Using real options analysis to support strategic management decisions

NASA Astrophysics Data System (ADS)

Kabaivanov, Stanimir; Markovska, Veneta; Milev, Mariyan

2013-12-01

Decision making is a complex process that requires taking into consideration multiple heterogeneous sources of uncertainty. Standard valuation and financial analysis techniques often fail to properly account for all these sources of risk as well as for all sources of additional flexibility. In this paper we explore applications of a modified binomial tree method for real options analysis (ROA) in an effort to improve decision making process. Usual cases of use of real options are analyzed with elaborate study on the applications and advantages that company management can derive from their application. A numeric results based on extending simple binomial tree approach for multiple sources of uncertainty are provided to demonstrate the improvement effects on management decisions.

Solid waste management practices in wet coffee processing industries of Gidabo watershed, Ethiopia.

PubMed

Ulsido, Mihret D; Li, Meng

2016-07-01

The financial and social contributions of coffee processing industries within most coffee export-based national economies like Ethiopia are generally high. The type and amount of waste produced and the waste management options adopted by these industries can have negative effects on the environment. This study investigated the solid waste management options adopted in wet coffee processing industries in the Gidabo watershed of Ethiopia. A field observation and assessment were made to identify whether the operational characteristics of the industries have any effect on the waste management options that were practiced. The investigation was conducted on 125 wet coffee processing industries about their solid waste handling techniques. Focus group discussion, structured questionnaires, key informant interview and transect walks are some of the tools employed during the investigation. Two major types of wastes, namely hull-bean-pulp blended solid waste and wastewater rich in dissolved and suspended solids were generated in the industries. Wet mills, on average, released 20.69% green coffee bean, 18.58% water and 60.74% pulp by weight. Even though these wastes are rich in organic matter and recyclables; the most favoured solid waste management options in the watershed were disposal (50.4%) and industrial or household composting (49.6%). Laxity and impulsive decision are the driving motives behind solid waste management in Gidabo watershed. Therefore, to reduce possible contamination of the environment, wastes generated during the processing of red coffee cherries, such as coffee wet mill solid wastes, should be handled properly and effectively through maximisation of their benefits with minimised losses. © The Author(s) 2016.

Fusion Teaching: Utilizing Course Management Technology to Deliver an Effective Multimodal Pedagogy

ERIC Educational Resources Information Center

Childs, Bradley D.; Cochran, Howard H.; Velikova, Marieta

2013-01-01

Fusion teaching merges several pedagogies into a coherent whole. Course management technology allows for the digitization and delivery of pedagogies in an effective and exciting manner. Online course management options more easily enable outcome assessment and monitoring for continuous improvement.

Maximizing value in opioid utilization: Is oxycodone immediate release a good option for pain management?

PubMed

Pergolizzi, Joseph V; Köknel Talu, Gül; Zmponga, Gianpetrio; Erdine, Serdar; Taylor, Robert; Ayan, Burak; Raffa, Robert B

2015-01-01

The modern approach to the management of pain involves optimizing all aspects of the process. This includes utilization of pharmacologic and non-pharmacologic modalities, consideration of patient characteristics, proper matching of the physiology of the pain with the analgesic's mechanism of action (pharmacodynamics, PD), and the onset and duration of action (pharmacokinetics, PK). No single agent or formulation satisfies all of the requirements for all patients. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) are effective options for inflammatory pain and, as is acetaminophen, for mild pain. Specialized agents are helpful for particular pains, such as for migraine headache. Opioids remain the standard option for severe pain. Although they are generally a safe and effective option, opioids can produce dose-limiting adverse effects and have abuse potential. The goal of pain therapy is thus to achieve the maximum pain relief with the least amount of opioid exposure. Against this background of measured approach to the use of analgesics, an immediate release (IR) oral formulation of the established opioid oxycodone has been developed to provide rapid onset of action and rate of titration, both of which could maximize temporal matching of dose with pain level and reduce total exposure to drug. This article considers the option of an immediate release (IR) oral formulation for the management of pain.

City-scale analysis of water-related energy identifies more cost-effective solutions.

PubMed

Lam, Ka Leung; Kenway, Steven J; Lant, Paul A

2017-02-01

Energy and greenhouse gas management in urban water systems typically focus on optimising within the direct system boundary of water utilities that covers the centralised water supply and wastewater treatment systems, despite a greater energy influence by the water end use. This work develops a cost curve of water-related energy management options from a city perspective for a hypothetical Australian city. It is compared with that from the water utility perspective. The curves are based on 18 water-related energy management options that have been implemented or evaluated in Australia. In the studied scenario, the cost-effective energy saving potential from a city perspective (292 GWh/year) is far more significant than that from a utility perspective (65 GWh/year). In some cases, for similar capital cost, if regional water planners invested in end use options instead of utility options, a greater energy saving potential at a greater cost-effectiveness could be achieved in urban water systems. For example, upgrading a wastewater treatment plant for biogas recovery at a capital cost of $27.2 million would save 31 GWh/year with a marginal cost saving of $63/MWh, while solar hot water system rebates at a cost of $28.6 million would save 67 GWh/year with a marginal cost saving of $111/MWh. Options related to hot water use such as water-efficient shower heads, water-efficient clothes washers and solar hot water system rebates are among the most cost-effective city-scale opportunities. This study demonstrates the use of cost curves to compare both utility and end use options in a consistent framework. It also illustrates that focusing solely on managing the energy use within the utility would miss substantial non-utility water-related energy saving opportunities. There is a need to broaden the conventional scope of cost curve analysis to include water-related energy and greenhouse gas at the water end use, and to value their management from a city perspective. This would create opportunities where the same capital investment could achieve far greater energy savings and greenhouse gas emissions abatement. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effects and Management of Parthenium hysterophorus: A Weed of Global Significance

PubMed Central

Aggarwal, Neeraj Kumar; Kumar, Vikas; Dhiman, Romika

2014-01-01

Congress grass, Parthenium hysterophorus L., of the family Asteraceae (tribe: Heliantheae), is an erect and much branched annual or ephermeral herb, known for its notorious role as environmental, medical, and agricultural hazards. It is believed to have been introduced into India and Australia from North America and in the last few years the weed has emerged as the seventh most devastating weed in Africa, Asia, and Australia. The aim of this review is to provide general information about the physiology, distribution, ill effects, and management of parthenium. Control of parthenium has been tried by various methods, but no single management option would be adequate to manage parthenium, and there is a need to integrate various management options. Successful management of this weed can only be achieved by an integrated approach with biological control as the key element. PMID:27355059

ANALYSIS OF THE POTENTIAL EFFECTS OF TOXICS ON MUNICIPAL SOLID WASTE MANAGEMENT OPTIONS

EPA Science Inventory

Many alternative waste management practices and strategies are available to manage the large quantities of MSW generated every year. hese management alternatives include recycling, composting, waste-to-fuel/energy recovery, and landfilling. n choosing the best possible management...

Watershed Management Optimization Support Tool (WMOST) Webinar

EPA Pesticide Factsheets

EPA’s WMOST is a publicly available tool that can be used by state and local managers to screen a wide-range of options for cost-effective management of water resources, and it supports a broader integrated watershed management approach.

Operational approaches to managing forests of the future in Mediterranean regions within a context of changing climates

NASA Astrophysics Data System (ADS)

Stephens, Scott L.; Millar, Constance I.; Collins, Brandon M.

2010-04-01

Many US forest managers have used historical ecology information to assist in the development of desired conditions. While there are many important lessons to learn from the past, we believe that we cannot rely on past forest conditions to provide us with blueprints for future management. To respond to this uncertainty, managers will be challenged to integrate adaptation strategies into plans in response to changing climates. Adaptive strategies include resistance options, resilience options, response options, and realignment options. Our objectives are to present ideas that could be useful in developing plans under changing climates that could be applicable to forests with Mediterranean climates. We believe that managing for species persistence at the broad ecoregion scale is the most appropriate goal when considering the effects of changing climates. Such a goal relaxes expectations that current species ranges will remain constant, or that population abundances, distribution, species compositions and dominances should remain stable. Allowing fundamental ecosystem processes to operate within forested landscapes will be critical. Management and political institutions will have to acknowledge and embrace uncertainty in the future since we are moving into a time period with few analogs and inevitably, there will be surprises.

Management Options for Reducing the Release of Antibiotics and Antibiotic Resistance Genes to the Environment

PubMed Central

Pruden, Amy; Amézquita, Alejandro; Collignon, Peter; Brandt, Kristian K.; Graham, David W.; Lazorchak, James M.; Suzuki, Satoru; Silley, Peter; Snape, Jason R.; Topp, Edward; Zhang, Tong; Zhu, Yong-Guan

2013-01-01

Background: There is growing concern worldwide about the role of polluted soil and water environments in the development and dissemination of antibiotic resistance. Objective: Our aim in this study was to identify management options for reducing the spread of antibiotics and antibiotic-resistance determinants via environmental pathways, with the ultimate goal of extending the useful life span of antibiotics. We also examined incentives and disincentives for action. Methods: We focused on management options with respect to limiting agricultural sources; treatment of domestic, hospital, and industrial wastewater; and aquaculture. Discussion: We identified several options, such as nutrient management, runoff control, and infrastructure upgrades. Where appropriate, a cross-section of examples from various regions of the world is provided. The importance of monitoring and validating effectiveness of management strategies is also highlighted. Finally, we describe a case study in Sweden that illustrates the critical role of communication to engage stakeholders and promote action. Conclusions: Environmental releases of antibiotics and antibiotic-resistant bacteria can in many cases be reduced at little or no cost. Some management options are synergistic with existing policies and goals. The anticipated benefit is an extended useful life span for current and future antibiotics. Although risk reductions are often difficult to quantify, the severity of accelerating worldwide morbidity and mortality rates associated with antibiotic resistance strongly indicate the need for action. PMID:23735422

76 FR 12771 - Self-Regulatory Organizations; NASDAQ OMX BX, Inc.; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-08

... reciprocity in matching other exchanges' Weekly option choices, BOX discontinues trading Weekly option classes... management purposes. \\5\\ As discussed above, because of the reciprocity provision of the Weeklys Program, the...

Using info-Gap Decision Theory for Water Resources Planning Under Severe Uncertainty

NASA Astrophysics Data System (ADS)

Korteling, B.; Brazier, R.; Kapelan, Z.; Dessai, S.

2012-12-01

Water resource managers are required to develop comprehensive water resource plans based on severely uncertain information of the effects of climate change on local hydrology and future socio-economic changes on localised demand. In England and Wales, current water resource planning methodologies include a headroom estimation process that quantifies uncertainty based on only one point of an assumed range of deviations from the expected climate and projected demand 25 years into the future. There are many situations where there is not enough knowledge to be able to estimate a representative probability of occurrence, or to be confident that the tails of an assumed probability distribution will not exhibit unexpected skewness, or that the kurtosis of a distribution differs from the norm. These situations can be considered severely uncertain. Information-Gap decision theory offers a method to sample a wider range of uncertainty than with traditional methods, and as a result, compare the robustness of various water resource management options under conditions of severe uncertainty. A more robust management option is one that delivers the same level of performance as other options at higher levels of uncertainty. A case study is based on a Water Supply Area that encompasses the county of Cornwall in southwest England containing 17 reservoirs and 19 demand nodes. The performance success of management options are evaluated primarily by measures of water availability including a reservoir risk measure that tests the probability and magnitude that strategic reservoir storage levels fall below the drought management curve under adverse conditions and also a safety margin deficit that tests how quickly reservoir levels can return to optimum operating levels in favourable conditions. Multi-Criteria Decision Analysis (MCDA) is used to test the effectiveness of different management options with different weightings for metrics other than water availability including; capital and operating costs, costs to customers, carbon emissions, environmental impact and social acceptability. Findings show that beyond the uncertainty range explored with the traditional headroom method, preference reversals can occur, i.e. some management options that underperform at lower uncertainties, outperform at higher levels of uncertainty. This study also shows that when 50% or more of the population adopts demand side management, efficiency related measures and innovative options such as rainwater collection can perform equally well or better than some supply side options. The additional use of MCDA shifts the focus away from reservoir expansion options that perform best with respect to water availability, to combined strategies that include innovative demand side management actions of rainwater collection and greywater reuse as well as efficiency measures and additional regional transfers. This research illustrates how an Info-Gap based approach can offer a comprehensive picture of potential supply/demand futures and a rich variety of information to support adaptive management of water systems under severe uncertainty.

Perturbations and 3R in carbon management.

PubMed

Pant, Deepak; Sharma, Virbala; Singh, Pooja; Kumar, Manoj; Giri, Anand; Singh, M P

2017-02-01

Perturbations in various carbon pools like biological, geological, oceanic, and missing carbon sink affect its global data, which are generally neglected or ignored in routine calculations. These natural and anthropogenic events need to be considered before projecting a sustainable carbon management plan. These plans have both general and experimental aspects. General plans should focus on (a) minimizing emission; (b) maximizing environmentally sound reuse, reduce, and recycling; (c) effective treatment; and (d) converting carbon into valuable products with atom economy. Experimental carbon management plans involving various biological and chemical techniques with limitation in terms of research level and economic feasibility. Chemical options have benefits of higher productivity and wider product range, but it suffers from its higher-energy requirements and environmental unfriendliness. In contrast to this, biological options are more selective and less energy intensive, but their productivity is very low. Hence, there is a requirement of hybrid process where the benefits of both the options, i.e., biological and chemical, can be reaped. In view of above, the proposed review targets to highlight the various perturbations in the global carbon cycle and their effects; study the currently practiced options of carbon management, specifically in light of 3R principle; and propose various new hybrid methods by compatible combinations of chemical and biological processes to develop better and safer carbon management. These methods are hypothetical so they may require further research and validations but may provide a comprehensive base for developing such management methods.

A Landscape Model (LEEMATH) to Evaluate Effects of Management Impacts on Timber and Wildlife Habitat

Treesearch

Harbin Li; David L. Gartner; Pu Mou; Carl C. Trettin

2000-01-01

Managing forest resources for sustainability requires the successful integration of economic and ecological goals. To attain such integration, land managers need decision support tools that incorporate science, land-use strategies, and policy options to assess resources sustainability at large scales. Landscape Evaluation of Effects of Management Activities on Timber...

Neuromodulation in bladder dysfunction.

PubMed

Hasan, S T; Neal, D E

1998-10-01

Neuromodulation is one option for the management of a wide variety of lower urinary tract disorders, including non-neuropathic and neuropathic bladder dysfunctions. The mechanisms of action of the reported techniques remain unclear; urodynamic changes are minimal, but symptomatic improvements are common. Although the treatment is relatively free from side-effects compared with more aggressive surgical options, the placebo effect is likely to be significant. Its exact cost effectiveness is unclear, but the technology is a welcome addition to the range of treatment options for lower urinary tract dysfunctions, such as urgency and urge incontinence.

41 CFR 102-194.5 - What is the Standard and Optional Forms Management Program?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What is the Standard and Optional Forms Management Program? 102-194.5 Section 102-194.5 Public Contracts and Property Management... PROGRAMS 194-STANDARD AND OPTIONAL FORMS MANAGEMENT PROGRAM § 102-194.5 What is the Standard and Optional...

Beyond usual care: the economic consequences of expanding treatment options in early pregnancy loss.

PubMed

Dalton, Vanessa K; Liang, Angela; Hutton, David W; Zochowski, Melissa K; Fendrick, A Mark

2015-02-01

The objective of this study was to estimate the economic consequences of expanding options for early pregnancy loss (EPL) treatment beyond expectant management and operating room surgical evacuation (usual care). We constructed a decision model using a hypothetical cohort of women undergoing EPL management within a 30 day horizon. Treatment options under the usual care arm include expectant management and surgical uterine evacuation in an operating room (OR). Treatment options under the expanded care arm included all evidence-based safe and effective treatment options for EPL: expectant management, misoprostol treatment, surgical uterine evacuation in an office setting, and surgical uterine evacuation in an OR. Probabilities of entering various treatment pathways were based on previously published observational studies. The cost per case was US $241.29 lower for women undergoing treatment in the expanded care model as compared with the usual care model (US $1033.29 per case vs US $1274.58 per case, expanded care and usual care, respectively). The model was the most sensitive to the failure rate of the expectant management arm, the cost of the OR surgical procedure, the proportion of women undergoing an OR surgical procedure under usual care, and the additional cost per patient associated with implementing and using the expanded care model. This study demonstrates that expanding women's treatment options for EPL beyond what is typically available can result in lower direct medical expenditures. Copyright © 2015 Elsevier Inc. All rights reserved.

Selected Energy Management Options for Small Business and Local Government.

ERIC Educational Resources Information Center

Wert, Jonathan M.; Worthington, Barry K.

This document is a checklist of 257 energy management options for small business and local government. The energy management options are categorized under: (1) Energy management strategies; (2) Buildings; (3) Lighting; (4) Water; (5) Waste operations; (6) Equipment; (7) Transportation; and (8) Food preparation. To select options for…

Ocean acidification: Linking science to management solutions using the Great Barrier Reef as a case study.

PubMed

Albright, Rebecca; Anthony, Kenneth R N; Baird, Mark; Beeden, Roger; Byrne, Maria; Collier, Catherine; Dove, Sophie; Fabricius, Katharina; Hoegh-Guldberg, Ove; Kelly, Ryan P; Lough, Janice; Mongin, Mathieu; Munday, Philip L; Pears, Rachel J; Russell, Bayden D; Tilbrook, Bronte; Abal, Eva

2016-11-01

Coral reefs are one of the most vulnerable ecosystems to ocean acidification. While our understanding of the potential impacts of ocean acidification on coral reef ecosystems is growing, gaps remain that limit our ability to translate scientific knowledge into management action. To guide solution-based research, we review the current knowledge of ocean acidification impacts on coral reefs alongside management needs and priorities. We use the world's largest continuous reef system, Australia's Great Barrier Reef (GBR), as a case study. We integrate scientific knowledge gained from a variety of approaches (e.g., laboratory studies, field observations, and ecosystem modelling) and scales (e.g., cell, organism, ecosystem) that underpin a systems-level understanding of how ocean acidification is likely to impact the GBR and associated goods and services. We then discuss local and regional management options that may be effective to help mitigate the effects of ocean acidification on the GBR, with likely application to other coral reef systems. We develop a research framework for linking solution-based ocean acidification research to practical management options. The framework assists in identifying effective and cost-efficient options for supporting ecosystem resilience. The framework enables on-the-ground OA management to be the focus, while not losing sight of CO2 mitigation as the ultimate solution. Copyright © 2016 Elsevier Ltd. All rights reserved.

Back to the future: assessing accuracy and sensitivity of a forest growth model

Treesearch

Susan Hummel; Paul Meznarich

2014-01-01

The Forest Vegetation Simulator (FVS) is a widely used computer model that projects forest growth and predicts the effects of disturbances such as fire, insects, harvests, or disease. Land managers often use these projections to decide among silvicultural options and estimate the potential effects of these options on forest conditions. Despite FVS's popularity,...

Building Space Management | Climate Neutral Research Campuses | NREL

Science.gov Websites

Building Space Management Building Space Management Building space represents one of the largest recruiting and successful acquisition of research funding. Learn more about how space management is necessary Options Research campuses reduce the need for new space through more effective space management

Meadow management and treatment options [chapter 8

Treesearch

Jeanne C. Chambers; Jerry R. Miller

2011-01-01

Restoration and management objectives and approaches are most effective when based on an understanding of ecosystem processes and the long- and short-term causes of disturbance (Wohl and others 2005). As detailed in previous chapters, several factors are critical in developing effective management strategies for streams and their associated meadow ecosystems in the...

A review on technological options of waste to energy for effective management of municipal solid waste.

PubMed

Kumar, Atul; Samadder, S R

2017-11-01

Approximately one-fourth population across the world rely on traditional fuels (kerosene, natural gas, biomass residue, firewood, coal, animal dung, etc.) for domestic use despite significant socioeconomic and technological development. Fossil fuel reserves are being exploited at a very fast rate to meet the increasing energy demands, so there is a need to find alternative sources of energy before all the fossil fuel reserves are depleted. Waste to energy (WTE) can be considered as a potential alternative source of energy, which is economically viable and environmentally sustainable. The present study reviewed the current global scenario of WTE technological options (incineration, pyrolysis, gasification, anaerobic digestion, and landfilling with gas recovery) for effective energy recovery and the challenges faced by developed and developing countries. This review will provide a framework for evaluating WTE technological options based on case studies of developed and developing countries. Unsanitary landfilling is the most commonly practiced waste disposal option in the developing countries. However, developed countries have realised the potential of WTE technologies for effective municipal solid waste management (MSWM). This review will help the policy makers and the implementing authorities involved in MSWM to understand the current status, challenges and barriers for effective management of municipal solid waste. This review concluded WTE as a potential renewable source of energy, which will partly meet the energy demand and ensure effective MSWM. Copyright © 2017 Elsevier Ltd. All rights reserved.

Bisphenol A and Risk Management Ethics

PubMed Central

Resnik, David B.; Elliot, Kevin C.

2013-01-01

It is widely recognized that endocrine disrupting compounds, such as Bisphenol A, pose challenges for traditional paradigms in toxicology, insofar as these substances appear to have a wider range of low-dose effects than previously recognized. These compounds also pose challenges for ethics and policymaking. When a chemical does not have significant low-dose effects, regulators can allow it to be introduced into commerce or the environment, provided that procedures and rules are in place to keep exposures below an acceptable level. This option allows society to maximize the benefits from the use of the chemical while minimizing risks to human health or the environment, and it represents a compromise between competing values. When it is not possible to establish acceptable exposure levels for chemicals that pose significant health or environmental risks, the most reasonable options for risk management may be to enact either partial or complete bans on their use. These options create greater moral conflict than other risk management strategies, leaving policymakers difficult choices between competing values. PMID:24471646

Bisphenol A and risk management ethics.

PubMed

Resnik, David B; Elliott, Kevin C

2015-03-01

It is widely recognized that endocrine disrupting compounds, such as Bisphenol A, pose challenges for traditional paradigms in toxicology, insofar as these substances appear to have a wider range of low-dose effects than previously recognized. These compounds also pose challenges for ethics and policymaking. When a chemical does not have significant low-dose effects, regulators can allow it to be introduced into commerce or the environment, provided that procedures and rules are in place to keep exposures below an acceptable level. This option allows society to maximize the benefits from the use of the chemical while minimizing risks to human health or the environment, and it represents a compromise between competing values. When it is not possible to establish acceptable exposure levels for chemicals that pose significant health or environmental risks, the most reasonable options for risk management may be to enact either partial or complete bans on their use. These options create greater moral conflict than other risk management strategies, leaving policymakers difficult choices between competing values. © 2014 John Wiley & Sons Ltd.

Herbal Medicine Offered as an Initiative Therapeutic Option for the Management of Hepatocellular Carcinoma.

PubMed

Chen, Shao-Ru; Qiu, Hong-Cong; Hu, Yang; Wang, Ying; Wang, Yi-Tao

2016-06-01

Hepatocellular carcinoma (HCC) is a common malignant cancer and is the third leading cause of death worldwide. Effective treatment of this disease is limited by the complicated molecular mechanism underlying HCC pathogenesis. Thus, therapeutic options for HCC management are urgently needed. Targeting the Wnt/β-catenin, Hedgehog, Notch, and Hippo-YAP signaling pathways in cancer stem cell development has been extensively investigated as an alternative treatment. Herbal medicine has emerged as an initiative therapeutic option for HCC management because of its multi-level, multi-target, and coordinated intervention effects. In this article, we summarized the recent progress and clinical benefits of targeting the above mentioned signaling pathways and using natural products such as herbal medicine formulas to treat HCC. Proving the clinical success of herbal medicine is expected to deepen the knowledge on herbal medicine efficiency and hasten the adoption of new therapies. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Management intensity at field and landscape levels affects the structure of generalist predator communities.

PubMed

Rusch, Adrien; Birkhofer, Klaus; Bommarco, Riccardo; Smith, Henrik G; Ekbom, Barbara

2014-07-01

Agricultural intensification is recognised as a major driver of biodiversity loss in human-modified landscapes. Several agro-environmental measures at different spatial scales have been suggested to mitigate the negative impact of intensification on biodiversity and ecosystem services. The effect of these measures on the functional structure of service-providing communities remains, however, largely unexplored. Using two distinct landscape designs, we examined how the management options of organic farming at the field scale and crop diversification at the landscape level affect the taxonomic and functional structure of generalist predator communities and how these effects vary along a landscape complexity gradient. Organic farming as well as landscapes with longer and more diversified crop rotations enhanced the activity-density of spiders and rove beetles, but not the species richness or evenness. Our results indicate that the two management options affected the functional composition of communities, as they primarily enhanced the activity-density of functionally similar species. The two management options increased the functional similarity between spider species in regards to hunting mode and habitat preference. Organic farming enhanced the functional similarity of rove beetles. Management options at field and landscape levels were generally more important predictors of community structure when compared to landscape complexity. Our study highlights the importance of considering the functional composition of generalist predators in order to understand how agro-environmental measures at various scales shape community assemblages and ecosystem functioning in agricultural landscapes.

Managing the whole landscape: Historical, hybrid, and novel ecosystems

USGS Publications Warehouse

Hobbs, Richard J.; Higgs, Eric S.; Hall, Carol M.; Bridgewater, Peter; Chapin, F. Stuart; Ewel, John J.; Hallett, Lauren M.; Ellis, Erle C.; Harris, James; Hulvey, Kristen B.; Jackson, Stephen T.; Kennedy, Patricia L.; Kueffer, Christoph; Lach, Lori; Lantz, Trevor C.; Lugo, Ariel E.; Mascaro, Joseph; Murphy, Stephen D.; Nelson, Cara; Perring, Michael P.; Richardson, David M.; Seastedt, Timothy; Standish, Rachel J.; Starzomski, Brian M.; Suding, Katharine N.; Tognetti, Pedro M.; Yakob, Laith; Yung, Laurie

2014-01-01

The reality confronting ecosystem managers today is one of heterogeneous, rapidly transforming landscapes, particularly in the areas more affected by urban and agricultural development. A landscape management framework that incorporates all systems, across the spectrum of degrees of alteration, provides a fuller set of options for how and when to intervene, uses limited resources more effectively, and increases the chances of achieving management goals. That many ecosystems have departed so substantially from their historical trajectory that they defy conventional restoration is not in dispute. Acknowledging novel ecosystems need not constitute a threat to existing policy and management approaches. Rather, the development of an integrated approach to management interventions can provide options that are in tune with the current reality of rapid ecosystem change.

Temporary stream and wetland crossing options for forest management.

Treesearch

Charles R. Blinn; Rick Dahlman; Lola Hislop; Michael A. Thompson

1998-01-01

Discusses temporary options for crossing streams and wetland soils with forest harvesting and transportation equipment. Reviews the available literature on the environmental effects of temporary crossings. Provides an overview of regulations pertaining to temporary crossings for several jurisdictions in the Great Lakes Region.

Temporary stream and wetland crossing options for forest management

Treesearch

Charles R. Blinn; Rick Dahlman; Lola Hislop; Michael A. Thompson

1998-01-01

Discusses temporary options for crossing streams and wetland soils with forest harvesting and transportation equipment. Reviews the available literature on the environmental effects of temporary crossings. Provides an overview of regulations pertaining to temporary crossings for several jurisdictions in the Great Lakes Region.

Greenhouse Gas and Ammonia Emissions from Different Stages of Liquid Manure Management Chains: Abatement Options and Emission Interactions.

PubMed

Mohankumar Sajeev, Erangu Purath; Winiwarter, Wilfried; Amon, Barbara

2018-01-01

Farm livestock manure is an important source of ammonia and greenhouse gases. Concerns over the environmental impact of emissions from manure management have resulted in research efforts focusing on emission abatement. However, questions regarding the successful abatement of manure-related emissions remain. This study uses a meta-analytical approach comprising 89 peer-reviewed studies to quantify emission reduction potentials of abatement options for liquid manure management chains from cattle and pigs. Analyses of emission reductions highlight the importance of accounting for interactions between emissions. Only three out of the eight abatement options considered (frequent removal of manure, anaerobic digesters, and manure acidification) reduced ammonia (3-60%), nitrous oxide (21-55%), and methane (29-74%) emissions simultaneously, whereas in all other cases, tradeoffs were identified. The results demonstrate that a shift from single-stage emission abatement options towards a whole-chain perspective is vital in reducing overall emissions along the manure management chain. The study also identifies some key elements like proper clustering, reporting of influencing factors, and explicitly describing assumptions associated with abatement options that can reduce variability in emission reduction estimates. Prioritization of abatement options according to their functioning can help to determine low-risk emission reduction options, specifically options that alter manure characteristics (e.g., reduced protein diets, anaerobic digestion, or slurry acidification). These insights supported by comprehensive emission measurement studies can help improve the effectiveness of emission abatement and harmonize strategies aimed at reducing air pollution and climate change simultaneously. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Managing the pain of knee osteoarthritis.

PubMed

Hrnack, Scott A; Barber, F Alan

2014-09-01

Pain from knee osteoarthritis creates a significant burden for symptomatic patients, who are often forced to change their lifestyle because of their symptoms. Activity modification, therapy, weight loss, nonsteroidal anti-inflammatory drugs, shoe orthotics, bracing, and injections are the nonoperative options available. New technologies are also emerging in the treatment of knee osteoarthritis. Ultimately, these therapeutic modalities should reduce pain and increase the overall functioning of patients. These nonoperative modalities give the clinician several effective options before surgical management is considered.

Fire management and carbon sequestration in Pine Barren Forests

Treesearch

Kenneth L. Clark; Nicholas Skowronski; Michael Gallagher

2015-01-01

Prescribed burning is the major viable option that land managers have for reducing hazardous fuels and ensuring the regeneration of fire-dependent species in a cost-effective manner in Pine Barren ecosystems. Fuels management activities are directly linked to carbon (C) storage and rates of C sequestration by forests. To evaluate the effects of prescribed burning on...

Light-Duty Vehicle Thermal Management | Transportation Research | NREL

Science.gov Websites

Light-Duty Vehicle Thermal Management Light-Duty Vehicle Thermal Management Image of a semi transportation options, the lab is working to optimize the thermal management of both electric-drive and fuel per year just to air-condition these LDVs. NREL evaluates the effectiveness of thermal management

Making effective referrals: a knowledge-management approach.

PubMed Central

Einbinder, J. S.; Klein, D. A.; Safran, C. S.

1997-01-01

Patients and physicians often choose specially consultants with only limited knowledge of the available options. Access to information about specialists that was directly relevant to patient and clinician preferences could improve the effectiveness of the referral process. We have developed a prescriptive representation of the process of selecting consultants. This "referral map," based on decision theory, uses patient and provider preferences elicited through a literature review and interviews with physicians and provides a formal framework for representing referral knowledge and for evaluating referral options. Our method suggests that the goals and processes of selecting consultants can be managed more systematically using explicit repositories. Such systematic management promises to have a beneficial impact on the delivery of health care, as well as on patient satisfaction. PMID:9357642

76 FR 31998 - Cancellation of an Optional Form by the Office of Personnel Management

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-02

... OFFICE OF PERSONNEL MANAGEMENT Cancellation of an Optional Form by the Office of Personnel Management AGENCY: U.S. Office of Personnel Management. ACTION: Notice. SUMMARY: The U.S. Office of Personnel Management (OPM) is cancelling the Optional Application for Federal Employment. The information contained in...

ANALYSIS OF THE POTENTIAL EFFECTS OF TOXICS ON MUNICIPAL SOLID WASTE MANGEMENT OPTIONS

EPA Science Inventory

Many alternative waste management practices and strategies are available to manage the large quantities of MSW generated every year. These management alternatives include recycling, composting, waste-to-fuel/energy recovery, and landfilling. In choosing the best possible manageme...

Manager's handbook for oaks in the north-central states.

Treesearch

Ivan L. Sander

1977-01-01

Presents a key for choosing management options. Discusses silvicultural treatments to ensure reproduction and regulate stand density for efficient timber production. Also discusses water, wildlife, esthetics, and their effects on timber production.

Impact of dentists' years since graduation on management of temporomandibular disorders.

PubMed

Reissmann, Daniel R; Behn, Alexandra; Schierz, Oliver; List, Thomas; Heydecke, Guido

2015-12-01

The aims were to assess the impact of the number of years since dentists' graduation on appraisement of diagnostic needs and utilization of treatment options for temporomandibular disorders (TMD) and to investigate whether increased knowledge in TMD is sufficiently considered in today's dentist's undergraduate curricula and, therefore, represented in more evidence-based TMD management in dentists with less years since graduation. A questionnaire regarding knowledge and management of TMD was developed and was subsequently applied in a random sample of 400 dentists in a region in Northern Germany. Of the 222 dentists (response rate 55.6 %), participating in the study, the frequency of TMD treatment need in the general population was estimated at 21.5 %, with lower values in dentists with more years passed since graduation. Measures regarding utilization of standardized examination forms, perceptions of insufficient specialization, and referrals of patients to TMD specialists indicated a lower quality and certainty in TMD management in participants with less time since graduation. While the provision of splints was a well-established treatment option in initial TMD management of all participants, additional TMD treatment options were mentioned less often, with lower proportions of participants making use of these options within the first decade since graduation. Evidence-based TMD management is not fully represented in dental practitioners in Germany. This might be due to an insufficient consideration of TMD management in the dentist's undergraduate curricula. Effective interventions to increase dentists' knowledge and to change dentists' practices in TMD management are required.

Management of urinary incontinence in residential care.

PubMed

Lim, David S

2016-07-01

Urinary incontinence is prevalent in residential care and rates are expected to increase with the ageing population in Australia. It contributes to poor quality of life (QoL), functional impairments in activities of daily living, and deterioration of mental and sexual health. Management depends on the type of incontinence, its aetiology, the severity of symptoms, the effects on QoL, and patient factors. Treatment options include active treatment and passive containment. However, not all active treatment options are feasible in residential care. There is little evidence to advise on standard best practice. The aims of this article are to review treatment options for urinary incontinence in residential care, feasibility of service delivery and challenges associated with this. A greater understanding of the issues surrounding the management of urinary incontinence in residential care is required to deliver satisfactory patient-centred care on a consistent basis.

Fort Collins Science Center: Policy Analysis and Science Assistance

USGS Publications Warehouse

Lamb, Berton L.

2004-01-01

PASA's mission is to integrate biological, social, and economic research so that resource managers can use the resulting information to make informed decisions and resolve resource management conflicts. PASA scientists pursue and conduct scientific analyses that help agencies and Native American tribes to (1) identify impending policy controversies and areas where social and natural science research is needed to address future policy questions; (2) develop methods and approaches to assist researchers in preparing scientific evidence; (3) assess habitat alteration in a manner consistent with policy needs; and (4) evaluate policy options. Branch scientists also evaluate policy options (e.g., effects of different land treatments, fish and wildlife management practices, or visitor/recreation management practices) in response to specific questions faced by policymakers and managers.

13 CFR 107.250 - Exclusion of stock options issued by Licensee from Management Expenses.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Sbic § 107.250 Exclusion of stock options issued by Licensee from Management Expenses. Stock options... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Exclusion of stock options issued by Licensee from Management Expenses. 107.250 Section 107.250 Business Credit and Assistance SMALL...

Emergency Management of Malignant Acute Left-Sided Colonic Obstruction

PubMed Central

Trompetas, Vasileios

2008-01-01

INTRODUCTION The management of acute left-sided colonic obstruction still remains a challenging problem despite significant progress. METHODS A literature search was undertaken using PubMed and the Cochrane Library regarding the options in emergency management of left-sided colonic obstruction focusing on outcomes such as mortality, morbidity, long-term prognosis and cost effectiveness. DISCUSSION Colonic stenting is the best option either for palliation or as a bridge to surgery. It reduces morbidity and mortality rate and the need for colostomy formation. Stenting is likely to be cost effective, but data are variable depending on the individual healthcare system. Nevertheless, surgical management remains relevant as colonic stenting has a small rate of failure, and it is not always available. There are various surgical options. One-stage primary resection and anastomosis is the preferred choice for low-risk patients. Intra-operative colonic irrigation has no proven benefit. Subtotal colectomy is useful in cases of proximal bowel damage or synchronous tumours. Hartmann's procedure should be reserved for high-risk patients. Simple colostomy has no role other than for use in very ill patients who are not fit for any other procedure. PMID:18430330

The Template for Assessing Climate Change Impacts and Management Options (TACCIMO): Science at Your Fingertips

NASA Astrophysics Data System (ADS)

Jennings, L. N.; Treasure, E.; Moore Myers, J.; McNulty, S.

2012-12-01

There is an ever-increasing volume of useful scientific knowledge about climate change effects and management options for natural ecosystems. Agencies such as the USDA Forest Service have been charged with the need to evaluate this body of knowledge and if necessary adapt to the impacts of climate change in their forest planning and management. However, the combined volume of existing information and rate of development of new information, lack of climate change specialists, and limited technology transfer mechanisms make efficient access and use difficult. The Template for Assessing Climate Change Impacts and Management Options (TACCIMO) addresses this difficulty through its publically accessible web-based tool that puts current and concise climate change science at the fingertips of forest planners and managers. A collaborative product of the USDA Forest Service Research Stations and the National Forest System, TACCIMO integrates peer-reviewed research with management and planning options through search and reporting tools that connect land managers with information they can trust. TACCIMO highlights elements from the wealth of climate change science with attention to what natural resource planners and managers need through a searchable repository of over 4,000 effects of climate change and close to 1,000 adaptive management options, all excerpted from a growing body of peer-reviewed scientific literature. A geospatial mapping application provides downscaled climate data for the nation and other spatially explicit models relevant to evaluating climate change impacts on forests. Report generators assist users in capturing outputs specific to a given location and resource area in a consistent and organized manner. For USDA Forest Service users, science findings can be readily linked with management conditions and capabilities from national forest management plans. The development of TACCIMO was guided by interactions with natural resource professionals, resulting in a flexible framework that allows new information to be added routinely and existing information to be reorganized as new science emerges and management needs change. TACCIMO is currently being used to support climate change science assessments for national forest land and management plan revisions in El Yunque National Forest in Puerto Rico, the Southern Sierra national forests in California, and Francis Marion National Forest in South Carolina. The tool is also being actively used by state, extension, and private natural resource professionals for climate change education and outreach. For all users, TACCIMO provides a fast, concise, and creditable starting point to guide critical thinking, additional analysis, and expert consultation to support all aspects of natural resource management decision making.

Carbon footprint and energy use of food waste management options for fresh fruit and vegetables from supermarkets.

PubMed

Eriksson, Mattias; Spångberg, Johanna

2017-02-01

Food waste is a problem with economic, environmental and social implications, making it both important and complex. Previous studies have addressed food waste management options at the less prioritised end of the waste hierarchy, but information on more prioritised levels is also needed when selecting the best available waste management options. Investigating the global warming potential and primary energy use of different waste management options offers a limited perspective, but is still important for validating impacts from the waste hierarchy in a local context. This study compared the effect on greenhouse gas emissions and primary energy use of different food waste management scenarios in the city of Växjö, Sweden. A life cycle assessment was performed for four waste management scenarios (incineration, anaerobic digestion, conversion and donation), using five food products (bananas, tomatoes, apples, oranges and sweet peppers) from the fresh fruit and vegetables department in two supermarkets as examples when treated as individual waste streams. For all five waste streams, the established waste hierarchy was a useful tool for prioritising the various options, since the re-use options (conversion and donation) reduced the greenhouse gas emissions and the primary energy use to a significantly higher degree than the energy recovery options (incineration and anaerobic digestion). The substitution of other products and services had a major impact on the results in all scenarios. Re-use scenarios where food was replaced therefore had much higher potential to reduce environmental impact than the energy recovery scenarios where fossil fuel was replaced. This is due to the high level of resources needed to produce food compared with production of fossil fuels, but also to fresh fruit and vegetables having a high water content, making them inefficient as energy carriers. Waste valorisation measures should therefore focus on directing each type of food to the waste management system that can substitute the most resource-demanding products or services, even when the whole waste flow cannot be treated with the same method. Copyright © 2017 Elsevier Ltd. All rights reserved.

Integrating fisheries approaches and household utility models for improved resource management.

PubMed

Milner-Gulland, E J

2011-01-25

Natural resource management is littered with cases of overexploitation and ineffectual management, leading to loss of both biodiversity and human welfare. Disciplinary boundaries stifle the search for solutions to these issues. Here, I combine the approach of management strategy evaluation, widely applied in fisheries, with household utility models from the conservation and development literature, to produce an integrated framework for evaluating the effectiveness of competing management strategies for harvested resources against a range of performance metrics. I demonstrate the strengths of this approach with a simple model, and use it to examine the effect of manager ignorance of household decisions on resource management effectiveness, and an allocation tradeoff between monitoring resource stocks to reduce observation uncertainty and monitoring users to improve compliance. I show that this integrated framework enables management assessments to consider household utility as a direct metric for system performance, and that although utility and resource stock conservation metrics are well aligned, harvest yield is a poor proxy for both, because it is a product of household allocation decisions between alternate livelihood options, rather than an end in itself. This approach has potential far beyond single-species harvesting in situations where managers are in full control; I show that the integrated approach enables a range of management intervention options to be evaluated within the same framework.

Designing cost effective water demand management programs in Australia.

PubMed

White, S B; Fane, S A

2002-01-01

This paper describes recent experience with integrated resource planning (IRP) and the application of least cost planning (LCP) for the evaluation of demand management strategies in urban water. Two Australian case studies, Sydney and Northern New South Wales (NSW) are used in illustration. LCP can determine the most cost effective means of providing water services or alternatively the cheapest forms of water conservation. LCP contrasts to a traditional approach of evaluation which looks only at means of increasing supply. Detailed investigation of water usage, known as end-use analysis, is required for LCP. End-use analysis allows both rigorous demand forecasting, and the development and evaluation of conservation strategies. Strategies include education campaigns, increasing water use efficiency and promoting wastewater reuse or rainwater tanks. The optimal mix of conservation strategies and conventional capacity expansion is identified based on levelised unit cost. IRP uses LCP in the iterative process, evaluating and assessing options, investing in selected options, measuring the results, and then re-evaluating options. Key to this process is the design of cost effective demand management programs. IRP however includes a range of parameters beyond least economic cost in the planning process and program designs, including uncertainty, benefit partitioning and implementation considerations.

Watershed Management Optimization Support Tool (WMOST) v1: Theoretical Documentation

EPA Science Inventory

The Watershed Management Optimization Support Tool (WMOST) is a screening model that is spatially lumped with options for a daily or monthly time step. It is specifically focused on modeling the effect of management decisions on the watershed. The model considers water flows and ...

44 CFR 334.2 - Policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., each Federal department and agency shall prepare its national security emergency preparedness plans and... preparedness plans and programs to provide appropriate and effective response options for consideration in... Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY...

Evaluating holistic environmental consequences of brownfield management options using consequential life cycle assessment for different perspectives.

PubMed

Lesage, Pascal; Deschênes, Louise; Samson, Réjean

2007-08-01

Brownfields are abandoned, idled, or underused sites whose reuse necessitates some sort of intervention. These sites are largely urban and are frequently contaminated. Brownfield management options can be associated with three types of environmental consequences: those resulting from changes in the site's environmental quality (primary impacts); those resulting from the actual intervention stage (secondary impacts); and, if the vocation of the site changes, those resulting from effects on regional land use (tertiary impacts). Different stakeholders and decision-making contexts will place a different importance on each of these types of impacts. This article proposes a framework for comparing brownfield management options in regard to these three types of environmental impacts and for interpreting these results from different perspectives. The assessment framework is based on consequential life cycle assessment (LCA), which is shown to provide environmental information on the three types of impacts. The results for a case study are presented, where a "rehabilitation" option allowing residential redevelopment is compared to an "exposure minimization" option not resulting in the site being reused. Calculated primary and tertiary impacts are favorable to the rehabilitation option, whereas secondary impacts are favorable to the exposure minimization option. A ternary diagram presents the favorable option for different stereotypical perspectives. Tertiary impacts are much greater than secondary impacts, and consequently all perspectives that consider tertiary impacts favor rehabilitation. The perspective that considers primary and secondary impacts receives conflicting information. The ternary diagram, showing results for all perspectives, could possibly be useful for consensus-building among stakeholders.

Evaluating Holistic Environmental Consequences of Brownfield Management Options Using Consequential Life Cycle Assessment for Different Perspectives

NASA Astrophysics Data System (ADS)

Lesage, Pascal; Deschênes, Louise; Samson, Réjean

2007-08-01

Brownfields are abandoned, idled, or underused sites whose reuse necessitates some sort of intervention. These sites are largely urban and are frequently contaminated. Brownfield management options can be associated with three types of environmental consequences: those resulting from changes in the site’s environmental quality (primary impacts); those resulting from the actual intervention stage (secondary impacts); and, if the vocation of the site changes, those resulting from effects on regional land use (tertiary impacts). Different stakeholders and decision-making contexts will place a different importance on each of these types of impacts. This article proposes a framework for comparing brownfield management options in regard to these three types of environmental impacts and for interpreting these results from different perspectives. The assessment framework is based on consequential life cycle assessment (LCA), which is shown to provide environmental information on the three types of impacts. The results for a case study are presented, where a “rehabilitation” option allowing residential redevelopment is compared to an “exposure minimization” option not resulting in the site being reused. Calculated primary and tertiary impacts are favorable to the rehabilitation option, whereas secondary impacts are favorable to the exposure minimization option. A ternary diagram presents the favorable option for different stereotypical perspectives. Tertiary impacts are much greater than secondary impacts, and consequently all perspectives that consider tertiary impacts favor rehabilitation. The perspective that considers primary and secondary impacts receives conflicting information. The ternary diagram, showing results for all perspectives, could possibly be useful for consensus-building among stakeholders.

Therapeutic options for intractable hematuria in advanced bladder cancer.

PubMed

Abt, Dominik; Bywater, Mirjam; Engeler, Daniel Stephan; Schmid, Hans-Peter

2013-07-01

Intractable hematuria is a common and severe complication in patients with inoperable bladder carcinoma. The aim was to provide an overview of therapeutic options for such cases, and analyze their effectiveness and risk profile, so a systematic literature search of peer-reviewed papers published up to September 2012 was carried out. Various options are available to treat hematuria in patients with inoperable bladder cancer; these include orally administered epsilon-aminocaproic acid, intravesical formalin, alum or prostaglandin irrigation, hydrostatic pressure, urinary diversion, radiotherapy, embolization and intraarterial mitoxantrone perfusion. These treatment options are associated with different prospects of success, risks and side-effects. Well-designed and large studies comparing options are completely lacking. Despite various treatment options, management of intractable hematuria in patients with inoperable bladder cancer remains a challenge, and most of the reported methods should be seen as experimental. Interventional radiology and alum instillation seem to be suitable alternative options for patients who, after critical consideration, cannot be treated by irrigation, transurethral resection or palliative cystectomy. © 2013 The Japanese Urological Association.

Responding to climate change in national forests: a guidebook for developing adaptation options

Treesearch

David L. Peterson; Connie I. Millar; Linda A. Joyce; Michael J. Furniss; Jessica E. Halofsky; Ronald P. Neilson; Toni Lyn Morelli

2011-01-01

This guidebook contains science-based principles, processes, and tools necessary to assist with developing adaptation options for national forest lands. The adaptation process is based on partnerships between local resource managers and scientists who work collaboratively to understand potential climate change effects, identify important resource issues, and develop...

76 FR 19165 - Self-Regulatory Organizations; Notice of Filing and Immediate Effectiveness of Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-06

...\\ Additionally, the Exchange proposes to increase the number of option classes on individual stocks for which the... underlying stock is traded. Currently, Exchange Rule 6.4 at Commentary .03 permits the listing of options... security and meet their investment, trading and risk management requirements. [[Page 19166

Management Options for Biochemically Recurrent Prostate Cancer.

PubMed

Fakhrejahani, Farhad; Madan, Ravi A; Dahut, William L

2017-05-01

Prostate cancer is the most common solid tumor malignancy in men worldwide. Treatment with surgery and radiation can be curative in organ-confined disease. Unfortunately, about one third of men develop biochemically recurrent disease based only on rising prostate-specific antigen (PSA) in the absence of visible disease on conventional imaging. For these patients with biochemical recurrent prostate cancer, there is no uniform guideline for subsequent management. Based on available data, it seems prudent that biochemical recurrent prostate cancer should initially be evaluated for salvage radiation or prostatectomy, with curative intent. In selected cases, high-intensity focused ultrasound and cryotherapy may be considered in patients that meet very narrow criteria as defined by non-randomized trials. If salvage options are not practical or unsuccessful, androgen deprivation therapy (ADT) is a standard option for disease control. While some patients prefer ADT to manage the disease immediately, others defer treatment because of the associated toxicity. In the absence of definitive randomized data, patients may be followed using PSA doubling time as a trigger to initiate ADT. Based on retrospective data, a PSA doubling time of less than 3-6 months has been associated with near-term development of metastasis and thus could be used signal to initiate ADT. Once treatment is begun, patients and their providers can choose between an intermittent and continuous ADT strategy. The intermittent approach may limit side effects but in patients with metastatic disease studies could not exclude a 20% greater risk of death. In men with biochemical recurrence, large studies have shown that intermittent therapy is non-inferior to continuous therapy, thus making this a reasonable option. Since biochemically recurrent prostate cancer is defined by technological limitations of radiographic detection, as new imaging (i.e., PSMA) strategies are developed, it may alter how the disease is monitored and perhaps managed. Furthermore, patients have no symptoms related to their disease and thus many prefer options that minimize toxicity. For this reason, herbal agents and immunotherapy are under investigation as potential alternatives to ADT and its accompanying side effects. New therapeutic options combined with improved imaging to evaluate the disease may markedly change how biochemically recurrent prostate cancer is managed in the future.

75 FR 43928 - New England Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-27

... effects of fishing on Essential Fish Habitat (EFH) across all Council FMPs. These management options are being developed as part of Phase 2 of Essential Fish Habitat Omnibus Amendment 2. Broadly speaking, the... England Fishery Management Council (Council) is scheduling a public meeting of its Habitat/MPA/Ecosystem...

Financial Management. Guide to Standards and Implementation. Career & Technology Studies.

ERIC Educational Resources Information Center

Alberta Dept. of Education, Edmonton. Curriculum Standards Branch.

This Alberta curriculum guide defines competencies that help students build daily living skills, investigate career options in financial management, use technology in the financial management field effectively and efficiently, and prepare for entry into the workplace or related postsecondary programs. The first section provides a program rationale…

Ponderosa pine managed-yield simulator: PPSIM users guide.

Treesearch

D.J. DeMars; J.W. Barrett

1987-01-01

PPSIM simulates yields of natural and managed ponderosa pine stands. Management practices and effects that can be simulated include commercial thinning, fertilization, genetic improvement, and presence of dwarf mistletoe. An option is available that adjusts growth to simulate local conditions. Equations used in PPSIM describe growth of natural...

Managing for climate change on protected areas: An adaptive management decision making framework.

PubMed

Tanner-McAllister, Sherri L; Rhodes, Jonathan; Hockings, Marc

2017-12-15

Current protected area management is becoming more challenging with advancing climate change and current park management techniques may not be adequate to adapt for effective management into the future. The framework presented here provides an adaptive management decision making process to assist protected area managers with adapting on-park management to climate change. The framework sets out a 4 step process. One, a good understanding of the park's context within climate change. Secondly, a thorough understanding of the park management systems including governance, planning and management systems. Thirdly, a series of management options set out as an accept/prevent change style structure, including a systematic assessment of those options. The adaptive approaches are defined as acceptance of anthropogenic climate change impact and attempt to adapt to a new climatic environment or prevention of change and attempt to maintain current systems under new climatic variations. Last, implementation and monitoring of long term trends in response to ecological responses to management interventions and assessing management effectiveness. The framework addresses many issues currently with park management in dealing with climate change including the considerable amount of research focussing on 'off-reserve' strategies, and threats and stress focused in situ park management. Copyright © 2017 Elsevier Ltd. All rights reserved.

Cost-effectiveness of sialendoscopy versus medical management for radioiodine-induced sialadenitis.

PubMed

Kowalczyk, David M; Jordan, J Randall; Stringer, Scott P

2018-03-30

The medical management and radiographic identification of radioiodine-induced sialadenitis (RAIS) is challenging. This study utilizes a cost-effectiveness analysis to compare upfront sialendoscopy as both a diagnostic and therapeutic option versus multiple modalities of diagnostic radiography along with medical management. Literature review and cost-effectiveness analysis. A literature review was performed to identify the outcomes of medical management, sialendoscopy, diagnostic radiography, and surgical complications. All charges were obtained from the University of Mississippi Budget Office in 2017 US dollars and converted to costs using the 2017 Medicare Cost-to-Charge Ratio for urban medical centers. A cost-effectiveness analysis was used to evaluate the four treatment arms-sialendoscopy, medical management- ultrasound, medical management-computed tomography (CT) sialography, and medical management-magnetic resonance (MR) sialography. Sensitivity analyses were used to evaluate the confidence levels of the economic evaluation. The incremental cost-effectiveness ratio for upfront sialendoscopy versus medical management-ultrasound was $30,402.30, which demonstrates that sialendoscopy is the more cost-effective option given a willingness-to-pay threshold of $50,000. The probability that this decision is correct at a willingness-to-pay of $50,000 is 64.5%. Sialendoscopic improvement was the most sensitive variable requiring a threshold of 0.70. Of the three imaging modalities, ultrasound dominated MR and CT sialography, both of which required a willingness-to-pay of greater than $90,000 to realize a difference. Upfront sialendoscopy is more cost-effective compared to medical management utilizing diagnostic ultrasound assuming a willingness-to-pay threshold of $50,000. There is a clear cost-effectiveness to using ultrasound with medical management over CT and MR sialography in the diagnosis and management of RAIS. NA. Laryngoscope, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

Communicating forest management science and practices through visualized and animated media approaches to community presentations: An exploration and assessment

Treesearch

Donald E. Zimmerman; Carol Akerelrea; Jane Kapler Smith; Garrett J. O' Keefe

2006-01-01

Natural-resource managers have used a variety of computer-mediated presentation methods to communicate management practices to diverse publics. We explored the effects of visualizing and animating predictions from mathematical models in computerized presentations explaining forest succession (forest growth and change through time), fire behavior, and management options...

Beneficial effects of honey dressings in wound management.

PubMed

Sharp, Ailsa

Honey was commonly used to treat wounds until the introduction of antibiotics. However, increasing numbers of antibiotic-resistant bacteria mean that alternative treatment options, such as honey, are receiving renewed interest. This article provides an overview of the use of honey in wound management and reviews the evidence to support its effectiveness.

Idiopathic pulmonary fibrosis: a holistic approach to disease management in the antifibrotic age.

PubMed

Shaw, Jonathon; Marshall, Tracey; Morris, Helen; Hayton, Conal; Chaudhuri, Nazia

2017-11-01

Idiopathic pulmonary fibrosis (IPF) is the most common cause of interstitial lung disease (ILD) and carries a worse prognosis than many cancers. Until recently, there were no active treatment options available for patients with IPF, meaning palliation or lung transplantation in selected patients were the only options. The management of IPF has changed dramatically over the last decade with the advent of two antifibrotic agents; pirfenidone and nintedanib. These new agents have been shown to reduce decline in lung function and pirfenidone has been shown to reduce mortality. The changing landscape of IPF diagnosis and management present a number of issues that may be encountered including management of side effects related to antifibrotic therapy. This article aims to give an overview of the holistic approach to the management of patients with IPF, including antifibrotic management, symptom management and the invaluable role of the ILD specialist nurse.

Idiopathic pulmonary fibrosis: a holistic approach to disease management in the antifibrotic age

PubMed Central

Shaw, Jonathon; Marshall, Tracey; Morris, Helen; Chaudhuri, Nazia

2017-01-01

Idiopathic pulmonary fibrosis (IPF) is the most common cause of interstitial lung disease (ILD) and carries a worse prognosis than many cancers. Until recently, there were no active treatment options available for patients with IPF, meaning palliation or lung transplantation in selected patients were the only options. The management of IPF has changed dramatically over the last decade with the advent of two antifibrotic agents; pirfenidone and nintedanib. These new agents have been shown to reduce decline in lung function and pirfenidone has been shown to reduce mortality. The changing landscape of IPF diagnosis and management present a number of issues that may be encountered including management of side effects related to antifibrotic therapy. This article aims to give an overview of the holistic approach to the management of patients with IPF, including antifibrotic management, symptom management and the invaluable role of the ILD specialist nurse. PMID:29268540

Joint protection and hand exercises for hand osteoarthritis: an economic evaluation comparing methods for the analysis of factorial trials

PubMed Central

Oppong, Raymond; Nicholls, Elaine; Whitehurst, David G. T.; Hill, Susan; Hammond, Alison; Hay, Elaine M.; Dziedzic, Krysia

2015-01-01

Objectives. Evidence regarding the cost-effectiveness of joint protection and hand exercises for the management of hand OA is not well established. The primary aim of this study is to assess the cost-effectiveness (cost-utility) of these management options. In addition, given the absence of consensus regarding the conduct of economic evaluation alongside factorial trials, we compare different analytical methodologies. Methods. A trial-based economic evaluation to assess the cost-utility of joint protection only, hand exercises only and joint protection plus hand exercises compared with leaflet and advice was undertaken over a 12 month period from a UK National Health Service perspective. Patient-level mean costs and mean quality-adjusted life years (QALYs) were calculated for each trial arm. Incremental cost-effectiveness ratios (ICERs) were estimated and cost-effectiveness acceptability curves were constructed. The base case analysis used a within-the-table analysis methodology. Two further methods were explored: the at-the-margins approach and a regression-based approach with or without an interaction term. Results. Mean costs (QALYs) were £58.46 (s.d. 0.662) for leaflet and advice, £92.12 (s.d. 0.659) for joint protection, £64.51 (s.d. 0.681) for hand exercises and £112.38 (s.d. 0.658) for joint protection plus hand exercises. In the base case, hand exercises were the cost-effective option, with an ICER of £318 per QALY gained. Hand exercises remained the most cost-effective management strategy when adopting alternative methodological approaches. Conclusion. This is the first trial evaluating the cost-effectiveness of occupational therapy-supported approaches to self-management for hand OA. Our findings showed that hand exercises were the most cost-effective option. PMID:25339642

23 CFR 500.104 - State option.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false State option. 500.104 Section 500.104 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION TRANSPORTATION INFRASTRUCTURE MANAGEMENT MANAGEMENT AND MONITORING SYSTEMS Management Systems § 500.104 State option. Except as specified in § 500.105 (a...

Future water supply management adaptation measures - case study of Ljubljana field aquifer

NASA Astrophysics Data System (ADS)

Čenčur Curk, B.; Zajc Benda, T.; Souvent, P.; Bračič Železnik, B.; Bogardi, I.

2012-04-01

The main drinking water supply problems are related to the significant change of groundwater quantity and quality observed in the last decades as an effect of land use practices and very likely also climate change. The latter may affect the ability of drinking water suppliers to provide enough water of sufficient quality to the consumers. These topics were studied in the frame of SEE project CC-WaterS (Climate Change and Impact on Water Supply) with the main goal to develop a water supply management system regarding optimisation of water extraction and land use restrictions under climate change scenarios for water suppliers, since existing management practices are mostly inadequate to reduce impacts of CC on water supply reliability. The main goal was a designation of appropriate measures and risk assessment to adapt water supply to changing climate and land use activities considering socio-economic aspects. This was accomplished by using 'Fuzzy Decimaker', which is a tool for selecting and ranking risk reduction measures or management actions for local waterworks or water authorities under the pressure of climate change. Firstly, management options were selected and ranked. For public water supply of Ljubljana, the capital of Slovenia, several management options were selected. For improvement of water supply and preservation of water resource quantities there is a need for engineering interventions, such as reducing water losses on pipelines. For improving drinking water safety and preserving water resource quality farmers are not allowed to use fertilisers in the first safeguarding zone and they get compensations for income reduction because of lower farming production. Compensations for farming restrictions in the second safeguarding zone were applied as additional management option. On the other hand, drinking water treatment is another management option to be considered. Trends in groundwater level are decreasing, above all recharge areas of waterworks; therefore there is a threat of reduction of water resource availability. For this following management options were proposed: artificial recharge with infiltration wells, setting up new and additional waterworks (one with river bank filtration, one with exploitation of local porous aquifer and one with deep groundwater exploitation from dolomite aquifer). Management actions can be evaluated according to several criteria, such as water supply risk reduction for the various users (drinking, agricultural, industrial and ecological), realization of the actions (cost, flexibility and leg time). Ranking criteria are characterized by different units (e.g. units of water supply (quantity) risk may involve number of unsupplied people, monetary terms, agricultural area or habitat loss). Decision making process is followed by defining relative weights, balancing factors and best and worst values for the indicators; calculating base risk and risk elements for each management option and sensitivity analysis. The result of this decision making process is evaluation of preferred management option(s) according to the ranking results.

Estimating option values of solar radiation management assuming that climate sensitivity is uncertain.

PubMed

Arino, Yosuke; Akimoto, Keigo; Sano, Fuminori; Homma, Takashi; Oda, Junichiro; Tomoda, Toshimasa

2016-05-24

Although solar radiation management (SRM) might play a role as an emergency geoengineering measure, its potential risks remain uncertain, and hence there are ethical and governance issues in the face of SRM's actual deployment. By using an integrated assessment model, we first present one possible methodology for evaluating the value arising from retaining an SRM option given the uncertainty of climate sensitivity, and also examine sensitivities of the option value to SRM's side effects (damages). Reflecting the governance challenges on immediate SRM deployment, we assume scenarios in which SRM could only be deployed with a limited degree of cooling (0.5 °C) only after 2050, when climate sensitivity uncertainty is assumed to be resolved and only when the sensitivity is found to be high (T2x = 4 °C). We conduct a cost-effectiveness analysis with constraining temperature rise as the objective. The SRM option value is originated from its rapid cooling capability that would alleviate the mitigation requirement under climate sensitivity uncertainty and thereby reduce mitigation costs. According to our estimates, the option value during 1990-2049 for a +2.4 °C target (the lowest temperature target level for which there were feasible solutions in this model study) relative to preindustrial levels were in the range between $2.5 and $5.9 trillion, taking into account the maximum level of side effects shown in the existing literature. The result indicates that lower limits of the option values for temperature targets below +2.4 °C would be greater than $2.5 trillion.

Estimating option values of solar radiation management assuming that climate sensitivity is uncertain

PubMed Central

Arino, Yosuke; Akimoto, Keigo; Sano, Fuminori; Homma, Takashi; Oda, Junichiro; Tomoda, Toshimasa

2016-01-01

Although solar radiation management (SRM) might play a role as an emergency geoengineering measure, its potential risks remain uncertain, and hence there are ethical and governance issues in the face of SRM’s actual deployment. By using an integrated assessment model, we first present one possible methodology for evaluating the value arising from retaining an SRM option given the uncertainty of climate sensitivity, and also examine sensitivities of the option value to SRM’s side effects (damages). Reflecting the governance challenges on immediate SRM deployment, we assume scenarios in which SRM could only be deployed with a limited degree of cooling (0.5 °C) only after 2050, when climate sensitivity uncertainty is assumed to be resolved and only when the sensitivity is found to be high (T2x = 4 °C). We conduct a cost-effectiveness analysis with constraining temperature rise as the objective. The SRM option value is originated from its rapid cooling capability that would alleviate the mitigation requirement under climate sensitivity uncertainty and thereby reduce mitigation costs. According to our estimates, the option value during 1990–2049 for a +2.4 °C target (the lowest temperature target level for which there were feasible solutions in this model study) relative to preindustrial levels were in the range between $2.5 and $5.9 trillion, taking into account the maximum level of side effects shown in the existing literature. The result indicates that lower limits of the option values for temperature targets below +2.4 °C would be greater than $2.5 trillion. PMID:27162346

Options for enhancing the effectiveness of Virginia's safety management system : final report.

DOT National Transportation Integrated Search

1996-02-01

In 1993, Virginia began to formalize the relationships and organizational structure for its Safety Management System (SMS). Although the SMS is no longer a federal requirement, Virginia decided to continue its implementation. The Focal Point for the ...

Cost-effectiveness of the management of rh-negative pregnant women.

PubMed

Duplantie, Julie; Gonzales, Odilon Martinez; Bois, Antoine; Nshimyumukiza, Léon; Gekas, Jean; Bujold, Emmanuel; Morin, Valérie; Vallée, Maud; Giguère, Yves; Gagné, Christian; Rousseau, François; Reinharz, Daniel

2013-08-01

The purpose of this study was to determine the most cost-effective option to prevent alloimmunization against the Rh factor. A virtual population of Rh-negative pregnant women in Quebec was built to simulate the cost-effectiveness of preventing alloimmunization. The model considered four options: (1) systematic use of anti-D immunoglobulin; (2) fetal Rh(D) genotyping; (3) immunological determination of the father's Rh type; (4) mixed screening: immunological determination of the father's Rh type, followed if positive by fetal Rh(D) genotyping. Two outcomes were considered, in addition to the estimated costs: (1) the number of babies without hemolytic disease, and (2) the number of surviving infants. In a first pregnancy, two options emerged as the most cost-effective options: systematic prophylaxis and immunological Rh typing of the father, with overlapping confidence intervals between them. In a second pregnancy, the results were similar. In all cases (first or second pregnancy or a combination of the two) fetal genotyping was not found to be a cost-effective option. Routine prophylaxis and immunological Rh typing of the father are the most cost-effective options for the prevention of Rh alloimmunization. Considering that immunological typing of the father would probably not be carried out by the majority of clinicians, routine prophylaxis remains the preferred option. However, this could change if the cost of Rh(D) fetal genotyping fell below $140 per sample.

Assessing the Value of Information for Identifying Optimal Floodplain Management Portfolios

NASA Astrophysics Data System (ADS)

Read, L.; Bates, M.; Hui, R.; Lund, J. R.

2014-12-01

Floodplain management is a complex portfolio problem that can be analyzed from an integrated perspective incorporating traditionally structural and nonstructural options. One method to identify effective strategies for preparing, responding to, and recovering from floods is to optimize for a portfolio of temporary (emergency) and permanent floodplain management options. A risk-based optimization approach to this problem assigns probabilities to specific flood events and calculates the associated expected damages. This approach is currently limited by: (1) the assumption of perfect flood forecast information, i.e. implementing temporary management activities according to the actual flood event may differ from optimizing based on forecasted information and (2) the inability to assess system resilience across a range of possible future events (risk-centric approach). Resilience is defined here as the ability of a system to absorb and recover from a severe disturbance or extreme event. In our analysis, resilience is a system property that requires integration of physical, social, and information domains. This work employs a 3-stage linear program to identify the optimal mix of floodplain management options using conditional probabilities to represent perfect and imperfect flood stages (forecast vs. actual events). We assess the value of information in terms of minimizing damage costs for two theoretical cases - urban and rural systems. We use portfolio analysis to explore how the set of optimal management options differs depending on whether the goal is for the system to be risk-adverse to a specified event or resilient over a range of events.

Management/Technical Interaction in Integrated Information System Development.

ERIC Educational Resources Information Center

Bagley, Clarence H.; Gardner, Don E.

The integrated information system element of the management information system concept has practical applications for management in the areas of both information analysis and decision-model building. Four basic options for achieving integration in operational data systems are: a default option, the coordinated file option, the distributed…

Alternative skid trail retirement options for steep terrain logging

Treesearch

Mathew F. Smidt; Randall K. Kolka

2001-01-01

In winter 1999-2000 trials of deep tillage and recontouring of skid trails were implemented on three sites in northeastern Kentucky, USA to examine their potential as skid trail retirement options. While effective, current Best Management Practices (BMPs) for trail retirement do not address two potential benefits of retirement: recovery of normal hill slope hydrology...

Alternative skid trail retirement options for steep terrain logging

Treesearch

Mathew F. Smidt; Randall K. Kelka

2001-01-01

In winter 1999-2000 trials of deep tillage and recontouring of skid trails were implemented on three sites in northeastern Kentucky, USA to examine their potential as skid trail retirement options. While effective, current Best Management Practices (BMPs) for trail retirement do not address two potential benefits of retirement: recovery of normal hill slope\\r\\...

Recurrent Clostridium difficile Infection: From Colonization to Cure

PubMed Central

Shields, Kelsey; Araujo-Castillo, Roger V.; Theethira, Thimmaiah G.; Alonso, Carolyn D.; Kelly, Ciaran

2015-01-01

Clostridium difficile infection (CDI) is increasingly prevalent, dangerous and challenging to prevent and manage. Despite intense national and international attention the incidence of primary and of recurrent CDI (PCDI and RCDI, respectively) have risen rapidly throughout the past decade. Of major concern is the increase in cases of RCDI resulting in substantial morbidity, morality and economic burden. RCDI management remains challenging as there is no uniformly effective therapy, no firm consensus on optimal treatment, and reliable data regarding RCDI-specific treatment options is scant. Novel therapeutic strategies are critically needed to rapidly, accurately, and effectively identify and treat patients with, or at-risk for, RCDI. In this review we consider the factors implicated in the epidemiology, pathogenesis and clinical presentation of RCDI, evaluate current management options for RCDI and explore novel and emerging therapies. PMID:25930686

Management of stage IV rectal cancer: Palliative options

PubMed Central

Ronnekleiv-Kelly, Sean M; Kennedy, Gregory D

2011-01-01

Approximately 30% of patients with rectal cancer present with metastatic disease. Many of these patients have symptoms of bleeding or obstruction. Several treatment options are available to deal with the various complications that may afflict these patients. Endorectal stenting, laser ablation, and operative resection are a few of the options available to the patient with a malignant large bowel obstruction. A thorough understanding of treatment options will ensure the patient is offered the most effective therapy with the least amount of associated morbidity. In this review, we describe various options for palliation of symptoms in patients with metastatic rectal cancer. Additionally, we briefly discuss treatment for asymptomatic patients with metastatic disease. PMID:21412493

75 FR 71168 - Self-Regulatory Organizations; BATS Exchange, Inc.; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-22

... flexibility and the ability to more closely tailor their investment and risk management strategies and... will aid investors by offering opportunities to manage risk and execute a variety of option strategies... to provide investors with additional strikes for investment, trading, and risk management purposes. 2...

Streamside Management Zones Affect Movement of Silvicultural Nitrogen and Phosphorus Fertilizers to Piedmont Streams

Treesearch

Joseph M. Secoges; Wallace M. Aust; John R. Seiler; C. Andrew Dolloff; William A. Lakel

2013-01-01

Forestry best management practices (BMP) recommendations for streamside management zones (SMZs) are based on limited data regarding SMZ width, partial harvests, and nutrient movements after forest fertilization. Agricultural fertilization is commonly linked to increased stream nutrients. However, less is known about effectiveness of SMZ options for controlling nutrient...

Cost-effectiveness analysis of Option B+ for HIV prevention and treatment of mothers and children in Malawi.

PubMed

Fasawe, Olufunke; Avila, Carlos; Shaffer, Nathan; Schouten, Erik; Chimbwandira, Frank; Hoos, David; Nakakeeto, Olive; De Lay, Paul

2013-01-01

The Ministry of Health in Malawi is implementing a pragmatic and innovative approach for the management of all HIV-infected pregnant women, termed Option B+, which consists of providing life-long antiretroviral treatment, regardless of their CD4 count or clinical stage. Our objective was to determine if Option B+ represents a cost-effective option. A decision model simulates the disease progression of a cohort of HIV-infected pregnant women receiving prophylaxis and antiretroviral therapy, and estimates the number of paediatric infections averted and maternal life years gained over a ten-year time horizon. We assess the cost-effectiveness from the Ministry of Health perspective while taking into account the practical realities of implementing ART services in Malawi. If implemented as recommended by the World Health Organization, options A, B and B+ are equivalent in preventing new infant infections, yielding cost effectiveness ratios between US$ 37 and US$ 69 per disability adjusted life year averted in children. However, when the three options are compared to the current practice, the provision of antiretroviral therapy to all mothers (Option B+) not only prevents infant infections, but also improves the ten-year survival in mothers more than four-fold. This translates into saving more than 250,000 maternal life years, as compared to mothers receiving only Option A or B, with savings of 153,000 and 172,000 life years respectively. Option B+ also yields favourable incremental cost effectiveness ratios (ICER) of US$ 455 per life year gained over the current practice. In Malawi, Option B+ represents a favorable policy option from a cost-effectiveness perspective to prevent future infant infections, save mothers' lives and reduce orphanhood. Although Option B+ would require more financial resources initially, it would save societal resources in the long-term and represents a strategic option to simplify and integrate HIV services into maternal, newborn and child health programmes.

41 CFR 101-39.004 - Optional operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

...-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.0-General Provisions § 101-39.004 Optional operations. Nothing in this part shall preclude the establishment or operation of interagency fleet management systems by GSA or by... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Optional operations. 101...

Public expectations about access fees and road closures on public lands

USGS Publications Warehouse

Cline, K.; Lamb, B.L.; Ponds, P.D.

2006-01-01

It is sometimes suggested that land managers could better communicate with the general public by relying on people who are active in community affairs to frame the message. By comparing responses from the 'attentive' and general public on the Colorado Plateau in the USA, this study investigated the expected effects of using recreation access fees or road closures to manage recreation on public lands. Although neither the attentive nor general public strongly anticipated benefits from the two management options, the attentive public was more likely than the general public to report positive expectations. Those more likely to expect fewer benefits from the management options do so because of factors that are outside the influence of managers (e.g., socio-demographics and value orientation). The results point out challenges for building public support through mobilizing the attentive public to develop a positive management atmosphere with fees and road closures. ?? 2006 University of Newcastle upon Tyne.

Current issues and challenges in the management of bariatric patients.

PubMed

Bell, Sue Ellen

2005-01-01

Morbid obesity is an increasingly common healthcare problem, and providers and patients currently face numerous challenges in dealing with this problem effectively. Issues addressed in this article include the effect of stigma, the need for more evidence regarding effective management options, and the declining insurance coverage for bariatric surgery. The role of bariatric surgery in effective management of morbid obesity is discussed, along with the effect on and possible reasons for declining coverage. A comparison between benefits and coverage for bariatric surgery and angioplasty/stent placement is included.

Scleral Lenses in the Management of Corneal Irregularity and Ocular Surface Disease.

PubMed

Shorter, Ellen; Harthan, Jennifer; Nau, Cherie B; Nau, Amy; Barr, Joseph T; Hodge, David O; Schornack, Muriel M

2017-09-29

To describe current practice patterns regarding the use of scleral lens therapy in the management of corneal irregularity and ocular surface disease among eye care providers who fit scleral lenses. The Scleral Lenses in Current Ophthalmic Practice: an Evaluation (SCOPE) study group conducted an electronic survey of eye care providers from January 15 to March 31, 2015. Respondents ranked management options for corneal irregularity in the order in which they would generally consider their use. Respondents also ranked options for the management of ocular surface disease in the order in which they would use each of the treatments. Results for each option were analyzed as percentage first-place ranking; percentage first-, second-, or third-place ranking; and mean rank score. Survey responses were obtained from 723 providers who had fit 5 or more scleral lenses. Of these respondents, 629 ranked options for management of corneal irregularity and 612 ranked options for management of ocular surface disease. Corneal rigid gas-permeable lenses were the first option for management of corneal irregularity for 44% of respondents, and scleral lenses were the first option for 34% of respondents. Lubricant drops were the first therapeutic recommendation for ocular surface disease for 84% of respondents, and scleral lenses were ranked first by 6% of respondents. Scleral lenses rank second only to corneal rigid gas-permeable lenses for management of corneal irregularity. Scleral lenses are generally considered after other medical intervention and before surgery for the management of ocular surface disease.

Placing the power of real options analysis into the hands of natural resource managers - taking the next step.

PubMed

Nelson, Rohan; Howden, Mark; Hayman, Peter

2013-07-30

This paper explores heuristic methods with potential to place the analytical power of real options analysis into the hands of natural resource managers. The complexity of real options analysis has led to patchy or ephemeral adoption even by corporate managers familiar with the financial-market origins of valuation methods. Intuitively accessible methods for estimating the value of real options have begun to evolve, but their evaluation has mostly been limited to researcher-driven applications. In this paper we work closely with Bush Heritage Australia to evaluate the potential of real options analysis to support the intuitive judgement of conservation estate managers in covenanting land with uncertain future conservation value due to climate change. The results show that modified decision trees have potential to estimate the option value of covenanting individual properties while time and ongoing research resolves their future conservation value. Complementing this, Luehrman's option space has potential to assist managers with limited budgets to increase the portfolio value of multiple properties with different conservation attributes. Copyright © 2013 Elsevier Ltd. All rights reserved.

Climate change, coral reef ecosystems, and management options for marine protected areas.

PubMed

Keller, Brian D; Gleason, Daniel F; McLeod, Elizabeth; Woodley, Christa M; Airamé, Satie; Causey, Billy D; Friedlander, Alan M; Grober-Dunsmore, Rikki; Johnson, Johanna E; Miller, Steven L; Steneck, Robert S

2009-12-01

Marine protected areas (MPAs) provide place-based management of marine ecosystems through various degrees and types of protective actions. Habitats such as coral reefs are especially susceptible to degradation resulting from climate change, as evidenced by mass bleaching events over the past two decades. Marine ecosystems are being altered by direct effects of climate change including ocean warming, ocean acidification, rising sea level, changing circulation patterns, increasing severity of storms, and changing freshwater influxes. As impacts of climate change strengthen they may exacerbate effects of existing stressors and require new or modified management approaches; MPA networks are generally accepted as an improvement over individual MPAs to address multiple threats to the marine environment. While MPA networks are considered a potentially effective management approach for conserving marine biodiversity, they should be established in conjunction with other management strategies, such as fisheries regulations and reductions of nutrients and other forms of land-based pollution. Information about interactions between climate change and more "traditional" stressors is limited. MPA managers are faced with high levels of uncertainty about likely outcomes of management actions because climate change impacts have strong interactions with existing stressors, such as land-based sources of pollution, overfishing and destructive fishing practices, invasive species, and diseases. Management options include ameliorating existing stressors, protecting potentially resilient areas, developing networks of MPAs, and integrating climate change into MPA planning, management, and evaluation.

Endoscopic management of difficult common bile duct stones

PubMed Central

Trikudanathan, Guru; Navaneethan, Udayakumar; Parsi, Mansour A

2013-01-01

Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected patients. Ductal clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have failed. Biliary stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities. PMID:23345939

41 CFR 101-39.4901 - Obtaining standard and optional forms.

Code of Federal Regulations, 2010 CFR

2010-07-01

... VEHICLES 39-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.49-Forms § 101-39.4901 Obtaining standard and optional... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Obtaining standard and optional forms. 101-39.4901 Section 101-39.4901 Public Contracts and Property Management Federal Property...

Stress urinary incontinence in women: Current and emerging therapeutic options

PubMed Central

Shamout, Samer; Campeau, Lysanne

2017-01-01

Surgical management of stress urinary incontinence (SUI) is most commonly achieved by midurethral synthetic sling (MUS) insertion as a first-line surgical option. A great deal of research continues to evolve new management strategies to reach an optimal balance of high efficacy and minimal adverse events. This expert opinion review provides a brief and comprehensive discussion of recent advances and ongoing research in the management of SUI, with an emphasis on single-incision mini-slings, vaginal laser treatment, and cell-based therapy. It is based on data obtained from numerous published meta-analyses and original studies identified through literature search. Single-incision mini-slings appear equally effective initially compared with standard MUS (retropubic or transobturator) for the treatment of female SUI; however, this efficacy lacks durability evidence beyond one-year followup. There is a lack of sufficient clinical evidence to currently confirm long-term safety and effectiveness of cell-therapy and non-ablative vaginal laser therapy, besides suggestion of apparent initial safety. There are still significant challenges to overcome before widespread clinical practice of the latter two modalities. Future research should be aimed at identifying groups of patients who might benefit from these minimally invasive therapeutic options. PMID:28616118

How widely applicable is river basin management? An analysis of wastewater management in an arid transboundary case.

PubMed

Dombrowsky, Ines; Almog, Ram; Becker, Nir; Feitelson, Eran; Klawitter, Simone; Lindemann, Stefan; Mutlak, Natalie

2010-05-01

The basin scale has been promoted universally as the optimal management unit that allows for the internalization of all external effects caused by multiple water uses. However, the basin scale has been put forward largely on the basis of experience in temperate zones. Hence whether the basin scale is the best scale for management in other settings remains questionable. To address these questions this paper analyzes the economic viability and the political feasibility of alternative management options in the Kidron/Wadi Nar region. The Kidron/Wadi Nar is a small basin in which wastewater from eastern Jerusalem flows through the desert to the Dead Sea. Various options for managing these wastewater flows were analyzed ex ante on the basis of both a cost benefit and a multi-criteria analysis. The paper finds that due to economies of scale, a pure basin approach is not desirable from a physical and economic perspective. Furthermore, in terms of political feasibility, it seems that the option which prompts the fewest objections from influential stakeholder groups in the two entities under the current asymmetrical political setting is not a basin solution either, but a two plant solution based on an outsourcing arrangement. These findings imply that the river basin management approach can not be considered the best management approach for the arid transboundary case at hand, and hence is not unequivocally universally applicable.

How Widely Applicable is River Basin Management? An Analysis of Wastewater Management in an Arid Transboundary Case

NASA Astrophysics Data System (ADS)

Dombrowsky, Ines; Almog, Ram; Becker, Nir; Feitelson, Eran; Klawitter, Simone; Lindemann, Stefan; Mutlak, Natalie

2010-05-01

The basin scale has been promoted universally as the optimal management unit that allows for the internalization of all external effects caused by multiple water uses. However, the basin scale has been put forward largely on the basis of experience in temperate zones. Hence whether the basin scale is the best scale for management in other settings remains questionable. To address these questions this paper analyzes the economic viability and the political feasibility of alternative management options in the Kidron/Wadi Nar region. The Kidron/Wadi Nar is a small basin in which wastewater from eastern Jerusalem flows through the desert to the Dead Sea. Various options for managing these wastewater flows were analyzed ex ante on the basis of both a cost benefit and a multi-criteria analysis. The paper finds that due to economies of scale, a pure basin approach is not desirable from a physical and economic perspective. Furthermore, in terms of political feasibility, it seems that the option which prompts the fewest objections from influential stakeholder groups in the two entities under the current asymmetrical political setting is not a basin solution either, but a two plant solution based on an outsourcing arrangement. These findings imply that the river basin management approach can not be considered the best management approach for the arid transboundary case at hand, and hence is not unequivocally universally applicable.

Preliminary review of adaptation options for climate-sensitive ecosystems and resources. A report by the U.S. Climate Change Science Program and the Subcommittee on Global Change Research

USGS Publications Warehouse

Baron, Jill S.; Griffith, Brad; Joyce, Linda A.; Kareiva, Peter; Keller, Brian D.; Palmer, Margaret A.; Peterson, Charles H.; Scott, J. Michael; Julius, Susan Herrod; West, Jordan M.

2008-01-01

Climate variables are key determinants of geographic distributions and biophysical characteristics of ecosystems, communities, and species. Climate change is therefore affecting many species attributes, ecological interactions, and ecosystem processes. Because changes in the climate system will continue into the future regardless of emissions mitigation, strategies for protecting climate-sensitive ecosystems through management will be increasingly important. While there will always be uncertainties associated with the future path of climate change, the response of ecosystems to climate impacts, and the effects of management, it is both possible and essential for adaptation to proceed using the best available science. This report provides a preliminary review of adaptation options for climate-sensitive ecosystems and resources in the United States. The term “adaptation” in this document refers to adjustments in human social systems (e.g., management) in response to climate stimuli and their effects. Since management always occurs in the context of desired ecosystem conditions or natural resource management goals, it is instructive to examine particular goals and processes used by different organizations to fulfill their objectives. Such an examination allows for discussion of specific adaptation options as well as potential barriers and opportunities for implementation. Using this approach, this report presents a series of chapters on the following selected management systems: National Forests, National Parks, National Wildlife Refuges, Wild and Scenic Rivers, National Estuaries, and Marine Protected Areas. For these chapters, the authors draw on the literature, their own expert opinion, and expert workshops composed of resource management scientists and representatives of managing agencies. The information drawn from across these chapters is then analyzed to develop the key synthetic messages presented below.

Contemporary management of cancer of the oral cavity

PubMed Central

Genden, Eric M.; Silver, Carl E.; Takes, Robert P.; Suárez, Carlos; Owen, Randall P.; Haigentz, Missak; Stoeckli, Sandro J.; Shaha, Ashok R.; Rapidis, Alexander D.; Rodrigo, Juan Pablo; Rinaldo, Alessandra

2010-01-01

Oral cancer represents a common entity comprising a third of all head and neck malignant tumors. The options for curative treatment of oral cavity cancer have not changed significantly in the last three decades; however, the work up, the approach to surveillance, and the options for reconstruction have evolved significantly. Because of the profound functional and cosmetic importance of the oral cavity, management of oral cavity cancers requires a thorough understanding of disease progression, approaches to management and options for reconstruction. The purpose of this review is to discuss the most current management options for oral cavity cancers. PMID:20155361

Application of a Structured Decision Process for Informing Watershed Management Options in Guánica Bay, Puerto Rico

EPA Science Inventory

The Guánica Bay watershed has been a priority for research, assessment and management since the 1970s, and since 2008, has been the focus of a U.S. Coral Reef Task Force (USCRTF) research initiative involving multiple agencies assembled to address the effect of land management de...

Pathway models for analysing and managing the introduction of alien plant pests—an overview and categorization

Treesearch

J.C. Douma; M. Pautasso; R.C. Venette; C. Robinet; L. Hemerik; M.C.M. Mourits; J. Schans; W. van der Werf

2016-01-01

Alien plant pests are introduced into new areas at unprecedented rates through global trade, transport, tourism and travel, threatening biodiversity and agriculture. Increasingly, the movement and introduction of pests is analysed with pathway models to provide risk managers with quantitative estimates of introduction risks and effectiveness of management options....

77 FR 72894 - Self-Regulatory Organizations; BATS Exchange, Inc.; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-06

... Change To Expand the Availability of Risk Management Tools November 30, 2012. Pursuant to Section 19(b)(1... Exchange's Risk Management Tool (the ``Tool'') to all Exchange Members.\\3\\ The Tool is currently available... Access Risk Management Tool.\\6\\ This optional service acts as a risk filter by causing the orders of...

A novel method to value real options in health care: the case of a multicohort human papillomavirus vaccination strategy.

PubMed

Favato, Giampiero; Baio, Gianluca; Capone, Alessandro; Marcellusi, Andrea; Saverio Mennini, Francesco

2013-07-01

A large number of economic evaluations have already confirmed the cost-effectiveness of different human papillomavirus (HPV) vaccination strategies. Standard analyses might not capture the full economic value of novel vaccination programs because the cost-effectiveness paradigm fails to take into account the value of active management. Management decisions can be seen as real options, a term used to refer to the application of option pricing theory to the valuation of investments in nonfinancial assets in which much of the value is attributable to flexibility and learning over time. The aim of this article was to discuss the potential advantages shown by using the payoff method in the valuation of the cost-effectiveness of competing HPV immunization programs. This was the first study, to the best of our knowledge, to use the payoff method to determine the real option values of 4 different HPV vaccination strategies targeting female subjects aged 12, 15, 18, and 25 years. The payoff method derives the real option value from the triangular payoff distribution of the project's net present value, which is treated as a triangular fuzzy number. To inform the real option model, cost-effectiveness data were derived from an empirically calibrated Bayesian model designed to assess the cost-effectiveness of a multicohort HPV vaccination strategy in the context of the current cervical cancer screening program in Italy. A net health benefit approach was used to calculate the expected fuzzy net present value for each of the 4 vaccination strategies evaluated. Costs per quality-adjusted life-year gained seemed to be related to the number of cohorts targeted: a single cohort of girls aged 12 years (€10,955 [95% CI, -1,021 to 28,212]) revealed the lowest cost among the 4 alternative strategies evaluated. The real option valuation challenged the cost-effectiveness dominance of a single cohort of 12-year-old girls. The simultaneous vaccination of 2 cohorts of girls aged 12 and 15 years yielded a real option value (€17,723) equivalent to that attributed to a single cohort of 12-year-old girls (€17,460). The payoff method showed distinctive advantages in the valuation of the cost-effectiveness of competing health care interventions, essentially determined by the replacement of the nonfuzzy numbers that are commonly used in cost-effectiveness analysis models, with fuzzy numbers as an input to inform the real option pricing method. The real option approach to value uncertainty makes policy making in health care an evolutionary process and creates a new "space" for decision-making choices. Copyright © 2013 Elsevier HS Journals, Inc. All rights reserved.

Ditch network maintenance in peat-dominated boreal forests: Review and analysis of water quality management options.

PubMed

Nieminen, Mika; Piirainen, Sirpa; Sikström, Ulf; Löfgren, Stefan; Marttila, Hannu; Sarkkola, Sakari; Laurén, Ari; Finér, Leena

2018-03-27

The objective of this study was to evaluate the potential of different water management options to mitigate sediment and nutrient exports from ditch network maintenance (DNM) areas in boreal peatland forests. Available literature was reviewed, past data reanalyzed, effects of drainage intensity modeled, and major research gaps identified. The results indicate that excess downstream loads may be difficult to prevent. Water protection structures constructed to capture eroded matter are either inefficient (sedimentation ponds) or difficult to apply (wetland buffers). It may be more efficient to decrease erosion, either by limiting peak water velocity (dam structures) or by adjusting ditch depth and spacing to enable satisfactory drainage without exposing the mineral soil below peat. Future research should be directed towards the effects of ditch breaks and adjusted ditch depth and spacing in managing water quality in DNM areas.

Carotid Artery Stenting, Endarterectomy, or Medical Treatment Alone: The Debate Is Not Over

PubMed Central

Kassaian, Seyed Ebrahim; Goodarzynejad, Hamidreza

2011-01-01

The management of carotid artery stenosis reduces the risk of stroke and its related deaths. Management options include risk factor modification and medical therapy, carotid endarterectomy (CEA), and carotid artery stenting (CAS). Although several randomized controlled trials (RCTs), mostly conducted in late-1980s and mid-1990s, have proved CEA to be effective in the prevention of ipsilateral ischemic events in selected patients with carotid artery stenosis, aggressive risk factor modification and medical therapy with recently introduced antiplatelet agents, statins, and more effective antihypertensive medications may have reduced compelling indications for immediate surgery in asymptomatic populations. Also recently, due to improvements in percutaneous techniques and carotid stents, CAS has received wide attention as a potential alternative to CEA. Herein, we review the recent data on the management options of carotid artery stenosis and seek to identify the most appropriate treatment strategy in selected patients with carotid artery stenosis. PMID:23074598

Perioperative Interrogation of St. Jude Cardiovascular Implantable Electronic Devices: A Guide for Anesthesiologists.

PubMed

Cronin, Brett; Essandoh, Michael K

2018-04-01

Feelings of trepidation or uncertainty regarding cardiovascular implantable electronic devices (CIEDs) in the perioperative period can often be mitigated by a thorough knowledge of societal recommendations, recommended management options, and familiarity with CIEDs. Given that effective interpretation of an interrogation report is vital to determining perioperative management options and applying societal recommendations, the creation and interpretation of St. Jude CIED interrogation reports are discussed. In an effort to increase the familiarity with St. Jude transvenous CIEDs amongst anesthesiologists, basic programming of a St. Jude pacemaker and implantable cardioverter defibrillator (ICD) also are described. Published by Elsevier Inc.

Evaluating options for balancing the water-electricity nexus in California: part 1--securing water availability.

PubMed

Tarroja, Brian; AghaKouchak, Amir; Sobhani, Reza; Feldman, David; Jiang, Sunny; Samuelsen, Scott

2014-11-01

The technical potential and effectiveness of different water supply options for securing water availability in a large-scale, interconnected water supply system under historical and climate-change augmented inflow and demand conditions were compared. Part 1 of the study focused on determining the scale of the options required to secure water availability and compared the effectiveness of different options. A spatially and temporally resolved model of California's major surface reservoirs was developed, and its sensitivity to urban water conservation, desalination, and water reuse was examined. Potential capacities of the different options were determined. Under historical (baseline) hydrology conditions, many individual options were found to be capable of securing water availability alone. Under climate change augment conditions, a portfolio approach was necessary. The water savings from many individual options other than desalination were insufficient in the latter, however, relying on seawater desalination alone requires extreme capacity installations which have energy, brine disposal, management, and cost implications. The importance of identifying and utilizing points of leverage in the system for choosing where to deploy different options is also demonstrated. Copyright © 2014 Elsevier B.V. All rights reserved.

Weighing the options for limiting surplus animals.

PubMed

Asa, Cheryl

2016-05-01

The unsustainability of many animal programs managed by zoos and aquariums has brought renewed attention to unresolved questions about various management strategies. Solving the "sustainability crisis" for many species will require housing more adults and producing more offspring than there are existing spaces in accredited zoos and aquariums. Careful reproductive management is central to addressing this challenge, but opinions differ about which management strategies are best for an individual, for a species, for an institution, or for a country or region. The primary options for limiting the number of animals that would be surplus to the population are to prevent reproduction or to euthanize. However, there is much misunderstanding about methods for controlling reproduction, in particular about contraceptives and species differences in their effects. Careful weighing of all the options is called for. Lifetime Reproductive Planning may help increase breeding success through careful reproductive management but cannot eliminate production of surplus animals. Limiting reproduction does not address the problem of animals already in the population. Despite best efforts and planning, consistently hitting target numbers for a population may never be achieved. Increasing capacity provides a temporary patch when targets are exceeded, but is not a long-term solution, since each generation potentially produces even more individuals needing even more space. Welfare considerations should be included in discussions of management euthanasia and its alternatives. Such discussions will be most productive if based on full awareness of the advantages and disadvantages of all the options. Zoo Biol. 35:183-186, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Options for managing hypoxic blackwater events in river systems: a review.

PubMed

Kerr, Janice L; Baldwin, Darren S; Whitworth, Kerry L

2013-01-15

Blackwater events are characterised by a high concentration of dissolved organic carbon in the water column. They occur naturally in lowland rivers with forested floodplains and bring a variety of benefits to both aquatic and floodplain biota. However, particularly when accompanied by high temperatures, respiration of the organic carbon may cause blackwater to become hypoxic. This may lead to a range of lethal and sub-lethal effects on the aquatic biota. We review the current scientific knowledge concerning the management of blackwater and hypoxia, and examine how this knowledge may be applied to the management of hypoxic blackwater events in lowland river systems. A range of management options, which aim to either prevent the development of hypoxic blackwater or to reintroduce oxygen into deoxygenated waters, are reported. Mitigation options that may be applicable to lowland river systems include manipulating the season and magnitude of floods in regulated rivers, increasing roughness in flow paths, establishing oxygenated refugia for aquatic biota and introducing hydraulic structures that promote turbulence and re-aeration. With climatic changes trending towards a scenario where extreme events leading to the development of hypoxic blackwater are more probable, it is now vital to validate and optimise management options on local and regional scales and work towards closing knowledge gaps. With judicious management of regulated rivers, it is possible to minimise the impacts of hypoxic flows while preserving the benefits brought to floodplain and river ecosystems by seasonal flooding and carbon exchange. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Outcome of Keratoconus Management: Review of the Past 20 Years' Contemporary Treatment Modalities.

PubMed

Mandathara, Preeji S; Stapleton, Fiona J; Willcox, Mark D P

2017-05-01

To describe the past 20 years' contemporary management modalities for keratoconus (KC) and their outcomes and failures and to propose recommendations in reporting their outcomes. A systematic review of the literature on KC management options for the last 20 years was performed. Original articles that reported the outcome of any form of KC management other than full-thickness or lamellar corneal graft were reviewed to collect information on their outcomes and complications and the level of scientific evidence of the study. A total of 1,147 articles retrieved and of those, 241 satisfied the inclusion criteria, and 41.1% of them were prospective case series. The higher level of evidence studies, that is, randomized controlled trials (RCTs), were limited to only one intervention, that is, corneal collagen cross-linking (CXL). However, the quality of most RCTs was limited because of performance and detection bias. Contact lenses (CLs) remain the mainstream of KC management and were associated with reversible and non-sight-threatening complications. Surgical options such as intracorneal segment implantation and phakic intraocular lens are considered in the visual rehabilitation of CL intolerants, and CXL is the only available option to stop or delay the disease progression. Generally, these surgical procedures are associated with transient inflammatory events and permanent sequelae. The published studies on KC management options varied significantly with respect to the study population, age of participants, severity of KC, clinical outcome measurements, and follow-up period. High-quality longer follow-up RCTs are required to evaluate the long-term effects of KC interventions.

Cost-effectiveness of nitrogen mitigation by alternative household wastewater management technologies.

PubMed

Wood, Alison; Blackhurst, Michael; Hawkins, Troy; Xue, Xiaobo; Ashbolt, Nicholas; Garland, Jay

2015-03-01

Household wastewater, especially from conventional septic systems, is a major contributor to nitrogen pollution. Alternative household wastewater management technologies provide similar sewerage management services but their life cycle costs and nitrogen flow implications remain uncertain. This paper addresses two key questions: (1) what are the total costs, nitrogen mitigation potential, and cost-effectiveness of a range of conventional and alternative municipal wastewater treatment technologies, and (2) what uncertainties influence these outcomes and how can we improve our understanding of these technologies? We estimate a household nitrogen mass balance for various household wastewater treatment systems and combine this mass balance with life cycle cost assessment to calculate the cost-effectiveness of nitrogen mitigation, which we define as nitrogen removed from the local watershed. We apply our methods to Falmouth, MA, where failing septic systems have caused heightened eutrophication in local receiving water bodies. We find that flushing and dry (composting) urine-diversion toilets paired with conventional septic systems for greywater management demonstrate the lowest life cycle cost and highest cost-effectiveness (dollars per kilogram of nitrogen removed from the watershed). Composting toilets are also attractive options in some cases, particularly best-case nitrogen mitigation. Innovative/advanced septic systems designed for high-level nitrogen removal are cost-competitive options for newly constructed homes, except at their most expensive. A centralized wastewater treatment plant is the most expensive and least cost-effective option in all cases. Using a greywater recycling system with any treatment technology increases the cost without adding any nitrogen removal benefits. Sensitivity analysis shows that these results are robust considering a range of cases and uncertainties. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Management of obstructive sleep apnea in the indigent population: a deviation of standard of care?

PubMed

Hamblin, John S; Sandulache, Vlad C; Alapat, Philip M; Takashima, Masayoshi

2014-03-01

Comprehensive management of patients with obstructive sleep apnea (OSA) typically is managed best via a multidisciplinary approach, involving otolaryngologists, sleep psychologists/psychiatrists, pulmonologists, neurologists, oral surgeons, and sleep trained dentists. By utilizing these resources, one could fashion a treatment individualized to the patient, giving rise to the holistic phrase of "personalized medicine." Unfortunately, in situations and environments with limited resources, the treatment options in an otolaryngologist's armamentarium are restricted--typically to continuous positive airway pressure (CPAP) versus sleep surgery. However, a recent patient encounter highlighted here shows how a hospital's reimbursement policy effectively dictated a patient's medical management to sleep surgery. This occurred although the current gold standard for the initial treatment of OSA is CPAP. Changing the course of medical/surgical management by selectively restricting funding is a cause of concern, especially when it promotes patients to choose a treatment option that is not considered the current standard of care.

Project Overview: A Reef Manager’s Guide to Coral Bleaching

EPA Science Inventory

The purpose of this report is to provide the latest scientific knowledge and discuss available management options to assist local and regional managers in responding effectively to mass coral bleaching events.

Background

Timetabling: A Shared Services Model

ERIC Educational Resources Information Center

O'Regan, Carmel

2012-01-01

This paper identifies common timetabling issues and options as experienced in Australian universities, and develops a rationale to inform management decisions on a suitable system and the associated policies, procedures, management structure and resources at the University of Newcastle, to enable more effective timetabling in line with the needs…

Refining ASD for disease management in strawberry and apple production

USDA-ARS?s Scientific Manuscript database

Anaerobic soil disinfestation (ASD) has been studied as an industry level option for replacing soil fumigants to manage soil-borne diseases in both annual and perennial crop production systems. Although ASD has proven effective for the suppression of certain soil-borne pathogens in both strawberry ...

REGIONAL VULNERABILITY ASSESSMENT (REVA): TARGETING RISK MANAGEMENT ACTIONS AND PROVIDING OPTIONS FOR INTEGRATED MANAGEMENT

EPA Science Inventory

EPA's Regional Vulnerability Assessment (ReVA) program is an approach to regional scale, priority-setting assessment being developed by EPA's Office of Research and Development (ORD). ReVA will effectively informs decision-makers as to the magnitude, extent, distribution, and unc...

Perforations and how to manage: The coronary interventionalist and peripheral interventionalist working together for a solution.

PubMed

Heuser, Richard R

2018-02-01

Perforations can occur in both peripheral and coronary interventional procedures potentially resulting in severe morbidity A readily available therapeutic option to treat perforations should be present in every cath lab that does coronary and peripheral procedures The use of a coagulated thrombus injection can be an effective treatment option, but if a major vessel is affected that must remain patent, one viable option is to administer the patients' own clotted blood to recanalize the vessel without permanent sequelae. © 2018 Wiley Periodicals, Inc.

Indications and interventional options for non-resectable tracheal stenosis

PubMed Central

Bacon, Jenny Louise; Patterson, Caroline Marie

2014-01-01

Non-specific presentation and normal examination findings in early disease often result in tracheal obstruction being overlooked as a diagnosis until patients present acutely. Once diagnosed, surgical options should be considered, but often patient co-morbidity necessitates other interventional options. Non-resectable tracheal stenosis can be successfully managed by interventional bronchoscopy, with therapeutic options including airway dilatation, local tissue destruction and airway stenting. There are common aspects to the management of tracheal obstruction, tracheomalacia and tracheal fistulae. This paper reviews the pathogenesis, presentation, investigation and management of tracheal disease, with a focus on tracheal obstruction and the role of endotracheal intervention in management. PMID:24624290

Technical options for the mitigation of direct methane and nitrous oxide emissions from livestock: a review.

PubMed

Gerber, P J; Hristov, A N; Henderson, B; Makkar, H; Oh, J; Lee, C; Meinen, R; Montes, F; Ott, T; Firkins, J; Rotz, A; Dell, C; Adesogan, A T; Yang, W Z; Tricarico, J M; Kebreab, E; Waghorn, G; Dijkstra, J; Oosting, S

2013-06-01

Although livestock production accounts for a sizeable share of global greenhouse gas emissions, numerous technical options have been identified to mitigate these emissions. In this review, a subset of these options, which have proven to be effective, are discussed. These include measures to reduce CH4 emissions from enteric fermentation by ruminants, the largest single emission source from the global livestock sector, and for reducing CH4 and N2O emissions from manure. A unique feature of this review is the high level of attention given to interactions between mitigation options and productivity. Among the feed supplement options for lowering enteric emissions, dietary lipids, nitrates and ionophores are identified as the most effective. Forage quality, feed processing and precision feeding have the best prospects among the various available feed and feed management measures. With regard to manure, dietary measures that reduce the amount of N excreted (e.g. better matching of dietary protein to animal needs), shift N excretion from urine to faeces (e.g. tannin inclusion at low levels) and reduce the amount of fermentable organic matter excreted are recommended. Among the many 'end-of-pipe' measures available for manure management, approaches that capture and/or process CH4 emissions during storage (e.g. anaerobic digestion, biofiltration, composting), as well as subsurface injection of manure, are among the most encouraging options flagged in this section of the review. The importance of a multiple gas perspective is critical when assessing mitigation potentials, because most of the options reviewed show strong interactions among sources of greenhouse gas (GHG) emissions. The paper reviews current knowledge on potential pollution swapping, whereby the reduction of one GHG or emission source leads to unintended increases in another.

Shale gas wastewater management under uncertainty.

PubMed

Zhang, Xiaodong; Sun, Alexander Y; Duncan, Ian J

2016-01-01

This work presents an optimization framework for evaluating different wastewater treatment/disposal options for water management during hydraulic fracturing (HF) operations. This framework takes into account both cost-effectiveness and system uncertainty. HF has enabled rapid development of shale gas resources. However, wastewater management has been one of the most contentious and widely publicized issues in shale gas production. The flowback and produced water (known as FP water) generated by HF may pose a serious risk to the surrounding environment and public health because this wastewater usually contains many toxic chemicals and high levels of total dissolved solids (TDS). Various treatment/disposal options are available for FP water management, such as underground injection, hazardous wastewater treatment plants, and/or reuse. In order to cost-effectively plan FP water management practices, including allocating FP water to different options and planning treatment facility capacity expansion, an optimization model named UO-FPW is developed in this study. The UO-FPW model can handle the uncertain information expressed in the form of fuzzy membership functions and probability density functions in the modeling parameters. The UO-FPW model is applied to a representative hypothetical case study to demonstrate its applicability in practice. The modeling results reflect the tradeoffs between economic objective (i.e., minimizing total-system cost) and system reliability (i.e., risk of violating fuzzy and/or random constraints, and meeting FP water treatment/disposal requirements). Using the developed optimization model, decision makers can make and adjust appropriate FP water management strategies through refining the values of feasibility degrees for fuzzy constraints and the probability levels for random constraints if the solutions are not satisfactory. The optimization model can be easily integrated into decision support systems for shale oil/gas lifecycle management. Copyright © 2015 Elsevier Ltd. All rights reserved.

Spreadsheet WATERSHED modeling for nonpoint-source pollution management in a Wisconsin basin

USGS Publications Warehouse

Walker, J.F.; Pickard, S.A.; Sonzogni, W.C.

1989-01-01

Although several sophisticated nonpoint pollution models exist, few are available that are easy to use, cover a variety of conditions, and integrate a wide range of information to allow managers and planners to assess different control strategies. Here, a straightforward pollutant input accounting approach is presented in the form of an existing model (WATERSHED) that has been adapted to run on modern electronic spreadsheets. As an application, WATERSHED is used to assess options to improve the quality of highly eutrophic Delavan Lake in Wisconsin. WATERSHED is flexible in that several techniques, such as the Universal Soil Loss Equation or unit-area loadings, can be used to estimate nonpoint-source inputs. Once the model parameters are determined (and calibrated, if possible), the spreadsheet features can be used to conduct a sensitivity analysis of management options. In the case of Delavan Lake, it was concluded that, although some nonpoint controls were cost-effective, the overall reduction in phosphorus would be insufficient to measurably improve water quality.A straightforward pollutant input accounting approach is presented in the form of an existing model (WATERSHED) that has been adapted to run on modern electronic spreadsheets. As an application, WATERSHED is used to assess options to improve the quality of highly eutrophic Delavan Lake in Wisconsin. WATERSHED is flexible in that several techniques, such as the Universal Soil Loss Equation or unit-area loadings, can be used to estimate nonpoint-source inputs. Once the model parameters are determined (and calibrated, if possible), the spreadsheet features can be used to conduct a sensitivity analysis of management options. In the case of Delavan Lake, it was concluded that, although some nonpoint controls were cost-effective, the overall reduction in phosphorus would be insufficient to measurably improve water quality.

Management and Marketing. Guide to Standards and Implementation. Career & Technology Studies.

ERIC Educational Resources Information Center

Alberta Dept. of Education, Edmonton. Curriculum Standards Branch.

This Alberta curriculum guide defines competencies that help students build daily living skills, investigate career options in management and marketing occupations, use technology in these fields effectively and efficiently, and prepare for entry into the workplace or related postsecondary programs. The first section provides a program rationale…

A Menu of Options for Developing Tribal Air Grant Work Plans and Managing Grants for Environmental Results

EPA Pesticide Factsheets

Tool to assist tribes that apply for Clean Air Act (CAA) funding to draft more effective work plans for projects that will develop tribal knowledge of air quality issues and build tribal expertise to manage air quality on tribal lands.

Using VELMA to Quantify and Visualize the Effectiveness of Green Infrastructure Options for Protecting Water Quality

EPA Science Inventory

This webinar describes the use of VELMA, a spatially-distributed ecohydrological model, to identify green infrastructure (GI) best management practices for protecting water quality in intensively managed watersheds. The seminar will include a brief description of VELMA and an ex...

Load Management - Methods to Reduce Electric Utilities Peak Loads.

DTIC Science & Technology

1983-08-01

for electric utilities.1 The largest impact came in 1978 when the Public Utilities Regulatory Policies Act ( PURPA ) was enacted which required state...management option. 7 CHAPTER VII CONCLUSION Since PURPA was enacted in 1978, utilities have been required to investigate methods in which to more effectively

77 FR 16540 - New England Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-21

... development and analysis in Omnibus Essential Fish Habitat Amendment 2. Two types of measures will be considered at the meeting: (1) Options to minimize the adverse effects of fishing on Essential Fish Habitat... England Fishery Management Council (Council) is scheduling a public meeting of its Habitat Oversight...

The Hepatitis C Self-Management Program: Sustainability of Primary Outcomes at 1 Year

ERIC Educational Resources Information Center

Groessl, Erik J.; Ho, Samuel B.; Asch, Steven M.; Stepnowsky, Carl J.; Laurent, Diana; Gifford, Allen L.

2013-01-01

Objective: Chronic hepatitis C infection afflicts millions of people worldwide. Although antiviral treatments are increasingly effective, many hepatitis C virus (HCV) patients avoid treatment, do not complete or respond to treatment, or have contraindications. Self-management interventions are one option for promoting behavioral changes leading to…

Economic analysis of emerald ash borer (Coleoptera: Buprestidae) management options.

PubMed

Vannatta, A R; Hauer, R H; Schuettpelz, N M

2012-02-01

Emerald ash borer, Agrilus planipennis (Fairmaire) (Coleoptera: Buprestidae), plays a significant role in the health and extent of management of native North American ash species in urban forests. An economic analysis of management options was performed to aid decision makers in preparing for likely future infestations. Separate ash tree population valuations were derived from the i-Tree Streets program and the Council of Tree and Landscape Appraisers (CTLA) methodology. A relative economic analysis was used to compare a control option (do-nothing approach, only removing ash trees as they die) to three distinct management options: 1) preemptive removal of all ash trees over a 5 yr period, 2) preemptive removal of all ash trees and replacement with comparable nonash trees, or 3) treating the entire population of ash trees with insecticides to minimize mortality. For each valuation and management option, an annual analysis was performed for both the remaining ash tree population and those lost to emerald ash borer. Retention of ash trees using insecticide treatments typically retained greater urban forest value, followed by doing nothing (control), which was better than preemptive removal and replacement. Preemptive removal without tree replacement, which was the least expensive management option, also provided the lowest net urban forest value over the 20-yr simulation. A "no emerald ash borer" scenario was modeled to further serve as a benchmark for each management option and provide a level of economic justification for regulatory programs aimed at slowing the movement of emerald ash borer.

Exposure Assessment of Livestock Carcass Management ...

EPA Pesticide Factsheets

Report This report describes relative exposures and hazards for different livestock carcass management options in the event of a natural disaster. A quantitative exposure assessment by which livestock carcass management options are ranked relative to one another for a hypothetical site setting, a standardized set of environmental conditions (e.g., meteorology), and following a single set of assumptions about how the carcass management options are designed and implemented. These settings, conditions, and assumptions are not necessarily representative of site-specific carcass management efforts. Therefore, the exposure assessment should not be interpreted as estimating levels of chemical and microbial exposure that can be expected to result from the management options evaluated. The intent of the relative rankings is to support scientifically-based livestock carcass management decisions that consider potential hazards to human health, livestock, and the environment. This exposure assessment also provides information to support choices about mitigation measures to minimize or eliminate specific exposure pathways.

Climate change, variability and extreme events : risk assessment and management strategies in a Peach cultivated area in Italy.

NASA Astrophysics Data System (ADS)

Alfieri, Silvia Maria; De Lorenzi, Francesca; Basile, Angelo; Bonfante, Antonello; Missere, Daniele; Menenti, Massimo

2014-05-01

Climate change in Mediterranean area is likely to reduce precipitation amounts and to increase temperature thus affecting the timing of development stages and the productivity of crops. Further, extreme weather events are expected to increase in the future leading to significant increase in agricultural risk. Some strategies for effectively managing risks and adapting to climate change involve adjustments to irrigation management and use of different varieties. We quantified the risk on Peach production in an irrigated area of "Emilia Romagna" region ( Italy) taking into account the impact on crop yield due to climate change and variability and to extreme weather events as well as the ability of the agricultural system to modulate this impact (adaptive capacity) through changes in water and crop management. We have focused on climatic events causing insufficient water supply to crops, while taking into account the effect of climate on the duration and timing of phenological stages. Further, extreme maximum and minimum temperature events causing significant reduction of crop yield have been considered using phase-specific critical temperatures. In our study risk was assessed as the product of the probability of a damaging event (hazard), such as drought or extreme temperatures, and the estimated impact of such an event (vulnerability). To estimate vulnerability we took into account the possible options to reduce risk, by combining estimates of the sensitivity of the system (negative impact on crop yield) and its adaptive capacity. The latter was evaluated as the relative improvement due to alternate management options: the use of alternate varieties or the changes in irrigation management. Vulnerability was quantified using cultivar-specific thermal and hydrologic requirements of a set of cultivars determined by experimental data and from scientific literature. Critical temperatures determining a certain reduction of crop yield have been estimated and used to assess thermal hazard and vulnerability in sensitive phenological stages. Cultivar-specific yield response functions to water availability were used to assess the reduction of yield for a determinate management option. Downscaled climate scenarios have been used to calculate indicators of soil water availability and thermal times and to evaluate the variability of crop phenology in combination with critical temperatures. Two climate scenarios were considered: reference (1961-90) and future (2021-2050) climate, the former from climatic statistics on observed variables, and the latter from statistical downscaling of general circulation models (AOGCM). Management options were defined by combinations of irrigation strategies (optimal, rainfed and deficit) with use of alternate varieties. As regards hydrologic conditions, risk assessment has been done at landscape scale in all soil units within each study area. The mechanistic model SWAP (Soil-Water-Atmosphere-Plant model) of water flow in the soil-plant-atmosphere system was used to describe the hydrological conditions in response to climate and irrigation. Different farm management options were evaluated. In a moderate water shortage scenario, deficit irrigation was an effective strategy to cope with climate change risks. In a severe water shortage scenario, the study showed the potentiality of intra-specific biodiversity to reduce risk of yield losses, although costs should be evaluated against the benefits of each specific management option. The work was carried out within the Italian national project AGROSCENARI funded by the Ministry for Agricultural, Food and Forest Policies (MIPAAF, D.M. 8608/7303/2008)

Bioremediation of oil-contaminated soils: A recipe for success

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

Wittenbach, S.A.

1995-12-31

Bioremediation of land crude oil and lube oil spills is an effective and economical option. Other options include road spreading (where permitted), thermal desorption, and off-site disposal. The challenge for environment and operations managers is to select the best approach for each remediation site. Costs and liability for off-site disposal are ever increasing. Kerr-McGee`s extensive field research in eastern and western Texas provides the data to support bioremediation as a legitimate and valid option. Both practical and economical bioremediation as a legitimate and valid option. Both practical and economical, bioremediation also offers a lower risk of, for example, Superfund clean-upmore » exposure than off-site disposal.« less

Medical management of heavy menstrual bleeding

PubMed Central

Maybin, Jacqueline A; Critchley, Hilary OD

2016-01-01

Women with benign heavy menstrual bleeding have the choice of a number of medical treatment options to reduce their blood loss and improve quality of life. The role of the clinician is to provide information to facilitate women in making an appropriate choice. Unfortunately, many options can be associated with hormonal side effects, prevention of fertility and lack of efficacy, leading to discontinuation and progression to surgical interventions. Herein, we discuss the various options currently available to women, including antifibrinolytics, nonsteroidal anti-inflammatory preparations, oral contraceptive pills and oral, injectable and intrauterine progestogens. In addition, we describe the more novel option of selective progesterone receptor modulators and their current benefits and limitations. PMID:26695687

Functional management of Achilles tendon rupture: A viable option for non-operative management.

PubMed

Karkhanis, S; Mumtaz, H; Kurdy, N

2010-06-01

Functional management of the ruptured Achilles tendon can be effective using orthoses like the removable walker boot (Foam Walker Boot, Air Cast UK Limited, Lincolnshire, United Kingdom). We conducted this study to look at the outcome of our protocol using this orthosis. We retrospectively reviewed 107 non-operatively managed Achilles tendon ruptures over the last 5 years. Case notes were analyzed for demographics and immediate outcomes. Long term outcomes were assessed by a postal questionnaire using the Achilles Tendon Total Rupture Score (ATRS). Of the 107 tendons (male:female=71:36, mean age=50 years), 105 tendons (98%) healed with an average discharge time of 22 weeks. Six patients reported major complications and 6 reported minor complications. We received 56 questionnaires with a mean ATRS score of 21. Seventy-seven percent returned to pre-injury level of activity. Functional management of Achilles tendon rupture, under appropriate supervision, provides a viable option for non-operative management. Copyright 2009 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Managing hydroclimatological risk to water supply with option contracts and reservoir index insurance

NASA Astrophysics Data System (ADS)

Brown, Casey; Carriquiry, Miguel

2007-11-01

This paper explores the performance of a system of economic instruments designed to facilitate the reduction of hydroclimatologic variability-induced impacts on stakeholders of shared water supply. The system is composed of bulk water option contracts between urban water suppliers and agricultural users and insurance indexed on reservoir inflows. The insurance is designed to cover the financial needs of the water supplier in situations where the option is likely to be exercised. Insurance provides the irregularly needed funds for exercising the water options. The combined option contract - reservoir index insurance system creates risk sharing between sectors that is currently lacking in many shared water situations. Contracts are designed for a shared agriculture - urban water system in Metro Manila, Philippines, using optimization and Monte Carlo analysis. Observed reservoir inflows are used to simulate contract performance. Results indicate the option - insurance design effectively smooths water supply costs of hydrologic variability for both agriculture and urban water.

41 CFR 102-194.40 - For what Standard or Optional forms should an electronic version not be made available?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false For what Standard or... Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION ADMINISTRATIVE PROGRAMS 194-STANDARD AND OPTIONAL FORMS MANAGEMENT PROGRAM § 102-194.40...

Effectiveness of a confinement strategy for reducing campsite impacts in Shenandoah National Park

USGS Publications Warehouse

Reid, S.E.; Marion, J.L.

2004-01-01

The expansion and proliferation of backcountry campsites is a persistent problem in many parks and protected areas. Shenandoah National Park (SNP) has one of the highest backcountry overnight use densities in the USA national parks system. SNP managers implemented a multi-option backcountry camping policy in 2000 that included camping containment with established campsites. These actions were intended to reduce the number of campsites and the area of camping disturbance at each site. This paper describes a longitudinal adaptive management assessment of the new campsite policies, applying quantitative measures of campsite conditions to evaluate the efficacy of management interventions. Physical campsite measurements combined with qualitative visitor interviews indicated SNP had successfully reduced the number of campsites and aggregate measures of camping-related disturbance in the Park, while minimizing the use of regulations, site facilities and staff resources. Implications for managers of other protected areas are that an established site camping policy can minimize camping disturbance, including the number and size of campsites, provided managers can sustain rehabilitation efforts to close and restore unneeded campsites. Experiential attributes, such as the potential for solitude, can also be manipulated through control over the selection of established campsites. Integrating resource and social science methods also provided a more holistic perspective on management policy assessments. Adaptive management research provided a timely evaluation of management success while facilitating effective modifications in response to unforeseen challenges. Conclusions regarding the effectiveness of a visitor impact containment strategy involving an established site camping option are offered.

Financing Alternatives Comparison Tool

EPA Pesticide Factsheets

FACT is a financial analysis tool that helps identify the most cost-effective method to fund a wastewater or drinking water management project. It produces a comprehensive analysis that compares various financing options.

Research on Agricultural Product Options Pricing Based on Lévy Copula

NASA Astrophysics Data System (ADS)

Qiu, Hong

2017-11-01

China is a large agricultural country, and the healthy development of agriculture is related to the stability of the whole society. With the advancement of modern agriculture and the expansion of agricultural scale, the demand for farmers to avoid market risks is increasingly urgent. Option trading has the effect of attracting farmers’ intervention, promoting order agriculture development, perfecting agricultural support policy and promoting the development of agricultural futures market. Relative to the futures, the option transaction because the margin is low, reducing the trader’s entry threshold, you can make more small and medium investors to participate. This is not only active in the futures market, but also for many small and medium investors to provide effective financial management tools.

Clinically localized prostate cancer in 2017: A review of comparative effectiveness.

PubMed

Lavery, Hugh J; Cooperberg, Matthew R

2017-02-01

Introducing the topic of comparative effectiveness for prostate cancer treatments with a reminder of the disease's heterogeneity risks tautology. However, the profound variation both in this cancer's biology and its clinical course is increasingly widely recognized, while management alternatives for clinically localized prostate cancer have exploded. Available options now include active surveillance, multiple surgical approaches to prostatectomy, various forms of external-beam and interstitial radiation, and a growing list of energy ablative technologies. Each treatment option has its own efficacy rate as well as its own set of complications, side effects and financial costs. Difficulties comparing these options, together with the high prevalence of the disease, led the Institute of Medicine to include localized prostate cancer among the top 25 priority conditions for future comparative effectiveness research. The sheer volume of possible treatment options, with their individual risks and benefits, can be confusing for patients and clinicians to research, understand and explain. To help clinicians navigate these treatment options, we have assembled this Urologic Oncology Seminar on the comparative effectiveness of treatments for clinically localized prostate cancer. The articles focus on high quality evidence-based medicine and most have included useful tables summarizing seminal trials and available resources. Copyright © 2017 Elsevier Inc. All rights reserved.

Executive summary

Treesearch

Susan H. Julius; Jordan M. West; Geoffrey M. Blate; Jill S. Baron; Brad Griffith; Linda A. Joyce; Peter Kareiva; Brian D. Keller; Margaret A. Palmer; Charles H. Peterson; J. Michael Scott

2008-01-01

This report provides a preliminary review of adaptation options for climate-sensitive ecosystems and resources in the United States. The term “adaptation” in this document refers to adjustments in human social systems (e.g., management) in response to climate stimuli and their effects. Since management always occurs in the context of desired ecosystem conditions or...

78 FR 38422 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-26

... Floor Broker Management System. II. Self-Regulatory Organization's Statement of the Purpose of, and... SECURITIES AND EXCHANGE COMMISSION [Release No. 34-69811; File No. SR-Phlx-2013-67] Self... Change To Delay the Implementation of its New Options Floor Broker Management System June 20, 2013...

Evaluation of CSM-CROPGRO-Cotton for simulating effects of management and climate change on cotton growth and evapotranspiration in an arid environment

USDA-ARS?s Scientific Manuscript database

Originally developed for simulating soybean growth and development, the CROPGRO model was recently re-parameterized for cotton. However, further efforts are necessary to evaluate the model's performance against field measurements for new environments and management options. The objective of this stu...

Status and potential of terrestrial carbon sequestration in West Virginia

Treesearch

Benktesh D. Sharma; Jingxin Wang

2011-01-01

Terrestrial ecosystem management offers cost-effective ways to enhance carbon (C) sequestration. This study utilized C stock and C sequestration in forest and agricultural lands, abandoned mine lands, and harvested wood products to estimate the net current annual C sequestration in West Virginia. Several management options within these components were simulated using a...

Middle School Students' Decision-Making on Solid Waste Management in Taiwan.

ERIC Educational Resources Information Center

Wang, Kuo-Hua

The purpose of the study was to determine the effectiveness of a HyperCard simulation upon student's concepts, opinions, and option-rankings on solid waste management, and to investigate what cognitive activities of the students were involved in the decision-making processes. One hundred eighth-grade students in Taiwan participated in this…

Economic evaluation of an internet-based weight management program

USDA-ARS?s Scientific Manuscript database

To determine whether a behavioral Internet treatment (BIT) program for weight management is a viable, cost-effective option compared with usual care (UC) in a diverse sample of overweight (average body mass index = 29 kg/m2), healthy adults (mean age = 34 years) serving in the US Air Force. Two-grou...

Effects of ICT Integration in Management of Private Secondary Schools in Nairobi County, Kenya: Policy Options and Practices

ERIC Educational Resources Information Center

Oyier, Charles Richard; Odundo, Paul Amollo; Lilian, Ganira Khavugwi; Wangui, Kahiga Ruth

2015-01-01

The convergence between telecommunication, broadcasting multimedia and related technologies commonly known as Information and Communication Technologies (ICT), promises a fundamental change in educational management. ICT could be the missing tool in improving efficiency of private secondary schools to cope with rapidly changing world to…

Emerging therapies for the management of chronic hyperkalemia in the ambulatory care setting.

PubMed

Henneman, Amy; Guirguis, Erenie; Grace, Yasmin; Patel, Dimple; Shah, Bhoomi

2016-01-15

Emerging treatment options for the management of chronic hyperkalemia in the outpatient setting are reviewed. Current treatment options for the management of hyperkalemia are limited and often accompanied by serious adverse effects. Two investigational drugs for the treatment of hyperkalemia are being evaluated in Phase III trials: sodium zirconium cyclosilicate and patiromer. Both of these drugs are administered orally and act by enhancing potassium's removal, predominantly through the gastrointestinal tract. The safety and efficacy of sodium zirconium cyclosilicate and patiromer were evaluated in Phase II and III trials. Both agents were studied in patients with chronic mild-to-severe hyperkalemia, chronic kidney disease (CKD), or heart failure as well as those taking a renin-angiotensin system (RAS) inhibitor, an aldosterone antagonist, or both therapies. These clinical trials found that sodium zirconium cyclosilicate and patiromer normalized serum potassium levels quickly and maintained normalized serum potassium levels over several weeks. Both medications caused a rapid decrease in serum potassium, with two studies examining efficacy endpoints for 12 weeks or longer. The overall frequency of adverse effects in these clinical trials was low, with gastrointestinal adverse events being the most commonly observed. Options for the management of hyperkalemia, particularly chronic hyperkalemia in the outpatient setting, are limited. Both sodium zirconium cyclosilicate and patiromer are emerging therapies that may provide long-term management of hyperkalemia, particularly in patients with underlying heart failure or CKD as well as those taking an RAS inhibitor, an aldosterone antagonist, or both. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

A System Dynamics Approach for the Selection of Contaminated Land Management Options

NASA Astrophysics Data System (ADS)

McKnight, U. S.; Kuebert, M.; Finkel, M.; Bieg, M.

2006-12-01

Large-scale contaminated land and groundwater is a widespread problem that can severely impact human health, the environment and the economy at many urban sites all over the world. Usually a considerable number of potential management solutions exist at each of these sites. A detailed investigation of all these options, however, is not economically feasible which makes streamlining of the planning and decision process a mandatory requirement. Decisions to be taken should be made as early as possible in order to reduce expenditures on site investigation. Therefore, a tiered decision-making procedure is required, including (i) identification and prioritization of focal areas of risks, (ii) feasibility screening of remediation targets and available management alternatives to narrow the range of possible options for (iii) subsequent detailed investigations of only a select group of preferable options. For each of these elements, tailored decision and investigation concepts are required. These concepts and applied methods should be specifically adapted to the type and scale of the particular decision to be taken- more target-oriented, cost-efficient investigation programs, as well as model-based assessment methods are needed (Ruegner et al. 2006). A gap exists within this framework with respect to preliminary assessment methodologies representing the first decision level. To fill this gap, a new system dynamics approach has been developed that represents the system of source- pathway-receptor sequences by means of a mass flux model. The dynamics are governed by the effects of possible remedial actions, which are described as mass flux change over time (Serapiglia et al. 2005). This approach has been implemented in the preliminary evaluation tool CARO-plus (Cost-efficiency Assessment of Remediation Options) that models the effects of potential remedial actions, including tackling the contaminant source and managing the groundwater plume. The model represents the causal relationships that exist between the state of the system, the effects of the technologies and their costs, and may considerably impact the outcome to be predicted. The tool enables a fast and effective "screening" of management scenarios using simplified approaches (analytical models). Replacing the concept of total cleanup of sites based on concentration standards, the evaluation tool contains risk modules that describe exposure pathways, i.e. transfer of contaminants from groundwater to the receptor "human being", in accordance to MEPAS (Strenge & Chamberlain 1995). As multiple lines of evidence may apply, the effects of remediation options can be analyzed on the basis of contaminant mass flux, concentrations, and/or risk indices (carcinogenic/noncarcinogenic). Costs are calculated in terms of net present values. Uncertainty is taken into account using Monte-Carlo sensitivity analyses. In the presentation, examples will be shown for how the proposed approach helps to pre-select compatible remediation options by giving an overview to the following set of questions: (i) what is the time scale for risks expected at a particular site, (ii) does the scenario reduce/control risk at the receptor, (iii) is the scenario compatible with cleanup objectives (e.g. in the case that concentration standards are still required for specific compounds present at a site), (iv) does the scenario satisfy cost objectives and can therefore be considered financially viable, (v) is the scenario acceptable to regulators and the community, and (vi) what factors are most critical to the decision-making process.

41 CFR 102-194.25 - What is an automated Standard or Optional format?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION ADMINISTRATIVE PROGRAMS 194-STANDARD AND OPTIONAL FORMS MANAGEMENT PROGRAM § 102-194.25 What is an automated Standard or... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What is an automated...

Soak Up the Rain New England Webinar Series: National ...

EPA Pesticide Factsheets

Presenters will provide an introduction to the most recent EPA green infrastructure tools to R1 stakeholders; and their use in making decisions about implementing green infrastructure. We will discuss structuring your green infrastructure decision, finding appropriate information and tools, evaluating options and selecting the right Best Management Practices mix for your needs.WMOST (Watershed Management Optimization Support Tool)- for screening a wide range of practices for cost-effectiveness in achieving watershed or water utilities management goals.GIWiz (Green Infrastructure Wizard)- a web application connecting communities to EPA Green Infrastructure tools and resources.Opti-Tool-designed to assist in developing technically sound and optimized cost-effective Stormwater management plans. National Stormwater Calculator- a desktop application for estimating the impact of land cover change and green infrastructure controls on stormwater runoff. DASEES-GI (Decision Analysis for a Sustainable Environment, Economy, and Society) – a framework for linking objectives and measures with green infrastructure methods. Presenters will provide an introduction to the most recent EPA green infrastructure tools to R1 stakeholders; and their use in making decisions about implementing green infrastructure. We will discuss structuring your green infrastructure decision, finding appropriate information and tools, evaluating options and selecting the right Best Management Pr

Management of complications of Dupuytren contracture.

PubMed

Cheung, Kevin; Walley, Kempland C; Rozental, Tamara D

2015-05-01

This evidence-based article discusses the current management options of Dupuytren disease and strategies to avoid and manage any potential complications. Treatment options include fasciectomy, needle fasciotomy/aponeurotomy, and collagenase injection. Complications include digital nerve and artery injury, flexor tendon injury, skin fissures and wound healing complications, hematoma, infection, flare reaction/complex regional pain syndrome, and recurrence. Complication rates, prevention, and management differ with each treatment modality. A detailed understanding of each of these options allows hand surgeons to select the most appropriate treatment for each patient. Copyright © 2015 Elsevier Inc. All rights reserved.

Cooperative Drought Adaptation: Integrating Infrastructure Development, Conservation, and Water Transfers into Adaptive Policy Pathways

NASA Astrophysics Data System (ADS)

Zeff, H. B.; Characklis, G. W.; Reed, P. M.; Herman, J. D.

2015-12-01

Water supply policies that integrate portfolios of short-term management decisions with long-term infrastructure development enable utilities to adapt to a range of future scenarios. An effective mix of short-term management actions can augment existing infrastructure, potentially forestalling new development. Likewise, coordinated expansion of infrastructure such as regional interconnections and shared treatment capacity can increase the effectiveness of some management actions like water transfers. Highly adaptable decision pathways that mix long-term infrastructure options and short-term management actions require decision triggers capable of incorporating the impact of these time-evolving decisions on growing water supply needs. Here, we adapt risk-based triggers to sequence a set of potential infrastructure options in combination with utility-specific conservation actions and inter-utility water transfers. Individual infrastructure pathways can be augmented with conservation or water transfers to reduce the cost of meeting utility objectives, but they can also include cooperatively developed, shared infrastructure that expands regional capacity to transfer water. This analysis explores the role of cooperation among four water utilities in the 'Research Triangle' region of North Carolina by formulating three distinct categories of adaptive policy pathways: independent action (utility-specific conservation and supply infrastructure only), weak cooperation (utility-specific conservation and infrastructure development with regional transfers), and strong cooperation (utility specific conservation and jointly developed of regional infrastructure that supports transfers). Results suggest that strong cooperation aids the utilities in meeting their individual objections at substantially lower costs and with fewer irreversible infrastructure options.

Evaluation of Policy Options for Increasing the Availability of Primary Care Services in Rural Washington State.

PubMed

Friedberg, Mark W; Martsolf, Grant R; White, Chapin; Auerbach, David I; Kandrack, Ryan; Reid, Rachel O; Butcher, Emily; Yu, Hao; Hollands, Simon; Nie, Xiaoyu

2017-01-01

The Washington State legislature has recently considered several policy options to address a perceived shortage of primary care physicians in rural Washington. These policy options include opening the new Elson S. Floyd College of Medicine at Washington State University in 2017; increasing the number of primary care residency positions in the state; expanding educational loan-repayment incentives to encourage primary care physicians to practice in rural Washington; increasing Medicaid payment rates for primary care physicians in rural Washington; and encouraging the adoption of alternative models of primary care, such as medical homes and nurse-managed health centers, that reallocate work from physicians to nurse practitioners (NPs) and physician assistants (PAs). RAND Corporation researchers projected the effects that these and other policy options could have on the state's rural primary care workforce through 2025. They project a 7-percent decrease in the number of rural primary care physicians and a 5-percent decrease in the number of urban ones. None of the policy options modeled in this study, on its own, will offset this expected decrease by relying on physicians alone. However, combinations of these strategies or partial reallocation of rural primary care services to NPs and PAs via such new practice models as medical homes and nurse-managed health centers are plausible options for preserving the overall availability of primary care services in rural Washington through 2025.

A Nurse-Directed Model for Nitrous Oxide Use During Labor.

PubMed

Pinyan, Toni; Curlee, Kelly; Keever, Mellanie; Baldwin, Kathleen M

Nitrous oxide has a long history of use and has been well documented in the literature as a safe, effective, and inexpensive option for pain management in labor in other countries, but it is underused in the United States. Pain relief options for laboring women in rural community hospitals with a small perinatal service are limited due to lack of availability of in-house anesthesia coverage. This quality improvement project involved development and implementation of a nurse-driven, self-administered, demand-flow nitrous oxide program as an option for pain relief for laboring women in a rural community hospital. Women's Services registered nurses developed the project using an interdisciplinary team approach based on an extensive literature review and consultation with experts across the country. The hospital is part of a large healthcare system; approval was sought and obtained by the system as part of the project. Cost analysis and patient satisfaction data were evaluated. Outcomes were monitored. Approximately one half of the patients who have given birth at the hospital since initiation of the project have used nitrous oxide during labor. The majority of women who participated in a survey after birth found it helpful during mild-to-moderate labor pain. No adverse effects have noted in either the mother or the baby following nitrous oxide use. Initiation and management of nitrous oxide by registered nurses is a safe and cost-effective option for labor pain. It may be especially beneficial in hospitals that do not have 24/7 in-house anesthesia coverage.

User Guide for the Financing Alternatives Comparison Tool

EPA Pesticide Factsheets

FACT is a financial analysis tool that helps identify the most cost-effective method to fund a wastewater or drinking water management project. It creates a comprehensive analysis that compares various financing options.

77 FR 75243 - Self-Regulatory Organizations; Options Clearing Corporation; Order Approving Proposed Rule Change...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-19

... modeling and risk management procedures (``Risk Management Proposal'') \\9\\ is approved by the Commission.... The enhancements are part of OCC's ongoing efforts to test and improve its risk management operations... Index Options,\\12\\ and only subject to the filing and approval of the Risk Management Proposal, as...

Principles of Burn Pain Management.

PubMed

James, Dominika Lipowska; Jowza, Maryam

2017-10-01

This article describes pathophysiology of burn injury-related pain and the basic principles of burn pain management. The focus is on concepts of perioperative and periprocedural pain management with extensive discussion of opioid-based analgesia, including patient-controlled analgesia, challenges of effective opioid therapy in opioid-tolerant patients, and opioid-induced hyperalgesia. The principles of multimodal pain management are discussed, including the importance of psychological counseling, perioperative interventional pain procedures, and alternative pain management options. A brief synopsis of the principles of outpatient pain management is provided. Copyright © 2017 Elsevier Inc. All rights reserved.

Emerging treatment options for the management of pemphigus vulgaris

PubMed Central

Kridin, Khalaf

2018-01-01

Pemphigus vulgaris (PV) is a life-threatening disease belonging to the pemphigus group of autoimmune intra-epidermal bullous diseases of the skin and mucosae. The therapeutic management of PV remains challenging and, in some cases, conventional therapy is not adequate to induce clinical remission. The cornerstone of PV treatment remains systemic corticosteroids. Although very effective, long-term corticosteroid administration is characterized by substantial adverse effects. Corticosteroid-sparing adjuvant therapies have been employed in the treatment of PV, aiming to reduce the necessary cumulative dose of corticosteroids. Specifically, immunosuppressive agents such as azathioprine and mycophenolate mofetil are widely used in PV. More recently, high-dose intravenous immunoglobulins, immunoadsorption, and rituximab have been established as additional successful therapeutic options. This review covers both conventional and emerging therapies in PV. In addition, it sheds light on potential future treatment strategies for this disease. PMID:29740210

Counseling women with early pregnancy failure: utilizing evidence, preserving preference.

PubMed

Wallace, Robin R; Goodman, Suzan; Freedman, Lori R; Dalton, Vanessa K; Harris, Lisa H

2010-12-01

To apply principles of shared decision-making to EPF management counseling. To present a patient treatment priority checklist developed from review of available literature on patient priorities for EPF management. Review of evidence for patient preferences; personal, emotional, physical and clinical factors that may influence patient priorities for EPF management; and the clinical factors, resources, and provider bias that may influence current practice. Women have strong and diverse preferences for EPF management and report higher satisfaction when treated according to these preferences. However, estimates of actual treatment patterns suggest that current practice does not reflect the evidence for safety and acceptability of all options, or patient preferences. Multiple practice barriers and biases exist that may be influencing provider counseling about options for EPF management. Choosing management for EPF is a preference-sensitive decision. A patient-centered approach to EPF management should incorporate counseling about all treatment options. Providers can integrate a counseling model into EPF management practice that utilizes principles of shared decision-making and an organized method for eliciting patient preferences, priorities, and concerns about treatment options. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Case management information systems: how to put the pieces together now and beyond year 2000.

PubMed

Matthews, Pamela

2002-01-01

The case management process is a critical management and operational component in the delivery of customer services across the patient care continuum. Case management has transcended time and will continue to be a viable infrastructure process for successful organizations in the future. A key component of the case management infrastructure is information systems and technology support. Case management challenges include effective deployment and use of systems and technology. As more sophisticated, integrated systems are made available, case managers can use these tools to continue to expand effectively beyond the patient's episodic event to provide greater levels of cradle-to-grave management of healthcare. This article explores methods for defining case management system needs and identifying automation options available to the case manager.

A feasibility study of municipal solid waste incineration fly ash utilisation in Estonia.

PubMed

Berber, Hakan; Frey, Ruedi; Voronova, Viktoria; Koroljova, Arina

2017-09-01

The purpose of this paper is to discuss the alternative environmental management options for the utilisation of municipal solid waste (MSW) incineration fly ash (FA), which is generated at Iru Power Plant where MSW is incinerated in Estonia. To determine sustainable and economically feasible environmental management options for MSW incineration FA in Estonia, CO 2 sequestration with a further carbonation process was examined. A partial Cost & Benefit Analysis has been conducted to compare the carbonation process to the current situation. Two carbonation options were developed. Option 1 is to use carbonated FA in any other processes based on the waste-to-product principle. Option 2 is to send carbonated FA to the non-hazardous landfill in Tallinn, Estonia. Important parameters, such as Net Present Value (NPV), Internal Rate of Return (IRR), Benefit-Cost Ratio (BCR) and Break Even Point (BEP), have been calculated for carbonation options and the current case. In addition, a sensitivity analysis has been conducted to examine its robustness. The results showed that the best option is carbonation Option 1 with NPV of 9,209,662 EUR, IRR of 43%, BCR of 2.63 and BEP between 2018 and 2019. Both Options 1 and 2 constitute more sustainable and environmentally friendly management options compared to the current situation. It can be concluded that this preliminary feasibility study showed that running a carbonation plant may be profitable and sustainable for Estonia. Currently, there is no treatment technology for MSW incineration FA in Estonia and FA is sent to a neighbouring country for further utilisation. This is the first study to demonstrate FA management options with economic and environmental benefits.

Integrating ecophysiology and forest landscape models to improve projections of drought effects under climate change

Treesearch

Eric J. Gustafson; Arjan M.G. De Bruijn; Robert E. Pangle; Jean-Marc Limousin; Nate G. McDowell; William T. Pockman; Brian R. Sturtevant; Jordan D. Muss; Mark E. Kubiske

2015-01-01

Fundamental drivers of ecosystem processes such as temperature and precipitation are rapidly changing and creating novel environmental conditions. Forest landscape models (FLM) are used by managers and policy-makers to make projections of future ecosystem dynamics under alternative management or policy options, but the links between the fundamental drivers and...

Herbicide options for hardwood management

Treesearch

Andrew W. Ezell; A. Brady Self

2016-01-01

The use of herbicides in hardwood management presents special problems in that many of the most effective herbicides are either designed to control hardwoods or the product is not labeled for such applications. Numerous studies involving herbicide application in hardwoods have been completed at Mississippi State University. This paper is a compilation of results from...

77 FR 35719 - Self-Regulatory Organizations; BATS Exchange, Inc.; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-14

... Change To Adopt Rules Related to Risk Management Functionality for BATS Options June 8, 2012. Pursuant to... serves an important risk management purpose, it operates consistent with the firm quote obligations of a... Change The Exchange proposes to adopt Rule 21.16, entitled ``Risk Monitor Mechanism'', to codify the risk...

When all seems lost: management of refractory constipation-Surgery, rectal irrigation, percutaneous endoscopic colostomy, and more.

PubMed

Wilkinson-Smith, V; Bharucha, A E; Emmanuel, A; Knowles, C; Yiannakou, Y; Corsetti, M

2018-05-01

While the pharmacological armamentarium for chronic constipation has expanded over the past few years, a substantial proportion of constipated patients do not respond to these medications. This review summarizes the pharmacological and behavioral options for managing constipation and details the management of refractory constipation. Refractory constipation is defined as an inadequate improvement in constipation symptoms evaluated with an objective scale despite adequate therapy (ie, pharmacological and/or behavioral) that is based on the underlying pathophysiology of constipation. Minimally invasive (ie, rectal irrigation and percutaneous endoscopic colostomy) and surgical therapies are used to manage refractory constipation. This review appraises these options, and in particular, percutaneous endoscopic colostomy, which as detailed by an article in this issue, is a less invasive option for managing refractory constipation than surgery. While these options benefit some patients, the evidence of the risk: benefit profile for these therapies is limited. © 2018 John Wiley & Sons Ltd.

Assessing Land Management Change Effects on Forest Carbon and Emissions Under Changing Climate

NASA Astrophysics Data System (ADS)

Law, B. E.

2014-12-01

There has been limited focus on fine-scale land management change effects on forest carbon under future environmental conditions (climate, nitrogen deposition, increased atmospheric CO2). Forest management decisions are often made at the landscape to regional levels before analyses have been conducted to determine the potential outcomes and effectiveness of such actions. Scientists need to evaluate plausible land management actions in a timely manner to help shape policy and strategic land management. Issues of interest include species-level adaptation to climate, resilience and vulnerability to mortality within forested landscapes and regions. Efforts are underway to improve land system model simulation of future mortality related to climate, and to develop and evaluate plausible land management options that could help mitigate or avoid future die-offs. Vulnerability to drought-related mortality varies among species and with tree size or age. Predictors of species ability to survive in specific environments are still not resolved. A challenge is limited observations for fine-scale (e.g. 4 km2) modeling, particularly physiological parameters. Uncertainties are primarily associated with future land management and policy decisions. They include the interface with economic factors and with other ecosystem services (biodiversity, water availability, wildlife habitat). The outcomes of future management scenarios should be compared with business-as-usual management under the same environmental conditions to determine the effects of management changes on forest carbon and net emissions to the atmosphere. For example, in the western U.S., land system modeling and life cycle assessment of several management options to reduce impacts of fire reduced long-term forest carbon gain and increased carbon emissions compared with business-as-usual management under future environmental conditions. The enhanced net carbon uptake with climate and reduced fire emissions after thinning did not compensate for the increased wood removals over 90 years, leading to reduced net biome production. Analysis of land management change scenarios at fine scales is needed, and should consider other ecological values in addition to carbon.

DISPOSITION PATHS FOR ROCKY FLATS GLOVEBOXES: EVALUATING OPTIONS

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

Lobdell, D.; Geimer, R.; Larsen, P.

2003-02-27

The Kaiser-Hill Company, LLC has the responsibility for closure activities at the Rocky Flats Environmental Technology Site (RFETS). One of the challenges faced for closure is the disposition of radiologically contaminated gloveboxes. Evaluation of the disposition options for gloveboxes included a detailed analysis of available treatment capabilities, disposal facilities, and lifecycle costs. The Kaiser-Hill Company, LLC followed several processes in determining how the gloveboxes would be managed for disposition. Currently, multiple disposition paths have been chosen to accommodate the needs of the varying styles and conditions of the gloveboxes, meet the needs of the decommissioning team, and to best managemore » lifecycle costs. Several challenges associated with developing a disposition path that addresses both the radiological and RCRA concerns as well as offering the most cost-effective solution were encountered. These challenges included meeting the radiological waste acceptance criteria of available disposal facilities, making a RCRA determination, evaluating treatment options and costs, addressing void requirements associated with disposal, and identifying packaging and transportation options. The varying disposal facility requirements affected disposition choices. Facility conditions that impacted decisions included radiological and chemical waste acceptance criteria, physical requirements, and measurement for payment options. The facility requirements also impacted onsite activities including management strategies, decontamination activities, and life-cycle cost.« less

An expanded conceptual framework for solution-focused management of chemical pollution in European waters.

PubMed

Munthe, John; Brorström-Lundén, Eva; Rahmberg, Magnus; Posthuma, Leo; Altenburger, Rolf; Brack, Werner; Bunke, Dirk; Engelen, Guy; Gawlik, Bernd Manfred; van Gils, Jos; Herráez, David López; Rydberg, Tomas; Slobodnik, Jaroslav; van Wezel, Annemarie

2017-01-01

This paper describes a conceptual framework for solutions-focused management of chemical contaminants built on novel and systematic approaches for identifying, quantifying and reducing risks of these substances. The conceptual framework was developed in interaction with stakeholders representing relevant authorities and organisations responsible for managing environmental quality of water bodies. Stakeholder needs were compiled via a survey and dialogue. The content of the conceptual framework was thereafter developed with inputs from relevant scientific disciplines. The conceptual framework consists of four access points: Chemicals, Environment, Abatement and Society, representing different aspects and approaches to engaging in the issue of chemical contamination of surface waters. It widens the scope for assessment and management of chemicals in comparison to a traditional (mostly) perchemical risk assessment approaches by including abatement- and societal approaches as optional solutions. The solution-focused approach implies an identification of abatement- and policy options upfront in the risk assessment process. The conceptual framework was designed for use in current and future chemical pollution assessments for the aquatic environment, including the specific challenges encountered in prioritising individual chemicals and mixtures, and is applicable for the development of approaches for safe chemical management in a broader sense. The four access points of the conceptual framework are interlinked by four key topics representing the main scientific challenges that need to be addressed, i.e.: identifying and prioritising hazardous chemicals at different scales; selecting relevant and efficient abatement options; providing regulatory support for chemicals management; predicting and prioritising future chemical risks. The conceptual framework aligns current challenges in the safe production and use of chemicals. The current state of knowledge and implementation of these challenges is described. The use of the conceptual framework, and addressing the challenges, is intended to support: (1) forwarding sustainable use of chemicals, (2) identification of pollutants of priority concern for cost-effective management, (3) the selection of optimal abatement options and (4) the development and use of optimised legal and policy instruments.

Pollution Swapping in Agricultural Systems: deciding between mitigation measures with conflicting outcomes

NASA Astrophysics Data System (ADS)

Quinton, John; Stevens, Carly

2010-05-01

Pollution swapping occurs when a mitigation option introduced to reduce one pollutant results in an increase in a different pollutant. Although the concept of pollution swapping is widely understood it has received little attention in research and policy design. This study investigated diffuse pollution mitigation options applied in combinable crop systems. They are: cover crops, residue management, no-tillage, riparian buffer zones, contour grass strips and constructed wetlands. A wide range of water and atmospheric pollutants were considered, including nitrogen, phosphorus, carbon and sulphur. It is clear from this investigation that there is no single mitigation option that will reduce all pollutants and in this poster we consider how choices may be made between mitigation measures which may have a positive effect on one pollutant but a negative effect on another.

41 CFR 101-39.004 - Optional operations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS AVIATION, TRANSPORTATION, AND MOTOR VEHICLES 39-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.0-General Provisions § 101-39.004 Optional operations. Nothing in this part shall preclude the establishment or operation of interagency fleet management systems by GSA or by...

41 CFR 101-39.004 - Optional operations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS AVIATION, TRANSPORTATION, AND MOTOR VEHICLES 39-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.0-General Provisions § 101-39.004 Optional operations. Nothing in this part shall preclude the establishment or operation of interagency fleet management systems by GSA or by...

School Management Options for American Indians.

ERIC Educational Resources Information Center

Streiff, Paul R.

In response to the Presidential/Secretarial Educational Objective of 1975 which called for a statement from American Indian communities relative to their educational management preferences, the Office of Indian Education Programs (OIEP) established a program for gathering and disseminating educational management options to Indian people. A seven…

Flexibility in Flood Management Design: Proactive Planning Under Climate Change Uncertainty

NASA Astrophysics Data System (ADS)

Smet, K.; de Neufville, R.; van der Vlist, M.

2015-12-01

This paper presents an innovative, value-enhancing procedure for effective planning and design of long-lived flood management infrastructure given uncertain future flooding threats due to climate change. Designing infrastructure that can be adapted over time is a method to safeguard the efficacy of current design decisions given uncertainty about rates and future impacts of climate change. This paper explores the value of embedding "options" in a physical structure, where an option is the right but not the obligation to do something at a later date (e.g. over-dimensioning a floodwall foundation now facilitates a future height addition in response to observed increases in sea level; building of extra pump bays in a pumping station now enables the addition of pumping capacity whenever increased precipitation warrants an expansion.) The proposed procedure couples a simulation model that captures future climate induced changes to the hydrologic operating environment of a structure, with an economic model that estimates the lifetime economic performance of alternative investments. The economic model uses Real "In" Options analysis, a type of cash flow analysis that quantifies the implicit value of options and the flexibility they provide. This procedure is demonstrated using replacement planning for the multi-functional pumping station IJmuiden on the North Sea Canal in the Netherlands. Flexibility in design decisions is modelled, varying the size and specific options included in the new structure. Results indicate that the incorporation of options within the structural design has the potential to improve its economic performance, as compared to more traditional, "build it once and build it big" designs where flexibility is not an explicit design criterion. The added value resulting from the incorporation of flexibility varies with the range of future conditions considered, as well as the options examined. This procedure could be applied more broadly to explore investment strategies for the design of other flood management structures.

Modelling the dynamics of feral alfalfa populations and its management implications.

PubMed

Bagavathiannan, Muthukumar V; Begg, Graham S; Gulden, Robert H; Van Acker, Rene C

2012-01-01

Feral populations of cultivated crops can pose challenges to novel trait confinement within agricultural landscapes. Simulation models can be helpful in investigating the underlying dynamics of feral populations and determining suitable management options. We developed a stage-structured matrix population model for roadside feral alfalfa populations occurring in southern Manitoba, Canada. The model accounted for the existence of density-dependence and recruitment subsidy in feral populations. We used the model to investigate the long-term dynamics of feral alfalfa populations, and to evaluate the effectiveness of simulated management strategies such as herbicide application and mowing in controlling feral alfalfa. Results suggest that alfalfa populations occurring in roadside habitats can be persistent and less likely to go extinct under current roadverge management scenarios. Management attempts focused on controlling adult plants alone can be counterproductive due to the presence of density-dependent effects. Targeted herbicide application, which can achieve complete control of seedlings, rosettes and established plants, will be an effective strategy, but the seedbank population may contribute to new recruits. In regions where roadside mowing is regularly practiced, devising a timely mowing strategy (early- to mid-August for southern Manitoba), one that can totally prevent seed production, will be a feasible option for managing feral alfalfa populations. Feral alfalfa populations can be persistent in roadside habitats. Timely mowing or regular targeted herbicide application will be effective in managing feral alfalfa populations and limit feral-population-mediated gene flow in alfalfa. However, in the context of novel trait confinement, the extent to which feral alfalfa populations need to be managed will be dictated by the tolerance levels established by specific production systems for specific traits. The modelling framework outlined in this paper could be applied to other perennial herbaceous plants with similar life-history characteristics.

The cost-effectiveness of sacral nerve stimulation (SNS) for the treatment of idiopathic medically refractory overactive bladder (wet) in the UK.

PubMed

Autiero, Silke Walleser; Hallas, Natalie; Betts, Christopher D; Ockrim, Jeremy L

2015-12-01

To estimate the long-term cost-effectiveness of specialised treatment options for medically refractory idiopathic overactive bladder (OAB) wet. The cost-effectiveness of competing treatment options for patients with medically refractory idiopathic OAB wet was estimated from the perspective of the National Health Service in the UK. We compared sacral nerve stimulation (SNS) with percutaneous nerve evaluation (PNE) or tined-lead evaluation (TLE) with optimal medical therapy (OMT), botulinum toxin type A (BoNT-A) injections, and percutaneous tibial nerve stimulation (PTNS). We used a Markov model with a 10-year time horizon for all treatment options with the exception of PTNS, which has a time horizon of 5 years. Costs and effects (measured as quality-adjusted life years) were calculated to derive incremental cost-effectiveness ratios (ICERs). Direct medical resources included are: device and drug acquisition costs, pre-procedure and procedure costs, and the cost of managing adverse events. Deterministic sensitivity analyses were performed to test robustness of results. At 5 years, SNS (PNE or TLE) was more effective and less costly than PTNS. Compared with OMT at 10 years, SNS (PNE or TLE) was more costly and more effective, and compared with BoNT-A, SNS PNE was less costly and more effective, and SNS TLE was more costly and more effective. Decreasing the BoNT-A dose from 150 to 100 IU marginally increased the 10 year ICERs for SNS TLE and PNE (SNS PNE was no longer dominant). However, both SNS options remained cost-effective. In the management of patients with idiopathic OAB wet, the results of this cost-utility analysis favours SNS (PNE or TLE) over PTNS or OMT, and the most efficient treatment strategy is SNS PNE over BoNT-A over a 10-year period. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

Management of hereditary breast and ovarian cancer.

PubMed

Yamauchi, Hideko; Takei, Junko

2018-02-01

Hereditary breast and ovarian cancer (HBOC) syndrome represents 5-10% of all breast cancers. In Japan, the HBOC syndrome is frequently diagnosed in patients with breast cancer. Therefore, a treatment strategy combining a plan for existing breast cancer and for reduction of future breast and ovarian cancer risk is necessary. Breast cancer risk-reducing management involves three options-surveillance, chemoprevention, and risk-reducing mastectomy (RRM). RRM can prevent >90% of new breast cancers. Ovarian cancer risk management options are more limited, and risk-reduction salpingo-oophorectomy is the only option since there is no proven effective early detection method available. The local recurrence rate following breast-conserving surgery in BRCA1/2 mutation-associated breast cancer is not significantly higher than that in sporadic breast cancer. Furthermore, there is no difference in prognosis between surgical methods. Clinicians should inform patients that there are no data on long-term monitoring and fully discuss risks of re-developing breast cancer with patients when choosing the surgical method. In HBOC, BRCA1/2 mutations lead to failure of double-strand DNA break repair, with poly ADP-ribose polymerase (PARP) playing an important role in single-strand DNA nick repair. Use of PARP inhibitors in HBOC prevents DNA repair (synthetic lethality) leading to cell death. This review summarizes management of the HBOC syndrome based on recent evidence.

Wildlife habitats in managed rangelands—the Great Basin of southeastern Oregon: management practices and options.

Treesearch

Frederick C. Hall

1985-01-01

Management practices and options to provide habitat for wildlife in the Great Basin of southeastern Oregon deal with both vegetation treatment and protection, livestock management, maintenance or distribution of water developments, protection of wildlife areas through road closures or fencing, and direct manipulation of wildlife through hunting, trapping, or other...

SYNTHESIS OF SPATIAL DATA FOR DECISION-MAKING

EPA Science Inventory

EPA'S Regional Vulnerability Assessment Program (ReVA) has developed a web-based statistical tool that synthesizes available spatial data into indices of condition, vulnerability (risk, considering cumulative effects), and feasibility of management options. The Environmental Deci...

Physicians in health care management: 10. Managing conflict through negotiation.

PubMed Central

Lemieux-Charles, L

1994-01-01

The recent focus on collaborative relationships in health care means that people and groups must cooperate to accomplish clinical and management tasks. This increasing interdependence may also cause increased organizational conflict. The management of conflicts is critical to the effectiveness of an organization. Negotiating strategies, based on Fisher and Ury's method of "principled negotiation," include establishing superordinate goals, separating the people from the problem, focussing on interests, inventing options, using objective criteria and defining success in terms of gains. PMID:7922944

5 CFR 870.705 - Amount and election of Option B and Option C.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Amount and election of Option B and Option C. 870.705 Section 870.705 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED... Compensationers § 870.705 Amount and election of Option B and Option C. (a) The number of multiples of Option B...

Efficacy and Safety of Remifentanil as an Alternative Labor Analgesic

PubMed Central

Devabhakthuni, Sandeep

2013-01-01

The objective of this review was to evaluate the clinical efficacy and safety of remifentanil in the management of labor pain. Although neuraxial analgesia is the best option during labor, alternative analgesic options are needed for patients with contraindications. Using a systematic literature search, clinical outcomes of remifentanil for labor pain have been summarized. Also, comparisons of remifentanil to other options including meperidine, epidural analgesia, fentanyl, and nitrous oxide are provided. Based on the literature review, remifentanil is associated with high overall maternal satisfaction and favorable side-effect profile. However, due to the low reporting of adverse events, large, randomized controlled trials are needed to evaluate maternal and neonatal safety adequately and determine the optimal dosing needed to provide effective analgesia. While remifentanil is a feasible alternative for patients who cannot or do not want to receive epidural analgesia, administration should be monitored closely for potential adverse effects. PMID:24665213

Military Personnel: DOD Should Develop a Plan to Evaluate the Effectiveness of Its Career Intermission Pilot Program

DTIC Science & Technology

2015-10-01

allowed them to address work - life balance challenges, such as managing deployment schedules and caring for family, that could not be achieved using...Career Intermissions In addition, officials stated that a career sabbatical may help to address the work - life balance that cannot be...suitable option for work / life balance that helps offset goals/issues that cannot be addressed while on active duty and gives sailors an option besides

Roadwaste : issues and options.

DOT National Transportation Integrated Search

1998-06-01

The Oregon Department of Transportation (ODOT) is conducting a study to determine roadwaste management options. Phase 1 consisted of a thorough review of regulations and standards, roadwaste characterization, current management practices, and new tec...

41 CFR 101-26.302 - Standard and optional forms.

Code of Federal Regulations, 2013 CFR

2013-07-01

... forms. 101-26.302 Section 101-26.302 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.3-Procurement of GSA Stock Items § 101-26.302 Standard and optional forms. Agencies...

41 CFR 101-26.302 - Standard and optional forms.

Code of Federal Regulations, 2011 CFR

2011-07-01

... forms. 101-26.302 Section 101-26.302 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.3-Procurement of GSA Stock Items § 101-26.302 Standard and optional forms. Agencies...

41 CFR 101-26.302 - Standard and optional forms.

Code of Federal Regulations, 2012 CFR

2012-07-01

... forms. 101-26.302 Section 101-26.302 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.3-Procurement of GSA Stock Items § 101-26.302 Standard and optional forms. Agencies...

41 CFR 101-26.302 - Standard and optional forms.

Code of Federal Regulations, 2010 CFR

2010-07-01

... forms. 101-26.302 Section 101-26.302 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.3-Procurement of GSA Stock Items § 101-26.302 Standard and optional forms. Agencies...

41 CFR 101-26.302 - Standard and optional forms.

Code of Federal Regulations, 2014 CFR

2014-07-01

... forms. 101-26.302 Section 101-26.302 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.3-Procurement of GSA Stock Items § 101-26.302 Standard and optional forms. Agencies...

Displaced intra-articular calcaneal fractures.

PubMed

Bajammal, Sohail; Tornetta, Paul; Sanders, David; Bhandari, Mohit

2005-01-01

Calcaneal fractures comprise 1 to 2 percent of all fractures. Approximately 75% of calcaneal fractures are intra-articular. The management of intra-articular calcaneal fractures remains controversial. Nonoperative treatment options include elevation, ice, early mobilization, and cyclic compression of the plantar arch. Operative treatment options include closed reduction and percutaneous pin fixation, open reduction and internal fixation, and arthrodesis. The effect of operative versus nonoperative treatment has been the focus of several comparative studies. This study was designed to determine the effect of operative treatment compared with nonoperative treatment on the rate of union, complications, and functional outcome after intra-articular calcaneal fracture in adults.

Food and Drug Administration upscheduling of hydrocodone and the effects on nurse practitioner pain management practices.

PubMed

Mack, Rachel

2018-06-01

In 2013, the Advisory Committee of the Food and Drug Administration determined hydrocodone combination medications (HCMs) needed tighter regulation due to high abuse potential; they recommended upscheduling HCMs from Schedule III to II. The purpose of this study was to examine the effect of upscheduling of HCMs on pain management practices of advanced practiced registered nurses (APRNs) in Oklahoma. In this qualitative study, 25 participants described their primary care experiences after the upscheduling. A thematic analysis was used to understand the effects on APRN pain management practices. The upscheduling of HCMs has greatly affected the pain management practices of APRNs in a state where Schedule II narcotic prescribing is forbidden. Findings will assist APRNs with improving patient access to care, implementing practice regulations, and exploring options for alternative pain therapies in primary care. Upscheduling of HCMs has had a severe impact on APRNs, affecting their prescribing practices and leading to increased referrals. They noted limited treatment options, increased health care costs, and decreased access to care. The APRNs understand the problem of prescription opioid abuse, diversion, and misuse. A consensus model could standardize the regulatory process for APRNs, increase interstate mobility for practice, and increase access to APRN care nationwide.

Resolving future fire management conflicts using multicriteria decision making.

PubMed

Driscoll, Don A; Bode, Michael; Bradstock, Ross A; Keith, David A; Penman, Trent D; Price, Owen F

2016-02-01

Management strategies to reduce the risks to human life and property from wildfire commonly involve burning native vegetation. However, planned burning can conflict with other societal objectives such as human health and biodiversity conservation. These conflicts are likely to intensify as fire regimes change under future climates and as growing human populations encroach farther into fire-prone ecosystems. Decisions about managing fire risks are therefore complex and warrant more sophisticated approaches than are typically used. We applied a multicriteria decision making approach (MCDA) with the potential to improve fire management outcomes to the case of a highly populated, biodiverse, and flammable wildland-urban interface. We considered the effects of 22 planned burning options on 8 objectives: house protection, maximizing water quality, minimizing carbon emissions and impacts on human health, and minimizing declines of 5 distinct species types. The MCDA identified a small number of management options (burning forest adjacent to houses) that performed well for most objectives, but not for one species type (arboreal mammal) or for water quality. Although MCDA made the conflict between objectives explicit, resolution of the problem depended on the weighting assigned to each objective. Additive weighting of criteria traded off the arboreal mammal and water quality objectives for other objectives. Multiplicative weighting identified scenarios that avoided poor outcomes for any objective, which is important for avoiding potentially irreversible biodiversity losses. To distinguish reliably among management options, future work should focus on reducing uncertainty in outcomes across a range of objectives. Considering management actions that have more predictable outcomes than landscape fuel management will be important. We found that, where data were adequate, an MCDA can support decision making in the complex and often conflicted area of fire management. © 2015 Society for Conservation Biology.

Current treatment for vitreous floaters.

PubMed

Sendrowski, David P; Bronstein, Mark A

2010-03-01

Vitreous floaters are a common complaint in the ophthalmic care setting. Patients seek explanation and advice regarding possible treatment options. Because the condition is considered benign, ophthalmic care practitioners have little to offer regarding treatment options. The majority of cases encountered are managed with patient education and reassurance. Although almost all patients accept the conservative management option, there is a small subset of patients who may desire a more aggressive treatment intervention for resolution of their visual symptoms. Information with regard to treatment options is readily available to patients through Internet searches and non-peer reviewed educational Web sites. The risks and benefits for these treatment options are not fully covered. Management of floaters should include education regarding "off-label" procedures as well as discussion about benefits and risks associated with such treatment options. It is vital that eye care practitioners advise and counsel patients with symptomatic floaters for optimum ocular health care. This article reviews the current conventional and "off-label" treatment options for symptomatic patients with vitreous floaters. Copyright (c) 2010 American Optometric Association. Published by Elsevier Inc. All rights reserved.

Knowledge and Attitude Towards Pharmacological Management of Acute Agitation: A Survey of Psychiatrists, Psychiatry Residents, and Psychiatric Nurses.

PubMed

Tangu, KeumbÔh; Ifeanyi, Adaora; Velusamy, Mayurapriya; Dar, Sara; Shah, Nurun; Ezeobele, Ifeoma E; Okusaga, Olaoluwa O

2017-06-01

The authors compared the current knowledge and attitude of psychiatrists, psychiatry residents, and psychiatric nurses towards the pharmacological management of acute agitation. Questionnaires were electronically distributed to all attending psychiatrists, psychiatry residents, and psychiatric nurses who were either employed by the University Department of Psychiatry and Behavioral Sciences or were staff at a 250-bed affiliated Psychiatric Hospital. Where possible, Fisher's exact test was used to compare responses to questions based on designation. Of the 250 questionnaires distributed, 112 were returned (response rate of 44.8%), of which 64 (57.1%) were psychiatric nurses, 27 (24.1%) were attending psychiatrists, and 21 (18.8%) were psychiatry residents. A significantly higher percentage of attending psychiatrists and psychiatric nurses compared to psychiatry residents thought that newer second- generation antipsychotics (SGAs) are not as effective as older first-generation antipsychotics (FGAs) for managing acute agitation (55.6, 48.4, and 9.5% respectively, p = 0.008). The combination of intramuscular haloperidol, lorazepam, and diphenhydramine was the most preferred option chosen by all designations for the psychopharmacological management of severe agitation. Furthermore, a larger percentage of the psychiatric nurses, in comparison to attending psychiatrists, also chose the combination of intramuscular chlorpromazine, lorazepam, and diphenhydramine as an option for managing severe agitation; no psychiatry resident chose this option. Knowledge of evidence-based psychopharmacological management of agitation differs among attending psychiatrists, psychiatry residents and psychiatric nurses. Although the management of agitation should be individualized and context specific, monotherapy should be considered first where applicable.

Management for adaptation

Treesearch

John Innes; Linda A. Joyce; Seppo Kellomaki; Bastiaan Louman; Aynslie Ogden; Ian Thompson; Matthew Ayres; Chin Ong; Heru Santoso; Brent Sohngen; Anita Wreford

2009-01-01

This chapter develops a framework to explore examples of adaptation options that could be used to ensure that the ecosystem services provided by forests are maintained under future climates. The services are divided into broad areas within which managers can identify specific management goals for individual forests or landscapes. Adaptation options exist for the major...

Bt: One Option for Gypsy Moth Management

Treesearch

Deborah C. Mccullough; Leah S. Bauer

2000-01-01

Though the gypsy moth will never go away, you have a variety of options to help manage this pest during outbreaks. One option involves the use of Bt to protect tree foliage and reduce the annoyance caused by gypsy moth caterpillars during an outbreak. Bt or Btk refers to a microorganism called Bacillus Thuringeniesis var. kurstaki. Bt has been widely adopted for...

Pricing real estate index options under stochastic interest rates

NASA Astrophysics Data System (ADS)

Gong, Pu; Dai, Jun

2017-08-01

Real estate derivatives as new financial instruments are not merely risk management tools but also provide a novel way to gain exposure to real estate assets without buying or selling the physical assets. Although real estate derivatives market has exhibited a rapid development in recent years, the valuation challenge of real estate derivatives remains a great obstacle for further development in this market. In this paper, we derive a partial differential equation contingent on a real estate index in a stochastic interest rate environment and propose a modified finite difference method that adopts the non-uniform grids to solve this problem. Numerical results confirm the efficiency of the method and indicate that constant interest rate models lead to the mispricing of options and the effects of stochastic interest rates on option prices depend on whether the term structure of interest rates is rising or falling. Finally, we have investigated and compared the different effects of stochastic interest rates on European and American option prices.

Template for assessing climate change impacts and management options: TACCIMO user guide version 2.2

Treesearch

Emrys Treasure; Steven McNulty; Jennifer Moore Myers; Lisa Nicole Jennings

2014-01-01

The Template for Assessing Climate Change Impacts and Management Options (TACCIMO) is a Web-based tool developed by the Forest Service, U.S. Department of Agriculture to assist Federal, State, and private land managers and planners with evaluation of climate change science implications for sustainable natural resource management. TACCIMO is a dynamic information...

Effectiveness and costs of overland skid trail BMPs

Treesearch

Clay Sawyers; W. Michael Aust; M. Chad Bolding; William A. Lakel III

2012-01-01

Forestry Best Management Practices (BMPs) are designed to protect water quality; however, little data exists comparing the efficacy and costs of different BMP options for skid trail closure. Study objectives were to evaluate erosion control effectiveness and implementation costs of five overland skid trail closure techniques. Closure techniques were: waterbar only (...

Fire Effects Information System: New engine, remodeled interior, added options

Treesearch

Jane Kapler Smith

2010-01-01

Some of today's firefighters weren't even born when the Fire Effects Information System (FEIS) (Web site ) "hit the streets" in 1986. Managers might remember using a dial-up connection in the early 1990s to access information on biology, ecology, and fire offered by FEIS.

Role of the U.S. Forest Service: Helping forests, grasslands, and wildlife adapt to shifts in climate

Treesearch

Monica S. Tomosy; Frank R. Thompson; Douglas Boyce

2011-01-01

This fall, the U.S. Forest Service (USFS) will release a comprehensive new guidebook designed to help managers develop climate adaptation options for National Forests (Peterson et al. 2011, in press). The adaptation process is based on partnerships between local resource managers and scientists working collaboratively to understand potential climate change effects,...

Charting a Clear Course: A Resource Guide for Building Successful Partnerships between Charter Schools and School Management Organizations. Second Edition.

ERIC Educational Resources Information Center

Hassel, Bryan; Lin, Margaret

As the charter-school option has expanded across the country, contracting for educational management services is an increasingly available and attractive choice for charter-school governing boards and founding groups. To make contractual relationships work well, charter-school boards need to strike an effective balance between fulfilling their…

Wildlife adaptations and management in eastside interior forests with mixed severity fire regimes.

Treesearch

John F. Lehmkuhl

2004-01-01

Little is known about the effects of mixed severity fire on wildlife, but a population viability analysis framework that considers habitat quantity and quality, species life history, and species population structure can be used to analyze management options. Landscape-scale habitat patterns under a mixed severity fire regime are a mosaic of compositional and structural...

Climate-induced changes in vulnerability to biological threats in the southern United States

Treesearch

Rabiu Olatinwo; Qinfeng Guo; Songlin Fei; William Otrosina; Kier Klepzig; Douglas Streett

2014-01-01

Forest land managers face the challenges of preparing their forests for the impacts of climate change. However, climate change adds a new dimension to the task of developing and testing science-based management options to deal with the effects of stressors on forest ecosystems in the southern United States. The large spatial scale and complex interactions make...

Learning to Swim Using Video Modelling and Video Feedback within a Self-Management Program

ERIC Educational Resources Information Center

Lao, So-An; Furlonger, Brett E.; Moore, Dennis W.; Busacca, Margherita

2016-01-01

Although many adults who cannot swim are primarily interested in learning by direct coaching there are options that have a focus on self-directed learning. As an alternative a self-management program combined with video modelling, video feedback and high quality and affordable video technology was used to assess its effectiveness to assisting an…

Medical management of motor fluctuations.

PubMed

Dewey, Richard B

2008-08-01

Given the magnitude of the problem of motor fluctuations in patients who have Parkinson's disease treated with levodopa, a significant effort has been expended by physicians, researchers, and pharmaceutical manufacturers over the years to find effective treatments. This article briefly reviews the medical options for managing motor fluctuations that are in common use in the United States or that are expected to be available soon.

A Review and Update of Treatment Options and Controversies in the Management of Hepatocellular Carcinoma.

PubMed

Dhir, Mashaal; Melin, Alyson A; Douaiher, Jeffrey; Lin, Chi; Zhen, Weining Ken; Hussain, Shahid M; Geschwind, Jean-Francois H; Doyle, Maria B Majella; Abou-Alfa, Ghassan K; Are, Chandrakanth

2016-06-01

To review the current management, outline recent advances and address controversies in the management of hepatocellular carcinoma (HCC). The treatment of HCC is multidisciplinary involving hepatologists, surgeons, medical oncologists, radiation oncologists, radiologists, interventional radiologists, and other disciplines. Each of these disciplines brings its unique perspective and differing opinions that add to controversies in the management of HCC. A focused literature review was performed to identify recent studies on the management of HCC and thereby summarize relevant information on the various therapeutic modalities and controversies involved in the treatment of HCC. The main treatment algorithms continue to rely on hepatic resection or transplantation with controversies involving patients harboring early stage disease and borderline hepatic function. The other treatment strategies include locoregional therapies, radiation, and systemic therapy used alone or in combination with other treatment modalities. Recent advances in locoregional therapies, radiation, and systemic therapies have provided better therapeutic options with curative intent potential for some locoregional therapies. Further refinements in combination therapies such as algorithms consisting of locoregional therapies and systemic or radiation therapies are likely to add additional options and improve survival. The management of HCC has witnessed significant strides with advances in existing options and introduction of several new treatment modalities of various combinations. Further refinements in these treatment options combined with enrollment in clinical trials are essential to improve the management and outcomes of patients with HCC.

A Policy Alternative Analysis and Simplified Scoring Method to Assess Policy Options for Marine Conservation Areas

NASA Astrophysics Data System (ADS)

Sharuga, S. M.; Reams, M.

2016-02-01

Traditional approaches to marine conservation and management are increasingly being found as inadequate; and, consequently, more complex ecosystem-based approaches to protecting marine ecosystems are growing in popularity. Ecosystem-based approaches, however, can be particularly challenging at a local level where resources and knowledge of specific marine conservation components may be limited. Marine conservation areas are known by a variety of names globally, but can be divided into four general types: Marine Protected Areas (MPAs), Marine Reserves, Fishery Reserves, and Ecological Reserves (i.e. "no take zones"). Each type of conservation area involves specific objectives, program elements and likely socioeconomic consequences. As an aid to community stakeholders and decision makers considering establishment of a marine conservation area, a simple method to compare and score the objectives and attributes of these four approaches is presented. A range of evaluation criteria are considered, including conservation of biodiversity and habitat, effective fishery management, overall cost-effectiveness, fairness to current users, enhancement of recreational activities, fairness to taxpayers, and conservation of genetic diversity. Environmental and socioeconomic costs and benefits of each type of conservation area are also considered. When exploring options for managing the marine environment, particular resource conservation needs must be evaluated individually on a case-by-case basis and the type of conservation area established must be tailored accordingly. However, MPAs are often more successful than other conservation areas because they offer a compromise between the needs of society and the environment, and therefore represent a viable option for ecosystem-based management.

A Policy Alternative Analysis and Simplified Scoring Method to Assess Policy Options for Marine Conservation Areas

NASA Astrophysics Data System (ADS)

Sharuga, S. M.; Reams, M.

2016-12-01

Traditional approaches to marine conservation and management are increasingly being found as inadequate; and, consequently, more complex ecosystem-based approaches to protecting marine ecosystems are growing in popularity. Ecosystem-based approaches, however, can be particularly challenging at a local level where resources and knowledge of specific marine conservation components may be limited. Marine conservation areas are known by a variety of names globally, but can be divided into four general types: Marine Protected Areas (MPAs), Marine Reserves, Fishery Reserves, and Ecological Reserves (i.e. "no take zones"). Each type of conservation area involves specific objectives, program elements and likely socioeconomic consequences. As an aid to community stakeholders and decision makers considering establishment of a marine conservation area, a simple method to compare and score the objectives and attributes of these four approaches is presented. A range of evaluation criteria are considered, including conservation of biodiversity and habitat, effective fishery management, overall cost-effectiveness, fairness to current users, enhancement of recreational activities, fairness to taxpayers, and conservation of genetic diversity. Environmental and socioeconomic costs and benefits of each type of conservation area are also considered. When exploring options for managing the marine environment, particular resource conservation needs must be evaluated individually on a case-by-case basis and the type of conservation area established must be tailored accordingly. However, MPAs are often more successful than other conservation areas because they offer a compromise between the needs of society and the environment, and therefore represent a viable option for ecosystem-based management.

Topical treatment of psoriasis.

PubMed

Laws, Philip M; Young, Helen S

2010-08-01

The majority of patients with psoriasis can be safely and effectively treated with topical therapy alone, either under the supervision of a family physician or dermatologist. For those requiring systemic agents, topical therapies can provide additional benefit. Optimal use of topical therapy requires an awareness of the range and efficacy of all products. The review covers the efficacy and role of topical therapies including emollients, corticosteroids, vitamin D analogs, calcineurin inhibitors, dithranol, coal tar, retinoids, keratolyics and combination therapy. The report was prepared following a PubMed and Embase literature search up to April 2010. The paper provides a broad review of the relevant topical therapeutic options available in routine clinical practice for the management of psoriasis and a recommendation for selection of treatment. Topical therapies used appropriately provide a safe and effective option for the management of psoriasis. An awareness of the available products and their efficacy is key to treatment selection and patient satisfaction.

Establishing public health security in a postwar Iraq: constitutional obstacles and lessons for other federalizing states.

PubMed

Wilson, Kumanan; Fidler, David P; McDougall, Christopher W; Lazar, Harvey

2009-06-01

The public health consequences of the conflict in Iraq will likely continue after the violence has subsided. Reestablishing public health security will require large investments in infrastructure and the creation of effective systems of governance. On the question of governance, the allocation of powers in the new constitution of Iraq is critical. Given the ease with which public health threats cross borders, the constitution needs to grant to the federal government the legal authority to manage such threats and simultaneously meet international requirements. Unfortunately, the draft constitution does not accomplish this objective. If politically possible, the constitution should be amended to provide the federal government with this authority. If not possible, the Iraqi federal government would have two options. It could attempt to use alternative constitutional powers, such as national security powers. This option would be contentious and the results uncertain. Alternatively, the federal government could attempt to establish collaborative relationships with regional governments. Residual sectarian tensions create potential problems for this option, however. Reflecting on the Iraqi situation, we conclude that other federalizing countries emerging from conflict should ensure that their constitutions provide the federal government with the necessary authority to manage threats to public health security effectively.

Benchmarking of Decision-Support Tools Used for Tiered Sustainable Remediation Appraisal.

PubMed

Smith, Jonathan W N; Kerrison, Gavin

2013-01-01

Sustainable remediation comprises soil and groundwater risk-management actions that are selected, designed, and operated to maximize net environmental, social, and economic benefit (while assuring protection of human health and safety). This paper describes a benchmarking exercise to comparatively assess potential differences in environmental management decision making resulting from application of different sustainability appraisal tools ranging from simple (qualitative) to more quantitative (multi-criteria and fully monetized cost-benefit analysis), as outlined in the SuRF-UK framework. The appraisal tools were used to rank remedial options for risk management of a subsurface petroleum release that occurred at a petrol filling station in central England. The remediation options were benchmarked using a consistent set of soil and groundwater data for each tier of sustainability appraisal. The ranking of remedial options was very similar in all three tiers, and an environmental management decision to select the most sustainable options at tier 1 would have been the same decision at tiers 2 and 3. The exercise showed that, for relatively simple remediation projects, a simple sustainability appraisal led to the same remediation option selection as more complex appraisal, and can be used to reliably inform environmental management decisions on other relatively simple land contamination projects.

Development of risk-based air quality management strategies under impacts of climate change.

PubMed

Liao, Kuo-Jen; Amar, Praveen; Tagaris, Efthimios; Russell, Armistead G

2012-05-01

Climate change is forecast to adversely affect air quality through perturbations in meteorological conditions, photochemical reactions, and precursor emissions. To protect the environment and human health from air pollution, there is an increasing recognition of the necessity of developing effective air quality management strategies under the impacts of climate change. This paper presents a framework for developing risk-based air quality management strategies that can help policy makers improve their decision-making processes in response to current and future climate change about 30-50 years from now. Development of air quality management strategies under the impacts of climate change is fundamentally a risk assessment and risk management process involving four steps: (1) assessment of the impacts of climate change and associated uncertainties; (2) determination of air quality targets; (3) selections of potential air quality management options; and (4) identification of preferred air quality management strategies that minimize control costs, maximize benefits, or limit the adverse effects of climate change on air quality when considering the scarcity of resources. The main challenge relates to the level of uncertainties associated with climate change forecasts and advancements in future control measures, since they will significantly affect the risk assessment results and development of effective air quality management plans. The concept presented in this paper can help decision makers make appropriate responses to climate change, since it provides an integrated approach for climate risk assessment and management when developing air quality management strategies. Development of climate-responsive air quality management strategies is fundamentally a risk assessment and risk management process. The risk assessment process includes quantification of climate change impacts on air quality and associated uncertainties. Risk management for air quality under the impacts of climate change includes determination of air quality targets, selections of potential management options, and identification of effective air quality management strategies through decision-making models. The risk-based decision-making framework can also be applied to develop climate-responsive management strategies for the other environmental dimensions and assess costs and benefits of future environmental management policies.

Managing AVN following internal fixation: treatment options and clinical results.

PubMed

Hoskinson, Simon; Morison, Zachary; Shahrokhi, Shahram; Schemitsch, Emil H

2015-03-01

Avascular necrosis (AVN) after internal fixation of intracapsular hip fractures is a progressive multifactorial disease that ultimately results in local ischemia with ensuing osteocyte necrosis and structural compromise. This disease can cause significant clinical morbidity and affects patients of any age, including young and active patients. Effective treatment of this condition among young adults is challenging due to their high functional demands. The aim of managing AVN is to relieve pain, preserve range of movement and improve function. Treatment methods vary depending on the stage of the disease and can be broadly categorised into two options, hip preserving surgery and hip arthroplasty. Although, hip preserving techniques are attractive in the young adult, they may alter the morphology of the proximal femur and make subsequent arthroplasty more challenging. Conversely, arthroplasty in the young adult may require repeat revision procedures throughout the patient's life. Current evidence suggests that modifications of prevailing treatments, in addition to new technologies, have led to the development of management strategies that may be able to alter the course of femoral head osteonecrosis. This review aims to summarise the options available for treatment of AVN in the young adult and review the clinical results. Copyright © 2014 Elsevier Ltd. All rights reserved.

The evolution of prostacyclins in pulmonary arterial hypertension: from classical treatment to modern management.

PubMed

Burger, Charles D; D'Albini, Lesley; Raspa, Susan; Pruett, Janis A

2016-01-01

Prostacyclins for the treatment of pulmonary arterial hypertension (PAH) have historically been covered under the insurance medical benefit because they require durable medical equipment and are administered by an intravenous, subcutaneous, or inhalation route. However, more treatment options that target the prostacyclin pathway have become available. As the number and type of options expand, an improved understanding of these drugs will aid managed care decision makers in evaluating new treatment options and making clinically sound and cost-effective treatment decisions. PAH is a progressive disease of pulmonary vascular remodeling that increases pulmonary vascular resistance and often results in right-side heart failure and death if left untreated. Adverse event profiles, the complexity of administration modalities, and potential complications must be considered when administering prostacyclin therapy. Traditional modes of administration, with their potential challenges and complications, may have contributed to the unmet need for an oral agent. Another consideration for managed care decision makers is that oral agents are generally covered under the insurance pharmacy benefit. Access to oral medications with long-term outcomes data, as well as the improved convenience of oral therapy, may help patients with PAH maximize function by maintaining a more convenient and consistent therapeutic regimen.

Moving towards ecosystem-based fisheries management: Options for parameterizing multi-species biological reference points

NASA Astrophysics Data System (ADS)

Moffitt, Elizabeth A.; Punt, André E.; Holsman, Kirstin; Aydin, Kerim Y.; Ianelli, James N.; Ortiz, Ivonne

2016-12-01

Multi-species models can improve our understanding of the effects of fishing so that it is possible to make informed and transparent decisions regarding fishery impacts. Broad application of multi-species assessment models to support ecosystem-based fisheries management (EBFM) requires the development and testing of multi-species biological reference points (MBRPs) for use in harvest-control rules. We outline and contrast several possible MBRPs that range from those that can be readily used in current frameworks to those belonging to a broader EBFM context. We demonstrate each of the possible MBRPs using a simple two species model, motivated by walleye pollock (Gadus chalcogrammus) and Pacific cod (Gadus macrocephalus) in the eastern Bering Sea, to illustrate differences among methods. The MBRPs we outline each differ in how they approach the multiple, potentially conflicting management objectives and trade-offs of EBFM. These options for MBRPs allow multi-species models to be readily adapted for EBFM across a diversity of management mandates and approaches.

Considerations for management of migraine symptoms in the primary care setting.

PubMed

Silberstein, Stephen D

2016-06-01

Migraine is a common disabling brain disorder that affects one in seven US citizens annually. The burden of migraine is substantial, both in economic terms and for individual patients and their close family members. Initial medical consultations for migraine are usually with a primary care physician (PCP), and it is predominantly managed in a primary care setting; therefore, PCPs need a thorough understanding of migraine and the treatment options. This review provides an overview of the prevalence, symptoms, burden, and diagnosis of migraine with a focus on adults. Important aspects of migraine management, such as medication overuse and chronic migraine, are highlighted and insight is provided into factors for consideration when prescribing acute/abortive treatment for migraine to ensure that individual patients receive optimal pharmaceutical management. The effects of associated symptoms, e.g. nausea/vomiting, on treatment efficacy are pertinent in migraine; however, many therapy options, including alternative delivery systems, are available, thus facilitating the selection of optimal treatment for an individual patient.

Capturing and Explaining Preference Heterogeneity for Wetland Management Options in the Kilombero Valley, Tanzania

NASA Astrophysics Data System (ADS)

Speelman, Stijn; Mombo, Felister; Vandermeulen, Valerie; Phillip, Damas; Van Huylenbroeck, Guido

2015-01-01

Wetland degradation has recently received considerable research attention. Although wetlands are valuable ecosystems, their actual value is difficult to measure because the services they provide often do not have market values. The current study seeks to investigate the preferences for wetland management options in the Kilombero Valley, central Tanzania using choice modeling. The results show that both respondents from the Kilombero Valley and Morogoro Municipality desire improvements in the condition of the wetlands. This indicates that the ongoing degradation is not socially optimal. A second finding is that the preferences for wetland conservation are heterogeneous and can be linked to livelihood characteristics. Communities living in the area, for example, are highly dependent on the wetland for their livelihood and would be impacted by conservation measures. Therefore, in order to reduce the pressure on wetlands, it is necessary and imperative to explore the options for alternative income-generating activities or to focus, for example, on technologies to improve efficiency and effectiveness in crop production.

New treatment options in the management of hypertension: appraising the potential role of azilsartan medoxomil

PubMed Central

Volpe, Massimo; Savoia, Carmine

2012-01-01

Renin–angiotensin–system (RAS) activation plays a key role in the development of hypertension and cardiovascular disease. Drugs that antagonize the RAS (angiotensin-converting enzyme [ACE] inhibitors and angiotensin receptor blockers [ARBs]) have proven clinical efficacy in reducing blood pressure values and cardiovascular morbidity and mortality. ACE inhibitors partially inhibit plasma ACE, and angiotensin II generation. Thus, ARBs, which block selectively type 1 angiotensin II receptor (AT1R), have been developed and used in the clinical management of hypertension and cardiovascular disease. Experimental and clinical trials with ARBs indicate that this class of drug represents an effective, safe and well tolerated therapeutic option for the prevention and care of hypertension, even though there is no proven superiority as compared to ACE inhibitors except for the better tolerability. Most ARBs may not completely inhibit the AT1R at the approved clinical doses. Azilsartan medoxomil is a newly approved ARB for the management of hypertension. This ARB induces a potent and long-lasting antihypertensive effect and may have cardioprotective properties. This article reviews the current evidence on the clinical effectiveness of azilsartan in hypertension. PMID:22457601

A cost-benefit analysis of produced water management opportunities in selected unconventional oil and gas plays

NASA Astrophysics Data System (ADS)

Marsters, P.; Macknick, J.; Bazilian, M.; Newmark, R. L.

2013-12-01

Unconventional oil and gas production in North America has grown enormously over the past decade. The combination of horizontal drilling and hydraulic fracturing has made production from shale and other unconventional resources economically attractive for oil and gas operators, but has also resulted in concerns over potential water use and pollution issues. Hydraulic fracturing operations must manage large volumes of water on both the front end as well as the back end of operations, as significant amounts of water are coproduced with hydrocarbons. This water--often called flowback or produced water--can contain chemicals from the hydraulic fracturing fluid, salts dissolved from the source rock, various minerals, volatile organic chemicals, and radioactive constituents, all of which pose potential management, safety, and public health issues. While the long-term effects of hydraulic fracturing on aquifers, drinking water supplies, and surface water resources are still being assessed, the immediate impacts of produced water on local infrastructure and water supplies are readily evident. Produced water management options are often limited to underground injection, disposal at centralized treatment facilities, or recycling for future hydraulic fracturing operations. The costs of treatment, transport, and recycling are heavily dependent on local regulations, existing infrastructure, and technologies utilized. Produced water treatment costs also change over time during energy production as the quality of the produced water often changes. To date there is no publicly available model that evaluates the cost tradeoffs associated with different produced water management techniques in different regions. This study addresses that gap by characterizing the volume, qualities, and temporal dynamics of produced water in several unconventional oil and gas plays; evaluating potential produced water management options, including reuse and recycling; and assessing how hydraulic fracturing and produced water issues relate to the larger water-energy nexus. Specifically, this study develops a play-specific model to compare the decision factors and costs involved in managing produced water. For example, when transport distances to a wastewater disposal site are far enough, options for recycling water become more favorable, depending on the characteristics of each play. This model can provide policymakers and other interested parties with cost estimates of different water management options, including a better understanding of the costs and opportunities associated with recycling produced water. This work provides a cross-play assessment of produced water management options and costs and could serve as the foundation for more detailed analyses of opportunities to minimize hydraulic fracturing's impacts on freshwater resources.

17 CFR 210.12-12B - Open option contracts written.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Open option contracts written... § 210.12-12B Open option contracts written. [For management investment companies only] Col. A Col. B Col... Information as to put options shall be shown separately from information as to call options. 2 Options of an...

Editorial Commentary: In a World of Endless Options, Is There a Single Solution? Management Options for Failed Anterior Instability Surgery in Athletes.

PubMed

Matzkin, Elizabeth

2018-05-01

There are many options to manage anterior instability of the shoulder. The management of athletes who have failed previous operative stabilization can make choosing a treatment solution difficult. A modified Latarjet without capsulolabral repair has been demonstrated to be a good choice when treating failed stabilization in a high-risk population with sufficient return to play and outcomes. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Management of trichomonas vaginalis in women with suspected metronidazole hypersensitivity.

PubMed

Helms, Donna J; Mosure, Debra J; Secor, W Evan; Workowski, Kimberly A

2008-04-01

Standard treatment for Trichomonas vaginalis is metronidazole or tinidazole. Hypersensitivity to these drugs has been documented but is poorly understood. Desensitization is an option described in limited reports of women with hypersensitivity to nitroimidazoles. The purpose of this analysis is to improve documentation of management for trichomonas infections among women with metronidazole hypersensitivity. Clinicians who consulted Centers for Disease Control and Prevention concerning patients with suspected hypersensitivity to metronidazole were provided with treatment options and asked to report outcomes. From September 2003-September 2006, complete information was obtained for 59 women. The most common reactions were urticaria (47%) and facial edema (11%). Fifteen of these women (25.4%) were treated with metronidazole desensitization and all had eradication of their infection. Seventeen women (28.8%) were treated with alternative intravaginal drugs, which were less successful; 5 of 17 infections (29.4%) were eradicated. Metronidazole desensitization was effective in the management of women with nitroimidazole hypersensitivity.

Focal cryotherapy in the treatment of localized prostate cancer.

PubMed

Nguyen, Huy D; Allen, Bryan J; Pow-Sang, Julio M

2013-07-01

The management choice for newly diagnosed localized prostate cancer presents a challenge to both the physician and the patient. Traditionally, surgery and radiation therapy have been the most commonly recommended options. More recently, active surveillance is recommended as the preferred management choice for a subset of men with localized, low-risk cancer. Recent reports also suggest that focal cryotherapy may be considered as a management option for selected cases of clinically localized prostate cancer. A review of the literature on focal cryotherapy from 2002 to 2012 was performed. Outcomes on cancer control, complications, and quality of life were extracted and assessed. The biochemical disease-free survival at 5 years is comparable to whole gland treatment modalities. Complications are minimal and comparable with other local treatment modalities. Focal cryotherapy is safe and effective, and it may improve failure rates in men who initially pursue active surveillance protocols. Early outcomes with cancer control are encouraging.

Workability and Requests for Flexible Work Arrangements Among Older Adults: The Role of a Time and Place Management Intervention.

PubMed

Morelock, Jeremiah C; McNamara, Tay K; James, Jacquelyn B

2017-11-01

This article investigates the effect of an intervention on the workability of older adults (i.e., the competence, health, and other mental and physical characteristics that workers need to meet the demands of their jobs). We used data from health care workers ( N = 437) who participated in a "time and place management" (TPM) intervention. Although related to flexible work options that aim to give workers more choice and control over the time and place of their work, TPM is conceptually distinct in that it focuses on the processes and guidelines necessary to the successful management of choice and control rather than the options alone. We focused on how the TPM intervention moderated the relationship between age and workability over time, with a particular focus on variation by baseline workability. Our results indicated that the intervention can benefit older workers with low workability.

Sickle cell disease and HIV: a case highlighting management challenges for children in a resource-limited setting.

PubMed

Odera, Esther Brenda; Kwobah, Charles; Stone, Geren; Some, Faraj; Vreeman, Rachel Christine

2014-01-01

Sickle cell disease (SCD) is a genetic disorder resulting from a mutation in the hemoglobin (Hb) gene. Sickle cell disease results in chronic anemia and a variety of acute and chronic complications that can lead to early mortality. A child with both SCD and HIV presents a management challenge, particularly in a resource-limited setting. In this case report, we describe the case of an 18-month-old Kenyan girl with SCD and HIV who developed a severe hypersensitivity reaction to first-line antiretroviral therapy (ART). Selecting an appropriate drug substitute for a child with SCD and HIV presents a management dilemma when the available options have problematic side effect profiles or are inaccessible or inappropriate according to national guidelines. The challenges in choosing an appropriate ART regimen for a child with SCD and HIV highlight the lack of data and scarcity of treatment options for pediatric patients.

75 FR 20649 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Order Granting...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-20

..., stock index futures contracts, options on futures, options on securities and indexes, equity caps... holding and/ or managing portfolios or baskets of securities, commodity futures contracts, options on commodity futures contracts, swaps, forward contracts and/or options on physical commodities and/or non-U.S...

Management Options for Control of a Stunt and Needle Nematode in Southern Forest Nurseries

Treesearch

Michelle M. Cram; Stephen W. Fraedrich

2005-01-01

Crop rotation and fallow are management options that can be used to control plant parasitic nematodes in forest tree nurseries. Before these options can be put into practice, it is important to determine the host range and survivability under fallow of the parasitic nematode to be controlled. The results of host range tests on a needle nematode (Longidorus...

Current treatment options for the management of esophageal cancer

PubMed Central

Mawhinney, Mark R; Glasgow, Robert E

2012-01-01

In recent years, esophageal cancer characteristics and management options have evolved significantly. There has been a sharp increase in the frequency of esophageal adenocarcinoma and a decline in the frequency of squamous cell carcinoma. A more comprehensive understanding of prognostic factors influencing outcome has also been developed. This has led to more management options for esophageal cancer at all stages than ever before. A multidisciplinary, team approach to management in a high volume center is the preferred approach. Each patient should be individually assessed based on type of cancer, local or regional involvement, and his or her own functional status to determine an appropriate treatment regimen. This review will discuss management of esophageal cancer relative to disease progression and patient functional status. PMID:23152702

RESTORATION PLUS: A COLLABORATIVE RESEARCH PROGRAM TO DEVELOP AND EVALUATE ECOSYSTEM RESTORATION AND MANAGEMENT OPTIONS TO ACHIEVE ECOLOGICALLY AND ECONOMICALLY SUSTAINABLE SOLUTIONS

EPA Science Inventory

EPA is evaluating ecosystem restoration and management techniques to ensure they create sustainable solutions for degraded watersheds. ORD NRMRL initiated the Restoration Plus (RePlus) program in 2002 to a) evaluate ecosystem restoration and management options, b) assess the non-...

A one-year economic evaluation of six alternative strategies in the management of uninvestigated upper gastrointestinal symptoms in Canadian primary care.

PubMed

Barkun, Alan N; Crott, Ralph; Fallone, Carlo A; Kennedy, Wendy A; Lachaine, Jean; Levinton, Carey; Armstrong, David; Chiba, Naoki; Thomson, Alan; Veldhuyzen van Zanten, Sander; Sinclair, Paul; Escobedo, Sergio; Chakraborty, Bijan; Smyth, Sandra; White, Robert; Kalra, Helen; Nevin, Krista

2010-08-01

The cost-effectiveness of initial strategies in managing Canadian patients with uninvestigated upper gastrointestinalsymptoms remains controversial. To assess the cost-effectiveness of six management approaches to uninvestigated upper gastrointestinal symptoms in the Canadian setting. The present study analyzed data from four randomized trials assessing homogeneous and complementary populations of Canadian patients with uninvestigated upper gastrointestinal symptoms with comparable outcomes. Symptom-free months, qualityadjusted life-years (QALYs) and direct costs in Canadian dollars of two management approaches based on the Canadian Dyspepsia Working Group (CanDys) Clinical Management Tool, and four additional strategies (two empirical antisecretory agents, and two prompt endoscopy) were examined and compared. Prevalence data, probabilities, utilities and costs were included in a Markov model, while sensitivity analysis used Monte Carlo simulations. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were determined. Empirical omeprazole cost $226 per QALY ($49 per symptom-free month) per patient. CanDys omeprazole and endoscopy approaches were more effective than empirical omeprazole, but more costly. Alternatives using H2-receptor antagonists were less effective than those using a proton pump inhibitor. No significant differences were found for most incremental cost-effectiveness ratios. As willingness to pay (WTP) thresholds rose from $226 to $24,000 per QALY, empirical antisecretory approaches were less likely to be the most costeffective choice, with CanDys omeprazole progressively becoming a more likely option. For WTP values ranging from $24,000 to $70,000 per QALY, the most clinically relevant range, CanDys omeprazole was the most cost-effective strategy (32% to 46% of the time), with prompt endoscopy-proton pump inhibitor favoured at higher WTP values. Although no strategy was the indisputable cost effective option, CanDys omeprazole may be the strategy of choiceover a clinically relevant range of WTP assumptions in the initial management of Canadian patients with uninvestigated dyspepsia.

Introduction: Strengthening the foundation of wildland fire Effects prediction for research and management

Treesearch

Matthew B. Dickinson; Kevin C. Ryan

2010-01-01

As prescribed fire use increases and the options for responding to wildfires continue to expand beyond suppression, the need for improving fire effects prediction capabilities be¬comes increasingly apparent. The papers in this Fire Ecology special issue describe recent advances in fire effects prediction for key classes of direct (first-order) fire effects. Important...

Options for change in the NHS consultant contract.

PubMed

Clarke, R W; Gray, C

The lead negotiators for the management and consultant sides in an NHS trust in northern England responded to debate in their trust about consultant contracts by offering to research the attitudes of their peers towards a variety of contract options. The options tested included the current contract; models already examined in the trust and elsewhere, such as time sensitive and mild performance related contracts; and some more radical and speculative possibilities, including consultants franchising their services to the trust. Beyond the predictable conclusion that consultants would prefer no change while managers desired it, a time sensitive contract emerged as having potential for successful negotiation. On the other hand, neither consultants nor managers favoured a strict performance related contract or a fee for service contract. There was a strong similarity of opinion between the two groups on the relative salary values of the options, though the consultants consistently priced these higher than the managers.

Options for change in the NHS consultant contract.

PubMed Central

Clarke, R. W.; Gray, C.

1994-01-01

The lead negotiators for the management and consultant sides in an NHS trust in northern England responded to debate in their trust about consultant contracts by offering to research the attitudes of their peers towards a variety of contract options. The options tested included the current contract; models already examined in the trust and elsewhere, such as time sensitive and mild performance related contracts; and some more radical and speculative possibilities, including consultants franchising their services to the trust. Beyond the predictable conclusion that consultants would prefer no change while managers desired it, a time sensitive contract emerged as having potential for successful negotiation. On the other hand, neither consultants nor managers favoured a strict performance related contract or a fee for service contract. There was a strong similarity of opinion between the two groups on the relative salary values of the options, though the consultants consistently priced these higher than the managers. PMID:8086915

IDENTIFICATION OF TOXICANTS IN WHOLE MARINE SEDIMENTS: METHODS AND RESULTS

EPA Science Inventory

Identification of stressors in aquatic systems is critical to sound assessment and management of our nation's waterways. Information from stressor identification can be useful in designing effective sediment remediation methods, assessing options for sediment disposal, allowing m...

CHARACTERIZING AND MITIGATING PATHOGENIC ORGANISMS RELATED TO CAFOS

EPA Science Inventory

CHARACTERIZING AND MITIGATING PATHOGENIC ORGANISMS RELATED TO CAFOs John Haines and Shane Rogers NRMRL Science Questions MYP Science Ouestion: What BMP treatment systems and restoration technologies are most effective options for watershed management? For mixed land use wa...

EMAS position statement: Non-hormonal management of menopausal vasomotor symptoms.

PubMed

Mintziori, Gesthimani; Lambrinoudaki, Irene; Goulis, Dimitrios G; Ceausu, Iuliana; Depypere, Herman; Erel, C Tamer; Pérez-López, Faustino R; Schenck-Gustafsson, Karin; Simoncini, Tommaso; Tremollieres, Florence; Rees, Margaret

2015-07-01

To review non-hormonal therapy options for menopausal vasomotor symptoms. The current EMAS position paper aims to provide to provide guidance for managing peri- and postmenopausal women who cannot or do not wish to take menopausal hormone therapy (MHT). Literature review and consensus of expert opinion. Non-hormonal management of menopausal symptoms includes lifestyle modifications, diet and food supplements, non-hormonal medications and application of behavioral and alternative medicine therapies. There is insufficient or conflicting evidence to suggest that exercise, supplements or a diet rich in phytoestrogens are effective for vasomotor menopausal symptoms. Selective serotonin-reuptake inhibitors (SSRIs), serotonin norepinephrine-reuptake inhibitors (SNRIs) and gabapentin could be proposed as alternatives to MHT for menopausal symptoms, mainly hot flushes. Behavioral therapies and alternative medicine interventions have been tried, but the available evidence is still limited. A number of interventions for non-hormonal management of menopausal vasomotor symptoms are now available. For women who cannot or do not wish to take estrogens, non-hormonal management is now a realistic option. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Generating Options for Active Risk Control (GO-ARC): introducing a novel technique.

PubMed

Card, Alan J; Ward, James R; Clarkson, P John

2014-01-01

After investing significant amounts of time and money in conducting formal risk assessments, such as root cause analysis (RCA) or failure mode and effects analysis (FMEA), healthcare workers are left to their own devices in generating high-quality risk control options. They often experience difficulty in doing so, and tend toward an overreliance on administrative controls (the weakest category in the hierarchy of risk controls). This has important implications for patient safety and the cost effectiveness of risk management operations. This paper describes a before and after pilot study of the Generating Options for Active Risk Control (GO-ARC) technique, a novel tool to improve the quality of the risk control options generation process. The quantity, quality (using the three-tiered hierarchy of risk controls), variety, and novelty of risk controls generated. Use of the GO-ARC technique was associated with improvement on all measures. While this pilot study has some notable limitations, it appears that the GO-ARC technique improved the risk control options generation process. Further research is needed to confirm this finding. It is also important to note that improved risk control options are a necessary, but not sufficient, step toward the implementation of more robust risk controls. © 2013 National Association for Healthcare Quality.

Managing the side effects of multiple sclerosis therapy: pharmacotherapy options for patients.

PubMed

Rommer, Paulus S; Zettl, Uwe K

2018-04-01

Multiple sclerosis (MS) is an immune-mediated and neurodegenerative disease with an unpredictable outcome. Immune-modulatory treatment aims at decreasing long-term disability. With the increasing number of treatment options, it is essential to fully digest the possible side effects of the available therapeutics and to monitor patients is essential. Areas covered: All approved disease-modifying drugs (DMD) for MS are discussed in this review. Mode of action, adverse effects, reported risks for infections and malignancies, and pregnancy related issues are discussed in the review. The authors also provide suggestions for monitoring therapy. For all approved DMDs the pivotal studies have been included for possible side effects, as well as reports by health authorities. For this manuscript, PubMed was checked for reports on side effects for various drugs. Expert opinion: Treatment options in MS are manifold, each carrying different risks. The safety-risk profile for approved agents is favorable. Knowing and monitoring these possible side effects is essential to minimize risks associated with treatment. Presently, the long-term experience for some of these therapies is missing and this must be addressed.

Integrated cost-effectiveness analysis of agri-environmental measures for water quality.

PubMed

Balana, Bedru B; Jackson-Blake, Leah; Martin-Ortega, Julia; Dunn, Sarah

2015-09-15

This paper presents an application of integrated methodological approach for identifying cost-effective combinations of agri-environmental measures to achieve water quality targets. The methodological approach involves linking hydro-chemical modelling with economic costs of mitigation measures. The utility of the approach was explored for the River Dee catchment in North East Scotland, examining the cost-effectiveness of mitigation measures for nitrogen (N) and phosphorus (P) pollutants. In-stream nitrate concentration was modelled using the STREAM-N and phosphorus using INCA-P model. Both models were first run for baseline conditions and then their effectiveness for changes in land management was simulated. Costs were based on farm income foregone, capital and operational expenditures. The costs and effects data were integrated using 'Risk Solver Platform' optimization in excel to produce the most cost-effective combination of measures by which target nutrient reductions could be attained at a minimum economic cost. The analysis identified different combination of measures as most cost-effective for the two pollutants. An important aspect of this paper is integration of model-based effectiveness estimates with economic cost of measures for cost-effectiveness analysis of land and water management options. The methodological approach developed is not limited to the two pollutants and the selected agri-environmental measures considered in the paper; the approach can be adapted to the cost-effectiveness analysis of any catchment-scale environmental management options. Copyright © 2015 Elsevier Ltd. All rights reserved.

Management options of non-syndromic sagittal craniosynostosis.

PubMed

Lee, Bryan S; Hwang, Lee S; Doumit, Gaby D; Wooley, Joseph; Papay, Francis A; Luciano, Mark G; Recinos, Violette M

2017-05-01

There have been various effective surgical procedures for the treatment of non-syndromic sagittal craniosynostosis, but no definitive guidelines for management have been established. We conducted a study to elucidate the current state of practice and establish a warranted standard of care. An Internet-based study was sent to 180 pediatric neurosurgeons across the country and 102 craniofacial plastic surgeons in fourteen different countries, to collect data for primary indication for surgical management, preference for timing and choice of surgery, and pre-, peri-, and post-operative management options. The overall response rate from both groups was 32% (n=90/284). Skull deformity was the primary indication for surgical treatment in patients without signs of hydrocephalus for both neurosurgeons and craniofacial surgeons (80% and 63%, respectively). Open surgical management was most commonly performed at six months of age by neurosurgeons (46%) and also by craniofacial surgeons (35%). Open surgical approach was favored for patients younger than four months of age by neurosurgeons (50%), but endoscopic approach was favored by craniofacial surgeons (35%). When performing an open surgical intervention, most neurosurgeons preferred pi or reversed pi procedure (27%), whereas total cranial vault remodeling was the most commonly performed procedure by craniofacial surgeons (37%). The data demonstrated a discrepancy in the treatment options for non-syndromic sagittal craniosynostosis. By conducting/comparing a wide survey to collect consolidative data from both groups of pediatric neurosurgeons and craniofacial plastic surgeons, we can attempt to facilitate the establishment of standard of care. Copyright © 2017 Elsevier Ltd. All rights reserved.

Obsessive Compulsive Treatment Efficacy Trial (OCTET) comparing the clinical and cost effectiveness of self-managed therapies: study protocol for a randomised controlled trial.

PubMed

Gellatly, Judith; Bower, Peter; McMillan, Dean; Roberts, Christopher; Byford, Sarah; Bee, Penny; Gilbody, Simon; Arundel, Catherine; Hardy, Gillian; Barkham, Michael; Reynolds, Shirley; Gega, Lina; Mottram, Patricia; Lidbetter, Nicola; Pedley, Rebecca; Peckham, Emily; Connell, Janice; Molle, Jo; O'Leary, Neil; Lovell, Karina

2014-07-10

UK National Institute of Health and Clinical Excellence guidelines for obsessive compulsive disorder (OCD) specify recommendations for the treatment and management of OCD using a stepped care approach. Steps three to six of this model recommend treatment options for people with OCD that range from low-intensity guided self-help (GSH) to more intensive psychological and pharmacological interventions. Cognitive behavioural therapy (CBT), including exposure and response prevention, is the recommended psychological treatment. However, whilst there is some preliminary evidence that self-managed therapy packages for OCD can be effective, a more robust evidence base of their clinical and cost effectiveness and acceptability is required. Our proposed study will test two different self-help treatments for OCD: 1) computerised CBT (cCBT) using OCFighter, an internet-delivered OCD treatment package; and 2) GSH using a book. Both treatments will be accompanied by email or telephone support from a mental health professional. We will evaluate the effectiveness, cost and patient and health professional acceptability of the treatments. This study will provide more robust evidence of efficacy, cost effectiveness and acceptability of self-help treatments for OCD. If cCBT and/or GSH prove effective, it will provide additional, more accessible treatment options for people with OCD. Current Controlled Trials: ISRCTN73535163. Date of registration: 5 April 2011.

Non-invasive Management Options for Erectile Dysfunction When a Phosphodiesterase Type 5 Inhibitor Fails.

PubMed

Lee, Mary; Sharifi, Roohollah

2018-03-01

Phosphodiesterase type 5 inhibitors (PDE5Is) are the drug of choice for medical management of erectile dysfunction (ED). On-demand PDE5Is have an overall efficacy of 60-70% for ED; 30-35% of patients fail to respond to a PDE5I, and 30-50% of non-responders can be salvaged with detailed counseling on proper use and physician follow-up to ensure that the patient has been prescribed an appropriate and full PDE5I clinical trial. True non-responders may be offered intracavernosal injections of erectogenic drugs, intraurethral alprostadil, or surgical insertion of a penile prosthesis. Such options are not discreet and are associated with more adverse effects than PDE5Is. Thus patients may request additional non-invasive medical management options. This review describes published literature on patients who failed to respond to an on-demand PDE5I regimen and were treated with a non-invasive PDEI-based regimen, including switching from one PDE5I to another; increasing the dose of PDE5I above the labeled dosage range; using two PDE5Is concurrently; using a daily PDE5I regimen; or combining a PDE5I with a testosterone supplement, α-adrenergic antagonist, intraurethral or intracavernosal alprostadil, vacuum erection device, or low-intensity shock wave therapy. The limitations of published clinical trials do not allow for sufficient evidence to recommend one option over another. Therefore, in PDE5I-refractory patients, the choice of a specific next step should be individualized based on the preference of the patient and his sexual partner, the advantages and disadvantages of the various options, the concurrent medical illnesses and medications of the patient, and the patient's response to treatment.

MODELING CONCEPTS FOR BMP/LID SIMULATION

EPA Science Inventory

Enhancement of simulation options for stormwater best management practices (BMPs) and hydrologic source control is discussed in the context of the EPA Storm Water Management Model (SWMM). Options for improvement of various BMP representations are presented, with emphasis on inco...

Geographic considerations for fire management in the Eastern United States: geomorphology and topography, soils, and climate

Treesearch

Barton D. Clinton; James M. Vose; Erika C. Cohen

2012-01-01

Across the Eastern United States, there is on average an estimated 36 MT ha–1 (16 tons ac–1) of dead woody fuel (Chojnacky and others 2004). Variations in fuel type, size, and flammability make the selection of treatment options critical for effective fuels management. The region is a complex landscape characterized by...

Modeling trade-offs between fire threat reduction and late-seral forest structure.

Treesearch

David E. Calkin; Susan Stevens Hummel; James K. Agee

2005-01-01

Evaluating the effects of managing for one forest resource in terms of associated impacts on other resources is not easy. Yet methods to identify potential trade-offs among forest resources are necessary to inform people about the implications of management options on public land. This paper uses a case study from a forest reserve in the northwestern United States to...

Assessing the effect of a fuel break network to reduce burnt area and wildfire risk transmission

Treesearch

Tiago M. Oliveira; Ana M. G. Barros; Alan A. Ager; Paulo M. Fernandes

2016-01-01

Wildfires pose complex challenges to policymakers and fire agencies. Fuel break networks and area-wide fuel treatments are risk-management options to reduce losses from large fires. Two fuel management scenarios covering 3% of the fire-prone Algarve region of Portugal and differing in the intensity of treatment in 120-m wide fuel breaks were examined and compared with...

A Multi-Attribute Assessment of Site Preparation Effects on the Socioeconomical and Ecological Attributes of Loblolly Pine (Pinus taeda) Stands

Treesearch

James H. Miller; Jianbang Gan; Stephen H. Kolison; Robert S. Boyd; Kenneth L. McNabb; B. Graeme Lockaby

1998-01-01

The public demands both commodity and non-commodity goods and srvices from our forests. This requires management options that not only provide fiber, clean water, wildlife habitat, and mcreation, but do so in a biologically sustainable manner, resulting in healthy productive forests into perpetuity. A common forest management activity used to enhance fiber production...

75 FR 40005 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Order Granting...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-13

... including, but not limited to, stock index futures contracts, options on futures, options on securities and... holding and/ or managing portfolios or baskets of securities, commodity futures contracts, options on commodity futures contracts, swaps, forward contracts and/or options on physical commodities and/or non-U.S...

Intrapleural cisplatin for management of malignant pleural effusion in a patient with plasma cell leucaemia.

PubMed

Agarwal, Abhishek; Klair, Jagpal; Patolia, Setu; Meena, Nikhil K

2015-06-29

Plasma cell leucaemia (PCL) is a rare aggressive form of multiple myeloma. It occasionally involves the pleura, causing malignant pleural effusion (MPE). MPE presents a management dilemma for physicians, given the different treatment options available with varying efficacy and side effects. We report a case of a 64-year-old man with MPE due to PCL, successfully managed with intrapleural cisplatin and a tunnelled pleural catheter. We believe this to be the first report of management of PCL-associated MPE with intrapleural cisplatin. 2015 BMJ Publishing Group Ltd.

Chondrosarcoma third metacarpal: Diagnosis and management options.

PubMed

Sharma, Vipin; Verma, Lucky; Chander, Bal; Sharma, Seema

2018-01-01

Chondrosarcoma is a rare malignant tumor of cartilage commonly arising in the pelvis, proximal femur, and humerus, but quite uncommon in the small bones of the hand. Although limited surgical procedures such as curettage are mentioned as a management option in low-grade chondrosarcomas, they tend to have a high rate of recurrences. Hence, wide excision is recommended as a treatment option even in low-grade chondrosarcomas of the hand.

Integrated Decision-Making Tool to Develop Spent Fuel Strategies for Research Reactors

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

Beatty, Randy L; Harrison, Thomas J

IAEA Member States operating or having previously operated a Research Reactor are responsible for the safe and sustainable management and disposal of associated radioactive waste, including research reactor spent nuclear fuel (RRSNF). This includes the safe disposal of RRSNF or the corresponding equivalent waste returned after spent fuel reprocessing. One key challenge to developing general recommendations lies in the diversity of spent fuel types, locations and national/regional circumstances rather than mass or volume alone. This is especially true given that RRSNF inventories are relatively small, and research reactors are rarely operated at a high power level or duration typical ofmore » commercial power plants. Presently, many countries lack an effective long-term policy for managing RRSNF. This paper presents results of the International Atomic Energy Agency (IAEA) Coordinated Research Project (CRP) #T33001 on Options and Technologies for Managing the Back End of the Research Reactor Nuclear Fuel Cycle which includes an Integrated Decision Making Tool called BRIDE (Back-end Research reactor Integrated Decision Evaluation). This is a multi-attribute decision-making tool that combines the Total Estimated Cost of each life-cycle scenario with Non-economic factors such as public acceptance, technical maturity etc and ranks optional back-end scenarios specific to member states situations in order to develop a specific member state strategic plan with a preferred or recommended option for managing spent fuel from Research Reactors.« less

Emphysematous pyelonephritis with calculus: Management strategies.

PubMed

Goel, Tanmaya; Reddy, Sreedhar; Thomas, Joseph

2007-07-01

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. 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. 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. In EPN with stones, nephrectomy is not the sole option available and they can be effectively managed with open / endoscopic measures.

Pain and pain management in haemophilia

PubMed Central

Auerswald, Günter; Dolan, Gerry; Duffy, Anne; Hermans, Cedric; Jiménez-Yuste, Victor; Ljung, Rolf; Morfini, Massimo; Lambert, Thierry; Šalek, Silva Zupančić

2016-01-01

Joint pain is common in haemophilia and may be acute or chronic. Effective pain management in haemophilia is essential to reduce the burden that pain imposes on patients. However, the choice of appropriate pain-relieving measures is challenging, as there is a complex interplay of factors affecting pain perception. This can manifest as differences in patients’ experiences and response to pain, which require an individualized approach to pain management. Prophylaxis with factor replacement reduces the likelihood of bleeds and bleed-related pain, whereas on-demand therapy ensures rapid bleed resolution and pain relief. Although use of replacement or bypassing therapy is often the first intervention for pain, additional pain relief strategies may be required. There is an array of analgesic options, but consideration should be paid to the adverse effects of each class. Nevertheless, a combination of medications that act at different points in the pain pathway may be beneficial. Nonpharmacological measures may also help patients and include active coping strategies; rest, ice, compression, and elevation; complementary therapies; and physiotherapy. Joint aspiration may also reduce acute joint pain, and joint steroid injections may alleviate chronic pain. In the longer term, increasing use of prophylaxis or performing surgery may be necessary to reduce the burden of pain caused by the degenerative effects of repeated bleeds. Whichever treatment option is chosen, it is important to monitor pain and adjust patient management accordingly. Beyond specific pain management approaches, ongoing collaboration between multidisciplinary teams, which should include physiotherapists and pain specialists, may improve outcomes for patients. PMID:27439216

Modelling the impacts of agricultural management practices on river water quality in Eastern England.

PubMed

Taylor, Sam D; He, Yi; Hiscock, Kevin M

2016-09-15

Agricultural diffuse water pollution remains a notable global pressure on water quality, posing risks to aquatic ecosystems, human health and water resources and as a result legislation has been introduced in many parts of the world to protect water bodies. Due to their efficiency and cost-effectiveness, water quality models have been increasingly applied to catchments as Decision Support Tools (DSTs) to identify mitigation options that can be introduced to reduce agricultural diffuse water pollution and improve water quality. In this study, the Soil and Water Assessment Tool (SWAT) was applied to the River Wensum catchment in eastern England with the aim of quantifying the long-term impacts of potential changes to agricultural management practices on river water quality. Calibration and validation were successfully performed at a daily time-step against observations of discharge, nitrate and total phosphorus obtained from high-frequency water quality monitoring within the Blackwater sub-catchment, covering an area of 19.6 km(2). A variety of mitigation options were identified and modelled, both singly and in combination, and their long-term effects on nitrate and total phosphorus losses were quantified together with the 95% uncertainty range of model predictions. Results showed that introducing a red clover cover crop to the crop rotation scheme applied within the catchment reduced nitrate losses by 19.6%. Buffer strips of 2 m and 6 m width represented the most effective options to reduce total phosphorus losses, achieving reductions of 12.2% and 16.9%, respectively. This is one of the first studies to quantify the impacts of agricultural mitigation options on long-term water quality for nitrate and total phosphorus at a daily resolution, in addition to providing an estimate of the uncertainties of those impacts. The results highlighted the need to consider multiple pollutants, the degree of uncertainty associated with model predictions and the risk of unintended pollutant impacts when evaluating the effectiveness of mitigation options, and showed that high-frequency water quality datasets can be applied to robustly calibrate water quality models, creating DSTs that are more effective and reliable. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

COMBINATION OF IRON AND MIXED ANAEROBIC CULTURE FOR PERCHLOROETHENE DEGRADATION

EPA Science Inventory

Permeable reactive barriers (PRB's) are an emerging, alternative in-situ approach for remediating contaminated groundwater that combine subsurface fluid flow management with a passive chemical treatment zone. PRB's are a potentially more cost effective treatment option at severa...

Maryland Department of the Environment

Science.gov Websites

Open - New lead laws now in effect for rental properties. Register your property today. Notices and /ParameterList.aspx?list={ListId}&ID={ItemId} 0x0 0x4 FileType rdl 353 Manage Processing Options /_layouts

AN OVERVIEW OF TOXICANT IDENTIFICATION IN SEDIMENTS AND DREDGED MATERIALS

EPA Science Inventory

The identification of toxicants affecting aquatic benthic systems is critical to sound assessment and management of our nation?s waterways. Identification of toxicants can be useful in designing effective sediment remediation plans and reasonable options for sediment disposal. K...

IDENTIFICATION OF STRESSORS IN TOXIC SEDIMENTS: WHOLE SEDIMENT AND INSTITIAL WATER RESULTS

EPA Science Inventory

Identification of stressors in aquatic systems is critical to sound assessment and management of our nation's waterways. Information from stressor identification can be useful in designing effective sediment remediation methods, assessing options for sediment disposal, allowing m...

Safety Effects of the Conversion of Rural Two-Lane Roadways to Four-Lane Roadways

DOT National Transportation Integrated Search

2012-08-01

This report presents the analyses and conclusions from work focused on analyzing multiple options for organizational and operational models for certificate management entities (CMEs) within the connected vehicle system. The report discusses all funct...

TIES: EVERYTHING YOU WANTED TO KNOW BUT WERE AFRAID TO ASK

EPA Science Inventory

Identification of stressors in aquatic systems is critical to sound assessment and management of our nation's waterways. Information from stressor identification can be useful in designing effective sediment remediation methods, assessing options for sediment disposal, allowing m...

SSAT maintenance of certification: literature review on gastroesophageal reflux disease and hiatal hernia.

PubMed

Soper, Nathaniel J

2011-08-01

This article reviews the current literature pertaining to the diagnosis and management of gastroesophageal reflux disease (GERD) and hiatal hernia. GERD is one of the most common gastrointestinal disorders in the USA. For effective management, a conclusive diagnosis must be made. Most patients are effectively managed by acid suppression therapy, whereas others require procedural treatment. Endoluminal treatment of GERD is an option, but long-term results of this therapy are unknown. The "gold standard" surgical treatment of GERD is laparoscopic Nissen fundoplication. Large hiatal hernias are difficult to manage with a relatively high rate of recurrent hiatal hernia. Whether or not to use mesh at the hiatus to decrease this occurrence is currently debatable.

A potential role for N-acetylcysteine in the management of methamphetamine dependence.

PubMed

McKetin, Rebecca; Dean, Olivia M; Baker, Amanda L; Carter, Greg; Turner, Alyna; Kelly, Peter J; Berk, Michael

2017-03-01

Methamphetamine dependence is a growing problem in Australia and globally. Currently, there are no approved pharmacotherapy options for the management of methamphetamine dependence. N-acetylcysteine is one potential pharmacotherapy option. It has received growing attention as a therapy for managing addictions because of its capacity to restore homeostasis to brain glutamate systems disrupted in addiction and thereby reduce craving and the risk of relapse. N-acetylcysteine also has antioxidant properties that protect against methamphetamine-induced toxicity and it may therefore assist in the management of the neuropsychiatric and neurocognitive effects of methamphetamine. This commentary overviews the actions of N-acetylcysteine and evidence for its efficacy in treating addiction with a particular focus on its potential utility for methamphetamine dependence. We conclude that the preliminary evidence indicates a need for full-scale trials to definitively establish whether N-acetylcysteine has a therapeutic benefit and the nature of this benefit, for managing methamphetamine dependence. [McKetin R, Dean O, Baker A. L, Carter G, Turner A, Kelly P. J, Berk M. A potential role for N-acetylcysteine in the management of methamphetamine dependence. Drug Alcohol Rev 2017;36:153-159]. © 2016 Australasian Professional Society on Alcohol and other Drugs.

Federal Employees Health Benefits Program: Enrollment Options Following the Termination of a Plan or Plan Option. Final rule.

PubMed

2015-10-28

The U.S. Office of Personnel Management (OPM) is issuing a final rule to amend the Federal Employees Health Benefits (FEHB) Program regulations regarding enrollment options following the termination of a plan or plan option.

Parental Preference Assessment for Vesicoureteral Reflux Management in Children.

PubMed

Tran, Geraldine N; Bodapati, Anand V; Routh, Jonathan C; Saigal, Christopher S; Copp, Hillary L

2017-03-01

Parents of children with vesicoureteral reflux are presented with a variety of management options, which in many cases offer a similar risk-benefit ratio. To facilitate shared decision making, parental preferences regarding vesicoureteral reflux treatment options need to be acknowledged. We aimed to characterize the clinical experience of parents and elicit core themes affecting decision making in regard to managing vesicoureteral reflux in their child. A semistructured, qualitative interview script was developed and vetted by 25 pediatric urologists to discuss treatment options for vesicoureteral reflux. Additional patient interviews were conducted until new themes failed to arise. Content analysis was performed to extract all statements that described treatment options. Similar statements were combined until a final list of unique themes emerged. A total of 26 interviews were performed, yielding 689 statements about overall parent experiences with managing vesicoureteral reflux in the child and 450 statements (65%) pertaining to treatment options. Of the 13 themes that emerged, those most commonly considered were the prevention of future urinary tract infections by 85% of parents, the efficacy rate of treatment options by 85%, the burden of daily maintenance or compliance by 77%, antibiotic resistance by 69%, chronic kidney damage by 62% and invasiveness by 58%. Our study emphasizes that when choosing a treatment option for vesicoureteral reflux in their child, parent preferences regarding risks and benefits are variable. However, their chief concerns include whether a method decreases the risk of urinary tract infections, has an acceptable efficacy rate and aligns itself with the capabilities of the family. These themes help frame discussions between families and clinicians regarding vesicoureteral reflux management, and they can facilitate shared decision making. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Assessing the effect of climate change on carbon sequestration in a Mexican dry forest in the Yucatan Peninsula

Treesearch

Z. Dai; K.D. Johnson; R.A. Birdsey; J.L. Hernandez-Stefanoni; J.M. Dupuy

2015-01-01

Assessing the effect of climate change on carbon sequestration in tropical forest ecosystems is important to inform monitoring, reporting, and verification (MRV) for reducing deforestation and forest degradation (REDD), and to effectively assess forest management options under climate change. Two process-based models, Forest-DNDC and Biome-BGC, with different spatial...

Management options of varicoceles

PubMed Central

Chan, Peter

2011-01-01

Varicocele is one of the most common causes of male infertility. Treatment options for varicoceles includes open varicocelectomy performed at various anatomical levels. Laparoscopic varicocelectomy has been established to be a safe and effective treatment for varicoceles. Robotic surgery has been introduced recently as an alternative surgical option for varicocelectomy. Microsurgical varicocelectomy has gained increasing popularity among experts in male reproductive medicine as the treatment of choice for varicocele because of its superior surgical outcomes. There is a growing volume of literature in the recent years on minimal invasive varicocele treatment with percutaneous retrograde and anterograde venous embolization/sclerotherapy. In this review, we will discuss the advantages and limitations associated with each treatment modality for varicoceles. Employment of these advanced techniques of varicocelectomy can provide a safe and effective approach aiming to eliminate varicocele, preserve testicular function and, in a substantial number of men, increase semen quality and the likelihood of pregnancy. PMID:21716892

Urolift - minimally invasive surgical BPH management.

PubMed

Pushkaran, Anish; Stainer, Victoria; Muir, Gordon; Shergill, Iqbal S

2017-03-01

An ideal treatment option for symptomatic Benign Prostatic Hyperplasia (BPH) should relieve lower urinary tract symptoms (LUTS) and restore Quality of Life (QoL). Currently available medical therapies and surgical options for symptomatic BPH have side effects that adversely affects quality of life. Prostatic urethral lift (PUL) is a novel endourology procedure that promises to relieve LUTS without the aforementioned side effects. Areas covered: We diligently reviewed all the published literature on PUL, till July 2016 using standard search criteria. Expert commentary: There is good quality evidence to establish the efficiency of PUL in treating symptomatic BPH without adversely affecting the QoL. Based on the current literature, PUL can be considered as an option for those symptomatic BPH patients with small or medium size prostates (< 80 ml) without median lobe enlargement, who failed on medical therapy or are intolerant to it and wish to preserve their sexual function.

Preeradication vaccine policy options for poliovirus infection and disease control.

PubMed

Thompson, Kimberly M; Pallansch, Mark A; Duintjer Tebbens, Radboud J; Wassilak, Steve G; Kim, Jong-Hoon; Cochi, Stephen L

2013-04-01

With the circulation of wild poliovirus (WPV) types 1 and 3 continuing more than a decade after the original goal of eradicating all three types of WPVs by 2000, policymakers consider many immunization options as they strive to stop transmission in the remaining endemic and outbreak areas and prevent reintroductions of live polioviruses into nonendemic areas. While polio vaccination choices may appear simple, our analysis of current options shows remarkable complexity. We offer important context for current and future polio vaccine decisions and policy analyses by developing decision trees that clearly identify potential options currently used by countries as they evaluate national polio vaccine choices. Based on a comprehensive review of the literature we (1) identify the current vaccination options that national health leaders consider for polio vaccination, (2) characterize current practices and factors that appear to influence national and international choices, and (3) assess the evidence of vaccine effectiveness considering sources of variability between countries and uncertainties associated with limitations of the data. With low numbers of cases occurring globally, the management of polio risks might seem like a relatively low priority, but stopping live poliovirus circulation requires making proactive and intentional choices to manage population immunity in the remaining endemic areas and to prevent reestablishment in nonendemic areas. Our analysis shows remarkable variability in the current national polio vaccine product choices and schedules, with combination vaccine options containing inactivated poliovirus vaccine and different formulations of oral poliovirus vaccine making choices increasingly difficult for national health leaders. © 2013 Society for Risk Analysis.

Modeling the influence of climate change on watershed systems: Adaptation through targeted practices

NASA Astrophysics Data System (ADS)

Dudula, John; Randhir, Timothy O.

2016-10-01

Climate change may influence hydrologic processes of watersheds (IPCC, 2013) and increased runoff may cause flooding, eroded stream banks, widening of stream channels, increased pollutant loading, and consequently impairment of aquatic life. The goal of this study was to quantify the potential impacts of climate change on watershed hydrologic processes and to evaluate scale and effectiveness of management practices for adaptation. We simulate baseline watershed conditions using the Hydrological Simulation Program Fortran (HSPF) simulation model to examine the possible effects of changing climate on watershed processes. We also simulate the effects of adaptation and mitigation through specific best management strategies for various climatic scenarios. With continuing low-flow conditions and vulnerability to climate change, the Ipswich watershed is the focus of this study. We quantify fluxes in runoff, evapotranspiration, infiltration, sediment load, and nutrient concentrations under baseline and climate change scenarios (near and far future). We model adaptation options for mitigating climate effects on watershed processes using bioretention/raingarden Best Management Practices (BMPs). It was observed that climate change has a significant impact on watershed runoff and carefully designed and maintained BMPs at subwatershed scale can be effective in mitigating some of the problems related to stormwater runoff. Policy options include implementation of BMPs through education and incentives for scale-dependent and site specific bioretention units/raingardens to increase the resilience of the watershed system to current and future climate change.

Treatment options for the management of exercise-induced asthma and bronchoconstriction.

PubMed

Millward, David T; Tanner, Lindsay G; Brown, Mark A

2010-12-01

Treatment for exercise-induced bronchospasm and exercise-induced asthma includes both pharmacologic and nonpharmacologic options. Pharmacologic agents that have been proven to be effective for treating these conditions include short- and long-acting β2-adrenoceptor agonists, mast cell-stabilizing agents, anticholinergics, leukotriene receptor antagonists, and inhaled corticosteroids (ICS). When selecting the most appropriate medication, factors to consider include the effectiveness of each, the duration of action, frequency of administration, potential side effects, and tolerance level. Long-acting β2-adrenoceptor agonists should not be used without ICS. Nonpharmacologic treatments include physical conditioning, incorporating a warm-up before and a cool-down period after exercise, performing nasal breathing, avoiding cold weather or environmental allergens, using a face mask or other aid to warm and humidify inhaled air, and modifying dietary intake. The data to support nonpharmacologic treatments are limited; however, they are routinely recommended because of the low risk associated with their use. This article highlights the advantages and limitations of each treatment option.

Patrick Air Force Base integrated resource assessment. Volume 1, Executive summary

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

Sandusky, W.F.; Wahlstrom, R.R.

1994-03-01

Some of the most difficult problems encountered at federal sites in reducing energy consumption in a cost-effective manner revolve around understanding where energy is being used and what technologies can be employed to decrease energy use. Many large federal sites have one or two meters to track electric energy use for several thousand buildings and numerous industrial processes. Even where meters are available on individual buildings or family housing units, the meters are not consistently read. When the federal energy manager has been able to identify high energy users, the energy manager may not have the background, training, or resourcesmore » to determine the most cost-effective options for reducing this energy use. This limitation can lead to selection of suboptimal projects that prevent the site from achieving full life-cycle cost savings. The USDOE Federal Energy Management Program has been tasked by the US Air Force Space Command to identify, evaluate, and acquire all cost-effective energy projects at selected federal facilities. This is part of a model program developed to provide a systematic approach to evaluating energy opportunities. The program (1) identifies the building groups and end uses using the most energy (not just having the greatest energy-use intensity) and (2) evaluates the numerous options for retrofit or installation of new technology that will result in the selection of the most cost-effective technologies. This model program provides the federal energy manager with a road map to significantly reduce energy use in a planned, rational, cost-effective fashion that is not biased by the constraints of the typical funding sources available to federal sites. The results from this assessment process can easily be turned into a 5- to 10-year energy management plan.« less

Positioning Model-Supported, Participatory, Water Management Decision Making under Uncertainty within the Western Philosphical Discourse on Knowledge and Governance

NASA Astrophysics Data System (ADS)

Purkey, D. R.; Escobar, M.; Mehta, V. K.; Forni, L.

2016-12-01

Two important trends currently shape the manner in which water resources planning and decision making occurs. The first relates to the increasing reliance on participatory stakeholder processes as a forum for evaluating water management options and selecting the appropriate course of action. The second relates to the growing recognition that earlier deterministic approaches to this evaluation of options may no longer be appropriate, nor required. The convergence of these two trends poses questions as to the proper role of data, information, analysis and expertise in the inherently social and political process of negotiating water resources management agreements and implementing water resources management interventions. The question of how to discover the best or optimal option in the face of deep uncertainty related to climate change, demography, economic development, and regulatory reform is compelling. More fundamentally the question of whether the "perfect" option even exits to be discovered is perhaps more critical. While this existential question may be new to the water resource management community, it is not new to western political theory. This paper explores early classical philosophical writing related to issues of knowledge and governance as captured in the work of Plato and Aristotle; and then attempts to place a new approach to analysis-supported, stakeholder-driven water resources planning and decision making within this philosophical discourse. Using examples from river systems in California and the Andes, where the theory of Robust Decision Making has been used as an organizing construct for stakeholder processes, it is argued that the expectation that analysis will lead to the discovery of the perfect option is not warranted when stakeholders are engaged in the process of discovering a consensus option. This argument will touch upon issue of the diversity of values, model uncertainty and creditability, and the visualization of model output required to explore the implications of various management options across a range of inherently unknowable future conditions.

NOHIMS (Naval Occupational Health Information Management System) Users’ Guide: Introduction and OHS (Occupational Health System) Options.

DTIC Science & Technology

1984-06-26

irred. 2’. 4’.. Nava Het esarch CenterU 0i P. 0. Bx 8512 San iego Caiforia 2138917 P. W. SUMMARY The Naval Occupational Health information Management System (WHIMS...Introduction and OHS Options I. INTRODUCTION TO THE NAVY OCCUPATIONAL HEALTH INFORMATION MANAGEMENT SYSTEM (NOHIMS) The objective of NOHIMS is to provide an

The management of patients with limited-stage classical Hodgkin lymphoma.

PubMed

Gospodarowicz, Mary K; Meyer, Ralph M

2006-01-01

The term limited-stage Hodgkin lymphoma refers to those patients with stage I-II disease and an absence of bulky disease. Among those patients with classical Hodgkin lymphoma, approximately one-third of patients will fall into this category. As long-term disease control can now be anticipated in more than 90% of these patients, management strategies must increasingly address the need to reduce the long-term treatment-related risks. Current treatment options include use of combined modality therapy that includes an abbreviated course of chemotherapy and involved-field radiation or treatment with chemotherapy, currently consisting of ABVD, as a single modality. The choice of treatment between these two options involves specific trade-offs that must balance issues of disease control against long-term risk of late effects.

Pre-defined and optional staging for the deployment of enterprise systems: a case study and a framework

NASA Astrophysics Data System (ADS)

Lichtenstein, Yossi; Cucuy, Shy; Fink, Lior

2017-03-01

The effective deployment of enterprise systems has been a major challenge for many organisations. Customising the new system, changing business processes, and integrating multiple information sources are all difficult tasks. As such, they are typically done in carefully planned stages in a process known as phased implementation. Using ideas from Option Theory, this article critiques aspects of phased implementation. One customer relationship management (CRM) project and its phased implementation are described in detail and ten other enterprise system deployments are summarised as a basis for the observation that almost all deployment stages are pre-defined operational steps rather than decision points. However, Option Theory suggests that optional stages, to be used only when risk materialises, should be integral parts of project plans. Although such optional stages are often more valuable than pre-defined stages, the evidence presented in this article shows that they are only rarely utilised. Therefore, a simple framework is presented; it first identifies risks related to the deployment of enterprise systems, then identifies optional stages that can mitigate these risks, and finally compares the costs and benefits of both pre-defined and optional stages.

Roadwaste : Issues and Options : appendices.

DOT National Transportation Integrated Search

1998-06-01

The appendices belong to "Roadwaste : Issues and Options". : The Oregon Department of Transportation (ODOT) is conducting a study to determine roadwaste management options. Phase 1 consisted of a thorough review of regulations and standards, roadwast...

Changing climate, challenging choices: identifying and evaluating climate change adaptation options for protected areas management in Ontario, Canada.

PubMed

Lemieux, Christopher J; Scott, Daniel J

2011-10-01

Climate change will pose increasingly significant challenges to managers of parks and other forms of protected areas around the world. Over the past two decades, numerous scientific publications have identified potential adaptations, but their suitability from legal, policy, financial, internal capacity, and other management perspectives has not been evaluated for any protected area agency or organization. In this study, a panel of protected area experts applied a Policy Delphi methodology to identify and evaluate climate change adaptation options across the primary management areas of a protected area agency in Canada. The panel identified and evaluated one hundred and sixty five (165) adaptation options for their perceived desirability and feasibility. While the results revealed a high level of agreement with respect to the desirability of adaptation options and a moderate level of capacity pertaining to policy formulation and management direction, a perception of low capacity for implementation in most other program areas was identified. A separate panel of senior park agency decision-makers used a multiple criterion decision-facilitation matrix to further evaluate the institutional feasibility of the 56 most desirable adaptation options identified by the initial expert panel and to prioritize them for consideration in a climate change action plan. Critically, only two of the 56 adaptation options evaluated by senior decision-makers were deemed definitely implementable, due largely to fiscal and internal capacity limitations. These challenges are common to protected area agencies in developed countries and pervade those in developing countries, revealing that limited adaptive capacity represents a substantive barrier to biodiversity conservation and other protected area management objectives in an era of rapid climate change.

Changing Climate, Challenging Choices: Identifying and Evaluating Climate Change Adaptation Options for Protected Areas Management in Ontario, Canada

NASA Astrophysics Data System (ADS)

Lemieux, Christopher J.; Scott, Daniel J.

2011-10-01

Climate change will pose increasingly significant challenges to managers of parks and other forms of protected areas around the world. Over the past two decades, numerous scientific publications have identified potential adaptations, but their suitability from legal, policy, financial, internal capacity, and other management perspectives has not been evaluated for any protected area agency or organization. In this study, a panel of protected area experts applied a Policy Delphi methodology to identify and evaluate climate change adaptation options across the primary management areas of a protected area agency in Canada. The panel identified and evaluated one hundred and sixty five (165) adaptation options for their perceived desirability and feasibility. While the results revealed a high level of agreement with respect to the desirability of adaptation options and a moderate level of capacity pertaining to policy formulation and management direction, a perception of low capacity for implementation in most other program areas was identified. A separate panel of senior park agency decision-makers used a multiple criterion decision-facilitation matrix to further evaluate the institutional feasibility of the 56 most desirable adaptation options identified by the initial expert panel and to prioritize them for consideration in a climate change action plan. Critically, only two of the 56 adaptation options evaluated by senior decision-makers were deemed definitely implementable, due largely to fiscal and internal capacity limitations. These challenges are common to protected area agencies in developed countries and pervade those in developing countries, revealing that limited adaptive capacity represents a substantive barrier to biodiversity conservation and other protected area management objectives in an era of rapid climate change.

Investigating the cost-effectiveness of nutrient credit use as an option for stormwater permitting requirements.

DOT National Transportation Integrated Search

2014-07-01

The purpose of this study was to determine the feasibility of the Virginia Department of Transportation (VDOT) : participating in water quality trading (WQT) in lieu of constructing onsite structural best management practices (BMPs) to : achieve comp...

Tadalafil - a therapeutic option in the management of BPH-LUTS.

PubMed

Carson, C C; Rosenberg, M; Kissel, J; Wong, D G

2014-01-01

Men with signs of benign prostatic hyperplasia (BPH) may experience lower urinary tract symptoms (LUTS) such as urinary frequency, urgency, intermittence, nocturia, straining, incomplete emptying or a weak urinary stream. The effective management of LUTS suggestive of BPH (BPH-LUTS) requires careful consideration of several factors, including the severity of a patient's symptoms, concurrent or other coexisting medical conditions, the ability to improve symptoms and impact quality of life (QOL), as well as the potential side effects of available treatment options. Several clinical studies have assessed phosphodiesterase type 5 (PDE5) inhibitors in reducing LUTS; however, tadalafil is the only PDE5 inhibitor approved for the treatment of signs and symptoms of BPH, as well as in men with both erectile dysfunction (ED) and the signs and symptoms of BPH. This review examined articles that assessed tadalafil in patients with signs and symptoms of BPH, with or without erectile dysfunction (ED), which led to regulatory approval in the United States and Europe. In dose-ranging and confirmatory studies, results demonstrate that tadalafil significantly improved total International Prostate Symptom Score (IPSS) following 12 weeks of treatment with once daily tadalafil 5 mg. Statistically significant improvements in Benign Prostatic Hyperplasia Impact Index (BII), IPSS subscores, IPSS QOL and International Index of Erectile Function (IIEF) were also observed. Improvement in urinary symptoms occurred regardless of age, previous treatment with an α1 -adrenergic blocker, BPH-LUTS severity at baseline or ED status. While tadalafil is most frequently recognised as a standard treatment option for men with ED, it also represents a well-tolerated and effective treatment option in men with moderate to severe BPH-LUTS. © 2013 John Wiley & Sons Ltd.

Default neglect in attempts at social influence.

PubMed

Zlatev, Julian J; Daniels, David P; Kim, Hajin; Neale, Margaret A

2017-12-26

Current theories suggest that people understand how to exploit common biases to influence others. However, these predictions have received little empirical attention. We consider a widely studied bias with special policy relevance: the default effect, which is the tendency to choose whichever option is the status quo. We asked participants (including managers, law/business/medical students, and US adults) to nudge others toward selecting a target option by choosing whether to present that target option as the default. In contrast to theoretical predictions, we find that people often fail to understand and/or use defaults to influence others, i.e., they show "default neglect." First, in one-shot default-setting games, we find that only 50.8% of participants set the target option as the default across 11 samples ( n = 2,844), consistent with people not systematically using defaults at all. Second, when participants have multiple opportunities for experience and feedback, they still do not systematically use defaults. Third, we investigate beliefs related to the default effect. People seem to anticipate some mechanisms that drive default effects, yet most people do not believe in the default effect on average, even in cases where they do use defaults. We discuss implications of default neglect for decision making, social influence, and evidence-based policy.

Distraction subtalar arthrodesis.

PubMed

Jackson, J Benjamin; Jacobson, Lance; Banerjee, Rahul; Nickisch, Florian

2015-06-01

There is a high potential for disability following calcaneal fracture. This potential exists whether a patient is treated with conservative or operative management. Subfibular impingement and irritation of the peroneal tendon and sural nerve may also be present. Posttraumatic arthritis of the subtalar joint can occur. In patients with symptomatic calcaneal malunion, systematic evaluation is required to determine the source of pain. Nonsurgical treatment may be effective. One surgical treatment option is subtalar distraction arthrodesis. High rates of successful arthrodesis and patient satisfaction have been reported with this surgical option in correctly selected patients. Published by Elsevier Inc.

77 FR 58983 - New England Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-25

...-0492. SUPPLEMENTARY INFORMATION: The Habitat Advisory Panel and Plan Development Team will review and further develop alternatives for Omnibus Essential Fish Habitat Amendment 2. Related to gear modification options for Habitat Management Areas, they will discuss ground cable modification options in general and...

48 CFR 47.305-11 - Options in shipment and delivery.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Options in shipment and... CONTRACT MANAGEMENT TRANSPORTATION Transportation in Supply Contracts 47.305-11 Options in shipment and... shipment and delivery, it may be desirable to provide specifically for certain options in the solicitation...

Phytoremediation of landfill leachate.

PubMed

Jones, D L; Williamson, K L; Owen, A G

2006-01-01

Leachate emissions from landfill sites are of concern, primarily due to their toxic impact when released unchecked into the environment, and the potential for landfill sites to generate leachate for many hundreds of years following closure. Consequently, economically and environmentally sustainable disposal options are a priority in waste management. One potential option is the use of soil-plant based remediation schemes. In many cases, using either trees (including short rotation coppice) or grassland, phytoremediation of leachate has been successful. However, there are a significant number of examples where phytoremediation has failed. Typically, this failure can be ascribed to excessive leachate application and poor management due to a fundamental lack of understanding of the plant-soil system. On balance, with careful management, phytoremediation can be viewed as a sustainable, cost effective and environmentally sound option which is capable of treating 250m(3)ha(-1)yr(-1). However, these schemes have a requirement for large land areas and must be capable of responding to changes in leachate quality and quantity, problems of scheme establishment and maintenance, continual environmental monitoring and seasonal patterns of plant growth. Although the fundamental underpinning science is well understood, further work is required to create long-term predictive remediation models, full environmental impact assessments, a complete life-cycle analysis and economic analyses for a wide range of landfill scenarios.

Supply chain dynamics in healthcare services.

PubMed

Samuel, Cherian; Gonapa, Kasiviswanadh; Chaudhary, P K; Mishra, Ananya

2010-01-01

The purpose of this paper is to analyse health service supply chain systems. A great deal of literature is available on supply chain management in finished goods inventory situations; however, little research exists on managing service capacity when finished goods inventories are absent. System dynamics models for a typical service-oriented supply chain such as healthcare processes are developed, wherein three service stages are presented sequentially. Just like supply chains with finished goods inventory, healthcare service supply chains also show dynamic behaviour. Comparing options, service reduction, and capacity adjustment delays showed that reducing capacity adjustment and service delays gives better results. The study is confined to health service-oriented supply chains. Further work includes extending the study to service-oriented supply chains with parallel processing, i.e. having more than one stage to perform a similar operation and also to study the behaviour in service-oriented supply chains that have re-entrant orders and applications. Specific case studies can also be developed to reveal factors relevant to particular service-oriented supply chains. The paper explains the bullwhip effect in healthcare service-oriented supply chains. Reducing stages and capacity adjustment are strategic options for service-oriented supply chains. The paper throws light on policy options for managing healthcare service-oriented supply chain dynamics.

Indirect ecological effects in invaded landscapes: Spillover and spillback from biological control agents to native analogues

USDA-ARS?s Scientific Manuscript database

Biological control remains an effective option for managing large-scale weed problems in natural areas. The predation or parasitism of biological control agents by other species present in the introduced range (biotic resistance) is well studied and is often cited as the cause for a lack of establis...

Effect of an Exercise and Weight Control Curriculum: Views of Obesity among Exercise Science Students

ERIC Educational Resources Information Center

Richardson, Laura A.; Fister, Carrie L.; Ramlo, Susan E.

2015-01-01

Awareness of effective weight management strategies is necessary to prepare exercise science students for future work with obesity. Exercise science faculty members developed a course related to exercise as a therapeutic tool and options available for weight loss. The purpose of the present study was to investigate student views of weight…

Detecting and Managing Adverse Effects of Antipsychotic Medications: Current State of Play.

PubMed

Ames, Donna; Carr-Lopez, Sian M; Gutierrez, Mary A; Pierre, Joseph M; Rosen, Jennifer A; Shakib, Susan; Yudofsky, Lynn M

2016-06-01

Antipsychotics are some of the most frequently prescribed medications not only for psychotic disorders and symptoms but also for a wide range of on-label and off-label indications. Because second-generation antipsychotics have largely replaced first-generation antipsychotics as first-line options due to their substantially decreased risk of extrapyramidal side effects, attention has shifted to other clinically concerning adverse events associated with antipsychotic therapy. The focus of this article is to update the nonextrapyramidal side effects associated with second-generation antipsychotics. Issues surrounding diagnosis and monitoring as well as clinical management are addressed. Published by Elsevier Inc.

Creative employee scheduling in the health information management department.

PubMed

Hyde, C S

1998-02-01

What effect do schedules have on employees and department activities? Negative effects such as backlogs, poor employee morale, and absenteeism may be due to scheduling practices currently in place. The value of effective employee scheduling practices may be seen in areas of improved productivity. The process of developing schedules should include assessing department areas, understanding operational needs, choosing an option, and implementation. Finding a schedule that meets the needs of managers as well as those of the employees is rewarding. It is a win-win situation, and the benefits can yield increased productivity, decreased turnover, and higher morale.

Real options analysis for land use management: Methods, application, and implications for policy.

PubMed

Regan, Courtney M; Bryan, Brett A; Connor, Jeffery D; Meyer, Wayne S; Ostendorf, Bertram; Zhu, Zili; Bao, Chenming

2015-09-15

Discounted cash flow analysis, including net present value is an established way to value land use and management investments which accounts for the time-value of money. However, it provides a static view and assumes passive commitment to an investment strategy when real world land use and management investment decisions are characterised by uncertainty, irreversibility, change, and adaptation. Real options analysis has been proposed as a better valuation method under uncertainty and where the opportunity exists to delay investment decisions, pending more information. We briefly review the use of discounted cash flow methods in land use and management and discuss their benefits and limitations. We then provide an overview of real options analysis, describe the main analytical methods, and summarize its application to land use investment decisions. Real options analysis is largely underutilized in evaluating land use decisions, despite uncertainty in policy and economic drivers, the irreversibility and sunk costs involved. New simulation methods offer the potential for overcoming current technical challenges to implementation as demonstrated with a real options simulation model used to evaluate an agricultural land use decision in South Australia. We conclude that considering option values in future policy design will provide a more realistic assessment of landholder investment decision making and provide insights for improved policy performance. Copyright © 2015 Elsevier Ltd. All rights reserved.

Greenhouse gas balances in low-productive drained boreal peatlands - is climate-friendly management possible?

NASA Astrophysics Data System (ADS)

Ojanen, Paavo; Minkkinen, Kari; Heikkinen, Tiina; Penttilä, Timo

2016-04-01

Five million hectares of peatland has been drained for forestry in Finland. About 20% of that, i.e. one million hectares, has been estimated to be so low-productive that the profitability of keeping them in forestry is questionable. At the same time, drainage has introduced changes in the ecosystem functions of these peatlands, including fluxes of greenhouse gases. Options to manage such peatlands include for example 1) no measures, i.e. leaving the drained peatlands as they are 2) increasing intensity by e.g. repetitive fertilisations and 3) restoration back to functional peatlands. Here we estimate the greenhouse gas impacts of these three management options. We collected GHG and organic carbon flux data from 50 low-productive peatlands under these management options over two years 2014-2015. Gas fluxes (CO2, CH4, N2O) were measured with closed chambers. Litter production rates of different plants above and below ground were estimated using litter traps (trees), biomass sampling (roots), through-grow nets (mosses), allometric biomass models (other vasculars) and published turnover rates (roots, other vasculars). Characteristics for estimating tree stand biomass increment were measured at each site from circular sample plots. In this presentation we will estimate the GHG impacts for the different management options, and aim to find the most climate-friendly options for the management of low-productive peatlands in the short and long term. This work was funded by Life+ LIFE12/ENV/FI/150.

Management of the Jehovah’s Witness in Obstetrics and Gynecology: A Comprehensive Medical, Ethical and Legal Approach

PubMed Central

Zeybek, Burak; Childress, Andrew; Kilic, Gokhan S.; Phelps, John; Pacheco, Luis; Carter, Michele; Borahay, Mostafa A.

2016-01-01

Importance Obstetricians and gynecologists frequently deal with hemorrhage so they should be familiar with management of patients who refuse blood transfusion. Although there are some reports in the literature about management of Jehovah’s Witness patients in obstetrics and gynecology, most of them are case reports and a comprehensive review about these patients including ethico-legal perspective is lacking. Objective This review outlines the medical, ethical and legal implications of management of Jehovah’s Witness patients in obstetrical and gynecological settings. Evidence Acquisition A search of published literature using Pubmed, Ovid Medline, EMBASE and Cochrane databases was conducted about physiology of oxygen delivery and response to tissue hypoxia, mortality rates at certain hemoglobin levels, medical management options for anemic patients who refuse blood transfusion and ethical/legal considerations in Jehovah’s Witness patients. Results Early diagnosis of anemia and immediate initiation of therapy is essential in patients who refuse blood transfusion. Medical management options include iron supplementation and erythropoietin. There are also some promising therapies that are in development such as anti-hepcidin antibodies and hemoglobin based oxygen carriers. Options to decrease blood loss include anti-fibrinolytics, desmopressin, recombinant Factor VII and factor concentrates. When surgery is the only option, every effort should be made to pursue minimally invasive approaches. Conclusion and Relevance All obstetricians and gynecologists should be familiar with alternatives and ‘less invasive’ options for patients who refuse blood transfusions. Target Audience Obstetricians and gynecologists, family physicians PMID:27526872

30 CFR 204.203 - What is the other relief option?

Code of Federal Regulations, 2010 CFR

2010-07-01

... MANAGEMENT ALTERNATIVES FOR MARGINAL PROPERTIES Accounting and Auditing Relief § 204.203 What is the other relief option? (a) Under this relief option, you may request any type of accounting and auditing relief...

Dialysis-associated steal syndrome (DASS).

PubMed

Mohamed, Ahmed S; Peden, Eric K

2017-03-06

In this article, we will review the clinical symptoms of dialysis access steal syndrome (DASS), evaluation, treatment options, and our approach and treatment algorithm. We reviewed the literature discussing different aspects of DASS including its epidemiology, pathogenesis, clinical presentation, evaluation and management options. DASS is the most dreaded complication of access surgery. Although the incidence is low, all providers caring for dialysis patients should be aware of this problem. Symptoms can range from mild to limb threatening. Although various tests are available, the diagnosis of DASS remains a clinical one and requires thoughtful management to have the best outcomes. Multiple treatment options exist for steal. We present diagnostic evaluation and management algorithm.

Understanding Consistency Maintenance in Service Discovery Architectures during Communication Failure

DTIC Science & Technology

2002-07-01

our general model include: (1) service user (SU), (2) service manager (SM), and (3) service cache manager ( SCM ), where the SCM is an optional...maintained by SMs that satisfy specific requirements. Where employed, the SCM operates as an intermediary, matching advertised SDs of SMs to...Directory Service Agent (optional) not applicableLookup ServiceService Cache Manager ( SCM ) Service URL Service Type Service Attributes Template URL

Complications of transplantation. Part 1: renal transplants.

PubMed

Khaja, Minhaj S; Matsumoto, Alan H; Saad, Wael E

2014-10-01

Vascular complications after solid-organ transplantation are not uncommon and may lead to graft dysfunction and ultimately graft loss. A thorough understanding of the surgical anatomy, etiologies, and types of vascular complications, their presentation, and the options for management are important for managing these complex patients. This article reviews the basic surgical anatomy, vascular complications, and endovascular management options of vascular complications in patients with renal transplants.

Public Response to Wildfire: Is the Australian "Stay and Defend or Leave Early" Approach an Option for Wildfire Management in the United States?

Treesearch

Sarah M. McCaffrey; Alan Rhodes

2009-01-01

In the United States, the increasing costs and negative impacts of wildfires are causing fire managers and policymakers to reexamine traditional approaches to fire management including whether mass evacuation of populations threatened by wildfire is always the most appropriate option. This article examines the Australian "stay and defend or leave early" (SDLE...

Management Options For Reducing The Release Of Antibiotics And Antibiotic Resistance Genes To The Environment

EPA Science Inventory

Background: There is growing concern worldwide about the role of polluted soil and water - 77 environments in the development and dissemination of antibiotic resistance. 78 Objective: To identify management options for reducing the spread of antibiotics and 79 antibiotic resist...

75 FR 14427 - Gulf of Mexico Fishery Management Council (Council); Public Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-25

.... Stephen Bortone, Executive Director, Gulf of Mexico Fishery Management Council; telephone: 813- 348-1630... Reef Fish Scientific and Statistical Committee; discuss Options Paper for Amendment 32 Gag/Red Grouper... Statistical Committee Acceptable Biological Catch Control Rule Report; discuss the Options Paper for the...

Consider Creating a Channel Management Strategy with Both Colleagues and Patients

PubMed Central

Felkey, Bill G.; Fox, Brent I.

2013-01-01

Patient engagement is poised to provide considerable opportunities for reaching patients. The range of connectivity options should be considered to include the best option for each specific patient. In this article, we address this area of growing importance, telecommunication channel management. PMID:24421455

Grazing management options in meeting objectives of grazing experiments

USDA-ARS?s Scientific Manuscript database

Decisions on which grazing management option to use in grazing experiments can be critical in meeting research objectives and generating information for the scientific community or technologies that meets the needs of forage-based enterprises. It is necessary to have an understanding of animal per...

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

OysterFutures: Integrating Stakeholder Objectives with Natural System Models to Promote Sustainable Natural Resource Policy

NASA Astrophysics Data System (ADS)

North, E. W.; Blair, J.; Cornwell, J. C.; Freitag, A. E.; Gawde, R. K.; Hartley, T. W.; Hood, R. R.; Jones, R. M.; Miller, T. J.; Thomas, J. E.; Wainger, L. A.; Wilberg, M. J.

2016-02-01

Achieving effective natural resource management is challenged by multiple and often competing objectives, a restricted set of policy options, and uncertainty in the performance of those options. Yet, managers need policies that allow continued use of natural resources while ensuring access for future generations and maintenance of ecosystem services. Formal approaches are needed that will assist managers and stakeholders in choosing policy options that have a high likelihood of achieving social, ecological, and economic goals. The goal of this project, OysterFutures, is to address this need by improving the use of predictive models to support sustainable natural resource policy and management. A stakeholder-centered process will be used to build an integrated model that combines estuarine physics, oyster life history, and the ecosystem services that oysters provide (e.g., harvest, water quality) to forecast outcomes under alternative management strategies. Through a series of facilitated meetings, stakeholders will participate in a science-based collaborative process which will allow them to project how well policies are expected to meet their objectives using the integrated model. This iterative process will ensure that the model will incorporate the complex human uses of the ecosystem as well as focus on the outcomes most important to the stakeholders. In addition, a study of the socioeconomic drivers of stakeholder involvement, information flow, use and influence, and policy formation will be undertaken to improve the process, enhance implementation success of recommended policies, and provide new ideas for integrating natural and social sciences, and scientists, in sustainable resource management. In this presentation, the strategy for integrating natural system models, stakeholder views, and sociological studies as well as methods for selecting stakeholders and facilitating stakeholder meetings will be described and discussed.

Developing Spatial Management Options for the Protection of Vulnerable Marine Ecosystems in the South Pacific Ocean Region.

NASA Astrophysics Data System (ADS)

Rowden, A. A.; Lundquist, C. J.; Clark, M. R.; Anderson, O. F.; Guinotte, J. M.; Baird, S. J.; Roux, M. J.; Wadhwa, S.

2016-02-01

The South Pacific Regional Fisheries Management Organisation (SPRFMO) Convention includes specific provisions to protect vulnerable marine ecosystems (VMEs). The SPRFMO Commission has determined that the interim measures put in place to protect VMEs would be replaced by an improved system of fishable and closed areas. These closures would effectively represent a preliminary spatial management plan, whereby conservation and management measures are implemented that will result in sustainable fisheries and benthic protection. We used the conservation planning tool Zonation to develop spatial management options that balance the protection of VMEs with utilisation of high value areas for fishing. Input data included habitat suitability maps, and uncertainties associated with these model predictions, for eleven VME indicator taxa (4 Scleractinian coral species; 3 other cnidarian groups (Family Stylasteridae, Order Antipatharia, Order Pennatulacea; 2 classes of sponges (Demospongiae, Hexactinellidae), and 2 echninoderm groups (Crinoidea and Brisingida)) at bathyal depths across the entire SPRFMO area (divided into 1 km2 grid cells); New Zealand fishing catch data (for two different time periods and trawl types); naturalness (represented by proxy variable using the number of trawl tows); and a bioregionalisation scheme. Running various scenario models for spatial planning allowed for the cost to fishing to be determined, in terms of the amount of the trawl catch footprint lost if high priority areas for VME indicator taxa are protected. Generally, the cost to fishing was low given the relatively high proportion of suitable habitat for VME indicator taxa protected. The main outcome of the present study is a demonstration of the practical utility of using available data, including modelled data, and the Zonation conservation planning software tool to develop options for the spatial management of the SPRFMO area.

Development of a patient decision aid for people with refractory angina: protocol for a three-phase pilot study

PubMed Central

2014-01-01

Background Refractory angina is a severe chronic disease, defined as angina which cannot be controlled by usual treatments for heart disease. This disease is frightening, debilitating, and difficult to manage. Many people suffering refractory have inadequate pain relief, continually revisit emergency departments for help, undergo repeated cardiac investigations, and struggle with obtaining appropriate care. There is no clear framework to help people understand the risks and benefits of available treatment options in Canada. Some treatments for refractory angina are invasive, while others are not covered by provincial health insurance plans. Effective care for refractory angina sufferers in Canada is critically underdeveloped; it is important that healthcare professionals and refractory angina sufferers alike understand the treatment options and their implications. This proposal builds on the recent Canadian practice guidelines for the management of refractory angina. We propose to develop a decision support tool in order to help people suffering from refractory angina make well-informed decisions about their healthcare and reduce their uncertainty about treatment options. Methods This project will be conducted in three phases: a) development of the support tool with input from clinical experts, the Canadian refractory angina guidelines, and people living with refractory angina, b) pilot testing of the usability of the tool, and c) formal preliminary evaluation of the effectiveness of the support tool to help people make informed decisions about treatment options. Discussion A decision support tool for refractory angina is needed and the available data suggest that by developing such a tool, we may be able to help refractory angina sufferers better understand their condition and the effectiveness of available treatment options (in their respective clinical settings) as well as their implications (e.g. risks vs. benefits). By virtue of this tool, we may also be able to facilitate identification and inclusion of patients’ values and preferences in the decision making process. This is particularly important as refractory angina is an intractable condition, necessitating that the selected course of treatment be lifelong. This study will yield a much needed patient decision aid for people living with refractory angina and pilot data to support a subsequent effectiveness study. PMID:24920518

Iron overload and chelation therapy in myelodysplastic syndromes.

PubMed

Temraz, Sally; Santini, Valeria; Musallam, Khaled; Taher, Ali

2014-07-01

Iron overload remains a concern in MDS patients especially those requiring recurrent blood transfusions. The consequence of iron overload may be more relevant in patients with low and intermediate-1 risk MDS who may survive long enough to experience such manifestations. It is a matter of debate whether this overload has time to yield organ damage, but it is quite evident that cellular damage and DNA genotoxic effect are induced. Iron overload may play a critical role in exacerbating pre-existing morbidity or even unmask silent ones. Under these circumstances, iron chelation therapy could play an integral role in the management of these patients. This review entails an in depth analysis of iron overload in MDS patients; its pathophysiology, effect on survival, associated risks and diagnostic options. It also discusses management options in relation to chelation therapy used in MDS patients and the impact it has on survival, hematologic response and organ function. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Recent California Water Transfers: Emerging Options in Water Management

DTIC Science & Technology

1992-12-01

geographically separated, requiring the use of conveyance and storage systems controlled by other parties. The controversies and complexities of effecting ...systematic examination of the engineering and operational aspects of water transfers. Instead, the mechanics of economically effecting actual water...drought and is now part of almost all California urban water plans and operations. The current drought also has had significant effects on how water

Life Cycle Assessment of landfill biogas management: sensitivity to diffuse and combustion air emissions.

PubMed

Beylot, Antoine; Villeneuve, Jacques; Bellenfant, Gaël

2013-02-01

GOAL AND SCOPE: The life cycle inventory of landfill emissions is a key point in Life Cycle Assessment (LCA) of waste management options and is highly subject to discussion. Result sensitivity to data inventory is accounted for through the implementation of scenarios that help examine how waste landfilling should be modeled in LCA. Four landfill biogas management options are environmentally evaluated in a Life Cycle Assessment perspective: (1) no biogas management (open dump), conventional landfill with (2) flaring, (3) combined heat and power (CHP) production in an internal combustion engine and (4) biogas upgrading for use as a fuel in buses. Average, maximum and minimum literature values are considered both for combustion emission factors in flares and engines and for trace pollutant concentrations in biogas. Biogas upgrading for use as a fuel in buses appears as the most relevant option with respect to most non-toxic impact categories and ecotoxicity, when considering average values for trace gas concentrations and combustion emission factors. Biogas combustion in an engine for CHP production shows the best performances in terms of climate change, but generates significantly higher photochemical oxidant formation and marine eutrophication impact potentials than flaring or biogas upgrading for use as a fuel in buses. However the calculated environmental impact potentials of landfill biogas management options depend largely on the trace gas concentrations implemented in the model. The use of average or extreme values reported in the literature significantly modifies the impact potential of a given scenario (up to two orders of magnitude for open dumps with respect to human toxicity). This should be taken into account when comparing landfilling with other waste management options. Also, the actual performances of a landfill top cover (in terms of oxidation rates) and combustion technology (in terms of emission factors) appear as key parameters affecting the ranking of biogas management options. Copyright © 2012 Elsevier Ltd. All rights reserved.

Space station data system analysis/architecture study. Task 2: Options development, DR-5. Volume 3: Programmatic options

NASA Technical Reports Server (NTRS)

1985-01-01

Task 2 in the Space Station Data System (SSDS) Analysis/Architecture Study is the development of an information base that will support the conduct of trade studies and provide sufficient data to make design/programmatic decisions. This volume identifies the preferred options in the programmatic category and characterizes these options with respect to performance attributes, constraints, costs, and risks. The programmatic category includes methods used to administrate/manage the development, operation and maintenance of the SSDS. The specific areas discussed include standardization/commonality; systems management; and systems development, including hardware procurement, software development and system integration, test and verification.

Space station data system analysis/architecture study. Task 2: Options development, DR-5. Volume 2: Design options

NASA Technical Reports Server (NTRS)

1985-01-01

The primary objective of Task 2 is the development of an information base that will support the conduct of trade studies and provide sufficient data to make key design/programmatic decisions. This includes: (1) the establishment of option categories that are most likely to influence Space Station Data System (SSDS) definition; (2) the identification of preferred options in each category; and (3) the characterization of these options with respect to performance attributes, constraints, cost and risk. This volume contains the options development for the design category. This category comprises alternative structures, configurations and techniques that can be used to develop designs that are responsive to the SSDS requirements. The specific areas discussed are software, including data base management and distributed operating systems; system architecture, including fault tolerance and system growth/automation/autonomy and system interfaces; time management; and system security/privacy. Also discussed are space communications and local area networking.

Air traffic management evaluation tool

NASA Technical Reports Server (NTRS)

Sheth, Kapil S. (Inventor); Sridhar, Banavar (Inventor); Bilimoria, Karl D. (Inventor); Grabbe, Shon (Inventor); Chatterji, Gano Broto (Inventor); Schipper, John F. (Inventor)

2010-01-01

Method and system for evaluating and implementing air traffic management tools and approaches for managing and avoiding an air traffic incident before the incident occurs. The invention provides flight plan routing and direct routing or wind optimal routing, using great circle navigation and spherical Earth geometry. The invention provides for aircraft dynamics effects, such as wind effects at each altitude, altitude changes, airspeed changes and aircraft turns to provide predictions of aircraft trajectory (and, optionally, aircraft fuel use). A second system provides several aviation applications using the first system. These applications include conflict detection and resolution, miles-in trail or minutes-in-trail aircraft separation, flight arrival management, flight re-routing, weather prediction and analysis and interpolation of weather variables based upon sparse measurements.

Environmental strategies: A case study of systematic evaluation

NASA Astrophysics Data System (ADS)

Sherman, Douglas J.; Garès, Paul A.

1982-09-01

A major problem facing environmental managers is the necessity to effectively evaluate management alternatives. Traditional environmental assessments have emphasized the use of economic analyses. These approaches are often deficient due to difficulty in assigning dollar values to environmental systems and to social amenities. A more flexible decisionmaking model has been developed to analyze management options for coping with beach erosion problems at the Sandy Hook Unit of Gateway National Recreation Area in New Jersey. This model is comprised of decision-making variables which are formulated from a combination of environmental and management criteria, and it has an accept-reject format in which the management options are analyzed in terms of the variables. Through logical ordering of the insertion of the variables into the model, stepwise elimination of alternatives is possible. A hierarchy of variables is determined through estimating work required to complete an assessment of the alternatives for each variable. The assessment requiring the least work is performed first so that the more difficult evaluation will be limited to fewer alternatives. The application of this approach is illustrated with a case study in which beach protection alternatives were evaluated for the United States National Park Service.

American power conference: Proceedings

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

Not Available

1994-01-01

The first volume of this conference contains papers on the following topics: (1) Controls, monitoring, and expert systems (Harnessing microprocessor revolution for a more competitive power industry; Plant control--Upgrades; Neural network applications); (2) Diversification and globalization (Electric utility diversification/globalization--Panel; Private power in developing countries); (3) Environment and clean air (Clean Air compliance costs; Site selection for power stations and related facilities; Electric utility trace substance emissions; Solid waste disposal and commercial use; Precipitators/fabric filters; and Effect of flow modifications on fisheries and water quality); (4) Generation--Fuel options equipment (Alternate fuels; Advances in fuel cells for electric power applications; Secondary containmentmore » and seismic requirements for petrochemical facilities; Clean coal technology demonstration; Advanced energy systems; Hydropower); (5) Nuclear operations options (Radioactive waste management and disposal; Off normal conditions; Advanced light water reactors--15 years after TMI; Structural dynamic analyses for nuclear power plants); (6) Retrofit, betterment, repowering maintenance (Project management; Improving competitiveness through process re-engineering; Central stations; Water and wastewater treatment); (7) System planning, operation demand maintenance (Transmission system access; Stability; Systems planning); (8) Transmission and distribution (Transformers; Relaying for system protection; Managing EMF effects); and (9) Education (Power engineering). 155 papers have been processed separately for inclusion on the data base.« less

A decision support tool for sustainable planning of urban water systems: presenting the Dynamic Urban Water Simulation Model.

PubMed

Willuweit, Lars; O'Sullivan, John J

2013-12-15

Population growth, urbanisation and climate change represent significant pressures on urban water resources, requiring water managers to consider a wider array of management options that account for economic, social and environmental factors. The Dynamic Urban Water Simulation Model (DUWSiM) developed in this study links urban water balance concepts with the land use dynamics model MOLAND and the climate model LARS-WG, providing a platform for long term planning of urban water supply and water demand by analysing the effects of urbanisation scenarios and climatic changes on the urban water cycle. Based on potential urbanisation scenarios and their effects on a city's water cycle, DUWSiM provides the functionality for assessing the feasibility of centralised and decentralised water supply and water demand management options based on forecasted water demand, stormwater and wastewater generation, whole life cost and energy and potential for water recycling. DUWSiM has been tested using data from Dublin, the capital of Ireland, and it has been shown that the model is able to satisfactorily predict water demand and stormwater runoff. Copyright © 2013 Elsevier Ltd. All rights reserved.

Distributed Energy Implementation Options

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

Shah, Chandralata N

2017-09-13

This presentation covers the options for implementing distributed energy projects. It distinguishes between options available for distributed energy that is government owned versus privately owned, with a focus on the privately owned options including Energy Savings Performance Contract Energy Sales Agreements (ESPC ESAs). The presentation covers the new ESPC ESA Toolkit and other Federal Energy Management Program resources.

Scope Complexity Options Risks Excursions (SCORE) Version 3.0 Mathematical Description.

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

Gearhart, Jared Lee; Samberson, Jonell Nicole; Shettigar, Subhasini

The purpose of the Scope, Complexity, Options, Risks, Excursions (SCORE) model is to estimate the relative complexity of design variants of future warhead options. The results of this model allow those considering these options to understand the complexity tradeoffs between proposed warhead options. The core idea of SCORE is to divide a warhead option into a well- defined set of scope elements and then estimate the complexity of each scope element against a well understood reference system. The uncertainty associated with estimates can also be captured. A weighted summation of the relative complexity of each scope element is used tomore » determine the total complexity of the proposed warhead option or portions of the warhead option (i.e., a National Work Breakdown Structure code). The SCORE analysis process is a growing multi-organizational Nuclear Security Enterprise (NSE) effort, under the management of the NA- 12 led Enterprise Modeling and Analysis Consortium (EMAC), that has provided the data elicitation, integration and computation needed to support the out-year Life Extension Program (LEP) cost estimates included in the Stockpile Stewardship Management Plan (SSMP).« less

Sound therapy for tinnitus management: practicable options.

PubMed

Hoare, Derek J; Searchfield, Grant D; El Refaie, Amr; Henry, James A

2014-01-01

The authors reviewed practicable options of sound therapy for tinnitus, the evidence base for each option, and the implications of each option for the patient and for clinical practice. To provide a general guide to selecting sound therapy options in clinical practice. Practicable sound therapy options. Where available, peer-reviewed empirical studies, conference proceedings, and review studies were examined. Material relevant to the purpose was summarized in a narrative. The number of peer-reviewed publications pertaining to each sound therapy option reviewed varied significantly (from none to over 10). Overall there is currently insufficient evidence to support or refute the routine use of individual sound therapy options. It is likely, however, that sound therapy combined with education and counseling is generally helpful to patients. Clinicians need to be guided by the patient's point of care, patient motivation and expectations of sound therapy, and the acceptability of the intervention both in terms of the sound stimuli they are to use and whether they are willing to use sound extensively or intermittently. Clinicians should also clarify to patients the role sound therapy is expected to play in the management plan. American Academy of Audiology.

Analysis of returns above variable costs for management of Verticillium wilt in cotton

USDA-ARS?s Scientific Manuscript database

A large plot study located in Halfway, TX, was conducted from 2007 to 2013 in an irrigated field infested with Verticillium wilt. Management options (crop rotation, irrigation amount, variety election) and combinations of options that can reduce this disease were compared using returns above variabl...

Lethal trap trees: a potential option for emerald ash borer (Agrilus planipennis Fairmaire) management

Treesearch

Deborah G McCullough; Therese M. Poland; Phillip A. Lewis

2015-01-01

BACKGROUND: Economic and ecological impacts of ash (Fraxinus spp.) mortality resulting from emerald ash borer (EAB) (Agrilus planipennis Fairmaire) invasion are severe in forested, residential and urban areas. Management options include girdling ash trees to attract ovipositing adult beetles and then destroying infested trees...

Longleaf Pine: Natural Regeneration and Management

Treesearch

William D. Boyer

1999-01-01

Longleaf pine has long been recognized as a high-quality timber tree providing a number of valuable products. It is a versatile species with characteristics allowing the use of several silvicultural options. Both natural and artificial regeneration of longleaf pine are now practical management options. Natural regeneration is a lowcost alternative whenever sufficient...

76 FR 72488 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-23

... investment and risk management strategies and decisions. The Exchange further believes this proposed rule change will provide investors with additional Weekly option classes for investment, trading and risk management purposes. Therefore, the Exchange requests a modest expansion of the current Weeklys Program. The...

78 FR 27367 - New England Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-10

... Development Team (PDT) meeting; (4) provide a presentation outlining DAS/trip limit options developed by the... (ACT--applying management uncertainty to ACL), the range of DAS/trip limit alternatives (specifications), changes to the permit category H fishery boundary and any other options for DAS changes; (6) discuss...

12 CFR 350.4 - Contents of annual disclosure statement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... for each such year. The annual disclosure statement may, at the option of bank management, consist of... Reserve System: (i) Schedule RC (Balance Sheet); (ii) Schedule RC-N (Past Due and Nonaccrual, Loans... option, provide additional information that bank management considers important to an evaluation of the...

12 CFR 18.4 - Contents of annual disclosure statement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the preceding year. The annual disclosure statement may, at the option of bank management, consist of... schedules. (1) For national banks: (i) Schedule RC (Balance Sheet); (ii) Schedule RC-N (Past Due and... narrative. Bank management may, at its option, provide a narrative discussion to supplement the annual...

Management of solid waste

NASA Astrophysics Data System (ADS)

Thompson, W. T.; Stinton, L. H.

1980-04-01

Compliance with the latest regulatory requirements addressing disposal of radioactive, hazardous, and sanitary solid waste criteria in the selection, design, and operation of solid waste management facilities. Due to the state of flux of these regulatory requirements from EPA and NRC, several waste management options were of solid waste. The current regulatory constraints and the design and operational requirements for construction of both storage and disposal facilities for use in management of DOE-ORO solid waste are highlighted. Capital operational costs are included for both disposal and storage options.

Asthma Management in the Era of Smart-Medicine: Devices, Gadgets, Apps and Telemedicine.

PubMed

Katwa, Umakanth; Rivera, Estefania

2018-03-10

Asthma is the most common chronic pediatric condition. Effective asthma management requires a proactive and inclusive approach that controls the patient's symptoms and prevents recurrence of exacerbations. Clinicians should encourage patients to become involved in their management since self-management approaches have proven to be an effective means for chronic illness treatment. Novel forms of self-monitoring and management are technological interventions. In the last decade, novel technology has been developed and used to improve asthma control since it is a powerful agent that addresses a variety of challenges in chronic disease management such as education, communication and adherence. A myriad of technology-based strategies are available although many of these are not evidence based and further studies are needed to evaluate their efficacy in specific asthma-control endpoints. Herein, authors present a review of current and future technology-based options for asthma management and a comparison between them.

Strategies in Interventional Radiology: Formation of an Interdisciplinary Center of Vascular Anomalies - Chances and Challenges for Effective and Efficient Patient Management.

PubMed

Sadick, Maliha; Dally, Franz Josef; Schönberg, Stefan O; Stroszczynski, Christian; Wohlgemuth, Walter A

2017-10-01

Background  Radiology is an interdisciplinary field dedicated to the diagnosis and treatment of numerous diseases and is involved in the development of multimodal treatment concepts. Method  Interdisciplinary case management, a broad spectrum of diagnostic imaging facilities and dedicated endovascular radiological treatment options are valuable tools that allow radiology to set up an interdisciplinary center for vascular anomalies. Results  Image-based diagnosis combined with endovascular treatment options is an essential tool for the treatment of patients with highly complex vascular diseases. These vascular anomalies can affect numerous parts of the body so that a multidisciplinary treatment approach is required for optimal patient care. Conclusion  This paper discusses the possibilities and challenges regarding effective and efficient patient management in connection with the formation of an interdisciplinary center for vascular anomalies with strengthening of the clinical role of radiologists. Key points   · Vascular anomalies, which include vascular tumors and malformations, are complex to diagnose and treat.. · There are far more patients with vascular anomalies requiring therapy than interdisciplinary centers for vascular anomalies - there is currently a shortage of dedicated interdisciplinary centers for vascular anomalies in Germany that can provide dedicated care for affected patients.. · Radiology includes a broad spectrum of diagnostic and minimally invasive therapeutic tools which allow the formation of an interdisciplinary center for vascular anomalies for effective, efficient and comprehensive patient management.. Citation Format · Sadick M, Dally FJ, Schönberg SO et al. Strategies in Interventional Radiology: Formation of an Interdisciplinary Center of Vascular Anomalies - Chances and Challenges for Effective and Efficient Patient Management. Fortschr Röntgenstr 2017; 189: 957 - 966. © Georg Thieme Verlag KG Stuttgart · New York.

Free-roaming dog populations: a cost-benefit model for different management options, applied to Abruzzo, Italy.

PubMed

Høgåsen, H R; Er, C; Di Nardo, A; Dalla Villa, P

2013-11-01

Since 1991, Italian free-roaming dogs have been under government protection and euthanasia is restricted by law. Management measures are regulated at the regional level and include: kennelling, adoptions, conversion of stray dogs into block dogs, and population control of owned dogs. "Block dogs" are free-roaming dogs that have been collected by the veterinary services, microchipped, sterilised, vaccinated, and released under the responsibility of the local municipalities. The present paper describes a cost-benefit model for different management options and applies it to two provinces in Abruzzo, central Italy. The model considers welfare, nuisance and direct costs to the municipality. Welfare is quantified based on the expert opinions of 60 local veterinarians, who were asked to assign a score for each dog category according to the five freedoms: freedom from pain, physical discomfort, disease, fear, and freedom to express normal behaviour. Nuisance was assessed only for comparisons between management options, using the number of free-roaming dogs per inhabitant as a proxy indicator. A community dog population model was constructed to predict the effect of management on the different subpopulations of dogs during a ten-year period. It is a user-friendly deterministic model in Excel, easily adaptable to different communities to assess the impact of their dog management policy on welfare, nuisance and direct monetary cost. We present results for Teramo and Pescara provinces. Today's management system is compared to alternative models, which evaluate the effect of specific interventions. These include either a 10% yearly increase in kennel capacity, an increase in adoptions from kennels, a doubling of the capture of stray dogs, or a stabilisation of the owned dog population. Results indicate that optimal management decisions are complex because welfare, nuisance and monetary costs may imply conflicting interventions. Nevertheless, they clearly indicate that management actions that would act on dog ownership patterns to reduce the number of free-roaming dogs would have the most favourable outcomes. These include reducing the reproductive capacity of the owned dog population, stronger enforcement of mandatory dog identification, reducing abandonment and increasing adoptions. This would increase welfare and free resources for implementing public campaigns. Block dogs may be an important intermediary means to reduce stray dogs, but adoption would be preferable. Copyright © 2013 Elsevier B.V. All rights reserved.

Nonarteritic anterior ischemic optic neuropathy: cause, effect, and management.

PubMed

Berry, Shauna; Lin, Weijie V; Sadaka, Ama; Lee, Andrew G

2017-01-01

Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common form of ischemic optic neuropathy and the second most common optic neuropathy. Patients are generally over the age of 50 years with vasculopathic risk factors (eg, diabetes mellitus, hypertension, and obstructive sleep apnea). The exact mechanism of NAION is not fully understood. In addition, several treatment options have been proposed. This article summarizes the current literature on the diagnosis, treatment, and management of NAION.

Developing principles of sustainability and stakeholder engagement for "gentle" remediation approaches: the European context.

PubMed

Cundy, A B; Bardos, R P; Church, A; Puschenreiter, M; Friesl-Hanl, W; Müller, I; Neu, S; Mench, M; Witters, N; Vangronsveld, J

2013-11-15

Gentle Remediation Options (GRO) are risk management strategies or techniques for contaminated sites that result in no gross reduction in soil functionality (or a net gain) as well as risk management. Intelligently applied GROs can provide: (a) rapid risk management via pathway control, through containment and stabilisation, coupled with a longer term removal or immobilisation/isolation of the contaminant source term; and (b) a range of additional economic (e.g. biomass generation), social (e.g. leisure and recreation) and environmental (e.g. CO2 sequestration) benefits. In order for these benefits to be optimised or indeed realised, effective stakeholder engagement is required. This paper reviews current sector practice in stakeholder engagement and its importance when implementing GRO and other remediation options. From this, knowledge gaps are identified, and strategies to promote more effective stakeholder engagement during GRO application are outlined. Further work is required on integrating stakeholder engagement strategies into decision support systems and tools for GRO (to raise the profile of the benefits of effective stakeholder engagement and participation, particularly with sector professionals), and developing criteria for the identification of different stakeholder profiles/categories. Demonstrator sites can make a significant contribution to stakeholder engagement via providing evidence on the effectiveness of GRO under varying site contexts and conditions. Effective and sustained engagement strategies however will be required to ensure that site risk is effectively managed over the longer-term, and that full potential benefits of GRO (e.g. CO2 sequestration, economic returns from biomass generation and "leverage" of marginal land, amenity and educational value, ecosystem services) are realised and communicated to stakeholders. Copyright © 2013 Elsevier Ltd. All rights reserved.

Understanding Consistency Maintenance in Service Discovery Architectures in Response to Message Loss

DTIC Science & Technology

2002-07-01

manager (SM), and (3) service cache manager ( SCM ). The SCM is an optional element not supported by all discovery protocols. These components participate...the SCM operates as an intermediary, matching advertised SDs of SMs to requirements provided by SUs. Table 1 shows how these general concepts map...Service DescriptionService ItemService Description (SD) Directory Service Agent (optional) not applicableLookup ServiceService Cache Manager ( SCM

25 CFR 1200.5 - What are the advantages and disadvantages of managing trust funds under the options in § 1200.4?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 2 2010-04-01 2010-04-01 false What are the advantages and disadvantages of managing trust funds under the options in § 1200.4? 1200.5 Section 1200.5 Indians OFFICE OF THE SPECIAL TRUSTEE... General Provisions § 1200.5 What are the advantages and disadvantages of managing trust funds under the...

Calcific tendinitis of the rotator cuff: management options.

PubMed

Suzuki, Kentaro; Potts, Aaron; Anakwenze, Oke; Singh, Anshu

2014-11-01

Calcific tendinitis of the rotator cuff tendons is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. It is thought to be an active, cell-mediated process, although the exact pathophysiology remains unclear. Nonsurgical management continues to be the mainstay of treatment; most patients improve with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections. Several options are available for patients who fail nonsurgical treatment, including extracorporeal shock wave therapy, ultrasound-guided needle lavage, and surgical débridement. These modalities alleviate pain by eliminating the calcific deposit, and several recent studies have demonstrated success with the use of these treatment options. Surgical management options include arthroscopic procedures to remove calcific deposits and subacromial decompression; however, the role of subacromial decompression and repair of rotator cuff defects created by removing these deposits remains controversial. Copyright 2014 by the American Academy of Orthopaedic Surgeons.

Effectiveness and safety of treatments used for the management of patent ductus arteriosus (PDA) in preterm infants: a protocol for a systematic review and network meta-analysis.

PubMed

Mitra, Souvik; Florez, Ivan D; Tamayo, Maria E; Aune, Dagfinn; Mbuagbaw, Lawrence; Veroniki, Areti-Angeliki; Thabane, Lehana

2016-07-25

Management of patent ductus arteriosus (PDA) in preterm infants is one of the most controversial topics in neonatal medicine. The availability of different pharmacotherapeutic options often poses a practical challenge to the practising neonatologist as to which one to choose as a therapeutic option. Our objectives are to determine the relative merits of the available pharmacotherapeutic options for the management of PDA. We will conduct a systematic review of all randomised controlled trials evaluating the use of intravenous or oral: indomethacin, ibuprofen and acetaminophen for the treatment of PDA in preterm infants. The primary outcome is failure of closure of the PDA. Secondary outcomes are neonatal mortality, need for surgical closure, duration of ventilator support, chronic lung disease, intraventricular haemorrhage, periventricular leukomalacia, necrotising enterocolitis, gastrointestinal bleeding, time to full enteral feeds and oliguria. We will search Medline, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) as well as grey literature resources. Two reviewers will independently screen titles and abstracts, review full texts, extract information, and assess the risk of bias (ROB) and the confidence in the estimate (with Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach). Subgroup analysis according to gestational age, birth weight, different doses of interventions, time of administration of the first dose of the intervention, and echocardiographic definition of haemodynamically significant PDA and ROB are planned. We will perform a Bayesian network meta-analysis to combine the pooled direct and indirect treatment effect estimates for each outcome, if adequate data are available. The results will help to reduce the uncertainty about the safety and effectiveness of the interventions, will identify knowledge gaps or will encourage further research for other therapeutic options. Therefore, its results will be disseminated through peer-reviewed publications and conference presentations. On the basis of the nature of its design, no ethics approval is necessary for this study. CRD42015015797. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Transboundary Movements of Hazardous Wastes. A Comparative Analysis of Policy Options to Control the International Waste Trade.

ERIC Educational Resources Information Center

Hilz, Christoph; Ehrenfeld, John R.

1991-01-01

Several policy frameworks for managing hazardous waste import/export are examined with respect to economic issues, environmental sustainability, and administrative feasibility and effectiveness. Several recommendations for improving the present instrument and implementing process are offered. (Author/CW)

LONG-TERM PERFORMANCE OF PERMEABLE REACTIVE BARRIERS: AN UPDATE ON A U.S. MULTI-AGENCY INITIATIVE

EPA Science Inventory

Permeable reactive barriers (PRB's) are an emerging, alternative in-situ approach for remediating contaminated groundwater that combine subsurface fluid flow management with a passive chemical treatment zone. PRB's are a potentially more cost effective treatment option at seve...

Economic analysis of small-scale agricultural digesters in the United States

USDA-ARS?s Scientific Manuscript database

Anaerobic digestion is a manure treatment option that is gaining popularity throughout the world due to its multiple environmental and economic benefits. However, further research is needed for anaerobic technology to become more readily available, cost effective and manageable for small-scale to m...

Phenyl propionate and sex pheromone for monitoring navel orangeworm in the presence of mating disruption

USDA-ARS?s Scientific Manuscript database

The recent availability of sex pheromone lures for the navel orangeworm, Amyelois transitella (Walker) (Lepidoptera: Pyralidae), improves options for monitoring this key pest in conventionally-managed almonds. These lures are, however, minimally effective in the presence of mating disruption. Experi...

Solar Greenhouses and Sunspaces: Lessons Learned.

ERIC Educational Resources Information Center

Thomas, Stephen G.; And Others

Solar technology systems are being studied, managed, built and offered as an effective alternative energy option. This publication presents background material for the building and operation of better sunspaces and greenhouses. Recent developments in solar technology are explained and information on solar greenhouse and sunspace is provided (in…

Decision scenario analysis for addressing sediment accumulation in Lago Lucchetti, Puerto Rico

EPA Science Inventory

A Bayesian belief network (BBN) was used to characterize the effects of sediment accumulation on water storage capacity of a reservoir (Lago Lucchetti) in southwest Puerto Rico and the potential of different management options to increase reservoir life expectancy. Water and sedi...

Developing and implementing climate change adaptation options in forest ecosystems: a case study in southwestern Oregon, USA

Treesearch

Jessica E. Halofsky; David L. Peterson; Kerry L. Metlen; Gwyneth M. Myer; Alaric V. Sample

2016-01-01

Climate change will likely have significant effects on forest ecosystems worldwide. In Mediterranean regions, such as that in southwestern Oregon, USA, changes will likely be driven mainly by wildfire and drought. To minimize the negative effects of climate change, resource managers require tools and information to assess climate change vulnerabilities and to develop...

Modelling effects of geoengineering options in response to climate change and global warming: implications for coral reefs.

PubMed

Crabbe, M J C

2009-12-01

Climate change will have serious effects on the planet and on its ecosystems. Currently, mitigation efforts are proving ineffectual in reducing anthropogenic CO2 emissions. Coral reefs are the most sensitive ecosystems on the planet to climate change, and here we review modelling a number of geoengineering options, and their potential influence on coral reefs. There are two categories of geoengineering, shortwave solar radiation management and longwave carbon dioxide removal. The first set of techniques only reduce some, but not all, effects of climate change, while possibly creating other problems. They also do not affect CO2 levels and therefore fail to address the wider effects of rising CO2, including ocean acidification, important for coral reefs. Solar radiation is important to coral growth and survival, and solar radiation management is not in general appropriate for this ecosystem. Longwave carbon dioxide removal techniques address the root cause of climate change, rising CO2 concentrations, they have relatively low uncertainties and risks. They are worthy of further research and potential implementation, particularly carbon capture and storage, biochar, and afforestation methods, alongside increased mitigation of atmospheric CO2 concentrations.

Screening regional management options for their impact on climate resilience: an approach and case study in the Venen-Vechtstreek wetlands in the Netherlands.

PubMed

Wardekker, J A; Wildschut, D; Stemberger, S; van der Sluijs, J P

2016-01-01

Freshwater systems provide various resources and services. These are often vulnerable to climate change and other pressures. Therefore, enhancing resilience to climate change is important for their long term viability. This paper explores how management options can be evaluated on their resilience implications. The approach included five steps: (1) characterizing the system, (2) characterizing the impacts of climate change and other disturbances, (3) inventorying management options, (4) assessing the impacts of these on climate resilience, and (5) follow-up analysis. For the resilience assessment, we used a set of 'resilience principles': homeostasis, omnivory, high flux, flatness, buffering, and redundancy. We applied the approach in a case study in a Dutch wetlands region. Many options in the region's management plan contribute to resilience, however, the plan underutilised several principles, particularly flatness, but also redundancy and omnivory for agriculture, and high flux for nature. Co-benefits was identified as an important additional criterion to obtain support for adaptation from local stakeholders, such as farmers. The approach provided a relatively quick and participatory way to screen options. It allowed us to consider multiple impacts and sectors, multiple dimensions of resilience, and stakeholder perspectives. The results can be used to identify gaps or pitfalls, and set priorities for follow-up analyses.

Sustainability assessment of electrokinetic bioremediation compared with alternative remediation options for a petroleum release site.

PubMed

Gill, R T; Thornton, S F; Harbottle, M J; Smith, J W N

2016-12-15

Sustainable management practices can be applied to the remediation of contaminated land to maximise the economic, environmental and social benefits of the process. The Sustainable Remediation Forum UK (SuRF-UK) have developed a framework to support the implementation of sustainable practices within contaminated land management and decision making. This study applies the framework, including qualitative (Tier 1) and semi-quantitative (Tier 2) sustainability assessments, to a complex site where the principal contaminant source is unleaded gasoline, giving rise to a dissolved phase BTEX and MTBE plume. The pathway is groundwater migration through a chalk aquifer and the receptor is a water supply borehole. A hydraulic containment system (HCS) has been installed to manage the MTBE plume migration. The options considered to remediate the MTBE source include monitored natural attenuation (MNA), air sparging/soil vapour extraction (AS/SVE), pump and treat (PT) and electrokinetic-enhanced bioremediation (EK-BIO). A sustainability indictor set from the SuRF-UK framework, including priority indicator categories selected during a stakeholder engagement workshop, was used to frame the assessments. At Tier 1 the options are ranked based on qualitative supporting information, whereas in Tier 2 a multi-criteria analysis is applied. Furthermore, the multi-criteria analysis was refined for scenarios where photovoltaics (PVs) are included and amendments are excluded from the EK-BIO option. Overall, the analysis identified AS/SVE and EK-BIO as more sustainable remediation options at this site than either PT or MNA. The wider implications of this study include: (1) an appraisal of the management decision from each Tier of the assessment with the aim to highlight areas for time and cost savings for similar assessments in the future; (2) the observation that EK-BIO performed well against key indicator categories compared to the other intensive treatments; and (3) introducing methods to improve the sustainability of the EK-BIO treatment design (such as PVs) did not have a significant effect in this instance. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Therapeutic options to manage bleeding in a dentist’s office

PubMed

Rostetter, Claudio; Finkenstädt, Tim; Rücker, Martin; Lübbers, Heinz-Theo

2018-06-18

This manuscript provides an overview of therapeutic options for the problem of bleeding in a dentist’s office. Bleeding after tooth extraction is a very common finding in dental medicine and persistent blood in the mouth is obviously uncomfortable and sometimes terrifying for the patient. Most bleedings can be stopped simply with compression, in some cases a homeostatic therapy is necessary. For local compression, a swab with tranexamic acid is useful. If local compression is not sufficient, sutures are often an option. A very effective therapy would also be Tabotamp®, a local hemostypticum which is placed onto the bleeding and should increase the thrombocytic aggregation. In the worst case Floseal®, a human Thrombin, can be placed locally. It stops the bleeding very fast and sufficiently.

75 FR 41790 - Address Management Services-Elimination of the Manual Card Option for Address Sequencing Services

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-19

... Electronic Address Sequencing (EAS) service processes a customer's addresses file for walk sequence and/or... POSTAL SERVICE 39 CFR Part 111 Address Management Services--Elimination of the Manual Card Option for Address Sequencing Services AGENCY: Postal Service TM . ACTION: Proposed rule. SUMMARY: The Postal...

Treatment Principles for the Management of Mold Infections

PubMed Central

Kontoyiannis, Dimitrios P.; Lewis, Russell E.

2015-01-01

Survival rates among immunocompromised patients with invasive mold infections have markedly improved over the last decade with earlier diagnosis and new antifungal treatment options. Yet, increasing antifungal resistance, breakthrough infections with intrinsically resistant fungi, and potentially life-threatening adverse effects and drug interactions are becoming more problematic, especially with prolonged therapy. Evidence-based recommendations for treating invasive aspergillosis and mucormycosis provide excellent guidance on the initial workup and treatment of these molds, but they cannot address all of the key management issues. Herein, we discuss 10 general treatment principles in the management of invasive mold disease in immunocompromised patients and discuss how these principles can be integrated to develop an effective, individualized treatment plan. PMID:25377139

Cost analysis of the Hemodialysis Reliable Outflow (HeRO) Graft compared to the tunneled dialysis catheter.

PubMed

Al Shakarchi, Julien; Inston, Nicholas; Jones, Robert G; Maclaine, Grant; Hollinworth, David

2016-04-01

In end-stage renal disease patients with central venous obstruction, who have limited vascular access options, the Hemodialysis Reliable Outflow (HeRO) Graft is a new alternative with a lower incidence of complications and longer effective device life compared to tunneled dialysis catheters (TDCs). We undertook an economic analysis of introducing the HeRO Graft in the UK. A 1-year cost-consequence decision analytic model was developed comparing management with the HeRO Graft to TDCs from the perspective of the National Health Service in England. The model comprises four 3-month cycles during which the vascular access option either remains functional for hemodialysis or fails, patients can experience access-related infection and device thrombosis, and they can also accrue associated costs. Clinical input data were sourced from published studies and unit cost data from National Health Service 2014-15 Reference Costs. In the base case, a 100-patient cohort managed with the HeRO Graft experienced 6 fewer failed devices, 53 fewer access-related infections, and 67 fewer device thromboses compared to patients managed with TDCs. Although the initial device and placement costs for the HeRO Graft are greater than those for TDCs, savings from the lower incidence of device complications and longer effective device patency reduces these costs. Overall net annual costs are £2600 for each HeRO Graft-managed patient compared to TDC-managed patients. If the National Health Service were to reimburse hemodialysis at a uniform rate regardless of the type of vascular access, net 1-year savings of £1200 per patient are estimated for individuals managed with the HeRO Graft. The base case results showed a marginal net positive cost associated with vascular access with the HeRO Graft compared with TDCs for the incremental clinical benefit of reductions in patency failures, device-related thrombosis, and access-related infection events in a patient population with limited options for dialysis vascular access. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Estimation and prediction under local volatility jump-diffusion model

NASA Astrophysics Data System (ADS)

Kim, Namhyoung; Lee, Younhee

2018-02-01

Volatility is an important factor in operating a company and managing risk. In the portfolio optimization and risk hedging using the option, the value of the option is evaluated using the volatility model. Various attempts have been made to predict option value. Recent studies have shown that stochastic volatility models and jump-diffusion models reflect stock price movements accurately. However, these models have practical limitations. Combining them with the local volatility model, which is widely used among practitioners, may lead to better performance. In this study, we propose a more effective and efficient method of estimating option prices by combining the local volatility model with the jump-diffusion model and apply it using both artificial and actual market data to evaluate its performance. The calibration process for estimating the jump parameters and local volatility surfaces is divided into three stages. We apply the local volatility model, stochastic volatility model, and local volatility jump-diffusion model estimated by the proposed method to KOSPI 200 index option pricing. The proposed method displays good estimation and prediction performance.

The '06 trap trees in '07

Treesearch

Andrea C. Anulewicz; Deborah G. McCullough; Therese M. Poland; David Cappaert

2008-01-01

To date, use of girdled trap trees remain the most effective method employed by regulatory and resource management agencies for detecting low-density populations of emerald ash borer (EAB), Agrilus planipennis Fairmaire. Locating suitable trees can be difficult, and felling and debarking trap trees is expensive. Alternative options for EAB detection...

Improved methodology to assess modification and completion of landfill gas management in the aftercare period

USDA-ARS?s Scientific Manuscript database

Municipal solid waste landfills represent the dominant option for waste disposal in many parts of the world. While some countries have greatly reduced their reliance on landfills, there remain thousands of landfills that require aftercare. The development of cost-effective strategies for landfill af...

76 FR 28113 - Self-Regulatory Organizations; Notice of Filing and Immediate Effectiveness of Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-13

... enter eligible contracts into the Exchange's Floor Broker Management System (``FBMS'').\\3\\ To qualify... brokers and/or their employees to enter, route, and report transactions stemming from options orders... the Exchange. The Exchange believes that rewarding members that contribute the most liquidity or...

Afforestation effects on soil carbon storage in the United States: a synthesis

Treesearch

L.E. Nave; C.W. Swanston; U. Mishra; K.J. Nadelhoffer

2013-01-01

Afforestation (tree establishment on nonforested land) is a management option for increasing terrestrial C sequestration and mitigating rising atmospheric carbon dioxide because, compared to nonforested land uses, afforestation increases C storage in aboveground pools. However, because terrestrial ecosystems typically store most of their C in soils, afforestation...

76 FR 7841 - Agency Information Collection Activities; Proposed Collections; Toxic Chemical Release Reporting...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-11

... prevention and waste management data, including recycling information, for such chemicals. 42 U.S.C. 13106... reporting forms and associated instructions, but these changes are estimated to have a negligible effect on... source reduction activities, and provide additional optional information on source reduction, recycling...

Vegetated treatment area (VTAs) efficiences for E. coli and nutrient removal on small-scale swine operations

USDA-ARS?s Scientific Manuscript database

As small-scale animal feeding operations work to manage their byproducts and avoid regulation, they need practical, cost-effective methods to reduce environmental impact. One such option is using vegetative treatment areas (VTAs) with perennial grasses to treat runoff; however, research is limited ...

Impacts of fire on sage-grouse habitat and diet resources

USDA-ARS?s Scientific Manuscript database

Small (<40.5-ha) patch fires or mechanical manipulations to reduce big sagebrush (Artemisia tridentata) cover has been suggested as a management option to improve sage-grouse prenesting and brood rearing habitat and provide a diverse habitat mosaic. We evaluated the effects of prescribed fire and wi...

Montessori Practices: Options for a Digital Age

ERIC Educational Resources Information Center

Powell, Mark

2016-01-01

Mark Powell's plea for an open-minded view on the full scope of technology that is compatible with Montessori education enriches Maria Montessori's clear modernism of welcoming science into her educational vision. Growing up digital can be intelligently managed so that "technology may offer an effective, adaptable, and easily available means…

Alternative therapeutic options for medical management of epilepsy in apes.

PubMed

Gerlach, Trevor; Clyde, Victoria L; Morris, George L; Bell, Barbara; Wallace, Roberta S

2011-06-01

Phenobarbital has been the primary antiepileptic drug used in primates, but the dosage required for seizure control is frequently associated with significant side effects. Newer antiepileptic drugs and adjunctive therapies currently being used in human medicine provide additional options for treatment of nonhuman primates. This report describes different drug regimes used for control of epileptic seizures in apes at the Milwaukee County Zoo (Milwaukee, Wisconsin, U.S.A.), including the addition of acetazolamide to phenobarbital, levetiracetam, carbamazepine, and the use of extended cycle oral contraceptives to assist seizure control in female apes with catamenial epilepsy.

Acquiring Enterprise Systems as a Portfolio of Real Options

DTIC Science & Technology

2012-04-30

expanded beyond valuing individual projects by the real options method to the valuation of a portfolio of options. Bardhan , Bagchi, and Soustad (2004... Bardhan , I., Bagchi, S., & Soustad, R. (2004). Prioritizing a portfolio of information technology investment projects. Journal of Management

Managing Disease Risks from Trade: Strategic Behavior with Many Choices and Price Effects.

PubMed

Chitchumnong, Piyayut; Horan, Richard D

2018-03-16

An individual's infectious disease risks, and hence the individual's incentives for risk mitigation, may be influenced by others' risk management choices. If so, then there will be strategic interactions among individuals, whereby each makes his or her own risk management decisions based, at least in part, on the expected decisions of others. Prior work has shown that multiple equilibria could arise in this setting, with one equilibrium being a coordination failure in which individuals make too few investments in protection. However, these results are largely based on simplified models involving a single management choice and fixed prices that may influence risk management incentives. Relaxing these assumptions, we find strategic interactions influence, and are influenced by, choices involving multiple management options and market price effects. In particular, we find these features can reduce or eliminate concerns about multiple equilibria and coordination failure. This has important policy implications relative to simpler models.

Adaptation of water resource systems to an uncertain future

NASA Astrophysics Data System (ADS)

Walsh, C. L.; Blenkinsop, S.; Fowler, H. J.; Burton, A.; Dawson, R. J.; Glenis, V.; Manning, L. J.; Kilsby, C. G.

2015-09-01

Globally, water resources management faces significant challenges from changing climate and growing populations. At local scales, the information provided by climate models is insufficient to support the water sector in making future adaptation decisions. Furthermore, projections of change in local water resources are wrought with uncertainties surrounding natural variability, future greenhouse gas emissions, model structure, population growth and water consumption habits. To analyse the magnitude of these uncertainties, and their implications for local scale water resource planning, we present a top-down approach for testing climate change adaptation options using probabilistic climate scenarios and demand projections. An integrated modelling framework is developed which implements a new, gridded spatial weather generator, coupled with a rainfall-runoff model and water resource management simulation model. We use this to provide projections of the number of days, and associated uncertainty that will require implementation of demand saving measures such as hose pipe bans and drought orders. Results, which are demonstrated for the Thames basin, UK, indicate existing water supplies are sensitive to a changing climate and an increasing population, and that the frequency of severe demand saving measures are projected to increase. Considering both climate projections and population growth the median number of drought order occurrences may increase five-fold. The effectiveness of a range of demand management and supply options have been tested and shown to provide significant benefits in terms of reducing the number of demand saving days. We found that increased supply arising from various adaptation options may compensate for increasingly variable flows; however, without reductions in overall demand for water resources such options will be insufficient on their own to adapt to uncertainties in the projected changes in climate and population. For example, a 30 % reduction in overall demand by 2050 has a greater impact on reducing the frequency of drought orders than any of the individual or combinations of supply options; hence a portfolio of measures are required.

Nonoperative options for management of residual stones after cholecystostomy in high-risk patients

NASA Astrophysics Data System (ADS)

Reed, David M.; Daye, S. S.; Lincer, R. M.

1993-05-01

Cholecystostomy is frequently performed to obtain control of sepsis in high risk patients with acute cholecystitis. Retained stones in the gallbladder may cause future clinical problems. We present two patients with cholecystostomy tubes managed non-operatively. A review of other reported methods for stone extraction or destruction is also presented. Knowledge of safe and effective techniques for removal of these stones, using minimally invasive techniques is useful to the general surgeon.

Environmental Assessment for the Management Options for Branch Memorial Park and Pond, Edwards Air Force Base, California

DTIC Science & Technology

2008-09-01

resources, park lands, prime farmlands, wetlands , wild and scenic rivers, or ecologically critical areas; and b. The degree to which the effects on...fish, such as large-mouth bass and blue gill, will greatly reduce or eliminate mosquito larvae (Management of Ponds, Wetlands , and Other Water...or organization parties, quiet dining, relaxing, bird watching, enjoying nature, looking at wild flowers, and fishing. The annual Fishing Derby is

Surgical management of spontaneous in-the-bag intraocular lens and capsular tension ring complex dislocation.

PubMed

Gunenc, Uzeyir; Kocak, Nilufer; Ozturk, A Taylan; Arikan, Gul

2014-08-01

We describe a technique to manage late spontaneous intraocular lens (IOL) and capsular tension ring (CTR) dislocation within the intact capsular bag. The subluxated IOL and CTR complex can be positioned in a closed chamber and fixed to the pars plana at both 3 and 9 o'clock quadrants with the presented ab externo direct scleral suturation technique which provides an easy, safe and effective surgical option for such cases.

Fertility concerns in men with genitourinary malignancies: Treatment dilemmas, fertility options, and medicolegal considerations.

PubMed

Polland, Allison; Berookhim, Boback M

2016-09-01

With increasing genitourinary cancer survivorship in patients of reproductive age, fertility preservation has become a greater focus in the management of these patients. We performed a review of articles pertaining to male infertility, fertility preservation, and genitourinary cancers. The aim was to review causes of infertility in patients with cancer, current options for fertility preservation, research that may expand preservation options, and ethical as well as medicolegal considerations. There are multiple causes of infertility in male patients with cancer, including the malignancy itself, and the treatments required to achieve a potential cure. Surgery can affect the normal pathways for erection, emission, and ejaculation. Chemotherapy can have a profound negative effect on spermatogenesis by causing chromosomal aberrations, maturation arrest, mutagenesis, and impaired spermatozoa motility. Radiation can cause cellular apoptosis with resultant reduction in spermatogonial stem cells. There are numerous methods to secure fertility before cancer treatment with the aid of cryopreservation ranging from simple patient-provided semen samples to complex sperm retrieval techniques. Research in the field of spermatogenic stem cells may lead to improved treatment options such as autotransplant of stem cells for repopulation of the testes after cancer treatment. Early discussion of possible fertility effects in patients undergoing genitourinary cancer treatment is critical in this era of increasing survivorship. Although current cancer treatments can cause infertility, there are well-established options for fertility preservation and current research will likely lead to improved treatment options. Copyright © 2016 Elsevier Inc. All rights reserved.

Policy Options for Addressing Health System and Human Resources for Health Crisis in Liberia Post-Ebola Epidemic.

PubMed

Budy, Fidel C T

2015-01-01

Qualified healthcare workers within an effective health system are critical in promoting and achieving greater health outcomes such as those espoused in the Millennium Development Goals. Liberia is currently struggling with the effects of a brutal 14-year long civil war that devastated health infrastructures and caused most qualified health workers to flee and settle in foreign countries. The current output of locally trained health workers is not adequate for the tasks at hand. The recent Ebola Virus Disease (EVD) exposed the failings of the Liberian healthcare system. There is limited evidence of policies that could be replicated in Liberia to encourage qualified diaspora Liberian health workers to return and contribute to managing the phenomenon. This paper reviews the historical context for the human resources for health crisis in Liberia; it critically examines two context-specific health policy options to address the crisis, and recommends reverse brain drain as a policy option to address the immediate and critical crisis facing the health care sector in Liberia.

Exercise Recommendations for the Management of Symptoms Clusters Resulting from Cancer and Cancer Treatments

PubMed Central

Mustian, Karen M.; Cole, Calvin L.; Lin, Po Ju; Asare, Matt; Fung, Chunkit; Janelsins, Michelle C.; Kamen, Charles S.; Peppone, Luke J.; Magnuson, Allison

2017-01-01

Objective To review existing exercise guidelines for cancer patients and survivors for the management of symptom clusters. Data source Review of Pubmed literature and published exercise guidelines. Conclusion Cancer and its treatments are responsible for a copious number of incapacitating symptoms that markedly impair quality of life (QOL). The exercise oncology literature provides consistent support for the safety and efficacy of exercise interventions in managing cancer- and treatment-related symptoms as well as improving quality of life in cancer patients and survivors. Implications for Nursing Practice Effective management of symptoms enhances recovery, resumption of normal life activities and QOL for patients and survivors. Exercise is a safe, appropriate and effective therapeutic option before, during, and after the completion of treatment for alleviating symptoms and symptom clusters. PMID:27776835

Does competition by health maintenance organizations affect the adoption of cost-containment measures by fee-for-service plans?

PubMed

Joesch, J M; Wickizer, T M; Feldstein, P J

1998-06-01

How groups insured by fee-for-service health plans react to increased competition from health maintenance organizations (HMOs) is an unresolved question. We investigated whether groups insured by indemnity plans respond to HMO market competition by changing selected health insurance features, such as deductible amounts, stop loss levels, and coinsurance rates, or by adopting utilization management or preferred provider organization (PPO) benefit options. We collected benefit design data for the years 1985 through 1992 from 95 insured groups in 62 US metropolitan statistical areas. Multivariate hazard analysis showed that groups located in markets with higher rates of change in HMO enrollment were less likely to increase deductibles or stop loss levels. Groups located in markets with higher HMO enrollment were more likely to adopt utilization management or PPO benefit options. A group located in a market with an HMO penetration rate of 20% was 65% more likely to have included a PPO option as part of its insurance benefit plan than a group located in a market with an HMO penetration rate of 15% (p < 0.05). Concern about possible adverse selection effects may deter some fee-for-service groups from changing their health insurance coverage. Under some conditions, however, groups insured under fee-for-service plans do respond to managed care competition by changing their insurance benefits to achieve greater cost containment.

Phytoremediation of landfill leachate

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

Jones, D.L.; Williamson, K.L.; Owen, A.G.

Leachate emissions from landfill sites are of concern, primarily due to their toxic impact when released unchecked into the environment, and the potential for landfill sites to generate leachate for many hundreds of years following closure. Consequently, economically and environmentally sustainable disposal options are a priority in waste management. One potential option is the use of soil-plant based remediation schemes. In many cases, using either trees (including short rotation coppice) or grassland, phytoremediation of leachate has been successful. However, there are a significant number of examples where phytoremediation has failed. Typically, this failure can be ascribed to excessive leachate applicationmore » and poor management due to a fundamental lack of understanding of the plant-soil system. On balance, with careful management, phytoremediation can be viewed as a sustainable, cost effective and environmentally sound option which is capable of treating 250 m{sup 3} ha{sup -1} yr{sup -1}. However, these schemes have a requirement for large land areas and must be capable of responding to changes in leachate quality and quantity, problems of scheme establishment and maintenance, continual environmental monitoring and seasonal patterns of plant growth. Although the fundamental underpinning science is well understood, further work is required to create long-term predictive remediation models, full environmental impact assessments, a complete life-cycle analysis and economic analyses for a wide range of landfill scenarios.« less

Exploring Opioid-Sparing Multimodal Analgesia Options in Trauma: A Nursing Perspective

PubMed Central

Lyons, Mary; Montgomery, Robert; Quinlan-Colwell, Ann

2016-01-01

Challenges with opioids (e.g., adverse events, misuse and abuse with long-term administration) have led to a renewed emphasis on opioid-sparing multimodal management of trauma pain. To assess the extent to which currently available evidence supports the efficacy and safety of various nonopioid analgesics and techniques to manage trauma pain, a literature search of recently published references was performed. Additional citations were included on the basis of authors' knowledge of the literature. Effective options for opioid-sparing analgesics include oral and intravenous (IV) acetaminophen; nonsteroidal anti-inflammatory drugs available via multiple routes; and anticonvulsants, which are especially effective for neuropathic pain associated with trauma. Intravenous routes (e.g., IV acetaminophen, IV ketorolac) may be associated with a faster onset of action than oral routes. Additional adjuvants for the treatment of trauma pain are muscle relaxants and alpha-2 adrenergic agonists. Ketamine and regional techniques play an important role in multimodal therapy but require medical and nursing support. Nonpharmacologic treatments (e.g., cryotherapy, distraction techniques, breathing and relaxation, acupuncture) supplement pharmacologic analgesics and can be safe and easy to implement. In conclusion, opioid-sparing multimodal analgesia addresses concerns associated with high doses of opioids, and many pharmacologic and nonpharmacologic options are available to implement this strategy. Nurses play key roles in comprehensive patient assessment; administration of patient-focused, opioid-sparing, multimodal analgesia in trauma; and monitoring for safety concerns. PMID:27828892

Exploring Opioid-Sparing Multimodal Analgesia Options in Trauma: A Nursing Perspective.

PubMed

Sullivan, Denise; Lyons, Mary; Montgomery, Robert; Quinlan-Colwell, Ann

Challenges with opioids (e.g., adverse events, misuse and abuse with long-term administration) have led to a renewed emphasis on opioid-sparing multimodal management of trauma pain. To assess the extent to which currently available evidence supports the efficacy and safety of various nonopioid analgesics and techniques to manage trauma pain, a literature search of recently published references was performed. Additional citations were included on the basis of authors' knowledge of the literature. Effective options for opioid-sparing analgesics include oral and intravenous (IV) acetaminophen; nonsteroidal anti-inflammatory drugs available via multiple routes; and anticonvulsants, which are especially effective for neuropathic pain associated with trauma. Intravenous routes (e.g., IV acetaminophen, IV ketorolac) may be associated with a faster onset of action than oral routes. Additional adjuvants for the treatment of trauma pain are muscle relaxants and alpha-2 adrenergic agonists. Ketamine and regional techniques play an important role in multimodal therapy but require medical and nursing support. Nonpharmacologic treatments (e.g., cryotherapy, distraction techniques, breathing and relaxation, acupuncture) supplement pharmacologic analgesics and can be safe and easy to implement. In conclusion, opioid-sparing multimodal analgesia addresses concerns associated with high doses of opioids, and many pharmacologic and nonpharmacologic options are available to implement this strategy. Nurses play key roles in comprehensive patient assessment; administration of patient-focused, opioid-sparing, multimodal analgesia in trauma; and monitoring for safety concerns.

Treatment options for moderate-to-very severe chronic obstructive pulmonary disease.

PubMed

Cazzola, Mario; Rogliani, Paola; Ora, Josuel; Matera, Maria Gabriella

2016-01-01

The appropriate drug management of COPD is still based on the use of bronchodilators, possibly associated with an anti-inflammatory agent. However, there are still fundamental questions that require clarification to optimise their use and major unmet clinical needs that must be addressed. The advances obtained with the pharmacological options currently consolidated and the different approaches that are often used in an attempt to respond to unmet therapeutic needs are reviewed Expert opinion: In view of the unsatisfactory status of current treatments for COPD, there is an urgent need for alternative and more effective therapeutic approaches that will help to relieve patient symptoms and affect the natural course of COPD, inhibiting chronic inflammation and reversing the disease process or preventing its progression. However, new pharmacologic options have proved difficult to develop. Therefore, it is mandatory to optimize the use of the treatment options at our disposal. However, there are still fundamental questions regarding their use, including the step-up and step-down pharmacological approach, that require clarification to optimise the use of these drugs. It is likely that phenotyping COPD patients would help in identifying the right treatment for each COPD patient and improve the effectiveness of therapies.

Herbicide-Resistant Crops: Utilities and Limitations for Herbicide-Resistant Weed Management

PubMed Central

2010-01-01

Since 1996, genetically modified herbicide-resistant (HR) crops, particularly glyphosate-resistant (GR) crops, have transformed the tactics that corn, soybean, and cotton growers use to manage weeds. The use of GR crops continues to grow, but weeds are adapting to the common practice of using only glyphosate to control weeds. Growers using only a single mode of action to manage weeds need to change to a more diverse array of herbicidal, mechanical, and cultural practices to maintain the effectiveness of glyphosate. Unfortunately, the introduction of GR crops and the high initial efficacy of glyphosate often lead to a decline in the use of other herbicide options and less investment by industry to discover new herbicide active ingredients. With some exceptions, most growers can still manage their weed problems with currently available selective and HR crop-enabled herbicides. However, current crop management systems are in jeopardy given the pace at which weed populations are evolving glyphosate resistance. New HR crop technologies will expand the utility of currently available herbicides and enable new interim solutions for growers to manage HR weeds, but will not replace the long-term need to diversify weed management tactics and discover herbicides with new modes of action. This paper reviews the strengths and weaknesses of anticipated weed management options and the best management practices that growers need to implement in HR crops to maximize the long-term benefits of current technologies and reduce weed shifts to difficult-to-control and HR weeds. PMID:20586458

Stockbridge Munsee Community Health and Wellness Center and the Mohican Family Center Renewable Energy and Energy Efficiency Feasibility Study

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

DeRocher, Andy; Barrnett, Michael

2014-03-14

The results of the Renewable Energy and Energy Efficiency Feasibility Study of Stockbridge Munsee Community’s Health and Wellness Center (HWC) indicate that a variety of renewable energy options and energy conservation measures (ECMs) exist for the facility. A requirement of the Request for Proposal for this study was to assess renewable energy options that could offset 30 to 100 percent of the HWC’s energy use. This study identifies that a geothermal system is the most cost effective renewable energy option available to decrease the HWC’s energy consumption by 30 to 100 percent. Currently the HWC performs in the lowest 8more » percent of buildings in its building category, as scored in the EPA portfolio manager benchmarking tool. Multiple ECM opportunities have been identified with paybacks of less than five years to yield an estimated 25-percent decrease in annual energyconsumption. The ECMs within this payback period are estimated to save $26,800 per year with an implementation cost of just $4,650 (0.2 year payback). For the Mohican Family Center document: The results of the Renewable Energy and Energy Efficiency Feasibility Study of Stockbridge Munsee Community’s Mohican Family Center (MFC) indicate that a variety of renewable energy options and energy conservation measures (ECMs) exist for the facility. A requirement of the Request for Proposal for this study was to assess renewable energy options that could offset 30 to 100 percent of the MFC’s energy use. This study identifies that a geothermal system is the most cost effective renewable energy option available to decrease the MFC’s energy consumption by 30 to 100 percent. Currently the MFC performs better than 80 percent of buildings in its building category, as scored in the EPA portfolio manager benchmarking tool. Multiple ECM opportunities have been identified with short term paybacks to yield an estimated 13-percent decrease in energy consumption. The ECMs within this payback period are estimated to save $3,100 per year with an implementation cost of under $20,000.« less

Use of large-scale silvicultural studies to evaluate management options in Pacific Northwest forests of the United States.

Treesearch

Stephen E. Reutebuch; Constance A. Harrington; David D. Marshall; Leslie C. Brodie

2004-01-01

A suite of large-scale silvicultural experiments has been established to develop and assess operational silviculture options for the Pacific Northwest Douglas-fir (Pseudotsuga menziesii [Mirb.] Franco vat. menziesii) forests. This paper summarizes three such studies that focus on three major stages in the life of managed stands...

Identifying wood utilization options for ecosystem management : summary of a national research project

Treesearch

K. E. Skog; R. J. Barbour; J. E. Baumgras; A. Clark

1997-01-01

Using an ecosystem approach to forest management will change silvicultural practices, thus requiring utilization options to provide revenue and to help offset the costs of the silviculture treatments. The Forest Service, university cooperators, and several industry mills in the southern, western, and northeastern United States have been involved in a national...

Developing management options for longleaf communities of the gulf coastal plain

Treesearch

Kenneth W. Outcalt

2003-01-01

Choosing treatments to reduce fuel loads and readjust structure and composition in longleaf communities of the Gulf Coastal Plains region is difficult because benefits and costs of possible treatment combinations are not fully known. The objective of this research project is to develop management options to reduce fuels and restore the ecosystem that are economically...

Developing fire management mixes for fire program planning

Treesearch

Armando González-Cabán; Patricia B. Shinkle; Thomas J. Mills

1986-01-01

Evaluating economic efficiency of fire management program options requires information on the firefighting inputs, such as vehicles and crews, that would be needed to execute the program option selected. An algorithm was developed to translate automatically dollars allocated to type of firefighting inputs to numbers of units, using a set of weights for a specific fire...

Late-successional and old-growth forest effectiveness monitoring plan for the Northwest Forest Plan.

Treesearch

Miles Hemstrom; Thomas Spies; Craig Palmer; Ross Kiester; John Teply; Phil McDonald; Ralph. Warbington

1998-01-01

This report presents options for long-term effectiveness monitoring of late-successional and old-growth forests under the Northwest Forest Plan. It describes methods to answer questions about how much late-successional forest exists on Federal land, its pattern, how it’s changing, and if the Forest Plan is providing for its conservation and management. It specifies...

Effects of dormant-season fire at three different fire frequencies in shortgrass steppe of the southern Great Plains

Treesearch

Paulette L. Ford; Carleton S. White

2008-01-01

Prior to proceeding with large-scale fire reintroduction as a grassland management option, appropriate fire frequencies need to be determined. This research experimentally tested the effects of dormant-season fire on ground cover and on plant and soil nutrient cycling in shortgrass steppe at three different fire frequencies. The objective was to determine if fire...

Nonmarket benefits of reducing environmental effects of potential wildfires in beetle-killed trees: A contingent valuation study

Treesearch

Maryam Tabatabaei; John B. Loomis; Daniel W. McCollum

2015-01-01

We estimated Colorado households’ nonmarket values for two forest management options for reducing intensity of future wildfires and associated nonmarket environmental effects wildfires. The first policy is the traditional harvesting of pine beetle-killed trees and burning of the slash piles of residual materials on-site. The second involves harvesting but moving the...

Watch for pitfalls of discounted cash flow techniques.

PubMed

Chow, C W; McNamee, A H

1991-04-01

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

Caspofungin in the treatment of invasive fungal infections.

PubMed

Keady, Simon; Thacker, Meera

2006-02-01

Caspofungin is a member of a new class of antifungals called Echinocandins and is the first to have marketing authorisation in the United Kingdom. This article reviews the clinical efficacy, side effect profile, dosing and administration schedule of caspofungin. The article also discusses the warnings and precautions associated with the use of this drug. Caspofungin is an effective treatment option in the management of fungal infections.

Integrated models to support multiobjective ecological restoration decisions.

PubMed

Fraser, Hannah; Rumpff, Libby; Yen, Jian D L; Robinson, Doug; Wintle, Brendan A

2017-12-01

Many objectives motivate ecological restoration, including improving vegetation condition, increasing the range and abundance of threatened species, and improving species richness and diversity. Although models have been used to examine the outcomes of ecological restoration, few researchers have attempted to develop models to account for multiple, potentially competing objectives. We developed a combined state-and-transition, species-distribution model to predict the effects of restoration actions on vegetation condition and extent, bird diversity, and the distribution of several bird species in southeastern Australian woodlands. The actions reflected several management objectives. We then validated the models against an independent data set and investigated how the best management decision might change when objectives were valued differently. We also used model results to identify effective restoration options for vegetation and bird species under a constrained budget. In the examples we evaluated, no one action (improving vegetation condition and extent, increasing bird diversity, or increasing the probability of occurrence for threatened species) provided the best outcome across all objectives. In agricultural lands, the optimal management actions for promoting the occurrence of the Brown Treecreeper (Climacteris picumnus), an iconic threatened species, resulted in little improvement in the extent of the vegetation and a high probability of decreased vegetation condition. This result highlights that the best management action in any situation depends on how much the different objectives are valued. In our example scenario, no management or weed control were most likely to be the best management options to satisfy multiple restoration objectives. Our approach to exploring trade-offs in management outcomes through integrated modeling and structured decision-support approaches has wide application for situations in which trade-offs exist between competing conservation objectives. © 2017 Society for Conservation Biology.

A mixed methods evaluation of paediatric trainee preparedness to manage cardiopulmonary arrests.

PubMed

Walsh, Órla; Lydon, Sinéad; O'Connor, Paul

2017-12-01

Paediatric cardiopulmonary arrest (CPA) survival rates are strongly linked to the training of the doctors responding to the event. This study sought to characterise the level of experience in managing CPAs among paediatric trainees and to investigate the nontechnical (NTS) required to effectively lead a paediatric CPA team. A mixed-methods research design was used. For the quantitative phase, a questionnaire was developed to assess training, confidence, and experiences related to CPA management. During the qualitative phase, 17 paediatric trainees participated in a series of critical incident technique (CIT) interviews to explore the NTS used during the management of paediatric CPAs. A total of 56 of 131 (37.1% response rate) trainees responded to the preparedness questionnaire. A total of 48.2% of respondents expressed low confidence in their skill as a team leader during the management of a CPA. The CIT interviews highlighted deficiencies in specific NTS (identifying options, prioritising, and identifying and utilising resources). Our results indicate that there is a desire for more training in CPA management among paediatric trainees, in particular as a team leader, which includes a focus on key NTS. What is Known • Levels of preparedness to be a paediatric cardiopulmonary arrests team member/leader are generally lower than desirable. • The importance of nontechnical skills to the effective performance of adult cardiopulmonary arrests teams has been identified. What is New • Levels of preparedness to be a cardiopulmonary arrests team member were higher than reported in US studies. • There is a need for greater training in cardiopulmonary arrest management which includes a focus on key nontechnical skills to include identifying options, prioritising, identifying and utilising resources.

Phytoremediation as a management option for contaminated sediments in tidal marshes, flood control areas and dredged sediment landfill sites.

PubMed

Bert, Valérie; Seuntjens, Piet; Dejonghe, Winnie; Lacherez, Sophie; Thuy, Hoang Thi Thanh; Vandecasteele, Bart

2009-11-01

Polluted sediments in rivers may be transported by the river to the sea, spread over river banks and tidal marshes or managed, i.e. actively dredged and disposed of on land. Once sedimented on tidal marshes, alluvial areas or control flood areas, the polluted sediments enter semi-terrestrial ecosystems or agro-ecosystems and may pose a risk. Disposal of polluted dredged sediments on land may also lead to certain risks. Up to a few years ago, contaminated dredged sediments were placed in confined disposal facilities. The European policy encourages sediment valorisation and this will be a technological challenge for the near future. Currently, contaminated dredged sediments are often not valorisable due to their high content of contaminants and their consequent hazardous properties. In addition, it is generally admitted that treatment and re-use of heavily contaminated dredged sediments is not a cost-effective alternative to confined disposal. For contaminated sediments and associated disposal facilities used in the past, a realistic, low cost, safe, ecologically sound and sustainable management option is required. In this context, phytoremediation is proposed in the literature as a management option. The aim of this paper is to review the current knowledge on management, (phyto)remediation and associated risks in the particular case of sediments contaminated with organic and inorganic pollutants. This paper deals with the following features: (1) management and remediation of contaminated sediments and associated risk assessment; (2) management options for ecosystems on polluted sediments, based on phytoremediation of contaminated sediments with focus on phytoextraction, phytostabilisation and phytoremediation of organic pollutants and (3) microbial and mycorrhizal processes occurring in contaminated sediments during phytoremediation. In this review, an overview is given of phytoremediation as a management option for semi-terrestrial and terrestrial ecosystems affected by polluted sediments, and the processes affecting pollutant bioavailability in the sediments. Studies that combine contaminated sediment and phytoremediation are relatively recent and are increasing in number since few years. Several papers suggest including phytoremediation in a management scheme for contaminated dredged sediments and state that phytoremediation can contribute to the revaluation of land-disposed contaminated sediments. The status of sediments, i.e. reduced or oxidised, highly influences contaminant mobility, its (eco)toxicity and the success of phytoremediation. Studies are performed either on near-fresh sediment or on sediment-derived soil. Field studies show temporal negative effects on plant growth due to oxidation and subsequent ageing of contaminated sediments disposed on land. The review shows that a large variety of plants and trees are able to colonise or develop on contaminated dredged sediment in particular conditions or events (e.g. high level of organic matter, clay and moisture content, flooding, seasonal hydrological variations). Depending on the studies, trees, high-biomass crop species and graminaceous species could be used to degrade organic pollutants, to extract or to stabilise inorganic pollutants. Water content of sediment is a limiting factor for mycorrhizal development. In sediment, specific bacteria may enhance the mobilisation of inorganic contaminants whereas others may participate in their immobilisation. Bacteria are also able to degrade organic pollutants. Their actions may be increased in the presence of plants. Choice of plants is particularly crucial for phytoremediation success on contaminated sediments. Extremely few studies are long-term field-based studies. Short-term effects and resilience of ecosystems is observed in long-term studies, i.e. due to degradation and stabilisation of pollutants. Terrestrial ecosystems affected by polluted sediments range from riverine tidal marshes with several interacting processes and vegetation development mainly determined by hydrology, over alluvial soils affected by overbank sedimentation (including flood control areas), to dredged sediment disposal facilities where hydrology and vegetation might be affected or managed by human intervention. This gradient is also a gradient of systems with highly variable soil and hydrological conditions in a temporal scale (tidal marshes) versus systems with a distinct soil development over time (dredged sediment landfill sites). In some circumstances (e.g. to avoid flooding or to ensure navigation) dredging operations are necessary. Management and remediation of contaminated sediments are necessary to reduce the ecological risks and risks associated with food chain contamination and leaching. Besides disposal, classical remediation technologies for contaminated sediment also extract or destroy contaminants. These techniques imply the sediment structure deterioration and prohibitive costs. On the contrary, phytoremediation could be a low-cost option, particularly suited to in situ remediation of large sites and environmentally friendly. However, phytoremediation is rarely included in the management scheme of contaminated sediment and accepted as a viable option. Phytoremediation is still an emerging technology that has to prove its sustainability at field scale. Research needs to focus on optimisations to enhance applicability and to address the economic feasibility of phytoremediation.

Taking action against ocean acidification: a review of management and policy options.

PubMed

Billé, Raphaël; Kelly, Ryan; Biastoch, Arne; Harrould-Kolieb, Ellycia; Herr, Dorothée; Joos, Fortunat; Kroeker, Kristy; Laffoley, Dan; Oschlies, Andreas; Gattuso, Jean-Pierre

2013-10-01

Ocean acidification has emerged over the last two decades as one of the largest threats to marine organisms and ecosystems. However, most research efforts on ocean acidification have so far neglected management and related policy issues to focus instead on understanding its ecological and biogeochemical implications. This shortfall is addressed here with a systematic, international and critical review of management and policy options. In particular, we investigate the assumption that fighting acidification is mainly, but not only, about reducing CO2 emissions, and explore the leeway that this emerging problem may open in old environmental issues. We review nine types of management responses, initially grouped under four categories: preventing ocean acidification; strengthening ecosystem resilience; adapting human activities; and repairing damages. Connecting and comparing options leads to classifying them, in a qualitative way, according to their potential and feasibility. While reducing CO2 emissions is confirmed as the key action that must be taken against acidification, some of the other options appear to have the potential to buy time, e.g. by relieving the pressure of other stressors, and help marine life face unavoidable acidification. Although the existing legal basis to take action shows few gaps, policy challenges are significant: tackling them will mean succeeding in various areas of environmental management where we failed to a large extent so far.

Taking Action Against Ocean Acidification: A Review of Management and Policy Options

NASA Astrophysics Data System (ADS)

Billé, Raphaël; Kelly, Ryan; Biastoch, Arne; Harrould-Kolieb, Ellycia; Herr, Dorothée; Joos, Fortunat; Kroeker, Kristy; Laffoley, Dan; Oschlies, Andreas; Gattuso, Jean-Pierre

2013-10-01

Ocean acidification has emerged over the last two decades as one of the largest threats to marine organisms and ecosystems. However, most research efforts on ocean acidification have so far neglected management and related policy issues to focus instead on understanding its ecological and biogeochemical implications. This shortfall is addressed here with a systematic, international and critical review of management and policy options. In particular, we investigate the assumption that fighting acidification is mainly, but not only, about reducing CO2 emissions, and explore the leeway that this emerging problem may open in old environmental issues. We review nine types of management responses, initially grouped under four categories: preventing ocean acidification; strengthening ecosystem resilience; adapting human activities; and repairing damages. Connecting and comparing options leads to classifying them, in a qualitative way, according to their potential and feasibility. While reducing CO2 emissions is confirmed as the key action that must be taken against acidification, some of the other options appear to have the potential to buy time, e.g. by relieving the pressure of other stressors, and help marine life face unavoidable acidification. Although the existing legal basis to take action shows few gaps, policy challenges are significant: tackling them will mean succeeding in various areas of environmental management where we failed to a large extent so far.

Alternatives to neonicotinoid insecticides for pest control: case studies in agriculture and forestry.

PubMed

Furlan, Lorenzo; Kreutzweiser, David

2015-01-01

Neonicotinoid insecticides are widely used for control of insect pests around the world and are especially pervasive in agricultural pest management. There is a growing body of evidence indicating that the broad-scale and prophylactic uses of neonicotinoids pose serious risks of harm to beneficial organisms and their ecological function. This provides the impetus for exploring alternatives to neonicotinoid insecticides for controlling insect pests. We draw from examples of alternative pest control options in Italian maize production and Canadian forestry to illustrate the principles of applying alternatives to neonicotinoids under an integrated pest management (IPM) strategy. An IPM approach considers all relevant and available information to make informed management decisions, providing pest control options based on actual need. We explore the benefits and challenges of several options for management of three insect pests in maize crops and an invasive insect pest in forests, including diversifying crop rotations, altering the timing of planting, tillage and irrigation, using less sensitive crops in infested areas, applying biological control agents, and turning to alternative reduced risk insecticides. Continued research into alternatives is warranted, but equally pressing is the need for information transfer and training for farmers and pest managers and the need for policies and regulations to encourage the adoption of IPM strategies and their alternative pest control options.

Decision analysis and drug development portfolio management: uncovering the real options value of your projects.

PubMed

Rosati, Nicoletta

2002-04-01

Project selection and portfolio management are particularly challenging in the pharmaceutical industry due to the high risk - high stake nature of the drug development process. In the recent years, scholars and industry experts have agreed that traditional Net-Present-Value evaluation of the projects fails to capture the value of managerial flexibility, and encouraged adopting a real options approach to recover the missed value. In this paper, we take a closer look at the drug development process and at the indices currently used to rank projects. We discuss the economic value of information and of real options arising in drug development and present decision analysis as an ideal framework for the implementation of real options valuation.

Advanced Management of Severe Keloids.

PubMed

Hagele, Thomas; Nyanda, Hoka; Patel, Nishit; Russell, Nicole; Cohen, George; Nelson, Christopher

2017-01-01

Keloids negatively impact the health and quality of life of many affected dermatologic patients. Treating keloids is often difficult, and suboptimal responses are frequent. Fortunately, there are many treatment options available to the clinician that may lead to improved clinical outcomes. We present a review of currently available therapeutic options. Intralesional steroid injection remains the first-line treatment for keloids. Imiquimod, direct interferon therapy, or intralesional 5-flurouracil may alleviate the need for excessive corticosteroid therapy. Radiation and laser therapy are emerging therapeutic options that have demonstrated efficacy in reviewed studies. Given the unsatisfactory outcomes associated with pressure dressings, vitamin E, ablative laser, and surgical excision, these options should be avoided in keloid management. Further research is needed to evaluate the efficacy and recurrence associated with the reviewed therapeutics.

[Pain management in chronic pancreatitis and chronic inflammatory bowel diseases].

PubMed

Preiß, J C; Hoffmann, J C

2014-06-01

Apart from local inflammation and defects in secretion, central mechanisms are important for pain etiology in chronic pancreatitis. Therefore, centrally acting co-analgetic agents can be used in addition to classical pain medications. Endoscopic interventions are preferred in patients with obvious dilation of the pancreatic duct. Surgical interventions are generally more effective although they are usually reserved for patients with prior failure of conservative treatment. Diverse surgical options with different efficacies and morbidities are used in individual patients.One of the main problems in chronic inflammatory bowel diseases is abdominal pain. Primarily the underlying disease needs to be adequately treated. Symptomatic pain management will most likely include treatment with acetaminophen and tramadol as well as occasionally principles of a multimodal pain regimen. For the treatment of arthralgia as well as enteropathy-associated arthritis the same treatment options are available as for other spondyloarthritic disorders.

Advances in facial reanimation.

PubMed

Tate, James R; Tollefson, Travis T

2006-08-01

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

Updates in the management of diabetic macular edema.

PubMed

Mathew, Christopher; Yunirakasiwi, Anastasia; Sanjay, Srinivasan

2015-01-01

Diabetes mellitus is a chronic disease which has multiple effects on different end-organs, including the retina. In this paper, we discuss updates on diabetic macular edema (DME) and the management options. The underlying pathology of DME is the leakage of exudates from retinal microaneurysms, which trigger subsequent inflammatory reactions. Both clinical and imaging techniques are useful in diagnosing, classifying, and gauging the severity of DME. We performed a comprehensive literature search using the keywords "diabetes," "macula edema," "epidemiology," "pathogenesis," "optical coherence tomography," "intravitreal injections," "systemic treatment," "hypertension," "hyperlipidemia," "anemia," and "renal disease" and collated a total of 47 relevant articles published in English language. The main modalities of treatment currently in use comprise laser photocoagulation, intravitreal pharmacological and selected systemic pharmacological options. In addition, we mention some novel therapies that show promise in treating DME. We also review systemic factors associated with exacerbation or improvement in DME.

Perforated gastric ulcer--reappraisal of surgical options.

PubMed

Madiba, T E; Nair, R; Mulaudzi, T V; Thomson, S R

2005-08-01

The available operative procedures for perforated gastric ulcer are gastrectomy, ulcer excision and omental patch closure. This study analysed the outcome of these operative options in a single institution. Seventy-two patients (mean age 43 years, 62 males) with perforated gastric ulcers were managed by laparotomy. There were 34 lesser curve (incisural) and 38 antral ulcers. Partial gastrectomy was performed in 27 patients, ulcer excision in 27 and simple patch closure in 18. Two ulcers were malignant. The mortality rate was 18% (26% for gastrectomy, 19% for ulcer excision and 5% for patch closure). Shock on admission (p = 0.006) and Candida (p = 0.020) in the histological specimen were predictive of poor outcome. Hospital stay was similar in the 3 groups. Omental patch closure and ulcer excision are as effective as gastrectomy in the management of perforated gastric ulcer and merit consideration as first-line therapy in technically applicable cases.

Update on treatment modalities for optic nerve sheath meningiomas.

PubMed

Liu, James K; Forman, Scott; Moorthy, Chitti R; Benzil, Deborah L

2003-05-15

Optic nerve sheath meningiomas (ONSMs) represent 1 to 2% of all meningiomas and one third of all optic nerve tumors. The management of ONSMs is controversial. Traditional surgical removal often results in postoperative blindness in the affected eye and thus has been abandoned as a treatment option in most patients. Surgery may be unnecessarily aggressive, especially if the patient has useful vision. When these tumors are left untreated, however, ensuing progressive visual impairment may lead to complete blindness. More recently, radiotherapy has gained wider acceptance as a treatment for these lesions. The authors of some reports have suggested that fractionated stereotactic radiosurgery (SRS) may be the best option for treating primary ONSMs. In patients with documented progressive visual deterioration, fractionated SRS may be effective in improving or stabilizing remaining functional vision. The authors review the clinical presentation, radiographic characteristics, and management of ONSMs, emphasizing the use of fractionated SRS.

The management of scoliosis in children with cerebral palsy: a review

PubMed Central

Gardner, Adrian

2016-01-01

Children who suffer with cerebral palsy (CP) have a significant chance of developing scoliosis during their early years and adolescence. The behavior of this scoliosis is closely associated with the severity of the CP disability and unlike idiopathic scoliosis, it continues to progress beyond skeletal maturity. Conservative measures may slow the progression of the curve, however, surgery remains the only definitive management option. Advances in surgical technique over the last 50 years have provided methods to effectively treat the deformity while also reducing complication rates. The increased risk of surgical complications with these complex patients make decisions about treatment challenging, however with careful pre-operative optimization and post-operative care, surgery can offer a significant improvement in quality of life. This review discusses the development of scoliosis in CP patient, evaluates conservative and surgical treatment options and assesses post-operative outcome. PMID:28097247

42 CFR 438.356 - State contract options.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false State contract options. 438.356 Section 438.356 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE External Quality Review § 438.356 State contract options...

Novel pharmacological approaches for the treatment of acne vulgaris.

PubMed

Valente Duarte de Sousa, Isabel Cristina

2014-10-01

Acne vulgaris is the most common skin disease worldwide; yet, current treatment options, although effective, are associated with unwanted side effects, chronicity, relapses and recurrences. The adequate control of the four pathogenic mechanisms, involved in the appearance of acne lesions, is paramount to treatment success. The authors discuss and evaluate the pathogenic pathways related to the mechanisms of action of novel molecules, which are currently under investigation for the treatment of acne vulgaris. The manuscript is based on comprehensive searches made through PubMed, GoogleScholar and ClinicalTrial.gov, using different combination of key words, which include acne vulgaris, pathogenesis, treatment, sebogenesis and Propionibacterium acnes. In the near future, more effective treatments with fewer side effects are expected. The use of topical antiandrogens, acetylcholine inhibitors and PPAR modulators seem to be promising options for controlling sebum production. Retinoic acid metabolism-blocking agents and IL-1α inhibitors have the potential to become legitimate alternative options to retinoid therapy in the management of infundibular dyskeratosis. Indeed, the authors believe that there will likely be a decline in the use of antibiotics for controlling P. acnes colonization and targeting the inflammation cascade.

Perceived impact of Nepalese food and food culture in diabetes.

PubMed

Sapkota, Sujata; Brien, Jo-Anne E; Gwynn, Josephine; Flood, Victoria; Aslani, Parisa

2017-06-01

Consuming a healthy diet forms an important component of diabetes management; however, adhering to a healthy diet is challenging. Dietary behaviour is often guided by socio-cultural, environmental and emotional factors, and not necessarily by physical and nutritional needs. This study explored Nepalese patients' perceptions of the impact of diet, diet management requirement for diabetes and how Nepalese food culture in particular influenced diet management. Interviews were conducted with Nepalese participants with type 2 diabetes in Sydney and Kathmandu; and data was thematically analysed. Diet was recognized as a cause of, and a key treatment modality, in diabetes. Besides doctors, participants in Nepal received a large amount of dietary information from the community. Dietary changes formed a major component of lifestyle modifications adopted after diagnosis, and mostly consisted of removal of foods with added sugar and foods with high total sugar content from the diet, and a reduction in overall quantity of foods consumed. Perceived dietary restriction requirements created social and emotional discomfort to patients. Most participants perceived the Nepalese food culture as a barrier to effective diet management. Meals high in carbohydrates, limited food choices, and food preparation methods were identified as barriers, particularly in Nepal. In Australia, participants reported greater availability and easier access to appropriate food, and healthier cooking options. The socio-cultural aspects of food behaviour, mainly, food practices during social events were identified as significant barriers. Although diet was acknowledged as an important component of diabetes care, and most adopted changes in their diet post-diagnosis, effective and sustained changes were difficult to achieve. Future public health campaigns and education strategies should focus on improving diet knowledge, awareness of food options for diabetes, and effective dietary management. Copyright © 2017 Elsevier Ltd. All rights reserved.

Surgical Management of Hemorrhoids

PubMed Central

Agbo, S. P.

2011-01-01

Hemorrhoids are common human afflictions known since the dawn of history. Surgical management of this condition has made tremendous progress from complex ligation and excision procedures in the past to simpler techniques that allow the patient to return to normal life within a short period. Newer techniques try to improve on the post-operative complications of older ones. The surgical options for the management of hemorrhoids today are many. Capturing all in a single article may be difficult if not impossible. The aim of this study therefore is to present in a concise form some of the common surgical options in current literature, highlighting some important post operative complications. Current literature is searched using MEDLINE, EMBASE and the Cochrane library. The conclusion is that even though there are many surgical options in the management of hemorrhoids today, most employ the ligature and excision technique with newer ones having reduced post operative pain and bleeding. PMID:22413048

Non-surgical management of early knee osteoarthritis.

PubMed

Kon, Elizaveta; Filardo, Giuseppe; Drobnic, Matej; Madry, Henning; Jelic, Mislav; van Dijk, Niek; Della Villa, Stefano

2012-03-01

Conservative approach is usually the first choice for the management of the knee degeneration processes, especially in the phase of the disease recognized as early osteoarthritis (OA) with no clear lesions or associated abnormalities requiring to be addressed surgically. A wide spectrum of treatments is available, from non-pharmacological modalities to dietary supplements and pharmacological therapies, as well as minimally invasive procedures involving injections of various substances aiming to restore joint homeostasis and provide clinical improvement and possibly a disease-modifying effect. Numerous pharmaceuticals have been proposed, but since no therapy has shown all the characteristic of an ideal treatment, and side effects have been reported at both systemic and local level, the use of pharmacological agents should be considered with caution by assessing the risk/benefit ratio of the drugs prescribed. Both patients and physicians should have realistic outcome goals in pharmacological treatment, which should be considered together with other conservative measures. A combination of these therapeutic options is a more preferable scenario, in particular considering the evidence available for non-pharmacological management. In fact, exercise is an effective conservative approach, even if long-term effectiveness and optimal dose and administration modalities still need to be clarified. Finally, physical therapies are emerging as viable treatment options, and novel biological approaches are under study. Further studies to increase the limited medical evidence on conservative treatments, optimizing results, application modalities, indications, and focusing on early OA will be necessary in the future. Level of evidence IV.

Effectiveness of a publicly-funded demonstration program to promote management of dryland salinity.

PubMed

Robertson, M J; Measham, T G; Batchelor, G; George, R; Kingwell, R; Hosking, K

2009-07-01

Community and catchment-based approaches to salinity management continue to attract interest in Australia. In one such approach, Catchment Demonstration Initiative (CDI) projects were established by the Western Australian (WA) Government in 2000 for targeted investment in large-scale catchment-based demonstrations of integrated salinity management practices. The aim was to promote a process for technically-informed salinity management by landholders. This paper offers an evaluation of the effectiveness of one CDI project in the central wheatbelt of WA, covering issues including: its role in fostering adoption of salinity management options, the role of research and the technical requirements for design and implementation of on-ground works, the role of monitoring and evaluation, the identification and measurement of public and private benefits, comparison and identification of the place and value of plant-based and engineering-based options, reliance on social processes and impacts of constraints on capacity, management of governance and administration requirements and an appreciation of the value of group-based approaches. A number of factors may reduce the effectiveness of CDI-type approaches in facilitating landholder action to address salinity, many of these are socially-based. Such approaches can create considerable demands on landholders, can be expensive (because of the planning and accountability required) on the basis of dollars per hectare impacted, and can be difficult to garner ownership from all involved. An additional problem could be that few community groups would have the capacity to run such programs and disseminate the new knowledge so that the CDI-type projects can impact outside the focus catchment. In common with many publicly-funded approaches to salinity, we found that direct benefits on public assets are smaller than planned and that results from science-based requirements of monitoring and evaluation have long lead times, causing farmers to either wait for the information or act sooner and take risks based on initial results. We also found that often it is a clear outline of the process that is of most importance in decision making as opposed to the actual results. We identified limitations in regulatory processes and the capacity for local government to engage in the CDI. The opportunities that CDI-type approaches provide centre around the value of its group-based approach. We conclude that they can overcome knowledge constraints in managing salinity by fostering group-based learning, offer a structured process of trialling options so that the costs and benefits can be clearly and transparently quantified, and avoid the costly mistakes and "learning failures" of the past.

Providing Guidance for Patients With Moderate-to-Severe Psoriasis Who Are Candidates for Biologic Therapy: Role of the Nurse Practitioner and Physician Assistant.

PubMed

Aldredge, Lakshi M; Young, Melodie S

2016-01-01

Psoriasis is a chronic, immune-mediated disease characterized by itchy, scaly, and often painful plaques in the skin. Psoriasis can have significant psychosocial burdens and increased risks for numerous comorbidities, including diabetes, hypertension, and cardiovascular disease, particularly in patients with moderate-to-severe disease. Dermatology nurse practitioners and physician assistants are an important part of the healthcare team, contributing to all aspects of psoriasis management. This review reinforces the unique aspects of care that nurse practitioners and physician assistants provide to patients with psoriasis, such as facilitating conversations about managing disease, setting appropriate expectations, and considering treatment options, including when treatment response or tolerability is suboptimal. The importance of relationship building is stressed. Patient management topics discussed include helpful tips about assessing treatment options, initiating biologic therapy, optimizing patient adherence, and managing comorbidities. Also reviewed are how to deal with common barriers including lack of knowledge about psoriasis or making healthy lifestyle changes, fear of injections or side effect risks, lack of health insurance, and concerns about treatment costs. Overall, by forming meaningful relationships and engaging patients in their psoriasis care, nurse practitioners and physician assistants can help to optimize clinical efficacy outcomes and consistently manage moderate-to-severe psoriasis and its comorbidities over the patient's life course.

Linking intended visitation to regional economic impact models of bison and elk management

USGS Publications Warehouse

Loomis, J.; Caughlan, L.

2004-01-01

This article links intended National Park visitation estimates to regional economic models to calculate the employment impacts of alternative bison and elk management strategies. The survey described alternative National Elk Refuge (NER) management actions and the effects on elk and bison populations at the NER and adjacent Grand Teton National Park (GTNP). Park visitors were then asked if they would change their number of visits with each potential management action. Results indicate there would be a 10% decrease in visitation if bison populations were reduced from 600 to 400 animals and elk populations were reduced in GTNP and the NER. The related decrease in jobs in Teton counties of Wyoming and Idaho is estimated at 5.5%. Adopting a “no active management” option of never feeding elk and bison on the NER yields about one-third the current bison population (200 bison) and about half the elk population. Visitors surveyed about this management option would take about 20% fewer trips, resulting in an 11.3% decrease in employment. Linking intended visitation surveys and regional economic models represents a useful tool for natural resource planners who must present the consequences of potential actions in Environmental Impact Statements and plans to the public and decision makers prior to any action being implemented.

Premature ejaculation: A clinical review for the general physician.

PubMed

Chung, Eric; Gilbert, Brent; Perera, Marlon; Roberts, Matthew J

2015-10-01

Premature ejaculation is one of the most common sexual dysfunctions in men. Recent epidemiological studies suggest its prevalence in Australia may range from 21-31% This article will discuss the current definition of premature ejaculation from a urological perspective. It will provide an understanding of the pathogenesis of premature ejaculation, as well as assessment and management options. Premature ejaculation can have a significant adverse effect on the quality of life for the patient and his sexual partners. It can potentially lead to psychological distress, diminished self- esteem, anxiety, erectile dysfunction, reduced libido and poor interpersonal relationships. Most men feel reluctant to discuss premature ejaculation with their general practitioner despite its psychological, emotional and relational effects. Effective, evidence-based treatment options are available and physicians should feel confident when exploring ways to improve the quality of life for men with sexual dysfunction.

Knowledge and Practices Relating to Acute Pesticide Poisoning Among Health Care Providers in Selected Regions of Tanzania.

PubMed

Lekei, Elikana; Ngowi, Aiwerasia V; Mkalanga, Habib; London, Leslie

2017-01-01

Acute pesticide poisoning (APP) is commonly underdiagnosed in Tanzania. Studies in developing countries suggest that a lack of diagnostic skills among health care providers (HCPs) undermines surveillance for APP. This study aimed at characterizing experience and skills of Tanzanian HCPs regarding APP diagnosis and management. The population included HCPs responsible for managing APP in Kilimanjaro and Arusha regions (n = 91). The resulting sample included 66 respondents (response rate: 73%). The data were collected in 2005 using a standardized questionnaire. Half of all respondents (50%) reported handling at least 1 APP case with 15% reporting handling more than 5 cases in the past. Reported experience of handling an APP case was marginally higher in respondents who reported ⩾4 years of work experience in the health sector compared with those with <4 years of work experience (odds ratio = 1.32; 95% confidence interval = 0.9-1.5). Most of the respondents had high knowledge of exposure routes, reporting awareness of oral (98.5%), inhalational (93.9%), and dermal (77%) routes. The study revealed low awareness of pesticide classification by chemical groups (29%) or World Health Organization hazard (0%) and weak knowledge on pesticide label instructions (55%). Organophosphates accounted for 35% of the pesticide products reported by respondents as being responsible for poisoning. Some treatment options were incorrectly reported as first aid options, and some reported first aid options were wrong or inappropriate. The study revealed that HCPs in northern Tanzania lack adequate skills to diagnose and manage APP. For effective surveillance of APP, there is a need to include training on hazards, classification, diagnosis, and health effects in the training programmes for all HCPs in Tanzania.

Knowledge and Practices Relating to Acute Pesticide Poisoning Among Health Care Providers in Selected Regions of Tanzania

PubMed Central

Lekei, Elikana; Ngowi, Aiwerasia V; Mkalanga, Habib; London, Leslie

2017-01-01

Background: Acute pesticide poisoning (APP) is commonly underdiagnosed in Tanzania. Studies in developing countries suggest that a lack of diagnostic skills among health care providers (HCPs) undermines surveillance for APP. This study aimed at characterizing experience and skills of Tanzanian HCPs regarding APP diagnosis and management. Methodology: The population included HCPs responsible for managing APP in Kilimanjaro and Arusha regions (n = 91). The resulting sample included 66 respondents (response rate: 73%). The data were collected in 2005 using a standardized questionnaire. Results: Half of all respondents (50%) reported handling at least 1 APP case with 15% reporting handling more than 5 cases in the past. Reported experience of handling an APP case was marginally higher in respondents who reported ⩾4 years of work experience in the health sector compared with those with <4 years of work experience (odds ratio = 1.32; 95% confidence interval = 0.9-1.5). Most of the respondents had high knowledge of exposure routes, reporting awareness of oral (98.5%), inhalational (93.9%), and dermal (77%) routes. The study revealed low awareness of pesticide classification by chemical groups (29%) or World Health Organization hazard (0%) and weak knowledge on pesticide label instructions (55%). Organophosphates accounted for 35% of the pesticide products reported by respondents as being responsible for poisoning. Some treatment options were incorrectly reported as first aid options, and some reported first aid options were wrong or inappropriate. Conclusions: The study revealed that HCPs in northern Tanzania lack adequate skills to diagnose and manage APP. For effective surveillance of APP, there is a need to include training on hazards, classification, diagnosis, and health effects in the training programmes for all HCPs in Tanzania. PMID:28469444

Sickle Cell Disease: Management Options and Challenges in Developing Countries

PubMed Central

Ansong, Daniel; Akoto, Alex Osei; Ocloo, Delaena; Ohene-Frempong, Kwaku

2013-01-01

Sickle Cell Disease (SCD) is the most common genetic disorder of haemoglobin in sub-Saharan Africa. This commentary focuses on the management options available and the challenges that health care professionals in developing countries face in caring for patients with SCD. In a developing countries like Ghana, new-born screening is now about to be implemented on a national scale. Common and important morbidities associated with SCD are vaso-occlusive episodes, infections, Acute Chest Syndrome (ACS), Stroke and hip necrosis. Approaches to the management of these morbidities are far advanced in the developed countries. The differences in setting and resource limitations in developing countries bring challenges that have a major influence in management options in developing countries. Obviously clinicians in developing countries face challenges in managing SCD patients. However understanding the disease, its progression, and instituting the appropriate preventive methods are paramount in its management. Emphasis should be placed on early counselling, new-born screening, anti-microbial prophylaxis, vaccination against infections, and training of healthcare workers, patients and caregivers. These interventions are affordable in developing countries. PMID:24363877

Hemorrhagic cystitis: A challenge to the urologist

PubMed Central

Manikandan, R.; Kumar, Santosh; Dorairajan, Lalgudi N.

2010-01-01

Severe hemorrhagic cystitis often arises from anticancer chemotherapy or radiotherapy for pelvic malignancies. Infectious etiologies are less common causes except in immunocompromised hosts. These cases can be challenging problems for the urologist and a source of substantial morbidity and sometimes mortality for the patients. A variety of modalities of treatment have been described for the management of hemorrhagic cystitis but there is none that is uniformly effective. Some progress has been made in the understanding and management of viral hemorrhagic cystitis. This article reviews the common causes of severe hemorrhagic cystitis and the currently available management options. PMID:20877590

Dietary Management of Obesity: Cornerstones of Healthy Eating Patterns.

PubMed

Smethers, Alissa D; Rolls, Barbara J

2018-01-01

Several dietary patterns, both macronutrient and food based, can lead to weight loss. A key strategy for weight management that can be applied across dietary patterns is to reduce energy density. Clinical trials show that reducing energy density is effective for weight loss and weight loss maintenance. A variety of practical strategies and tools can help facilitate successful weight management by reducing energy density, providing portion control, and improving diet quality. The flexibility of energy density gives patients options to tailor and personalize their dietary pattern to reduce energy intake for sustainable weight loss. Copyright © 2017 Elsevier Inc. All rights reserved.

Lethal trap trees: a potential option for emerald ash borer (Agrilus planipennis Fairmaire) management.

PubMed

McCullough, Deborah G; Poland, Therese M; Lewis, Phillip A

2016-05-01

Economic and ecological impacts of ash (Fraxinus spp.) mortality resulting from emerald ash borer (EAB) (Agrilus planipennis Fairmaire) invasion are severe in forested, residential and urban areas. Management options include girdling ash trees to attract ovipositing adult beetles and then destroying infested trees before larvae develop or protecting ash with a highly effective, systemic emamectin benzoate insecticide. Injecting this insecticide and then girdling injected trees a few weeks later could effectively create lethal trap trees, similar to a bait-and-kill tactic, if girdling does not interfere with insecticide translocation. We compared EAB larval densities on girdled trees, trees injected with the emamectin benzoate insecticide, trees injected with the insecticide and then girdled 18-21 days later and untreated controls at multiple sites. Pretreatment larval densities did not differ among treatments. Current-year larval densities were higher on girdled and control trees than on any trees treated with insecticide at all sites. Foliar residue analysis and adult EAB bioassays showed that girdling trees after insecticide injections did not reduce insecticide translocation. Girdling ash trees to attract adult EAB did not reduce efficacy of emamectin benzoate trunk injections applied ≥ 18 days earlier and could potentially be used in integrated management programs to slow EAB population growth. © 2015 Society of Chemical Industry.

Novel approaches for the management of tendinopathy.

PubMed

Maffulli, Nicola; Longo, Umile Giuseppe; Denaro, Vincenzo

2010-11-03

Tendinopathy is a failed healing response of the tendon. Despite an abundance of therapeutic options, very few randomized prospective, placebo-controlled trials have been carried out to assist physicians in choosing the best evidence-based management. Eccentric exercises have been proposed to promote collagen fiber cross-link formation within the tendon, thereby facilitating tendon remodeling. Overall results suggest a trend for a positive effect of eccentric exercises, with no reported adverse effects. Combining eccentric training and shock wave therapy produces higher success rates compared with eccentric loading alone or shock wave therapy alone. The use of injectable substances such as platelet-rich plasma, autologous blood, polidocanol, corticosteroids, and aprotinin in and around tendons is popular, but there is minimal clinical evidence to support their use. The aim of operative treatment is to excise fibrotic adhesions, remove areas of failed healing, and make multiple longitudinal incisions in the tendon to detect intratendinous lesions and to restore vascularity and possibly stimulate the remaining viable cells to initiate cell matrix response and healing. New operative procedures include endoscopy, electrocoagulation, and minimally invasive stripping. The aim of these techniques is to disrupt the abnormal neoinnervation to interfere with the pain sensation caused by tendinopathy. Randomized controlled trials are necessary to better clarify the best therapeutic options for the management of tendinopathy.

Antisense therapy and emerging applications for the management of dyslipidemia.

PubMed

Toth, Peter P

2011-01-01

Because a significant percentage of patients who require high-dose statin therapy for dyslipidemia experience treatment-related muscle symptoms and an inconsistent clinical response, alternative or adjunctive approaches to the management of dyslipidemia are needed. One alternative approach, antisense therapy, may offer an effective and well-tolerated option for patients not satisfactorily responsive to or intolerant to standard pharmacologic dyslipidemia therapies. This review provides an overview of antisense technology and its potential role in the management of dyslipidemia. Source material was obtained primarily from the published literature identified through a search of the PubMed database. Antisense technology is an evolving approach to therapy that has gone through a series of refinements to enhance molecular stability, potency, and tolerability. Mipomersen is an antisense molecule capable of producing clinically meaningful reductions in low-density lipoprotein cholesterol in patients with severe familial hypercholesterolemia. Further long-term clinical studies are required to more clearly quantify its impact on risk for cardiovascular events and establish whether it increases risk for hepatosteatosis. Antisense therapy represents a potentially effective and well-tolerated emerging treatment modality for numerous diseases. In the treatment of hypercholesterolemia, the antisense therapy mipomersen may provide a possible treatment option for patients with treatment-resistant dyslipidemia. Copyright © 2011 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Management of scars: updated practical guidelines and use of silicones.

PubMed

Meaume, Sylvie; Le Pillouer-Prost, Anne; Richert, Bertrand; Roseeuw, Diane; Vadoud, Javid

2014-01-01

Hypertrophic scars and keloids resulting from surgery, burns, trauma and infection can be associated with substantial physical and psychological distress. Various non-invasive and invasive options are currently available for the prevention and treatment of these scars. Recently, an international multidisciplinary group of 24 experts on scar management (dermatologists; plastic and reconstructive surgeons; general surgeons; physical medicine, rehabilitation and burns specialists; psychosocial and behavioural researchers; epidemiologists; beauticians) convened to update a set of practical guidelines for the prevention and treatment of hypertrophic and keloid scars on the basis of the latest published clinical evidence on existing scar management options. Silicone-based products such as sheets and gels are recommended as the gold standard, first-line, non-invasive option for both the prevention and treatment of scars. Other general scar preventative measures include avoiding sun exposure, compression therapy, taping and the use of moisturisers. Invasive treatment options include intralesional injections of corticosteroids and/or 5-fluorouracil, cryotherapy, radiotherapy, laser therapy and surgical excision. All of these options may be used alone or as part of combination therapy. Of utmost importance is the regular re-evaluation of patients every four to eight weeks to evaluate whether additional treatment is warranted. The amount of scar management measures that are applied to each wound depends on the patient's risk of developing a scar and their level of concern about the scar's appearance. The practical advice presented in the current guidelines should be combined with clinical judgement when deciding on the most appropriate scar management measures for an individual patient.

Stent-Graft Repair of a Large Cervical Internal Carotid Artery Pseudoaneurysm Causing Dysphagia

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

Gupta, Vivek, E-mail: drvivekgupta.pgi@gmail.com; Niranjan, Khandelwal; Rawat, Lokesh

2009-05-15

Pseudoaneurysms of the cervical internal carotid artery (ICA) are rare and most frequently result from trauma, infection, or sometimes spontaneously. They have the potential to cause life-threatening hemorrhage; thus, their immediate management is necessary. Endovascular treatment by stent graft placement in the affected artery appears to be a safe and effective treatment option. We present a case of a child who presented with neck swelling and dysphagia caused by a ruptured cervical ICA pseudoaneurysm which was managed by stent graft placement.

43 CFR 2654.1 - Exercise of option.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Exercise of option. 2654.1 Section 2654.1 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT... Exercise of option. (a) Any village corporation which has not, by December 18, 1973, elected to acquire...

43 CFR 2654.1 - Exercise of option.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Exercise of option. 2654.1 Section 2654.1 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT... Exercise of option. (a) Any village corporation which has not, by December 18, 1973, elected to acquire...

43 CFR 2654.1 - Exercise of option.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Exercise of option. 2654.1 Section 2654.1 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT... Exercise of option. (a) Any village corporation which has not, by December 18, 1973, elected to acquire...

43 CFR 2654.1 - Exercise of option.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Exercise of option. 2654.1 Section 2654.1 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT... Exercise of option. (a) Any village corporation which has not, by December 18, 1973, elected to acquire...

17 CFR 33.7 - Disclosure.

Code of Federal Regulations, 2010 CFR

2010-04-01

... introducing broker shall be deemed to be an option customer. (Approved by the Office of Management and Budget..., may open or cause the opening of a commodity option account for an option customer, other than for a customer specified in § 1.55(f) of this chapter, unless the futures commission merchant or introducing...

77 FR 16879 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Order Granting Approval of Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-22

... financial information for investment advisory services, fund administration, portfolio management, financial... the Exchange will be European-style exercise.\\17\\ Upon exercise, holders of options contracts would... Corporation (``OCC'').\\19\\ \\17\\ Unlike American style options, European style options may be exercised only on...

The Implications of Real Options on ERP-Enabled Adoption

ERIC Educational Resources Information Center

Nwankpa, Joseph K.

2012-01-01

Current research on Enterprise Resource Planning (ERP) systems and real options focuses on valuation and justification issues that manager's face prior to project approval with existing literature attempting to demonstrate that ERP systems as technology positioning investments have option-like characteristics thus making such ERP systems…

17 CFR 33.7 - Disclosure.

Code of Federal Regulations, 2011 CFR

2011-04-01

... introducing broker shall be deemed to be an option customer. (Approved by the Office of Management and Budget..., may open or cause the opening of a commodity option account for an option customer, other than for a customer specified in § 1.55(f) of this chapter, unless the futures commission merchant or introducing...

17 CFR 33.7 - Disclosure.

Code of Federal Regulations, 2012 CFR

2012-04-01

... introducing broker shall be deemed to be an option customer. (Approved by the Office of Management and Budget..., may open or cause the opening of a commodity option account for an option customer, other than for a customer specified in § 1.55(f) of this chapter, unless the futures commission merchant or introducing...

Assessing Changes in Amphibian Population Dynamics Following Experimental Manipulations of Introduced Fish

Treesearch

Karen L. Pope

2008-01-01

Sport-fish introductions are now recognized as an important cause of amphibian decline, but few researchers have quantified the demographic responses of amphibians to current options in fisheries management designed to minimize effects on sensitive amphibians. Demographic analyses with mark–recapture data allow researchers to assess the relative importance of...

Preparing for Growth: Human Capital Innovations in Charter Public Schools

ERIC Educational Resources Information Center

Chadwick, Christi; Kowal, Julie

2011-01-01

Charter schools and successful charter management organizations that run them have grown significantly over the past decade but they must dramatically increase their scale in order to meet the demand for high-quality public school options for America's children. The limited supply of effective leaders and teachers is one of the key barriers…

Designing Effective Projects: Decision Options for Maximizing Learning and Project Success

ERIC Educational Resources Information Center

Volkema, Roger J.

2010-01-01

In recent years, more and more business schools have introduced team-based projects into their curricula as a means of addressing corporate, small business, and community-service issues while teaching students a variety of project management skills (technical and sociocultural). In designing a project-oriented course, an instructor has a number of…

Inferences from growing trees backwards

Treesearch

David W. Green; Kent A. McDonald

1997-01-01

The objective of this paper is to illustrate how longitudinal stress wave techniques can be useful in tracking the future quality of a growing tree. Monitoring the quality of selected trees in a plantation forest could provide early input to decisions on the effectiveness of management practices, or future utilization options, for trees in a plantation. There will...

Cost, production and effectiveness of masticated fireline.

Treesearch

Elizabeth Dodson; Dana Mitchell

2016-01-01

Fire managers are continuously looking for improved methods to construct fireline with minimal resource damage. One option for fireline construction that has so far received limited attention is the use of mastication equipment. This study evaluated a masticating disk mounted on a self-leveling feller- buncher for the cost, speed, and adherence to fireline...

Two-aged silvicultural treatments in lodgepole pine stands can be economically viable

Treesearch

Ward W. McCaughey; Steven J. Martin; Dean A. Blomquist

2006-01-01

Economically viable silvicultural options are critical for management activities that provide wood products, reduce forest fuels, improve forest health, and enhance wildlife habitat. The Tenderfoot Research Project was developed in the late 1990s to evaluate and quantify ecological and biological effects of two-aged silvicultural treatments including prescribed fire in...

A wildfire risk assessment framework for land and resource management

Treesearch

Joe H. Scott; Matthew P. Thompson; David E. Calkin

2013-01-01

Wildfires can result in significant, long-lasting impacts to ecological, social, and economic systems. It is necessary, therefore, to identify and understand the risks posed by wildland fire, and to develop cost-effective mitigation strategies accordingly. This report presents a general framework with which to assess wildfire risk and explore mitigation options, and...

The Future of the National Technical Information Service: Issues and Options.

ERIC Educational Resources Information Center

McClure, Charles R.

In recent years there has been considerable debate about the appropriate role, management structure, and activities for the National Technical Information Service (NTIS). This background paper identifies key issues that require attention by Congress and by NTIS itself to increase the effectiveness of NTIS in the collection and dissemination of…

The Theoretical and Empirical Basis for Meditation as an Intervention for PTSD

ERIC Educational Resources Information Center

Lang, Ariel J.; Strauss, Jennifer L.; Bomyea, Jessica; Bormann, Jill E.; Hickman, Steven D.; Good, Raquel C.; Essex, Michael

2012-01-01

In spite of the existence of good empirically supported treatments for posttraumatic stress disorder (PTSD), consumers and providers continue to ask for more options for managing this common and often chronic condition. Meditation-based approaches are being widely implemented, but there is minimal research rigorously assessing their effectiveness.…

Incentives for School Diversification: Competition and Promotional Patterns in Local Education Markets

ERIC Educational Resources Information Center

Lubienski, Christopher

2006-01-01

Reforms using market-style mechanisms of parental choice and competition between schools are intended to leverage change by compelling schools to diversify options and increase effectiveness. Yet, some research challenges those assumptions, suggesting that schools in competitive climates are more likely to focus on image management to attract a…

Teaching Math to My Scholars: Inner City Middle School Students

ERIC Educational Resources Information Center

Iyer, Ranjani; Pitts, Joseph

2017-01-01

Teaching in an inner city school requires classroom management, resilience, and most importantly strategies to promote learning and growth. There is a constant need for acceleration in student growth in core subjects, especially Math. A blended learning model can be an effective option for schools to personalize learning experiences for students…

Chemical yields from low-temperature pyrolysis of CCA-treated wood

Treesearch

Qirong Fu; Dimitris Argyropolous; Lucian Lucia; David Tilotta; Stan Lebow

2009-01-01

Low-temperature pyrolysis offers a feasible option for wood-waste management and the recovery of a variety of useful chemicals. The effect of chromated copper arsenate (CCA) wood preservative on the yield and composition of various pyrolysis products was investigated in the present research. A novel quantitative 31P nuclear magnetic resonance (...

Obesity disease management opportunities and barriers.

PubMed

Sidorov, Jaan E; Fitzner, Karen

2006-04-01

Disease management, a system of coordinated health care interventions and communications for chronically ill populations, relies on patient education and case management to engage individuals in the management of their condition. Disease management also aims to enhance the quality of interactions between doctors and patients and advance evidence-based medicine. Because these programs' interventions frequently include helping individuals who suffer comorbidities associated with obesity to reduce their BMI, adaptation of disease management to populations with obesity seems a viable option. A major barrier for implementing disease management for obesity, however, is the lack of proven return on investment, which limits health plan and disease management organization interest. Purchaser demand may overcome this reluctance. Further research is needed to objectively test whether disease management interventions would be clinically effective for obese populations, produce positive financial outcomes for insurers, and enhance workplace productivity.

Contingency Management and Deliberative Decision-Making Processes.

PubMed

Regier, Paul S; Redish, A David

2015-01-01

Contingency management is an effective treatment for drug addiction. The current explanation for its success is rooted in alternative reinforcement theory. We suggest that alternative reinforcement theory is inadequate to explain the success of contingency management and produce a model based on demand curves that show how little the monetary rewards offered in this treatment would affect drug use. Instead, we offer an explanation of its success based on the concept that it accesses deliberative decision-making processes. We suggest that contingency management is effective because it offers a concrete and immediate alternative to using drugs, which engages deliberative processes, improves the ability of those deliberative processes to attend to non-drug options, and offsets more automatic action-selection systems. This theory makes explicit predictions that can be tested, suggests which users will be most helped by contingency management, and suggests improvements in its implementation.

Contingency Management and Deliberative Decision-Making Processes

PubMed Central

Regier, Paul S.; Redish, A. David

2015-01-01

Contingency management is an effective treatment for drug addiction. The current explanation for its success is rooted in alternative reinforcement theory. We suggest that alternative reinforcement theory is inadequate to explain the success of contingency management and produce a model based on demand curves that show how little the monetary rewards offered in this treatment would affect drug use. Instead, we offer an explanation of its success based on the concept that it accesses deliberative decision-making processes. We suggest that contingency management is effective because it offers a concrete and immediate alternative to using drugs, which engages deliberative processes, improves the ability of those deliberative processes to attend to non-drug options, and offsets more automatic action-selection systems. This theory makes explicit predictions that can be tested, suggests which users will be most helped by contingency management, and suggests improvements in its implementation. PMID:26082725

A comparison of benefit and economic value between two sound therapy tinnitus management options.

PubMed

Newman, Craig W; Sandridge, Sharon A

2012-02-01

Sound therapy coupled with appropriate counseling has gained widespread acceptance in the audiological management of tinnitus. For many years, ear level sound generators (SGs) have been used to provide masking relief and to promote tinnitus habituation. More recently, an alternative treatment device was introduced, the Neuromonics Tinnitus Treatment (NTT), which employs spectrally-modified music in an acoustic desensitization approach in order to help patients overcome the disturbing consequences of tinnitus. It is unknown, however, if one treatment plan is more efficacious and cost-effective in comparison to the other. In today's economic climate, it has become critical that clinicians justify the value of tinnitus treatment devices in relation to observed benefit. To determine perceived benefit from, and economic value associated with, two forms of sound therapy, namely, SGs and NTT. Retrospective between-subject clinical study. A sample of convenience comprised of 56 patients drawn from the Tinnitus Management Clinic at the Cleveland Clinic participated. Twenty-three patients selected SGs, and 33 patients selected NTT as their preferred sound therapy treatment option. Sound therapy benefit was quantified using the Tinnitus Handicap Inventory (THI). The questionnaire was administered before and 6 mo after initiation of tinnitus treatment. Prior to device fitting, all patients participated in a 1.5 hr group education session about tinnitus and its management. Economic value comparisons between sound therapy options were made using a cost-effectiveness analysis (CEA) and cost-utility analysis (CUA). THI scores indicated a significant improvement (p < 0.001) in tinnitus reduction for both treatment types between a pre- and 6 mo postfitting interval, yet there were no differences (p > 0.05) between the treatment alternatives at baseline or 6 mo postfitting. The magnitude of improvement for both SGs and NTT was dependent on initial perceived tinnitus handicap. Based on the CEA and CUA economic analyses alone, it appears that the SGs may be the more cost-effective alternative; however, the magnitude of economic value is a function of preexisting perceived tinnitus activity limitation/participation restriction. Both SGs and NTT provide significant reduction in perceived tinnitus handicap, with benefit being more pronounced for those patients having greater tinnitus problems at the beginning of therapy. Although the economic models favored the SGs over the NTT, there are several other critical factors that clinicians must take into account when recommending a specific sound therapy option. These include initial tinnitus severity complaints and a number of patient preference variables such as sound preference, listening acceptability, and lifestyle. American Academy of Audiology.

Management options for songbirds using the oak shelterwood-burn technique in upland forests of the Southeastern United States

Treesearch

J. Drew Lanham; Patrick D. Keyser; Patrick H. Brose; David H. Van Lear

2002-01-01

The shelterwood-burn technique is a novel method for regenerating oak-dominated stands on some upland sites while simultaneously minimizing undesirable hardwood intrusion with prescribed fire. Management options available within an oak shelterwood-burn regime will create variably structured habitats that may potentially harbor avian communities of mature forest and...

Managing forest structure and fire hazard--a tool for planners.

Treesearch

M.C. Johnson; D.L. Peterson; C.L. Raymond

2006-01-01

Fire planners and other resource managers need to examine a range of potential fuel and vegetation treatments to select options that will lead to desired outcomes for fire hazard and natural resource conditions. A new approach to this issue integrates concepts and tools from silviculture and fuel science to quantify outcomes for a large number of treatment options in...

Managing chronic back pain: impact of an interdisciplinary team approach.

PubMed

Flavell, H A; Carrafa, G P; Thomas, C H; Disler, P B

1996-09-02

To evaluate the effectiveness of a six-week outpatient program in pain management for patients with chronic back pain. Retrospective review. Rehabilitation Clinical Business Unit, Essendon campus of the Royal Melbourne Hospital. 138 consecutive patients who participated in the unit's Chronic Back Pain Programme between 1991 and 1993. Multidisciplinary program that promoted pain management rather than "cure", with two six-hour group sessions per week for six weeks. Patient assessments before the program and at program completion and at three months' follow-up, with the West Haven-Yale Multidimensional Pain Inventory (WHYMPI) and a four-minute walk test. At program completion, the WHYMPI showed significant decreases in the amount pain interfered with life and significant increases in patient sense of control and activity level. However, severity of pain remained the same. All these effects were maintained three months later. A brief outpatient program was effective in improving pain management in a group of chronic back pain sufferers. This seems a useful and relatively inexpensive option in managing this problematic group of patients.

Treatment principles for the management of mold infections.

PubMed

Kontoyiannis, Dimitrios P; Lewis, Russell E

2014-11-06

Survival rates among immunocompromised patients with invasive mold infections have markedly improved over the last decade with earlier diagnosis and new antifungal treatment options. Yet, increasing antifungal resistance, breakthrough infections with intrinsically resistant fungi, and potentially life-threatening adverse effects and drug interactions are becoming more problematic, especially with prolonged therapy. Evidence-based recommendations for treating invasive aspergillosis and mucormycosis provide excellent guidance on the initial workup and treatment of these molds, but they cannot address all of the key management issues. Herein, we discuss 10 general treatment principles in the management of invasive mold disease in immunocompromised patients and discuss how these principles can be integrated to develop an effective, individualized treatment plan. Copyright © 2015 Cold Spring Harbor Laboratory Press; all rights reserved.

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

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

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 ofmore » 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.« less

Thermal management system options for high power space platforms

NASA Technical Reports Server (NTRS)

Sadunas, J. A.; Lehtinen, A.; Parish, R.

1985-01-01

Thermal Management System (TMS) design options for a high power (75kWe), low earth orbit, multimodule space platform were investigated. The approach taken was to establish a baseline TMS representative of current technology, and to make incremental improvements through successive subsystem trades that lead to a candidate TMS. The TMS trades included centralized and decentralized transport, single-phase and two-phase transport, alternate working fluids, liquid loop and heat pipe radiators, deployed fixed, body mounted and steerable radiators, and thermal storage. The subsystem options were evaluated against criteria such as weight, TMS power requirement, reliability, system isothermality penalty, and growth potential.

Cost Effective Printing of Laboratory Reports: Biochemist's and Physician's debate and Institutions Dilemma.

PubMed

Harith, Arun Kumar; Avs, Anil Kumar; Sampath, Sangeetha

2017-02-01

Laboratory investigations account for significant percentage of healthcare expenses. Every hospital and laboratory especially in the government sector wants to cut down the expenses on reports and offer inferior printouts of reports. The debate of printing attractive reports (clientele aspiration) Vs costs cutting (managerial issues) continues. It becomes the moral responsibility of doctors to guide the management into implementing an effective and economical option of report transcription. Cutting cost is always good but it should be achieved in an effective way keeping in mind the expectation of all the stake holders and ensuring that quality is not significantly compromised. The data regarding economics of printing available on the Internet may be market driven and not a true reflection of printing cost. The present study was undertaken to generate data on the economics of printing reports on various platforms to enable managers to make informed decision on choice of optimal printing option. To provide practical data on economics of printing reports using various printing options available in the country. Four printing devices (laser printer, inkjet printer, dotmatrix printer and thermal printer) were connected to the laboratory information system and the reports printed from them were critically evaluated for the following parameters - cost of stationary, printing cost, time of printing and clientele satisfaction. The cost of printing a single report on laser printer, inkjet printer, dotmatrix printer and thermal printers was Rs 0.75, Rs 0.65, Rs 0.20 and Rs 0.93 respectively. The time taken to print 30 reports were 162 sec, 193 sec, 210 and 60 sec respectively. Clientele satisfaction scores were best with Laser and Inkjet printed reports. The most economical mode of printing is Dot Matrix printer using DOS output for printing. However, when the workload of a laboratory is high, then the use of laser printer is not prohibitively expensive option and can be resorted to. Use of thermal printer was found to be unsatisfactory.

Setting priorities for land management to mitigate climate change

PubMed Central

2012-01-01

Background No consensus has been reached how to measure the effectiveness of climate change mitigation in the land-use sector and how to prioritize land use accordingly. We used the long-term cumulative and average sectorial C stocks in biomass, soil and products, C stock changes, the substitution of fossil energy and of energy-intensive products, and net present value (NPV) as evaluation criteria for the effectiveness of a hectare of productive land to mitigate climate change and produce economic returns. We evaluated land management options using real-life data of Thuringia, a region representative for central-western European conditions, and input from life cycle assessment, with a carbon-tracking model. We focused on solid biomass use for energy production. Results In forestry, the traditional timber production was most economically viable and most climate-friendly due to an assumed recycling rate of 80% of wood products for bioenergy. Intensification towards "pure bioenergy production" would reduce the average sectorial C stocks and the C substitution and would turn NPV negative. In the forest conservation (non-use) option, the sectorial C stocks increased by 52% against timber production, which was not compensated by foregone wood products and C substitution. Among the cropland options wheat for food with straw use for energy, whole cereals for energy, and short rotation coppice for bioenergy the latter was most climate-friendly. However, specific subsidies or incentives for perennials would be needed to favour this option. Conclusions When using the harvested products as materials prior to energy use there is no climate argument to support intensification by switching from sawn-wood timber production towards energy-wood in forestry systems. A legal framework would be needed to ensure that harvested products are first used for raw materials prior to energy use. Only an effective recycling of biomaterials frees land for long-term sustained C sequestration by conservation. Reuse cascades avoid additional emissions from shifting production or intensification. PMID:22423646

Adapting to a Changing Colorado River: Making Future Water Deliveries More Reliable Through Robust Management Strategies

NASA Astrophysics Data System (ADS)

Groves, D.; Bloom, E.; Fischbach, J. R.; Knopman, D.

2013-12-01

The U.S. Bureau of Reclamation and water management agencies representing the seven Colorado River Basin States initiated the Colorado River Basin Study in January 2010 to evaluate the resiliency of the Colorado River system over the next 50 years and compare different options for ensuring successful management of the river's resources. RAND was asked to join this Basin Study Team in January 2012 to help develop an analytic approach to identify key vulnerabilities in managing the Colorado River basin over the coming decades and to evaluate different options that could reduce this vulnerability. Using a quantitative approach for planning under uncertainty called Robust Decision Making (RDM), the RAND team assisted the Basin Study by: identifying future vulnerable conditions that could lead to imbalances that could cause the basin to be unable to meet its water delivery objectives; developing a computer-based tool to define 'portfolios' of management options reflecting different strategies for reducing basin imbalances; evaluating these portfolios across thousands of future scenarios to determine how much they could improve basin outcomes; and analyzing the results from the system simulations to identify key tradeoffs among the portfolios. This talk will describe RAND's contribution to the Basin Study, focusing on the methodologies used to to identify vulnerabilities for Upper Basin and Lower Basin water supply reliability and to compare portfolios of options. Several key findings emerged from the study. Future Streamflow and Climate Conditions Are Key: - Vulnerable conditions arise in a majority of scenarios where streamflows are lower than historical averages and where drought conditions persist for eight years or more. - Depending where the shortages occur, problems will arise for delivery obligations for the upper river basin and the lower river basin. The lower river basin is vulnerable to a broader range of plausible future conditions. Additional Investments in Infrastructure and Efficiency Could Improve Performance and Reduce Risk: - Different portfolios of water-supply and demand-reduction options offer performance trade-offs. - Different types of options in the portfolios, such as conservation, desalination, or water banking, would affect future outcomes and costs of implementation. - Analysis of all the portfolios identified important near-term, high-priority options that should be implemented in the near future, including municipal, industrial, and agricultural conservation. Other Solutions May Be Required: - If future hydrologic conditions develop in a manner consistent with the more pessimistic projections, the Basin is increasingly likely to face vulnerable conditions. The region may need to consider additional management options.

Office Procedures in Refractory Chronic Rhinosinusitis.

PubMed

Thamboo, Andrew; Patel, Zara M

2017-02-01

Office procedures in chronic rhinosinusitis (CRS) can be considered before and after medical management, as well as before and after surgical management. This article focuses specifically on refractory CRS, meaning those patients who have failed medical and surgical management already. The options available in the management of refractory CRS depend on the personnel, equipment, and instrumentation available in the office setting; surgeon experience; and patient suitability and tolerability. This article provides readers with possible procedural options that can be done in their clinics with indications, patient selection, potential complications, and postoperative considerations. Copyright © 2016 Elsevier Inc. All rights reserved.

Non-orthodontic intervention and non-nutritive sucking behaviours: A literature review.

PubMed

Tanny, Liyana; Huang, Boyen; Naung, Noel Ye; Currie, Geoffrey

2018-04-01

Anterior open bite (AOB) is one of the most complex malocclusions to manage. AOB is caused by either by skeletal, genetic or environmental factors. Numerous treatment options are currently utilised to manage AOB. These vary from non-invasive behavioural shaping to orthodontic and surgical interventions. This paper reviews the available orthodontic and non-orthodontic interventions used in the management of AOB. The literature review was carried out using the PubMed search engine from the first of January 2000 to the first of June 2017. Two major keywords (open bite and anterior open bite) were used in addition to 23 minor keywords in the review. AOB is one of the most complex malocclusions to treat with high relapse rates. Long term outcome in treatments of patients with AOB was substantially low. Relapse rates were not taken into consideration for some of the literature reviewed. Despite limitations of the literature, it is recommended that orofacial myofunctional therapy (OMT) and non-orthodontic intervention (NOI) be used in conjunction as an effective treatment option for Anterior Open Bite. Copyright © 2018. Published by Elsevier Taiwan.

Application of Remote Sensing for Forest Management in Nepal

NASA Astrophysics Data System (ADS)

Bajracharya, B.; Matin, M. A.

2016-12-01

Large area of the Hindu Kush Himalayan (HKH) region is covered by forest that is playing a vital role to address the challenges of climate change and livelihood options for a growing population. Effective management of forest cover needs establishment of regular monitoring system for forest. Supporting REDD assessment needs reliable baseline assessment of forest biomass and its monitoring at multiple scale. Adaptation of forest to climate change needs understanding vulnerability of forests and dependence of local communities on these forest. We present here different forest monitoring products developed under the SERVIR-Himalaya programme to address these issues. Landsat 30 meter images were used for decadal land cover change assessment and annual forest change hotspot monitoring. Methodology developed for biomass estimation at national and sub-national level biomass estimation. Decision support system was developed for analysis of forest vulnerability and dependence and selection of adaptation options based on resource availability. These products are forming the basis for development of an integrated system that will be very useful for comprehensive forest monitoring and long term strategy development for sustainable forest management.

A model to minimize joint total costs for industrial waste producers and waste management companies.

PubMed

Tietze-Stöckinger, Ingela; Fichtner, Wolf; Rentz, Otto

2004-12-01

The model LINKopt is a mixed-integer, linear programming model for mid- and long-term planning of waste management options on an inter-company level. There has been a large increase in the transportation of waste material in Germany, which has been attributed to the implementation of the European Directive 75/442/EEC on waste. Similar situations are expected to emerge in other European countries. The model LINKopt has been developed to determine a waste management system with minimal decision-relevant costs considering transportation, handling, storage and treatment of waste materials. The model can serve as a tool to evaluate various waste management strategies and to obtain the optimal combination of investment options. In addition to costs, ecological aspects are considered by determining the total mileage associated with the waste management system. The model has been applied to a German case study evaluating different investment options for a co-operation between Daimler-Chrysler AG at Rastatt, its suppliers, and the waste management company SITA P+R GmbH. The results show that the installation of waste management facilities at the premises of the waste producer would lead to significant reductions in costs and transportation.

Design and analysis of simple choice surveys for natural resource management

USGS Publications Warehouse

Fieberg, John; Cornicelli, Louis; Fulton, David C.; Grund, Marrett D.

2010-01-01

We used a simple yet powerful method for judging public support for management actions from randomized surveys. We asked respondents to rank choices (representing management regulations under consideration) according to their preference, and we then used discrete choice models to estimate probability of choosing among options (conditional on the set of options presented to respondents). Because choices may share similar unmodeled characteristics, the multinomial logit model, commonly applied to discrete choice data, may not be appropriate. We introduced the nested logit model, which offers a simple approach for incorporating correlation among choices. This forced choice survey approach provides a useful method of gathering public input; it is relatively easy to apply in practice, and the data are likely to be more informative than asking constituents to rate attractiveness of each option separately.

Competitive strategy in turbulent healthcare markets: an analysis of financially effective teaching hospitals.

PubMed

Langabeer, J

1998-01-01

As the healthcare marketplace, characterized by declining revenues and heavy price competition, continues to evolve toward managed care, teaching hospitals are being forced to act more like traditional industrial organizations. Profit-oriented behavior, including emphases on market strategies and competitive advantage, is now a necessity if these hospitals are going to survive the transition to managed care. To help teaching hospitals evaluate strategic options that maximize financial effectiveness, this study examined the financial and operating data for 100 major U.S. teaching hospitals to determine relationships among competitive strategy, market environment, and financial return on invested capital. Results should help major hospitals formulate more effective strategies to combat environmental turbulence.

Migraine Management During Menstruation and Menopause.

PubMed

MacGregor, E Anne

2015-08-01

Migraine is most prevalent in women during their reproductive years. An understanding of the effects of menstruation and menopause on migraine can enable neurologists to provide targeted and appropriate medical and hormonal strategies, enabling their patients to achieve better control of migraine and reduced disability. This article reviews the effects of hormonal events on migraine and summarizes the evidence-based options available for management. Estrogen "withdrawal" during the late luteal phase of the natural menstrual cycle and the hormone-free interval of combined hormonal contraceptives has long been implicated in the pathophysiology of menstrual migraine. However, more recent research suggests that other independent mechanisms may be relevant. Prostaglandin inhibitors used for management of dysmenorrhea are effective for associated menstrual migraine, suggesting a common pathophysiology. The interplay between serotonin and estrogen also deserves further research. Menstrual and perimenopausal migraine can be managed effectively using a variety of strategies, the choice of which depends on the efficacy of acute treatment, predictability and regularity of menstruation, use of contraception, and presence of menstrual disorders or perimenopausal vasomotor symptoms.

Ankle arthritis: review of diagnosis and operative management.

PubMed

Grunfeld, Robert; Aydogan, Umur; Juliano, Paul

2014-03-01

The diagnostic and therapeutic options for ankle arthritis are reviewed. The current standard of care for nonoperative options include the use of nonsteroidal antiinflammatory drugs, corticosteroid injections, orthotics, and ankle braces. Other modalities lack high-quality research studies to delineate their appropriateness and effectiveness. The gold standard for operative intervention in end-stage degenerative arthritis remains arthrodesis, but evidence for the superiority in functional outcomes of total ankle arthroplasty is increasing. The next few years will enable more informed decisions and, with more prospective high-quality studies, the most appropriate patient population for total ankle arthroplasty can be identified. Copyright © 2014 Elsevier Inc. All rights reserved.

Fighting Fire with Fire: Surgical Options for Patients with Drug-Resistant Epilepsy.

PubMed

Bayer, Alina D; Blum, Andrew S; Asaad, Wael F; Roth, Julie; Toms, Steven A; Deck, Gina M

2018-03-01

While antiepileptic drugs (AEDs) provide adequate seizure control for most patients with epilepsy, ~30% continue to have seizures despite treatment with two or more AEDs.1 In addition to direct harm from seizures, poor epilepsy control correlates with higher mortality, morbidity, 2, 3 and cost to the healthcare system.4 In the subset of patients with persistent seizures despite medical management, surgical intervention and neuromodulation may be more effective. Primary care physicians and general neurologists should be aware of non-AED treatment options that are standard of care for drug- resistant epilepsy (DRE). [Full article available at http://rimed.org/rimedicaljournal-2018-03.asp].

An Indicator Approach to Assessing Benefits of Carbon Sequestration and Other Ecosystem Services

NASA Astrophysics Data System (ADS)

Dale, V. H.; Kline, K. L.; Parish, E. S.

2017-12-01

While geoengineering offers one approach to carbon management, another tactic is providing land owners and managers with incentives to more efficiently and consistently increase carbon stocks and storage in soils and above ground. Growing bioenergy crops entails such an option. Landscape design can help identify where different strategies best fit into the larger framework of resource management to achieve desired stakeholder objectives. Our research goal is to develop means to assess management options and identify those that offer the highest degree of sustainability as measured by the provision to society of specific economic, environmental and social services with the least costs. Oak Ridge National Laboratory (ORNL) has worked with the US Department of Energy to develop an approach for assessing progress toward better management to improve sustainability. This approach involves six steps with decisions made at each step. First the scope of the assessment is established based on the particular context and options. Next indicators that pertain to the objective are selected and prioritized. Then, baselines and targets are determined for each indicator. Fourth, indicator values are measured, collected, and evaluated. Once the values are in hand, trends and tradeoffs in the indicator set are analyzed. The final step seeks to define and deploy good practices for the activity. ORNL's proposed checklist of environmental and socioeconomic indicators includes greenhouse gases and soil quality (including carbon) and emphasizes that changes in carbon stocks must be viewed in terms of their effects on other indicators, such as those for water quality and quantity, biodiversity, air quality, and productivity as well as on socioeconomic costs and benefits. The framework developed to select and evaluate indicators and assess progress toward sustainability goals is being encapsulated into a visualization tool. Visualization will inform stakeholders about potential effects of decisions, allowing them to make choices that can have better outcomes than might have occurred otherwise. The concept of continual improvement forms the core of developing more sustainable development pathways, including those that will lead to carbon-negative systems.

Adaptation Pathway of Low Impact Development Planning under Climate Change for a Sustainable Rural Community

NASA Astrophysics Data System (ADS)

Chen, P. Y.; Tung, C. P.

2016-12-01

The study focuses on developing the methodology of adaptation pathway for storm water management in a community scale. Following previous results on adaptation procedures including problem and goal setup, current risk assessment and analysis, future risk assessment and analysis, and adaptation options identification and evaluation, the study aims at analyzing adaptation pathway planning and implementation, namely the fifth step, for applying low impact development (LID). Based on the efficacy analyses of the feasible adaptation options, an adaptation pathway map can be build. Each pathway is a combination of the adaptation measures arranged in certain order. The developed adaptation pathway map visualizes the relative effectiveness and the connection of the adaptation measures. In addition, the tipping points of the system can be clearly identified and the triggers can be defined accordingly. There are multiple choices of pathways in an adaptation pathway map, which can be referred as pathway candidates. To ensure the applicability and operability, the methodology of adaptation pathway analysis is applied to a case study. Required information for developing an adaptation pathway map includes the scores of the adaptation options on the criteria, namely the effects, costs, immediacy, and side effect. Feasible adaptation options for the design case are dredging, pipeline expansion, pumping station, LID and detention pond. By ranking the options according to the criteria, LID is found dominating dredging and pumping station in this case. The information of the pathway candidates can be further used by the stakeholders to select the most suitable and promising pathway.

International Myeloma Working Group recommendations for global myeloma care.

PubMed

Ludwig, H; Miguel, J S; Dimopoulos, M A; Palumbo, A; Garcia Sanz, R; Powles, R; Lentzsch, S; Ming Chen, W; Hou, J; Jurczyszyn, A; Romeril, K; Hajek, R; Terpos, E; Shimizu, K; Joshua, D; Hungria, V; Rodriguez Morales, A; Ben-Yehuda, D; Sondergeld, P; Zamagni, E; Durie, B

2014-05-01

Recent developments have led to remarkable improvements in the assessment and treatment of patients with multiple myeloma (MM). New technologies have become available to precisely evaluate the biology and extent of the disease, including information about cytogenetics and genetic abnormalities, extramedullary manifestations and minimal residual disease. New, more effective drugs have been introduced into clinical practice, which enable clinicians to significantly improve the outcome of patients but also pose new challenges for the prevention and management of their specific side effects. Given these various new options and challenges, it is important to identify the minimal requirements for diagnosis and treatment of patients, as access to the most sophisticated advances may vary depending on local circumstances. Here, we propose the minimal requirements and possible options for diagnosis, monitoring and treatment of patients with multiple myeloma.

Acute and Chronic Cardiovascular Effects of Hyperkalemia: New Insights Into Prevention and Clinical Management.

PubMed

Krishnan, Sandeep K; Lepor, Norman E

2016-01-01

Hyperkalemia is a common electrolyte disorder associated with life-threatening cardiac arrhythmias and increased mortality. Patients at greatest risk for hyperkalemia include those with diabetes and those with impaired renal function in whom a defect in the excretion of renal potassium may already exist. Hyperkalemia is likely to become more common clinically because angiotensin receptor blockers and angiotensin-converting enzyme inhibitors are increasingly being used in higher doses and are thought to confer cardiovascular and renal protection. Until recently, options for treating hyperkalemia were limited to the use of thiazide and loop diuretics and sodium polystyrene sulfonate. Newer options such as sodium zirconium cyclosilicate will allow for the safe and effective treatment of hyperkalemia while maintaining patients on prescribed renin-angiotensin-aldosterone system inhibitors.

Rim Sim: A Role-Play Simulation

USGS Publications Warehouse

Barrett, Robert C.; Frew, Suzanne L.; Howell, David G.; Karl, Herman A.; Rudin, Emily B.

2003-01-01

Rim Sim is a 6-hour, eight-party negotiation that focuses on creating a framework for the long-term disaster-recovery efforts. It involves a range of players from five countries affected by two natural disasters: a typhoon about a year ago and an earthquake about 6 months ago. The players are members of an International Disaster Working Group (IDWG) that has been created by an international commission. The IDWG has been charged with drawing up a framework for managing two issues: the reconstruction of regionally significant infrastructure and the design of a mechanism for allocating funding to each country for reconstruction of local infrastructure and ongoing humanitarian needs. The first issue will involve making choices among five options (two harbor options, two airport options, and one rail-line option), each of which will have three levels at which to rebuild. The second issue will involve five starting-point options. Participants are encouraged to invent other options for both issues. The goal of Rim Sim is to raise questions about traditional approaches to disaster-preparedness planning and reconstruction efforts in an international setting, in this case the Pacific Rim. Players must confront the reverberating effects of disasters and the problems of using science and technical information in decisionmaking, and are introduced to a consensus-building approach emphasizing face-to-face dialog and multinational cooperation in dealing with humanitarian concerns, as well as long-term efforts to reconstruct local and regional infrastructure. The Rim Sim simulation raises four key points: ripple effects of disasters, role of science, multiparty negotiation, and building personal relationships.

Molecular targeted therapies for solid tumors: management of side effects.

PubMed

Grünwald, Viktor; Soltau, Jens; Ivanyi, Philipp; Rentschler, Jochen; Reuter, Christoph; Drevs, Joachim

2009-03-01

This review will provide physicians and oncologists with an overview of side effects related to targeted agents that inhibit vascular endothelial growth factor (VEGF), epidermal growth factor (EGF) and mammalian target of rapamycin (mTOR) signaling in the treatment of solid tumors. Such targeted agents can be divided into monoclonal antibodies, tyrosine kinase inhibitors, multitargeted tyrosine kinase inhibitors and serine/threonine kinase inhibitors. Molecular targeted therapies are generally well tolerated, but inhibitory effects on the biological function of the targets in healthy tissue can result in specific treatment-related side effects, particularly with multitargeted agents. We offer some guidance on how to manage adverse events in cancer patients based on the range of options currently available. Copyright 2009 S. Karger AG, Basel.

Study of Agricultural Product Options Pricing

NASA Astrophysics Data System (ADS)

HONG, Qiu

2017-09-01

China is a large agricultural country, and the healthy development of agriculture is related to the stability of the whole society. The agricultural production and management of agricultural products are confronted with many risks, especially the market risks. Option contract is the object of option market transaction, so it is very important to study the option contract of agricultural products. Option trading separates the risk and profit, so that the trader can avoid the risk while retaining the opportunity to obtain income. The option has the characteristics of low transaction cost, simple and efficient, so it is suitable for small and medium investors.

Coadjuvant treatment with surgery and pirfenidone in severe facial trauma due to dog bite.

PubMed

Cantú-Cantú, María Zulema; Lyra-González, Iván; Armendáriz-Borunda, Juan

2013-03-01

This case report assesses the effectiveness of surgery plus pirfenidone (PFD) as a concomitant therapy in the management of facial trauma after severe dog bite. A 16-month-old female patient who suffered a severe attack by a big-sized dog (Rottweiler) in the midface area was managed with surgery/PFD combination and followed up for 20 months to evaluate the efficacy to control, prevent, and improve injury sequels. Surgery/PFD combination offered a good complementary therapy downregulating inflammatory activity, improving blood supply, and activating cytokine modulation and collagen synthesis/biosynthesis (scar control). No side effects were reported in this case report. Surgery/PFD management for severe facial dog bites represents a safe and effective therapeutic option to protect and improve a patient's quality of life, minimizing long-time sequels.

17 CFR 210.12-12B - Open option contracts written.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 17 Commodity and Securities Exchanges 3 2014-04-01 2014-04-01 false Open option contracts written. 210.12-12B Section 210.12-12B Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION... AND CONSERVATION ACT OF 1975 For Management Investment Companies § 210.12-12B Open option contracts...

17 CFR 210.12-12B - Open option contracts written.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 17 Commodity and Securities Exchanges 2 2011-04-01 2011-04-01 false Open option contracts written. 210.12-12B Section 210.12-12B Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION... § 210.12-12B Open option contracts written. [For management investment companies only] Col. A Col. B Col...

5 CFR 875.302 - What are the options for making premium payments?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false What are the options for making premium payments? 875.302 Section 875.302 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL... options for making premium payments? (a) Premium payments may be made by Federal payroll or annuity...

78 FR 70961 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Notice to...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-27

... for OMB Review; Comment Request; Notice to Employees of Coverage Options Under Fair Labor Standards... Employees of Coverage Options Under Fair Labor Standards Act Section 18B,'' to the Office of Management and... and a related model notice of healthcare coverage options available under the Patient Protection and...

Towards sustainable sanitation management: Establishing the costs and willingness to pay for emptying and transporting sludge in rural districts with high rates of access to latrines

PubMed Central

Hardy, Richard; Ahmed, Rizwan; Habib, Ahasan; Asad, N. S. M.; Rahman, Mominur; Hasan, M.; Dey, Digbijoy; Fletcher, Louise; Camargo-Valero, Miller Alonso; Chaitanya Rao, Krishna; Fernando, Sudarshana

2017-01-01

Motivation Proper management of fecal sludge has significant positive health and environmental externalities. Most research on managing onsite sanitation so far either simulates the costs of, or the welfare effects from, managing sludge in situ in pit latrines. Thus, designing management strategies for onsite rural sanitation is challenging, because the actual costs of transporting sludge for treatment, and sources for financing these transport costs, are not well understood. Methods In this paper we calculate the actual cost of sludge management from onsite latrines, and identify the contributions that latrine owners are willing to make to finance the costs. A spreadsheet-based model is used to identify a cost-effective transport option, and to calculate the cost per household. Then a double-bound contingent valuation method is used to elicit from pit-latrine owners their willingness-to-pay to have sludge transported away. This methodology is employed for the case of a rural subdistrict in Bangladesh called Bhaluka, a unit of administration at which sludge management services are being piloted by the Government of Bangladesh. Results The typical sludge accumulation rate in Bhaluka is calculated at 0.11 liters/person/day and a typical latrine will need to be emptied approximately once every 3 to 4 years. The costs of emptying and transport are high; approximately USD 13 per emptying event (circa 14% of average monthly income); household contributions could cover around 47% of this cost. However, if costs were spread over time, the service would cost USD 4 per year per household, or USD 0.31 per month per household—comparable to current expenditures of rural households on telecommunications. Conclusion This is one of few research papers that brings the costs of waste management together with financing of that cost, to provide evidence for an implementable solution. This framework can be used to identify cost effective sludge management options and private contributions towards that cost in other (context-specific) administrative areas where onsite sanitation is widespread. PMID:28323885

Towards sustainable sanitation management: Establishing the costs and willingness to pay for emptying and transporting sludge in rural districts with high rates of access to latrines.

PubMed

Balasubramanya, Soumya; Evans, Barbara; Hardy, Richard; Ahmed, Rizwan; Habib, Ahasan; Asad, N S M; Rahman, Mominur; Hasan, M; Dey, Digbijoy; Fletcher, Louise; Camargo-Valero, Miller Alonso; Chaitanya Rao, Krishna; Fernando, Sudarshana

2017-01-01

Proper management of fecal sludge has significant positive health and environmental externalities. Most research on managing onsite sanitation so far either simulates the costs of, or the welfare effects from, managing sludge in situ in pit latrines. Thus, designing management strategies for onsite rural sanitation is challenging, because the actual costs of transporting sludge for treatment, and sources for financing these transport costs, are not well understood. In this paper we calculate the actual cost of sludge management from onsite latrines, and identify the contributions that latrine owners are willing to make to finance the costs. A spreadsheet-based model is used to identify a cost-effective transport option, and to calculate the cost per household. Then a double-bound contingent valuation method is used to elicit from pit-latrine owners their willingness-to-pay to have sludge transported away. This methodology is employed for the case of a rural subdistrict in Bangladesh called Bhaluka, a unit of administration at which sludge management services are being piloted by the Government of Bangladesh. The typical sludge accumulation rate in Bhaluka is calculated at 0.11 liters/person/day and a typical latrine will need to be emptied approximately once every 3 to 4 years. The costs of emptying and transport are high; approximately USD 13 per emptying event (circa 14% of average monthly income); household contributions could cover around 47% of this cost. However, if costs were spread over time, the service would cost USD 4 per year per household, or USD 0.31 per month per household-comparable to current expenditures of rural households on telecommunications. This is one of few research papers that brings the costs of waste management together with financing of that cost, to provide evidence for an implementable solution. This framework can be used to identify cost effective sludge management options and private contributions towards that cost in other (context-specific) administrative areas where onsite sanitation is widespread.

NASA's EOSDIS: options for data providers

NASA Astrophysics Data System (ADS)

Khalsa, Siri J.; Ujhazy, John E.

1995-12-01

EOSDIS, the data and information system being developed by NASA to support interdisciplinary earth science research into the 21st century, will do more than manage and distribute data from EOS-era satellites. It will also promote the exchange of data, tools, and research results across disciplinary, agency, and national boundaries. This paper describes the options that data providers will have for interacting with the EOSDIS Core System (ECS), the infrastructure of EOSDIS. The options include: using the ECS advertising service to announce the availability of data at the provider's site; submitting a candidate data set to one of the Distributed Active Archive Centers (DAACs); establishing a data server that will make the data accessible via ECS and establishing Local Information Manager (LIM) which would make the data available for multi-site searches. One additional option is through custom gateway interfaces which would provide access to existing data archives. The gateway, data server, and LIM options require the implementation of ECS code at the provider site to insure proper protocols. The advertisement and ingest options require no part of ECS design to reside at the provider site.

Flexibility in flood management design: proactive planning under uncertainty

NASA Astrophysics Data System (ADS)

Smet, K.; de Neufville, R.; van der Vlist, M.

2016-12-01

This paper presents a value-enhancing approach for proactive planning and design of long-lived flood management infrastructure given uncertain future flooding threats. Designing infrastructure that can be adapted over time is a method to safeguard the efficacy of current design decisions given future uncertainties. We explore the value of embedding "options" in a physical structure, where an option is the right but not the obligation to do something at a later date (e.g. over-dimensioning a floodwall foundation now facilitates a future height addition in response to observed increases in sea level; building extra pump bays in a drainage pumping station enables the easy addition of pumping capacity whenever increased precipitation warrants an expansion.) The proposed approach couples a simulation model that captures future climate induced changes to the hydrologic operating environment of a structure, with an economic model that estimates the lifetime economic performance of alternative investment strategies. The economic model uses Real "In" Options analysis, a type of cash flow analysis that quantifies the implicit value of options and the flexibility they provide. We demonstrate the approach using replacement planning for the multi-functional pumping station IJmuiden on the North Sea Canal in the Netherlands. The analysis models flexibility in design decisions, varying the size and specific options included in the new structure. Results indicate that the incorporation of options within the structural design has the potential to improve its economic performance, as compared to more traditional, "build it once and build it big" designs where flexibility is not an explicit design criterion. The added value resulting from the incorporation of flexibility varies with the range of future conditions considered, and the specific options examined. This approach could be applied to explore investment strategies for the design of other flood management structures, as well as be expanded to look more at flexibility within an infrastructure network rather than a single structure. Flexibility in flood management design:proactive planning under uncertainty

An initial evaluation of potential options for managing riparian reserves of the Aquatic Conservation Strategy of the Northwest Forest Plan

Treesearch

Gordon H. Reeves; Brian R. Pickard; K. Norman Johnson

2016-01-01

The Aquatic Conservation Strategy (ACS) of the Northwest Forest Plan guides management of riparian and aquatic ecosystems on federal lands in western Oregon, western Washington, and northern California. We applied new scientific findings and tools to evaluate two potential options, A and B, for refining interim riparian reserves to meet ACS goals and likely challenges...

Evaluation Report of the Presidential/Secretarial Objective -- School Management Options Available to Indian People. Research and Evaluation Report Series No. 29.08.

ERIC Educational Resources Information Center

National Indian Training and Research Center, Tempe, AZ.

Presenting evaluations of the Bureau of Indian Affairs' (BIA) implementation of the School Management Option Project, a project designed to further American Indian control of schools and elevated to the status of Presidential/Secretarial Objective (P/SO) in 1974, this report includes separate evaluations by the National Indian Training and…

An economic evaluation of precommercial thinning in predominately paper birch stands

Treesearch

Orris D. McCauley; David P. Worley

1969-01-01

Before timber managers invest their time and money in precommercial thinnings in paper birch stands, they should know what thinning options are open to them and should have some idea of the response they might expect from the alternatives. Equipped with a knowledge of these options, the manager can select the monetary and output goals that best suit his own situation...

Acting on uncertainty in landscape management—options forestry.

Treesearch

Jonathan Thompson

2005-01-01

In response to the highly uncertain outcomes inherent in forest management, “options forestry” has been introduced as a novel approach that includes an honest appraisal of uncertainties and learning as a specific objective. The strategy is unique in that it uses a variety of management pathways, all designed to reach the same goal, and structures them in a rigorous...

Incontinence Treatment: Newer Treatment Options

MedlinePlus

... Living with Incontinence Incontinence and Relationships Incontinence and Aging Managing Incontinence Managing Incontinence: A Survey The Patient's ... Living with Incontinence Incontinence and Relationships Incontinence and Aging Managing Incontinence Managing Incontinence: A Survey The Patient's ...

Simulation of groundwater flow and analysis of the effects of water-management options in the North Platte Natural Resources District, Nebraska

USGS Publications Warehouse

Peterson, Steven M.; Flynn, Amanda T.; Vrabel, Joseph; Ryter, Derek W.

2015-08-12

The calibrated groundwater-flow model was used with the Groundwater-Management Process for the 2005 version of the U.S. Geological Survey modular three-dimensional groundwater model, MODFLOW–2005, to provide a tool for the NPNRD to better understand how water-management decisions could affect stream base flows of the North Platte River at Bridgeport, Nebr., streamgage in a future period from 2008 to 2019 under varying climatic conditions. The simulation-optimization model was constructed to analyze the maximum increase in simulated stream base flow that could be obtained with the minimum amount of reductions in groundwater withdrawals for irrigation. A second analysis extended the first to analyze the simulated base-flow benefit of groundwater withdrawals along with application of intentional recharge, that is, water from canals being released into rangeland areas with sandy soils. With optimized groundwater withdrawals and intentional recharge, the maximum simulated stream base flow was 15–23 cubic feet per second (ft3/s) greater than with no management at all, or 10–15 ft3/s larger than with managed groundwater withdrawals only. These results indicate not only the amount that simulated stream base flow can be increased by these management options, but also the locations where the management options provide the most or least benefit to the simulated stream base flow. For the analyses in this report, simulated base flow was best optimized by reductions in groundwater withdrawals north of the North Platte River and in the western half of the area. Intentional recharge sites selected by the optimization had a complex distribution but were more likely to be closer to the North Platte River or its tributaries. Future users of the simulation-optimization model will be able to modify the input files as to type, location, and timing of constraints, decision variables of groundwater withdrawals by zone, and other variables to explore other feasible management scenarios that may yield different increases in simulated future base flow of the North Platte River.

Saroglitazar for the treatment of dyslipidemia in diabetic patients.

PubMed

Joshi, Shashank R

2015-03-01

Diabetes and dyslipidemia are commonly associated modifiable risk factors for cardiovascular diseases. Majority of patients with diabetes also suffer from dyslipidemia (diabetic dyslipidemia). Diabetic dyslipidemia is more atherogenic as it is commonly associated with high triglyceride (TG) levels, high proportion of small dense low-density lipoprotein cholesterol and low high-density lipoprotein cholesterol (HDL-C) level (atherogenic dyslipidemia). Currently used pharmacotherapies for the management of diabetes and dyslipidemia like thiazolidinediones (PPAR-γ agonist; for insulin resistance) and fibrates (PPAR-α agonist; for hypertriglyceridemia) have many limitations and side effects. Saroglitazar , a dual PPAR-α/γ agonists, is an emerging therapeutic option with its dual benefit on glycemic and lipid parameters. This paper reviews the clinical development of saroglitazar for the management of diabetic dyslipidemia. The efficacy and safety profile of saroglitazar is reviewed in context to currently available therapy like pioglitazone for diabetes and fibrates for hypertriglyceridemia. In addition, this paper also reviews the association between diabetes and dyslipidemia and the role of TG in reducing cardiovascular events. Saroglitazar, a dual PPAR-α/γ agonist, is a potential therapeutic option for the management of diabetic dyslipidemia. It has dual benefit of significant improvement in glycemic parameters (glycated hemoglobin and fasting blood glucose) and significant improvement in dyslipidemia (TGs, apolipoprotein B, non-HDL-C). The results of Phase III clinical trials indicate that saroglitazar is devoid of conventional side effects of fibrates and pioglitazone. Future clinical trials of saroglitazar will further establish its place in the management of diabetes, dyslipidemia and associated cardiovascular risk.

Management Options for Twisted Gastric Tube after Laparoscopic Sleeve Gastrectomy.

PubMed

Abd Ellatif, Mohamed E; Abbas, Ashraf; El Nakeeb, Ayman; Magdy, Alaa; Salama, Asaad F; Bashah, Moataz M; Dawoud, Ibrahim; Gamal, Maged Ali; Sargsyan, Davit

2017-09-01

This study aims to determine the incidence, etiology, and management options for symptomatic gastric obstruction caused by axially twisted sleeve gastrectomy. In this retrospective study, we reviewed medical charts of all morbidly obese patients who underwent laparoscopic sleeve gastrectomy. Patients who developed gastric obstruction symptoms and were diagnosed with twisted sleeve gastrectomy were identified and included in this study. From October 2005 to December 2015, there are 3634 morbidly obese patients who underwent laparoscopic sleeve gastrectomy (LSG). Eighty-six (2.3%) patients developed symptoms of gastric obstruction. Forty-five (1.23%) patients were included in this study. The mean time of presentation was 59.8 days after surgery. Upper GI contrast study was done routinely, and it was positive for axial twist in 37 (82%) patients. Abdominal CT with oral and IV contrast was done in eight (18%) when swallow study was equivocal. Endoscopic treatment was successful in 43 patients (95.5%). Sixteen patients were successfully managed by endoscopic stenting, and 29 patients had balloon dilation. The average numbers of dilation sessions were 1.7. Out of these 29 patients, 18 responded well to a single session of dilatation and did not require any further dilatation sessions. Two patients who failed to respond to three subsequent sessions of balloon dilation underwent laparoscopic adhesiolysis and gastropexy. Endoscopic stenting is an effective tool in management of axial rotation of sleeved stomach. Balloon dilation can also be effective in selected cases. Few cases might require laparoscopic adhesiolysis and gastropexy.

Thermometers: Understand the Options

MedlinePlus

... the options Thermometers come in a variety of styles. Understand the different types of thermometers and how ... MA. Fever in infants and children: Pathophysiology and management. http://www.uptodate.com/home. Accessed July 23, ...

What weight loss treatment options do geriatric patients with overweight and obesity want to consider?

PubMed

MacMillan, M; Cummins, K; Fujioka, K

2016-12-01

Since the 1990s, a number of weight loss medications have been removed from the USA and or European market because of adverse events associated with these medications. These medications include fenfluramine (heart valve thickening), sibutramine (cardiovascular risk) and rimonabant (depression). This history may affect a patient's desire to consider weight loss medications as an option for weight management. This descriptive study was designed to observe what treatment options the geriatric patient (age 65 or higher) seeking weight loss would like to consider, as well as the reasons they felt they struggled with overweight or obesity. A questionnaire was given to 102 geriatric patients with overweight or obesity before starting a weight loss programme at a weight management centre. The questionnaire asked the patient why they felt they were overweight or obese and what treatment options they wished to consider. The geriatric patients were matched with younger patients in body mass index and sex. The three most common perceptions that geriatric patients felt were causes of their increased weight were 'lack of exercise' (76.2%), 'poor food choices' (59.4%) and 'cravings' (47.5%). When geriatric patients were asked what treatment options they would like to discuss, the four most common options requested were 'diet and healthy eating' (67.3%), weight loss medications (57.4%), a request for a 'metabolic work up' (55.4%) and 'exercise' (53.5%). These responses were no different from their younger cohorts. When geriatric patients with a body mass index of 35 or higher were given bariatric surgery as a treatment option, 21.9% marked it as a treatment option they would like to consider. Over half of geriatric patients desired to discuss weight loss medications as a treatment option. Diet and exercise were also of strong interest, which is in line with current weight management guidelines.