Data System (ADS)

    Ahlfeld, D.; Mulligan, K.; Brown, C. M.; Yang, Y. E.

    2011-12-01

    In many agricultural regions of the world, aquifer overdrafting for agricultural irrigation continues. Management strategies are investigated that transition from this unsustainable use of water to a future, diminished use of irrigation. Complications arising from climate change and volatile energy prices are considered. A command and control strategy is modeled using combined simulation and optimization techniques. This strategy is compared with market based mechanisms such as cap and trade and Pigouvian pricing that are modeled using agent based methods. The formulations are designed to model the effects of different management strategies including those that seek to avoid rapid changes in basin-wide water utilization (considered a surrogate for agricultural production) over this time period. Formulations also include limits on total reduction in aquifer storage and controls on streamflow in the basin. The management formulations used in this study are developed for planning horizons of 50 to 100 years and use the Republican River Basin in the High Plains Aquifer as a case study. Historical and climate-adjusted recharge patterns are considered. Spatial and temporal variation in total irrigated acreage and the aquifer storage change determined by the solutions of the management formulations are analyzed and presented.

  13. University Students' Views of Obesity and Weight Management Strategies

    ERIC Educational Resources Information Center

    Okonkwo, Ononuju; While, Alison

    2010-01-01

    Objective: To investigate the knowledge and views of university students regarding obesity and weight management strategies. Design: Online questionnaire-based survey of undergraduate and postgraduate university students in a large London university with a diverse student population. Method: The survey was administered online and circulated…

  14. San Francisco Bay Long Term Management Strategy for Dredging

    EPA Pesticide Factsheets

    The San Francisco Bay Long Term Management Strategy (LTMS) is a cooperative effort to develop a new approach to dredging and dredged material disposal in the San Francisco Bay area. The LTMS serves as the Regional Dredging Team for the San Francisco area.

  15. Managing Student Participation: Teacher Strategies in a Virtual EFL Course

    ERIC Educational Resources Information Center

    Wang, Airong

    2014-01-01

    This paper aims to explore teacher strategies for managing student participation in a complex Multi-user Virtual Environment. Data include transcribed recordings from a task-based EFL course in Second Life. Conversational Analysis is adopted to analyze the teacher's verbal language output in the transcript, and a student questionnaire is used to…

  16. Hand fractures: a review of current treatment strategies.

    PubMed

    Meals, Clifton; Meals, Roy

    2013-05-01

    Fractures of the tubular bones of the hand are common and potentially debilitating. The majority of these injuries may be treated without an operation. Surgery, however, offers distinct advantages in properly selected cases. We present a review of hand fracture management, with special attention paid to advances since 2008. The history and mechanisms of these fractures are discussed, as are treatment options and common complications. Early mobilization of the fractured hand is emphasized because soft tissue recovery may be more problematic than that of bone.

  17. Insecticide Resistance and Management Strategies in Urban Ecosystems

    PubMed Central

    Zhu, Fang; Lavine, Laura; O’Neal, Sally; Lavine, Mark; Foss, Carrie; Walsh, Douglas

    2016-01-01

    The increased urbanization of a growing global population makes imperative the development of sustainable integrated pest management (IPM) strategies for urban pest control. This emphasizes pests that are closely associated with the health and wellbeing of humans and domesticated animals. Concurrently there are regulatory requirements enforced to minimize inadvertent exposures to insecticides in the urban environment. Development of insecticide resistance management (IRM) strategies in urban ecosystems involves understanding the status and mechanisms of insecticide resistance and reducing insecticide selection pressure by combining multiple chemical and non-chemical approaches. In this review, we will focus on the commonly used insecticides and molecular and physiological mechanisms underlying insecticide resistance in six major urban insect pests: house fly, German cockroach, mosquitoes, red flour beetle, bed bugs and head louse. We will also discuss several strategies that may prove promising for future urban IPM programs. PMID:26751480

  18. Communication strategies and volunteer management for the IAU-OAD

    NASA Astrophysics Data System (ADS)

    Sankatsing Nava, Tibisay

    2015-08-01

    The IAU Office of Astronomy for Development will be developing a new communication strategy to promote its projects in a way that is relevant to stakeholders and the general public. Ideas include a magazine featuring best practices within the field of astronomy for development and setting up a workflow of communication that integrates the different outputs of the office and effectively uses the information collection tools developed by OAD team members.To accomplish these tasks the OAD will also develop a community management strategy with existing tools to effectively harness the skills of OAD volunteers for communication purposes. This talk will discuss the new communication strategy of the OAD as well the expanded community management plans.

  19. Current strategies for vitamin E biofortification of crops.

    PubMed

    Mène-Saffrané, Laurent; Pellaud, Sébastien

    2017-03-16

    Vitamin E refers to four tocopherols and four tocotrienols that are exclusively synthesized by photosynthetic organisms. While α-tocopherol is the most potent vitamin E compound, it is not the main form consumed since the composition of most major crops is dominated by γ-tocopherol. Nutritional studies show that populations of developed countries do not consume enough vitamin E and that a large proportion of individuals exhibit plasma α-tocopherol deficiency. Following the identification of vitamin E biosynthetic genes, several strategies including metabolic engineering, classic breeding and mutation breeding, have been undertaken to improve the vitamin E content of crops. In addition to providing crops in which vitamin E content is enhanced, these studies are revealing the bottlenecks limiting its biosynthesis.

  20. Current development in genetic engineering strategies of Bacillus species.

    PubMed

    Dong, Huina; Zhang, Dawei

    2014-05-03

    The complete sequencing and annotation of the genomes of industrially-important Bacillus species has enhanced our understanding of their properties, and allowed advances in genetic manipulations in other Bacillus species. Post-genomic studies require simple and highly efficient tools to enable genetic manipulation. Here, we summarize the recent progress in genetic engineering strategies for Bacillus species. We review the available genetic tools that have been developed in Bacillus species, as well as methods developed in other species that may also be applicable in Bacillus. Furthermore, we address the limitations and challenges of the existing methods, and discuss the future research prospects in developing novel and useful tools for genetic modification of Bacillus species.

  1. Research on transient hysteresis current control strategy of DC-DC converter

    NASA Astrophysics Data System (ADS)

    Zhang, Ting; Wang, Zu-liang; Zhao, Yu-kai

    2017-01-01

    In order to improve the dynamic performance of DC-DC converter, transient hysteresis current control strategy is proposed which is based on parallel computing and combinational logic. By making a comparison between the real-time inductor current and the threshold inductor current, the switch is controlled more accurately. Under the Matlab/Simulink environment, the process of the Buck-Boost converter was simulated. The simulation results show that the transient hysteresis current control strategy can effectively overcome the disadvantages when load changes or input voltage disturbance occurs, it posses high load regulation and short dynamic response time, and it verifies the feasibility of the proposed strategy.

  2. Rule Driven Multi-Objective Management (RDMOM) - An Alternative Form for Describing and Developing Effective Water Resources Management Strategies

    NASA Astrophysics Data System (ADS)

    Sheer, D. P.

    2011-12-01

    Economics provides a model for describing human behavior applied to the management of water resources, but that model assumes, among other things, that managers have a way of directly relating immediate actions to long-term economic outcomes. This is rarely the case in water resources problems where uncertainty has significant impacts on the effectiveness of management strategies and where the management objectives are very difficult to commensurate. The difficulty in using economics is even greater in multiparty disputes, where each party has a different relative value for each of the management objectives, and many of the management objectives are shared. A three step approach to collaborative decision making can overcome these difficulties. The first step involves creating science based performance measures and evaluation tools to estimate the effect of alternative management strategies on each of the non-commensurate objectives. The second step involves developing short-term surrogate operating objectives that implicitly deal with all of the aspects of the long term uncertainty. Management that continually "optimizes" the short-term objectives subject to physical and other constraints that change through time can be characterized as Rule Driven Multi-Objective Management (RDMOM). RDMOM strategies are then tested in simulation models to provide the basis for evaluating performance measures. Participants in the collaborative process then engage in multiparty discussions that create new alternatives, and "barter" a deal. RDMOM does not assume that managers fully understand the link between current actions and long term goals. Rather, it assumes that managers operate to achieve short-term surrogate objectives which they believe will achieve an appropriate balance of both short and long-term incommensurable benefits. A reservoir rule curve is a simple, but often not particularly effective, example of the real-world implementation of RDMOM. Water managers find they

  3. Invasive Aspergillosis: Current Strategies for Diagnosis and Management.

    PubMed

    Cadena, Jose; Thompson, George R; Patterson, Thomas F

    2016-03-01

    Aspergillosis remains a significant cause of morbidity and mortality in the immunocompromised population. The spectrum of disease is broad, ranging from severe and rapidly fatal infection to noninvasive disease. The diversity of patients and risk factors complicates diagnostic and therapeutic decision-making. Invasive procedures are often precluded by host status; noninvasive diagnostic tests vary in their sensitivity and specificity. Advancements in understanding the pathophysiology of invasive aspergillosis and host genetics in differential risk have also occurred. Future work may assist in therapeutic decision-making and patient prognosis. Voriconazole remains the preferred agent for treatment. Additional alternatives have emerged.

  4. Wind disasters: A comprehensive review of current management strategies

    PubMed Central

    Marchigiani, Raffaele; Gordy, Stephanie; Cipolla, James; Adams, Raeanna C; Evans, David C; Stehly, Christy; Galwankar, Sagar; Russell, Sarah; Marco, Alan P; Kman, Nicholas; Bhoi, Sanjeev; Stawicki, Stanislaw P A; Papadimos, Thomas J

    2013-01-01

    Wind disasters are responsible for tremendous physical destruction, injury, loss of life and economic damage. In this review, we discuss disaster preparedness and effective medical response to wind disasters. The epidemiology of disease and injury patterns observed in the early and late phases of wind disasters are reviewed. The authors highlight the importance of advance planning and adequate preparation as well as prompt and well-organized response to potential damage involving healthcare infrastructure and the associated consequences to the medical response system. Ways to minimize both the extent of infrastructure damage and its effects on the healthcare system are discussed, focusing on lessons learned from recent major wind disasters around the globe. Finally, aspects of healthcare delivery in disaster zones are reviewed. PMID:23961458

  5. Clinical management of dilated cardiomyopathy: current knowledge and future perspectives.

    PubMed

    Merlo, Marco; Cannatá, Antonio; Vitagliano, Alice; Zambon, Elena; Lardieri, Gerardina; Sinagra, Gianfranco

    2016-01-01

    Dilated cardiomyopathy (DCM) is a primary heart muscle disease characterized by a progressive dilation and dysfunction of either the left or both ventricles. The management of DCM is currently challenging for clinicians. The persistent lack of knowledge about the etiology and pathophysiology of this disease continues to determine important fields of uncertainty in managing this condition. Molecular cardiology and genetics currently represent the most crucial horizon of increasing knowledge. Understanding the mechanisms underlying the disease allows clinicians to treat this disease more effectively and to further improve outcomes of DCM patients through advancements in etiologic characterization, prognostic stratification and individualized therapy. Left ventricular reverse remodeling predicts a lower rate of major cardiac adverse events independently from other factors. Optimized medical treatment and device implantation are pivotal in inducing left ventricular reverse remodeling. Newly identified targets, such as angiotensin-neprilysin inhibition, phosphodiesterase inhibition and calcium sensitizing are important in improving prognosis in patients affected by DCM.

  6. Current Concepts in the Management of Meconium Aspiration Syndrome.

    PubMed

    Chettri, Subhash; Bhat, B Vishnu; Adhisivam, B

    2016-10-01

    In developing countries, meconium aspiration syndrome (MAS) is an important cause of morbidity and mortality among neonates. The concepts of pathophysiology and management of meconium stained amniotic fluid (MSAF) and meconium aspiration syndrome have undergone tremendous change in recent years. Routine intranatal and postnatal endotracheal suctioning of meconium in vigorous infants is no longer recommended. Recent studies have challenged its role even in non-vigorous infants. Supportive therapy like oxygen supplementation, mechanical ventilation and intravenous fluids are the cornerstone in the management of meconium aspiration syndrome. Availability of surfactant, inhaled nitric oxide, high frequency ventilators and extracorporeal membrane oxygenation has made it possible to salvage more infants with meconium aspiration syndrome. In this review the authors have discussed the current concepts in the pathophysiology and management of MAS. Drugs in trials and future therapeutic targets are also discussed briefly.

  7. Hemangiomas and Vascular Malformations: Current Theory and Management

    PubMed Central

    Richter, Gresham T.; Friedman, Adva B.

    2012-01-01

    Vascular anomalies are a heterogeneous group of congenital blood vessel disorders more typically referred to as birthmarks. Subcategorized into vascular tumors and malformations, each anomaly is characterized by specific morphology, pathophysiology, clinical behavior, and management approach. Hemangiomas are the most common vascular tumor. Lymphatic, capillary, venous, and arteriovenous malformations make up the majority of vascular malformations. This paper reviews current theory and practice in the etiology, diagnosis, and treatment of these more common vascular anomalies. PMID:22611412

  8. Integrated Management of Childhood Illness (IMCI): a robust strategy.

    PubMed

    Patwari, A K; Raina, Neena

    2002-01-01

    Integrated Management of Childhood Illness (IMCI), a strategy fostering holistic approach to child health and development, is built upon successful experiences gained from effective child health interventions like immunization, oral rehydration therapy, management of acute respiratory infections and improved infant feeding. The core intervention of IMCI is integrated management of the five most important causes of childhood deaths-acute respiratory infections, diarrheal diseases, measles, malaria and malnutrition. Using a set of interventions for the integrated treatment and prevention of major childhood illnesses, the IMCI strategy aims to reduce death as well as the frequency and severity of illness and disability, thus contributing to improved growth and development. In health facilities, the IMCI strategy promotes the accurate identification of childhood illness (es) in the outpatient settings, ensures appropriate combined treatment of all major illnesses, strengthens the counselling of caretakers and the provision of preventive services, and speeds up the referral of severely ill children. The strategy also aims to improve the quality of care of sick children at the referral level. It also creates a scientifically sound link between the management guidelines at the community level and the management approach in a referral centre. The strategy also envisages actual situations when referral is not possible and offers the best possible options in such circumstances. In the home setting, it promotes appropriate early home care and care-seeking, improved nutrition and prevention, and the correct implementation of prescribed care. In addition to its focus on treatment of illness in the health facility as well as at home, it also provides an opportunity for important preventive interventions such as immunization and improved infant and child nutrition including breastfeeding. The IMCI strategy reduces wastage of resources and avoids duplication of efforts that may

  9. Ethanol wet-bonding challenges current anti-degradation strategy.

    PubMed

    Sadek, F T; Braga, R R; Muench, A; Liu, Y; Pashley, D H; Tay, F R

    2010-12-01

    The long-term effectiveness of chlorhexidine as a matrix metalloproteinase (MMP) inhibitor may be compromised when water is incompletely removed during dentin bonding. This study challenged this anti-bond degradation strategy by testing the null hypothesis that wet-bonding with water or ethanol has no effect on the effectiveness of chlorhexidine in preventing hybrid layer degradation over an 18-month period. Acid-etched dentin was bonded under pulpal pressure simulation with Scotchbond MP and Single Bond 2, with water wet-bonding or with a hydrophobic adhesive with ethanol wet-bonding, with or without pre-treatment with chlorhexidine diacetate (CHD). Resin-dentin beams were prepared for bond strength and TEM evaluation after 24 hrs and after aging in artificial saliva for 9 and 18 mos. Bonds made to ethanol-saturated dentin did not change over time with preservation of hybrid layer integrity. Bonds made to CHD pre-treated acid-etched dentin with commercial adhesives with water wet-bonding were preserved after 9 mos but not after 18 mos, with severe hybrid layer degradation. The results led to rejection of the null hypothesis and highlight the concept of biomimetic water replacement from the collagen intrafibrillar compartments as the ultimate goal in extending the longevity of resin-dentin bonds.

  10. Ethanol Wet-bonding Challenges Current Anti-degradation Strategy

    PubMed Central

    Sadek, F.T.; Braga, R.R.; Muench, A.; Liu, Y.; Pashley, D.H.; Tay, F.R.

    2010-01-01

    The long-term effectiveness of chlorhexidine as a matrix metalloproteinase (MMP) inhibitor may be compromised when water is incompletely removed during dentin bonding. This study challenged this anti-bond degradation strategy by testing the null hypothesis that wet-bonding with water or ethanol has no effect on the effectiveness of chlorhexidine in preventing hybrid layer degradation over an 18-month period. Acid-etched dentin was bonded under pulpal pressure simulation with Scotchbond MP and Single Bond 2, with water wet-bonding or with a hydrophobic adhesive with ethanol wet-bonding, with or without pre-treatment with chlorhexidine diacetate (CHD). Resin-dentin beams were prepared for bond strength and TEM evaluation after 24 hrs and after aging in artificial saliva for 9 and 18 mos. Bonds made to ethanol-saturated dentin did not change over time with preservation of hybrid layer integrity. Bonds made to CHD pre-treated acid-etched dentin with commercial adhesives with water wet-bonding were preserved after 9 mos but not after 18 mos, with severe hybrid layer degradation. The results led to rejection of the null hypothesis and highlight the concept of biomimetic water replacement from the collagen intrafibrillar compartments as the ultimate goal in extending the longevity of resin-dentin bonds. PMID:20940353

  11. Current strategies for sustaining drug release from electrospun nanofibers

    PubMed Central

    Chou, Shih-Feng; Carson, Daniel; Woodrow, Kim A.

    2017-01-01

    Electrospun drug-eluting fibers are emerging as a novel dosage form for multipurpose prevention against sexually transmitted infections, including HIV, and unintended pregnancy. Previous work from our lab and others show the versatility of this platform to deliver large doses of physico-chemically diverse agents. However, there is still an unmet need to develop practical fiber formulations for water-soluble small molecule drugs needed at high dosing due to intrinsic low potency or desire for sustained prevention. To date, most sustained release fibers have been restricted to the delivery of biologics or hydrophobic small molecules at low drug loading of typically < 1 wt.%, which is often impractical for most clinical applications. For hydrophilic small molecule drugs, their high aqueous solubility and poor partitioning and incompatibility with insoluble polymers make long-term release even more challenging. Here we investigate several existing strategies to sustain release of hydrophilic small molecule drugs that are highly-loaded in electrospun fibers. In particular, we investigate what is known about the design constraints required to realize multi-day release from fibers fabricated from uniaxial and coaxial electrospinning. PMID:26363300

  12. Current strategies for sustaining drug release from electrospun nanofibers.

    PubMed

    Chou, Shih-Feng; Carson, Daniel; Woodrow, Kim A

    2015-12-28

    Electrospun drug-eluting fibers are emerging as a novel dosage form for multipurpose prevention against sexually transmitted infections, including HIV, and unintended pregnancy. Previous work from our lab and others show the versatility of this platform to deliver large doses of physico-chemically diverse agents. However, there is still an unmet need to develop practical fiber formulations for water-soluble small molecule drugs needed at high dosing due to intrinsic low potency or desire for sustained prevention. To date, most sustained release fibers have been restricted to the delivery of biologics or hydrophobic small molecules at low drug loading of typically <1 wt.%, which is often impractical for most clinical applications. For hydrophilic small molecule drugs, their high aqueous solubility and poor partitioning and incompatibility with insoluble polymers make long-term release even more challenging. Here we investigate several existing strategies to sustain release of hydrophilic small molecule drugs that are highly-loaded in electrospun fibers. In particular, we investigate what is known about the design constraints required to realize multi-day release from fibers fabricated from uniaxial and coaxial electrospinning.

  13. Current strategies and challenges in engineering a bioartificial kidney.

    PubMed

    Kim, Steven; Fissell, William H; Humes, David H; Roy, Shuvo

    2015-01-01

    Renal replacement therapy was an early pioneer in both extra-corporeal organ replacement and whole organ transplantation. Today, the success of this pioneering work is directly demonstrated in the millions of patients worldwide successfully treated with dialysis and kidney transplantation. However, there remain significant shortcomings to current treatment modalities that limit clinical outcomes and quality of life. To address these problems, researchers have turned to using cell-based therapies for the development of a bioartificial kidney. These approaches aim to recapitulate the numerous functions of the healthy kidney including solute clearance, fluid homeostasis and metabolic and endocrine functions. This review will examine the state-of-the-art in kidney bioengineering by evaluating the various techniques currently being utilized to create a bioartificial kidney. These promising new technologies, however, still need to address key issues that may limit the widespread adoption of cell therapy including cell sourcing, organ scaffolding, and immune response. Additionally, while these new methods have shown success in animal models, it remains to be seen whether these techniques can be successfully adapted for clinical treatment in humans.

  14. Current Strategies and Challenges in Engineering a Bioartificial Kidney

    PubMed Central

    Kim, Steven; Fissell, William H.; Humes, H. David; Roy, Shuvo

    2015-01-01

    Renal replacement therapy was an early pioneer in both extra-corporeal organ replacement and whole organ transplantation. Today, the success of this pioneering work is directly demonstrated in the millions of patients worldwide successfully treated with dialysis and kidney transplantation. However, there remain significant shortcomings to current treatment modalities that limit clinical outcomes and quality of life. To address these problems, researchers have turned to using cell-based therapies for the development of a bioartificial kidney. These approaches aim to recapitulate the numerous functions of the healthy kidney including solute clearance and fluid homeostasis as well as metabolic and endocrine function. This review will examine the state-of-the-art in kidney bioengineering by evaluating the various techniques currently being utilized to create a bioartificial kidney. These promising new technologies, however, still need to address key issues that may limit the widespread adoption of cell therapy including cell sourcing, organ scaffolding, and immune response. Additionally, while these new methods have shown success in animal models, it remains to be seen whether these techniques can be successfully adapted for clinical treatment in humans. PMID:25553375

  15. Evaluation of two communication strategies to improve udder health management.

    PubMed

    Jansen, J; Renes, R J; Lam, T J G M

    2010-02-01

    Worldwide, programs to improve udder health are implemented using communication tools and methods that inform and persuade dairy farmers. This study evaluated 2 communication strategies used in a mastitis control program in the Netherlands. To improve farmers' udder health management, tools such as instruction cards, treatment plans, checklists and software were developed following an argument-based comprehensive "central route." These tools were used during on-farm study group meetings for farmers organized by veterinarians and also during individual veterinarian-farmer interactions. The second strategy aimed at adopting a single management practice to increase the use of milking gloves during milking. This approach followed a straightforward "peripheral" route that used implicit persuasion techniques. Results of an online survey of 374 Dutch dairy farmers showed that most farmers were able and willing to use the educational management tools to increase udder health on their farms. They evaluated the tools positively regardless of the mastitis problems on their farms. This seems to indicate that the central route of communication is most effective when farmers are motivated to work on udder health in general. Results of repeated random telephone surveys before, during, and after the campaign on the use of milking gloves showed that the use of gloves increased from 20.9 to 42.0% of the respondents. Respondents' opinions about milking gloves also changed favorably, indicating that a relatively short peripheral campaign on a single action can have a sustained effect on farmers' behavior. Both communication strategies seem to be potentially successful in disseminating knowledge to a specific target group of farmers and in changing that group's behavior. However, to reach as many farmers as possible, the strategies should be combined. When optimizing these strategies, both the farmers' motivation to work on udder health and the aim of the campaign should be considered

  16. Pain management strategies used by patients with breast and gynecologic cancer with postoperative pain.

    PubMed

    Kwekkeboom, K L

    2001-10-01

    Many people with cancer will experience pain when they are outside of structured care settings. Patients must provide their own self-care, drawing on instructions from healthcare providers and on independently developed plans for pain management. With growing interest in complementary therapies, the scope of nonpharmacologic interventions used by patients with cancer to manage pain may be very different than 10-15 years ago. The purpose of this study was to describe steps taken by patients with breast and gynecologic cancer to manage pain after discharge from a surgical hospitalization. A secondary analysis was completed using data from 34 women who participated in a randomized trial of guided imagery. Techniques used included positioning, distraction, relaxation, heat, and eating/drinking. Compared to results of previous studies, increased use of relaxation strategies (breathing, imagery, music, meditation) was noted in the current study. The majority of participants used nonpharmacologic strategies in addition to analgesic medications. Pain-related outcomes were similar among persons who used analgesic medications alone and those who used a combination of analgesics and nonpharmacologic strategies. Nurses may benefit from knowing which pain management strategies patients find helpful so that they can encourage their use and teach similar strategies to the patients who find them useful.

  17. Management of constipation in the elderly: emerging therapeutic strategies.

    PubMed

    Kapoor, Shailendra

    2008-09-07

    A number of new, novel strategies for managing constipation in the elderly have emerged over the past few years. Prucalopride is one such new agent that is highly efficacious in managing chronic constipation. In fact, Camilleri et al in a recent study reported that the average number of bowel movements increased by at least one in nearly 47% of the patients who were administered a dose of 4 mg. Lubiprostone is another new agent recently approved by the FDA that shows efficacy in managing the symptoms of constipation. Neostigmine has also been successfully used for the management of recalcitrant constipation. Most of these studies have used subcutaneous neostigmine. Symbiotic yogurt containing components, such as Bifidobacterium and fructoligosaccharide, have also been recently shown to be highly effective in improving symptoms of constipation. Elderly patients especially those in hospices and nursing homes are often on opioids for pain management. Constipation secondary to opioid use is extremely common in nursing homes. Subcutaneous methylnaltrexone has recently been shown to be highly effective in the management of opioid-related constipation, and was recently approved by the FDA. Sacral nerve stimulation is another emerging strategy. A recent analysis by Mowatt et al supports the efficacy of this technique. Botulinum toxin is another agent that has already been successfully used for the management of chronic, refractory constipation in children and may be very effective for elderly constipation. Further larger studies are needed to confirm the findings noted in these studies. Constipation is clearly a major issue in the elderly and these new, emerging strategies will hopefully improve the quality of life and relieve the symptoms of constipation in this population.

  18. Climate change adaptation strategies for resource management and conservation planning.

    PubMed

    Lawler, Joshua J

    2009-04-01

    Recent rapid changes in the Earth's climate have altered ecological systems around the globe. Global warming has been linked to changes in physiology, phenology, species distributions, interspecific interactions, and disturbance regimes. Projected future climate change will undoubtedly result in even more dramatic shifts in the states of many ecosystems. These shifts will provide one of the largest challenges to natural resource managers and conservation planners. Managing natural resources and ecosystems in the face of uncertain climate requires new approaches. Here, the many adaptation strategies that have been proposed for managing natural systems in a changing climate are reviewed. Most of the recommended approaches are general principles and many are tools that managers are already using. What is new is a turning toward a more agile management perspective. To address climate change, managers will need to act over different spatial and temporal scales. The focus of restoration will need to shift from historic species assemblages to potential future ecosystem services. Active adaptive management based on potential future climate impact scenarios will need to be a part of everyday operations. And triage will likely become a critical option. Although many concepts and tools for addressing climate change have been proposed, key pieces of information are still missing. To successfully manage for climate change, a better understanding will be needed of which species and systems will likely be most affected by climate change, how to preserve and enhance the evolutionary capacity of species, how to implement effective adaptive management in new systems, and perhaps most importantly, in which situations and systems will the general adaptation strategies that have been proposed work and how can they be effectively applied.

  19. [Current state of treatment strategies for atrial fibrillation].

    PubMed

    Rogge, C; Hilbert, S; Dagres, N; Hindricks, G

    2016-05-01

    Atrial fibrillation is the most common form of persistent cardiac arrhythmia with a greatly increasing prevalence due to an aging population and increasing cardiovascular risk factors. Apart from impairment of the quality of life atrial fibrillation is associated with a high morbidity, most importantly stroke and heart failure. The therapy is complex and aims at improving symptoms as well as the prevention of thromboembolic complications, heart failure and aggravating comorbidities. Based on individual patient characteristics and symptoms therapy is mainly based on heart rate control by pharmacological means or therapy for maintaining sinus rhythm. This treatment includes antiarrhythmic drugs and catheter ablation. Current research is aimed at the investigation of the electrophysiological mechanisms of recurrent therapy refractive atrial fibrillation and the question whether the maintenance of sinus rhythm can improve the prognosis of atrial fibrillation.

  20. [Current and future diagnostic strategies in venous thromboembolic disease].

    PubMed

    Gabriel Botella, F; Labiós Gómez, M; Brasó Aznar, J V; Llavador Ros, G; Bort Martí, J

    1999-08-01

    Thromboembolic disease (TD), which includes deep venous thrombosis (DVT) and pulmonary embolism (PE), is the most common acute cardiovascular condition after ischemic cardiopathy and stroke. It is often difficult to diagnose, as it is well-known that half of PE episodes appear are recognized while the patient is still alive and which appear in 30-40% of symptomatic patients. Nonetheless, there are two well-differentiated phases in the diagnosis of TD: the suspicion, and the diagnosis. The first is very important, and is within the competence of any physician. The second can be ratified when carrying out specific tests. We have developed successive steps in the two phases of diagnosis, we critically review the distinct parts currently implicated in the strategic diagnosis of TD. Finally, we analyze the new diagnostic techniques to substitute, possibly, angiography in many cases, and perhaps to include ventilation/perfusion (V/Q) pulmonary gammagraphy, once become generally available.

  1. Ebola virus outbreak, updates on current therapeutic strategies.

    PubMed

    Elshabrawy, Hatem A; Erickson, Timothy B; Prabhakar, Bellur S

    2015-07-01

    Filoviruses are enveloped negative-sense single-stranded RNA viruses, which include Ebola and Marburg viruses, known to cause hemorrhagic fever in humans with a case fatality of up to 90%. There have been several Ebola virus outbreaks since the first outbreak in the Democratic Republic of Congo in 1976 of which, the recent 2013-2015 epidemic in Guinea, Liberia, and Sierra Leone is the largest in recorded history. Within a few months of the start of the outbreak in December 2013, thousands of infected cases were reported with a significant number of deaths. As of March 2015, according to the Centers for Disease Control and Prevention, there have been nearly 25,000 suspected cases, with 15,000 confirmed by laboratory testing, and over 10,000 deaths. The large number of cases and the high mortality rate, combined with the lack of effective Food and Drug Administration-approved treatments, necessitate the development of potent and safe therapeutic measures to combat the current and future outbreaks. Since the beginning of the outbreak, there have been considerable efforts to develop and characterize protective measures including vaccines and antiviral small molecules, and some have proven effective in vitro and in animal models. Most recently, a cocktail of monoclonal antibodies has been shown to be highly effective in protecting non-human primates from Ebola virus infection. In this review, we will discuss what is known about the nature of the virus, phylogenetic classification, genomic organization and replication, disease transmission, and viral entry and highlight the current approaches and efforts, in the development of therapeutics, to control the outbreak.

  2. Harmonization of laboratory testing - Current achievements and future strategies.

    PubMed

    Tate, Jillian R; Johnson, Roger; Barth, Julian; Panteghini, Mauro

    2014-05-15

    Harmonization in laboratory testing is more far-reaching than merely analytical harmonization. It includes all aspects of the total testing process from the "pre-pre-analytical" phase through analysis to the "post-post-analytical" phase. Harmonizing the pre-analytical phase requires use of standardized operating procedures for correct test selection, sample collection and handling, while standardized test terminology, and units and traceability to ISO standard 17511 are required to ensure equivalency of measurement results. Use of harmonized reference intervals and decision limits for analytes where platforms share allowable bias requirements will reduce inaccurate clinical interpretation and unnecessary laboratory testing. In the post-analytical phase, harmonized procedures for the management of critical laboratory test results are required to improve service quality and ensure patient safety. Monitoring of the outcomes of harmonization activities is through surveillance by external quality assessment schemes that use commutable materials and auditing of the "pre-pre-analytical" and "post-post-analytical" phases. Successful implementation of harmonization in laboratory testing requires input by all stakeholders, including the clinical laboratory community, diagnostics industry, clinicians, professional societies, IT providers, consumer advocate groups and governmental bodies.

  3. The Effectiveness of Time Management Strategies Instruction on Students' Academic Time Management and Academic Self Efficacy

    ERIC Educational Resources Information Center

    Kader, Fathi Abdul Hamid Abdul; Eissa, Mourad Ali

    2015-01-01

    This study investigated the effect of using time management strategies instruction on improving first year learning disabled students' academic time management and academic self efficacy. A total of 60 students identified with LD participated. The sample was divided into two groups; experimental (n = 30 boys) and control (n = 30 boys). ANCOVA and…

  4. Prevalence, Diagnosis and Management of Pancreatic Cystic Neoplasms: Current Status and Future Directions

    PubMed Central

    Farrell, James J.

    2015-01-01

    Cystic neoplasms of the pancreas are found with increasing prevalence, especially in elderly asymptomatic individuals. Although the overall risk of malignancy is very low, the presence of these pancreatic cysts is associated with a large degree of anxiety and further medical investigation due to concerns about malignancy. This review discusses the different cystic neoplasms of the pancreas and reports diagnostic strategies based on clinical features and imaging data. Surgical and nonsurgical management of the most common cystic neoplasms, based on the recently revised Sendai guidelines, is also discussed, with special reference to intraductal papillary mucinous neoplasm (IPMN; particularly the branch duct variant), which is the lesion most frequently identified incidentally. IPMN pathology, its risk for development into pancreatic ductal adenocarcinoma, the pros and cons of current guidelines for management, and the potential role of endoscopic ultrasound in determining cancer risk are discussed. Finally, surgical treatment, strategies for surveillance of pancreatic cysts, and possible future directions are discussed. PMID:26343068

  5. Strategies for self-management of HIV-related anxiety.

    PubMed

    Kemppainen, J K; Eller, L S; Bunch, E; Hamilton, M J; Dole, P; Holzemer, W; Kirksey, K; Nicholas, P K; Corless, I B; Coleman, C; Nokes, K M; Reynolds, N; Sefcik, L; Wantland, D; Tsai, Y-F

    2006-08-01

    This study examines the frequency and effectiveness of commonly used strategies for self management of anxiety in an international sample of 502 participants from Norway (n=42, 8%), Taiwan (n=35, 7%), and the US (n=426, 85%). An activities checklist summarized into five categories of self-care behaviours including activities/thoughts, exercise, medications, complementary therapies, and substance use determined self-care behaviours. Ratings of frequency and effectiveness for each self-care activity were also included. Praying received the highest overall rating of effectiveness of any self-management strategies included in this study at 8.10 (scale 1 to 10), followed by meditation (7.37), exercising (7.32), using relaxation techniques (7.22), cooking (6.98), and walking (6.90). An analysis of effectiveness scores for each self-care strategy by country reflected a wide variation. The three most effective anxiety self-care strategies reported by participants from Norway included exercise (7.31), walking (6.96), and reading (6.44). Highest ratings of effectiveness by participants from Taiwan included talking with others with HIV (6.0), attending support groups (6.0), and exercising (6.0). US participants allocated highest ratings of effectiveness to complementary/alternative therapies, including praying (8.10), meditating (7.43), and using relaxation techniques (7.35). Regardless of the country, watching television and talking with family and friends were the two most frequently reported strategies. These strategies for self-management of HIV-related anxiety are important for clinicians to be aware of in the care of persons with HIV/AIDS.

  6. Systematic review of current and emerging strategies for reducing morbidity from malaria in sickle cell disease.

    PubMed

    Aneni, Ehimen C; Hamer, Davidson H; Gill, Christopher J

    2013-03-01

    Sickle cell disease (SCD) is a chronic debilitating disorder affecting erythrocytes, which is especially prevalent throughout Sub-Saharan Africa and among individuals of African descent. Because malaria is thought to be a significant cause of morbidity and mortality in patients with SCD, malaria chemoprophylaxis is often recommended for these patients. In SCD, malaria chemoprophylaxis reduces malaria parasite count, anaemia and the need for blood transfusion, and improves clinical outcomes. However, the effectiveness of malaria chemoprophylaxis in the setting of SCD is based on a few studies conducted prior to the emergence of widespread antimalarial drug resistance. Consequently, it is uncertain what the optimal strategy for managing patients with SCD in malarious areas should be. Despite the widespread use of hydroxyurea in non-malarious regions, little is known about its effect in malaria-endemic areas or on malaria-related outcomes. On the one hand, hydroxyurea upregulates intercellular cell adhesion molecule 1 (ICAM-1), the cell surface receptor for adhesion of Plasmodium falciparum-infected erythrocytes, and theoretically, it could enhance parasite replication. On the other hand, hydroxyurea increases levels of foetal haemoglobin, which is protective against malaria. We explore what is currently known about the interactions between SCD and malaria and review the published literature on the efficacy of malaria chemoprophylaxis in SCD. We also consider alternative strategies, including hydroxyurea, in the reduction of malaria-associated morbidity and mortality in patients with SCD.

  7. Overview of current surgical strategies for aortic disease in patients with Marfan syndrome.

    PubMed

    Miyahara, Shunsuke; Okita, Yutaka

    2016-09-01

    Marfan syndrome is a heritable, systemic disorder of the connective tissue with a high penetrance, named after Dr. Antoine Marfan. The most clinically important manifestations of this syndrome are cardiovascular pathologies which cause life-threatening events, such as acute aortic dissections, aortic rupture and regurgitation of the aortic valve or other artrioventricular valves leading to heart failure. These events play important roles in the life expectancy of patients with this disorder, especially prior to the development of effective surgical approaches for proximal ascending aortic disease. To prevent such catastrophic aortic events, a lower threshold has been recommended for prophylactic interventions on the aortic root. After prophylactic root replacement, disease in the aorta beyond the root and distal to the arch remains a cause for concern. Multiple surgeries are required throughout a patient's lifetime that can be problematic due to distal lesions complicated by dissection. Many controversies in surgical strategies remain, such as endovascular repair, to manage such complex cases. This review examines the trends in surgical strategies for the treatment of cardiovascular disease in patients with Marfan syndrome, and current perspectives in this field.

  8. Health Self-management Among Older Prisoners: Current Understandings and Directions for Policy, Practice, and Research.

    PubMed

    Ruggiano, Nicole; Lukic, Andreja; Blowers, Anita; Doerner, Jill

    The population of aging prisoners has increased significantly over the past several decades, resulting in concerns about the criminal justice system's ability to address the needs of prisoners and parolees with chronic health conditions. This is troubling, given the health disparities among incarcerated populations. Health self-management has become a strategy within the community-based health care industry to improve health services and outcomes while reducing health care costs for nonincarcerated individuals with chronic conditions. However, to date little research has focused on the practice or promotion of health self-management among current and former incarcerated populations. This article highlights current understandings about chronic health self-management among older prisoners and parolees, with an emphasis on the potential benefits and current challenges in promoting their health self-management practices. Finally, specific recommendations are made for promoting health self-management for these populations through social work practice, policy advocacy, and research to achieve goals in improving health outcomes and reducing healthcare costs.

  9. Identification and initial assessment of candidate BWR late-phase in-vessel accident management strategies

    SciTech Connect

    Hodge, S.A.

    1991-04-15

    Work sponsored by the United States Nuclear Regulatory Commission (USNRC) to identify and perform preliminary assessments of candidate BWR (boiling water reactor) in-vessel accident management strategies was completed at Oak Ridge National Laboratory (ORNL) during fiscal year 1990. Mitigative strategies for containment events have been the subject of a companion study at Brookhaven National Laboratory. The focus of this Oak Ridge effort was the development of new strategies for mitigation of the late phase events, that is, the events that would occur in-vessel after the onset of significant core damage. The work began with an investigation of the current status of BWR in-vessel accident management procedures and proceeded through a preliminary evaluation of several candidate new strategies. The steps leading to the identification of the candidate strategies are described. The four new candidate late-phase (in-vessel) accident mitigation strategies identified by this study and discussed in the report are: (1) keep the reactor vessel depressurized; (2) restore injection in a controlled manner; (3) inject boron if control blade damage has occurred; and (4) containment flooding to maintain core and structural debris in-vessel. Additional assessments of these strategies are proposed.

  10. Breast cancer pain management - A review of current & novel therapies

    PubMed Central

    Satija, Aanchal; Ahmed, Syed Mehmood; Gupta, Rahul; Ahmed, Arif; Rana, Shiv Pratap Singh; Singh, Suraj Pal; Mishra, Seema; Bhatnagar, Sushma

    2014-01-01

    Breast cancer is one of the most prevalent cancers amongst women in the world. Unfortunately, even after adequate treatment, some patients experience severe pain either due to disease progression or due to treatment related side effects. The persistent pain causes a negative physical and psychosocial impact on patients’ lives. Current rational pain management is patient-centred and requires a thorough psychological assessment. Usually adequate analgesia is achieved by adopting the WHO's three step analgesic ladder. As the disease progresses, the pain experienced by the patient also increases. This necessitates the administration of opioids and adjuvant analgesics to the breast cancer patients experiencing severe pain. However, opioid use is associated with intolerable side effects like constipation, nausea, vomiting, fear of dependence, and tolerance. Concomitant medications are required to combat these unacceptable side effects. Adjuvant analgesics need to be added to provide adequate and satisfactory analgesia. These factors worsen the psychological state of patients and deteriorate their quality of life. Hence, there is a need to develop therapeutic modalities to provide adequate analgesia with minimum side effects. This review article focuses on the current treatments available for cancer pain management, their limitations, and novel targets and non-pharmacological measures under investigation which have the potential to produce a radical change in pain management measures for the breast cancer patients. PMID:24718395

  11. Water management: Current and future challenges and research directions

    NASA Astrophysics Data System (ADS)

    Cosgrove, William J.; Loucks, Daniel P.

    2015-06-01

    Water distinguishes our planet compared to all the others we know about. While the global supply of available freshwater is more than adequate to meet all current and foreseeable water demands, its spatial and temporal distributions are not. There are many regions where our freshwater resources are inadequate to meet domestic, economic development and environmental needs. In such regions, the lack of adequate clean water to meet human drinking water and sanitation needs is indeed a constraint on human health and productivity and hence on economic development as well as on the maintenance of a clean environment and healthy ecosystems. All of us involved in research must find ways to remove these constraints. We face multiple challenges in doing that, especially given a changing and uncertain future climate, and a rapidly growing population that is driving increased social and economic development, globalization, and urbanization. How best to meet these challenges requires research in all aspects of water management. Since 1965, the journal Water Resources Research has played an important role in reporting and disseminating current research related to managing the quantity and quality and cost of this resource. This paper identifies the issues facing water managers today and future research needed to better inform those who strive to create a more sustainable and desirable future.

  12. Managing the Services Supply Chain in the Department of Defense: Empirical Study of the Current Management Practices in the Army

    DTIC Science & Technology

    2009-09-21

    Managing the Services Supply Chain in the Department of Defense: Empirical Study of the Current Management Practices in the Army 21 September...Managing the Services Supply Chain in the Department of Defense: Empirical Study of the Current Management Practices in the Army 5a. CONTRACT NUMBER 5b...Service Supply Chain , Services Acquisition, Service Lifecycle, Contract Management, Project Management, Program Management = = ^Åèìáëáíáçå=oÉëÉ~êÅÜ

  13. Mobile applications for obesity and weight management: current market characteristics.

    PubMed

    Nikolaou, C K; Lean, M E J

    2017-01-01

    Mobile-Health (mHealth) is the fastest-developing eHealth sector, with over 100 000 health applications (apps) currently available. Overweight/obesity is a problem of wide public concern that is potentially treatable/preventable through mHealth. This study describes the current weight-management app-market. Five app stores (Apple, Google, Amazon, Windows and Blackberry) in UK, US, Russia, Japan and Germany, Italy, France, China, Australia and Canada were searched for keywords: 'weight', 'calorie', 'weight-loss', 'slimming', 'diet', 'dietitian' and 'overweight' in January/February 2016 using App-Annie software. The 10 most downloaded apps in the lifetime of an app were recorded. Developers' lists and the app descriptions were searched to identify any professional input with keywords 'professional', 'dietitian' and 'nutritionist'. A total of 28 905 relevant apps were identified as follows: Apple iTunes=8559 (4634, 54% paid), Google Play=1762 (597, 33.9% paid), Amazon App=13569 (4821, 35.5% paid), Windows=2419 (819, 17% paid) and Blackberry=2596 (940, 36% paid). The 28 905 identified apps focused mainly on physical activity (34%), diet (31%), and recording/monitoring of exercise, calorie intake and body weight (23%). Only 17 apps (0.05%) were developed with identifiable professional input. Apps on weight management are widely available and very popular but currently lack professional content expertise. Encouraging app development based on evidence-based online approaches would assure content quality, allowing healthcare professionals to recommend their use.

  14. Improving nursing students' communication skills using crew resource management strategies.

    PubMed

    Aebersold, Michelle; Tschannen, Dana; Sculli, Gary

    2013-03-01

    To provide optimal patient care, all members of the health care team must effectively communicate patient status and the current plan of care. The Crew Resource Management (CRM) training system has been successfully used in the aviation industry to manage human error and reduce risk in the operational environment. CRM focuses on behaviors that support communication and teamwork and is modifiable to be used in nursing education. A version of CRM-nursing crew resource management-was implemented in a group of senior undergraduate nursing students. Students were satisfied with the program, and in a subsequent simulation they demonstrated the ability to use the communication techniques learned.

  15. Aircrew Discourse: Exploring Strategies of Information and Action Management

    NASA Technical Reports Server (NTRS)

    Irwin, Cheryl M.; Veinott, Elizabeth S.; Shafto, Michael G. (Technical Monitor)

    1995-01-01

    This paper explores methodology issues encountered in the analysis of flightcrew communications in aviation simulation research. Examples are provided by two recent studies which are compared on three issues: level of analysis, data definition, and interpretation of the results. The data discussed were collected in a study comparing two levels of aircraft automation. The first example is an investigation of how pilots' information transfer strategies differed as a function of automation during low and high-workload flight phases. The second study focuses on how crews managed actions in the two aircraft during a ten minute, high-workload flight segment. Results indicated that crews in the two aircraft differed in their strategies of information and action management. The differences are discussed in terms of their operational and research significance.

  16. Current concepts in the management of acute pancreatitis

    PubMed Central

    Srinivasan, Gautham; Venkatakrishnan, L.; Sambandam, Swaminathan; Singh, Gursharan; Kaur, Maninder; Janarthan, Krishnaveni; John, B. Joseph

    2016-01-01

    Guidelines for the management of acute pancreatitis (AP) are based on the Western experience, which may be difficult to extrapolate in India due to socioeconomic constraints. Hence, modifications based on the available resources and referral patterns should be introduced so as to ensure appropriate care. We reviewed the current literature on the management of AP available in English on Medline and proposed guidelines locally applicable. Patients of AP presenting with systemic inflammatory response syndrome are at risk of moderate-severe pancreatitis and hence, should be referred to a tertiary center early. The vast majority of patients with AP have mild disease and can be managed at smaller centers. Early aggressive fluid resuscitation with controlled fluid expansion, early enteral nutrition, and culture-directed antibiotics improve outcomes in AP. Infected pancreatic necrosis should be managed in a tertiary care hospital within a multidisciplinary setup. The “step up” approach involving antibiotics, percutaneous drainage, and minimally invasive necrosectomy instituted sequentially based on clinical response has improved the outcomes in this subgroup of patients. PMID:28348985

  17. Ewing Sarcoma: Current Management and Future Approaches Through Collaboration.

    PubMed

    Gaspar, Nathalie; Hawkins, Douglas S; Dirksen, Uta; Lewis, Ian J; Ferrari, Stefano; Le Deley, Marie-Cecile; Kovar, Heinrich; Grimer, Robert; Whelan, Jeremy; Claude, Line; Delattre, Olivier; Paulussen, Michael; Picci, Piero; Sundby Hall, Kirsten; van den Berg, Hendrik; Ladenstein, Ruth; Michon, Jean; Hjorth, Lars; Judson, Ian; Luksch, Roberto; Bernstein, Mark L; Marec-Bérard, Perrine; Brennan, Bernadette; Craft, Alan W; Womer, Richard B; Juergens, Heribert; Oberlin, Odile

    2015-09-20

    Ewing sarcoma (ES) is an aggressive sarcoma of bone and soft tissue occurring at any age with a peak incidence in adolescents and young adults. The treatment of ES relies on a multidisciplinary approach, coupling risk-adapted intensive neoadjuvant and adjuvant chemotherapies with surgery and/or radiotherapy for control of the primary site and possible metastatic disease. The optimization of ES multimodality therapeutic strategies has resulted from the efforts of several national and international groups in Europe and North America and from cooperation between pediatric and medical oncologists. Successive first-line trials addressed the efficacy of various cyclic combinations of drugs incorporating doxorubicin, vincristine, cyclophosphamide, ifosfamide, etoposide, and dactinomycin and identified prognostic factors now used to tailor therapies. The role of high-dose chemotherapy is still debated. Current 5-year overall survival for patients with localized disease is 65% to 75%. Patients with metastases have a 5-year overall survival < 30%, except for those with isolated pulmonary metastasis (approximately 50%). Patients with recurrence have a dismal prognosis. The many insights into the biology of the EWS-FLI1 protein in the initiation and progression of ES remain to be translated into novel therapeutic strategies. Current options and future approaches will be discussed.

  18. Burns: Pathophysiology of Systemic Complications and Current Management

    PubMed Central

    Nielson, Colton B.; Duethman, Nicholas C.; Howard, James M.; Moncure, Michael

    2017-01-01

    As a result of many years of research, the intricate cellular mechanisms of burn injury are slowly becoming clear. Yet, knowledge of these cellular mechanisms and a multitude of resulting studies have often failed to translate into improved clinical treatment for burn injuries. Perhaps the most valuable information to date is the years of clinical experience and observations in the management and treatment of patients, which has contributed to a gradual improvement in reported outcomes of mortality. This review provides a discussion of the cellular mechanisms and pathways involved in burn injury, resultant systemic effects on organ systems, current management and treatment, and potential therapies that we may see implemented in the future. PMID:27183443

  19. International Border Management Systems (IBMS) Program : visions and strategies.

    SciTech Connect

    McDaniel, Michael; Mohagheghi, Amir Hossein

    2011-02-01

    Sandia National Laboratories (SNL), International Border Management Systems (IBMS) Program is working to establish a long-term border security strategy with United States Central Command (CENTCOM). Efforts are being made to synthesize border security capabilities and technologies maintained at the Laboratories, and coordinate with subject matter expertise from both the New Mexico and California offices. The vision for SNL is to provide science and technology support for international projects and engagements on border security.

  20. Run-to-Run Control Strategy for Diabetes Management

    DTIC Science & Technology

    2007-11-02

    quite serious ( diabetic coma), and the long- term implications of varying glucose levels ( nephropathy , retinopathy, and other tissue damage ) have...Trial Re- search Group, \\The e ect of intensive treatment of diabetes on the development and progression of long{term complications in insulin{dependent...1 RUN-TO-RUN CONTROL STRATEGY FOR DIABETES MANAGEMENT F.J. Doyle III1, B. Srinivasan2, and D. Bonvin2 1Department of Chemical Engineering, University

  1. Current concepts in the diagnosis and management of left ventricular assist device infections.

    PubMed

    Nienaber, Juhsien; Wilhelm, Mark P; Sohail, M Rizwan

    2013-02-01

    Left ventricular assist devices (LVAD) are increasingly being used both as a bridge to transplantation and for long-term myocardial surrogate destination therapy in patients with end-stage heart failure. Primarily owing to the presence of a driveline that connects the device to an external battery through an open skin incision, the rates of LVAD-related infections (LVADRIs) are high, ranging from 30 to 50%. LVADRIs can be broadly classified into driveline infection, pump pocket infection, bloodstream infection and endocarditis/pump or cannula infection. Diagnostic evaluation and management of these complicated infections can be quite challenging for clinicians involved in the care of these patients. Here, the authors summarize the current epidemiology, microbiology, diagnostic approach and management strategies for each type of LVADRI. The authors also review current concepts regarding antibiotic prophylaxis for LVAD implantation. Finally, the authors highlight the gaps in the knowledge of LVADRI and provide directions for future studies.

  2. An environmental analysis for comparing waste management options and strategies.

    PubMed

    Marchettini, N; Ridolfi, R; Rustici, M

    2007-01-01

    The debate on different waste management practices has become an issue of utmost importance as human activities have overloaded the assimilative capacity of the biosphere. Recent Italian law on solid waste management recommends an increase in material recycling and energy recovery, and only foresees landfill disposal for inert materials and residues from recovery and recycling. A correct waste management policy should be based on the principles of sustainable development, according to which our refuse is not simply regarded as something to eliminate but rather as a potential resource. This requires the creation of an integrated waste management plan that makes full use of all available technologies. In this context, eMergy analysis is applied to evaluate three different forms of waste treatment and construct an approach capable of assessing the whole strategy of waste management. The evaluation included how much investment is needed for each type of waste management and how much "utility" is extracted from wastes, through the use of two indicators: Environmental yield ratio (EYR) and Net eMergy. Our results show that landfill is the worst system in terms of eMergy costs and eMergy benefits. Composting is the most efficient system in recovering eMergy (highest EYR) from municipal solid waste (MSW) while incineration is capable of saving the greatest quantity of eMergy per gram of MSW (highest net eMergy). This analysis has made it possible to assess the sustainability and the efficiency of individual options but could also be used to assess a greater environmental strategy for waste management, considering a system that might include landfills, incineration, composting, etc.

  3. Chronic pain management strategies used by low income overweight Latinos

    PubMed Central

    Rutledge, Dana N; Cantero, Patricia J; Ruiz, Jeanette E

    2013-01-01

    Objectives In group interviews, we examined strategies used to manage chronic pain from the perspective of the individual. Methods Sixteen low income overweight Latino adults participated in two group interviews facilitated by a trained moderator who inquired about the type of chronic pain suffered by participants, followed by more specific questions about pain management. Interviews were audio-recorded, transcribed verbatim (Spanish), back-translated into English, and analyzed using thematic analysis. Results Participants’ pain varied in type, location, and intensity. Participants discussed pain-related changes in activities and social life, and difficulties with health care providers, and as a result, we discovered five major themes: Pain-related Life Alterations, Enduring the Pain, Trying Different Strategies, Emotional Suffering, and Encounters with Health Care System/Providers. Discussion Findings indicated that there are opportunities for providers to improve care for low income overweight Latinos with chronic pain by listening respectfully to how pain alters their daily lives and assisting them in feasible self management strategies. PMID:23129787

  4. Delusional infestations: case series, differential diagnoses, and management strategies.

    PubMed

    Diaz, James H; Nesbitt, Lee T

    2014-01-01

    Physicians are not infrequently consulted by distraught patients with delusions of infestation who believe that they are infested with external or internal parasites and describe a crawling sensation of bugs or worms on or under their skin. Internet search engines were queried with the keywords as search terms to examine the latest articles on delusional infestations in order to describe presenting manifestations, differential diagnoses, and effective management strategies. The demographic and behavioral features of delusional infestations have remained constant and include: (1) onset in well-educated, middle-aged adults who are pet owners; (2) production of purported specimens of causative parasites; (3) pesticide overtreatment of themselves, their households, and pets; (4) excessive cleaning or vacuuming of households; (5) intense anger and resentment directed at physicians failing to confirm their self-diagnoses; and (6) sharing delusional symptoms with spouses or relatives. Although some reports have suggested that cases of delusional infestation are increasing today in the tropics, most studies have confirmed a stable incidence over time and similar disorder demographics worldwide. However, management strategies for delusional infestations have changed significantly over time with second generation, atypical antipsychotics offering safer adverse effect profiles and better prognoses than earlier therapies with first generation, typical antipsychotics. The most effective management strategies for delusional infestations include empathetic history-taking and active listening to the patient, careful exclusion of true parasitoses, and a therapeutic regimen that includes a second generation neuroleptic agent.

  5. Current techniques in the management of cervical myelopathy and radiculopathy.

    PubMed

    Gerard, Carter S; O'Toole, John E

    2014-04-01

    Posterior decompressive procedures are a fundamental component of the surgical treatment of symptomatic cervical degenerative disease. Posterior approaches have the appeal of avoiding complications associated with anterior approaches such as esophageal injury, recurrent laryngeal nerve paralysis, dysphagia, and adjacent-level disease after fusion. Although open procedures are effective, the extensive subperiosteal stripping of the paraspinal musculature leads to increased blood loss, longer hospital stays, and more postoperative pain, and potentially contributes to instability. Minimally invasive access has been developed to limit approach-related morbidity. This article reviews current techniques in minimally invasive surgical management of cervical myelopathy and radiculopathy.

  6. Management of knee osteoarthritis. Current status and future trends.

    PubMed

    Ondrésik, Marta; Azevedo Maia, Fatima R; da Silva Morais, Alain; Gertrudes, Ana C; Dias Bacelar, Ana H; Correia, Cristina; Gonçalves, Cristiana; Radhouani, Hajer; Amandi Sousa, Rui; Oliveira, Joaquim M; Reis, Rui L

    2017-04-01

    Osteoarthritis (OA) affects a large number of the population, and its incidence is showing a growing trend with the increasing life span. OA is the most prevalent joint condition worldwide, and currently, there is no functional cure for it. This review seeks to briefly overview the management of knee OA concerning standardized pharmaceutical and clinical approaches, as well as the new biotechnological horizons of OA treatment. The potential of biomaterials and state of the art of advanced therapeutic approaches, such as cell and gene therapy focused primarily on cartilage regeneration are the main subjects of this review. Biotechnol. Bioeng. 2017;114: 717-739. © 2016 Wiley Periodicals, Inc.

  7. Interactive effects of environmental change and management strategies on regional forest carbon emissions.

    PubMed

    Hudiburg, Tara W; Luyssaert, Sebastiaan; Thornton, Peter E; Law, Beverly E

    2013-11-19

    Climate mitigation activities in forests need to be quantified in terms of the long-term effects on forest carbon stocks, accumulation, and emissions. The impacts of future environmental change and bioenergy harvests on regional forest carbon storage have not been quantified. We conducted a comprehensive modeling study and life-cycle assessment of the impacts of projected changes in climate, CO2 concentration, and N deposition, and region-wide forest management policies on regional forest carbon fluxes. By 2100, if current management strategies continue, then the warming and CO2 fertilization effect in the given projections result in a 32-68% increase in net carbon uptake, overshadowing increased carbon emissions from projected increases in fire activity and other forest disturbance factors. To test the response to new harvesting strategies, repeated thinnings were applied in areas susceptible to fire to reduce mortality, and two clear-cut rotations were applied in productive forests to provide biomass for wood products and bioenergy. The management strategies examined here lead to long-term increased carbon emissions over current harvesting practices, although semiarid regions contribute little to the increase. The harvest rates were unsustainable. This comprehensive approach could serve as a foundation for regional place-based assessments of management effects on future carbon sequestration by forests in other locations.

  8. Regional economic analysis of current and proposed management alternatives for Rappahannock River Valley National Wildlife Refuge

    USGS Publications Warehouse

    Koontz, Lynne; Sexton, Natalie; Donovan, Ryan

    2009-01-01

    The National Wildlife Refuge System Improvement Act of 1997 requires all units of the National Wildlife Refuge System to be managed under a Comprehensive Conservation Plan. The Comprehensive Conservation Plan must describe the desired future conditions of a refuge and provide long-range guidance and management direction to achieve refuge purposes. The Rappahannock River Valley National Wildlife Refuge (refuge) is in the process of developing a range of management goals, objectives, and strategies for the Comprehensive Conservation Plan. The Comprehensive Conservation Plan for the refuge must contain an analysis of expected effects associated with current and proposed refuge management strategies. The purpose of this study was to assess the regional economic implications associated with draft Comprehensive Conservation Plan management strategies. Special interest groups and local residents often criticize a change in refuge management, especially if there is a perceived negative impact to the local economy. Having objective data on economic impacts may show that these fears are overstated. Quite often, the extent of economic benefits a refuge provides to a local community is not fully recognized, yet at the same time the effects of negative changes is overstated. Spending associated with refuge recreational activities, such as wildlife viewing and hunting, can generate considerable tourist activity for surrounding communities. Additionally, refuge personnel typically spend considerable amounts of money purchasing supplies in local stores, repairing equipment and purchasing fuel at the local service stations, and reside and spend their salaries in the local community. For refuge Comprehensive Conservation Plan planning, a regional economic assessment provides a means of estimating how current management (no action alternative) and proposed management activities (alternatives) could affect the local economy. This type of analysis provides two critical pieces of

  9. Current approach in diagnosis and management of anterior uveitis

    PubMed Central

    Agrawal, Rupesh V; Murthy, Somasheila; Sangwan, Virender; Biswas, Jyotirmay

    2010-01-01

    Uveitis is composed of a diverse group of disease entities, which in total has been estimated to cause approximately 10% of blindness. Uveitis is broadly classified into anterior, intermediate, posterior and panuveitis based on the anatomical involvement of the eye. Anterior uveitis is, however, the commonest form of uveitis with varying incidences reported in worldwide literature. Anterior uveitis can be very benign to present with but often can lead to severe morbidity if not treated appropriately. The present article will assist ophthalmologists in accurately diagnosing anterior uveitis, improving the quality of care rendered to patients with anterior uveitis, minimizing the adverse effects of anterior uveitis, developing a decision-making strategy for management of patients at risk of permanent visual loss from anterior uveitis, informing and educating patients and other healthcare practitioners about the visual complications, risk factors, and treatment options associated with anterior uveitis. PMID:20029142

  10. Building an information security strategy for EHR: guidelines for assessing the current situation.

    PubMed

    Mohammad, Yara; Stergioulas, Lampros

    2010-01-01

    This paper is looking at electronic health record (EHR) systems and their information security strategy. It focuses on the first step of building an information security strategy which is analysing the current situation of an EHR system. This research is based on different research methods applied to different EHR systems. In this paper we define eight elements that can be used as guidelines for how best to assess the current situation of any EHR system.

  11. Reversal agents for oral antiplatelet and anticoagulant treatment during bleeding events: current strategies.

    PubMed

    Raimondi, Peter; Hylek, Elaine M; Aronis, Konstantinos N

    2016-12-05

    There is an increasing prevalence of cardiovascular diseases that warrant antithrombotic therapy. Antithrombotic therapy includes antiplatelet agents and anticoagulation therapy with vitamin K antagonists (VKAs) or non-Vitamin K oral anticoagulants (NOACs). Antithrombotic therapy is associated with increased rates of bleeding. In this review we summarize the evidence and provide strategies for the management of severe bleeding in the setting of antithrombotic therapy. There is limited data on the management of bleeding in the setting of antiplatelet therapy. We recommend discontinuation of the antiplatelet, as well as administration of platelet transfusions and desmopressin only in the setting of life-threatening bleeding. For patients presenting with severe bleeding in the setting of VKAs, we recommend discontinuation of VKA and prompt administration of 10 mg intravenous vitamin K plus 50 units/kg 4-factor prothrombin complex concentrate (PCC). If 4-factor PCC is not available 3-factor PCC or fresh frozen plasma (FFP) can be used, but these are inferior to 4-factor PCC. For patients presenting with severe bleeding while on dabigatran, we recommend discontinuation of dabigatran and intravenous administration of 5g idarucizumab. There is currently no available reversal agent for factor Xa inhibitors. Andexanet alpha is a factor Xa-specific inhibitor that is currently undergoing FDA review. Until andexanet alpha becomes available we recommend discontinuation of the factor Xa inhibitor and administration of 50 units/kg 4-factor PCC. The decision to discontinue and/or reverse antithrombotic therapy should be made on a case-by-case basis and the competing risk from discontinuation and/or reversal of antithrombotic therapy should be taken in consideration.

  12. User Reaction to Current Contents: Behavioral, Social, and Management Sciences*

    PubMed Central

    Matheson, Nina W.

    1971-01-01

    The Missouri Institute of Psychiatry Library Current Contents Service offers free dissemination of ISI's Current Contents: Behavioral, Social and Management Sciences to 144 mental health professionals employed at twelve locations in the Missouri Division of Mental Health system. The service includes free document delivery of up to 100 articles per subscription. Sixty percent of the participants in the project are sharing copies of CCBSMS with their colleagues. Operation of the service is described, and data on degree of use are analyzed by user professional orientation and hospital location. The most frequently cited journal titles are compared to lists of heavily used titles derived from other sources. These lists of titles are offered as empirical guides to frequently consulted behavioral science journals. After six months experience participants appear to be highly satisfied. Ninetytwo percent responding to an evaluative questionnaire want to continue the service another year. PMID:5582098

  13. Managing temptation in obesity treatment: a neurobehavioral model of intervention strategies

    PubMed Central

    Appelhans, Bradley M; French, Simone A; Pagoto, Sherry L; Sherwood, Nancy E

    2015-01-01

    Weight loss outcomes in lifestyle interventions for obesity are primarily a function of sustained adherence to a reduced-energy diet, and most lapses in diet adherence are precipitated by temptation from palatable food. The high nonresponse and relapse rates of lifestyle interventions suggest that current temptation management approaches may be insufficient for most participants. In this conceptual review, we discuss three neurobehavioral processes (attentional bias, temporal discounting, and the cold-hot empathy gap) that emerge during temptation and contribute to lapses in diet adherence. Characterizing the neurobehavioral profile of temptation highlights an important distinction between temptation resistance strategies aimed at overcoming temptation while it is experienced, and temptation prevention strategies that seek to avoid or minimize exposure to tempting stimuli. Many temptation resistance and temptation prevention strategies heavily rely on executive functions mediated by prefrontal systems that are prone to disruption by common occurrences such as stress, insufficient sleep, and even exposure to tempting stimuli. In contrast, commitment strategies are a set of devices that enable individuals to manage temptation by constraining their future choices, without placing heavy demands on executive functions. These concepts are synthesized in a conceptual model that categorizes temptation management approaches based on their intended effects on reward processing and degree of reliance on executive functions. We conclude by discussing the implications of our model for strengthening temptation management approaches in future lifestyle interventions, tailoring these approaches based on key individual difference variables, and suggesting high-priority topics for future research. PMID:26431681

  14. Multidisciplinary strategies in the management of early chronic kidney disease.

    PubMed

    Martínez-Ramírez, Héctor R; Cortés-Sanabria, Laura; Rojas-Campos, Enrique; Hernández-Herrera, Aurora; Cueto-Manzano, Alfonso M

    2013-11-01

    Chronic kidney disease (CKD) is a worldwide epidemic especially in developing countries, with clear deficiencies in identification and treatment. Better care of CKD requires more than only economic resources, utilization of health research in policy-making and health systems changes that produce better outcomes. A multidisciplinary approach may facilitate and improve management of patients from early CKD in the primary health-care setting. This approach is a strategy for improving comprehensive care, initiating and maintaining healthy behaviors, promoting teamwork, eliminating barriers to achieve goals and improving the processes of care. A multidisciplinary intervention may include educational processes guided by health professional, use of self-help groups and the development of a CKD management plan. The complex and fragmented care management of patients with CKD, associated with poor outcome, enhances the importance of implementing a multidisciplinary approach in the management of this disease from the early stages. Multidisciplinary strategies should focus on the needs of patients (to increase their empowerment) and should be adapted to the resources and health systems prevailing in each country; its systematic implementation can help to improve patient care and slow the progression of CKD.

  15. Profiles of classroom behavior in high schools: associations with teacher behavior management strategies and classroom composition.

    PubMed

    Pas, Elise T; Cash, Anne H; O'Brennan, Lindsey; Debnam, Katrina J; Bradshaw, Catherine P

    2015-04-01

    Although there has been considerable attention to the issue of classroom management and processes in educational reform models, there has been relatively limited research on these factors in high schools. The current study utilized observational data from 1262 classrooms in 52 high schools to examine teacher classroom management strategies and ratings of student compliance, engagement, and social disruption. Latent profile analysis (LPA) was conducted to examine specific patterns of classroom-wide student behavior in relation to teachers' use of classroom management strategies and classroom composition. The LPA revealed three distinct classroom behavioral profiles where students consistently met behavioral expectations (71%), inconsistently met expectations (23%), and were noncompliant (6%). Analyses indicated a functional association between patterns of student behavior and teachers' classroom management. In classrooms where students consistently met expectations, teachers provided more opportunities to respond and less disapproval and reactive behavioral management. Classrooms with noncompliant students had teachers who used the most disapproval and reactive behavior management. In addition, classrooms characterized as consistent had fewer males and more White students than classrooms characterized by inconsistent and noncompliant behaviors. These findings highlight the link between student patterns of behavior and teacher classroom management and have important implications for screening and professional development.

  16. Strategy Guideline: Quality Management in Existing Homes; Cantilever Floor Example

    SciTech Connect

    Taggart, J.; Sikora, J.; Wiehagen, J.; Wood, A.

    2011-12-01

    This guideline is designed to highlight the QA process that can be applied to any residential building retrofit activity. The cantilevered floor retrofit detailed in this guideline is included only to provide an actual retrofit example to better illustrate the QA activities being presented. The goal of existing home high performing remodeling quality management systems (HPR-QMS) is to establish practices and processes that can be used throughout any remodeling project. The research presented in this document provides a comparison of a selected retrofit activity as typically done versus that same retrofit activity approached from an integrated high performance remodeling and quality management perspective. It highlights some key quality management tools and approaches that can be adopted incrementally by a high performance remodeler for this or any high performance retrofit. This example is intended as a template and establishes a methodology that can be used to develop a portfolio of high performance remodeling strategies.

  17. The Role of Individual Differences and Situational Variables in the Use of Workplace Sexual Identity Management Strategies.

    PubMed

    Reed, Louren; Leuty, Melanie E

    2016-07-01

    Examination of individual difference variables have been largely ignored within research on the use of workplace sexual identity management strategies. The current study examined personality traits (extraversion, openness, and neuroticism), facets of sexual identity development (identity confusion, internalized heterosexism), and situational variables (e.g., perceptions of workplace climate and heterosexism) in explaining the use of management strategies, as well as possible interactions between individual and situational factors. Perceptions of the workplace climate toward lesbian and gay individuals significantly related to the use each of the management strategies, and Internalized Heterosexism was found to significantly predict the use of the Explicitly Out strategy. Most interactions between individual difference and situational variables were not supported, with the exception of an interaction between workplace heterosexism and internalized homophobia in explaining the use of the Explicitly Out strategy.

  18. Excellence in supply chain management--trends and strategies to enhance profitability. Panel discussion.

    PubMed

    Gerhart, Bobbie; Baskel, Chris; Van Drasek, Jim; Downing, Scott

    2004-12-13

    Supply-chain management--the art of getting the most at the least cost from the products and services purchased by an organization--has transformed industries such as manufacturing and retailing, and can potentially do the same for healthcare. VHA is committed to keeping its members educated on current thinking and best practices in supply-chain management. In support of that mission, four supply chain experts gathered in Chicago recently at Modern Healthcare's offices to discuss the issues they face in their organizations and the strategies they've found most successful in addressing them.

  19. Urethral recurrence after cystectomy: current preventative measures, diagnosis and management.

    PubMed

    Chan, Yvonne; Fisher, Patrick; Tilki, Derya; Evans, Christopher P

    2016-04-01

    To summarise the current literature on the diagnosis and management of urethral recurrence (UR) after radical cystectomy (RC), as UR after RC is rare but associated with high mortality. With the recently increased use of orthotopic bladder substitution and the questionable benefit of prophylactic urethrectomy, identification of patients at high risk of UR, management of the remnant urethra, and treatment of UR become critical questions. A review of the PubMed database from 1980 to 2014 was performed to identify studies evaluating recurrent urothelial cancer of the urethra after RC. The search terms used included 'urethral recurrence', 'cystectomy' or 'cystoprostatectomy'. Selected studies provided information on the type of urinary diversion performed, the incidence of UR, and the time to UR. Incidence of UR after RC ranges from 1% to 8% with most recurrences occurring within the first 2 years after surgery. Increased risk of UR is associated with involvement of the prostate, tumour multifocality, bladder neck involvement, and cutaneous diversion. The median overall survival after UR ranges from 6 to 54 months and the 5-year disease-specific survival after UR is reported to be between zero and 83%. UR remains a relatively rare event. Current literature suggests that urethral wash cytology may be useful in patients with intermediate- to high-risk of recurrence to enable early detection of non-invasive disease, which may be amenable to conservative therapy before urethrectomy.

  20. Assessment of soil sealing management responses, strategies, and targets toward ecologically sustainable urban land use management.

    PubMed

    Artmann, Martina

    2014-05-01

    Soil sealing has negative impacts on ecosystem services since urban green and soil get lost. Although there is political commitment to stop further sealing, no reversal of this trend can be observed in Europe. This paper raises the questions (1) which strategies can be regarded as being efficient toward ecologically sustainable management of urban soil sealing and (2) who has competences and should take responsibility to steer soil sealing? The analyses are conducted in Germany. The assessment of strategies is carried out using indicators as part of a content analysis. Legal-planning, informal-planning, economic-fiscal, co-operative, and informational strategies are analyzed. Results show that there is a sufficient basis of strategies to secure urban ecosystem services by protecting urban green and reducing urban gray where microclimate regulation is a main target. However, soil sealing management lacks a spatial strategically overview as well as the consideration of services provided by fertile soils.

  1. The current role of thiazolidinediones in diabetes management.

    PubMed

    Rizos, Christos V; Kei, Anastazia; Elisaf, Moses S

    2016-08-01

    Among the epidemics of modern time, type 2 diabetes mellitus (T2DM) is one of the main contributors to overall morbidity as well as mortality. A number of different treatment options are available for the management of diabetes. Among them thiazolidinediones (TZDs) is an interesting drug class since it does not target the result of T2DM, i.e., hyperglycemia but rather some of the core mechanisms of the disease. Indeed, glitazones increase insulin sensitivity by activating the peroxisome proliferator-activated receptor γ, which plays an important role in regulating various metabolic parameters. Although TZDs have an established efficacy in T2DM treatment, their usage during the past years was questioned following the emergence of some alarming data regarding their safety and especially the cardiovascular safety of rosiglitazone. As a result, there is often some skepticism about the current role of TZDs in T2DM management. This mainly affects rosiglitazone even leading to its withdrawal from several markets in contrast to pioglitazone, which has shown a beneficial cardiovascular profile. A comprehensive assessment of the benefit-to-risk ratio of TZDs is required in order to better understand the place of these drugs in T2DM management.

  2. Current therapeutic strategies for advanced pancreatic cancer: A review for clinicians

    PubMed Central

    Spadi, Rosella; Brusa, Federica; Ponzetti, Agostino; Chiappino, Isabella; Birocco, Nadia; Ciuffreda, Libero; Satolli, Maria Antonietta

    2016-01-01

    Pancreatic cancer (PC) would become the second leading cause of cancer death in the near future, despite representing only 3% of new cancer diagnosis. Survival improvement will come from a better knowledge of risk factors, earlier diagnosis, better integration of locoregional and systemic therapies, as well as the development of more efficacious drugs rising from a deeper understanding of disease biology. For patients with unresectable, non-metastatic disease, combined strategies encompassing primary chemotherapy and radiation seems to be promising. In fit patients, new polychemotherapy regimens can lead to better outcomes in terms of slight but significant survival improvement associated with a positive impact on quality of life. The upfront use of these regimes can also increase the rate of radical resections in borderline resectable and locally advanced PC. Second line treatments showed to positively affect both overall survival and quality of life in fit patients affected by metastatic disease. At present, oxaliplatin-based regimens are the most extensively studied. Nonetheless, other promising drugs are currently under evaluation. Presently, in addition to surgery and conventional radiation therapy, new locoregional treatment techniques are emerging as alternative options in the multimodal approach to patients or diseases not suitable for radical surgery. As of today, in contrast with other types of cancer, targeted therapies failed to show relevant activity either alone or in combination with chemotherapy and, thus, current clinical practice does not include them. Up to now, despite the fact of extremely promising results in different tumors, also immunotherapy is not in the actual therapeutic armamentarium for PC. In the present paper, we provide a comprehensive review of the current state of the art of clinical practice and research in PC aiming to offer a guide for clinicians on the most relevant topics in the management of this disease. PMID:26862489

  3. Current situation of endoscopic biliary cannulation and salvage techniques for difficult cases: Current strategies in Japan.

    PubMed

    Yasuda, Ichiro; Isayama, Hiroyuki; Bhatia, Vikram

    2016-04-01

    In the pancreatobiliary session at Endoscopic Forum Japan (EFJ) 2015, current trends of routine biliary cannulation techniques and salvage techniques for difficult biliary cannulation cases were discussed. Endoscopists from nine Japanese high-volume centers along with two overseas centers participated in the questionnaires and discussion. It was concluded that, currently, in Western countries, the wire-guided cannulation (WGC) technique is favored during initial cannulation attempts. However, the conventional technique using an endoscopic retrograde cholangiopancreatography catheter with contrast medium injection is still used as first choice at most Japanese high-volume centers. The WGC technique is used as the second choice at some institutions only. After failed biliary cannulation attempts, the initial salvage option preferred in most centers includes pancreatic guidewire placement, followed by precut techniques as the second salvage choice. Among several precut techniques, the free-hand needle knife sphincterotomy with cutting upwards from the pancreatic duct is most popular. Endoscopic ultrasonography-guided rendezvous technique is also carried out as a final salvage option at select institutions.

  4. Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss

    PubMed Central

    Ramhamadany, Eamon; Modi, Chetan S

    2016-01-01

    The management of recurrent anterior gleno-humeral joint instability is challenging in the presence of bone loss. It is often seen in young athletic patients and dislocations related to epileptic seizures and may involve glenoid bone deficiency, humeral bone deficiency or combined bipolar lesions. It is critical to accurately identify and assess the amount and position of bone loss in order to select the most appropriate treatment and reduce the risk of recurrent instability after surgery. The current literature suggests that coracoid and iliac crest bone block transfers are reliable for treating glenoid defects. The treatment of humeral defects is more controversial, however, although good early results have been reported after arthroscopic Remplissage for small defects. Larger humeral defects may require complex reconstruction or partial resurfacing. There is currently very limited evidence to support treatment strategies when dealing with bipolar lesions. The aim of this review is to summarise the current evidence regarding the best imaging modalities and treatment strategies in managing this complex problem relating particularly to contact athletes and dislocations related to epileptic seizures. PMID:27335809

  5. Comparing the refuge strategy for managing the evolution of insect resistance under different reproductive strategies.

    PubMed

    Crowder, David W; Carrière, Yves

    2009-12-07

    Genetically modified (GM) crops are used extensively worldwide to control diploid agricultural insect pests that reproduce sexually. However, future GM crops will likely soon target haplodiploid and parthenogenetic insects. As rapid pest adaptation could compromise these novel crops, strategies to manage resistance in haplodiploid and parthenogenetic pests are urgently needed. Here, we developed models to characterize factors that could delay or prevent the evolution of resistance to GM crops in diploid, haplodiploid, and parthenogenetic insect pests. The standard strategy for managing resistance in diploid pests relies on refuges of non-GM host plants and GM crops that produce high toxin concentrations. Although the tenets of the standard refuge strategy apply to all pests, this strategy does not greatly delay the evolution of resistance in haplodiploid or parthenogenetic pests. Two additional factors are needed to effectively delay or prevent the evolution of resistance in such pests, large recessive or smaller non-recessive fitness costs must reduce the fitness of resistance individuals in refuges (and ideally also on GM crops), and resistant individuals must have lower fitness on GM compared to non-GM crops (incomplete resistance). Recent research indicates that the magnitude and dominance of fitness costs could be increased by using specific host-plants, natural enemies, or pathogens. Furthermore, incomplete resistance could be enhanced by engineering desirable traits into novel GM crops. Thus, the sustainability of GM crops that target haplodiploid or parthenogenetic pests will require careful consideration of the effects of reproductive mode, fitness costs, and incomplete resistance.

  6. Evaluation and Management of Hepatic Encephalopathy: Current Status and Future Directions.

    PubMed

    Suraweera, Duminda; Sundaram, Vinay; Saab, Sammy

    2016-07-15

    Hepatic encephalopathy is a spectrum of neurocognitive manifestations often seen in patients with liver injury or rarely in patients with portosystemic shunting without liver injury. It can be divided into minimal (covert) hepatic encephalopathy and overt hepatic encephalopathy, depending on the severity. Patients with hepatic encephalopathy have compromised clinical outcomes, decreased quality of life, and increased healthcare utilization, often resulting in a heavy financial and personal burden on caregivers. The diagnosis remains largely clinical, with the exclusion of possible other causes for the altered mental status. Current treatment strategies include nonabsorbable disaccharides and antibiotics. This review will focus on the diagnosis, management and clinical impact of hepatic encephalopathy.

  7. Evaluation and Management of Hepatic Encephalopathy: Current Status and Future Directions

    PubMed Central

    Suraweera, Duminda; Sundaram, Vinay; Saab, Sammy

    2016-01-01

    Hepatic encephalopathy is a spectrum of neurocognitive manifestations often seen in patients with liver injury or rarely in patients with portosystemic shunting without liver injury. It can be divided into minimal (covert) hepatic encephalopathy and overt hepatic encephalopathy, depending on the severity. Patients with hepatic encephalopathy have compromised clinical outcomes, decreased quality of life, and increased healthcare utilization, often resulting in a heavy financial and personal burden on caregivers. The diagnosis remains largely clinical, with the exclusion of possible other causes for the altered mental status. Current treatment strategies include nonabsorbable disaccharides and antibiotics. This review will focus on the diagnosis, management and clinical impact of hepatic encephalopathy. PMID:27377741

  8. Current knowledge of hagfish reproduction: implications for fisheries management.

    PubMed

    Powell, Mickie L; Kavanaugh, Scott I; Sower, Stacia A

    2005-01-01

    This review briefly summarizes the latest findings on reproductive endocrinology of Atlantic hagfish (Myxine glutinosa) and implications for fisheries management. In response to a major decline or collapse of the fisheries (groundfish and anadromous species) industry in the Northeast, species that were once considered alternative or underutilized have and are being identified that may be suitable for commercial harvest, one such example is the hagfish. Hagfish in recent years have been sought after as valuable fish not only for their flesh, but also their skin. Currently, there are no regulations governing the harvesting of hagfish along the East Coast. There has been little to no information of the life history of hagfish including growth rate, age determination, reproductive biology, life span, and larval size at hatching. Thus, the level at which a sustainable fisheries for this species can be maintained is unknown. In some parts of the world, hagfish stocks are being depleted due to overfishing. In order for fisheries management to manage its hagfish stocks and develop a sustainable commercial hagfish fishery, critical information is needed to assist in determining the optimal use of this valuable resource.Key elements of the reproductive system have not been elucidated in hagfish. However, there is new evidence from recent reproductive studies that Atlantic hagfish may have a seasonal reproductive cycle. These data include seasonal changes in gonadotropin-releasing hormone (GnRH), gonadal steroids, estradiol and progesterone, corresponding to gonadal reproductive stages along with the putative identity of a functional corpus luteum. This newly acquired data may provide important information to fisheries managers of the East Coast.

  9. Assertive Classroom Management Strategies and Students' Performance: The Case of EFL Classroom

    ERIC Educational Resources Information Center

    Aliakbari, Mohammad; Bozorgmanesh, Bafrin

    2015-01-01

    Ample research findings support the effective role that classroom management strategies play in enhancing students' learning. Drawing upon Iranian high school teachers' classroom management strategies, this article is intended to examine the extent to which these teachers follow assertive classroom management strategies and if these strategies…

  10. Linguistic Gender Sensitivity Strategies in Current South African Intermediate Phase English Workbooks: Feminisation or Degenderisation?

    ERIC Educational Resources Information Center

    Sibanda, Jabulani; Sibanda, Lucy

    2016-01-01

    This study extends research on manifestations of gender insensitivity in learners' reading materials by shifting attention to the linguistic strategies that authors of current texts employ for the realisation of gender sensitivity. We analysed the content of 12 current (2014) English workbooks (Grade 4-6) used in South African government and…

  11. A strategy for monitoring and managing declines in an amphibian community.

    PubMed

    Grant, Evan H Campbell; Zipkin, Elise F; Nichols, James D; Campbell, J Patrick

    2013-12-01

    Although many taxa have declined globally, conservation actions are inherently local. Ecosystems degrade even in protected areas, and maintaining natural systems in a desired condition may require active management. Implementing management decisions under uncertainty requires a logical and transparent process to identify objectives, develop management actions, formulate system models to link actions with objectives, monitor to reduce uncertainty and identify system state (i.e., resource condition), and determine an optimal management strategy. We applied one such structured decision-making approach that incorporates these critical elements to inform management of amphibian populations in a protected area managed by the U.S. National Park Service. Climate change is expected to affect amphibian occupancy of wetlands and to increase uncertainty in management decision making. We used the tools of structured decision making to identify short-term management solutions that incorporate our current understanding of the effect of climate change on amphibians, emphasizing how management can be undertaken even with incomplete information. Estrategia para Monitorear y Manejar Disminuciones en una Comunidad de Anfibios.

  12. A Climate Change Adaptation Strategy for Management of ...

    EPA Pesticide Factsheets

    Sea level rise is causing shoreline erosion, increased coastal flooding, and marsh vulnerability to the impact of storms. Coastal marshes provide flood abatement, carbon and nutrient sequestration, water quality maintenance, and habitat for fish, shellfish, and wildlife, including species of concern, such as the saltmarsh sparrow (Ammodramus caudacutus). We present a climate change adaptation strategy (CCAS) adopted by scientific, management, and policy stakeholders for managing coastal marshes and enhancing system resiliency. A common adaptive management approach previously used for restoration projects was modified to identify climate-related vulnerabilities and plan climate change adaptive actions. As an example of implementation of the CCAS, we describe the stakeholder plans and management actions the US Fish and Wildlife Service and partners developed to build coastal resiliency in the Narrow River Estuary, RI, in the aftermath of Superstorm Sandy. When possible, an experimental BACI (before-after, control-impact) design, described as pre- and post-sampling at the impact site and one or more control sites, was incorporated into the climate change adaptation and implementation plans. Specific climate change adaptive actions and monitoring plans are described and include shoreline stabilization, restoring marsh drainage, increasing marsh elevation, and enabling upland marsh migration. The CCAS provides a framework and methodology for successfully managing coa

  13. Building Research Relationships With Managed Care Organizations: Issues and Strategies

    PubMed Central

    LEIN, CATHERINE; COLLINS, CLARE; LYLES, JUDITH S.; HILLMAN, DONALD; SMITH, ROBERT C.

    2006-01-01

    Managed care is now the dominant form of healthcare in the United States. The need for clinical research about the organization, delivery, and outcomes of primary care services in managed care models is high, yet access to managed care organizations as sites for clinical research may be problematic. The purpose of this article is to describe issues involved in obtaining access to managed care settings for clinical research and practical strategies for successful collaboration using literature review and case description. Three steps for developing collaborative relationships with managed care organizations (MCOs) are presented: 1) assessment of organizational structure, history, and culture; 2) finding common ground; and 3) project implementation. These steps are discussed within the context of MCO systems issues and a relationship-centered approach to communication between researchers and individuals from the MCO. Successful relationships with MCOs for clinical research are possible when careful attention is paid to inclusion of MCOs as collaborators in the development of the research questions and design, and as partners in the research implementation process. PMID:17203136

  14. Do continence management strategies reduce falls? a systematic review.

    PubMed

    Batchelor, Frances A; Dow, Briony; Low, May-Ann

    2013-12-01

    Urinary incontinence is associated with increased fall risk, and fall prevention programs include recommendations to manage continence as one component of fall reduction. However, the evidence to support this recommendation is unclear. The aim of this study was to identify continence management interventions that are effective in decreasing falls. A systematic review of the literature was conducted. Studies were included if they evaluated the effect of any type of continence management strategy on falls in older adults. The included studies were assessed for quality, and data relating to participants, interventions and outcomes were extracted by two independent reviewers. Four articles met the inclusion criteria. Two studies were randomised controlled trials, one a retrospective cohort study and one an uncontrolled intervention study. Interventions included pharmacological agents, a toileting regime combined with physical activity and an individualised continence program. Only the study evaluating the combination of physical activity and prompted voiding found an effect on falls. It is surprising that there has been so little research into continence management interventions that include fall outcomes. A toileting regime combined with physical activity may reduce falls in residential care. There is a need for further studies investigating the impact of continence management on falls.

  15. Optimal management strategies in variable environments: Stochastic optimal control methods

    USGS Publications Warehouse

    Williams, B.K.

    1985-01-01

    Dynamic optimization was used to investigate the optimal defoliation of salt desert shrubs in north-western Utah. Management was formulated in the context of optimal stochastic control theory, with objective functions composed of discounted or time-averaged biomass yields. Climatic variability and community patterns of salt desert shrublands make the application of stochastic optimal control both feasible and necessary. A primary production model was used to simulate shrub responses and harvest yields under a variety of climatic regimes and defoliation patterns. The simulation results then were used in an optimization model to determine optimal defoliation strategies. The latter model encodes an algorithm for finite state, finite action, infinite discrete time horizon Markov decision processes. Three questions were addressed: (i) What effect do changes in weather patterns have on optimal management strategies? (ii) What effect does the discounting of future returns have? (iii) How do the optimal strategies perform relative to certain fixed defoliation strategies? An analysis was performed for the three shrub species, winterfat (Ceratoides lanata), shadscale (Atriplex confertifolia) and big sagebrush (Artemisia tridentata). In general, the results indicate substantial differences among species in optimal control strategies, which are associated with differences in physiological and morphological characteristics. Optimal policies for big sagebrush varied less with variation in climate, reserve levels and discount rates than did either shadscale or winterfat. This was attributed primarily to the overwintering of photosynthetically active tissue and to metabolic activity early in the growing season. Optimal defoliation of shadscale and winterfat generally was more responsive to differences in plant vigor and climate, reflecting the sensitivity of these species to utilization and replenishment of carbohydrate reserves. Similarities could be seen in the influence of both

  16. Management strategies for persistent epithelial defects of the cornea

    PubMed Central

    Katzman, Lee R.; Jeng, Bennie H.

    2014-01-01

    Management of patients with persistent epithelial defects of the cornea can be challenging to even the seasoned ophthalmologist. It is essential that one understands not only the pathophysiology of the failure of the epithelium to migrate and close a wound appropriately, but also the mechanism of action of the available treatment modalities at one’s disposal. This article serves as a review of current standard therapies, recently introduced alternative therapies gaining in popularity, and a look into the newest developments that may change the way we manage corneal surface disease. PMID:25278792

  17. Postoperative dressing and management strategies for transtibial amputations: a critical review.

    PubMed

    Smith, Douglas G; McFarland, Lynne V; Sangeorzan, Bruce J; Reiber, Gayle E; Czerniecki, Joseph M

    2003-01-01

    Postamputation management is an important determinant of recovery from amputation. However, consensus on the most effective postoperative management strategies for individuals undergoing transtibial amputation (TTA) is lacking. Dressings can include simple soft gauze dressings, thigh-high rigid cast dressings, shorter removable rigid dressings, and prefabricated pneumatic dressings. Postoperative prosthetic attachments can be added to all but simple soft dressings. These dressings address the need to cleanly cover a fresh surgical wound, but not all postoperative dressings are designed to facilitate the strategic goals of preventing knee contractures, reducing edema, protecting from external trauma, or facilitating early weight bearing. The type of dressing and management strategy often overlap and are certainly interrelated. Current protocols and decisions are based on local practice, skill, and intuition. The current available literature is challenging, and difficulties include variations in healing potential, in comorbidity, in surgical-level selection, in techniques and skill, in experience with postoperative strategies, and with poorly defined outcome criteria. This paper reviews the published literature and compares measures of safety, efficacy, and clinical outcomes of the various techniques. Analysis of 10 controlled studies supported only 4 of the 14 claims cited in uncontrolled, descriptive studies.

  18. Paradigm Shift in the Management Strategy for Epithelial Ovarian Cancer.

    PubMed

    Fujiwara, Keiichi; McAlpine, Jessica N; Lheureux, Stephanie; Matsumura, Noriomi; Oza, Amit M

    2016-01-01

    The hypothesis on the pathogenesis of epithelial ovarian cancer continues to evolve. Although epithelial ovarian cancer had been assumed to arise from the coelomic epithelium of the ovarian surface, it is now becoming clearer that the majority of serous carcinomas arise from epithelium of the distal fallopian tube, whereas clear cell and endometrioid cancers arise from endometriosis. Molecular and genomic characteristics of epithelial ovarian cancer have been extensively investigated. Our understanding of pathogenesis of the various histologic types of ovarian cancer have begun to inform changes to the strategies for management of epithelial ovarian cancer, which represent a paradigm shift not only for treatment but also for prevention, which previously had not been considered achievable. In this article, we will discuss novel attempts at the prevention of high-grade serous ovarian cancer and treatment strategies for two distinct entities in epithelial ovarian cancer: low-grade serous and clear cell ovarian carcinomas, which are relatively rare and resistant to conventional chemotherapy.

  19. Financial management and dental school strength, Part I: Strategy.

    PubMed

    Chambers, David W; Bergstrom, Roy

    2004-04-01

    The ultimate goal of financial management in a dental school is to accumulate assets that are available for strategic growth, which is a parallel objective to the profit motive in business. Budget development is often grounded in an income statement framework where the goal is to match revenues and expenses. Only when a balance sheet perspective (assets = liabilities + equity) is adopted can strategic growth be fully addressed. Four views of budgeting are presented in this article: 1) covering expenses, 2) shopping, 3) strategic support, and 4) budgeting as strategy. These perceptions of the budgeting process form a continuum, moving from a weak strategic position (covering expenses) to a strong one (budgeting as strategy) that encourages the accumulation of assets that build equity in the organization.

  20. Current techniques and strategies for anesthesia in patients undergoing peripheral bypass surgery.

    PubMed

    Bouman, E; Dortangs, E; Buhre, W; Gramke, H F

    2014-04-01

    Peripheral arterial disease is an illness with a high prevalence in Europe and North America. The disease is associated with a significant impact on quality of life. Despite advanced medical and endovascular treatments, surgery is often indicated to prevent the consequences of ischemic injury. Usually, these patients do have significant comorbidities resulting in an increased risk for anesthesia-related complications. While general anesthesia is commonly used for the majority of the patients, local and regional anesthesia (RA) offer several possible advantages such as stable cardiovascular hemodynamic perioperative course, improved postoperative pain relief and prevention of chronic postsurgical pain syndromes. This review will discuss perioperative management, available evidence regarding general anesthesia and various regional anesthetic techniques for peripheral vascular surgery, and the current advises regarding anticoagulants and RA. No definitive conclusions can be drawn from the existing literature with respect to superiority of general or neuraxial anesthesia or even RA. Maybe the profits lie in the combination of techniques, a strategy, to overcome the risks of one and use the benefits of the other technique. From circumstantial evidence, it is most likely that the experience of the anesthetic and surgical team is one of the major determinants of perioperative complications independent from the individual anesthesia technique.

  1. Human resources for mental health care: current situation and strategies for action.

    PubMed

    Kakuma, Ritsuko; Minas, Harry; van Ginneken, Nadja; Dal Poz, Mario R; Desiraju, Keshav; Morris, Jodi E; Saxena, Shekhar; Scheffler, Richard M

    2011-11-05

    A challenge faced by many countries is to provide adequate human resources for delivery of essential mental health interventions. The overwhelming worldwide shortage of human resources for mental health, particularly in low-income and middle-income countries, is well established. Here, we review the current state of human resources for mental health, needs, and strategies for action. At present, human resources for mental health in countries of low and middle income show a serious shortfall that is likely to grow unless effective steps are taken. Evidence suggests that mental health care can be delivered effectively in primary health-care settings, through community-based programmes and task-shifting approaches. Non-specialist health professionals, lay workers, affected individuals, and caregivers with brief training and appropriate supervision by mental health specialists are able to detect, diagnose, treat, and monitor individuals with mental disorders and reduce caregiver burden. We also discuss scale-up costs, human resources management, and leadership for mental health, particularly within the context of low-income and middle-income countries.

  2. Flecainide: Current status and perspectives in arrhythmia management

    PubMed Central

    Andrikopoulos, George K; Pastromas, Sokratis; Tzeis, Stylianos

    2015-01-01

    Flecainide acetate is a class IC antiarrhythmic agent and its clinical efficacy has been confirmed by the results of several clinical trials. Nowadays, flecainide is recommended as one of the first line therapies for pharmacological conversion as well as maintenance of sinus rhythm in patients with atrial fibrillation and/or supraventricular tachycardias. Based on the Cardiac Arrhythmia Suppression Trial study results, flecainide is not recommended in patients with structural heart disease due to high proarrhythmic risk. Recent data support the role of flecainide in preventing ventricular tachyarrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia associated both with ryanodine receptor and calsequestrin mutations. We herein review the current clinical data related to flecainide use in clinical practice and some concerns about its role in the management of patients with coronary artery disease. PMID:25717355

  3. Current management of bronchiectasis: review and 3 case studies.

    PubMed

    Silverman, Enid; Ebright, Linda; Kwiatkowski, Marianne; Cullina, Joanne

    2003-01-01

    Bronchiectasis is the abnormal, irreversible dilatation of diseased bronchi. Permanently dilated airways, usually in the medium-sized bronchi, are inflamed and often obstructed with thick, purulent secretions. Known causative factors include postinfection bronchial damage, postinhalation injury, hypersensitivity reactions, and congenital airway obstructive disorders. Typical symptoms include sputum overproduction, fever, pleurisy, dyspnea, and chronic cough. Diagnosis involves radiographic studies and pulmonary function testing. Treatment includes oral, aerosolized, or intravenous antibiotic therapy according to the severity of the exacerbation, and mucus clearance by means of bronchial hygiene assistive devices, chest physiotherapy, postural drainage, and high-frequency chest compression. We present a review of bronchiectasis and offer 3 case studies illustrating current management of different presentations, including use of aerosolized antibiotics for patients infected with Pseudomonas aeruginosa. Although an adjunctive program of pulmonary rehabilitation may be useful for patients with bronchiectasis, no confirming studies have been performed to date, and additional research in this area is warranted.

  4. Current conservative management and classification of club foot: A review.

    PubMed

    Balasankar, Ganesan; Luximon, Ameersing; Al-Jumaily, Adel

    2016-11-30

    Clubfoot, known as congenital talipes equinovarus, is one of the complex paediatric foot deformity with the incidence of 1 in every 1000 live births. It consists of four complex foot abnormalities such as forefoot adductus, midfoot cavus, and hindfoot varus and ankle equinus. There are a number of surgical techniques (soft tissue releases, arthrodesis) used to correct clubfoot. However currently the conservative management (manipulation, serial casting, and braces) of clubfoot is considered as the best choice and it is widely accepted among orthopaedists. Clubfoot treated with surgical techniques might suffer various complications such as soft tissues contractures, neurovascular complications, infections, and shortening of the limbs. Although conservative method is generally considered as an effective method, it is still challenging to cure clubfoot in advance stages. Also, the classification of the initial severity of clubfoot is essential to evaluate the outcome of the treatment. In this review, the aim is to review the different types of conservative method and the assessment of clubfoot severity.

  5. Current status of minimally invasive endoscopic management for Zenker diverticulum.

    PubMed

    Aiolfi, Alberto; Scolari, Federica; Saino, Greta; Bonavina, Luigi

    2015-02-16

    Surgical resection has been the mainstay of treatment of pharyngoesophageal (Zenker) diverticula over the past century. Developments in minimally invasive surgery and new endoscopic devices have led to a paradigm change. The concept of dividing the septum between the esophagus and the pouch rather than resecting the pouch itself has been revisited during the last three decades and new technologies have been investigated to make the transoral operation safe and effective. The internal pharyngoesophageal myotomy accomplished through the transoral stapling approach has been shown to effectively relieve outflow obstruction and restore physiological bolus transit in patients with medium size diverticula. Transoral techniques, either through a rigid device or by flexible endoscopy, are gaining popularity over the open surgical approach due the low morbidity, the fast recovery time and the fact that the procedure can be safely repeated. We provide an analysis of the the current status of minimally invasive endoscopic management of Zenker diverticulum.

  6. Current status of minimally invasive endoscopic management for Zenker diverticulum

    PubMed Central

    Aiolfi, Alberto; Scolari, Federica; Saino, Greta; Bonavina, Luigi

    2015-01-01

    Surgical resection has been the mainstay of treatment of pharyngoesophageal (Zenker) diverticula over the past century. Developments in minimally invasive surgery and new endoscopic devices have led to a paradigm change. The concept of dividing the septum between the esophagus and the pouch rather than resecting the pouch itself has been revisited during the last three decades and new technologies have been investigated to make the transoral operation safe and effective. The internal pharyngoesophageal myotomy accomplished through the transoral stapling approach has been shown to effectively relieve outflow obstruction and restore physiological bolus transit in patients with medium size diverticula. Transoral techniques, either through a rigid device or by flexible endoscopy, are gaining popularity over the open surgical approach due the low morbidity, the fast recovery time and the fact that the procedure can be safely repeated. We provide an analysis of the the current status of minimally invasive endoscopic management of Zenker diverticulum. PMID:25685264

  7. The pathophysiology, diagnosis and current management of acute compartment syndrome.

    PubMed

    Donaldson, James; Haddad, Behrooz; Khan, Wasim S

    2014-01-01

    Acute compartment syndrome (ACS) is a surgical emergency warranting prompt evaluation and treatment. It can occur with any elevation in interstitial pressure in a closed osseo-fascial compartment. Resultant ischaemic damage may be irreversible within six hours and can result in long-term morbidity and even death. The diagnosis is largely clinical with the classical description of 'pain out of proportion to the injury'. Compartment pressure monitors can be a helpful adjunct where the diagnosis is in doubt. Initial treatment is with the removal of any constricting dressings or casts, avoiding hypotension and optimizing tissue perfusion by keeping the limb at heart level. If symptoms persist, definitive treatment is necessary with timely surgical decompression of all the involved compartments. This article reviews the pathophysiology, diagnosis and current management of ACS.

  8. Current practices of the child neurologist in managing sports concussion.

    PubMed

    Broshek, Donna K; Samples, Hillary; Beard, Jennifer; Goodkin, Howard P

    2014-01-01

    Given the 2010 position statement issued by the American Academy of Neurology that neurologists be consulted on return-to-play decisions following a concussion, we surveyed members of the Child Neurology Society to asses clinical practice management of concussion among child neurologists. Among the 239 respondents, the majority continued to rely on the American Academy of Neurology's 1997 Practice Parameter to guide their decision-making process. Although the 2008 consensus statement from the Third International Conference on Concussion in Sport (Zurich Guidelines) is currently considered the most up-to-date guideline, few respondents relied exclusively on this guideline. More respondents who completed continuing medical education on concussion reported making clinical decisions based on the Zurich guidelines. The finding that child neurologists who completed continuing medical education had a greater familiarity with the more recently proposed consensus-based concussion guidelines supports the development of additional education in sports concussion at all levels of child neurology training.

  9. Current Pharmacological Management in Juvenile Huntington’s Disease

    PubMed Central

    Robertson, Lisa; Santini, Helen; O'Donovan, Kirsty L; Squitieri, Ferdinando; Barker, Roger A; Rakowicz, Maria; Landwehrmeyer, G. Bernhard; Quarrell, Oliver

    2012-01-01

    Background: The clinical presentation of Juvenile Huntington’s Disease (JHD) can be very different from adult-onset HD with little evidence to guide symptomatic management. Aim: To survey the current use of pharmacological treatments for JHD. Methods: Patients were identified through the HD Association, Hospital Doctors and the European Huntington’s Disease Network REGISTRY study. Results: The most commonly prescribed agents were anti-psychotics (24/45), anti-depressants (17/45) and anti-parkinsonian medications (15/45). 5 patients were taking more than 8 medications. Conclusions: The most commonly prescribed group of medication was the anti-psychotic. Many patients were on multiple therapies, highlighting the need to rationalise medications. PMID:22474619

  10. Current concepts in the management of complex elbow trauma.

    PubMed

    Morrey, B F

    2009-06-01

    Complex instability of the elbow, also known as fracture dislocation of the elbow, is one of the most challenging injuries of the musculoskeletal system. A clear understanding of the biomechanics of the joint with special focus on the relative contributions of the articular components and the ligamentous constraints is critical to the proper management of these injuries. The accurate recognition and implications of associated injuries offers a rationale for approaching these difficult problems by appropriately addressing the elements of the trauma. Further, doing so in a timely fashion enhances the outcome. Currently, even the most devastating of injuries are felt to have a more favourable prognosis than was present in the past if the principles contained herein are followed.

  11. Epidemic keratoconjunctivitis: A review of current concepts in management

    PubMed Central

    Pihos, Andria M.

    2012-01-01

    Epidemic keratoconjunctivitis (EKC) is an ocular surface infection caused by adenovirus. To date, there are no approved topical antiadenoviral therapeutics to treat EKC. Recent research reveals that treatment with topical corticosteroids for symptomatic relief of EKC enhances adenovirus replication and delays cell shedding from the ocular surface which delays adenovirus elimination. The current management of EKC largely revolves around accurate diagnosis of the condition and implementation of disinfection protocol to prevent its spread. Development of an effective antiviral treatment that addresses inflammation and does not prolong viral shedding would provide significant benefit. The literature reports on a variety of therapeutics that could potentially satisfy this deficiency. Topical ganciclovir and povidone-iodine combination drops have shown the most recent potential, but both therapeutics need to be investigated in larger scale studies. Until an antiadenoviral option is produced, the treatment of EKC should maintain a judicious case by case approach aiming to contain its dissemination and prevent visual consequences.

  12. Para-phenylenediamine allergy: current perspectives on diagnosis and management

    PubMed Central

    Mukkanna, Krishna Sumanth; Stone, Natalie M; Ingram, John R

    2017-01-01

    Para-phenylenediamine (PPD) is the commonest and most well-known component of hair dyes. Oxidative hair dyes and dark henna temporary tattoos contain PPD. Individuals may be sensitized to PPD by temporary henna tattooing in addition to dyeing their hair. PPD allergy can cause severe reactions and may result in complications. In recent years, frequency of positive patch test reactions to PPD has been increasing. Cross-sensitization to other contact allergens may occur, in particular to other hair dye components. Hairdressers are at a high risk for PPD allergy and require counseling regarding techniques to minimize exposure and protective measures while handling hair dye. We focus this review on the current perspectives of diagnosis and management of PPD allergy. PMID:28176912

  13. Current Concepts in Orthopedic Management of Multiple Trauma

    PubMed Central

    Kucukdurmaz, Fatih; Alijanipour, Pouya

    2015-01-01

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

  14. Management strategies for problem behaviors in the patient with dementia.

    PubMed

    Lehninger, F W; Ravindran, V L; Stewart, J T

    1998-04-01

    Psychiatric and behavioral problems are present in most patients with dementia and are usually the clinician's main focus of management. Differential diagnosis of these problems can be challenging, but the effort is essential for planning appropriate therapy. Pharmacologic interventions are available for treatment of depression, agitation, aggression, psychotic symptoms, wandering, and sleep disorders. Given the less than favorable risk-benefit ratio of most psychotropic drugs in the population of older patients with dementia, the importance of nonpharmacologic strategies and limiting treatment goals should not be overlooked.

  15. NEW MOLECULAR MEDICINE-BASED SCAR MANAGEMENT STRATEGIES

    PubMed Central

    Arno, Anna I; Gauglitz, Gerd G; Barret, Juan P; Jeschke, Marc G

    2014-01-01

    Keloids and hypertrophic scars are prevalent disabling conditions with still suboptimal treatments. Basic science and molecular-based medicine research has contributed to unravel new bench-to-bedside scar therapies, and to dissect the complex signaling pathways involved. Peptides such as transforming growth factor beta (TGF-β) superfamily, with SMADs, Ski, SnoN, Fussels, endoglin, DS-Sily, Cav-1p, AZX100, thymosin-β4 and other related molecules may emerge as targets to prevent and treat keloids and hypertrophic scars. The aim of this review is to describe the basic complexity of these new molecular scar management strategies, and point out new fibrosis research lines. PMID:24438742

  16. Urban water management in cities: historical, current and future regimes.

    PubMed

    Brown, R R; Keath, N; Wong, T H F

    2009-01-01

    Drawing from three phases of a social research programme between 2002 and 2008, this paper proposes a framework for underpinning the development of urban water transitions policy and city-scale benchmarking at the macro scale. Through detailed historical, contemporary and futures research involving Australian cities, a transitions framework is proposed, presenting a typology of six city states, namely the 'Water Supply City', the 'Sewered City', the 'Drained City', the 'Waterways City', the 'Water Cycle City', and the 'Water Sensitive City'. This framework recognises the temporal, ideological and technological contexts that cities transition through when moving towards sustainable urban water conditions. The aim of this research is to assist urban water managers with understanding the scope of the hydro-social contracts currently operating across cities in order to determine the capacity development and cultural reform initiatives needed to effectively expedite the transition to more sustainable water management and ultimately to Water Sensitive Cities. One of the values of this framework is that it can be used by strategists and policy makers as a heuristic device and/or the basis for a future city state benchmarking tool. From a research perspective it can be an underpinning framework for future work on transitions policy research.

  17. Current and emerging treatment options in the management of lupus

    PubMed Central

    Jordan, Natasha; D’Cruz, David

    2016-01-01

    Systemic lupus erythematosus (SLE) is a complex autoimmune disease with variable clinical manifestations. While the clearest guidelines for the treatment of SLE exist in the context of lupus nephritis, patients with other lupus manifestations such as neuropsychiatric, hematologic, musculoskeletal, and severe cutaneous lupus frequently require immunosuppression and/or biologic therapy. Conventional immunosuppressive agents such as mycophenolate mofetil, azathioprine, and cyclophosphamide are widely used in the management of SLE with current more rationalized treatment regimens optimizing the use of these agents while minimizing potential toxicity. The advent of biologic therapies has advanced the treatment of SLE particularly in patients with refractory disease. The CD20 monoclonal antibody rituximab and the anti-BLyS agent belimumab are now widely in use in clinical practice. Several other biologic agents are in ongoing clinical trials. While immunosuppressive and biologic agents are the foundation of inflammatory disease control in SLE, the importance of managing comorbidities such as cardiovascular risk factors, bone health, and minimizing susceptibility to infection should not be neglected. PMID:27529058

  18. Current and emerging treatment options in the management of lupus.

    PubMed

    Jordan, Natasha; D'Cruz, David

    2016-01-01

    Systemic lupus erythematosus (SLE) is a complex autoimmune disease with variable clinical manifestations. While the clearest guidelines for the treatment of SLE exist in the context of lupus nephritis, patients with other lupus manifestations such as neuropsychiatric, hematologic, musculoskeletal, and severe cutaneous lupus frequently require immunosuppression and/or biologic therapy. Conventional immunosuppressive agents such as mycophenolate mofetil, azathioprine, and cyclophosphamide are widely used in the management of SLE with current more rationalized treatment regimens optimizing the use of these agents while minimizing potential toxicity. The advent of biologic therapies has advanced the treatment of SLE particularly in patients with refractory disease. The CD20 monoclonal antibody rituximab and the anti-BLyS agent belimumab are now widely in use in clinical practice. Several other biologic agents are in ongoing clinical trials. While immunosuppressive and biologic agents are the foundation of inflammatory disease control in SLE, the importance of managing comorbidities such as cardiovascular risk factors, bone health, and minimizing susceptibility to infection should not be neglected.

  19. Strategies for Managing Mobile Devices for Use by Hospitalized Inpatients

    PubMed Central

    Dykes, Patricia C.; Stade, Diana; Dalal, Anuj; Clements, Marsha; Collins, Sarah; Chang, Frank; Fladger, Anne; Getty, George; Hanna, John; Kandala, Ravali; Lehmann, Lisa S.; Leone, Kathleen; Massaro, Anthony F.; Mlaver, Eli; McNally, Kelly; Ravindran, Sucheta; Schnock, Kumiko; Bates, David W.

    2015-01-01

    Despite the potential advantages, implementation of mobile devices and ongoing management pose challenges in the hospital environment. Our team implemented the PROSPECT (Promoting Respect and Ongoing Safety through Patient-centeredness, Engagement, Communication and Technology) project at Brigham and Women’s Hospital. The goal of PROSPECT is to transform the hospital environment by providing a suite of e-tools to facilitate teamwork among nurses, physicians, patients and to engage patients and care partners in their plan of care. In this paper, we describe the device-related decisions and challenges faced including device and accessory selection, integration, information and device security, infection control, user access, and ongoing operation and maintenance. We relate the strategies that we used for managing mobile devices and lessons learned based on our experiences. PMID:26958185

  20. Strategies for Managing Mobile Devices for Use by Hospitalized Inpatients.

    PubMed

    Dykes, Patricia C; Stade, Diana; Dalal, Anuj; Clements, Marsha; Collins, Sarah; Chang, Frank; Fladger, Anne; Getty, George; Hanna, John; Kandala, Ravali; Lehmann, Lisa S; Leone, Kathleen; Massaro, Anthony F; Mlaver, Eli; McNally, Kelly; Ravindran, Sucheta; Schnock, Kumiko; Bates, David W

    2015-01-01

    Despite the potential advantages, implementation of mobile devices and ongoing management pose challenges in the hospital environment. Our team implemented the PROSPECT (Promoting Respect and Ongoing Safety through Patient-centeredness, Engagement, Communication and Technology) project at Brigham and Women's Hospital. The goal of PROSPECT is to transform the hospital environment by providing a suite of e-tools to facilitate teamwork among nurses, physicians, patients and to engage patients and care partners in their plan of care. In this paper, we describe the device-related decisions and challenges faced including device and accessory selection, integration, information and device security, infection control, user access, and ongoing operation and maintenance. We relate the strategies that we used for managing mobile devices and lessons learned based on our experiences.

  1. A Review of Enrollment Management: Issues and Strategies. Management/Marketing Special Project.

    ERIC Educational Resources Information Center

    O'Brien, Ed; And Others

    This report presents findings and recommendations from a project undertaken by the Maricopa County Community College District (MCCCD) to determine reasons for a decline in business course enrollments and develop strategies to increase enrollments in management and marketing programs throughout the district. Following background information on the…

  2. Regional governance: strategies and disputes in health region management

    PubMed Central

    dos Santos, Adriano Maia; Giovanella, Ligia

    2014-01-01

    OBJECTIVE To analyze the regional governance of the health systemin relation to management strategies and disputes. METHODOLOGICAL PROCEDURES A qualitative study with health managers from 19 municipalities in the health region of Bahia, Northeastern Brazil. Data were drawn from 17 semi-structured interviews of state, regional, and municipal health policymakers and managers; a focus group; observations of the regional interagency committee; and documents in 2012. The political-institutional and the organizational components were analyzed in the light of dialectical hermeneutics. RESULTS The regional interagency committee is the chief regional governance strategy/component and functions as a strategic tool for strengthening governance. It brings together a diversity of members responsible for decision making in the healthcare territories, who need to negotiate the allocation of funding and the distribution of facilities for common use in the region. The high turnover of health secretaries, their lack of autonomy from the local executive decisions, inadequate technical training to exercise their function, and the influence of party politics on decision making stand as obstacles to the regional interagency committee’s permeability to social demands. Funding is insufficient to enable the fulfillment of the officially integrated agreed-upon program or to boost public supply by the system, requiring that public managers procure services from the private market at values higher than the national health service price schedule (Brazilian Unified Health System Table). The study determined that “facilitators” under contract to health departments accelerated access to specialized (diagnostic, therapeutic and/or surgical) services in other municipalities by direct payment to physicians for procedure costs already covered by the Brazilian Unified Health System. CONCLUSIONS The characteristics identified a regionalized system with a conflictive pattern of governance and

  3. Current management of diabetes mellitus and future directions in care.

    PubMed

    Chatterjee, Sudesna; Davies, Melanie J

    2015-11-01

    The last 90 years have seen considerable advances in the management of type 1 and type 2 diabetes. Prof MacLean of Guy's Hospital wrote in the Postgraduate Medical Journal in 1926 about the numerous challenges that faced patients and their healthcare professionals in delivering safe and effective diabetes care at that time. The discovery of insulin in 1922 heralded a new age in enabling long-term glycaemic control, which reduced morbidity and mortality. Thirty years later, the first oral agents for diabetes, the biguanides and sulfonylureas, appeared and freed type 2 patients from having to inject insulin following diagnosis. Improvements in insulin formulations over the decades, including rapid-acting and long-acting insulin analogues that more closely mimic physiological insulin secretion, have increased the flexibility and efficacy of type 1 diabetes management. The last two decades have seen major advances in technology, which has manifested in more accurate glucose monitoring systems and insulin delivery devices ('insulin pump'). Increased understanding of the pathophysiological deficits underlying type 2 diabetes has led to the development of targeted therapeutic approaches such as on the small intestine (glucagon-like peptide-1 receptor analogues and dipeptidyl-peptidase IV inhibitors) and kidneys (sodium-glucose cotransporter-2 inhibitors). A patient-centred approach delivered by a multidisciplinary team is now advocated. Glycaemic targets are set according to individual circumstances, taking into account factors such as weight, hypoglycaemia risk and patient preference. Stepwise treatment guidelines devised by international diabetes organisations standardise and rationalise management. Structured education programmes and psychological support are now well-established as essential for improving patient motivation and self-empowerment. Large multicentre randomised trials have confirmed the effectiveness of intensive glycaemic control on microvascular

  4. Current Clinical Practice Scenario of Osteoporosis Management in India

    PubMed Central

    Jhaveri, Shailesh; Upashani, Tejas; Bhadauria, Jitendra; Patel, Kamlesh

    2015-01-01

    Background Various osteoporosis guidelines are available for practice. Aim To understand the current clinical practice scenario from the perspective of Indian orthopaedicians, especially about the epidemiology, clinical manifestations, approach to diagnosis and management and patient compliance patterns to long term treatment. Materials and Methods A pre-validated structured questionnaire containing questions (mostly objective, some open-ended) catering to various objectives of the study was circulated amongst orthopaedic surgeons across India by means of post/courier, after giving a brief overview of the study telephonically. Data was extracted from the completed questionnaires, and analysed using Microsoft Excel software. Results The questionnaire was filled by a total of 84 orthopaedicians throughout India. The prevalence of osteoporosis in India according to the orthopaedic surgeons was 38.4% and there was a female preponderance. Most of the respondents felt out of every 100 osteoporosis patients in India, less than 20 patients are actually diagnosed and treated for osteoporosis. The most common initial presenting feature of established osteoporosis cases was general symptoms. Most respondents preferred Dual-energy X-ray absorptiometry (DEXA) as the initial investigation for the diagnosis of osteoporosis in a patient presenting with typical features. While most respondents preferred once-a-month oral over intravenous (IV) bisphosphonates, they agreed that IV administration had advantages such as lower gastrointestinal side effects and improved compliance. The average duration of therapy of oral bisphosphonates was the longest (27.04 months) among the other anti- osteoporosis therapies that they used. On an average, the patient compliance rate in osteoporosis management was around 64%. IV Zoledronic acid (ZA) and intranasal calcitonin were infrequently used than other anti- osteoporosis therapies. While concerns about cost and availability deterred more frequent

  5. Arrhythmias in athletes: evidence-based strategies and challenges for diagnosis, management, and sports eligibility.

    PubMed

    Fragakis, Nikolaos; Pagourelias, Efstathios D; Koskinas, Konstantinos C; Vassilikos, Vassilios

    2013-01-01

    Assessment and management of cardiac rhythm disorders in athletes is particularly challenging. An accurate diagnosis and optimal risk-stratification are often limited because of substantial phenotypic overlap between pathological entities and adaptive cardiovascular responses that normally occur in athletes. An accurate diagnosis, however, is particularly important in this population, as 2 competing risks need to be cautiously balanced: the risk of under-diagnosis of an arrhythmogenic substrate that may trigger life-threatening events versus the risk of over-diagnosis that may result in an athlete's improper disqualification. Accordingly, the management of arrhythmias in athletes may pose therapeutic dilemmas, and often differs substantially compared with the general population. In this review, we present the most frequently observed arrhythmias in athletes and briefly discuss their pathophysiologic substrate. We further propose diagnostic and therapeutic strategies based upon current guidelines, official recommendations, and emerging evidence from relevant clinical investigations. We focus particularly on disparities in current guidelines regarding the management of certain rhythm disorders, as these areas of uncertainty may reflect the challenging nature of these disorders and may indicate the need for individualized approaches in every-day clinical practice. A better understanding of the normal electrophysiological responses to chronic exercise, and of the pathophysiological basis and the true clinical significance of arrhythmias in athletes, may enhance decision-making, and may allow for management strategies which more prudently weigh the risk-to-benefit ratio of each approach.

  6. Intervention strategies for the management of human error

    NASA Technical Reports Server (NTRS)

    Wiener, Earl L.

    1993-01-01

    This report examines the management of human error in the cockpit. The principles probably apply as well to other applications in the aviation realm (e.g. air traffic control, dispatch, weather, etc.) as well as other high-risk systems outside of aviation (e.g. shipping, high-technology medical procedures, military operations, nuclear power production). Management of human error is distinguished from error prevention. It is a more encompassing term, which includes not only the prevention of error, but also a means of disallowing an error, once made, from adversely affecting system output. Such techniques include: traditional human factors engineering, improvement of feedback and feedforward of information from system to crew, 'error-evident' displays which make erroneous input more obvious to the crew, trapping of errors within a system, goal-sharing between humans and machines (also called 'intent-driven' systems), paperwork management, and behaviorally based approaches, including procedures, standardization, checklist design, training, cockpit resource management, etc. Fifteen guidelines for the design and implementation of intervention strategies are included.

  7. Management of achilles tendon injury: A current concepts systematic review

    PubMed Central

    Gulati, Vivek; Jaggard, Matthew; Al-Nammari, Shafic Said; Uzoigwe, Chika; Gulati, Pooja; Ismail, Nizar; Gibbons, Charles; Gupte, Chinmay

    2015-01-01

    Achilles tendon rupture has been on the rise over recent years due to a variety of reasons. It is a debilitating injury with a protracted and sometimes incomplete recovery. Management strategy is a controversial topic and evidence supporting a definite approach is limited. Opinion is divided between surgical repair and conservative immobilisation in conjunction with functional orthoses. A systematic search of the literature was performed. Pubmed, Medline and EmBase databases were searched for Achilles tendon and a variety of synonymous terms. A recent wealth of reporting suggests that conservative regimens with early weight bearing or mobilisation have equivalent or improved rates of re-rupture to operative regimes. The application of dynamic ultrasound assessment of tendon gap may prove crucial in minimising re-rupture and improving outcomes. Studies employing functional assessments have found equivalent function between operative and conservative treatments. However, no specific tests in peak power, push off strength or athletic performance have been reported and whether an advantage in operative treatment exists remains undetermined. PMID:25992315

  8. Current concepts in the management of diabetic nephropathy.

    PubMed

    Waanders, F; Visser, F W; Gans, R O B

    2013-11-01

    Although much progress has been made in slowing the progression of diabetic nephropathy, renal dysfunction and development of end-stage renal disease (ESRD) remain major concerns in diabetes. In addition, diabetic patients with microalbuminuria have an increased cardiovascular mortality. Therefore, new treatment modalities or strategies are needed to prevent or slow the progression of diabetic nephropathy and prevent cardiovascular disease in diabetes. In this review we describe current concepts in pathophysiology, treatment goals and we discuss future developments in the treatment of diabetic nephropathy. Common risk factors for diabetic nephropathy and its progression are longer duration, poor glycaemic control, hypertension and the presence of albuminuria. Available treatment options, especially renin-angiotensin aldosterone system (RAAS) blockade, but also better blood pressure and blood glucose control, decrease the incidence of cardiovascular disease and renal disease in diabetes. It is important that treatment goals are tailored to the individual patient with individual treatment goals of glycaemic control and blood pressure, depending on age, type of diabetes and diabetes duration. Aggressive treatment of glucose control and blood pressure might not always be best practice for every patient. Since the proportion of ESRD due to diabetic nephropathy remains high, optimisation of RAAS blockade is advocated and can be achieved by adequate sodium restriction and/or diuretic treatment. Moreover, aldosterone blockade might be a valuable strategy, which has potency to slow the progression of diabetic renal disease. Other possible future interventions are under investigation, but large clinical trials have to be awaited to confirm the safety and efficacy of these drugs.

  9. Managing differences: the central challenge of global strategy.

    PubMed

    Ghemawat, Pankaj

    2007-03-01

    The main goal of any international strategy should be to manage the large differences that arise at the borders of markets. Yet executives often fail to exploit market and production discrepancies, focusing instead on the tensions between standardization and localization. In this article, Pankaj Ghemawat presents a new framework that encompasses all three effective responses to the challenges of globalization. He calls it the AAA Triangle. The A's stand for the three distinct types of international strategy. Through adaptation, companies seek to boost revenues and market share by maximizing their local relevance. Through aggregation, they attempt to deliver economies of scale by creating regional, or sometimes global, operations. And through arbitrage, they exploit disparities between national or regional markets, often by locating different parts of the supply chain in different places--for instance, call centers in India, factories in China, and retail shops in Western Europe. Ghemawat draws on several examples that illustrate how organizations use and balance these strategies and describes the trade-offs they make as they do so. Because most enterprises should draw from all three A's to some extent, the framework can be used to develop a summary scorecard indicating how well the company is globalizing. However, given the tensions among the strategies, it's not enough simply to tick off the corresponding boxes. Strategic choice requires some degree of prioritization--and the framework can help with that as well. While it is possible to make progress on all three strategies, companies usually must focus on one or two when trying to build competitive advantage.

  10. Management strategy evaluation of pheromone-baited trapping techniques to improve management of invasive sea lamprey

    USGS Publications Warehouse

    Dawson, Heather; Jones, Michael L.; Irwin, Brian J.; Johnson, Nicholas; Wagner, Michael C.; Szymanski, Melissa

    2016-01-01

    We applied a management strategy evaluation (MSE) model to examine the potential cost-effectiveness of using pheromone-baited trapping along with conventional lampricide treatment to manage invasive sea lamprey. Four pheromone-baited trapping strategies were modeled: (1) stream activation wherein pheromone was applied to existing traps to achieve 10−12 mol/L in-stream concentration, (2) stream activation plus two additional traps downstream with pheromone applied at 2.5 mg/hr (reverse-intercept approach), (3) trap activation wherein pheromone was applied at 10 mg/hr to existing traps, and (4) trap activation and reverse-intercept approach. Each new strategy was applied, with remaining funds applied to conventional lampricide control. Simulating deployment of these hybrid strategies on fourteen Lake Michigan streams resulted in increases of 17 and 11% (strategies 1 and 2) and decreases of 4 and 7% (strategies 3 and 4) of the lakewide mean abundance of adult sea lamprey relative to status quo. MSE revealed performance targets for trap efficacy to guide additional research because results indicate that combining lampricides and high efficacy trapping technologies can reduce sea lamprey abundance on average without increasing control costs.

  11. Instantaneous Project Controls: Current Status, State of the Art, Benefits, and Strategies

    ERIC Educational Resources Information Center

    Abbaszadegan, Amin

    2016-01-01

    Despite advancements in construction and construction-related technology, capital project performance deviations, typically overruns, remain endemic within the capital projects industry. Currently, management is generally unaware of the current status of their projects, and thus monitoring and control of projects are not achieved effectively. In…

  12. Current Management of Alcoholic Hepatitis and Future Therapies

    PubMed Central

    Saberi, Behnam; Dadabhai, Alia S.; Jang, Yoon-Young; Gurakar, Ahmet; Mezey, Esteban

    2016-01-01

    Abstract Alcohol is one of the most common etiologies of liver disease, and alcoholic liver disease overall is the second most common indication for liver transplantation in the United States. It encompasses a spectrum of disease, including fatty liver disease, alcoholic hepatitis (AH), and alcoholic cirrhosis. AH can range from mild to severe disease, with severe disease being defined as: Discriminant Function (DF) ≥ 32, or Model for End-stage Liver Disease (MELD) ≥ 21, or presence of hepatic encephalopathy. Management of the mild disease consists mainly of abstinence and supportive care. Severe AH is associated with significant mortality. Currently, there is no ideal medical treatment for this condition. Besides alcohol cessation, corticosteroids have been used with conflicting results and are associated with an inherent risk of infection. Overall steroids have shown short term benefit when compared to placebo, but they have no obvious long term benefits. Pentoxifylline does not improve survival in patients with severe AH and is no longer recommended based on the results of the STOPAH (Steroid Or Pentoxifylline for Alcoholic Hepatitis) trial. Anti-tumor necrosis factor (TNF) agents are associated with increased risk of life threatening infections and death. Currently, early stage trials are underway, mainly targeting novel pathways based on disease pathogenesis, including modulation of innate immune system, inhibition of gut-liver axis and cell death pathways, and activation of transcription factor farnesyl X receptor (FXR). Future treatment may lie in human induced pluripotent stem cell (iPSC) technology, which is currently under investigation for the study of pathogenesis, drug discovery, and stem cell transplantation. Liver transplantation has been reported with good results in highly selected patients but is controversial due to limited organ supply. PMID:27350941

  13. History of the current understanding and management of tethered spinal cord.

    PubMed

    Safavi-Abbasi, Sam; Mapstone, Timothy B; Archer, Jacob B; Wilson, Christopher; Theodore, Nicholas; Spetzler, Robert F; Preul, Mark C

    2016-07-01

    An understanding of the underlying pathophysiology of tethered cord syndrome (TCS) and modern management strategies have only developed within the past few decades. Current understanding of this entity first began with the understanding and management of spina bifida; this later led to the gradual recognition of spina bifida occulta and the symptoms associated with tethering of the filum terminale. In the 17th century, Dutch anatomists provided the first descriptions and initiated surgical management efforts for spina bifida. In the 19th century, the term "spina bifida occulta" was coined and various presentations of spinal dysraphism were appreciated. The association of urinary, cutaneous, and skeletal abnormalities with spinal dysraphism was recognized in the 20th century. Early in the 20th century, some physicians began to suspect that traction on the conus medullaris caused myelodysplasia-related symptoms and that prophylactic surgical management could prevent the occurrence of clinical manifestations. It was not, however, until later in the 20th century that the term "tethered spinal cord" and the modern management of TCS were introduced. This gradual advancement in understanding at a time before the development of modern imaging modalities illustrates how, over the centuries, anatomists, pathologists, neurologists, and surgeons used clinical examination, a high level of suspicion, and interest in the subtle and overt clinical appearances of spinal dysraphism and TCS to advance understanding of pathophysiology, clinical appearance, and treatment of this entity. With the availability of modern imaging, spinal dysraphism can now be diagnosed and treated as early as the intrauterine stage.

  14. Disease Management Evaluation: A Comprehensive Review of Current State of the Art.

    PubMed

    Conklin, Annalijn; Nolte, Ellen

    2011-01-01

    Many countries across Europe and elsewhere have been experimenting with various structured approaches to manage patients with chronic illness as a way to improve quality of care, reduce costs and lead to better population health outcomes in the long run. Despite a body of studies of disease management interventions, uncertainty about the effects of these remains not least because current guidance on evaluation methods and metrics require further development to enhance scientific rigour while also being practical in routine operations. This article provides details from a report that reviews the academic and grey literature to help advance the task of improving the science of assessing disease management initiatives in Europe. Challenges identified are methodological, analytical and conceptual in nature, with a key issue being the establishment of the counterfactual. An array of sophisticated statistical techniques and analytical frameworks can assist in the construction of a sound comparison strategy when a randomised controlled trial is not possible. Issues to consider include: a clear framework of the mechanisms of action and expected effects of disease management; an understanding of the characteristics of disease management (scope, content, dose, context), and of the intervention and target populations (disease type, severity, case-mix); a period of observation over multiple years; and a logical link between performance measures and the intervention's aims and underlying theory of behaviour change.

  15. Regulations, Policies and Strategies for LLRW Management in Bangladesh - 12368

    SciTech Connect

    Mollah, A.S.

    2012-07-01

    Low level radioactive waste (LLW) is generated from various nuclear applications in Bangladesh. The major sources of radioactive waste in the country are at present: (a) the 3 MW TRIGA Mark-II research reactor; (b) the radioisotope production facility; (c) the medical, industrial and research facilities that use radionuclides; and (d) the industrial facility for processing monazite sands. Radioactive waste needs to be safely managed because it is potentially hazardous to human health and the environment. According to Nuclear Safety and Radiation Control Act-93, the Bangladesh Atomic Energy Commission (BAEC) is the governmental body responsible for the receipt and final disposal of radioactive wastes in the whole country. Waste management policy has become an important environmental, social, and economical issue for LLW in Bangladesh. Policy and strategies will serve as a basic guide for radioactive waste management in Bangladesh. The waste generator is responsible for on-site collection, conditioning and temporary storage of the waste arising from his practice. The Central Waste Processing and Storage Unit (CWPSU) of BAEC is the designated national facility with the requisite facility for the treatment, conditioning and storage of radioactive waste until a final disposal facility is established and becomes operational. The Regulatory Authority is responsible for the enforcement of compliance with provisions of the waste management regulation and other relevant requirements by the waste generator and the CWPSU. The objective of this paper is to present, in a concise form, basic information about the radioactive waste management infrastructure, regulations, policies and strategies including the total inventory of low level radioactive waste in the country. For improvement and strengthening in terms of operational capability, safety and security of RW including spent radioactive sources and overall security of the facility (CWPSF), the facility is expected to serve

  16. Flexible and robust strategies for waste management in Sweden

    SciTech Connect

    Finnveden, Goeran Bjoerklund, Anna; Reich, Marcus Carlsson; Eriksson, Ola; Soerbom, Adrienne

    2007-07-01

    Treatment of solid waste continues to be on the political agenda. Waste disposal issues are often viewed from an environmental perspective, but economic and social aspects also need to be considered when deciding on waste strategies and policy instruments. The aim of this paper is to suggest flexible and robust strategies for waste management in Sweden, and to discuss different policy instruments. Emphasis is on environmental aspects, but social and economic aspects are also considered. The results show that most waste treatment methods have a role to play in a robust and flexible integrated waste management system, and that the waste hierarchy is valid as a rule of thumb from an environmental perspective. A review of social aspects shows that there is a general willingness among people to source separate wastes. A package of policy instruments can include landfill tax, an incineration tax which is differentiated with respect to the content of fossil fuels and a weight based incineration tax, as well as support to the use of biogas and recycled materials.

  17. A mathematically guided strategy for risk assessment and management.

    SciTech Connect

    Cooper, James Arlin

    2005-03-01

    Strategies for risk assessment and management of high consequence operations are often based on factors such as physical analysis, analysis of software and other logical processing, and analysis of statistically determined human actions. Conventional analysis methods work well for processing objective information. However, in practical situations, much or most of the data available are subjective. Also, there are potential resultant pitfalls where conventional analysis might be unrealistic, such as improperly using event tree and fault tree failure descriptions where failures or events are soft (partial) rather than crisp (binary), neglecting or misinterpreting dependence (positive, negative, correlation), and aggregating nonlinear contributions linearly. There are also personnel issues that transcend basic human factors statistics. For example, sustained productivity and safety in critical operations can depend on the morale of involved personnel. In addition, motivation is significantly influenced by 'latent effects', which are pre-occurring influences. This paper addresses these challenges and proposes techniques for subjective risk analysis, latent effects risk analysis and a hybrid analysis that also includes objective risk analysis. The goal is an improved strategy for risk management.

  18. Habitat Demonstration Unit Project Leadership and Management Strategies

    NASA Technical Reports Server (NTRS)

    Kennedy, Kriss J.

    2011-01-01

    This paper gives an overview of the National Aeronautics and Space Administration (NASA) led multi-center Habitat Demonstration Unit (HDU) project leadership and management strategies. The HDU project team constructed and tested an analog prototype lunar surface habitat/laboratory called the Pressurized Excursion Module (PEM) during 2010. The prototype unit subsystems were integrated in a short amount of time, utilizing a tiger team approach that brought together over 20 habitation-related technologies and innovations from a variety of NASA centers. This paper describes the leadership and management strategies as well as lessons learned pertaining to leading and managing a multi-center diverse team in a rapid prototype environment. The PEM configuration went from a paper design to an operational surface habitat demonstration unit in less than 12 months. The HDU project is part of the strategic plan from the Exploration Systems Mission Directorate (ESMD) Directorate Integration Office (DIO) and the Exploration Mission Systems Office (EMSO) to test destination elements in analog environments. The 2011 HDU-Deep Space Habitat (DSH) configuration will build upon the PEM work, and emphasize validity of crew operations (remote working and living), EVA operations, mission operations, logistics operations, and science operations that might be required in a deep space context for Near Earth Object (NEO) exploration mission architectures. The 2011 HDU-DSH will be field-tested during the 2011 Desert Research and Technologies Studies (DRaTS) field tests. The HDU project is a "technology-pull" project that integrates technologies and innovations from multiple NASA centers. This project will repurpose the HDU 2010 demo unit that was field tested in the 2010 DRaTS, adding habitation functionality to the prototype unit. This paper will describe the strategy of establishing a multi-center project management team that put in place the key multi-center leadership skills and

  19. Defining a data management strategy for USGS Chesapeake Bay studies

    USGS Publications Warehouse

    Ladino, Cassandra

    2013-01-01

    The mission of U.S. Geological Survey’s (USGS) Chesapeake Bay studies is to provide integrated science for improved understanding and management of the Chesapeake Bay ecosystem. Collective USGS efforts in the Chesapeake Bay watershed began in the 1980s, and by the mid-1990s the USGS adopted the watershed as one of its national place-based study areas. Great focus and effort by the USGS have been directed toward Chesapeake Bay studies for almost three decades. The USGS plays a key role in using “ecosystem-based adaptive management, which will provide science to improve the efficiency and accountability of Chesapeake Bay Program activities” (Phillips, 2011). Each year USGS Chesapeake Bay studies produce published research, monitoring data, and models addressing aspects of bay restoration such as, but not limited to, fish health, water quality, land-cover change, and habitat loss. The USGS is responsible for collaborating and sharing this information with other Federal agencies and partners as described under the President’s Executive Order 13508—Strategy for Protecting and Restoring the Chesapeake Bay Watershed signed by President Obama in 2009. Historically, the USGS Chesapeake Bay studies have relied on national USGS databases to store only major nationally available sources of data such as streamflow and water-quality data collected through local monitoring programs and projects, leaving a multitude of other important project data out of the data management process. This practice has led to inefficient methods of finding Chesapeake Bay studies data and underutilization of data resources. Data management by definition is “the business functions that develop and execute plans, policies, practices and projects that acquire, control, protect, deliver and enhance the value of data and information.” (Mosley, 2008a). In other words, data management is a way to preserve, integrate, and share data to address the needs of the Chesapeake Bay studies to better

  20. Current interventions in the management of knee osteoarthritis

    PubMed Central

    Bhatia, Dinesh; Bejarano, Tatiana; Novo, Mario

    2013-01-01

    Osteoarthritis (OA) is progressive joint disease characterized by joint inflammation and a reparative bone response and is one of the top five most disabling conditions that affects more than one-third of persons > 65 years of age, with an average estimation of about 30 million Americans currently affected by this disease. Global estimates reveal more than 100 million people are affected by OA. The financial expenditures for the care of persons with OA are estimated at a total annual national cost estimate of $15.5-$28.6 billion per year. As the number of people >65 years increases, so does the prevalence of OA and the need for cost-effective treatment and care. Developing a treatment strategy which encompasses the underlying physiology of degenerative joint disease is crucial, but it should be considerate to the different age ranges and different population needs. This paper focuses on different exercise and treatment protocols (pharmacological and non-pharmacological), the outcomes of a rehabilitation center, clinician-directed program versus an at home directed individual program to view what parameters are best at reducing pain, increasing functional independence, and reducing cost for persons diagnosed with knee OA. PMID:23559821

  1. Management strategies in apple orchards influence earwig community.

    PubMed

    Malagnoux, Laure; Marliac, Gaëlle; Simon, Sylvaine; Rault, Magali; Capowiez, Yvan

    2015-04-01

    Our aim was to assess whether different apple orchard management strategies (low-input, organic, Integrated Pest Management (IPM)) would have an effect on earwigs, which are important natural enemies of apple pests. These commercial orchards were as well compared to abandoned orchards. The density of Forficula auricularia and Forficula pubescens was studied for three years in 74 orchards around Avignon. The pesticide usage, some orchard characteristics and two small-scale landscape parameters were characterized. Pesticide use was significantly different between low-input, organic and IPM orchards with particularly significant differences in the number of insecticide applications (2.2, 4.9 and 9.2 respectively). Pesticide use had a much stronger impact on earwig community than other characteristics. F. auricularia density was significantly lower in IPM orchards (0.47 individuals per tree) compared to organic, low-input and abandoned orchards (3.1, 4.5 and 1.6 individuals per tree, respectively). F. pubescens was almost absent from IPM orchards and its abundance was higher in abandoned or low-input orchards compared to organic orchards (1.5 and 2.8 vs 0.8 individuals per tree). The percentage of F. pubescens in the earwig community decreased from abandoned (52%) to low-input (40%), organic (15%) and IPM orchards (0.5%). These results were confirmed by LD50 assays showing that for the two pesticides causing mortality close to normal application rates (chlorpyrifos-ethyl and acetamiprid), F. pubescens was significantly more sensitive than F. auricularia. Since earwigs are also easy to capture and identify, they may be useful to estimate the effects of management strategies and their modification in pome fruit orchards.

  2. Ascent, dominance, and decline of the alewife in the Great Lakes: Food web interactions and management strategies

    USGS Publications Warehouse

    O'Gorman, Robert; Stewart, Thomas J.; Taylor, William W.; Ferreri, C. Paola

    1999-01-01

    This article chronicles the ascent, dominance, and decline of the alewife (Alosa pseudoharengus) in the Great Lakes and tracks the gradual accumulation of knowledge on the fish's effect on the aquatic community. Changes in management strategies for alewife are followed, and the current management dilemma is framed in light of the alewife's effect on inidigenous fishes and the changing biota and trophic status of the Great Lakes.

  3. Current management for word finding difficulties by speech-language therapists in South African remedial schools.

    PubMed

    de Rauville, Ingrid; Chetty, Sandhya; Pahl, Jenny

    2006-01-01

    Word finding difficulties frequently found in learners with language learning difficulties (Casby, 1992) are an integral part of Speech-Language Therapists' management role when working with learning disabled children. This study investigated current management for word finding difficulties by 70 Speech-Language Therapists in South African remedial schools. A descriptive survey design using a quantitative and qualitative approach was used. A questionnaire and follow-up focus group discussion were used to collect data. Results highlighted the use of the Renfrew Word Finding Scale (Renfrew, 1972, 1995) as the most frequently used formal assessment tool. Language sample analysis and discourse analysis were the most frequently used informal assessment procedures. Formal intervention programmes were generally not used. Phonetic, phonemic or phonological cueing were the most frequently used therapeutic strategies. The authors note strengths and raise concerns about current management for word finding difficulties in South African remedial schools, particularly in terms of bilingualism. Opportunities are highlighted regarding the development of assessment and intervention measures relevant to the diverse learning disabled population in South Africa.

  4. Turnaround Management Strategies: The Adaptive Model and the Constructive Model. ASHE 1983 Annual Meeting Paper.

    ERIC Educational Resources Information Center

    Chaffee, Ellen E.

    The use of two management strategies by 14 liberal arts and comprehensive colleges attempting to recover from serious financial decline during 1973-1976 were studied. The adaptive model of strategy, based on resource dependence, involves managing demands in order to satisfy critical-resource providers. The constructive model of strategy, based on…

  5. Current Issues in Malignant Pleural Mesothelioma Evaluation and Management

    PubMed Central

    Ai, Jing

    2014-01-01

    Malignant pleural mesothelioma (MPM) is an uncommon disease most often associated with occupational asbestos exposure and is steadily increasing in worldwide incidence. Patients typically present at an older age, with advanced clinical stage and other medical comorbidities, making management quite challenging. Despite great efforts, the prognosis of MPM remains poor, especially at progression after initial treatment. Macroscopic complete resection of MPM can be achieved through extrapleural pneumonectomy (EPP) or extended (ie, radical) pleurectomy (e-P/D) in selected patients and can result in prolonged survival when incorporated into a multimodality approach. Given the morbidity associated with surgical resection of MPM, optimizing identification of appropriate patients is essential. Unfortunately, most patients are not candidates for EPP or e-P/D due to advanced stage, age, and/or medical comorbidity. Pemetrexed and platinum combination chemotherapy has become the cornerstone of therapy for patients with unresectable disease because the combination is associated with improved survival and quality of life in treated patients. However, MPM eventually becomes resistant to initial therapy, and benefit to further lines of therapy has not been substantiated in randomized clinical trials. Translational research has provided exciting insights into tumorigenesis, biomarkers, and immune response in MPM, leading to the development of multiple novel therapeutic agents that are currently in clinical trials. These advances hold the promise of a new era in the treatment of MPM and suggest that this disease will not be left behind in the war on cancer. PMID:25061089

  6. Developing an information resources management strategy for regulatory veterinary medicine: a national imperative.

    PubMed

    Miller, L E; Honeycutt, T L; Cowen, P; Morrow, W E; Hueston, W D

    1994-10-15

    Lack of a standardized information technology management strategy has resulted in state and federal information systems evolving separately, rather than in tandem. Absence of an information management strategy will eventually affect regulatory program management, epidemiologic research, and domestic and international livestock trade. Producers will ultimately pay the price for the lack of regulatory coordination of US animal health and disease information. The longer the development of state and federal information technology management strategies is postponed, the more cost-, labor-, and time-intensive correcting the deficiency will be. Development of a national information resources management environment is the first step in constructing state and federal information technology strategies.

  7. Household energy management strategies in Bulgaria's transitioning energy sector

    NASA Astrophysics Data System (ADS)

    Carper, Mark Daniel Lynn

    Recent transition literature of post-socialist states has addressed the shortcomings of a rapid blanket implementation of neo-liberal policies and practices placed upon a landscape barren of the needed institutions and experiences. Included in these observations are the policy-making oversight of spatial socioeconomic variations and their individual and diverse methods of coping with their individual challenges. Of such literature addressing the case of Bulgaria, a good portion deals with the spatial consequences of restructuring as well as with embedded disputes over access to and control of resources. With few exceptions, studies of Bulgaria's changing energy sector have largely been at the state level and have not been placed within the context of spatial disparities of socioeconomic response. By exploring the variations of household energy management strategies across space, my dissertation places this resource within such a theoretical context and offers analysis based on respective levels of economic and human development, inherited material infrastructures, the organization and activities of institutions, and fuel and technological availability. A closed survey was distributed to explore six investigational themes across four geographic realms. The investigational themes include materials of housing construction, methods of household heating, use of electrical appliances, energy conservation strategies, awareness and use of energy conservation technologies, and attitudes toward the transitioning energy sector. The geographic realms include countrywide results, the urban-rural divide, regional variations, and urban divisions of the capital city, Sofia. Results conclude that, indeed, energy management strategies at the household level have been shaped by multiple variables, many of which differ across space. These variables include price sensitivity, degree of dependence on remnant technologies, fuel and substitute availability, and level of human and

  8. Strategies, methods and tools for managing nanorisks in construction

    NASA Astrophysics Data System (ADS)

    López de Ipiña, J. M.; Vaquero, C.; Boutry, D.; Damlencourt, J. F.; Neofytou, P.; Pilou, M.; Jankowska, E.; Larraza, I.; Pina, R.; Fernández, S.; Contreras, S.; Romero, A.; Calderon, M.; Swiezewsk, P.; Otkallo, K.; Pintea, A.; Salazar, C.; Oroz, T.; Hargreaves, B.; Ciobanu, R.; Tabrea, A.; Hazebrouck, B.; Salvi, O.; Stockmann-Juvala, H.; Vaananen, V.; Pui, D. H. Y.; Thompson, Drew

    2015-05-01

    This paper presents a general overview of the work carried out by European project SCAFFOLD (GA 280535) during its 30 months of life, with special emphasis on risk management component. The research conducted by SCAFFOLD is focused on the European construction sector and considers 5 types of nanomaterials (TiO2, SiO2, carbon nanofibres, cellulose nanofibers and nanoclays), 6 construction applications (Depollutant mortars, selfcompacting concretes, coatings, self-cleaning coatings, fire resistant panels and insulation materials) and 26 exposure scenarios, including lab, pilot and industrial scales. The document focuses on the structure, content and operation modes of the Risk Management Toolkit developed by the project to facilitate the implementation of “nano-management” in construction companies. The tool deploys and integrated approach OHSAS 18001 - ISO 31000 and is currently being validated on 5 industrial case studies.

  9. WOMEN IN MANAGEMENT: Analysis of Current Population Survey Data

    DTIC Science & Technology

    2007-11-02

    were represented in management positions compared to their representation in all positions within particular industries, and (3) identified salary differentials between men and women in full- time management positions.

  10. Contract management of Ontario's cancer surgery wait times strategy.

    PubMed

    Cheng, Siu Mee; Irish, Jonathan C; Thompson, Leslee J

    2007-01-01

    The province of Ontario, as a result of the First Ministers' Meeting, was committed to addressing surgery wait times in Ontario. The Ministry of Health and Long-Term Care's response to this commitment was the Wait Times Strategy (WTS) initiative, which addressed access issues with the aim of positively impacting wait times in cancer surgery. Cancer Care Ontario (CCO) was tasked with managing the cancer surgery WTS. CCO engaged in accountability agreements with Ontario hospitals to provide incremental cancer surgery volumes, in return for one-time funding. Through the use of accountability agreements, CCO was able to tie service volume delivery, quality care initiatives and reporting requirements to funding. Other elements of the cancer surgery WTS implementation included the development of wait times definitions, guidelines and targets; the use of a performance management system; facilitation by existing regional cancer leads and continued development of regional cancer programs. Eight key lessons were learned: (1) baseline volume guarantees are critical to ensuring that wait times are positively impacted; (2) there is a need to create a balance between accountability and systems management; (3) clinical quality initiatives can be tied to funding initiatives; (4) allocations of services should be informed by many factors; (5) regional leadership is key to ensuring that local needs are met; (6) data are invaluable in improving performance; (7) there is regional disparity in service delivery, capacity and resources across the province; and (8) program sustainability is an underlying goal of the WTS for cancer surgery. The implication is that accountability agreements can be leveraged to create sustainable health management systems.

  11. Warehouse Performance and Supply Chain Management: Current Practices in the Use of Performance Measures.

    DTIC Science & Technology

    1996-05-01

    supply chain management logistics strategy, measure performance compared to companies with more traditional logistics strategies and how each of these two groups rate their performance measures in terms of effectiveness. Little research has been published in the area of warehouse performance measurements and this research provides exploratory information. In order to properly distinguish which companies use supply chain management versus companies which use a traditional logistics strategy, this study also provides a comprehensive literature review on

  12. Metacognitive Strategy Knowledge: Comparison of Former Reading Recovery Children and Their Current Classmates

    ERIC Educational Resources Information Center

    Schmitt, Maribeth Cassidy

    2003-01-01

    The purpose of this study was two-fold: (a) to explore the nature of elementary school children's metacognitive knowledge of strategies appropriate for before, during, and after reading; and (b) to determine whether children who had participated in Reading Recovery instruction in the first grade had similar understandings as their current third-…

  13. Parent Retrospective Recollections of Bullying and Current Views, Concerns, and Strategies to Cope with Children's Bullying

    ERIC Educational Resources Information Center

    Cooper, Leigh A.; Nickerson, Amanda B.

    2013-01-01

    In this study, parent history of bullying was examined in terms of general involvement with bullying, specific types of bullying experienced, level of hurtfulness associated with the experience, and when bullying occurred. Parent current views, levels of concern, and strategies used to cope with bullying were also evaluated. Finally, the…

  14. Regional Sediment Management Strategies for the Vicinity of St. Augustine Inlet, St. Johns County, Florida

    DTIC Science & Technology

    2016-07-01

    ER D C/ CH L TR -1 6- 12 Regional Sediment Management (RSM) Program Regional Sediment Management Strategies for the Vicinity of St. Augustine...default. Regional Sediment Management (RSM) Program ERDC/CHL TR-16-12 July 2016 Regional Sediment Management Strategies for the Vicinity of St...Augustine Inlet RSM” ERDC/CHL TR-16-12 ii Abstract This report provides a description of Regional Sediment Management (RSM) investigations performed

  15. Climate change implications of shifting forest management strategy in a boreal forest ecosystem of Norway.

    PubMed

    Bright, Ryan M; Antón-Fernández, Clara; Astrup, Rasmus; Cherubini, Francesco; Kvalevåg, Maria; Strømman, Anders H

    2014-02-01

    Empirical models alongside remotely sensed and station measured meteorological observations are employed to investigate both the local and global direct climate change impacts of alternative forest management strategies within a boreal ecosystem of eastern Norway. Stand-level analysis is firstly executed to attribute differences in daily, seasonal, and annual mean surface temperatures to differences in surface intrinsic biophysical properties across conifer, deciduous, and clear-cut sites. Relative to a conifer site, a slight local cooling of −0.13 °C at a deciduous site and −0.25 °C at a clear-cut site were observed over a 6-year period, which were mostly attributed to a higher albedo throughout the year. When monthly mean albedo trajectories over the entire managed forest landscape were taken into consideration, we found that strategies promoting natural regeneration of coniferous sites with native deciduous species led to substantial global direct climate cooling benefits relative to those maintaining current silviculture regimes – despite predicted long-term regional warming feedbacks and a reduced albedo in spring and autumn months. The magnitude and duration of the cooling benefit depended largely on whether management strategies jointly promoted an enhanced material supply over business-as-usual levels. Expressed in terms of an equivalent CO2 emission pulse at the start of the simulation, the net climate response at the end of the 21st century spanned −8 to −159 Tg-CO2-eq., depending on whether near-term harvest levels increased or followed current trends, respectively. This magnitude equates to approximately −20 to −300% of Norway's annual domestic (production) emission impact. Our analysis supports the assertion that a carbon-only focus in the design and implementation of forest management policy in boreal and other climatically similar regions can be counterproductive – and at best – suboptimal if boreal forests are to be used as a

  16. Current available strategies to mitigate greenhouse gas emissions in livestock systems: an animal welfare perspective.

    PubMed

    Llonch, P; Haskell, M J; Dewhurst, R J; Turner, S P

    2017-02-01

    Livestock production is a major contributor to greenhouse gas (GHG) emissions, so will play a significant role in the mitigation effort. Recent literature highlights different strategies to mitigate GHG emissions in the livestock sector. Animal welfare is a criterion of sustainability and any strategy designed to reduce the carbon footprint of livestock production should consider animal welfare amongst other sustainability metrics. We discuss and tabulate the likely relationships and trade-offs between the GHG mitigation potential of mitigation strategies and their welfare consequences, focusing on ruminant species and on cattle in particular. The major livestock GHG mitigation strategies were classified according to their mitigation approach as reducing total emissions (inhibiting methane production in the rumen), or reducing emissions intensity (Ei; reducing CH4 per output unit without directly targeting methanogenesis). Strategies classified as antimethanogenic included chemical inhibitors, electron acceptors (i.e. nitrates), ionophores (i.e. Monensin) and dietary lipids. Increasing diet digestibility, intensive housing, improving health and welfare, increasing reproductive efficiency and breeding for higher productivity were categorized as strategies that reduce Ei. Strategies that increase productivity are very promising ways to reduce the livestock carbon footprint, though in intensive systems this is likely to be achieved at the cost of welfare. Other strategies can effectively reduce GHG emissions whilst simultaneously improving animal welfare (e.g. feed supplementation or improving health). These win-win strategies should be strongly supported as they address both environmental and ethical sustainability. In order to identify the most cost-effective measures for improving environmental sustainability of livestock production, the consequences of current and future strategies for animal welfare must be scrutinized and contrasted against their effectiveness

  17. Case Management in Community Corrections: Current Status and Future Directions

    ERIC Educational Resources Information Center

    Day, Andrew; Hardcastle, Lesley; Birgden, Astrid

    2012-01-01

    Case management is commonly regarded as the foundation of effective service provision across a wide range of human service settings. This article considers the case management that is offered to clients of community corrections, identifying the distinctive features of case management in this particular setting, and reviewing the empirical evidence…

  18. Risk management of seasonal influenza during pregnancy: current perspectives

    PubMed Central

    Yudin, Mark H

    2014-01-01

    Influenza poses unique risks to pregnant women, who are particularly susceptible to morbidity and mortality. Historically, pregnant women have been overrepresented among patients with severe illness and complications from influenza, and have been more likely to require hospitalization and intensive care unit admission. An increased risk of adverse outcomes is also present for fetuses/neonates born to women affected by influenza during pregnancy. These risks to mothers and babies have been observed during both nonpandemic and pandemic influenza seasons. During the H1N1 influenza pandemic of 2009–2010, pregnant women were more likely to be hospitalized or admitted to intensive care units, and were at higher risk of death compared to nonpregnant adults. Vaccination remains the most effective intervention to prevent severe illness, and antiviral medications are an important adjunct to ameliorate disease when it occurs. Unfortunately, despite national guidelines recommending universal vaccination for women who are pregnant during influenza season, actual vaccination rates do not achieve desired targets among pregnant women. Pregnant women are also sometimes reluctant to use antiviral medications during pregnancy. Some of the barriers to use of vaccines and medications during pregnancy are a lack of knowledge of recommendations and of safety data. By improving knowledge and understanding of influenza and vaccination recommendations, vaccine acceptance rates among pregnant women can be improved. Currently, the appropriate use of vaccination and antiviral medications is the best line of defense against influenza and its sequelae among pregnant women, and strategies to increase acceptance are crucial. This article will review the importance of influenza in pregnancy, and discuss vaccination and antiviral medications for pregnant women. PMID:25114593

  19. Blending Effective Behavior Management and Literacy Strategies for Preschoolers Exhibiting Negative Behavior

    ERIC Educational Resources Information Center

    Smith, Jaime

    2009-01-01

    Sometimes students will exhibit various aggressive behaviors in the preschool classroom. Early childhood educators need to have behavior management strategies to manage the students' negative behaviors within the classroom setting. This article will provide a rationale for embedding literacy instruction within behavior management strategies to…

  20. Dementia Management Strategies and Adjustment of Family Members of Older Patients.

    ERIC Educational Resources Information Center

    Hinrichsen, Gregory A.; Niederehe, George

    1994-01-01

    Examined how strategies to manage dementia problems in 152 older people were associated with adjustment of family members while providing assistance to relative. Identified three dementia management strategies (criticism, encouragement, and active management) that were associated with three indices of family members' emotional adjustment (burden,…

  1. Antioxidant Strategies in the Management of Diabetic Neuropathy

    PubMed Central

    Oyenihi, Ayodeji Babatunde; Ayeleso, Ademola Olabode; Masola, Bubuya

    2015-01-01

    Chronic hyperglycaemia (an abnormally high glucose concentration in the blood) resulting from defects in insulin secretion/action, or both, is the major hallmark of diabetes in which it is known to be involved in the progression of the condition to different complications that include diabetic neuropathy. Diabetic neuropathy (diabetes-induced nerve damage) is the most common diabetic complication and can be devastating because it can lead to disability. There is an increasing body of evidence associating diabetic neuropathy with oxidative stress. Oxidative stress results from the production of oxygen free radicals in the body in excess of its ability to eliminate them by antioxidant activity. Antioxidants have different mechanisms and sites of actions by which they exert their biochemical effects and ameliorate nerve dysfunction in diabetes by acting directly against oxidative damage. This review will examine different strategies for managing diabetic neuropathy which rely on exogenous antioxidants. PMID:25821809

  2. STRATEGIES AND TECHNOLOGY FOR MANAGING HIGH-CARBON ASH

    SciTech Connect

    Robert Hurt; Eric Suuberg; John Veranth; Xu Chen

    2002-09-10

    The overall objective of the present project is to identify and assess strategies and solutions for the management of industry problems related to carbon in ash. Specific research issues to be addressed include: (1) the effect of parent fuel selection on ash properties and adsorptivity, including a first ever examination of the air entrainment behavior of ashes from alternative (non-coal) fuels; (2) the effect of various low-NOx firing modes on ash properties and adsorptivity; and (3) the kinetics and mechanism of ash ozonation. This data will provide scientific and engineering support of the ongoing process development activities. During this fourth project period we completed the characterization of ozone-treated carbon surfaces and wrote a comprehensive report on the mechanism through which ozone suppresses the adsorption of concrete surfactants.

  3. STRATEGIES AND TECHNOLOGY FOR MANAGING HIGH-CARBON ASH

    SciTech Connect

    Robert Hurt; Eric Suuberg; John Veranth; Xu Chen

    2003-05-20

    The overall objective of the present project is to identify and assess strategies and solutions for the management of industry problems related to carbon in ash. Specific research issues to be addressed include: (1) the effect of parent fuel selection on ash properties and adsorptivity, including a first ever examination of the air entrainment behavior of ashes from alternative (non-coal) fuels; (2) the effect of various low-NOx firing modes on ash properties and adsorptivity; and (3) the kinetics and mechanism of ash ozonation. This data will provide scientific and engineering support of the ongoing process development activities. During this fourth project period we completed the characterization of ozone-treated carbon surfaces and wrote a comprehensive report on the mechanism through which ozone suppresses the adsorption of concrete surfactants.

  4. Biosolids management strategies: an evaluation of energy production as an alternative to land application.

    PubMed

    Egan, Maureen

    2013-07-01

    Currently, more than half of the biosolids produced within the USA are land applied. Land application of biosolids introduces organic contaminants into the environment. There are potential ecological and human health risks associated with land application of biosolids. Biosolids may be used as a renewable energy source. Nutrients may be recovered from biosolids used for energy generation for use as fertilizer. The by-products of biosolids energy generation may be used beneficially in construction materials. It is recommended that energy generation replace land application as the leading biosolids management strategy.

  5. Practical Strategies to Enhance Executive Functioning and Strengthen Diabetes Management Across the Lifespan

    PubMed Central

    Hilliard, Marisa E.; Schwartz, David D.; Anderson, Barbara J.

    2015-01-01

    The complex type 1 diabetes (T1D) management regimen places extra demands on one's ability to plan, organize, and problem-solve, a set of skills described as executive functioning (EF). Research on the relation between EF and T1D management has been mounting and suggest that deficits in EF skills likely interfere with optimal management. However, given the substantial EF demands of T1D management, any person with T1D, including those without clinically significant deficits, could likely benefit from strategies to improve diabetes-related EF skills. The current review outlines typical EF development across the lifespan and suggests behavioral strategies (e.g., environmental modifications) from the EF literature and clinical experience to enhance EF skills at each period of development. When executive dysfunction is suspected, formal neuropsychological assessment is recommended as EF concerns can be a significant problem of their own, or they could be an indicator of another psychological disorder, such as depression or dementia. PMID:26084581

  6. Practical strategies to enhance executive functioning and strengthen diabetes management across the lifespan.

    PubMed

    Wasserman, Rachel M; Hilliard, Marisa E; Schwartz, David D; Anderson, Barbara J

    2015-08-01

    The complex type 1 diabetes (T1D) management regimen places extra demands on one's ability to plan, organize, and problem-solve, a set of skills described as executive functioning (EF). Research on the relation between EF and T1D management has been mounting and suggest that deficits in EF skills likely interfere with optimal management. However, given the substantial EF demands of T1D management, any person with T1D, including those without clinically significant deficits, could likely benefit from strategies to improve diabetes-related EF skills. The current review outlines typical EF development across the lifespan and suggests behavioral strategies (e.g., environmental modifications) from the EF literature and clinical experience to enhance EF skills at each period of development. When executive dysfunction is suspected, formal neuropsychological assessment is recommended as EF concerns can be a significant problem of their own, or they could be an indicator of another psychological disorder, such as depression or dementia.

  7. Business Management Coaching: Focusing on Entrepreneur's Current Position and Aims

    ERIC Educational Resources Information Center

    Cheah, Kheng T.

    2012-01-01

    One-to-one business coaching over 6 months was provided to nine clients in Hawaii to help them acquire business transition skills. The STARS model was used to determine the individual business situation and to explore suitable leadership strategies to move forward. Systematically, each client developed a business model, business strategies, a…

  8. Integrated design strategy for product life-cycle management

    NASA Astrophysics Data System (ADS)

    Johnson, G. Patrick

    2001-02-01

    Two major trends suggest new considerations for environmentally conscious manufacturing (ECM) -- the continuation of dematerialization and the growing trend toward goods becoming services. A diversity of existing research could be integrated around those trends in ways that can enhance ECM. Major research-based achievements in information, computation, and communications systems, sophisticated and inexpensive sensing capabilities, highly automated and precise manufacturing technologies, and new materials continue to drive the phenomenon of dematerialization - the reduction of the material and energy content of per capita GDP. Knowledge is also growing about the sociology, economics, mathematics, management and organization of complex socio-economic systems. And that has driven a trend towards goods evolving into services. But even with these significant trends, the value of material, energy, information and human resources incorporated into the manufacture, use and disposal of modern products and services often far exceeds the benefits realized. Multi-disciplinary research integrating these drivers with advances in ECM concepts could be the basis for a new strategy of production. It is argued that a strategy of integrating information resources with physical and human resources over product life cycles, together with considering products as streams of service over time, could lead to significant economic payoff. That strategy leads to an overall design concept to minimize costs of all resources over the product life cycle to more fully capture benefits of all resources incorporated into modern products. It is possible by including life cycle monitoring, periodic component replacement, re-manufacture, salvage and human factor skill enhancement into initial design.

  9. Contemporary strategies in the diagnosis and management of heart failure.

    PubMed

    Dunlay, Shannon M; Pereira, Naveen L; Kushwaha, Sudhir S

    2014-05-01

    Heart failure (HF) is an important public health problem, and strategies are needed to improve outcomes and decrease health care resource utilization and costs. Its prevalence has increased as the population ages, and HF continues to be associated with a high mortality rate and frequent need for hospitalization. The total cost of care for patients with HF was $30.7 billion in 2012, and it is estimated to more than double to $69.8 billion by 2030. Given this reality, there has been recent investigation into ways of identifying and preventing HF in patients at risk (stage A HF) and those with cardiac structural and functional abnormalities but no clinical HF symptoms (stage B). For patients who have symptoms of HF (stage C), there has been important research into the most effective ways to decongest patients hospitalized with acute decompensated HF and prevent future hospital readmissions. Successful strategies to treat patients with HF and preserved ejection fraction, which has increased in prevalence, continue to be sought. We are in the midst of a rapid evolution in our ability to care for patients with end-stage HF (stage D) because of the introduction of and improvements in mechanical circulatory support. Left ventricular assist devices used as destination therapy offer an important therapeutic option to patients who do not qualify for heart transplant because of advanced age or excessive comorbidity. This review provides a thorough update on contemporary strategies in the diagnosis and management of HF by stage (A to D) that have emerged during the past several years.

  10. Information Management Strategies in Early Adolescence: Developmental Change in Use and Transactional Associations with Psychological Adjustment

    ERIC Educational Resources Information Center

    Laird, Robert D.; Marrero, Matthew D.; Melching, Jessica A.; Kuhn, Emily S.

    2013-01-01

    Adolescents use various strategies to manage their parents' access to information. This study tested developmental change in strategy use, longitudinal associations between disclosing and concealing strategies, and longitudinal associations linking disclosing and concealing strategies with antisocial behavior and depressive symptoms. Self-report…

  11. Implications for local and global climate of alternative forest management strategies in Norway

    NASA Astrophysics Data System (ADS)

    Bright, Ryan M.; Antón-Fernández, Clara; Astrup, Rasmus; Cherubini, Francesco; Kvalevåg, Maria; Hammer Strømman, Anders

    2014-05-01

    We applied a mix of observation and empirical models to evaluate both local and global climate effects of three realistic alternative forest management scenarios in the boreal forests of Norway's largest logging region. The alternative management scenarios embraced strategies aimed at increasing harvest intensities and allowing harvested conifer sites to regenerate naturally with broadleaved species. Stand-level analysis was firstly executed to attribute differences in daily, seasonal, and annual mean surface temperatures to differences in surface intrinsic biophysical properties across coniferous, deciduous, and clear-cut sites. Relative to a coniferous site, we observed a slight local cooling of 0.13 °C at a deciduous site and 0.25 °C at a clear-cut site over a 6-year period which was mostly attributed to a higher albedo throughout the year. When monthly mean albedo trajectories over the entire managed forest landscape were taken into consideration, we found that strategies promoting natural regeneration of coniferous sites with native deciduous species led to substantial global direct climate cooling benefits relative to those maintaining current silviculture regimes - despite predicted long-term regional warming feedbacks and a reduced albedo in spring and autumn months. The magnitude and duration of the cooling benefit depended largely on whether management strategies simultaneously promoted an enhanced material supply over business-as-usual levels. While additional climate impact linked to changes in life-cycle emissions and to changes in the global supply and demand of timber products ought to be factored into any mitigation-oriented climate policy involving the forestry sector, our analysis demonstrates that - within the boundaries of the managed forest ecosystem - excluding important biogeophysical considerations like surface albedo change may lead to sub-optimal climate policy.

  12. Ebola hemorrhagic fever outbreaks: strategies for effective epidemic management, containment and control.

    PubMed

    Matua, Gerald Amandu; Van der Wal, Dirk Mostert; Locsin, Rozzano C

    2015-01-01

    Ebola hemorrhagic fever, caused by the highly virulent RNA virus of the filoviridae family, has become one of the world's most feared pathogens. The virus induces acute fever and death, often associated with hemorrhagic symptoms in up to 90% of infected patients. The known sub-types of the virus are Zaire, Sudan, Taï Forest, Bundibugyo and Reston Ebola viruses. In the past, outbreaks were limited to the East and Central African tropical belt with the exception of Ebola Reston outbreaks that occurred in animal facilities in the Philippines, USA and Italy. The on-going outbreak in West Africa that is causing numerous deaths and severe socio-economic challenges has resulted in widespread anxiety globally. This panic may be attributed to the intense media interest, the rapid spread of the virus to other countries like United States and Spain, and moreover, to the absence of an approved treatment or vaccine. Informed by this widespread fear and anxiety, we analyzed the commonly used strategies to manage and control Ebola outbreaks and proposed new approaches that could improve epidemic management and control during future outbreaks. We based our recommendations on epidemic management practices employed during recent outbreaks in East, Central and West Africa, and synthesis of peer-reviewed publications as well as published "field" information from individuals and organizations recently involved in the management of Ebola epidemics. The current epidemic management approaches are largely "reactive", with containment efforts aimed at halting spread of existing outbreaks. We recommend that for better outcomes, in addition to "reactive" interventions, "pre-emptive" strategies also need to be instituted. We conclude that emphasizing both "reactive" and "pre-emptive" strategies is more likely to lead to better epidemic preparedness and response at individual, community, institutional, and government levels, resulting in timely containment of future Ebola outbreaks.

  13. Current state of hereditary angioedema management: a patient survey.

    PubMed

    Banerji, Aleena; Busse, Paula; Christiansen, Sandra C; Li, Henry; Lumry, William; Davis-Lorton, Mark; Bernstein, Jonathan A; Frank, Michael; Castaldo, Anthony; Long, Janet F; Zuraw, Bruce L; Riedl, Marc

    2015-01-01

    Hereditary angioedema (HAE) is a chronic disease with a high burden of disease that is poorly understood and often misdiagnosed. Availability of treatments, including C1 esterase inhibitor (C1INH) replacement, ecallantide, and icatibant, marks a significant advance for HAE patients. We aimed to better understand the current state of HAE care, from a patient perspective, after the introduction of several novel therapies. One session of the United States Hereditary Angioedema Association 2013 patient summit was devoted to data collection for this study. Patients attending the summit were self-selected, and HAE diagnosis was self-reported. Survey questions assessed patient characteristics, burden of disease, and treatment. Participant responses were captured using an audience response system. We surveyed 149 (80%) type I and II HAE (HAE-C1INH) and 37 (20%) HAE with normal C1INH (HAE-nlC1INH) patients. HAE-C1INH (72%) and HAE-nlCINH patients (76%) equally reported that HAE had a significant impact on quality of life (QOL). A third of HAE-C1INH patients were diagnosed within one year of their first HAE attack, but another third reported a delay of more than 10 years. Most HAE-C1INH (88%) and HAE-nlC1INH (76%) patients had on-demand treatment available. HAE-C1INH patients frequently had an individual treatment plan (76%) compared with 50% of HAE-nlC1INH patients. Most HAE-C1INH patients went to the emergency department (ED) or were hospitalized less than once every six months (80%). Our findings show that HAE management is improving with good access to on-demand and prophylactic treatment options. However, HAE patients still have a significant burden of disease and continued research and educational efforts are needed.

  14. Current state of hereditary angioedema management: A patient survey

    PubMed Central

    Busse, Paula; Christiansen, Sandra C.; Li, Henry; Lumry, William; Davis-Lorton, Mark; Bernstein, Jonathan A.; Frank, Michael; Castaldo, Anthony; Long, Janet F.; Zuraw, Bruce L.; Riedl, Marc

    2015-01-01

    Hereditary angioedema (HAE) is a chronic disease with a high burden of disease that is poorly understood and often misdiagnosed. Availability of treatments, including C1 esterase inhibitor (C1INH) replacement, ecallantide, and icatibant, marks a significant advance for HAE patients. We aimed to better understand the current state of HAE care, from a patient perspective, after the introduction of several novel therapies. One session of the United States Hereditary Angioedema Association 2013 patient summit was devoted to data collection for this study. Patients attending the summit were self-selected, and HAE diagnosis was self-reported. Survey questions assessed patient characteristics, burden of disease, and treatment. Participant responses were captured using an audience response system. We surveyed 149 (80%) type I and II HAE (HAE-C1INH) and 37 (20%) HAE with normal C1INH (HAE-nlC1INH) patients. HAE-C1INH (72%) and HAE-nlCINH patients (76%) equally reported that HAE had a significant impact on quality of life (QOL). A third of HAE-C1INH patients were diagnosed within one year of their first HAE attack, but another third reported a delay of more than 10 years. Most HAE-C1INH (88%) and HAE-nlC1INH (76%) patients had on-demand treatment available. HAE-C1INH patients frequently had an individual treatment plan (76%) compared with 50% of HAE-nlC1INH patients. Most HAE-C1INH patients went to the emergency department (ED) or were hospitalized less than once every six months (80%). Our findings show that HAE management is improving with good access to on-demand and prophylactic treatment options. However, HAE patients still have a significant burden of disease and continued research and educational efforts are needed. PMID:25976438

  15. Retaining Staff Employees: The Relationship between Human Resources Management Strategies and Organizational Commitment.

    ERIC Educational Resources Information Center

    Buck, Jeffrey M.; Watson, John L.

    2002-01-01

    Explored whether an institution's human resources management (HRM) strategies can influence individuals' organizational commitment levels, which ultimately can affect staff turnover rates. Found significant relationship between certain HRM strategies and commitment constructs. (EV)

  16. Green supply chain management strategy selection using analytic network process: case study at PT XYZ

    NASA Astrophysics Data System (ADS)

    Adelina, W.; Kusumastuti, R. D.

    2017-01-01

    This study is about business strategy selection for green supply chain management (GSCM) for PT XYZ by using Analytic Network Process (ANP). GSCM is initiated as a response to reduce environmental impacts from industrial activities. The purposes of this study are identifying criteria and sub criteria in selecting GSCM Strategy, and analysing a suitable GSCM strategy for PT XYZ. This study proposes ANP network with 6 criteria and 29 sub criteria, which are obtained from the literature and experts’ judgements. One of the six criteria contains GSCM strategy options, namely risk-based strategy, efficiency-based strategy, innovation-based strategy, and closed loop strategy. ANP solves complex GSCM strategy-selection by using a more structured process and considering green perspectives from experts. The result indicates that innovation-based strategy is the most suitable green supply chain management strategy for PT XYZ.

  17. Strategies for the Use of Tidal Stream Currents for Power Generation

    NASA Astrophysics Data System (ADS)

    Orhan, Kadir; Mayerle, Roberto

    2015-04-01

    Indonesia is one of the priority countries in Southeast Asia for the development of ocean renewable energy facilities and The National Energy Council intends to increase the role of ocean energy significantly in the energy mix for 2010-2050. To this end, the joint German-Indonesian project "Ocean Renewable Energy ORE-12" aims at the identification of marine environments in the Indonesian Archipelago, which are suitable for the efficient generation of electric power by converter facilities. This study, within the ORE-12 project, is focused on the tidal stream currents on the straits between the Indian Ocean and Flores Sea to estimate the energy potentials and to develop strategies for producing renewable energy. FLOW module of Delft3D has been used to run hydrodynamic models for site assessment and design development. In site assessment phase, 2D models have been operated for a-month long periods and with a resolution of 500 m. Later on, in design development phase, detailed 3D models have been developed and operated for three-month long periods and with a resolution of 50 m. Bathymetric data for models have been obtained from the GEBCO_08 Grid and wind data from the Global Forecast System of NOAA's National Climatic Data Center. To set the boundary conditions of models, tidal forcing with 11 harmonic constituents was supplied from TPXO Indian Ocean Atlas (1/12° regional model) and data from HYCOM+NCODA Global 1/12° Analysis have been used to determine salinity and temperature on open boundaries. After the field survey is complete, water level time-series supplied from a tidal gauge located in the domain of interest (8° 20΄ 9.7" S, 122° 54΄ 51.9" E) have been used to verify the models and then energy potentials of the straits have been estimated. As a next step, correspondence between model outputs and measurements taken by the radar system of TerraSAR-X satellite (DLR) will be analysed. Also for the assessment of environmental impacts caused by tidal stream

  18. Fluorescent Labeling of Plasmid DNA and mRNA: Gains and Losses of Current Labeling Strategies.

    PubMed

    Rombouts, K; Braeckmans, K; Remaut, K

    2016-02-17

    Live-cell imaging has provided the life sciences with insights into the cell biology and dynamics. Fluorescent labeling of target molecules proves to be indispensable in this regard. In this Review, we focus on the current fluorescent labeling strategies for nucleic acids, and in particular mRNA (mRNA) and plasmid DNA (pDNA), which are of interest to a broad range of scientific fields. By giving a background of the available techniques and an evaluation of the pros and cons, we try to supply scientists with all the information needed to come to an informed choice of nucleic acid labeling strategy aimed at their particular needs.

  19. Current strategies to create tailored and risk-adapted therapies for CLL patients.

    PubMed

    Cramer, Paula; Eichhorst, Barbara; Reinhardt, Hans Christian; Hallek, Michael

    2016-03-01

    Given the current dynamics in the development of novel agents for CLL therapy, the task to find optimal, non-toxic combinations has become the primary goal. This article gives an update of the most interesting novel drugs. The strategy of the German CLL Study Group to use these agents in combinations is described in detail, highlighting the strategy and first results of a recently started series of phase II combination trials, the BXX series using agents such as bendamustine, idelalisib, ibrutinib, obinutuzumab, ofatumumab and venetoclax.

  20. The management of anthelmintic resistance in grazing ruminants in Australasia--strategies and experiences.

    PubMed

    Leathwick, D M; Besier, R B

    2014-07-30

    In many countries the presence of anthelmintic resistance in nematodes of small ruminants, and in some cases also in those infecting cattle and horses, has become the status quo rather than the exception. It is clear that consideration of anthelmintic resistance, and its management, should be an integral component of anthelmintic use regardless of country or host species. Many years of research into understanding the development and management of anthelmintic resistance in nematodes of small ruminants has resulted in an array of strategies for minimising selection for resistance and for dealing with it once it has developed. Importantly, many of these strategies are now supported by empirical science and some have been assessed and evaluated on commercial farms. In sheep the cost of resistance has been measured at about 10% of the value of the lamb at sale which means that losses due to undetected resistance far outweigh the cost of testing anthelmintic efficacy. Despite this many farmers still do not test for anthelmintic resistance on their farm. Many resistance management strategies have been developed and some of these have been tailored for specific environments and/or nematode species. However, in general, most strategies can be categorised as either; identify and mitigate high risk management practices, maintain an anthelmintic-susceptible population in refugia, choose the optimal anthelmintic (combinations and formulations), or prevent the introduction of resistant nematodes. Experiences with sheep farmers in both New Zealand and Australia indicate that acceptance and implementation of resistance management practices is relatively easy as long as the need to do so is clear and the recommended practices meet the farmer's criteria for practicality. A major difference between Australasia and many other countries is the availability and widespread acceptance of combination anthelmintics as a resistance management tool. The current situation in cattle and horses

  1. Adapting global influenza management strategies to address emerging viruses.

    PubMed

    Noah, Diana L; Noah, James W

    2013-07-15

    Death by respiratory complications from influenza infections continues to be a major global health concern. Antiviral drugs are widely available for therapy and prophylaxis, but viral mutations have resulted in resistance that threatens to reduce the long-term utility of approved antivirals. Vaccination is the best method for controlling influenza, but vaccine strategies are blunted by virus antigenic drift and shift. Genetic shift in particular has led to four pandemics in the last century, which have prompted the development of efficient global surveillance and vaccination programs. Although the influenza pandemic of 2009 emphasized the need for the rapid standardization of global surveillance methods and the preparation and dissemination of global assay standards for improved reporting and diagnostic tools, outbreaks of novel influenza strains continue to occur, and current efforts must be enhanced by aggressive public education programs to promote increased vaccination rates in the global population. Recently, a novel H7N9 avian influenza virus with potential to become a pandemic strain emerged in China and was transmitted from animals to humans with a demonstrated >20% mortality rate. Sporadic outbreaks of highly lethal avian virus strains have already increased public awareness and altered annual vaccine production strategies to prevent the natural adaption of this virus to human-to-human transmission. Additional strategies for combating influenza include advancement of new antivirals for unexploited viral or host cellular targets; novel adjuvants and alternate vaccine delivery systems; and development of universal protein, DNA, or multivalent vaccines designed to increase immune responsiveness and enhance public health response times.

  2. Nutrition and Physical Activity Strategies for Cancer Prevention in Current National Comprehensive Cancer Control Program Plans.

    PubMed

    Puckett, Mary; Neri, Antonio; Underwood, J Michael; Stewart, Sherri L

    2016-10-01

    Obesity, diet and physical inactivity are risk factors for some cancers. Grantees of the National Comprehensive Cancer Control Program (NCCCP) in US states, tribes, and territories develop plans to coordinate funding and activities for cancer prevention and control. Including information and goals related to nutrition and physical activity (NPA) is a key opportunity for primary cancer prevention, but it is currently unclear to what extent NCCCP plans address these issues. We reviewed 69 NCCCP plans and searched for terms related to NPA. Plans were coded as (1) knowledge of NPA and cancer link; (2) goals to improve NPA behaviors; and (3) strategies to increase healthy NPA activities, environments, or systems changes. NPA content was consistently included in all cancer plans examined across all years. Only 4 (6 %) outlined only the relationship between NPA and cancer without goals or strategies. Fifty-nine plans (89 %) contained goals or strategies related to NPA, with 53 (82 %) including both. However, numbers of goals, strategies, and detail provided varied widely. All programs recognized the importance of NPA in cancer prevention. Most plans included NPA goals and strategies. Increasing the presence of NPA strategies that can be modified or adapted appropriately locally could help with more widespread implementation and measurement of NPA interventions.

  3. Strategy for Texture Management in Metals Additive Manufacturing

    NASA Astrophysics Data System (ADS)

    Kirka, M. M.; Lee, Y.; Greeley, D. A.; Okello, A.; Goin, M. J.; Pearce, M. T.; Dehoff, R. R.

    2017-03-01

    Additive manufacturing (AM) technologies have long been recognized for their ability to fabricate complex geometric components directly from models conceptualized through computers, allowing for complicated designs and assemblies to be fabricated at lower costs, with shorter time to market, and improved function. Lacking behind the design complexity aspect is the ability to fully exploit AM processes for control over texture within AM components. Currently, standard heat-fill strategies utilized in AM processes result in largely columnar grain structures. Proposed in this work is a point heat source fill for the electron beam melting (EBM) process through which the texture in AM materials can be controlled. Through this point heat source strategy, the ability to form either columnar or equiaxed grain structures upon solidification through changes in the process parameters associated with the point heat source fill is demonstrated for the nickel-base superalloy, Inconel 718. Mechanically, the material is demonstrated to exhibit either anisotropic properties for the columnar-grained material fabricated through using the standard raster scan of the EBM process or isotropic properties for the equiaxed material fabricated using the point heat source fill.

  4. Motor complications in Parkinson's disease: a comprehensive review of emergent management strategies.

    PubMed

    Marques de Sousa, Susana; Massano, João

    2013-11-01

    Motor complications (dyskinesias and motor fluctuations) are a common and disabling problem of dopaminergic therapy in Parkinson's disease, which are often difficult to treat with the current therapeutic strategies. It has been proposed that continuous dopaminergic delivery could reduce the emergence of motor complications, which has been tried with levodopa intestinal infusion or subcutaneous apomorphine infusion. In selected refractory cases, surgical approaches such as deep brain stimulation should be considered. Ongoing clinical and preclinical research tried to lead the field into the discovery of other therapeutic targets and strategies that might prevent or reduce motor complications. These include drugs targeting non-dopaminergic systems (e.g. glutamatergic, serotonergic, noradrenergic, adenosinergic and cholinergic systems), gene therapy for delivering neurotrophic factors or critical enzymes for dopamine synthesis, and cell therapy. These studies found variable results, some of them promising, with the possibility of new therapeutic armamentarium in the management of Parkinson's disease in the near future.

  5. An integrated water resources management strategy for Al-Ain City, United Arab Emirates

    NASA Astrophysics Data System (ADS)

    Mohamed, M. M.

    2014-09-01

    Al-Ain is the second largest city in the Emirate of Abu Dhabi and the third in the UAE. Currently, desalination plants are the only source of drinking water in the city with an average daily supply of 170 MIG. Recently, Abu Dhabi Urban Planning Council (UPC) released Al-Ain 2030 Plan. Projects suggested in this plan, over and above the expected natural population growth, will certainly put additional stress on the water resources in the city. Therefore, Al-Ain city seems to be in urgent need for an integrated water resources management strategy towards achieving sustainable development. This strategy will contain three main components; namely, a Water Demand Forecasting Model (WDFM), a Water Budget Model (WBM), and a Water Resources Optimization Model (WROM). The main aim of this paper is to present the WBM that estimates all inflows and outflows to assess water resources sustainability in the city.

  6. An Integrated Modeling and Data Management Strategy for Cellulosic Biomass Production Decisions

    SciTech Connect

    David J. Muth Jr.; K. Mark Bryden; Joshua B. Koch

    2012-07-01

    Emerging cellulosic bioenergy markets can provide land managers with additional options for crop production decisions. Integrating dedicated bioenergy crops such as perennial grasses and short rotation woody species within the agricultural landscape can have positive impacts on several environmental processes including increased soil organic matter in degraded soils, reduced sediment loading in watersheds, lower green house gas (GHG) fluxes, and reduced nutrient loading in watersheds. Implementing this type of diverse bioenergy production system in a way that maximizes potential environmental benefits requires a dynamic integrated modeling and data management strategy. This paper presents a strategy for designing diverse bioenergy cropping systems within the existing row crop production landscape in the midwestern United States. The integrated model developed quantifies a wide range environmental processes including soil erosion from wind and water, soil organic matter changes, and soil GHG fluxes within a geospatial data management framework. This framework assembles and formats information from multiple spatial and temporal scales. The data assembled includes yield and productivity data from harvesting equipment at the 1m scale, surface topography data from LiDAR mapping at the less than 1m scale, soil data from US soil survey databases at the 10m to 100m scale, and climate data at the county scale. These models and data tools are assembled into an integrated computational environment that is used to determine sustainable removal rates for agricultural residues for bioenergy production at the sub-field scale under a wide range of land management practices. Using this integrated model, innovative management practices including cover cropping are then introduced and evaluated for their impact on bioenergy production and important environmental processes. The impacts of introducing dedicated energy crops onto high-risk landscape positions currently being manage in

  7. Mathematics, Pricing, Market Risk Management and Trading Strategies for Financial Derivatives (2/3)

    ScienceCinema

    None

    2016-07-12

    Market Trading and Risk Management of Vanilla FX Options - Measures of Market Risk - Implied Volatility - FX Risk Reversals, FX Strangles - Valuation and Risk Calculations - Risk Management - Market Trading Strategies

  8. Climate change on the Colorado River: a method to search for robust management strategies

    NASA Astrophysics Data System (ADS)

    Keefe, R.; Fischbach, J. R.

    2010-12-01

    The Colorado River is a principal source of water for the seven Basin States, providing approximately 16.5 maf per year to users in the southwestern United States and Mexico. Though the dynamics of the river ensure Upper Basin users a reliable supply of water, the three Lower Basin states (California, Nevada, and Arizona) are in danger of delivery interruptions as Upper Basin demand increases and climate change threatens to reduce future streamflows. In light of the recent drought and uncertain effects of climate change on Colorado River flows, we evaluate the performance of a suite of policies modeled after the shortage sharing agreement adopted in December 2007 by the Department of the Interior. We build on the current literature by using a simplified model of the Lower Colorado River to consider future streamflow scenarios given climate change uncertainty. We also generate different scenarios of parametric consumptive use growth in the Upper Basin and evaluate alternate management strategies in light of these uncertainties. Uncertainty associated with climate change is represented with a multi-model ensemble from the literature, using a nearest neighbor perturbation to increase the size of the ensemble. We use Robust Decision Making to compare near-term or long-term management strategies across an ensemble of plausible future scenarios with the goal of identifying one or more approaches that are robust to alternate assumptions about the future. This method entails using search algorithms to quantitatively identify vulnerabilities that may threaten a given strategy (including the current operating policy) and characterize key tradeoffs between strategies under different scenarios.

  9. Ovarian Hyperstimulation Syndrome: Current Views on Pathophysiology, Risk Factors, Prevention, and Management

    PubMed Central

    Alper, Michael M; Smith, Laura P; Sills, Eric Scott

    2009-01-01

    Objective: To summarize current views on the pathophysiology, risk factors, prevention, clinical features, and management of Ovarian Hyperstimulation Syndrome (OHSS). Design: Literature review Results: OHSS is a condition characterized by increased capillary permeability, and experimental evidence has identified a provocative link to pathologic vasoactive cytokine actions. Although the ultimate physiologic mechanism of OHSS is not yet known, there are well-known risk factors that must be considered during the administration of medications to treat infertility. Clinical features are consequences of third-spaced intravascular fluid, and OHSS may become life-threatening secondary to thromboembolism or compromised pulmonary or cardiovascular function. Cornerstones of prevention have historically included cycle cancellation, coasting, decreased dosing of human chorionic gonadotropin (hCG) trigger, use of an agonist trigger, and cryopreservation of all embryos. Newer methods of prevention include the administration of a dopamine agonist medication. Management options for OHSS include outpatient transvaginal paracentesis, outpatient transabdominal paracentesis, and inpatient hospitalization with or without paracentesis. Conclusions: OHSS continues to be a serious complication of assisted reproductive therapy (ART), with no universally agreed upon best method of prevention. Coasting and cryopreservation of all embryos are the most commonly used approaches in the literature, but cycle cancellation is the only method that can completely prevent the development of OHSS. Dopamine agonists are currently being investigated to both prevent and improve the clinical course in OHSS. Recent publications suggest that outpatient paracentesis both prevents the need for inpatient hospitalization and is a cost-effective strategy. PMID:20485578

  10. Targeted therapies with companion diagnostics in the management of breast cancer: current perspectives.

    PubMed

    Myers, Meagan B

    2016-01-01

    Breast cancer is a multifaceted disease exhibiting both intertumoral and intratumoral heterogeneity as well as variable disease course. Over 2 decades of research has advanced the understanding of the molecular substructure of breast cancer, directing the development of new therapeutic strategies against these actionable targets. In vitro diagnostics, and specifically companion diagnostics, have been integral in the successful development and implementation of these targeted therapies, such as those directed against the human epidermal growth factor receptor 2. Lately, there has been a surge in the development, commercialization, and marketing of diagnostic assays to assist in breast cancer patient care. More recently, multigene signature assays, such as Oncotype DX, MammaPrint, and Prosigna, have been integrated in the clinical setting in order to tailor decisions on adjuvant endocrine and chemotherapy treatment. This review provides an overview of the current state of breast cancer management and the use of companion diagnostics to direct personalized approaches in the treatment of breast cancer.

  11. [Evaluation of disease management programs--current deficits, demands and methods].

    PubMed

    Gerlach, Ferdinand M; Beyer, Martin; Szecsenyi, Joachim; Raspe, Heiner

    2003-10-01

    The evaluation of disease management programmes is necessary and has been made obligatory in Germany by the Fifth Book of Social Code. So far there has been extensive ambiguity as regards the precise definition of suitable strategies for the evaluation. Considering the scientific evaluation of the diabetes contract in North-Rhine current deficits of the evaluation of already existing programmes for chronically ill patients are exemplarily described. On the basis of international experience reasonable demands are discussed that ought to be accomplished when evaluating the effectiveness and benefit of the programmes. Taking the British Medical Research Council as an example, a four-step model will be suggested as a loophole in the methodological dilemma of varying suitable study designs, which allows for the adequate evaluation of even complex interventions.

  12. Prognostics and Health Management of Wind Turbines: Current Status and Future Opportunities

    SciTech Connect

    Sheng, Shuangwen

    2016-10-04

    This presentation was given at the 2016 Annual Conference of the Prognostics and Health Management Society. It covers the current status and challenges and opportunities of prognostics and health management of wind turbines.

  13. Treatment of Thrombotic Antiphospholipid Syndrome: The Rationale of Current Management-An Insight into Future Approaches.

    PubMed

    Chighizola, Cecilia Beatrice; Ubiali, Tania; Meroni, Pier Luigi

    2015-01-01

    Vascular thrombosis and pregnancy morbidity represent the clinical manifestations of antiphospholipid syndrome (APS), which is serologically characterized by the persistent positivity of antiphospholipid antibodies (aPL). Antiplatelet and anticoagulant agents currently provide the mainstay of APS treatment. However, the debate is still open: controversies involve the intensity and the duration of anticoagulation and the treatment of stroke and refractory cases. Unfortunately, the literature cannot provide definite answers to these controversial issues as it is flawed by many limitations, mainly due to the recruitment of patients not fulfilling laboratory and clinical criteria for APS. The recommended therapeutic management of different aPL-related clinical manifestations is hereby presented, with a critical appraisal of the evidence supporting such approaches. Cutting edge therapeutic strategies are also discussed, presenting the pioneer reports about the efficacy of novel pharmacological agents in APS. Thanks to a better understanding of aPL pathogenic mechanisms, new therapeutic targets will soon be explored. Much work is still to be done to unravel the most controversial issues about APS management: future studies are warranted to define the optimal management according to aPL risk profile and to assess the impact of a strict control of cardiovascular risk factors on disease control.

  14. Novel strategies: challenge loop diuretics and sodium management in heart failure--part II.

    PubMed

    Di Pasquale, Pietro; Sarullo, Filippo M; Paterna, Salvatorew

    2007-01-01

    The conflicting results of diuretic treatments in heart failure (HF) and the importance of Na management in the context of the cardiorenal syndrome and neurohormonal activation in HF have suggested novel and counterintuitive strategies, focused primarily on the use of vasopressin antagonists and hypertonic saline solution with high doses of loop diuretics and their neurohormonal interference. The emerging novel therapies involving direct inhibition of vasopressin receptors appear to show promising results. The use of hypertonic saline solution mixed with a high dose of loop diuretics produces, probably by indirect mechanisms, a reduction or inhibition of the activated neurohormonal systems in HF patients. This treatment opens a new window on the role of sodium management in these patients and on the relation between sodium and the kidney's role and function in heart failure. The authors review the current evidence for these therapies and suggest hypothetical bases for their efficacy.

  15. An optimized strategy for the management of spent steam generators

    SciTech Connect

    Cantrel, Eric; Denissen, Luc; Davain, Henri; Leveau, Jean-Phillipe; Lauwers, Johan; Gillet, Thierry

    2007-07-01

    The decommissioning of the BR3 (Belgian Reactor 3) approaches its final phase. The electro-mechanical dismantling is almost completed and the program related to the decontamination of the building structures has been initiated. The issue of the evacuation of the primary circuit large components, and more specifically of the Steam Generator (SG), has been dealt successfully, applying innovative technologies to lead to remarkable results in terms of waste volume minimization and occupational radiation exposure. The strategy applied for the evacuation of the BR3 SG resulted from the elaboration and comparison of the following scenarios: - Closed loop chemical decontamination prior to dismantling, cutting and unconditional release or release after melting, - Cutting of the components without decontamination and evacuation of the materials in their respective waste categories, - Cutting, decontamination of the SG secondary side and evacuation of the full SG primary side to the melting facility for recycling. While the availability of the in-house developed MEDOC{sup R} process made the clearance of the SG bundle technically feasible, nuclear safety requirements and financial aspects were also in favour of the closed loop decontamination: minimization of contamination spreading and staff exposure during all subsequent manipulations, minimization of radwaste costs. For the segmentation of this component, different techniques have been considered: An abrasive water jet (AWJ) cutting tool, A prototype diamond wire developed for this application. The diamond wire allowed to cut in a single pass both the carbon steel shell and the stainless steel tube bundle. While the implementation of the diamond wire saw is rather simple, working conditions must be optimised to limit wearing of the wire and secondary waste production. Existing experience can be extrapolated to different legal frameworks in order to propose a financially and technically optimised 'all-in' strategy for the

  16. CURRENT STATUS OF THE IAEA'S NET ENABLED WASTE MANAGEMENT DATABASE

    SciTech Connect

    Csullog, G.W.; Pozdniakov, I.; Bellag, M.J.

    2003-02-27

    The International Atomic Energy Agency's Net Enabled Waste Management Database (NEWMDB) contains information on national radioactive waste management programs and organizations, plans and activities, relevant laws and regulations, policies and radioactive waste inventories. The NEWMDB, which was launched on the Internet July 6, 2001, is the successor to the Agency's Waste Management Database (WMDB), which was in use during the 1990's. The NEWMDB's first data collection cycle took place from July 2001 to March 2002. Agency Member State participation in the first data collection cycle was low--only 22 submissions were received. However, the first data collection cycle demonstrated that: the NEWMDB could be used to collect information on national radioactive waste management programs and radioactive waste inventories annually, the NEWMDB data can support the routine reporting of status and trends in radioactive waste management based on quantitative data, the NEWMDB can support the compilation of a consolidated, international radioactive waste inventory based on a unified waste classification scheme, the data needed to compute an indicator of sustainable development for radioactive waste management are available at the national level, NEWMDB data can be used to assess the development and implementation of national systems for radioactive waste management, and the NEWMDB can support the reporting requirements of the Joint Convention on the Safety of Spent Fuel Management and on the Safety of Radioactive Waste Management. Agency Member States that had not made data submissions in the first cycle were asked to submit data during an extension of the first cycle (July 2002--January 2003). When this paper was written, the Agency had conducted two of three international workshops to provide training for future NEWMDB data collection cycles and to compile lessons learned for the first data collection cycle. A third workshop was scheduled for January 2003. This paper provides

  17. Current advancements and potential strategies in the development of MERS-CoV vaccines.

    PubMed

    Zhang, Naru; Jiang, Shibo; Du, Lanying

    2014-06-01

    Middle East respiratory syndrome (MERS) is a newly emerging infectious disease caused by a novel coronavirus, MERS-coronavirus (MERS-CoV), a new member in the lineage C of β-coronavirus (β-CoV). The increased human cases and high mortality rate of MERS-CoV infection make it essential to develop safe and effective vaccines. In this review, the current advancements and potential strategies in the development of MERS vaccines, particularly subunit vaccines based on MERS-CoV spike (S) protein and its receptor-binding domain (RBD), are discussed. How to improve the efficacy of subunit vaccines through novel adjuvant formulations and routes of administration as well as currently available animal models for evaluating the in vivo efficacy of MERS-CoV vaccines are also addressed. Overall, these strategies may have important implications for the development of effective and safe vaccines for MERS-CoV in the future.

  18. Current advancements and potential strategies in the development of MERS-CoV vaccines

    PubMed Central

    Zhang, Naru; Jiang, Shibo; Du, Lanying

    2014-01-01

    Middle East respiratory syndrome (MERS) is a newly emerging infectious disease caused by a novel coronavirus, MERS-coronavirus (MERS-CoV), a new member in the lineage C of β-coronavirus (β-CoV). The increased human cases and high mortality rate of MERS-CoV infection make it essential to develop safe and effective vaccines. In this review, the current advancements and potential strategies in the development of MERS vaccines, particularly subunit vaccines based on MERS-CoV spike (S) protein and its receptor-binding domain (RBD), are discussed. How to improve the efficacy of subunit vaccines through novel adjuvant formulations and routes of administration as well as currently available animal models for evaluating the in vivo efficacy of MERS-CoV vaccines are also addressed. Overall, these strategies may have important implications for the development of effective and safe vaccines for MERS-CoV in the future. PMID:24766432

  19. Modeling and managing urban water demand through smart meters: Benefits and challenges from current research and emerging trends

    NASA Astrophysics Data System (ADS)

    Cominola, A.; Giuliani, M.; Castelletti, A.; Piga, D.; Rizzoli, A. E.

    2015-12-01

    Urban population growth, climate and land use change are expected to boost residential water demand in urban contexts in the next decades. In such a context, developing suitable demand-side management strategies is essential to meet future water demands, pursue water savings, and reduce the costs for water utilities. Yet, the effectiveness of water demand management strategies (WDMS) relies on our understanding of water consumers' behavior, their consumption habits, and the water use drivers. While low spatial and temporal resolution water consumption data, as traditionally gathered for billing purposes, hardly support this understanding, the advent of high-resolution, smart metering technologies allowed for quasi real-time monitoring water consumption at the single household level. This, in turn, is advancing our ability in characterizing consumers' behavior, modeling, and designing user-oriented residential water demand management strategies. Several water smart metering programs have been rolled-out in the last two decades worldwide, addressing one or more of the following water demand management phases: (i) data gathering, (ii) water end-uses characterization, (iii) user modeling, (iv) design and implementation of personalized WDMS. Moreover, the number of research studies in this domain is quickly increasing and big economic investments are currently being devoted worldwide to smart metering programs. With this work, we contribute the first comprehensive review of more than 100 experiences in the field of residential water demand modeling and management, and we propose a general framework for their classification. We revise consolidated practices, identify emerging trends and highlight the challenges and opportunities for future developments given by the use of smart meters advancing residential water demand management. Our analysis of the status quo of smart urban water demand management research and market constitutes a structured collection of information

  20. Current approaches to the management of new-onset ulcerative colitis

    PubMed Central

    Marchioni Beery, Renée; Kane, Sunanda

    2014-01-01

    Ulcerative colitis (UC) is an idiopathic, inflammatory gastrointestinal disease of the colon. As a chronic condition, UC follows a relapsing and remitting course with medical maintenance during periods of quiescent disease and appropriate escalation of therapy during times of flare. Initial treatment strategies must not only take into account current clinical presentation (with specific regard for extent and severity of disease activity) but must also take into consideration treatment options for the long-term. The following review offers an approach to new-onset UC with a focus on early treatment strategies. An introduction to the disease entity is provided along with an approach to initial diagnosis. Stratification of patients based on clinical parameters, disease extent, and severity of illness is paramount to determining course of therapy. Frequent assessments are required to determine clinical response, and treatment intensification may be warranted if expected improvement goals are not appropriately reached. Mild-to- moderate UC can be managed with aminosalicylates, mesalamine, and topical corticosteroids with oral corticosteroids reserved for unresponsive cases. Moderate-to-severe UC generally requires oral or intravenous corticosteroids in the short-term with consideration of long-term management options such as biologic agents (as initial therapy or in transition from steroids) or thiopurines (as bridging therapy). Patients with severe or fulminant UC who are recalcitrant to medical therapy or who develop disease complications (such as toxic megacolon) should be considered for colectomy. Early surgical referral in severe or refractory UC is crucial, and colectomy may be a life-saving procedure. The authors provide a comprehensive evidence-based approach to current treatment options for new-onset UC with discussion of long-term therapeutic efficacy and safety, patient-centered perspectives including quality of life and medication compliance, and future

  1. Land use and management in PR China: problems and strategies.

    PubMed

    Cai, Y

    1990-10-01

    The conflict between population and land in China results from high population density, declining availability of arable land, decrease in cropland, overgrazing, inability to afford imported grain, and expansion of land use for urbanization. Unwise decisions have been made. These decisions have resulted in land degradation, soil erosion, deforestation, degradation of grasslands, waste of land for freight storage or waste disposal due to low grain prices, and nonagricultural constructions on croplands. Ineffective land management problems are identified as: 1) the lack of an economic means of guiding land use and land is not valued; the lack of any mechanism to ensure economic land use including public lands which are not accounted for with rent; 2) the lack of integration of departments into the decision making structure and too many departments making decisions about the same land; 3) the lack of choice in land use which results in higher government departments being unaware of local conditions, and the lack of appropriate investment which results in short-term exploitation; and 4) surveys are inadequate for decision making. The strategies suggested for improvement in land use management include low resources expenditure in production and appropriate goods consumption. The goal is to sustain subsistence with gradual improvement through development. Land resources must be conserved and the environment protected. The solutions to depend on food imports or reduce the nutritional level deny the equally plausible solution to generate a higher level of input. The profit motive and scientific agricultural practices could accomplish this end. Reclamation for cropland is possible for 8 million hectares of wasteland in wide areas in Sanjiang Plain and 3.4 million hectares in small pockets in Eastern Monsoon China. Traditional agriculture must be transformed and an optimum scale of land operation established. Land tenure reform is necessary. Regional conditions must prevail

  2. Managing the Services Supply Chain in the Department of Defense: An Empirical Study of Current Management Practices

    DTIC Science & Technology

    2009-04-22

    ååì~ä=^Åèìáëáíáçå= oÉëÉ~êÅÜ=póãéçëáìã= MANAGING THE SERVICES SUPPLY CHAIN IN THE DEPARTMENT OF DEFENSE: AN EMPIRICAL STUDY OF CURRENT MANAGEMENT...TITLE AND SUBTITLE Managing the Services Supply Chain in the Department of Defense: An Empirical Study of Current Management Practices 5a. CONTRACT...INTENTIONALLY LEFT BLANK = = ==================aÉÑÉåëÉ=^Åèìáëáíáçå=áå=qê~åëáíáçå======== - 279 - = = Managing the Services Supply Chain in the

  3. Vermicomposting as manure management strategy for urban small-holder animal farms - Kampala case study.

    PubMed

    Lalander, Cecilia Helena; Komakech, Allan John; Vinnerås, Björn

    2015-05-01

    Inadequate organic waste management can contribute to the spread of diseases and have negative impacts on the environment. Vermicomposting organic waste could have dual beneficial effects by generating an economically viable animal feed protein in the form of worm biomass, while alleviating the negative effects of poor organic waste management. In this study, a low-maintenance vermicomposting system was evaluated as manure and food waste management system for small-holder farmers. A vermicomposting system using the earthworm species Eudrilus eugeniae and treating cow manure and food waste was set up in Kampala, Uganda, and monitored for 172days. The material degradation and protein production rates were evaluated after 63days and at the end of the experiment. The material reduction was 45.9% and the waste-to-biomass conversion rate was 3.5% in the vermicomposting process on a total solids basis. A possible increase in the conversion rate could be achieved by increasing the frequency of worm harvesting. Vermicomposting was found to be a viable manure management method in small-scale urban animal agriculture; the return of investment was calculated to be 280% for treating the manure of a 450kg cow. The vermicompost was not sanitised, although hygiene quality could be improved by introducing a post-stabilisation step in which no fresh material is added. The value of the animal feed protein generated in the process can act as an incentive to improve current manure management strategies.

  4. Strategies of bringing drug product marketing applications to meet current regulatory standards.

    PubMed

    Wu, Yan; Freed, Anita; Lavrich, David; Raghavachari, Ramesh; Huynh-Ba, Kim; Shah, Ketan; Alasandro, Mark

    2015-08-01

    In the past decade, many guidance documents have been issued through collaboration of global organizations and regulatory authorities. Most of these are applicable to new products, but there is a risk that currently marketed products will not meet the new compliance standards during audits and inspections while companies continue to make changes through the product life cycle for continuous improvement or market demands. This discussion presents different strategies to bringing drug product marketing applications to meet current and emerging standards. It also discusses stability and method designs to meet process validation and global development efforts.

  5. Performance optimization of current focusing and virtual electrode strategies in retinal implants.

    PubMed

    Khalili Moghaddam, Gita; Lovell, Nigel H; Wilke, Robert G H; Suaning, Gregg J; Dokos, Socrates

    2014-11-01

    The electrode configuration in an implanted visual prosthesis array affects the spatial electric field distribution within the retina, contributing to current focusing and virtual electrode (VE) stimulation strategies. In this paper, a finite element model incorporating various electrode configurations was used to study the interaction between electrode size and electrode-to-cell distance in current focusing and VE stimulation paradigms. The electrode array unit comprises an active electrode, six flanking return electrodes and a distant monopolar return. A quasi-monopolar (QMP) fraction is defined as the proportion of current which can be preferentially returned through the distant return, in comparison with the more adjacent flanking electrodes. The simulation results indicate that current focusing and VE strategies can be optimized by tuning the QMP fraction. The QMP fraction is adjusted to optimize the electric field spread based on retinal ganglion cell (RGC) density in the degenerate retina, thereby offsetting the effect of inhomogeneous distribution of surviving RGCs and leading to a uniform stimulation paradigm across electrodes. Importantly, there is negligible difference in functional performance across electrode configurations for distances less than the electrode diameter, implying that the stimulation mode does not significantly affect activation threshold or activated retinal area for electrode diameters greater than the retinal thickness. Furthermore, the QMP fraction has a significant effect on VE performance, defined by activation threshold and activated retinal area, when threshold current is evenly divided between two adjacent active electrodes.

  6. Is one technology best? Control strategies to meet current and future regulations

    SciTech Connect

    Altin, C.A.; Bustard, C.J.; Gelfand, P.; Sloat, D.G.; Belba, V.H.

    1994-12-31

    A slide presentation is given that discusses control strategies to meet current and future regulations. Most new regulations will require incremental reductions in specific emissions creating a market for technologies that can be retrofitted to existing systems. Since most metals are associated with particulate matter, improving particle collection will lead to reduced metal emissions and the disposal of sorbents used for capturing vapor phase pollutants, e.g., SO{sub 2} and Hg, can dominate the economics of the process.

  7. Ecologically Significant Monitoring Strategies for Watershed Managers and Applied Ecohydrologists

    NASA Astrophysics Data System (ADS)

    Buchanan, B. P.; Walter, T.

    2007-12-01

    Upper Klamath Lake in Southern Oregon is home to a unique and increasingly rare strain of redband rainbow trout (Oncorhynchus mykiss newberrii). Populations connected to perennial lake systems such as the Upper Klamath have evolved adfluvial life histories and may possess unique adaptations that underscore their importance as units of conservation. Anthropogenic disturbance including stream channelization, timber harvest, livestock grazing and irrigation diversion have resulted in a 41 percent reduction in the redband's historic habitat and the disappearance of 11 redband trout populations throughout Oregon, Washington, and Idaho. In an effort to actively conserve this sensitive subspecies, a stream creation project was undertaken with the goal of increasing viable spawning and rearing habitat in Crooked Creek, a tributary to Upper Klamath Lake. A combination of analogue, empirical and analytical techniques were employed in the design of the created channel morphology (i.e. channel planform, profile, and cross-section), the sizing of bed substrate and spawning gravels and the design of in-stream habitat and scour structures. The project, completed in the fall of 1996, was qualitatively judged a success (e.g. trout were observed actively spawning and young-of-the-year were collected during unsystematic surveys). Unfortunately, as is often the case in the stream enhancement/restoration field, funding and personnel time were lacking for the implementation of a robust post-construction monitoring plan. Thus, project success was ascertained through cursory analyses and anecdotal reports. An opportunity to implement a similar stream creation project in a nearby watershed has afforded us the chance to return to the project site and conduct a more comprehensive, quantitative analysis of the project's success. A discussion of the original design methods and a review of several state of the art monitoring strategies are provided to assist watershed managers and applied

  8. Current Approach in the Diagnosis and Management of Uveitic Glaucoma

    PubMed Central

    Muñoz-Negrete, Francisco J.; Moreno-Montañés, Javier; Hernández-Martínez, Paula; Rebolleda, Gema

    2015-01-01

    Uveitic glaucoma (UG) typically is associated with very high intraocular pressure (IOP) and more intense optic nerve damage than other glaucoma types. This secondary glaucoma requires an early diagnosis and adequate management of both uveitis and glaucoma. It is mandatory to identify the mechanisms of IOP elevation that in many eyes have multiple combined mechanisms. Management of these patients commonly requires an interdisciplinary approach that includes a glaucoma specialist and rheumatologist to control the inflammation and IOP. Glaucoma surgery is required early in these patients due to the high IOP usually present and is less successful than in primary open-angle glaucoma. Recurrent uveitic episodes, multiple mechanism, and the complications associated with uveitis make surgical management of UG challenging. In this review, the management and treatment of UG are updated to clarify the pathogenesis and prevent optic nerve damage. PMID:26558280

  9. Current and emerging formulation strategies for the effective transdermal delivery of HIV inhibitors

    PubMed Central

    Ham, Anthony S; Buckheit, Robert W

    2015-01-01

    Current and emerging formulation strategies for skin permeation are poised to open the transdermal drug delivery to a broader range of small molecule compounds that do not fit the traditional requirements for successful transdermal drug delivery, allowing the development of new patch technologies to deliver antiretroviral drugs that were previously incapable of being delivered through transdermal means. Transdermal drug delivery offers several distinct advantages over traditional dosage forms. Current antiretroviral drugs used for the treatment of HIV infection include a variety of highly active small molecule compounds with significantly limited skin permeability, and thus new and novel means of enhancing transport through the skin are needed. Current and emerging formulation strategies are poised to open the transdermal drug delivery to a broader range of compounds that do not fit the traditional requirements for successful transdermal drug delivery, allowing the development of new patch technologies to deliver antiretroviral drugs that were previously incapable of being delivered through transdermal means. Thus, with continuing research into skin permeability and patch formulation strategies, there is a large potential for antiretroviral transdermal drug delivery. PMID:25690088

  10. Assessment of regional management strategies for controlling seawater intrusion

    USGS Publications Warehouse

    Reichard, E.G.; Johnson, T.A.

    2005-01-01

    Simulation-optimization methods, applied with adequate sensitivity tests, can provide useful quantitative guidance for controlling seawater intrusion. This is demonstrated in an application to the West Coast Basin of coastal Los Angeles that considers two management options for improving hydraulic control of seawater intrusion: increased injection into barrier wells and in lieu delivery of surface water to replace current pumpage. For the base-case optimization analysis, assuming constant groundwater demand, in lieu delivery was determined to be most cost effective. Reduced-cost information from the optimization provided guidance for prioritizing locations for in lieu delivery. Model sensitivity to a suite of hydrologic, economic, and policy factors was tested. Raising the imposed average water-level constraint at the hydraulic-control locations resulted in nonlinear increases in cost. Systematic varying of the relative costs of injection and in lieu water yielded a trade-off curve between relative costs and injection/in lieu amounts. Changing the assumed future scenario to one of increasing pumpage in the adjacent Central Basin caused a small increase in the computed costs of seawater intrusion control. Changing the assumed boundary condition representing interaction with an adjacent basin did not affect the optimization results. Reducing the assumed hydraulic conductivity of the main productive aquifer resulted in a large increase in the model-computed cost. Journal of Water Resources Planning and Management ?? ASCE.

  11. Oral and infusion levodopa-based strategies for managing motor complications in patients with Parkinson's disease.

    PubMed

    Antonini, Angelo; Chaudhuri, K Ray; Martinez-Martin, Pablo; Odin, Per

    2010-02-01

    Levodopa is the most effective treatment for Parkinson's disease (PD) signs and symptoms, and patients invariably will require it during the course of the disease. It also provides benefits in activities of daily living, quality of life and life expectancy. However, after a few years of levodopa treatment the majority of patients will experience motor fluctuations and dyskinesia. Initial use of a dopamine receptor agonist may delay the emergence of motor fluctuations but at the cost of reduced symptomatic control compared with the use of levodopa in some cases. Adequate management of motor fluctuations and dyskinesia is essential to maintaining satisfactory quality of life at the advanced stage of disease. Various levodopa-based strategies are currently available that aim to control motor complications (wearing-off and dyskinesia) in PD and each approach has its own unique benefit and risk profile. Strategies such as dose fragmentation (smaller, more frequent dosing) or the use of orally administered, liquid levodopa formulations or melevodopa can reduce off-time intervals or facilitate absorption. More recently introduced, continuous delivery of dopaminergic medications may represent a more effective approach to treat motor complications in advanced PD and its effect can be perceived from improvement in clinical scales, as well as in health-related items. Indeed, continuous levodopa delivery by duodenal infusion may stabilize and significantly improve motor function as well as patients' quality of life. We propose a treatment algorithm that takes into account all currently available levodopa-based treatment strategies for motor complications in patients with PD.

  12. The community resource management area mechanism: a strategy to manage African forest resources for REDD+.

    PubMed

    Asare, Rebecca A; Kyei, Andrew; Mason, John J

    2013-01-01

    Climate change poses a significant threat to Africa, and deforestation rates have increased in recent years. Mitigation initiatives such as REDD+ are widely considered as potentially efficient ways to generate emission reductions (or removals), conserve or sustainably manage forests, and bring benefits to communities, but effective implementation models are lacking. This paper presents the case of Ghana's Community Resource Management Area (CREMA) mechanism, an innovative natural resource governance and landscape-level planning tool that authorizes communities to manage their natural resources for economic and livelihood benefits. This paper argues that while the CREMA was originally developed to facilitate community-based wildlife management and habitat protection, it offers a promising community-based structure and process for managing African forest resources for REDD+. At a theoretical level, it conforms to the ecological, socio-cultural and economic factors that drive resource-users' decision process and practices. And from a practical mitigation standpoint, the CREMA has the potential to help solve many of the key challenges for REDD+ in Africa, including definition of boundaries, smallholder aggregation, free prior and informed consent, ensuring permanence, preventing leakage, clarifying land tenure and carbon rights, as well as enabling equitable benefit-sharing arrangements. Ultimately, CREMA's potential as a forest management and climate change mitigation strategy that generates livelihood benefits for smallholder farmers and forest users will depend upon the willingness of African governments to support the mechanism and give it full legislative backing, and the motivation of communities to adopt the CREMA and integrate democratic decision-making and planning with their traditional values and natural resource management systems.

  13. The community resource management area mechanism: a strategy to manage African forest resources for REDD+

    PubMed Central

    Asare, Rebecca A.; Kyei, Andrew; Mason, John J.

    2013-01-01

    Climate change poses a significant threat to Africa, and deforestation rates have increased in recent years. Mitigation initiatives such as REDD+ are widely considered as potentially efficient ways to generate emission reductions (or removals), conserve or sustainably manage forests, and bring benefits to communities, but effective implementation models are lacking. This paper presents the case of Ghana's Community Resource Management Area (CREMA) mechanism, an innovative natural resource governance and landscape-level planning tool that authorizes communities to manage their natural resources for economic and livelihood benefits. This paper argues that while the CREMA was originally developed to facilitate community-based wildlife management and habitat protection, it offers a promising community-based structure and process for managing African forest resources for REDD+. At a theoretical level, it conforms to the ecological, socio-cultural and economic factors that drive resource-users’ decision process and practices. And from a practical mitigation standpoint, the CREMA has the potential to help solve many of the key challenges for REDD+ in Africa, including definition of boundaries, smallholder aggregation, free prior and informed consent, ensuring permanence, preventing leakage, clarifying land tenure and carbon rights, as well as enabling equitable benefit-sharing arrangements. Ultimately, CREMA's potential as a forest management and climate change mitigation strategy that generates livelihood benefits for smallholder farmers and forest users will depend upon the willingness of African governments to support the mechanism and give it full legislative backing, and the motivation of communities to adopt the CREMA and integrate democratic decision-making and planning with their traditional values and natural resource management systems. PMID:23878338

  14. Real Time Energy Management Control Strategies for Hybrid Powertrains

    NASA Astrophysics Data System (ADS)

    Zaher, Mohamed Hegazi Mohamed

    In order to improve fuel efficiency and reduce emissions of mobile vehicles, various hybrid power-train concepts have been developed over the years. This thesis focuses on embedded control of hybrid powertrain concepts for mobile vehicle applications. Optimal robust control approach is used to develop a real time energy management strategy for continuous operations. The main idea is to store the normally wasted mechanical regenerative energy in energy storage devices for later usage. The regenerative energy recovery opportunity exists in any condition where the speed of motion is in opposite direction to the applied force or torque. This is the case when the vehicle is braking, decelerating, or the motion is driven by gravitational force, or load driven. There are three main concepts for regernerative energy storing devices in hybrid vehicles: electric, hydraulic, and flywheel. The real time control challenge is to balance the system power demand from the engine and the hybrid storage device, without depleting the energy storage device or stalling the engine in any work cycle, while making optimal use of the energy saving opportunities in a given operational, often repetitive cycle. In the worst case scenario, only engine is used and hybrid system completely disabled. A rule based control is developed and tuned for different work cycles and linked to a gain scheduling algorithm. A gain scheduling algorithm identifies the cycle being performed by the machine and its position via GPS, and maps them to the gains.

  15. STRATEGIES AND TECHNOLOGY FOR MANAGING HIGH-CARBON ASH

    SciTech Connect

    Robert Hurt; Eric Suuberg; John Veranth; Xu Chen; Indrek Kulaots

    2004-02-13

    The overall objective of the present project was to identify and assess strategies and solutions for the management of industry problems related to carbon in ash. Specific issues addressed included: (1) the effect of parent fuel selection on ash properties and adsorptivity, including a first ever examination of the air entrainment behavior of ashes from alternative (non-coal) fuels; (2) the effect of various low-NOx firing modes on ash properties and adsorptivity based on pilot-plant studies; and (3) the kinetics and mechanism of ash ozonation. This laboratory data has provided scientific and engineering support and underpinning for parallel process development activities. The development work on the ash ozonation process has now transitioned into a scale-up and commercialization project involving a multi-industry team and scheduled to begin in 2004. This report describes and documents the laboratory and pilot-scale work in the above three areas done at Brown University and the University of Utah during this three-year project.

  16. STRATEGIES AND TECHNOLOGY FOR MANAGING HIGH-CARBON ASH

    SciTech Connect

    Robert Hurt; Eric Suuberg; John Veranth

    2001-12-26

    The overall objective of the present project is to identify and assess strategies and solutions for the management of industry problems related to carbon in ash. Specific research issues to be addressed include: the effect of parent fuel selection on ash properties and adsorptivity, including a first ever examination of the air entrainment behavior of ashes from alternative (non-coal) fuels; the effect of various low-NOx firing modes on ash properties and adsorptivity; and the kinetics and mechanism of ash ozonation. This data will provide scientific and engineering support of the ongoing process development activities. This first project period, experiments were carried out to better understand the fundamental nature of the ozonation effect on ash. Carbon surfaces were characterized by surfactant adsorption, and by X-ray Photoelectron Spectroscopy before and after oxidation, both by air at 440 C and by ozone at room temperature. The results strongly suggest that the beneficial effect of ozonation is in large part due to chemical modification of the carbon surfaces.

  17. STRATEGIES AND TECHNOLOGY FOR MANAGING HIGH-CARBON ASH

    SciTech Connect

    Robert Hurt; Eric Suuberg; John Veranth

    2001-06-22

    The overall objective of the present project is to identify and assess strategies and solutions for the management of industry problems related to carbon in ash. Specific research issues to be addressed include: (1) the effect of parent fuel selection on ash properties and adsorptivity, including a first ever examination of the air entrainment behavior of ashes from alternative (non-coal) fuels; (2) the effect of various low-NOx firing modes on ash properties and adsorptivity; and (3) the kinetics and mechanism of ash ozonation. This data will provide scientific and engineering support of the ongoing process development activities. This first project period, experiments were carried out to better understand the fundamental nature of the ozonation effect on ash. Carbon surfaces were characterized by surfactant adsorption, and by X-ray Photoelectron Spectroscopy before and after oxidation, both by air at 440 C and by ozone at room temperature. The results strongly suggest that the beneficial effect of ozonation is in large part due to chemical modification of the carbon surfaces.

  18. Selection of a management strategy for pediatric brainstem tumors

    SciTech Connect

    Halperin, E.C.; Wehn, S.M.; Scott, J.W.; Djang, W.; Oakes, W.J.; Friedman, H.S.

    1989-01-01

    Brainstem tumors arise in portions of the rhombencephalon and mesencephalon. Some authorities include diencephalic tumors in this group. We have reviewed our clinical experience of 69 children (less than 21 years of age) with brainstem tumors evaluated and treated at Duke University Medical Center (DUMC) from 1960 to 1986. There were 19 patients with group 1 tumors (thalamus, third ventricle region, or midbrain) and 50 with group II tumors (pons, medulla oblongata). The common presenting signs and symptoms were ataxia, headache, motor loss, and cranial nerve palsies. The most commonly employed diagnostic imaging studies were air examinations and CT. Preradiotherapy confirmation of malignancy was obtained in five group I patients (astrocytoma, 4; germinoma, 1) and 8 group II patients (astrocytoma, 3; anaplastic astrocytoma, 2; glioblastoma multiforme, 3). All patients received radiotherapy. The 5-year survival rate for the entire population was 40%. The survival rate for group I patients was significantly better than that observed for group II patients. In the 50 group II patients neither patient sex nor age nor presence of cranial nerve palsies nor pretreatment CT scan findings nor field size influenced survival. A long duration of symptoms positively influenced survival. The vast majority of tumor recurrences were within the radiation field. Half of the patients had either stable or improved Karnofsky status 6 months following completion of irradiation. The management strategy for childhood brainstem tumors is discussed.

  19. An integrated crop- and soil-based strategy for variable-rate nitrogen management in corn

    NASA Astrophysics Data System (ADS)

    Roberts, Darrin F.

    Nitrogen (N) management in cereal crops has been the subject of considerable research and debate for several decades. Historic N management practices have contributed to low nitrogen use efficiency (NUE). Low NUE can be caused by such things as poor synchronization between soil N supply and crop demand, uniform application rates of fertilizer N to spatially variable landscapes, and failure to account for temporally variable influences on soil N supply and crop N need. Active canopy reflectance sensors and management zones (MZ) have been studied separately as possible plant- and soil-based N management tools to increase NUE. Recently, some have suggested that the integration of these two approaches would provide a more robust N management strategy that could more effectively account for soil and plant effects on crop N need. For this reason, the goal of this research was to develop an N application strategy that would account for spatial variability in soil properties and use active canopy reflectance sensors to determine in-season, on-the-go N fertilizer rates, thereby increasing NUE and economic return for producers over current N management practices. To address this overall goal, a series of studies were conducted to better understand active canopy sensor use and explore the possibility of integrating spatial soil data with active canopy sensors. Sensor placement to assess crop N status was first examined. It was found that the greatest reduction in error over sensing each individual row for a hypothetical 24-row applicator was obtained with 2-3 sensors estimating an average chlorophyll index for the entire boom width. Next, use of active sensor-based soil organic matter (OM) estimation was compared to more conventional aerial image-based soil OM estimation. By adjusting regression intercept values for each field, OM could be predicted using either a single sensor or image data layer. The final study consisted of validation of the active sensor algorithm

  20. The current state of personal training: managers' perspectives.

    PubMed

    Melton, Deana I; Dail, Teresa K; Katula, Jeffrey A; Mustian, Karen M

    2010-11-01

    Fitness managers play an integral role in the day-to-day operation of the facilities in which they work. One of the most critical responsibilities is that of hiring, training, and supervising personal trainers. Research studies have identified a number of qualities and competencies that an effective exercise leader is required to have, but there is little scholarly work addressing managers' attitudes surrounding the performance of personal trainers. Using focus group methodology, managers of personal trainers were recruited to provide viewpoints related to desirable qualities of personal trainers and opinions regarding certification and academic preparation. Responses of the participants were transcribed, coded, and analyzed for themes. Two global themes, Selection Rationale and Negative Characteristics, emerged. Selection Rationale consisted of qualities that influence a manager's decision to hire a particular trainer (e.g., physique, education, social skills). Negative characteristics referred to qualities considered unethical or unprofessional (e.g., sexual comments, misuse of power) and the consequences of those behaviors (e.g., loss of clients, potential for litigation). The results suggest that undergraduate exercise science programs devote additional time toward the development of the affective qualities of future fitness trainers. Managers also recommended licensure for employees.