Optimizing conservation strategies for a threatened tree species: In situ conservation of white ash (Fraxinus americana L.) genetic diversity through insecticide treatment

Treesearch

Charles Flower; Jeremie Fant; Sean Hoban; Kathleen Knight; Laura Steger; Elijah Aubihl; Miquel Gonzalez-Meler; Stephen Forry; Andrea Hille; Alejandro Royo

2018-01-01

Forest resources face numerous threats that require costly management. Hence, there is an increasing need for data-informed strategies to guide conservation practices. The introduction of the emerald ash borer to North America has caused rapid declines in ash populations (Fraxinus spp. L.). Natural resource managers are faced with a choice of...

Constraining neutron guide optimizations with phase-space considerations

NASA Astrophysics Data System (ADS)

Bertelsen, Mads; Lefmann, Kim

2016-09-01

We introduce a method named the Minimalist Principle that serves to reduce the parameter space for neutron guide optimization when the required beam divergence is limited. The reduced parameter space will restrict the optimization to guides with a minimal neutron intake that are still theoretically able to deliver the maximal possible performance. The geometrical constraints are derived using phase-space propagation from moderator to guide and from guide to sample, while assuming that the optimized guides will achieve perfect transport of the limited neutron intake. Guide systems optimized using these constraints are shown to provide performance close to guides optimized without any constraints, however the divergence received at the sample is limited to the desired interval, even when the neutron transport is not limited by the supermirrors used in the guide. As the constraints strongly limit the parameter space for the optimizer, two control parameters are introduced that can be used to adjust the selected subspace, effectively balancing between maximizing neutron transport and avoiding background from unnecessary neutrons. One parameter is needed to describe the expected focusing abilities of the guide to be optimized, going from perfectly focusing to no correlation between position and velocity. The second parameter controls neutron intake into the guide, so that one can select exactly how aggressively the background should be limited. We show examples of guides optimized using these constraints which demonstrates the higher signal to noise than conventional optimizations. Furthermore the parameter controlling neutron intake is explored which shows that the simulated optimal neutron intake is close to the analytically predicted, when assuming that the guide is dominated by multiple scattering events.

Focus on fresh frozen plasma - facilitating optimal management of bleeding through collaboration between clinicians and transfusion specialists on component specifications.

PubMed

MacLennan, Sheila

2016-01-01

A symposium on plasma for direct clinical use was held in September 2015 by the European directorate for the quality of medicines and healthcare (EDQM) in order to consider changes to the Council of Europe guide to the preparation, use and quality assurance of blood components monographs on plasma components. The programme reviewed use of plasma in various settings, novel components, adverse reactions, manufacturing and quality monitoring issues. The main requirement identified was that plasma should be made available to support early transfusion in the trauma/massive haemorrhage setting. Further guidance on component manufacturing and reviewing of quality monitoring requirements will also be addressed. A working group has been established to review component monographs and other advice in the guide relating to plasma components, with the aim of providing optimal components to support clinical management of patients requiring plasma. Crown Copyright © 2016. Published by Elsevier Masson SAS. All rights reserved.

Human-Guided Management of Collaborating Unmanned Vehicles in Degraded Communication Environments

DTIC Science & Technology

2010-05-01

system operated by the U.S. Air Force exemplifies the utility of unmanned systems. Predator drones have been employed extensively in intelligence...Massachusetts, USA), 2005. [50] Flint, M., T. Khobanova, and M. Curry , “Decentralized control using global optimization,” in Pro- ceedings of the AIAA

Simultaneous optimization of the cavity heat load and trip rates in linacs using a genetic algorithm

DOE PAGES

Terzić, Balša; Hofler, Alicia S.; Reeves, Cody J.; ...

2014-10-15

In this paper, a genetic algorithm-based optimization is used to simultaneously minimize two competing objectives guiding the operation of the Jefferson Lab's Continuous Electron Beam Accelerator Facility linacs: cavity heat load and radio frequency cavity trip rates. The results represent a significant improvement to the standard linac energy management tool and thereby could lead to a more efficient Continuous Electron Beam Accelerator Facility configuration. This study also serves as a proof of principle of how a genetic algorithm can be used for optimizing other linac-based machines.

A guide to cancer pain management.

PubMed

Hutton, Natalie; McGee, Anne; Dunbar, Catherine

2008-10-01

Most, if not all, cancer patients require care from community teams at some stage during their disease trajectory. For many of these patients, community nurses and General Practitioners are the main point of contact. Pain is reported by between 55-95% of patients with advanced or terminal disease. Optimal pain control positively impacts on the physical, emotional and functional well-being of the patient. Despite the existence of guidelines (WHO, 1996) (SIGN, 2000) and a wealth of literature on cancer pain management, half of all patients in Western countries still do not receive adequate pain relief. This article looks at the reasons behind this and provides community nurses with an overview of up-to-date information on pain pathophysiology and management, so that the control of cancer pain can be optimized in the community.

Self-guided management of exome and whole-genome sequencing results: changing the results return model.

PubMed

Yu, Joon-Ho; Jamal, Seema M; Tabor, Holly K; Bamshad, Michael J

2013-09-01

Researchers and clinicians face the practical and ethical challenge of if and how to offer for return the wide and varied scope of results available from individual exome sequencing and whole-genome sequencing. We argue that rather than viewing individual exome sequencing and whole-genome sequencing as a test for which results need to be "returned," that the technology should instead be framed as a dynamic resource of information from which results should be "managed" over the lifetime of an individual. We further suggest that individual exome sequencing and whole-genome sequencing results management is optimized using a self-guided approach that enables individuals to self-select among results offered for return in a convenient, confidential, personalized context that is responsive to their value system. This approach respects autonomy, allows individuals to maximize potential benefits of genomic information (beneficence) and minimize potential harms (nonmaleficence), and also preserves their right to an open future to the extent they desire or think is appropriate. We describe key challenges and advantages of such a self-guided management system and offer guidance on implementation using an information systems approach.

The automatic neutron guide optimizer guide_bot

NASA Astrophysics Data System (ADS)

Bertelsen, Mads

2017-09-01

The guide optimization software guide_bot is introduced, the main purpose of which is to reduce the time spent programming when performing numerical optimization of neutron guides. A limited amount of information on the overall guide geometry and a figure of merit describing the desired beam is used to generate the code necessary to solve the problem. A generated McStas instrument file performs the Monte Carlo ray-tracing, which is controlled by iFit optimization scripts. The resulting optimal guide is thoroughly characterized, both in terms of brilliance transfer from an idealized source and on a more realistic source such as the ESS Butterfly moderator. Basic MATLAB knowledge is required from the user, but no experience with McStas or iFit is necessary. This paper briefly describes how guide_bot is used and some important aspects of the code. A short validation against earlier work is performed which shows the expected agreement. In addition a scan over the vertical divergence requirement, where individual guide optimizations are performed for each corresponding figure of merit, provides valuable data on the consequences of this parameter. The guide_bot software package is best suited for the start of an instrument design project as it excels at comparing a large amount of different guide alternatives for a specific set of instrument requirements, but is still applicable in later stages as constraints can be used to optimize more specific guides.

Shelf life modelling for first-expired-first-out warehouse management

PubMed Central

Hertog, Maarten L. A. T. M.; Uysal, Ismail; McCarthy, Ultan; Verlinden, Bert M.; Nicolaï, Bart M.

2014-01-01

In the supply chain of perishable food products, large losses are incurred between farm and fork. Given the limited land resources and an ever-growing population, the food supply chain is faced with the challenge of increasing its handling efficiency and minimizing post-harvest food losses. Huge value can be added by optimizing warehouse management systems, taking into account the estimated remaining shelf life of the product, and matching it to the requirements of the subsequent part of the handling chain. This contribution focuses on how model approaches estimating quality changes and remaining shelf life can be combined in optimizing first-expired-first-out cold chain management strategies for perishable products. To this end, shelf-life-related performance indicators are used to introduce remaining shelf life and product quality in the cost function when optimizing the supply chain. A combinatorial exhaustive-search algorithm is shown to be feasible as the complexity of the optimization problem is sufficiently low for the size and properties of a typical commercial cold chain. The estimated shelf life distances for a particular batch can thus be taken as a guide to optimize logistics. PMID:24797134

Inpatient Management of Diabetic Foot Infections: A Review of the Guidelines for Hospitalists.

PubMed

Thurber, Emilia G; Kisuule, Flora; Humbyrd, Casey; Townsend, Jennifer

2017-12-01

Diabetic foot infections (DFIs) are common and represent the leading cause for hospitalization among diabetic complications. Without proper management, DFIs may lead to amputation, which is associated with a decreased quality of life and increased mortality. However, there is currently significant variation in the management of DFIs, and many providers fail to perform critical prevention and assessment measures. In this review, we will provide an overview of the diagnosis, management, and discharge planning of hospitalized patients with DFIs to guide hospitalists in the optimal inpatient care of patients with this condition. © 2017 Society of Hospital Medicine.

Counseling for the Training of Leaders and Leadership Development: A Commentary

ERIC Educational Resources Information Center

Barreto, Alfonso

2012-01-01

Counseling is the instrument that empowers training and forges the development of leaders in their essential drive to inspire and guide others. As much a discipline and praxis as a professional practice, counseling increases consciousness and optimizes the management and synergy of human energy. This article addresses methods for sustaining…

Identifying species conservation strategies to reduce disease-associated declines

USGS Publications Warehouse

Gerber, Brian D.; Converse, Sarah J.; Muths, Erin L.; Crockett, Harry J.; Mosher, Brittany A.; Bailey, Larissa L.

2018-01-01

Emerging infectious diseases (EIDs) are a salient threat to many animal taxa, causing local and global extinctions, altering communities and ecosystem function. The EID chytridiomycosis is a prominent driver of amphibian declines, which is caused by the fungal pathogen Batrachochytrium dendrobatidis (Bd). To guide conservation policy, we developed a predictive decision-analytic model that combines empirical knowledge of host-pathogen metapopulation dynamics with expert judgment regarding effects of management actions, to select from potential conservation strategies. We apply our approach to a boreal toad (Anaxyrus boreas boreas) and Bd system, identifying optimal strategies that balance tradeoffs in maximizing toad population persistence and landscape-level distribution, while considering costs. The most robust strategy is expected to reduce the decline of toad breeding sites from 53% to 21% over 50 years. Our findings are incorporated into management policy to guide conservation planning. Our online modeling application provides a template for managers of other systems challenged by EIDs.

Bioimpedance-Guided Fluid Management in Hemodialysis Patients

PubMed Central

Arias-Guillén, Marta; Wabel, Peter; Fontseré, Néstor; Carrera, Montserrat; Campistol, José Maria; Maduell, Francisco

2013-01-01

Summary Background and objectives Achieving and maintaining optimal fluid status remains a major challenge in hemodialysis therapy. The aim of this interventional study was to assess the feasibility and clinical consequences of active fluid management guided by bioimpedance spectroscopy in chronic hemodialysis patients. Design, setting, participants, & measurements Fluid status was optimized prospectively in 55 chronic hemodialysis patients over 3 months (November 2011 to February 2012). Predialysis fluid overload was measured weekly using the Fresenius Body Composition Monitor. Time-averaged fluid overload was calculated as the average between pre- and postdialysis fluid overload. The study aimed to bring the time-averaged fluid overload of all patients into a target range of 0.5±0.75 L within the first month and maintain optimal fluid status until study end. Postweight was adjusted weekly according to a predefined protocol. Results Time-averaged fluid overload in the complete study cohort was 0.9±1.6 L at baseline and 0.6±1.1 L at study end. Time-averaged fluid overload decreased by −1.20±1.32 L (P<0.01) in the fluid-overloaded group (n=17), remained unchanged in the normovolemic group (n=26, P=0.59), and increased by 0.59±0.76 L (P=0.02) in the dehydrated group (n=12). Every 1 L change in fluid overload was accompanied by a 9.9 mmHg/L change in predialysis systolic BP (r=0.55, P<0.001). At study end, 76% of all patients were either on time-averaged fluid overload target or at least closer to target than at study start. The number of intradialytic symptoms did not change significantly in any of the subgroups. Conclusions Active fluid management guided by bioimpedance spectroscopy was associated with an improvement in overall fluid status and BP. PMID:23949235

Management of EGFR-mutated non-small-cell lung cancer: practical implications from a clinical and pathology perspective

PubMed Central

Cabanero, M.; Sangha, R.; Sheffield, B.S.; Sukhai, M.; Pakkal, M.; Kamel-Reid, S.; Karsan, A.; Ionescu, D.; Juergens, R.A.; Butts, C.; Tsao, M.S.

2017-01-01

Starting in the early 2000s, non-small-cell lung cancer (nsclc) subtypes have evolved from being histologically described to molecularly defined. Management of lung adenocarcinomas now generally requires multiple molecular tests at baseline to define the optimal treatment strategy. More recently, second biopsies performed at progression in patients treated with tyrosine kinase inhibitors (tkis) have further defined the continued use of molecularly targeted therapy. In the present article, we focus on one molecular subtype: EGFR-mutated nsclc. For that patient population, multiple lines of tki therapy are now available either clinically or in clinical trials. Each line of treatment is guided by the specific mutations (for example, L858R, T790M, C797S) identified in EGFR. We first describe the various mechanisms of acquired resistance to EGFR tki treatment. We then focus on strategies that clinicians and pathologists can both use during tissue acquisition and handling to optimize patient results. We also discuss future directions for the molecular characterization of lung cancers with driver mutations, including liquid biopsies. Finally, we provide an algorithm to guide treating physicians managing patients with EGFR-mutated nsclc. The same framework can also be applied to other molecularly defined nsclc subgroups as resistance patterns are elucidated and additional lines of treatment are developed. PMID:28490925

Using diffusion of innovations theory to guide diabetes management program development: an illustrative example.

PubMed

De Civita, Mirella; Dasgupta, Kaberi

2007-09-01

Optimal management of type 2 diabetes requires achievement of optimal glucose, blood pressure and lipid targets through promotion of prudent diet, regular physical activity and adherence to necessary medication. This may require the development of new programs for the coordination of required multidisciplinary services. Diffusion of innovations theory offers a conceptual framework that may facilitate the implementation of such programs. To illustrate this, we have re-examined the implementation experiences previously reported by the developers of an actual diabetes management pilot program in Montreal, with an eye toward identifying potentially important process factors that could effectively increase adoption and sustainability. Physician participation in the program appeared to be influenced by perceived advantages of participation, compatibility of the program with own perspective and perceived barriers to participation. Organizational features that may have influenced participation included the extent of the program's integration within the existing health care system. A thorough consideration of process factors that impact system and team integration must equally include a focus on ensuring ongoing partnerships among the producers of the model, governments, nongovernmental organizations, private industry, user professionals and patients. This can only be achieved when a knowledge transfer action plan is developed to guide program development, implementation and sustainability.

Natriuretic peptide-guided management in heart failure.

PubMed

Chioncel, Ovidiu; Collins, Sean P; Greene, Stephen J; Ambrosy, Andrew P; Vaduganathan, Muthiah; Macarie, Cezar; Butler, Javed; Gheorghiade, Mihai

2016-08-01

Heart failure is a clinical syndrome that manifests from various cardiac and noncardiac abnormalities. Accordingly, rapid and readily accessible methods for diagnosis and risk stratification are invaluable for providing clinical care, deciding allocation of scare resources, and designing selection criteria for clinical trials. Natriuretic peptides represent one of the most important diagnostic and prognostic tools available for the care of heart failure patients. Natriuretic peptide testing has the distinct advantage of objectivity, reproducibility, and widespread availability.The concept of tailoring heart failure management to achieve a target value of natriuretic peptides has been tested in various clinical trials and may be considered as an effective method for longitudinal biomonitoring and guiding escalation of heart failure therapies with overall favorable results.Although heart failure trials support efficacy and safety of natriuretic peptide-guided therapy as compared with usual care, the relationship between natriuretic peptide trajectory and clinical benefit has not been uniform across the trials, and certain subgroups have not shown robust benefit. Furthermore, the precise natriuretic peptide value ranges and time intervals of testing are still under investigation. If natriuretic peptides fail to decrease following intensification of therapy, further work is needed to clarify the optimal pharmacologic approach. Despite decreasing natriuretic peptide levels, some patients may present with other high-risk features (e.g. elevated troponin). A multimarker panel investigating multiple pathological processes will likely be an optimal alternative, but this will require prospective validation.Future research will be needed to clarify the type and magnitude of the target natriuretic peptide therapeutic response, as well as the duration of natriuretic peptide-guided therapy in heart failure patients.

Lead optimization attrition analysis (LOAA): a novel and general methodology for medicinal chemistry.

PubMed

Munson, Mark; Lieberman, Harvey; Tserlin, Elina; Rocnik, Jennifer; Ge, Jie; Fitzgerald, Maria; Patel, Vinod; Garcia-Echeverria, Carlos

2015-08-01

Herein, we report a novel and general method, lead optimization attrition analysis (LOAA), to benchmark two distinct small-molecule lead series using a relatively unbiased, simple technique and commercially available software. We illustrate this approach with data collected during lead optimization of two independent oncology programs as a case study. Easily generated graphics and attrition curves enabled us to calibrate progress and support go/no go decisions on each program. We believe that this data-driven technique could be used broadly by medicinal chemists and management to guide strategic decisions during drug discovery. Copyright © 2015 Elsevier Ltd. All rights reserved.

Nitrates as a Treatment of Acute Heart Failure

PubMed Central

Alzahri, Mohammad S; Rohra, Anita

2016-01-01

The purpose of this article is to review the clinical efficacy and safety of nitrates in acute heart failure (AHF) by examining various trials on nitrates in AHF. Management of AHF can be challenging due to the lack of objective clinical evidence guiding optimal management. There have been many articles suggesting that, despite a benefit, nitrates are underused in clinical practice. Nitrates, when appropriately dosed, have a favourable effect on symptoms, blood pressure, intubation rates, mortality and other parameters. PMID:28785453

Leveraging human decision making through the optimal management of centralized resources

NASA Astrophysics Data System (ADS)

Hyden, Paul; McGrath, Richard G.

2016-05-01

Combining results from mixed integer optimization, stochastic modeling and queuing theory, we will advance the interdisciplinary problem of efficiently and effectively allocating centrally managed resources. Academia currently fails to address this, as the esoteric demands of each of these large research areas limits work across traditional boundaries. The commercial space does not currently address these challenges due to the absence of a profit metric. By constructing algorithms that explicitly use inputs across boundaries, we are able to incorporate the advantages of using human decision makers. Key improvements in the underlying algorithms are made possible by aligning decision maker goals with the feedback loops introduced between the core optimization step and the modeling of the overall stochastic process of supply and demand. A key observation is that human decision-makers must be explicitly included in the analysis for these approaches to be ultimately successful. Transformative access gives warfighters and mission owners greater understanding of global needs and allows for relationships to guide optimal resource allocation decisions. Mastery of demand processes and optimization bottlenecks reveals long term maximum marginal utility gaps in capabilities.

Applying sport psychology to improve clinical performance.

PubMed

Church, Helen R; Rumbold, James L; Sandars, John

2017-12-01

Preparedness for practice has become an international theme within Medical Education: for healthcare systems to maintain their highest clinical standards, junior doctors must "hit the ground running" on beginning work. Despite demonstrating logical, structured assessment and management plans during their undergraduate examinations, many newly qualified doctors report difficulty in translating this theoretical knowledge into the real clinical environment. "Preparedness" must constitute more than the knowledge and skills acquired during medical school. Complexities of the clinical environment overwhelm some junior doctors, who acknowledge that they lack strategies to manage their anxieties, under-confidence and low self-efficacy. If uncontrolled, such negative emotions and behaviors may impede the delivery of time-critical treatment for acutely unwell patients and compound junior doctors' self-doubt, thus impacting future patient encounters. Medical Education often seeks inspiration from other industries for potential solutions to challenges. To address "preparedness for practice," this AMEE Guide highlights sport psychology: elite sportspeople train both physically and psychologically for their discipline. The latter promotes management of negative emotions, distractions and under-confidence, thus optimizing performance despite immense pressures of career-defining moments. Similar techniques might allow junior doctors to optimize patient care, especially within stressful situations. This AMEE Guide introduces the novel conceptual model, PERFORM, which targets the challenges faced by junior doctors on graduation. The model applies pre-performance routines from sport psychology with the self-regulatory processes of metacognition to the clinical context. This model could potentially equip junior doctors, and other healthcare professionals facing similar challenges, with strategies to optimize clinical care under the most difficult circumstances.

Airway Management of Near-Complete Tracheal Transection by Through-the-Wound Intubation: A Case Report.

PubMed

Jean, Yuel-Kai; Potnuru, Paul; Diez, Christian

2018-06-11

We present an approach to airway management in a patient with machete injuries culminating in near-complete cricotracheal transection, in addition to a gunshot wound to the neck. Initial airway was established by direct intubation through the cricotracheal wound. Once the airway was secured, a bronchoscopy-guided orotracheal intubation was performed with simultaneous retraction of the cricotracheal airway to optimize the surgical field. This case offers insight into a rarely performed approach to airway management. Furthermore, our case report demonstrates that, in select airway injuries, performing through-the-wound intubation engenders a multitude of benefits.

Goals and Objectives to Optimize the Value of an Acute Pain Service in Perioperative Pain Management.

PubMed

Le-Wendling, Linda; Glick, Wesley; Tighe, Patrick

2017-12-01

As newer pharmacologic and procedural interventions, technology, and data on outcomes in pain management are becoming available, effective acute pain management will require a dedicated Acute Pain Service (APS) to help determine the most optimal pain management plan for the patients. Goals for pain management must take into consideration the side effect profile of drugs and potential complications of procedural interventions. Multiple objective optimization is the combination of multiple different objectives for acute pain management. Simple use of opioids, for example, can reduce all pain to minimal levels, but at what cost to the patient, the medical system, and to public health as a whole? Many models for APS exist based on personnel's skills, knowledge and experience, but effective use of an APS will also require allocation of time, space, financial, and personnel resources with clear objectives and a feedback mechanism to guide changes to acute pain medicine practices to meet the constantly evolving medical field. Physician-based practices have the advantage of developing protocols for the management of low-variability, high-occurrence scenarios in addition to tailoring care to individual patients with high-variability, low-occurrence scenarios. Frequent feedback and data collection/assessment on patient outcomes is essential in evaluating the efficacy of the Acute Pain Service's intervention in improving patient outcomes in the acute and perioperative setting.

Basic Principles of Electrical Network Reliability Optimization in Liberalised Electricity Market

NASA Astrophysics Data System (ADS)

Oleinikova, I.; Krishans, Z.; Mutule, A.

2008-01-01

The authors propose to select long-term solutions to the reliability problems of electrical networks in the stage of development planning. The guide lines or basic principles of such optimization are: 1) its dynamical nature; 2) development sustainability; 3) integrated solution of the problems of network development and electricity supply reliability; 4) consideration of information uncertainty; 5) concurrent consideration of the network and generation development problems; 6) application of specialized information technologies; 7) definition of requirements for independent electricity producers. In the article, the major aspects of liberalized electricity market, its functions and tasks are reviewed, with emphasis placed on the optimization of electrical network development as a significant component of sustainable management of power systems.

CANARY Risk Management of Adenocarcinoma: The Future of Imaging?

PubMed Central

Foley, Finbar; Rajagopalan, Srinivasan; Raghunath, Sushravya M; Boland, Jennifer M; Karwoski, Ronald A.; Maldonado, Fabien; Bartholmai, Brian J; Peikert, Tobias

2016-01-01

Increased clinical utilization of chest high resolution computed tomography results in increased identification of lung adenocarcinomas and persistent sub-solid opacities. However, these lesions range from very indolent to extremely aggressive tumors. Clinically relevant diagnostic tools to non-invasively risk stratify and guide individualized management of these lesions are lacking. Research efforts investigating semi-quantitative measures to decrease inter- and intra-rater variability are emerging, and in some cases steps have been taken to automate this process. However, many such methods currently are still sub-optimal, require validation and are not yet clinically applicable. The Computer-Aided Nodule Assessment and Risk Yield (CANARY) software application represents a validated tool for the automated, quantitative, non-invasive tool for risk stratification of adenocarcinoma lung nodules. CANARY correlates well with consensus histology and post-surgical patient outcomes and therefore may help to guide individualized patient management e.g. in identification of nodules amenable to radiological surveillance, or in need of adjunctive therapy. PMID:27568149

Hyperammonemic Encephalopathy Associated With Fibrolamellar Hepatocellular Carcinoma: Case Report, Literature Review, and Proposed Treatment Algorithm.

PubMed

Chapuy, Claudia I; Sahai, Inderneel; Sharma, Rohit; Zhu, Andrew X; Kozyreva, Olga N

2016-04-01

We report a case of a 31-year-old man with metastatic fibrolamellar hepatocellular carcinoma (FLHCC) treated with gemcitabine and oxaliplatin complicated by hyperammonemic encephalopathy biochemically consistent with acquired ornithine transcarbamylase deficiency. Awareness of FLHCC-associated hyperammonemic encephalopathy and a pathophysiology-based management approach can optimize patient outcome and prevent serious complications. A discussion of the management, literature review, and proposed treatment algorithm of this rare metabolic complication are presented. Pathophysiology-guided management of cancer-associated hyperammonemic encephalopathy can improve patient outcome and prevent life-threatening complications. Community and academic oncologists should be aware of this serious metabolic complication of cancer and be familiar with its management. ©AlphaMed Press.

Optimizing the well pumping rate and its distance from a stream

NASA Astrophysics Data System (ADS)

Abdel-Hafez, M. H.; Ogden, F. L.

2008-12-01

Both ground water and surface water are very important component of the water resources. Since they are coupled systems in riparian areas, management strategies that neglect interactions between them penalize senior surface water rights to the benefit of junior ground water rights holders in the prior appropriation rights system. Water rights managers face a problem in deciding which wells need to be shut down and when, in the case of depleted stream flow. A simulation model representing a combined hypothetical aquifer and stream has been developed using MODFLOW 2000 to capture parameter sensitivity, test management strategies and guide field data collection campaigns to support modeling. An optimization approach has been applied to optimize both the well distance from the stream and the maximum pumping rate that does not affect the stream discharge downstream the pumping wells. Conjunctive management can be modeled by coupling the numerical simulation model with the optimization techniques using the response matrix technique. The response matrix can be obtained by calculating the response coefficient for each well and stream. The main assumption of the response matrix technique is that the amount of water out of the stream to the aquifer is linearly proportional to the well pumping rate (Barlow et al. 2003). The results are presented in dimensionless form, which can be used by the water managers to solve conflicts between surface water and ground water holders by making the appropriate decision to choose which well need to be shut down first.

Advanced order management in ERM systems: the tic-tac-toe algorithm

NASA Astrophysics Data System (ADS)

Badell, Mariana; Fernandez, Elena; Puigjaner, Luis

2000-10-01

The concept behind improved enterprise resource planning systems (ERP) systems is the overall integration of the whole enterprise functionality into the management systems through financial links. Converting current software into real management decision tools requires crucial changes in the current approach to ERP systems. This evolution must be able to incorporate the technological achievements both properly and in time. The exploitation phase of plants needs an open web-based environment for collaborative business-engineering with on-line schedulers. Today's short lifecycles of products and processes require sharp and finely tuned management actions that must be guided by scheduling tools. Additionally, such actions must be able to keep track of money movements related to supply chain events. Thus, the necessary outputs require financial-production integration at the scheduling level as proposed in the new approach of enterprise management systems (ERM). Within this framework, the economical analysis of the due date policy and its optimization become essential to manage dynamically realistic and optimal delivery dates with price-time trade-off during the marketing activities. In this work we propose a scheduling tool with web-based interface conducted by autonomous agents when precise economic information relative to plant and business actions and their effects are provided. It aims to attain a better arrangement of the marketing and production events in order to face the bid/bargain process during e-commerce. Additionally, management systems require real time execution and an efficient transaction-oriented approach capable to dynamically adopt realistic and optimal actions to support marketing management. To this end the TicTacToe algorithm provides sequence optimization with acceptable tolerances in realistic time.

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

PubMed

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

2016-02-01

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

A guided search genetic algorithm using mined rules for optimal affective product design

NASA Astrophysics Data System (ADS)

Fung, Chris K. Y.; Kwong, C. K.; Chan, Kit Yan; Jiang, H.

2014-08-01

Affective design is an important aspect of new product development, especially for consumer products, to achieve a competitive edge in the marketplace. It can help companies to develop new products that can better satisfy the emotional needs of customers. However, product designers usually encounter difficulties in determining the optimal settings of the design attributes for affective design. In this article, a novel guided search genetic algorithm (GA) approach is proposed to determine the optimal design attribute settings for affective design. The optimization model formulated based on the proposed approach applied constraints and guided search operators, which were formulated based on mined rules, to guide the GA search and to achieve desirable solutions. A case study on the affective design of mobile phones was conducted to illustrate the proposed approach and validate its effectiveness. Validation tests were conducted, and the results show that the guided search GA approach outperforms the GA approach without the guided search strategy in terms of GA convergence and computational time. In addition, the guided search optimization model is capable of improving GA to generate good solutions for affective design.

Prevention and management of cochlear implant infections.

PubMed

Gluth, Michael B; Singh, Rajesh; Atlas, Marcus D

2011-11-01

Understanding the issues of infection related to an implantable medical device is crucial to all cochlear implant teams. Furthermore, given the risk of central nervous system complications and the relatively high quantity of underlying resource investment associated with cochlear implantation, the stakes of infection are high. The optimal strategies to prevent and manage such infections are still evolving as good-quality prospective data to guide such management decisions are not yet abundant within the medical literature and many recommendations are based on retrospective reviews or anecdotal evidence. We will outline a general strategy to deal with cochlear implant-related infection based on both the authors' experience and the published literature.

Oncology Gold Standard™ practical consensus recommendations 2016 for treatment of advanced clear cell renal cell carcinoma.

PubMed

Batra, U; Parikh, P M; Prabhash, K; Tongaonkar, H B; Chibber, P; Dabkara, D; Deshmukh, C; Ghadyalpatil, N; Hingmire, S; Joshi, A; Raghunath, S K; Rajappa, S; Rajendranath, R; Rawal, S K; Singh, Manisha; Singh, R; Somashekhar, S P; Sood, R

2016-01-01

The Oncology Gold Standard (OGS) Expert Group on renal cell carcinoma (RCC) developed the consensus statement to provide community oncologists practical guidelines on the management of advanced clear cell (cc) RCC using published evidence, practical experience of experts in real life management, and results of a nationwide survey involving 144 health-care professionals. Six broad question categories containing 33 unique questions cover major situations in the routine management of RCC. This document serves as a ready guide for the standard of care to optimize outcome. The table of "Take Home Messages" at the end is a convenient tool for busy practitioners.

Enhancing Self-Efficacy for Optimized Patient Outcomes through the Theory of Symptom Self-Management

PubMed Central

Hoffman, Amy J.

2012-01-01

Background In today’s world, greater patient empowerment is imperative since 90 million Americans live with one or more chronic conditions such as cancer. Evidence reveals that healthy behaviors such as effective symptom self-management can prevent or reduce much of the suffering from cancer. Oncology nurses play a pivotal role in developing a symptom self-management plan that is critical to optimizing a patient’s symptom self-management behaviors. Objective This article uses exemplars to describe how oncology nurses can apply a tested middle-range theory, the Theory of Symptom Self-Management, to clinical practice by incorporating interventions to increase a patient’s perceived self-efficacy to optimize patient outcomes. Methods The Theory of Symptom Self-Management provides a means to understand the dynamic aspects of symptom self-management and provides a tested framework for the development of efficacy enhancing interventions for use by oncology nurses in clinical practice. Results Exemplars based on the Theory of Symptom Self-Management that depict how oncology nursing can use perceived self-efficacy enhancing symptom self-management interventions to improve the functional status and quality of life of their patients. Conclusion Guided by a theoretical approach, oncology nurses can have a significant positive impact on the lives of their patients by reducing the symptom burden associated with cancer and its treatment. Implications for Practice Oncology nurses can partner with their patients to design tailored approaches to symptom self-management. These tailored approaches provide the ability to implement patient specific behaviors that recognize, prevent, relieve, or decrease the timing, intensity, distress, concurrence, and unpleasant quality of symptoms. PMID:22495550

Electrical impedance tomography

PubMed Central

Lobo, Beatriz; Hermosa, Cecilia; Abella, Ana

2018-01-01

Continuous assessment of respiratory status is one of the cornerstones of modern intensive care unit (ICU) monitoring systems. Electrical impedance tomography (EIT), although with some constraints, may play the lead as a new diagnostic and guiding tool for an adequate optimization of mechanical ventilation in critically ill patients. EIT may assist in defining mechanical ventilation settings, assess distribution of tidal volume and of end-expiratory lung volume (EELV) and contribute to titrate positive end-expiratory pressure (PEEP)/tidal volume combinations. It may also quantify gains (recruitment) and losses (overdistention or derecruitment), granting a more realistic evaluation of different ventilator modes or recruitment maneuvers, and helping in the identification of responders and non-responders to such maneuvers. Moreover, EIT also contributes to the management of life-threatening lung diseases such as pneumothorax, and aids in guiding fluid management in the critical care setting. Lastly, assessment of cardiac function and lung perfusion through electrical impedance is on the way. PMID:29430443

Clinical Utility of Viral Load in Management of Cytomegalovirus Infection after Solid Organ Transplantation

PubMed Central

2013-01-01

SUMMARY The negative impact of cytomegalovirus (CMV) infection on transplant outcomes warrants efforts toward improving its prevention, diagnosis, and treatment. During the last 2 decades, significant breakthroughs in diagnostic virology have facilitated remarkable improvements in CMV disease management. During this period, CMV nucleic acid amplification testing (NAT) evolved to become one of the most commonly performed tests in clinical virology laboratories. NAT provides a means for rapid and sensitive diagnosis of CMV infection in transplant recipients. Viral quantification also introduced several principles of CMV disease management. Specifically, viral load has been utilized (i) for prognostication of CMV disease, (ii) to guide preemptive therapy, (iii) to assess the efficacy of antiviral treatment, (iv) to guide the duration of treatment, and (v) to indicate the risk of clinical relapse or antiviral drug resistance. However, there remain important limitations that require further optimization, including the interassay variability in viral load reporting, which has limited the generation of standardized viral load thresholds for various clinical indications. The recent introduction of an international reference standard should advance the major goal of uniform viral load reporting and interpretation. However, it has also become apparent that other aspects of NAT should be standardized, including sample selection, nucleic acid extraction, amplification, detection, and calibration, among others. This review article synthesizes the vast amount of information on CMV NAT and provides a timely review of the clinical utility of viral load testing in the management of CMV in solid organ transplant recipients. Current limitations are highlighted, and avenues for further research are suggested to optimize the clinical application of NAT in the management of CMV after transplantation. PMID:24092851

Status of integrated multidisciplinary rotorcraft optimization research at the Langley Research Center

NASA Technical Reports Server (NTRS)

Mantay, Wayne R.; Adelman, Howard M.

1990-01-01

This paper describes a joint NASA/Army research activity at the Langley Research Center to develop optimization procedures aimed at improving the rotor blade design process by integrating appropriate disciplines and accounting for important interactions among the disciplines. The activity is being guided by a Steering Committee made up of key NASA and Army researchers and managers. The paper describes the optimization formulation in terms of the objective function, design variables, and constraints. The analysis aspects are discussed, and the interdisciplinary interactions are defined in terms of the information that must be transferred among disciplinary analyses as well as the trade-offs between disciplines in determining the details of the design. At this writing, some significant progress has been made. Results given in the paper represent accomplishments in rotor aerodynamic performance optimization for minimum horsepower, rotor dynamic optimization for vibration reduction, approximate analysis of frequencies and mode shapes, rotor structural optimization for minimum weight, and integrated aerodynamic load/dynamics optimization for minimum vibration and weight.

An External Archive-Guided Multiobjective Particle Swarm Optimization Algorithm.

PubMed

Zhu, Qingling; Lin, Qiuzhen; Chen, Weineng; Wong, Ka-Chun; Coello Coello, Carlos A; Li, Jianqiang; Chen, Jianyong; Zhang, Jun

2017-09-01

The selection of swarm leaders (i.e., the personal best and global best), is important in the design of a multiobjective particle swarm optimization (MOPSO) algorithm. Such leaders are expected to effectively guide the swarm to approach the true Pareto optimal front. In this paper, we present a novel external archive-guided MOPSO algorithm (AgMOPSO), where the leaders for velocity update are all selected from the external archive. In our algorithm, multiobjective optimization problems (MOPs) are transformed into a set of subproblems using a decomposition approach, and then each particle is assigned accordingly to optimize each subproblem. A novel archive-guided velocity update method is designed to guide the swarm for exploration, and the external archive is also evolved using an immune-based evolutionary strategy. These proposed approaches speed up the convergence of AgMOPSO. The experimental results fully demonstrate the superiority of our proposed AgMOPSO in solving most of the test problems adopted, in terms of two commonly used performance measures. Moreover, the effectiveness of our proposed archive-guided velocity update method and immune-based evolutionary strategy is also experimentally validated on more than 30 test MOPs.

Irritable bowel syndrome: contemporary nutrition management strategies.

PubMed

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

2014-09-01

Irritable bowel syndrome is a complex disorder whose pathophysiology involves alterations in the enteric microbiota, visceral hypersensitivity, gut immune/barrier function, hypothalamic-pituitary-adrenal axis regulation, neurotransmitters, stress response, psychological factors, and more. The importance of diet in the management of irritable bowel syndrome has taken center stage in recent times as the literature validates the relationship of certain foods with the provocation of symptoms. Likewise, a number of elimination dietary programs have been successful in alleviating irritable bowel syndrome symptoms. Knowledge of the dietary management strategies for irritable bowel syndrome will help guide nutritionists and healthcare practitioners to deliver optimal outcomes. This tutorial reviews the nutrition management strategies for irritable bowel syndrome. © 2014 American Society for Parenteral and Enteral Nutrition.

Item Unique Identification Capability Expansion: Established Process Analysis, Cost Benefit Analysis, and Optimal Marking Procedures

DTIC Science & Technology

2014-12-01

chemical etching EDM electrical discharge machine EID enterprise identifier EOSS Engineering Operational Sequencing System F Fahrenheit...Center in Corona , California, released a DoN IUID Marking Guide, which made recommendations on how to mark legacy items. It provides technical...uploaded into the IUID registry managed by the Naval Surface Warfare Center (NSWC) in Corona , California. There is no set amount of information

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

PubMed Central

Mears, Simon C.

2015-01-01

Over the past 4 decades, much has been learned about the pathophysiology and treatment of osteoporosis, the prevention of fragility fractures, and the perioperative management of patients who have these debilitating injuries. However, the volume of published literature on this topic is staggering and far too voluminous for any clinician to review and synthesize by him or herself. This manuscript thoroughly summarizes the latest research on fragility fractures and provides the reader with valuable strategies to optimize the prevention and management of these devastating injuries. The information contained in this article will prove invaluable to any health care provider or health system administrator who is involved in the prevention and management of fragility hip fractures. As providers begin to gain a better understanding of the principles espoused in this article, it is our hope that they will be able to use this information to optimize the care they provide for elderly patients who are at risk of or who have osteoporotic fractures. PMID:26246957

Program MAMO: Models for avian management optimization-user guide

USGS Publications Warehouse

Guillaumet, Alban; Paxton, Eben H.

2017-01-01

The following chapters describe the structure and code of MAMO, and walk the reader through running the different components of the program with sample data. This manual should be used alongside a computer running R, so that the reader can copy and paste code into R, observe the output, and follow along interactively. Taken together, chapters 2–4 will allow the user to replicate a simulation study investigating the consequences of climate change and two potential management actions on the population dynamics of a vulnerable and iconic Hawaiian forest bird, the ‘I‘iwi (Drepanis coccinea; hereafter IIWI).

Oncology Gold Standard™ practical consensus recommendations 2016 for treatment of advanced clear cell renal cell carcinoma

PubMed Central

Batra, U; Parikh, PM; Prabhash, K; Tongaonkar, HB; Chibber, P; Dabkara, D; Deshmukh, C; Ghadyalpatil, N; Hingmire, S; Joshi, A; Raghunath, SK; Rajappa, S; Rajendranath, R; Rawal, SK; Singh, Manisha; Singh, R; Somashekhar, SP; Sood, R

2016-01-01

The Oncology Gold Standard (OGS) Expert Group on renal cell carcinoma (RCC) developed the consensus statement to provide community oncologists practical guidelines on the management of advanced clear cell (cc) RCC using published evidence, practical experience of experts in real life management, and results of a nationwide survey involving 144 health-care professionals. Six broad question categories containing 33 unique questions cover major situations in the routine management of RCC. This document serves as a ready guide for the standard of care to optimize outcome. The table of “Take Home Messages” at the end is a convenient tool for busy practitioners. PMID:28032079

Inflammatory and Other Biomarkers: Role in Pathophysiology and Prediction of Gestational Diabetes Mellitus

PubMed Central

Abell, Sally K.; De Courten, Barbora; Boyle, Jacqueline A.; Teede, Helena J.

2015-01-01

Understanding pathophysiology and identifying mothers at risk of major pregnancy complications is vital to effective prevention and optimal management. However, in current antenatal care, understanding of pathophysiology of complications is limited. In gestational diabetes mellitus (GDM), risk prediction is mostly based on maternal history and clinical risk factors and may not optimally identify high risk pregnancies. Hence, universal screening is widely recommended. Here, we will explore the literature on GDM and biomarkers including inflammatory markers, adipokines, endothelial function and lipids to advance understanding of pathophysiology and explore risk prediction, with a goal to guide prevention and treatment of GDM. PMID:26110385

A guide to multi-objective optimization for ecological problems with an application to cackling goose management

USGS Publications Warehouse

Williams, Perry J.; Kendall, William L.

2017-01-01

Choices in ecological research and management are the result of balancing multiple, often competing, objectives. Multi-objective optimization (MOO) is a formal decision-theoretic framework for solving multiple objective problems. MOO is used extensively in other fields including engineering, economics, and operations research. However, its application for solving ecological problems has been sparse, perhaps due to a lack of widespread understanding. Thus, our objective was to provide an accessible primer on MOO, including a review of methods common in other fields, a review of their application in ecology, and a demonstration to an applied resource management problem.A large class of methods for solving MOO problems can be separated into two strategies: modelling preferences pre-optimization (the a priori strategy), or modelling preferences post-optimization (the a posteriori strategy). The a priori strategy requires describing preferences among objectives without knowledge of how preferences affect the resulting decision. In the a posteriori strategy, the decision maker simultaneously considers a set of solutions (the Pareto optimal set) and makes a choice based on the trade-offs observed in the set. We describe several methods for modelling preferences pre-optimization, including: the bounded objective function method, the lexicographic method, and the weighted-sum method. We discuss modelling preferences post-optimization through examination of the Pareto optimal set. We applied each MOO strategy to the natural resource management problem of selecting a population target for cackling goose (Branta hutchinsii minima) abundance. Cackling geese provide food security to Native Alaskan subsistence hunters in the goose's nesting area, but depredate crops on private agricultural fields in wintering areas. We developed objective functions to represent the competing objectives related to the cackling goose population target and identified an optimal solution first using the a priori strategy, and then by examining trade-offs in the Pareto set using the a posteriori strategy. We used four approaches for selecting a final solution within the a posteriori strategy; the most common optimal solution, the most robust optimal solution, and two solutions based on maximizing a restricted portion of the Pareto set. We discuss MOO with respect to natural resource management, but MOO is sufficiently general to cover any ecological problem that contains multiple competing objectives that can be quantified using objective functions.

The Chromosome 18 Clinical Resource Center.

PubMed

Cody, Jannine D; Hasi-Zogaj, Minire; Heard, Patricia; Hill, Annice; Rupert, David; Sebold, Courtney; Soileau, Bridgette; Hale, Daniel E

2018-05-01

The Chromosome 18 Clinical Research Center has created a pediatrician-friendly virtual resource center for managing patients with chromosome 18 abnormalities. To date, children with rare chromosome abnormalities have been cared for either symptomatically or palliatively as a reaction to the presenting medical problems. As we enter an era of genomic-informed medicine, we can provide children, even those with individually unique chromosome abnormalities, with proactive medical care and management based on the most contemporary data on their specific genomic change. It is problematic for practicing physicians to obtain and use the emerging data on specific genes because this information is derived from diverse sources (e.g., animal studies, case reports, in vitro explorations) and is often published in sources that are not easily accessible in the clinical setting. The Chromosome 18 Clinical Resource Center remedies this challenging problem by curating and synthesizing the data with clinical implications. The data are collected from our database of over 26 years of natural history and medical data from over 650 individuals with chromosome 18 abnormalities. The resulting management guides and video presentations are a first edition of this collated data specifically oriented to guide clinicians toward the optimization of care for each child. The chromosome 18 data and guides also serve as models for an approach to the management of any individual with a rare chromosome abnormality of which there are over 1,300 born every year in the US alone. © 2018 The Authors. Molecular Genetics & Genomic Medicine published by Wiley Periodicals, Inc.

Outcomes of topography-guided versus wavefront-optimized laser in situ keratomileusis for myopia in virgin eyes.

PubMed

Jain, Arun Kumar; Malhotra, Chintan; Pasari, Anand; Kumar, Pawan; Moshirfar, Majid

2016-09-01

To compare the outcomes of topography-guided and wavefront-optimized treatment in patients having laser in situ keratomileusis (LASIK) for myopia. Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Prospective contralateral-eye case study. Patients had topography-guided LASIK in 1 eye and wavefront-optimized LASIK in the contralateral eye using the Customized Refractive Surgery Master software and Mel 80 excimer laser. Refractive (residual manifest refraction spherical equivalent [MRSE], higher-order aberrations [HOAs]), and visual (uncorrected distance visual acuity [UDVA] and photopic and mesopic contrast sensitivity) outcomes were prospectively analyzed 6 months postoperatively. The study comprised 35 patients. The UDVA was 0.0 logMAR or better and the postoperative residual MRSE was ±0.50 diopter in 94.29% of eyes in the topography-guided group and 85.71% of eyes in the wavefront-optimized group (P = .09). More eyes in the topography-guided group than in the wavefront-optimized group had a UDVA of -0.1 logMAR or better (P = .04). Topography-guided LASIK was associated with less deterioration of mesopic contrast sensitivity at higher spatial frequencies (12 cycles per degree [cpd] and 18 cpd) and lower amounts of induced coma (P = .04) and spherical aberration (P = .04). Less stromal tissue was ablated in the topography-guided group (mean 61.57 μm ± 16.23 [SD]) than in the wavefront-optimized group (mean 79.71 ± 14.81 μm) (P < .001). Although topography-guided LASIK and wavefront-optimized LASIK gave excellent results, topography-guided LASIK was associated with better contrast sensitivity, lower induction of HOAs, and a smaller amount of tissue ablation. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

SU-E-T-247: Determinations of the Optimal Phase for Respiratory Gated Radiotherapy From Statistical Analysis Using a Visible Guidance System

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

Oh, S; Yea, J; Kang, M

Purpose: Respiratory gated radiation therapy (RGRT) is used to minimize the radiation dose to normal tissue in lung cancer patients. Determination of the optimal point in the respiratory phase of a patient is important in RGRT but it is not easy. The goal of the present study was to see if a visible guidance system is helpful in determining the optimal phase in respiratory gated therapy. Methods: The breathing signals of 23 lung cancer patients were recorded with a Real-time Position Management (RPM) respiratory gating system (Varian, USA). The patients underwent breathing training with our visible guidance system, after whichmore » their breathing signals were recorded during 5 min of free breathing and 5 min of guided breathing. The breathing signals recorded between 3 and 5 min before and after training were compared. We performed statistical analysis of the breathing signals to find the optimal duty cycle in guided breathing for RGRT. Results: The breathing signals aided by the visible guidance system had more regular cycles over time and smaller variations in the positions of the marker block than the free breathing signals. Of the 23 lung cancer patients, 19 showed statistically significant differences by time when the values obtained before and after breathing were compared (p < 0.05); 30% and 40% of the duty cycle, respectively, was determined to be the most effective, and the corresponding phases were 30 60% (duty cycle, 30%; p < 0.05) and 30 70% (duty cycle, 40%; p < 0.05). Conclusion: Respiratory regularity was significantly improved with the use of the RPM with our visible guiding system; therefore, it would help improve the accuracy and efficiency of RGRT.« less

An initiative in multidisciplinary optimization of rotorcraft

NASA Technical Reports Server (NTRS)

Adelman, Howard M.; Mantay, Wayne R.

1989-01-01

Described is a joint NASA/Army initiative at the Langley Research Center to develop optimization procedures aimed at improving the rotor blade design process by integrating appropriate disciplines and accounting for important interactions among the disciplines. The activity is being guided by a Steering Committee made up of key NASA and Army researchers and managers. The committee, which has been named IRASC (Integrated Rotorcraft Analysis Steering Committee), has defined two principal foci for the activity: a white paper which sets forth the goals and plans of the effort; and a rotor design project which will validate the basic constituents, as well as the overall design methodology for multidisciplinary optimization. The optimization formulation is described in terms of the objective function, design variables, and constraints. Additionally, some of the analysis aspects are discussed and an initial attempt at defining the interdisciplinary couplings is summarized. At this writing, some significant progress has been made, principally in the areas of single discipline optimization. Results are given which represent accomplishments in rotor aerodynamic performance optimization for minimum hover horsepower, rotor dynamic optimization for vibration reduction, and rotor structural optimization for minimum weight.

An initiative in multidisciplinary optimization of rotorcraft

NASA Technical Reports Server (NTRS)

Adelman, Howard M.; Mantay, Wayne R.

1988-01-01

Described is a joint NASA/Army initiative at the Langley Research Center to develop optimization procedures aimed at improving the rotor blade design process by integrating appropriate disciplines and accounting for important interactions among the disciplines. The activity is being guided by a Steering Committee made up of key NASA and Army researchers and managers. The committee, which has been named IRASC (Integrated Rotorcraft Analysis Steering Committee), has defined two principal foci for the activity: a white paper which sets forth the goals and plans of the effort; and a rotor design project which will validate the basic constituents, as well as the overall design methodology for multidisciplinary optimization. The paper describes the optimization formulation in terms of the objective function, design variables, and constraints. Additionally, some of the analysis aspects are discussed and an initial attempt at defining the interdisciplinary couplings is summarized. At this writing, some significant progress has been made, principally in the areas of single discipline optimization. Results are given which represent accomplishments in rotor aerodynamic performance optimization for minimum hover horsepower, rotor dynamic optimization for vibration reduction, and rotor structural optimization for minimum weight.

Mode perturbation method for optimal guided wave mode and frequency selection.

PubMed

Philtron, J H; Rose, J L

2014-09-01

With a thorough understanding of guided wave mechanics, researchers can predict which guided wave modes will have a high probability of success in a particular nondestructive evaluation application. However, work continues to find optimal mode and frequency selection for a given application. This "optimal" mode could give the highest sensitivity to defects or the greatest penetration power, increasing inspection efficiency. Since material properties used for modeling work may be estimates, in many cases guided wave mode and frequency selection can be adjusted for increased inspection efficiency in the field. In this paper, a novel mode and frequency perturbation method is described and used to identify optimal mode points based on quantifiable wave characteristics. The technique uses an ultrasonic phased array comb transducer to sweep in phase velocity and frequency space. It is demonstrated using guided interface waves for bond evaluation. After searching nearby mode points, an optimal mode and frequency can be selected which has the highest sensitivity to a defect, or gives the greatest penetration power. The optimal mode choice for a given application depends on the requirements of the inspection. Copyright © 2014 Elsevier B.V. All rights reserved.

Optimal surveillance strategy for invasive species management when surveys stop after detection.

PubMed

Guillera-Arroita, Gurutzeta; Hauser, Cindy E; McCarthy, Michael A

2014-05-01

Invasive species are a cause for concern in natural and economic systems and require both monitoring and management. There is a trade-off between the amount of resources spent on surveying for the species and conducting early management of occupied sites, and the resources that are ultimately spent in delayed management at sites where the species was present but undetected. Previous work addressed this optimal resource allocation problem assuming that surveys continue despite detection until the initially planned survey effort is consumed. However, a more realistic scenario is often that surveys stop after detection (i.e., follow a "removal" sampling design) and then management begins. Such an approach will indicate a different optimal survey design and can be expected to be more efficient. We analyze this case and compare the expected efficiency of invasive species management programs under both survey methods. We also evaluate the impact of mis-specifying the type of sampling approach during the program design phase. We derive analytical expressions that optimize resource allocation between monitoring and management in surveillance programs when surveys stop after detection. We do this under a scenario of unconstrained resources and scenarios where survey budget is constrained. The efficiency of surveillance programs is greater if a "removal survey" design is used, with larger gains obtained when savings from early detection are high, occupancy is high, and survey costs are not much lower than early management costs at a site. Designing a surveillance program disregarding that surveys stop after detection can result in an efficiency loss. Our results help guide the design of future surveillance programs for invasive species. Addressing program design within a decision-theoretic framework can lead to a better use of available resources. We show how species prevalence, its detectability, and the benefits derived from early detection can be considered.

An integrated multidisciplinary algorithm for the management of spinal metastases: an International Spine Oncology Consortium report.

PubMed

Spratt, Daniel E; Beeler, Whitney H; de Moraes, Fabio Y; Rhines, Laurence D; Gemmete, Joseph J; Chaudhary, Neeraj; Shultz, David B; Smith, Sean R; Berlin, Alejandro; Dahele, Max; Slotman, Ben J; Younge, Kelly C; Bilsky, Mark; Park, Paul; Szerlip, Nicholas J

2017-12-01

Spinal metastases are becoming increasingly common because patients with metastatic disease are living longer. The close proximity of the spinal cord to the vertebral column limits many conventional therapeutic options that can otherwise be used to treat cancer. In response to this problem, an innovative multidisciplinary approach has been developed for the management of spinal metastases, leveraging the capabilities of image-guided stereotactic radiosurgery, separation surgery, vertebroplasty, and minimally invasive local ablative approaches. In this Review, we discuss the variables that should be considered during the management of these patients and review the role of each discipline and their respective management options to provide optimal care. This work is synthesised into a practical algorithm to aid clinicians in the management of patients with spinal metastasis. Copyright © 2017 Elsevier Ltd. All rights reserved.

Management of immune thrombocytopenia: Korean experts recommendation in 2017.

PubMed

Jang, Jun Ho; Kim, Ji Yoon; Mun, Yeung-Chul; Bang, Soo-Mee; Lim, Yeon Jung; Shin, Dong-Yeop; Choi, Young Bae; Yhim, Ho-Young; Lee, Jong Wook; Kook, Hoon

2017-12-01

Management options for patients with immune thrombocytopenia (ITP) have evolved substantially over the past decades. The American Society of Hematology published a treatment guideline for clinicians referring to the management of ITP in 2011. This evidence-based practice guideline for ITP enables the appropriate treatment of a larger proportion of patients and the maintenance of normal platelet counts. Korean authority operates a unified mandatory national health insurance system. Even though we have a uniform standard guideline enforced by insurance reimbursement, there are several unsolved issues in real practice in ITP treatment. To optimize the management of Korean ITP patients, the Korean Society of Hematology Aplastic Anemia Working Party (KSHAAWP) reviewed the consensus and the Korean data on the clinical practices of ITP therapy. Here, we report a Korean expert recommendation guide for the management of ITP.

Wavefront-guided versus wavefront-optimized laser in situ keratomileusis: contralateral comparative study.

PubMed

Padmanabhan, Prema; Mrochen, Michael; Basuthkar, Subam; Viswanathan, Deepa; Joseph, Roy

2008-03-01

To compare the outcomes of wavefront-guided and wavefront-optimized treatment in fellow eyes of patients having laser in situ keratomileusis (LASIK) for myopia. Medical and Vision Research Foundation, Tamil Nadu, India. This prospective comparative study comprised 27 patients who had wavefront-guided LASIK in 1 eye and wavefront-optimized LASIK in the fellow eye. The Hansatome (Bausch & Lomb) was used to create a superior-hinged flap and the Allegretto laser (WaveLight Laser Technologie AG), for photoablation. The Allegretto wave analyzer was used to measure ocular wavefront aberrations and the Functional Acuity Contrast Test chart, to measure contrast sensitivity before and 1 month after LASIK. The refractive and visual outcomes and the changes in aberrations and contrast sensitivity were compared between the 2 treatment modalities. One month postoperatively, 92% of eyes in the wavefront-guided group and 85% in the wavefront-optimized group had uncorrected visual acuity of 20/20 or better; 93% and 89%, respectively, had a postoperative spherical equivalent refraction of +/-0.50 diopter. The differences between groups were not statistically significant. Wavefront-guided LASIK induced less change in 18 of 22 higher-order Zernike terms than wavefront-optimized LASIK, with the change in positive spherical aberration the only statistically significant one (P= .01). Contrast sensitivity improved at the low and middle spatial frequencies (not statistically significant) and worsened significantly at high spatial frequencies after wavefront-guided LASIK; there was a statistically significant worsening at all spatial frequencies after wavefront-optimized LASIK. Although both wavefront-guided and wavefront-optimized LASIK gave excellent refractive correction results, the former induced less higher-order aberrations and was associated with better contrast sensitivity.

New knowledge-based genetic algorithm for excavator boom structural optimization

NASA Astrophysics Data System (ADS)

Hua, Haiyan; Lin, Shuwen

2014-03-01

Due to the insufficiency of utilizing knowledge to guide the complex optimal searching, existing genetic algorithms fail to effectively solve excavator boom structural optimization problem. To improve the optimization efficiency and quality, a new knowledge-based real-coded genetic algorithm is proposed. A dual evolution mechanism combining knowledge evolution with genetic algorithm is established to extract, handle and utilize the shallow and deep implicit constraint knowledge to guide the optimal searching of genetic algorithm circularly. Based on this dual evolution mechanism, knowledge evolution and population evolution can be connected by knowledge influence operators to improve the configurability of knowledge and genetic operators. Then, the new knowledge-based selection operator, crossover operator and mutation operator are proposed to integrate the optimal process knowledge and domain culture to guide the excavator boom structural optimization. Eight kinds of testing algorithms, which include different genetic operators, are taken as examples to solve the structural optimization of a medium-sized excavator boom. By comparing the results of optimization, it is shown that the algorithm including all the new knowledge-based genetic operators can more remarkably improve the evolutionary rate and searching ability than other testing algorithms, which demonstrates the effectiveness of knowledge for guiding optimal searching. The proposed knowledge-based genetic algorithm by combining multi-level knowledge evolution with numerical optimization provides a new effective method for solving the complex engineering optimization problem.

Evaluation of an optimized shade guide made from porcelain powder mixtures.

PubMed

Wang, Peng; Wei, Jiaqiang; Li, Qing; Wang, Yining

2014-12-01

Color errors associated with current shade guides and problems with color selection and duplication are still challenging for restorative dentists. The purpose of this study was to evaluate an optimized shade guide for visual shade duplication. Color distributions (L*, a*, and b*) of the maxillary left central incisors of 236 participants, whose ages ranged from 20 to 60, were measured with a spectrophotometer. Based on this color map, an optimized shade guide was designed with 14 shade tabs evenly distributed within the given color range of the natural incisors. The shade tabs were fabricated with porcelain powder mixtures and conventional laboratory procedures. A comparison of shade duplication by using the optimized and Vitapan Classical shade guides was conducted. Thirty Chinese participants were involved, and the colors of the left maxillary incisors were selected by using 2 shade guides. Metal ceramic crowns were fabricated according to the results of the shade selection. The colors of the shade tabs, natural teeth, and the ceramic crowns were measured with a spectrophotometer. The color differences among the natural teeth, the shade tabs, and the corresponding metal ceramic crowns were calculated and analyzed (α=.017). Significant differences were found in both phases of shade determination and shade duplication (P<.017). The total number of color errors with the optimized shade guide was 3.5, which was significantly less than that of Vitapan, 5.1 (P<.001). The optimized shade guide system improved performance not only in the color selection phase but also in the color of the fabricated crowns. Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Imaging of iatrogenic oesophageal injuries using optimized CT oesophageal leak protocol: pearls and pitfalls.

PubMed

Madan, Rachna; Laur, Olga; Crudup, Breland; Peavy, Latia; Carter, Brett W

2018-02-01

Iatrogenic injury to the oesophagus is a serious complication which is increasingly seen in clinical practice secondary to expansion and greater acceptability of surgical and endoscopic oesophageal procedures. Morbidity and mortality following such injury is high. This is mostly due to an inflammatory response to gastric contents in the mediastinum, and the negative intrathoracic pressures that may further draw out oesophageal contents into the mediastinum leading to mediastinitis. Subsequently, pulmonary complications such as pneumonia or abscess may ensue leading to rapid clinical deterioration. Optimized and timely cross-sectional imaging evaluation is necessary for early and aggressive management of these complications. The goal of this review is to make the radiologist aware of the importance of early and accurate identification of postoperative oesophageal injury using optimized CT imaging protocols and use of oral contrast. Specifically, it is critical to differentiate benign post-operative findings, such as herniated viscus or redundant anastomosis, from clinically significant postoperative complications as this helps guide appropriate management. Advantages and drawbacks of other diagnostic methods, such as contrast oesophagogram, are also discussed.

Full-length silicone insoles versus ultrasound-guided corticosteroid injection in the management of plantar fasciitis: a randomized clinical trial.

PubMed

Yucel, Ufuk; Kucuksen, Sami; Cingoz, Havva T; Anliacik, Emel; Ozbek, Orhan; Salli, Ali; Ugurlu, Hatice

2013-12-01

Plantar fasciitis often leads to disability. Optimal treatment for this clinical condition is still unknown. To compare the effectiveness of wearing a full-length silicone insole with ultrasound-guided corticosteroid injection in the management of plantar fasciitis. Randomized clinical trial. Forty-two patients with chronic unilateral plantar fasciitis were allocated randomly to have an ultrasound-guided corticosteroid injection or wear a full-length silicone insole. Data were collected before the procedure and 1 month after. The primary outcome measures included first-step heel pain via Visual Analogue Scale and Heel Tenderness Index. Other outcome measures were the Foot and Ankle Outcome Score and ultrasonographic thickness of the plantar fascia. After 1 month, a significant improvement was shown in Visual Analogue Scale, Heel Tenderness Index, Foot and Ankle Outcome Score, and ultrasonographic thickness of plantar fascia in both groups. Visual Analogue Scale scores, Foot and Ankle Outcome Score pain, Foot and Ankle Outcome Score for activities of daily living, Foot and Ankle Outcome Score for sport and recreation function, and plantar fascia thickness were better in injection group than in insole group (p < 0.05). Although both ultrasound-guided corticosteroid injection and wearing a full-length silicone insole were effective in the conservative treatment of plantar fasciitis, we recommend the use of silicone insoles as a first line of treatment for persons with plantar fasciitis.

Design and Implementation of the Resuscitation Outcomes Consortium Pragmatic Airway Resuscitation Trial (PART)

PubMed Central

Wang, Henry E.; Prince, David; Stephens, Shannon W.; Herren, Heather; Daya, Mohamud; Richmond, Neal; Carlson, Jestin; Warden, Craig; Colella, M. Riccardo; Brienza, Ashley; Aufderheide, Tom P.; Idris, Ahamed; Schmicker, Robert; May, Susanne; Nichol, Graham

2016-01-01

Airway management is an important component of resuscitation from out-of-hospital cardiac arrest (OHCA). The optimal approach to advanced airway management is unknown. The Pragmatic Airway Resuscitation Trial (PART) will compare the effectiveness of endotracheal intubation (ETI) and Laryngeal Tube (LT) insertion upon 72-hour survival in adult OHCA. Encompassing United States Emergency Medical Services agencies affiliated with the Resuscitation Outcomes Consortium (ROC), PART will use a cluster-crossover randomized design. Participating subjects will include adult, non-traumatic OHCA requiring bag-valve-mask ventilation. Trial interventions will include 1) initial airway management with ETI and 2) initial airway management with LT. The primary and secondary trial outcomes are 72-hour survival and return of spontaneous circulation. Additional clinical outcomes will include airway management process and adverse events. The trial will enroll a total of 3,000 subjects. Results of PART may guide the selection of advanced airway management strategies in OHCA. PMID:26851059

Modeling impacts of water and fertilizer management on the ecosystem service of rice rotated cropping system in China

NASA Astrophysics Data System (ADS)

Chen, H.; Yu, C.; Li, C.

2015-12-01

Sustainable agricultural intensification demand optimum resource managements of agro-ecosystems. Detailed information on the impacts of water use and nutrient application on agro-ecosystem services including crop yields, greenhouse gas (GHG) emissions and nitrogen (N) loss is the key to guide field managements. In this study, we use the DeNitrification-DeComposition (DNDC) model to simulate the biogeochemical processes for rice rotated cropping systems in China. We set varied scenarios of water use in more than 1600 counties, and derived optimal rates of N application for each county in accordance to water use scenarios. Our results suggest that 0.88 ± 0.33 Tg per year (mean ± standard deviation) of synthetic N could be reduced without reducing rice yields, which accounts for 15.7 ± 5.9% of current N application in China. Field managements with shallow flooding and optimal N applications could enhance ecosystem services on a national scale, leading to 34.3% reduction of GHG emissions (CH4, N2O, and CO2), 2.8% reduction of overall N loss (NH3 volatilization, denitrification and N leaching) and 1.7% increase of rice yields, as compared to current management conditions. Among provinces with major rice production, Jiangsu, Yunnan, Guizhou, and Hubei could achieve more than 40% reduction of GHG emissions under appropriate water managements, while Zhejiang, Guangdong, and Fujian could reduce more than 30% N loss with optimal N applications. Our modeling efforts suggest that China is likely to benefit from reforming water and fertilization managements for rice rotated cropping system in terms of sustainable crop yields, GHG emission mitigation and N loss reduction, and the reformation should be prioritized in the above-mentioned provinces. Keywords: water regime, nitrogen fertilization, sustainable management, ecological modeling, DNDC

The theoretical basis for practice-relevant medication use research: patient-centered/behavioral theories.

PubMed

Blalock, Susan J

2011-12-01

There is an urgent need for research to improve the quality of medication use among those who require pharmacotherapy. To describe how behavioral science theories can help to achieve this goal. We begin by describing what a theory is and the functions that theories serve. We then provide 8 guiding principles that are crucial for investigators to understand if they are to use theory appropriately. We conclude by discussing the need for a new model of patient medication self-management that incorporates information concerning factors operating at all levels of the ecological framework, ranging from patient-level to societal-level factors. The 8 guiding principles discussed are the following: (1) There is no single theory that is appropriate for guiding all medication use research; (2) Behavioral science theories are probabilistic, not deterministic; (3) When trying to influence a health behavior, the health behavior of interest must be defined precisely; (4) Many factors outside of patient control influence patient medication use; (5) Every patient is unique; (6) Patient motivation is a fundamental ingredient required to optimize medication use, especially when maintenance of long term behavior is the goal; (7) Health care providers can have a profound effect on patient medication use, and this effect can operate through several possible causal pathways; and (8) When planning an intervention to optimize medication use, it is important to develop a conceptual model that links intervention inputs to the ultimate outcomes that are desired. Medication use can be influenced by a wide variety of factors acting at different levels of the ecological model. The quality of research on medication use could be improved by development of an ecological model specific to medication self-management. Copyright © 2011 Elsevier Inc. All rights reserved.

BIS-Guided Total Intravenous Anesthesia for Orchiopexy and Circumcision in a Child with Severe Autism: A Case Report

PubMed Central

Okur, Selçuk; Arıkan, Müge; Temel, Gülşen; Temel, Volkan

2012-01-01

Autistic children are very difficult to manage in the hospital setting because they react badly to any change in routine. We describe a case of 10-year-old male patient with severe autism undergoing orchidopexy and circumcision. Following premedication, anesthesia was induced with remifentanil, propofol, atracurium, and maintained with total intravenous anesthesia (propofol and remifentanil). The Bispectral Index System was monitored for determination of the depth of anesthesia. After surgery, all infusions were discontinued. The patient was then transferred to the postanesthetic care unit. There were no adverse events observed during the anesthetic management. The patient was discharged from the hospital on the second postoperative day. Bispectral Index System-guided Total Intravenous Anesthesia can provide some advantages for patient with autism, such as hemodynamic stability, early and easy recovery, to facilitate faster discharge, to optimize the delivery of anesthetic agents, to minimize its adverse effects, and to maximize its safety. PMID:23227368

A Guided, Conservative Approach for the Management of Localized Mandibular Anterior Tooth Wear.

PubMed

Mehta, Shamir B; Francis, Selar; Banerji, Subir

2016-03-01

The successful management of the worn mandibular anterior dentition may present an awkward challenge to the dental operator. The purpose of this article is to describe a case report illustrating the use of a guided, three-dimensional protocol for the ultra-conservative and predictable restoration of the worn lower anterior dentition using direct resin composite. This technique utilizes information based on established biomechanical and occlusal principles to fabricate a diagnostic wax-up, which is duplicated in dental stone. This is used to prepare a vacuum-formed modified stent, assisting the clinician to place directly bonded resin composite restorations to restore the worn lower anterior dentition. The technique, described in 2012 and referred to as 'injection moulding' has the potential to offer optimal form, function and an aesthetic outcome in an efficient manner. CPD/Clinical Relevance: This article aims to describe an alternative technique to simplify the processes involved with restoration of worn lower anterior teeth.

Muscle Injuries: A Brief Guide to Classification and Management

PubMed Central

Maffulli, Nicola; Del Buono, Angelo; Oliva, Francesco; Giai Via, Alessio; Frizziero, Antonio; Barazzuol, Michele; Brancaccio, Paola; Freschi, Marco; Galletti, Stefano; Lisitano, Gianfranco; Melegati, Gianluca; Nanni, Gianni; Pasta, Ghito; Ramponi, Carlo; Rizzo, Diego; Testa, Vittorino; Valent, Alessandro

2015-01-01

Muscle injuries are frequent in athletes. Despite their high incidence, advances in clinical diagnostic criteria and imaging, their optimal management and rehabilitation strategies are still debated in literature. Furthermore, reinjury rate is high after a muscle lesion, and an improper treatment or an early return to sports can increase the rate of reinjury and complications. Most muscle injuries are managed conservatively with excellent results, and surgery is normally advocated only for larger tears. This article reviews the current literature to provide physicians and rehabilitation specialists with the necessary basic tools to diagnose, classify and to treat muscle injuries. Based on anatomy, biomechanics, and imaging features of muscle injury, the use of a recently reported new classification system is also advocated. PMID:26535183

Artificial intelligence for optimal anemia management in end-stage renal disease.

PubMed

Brier, Michael E; Gaweda, Adam E

2016-08-01

Computational intelligence for the prediction of hemoglobin to guide the selection of erythropoiesis-stimulating agent dose results in improved anemia management. The models used for the prediction result from the use of individual patient data and help to increase the number of hemoglobin observations within the target range. The benefits of using these modeling techniques appear to be a decrease in erythropoiesis-stimulating agent use and a decrease in the number of transfusions. This study confirms the results of previous smaller studies and suggests that additional beneficial results may be achieved. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Acute Right Ventricular Dysfunction in Intensive Care Unit

PubMed Central

Domingo, Enric

2017-01-01

The role of the left ventricle in ICU patients with circulatory shock has long been considered. However, acute right ventricle (RV) dysfunction causes and aggravates many common critical diseases (acute respiratory distress syndrome, pulmonary embolism, acute myocardial infarction, and postoperative cardiac surgery). Several supportive therapies, including mechanical ventilation and fluid management, can make RV dysfunction worse, potentially exacerbating shock. We briefly review the epidemiology, pathophysiology, diagnosis, and recommendations to guide management of acute RV dysfunction in ICU patients. Our aim is to clarify the complex effects of mechanical ventilation, fluid therapy, vasoactive drug infusions, and other therapies to resuscitate the critical patient optimally. PMID:29201914

Structure-Guided Design and Optimization of Dipeptidyl Inhibitors of Norovirus 3CL Protease. Structure–Activity Relationships and Biochemical, X-ray Crystallographic, Cell-Based, and In Vivo Studies

DOE PAGES

Galasiti Kankanamalage, Anushka C.; Kim, Yunjeong; Weerawarna, Pathum M.; ...

2015-04-09

Norovirus infection constitutes the primary cause of acute viral gastroenteritis. There are currently no vaccines or norovirus-specific antiviral therapeutics available for the management of norovirus infection. Norovirus 3C-like protease is essential for viral replication, consequently, inhibition of this enzyme is a fruitful avenue of investigation that may lead to the emergence of antinorovirus therapeutics. We describe herein the optimization of dipeptidyl inhibitors of norovirus 3C-like protease using iterative SAR, X-ray crystallographic, and enzyme and cell-based studies. We also demonstrate herein in vivo efficacy of an inhibitor using the murine model of norovirus infection.

Effectiveness of Directional Preference to Guide Management of Low Back Pain in Canadian Armed Forces Members: A Pragmatic Study.

PubMed

Franz, Anja; Lacasse, Anaïs; Donelson, Ronald; Tousignant-Laflamme, Yannick

2017-11-01

Low-back pain (LBP) is a leading cause for disability in military personnel. Consequently, effective management strategies are required to maintaining operational capabilities. Physical therapy clinical practice guidelines recommend the use of directional preference (DP) to guide management. The effectiveness of this approach has not been tested in military personnel using a pragmatic study design. Pragmatic studies are ideal to inform clinicians and policymakers about the usefulness of proven interventions in real-life clinical conditions. The purpose of this study was therefore to determine, in clinical practice, the effectiveness of a management approach guided by DP vs. usual care (UC) physical therapy in Canadian Armed Forces (CAF) members with LBP. A pragmatic study was conducted among 44 consecutive CAF members with LBP who received management guided by DP (n = 22) or UC (n = 22). Outcomes were pain intensity (primary outcome), pain location and frequency, perceived disability, medication use, perceived global effect (pain, function, overall status), work loss, and health care utilization. The effectiveness of the intervention was assessed at 1-month and 3-months follow-up. Statistically significant differences favoring the DP group were observed for pain intensity (Δ 1 month: 1.9/10; 95% confidence interval [CI]; 0.97-2.89; Δ 3 months: 1.3/10; 95% CI: 0.35-2.31), pain location at 1 month (54.5% vs. 19.0%; p = 0.02) and 3 months (68.2% vs. 38.1%; p = 0.01), disability (Δ 1 month: 4.3/24; 95% CI: 2.12-6.38; Δ 3 months: 3.5/24; 95% CI; 1.59-5.33), perceived global effect at 1 month (pain: 86.4% vs. 57.1%; function: 81.8% vs. 47.6%; overall status: 86.4% vs. 57.1%) and 3 months (pain: 95.5% vs. 71.1%; overall status: 95.5% vs. 66.7%) with p values < 0.05, and improvement in work status at 3 months (54.5% vs. 23.8%; p = 0.04). DP-guided management appears more effective than UC physical therapy to reduce pain and improve function in CAF members with LBP. Rapid improvements and the patient's ability to self-manage may prove especially advantageous in deployed settings. Our findings are particularly useful to inform military policymakers and clinicians on optimal management for CAF members. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Providers' Perspectives on Case Management of a Healthy Start Program: A Qualitative Study

PubMed Central

Moise, Imelda K.; Mulhall, Peter F.

2016-01-01

Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded and the case managers' comments were transcribed verbatim. Transcripts were analyzed using thematic analysis, a deductive approach. Data were collected in 2013 and analyzed in 2015. Case managers are challenged by externalities (demographic shifts in target populations, poverty); contractual requirements (predefined catchment neighborhoods, caseload); limited support (client incentives, tailored training, and a high staff turnover rate); and logistic difficulties (organizational issues). Their approach to case management tends to be focused on linking Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded and the case managers' comments were transcribed verbatim. Transcripts were analyzed using thematic analysis, a deductive approach. Data were collected in 2013 and analyzed in 2015. Case managers are challenged by externalities (demographic shifts in target populations, poverty); contractual requirements (predefined catchment neighborhoods, caseload); limited support (client incentives, tailored training, and a high staff turnover rate); and logistic difficulties (organizational issues). Their approach to case management tends to be focused on linking clients to adequate services rather than reporting performance. Case managers favored measurable deliverables rather than operational work products. A proposed solution to current challenges emphasizes and encourages the iterative learning process and shared decision making between program targets, funders and providers. Case managers are aware of the challenging environment in which they operate for their clients and for themselves. However, future interventions will require clearly identified performance measures and increased systems support. PMID:27149061

Evaluation of early antimicrobial therapy adaptation guided by the BetaLACTA® test: a case-control study.

PubMed

Garnier, Marc; Rozencwajg, Sacha; Pham, Tài; Vimont, Sophie; Blayau, Clarisse; Hafiani, Mehdi; Fulgencio, Jean-Pierre; Bonnet, Francis; Mainardi, Jean-Luc; Arlet, Guillaume; Fartoukh, Muriel; Gallah, Salah; Quesnel, Christophe

2017-06-28

Rapid diagnostic tests detecting microbial resistance are needed for limiting the duration of inappropriateness of empirical antimicrobial therapy (EAT) in intensive care unit patients, besides reducing the use of broad-spectrum antibiotics. We hypothesized that the betaLACTA® test (BLT) could lead to early increase in the adequacy of antimicrobial therapy. This was a case-control study. Sixty-one patients with BLT-guided adaptation of EAT were prospectively included, and then matched with 61 "controls" having similar infection characteristics (community or hospital-acquired, and source of infection), in whom EAT was conventionally adapted to antibiogram results. Endpoints were to compare the proportion of appropriate (primary endpoint) and optimal (secondary endpoint) antimicrobial therapies with each of the two strategies, once microbiological sample culture results were available. Characteristics of patients, infections and EAT at inclusion were similar between groups. Nine early escalations of EAT occurred in the BLT-guided adaptation group, reaching 98% appropriateness vs. 77% in the conventional adaptation group (p < 0.01). The BLT reduced the time until escalation of an inappropriate EAT from 50.5 (48-73) to 27 (24-28) hours (p < 0.01). Seventeen early de-escalations occurred in the BLT-guided adaptation group, compared to one in the conventional adaptation group, reducing patients' exposure to broad-spectrum beta-lactam such as carbapenems. In multivariate analysis, use of the BLT was strongly associated with early appropriate (OR = 18 (3.4-333.8), p = 0.006) and optimal (OR = 35.5 (9.6-231.9), p < 0.001) antimicrobial therapies. Safety parameters were similar between groups. Our study suggests that a BLT-guided adaptation strategy may allow early beta-lactam adaptation from the first 24 hours following the beginning of sepsis management.

Use of structured decision making to identify monitoring variables and management priorities for salt marsh ecosystems

USGS Publications Warehouse

Neckles, Hilary A.; Lyons, James E.; Guntenspergen, Glenn R.; Shriver, W. Gregory; Adamowicz, Susan C.

2015-01-01

Most salt marshes in the USA have been degraded by human activities, and coastal managers are faced with complex choices among possible actions to restore or enhance ecosystem integrity. We applied structured decision making (SDM) to guide selection of monitoring variables and management priorities for salt marshes within the National Wildlife Refuge System in the northeastern USA. In general, SDM is a systematic process for decomposing a decision into its essential elements. We first engaged stakeholders in clarifying regional salt marsh decision problems, defining objectives and attributes to evaluate whether objectives are achieved, and developing a pool of alternative management actions for achieving objectives. Through this process, we identified salt marsh attributes that were applicable to monitoring National Wildlife Refuges on a regional scale and that targeted management needs. We then analyzed management decisions within three salt marsh units at Prime Hook National Wildlife Refuge, coastal Delaware, as a case example of prioritizing management alternatives. Values for salt marsh attributes were estimated from 2 years of baseline monitoring data and expert opinion. We used linear value modeling to aggregate multiple attributes into a single performance score for each alternative, constrained optimization to identify alternatives that maximized total management benefits subject to refuge-wide cost constraints, and used graphical analysis to identify the optimal set of alternatives for the refuge. SDM offers an efficient, transparent approach for integrating monitoring into management practice and improving the quality of management decisions.

The Operation Method of Smarter City Based on Ecological Theory

NASA Astrophysics Data System (ADS)

Fan, C.; Fan, H. Y.

2017-10-01

As the city and urbanization’s accelerated pace has caused galloping population, the urban framework is extending with increasingly complex social problems. The urban management tends to become complicated and the governance seems more difficult to pursue. exploring the urban management’s new model has attracted local governments’ urgent attention. tcombines the guiding ideology and that management’s practices based on ecological theory, explains the Smarter city Ecology Managementmodel’s formation, makes modern urban management’s comparative analysis and further defines the aforesaid management mode’s conceptual model. Based on the smarter city system theory’s ecological carrying capacity, the author uses mathematical model to prove the coordination relationship between the smarter city Ecology Managementmode’s subsystems, demonstrates that it can improve the urban management’s overall level, emphasizes smarter city management integrity, believing that urban system’s optimization is based on each subsystem being optimized, attaching the importance to elements, structure, and balance between each subsystem and between internal elements. Through the establishment of the smarter city Ecology Managementmodel’s conceptual model and theoretical argumentation, it provides a theoretical basis and technical guidance to that model’s innovation.

CT guided transthoracic catheter drainage of intrapulmonary abscess.

PubMed

Yunus, Mahira

2009-10-01

To determine the efficacy of CT- guided transthoracic catheter drainage of intrapulmonary abscess considering success rate versus complications. This prospective study was carried out at radiology department of Al-Noor Specialist Hospital, Makkah, Saudi Arabia, from 1.1.2003 to 31.12.2005. Nineteen patients were selected for CT guided percutaneous drainage. Under CT guidance catheter placement was carried out using Seldinger technique. Nineteen patients with lung abscess were selected for the percutaneous CT guided drainage. Eight (42.105%) patients encountered no complications and lung abscess completely resolved with no residual cavity. Five (26.31%) patients developed pneumothorax, which was the most common complication of this study. These patients were kept under observation and followed-up by chest X-rays. Three (15.78%) had mild pneumothorax, which resolved and needed no further management, while two (10.52%) patients developed moderate pneumothorax and chest tube was inserted. Two (10.52%) patients developed mild haemoptysis which resolved within two hours, hence, no further management was required. Two (10.52%) patients had residual cavity and surgery was performed. Congenital cystic adenomatoid malformation (CCAM) was found in both cases. Two patients out of nineteen patients (10.52%) developed bronchopleural fistula and were operated. No mortality occurred during or after the procedure. CT allows optimal placement of catheter and hence enables safe and effective percutaneous evacuation of lung abscess. The morbidity and mortality of patients with percutaneous catheter drainage is lower than with surgical resection. Hence, CT guided drainage should be considered the first therapeutic choice in most patients of lung abscess who do not respond to medical therapy.

Elementary Introduction to the Green Management of the Construction in Whole Process

NASA Astrophysics Data System (ADS)

Na), Wu Y. N.(Yun; Yu), Yan H. Y.(Hong; Jun), Huang Z. J.(Zhi

Construction industries consume more energy resources than necessary. it is essential to establish a management system with all pollution problems resolved to construct green buildings. By applying the theory of whole life cycle, this paper divides the whole process of construction into four sub-phases, which will also be subdivided into more concrete working procedures. Based on this, a systematic framework is promoted for the green management of the construction, especially and creatively, considering the green aims as important as the traditional three aims-"quality aim, schedule aim and cost aim". This framework, adhering to the integration idea-"customers first, whole optimal", regards the green control and workflow as an organic whole in order to build green, sustainable and healthy architecture, and then provide a perfect guide and reference to the green management.

Comprehensive Guide for Middle School Programs. Instructor's Guide.

ERIC Educational Resources Information Center

Hansen, Joan

This instructor's guide contains materials for use in teaching a middle school exploratory home economics course. Addressed in the individual units of the guide are the following topics: nutrition education and food management, parenting education, resource management, clothing management, and personal management. Each section contains a unit…

Optimization and experimental validation of stiff porous phononic plates for widest complete bandgap of mixed fundamental guided wave modes

NASA Astrophysics Data System (ADS)

Hedayatrasa, Saeid; Kersemans, Mathias; Abhary, Kazem; Uddin, Mohammad; Van Paepegem, Wim

2018-01-01

Phononic crystal plates (PhPs) have promising application in manipulation of guided waves for design of low-loss acoustic devices and built-in acoustic metamaterial lenses in plate structures. The prominent feature of phononic crystals is the existence of frequency bandgaps over which the waves are stopped, or are resonated and guided within appropriate defects. Therefore, maximized bandgaps of PhPs are desirable to enhance their phononic controllability. Porous PhPs produced through perforation of a uniform background plate, in which the porous interfaces act as strong reflectors of wave energy, are relatively easy to produce. However, the research in optimization of porous PhPs and experimental validation of achieved topologies has been very limited and particularly focused on bandgaps of flexural (asymmetric) wave modes. In this paper, porous PhPs are optimized through an efficient multiobjective genetic algorithm for widest complete bandgap of mixed fundamental guided wave modes (symmetric and asymmetric) and maximized stiffness. The Pareto front of optimization is analyzed and variation of bandgap efficiency with respect to stiffness is presented for various optimized topologies. Selected optimized topologies from the stiff and compliant regimes of Pareto front are manufactured by water-jetting an aluminum plate and their promising bandgap efficiency is experimentally observed. An optimized Pareto topology is also chosen and manufactured by laser cutting a Plexiglas (PMMA) plate, and its performance in self-collimation and focusing of guided waves is verified as compared to calculated dispersion properties.

Asset management guide : focusing on the management of our transit investments.

DOT National Transportation Integrated Search

2012-10-01

To advance transit asset management, this guide provides a transit-specific asset management framework for managing assets indi-vidually and as a portfolio of assets that comprise an integrated system. The guide provides flexible, yet targeted guidan...

Asset management guide : focusing on the management of our transit investments [updated November 2016].

DOT National Transportation Integrated Search

2016-11-01

To advance transit asset management, this guide provides a transit-specific asset management framework for managing assets individually and as a portfolio of assets that comprise an integrated system. The guide provides flexible, yet targeted guidanc...

Application of TOPSIS and VIKOR improved versions in a multi criteria decision analysis to develop an optimized municipal solid waste management model.

PubMed

Aghajani Mir, M; Taherei Ghazvinei, P; Sulaiman, N M N; Basri, N E A; Saheri, S; Mahmood, N Z; Jahan, A; Begum, R A; Aghamohammadi, N

2016-01-15

Selecting a suitable Multi Criteria Decision Making (MCDM) method is a crucial stage to establish a Solid Waste Management (SWM) system. Main objective of the current study is to demonstrate and evaluate a proposed method using Multiple Criteria Decision Making methods (MCDM). An improved version of Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) applied to obtain the best municipal solid waste management method by comparing and ranking the scenarios. Applying this method in order to rank treatment methods is introduced as one contribution of the study. Besides, Viekriterijumsko Kompromisno Rangiranje (VIKOR) compromise solution method applied for sensitivity analyses. The proposed method can assist urban decision makers in prioritizing and selecting an optimized Municipal Solid Waste (MSW) treatment system. Besides, a logical and systematic scientific method was proposed to guide an appropriate decision-making. A modified TOPSIS methodology as a superior to existing methods for first time was applied for MSW problems. Applying this method in order to rank treatment methods is introduced as one contribution of the study. Next, 11 scenarios of MSW treatment methods are defined and compared environmentally and economically based on the waste management conditions. Results show that integrating a sanitary landfill (18.1%), RDF (3.1%), composting (2%), anaerobic digestion (40.4%), and recycling (36.4%) was an optimized model of integrated waste management. An applied decision-making structure provides the opportunity for optimum decision-making. Therefore, the mix of recycling and anaerobic digestion and a sanitary landfill with Electricity Production (EP) are the preferred options for MSW management. Copyright © 2015 Elsevier Ltd. All rights reserved.

Investigation on Reservoir Operation of Agricultural Water Resources Management for Drought Mitigation

NASA Astrophysics Data System (ADS)

Cheng, C. L.

2015-12-01

Investigation on Reservoir Operation of Agricultural Water Resources Management for Drought Mitigation Chung-Lien Cheng, Wen-Ping Tsai, Fi-John Chang* Department of Bioenvironmental Systems Engineering, National Taiwan University, Da-An District, Taipei 10617, Taiwan, ROC.Corresponding author: Fi-John Chang (changfj@ntu.edu.tw) AbstractIn Taiwan, the population growth and economic development has led to considerable and increasing demands for natural water resources in the last decades. Under such condition, water shortage problems have frequently occurred in northern Taiwan in recent years such that water is usually transferred from irrigation sectors to public sectors during drought periods. Facing the uneven spatial and temporal distribution of water resources and the problems of increasing water shortages, it is a primary and critical issue to simultaneously satisfy multiple water uses through adequate reservoir operations for sustainable water resources management. Therefore, we intend to build an intelligent reservoir operation system for the assessment of agricultural water resources management strategy in response to food security during drought periods. This study first uses the grey system to forecast the agricultural water demand during February and April for assessing future agricultural water demands. In the second part, we build an intelligent water resources system by using the non-dominated sorting genetic algorithm-II (NSGA-II), an optimization tool, for searching the water allocation series based on different water demand scenarios created from the first part to optimize the water supply operation for different water sectors. The results can be a reference guide for adequate agricultural water resources management during drought periods. Keywords: Non-dominated sorting genetic algorithm-II (NSGA-II); Grey System; Optimization; Agricultural Water Resources Management.

The role of biogeochemical hotspots, landscape heterogeneity, and hydrological connectivity for minimizing forestry effects on water quality.

PubMed

Laudon, Hjalmar; Kuglerová, Lenka; Sponseller, Ryan A; Futter, Martyn; Nordin, Annika; Bishop, Kevin; Lundmark, Tomas; Egnell, Gustaf; Ågren, Anneli M

2016-02-01

Protecting water quality in forested regions is increasingly important as pressures from land-use, long-range transport of air pollutants, and climate change intensify. Maintaining forest industry without jeopardizing sustainability of surface water quality therefore requires new tools and approaches. Here, we show how forest management can be optimized by incorporating landscape sensitivity and hydrological connectivity into a framework that promotes the protection of water quality. We discuss how this approach can be operationalized into a hydromapping tool to support forestry operations that minimize water quality impacts. We specifically focus on how hydromapping can be used to support three fundamental aspects of land management planning including how to (i) locate areas where different forestry practices can be conducted with minimal water quality impact; (ii) guide the off-road driving of forestry machines to minimize soil damage; and (iii) optimize the design of riparian buffer zones. While this work has a boreal perspective, these concepts and approaches have broad-scale applicability.

Optimal health and disease management using spatial uncertainty: a geographic characterization of emergent artemisinin-resistant Plasmodium falciparum distributions in Southeast Asia.

PubMed

Grist, Eric P M; Flegg, Jennifer A; Humphreys, Georgina; Mas, Ignacio Suay; Anderson, Tim J C; Ashley, Elizabeth A; Day, Nicholas P J; Dhorda, Mehul; Dondorp, Arjen M; Faiz, M Abul; Gething, Peter W; Hien, Tran T; Hlaing, Tin M; Imwong, Mallika; Kindermans, Jean-Marie; Maude, Richard J; Mayxay, Mayfong; McDew-White, Marina; Menard, Didier; Nair, Shalini; Nosten, Francois; Newton, Paul N; Price, Ric N; Pukrittayakamee, Sasithon; Takala-Harrison, Shannon; Smithuis, Frank; Nguyen, Nhien T; Tun, Kyaw M; White, Nicholas J; Witkowski, Benoit; Woodrow, Charles J; Fairhurst, Rick M; Sibley, Carol Hopkins; Guerin, Philippe J

2016-10-24

Artemisinin-resistant Plasmodium falciparum malaria parasites are now present across much of mainland Southeast Asia, where ongoing surveys are measuring and mapping their spatial distribution. These efforts require substantial resources. Here we propose a generic 'smart surveillance' methodology to identify optimal candidate sites for future sampling and thus map the distribution of artemisinin resistance most efficiently. The approach uses the 'uncertainty' map generated iteratively by a geostatistical model to determine optimal locations for subsequent sampling. The methodology is illustrated using recent data on the prevalence of the K13-propeller polymorphism (a genetic marker of artemisinin resistance) in the Greater Mekong Subregion. This methodology, which has broader application to geostatistical mapping in general, could improve the quality and efficiency of drug resistance mapping and thereby guide practical operations to eliminate malaria in affected areas.

Agile software development in an earned value world: a survival guide

NASA Astrophysics Data System (ADS)

Kantor, Jeffrey; Long, Kevin; Becla, Jacek; Economou, Frossie; Gelman, Margaret; Juric, Mario; Lambert, Ron; Krughoff, Simon; Swinbank, John D.; Wu, Xiuqin

2016-08-01

Agile methodologies are current best practice in software development. They are favored for, among other reasons, preventing premature optimization by taking a somewhat short-term focus, and allowing frequent replans/reprioritizations of upcoming development work based on recent results and current backlog. At the same time, funding agencies prescribe earned value management accounting for large projects which, these days, inevitably include substantial software components. Earned Value approaches emphasize a more comprehensive and typically longer-range plan, and tend to characterize frequent replans and reprioritizations as indicative of problems. Here we describe the planning, execution and reporting framework used by the LSST Data Management team, that navigates these opposite tensions.

Preliminary analysis of posttraumatic stress disorder screening within specialty clinic setting for OIF/OEF veterans seeking care for neck or back pain.

PubMed

Dunn, Andrew S; Julian, Terri; Formolo, Lance R; Green, Bart N; Chicoine, David R

2011-01-01

Escalating prevalence estimates of posttraumatic stress disorder (PTSD) among recently returning Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans highlight the need for early detection and management for reducing chronic mental illness and disability. Because PTSD and chronic pain are common comorbid conditions among veterans, PTSD screening within specialty clinic settings addressing musculoskeletal pain may be of value. This retrospective study evaluated measures of diagnostic value for the PTSD Checklist (PCL) for a sample (n = 79) of OIF/OEF veterans seeking care for neck or back pain within a Department of Veterans Affairs specialty clinic. Because published accounts of optimal PCL cutoff scores vary considerably, we used receiver operating characteristic curves to identify whether the optimal PCL cutoff score for the sample differed from a conventional cutoff score of 50. A clinical psychologist experienced in diagnosing and managing PTSD confirmed the diagnosis of PTSD for 37 veterans through a review of clinical records. The prevalence of diagnosed PTSD was 46.8%, with an optimal PCL cutoff score of 44. These findings may guide future research and influence clinical practice regarding PTSD screening for recently returning veterans with chronic pain.

AASHTO transportation asset management guide : a focus on implementation executive summary.

DOT National Transportation Integrated Search

2013-06-01

This AASHTO Transportation Asset Management Executive Summary serves as a companion to the AASHTO Transportation : Asset Management GuideA Focus on Implementation, which takes as a starting point the Transportation : Asset Management Guide publish...

Evaluation of a Modified User Guide for Hearing Aid Management.

PubMed

Caposecco, Andrea; Hickson, Louise; Meyer, Carly; Khan, Asaduzzaman

2016-01-01

This study investigated if a hearing aid user guide modified using best practice principles for health literacy resulted in superior ability to perform hearing aid management tasks, compared with the user guide in the original form. This research utilized a two-arm study design to compare the original manufacturer's user guide with a modified user guide for the same hearing aid--an Oticon Acto behind-the-ear aid with an open dome. The modified user guide had a lower reading grade level (4.2 versus 10.5), used a larger font size, included more graphics, and had less technical information. Eighty-nine adults ages 55 years and over were included in the study; none had experience with hearing aid use or management. Participants were randomly assigned either the modified guide (n = 47) or the original guide (n = 42). All participants were administered the Hearing Aid Management test, designed for this study, which assessed their ability to perform seven management tasks (e.g., change battery) with their assigned user guide. The regression analysis indicated that the type of user guide was significantly associated with performance on the Hearing Aid Management test, adjusting for 11 potential covariates. In addition, participants assigned the modified guide required significantly fewer prompts to perform tasks and were significantly more likely to perform four of the seven tasks without the need for prompts. The median time taken by those assigned the modified guide was also significantly shorter for three of the tasks. Other variables associated with performance on the Hearing Aid Management test were health literacy level, finger dexterity, and age. Findings indicate that the need to design hearing aid user guides in line with best practice principles of health literacy as a means of facilitating improved hearing aid management in older adults.

Application of implantable hemodynamic monitoring in the management of patients with diastolic heart failure: a subgroup analysis of the COMPASS-HF trial.

PubMed

Zile, Michael R; Bourge, Robert C; Bennett, Tom D; Stevenson, Lynne Warner; Cho, Yong K; Adamson, Philip B; Aaron, Mark F; Aranda, Juan M; Abraham, William T; Smart, Frank W; Kueffer, Fred J

2008-12-01

Nearly half of all patients with chronic heart failure (HF) have a normal ejection fraction (EF), and abnormal diastolic function (ie, diastolic heart failure [DHF]). However, appropriate management of DHF patients remains a difficult and uncertain challenge. The Chronicle Offers Management to Patients with Advanced Signs and Symptoms of Heart Failure (COMPASS-HF) trial was designed to evaluate whether an implantable hemodynamic monitor (IHM) was safe and effective in reducing the number of heart failure-related events (HFRE) in patients with chronic HF. The current study presents data on a prespecified and planned subgroup analysis from the COMPASS-HF trial: 70 patients with an EF > or =50% (ie, DHF). As such, this represents a subgroup analysis of the COMPASS-HF Trial. DHF patients were randomized to IHM-guided care (treatment) vs. standard care (control) for 6 months. All 70 patients received optimal medical therapy, but the hemodynamic information from the IHM was used to guide patient management only in the treatment group. The HFRE rate in DHF patients randomized to treatment was 0.58 events/6 months compared with DHF patients randomized to control, which was 0.73 events/6 months; this represented a 20% nonsignificant reduction in the overall HFRE rate in the treatment group (95% CI = -46, 56, P = .66). There was a 29% nonsignificant reduction in the relative risk of a HF hospitalization in the DHF patients randomized to treatment compared with DHF patients randomized to control (95% CI = -69, 70, P = .43). The IHM was shown to be safe and was associated with a very low system-related and procedure-related complication rate in DHF patients. However, in this subgroup analysis limited to 70 DHF patients, the addition IHM-guided care did not significantly lower the rate of HFR events. The results of this subgroup analysis in DHF patients, for whom there are currently no proven, effective management strategies, will be used to design future studies defining the effects of IHM-guided care in patients with DHF.

Feasibility of computed tomography-guided core needle biopsy in producing state-of-the-art clinical management in Chinese lung cancer.

PubMed

Chen, Hua-Jun; Yang, Jin-Ji; Fang, Liang-Yi; Huang, Min-Min; Yan, Hong-Hong; Zhang, Xu-Chao; Xu, Chong-Rui; Wu, Yi-Long

2014-03-01

A satisfactory biopsy determines the state-of-the-art management of lung cancer in this era of personalized medicine. This study aimed to investigate the suitability and efficacy of computed tomography (CT)-guided core needle biopsy in clinical management. A cohort of 353 patients with clinically suspected lung cancer was enrolled in the study. Patient factors and biopsy variables were recorded. Epidermal growth factor receptor (EGFR) gene mutations and echinoderm microtubule-associated protein-like 4 (EML4)-anaplastic lymphoma kinase (ALK) rearrangement were detected in tumor specimens. Adequacy of biopsic obtainment for clinical trial screening and tissue bank establishment were reviewed. Overall diagnostic accuracy of malignancy achieved 98.5%. The median biopsy time of the cohort was 20 minutes. In patients with non-small cell lung cancer (NSCLC), 99.3% (287/289) were diagnosed as specific histologic subtypes, and two patients (0.7%) were determined as NSCLC not otherwise specified (NOS). EGFR mutations were analyzed in 81.7% (236/289) of patients with NSCLC, and 98.7% (233/236) showed conclusive results. EML4-ALK gene fusion was tested in 43.9% (127/289) of NSCLC patients, and 98.4% (125/127) showed conclusive results: 6.4% (8/125) of those had gene fusion. Ninety-six NSCLC patients participated in clinical trial screening and provided mandatory tumor slides for molecular profiling. Pathological evaluation was fulfilled in 90 patients (93.8%); 99.4% (320/322) of patients with malignancy provided extra tissue for the establishment of a tumor bank. CT-guided core needle biopsy provided optimal clinical management in this era of translational medicine. The biopsic modality should be prioritized in selected lung cancer patients.

Feasibility of computed tomography-guided core needle biopsy in producing state-of-the-art clinical management in Chinese lung cancer

PubMed Central

Chen, Hua-Jun; Yang, Jin-Ji; Fang, Liang-Yi; Huang, Min-Min; Yan, Hong-Hong; Zhang, Xu-Chao; Xu, Chong-Rui; Wu, Yi-Long

2014-01-01

Background A satisfactory biopsy determines the state-of-the-art management of lung cancer in this era of personalized medicine. This study aimed to investigate the suitability and efficacy of computed tomography (CT)-guided core needle biopsy in clinical management. Methods A cohort of 353 patients with clinically suspected lung cancer was enrolled in the study. Patient factors and biopsy variables were recorded. Epidermal growth factor receptor (EGFR) gene mutations and echinoderm microtubule-associated protein-like 4 (EML4)-anaplastic lymphoma kinase (ALK) rearrangement were detected in tumor specimens. Adequacy of biopsic obtainment for clinical trial screening and tissue bank establishment were reviewed. Results Overall diagnostic accuracy of malignancy achieved 98.5%. The median biopsy time of the cohort was 20 minutes. In patients with non-small cell lung cancer (NSCLC), 99.3% (287/289) were diagnosed as specific histologic subtypes, and two patients (0.7%) were determined as NSCLC not otherwise specified (NOS). EGFR mutations were analyzed in 81.7% (236/289) of patients with NSCLC, and 98.7% (233/236) showed conclusive results. EML4-ALK gene fusion was tested in 43.9% (127/289) of NSCLC patients, and 98.4% (125/127) showed conclusive results: 6.4% (8/125) of those had gene fusion. Ninety-six NSCLC patients participated in clinical trial screening and provided mandatory tumor slides for molecular profiling. Pathological evaluation was fulfilled in 90 patients (93.8%); 99.4% (320/322) of patients with malignancy provided extra tissue for the establishment of a tumor bank. Conclusions CT-guided core needle biopsy provided optimal clinical management in this era of translational medicine. The biopsic modality should be prioritized in selected lung cancer patients. PMID:26766993

The recognition and management of sepsis and septic shock: a guide for non-intensivists.

PubMed

Keeley, Alexander; Hine, Paul; Nsutebu, Emmanuel

2017-10-01

Sepsis is common, often fatal and requires rapid interventions to improve outcomes. While the optimal management of sepsis in the intensive care setting is the focus of extensive research interest, the mainstay of the recognition and initial management of sepsis will occur outside the intensive care setting. Therefore, it is key that institutions and clinicians remain well informed of the current updates in sepsis management and continue to use them to deliver appropriate and timely interventions to enhance patient survival. This review discusses the latest updates in sepsis care including the new consensus definition of sepsis, the outcome of the proCESS, ProMISe and ARISE trials of early goal directed therapy (EGDT), and the most recent guidelines from the Surviving Sepsis Campaign. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

INTEGRATING HEALTH TECHNOLOGY ASSESSMENT PRINCIPLES IN FORMULARY MANAGEMENT.

PubMed

Teng, Monica; Khoo, Ai Leng; Zhao, Ying Jiao; Lin, Liang; Lim, Boon Peng

2016-01-01

Effective formulary management in healthcare institutions safeguards rational drug use and optimizes health outcomes. We implemented a formulary management program integrating the principles of health technology assessment (HTA) to improve the safe, appropriate, and cost-effective use of medicine in Singapore. A 3-year formulary management program was initiated in 2011 in five public healthcare institutions. This program was managed by a project team comprising HTA researchers. The project team worked with institutional pharmacy and therapeutics (P&T) committees to: (i) develop tools for formulary drug review and decision making; (ii) enhance the HTA knowledge and skills of formulary pharmacists and members of P&T committees; (iii) devise a prioritization framework to overcome resource constraints and time pressure; and (iv) conceptualize and implement a framework to review existing formulary. Tools that facilitate drug request submission, drug review, and decision making were developed for formulary drug inclusion. A systematic framework to review existing formulary was also developed and tested in selected institutions. A competency development plan was rolled out over 2 years to enhance formulary pharmacists' proficiency in systematic literature search and review, meta-analysis, and pharmacoeconomic evaluation. The plan comprised training workshops and on-the-job knowledge transfer between the project team and institutional formulary pharmacists through collaborating on selected drug reviews. A resource guide that consolidated the tools and templates was published to encourage the adoption of best practices in formulary management. Based on the concepts of HTA, we implemented an evidence-based approach to optimize formulary management.

A new memetic algorithm for mitigating tandem automated guided vehicle system partitioning problem

NASA Astrophysics Data System (ADS)

Pourrahimian, Parinaz

2017-11-01

Automated Guided Vehicle System (AGVS) provides the flexibility and automation demanded by Flexible Manufacturing System (FMS). However, with the growing concern on responsible management of resource use, it is crucial to manage these vehicles in an efficient way in order reduces travel time and controls conflicts and congestions. This paper presents the development process of a new Memetic Algorithm (MA) for optimizing partitioning problem of tandem AGVS. MAs employ a Genetic Algorithm (GA), as a global search, and apply a local search to bring the solutions to a local optimum point. A new Tabu Search (TS) has been developed and combined with a GA to refine the newly generated individuals by GA. The aim of the proposed algorithm is to minimize the maximum workload of the system. After all, the performance of the proposed algorithm is evaluated using Matlab. This study also compared the objective function of the proposed MA with GA. The results showed that the TS, as a local search, significantly improves the objective function of the GA for different system sizes with large and small numbers of zone by 1.26 in average.

Multi-model groundwater-management optimization: reconciling disparate conceptual models

NASA Astrophysics Data System (ADS)

Timani, Bassel; Peralta, Richard

2015-09-01

Disagreement among policymakers often involves policy issues and differences between the decision makers' implicit utility functions. Significant disagreement can also exist concerning conceptual models of the physical system. Disagreement on the validity of a single simulation model delays discussion on policy issues and prevents the adoption of consensus management strategies. For such a contentious situation, the proposed multi-conceptual model optimization (MCMO) can help stakeholders reach a compromise strategy. MCMO computes mathematically optimal strategies that simultaneously satisfy analogous constraints and bounds in multiple numerical models that differ in boundary conditions, hydrogeologic stratigraphy, and discretization. Shadow prices and trade-offs guide the process of refining the first MCMO-developed `multi-model strategy into a realistic compromise management strategy. By employing automated cycling, MCMO is practical for linear and nonlinear aquifer systems. In this reconnaissance study, MCMO application to the multilayer Cache Valley (Utah and Idaho, USA) river-aquifer system employs two simulation models with analogous background conditions but different vertical discretization and boundary conditions. The objective is to maximize additional safe pumping (beyond current pumping), subject to constraints on groundwater head and seepage from the aquifer to surface waters. MCMO application reveals that in order to protect the local ecosystem, increased groundwater pumping can satisfy only 40 % of projected water demand increase. To explore the possibility of increasing that pumping while protecting the ecosystem, MCMO clearly identifies localities requiring additional field data. MCMO is applicable to other areas and optimization problems than used here. Steps to prepare comparable sub-models for MCMO use are area-dependent.

A Large-Telescope Natural Guide Star AO System

NASA Technical Reports Server (NTRS)

Redding, David; Milman, Mark; Needels, Laura

1994-01-01

None given. From overview and conclusion:Keck Telescope case study. Objectives-low cost, good sky coverage. Approach--natural guide star at 0.8um, correcting at 2.2um.Concl- Good performance is possible for Keck with natural guide star AO system (SR>0.2 to mag 17+).AO-optimized CCD should b every effective. Optimizing td is very effective.Spatial Coadding is not effective except perhaps at extreme low light levels.

An online tool for tracking soil nitrogen

NASA Astrophysics Data System (ADS)

Wang, J.; Umar, M.; Banger, K.; Pittelkow, C. M.; Nafziger, E. D.

2016-12-01

Near real-time crop models can be useful tools for optimizing agricultural management practices. For example, model simulations can potentially provide current estimates of nitrogen availability in soil, helping growers decide whether more nitrogen needs to be applied in a given season. Traditionally, crop models have been used at point locations (i.e. single fields) with homogenous soil, climate and initial conditions. However, nitrogen availability across fields with varied weather and soil conditions at a regional or national level is necessary to guide better management decisions. This study presents the development of a publicly available, online tool that automates the integration of high-spatial-resolution forecast and past weather and soil data in DSSAT to estimate nitrogen availability for individual fields in Illinois. The model has been calibrated with field experiments from past year at six research corn fields across Illinois. These sites were treated with applications of different N fertilizer timings and amounts. The tool requires minimal management information from growers and yet has the capability to simulate nitrogen-water-crop interactions with calibrated parameters that are more appropriate for Illinois. The results from the tool will be combined with incoming field experiment data from 2016 for model validation and further improvement of model's predictive accuracy. The tool has the potential to help guide better nitrogen management practices to maximize economic and environmental benefits.

Identification of watershed priority management areas under water quality constraints: A simulation-optimization approach with ideal load reduction

NASA Astrophysics Data System (ADS)

Dong, Feifei; Liu, Yong; Wu, Zhen; Chen, Yihui; Guo, Huaicheng

2018-07-01

Targeting nonpoint source (NPS) pollution hot spots is of vital importance for placement of best management practices (BMPs). Although physically-based watershed models have been widely used to estimate nutrient emissions, connections between nutrient abatement and compliance of water quality standards have been rarely considered in NPS hotspot ranking, which may lead to ineffective decision-making. It's critical to develop a strategy to identify priority management areas (PMAs) based on water quality response to nutrient load mitigation. A water quality constrained PMA identification framework was thereby proposed in this study, based on the simulation-optimization approach with ideal load reduction (ILR-SO). It integrates the physically-based Soil and Water Assessment Tool (SWAT) model and an optimization model under constraints of site-specific water quality standards. To our knowledge, it was the first effort to identify PMAs with simulation-based optimization. The SWAT model was established to simulate temporal and spatial nutrient loading and evaluate effectiveness of pollution mitigation. A metamodel was trained to establish a quantitative relationship between sources and water quality. Ranking of priority areas is based on required nutrient load reduction in each sub-watershed targeting to satisfy water quality standards in waterbodies, which was calculated with genetic algorithm (GA). The proposed approach was used for identification of PMAs on the basis of diffuse total phosphorus (TP) in Lake Dianchi Watershed, one of the three most eutrophic large lakes in China. The modeling results demonstrated that 85% of diffuse TP came from 30% of the watershed area. Compared with the two conventional targeting strategies based on overland nutrient loss and instream nutrient loading, the ILR-SO model identified distinct PMAs and narrowed down the coverage of management areas. This study addressed the urgent need to incorporate water quality response into PMA identification and showed that the ILR-SO approach is effective to guide watershed management for aquatic ecosystem restoration.

MC ray-tracing optimization of lobster-eye focusing devices with RESTRAX

NASA Astrophysics Data System (ADS)

Šaroun, Jan; Kulda, Jiří

2006-11-01

The enhanced functionalities of the latest version of the RESTRAX software, providing a high-speed Monte Carlo (MC) ray-tracing code to represent a virtual three-axis neutron spectrometer, include representation of parabolic and elliptic guide profiles and facilities for numerical optimization of parameter values, characterizing the instrument components. As examples, we present simulations of a doubly focusing monochromator in combination with cold neutron guides and lobster-eye supermirror devices, concentrating a monochromatic beam to small sample volumes. A Levenberg-Marquardt minimization algorithm is used to optimize simultaneously several parameters of the monochromator and lobster-eye guides. We compare the performance of optimized configurations in terms of monochromatic neutron flux and energy spread and demonstrate the effect of lobster-eye optics on beam transformations in real and momentum subspaces.

77 FR 33253 - Regulatory Guide 8.33, Quality Management Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-05

... NUCLEAR REGULATORY COMMISSION [NRC-2012-0126] Regulatory Guide 8.33, Quality Management Program... Regulatory Commission (NRC or Commission) is withdrawing Regulatory Guide (RG) 8.33, ``Quality Management... Quality Management Program was deleted from the regulations as part of an overall revision in 2002 of the...

Postoperative Stereotactic Body Radiation Therapy (SBRT) for Spine Metastases: A Critical Review to Guide Practice

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

Redmond, Kristin J., E-mail: kjanson3@jhmi.edu; Lo, Simon S.; Fisher, Charles

Postoperative stereotactic body radiation therapy (SBRT) for metastatic spinal tumors is increasingly being performed in clinical practice. Whereas the fundamentals of SBRT practice for intact spinal metastases are established, there are as yet no comprehensive practice guidelines for the postoperative indications. In particular, there are unique considerations for patient selection and treatment planning specific to postoperative spine SBRT that are critical for safe and effective management. The purpose of this critical review is to discuss the rationale for treatment, describe those factors affecting surgical decision making, introduce modern surgical trends, and summarize treatment outcomes for both conventional postoperative external beammore » radiation therapy and postoperative spine SBRT. Lastly, an in-depth practical discussion with respect to treatment planning and delivery considerations is provided to help guide optimal practice.« less

HSM implementation guide for managers.

DOT National Transportation Integrated Search

2011-09-01

This guide is intended for managers of departments of transportation (DOT) charged with leading and managing agency programs impacting the project development process and safety programs. This guide is based on lessons learned from early adopters of ...

Making do with less: Must sparse data preclude informed harvest strategies for European waterbirds?

USGS Publications Warehouse

Johnson, Fred A.; Alhainen, Mikko; Fox, Anthony D.; Madsen, Jesper; Guillemain, Matthieu

2018-01-01

The demography of many European waterbirds is not well understood because most countries have conducted little monitoring and assessment, and coordination among countries on waterbird management has little precedent. Yet intergovernmental treaties now mandate the use of sustainable, adaptive harvest strategies, whose development is challenged by a paucity of demographic information. In this study, we explore how a combination of allometric relationships, fragmentary monitoring and research information, and expert judgment can be used to estimate the parameters of a theta-logistic population model, which in turn can be used in a Markov decision process to derive optimal harvesting strategies. We show how to account for considerable parametric uncertainty, as well as for different management objectives. We illustrate our methodology with a poorly understood population of taiga bean geese (Anser fabalis fabalis), which is a popular game bird in Fennoscandia. Our results for taiga bean geese suggest that they may have demographic rates similar to other, well-studied species of geese, and our model-based predictions of population size are consistent with the limited monitoring information available. Importantly, we found that by using a Markov decision process, a simple scalar population model may be sufficient to guide harvest management of this species, even if its demography is age-structured. Finally, we demonstrated how two different management objectives can lead to very different optimal harvesting strategies, and how conflicting objectives may be traded off with each other. This approach will have broad application for European waterbirds by providing preliminary estimates of key demographic parameters, by providing insights into the monitoring and research activities needed to corroborate those estimates, and by producing harvest management strategies that are optimal with respect to the managers’ objectives, options, and available demographic information.

Surveillance theory applied to virus detection: a case for targeted discovery

USGS Publications Warehouse

Bogich, Tiffany L.; Anthony, Simon J.; Nichols, James D.

2013-01-01

Virus detection and mathematical modeling have gone through rapid developments in the past decade. Both offer new insights into the epidemiology of infectious disease and characterization of future risk; however, modeling has not yet been applied to designing the best surveillance strategies for viral and pathogen discovery. We review recent developments and propose methods to integrate viral and pathogen discovery and mathematical modeling through optimal surveillance theory, arguing for a more targeted approach to novel virus detection guided by the principles of adaptive management and structured decision-making.

Computer-aided diagnostic strategy selection.

PubMed

Greenes, R A

1986-03-01

Determination of the optimal diagnostic work-up strategy for the patient is becoming a major concern for the practicing physician. Overlap of the indications for various diagnostic procedures, differences in their invasiveness or risk, and high costs have made physicians aware of the need to consider the choice of procedure carefully, as well as its relation to management actions available. In this article, the author discusses research approaches that aim toward development of formal decision analytic methods to allow the physician to determine optimal strategy; clinical algorithms or rules as guides to physician decisions; improved measures for characterizing the performance of diagnostic tests; educational tools for increasing the familiarity of physicians with the concepts underlying these measures and analytic procedures; and computer-based aids for facilitating the employment of these resources in actual clinical practice.

Applying change management metaphors to a national e-Health strategy.

PubMed

Saunders, Chad; Scott, Richard E

2014-01-01

Recent attempts at a collective understanding of how to develop an e-Health strategy have addressed the individual organisation, collection of organisations, and national levels. At the national level the World Health Organisation's National eHealth Strategy Toolkit serves as an exemplar that consolidates knowledge in this area, guides practical implementations, and identifies areas for future research. A key implication of this toolkit is the considerable number of organisational changes required to successfully apply their ideas in practice. This study looks critically at the confluence of change management and e-Health strategy using metaphors that underpin established models of change management. Several of Morgan's organisational metaphors are presented (highlighting varied beliefs and assumptions regarding how change is enacted, who is responsible for the change, and guiding principles for that change), and used to provide a framework. Attention is then directed to several prominent models of change management that exemplify one or more of these metaphors, and these theoretical insights are applied to evaluate the World Health Organisation's National eHealth Strategy Toolkit. The paper presents areas for consideration when using the WHO/ITU toolkit, and suggestions on how to improve its use in practice. The goal is to seek insight regarding the optimal sequence of steps needed to ensure successful implementation and integration of e-health into health systems using change management models. No single model, toolkit, or guideline will offer all the needed answers, but clarity around the underlying metaphors informing the change management models being used provides valuable insight so potentially challenging areas can be avoided or mitigated.

Utility and Scope of Rapid Prototyping in Patients with Complex Muscular Ventricular Septal Defects or Double-Outlet Right Ventricle: Does it Alter Management Decisions?

PubMed

Bhatla, Puneet; Tretter, Justin T; Ludomirsky, Achi; Argilla, Michael; Latson, Larry A; Chakravarti, Sujata; Barker, Piers C; Yoo, Shi-Joon; McElhinney, Doff B; Wake, Nicole; Mosca, Ralph S

2017-01-01

Rapid prototyping facilitates comprehension of complex cardiac anatomy. However, determining when this additional information proves instrumental in patient management remains a challenge. We describe our experience with patient-specific anatomic models created using rapid prototyping from various imaging modalities, suggesting their utility in surgical and interventional planning in congenital heart disease (CHD). Virtual and physical 3-dimensional (3D) models were generated from CT or MRI data, using commercially available software for patients with complex muscular ventricular septal defects (CMVSD) and double-outlet right ventricle (DORV). Six patients with complex anatomy and uncertainty of the optimal management strategy were included in this study. The models were subsequently used to guide management decisions, and the outcomes reviewed. 3D models clearly demonstrated the complex intra-cardiac anatomy in all six patients and were utilized to guide management decisions. In the three patients with CMVSD, one underwent successful endovascular device closure following a prior failed attempt at transcatheter closure, and the other two underwent successful primary surgical closure with the aid of 3D models. In all three cases of DORV, the models provided better anatomic delineation and additional information that altered or confirmed the surgical plan. Patient-specific 3D heart models show promise in accurately defining intra-cardiac anatomy in CHD, specifically CMVSD and DORV. We believe these models improve understanding of the complex anatomical spatial relationships in these defects and provide additional insight for pre/intra-interventional management and surgical planning.

Multimodal Analgesia in Breast Surgical Procedures: Technical and Pharmacological Considerations for Liposomal Bupivacaine Use

PubMed Central

Newman, Martin I.; Seeley, Neil; Hutchins, Jacob; Smith, Kevin L.; Mena, Gabriel; Selber, Jesse C.; Saint-Cyr, Michel H.; Gadsden, Jeffrey C.

2017-01-01

Enhanced recovery after surgery is a multidisciplinary perioperative clinical pathway that uses evidence-based interventions to improve the patient experience as well as increase satisfaction, reduce costs, mitigate the surgical stress response, accelerate functional recovery, and decrease perioperative complications. One of the most important elements of enhanced recovery pathways is multimodal pain management. Herein, aspects relating to multimodal analgesia following breast surgical procedures are discussed with the understanding that treatment decisions should be individualized and guided by sound clinical judgment. A review of liposomal bupivacaine, a prolonged-release formulation of bupivacaine, in the management of postoperative pain following breast surgical procedures is presented, and technical guidance regarding optimal administration of liposomal bupivacaine is provided. PMID:29062649

Adrenal incidentaloma caused by extramedullary haematopoiesis: conservative management is optimal.

PubMed

Sekar, Suganya; Burad, Deepak; Abraham, Aby; Paul, Mazhuvanchary Jacob

2015-09-21

We present a thalassaemic patient with extramedullary haematopoiesis in the adrenal gland, which is one of the rare sites of involvement. A 29-year-old man presented with a history of anaemia since childhood which required blood transfusion recently. On examination, he had pallor, icterus and splenomegaly with no other palpable abdominal mass. He was diagnosed to have β-thalassaemia. Ultrasonography of the abdomen showed an incidental right adrenal mass with splenomegaly; CT revealed a large right adrenal mass with heterogeneous density. Adrenal adenoma, carcinoma and extramedullary haematopoiesis were considered in the differential diagnosis. After excluding a functioning tumour, the diagnosis was confirmed by ultrasound-guided biopsy. Since the patient was asymptomatic, the adrenal lesion was managed conservatively. 2015 BMJ Publishing Group Ltd.

Gearing up to the factory of the future

NASA Astrophysics Data System (ADS)

Godfrey, D. E.

1985-01-01

The features of factories and manufacturing techniques and tools of the near future are discussed. The spur to incorporate new technologies on the factory floor will originate in management, who must guide the interfacing of computer-enhanced equipment with traditional manpower, materials and machines. Electronic control with responsiveness and flexibility will be the key concept in an integrated approach to processing materials. Microprocessor controlled laser and fluid cutters add accuracy to cutting operations. Unattended operation will become feasible when automated inspection is added to a work station through developments in robot vision. Optimum shop management will be achieved through AI programming of parts manufacturing, optimized work flows, and cost accounting. The automation enhancements will allow designers to affect directly parts being produced on the factory floor.

Surgical Management of the Constricted or Obliterated Vagina.

PubMed

Gebhart, John B; Schmitt, Jennifer J

2016-08-01

Management of the constricted or obliterated vagina demands an understanding and recognition of the potential etiologies leading to this presentation. A thorough and comprehensive medical and surgical review is required to arrive at an accurate diagnosis, which then will guide medical or surgical intervention. It is paramount to recognize when underlying medical conditions are contributing to these conditions and to begin medical therapy; failure to do so will often yield suboptimal results. When these conditions arise after surgical interventions, compensatory surgical techniques that correct upper and lower vaginal strictures or obliteration include incision through the stricture, vaginal advancement, Z-plasty, skin grafts, perineal flaps, and abdominal flaps and grafts. Postoperative surveillance and dilation are critical to optimize long-term success.

Consensus guidelines for the diagnosis and management of patients with classic hairy cell leukemia.

PubMed

Grever, Michael R; Abdel-Wahab, Omar; Andritsos, Leslie A; Banerji, Versha; Barrientos, Jacqueline; Blachly, James S; Call, Timothy G; Catovsky, Daniel; Dearden, Claire; Demeter, Judit; Else, Monica; Forconi, Francesco; Gozzetti, Alessandro; Ho, Anthony D; Johnston, James B; Jones, Jeffrey; Juliusson, Gunnar; Kraut, Eric; Kreitman, Robert J; Larratt, Loree; Lauria, Francesco; Lozanski, Gerard; Montserrat, Emili; Parikh, Sameer A; Park, Jae H; Polliack, Aaron; Quest, Graeme R; Rai, Kanti R; Ravandi, Farhad; Robak, Tadeusz; Saven, Alan; Seymour, John F; Tadmor, Tamar; Tallman, Martin S; Tam, Constantine; Tiacci, Enrico; Troussard, Xavier; Zent, Clive S; Zenz, Thorsten; Zinzani, Pier Luigi; Falini, Brunangelo

2017-02-02

Hairy cell leukemia is an uncommon hematologic malignancy characterized by pancytopenia and marked susceptibility to infection. Tremendous progress in the management of patients with this disease has resulted in high response rates and improved survival, yet relapse and an appropriate approach to re-treatment present continuing areas for research. The disease and its effective treatment are associated with immunosuppression. Because more patients are being treated with alternative programs, comparison of results will require general agreement on definitions of response, relapse, and methods of determining minimal residual disease. The development of internationally accepted, reproducible criteria is of paramount importance in evaluating and comparing clinical trials to provide optimal care. Despite the success achieved in managing these patients, continued participation in available clinical trials in the first-line and particularly in the relapse setting is highly recommended. The Hairy Cell Leukemia Foundation convened an international conference to provide common definitions and structure to guide current management. There is substantial opportunity for continued research in this disease. In addition to the importance of optimizing the prevention and management of the serious risk of infection, organized evaluations of minimal residual disease and treatment at relapse offer ample opportunities for clinical research. Finally, a scholarly evaluation of quality of life in the increasing number of survivors of this now manageable chronic illness merits further study. The development of consensus guidelines for this disease offers a framework for continued enhancement of the outcome for patients.

Consensus guidelines for the diagnosis and management of patients with classic hairy cell leukemia

PubMed Central

Abdel-Wahab, Omar; Andritsos, Leslie A.; Banerji, Versha; Barrientos, Jacqueline; Blachly, James S.; Call, Timothy G.; Catovsky, Daniel; Dearden, Claire; Demeter, Judit; Else, Monica; Forconi, Francesco; Gozzetti, Alessandro; Ho, Anthony D.; Johnston, James B.; Jones, Jeffrey; Juliusson, Gunnar; Kraut, Eric; Kreitman, Robert J.; Larratt, Loree; Lauria, Francesco; Lozanski, Gerard; Montserrat, Emili; Parikh, Sameer A.; Park, Jae H.; Polliack, Aaron; Quest, Graeme R.; Rai, Kanti R.; Ravandi, Farhad; Robak, Tadeusz; Saven, Alan; Seymour, John F.; Tadmor, Tamar; Tallman, Martin S.; Tam, Constantine; Tiacci, Enrico; Troussard, Xavier; Zent, Clive S.; Zenz, Thorsten; Zinzani, Pier Luigi; Falini, Brunangelo

2017-01-01

Hairy cell leukemia is an uncommon hematologic malignancy characterized by pancytopenia and marked susceptibility to infection. Tremendous progress in the management of patients with this disease has resulted in high response rates and improved survival, yet relapse and an appropriate approach to re-treatment present continuing areas for research. The disease and its effective treatment are associated with immunosuppression. Because more patients are being treated with alternative programs, comparison of results will require general agreement on definitions of response, relapse, and methods of determining minimal residual disease. The development of internationally accepted, reproducible criteria is of paramount importance in evaluating and comparing clinical trials to provide optimal care. Despite the success achieved in managing these patients, continued participation in available clinical trials in the first-line and particularly in the relapse setting is highly recommended. The Hairy Cell Leukemia Foundation convened an international conference to provide common definitions and structure to guide current management. There is substantial opportunity for continued research in this disease. In addition to the importance of optimizing the prevention and management of the serious risk of infection, organized evaluations of minimal residual disease and treatment at relapse offer ample opportunities for clinical research. Finally, a scholarly evaluation of quality of life in the increasing number of survivors of this now manageable chronic illness merits further study. The development of consensus guidelines for this disease offers a framework for continued enhancement of the outcome for patients. PMID:27903528

Average variograms to guide soil sampling

NASA Astrophysics Data System (ADS)

Kerry, R.; Oliver, M. A.

2004-10-01

To manage land in a site-specific way for agriculture requires detailed maps of the variation in the soil properties of interest. To predict accurately for mapping, the interval at which the soil is sampled should relate to the scale of spatial variation. A variogram can be used to guide sampling in two ways. A sampling interval of less than half the range of spatial dependence can be used, or the variogram can be used with the kriging equations to determine an optimal sampling interval to achieve a given tolerable error. A variogram might not be available for the site, but if the variograms of several soil properties were available on a similar parent material and or particular topographic positions an average variogram could be calculated from these. Averages of the variogram ranges and standardized average variograms from four different parent materials in southern England were used to suggest suitable sampling intervals for future surveys in similar pedological settings based on half the variogram range. The standardized average variograms were also used to determine optimal sampling intervals using the kriging equations. Similar sampling intervals were suggested by each method and the maps of predictions based on data at different grid spacings were evaluated for the different parent materials. Variograms of loss on ignition (LOI) taken from the literature for other sites in southern England with similar parent materials had ranges close to the average for a given parent material showing the possible wider application of such averages to guide sampling.

Colour compatibility between teeth and dental shade guides in Quinquagenarians and Septuagenarians.

PubMed

Cocking, C; Cevirgen, E; Helling, S; Oswald, M; Corcodel, N; Rammelsberg, P; Reinelt, G; Hassel, A J

2009-11-01

The aim of this investigation was to determine colour compatibility between dental shade guides, namely, VITA Classical (VC) and VITA 3D-Master (3D), and human teeth in quinquagenarians and septuagenarians. Tooth colour, described in terms of L*a*b* values of the middle third of facial tooth surface of 1391 teeth, was measured using VITA Easyshade in 195 subjects (48% female). These were compared with the colours (L*a*b* values) of the shade tabs of VC and 3D. The mean coverage error and the percentage of tooth colours being within a given colour difference (DeltaE(ab)) from the tabs of VC and 3D were calculated. For comparison, hypothetical, optimized, population-specific shade guides were additionally calculated based on discrete optimization techniques for optimizing coverage. Mean coverage error was DeltaE(ab) = 3.51 for VC and DeltaE(ab) = 2.96 for 3D. Coverage of tooth colours by the tabs of VC and 3D within DeltaE(ab) = 2 was 23% and 24%, respectively, (DeltaE(ab)

A Guiding Evolutionary Algorithm with Greedy Strategy for Global Optimization Problems

PubMed Central

Cao, Leilei; Xu, Lihong; Goodman, Erik D.

2016-01-01

A Guiding Evolutionary Algorithm (GEA) with greedy strategy for global optimization problems is proposed. Inspired by Particle Swarm Optimization, the Genetic Algorithm, and the Bat Algorithm, the GEA was designed to retain some advantages of each method while avoiding some disadvantages. In contrast to the usual Genetic Algorithm, each individual in GEA is crossed with the current global best one instead of a randomly selected individual. The current best individual served as a guide to attract offspring to its region of genotype space. Mutation was added to offspring according to a dynamic mutation probability. To increase the capability of exploitation, a local search mechanism was applied to new individuals according to a dynamic probability of local search. Experimental results show that GEA outperformed the other three typical global optimization algorithms with which it was compared. PMID:27293421

A Guiding Evolutionary Algorithm with Greedy Strategy for Global Optimization Problems.

PubMed

Cao, Leilei; Xu, Lihong; Goodman, Erik D

2016-01-01

A Guiding Evolutionary Algorithm (GEA) with greedy strategy for global optimization problems is proposed. Inspired by Particle Swarm Optimization, the Genetic Algorithm, and the Bat Algorithm, the GEA was designed to retain some advantages of each method while avoiding some disadvantages. In contrast to the usual Genetic Algorithm, each individual in GEA is crossed with the current global best one instead of a randomly selected individual. The current best individual served as a guide to attract offspring to its region of genotype space. Mutation was added to offspring according to a dynamic mutation probability. To increase the capability of exploitation, a local search mechanism was applied to new individuals according to a dynamic probability of local search. Experimental results show that GEA outperformed the other three typical global optimization algorithms with which it was compared.

Health information management in the home: a human factors assessment.

PubMed

Zayas-Cabán, Teresa

2012-01-01

Achieving optimal health outcomes requires that consumers maintain myriad health data and understand how to utilize appropriate health information management applications. This case study investigated four families' health information management tasks in their homes. Four different families participated in the study: a single parent household; two nuclear family households; and an extended family household. A work system model known as the balance model was used as a guiding framework for data collection. Data collection consisted of three stages: (1) primary health information manager interviews; (2) family interviews; and (3) task observations. Overall, families reported 69 unique health information management tasks that took place in nine different locations, using 22 different information storage artifacts. Frequently occurring tasks related to health management or health coordination were conducted in public spaces. Less frequent or more time-consuming tasks, such as researching a health concern or storing medical history, were performed in private spaces such as bedrooms or studies. Similarities across households suggest potential foundational design elements that consumer health information technology application designers need to balance with tailored interventions to successfully support variations in individuals' health information management needs.

How can a social capital framework guide managers to develop positive nurse relationships and patient outcomes?

PubMed

Hofmeyer, Anne T

2013-07-01

To examine how social capital could be a mediating factor through which managers' leadership positively influences relationships with nurses and quality patient outcomes. The relationship between leadership, what managers do and optimal outcomes for patients are well established. What is not yet clear is an understanding about specific mechanisms by which managers' leadership builds social capital to foster cohesive team relationships and quality patient outcomes. Conceptual links are drawn between human capital and leadership styles of managers. Social capital is introduced and contextualized through exemplars from a Canadian study. Exemplars illustrate how the presence or absence of social capital influenced nurses' productivity to deliver quality patient care. Nurse researchers could use the Social Capital Framework (SCF) to examine the mediating role of social capital in relationships between managers and nurses. These findings could inform managers' strategies to foster positive networks and norms between nurses to deliver quality patient care. Leadership that uses a framework of social capital will enhance team relationships between nurses. Enhanced cohesion will have a positive impact on patient outcomes. © 2013 John Wiley & Sons Ltd.

75 FR 16486 - Proposed Comment Request for Review of ACF Disaster Case Management Implementation Guide; Office...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-01

... Request for Review of ACF Disaster Case Management Implementation Guide; Office of Human Services... in the Federal Register for comments on the ACF Disaster Case Management Implementation Guide, dated December 2009. Disaster case management is the process of organizing and providing a timely, coordinated...

Integrated Baseline System (IBS). Version 1.03, System Management Guide

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

Williams, J.R.; Bailey, S.; Bower, J.C.

This IBS System Management Guide explains how to install or upgrade the Integrated Baseline System (IBS) software package. The IBS is an emergency management planning and analysis tool that was developed under the direction of the Federal Emergency Management Agency (FEMA). This guide includes detailed instructions for installing the IBS software package on a Digital Equipment Corporation (DEC) VAX computer from the IBS distribution tapes. The installation instructions include procedures for both first-time installations and upgrades to existing IBS installations. To ensure that the system manager has the background necessary for successful installation of the IBS package, this guide alsomore » includes information on IBS computer requirements, software organization, and the generation of IBS distribution tapes. When special utility programs are used during IBS installation and setups, this guide refers you to the IBS Utilities Guide for specific instructions. This guide also refers you to the IBS Data Management Guide for detailed descriptions of some IBS data files and structures. Any special requirements for installation are not documented here but should be included in a set of installation notes that come with the distribution tapes.« less

Complaint-adaptive power density optimization as a tool for HTP-guided steering in deep hyperthermia treatment of pelvic tumors

NASA Astrophysics Data System (ADS)

Canters, R. A. M.; Franckena, M.; van der Zee, J.; Van Rhoon, G. C.

2008-12-01

For an efficient clinical use of HTP (hyperthermia treatment planning), optimization methods are needed. In this study, a complaint-adaptive PD (power density) optimization as a tool for HTP-guided steering in deep hyperthermia of pelvic tumors is developed and tested. PD distribution in patients is predicted using FE-models. Two goal functions, Opt1 and Opt2, are applied to optimize PD distributions. Optimization consists of three steps: initial optimization, adaptive optimization after a first complaint and increasing the weight of a region after recurring complaints. Opt1 initially considers only target PD whereas Opt2 also takes into account hot spots. After patient complaints though, both limit PD in a region. Opt1 and Opt2 are evaluated in a phantom test, using patient models and during hyperthermia treatment. The phantom test and a sensitivity study in ten patient models, show that HTP-guided steering is most effective in peripheral complaint regions. Clinical evaluation in two groups of five patients shows that time between complaints is longer using Opt2 (p = 0.007). However, this does not lead to significantly different temperatures (T50s of 40.3 (Opt1) versus 40.1 °C (Opt2) (p = 0.898)). HTP-guided steering is feasible in terms of PD reduction in complaint regions and in time consumption. Opt2 is preferable in future use, because of better complaint reduction and control.

One-year eye-to-eye comparison of wavefront-guided versus wavefront-optimized laser in situ keratomileusis in hyperopes

PubMed Central

Sáles, Christopher S; Manche, Edward E

2014-01-01

Background To compare wavefront (WF)-guided and WF-optimized laser in situ keratomileusis (LASIK) in hyperopes with respect to the parameters of safety, efficacy, predictability, refractive error, uncorrected distance visual acuity, corrected distance visual acuity, contrast sensitivity, and higher order aberrations. Methods Twenty-two eyes of eleven participants with hyperopia with or without astigmatism were prospectively randomized to receive WF-guided LASIK with the VISX CustomVue S4 IR or WF-optimized LASIK with the WaveLight Allegretto Eye-Q 400 Hz. LASIK flaps were created using the 150-kHz IntraLase iFS. Evaluations included measurement of uncorrected distance visual acuity, corrected distance visual acuity, <5% and <25% contrast sensitivity, and WF aberrometry. Patients also completed a questionnaire detailing symptoms on a quantitative grading scale. Results There were no statistically significant differences between the groups for any of the variables studied after 12 months of follow-up (all P>0.05). Conclusion This comparative case series of 11 subjects with hyperopia showed that WF-guided and WF-optimized LASIK had similar clinical outcomes at 12 months. PMID:25419115

Creating a mobile subject guide to improve access to point-of-care resources for medical students: a case study

PubMed Central

Boruff, Jill T; Bilodeau, Edward

2012-01-01

Question: Can a mobile optimized subject guide facilitate medical student access to mobile point-of-care tools? Setting: The guide was created at a library at a research-intensive university with six teaching hospital sites. Objectives: The team created a guide facilitating medical student access to point-of-care tools directly on mobile devices to provide information allowing them to access and set up resources with little assistance. Methods: Two librarians designed a mobile optimized subject guide for medicine and conducted a survey to test its usefulness. Results: Web analytics and survey results demonstrate that the guide is used and the students are satisfied. Conclusion: The library will continue to use the subject guide as its primary means of supporting mobile devices. It remains to be seen if the mobile guide facilitates access for those who do not need assistance and want direct access to the resources. Internet access in the hospitals remains an issue. PMID:22272160

Creating a mobile subject guide to improve access to point-of-care resources for medical students: a case study.

PubMed

Boruff, Jill T; Bilodeau, Edward

2012-01-01

Can a mobile optimized subject guide facilitate medical student access to mobile point-of-care tools? The guide was created at a library at a research-intensive university with six teaching hospital sites. The team created a guide facilitating medical student access to point-of-care tools directly on mobile devices to provide information allowing them to access and set up resources with little assistance. Two librarians designed a mobile optimized subject guide for medicine and conducted a survey to test its usefulness. Web analytics and survey results demonstrate that the guide is used and the students are satisfied. The library will continue to use the subject guide as its primary means of supporting mobile devices. It remains to be seen if the mobile guide facilitates access for those who do not need assistance and want direct access to the resources. Internet access in the hospitals remains an issue.

Multi-Objective Optimization of a Turbofan for an Advanced, Single-Aisle Transport

NASA Technical Reports Server (NTRS)

Berton, Jeffrey J.; Guynn, Mark D.

2012-01-01

Considerable interest surrounds the design of the next generation of single-aisle commercial transports in the Boeing 737 and Airbus A320 class. Aircraft designers will depend on advanced, next-generation turbofan engines to power these airplanes. The focus of this study is to apply single- and multi-objective optimization algorithms to the conceptual design of ultrahigh bypass turbofan engines for this class of aircraft, using NASA s Subsonic Fixed Wing Project metrics as multidisciplinary objectives for optimization. The independent design variables investigated include three continuous variables: sea level static thrust, wing reference area, and aerodynamic design point fan pressure ratio, and four discrete variables: overall pressure ratio, fan drive system architecture (i.e., direct- or gear-driven), bypass nozzle architecture (i.e., fixed- or variable geometry), and the high- and low-pressure compressor work split. Ramp weight, fuel burn, noise, and emissions are the parameters treated as dependent objective functions. These optimized solutions provide insight to the ultrahigh bypass engine design process and provide information to NASA program management to help guide its technology development efforts.

The need for spatially explicit quantification of benefits in invasive-species management.

PubMed

Januchowski-Hartley, Stephanie R; Adams, Vanessa M; Hermoso, Virgilio

2018-04-01

Worldwide, invasive species are a leading driver of environmental change across terrestrial, marine, and freshwater environments and cost billions of dollars annually in ecological damages and economic losses. Resources limit invasive-species control, and planning processes are needed to identify cost-effective solutions. Thus, studies are increasingly considering spatially variable natural and socioeconomic assets (e.g., species persistence, recreational fishing) when planning the allocation of actions for invasive-species management. There is a need to improve understanding of how such assets are considered in invasive-species management. We reviewed over 1600 studies focused on management of invasive species, including flora and fauna. Eighty-four of these studies were included in our final analysis because they focused on the prioritization of actions for invasive species management. Forty-five percent (n = 38) of these studies were based on spatial optimization methods, and 35% (n = 13) accounted for spatially variable assets. Across all 84 optimization studies considered, 27% (n = 23) explicitly accounted for spatially variable assets. Based on our findings, we further explored the potential costs and benefits to invasive species management when spatially variable assets are explicitly considered or not. To include spatially variable assets in decision-making processes that guide invasive-species management there is a need to quantify environmental responses to invasive species and to enhance understanding of potential impacts of invasive species on different natural or socioeconomic assets. We suggest these gaps could be filled by systematic reviews, quantifying invasive species impacts on native species at different periods, and broadening sources and enhancing sharing of knowledge. © 2017 Society for Conservation Biology.

Knowing 'something is not right' is beyond intuition: development of a clinical algorithm to enhance surveillance and assist nurses to organise and communicate clinical findings.

PubMed

Brier, Jessica; Carolyn, Moalem; Haverly, Marsha; Januario, Mary Ellen; Padula, Cynthia; Tal, Ahuva; Triosh, Henia

2015-03-01

To develop a clinical algorithm to guide nurses' critical thinking through systematic surveillance, assessment, actions required and communication strategies. To achieve this, an international, multiphase project was initiated. Patients receive hospital care postoperatively because they require the skilled surveillance of nurses. Effective assessment of postoperative patients is essential for early detection of clinical deterioration and optimal care management. Despite the significant amount of time devoted to surveillance activities, there is lack of evidence that nurses use a consistent, systematic approach in surveillance, management and communication, potentially leading to less optimal outcomes. Several explanations for the lack of consistency have been suggested in the literature. Mixed methods approach. Retrospective chart review; semi-structured interviews conducted with expert nurses (n = 10); algorithm development. Themes developed from the semi-structured interviews, including (1) complete, systematic assessment, (2) something is not right (3) validating with others, (4) influencing factors and (5) frustration with lack of response when communicating findings were used as the basis for development of the Surveillance Algorithm for Post-Surgical Patients. The algorithm proved beneficial based on limited use in clinical settings. Further work is needed to fully test it in education and practice. The Surveillance Algorithm for Post-Surgical Patients represents the approach of expert nurses, and serves to guide less expert nurses' observations, critical thinking, actions and communication. Based on this approach, the algorithm assists nurses to develop skills promoting early detection, intervention and communication in cases of patient deterioration. © 2014 John Wiley & Sons Ltd.

Long-term management of cirrhosis. Appropriate supportive care is both critical and difficult.

PubMed

Habib, A; Bond, W M; Heuman, D M

2001-03-01

Orthotopic liver transplantation has emerged as an important treatment option for patients with advanced liver disease. However, each year the number of new cases of cirrhosis exceeds the number of livers available for transplantation by a factor of 5 to 10. This translates into long waiting lists and restrictive criteria for selecting transplant recipients. Until advances in surgical technique or biotechnology increase the availability of organs for transplantation, the majority of patients with advanced liver disease will have to be managed medically for years--perhaps indefinitely. Early consultation with a liver transplant center can be helpful. The transplant hepatologist and surgeon can help with triage decisions, guide workup, provide advice about patient care, optimize the timing of transplantation, offer specialized diagnostic and therapeutic options, and help the treating physician stay abreast of the continuous changes in this complex field. In the final analysis, however, it is often the skill and diligence of the primary care physician in diagnosing liver disease, identifying and treating correctable causes, optimizing the patient's health and nutrition, and anticipating and preventing catastrophic complications that determine whether the patient lives or dies.

Magnetic resonance imaging of water content across the Nafion membrane in an operational PEM fuel cell.

PubMed

Zhang, Ziheng; Martin, Jonathan; Wu, Jinfeng; Wang, Haijiang; Promislow, Keith; Balcom, Bruce J

2008-08-01

Water management is critical to optimize the operation of polymer electrolyte membrane fuel cells. At present, numerical models are employed to guide water management in such fuel cells. Accurate measurements of water content variation in polymer electrolyte membrane fuel cells are required to validate these models and to optimize fuel cell behavior. We report a direct water content measurement across the Nafion membrane in an operational polymer electrolyte membrane fuel cell, employing double half k-space spin echo single point imaging techniques. The MRI measurements with T2 mapping were undertaken with a parallel plate resonator to avoid the effects of RF screening. The parallel plate resonator employs the electrodes inherent to the fuel cell to create a resonant circuit at RF frequencies for MR excitation and detection, while still operating as a conventional fuel cell at DC. Three stages of fuel cell operation were investigated: activation, operation and dehydration. Each profile was acquired in 6 min, with 6 microm nominal resolution and a SNR of better than 15.

Development and demonstration of an on-board mission planner for helicopters

NASA Technical Reports Server (NTRS)

Deutsch, Owen L.; Desai, Mukund

1988-01-01

Mission management tasks can be distributed within a planning hierarchy, where each level of the hierarchy addresses a scope of action, and associated time scale or planning horizon, and requirements for plan generation response time. The current work is focused on the far-field planning subproblem, with a scope and planning horizon encompassing the entire mission and with a response time required to be about two minutes. The far-feld planning problem is posed as a constrained optimization problem and algorithms and structural organizations are proposed for the solution. Algorithms are implemented in a developmental environment, and performance is assessed with respect to optimality and feasibility for the intended application and in comparison with alternative algorithms. This is done for the three major components of far-field planning: goal planning, waypoint path planning, and timeline management. It appears feasible to meet performance requirements on a 10 Mips flyable processor (dedicated to far-field planning) using a heuristically-guided simulated annealing technique for the goal planner, a modified A* search for the waypoint path planner, and a speed scheduling technique developed for this project.

Designing Flood Management Systems for Joint Economic and Ecological Robustness

NASA Astrophysics Data System (ADS)

Spence, C. M.; Grantham, T.; Brown, C. M.; Poff, N. L.

2015-12-01

Freshwater ecosystems across the United States are threatened by hydrologic change caused by water management operations and non-stationary climate trends. Nonstationary hydrology also threatens flood management systems' performance. Ecosystem managers and flood risk managers need tools to design systems that achieve flood risk reduction objectives while sustaining ecosystem functions and services in an uncertain hydrologic future. Robust optimization is used in water resources engineering to guide system design under climate change uncertainty. Using principles introduced by Eco-Engineering Decision Scaling (EEDS), we extend robust optimization techniques to design flood management systems that meet both economic and ecological goals simultaneously across a broad range of future climate conditions. We use three alternative robustness indices to identify flood risk management solutions that preserve critical ecosystem functions in a case study from the Iowa River, where recent severe flooding has tested the limits of the existing flood management system. We seek design modifications to the system that both reduce expected cost of flood damage while increasing ecologically beneficial inundation of riparian floodplains across a wide range of plausible climate futures. The first robustness index measures robustness as the fraction of potential climate scenarios in which both engineering and ecological performance goals are met, implicitly weighting each climate scenario equally. The second index builds on the first by using climate projections to weight each climate scenario, prioritizing acceptable performance in climate scenarios most consistent with climate projections. The last index measures robustness as mean performance across all climate scenarios, but penalizes scenarios with worse performance than average, rewarding consistency. Results stemming from alternate robustness indices reflect implicit assumptions about attitudes toward risk and reveal the tradeoffs between using structural and non-structural flood management strategies to ensure economic and ecological robustness.

Simple rules can guide whether land- or ocean-based conservation will best benefit marine ecosystems.

PubMed

Saunders, Megan I; Bode, Michael; Atkinson, Scott; Klein, Carissa J; Metaxas, Anna; Beher, Jutta; Beger, Maria; Mills, Morena; Giakoumi, Sylvaine; Tulloch, Vivitskaia; Possingham, Hugh P

2017-09-01

Coastal marine ecosystems can be managed by actions undertaken both on the land and in the ocean. Quantifying and comparing the costs and benefits of actions in both realms is therefore necessary for efficient management. Here, we quantify the link between terrestrial sediment runoff and a downstream coastal marine ecosystem and contrast the cost-effectiveness of marine- and land-based conservation actions. We use a dynamic land- and sea-scape model to determine whether limited funds should be directed to 1 of 4 alternative conservation actions-protection on land, protection in the ocean, restoration on land, or restoration in the ocean-to maximise the extent of light-dependent marine benthic habitats across decadal timescales. We apply the model to a case study for a seagrass meadow in Australia. We find that marine restoration is the most cost-effective action over decadal timescales in this system, based on a conservative estimate of the rate at which seagrass can expand into a new habitat. The optimal decision will vary in different social-ecological contexts, but some basic information can guide optimal investments to counteract land- and ocean-based stressors: (1) marine restoration should be prioritised if the rates of marine ecosystem decline and expansion are similar and low; (2) marine protection should take precedence if the rate of marine ecosystem decline is high or if the adjacent catchment is relatively intact and has a low rate of vegetation decline; (3) land-based actions are optimal when the ratio of marine ecosystem expansion to decline is greater than 1:1.4, with terrestrial restoration typically the most cost-effective action; and (4) land protection should be prioritised if the catchment is relatively intact but the rate of vegetation decline is high. These rules of thumb illustrate how cost-effective conservation outcomes for connected land-ocean systems can proceed without complex modelling.

Simple rules can guide whether land- or ocean-based conservation will best benefit marine ecosystems

PubMed Central

Bode, Michael; Atkinson, Scott; Klein, Carissa J.; Metaxas, Anna; Beher, Jutta; Beger, Maria; Mills, Morena; Giakoumi, Sylvaine; Tulloch, Vivitskaia; Possingham, Hugh P.

2017-01-01

Coastal marine ecosystems can be managed by actions undertaken both on the land and in the ocean. Quantifying and comparing the costs and benefits of actions in both realms is therefore necessary for efficient management. Here, we quantify the link between terrestrial sediment runoff and a downstream coastal marine ecosystem and contrast the cost-effectiveness of marine- and land-based conservation actions. We use a dynamic land- and sea-scape model to determine whether limited funds should be directed to 1 of 4 alternative conservation actions—protection on land, protection in the ocean, restoration on land, or restoration in the ocean—to maximise the extent of light-dependent marine benthic habitats across decadal timescales. We apply the model to a case study for a seagrass meadow in Australia. We find that marine restoration is the most cost-effective action over decadal timescales in this system, based on a conservative estimate of the rate at which seagrass can expand into a new habitat. The optimal decision will vary in different social–ecological contexts, but some basic information can guide optimal investments to counteract land- and ocean-based stressors: (1) marine restoration should be prioritised if the rates of marine ecosystem decline and expansion are similar and low; (2) marine protection should take precedence if the rate of marine ecosystem decline is high or if the adjacent catchment is relatively intact and has a low rate of vegetation decline; (3) land-based actions are optimal when the ratio of marine ecosystem expansion to decline is greater than 1:1.4, with terrestrial restoration typically the most cost-effective action; and (4) land protection should be prioritised if the catchment is relatively intact but the rate of vegetation decline is high. These rules of thumb illustrate how cost-effective conservation outcomes for connected land–ocean systems can proceed without complex modelling. PMID:28877168

Endoscopic Management of Peri-Pancreatic Fluid Collections.

PubMed

Yip, Hon Chi; Teoh, Anthony Yuen Bun

2017-09-15

In the past decade, there has been a progressive paradigm shift in the management of peri-pancreatic fluid collections after acute pancreatitis. Refinements in the definitions of fluid collections from the updated Atlanta classification have enabled better communication amongst physicians in an effort to formulate optimal treatments. Endoscopic ultrasound (EUS)-guided drainage of pancreatic pseudocysts has emerged as the procedure of choice over surgical cystogastrostomy. The approach provides similar success rates with low complications and better quality of life compared with surgery. However, an endoscopic "step up" approach in the management of pancreatic walled-off necrosis has also been advocated. Both endoscopic and percutaneous drainage routes may be used depending on the anatomical location of the collections. New-generation large diameter EUS-specific stent systems have also recently been described. The device allows precise and effective drainage of the collections and permits endoscopic necrosectomy through the stents.

Patient-centered blood management.

PubMed

Hohmuth, Benjamin; Ozawa, Sherri; Ashton, Maria; Melseth, Richard L

2014-01-01

Transfusions are common in hospitalized patients but carry significant risk, with associated morbidity and mortality that increases with each unit of blood received. Clinical trials consistently support a conservative over a liberal approach to transfusion. Yet there remains wide variation in practice, and more than half of red cell transfusions may be inappropriate. Adopting a more comprehensive approach to the bleeding, coagulopathic, or anemic patient has the potential to improve patient care. We present a patient-centered blood management (PBM) paradigm. The 4 guiding principles of effective PBM that we present include anemia management, coagulation optimization, blood conservation, and patient-centered decision making. PBM has the potential to decrease transfusion rates, decrease practice variation, and improve patient outcomes. PBM's value proposition is highly aligned with that of hospital medicine. Hospitalists' dual role as front-line care providers and quality improvement leaders make them the ideal candidates to develop, implement, and practice PBM. © 2013 Society of Hospital Medicine.

Fluid therapy and the hypovolemic microcirculation.

PubMed

Gruartmoner, G; Mesquida, J; Ince, Can

2015-08-01

In shock states, optimizing intravascular volume is crucial to promote an adequate oxygen delivery to the tissues. Our current practice in fluid management pivots on the Frank-Starling law of the heart, and the effects of fluids are measured according to the induced changes on stroke volume. The purpose of this review is to evaluate the boundaries of current macrohemodynamic approach to fluid administration, and to introduce the microcirculatory integration as a fundamental part of tissue perfusion monitoring. Macrocirculatory changes induced by volume expansion are not always coupled to proportional changes in microcirculatory perfusion. Loss of hemodynamic coherence limits the value of guiding fluid therapy according to macrohemodynamics, and highlights the importance of evaluating the ultimate target of volume administration, the microcirculation. Current approach to intravascular volume optimization is made from a macrohemodynamic perspective. However, several situations wherein macrocirculatory and microcirculatory coherence is lost have been described. Future clinical trials should explore the usefulness of integrating the microcirculatory evaluation in fluid optimization.

Neutron optics concept for the materials engineering diffractometer at the ESS

NASA Astrophysics Data System (ADS)

Šaroun, J.; Fenske, J.; Rouijaa, M.; Beran, P.; Navrátil, J.; Lukáš, P.; Schreyer, A.; Strobl, M.

2016-09-01

The Beamline for European Materials Engineering Research (BEER) has been recently proposed to be built at the European Spallation Source (ESS). The presented concept of neutron delivery optics for this instrument addresses the problems of bi-spectral beam extraction from a small moderator, optimization of neutron guides profile for long-range neutron transport and focusing at the sample under various constraints. They include free space before and after the guides, a narrow guide section with gaps for choppers, closing of direct line of sight and cost reduction by optimization of the guides cross-section and coating. A system of slits and exchangeable focusing optics is proposed in order to match various wavelength resolution options provided by the pulse shaping and modulation choppers, which permits to efficiently trade resolution for intensity in a wide range. Simulated performance characteristics such as brilliance transfer ratio are complemented by the analysis of the histories of “useful” neutrons obtained by back tracing neutrons hitting the sample, which helps to optimize some of the neutron guide parameters such as supermirror coating.

A detailed examination of the LWFA in the Self-Guided Nonlinear Blowout Regime for 15-100 Joule Lasers

NASA Astrophysics Data System (ADS)

Davidson, Asher; Tableman, Adam; Yu, Peicheng; An, Weiming; Tsung, Frank; Mori, Warren; Lu, Wei; Fonseca, Ricardo

2017-10-01

We examine scaling laws for LWFA in the regime nonlinear, self-guided regime in detail using the quasi-3D version of the particle-in-cell code OSIRIS. We find that the scaling laws continue to work well when we fix the normalized laser amplitude while reducing plasma density. It is further found that the energy gain for fixed laser energy can be improved by shortening the pulse length until self-guiding almost no longer occurs and that the energy gain can be optimized by using lasers with asymmetric longitudinal profiles. We find that when optimized, a 15 J laser may yield particle energies as high as 5.3 GeV without the need of any external guiding. Detailed studies for optimizing energy gains from 30 J and 100 J lasers will also presented which indicate that energies in excess of 10 GeV can be possible in the near term without the need for external guiding. This work is supported by the NSF and DOE.

Asthma management simulation for children: translating theory, methods, and strategies to effect behavior change.

PubMed

Shegog, Ross; Bartholomew, L Kay; Gold, Robert S; Pierrel, Elaine; Parcel, Guy S; Sockrider, Marianna M; Czyzewski, Danita I; Fernandez, Maria E; Berlin, Nina J; Abramson, Stuart

2006-01-01

Translating behavioral theories, models, and strategies to guide the development and structure of computer-based health applications is well recognized, although a continued challenge for program developers. A stepped approach to translate behavioral theory in the design of simulations to teach chronic disease management to children is described. This includes the translation steps to: 1) define target behaviors and their determinants, 2) identify theoretical methods to optimize behavioral change, and 3) choose educational strategies to effectively apply these methods and combine these into a cohesive computer-based simulation for health education. Asthma is used to exemplify a chronic health management problem and a computer-based asthma management simulation (Watch, Discover, Think and Act) that has been evaluated and shown to effect asthma self-management in children is used to exemplify the application of theory to practice. Impact and outcome evaluation studies have indicated the effectiveness of these steps in providing increased rigor and accountability, suggesting their utility for educators and developers seeking to apply simulations to enhance self-management behaviors in patients.

Planning, Management and Evaluation: Realizing PIC Potential. Private Industry Council Guide. Working Draft.

ERIC Educational Resources Information Center

National Alliance of Business, Inc., Washington, DC.

This Planning, Management, and Evaluation (PME) guide was developed by the National Alliance of Business as part of its program of management assistance for Private Industry Councils (PICs). The guide is a tool which PICs can use to improve their capability to plan, manage, and evaluate the programs which they administer, and to establish locally…

Central States forest management guides as applied in STEMS.

Treesearch

Nancy R. Walters

1988-01-01

Describes a management prescription system for Central States cover types developed for use in the Central States Stand and Tree Evaluation and Modeling System (STEMS). It includes one management guide for each of the six major cover types in the region. Each guide consists of a decision key that prescribes management, based on stand characteristics and a set of...

Thymic Carcinoma Management Patterns among International Thymic Malignancy Interest Group (ITMIG) Physicians with Consensus from the Thymic Carcinoma Working Group.

PubMed

Shepherd, Annemarie; Riely, Gregory; Detterbeck, Frank; Simone, Charles B; Ahmad, Usman; Huang, James; Korst, Robert; Rajan, Arun; Rimner, Andreas

2017-04-01

Thymic carcinomas are rare epithelial malignancies with limited data to guide management. To identify areas of agreement and variability in current clinical practice, a 16-question electronic survey was given to members of the International Thymic Malignancy Interest Group (ITMIG). Areas of controversy were discussed with the Thymic Carcinoma Working Group and consensus was achieved, as described. A total of 100 ITMIG members responded. There was general agreement regarding the role for multimodality therapy with definitive surgical resection in physically fit patients with advanced but resectable disease. Areas of controversy included the need for histologic confirmation before surgery, the role of adjuvant therapy, the optimal first-line chemotherapy regimen, and the recommended treatment course for marginally resectable disease with invasion into the great vessels, pericardium, and lungs. The results of the questionnaire provide a description of the management of thymic carcinoma by 100 ITMIG members with a specific interest or expertise in thymic malignancies. Although there was agreement in some areas, clinical practice appears to vary significantly. There is a great need for collaborative research to identify optimal evaluation and treatment strategies. Given the need for multimodality therapy in many cases, a multidisciplinary discussion of the management of patients with thymic carcinoma is critical. Copyright © 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

Pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy.

PubMed

Brogly, Nicolas; Schiraldi, Renato; Puertas, Laura; Maggi, Genaro; Yanci, Eduardo Alonso; Maldonado, Ever Hugo Martinez; Arévalo, Emilia Guasch; Rodríguez, Fernando Gilsanz

2016-01-01

The delivery of cardiac patients is a challenge for the anaesthesiologist, to whom the welfare of both the mother and the foetus is a main issue. In case of caesarean section, advanced monitoring allows to optimize haemodynamic condition and to improve morbidity and mortality. To describe the use of pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy. We describe the case of a 28-year-old woman with a congenital heart disease who was submitted to a caesarean section under general anaesthesia for maternal pathology and foetal breech presentation. Intra- and post-operative management was optimized by advanced haemodynamic monitorization obtained by pulse contour wave analysis and thermodilution calibration (Picco Plus(®) monitor). The information about preload, myocardial contractility and postcharge was useful in guiding the fluid therapy and the use of vasoactive drugs. This case report illustrates the importance of advanced haemodynamic monitoring with an acceptably invasive device in obstetric patients with high cardiac risk. The increasing experience in advanced haemodynamic management will probably permit to decrease morbidity and mortality of obstetric patients in the future. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

[Pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy].

PubMed

Brogly, Nicolas; Schiraldi, Renato; Puertas, Laura; Maggi, Genaro; Yanci, Eduardo Alonso; Maldonado, Ever Hugo Martinez; Arévalo, Emilia Guasch; Rodríguez, Fernando Gilsanz

2016-01-01

The delivery of cardiac patients is a challenge for the anaesthesiologist, to whom the welfare of both the mother and the foetus is a main issue. In case of caesarean section, advanced monitoring allows to optimize haemodynamic condition and to improve morbidity and mortality. To describe the use of pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy. We describe the case of a 28-year-old woman with a congenital heart disease who was submitted to a caesarean section under general anaesthesia for maternal pathology and foetal breech presentation. Intra- and post-operative management was optimized by advanced haemodynamic monitorization obtained by pulse contour wave analysis and thermodilution calibration (Picco Plus(®) monitor). The information about preload, myocardial contractility and postcharge was useful in guiding the fluid therapy and the use of vasoactive drugs. This case report illustrates the importance of advanced haemodynamic monitoring with an acceptably invasive device in obstetric patients with high cardiac risk. The increasing experience in advanced haemodynamic management will probably permit to decrease morbidity and mortality of obstetric patients in the future. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

COLLABORATIVE GUIDE: A REEF MANAGER'S GUIDE TO ...

EPA Pesticide Factsheets

Innovative strategies to conserve the world's coral reefs are included in a new guide released today by NOAA, and the Australian Great Barrier Reef Marine Park Authority, with author contributions from a variety of international partners from government agencies, non-governmental organizations, and academic institutions. Referred to as A Reef Manager's Guide to Coral Bleaching, the guide will provide coral reef managers with the latest scientific information on the causes of coral bleaching and new management strategies for responding to this significant threat to coral reef ecosystems. Innovative strategies to conserve the world's coral reefs are included in a new guide released today by NOAA, and the Australian Great Barrier Reef Marine Park Authority, with author contributions from a variety of international partners from government agencies, non-governmental organizations, and academic institutions. Dr. Jordan West, of the National Center for Environmental Assessment, was a major contributor to the guide. Referred to as

Agribusiness Sales, Marketing, and Management. Instructor Guide [and] Student Reference.

ERIC Educational Resources Information Center

Schneiderheinze, Ronald; Wood, Christina

This curriculum guide incorporates the needed components to aid agriculture teachers in the implementation of the Vocational Instructional Management System in agribusiness sales, marketing, and management. The guide begins with a list of the competencies/objectives found in the nine units; list of references and materials; teaching calendar; and…

Business Management Course Guide.

ERIC Educational Resources Information Center

North Carolina State Dept. of Public Instruction, Raleigh. Div. of Vocational Education.

This course guide is designed for teaching about the U.S. business system. Students are introduced to management functions and the background knowledge/skills necessary to be a successful manager. The guide contains 10 competency goals: (1) nature of U.S. business; (2) environment of business; (3) types of business ownership; (4) management…

The use of cardiac output monitoring to guide the administration of intravenous fluid during hyperthermic intraperitoneal chemotherapy.

PubMed

Thanigaimani, K; Mohamed, F; Cecil, T; Moran, B J; Bell, J

2013-12-01

The optimal strategy for intravenous (IV) fluid management during administration of hyperthermic intraperitoneal chemotherapy (HIPEC) is unclear. In this prospective study we describe the use of a LiDCOrapid™ (LiDCO, Cambridge, UK) cardiac output monitor to guide IV fluid management during cytoreductive surgery (CRS) with HIPEC. The aim of this study was to determine whether cardiac output monitoring will allow close maintenance of physiological parameters during the HIPEC phase. Twenty-five patients who underwent CRS combined with HIPEC were included in the study. Intra-operative IV fluid boluses were titrated using parameters measured by the LiDCOrapid™ monitor. Stroke volume variation was maintained below 10% with fluid boluses and mean arterial pressure was maintained within 20% of the baseline figure with vasopressors. There was no significant change in heart rate and cardiac output. The systemic vascular resistance dropped from an average of 966 dyn.s/cm-5 to 797 dyn s/cm(5) at 60 min during the HIPEC phase (P = 0.62) despite an increase in the dose of phenylepherine. The average total volume of fluid given was 748 ml in the first 30 min and 630 ml in the second 30 min with an average urine output of 307 and 445 ml, respectively. The change in lactate levels was not statistically or clinically significant. LiDCOrapid™ is an effective noninvasive tool for guiding fluid management in this population. It allows the anaesthesiologist to maintain tight control of essential physiological parameters during a phase of the procedure in which there is a risk of renal injury. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

Optimizing wavefront-guided corrections for highly aberrated eyes in the presence of registration uncertainty

PubMed Central

Shi, Yue; Queener, Hope M.; Marsack, Jason D.; Ravikumar, Ayeswarya; Bedell, Harold E.; Applegate, Raymond A.

2013-01-01

Dynamic registration uncertainty of a wavefront-guided correction with respect to underlying wavefront error (WFE) inevitably decreases retinal image quality. A partial correction may improve average retinal image quality and visual acuity in the presence of registration uncertainties. The purpose of this paper is to (a) develop an algorithm to optimize wavefront-guided correction that improves visual acuity given registration uncertainty and (b) test the hypothesis that these corrections provide improved visual performance in the presence of these uncertainties as compared to a full-magnitude correction or a correction by Guirao, Cox, and Williams (2002). A stochastic parallel gradient descent (SPGD) algorithm was used to optimize the partial-magnitude correction for three keratoconic eyes based on measured scleral contact lens movement. Given its high correlation with logMAR acuity, the retinal image quality metric log visual Strehl was used as a predictor of visual acuity. Predicted values of visual acuity with the optimized corrections were validated by regressing measured acuity loss against predicted loss. Measured loss was obtained from normal subjects viewing acuity charts that were degraded by the residual aberrations generated by the movement of the full-magnitude correction, the correction by Guirao, and optimized SPGD correction. Partial-magnitude corrections optimized with an SPGD algorithm provide at least one line improvement of average visual acuity over the full magnitude and the correction by Guirao given the registration uncertainty. This study demonstrates that it is possible to improve the average visual acuity by optimizing wavefront-guided correction in the presence of registration uncertainty. PMID:23757512

Review of Gallium-68 PSMA PET/CT Imaging in the Management of Prostate Cancer

PubMed Central

Lenzo, Nat P.; Meyrick, Danielle; Turner, J. Harvey

2018-01-01

Over 90% of prostate cancers over-express prostate specific membrane antigen (PSMA) and these tumor cells may be accurately targeted for diagnosis by 68Ga-PSMA-positron emission tomography/computed tomography (68Ga-PSMA-PET/CT) imaging. This novel molecular imaging modality appears clinically to have superseded CT, and appears superior to MR imaging, for the detection of metastatic disease. 68Ga-PSMA PET/CT has the ability to reliably stage prostate cancer at presentation and can help inform an optimal treatment approach. Novel diagnostic applications of 68Ga-PSMA PET/CT include guiding biopsy to improve sampling accuracy, and guiding surgery and radiotherapy. In addition to facilitating the management of metastatic castrate resistant prostate cancer (mCRPC), 68Ga-PSMA can select patients who may benefit from targeted systemic radionuclide therapy. 68Ga-PSMA is the diagnostic positron-emitting theranostic pair with the beta emitter Lutetium-177 PSMA (177Lu-PSMA) and alpha-emitter Actinium-225 PSMA (225Ac-PSMA) which can both be used to treat PSMA-avid metastases of prostate cancer in the molecular tumor-targeted approach of theranostic nuclear oncology. PMID:29439481

GRA prospectus: optimizing design and management of protected areas

USGS Publications Warehouse

Bernknopf, Richard; Halsing, David

2001-01-01

Protected areas comprise one major type of global conservation effort that has been in the form of parks, easements, or conservation concessions. Though protected areas are increasing in number and size throughout tropical ecosystems, there is no systematic method for optimally targeting specific local areas for protection, designing the protected area, and monitoring it, or for guiding follow-up actions to manage it or its surroundings over the long run. Without such a system, conservation projects often cost more than necessary and/or risk protecting ecosystems and biodiversity less efficiently than desired. Correcting these failures requires tools and strategies for improving the placement, design, and long-term management of protected areas. The objective of this project is to develop a set of spatially based analytical tools to improve the selection, design, and management of protected areas. In this project, several conservation concessions will be compared using an economic optimization technique. The forest land use portfolio model is an integrated assessment that measures investment in different land uses in a forest. The case studies of individual tropical ecosystems are developed as forest (land) use and preservation portfolios in a geographic information system (GIS). Conservation concessions involve a private organization purchasing development and resource access rights in a certain area and retiring them. Forests are put into conservation, and those people who would otherwise have benefited from extracting resources or selling the right to do so are compensated. Concessions are legal agreements wherein the exact amount and nature of the compensation result from a negotiated agreement between an agent of the conservation community and the local community. Funds are placed in a trust fund, and annual payments are made to local communities and regional/national governments. The payments are made pending third-party verification that the forest expanse and quality have been maintained.

Asian consensus workshop report: expert consensus guideline for the management of intermediate and advanced hepatocellular carcinoma in Asia.

PubMed

Han, Kwang-Hyub; Kudo, Masatochi; Ye, Sheng-Long; Choi, Jong Young; Poon, Roonni Tung-Ping; Seong, Jinsil; Park, Joong-Won; Ichida, Takafumi; Chung, Jin Wook; Chow, Pierce; Cheng, Ann-Lii

2011-01-01

Hepatocellular carcinoma (HCC) is a highly prevalent disease in many Asian countries, accounting for 80% of victims worldwide. Screening programs improve the detection of early HCC and have a positive impact on survival, but the majority of HCC patients in Asia still present with advanced stage disease. The treatment outcomes of HCC are affected by multiple variables, including liver function, performance status of the patient, and tumor stage. Therefore, it is not easy to apply a multidisciplinary therapeutic approach for optimal management. At present, limited numbers of HCC patients are eligible for curative therapies such as surgery or ablation in Asia. Therefore, most patients are eligible for only palliative treatments. For optimal management, the treatment choice is guided by staging systems and treatment guidelines. Numerous staging systems have been proposed and treatment guidelines vary by region. According to the Barcelona Clinic Liver Cancer (BCLC) guideline based on evidence from randomized clinical trials, only transarterial chemoembolization (TACE) is recommended for intermediate stage HCC and sorafenib for advanced stage HCC. However, treatment guidelines from Asian countries have adopted several other therapeutic modalities such as a surgical approach, hepatic arterial infusion chemotherapy, external radiation, and their combinations based on clinical experiences for intermediate and advanced stage HCC. Although TACE is the main therapeutic modality in the intermediate stage, overall therapeutic outcomes depend on the tumor size. In the advanced stage, the prognosis depends on the tumor status, e.g. major vessel invasion or extrahepatic spread. Thus, a new staging system representing prognoses suitable for Asian HCC patients and a corresponding optimal treatment algorithm should be further investigated using evidence-based data, which will finally bring about an Asian consensus for the management of intermediate and advanced stage HCC. Copyright © 2011 S. Karger AG, Basel.

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

Lakshminarayan, Raghuram, E-mail: raghuram.lakshminarayan@hey.nhs.u; Simpson, James O.; Ettles, Duncan F., E-mail: Duncan.Ettles@hey.nhs.u

Magnetic resonance angiography (MRA) has become an established imaging modality in the management of lower-limb arterial disease, with emerging roles in treatment planning and follow-up. Contrast-enhanced MRA is now the most widely used technique with clinically acceptable results in the majority of patients. Difficulties in imaging and image interpretation are recognised in certain subgroups, including patients with critical limb ischaemia as well as patients with stents. Although newer contrast agents and refined imaging protocols may offer some solutions to these problems, this optimism is balanced by concerns about the toxicity of certain gadolinium chelates. Further development of interventional MRA remainsmore » one of the most significant challenges in the development of magnetic resonance imaging-guided peripheral vascular intervention. The status of MRA in managing patients with lower-limb arterial disease in current clinical practice is reviewed.« less

The 'realities' of part-time nursing: a grounded theory study.

PubMed

Jamieson, Lynn N; Williams, Leonie Mosel; Lauder, William; Dwyer, Trudy

2008-10-01

To develop a theory that explains the 'realities' of part-time nursing. While little is known about the phenomenon of part-time nursing, increasing numbers of nurses work in part-time employment. Grounded theory. The problem that part-time nurses shared was an inability to achieve their personal optimal nursing potential. Motivators to work part-time, employment hours, specialty, individual and organizational factors formed contextual conditions that led to this problem. Part-time nurses responded to the challenges through a process of adaptation and adjustment. Harnessing the full productive potential of part-time nurses requires support to limit the difficulties that they encounter. The developed theory provides a valuable guide to managerial action. Nurse Managers need to consider the developed substantive theory when planning and managing nursing workforces.

Contemporary Medical and Surgical Management of X-linked Hypophosphatemic Rickets.

PubMed

Sharkey, Melinda S; Grunseich, Karl; Carpenter, Thomas O

2015-07-01

X-linked hypophosphatemia is an inheritable disorder of renal phosphate wasting that clinically manifests with rachitic bone pathology. X-linked hypophosphatemia is frequently misdiagnosed and mismanaged. Optimized medical therapy is the cornerstone of treatment. Even with ideal medical management, progressive bony deformity may develop in some children and adults. Medical treatment is paramount to the success of orthopaedic surgical procedures in both children and adults with X-linked hypophosphatemia. Successful correction of complex, multiapical bone deformities found in patients with X-linked hypophosphatemia is possible with careful surgical planning and exacting surgical technique. Multiple methods of deformity correction are used, including acute and gradual correction. Treatment of some pediatric bony deformity with guided growth techniques may be possible. Copyright 2015 by the American Academy of Orthopaedic Surgeons.

Guiding principles of fluid and volume therapy.

PubMed

Aditianingsih, Dita; George, Yohanes W H

2014-09-01

Fluid therapy is a core concept in the management of perioperative and critically ill patients for maintenance of intravascular volume and organ perfusion. Recent evidence regarding the vascular barrier and its role in terms of vascular leakage has led to a new concept for fluid administration. The choice of fluid used should be based on the fluid composition and the underlying pathophysiology of the patient. Avoidance of both hypo- and hypervolaemia is essential when treating circulatory failure. In daily practice, the assessment of individual thresholds in order to optimize cardiac preload and avoid hypovolaemia or deleterious fluid overload remains a challenge. Liberal versus restrictive fluid management has been challenged by recent evidence, and the ideal approach appears to be goal-directed fluid therapy. Copyright © 2014 Elsevier Ltd. All rights reserved.

Clinicians' Perspectives on Managing Symptom Clusters in Advanced Cancer: A Semistructured Interview Study.

PubMed

Dong, Skye T; Butow, Phyllis N; Agar, Meera; Lovell, Melanie R; Boyle, Frances; Stockler, Martin; Forster, Benjamin C; Tong, Allison

2016-04-01

Managing symptom clusters or multiple concurrent symptoms in patients with advanced cancer remains a clinical challenge. The optimal processes constituting effective management of symptom clusters remain uncertain. To describe the attitudes and strategies of clinicians in managing multiple co-occurring symptoms in patients with advanced cancer. Semistructured interviews were conducted with 48 clinicians (palliative care physicians [n = 10], oncologists [n = 6], general practitioners [n = 6], nurses [n = 12], and allied health providers [n = 14]), purposively recruited from two acute hospitals, two palliative care centers, and four community general practices in Sydney, Australia. Transcripts were analyzed using thematic analysis and adapted grounded theory. Six themes were identified: uncertainty in decision making (inadequacy of scientific evidence, relying on experiential knowledge, and pressure to optimize care); attunement to patient and family (sensitivity to multiple cues, prioritizing individual preferences, addressing psychosocial and physical interactions, and opening Pandora's box); deciphering cause to guide intervention (disaggregating symptoms and interactions, flexibility in assessment, and curtailing investigative intrusiveness); balancing complexities in medical management (trading off side effects, minimizing mismatched goals, and urgency in resolving severe symptoms); fostering hope and empowerment (allaying fear of the unknown, encouraging meaning making, championing patient empowerment, and truth telling); and depending on multidisciplinary expertise (maximizing knowledge exchange, sharing management responsibility, contending with hierarchical tensions, and isolation and discontinuity of care). Management of symptom clusters, as both an art and a science, is currently fraught with uncertainty in decision making. Strengthening multidisciplinary collaboration, continuity of care, more pragmatic planning of clinical trials to address more than one symptom, and training in symptom cluster management are required. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

A guide for roadside vegetation management

DOT National Transportation Integrated Search

2009-10-01

Implementing a comprehensive turf management program significantly reduces the overall cost of managing the vegetation along state roadways. This guide provides methods for efficiently and effectively managing the activities that will achieve and mai...

Research on Livable Community Evaluation Based on GIS

NASA Astrophysics Data System (ADS)

Yin, Zhangcai; Wu, Yang; Jin, Zhanghaonan; Zhang, Xu

2018-01-01

Community is the basic unit of the city. Research on livable community could provide a bottom-up research path for the realization of livable city. Livability is the total factor affecting the quality of community life. In this paper, livable community evaluation indexes are evaluated based on GIS and fuzzy comprehensive evaluation method. Then the sum-index and sub-index of community livability are both calculated. And community livable evaluation index system is constructed based on the platform of GIS. This study provides theoretical support for the construction and management of livable communities, so as to guide the development and optimization of city.

Laboratory Diagnosis of Infective Endocarditis

PubMed Central

Liesman, Rachael M.; Pritt, Bobbi S.; Maleszewski, Joseph J.

2017-01-01

ABSTRACT Infective endocarditis is life-threatening; identification of the underlying etiology informs optimized individual patient management. Changing epidemiology, advances in blood culture techniques, and new diagnostics guide the application of laboratory testing for diagnosis of endocarditis. Blood cultures remain the standard test for microbial diagnosis, with directed serological testing (i.e., Q fever serology, Bartonella serology) in culture-negative cases. Histopathology and molecular diagnostics (e.g., 16S rRNA gene PCR/sequencing, Tropheryma whipplei PCR) may be applied to resected valves to aid in diagnosis. Herein, we summarize recent knowledge in this area and propose a microbiologic and pathological algorithm for endocarditis diagnosis. PMID:28659319

Management of recent-onset sustained atrial fibrillation: pharmacologic and nonpharmacologic strategies.

PubMed

Lau, Dennis H; Kalman, Jonathan; Sanders, Prashanthan

2014-09-01

Recent studies have highlighted significant variations in the management of recent-onset sustained atrial fibrillation (AF). We aim to provide a succinct and clear management algorithm for physicians treating patients with recent-onset sustained AF. We performed a comprehensive search of the literature on the management of recent-onset sustained AF with focus on studies reporting cardioversion of AF, antiarrhythmic agents, and anticoagulation. We also reviewed recent practice guidelines on AF management. This review provides a guide on a tailored management approach of patients with recent-onset sustained AF. After initial detailed clinical assessment, optimal rate and rhythm control options can be provided, depending on hemodynamic stability, duration of AF episode, and AF stroke risk. Issues surrounding electrical and pharmacologic cardioversion are discussed in detail. We emphasize the importance of thromboembolic risk assessment and appropriate anticoagulation surrounding the point of cardioversion. Last, we highlighted the need for appropriate specialized follow-up care after acute AF management. Despite the highly heterogeneous clinical presentations, management of recent-onset sustained AF must include stroke risk assessment, appropriate anticoagulation, and follow-up care in all patients beyond optimum rate and rhythm control strategies. Copyright © 2014. Published by Elsevier Inc.

South Carolina Guide for Small Business Management.

ERIC Educational Resources Information Center

Vaughan, Ellen C.; Elliott, Ronald T.

This guide for small business management in South Carolina addresses the three domains of learning: psychomotor, cognitive, and affective. The guide contains suggestions for specific classroom activities for each domain. Each of the 11 units or tasks in the guide contains a competency statement followed by performance objectives, job-relevant…

Market Intelligence Guide

DTIC Science & Technology

2012-01-05

learn about the latest designs , trends in fashion, and scientific breakthroughs in chair ergonomics . Using this tradeshow, the Furnishings Commodity...these tools is essential to designing the optimal contract that reaps the most value from the exchange. Therefore, this market intelligence guide is...portfolio matrix) that are transferrable to the not-for-profit sector are absent. Each of these tools is essential to designing the optimal contract that

Managing Your Money. Leader's Guide [and] Participant's Workbook.

ERIC Educational Resources Information Center

Nieuwenhuis, Ann; Hathaway, Irene

This document contains both a leader's guide and participant's workbook on money management. The leader's and participant's guides contain 10 parts each: (1) danger signs in money management; (2) what's important to you; (3) spending for the future; (4) financial fitness; (5) use credit wisely; (6) decisions, decisions; (7) shopping basics; (8)…

Identifying predictive factors for long-term complications following button battery impactions: A case series and literature review.

PubMed

Eliason, Michael J; Melzer, Jonathan M; Winters, Jessica R; Gallagher, Thomas Q

2016-08-01

To complement a case series review of button battery impactions managed at our single military tertiary care center with a thorough literature review of laboratory research and clinical cases to develop a protocol to optimize patient care. Specifically, to identify predictive factors of long-term complications which can be used by the pediatric otolaryngologist to guide patient management after button battery impactions. A retrospective review of the Department of Defense's electronic medical record systems was conducted to identify patients with button battery ingestions and then characterize their treatment course. A thorough literature review complemented the lessons learned to identify potentially predictive clinical measures for long-term complications. Eight patients were identified as being treated for button battery impaction in the aerodigestive tract with two sustaining long-term complications. The median age of the patients treated was 33 months old and the median estimated time of impaction in the aerodigestive tract prior to removal was 10.5 h. Time of impaction, anatomic direction of the battery's negative pole, and identifying specific battery parameters were identified as factors that may be employed to predict sequelae. Based on case reviews, advancements in battery manufacturing, and laboratory research, there are distinct clinical factors that should be assessed at the time of initial therapy to guide follow-up management to minimize potential catastrophic sequelae of button battery ingestion. Published by Elsevier Ireland Ltd.

Characterization of Aircraft Structural Damage Using Guided Wave Based Finite Element Analysis for In-Flight Structural Health Management

NASA Technical Reports Server (NTRS)

Seshadri, Banavara R.; Krishnamurthy, Thiagarajan; Ross, Richard W.

2016-01-01

The development of multidisciplinary Integrated Vehicle Health Management (IVHM) tools will enable accurate detection, diagnosis and prognosis of damage under normal and adverse conditions during flight. The adverse conditions include loss of control caused by environmental factors, actuator and sensor faults or failures, and structural damage conditions. A major concern is the growth of undetected damage/cracks due to fatigue and low velocity foreign object impact that can reach a critical size during flight, resulting in loss of control of the aircraft. To avoid unstable catastrophic propagation of damage during a flight, load levels must be maintained that are below the load-carrying capacity for damaged aircraft structures. Hence, a capability is needed for accurate real-time predictions of safe load carrying capacity for aircraft structures with complex damage configurations. In the present work, a procedure is developed that uses guided wave responses to interrogate damage. As the guided wave interacts with damage, the signal attenuates in some directions and reflects in others. This results in a difference in signal magnitude as well as phase shifts between signal responses for damaged and undamaged structures. Accurate estimation of damage size and location is made by evaluating the cumulative signal responses at various pre-selected sensor locations using a genetic algorithm (GA) based optimization procedure. The damage size and location is obtained by minimizing the difference between the reference responses and the responses obtained by wave propagation finite element analysis of different representative cracks, geometries and sizes.

Minimally invasive image-guided interventional management of hepatic artery pseudoaneurysms.

PubMed

Vyas, Sameer; Khandelwal, Niranjan; Gupta, Vivek; Kamal Ahuja, Chirag; Kumar, Ajay; Kalra, Naveen; Kang, Mandeep; Prakash, Mahesh

2014-01-01

Hepatic artery pseudoaneurysms (HAPs) are uncommon entities. With the development of interventional techniques, their management has evolved from conventional (surgical) to non-surgical minimally invasive image-guided interventional techniques. Fifteen cases of HAPs who had undergone non-surgical interventional management in our department were reviewed. All patients were comprehensively evaluated for demographic information, morphology of pseudoaneurysm, indication for intervention and means of intervention, approach (endovascular or percutaneous), follow up and complications. Trauma and iatrogenic injury were most common causes of HAPs. Most of the HAPs (9 out of 10 in whom long follow up was available) managed with image-guided interventional techniques had favorable outcome. Minimally invasive image-guided interventional management is the preferred modality for HAPs.

A guide for local agency pavement managers

DOT National Transportation Integrated Search

1994-12-01

The purpose of this guide is to provide Washington's local agencies with a practical document that will assist pavement managers in understanding the pavement management process and the steps necessary to implement their own pavement management syste...

Managing the Office Environment. Instructor's Guide. Student Activity Packet. Office Occupations.

ERIC Educational Resources Information Center

Johnson, Diane E.

This training package, one in a series of instructional modules consisting of an instructor's guide and a student activity packet, deals with managing the office environment. Included in the instructor's guide are general directions for implementing the presentation; a detailed guide for teaching the lesson that includes performance objectives,…

Laboratory cost control and financial management software.

PubMed

Mayer, M

1998-02-09

Economical constraints within the health care system advocate the introduction of tighter control of costs in clinical laboratories. Detailed cost information forms the basis for cost control and financial management. Based on the cost information, proper decisions regarding priorities, procedure choices, personnel policies and investments can be made. This presentation outlines some principles of cost analysis, describes common limitations of cost analysis, and exemplifies use of software to achieve optimized cost control. One commercially available cost analysis software, LabCost, is described in some detail. In addition to provision of cost information, LabCost also serves as a general management tool for resource handling, accounting, inventory management and billing. The application of LabCost in the selection process of a new high throughput analyzer for a large clinical chemistry service is taken as an example for decisions that can be assisted by cost evaluation. It is concluded that laboratory management that wisely utilizes cost analysis to support the decision-making process will undoubtedly have a clear advantage over those laboratories that fail to employ cost considerations to guide their actions.

Diagnosis and management of factor V Leiden.

PubMed

Campello, Elena; Spiezia, Luca; Simioni, Paolo

2016-12-01

The discovery of the factor V Leiden (FVL) missense mutation (Arg506Gln) causing factor V resistance to the anticoagulant action of activated protein C was a landmark that allowed a better understanding of the basis of inherited thrombotic risk. FVL mutation is currently the most common known hereditary defect predisposing to venous thrombosis. Areas covered: Novel data-driven FVL diagnosis and therapeutic approaches in the management of FVL carriers in various clinical settings. Brief conclusions on topics of direct clinical relevance including currently available indications for primary and secondary prophylaxis, the management of female, pediatric carriers and asymptomatic relatives. Latest evidence on the association between FVL and cancer, as well as the possible use of direct oral anticoagulant therapy. Expert commentary: Although FVL diagnosis nowadays is highly accurate, many doubts remain regarding the best management and therapeutic protocols. The main role of clinicians is to tailor therapeutic strategies to carriers and their relatives. High familial penetrance, distinctive aspects of the first thrombotic event (provoked/unprovoked, age, etc.) and laboratory biomarkers can guide the optimal management of secondary antithrombotic prophylaxis, primary prophylaxis in asymptomatic individuals, and whether to screen relatives.

Management Strategies for CLN2 Disease.

PubMed

Williams, Ruth E; Adams, Heather R; Blohm, Martin; Cohen-Pfeffer, Jessica L; de Los Reyes, Emily; Denecke, Jonas; Drago, Kristen; Fairhurst, Charlie; Frazier, Margie; Guelbert, Norberto; Kiss, Szilárd; Kofler, Annamaria; Lawson, John A; Lehwald, Lenora; Leung, Mary-Anne; Mikhaylova, Svetlana; Mink, Jonathan W; Nickel, Miriam; Shediac, Renée; Sims, Katherine; Specchio, Nicola; Topcu, Meral; von Löbbecke, Ina; West, Andrea; Zernikow, Boris; Schulz, Angela

2017-04-01

CLN2 disease (neuronal ceroid lipofuscinosis type 2) is a rare, autosomal recessive, pediatric-onset, rapidly progressive neurodegenerative lysosomal storage disorder caused by tripeptidyl peptidase 1 (TPP1) enzyme deficiency, and is characterized by language delay, seizures, rapid cognitive and motor decline, blindness, and early death. No management guidelines exist and there is a paucity of published disease-specific evidence to inform clinical practice, which currently draws upon experience from the field of childhood neurodisability. Twenty-four disease experts were surveyed on CLN2 disease management and a subset met to discuss current practice. Management goals and strategies are consistent among experts globally and are guided by the principles of pediatric palliative care. Goals and interventions evolve as the disease progresses, with a shift in focus from maintenance of function early in the disease to maintenance of quality of life. A multidisciplinary approach is critical for optimal patient care. This work represents an initial step toward the development of consensus-based management guidelines for CLN2 disease. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Summer-Jobs-for-Youth Program Guide. How to Develop and Manage a Summer Youth Jobs Program. A Technical Assistance Guide.

ERIC Educational Resources Information Center

National Alliance of Business, Inc., Washington, DC.

This guide offers a practical approach for operating summer youth employment programs that involves cooperation among private businesses and local organizations. A timetable provides a month-by-month schedule. Seven sections discuss management responsibilities. Program Planning covers scope, goals, and coordination. Program Management addresses…

Visualising Pareto-optimal trade-offs helps move beyond monetary-only criteria for water management decisions

NASA Astrophysics Data System (ADS)

Hurford, Anthony; Harou, Julien

2014-05-01

Water related eco-system services are important to the livelihoods of the poorest sectors of society in developing countries. Degradation or loss of these services can increase the vulnerability of people decreasing their capacity to support themselves. New approaches to help guide water resources management decisions are needed which account for the non-market value of ecosystem goods and services. In case studies from Brazil and Kenya we demonstrate the capability of many objective Pareto-optimal trade-off analysis to help decision makers balance economic and non-market benefits from the management of existing multi-reservoir systems. A multi-criteria search algorithm is coupled to a water resources management simulator of each basin to generate a set of Pareto-approximate trade-offs representing the best case management decisions. In both cases, volume dependent reservoir release rules are the management decisions being optimised. In the Kenyan case we further assess the impacts of proposed irrigation investments, and how the possibility of new investments impacts the system's trade-offs. During the multi-criteria search (optimisation), performance of different sets of management decisions (policies) is assessed against case-specific objective functions representing provision of water supply and irrigation, hydropower generation and maintenance of ecosystem services. Results are visualised as trade-off surfaces to help decision makers understand the impacts of different policies on a broad range of stakeholders and to assist in decision-making. These case studies show how the approach can reveal unexpected opportunities for win-win solutions, and quantify the trade-offs between investing to increase agricultural revenue and negative impacts on protected ecosystems which support rural livelihoods.

Optical Quality, Threshold Target Identification, and Military Target Task Performance After Advanced Keratorefractive Surgery

DTIC Science & Technology

2012-05-01

undergo wavefront-guided (WFG) photorefractive keratectomy ( PRK ), WFG laser in situ keratomileusis ( LASIK ), wavefront optimized (WFO) PRK or WFO...Military, Refractive Surgery, PRK , LASIK , Night Vision, Wavefront Optimized, Wavefront Guided, Visual Performance, Quality of Vision, Outcomes...military. In a prospective, randomized treatment trial we will enroll 224 nearsighted soldiers to WFG photorefractive keratectomy ( PRK ), WFG LASIK , WFO PRK

Optical Quality and Threshold Target Identification and Military Target Task Performance after Advanced Keratorefractive Surgery

DTIC Science & Technology

2013-05-01

and Sensors Directorate. • Study participants and physicians select treatment: PRK or LASIK . WFG vs . WFO treatment modality is randomized. The...to undergo wavefront-guided (WFG) photorefractive keratectomy ( PRK ), WFG laser in situ keratomileusis ( LASIK ), wavefront optimized (WFO) PRK or WFO...TERMS Military, Refractive Surgery, PRK , LASIK , Night Vision, Wavefront Optimized, Wavefront Guided, Visual Performance, Quality of Vision, Outcomes

Early prediction of oral calcium and vitamin D requirements in post-thyroidectomy hypocalcaemia.

PubMed

Al-Dhahri, Saleh F; Mubasher, Mohamed; Al-Muhawas, Fida; Alessa, Mohammed; Terkawi, Rayan S; Terkawi, Abdullah S

2014-09-01

To optimize and individualize post-thyroidectomy hypocalcemia management. A multicenter prospective cohort study. Two tertiary care hospitals. parathyroid hormone (PTH) was measured preoperatively, then at 1 and 6 hours after surgery. The required doses of calcium and vitamin D were defined as those maintaining the patients asymptomatic and their cCa ≥ 2 mmol/L. They were used as an endpoint in a generalized linear mixed effect model (GLIMMEX) aiming to identify the best predictors of these optimal required doses. Models were evaluated by goodness of fit and Receiver Operating Characteristic (ROC) curves. One hundred and sixty-eight patients were analyzed; 85.1% were female, 49.3% had BMI > 30, and 64% had vitamin D deficiency. Post-thyroidectomy hypocalcemia was found in 25.6%, of whom 18 (41.9%) were symptomatic and received intravenous calcium. First hour percentage of drop in PTH correlated positively with the severity of hypocalcemia (P < .0001). The GLIMMIX prediction model for oral calcium requirement was based on first-hour percentage change from preoperative PTH level, preoperative actual PTH, BMI, and thyroid function. The same predictors were identified for vitamin D, except that thyroid function was replaced with vitamin D status. These factors were used to build predictive equations for calcium and vitamin D doses. Our findings help to optimize management of post-thyroidectomy hypocalcemia by assisting in the early identification of those who are not at risk of hypocalcaemia and by guiding early effective management of those at risk. This may reduce complications and medical cost. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

Pharmacological management of anticholinergic delirium - theory, evidence and practice.

PubMed

Dawson, Andrew H; Buckley, Nicholas A

2016-03-01

The spectrum of anticholinergic delirium is a common complication following drug overdose. Patients with severe toxicity can have significant distress and behavioural problems that often require pharmacological management. Cholinesterase inhibitors, such as physostigmine, are effective but widespread use has been limited by concerns about safety, optimal dosing and variable supply. Case series support efficacy in reversal of anticholinergic delirium. However doses vary widely and higher doses commonly lead to cholinergic toxicity. Seizures are reported in up to 2.5% of patients and occasional cardiotoxic effects are also recorded. This article reviews the serendipitous path whereby physostigmine evolved into the preferred anticholinesterase antidote largely without any research to indicate the optimal dosing strategy. Adverse events observed in case series should be considered in the context of pharmacokinetic/pharmacodynamic studies of physostigmine which suggest a much longer latency before the maximal increase in brain acetylcholine than had been previously assumed. This would favour protocols that use lower doses and longer re-dosing intervals. We propose based on the evidence reviewed that the use of cholinesterase inhibitors should be considered in anticholinergic delirium that has not responded to non-pharmacological delirium management. The optimal risk/benefit would be with a titrated dose of 0.5 to 1 mg physostigmine (0.01-0.02 mg kg(-1) in children) with a minimum delay of 10-15 min before re-dosing. Slower onset and longer acting agents such as rivastigmine would also be logical but more research is needed to guide the appropriate dose in this setting. © 2015 The British Pharmacological Society.

Agile, a guiding principle for health care improvement?

PubMed

Tolf, Sara; Nyström, Monica E; Tishelman, Carol; Brommels, Mats; Hansson, Johan

2015-01-01

The purpose of this paper is to contribute to increased understanding of the concept agile and its potential for hospital managers to optimize design of organizational structures and processes to combine internal efficiency and external effectiveness. An integrative review was conducted using the reSEARCH database. Articles met the following criteria: first, a definition of agility; second, descriptions of enablers of becoming an agile organization; and finally, discussions of agile on multiple organizational levels. In total, 60 articles qualified for the final analysis. Organizational agility rests on the assumption that the environment is uncertain, ranging from frequently changing to highly unpredictable. Proactive, reactive or embracive coping strategies were described as possible ways to handle such uncertain environments. Five organizational capacities were derived as necessary for hospitals to use the strategies optimally: transparent and transient inter-organizational links; market sensitivity and customer focus; management by support for self-organizing employees; organic structures that are elastic and responsive; flexible human and resource capacity for timely delivery. Agile is portrayed as either the "new paradigm" following lean, the needed development on top of a lean base, or as complementary to lean in distinct hybrid strategies. Environmental uncertainty needs to be matched with coping strategies and organizational capacities to design processes responsive to real needs of health care. This implies that lean and agile can be combined to optimize the design of hospitals, to meet different variations in demand and create good patient management. While considerable value has been paid to strategies to improve the internal efficiency within hospitals, this review raise the attention to the value of strategies of external effectiveness.

75 FR 68811 - Recovery Publication, P-395, Fire Management Assistance Grant Program (FMAGP) Guide

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-09

... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA-2010-0066] Recovery Publication, P-395, Fire Management Assistance Grant Program (FMAGP) Guide AGENCY: Federal... Emergency Management Agency (FEMA) is accepting comments on the Fire Management Assistance Grant Program...

Free web-based modelling platform for managed aquifer recharge (MAR) applications

NASA Astrophysics Data System (ADS)

Stefan, Catalin; Junghanns, Ralf; Glaß, Jana; Sallwey, Jana; Fatkhutdinov, Aybulat; Fichtner, Thomas; Barquero, Felix; Moreno, Miguel; Bonilla, José; Kwoyiga, Lydia

2017-04-01

Managed aquifer recharge represents a valuable instrument for sustainable water resources management. The concept implies purposeful infiltration of surface water into underground for later recovery or environmental benefits. Over decades, MAR schemes were successfully installed worldwide for a variety of reasons: to maximize the natural storage capacity of aquifers, physical aquifer management, water quality management, and ecological benefits. The INOWAS-DSS platform provides a collection of free web-based tools for planning, management and optimization of main components of MAR schemes. The tools are grouped into 13 specific applications that cover most relevant challenges encountered at MAR sites, both from quantitative and qualitative perspectives. The applications include among others the optimization of MAR site location, the assessment of saltwater intrusion, the restoration of groundwater levels in overexploited aquifers, the maximization of natural storage capacity of aquifers, the improvement of water quality, the design and operational optimization of MAR schemes, clogging development and risk assessment. The platform contains a collection of about 35 web-based tools of various degrees of complexity, which are either included in application specific workflows or used as standalone modelling instruments. Among them are simple tools derived from data mining and empirical equations, analytical groundwater related equations, as well as complex numerical flow and transport models (MODFLOW, MT3DMS and SEAWAT). Up to now, the simulation core of the INOWAS-DSS, which is based on the finite differences groundwater flow model MODFLOW, is implemented and runs on the web. A scenario analyser helps to easily set up and evaluate new management options as well as future development such as land use and climate change and compare them to previous scenarios. Additionally simple tools such as analytical equations to assess saltwater intrusion are already running online. Besides the simulation tools, a web-based data base is under development where geospatial and time series data can be stored, managed, and processed. Furthermore, a web-based information system containing user guides for the various developed tools and applications as well as basic information on MAR and related topics is published and will be regularly expanded as new tools are getting implemented. The INOWAS-DSS including its simulation tools, data base and information system provides an extensive framework to manage, plan and optimize MAR facilities. As the INOWAS-DSS is an open-source software accessible via the internet using standard web browsers, it offers new ways for data sharing and collaboration among various partners and decision makers.

Update to a guide to standardized highway lighting pole hardware.

DOT National Transportation Integrated Search

2013-03-01

This report describes the development of an updated Online Guide to Luminaire Supports. The Guide is a web-based content : management system for luminaire support systems that allows full viewing, submission, management, and reporting services : to i...

GUIDE TO SEPTAGE TREATMENT AND DISPOSAL

EPA Science Inventory

This guide presents information on the handling, treatment, and disposal of septage in a format easily used by administrators of waste management programs, septage haulers, and managers or operators of septage handling facilities. The guide does not provide detailed engineering d...

Ecological Modeling Guide for Ecosystem Restoration and Management

DTIC Science & Technology

2012-08-01

may result from proposed restoration and management actions. This report provides information to guide environmental planers in selection, development...actions. This report provides information to guide environmental planers in selection, development, evaluation and documentation of ecological models. A

23 CFR 973.208 - Indian lands pavement management system (PMS).

Code of Federal Regulations, 2013 CFR

2013-04-01

... 23 Highways 1 2013-04-01 2013-04-01 false Indian lands pavement management system (PMS). 973.208... PROGRAM Bureau of Indian Affairs Management Systems § 973.208 Indian lands pavement management system (PMS... concepts described in the AASHTO's “Pavement Management Guide.” 1 1 “Pavement Management Guide,” AASHTO...

23 CFR 973.208 - Indian lands pavement management system (PMS).

Code of Federal Regulations, 2010 CFR

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false Indian lands pavement management system (PMS). 973.208... PROGRAM Bureau of Indian Affairs Management Systems § 973.208 Indian lands pavement management system (PMS... concepts described in the AASHTO's “Pavement Management Guide.” 1 1 “Pavement Management Guide,” AASHTO...

23 CFR 973.208 - Indian lands pavement management system (PMS).

Code of Federal Regulations, 2012 CFR

2012-04-01

... 23 Highways 1 2012-04-01 2012-04-01 false Indian lands pavement management system (PMS). 973.208... PROGRAM Bureau of Indian Affairs Management Systems § 973.208 Indian lands pavement management system (PMS... concepts described in the AASHTO's “Pavement Management Guide.” 1 1 “Pavement Management Guide,” AASHTO...

23 CFR 973.208 - Indian lands pavement management system (PMS).

Code of Federal Regulations, 2014 CFR

2014-04-01

... 23 Highways 1 2014-04-01 2014-04-01 false Indian lands pavement management system (PMS). 973.208... PROGRAM Bureau of Indian Affairs Management Systems § 973.208 Indian lands pavement management system (PMS... concepts described in the AASHTO's “Pavement Management Guide.” 1 1 “Pavement Management Guide,” AASHTO...

23 CFR 973.208 - Indian lands pavement management system (PMS).

Code of Federal Regulations, 2011 CFR

2011-04-01

... 23 Highways 1 2011-04-01 2011-04-01 false Indian lands pavement management system (PMS). 973.208... PROGRAM Bureau of Indian Affairs Management Systems § 973.208 Indian lands pavement management system (PMS... concepts described in the AASHTO's “Pavement Management Guide.” 1 1 “Pavement Management Guide,” AASHTO...

Guide for Industrial Waste Management

EPA Pesticide Factsheets

The purpose of the Guide is to provide facility managers, state and tribal regulators, and the interested public with recommendations and tools to better address the management of land-disposed, non-hazardousindustrial wastes.

Managing Home and Work Responsibilities. Secondary Learning Guide 9. Project Connect. Linking Self-Family-Work.

ERIC Educational Resources Information Center

Emily Hall Tremaine Foundation, Inc., Hartford, CT.

This competency-based secondary learning guide on managing home and work responsibilities is part of a series that are adaptations of guides developed for adult consumer and homemaking education programs. The guides provide students with experiences that help them learn to do the following: make decisions; use creative approaches to solve…

Preventing & Managing Communicable Diseases. Training Guides for the Head Start Learning Community.

ERIC Educational Resources Information Center

Bowman (James) Associates, San Francisco, CA.

This training guide is intended to improve the skills of Head Start staff and families in dealing with communicable diseases. The guide addresses attitudes toward communicable diseases, how to reduce the spread of disease, and how to recognize and manage illnesses more effectively. The guide consists of six working sections. The first three are…

Gravel roads management : volume 2, gravel roads management : implementation guide.

DOT National Transportation Integrated Search

2011-10-01

This report establishes procedures for managing dirt and gravel roads, with a primary focus on smaller agencies, such as Wyoming counties, that must manage their roads with very limited resources. The report strives, first, to guide and assist smalle...

Gravel roads management : volume 3, gravel roads management : programming guide.

DOT National Transportation Integrated Search

2010-10-01

This report establishes procedures for managing dirt and gravel roads, with a primary focus on smaller agencies, such as Wyoming counties, that must manage their roads with very limited resources. The report strives, first, to guide and assist smalle...

Fire managers field guide: hazardous fuels management in subtropical pine flatwoods and tropical pine rocklands

Treesearch

Joseph J. O’Brien; Kathryn A. Mordecai; Leslie Wolcott

2010-01-01

This publication is a field guide to tactics and techniques for dealing with hazardous fuels in subtropical pine flatwoods and tropical pine rocklands. The guide covers prescribed fire, mechanical, chemical, and other means for reducing and managing wildland fuels in these systems. Also, a list of exotic plants that contribute to hazardous fuel problems is included...

Optimal control of population recovery--the role of economic restoration threshold.

PubMed

Lampert, Adam; Hastings, Alan

2014-01-01

A variety of ecological systems around the world have been damaged in recent years, either by natural factors such as invasive species, storms and global change or by direct human activities such as overfishing and water pollution. Restoration of these systems to provide ecosystem services entails significant economic benefits. Thus, choosing how and when to restore in an optimal fashion is important, but has not been well studied. Here we examine a general model where population growth can be induced or accelerated by investing in active restoration. We show that the most cost-effective method to restore an ecosystem dictates investment until the population approaches an 'economic restoration threshold', a density above which the ecosystem should be left to recover naturally. Therefore, determining this threshold is a key general approach for guiding efficient restoration management, and we demonstrate how to calculate this threshold for both deterministic and stochastic ecosystems. © 2013 John Wiley & Sons Ltd/CNRS.

History matching through dynamic decision-making

PubMed Central

Maschio, Célio; Santos, Antonio Alberto; Schiozer, Denis; Rocha, Anderson

2017-01-01

History matching is the process of modifying the uncertain attributes of a reservoir model to reproduce the real reservoir performance. It is a classical reservoir engineering problem and plays an important role in reservoir management since the resulting models are used to support decisions in other tasks such as economic analysis and production strategy. This work introduces a dynamic decision-making optimization framework for history matching problems in which new models are generated based on, and guided by, the dynamic analysis of the data of available solutions. The optimization framework follows a ‘learning-from-data’ approach, and includes two optimizer components that use machine learning techniques, such as unsupervised learning and statistical analysis, to uncover patterns of input attributes that lead to good output responses. These patterns are used to support the decision-making process while generating new, and better, history matched solutions. The proposed framework is applied to a benchmark model (UNISIM-I-H) based on the Namorado field in Brazil. Results show the potential the dynamic decision-making optimization framework has for improving the quality of history matching solutions using a substantial smaller number of simulations when compared with a previous work on the same benchmark. PMID:28582413

Weather integration in TMC operations : a self-evaluation and planning guide.

DOT National Transportation Integrated Search

2009-04-01

This flyer describes how Traffic Management Centers (TMC) can integrate weather information into their daily operations, and is based on the Road Weather Management Program publication, Self-Evaluation and Planning Guide (FHWA-JPO-08-057). The Guide ...

Routine road maintenance water quality and habitat guide : best management practices

DOT National Transportation Integrated Search

2009-01-01

Since June 9, 1999 the Oregon Department of Transportation (ODOT) has implemented the Routine Road Maintenance: Water Quality and Habitat Guide Best Management Practices (the Guide), and is considered the cornerstone of the ODOT'd Office of Maintenan...

Children's, parents' and health professionals' views on the management of childhood asthma: a qualitative study.

PubMed

Searle, Aidan; Jago, Russell; Henderson, John; Turner, Katrina M

2017-09-11

The management of childhood asthma is often sub-optimal. Parents and other caregivers are primarily responsible for disease management and this responsibility includes communication with health professionals. The aim of this multi-perspective qualitative study was to explore the views of children, parents and health professionals to gain insight into the approach to clinical care in the management of childhood asthma. Interviews were held with nine parent-child (6-8 years) dyads, and 13 health professionals working in primary and secondary care. Interviews were transcribed verbatim and analysed thematically. Three key themes emerged that were common to all data sets; (1) Child and parent awareness of symptoms; (2) Management and child wellbeing; and (3) Professional communication education and consultation with families. Although some children demonstrate good awareness of symptoms and appropriate use of medication, some parents expressed difficulty in identifying triggers and symptoms of asthma. Furthermore, parents lacked awareness regarding appropriate use of medication for preventing and managing symptoms of asthma. Health professionals believed that communication and education was lacking. Data from all participants suggested that consultations could be enhanced with greater emphasis on children's and parents' perceptions of asthma in the development of asthma management plans. GUIDING FAMILIES THROUGH DISEASE MANAGEMENT: Both parents' and children's perceptions and understanding of childhood asthma should be considered when developing asthma management plans. The management of asthma is challenging and can result in poor disease outcomes if care is not taken. An individual's perception of their (or their child's) asthma can also affect the efficacy of treatment. Aidan Searle at the Bristol Biomedical Research Centre, UK, and co-workers, interviewed nine parent-child groups and thirteen health professionals to determine their perceptions of childhood asthma management in primary care. While some children had a strong awareness of symptoms and appropriate medication use, some parents found it difficult to identify asthma triggers and symptoms. Parents also displayed a lack of understanding of management through medication. Health professionals focused on the need for clearer information for families when guiding management of childhood asthma.

Title IV Cash Management Life Cycle Training. Participant's Guide.

ERIC Educational Resources Information Center

Department of Education, Washington, DC.

This participant's guide includes: "Introduction: Welcome to Cash Management Life Cycle Training"; "Module 1: Review of Cash Management Principles" (cash management overview and activity); "Module 2: Common Origination and Disbursement (COD) System Overview" (e.g., full participants and phase-in participants, COD…

Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions: Endorsed by the Chinese Society of Cardiology.

PubMed

Räber, Lorenz; Mintz, Gary S; Koskinas, Konstantinos C; Johnson, Thomas W; Holm, Niels R; Onuma, Yoshinubo; Radu, Maria D; Joner, Michael; Yu, Bo; Jia, Haibo; Menevau, Nicolas; de la Torre Hernandez, Jose M; Escaned, Javier; Hill, Jonathan; Prati, Francesco; Colombo, Antonio; di Mario, Carlo; Regar, Evelyn; Capodanno, Davide; Wijns, William; Byrne, Robert A; Guagliumi, Giulio

2018-05-22

This Consensus Document is the first of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The first document appraises the role of intracoronary imaging to guide percutaneous coronary interventions (PCIs) in clinical practice. Current evidence regarding the impact of intracoronary imaging guidance on cardiovascular outcomes is summarized, and patients or lesions most likely to derive clinical benefit from an imaging-guided intervention are identified. The relevance of the use of IVUS or OCT prior to PCI for optimizing stent sizing (stent length and diameter) and planning the procedural strategy is discussed. Regarding post-implantation imaging, the consensus group recommends key parameters that characterize an optimal PCI result and provides cut-offs to guide corrective measures and optimize the stenting result. Moreover, routine performance of intracoronary imaging in patients with stent failure (restenosis or stent thrombosis) is recommended. Finally, strengths and limitations of IVUS and OCT for guiding PCI and assessing stent failures and areas that warrant further research are critically discussed.

A comprehensive picture of palliative care at home from the people involved.

PubMed

Appelin, Gunilla; Brobäck, Gunilla; Berterö, Carina

2005-12-01

The purpose of this study was to identify the comprehensive picture of palliative care in the home, as experienced by the people involved. The study is a secondary analysis of three phenomenological studies including six cancer patients, six next of kin and six district nurses. Data were collected in qualitative interviews using an interview guide. The interviews were tape-recorded and transcribed verbatim. In this secondary analysis, data were analysed by hermeneutic analysis guided by Gadamer. The guiding questions during the reading were: Is there an advantage receiving palliative care at home? Is there a disadvantage receiving palliative care at home? The findings indicate that the advantages of palliative care at home is; striving for normal life, including the care in the home composed of physical care and emotional/mental care. Striving for normal life also includes emotional feelings, safety and resources and policies which regulates this activity. Disadvantages of palliative care at home are commitment, composed of adaptation and extra work, and demands, composed of frustration and uncertainty. If the people involved are to be able to manage the situation and optimize living while dying, there must be support and resources facilitating the situation.

Challenges of Fracture Management for Adults With Osteogenesis Imperfecta.

PubMed

Gil, Joseph A; DeFroda, Steven F; Sindhu, Kunal; Cruz, Aristides I; Daniels, Alan H

2017-01-01

Osteogenesis imperfecta is caused by qualitative or quantitative defects in type I collagen. Although often considered a disease with primarily pediatric manifestations, more than 25% of lifetime fractures are reported to occur in adulthood. General care of adults with osteogenesis imperfecta involves measures to preserve bone density, regular monitoring of hearing and dentition, and maintenance of muscle strength through physical therapy. Surgical stabilization of fractures in these patients can be challenging because of low bone mineral density, preexisting skeletal deformities, or obstruction by instrumentation from previous surgeries. Additionally, unique perioperative considerations exist when operatively managing fractures in patients with osteogenesis imperfecta. To date, there is little high-quality literature to help guide the optimal treatment of fractures in adult patients with osteogenesis imperfecta. [Orthopedics. 2017; 40(1):e17-e22.]. Copyright 2016, SLACK Incorporated.

Legacy Phosphorus Effect and Need to Re-calibrate Soil Test P Methods for Organic Crop Production.

NASA Astrophysics Data System (ADS)

Dao, Thanh H.; Schomberg, Harry H.; Cavigelli, Michel A.

2015-04-01

Phosphorus (P) is a required nutrient for the normal development and growth of plants and supplemental P is needed in most cultivated soils. Large inputs of cover crop residues and nutrient-rich animal manure are added to supply needed nutrients to promote the optimal production of organic grain crops and forages. The effects of crop rotations and tillage management of the near-surface zone on labile phosphorus (P) forms were studied in soil under conventional and organic crop management systems in the mid-Atlantic region of the U.S. after 18 years due to the increased interest in these alternative systems. Soil nutrient surpluses likely caused by low grain yields resulted in large pools of exchangeable phosphate-P and equally large pools of enzyme-labile organic P (Po) in soils under organic management. In addition, the difference in the P loading rates between the conventional and organic treatments as guided by routine soil test recommendations suggested that overestimating plant P requirements contributed to soil P surpluses because routine soil testing procedures did not account for the presence and size of the soil enzyme-labile Po pool. The effect of large P additions is long-lasting as they continued to contribute to elevated soil total bioactive P concentrations 12 or more years later. Consequently, accurate estimates of crop P requirements, P turnover in soil, and real-time plant and soil sensing systems are critical considerations to optimally manage manure-derived nutrients in organic crop production.

Fractures in sport: Optimising their management and outcome

PubMed Central

Robertson, Greg AJ; Wood, Alexander M

2015-01-01

Fractures in sport are a specialised cohort of fracture injuries, occurring in a high functioning population, in which the goals are rapid restoration of function and return to play with the minimal symptom profile possible. While the general principles of fracture management, namely accurate fracture reduction, appropriate immobilisation and timely rehabilitation, guide the treatment of these injuries, management of fractures in athletic populations can differ significantly from those in the general population, due to the need to facilitate a rapid return to high demand activities. However, despite fractures comprising up to 10% of all of sporting injuries, dedicated research into the management and outcome of sport-related fractures is limited. In order to assess the optimal methods of treating such injuries, and so allow optimisation of their outcome, the evidence for the management of each specific sport-related fracture type requires assessment and analysis. We present and review the current evidence directing management of fractures in athletes with an aim to promote valid innovative methods and optimise the outcome of such injuries. From this, key recommendations are provided for the management of the common fracture types seen in the athlete. Six case reports are also presented to illustrate the management planning and application of sport-focussed fracture management in the clinical setting. PMID:26716081

Management of Retained Intervention Guide-wire: A Literature Review

PubMed Central

Al-Moghairi, Abdulrahman M; Al-Amri, Hussein S

2013-01-01

Percutaneous coronary angioplasty is increasingly employed in the treatment of patients with complex coronary artery disease. Different steerable guide wires used to open occluded vessel and facilitate balloon and stent deployment. However, the guide-wire itself is not without hazard: it may perforate or dissect the vessel, but fracture or entrapment is uncommon. Its management depends on the clinical situation of the patient, as well as the position and length of the remnant. In this review we discuss the angioplasty guide-wire fracture and entrapment risk factors, potential risks and management. PMID:23116055

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

NASA Astrophysics Data System (ADS)

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

2013-02-01

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

Kentucky Consumer & Homemaking Education. Management-Consumer Education. Curriculum Guide, Semester Course.

ERIC Educational Resources Information Center

Waldrop, Suzanne H.

Intended for use by teachers at the high school level, this curriculum guide, which is one in a series of guides for consumer and homemaking education in Kentucky, outlines a semester special interest course in home management. The two units, comprehensive I and II, which are prerequisites for this course are found in a separate guide (CE 017…

A silvicultural guide for northern hardwoods in the northeast

Treesearch

William B. Leak; Dale S. Solomon; Stanley M. Filip; Stanley M. Filip

1969-01-01

The purpose of this paper is to provide a practical guide to the management of northern hardwoods - principally beech, birch, and maple-in the Northeast. The guide was designed to provide the kind of information that is needed not only for long-term management planning, but also for short-term silvicultural prescriptions for specific timber stand conditions. The guide...

Drafting Lab Management Guide.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Instructional Materials Lab.

This manual was developed to guide drafting instructors and vocational supervisors in sequencing laboratory instruction and controlling the flow of work for a 2-year machine trades training program. The first part of the guide provides information on program management (program description, safety concerns, academic issues, implementation…

Setting the Course for Clean Water: A Citizen's Guide to the Section 208 Water Quality Management Program.

ERIC Educational Resources Information Center

Donley, Diane L.; Albright, Catherine

This is a citizen's guide to the section 208 water quality management program. Section 208 refers to that section of the Federal Water Pollution Control Act of 1972 (the Clean Water Act) which calls for public participation in water quality management planning. Included in this guide are chapters on controlling pollution through the Clean Water…

Optimal flow for brown trout: Habitat - prey optimization.

PubMed

Fornaroli, Riccardo; Cabrini, Riccardo; Sartori, Laura; Marazzi, Francesca; Canobbio, Sergio; Mezzanotte, Valeria

2016-10-01

The correct definition of ecosystem needs is essential in order to guide policy and management strategies to optimize the increasing use of freshwater by human activities. Commonly, the assessment of the optimal or minimum flow rates needed to preserve ecosystem functionality has been done by habitat-based models that define a relationship between in-stream flow and habitat availability for various species of fish. We propose a new approach for the identification of optimal flows using the limiting factor approach and the evaluation of basic ecological relationships, considering the appropriate spatial scale for different organisms. We developed density-environment relationships for three different life stages of brown trout that show the limiting effects of hydromorphological variables at habitat scale. In our analyses, we found that the factors limiting the densities of trout were water velocity, substrate characteristics and refugia availability. For all the life stages, the selected models considered simultaneously two variables and implied that higher velocities provided a less suitable habitat, regardless of other physical characteristics and with different patterns. We used these relationships within habitat based models in order to select a range of flows that preserve most of the physical habitat for all the life stages. We also estimated the effect of varying discharge flows on macroinvertebrate biomass and used the obtained results to identify an optimal flow maximizing habitat and prey availability. Copyright © 2016 Elsevier B.V. All rights reserved.

Visitor Access and Transportation Guide.

DOT National Transportation Integrated Search

2011-09-30

This visitor access and transportation guide presents opportunities to manage or improve circulation and travel patterns in areas managed by Federal Land Management Agencies (FLMAs), such as the National Park Service (NPS), U.S. Forest Service (USFS)...

23 CFR 971.208 - Federal lands pavement management system (PMS).

Code of Federal Regulations, 2012 CFR

2012-04-01

... 23 Highways 1 2012-04-01 2012-04-01 false Federal lands pavement management system (PMS). 971.208... lands pavement management system (PMS). In addition to the requirements provided in § 971.204, the PMS... the concepts described in the AASHTO's “Pavement Management Guide.” 1 1 “Pavement Management Guide...

23 CFR 971.208 - Federal lands pavement management system (PMS).

Code of Federal Regulations, 2010 CFR

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false Federal lands pavement management system (PMS). 971.208... lands pavement management system (PMS). In addition to the requirements provided in § 971.204, the PMS... the concepts described in the AASHTO's “Pavement Management Guide.” 1 1 “Pavement Management Guide...

23 CFR 971.208 - Federal lands pavement management system (PMS).

Code of Federal Regulations, 2011 CFR

2011-04-01

... 23 Highways 1 2011-04-01 2011-04-01 false Federal lands pavement management system (PMS). 971.208... lands pavement management system (PMS). In addition to the requirements provided in § 971.204, the PMS... the concepts described in the AASHTO's “Pavement Management Guide.” 1 1 “Pavement Management Guide...

23 CFR 971.208 - Federal lands pavement management system (PMS).

Code of Federal Regulations, 2014 CFR

2014-04-01

... 23 Highways 1 2014-04-01 2014-04-01 false Federal lands pavement management system (PMS). 971.208... lands pavement management system (PMS). In addition to the requirements provided in § 971.204, the PMS... the concepts described in the AASHTO's “Pavement Management Guide.” 1 1 “Pavement Management Guide...

23 CFR 971.208 - Federal lands pavement management system (PMS).

Code of Federal Regulations, 2013 CFR

2013-04-01

... 23 Highways 1 2013-04-01 2013-04-01 false Federal lands pavement management system (PMS). 971.208... lands pavement management system (PMS). In addition to the requirements provided in § 971.204, the PMS... the concepts described in the AASHTO's “Pavement Management Guide.” 1 1 “Pavement Management Guide...

General Mission Analysis Tool (GMAT) User's Guide (Draft)

NASA Technical Reports Server (NTRS)

Hughes, Steven P.

2007-01-01

4The General Mission Analysis Tool (GMAT) is a space trajectory optimization and mission analysis system. This document is a draft of the users guide for the tool. Included in the guide is information about Configuring Objects/Resources, Object Fields: Quick Look-up Tables, and Commands and Events.

Telecourse Study Guide to "Here's to Your Health."

ERIC Educational Resources Information Center

Richards, Donna

This study guide was prepared to accompany "Here's to Your Health," a telecourse focusing on lifestyle factors influencing health, which was designed to provide the tools necessary for achieving and maintaining an optimal, healthy lifestyle. For each of 27 lessons, the study guide presents learning objectives, an overview of content, study…

Hospitality Management. Florida Vocational Program Guide.

ERIC Educational Resources Information Center

Florida State Univ., Tallahassee. Center for Instructional Development and Services.

This program guide is intended for the implementation of a hospitality management program in Florida secondary and postsecondary schools. The program guide describes the program content and structure, provides a program description, describes jobs under the program, and includes a curriculum framework and student performance standards for…

Machine Trades Lab Management Guide.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Instructional Materials Lab.

This manual was developed to guide machine trades instructors and vocational supervisors in sequencing laboratory instruction and controlling the flow of work for a 2-year machine trades training program. The first part of the guide provides information on program management (program description, safety concerns, academic issues, implementation…

The art of appropriate evaluation : a guide for highway safety program managers

DOT National Transportation Integrated Search

2008-08-01

The guide, updated from its original release in 1999, is intended for project managers who will oversee the evaluation of traffic safety programs. It describes the benefits of evaluation and provides an overview of the steps involved. The guide inclu...

The art of appropriate evaluation : a guide for highway safety program managers

DOT National Transportation Integrated Search

2008-12-01

The guide, updated from its original release in 1999, is intended for project managers who will oversee the evaluation of traffic safety programs. It describes the benefits of evaluation and provides an overview of the steps involved. The guide inclu...

Lower limb stress fractures in sport: Optimising their management and outcome

PubMed Central

Robertson, Greg A J; Wood, Alexander M

2017-01-01

Stress fractures in sport are becoming increasing more common, comprising up to 10% of all of sporting injuries. Around 90% of such injuries are located in the lower limb. This articles aims to define the optimal management of lower limb stress fractures in the athlete, with a view to maximise return rates and minimise return times to sport. Treatment planning of this condition is specific to the location of the injury. However, there remains a clear division of stress fractures by “high” and “low” risk. “Low risk” stress fractures are those with a low probability of fracture propagation, delayed union, or non-union, and so can be managed reliably with rest and exercise limitation. These include stress fractures of the Postero-Medial Tibial Diaphysis, Metatarsal Shafts, Distal Fibula, Medial Femoral Neck, Femoral Shaft and Calcaneus. “High risk” stress fractures, in contrast, have increased rates of fracture propagation, displacement, delayed and non-union, and so require immediate cessation of activity, with orthopaedic referral, to assess the need for surgical intervention. These include stress fractures of the Anterior Tibial Diaphysis, Fifth Metatarsal Base, Medial Malleolus, Lateral Femoral Neck, Tarsal Navicular and Great Toe Sesamoids. In order to establish the optimal methods for managing these injuries, we present and review the current evidence which guides the treatment of stress fractures in athletes. From this, we note an increased role for surgical management of certain high risk stress fractures to improve return times and rates to sport. Following this, key recommendations are provided for the management of the common stress fracture types seen in the athlete. Five case reports are also presented to illustrate the application of sport-focussed lower limb stress fracture treatment in the clinical setting. PMID:28361017

Robust plan optimization for electromagnetic transponder guided hypo-fractionated prostate treatment using volumetric modulated arc therapy

NASA Astrophysics Data System (ADS)

Zhang, Pengpeng; Hunt, Margie; Happersett, Laura; Yang, Jie; Zelefsky, Michael; Mageras, Gig

2013-11-01

To develop an optimization algorithm for volumetric modulated arc therapy which incorporates an electromagnetic tracking (EMT) guided gating strategy and is robust to residual intra-fractional motion uncertainties. In a computer simulation, intra-fractional motion traces from prior treatments with EMT were converted to a probability distribution function (PDF), truncated using a patient specific action volume that encloses allowed deviations from the planned position, and renormalized to yield a new PDF with EMT-gated interventions. In lieu of a conventional planning target volume (PTV), multiple instances of clinical target volume (CTV) and organs at risk (OARs) were replicated and displaced to extreme positions inside the action volume representing possible delivery scenarios. When optimizing the volumetric modulated arc therapy plan, doses to the CTV and OARs were calculated as a sum of doses to the replicas weighted by the PDF to account for motion. A treatment plan meeting the clinical constraints was produced and compared to the counterpart conventional margin (PTV) plan. EMT traces from a separate testing database served to simulate motion during gated delivery. Dosimetric end points extracted from dose accumulations for each motion trace were utilized to evaluate potential clinical benefit. Five prostate cases from a hypofractionated protocol (42.5 Gy in 5 fractions) were retrospectively investigated. The patient specific gating window resulted in tight anterior and inferior action levels (∼1 mm) to protect rectal wall and bladder wall, and resulted in an average of four beam interruptions per fraction in the simulation. The robust-optimized plans achieved the same average CTV D95 coverage of 40.5 Gy as the PTV-optimized plans, but with reduced patient-averaged rectum wall D1cc by 2.2 Gy (range 0.7 to 4.7 Gy) and bladder wall mean dose by 2.9 Gy (range 2.0 to 3.4 Gy). Integration of an intra-fractional motion management strategy into the robust optimization process is feasible and may yield improved OAR sparing compared to the standard margin approach.

Robust plan optimization for electromagnetic transponder guided hypo-fractionated prostate treatment using volumetric modulated arc therapy.

PubMed

Zhang, Pengpeng; Hunt, Margie; Happersett, Laura; Yang, Jie; Zelefsky, Michael; Mageras, Gig

2013-11-07

To develop an optimization algorithm for volumetric modulated arc therapy which incorporates an electromagnetic tracking (EMT) guided gating strategy and is robust to residual intra-fractional motion uncertainties. In a computer simulation, intra-fractional motion traces from prior treatments with EMT were converted to a probability distribution function (PDF), truncated using a patient specific action volume that encloses allowed deviations from the planned position, and renormalized to yield a new PDF with EMT-gated interventions. In lieu of a conventional planning target volume (PTV), multiple instances of clinical target volume (CTV) and organs at risk (OARs) were replicated and displaced to extreme positions inside the action volume representing possible delivery scenarios. When optimizing the volumetric modulated arc therapy plan, doses to the CTV and OARs were calculated as a sum of doses to the replicas weighted by the PDF to account for motion. A treatment plan meeting the clinical constraints was produced and compared to the counterpart conventional margin (PTV) plan. EMT traces from a separate testing database served to simulate motion during gated delivery. Dosimetric end points extracted from dose accumulations for each motion trace were utilized to evaluate potential clinical benefit. Five prostate cases from a hypofractionated protocol (42.5 Gy in 5 fractions) were retrospectively investigated. The patient specific gating window resulted in tight anterior and inferior action levels (~1 mm) to protect rectal wall and bladder wall, and resulted in an average of four beam interruptions per fraction in the simulation. The robust-optimized plans achieved the same average CTV D95 coverage of 40.5 Gy as the PTV-optimized plans, but with reduced patient-averaged rectum wall D1cc by 2.2 Gy (range 0.7 to 4.7 Gy) and bladder wall mean dose by 2.9 Gy (range 2.0 to 3.4 Gy). Integration of an intra-fractional motion management strategy into the robust optimization process is feasible and may yield improved OAR sparing compared to the standard margin approach.

Transfer of computer software technology through workshops: The case of fish bioenergetics modeling

USGS Publications Warehouse

Johnson, B.L.

1992-01-01

A three-part program is proposed to promote the availability and use of computer software packages to fishery managers and researchers. The approach consists of journal articles that announce new technologies, technical reports that serve as user's guides, and hands-on workshops that provide direct instruction to new users. Workshops, which allow experienced users to directly instruct novices in software operation and application are important, but often neglected. The author's experience with organizing and conducting bioenergetics modeling workshops suggests the optimal workshop would take 2 days, have 10-15 participants, one computer for every two users, and one instructor for every 5-6 people.

Guide to Developing an Environmental Management System - Act

EPA Pesticide Factsheets

This page takes you though the basic steps (Plan, Do, Check, Act) of building an Environmental Management System (EMS) as they are outlined in the 2001 Second Edition of Environmental Management Systems: An Implementation Guide. Act section.

Guide to Developing an Environmental Management System - Plan

EPA Pesticide Factsheets

This page takes you though the basic steps (Plan, Do, Check, Act) of building an Environmental Management System (EMS) as they are outlined in the 2001 Second Edition of Environmental Management Systems: An Implementation Guide. Plan section.

Guide to Developing an Environmental Management System - Check

EPA Pesticide Factsheets

This page takes you though the basic steps (Plan, Do, Check, Act) of building an Environmental Management System (EMS) as they are outlined in the 2001 Second Edition of Environmental Management Systems: An Implementation Guide. Check section.

MRI-guided stereotactic neurosurgical procedures in a diagnostic MRI suite: Background and safe practice recommendations.

PubMed

Larson, Paul S; Willie, Jon T; Vadivelu, Sudhakar; Azmi-Ghadimi, Hooman; Nichols, Amy; Fauerbach, Loretta Litz; Johnson, Helen Boehm; Graham, Denise

2017-07-01

The development of navigation technology facilitating MRI-guided stereotactic neurosurgery has enabled neurosurgeons to perform a variety of procedures ranging from deep brain stimulation to laser ablation entirely within an intraoperative or diagnostic MRI suite while having real-time visualization of brain anatomy. Prior to this technology, some of these procedures required multisite workflow patterns that presented significant risk to the patient during transport. For those facilities with access to this technology, safe practice guidelines exist only for procedures performed within an intraoperative MRI. There are currently no safe practice guidelines or parameters available for facilities looking to integrate this technology into practice in conventional MRI suites. Performing neurosurgical procedures in a diagnostic MRI suite does require precautionary measures. The relative novelty of technology and workflows for direct MRI-guided procedures requires consideration of safe practice recommendations, including those pertaining to infection control and magnet safety issues. This article proposes a framework of safe practice recommendations designed for assessing readiness and optimization of MRI-guided neurosurgical interventions in the diagnostic MRI suite in an effort to mitigate patient risk. The framework is based on existing clinical evidence, recommendations, and guidelines related to infection control and prevention, health care-associated infections, and magnet safety, as well as the clinical and practical experience of neurosurgeons utilizing this technology. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.

Using an interview guide to identify effective nurse managers: phase II, outcomes.

PubMed

Fosbinder, D; Everson-Bates, S; Hendrix, L

2000-01-01

The investigators report validation of a survey tool called the Interview Guide to assist in the selection of nurses who will be effective as managers. Nurse administrators rated nurse managers at six months and two years after hire. The Interview Guide rated the management qualities "seeing the big picture" and potential for "rehire" as the best predictors of managerial success. After two years, a good "self-concept" or a "flexible attitude" was the best predictor. The ability to manage conflict was the most significant competency for predicting rehire at both six months and two years.

Biventricular pacemaker optimization guided by comprehensive echocardiography-preliminary observations regarding the effects on systolic and diastolic ventricular function and third heart sound.

PubMed

Taha, Nima; Zhang, Jing; Ranjan, Rupesh; Daneshvar, Samuel; Castillo, Edilzar; Guillen, Elizabeth; Montoya, Martha C; Velasquez, Giovanna; Naqvi, Tasneem Z

2010-08-01

Doppler echocardiography of mitral inflow or aortic outflow or both has been validated and advocated to guide biventricular (Biv) pacemaker optimization. A comprehensive and tailored Doppler echocardiographic evaluation may be required in patients with heart failure to assist with Biv pacemaker optimization. The third heart sound (S(3)), an acoustic cardiographic parameter, has been demonstrated to be a highly specific finding for hemodynamic evaluation in patients with heart failure. The aims of this study were to evaluate the use of comprehensive Doppler echocardiography as a guide during Biv pacemaker optimization in patients after cardiac resynchronization therapy and to evaluate the feasibility of S(3) intensity to be a cost-efficient parameter for Biv pacemaker optimization compared with Doppler echocardiography. Comprehensive Doppler echocardiographic evaluations were performed during Biv pacemaker optimization in 44 patients referred for pacemaker optimization (mean age, 71 + or - 12 years; mean left ventricular ejection fraction, 34 + or - 11%). Blinded assessment of S(3) intensity was performed simultaneously using acoustic cardiography. The correlation and improvement in cardiac hemodynamics were analyzed between the methods. Echocardiographically guided optimization resulted in significant improvements in the left ventricular outflow velocity-time integral (15.92 + or - 4.77 to 18.51 + or - 5.19 cm, P < .001), ejection time (278 + or - 40 to 293 + or - 40 ms, P < .001), myocardial performance index (0.57 + or - 0.19 to 0.44 + or - 0.14, P < .002), and peak pulmonary artery systolic pressure (42 + or - 13 to 36 + or - 11 mm Hg, P < .04) and decreased S(3) intensity from 4.81 + or - 1.84 at baseline to 3.96 + or - 1.22 after optimization (P < .02) for the overall study group and from 6.63 + or - 1.37 to 4.85 + or - 1.13 (P < .001) in the 18 patients with baseline S(3) intensity > 5.0. The correlation between echocardiographic and acoustic cardiographic S(3) intensity for optimal atrioventricular delay was 0.86 (P < .001) and for optimal interventricular delay was 0.64 (P < .001). Optimal atrioventricular delay was identical by echocardiographic and acoustic cardiographic S(3) intensity in 56%, and optimal interventricular delay was identical in 75% of patients. Pacemakers were permanently programmed on the basis of echocardiographic evaluation. In 35 patients available for follow up, the mean New York Heart Association class reduced from 2.55 + or - 0.81 to 1.77 + or - 0.90 (P < .001) and the mean quality-of-life score as assessed by Minnesota Living With Heart Failure Questionnaire improved from 45 + or - 28 to 32 + or - 28 (P = .08) at 2.5 + or - 2.1 months. Comprehensive echocardiographically guided Biv pacemaker optimization produces significant improvement in Doppler echocardiographic hemodynamics, a reduction in S(3) intensity, and an improvement in functional class in patients after cardiac resynchronization therapy. Copyright 2010 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

A Programmed Enterprise Analysis Teaching Guide for Selected Farm Enterprises in North Dakota: Prepared as Part of the Farm Management Education In-Service Workshop.

ERIC Educational Resources Information Center

North Dakota State Board for Vocational Education, Bismarck.

The series of programmed teaching guides for the enterprise analysis of selected enterprises was prepared by the participants in a Farm Management Education In-Service Workshop at North Dakota State University. The guide should be useful to teachers of adult Farm Managment classes in helping to teach farmers to make a thorough analysis of the…

O&M Best Practices - A Guide to Achieving Operational Efficiency (Release 2.0)

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

Sullivan, Gregory P.; Pugh, Ray; Melendez, Aldo P.

2004-07-31

This guide, sponsored by DOE's Federal Energy Management Program, highlights operations and maintenance (O&M) programs targeting energy efficiency that are estimated to save 5% to 20% on energy bills without a significant capital investment. The purpose of this guide is to provide the federal O&M energy manager and practitioner with useful information about O&M management, technologies, energy efficiency and cost-reduction approaches.

Jet lag and travel fatigue: a comprehensive management plan for sport medicine physicians and high-performance support teams.

PubMed

Samuels, Charles H

2012-05-01

The impact of transcontinental travel and high-volume travel on athletes can result in physiologic disturbances and a complicated set of physical symptoms. Jet lag and travel fatigue have been identified by athletes, athletic trainers, coaches, and physicians as important but challenging problems that could benefit from practical solutions. Currently, there is a culture of disregard and lack of knowledge regarding the negative effects of jet lag and travel fatigue on the athlete's well-being and performance. In addition, the key physiologic metric (determination of the human circadian phase) that guides jet lag treatment interventions is elusive and thus limits evidence-based therapeutic advice. A better understanding of preflight, in-flight, and postflight management options, such as use of melatonin or the judicious application of sedatives, is important for the sports clinician to help athletes limit fatigue symptoms and maintain optimal performance. The purpose of this article was to provide a practical applied method of implementing a travel management program for athletic teams.

Pesticide-Induced Stress in Arthropod Pests for Optimized Integrated Pest Management Programs.

PubMed

Guedes, R N C; Smagghe, G; Stark, J D; Desneux, N

2016-01-01

More than six decades after the onset of wide-scale commercial use of synthetic pesticides and more than fifty years after Rachel Carson's Silent Spring, pesticides, particularly insecticides, arguably remain the most influential pest management tool around the globe. Nevertheless, pesticide use is still a controversial issue and is at the regulatory forefront in most countries. The older generation of insecticide groups has been largely replaced by a plethora of novel molecules that exhibit improved human and environmental safety profiles. However, the use of such compounds is guided by their short-term efficacy; the indirect and subtler effects on their target species, namely arthropod pest species, have been neglected. Curiously, comprehensive risk assessments have increasingly explored effects on nontarget species, contrasting with the majority of efforts focused on the target arthropod pest species. The present review mitigates this shortcoming by hierarchically exploring within an ecotoxicology framework applied to integrated pest management the myriad effects of insecticide use on arthropod pest species.

Common management issues in pediatric patients with mild bleeding disorders.

PubMed

O'Brien, Sarah H

2012-10-01

Type 1 von Willebrand disease and mild platelet function defects are among the most common disorders seen by pediatric hematologists. The management and prevention of bleeding in these patients can be challenging, as there are limited published data to guide clinical practice, and a complete lack of randomized clinical trials. Desmopressin (DDAVP) and antifibrinolytics are the mainstays of treatment in these patients, yet the optimal dosing and timing of these agents to prevent or resolve bleeding, while minimizing adverse side effects, is sometimes unclear. DDAVP-induced hyponatremia is a particularly under-recognized complication in children with bleeding disorders who undergo surgery. Clinicians need to be aware of local measures that are equally important in treating problems such as epistaxis and surgical bleeding. This review will discuss the published literature and provide practical suggestions regarding four common management issues in the care of children and adolescents with mild bleeding disorders: epistaxis, heavy menstrual bleeding, dental extractions, and tonsillectomy. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Systematic Sensor Selection Strategy (S4) User Guide

NASA Technical Reports Server (NTRS)

Sowers, T. Shane

2012-01-01

This paper describes a User Guide for the Systematic Sensor Selection Strategy (S4). S4 was developed to optimally select a sensor suite from a larger pool of candidate sensors based on their performance in a diagnostic system. For aerospace systems, selecting the proper sensors is important for ensuring adequate measurement coverage to satisfy operational, maintenance, performance, and system diagnostic criteria. S4 optimizes the selection of sensors based on the system fault diagnostic approach while taking conflicting objectives such as cost, weight and reliability into consideration. S4 can be described as a general architecture structured to accommodate application-specific components and requirements. It performs combinational optimization with a user defined merit or cost function to identify optimum or near-optimum sensor suite solutions. The S4 User Guide describes the sensor selection procedure and presents an example problem using an open source turbofan engine simulation to demonstrate its application.

Government Materials on Enrollment Management and Planning in Higher Education: A Resource Guide.

ERIC Educational Resources Information Center

Lewis, David G.

The guide is intended to provide admissions directors, academic deans, institutional planning officers, and faculty with access to government sources of information concerning college enrollment management. Sections provide information on: using the guide; additional government document information sources; using government documents; acquiring…

Building Maintenance and Utilities Management. Florida Vocational Program Guide.

ERIC Educational Resources Information Center

University of South Florida, Tampa. Dept. of Adult and Vocational Education.

This program guide identifies primary concerns in the organization, operation, and evaluation of a building maintenance and utilities management program. It is designed for local school district and community college administrators, instructors, program advisory committees, and regional coordinating councils. The guide begins with the Dictionary…

Using Intervention Mapping to develop the Parents as Agents of Change (PAC©) intervention for managing pediatric obesity.

PubMed

Ball, Geoff D C; Mushquash, Aislin R; Keaschuk, Rachel A; Ambler, Kathryn A; Newton, Amanda S

2017-01-13

Pediatric obesity has become increasingly prevalent over recent decades. In view of the psychosocial and physical health risks, and the high likelihood that children with obesity will grow to become adults with obesity, there is a clear need to develop evidence-based interventions that can be delivered in the health care system to optimize the health and well-being of children with obesity and their families. The aim of this paper is to describe the development, implementation, and planned evaluation of a parent-based weight management intervention designed for parents of 8-12 year olds with obesity. The principles of Intervention Mapping (IM) were used to develop an intervention called Parents as Agents of Change (PAC © ). From 2006 to 2009, an environmental scan plus qualitative (individual interviews with parents and children), quantitative (medical record reviews), and literature review data were collected to gain broad insight into family factors related to pediatric obesity and its management. Theoretical frameworks and empirical evidence guided curriculum development, which was founded primarily on the tenets of family systems theory and cognitive behavioral theory. PAC was developed as a manualized, 16-session, group-based, health care professional-led intervention for parents to address individual, family, and environmental factors related to the management of pediatric obesity. The intervention was refined based on feedback from local and international experts, and has been implemented successfully in a multi-disciplinary weight management centre in a children's hospital. IM provided a practical framework to guide the systematic development of a pediatric weight management intervention for parents of children with obesity. This logical, step-by-step process blends theory and practice and is broadly applicable in the context of obesity management intervention development and evaluation. Following intervention development, the PAC intervention was evaluated within a randomized clinical trial. Trial registration NCT01267097; clinicaltrials.gov.

Profiling Patients' Healthcare Needs to Support Integrated, Person-Centered Models for Long-Term Disease Management (Profile): Research Design.

PubMed

Elissen, Arianne Mj; Hertroijs, Dorijn Fl; Schaper, Nicolaas C; Vrijhoef, Hubertus Jm; Ruwaard, Dirk

2016-04-29

This article presents the design of PROFILe, a study investigating which (bio)medical and non-(bio)medical patient characteristics should guide more tailored chronic care. Based on this insight, the project aims to develop and validate 'patient profiles' that can be used in practice to determine optimal treatment strategies for subgroups of chronically ill with similar healthcare needs and preferences. PROFILe is a practice-based research comprising four phases. The project focuses on patients with type 2 diabetes. During the first study phase, patient profiles are drafted based on a systematic literature research, latent class growth modeling, and expert collaboration. In phase 2, the profiles are validated from a clinical, patient-related and statistical perspective. Phase 3 involves a discrete choice experiment to gain insight into the patient preferences that exist per profile. In phase 4, the results from all analyses are integrated and recommendations formulated on which patient characteristics should guide tailored chronic care. PROFILe is an innovative study which uses a uniquely holistic approach to assess the healthcare needs and preferences of chronically ill. The patient profiles resulting from this project must be tested in practice to investigate the effects of tailored management on patient experience, population health and costs.

Managing Highway Maintenance: Instructor's Guide: For Training in Managing Highway Maintenance.

ERIC Educational Resources Information Center

Federal Highway Administration (DOT), Washington, DC. Offices of Research and Development.

The guide, intended for use by training officers and field instructors in highway maintenance management, contains five courses with a combined total of 17 units of instruction for maintenance engineers and supervisors. The curriculum incorporates management concepts and practices of State, county, and city maintenance agencies which have…

Who's Minding the Shore? A Citizens' Guide to Coastal Management.

ERIC Educational Resources Information Center

Beers, Roger; And Others

This citizen's guide is designed to illustrate the ways that citizens can participate in their state's development of a coastal management program. The Provisions of the Coastal Zone Management Act are discussed and the requirements of an effective management program are considered. Some background information outlining the ecological factors…

Guide to Effective Purchasing. Operational Management Programme.

ERIC Educational Resources Information Center

Frediani, Pam

This manual is intended to help create and sustain good relations between purchasers and suppliers of foods and related products. It is designed to guide anyone involved in the purchasing function: purchasing officers and managers in medium and large establishments, food and beverage managers, catering managers, chefs, caterers, restaurateurs,…

A Practical Guide to Enrollment and Retention Management in Higher Education.

ERIC Educational Resources Information Center

Dennis, Marguerite J.

This book offers a guide to designing and implementing an enrollment and retention management program for colleges and universities. Emphasis is on a system which integrates the activities of the offices of enrollment management, retention management, admission, financial aid, registration, research, and public relations, including publications…

Safety and efficacy of percutaneous cecostomy/colostomy for treatment of large bowel obstruction in adults with cancer.

PubMed

Tewari, Sanjit O; Getrajdman, George I; Petre, Elena N; Sofocleous, Constantinos T; Siegelbaum, Robert H; Erinjeri, Joseph P; Weiser, Martin R; Thornton, Raymond H

2015-02-01

To assess the safety and efficacy of image-guided percutaneous cecostomy/colostomy (PC) in the management of colonic obstruction in patients with cancer. Twenty-seven consecutive patients underwent image-guided PC to relieve large bowel obstruction at a single institution between 2000 and 2012. Colonic obstruction was the common indication. Patient demographics, diagnosis, procedural details, and outcomes including maximum colonic distension (MCD; ie, greatest transverse measurement of the colon on radiograph or scout computed tomography image) were recorded and retrospectively analyzed. Following PC, no patient experienced colonic perforation; pain was relieved in 24 of 27 patients (89%). Catheters with tip position in luminal gas rather than mixed stool/gas or stool were associated with greater decrease in MCD (-40%, -12%, and -16%, respectively), with the difference reaching statistical significance (P = .002 and P = .013, respectively). Catheter size was not associated with change in MCD (P = .978). Catheters were successfully removed from six of nine patients (67%) with functional obstructions and two of 18 patients (11%) with mechanical obstructions. One patient underwent endoscopic stent placement after catheter removal. Three patients required diverting colostomy after PC, and their catheters were removed at the time of surgery. One major complication (3.7%; subcutaneous emphysema, pneumomediastinum, and sepsis) occurred 8 days after PC and was successfully treated with cecostomy exchange, soft-tissue drainage, and intravenous antibiotic therapy. Image-guided PC is safe and effective for management of functional and mechanical bowel obstruction in patients with cancer. For optimal efficacy, catheters should terminate within luminal gas. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

A Practical Guide for Personnel Management: The Essential Elements.

ERIC Educational Resources Information Center

Todaro, Julie B.

The essential elements of personnel management are outlined. Personnel management may be called by various names and may be practiced by various levels of management, but in any case it is one of the most important elements of a management position. While sample forms generally relate to Texas community colleges and libraries, the guide is written…

A governor's guide to emergency management. Volume one, Natural disasters

DOT National Transportation Integrated Search

2001-02-27

With lives, infrastructure, and resources at stake, governors must become instant experts in emergency management when their states are affected by natural disaster. The purpose of A Governor's Guide to Emergency Management is to provide governors an...

75 FR 65365 - Disaster Temporary Housing Operational Guide

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-22

... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA-2010-0062] Disaster Temporary Housing Operational Guide AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice of availability; request for comments. SUMMARY: The Federal Emergency Management Agency (FEMA) is...

Health software: a new CEI Guide for software management in medical environment.

PubMed

Giacomozzi, Claudia; Martelli, Francesco

2016-01-01

The increasing spread of software components in the healthcare context renders explanatory guides relevant and mandatory to interpret laws and standards, and to support safe management of software products in healthcare. In 2012 a working group has been settled for the above purposes at Italian Electrotechnical Committee (CEI), made of experts from Italian National Institute of Health (ISS), representatives of industry, and representatives of the healthcare organizations. As a first outcome of the group activity, Guide CEI 62-237 was published in February 2015. The Guide incorporates an innovative approach based on the proper contextualization of software products, either medical devices or not, to the specific healthcare scenario, and addresses the risk management of IT systems. The Guide provides operators and manufacturers with an interpretative support with many detailed examples to facilitate the proper contextualization and management of health software, in compliance with related European and international regulations and standards.

Swimming Pools. Managing School Facilities, Guide 2.

ERIC Educational Resources Information Center

Department for Education and Employment, London (England). Architects and Building Branch.

This guide for schools with swimming pools offers advice concerning appropriate training for pool managers, the importance of water quality and testing, safety in the handling of chemicals, maintenance and cleaning requirements, pool security, and health concerns. The guide covers both indoor and outdoor pools, explains some technical terms,…

Management and Family Economics Student Modules. Instructor's Guide.

ERIC Educational Resources Information Center

South Carolina State Dept. of Education, Columbia. Home Economics Education Section.

This instructor's guide was designed to help teachers present a performance-based course in family management and economics to high school students. The guide contains a listing of the modules contained in the student modules with suggested levels and courses for teaching; additional learning experiences; lists of supplemental resources and…

An ecological basis for ecosystem management

Treesearch

M. R. Kaufmann; R. T. Graham; D. A. Boyce; W. H. Moir; L. Perry; R. T. Reynolds; R. L. Bassett; P. Mehlhop; C. B. Edminster; W. M. Block; P. S. Corn

1994-01-01

Guiding principles based on conservation biology are applied in assessing ecosystem needs. Ecosystem, economic, and social needs are integrated in a decision model in which the guiding principles are used as a primary filter for evaluating proposed actions. Management practices consistent with the guiding principles are likely to lead to ecological, economic, and...

Family and Career Management. Teacher's Instructional Guide.

ERIC Educational Resources Information Center

Mathieson, Mary

This instructional guide for a one-half credit course for grades 11-12 emphasizes preparation for family and career roles, effective management, and personal and career effectiveness. Introductory materials are a course description; overview of course design; facilities, equipment, and resources; and how to use the instructional guide. Texas…

Transportation Systems. Curriculum Guide for Technology Education.

ERIC Educational Resources Information Center

Chastain, Gary K.

This curriculum guide for a 1-semester or 1-year course in transportation provides activities that show and explain many of the occupations, devices, and systems that are related to transportation on land, water, air, and space. The guide contains competencies (task lists), student competency records, and management sheets. Management sheets,…

Rainforest birds: A land manager's guide to breeding bird habitat in young conifer forests in the Pacific Northwest

USGS Publications Warehouse

Altman, Bob; Hagar, Joan

2007-01-01

An underlying premise of the Guide is that forest management has a direct and significant influence on bird populations. Consequently, manipulation of forest conditions as part of forest management can be designed and implemented to achieve bird conservation objectives (Busing and Garman, 2002; Lehmkuhl and others, 2002). It is not our intent to describe all the potential forest management activities that could be conducted to achieve the desired habitat conditions for birds. Those need to be determined locally by assessing the most ecologically appropriate management at each site. However, to assist land managers, the Guide offers some basic forest management activities that are widely accepted for achieving habitat conditions and features which benefit breeding birds.

Shade guide optimization--a novel shade arrangement principle for both ceramic and composite shade guides when identifying composite test objects.

PubMed

Østervemb, Niels; Jørgensen, Jette Nedergaard; Hørsted-Bindslev, Preben

2011-02-01

The most widely used shade guide for composite materials is made of ceramic and arranged according to a non-proven method. There is a need for a composite shade guide using a scientifically based arrangement principle. To compare the shade tab arrangement of the Vitapan Classical shade guide and an individually made composite shade guide using both the originally proposed arrangement principle and arranged according to ΔE2000 values with hue group division. An individual composite shade guide made from Filtek Supreme XT body colors was compared to the Vitapan Classical shade guide. Twenty-five students matched color samples made from Filtek Supreme XT body colors using the two shade guides arranged after the two proposed principles--four shade guides in total. Age, sequence, gender, time, and number of correct matches were recorded. The proposed visually optimal composite shade guide was both fastest and had the highest number of correct matches. Gender was significantly associated with time used for color sampling but not regarding the number of correct shade matches. A composite shade guide is superior compared to the ceramic Vitapan Classical guide when using composite test objects. A rearrangement of the shade guide according to hue, subdivided according to ΔE2000, significantly reduces the time needed to take a color sample and increases the number of correct shade matches. Total color difference in relation to the lightest tab with hue group division is recommended as a possible and universally applicable mode of tab arrangement in dental color standards. Moreover, a shade guide made of the composite materials itself is to be preferred as both a faster and more accurate method of determining color. © 2011, COPYRIGHT THE AUTHORS. JOURNAL COMPILATION © 2011, WILEY PERIODICALS, INC.

Guide to Developing an Environmental Management System - Do

EPA Pesticide Factsheets

This page takes you though the basic steps (Plan, Do, Check, Act) of building an Environmental Management System (EMS) as they are outlined in the 2001 Second Edition of Environmental Management Systems: An Implementation Guide. This is the Do section.

Silvicultural guide for northern hardwood types in the Northeast (revised)

Treesearch

William B. Leak; Dale S. Solomon; Paul S. DeBald

1987-01-01

A practical guide to the management of northern hardwoods for timber production in New England and New York. Both even-aged management are considered, and specific treatments are prescribed for a range of stand conditions and management objectives.

Synchronic interval Gaussian mixed-integer programming for air quality management.

PubMed

Cheng, Guanhui; Huang, Guohe Gordon; Dong, Cong

2015-12-15

To reveal the synchronism of interval uncertainties, the tradeoff between system optimality and security, the discreteness of facility-expansion options, the uncertainty of pollutant dispersion processes, and the seasonality of wind features in air quality management (AQM) systems, a synchronic interval Gaussian mixed-integer programming (SIGMIP) approach is proposed in this study. A robust interval Gaussian dispersion model is developed for approaching the pollutant dispersion process under interval uncertainties and seasonal variations. The reflection of synchronic effects of interval uncertainties in the programming objective is enabled through introducing interval functions. The proposition of constraint violation degrees helps quantify the tradeoff between system optimality and constraint violation under interval uncertainties. The overall optimality of system profits of an SIGMIP model is achieved based on the definition of an integrally optimal solution. Integer variables in the SIGMIP model are resolved by the existing cutting-plane method. Combining these efforts leads to an effective algorithm for the SIGMIP model. An application to an AQM problem in a region in Shandong Province, China, reveals that the proposed SIGMIP model can facilitate identifying the desired scheme for AQM. The enhancement of the robustness of optimization exercises may be helpful for increasing the reliability of suggested schemes for AQM under these complexities. The interrelated tradeoffs among control measures, emission sources, flow processes, receptors, influencing factors, and economic and environmental goals are effectively balanced. Interests of many stakeholders are reasonably coordinated. The harmony between economic development and air quality control is enabled. Results also indicate that the constraint violation degree is effective at reflecting the compromise relationship between constraint-violation risks and system optimality under interval uncertainties. This can help decision makers mitigate potential risks, e.g. insufficiency of pollutant treatment capabilities, exceedance of air quality standards, deficiency of pollution control fund, or imbalance of economic or environmental stress, in the process of guiding AQM. Copyright © 2015 Elsevier B.V. All rights reserved.

Operations & Maintenance Best Practices - A Guide to Achieving Operational Efficiency (Release 3)

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

Sullivan, Greg; Pugh, Ray; Melendez, Aldo P.

This guide highlights operations and maintenance programs targeting energy and water efficiency that are estimated to save 5% to 20% on energy bills without a significant capital investment. The purpose of this guide is to provide you, the Operations and Maintenance (O&M)/Energy manager and practitioner, with useful information about O&M management, technologies, energy and water efficiency, and cost-reduction approaches. To make this guide useful and to reflect your needs and concerns, the authors met with O&M and Energy managers via Federal Energy Management Program (FEMP) workshops. In addition, the authors conducted extensive literature searches and contacted numerous vendors and industrymore » experts. The information and case studies that appear in this guide resulted from these activities. It needs to be stated at the outset that this guide is designed to provide information on effective O&M as it applies to systems and equipment typically found at Federal facilities. This guide is not designed to provide the reader with step-by-step procedures for performing O&M on any specific piece of equipment. Rather, this guide first directs the user to the manufacturer's specifications and recommendations. In no way should the recommendations in this guide be used in place of manufacturer's recommendations. The recommendations in this guide are designed to supplement those of the manufacturer, or, as is all too often the case, provide guidance for systems and equipment for which all technical documentation has been lost. As a rule, this guide will first defer to the manufacturer's recommendations on equipment operation and maintenance.« less

Management of envenomations during pregnancy.

PubMed

Brown, S A; Seifert, S A; Rayburn, W F

2013-01-01

Envenomations during pregnancy pose all the problems of envenomation in the nonpregnant state with additional complexity related to maternal physiologic changes, medication use during pregnancy, and the well-being of the fetus. We review the obstetric literature and management options available to prevent maternal morbidity and mortality while limiting adverse obstetric outcomes after envenomation in pregnancy. In January 2012, we searched the U.S. National Library of Medicine Medline/PubMed, Toxline, Reprotox, Google Scholar and Micromedex databases, core surgery and internal medicine textbooks, and references of retrieved articles for the years 1966 through 2011. Search terms included "envenomation in pregnancy," "stings in pregnancy," "antivenom use in pregnancy," "anaphylaxis in pregnancy," and variants of these with known venomous animals. Reference lists generated further case reports and articles. We included English language articles and abstracts. Levels of Evidence (LOE) for the reports cited and Grades of Recommendations (GOR) based on LOE for our recommendations use the National Guidelines Clearinghouse metric of the US DHHS. Recommendations for the management of envenomation in pregnancy are guided primarily by studies on nonpregnant persons and case reports of pregnancy. Clinically significant envenomations in pregnancy are reported for snakes, spiders, scorpions, jellyfish, and hymenoptera (bees, wasps, hornets, and ants). Adverse obstetric outcomes including miscarriage, preterm birth, placental abruption, and stillbirth are associated with envenomation in pregnancy. The limited available literature suggests that adverse outcomes are primarily related to venom effects on the mother. Optimization of maternal health such as management of anaphylaxis and antivenom administration is likely the best approach to improve fetal outcomes despite potential risks to the fetus of medication administration during pregnancy. Obstetric evaluation and fetal monitoring are imperative in cases of severe envenomation. The medical literature regarding envenomation in pregnancy includes primarily retrospective reviews and case series. The limited available evidence suggests that optimal management includes a venom-specific approach, including supportive care, antivenom administration in appropriate cases, treatment of anaphylaxis if present, and fetal assessment. The current available evidence suggests that antivenom use is safe in pregnancy and that what is good for the mother is good for the fetus. Further research is needed to clarify the optimal management schema for envenomation in pregnancy.

Guidelines for the diagnosis and antimicrobial therapy of canine superficial bacterial folliculitis (Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases).

PubMed

Hillier, Andrew; Lloyd, David H; Weese, J Scott; Blondeau, Joseph M; Boothe, Dawn; Breitschwerdt, Edward; Guardabassi, Luca; Papich, Mark G; Rankin, Shelley; Turnidge, John D; Sykes, Jane E

2014-06-01

Superficial bacterial folliculitis (SBF) is usually caused by Staphylococcus pseudintermedius and routinely treated with systemic antimicrobial agents. Infection is a consequence of reduced immunity associated with alterations of the skin barrier and underlying diseases that may be difficult to diagnose and resolve; thus, SBF is frequently recurrent and repeated treatment is necessary. The emergence of multiresistant bacteria, particularly meticillin-resistant S. pseudintermedius (MRSP), has focused attention on the need for optimal management of SBF. Provision of an internationally available resource guiding practitioners in the diagnosis, treatment and prevention of SBF. The guidelines were developed by the Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases, with consultation and advice from diplomates of the American and European Colleges of Veterinary Dermatology. They describe optimal methods for the diagnosis and management of SBF, including isolation of the causative organism, antimicrobial susceptibility testing, selection of antimicrobial drugs, therapeutic protocols and advice on infection control. Guidance is given for topical and systemic modalities, including approaches suitable for MRSP. Systemic drugs are classified in three tiers. Tier one drugs are used when diagnosis is clear cut and risk factors for antimicrobial drug resistance are not present. Otherwise, tier two drugs are used and antimicrobial susceptibility tests are mandatory. Tier three includes drugs reserved for highly resistant infections; their use is strongly discouraged and, when necessary, they should be used in consultation with specialists. Optimal management of SBF will improve antimicrobial use and reduce selection of MRSP and other multidrug-resistant bacteria affecting animal and human health. © 2014 ESVD and ACVD.

Development of a web based monitoring system for safety and activity analysis in operating theatres.

PubMed

Frosini, Francesco; Miniati, Roberto; Avezzano, Paolo; Cecconi, Giulio; Dori, Fabrizio; Gentili, Guido Biffi; Belardinelli, Andrea

2016-01-01

The management and the monitoring of the operating rooms on the part of the general management have the objective of optimizing their use and maximizing the internal safety. The expenses owed to their safe use represent, besides reimbursements coming from the surgical activity, important factors for the analysis of the medical facility. Given that it is not possible to reduce the safety, it is necessary to develop supporting systems with the aim to enhance and optimize the use of the rooms. The developed analysis model of the operating rooms in this study is based on the specific performance indicators and allows the effective monitoring of both the parameters that influence the safety (environmental, microbiological parameters) and those that influence the efficiency of the usage (employment rate, delays, necessary formalities, etc.). This allows you to have a systematic dashboard on hand for all of the OTs and, thus, organize the intervention schedules and more appropriate improvements. A monitoring dashboard has been achieved, accessible from any platform and any device, capable of aggregating hospital information. The undertaken organizational modifications, through the use of the dashboard, have allowed for an average annual savings of 29.52 minutes per intervention and increase the use of the ORs of 5%. The increment of the employment rate and the optimization of the operating room have allowed for savings of around $299,88 for every intervention carried out in 2013, corresponding to an annual savings of $343,362,60. Integration dashboards, as the one proposed in this study as a prototype, represent a governance model of economically sustainable healthcare systems capable of guiding the hospital management in the choices and in the implementation of the most efficient organizational modifications.

Optimizing bowel preparation for colonoscopy: a guide to enhance quality of visualization

PubMed Central

Bechtold, Matthew L.; Mir, Fazia; Puli, Srinivas R.; Nguyen, Douglas L.

2016-01-01

Colonoscopy is an important screening and therapeutic modality for colorectal cancer. Unlike other screening tests, colonoscopy is dependent on pre-procedure bowel preparation. If the bowel preparation is poor, significant pathology may be missed. Many factors are known to improve bowel preparation. This review will highlight those factors that may optimize the bowel preparation, including choice of bowel preparation, grading or scoring of the bowel preparation, special factors that influence preparation, and diet prior to colonoscopy that affects bowel preparation. The aim of the review is to offer suggestions and guide endoscopists on how to optimize the bowel preparation for the patients undergoing colonoscopy. PMID:27065725

Development of a Simplified Sustainable Facilities Guide

DTIC Science & Technology

2003-04-18

Government Through Efficient Energy Management , June 3, 1999 EO 13148 Greening the Government Through Leadership in Environmental Management ...architects, engineers, and project managers . - The United States Green Building Council (USGBC) has created the " Leadership in Energy and...SIMPLIFIED SUSTAINABLE FACILITIES GUIDE THESIS Presented to the Faculty Department of Systems and Engineering Management

Management Information Systems in the Public Sector. A Human Resources Management Course Monograph. No. 4.

ERIC Educational Resources Information Center

Cerveny, Robert P.

This curriculum guide provides an introduction to Management Information Systems (MIS) concepts and techniques for students preparing to develop MISs in professional settings, and to assist in MIS evaluation. According to the guide, students are exposed to concepts drawn from systems theory, information theory, management theory, data base…

Can Subjects be Guided to Optimal Decisions The Use of a Real-Time Training Intervention Model

DTIC Science & Technology

2016-06-01

execution of the task and may then be analyzed to determine if there is correlation between designated factors (scores, proportion of time in each...state with their decision performance in real time could allow training systems to be designed to tailor training to the individual decision maker...release; distribution is unlimited CAN SUBJECTS BE GUIDED TO OPTIMAL DECISIONS? THE USE OF A REAL- TIME TRAINING INTERVENTION MODEL by Travis D

A patient-focused framework integrating self-management and informatics.

PubMed

Knight, Elizabeth P; Shea, Kimberly

2014-03-01

This article introduces a framework to (a) guide chronic illness self-management interventions through the integration of self-management and nursing informatics, (b) focus self-management research, and (c) promote ethical, patient-empowering technology use by practicing nurses. Existing theory and research focusing on chronic illness, self-management, health-enabling technology, and nursing informatics were reviewed and examined and key concepts were identified. A care paradigm focusing on concordance, rather than compliance, served as the overall guiding principle. This framework identifies key relationships among self-management (patient behaviors), health force (patient characteristics), and patient-defined goals. The role of health-enabling technology supporting these relationships is explored in the context of nursing informatics. The Empowerment Informatics framework can guide intervention design and evaluation and support practicing nurses' ethical use of technology as part of self-management support. Nurses worldwide provide support to patients who are living with chronic illnesses. As pressures related to cost and access to care increase, technology-enabled self-management interventions will become increasingly common. This patient-focused framework can guide nursing practice using technology that prioritizes patient needs. © 2013 Sigma Theta Tau International.

A Bachelor of Engineering Technology Curriculum in Water Quality Management: Course Guides.

ERIC Educational Resources Information Center

Cole, Charles A.; And Others

Contained are course guides for a Bachelor of Engineering Technology (BET) Curriculum in Water Quality Management. Detailed course content, as well as instructional resources, are included in this volume. Each guide is written in behavioral terms using the instructional objective format. A suggested curriculum is shown with methods of…

A Stress-Management Guide for Young People.

ERIC Educational Resources Information Center

Youngs, Bettie B.

This document presents a comprehensive guide to help young people understand and cope with stress, pressure, and anxiety. Adolescent readers are introduced to the concept of stress, the ways that stress can affect them, and the skills and techniques needed to help them learn effective ways to reduce and manage stress. The guide begins by defining…

Contract Management or Self-Operation: A Decision-Making Guide for Higher Education.

ERIC Educational Resources Information Center

Goldstein, Philip J.; And Others

This guide offers an objective framework for deciding whether self-operation or contract management (also known as privatization or "outsourcing") will best serve the goals and objectives of an individual institution of higher education. The guide is organized into four chapters. Chapter 1 briefly outlines the evolution of contract…

Student Guide for Documenting Experiential Learning: Business Management and Marketing.

ERIC Educational Resources Information Center

Coastline Community Coll., Fountain Valley, CA.

Coastline Community College has developed a series of guides to assist adults who wish to obtain college credit or advanced standing in evaluating and verifying their non-college learning experiences. This guide lists the competency requirements of seven courses within the Business Management and Marketing program: Principles of Accounting,…

Student Guide for Documenting Experiential Learning: Sales and Marketing Management.

ERIC Educational Resources Information Center

Coastline Community Coll., Fountain Valley, CA.

Coastline Community College has developed a series of guides to assist adults who wish to obtain college credit or advanced standing in evaluating and verifying their non-college learning experiences. This guide lists the competency requirements of six courses in the Sales and Marketing Management program: Principles of Accounting, Salesmanship,…

Consumer Education: Ecological Resource Management. Home & Family Life Curriculum Guide: H.E. Bulletin No. 43.

ERIC Educational Resources Information Center

Washington Office of the State Superintendent of Public Instruction, Olympia.

The future ability of secondary students to interact in a progressively technologically-oriented society is the purpose of this curriculum guide on consumer education. The guide teaches consumer decision-making, resource management, and advocacy/action. The introduction discusses the future of society and technology. Each of three sections…

Business Ownership and Management Core Curriculum. Teacher's Guide.

ERIC Educational Resources Information Center

National Business Education Association, Washington, DC.

This curriculum guide accompanies a business ownership and management curriculum designed for the prevocational and exploratory grade levels (grades 7-9). An explanation of the need for such a curriculum, an overview of the curriculum, and instructions for using this guide are included in the three introductory sections. Major content consists of…

Personal Money Management. Instructor's Guide. Third Edition.

ERIC Educational Resources Information Center

Bailard, Thomas E.; And Others

This instructor's guide is designed to accompany the text "Personal Money Management" and companion study guide (CE 023 968). It is intended to assist instructors in developing their own course outlines and teaching styles to suit the particular needs of their students. An introduction offers (1) an outline of the rationale behind the somewhat…

Personal Money Management. Study Guide. Third Edition.

ERIC Educational Resources Information Center

Bailard, Thomas E.; And Others

This guide is designed to accompany the text, Personal Money Management (CE 023 967), and the companion instructor's guide (CE 023 969). It is intended as an aid to understanding the materials read in the text and to applying the concepts and ideas to the student's own financial circumstances. Each chapter contains these sections: performance…

A Guide Management System Based on RFID and Bluetooth Technology

NASA Astrophysics Data System (ADS)

Li, Han-Sheng; Wang, Jun-Jun

The most fundamental and important requirement of the tour guide in the tour process is to ensure the safety of tourists. In this paper, a portable guide management system is designed based on RFID technology, the Android software and blue-tooth communication technology. Through this system, the guide can get real-time information if some tourists are l behind, and send text message or dial to those tourists who are l behind immediately. The system reduces the roll-calling time on the tourists, improves the tour guide work efficiency and service quality.

Guiding Principles for Data Requirements

EPA Pesticide Factsheets

The principles in the document are intended to help guide the identification of data needs, promote and optimize full use of existing knowledge, provide consistency in the data request process across all scientific disciplines for pesticide review.

Interim guide for optimum joint performance of concrete pavements.

DOT National Transportation Integrated Search

2011-09-01

The purpose of this guide is to help practitioners understand how to optimize concrete pavement joint performance through the identification, mitigation, and prevention of joint deterioration. It summarizes current knowledge from research and practic...

Management of Cardiac Tamponade: A Comperative Study between Echo-Guided Pericardiocentesis and Surgery—A Report of 100 Patients

PubMed Central

Gumrukcuoglu, Hasan Ali; Odabasi, Dolunay; Akdag, Serkan; Ekim, Hasan

2011-01-01

Background. Cardiac tamponade (CT) represents a life-threatening condition, and the optimal method of draining accumulated pericardial fluid remains controversial. We have reviewed 100 patients with CT at our institution over a five-year period and compared the results of echo-guided pericardiocentesis, primary surgical treatment, and surgical treatment following pericardiocentesis with regard to functional outcomes. Methods. The study group consisted of 100 patients with CT attending Yuzuncu Yil University from January 2005 to January 2010 who underwent one of the 3 treatment options (echo-guided pericardiocentesis, primary surgical treatment, and surgical treatment following pericardiocentesis). CT was defined by clinical and echocardiographic criteria. Data on medical history, characteristics of the pericardial fluid, treatment strategy, and follow-up data were collected. Results. Echo-guided pericardiocentesis was performed in 38 (38%) patients (Group A), primary surgical treatment was preformed in 36 (36%) patients (Group B), and surgical treatment following pericardiocentesis was performed in 26 (26%) patients (Group C). Idiopathic and malignant diseases were primary cause of tamponade (28% and 28%, resp.), followed by tuberculosis (14%). Total complication rates, 30-day mortality, and total mortality rates were highest in Group C. Recurrence of tamponade before 90 days was highest in Group A. Conclusions. According to our results, minimal invasive procedure echo-guided pericardiocentesis should be the first choice because of lower complication and mortality rates especially in idiopathic cases and in patients with hemodynamic instability. Surgical approach might be performed for traumatic cases, purulent, recurrent, or malign effusions with higher complication and mortality rates. PMID:21941665

Management of Cardiac Tamponade: A Comperative Study between Echo-Guided Pericardiocentesis and Surgery-A Report of 100 Patients.

PubMed

Gumrukcuoglu, Hasan Ali; Odabasi, Dolunay; Akdag, Serkan; Ekim, Hasan

2011-01-01

Background. Cardiac tamponade (CT) represents a life-threatening condition, and the optimal method of draining accumulated pericardial fluid remains controversial. We have reviewed 100 patients with CT at our institution over a five-year period and compared the results of echo-guided pericardiocentesis, primary surgical treatment, and surgical treatment following pericardiocentesis with regard to functional outcomes. Methods. The study group consisted of 100 patients with CT attending Yuzuncu Yil University from January 2005 to January 2010 who underwent one of the 3 treatment options (echo-guided pericardiocentesis, primary surgical treatment, and surgical treatment following pericardiocentesis). CT was defined by clinical and echocardiographic criteria. Data on medical history, characteristics of the pericardial fluid, treatment strategy, and follow-up data were collected. Results. Echo-guided pericardiocentesis was performed in 38 (38%) patients (Group A), primary surgical treatment was preformed in 36 (36%) patients (Group B), and surgical treatment following pericardiocentesis was performed in 26 (26%) patients (Group C). Idiopathic and malignant diseases were primary cause of tamponade (28% and 28%, resp.), followed by tuberculosis (14%). Total complication rates, 30-day mortality, and total mortality rates were highest in Group C. Recurrence of tamponade before 90 days was highest in Group A. Conclusions. According to our results, minimal invasive procedure echo-guided pericardiocentesis should be the first choice because of lower complication and mortality rates especially in idiopathic cases and in patients with hemodynamic instability. Surgical approach might be performed for traumatic cases, purulent, recurrent, or malign effusions with higher complication and mortality rates.

Rehabilitation and Prevention of Proximal Hamstring Tendinopathy.

PubMed

Beatty, Nicholas R; Félix, Ioonna; Hettler, Jessica; Moley, Peter J; Wyss, James F

Proximal hamstring tendinopathy (PHT) comprises a small but significant portion of hamstring injuries in athletes, especially runners. PHT is a chronic condition that is clinically diagnosed but can be supported with imaging. The main presenting complaint is pain in the lower gluteal or ischial region that may or may not radiate along the hamstrings in the posterior thigh. There is little scientific evidence on which to base the rehabilitation management of PHT. Treatment is almost always conservative, with a focus on activity modification, addressing contributing biomechanical deficiencies, effective tendon loading including eccentric training, and ultrasound-guided interventional procedures which may facilitate rehabilitation. Surgery is limited to recalcitrant cases or those involving concomitant high-grade musculotendinous pathology. The keys to PHT management include early and accurate diagnosis, optimal rehabilitation to allow for a safe return to preinjury activity level, and preventative strategies to reduce risk of reinjury.

Management of Labour and Delivery in a Patient With Acquired Factor VII Deficiency With Inhibitor: A Case Report.

PubMed

Matei, Anca; Dolan, Sean; Andrews, James; Rivard, Georges-Étienne

2016-02-01

Acquired factor VII (FVII) deficiency with inhibitor increases the risk of hemorrhage during pregnancy. However, there are no published reports guiding its management in the peripartum period. A 24-year-old woman with inhibitory antibodies to FVII delivered at 34 weeks of gestation. The patient was administered recombinant factor VIIa (rFVIIa) and tranexamic acid. There were no bleeding-related complications; however, the FVII level was supratherapeutic. The patient returned during a second pregnancy. A reduced dose of rFVIIa was administered. The delivery was complicated by postpartum hemorrhage, which resolved with the addition of uterotonic agents. Recombinant FVIIa and tranexamic acid offer an effective peripartum treatment in women with inhibitory antibody to FVII. Further research should delineate the optimal time of administration. Copyright © 2016 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

Challenges and opportunities in patient-specific, motion-managed and PET/CT-guided radiation therapy of lung cancer: review and perspective

PubMed Central

2012-01-01

The increasing interest in combined positron emission tomography (PET) and computed tomography (CT) to guide lung cancer radiation therapy planning has been well documented. Motion management strategies during treatment simulation PET/CT imaging and treatment delivery have been proposed to improve the precision and accuracy of radiotherapy. In light of these research advances, why has translation of motion-managed PET/CT to clinical radiotherapy been slow and infrequent? Solutions to this problem are as complex as they are numerous, driven by large inter-patient variability in tumor motion trajectories across a highly heterogeneous population. Such variation dictates a comprehensive and patient-specific incorporation of motion management strategies into PET/CT-guided radiotherapy rather than a one-size-fits-all tactic. This review summarizes challenges and opportunities for clinical translation of advances in PET/CT-guided radiotherapy, as well as in respiratory motion-managed radiotherapy of lung cancer. These two concepts are then integrated into proposed patient-specific workflows that span classification schemes, PET/CT image formation, treatment planning, and adaptive image-guided radiotherapy delivery techniques. PMID:23369522

Optimizing patient treatment decisions in an era of rapid technological advances: the case of hepatitis C treatment.

PubMed

Liu, Shan; Brandeau, Margaret L; Goldhaber-Fiebert, Jeremy D

2017-03-01

How long should a patient with a treatable chronic disease wait for more effective treatments before accepting the best available treatment? We develop a framework to guide optimal treatment decisions for a deteriorating chronic disease when treatment technologies are improving over time. We formulate an optimal stopping problem using a discrete-time, finite-horizon Markov decision process. The goal is to maximize a patient's quality-adjusted life expectancy. We derive structural properties of the model and analytically solve a three-period treatment decision problem. We illustrate the model with the example of treatment for chronic hepatitis C virus (HCV). Chronic HCV affects 3-4 million Americans and has been historically difficult to treat, but increasingly effective treatments have been commercialized in the past few years. We show that the optimal treatment decision is more likely to be to accept currently available treatment-despite expectations for future treatment improvement-for patients who have high-risk history, who are older, or who have more comorbidities. Insights from this study can guide HCV treatment decisions for individual patients. More broadly, our model can guide treatment decisions for curable chronic diseases by finding the optimal treatment policy for individual patients in a heterogeneous population.

Optimizing Patient Treatment Decisions in an Era of Rapid Technological Advances: The Case of Hepatitis C Treatment

PubMed Central

Liu, Shan; Goldhaber-Fiebert, Jeremy D.; Brandeau, Margaret L.

2015-01-01

How long should a patient with a treatable chronic disease wait for more effective treatments before accepting the best available treatment? We develop a framework to guide optimal treatment decisions for a deteriorating chronic disease when treatment technologies are improving over time. We formulate an optimal stopping problem using a discrete-time, finite-horizon Markov decision process. The goal is to maximize a patient’s quality-adjusted life expectancy. We derive structural properties of the model and analytically solve a three-period treatment decision problem. We illustrate the model with the example of treatment for chronic hepatitis C virus (HCV). Chronic HCV affects 3–4 million Americans and has been historically difficult to treat, but increasingly effective treatments have been commercialized in the past few years. We show that the optimal treatment decision is more likely to be to accept currently available treatment—despite expectations for future treatment improvement—for patients who have high-risk history, who are older, or who have more comorbidities. Insights from this study can guide HCV treatment decisions for individual patients. More broadly, our model can guide treatment decisions for curable chronic diseases by finding the optimal treatment policy for individual patients in a heterogeneous population. PMID:26188961

Classifier-Guided Sampling for Complex Energy System Optimization

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

Backlund, Peter B.; Eddy, John P.

2015-09-01

This report documents the results of a Laboratory Directed Research and Development (LDRD) effort enti tled "Classifier - Guided Sampling for Complex Energy System Optimization" that was conducted during FY 2014 and FY 2015. The goal of this proj ect was to develop, implement, and test major improvements to the classifier - guided sampling (CGS) algorithm. CGS is type of evolutionary algorithm for perform ing search and optimization over a set of discrete design variables in the face of one or more objective functions. E xisting evolutionary algorithms, such as genetic algorithms , may require a large number of omore » bjecti ve function evaluations to identify optimal or near - optimal solutions . Reducing the number of evaluations can result in significant time savings, especially if the objective function is computationally expensive. CGS reduce s the evaluation count by us ing a Bayesian network classifier to filter out non - promising candidate designs , prior to evaluation, based on their posterior probabilit ies . In this project, b oth the single - objective and multi - objective version s of the CGS are developed and tested on a set of benchm ark problems. As a domain - specific case study, CGS is used to design a microgrid for use in islanded mode during an extended bulk power grid outage.« less

Fashion Production and Management Program Guide.

ERIC Educational Resources Information Center

Georgia Univ., Athens. Div. of Vocational Education.

This program guide presents the standard fashion production and management curriculum for technical institutes in Georgia. It is designed to relate primarily to the development of those skills needed to become a qualified alterationist, clothing design assistant, home textiles assistant, fashion management assistant, or tailoring assistant. A…

Optimal water resource allocation modelling in the Lowveld of Zimbabwe

NASA Astrophysics Data System (ADS)

Mhiribidi, Delight; Nobert, Joel; Gumindoga, Webster; Rwasoka, Donald T.

2018-05-01

The management and allocation of water from multi-reservoir systems is complex and thus requires dynamic modelling systems to achieve optimality. A multi-reservoir system in the Southern Lowveld of Zimbabwe is used for irrigation of sugarcane estates that produce sugar for both local and export consumption. The system is burdened with water allocation problems, made worse by decommissioning of dams. Thus the aim of this research was to develop an operating policy model for the Lowveld multi-reservoir system.The Mann Kendall Trend and Wilcoxon Signed-Rank tests were used to assess the variability of historic monthly rainfall and dam inflows for the period 1899-2015. The WEAP model was set up to evaluate the water allocation system of the catchment and come-up with a reference scenario for the 2015/2016 hydrologic year. Stochastic Dynamic Programming approach was used for optimisation of the multi-reservoirs releases.Results showed no significant trend in the rainfall but a significantly decreasing trend in inflows (p < 0.05). The water allocation model (WEAP) showed significant deficits ( ˜ 40 %) in irrigation water allocation in the reference scenario. The optimal rule curves for all the twelve months for each reservoir were obtained and considered to be a proper guideline for solving multi- reservoir management problems within the catchment. The rule curves are effective tools in guiding decision makers in the release of water without emptying the reservoirs but at the same time satisfying the demands based on the inflow, initial storage and end of month storage.

Flood Catastrophe Model for Designing Optimal Flood Insurance Program: Estimating Location-Specific Premiums in the Netherlands.

PubMed

Ermolieva, T; Filatova, T; Ermoliev, Y; Obersteiner, M; de Bruijn, K M; Jeuken, A

2017-01-01

As flood risks grow worldwide, a well-designed insurance program engaging various stakeholders becomes a vital instrument in flood risk management. The main challenge concerns the applicability of standard approaches for calculating insurance premiums of rare catastrophic losses. This article focuses on the design of a flood-loss-sharing program involving private insurance based on location-specific exposures. The analysis is guided by a developed integrated catastrophe risk management (ICRM) model consisting of a GIS-based flood model and a stochastic optimization procedure with respect to location-specific risk exposures. To achieve the stability and robustness of the program towards floods with various recurrences, the ICRM uses stochastic optimization procedure, which relies on quantile-related risk functions of a systemic insolvency involving overpayments and underpayments of the stakeholders. Two alternative ways of calculating insurance premiums are compared: the robust derived with the ICRM and the traditional average annual loss approach. The applicability of the proposed model is illustrated in a case study of a Rotterdam area outside the main flood protection system in the Netherlands. Our numerical experiments demonstrate essential advantages of the robust premiums, namely, that they: (1) guarantee the program's solvency under all relevant flood scenarios rather than one average event; (2) establish a tradeoff between the security of the program and the welfare of locations; and (3) decrease the need for other risk transfer and risk reduction measures. © 2016 Society for Risk Analysis.

DISSECT: a new mnemonic-based approach to the categorization of aortic dissection.

PubMed

Dake, M D; Thompson, M; van Sambeek, M; Vermassen, F; Morales, J P

2013-08-01

Classification systems for aortic dissection provide important guides to clinical decision-making, but the relevance of traditional categorization schemes is being questioned in an era when endovascular techniques are assuming a growing role in the management of this frequently complex and catastrophic entity. In recognition of the expanding range of interventional therapies now used as alternatives to conventional treatment approaches, the Working Group on Aortic Diseases of the DEFINE Project developed a categorization system that features the specific anatomic and clinical manifestations of the disease process that are most relevant to contemporary decision-making. The DISSECT classification system is a mnemonic-based approach to the evaluation of aortic dissection. It guides clinicians through an assessment of six critical characteristics that facilitate optimal communication of the most salient details that currently influence the selection of a therapeutic option, including those findings that are key when considering an endovascular procedure, but are not taken into account by the DeBakey or Stanford categorization schemes. The six features of aortic dissection include: duration of disease; intimal tear location; size of the dissected aorta; segmental extent of aortic involvement; clinical complications of the dissection, and thrombus within the aortic false lumen. In current clinical practice, endovascular therapy is increasingly considered as an alternative to medical management or open surgical repair in select cases of type B aortic dissection. Currently, endovascular aortic repair is not used for patients with type A aortic dissection, but catheter-based techniques directed at peripheral branch vessel ischemia that may complicate type A dissection are considered valuable adjunctive interventions, when indicated. The use of a new system for categorization of aortic dissection, DISSECT, addresses the shortcomings of well-known established schemes devised more than 40 years ago, before the introduction of endovascular techniques. It will serve as a guide to support a critical analysis of contemporary therapeutic options and inform management decisions based on specific features of the disease process. Copyright © 2013 European Society for Vascular Surgery. All rights reserved.

Status Update on the NCRP Scientific Committee SC 5-1 Report: Decision Making for Late-Phase Recovery from Nuclear or Radiological Incidents - 13450

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

Chen, S.Y.

2013-07-01

In August 2008, the U.S. Department of Homeland Security (DHS) issued its final Protective Action Guide (PAG) for radiological dispersal device (RDD) and improvised nuclear device (IND) incidents. This document specifies protective actions for public health during the early and intermediate phases and cleanup guidance for the late phase of RDD or IND incidents, and it discusses approaches to implementing the necessary actions. However, while the PAG provides specific guidance for the early and intermediate phases, it prescribes no equivalent guidance for the late-phase cleanup actions. Instead, the PAG offers a general description of a complex process using a site-specificmore » optimization approach. This approach does not predetermine cleanup levels but approaches the problem from the factors that would bear on the final agreed-on cleanup levels. Based on this approach, the decision-making process involves multifaceted considerations including public health, the environment, and the economy, as well as socio-political factors. In an effort to fully define the process and approach to be used in optimizing late-phase recovery and site restoration following an RDD or IND incident, DHS has tasked the NCRP with preparing a comprehensive report addressing all aspects of the optimization process. Preparation of the NCRP report is a three-year (2010-2013) project assigned to a scientific committee, the Scientific Committee (SC) 5-1; the report was initially titled, Approach to Optimizing Decision Making for Late- Phase Recovery from Nuclear or Radiological Terrorism Incidents. Members of SC 5-1 represent a broad range of expertise, including homeland security, health physics, risk and decision analysis, economics, environmental remediation and radioactive waste management, and communication. In the wake of the Fukushima nuclear accident of 2011, and guided by a recent process led by the White House through a Principal Level Exercise (PLE), the optimization approach has since been expanded to include off-site contamination from major nuclear power plant accidents as well as other nuclear or radiological incidents. The expanded application under the current guidance has thus led to a broadened scope of the report, which is reflected in its new title, Decision Making for Late-Phase Recovery from Nuclear or Radiological Incidents. The NCRP report, which is due for publication in 2013, will substantiate the current DHS guidance by clarifying and elaborating on the processes required for the development and implementation of procedures for optimizing decision making for late-phase recovery, enabling the establishment of cleanup goals on a site-specific basis. The report will contain a series of topics addressing important issues related to the long-term recovery from nuclear or radiological incidents. Special topics relevant to supporting the optimization of the decision-making process will include cost-benefit analysis, radioactive waste management, risk communication, stakeholder interaction, risk assessment, and decontamination approaches and techniques. The committee also evaluated past nuclear and radiological incidents for their relevance to the report, including the emerging issues associated with the Fukushima nuclear accident. Thus, due to the commonality of the late-phase issues (such as the potential widespread contamination following an event), the majority of the information pertaining to the response in the late-phase decision-making period, including site-specific optimization framework and approach, could be used or adapted for use in case of similar situations that are not due to terrorism, such as those that would be caused by major nuclear facility accidents or radiological incidents. To ensure that the report and the NCRP recommendations are current and relevant to the effective implementation of federal guidance, SC 5-1 has actively coordinated with the agencies of interest and other relevant stakeholders throughout the duration of the project. The resulting report will be an important resource to guide those involved in late-phase recovery efforts following a nuclear or radiological incident. (authors)« less

An Improved Quantum-Behaved Particle Swarm Optimization Algorithm with Elitist Breeding for Unconstrained Optimization.

PubMed

Yang, Zhen-Lun; Wu, Angus; Min, Hua-Qing

2015-01-01

An improved quantum-behaved particle swarm optimization with elitist breeding (EB-QPSO) for unconstrained optimization is presented and empirically studied in this paper. In EB-QPSO, the novel elitist breeding strategy acts on the elitists of the swarm to escape from the likely local optima and guide the swarm to perform more efficient search. During the iterative optimization process of EB-QPSO, when criteria met, the personal best of each particle and the global best of the swarm are used to generate new diverse individuals through the transposon operators. The new generated individuals with better fitness are selected to be the new personal best particles and global best particle to guide the swarm for further solution exploration. A comprehensive simulation study is conducted on a set of twelve benchmark functions. Compared with five state-of-the-art quantum-behaved particle swarm optimization algorithms, the proposed EB-QPSO performs more competitively in all of the benchmark functions in terms of better global search capability and faster convergence rate.

7 CFR Guide 1 to Subpart G of... - Project Management Agreement Between the ____ Regional Commission and the Farmers Home...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 13 2010-01-01 2009-01-01 true Project Management Agreement Between the ____ Regional... Guide 1 to Subpart G of Part 1942—Project Management Agreement Between the ____ Regional Commission and... successor agency under Public Law 103-354, in concurring to this Project Management Agreement, hereby...

Beyond the Award Letter: Fund Management for Leaders of Small Youth-Serving Organizations

ERIC Educational Resources Information Center

Gager, Jenifer; Marchand, Vicky

2009-01-01

This paper was created for executive directors, directors of finance and administration, and program managers of small youth-serving non-profit organizations. This guide supports and enhances the systems they use to manage grants and contracts. This guide is organized to use as a quick self-assessment of their fund management practices: (1) seven…

Federal Emergency Management Information System (FEMIS) system administration guide. Version 1.2

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

Burford, M.J.; Burnett, R.A.; Curtis, L.M.

The Federal Emergency Management Information System (FEMIS) is an emergency management planning and analysis tool that is being developed under the direction of the US Army Chemical biological Defense Command. The FEMIS System Administration Guide defines FEMIS hardware and software requirements and gives instructions for installing the FEMIS system package. System administrators, database administrators, and general users can use this guide to install, configure, and maintain the FEMIS client software package. This document provides a description of the FEMIS environment; distribution media; data, communications, and electronic mail servers; user workstations; and system management.

Detection of MDR1 mRNA expression with optimized gold nanoparticle beacon

NASA Astrophysics Data System (ADS)

Zhou, Qiumei; Qian, Zhiyu; Gu, Yueqing

2016-03-01

MDR1 (multidrug resistance gene) mRNA expression is a promising biomarker for the prediction of doxorubicin resistance in clinic. However, the traditional technical process in clinic is complicated and cannot perform the real-time detection mRNA in living single cells. In this study, the expression of MDR1 mRNA was analyzed based on optimized gold nanoparticle beacon in tumor cells. Firstly, gold nanoparticle (AuNP) was modified by thiol-PEG, and the MDR1 beacon sequence was screened and optimized using a BLAST bioinformatics strategy. Then, optimized MDR1 molecular beacons were characterized by transmission electron microscope, UV-vis and fluorescence spectroscopies. The cytotoxicity of MDR1 molecular beacon on L-02, K562 and K562/Adr cells were investigated by MTT assay, suggesting that MDR1 molecular beacon was low inherent cytotoxicity. Dark field microscope was used to investigate the cellular uptake of hDAuNP beacon assisted with ultrasound. Finally, laser scanning confocal microscope images showed that there was a significant difference in MDR1 mRNA expression in K562 and K562/Adr cells, which was consistent with the results of q-PCR measurement. In summary, optimized MDR1 molecular beacon designed in this study is a reliable strategy for detection MDR1 mRNA expression in living tumor cells, and will be a promising strategy for in guiding patient treatment and management in individualized medication.

Rotorcraft Diagnostics

NASA Technical Reports Server (NTRS)

Haste, Deepak; Azam, Mohammad; Ghoshal, Sudipto; Monte, James

2012-01-01

Health management (HM) in any engineering systems requires adequate understanding about the system s functioning; a sufficient amount of monitored data; the capability to extract, analyze, and collate information; and the capability to combine understanding and information for HM-related estimation and decision-making. Rotorcraft systems are, in general, highly complex. Obtaining adequate understanding about functioning of such systems is quite difficult, because of the proprietary (restricted access) nature of their designs and dynamic models. Development of an EIM (exact inverse map) solution for rotorcraft requires a process that can overcome the abovementioned difficulties and maximally utilize monitored information for HM facilitation via employing advanced analytic techniques. The goal was to develop a versatile HM solution for rotorcraft for facilitation of the Condition Based Maintenance Plus (CBM+) capabilities. The effort was geared towards developing analytic and reasoning techniques, and proving the ability to embed the required capabilities on a rotorcraft platform, paving the way for implementing the solution on an aircraft-level system for consolidation and reporting. The solution for rotorcraft can he used offboard or embedded directly onto a rotorcraft system. The envisioned solution utilizes available monitored and archived data for real-time fault detection and identification, failure precursor identification, and offline fault detection and diagnostics, health condition forecasting, optimal guided troubleshooting, and maintenance decision support. A variant of the onboard version is a self-contained hardware and software (HW+SW) package that can be embedded on rotorcraft systems. The HM solution comprises components that gather/ingest data and information, perform information/feature extraction, analyze information in conjunction with the dependency/diagnostic model of the target system, facilitate optimal guided troubleshooting, and offer decision support for optimal maintenance.

The good CPD guide: A practical guide to managed continuing professional development in medicine Janet Grant The good CPD guide: A practical guide to managed continuing professional development in medicine Radcliffe Publishing 190pp £29.99 9781846195709 1846195705 [Formula: see text].

PubMed

2012-02-10

DURING HARD times, when education budgets decrease, the purpose of continuing professional development (CPD) programmes must be made clear to practitioners and services. Clarity is crucial in ensuring that CPD programmes receive adequate funding, and that enough time and professional effort are devoted to them.

Cash Management/Data Matching. Training Guide.

ERIC Educational Resources Information Center

Office of Student Financial Assistance (ED), Washington, DC.

This training guide for financial aid staff explains the process of direct loan reconciliation and suggests appropriate cash management accounting practices. Chapter 1 explains the importance of cash management, the role of data matching, and reviews basic reconciliation concepts and terms and direct loan reporting requirements. Chapter 2 reviews…

Fiscal Management Training. Participant's Guide.

ERIC Educational Resources Information Center

Office of Student Financial Assistance (ED), Washington, DC.

This document is the participant's guide for fiscal management training for administrators managing an institution's Title IV program funds. The workshop is designed to prepare participants to understand an institution's responsibilities with regard to Title IV. It describes the recordkeeping requirements of the Title IV program and the accounting…

Turf and Lawn Management: A Course in Agricultural Education. Curriculum Guide. Preliminary Draft.

ERIC Educational Resources Information Center

Mercer, R. J., Ed.

The curriculum guide (preliminary draft) is a result of the revision of the total South Carolina agricultural education curriculum; the scope of the turf and lawn management industry and its direct and indirect employment opportunities provide ample reasons for such a course offering in South Carolina high schools. The guide presents objectives,…

Kentucky Consumer & Homemaking Education. Management-Consumer Education. Curriculum Guide, Comprehensive Courses.

ERIC Educational Resources Information Center

Waldrop, Suzanne H.

Intended for use by teachers on the junior high and high school levels, this curriculum guide, which is one in a series of guides for consumer and homemaking education in Kentucky, outlines three courses in the area of management-consumer education. The junior high unit acquaints the student with the concepts of decision making and assessing…

Bug Off: A Guide for Integrated Pest Management in Granville Schools.

ERIC Educational Resources Information Center

2001

This guide describes options for the Granville schools when dealing with pests. It is based on Integrated Pest Management (IPM), a philosophy that employs safe and practical pest control methods. The guide can be used to incorporate IPM philosophy into the school systems. The first section provides the environmental context for an interest in…

Contract Administration: Understanding Limitations on Management Rights. A Presenter's Guide. Research Based Training for School Administrators.

ERIC Educational Resources Information Center

Oregon Univ., Eugene. Center for Educational Policy and Management.

This workshop presenter's guide is intended for use by administrators in training one another in the Project Leadership program developed by the Association of California School Administrators (ACSA). The purpose of this particular guide is to train administrators to interpret common contract provisions that affect management's decision-making…

Smoke management guide for prescribed and wildland fire: 2001 edition.

Treesearch

Colin C. Hardy; Roger D. Ottmar; Janice L Peterson; John E. Core; Paula Seamon

2001-01-01

The National Wildfire Coordinating Group's (NWCG) Fire Use Working Team has assumed overall responsibility for sponsoring the development and production of this revised Smoke Management Guide for Prescribed and Wildland Fire (the "Guide"). The Mission Statement for the Fire Use Working Team includes the need to coordinate and advocate the use of fire to...

Pathways to a Sustainable Future: A Curriculum Guide for Maine Schools Exploring Waste Management Issues.

ERIC Educational Resources Information Center

Chewonki Foundation, Wiscasset, ME.

This action guide is designed to help students and teachers become aware of the concepts and issues of waste management, and to motivate them to action in the classroom, school, home, and community. The guide emphasizes interdisciplinary activities that concentrate on the process of problem solving. Activities are identified by appropriate grade…

A Manager's Guide to Objectives. Revised Edition.

ERIC Educational Resources Information Center

Miller, Donald R.; And Others

This guide, focusing on participative management and the requirements of public decision-making in education, is designed as a management referent for the development and use of verifiable performance objectives. In addition to an indexed main section, the volume contains an anlysis matrix for educational objectives; formats for and examples of…

Total School Energy Management Program.

ERIC Educational Resources Information Center

Energy Education Programs, Woodstock, IL.

This energy management program is intended to give school administrators some ideas about how to get started in managing energy conservation. An Implementation Guide provides options and step-by-step approaches for marshaling resources and organizing to get a program off the ground. A Curriculum Review and Development Guide includes general…

Improving Education Together: A Guide to Labor-Management­-Community Collaboration

ERIC Educational Resources Information Center

Marietta, Geoff; d'Entremont, Chad; Murphy Kaur, Emily

2017-01-01

"Improving Education Together" offers a step-by-step guide to Labor-Management-Community (LMC) collaboration, an intervention that has successfully improved student outcomes in a wide variety of school districts across the country. The authors illustrate how a culture of collaboration between labor, management, and community stakeholders…

Improving Education Together: A Guide to Labor-Management-Community Collaboration

ERIC Educational Resources Information Center

Marietta, Geoff; d'Entremont, Chad; Kaur, Emily Murphy

2017-01-01

"Improving Education Together" offers a step-by-step guide to Labor-Management-Community (LMC) collaboration, an intervention that has successfully improved student outcomes in a wide variety of school districts across the country. The authors illustrate how a culture of collaboration between labor, management, and community stakeholders…

Action Guide for Emergency Management at Institutions of Higher Education

ERIC Educational Resources Information Center

Office of Safe and Drug-Free Schools, US Department of Education, 2010

2010-01-01

This "Action Guide for Emergency Management at Higher Education Institutions" has been developed to give higher education institutions a useful resource in the field of emergency management. It is intended for community colleges, four-year colleges and universities, graduate schools, and research institutions associated with higher education…

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…

Issues for Active State Management of the JTPA Title III Grant: A Guide for State Planners and Managers.

ERIC Educational Resources Information Center

Reesman, Cilla J.

This technical assistance guide presents the various options available to state planners and managers in considering five elements of active grant management. Each element is treated in a separate chapter. Chapter 1 addresses issues surrounding the setting of policies that ensure that Title III grants complement state agendas. Chapter 2 concerns…

Resource Management Resource Guide. A Resource for Teaching the Resource Management Core Course Area of Ohio's Work and Family Life Program.

ERIC Educational Resources Information Center

Kister, Joanna; And Others

This Resource Management Resource Guide is intended to help teachers implement Ohio's Work and Family Life Program. Course content focuses on the practical problems related to managing human and material resources, making consumer decisions, and feeding, clothing, and housing the family. These practical problems are posed through case studies and…

Transrectal EUS-guided FNA biopsy of a presacral chordoma-report of a case and review of the literature

PubMed Central

Gottlieb, Klaus; Lin, Paul H; Liu, David M; Anders, Karl

2008-01-01

Chordomas are rare tumors which originate from the remnants of the notochord. These tumors are locally aggressive and have a predilection for the ends of the axial skeleton. An important prerequisite for optimal management of these tumors is a correct preoperative diagnosis. The present case is the first report of the use of endoscopic ultrasound to obtain transrectal fine needle aspiration biopsy of a presacral chordoma. A review of the prior computer tomography (CT) scans allowed us to calculate the tumor volume doubling time (18.3 mo). Transrectal biopsy of chordomas is controversial, however we believe that such concerns are not justified. PMID:18442211

Mechanical System Analysis/Design Tool (MSAT) Quick Guide

NASA Technical Reports Server (NTRS)

Lee, HauHua; Kolb, Mark; Madelone, Jack

1998-01-01

MSAT is a unique multi-component multi-disciplinary tool that organizes design analysis tasks around object-oriented representations of configuration components, analysis programs and modules, and data transfer links between them. This creative modular architecture enables rapid generation of input stream for trade-off studies of various engine configurations. The data transfer links automatically transport output from one application as relevant input to the next application once the sequence is set up by the user. The computations are managed via constraint propagation - the constraints supplied by the user as part of any optimization module. The software can be used in the preliminary design stage as well as during the detail design of product development process.

Guide for optimizing the effectiveness and the efficiency of roadway lighting.

DOT National Transportation Integrated Search

2012-06-01

The objective of the present project was to develop a simple guide for roadway lighting replacement : approaches using new light source technologies to maintain visibility for safety, while reducing energy use. : Several roadway types were evaluated:...

National Library of Medicine

MedlinePlus

... Disasters and Public Health Emergencies The NLM Disaster Information Management Research Center has tools, guides, and databases to ... Disasters and Public Health Emergencies The NLM Disaster Information Management Research Center has tools, guides, and databases to ...

77 FR 23277 - Proposed Leasehold Surrender Interest Guide

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-18

... Harvey, Asset Management Branch Chief, 202-513-7150. Before including your address, phone number, email... Management Improvement Act of 1998 (Pub. L. 105-391; 36 CFR part 51), the proposed LSI Guide provides...

Maritime labor-management affiliation guide 2000

DOT National Transportation Integrated Search

2000-01-01

This guide presents brief descriptions of major maritime management and trade organizations, seafaring labor organizations and their affiliations. Also included are U.S.-flag ship owner/operator companies, and their union affiliations. A directory of...

Public health program planning logic model for community engaged type 2 diabetes management and prevention.

PubMed

West, Joseph F

2014-02-01

Diabetes remains a growing epidemic with widening health inequity gaps in disease management, self-management knowledge, access to care and outcomes. Yet there is a paucity of evaluation tools for community engaged interventions aimed at closing the gaps and improving health. The Guide to Community Preventive Services (the Community Guide) developed by the Task Force on Community Preventive Services (the Task Force) at the Centers for Disease Control and Prevention (CDC) recommends two healthcare system level interventions, case management interventions and disease management programs, to improve glycemic control. However, as a public health resource guide for diabetes interventions a model for community engagement is a glaringly absent component of the Community Guide recommendations. In large part there are few evidence-based interventions featuring community engagement as a practice and system-level focus of chronic disease and Type 2 diabetes management. The central argument presented in this paper is that the absence of these types of interventions is due to the lack of tools for modeling and evaluating such interventions, especially among disparate and poor populations. A conceptual model emphasizing action-oriented micro-level community engagement is needed to complement the Community Guide and serve as the basis for testing and evaluation of these kinds of interventions. A unique logic model advancing the Community Guide diabetes recommendations toward measureable and sustainable community engagement for improved Type 2 diabetes outcomes is presented. Copyright © 2013 Elsevier Ltd. All rights reserved.

Optimized guide RNA structure for genome editing via Cas9

PubMed Central

Xu, Jianyong; Lian, Wei; Jia, Yuning; Li, Lingyun; Huang, Zhong

2017-01-01

The genome editing tool Cas9-gRNA (guide RNA) has been successfully applied in different cell types and organisms with high efficiency. However, more efforts need to be made to enhance both efficiency and specificity. In the current study, we optimized the guide RNA structure of Streptococcus pyogenes CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats)/Cas (CRISPR-associated) system to improve its genome editing efficiency. Comparing with the original functional structure of guide RNA, which is composed of crRNA and tracrRNA, the widely used chimeric gRNA has shorter crRNA and tracrRNA sequence. The deleted RNA sequence could form extra loop structure, which might enhance the stability of the guide RNA structure and subsequently the genome editing efficiency. Thus the genome editing efficiency of different forms of guide RNA was tested. And we found that the chimeric structure of gRNA with original full length of crRNA and tracrRNA showed higher genome editing efficiency than the conventional chimeric structure or other types of gRNA we tested. Therefore our data here uncovered the new type of gRNA structure with higher genome editing efficiency. PMID:29212218

Project Overview: A Reef Manager's Guide to Coral Bleaching ...

EPA Pesticide Factsheets

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 A Reef Manager’s Guide to Coral Bleaching is the result of a collaborative effort by over 50 scientists and managers to: (1) share the best available scientific information on climate-related coral bleaching; and (2) compile a tool kit of currently available strategies for adaptive management of coral reefs in a changing climate. The result is a compendium of current information, tools, and practical suggestions to aid managers in their efforts to protect reefs in a way that maximizes reef resilience in the face of continuing climate change. The Guide is a joint publication of the National Oceanic and Atmospheric Administration, the Great Barrier Reef Marine Park Authority, and The World Conservation Union, with author contributions from a variety of international partners from government agencies, non-governmental organizations, and academic institutions. EPA’s Office of Research and Development was a major contributor to the Guide through authorship and participation in the final review and editing process for the entire report. A Reef Manager’s Guide to Coral Bleaching is the result of a collaborative effort by over 50 scientists and managers to: (1) share the best available scientific information on climate-related coral blea

A novel applicator design for intracavitary brachytherapy of the nasopharynx: Simulated reconstruction, image-guided adaptive brachytherapy planning, and dosimetry.

PubMed

Bacorro, Warren R; Agas, Ryan Anthony F; Cabrera, Stellar Marie R; Bojador, Maureen R; Sogono, Paolo G; Mejia, Michael Benedict A; Sy Ortin, Teresa T

2018-05-11

In nasopharyngeal cancer, brachytherapy is given as boost in primary treatment or as salvage for recurrent or persistent disease. The Rotterdam nasopharyngeal applicator (RNA) allows for suboptimal reduction of soft palate radiation dose, based on image-guided brachytherapy plans. Building on the RNA, we propose a novel design, the Benavides nasopharyngeal applicator (BNA). The virtual BNA was reconstructed on two cases (one T1, one T2) previously treated with intracavitary brachytherapy using the RNA. Dose was prescribed to the high-risk clinical target volumes (CTVs) and optimization was such that high-risk CTV D90 ≥ 100% of prescribed dose (PD), intermediate-risk-CTV D90 ≥ 75% PD, and soft palate D2cc ≤ 120% PD. The optimized RNA and BNA image-guided brachytherapy plans were compared in terms of CTV coverage and organs-at-risk sparing. Optimization objectives were more easily met with the BNA. For the T1 case, all three planning objectives were easily achieved in both the RNA and BNA, but with 18-19% lower soft palate doses with the BNA. For the T2 case, the CTV planning objectives were achieved in both the RNA and BNA, but the soft palate constraint was only achieved with the BNA, with 38-41% lower soft palate doses. Compared to the RNA, the BNA permits easier optimization and improves therapeutic ratio by a significant reduction of soft palate doses, based on simulation using a proposed system for CTV/organs-at-risk delineation, prescription, and optimization for image-guided adaptive brachytherapy. Clinical piloting using a prototype is necessary to evaluate its feasibility and utility. Copyright © 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Supply-Chain Optimization Template

NASA Technical Reports Server (NTRS)

Quiett, William F.; Sealing, Scott L.

2009-01-01

The Supply-Chain Optimization Template (SCOT) is an instructional guide for identifying, evaluating, and optimizing (including re-engineering) aerospace- oriented supply chains. The SCOT was derived from the Supply Chain Council s Supply-Chain Operations Reference (SCC SCOR) Model, which is more generic and more oriented toward achieving a competitive advantage in business.

Facilities Information Management: A Guide for State and Local Education Agencies. NCES 2003-400

ERIC Educational Resources Information Center

National Center for Education Statistics (ED), Washington, DC.

This Guide has been developed to provide a framework for decision makers, school facility managers, and the public to identify a basic set of school facilities data elements, including definitions that will meet their information needs. Chapter 1 describes the purpose, scope, and intended audience for this guide. Chapter 2 describes how to use the…

Library Subject Guides: A Content Management Case Study at the Open University, UK

ERIC Educational Resources Information Center

Wales, Tim

2005-01-01

Purpose: To share the experiences and challenges faced by the Open University Library (OUL) in developing a content management (CM) system for its subject guides. Design/methodology/approach: A summary of multi-format subject guide production at the OUL is provided to justify the decision to develop a new system for their production using a…

Kentucky Consumer & Homemaking Education. Clothing Management. Curriculum Guide, Semester Course.

ERIC Educational Resources Information Center

Powers, Betty C.

Intended for use by teachers at the high school level, this curriculum guide, which is one in a series of guides for consumer and homemaking education in Kentucky, outlines a semester special interest course in clothing management. As the concluding course of a curriculum on this subject which commences on the junior high level in a separate guide…

Life Management: Moving Out! Solving Practical Problems for Independent Living. Utah Home Economics and Family Life Curriculum Guide.

ERIC Educational Resources Information Center

Utah State Office of Education, Salt Lake City.

This guide, which has been developed for Utah's home economics and family life education program, contains materials for use in teaching a life management course emphasizing the problem-solving skills required for independent living. Discussed first are the assumptions underlying the curriculum, development of the guide, and suggestions for its…

eHealth: individualization of mesalazine treatment through a self-managed web-based solution in mild-to-moderate ulcerative colitis.

PubMed

Pedersen, Natalia; Thielsen, Peter; Martinsen, Lars; Bennedsen, Mette; Haaber, Anne; Langholz, Ebbe; Végh, Zsuzsanna; Duricova, Dana; Jess, Tine; Bell, Sally; Burisch, Johan; Munkholm, Pia

2014-12-01

To individualize treatment with mesalazine for ulcerative colitis relapses through a self-managed, web-based solution to optimize the short-term disease course. Prospective, open-label, web-guided study with 3 months mesalazine therapy among patients with mild-to-moderate ulcerative colitis. Once a week, patients completed the simple clinical colitis activity index (SCCAI) and registered fecal calprotectin (FC) on the web application: www.meza.constant-care.dk. SCCAI and FC were summed and resulted in a total inflammatory burden score (TIBS). Deep remission was defined as SCCAI ≤1; FC = 0, and TIBS ≤1. A total of 95 patients (62% females; median age 45 yr) were included in the study and allocated 4.8 g mesalazine per day. Of these, 82 (86%) patients were adherent to web therapy, completing 3 months of web-guided mesalazine therapy. Of the 82 adherent patients, 72 (88%) continued mesalazine and 10 (12%) needed rescue therapy. From weeks 0 to 12, patients had experienced a significant reduction in mean SCCAI (4.6 versus 1.6, P < 0.001), mean FC (437 versus 195, P < 0.001), and mean TIBS (6.7 versus 2.4, P < 0.001). Based on TIBS values (≤1), the dose of mesalazine was reduced to 2.4 g in 25% of patients at week 3 in 50% of subjects at week 5 and in 88% of patients at week 12. Web-guided therapy with mesalazine in mild-to-moderate ulcerative colitis helps to individualize the dose and improve adherence to therapy. The study confirms mesalazine efficacy in mild-to-moderate UC, significantly improving TIBS values in majority of the patients.

Water Use Optimization Toolset Project: Development and Demonstration Phase Draft Report

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

Gasper, John R.; Veselka, Thomas D.; Mahalik, Matthew R.

2014-05-19

This report summarizes the results of the development and demonstration phase of the Water Use Optimization Toolset (WUOT) project. It identifies the objective and goals that guided the project, as well as demonstrating potential benefits that could be obtained by applying the WUOT in different geo-hydrologic systems across the United States. A major challenge facing conventional hydropower plants is to operate more efficiently while dealing with an increasingly uncertain water-constrained environment and complex electricity markets. The goal of this 3-year WUOT project, which is funded by the U.S. Department of Energy (DOE), is to improve water management, resulting in moremore » energy, revenues, and grid services from available water, and to enhance environmental benefits from improved hydropower operations and planning while maintaining institutional water delivery requirements. The long-term goal is for the WUOT to be used by environmental analysts and deployed by hydropower schedulers and operators to assist in market, dispatch, and operational decisions.« less

Data mining to support simulation modeling of patient flow in hospitals.

PubMed

Isken, Mark W; Rajagopalan, Balaji

2002-04-01

Spiraling health care costs in the United States are driving institutions to continually address the challenge of optimizing the use of scarce resources. One of the first steps towards optimizing resources is to utilize capacity effectively. For hospital capacity planning problems such as allocation of inpatient beds, computer simulation is often the method of choice. One of the more difficult aspects of using simulation models for such studies is the creation of a manageable set of patient types to include in the model. The objective of this paper is to demonstrate the potential of using data mining techniques, specifically clustering techniques such as K-means, to help guide the development of patient type definitions for purposes of building computer simulation or analytical models of patient flow in hospitals. Using data from a hospital in the Midwest this study brings forth several important issues that researchers need to address when applying clustering techniques in general and specifically to hospital data.

Many-objective reservoir policy identification and refinement to reduce policy inertia and myopia in water management

NASA Astrophysics Data System (ADS)

Giuliani, M.; Herman, J. D.; Castelletti, A.; Reed, P.

2014-04-01

This study contributes a decision analytic framework to overcome policy inertia and myopia in complex river basin management contexts. The framework combines reservoir policy identification, many-objective optimization under uncertainty, and visual analytics to characterize current operations and discover key trade-offs between alternative policies for balancing competing demands and system uncertainties. The approach is demonstrated on the Conowingo Dam, located within the Lower Susquehanna River, USA. The Lower Susquehanna River is an interstate water body that has been subject to intensive water management efforts due to competing demands from urban water supply, atomic power plant cooling, hydropower production, and federally regulated environmental flows. We have identified a baseline operating policy for the Conowingo Dam that closely reproduces the dynamics of current releases and flows for the Lower Susquehanna and thus can be used to represent the preferences structure guiding current operations. Starting from this baseline policy, our proposed decision analytic framework then combines evolutionary many-objective optimization with visual analytics to discover new operating policies that better balance the trade-offs within the Lower Susquehanna. Our results confirm that the baseline operating policy, which only considers deterministic historical inflows, significantly overestimates the system's reliability in meeting the reservoir's competing demands. Our proposed framework removes this bias by successfully identifying alternative reservoir policies that are more robust to hydroclimatic uncertainties while also better addressing the trade-offs across the Conowingo Dam's multisector services.

A review of the clinical utility of duloxetine in the treatment of diabetic peripheral neuropathic pain

PubMed Central

King, Jordan B; Schauerhamer, Marisa B; Bellows, Brandon K

2015-01-01

Diabetes mellitus is a world-wide epidemic with many long-term complications, with neuropathy being the most common. In particular, diabetic peripheral neuropathic pain (DPNP), can be one of the most distressing complications associated with diabetes, leading to decreases in physical and mental quality of life. Despite the availability of many efficient medications, DPNP remains a challenge to treat, and the optimal sequencing of pharmacotherapy remains unknown. Currently, there are only three medications approved by the US Food and Drug Administration specifically for the management of DPNP. Duloxetine (DUL), a selective serotonin-norepinephrine reuptake inhibitor, is one of these. With the goal of optimizing pharmacotherapy use in DPNP population, a review of current literature was conducted, and the clinical utility of DUL described. Along with early clinical trials, recently published observational studies and pharmacoeconomic models may be useful in guiding decision making by clinicians and managed care organizations. In real-world practice settings, DUL is associated with decreased or similar opioid utilization, increased medication adherence, and similar health care costs compared with current standard of care. DUL has consistently been found to be a cost-effective option over short time-horizons. Currently, the long-term cost-effectiveness of DUL is unknown. Evidence derived from randomized clinical trials, real-world observations, and economic models support the use of DUL as a first-line treatment option from the perspective of the patient, clinician, and managed care payer. PMID:26309404

A review of the clinical utility of duloxetine in the treatment of diabetic peripheral neuropathic pain.

PubMed

King, Jordan B; Schauerhamer, Marisa B; Bellows, Brandon K

2015-01-01

Diabetes mellitus is a world-wide epidemic with many long-term complications, with neuropathy being the most common. In particular, diabetic peripheral neuropathic pain (DPNP), can be one of the most distressing complications associated with diabetes, leading to decreases in physical and mental quality of life. Despite the availability of many efficient medications, DPNP remains a challenge to treat, and the optimal sequencing of pharmacotherapy remains unknown. Currently, there are only three medications approved by the US Food and Drug Administration specifically for the management of DPNP. Duloxetine (DUL), a selective serotonin-norepinephrine reuptake inhibitor, is one of these. With the goal of optimizing pharmacotherapy use in DPNP population, a review of current literature was conducted, and the clinical utility of DUL described. Along with early clinical trials, recently published observational studies and pharmacoeconomic models may be useful in guiding decision making by clinicians and managed care organizations. In real-world practice settings, DUL is associated with decreased or similar opioid utilization, increased medication adherence, and similar health care costs compared with current standard of care. DUL has consistently been found to be a cost-effective option over short time-horizons. Currently, the long-term cost-effectiveness of DUL is unknown. Evidence derived from randomized clinical trials, real-world observations, and economic models support the use of DUL as a first-line treatment option from the perspective of the patient, clinician, and managed care payer.

Community Solutions for Stormwater Management: A Guide for Voluntary Long-Term Planning

EPA Pesticide Factsheets

This draft guide describes how to develop a comprehensive long-term community stormwater plan that integrates stormwater management with communities’ broader plans for economic development, infrastructure investment and environmental compliance.

Guide to good practices for line and training manager activities

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

NONE

1998-06-01

The purpose of this guide is to provide direction for line and training managers in carrying out their responsibilities for training and qualifying personnel and to verify that existing training activities are effective.

Optimal design of a piezoelectric transducer for exciting guided wave ultrasound in rails

NASA Astrophysics Data System (ADS)

Ramatlo, Dineo A.; Wilke, Daniel N.; Loveday, Philip W.

2017-02-01

An existing Ultrasonic Broken Rail Detection System installed in South Africa on a heavy duty railway line is currently being upgraded to include defect detection and location. To accomplish this, an ultrasonic piezoelectric transducer to strongly excite a guided wave mode with energy concentrated in the web (web mode) of a rail is required. A previous study demonstrated that the recently developed SAFE-3D (Semi-Analytical Finite Element - 3 Dimensional) method can effectively predict the guided waves excited by a resonant piezoelectric transducer. In this study, the SAFE-3D model is used in the design optimization of a rail web transducer. A bound-constrained optimization problem was formulated to maximize the energy transmitted by the transducer in the web mode when driven by a pre-defined excitation signal. Dimensions of the transducer components were selected as the three design variables. A Latin hypercube sampled design of experiments that required a total of 500 SAFE-3D analyses in the design space was employed in a response surface-based optimization approach. The Nelder-Mead optimization algorithm was then used to find an optimal transducer design on the constructed response surface. The radial basis function response surface was first verified by comparing a number of predicted responses against the computed SAFE-3D responses. The performance of the optimal transducer predicted by the optimization algorithm on the response surface was also verified to be sufficiently accurate using SAFE-3D. The computational advantages of SAFE-3D in optimal transducer design are noteworthy as more than 500 analyses were performed. The optimal design was then manufactured and experimental measurements were used to validate the predicted performance. The adopted design method has demonstrated the capability to automate the design of transducers for a particular rail cross-section and frequency range.

Implantable Hemodynamic Monitoring for Heart Failure Patients.

PubMed

Abraham, William T; Perl, Leor

2017-07-18

Rates of heart failure hospitalization remain unacceptably high. Such hospitalizations are associated with substantial patient, caregiver, and economic costs. Randomized controlled trials of noninvasive telemedical systems have failed to demonstrate reduced rates of hospitalization. The failure of these technologies may be due to the limitations of the signals measured. Intracardiac and pulmonary artery pressure-guided management has become a focus of hospitalization reduction in heart failure. Early studies using implantable hemodynamic monitors demonstrated the potential of pressure-based heart failure management, whereas subsequent studies confirmed the clinical utility of this approach. One large pivotal trial proved the safety and efficacy of pulmonary artery pressure-guided heart failure management, showing a marked reduction in heart failure hospitalizations in patients randomized to active pressure-guided management. "Next-generation" implantable hemodynamic monitors are in development, and novel approaches for the use of this data promise to expand the use of pressure-guided heart failure management. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Science You Can Use Bulletin: Revisiting disturbance: A new guide for keeping dry mixed conifer forests healthy through fuel management

Treesearch

Sue Miller; Theresa Jain; Mike A. Battaglia; Han-Sup Han; Russell T. Graham; Christopher R. Keyes; Jeremy S. Fried; Jonathan E. Sandquist

2014-01-01

Planning for hazardous fuels reduction can be challenging, given that land managers must balance multiple resource objectives. To help managers with planning and implementing fuel treatments, the Rocky Mountain Research Station, with support from the Joint Fire Science Program, has published A Comprehensive Guide to Fuel Management Practices for Dry Mixed Conifer...

Efficacy and cost-effectiveness of minimal guided and unguided internet-based mobile supported stress-management in employees with occupational stress: a three-armed randomised controlled trial.

PubMed

Ebert, David Daniel; Lehr, Dirk; Smit, Filip; Zarski, Anna-Carlotta; Riper, Heleen; Heber, Elena; Cuijpers, Pim; Berking, Matthias

2014-08-07

Internet- and mobile based stress-management interventions (iSMI) may be an effective means to address the negative consequences of occupational stress. However, available results from randomised controlled trials are conflicting. Moreover, it is yet not clear whether guided or unguided self-help iSMI provide better value for money. Internet-based mental health interventions without guidance are often much less effective than interventions including at least some guidance from a professional. However, direct comparisons in randomised controlled trials are scarce and, to the best of our knowledge, the comparative (cost)-effectiveness of guided vs. unguided iSMI has not yet been studied. Hence, this study investigates the acceptability and (cost-) effectiveness of minimal guided and unguided iSMI in employees with heightened levels of perceived stress. A three-armed randomised controlled trial (RCT) will be conducted to compare a minimal guided and unguided iSMI with a waiting list control condition (WLC). Both active conditions are based on the same iSMI, i.e. GET.ON Stress, and differ only with regard to the guidance format. Employees with heightened levels of perceived stress (PSS ≥ 22) will be randomised to one of three conditions. Primary outcome will be comparative changes in perceived stress (PSS). Secondary outcomes include changes in self-reported depression, work-engagement, presenteeism and absenteeism. Moreover, a cost-effectiveness analysis will be conducted from a societal perspective, including both direct medical costs and costs related to productivity losses. In addition, a cost-benefit analysis will be conducted from the employer's perspective. Incremental net-benefit regression analyses will address the question if there are any baseline factors (i.e. subgroups of employees) associated with particularly favorable cost-effectiveness when the experimental intervention is offered. Assessments take place at baseline, 7 weeks post-treatment and 6 months after randomisation. Online-based (guided) self-help interventions could be an acceptable, effective and economically sustainable approach to offer evidence-based intervention alternatives to reduce the negative consequences associated with work-related stress. This study evaluates the (cost-) effectiveness of two versions of an iSMI, minimal guided and unguided iSMI. Thus, the present study will further enhance the evidence-base for iSMI and provide valuable information about the optimal balance between outcome and economic costs. German Clinical Trial Registration (DRKS): DRKS00005687.

A Guide for Planning Occupational Programs in Farm Production and Management.

ERIC Educational Resources Information Center

New York State Education Dept., Albany. Bureau of Secondary Curriculum Development.

Intended for personnel in charge of establishing and conducting programs in farm production and management, the guide reflects the changes in farming by emphasizing farm business management and farm mechanization. The introductory chapter suggests criteria for selecting students and lists some of the occupations for which the program will provide…

Managing In-House Development of a Campus-Wide Information System

ERIC Educational Resources Information Center

Shurville, Simon; Williams, John

2005-01-01

Purpose: To show how a combination of hard and soft project and change management methodologies guided successful in-house development of a campus-wide information system. Design/methodology/approach: A case study of the methodologies and management structures that guided the development is presented. Findings: Applying a combination of the…

Elements of a Knowledge Management Guide for Public Sector Organizations

ERIC Educational Resources Information Center

Harris, Mark Cameron

2013-01-01

This study explored the factors that are critical to the success of public (government) sector knowledge management initiatives and the lessons from private sector knowledge management and organizational learning that apply in the public sector. The goal was to create a concise guide, based on research-validated success factors, to aid government…

Use of Care Paths to Improve Patient Management

ERIC Educational Resources Information Center

Campbell, Suzann K.

2013-01-01

The purpose of this special issue of Physical & Occupational Therapy in Pediatrics is to present an evidence-based system to guide the physical therapy management of patients in the Neonatal Intensive Care Unit (NICU). Two systematic guides to patient management will be presented. The first is a care path intended primarily for use by physical…

Range Management and Ecology. Curriculum Guide for Agriscience 382.

ERIC Educational Resources Information Center

Texas A and M Univ., College Station. Dept. of Agricultural Education.

This curriculum guide provides materials for teachers to use in developing a course in "Range Management and Ecology, Agriscience 382," one of 28 semester courses in agricultural science and technology for Texas high schools. This introductory course is designed to acquaint students with the ecology and management of native rangeland for…

Your Guide for Teaching Money Management. [Revised.] Money Management.

ERIC Educational Resources Information Center

Baran, Nancy H., Ed.; Tarrant, Sharon M., Ed.

This guide provides a framework for teaching consumer education to senior high and adult education classes. It may be used to develop a broad consumer economics program, to teach a single unit, or to incorporate money-managing concepts into various subject areas. Introductory materials include suggestions for adapting materials to curriculum…

NED-2 User's Guide

Treesearch

Mark J. Twery; Peter D. Knopp; Scott A. Thomasma; Donald E. Nute

2011-01-01

This is the user's guide for NED-2, which is the latest version of NED, a forest ecosystem management decision support system. This software is part of a family of software products intended to help resource managers develop goals, assess current and future conditions, and produce sustainable management plans for forest properties. Designed for stand-alone Windows...

NED-2 reference guide

Treesearch

Mark J. Twery; Peter D. Knopp; Scott A. Thomasma; Donald E. Nute

2012-01-01

This is the reference guide for NED-2, which is the latest version of NED, a forest ecosystem management decision support system. This software is part of a family of software products intended to help resource managers develop goals, assess current and future conditions, and produce sustainable management plans for forest properties. Designed for stand-alone Windows-...

Agribusiness Management and Operation. Instructional Materials Developed for Iowa Agricultural Science, Technology and Marketing Teachers.

ERIC Educational Resources Information Center

Iowa State Univ. of Science and Technology, Ames. Dept. of Agricultural Education.

This curriculum guide can be used by secondary and postsecondary agriculture, technology, and marketing instructors to decide what and how to teach about agricultural business organization and management, especially in Iowa. The guide consists of five instructional units: (1) agribusiness organization and management; (2) livestock sales and…

Optimized Autonomous Space - In-situ Sensorweb: A new Tool for Monitoring Restless Volcanoes

NASA Astrophysics Data System (ADS)

Lahusen, R. G.; Kedar, S.; Song, W.; Chien, S.; Shirazi, B.; Davies, A.; Tran, D.; Pieri, D.

2007-12-01

An interagency team of earth scientists, space scientists and computer scientists are collaborating to develop a real-time monitoring system optimized for rapid deployment at restless volcanoes. The primary goals of this Optimized Autonomous Space In-situ Sensorweb (OASIS) are: 1) integrate complementary space and in-situ (ground-based) elements into an interactive, autonomous sensorweb; 2) advance sensorweb power and communication resource management technology; and 3) enable scalability for seamless infusion of future space and in-situ assets into the sensorweb. A prototype system will be deployed on Mount St. Helens by December 2009. Each node will include GPS, seismic, infrasonic and lightning (for ash plume detection) sensors plus autonomous decision making capabilities and interaction with EO-1 multi-spectral satellite. This three year project is jointly funded by NASA AIST program and USGS Volcano Hazards Program. Work has begun with a rigorous multi-disciplinary discussion and resulted in a system requirements document aimed to guide the design of OASIS and future networks and to achieve the project's stated goals. In this presentation we will highlight the key OASIS system requirements, their rationale and the physical and technical challenges they pose. Preliminary design decisions will be presented.

Optimal Routing and Control of Multiple Agents Moving in a Transportation Network and Subject to an Arrival Schedule and Separation Constraints

NASA Technical Reports Server (NTRS)

Sadovsky, A. V.; Davis, D.; Isaacson, D. R.

2012-01-01

We address the problem of navigating a set of moving agents, e.g. automated guided vehicles, through a transportation network so as to bring each agent to its destination at a specified time. Each pair of agents is required to be separated by a minimal distance, generally agent-dependent, at all times. The speed range, initial position, required destination, and required time of arrival at destination for each agent are assumed provided. The movement of each agent is governed by a controlled differential equation (state equation). The problem consists in choosing for each agent a path and a control strategy so as to meet the constraints and reach the destination at the required time. This problem arises in various fields of transportation, including Air Traffic Management and train coordination, and in robotics. The main contribution of the paper is a model that allows to recast this problem as a decoupled collection of problems in classical optimal control and is easily generalized to the case when inertia cannot be neglected. Some qualitative insight into solution behavior is obtained using the Pontryagin Maximum Principle. Sample numerical solutions are computed using a numerical optimal control solver.

Spatial frequency performance limitations of radiation dose optimization and beam positioning

NASA Astrophysics Data System (ADS)

Stewart, James M. P.; Stapleton, Shawn; Chaudary, Naz; Lindsay, Patricia E.; Jaffray, David A.

2018-06-01

The flexibility and sophistication of modern radiotherapy treatment planning and delivery methods have advanced techniques to improve the therapeutic ratio. Contemporary dose optimization and calculation algorithms facilitate radiotherapy plans which closely conform the three-dimensional dose distribution to the target, with beam shaping devices and image guided field targeting ensuring the fidelity and accuracy of treatment delivery. Ultimately, dose distribution conformity is limited by the maximum deliverable dose gradient; shallow dose gradients challenge techniques to deliver a tumoricidal radiation dose while minimizing dose to surrounding tissue. In this work, this ‘dose delivery resolution’ observation is rigorously formalized for a general dose delivery model based on the superposition of dose kernel primitives. It is proven that the spatial resolution of a delivered dose is bounded by the spatial frequency content of the underlying dose kernel, which in turn defines a lower bound in the minimization of a dose optimization objective function. In addition, it is shown that this optimization is penalized by a dose deposition strategy which enforces a constant relative phase (or constant spacing) between individual radiation beams. These results are further refined to provide a direct, analytic method to estimate the dose distribution arising from the minimization of such an optimization function. The efficacy of the overall framework is demonstrated on an image guided small animal microirradiator for a set of two-dimensional hypoxia guided dose prescriptions.

Dopamine in the management of shock.

PubMed Central

Thompson, W L

1977-01-01

Shock is a syndrome with serious prognostic implications--the harbinger of death. Hypoperfusion of essential organs is common, though total blood flow may be significantly greater than normal. Specific therapy is directed to the specific inciting event--infection, abscess, tamponade, &c. Symptomatic therapy keeps the patient alive until we discover the specific problem or until he recovers spontaneously. The intravascular volume must be carefully monitored and corrected, using the pulmonary wedge pressure as the principal guide, and colloid osmotic pressure must be maintained. If the patient does not respond to volume augmentation alone then inotropic drugs may be needed, and of these dopamine is a selective vasodilator which redirects blood flow to the critical organs. The outstanding challenge in shock is the maldistribution of perfusion in the microvasculature. Although this may be ameliorated by the early administration of large doses of glucocorticoids, there is little convincing that these drugs constitute more than supportive therapy. Of greatest importance is reevaluation, reevaluation, and reevaluation. The patient in shock becomes a new patient every five minutes. Drugs that formerly worked, doses previously optimal--these are no guide because the situation changes so rapidly. The principles of management are to monitor vital functions, constantly vary drugs and doses, and continually attempt to put right all the parameters measured. This strategy will be more effective when we know what parameters to measure. PMID:264200

Ultrasonic guided wave bondline evaluation of thick metallic structures with viscoelastic coatings and the demonstration of a novel mode sweep technique

NASA Astrophysics Data System (ADS)

Bostron, Jason

Ultrasonic guided waves are becoming more widely used in nondestructive evaluation applications due to their efficiency in defect detection, ability to inspect hidden areas, and other reasons. This dissertation addresses two main topics: ultrasonic guided wave bond evaluation of thin and thick coatings on thick metallic structures, and the use of a novel phased array technique for optimal guided wave mode and frequency selection. (Abstract shortened by UMI.).

A governor's guide to emergency management. Volume two : homeland security

DOT National Transportation Integrated Search

2002-09-19

Homeland security is a complex challenge that demands significant investment; collaboration among local, state, and federal governments; and integration with the private sector. The purpose of A Governor's Guide to Emergency Management Volume Two: Ho...

Integrated corridor management : implementation guide and lessons learned.

DOT National Transportation Integrated Search

2012-02-01

This implementation guide is intended for use by adopters of integrated corridor management (ICM) approaches and strategies to address congestion and travel time reliability issues within specific travel corridors. It introduces the topic of ICM and ...

GUIDE FOR SELF-EXAMINATION AND PLANNING, THE CLUB ANALYSIS PROGRAM OF INDUSTRIAL MANAGEMENT CLUBS OF THE YMCA.

ERIC Educational Resources Information Center

MEYER, WILLIAM F.

THIS GUIDE PROVIDES A QUESTION AND ANSWER METHOD IN WHICH LEADERS OF INDUSTRIAL MANAGEMENT CLUBS (IMC) MAY EVALUATE CLUB PROGRESS AND ACCOMPLISHMENTS. A REPORT OF A NATIONAL STUDY MADE BY GEORGE WILLIAMS COLLEGE ON I.M.C. MEMBERS AND THEIR ATTITUDES TOWARD CLUB PROGRESS IS PROVIDED AS A GUIDE FOR GATHERING INFORMATION. A SMALL CORE STEERING…

Putting "Service" into Library Staff Training: A Library Manager's Training Guide. LAMA Occasional Papers Series. A Patron-Centered Guide.

ERIC Educational Resources Information Center

Bessler, Joanne M.

This guide is built on librarianship training literature and customer service research from a variety of professions. It tells library managers how to identify and describe service ideals, to translate these ideals into realistic goals, and to lead new and experienced staff in fulfilling these service ideals. They are encouraged to focus the…

Revised white pine stocking guide for managed stands

Treesearch

William B. Leak; Neil I. Lamson

1999-01-01

Stocking guides are basic tools for forest managers. They provide estimates of the range in acceptable stocking for full occupancy of the site. The first stocking guide for white pine was developed by Philbrook et al (1973). It was of conventional format: showing trees and basal area per acre (in the main crown canopy) by mean stand dbh (the tree of average basal area...

Application of threshold concepts to ecological management problems: occupancy of Golden Eagles in Denali National Park, Alaska: Chapter 5

USGS Publications Warehouse

Eaton, Mitchell J.; Martin, Julien; Nichols, James D.; McIntyre, Carol; McCluskie, Maggie C.; Schmutz, Joel A.; Lubow, Bruce L.; Runge, Michael C.; Edited by Guntenspergen, Glenn R.

2014-01-01

In this chapter, we demonstrate the application of the various classes of thresholds, detailed in earlier chapters and elsewhere, via an actual but simplified natural resource management case study. We intend our example to provide the reader with the ability to recognize and apply the theoretical concepts of utility, ecological and decision thresholds to management problems through a formalized decision-analytic process. Our case study concerns the management of human recreational activities in Alaska’s Denali National Park, USA, and the possible impacts of such activities on nesting Golden Eagles, Aquila chrysaetos. Managers desire to allow visitors the greatest amount of access to park lands, provided that eagle nesting-site occupancy is maintained at a level determined to be acceptable by the managers themselves. As these two management objectives are potentially at odds, we treat minimum desired occupancy level as a utility threshold which, then, serves to guide the selection of annual management alternatives in the decision process. As human disturbance is not the only factor influencing eagle occupancy, we model nesting-site dynamics as a function of both disturbance and prey availability. We incorporate uncertainty in these dynamics by considering several hypotheses, including a hypothesis that site occupancy is affected only at a threshold level of prey abundance (i.e., an ecological threshold effect). By considering competing management objectives and accounting for two forms of thresholds in the decision process, we are able to determine the optimal number of annual nesting-site restrictions that will produce the greatest long-term benefits for both eagles and humans. Setting a utility threshold of 75 occupied sites, out of a total of 90 potential nesting sites, the optimization specified a decision threshold at approximately 80 occupied sites. At the point that current occupancy falls below 80 sites, the recommended decision is to begin restricting access to humans; above this level, it is recommended that all eagle territories be opened to human recreation. We evaluated the sensitivity of the decision threshold to uncertainty in system dynamics and to management objectives (i.e., to the utility threshold).

Status of adolescent pelvic inflammatory disease management in the United States.

PubMed

Trent, Maria

2013-10-01

Pelvic inflammatory disease (PID) is a common and serious reproductive health disorder and disease rates remain unacceptably high among adolescent girls and young adult women in the United States. Despite data demonstrating that women experience major adverse health outcomes after PID, national recommendations for management of adolescents have become increasingly less cautious in an era of cost-containment. In this review, we take an alternative look at published data on adolescents with PID to frame the next steps for optimizing management for this vulnerable population. Several findings emerge from review of the literature. First, there is limited evidence to guide the best practice strategies for adolescents with PID due to low enrolment of early and middle adolescents in national trials. Second, adolescents and adult women in the United States receive suboptimal treatment regimens per Centers for Disease Control and Prevention (CDC) standards. Third, available evidence suggests that adolescents are at an increased risk for poor adherence to CDC recommendations for self-care, reacquisition of sexually transmitted infections (STIs) and PID, and subsequent adverse reproductive health outcomes. Efforts to develop and integrate adolescent-focused, evidence-based strategies for PID management and prevention of subsequent STIs and recurrent PID are warranted.

The next 10 years in the management of peripheral artery disease: perspectives from the 'PAD 2009' Conference.

PubMed

Norgren, L; Hiatt, W R; Dormandy, J A; Hirsch, A T; Jaff, M R; Diehm, C; Baumgartner, I; Belch, J J F

2010-09-01

To briefly inform on the conclusions from a conference on the next 10 years in the management of peripheral artery disease (PAD). International participation, invited presentations and open discussion were based on the following issues: Why is PAD under-recognised? Health economic impact of PAD; funding of PAD research; changes of treatment options? Aspects on clinical trials and regulatory views; and the role of guidelines. A relative lack of knowledge about cardiovascular risk and optimal management of PAD patients exists not only among the public, but also in parts of the health-care system. Specialists are required to act for improved information. More specific PAD research is needed for risk management and to apply the best possible evaluation of evidence for treatment strategies. Better strategies for funding are required based on, for example, public/private initiatives. The proportion of endovascular treatments is steadily increasing, more frequently based on observational studies than on randomised controlled trials. The role of guidelines is therefore important to guide the profession in the assessment of most relevant treatment. Copyright 2010 European Society for Vascular Surgery. All rights reserved.

The role of endoscopic intervention in the management of inflammatory pancreatic fluid collections.

PubMed

Parihar, Vikrant; Ridgway, Paul F; Conlon, Kevin C; Huggett, Matthew; Ryan, Barbara M

2017-04-01

Pancreatic fluid collections (PFCs) are a frequent complication of pancreatitis, or less commonly, pancreatic trauma or surgery. The revised Atlanta Classification categorizes PFCs as acute or chronic, with further subclassification of acute collections into acute peripancreatic collections and acute necrotic collections and of chronic fluid collections into pseudocysts and walled-off pancreatic necrosis. Acute PFCs are generally only subjected to an intervention when they are infected and not responding to antibiotics and are not managed endoscopically. Chronic PFCs, both pseudocysts and walled-off pancreatic necrosis, require intervention only when symptomatic or enlarging over time. Endoscopic ultrasound-guided drainage has become the mainstay of management for chronic PFCs that require intervention. Developments in medical devices over the past few years have significantly simplified and shortened the duration of the procedure itself, but the optimum choice of stent in different clinical scenarios remains to be defined, as does the place of endoscopic necrosectomy. To optimize outcomes, these patients should undergo a careful preprocedure workup and discussion in a multidisciplinary environment and procedures should be carried out in high-volume pancreatic units.

Drug efficiency: a new concept to guide lead optimization programs towards the selection of better clinical candidates.

PubMed

Braggio, Simone; Montanari, Dino; Rossi, Tino; Ratti, Emiliangelo

2010-07-01

As a result of their wide acceptance and conceptual simplicity, drug-like concepts are having a major influence on the drug discovery process, particularly in the selection of the 'optimal' absorption, distribution, metabolism, excretion and toxicity and physicochemical parameters space. While they have an undisputable value when assessing the potential of lead series or in evaluating inherent risk of a portfolio of drug candidates, they result much less useful in weighing up compounds for the selection of the best potential clinical candidate. We introduce the concept of drug efficiency as a new tool both to guide the drug discovery program teams during the lead optimization phase and to better assess the developability potential of a drug candidate.

Development and numerical analysis of low specific speed mixed-flow pump

NASA Astrophysics Data System (ADS)

Li, H. F.; Huo, Y. W.; Pan, Z. B.; Zhou, W. C.; He, M. H.

2012-11-01

With the development of the city, the market of the mixed flow pump with large flux and high head is prospect. The KSB Shanghai Pump Co., LTD decided to develop low speed specific speed mixed flow pump to meet the market requirements. Based on the centrifugal pump and axial flow pump model, aiming at the characteristics of large flux and high head, a new type of guide vane mixed flow pump was designed. The computational fluid dynamics method was adopted to analyze the internal flow of the new type model and predict its performances. The time-averaged Navier-Stokes equations were closed by SST k-ω turbulent model to adapt internal flow of guide vane with larger curvatures. The multi-reference frame(MRF) method was used to deal with the coupling of rotating impeller and static guide vane, and the SIMPLEC method was adopted to achieve the coupling solution of velocity and pressure. The computational results shows that there is great flow impact on the head of vanes at different working conditions, and there is great flow separation at the tailing of the guide vanes at different working conditions, and all will affect the performance of pump. Based on the computational results, optimizations were carried out to decrease the impact on the head of vanes and flow separation at the tailing of the guide vanes. The optimized model was simulated and its performance was predicted. The computational results show that the impact on the head of vanes and the separation at the tailing of the guide vanes disappeared. The high efficiency of the optimized pump is wide, and it fit the original design destination. The newly designed mixed flow pump is now in modeling and its experimental performance will be getting soon.

Can nurse teachers manage student incivility by guided democracy? A grounded theory study

PubMed Central

Rad, Mostafa; Ildarabadi, Eshagh

2017-01-01

Introduction Managing incivility in academic settings is among the basic concerns and challenges of most educational systems, including nursing education. Incivility management cannot be considered devoid of disruptive behaviors. However, incivility management is a complexphenomenon upon which few studies are conducted. Objectives The present study aims at discovering teachers and students’ experiences regarding incivility and developing an approach to manage nursing students’ incivility. Design The present study was conducted based on the qualitative research design of the grounded theory methodology. Settings This study was conducted at schools of nursing in academic settings in Iran. Participants Study participants in the present study include nurse teachers (N=20) and nursing students (N=9). Method In-depth semi-structured interviews were conducted using theoretical and purposive sampling. Constant comparative analysis was used for data analysis. Results The results include four main categories; (1) deterioration of learning; (2) dominant individual and organisational culture; (3) guided democracy; and (4) movement toward professionalism. Guided democracy is recognised as the main basic psychosocial process for incivility management. Conclusions Incivility management is pursued to help learners develop professional performance. As indicated by the results of the present study, guided democracy is an effective strategy for incivility management in nursing education. PMID:28716787

Partners for the optimal organisation of the healthcare continuum for high users of health and social services: protocol of a developmental evaluation case study design

PubMed Central

Hudon, Catherine; Chouinard, Maud-Christine; Couture, Martine; Brousselle, Astrid; Couture, Eva Marjorie; Dubois, Marie-France; Fortin, Martin; Freund, Tobias; Loignon, Christine; Mireault, Jean; Pluye, Pierre; Roberge, Pasquale; Rodriguez, Charo

2014-01-01

Introduction Case management allows us to respond to the complex needs of a vulnerable clientele through a structured approach that promotes enhanced interaction between partners. Syntheses on the subject converge towards a need for a better description of the relationships between programmes and their local context, as well as the characteristics of the clienteles and programmes that contribute to positive impacts. The purpose of this project is thus to describe and evaluate the case management programmes of four health and social services centres in the Saguenay-Lac- Saint-Jean region of Québec, Canada, in order to inform their improvement while creating knowledge on case management that can be useful in other contexts. Methods and analysis This research relies on a multiple embedded case study design based on a developmental evaluation approach. We will work with the case management programme for high users of hospital services of each centre. Three different units of analysis will be interwoven to obtain an in-depth understanding of each case, that is: (1) health and social services centre and local services network, (2) case management programme and (3) patients who are high users of services. Two strategies for programme evaluation (logic models and implementation analysis) will guide the mixed data collection based on qualitative and quantitative methods. This data collection will rely on: (1) individual interviews and focus groups; (2) participant observation; (3) document analysis; (4) clinical and administrative data and (5) questionnaires. Description and comparison of cases, and integration of qualitative and quantitative data will be used to guide the data analysis. Ethics and dissemination The study protocol was approved by the Ethics Research Boards of the four health and social services centres (HSSCs) involved. Findings will be disseminated by publications in peer-reviewed journals, conferences, and policy and practice partners in local and national government. PMID:25468510

Guide to Documenting and Managing Cost and Performance Information for Remediation Projects - Revised Version

EPA Pesticide Factsheets

This Guide to Documenting and Managing Cost and Performance Information for Remediation Projects provides the recommended procedures for documenting the results of completed and on-going full-scale and demonstration-scale remediation projects.

Traffic analysis toolbox volume XIII : integrated corridor management analysis, modeling, and simulation guide

DOT National Transportation Integrated Search

2017-02-01

As part of the Federal Highway Administration (FHWA) Traffic Analysis Toolbox (Volume XIII), this guide was designed to help corridor stakeholders implement the Integrated Corridor Management (ICM) Analysis, Modeling, and Simulation (AMS) methodology...

Traffic analysis toolbox volume XIII : integrated corridor management analysis, modeling, and simulation guide.

DOT National Transportation Integrated Search

2017-02-01

As part of the Federal Highway Administration (FHWA) Traffic Analysis Toolbox (Volume XIII), this guide was designed to help corridor stakeholders implement the Integrated Corridor Management (ICM) Analysis, Modeling, and Simulation (AMS) methodology...

Guide to effective research-management collaboration at long-term environmental research sites

Treesearch

Frederick J. Swanson; Steve Eubanks; Mary Beth Adams; John C. Brissette

2010-01-01

The Forest Service system of experimental forests and ranges (EFRs) and other sites of long-term silvicultural, watershed, and ecological research have contributed to science and natural resource management for more than a century. An important aspect of the success of EFR programs is strong collaboration between the research and land manager communities. This guide...

Urban Tree Risk Management:A Community Guide to Program Design and Implementation

Treesearch

Jill Pokorny; Joseph O' Brien; Richard Hauer; Gary Johnson; Jana Albers; Peter Bedker; Manfred Mielke

2003-01-01

Urban Tree Risk Management: A Community Guide to Program Design and Implementation is a fully illustrated, easy to read training manual written for community leaders, administrators, city foresters, parks and public works staff, and private tree care practitioners. The manual is designed to assist communities design, adopt and implement tree risk management programs,...

A DRDC Management Accountability Framework

DTIC Science & Technology

2009-09-01

51 A.2 Cultural Theory: Risk, Blame and Good Governance ................................................. 53 A.3...the MAF. These elements guide good management, enclosing the elements required to make good decisions. 18 In essence, the elements focus on the...of these areas.20 As a guide to good management practices, the elements focus on organizational capacity and capability within a department 21

How To Select an Event Management System: A Guide to Selecting the Most Effective Resource Management System for College Union and Student Activities Professionals.

ERIC Educational Resources Information Center

Anderson, Scott; Raasch, Kevin

2002-01-01

Provides an evaluation template for student activities professionals charged with evaluating competitive event scheduling software. Guides staff in making an informed decision on whether to retain event management technology provided through an existing vendor or choose "best-of-breed" scheduling software. (EV)

Forest pest management in a changing world

Treesearch

Andrew M. Liebhold

2012-01-01

The scope, context and science guiding forest pest management have evolved and are likely to continue changing into the future. Here, I present six areas of advice to guide practitioners in the implementation of forest pest management. First, human dimensions will continue to play a key role in most pest problems and should always be a primary consideration in...

A Guide for Managers of Child Day Care Agencies.

ERIC Educational Resources Information Center

Migrant Opportunity Program, Phoenix, AZ.

This guide was compiled by a group of rural Arizona day care center managers working under the Migrant Opportunity Program (MOP) established in 1965. The managers were previously inexperienced and, at the end of two years, were interested in self-improvement and more efficient ways to perform their jobs. Their collaboration and idea exchange,…

Water Resource Management. [Student Guide] and Teacher's Guide.

ERIC Educational Resources Information Center

Young, Donald B.; Pottenger, Francis M.

This student guide and accompanying teacher's guide are a product of the Foundational Approaches in Science Teaching (FAST) curriculum development project at the University of Hawaii. In the teaching guide, the introduction gives a description of the underlying theory and practice in FAST and includes the FAST instructional model, descriptions of…

Density-to-Potential Inversions to Guide Development of Exchange-Correlation Approximations at Finite Temperature

NASA Astrophysics Data System (ADS)

Jensen, Daniel; Wasserman, Adam; Baczewski, Andrew

The construction of approximations to the exchange-correlation potential for warm dense matter (WDM) is a topic of significant recent interest. In this work, we study the inverse problem of Kohn-Sham (KS) DFT as a means of guiding functional design at zero temperature and in WDM. Whereas the forward problem solves the KS equations to produce a density from a specified exchange-correlation potential, the inverse problem seeks to construct the exchange-correlation potential from specified densities. These two problems require different computational methods and convergence criteria despite sharing the same mathematical equations. We present two new inversion methods based on constrained variational and PDE-constrained optimization methods. We adapt these methods to finite temperature calculations to reveal the exchange-correlation potential's temperature dependence in WDM-relevant conditions. The different inversion methods presented are applied to both non-interacting and interacting model systems for comparison. Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U.S. Department of Energy's National Security Administration under contract DE-AC04-94.

Practice guidelines for endoscopic ultrasound-guided celiac plexus neurolysis.

PubMed

Wyse, Jonathan M; Battat, Robert; Sun, Siyu; Saftoiu, Adrian; Siddiqui, Ali A; Leong, Ang Tiing; Arturo Arias, Brenda Lucia; Fabbri, Carlo; Adler, Douglas G; Santo, Erwin; Kalaitzakis, Evangelos; Artifon, Everson; Mishra, Girish; Okasha, Hussein Hassan; Poley, Jan Werner; Guo, Jintao; Vila, Juan J; Lee, Linda S; Sharma, Malay; Bhutani, Manoop S; Giovannini, Marc; Kitano, Masayuki; Eloubeidi, Mohamad Ali; Khashab, Mouen A; Nguyen, Nam Q; Saxena, Payal; Vilmann, Peter; Fusaroli, Pietro; Garg, Pramod Kumar; Ho, Sammy; Mukai, Shuntaro; Carrara, Silvia; Sridhar, Subbaramiah; Lakhtakia, Sundeep; Rana, Surinder S; Dhir, Vinay; Sahai, Anand V

2017-01-01

The objective of guideline was to provide clear and relevant consensus statements to form a practical guideline for clinicians on the indications, optimal technique, safety and efficacy of endoscopic ultrasound guided celiac plexus neurolysis (EUS-CPN). Six important clinical questions were determined regarding EUS-CPN. Following a detailed literature review, 6 statements were proposed attempting to answer those questions. A group of expert endosonographers convened in Chicago, United States (May 2016), where the statements were presented and feedback provided. Subsequently a consensus group of 35 expert endosonographers voted based on their individual level of agreement. A strong recommendation required 80% voter agreement. The modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria were used to rate the strength of recommendations and the quality of evidence. Eighty percent agreement was reached on 5 of 6 consensus statements, 79.4% agreement was reached on the remaining one. EUS-CPN is efficacious, should be integrated into the management of pancreas cancer pain, and can be considered early at the time of diagnosis of inoperable disease. Techniques may still vary based on operator experience. Serious complications exist, but are rare.

Total Quality Management Guide. Volume 2. A Guide to Implementation

DTIC Science & Technology

1990-02-15

Kaoru . Guide to Quality Control. Asian Productivity Organization. 1984. Ishikawa , Kaoru . What is Total Quality Control? The Japanese Way. Englewood...of the new Systems Age. The theories of Deming, Juran, Ishikawa , and other management methods that still predominate are pioneers of Systems Age...Feigenbaum, Armand V. Total Quality Control. New York: McGraw-Hill Book Company. 1983. bnai, Masaaki. Kaizen. New York: Random House. 1986. Ishikawa

Civil Engineering Work Information Management System (WIMS) Planning Guide,

DTIC Science & Technology

1985-04-01

WORK INFORMATION MANAGEMENT SYSTEM PLANNING GUIDE l-!O L~ JAUG 0)12 13 "’ ’’’ " " 𔄂 5 7 2 2 0 0 9 W WTVF--- DISCLAIMER The views and conclusions...y CHAPTER PAGE I INTRODUCTION What is WIMS? --------------------------------- 1I Why Do We Need A WIMS Planning Guide? ------------ I The Target...Administrator ------------------ 21 6 EQUIPMENT AND SUPPLIES Introduction ------------------------------- 22 Magnetic Media Supplies

Traveling through Time: The Forum Guide to Longitudinal Data Systems. Book Three of Four: Effectively Managing LDS Data. NFES 2011-805

ERIC Educational Resources Information Center

National Forum on Education Statistics, 2011

2011-01-01

This document, "Book Three of Four: Effectively Managing LDS Data," is the third installment of this Forum series of guides on longitudinal data systems (LDS). This third book in the guide series discusses organizational issues aimed at moving the project forward and ensuring that the data are of high quality so that users may leverage…

Percutaneous magnetic resonance imaging-guided bone tumor management and magnetic resonance imaging-guided bone therapy.

PubMed

Sequeiros, Roberto Blanco; Fritz, Jan; Ojala, Risto; Carrino, John A

2011-08-01

Magnetic resonance imaging (MRI) is promising tool for image-guided therapy. In musculoskeletal setting, image-guided therapy is used to direct diagnostic and therapeutic procedures and to steer patient management. Studies have demonstrated that MRI-guided interventions involving bone, soft tissue, joints, and intervertebral disks are safe and in selected indications can be the preferred action to manage clinical situation. Often, these procedures are technically similar to those performed in other modalities (computed tomography, fluoroscopy) for bone and soft tissue lesions. However, the procedural perception to the operator can be very different to other modalities because of the vastly increased data.Magnetic resonance imaging guidance is particularly advantageous should the lesion not be visible by other modalities, for selective lesion targeting, intra-articular locations, cyst aspiration, and locations adjacent to surgical hardware. Palliative tumor-related pain management such as ablation therapy forms a subset of procedures that are frequently performed under MRI. Another suitable entity for MRI guidance are the therapeutic percutaneous osseous or joint-related benign or reactive conditions such as osteoid osteoma, epiphyseal bone bridging, osteochondritis dissecans, bone cysts, localized bone necrosis, and posttraumatic lesions. In this article, we will describe in detail the technical aspects of performing MRI-guided therapeutic musculoskeletal procedures as well as the clinical indications.

Design and optimization of surface profilometer based on coplanar guide rail

NASA Astrophysics Data System (ADS)

Chen, Shuai; Dai, Yifan; Hu, Hao; Tie, Guipeng

2017-10-01

In order to implement the sub-micron precision measurement, a surface profilometer which based on the coplanar guide rail is designed. This profilometer adopts the open type air floating load and is driven by the magnetic force. As to achieve sub-micron accuracy, the flatness of granite guide working face and aerodynamic block are both processed to the micron level based on the homogenization of air flotation film theory. Permanent magnet which could reduce the influence of the driving disturbance to the measurement accuracy is used as the driving part. In this paper, the bearing capacity and the air floating stiffness of air floating block are both simulated and analyzed as to optimize the design parameters firstly. The layout and magnetic force of the magnet are also simulated. According to the simulation results, type selection and the position arrangement of the magnets are then confirmed. The test results on the experimental platform show that the surface profilometer based on coplanar guide rail possess the basis for realizing the submicron precision measurement.

Barriers to Engagement in a Workplace Weight Management Program: A Qualitative Study.

PubMed

Clancy, Shayna M; Stroo, Marissa; Schoenfisch, Ashley; Dabrera, Thushani; Østbye, Truls

2018-03-01

To investigate (1) why some participants in a workplace weight management program were more engaged in the program, (2) specific barriers and facilitators for engagement and weight loss, and (3) suggest how workplaces may better engage employees in these programs to improve their effectiveness. Qualitative study (8 focus groups). A large academic university and medical system. Twenty-six (5%) of the 550 employees who participated in a weight management program as part of the Steps to Health study. A trained moderator guided the audio-recorded focus groups. Transcripts were analyzed using the directed content analysis approach. Participants faced numerous barriers to engagement in workplace weight management programs, both within and outside the workplace. Participants viewed the coaches positively and reported that the coaches had a strong influence on their engagement in the program. Participants suggested increased frequency and variety of contact by coaches, on-site group exercise classes, and tailored educational materials. Workplace weight management programs may be improved by being more flexible around participants' schedules and changing needs, by increasing access to affordable, convenient exercise facilities, and by implementing institutional changes that encourage healthy eating and physical activity during the workday. Employers should measure program engagement and solicit participant feedback to ensure that the programs are appropriate and delivered in an optimal manner.

N-terminal pro brain natriuretic peptide-guided management in patients with heart failure and preserved ejection fraction: findings from the Trial of Intensified versus standard medical therapy in elderly patients with congestive heart failure (TIME-CHF).

PubMed

Maeder, Micha T; Rickenbacher, Peter; Rickli, Hans; Abbühl, Heidi; Gutmann, Marc; Erne, Paul; Vuilliomenet, André; Peter, Martin; Pfisterer, Matthias; Brunner-La Rocca, Hans-Peter

2013-10-01

To assess the effects of an NT-proBNP-guided medical management on 18-month outcomes in patients with heart failure (HF) and preserved LVEF ( HFpEF). Patients with HFpEF (LVEF >45%; n = 123) and HF with reduced LVEF (HFrEF; LVEF ≤45%; n = 499) with age ≥60 years, NYHA class ≥ II, and elevated NT-proBNP (>400 ng/L or >800 ng/L depending on age) were randomized to medical therapy titrated only to reduce symptoms to NYHA ≤II (symptom-guided) or also to reduce NT-proBNP below the inclusion threshold (NT-proBNP-guided) during a 6-month period. Patients were followed for an additional 12 months. Despite similar treatment escalation, NT-proBNP reduction and symptom relief were less in HFpEF than in HFrEF. Hospitalization-free survival at 18 months was worse in HFpEF than in HFrEF (P = 0.02), while survival and HF hospitalization-free survival did not differ. Among HFpEF patients, NT-proBNP reduction and symptom relief were similar in the symptom-guided (n = 59) and NT-proBNP-guided (n = 64) group despite more aggressive treatment in the NT-proBNP-guided group. In contrast to effects in HFrEF, NT-proBNP-guided management tended to worsen 18-month outcomes in HFpEF, with P-values for the interactions between LVEF stratum and management strategy of 0.2 for hospitalization-free survival, 0.03 for survival, and 0.01 for HF hospitalization-free survival. Outcomes in HFpEF were not better than in HFrEF, and opposite effects of NT-proBNP-guided management were observed in HFpEF compared with HFrEF. These preliminary findings suggest that, in contrast to HFrEF, NT-proBNP-guided therapy may not be beneficial in HFpEF. Trial registration ISRCTN43596477.

Decision support system for drinking water management

NASA Astrophysics Data System (ADS)

Janža, M.

2012-04-01

The problems in drinking water management are complex and often solutions must be reached under strict time constrains. This is especially distinct in case of environmental accidents in the catchment areas of the wells that are used for drinking water supply. The beneficial tools that can help decision makers and make program of activities more efficient are decision support systems (DSS). In general they are defined as computer-based support systems that help decision makers utilize data and models to solve unstructured problems. The presented DSS was developed in the frame of INCOME project which is focused on the long-term stable and safe drinking water supply in Ljubljana. The two main water resources Ljubljana polje and Barje alluvial aquifers are characterized by a strong interconnection of surface and groundwater, high vulnerability, high velocities of groundwater flow and pollutant transport. In case of sudden pollution, reactions should be very fast to avoid serious impact to the water supply. In the area high pressures arising from urbanization, industry, traffic, agriculture and old environmental burdens. The aim of the developed DSS is to optimize the activities in cases of emergency water management and to optimize the administrative work regarding the activities that can improve groundwater quality status. The DSS is an interactive computer system that utilizes data base, hydrological modelling, and experts' and stakeholders' knowledge. It consists of three components, tackling the different abovementioned issues in water management. The first one utilizes the work on identification, cleaning up and restoration of illegal dumpsites that are a serious threat to the qualitative status of groundwater. The other two components utilize the predictive capability of the hydrological model and scenario analysis. The user interacts with the system by a graphical interface that guides the user step-by-step to the recommended remedial measures. Consequently, the acquisition of information to support the water management's decisions is simplified and faster, thus contributing to more efficient water management and a safer supply of drinking water.

Contribution to the development of a food guide in Benin: linear programming for the optimization of local diets.

PubMed

Levesque, Sarah; Delisle, Hélène; Agueh, Victoire

2015-03-01

Food guides are important tools for nutrition education. While developing a food guide in Benin, the objective was to determine the daily number of servings per food group and the portion sizes of common foods to be recommended. Linear programming (LP) was used to determine, for each predefined food group, the optimal number and size of servings of commonly consumed foods. Two types of constraints were introduced into the LP models: (i) WHO/FAO Recommended Nutrient Intakes and dietary guidelines for the prevention of chronic diseases; and (ii) dietary patterns based on local food consumption data recently collected in southern Benin in 541 adults. Dietary intakes of the upper tertile of participants for diet quality based on prevention and micronutrient adequacy scores were used in the LP algorithms. Southern area of the Republic of Benin. Local key-players in nutrition (n 30) from the government, academic institutions, international organizations and civil society were partners in the development of the food guide directed at the population. The number of servings per food group and the portion size for eight age-sex groups were determined. For four limiting micronutrients (Fe, Ca, folate and Zn), local diets could be optimized to meet only 70 % of the Recommended Nutrient Intakes, not 100 %. It was possible to determine the daily number of servings and the portion sizes of common foods that can be recommended in Benin with the help of LP to optimize local diets, although Recommended Nutrient Intakes were not fully met for a few critical micronutrients.

7 CFR Exhibit B to Subpart G of... - Development and Implementation of Natural Resource Management Guide

Code of Federal Regulations, 2010 CFR

2010-01-01

... resource management guide needs to be developed in full recognition of its role as an internal Agency.... County Supervisors shall contact local officials and shall be responsible for being familiar with and for...

HEALTH CARE GUIDE TO POLLUTION PREVENTION IMPLEMENTATION THROUGH ENVIRONMENTAL MANAGEMENT SYSTEMS

EPA Science Inventory

The Health Care Guide to Pollution Prevention Implementation through Environmental Management Systems provides example EMS procedures and forms used in four ISO 14001 EMS certified hospitals. The latest revisions include more EMS hospital case studies, more compliance resources, ...

Integrated corridor management : implementation guide and lessons learned (final report version 2.0).

DOT National Transportation Integrated Search

2015-09-01

This implementation guide is intended for use by adopters of integrated corridor management (ICM) approaches and strategies to address congestion and travel time reliability issues within specific travel corridors. It introduces the topic of ICM and ...

Manufacturing Technology.

ERIC Educational Resources Information Center

Barnes, James L.

This curriculum guide is designed to assist junior high school industrial arts teachers in planning new courses and revising existing courses in manufacturing technology. Addressed in the individual units of the guide are the following topics: introduction to manufacturing, materials processing, personnel management, production management,…

Optimization of pressure gauge locations for water distribution systems using entropy theory.

PubMed

Yoo, Do Guen; Chang, Dong Eil; Jun, Hwandon; Kim, Joong Hoon

2012-12-01

It is essential to select the optimal pressure gauge location for effective management and maintenance of water distribution systems. This study proposes an objective and quantified standard for selecting the optimal pressure gauge location by defining the pressure change at other nodes as a result of demand change at a specific node using entropy theory. Two cases are considered in terms of demand change: that in which demand at all nodes shows peak load by using a peak factor and that comprising the demand change of the normal distribution whose average is the base demand. The actual pressure change pattern is determined by using the emitter function of EPANET to reflect the pressure that changes practically at each node. The optimal pressure gauge location is determined by prioritizing the node that processes the largest amount of information it gives to (giving entropy) and receives from (receiving entropy) the whole system according to the entropy standard. The suggested model is applied to one virtual and one real pipe network, and the optimal pressure gauge location combination is calculated by implementing the sensitivity analysis based on the study results. These analysis results support the following two conclusions. Firstly, the installation priority of the pressure gauge in water distribution networks can be determined with a more objective standard through the entropy theory. Secondly, the model can be used as an efficient decision-making guide for gauge installation in water distribution systems.

Quantum Dot Detectors with Plasmonic Structures

DTIC Science & Technology

2015-05-15

plasmon polariton mode and a guided Fabry-Perot mode. The simulation method accomplished in this paper provides a generalized approach to optimize the...plasmon polariton (SPP) mode and a guided Fabry-Perot mode, that enhance x or y (along the polarization direction used in simulation) and z (along the...resulting from surface plasmon polariton and guided Fabry-Perot modes) are shown in the inset to Fig. 3. This figure also shows the simulated

Algorithm-enabled exploration of image-quality potential of cone-beam CT in image-guided radiation therapy

NASA Astrophysics Data System (ADS)

Han, Xiao; Pearson, Erik; Pelizzari, Charles; Al-Hallaq, Hania; Sidky, Emil Y.; Bian, Junguo; Pan, Xiaochuan

2015-06-01

Kilo-voltage (KV) cone-beam computed tomography (CBCT) unit mounted onto a linear accelerator treatment system, often referred to as on-board imager (OBI), plays an increasingly important role in image-guided radiation therapy. While the FDK algorithm is currently used for reconstructing images from clinical OBI data, optimization-based reconstruction has also been investigated for OBI CBCT. An optimization-based reconstruction involves numerous parameters, which can significantly impact reconstruction properties (or utility). The success of an optimization-based reconstruction for a particular class of practical applications thus relies strongly on appropriate selection of parameter values. In the work, we focus on tailoring the constrained-TV-minimization-based reconstruction, an optimization-based reconstruction previously shown of some potential for CBCT imaging conditions of practical interest, to OBI imaging through appropriate selection of parameter values. In particular, for given real data of phantoms and patient collected with OBI CBCT, we first devise utility metrics specific to OBI-quality-assurance tasks and then apply them to guiding the selection of parameter values in constrained-TV-minimization-based reconstruction. The study results show that the reconstructions are with improvement, relative to clinical FDK reconstruction, in both visualization and quantitative assessments in terms of the devised utility metrics.

Pharmacists' guide to the management of organ donors after brain death.

PubMed

Korte, Catherine; Garber, Jennifer L; Descourouez, Jillian L; Richards, Katelyn R; Hardinger, Karen

2016-11-15

This article reviews organ donor pathophysiology as it relates to medication use with the goal of maximizing the successful procurement and transplantation of donor organs. The number of patients requiring organ transplantation continues to grow, yet organ donation rates remain flat, making it critical to appropriately manage each organ donor in order to ensure viability of all transplantable organs. The care given to one organ donor is tantamount to the care of several transplant recipients. Aggressive donor management ensures that the largest number of organs can be successfully procured and improves the organs' overall quality. Hospital pharmacists are responsible for processing orders and preparing the medications outlined in donor management algorithms developed by their respective medical systems. It is important that pharmacists understand the details of the medications used in these protocols in order to critically evaluate each medication order and appropriately manage the donor. Typical medications used in organ donors after brain death include medications for blood pressure management and fluid resuscitation, medications necessary for electrolyte management, blood products, vasopressors, hormone replacement therapy, antiinfectives, anticoagulants, paralytics, and organ preservation solutions. It is essential to provide optimal pharmacotherapy for each organ donor to ensure organ recovery and donation. Typical medications used in organ donors include agents for blood pressure management and fluid resuscitation, medications necessary for electrolyte management, blood products, vasopressors, hormone replacement therapy, antiinfectives, anticoagulants, paralytics, and organ preservation solutions. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

A robust optimization model for distribution and evacuation in the disaster response phase

NASA Astrophysics Data System (ADS)

Fereiduni, Meysam; Shahanaghi, Kamran

2017-03-01

Natural disasters, such as earthquakes, affect thousands of people and can cause enormous financial loss. Therefore, an efficient response immediately following a natural disaster is vital to minimize the aforementioned negative effects. This research paper presents a network design model for humanitarian logistics which will assist in location and allocation decisions for multiple disaster periods. At first, a single-objective optimization model is presented that addresses the response phase of disaster management. This model will help the decision makers to make the most optimal choices in regard to location, allocation, and evacuation simultaneously. The proposed model also considers emergency tents as temporary medical centers. To cope with the uncertainty and dynamic nature of disasters, and their consequences, our multi-period robust model considers the values of critical input data in a set of various scenarios. Second, because of probable disruption in the distribution infrastructure (such as bridges), the Monte Carlo simulation is used for generating related random numbers and different scenarios; the p-robust approach is utilized to formulate the new network. The p-robust approach can predict possible damages along pathways and among relief bases. We render a case study of our robust optimization approach for Tehran's plausible earthquake in region 1. Sensitivity analysis' experiments are proposed to explore the effects of various problem parameters. These experiments will give managerial insights and can guide DMs under a variety of conditions. Then, the performances of the "robust optimization" approach and the "p-robust optimization" approach are evaluated. Intriguing results and practical insights are demonstrated by our analysis on this comparison.

Automatic efficiency optimization of an axial compressor with adjustable inlet guide vanes

NASA Astrophysics Data System (ADS)

Li, Jichao; Lin, Feng; Nie, Chaoqun; Chen, Jingyi

2012-04-01

The inlet attack angle of rotor blade reasonably can be adjusted with the change of the stagger angle of inlet guide vane (IGV); so the efficiency of each condition will be affected. For the purpose to improve the efficiency, the DSP (Digital Signal Processor) controller is designed to adjust the stagger angle of IGV automatically in order to optimize the efficiency at any operating condition. The A/D signal collection includes inlet static pressure, outlet static pressure, outlet total pressure, rotor speed and torque signal, the efficiency can be calculated in the DSP, and the angle signal for the stepping motor which control the IGV will be sent out from the D/A. Experimental investigations are performed in a three-stage, low-speed axial compressor with variable inlet guide vanes. It is demonstrated that the DSP designed can well adjust the stagger angle of IGV online, the efficiency under different conditions can be optimized. This establishment of DSP online adjustment scheme may provide a practical solution for improving performance of multi-stage axial flow compressor when its operating condition is varied.

A Team Approach to Behaviour Management: A Training Guide for SENCOs Working with Teacher Assistants

ERIC Educational Resources Information Center

Derrington, Chris; Groom, Barry

2004-01-01

This training guide has been developed and written primarily for Special Educational Needs Co-Ordinators (SENCOs) in primary, secondary and special schools who manage the work of teaching assistants. It will also be of interest to other senior teachers or advisory staff who lead training in the area of behaviour management. There has been a…

Crisis Data Management: A Forum Guide to Collecting and Managing Data about Displaced Students. NFES 2010-804

ERIC Educational Resources Information Center

National Forum on Education Statistics, 2010

2010-01-01

In the aftermath of hurricanes Katrina and Rita, the immediate demand for data about displaced students overwhelmed many school districts that had gained or lost students because of the disasters. The scale of these crises and their effects on school operations and management were in many ways unprecedented. This guide reflects "lessons…

A Practical Guide to Management of Common Pests in Schools. Integrated Pest Management.

ERIC Educational Resources Information Center

Illinois State Dept. of Public Health, Springfield.

This 3-part manual is designed to assist school officials understand the principles of Integrated Pest Management and aid them in implementing those principles into a comprehensive pest control program in their facilities. Developed for Illinois, this guide can be applied in part or in total to other areas of the country. Part 1 explains what an…

Agricultural Education Curriculum Guide. Agricultural Production and Management I. Course No. 6811. Agricultural Production and Management II. Course No. 6812.

ERIC Educational Resources Information Center

North Carolina State Dept. of Public Instruction, Raleigh.

This document is designed for use by teachers of Agricultural Production and Management courses in North Carolina. It updates the competencies and content outlines from the previous guide. It lists core and optional competencies for two courses in seven areas as follows: leadership; supervised agricultural experience programs; animal science;…

MRI-guided Breast Biopsy: Outcomes and Impact on Patient Management

PubMed Central

Kamel, Ihab R; Macura, Katarzyna J

2014-01-01

Introduction The purpose of this study was to correlate the pathology results of magnetic resonance imaging (MRI)-guided breast biopsies at our institution to MRI findings and patient clinical history characteristics. The impact of MRI-guided breast biopsies on surgical management in patients with a new diagnosis of breast cancer was also assessed. Patients and Methods In this HIPAA-compliant study we retrospectively reviewed all MRI-guided breast biopsies performed 3/2006–5/2012. Clinical history, MRI features and pathology outcomes were reviewed. In patients undergoing breast MRI to evaluate extent of disease, any change in surgical management resulting from the MRI-guided biopsy was recorded. Statistical analysis included binary logistic regression and independent student’s t-test. Results Two-hundred fifteen lesions in 168 patients were included, of which 23 (10.7%) were malignant, 43 (20%) were high risk, and 149 (69.3%) were benign. No clinical characteristic was associated with malignancy in our cohort. MRI features associated with malignancy were: larger size (mean 2.6 cm versus 1.3 cm, p=0.046), washout kinetics (18% malignancy rate, p=0.02) and marked background parenchymal enhancement (40% malignancy rate, p-value <0.001 to 0.03). Nineteen (28%) of the 67 patients with a new diagnosis of breast cancer undergoing MRI-guided breast biopsy had a change in surgical management based on the biopsy result. Conclusions Malignancy rate was associated with lesion size, washout kinetics and marked background enhancement of the breast parenchyma but was not associated with any clinical history characteristics. Pre-operative MRI-guided breast biopsies changed surgical management in 28% of women with a new diagnosis of breast cancer. PMID:25499596

Scheduling Guide for Program Managers

DTIC Science & Technology

2001-10-01

58 Chapter 8 TIME MANAGEMENT ....................................................................................... 59...8.1 Time Management and the Program...60 8.2 Time Management and the Program Manager

OPTIMAL WELL LOCATOR (OWL): A SCREENING TOOL FOR EVALUATING LOCATIONS OF MONITORING WELLS: USER'S GUIDE VERSION 1.2

EPA Science Inventory

The Optimal Well Locator ( OWL) program was designed and developed by USEPA to be a screening tool to evaluate and optimize the placement of wells in long term monitoring networks at small sites. The first objective of the OWL program is to allow the user to visualize the change ...

INTRODUCTION TO THE MOVEMENT SYSTEM AS THE FOUNDATION FOR PHYSICAL THERAPIST PRACTICE EDUCATION AND RESEARCH.

PubMed

Saladin, Lisa; Voight, Michael

2017-11-01

In 2013, the American Physical Therapy Association (APTA) adopted an inspiring new vision, "Transforming society by optimizing movement to improve the human experience." This new vision for our profession calls us to action as physical therapists to transform society by using our skills, knowledge, and expertise related to the movement system in order to optimize movement, promote health and wellness, mitigate the progression of impairments, and prevent the development of (additional) disability. The guiding principle of the new vision is "identity," which can be summarized as "The physical therapy profession will define and promote the movement system as the foundation for optimizing movement to improve the health of society." Recognition and validation of the movement system is essential to understand the structure, function, and potential of the human body. As currently defined, the "movement system" represents the collection of systems (cardiovascular, pulmonary, endocrine, integumentary, nervous, and musculoskeletal) that interact to move the body or its component parts. By better characterizing physical therapists as movement system experts, we seek to solidify our professional identity within the medical community and society. The physical therapist will be responsible for evaluating and managing an individual's movement system across the lifespan to promote optimal development; diagnose impairments, activity limitations, and participation restrictions; and provide interventions targeted at preventing or ameliorating activity limitations and participation restrictions. 5.

Liquid Pipeline Operator's Control Room Human Factors Risk Assessment and Management Guide

DOT National Transportation Integrated Search

2008-11-26

The purpose of this guide is to document methodologies, tools, procedures, guidance, and instructions that have been developed to provide liquid pipeline operators with an efficient and effective means of managing the human factors risks in their con...

Major Bleeding after Percutaneous Image-Guided Biopsies: Frequency, Predictors, and Periprocedural Management

PubMed Central

Kennedy, Sean A.; Milovanovic, Lazar; Midia, Mehran

2015-01-01

Major bleeding remains an uncommon yet potentially devastating complication following percutaneous image-guided biopsy. This article reviews two cases of major bleeding after percutaneous biopsy and discusses the frequency, predictors, and periprocedural management of major postprocedural bleeding. PMID:25762845

Library of Michigan: Financial Management Reference Guide.

ERIC Educational Resources Information Center

Michigan Library, Lansing.

Developed to provide library directors, staff, and board members with information for performing accounting and financial management functions, this guide answers frequently asked questions, describes common practices and processes, provides examples and suggested formats for selected financial reports, and identifies issues that may require…

EPA Science Matters Newsletter: Greener Cleanups at Hazardous Waste Sites (Published August 2013)

EPA Pesticide Factsheets

Read about the EPA’s Smart Energy Resources Guide (SERG). The guide covers techniques for superfund managers to reduce cleanup emissions in a process called green remediation, and can be used by any site remediation and redevelopment manager.

School Planning and Management Buyer's Guide 2000.

ERIC Educational Resources Information Center

School Planning and Management, 1999

1999-01-01

Presents product information and a suppliers' directory for school purchasing managers for the year 2000, including a detailed product showcase and case histories and a section on descriptions of free brochures, pamphlets, and guides from key suppliers. An advertiser index concludes the issue. (GR)

Chronic disease management: a review of current performance across quality of care domains and opportunities for improving osteoarthritis care.

PubMed

Brand, Caroline A; Ackerman, Ilana N; Bohensky, Megan A; Bennell, Kim L

2013-02-01

Osteoarthritis is the most prevalent chronic joint disease worldwide. The incidence and prevalence are increasing as the population ages and lifestyle risk factors such as obesity increase. There are several evidence-based clinical practice guidelines available to guide clinician decision making, but there is evidence that care provided is suboptimal across all domains of quality: effectiveness, safety, timeliness and appropriateness, patient-centered care, and efficiency. System, clinician, and patient barriers to optimizing care need to be addressed. Innovative models designed to meet patient needs and those that harness social networks must be developed, especially to support those with mild to moderate disease. Copyright © 2013 Elsevier Inc. All rights reserved.

On Our Way to the European Higher Education Space--A Proposal for a Teaching Guide for the Management Control Course in the Business Management and Administration Degree

ERIC Educational Resources Information Center

Ruiz, Mercedes; Tirado, Pilar; Menor; Esther

2009-01-01

In order to adapt curricula to the new European system of credits, ECTS (European Credit Transfer System), it is necessary to previously elaborate a teaching guide. The teaching guide clarifies the subject syllabus making it easier for learners to understand, sets objectives related to the competencies and skills to be acquired, plans activities…

Feasibility and impact of a computer-guided consultation on guideline-based management of COPD in general practice.

PubMed

Angus, Robert M; Thompson, Elizabeth B; Davies, Lisa; Trusdale, Ann; Hodgson, Chris; McKnight, Eddie; Davies, Andrew; Pearson, Mike G

2012-12-01

Applying guidelines is a universal challenge that is often not met. Intelligent software systems that facilitate real-time management during a clinical interaction may offer a solution. To determine if the use of a computer-guided consultation that facilitates the National Institute for Health and Clinical Excellence-based chronic obstructive pulmonary disease (COPD) guidance and prompts clinical decision-making is feasible in primary care and to assess its impact on diagnosis and management in reviews of COPD patients. Practice nurses, one-third of whom had no specific respiratory training, undertook a computer-guided review in the usual consulting room setting using a laptop computer with the screen visible to them and to the patient. A total of 293 patients (mean (SD) age 69.7 (10.1) years, 163 (55.6%) male) with a diagnosis of COPD were randomly selected from GP databases in 16 practices and assessed. Of 236 patients who had spirometry, 45 (19%) did not have airflow obstruction and the guided clinical history changed the primary diagnosis from COPD in a further 24 patients. In the 191 patients with confirmed COPD, the consultations prompted management changes including 169 recommendations for altered prescribing of inhalers (addition or discontinuation, inhaler dose or device). In addition, 47% of the 55 current smokers were referred for smoking cessation support, 12 (6%) for oxygen assessment, and 47 (24%) for pulmonary rehabilitation. Computer-guided consultations are practicable in general practice. Primary care COPD databases were confirmed to contain a significant proportion of incorrectly assigned patients. They resulted in interventions and the rationalisation of prescribing in line with recommendations. Only in 22 (12%) of those fully assessed was no management change suggested. The introduction of a computer-guided consultation offers the prospect of comprehensive guideline quality management.

a Geographic Analysis of Optimal Signage Location Selection in Scenic Area

NASA Astrophysics Data System (ADS)

Ruan, Ling; Long, Ying; Zhang, Ling; Wu, Xiao Ling

2016-06-01

As an important part of the scenic area infrastructure services, signage guiding system plays an indispensable role in guiding the way and improving the quality of tourism experience. This paper proposes an optimal method in signage location selection and direction content design in a scenic area based on geographic analysis. The object of the research is to provide a best solution to arrange limited guiding boards in a tourism area to show ways arriving at any scenic spot from any entrance. There are four steps to achieve the research object. First, the spatial distribution of the junction of the scenic road, the passageway and the scenic spots is analyzed. Then, the count of scenic roads intersection on the shortest path between all entrances and all scenic spots is calculated. Next, combing with the grade of the scenic road and scenic spots, the importance of each road intersection is estimated quantitatively. Finally, according to the importance of all road intersections, the most suitable layout locations of signage guiding boards can be provided. In addition, the method is applied in the Ming Tomb scenic area in China and the result is compared with the existing signage guiding space layout.

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

PubMed

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

2012-01-01

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

Can nurse teachers manage student incivility by guided democracy? A grounded theory study.

PubMed

Rad, Mostafa; Karimi Moonaghi, Hossein; Ildarabadi, Eshagh

2017-07-17

Managing incivility in academic settings is among the basic concerns and challenges of most educational systems, including nursing education. Incivility management cannot be considered devoid of disruptive behaviors. However, incivility management is a complexphenomenon upon which few studies are conducted. The present study aims at discovering teachers and students' experiences regarding incivility and developing an approach to manage nursing students' incivility. The present study was conducted based on the qualitative research design of the grounded theory methodology. This study was conducted at schools of nursing in academic settings in Iran. Study participants in the present study include nurse teachers (N=20) and nursing students (N=9). In-depth semi-structured interviews were conducted using theoretical and purposive sampling. Constant comparative analysis was used for data analysis. The results include four main categories; (1) deterioration of learning; (2) dominant individual and organisational culture; (3) guided democracy; and (4) movement toward professionalism. Guided democracy is recognised as the main basic psychosocial process for incivility management. Incivility management is pursued to help learners develop professional performance. As indicated by the results of the present study, guided democracy is an effective strategy for incivility management in nursing education. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Food Production, Management, and Services: Curriculum Guide.

ERIC Educational Resources Information Center

Mumme, Debbie; Koukel, Sonja

This curriculum guide provides occupationally specific training designed to develop knowledge and skills for employment in the area of food production, management, and services. Contents include the Texas Essential Knowledge and Skills (TEAKS); sample course outlines; instructional strategies organized topically by chapters, each containing a…

Curriculum Development for Life Management.

ERIC Educational Resources Information Center

Morse, Betty R.; And Others

Developed by several colleges in California, this guide contains a curriculum for a course in Life Management (usually taught in the home economics area). The introductory sections of the guide contain the following information: recommendations from the pilot test teachers, rationale, course description, goals, justification for including the…

Stand density management of southern bottomland hardwoods

Treesearch

J.C.G. Goelz; J.S. Meadows

1997-01-01

We present tools to guide stand density management of southern bottomiand hardwoods and we provide guidance in their implementation. We present stocking guides for southern bottomland hardwoods and variants for associated forest types, water tupelo (Nyssa aquarica L.) and sweetgum (Liquidumbar styraciflua L.). The A-line...

Understanding Tourette Syndrome: An Educators' Guide for the Inclusive Classroom.

ERIC Educational Resources Information Center

Knight, Diane

1999-01-01

This guide to Tourette Syndrome addresses prevalence and etiology, associated behaviors (such as obsessive-compulsive disorder and attention deficit hyperactivity disorder), treatment approaches and medication, and classroom management techniques (such as handling tic release/stress and managing hyperactivity/controlling attentional impulses). (DB)

Brain natriuretic peptide-guided therapy in the inpatient management of decompensated heart failure.

PubMed

Saremi, Adonis; Gopal, Dipika; Maisel, Alan S

2012-02-01

Heart failure is extremely prevalent and is associated with significant mortality, morbidity and cost. Studies have already established mortality benefit with the use of neurohormonal blockade therapy in systolic failure. Unfortunately, physical signs and symptoms of heart failure lack diagnostic sensitivity and specificity, and medication doses proven to improve mortality in clinical trials are often not achieved. Brain natriuretic peptide (BNP) has proven to be of clinical use in the diagnosis and prognosis of heart failure, and recent efforts have been taken to further elucidate its role in guiding heart failure management. Multiple studies have been conducted on outpatient guided management, and although still controversial, there is a trend towards improved outcomes. Inpatient studies are lacking, but preliminary data suggest various BNP cut-off values, as well as percentage changes in BNP, that could be useful in predicting outcomes and improving mortality. In the future, heart failure management will probably involve an algorithm using clinical assessment and a multibiomarker-guided approach.

Endoscopic Ultrasound-Guided Management of Pancreatic Fluid Collections: Update and Review of the Literature

PubMed Central

Alali, Ali; Mosko, Jeffrey; May, Gary; Teshima, Christopher

2017-01-01

Severe acute pancreatitis is often complicated by the development of pancreatic fluid collections (PFCs), which may be associated with significant morbidity and mortality. It is crucial to accurately classify these collections as a pseudocyst or walled-off necrosis (WON) given significant differences in outcomes and management. Interventions for PFCs have increasingly shifted to less invasive strategies, with endoscopic ultrasound (EUS)-guided methods being shown to be safer and equally effective as more invasive surgical techniques. In recent years, many new developments have improved the safety and efficacy of EUS-guided interventions, such as the introduction of lumen-apposing metal stents (LAMS), direct endoscopic necrosectomy (DEN) and multiple other adjunctive techniques. Despite these developments, treatment of PFCs, and infected WON in particular, continues to be associated with significant morbidity and mortality. In this article, we discuss the EUS-guided management of PFCs while reviewing the latest developments and controversies in the field. We end by summarizing our own approach to managing PFCs. PMID:28391671

Choosing an Optical Disc System: A Guide for Users and Resellers.

ERIC Educational Resources Information Center

Vane-Tempest, Stewart

1995-01-01

Presents a guide for selecting an optional disc system. Highlights include storage hierarchy; standards; data life cycles; security; implementing an optical jukebox system; optimizing the system; performance; quality and reliability; software; cost of online versus near-line; and growing opportunities. Sidebars provide additional information on…

The genetics of phaeochromocytoma: using clinical features to guide genetic testing.

PubMed

Jafri, Mariam; Maher, Eamonn R

2012-02-01

Phaeochromocytoma is a rare, usually benign, tumour predominantly managed by endocrinologists. Over the last decade, major advances have been made in understanding the molecular genetic basis of adrenal and extra-adrenal phaeochromocytoma (also referred to as adrenal phaeochromocytoma (aPCA) and extra-adrenal functional paraganglioma (eFPGL)). In contrast to the previously held belief that only 10% of cases had a genetic component, currently about one-third of all aPCA/eFPGL cases are thought to be attributable to germline mutations in at least nine genes (NF1, RET, SDHA, SDHB, SDHC, SDHD, TMEM127, MAX and VHL). Recognition of inherited cases of aPCA/eFPGL is critical for optimal patient management. Thus, the identification of a germline mutation can predict risks of malignancy, recurrent disease, associated non-chromaffin tumours and risks to other family members. Mutation carriers should be offered specific surveillance programmes (according to the relevant gene). In this review, we will describe the genetics of aPCA/eFPGL and strategies for genetic testing.

[Vertebroplasty: state of the art].

PubMed

Chiras, J; Barragán-Campos, H M; Cormier, E; Jean, B; Rose, M; LeJean, L

2007-09-01

Over the last 10 years, there has been much development in the management of metastatic and osteoporotic vertebral compression fractures using vertebroplasty. This percutaneous image-guided interventional radiology procedure allows stabilization of a vertebral body by injection of an acrylic cement and frequently results in significant symptomatic relief. During cement polymerisation, an exothermic reaction may destroy adjacent tumor cells. Advances have been made to reduce complications from extravasation of cement in veins or surrounding soft tissues. Safety relates to experience but also to technical parameters: optimal cement radio-density, adequate digital fluoroscopy unit (single or bi-plane digital angiography unit), development of cements other than PMMA to avoid the risk of adjacent vertebral compression fractures. The rate of symptomatic relief from vertebroplasty performed for its principal indications (vertebral hemangioma, metastases, osteoporotic fractures) reaches 90-95%. The rate of complications is about 2% for metastases and less than 0.5% for osteoporotic fractures. Vertebroplasty plays a major role in the management of specific bone weakening vertebral lesions causing, obviating the need for kyphoplasty.

Management of Facial Pyoderma Gangrenosum Using Platelet-Rich Fibrin: A Technical Report.

PubMed

Fortunato, Leonzio; Barone, Selene; Bennardo, Francesco; Giudice, Amerigo

2018-01-31

This report describes a case of local pyoderma gangrenosum that was treated with short-term immunosuppressive therapy and the topical application of platelet-rich fibrin (PRF). Medical treatment included oral corticosteroid therapy and topical treatment with PRF in solid and liquid form. This therapy initially led to the reduction of the ulcer's size and an improvement in symptoms, until the ulcer was completely healed after a few weeks. A relapse was treated with only the application of PRF to the affected tissue with excellent recovery. The efficacy of PRF as a guide for wound healing is a result of the continuous release of growth factors involved in tissue repair mechanisms. PRF has proved to be suitable for the management of facial pyoderma gangrenosum while allowing a reduction in systemic corticosteroid therapy. The ease of preparation, low cost, and outpatient use make PRF an optimal scaffold for tissue healing processes. Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Economic data for wildland planning and management in the western United States: a source guide

Treesearch

Eric Eisenman; Lee C. Wensel; Edward C. Thor; Thomas W. Stuart

1980-01-01

This guide identifies and describes sources of economic data useful to wildland managers and planners in the Western United States. The data are categorized by six types of management activities: outdoor recreation and wilderness; wildlife and fish; range; timber; land and water; and minerals and energy. For each type of activity, data sources are identified as to...

Depleted UF6 Management Information Network - A resource for the public,

Science.gov Websites

Depleted UF6 Management Information Network Web Site is an online repository of information about the U.S ) and DUF6, research and development efforts for beneficial uses of DU, DOE's program for management of line DUF6 Guide DUF6 Guide line Introductory information about depleted uranium: how it is created

Poultry Products Management. 2+2+2 Articulated Curriculum in Agricultural Technology: First Year Final Report. July 1, 1989-June 30, 1990.

ERIC Educational Resources Information Center

Northeast Texas Community Coll., Mount Pleasant.

This guide is for an articulated two-year high school, two-year college curriculum for poultry products management developed by two postsecondary and five secondary institutions and representatives of the private sector in Texas. The guide includes the following: (1) a brief description of the occupation of poultry products manager; (2) the basic…

Dairy Products Management. 2+2+2 Articulated Curriculum in Agricultural Technology: First Year Final Report. July 1, 1989-June 30, 1990.

ERIC Educational Resources Information Center

Northeast Texas Community Coll., Mount Pleasant.

This guide is for an articulated two-year high school, two-year college curriculum for dairy products management developed by two postsecondary and five secondary institutions and representatives of the private sector in Texas. The guide includes the following: (1) a brief description of the occupation of dairy products manager; (2) the basic…

Integrated Baseline System (IBS) Version 2.0: Utilities Guide

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

Burford, M.J.; Downing, T.R.; Williams, J.R.

1994-03-01

The Integrated Baseline System (IBS) is an emergency management planning and analysis tool being developed under the direction of the US Army Nuclear and Chemical Agency. This Utilities Guide explains how you can use the IBS utility programs to manage and manipulate various kinds of IBS data. These programs include utilities for creating, editing, and displaying maps and other data that are referenced to geographic location. The intended audience for this document are chiefly data managers but also system managers and some emergency management planners and analysts.

Aircraft/Air Traffic Management Functional Analysis Model. Version 2.0; User's Guide

NASA Technical Reports Server (NTRS)

Etheridge, Melvin; Plugge, Joana; Retina, Nusrat

1998-01-01

The Aircraft/Air Traffic Management Functional Analysis Model, Version 2.0 (FAM 2.0), is a discrete event simulation model designed to support analysis of alternative concepts in air traffic management and control. FAM 2.0 was developed by the Logistics Management Institute (LMI) a National Aeronautics and Space Administration (NASA) contract. This document provides a guide for using the model in analysis. Those interested in making enhancements or modification to the model should consult the companion document, Aircraft/Air Traffic Management Functional Analysis Model, Version 2.0 Technical Description.

Managerial Accounting. Study Guide.

ERIC Educational Resources Information Center

Plachta, Leonard E.

This self-instructional study guide is part of the materials for a college-level programmed course in managerial accounting. The study guide is intended for use by students in conjuction with a separate textbook, Horngren's "Accounting for Management Control: An Introduction," and a workbook, Curry's "Student Guide to Accounting for Management…

Quality Management Program

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

Not Available

1991-10-01

According to {section} 35.32, Quality Management Program,'' of 10 CFR Part 35, Medical Use of Byproduct Material,'' applicants or licensees, as applicable, are required to establish a quality management (QM) program. This regulatory guide provides guidance to licensees and applicants for developing policies and procedures for the QM program. This guide does not restrict or limit the licensee from using other guidance that may be equally useful in developing a QM program, e.g., information available from the Joint Commission on Accreditation of Healthcare Organizations or the American College of Radiology. Any information collection activities mentioned in this regulatory guide aremore » contained as requirements in 10 CFR Part 35, which provides the regulatory basis for this guide. This information collection requirements in 10 CFR Part 35 have been cleared under OMB Clearance No. 3150-0010.« less

Quality quandaries: Understanding aspects influencing different types of multiple response optimization

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

Anderson-Cook, Christine M.; Cao, Yongtao; Lu, Lu

In this study, optimizing with several responses can benefit from an objective approach of eliminating non-contenders, understanding trade-offs between competing responses, and then identifying a final choice that matches optimization priorities. To offer insights that help guide thoughtful decisions, we explore and summarize different patterns of solution sets and their trade-offs for different types of optimization with responses that are to be maximized and/or to achieve a target.

Quality quandaries: Understanding aspects influencing different types of multiple response optimization

DOE PAGES

Anderson-Cook, Christine M.; Cao, Yongtao; Lu, Lu

2016-08-26

In this study, optimizing with several responses can benefit from an objective approach of eliminating non-contenders, understanding trade-offs between competing responses, and then identifying a final choice that matches optimization priorities. To offer insights that help guide thoughtful decisions, we explore and summarize different patterns of solution sets and their trade-offs for different types of optimization with responses that are to be maximized and/or to achieve a target.

A fast inverse treatment planning strategy facilitating optimized catheter selection in image-guided high-dose-rate interstitial gynecologic brachytherapy.

PubMed

Guthier, Christian V; Damato, Antonio L; Hesser, Juergen W; Viswanathan, Akila N; Cormack, Robert A

2017-12-01

Interstitial high-dose rate (HDR) brachytherapy is an important therapeutic strategy for the treatment of locally advanced gynecologic (GYN) cancers. The outcome of this therapy is determined by the quality of dose distribution achieved. This paper focuses on a novel yet simple heuristic for catheter selection for GYN HDR brachytherapy and their comparison against state of the art optimization strategies. The proposed technique is intended to act as a decision-supporting tool to select a favorable needle configuration. The presented heuristic for catheter optimization is based on a shrinkage-type algorithm (SACO). It is compared against state of the art planning in a retrospective study of 20 patients who previously received image-guided interstitial HDR brachytherapy using a Syed Neblett template. From those plans, template orientation and position are estimated via a rigid registration of the template with the actual catheter trajectories. All potential straight trajectories intersecting the contoured clinical target volume (CTV) are considered for catheter optimization. Retrospectively generated plans and clinical plans are compared with respect to dosimetric performance and optimization time. All plans were generated with one single run of the optimizer lasting 0.6-97.4 s. Compared to manual optimization, SACO yields a statistically significant (P ≤ 0.05) improved target coverage while at the same time fulfilling all dosimetric constraints for organs at risk (OARs). Comparing inverse planning strategies, dosimetric evaluation for SACO and "hybrid inverse planning and optimization" (HIPO), as gold standard, shows no statistically significant difference (P > 0.05). However, SACO provides the potential to reduce the number of used catheters without compromising plan quality. The proposed heuristic for needle selection provides fast catheter selection with optimization times suited for intraoperative treatment planning. Compared to manual optimization, the proposed methodology results in fewer catheters without a clinically significant loss in plan quality. The proposed approach can be used as a decision support tool that guides the user to find the ideal number and configuration of catheters. © 2017 American Association of Physicists in Medicine.

Optimizing preoperative blood ordering with data acquired from an anesthesia information management system.

PubMed

Frank, Steven M; Rothschild, James A; Masear, Courtney G; Rivers, Richard J; Merritt, William T; Savage, Will J; Ness, Paul M

2013-06-01

The maximum surgical blood order schedule (MSBOS) is used to determine preoperative blood orders for specific surgical procedures. Because the list was developed in the late 1970s, many new surgical procedures have been introduced and others improved upon, making the original MSBOS obsolete. The authors describe methods to create an updated, institution-specific MSBOS to guide preoperative blood ordering. Blood utilization data for 53,526 patients undergoing 1,632 different surgical procedures were gathered from an anesthesia information management system. A novel algorithm based on previously defined criteria was used to create an MSBOS for each surgical specialty. The economic implications were calculated based on the number of blood orders placed, but not indicated, according to the MSBOS. Among 27,825 surgical cases that did not require preoperative blood orders as determined by the MSBOS, 9,099 (32.7%) had a type and screen, and 2,643 (9.5%) had a crossmatch ordered. Of 4,644 cases determined to require only a type and screen, 1,509 (32.5%) had a type and crossmatch ordered. By using the MSBOS to eliminate unnecessary blood orders, the authors calculated a potential reduction in hospital charges and actual costs of $211,448 and $43,135 per year, respectively, or $8.89 and $1.81 per surgical patient, respectively. An institution-specific MSBOS can be created, using blood utilization data extracted from an anesthesia information management system along with our proposed algorithm. Using these methods to optimize the process of preoperative blood ordering can potentially improve operating room efficiency, increase patient safety, and decrease costs.

Saving Energy. Managing School Facilities, Guide 3.

ERIC Educational Resources Information Center

Department for Education and Employment, London (England). Architects and Building Branch.

This guide offers information on how schools can implement an energy saving action plan to reduce their energy costs. Various low-cost energy-saving measures are recommended covering heating levels and heating systems, electricity demand reduction and lighting, ventilation, hot water usage, and swimming pool energy management. Additional…

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

Management. Teacher's Instructional Guide.

ERIC Educational Resources Information Center

Hutnyak, Dana

This teacher's instructional guide, which is part of a family and consumer sciences education series focusing on a broad range of employment opportunities, is intended to assist teachers responsible for teaching one- and two-year management programs for Texas high school students. The following are among the items included: (1) introductory…

VoCATS User Guide. [Draft.

ERIC Educational Resources Information Center

North Carolina State Dept. of Public Instruction, Raleigh. Div. of Vocational Education Services.

This guide focuses on use of the North Carolina Vocational Competency Achievement Tracking System (VoCATS)-designated software in the instructional management process. (VoCATS is a competency-based, computer-based instructional management system that allows the collection of data on student performance achievement prior to, during, and following…

Management of Student Aid: A Guide for Presidents.

ERIC Educational Resources Information Center

El-Khawas, Elaine

A guide offering a quick review of principles, decisions, and responsibilities in financial aid management has been developed to aid presidents, trustees, and senior administrators of colleges and universities. The handbook stresses the possible implications of aid for enrollment, financial stability, and institutional mission. Topics that are…

Policy options evaluation tool for managed lanes (POET-ML) users guide and methodology description : Federal Highway Administration HOV lane performance

DOT National Transportation Integrated Search

2008-12-01

Users guide for a sketch planning tool for exploring policy alternatives. It is intended for an audience of transportation professionals responsible for planning, designing, funding, operating, enforcing, monitoring, and managing HOV and HOT lanes...

Management Guide to the Protection of Information Resources.

ERIC Educational Resources Information Center

Helsing, Cheryl; And Others

This guide introduces information systems security concerns and outlines the issues that must be addressed by all agency managers in meeting their responsibilities to protect information systems within their organizations. It describes the essential components of an effective information resource protection process that applies to an individual…

Design optimization of large-size format edge-lit light guide units

NASA Astrophysics Data System (ADS)

Hastanin, J.; Lenaerts, C.; Fleury-Frenette, K.

2016-04-01

In this paper, we present an original method of dot pattern generation dedicated to large-size format light guide plate (LGP) design optimization, such as photo-bioreactors, the number of dots greatly exceeds the maximum allowable number of optical objects supported by most common ray-tracing software. In the proposed method, in order to simplify the computational problem, the original optical system is replaced by an equivalent one. Accordingly, an original dot pattern is splitted into multiple small sections, inside which the dot size variation is less than the ink dots printing typical resolution. Then, these sections are replaced by equivalent cells with continuous diffusing film. After that, we adjust the TIS (Total Integrated Scatter) two-dimensional distribution over the grid of equivalent cells, using an iterative optimization procedure. Finally, the obtained optimal TIS distribution is converted into the dot size distribution by applying an appropriate conversion rule. An original semi-empirical equation dedicated to rectangular large-size LGPs is proposed for the initial guess of TIS distribution. It allows significantly reduce the total time needed to dot pattern optimization.

Optimization of Residual Stresses in MMC's Using Compensating/Compliant Interfacial Layers. Part 2: OPTCOMP User's Guide

NASA Technical Reports Server (NTRS)

Pindera, Marek-Jerzy; Salzar, Robert S.; Williams, Todd O.

1994-01-01

A user's guide for the computer program OPTCOMP is presented in this report. This program provides a capability to optimize the fabrication or service-induced residual stresses in uni-directional metal matrix composites subjected to combined thermo-mechanical axisymmetric loading using compensating or compliant layers at the fiber/matrix interface. The user specifies the architecture and the initial material parameters of the interfacial region, which can be either elastic or elastoplastic, and defines the design variables, together with the objective function, the associated constraints and the loading history through a user-friendly data input interface. The optimization procedure is based on an efficient solution methodology for the elastoplastic response of an arbitrarily layered multiple concentric cylinder model that is coupled to the commercial optimization package DOT. The solution methodology for the arbitrarily layered cylinder is based on the local-global stiffness matrix formulation and Mendelson's iterative technique of successive elastic solutions developed for elastoplastic boundary-value problems. The optimization algorithm employed in DOT is based on the method of feasible directions.

Goal setting in diabetes self-management: taking the baby steps to success.

PubMed

DeWalt, Darren A; Davis, Terry C; Wallace, Andrea S; Seligman, Hilary K; Bryant-Shilliday, Betsy; Arnold, Connie L; Freburger, Janet; Schillinger, Dean

2009-11-01

To evaluate the usefulness of a diabetes self-management guide and a brief counseling intervention in helping patients set and achieve their behavioral goals. We conducted a quasi-experimental study using a one group pretest posttest design to assess the effectiveness of a goal setting intervention along with a self-management guide. English- and Spanish-speaking patients with diabetes had one in-person session and two telephone follow-up calls with a non-clinical provider over a 12-16-week period. At each call and at the end of the study, we assessed success in achieving behavioral goals and problem solving toward those goals. Satisfaction with the self-management guide was assessed at the end of the study. We enrolled 250 patients across three sites and 229 patients completed the study. Most patients chose to set goals in diet and exercise domains. 93% of patients achieved at least one behavioral goal during the study and 73% achieved at least two behavioral goals. Many patients exhibited problem solving behavior to achieve their goals. We found no significant differences in reported achievement of behavior goals by literacy or language. Patients were very satisfied with the guide. A brief goal setting intervention along with a diabetes self-management guide helped patients set and achieve healthy behavioral goals. Non-clinical providers can successfully help a diverse range of patients with diabetes set and achieve behavioral goals.

Preclinical Feasibility of a Technology Framework for MRI-guided Iliac Angioplasty

PubMed Central

Rube, Martin A.; Fernandez-Gutierrez, Fabiola; Cox, Benjamin F.; Holbrook, Andrew B.; Houston, J. Graeme; White, Richard D.; McLeod, Helen; Fatahi, Mahsa; Melzer, Andreas

2015-01-01

Purpose Interventional MRI has significant potential for image guidance of iliac angioplasty and related vascular procedures. A technology framework with in-room image display, control, communication and MRI-guided intervention techniques was designed and tested for its potential to provide safe, fast and efficient MRI-guided angioplasty of the iliac arteries. Methods A 1.5T MRI scanner was adapted for interactive imaging during endovascular procedures using new or modified interventional devices such as guidewires and catheters. A perfused vascular phantom was used for testing. Pre-, intra- and post-procedural visualization and measurement of vascular morphology and flow was implemented. A detailed analysis of X-Ray fluoroscopic angiography workflow was conducted and applied. Two interventional radiologists and one physician in training performed 39 procedures. All procedures were timed and analyzed. Results MRI-guided iliac angioplasty procedures were successfully performed with progressive adaptation of techniques and workflow. The workflow, setup and protocol enabled a reduction in table time for a dedicated MRI-guided procedure to 6 min 33 s with a mean procedure time of 9 min 2 s, comparable to the mean procedure time of 8 min 42 s for the standard X-Ray guided procedure. Conclusions MRI-guided iliac vascular interventions were found to be feasible and practical using this framework and optimized workflow. In particular the real-time flow analysis was found to be helpful for pre- and post-interventional assessments. Design optimization of the catheters and in vivo experiments are required before clinical evaluation. PMID:25102933

Optimizing care for Canadians with diabetic nephropathy in 2015.

PubMed

Lloyd, Alissa; Komenda, Paul

2015-06-01

Diabetic chronic kidney disease (CKD) is the cause of kidney failure in approximately 35% of Canadian patients requiring dialysis. Traditionally, only a minority of patients with type 2 diabetes and CKD progress to kidney failure because they die of a cardiovascular event first. However, with contemporary therapies for diabetes and cardiovascular disease, this may no longer be true. The classic description of diabetic CKD is the development of albuminuria followed by progressive kidney dysfunction in a patient with longstanding diabetes. Many exciting candidate agents are under study to halt the progression of diabetic CKD; current therapies center on optimizing glycemic control, renin angiotensin system inhibition, blood pressure control and lipid management. Lifestyle modifications, such as salt and protein restriction as well as smoking cessation, may also be of benefit. Unfortunately, these accepted therapies do not entirely halt the progression of diabetic CKD. Also unfortunately, the presence of CKD in general is under-recognized by primary care providers, which can lead to late referral, missed opportunities for preventive care and inadvertent administration of potentially harmful interventions. Not all patients require referral to nephrology for diagnosis and management, but modern risk-prediction algorithms, such as the kidney failure risk equation, may help to guide referral appropriateness and dialysis modality planning in subspecialty nephrology multidisciplinary care clinics. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

Application of biomarkers in cancer risk management: evaluation from stochastic clonal evolutionary and dynamic system optimization points of view.

PubMed

Li, Xiaohong; Blount, Patricia L; Vaughan, Thomas L; Reid, Brian J

2011-02-01

Aside from primary prevention, early detection remains the most effective way to decrease mortality associated with the majority of solid cancers. Previous cancer screening models are largely based on classification of at-risk populations into three conceptually defined groups (normal, cancer without symptoms, and cancer with symptoms). Unfortunately, this approach has achieved limited successes in reducing cancer mortality. With advances in molecular biology and genomic technologies, many candidate somatic genetic and epigenetic "biomarkers" have been identified as potential predictors of cancer risk. However, none have yet been validated as robust predictors of progression to cancer or shown to reduce cancer mortality. In this Perspective, we first define the necessary and sufficient conditions for precise prediction of future cancer development and early cancer detection within a simple physical model framework. We then evaluate cancer risk prediction and early detection from a dynamic clonal evolution point of view, examining the implications of dynamic clonal evolution of biomarkers and the application of clonal evolution for cancer risk management in clinical practice. Finally, we propose a framework to guide future collaborative research between mathematical modelers and biomarker researchers to design studies to investigate and model dynamic clonal evolution. This approach will allow optimization of available resources for cancer control and intervention timing based on molecular biomarkers in predicting cancer among various risk subsets that dynamically evolve over time.

Self-Guided Multimedia Stress Management and Resilience Training for Flight Controllers

NASA Technical Reports Server (NTRS)

Rose, R. D.; Zbozinek, T. D.; Hentschel, P. G.; Smith, S, M.; O'Brien J.; Oftedal, A.; Craske, M. G.

2016-01-01

Stress and anxiety-related problems are among the most common and costly behavioral health problems in society, and for those working in operational environments (i.e. astronauts, flight controllers, military) this can seriously impact crew performance, safety, and wellbeing. Technology-based interventions are effective for treating behavioral health problems, and can significantly improve the delivery of evidence-based health care. This study is evaluating the effectiveness, usefulness, and usability of a self-guided multimedia stress management and resilience training program in a randomized controlled trial (RCT) with a sample of flight controllers at Johnson Space Center. The intervention, SMART-OP (Stress Management and Resilience Training for Optimal Performance), is a six-session, cognitive behavioral-based computer program that uses self-guided, interactive activities to teach skills that can help individuals build resilience and manage stress. In a prior RCT with a sample of stressed but otherwise healthy individuals, SMART-OP reduced perceived stress and increased perceived control over stress in comparison to an Attention Control (AC) group. SMART-OP was rated as "highly useful" and "excellent" in usability and acceptability. Based on a-amylase data, individuals in SMART-OP recovered quicker and more completely from a social stress test as compared to the AC group [1]. In the current study, flight controllers are randomized either to receive SMART-OP training, or to a 6-week waitlist control period (WLC) before beginning SMART-OP. Eligible participants include JSC flight controllers and instructors without any medical or psychiatric disorder, but who are stressed based on self-report. Flight controllers provide a valid analog sample to astronauts in that they work in an operational setting, use similar terminology to astronauts, are mission-focused, and work under the same broader work culture. The study began in December 2014, and to date 79 flight controllers and instructors have expressed interest in the study, 49 of those were cleared for participation, we have screened 44 for eligibility, and 23 have met inclusion criteria. Recruitment is ongoing and the study will continue until December 2016. Outcome measures include perceived stress, perceived control over stress, resilience, mood, personality, emotion regulation, sleep, health behaviors, and psychophysiological data such as 24-hour heart rate, alpha amylase, and urinary and salivary cortisol. We are also collecting user feedback such as usability, working alliance, usefulness, and treatment credibility.

Greening Federal Facilities: An Energy, Environmental, and Economic Resource Guide for Federal Facility Managers and Designers; Second Edition

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

Wilson, A.

2001-05-16

Greening Federal Facilities, Second Edition, is a nuts-and-bolts resource guide compiled to increase energy and resource efficiency, cut waste, and improve the performance of Federal buildings and facilities. The guide highlights practical actions that facility managers, design and construction staff, procurement officials, and facility planners can take to save energy and money, improve the comfort and productivity of employees, and benefit the environment. It supports a national effort to promote energy and environmental efficiency in the nation's 500,000 Federal buildings and facilities. Topics covered include current Federal regulations; environmental and energy decision-making; site and landscape issues; building design; energy systems;more » water and wastewater; materials; waste management, and recycling; indoor environmental quality; and managing buildings.« less

Principles of effective USA federal fire management plans

USGS Publications Warehouse

Meyer, Marc D.; Roberts, Susan L.; Wills, Robin; Brooks, Matthew L.; Winford, Eric M.

2015-01-01

Federal fire management plans are essential implementation guides for the management of wildland fire on federal lands. Recent changes in federal fire policy implementation guidance and fire science information suggest the need for substantial changes in federal fire management plans of the United States. Federal land management agencies are also undergoing land management planning efforts that will initiate revision of fire management plans across the country. Using the southern Sierra Nevada as a case study, we briefly describe the underlying framework of fire management plans, assess their consistency with guiding principles based on current science information and federal policy guidance, and provide recommendations for the development of future fire management plans. Based on our review, we recommend that future fire management plans be: (1) consistent and compatible, (2) collaborative, (3) clear and comprehensive, (4) spatially and temporally scalable, (5) informed by the best available science, and (6) flexible and adaptive. In addition, we identify and describe several strategic guides or “tools” that can enhance these core principles and benefit future fire management plans in the following areas: planning and prioritization, science integration, climate change adaptation, partnerships, monitoring, education and communication, and applied fire management. These principles and tools are essential to successfully realize fire management goals and objectives in a rapidly changing world.

Patient-centered disease management (PCDM) for heart failure: study protocol for a randomised controlled trial.

PubMed

Bekelman, David B; Plomondon, Mary E; Sullivan, Mark D; Nelson, Karin; Hattler, Brack; McBryde, Connor; Lehmann, Kenneth G; Potfay, Jonathan; Heidenreich, Paul; Rumsfeld, John S

2013-07-09

Chronic heart failure (HF) disease management programs have reported inconsistent results and have not included comorbid depression management or specifically focused on improving patient-reported outcomes. The Patient Centered Disease Management (PCDM) trial was designed to test the effectiveness of collaborative care disease management in improving health status (symptoms, functioning, and quality of life) in patients with HF who reported poor HF-specific health status. Patients with a HF diagnosis at four VA Medical Centers were identified through population-based sampling. Patients with a Kansas City Cardiomyopathy Questionnaire (KCCQ, a measure of HF-specific health status) score of < 60 (heavy symptom burden and impaired quality of life) were invited to enroll in the PCDM trial. Enrolled patients were randomized to receive usual care or the PCDM intervention, which included: (1) collaborative care management by VA clinicians including a nurse, cardiologist, internist, and psychiatrist, who worked with patients and their primary care providers to provide guideline-concordant care management, (2) home telemonitoring and guided patient self-management support, and (3) screening and treatment for comorbid depression. The primary study outcome is change in overall KCCQ score. Secondary outcomes include depression, medication adherence, guideline-based care, hospitalizations, and mortality. The PCDM trial builds on previous studies of HF disease management by prioritizing patient health status, implementing a collaborative care model of health care delivery, and addressing depression, a key barrier to optimal disease management. The study has been designed as an 'effectiveness trial' to support broader implementation in the healthcare system if it is successful. Unique identifier: NCT00461513.

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…

Discover a Watershed: The Watershed Manager Educators Guide

ERIC Educational Resources Information Center

Project WET Foundation, 2002

2002-01-01

This guide contains 19 science-based, multidisciplinary activities that teach what a watershed is, how it works and why we must all consider ourselves watershed managers. An extensive background section introduces readers to fundamental watershed concepts. Each activity adapts to local watersheds, contains e-links for further Internet research and…

Proceedings-1979 third annual practical conference on communication

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

Not Available

1981-04-01

Topics covered at the meeting include: nonacademic writing, writer and editor training in technical publications, readability of technical documents, guide for beginning technical editors, a visual aids data base, newsletter publishing, style guide for a project management organization, word processing, computer graphics, text management for technical documentation, and typographical terminology.

Emergency Management Instruction. Instructor's Guide for Grades 7-9.

ERIC Educational Resources Information Center

North Carolina State Div. of Emergency Management, Raleigh.

Emergency Management education seeks to give students basic information about natural and man-made disasters, preparedness procedures, and survival techniques. The intent of this guide is to aid teachers in presenting disaster survival instruction in the junior high school grades. The materials are designed to supplement existing curricula, where…

Colleges and Money. A Faculty Guide to Academic Economics.

ERIC Educational Resources Information Center

Change Magazine, New Rochelle, NY.

The basics of academic economics are examined in this faculty guide. The modern management movement has reached American higher education and has created new expectations concerning the faculty's role. An earlier preoccupation with management methods has been replaced by concentration on evaluation. Faculty should share in the preparation of their…

Food Production, Management, and Services Curriculum Guide.

ERIC Educational Resources Information Center

Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

This food production, management, and services curriculum guide provides information needed by teachers. It begins with a list of the competencies and subcompetencies that are the essential elements and the sub-elements prescribed in the Texas Administrative Codes for Vocational Home Economics. Each chapter consists of teaching strategies. They…

Internet Policy Handbook for Libraries. Neal-Schuman NetGuide Series.

ERIC Educational Resources Information Center

Smith, Mark

This book is intended to guide library administrators--directors and departmental managers in public, school, and academic libraries--through the many complex decisions inherent in managing public Internet access. The handbook systematically deals with each possible element of an Internet policy. It identifies the options available at each…

A Farm Management Problem. Teacher Guide. AGDEX 810.

ERIC Educational Resources Information Center

Cackler, William

This guide is intended to assist teachers in conducting a farm management simulation that has been designed to help vocational agriculture students acquire competency in both crop and livestock farming. The introductory section includes an overview of the simulation, planning considerations and suggested grading criteria, and a suggested sequence…

Feeding & Management of Dairy Calves & Heifers. Teacher's Guide.

ERIC Educational Resources Information Center

Bjoraker, Walt

This guide is designed to assist postsecondary and secondary teachers of agriculture in their use of the University of Wisconsin bulletin "Raising Dairy Replacements" in their dairy science instructional program. Eight lessons are provided in this unit: breeding decisions, management of cows from breeding to calving, care at calving time, the…

Housekeeping Management Assistant. [Teacher's Copy]. Revised.

ERIC Educational Resources Information Center

Texas Education Agency, Austin. Dept. of Occupational Education and Technology.

The curriculum guide, one of a series prepared to assist teacher-coordinators in promoting and teaching home economics cooperative education programs, provides a course of study for the housekeeping management assistant occupation. In addition to a brief overview, job description, and job analysis of the occupation, the guide's four main sections…

Administration of Child Care Programs: Business Management. Instructor's Guide.

ERIC Educational Resources Information Center

Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

Designed for use by postsecondary child development instructors, this guide is organized into four units that expose students to the general competencies and business management aspects of child care program administration. Introductory materials discuss the use of the materials and provide guidelines for evaluating students. The four units cover…

Home Management and Consumer Education.

ERIC Educational Resources Information Center

Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

Designed for use in consumer and homemaking education in Texas, this curriculum guide is on the subject of home management and consumer education. An introduction to the guide, covering its use and program and curriculum planning, provides a list of suggested reading. Information on teaching handicapped and disadvantaged students follows. The…

Fire Safety. Managing School Facilities, Guide 6.

ERIC Educational Resources Information Center

Department for Education and Employment, London (England). Architects and Building Branch.

This booklet discusses how United Kingdom schools can manage fire safety and minimize the risk of fire. The guide examines what legislation school buildings must comply with and covers the major risks. It also describes training and evacuation procedures and provides guidance on fire precautions, alarm systems, fire fighting equipment, and escape…

Tank waste remediation system privatization infrastructure program requirements and document management process guide

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

ROOT, R.W.

1999-05-18

This guide provides the Tank Waste Remediation System Privatization Infrastructure Program management with processes and requirements to appropriately control information and documents in accordance with the Tank Waste Remediation System Configuration Management Plan (Vann 1998b). This includes documents and information created by the program, as well as non-program generated materials submitted to the project. It provides appropriate approval/control, distribution and filing systems.

Perioperative cardiopulmonary exercise testing (CPET): consensus clinical guidelines on indications, organization, conduct, and physiological interpretation.

PubMed

Levett, D Z H; Jack, S; Swart, M; Carlisle, J; Wilson, J; Snowden, C; Riley, M; Danjoux, G; Ward, S A; Older, P; Grocott, M P W

2018-03-01

The use of perioperative cardiopulmonary exercise testing (CPET) to evaluate the risk of adverse perioperative events and inform the perioperative management of patients undergoing surgery has increased over the last decade. CPET provides an objective assessment of exercise capacity preoperatively and identifies the causes of exercise limitation. This information may be used to assist clinicians and patients in decisions about the most appropriate surgical and non-surgical management during the perioperative period. Information gained from CPET can be used to estimate the likelihood of perioperative morbidity and mortality, to inform the processes of multidisciplinary collaborative decision making and consent, to triage patients for perioperative care (ward vs critical care), to direct preoperative interventions and optimization, to identify new comorbidities, to evaluate the effects of neoadjuvant cancer therapies, to guide prehabilitation and rehabilitation, and to guide intraoperative anaesthetic practice. With the rapid uptake of CPET, standardization is key to ensure valid, reproducible results that can inform clinical decision making. Recently, an international Perioperative Exercise Testing and Training Society has been established (POETTS www.poetts.co.uk) promoting the highest standards of care for patients undergoing exercise testing, training, or both in the perioperative setting. These clinical cardiopulmonary exercise testing guidelines have been developed by consensus by the Perioperative Exercise Testing and Training Society after systematic literature review. The guidelines have been endorsed by the Association of Respiratory Technology and Physiology (ARTP). Copyright © 2017. Published by Elsevier Ltd.

The management of lower gastrointestinal bleeding.

PubMed

Marion, Y; Lebreton, G; Le Pennec, V; Hourna, E; Viennot, S; Alves, A

2014-06-01

Lower gastrointestinal (LGI) bleeding is generally less severe than upper gastrointestinal (UGI) bleeding with spontaneous cessation of bleeding in 80% of cases and a mortality of 2-4%. However, unlike UGI bleeding, there is no consensual agreement about management. Once the patient has been stabilized, the main objective and greatest difficulty is to identify the location of bleeding in order to provide specific appropriate treatment. While upper endoscopy and colonoscopy remain the essential first-line examinations, the development and availability of angiography have made this an important imaging modality for cases of active bleeding; they allow diagnostic localization of bleeding and guide subsequent therapy, whether therapeutic embolization, interventional colonoscopy or, if other techniques fail or are unavailable, surgery directed at the precise site of bleeding. Furthermore, newly developed endoscopic techniques, particularly video capsule enteroscopy, now allow minimally invasive exploration of the small intestine; if this is positive, it will guide subsequent assisted enteroscopy or surgery. Other small bowel imaging techniques include enteroclysis by CT or magnetic resonance imaging. At the present time, exploratory surgery is no longer a first-line approach. In view of the lesser gravity of LGI bleeding, it is most reasonable to simply stabilize the patient initially for subsequent transfer to a specialized center, if minimally invasive techniques are not available at the local hospital. In all cases, the complexity and diversity of LGI bleeding require a multidisciplinary collaboration involving the gastroenterologist, radiologist, intensivist and surgeon to optimize diagnosis and treatment of the patient. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Social Planning for Small Cities.

ERIC Educational Resources Information Center

Meyers, James

Derived mainly from publications by the League of California Cities, this guide to social planning for small cities presents the following: (1) social planning definitions; (2) a checklist of social planning concerns (provision for: adequate income and economic opportunity; optimal environmental conditions for basic material needs; optimal health…

The value of telemonitoring and ICT-guided disease management in heart failure: Results from the IN TOUCH study.

PubMed

Kraai, Imke; de Vries, Arjen; Vermeulen, Karin; van Deursen, Vincent; van der Wal, Martje; de Jong, Richard; van Dijk, René; Jaarsma, Tiny; Hillege, Hans; Lesman, Ivonne

2016-01-01

It is still unclear whether telemonitoring reduces hospitalization and mortality in heart failure (HF) patients and whether adding an Information and Computing Technology-guided-disease-management-system (ICT-guided-DMS) improves clinical and patient reported outcomes or reduces healthcare costs. A multicenter randomized controlled trial was performed testing the effects of INnovative ICT-guided-DMS combined with Telemonitoring in OUtpatient clinics for Chronic HF patients (IN TOUCH) with in total 179 patients (mean age 69 years; 72% male; 77% in New York Heart Association Classification (NYHA) III-IV; mean left ventricular ejection fraction was 28%). Patients were randomized to ICT-guided-DMS or to ICT-guided-DMS+telemonitoring with a follow-up of nine months. The composite endpoint included mortality, HF-readmission and change in health-related quality of life (HR-QoL). In total 177 patients were eligible for analyses. The mean score of the primary composite endpoint was -0.63 in ICT-guided-DMS vs. -0.73 in ICT-guided-DMS+telemonitoring (mean difference 0.1, 95% CI: -0.67 +0.82, p=0.39). All-cause mortality in ICT-guided-DMS was 12% versus 15% in ICT-guided-DMS+telemonitoring (p=0.27); HF-readmission 28% vs. 27% p=0.87; all-cause readmission was 49% vs. 51% (p=0.78). HR-QoL improved in most patients and was equal in both groups. Incremental costs were €1360 in favor of ICT-guided-DMS. ICT-guided-DMS+telemonitoring had significantly fewer HF-outpatient-clinic visits (p<0.01). ICT-guided-DMS+telemonitoring for the management of HF patients did not affect the primary and secondary endpoints. However, we did find a reduction in visits to the HF-outpatient clinic in this group suggesting that telemonitoring might be safe to use in reorganizing HF-care with relatively low costs. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.