Science.gov

Sample records for long-term waste management

  1. Long-term nuclear waste management: Present status and alternatives

    NASA Astrophysics Data System (ADS)

    Schapira, J. P.

    1989-08-01

    Long-term nuclear waste management deals with the final and irreversible stage of waste disposal, on surface and in deep geological formations (according to the waste type), when institutional surveillance is over. There are presently two main options available to deal with the wastes generated by spent nuclear fuel unloaded from reactors and containing most of the radiotoxicity produced all along the nuclear fuel cycle. Since the end of Word War II, spent-fuel reprocessing technology has gone through three different stages, ending up with considerable technical achievements and large investments (construction of large facilities, UP3 in France and THORP in the UK). However, having to face spent-fuel risings and lack of reprocessing capacities, since the mid-seventies some countries are considering the possibility of direct spent-fuel disposal without reprocessing. These two options are discussed in terms of long-term waste management. Because of the types of waste conditioning and packaging adopted with present reprocessing technology, in that case long-term safety, after a few centuries, relies completely on the geological barriers. On the other hand, long-term safety with the second option is based essentially on the retention properties of uranium oxide with respect to actinides. Finally, alternatives such as chemical partitioning of minor actinides followed by their transmutation, either in reactors or using high-energy particle accelerators, are under discussion. Apart from the standard reprocessing (after a cooling period of 3-5 years), all the other options called for a long period (50 years) of interim storage, preventing the adoption of irreversible, costly and not well proved waste management solutions, and leaving time to develop and assess these alternative methods.

  2. Design of the Long-term Waste Management Facility for Historic LLRW Port Hope Project - 13322

    SciTech Connect

    Campbell, Don; Barton, David; Case, Glenn

    2013-07-01

    The Municipality of Port Hope is located on the northern shores of Lake Ontario approximately 100 km east of Toronto, Ontario, Canada. Starting in the 1930's, radium and later uranium processing by Eldorado Gold Mines Limited (subsequently Eldorado Nuclear Limited) (Eldorado) at their refinery in Port Hope resulted in the generation of process residues and wastes that were disposed of indiscriminately throughout the Municipality until about the mid-1950's. These process residues contained radium (Ra- 226), uranium, arsenic and other contaminants. Between 1944 and 1988, Eldorado was a Federal Crown Corporation, and as such, the Canadian Federal Government has assumed responsibility for the clean-up and long-term management of the historic waste produced by Eldorado during this period. The Port Hope Project involves the construction and development of a new long-term waste management facility (LTWMF), and the remediation and transfer of the historic wastes located within the Municipality of Port Hope to the new LTWMF. The new LTWMF will consist of an engineered above-ground containment mound designed to contain and isolate the wastes from the surrounding environment for the next several hundred years. The design of the engineered containment mound consists of a primary and secondary composite base liner system and composite final cover system, made up of both natural materials (e.g., compacted clay, granular materials) and synthetic materials (e.g., geo-synthetic clay liner, geo-membrane, geo-textiles). The engineered containment mound will cover an area of approximately 13 hectares and will contain the estimated 1.2 million cubic metres of waste that will be generated from the remedial activities within Port Hope. The LTWMF will also include infrastructure and support facilities such as access roads, administrative offices, laboratory, equipment and personnel decontamination facilities, waste water treatment plant and other ancillary facilities. Preliminary

  3. Current Status of the United Kingdom Programme for Long-Term Radioactive Waste Management

    SciTech Connect

    Murray, C. H.; Hooper, A. J.; Mathieson, J.

    2002-02-27

    In 1997, the UK programme for the deep disposal of radioactive waste was ''stopped dead in its tracks'' with the refusal by the Secretary of State for the Environment to allow Nirex to go ahead with its plans for an underground Rock Characterisation Facility at Sellafield in north-west England. Since that time a House of Lords' Select Committee has held an inquiry into what went wrong and what the way ahead should be. In addition, Nirex and the nuclear industry players have also been analyzing the past with a view to learning from the experience in taking things forward. In Nirex's view this is essentially an ethical issue; the waste exists and we should deal with it in this generation. Three areas need to be better addressed if a successful program of management of the nation's radioactive waste is to be achieved: the process of how policy development and implementation can be achieved; the structure of the nuclear industry and its relationship to the waste management organization; and the behavior of the players in their interaction with stakeholders. All three are underpinned by the need for transparency. In recognition that developing a policy for managing radioactive waste has to be achieved with the support of all stakeholders, the Government instigated a consultation exercise in September 2001. The initial phase of this initiative is essentially a consultation about consultation and is intended to decide on how the next stages of a six year policy development program should be addressed. In addition to this exercise, the Government is undertaking a fundamental review of the structuring of the United Kingdom Atomic Energy Authority (UKAEA) and British Nuclear Fuels plc (BNFL). They are both shareholders in Nirex and in November 2001 the Government announced the setting up of a Liabilities Management Authority (LMA) to manage the long-term nuclear liabilities that are publicly owned, particularly through those organizations. The future of Nirex will be

  4. Governing Long-Term Risks in Radioactive Waste Management: Reversibility and Knowledge Transfer Across Generations

    NASA Astrophysics Data System (ADS)

    Lehtonen, M.

    2014-12-01

    Safe management of the long-lived and high-level radioactive waste originating primarily from nuclear power stations requires isolating and confining the waste for periods up to 100 000 years. Disposal in deep geological formations is currently the solution advocated by international organisations (e.g. the IAEA and the OECD-NEA) and governments, but nowhere in the world is such repository for civilian nuclear waste in operation yet. Concerns about the governance of the involved risks and uncertainties for such long periods lie at the heart of the controversies that have slowed down the identification of a solution. In order to draw lessons potentially relevant for the governance of long-term climate risks, this paper examines the ways in which two interrelated aspects have been addressed in nuclear waste management in France, the US, and the Nordic countries. The first issue concerns "reversibility" - i.e. the possibility on one hand to retrieve the waste once it has been disposed of in a repository, and on the other to return at any point in time along the decision-making process to the previous decision-making phase. Reversibility constitutes today a fundamental, legally binding requirement in French radioactive waste policy. A strategy for managing risk and uncertainty as such, reversibility nevertheless also poses significant safety challenges of its own. The second topic goes beyond the timescales (max. 300 years) in which reversibility is usually considered applicable, addressing the question of intergenerational knowledge transfer, comparing the Nordic and the American approaches to the issue. The key challenge here is ensuring the transfer to the future generations - for periods up to 100 000 years - of sufficient knowledge concerning the siting, characteristics and management of the waste deposited in a repository. Even more fundamentally, instead of knowledge transfer, should we rather aim at "active forgetting", in order to prevent the curious in the

  5. Concrete long-term behaviour in the context of nuclear waste management: Experimental and modelling research strategy

    NASA Astrophysics Data System (ADS)

    Gallé, C.; Peycelon, H.; Le Bescop, P.; Bejaoui, S.; L'Hostis, V.; Bary, B.; Bouniol, P.; Richet, C.

    2006-11-01

    This paper draws the main lines of the scientific strategy adopted by CEA for its R&D programme dedicated to the study of the long-term behaviour of cement-based materials in relationship with cemented nuclear waste management. In the framework of the safety assessment analysis, the long-term stability of waste package confinement and mechanical properties is required. This analysis was achieved considering the different environmental conditions atmospheric and water saturated environments which could affect the waste package. As far as the unsaturated phase (storage) is concerned, corrosion and air carbonation of reinforced concrete were identified as the two main phenomena which could jeopardize the waste package long-term performances. During the disposal phase, underground water leaching may significantly contribute to the chemical degradation of concrete. The understanding and modelling of phenomena and mechanisms responsible of such degradation are therefore essential to make relevant and robust long-term predictions. With this aim, CEA has developed an extended research programme to assess the long-term degradation of concrete through a chemistry-transport and mechanical coupled approach. The relevancy and validity of such a programme are discussed here.

  6. A review of approaches for the long-term management of municipal solid waste landfills.

    PubMed

    Laner, David; Crest, Marion; Scharff, Heijo; Morris, Jeremy W F; Barlaz, Morton A

    2012-03-01

    After closure, municipal solid waste (MSW) landfills must be managed and controlled to avoid adverse effects on human health and the environment (HHE). Aftercare (or post-closure care) can be brought to an end when the authorities consider the landfill to no longer pose a threat to HHE. Different approaches have been suggested for long-term landfill management and evaluation of aftercare completion. In this paper, research on aftercare and its completion is analyzed and regulatory approaches for the completion of landfill aftercare are reviewed. Approaches to aftercare could be categorized as (i) target values, (ii) impact/risk assessment, and (iii) performance based. Comparison of these approaches illustrates that each has limitations and strengths. While target values are typically used as screening indicators to be complemented with site-specific assessments, impact/risk assessment approaches address the core issue about aftercare completion, but face large uncertainties and require a high level of expertise. A performance-based approach allows for the combination of target values and impact/risk assessments in a consistent evaluation framework with the aim of sequentially reducing aftercare intensity and, ultimately, leading to the completion of aftercare. At a regulatory level, simple qualitative criteria are typically used as the primary basis for defining completion of aftercare, most likely due to the complexity of developing rigorous evaluation methodologies. This paper argues that development of transparent and consistent regulatory procedures represents the basis for defining the desired state of a landfill at the end of aftercare and for reducing uncertainty about the intensity and duration of aftercare. In this context, recently presented technical guidelines and the ongoing debate with respect to their regulatory acceptance are a valuable step towards developing strategies for the cost-effective protection of HHE at closed MSW landfills. To assess the

  7. Sandia National Laboratories performance assessment methodology for long-term environmental programs : the history of nuclear waste management.

    SciTech Connect

    Marietta, Melvin Gary; Anderson, D. Richard; Bonano, Evaristo J.; Meacham, Paul Gregory

    2011-11-01

    Sandia National Laboratories (SNL) is the world leader in the development of the detailed science underpinning the application of a probabilistic risk assessment methodology, referred to in this report as performance assessment (PA), for (1) understanding and forecasting the long-term behavior of a radioactive waste disposal system, (2) estimating the ability of the disposal system and its various components to isolate the waste, (3) developing regulations, (4) implementing programs to estimate the safety that the system can afford to individuals and to the environment, and (5) demonstrating compliance with the attendant regulatory requirements. This report documents the evolution of the SNL PA methodology from inception in the mid-1970s, summarizing major SNL PA applications including: the Subseabed Disposal Project PAs for high-level radioactive waste; the Waste Isolation Pilot Plant PAs for disposal of defense transuranic waste; the Yucca Mountain Project total system PAs for deep geologic disposal of spent nuclear fuel and high-level radioactive waste; PAs for the Greater Confinement Borehole Disposal boreholes at the Nevada National Security Site; and PA evaluations for disposal of high-level wastes and Department of Energy spent nuclear fuels stored at Idaho National Laboratory. In addition, the report summarizes smaller PA programs for long-term cover systems implemented for the Monticello, Utah, mill-tailings repository; a PA for the SNL Mixed Waste Landfill in support of environmental restoration; PA support for radioactive waste management efforts in Egypt, Iraq, and Taiwan; and, most recently, PAs for analysis of alternative high-level radioactive waste disposal strategies including repositories deep borehole disposal and geologic repositories in shale and granite. Finally, this report summarizes the extension of the PA methodology for radioactive waste disposal toward development of an enhanced PA system for carbon sequestration and storage systems

  8. Exploration of urban deposits: long-term prospects for resource and waste management.

    PubMed

    Wittmer, Dominic; Lichtensteiger, Thomas

    2007-06-01

    Many materials currently in use are potentially available to become raw materials for future production if the materials are recycled instead of discarded as solid waste. However, the structure and life-expectancy of these secondary resources have not been sufficiently examined, and comprehensive methods for forecasting the availability of such materials are still lacking. This study presents a method for identifying anthropogenic material stocks in combination with the method of material flow analysis (MFA). The method was applied to copper in Switzerland as an example, with the focus on use in buildings. The exploration concept was a three-step process. First, a MFA identified the relevant stocks within the inventory of the region. Second, these stocks were inventoried through a building stock model and determination of key parameters that were defined by surveying selected buildings and from the literature. Third, the study team developed a dynamic MFA model to describe the copper stocks and flows during the period 1900-2000. The results of the copper stock calculation (in kg capita(-1)) were: buildings 79 +/- 11, infrastructure 107 +/- 25, movables 34 +/- 9, landfills 50 +/- 12. The calibrated model enabled the study team to develop resource and waste management scenarios forecasting waste flows. It is shown that the conversion of buildings into other uses may affect the waste flows significantly.

  9. Design and operation of an anaerobic digester for waste management and fuel generation during long term lunar mission

    NASA Astrophysics Data System (ADS)

    Dhoble, Abhishek S.; Pullammanappallil, Pratap C.

    2014-10-01

    Waste treatment and management for manned long term exploratory missions to moon will be a challenge due to longer mission duration. The present study investigated appropriate digester technologies that could be used on the base. The effect of stirring, operation temperature, organic loading rate and reactor design on the methane production rate and methane yield was studied. For the same duration of digestion, the unmixed digester produced 20-50% more methane than mixed system. Two-stage design which separated the soluble components from the solids and treated them separately had more rapid kinetics than one stage system, producing the target methane potential in one-half the retention time than the one stage system. The two stage system degraded 6% more solids than the single stage system. The two stage design formed the basis of a prototype digester sized for a four-person crew during one year exploratory lunar mission.

  10. OBRA: a European project to create an observatory for long-term governance on radioactive waste management

    SciTech Connect

    Martell, Meritxell; Duro, Lara; Bruno, Jordi; Kopetz, Irene

    2007-07-01

    Available in abstract form only. Full text of publication follows: This paper introduces a number of topics that will be addressed by the 'OBRA' project. The OBRA project (2006-2008) is a 2-year Coordination Action under the 6. EURATOM Framework Program (FP) which started on 1. November 2006 and will finish on 31. October 2008. The project aims to assess the feasibility of creating an Observatory for Long-term Governance on Radioactive Waste Management in Europe. OBRA will devise an Observatory to promote appropriate forms of interaction between stakeholders, mainly local and regional communities and experts. The focus and value of OBRA lies on the development of a concrete tool to promote governance processes. With respect to this objective, the paper introduces the project and some of the key questions that have been addressed in the first creative workshop and which will be the focus of OBRA in the following months. (authors)

  11. Transuranic waste: long-term planning

    SciTech Connect

    Young, K.C.

    1985-07-01

    Societal concerns for the safe handling and disposal of toxic waste are behind many of the regulations and the control measures in effect today. Transuranic waste, a specific category of toxic (radioactive) waste, serves as a good example of how regulations and controls impact changes in waste processing - and vice versa. As problems would arise with waste processing, changes would be instituted. These changes improved techniques for handling and disposal of transuranic waste, reduced the risk of breached containment, and were usually linked with regulatory changes. Today, however, we face a greater public awareness of and concern for toxic waste control; thus, we must anticipate potential problems and work on resolving them before they can become real problems. System safety analyses are valuable aids in long-term planning for operations involving transuranic as well as other toxic materials. Examples of specific system safety analytical methods demonstrate how problems can be anticipated and resolution initiated in a timely manner having minimal impacts upon allocation of resource and operational goals. 7 refs., 1 fig.

  12. Environmental evaluation of alternatives for long-term management of Defense high-level radioactive wastes at the Idaho Chemical Processing Plant

    SciTech Connect

    Not Available

    1982-09-01

    The U.S. Department of Energy (DOE) is considering the selection of a strategy for the long-term management of the defense high-level wastes at the Idaho Chemical Processing Plant (ICPP). This report describes the environmental impacts of alternative strategies. These alternative strategies include leaving the calcine in its present form at the Idaho National Engineering Laboratory (INEL), or retrieving and modifying the calcine to a more durable waste form and disposing of it either at the INEL or in an offsite repository. This report addresses only the alternatives for a program to manage the high-level waste generated at the ICPP. 24 figures, 60 tables.

  13. Better Understanding Public Perceptions of Risk: Possible Implications for Long-term Environmental Stewardship and Hazardous Waste Management

    SciTech Connect

    Joe, Jeffrey Clark; Harbour, Gerald Lee

    2002-10-01

    In the treatment, disposition, and long-term stewardship (e.g., storage) of hazardous waste forms, questions that are of particular concern are: • What is technically feasible and safe, • What is economically affordable, • What is legally mandated and allowable, and • What is publicly acceptable? Although DOE is exerting considerable effort in making sound science-based decisions that are economical and meet legal requirements, it may be lapse in not gaining a better understanding of how public perceptions are formed. This observation appears especially true in regards to the perceived long-term integrity and safety of various proposed hazardous waste storage options. The purpose of this research was to investigate how differences in how hazardous materials are configured and how those configurations are presented affect peoples’ perceptions of how safe they are. Specifically, we designed a preliminary experiment that assessed the public’s perception of risk for various storage configurations of hazardous materials. We included into the design factors to measure participants’ deliberative and spontaneous response to the perceived safety (or danger) posed by different hazardous materials storage configurations. The critical objectives of the proposed effort were to identify specific characteristics of hazardous materials storage configuration and to identify possible differences in deliberative and spontaneous processing of those specific characteristics. Identification of these objectives is critical in understanding what does and does not constitute an acceptable approach to hazardous waste treatment, disposition, and long-term storage. FY01 TECHNICAL OBJECTIVES • Develop an experimental process for collecting perceptions regarding the perceived safety and long-term integrity of hazardous waste storage systems. • Develop a computer-based, reusable collection instrument “system” with associated graphical images. • Validate the applicability

  14. Inexact fuzzy-stochastic mixed integer programming approach for long-term planning of waste management---Part B: case study.

    PubMed

    Guo, P; Huang, G H

    2009-01-01

    In this study, a solid waste decision-support system was developed for the long-term planning of waste management in the City of Regina, Canada. Interactions among various system components, objectives, and constraints will be analyzed. Issues concerning planning for cost-effective diversion and prolongation of the landfill will be addressed. Decisions of system-capacity expansion and waste allocation within a multi-facility, multi-option, and multi-period context will be obtained. The obtained results would provide useful information and decision-support for the City's solid waste management and planning. In the application, four scenarios are considered. Through the above scenario analyses under different waste-management policies, useful decision support for the City's solid waste managers and decision makers was generated. Analyses for the effects of varied policies (for allowable waste flows to different facilities) under 35 and 50% diversion goals were also undertaken. Tradeoffs among system cost and constraint-violation risk were analyzed. Generally, a policy with lower allowable waste-flow levels corresponded to a lower system cost under advantageous conditions but, at the same time, a higher penalty when such allowances were violated. A policy with higher allowable flow levels corresponded to a higher cost under disadvantageous conditions. The modeling results were useful for (i) scheduling adequate time and capacity for long-term planning of the facility development and/or expansion in the city's waste management system, (ii) adjusting of the existing waste flow allocation patterns to satisfy the city's diversion goal, and (iii) generating of desired policies for managing the city's waste generation, collection and disposal.

  15. Topical report on release scenario analysis of long-term management of high-level defense waste at the Hanford Site

    SciTech Connect

    Wallace, R.W.; Landstrom, D.K.; Blair, S.C.; Howes, B.W.; Robkin, M.A.; Benson, G.L.; Reisenauer, A.E.; Walters, W.H.; Zimmerman, M.G.

    1980-11-01

    Potential release scenarios for the defense high-level waste (HLW) on the Hanford Site are presented. Presented in this report are the three components necessary for evaluating the various alternatives under consideration for long-term management of Hanford defense HLW: identification of scenarios and events which might directly or indirectly disrupt radionuclide containment barriers; geotransport calculations of waste migration through the site media; and consequence (dose) analyses based on groundwater and air pathways calculations. The scenarios described in this report provide the necessary parameters for radionuclide transport and consequence analysis. Scenarios are categorized as either bounding or nonbounding. Bounding scenarios consider worst case or what if situations where an actual and significant release of waste material to the environment would happen if the scenario were to occur. Bounding scenarios include both near-term and long-term scenarios. Near-term scenarios are events which occur at 100 years from 1990. Long term scenarios are potential events considered to occur at 1000 and 10,000 years from 1990. Nonbounding scenarios consider events which result in insignificant releases or no release at all to the environment. Three release mechanisms are described in this report: (1) direct exposure of waste to the biosphere by a defined sequence of events (scenario) such as human intrusion by drilling; (2) radionuclides contacting an unconfined aquifer through downward percolation of groundwater or a rising water table; and (3) cataclysmic or explosive release of radionuclides by such mechanisms as meteorite impact, fire and explosion, criticality, or seismic events. Scenarios in this report present ways in which these release mechanisms could occur at a waste management facility. The scenarios are applied to the two in-tank waste management alternatives: in-situ disposal and continued present action.

  16. Long-term management of liquid high-level radioactive wastes stored at the Western New York Nuclear Service Center, West Valley

    NASA Astrophysics Data System (ADS)

    1981-07-01

    Environmental implications of possible alternatives for long-term management of the liquid high-level radioactive wastes stored in underground tanks in West Valley, New York were assessed and compared. Four basic alternatives, as well as options within these alternatives, considered in the EIS: (1) onsite processing to a terminal waste form for shipment and disposal in a federa repository; (2) onsite conversion to a solid interim form for shipment to a federal waste facility for later processing to a terminal form and shipment and subsequent disposal in a federal repository; (3) mixing the liquid wastes with cement and other additives, pouring it back into the existing tanks, and leaving onsite; and (4) no action (continued storage of the wastes in liquid form in the underground tanks at West Valley). Mitigative measures for environmental impacts were be required.

  17. 'CATT' A project on Co-operation and Technology Transfer on Long-Term Radioactive Waste Management for EU Member States with Small Nuclear Programmes

    SciTech Connect

    Mathieson, J.; Lindberg, C.

    2006-07-01

    Many of the European Union's (EU) 25 countries have considerable inventories of long-lived radioactive waste that will remain potentially hazardous for many thousands of years. Of these, several have advanced concepts and programmes for the treatment and disposal (and other long - term management options) for spent fuel and long-lived radioactive waste. Collectively, these Member States have spent the equivalent of many billions of euros in developing such concepts and some have further developed the concepts into proposed operational facilities. Member States with small nuclear programmes, face the expensive and daunting prospect o f developing their own concepts for dealing with their spent fuel and high level waste. One answer would be to seek solutions which could take advantage of the investment costs in the technology and underpinning science already incurred in the more established programmes. Thus technology transfer between Member States in areas of high level waste and spent fuel encapsulation, repository development etc. would allow the establishment of disposal facilities within any Member State for it to deal with its own wastes. The national waste management organisations of the UK (Mirex), Sweden (SKB), German y (DBE), Lithuania (RATA), Bulgaria (DPRAO) and Slovenia (ARAO), together with JRC of the Netherlands, are to undertake a project under the auspices of the EU's 6. R and D Framework Programme (FP6). The 18 month project will examine the technical, intellectual property, legal, financial and societal implications of the idea. It goes by the acronym 'CATT' - 'Cooperation and technology transfer on long term radioactive waste management for Member States with small nuclear programmes'. This paper describes the CATT project which will look at technology transfer methodologies by which Member States could co-operate. It covers the potential issues which may arise and ho w these may be addressed. (authors)

  18. Inexact fuzzy-stochastic mixed-integer programming approach for long-term planning of waste management--Part A: methodology.

    PubMed

    Guo, P; Huang, G H

    2009-01-01

    In this study, an inexact fuzzy chance-constrained two-stage mixed-integer linear programming (IFCTIP) approach is proposed for supporting long-term planning of waste-management systems under multiple uncertainties in the City of Regina, Canada. The method improves upon the existing inexact two-stage programming and mixed-integer linear programming techniques by incorporating uncertainties expressed as multiple uncertainties of intervals and dual probability distributions within a general optimization framework. The developed method can provide an effective linkage between the predefined environmental policies and the associated economic implications. Four special characteristics of the proposed method make it unique compared with other optimization techniques that deal with uncertainties. Firstly, it provides a linkage to predefined policies that have to be respected when a modeling effort is undertaken; secondly, it is useful for tackling uncertainties presented as intervals, probabilities, fuzzy sets and their incorporation; thirdly, it facilitates dynamic analysis for decisions of facility-expansion planning and waste-flow allocation within a multi-facility, multi-period, multi-level, and multi-option context; fourthly, the penalties are exercised with recourse against any infeasibility, which permits in-depth analyses of various policy scenarios that are associated with different levels of economic consequences when the promised solid waste-generation rates are violated. In a companion paper, the developed method is applied to a real case for the long-term planning of waste management in the City of Regina, Canada.

  19. Geologic processes in the RWMC area, Idaho National Engineering Laboratory: Implications for long term stability and soil erosion at the radioactive waste management complex

    SciTech Connect

    Hackett, W.R.; Tullis, J.A.; Smith, R.P.

    1995-09-01

    The Radioactive Waste Management Complex (RWMC) is the disposal and storage facility for low-level radioactive waste at the Idaho National Engineering Laboratory (INEL). Transuranic waste and mixed wastes were also disposed at the RWMC until 1970. It is located in the southwestern part of the INEL about 80 km west of Idaho Falls, Idaho. The INEL occupies a portion of the Eastern Snake River Plain (ESRP), a low-relief, basalt, and sediment-floored basin within the northern Rocky Mountains and northeastern Basin and Range Province. It is a cool and semiarid, sagebrush steppe desert characterized by irregular, rolling terrain. The RWMC began disposal of INEL-generated wastes in 1952, and since 1954, wastes have been accepted from other Federal facilities. Much of the waste is buried in shallow trenches, pits, and soil vaults. Until about 1970, trenches and pits were excavated to the basalt surface, leaving no sediments between the waste and the top of the basalt. Since 1970, a layer of sediment (about 1 m) has been left between the waste and the basalt. The United States Department of Energy (DOE) has developed regulations specific to radioactive-waste disposal, including environmental standards and performance objectives. The regulation applicable to all DOE facilities is DOE Order 5820.2A (Radioactive Waste Management). An important consideration for the performance assessment of the RWMC is the long-term geomorphic stability of the site. Several investigators have identified geologic processes and events that could disrupt a radioactive waste disposal facility. Examples of these {open_quotes}geomorphic hazards{close_quotes} include changes in stream discharge, sediment load, and base level, which may result from climate change, tectonic processes, or magmatic processes. In the performance assessment, these hazards are incorporated into scenarios that may affect the future performance of the RWMC.

  20. Social scientist on board in long-term management of high level and/or long-lived radioactive waste in Belgium

    SciTech Connect

    Parotte, C.

    2013-07-01

    In Belgium, the long-term management of radioactive waste is under the exclusive competence of the Belgian Agency for Radioactive Waste and Enriched Fissile Materials (knew as ONDRAF/NIRAS). Unlike low-level waste, no institutional policy has yet been formally approved for the long-term management of high level and/or long-lived radioactive waste (knew as B and C waste). In this context, ONDRAF/NIRAS considers the public and stakeholders' participation as an essential factor in the formulation of an effective and legitimate policy. This is why it has decided to integrate them in different ways during the elaboration of the Waste Plan (ONDRAF/NIRAS-document containing guidelines to make a principled policy decision about nuclear waste management). To do so, social scientists have been regularly mobilized either as external evaluators, follow-up committee members, or participatory observants. Hence, the Waste Plan is only the first step in a long decision-making process. For a PhD student under contract with ONDRAF/NIRAS, this mandate consists of thinking out a way to construct an inter-organizational innovative communication system that would be participative, transparent and embedded in a long-term perspective, thus integrating all the further legal steps to take throughout the decision-making process. In this regard, two paradoxical constraints must be taken into account: on the one hand, my own influence on the legal decision-making process should remain limited, because of a series of constraints, lock-ins and previous decisions which have to be respected; on the other hand, ONDRAF/NIRAS expects the research conclusions to be policy relevant and useful. In this paper, the purpose is twofold. Firstly, the issues raised by this policy mandate is an opportunity to question the per-formative dimensions of the social scientist in the decision-making process and, more specifically, to have a reflexive view on our position as PhD Student. Secondly, assuming the role of

  1. Landfilling of solid and hazardous waste: Facing long-term liability

    SciTech Connect

    Lee, G.F.; Jones-Lee, A.

    1994-12-31

    In the past, the cheapest method available was used for the management of solid non-hazardous and hazardous waste. Now with cradle-to-grave liability, many companies are more critically evaluating the near-term and long-term liabilities and costs associated with various options for solid and liquid waste management. Recycle and reuse of wastes with residue management that eliminates long-term liability are the most desirable. However, most waste management programs involve some landfilling of wastes and/or treated residues. The disposal of hazardous and non-hazardous wastes in such landfills carries a significant, perpetual liability for clean-up of contaminated groundwaters and eventual Superfund-like activities for waste removal and proper management. The inability of US EPA-prescribed Subtitle C and D landfills to prevent groundwater pollution by landfill leachate for as long as the wastes are a threat should be of significant concern to all waste generators. Solid and hazardous waste generators should critically evaluate the potential near-term and long-term liabilities associated with any particular approach for waste management, resource recovery (including fuel blending, solvent recovery, and reuse), and management of waste residues. This paper reviews why landfills of the type being developed today do no eliminate long-term liability associated with wastes and issues of long-term liability associated with alternative methods of waste management.

  2. Managing Records for the Long Term - 12363

    SciTech Connect

    Montgomery, John V.; Gueretta, Jeanie

    2012-07-01

    The U.S. Department of Energy (DOE) is responsible for managing vast amounts of information documenting historical and current operations. This information is critical to the operations of the DOE Office of Legacy Management. Managing legacy records and information is challenging in terms of accessibility and changing technology. The Office of Legacy Management is meeting these challenges by making records and information management an organizational priority. The Office of Legacy Management mission is to manage DOE post-closure responsibilities at former Cold War weapons sites to ensure the future protection of human health and the environment. These responsibilities include environmental stewardship and long-term preservation and management of operational and environmental cleanup records associated with each site. A primary organizational goal for the Office of Legacy Management is to 'Preserve, Protect, and Share Records and Information'. Managing records for long-term preservation is an important responsibility. Adequate and dedicated resources and management support are required to perform this responsibility successfully. Records tell the story of an organization and may be required to defend an organization in court, provide historical information, identify lessons learned, or provide valuable information for researchers. Loss of records or the inability to retrieve records because of poor records management processes can have serious consequences and even lead to an organisation's downfall. Organizations must invest time and resources to establish a good records management program because of its significance to the organization as a whole. The Office of Legacy Management will continue to research and apply innovative ways of doing business to ensure that the organization stays at the forefront of effective records and information management. DOE is committed to preserving records that document our nation's Cold War legacy, and the Office of Legacy

  3. Long-term management of prolactinomas.

    PubMed

    Schlechte, Janet A

    2007-08-01

    Prolactinomas are a frequent cause of gonadal dysfunction and infertility, especially in young women. The regulation of prolactin secretion and the efficacy of dopamine agonists in the therapy of prolactinomas are well established. The current challenges in management of prolactinomas are related to follow-up after successful therapy. Issues and questions to be addressed in this approach to long-term management of prolactinomas include the frequency of radiographic monitoring, effect of pregnancy and menopause, safety of estrogen in women taking oral contraceptives, and the potential for discontinuation of dopamine agonist therapy.

  4. Managing soils for long-term productivity

    PubMed Central

    Syers, J. K.

    1997-01-01

    Meeting the goal of long-term agricultural productivity requires that soil degradation be halted and reversed. Soil fertility decline is a key factor in soil degradation and is probably the major cause of declining crop yields. There is evidence that the contribution of declining soil fertility to soil degradation has been underestimated.
    Sensitivity to soil degradation is implicit in the assessment of the sustainability of land management practices, with wide recognition of the fact that soils vary in their ability to resist change and recover subsequent to stress. The concept of resilience in relation to sustainability requires further elaboration and evaluation.
    In the context of soil degradation, a decline in soil fertility is primarily interpreted as the depletion of organic matter and plant nutrients. Despite a higher turnover rate of organic matter in the tropics there is no intrinsic difference between the organic matter content of soils from tropical and temperate regions. The level of organic matter in a soil is closely related to the above and below ground inputs. In the absence of adequate organic material inputs and where cultivation is continuous, soil organic matter declines progressively. Maintaining the quantity and quality of soil organic matter should be a guiding principle in developing management practices.
    Soil microbial biomass serves as an important reservoir of nitrogen (N), phosphorus (P) and sulphur (S), and regulates the cycling of organic matter and nutrients. Because of its high turnover rate, microbial biomass reacts quickly to changes in management and is a sensitive indicator for monitoring and predicting changes in soil organic matter. Modelling techniques have been reasonably successful in predicting changes in soil organic matter with different organic material inputs, but there is little information from the tropics.
    Nutrient depletion through harvested crop components and residue removal, and by leaching and soil

  5. Comprehensive monitoring and management of a long-term thermophilic CSTR treating coffee grounds, coffee liquid, milk waste, and municipal sludge.

    PubMed

    Shofie, Mohammad; Qiao, Wei; Li, Qian; Takayanagi, Kazuyuki; Li, Yu-You

    2015-09-01

    The CSTR process has previously not been successfully applied to treat coffee residues under thermophilic temperature and long term operation. In this experiment, the CSTR was fed with mixture substrate (TS ∼ 70 g/L) of coffee grounds, coffee wastewater, milk waste and municipal sludge and it was operated under 55 °C for 225 days. A steady state was achieved under HRT 30 days and OLR 4.0 kg-COD/m(3)/d. However, there was an 35 days inhibition with VFA accumulation (propionic acid 700-1900 mg/L) when doubling the OLR by shortening HRT to 15 days. But, an addition of microelements and sulfate (0.5 g/L) in feedstock increased reactor resilience and stability under high loading rate and propionic acid stress. Continuous monitoring of hydrogen in biogas indicated the imbalance of acetogenesis. The effectiveness of comprehensive parameters (total VFA, propionic acid, IA/PA, IA/TA and CH4 content) was proved to manage the thermophilic system.

  6. Waste transmutation with minimal fuel cycle long-term risk

    SciTech Connect

    Slessarev, I.; Salvatores, M.; Uematsu, M.

    1995-10-01

    Hybrid systems (source-driven subcritical reactors), are investigated at CEA, mainly from a conceptual point of view, in order to assess their potential to transmute radioactive wastes (mainly long-lived fission products, LLFP) and their potential to insure a minimal long-term radiological risk related both to the fuel inventory inside the system and to the full fuel cycle (mass flows, reprocessing transport, waste disposal). The physics of these systems has been explored and work is in progress both in the field of basic data and INC code validation, in the frame of international collaborations and in the field of conceptual design studies. The most interesting feature of subcritical source-driven system is related to the possibility to obtain an {open_quotes}excess{close_quotes} of neutrons per fission, which can be used to reduce the long-term radiological risk. A specific example will be discussed here.

  7. Estimating the Long Term Liability from Landfilling Hazardous Waste

    DTIC Science & Technology

    1992-01-01

    consumer welfare or benefit is made clear. Hence, if CS is 15 Pindyck , R.S., and Rubinfeld, D.L., Microeconomics , Macmillan, New York, 1989, p. 291...J. Hopkins, 1990. 38. Pindyck , R.S., and Rubinfeld, D.L., Microeconomics , MacMillan, NY, 1989. 39. Purcell, A., "The Economic Imperative," Government...associated with alternative hazardous waste disposal methods. Using microeconomic theory, a liability factor model has been developed to predict the long-term

  8. Long-term high-level waste technology

    NASA Astrophysics Data System (ADS)

    Corman, W. R.

    1981-08-01

    Work performed at sites to immobilize high-level radioactive wastes is described. Program management and support with subtasks of management and budget, environmental and safety assessments, waste preparation, storage or disposal; waste retrieval, separation and concentration are discussed. Waste fixation and characterization, process and equipment development, final handling, canister development and characterization and onsite storage or disposal are also reported. Event trees defining possible accidents were completed in a safety assessment of continued in-tank storage of high-level waste. Two low-cost waste forms (tailored concrete and bitumen) were investigated as candidate immobilization forms. Comparative impact tests and leaching tests were also conducted on glasses, ceramics, and concretes. A process design description was written for the tailored ceramic process.

  9. Radionuclide Incorporation and Long Term Performance of Apatite Waste Forms

    SciTech Connect

    Wang, Jianwei; Lian, Jie; Gao, Fei

    2016-01-04

    This project aims to combines state-of-the-art experimental and characterization techniques with atomistic simulations based on density functional theory (DFT) and molecular dynamics (MD) simulations. With an initial focus on long-lived I-129 and other radionuclides such as Cs, Sr in apatite structure, specific research objectives include the atomic scale understanding of: (1) incorporation behavior of the radionuclides and their effects on the crystal chemistry and phase stability; (2) stability and microstructure evolution of designed waste forms under coupled temperature and radiation environments; (3) incorporation and migration energetics of radionuclides and release behaviors as probed by DFT and molecular dynamics (MD) simulations; and (4) chemical durability as measured in dissolution experiments for long term performance evaluation and model validation.

  10. Environmental Management Long-Term Stewardship Transition Guidance

    SciTech Connect

    Kristofferson, Keith

    2001-11-01

    Long-term stewardship consists of those actions necessary to maintain and demonstrate continued protection of human health and the environment after the completion of facility cleanup. Long-term stewardship is administered and overseen by the U.S. Department of Energy Environmental Management Office of Science and Technology. This report describes the background of long-term stewardship and gives general guidance about considerations when ownership and/or responsibility of a site should be transferred to a long-term stewardship program. This guidance document will assist the U.S. Department of Energy in: (a) ensuring that the long-term stewardship program leads transition planning with respect to facility and site areas, and (b) describing the classes and types of criteria and data required to initiate transition for areas and sites where the facility mission has ended and cleanup is complete.

  11. Neonatal management and long-term sequelae.

    PubMed

    Halliday, Henry L

    2009-12-01

    Intrauterine or fetal growth restriction is best defined by using customised birth weight percentiles based upon the growth potential for an individual infant. Growth restriction in utero may be classified as asymmetric or symmetric depending upon the duration of the process. Asymmetric growth restriction is caused by placental insufficiency, maternal hypertensive conditions, long-standing maternal diabetes, smoking, living at altitude or multiple gestation. Symmetric growth restriction may be due to congenital infections, chromosomal or other abnormalities, fetal alcohol syndrome, low socioeconomic status or be constitutional. The underlying cause of growth restriction often predicts the potential adverse effects on the foetus and newborn and later effects in childhood and adulthood. With placental insufficiency, there may be chronic or acute on chronic fetal hypoxia with birth asphyxia and hypothermia, neonatal hypoglycaemia, polycythaemia and coagulopathy. Management is directed at prevention or early treatment of these conditions. In contrast, symmetrically growth-restricted infants should be examined carefully to look for congenital infections and malformations that may need specific interventions. Infants with constitutional short stature generally do not need any specific management. Feeding of growth-restricted infants is important to overcome deficiencies incurred in utero. Most infants show catch-up growth although about 10% do not. Those with excessive catch-up growth may be at greatest risk of developing insulin resistance in adulthood leading to diabetes, obesity and heart disease. The so-called fetal origins of disease may actually have a postnatal onset related more to excessive weight gain in infancy. There is still controversy over the indications for growth hormone treatment in growth-restricted infants who remain of short stature in early childhood. Intrauterine growth restriction is also associated with a five- to seven-fold increased risk of

  12. Long-term management of patients with multiple sclerosis.

    PubMed

    Weightman, Cherie

    2006-07-01

    This article explores the challenges of long-term case management for patients who have multiple sclerosis (MS). Currently there is scant research into district nursing input into long-term management of patients who have MS. Until now the role of the community nurses has been confined to palliation or terminal care, focusing on the more physical manifestations of MS. The contemporary role of district nurse is going to evolve to include proactive approaches. Governmental initiatives demand proactive services, and place emphasis on self-care for patients with MS. Themes that emerge from this article relate to the pre-existing skills--such as managing patients with complex needs and the advanced assessment skills--that will be required to achieve this. What is clear is that community nurses already possess many of the prerequisite skills needed for long-term management, and they should not be daunted by this prospect.

  13. Method for Water Management Considering Long-term Probabilistic Forecasts

    NASA Astrophysics Data System (ADS)

    Hwang, J.; Kang, J.; Suh, A. S.

    2015-12-01

    This research is aimed at predicting the monthly inflow of the Andong-dam basin in South Korea using long-term probabilistic forecasts to apply long-term forecasts to water management. Forecasted Cumulative Distribution Functions (CDFs) of monthly precipitation are plotted by combining the range of monthly precipitation based on proper Probability Density Function (PDF) in past data with probabilistic forecasts in each category. Ensembles of inflow are estimated by entering generated ensembles of precipitation based on the CDFs into the 'abcd' water budget model. The bias and RMSE between averages in past data and observed inflow are compared to them in forecasted ensembles. In our results, the bias and RMSE of average precipitation in the forecasted ensemble are bigger than in past data, whereas the average inflow in the forecasted ensemble is smaller than in past data. This result could be used for reference data to apply long-term forecasts to water management, because of the limit in the number of forecasted data for verification and differences between the Andong-dam basin and the forecasted regions. This research has significance by suggesting a method of applying probabilistic information in climate variables from long-term forecasts to water management in Korea. Original data of a climate model, which produces long-term probabilistic forecasts should be verified directly as input data of a water budget model in the future, so that a more scientific response in water management against uncertainty of climate change could be reached.

  14. Long-term forest management and climate effects on streamflow

    Treesearch

    Shelby G. Laird; C.R. Ford; S.H. Laseter; J.M. Vose

    2011-01-01

    Long-term watershed studies are a powerful tool for examining interactions among management activities, streamflow, and climatic variability. Understanding these interactions is critical for exploring the potential of forest management to adapt to or mitigate against the effects of climate change. The Coweeta Hydrologic Laboratory, located in North Carolina, USA, is a...

  15. National long-term high-level waste-technology program

    NASA Astrophysics Data System (ADS)

    Gray, P. L.

    The national program for long-term management of high level waste (HLW) from nuclear fuels reprocessing is discussed. This covers only DOE defense wastes. Current emphasis is on solidification of waste into a form that, along with additional barriers, may be permanently stored in a repository. An integrated national plan incorporates all the elements of such an overall HLW disposal system. Interim storage is in near-surface tanks at the Hanford and Savannah River sites. At the Idaho site, waste is stored in bins after being calcined. Some Idaho waste is liquid and is also stored in tanks before calcination. Retrieval and immobilization of HLW into a solid, low-release form represent the major elements for which our long-term program has responsibility. Once solidified, the waste will temporarily remain onsite until the final disposal site is prepared for receipt of waste. Currently, a geologic repository is favored for ultimate disposal, although other possibilities such as seabed, icecap, space, and near-surface disposal are also being considered.

  16. Long term management practices influenced soil aggregation and carbon dynamics

    USDA-ARS?s Scientific Manuscript database

    Soil aggregation protects soil organic C (SOC) against rapid decomposition, improves soil quality, and reduces soil erosion potential. The objectives of this study are to evaluate the effects of long-term (21 yrs.) management practices on SOC, water stable aggregate (WSA), and aggregate-associated ...

  17. Wildfire Mitigation and Private Lands: Managing Long-Term Vulnerabilities

    Treesearch

    Brian Muller; Stacey Schulte

    2006-01-01

    Long-term management of wildfire vulnerability requires strategies that address complex interactions between fire ecology and human settlement. In this paper, we examine the integration of wildfire mitigation and land use planning in county governments in the western U.S. This research relies on data from two sources. First, we conducted a survey of land use...

  18. San Francisco Bay Long Term Management Strategy for Dredging

    EPA Pesticide Factsheets

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

  19. The aging network and managed long-term care.

    PubMed

    Polivka, Larry; Zayac, Helen

    2008-10-01

    Since the early 1980s, service providers and area agencies on aging, that is, the aging network, have developed a number of strengths as they built a community-based long-term-care system in most states. Many area agencies and providers now have the capacity to assess the needs of older persons, identify appropriate services, and administer cost-effective community programs while operating within fixed, capped budgets. They have also been able to identify and maintain roles for informal caregivers, draw on community resources through donations and the use of volunteers, and create substantial political support. In this article we argue that the aging network should draw on these strengths to develop integrated long-term-care systems designed to shift the balance of state long-term-care systems from institutional to home- and community-based services. We also argue that the nonprofit aging network, because it is made up of area agencies on aging and service providers, provides a potentially more effective framework for the integration of long-term-care resources than do proprietary managed care organizations.

  20. The Long-term Management of Used Nuclear Fuel in Canada: A Geoscientific Prespective

    NASA Astrophysics Data System (ADS)

    Belfadhel, B.

    2009-05-01

    The Nuclear Waste Management Organization (NWMO) is responsible for implementing Adaptive Phased Management, the approach selected by the Government of Canada for long-term management of used nuclear fuel waste generated by Canadian nuclear reactors. In support of this objective, NWMO is pursuing an active technical research and development program in areas such as repository engineering, repository geoscience and repository safety. The geoscience work program is designed to develop a geoscientific basis for understanding long-term geosphere barrier performance, as well as building confidence in deep geological repository safety in both sedimentary and crystalline settings. This is achieved through a multidisciplinary approach involving the coordinated effort of research groups drawn from universities, consultants, and international nuclear waste management organizations. The main objectives of the program are to: develop tools and methods to improve NWMO's geosphere characterization capabilities and develop readiness for evaluating potential candidate sites in willing host communities; advance the understanding of long-term physical and geochemical evolution of the geosphere at time scales relevant to repository safety; and improve numerical methods to assess the geosphere evolution and its response to long-term perturbations. The paper provides an overview of the geoscience issues and challenges associated with the development of deep geological repositories and key activities that the NWMO is pursuing to address them.

  1. The Starkey project: long-term research for long-term management solutions.

    Treesearch

    Thomas M. Quigley; Michael J. Wisdom

    2004-01-01

    The Starkey Project is a unique, long-term research program designed to study the effects of key resource uses of national forests on mule deer (Odocoileus hemionus) and elk (Cervus elaphus) habitats and populations located at the Starkey Experimental Forest and Range (Starkey). The purpose of the project was to fill knowledge...

  2. Long-term high-level waste technology

    NASA Astrophysics Data System (ADS)

    Cornman, W. R.

    1980-07-01

    This series of reports summarizes research and development studies on the immobilization of high level wastes from the chemical reprocessing of nuclear reactor fuels. Immobilization of the wastes (defense and commercial) consists of placing them in a high integrity form with a very low potential for radionuclide release. Immobilization of commercial wastes is being considered on a contingency basis in the event that reprocessing is resumed. The basic plan for meeting the goal of immobilization of the DOE high level wastes is: (1) to develop technology to support a realistic choice of waste form alternatives for each of the three DOE sites; (2) to develop product and processing technology with sufficient scaleup to provide design data for full scale facilities; and (3) to construct and operate the facilities.

  3. The long term storage of radioactive waste and spent fuel: safety and policy considerations

    SciTech Connect

    Rowat, J.; Metcalf, P.

    2007-07-01

    Storage is a necessary step in the overall management of radioactive waste. In recent years, due to the unavailability of disposal facilities, storage facilities intended originally as temporary, have had their lifetimes extended and consideration has been given, in some countries, to the use of long term storage (LTS) as a management option. In 2003, the IAEA published a position paper titled 'The Long Term Storage of Radioactive Waste: Safety and Sustainability'. The position paper, which written for a non-specialist audience, focused on seven key factors for safety and sustainability of LTS, namely: safety, maintenance/institutional control, retrieval, security, costs, community attitudes and retention of information. The Agency is preparing a follow-up report to the position paper that elaborates in a more technical manner upon the issues raised in the position paper and issues important for implementation of LTS. It also provides some discussion of the reasons for implementing a LTS option and contrasts LTS with aspects of other management options. The present paper provides an overview of the draft follow-up report. (authors)

  4. Medication management for nurses working in long-term care.

    PubMed

    Ellis, Wendy; Kaasalainen, Sharon; Baxter, Pamela; Ploeg, Jenny

    2012-09-01

    In long-term care (LTC), the complexity of residents' conditions and their treatment requirements present challenges for nurses managing medications. The purpose of this qualitative descriptive study was to explore medication management as described by licensed nurses working in LTC. A total of 22 licensed nurses from 2 LTC facilities located in the Canadian province of Ontario participated in 4 focus groups. Thematic content analysis was used to organize data into themes and a conceptual model was developed. The overarching theme was that nurses are "racing against time" to manage medications and 3 subthemes described how they coped with this important care process: preparing to race, running the race, and finishing the race. Barriers to safe medication management included time restraints, knowledge limitations, interruptions and distractions, and poor communication. The findings can be used to better inform health-care providers and to guide future research. They also have the potential to directly impact outcomes related to safe medication management in LTC.

  5. An analysis of precipitation occurrences in Los Alamos, New Mexico, for long-term predictions of waste repository behavior

    SciTech Connect

    Nyhan, J.; Beckman, R.; Bowen, B.

    1989-02-01

    This study describes precipitation as an uncontrolled natural input influencing the hydrology of waste repositories in terms of their ultimate long-term closure. The general climatology of the western states, including that of New Mexico and Los Alamos, is first described. An analysis of the precipitation patterns at Los Alamos is then presented to be used for predicting long-term precipitation occurrences and shallow land burial site behavior. The waste management implications of this precipitation analysis are then discussed and future meteorological research needs are identified. 13 refs., 10 figs., 2 tabs.

  6. Transverse vaginal septae: management and long-term outcomes.

    PubMed

    Williams, C E; Nakhal, R S; Hall-Craggs, M A; Wood, D; Cutner, A; Pattison, S H; Creighton, S M

    2014-12-01

    To examine the management and long-term outcomes of transverse vaginal septae. Observational study with cross-sectional and retrospective arms. Tertiary referral centre specialising in Müllerian anomalies. Forty-six girls and women with a transverse vaginal septum. Data from medical records of all cases (1998-2013) of transverse vaginal septae were collected and reviewed. Patients over 16 years of age also completed a questionnaire. Presentation, examination findings, investigations, surgery, and long-term reproductive outcomes. The septae in the study were described as follows: 61% (95% CI 0.46-0.74) were imperforate, and presented with obstructed menstruation; 39% (95% CI 0.26-0.54) were perforate, and presented with a variety of concerns; 72% (95% CI 0.57-0.83) were low, 22% (95% CI 0.12-0.36) were mid-vaginal, and 6% (95% CI 0.02-0.18) were high; 33% were managed via an abdominoperineal approach, 59% were managed via a vaginal approach, and 6% had laparoscopic resection (one patient did not have surgery); 11% (95% CI 0.05-0.23) of patients presented with reobstruction, all following abdominoperineal vaginoplasty; 7% presented with vaginal stenosis, two following vaginal resection and one following the abdominoperineal approach; 61% of questionnaires were returned. These results showed that 22/23 patients were menstruating and one had a hysterectomy, 74% had been sexually active, 35% had dyspareunia, and 36% complained of dysmenorrhoea. There were seven pregnancies, with one termination and six live births, all following the vaginal excision of a transverse vaginal septum. Transverse vaginal septae resected vaginally or laparoscopically have low complication rates and good long-term outcomes. Complex septae require more extensive surgery, with an increased risk of complications. © 2014 Royal College of Obstetricians and Gynaecologists.

  7. General practitioners' management of the long-term sick role.

    PubMed

    Higgins, Angela; Porter, Sam; O'Halloran, Peter

    2014-04-01

    In this paper, we use qualitative research techniques to examine the role of general practitioners in the management of the long-term sickness absence. In order to uncover the perspectives of all the main agents affected by the actions of general practitioners, a case study approach focussing on one particular employment sector, the public health service, is adopted. The role of family physicians is viewed from the perspectives of health service managers, occupational health physicians, employees/patients, and general practitioners. Our argument is theoretically framed by Talcott Parsons's model of the medical contribution to the sick role, along with subsequent conceptualisations of the social role and position of physicians. Sixty one semi-structured interviews and three focus group interviews were conducted in three Health and Social Care Trusts in Northern Ireland between 2010 and 2012. There was a consensus among respondents that general practitioners put far more weight on the preferences and needs of their patients than they did on the requirements of employing organisations. This was explained by respondents in terms of the propinquity and longevity of relationships between doctors and their patients, and by the ideology of holistic care and patient advocacy that general practitioners viewed as providing the foundations of their approach to patients. The approach of general practitioners was viewed negatively by managers and occupational health physicians, and more positively by general practitioners and patients. However, there is some evidence that general practitioners would be prepared to forfeit their role as validators of sick leave. Given the imperatives of both state and capital to reduce the financial burden of long-term sickness, this preparedness puts into doubt the continued role of general practitioners as gatekeepers to legitimate long-term sickness absence.

  8. Long-term management of gout: nonpharmacologic and pharmacologic therapies.

    PubMed

    Chaichian, Yashaar; Chohan, Saima; Becker, Michael A

    2014-05-01

    Gout is a common disorder with clinical signs and symptoms resulting from inflammatory responses to monosodium urate crystals deposited in tissues from extracellular fluids saturated for urate. Long-term management of gout focuses on nonpharmacologic and pharmacologic means to achieve and maintain serum urate levels in a subsaturating range. Despite a firm understanding of gout pathophysiology, means to achieve certain diagnosis, and a variety of effective therapies, treatment outcomes remain suboptimal. In this review, available nonpharmacologic and pharmacologic therapies for chronic gout are discussed and a framework is provided for successful achievement and maintenance of goal-range serum urate levels. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Geological Disposal of Radioactive Waste: A Long-Term Socio-Technical Experiment.

    PubMed

    Schröder, Jantine

    2016-06-01

    In this article we investigate whether long-term radioactive waste management by means of geological disposal can be understood as a social experiment. Geological disposal is a rather particular technology in the way it deals with the analytical and ethical complexities implied by the idea of technological innovation as social experimentation, because it is presented as a technology that ultimately functions without human involvement. We argue that, even when the long term function of the 'social' is foreseen to be restricted to safeguarding the functioning of the 'technical', geological disposal is still a social experiment. In order to better understand this argument and explore how it could be addressed, we elaborate the idea of social experimentation with the notion of co-production and the analytical tools of delegation, prescription and network as developed by actor-network theory. In doing so we emphasize that geological disposal inherently involves relations between surface and subsurface, between humans and nonhumans, between the social, material and natural realm, and that these relations require recognition and further elaboration. In other words, we argue that geological disposal concurrently is a social and a technical experiment, or better, a long-term socio-technical experiment. We end with proposing the idea of 'actor-networking' as a sensitizing concept for future research into what geological disposal as a socio-technical experiment could look like.

  10. Change Ahead: Transient Scenarios for Long-term Water Management

    NASA Astrophysics Data System (ADS)

    Haasnoot, Marjolijn; Beersma, Jules; Schellekens, Jaap

    2013-04-01

    While the use of an ensemble of transient scenarios is common in climate change studies, they are rarely used in water management studies. Present planning studies on long-term water management often use a few plausible futures for one or two projection years, ignoring the dynamic aspect of adaptation through the interaction between the water system and society. Over the course of time society experiences, learns and adapts to changes and events, making policy responses part of a plausible future, and thus the success of a water management strategy. Exploring transient scenarios and policy options over time can support decision making on water management strategies in an uncertain and changing environment. We have developed and applied such a method, called exploring adaptation pathways (Haasnoot et al., 2012; Haasnoot et al., 2011). This method uses multiple realisations of transient scenarios to assess the efficacy of policy actions over time. In case specified objectives are not achieved anymore, an adaptation tipping point (Kwadijk et al., 2010) is reached. After reaching a tipping point, additional actions are needed to reach the objectives. As a result, a pathway emerges. In this presentation we describe the development of transient scenarios for long term water management, and how these scenarios can be used for long term water management under uncertainty. We illustrate this with thought experiments, and results from computational modeling experiment for exploring adaptation pathways in the lower Rhine delta. The results and the thought experiments show, among others, that climate variability is at least just as important as climate change for taking decisions in water management. References Haasnoot, M., Middelkoop, H., Offermans, A., Beek, E., Deursen, W.A.v. (2012) Exploring pathways for sustainable water management in river deltas in a changing environment. Climatic Change 115, 795-819. Haasnoot, M., Middelkoop, H., van Beek, E., van Deursen, W

  11. Development of long-term performance models for radioactive waste forms

    SciTech Connect

    Bacon, Diana H.; Pierce, Eric M.

    2011-03-22

    The long-term performance of solid radioactive waste is measured by the release rate of radionuclides into the environment, which depends on corrosion or weathering rates of the solid waste form. The reactions involved depend on the characteristics of the solid matrix containing the radioactive waste, the radionuclides of interest, and their interaction with surrounding geologic materials. This chapter describes thermo-hydro-mechanical and reactive transport models related to the long-term performance of solid radioactive waste forms, including metal, ceramic, glass, steam reformer and cement. Future trends involving Monte-Carlo simulations and coupled/multi-scale process modeling are also discussed.

  12. Complications and management of forgotten long-term biliary stents

    PubMed Central

    Sohn, Se Hoon; Park, Jae Hyun; Kim, Kook Hyun; Kim, Tae Nyeun

    2017-01-01

    AIM To evaluate complications and management outcomes of retained long-term plastic biliary stents. METHODS Endoscopic plastic biliary stent placement was performed in 802 patients at Yeungnam University Hospital between January 2000 and December 2014. Follow-up loss with a subsequently forgotten stent for more than 12 mo occurred in 38 patients. We retrospectively examined the cause of biliary stent insertion, status of stents, complications associated with biliary stents and management outcomes of long-term plastic biliary stents. Continuous variables were analyzed using the t test. Observed frequencies in subsets of the study population were compared using Fisher’s exact test and χ2 tests. Statistical significance was defined as P < 0.05 (two-tailed). RESULTS Mean age of patients was 73.7 ± 12 years and male-to-female ratio was 2.2:1. Indications of plastic biliary stent insertion were bile duct stones (63.2%, 24/38) and benign bile duct stricture (52.6%, 20/38). Mean duration of retained plastic stent was 22.6 ± 12.2 mo, and in 10 cases (26.3%), stents were retained for more than 24 mo. Common bile duct (CBD) stones or sludge were found in most cases (92.1%, 35/38). The most common complication was acute cholangitis (94.7%, 36/38). Stent removal by endoscopic approach was successfully performed in 92.1% (35/38) of the cases. In 3 cases, an additional plastic stent was inserted alongside the previous stent due to failure of the stent removal. Endoscopic removal of bile duct stones was successful in 73.7% (28/38) of the cases. When patients were divided into two groups by duration of stent placement (12 to 24 mo vs over 24 mo), there were no differences in the development of cholangitis, presence of biliary stones, and success rate of endoscopic removal of stones and biliary stents. CONCLUSION The most common complication of retained long-term plastic biliary stents was acute cholangitis associated with CBD stones. Endoscopic management was successfully

  13. Complications and management of forgotten long-term biliary stents.

    PubMed

    Sohn, Se Hoon; Park, Jae Hyun; Kim, Kook Hyun; Kim, Tae Nyeun

    2017-01-28

    To evaluate complications and management outcomes of retained long-term plastic biliary stents. Endoscopic plastic biliary stent placement was performed in 802 patients at Yeungnam University Hospital between January 2000 and December 2014. Follow-up loss with a subsequently forgotten stent for more than 12 mo occurred in 38 patients. We retrospectively examined the cause of biliary stent insertion, status of stents, complications associated with biliary stents and management outcomes of long-term plastic biliary stents. Continuous variables were analyzed using the t test. Observed frequencies in subsets of the study population were compared using Fisher's exact test and χ(2) tests. Statistical significance was defined as P < 0.05 (two-tailed). Mean age of patients was 73.7 ± 12 years and male-to-female ratio was 2.2:1. Indications of plastic biliary stent insertion were bile duct stones (63.2%, 24/38) and benign bile duct stricture (52.6%, 20/38). Mean duration of retained plastic stent was 22.6 ± 12.2 mo, and in 10 cases (26.3%), stents were retained for more than 24 mo. Common bile duct (CBD) stones or sludge were found in most cases (92.1%, 35/38). The most common complication was acute cholangitis (94.7%, 36/38). Stent removal by endoscopic approach was successfully performed in 92.1% (35/38) of the cases. In 3 cases, an additional plastic stent was inserted alongside the previous stent due to failure of the stent removal. Endoscopic removal of bile duct stones was successful in 73.7% (28/38) of the cases. When patients were divided into two groups by duration of stent placement (12 to 24 mo vs over 24 mo), there were no differences in the development of cholangitis, presence of biliary stones, and success rate of endoscopic removal of stones and biliary stents. The most common complication of retained long-term plastic biliary stents was acute cholangitis associated with CBD stones. Endoscopic management was successfully performed in most cases.

  14. Long-term management of patients with urea cycle disorders.

    PubMed

    Berry, G T; Steiner, R D

    2001-01-01

    The long-term treatment of patients with urea cycle disorders (UCDs) includes diet treatment and use of specific medications. Guidelines are provided for patients with a severe phenotype. However, treatment must be tailored for each individual, especially with regard to residual enzyme function and in vivo metabolic capacity. This will be reflected in tests used for monitoring therapy that should be performed on a periodic basis. The goal of therapy is to eliminate chronic complications, a laudable but rarely attainable goal. Sick-day rules are discussed. Chronic management also includes diverse services that are essential to the success of the metabolic program. These include neurologic and developmental evaluations, feeding team evaluation and therapy, physical and occupational therapies, speech therapy, school and educational services, social service intervention, psychologic services, and genetic counseling.

  15. Long-term strategy in the management of postmenopausal osteoporosis.

    PubMed

    Rizzoli, René

    2007-12-01

    The lifetime fracture risk at 50 years of age is about 50% in women and 20% in men. Osteoporotic fractures are associated with severe morbidity, increased mortality, quality-of-life alterations, and high management costs, most notably in the oldest age groups. The steady increase in life expectancy is matched by a rise in the absolute fracture risk. Effective prevention is therefore crucial. The goal of prevention, which must be not only effective, but also safe, is to diminish the risk of vertebral, peripheral, and hip fractures. Several medications were effective in double-blind controlled trials in which the fracture incidence was the primary endpoint. Long-term data are available to confirm the good safety profile of these medications.

  16. [Outsourcing in long-term care: a risk management approach].

    PubMed

    Guimarães, Cristina Machado; Carvalho, José Crespo de

    2012-05-01

    This article seeks to investigate outsourcing decisions in supply chain management of healthcare organizations, namely the motives and constraints behind the decision, the selection criteria for activities to be outsourced to third parties, the type of possible agreements, and the impact of this decision on the organization per se. A case study of the start-up phase of a Long-term Care unit with an innovative approach and high levels of customization was conducted to understand the outsourcing process in a start-up context (not in the standard context of organizational change) and a risk evaluation matrix was created for outsourcing activities in order to define and implement a performance monitoring process. This study seeks to understand how to evaluate and assess the risks of an outsourcing strategy and proposes a monitoring model using risk management tools. It was shown that the risk management approach can be a solution for monitoring outsourcing in the organizational start-up phase. Conclusions concerning dissatisfaction with the results of outsourcing strategies adopted are also presented.

  17. Instability of infiltration fronts due to long term irrigation of treated waste water

    NASA Astrophysics Data System (ADS)

    Leuther, Frederic; Weller, Ulrich; Schlüter, Steffen; Wallach, Rony; Vogel, Hans-Jörg

    2017-04-01

    Irrigation of treated waste water (TWW) is a common practice in arid and semiarid areas as it combines a sustainable, all-season available water recourse and the recycling of nutrients. Previous studies have shown that organic compounds can affect wettability of mineral surfaces and may change soil structure. Since TWW provides high loads of organic material, long-term irrigation can lead to persistent structure alteration, hydrophobicity, preferential flow, and leaching of chemicals and nutrients. In this study we (i) developed a new approach to quantify water movement in undisturbed soil cores via X-ray radiography and (ii) detected instabilities of water infiltration in soils irrigated with TWW since more than 20 years. We investigated soil samples from two orchards in Israel with long-term irrigation of TWW, one of them additionally irrigated with fresh water. The samples provide two different soil textures, and two different treatments of irrigation: fresh water and TWW. Furthermore, we included seasonal dependencies (dry season and rainy season) to determine persistency of effects. Undisturbed, cylindrical soil samples were taken from the upper soil layer (0-20cm) and irrigation experiments were performed inside an X-ray system. Via image analysis we quantified the infiltration front propagation and spatial moisture distribution as a function of time and repeated the experiments with different initial moisture contents. In this study we show that the stability of infiltration front in these soils is dependent on the irrigated water quality and on the initial water content. Furthermore, we demonstrate that long-term irrigation of TWW can lead to a persistent change in wettability, independent of the season. This study provides experimental evidence about importance of optimizing irrigation management to prevent preferential flow.

  18. LONG-TERM MANAGEMENT OF PATIENTS AFTER ADRENALECTOMY

    PubMed Central

    Simkin, Benjamin

    1957-01-01

    Experience with the long-term medical management of 17 patients previously subjected to surgical adrenalectomy was reviewed. Maintenance adrenal cortical replacement requirements consisted of oral cortisone, 37.5 to 50 mg. daily in all patients; desoxycorticosterone acetate (DOCA), 2 mg. daily, sublingually in all patients; and supplemental sodium chloride, 1 to 4 grams daily, in seven patients. This provides steroids with glucocorticoid and mineralocorticoid activity and an adequate salt intake. The subjective well-being of the patient was the best indicator of adequate replacement therapy. Under stable conditions, established dosage schedules required surprisingly little adjustment over long periods of time. The primary need of patients without adrenal glands when they are subjected to such stresses as infections, trauma or surgical operation, is for more glucocorticoids. Ordinarily, more DOCA and extra sodium chloride is not required. Mild infections can be dealt with by temporarily increasing the daily oral cortisone requirement, the patient remaining ambulatory. Severe infections with pronounced systemic manifestations require hospitalization and parenteral administration of glucocorticoids. Knowing how long it takes for the various glucocorticoid preparations to take effect and how long they continue to act is important in the management of patients who have had adrenalectomy, particularly in dealing with extraordinary stresses or emergencies. PMID:13489497

  19. Gas Generation Rates as an Indicator for the Long Term Stability of Radioactive Waste Products

    SciTech Connect

    Steyer, S.; Brennecke, P.; Bandt, G.; Kroger, H.

    2007-07-01

    Pursuant to the 'Act on the Peaceful Utilization of Atomic Energy and the Protection against its Hazards' (Atomic Energy Act) the Federal Office for Radiation Protection (Bundesamt fuer Strahlenschutz, BfS) is legally responsible for the construction and operation of federal facilities for the disposal of radioactive waste. Within the scope of this responsibility, particular due to par. 74(1) Ordinance on Radiation Protection, BfS defines all safety-related requirements on waste packages envisaged for disposal, establishes guidelines for the conditioning of radioactive waste and approves the fulfillment of the waste acceptance requirements within the radioactive waste quality control system. BfS also provides criteria to enable the assessment of methods for the treatment and packaging of radioactive waste to produce waste packages suitable for disposal according to par. 74(2) Ordinance on Radiation Protection. Due to the present non-availability of a repository in Germany, quality control measures for all types of radioactive waste products are carried out prior to interim storage with respect to the future disposal. As a result BfS approves the demonstrated properties of the radioactive waste packages and confirms the fulfillment of the respective requirements. After several years of storage the properties of waste packages might have changed. By proving, that such changes have no significant impact on the quality of the waste product, the effort of requalification could be minimized. Therefore, data on the long-term behavior of radioactive waste products need to be acquired and indicators to prove the long-term stability have to be quantified. Preferably, such indicators can be determined easily with non-destructive methods, even for legacy waste packages. A promising parameter is the gas generation rate. The relationship between gas generation rate and long term stability is presented as first result of an ongoing study on behalf of BfS. Permissible gas

  20. Diagnosis, management, and long-term outcomes of rectovaginal endometriosis

    PubMed Central

    Moawad, Nash S; Caplin, Andrea

    2013-01-01

    Rectovaginal endometriosis is the most severe form of endometriosis. Clinically, it presents with a number of symptoms including chronic pelvic pain, dysmenorrhea, deep dyspareunia, dyschezia, and rectal bleeding. The gold standard for diagnosis is laparoscopy with histological confirmation; however, there are a number of options for presurgical diagnosis, including clinical examination, transvaginal/transrectal ultrasound, magnetic resonance imagining, colonoscopy, and computed tomography colonography. Treatment can be medical or surgical. Medical therapies include birth control pills, oral progestins, gonadotropin-releasing hormone agonists, danazol, and injectable progestins. Analgesics are often used as well. Surgery improves up to 70% of symptoms. Surgery is either ablative or excisional, and is conducted via transvaginal, laparoscopic, laparotomy, or combined approaches. Common surgical techniques involve shaving of the superficial rectal lesion, laparoscopic anterior discoid resection, and low anterior bowel resection and reanastomosis. Outcomes are generally favorable, but postoperative complications may include intra-abdominal bleeding, anastomotic leaks, rectovaginal fistulas, strictures, chronic constipation, and the need for reoperation. Recurrence of rectal endometriosis is a possibility as well. Other outcomes are improved pain-related symptoms and fertility. Long-term outcomes vary according to the management strategy used. This review will provide the most recent approaches and techniques for the diagnosis and treatment of rectovaginal endometriosis. PMID:24232977

  1. Digital health system for personalised COPD long-term management.

    PubMed

    Velardo, Carmelo; Shah, Syed Ahmar; Gibson, Oliver; Clifford, Gari; Heneghan, Carl; Rutter, Heather; Farmer, Andrew; Tarassenko, Lionel

    2017-02-20

    Recent telehealth studies have demonstrated minor impact on patients affected by long-term conditions. The use of technology does not guarantee the compliance required for sustained collection of high-quality symptom and physiological data. Remote monitoring alone is not sufficient for successful disease management. A patient-centred design approach is needed in order to allow the personalisation of interventions and encourage the completion of daily self-management tasks. A digital health system was designed to support patients suffering from chronic obstructive pulmonary disease in self-managing their condition. The system includes a mobile application running on a consumer tablet personal computer and a secure backend server accessible to the health professionals in charge of patient management. The patient daily routine included the completion of an adaptive, electronic symptom diary on the tablet, and the measurement of oxygen saturation via a wireless pulse oximeter. The design of the system was based on a patient-centred design approach, informed by patient workshops. One hundred and ten patients in the intervention arm of a randomised controlled trial were subsequently given the tablet computer and pulse oximeter for a 12-month period. Patients were encouraged, but not mandated, to use the digital health system daily. The average used was 6.0 times a week by all those who participated in the full trial. Three months after enrolment, patients were able to complete their symptom diary and oxygen saturation measurement in less than 1 m 40s (96% of symptom diaries). Custom algorithms, based on the self-monitoring data collected during the first 50 days of use, were developed to personalise alert thresholds. Strategies and tools aimed at refining a digital health intervention require iterative use to enable convergence on an optimal, usable design. 'Continuous improvement' allowed feedback from users to have an immediate impact on the design of the system (e

  2. Final Long-Term Management and Storage of Elemental Mercury Environmental Impact Statement Volume 2

    SciTech Connect

    Not Available

    2011-01-01

    Pursuant to the Mercury Export Ban Act of 2008 (P.L. 110-414), DOE was directed to designate a facility or facilities for the long-term management and storage of elemental mercury generated within the United States. Therefore, DOE has analyzed the storage of up to 10,000 metric tons (11,000 tons) of elemental mercury in a facility(ies) constructed and operated in accordance with the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act (74 FR 31723). DOE prepared this Final Mercury Storage EIS in accordance with the National Environmental Policy Act of 1969 (NEPA), as amended (42 U.S.C. 4321 et seq.), the Council on Environmental Quality (CEQ) implementing regulations (40 CFR 1500–1508), and DOE’s NEPA implementing procedures (10 CFR 1021) to evaluate reasonable alternatives for a facility(ies) for the long-term management and storage of elemental mercury. This Final Mercury Storage EIS analyzes the potential environmental, human health, and socioeconomic impacts of elemental mercury storage at seven candidate locations: Grand Junction Disposal Site near Grand Junction, Colorado; Hanford Site near Richland, Washington; Hawthorne Army Depot near Hawthorne, Nevada; Idaho National Laboratory near Idaho Falls, Idaho; Kansas City Plant in Kansas City, Missouri; Savannah River Site near Aiken, South Carolina; and Waste Control Specialists, LLC, site near Andrews, Texas. As required by CEQ NEPA regulations, the No Action Alternative was also analyzed as a basis for comparison. DOE intends to decide (1) where to locate the elemental mercury storage facility(ies) and (2) whether to use existing buildings, new buildings, or a combination of existing and new buildings. DOE’s Preferred Alternative for the long-term management and storage of mercury is the Waste Control Specialists, LLC, site near Andrews, Texas.

  3. Final Long-Term Management and Storage of Elemental Mercury Environmental Impact Statement Volume1

    SciTech Connect

    Not Available

    2011-01-01

    Pursuant to the Mercury Export Ban Act of 2008 (P.L. 110-414), DOE was directed to designate a facility or facilities for the long-term management and storage of elemental mercury generated within the United States. Therefore, DOE has analyzed the storage of up to 10,000 metric tons (11,000 tons) of elemental mercury in a facility(ies) constructed and operated in accordance with the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act (74 FR 31723).DOE prepared this Final Mercury Storage EIS in accordance with the National Environmental Policy Act of 1969 (NEPA), as amended (42 U.S.C. 4321 et seq.), the Council on Environmental Quality (CEQ) implementing regulations (40 CFR 1500–1508), and DOE’s NEPA implementing procedures (10 CFR 1021) to evaluate reasonable alternatives for a facility(ies) for the long-term management and storage of elemental mercury. This Final Mercury Storage EIS analyzes the potential environmental, human health, and socioeconomic impacts of elemental mercury storage at seven candidate locations:Grand Junction Disposal Site near Grand Junction, Colorado; Hanford Site near Richland, Washington; Hawthorne Army Depot near Hawthorne, Nevada; Idaho National Laboratory near Idaho Falls, Idaho;Kansas City Plant in Kansas City, Missouri; Savannah River Site near Aiken, South Carolina; and Waste Control Specialists, LLC, site near Andrews, Texas. As required by CEQ NEPA regulations, the No Action Alternative was also analyzed as a basis for comparison. DOE intends to decide (1) where to locate the elemental mercury storage facility(ies) and (2) whether to use existing buildings, new buildings, or a combination of existing and new buildings. DOE’s Preferred Alternative for the long-term management and storage of mercury is the Waste Control Specialists, LLC, site near Andrews, Texas.

  4. Effects of aqueous environment on long-term durability of phosphate-bonded ceramic waste forms

    SciTech Connect

    Singh, D.; Wagh, A.S.; Jeong, S.Y.

    1996-03-01

    Over the last few years, Argonne National Laboratory has been developing room-temperature-setting chemically-bonded phosphate ceramics for solidifying and stabilizing low-level mixed wastes. This technology is crucial for stabilizing waste streams that contain volatile species and off-gas secondary waste streams generated by high-temperature treatment of such wastes. Magnesium phosphate ceramic has been developed to treat mixed wastes such as ash, salts, and cement sludges. Waste forms of surrogate waste streams were fabricated by acid-base reactions between the mixtures of magnesium oxide powders and the wastes, and phosphoric acid or acid phosphate solutions. Dense and hard ceramic waste forms are produced in this process. The principal advantage of this technology is that the contaminants are immobilized by both chemical stabilization and subsequent microencapsulation of the reaction products. This paper reports the results of durability studies conducted on waste forms made with ash waste streams spiked with hazardous and radioactive surrogates. Standard leaching tests such as ANS 16.1 and TCLP were conducted on the final waste forms. Fates of the contaminants in the final waste forms were established by electron microscopy. In addition, stability of the waste forms in aqueous environments was evaluated with long-term water-immersion tests.

  5. The Basics of Long-Term Debt Issuance and Management

    ERIC Educational Resources Information Center

    Van Meter, Christine M.

    2011-01-01

    Issuing long-term debt can be a complex, multifaceted process. Although the process varies by stare, typically the school business official and the district solicitor work with the financing ream, which includes a financial adviser, bond counsel, underwriter, raring agency, and possibly a bond insurance agent, paying agent, and architect.…

  6. The Basics of Long-Term Debt Issuance and Management

    ERIC Educational Resources Information Center

    Van Meter, Christine M.

    2011-01-01

    Issuing long-term debt can be a complex, multifaceted process. Although the process varies by stare, typically the school business official and the district solicitor work with the financing ream, which includes a financial adviser, bond counsel, underwriter, raring agency, and possibly a bond insurance agent, paying agent, and architect.…

  7. The Aging Network and Managed Long-Term Care

    ERIC Educational Resources Information Center

    Polivka, Larry; Zayac, Helen

    2008-01-01

    Since the early 1980s, service providers and area agencies on aging, that is, the aging network, have developed a number of strengths as they built a community-based long-term-care system in most states. Many area agencies and providers now have the capacity to assess the needs of older persons, identify appropriate services, and administer…

  8. Actinobacterial community dynamics in long term managed grasslands.

    PubMed

    Jenkins, Sasha N; Waite, Ian S; Blackburn, Adrian; Husband, Rebecca; Rushton, Steven P; Manning, David C; O'Donnell, Anthony G

    2009-05-01

    Palace Leas, a long-term experiment at Cockle Park Farm, Northumberland, UK was established in winter 1896-1897 since when the 13 plots have received regular and virtually unchanged mineral fertiliser and farm yard manure inputs. Fertilisers have had a profound impact on soil pH with the organically fertilised plots showing a significantly higher pH than those receiving mineral fertiliser where ammonium sulphate has led to soil acidification. Here, we investigate the impact of organic and mineral fertilisers on the actinobacterial community structure of these soils using terminal restriction fragment length polymorphism (T-RFLP) and 16S rRNA gene analysis. To differentiate fertiliser effects from seasonal variation, soils were sampled three times over one growing season between May and September 2004 and January 2005. Community profiles obtained using T-RFLP were analysed using multivariate statistics to investigate the relationship between community structure, seasonality and fertiliser management. Soil pH was shown to be the most significant edaphic factor influencing actinobacterial communities. Canonical correspondence analysis, used to investigate the relationship between the 16S rRNA gene community profiles and the environmental parameters, showed that actinobacterial communities also responded to soil water content with major changes evident over the summer months between May and September. Quantitative PCR of the actinobacterial and fungal 16S and 18S rRNA genes, respectively suggested that fungal rRNA gene copy numbers were negatively correlated (P = 0.0131) with increasing actinobacterial signals. A similar relationship (P = 0.000365) was also evident when fatty acid methyl esters indicative of actinobacterial biomass (10-methyloctadecanoic acid) were compared with the amounts of fungal octadecadienoic acid (18:2omega9,12). These results show clearly that soil pH is a major driver of change in actinobacterial communities and that genera such as

  9. Long-term degradation (or improvement?) of cementitious grout/concrete for waste disposal at Hanford

    SciTech Connect

    Piepho, M.G.

    1997-12-31

    If grout and/or concrete barriers and containments are considered for long-term (500 yrs to 100,000 ) waste disposal, then long-term degradation of grout/cement materials (and others) need to be studied. Long-term degradations of a cementitious grout monolith (15.4mW x 10.4mH x 37.6mL) and its containment concrete shell and asphalt shell (each 1-m thick) were analyzed. The main degradation process of the concrete shell was believed to be fractures due to construction joints, shrinkage, thermal stress, settlement, and seismic events. A scenario with fractures was modeled (flow and transport model) for long-term risk performance (out to a million yrs). Even though the concrete/grout is expected to fracture, the concrete/grout chemistry, which has high Ph value, is very beneficial in causing calcite deposits from calcium in the water precipitating in the fractures. These calcite deposits will tend to plug the fracture and keep water from entering. The effectiveness of such plugging needs to be studied more. It`s possible that the plugged fractures are more impermeable than the original concrete/grout. The long-term performance of concrete/grout barriers will be determined by its chemistry, not its mechanical properties.

  10. [Long-term results of severe acute pancreatitis management].

    PubMed

    Ermolov, A S; Blagovestnov, D A; Rogal, M L; Omel Yanovich, D A

    To assess the long-term results and quality of life of patients after different medical and tactical approaches in treatment of severe acute pancreatitis. Long-term outcomes were studied in 210 patients with severe acute pancreatitis for the period 2003-2013. There were 144 (68.6%) men. The quality of life of patients undergoing both aseptic (GIQLI - 112.9±1.3 points) and infected (GIQLI - 108.8±2.2 points) destructive complications of severe pancreatitis is lower (p=0.00001) compared with healthy population. Reccurence of acute pancreatitis was observed in 27.6% of patients. Diabetes mellitus developed in 40.5% and 23.6% of patients after infected and aseptic complications of severe pancreatitis respectively. Exocrine insufficiency was detected in 32.6% and 38.2% of patients who underwent aseptic and infected complications respectively. Postoperative hernia was observed in 30.8% of patients. Herewith, hernias (p<0.05) are predominantly formed after open operations (73,6%) than minimally invasive procedures (2.6%). Chronic pseudocyst was detected in 13.0% of patients after aseptic complications of severe pancreatitis and in 17.6% after infected complications. Quality of life and long-term outcomes are better in patients who were treated using only conservative methods and/or minimally invasive surgical interventions.

  11. Review article: the long-term management of ulcerative colitis.

    PubMed

    Hanauer, S B

    2004-10-01

    After the induction of remission, the second priority of therapy for ulcerative colitis is sustained clinical remission, defined as the absence of inflammatory symptoms (diarrhoea, bleeding, rectal urgency) and the maintenance of an intact mucosa, with the absence of ulcers, friability or significant granularity at endoscopy. The 'optimal' maintenance strategy will depend on the therapy needed to induce remission. Thus, the transition from induction to maintenance therapy will be determined by the intensity of acute therapy necessary to induce remission and the duration of therapy required to complete the resolution of clinical symptoms. There are few controlled clinical trials pertaining to maintenance after each induction regimen. However, experience dictates that aminosalicylates are efficacious after aminosalicylate-induced remissions, that steroids should be tapered according to the time required to induce remission, that patients requiring ciclosporin will benefit from the addition of long-term immunomodulation with azathioprine or mercaptopurine, and that many patients with distal colitis who require topical mesalazine (mesalamine) will continue to need topical therapy to maintain remission, albeit at reduced frequency. The expectations for maintenance therapy require patient adherence to the prescribed treatment regimen. Patients require education with regard to the long-term goals of maintenance therapy (e.g. prevention of relapse, reduction of long-term complications of disease activity or risks of acute therapy with steroids), and should be warned against the use of nonsteroidal anti-inflammatory drugs and cautioned about the cessation of smoking, when applicable, due to potential risks of relapse or chronic activity.

  12. Nuclear Waste Disposal and Strategies for Predicting Long-Term Performance of Material

    SciTech Connect

    Wicks, G G

    2001-03-28

    Ceramics have been an important part of the nuclear community for many years. On December 2, 1942, an historic event occurred under the West Stands of Stagg Field, at the University of Chicago. Man initiated his first self-sustaining nuclear chain reaction and controlled it. The impact of this event on civilization is considered by many as monumental and compared by some to other significant events in history, such as the invention of the steam engine and the manufacturing of the first automobile. Making this event possible and the successful operation of this first man-made nuclear reactor, was the use of forty tons of UO2. The use of natural or enriched UO2 is still used today as a nuclear fuel in many nuclear power plants operating world-wide. Other ceramic materials, such as 238Pu, are used for other important purposes, such as ceramic fuels for space exploration to provide electrical power to operate instruments on board spacecrafts. Radioisotopic Thermoelectric Generators (RTGs) are used to supply electrical power and consist of a nuclear heat source and converter to transform heat energy from radioactive decay into electrical power, thus providing reliable and relatively uniform power over the very long lifetime of a mission. These sources have been used in the Galileo spacecraft orbiting Jupiter and for scientific investigations of Saturn with the Cassini spacecraft. Still another very important series of applications using the unique properties of ceramics in the nuclear field, are as immobilization matrices for management of some of the most hazardous wastes known to man. For example, in long-term management of radioactive and hazardous wastes, glass matrices are currently in production immobilizing high-level radioactive materials, and cementious forms have also been produced to incorporate low level wastes. Also, as part of nuclear disarmament activities, assemblages of crystalline phases are being developed for immobilizing weapons grade plutonium, to

  13. Managed Care and Long-Term Services for People with Mental Retardation. ARC Q&A.

    ERIC Educational Resources Information Center

    Arc, Arlington, TX.

    This fact sheet uses a question-and-answer format to summarize issues related to managed care and long-term services for people with mental retardation. Questions and answers address the following topics: the evolving concept of "managed care"; the application of managed care to provide cost-efficient long-term services for people with mental…

  14. Information Package on Managed Care and Long-Term Supports for People with Developmental Disabilities.

    ERIC Educational Resources Information Center

    Syracuse Univ., NY. Center on Human Policy.

    This collection of papers on managed care and long-term supports for people with developmental disabilities includes a range of reprinted articles and resource materials that provide different kinds of information and opinions on the impact of managed care. Articles include: "A Position Statement on Managed Care and Long-Term Supports in…

  15. Managing Osteoporosis Patients after Long-Term Bisphosphonate Treatment

    PubMed Central

    Adler, Robert A.; Fuleihan, Ghada El-Hajj; Bauer, Douglas C.; Camacho, Pauline M.; Clarke, Bart L.; Clines, Gregory A.; Compston, Juliet E.; Drake, Matthew T.; Edwards, Beatrice J.; Favus, Murray J.; Greenspan, Susan L.; McKinney, Ross; Pignolo, Robert J.; Sellmeyer, Deborah E.

    2016-01-01

    Bisphosphonates (BPs) are the most commonly used medications for osteoporosis, but optimal duration of therapy is unknown. This ASBMR report provides guidance on BP therapy duration with a risk benefit perspective. Two trials provided evidence for long-term BP use. In the Fracture Intervention Trial Long-term Extension (FLEX), postmenopausal women receiving alendronate for 10 years had fewer clinical vertebral fractures than those switched to placebo after 5 years. In the HORIZON extension, women who received 6 annual infusions of zoledronic acid had fewer morphometric vertebral fractures compared with those switched to placebo after 3 years. Low hip T-score between −2 and −2.5 in FLEX and below −2.5 in HORIZON extension predicted a beneficial response to continued therapy. Hence, the Task Force suggests that after 5 years of oral BP or 3 years of intravenous BP, women should be reassessed. Women with previous major osteoporotic fracture, those who fracture on therapy, or others at high risk should generally continue therapy for up to 10 years (oral) or 6 years (intravenous), with periodic risk-benefit evaluation. Older women, those with a low hip T-score or high fracture risk score are considered high risk. The risk of osteonecrosis of the jaw and atypical femoral fracture increases with BP therapy duration, but such rare events are far outweighed by fracture risk reduction with BPs in high risk patients. For women not at high fracture risk after 3–5 years of BP treatment, a drug holiday of 2–3 years can be considered, with periodic reassessment. The algorithm provided for long term BP use is based on limited evidence in mostly Caucasian postmenopausal women and only for vertebral fracture reduction. It is probably applicable to men and patients with glucocorticoid-induced osteoporosis, with some adaptations. It is unlikely that future osteoporosis trials will provide data for formulating definitive recommendations. PMID:26350171

  16. Long-term Management of Patients After Weight Loss Surgery

    PubMed Central

    Richardson, William S.; Plaisance, Amber M.; Periou, Laura; Buquoi, Jennifer; Tillery, Deanna

    2009-01-01

    Bariatric surgery is becoming very common, and most physicians will have contact with bariatric patients. Many aspects to follow-up are not generally known. The objective of this article is to help other physicians understand what follow-up entails to assist them with the care of these patients. It is expected that patients are followed up by the bariatric team for a lifetime, as care is complicated and lifetime follow-up is the key to long-term success. PMID:21603433

  17. An international initiative on long-term behavior of high-level nuclear waste glass

    SciTech Connect

    Gin, S.; Abdelouas, A.; Criscenti, L. J.; Ebert, W. L.; Ferrand, K.; Geisler, T.; Harrison, M. T.; Inagaki, Y.; Mitsui, S.; Mueller, K. T.; Marra, J. C.; Pantano, C. G.; Pierce, E. M.; Ryan, J. V.; Schofield, J. M.; Steefel, C. I.; Vienna, J. D.

    2013-08-07

    Nations using borosilicate glass as an immobilization material for radioactive waste have reinforced the importance of scientific collaboration to obtain a consensus on the mechanisms controlling the long-term dissolution rate of glass. This goal is deemed to be crucial for the development of reliable performance assessment models for geological disposal. The collaborating laboratories all conduct fundamental and/or applied research using modern materials science techniques. This paper briefly reviews the radioactive waste vitrification programs of the six participant nations and summarizes the current state of glass corrosion science, emphasizing the common scientific needs and justifications for on-going initiatives.

  18. An international initiative on long-term behavior of high-level nuclear waste glass

    SciTech Connect

    Gin, Stephane; Criscenti, Louise J.; Ebert, W. L.; Ferrand, Karine; Geisler, Thorsten; Harrison, Mike T.; Inagaki, Yaohiro; Mitsui, Seiichiro; Mueller, Karl T.; Marra, James C.; Pantano, Carlo G.; Pierce, Eric M.; Ryan, Joseph V.; Schofield, James M.; Steefel, Carl I.; Vienna, John D.

    2013-06-01

    Nations producing borosilicate glass as an immobilization material for radioactive wastes resulting from spent nuclear fuel reprocessing have reinforced scientific collaboration to obtain consensus on mechanisms controlling the long-term dissolution rate of glass. This goal is deemed to be crucial for the development of reliable performance assessment models for geological disposal. The collaborating laboratories all conduct fundamental and/or applied research with modern materials science techniques. The paper briefly reviews the radioactive waste vitrification programmes of the six participant nations and summarizes the state-of-the-art of glass corrosion science, emphasizing common scientific needs and justifications for on-going initiatives.

  19. Arsenic solubility and distribution in poultry waste and long-term amended soil.

    PubMed

    Han, F X; Kingery, W L; Selim, H M; Gerard, P D; Cox, M S; Oldham, J L

    2004-03-05

    The purpose of this study was to quantify the solubility and distribution of As among solid-phase components in poultry wastes and soils receiving long-term poultry waste applications. Arsenic in the water-soluble, NaOCl-extractable (organically bound), NH(2)OH x HCl-extractable (oxide bound) and residual fractions were quantified in an Upper Coastal Plain soil (Neshoba County, MS) that received annual waste applications. After 25 years, As in the amended soil had a mean of 8.4 mg kg(-1) compared to 2.68 mg kg(-1) for a non-amended soil. Arsenic in the amended soil was mainly in the residual fraction (72% of total), which is generally considered the least bioavailable fraction. Arsenic in poultry waste samples was primarily water-soluble (5.3-25.1 mg kg(-1)), representing 36-75% of the total As. To assess the extent of spatial heterogeneity, total As in a 0.5-ha area within the long-term waste-amended field was quantified. Soil surface samples were taken on 10-m grid points and results for total As appeared negatively skewed and approximated a bimodal distribution. Total As in the amended soil was strongly correlated with Fe oxides, clay and hydroxy interlayered vermiculite concentrations, and negatively correlated with Mehlich III-P, mica and quartz contents.

  20. Some Trends in Radioactive Waste Form Behavior Revealed in Long-Term Field Tests

    SciTech Connect

    Ojovan, M. I.; Ojovan, N. V.; Startceva, I. V.; Barinov, A. S.

    2002-02-25

    Results from long-term field tests with borosilicate glass, cement and bitumen waste forms containing actual intermediate-level radioactive waste are summarized and discussed in the paper. Leaching behavior of the waste forms was evaluated by monitoring the contamination of contacting water. Measured leach rates of the three waste-form materials were in a narrow range in shallow subsurface repositories, but varied in a wide range at an open testing site owing to weathering of bitumen and cement materials. The repositories were opened after 12-year testing for visual examination, sampling and analysis. All retrieved waste forms were in good physical condition. The study has not revealed any negative changes in the waste glass. Some ageing processes were detected in cement and bitumen waste forms, which can positively (bitumen) or negatively (cement) affect physical and containment properties of these waste materials. It has been established that a significant proportion of the radioactive inventory in the bitumen waste form became associated with the bitumen phase. Phase separation of this radioactive bitumen has shown, than the asphaltene fraction is responsible for the major part of the radioactivity retained by the bitumen.

  1. Long-term anaerobic digestion of food waste stabilized by trace elements.

    PubMed

    Zhang, Lei; Jahng, Deokjin

    2012-08-01

    The purpose of this study was to examine if long-term anaerobic digestion of food waste in a semi-continuous single-stage reactor could be stabilized by supplementing trace elements. Contrary to the failure of anaerobic digestion of food waste alone, stable anaerobic digestion of food waste was achieved for 368 days by supplementing trace elements. Under the conditions of OLR (organic loading rates) of 2.19-6.64 g VS (volatile solid)/L day and 20-30 days of HRT (hydraulic retention time), a high methane yield (352-450 mL CH(4)/g VS(added)) was obtained, and no significant accumulation of volatile fatty acids was observed. The subsequent investigation on effects of individual trace elements (Co, Fe, Mo and Ni) showed that iron was essential for maintaining stable methane production. These results proved that the food waste used in this study was deficient in trace elements.

  2. Accumulation of heavy metals in a long-term poultry waste-amended soil

    SciTech Connect

    Han, F.X.; Kingery, W.L.; Selim, H.M.; Gerard, P.D.

    2000-03-01

    Various metals are added to poultry diets to facilitate weight increase and disease prevention. The large amounts of poultry waste produced annually are dispersed intensively over relatively small areas of land, resulting in accumulations that pose potential environmental risks to the surface and groundwater. The focus of this study was to assess the distribution of heavy metals among various solid-phase fractions in soil profiles from a 25-year poultry waste-amended soil. Copper and Zn accumulated close to the soil surface where the total amounts of Cu and Zn in waste-amended soils were significantly higher than in nonamended soils. The total metal concentrations in amended soils were not critically high. Copper in the amended soil was present mostly in the organic matter (OM) fraction (46.9%), whereas Zn was found in the easily reducible oxide (ERO) fraction (47.3%). This suggests that the Cu and Zn in this long-term amended soil are potentially bioavailable and mobile. The authors observed the mobility of Zn through much of the soil profile of the long-term waste-amended soil. Zinc in this soil profile was found primarily in forms of the residual (RES) and crystalline iron oxide bound (CryFe) fractions, followed by the organic matter-bound and exchangeable (EXC) fractions.

  3. Development of an Innovative Direct Push Sensor System for Long Term Monitoring of Environmental Waste Sites

    NASA Astrophysics Data System (ADS)

    Eddy-Dilek, C. A.; Riha, B. D.; Bosze, S.; Rossabi, J.

    2001-12-01

    As the focus of environmental restoration in the federal complex moves from active characterization and remediation to long term monitoring, the costs of long-term monitoring will escalate and eventually dominate ongoing environmental restoration budgets. Most of the major DOE sites including the Savannah River Site have a documented need for some type of long term monitoring system that does not rely on the use of standard groundwater monitoring wells. We have developed and installed a prototype monitoring system that can be used to measure and/or sample multiple parameters appropriate for long term monitoring of environmental waste sites. This system is designed to function as a sentinel system that detects when a significant change in water quality parameters or contaminant concentration occurs in a well characterized system. The sensor drive configuration is flexible and the sensor system is installed using direct push methods. Site specific monitoring scenarios will be need to be developed to address the specific long term monitoring objectives at a given site. The drive point has a sample port (soil gas or groundwater) and windows/ports for additional sensors. A prototype system was installed and has been monitored at the D-area at the Savannah River Site since July. The probes are located in an area where multiple contaminant plumes dominated by volatile organic compounds, metals and tritium are currently monitored using standard groundwater wells. Currently, the prototype system measures temperature, resisitivity, ORP and pH on a continuous basis. In addition, concetrations of volatile organic compounds and tritium are measured periodically by laboratory analysis of diffusion bag samples deployed in the sample ports of the prototype system. Results will be reported from a three-month monitoring interval. The results will be compared with baseline analyses of samples collected from the adjacent groundwater well.

  4. Improving self-management for patients with long-term conditions.

    PubMed

    Davies, Nicola J

    An increasing number of people are living with long-term conditions. These conditions cannot be cured, but can be managed through education, health promotion, medication, therapy and self-management. Self-management involves people taking responsibility for their own health and wellbeing, as well as learning to manage any long-term illnesses. Nurses play a pivotal role in providing advice, guidance, education and support to people living with long-term conditions. Self-management is important as it not only benefits the patient, but also provides wider opportunities for community and specialist nurses to use and develop their clinical and interpersonal skills.

  5. Analysis of long-term impacts of TRU waste remaining at generator/storage sites for No Action Alternative 2

    SciTech Connect

    Buck, J.W.; Bagaasen, L.M.; Bergeron, M.P.; Streile, G.P.

    1997-09-01

    This report is a supplement to the Waste Isolation Pilot Plant Disposal-Phase Final Supplemental Environmental Impact Statement (SEIS-II). Described herein are the underlying information, data, and assumptions used to estimate the long-term human-health impacts from exposure to radionuclides and hazardous chemicals in transuranic (TRU) waste remaining at major generator/storage sites after loss of institutional control under No Action Alternative 2. Under No Action Alternative 2, TRU wastes would not be emplaced at the Waste Isolation Pilot Plant (WIPP) but would remain at generator/storage sites in surface or near-surface storage. Waste generated at smaller sites would be consolidated at the major generator/storage sites. Current TRU waste management practices would continue, but newly generated waste would be treated to meet the WIPP waste acceptance criteria. For this alternative, institutional control was assumed to be lost 100 years after the end of the waste generation period, with exposure to radionuclides and hazardous chemicals in the TRU waste possible from direct intrusion and release to the surrounding environment. The potential human-health impacts from exposure to radionuclides and hazardous chemicals in TRU waste were analyzed for two different types of scenarios. Both analyses estimated site-specific, human-health impacts at seven major generator/storage sites: the Hanford Site (Hanford), Idaho National Engineering and Environmental Laboratory (INEEL), Lawrence Livermore National Laboratory (LLNL), Los Alamos National Laboratory (LANL), Oak Ridge National Laboratory (ORNL), Rocky Flats Environmental Technology Site (RFETS), and Savannah River Site (SRS). The analysis focused on these seven sites because 99 % of the estimated TRU waste volume and inventory would remain there under the assumptions of No Action Alternative 2.

  6. Hepatocellular carcinoma: Advances in diagnosis, management, and long term outcome.

    PubMed

    Bodzin, Adam S; Busuttil, Ronald W

    2015-05-28

    Hepatocellular carcinoma (HCC) remains a common and lethal malignancy worldwide and arises in the setting of a host of diseases. The incidence continues to increase despite multiple vaccines and therapies for viruses such as the hepatitis B and C viruses. In addition, due to the growing incidence of obesity in Western society, there is anticipation that there will be a growing population with HCC due to non-alcoholic fatty liver disease. Due to the growing frequency of this disease, screening is recommended using ultrasound with further imaging using magnetic resonance imaging and multi-detector computed tomography used for further characterization of masses. Great advances have been made to help with the early diagnosis of small lesions leading to potential curative resection or transplantation. Resection and transplantation maybe used in a variety of patients that are carefully selected based on underlying liver disease. Using certain guidelines and clinical acumen patients may have good outcomes with either resection or transplantation however many patients are inoperable at time of presentation. Fortunately, the use of new locoregional therapies has made down staging patients a potential option making them potential surgical candidates. Despite a growing population with HCC, new advances in viral therapies, chemotherapeutics, and an expanding population of surgical and transplant candidates might all contribute to improved long-term survival of these patients.

  7. Hepatocellular carcinoma: Advances in diagnosis, management, and long term outcome

    PubMed Central

    Bodzin, Adam S; Busuttil, Ronald W

    2015-01-01

    Hepatocellular carcinoma (HCC) remains a common and lethal malignancy worldwide and arises in the setting of a host of diseases. The incidence continues to increase despite multiple vaccines and therapies for viruses such as the hepatitis B and C viruses. In addition, due to the growing incidence of obesity in Western society, there is anticipation that there will be a growing population with HCC due to non-alcoholic fatty liver disease. Due to the growing frequency of this disease, screening is recommended using ultrasound with further imaging using magnetic resonance imaging and multi-detector computed tomography used for further characterization of masses. Great advances have been made to help with the early diagnosis of small lesions leading to potential curative resection or transplantation. Resection and transplantation maybe used in a variety of patients that are carefully selected based on underlying liver disease. Using certain guidelines and clinical acumen patients may have good outcomes with either resection or transplantation however many patients are inoperable at time of presentation. Fortunately, the use of new locoregional therapies has made down staging patients a potential option making them potential surgical candidates. Despite a growing population with HCC, new advances in viral therapies, chemotherapeutics, and an expanding population of surgical and transplant candidates might all contribute to improved long-term survival of these patients. PMID:26019732

  8. Long-term anaerobic digestion of food waste stabilized by trace elements

    SciTech Connect

    Zhang Lei; Jahng, Deokjin

    2012-08-15

    Highlights: Black-Right-Pointing-Pointer Korean food waste was found to contain low level of trace elements. Black-Right-Pointing-Pointer Stable anaerobic digestion of food waste was achieved by adding trace elements. Black-Right-Pointing-Pointer Iron played an important role in anaerobic digestion of food waste. Black-Right-Pointing-Pointer Cobalt addition further enhanced the process performance in the presence of iron. - Abstract: The purpose of this study was to examine if long-term anaerobic digestion of food waste in a semi-continuous single-stage reactor could be stabilized by supplementing trace elements. Contrary to the failure of anaerobic digestion of food waste alone, stable anaerobic digestion of food waste was achieved for 368 days by supplementing trace elements. Under the conditions of OLR (organic loading rates) of 2.19-6.64 g VS (volatile solid)/L day and 20-30 days of HRT (hydraulic retention time), a high methane yield (352-450 mL CH{sub 4}/g VS{sub added}) was obtained, and no significant accumulation of volatile fatty acids was observed. The subsequent investigation on effects of individual trace elements (Co, Fe, Mo and Ni) showed that iron was essential for maintaining stable methane production. These results proved that the food waste used in this study was deficient in trace elements.

  9. Summary of U.S. EPA research on solidified/stabilized waste form long-term durability

    SciTech Connect

    Kirk, D.R.

    1996-12-31

    Successful performance of solidification and stabilization treatment technologies largely depends on the ability of the treated waste to endure long term exposure to physical and chemical stresses. The available test methods to assess durability of treated wastes rely on results from laboratory tests; these procedures rely on freeze/thaw cycles, elevated temperature, and exposure to various solutions to simulate the stresses exerted on a solidified/stabilized (S/S) waste form over time. Unfortunately, none of the methods has been verified as replicating field behavior. In addition, the speciation of contaminants is a critical factor in determining long-term immobilization. Research is needed to cover areas which will address the issues associated with long-term performance of S/S waste forms. This paper discusses technical issues associated with long-term behavior of S/S waste forms and U.S. EPA research addressing these issues.

  10. LONG-TERM EFFECTS OF WASTE SOLUTIONS ON CONCRETE AND REINFORCING STEEL

    SciTech Connect

    DANIEL JI; START DC; KAAR PH

    1983-05-28

    This report has been prepared for the In Situ Waste Disposal Program Tank Assessment Task (WG-11) as part of an investigation to evaluate the long-term performance of waste storage tanks at the Hanford Site. This report, prepared by the Portland Cement Association, presents the results of four years of concrete degradation studies which exposed concrete and reinforcing steel, under load and at 180 F, to simulated double-shell slurry, simulated salt cake solution, and a control solution. Exposure length varied from 3 months to 36 months. In all cases, examination of the concrete and reinforcing steel at the end of the exposure indicated there was no attack, i.e., no evidence of rusting, cracking, disruption of mill scale or loss of strength. Radioactive waste resulting from the chemical processing of reactor fuel for recovery of special nuclear materials (primarily plutonium), has been accumulating at the Hanford Site since 1944. The defense waste is currently being stored in underground waste tanks and in capsules stored in water basins. Current U.S. Department of Energy (DOE) strategy is to emphasize development and implementation of technology for removal, solidification, and final disposition of defense waste at the Savannah River Site first, then at the Hanford Site. Final disposal of waste in tanks at Hanford is expected to consist of in-place stabilization of most tanks. Selected tank wastes may be retrieved. Disposal operations will be carried out during the next several decades. Consequently, defense waste will remain in the existing underground tanks at Hanford for at least several decades. To ensure the safe storage of the waste, the waste storage tanks are being evaluated for continued service as part of the DOE Waste Tank Evaluation Program (AR-005-10-02-G). Technical studies and laboratory tests have been conducted to determine the effect of the stored waste's chemicals and temperature on the reinforced concrete. Waste solutions, which can be

  11. Strategy for identifying natural analogs of the long-term performance of low-level waste disposal sites

    SciTech Connect

    Chatters, J.C.; Waugh, W.J.; Foley, M.G.; Kincaid, C.T.

    1990-07-01

    The US Department of Energy's Low-Level Waste (LLW) Management Program has asked Pacific Northwest Laboratory (PNL) to explore the feasibility of using natural analogs of anticipated waste site and conditions to help validate predictions of the performance of LLW disposal sites. Current regulations require LLW facilities to control the spread of hazardous substances into the environment for at least the next 500 years. Natural analog studies can provide information about processes affecting waste containment that cannot be fully explored through laboratory experimentation and modeling because of the extended period of required performance. For LLW applications, natural analogs include geochemical systems, pedogenic (soil formation) indicators, proxy climate data, and ecological and archaeological settings that portray long-term changes in disposal site environments and the survivability of proposed waste containment materials and structures. Analog data consist of estimates of performance assessment (PA) model input parameters that define possible future environmental states of waste sites, validation parameters that can be predicted by PA models, and descriptive information that can build public confidence in waste disposal practices. This document describes PNL's overall stategy for identifying analogs for LLW disposal systems, reviews lessons learned from past analogs work, outlines the findings of the workshop, and presents examples of analog studies that workshop participants found to be applicable to LLW performance assessment. The lessons from the high-level waste analogs experience and workshop discussions will be used to develop detailed study plans during FY 1990. 39 refs.

  12. Long-term geochemical evolution of acidic mine wastes under anaerobic conditions.

    PubMed

    Lu, Wenzhou; Lin, Chuxia; Ma, Yingqun

    2013-08-01

    A nearly 5-year anaerobic incubation experiment was conducted to observe the geochemical evolution of an acidic mine waste. Long-term storage of the mine waste under strict anaerobic conditions caused marked increase in aqueous sulfur, while aqueous iron showed no remarkable change. Co-existing oxidation and reduction of elemental sulfur appeared to play a central role in controlling the evolutionary trends of aqueous sulfur and iron. Addition of organic matter increased the aqueous Fe concentration, possibly due to enhanced iron mobilization by microbial iron reduction and increased iron solubility by forming organically complexed Fe species. Further addition of CaCO3 resulted in immobilization of aqueous iron and sulfur due to elevated pH and gypsum formation. The chemical behaviors of environmentally significant metals were markedly affected by the added organic matter; Al, Cr, Cu, Ni and Zn tended to be immobilized probably due to elevated pH and complexation with insoluble organic molecules, while As and Pb tended to be mobilized. Jarosite exhibited high stability after nearly 5 years of anaerobic incubation and even under circumneutral pH conditions. Long-term weathering of aluminosilicate through acid attack raised pH, while continuous reaction between the added CaCO3 and mine waste-borne stored acid decreased pH.

  13. Intended long term performances of cementitious engineered barriers for future storage and disposal facilities for radioactive wastes in Romania

    NASA Astrophysics Data System (ADS)

    Fako, R.; Barariu, Gh.; Toma, R.; Georgescu, R.; Sociu, F.

    2013-07-01

    Considering the EU statements, Romania is engaged to endorse in the near future the IAEA relevant publications on geological repository (CNCANa), to update the Medium and Long Term National Strategy for Safe Management of Radioactive Waste and to approve the Road Map for Geological Repository Development. Currently, for example, spent fuel is wet stored for 6 years and after this period it is transported to dry storage in MACSTOR-200 (a concrete monolithic module) where it is intended to remain at least 50 years. The present situation for radioactive waste management in Romania is reviewed in the present paper. Focus will be done on existent disposal facilities but, also, on future facilities planned for storage / disposal of radioactive wastes. Considering specific data for Romanian radioactive waste inventory, authors are reviewing the advance in the radioactive waste management in Romania considering its particularities. The team tries to highlight the expected limitations and unknown data related with cementitious engineered barriers that has to be faced in the near future incase of interim storage or for the upcoming long periods of disposal.

  14. Barriers and Facilitators in Pain Management in Long-Term Care Institutions: A Qualitative Study

    ERIC Educational Resources Information Center

    Fox, Patricia; Solomon, Patricia; Raina, Parminder; Jadad, Alejandro R.

    2004-01-01

    The purpose of this study was to identify barriers to the management of pain in long-term care institutions. Formal caregivers practising in four long-term care institutions in Hamilton, Ontario participated in eight focus groups. Participants included 6 physicians, 19 registered nurses, 8 registered practical nurses, 13 health care aides and 8…

  15. Barriers and Facilitators in Pain Management in Long-Term Care Institutions: A Qualitative Study

    ERIC Educational Resources Information Center

    Fox, Patricia; Solomon, Patricia; Raina, Parminder; Jadad, Alejandro R.

    2004-01-01

    The purpose of this study was to identify barriers to the management of pain in long-term care institutions. Formal caregivers practising in four long-term care institutions in Hamilton, Ontario participated in eight focus groups. Participants included 6 physicians, 19 registered nurses, 8 registered practical nurses, 13 health care aides and 8…

  16. Evaluating the feasibility of biological waste processing for long term space missions.

    PubMed

    Garland, J L; Alazraki, M P; Atkinson, C F; Finger, B W

    1998-01-01

    Recycling waste products during orbital (e.g., International Space Station) and planetary missions (e.g., lunar base, Mars transit mission, Martian base) will reduce storage and resupply costs. Wastes streams on the space station will include human hygiene water, urine, faeces, and trash. Longer term missions will contain human waste and inedible plant material from plant growth systems used for atmospheric regeneration, food production, and water recycling. The feasibility of biological and physical-chemical waste recycling is being investigated as part of National Aeronautics and Space Administration's (NASA) Advanced Life Support (ALS) Program. In-vessel composting has lower manpower requirements, lower water and volume requirements, and greater potential for sanitization of human waste compared to alternative bioreactor designs such as continuously stirred tank reactors (CSTR). Residual solids from the process (i.e. compost) could be used a biological air filter, a plant nutrient source, and a carbon sink. Potential in-vessel composting designs for both near- and long-term space missions are presented and discussed with respect to the unique aspects of space-based systems.

  17. Evaluating the feasibility of biological waste processing for long term space missions

    NASA Technical Reports Server (NTRS)

    Garland, J. L.; Alazraki, M. P.; Atkinson, C. F.; Finger, B. W.; Sager, J. C. (Principal Investigator)

    1998-01-01

    Recycling waste products during orbital (e.g., International Space Station) and planetary missions (e.g., lunar base, Mars transit mission, Martian base) will reduce storage and resupply costs. Wastes streams on the space station will include human hygiene water, urine, faeces, and trash. Longer term missions will contain human waste and inedible plant material from plant growth systems used for atmospheric regeneration, food production, and water recycling. The feasibility of biological and physical-chemical waste recycling is being investigated as part of National Aeronautics and Space Administration's (NASA) Advanced Life Support (ALS) Program. In-vessel composting has lower manpower requirements, lower water and volume requirements, and greater potential for sanitization of human waste compared to alternative bioreactor designs such as continuously stirred tank reactors (CSTR). Residual solids from the process (i.e. compost) could be used a biological air filter, a plant nutrient source, and a carbon sink. Potential in-vessel composting designs for both near- and long-term space missions are presented and discussed with respect to the unique aspects of space-based systems.

  18. Evaluating the feasibility of biological waste processing for long term space missions

    NASA Technical Reports Server (NTRS)

    Garland, J. L.; Alazraki, M. P.; Atkinson, C. F.; Finger, B. W.; Sager, J. C. (Principal Investigator)

    1998-01-01

    Recycling waste products during orbital (e.g., International Space Station) and planetary missions (e.g., lunar base, Mars transit mission, Martian base) will reduce storage and resupply costs. Wastes streams on the space station will include human hygiene water, urine, faeces, and trash. Longer term missions will contain human waste and inedible plant material from plant growth systems used for atmospheric regeneration, food production, and water recycling. The feasibility of biological and physical-chemical waste recycling is being investigated as part of National Aeronautics and Space Administration's (NASA) Advanced Life Support (ALS) Program. In-vessel composting has lower manpower requirements, lower water and volume requirements, and greater potential for sanitization of human waste compared to alternative bioreactor designs such as continuously stirred tank reactors (CSTR). Residual solids from the process (i.e. compost) could be used a biological air filter, a plant nutrient source, and a carbon sink. Potential in-vessel composting designs for both near- and long-term space missions are presented and discussed with respect to the unique aspects of space-based systems.

  19. Detailed description of a long-term low-level waste degradation experiment

    SciTech Connect

    Caron, F.; Torok, J.; Haas, M.K.; Manni, G.

    1997-12-31

    This work gives a detailed description of the important aspects of a long-term Low-Level Radioactive Waste (LLRW) degradation experiment, performed at Chalk River Laboratories (CRL). This experiment utilized actual LLRW. The wastes consist of unconditioned compacted refuse (paper, mop heads, paper towels, used clothing, etc.), which represents the bulk of the waste volume intended for near-surface disposal at CRL. Waste material was collected and compacted to make a total of 11 bales for this experiment. Each bale was then placed and sealed in separate steel containers which were connected to sampling lines. After a dry monitoring period, water was added to promote leaching and decomposition of the wastes. The leachate sampled had a composition similar to landfill leachates. Some applications of this experiment, used to support the safety case of near-surface disposal, are briefly discussed in this paper, e.g., the production of colloidal material, the nature and role of dissolved organics of microbial origin, etc.

  20. Estimation of underground cavities stability for long-term safety of nuclear waste repository

    NASA Astrophysics Data System (ADS)

    Rogojnikov, O.; Mansurov, V.

    2003-04-01

    There is the increased interest to a problem of storages of radioactive waste creation in geological structures in present. Such projects are developed and the construction of these objects is conducted in many countries. This is caused by real, safety and economically acceptable character of radioactive waste underground isolation from human environment. Exploitation term of this objects is tens, hundreds and more years. The rock massif is the long acting natural barrier on a way of radionuclides distribution so the problem of ecological safety is long-term stability of storages and surrounding rock. Therefore one of the main problems is the development of evaluation and forecasting methods of underground structures supporting constructions long stability. The regularities of roof of cameras and pillars deformation and failure in time, depending on its geometric sizes, physical-mechanical properties of rocks, stress state and massif structure are obtained as result of mine research. On basis of kinetic theory of rock failure, creep theory and statistical analysis of experimental datas, which was obtained in mine conditions, the model of supporting constructions long-term strength is developed. This model allows to make an estimation and forecasting of underground structures current state evolution in time.

  1. Decreasing Stress among Nurse Managers: A Long-Term Solution.

    ERIC Educational Resources Information Center

    Judkins, Sharon K.; Ingram, Melba

    2002-01-01

    Hospital nursing managers (n=31) in a rural Texas hospital completed a self-paced module on stress and hardiness (beliefs related to control, commitment, and challenge). Pre/posttest scores showed the module had a significant effect on understanding of stress and coping and increased their hardiness levels. (Contains 25 references.) (SK)

  2. Complications Associated with Long-Term Disposition of Newly-Generated Transuranic Waste: A National Laboratory Perspective

    SciTech Connect

    B.J. Orchard; L.A. Harvego; T.L. Carlson; R.P. Grant

    2009-03-01

    The Idaho National Laboratory (INL) is a multipurpose national laboratory delivering specialized science and engineering solutions for the U.S. Department of Energy (DOE). Sponsorship of INL was formally transferred to the DOE Office of Nuclear Energy, Science and Technology (NE) by Secretary Spencer Abraham in July 2002. The move to NE, and designation as the DOE lead nuclear energy laboratory for reactor technology, supports the nation’s expanding nuclear energy initiatives, placing INL at the center of work to develop advanced Generation IV nuclear energy systems; nuclear energy/hydrogen coproduction technology; advanced nuclear energy fuel cycle technologies; and providing national security answers to national infrastructure needs. As a result of the Laboratory’s NE mission, INL generates both contact-handled and remote-handled transuranic (TRU) waste from ongoing operations. Generation rates are relatively small and fluctuate based on specific programs and project activities being conducted; however, the Laboratory will continue to generate TRU waste well into the future in association with the NE mission. Currently, plans and capabilities are being established to transfer INL’s contact-handled TRU waste to the Advanced Mixed Waste Treatment Plant (AMWTP) for certification and disposal to the Waste Isolation Pilot Plant (WIPP). Remote-handled TRU waste is currently placed in storage at the Materials and Fuels Complex (MFC). In an effort to minimize future liabilities associated with the INL NE mission, INL is evaluating and assessing options for the management and disposition of all its TRU waste on a real-time basis at time of generation. This paper summarizes near-term activities to minimize future re handling of INL’s TRU waste, as well as, potential complications associated with the long-term disposition of newly-generated TRU waste. Potential complications impacting the disposition of INL newly-generated TRU waste include, but are not limited to

  3. Solid waste: terminological and long-term environmental risk assessment problems exemplified in a power plant fly ash study.

    PubMed

    Twardowska, Irena; Szczepanska, Jadwiga

    2002-02-21

    Legal definitions exert a significant impact on the waste management strategy. Waste that is technically suitable for recovery does not automatically become a raw material if there is no market for it, or its use is not commercially effective and, hence, they should be disposed of. The majority of disposed wastes, including recyclable waste, are not environmentally safe. Waste as a freshly generated anthropogenic material is not geochemically stable. Przezchlebie fly ash surface pond (Upper Silesia, Poland) in the post-closure stage was subject to field validation of the results of laboratory leaching/extraction tests and long-term column experiments on fly ash (FA) leaching behaviour under controlled conditions for environmental risk assessment. The study showed: (i) the possibility of a discontinuous non-linear time delayed increase of pollution potential of disused 'non-hazardous' large-volume waste in the dumping sites to the hazardous level; (ii) inconsistency of the laboratory leaching tests and the actual leaching behaviour of trace metals, particularly when equilibria conditions are dictated by kinetically determined reactions where the test results reflected entirely wash-out (I) and dissolution (II) phases, but did not comprise delayed release (III) phase; and (iii) necessity of life-cycle screening/monitoring of 'non-hazardous' dumping sites for contaminant release as a function of the primary (pH-Eh, ionic strength, ionic composition of solute) and secondary controlling factors (L/S-liquid to solid ratio, water flow conditions) along the vertical profile of an anthropogenic or natural vadose zone. These data are to be used to develop long-term predictive hydrogeochemical models and their field validation, and for providing an early warning and remedial actions with respect to the particular site. The formation of pH (and Eh) as a function of time-dependent (kinetically defined) processes appeared to be a key issue for a correct prediction of the

  4. 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.

  5. Accelerator-driven transmutation technologies for resolution of long-term nuclear waste concerns

    SciTech Connect

    Bowman, C.D.

    1996-10-01

    The paper provides a rationale for resolution of the long-term waste disposition issue based on complete destruction of fissile material and all higher actinides. It begins with a brief history of geologic storage leading to the present impasse in the US. The proliferation aspects of commercial plutonium are presented in a new light as a further driver for complete destruction. The special problems in Russia and the US of the disposition of the highly enriched spent naval reactor fuel and spent research reactor fuel are also presented. The scale of the system required for complete destruction is also examined and it is shown that a practical system for complete destruction of commercial and defense fissile material must be widely dispersed rather than concentrated at a single site. Central tenants of the US National Academy of Sciences recommendations on waste disposition are examined critically and several technologies considered for waste destruction are described briefly and compared Recommendations for waste disposition based on Accelerator-Driven Transmutation Technology suitable for both the US and Russia are presented.

  6. The long-term acceleration of waste glass corrosion: A preliminary review

    SciTech Connect

    Kielpinski, A.L.

    1995-07-01

    Whereas a prior conception of glass dissolution assumed a relatively rapid initial dissolution which then slowed to a smaller, fairly constant longer-term rate, some recent work suggests that these two stages are followed by a third phase of dissolution, in which the dissolution rate is accelerated with respect to what had previously been thought of as the final long-term rate. The goals of the present study are to compile experimental data which may have a bearing on this phenomena, and to provide an initial assessment of these data. The Savannah River Technology Center (SRTC) is contracted to develop glass formulation models for vitrification of Hanford low-level waste (LLW), in support of the Hanford Tank Waste Remediation System Technology Development Program. The phenomenon of an increase in corrosion rate, following a period characterized by a low corrosion rate, has been observed by a number of researchers on a number of waste glass compositions. Despite inherent ambiguities arising from SA/V (glass surface area to solution volume ratio) and other effects, valid comparisons can be made in which accelerated corrosion was observed in one test, but not in another. Some glass compositions do not appear to attain a plateau region; it may be that the observation of continued, non-negligible corrosion in these glasses represents a passage from the initial rate to the accelerated rate. The long-term corrosion is a function of the interaction between the glass and its environment, including the leaching solution and the surrounding materials. Reaction path modeling and stability field considerations have been used with some success to predict the changes in corrosion rate over time, due to these interactions. The accelerated corrosion phenomenon highlights the need for such integrated corrosion modeling and the scenario-specific nature of a particular glass composition`s durability.

  7. Long-Term Performance of Transuranic Waste Inadvertently Disposed in a Shallow Land Burial Trench at the Nevada Test Site

    SciTech Connect

    Gregory J. Shott; Vefa Yucel

    2009-07-16

    In 1986, 21 m3 of transuranic (TRU) waste was inadvertently disposed in a shallow land burial trench at the Area 5 Radioactive Waste Management Site on the Nevada Test Site. U.S. Department of Energy (DOE) TRU waste must be disposed in accordance with Title 40, Code of Federal Regulations (CFR), Part 191, Environmental Radiation Protection Standard for Management and Disposal of Spent Nuclear Fuel, High-Level, and Transuranic Radioactive Wastes. The Waste Isolation Pilot Plant is the only facility meeting these requirements. The National Research Council, however, has found that exhumation of buried TRU waste for disposal in a deep geologic repository may not be warranted when the effort, exposures, and expense of retrieval are not commensurate with the risk reduction achieved. The long-term risks of leaving the TRU waste in-place are evaluated in two probabilistic performance assessments. A composite analysis, assessing the dose from all disposed waste and interacting sources of residual contamination, estimates an annual total effective dose equivalent (TEDE) of 0.01 mSv, or 3 percent of the dose constraint. A 40 CFR 191 performance assessment also indicates there is reasonable assurance of meeting all requirements. The 40 CFR 191.15 annual mean TEDE for a member of the public is estimated to reach a maximum of 0.055 mSv at 10,000 years, or approximately 37 percent of the 0.15 mSv individual protection requirement. In both assessments greater than 99 percent of the dose is from co-disposed low-level waste. The simulated probability of the 40 CFR 191.13 cumulative release exceeding 1 and 10 times the release limit is estimated to be 0.0093 and less than 0.0001, respectively. Site characterization data and hydrologic process modeling support a conclusion of no groundwater pathway within 10,000 years. Monte Carlo uncertainty analysis indicates that there is reasonable assurance of meeting all regulatory requirements. Sensitivity analysis indicates that the results

  8. Long-term management--the way forward?

    PubMed

    Wallentin, L

    2000-01-01

    The mainstay of treatment for unstable coronary artery disease (UCAD) currently consists of antithrombotic therapy with aspirin plus unfractionated heparin (UFH), together with anti-ischemic treatment with beta blockers and nitrates. Recently, there has been a trend toward replacement of UFH with low-molecular-weight heparins (LMWHs), since these products offer significant advantages over the parent compound. Several lines of evidence suggest that prolongation of treatment with LMWHs beyond the acute phase may be appropriate in patients with UCAD. The Fragmin and Fast Revascularization during InStability in Coronary artery disease (FRISC II) study was designed to evaluate this hypothesis using the LMWH dalteparin sodium (Fragmin). A factorial design was used to randomize patients enrolled in the FRISC II study to an invasive or noninvasive management strategy, and to treatment with dalteparin sodium or placebo. Treatment with dalteparin sodium significantly reduced incidences of death and/or myocardial infarction (MI) during the first months of treatment (the reduction in the relative risk of double endpoint events was statistically significant at 47.0% at 1 month, and remained so at 2 months, but was no longer statistically significant at the 3-month assessment). However, risk, as defined by the triple endpoint of death, MI, and revascularization, was significantly lower (13.0% relative risk reduction) at 3-month follow-up in the treatment group randomized to dalteparin sodium than among patients receiving placebo. In patients in whom revascularization procedures were carried out, the risk of new, postprocedural events was low in both the placebo and dalteparin sodium arms. Thus, dalteparin sodium appears to protect patients from cardiac events until they undergo invasive procedures, and it can therefore be used as a bridge to revascularization.

  9. Case managers speak out: responding to depression in community long-term care.

    PubMed

    Munson, Michelle; Proctor, Enola; Morrow-Howell, Nancy; Fedoravicius, Nicole; Ware, Norma

    2007-08-01

    This study sought to understand how case managers in one publicly funded health and social service system, community long-term care, understand and address depression among their clients. Four focus groups with a total of 18 case managers were conducted. Case managers were asked a series of questions about their perspectives on the recognition and treatment of depression, including subthreshold depression, in community long-term care. Case managers perceived addressing depression as complex because of competing demands. Furthermore, case managers perceived conflict between their current role and what it would take to expand their role to include addressing depression. Case managers suggested that in order to successfully improve the detection and treatment of depression in community long-term care, systemic changes, such as increased support and training, may be necessary, along with a shift in the professional role of case managers.

  10. Long-term management of liver transplant recipients: A review for the internist.

    PubMed

    Issa, Danny H; Alkhouri, Naim

    2015-06-01

    Outcomes and long-term survival rates after liver transplantation have significantly improved over the last 5 decades, but the improved longevity is accompanied by long-term complications such as metabolic syndrome, obesity, cardiovascular disease, cancer, and bone disease. After the first year, the primary care physician assumes a greater role and provides most of the patient's care. This review provides a source for primary care physicians in managing the long-term medical complications seen in these patients. Copyright © 2015 Cleveland Clinic.

  11. Impact of microbial activity on the radioactive waste disposal: long term prediction of biocorrosion processes.

    PubMed

    Libert, Marie; Schütz, Marta Kerber; Esnault, Loïc; Féron, Damien; Bildstein, Olivier

    2014-06-01

    This study emphasizes different experimental approaches and provides perspectives to apprehend biocorrosion phenomena in the specific disposal environment by investigating microbial activity with regard to the modification of corrosion rate, which in turn can have an impact on the safety of radioactive waste geological disposal. It is found that iron-reducing bacteria are able to use corrosion products such as iron oxides and "dihydrogen" as new energy sources, especially in the disposal environment which contains low amounts of organic matter. Moreover, in the case of sulphate-reducing bacteria, the results show that mixed aerobic and anaerobic conditions are the most hazardous for stainless steel materials, a situation which is likely to occur in the early stage of a geological disposal. Finally, an integrated methodological approach is applied to validate the understanding of the complex processes and to design experiments aiming at the acquisition of kinetic data used in long term predictive modelling of biocorrosion processes.

  12. Investigation on polyetheretherketone composite for long term storage of nuclear waste

    NASA Astrophysics Data System (ADS)

    Ajeesh, G.; Bhowmik, Shantanu; Sivakumar, Venugopal; Varshney, Lalit; Kumar, Virendra; Abraham, Mathew

    2015-12-01

    This investigation highlights the effect of radiation, chemical and thermal environments on mechanical and thermal properties of Polyetheretherketone (PEEK) composites, which could prove to be an alternative material for long term storage of nuclear wastes. The tests are conducted on specimens made from PEEK and PEEK reinforced with carbon short fiber. The specimens are subjected to radiation doses, equivalent to the cumulative dosage for 500 years followed by exposure under highly corrosive and thermal environments. Studies under optical microscopy reveal that the dispersion of carbon short fiber in the PEEK Composites is significantly uniform. Differential scanning calorimeter (DSC) and thermo gravimetric analysis (TGA) indicates that there are no significant changes in thermal properties of PEEK composite when exposed to aggressive environments. It is further observed that there are no significant changes in mechanical properties of the composite after exposure to radiation and thermo-chemical environment.

  13. Evaluating long-term performance of in situ vitrified waste forms: Methodology and results

    SciTech Connect

    McGrail, B.P.; Olson, K.M.

    1992-11-01

    In situ vitrification (ISV) is an emerging technology for the remediation of hazardous and radioactive waste sites. The concept relies on the principle of Joule heating to raise the temperature of a soil between an array of electrodes above the melting temperature. After cooling, the melt solidifies into a massive glass and crystalline block similar to naturally occurring obsidian. Determining the long-term performance of ISV products in a changing regulatory environment requires a fundamental understanding of the mechanisms controlling the dissolution behavior of the material. A series of experiments was performed to determine the dissolution behavior of samples produced from the ISV processing of typical soils from the Idaho National Engineering Laboratory subsurface disposal area. Dissolution rate constant measurements were completed at 90{degrees}C over the pH range 2 to 11 for one sample obtained from a field test of the ISV process.

  14. Evaluating long-term performance of in situ vitrified waste forms: Methodology and results

    SciTech Connect

    McGrail, B.P.; Olson, K.M.

    1992-11-01

    In situ vitrification (ISV) is an emerging technology for the remediation of hazardous and radioactive waste sites. The concept relies on the principle of Joule heating to raise the temperature of a soil between an array of electrodes above the melting temperature. After cooling, the melt solidifies into a massive glass and crystalline block similar to naturally occurring obsidian. Determining the long-term performance of ISV products in a changing regulatory environment requires a fundamental understanding of the mechanisms controlling the dissolution behavior of the material. A series of experiments was performed to determine the dissolution behavior of samples produced from the ISV processing of typical soils from the Idaho National Engineering Laboratory subsurface disposal area. Dissolution rate constant measurements were completed at 90[degrees]C over the pH range 2 to 11 for one sample obtained from a field test of the ISV process.

  15. Long-term impacts on sewers following food waste disposer installation in housing areas.

    PubMed

    Mattsson, Jonathan; Hedström, Annelie; Viklander, Maria

    2014-01-01

    To increase biogas generation and decrease vehicle transportation of solid waste, the integration of food waste disposers (FWDs) into the wastewater system has been proposed. However, concerns have been raised about the long-term impact of the additional load of the FWDs on sewer systems. To examine the said impact, this study has used closed-circuit television inspection techniques to evaluate the status of 181 concrete pipes serving single family housing areas with a diameter of 225 mm, ranging from a 100% connection rate of households with an FWD to none. A minor study was also performed on a multi-family housing area, where mainly plastic pipes (200 mm) were used. The extent and distribution of deposits related to the ratio of FWDs, inclination and pipe sagging (backfalls) were ascertained by using linear regression and analysis of variance. The results showed that FWDs have had an impact on the level of deposits in the sewer, but this has, in turn, been of minor significance. With a high connection rate of FWDs upstream of a pipe, the extent of the total level of deposits, as well as finer sediments, was statistically determined to be greater. However, the majority of the deposits were observed to be small, which would suggest the impact of FWDs on sewer performance to be minor. As food waste not compatible with the FWD was seen in the sewers, educational campaigns could be beneficial to further lower the risks of sewer blocking.

  16. CONCRETE CONTAINERS FOR LONG TERM STORAGE AND FINAL DISPOSAL OF TRU WASTE AND LONG LIVED ILW

    SciTech Connect

    Sakamoto, H.; Asano, H.; Tunaboylu, K.; Mayer, G.; Klubertanz, G.; Kobayashi, S.; Komuro, T.; Wagner, E.

    2003-02-27

    Transuranic (TRU) waste packaging development has been conducted since 1998 by the Radioactive Waste Management Funding and Research Centre (RWMC) to support the TRU waste disposal concept in Japan. In this paper, the overview of development status of the reinforced concrete package is introduced. This package has been developed in order to satisfy the Japanese TRU waste disposal concept based on current technology and to provide a low cost package. Since 1998, the basic design work (safety evaluation, manufacturing and handling procedure, economic evaluation, elemental tests etc.) have been carried out. As a result, the basic specification of the package was decided. This report presents the concept as well as the results of basic design, focused on safety analysis and handling procedure of the package. Two types of the packages exist: - Package-A: for non-heat generating TRU waste from reprocessing in 200 l drums and - Package-B: for heat generating TRU-waste from reprocessing.

  17. Long-term stability and risk assessment of lead in mill waste treated by soluble phosphate.

    PubMed

    Tang, Xi; Yang, John

    2012-11-01

    In an effort to address public concerns of the long-term stability and ecological risk reduction of phosphate (P)-stabilized lead (Pb) in mine wastes, mill tailings located at the Jasper County Superfund Site of southwest Missouri, containing ~4000 mg Pb kg(-1), were treated in situ by phosphoric acid at three rates: 0; 7.5; and 10.0 g P kg(-1) soil. Field experiment consisted of 2- by 4-m plots arranged in a randomized complete block design with four replicates of each P level. Soil and plant samples were collected at a 3-month interval during five to six (5-6) years post treatments and analyzed for Pb bioaccessibility and leachability, microbial toxicity, Pb chemical fraction, and elemental composition of Pb solids, and Pb concentration in plant tissue. Results indicated that the P treatments significantly reduced bioaccessible and leachable Pb in the mill waste, and the reductions were maintained during the sampling period. Lead concentration in plant tissue was positively related to the Pb bioaccessibility. There was no significant toxicological effect of the treatments on soil microbial community. The treatment using 10 g P kg(-1) appeared to be most effective for overall risk reduction. The Pb stabilization and risk reduction by the P treatments were accomplished by the induced transformation of labile Pb species to relatively insoluble forms, probably pyromorphite-like minerals. This study illustrated that in situ Pb stabilization by soluble phosphate would be long-term and ecologically-safe, which could safeguard human health and ecosystem from Pb contamination in mining areas.

  18. A United States perspective on long-term management of areas contaminated with radioactive materials.

    PubMed

    Jones, C Rick

    2004-01-01

    The US has far-reaching and extensive experience in the long-term management of areas contaminated with radioactive materials. This experience base includes the Department of Energy's continued follow-up with Hiroshima and Nagasaki from the 1940s at the Radiological Effects Research Foundation in Hiroshima, Japan, the long-term management of the Marshall Islands Programme, the clean-up of the US nuclear weapons complex and the ongoing management of accident sites such as in Palomares, Spain. This paper discusses the lessons learnt and best practices gained from this far-reaching and extensive experience in the long-term management of areas contaminated with radioactive materials. Copyright 2004 Oxford University Press

  19. Predicting the long term durability of concrete engineered barriers in a geological repository for radioactive waste

    NASA Astrophysics Data System (ADS)

    Trotignon, L.; Devallois, V.; Peycelon, H.; Tiffreau, C.; Bourbon, X.

    In order to evaluate the long term waste package integrity in a geological repository for radioactive waste, simulations of the geochemical interactions between a concrete engineered barrier and a mudrock were conducted in 1-D geometry and on time periods of up to 10 6 y with the reactive transport code Hytec. Scenarios involving sulfate attack are shown to potentially alter strongly a concrete engineered barrier based on pure Portland based cement. Spatial extension of chemical degradation of the host rock due to high pH fluids is restricted to a radial distance of less than 2 m of the tunnel border in 100 000 y. Results suggest that illite and quartz destabilization rates are key parameters governing the geochemical evolution of the degraded interface. Results also suggest that controls on Mg availability and speciation at the border of the altered concrete are important for a proper understanding of this system. Another key process is the progressive localized cementation of the altered mudrock. Defining a conservative and robust modelling of the effects of cementation is not an easy task, as both porosity opening and closing occurs in this reactive system. Results obtained here suggest that coupling between pH dependence of mineral stability and feedback of mineral precipitation on pH sharpen the cementation front.

  20. Long-term criticality control in radioactive waste disposal facilities using depleted uranium

    SciTech Connect

    Forsberg, C.W.

    1997-02-19

    Plant photosynthesis has created a unique planetary-wide geochemistry - an oxidizing atmosphere with oxidizing surface waters on a planetary body with chemically reducing conditions near or at some distance below the surface. Uranium is four orders of magnitude more soluble under chemically oxidizing conditions than it is under chemically reducing conditions. Thus, uranium tends to leach from surface rock and disposal sites, move with groundwater, and concentrate where chemically reducing conditions appear. Earth`s geochemistry concentrates uranium and can separate uranium from all other elements except oxygen, hydrogen (in water), and silicon (silicates, etc). Fissile isotopes include {sup 235}U, {sup 233}U, and many higher actinides that eventually decay to one of these two uranium isotopes. The potential for nuclear criticality exists if the precipitated uranium from disposal sites has a significant fissile enrichment, mass, and volume. The earth`s geochemistry suggests that isotopic dilution of fissile materials in waste with {sup 238}U is a preferred strategy to prevent long-term nuclear criticality in and beyond the boundaries of waste disposal facilities because the {sup 238}U does not separate from the fissile uranium isotopes. Geological, laboratory, and theoretical data indicate that the potential for nuclear criticality can be minimized by diluting fissile materials with-{sup 238}U to 1 wt % {sup 235}U equivalent.

  1. The STRATEGY project: decision tools to aid sustainable restoration and long-term management of contaminated agricultural ecosystems.

    PubMed

    Howard, B J; Beresford, N A; Nisbet, A; Cox, G; Oughton, D H; Hunt, J; Alvarez, B; Andersson, K G; Liland, A; Voigt, G

    2005-01-01

    The STRATEGY project (Sustainable Restoration and Long-Term Management of Contaminated Rural, Urban and Industrial Ecosystems) aimed to provide a holistic decision framework for the selection of optimal restoration strategies for the long-term sustainable management of contaminated areas in Western Europe. A critical evaluation was carried out of countermeasures and waste disposal options, from which compendia of state-of-the-art restoration methods were compiled. A decision support system capable of optimising spatially varying restoration strategies, that considered the level of averted dose, costs (including those of waste disposal) and environmental side effects was developed. Appropriate methods of estimating indirect costs associated with side effects and of communicating with stakeholders were identified. The importance of stakeholder consultation at a local level and of ensuring that any response is site and scenario specific were emphasised. A value matrix approach was suggested as a method of addressing social and ethical issues within the decision-making process, and was designed to be compatible with both the countermeasure compendia and the decision support system. The applicability and usefulness of STRATEGY outputs for food production systems in the medium to long term is assessed.

  2. EPA'S OFFICE OF RESEARCH AND DEVELOPMENT PERSPECTIVE ON THE LONG-TERM MANAGEMENT OF EXCESS MERCURY

    EPA Science Inventory

    The Agency is discussing the issues of the long-tem management and retirement of excess mercury. The concept of mercury "retirement" or the long-term management of excess mercury is in its infancy. Currently, the regulatory system supports all mercury recycling initiatives. There...

  3. Guide to effective research-management collaboration at long-term environmental research sites

    Treesearch

    Frederick J. Swanson; Steve Eubanks; Mary Beth Adams; John C. Brissette; Carol DeMuth

    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...

  4. EPA'S OFFICE OF RESEARCH AND DEVELOPMENT PERSPECTIVE ON THE LONG-TERM MANAGEMENT OF EXCESS MERCURY

    EPA Science Inventory

    The Agency is discussing the issues of the long-tem management and retirement of excess mercury. The concept of mercury "retirement" or the long-term management of excess mercury is in its infancy. Currently, the regulatory system supports all mercury recycling initiatives. There...

  5. Long-term biological monitoring of environmental quality around a solid waste landfill assessed with lichens.

    PubMed

    Paoli, L; Corsini, A; Bigagli, V; Vannini, J; Bruscoli, C; Loppi, S

    2012-02-01

    The diversity of epiphytic lichens and the accumulation of selected trace elements in the lichen Flavoparmelia caperata L. (Hale) were used as indicators of pollution around a landfill in central Italy along 14 years of waste management. Lichens revealed an increased deposition for some elements (i.e., Cd, Cr, Fe and Ni) and a decrease of the lichen diversity at sites facing the landfill after an enlargement of the dumping area. However, the results allowed to exclude a significant increase in heavy metal depositions in the surrounding area and suggested that successful waste management may be associated with environmental quality. It is concluded that lichen monitoring might provide essential information to enhance the implementation of ecological impact assessment, supporting industrial regulatory procedures, also when waste management is concerned. Copyright © 2011 Elsevier Ltd. All rights reserved.

  6. Management of venous thromboembolism for older adults in long-term care facilities.

    PubMed

    Choi, Myunghan; Hector, Melvin

    2012-06-01

    To provide information on current evidence-based clinical management of venous thromboembolism (VTE) for nurse practitioners working for older adults in long-term care facilities. METHODS AND DATA RESOURCES: A systematic review and summary using current clinical guidelines and reliable clinical research studies: American Medical Directors Association, American College of Chest Physicians, Medline, PubMed, Refworks, and CINAHL. The management of VTE focuses on a comprehensive approach including acute and long-term pharmacologic approach, surgical and mechanical approach, prophylaxis of recurrent VTE, maintaining INR, and monitoring lab values. Recommendations based on the most current clinical research studies and guidelines will facilitate a cost-effective management of venous thromboembolism for older adults in long-term care facilities. ©2012 The Author(s) Journal compilation ©2012 American Academy of Nurse Practitioners.

  7. The nurse practitioner role in pain management in long-term care.

    PubMed

    Kaasalainen, Sharon; Martin-Misener, Ruth; Carter, Nancy; Dicenso, Alba; Donald, Faith; Baxter, Pamela

    2010-03-01

    This paper is a report of a study exploring the perceptions of long-term care team members and nurse managers about barriers and facilitators to optimal use of nurse practitioners to manage residents' pain in long-term care settings. Considering the high rates of pain in long-term care, research is needed to explore innovations in health-services delivery, including the emerging nurse practitioner role. For this study, an exploratory descriptive design was used to collect data in spring 2007 from five focus groups of nurses and 14 individual interviews with other healthcare team members and nurse managers. Data were analysed using thematic content analysis. Five pain management activities performed by nurse practitioners were identified, including assessing pain, prescribing pain medications, monitoring pain levels and side effects of pain medications, consulting and advocating for staff and patients, and leading and educating staff related to pain management. Factors that influenced the implementation of the nurse practitioner role included the availability of the nurse practitioner, scope of practice, role clarity, perceived added value of nurse practitioner role, terms of employment, nurse practitioner-physician relationship. Perceived outcomes of the nurse practitioner role were also described. The findings from this study contribute to our understanding of how the nurse practitioner role is perceived by other healthcare professionals, particularly in pain management. Stronger interprofessional collaborative relationships need to be facilitated within a model of care that includes a nurse practitioner, with the ultimate goal of improving pain management services in long-term care.

  8. In-Vessel Composting of Simulated Long-Term Missions Space-Related Solid Wastes

    NASA Technical Reports Server (NTRS)

    Rodriguez-Carias, Abner A.; Sager, John; Krumins, Valdis; Strayer, Richard; Hummerick, Mary; Roberts, Michael S.

    2002-01-01

    Reduction and stabilization of solid wastes generated during space missions is a major concern for the Advanced Life Support - Resource Recovery program at the NASA, Kennedy Space Center. Solid wastes provide substrates for pathogen proliferation, produce strong odor, and increase storage requirements during space missions. A five periods experiment was conducted to evaluate the Space Operation Bioconverter (SOB), an in vessel composting system, as a biological processing technology to reduce and stabilize simulated long-term missions space related solid-wastes (SRSW). For all periods, SRSW were sorted into components with fast (FBD) and slow (SBD) biodegradability. Uneaten food and plastic were used as a major FBD and SBD components, respectively. Compost temperature (C), CO2 production (%), mass reduction (%), and final pH were utilized as criteria to determine compost quality. In period 1, SOB was loaded with a 55% FBD: 45% SBD mixture and was allowed to compost for 7 days. An eleven day second composting period was conducted loading the SOB with 45% pre-composted SRSW and 55% FBD. Period 3 and 4 evaluated the use of styrofoam as a bulking agent and the substitution of regular by degradable plastic on the composting characteristics of SRSW, respectively. The use of ceramic as a bulking agent and the relationship between initial FBD mass and heat production was investigated in period 5. Composting SRSW resulted in an acidic fermentation with a minor increase in compost temperature, low CO2 production, and slightly mass reduction. Addition of styrofoam as a bulking agent and substitution of regular by biodegradable plastic improved the composting characteristics of SRSW, as evidenced by higher pH, CO2 production, compost temperature and mass reduction. Ceramic as a bulking agent and increase the initial FBD mass (4.4 kg) did not improve the composting process. In summary, the SOB is a potential biological technology for reduction and stabilization of mission space

  9. The essential value of long-term experimental data for hydrology and water management

    NASA Astrophysics Data System (ADS)

    Tetzlaff, Doerthe; Carey, Sean K.; McNamara, James P.; Laudon, Hjalmar; Soulsby, Chris

    2017-04-01

    Observations and data from long-term experimental watersheds are the foundation of hydrology as a geoscience. They allow us to benchmark process understanding, observe trends and natural cycles, and are prerequisites for testing predictive models. Long-term experimental watersheds also are places where new measurement technologies are developed. These studies offer a crucial evidence base for understanding and managing the provision of clean water supplies, predicting and mitigating the effects of floods, and protecting ecosystem services provided by rivers and wetlands. They also show how to manage land and water in an integrated, sustainable way that reduces environmental and economic costs.

  10. Modeling Cd and Cu mobility in soils amended by long-term urban waste compost applications

    NASA Astrophysics Data System (ADS)

    Filipović, Vilim; Cambier, Philippe; Matijević, Lana; Coquet, Yves; Pot, Valérie; Houot, Sabine; Benoit, Pierre

    2016-04-01

    Urban waste compost application to soil is an effective way for organic waste disposal and at the same time may have a positive effect on various soil rhizosphere processes. However, long term applications of organic waste amendments may lead to a noteworthy accumulation of micropollutants in soil. The long-term field experiment QualiAgro, an INRA-Veolia partnership (https://www6.inra.fr/qualiagro_eng/), has been conducted since 1998 with the objectives to characterize the agronomic value of urban composts and the environmental impacts of their application. Numerical modeling was performed using HYDRUS-2D to estimate the movement of Cd and Cu from compost incroporation in the tilled layer. Experimental plots regularly amended with co-compost of sewage sludge and green wastes (SGW), or a municipal solid waste compost (MSW) have been compared to control plot without any organic amendment (CONT). Field site was equipped with wicks lysimeters, TDR probes and tensiometers in order to determine water balance and trace metal concentrations during a 6 years' time period (2004-2010). In the tilled layer different structures (Δ - compacted clods, Γ - macroporous zone, IF - interfurrows, PP - plough pan) corresponding to the tillage and compost incorporation were delimited and reproduced in a 2-D model. The increase of Cd and Cu concentrations due to each compost addition was assumed to be located in IFs for further modeling. Four compost additions were performed during 2004-2010 period which increased the Cd and Cu concentrations in the IF zones considerably. After successful model description of water flow in highly heterogeneous soil profiles, Cd and Cu were added into the model and their fate was simulated during the same time period. Two approaches were followed to estimate plausible trace metals sorption coefficients (Kd), both while assuming equilibrium between dissolved and EDTA-extractable metals. The first approach was based on Kd estimated from ratios between

  11. Emergency Response and Long Term Planning: Two sides of the Coin for Managing Water Resources

    NASA Astrophysics Data System (ADS)

    Metchis, K.; Beller-Simms, N.

    2014-12-01

    As projected by the US National Climate Assessment and the IPCC, extreme climate and weather events are occurring more frequently and with more intensity across the nation. Communities - and the water resource managers that serve them - are facing difficult choices to increase emergency preparedness, recover from costly impacts, and increase long term resilience. The presentation is based on a recent set of case studies about what happened in six communities that experienced one or more extreme events, focusing on water resource management. Two of the case studies will be presented, revealing that building climate resilience is not just about long term planning - it is also about taking the steps to be prepared for - and to be able to recover from - emergency events. The results of this study have implications for educating local officials on ways to think about resilience to balance both long-term and short-term preparedness.

  12. Mixing-controlled uncertainty in long-term predictions of acid rock drainage from heterogeneous waste-rock piles

    NASA Astrophysics Data System (ADS)

    Pedretti, D.; Beckie, R. D.; Mayer, K. U.

    2015-12-01

    The chemistry of drainage from waste-rock piles at mine sites is difficult to predict because of a number of uncertainties including heterogeneous reactive mineral content, distribution of minerals, weathering rates and physical flow properties. In this presentation, we examine the effects of mixing on drainage chemistry over timescales of 100s of years. We use a 1-D streamtube conceptualization of flow in waste rocks and multicomponent reactive transport modeling. We simplify the reactive system to consist of acid-producing sulfide minerals and acid-neutralizing carbonate minerals and secondary sulfate and iron oxide minerals. We create multiple realizations of waste-rock piles with distinct distributions of reactive minerals along each flow path and examine the uncertainty of drainage geochemistry through time. The limited mixing of streamtubes that is characteristic of the vertical unsaturated flow in many waste-rock piles, allows individual flowpaths to sustain acid or neutral conditions to the base of the pile, where the streamtubes mix. Consequently, mixing and the acidity/alkalinity balance of the streamtube waters, and not the overall acid- and base-producing mineral contents, control the instantaneous discharge chemistry. Our results show that the limited mixing implied by preferential flow and the heterogeneous distribution of mineral contents lead to large uncertainty in drainage chemistry over short and medium time scales. However, over longer timescales when one of either the acid-producing or neutralizing primary phases is depleted, the drainage chemistry becomes less controlled by mixing and in turn less uncertain. A correct understanding of the temporal variability of uncertainty is key to make informed long-term decisions in mining settings regarding the management of waste material.

  13. Approaches to long-term conditions management and care for older people: similarities or differences?

    PubMed

    Tullett, Michael; Neno, Rebecca

    2008-03-01

    In the past few years, there has been an increased emphasis both on the care for older people and the management of long-term conditions within the United Kingdom. Currently, the Department of Health and the Scottish Executive identify and manage these two areas as separate entities. The aim of this article is to examine the current approaches to both of these areas of care and identify commonalities and articulate differences. The population across the world and particularly within the United Kingdom is ageing at an unprecedented rate. The numbers suffering long-term illness conditions has also risen sharply in recent years. As such, nurses need to be engaged at a strategic level in the design of robust and appropriate services for this increasing population group. A comprehensive literature review on long-term conditions and the care of older people was undertaken in an attempt to identify commonalities and differences in strategic and organizational approaches. A policy analysis was conducted to support the paper and establish links that may inform local service development. Proposing service development based on identified needs rather than organizational boundaries after the establishment of clear links between health and social care for those with long-term conditions and the ageing population. Nurse Managers need to be aware of the similarities and differences in political and theoretical approaches to the care for older people and the management of long-term conditions. By adopting this view, creativity in the service redesign and service provision can be fostered and nurtured as well as achieving a renewed focus on partnership working across organizational boundaries. With the current renewed political focus on health and social care, there is an opportunity in the UK to redefine the structure of care. This paper proposes similarities between caring for older people and for those with long-term conditions, and it is proposed these encapsulate the wider

  14. Long-term metapopulation study of the Glanville fritillary butterfly (Melitaea cinxia): survey methods, data management, and long-term population trends

    PubMed Central

    Ojanen, Sami P; Nieminen, Marko; Meyke, Evgeniy; Pöyry, Juha; Hanski, Ilkka

    2013-01-01

    Long-term observational studies conducted at large (regional) spatial scales contribute to better understanding of landscape effects on population and evolutionary dynamics, including the conditions that affect long-term viability of species, but large-scale studies are expensive and logistically challenging to keep running for a long time. Here, we describe the long-term metapopulation study of the Glanville fritillary butterfly (Melitaea cinxia) that has been conducted since 1991 in a large network of 4000 habitat patches (dry meadows) within a study area of 50 by 70 km in the Åland Islands in Finland. We explain how the landscape structure has been described, including definition, delimitation, and mapping of the habitat patches; methods of field survey, including the logistics, cost, and reliability of the survey; and data management using the EarthCape biodiversity platform. We describe the long-term metapopulation dynamics of the Glanville fritillary based on the survey. There has been no long-term change in the overall size of the metapopulation, but the level of spatial synchrony and hence the amplitude of fluctuations in year-to-year metapopulation dynamics have increased over the years, possibly due to increasing frequency of exceptional weather conditions. We discuss the added value of large-scale and long-term population studies, but also emphasize the need to integrate more targeted experimental studies in the context of long-term observational studies. For instance, in the case of the Glanville fritillary project, the long-term study has produced an opportunity to sample individuals for experiments from local populations with a known demographic history. These studies have demonstrated striking differences in dispersal rate and other life-history traits of individuals from newly established local populations (the offspring of colonizers) versus individuals from old, established local populations. The long-term observational study has stimulated the

  15. Long-term effect of ZnO nanoparticles on waste activated sludge anaerobic digestion.

    PubMed

    Mu, Hui; Chen, Yinguang

    2011-11-01

    The increasing use of zinc oxide nanoparticles (ZnO NPs) raises concerns about their environmental impacts, but the potential effect of ZnO NPs on sludge anaerobic digestion remains unknown. In this paper, long-term exposure experiments were carried out to investigate the influence of ZnO NPs on methane production during waste activated sludge (WAS) anaerobic digestion. The presence of 1 mg/g-TSS of ZnO NPs did not affect methane production, but 30 and 150 mg/g-TSS of ZnO NPs induced 18.3% and 75.1% of inhibition respectively, which showed that the impact of ZnO NPs on methane production was dosage dependant. Then, the mechanisms of ZnO NPs affecting sludge anaerobic digestion were investigated. It was found that the toxic effect of ZnO NPs on methane production was mainly due to the release of Zn(2+) from ZnO NPs, which may cause the inhibitory effects on the hydrolysis and methanation steps of sludge anaerobic digestion. Further investigations with enzyme and fluorescence in situ hybridization (FISH) assays indicated that higher concentration of ZnO NPs decreased the activities of protease and coenzyme F(420), and the abundance of methanogenesis Archaea.

  16. Long-term environmental impacts of building composites containing waste materials: Evaluation of the leaching protocols.

    PubMed

    Drinčić, Ana; Nikolić, Irena; Zuliani, Tea; Milačič, Radmila; Ščančar, Janez

    2017-01-01

    The NEN 7375 test has been proposed for evaluating the long-term environmental impacts caused by the release of contaminants from monolithic building and waste materials. Over a period of 64days, at specific points in time, the leaching solution (demineralised water) is replenished. By applying the NEN 7375 test, leaching of contaminants that is based mainly on diffusion is followed. In the present work, the results from modified leaching protocols were evaluated against those obtained by NEN 7375 test. In modified protocols, synthetic sea, surface and MilliQ water were used for the leaching of selected elements and chromate, molybdate and vanadate from compact and ground building composites (98% mixture of fly ash (80%) and cement (20%), and 2% of electric arc furnace (EAF) dust) over 6months. The leaching solutions were not replenished, imitating both the diffusion and the dissolution of contaminants. The data revealed larger extent of leaching when the leaching solution was not replenished. More extensive was also leaching from ground composites, which simulated the disintegration of the material over time. The composition of the leaching solution influenced the release of the matrix constituents from the composites and, consequently, the amount of elements and their chemical species. Synthetic sea and surface water used as leaching solutions, without replenishing, were found to be suitable to simulate the conditions when the building material is immersed in stagnant environmental waters. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Final Long-Term Management and Storage of Elemental Mercury Environmental Impact Statement Summary and Guide for Stakeholders

    SciTech Connect

    Not Available

    2011-01-01

    Pursuant to the Mercury Export Ban Act of 2008 (P.L. 110-414), DOE was directed to designate a facility or facilities for the long-term management and storage of elemental mercury generated within the United States. Therefore, DOE has analyzed the storage of up to 10,000 metric tons (11,000 tons) of elemental mercury in a facility(ies) constructed and operated in accordance with the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act (74 FR 31723). DOE prepared this Final Mercury Storage EIS in accordance with the National Environmental Policy Act of 1969 (NEPA), as amended (42 U.S.C. 4321 et seq.), the Council on Environmental Quality (CEQ) implementing regulations (40 CFR 1500–1508), and DOE’s NEPA implementing procedures (10 CFR 1021) to evaluate reasonable alternatives for a facility(ies) for the long-term management and storage of elemental mercury. This Final Mercury Storage EIS analyzes the potential environmental, human health, and socioeconomic impacts of elemental mercury storage at seven candidate locations: Grand Junction Disposal Site near Grand Junction, Colorado; Hanford Site near Richland, Washington; Hawthorne Army Depot near Hawthorne, Nevada; Idaho National Laboratory near Idaho Falls, Idaho; Kansas City Plant in Kansas City, Missouri; Savannah River Site near Aiken, South Carolina; and Waste Control Specialists, LLC, site near Andrews, Texas. As required by CEQ NEPA regulations, the No Action Alternative was also analyzed as a basis for comparison. DOE intends to decide (1) where to locate the elemental mercury storage facility(ies) and (2) whether to use existing buildings, new buildings, or a combination of existing and new buildings. DOE’s Preferred Alternative for the long-term management and storage of mercury is the Waste Control Specialists, LLC, site near Andrews, Texas.

  18. Creature comforts: personal communities, pets and the work of managing a long-term condition.

    PubMed

    Brooks, Helen L; Rogers, Anne; Kapadia, Dharmi; Pilgrim, Jack; Reeves, David; Vassilev, Ivaylo

    2013-06-01

    To explore in the context of peoples' personal social networks, the contribution that pets make to 'the work' associated with the management of long-term conditions. Mixed methods survey with nested parallel qualitative study; 300 participants were drawn from diabetes and chronic heart disease registers of General Practices across Greater Manchester in the North West of England. Notions of 'work' were used to describe the illness and everyday activities associated with chronic illness. Nineteen percent of participants identified at least one pet within their network. Pets contributed mostly to managing emotions (emotional work), to enhancing a sense of self identity (biographical work) and to a lesser extent practical tasks (everyday work). There were indicators that pets mediated relationships for people living with a long-term condition through very weak ties with others in domestic and community settings. The findings suggest that pets have unique qualities and are not simply substitutes for human relationships in long-term condition management. The study has potential implications for furthering a social contextual analysis of chronic illness, the understanding of relationships, and the meaning and the role of companion animals in long-term condition management.

  19. Roundtable on Long-Term Management In The Cleanup of Contaminated Sites

    SciTech Connect

    Aimee Houghton

    2002-06-28

    The Center for Public Environmental Oversight (CPEO) convened a roundtable in Washington, DC on June 28, 2002 to discuss innovative approaches to long-term management in the cleanup of contaminated property. Twenty participants attended the meeting, including representatives of federal agencies, local government, state regulatory agencies, environmental organizations, and thinking tanks, as well as private consultants with experience in site remediation and redevelopment.

  20. PRELIMINARY ANALYSIS OF ALTERNATIVES FOR THE LONG TERM MANAGEMENT OF EXCESS MERCURY

    EPA Science Inventory

    This report describes the use of a systematic method for comparing options for the long term management and retirement of surplus mercury in the U.S. The method chosen is the Analytical Hierarchy Procedure (AHP) as embodied in the Expert Choice 2000 software. The goal, criteria, ...

  1. Predicting agricultural management influence on long-term soil organic carbon dynamics: implications for biofuel production

    USDA-ARS?s Scientific Manuscript database

    Long-term field experiments (LTE) are ideal for predicting the influence of agricultural management on soil organic carbon (SOC) dynamics and examining biofuel crop residue removal policy questions. Our objectives were (i) to simulate SOC dynamics in LTE soils under various climates, crop rotations,...

  2. ANALYSIS OF ALTERNATIVES FOR THE LONG TERM MANAGEMENT OF EXCESS MERCURY

    EPA Science Inventory

    This paper describes a systematic method for comparing options for the long-term management of surplus elemental mercury in the U.S., using the Analytic Hierarchy Process (AHP) as embodied in commercially available Expert Choice software. A limited scope multi-criteria decisionan...

  3. ANALYSIS OF ALTERNATIVES FOR THE LONG TERM MANAGEMENT OF EXCESS MERCURY

    EPA Science Inventory

    This paper describes a systematic method for comparing options for the long-term management of surplus elemental mercury in the U.S., using the Analytic Hierarchy Process (AHP) as embodied in commercially available Expert Choice software. A limited scope multi-criteria decisionan...

  4. PRELIMINARY ANALYSIS OF ALTERNATIVES FOR THE LONG TERM MANAGEMENT OF EXCESS MERCURY

    EPA Science Inventory

    This report describes the use of a systematic method for comparing options for the long term management and retirement of surplus mercury in the U.S. The method chosen is the Analytical Hierarchy Procedure (AHP) as embodied in the Expert Choice 2000 software. The goal, criteria, ...

  5. Soil organic carbon and nitrogen in long-term manure management system

    USDA-ARS?s Scientific Manuscript database

    Long-term studies are extremely beneficial to understand and evaluate changes in soil quality and sustainability of specific management practices. The objectives of this study were to evaluate the effects of 70 yr of moldboard plowing with manure (M) and commercial fertilizer (F) additions on soil o...

  6. A Pilot Study of CME on Risk Management in Long-Term Care

    ERIC Educational Resources Information Center

    Powers, James; Pichert, James W.; Habermann, Ralf; Ribble, Rachel

    2004-01-01

    This pilot study's purpose was to evaluate behavioral changes among medical directors and physicians following CME on risk management in long-term care (LTC) facilities. The setting was a satellite conference at the AGS Meeting Symposium 2000. CME participants included 51 medical directors, attending physicians, and nurses. Evaluations were based…

  7. Long-term management impacts on carbon storage in Lake States forests

    Treesearch

    Matthew Powers; Randall Kolka; Brian Palik; Rachel McDonald; Martin. Jurgensen

    2011-01-01

    We examined carbon storage following 50+ years of forest management in two long-term silvicultural studies in red pine and northern hardwood ecosystems of North America’s Great Lakes region. The studies contrasted various thinning intensities (red pine) or selection cuttings, shelterwoods, and diameter-limit cuttings (northern hardwoods) to unmanaged controls of...

  8. Creature comforts: personal communities, pets and the work of managing a long-term condition

    PubMed Central

    Brooks, Helen L; Rogers, Anne; Kapadia, Dharmi; Pilgrim, Jack; Reeves, David; Vassilev, Ivaylo

    2013-01-01

    Objectives: To explore in the context of peoples’ personal social networks, the contribution that pets make to ‘the work’ associated with the management of long-term conditions. Method: Mixed methods survey with nested parallel qualitative study; 300 participants were drawn from diabetes and chronic heart disease registers of General Practices across Greater Manchester in the North West of England. Notions of ‘work’ were used to describe the illness and everyday activities associated with chronic illness. Results: Nineteen percent of participants identified at least one pet within their network. Pets contributed mostly to managing emotions (emotional work), to enhancing a sense of self identity (biographical work) and to a lesser extent practical tasks (everyday work). There were indicators that pets mediated relationships for people living with a long-term condition through very weak ties with others in domestic and community settings. Conclusion: The findings suggest that pets have unique qualities and are not simply substitutes for human relationships in long-term condition management. The study has potential implications for furthering a social contextual analysis of chronic illness, the understanding of relationships, and the meaning and the role of companion animals in long-term condition management. PMID:22777565

  9. The potential benefits of a new poliovirus vaccine for long-term poliovirus risk management.

    PubMed

    Duintjer Tebbens, Radboud J; Thompson, Kimberly M

    2016-12-01

    To estimate the incremental net benefits (INBs) of a hypothetical ideal vaccine with all of the advantages and no disadvantages of existing oral and inactivated poliovirus vaccines compared with current vaccines available for future outbreak response. INB estimates based on expected costs and polio cases from an existing global model of long-term poliovirus risk management. Excluding the development costs, an ideal poliovirus vaccine could offer expected INBs of US$1.6 billion. The ideal vaccine yields small benefits in most realizations of long-term risks, but great benefits in low-probability-high-consequence realizations. New poliovirus vaccines may offer valuable insurance against long-term poliovirus risks and new vaccine development efforts should continue as the world gathers more evidence about polio endgame risks.

  10. Does the Method of Sternal Repair Influence Long-Term Outcome in Management of Treated Mediastinitis?

    DTIC Science & Technology

    2011-03-15

    of cardiac surgery, reducing early and long-term survival. Current management ofPOM is based on sternal debridement, eradication of infection , and...POM were reviewed (1994-2008). Superficial infections and sternal nonunions were excluded. Management principles included sternal debridement...OF (n = 65), and secondary sternal closure (n = 61). Control of mediastinal infection was augmented with negative pressure therapy (NPT) in 73

  11. Short- and long-term releases of fluorocarbons from disposal of polyurethane foam waste.

    PubMed

    Kjeldsen, Peter; Scheutz, Charlotte

    2003-11-01

    Several halocarbons having very high global warming or ozone depletion potentials have been used as a blowing agent (BA) for insulation foam in home appliances, such as refrigerators and freezers. Many appliances are shredded after the end of their useful life. Release experiments carried out in the laboratory on insulation foam blown with the blowing agents CFC-11, HCFC-141b, HCF-134fa, and HFC-245fa revealed that not all blowing agents are released during a 6-week period following the shredding process. The experiments confirmed the hypothesis that the release could be divided into three segments: By shredding foam panels, a proportion of the closed cells is either split or damaged to a degree allowing for a sudden release of the contained atmosphere in the cell (the instantaneous release). Cells adjacent to the cut surface may be only slightly damaged by tiny cracks or holes allowing a relative slow release of the BA to the surroundings (the short-term release). A significant portion of the cells in the foam particle will be unaffected and only allows release governed by slow diffusion through the PUR cell wall (the long-term release). The magnitude of the releases is for all three types highly dependent on how fine the foam is shredded. The residual blowing agent remaining after the 6-week period may be very slowly released if the integrity of the foam particles with respect to diffusion properties is kept after disposal of the foam waste on landfills. It is shown by setting up a national model simulating the BA releases following decommissioning of used domestic refrigerators/freezers in the United States that the release patterns are highly dependent on how the appliances are shredded.

  12. Muscle wasting associated with the long-term use of mTOR inhibitors

    PubMed Central

    Gyawali, Bishal; Shimokata, Tomoya; Honda, Kazunori; Kondoh, Chihiro; Hayashi, Naomi; Yoshino, Yasushi; Sassa, Naoto; Nakano, Yasuyuki; Gotoh, Momokazu; Ando, Yuichi

    2016-01-01

    Some targeted therapies alter muscle mass due to interference with pathways of muscle metabolism. The effects of mammalian target of ra pamycin (mTOR) inhibitors on muscle mass have yet to be fully elucidated. In the present study, the computerized tomography (CT) scans of patients receiving mTOR inhibitors for at least 6 months taken at baseline and post-therapy were retrospectively retrieved, and body composition analyses were performed using the software, sliceOmatic version 5.0 (TomoVision, Inc., Magog, QC, Canada). The difference in body composition parameters was evaluated for significance. The time to treatment (TTF) failure was also compared between the sarcopenic and non-sarcopenic patients at the baseline. Of the 75 patients studied, 20 matched the inclusion criteria (including 16 males). The mean duration between the CT scans was 14.4±2.0 months. A total of 12 (60%) patients were sarcopenic at the baseline, whereas three more (75% in total) became sarcopenic following treatment. The use of mTOR inhibitors significantly decreased the skeletal muscle area (P=0.011) and lean body mass (P=0.007), although it had no effect on adipose tissue (P=0.163) or body weight (P=0.262). The rate of skeletal muscle wasting was 2.6 cm2/m2, or 2.3 kg in 6 months. The TTF did not differ between sarcopenic and non-sarcopenic patients, and was not significantly associated with any other parameter. To the best of our knowledge, this is the first study to demonstrate that the long-term use of mTOR inhibitors induces a marked loss of muscle mass. Due to the predictive and prognostic role of sarcopenia in cancer patients, these findings may have important clinical implications. PMID:27900103

  13. Assessment of long-term pH developments in leachate from waste incineration residues.

    PubMed

    Astrup, Thomas; Jakobsen, Rasmus; Christensen, Thomas H; Hansen, Jette B; Hjelmar, Ole

    2006-10-01

    Environmental assessment of residue disposal needs to account for long-term changes in leaching conditions. Leaching of heavy metals from incineration residues are highly affected by the leachate pH; the overall environmental consequences of disposing of these residues are therefore greatly influenced by changes in pH over time. The paper presents an approach for assessing pH changes in leachate from municipal solid waste incineration (MSWI) air-pollution-control (APC) residues. Residue samples were subjected to a stepwise batch extraction method in order to obtain residue samples at a range of pH values (similar to common pH-dependence tests), and then on these samples to determine leaching of alkalinity as well as remaining solid phase alkalinity. On a range of APC residues covering various pretreatment and disposal options, this procedure was used to determine leachable and residual alkalinity as a function of pH. Mass balance calculations for typical disposal scenarios were used to provide data on pH as a function of the liquid-to-solid (L/S) ratio in the leaching system. Regardless of residue type and pretreatment, pH was found to stay above 7 for L/S ratios up to about 2000 L kg(-1) corresponding to about 100,000 years in typical landfill scenarios. It was found that pH changes were mainly governed by alkalinity decreases from leaching processes rather than neutralization reactions. The results suggest that leaching testing for assessment purposes should be carried out in the alkaline range, for example, at pH 9. The paper offers a thorough basis for further modelling of incineration residue leaching and for modelling the environmental consequences of landfilling and utilization of these residues.

  14. Long term rehabilitation management and outcome of anti-NMDA receptor encephalitis: case reports.

    PubMed

    Bach, Laura J

    2014-01-01

    Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an auto immune-disorder. It is a life threatening condition that typically presents with viral illness, headaches, severe psychiatric symptoms, seizures, behavioural changes, decreasing levels of unconsciousness and progressive unresponsiveness, cognitive impairment, abnormal movements (e.g., dyskinesia), ataxia and hypoventilation. This paper describes the long term outcome and rehabilitation management of patients with NMDAR encephalitis and highlights the diverse outcome of this condition and the unique and individual long term management needs associated with this disorder. This is a case report study of three different patients with NMDAR encephalitis. All three cases are young women, two of whom presented with ovarian teratoma. Patient KH is the most impaired and was resident in a slow stream rehabilitation care home and presented with challenging behaviour. Patients RM and OA both lived in the community and presented with similar anxieties but diverse levels of cognition and motivation. A review of the literature is provided summarizing the disorder, interventions, management and challenges of this varied and complex condition. Standard neuropsychological tests and questionnaires to assess community integration (BICRO-39), quality of life (QOLIBRI-OS) and mood (HADS) were administered. Positive outcomes were achieved for all three patients using a variety of interventions which included behavioural management, family psycho-education and an integrated holistic multi-disciplinary team community approach. Memory and executive deficits were persistent in the long term and severity of impairments showed wide variability between patients. Emotional distress and behavioural difficulties were prominent and persistent and had a pronounced impact on rehabilitation. Continence issues were also a major factor impacting on the rehabilitation. Long term integrated and multi-disciplinary input by a variety of

  15. Enabling Long-Term Oceanographic Research: Changing Data Practices, Information Management Strategies and Informatics

    NASA Astrophysics Data System (ADS)

    Baker, K. S.; Chandler, C. L.

    2008-12-01

    Data management and informatics research are in a state of change in terms of data practices, information strategies, and roles. New ways of thinking about data and data management can facilitate interdisciplinary global ocean science. To meet contemporary expectations for local data use and reuse by a variety of audiences, collaborative strategies involving diverse teams of information professionals are developing. Such changes are fostering the growth of information infrastructures that support multi-scale sampling, data integration, and nascent networks of data repositories. In this retrospective, two examples of oceanographic projects incorporating data management in partnership with long-term science programs are reviewed: the Palmer Station Long-Term Ecological Research program (Palmer LTER) and the United States Joint Global Ocean Flux Study (US JGOFS). Lessons learned - short-term and long-term - from a decade of data management within these two communities will be presented. A conceptual framework called Ocean Informatics provides one example for managing the complexities inherent to sharing oceanographic data. Elements are discussed that address the economies-of-scale as well as the complexities-of-scale pertinent to a broad vision of information management and scientific research.

  16. Smartphone interventions for long-term health management of chronic diseases: an integrative review.

    PubMed

    Wang, Jingting; Wang, Yuanyuan; Wei, Chunlan; Yao, Nengliang Aaron; Yuan, Avery; Shan, Yuying; Yuan, Changrong

    2014-06-01

    Long-term health management is challenging for the rapidly growing number of patients with chronic diseases. Smartphone interventions offer promising solutions. This article presents features of smartphone interventions for long-term chronic condition management, illustrating how these applications benefit patients with chronic diseases. Systematic searches for smartphone health interventions were conducted in five publication databases. Articles were included only if (1) the smartphone application (app) was exclusively developed for patients with chronic diseases and (2) the article incorporated a defined outcome measurement to evaluate the effects of the implemented intervention. Sixteen articles were included in the final review, including studies in diabetes, mental health problems, overweight, cancer, and chronic obstructive pulmonary disease. These studies found that the smartphone intervention was a completely or at least partially effective tool to assist in managing some chronic diseases. With the help of health-related smartphone apps, patients with chronic conditions (1) felt secure in the knowledge that their illnesses were closely monitored, (2) participated in their own health management more effectively, and (3) felt that they had not been forgotten by their doctors and were taken good care of even outside the hospital/clinic. However, there are limited smartphone apps for the long-term health management of chronic diseases. More smartphone apps need to be developed to help people manage chronic diseases.

  17. Organic wastes decomposition technology, perspective for long-term autonomous missions

    NASA Astrophysics Data System (ADS)

    Viacheslav, Ilyin; Korshunov, Denis; Mardanov, Robert; Starkova, Lyubov; Deshevaya, Elena; Smirnov, Igor

    At present time there is no large problem in waste management in ISS space flight conditions, since spacecrafts "Progress" is used for it's removal from orbital station and the wastes burns in dense layers of Earth's atmosphere. However such method does not approach for far inter-planetary flights since interplanetary quarantine desires do not allow to deposit contaminated wastes outside the spacecraft. Essential part of wastes is formed by disposed means of personal hygiene and greenhouse wastes which are not safe from sanitary-epidemiological aspect. Above mentioned materials have one common feature: they can be subjected to biodegradation using different microbial compositions. Microbial decomposition of wastes as meets the main crite-ria of safety and power consumption. We investigated the effectiveness of method of disposed personal hygiene means biodegradation by anaerobic thermophiles with further purification of obtained decomposition products from chemical solvents with the help of mesophilic isolates in microaerophile conditions. Bacteria of Clostridium genera were selected for cellulolysis be-cause of their high specific endoglucanasic activity which less depends on substrate nature and relatively high growth rate on cellulose contaning substrates. As result some strains in case of optimal conditions (substrata pretreating, pH correction) decomposed means of personal hygiene with level of biodegradation up to 90With the purpose of purification, liqiud medi-ums originating from Closrtidium sp. exhibiting used like substrates for cellololitic fungi. It was shown that the cultures are able to change pH of media from slow-acid to neutral. Also the effectiveness of plant wastes biodegradation (vegetables homogenates) was studied using associations of mesophile aerobes trophically adapted to substrates. Rate of biodestruction of dry mass varied near 76To purify liquid products of biodegradation from chemicals cellulolytic fungal strains as well as bacterial

  18. Summary of the engineering analysis report for the long-term management of depleted uranium hexafluoride

    SciTech Connect

    Dubrin, J.W., Rahm-Crites, L.

    1997-09-01

    The Department of Energy (DOE) is reviewing ideas for the long-term management and use of its depleted uranium hexafluoride. DOE owns about 560,000 metric tons (over a billion pounds) of depleted uranium hexafluoride. This material is contained in steel cylinders located in storage yards near Paducah, Kentucky; Portsmouth, Ohio; and at the East Tennessee Technology Park (formerly the K-25 Site) in Oak Ridge, Tennessee. On November 10, 1994, DOE announced its new Depleted Uranium Hexafluoride Management Program by issuing a Request for Recommendations and an Advance Notice of Intent in the Federal Register (59 FR 56324 and 56325). The first part of this program consists of engineering, costs and environmental impact studies. Part one will conclude with the selection of a long-term management plan or strategy. Part two will carry out the selected strategy.

  19. Vitamin D deficiency in HIV: a shadow on long-term management?

    PubMed

    Orkin, Chloe; Wohl, David A; Williams, Andrew; Deckx, Henri

    2014-01-01

    Vitamin D deficiency in HIV infection has attracted much interest. The best known clinical outcomes of vitamin D deficiency are rickets (children) and osteomalacia (adults). Several non-skeletal disorders have also been linked to suboptimal vitamin D levels in the general population. The prevalence of vitamin D deficiency varies widely (6-100%) across diverse patient populations, with no evidence that it is higher in HIV-positive versus noninfected adults. Vitamin D deficiency may blunt immune restoration and exacerbate HIV complications (e.g. opportunistic infections, poor perinatal outcomes, wasting, HIV disease progression, AIDS events, and death). The nonnucleoside reverse transcriptase inhibitor efavirenz was associated with a relatively high risk of vitamin D deficiency; nevirapine, etravirine, and rilpivirine were noted to have less or no impact on vitamin D versus efavirenz in the limited data available. Protease inhibitors have either no or a low association with vitamin D deficiency. Nucleoside/nucleotide reverse transcriptase inhibitors (with the possible exception of zidovudine) also did not appear to be associated with vitamin D deficiency. Management of vitamin D deficiency in HIV-positive adults has not been rigorously evaluated; some guidelines recommend more vitamin D supplementation for HIV-positive adults on antiretrovirals versus the general population (e.g. 2-3 times higher vitamin D daily intake for the age group; loading dose up to 10,000 IU/day for 8-10 weeks and a maintenance dose of 800-2,000 IU/day). In conclusion, although vitamin D deficiency in HIV-positive adults can be prevalent, current evidence for its causes and impact is relatively weak. More data, particularly from large, controlled, long-term trials, regarding the benefits of correcting vitamin D levels in HIV-positive adults are needed.

  20. Integration of devices into long-term condition management: a synthesis of qualitative studies.

    PubMed

    Gately, Claire; Rogers, Anne; Kirk, Susan; McNally, Rosalind

    2008-06-01

    Understanding peoples' responses to and ability to incorporate technology for managing long-term conditions into their everyday lives is relevant for informing the development and implementation of new technologies as part of future long-term condition management in domestic environments. Future research and theory building can be facilitated by the synthesis of existing qualitative studies. A systematic search for qualitative studies of health technologies at home was undertaken on OVID CINAHL, OVID Medline and CSA databases for the period 1996-2006. Studies (n = 12) that met the inclusion criteria were synthesized and their analyses subjected to qualitative meta-synthesis. Analyses clustered into five themes: (1) managing multiple uncertainties; (2) the reconstruction of identity; (3) the struggle to remain autonomous while allowing dependence; (4) coming to terms with living a technology-assisted life; and (5) the usability of devices. These translated into a line of argument synthesis in which technology takes on the status of a personified ;other' around which a set of personal and relational attributions are subsequently constructed. These allow the extension of existing illness work to incorporate new technologies. Ambivalence about the value of technologies that are designed to assist with the management of a long-term condition reflects experiences of the disruptive effects of health technologies on personal identities and strategies of managing illness. At the same time, they are highly valued because they provided new opportunities to complete aspects of illness work that were previously impossible.

  1. Long-term disease management of patients with coronary disease by cardiac rehabilitation program staff.

    PubMed

    Squires, Ray W; Montero-Gomez, Aura; Allison, Thomas G; Thomas, Randal J

    2008-01-01

    Randomized-clinical trials have demonstrated the benefits of disease management for patients with coronary disease. It is not known if long-term disease management in routine clinical practice provided by cardiac rehabilitation (CR) program staff is possible. The goal of this study was to evaluate the feasibility and clinical benefits of a 3-year disease-management program in the setting of an outpatient CR facility. Consecutive patients (n = 503) referred to CR and who were available for long-term follow-up served as subjects. After a phase II CR program, disease managers assessed secondary-prevention goals every 3 to 6 months via face-to-face meetings with each patient. Outcome measures included use of cardioprotective medications, coronary risk factors, amount of habitual exercise training, and all-cause mortality. At 3 years, aspirin usage was 91%, statin usage 91%, beta-blocker usage 78%, and angiotensin-converting enzyme inhibitor usage 76%. Low-density lipoprotein cholesterol was 90 +/- 23 mg/dL, systolic blood pressure was 126 +/- 19 mm Hg, and body mass index was 29.0 +/- 5.1 kg/m2. Exercise training averaged 139 +/- 123 minutes per week. Annual mortality was 1.9%. There were no differences (P > .05) in medication usage or low-density lipoprotein cholesterol for men versus women, or for age below 65 years versus age 65 years or greater. Long-term disease management of patients with coronary disease in routine clinical practice by CR program staff is feasible and effective in achieving and maintaining secondary-prevention goals. Overweight remains a prevalent and persistent risk factor. We advocate expansion of CR programs into long-term coronary disease-management programs.

  2. A Specific Long-Term Plan for Management of U.S. Nuclear Spent Fuel

    SciTech Connect

    Levy, Salomon

    2006-07-01

    A specific plan consisting of six different steps is proposed to accelerate and improve the long-term management of U.S. Light Water Reactor (LWR) spent nuclear fuel. The first step is to construct additional, centralized, engineered (dry cask) spent fuel facilities to have a backup solution to Yucca Mountain (YM) delays or lack of capacity. The second step is to restart the development of the Integral Fast Reactor (IFR), in a burner mode, because of its inherent safety characteristics and its extensive past development in contrast to Acceleration Driven Systems (ADS). The IFR and an improved non-proliferation version of its pyro-processing technology can burn the plutonium (Pu) and minor actinides (MA) obtained by reprocessing LWR spent fuel. The remaining IFR and LWR fission products will be treated for storage at YM. The radiotoxicity of that high level waste (HLW) will fall below that of natural uranium in less than one thousand years. Due to anticipated increased capital, maintenance, and research costs for IFR, the third step is to reduce the required number of IFRs and their potential delays by implementing multiple recycles of Pu and Neptunium (Np) MA in LWR. That strategy is to use an advanced separation process, UREX+, and the MIX Pu option where the role and degradation of Pu is limited by uranium enrichment. UREX+ will decrease proliferation risks by avoiding Pu separation while the MIX fuel will lead to an equilibrium fuel recycle mode in LWR which will reduce U. S. Pu inventory and deliver much smaller volumes of less radioactive HLW to YM. In both steps two and three, Research and Development (R and D) is to emphasize the demonstration of multiple fuel reprocessing and fabrication, while improving HLW treatment, increasing proliferation resistance, and reducing losses of fissile material. The fourth step is to license and construct YM because it is needed for the disposal of defense wastes and the HLW to be generated under the proposed plan. The

  3. Human factors in waste management

    SciTech Connect

    Moray, N.

    1994-10-01

    This article examines the role of human factors in radioactive waste management. Although few problems and ergonomics are special to radioactive waste management, some problems are unique especially with long term storage. The entire sociotechnical system must be looked at in order to see where improvement can take place because operator errors, as seen in Chernobyl and Bhopal, are ultimately the result of management errors.

  4. Long-term management of an idiopathic gingival fibromatosis patient with the primary dentition.

    PubMed

    Kamolmatyakul, S; Kietthubthew, S; Anusaksathien, O

    2001-01-01

    Gingival fibromatosis is usually seen as an isolated finding or occasionally in association with other features as part of a syndrome. The combination of gingival enlargement, hypertrichosis, epilepsy and mental retardation is also a commonly reported syndrome that features gingival fibromatosis. The following report is about a mentally retarded patient who has shown no sign of hypertrichosis, but has been taking phenobarbital as a long-term therapy drug for anti-convulsion. Long-term management of this patient has been carried out from the age of one-and-a-half years to 14 years old. The patient's clinical features, treatment received, histopathologic presentation of gingival fibromatosis and proper management of the condition are discussed.

  5. Potential for long-term isolation by the Waste Isolation Pilot Plant disposal system

    SciTech Connect

    Bertram-Howery, S.G. ); Swift, P.N. )

    1990-06-01

    The US Department of Energy's (DOE) Waste Isolation Pilot Plant (WIPP) must comply with EPA regulation 40 CFR Part 191, Subpart B, which sets environmental standards for radioactive waste disposal. The regulation, Environmental Radiation Protection Standards for Management and Disposal of Spent Nuclear Fuel, High-Level and Transuranic Radioactive Wastes (hereafter referred to as the Standard), was vacated in 1987 by a Federal Court of Appeals and is underground revision. By agreement with the Sate of New Mexico, the WIPP project is evaluating compliance with the Standard as promulgated, in 1985 until a new regulation is available. This report summarizes the early-1990 status of Sandia National Laboratories' (SNL) understanding of the Project's ability to achieve compliance. The report reviews the qualitative and quantitative requirements for compliance, and identifies unknowns complicating performance assessment. It discusses in relatively nontechnical terms the approaches to resolving those unknowns, and concludes that SNL has reasonable confidence that compliance is achievable with the Standard as first promulgated. 46 refs., 7 figs.

  6. Female long term survivors after allo-HSCT: evaluation and management

    PubMed Central

    Shanis, Dana; Merideth, Melissa; Pulanic, Tajana Klepac; Savani, Bipin N; Battiwalla, Minoo; Stratton, Pamela

    2011-01-01

    Female long term survivors of allogeneic hematopoietic stem cell transplantation incur a significant burden of late effects. Genital GVHD, HPV reactivation, ovarian failure and infertility, sexual dysfunction and osteoporosis are concerns that can significantly impact quality of life. This review examines the risk, pathogenesis, clinical presentation and implications of these common complications. Recommendations are provided for evaluation and management of these late effects, and other obstetric and gynecologic issues that may arise in this patient population. PMID:22221788

  7. Dynamic phosphorus mass balance modeling of large watersheds: long-term implications of management strategies.

    PubMed

    Cassell, E A; Kort, R L; Meals, D W; Aschmann, S G; Dorioz, J M; Anderson, D P

    2001-01-01

    The principles of mass balance, compartment-flux diagramming, and dynamic simulation modeling are integrated to create computer models that estimate phosphorus (P) export from large-scale watersheds over long-term futures. These Watershed Ecosystem Nutrient Dynamics (WEND) models are applied to a 275,000 ha dairy-documented watershed and a 77,000 ha poultry-dominated watershed in northeastern USA. Model predictions of present-day P export loads are consistent with monitoring data and estimates made using P export coefficients. For both watersheds P import exceeds P export and P is accumulating in the agricultural soils. Agricultural and urban activities are major contributors to P export from both watersheds. Continued urban growth will increase P export over time unless wastewater management is substantially enhanced and/or rates of urban growth are controlled. Agriculture cannot rely solely on the implementation of increasingly stringent conservation practices to reduce long-term P export but must consider options that promote P input/output balance. The WEND modeling process is a powerful tool to integrate the diversity of activities in watersheds into a holistic framework. Model outputs are suited to assist managers to explore long-term effects of overall watershed management strategies on P export in comparison to environmental and economic goals.

  8. Unsaturated consolidation theory for the prediction of long-term municipal solid waste landfill settlement.

    PubMed

    Liu, Chia-Nan; Chen, Rong-Her; Chen, Kuo-Sheng

    2006-02-01

    The understanding of long-term landfill settlement is important for landfill design and rehabilitation. However, suitable models that can consider both the mechanical and biodecomposition mechanisms in predicting the long-term landfill settlement are generally not available. In this paper, a model based on unsaturated consolidation theory and considering the biodegradation process is introduced to simulate the landfill settlement behaviour. The details of problem formulations and the derivation of the solution for the formulated differential equation of gas pressure are presented. A step-by-step analytical procedure employing this approach for estimating settlement is proposed. The proposed model can generally model the typical features of short-term and long-term behaviour. The proposed model also yields results that are comparable with the field measurements.

  9. Regulatory issues for Waste Isolation Pilot Plant long-term compliance with U.S. Environmental Protection Agency 40 CFR 191B and 268

    SciTech Connect

    Anderson, D.R.; Marietta, M.G.; Higgins, P.J. Jr.

    1993-10-01

    Before disposing of transuranic radioactive waste at the Waste Isolation Pilot Plant (WIPP), the United States Department of Energy (DOE) must evaluate compliance with long-term regulations of the United States Environmental Protection Agency (EPA), specifically the Environmental Standards for the Management and Disposal of Spent Nuclear Fuel, High-Level and Transuranic Radioactive Wastes (40 CFR 191), and the Land Disposal Restrictions (40 CFR 268) of the Hazardous and Solid Waste Amendments to the Resource Conservation and Recovery Act (RCRA). Sandia National Laboratories (SNL) is conducting iterative performance assessments (PAs) of the WIPP for the DOE to provide interim guidance while preparing for final compliance evaluations. This paper provides background information on the regulations, describes the SNL WIPP PA Departments approach to developing a defensible technical basis for consistent compliance evaluations, and summarizes the major observations and conclusions drawn from the 1991 and 1992 PAs.

  10. Long-term cost-effectiveness of disease management in systolic heart failure.

    PubMed

    Miller, George; Randolph, Stephen; Forkner, Emma; Smith, Brad; Galbreath, Autumn Dawn

    2009-01-01

    Although congestive heart failure (CHF) is a primary target for disease management programs, previous studies have generated mixed results regarding the effectiveness and cost savings of disease management when applied to CHF. We estimated the long-term impact of systolic heart failure disease management from the results of an 18-month clinical trial. We used data generated from the trial (starting population distributions, resource utilization, mortality rates, and transition probabilities) in a Markov model to project results of continuing the disease management program for the patients' lifetimes. Outputs included distribution of illness severity, mortality, resource consumption, and the cost of resources consumed. Both cost and effectiveness were discounted at a rate of 3% per year. Cost-effectiveness was computed as cost per quality-adjusted life year (QALY) gained. Model results were validated against trial data and indicated that, over their lifetimes, patients experienced a lifespan extension of 51 days. Combined discounted lifetime program and medical costs were $4850 higher in the disease management group than the control group, but the program had a favorable long-term discounted cost-effectiveness of $43,650/QALY. These results are robust to assumptions regarding mortality rates, the impact of aging on the cost of care, the discount rate, utility values, and the targeted population. Estimation of the clinical benefits and financial burden of disease management can be enhanced by model-based analyses to project costs and effectiveness. Our results suggest that disease management of heart failure patients can be cost-effective over the long term.

  11. Enabling long-term oceanographic research: Changing data practices, information management strategies and informatics

    NASA Astrophysics Data System (ADS)

    Baker, Karen S.; Chandler, Cynthia L.

    2008-09-01

    Interdisciplinary global ocean science requires new ways of thinking about data and data management. With new data policies and growing technological capabilities, datasets of increasing variety and complexity are being made available digitally and data management is coming to be recognized as an integral part of scientific research. To meet the changing expectations of scientists collecting data and of data reuse by others, collaborative strategies involving diverse teams of information professionals are developing. These changes are stimulating the growth of information infrastructures that support multi-scale sampling, data repositories, and data integration. Two examples of oceanographic projects incorporating data management in partnership with science programs are discussed: the Palmer Station Long-Term Ecological Research program (Palmer LTER) and the United States Joint Global Ocean Flux Study (US JGOFS). Lessons learned from a decade of data management within these communities provide an experience base from which to develop information management strategies—short-term and long-term. Ocean Informatics provides one example of a conceptual framework for managing the complexities inherent to sharing oceanographic data. Elements are introduced that address the economies-of-scale and the complexities-of-scale pertinent to a broader vision of information management and scientific research.

  12. Challenges Experienced by School Managers in the Nkangala District, Mpumalanga, Regarding the Provision of Long Term Leadership

    ERIC Educational Resources Information Center

    van Niekerk, E. J.

    2012-01-01

    The long term leadership task of creating favourable circumstances for followers to excel are discussed in this article using narratives supplied by education managers in schools of the Nkangala District in Mpumalanga Province. Thereby deficiencies in the long term leadership proficiency of these managers are identified with a view to be able to…

  13. Challenges Experienced by School Managers in the Nkangala District, Mpumalanga, Regarding the Provision of Long Term Leadership

    ERIC Educational Resources Information Center

    van Niekerk, E. J.

    2012-01-01

    The long term leadership task of creating favourable circumstances for followers to excel are discussed in this article using narratives supplied by education managers in schools of the Nkangala District in Mpumalanga Province. Thereby deficiencies in the long term leadership proficiency of these managers are identified with a view to be able to…

  14. Characterization of options and their analysis requirements for the long-term management of depleted uranium hexafluoride

    SciTech Connect

    Dubrin, J.W.; Rosen, R.S.; Zoller, J.N.; Harri, J.W.; Schwertz, N.L.

    1995-12-01

    The Department of Energy (DOE) is examining alternative strategies for the long-term management of depleted uranium hexafluoride (UF{sub 6}) currently stored at the gaseous diffusion plants at Portsmouth, Ohio, and Paducah, Kentucky, and on the Oak Ridge Reservation in Oak Ridge, Tennessee. This paper describes the methodology for the comprehensive and ongoing technical analysis of the options being considered. An overview of these options, along with several of the suboptions being considered, is presented. The long-term management strategy alternatives fall into three broad categories: use, storage, or disposal. Conversion of the depleted UF6 to another form such as oxide or metal is needed to implement most of these alternatives. Likewise, transportation of materials is an integral part of constructing the complete pathway between the current storage condition and ultimate disposition. The analysis of options includes development of pre-conceptual designs; estimates of effluents, wastes, and emissions; specification of resource requirements; and preliminary hazards assessments. The results of this analysis will assist DOE in selecting a strategy by providing the engineering information necessary to evaluate the environmental impacts and costs of implementing the management strategy alternatives.

  15. The central role of lifestyle change in long-term weight management.

    PubMed

    Brownell, K D

    1999-01-01

    Lifestyle change--most notably, modification of eating behavior, physical activity, and psychologic factors like attitudes, goals, and emotions--is the central determinant of whether people will lose weight and maintain the loss. Even when medical intervention appears to be the primary treatment, as with pharmacotherapy, behavior plays the determining role in successful weight loss. For example, the likelihood that a patient will take his or her prescribed medication is influenced by thoughts, attitudes, behaviors, and social environment. The patient who is dissatisfied with the moderate weight loss produced by most treatments, and hence is prone to relapse, is affected by the same factors. Methods are available to help people develop the self-management skills necessary to produce long-term lifestyle change (1-3). As individuals internalize a new set of attitudes and behaviors, resisting old habits and acquiring new ones become easier. Only then will there be any reasonable chance of long-term weight-loss success.

  16. Long-Term Outcome of the Management of Chronic Neuropathic Pain: A Prospective Observational Study.

    PubMed

    Moulin, Dwight E; Clark, A John; Gordon, Allan; Lynch, Mary; Morley-Forster, Patricia K; Nathan, Howard; Smyth, Cathy; Toth, Cory; VanDenKerkhof, Elizabeth; Gilani, Ammar; Ware, Mark A

    2015-09-01

    This prospective observational cohort study addressed the long-term clinical effectiveness of the management of chronic neuropathic noncancer pain at 7 Canadian tertiary pain centers. Patients were treated according to standard guidelines and were followed at 3, 6, 12, 18, and 24 months. Standard outcome measures for pain, mood, quality of life, and overall treatment satisfaction were administered, with the primary outcome measure designated as the composite of 30% reduction in average pain intensity and 1-point decrease in the mean Interference Scale Score (0-10) of the Brief Pain Inventory at 12 months relative to baseline. Of 789 patients recruited, mean age was 53.5 ± 14.2 years (55% female) and mean duration of pain was 4.88 ± 5.82 years. Mean average pain intensity (0-10) at baseline was 6.1 ± 1.9. All standard outcome measures showed statistically significant improvement at 12 months relative to baseline (P < .001). However, only 23.7% attained clinically significant improvement in pain and function at 12 months as the primary outcome measure. Univariable analyses showed poorer outcomes at 12-month follow-up with longer duration of pain (P = .002), greater cigarette use (P = .01), more disability compensation (P = .001), and higher opioid doses at baseline and at 12 months (P < .02). Our present treatment modalities provide significant long-term benefit in only about a quarter of patients with neuropathic pain managed at tertiary care pain clinics. Opioid therapy may not be beneficial for the long term. Perspective: Evidence-based treatment of chronic neuropathic pain provides long-term benefit in only about one-quarter of patients seen in tertiary care centers. Opioid therapy may not be beneficial.

  17. Application of Polymers for the Long-Term Storage and Disposal of Low- and Intermediate-Level Radioactive Waste

    SciTech Connect

    Bonin, Hugues W.; Walker, Michael W.; Bui, Van Tam

    2004-01-15

    differences in chemical transition temperatures characteristic of radiation damage. All the changes in these properties are characteristic of the cross-linking phenomenon. For the glass-fiber-reinforced polymers, the results of the tests evidenced minor radiation degradation at the fiber/matrix interfaces. Based on these results, any of the investigated polymers could potentially be used for disposal containers due to their abilities to adequately resist radiation. This allowed proceeding one step further into determining a potential design framework for containers for the long-term storage and disposal of low- and intermediate-level radioactive waste.

  18. Long-Term Soil Experiments: A Key to Managing Earth's Rapidly Changing Critical Zones

    NASA Astrophysics Data System (ADS)

    Richter, D., Jr.

    2014-12-01

    In a few decades, managers of Earth's Critical Zones (biota, humans, land, and water) will be challenged to double food and fiber production and diminish adverse effects of management on the wider environment. To meet these challenges, an array of scientific approaches is being used to increase understanding of Critical Zone functioning and evolution, and one amongst these approaches needs to be long-term soil field studies to move us beyond black boxing the belowground Critical Zone, i.e., to further understanding of processes driving changes in the soil environment. Long-term soil experiments (LTSEs) provide direct observations of soil change and functioning across time scales of decades, data critical for biological, biogeochemical, and environmental assessments of sustainability; for predictions of soil fertility, productivity, and soil-environment interactions; and for developing models at a wide range of temporal and spatial scales. Unfortunately, LTSEs globally are not in a good state, and they take years to mature, are vulnerable to loss, and even today remain to be fully inventoried. Of the 250 LTSEs in a web-based network, results demonstrate that soils and belowground Critical Zones are highly dynamic and responsive to human management. The objective of this study is to review the contemporary state of LTSEs and consider how they contribute to three open questions: (1) can soils sustain a doubling of food production in the coming decades without further impinging on the wider environment, (2) how do soils interact with the global C cycle, and (3) how can soil management establish greater control over nutrient cycling. While LTSEs produce significant data and perspectives for all three questions, there is on-going need and opportunity for reviews of the long-term soil-research base, for establishment of an efficiently run network of LTSEs aimed at sustainability and improving management control over C and nutrient cycling, and for research teams that

  19. Potential of mass trapping for long-term pest management and eradication of invasive species.

    PubMed

    El-Sayed, A M; Suckling, D M; Wearing, C H; Byers, J A

    2006-10-01

    Semiochemical-based pest management programs comprise three major approaches that are being used to provide environmentally friendly control methods of insect pests: mass trapping, "lure and kill," and mating disruption. In this article, we review the potential of mass trapping in long-term pest management as well as in the eradication of invasive species. We discuss similarities and differences between mass trapping and other two main approaches of semiochemical-based pest management programs. We highlight several study cases where mass trapping has been used either in long-term pest management [e.g., codling moth, Cydia pomonella (L.); pink bollworm, Pectinophora gossypiella (Saunders); bark beetles, palm weevils, corn rootworms (Diabrotica spp.); and fruit flies] or in eradication of invasive species [e.g., gypsy moth, Lymantria dispar (L.); and boll weevil, Anthonomus grandis grandis Boheman). We list the critical issues that affect the efficacy of mass trapping and compare these with previously published models developed to investigate mass trapping efficacy in pest control. We conclude that mass trapping has good potential to suppress or eradicate low-density, isolated pest populations; however, its full potential in pest management has not been adequately realized and therefore encourages further research and development of this technology.

  20. Methods for assessing long-term mean pathogen count in drinking water and risk management implications.

    PubMed

    Englehardt, James D; Ashbolt, Nicholas J; Loewenstine, Chad; Gadzinski, Erik R; Ayenu-Prah, Albert Y

    2012-06-01

    Recently pathogen counts in drinking and source waters were shown theoretically to have the discrete Weibull (DW) or closely related discrete growth distribution (DGD). The result was demonstrated versus nine short-term and three simulated long-term water quality datasets. These distributions are highly skewed such that available datasets seldom represent the rare but important high-count events, making estimation of the long-term mean difficult. In the current work the methods, and data record length, required to assess long-term mean microbial count were evaluated by simulation of representative DW and DGD waterborne pathogen count distributions. Also, microbial count data were analyzed spectrally for correlation and cycles. In general, longer data records were required for more highly skewed distributions, conceptually associated with more highly treated water. In particular, 500-1,000 random samples were required for reliable assessment of the population mean ±10%, though 50-100 samples produced an estimate within one log (45%) below. A simple correlated first order model was shown to produce count series with 1/f signal, and such periodicity over many scales was shown in empirical microbial count data, for consideration in sampling. A tiered management strategy is recommended, including a plan for rapid response to unusual levels of routinely-monitored water quality indicators.

  1. Simulating long-term effectiveness and efficiency of management scenarios for an invasive grass

    USGS Publications Warehouse

    Jarnevich, Catherine S.; Holcombe, Tracy R.; Cullinane Thomas, Catherine; Frid, Leonardo; Olsson, Aaryn D.

    2015-01-01

    Resource managers are often faced with trade-offs in allocating limited resources to manage plant invasions. These decisions must often be made with uncertainty about the location of infestations, their rate of spread and effectiveness of management actions. Landscape level simulation tools such as state-and-transition simulation models (STSMs) can be used to evaluate the potential long term consequences of alternative management strategies and help identify those strategies that make efficient use of resources. We analyzed alternative management scenarios for African buffelgrass (Pennisetum ciliare syn. Cenchrus ciliaris) at Ironwood Forest National Monument, Arizona using a spatially explicit STSM implemented in the Tool for Exploratory Landscape Scenario Analyses (TELSA). Buffelgrass is an invasive grass that is spreading rapidly in the Sonoran Desert, affecting multiple habitats and jurisdictions. This invasion is creating a novel fire risk and transforming natural ecosystems. The model used in this application incorporates buffelgrass dispersal and establishment and management actions and effectiveness including inventory, treatment and post-treatment maintenance. We simulated 11 alternative scenarios developed in consultation with buffelgrass managers and other stakeholders. The scenarios vary according to the total budget allocated for management and the allocation of that budget between different kinds of management actions. Scenario results suggest that to achieve an actual reduction and stabilization of buffelgrass populations, management unconstrained by fiscal restrictions and across all jurisdictions and private lands is required; without broad and aggressive management, buffelgrass populations are expected to increase over time. However, results also suggest that large upfront investments can achieve control results that require relatively minimal spending in the future. Investing the necessary funds upfront to control the invasion results in the most

  2. Lack of long-term benefits of a 6-month heart failure disease management program.

    PubMed

    Nguyen, Viviane; Ducharme, Anique; White, Michel; Racine, Normand; O'Meara, Eileen; Zhang, Bin; Rouleau, Jean L; Brophy, James

    2007-05-01

    Heart failure (HF) represents a major burden on the health care system, causing repeated hospitalizations and numerous emergency department (ED) visits. In a 6-month randomized study of a multidisciplinary HF clinic, we have previously shown decreased hospital readmissions and improved quality of life. Despite these encouraging results, it is unknown if these beneficial effects are sustained. To assess long-term recurrent ED visits, readmissions, and mortality among HF patients who were discharged after a 6-month intensive HF management program (HFMP). Of the 230 subjects (New York Heart Association Class II-IV) who were initially randomized to standard follow-up care or to a HFMP for 6 months, 190 were studied retrospectively for long-term evaluation. Long-term data was obtained from the Quebec administrative health databases. We compared the intervention and control groups for the number of recurrent ED visits, hospital readmissions, and all-cause deaths. After a mean follow-up of 2.8 +/- 1.7 years, there was no difference in the composite end point of all-cause death, hospital admissions, and ED visits between those patients initially in the HFMP group and the controls. After multivariable adjustment, there was no difference in the composite primary endpoint (HR 1.01, 95% CI: 0.75-1.37) or in the secondary end point of all-cause death alone (HR 1.09, 95%CI:0.69-1.72) between those initially assigned to the HF clinic and those receiving usual care. For severely ill patients, the clinical and resource benefits of a 6-month HFMP are not sustained upon program cessation. Further research into the benefits of long-term HFMP is required.

  3. Disability management outcomes in the Ontario long-term care sector.

    PubMed

    Mustard, C A; Kalcevich, C; Steenstra, I A; Smith, P; Amick, B

    2010-12-01

    Optimal disability management practices supporting early and safe return-to-work involve the workplace adoption of formal policies and procedures to ensure the quality of disability management outcomes. In the Canadian province of Ontario, there are approximately 60,000 health care workers in 600 licensed facilities providing long-term residential care to approximately 75,000 elderly residents. Workers in this sector are exposed to high biomechanical demands arising from care-giving tasks and have a substantial risk of work-related disability. Over the period 2000-2006, many long-term care facilities in Ontario adopted disability management practices that encourage modified work arrangements. The objective of this study was to describe differences in modified work arrangements and disability outcomes in long-term care facilities in Ontario. Measures of disability episode outcomes are described for a representative sample of 32 Ontario long-term care facilities for two consecutive years 2005 and 2006. Data were obtained from a questionnaire survey of facilities, a survey of a representative sample of caregivers and administrative records from the provincial workers' compensation agency. A total of 28,747 days of disability attributed to work-related conditions were experienced by 3,271 full-time equivalent staff in 2005 (28,034 days in 2006). Average total disability days were 922 per 100 full-time equivalent staff in 2005 and 889 per 100 full-time equivalent staff in 2006. Disability compensation expenditures, measured as wage replacement benefits received by disabled workers, were estimated to be $72,332 per 100 full-time equivalent staff in 2005 and $64,619 per 100 full-time equivalent staff in 2006. On average, approximately 60% of all disability days were managed by modified duty arrangements and the proportion of total disability days managed by modified duty arrangements for each facility was correlated between the two observation years. Across facilities

  4. Long-Term Information Management (LTIM) of Safeguards Data at Repositories: Phase II

    SciTech Connect

    Haddal, Risa N.

    2016-10-01

    One of the challenges of implementing safeguards for geological repositories will be the long-term preservation of safeguards-related data for 100 years or more. While most countries considering the construction and operation of such facilities agree that safeguards information should be preserved, there are gaps with respect to standardized requirements, guidelines, timescales, and approaches. This study analyzes those gaps and explores research to clarify stakeholder needs, identify current policies, approaches, best practices and international standards, and explores existing safeguards information management infrastructure. The study also attempts to clarify what a safeguards data classification system might look like, how long data should be retained, and how information should be exchanged between stakeholders at different phases of a repository’s life cycle. The analysis produced a variety of recommendations on what information to preserve, how to preserve it, where to store it, retention options and how to exchange information in the long term. Key findings include the use of the globally recognized international records management standard, ISO15489, for guidance on the development of information management systems, and the development of a Key Information File (KIF). The KIF could be used to identify only the most relevant, high-level safeguards information and the history of decision making about the repository. The study also suggests implementing on-site and off-site records storage in digital and physical form; developing a safeguards data classification system; long-term records retention with periodic reviews every 5 to 10 years during each phase of the repository life cycle; and establishing transition procedures well in advance so that data shepherds and records officers can transfer information with incoming facility managers effectively and efficiently. These and other recommendations are further analyzed in this study.

  5. Comparison of long-term stability of containment systems for residues and wastes contaminated with naturally occurring radionuclides at an arid site and two humid sites

    SciTech Connect

    Winters, M.; Merry-Libby, P.; Hinchman, R.

    1985-01-01

    The long-term stability of near-surface containment systems designed for the management of radioactive wastes and residues contaminated with naturally occurring radionuclides are compared at the three different sites. The containment designs are: (1) a diked 8.9-m high mound, including a 3.2-m layered cap at a site (humid) near Lewiston, New York, (2) a 6.8-m-high mound, including a similar 3.2-m cap at a site (humid) near Oak Ridge, Tennessee, and (3) 4.8-m deep trenches with 3.0-m backfilled caps at a site (arid) near Hanford, Washington. Geological, hydrological, and biological factors affecting the long-term (1000-year) integrity of the containment systems at each site are examined, including: erosion, flooding, drought, wildfire, slope and cover failure, plant root penetration, burrowing animals, other soil-forming processes, and land-use changes. For the containment designs evaluated, releases of radon-222 at the arid site are predicted to be several orders of magnitude higher than at the two humid sites - upon initial burial and at 1000 years (after severe erosion). Transfer of wastes containing naturally occurring radionuclides from a humid to an arid environment offers little or no advantage relative to long-term stability of the containment system and has a definite disadvantage in terms of gaseous radioactive releases. 26 references, 3 figures, 4 tables.

  6. Pain management education in long-term care: it can make a difference.

    PubMed

    Long, Carol O

    2013-12-01

    Acute and chronic pain management for persons residing in long-term care settings is a serious problem. In an effort to change practice in pain management and improve resident outcomes, the Campaign Against Pain education program was instituted at Beatitudes Health Care Center in Phoenix, Arizona. In this pilot study, professional and certified nursing assistant (CNA) staff were surveyed before and after the training program to ascertain change in knowledge, attitudes, and barriers about pain. After the intensive training program and onsite consultation with the concomitant changes in policies, procedures, and documentation, professional and CNA staff knowledge improved after 6 months (F = 6.273; p = .02), attitudes changed (F = 12.26; p = .002), and barriers were mitigated. With a comprehensive quality improvement pain plan in place, the findings suggest that education in pain management in long-term care and program changes that adopt best practices in pain can make a difference. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  7. Effect of long-term industrial waste effluent pollution on soil enzyme activities and bacterial community composition.

    PubMed

    Subrahmanyam, Gangavarapu; Shen, Ju-Pei; Liu, Yu-Rong; Archana, Gattupalli; Zhang, Li-Mei

    2016-02-01

    Although numerous studies have addressed the influence of exogenous pollutants on microorganisms, the effect of long-term industrial waste effluent (IWE) pollution on the activity and diversity of soil bacteria was still unclear. Three soil samples characterized as uncontaminated (R1), moderately contaminated (R2), and highly contaminated (R3) receiving mixed organic and heavy metal pollutants for more than 20 years through IWE were collected along the Mahi River basin, Gujarat, western India. Basal soil respiration and in situ enzyme activities indicated an apparent deleterious effect of IWE on microbial activity and soil function. Community composition profiling of soil bacteria using 16S rRNA gene amplification and denaturing gradient gel electrophoresis (DGGE) method indicated an apparent bacterial community shift in the IWE-affected soils. Cloning and sequencing of DGGE bands revealed that the dominated bacterial phyla in polluted soil were affiliated with Firmicutes, Acidobacteria, and Actinobacteria, indicating that these bacterial phyla may have a high tolerance to pollutants. We suggested that specific bacterial phyla along with soil enzyme activities could be used as relevant biological indicators for long-term pollution assessment on soil quality. Graphical Abstract Bacterial community profiling and soil enzyme activities in long-term industrial waste effluent polluted soils.

  8. Chemical restrictions of roots in Ultisol subsoils lessened by long-term management

    NASA Technical Reports Server (NTRS)

    Hardy, D. H.; Raper, C. D. Jr; Miner, G. S.; Raper CD, J. r. (Principal Investigator)

    1990-01-01

    Exchangeable Al in subsoils of Ultisols in the southeastern USA can restrict rooting depth. Downward movement of basic cations (Ca, Mg, and K), applied as lime and fertilizer, may diminish that restriction over time. Materials from the argillic horizon were collected from three paired sites, having managed (long-term cropping) and nonmanaged topsoils (Typic Paleudults and Hapludults). One managed site was cropped continuously for 15 yr while the others were cultivated for more than 30 yr. Concentrations of extractable cations and other nutrients from the paired sites were compared to determine the magnitude of change due to management. The ability of the subsoils to support plant growth was evaluated in a missing-nutrient greenhouse experiment with sorghum [Sorghum bicolor (L.) Moench]. Subsoils of managed sites had greater effective cation-exchange capacity (CEC) and base saturation than those of non-managed sites. While availabilities of Ca, Mg, and K in subsoils of nonmanaged sites were inadequate to support maximal plant growth, they were adequate in subsoils of managed sites. Compared with nonmanaged sites, KCl-exchangeable Al in subsoils of managed sites was 23% lower at the 15-yr location and 65 and 100% lower at the two other locations. In the absence of lime, sorghum growth was almost totally inhibited on nonmanaged subsoils amended with optimum nutrients. On the managed subsoils, where 100, 65, and 23% of the nonmanaged exchangeable Al had been neutralized by topsoil fertilization and liming, growth reductions under the same conditions were 0, 50, and 100%, respectively. Thus, relatively long-term management had improved these Ultisol subsoils for root growth and development.

  9. Chemical restrictions of roots in Ultisol subsoils lessened by long-term management

    NASA Technical Reports Server (NTRS)

    Hardy, D. H.; Raper, C. D. Jr; Miner, G. S.; Raper CD, J. r. (Principal Investigator)

    1990-01-01

    Exchangeable Al in subsoils of Ultisols in the southeastern USA can restrict rooting depth. Downward movement of basic cations (Ca, Mg, and K), applied as lime and fertilizer, may diminish that restriction over time. Materials from the argillic horizon were collected from three paired sites, having managed (long-term cropping) and nonmanaged topsoils (Typic Paleudults and Hapludults). One managed site was cropped continuously for 15 yr while the others were cultivated for more than 30 yr. Concentrations of extractable cations and other nutrients from the paired sites were compared to determine the magnitude of change due to management. The ability of the subsoils to support plant growth was evaluated in a missing-nutrient greenhouse experiment with sorghum [Sorghum bicolor (L.) Moench]. Subsoils of managed sites had greater effective cation-exchange capacity (CEC) and base saturation than those of non-managed sites. While availabilities of Ca, Mg, and K in subsoils of nonmanaged sites were inadequate to support maximal plant growth, they were adequate in subsoils of managed sites. Compared with nonmanaged sites, KCl-exchangeable Al in subsoils of managed sites was 23% lower at the 15-yr location and 65 and 100% lower at the two other locations. In the absence of lime, sorghum growth was almost totally inhibited on nonmanaged subsoils amended with optimum nutrients. On the managed subsoils, where 100, 65, and 23% of the nonmanaged exchangeable Al had been neutralized by topsoil fertilization and liming, growth reductions under the same conditions were 0, 50, and 100%, respectively. Thus, relatively long-term management had improved these Ultisol subsoils for root growth and development.

  10. Integrated Corrosion Facility for long-term testing of candidate materials for high-level radioactive waste containment

    SciTech Connect

    Estill, J.C.; Dalder, E.N.C.; Gdowski, G.E.; McCright, R.D.

    1994-10-01

    A long-term-testing facility, the Integrated Corrosion Facility (I.C.F.), is being developed to investigate the corrosion behavior of candidate construction materials for high-level-radioactive waste packages for the potential repository at Yucca Mountain, Nevada. Corrosion phenomena will be characterized in environments considered possible under various scenarios of water contact with the waste packages. The testing of the materials will be conducted both in the liquid and high humidity vapor phases at 60 and 90{degrees}C. Three classes of materials with different degrees of corrosion resistance will be investigated in order to encompass the various design configurations of waste packages. The facility is expected to be in operation for a minimum of five years, and operation could be extended to longer times if warranted. A sufficient number of specimens will be emplaced in the test environments so that some can be removed and characterized periodically. The corrosion phenomena to be characterized are general, localized, galvanic, and stress corrosion cracking. The long-term data obtained from this study will be used in corrosion mechanism modeling, performance assessment, and waste package design. Three classes of materials are under consideration. The corrosion resistant materials are high-nickel alloys and titanium alloys; the corrosion allowance materials are low-alloy and carbon steels; and the intermediate corrosion resistant materials are copper-nickel alloys.

  11. Exploring the Nurse Practitioner Role in Managing Fractures in Long-Term Care

    PubMed Central

    Kaasalainen, Sharon; Papaioannou, Alexandra; Burgess, Jennifer; Van der Horst, Mary Lou

    2016-01-01

    The purpose of this study was to assess the current level of involvement of nurse practitioners (NPs) in activities related to preventing and managing fractures in long-term care (LTC). This study used a sequential explanatory mixed methods design that included two phases—a cross-sectional survey followed by qualitative interviews. A final sample of 12 NPs completed the online survey for a response rate of 67%. Eleven of the 12 NPs who completed the survey agreed to participate in a follow-up interview. NPs reported that they were quite engaged in managing fractures in LTC; specifically, they were most active in caring for residents post-fracture. NPs described their role as being holistic in nature in their assessment and treatments related to managing fractures. The findings from this mixed method study add to the growing body of knowledge related to how NPs manage fractures in LTC. PMID:25825270

  12. Challenges Associated With Managing Suicide Risk in Long-Term Care Facilities

    PubMed Central

    O'Riley, Alisa; Nadorff, Michael R.; Conwell, Yeates; Edelstein, Barry

    2016-01-01

    Little information about suicidal ideation and behavior in long-term care (LTC) facilities is available. Nonetheless, the implementation of the Minimum Data Set 3.0 requires that LTC facilities screen their residents for suicide risk and have protocols in place to effectively manage residents’ responses. In this article, the authors briefly discuss the risk factors of suicide in the elderly and the problems that suicidal ideation and behavior pose in the LTC environment. The authors explain issues that arise when trying to manage suicide risk in the elderly LTC population with general, traditional approaches. These inherent issues make it difficult to develop an effective protocol for managing suicide risk in LTC facilities, leading the authors to propose their own framework for assessing and managing suicide risk in the LTC setting. PMID:27610048

  13. Long-Term Engagement with Health-Management Technology: a Dynamic Process in Diabetes.

    PubMed

    Klasnja, Predrag; Kendall, Logan; Pratt, Wanda; Blondon, Katherine

    2015-01-01

    Diabetes management is a complex, dynamic process that is largely incumbent on patient choices and behavior. We explore how health-management needs-and the needs for technological support-change over time for individuals with diabetes. Through interviews and a focus group, we found that after initial diagnosis, individuals face acute information needs and chiefly turn to mobile applications and Internet resources to help understand the diabetes-specific factors that affect their health. Over time their focus shifts from highly regimented routines to more flexible ones that enable them to maintain a quality of life. Our results suggest that long-term engagement with health technology does not necessarily require continuous, sustained use: routine disease management could lead to a decrease in use, until a new event occurs. Our findings point to a need for tools that help patients with diabetes to effectively manage their health as their bodies, treatment and circumstances change over time.

  14. Long-Term Engagement with Health-Management Technology: a Dynamic Process in Diabetes

    PubMed Central

    Klasnja, Predrag; Kendall, Logan; Pratt, Wanda; Blondon, Katherine

    2015-01-01

    Diabetes management is a complex, dynamic process that is largely incumbent on patient choices and behavior. We explore how health-management needs—and the needs for technological support—change over time for individuals with diabetes. Through interviews and a focus group, we found that after initial diagnosis, individuals face acute information needs and chiefly turn to mobile applications and Internet resources to help understand the diabetes-specific factors that affect their health. Over time their focus shifts from highly regimented routines to more flexible ones that enable them to maintain a quality of life. Our results suggest that long-term engagement with health technology does not necessarily require continuous, sustained use: routine disease management could lead to a decrease in use, until a new event occurs. Our findings point to a need for tools that help patients with diabetes to effectively manage their health as their bodies, treatment and circumstances change over time. PMID:26958211

  15. From Sky to Archive: Long Term Management of Sky Survey Data

    NASA Astrophysics Data System (ADS)

    Darch, Peter T.; Sands, Ashley E.; Borgman, Christine; Golshan, Milena S.; Traweek, Sharon

    2017-01-01

    Sky survey data may remain scientifically valuable long beyond the end of a survey’s operational period, both for continuing inquiry and for calibrating and testing instruments for subsequent generations of surveys. Astronomy infrastructure has many stakeholders, including those concerned with data management. Research libraries are increasingly partnering with scholars to sustain access to data.The Sloan Digital Sky Survey (SDSS) was among the first major scientific projects to partner with libraries in this way, embarking on a data transfer process with two university libraries. We report on a qualitative case study of this process.Ideally, long-term sustainability of sky survey data would be a key part of planning and construction, but rarely does this occur. Teams are under pressure to deliver a project on time and on budget that produces high-quality data during its operational period, leaving few resources available to plan long-term data management. The difficulty of planning is further compounded by the complexity of predicting circumstances and needs of the astronomy community in future decades. SDSS team members regarded libraries, long-lived institutions concerned with access to scholarship, as a potential solution to long-term data sustainability.As the SDSS data transfer was the first of this scale attempted - 160 TB of data - astronomers and library staff were faced with scoping the range of activities involved. They spent two years planning this five-year process. While successful overall as demonstration projects, the libraries encountered many obstacles. We found all parties experienced difficulty in articulating their notions of “scientific data,” “archiving,” “serving,” and “providing access” to the datasets. Activities and interpretations of the data transfer process varied by institutional motivations for participation and by available infrastructure. We conclude several, rather than a single, “library solutions” for long-term

  16. Institutional Staff Training and Management: A Review of the Literature and a Model for Geriatric, Long-Term-Care Facilities.

    ERIC Educational Resources Information Center

    Burgio, Louis D.; Burgio, Kathryn L.

    1990-01-01

    Asserts that, if long-term care is to progress from custodial model to therapeutic model of rehabilitation, role of nursing assistants must be redesigned. Reviews current methods of institutional staff training and management and proposes model for geriatric, long-term care facilities. Discusses organizational resistance and offers suggestions for…

  17. Gastric bypass patients' goal-strategy-monitoring networks for long-term dietary management.

    PubMed

    Lynch, Amanda; Bisogni, Carole A

    2014-10-01

    Following gastric bypass surgery, patients must make dramatic dietary changes, but little is known about patients' perspectives on long-term dietary management after this surgery. This grounded theory, qualitative study sought to advance conceptual understanding of food choice by examining how gastric bypass patients constructed personal food systems to guide food and eating behaviors 12 months post-surgery. Two in-depth interviews were conducted with each of 16 adults, purposively sampled from bariatric support groups. Using constant comparative analysis of verbatim interview transcripts, researchers identified participants' goal-strategy-monitoring networks representing how participants used specific food and eating behaviors towards their main goals of: Weight Management, Overall Health, Avoiding Negative Reactions to Eating, and Integrating Dietary Changes with Daily Life. Linked to each main goal was a hierarchy of intermediary goals, strategies, and tactics. Participants used monitoring behaviors to assess strategy effectiveness towards goal achievement. Individuals' Weight Management networks were compared to uncover similarities and differences among strategy use and monitoring methods among those who maintained weight loss and those who regained weight. The complex, multilevel goal-strategy-monitoring networks identified illustrate the "work" involved in constructing new personal food systems after surgery, as well as advance understanding of strategies as a component of people's personal food systems. These findings provide researchers and practitioners with insight into the long-term dietary issues that gastric bypass patients face and a potential method for representing how people relate deliberate dietary behaviors to their goals.

  18. Towards sustainable groundwater use: setting long-term goals, backcasting, and managing adaptively.

    PubMed

    Gleeson, Tom; Alley, William M; Allen, Diana M; Sophocleous, Marios A; Zhou, Yangxiao; Taniguchi, Makoto; VanderSteen, Jonathan

    2012-01-01

    The sustainability of crucial earth resources, such as groundwater, is a critical issue. We consider groundwater sustainability a value-driven process of intra- and intergenerational equity that balances the environment, society, and economy. Synthesizing hydrogeological science and current sustainability concepts, we emphasize three sustainability approaches: setting multigenerational sustainability goals, backcasting, and managing adaptively. As most aquifer problems are long-term problems, we propose that multigenerational goals (50 to 100 years) for water quantity and quality that acknowledge the connections between groundwater, surface water, and ecosystems be set for many aquifers. The goals should be set by a watershed- or aquifer-based community in an inclusive and participatory manner. Policies for shorter time horizons should be developed by backcasting, and measures implemented through adaptive management to achieve the long-term goals. Two case histories illustrate the importance and complexity of a multigenerational perspective and adaptive management. These approaches could transform aquifer depletion and contamination to more sustainable groundwater use, providing groundwater for current and future generations while protecting ecological integrity and resilience.

  19. Soil aggregation and aggregating agents as affected by long term contrasting management of an Anthrosol

    NASA Astrophysics Data System (ADS)

    Zhang, Shulan; Wang, Renjie; Yang, Xueyun; Sun, Benhua; Li, Qinghui

    2016-12-01

    Soil aggregation was studied in a 21-year experiment conducted on an Anthrosol. The soil management regimes consisted of cropland abandonment, bare fallow without vegetation and cropping system. The cropping system was combined with the following nutrient management treatments: control (CONTROL, no nutrient input); nitrogen, phosphorus and potassium (NPK); straw plus NPK (SNPK); and manure (M) plus NPK (MNPK). Compared with the CONTROL treatment, the abandonment treatment significantly increased the formation of large soil macroaggregates (>2 mm) and consequently improved the stability of aggregates in the surface soil layer due to enhancement of hyphal length and of soil organic matter content. However, in response to long-term bare fallow treatment aggregate stability was low, as were the levels of aggregating agents. Long term fertilization significantly redistributed macroaggregates; this could be mainly ascribed to soil organic matter contributing to the formation of 0.5–2 mm classes of aggregates and a decrease in the formation of the >2 mm class of aggregates, especially in the MNPK treatment. Overall, hyphae represented a major aggregating agent in both of the systems tested, while soil organic compounds played significantly different roles in stabilizing aggregates in Anthrosol when the cropping system and the soil management regimes were compared.

  20. Soil aggregation and aggregating agents as affected by long term contrasting management of an Anthrosol

    PubMed Central

    Zhang, Shulan; Wang, Renjie; Yang, Xueyun; Sun, Benhua; Li, Qinghui

    2016-01-01

    Soil aggregation was studied in a 21-year experiment conducted on an Anthrosol. The soil management regimes consisted of cropland abandonment, bare fallow without vegetation and cropping system. The cropping system was combined with the following nutrient management treatments: control (CONTROL, no nutrient input); nitrogen, phosphorus and potassium (NPK); straw plus NPK (SNPK); and manure (M) plus NPK (MNPK). Compared with the CONTROL treatment, the abandonment treatment significantly increased the formation of large soil macroaggregates (>2 mm) and consequently improved the stability of aggregates in the surface soil layer due to enhancement of hyphal length and of soil organic matter content. However, in response to long-term bare fallow treatment aggregate stability was low, as were the levels of aggregating agents. Long term fertilization significantly redistributed macroaggregates; this could be mainly ascribed to soil organic matter contributing to the formation of 0.5–2 mm classes of aggregates and a decrease in the formation of the >2 mm class of aggregates, especially in the MNPK treatment. Overall, hyphae represented a major aggregating agent in both of the systems tested, while soil organic compounds played significantly different roles in stabilizing aggregates in Anthrosol when the cropping system and the soil management regimes were compared. PMID:27958366

  1. Towards sustainable groundwater use: Setting long-term goals, backcasting, and managing adaptively

    USGS Publications Warehouse

    Gleeson, T.; Alley, W.M.; Allen, D.M.; Sophocleous, M.A.; Zhou, Y.; Taniguchi, M.; Vandersteen, J.

    2012-01-01

    The sustainability of crucial earth resources, such as groundwater, is a critical issue. We consider groundwater sustainability a value-driven process of intra- and intergenerational equity that balances the environment, society, and economy. Synthesizing hydrogeological science and current sustainability concepts, we emphasize three sustainability approaches: setting multigenerational sustainability goals, backcasting, and managing adaptively. As most aquifer problems are long-term problems, we propose that multigenerational goals (50 to 100 years) for water quantity and quality that acknowledge the connections between groundwater, surface water, and ecosystems be set for many aquifers. The goals should be set by a watershed- or aquifer-based community in an inclusive and participatory manner. Policies for shorter time horizons should be developed by backcasting, and measures implemented through adaptive management to achieve the long-term goals. Two case histories illustrate the importance and complexity of a multigenerational perspective and adaptive management. These approaches could transform aquifer depletion and contamination to more sustainable groundwater use, providing groundwater for current and future generations while protecting ecological integrity and resilience. ?? 2011, The Author(s). Ground Water ?? 2011, National Ground Water Association.

  2. Composite quarterly technical report long-term high-level-waste technology, October-December 1981

    SciTech Connect

    Cornman, W.R.

    1982-06-01

    This document summarizes work performed at participating sites on the immobilization of high-level wastes from the chemical reprocessing of reactor fuels. The plan is to develop waste form alternatives for each of the three DOE sites (SRP, ICPP, and Hanford). Progress is reported in the following areas: waste preparation; fixation in glass, concrete, tailored ceramics, and coated particles; process and equipment development; and final handling. 12 figures, 19 tables. (DLC)

  3. Long-term affected energy production of waste to energy technologies identified by use of energy system analysis.

    PubMed

    Münster, M; Meibom, P

    2010-12-01

    Affected energy production is often decisive for the outcome of consequential life-cycle assessments when comparing the potential environmental impact of products or services. Affected energy production is however difficult to determine. In this article the future long-term affected energy production is identified by use of energy system analysis. The focus is on different uses of waste for energy production. The Waste-to-Energy technologies analysed include co-combustion of coal and waste, anaerobic digestion and thermal gasification. The analysis is based on optimization of both investments and production of electricity, district heating and bio-fuel in a future possible energy system in 2025 in the countries of the Northern European electricity market (Denmark, Norway, Sweden, Finland and Germany). Scenarios with different CO(2) quota costs are analysed. It is demonstrated that the waste incineration continues to treat the largest amount of waste. Investments in new waste incineration capacity may, however, be superseded by investments in new Waste-to-Energy technologies, particularly those utilising sorted fractions such as organic waste and refuse derived fuel. The changed use of waste proves to always affect a combination of technologies. What is affected varies among the different Waste-to-Energy technologies and is furthermore dependent on the CO(2) quota costs and on the geographical scope. The necessity for investments in flexibility measures varies with the different technologies such as storage of heat and waste as well as expansion of district heating networks. Finally, inflexible technologies such as nuclear power plants are shown to be affected.

  4. Long-term affected energy production of waste to energy technologies identified by use of energy system analysis

    SciTech Connect

    Muenster, M.; Meibom, P.

    2010-12-15

    Affected energy production is often decisive for the outcome of consequential life-cycle assessments when comparing the potential environmental impact of products or services. Affected energy production is however difficult to determine. In this article the future long-term affected energy production is identified by use of energy system analysis. The focus is on different uses of waste for energy production. The Waste-to-Energy technologies analysed include co-combustion of coal and waste, anaerobic digestion and thermal gasification. The analysis is based on optimization of both investments and production of electricity, district heating and bio-fuel in a future possible energy system in 2025 in the countries of the Northern European electricity market (Denmark, Norway, Sweden, Finland and Germany). Scenarios with different CO{sub 2} quota costs are analysed. It is demonstrated that the waste incineration continues to treat the largest amount of waste. Investments in new waste incineration capacity may, however, be superseded by investments in new Waste-to-Energy technologies, particularly those utilising sorted fractions such as organic waste and refuse derived fuel. The changed use of waste proves to always affect a combination of technologies. What is affected varies among the different Waste-to-Energy technologies and is furthermore dependent on the CO{sub 2} quota costs and on the geographical scope. The necessity for investments in flexibility measures varies with the different technologies such as storage of heat and waste as well as expansion of district heating networks. Finally, inflexible technologies such as nuclear power plants are shown to be affected.

  5. Biological waste gas treatment with a modified rotating biological contactor. Iota. Control of biofilm growth and long-term performance.

    PubMed

    Vinage, I; von Rohr, P Rudolf

    2003-11-01

    In this work, we introduce a modified rotating biological contactor (RBC) system and demonstrate its feasibility by applying the newly devised process to the biological treatment of artificial waste gas. In the proposed system, the waste gas is introduced to the bioreactor in the spacings between the rotating discs through a hollow shaft, thus allowing for intimate gas-liquid contact. A 91-l modified RBC containing 20 biofilm support discs 40 cm in diameter was used in the experiments. Toluene was used as the model pollutant, and the system was operated under standard operating conditions for more than one year in order to investigate its long-term performance and assess its ability to control the growth of the biofilm. It was demonstrated that the proposed system allows to efficiently control the growth of the biofilm, thus overcoming the clogging problem inherent in most conventional methods for the biological treatment of waste gas. Moreover, the system was shown to exhibit stationary long-term performance for a period of more than one year, hence indicating its feasibility for industrial application.

  6. Long-Term Biological Monitoring of an Impaired Stream: Implications for Environmental Management [Special Issue

    SciTech Connect

    Adams, Marshall; Brandt, Craig C; Christensen, Sigurd W; Efroymson, Rebecca Ann; Greeley Jr, Mark Stephen; Ham, Kenneth; Kszos, Lynn A; Loar, James M; McCracken, Kitty; Morris, Gail Wright; Peterson, Mark J; Ryon, Michael G; Smith, John G; Southworth, George R; Stewart, Arthur J

    2011-01-01

    The long-term ecological recovery of an impaired stream in response to an industrial facility's pollution abatement actions and the implications of the biological monitoring effort to environmental management is the subject of this special issue of Environmental Management. This final article focuses on the synthesis of the biological monitoring program's components and methods, the efficacy of various biological monitoring techniques to environmental management, and the lessons learned from the program that might be applicable to the design and application of other programs. The focus of the 25-year program has been on East Fork Poplar Creek, an ecologically impaired stream in Oak Ridge, Tennessee with varied and complex stressors from a Department of Energy facility in its headwaters. Major components of the long-term program included testing and monitoring of invertebrate and fish toxicity, bioindicators of fish health, fish contaminant accumulation, and instream communities (including periphyton, benthic macroinvertebrate, and fish). Key parallel components of the program include water chemistry sampling and data management. Multiple lines of evidence suggested positive ecological responses during three major pollution abatement periods. Based on this case study and the related literature, effective environmental management of impaired streams starts with program design that is consistent across space and time, but also adaptable to changing conditions. The biological monitoring approaches used for the program provided a strong basis for assessments of recovery from remedial actions, and the likely causes of impairment. This case study provides a unique application of multidisciplinary and quantitative techniques to address multiple and complex regulatory and programmatic goals, environmental stressors, and remedial actions.

  7. Long-term Biological Monitoring of an Impaired Stream: Synthesis and Environmental Management Implications

    SciTech Connect

    Peterson, Mark J; Efroymson, Rebecca Ann; Adams, Marshall

    2011-01-01

    The long-term ecological recovery of an impaired stream in response to an industrial facility's pollution abatement actions and the implications of the biological monitoring effort to environmental management is the subject of this special issue of Environmental Management. This final article focuses on the synthesis of the biological monitoring program's components and methods, the efficacy of various biological monitoring techniques to environmental management, and the lessons learned from the program that might be applicable to the design and application of other programs. The focus of the 25-year program has been on East Fork Poplar Creek, an ecologically impaired stream in Oak Ridge, Tennessee with varied and complex stressors from a Department of Energy facility in its headwaters. Major components of the long-term program included testing and monitoring of invertebrate and fish toxicity, bioindicators of fish health, fish contaminant accumulation, and instream communities (including periphyton, benthic macroinvertebrate, and fish). Key parallel components of the program include water chemistry sampling and data management. Multiple lines of evidence suggested positive ecological responses during three major pollution abatement periods. Based on this case study and the related literature, effective environmental management of impaired streams starts with program design that is consistent across space and time, but also adaptable to changing conditions. The biological monitoring approaches used for the program provided a strong basis for assessments of recovery from remedial actions, and the likely causes of impairment. This case study provides a unique application of multidisciplinary and quantitative techniques to address multiple and complex regulatory and programmatic goals, environmental stressors, and remedial actions.

  8. Long-Term Biological Monitoring of an Impaired Stream: Synthesis and Environmental Management Implications

    NASA Astrophysics Data System (ADS)

    Peterson, Mark J.; Efroymson, Rebecca A.; Adams, S. Marshall

    2011-06-01

    The long-term ecological recovery of an impaired stream in response to an industrial facility's pollution abatement actions and the implications of the biological monitoring effort to environmental management is the subject of this special issue of Environmental Management. This final article focuses on the synthesis of the biological monitoring program's components and methods, the efficacy of various biological monitoring techniques to environmental management, and the lessons learned from the program that might be applicable to the design and application of other programs. The focus of the 25-year program has been on East Fork Poplar Creek, an ecologically impaired stream in Oak Ridge, Tennessee with varied and complex stressors from a Department of Energy facility in its headwaters. Major components of the long-term program included testing and monitoring of invertebrate and fish toxicity, bioindicators of fish health, fish contaminant accumulation, and instream communities (including periphyton, benthic macroinvertebrate, and fish). Key parallel components of the program include water chemistry sampling and data management. Multiple lines of evidence suggested positive ecological responses during three major pollution abatement periods. Based on this case study and the related literature, effective environmental management of impaired streams starts with program design that is consistent across space and time, but also adaptable to changing conditions. The biological monitoring approaches used for the program provided a strong basis for assessments of recovery from remedial actions, and the likely causes of impairment. This case study provides a unique application of multidisciplinary and quantitative techniques to address multiple and complex regulatory and programmatic goals, environmental stressors, and remedial actions.

  9. Long-term follow-up of children with nonoperative management of blunt splenic trauma.

    PubMed

    Moore, Hunter B; Vane, Dennis W

    2010-03-01

    : The effectiveness of nonoperative management (NOM) of blunt splenic injuries (BSIs) in children is established; however, only limited data of their long-term follow-up exist. We hypothesize that long-term follow-up verifies that NOM of BSI in children is safe and effective. : From 1993 to 2008, 153 children (1-17 years, mean = 12) with BSI were admitted. Patients were contacted by telephone and answered a standardized questionnaire. Medical records were reviewed to validate injury grade, hospital stay, and complications. : Eighty patients (52%) participated; 18 were excluded (8 splenectomies, 2 splenorraphies, 3 comatose, 2 language barriers, and 3 with unavailable records). Mean follow-up of the remaining 62 patients was 74 months (range, 5-165 months). There were 9 grade I, 9 grade II, 22 grade III, 20 grade IV, and 2 grade V injuries. Mechanism of injury was motor vehicle crashes (14), falls (11), all terrain vehicle (ATV) crashes (10), snow recreation related (14), and other recreation (13). Two patients were readmitted for spleen complications (splenic cyst and hematoma), but neither required additional treatment. Seven patients reported potential spleen-related complications: six immunologic (asthma, rashes, and increased illness), two abdominal pain, and two psychiatric related to fear of reinjuring their spleen. Three children sustained a second BSI, and none required surgical intervention. : Long-term follow-up indicates that our protocol for NOM of BSI in children is safe, including secondary injuries. However, this study indicates that children who sustain BSI may require more counseling than presently provided. With an intact spleen, fear of immunologic dysfunction is irrational and indicates a lack of understanding at discharge. In addition, more intensive investigation and interventions for families that may suffer from posttraumatic stress disorder or related disorders appears indicated.

  10. Long-term management of type 2 diabetes with glucagon-like peptide-1 receptor agonists

    PubMed Central

    Courtney, Hamish; Nayar, Rahul; Rajeswaran, Chinnadorai; Jandhyala, Ravi

    2017-01-01

    Continuously reducing excess blood glucose is a primary goal for the management of type 2 diabetes (T2D). Most patients with T2D require glucose-lowering medications to achieve and maintain adequate glycemic control; however, treatment failure may occur, limiting treatment options. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are an emerging therapeutic class that can be prescribed for patients instead of basal insulin after the failure of oral therapies. Recent studies have focused on the durability and tolerability of long-term GLP-1RA therapy. This review summarizes the key efficacy and safety findings from prospective phase 3 clinical studies of at least 76 weeks’ duration for the GLP-1RAs currently approved in the United States and the European Union (albiglutide, dulaglutide, exenatide twice daily [BID], exenatide once weekly [QW], liraglutide, and lixisenatide). Currently, most of the long-term data are from uncontrolled extension studies, and continuous patient benefit has been observed for up to 3 years with multiple GLP-1RAs. Four-year comparative data demonstrated a longer time to treatment failure for exenatide BID than for sulfonylurea, and 3-year comparative extension data demonstrated greater glycated hemoglobin (HbA1c) reductions and weight loss with exenatide QW than with insulin glargine. Currently, the longest extension study for a GLP-1RA is the DURATION-1 study of exenatide QW, with >7 years of clinical data available. Data from DURATION-1 demonstrated that continuous HbA1c reductions and weight loss were observed for the patients continuing on the treatment, with no unexpected adverse events. Taken together, these data support GLP-1RAs as a long-term noninsulin treatment option after the failure of oral therapies. PMID:28331351

  11. Laboratory apparatus and operating procedures for determining the long-term environmental fate of EOR chemicals and other waste fluids

    SciTech Connect

    Kayser, M.B.; Collins, A.G.

    1985-11-01

    The objective of NIPER's EOR Environmental Compatibility project, BE3A, is to determine the compatibilities and potential long term environmental effects of EOR chemicals and injected waste fluids with reservoir fluids and rocks. To aid in this effort, a coreflooding system and injection/analysis procedures were designed. The system consists primarily of a Bureau of Mines stainless steel autoclave, or optional Hassler holder, pumps, and associated hardware. The system uses proven core flooding techniques, and may be used at moderately elevated temperatures and pressures. This report describes the apparatus and procedures involved in performing the research. 1 ref., 4 figs.

  12. Risks of nuclear waste disposal in space. III - Long-term orbital evolution of small particle distribution

    NASA Technical Reports Server (NTRS)

    Friedlander, A. L.; Wells, W. C.

    1980-01-01

    A study of long term risks is presented that treats an additional pathway that could result in earth reentry, namely, small radioactive particles released in solar orbit due to payload fragmentation by accidental explosion or meteoroid impact. A characterization of such an event and of the initial mass size distribution of particles is given for two extremes of waste form strength. Attention is given to numerical results showing the mass-time distribution of material and the fraction of initial mass intercepted by earth. It is concluded that it appears that program planners need not be to concerned about the risks of this particular failure mechanism and return pathway.

  13. Risks of nuclear waste disposal in space. III - Long-term orbital evolution of small particle distribution

    NASA Technical Reports Server (NTRS)

    Friedlander, A. L.; Wells, W. C.

    1980-01-01

    A study of long term risks is presented that treats an additional pathway that could result in earth reentry, namely, small radioactive particles released in solar orbit due to payload fragmentation by accidental explosion or meteoroid impact. A characterization of such an event and of the initial mass size distribution of particles is given for two extremes of waste form strength. Attention is given to numerical results showing the mass-time distribution of material and the fraction of initial mass intercepted by earth. It is concluded that it appears that program planners need not be to concerned about the risks of this particular failure mechanism and return pathway.

  14. STUDY ON THE RECYCLING SYSTEM OF WASTE PLASTICS AND MIXED PAPER FROM A LONG-TERM PERSPECTIVE

    NASA Astrophysics Data System (ADS)

    Fujii, Minoru; Fujita, Tsuyoshi; Chen, Xudong; Ohnishi, Satoshi; Osako, Masahiro; Moriguchi, Yuichi; Yamaguchi, Naohisa

    Plastics and mixed paper in municipal solid waste are valuable resources with high calorific value. However, the recycling cost to utilize them tends to be expensive. In addition, recycling system has to be consistent with the reduce of wastes on which should be put higher-priority to lower carbon emission and save resources in the long term. In this paper, we proposed a recycling system (smart recycling system) which consists of a local center an d existing facilities in arterial industries. In the local center, collected waste plastics and mixed paper from household are processed on the same line into a form suitable for transportation and handling in a facility of arterial in dustry which can utilize those wastes effectively. At the same time, a part of plastics with high quality is processed into a recycled resin in the center. It was suggested that, by utilizing existing facilities in arterial industries which have enough and flexible capacity to accept those wastes, the system can be a robust system even if the amount of wastes generation fluctuates widely. The effect of CO2 reduction and cost by installing the system were calculated and it was estimated that 3.5 million ton of additional annual CO2 reduction could be brought in Tokyo and surrounding three prefectures without co nsiderable increase in cost.

  15. Improving Pain Management and Long-Term Outcomes Following High-Energy Orthopaedic Trauma (Pain Study).

    PubMed

    Castillo, Renan C; Raja, Srinivasa N; Frey, Katherine P; Vallier, Heather A; Tornetta, Paul; Jaeblon, Todd; Goff, Brandon J; Gottschalk, Allan; Scharfstein, Daniel O; OʼToole, Robert V

    2017-04-01

    Poor pain control after orthopaedic trauma is a predictor of physical disability and numerous negative long-term outcomes. Despite increased awareness of the negative consequences of poorly controlled pain, analgesic therapy among hospitalized patients after orthopaedic trauma remains inconsistent and often inadequate. The Pain study is a 3 armed, prospective, double-blind, multicenter randomized trial designed to evaluate the effect of standard pain management versus standard pain management plus perioperative nonsteroidal anti-inflammatory drugs or pregabalin in patients of ages 18-85 with extremity fractures. The primary outcomes are chronic pain, opioid utilization during the 48 hours after definitive fixation and surgery for nonunion in the year after fixation. Secondary outcomes include preoperative and postoperative pain intensity, adverse events and complications, physical function, depression, and post-traumatic stress disorder. One year treatment costs are also compared between the groups.

  16. Staff teamwork in long-term care facilities: the influence of management style, training, and feedback.

    PubMed

    Tyler, Denise A; Parker, Victoria A

    2011-04-01

    The purpose of this study was to describe the organizational factors associated with high and low amounts of teamwork among direct-care workers in long-term care (LTC) facilities. A systematic analysis of observation data collected at 20 LTC facilities was first used to categorize facilities as high-, moderate-, or low-teamwork facilities. Next, qualitative analysis of 59 interviews collected in 4 high-teamwork and 5 low-teamwork facilities was used to identify the organizational factors associated with high and low teamwork. Findings showed that high- and low-teamwork LTC facilities in this study differed in three organizational areas: management style, training, and feedback and recognition. As such, improved teamwork in LTC facilities may result from changes to basic management practices, such as training and employee feedback.

  17. Case management and long-term conditions: the evolution of community matrons.

    PubMed

    Bentley, Allison

    2014-07-01

    It is now 10 years since the NHS Improvement Plan described a new clinical role for nurses and introduced the concept of community matrons for long-term conditions. This included conditions such as chronic obstructive pulmonary disease, diabetes, dementia, neurological conditions, heart failure, stroke and people with long and enduring mental illness. Despite initial concerns and scepticism about the role, community matrons continue to work with people to provide advanced clinical nursing care, often within a case-management model. Community matrons have continued to shape and develop this role around the main aims of preventing unnecessary emergency admissions, improving quality of life and outcomes for patients, and coordinating all elements of care. This article reviews the evidence, implementation and evolvement of case management within the role of the community matron.

  18. Long-term risk analysis associated with nuclear waste disposal in space

    NASA Technical Reports Server (NTRS)

    Friedlander, A. L.; Davis, D. R.

    1979-01-01

    An assessment and verification of previous analytic results on the long term risk of earth reentry for hazardous payloads is presented. The two areas were studied: (1) stability of nominal, near-circular storage orbits in the regions between Venus and earth and between earth and Mars, and (2) probability of earth reentry for off-nominal planet-crossing orbits resulting from deployment system failures. In the first area, numerical integrations of the equations of motion are compared with stability predications based on secular perturbation theory. The agreement is good in terms of the heliocentric distances covered and the general behavior of the orbital history, although certain near-resonance situations can lead to difficulty. In the second area, a Monte Carlo simulation of orbital evolution is used and the results compared with Opik's analytic theory of planetary encounters and collision statistics, with data verified to within a close order-of-magnitude.

  19. Long-term risk analysis associated with nuclear waste disposal in space

    NASA Technical Reports Server (NTRS)

    Friedlander, A. L.; Davis, D. R.

    1979-01-01

    An assessment and verification of previous analytic results on the long term risk of earth reentry for hazardous payloads is presented. The two areas were studied: (1) stability of nominal, near-circular storage orbits in the regions between Venus and earth and between earth and Mars, and (2) probability of earth reentry for off-nominal planet-crossing orbits resulting from deployment system failures. In the first area, numerical integrations of the equations of motion are compared with stability predications based on secular perturbation theory. The agreement is good in terms of the heliocentric distances covered and the general behavior of the orbital history, although certain near-resonance situations can lead to difficulty. In the second area, a Monte Carlo simulation of orbital evolution is used and the results compared with Opik's analytic theory of planetary encounters and collision statistics, with data verified to within a close order-of-magnitude.

  20. Developing cartoons for long-term condition self-management information

    PubMed Central

    2014-01-01

    Background Advocating the need to adopt more self-management policies has brought with it an increasing demand for information about living with and making decisions about long-term conditions, with a significant potential for using cartoons. However, the purposeful use of cartoons is notably absent in many areas of health care as is evidence of their acceptability to patients and lay others. This paper outlines the process used to develop and evaluate cartoons and their acceptability for a series of self-management guidebooks for people with inflammatory bowel disease, irritable bowel syndrome, diabetes, chronic obstructive pulmonary disease and chronic kidney disease (CKD). Methods Principles for a process to develop information and cartoons were developed. Cartoon topics were created using qualitative research methods to obtain lay views and experiences. The CKD guidebook was used to provide a detailed exemplar of the process. Focus group and trial participants were recruited from primary care CKD registers. The book was part of a trial intervention; selected participants evaluated the cartoons during in-depth interviews which incorporated think-aloud methods. Results In general, the cartoons developed by this process depict patient experiences, common situations, daily management dilemmas, making decisions and choices and the uncertainties associated with conditions. CKD cartoons were developed following two focus groups around the themes of getting a diagnosis; understanding the problem; feeling that facts were being withheld; and setting priorities. Think-aloud interviews with 27 trial participants found the CKD cartoons invoked amusement, recognition and reflection but were sometimes difficult to interpret. Conclusion Humour is frequently utilised by people with long-term conditions to help adjustment and coping. Cartoons can help provide clarity and understanding and could address concerns related to health literacy. Using cartoons to engage and motivate

  1. Estimation of PCB content in agricultural soils associated with long-term fertilization with organic waste.

    PubMed

    Antolín-Rodríguez, Juan M; Sánchez-Báscones, Mercedes; Martín-Ramos, Pablo; Bravo-Sánchez, Carmen T; Martín-Gil, Jesús

    2016-06-01

    Polychlorinated biphenyl (PCB) pollution related to the use of organic waste as fertilizers in agricultural soils is a cause of major concern. In the study presented herein, PCB concentration was studied through a field trial conducted in two agricultural soils in the province of Palencia (Spain) over a 4-year period, assessing the impact of irrigation and of different types of organic waste materials. The amounts of organic waste added to the soil were calculated according to the nitrogen needs of the crop, and the concentration of PCBs was determined before and after the application of the organic waste. The resulting persistence of the total PCB content in the agricultural soils, compared with the PCB concentration in the original soils, ranged from 27% to 90%, with the lowest value corresponding to irrigated soils treated with municipal solid waste compost (MSWC) and the highest value to non-irrigated soils treated with composted sewage sludge (CSS). An estimate of the PCB content in agricultural soils after the application of organic waste materials until year 2050 was obtained, resulting in a value below 5 ng·g(-1), considered a background value for soils in sites far away from potential pollution sources.

  2. Potential of "lure and kill" in long-term pest management and eradication of invasive species.

    PubMed

    El-Sayed, A M; Suckling, D M; Byers, J A; Jang, E B; Wearing, C H

    2009-06-01

    "Lure and kill" technology has been used for several decades in pest management and eradication of invasive species. In lure and kill, the insect pest attracted by a semiochemical lure is not "entrapped" at the source of the attractant as in mass trapping, but instead the insect is subjected to a killing agent, which eliminates affected individuals from the population after a short period. In past decades, a growing scientific literature has been published on this concept. This article provides the first review on the potential of lure and kill in long-term pest management and eradication of invasive species. We present a summary of lure and kill, either when used as a stand-alone control method or in combination with other methods. We discuss its efficacy in comparison with other control methods. Several case studies in which lure and kill has been used with the aims of long-term pest management (e.g., pink bollworm, Egyptian cotton leafworm, codling moth, apple maggot, biting flies, and bark beetles) or the eradication of invasive species (e.g., tephritid fruit flies and boll weevils) are provided. Subsequently, we identify essential knowledge required for successful lure and kill programs that include lure competitiveness with natural odor source; lure density; lure formulation and release rate; pest population density and risk of immigration; and biology and ecology of the target species. The risks associated with lure and kill, especially when used in the eradication programs, are highlighted. We comment on the cost-effectiveness of this technology and its strengths and weaknesses, and list key reasons for success and failure. We conclude that lure and kill can be highly effective in controlling small, low-density, isolated populations, and thus it has the potential to add value to long-term pest management. In the eradication of invasive species, lure and kill offers a major advantage in effectiveness by its being inverse density dependent and it provides

  3. Time management and leadership styles: an empirical study of long-term health care administrators.

    PubMed

    Hartley, H J; Kramer, J A

    1991-01-01

    Is there a relationship between the type of leadership style employed by long-term health care administrators and the effective use and management of time? This paper describes a 1989 study of 188 administrators of skilled nursing facilities and intermediate care facilities in Connecticut. Two self-rating instruments were employed: the Executive Time Management Inventory (Hartley, Kramer, et al.) and the LEAD-Self instrument (Hersey and Blanchard). Four hypotheses were tested at the .05 level of significance to examine relationships among time management, leadership style, size of facility, administrator experience, and cost factors. Statistical procedures included Pearson Product-Moment correlations, analysis of variance, t-tests, and partial correlations. Results of the study included (1) time management effectiveness increased as administrators gained more experience; (2) no significant relationship existed between type of leadership style and time management effectiveness; (3) women administrators perceived themselves as significantly more effective time managers than men did; (4) most health care administrators employed the same primary leadership style: "selling," which is defined as high relationship/high task; and (5) institutional size was not related to the time management effectiveness of the administrator. The findings have implications for pre-service and in-service training and for future studies in health administration education.

  4. Long Term Results of Innovative Procedure in Surgical Management of Chronic Lymphedema

    PubMed Central

    Mousavi, Seyed R.

    2016-01-01

    Background: Lymphedema is the result of impaired lymphatic drainage by the affected organ. This abnormality can be primary or secondary. Different operative approaches have been introduced to treat chronic lymphedema. Materials and Methods: This retrospective study included 816 patients who were diagnosed with chronic lower extremity lymphedema and did not respond to non-operative management for at least six months. Data was collected over 25 years, between March 1987 and March 2013. Doppler ultrasonography of the deep venous system was routinely undertaken in all patients to confirm patency. The patients underwent surgery and their progress was followed for at least one year postoperatively. Results: All patients were operated by the suggested technique and long term fallow-up which is a modified form of the Homan’s technique. The outcome was excellent, and 89.2% of patients were free of complication and 2% had poor results. The most common complication was wound seroma and wound infection. Conclusion: The long term results and considering the difficulties associated with the treatment of chronic lymphedema and the variety of surgical options, our method achieved excellent results, and may be proposed for the standard operative procedure for treating intractable forms of this disease. PMID:27990192

  5. Prevention and management of long-term catheter related infections in cancer patients.

    PubMed

    Hachem, Ray; Raad, Issam

    2002-01-01

    Long-term central venous catheters (CVC) are necessary in the care of cancer patients. However, catheter-related bloodstream infection (CRBSI) is commonly associated with serious complications resulting in considerable morbidity and mortality. The diagnosis of CRBSI frequently requires catheter removal to confirm the diagnosis by either quantitative or semiquantitative catheter culture method. Differential time to positivity, whereby a nonquantitative blood culture drawn from the CVC that becomes positive at least 2 hr earlier than the peripheral blood culture, is a new method for the diagnosis of CRBSI without removing the catheter. Prevention of CRBSI may be accomplished with the use of strict infection control measures, antimicrobial-impregnated catheters; and antibiotic-lock technique, as well as other methods. Once infection develops, management of long-term CRBSI is dictated by the type of organism, the severity of the infection, and availability of other venous access sites. If the infection is caused by Staphylococcus aureus, gram-negative bacilli, or Candida, the catheter should be removed and systemic antimicrobial therapy given for 10-14 days or longer in cases of complicated or deep-seated infection. In some cases, where there is no other venous access site, the catheter can remain in place, but a combination of systemic antimicrobials and antibiotic-lock therapy should be used.

  6. Contemporary In-Hospital and Long-Term Outcomes of Surgical Management for Fungal Endocarditis.

    PubMed

    Chen, Jinmiao; Li, Jun; Zhou, Tianyu; Hu, Kui; Yang, Zhaohua; Wang, Yao; Zhu, Kai; Hong, Tao; Lai, Hao; Wang, Chunsheng

    2017-08-03

    Fungal endocarditis (FE) is a rare and fatal disease. The contemporary in-hospital and long-term surgical outcomes of FE have not been adequately evaluated. This study describes our experience with the surgical management of FE.Eight FE patients who underwent surgery in our center from January 2004 to November 2016 were included in this study. Seven had fungal prosthetic valve endocarditis (PVE) and one fungal native valve endocarditis (NVE). The Bentall operation, Cabrol operation, and mitral valve replacement were performed in 4, 3, and 1 patient, respectively. The overall in-hospital mortality rate was 25% (2/8). The follow-up was completed in all surviving patients and the mean follow-up time was 55.5 ± 63.3 (range, 1-154) months. Two late deaths occurred at 2 months and 4 months after discharge. The other patients recovered well during the follow-up.FE is a devastating disease and surgical treatment has acceptable in-hospital and long-term mortality rates.

  7. Topical nonsteroidal anti-inflammatory drugs for management of osteoarthritis in long-term care patients

    PubMed Central

    Argoff, Charles E; Gloth, F Michael

    2011-01-01

    Osteoarthritis is common in patients ≥65 years of age. Although nonsteroidal anti-inflammatory drugs (NSAIDs) are often prescribed for osteoarthritis pain, they pose age-related cardiovascular, renal, and gastrointestinal risks. Two topical NSAIDs, diclofenac sodium 1% gel (DSG) and diclofenac sodium 1.5% in 45.5% dimethylsulfoxide solution (D-DMSO), are approved in the US for the treatment of osteoarthritis pain. Topical NSAIDs have shown efficacy and safety in knee (DSG, D-DMSO) and hand (DSG) osteoarthritis. Analyses of data from randomized controlled trials of DSG in hand and knee osteoarthritis demonstrate significant improvement of pain and function in both younger patients (<65 years) and older patients (≥65 years) and suggest good safety and tolerability. However, long-term safety data in older patients are limited. Topical NSAIDs can ease medication administration and help address barriers to pain management in older patients, such as taking multiple medications and inability to swallow, and are a valuable option for long-term care providers. PMID:22076115

  8. Assessing climate change and socio-economic uncertainties in long term management of water resources

    NASA Astrophysics Data System (ADS)

    Jahanshahi, Golnaz; Dawson, Richard; Walsh, Claire; Birkinshaw, Stephen; Glenis, Vassilis

    2015-04-01

    Long term management of water resources is challenging for decision makers given the range of uncertainties that exist. Such uncertainties are a function of long term drivers of change, such as climate, environmental loadings, demography, land use and other socio economic drivers. Impacts of climate change on frequency of extreme events such as drought make it a serious threat to water resources and water security. The release of probabilistic climate information, such as the UKCP09 scenarios, provides improved understanding of some uncertainties in climate models. This has motivated a more rigorous approach to dealing with other uncertainties in order to understand the sensitivity of investment decisions to future uncertainty and identify adaptation options that are as far as possible robust. We have developed and coupled a system of models that includes a weather generator, simulations of catchment hydrology, demand for water and the water resource system. This integrated model has been applied in the Thames catchment which supplies the city of London, UK. This region is one of the driest in the UK and hence sensitive to water availability. In addition, it is one of the fastest growing parts of the UK and plays an important economic role. Key uncertainties in long term water resources in the Thames catchment, many of which result from earth system processes, are identified and quantified. The implications of these uncertainties are explored using a combination of uncertainty analysis and sensitivity testing. The analysis shows considerable uncertainty in future rainfall, river flow and consequently water resource. For example, results indicate that by the 2050s, low flow (Q95) in the Thames catchment will range from -44 to +9% compared with the control scenario (1970s). Consequently, by the 2050s the average number of drought days are expected to increase 4-6 times relative to the 1970s. Uncertainties associated with urban growth increase these risks further

  9. Ecosystem responses to long-term nutrient management in an urban estuary: Tampa Bay, Florida, USA

    NASA Astrophysics Data System (ADS)

    Greening, H.; Janicki, A.; Sherwood, E. T.; Pribble, R.; Johansson, J. O. R.

    2014-12-01

    In subtropical Tampa Bay, Florida, USA, we evaluated restoration trajectories before and after nutrient management strategies were implemented using long-term trends in nutrient loading, water quality, primary production, and seagrass extent. Following citizen demands for action, reduction in wastewater nutrient loading of approximately 90% in the late 1970s lowered external total nitrogen (TN) loading by more than 50% within three years. Continuing nutrient management actions from public and private sectors were associated with a steadily declining TN load rate and with concomitant reduction in chlorophyll-a concentrations and ambient nutrient concentrations since the mid-1980s, despite an increase of more than 1 M people living within the Tampa Bay metropolitan area. Water quality (chlorophyll-a concentration, water clarity as indicated by Secchi disk depth, total nitrogen concentration and dissolved oxygen) and seagrass coverage are approaching conditions observed in the 1950s, before the large increases in human population in the watershed. Following recovery from an extreme weather event in 1997-1998, water clarity increased significantly and seagrass is expanding at a rate significantly different than before the event, suggesting a feedback mechanism as observed in other systems. Key elements supporting the nutrient management strategy and concomitant ecosystem recovery in Tampa Bay include: 1) active community involvement, including agreement about quantifiable restoration goals; 2) regulatory and voluntary reduction in nutrient loadings from point, atmospheric, and nonpoint sources; 3) long-term water quality and seagrass extent monitoring; and 4) a commitment from public and private sectors to work together to attain restoration goals. A shift from a turbid, phytoplankton-based system to a clear water, seagrass-based system that began in the 1980s following comprehensive nutrient loading reductions has resulted in a present-day Tampa Bay which looks and

  10. Is long-term pharmacist-managed anticoagulation service efficient? A pragmatic randomized controlled trial.

    PubMed

    Lalonde, Lyne; Martineau, Josée; Blais, Normand; Montigny, Martine; Ginsberg, Jeffrey; Fournier, Martine; Berbiche, Djamal; Vanier, Marie-Claude; Blais, Lucie; Perreault, Sylvie; Rodrigues, Isabel

    2008-07-01

    Some pharmacist-managed anticoagulation services (PMAS) provide initial follow-up to patients on oral anticoagulant, who are transferred to their physician once they are stabilized. This may be as effective as and less expensive than long-term PMAS follow-up. Once PMAS patients were stabilized and ready for discharge, they were randomized to be transferred to their physician or stay with the PMAS. Quality of international normalized ratio (INR) control, incidence of complications, health-related quality of life, use of health care services, and direct incremental cost of PMAS follow-up were evaluated. One hundred thirty-eight physicians and 250 patients participated. Patients were initially followed at the PMAS for a mean of 11.3 weeks and afterwards were followed by their physician (n = 122) or by the PMAS pharmacists (n = 128) for a mean of 14.9 and 14.5 weeks, respectively. Pharmacist-managed anticoagulation services' and physician's patients were within the exact target range 77.3% and 76.7% of the time (95% CI of the difference -4.9% to 6.0%) and within the extended range 93.0% and 91.6% of the time (95% CI -2.1% to 4.7%), respectively. Pharmacist-managed anticoagulation services patients have seen their family physician less often (95% CI -3.1 to -0.1 visit per year). Number of INR tests, incidence of complications, and health-related quality of life were similar in both groups. The incremental cost of PMAS follow-up was estimated at CAN$123.80 per patient year. Once PMAS patients are well stabilized, maintaining a PMAS follow-up or transferring them to their physician is associated with excellent INR control. However, long-term PMAS follow-up may be more expensive.

  11. Climate considerations in long-term safety assessments for nuclear waste repositories.

    PubMed

    Näslund, Jens-Ove; Brandefelt, Jenny; Liljedahl, Lillemor Claesson

    2013-05-01

    For a deep geological repository for spent nuclear fuel planned in Sweden, the safety assessment covers up to 1 million years. Climate scenarios range from high-end global warming for the coming 100 000 years, through deep permafrost, to large ice sheets during glacial conditions. In contrast, in an existing repository for short-lived waste the activity decays to low levels within a few tens of thousands of years. The shorter assessment period, 100 000 years, requires more focus on climate development over the coming tens of thousands of years, including the earliest possibility for permafrost growth and freezing of the engineered system. The handling of climate and climate change in safety assessments must be tailor-made for each repository concept and waste type. However, due to the uncertain future climate development on these vast time scales, all safety assessments for nuclear waste repositories require a range of possible climate scenarios.

  12. An International Initiative on Long-Term Behavior of High-Level Nuclear Waste Glass

    SciTech Connect

    Gin, Stephane; Abdelouas, Abdesselam; Criscenti, Louise J; Ebert, William L; Ferrand, K; Geisler, T; Harrison, Michael T; Inagaki, Y; Mitsui, S; Mueller, K T; Marra, James C; Pantano, Carlo G; Pierce, Eric M; Ryan, Joseph V; Schofield, J M; Steefel, Carl I; Vienna, John D.

    2013-01-01

    Nations using borosilicate glass as an immobilization material for radioactive waste have reinforced the importance of scientific collaboration to obtain a consensus on the mechanisms controlling the longterm dissolution rate of glass. This goal is deemed to be crucial for the development of reliable performance assessment models for geological disposal. The collaborating laboratories all conduct fundamental and/or applied research using modern materials science techniques. This paper briefly reviews the radioactive waste vitrification programs of the six participant nations and summarizes the current state of glass corrosion science, emphasizing the common scientific needs and justifications for on-going initiatives.

  13. Method for extracting metals from aqueous waste streams for long term storage

    DOEpatents

    Chaiko, D.J.

    1993-01-01

    A liquid-liquid extraction method for removing metals and hydrous metal colloids from waste streams is provided wherein said waste streams are contacted with a solvent system containing a water-in-oil microemulsion wherein the inverted micelles contain the extracted metal. A silicon alkoxide, either alone or in combination with other metal alkoxide compounds is added to the water-in-oil microemulsion, thereby allowing encapsulation of the extracted metal within a silicon oxide network. Lastly, the now-encapsulated metal is precipitated from the water-in-oil microemulsion phase to yield aggregates of metal-silicate particles having average. individual particle sizes of approximately 40 manometers.

  14. Method for extracting metals from aqueous waste streams for long term storage

    DOEpatents

    Chaiko, D.J.

    1995-03-07

    A liquid-liquid extraction method for removing metals and hydrous metal colloids from waste streams is provided wherein said waste streams are contacted with a solvent system containing a water-in-oil microemulsion wherein the inverted micelles contain the extracted metal. A silicon alkoxide, either alone or in combination with other metal alkoxide compounds is added to the water-in-oil microemulsion, thereby allowing encapsulation of the extracted metal within a silicon oxide network. Lastly, the now-encapsulated metal is precipitated from the water-in-oil microemulsion phase to yield aggregates of metal-silicate particles having average individual particle sizes of approximately 40 nanometers. 2 figs.

  15. Method for extracting metals from aqueous waste streams for long term storage

    DOEpatents

    Chaiko, David J.

    1995-01-01

    A liquid--liquid extraction method for removing metals and hydrous metal colloids from waste streams is provided wherein said waste streams are contacted with a solvent system containing a water-in-oil microemulsion wherein the inverted micelles contain the extracted metal. A silicon alkoxide, either alone or in combination with other metal alkoxide compounds is added to the water-in-oil microemulsion, thereby allowing encapsulation of the extracted metal within a silicon oxide network. Lastly, the now-encapsulated metal is precipitated from the water-in-oil microemulsion phase to yield aggregates of metal-silicate particles having average individual particle sizes of approximately 40 nanometers.

  16. Basalt glass: an analogue for the evaluation of the long-term stability of nuclear waste form borosilicate glasses

    SciTech Connect

    Byers, C.D.; Jercinovic, M.J.; Ewing, R.C.; Keil, K.

    1984-01-01

    The long-term stability of nuclear waste form borosilicate glasses can be evaluated by understanding the processes that effect the long-term alteration of glass and by comparing laboratory alteration of synthetic basalt and borosilicate glasses with the observed stability of naturally occurring basaltic glasses in diverse geologic environments. This paper presents detailed electron microprobe analyses of naturally altered basaltic glasses (with maximum ages of 10,000 to 20 million years) from low-temperature environments. These results are compared to laboratory data on the corrosion of a synthetic basaltic glass in MCC-1 tests (90/sup 0/C, a SA/V of 0.1 cm/sup -1/ and time periods up to 182 days), MCC-2 tests (190/sup 0/C, a SA/V of 0.1 cm/sup -1/ and time periods up to 210 days) and hydration tests in saturated water vapor (240/sup 0/C, an estimated SA/V of approx. 10/sup 6/ cm/sup -1/ and time periods up to 63 days). Additionally, laboratory-induced hydration alteration of synthetic basalt and borosilicate glasses is compared. These preliminary experiments provide evidence that the alteration processes observed for natural basalt glasses are relevant to understanding the alteration of nuclear waste glass, as both appear to react via similar processes. 12 references, 6 figures, 1 table.

  17. Prognosis of intractable epilepsy: is long-term seizure freedom possible with medical management?

    PubMed

    Munger Clary, Heidi; Choi, Hyunmi

    2011-08-01

    Until recently, very little data existed on long-term seizure prognosis of patients with intractable epilepsy. We review recent work that assessed seizure remission in patients with intractable epilepsy during medical management. Recent prevalence cohort studies among adults with longstanding intractable epilepsy have demonstrated notable proportions of patients attaining at least 1-year seizure freedom, ranging from more than 10% to nearly 30% of patients, when followed for mean duration of 18 months to 6 years. Additionally, a recent prospective cohort study of pediatric-onset intractable epilepsy (followed prospectively for seizure outcome from onset of intractability) revealed minimum 1-year seizure remission among more than half of study patients. Despite the notable rates of remission seen among patients with intractable epilepsy, many individuals experienced subsequent seizure relapse. These findings highlight the continued importance of surgical therapy for those who are good candidates and the need for further development of effective therapeutic interventions.

  18. Management of occlusion and thrombosis associated with long-term indwelling central venous catheters

    PubMed Central

    Baskin, Jacquelyn L.; Pui, Ching-Hon; Reiss, Ulrike; Wilimas, Judith A.; Metzger, Monika L.; Ribeiro, Raul C.; Howard, Scott C.

    2010-01-01

    Long-term central venous catheters (CVC) facilitate care for patients with chronic illnesses, but catheter occlusions and catheter-related thrombosis (CRT) are common complications. This review summarizes management of CVC and CRT. Mechanical CVC occlusions require cause-specific therapy; whereas, thrombotic occlusions usually resolve with thrombolytic therapy, such as alteplase. Prophylaxis with thrombolytic flushes may decrease CVC infections and CRT, but confirmatory studies and cost-effectiveness analysis are needed. Risk factors for CRT include previous catheter infections, malposition of the catheter tip, and prothrombotic states. CRT can lead to catheter infection, pulmonary embolism, and post-thrombotic syndrome. CRT is diagnosed primarily using Doppler ultrasound or venography and treated with anticoagulation for 6 weeks to a year, depending on the extent of the thrombus, response to initial therapy, and whether thrombophilic factors persist. Prevention of CRT includes proper positioning of the CVC and prevention of infections; anticoagulation prophylaxis is not recommended at present. PMID:19595350

  19. Long-term experiment with orchard floor management systems: influence on apple yield and chemical composition.

    PubMed

    Slatnar, Ana; Licznar-Malanczuk, Maria; Mikulic-Petkovsek, Maja; Stampar, Franci; Veberic, Robert

    2014-05-07

    The study focuses on the response of apple primary and secondary metabolism and some important quality parameters to three living mulch treatments, classical herbicide fallow, and black polypropylene strip application in two apple cultivars. Primary and secondary metabolites were analyzed after 10 years of ground cover experiments. Soluble solids, firmness, and color measurements indicate differences among orchard floor management treatments. Significantly, lower levels of individual sugars have been measured in fruit of different living mulch treatments compared with fruit harvested from trees subjected to the herbicide strip treatment. Total sugar content was higher in fruit of the herbicide strip treatment in both cultivars analyzed. Significantly higher levels of total organic acids were only detected in 'Pinova' fruit of the Festuca ovina L. treatment. Long-term response of both cultivars to living mulch treatments indicated that apples increase the accumulation of almost all analyzed individual phenolic compounds.

  20. Topical bromfenac sodium for long-term management of vernal keratoconjunctivitis.

    PubMed

    Uchio, Eiichi; Itoh, Yuki; Kadonosono, Kazuaki

    2007-01-01

    We evaluated the efficacy and safety of long-term management of patients with vernal keratoconjunctivitis (VKC) with bromfenac sodium eye drops in combination with corticosteroids and anti-allergic eye drops. Twenty-two patients with VKC were randomly assigned to receive two test eye drops, either bromfenac sodium 0.1% (group A) or placebo eye drops (normal saline; group B) for a mean observation period of 20.9 months. Topical corticosteroids and mast cell stabilizers were continued during the observation period. The mean 2-year recurrence rate was 90.9% in group A and 11.3% in group B, with a significant difference. No serious side effect was observed in group A. These results suggest that bromfenac sodium eye drops can be used as baseline local treatment in patients with VKC. Copyright (c) 2007 S. Karger AG, Basel.

  1. Update on osteoporosis management in long-term care: focus on bisphosphonates.

    PubMed

    Kamel, Hosam K

    2007-09-01

    Osteoporotic fractures are potentially devastating and associated with high morbidity and substantial economic burden. Residents of long-term care facilities are at greater risk of osteoporosis and its related fractures than those living in the community, yet osteoporosis is underdiagnosed and undertreated in these settings. Bisphosphonates are approved by the Food and Drug Administration for the treatment and prevention of osteoporosis in postmenopausal women. As a class, bisphosphonates have been shown to increase bone mineral density, decrease the markers of bone resorption, and reduce the risk of osteoporotic fractures. The 3 approved bisphosphonates are alendronate, risedronate, and ibandronate. Alendronate and risedronate are dosed daily or weekly and ibandronate, the most recently approved bisphosphonate, has been approved for monthly oral dosing or as an intravenous formulation to be given intermittently (every 3 months). In addition, other products with different mechanisms of action are in the pharmaceutical pipeline and may offer additional management options.

  2. Multidisciplinary management and long-term follow-up of mesiodens: a case report.

    PubMed

    Cogulu, Dilsah; Yetkiner, Enver; Akay, Cemal; Seckin, Ozlem; Alpoz, Riza

    2008-01-01

    Supernumerary teeth are relatively common in the oral cavity and are characterized by an excessive number of teeth. The term "mesiodens" refers to a supernumerary tooth located in the midline of the maxilla between the central incisors. Mesiodens may cause a variety of pathological complications such as impaction of the maxillary central incisors, tooth retention or delayed eruption of the permanent incisors, crowding, eruption within the nasal cavity, formation of diastema, intraoral infection, root anomaly, root resorption of adjacent teeth and cyst formation accompanied by bone destruction. Therefore it is recommended to follow-up with regular radiographic examination. Early diagnosis minimizes treatment needs and prevents associated complications. The present case, followed for 7 years, presented bilateral mesiodens resulting in delayed eruption of the permanent incisors and emphasizes the importance of multidisciplinary management and long-term follow-up.

  3. The strategic skills of business continuity managers: putting business continuity management into corporate long-term planning.

    PubMed

    Wong, Wei Ning Zechariah

    2009-11-01

    Despite its rapid development in the last two decades, business continuity management (BCM) as a discipline and a profession is still regarded by many as an operational entity of management. Two main issues are discussed in this paper: the role of BCM in strategic management and the strategic skills of business continuity managers. These issues are crucial as they represent the role of BCM in high-level corporate management. The paper discusses the importance of BCM in the long-term planning of organisational success and the preservation of future competitiveness. Finally, salient points that underpin the importance of its role in sustaining organisational performance are addressed.

  4. Understanding long-term variations in an elephant piosphere effect to manage impacts.

    PubMed

    Landman, Marietjie; Schoeman, David S; Hall-Martin, Anthony J; Kerley, Graham I H

    2012-01-01

    Surface water availability is a key driver of elephant impacts on biological diversity. Thus, understanding the spatio-temporal variations of these impacts in relation to water is critical to their management. However, elephant piosphere effects (i.e. the radial pattern of attenuating impact) are poorly described, with few long-term quantitative studies. Our understanding is further confounded by the complexity of systems with elephant (i.e. fenced, multiple water points, seasonal water availability, varying population densities) that likely limit the use of conceptual models to predict these impacts. Using 31 years of data on shrub structure in the succulent thickets of the Addo Elephant National Park, South Africa, we tested elephant effects at a single water point. Shrub structure showed a clear sigmoid response with distance from water, declining at both the upper and lower limits of sampling. Adjacent to water, this decline caused a roughly 300-m radial expansion of the grass-dominated habitats that replace shrub communities. Despite the clear relationship between shrub structure and ecological functioning in thicket, the extent of elephant effects varied between these features with distance from water. Moreover, these patterns co-varied with other confounding variables (e.g. the location of neighboring water points), which limits our ability to predict such effects in the absence of long-term data. We predict that elephant have the ability to cause severe transformation in succulent thicket habitats with abundant water supply and elevated elephant numbers. However, these piosphere effects are complex, suggesting that a more integrated understanding of elephant impacts on ecological heterogeneity may be required before water availability is used as a tool to manage impacts. We caution against the establishment of water points in novel succulent thicket habitats, and advocate a significant reduction in water provisioning at our study site, albeit with greater

  5. Understanding long-term fruit fly (Diptera: Tephritidae) population dynamics: implications for areawide management.

    PubMed

    Aluja, Martín; Ordano, Mariano; Guillén, Larissa; Rull, Juan

    2012-06-01

    Fruit flies (Diptera: Tephritidae) are devastating agricultural pests worldwide but studies on their long-term population dynamics are sparse. Our aim was to determine the mechanisms driving long-term population dynamics as a prerequisite for ecologically based areawide pest management. The population density of three pestiferous Anastrepha species [Anastrepha ludens (Loew), Anastrepha obliqua (Macquart), and Anastrepha serpentina (Wiedemann)] was determined in grapefruit (Citrus x paradisi Macfad.), mango (Mangifera indica L.), and sapodilla [Manilkara zapota (L.) P. Royen] orchards in central Veracruz, México, on a weekly basis over an 11-yr period. Fly populations exhibited relatively stable dynamics over time. Population dynamics were mainly driven by a direct density-dependent effect and a seasonal feedback process. We discovered direct and delayed influences that were correlated with both local (rainfall and air temperature) and global climatic variation (El Niño Southern Oscillation [ENSO] and North Atlantic Oscillation [NAO]), and detected differences among species and location of orchards with respect to the magnitude and nature (linear or nonlinear) of the observed effects, suggesting that highly mobile pest outbreaks become uncertain in response to significant climatic events at both global and local levels. That both NAO and ENSO affected Anastrepha population dynamics, coupled with the high mobility of Anastrepha adults and the discovery that when measured as rate of population change, local population fluctuations exhibited stable dynamics over time, suggests potential management scenarios for the species studied lie beyond the local scale and should be approached from an areawide perspective. Localized efforts, from individual growers will probably prove ineffective, and nonsustainable.

  6. Understanding Long-Term Variations in an Elephant Piosphere Effect to Manage Impacts

    PubMed Central

    Landman, Marietjie; Schoeman, David S.; Hall-Martin, Anthony J.; Kerley, Graham I. H.

    2012-01-01

    Surface water availability is a key driver of elephant impacts on biological diversity. Thus, understanding the spatio-temporal variations of these impacts in relation to water is critical to their management. However, elephant piosphere effects (i.e. the radial pattern of attenuating impact) are poorly described, with few long-term quantitative studies. Our understanding is further confounded by the complexity of systems with elephant (i.e. fenced, multiple water points, seasonal water availability, varying population densities) that likely limit the use of conceptual models to predict these impacts. Using 31 years of data on shrub structure in the succulent thickets of the Addo Elephant National Park, South Africa, we tested elephant effects at a single water point. Shrub structure showed a clear sigmoid response with distance from water, declining at both the upper and lower limits of sampling. Adjacent to water, this decline caused a roughly 300-m radial expansion of the grass-dominated habitats that replace shrub communities. Despite the clear relationship between shrub structure and ecological functioning in thicket, the extent of elephant effects varied between these features with distance from water. Moreover, these patterns co-varied with other confounding variables (e.g. the location of neighboring water points), which limits our ability to predict such effects in the absence of long-term data. We predict that elephant have the ability to cause severe transformation in succulent thicket habitats with abundant water supply and elevated elephant numbers. However, these piosphere effects are complex, suggesting that a more integrated understanding of elephant impacts on ecological heterogeneity may be required before water availability is used as a tool to manage impacts. We caution against the establishment of water points in novel succulent thicket habitats, and advocate a significant reduction in water provisioning at our study site, albeit with greater

  7. Pain Management in Long-Term Care Communities: A Quality Improvement Initiative

    PubMed Central

    Reid, M C; O’Neil, Kevin W.; Dancy, JaNeen; Berry, Carolyn A.; Stowell, Stephanie A.

    2015-01-01

    Pain is underrecognized and undertreated in the long-term care (LTC) setting. To improve the management of pain for LTC residents, the authors implemented a quality improvement (QI) initiative at one LTC facility. They conducted a needs assessment to identify areas for improvement and designed a 2-hour educational workshop for facility staff and local clinicians. Participants were asked to complete a survey before and after the workshop, which showed significant improvement in their knowledge of pain management and confidence in their ability to recognize and manage residents’ pain. To measure the effectiveness of the QI initiative, the authors performed a chart review at baseline and at 3 and 8 months after the workshop and evaluated relevant indicators of adequate pain assessment and management. The post-workshop chart reviews showed significant improvement in how consistently employees documented pain characteristics (ie, location, intensity, duration) in resident charts and in their use of targeted pain assessments for residents with cognitive dysfunction. The proportion of charts that included a documented plan for pain assessment was high at baseline and remained stable throughout the study. Overall, the findings suggest a QI initiative is an effective way to improve pain care practices in the LTC setting. PMID:25949232

  8. Hellsgate Winter Range Mitigation Project; Long-term Management Plan, Project Report 1993, Final Draft.

    SciTech Connect

    Berger, Matthew T.

    1994-01-01

    A study was conducted on the Hellsgate Winter Range Mitigation Project area, a 4,943 acre ranch purchased for mitigating some habitat losses associated with the original construction of Grand Coulee Dam and innundation of habitat by Lake Roosevelt. A Habitat Evaluation Procedure (HEP) study was used to determine habitat quality and quantity baseline data and future projections. Target species used in the study were sharp-tailed grouse (Tympanuchus phasianellus), mule deer (Odocoileus hemoinus), mink (Mustela vison), spotted sandpiper (Actiius colchicus), bobcat (Felis reufs), blue grouse (Dendragapus obscurus), and mourning dove (Zenaida macroura). From field data collected, limiting life values or HSI's (Habitat Suitability Index's) for each indicator species was determined for existing habitats on project lands. From this data a long term management plan was developed. This report is designed to provide guidance for the management of project lands in relation to the habitat cover types discussed and the indicator species used to evaluate these cover types. In addition, the plan discusses management actions, habitat enhancements, and tools that will be used to enhance, protect and restore habitats to desired conditions. Through planned management actions biodiversity and vegetative structure can be optimized over time to reduce or eliminate, limiting HSI values for selected wildlife on project lands.

  9. Long-term modeling of glass waste in portland cement- and clay-based matrices

    SciTech Connect

    Stockman, H.W.; Nagy, K.L.; Morris, C.E.

    1995-12-01

    A set of ``templates`` was developed for modeling waste glass interactions with cement-based and clay-based matrices. The templates consist of a modified thermodynamic database, and input files for the EQ3/6 reaction path code, containing embedded rate models and compositions for waste glass, cement, and several pozzolanic materials. Significant modifications were made in the thermodynamic data for Th, Pb, Ra, Ba, cement phases, and aqueous silica species. It was found that the cement-containing matrices could increase glass corrosion rates by several orders of magnitude (over matrixless or clay matrix systems), but they also offered the lowest overall solubility for Pb, Ra, Th and U. Addition of pozzolans to cement decreased calculated glass corrosion rates by up to a factor of 30. It is shown that with current modeling capabilities, the ``affinity effect`` cannot be trusted to passivate glass if nuclei are available for precipitation of secondary phases that reduce silica activity.

  10. CORROSION RELIABILITY PREDICTION: LONG TERM NUCLEAR WASTE STORAGE IN YUCCA MOUNTAIN

    SciTech Connect

    G.S. Frankel; E. Tada; B. Maier

    2005-08-18

    The US. Department of Energy has proposed the disposal of high level nuclear waste from commercial and defense reactors in a mined geologic repository under Yucca Mountain, Nevada. The waste will be stored in metallic canisters. The barrier against corrosion will be an Alloy 22 canister and a Ti Grade 7 drip shield. Both of these materials are extremely corrosion resistant. The environment inside Yucca Mountain is relatively benign, but the long time period over which these materials must resist penetration makes corrosion a concern. This paper presents a background of the corrosion issues and shows some recent results regarding measurements of localized corrosion under thin aqueous layers and layers that simulate wet dust deposits.

  11. On becoming a coach: a pilot intervention study with managers in long-term care.

    PubMed

    Cummings, Greta; Mallidou, Anastasia A; Masaoud, Elmabrok; Kumbamu, Ashok; Schalm, Corinne; Spence Laschinger, Heather K; Estabrooks, Carole A

    2014-01-01

    Health care leaders have called for the development of communication and leadership skills to improve manager-employee relationships, employee job satisfaction, quality care, and work environments. The aim of the study reported here was to pilot how a 2-day coaching workshop ("Coaching for Impressive CARE") conducted as a leadership development strategy influenced frontline care managers' coaching practices in residential long-term care (LTC) settings. We had four objectives: (a) to identify managers' perceptions of their role as a coach of employee performance in LTC facilities, (b) to understand managers' intentions to coach employee performance, (c) to examine opportunities and factors that contributed to or challenged implementation of workshop coaching skills in daily leadership/management practice, and (d) to examine managers' reports of using coaching practices and employee responses after the workshop. We used an exploratory/descriptive design involving pre-/post-workshop surveys, e-mail reminders, and focus groups to examine participation of 21 LTC managers in a 2-day coaching workshop and their use of coaching practices in the workplace. Focus group findings provided examples of how participants used their coaching skills in practice (e.g., communicating empathy) and how staff responded. Factors contributing to and challenging implementation of these coaching skills in the workplace were identified. Attitudes and intentions to be a coach increased significantly, and some coaching skills were used more frequently after the workshop, specifically planning for performance change with employees. The coaching workshop was feasible to implement, well received by participants, influenced their willingness to become coaches, and had some noted impact on their use of coaching behaviors in the workplace. Coaching skills by managers to improve staff performance with residents in LTC facilities can be learned.

  12. Flow barrier system for long-term high-level-waste isolation: Experimental results

    SciTech Connect

    Conca, J.L.; Apted, M.J.; Zhou, W.; Arthur, R.C.; Kessler, J.H.

    1998-10-01

    A flow barrier system (FBS) that includes a Richards barrier acts in an unsaturated hydrogeologic system to prevent the advective flow of water down through the barrier. Thus, an FBS placed above any solid waste material buried in the unsaturated zone could greatly aid in isolating the waste by keeping the waste away from flowing water. The FBS, consisting of a layer of highly conductive, fine-grained material overlying a sloped gravel layer, is proposed to isolate high-level radioactive waste (HLW) at a candidate disposal facility located in the unsaturated zone at Yucca Mountain in Nevada. A series of laboratory experiments were conducted to (a) assure that the FBS of a specific design can divert the anticipated maximum advective flow (under ideal conditions as well as for the case of a disturbed interface between the two layers caused by, for example, improper initial emplacement or faulting due to seismic activity), (b) investigate water inhibition into the gravel, and (c) measure the diffusion coefficient of the tuff gravel under partially saturated conditions. The main results show that (a) the FBS used in the study can divert point-source flow rates as high as 2.6 {times} 10{sup 5} {ell}/yr; (b) this FBS will continue performing with offsets of the interface as great as 50 cm or more; (c) after 12 months of testing, moisture penetrates the gravel only several grain diameters; and (d) the gravel effective diffusion coefficient is <10{sup {minus}11} cm{sup 2}/s under such low partial saturations. These results indicate that a properly designed FBS can be successful at isolating the HLW under the anticipated range of environmental conditions that exist both now and in the future at Yucca Mountain.

  13. Long-Term Environmental Monitoring of an Operating Deep Geologic Nuclear Waste Repository

    SciTech Connect

    Conca, J.; Kirchner, Th.; Monk, J.; Sage, S.

    2008-07-01

    In the present energy dilemma in which we find ourselves, the magnitude of humanity's energy needs requires that we embrace a multitude of various energy sources and applications. Nuclear energy must be a major portion of the distribution. One often-cited strategic hurdle to the commercial production of nuclear energy is the apparent lack of an acceptable nuclear waste repository. This issue has been quietly addressed at the U. S. Department of Energy (DOE) Waste Isolation Pilot Plant (WIPP; see http://www.wipp.energy.gov), the closest population center of significant size being Carlsbad, New Mexico. WIPP has been operating for about nine years, disposing of over 250,000 drum-equivalents of nuclear waste. From the standpoint of addressing operational and environmental risk, as well as public fear, WIPP has had extensive human health and environmental monitoring. The Carlsbad Environmental Monitoring and Research Center is in the Institute for Energy and the Environment, in the College of Engineering at New Mexico State University. Located in Carlsbad, NM, CEMRC has been the independent monitoring facility for the area around WIPP from 1993 to the present, i.e., from six years before disposal operations began to nine years of waste disposal operations (www.cemcr.org). Based on the radiological analyses of monitoring samples completed to date for area residents and site workers, and for selected aerosols, soils, sediments, drinking water and surface waters, there is no evidence of increases in radiological contaminants in the region of WIPP that could be attributed to releases from WIPP. Levels of radiological and non-radiological analytes measured since operations began in 1999 have been within the range of baseline levels measured previously, and are within the ranges measured by other entities at the State and local levels since well before disposal phase operations began in 1999. (authors)

  14. Establishing Long Term Data Management Research Priorities via a Data Decadal Survey

    NASA Astrophysics Data System (ADS)

    Wilson, A.; Uhlir, P.; Meyer, C. B.; Robinson, E.

    2013-12-01

    We live in a time of unprecedented collection of and access to scientific data. Improvements in sensor technologies and modeling capabilities are constantly producing new data sources. Data sets are being used for unexpected purposes far from their point of origin, as research spans projects, discipline domains, and temporal and geographic boundaries. The nature of science is evolving, with more open science, open publications, and changes to the nature of peer review and data "publication". Data-intensive, or computational science, has been identified as a new research paradigm. There is recognition that the creation of a data set can be a contribution to science deserving of recognition comparable to other scientific publications. Federally funded projects are generally expected to make their data open and accessible to everyone. In this dynamic environment, scientific progress is ever more dependent on good data management practices and policies. Yet current data management and stewardship practices are insufficient. Data sets created at great, and often public, expense are at risk of being lost for technological or organizational reasons. Insufficient documentation and understanding of data can mean that the data are used incorrectly or not at all. Scientific results are being scrutinized and questioned, and occasionally retracted due to problems in data management. The volume of data is greatly increasing while funding for data management is meager and generally must be found within existing budgets. Many federal government agencies, including NASA, USGS, NOAA and NSF are already making efforts to address data management issues. Executive memos and directives give substantial impetus to those efforts, such as the May 9 Executive Order directing agencies to implement Open Data Policy requirements and regularly report their progress. However, these distributed efforts risk duplicating effort, lack a unifying, long-term strategic vision, and too often work in

  15. Cross-Site Transfer System at Hanford: long-term strategy for waste acceptance

    SciTech Connect

    Shekarriz, A; Onishi, Y.; Smith, P.A.; Sterner, M.; Rector, D.R.; Virden, J.

    1997-02-01

    This report summarizes results of a technical panel review of the current methodology for accepting waste for transport through the Hanford Replacement Cross-Site Transfer System (RCSTS), which was constructed to replace the existing pipelines that hydraulically connect the 200 West and 200 East areas. This report is a complement to an existing document (Hudson 1996); the methodology proposed in that document was refined based on panel recommendations. The refinements were focused around predicting and preventing the 3 main modes suspected of plugging the existing CSTS: precipitation, gelation, particle dropout/settling. The proposed analysis will require integration of computer modeling and laboratory experiments to build a defensible case for transportability of a proposed slurry composition for a given tank. This will be validated by recirculating actual tank waste, in-tank and in-farm, prior to transport. The panel`s recommendation was that the probability of success of waste transfer would be greatly improved by integrating the predictive analysis with real-time control during RCSTS operation. The methodology will be optimized.

  16. Resolution of the long-term performance issues at the Waste Isolation Pilot Plant

    SciTech Connect

    Silva, M.K.; Rucker, D.F.; Chaturvedi, L.

    1999-10-01

    The Waste Isolation Pilot Plant (WIPP) is a geological repository for disposal of U.S. defense transuranic radioactive waste. Built and operated by the U.S. Department of Energy (DOE), it is located in the Permian age salt beds in southeastern New Mexico at a depth of 655 m. Performance assessment for the repository's compliance with the 10,000-year containment standards was completed in 1996 and the US Environmental Protection Agency (EPA) certified in 1998 that the repository meets compliance with the EPA standards 40 CFR 191 and 40 CFR 194. The Environmental Evaluation Group (EEG) review of the DOE's application for certification identified a number of issues. These related to the scenarios, conceptual models, and values of the input parameters used in the calculations. It is expected that these issues will be addressed and resolved during the first 5-year recertification process that began with the first receipt of waste at WIPP on March 26, 1999, and scheduled to be completed in March 2004.

  17. Engineering analysis report for the long-term management of depleted uranium hexafluoride : storage of depleted uranium metal.

    SciTech Connect

    Folga, S.M.; Kier, P.H.; Thimmapuram, P.R.

    2001-01-24

    This report contains an engineering analysis of long-term storage of uranium metal in boxes as an option for long-term management of depleted uranium hexafluoride (UF{sub 6}). Three storage facilities are considered: buildings, vaults, and mined cavities. Three cases are considered: either all, half, or a quarter of the depleted uranium metal that would be produced from the conversion of depleted UF{sub 6} is stored at the facility. The analysis of these alternatives is based on a box design used in the Final Programmatic Environmental Impact Statement for Alternative Strategies for the Long-Term Management and Use of Depleted Uranium Hexafluoride, report DOE/EIS-0269, published in 1999 by the US Department of Energy. This box design does not appear to effectively use space within the box. Hence, an alternative box design that allows for a reduced storage area is addressed in the appendices for long-term storage in buildings.

  18. Mobile phone messaging for facilitating self-management of long-term illnesses.

    PubMed

    de Jongh, Thyra; Gurol-Urganci, Ipek; Vodopivec-Jamsek, Vlasta; Car, Josip; Atun, Rifat

    2012-12-12

    Long-term illnesses affect a significant proportion of the population in developed and developing countries. Mobile phone messaging applications, such as Short Message Service (SMS) and Multimedia Message Service (MMS), may present convenient, cost-effective ways of supporting self-management and improving patients' self-efficacy skills through, for instance, medication reminders, therapy adjustments or supportive messages. To assess the effects of mobile phone messaging applications designed to facilitate self-management of long-term illnesses, in terms of impact on health outcomes and patients' capacity to self-manage their condition. Secondary objectives include assessment of: user evaluation of the intervention; health service utilisation and costs; and possible risks and harms associated with the intervention. We searched the Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library 2009, Issue 2), MEDLINE (OvidSP) (January 1993 to June 2009), EMBASE (OvidSP) (January 1993 to June 2009), PsycINFO (OvidSP) (January 1993 to June 2009), CINAHL (EbscoHOST) (January 1993 to June 2009), LILACS (January 1993 to June 2009) and African Health Anthology (January 1993 to June 2009).We also reviewed grey literature (including trial registers) and reference lists of articles. We included randomised controlled trials (RCTs), quasi-randomised controlled trials (QRCTs), controlled before-after (CBA) studies, or interrupted time series (ITS) studies with at least three time points before and after the intervention. We selected only studies where it was possible to assess the effects of mobile phone messaging independent of other technologies or interventions. Two review authors independently assessed all studies against the inclusion criteria, with any disagreements resolved by a third review author. Study design features, characteristics of target populations, interventions and controls, and results data were extracted by two review authors and confirmed by

  19. Managing long-term polycyclic aromatic hydrocarbon contaminated soils: a risk-based approach.

    PubMed

    Duan, Luchun; Naidu, Ravi; Thavamani, Palanisami; Meaklim, Jean; Megharaj, Mallavarapu

    2015-06-01

    Polycyclic aromatic hydrocarbons (PAHs) are a family of contaminants that consist of two or more aromatic rings fused together. Soils contaminated with PAHs pose significant risk to human and ecological health. Over the last 50 years, significant research has been directed towards the cleanup of PAH-contaminated soils to background level. However, this achieved only limited success especially with high molecular weight compounds. Notably, during the last 5-10 years, the approach to remediate PAH-contaminated soils has changed considerably. A risk-based prioritization of remediation interventions has become a valuable step in the management of contaminated sites. The hydrophobicity of PAHs underlines that their phase distribution in soil is strongly influenced by factors such as soil properties and ageing of PAHs within the soil. A risk-based approach recognizes that exposure and environmental effects of PAHs are not directly related to the commonly measured total chemical concentration. Thus, a bioavailability-based assessment using a combination of chemical analysis with toxicological assays and nonexhaustive extraction technique would serve as a valuable tool in risk-based approach for remediation of PAH-contaminated soils. In this paper, the fate and availability of PAHs in contaminated soils and their relevance to risk-based management of long-term contaminated soils are reviewed. This review may serve as guidance for the use of site-specific risk-based management methods.

  20. The effect of physicians' long-term use of CPOE on their test management work practices.

    PubMed

    Callen, Joanne L; Westbrook, Johanna I; Braithwaite, Jeffrey

    2006-01-01

    To explore physicians' work practices in relation to their long-term use of a computerized physician order entry system (CPOE). A cross-sectional qualitative study was conducted in four clinical units in two large Australian teaching hospitals. One hospital had used CPOE for over 10 years to order all clinical laboratory and radiology tests and view test results and the other had used the computerized viewing facility of the system for over seven years with tests ordered manually. Data were collected by non-participatory observations of physicians (55 sessions) and 28 interviews. Content analysis of the observation field notes, reflections on observations and interview transcripts were conducted by two researchers independently. A thematic grounded theory approach was used to derive key themes that would explain physicians work practices associated with CPOE use. Three themes relating to physicians' established use of CPOE were identified: (1) the effect of the hospital and clinical environment; (2) changes to work practices; and (3) physicians' management of information. Physicians' test management work practices using CPOE were related to diversity between: the hospitals; the clinical units' environment, and the users of the system. Hospitals need to understand and analyze physicians' test management work practices prior to and during the implementation of CPOE to accommodate their diverse ways of working with computerized information systems. In the current mixed media environment, physicians' use of manual and computerized information systems for sourcing and recording information impacts on efficiency and patient safety.

  1. The Effect of Physicians’ Long-term Use of CPOE on Their Test Management Work Practices

    PubMed Central

    Callen, Joanne L.; Westbrook, Johanna I.; Braithwaite, Jeffrey

    2006-01-01

    Objective To explore physicians’ work practices in relation to their long-term use of a computerized physician order entry system (CPOE). Design A cross-sectional qualitative study was conducted in four clinical units in two large Australian teaching hospitals. One hospital had used CPOE for over 10 years to order all clinical laboratory and radiology tests and view test results and the other had used the computerized viewing facility of the system for over seven years with tests ordered manually. Data were collected by non-participatory observations of physicians (55 sessions) and 28 interviews. Measurements Content analysis of the observation field notes, reflections on observations and interview transcripts were conducted by two researchers independently. A thematic grounded theory approach was used to derive key themes that would explain physicians work practices associated with CPOE use. Results Three themes relating to physicians’ established use of CPOE were identified: (1) the effect of the hospital and clinical environment; (2) changes to work practices; and (3) physicians’ management of information. Physicians’ test management work practices using CPOE were related to diversity between: the hospitals; the clinical units’ environment, and the users of the system. Conclusion Hospitals need to understand and analyze physicians’ test management work practices prior to and during the implementation of CPOE to accommodate their diverse ways of working with computerized information systems. In the current mixed media environment, physicians’ use of manual and computerized information systems for sourcing and recording information impacts on efficiency and patient safety. PMID:16929035

  2. Vegetation cover and long-term conservation of radioactive waste packages: the case study of the CSM waste disposal facility (Manche District, France).

    PubMed

    Petit-Berghem, Yves; Lemperiere, Guy

    2012-03-01

    The CSM is the first French waste disposal facility for radioactive waste. Waste material is buried several meters deep and protected by a multi-layer cover, and equipped with a drainage system. On the surface, the plant cover is a grassland vegetation type. A scientific assessment has been carried out by the Géophen laboratory, University of Caen, in order to better characterize the plant cover (ecological groups and associated soils) and to observe its medium and long term evolution. Field assessments made on 10 plots were complemented by laboratory analyses carried out over a period of 1 year. The results indicate scenarios and alternative solutions which could arise, in order to passively ensure the long-term safety of the waste disposal system. Several proposals for a blanket solution are currently being studied and discussed, under the auspices of international research institutions in order to determine the most appropriate materials for the storage conditions. One proposal is an increased thickness of these materials associated with a geotechnical barrier since it is well adapted to the forest plants which are likely to colonize the site. The current experiments that are carried out will allow to select the best option and could provide feedback for other waste disposal facility sites already being operated in France (CSFMA waste disposal facility, Aube district) or in other countries.

  3. Vegetation Cover and Long-Term Conservation of Radioactive Waste Packages: The Case Study of the CSM Waste Disposal Facility (Manche District, France)

    NASA Astrophysics Data System (ADS)

    Petit-Berghem, Yves; Lemperiere, Guy

    2012-03-01

    The CSM is the first French waste disposal facility for radioactive waste. Waste material is buried several meters deep and protected by a multi-layer cover, and equipped with a drainage system. On the surface, the plant cover is a grassland vegetation type. A scientific assessment has been carried out by the Géophen laboratory, University of Caen, in order to better characterize the plant cover (ecological groups and associated soils) and to observe its medium and long term evolution. Field assessments made on 10 plots were complemented by laboratory analyses carried out over a period of 1 year. The results indicate scenarios and alternative solutions which could arise, in order to passively ensure the long-term safety of the waste disposal system. Several proposals for a blanket solution are currently being studied and discussed, under the auspices of international research institutions in order to determine the most appropriate materials for the storage conditions. One proposal is an increased thickness of these materials associated with a geotechnical barrier since it is well adapted to the forest plants which are likely to colonize the site. The current experiments that are carried out will allow to select the best option and could provide feedback for other waste disposal facility sites already being operated in France (CSFMA waste disposal facility, Aube district) or in other countries.

  4. Integrating basic research and long-term management: a case study using avian research at the Savannah River Site

    Treesearch

    John B. Dunning; John C. Kilgo

    2000-01-01

    In this introduction to Avian Research at the Savannah River Site: A Model for Integrating Basic Research and Long-term Management, editors Dunning and Kilgo discuss the interrelationship between research and management at the Savannah River Site. They emphasize the increasing need for collaboration between scientists and land managers....

  5. Key Performance Criteria Affecting the Most the Safety of a Nuclear Waste Long Term Storage : A Case Study Commissioned by CEA

    SciTech Connect

    Marvy, A.; Lioure, A; Heriard-Dubreuil, G.; Gadbois, S.; Schneider, T.; Schieber, C.

    2003-02-24

    As part of the work scope set in the French law on high level long lived waste R&D passed in 1991, CEA is conducting a research program to establish the scientific basis and assess the feasibility of long term storage as an option for the safe management of nuclear waste for periods as long as centuries. This goal is a significant departure from the current industrial practice where storage facilities are usually built to last only a few decades. From a technical viewpoint such an extension in time seems feasible provided care and maintenance is exercised. Considering such long periods of time, the risk for Society of loosing oversight and control of such a facility is real, which triggers the question of whether and how long term storage safety can be actually achieved. Therefore CEA commissioned a study (1) in which MUTADIS Consultants (2) and CEPN (3) were both involved. The case study looks into several past and actual human enterprises conducted over significant periods o f time, one of them dating back to the end of the 18th century, and all identified out of the nuclear field. Then-prevailing societal behavior and organizational structures are screened out to show how they were or are still able to cope with similar oversight and control goals. As a result, the study group formulated a set of performance criteria relating to issues like responsibility, securing funds, legal and legislative implications, economic sustainable development, all being areas which are not traditionally considered as far as technical studies are concerned. These criteria can be most useful from the design stage onward, first in an attempt to define the facility construction and operating guiding principles, and thereafter to substantiate the safety case for long term storage and get geared to the public dialogue on that undertaking should it become a reality.

  6. Incorporating long-term climate change in performance assessment for the Waste Isolation Pilot Plant

    SciTech Connect

    Swift, P.N.; Baker, B.L.; Economy, K.; Garner, J.W.; Helton, J.C.; Rudeen, D.K.

    1993-09-18

    The United States Department of Energy (DOE) is developing the Waste Isolation Pilot Plant (WIPP) in southeastern New Mexico for the disposal of transuranic wastes generated by defense programs. Applicable regulations (40 CFR 191) require the DOE to evaluate disposal-system performance for 10,000 yr. Climatic changes may affect performance by altering groundwater flow. Paleoclimatic data from southeastern New Mexico and the surrounding area indicate that the wettest and coolest Quaternary climate at the site can be represented by that at the last glacial maximum, when mean annual precipitation was approximately twice that of the present. The hottest and driest climates have been similar to that of the present. The regularity of global glacial cycles during the late Pleistocene confirms that the climate of the last glacial maximum is suitable for use as a cooler and wetter bound for variability during the next 10,000 yr. Climate variability is incorporated into groundwater-flow modeling for WIPP PA by causing hydraulic head in a portion of the model-domain boundary to rise to the ground surface with hypothetical increases in precipitation during the next 10,000 yr. Variability in modeled disposal-system performance introduced by allowing head values to vary over this range is insignificant compared to variability resulting from other causes, including incomplete understanding of transport processes. Preliminary performance assessments suggest that climate variability will not affect regulatory compliance.

  7. Incorporating long-term climate change in performance assessment for the Waste Isolation Pilot Plant

    SciTech Connect

    Swift, P.N.; Baker, B.L.; Economy, K.; Garner, J.W.; Helton, J.C.; Rudeen, D.K.

    1994-03-01

    The United States Department of Energy (DOE) is developing the Waste Isolation Pilot Plant (WIPP) in southeastern New Mexico for the disposal of transuranic wastes generated by defense programs. Applicable regulations (40 CFR 191) require the DOE to evaluate disposal-system performance for 10,000 yr. Climatic changes may affect performance by altering groundwater flow. Paleoclimatic data from southeastern New Mexico and the surrounding area indicate that the wettest and coolest Quaternary climate at the site can be represented by that at the last glacial maximum, when mean annual precipitation was approximately twice that of the present. The hottest and driest climates have been similar to that of the present. The regularity of global glacial cycles during the late Pleistocene confirms that the climate of the last glacial maximum is suitable for use as a cooler and wetter bound for variability during the next 10,000 yr. Climate variability is incorporated into groundwater-flow modeling for WIPP PA by causing hydraulic head in a portion of the model-domain boundary to rise to the ground surface with hypothetical increases in precipitation during the next 10,000 yr. Variability in modeled disposal-system performance introduced by allowing had values to vary over this range is insignificant compared to variability resulting from other causes, including incomplete understanding of transport processes. Preliminary performance assessments suggest that climate variability will not affect regulatory compliance.

  8. Comparison of TCLP and long-term PCT performance on low-level mixed waste glasses

    SciTech Connect

    Cicero, C.A.; Andrews, M.K.; Bickford, D.F.

    1994-06-01

    The Mixed Waste Integrated Program (MWIP) of the US Department of Energy (DOE) is currently investigating technologies for conversion of low-level mixed waste (LLMW) into a form suitable for permanent disposal. Vitrification is one of the preferred technologies since it is capable of consistently producing a durable, leach resistant wasteform, while simultaneously minimizing disposal volumes. Since vitrification of LLMW is a relatively new concept, final wasteform specifications have not been developed. The Savannah River Technology Center (SRTC) of the Westinghouse Savannah River Company (WSRC) has developed the Product Consistency Test (PCI), which is a 7-day leaching procedure for glass. Comparison indicates that both tests have merit where LLMW glasses are concerned. The TCLP is an important test for determining the release of metals and for allowing the wasteform to be delisted while the PCT is more useful for determining consistent production of durable glass. It is a better indicator of the behavior of glass in disposal site conditions. Most aggressive leaching of common oxide glasses occurs under caustic rather than acidic conditions, therefore it is necessary to perform both tests. Further tests will be conducted using additional glass compositions and variations in the TCLP and the PCT.

  9. Ion-Exchange Interdiffusion Model with Potential Application to Long-Term Nuclear Waste Glass Performance

    SciTech Connect

    Neeway, James Joseph; Kerisit, Sebastien N.; Liu, Jia; Zhang, Jiandong; Zhu, Zihua; Riley, Brian Joseph; Ryan, Joseph Vincent

    2016-05-05

    Abstract: Ion exchange is an integral mechanism influencing the corrosion of glasses. Due to the formation of alteration layers in aqueous conditions, it is difficult to conclusively deconvolute the process of ion exchange from other processes, principally dissolution of the glass matrix. Therefore, we have developed a method to isolate alkali diffusion that involves contacting glass coupons with a solution of 6LiCl dissolved in functionally inert dimethyl sulfoxide. We employ the method at temperatures ranging from 25 to 150 °C with various glass formulations. Glass compositions include simulant nuclear waste glasses, such as SON68 and the international simple glass (ISG), glasses in which the nature of the alkali element was varied, and glasses that contained more than one alkali element. An interdiffusion model based on Fick’s second law was developed and applied to all experiments to extract diffusion coefficients. The model expands established models of interdiffusion to the case where multiple types of alkali sites are present in the glass. Activation energies for alkali ion exchange were calculated and the results are in agreement with those obtained in glass strengthening experiments but are nearly five times higher than values reported for diffusion-controlled processes in nuclear waste glass corrosion experiments. A discussion of the root causes for this apparent discrepancy is provided. The interdiffusion model derived from laboratory experiments is expected to be useful for modeling glass corrosion in a geological repository when the silicon concentration is high.

  10. Long-term field and laboratory leaching tests of cemented radioactive wastes.

    PubMed

    Ojovan, Michael I; Varlackova, Galina A; Golubeva, Zoya I; Burlaka, Olga N

    2011-03-15

    Experiments with real and simulated radioactive cementitious wasteforms were set up to compare the leaching behaviour of cementitious wasteforms containing nuclear power plant operational waste in field and laboratory test conditions. Experiments revealed that the average annual (137)Cs leach rate in deionised water was about thirty-five times greater compared with the measured average value for the 1st year of the field test. Cumulative leached fraction of (137)Cs for 1st year (3.74%) was close to values reported in literature for similar laboratory experiments in deionised water, however more than two orders of magnitude higher than the 1st year leached fraction of (137)Cs in the repository test (0.01%). Therefore, to compare field and laboratory test results, a scaling factor is required in order to account for surface to volume factor difference, multiplied by a temperature factor and a leach rate decrease coefficient related to the ground water composition.

  11. Implementing a balanced scorecard as a strategic management tool in a long-term care organization.

    PubMed

    Schalm, Corinne

    2008-01-01

    The Capital Care Group, the largest public sector continuing care organization in Canada, had no ready access to information on its own performance and therefore was limited in its pursuit of evidence-informed decision-making. To remedy this, it was decided to introduce a balanced scorecard. A literature review was conducted together with interviews with 10 other health care organizations which had implemented balanced scorecards. With this information, a workshop was held that resulted in a framework and about 120 potential indicators. Subsequently the number of indicators was reduced to 29, using pre-determined criteria. Development of a corporate balanced scorecard facilitated executive strategic thinking and clarified the organization's strategic direction. In parallel, scorecards were developed at the level of care centres. These had a common core of indicators, plus some site-specific ones. Development of the corporate scorecard took three years and an additional six months for the care centre scorecards. A formal implementation plan has been accepted by the executive team. Key to this is communicating to staff the role of scorecards for strategic management and not just performance measurement. Traditional thinking needs to change from a short-term operational focus to long-term strategy. In addition, champions need to be identified in each care centre and they need to be networked together. Finally, the scorecard is being integrated into existing operational management as a routine component together with resources to support its use. The balanced scorecard has focused on its role as a strategic management tool. The indicators and dimensions need to be customized to the organization. Senior management must be seen to be driving its introduction. It is worth spending sufficient time developing and implementing a scorecard rather than trying to rush its introduction. The scorecard needs to be integrated with existing management processes and sufficient

  12. Predicting Agricultural Management Influence on Long-Term Soil Organic Carbon Dynamics: Implications for Biofuel Production

    SciTech Connect

    Gollany, H. T.; Rickman, R. W.; Albrecht, S. L.; Liang, Y.; Kang, Shujiang; Machado, S.

    2011-01-01

    Long-term field experiments (LTE) are ideal for predicting the influence of agricultural management on soil organic carbon (SOC) dynamics and examining biofuel crop residue removal policy questions. Our objectives were (i) to simulate SOC dynamics in LTE soils under various climates, crop rotations, fertilizer or organic amendments, and crop residue managements using the CQESTR model and (ii) to predict the potential of no-tillage (NT) management to maintain SOC stocks while removing crop residue. Classical LTEs at Champaign, IL (1876), Columbia, MO (1888), Lethbridge, AB (1911), Breton, AB (1930), and Pendleton, OR (1931) were selected for their documented history of management practice and periodic soil organic matter (SOM) measurements. Management practices ranged from monoculture to 2- or 3-yr crop rotations, manure, no fertilizer or fertilizer additions, and crop residue returned, burned, or harvested. Measured and CQESTR predicted SOC stocks under diverse agronomic practices, mean annual temperature (2.1 19 C), precipitation (402 973 mm), and SOC (5.89 33.58 g SOC kg 1) at the LTE sites were significantly related (r 2 = 0.94, n = 186, P < 0.0001) with a slope not significantly different than 1. The simulation results indicated that the quantities of crop residue that can be sustainably harvested without jeopardizing SOC stocks were influenced by initial SOC stocks, crop rotation intensity, tillage practices, crop yield, and climate. Manure or a cover crop/intensified crop rotation under NT are options to mitigate loss of crop residue C, as using fertilizer alone is insufficient to overcome residue removal impact on SOC stocks

  13. Hypertension management in the oldest old: Findings from a large long-term care facility.

    PubMed

    Schwinn, Susan; McKay, Robin; Dinkel, Shirley; Mansfield, Bobbe; Da Cunha, Brooke Faria; Cummins, Savanna; Brunin, Krystal

    2017-03-01

    The purpose of this quality improvement project was to evaluate hypertension (HTN) management in patients 80 years of age and older who reside in a large, long-term care (LTC) facility. A retrospective chart audit was conducted on 75 charts of patients 80 years of age and older and who had a diagnosis of HTN. Using the 2011 American College of Cardiology Foundation/American Heart Association (ACCF/AHA) Expert Consensus Document on Management of Hypertension in the Elderly as a guide, blood pressure readings, significant comorbidities, and antihypertensive medication utilization were analyzed. LTC residents in this sample were often not treated according to expert recommendations. Specifically, analysis revealed overtreatment of uncomplicated HTN and undertreatment of those with comorbid conditions. Additionally, those with diabetes mellitus and chronic kidney disease were infrequently prescribed ace inhibitors/angiotensin receptor blockers, as recommended. Utilizing evidence-based practice (EBP) guidelines affords the best avenue for providing safe and effective treatment of HTN. While expert recommendations are available, researchers seldom recruit frail elders in LTC facilities into treatment investigations. In the absence of population-specific EBP guidelines, nurse practitioners must rely on expert opinion and diagnostic reasoning to individualize HTN treatment to this unique and vulnerable population. ©2016 American Association of Nurse Practitioners.

  14. Integrated, long term, sustainable, cost effective biosolids management at a large Canadian wastewater treatment facility.

    PubMed

    Leblanc, R J; Allain, C J; Laughton, P J; Henry, J G

    2004-01-01

    The Greater Moncton Sewerage Commission's 115,000 m3/d advanced, chemically assisted primary wastewater treatment facility located in New Brunswick, Canada, has developed an integrated, long term, sustainable, cost effective programme for the management and beneficial utilization of biosolids from lime stabilized raw sludge. The paper overviews biosolids production, lime stabilization, conveyance, and odour control followed by an indepth discussion of the wastewater sludge as a resource programme, namely: composting, mine site reclamation, landfill cover, land application for agricultural use, tree farming, sod farm base as a soil enrichment, topsoil manufacturing. The paper also addresses the issues of metals, pathogens, organic compounds, the quality control program along with the regulatory requirements. Biosolids capital and operating costs are presented. Research results on removal of metals from primary sludge using a unique biological process known as BIOSOL as developed by the University of Toronto, Canada to remove metals and destroy pathogens are presented. The paper also discusses an ongoing cooperative research project with the Université de Moncton where various mixtures of plant biosolids are composted with low quality soil. Integration, approach to sustainability and "cumulative effects" as part of the overall biosolids management strategy are also discussed.

  15. The long-term behaviors of passivation and hydride layer of commercial grade pure titanium in TRU waste disposal environments

    NASA Astrophysics Data System (ADS)

    Nakayama, Gen; Sakakibara, Yohei; Taniyama, Yoshihiro; Cho, Hideo; Jintoku, Takashi; Kawakami, Susumu; Takemoto, Mikio

    2008-09-01

    Preservation of the passivity under reducing environmental conditions for extended periods of time and the behavior of hydrogen evolution as the results of the preservation of the passivity of several candidate commercial grade pure titanium related to the small amount of palladium addition, such as Ti-Gr.17 for metallic containers to be buried under deep ground for disposing of transuranic (TRU) waste is investigated. The present investigation has revealed the following corrosion paths for the titanium alloys investigated. The passivity of the alloys is preserved as the result of repeated destruction and recovery of the surface films on the alloys. The long-term corrosion rate under the preserved passivity is of the order of 10 -6-10 -8 my -1 with evolution of hydrogen. The substrate alloys absorb parts of the hydrogen generated to form lath-type hydride phase before forming hydride layers at the final stage.

  16. Effect of soil erosion on the long-term stability of FUSRAP near-surface waste-burial sites

    SciTech Connect

    Knight, M.J.

    1983-04-01

    Decontamination of FUSRAP sites could result in the generation of large volumes (in excess of 400,000 m/sup 3/) of low-activity radioactive wastes (primarily contaminated soil and building materials) requiring subsequent disposal. It is likely that near-surface burial will be seriously considered as an option for disposal of these materials. A number of factors - including soil erosion - could adversely affect the long-term stability of a near-surface waste-burial site. The majority of FUSRAP sites are located in the humid eastern United States, where the principal cause of erosion is the action of water. This report examines the effect of soil erosion by water on burial-site stability based on analysis of four hypothetical near-surface burial sites. The Universal Soil Loss Equation was employed to estimate average annual soil loss from burial sites and the 1000-year effects of soil loss on the soil barrier (burial trench cap) placed over low-activity wastes. Results suggest that the land use of the burial site and the slope gradient of the burial trench cap significantly affect the rate of soil erosion. The development of measures limiting the potential land use of a burial site (e.g., mixing large rocks into the burial trench cap) may be required to preserve the integrity of a burial trench for long periods of time.

  17. Geographic variations of soil phosphorus induced by long-term land and manure nutrient management practices

    NASA Astrophysics Data System (ADS)

    Dao, Thanh

    2014-05-01

    Most natural and agricultural ecosystems are deficient in phosphorus (P), and supplemental P must be provided to attain optimal levels of agronomic production. Animal manure is often used to supply needed plant nutrients to enhance production of feed and fiber crops for human and livestock consumption. Soils have been treated with large amounts of P-enriched manure, and have shown elevated P levels in watersheds where there is a high density of intensive confined animal agriculture. Long-term additions can have lasting effects on the geographic distribution of soil microbes associated with the turnover of major soil nutrients, in particular non-mobile one such as P. We determined the distribution of soil P forms in a 10-ha no-till field that received annual additions of dairy manure at 0, 15, and 30 kg P ha-1 at the field scale for 16 consecutive years. Spectroscopic analyses of the near-surface zone were performed by X-ray fluorescence in soil cores taken to a depth of 0.2 m. Geostatistical methods were used to determine the spatial structure of the soil compositional data. Soil X-ray fluorescence spectral attributes were obtained based on a set of five parallel transects established across five experimental blocks, i.e., a 5 × 5 rectangular grid pattern. Three subsets of each soil attribute were identified for the three rates of manure addition. Long-term manure addition, albeit liquid manure, resulted in significant variability in soil P distribution in the near surface zone. The heterogeneity persisted over years of continuous no-tillage management. Therefore, a high density of geo-referenced soil measurements must be made to estimate the status of a required plant nutrient, especially a non-mobile nutrient in soil. A large number of timely measurements would require a rapid geo-referenced soil sensing spectroscopic method such as X-ray fluorescence to manage in near real-time the observed spatial variability of manure-treated fields.

  18. Impact of coastal management practice on long-term foredune behaviour

    NASA Astrophysics Data System (ADS)

    Wijnberg, Kathelijne M.; Bochev-van der Burgh, Lisette M.

    2010-05-01

    Coastal dunes located in densely populated areas provide various services to man, such as protection against flooding during storm surges, recreation, and nature conservation. As a result, man will interfere with the natural dynamics of coastal dunes if these negatively affect these functions. For example, local storm erosion of the foredune will reduce the safety level of dunes as flooding defence, or the resulting steep dune front can be perceived as a public safety issue (collapse). Usually, the applied management interventions aim at restoring the pre-storm situation. As such they result in an increased recovery rate from an erosional event as compared to post-storm recovery rates occurring without human intervention. The above raises the question whether the usually localized and intermittent human interventions will actually interfere with the long term evolution of the foredune area. And if so, whether these short term management interventions can turn out to be detrimental to the persistence of these functions in the long run. Especially for the flooding defence functionality this is of importance, as we can expect natural drivers of coastal behaviour, such as storm climatology and mean sea level stand, to change over the next century. To increase insight in the above issues we performed a case study on the behaviour of managed foredunes along the Holland coast (The Netherlands). Information on the morphologic behaviour was extracted by EOF-analysis from a 40 year data set (1965-2004) of annual, high-resolution elevation surveys of the subaerial part of coastal profile along about 90 km of coastline. Information on the applied dune management during this period was retrieved from documents as well as from interviews with coastal managers with long-term involvement in the actual dune maintenance practice in the studied area. It appeared that during the studied period the coastal management policy changed from being essentially reactive in nature to being pro

  19. An evaluation of a self-management program for patients with long-term conditions.

    PubMed

    Turner, Andrew; Anderson, Joanna K; Wallace, Louise M; Bourne, Claire

    2015-02-01

    To evaluate a group-based self-management program (SMP) delivered as part of a quality improvement program, Co-Creating Health, for patients living with one of four long-term conditions (LTCs): chronic obstructive pulmonary disease, depression, diabetes, and musculoskeletal pain. The 7 week SMP was co-delivered by lay and health professional tutors. Patients completed self-reported outcome measures at pre-course and 6 months follow-up. 486 patients completed (attended ≥5 sessions) the SMP and returned pre-course and 6 months follow up data. Patients reported significant improvements in patient activation (ES 0.65, p<0.001), with 53.9% of all patients reporting a meaningful ≥4 point improvement. Health-related quality of life (ES 0.06, p=0.04), and health status (ES 0.33, p<0.001) were also significantly improved. Patients' anxiety (ES 0.37, p<0.001) and depression (ES 0.31, p<0.001) significantly improved. Patients also reported significant improvements in their self-management skills (p values from p<0.001 to p=0.028). Attending the SMP led to improvements in a range of outcomes. Improvement in patient activation is important, as activated patients are more likely to perform self-care activities. Co-delivered SMPs provide meaningful improvements in activation for >50% of those who complete and are a useful addition to self-management support provision. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  20. Value of Inhaled Corticosteroid Therapy In Long-Term Asthma Management

    PubMed Central

    Beam, Donald S.

    2010-01-01

    Asthma, which affects more than 22 million people in the U.S. every year, poses a significant clinical and economic burden to our health care system. Patients, health care practitioners, and payers require a variety of resources to ensure optimal disease management and positive clinical outcomes while also managing costs. In addition, decision makers in health care must determine the most appropriate and cost-efficient therapy or class of agents to achieve asthma control. As such, payers rely on evidence-based medicine, including guidelines to determine the right therapy for the right patient. Inhaled corticosteroid (ICS) therapy plays a critical role in the management of mild-to-moderate persistent asthma. Despite national treatment guidelines that cite ICS therapy as the most effective and safest long-term treatment option for persistent asthma, ICS monotherapy continues to be underused. One retrospective claims study found that 55.2% of children with mild-to-moderate asthma received prescriptions for combination therapy (ICS and long-acting beta-agonists) as initial controller treatment. This practice is contrary to national treatment guidelines, which recommend a step-therapy approach. These prescribing patterns result in higher pharmacy costs, do not always ensure control of symptoms, and sometimes expose patients to potential safety risks. This article addresses the importance of ICS therapy in the treatment of mild-to-moderate asthma, as advocated by the National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 3 guidelines; the role of small airway disease in asthma pathophysiology; and the clinical and economic benefits of ICS therapy. PMID:20689625

  1. Analyzing sediment impacts for the Glen Canyon Long-term Experimental and Management Plan EIS

    NASA Astrophysics Data System (ADS)

    Russell, K.; Huang, V.; Varyu, D.; Greimann, B. P.; O'Connor, B. L.

    2013-12-01

    The Department of the Interior is currently evaluating alternatives in the Glen Canyon Dam Long-term Experimental and Management Plan (LTEMP) Environmental Impact Statement (EIS). The purpose of the EIS to evaluate dam operations and identify management actions and experimental options that will provide a framework for adaptively managing operations of Glen Canyon Dam over the next 15 to 20 years. Sediment and sandbars along the Colorado River are important downstream resources in Grand Canyon National Park. Sediment is one of the resources being analyzed for impacts in Marble and Grand Canyon. Since 1963, Glen Canyon Dam has regulated the flow in the Colorado River by decreasing the magnitude of annual flood flows and increasing the magnitude of base flows, and has nearly eliminated main-channel sand supply from the upper Colorado River Basin. These changes disrupted the natural ability of the river to build and maintain sandbars. Grand Canyon sandbars provide camping beaches for river runners and hikers, generate habitat for native fish and vegetation, and supply sediment to protect archaeological resources. In order to measure the impacts of the different alternatives on the sediment resource, several different models are being utilized. A sand budget numerical model that tracks the storage and transport of sand in the Colorado River below Glen Canyon Dam developed by the USGS is utilized. The model uses empirically based rating curves for specific particle sizes. The decision criteria for the high flow experiment environmental assessment is applied to the sand budget model as well as other flow changes incorporated in the alternatives. An empirically based sandbar volume model was also developed for the LTEMP EIS process to address the sandbar resource impacts. Based on the model results, performance criteria have been established to allow for comparisons between the alternatives. The criteria include the changes in the sand mass balance of the system, the

  2. The long-term incidence of urinary tract infection after endoscopic management of vesicoureteral reflux.

    PubMed

    Heckler, Adrienne M; Sung, Jennifer; Watters, Sean; Martinez Acevedo, Ann; Conlin, Michael; Skoog, Steven

    2014-06-01

    To evaluate the long-term urinary tract infection (UTI) rates after endoscopic correction of vesicoureteral reflux and the possible risk factors for urinary infection. A retrospective study of patients who underwent endoscopic management of vesicoureteral reflux at a single institution from 2001 to 2011 was performed. Patients were followed up for a minimum of 1 year. Voiding cystourethrograms were completed 3 months postoperatively. UTI questionnaire pertaining to the patient's UTI history before and after the surgery was mailed to each patient. Data were first evaluated looking only at culture-confirmed UTIs, and a second analysis included all patient-reported and culture-confirmed urinary infections. Factors considered in the analysis included sex, age, preoperative dimercaptosuccinic acid (DMSA) scan, reflux on postoperative voiding cystourethrogram, voiding dysfunction, and preoperative reflux grade. Data on 175 patients for a minimum of 1 year were collected. There were 34 of 175 confirmed UTIs after endoscopic management, and 11 confirmed febrile UTIs. There were no significant predictors of febrile or afebrile UTIs in this group. Fifty-three of 175 patients (30%) experienced any UTI, 19 of which were febrile (10%). In this group, recurrent reflux was the only significant predictor of UTI (P=.03) and febrile UTIs (P=.04). Patients with more UTIs preoperatively were more likely to have a postoperative febrile UTI. Rates of UTI and febrile UTI in endoscopic management are similar and no better than those for open ureteral reimplantation. Longer follow-up suggests an association of recurrent reflux and preoperative UTI rates as predictors of postoperative febrile UTIs. These patients benefit from closer postoperative observation. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Pentoxifylline as adjunct therapy to long-term clinical management of a right-to-left patent ductus arteriosus

    PubMed Central

    Turner, Elizabeth

    2016-01-01

    Management of a right-to-left (“reversed”) patent ductus arteriosus (PDA) focuses on control of clinical signs associated with hyperviscosity due to erythrocytosis. Pentoxifylline therapy is presented as an adjunct to routine phlebotomies for the long-term clinical management of reversed PDA in a 10-year-old Chihuahua. PMID:27247468

  4. Integrating Long-Term Avian Studies with Planning and Adaptive Management: Department of Energy Lands as a Case Study.

    SciTech Connect

    Burger, J.

    2000-10-01

    Long-term bio-monitoring of avian communities have been initiated, but they often lack a management component. Integration of the managers needs at an early stage is suggested as a means to increase the use of the data. Variation in community structure is important in understanding impacts. In addition, reference site must be carefully selected.

  5. Pentoxifylline as adjunct therapy to long-term clinical management of a right-to-left patent ductus arteriosus.

    PubMed

    Turner, Elizabeth

    2016-06-01

    Management of a right-to-left ("reversed") patent ductus arteriosus (PDA) focuses on control of clinical signs associated with hyperviscosity due to erythrocytosis. Pentoxifylline therapy is presented as an adjunct to routine phlebotomies for the long-term clinical management of reversed PDA in a 10-year-old Chihuahua.

  6. Recent Developments in Nuclear Waste Management in Canada

    SciTech Connect

    King, F.

    2002-02-27

    This paper describes recent developments in the field of nuclear waste management in Canada with a focus on management of nuclear fuel waste. Of particular significance is the April 2001 tabling in the Canadian House of Commons of Bill C-27, An Act respecting the long-term management of nuclear fuel waste. At the time of finalizing this paper (January 15, 2002), Bill C-27 is in Third Reading in the House of Commons and is expected to move to the Senate in February. The Nuclear Fuel Waste Act is expected to come into force later in 2002. This Act requires the three nuclear utilities in Canada owning nuclear fuel waste to form a waste management organization and deposit funds into a segregated fund for nuclear fuel waste long-term management. The waste management organization is then required to perform a study of long-term management approaches for nuclear fuel waste and submit the study to the federal government within three years. The federal government will select an approach for implementation by the waste management organization. The paper discusses the activities that the nuclear fuel waste owners currently have underway to prepare for the formation of the waste management organization. As background, the paper reviews the status of interim storage of nuclear fuel waste in Canada, and describes previous initiatives related to the development of a national strategy for nuclear fuel waste long-term management.

  7. Management of Charcot–Marie–Tooth disease: improving long-term care with a multidisciplinary approach

    PubMed Central

    McCorquodale, Donald; Pucillo, Evan M; Johnson, Nicholas E

    2016-01-01

    Charcot–Marie–Tooth (CMT) disease is the most common inherited neuropathy and one of the most common inherited diseases in humans. The diagnosis of CMT is traditionally made by the neurologic specialist, yet the optimal management of CMT patients includes genetic counselors, physical and occupational therapists, physiatrists, orthotists, mental health providers, and community resources. Rapidly developing genetic discoveries and novel gene discovery techniques continue to add a growing number of genetic subtypes of CMT. The first large clinical natural history and therapeutic trials have added to our knowledge of each CMT subtype and revealed how CMT impacts patient quality of life. In this review, we discuss several important trends in CMT research factors that will require a collaborative multidisciplinary approach. These include the development of large multicenter patient registries, standardized clinical instruments to assess disease progression and disability, and increasing recognition and use of patient-reported outcome measures. These developments will continue to guide strategies in long-term multidisciplinary efforts to maintain quality of life and preserve functionality in CMT patients. PMID:26855581

  8. Does the Cardiologist Have a Key Role in Long-Term Management of Hypertension?

    PubMed Central

    Wilke, Andreas; Steverding, Dietmar

    2011-01-01

    Background Hypertension is a widespread chronic condition which is usually treated with hypertensive drugs. However, 50% of hypertensive patients do not achieve control of their blood pressure below the standard target of 140/90 mmHg when treated with a single antihypertensive drug. Generally, hypertension specialists have a key role in managing hypertensive patients. Methods A retrospective case note review based on observations made in a cardiological outpatient clinic in Germany was carried out to assess whether the recommendation given by hypertension specialists were followed. The aim was to lower the blood pressure to < 130/85 mmHg over a period of six months by administering the new antihypertensive drug Zaneril® (lercanidipine/enalapril). Twenty-four hour blood pressure profiles were monitored a fortnight and six months later. Results Of the 130 patients, whose average blood pressure was 163/87 mmHg before receiving hypertensive treatment, only 44 (34%) were still on Zaneril® therapy six months later. Eighty-four patients (65%) did not turn up for follow-up examinations. The blood pressure of patients who were under Zaneril® therapy for the whole six months was better adjusted than that of patients who changed their treatment in the meantime (133/78 mmHg vs. 139/80 mmHg). Conclusions Specialists have only little influence on the long-term therapy of hypertensive patients.

  9. Persistent family concerns in long-term care settings: meaning and management.

    PubMed

    Marziali, Elsa; Shulman, Kenneth; Damianakis, Thecla

    2006-03-01

    The aim of this study was to understand institutional and family caregiver characteristics that contribute to the failure to resolve families' persistent complaints about nursing home care of their relatives. Key informant interviews with 9 family members who had persistent concerns about the care of their relatives were conducted. Two focus groups with 5 nurse managers provided staff perceptions of families whose persistent concerns remained unresolved. Content analysis of both individual interviews and focus groups resulted in the extraction of salient themes. Factors associated with persistent discord between families and staff included caregivers' perceptions of staff as incompetent, interfamilial conflicts, and unresolved psychosocial issues. Institutional factors contributing to persistent negative perceptions of care included staff's vulnerability in the face of challenges to their professional competence and stress due to disproportionate amounts of time spent educating and supporting health care aids to cope with distraught families. The failure to settle, in a mutually satisfactory manner, the complaints of this subgroup of families is discussed in the context of unresolved family issues that interact with institutional failure to respond in a manner that conveys understanding of caregiver stress that is invariably exacerbated when a family member is placed in a long-term care facility.

  10. Comprehensive management of hot-press hand injuries: long-term outcomes following reconstruction and rehabilitation.

    PubMed

    Hultman, Charles Scott; Erfanian, Kamil; Fraser, James; Thornton, Sydney J; Calvert, Catherine S; Cairns, Bruce A

    2010-05-01

    Hot-press hand injuries create significant challenges, in terms of acute coverage and restoration of function, and long-term outcomes are largely unknown. This article reviews the comprehensive management of hot-press hand injuries--which includes damage control procedures, resurfacing, reconstruction, and rehabilitation--and assesses outcomes such as return to work and final impairment ratings. We treated 56 patients with hot-press hand injuries, at a verified, accredited burn center in the Southeast between 1994 and 2008. Mechanism included laundry press (42 cases), industrial press (11 cases), and home appliance (3 cases). Mean burn size was 118 cm2, with 43 full-thickness and 13 partial thickness injuries. Mean follow-up was 17.7 months. During this 15-year period, 39 patients (70%) were admitted acutely (mean length of stay: 10.4 days), 48 patients (86%) required operative intervention, and 28 patients (50%) had secondary reconstruction, which included nerve decompression (11 cases), contracture release (11 cases), tendon procedures (11 cases), and joint repair (5 cases). Mean final impairment rating was 22%, with 38 patients (68%) returning to work. Hot-press hand burns can be devastating, but return to work is possible for most patients. We recommend early wound excision, aggressive perioperative hand therapy, low threshold for reconstructive procedures, and rehabilitative support.

  11. Use of opioids in long-term management of temporomandibular joint dysfunction.

    PubMed

    Bouloux, Gary F

    2011-07-01

    The long-term treatment of patients with chronic temporomandibular joint dysfunction has been challenging. The long-term use of opioids in these patients can be neither supported nor refuted based on current evidence. However, evidence is available to support the long-term use of opioids in other chronic noncancer pain states with reduced pain, improved function, and improved quality of life. One group of patients with chronic temporomandibular joint pain, for whom both noninvasive and invasive treatment has failed, might benefit from long-term opioid medication. The choices include morphine, fentanyl, oxycodone, tramadol, hydrocodone, and methadone. Adjunct medication, including antidepressant and anticonvulsant drugs, can also be used. The safety of these medications has been well established, but the potential for adverse drug-related behavior does exist, requiring appropriate patient selection, adequate monitoring, and intervention when needed.

  12. Long-term impact of acid resin waste deposits on soil quality of forest areas I. Contaminants and abiotic properties.

    PubMed

    Pérez-de-Mora, Alfredo; Madejón, Engracia; Cabrera, Francisco; Buegger, Franz; Fuss, Roland; Pritsch, Karin; Schloter, Michael

    2008-11-15

    Acid resins are residues characterised by elevated concentrations of hydrocarbons and trace elements, which were produced by mineral oil industries in Central Europe during the first half of the last century. Due to the lack of environmental legislation at that time, these wastes were dumped into excavated ponds in public areas without further protection. In this work, the long-term effects of such resin deposits on soil quality of two forest areas (Bayern, Germany) were assessed. We evaluated the distribution and accumulation of contaminants in the surroundings of the deposits, where the waste was disposed of about 60 years ago. General soil chemical properties such as pH, C, N and P content were also investigated. Chemical analysis of resin waste from the deposits revealed large amounts of potential contaminants such as hydrocarbons (93 g kg(-1)), As (63 mg kg(-1)), Cd (24 mg kg(-1)), Cu (1835 mg kg(-1)), Pb (8100 mg kg(-1)) and Zn (873 mg kg(-1)). Due to the location of the deposits on a hillside and the lack of adequate isolation, contaminants have been released downhill despite the solid nature of the waste. Five zones were investigated in each site: the deposit, three affected zones along the plume of contamination and a control zone. In affected zones, contaminants were 2 to 350 times higher than background levels depending on the site. In many cases, contaminants exceeded the German environmental guidelines for the soil-groundwater path and action levels based on extractable concentrations. Resin contamination yielded larger total C/total N ratios in affected zones, but no clear effect was observed on absolute C, N and P concentrations. In general, no major acidification effect was reported in affected zones.

  13. An Evaluation of Long-Term Performance of Liner Systems for Low-Level Waste Disposal Facilities

    SciTech Connect

    Arthur S. Rood; Annette L. Schafer; A. Jeffrey Sondrup

    2011-03-01

    Traditional liner systems consisting of a geosynthetic membrane underlying a waste disposal facility coupled with a leachate collection system have been proposed as a means of containing releases of low-level radioactive waste within the confines of the disposal facility and thereby eliminating migration of radionuclides into the vadose zone and groundwater. However, this type of hydraulic containment liner system is only effective as long as the leachate collection system remains functional or an overlying cover limits the total infiltration to the volumetric pore space of the disposal system. If either the leachate collection system fails, or the overlying cover becomes less effective during the 1,000’s of years of facility lifetime, the liner may fill with water and release contaminated water in a preferential or focused manner. If the height of the liner extends above the waste, the waste will become submerged which could increase the release rate and concentration of the leachate. If the liner extends near land surface, there is the potential for contamination reaching land surface creating a direct exposure pathway. Alternative protective liner systems can be engineered that eliminate radionuclide releases to the vadose zone during operations and minimizing long term migration of radionuclides from the disposal facility into the vadose zone and aquifer. Non-traditional systems include waste containerization in steel or composite materials. This type of system would promote drainage of clean infiltrating water through the facility without contacting the waste. Other alternatives include geochemical barriers designed to transmit water while adsorbing radionuclides beneath the facility. Facility performance for a hypothetical disposal facility has been compared for the hydraulic and steel containerization liner alternatives. Results were compared in terms of meeting the DOE Order 435.1 low-level waste performance objective of 25 mrem/yr all-pathways dose

  14. Long-term population dynamics of a managed burrowing owl colony

    USGS Publications Warehouse

    Barclay, John H.; Korfanta, Nicole M.; Kauffman, Matthew J.

    2011-01-01

    We analyzed the population dynamics of a burrowing owl (Athene cunicularia) colony at Mineta San Jose International Airport in San Jose, California, USA from 1990-2007. This colony was managed by using artificial burrows to reduce the occurrence of nesting owls along runways and within major airport improvement projects during the study period. We estimated annual reproduction in natural and artificial burrows and age-specific survival rates with mark-recapture techniques, and we estimated the relative contribution of these vital rates to population dynamics using a life table response experiment. The breeding colony showed 2 distinct periods of change: high population growth from 7 nesting pairs in 1991 to 40 pairs in 2002 and population decline to 17 pairs in 2007. Reproduction was highly variable: annual nesting success (pairs that raised =1 young) averaged 79% and ranged from 36% to 100%, whereas fecundity averaged 3.36 juveniles/pair and ranged from 1.43 juveniles/pair to 4.54 juveniles/pair. We estimated annual adult survival at 0.710 during the period of colony increase from 1996 to 2001 and 0.465 during decline from 2002 to 2007, but there was no change in annual survival of juveniles between the 2 time periods. Long-term population growth rate (lambda) estimated from average vital rates was lambdaa=1.072 with lambdai=1.288 during colony increase and lambdad=0.921 (DELTA lambda=0.368) during decline. A life table response experiment showed that change in adult survival rate during increasing and declining phases explained more than twice the variation in growth rate than other vital rates. Our findings suggest that management and conservation of declining burrowing owl populations should address factors that influence adult survival.

  15. Long-term management of reversible obstructive airways disease in adults.

    PubMed

    Lurie, A; Vlastos, F D; Dusser, D J; Strauch, G; Marsac, J

    1990-01-01

    The goals of the long-term management of reversible obstructive airways disease (ROAD) are to find the minimum treatment that controls symptoms, allows resumption of normal life, prevents severe attack and death, and controls airflow obstruction. ROADs include asthma, chronic bronchitis, and emphysema. Although the differential diagnosis between these different entities may be difficult, they share the same possibilities of pharmacotherapy, including bronchodilator and antiinflammatory drugs. beta 2-agonists administered via inhaled route produce the best bronchodilator/side effects ratio, provided that the drugs reach the bronchi. This underlines the importance of a proper inhalation technique when using a metered-dose inhaler. In patients with hand-breath coordination problems, powder inhalers or spacer devices are useful to ameliorate the therapeutic efficacy of inhaled drugs. Anticholinergic agents are usually less potent bronchodilators than inhaled beta 2 agonists in asthma, but they may have additive effects when associated with beta 2 agonists. Only a therapeutic trial with peak-flow monitoring can demonstrate the efficacy of anticholinergic drugs in individuals. Theophylline's kinetics are characterized by a narrow therapeutic index with high inter- and intraindividual variabilities. Sodium cromoglycate and nedocromil sodium are antiallergic drugs, the efficacy of which has been demonstrated in controlled studies. Corticosteroids are the most efficient anti-asthma drugs. Inhaled corticosteroid dosing should be tailored to each individual. If inhaled corticosteroid therapy is used in an oral corticosparing attempt, patients should be followed-up during several months. The management of ROAD includes the diagnostic procedures, the identification of triggers and inducers of airways obstruction, the assessment of severity of the disease, and then the treatment and education of the patient. Strategy design to achieve proper use of drugs by patients is discussed.

  16. Relevance of biotic pathways to the long-term regulation of nuclear waste disposal. Phase I. Final report. Vol. 4

    SciTech Connect

    McKenzie, D.H.; Cadwell, L.L.; Eberhardt, L.E.; Kennedy, W.E. Jr.; Peloquin, R.A.; Simmons, M.A.

    1984-05-01

    Licensing and regulation of commercial low-level waste (CLLW) burial facilities require that anticipated risks associated with burial sites be evaluated for the life of the facility. This work reviewed the existing capability to evaluate dose to man resulting from the potential redistribution of buried radionuclides by plants and animals that we have termed biotic transport. Through biotic transport, radionuclides can be moved to locations where they can enter exposure pathways to man. We found that predictive models currently in use did not address the long-term risks resulting from the cumulative transport of radionuclides. Although reports in the literature confirm that biotic transport phenomena are common, assessments routinely ignore the associated risks or dismiss them as insignificant without quantitative evaluation. To determine the potential impacts of biotic transport, we made order-of-magnitude estimates of the dose to man for biotic transport processes at reference arid and humid CLLW disposal sites. Estimated doses to site residents after assumed loss of institutional control were comparable to dose estimates for the intruder-agricultural scenario defined in the DEIS for 10 CFR 61 (NRC). The reported lack of potential importance of biotic transport at low-level waste sites in earlier assessment studies is not confirmed by order of magnitude estimates presented in this study. 17 references, 10 figures, 8 tables.

  17. Threshold responses of songbirds to long-term timber management on an active industrial forest

    USGS Publications Warehouse

    Becker, D.A.; Wood, P.B.; Keyser, P.D.; Wigley, T.B.; Dellinger, R.; Weakland, C.A.

    2011-01-01

    Forest managers often seek to balance economic benefits from timber harvesting with maintenance of habitat for wildlife, ecosystem function, and human uses. Most research on the relationship between avian abundance and active timber management has been short-term, lasting one to two years, creating the need to investigate long-term avian responses and to identify harvest thresholds when a small change in habitat results in a disproportionate response in relative abundance and nest success. Our objectives were to identify trends in relative abundance and nest success and to identify landscape-scale disturbance thresholds for avian species and habitat guilds in response to a variety of harvest treatments (clear-cuts, heavy and light partial harvests) over 14 years. We conducted point counts and monitored nests at an industrial forest in the central Appalachians of West Virginia during 1996-1998, 2001-2003, and 2007-2009. Early successional species increased in relative abundance across all three time periods, whereas interior-edge and forest-interior guilds peaked in relative abundance mid-study after which the forest-interior guild declined. Of 41 species with >10 detections, four (10%) declined significantly, 13 (32%) increased significantly (only three species among all periods), and 9 (22%) peaked in abundance mid-study (over the entire study period, four species had no significant change in abundance, four declined, and one increased). Based on piecewise linear models, forest-interior and interior-edge guilds' relative abundance harvest thresholds were 28% total harvests (all harvests combined), 10% clear-cut harvests, and 18% light partial harvests, after which abundances declined. Harvest thresholds for the early successional guild were 42% total harvests, 11% clear-cut harvest, and 10% light partial harvests, and relative abundances increased after surpassing thresholds albeit at a reduced rate of increase after the clear-cut threshold. Threshold confidence

  18. General approach to the long-term management at a former radium production site in Olen, Belgium

    SciTech Connect

    Dorado Lopez, Emma; Preter, Peter D

    2013-07-01

    The paper describes the methodology that ONDRAF/NIRAS, the Belgian Agency for Radioactive Waste and Enriched Fissile Materials, in consultation with the metallurgical company who aims the Olen-site, is developing and wants to apply to arrive at a safe and sustainable long-term solution in Olen. The complex problematic in Olen and how this does fit in the legal missions of ONDRAF/NIRAS is also presented. (authors)

  19. Automated telephone communication systems for preventive healthcare and management of long-term conditions.

    PubMed

    Posadzki, Pawel; Mastellos, Nikolaos; Ryan, Rebecca; Gunn, Laura H; Felix, Lambert M; Pappas, Yannis; Gagnon, Marie-Pierre; Julious, Steven A; Xiang, Liming; Oldenburg, Brian; Car, Josip

    2016-12-14

    Automated telephone communication systems (ATCS) can deliver voice messages and collect health-related information from patients using either their telephone's touch-tone keypad or voice recognition software. ATCS can supplement or replace telephone contact between health professionals and patients. There are four different types of ATCS: unidirectional (one-way, non-interactive voice communication), interactive voice response (IVR) systems, ATCS with additional functions such as access to an expert to request advice (ATCS Plus) and multimodal ATCS, where the calls are delivered as part of a multicomponent intervention. To assess the effects of ATCS for preventing disease and managing long-term conditions on behavioural change, clinical, process, cognitive, patient-centred and adverse outcomes. We searched 10 electronic databases (the Cochrane Central Register of Controlled Trials; MEDLINE; Embase; PsycINFO; CINAHL; Global Health; WHOLIS; LILACS; Web of Science; and ASSIA); three grey literature sources (Dissertation Abstracts, Index to Theses, Australasian Digital Theses); and two trial registries (www.controlled-trials.com; www.clinicaltrials.gov) for papers published between 1980 and June 2015. Randomised, cluster- and quasi-randomised trials, interrupted time series and controlled before-and-after studies comparing ATCS interventions, with any control or another ATCS type were eligible for inclusion. Studies in all settings, for all consumers/carers, in any preventive healthcare or long term condition management role were eligible. We used standard Cochrane methods to select and extract data and to appraise eligible studies. We included 132 trials (N = 4,669,689). Studies spanned across several clinical areas, assessing many comparisons based on evaluation of different ATCS types and variable comparison groups. Forty-one studies evaluated ATCS for delivering preventive healthcare, 84 for managing long-term conditions, and seven studies for appointment reminders

  20. Prediction of the long-term performance of crystalline nuclear waste form phases from studies of mineral analogues

    SciTech Connect

    Lumpkin, G.R.; Smith, K.L.; Blackford, M.G.

    1994-12-31

    This investigation outlines the use of natural analogues as a means of assessing the long-term performance of actinide host phases in crystalline nuclear waste forms. We employed several analytical techniques to study the mineral zirconolite, an important actinide host phase in Synroc and tailored ceramics. The following conclusions were reached: (1) Natural zirconolite experiences a crystalline to aperiodic transformation at doses of approximately 10{sup 15} to 10{sup 16} {alpha}/ma (0.08-1.0 dpa), consistent with the results of accelerated damage testing on synthetic zirconolite. (2) Damage microstructures are consistent with the accumulation and overlap of alpha-recoil collision cascades, resulting in aperiodic domains which increase in volume as a function of dose. (3) There is evidence for long-term annealing of alpha-recoil damage in zirconolite at a rate 2-5 times slower than in the structurally related mineral pyrochlore. (4) Analysis of data from the only documented natural zirconolites to show hydrothermal alteration [resulting from F- and P-rich aqueous fluids at T = 500-600{degrees}C and P = 2 kb, Giere and Williams (14)], suggests that Th and U were released to the fluid phase. (5) The effects of low temperature alteration of radiation damaged zirconolite by a Si-rich ground water or fluid phase were identified in the oldest (2.5 x 10{sup 9} yr) sample in our research collection. Alteration involved incorporation of Si along microfractures at the expense of Ca, Ti, and Fe, but Tb and U remained immobile. In this same sample, there is evidence for migration of at least 50% of the radiogenic Pb from both unaltered and altered areas of zirconolite. Most of the Pb may have been retained within the sample as fine precipitates of galena (PbS).

  1. Specific side effects of long-term imipramine management of panic disorder.

    PubMed

    Mavissakalian, Matig; Perel, James; Guo, Shenyang

    2002-04-01

    In a recent study, the authors suggested that tachycardia, dry mouth, and sweating continued to burden patients with panic disorder with agoraphobia who have shown marked and stable response to 6 months of imipramine treatment at the fixed, weight-adjusted dose of 2.25 mg/kg/day. Although sexual dysfunction and weight gain were not a significant burden in that study, they are important problems in long-term treatment with antidepressant drugs. In the present study, in the context of a randomized, double-blind, placebo-controlled, 1-year discontinuation and maintenance study of 53 patients with panic disorder with agoraphobia who respond to imipramine, the authors examine the extent and the specificity of these five side effects of imipramine maintenance using data at pretreatment, at the end of 24 weeks of open imipramine treatment (or month 0 of randomization), and at months 2, 4, 6, 8, 10, and 12 of randomized treatment. Hierarchical linear modeling and repeated measures of analyses of variance in subsamples of completers confirmed that dry mouth, sweating, and increased heart rate constitute a significant and specific enduring burden of imipramine maintenance treatment. The data also revealed that weight gain is a significant and specific side effect of 1-year imipramine maintenance treatment; however, the likelihood of reporting sexual dysfunction decreased over time, with no difference between the placebo and imipramine maintenance conditions. The results are discussed in the context of previous studies of imipramine side effects in the management of depression and the available literature of sexual and weight side effects of antidepressant medications in the treatment of anxiety disorders.

  2. Minimizing the regrets of long-term urban floodplain management decisions under deeply uncertain climate change

    NASA Astrophysics Data System (ADS)

    Hecht, J. S.; Kirshen, P. H.; Vogel, R. M.

    2016-12-01

    Making long-term floodplain management decisions under uncertain climate change is a major urban planning challenge of the 21stcentury. To support these efforts, we introduce a screening-level optimization model that identifies adaptation portfolios by minimizing the regrets associated with their flood-control and damage costs under different climate change trajectories that are deeply uncertain, i.e. have probabilities that cannot be specified plausibly. This mixed integer program explicitly considers the coupled damage-reduction impacts of different floodwall designs and property-scale investments (first-floor elevation, wet floodproofing of basements, permanent retreat and insurance), recommends implementation schedules, and assesses impacts to stakeholders residing in three types of homes. An application to a stylized municipality illuminates many nonlinear system dynamics stemming from large fixed capital costs, infrastructure design thresholds, and discharge-depth-damage relationships. If stakeholders tolerate mild damage, floodwalls that fully protect a community from large design events are less cost-effective than portfolios featuring both smaller floodwalls and property-scale measures. Potential losses of property tax revenue from permanent retreat motivate municipal property-tax initiatives for adaptation financing. Yet, insurance incentives for first-floor elevation may discourage locally financed floodwalls, in turn making lower-income residents more vulnerable to severe flooding. A budget constraint analysis underscores the benefits of flexible floodwall designs with low incremental expansion costs while near-optimal solutions demonstrate the scheduling flexibility of many property-scale measures. Finally, an equity analysis shows the importance of evaluating the overpayment and under-design regrets of recommended adaptation portfolios for each stakeholder and contrasts them to single-scenario model results.

  3. Management Of Saline Groundwater Discharge By Long-term Windmill Pumping In The Wheatbelt, Western Australia

    NASA Astrophysics Data System (ADS)

    Salama, R. B.; Otto, C. J.; Bartle, G. A.; Watson, G. D.

    1994-01-01

    Land and stream salinization in the Western Australian wheatbelt developed as a result of clearing of native vegetation. This caused a shift in the hydrological balance and a 10- to 30-fold increase in recharge. Rising water levels rejuvenated groundwater flow through paleao channels and increased baseflow to drainage lines. An increase in saline groundwater ascension (TDS 5000-30 000 mgl-1) to the near-surface, induced by rising pressure heads in the deeper semi-confined aquifer system, advanced land and stream salinization. Areas in a catchment where groundwater flow is channelled upwards by subsurface geological strctures are especially susceptible to salinization and water logging. Enhanced discharge by windmill pumping is an engineering method to reduce excess pressure heads of deep semi-confined aquifers in discharge areas and, consequently, lower water levels at shallower depths. It is an interim solution to halt and prevent salinization in the wheatbelt of Western Australia. Long-term field experiments in three catchments and modelling have shown that windmill pumping (15-30 m3d-1) in the wheatbelt can reduce water levels by 1 to 2 m at radial distance of more than 1 km after several years of pumping. The pumped groundwater can be reused for irrigation (TDS < 3000 mgl-1) or stock water (TDS < 10 000 mgl-1). In some instances, highly saline effluent can be discharged into saline streams or salt lakes. Often saline water disposal requires on-farm evaporation ponds or sacrificial basins. The enhanced discharge method should be part of an integrated catchment management program for the restoration of saline land and streams. the technology is applicable to other irrigated and non-irrigated salt-contaminated regions.

  4. Long-term lesser prairie-chicken nest ecology in response to grassland management

    USGS Publications Warehouse

    Fritts, Sarah R.; Grisham, Blake A.; Haukos, David A.; Boal, Clint W.; Patten, Michael; Wolfe, Don H.; Dixon, Charles; Cox, Robert D.; Heck, Willard R.

    2016-01-01

    Long-term population and range declines from habitat loss and fragmentation caused the lesser prairie-chicken (Tympanuchus pallidicinctus) to be a species of concern throughout its range. Current lesser prairie-chicken range in New Mexico and Texas is partially restricted to sand shinnery oak (Quercus havardii; hereafter shinnery oak) prairies, on which cattle grazing is the main socioeconomic driver for private landowners. Cattle producers within shinnery oak prairies often focus land management on shrub eradication using the herbicide tebuthiuron to promote grass production for forage; however, herbicide application alone, and in combination with grazing, may affect nest site selection and nest survival of lesser prairie-chickens through the reduction of shinnery oak and native grasses. We used a controlled, paired, completely randomized design study to assess the influence of grazing and tebuthiuron application and their combined use on nest site selection and nest survival from 2001 to 2010 in Roosevelt County, New Mexico, USA at 2 spatial scales (i.e., treatment and microhabitat) in 4 treatments: tebuthiuron with grazing, tebuthiuron without grazing, no tebuthiuron with grazing, and a control of no tebuthiuron and no grazing. Grazing treatment was a short-duration system in which plots were grazed once during the dormant season and once during the growing season. Stocking rate was calculated each season based on measured forage production and applied to remove ≤25% of available herbaceous material per season. At the treatment scale, we compared nest site selection among treatments using 1-way χ2 tests and nest survival among treatments using a priori candidate nest survival models in Program MARK. At the microhabitat scale, we identified important habitat predictors of nest site selection and nest survival using logistic regression and a priori candidate nest survival models in Program MARK, respectively. Females typically used treatments as expected and

  5. Long-term neurological conditions: management at the interface between neurology, rehabilitation and palliative care.

    PubMed

    Turner-Stokes, Lynne; Sykes, Nigel; Silber, Eli

    2008-04-01

    Long-term neurological conditions (LTNCs) comprise a diverse set of conditions resulting from injury or disease of the nervous system that will affect an individual for life. Some 10 million people in the UK are living with a neurological condition which has a significant impact on their lives, and they make up 19% of hospital admissions. These guidelines build on the Quality Requirements in the National Service Framework for Long-term (Neurological) Conditions to explore the interaction between specialist neurology, rehabilitation and palliative care services, and how they may best work together to provide long-term support for people with LTNCs and the family members who care for them. The guidelines also provide some practical advice for other clinicians when caring for someone with an LTNC, and outline indications for specialist referral. This article provides a brief summary. Full details of the methods and literature evaluation, as well as tools for implementation, are available in the full guideline.

  6. The Effectiveness of Self-Management Mobile Phone and Tablet Apps in Long-term Condition Management: A Systematic Review.

    PubMed

    Whitehead, Lisa; Seaton, Philippa

    2016-05-16

    Long-term conditions and their concomitant management place considerable pressure on patients, communities, and health care systems worldwide. International clinical guidelines on the majority of long-term conditions recommend the inclusion of self-management programs in routine management. Self-management programs have been associated with improved health outcomes; however, the successful and sustainable transfer of research programs into clinical practice has been inconsistent. Recent developments in mobile technology, such as mobile phone and tablet computer apps, could help in developing a platform for the delivery of self-management interventions that are adaptable, of low cost, and easily accessible. We conducted a systematic review to assess the effectiveness of mobile phone and tablet apps in self-management of key symptoms of long-term conditions. We searched PubMed, Embase, EBSCO databases, the Cochrane Library, and The Joanna Briggs Institute Library for randomized controlled trials that assessed the effectiveness of mobile phone and tablet apps in self-management of diabetes mellitus, cardiovascular disease, and chronic lung diseases from 2005-2016. We searched registers of current and ongoing trials, as well as the gray literature. We then checked the reference lists of all primary studies and review papers for additional references. The last search was run in February 2016. Of the 9 papers we reviewed, 6 of the interventions demonstrated a statistically significant improvement in the primary measure of clinical outcome. Where the intervention comprised an app only, 3 studies demonstrated a statistically significant improvement. Interventions to address diabetes mellitus (5/9) were the most common, followed by chronic lung disease (3/9) and cardiovascular disease (1/9). A total of 3 studies included multiple intervention groups using permutations of an intervention involving an app. The duration of the intervention ranged from 6 weeks to 1 year, and

  7. The Effectiveness of Self-Management Mobile Phone and Tablet Apps in Long-term Condition Management: A Systematic Review

    PubMed Central

    2016-01-01

    Background Long-term conditions and their concomitant management place considerable pressure on patients, communities, and health care systems worldwide. International clinical guidelines on the majority of long-term conditions recommend the inclusion of self-management programs in routine management. Self-management programs have been associated with improved health outcomes; however, the successful and sustainable transfer of research programs into clinical practice has been inconsistent. Recent developments in mobile technology, such as mobile phone and tablet computer apps, could help in developing a platform for the delivery of self-management interventions that are adaptable, of low cost, and easily accessible. Objective We conducted a systematic review to assess the effectiveness of mobile phone and tablet apps in self-management of key symptoms of long-term conditions. Methods We searched PubMed, Embase, EBSCO databases, the Cochrane Library, and The Joanna Briggs Institute Library for randomized controlled trials that assessed the effectiveness of mobile phone and tablet apps in self-management of diabetes mellitus, cardiovascular disease, and chronic lung diseases from 2005–2016. We searched registers of current and ongoing trials, as well as the gray literature. We then checked the reference lists of all primary studies and review papers for additional references. The last search was run in February 2016. Results Of the 9 papers we reviewed, 6 of the interventions demonstrated a statistically significant improvement in the primary measure of clinical outcome. Where the intervention comprised an app only, 3 studies demonstrated a statistically significant improvement. Interventions to address diabetes mellitus (5/9) were the most common, followed by chronic lung disease (3/9) and cardiovascular disease (1/9). A total of 3 studies included multiple intervention groups using permutations of an intervention involving an app. The duration of the

  8. Characteristics of spent fuel, high-level waste, and other radioactive wastes which may require long-term isolation

    SciTech Connect

    1988-06-01

    The purpose of this report, and the information contained in the associated computerized data bases, is to establish the DOE/OCRWM reference characteristics of the radioactive waste materials that may be accepted by DOE for emplacement in the mined geologic disposal system as developed under the Nuclear Waste Policy Act of 1982. This report provides relevant technical data for use by DOE and its supporting contractors and is not intended to be a policy document. This document is backed up by five PC-compatible data bases, written in a user-oriented, menu-driven format, which were developed for this purpose.

  9. Long-Term Effects of Outpatient Geriatric Evaluation and Management on Health Care Utilization, Cost, and Survival

    ERIC Educational Resources Information Center

    Engelhardt, Joseph B.; Toseland, Ronald W.; Gao, Jian; Banks, Steven

    2006-01-01

    Purpose: The long-term effectiveness and efficiency of an outpatient geriatric evaluation and management (GEM) program was compared to usual primary care (UPC). Design and Method: A randomized controlled group design was used. Health care utilization, cost of care, and survival were assessed during a 48-month period among a sample of 160 male…

  10. APPLICATION OF THE ANALYTIC HIERARCHY PROCESS TO COMPARE ALTERNATIVES FOR THE LONG-TERM MANAGEMENT OF SURPLUS MERCURY

    EPA Science Inventory

    This paper describes a systematic method for comparing options for the long-term management of surplus elemental mercury in the U.S., using the Analytic Hierarchy Process (AHP) as embodied in commercially available Expert Choice software. A limited scope multi-criteria decision-a...

  11. APPLICATION OF THE ANALYTIC HIERARCHY PROCESS TO COMPARE ALTERNATIVES FOR THE LONG-TERM MANAGEMENT OF SURPLUS MERCURY

    EPA Science Inventory

    This paper describes a systematic method for comparing options for the long-term management of surplus elemental mercury in the U.S., using the Analytic Hierarchy Process (AHP) as embodied in commercially available Expert Choice software. A limited scope multi-criteria decision-a...

  12. Long-Term Effects of Outpatient Geriatric Evaluation and Management on Health Care Utilization, Cost, and Survival

    ERIC Educational Resources Information Center

    Engelhardt, Joseph B.; Toseland, Ronald W.; Gao, Jian; Banks, Steven

    2006-01-01

    Purpose: The long-term effectiveness and efficiency of an outpatient geriatric evaluation and management (GEM) program was compared to usual primary care (UPC). Design and Method: A randomized controlled group design was used. Health care utilization, cost of care, and survival were assessed during a 48-month period among a sample of 160 male…

  13. Surgical management of acromegaly: Long term functional outcome analysis and assessment of recurrent/residual disease

    PubMed Central

    Banerji, Deepu; Das, Nitu K.; Sharma, Siddhiraj; Jindal, Yogesh; Jain, Vijendra K.; Behari, Sanjay

    2016-01-01

    Context: Functional growth hormone producing adenomas have long-term deleterious effects on the visual apparatus, the cardiovascular and musculoskeletal systems, and often predispose to malignancies. Since persistence of acromegaly affects outcome and quality of life, therapeutic interventions become mandatory. Aim: This study represents an analysis of long-term clinical and endocrinal outcome of 115 patients of acromegaly after surgical management. Setting and Design: Tertiary care retrospective study. Materials and Methods: One hundred and fifteen patients (male:female ratio: 1:1.09) with acromegalic features were studied. Apart from acromegalic features, their main clinical presentation also included headache, diminution of vision, field defects, ptosis, irregular menstruation, diabetes insipidus, diabetes mellitus and hypertension. Six of them presented with apoplexy. Their preoperative endocrinal evaluation included basal and suppressed growth hormone (GH), prolactin and thyroid levels. On the basis of axial and coronal CT scan or multiplanar MR imaging or both, the tumors were classified according to their suprasellar and parasellar extension (Hardy's grade). Transnasal trans-sphenoidal surgery (TSS) (n = 37) and sublabial, rhinoseptal TSS (n = 72) were the preferred approaches. Six patients with significant parasellar extensions underwent trans-cranial explorations. The patients were followed up at 6 and 12 weeks and then at 6 monthly intervals. Hormonal and CT/MR evaluation were also done. Attainment of random GH value less than 2.5 µg/L, and the nadir GH value after oral glucose tolerance test (OGTT) less than 1 µg/L were used as the criteria of cure. Findings: The patients were preoperatively in Hardy's tumor grade 0 (29), A (21), A+E (3), B (21), B+E (5), C (9), C+E (10), D (1) D+E (11), E (5), respectively. One hundred and one patients were available for follow-up (FU; median FU duration: 84 months; range: 6 to 132 months). Surgical cure was achieved

  14. Development of Approach for Long-Term Management of Disused Sealed Radioactive Sources - 13630

    SciTech Connect

    Kinker, M.; Reber, E.; Mansoux, H.; Bruno, G.

    2013-07-01

    Radioactive sources are used widely throughout the world in a variety of medical, industrial, research and military applications. When such radioactive sources are no longer used and are not intended to be used for the practice for which an authorization was granted, they are designated as 'disused sources'. Whether appropriate controls are in place during the useful life of a source or not, the end of this useful life is often a turning point after which it is more difficult to ensure the safety and security of the source over time. For various reasons, many disused sources cannot be returned to the manufacturer or the supplier for reuse or recycling. When these attempts fail, disused sources should be declared as radioactive waste and should be managed as such, in compliance with relevant international legal instruments and safety standards. However, disposal remains an unresolved issue in many counties, due to in part to limited public acceptance, insufficient funding, and a lack of practical examples of strategies for determining suitable disposal options. As a result, disused sources are often stored indefinitely at the facilities where they were once used. In order to prevent disused sources from becoming orphan sources, each country must develop and implement a comprehensive waste management strategy that includes disposal of disused sources. The International Atomic Energy Agency (IAEA) fosters international cooperation between countries and encourages the development of a harmonized 'cradle to grave' approach to managing sources consistent with international legal instruments, IAEA safety standards, and international good practices. This 'cradle to grave' approach requires the development of a national policy and implementing strategy, an adequate legal and regulatory framework, and adequate resources and infrastructure that cover the entire life cycle, from production and use of radioactive sources to disposal. (authors)

  15. Impact of Scots pine (Pinus sylvestris L.) plantings on long term (137)Cs and (90)Sr recycling from a waste burial site in the Chernobyl Red Forest.

    PubMed

    Thiry, Yves; Colle, Claude; Yoschenko, Vasyl; Levchuk, Svjatoslav; Van Hees, May; Hurtevent, Pierre; Kashparov, Valery

    2009-12-01

    Plantings of Scots pine (Pinus sylvestris L.) on a waste burial site in the Chernobyl Red Forest was shown to greatly influence the long term redistribution of radioactivity contained in sub-surfaces trenches. After 15 years of growth, aboveground biomass of the average tree growing on waste trench no.22 had accumulated 1.7 times more (137)Cs than that of trees growing off the trench, and 5.4 times more (90)Sr. At the scale of the trench and according to an average tree density of 3300 trees/ha for the study zone, tree contamination would correspond to 0.024% of the (137)Cs and 2.52% of the (90)Sr contained in the buried waste material. A quantitative description of the radionuclide cycling showed a potential for trees to annually extract up to 0.82% of the (90)Sr pool in the trench and 0.0038% of the (137)Cs. A preferential (90)Sr uptake from the deep soil is envisioned while pine roots would take up (137)Cs mostly from less contaminated shallow soil layers. The current upward flux of (90)Sr through vegetation appeared at least equal to downward loss in waste material leaching as reported by Dewiere et al. (2004, Journal of Environmental Radioactivity 74, 139-150). Using a prospective calculation model, we estimated that maximum (90)Sr cycling can be expected to occur at 40 years post-planting, resulting in 12% of the current (90)Sr content in the trench transferred to surface soils through biomass turnover and 7% stored in tree biomass. These results are preliminary, although based on accurate methodology. A more integrated ecosystem study leading to the coupling between biological and geochemical models of radionuclide cycling within the Red Forest seems opportune. Such a study would help in the adequate management of that new forest and the waste trenches upon which they reside.

  16. Long-term response of the mamane forest to feral herbivore management on Mauna Kea, Hawaii

    Treesearch

    E. Reddy; D. H. Van Vuren; P. G. Scowcroft; J. B. Kauffman; L. Perry

    2012-01-01

    Seven exclosure sites located on Mauna Kea, Hawaii and established in the 1960s and 70s were sampled to characterize long-term response of the mamane (Sophora chrysophylla) forest to protection from feral sheep grazing, and to assess impacts of non-native plant species and recurrent sheep presence on forest recovery. The forest provides essential...

  17. Management and long-term outcome of partial glossectomy in 2 horses

    PubMed Central

    Lang, Hayley M.; Panizzi, Luca; Smyth, Travis T.; Plaxton, Andrea E.; Lohmann, Katharina L.; Barber, Spencer M.

    2014-01-01

    Records were reviewed for 2 horses with partial glossectomy, 1 traumatic and 1 elective. According to long-term follow-up by telephone, both horses had recovered well, experiencing only temporary difficulty while eating, and went on to be ridden successfully using mouth bits. Partial glossectomy, therefore, had a favorable prognosis in 2 performance horses. PMID:24587510

  18. Long-term soil changes from forest harvesting and residue management in the northern Rocky Mountains

    Treesearch

    Woongsoon Jang; Deborah S. Page-Dumroese; Christopher R. Keyes

    2016-01-01

    Soil changes associated with forest harvesting, differing utilization levels, and post-harvest prescribed burning were determined using an empirical study to investigate the long-term impacts on soil physical and chemical properties at Coram Experimental Forest in northwestern Montana. In 1974, two replications of three regeneration cuttings (shelterwood,...

  19. 1989 Management Seminars for the New York Association of Long Term Care Administrators.

    ERIC Educational Resources Information Center

    Towne, Violet A.

    The collaboration between the continuing education arm of the State University of New York Institute of Technology at Utica/Rome and the New York Association for Long Term Care Administrators in the design, development and delivery of educational programs for nursing home and adult home administrators in New York State is reported. Program content…

  20. Long-term management of patients with celiac disease: Current practices of gastroenterologists in Canada

    PubMed Central

    Silvester, Jocelyn Anne; Rashid, Mohsin

    2010-01-01

    BACKGROUND: Long-term follow-up of patients with celiac disease is important for monitoring their clinical status, dietary compliance and complications. AIM: To examine the current practices of Canadian gastroenterologists providing long-term care to patients with celiac disease. METHODS: All gastroenterologists in Canada (n=585) were surveyed regarding their practice demographics, familiarity with celiac disease practice guidelines, and follow-up clinical examination and investigations. RESULTS: Of the 585 surveys mailed to gastroenterologists, 567 were expected to be returned. A total of 242 completed surveys (43%) were received. Of these, 237 (184 adult, 51 pediatric and two mixed) had an active practice that included patients with celiac disease. Long-term follow-up care was provided routinely by 76% of respondents. Follow-up consisted of annual clinic visits (67%), dietary review (77%), reinforcement of the need for adherence to a gluten-free diet (90%) and recommending membership in an advocacy group (65%). Physical examination was performed by 78%; most ordered laboratory tests including serology (65%). Adult gastroenterologists performed routine follow-up intestinal biopsy more often than their pediatric counterparts (46% versus 10%), but performed serology less frequently (48% versus 86%). Pediatric patients were more likely to be followed by a multidisciplinary team. All pediatric gastroenterologists were familiar with at least one celiac disease practice guideline, whereas 15% of adult gastroenterologists were not familiar with any practice guideline. The majority of gastroenterologists who did not routinely provide follow-up expected care to be provided by the patient’s primary physician (86%). CONCLUSIONS: Most gastroenterologists in Canada who responded to the survey provided long-term follow-up care to patients with celiac disease. The diverse practices reported underscore the need to develop consensus-based guidelines for long-term care of these

  1. Long term effect of alkali types on waste activated sludge hydrolytic acidification and microbial community at low temperature.

    PubMed

    Jin, Baodan; Wang, Shuying; Xing, Liqun; Li, Baikun; Peng, Yongzhen

    2016-01-01

    The effect of four alkali reagents (NaOH, KOH, Ca(OH)2, mixed alkali) on waste activated sludge (WAS) hydrolytic acidification and microbial community was studied in semi-continuous fermentation systems at low temperature (15°C) over long term operational time (65day). The results showed that protein and polysaccharide of NaOH (124.26, 11.92) was similar to that of KOH (109.53, 11.30), both were higher than Ca(OH)2 (70.66, 3.74) and mixed alkali (90.66, 8.71). The short chain fatty acids (SCFAs) of NaOH (231.62) was higher than KOH (220.62mg chemical oxygen demand (COD)/g VSS). Although Ca(OH)2 system had strong acidification capacity, the shortage of SCFAs occurred due to the low activity of hydrolase. Illumina MiSeq sequencing revealed that Tissierella and Erysipelothrix were enriched in the NaOH and Ca(OH)2 systems, where Peptostreptococcaceae incertae_sedis was enriched in the NaOH and KOH systems, less Anaerolinea was involved in Ca(OH)2 condition.

  2. Long-term effect of irrigation with waste water on soil microbial community in semi-arid conditions

    NASA Astrophysics Data System (ADS)

    García-Orenes, Fuensanta; Morugan, Alicia; Mar Alguacil, Mª; Roldan, Antonio

    2013-04-01

    The water shortage is one of the most serious environmental problems in semi-arid areas around the world, which implicates the search for alternatives sources of water to satisfy the water demand in these regions. The use of wastewater for the irrigation of agricultural land is one of most suitable solutions to save better quality water when the natural resources are scarce. The reuse of wastewater in soil irrigation is not a new practise and is increasing in many places around the world; however the implications for the sustainability of agro-ecosystems must be studied in deep. The objective of this work was to study the effects of the long-term irrigation with treated wastewater in soil microbial community (evaluated as abundance of phospholipid fatty acids, PLFA). The experiment was conducted in an area located in Alicante (Southeast Spain) (Coordinates 38° 17´38" N, 0° 33´50" W). During 40 years an experimental Citrus aurantium L. (orange tree) orchard has been drip-irrigated with waste water, and control plots with the same characteristics subjected to drip irrigation with fresh water, were also stabilised during all the experimental period. Soil samples from individual trees were colleted in a randomised design with three replicates for each irrigation treatment (irrigation with waste water and irrigation with fresh water), to analyse the abundance of PLFA at the end of the experiment. The results show a major content of total PLFA in soils irrigated with fresh water, also these soils showed higher variety of PLFAs, and so a higher variety of groups of microorganims.

  3. The geochemical release feature of Tl in Tl-rich pyrite mine wastes: a long-term leaching test.

    PubMed

    Li, Jinwen; Chen, Nan; Rajan, Ivy; Sun, Zhehua; Wu, Huiming; Chen, Diyun; Kong, Lingjun

    2017-05-01

    Identifying and revealing the geochemical behaviour of Tl during mine waste weathering are very important to assess the potential environmental impact of Thallium (Tl) from open mine-waste piles. Herein, two methods including the modified BCR sequential extraction and the long-term humidity cell tests (HCT) were employed to understand the Tl chemical fractions and to stimulate intense chemical weathering process, respectively. The results from BCR sequential extraction showed that the Tl concentration in the studied sample was 18.78 mg/kg, containing 1.878 mg/kg oxidisable, 0.282 mg/kg acid exchangeable and 1.596 mg/kg reducible Tl. The acid exchangeable fraction contributed to a particular potential risk to the aquatic marine life in the early stages and the Fe/Mn oxidisable fraction posed a potential risk being dissolved into solution at low pH (i.e. acidic conditions). The variations of Tl concentration in leachates were classified as two period as the pH values decrease. In the first period, the Tl concentrations decreased positively with pH value with poor correlation between pH value and SO4(2-) concentration in leachates. Drastic release of Tl was observed in the early period once the material was exposed to air and water, being ascribe to the acid exchangeable fraction bound to carbonate as dissolved by acid. During the second period, three increased peaks of Tl concentration (11.02, 16.03, 43.15 μg/L) and four increased peaks of SO4(2-) concentration (315, 390, 899.61 and 2670 mg/L) were observed. A good correlation (R (2) = 0.8384) between the concentrations of Tl and SO4(2-) was observed, indicating the Tl was mainly released from the oxidation of sulphide.

  4. Long-Term Condition Self-Management Support in Online Communities: A Meta-Synthesis of Qualitative Papers.

    PubMed

    Allen, Chris; Vassilev, Ivaylo; Kennedy, Anne; Rogers, Anne

    2016-03-10

    Recent years have seen an exponential increase in people with long-term conditions using the Internet for information and support. Prior research has examined support for long-term condition self-management through the provision of illness, everyday, and emotional work in the context of traditional offline communities. However, less is known about how communities hosted in digital spaces contribute through the creation of social ties and the mobilization of an online illness "workforce." The aim was to understand the negotiation of long-term condition illness work in patient online communities and how such work may assist the self-management of long-term conditions in daily life. A systematic search of qualitative papers was undertaken using various online databases for articles published since 2004. A total of 21 papers met the inclusion criteria of using qualitative methods and examined the use of peer-led online communities for those with a long-term condition. A qualitative meta-synthesis was undertaken and the review followed a line of argument synthesis. The main themes identified in relation to the negotiation of self-management support were (1) redressing offline experiential information and knowledge deficits, (2) the influence of modeling and learning behaviors from others on self-management, (3) engagement that validates illness and negates offline frustrations, (4) tie formation and community building, (5) narrative expression and cathartic release, and (6) dissociative anonymity and invisibility. These translated into a line of argument synthesis in which four network mechanisms for self-management support in patient online communities were identified. These were (1) collective knowledge and identification through lived experience; (2) support, information, and engagement through readily accessible gifting relationships; (3) sociability that extends beyond illness; and (4) online disinhibition as a facilitator in the negotiation of self-management

  5. Long-Term Condition Self-Management Support in Online Communities: A Meta-Synthesis of Qualitative Papers

    PubMed Central

    Vassilev, Ivaylo; Kennedy, Anne; Rogers, Anne

    2016-01-01

    Background Recent years have seen an exponential increase in people with long-term conditions using the Internet for information and support. Prior research has examined support for long-term condition self-management through the provision of illness, everyday, and emotional work in the context of traditional offline communities. However, less is known about how communities hosted in digital spaces contribute through the creation of social ties and the mobilization of an online illness “workforce.” Objective The aim was to understand the negotiation of long-term condition illness work in patient online communities and how such work may assist the self-management of long-term conditions in daily life. Methods A systematic search of qualitative papers was undertaken using various online databases for articles published since 2004. A total of 21 papers met the inclusion criteria of using qualitative methods and examined the use of peer-led online communities for those with a long-term condition. A qualitative meta-synthesis was undertaken and the review followed a line of argument synthesis. Results The main themes identified in relation to the negotiation of self-management support were (1) redressing offline experiential information and knowledge deficits, (2) the influence of modeling and learning behaviors from others on self-management, (3) engagement that validates illness and negates offline frustrations, (4) tie formation and community building, (5) narrative expression and cathartic release, and (6) dissociative anonymity and invisibility. These translated into a line of argument synthesis in which four network mechanisms for self-management support in patient online communities were identified. These were (1) collective knowledge and identification through lived experience; (2) support, information, and engagement through readily accessible gifting relationships; (3) sociability that extends beyond illness; and (4) online disinhibition as a facilitator

  6. Long-term simulations of water and isoproturon dynamics in a heterogeneous soil receiving different urban waste composts

    NASA Astrophysics Data System (ADS)

    Filipović, Vilim; Coquet, Yves; Pot, Valérie; Romić, Davor; Benoit, Pierre; Houot, Sabine

    2016-04-01

    Implementing various compost amendments and tillage practices has a large influence on soil structure and can create heterogeneities at the plot/field scale. While tillage affects soil physical properties, compost application influences also chemical properties like pesticide sorption and degradation. A long-term field experiment called "QualiAgro" (https://www6.inra.fr/qualiagro_eng/), conducted since 1998 aims at characterizing the agronomic value of urban waste composts and their environmental impacts. A modeling study was carried out using HYDRUS-2D for the 2004-2010 period to confront the effects of two different compost types combined with the presence of heterogeneities due to tillage in terms of water and isoproturon dynamics in soil. A municipal solid waste compost (MSW) and a co-compost of sewage sludge and green wastes (SGW) have been applied to experimental plots and compared to a control plot without any compost addition (CONT). Two wick lysimeters, 5 TDR probes, and 7 tensiometers were installed per plot to monitor water and isoproturon dynamics. In the ploughed layer, four zones with differing soil structure were identified: compacted clods (Δ), non-compacted soil (Γ), interfurrows (IF), and the plough pan (PP). These different soil structural zones were implemented into HYDRUS-2D according to field observation and using measured soil hydraulic properties. Lysimeter data showed (2004 -2010 period) that the CONT plot had the largest cumulative water outflow (1388 mm) compared to the MSW plot (962 mm) and SGW plot (979 mm). HYDRUS-2D was able to describe cumulative water outflow after calibration of soil hydraulic properties, for the whole 2004-2010 period with a model efficiency value of 0.99 for all three plots. Isoproturon leaching showed had the largest cumulative value in the CONT plot (21.31 μg) while similar cumulated isoproturon leachings were measured in the SGW (0.663 μg) and MSW (0.245 μg) plots. The model was able to simulate

  7. Long-term outcome after surgical and endovascular management of true and false subclavian artery aneurysms.

    PubMed

    Zehm, Sarah; Chemelli, Andreas; Jaschke, Werner; Fraedrich, Gustav; Rantner, Barbara

    2014-06-01

    Subclavian artery aneurysm is a rare but serious disease due to the risk of thrombosis, embolization, rupture and compression of adjacent structures. Treatment consists of surgical and endovascular techniques. Up to now few long-term follow-up results have been reported. In our study the results from 15 patients treated for subclavian artery aneurysms were evaluated. Eleven patients underwent open surgical reconstruction, four patients were treated endovascularly. After a mean follow-up period of 77 months (83 months for the open surgical group, 38 months for the endovascular group), 10 of 11 open surgical reconstructions and all primarily implanted stent grafts were patent. Secondary intervention was necessary in two patients. Thirty-day mortality for both treatment groups was 0%. Subclavian artery aneurysm-related symptoms disappeared in six out of 10 patients after the treatment. Long-term outcomes with good technical results, patency rates and low periprocedural morbidity could be shown in both treatment groups.

  8. MANAGEMENT OF ENDOCRINE DISEASE: Long-term outcomes of the treatment of central precocious puberty.

    PubMed

    Guaraldi, Federica; Beccuti, Guglielmo; Gori, Davide; Ghizzoni, Lucia

    2016-03-01

    GnRH analogues (GnRHa) are the treatment of choice for central precocious puberty (CPP), with the main objective to recover the height potential compromised by the premature fusion of growth cartilages. The aim of this review was to analyze long-term effects of GnRHa on height, body weight, reproductive function, and bone mineral density (BMD) in patients with CPP, as well as the potential predictors of outcome. Because randomized controlled trials on the effectiveness and long-term outcomes of treatment are not available, only qualified conclusions about the efficacy of interventions can be drawn. GnRHa treatment appears to improve adult height in girls with CPP, especially if diagnosed before the age of 6, whereas a real benefit in terms of adult height is still controversial in patients with the onset of puberty between 6 and 8 years of age. No height benefit was shown in patients treated after 8 years. Gonadal function is promptly restored in girls after cessation of treatment, and reproductive potential appears normal in young adulthood. Data are conflicting on the long-term risk of polycystic ovarian syndrome in both treated and untreated women. Fat mass is increased at the start of treatment but normalizes thereafter, and GnRHa itself does not seem to have any long-term effect on BMI. Similarly, analogue treatment does not appear to have a negative impact on BMD. Owing to the paucity of data available, no conclusions can be drawn on the repercussions of CPP and/or its treatment on the timing of menopause and on the health of the offspring.

  9. Juvenile Diabetes Mellitus and Concurrent Exocrine Pancreatic Insufficiency in a Labrador Retriever: Long-Term Management.

    PubMed

    Alvarez, Maria Saiz; Herrería-Bustillo, Vicente; Utset, Artur Font; Martínez, Jorge

    2015-01-01

    A 3 mo old, female, entire Labrador retriever presented with vomiting, diarrhea, polyuria, polydipsia, polyphagia, and stunted growth. Diagnostics revealed the presence of juvenile diabetes mellitus and concurrent exocrine pancreatic insufficiency. Pancreatic histopathology showed severe pancreatic atrophy. Successful treatment was achieved with a combination of insulin and pancreatic enzymes. This report describes successful long-term treatment of juvenile diabetes mellitus and concurrent exocrine pancreatic insufficiency in a dog.

  10. Waste Management Program. Technical progress report, October-December 1982

    SciTech Connect

    1983-07-01

    This quarterly report provides current information on operations and development programs for the management of radioactive wastes from operation of the Savannah River Plant and offplant participants. The studies on environmental and safety assessments, in situ storage or disposal, waste from development and characterization, process and equipment development, and low-level waste management are a part of the Long-Term Waste Management Technology Program. The following studies are reported for the SR Interim Waste Operations Program: surveillance and maintenance, waste concentration, low-level effluent waste, tank replacement/waste transfer, and solid waste storage and related activities.

  11. Characteristics of spent fuel, high-level waste, and other radioactive wastes which may require long-term isolation

    SciTech Connect

    1987-12-01

    The purpose of this report, and the information contained in the associated computerized data bases, is to establish the DOE/OCRWM reference characteristics of the radioactive waste materials that may be accepted by DOE for emplacement in the mined geologic disposal system. This report provides relevant technical data for use by DOE and its supporting contractors and is not intended to be a policy document. This document is backed up by five PC-compatible data bases, written in a user-oriented, menu-driven format, which were developed for this purpose. The data bases are the LWR Assemblies Data Base; the LWR Radiological Data Base; the LWR Quantities Data Base; the LWR NFA Hardware Data Base; and the High-Level Waste Data Base. The above data bases may be ordered using the included form. An introductory information diskette can be found inside the back cover of this report. It provides a brief introduction to each of these five PC data bases. 116 refs., 18 figs., 67 tabs.

  12. Characteristics of spent fuel, high-level waste, and other radioactive wastes which may require long-term isolation

    SciTech Connect

    1988-06-01

    The purpose of this report, and the information contained in the associated computerized data bases, is to establish the DOE/OCRWM reference characteristics of the radioactive waste materials that may be accepted by DOE for emplacement in the mined geologic disposal system. This report provides relevant technical data for use by DOE and its supporting contractors and is not intended to be a policy document. This document is backed up by five PC-compatible data bases, written in a user-oriented, menu-driven format, which were developed for this purpose. The data bases are the LWR Assemblies Data Base; the LWR Radiological Data Base; the LWR Quantities Data Base; the LWR NEA Hardware Data Base; and the High-Level Waste Data Base. The above data bases may be ordered using the included form. An introductory information diskette can be found inside the back cover of this report. It provides a brief introduction to each of these five PC data bases. Volume 8 contains 4 appendices. 14 refs., 20 figs., 20 tabs.

  13. Long-term assessment of the environmental fate of heavy metals in agricultural soil after cessation of organic waste treatments.

    PubMed

    Kwon, Soon-Ik; Jang, Yeon-A; Owens, Gary; Kim, Min-Kyeong; Jung, Goo-Bok; Hong, Seung-Chang; Chae, Mi-Jin; Kim, Kwon-Rae

    2014-06-01

    The current study examined the anthropogenic accumulation and natural decrease in metal concentrations in agricultural soils following organic waste application. Three common organic wastes, including municipal sewage sludge, alcohol fermentation processing sludge, and pig manure compost (PMC), were applied annually to an agricultural soil under field conditions over 7 years (1994-2000) at a rate of 12.5, 25, and 50 ton ha(-1) year(-1) and the soil accumulation of three metals of concern (Cu, Pb, and Zn) was monitored. Subsequently, organic waste amendments ceased and the experimental plots were managed using conventional fertilization for another 10 years (2001-2010) and the natural decrease in metal concentrations monitored. Although Cu and Zn concentrations in all experimental plots did not exceed the relevant guideline values (150 mg kg(-1) for Cu and 300 mg kg(-1) for Zn), significant increases in metal concentrations were observed from cumulative application of organic wastes over 7 years. For instance, PMC treatment resulted in an increase in Cu and Zn from 9.8 and 72 mg kg(-1) to 108.2 and 214.3 mg kg(-1), respectively. In addition, the natural decrease in Cu and Zn was not significant as soils amended with PMC showed only a 16 and 19 % decline in Cu and Zn concentrations, respectively, even 10 years after amendment ceased. This research suggested that more attention must be paid during production of organic waste-based amendments and at the application stage.

  14. Long-term no-tillage and organic input management enhanced the diversity and stability of soil microbial community.

    PubMed

    Wang, Yi; Li, Chunyue; Tu, Cong; Hoyt, Greg D; DeForest, Jared L; Hu, Shuijin

    2017-12-31

    Intensive tillage and high inputs of chemicals are frequently used in conventional agriculture management, which critically depresses soil properties and causes soil erosion and nonpoint source pollution. Conservation practices, such as no-tillage and organic farming, have potential to enhance soil health. However, the long-term impact of no-tillage and organic practices on soil microbial diversity and community structure has not been fully understood, particularly in humid, warm climate regions such as the southeast USA. We hypothesized that organic inputs will lead to greater microbial diversity and a more stable microbial community, and that the combination of no-tillage and organic inputs will maximize soil microbial diversity. We conducted a long-term experiment in the southern Appalachian mountains of North Carolina, USA to test these hypotheses. The results showed that soil microbial diversity and community structure diverged under different management regimes after long term continuous treatments. Organic input dominated the effect of management practices on soil microbial properties, although no-tillage practice also exerted significant impacts. Both no-tillage and organic inputs significantly promoted soil microbial diversity and community stability. The combination of no-tillage and organic management increased soil microbial diversity over the conventional tillage and led to a microbial community structure more similar to the one in an adjacent grassland. These results indicate that effective management through reducing tillage and increasing organic C inputs can enhance soil microbial diversity and community stability. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Social Network Type and Long-Term Condition Management Support: A Cross-Sectional Study in Six European Countries.

    PubMed

    Vassilev, Ivaylo; Rogers, Anne; Kennedy, Anne; Wensing, Michel; Koetsenruijter, Jan; Orlando, Rosanna; Portillo, Maria Carmen; Culliford, David

    2016-01-01

    Network types and characteristics have been linked to the capacity of inter-personal environments to mobilise and share resources. The aim of this paper is to examine personal network types in relation to long-term condition management in order to identify the properties of network types most likely to provide support for those with a long-term condition. A cross-sectional observational survey of people with type 2 diabetes using interviews and questionnaires was conducted between April and October 2013 in six European countries: Greece, Spain, Bulgaria, Norway, United Kingdom, and Netherlands. 1862 people with predominantly lower socio-economic status were recruited from each country. We used k-means clustering analysis to derive the network types, and one-way analysis of variance and multivariate logistic regression analysis to explore the relationship between network type socio-economic characteristics, self-management monitoring and skills, well-being, and network member work. Five network types of people with long-term conditions were identified: restricted, minimal family, family, weak ties, and diverse. Restricted network types represented those with the poorest self-management skills and were associated with limited support from social network members. Restricted networks were associated with poor indicators across self-management capacity, network support, and well-being. Diverse networks were associated with more enhanced self-management skills amongst those with a long-term condition and high level of emotional support. It was the three network types which had a large number of network members (diverse, weak ties, and family) where healthcare utilisation was most likely to correspond to existing health needs. Our findings suggest that type of increased social involvement is linked to greater self-management capacity and potentially lower formal health care costs indicating that diverse networks constitute the optimal network type as a policy in terms of

  16. Social Network Type and Long-Term Condition Management Support: A Cross-Sectional Study in Six European Countries

    PubMed Central

    2016-01-01

    Background Network types and characteristics have been linked to the capacity of inter-personal environments to mobilise and share resources. The aim of this paper is to examine personal network types in relation to long-term condition management in order to identify the properties of network types most likely to provide support for those with a long-term condition. Method A cross-sectional observational survey of people with type 2 diabetes using interviews and questionnaires was conducted between April and October 2013 in six European countries: Greece, Spain, Bulgaria, Norway, United Kingdom, and Netherlands. 1862 people with predominantly lower socio-economic status were recruited from each country. We used k-means clustering analysis to derive the network types, and one-way analysis of variance and multivariate logistic regression analysis to explore the relationship between network type socio-economic characteristics, self-management monitoring and skills, well-being, and network member work. Results Five network types of people with long-term conditions were identified: restricted, minimal family, family, weak ties, and diverse. Restricted network types represented those with the poorest self-management skills and were associated with limited support from social network members. Restricted networks were associated with poor indicators across self-management capacity, network support, and well-being. Diverse networks were associated with more enhanced self-management skills amongst those with a long-term condition and high level of emotional support. It was the three network types which had a large number of network members (diverse, weak ties, and family) where healthcare utilisation was most likely to correspond to existing health needs. Discussion Our findings suggest that type of increased social involvement is linked to greater self-management capacity and potentially lower formal health care costs indicating that diverse networks constitute the optimal

  17. Seasonal-Spatial Distribution and Long-Term Variation of Transparency in Xin'anjiang Reservoir: Implications for Reservoir Management.

    PubMed

    Wu, Zhixu; Zhang, Yunlin; Zhou, Yongqiang; Liu, Mingliang; Shi, Kun; Yu, Zuoming

    2015-08-12

    Water transparency is a useful indicator of water quality or productivity and is widely used to detect long-term changes in the water quality and eutrophication of lake ecosystems. Based on short-term spatial observations in the spring, summer, and winter and on long-term site-specific observation from 1988 to 2013, the spatial, seasonal, long-term variations, and the factors affecting transparency are presented for Xin'anjiang Reservoir (China). Spatially, transparency was high in the open water but low in the bays and the inflowing river mouths, reflecting the effect of river runoff. The seasonal effects were distinct, with lower values in the summer than in the winter, most likely due to river runoff and phytoplankton biomass increases. The transparency decreased significantly with a linear slope of 0.079 m/year, indicating a 2.05 m decrease and a marked decrease in water quality. A marked increase occurred in chlorophyll a (Chla) concentration, and a significant correlation was found between the transparency and Chla concentration, indicating that phytoplankton biomass can partially explain the long-term trend of transparency in Xin'anjiang Reservoir. The river input and phytoplankton biomass increase were associated with soil erosion and nutrient loss in the catchment. Our study will support future management of water quality in Xin'anjiang Reservoir.

  18. Seasonal-Spatial Distribution and Long-Term Variation of Transparency in Xin’anjiang Reservoir: Implications for Reservoir Management

    PubMed Central

    Wu, Zhixu; Zhang, Yunlin; Zhou, Yongqiang; Liu, Mingliang; Shi, Kun; Yu, Zuoming

    2015-01-01

    Water transparency is a useful indicator of water quality or productivity and is widely used to detect long-term changes in the water quality and eutrophication of lake ecosystems. Based on short-term spatial observations in the spring, summer, and winter and on long-term site-specific observation from 1988 to 2013, the spatial, seasonal, long-term variations, and the factors affecting transparency are presented for Xin’anjiang Reservoir (China). Spatially, transparency was high in the open water but low in the bays and the inflowing river mouths, reflecting the effect of river runoff. The seasonal effects were distinct, with lower values in the summer than in the winter, most likely due to river runoff and phytoplankton biomass increases. The transparency decreased significantly with a linear slope of 0.079 m/year, indicating a 2.05 m decrease and a marked decrease in water quality. A marked increase occurred in chlorophyll a (Chla) concentration, and a significant correlation was found between the transparency and Chla concentration, indicating that phytoplankton biomass can partially explain the long-term trend of transparency in Xin’anjiang Reservoir. The river input and phytoplankton biomass increase were associated with soil erosion and nutrient loss in the catchment. Our study will support future management of water quality in Xin’anjiang Reservoir. PMID:26274970

  19. Bio-effect-monitoring of long-term thermal wastes on the oyster, Crassostrea gigas, using heat shock proteins.

    PubMed

    Kim, Jin-Hyoung; Jeong, Su-Young; Kim, Pyung-Joong; Dahms, Hans-Uwe; Han, Kyung-Nam

    2017-06-15

    We bio-monitored the stress of oyster, Crassostrea gigas, for possible long term effects of thermal waste from a power plant. The expression level of its heat shock proteins (HSPs) was measured by real time-reverse transcript PCR along with their density and growth in the field. Oyster size varied in a distance dependent pattern. Physics modeling for evaluation of spreading of the thermal effluent revealed that station A is affected by the thermal effluents abundance, and the size of C. gigas showed a negative relationship with distance to the power plant. The abundance and size of C. gigas were smallest at station A, which was closest to the thermal effluent outlet. The kinetics of changes in the hsp70 and hsp90 mRNA levels in the mantle of C. gigas were also investigated. Regardless of the higher expression level of hsp70 mRNA than hsp90, both hsp70 and hsp90 mRNA levels were significantly higher at station A. The expression levels decreased inversely with distance from the thermal effluent outlet, with expression of hsp70 mRNA at station A being approximately 7-fold higher than at station B and 15-fold higher than at station C. Similarly, expression of hsp90 mRNA at station A was approximately 14-fold higher than at station B and 22-fold higher than at station C. The present findings provide new insights on biological correlation among the growth of individuals and population size and the molecular index in C. gigas following thermal effects. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Established users and the making of telecare work in long term condition management: implications for health policy.

    PubMed

    Rogers, Anne; Kirk, Sue; Gately, Claire; May, Carl R; Finch, Tracy

    2011-04-01

    Increasingly policy for long term condition management is focussing on new technologies. Telecare is viewed as a means of making services more responsive, equitable, cost and clinically-effective and able to play a central part in mediating between service users, professionals, and service providers. It has also been identified as helping to establish patient self-management for long term conditions. In this paper we consider the social practices of the work of telecare integration and incorporation for patients, their interactions with professionals and the synergy or otherwise with policy makers' expectations for how patients approach, use and interact with services. The research took place in England and in Wales and involved qualitative interviews with 31 individuals. Our research suggests that, telecare services provide both an adequate substitution for traditional services and additional benefits such as minimising the need to travel and the added reassurance of regular external surveillance. However, the nature of patient work involved is 'low level' rather than requiring higher level interpretation of readings and decision making commensurate with realising a policy vision of more independent and responsible self -managers. Indeed a paradox of the reliance and acceptance of telecare is the creation of new relationships and dependencies rather than the diminution of reliance envisaged by policy. The illumination of practices around telecare provides evidence for policy makers and others to adjust the predictions and presumptions about how telecare might enable and promote more effective long term condition management. Copyright © 2011 Elsevier Ltd. All rights reserved.

  1. Guidelines for screening and management of late and long-term consequences of myeloma and its treatment.

    PubMed

    Snowden, John A; Greenfield, Diana M; Bird, Jennifer M; Boland, Elaine; Bowcock, Stella; Fisher, Abigail; Low, Eric; Morris, Monica; Yong, Kwee; Pratt, Guy

    2017-03-01

    A growing population of long-term survivors of myeloma is now accumulating the 'late effects' not only of myeloma itself, but also of several lines of treatment given throughout the course of the disease. It is thus important to recognise the cumulative burden of the disease and treatment-related toxicity in both the stable and active phases of myeloma, some of which is unlikely to be detected by routine monitoring. We summarise here the evidence for the key late effects in long-term survivors of myeloma, including physical and psychosocial consequences (in Parts 1 and 2 respectively), and recommend the use of late-effects screening protocols in detection and intervention. The early recognition of late effects and effective management strategies should lead to an improvement in the management of myeloma patients, although evidence in this area is currently limited and further research is warranted. © 2017 John Wiley & Sons Ltd.

  2. Monitoring the Long-Term Effectiveness of Integrated Safety Management System (ISMS) Implementation Through Use of a Performance Dashboard Process

    SciTech Connect

    Michael D. Kinney and William D. Barrick

    2008-09-01

    This session will examine a method developed by Federal and Contractor personnel at the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office (NNSA/NSO) to examine long-term maintenance of DOE Integrated Safety Management System (ISMS) criteria, including safety culture attributes, as well as identification of process improvement opportunities. This process was initially developed in the summer of 2000 and has since been expanded to recognize the importance of safety culture attributes, and associated safety culture elements, as defined in DOE M 450.4-1, “Integrated Safety Management System Manual.” This process has proven to significantly enhance collective awareness of the importance of long-term ISMS implementation as well as support commitments by NNSA/NSO personnel to examine the continued effectiveness of ISMS processes.

  3. Long-term use of pramipexole in the management of restless legs syndrome.

    PubMed

    Lipford, Melissa C; Silber, Michael H

    2012-12-01

    Few studies have examined the long-term use of dopamine agonists for restless legs syndrome (RLS). We report a cohort study of 50 patients initially prescribed pramipexole between 1998 and 2002. The objective was to determine duration of treatment, long-term efficacy, development of side effects and augmentation over an extended period. We performed a long-term analysis on a previously reported group of patients initially followed for a mean of 27.2 months. Data were collected using retrospective chart reviews, written surveys and systematic telephone interviews. Pramipexole was used for a mean of 8 years (range 0.6-12 years). Nine (18%) discontinued pramipexole because of poor efficacy (four), impulse control disorders (ICD) (two), augmentation (one) and resolved symptoms (two). Pramipexole was reported completely effective in 40% (compared to 67% at the end of the initial study), partially effective in 58% and ineffective in 2%. The median daily dose increased from 0.38 mg after initial stabilization to 1.0mg at the end of the study. As many as 74% of patients experienced side effects. A total of 56% reported daytime sleepiness including 10% reporting sleep attacks while driving and 10% developed ICDs. Augmentation developed in 42% of patients, after a mean of 16.5 months, and no later than 4.1 years after commencing treatment. A total of 28% needed additional non-dopaminergic medications. The efficacy of pramipexole dropped with time, with increase in dose and addition of other agents, although the majority of patients remained on the drug. Problems included the development of augmentation within the first 4 years of therapy and side effects such as sleepiness increasing with time and the development of ICDs. The study highlights the need for further research into alternative non-dopaminergic treatments for RLS. Copyright © 2012 Elsevier B.V. All rights reserved.

  4. Long-term sampling of CO(2) from waste-to-energy plants: (14)C determination methodology, data variation and uncertainty.

    PubMed

    Fuglsang, Karsten; Pedersen, Niels Hald; Larsen, Anna Warberg; Astrup, Thomas Fruergaard

    2014-02-01

    A dedicated sampling and measurement method was developed for long-term measurements of biogenic and fossil-derived CO(2) from thermal waste-to-energy processes. Based on long-term sampling of CO(2) and (14)C determination, plant-specific emission factors can be determined more accurately, and the annual emission of fossil CO(2) from waste-to-energy plants can be monitored according to carbon trading schemes and renewable energy certificates. Weekly and monthly measurements were performed at five Danish waste incinerators. Significant variations between fractions of biogenic CO(2) emitted were observed, not only over time, but also between plants. From the results of monthly samples at one plant, the annual mean fraction of biogenic CO(2) was found to be 69% of the total annual CO(2) emissions. From weekly samples, taken every 3 months at the five plants, significant seasonal variations in biogenic CO(2) emissions were observed (between 56% and 71% biogenic CO(2)). These variations confirmed that biomass fractions in the waste can vary considerably, not only from day to day but also from month to month. An uncertainty budget for the measurement method itself showed that the expanded uncertainty of the method was ± 4.0 pmC (95 % confidence interval) at 62 pmC. The long-term sampling method was found to be useful for waste incinerators for determination of annual fossil and biogenic CO(2) emissions with relatively low uncertainty.

  5. Assessment of alternatives for long-term management of uranium ore residues and contaminated soils located at DOE's Niagara Falls Storage Site

    SciTech Connect

    Merry-Libby, P.

    1984-11-05

    About 11,000 m/sup 3/ of uranium ore residues and 180,000 m/sup 3/ of wastes (mostly slightly contaminated soils) are consolidated within a diked containment area at the Niagara Falls Storage Site (NFSS) located about 30 km north of Buffalo, NY. The residues account for less than 6% of the total volume of contaminated materials but almost 99% of the radioactivty. The average /sup 226/Ra concentration in the residues is 67,000 pCi/g. Several alternatives for long-term management of the wastes and residues are being considered, including: improvement of the containment at NFSS, modification of the form of the residues, management of the residues separately from the wastes, management of the wastes and residues at another humid site (Oak Ridge, TN) or arid site (Hanford, WA), and dispersal of the wastes in the ocean. Potential radiological risks are expected to be smaller than the nonradiological risks of occupational and transportation-related injuries and deaths. Dispersal of the slightly contaminated wastes in the ocean is not expected to result in any significant impacts on the ocean environment or pose any significant radiological risk to humans. It will be necessary to take perpetual care of the near-surface burial sites because the residues and wastes will remain hazardous for thousands of years. If controls cease, the radioactive materials will eventually be dispersed in the environment. Predicted loss of the earthen covers over the buried materials ranges from several hundred to more than two million years, depending primarily on the use of the land surface. Groundwater will eventually be contaminated in all alternatives; however, the groundwater pathway is relatively insignificant with respect to radiological risks to the general population. A person intruding into the residues would incur an extremely high radiation dose.

  6. Fathers and mothers developing skills in managing children's long-term medical conditions: how do their qualitative accounts compare?

    PubMed

    Swallow, V; Lambert, H; Santacroce, S; Macfadyen, A

    2011-07-01

    Little is known about the respective experience of fathers and mothers within couples when managing their child's long-term medical condition. This study therefore aimed to obtain and compare fathers' and mothers' accounts of managing long-term kidney conditions. Qualitative study involving individual then joint semi-structured interviews with 14 couples (biological fathers and mothers of 15 children whose care is managed at a specialist unit). Interviews were digitally recorded, transcribed and analysed using Framework Analysis. Transcripts within and across couples were compared. Fathers and mothers made a significant contribution to management and a key theme identified was 'developing skills' in: information processing, sharing/negotiating caregiving, restraining children, adapting to treatment regimens and communicating. Although skill development was often a challenging and uncertain process, both fathers and mothers wanted to and did participate in caregiving; they often negotiated this with each other to accommodate caring for other children, paid employment and to provide mutual practical and emotional support. Developing skills in holding their child for procedures and treatments was a major concern, but it was fathers who assumed the 'protector' role and worried more about their child's long-term health and well-being, while mothers concerned themselves more with current clinical issues and maintaining relationships with professionals. Expressing appreciation for fathers' and mothers' skill development may promote good 'working relationships' between professionals and both parents over the many years of the trajectory. Developing skills for home-based caregiving of long-term conditions is a challenging and uncertain process. Both parents often participate in caregiving, and the findings reported here may help professionals decide how best to support both parents in their home-based caregiving. © 2011 Blackwell Publishing Ltd.

  7. [Dysphagia management of acute and long-term critically ill intensive care patients].

    PubMed

    Zielske, J; Bohne, S; Axer, H; Brunkhorst, F M; Guntinas-Lichius, O

    2014-10-01

    Dysphagia is a severe complication in critically ill patients and affects more than half the patients in an intensive care unit. Dysphagia also has a strong impact on morbidity and mortality. Risk factors for the development of dysphagia are neurological diseases, age >55-70 years, intubation >7 days and sepsis. With increasing numbers of long-term survivors chronic dysphagia is becoming an increasing problem. There is not much knowledge on the influence of specific diseases, including the direct impact of sepsis on the development of dysphagia. Fiberoptic evaluation of swallowing is a standardized tool for bedside evaluation, helping to plan swallowing training during the acute phase and to decrease the rate of chronic dysphagia. For evaluation of chronic dysphagia even more extensive diagnostic tools as well as several options of stepwise rehabilitation using restitution, compensation and adaption strategies for swallowing exist. Currently it seems that these options are not being sufficiently utilized. In general, there is a need for controlled clinical trials analyzing specific swallowing rehabilitation concepts for former critically ill patients and long-term survivors.

  8. Long-term health consequences of premature or early menopause and considerations for management

    PubMed Central

    Faubion, Stephanie S.; Kuhle, Carol L.; Shuster, Lynne T.; Rocca, Walter A.

    2015-01-01

    Aim To review the current evidence concerning the long-term harmful effects of premature or early menopause, and to discuss some of the clinical implications. Material and methods Narrative review of the literature. Results Women undergoing premature or early menopause, either following bilateral salpingo-oophorectomy or because of primary ovarian insufficiency, experience the early loss of estrogen and other ovarian hormones. The long-term consequences of premature or early menopause include adverse effects on cognition, mood, cardiovascular, bone, and sexual health, as well as an increased risk of early mortality. The use of hormone therapy has been shown to lessen some, although not all of these risks. Therefore, multiple medical societies recommend providing hormone therapy at least until the natural age of menopause. It is important to individualize hormone therapy for women with early estrogen deficiency, and higher dosages may be needed to approximate physiological concentrations found in premenopausal women. It is also important to address the psychological impact of early menopause and to review the options for fertility and the potential need for contraception, if the ovaries are intact. Conclusions Women who undergo premature or early menopause should receive individualized hormone therapy and counseling. PMID:25845383

  9. Waste Management Program. Technical progress report, Aporil-June 1983

    SciTech Connect

    1984-02-01

    This quarterly report provides current information on operations and development programs for the management of radioactive wastes from operation of the Savannah River Plant. The studies on environmental and safety assessments, process and equipment development, TRU waste, and low-level waste are a part of the Long-Term Waste Management Technology Program. The following studies are reported for the SR Interim Waste Operations Program: surveillance and maintenance, waste concentration, low-level effluent waste, tank replacement/waste transfer, and solid waste storage and related activities.

  10. Waste management program

    NASA Astrophysics Data System (ADS)

    1980-09-01

    Current information on operations and development programs for the management of radioactive wastes from operation of the Savannah River Plant are reported. Process and equipment development studies are considered as well as surveillance and maintenance, waste concentration, low level effluent waste, waste tank evaluation, and tank replacement/waste transfer (formerly waste tank retirement). Criteria for the selection of sites for storage of waste forms produced in the Defense Waste Processing Facility are described.

  11. Legacy phosphorus accumulation and management in the global context: insights from long-term analysis of major river basins

    NASA Astrophysics Data System (ADS)

    Powers, S. M.; Burt, T. P.; Chan, N. I.; Elser, J. J.; Haygarth, P. M.; Howden, N. J. K.; Jarvie, H. P.; Peterson, H. M.; Shen, J.; Worrall, F.; Sharpley, A. N.

    2014-12-01

    Phosphorus (P) is closely linked to major societal concerns including food security and water quality, and human activities strongly control the modern global P cycle. Current knowledge of the P cycle includes many insights about relatively short-term processes, but a long-term and landscape-level view may be needed to understand P status and optimize P management towards P sustainability. We reconstructed long-term (>40 years) P mass balances and rates of P accumulation in three major river basins where excess P pollution is demanding improvements in P management at local, national, and international levels. We focus on: Maumee River Basin, a major source of agricultural P to Lake Erie, the southernmost and shallowest of the Laurentian Great Lakes; Thames River Basin, where fluxes of effluent P from the London, England metropolitan area have declined following improvements in wastewater treatment; Yangtze (Changjiang) River Basin, the largest in China, which is undergoing rapid economic development. The Maumee and Thames are intensively monitored, and show long-term declines in basin P inputs that represent a step towards P sustainability. However, river P outputs have been slower to decline, consistent with the hypothesis that legacy P is mobilizing from soils or from within the river network. Published data on the Yangtze indicate the P flux from land to water has clearly increased with industrialization and population growth. Historical trajectories of P accumulation and depletion in major river basins are providing new understanding about the long-term impacts of P management, including watershed P legacies and response times, that may inform future policy towards local, national, and global P sustainability.

  12. Cerebral performance category at hospital discharge predicts long-term survival of cardiac arrest survivors receiving targeted temperature management*.

    PubMed

    Hsu, Cindy H; Li, Jiaqi; Cinousis, Marisa J; Sheak, Kelsey R; Gaieski, David F; Abella, Benjamin S; Leary, Marion

    2014-12-01

    Despite recent advancements in post-cardiac arrest resuscitation, the optimal measurement of postarrest outcome remains unclear. We hypothesized that Cerebral Performance Category score can predict the long-term outcome of postarrest survivors who received targeted temperature management during their postarrest hospital care. Retrospective chart review. Two academic medical centers from May 2005 to December 2012. The medical records of 2,417 out-of-hospital and in-hospital patients post cardiac arrest were reviewed to identify 140 of 582 survivors who received targeted temperature management. None. The Cerebral Performance Category scores at hospital discharge were determined by three independent abstractors. The 1-month, 6-month, and 12-month survival of these patients was determined by reviewing hospital records and querying the Social Security Death Index and by follow-up telephone calls. The association of unadjusted long-term survival and adjusted survival with Cerebral Performance Category was calculated. Of the 2,417 patients who were identified to have undergone cardiac arrest, 24.1% (582/2,417) were successfully resuscitated, of whom 24.1% (140/582) received postarrest targeted temperature management. Overall, 42.9% of patients (60/140) were discharged with Cerebral Performance Category 1, 27.1% (38/140) with Cerebral Performance Category 2, 18.6% (26/140) with Cerebral Performance Category 3, and 11.4% (16/140) with Cerebral Performance Category 4. Cerebral Performance Category 1 survivors had the highest long-term survival followed by Cerebral Performance Categories 2 and 3, with Cerebral Performance Category 4 having the lowest long-term survival (p < 0.001, log-rank test). We found that Cerebral Performance Category 3 (hazard ratio = 3.62, p < 0.05) and Cerebral Performance Category 4 (hazard ratio = 12.73, p < 0.001) remained associated with worse survival after adjusting for age, gender, race, shockable rhythm, time to targeted temperature management

  13. Long-term medical management of gastro-esophageal reflux disease: how long and when to consider surgery?

    PubMed

    Venkataraman, Jayanthi; Krishnan, Arunkumar

    2012-01-01

    Gastro-esophageal reflux disease is a chronic, long standing disease. Spontaneous remission of GERD is rare and conservative management including life style modification measures is unlikely to relieve symptoms. Majority of patients with reflux disease require long-term acid suppressants. Proton pump inhibitors are the choice of drugs in management of these patients. The end point of treatment is not clear. Duration of treatment is individual based. The symptoms may be intermittent or on most days of the week. The treatment is therefore either a short course which may be for 8 to 12 weeks or 6 months, or continuous, intermittent or 'on-demand' basis. The maintenance therapy is with the lowest proton pump inhibitor (PPI) dose necessary for adequate symptom relief. Whether long-term PPI actually alters the natural history of reflux disease other than to reduce the incidence of peptic stricture is not known. Reported adverse effects due to PPI include Clostridium difficile colitis and bacterial gastroenteritis, osteoporosis, and vitamin B12 deficiency. Anti-reflux surgery is indicated for youngsters, those not willing for long-term PPI i.e. for years, large volume refluxers, especially the supine refluxers and bile refluxers.

  14. Long-term intensive management increased carbon occluded in phytolith (PhytOC) in bamboo forest soils

    NASA Astrophysics Data System (ADS)

    Huang, Zhang-Ting; Li, Yong-Fu; Jiang, Pei-Kun; Chang, Scott X.; Song, Zhao-Liang; Liu, Juan; Zhou, Guo-Mo

    2014-01-01

    Carbon (C) occluded in phytolith (PhytOC) is highly stable at millennium scale and its accumulation in soils can help increase long-term C sequestration. Here, we report that soil PhytOC storage significantly increased with increasing duration under intensive management (mulching and fertilization) in Lei bamboo (Phyllostachys praecox) plantations. The PhytOC storage in 0-40 cm soil layer in bamboo plantations increased by 217 Mg C ha-1, 20 years after being converted from paddy fields. The PhytOC accumulated at 79 kg C ha-1 yr-1, a rate far exceeding the global mean long-term soil C accumulation rate of 24 kg C ha-1 yr-1 reported in the literature. Approximately 86% of the increased PhytOC came from the large amount of mulch applied. Our data clearly demonstrate the decadal scale management effect on PhytOC accumulation, suggesting that heavy mulching is a potential method for increasing long-term organic C storage in soils for mitigating global climate change.

  15. Workshop proceedings: Developing the scientific basis for long-term land management of the Idaho National Engineering and Environmental Laboratory

    SciTech Connect

    Sperber, T.D.; Reynolds, T.D.; Breckenridge, R.P.

    1998-03-01

    Responses to a survey on the INEEL Comprehensive Facility and Land Use Plan (US DOE 1996a) indicated the need for additional discussion on environmental resources, disturbance, and land use issues on the Idaho National Engineering and Environmental Laboratory (INEEL). As a result, in September 1997, a workshop evaluated the existing scientific basis and determined future data needs for long-term land management on the INEEL. This INEEL Long-Term Land Management Workshop examined existing data on biotic, abiotic, and heritage resources and how these resources have been impacted by disturbance activities of the INEEL. Information gained from this workshop will help guide land and facility use decisions, identify data gaps, and focus future research efforts. This report summarizes background information on the INEEL and its long-term land use planning efforts, presentations and discussions at the workshop, and the existing data available at the INEEL. In this document, recommendations for future INEEL land use planning, research efforts, and future workshops are presented. The authors emphasize these are not policy statements, but comments and suggestions made by scientists and others participating in the workshop. Several appendices covering land use disturbance, legal drivers, land use assumptions and workshop participant comments, workshop participants and contributors, and the workshop agenda are also included.

  16. Long-term aeration management for improved N-removal via SND in a sequencing batch reactor.

    PubMed

    Third, K A; Gibbs, B; Newland, M; Cord-Ruwisch, R

    2005-09-01

    Management of the aeration length in a sequencing batch reactor (SBR) can improve N-removal by minimising the amount of organic substrate that is oxidised aerobically. This study investigates the long-term effect of aeration control on N-removal via simultaneous nitrification and denitrification (SND) by a mixed culture in a 2L acetate-fed SBR, using PHB as the electron donor for denitrification. The reactor was operated continuously with automated termination of the aerobic phase after ammonium depletion, using the specific oxygen uptake rate (SOUR) as the control parameter. This resulted in an increase of the organic loading rate (OLR) from 0.33 to 0.59 g BOD g(-1)d(-1). Over the first 12 cycles of operation, the PHB content of the biomass increased three-fold and resulted in a progressively increasing SOUR, which allowed an increased amount of nitrogen removal via SND from 34% to 52%. After one month of continuous operation with controlled aeration, the settling efficiency of the biomass had significantly improved (SVI 70 mL g(-1) X). Long-term oxygen management resulted in biomass with a higher capacity for N-removal via SND and improved settling characteristics. Our results may help to explain long-term historical effects of N-removal capabilities in WWTPs and assist design engineers in choosing an appropriate aeration length and OLR.

  17. Long-term intensive management increased carbon occluded in phytolith (PhytOC) in bamboo forest soils

    PubMed Central

    Huang, Zhang-ting; Li, Yong-fu; Jiang, Pei-kun; Chang, Scott X.; Song, Zhao-liang; Liu, Juan; Zhou, Guo-mo

    2014-01-01

    Carbon (C) occluded in phytolith (PhytOC) is highly stable at millennium scale and its accumulation in soils can help increase long-term C sequestration. Here, we report that soil PhytOC storage significantly increased with increasing duration under intensive management (mulching and fertilization) in Lei bamboo (Phyllostachys praecox) plantations. The PhytOC storage in 0–40 cm soil layer in bamboo plantations increased by 217 Mg C ha−1, 20 years after being converted from paddy fields. The PhytOC accumulated at 79 kg C ha−1 yr−1, a rate far exceeding the global mean long-term soil C accumulation rate of 24 kg C ha−1 yr−1 reported in the literature. Approximately 86% of the increased PhytOC came from the large amount of mulch applied. Our data clearly demonstrate the decadal scale management effect on PhytOC accumulation, suggesting that heavy mulching is a potential method for increasing long-term organic C storage in soils for mitigating global climate change. PMID:24398703

  18. Long-term intensive management increased carbon occluded in phytolith (PhytOC) in bamboo forest soils.

    PubMed

    Huang, Zhang-ting; Li, Yong-fu; Jiang, Pei-kun; Chang, Scott X; Song, Zhao-liang; Liu, Juan; Zhou, Guo-mo

    2014-01-08

    Carbon (C) occluded in phytolith (PhytOC) is highly stable at millennium scale and its accumulation in soils can help increase long-term C sequestration. Here, we report that soil PhytOC storage significantly increased with increasing duration under intensive management (mulching and fertilization) in Lei bamboo (Phyllostachys praecox) plantations. The PhytOC storage in 0-40 cm soil layer in bamboo plantations increased by 217 Mg C ha(-1), 20 years after being converted from paddy fields. The PhytOC accumulated at 79 kg C ha(-1) yr(-1), a rate far exceeding the global mean long-term soil C accumulation rate of 24 kg C ha(-1) yr(-1) reported in the literature. Approximately 86% of the increased PhytOC came from the large amount of mulch applied. Our data clearly demonstrate the decadal scale management effect on PhytOC accumulation, suggesting that heavy mulching is a potential method for increasing long-term organic C storage in soils for mitigating global climate change.

  19. Identification, optimal management, and infection control measures for Clostridium difficile-associated disease in long-term care.

    PubMed

    Fletcher, Kathleen Ryan; Cinalli, Marisa

    2007-01-01

    Residents of long-term care facilities are at an increased risk of exposure to Clostridium difficile and become more susceptible to infection after receiving antimicrobial therapy. An increasing number and more severe cases of C. difficile-associated disease (CDAD) have been reported over the last few years and have been linked to the emergence of a new, more virulent strain of C. difficile. These serious cases of disease have also been associated with a more atypical clinical presentation and have prompted the need for an improved means of early recognition and identification performed by the nursing staff. This article reviews the pathogenesis and risk factors for CDAD, changing epidemiology of CDAD, and characteristics of the newly identified strain. Also reviewed are the role of nursing in the identification of patients with CDAD; optimal management of CDAD; infection control strategies; and education of health care professionals, residents, and visitors in the long-term care setting.

  20. Importance of long-term observatories for ecosystem management: Variability in particle flux in the Northern Gulf of Mexico

    NASA Astrophysics Data System (ADS)

    Giering, Sari L. C.; Sweet, Julia; Asper, Vernon; Diercks, Arne; Yan, Beizahn; Passow, Uta

    2017-04-01

    After the Deepwater Horizon oil spill it became apparent that relatively little is known about the Gulf of Mexico ecosystem. The lack of a baseline complicates mitigation, management and ecosystem monitoring after such an event. We have established three long-term monitoring sites in the Gulf, where sinking particle flux has been measured at depths >1000 m since 2012. Even though the three sites are in close vicinity to each other (max distance 260 km) and at similar depths, they vary considerably in flux magnitude, composition and temporal pattern. At the most northern site a strong riverine influence drives a distinct seasonal pattern linked to the Mississippi discharge. The most southern site shows signals of oil-derived flux originating from natural oil seeps at this site. Our data highlights the importance of multiple long-term observatory sites in relatively close vicinity in areas with strong oceanographic gradients, particularly for areas with high human activities.

  1. Managing Heart Failure in Long-Term Care: Recommendations from an Interprofessional Stakeholder Consultation.

    PubMed

    Heckman, George A; Boscart, Veronique M; D'Elia, Teresa; Kelley, Mary Lou; Kaasalainen, Sharon; McAiney, Carrie A; van der Horst, Mary-Lou; McKelvie, Robert S

    2016-12-01

    Heart failure (HF) affects up to 20 per cent of residents in long-term care (LTC) and is associated with substantial morbidity, mortality, and health service utilization. Our study objective was to formulate recommendations on implementing HF care processes in LTC. A three-phase and iterative stakeholder consultation process, guided by expert panel input, was employed to develop recommendations on implementing care processes for HF in LTC. This article presents the results of the third phase, which consisted of a series of interdisciplinary workshops. We developed 17 recommendations. Key elements of these recommendations focus on improving interprofessional communication and improving HF-related knowledge among all LTC stakeholders. Engaging frontline staff, including personal support workers, was stated as an essential component of all recommendations. System-level recommendations include improving communication between LTC homes and acute care and other external health service providers, and developing facility-wide interventions to reduce dietary sodium intake and increase physical activity.

  2. Endovascular Management of the Arteria Profunda Femoralis: Long-Term Angiographic and Clinical Outcomes

    SciTech Connect

    Karnabatidis, Dimitrios Spiliopoulos, Stavros; Pastromas, Georgios; Katsanos, Kostantinos; Siablis, Dimitrios

    2012-10-15

    Purpose: This study was designed to investigate the long-term angiographic and clinical outcomes of percutaneous transluminal angioplasty (PTA) of the arteria profunda femoralis (PFA), in a series of patients suffering from critical limb ischemia (CLI) or severe intermittent claudication (IC). Methods: Our department's database was searched to identify patients who underwent PTA or bail-out stenting of the PFA. Among the study's inclusion criteria were Rutherford categories 3-6 and {>=}70% stenosis of the PFA. Only de novo stenotic lesions were assessed. Primary endpoints were technical success, angiographic lesion primary patency, angiographic binary in-lesion restenosis, and target lesion recanalization (TLR) rates. Secondary endpoints included patient survival, limb salvage, and complication rates. Patient's baseline demographics, lesion, and procedural details were analyzed. Results: Between 2001 and 2011, 20 consecutive patients (17 males) with a mean age of 73 {+-} 9 (range 53-87) years underwent PTA or bail-out stenting in 23 PFA lesions. Critical limb ischemia was the indication in eight of 20 patients (40%). The mean lesion length was 31 {+-} 9.5 mm. The procedural technical success was 100% (23/23), whereas mean time angiographic and clinical follow-up was 26.8 {+-} 24.6 months. According to the Kaplan-Meier analysis, primary patency and binary restenosis rate were 95 and 86.1% respectively up to 8 years follow-up. No TLR procedures were performed. The 8-year patient survival and limb salvage rates were 87.5 and 84.7% respectively. Conclusions: PTA or stenting of focal, stenotic, PFA lesions, in patients suffering from CLI or IC, exhibit high long-term primary patency rates, as well as low binary restenosis and TLR rates. Large, multicenter studies are required to validate these results.

  3. The Management of Chemical Waste in a University Setting.

    ERIC Educational Resources Information Center

    Coons, David Michael

    This thesis describes a study of the management of chemical waste at the State University of New York at Binghamton. The study revealed that the majority of chemical waste at the university is in the form of hazardous waste. It was hypothesized that the volume, related costs, and potential long-term liability associated with the disposal of…

  4. Long-term climate change mitigation potential with organic matter management on grasslands.

    PubMed

    Ryals, Rebecca; Hartman, Melannie D; Parton, William J; DeLonge, Marcia S; Silver, Whendee L

    2015-03-01

    Compost amendments to grasslands have been proposed as a strategy to mitigate climate change through carbon (C) sequestration, yet little research exists exploring the net mitigation potential or the long-term impacts of this strategy. We used field data and the DAYCENT biogeochemical model to investigate the climate change mitigation potential of compost amendments to grasslands in California, USA. The model was used to test ecosystem C and greenhouse gas responses to a range of compost qualities (carbon to nitrogen [C:N] ratios of 11.1, 20, or 30) and application rates (single addition of 14 Mg C/ha or 10 annual additions of 1.4 Mg C · ha(-1) · yr(-1)). The model was parameterized using site-specific weather, vegetation, and edaphic characteristics and was validated by comparing simulated soil C, nitrous oxide (N2O), methane (CH4), and carbon dioxide (CO2) fluxes, and net primary production (NPP) with three years of field data. All compost amendment scenarios led to net greenhouse gas sinks that persisted for several decades. Rates of climate change mitigation potential ranged from 130 ± 3 g to 158 ± 8 g CO2-eq · m(-2) ·yr(-1) (where "eq" stands for "equivalents") when assessed over a 10-year time period and 63 ± 2 g to 84 ± 10 g CO2- eq · m(-2) · yr(-1) over a 30-year time period. Both C storage and greenhouse gas emissions increased rapidly following amendments. Compost amendments with lower C:N led to higher C sequestration rates over time. However, these soils also experienced greater N20 fluxes. Multiple smaller compost additions resulted in similar cumulative C sequestration rates, albeit with a time lag, and lower cumulative N2O emissions. These results identify a trade-off between maximizing C sequestration and minimizing N2O emissions following amendments, and suggest that compost additions to grassland soils can have a long-term impact on C and greenhouse gas dynamics that contributes to climate change mitigation.

  5. The experience of facilitators and participants of long term condition self-management group programmes: A qualitative synthesis.

    PubMed

    Hughes, Stephen; Lewis, Sophie; Willis, Karen; Rogers, Anne; Wyke, Sally; Smith, Lorraine

    2017-07-01

    Our aim was to systematically review the qualitative literature about the experiences of both facilitators and participants in a range of group-based programmes to support the self-management of long-term conditions. We searched 7 databases using the terms 'self-management', 'group' and 'qualitative'. Full text articles meeting the inclusion criteria were retrieved for review. A thematic synthesis approach was used to analyse the studies. 2126 articles were identified and 24 were included for review. Group participants valued being with similar others and perceived peer support benefits. Facilitators (HCP and lay) had limited group specific training, were uncertain of purpose and prioritised education and medical conformity over supportive group processes and the promotion of self-management agency and engagement. Overall, studies prioritised positive descriptions. Group programmes' medical self-management focus may reduce their ability to contribute to patient-valued outcomes. Further research is needed to explore this disconnect. This review supports broadening the scope of group-based programmes to foreground shared learning, social support and development of agency. It is of relevance to developers and facilitators of group self-management programmes and their ability to address the burden of long-term conditions. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Of trophies and pillars: exploring the terror management functions of short-term and long-term relationship partners.

    PubMed

    Kosloff, Spee; Greenberg, Jeff; Sullivan, Daniel; Weise, David

    2010-08-01

    Prior terror management research shows that mortality salience (MS) motivates both self-esteem striving and worldview bolstering. The present research examined these processes in the context of dating preferences. It was hypothesized that in short-term romantic contexts, MS-induced self-esteem striving motivates interest in dating a physically attractive other, whereas in long-term romantic contexts, MS-induced motives for worldview validation heighten interest in dating a same-religion other. Study 1 showed that in a short-term dating context, MS increased preference for an attractive but religiously dissimilar person, whereas in a long-term dating context, MS increased preference for a religiously similar, less attractive person. Study 2 clarified that MS motivates preference for attractive short-term partners for their self-enhancing properties rather than their potential sexual availability. Study 3 supported the theorized processes, showing that under MS, self-esteem-relevant constructs became spontaneously accessible in short-term dating contexts, whereas worldview-relevant constructs became spontaneously accessible in long-term dating contexts.

  7. Model-Based Analysis of the Long-Term Effects of Fertilization Management on Cropland Soil Acidification.

    PubMed

    Zeng, Mufan; de Vries, Wim; Bonten, Luc T C; Zhu, Qichao; Hao, Tianxiang; Liu, Xuejun; Xu, Minggang; Shi, Xiaojun; Zhang, Fusuo; Shen, Jianbo

    2017-04-04

    Agricultural soil acidification in China is known to be caused by the over-application of nitrogen (N) fertilizers, but the long-term impacts of different fertilization practices on intensive cropland soil acidification are largely unknown. Here, we further developed the soil acidification model VSD+ for intensive agricultural systems and validated it against observed data from three long-term fertilization experiments in China. The model simulated well the changes in soil pH and base saturation over the last 20 years. The validated model was adopted to quantify the contribution of N and base cation (BC) fluxes to soil acidification. The net NO3(-) leaching and NO4(+)input accounted for 80% of the proton production under N application, whereas one-third of acid was produced by BC uptake when N was not applied. The simulated long-term (1990-2050) effects of different fertilizations on soil acidification showed that balanced N application combined with manure application avoids reduction of both soil pH and base saturation, while application of calcium nitrate and liming increases these two soil properties. Reducing NH4(+) input and NO3(-) leaching by optimizing N management and increasing BC inputs by manure application thus already seem to be effective approaches to mitigating soil acidification in intensive cropland systems.

  8. A data management proposal to connect in a hierarchical way nodes of the Spanish Long Term Ecological Research (LTER) network

    NASA Astrophysics Data System (ADS)

    Fuentes, Daniel; Pérez-Luque, Antonio J.; Bonet García, Francisco J.; Moreno-LLorca, Ricardo A.; Sánchez-Cano, Francisco M.; Suárez-Muñoz, María

    2017-04-01

    The Long Term Ecological Research (LTER) network aims to provide the scientific community, policy makers, and society with the knowledge and predictive understanding necessary to conserve, protect, and manage the ecosystems. LTER is organized into networks ranging from the global to national scale. In the top of network, the International Long Term Ecological Research (ILTER) Network coordinates among ecological researchers and LTER research networks at local, regional and global scales. In Spain, the Spanish Long Term Ecological Research (LTER-Spain) network was built to foster the collaboration and coordination between longest-lived ecological researchers and networks on a local scale. Currently composed by nine nodes, this network facilitates the data exchange, documentation and preservation encouraging the development of cross-disciplinary works. However, most nodes have no specific information systems, tools or qualified personnel to manage their data for continued conservation and there are no harmonized methodologies for long-term monitoring protocols. Hence, the main challenge is to place the nodes in its correct position in the network, providing the best tools that allow them to manage their data autonomously and make it easier for them to access information and knowledge in the network. This work proposes a connected structure composed by four LTER nodes located in southern Spain. The structure is built considering hierarchical approach: nodes that create information which is documented using metadata standards (such as Ecological Metadata Language, EML); and others nodes that gather metadata and information. We also take into account the capacity of each node to manage their own data and the premise that the data and metadata must be maintained where it is generated. The current state of the nodes is a follows: two of them have their own information management system (Sierra Nevada-Granada and Doñana Long-Term Socio-ecological Research Platform) and

  9. Possible use of EPDM in radioactive waste disposal: Long term low dose rate and short term high dose rate irradiation in aquatic and atmospheric environment

    NASA Astrophysics Data System (ADS)

    Hacıoğlu, Fırat; Özdemir, Tonguç; Çavdar, Seda; Usanmaz, Ali

    2013-02-01

    In this study, changes in the properties of ethylene propylene diene terpolymer (EPDM) irradiated with different dose rates in ambient atmosphere and aqueous environment were investigated. Irradiations were carried out both with low dose and high dose rate irradiation sources. EPDM samples which were differentiated from each other by peroxide type and 5-ethylidene 2-norbornene (ENB) contents were used. Long term low dose rate irradiations were carried out for the duration of up to 2.5 years (total dose of 1178 kGy) in two different irradiation environments. Dose rates (both high and low), irradiation environments (in aquatic and open to atmosphere), and peroxide types (aliphatic or aromatic) were the parameters studied. Characterization of irradiated EPDM samples were performed by hardness, compression, tensile, dynamic mechanical analysis (DMA), TGA-FTIR, ATR-FTIR, XRD and SEM tests. It was observed that the irradiation in water environment led to a lower degree of degradation when compared to that of irradiation open to atmosphere for the same irradiation dose. In addition, irradiation environment, peroxide type and dose rate had effects on the extent of change in the properties of EPDM. It was observed that EPDM is relatively radiation resistant and a candidate polymer for usage in radioactive waste management.

  10. Paroxetine in panic disorder: clinical management and long-term follow-up.

    PubMed

    Dannon, Pinhas N; Lowengrub, Katherine; Iancu, I; Kotler, Moshe

    2004-03-01

    Panic disorder is one of the most common anxiety disorders and has a lifetime prevalence of 3-5%. Panic attacks can begin at any age, but commonly have their onset in early adulthood between the ages of 20 and 40 years. Naturalistic data has shown that panic disorder has a chronic and relapsing course. Panic disorder is reported to be associated with an increased risk of suicidal behavior and comorbid psychiatric diagnoses such as depression and substance abuse. Currently, recommended treatment modalities for panic disorder include the use of antidepressant pharmacotherapy and/or cognitive behavioral therapy. Paroxetine is unique among the selective serotonin reuptake inhibitors since, in addition to its effect on the CNS serotonergic neurotransmission, it also has mild noradrenergic properties demonstrated to be effective in the treatment of anxiety disorders and depression. Paroxetine treatment has the potential to cause weight gain and sexual dysfunction, primarily anorgasmia and ejaculatory dysfunction for the long term. In the short-term, treatment causes nausea, gastrointestinal disturbances, irritability, headaches and eating and sleeping difficulties. Paroxetine is an example of an selective serotonin reuptake inhibitor agent, which has been well studied in the treatment of panic disorder and is efficacious and well-tolerated. Paroxetine pharmacotherapy has been recommended to be continued for 1 year as specified in the treatment guidelines set by the American Psychiatric Association in the treatment of panic disorder.

  11. Long-term management of the fearful adult patient using behavior modification and other modalities.

    PubMed

    Berggren, U

    2001-12-01

    This paper reviews reports on the treatment of fearful adult dental patients with special emphasis on behavioral and cognitive methods and long-term followup. A number of such treatment methods are available that can be used by dentists for the alleviation of fear and anxiety in their patients. At an "intuitive" level, many dentists probably use these methods frequently as a comprehensive part of everyday praxis. Considering the high number of fearful individuals visiting dentists regularly, a better knowledge of such methods would improve dental care for the majority of these patients. It would also help prevent aggravation of fears among individuals at risk. However, despite the success of treatment methods performed by specially trained dentists, it seems reasonable that there should be limits to what can be expected of a dentist in terms of psychological, diagnostic, and therapeutic competence. Dental phobia may constitute a complex psychological and odontological problem with far-reaching consequences for a relatively large proportion of fearful individuals. It therefore seems likely that optimal care of such patients can best be achieved by cross-disciplinary efforts involving both dentists and psychologists.

  12. A New Framework for Adaptive Sampling and Analysis During Long- Term Monitoring and Remedial Action Management

    SciTech Connect

    Minsker, Barbara

    2003-06-01

    The Argonne team has gathered available data on monitoring wells and measured hydraulic heads from the Argonne 317/319 site and sent it to UIUC. Xiaodong Li, a research assistant supported by the project, has reviewed the data and is beginning to fit spatiotemporal statistical models to it. Another research assistant, Yonas Demissie, has gotten the site's Modflow model working and is developing a transport model that will be used to generate artificial data. Abhishek Singh, a third research assistant supported by the project, has performed a literature review on inverse modeling and is receiving training on the software that will be used in this project (D2K). He has also created two models of user preferences and successfully implemented them with an interactive genetic algorithm on test functions. Meghna Babbar, the fourth research assistant supported by the project, has created an interactive genetic algorithm code and initial user interface in D2K. Gayathri Gopalakrishnan, the last research assistant who is partially supported by the project, has collected and analyzed data from the phytoremediation systems at the 317/319 site. She has found good correlations between concentrations in the ground water and in branches of the trees, which indicates excellent promise for using the trees as cost-effective long-term monitoring of the contaminants.

  13. Incorporating Oracle on-line space management with long-term archival technology

    NASA Technical Reports Server (NTRS)

    Moran, Steven M.; Zak, Victor J.

    1996-01-01

    The storage requirements of today's organizations are exploding. As computers continue to escalate in processing power, applications grow in complexity and data files grow in size and in number. As a result, organizations are forced to procure more and more megabytes of storage space. This paper focuses on how to expand the storage capacity of a Very Large Database (VLDB) cost-effectively within a Oracle7 data warehouse system by integrating long term archival storage sub-systems with traditional magnetic media. The Oracle architecture described in this paper was based on an actual proof of concept for a customer looking to store archived data on optical disks yet still have access to this data without user intervention. The customer had a requirement to maintain 10 years worth of data on-line. Data less than a year old still had the potential to be updated thus will reside on conventional magnetic disks. Data older than a year will be considered archived and will be placed on optical disks. The ability to archive data to optical disk and still have access to that data provides the system a means to retain large amounts of data that is readily accessible yet significantly reduces the cost of total system storage. Therefore, the cost benefits of archival storage devices can be incorporated into the Oracle storage medium and I/O subsystem without loosing any of the functionality of transaction processing, yet at the same time providing an organization access to all their data.

  14. HT and SERMs in the long-term management of osteoporosis.

    PubMed

    Tuppurainen, M

    2012-06-01

    Hormone therapy (HT) remains the treatment of choice for climacteric symptoms and for prevention and treatment of bone loss at least within ten years postmenopause. The usually prescribed HT doses have decreased during the past few years, and use of low-dose HT is becoming more popular, possibly decreasing the occurrence of unwanted side effects seen with conventional doses. HT has a fracture-reducing potential even at doses lower than usually recommended, but the positive effect of HT on bone disappears relatively soon after stopping HT. The fear of long-term side effects of HT, such as breast cancer, coronary heart disease (CHD) and thromboembolic events, has increased the demand to evaluate the role of alternative osteoporosis and fracture prevention medication in ageing women. The rapid worldwide decrease of HT use may increase the incidence of fractures if there are no compensative measures. Women who discontinue HT should be advised about rapid bone loss after HT, and given other potential treatment options. Intensive research into alternative approaches to deliver estrogenic activity to bone with no adverse effects on other tissues by using low doses of estrogen, selective estrogen receptor modulators (SERMs), or combinations of the two are ongoing. However, development of an ideal SERM has proved to be difficult, and individualization of bone-protective therapy is a remarkable challenge for professionals treating postmenopausal women.

  15. Waste management system

    NASA Technical Reports Server (NTRS)

    Sauer, R. L.; Jorgensen, G. K.

    1975-01-01

    The function of the waste management system was to control the disposition of solid and liquid wastes and waste stowage gases. The waste management system consisting of a urine subsystem and a fecal subsystem is described in detail and its overall performance is evaluated. Recommendations for improvement are given.

  16. How long is long-term? Reflections based on over 20 years of post-Chernobyl management in Norway.

    PubMed

    Liland, Astrid; Lochard, Jacques; Skuterud, Lavrans

    2009-07-01

    The radiation protection community has only recently started the important work of preparedness for long-term post-accidental management of radioactively contaminated areas, like for instance the EC projects STRATEGY, FARMING and EURANOS and the French authorities' CODIRPA and PAREX programmes. There are, however, different views concerning how long a long-term management might last. Based on the Norwegian and former Soviet Union experience after the Chernobyl accident, it is clear that a nuclear accident can entail decades of necessary management and rehabilitation of living conditions. The time period is dependent on a number of factors, e.g. amount of fallout, type of radionuclides, land use of contaminated area, number and density of people affected and available techniques and resources for implementing countermeasures. This paper discusses the management strategy implemented in Norway after the Chernobyl accident, the need for changing strategy over time and the important involvement of affected groups. Careful planning and reflections should be undertaken before actions are taken in the recovery phase, keeping in mind the possibility of decades with problems.

  17. An approach to quantifying long-term habitat change on managed forest lands

    Treesearch

    Paul B. Hamel; John B. Dunning

    2000-01-01

    Forest land managers must determine the effects of their management on nontarget resources, resources for which no current inventory is available, and for which no current inventory information exists. The tools available to managers to make these determinations consist of the inventory information gathered for those commodities desired to be produced, i.e.,...

  18. Forest management for mitigation and adaptation: insights from long-term silvicultural experiments

    Treesearch

    Anthony W. D' Amato; John B. Bradford; Shawn Fraver; Brian J. Palik

    2011-01-01

    Developing management strategies for addressing global climate change has become an increasingly important issue influencing forest management around the globe. Currently, management approaches are being proposed that intend to (1) mitigate climate change by enhancing forest carbon stores and (2) foster adaptation by maintaining compositionally and structurally complex...

  19. Management Communication Training: The Need for Long-Term Effectiveness Studies.

    ERIC Educational Resources Information Center

    Mattox, Robert J.; Smith, Robert L.

    Currently, training programs for management are an integral part of most organizations. One of the concerns about training programs has been the lack of research supporting change in management training. Recently, counselors have become involved in Human Resources Management (HRM). Organizations have been criticized for making few attempts to…

  20. Management Communication Training: The Need for Long-Term Effectiveness Studies.

    ERIC Educational Resources Information Center

    Mattox, Robert J.; Smith, Robert L.

    Currently, training programs for management are an integral part of most organizations. One of the concerns about training programs has been the lack of research supporting change in management training. Recently, counselors have become involved in Human Resources Management (HRM). Organizations have been criticized for making few attempts to…

  1. Long-term strategies of climate change adaptation to manage flooding events in urban areas

    NASA Astrophysics Data System (ADS)

    Pouget, Laurent; Russo, Beniamino; Redaño, Angel; Ribalaygua, Jaime

    2010-05-01

    Heavy and sudden rainfalls regularly affect the Mediterranean area, so a great number of people and buildings are exposed to the risk of rain-generated floods. Climate change is expected to modify this risk and, in the case that extreme rainfalls increase in frequencies and intensity, this could result in important damages, particularly in urban areas. This paper presents a project that aims to determine adaptation strategies to future flood risks in urban areas. It has been developed by a panel of water companies (R+i Alliance funding), and includes the evaluation of the climate change impact on the extreme rainfall, the use of innovative modelling tools to accurately forecast the flood risk and, finally, the definition of a pro-active and long-term planning against floods. This methodology has been applied in the city of Barcelona. Current climate models give some projections that are not directly applicable for flood risk studies, either because they do not have an adequate spatial and temporal resolution, or because they do not consider some important local factors, such as orography. These points have been considered within the project, when developing the design storms corresponding to future climatic conditions (e.g. years 2030 or 2050). The methodology uses statistical downscaling techniques based on global climate models predictions, including corrections for extreme events and convective storms, as well as temporal downscaling based on historical observations. The design storms created are used in combination with the predictions of sea level rise and land use evolutions to determine the future risk of flooding in the area of study. Once the boundary conditions are known, an accurate flood hazard assessment is done. It requires a local knowledge of the flow parameters in the whole analyzed domain. In urban catchments, in order to fulfill this requirement, powerful hydrological and hydraulic tools and detailed topographic data represent the unique way for

  2. Electrolyte management for effective long-term electro-osmotic transport in low-permeability soils.

    PubMed

    Cherepy, Nerine J; Wildenschild, Dorthe

    2003-07-01

    Electro-osmosis, a coupled-flow phenomenon in which an applied electrical potential gradient drives water flow, may be used to induce water flow through fine-grained sediments. Test cell measurements of electro-osmotic transport in clayey cores extracted from the 27-31 m depth range of the Lawrence Livermore National Laboratory site indicate the importance of pH control within the anode and cathode reservoirs. In our first experiment, pH was not controlled. As a result, carbonate precipitation and metals precipitation occurred near the cathode end of the core, with acidification near the anode. The combination of these acid and base reactions led to the decline of electro-osmotic flow by a factor of 2 in less than one pore volume. In a second experiment, long-term water transport (>21 pore volumes) at stable electro-osmotic conductivity (k(eo) approximately 1 x 10(-9) m2/s-V) was effected with anode reservoir pH > 8, and cathode reservoir pH < 6. Hydraulic conductivity (k(h)) of the same core was 4 x 10(-10) m/s under a 0.07 MPa hydraulic gradient without electro-osmosis. Stable electro-osmotic flow was measured at a velocity of 4 x 10(-7) m/s under a 4 V/cm voltage gradient, and no hydraulic gradient-3 orders of magnitude greater than the hydraulic flow. We also observed chloroform production in the anode reservoir, resulting from electrochemical production of chlorine gas reacting with trace organics. The chloroform was transported electro-osmotically to the cathode, without measurable loss to adsorption, volatilization, or degradation.

  3. Role of Brine Chemistry and Sorption in Potential Long-Term Storage of Radioactive Waste in Geologic Salt Formations: Experimental Evaluation of Sorption Parameters

    NASA Astrophysics Data System (ADS)

    Dittrich, T. M.; Emerson, H. P.; Michael, D. P.; Reed, D. T.

    2016-12-01

    Bedded geologic salt formations have been shown to have many favorable properties for the disposal of radioactive waste (i.e., reducing conditions, fracture healing). Performance assessment (PA) modeling for a 10,000 year period for the Waste Isolation Pilot Plant (WIPP) near Carlsbad, NM have predicted an extremely low risk of radioactive material reaching the surrounding environment after the 100 year period required for creep to seal the waste panels and access shafts. Human intrusion caused by drilling operations for oil and gas exploration is the main pathway of concern for environmental release of radioactive material due to pressurized brine pockets located within the salt formation below the repository. Our work focuses on the long-term capability of salt repositories and the associated geologic media to safely isolate stored radioactive waste from the surrounding environment, even in the event of a human intrusion scenario such as a direct brine release (DBR) due to a drilling operation intersecting a brine pocket. In particular, we are revisiting the degree of conservatism in the estimated sorption partition coefficients (Kds) used in the PA model based on complementary batch and column experimental methods (Dittrich and Reimus, 2016). The main focus of this work is to investigate the role of ionic strength, solution chemistry, and oxidation state (III-VI) in actinide sorption to dolomite rock. Based on redox conditions and solution chemistry expected in the WIPP, possible actinide species include Pu(III), Pu(IV), U(IV), U(VI), Np(IV), Np(V), Am(III), and Th(IV). We will present (1) a conceptual overview of Kd use in the PA model, (2) background and evolution of the Kd ranges used, and (3) results from batch and column experiments and model predictions for Kds with WIPP-relevant geologic media. We will also briefly discuss the challenges of upscaling from lab experiments to field scale predictions, the presence of ligands (e.g., acetate, citrate, EDTA

  4. Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults

    PubMed Central

    2009-01-01

    Background: Obstructive sleep apnea (OSA) is a common chronic disorder that often requires lifelong care. Available practice parameters provide evidence-based recommendations for addressing aspects of care. Objective: This guideline is designed to assist primary care providers as well as sleep medicine specialists, surgeons, and dentists who care for patients with OSA by providing a comprehensive strategy for the evaluation, management and long-term care of adult patients with OSA. Methods: The Adult OSA Task Force of the American Academy of Sleep Medicine (AASM) was assembled to produce a clinical guideline from a review of existing practice parameters and available literature. All existing evidence-based AASM practice parameters relevant to the evaluation and management of OSA in adults were incorporated into this guideline. For areas not covered by the practice parameters, the task force performed a literature review and made consensus recommendations using a modified nominal group technique. Recommendations: Questions regarding OSA should be incorporated into routine health evaluations. Suspicion of OSA should trigger a comprehensive sleep evaluation. The diagnostic strategy includes a sleep-oriented history and physical examination, objective testing, and education of the patient. The presence or absence and severity of OSA must be determined before initiating treatment in order to identify those patients at risk of developing the complications of sleep apnea, guide selection of appropriate treatment, and to provide a baseline to establish the effectiveness of subsequent treatment. Once the diagnosis is established, the patient should be included in deciding an appropriate treatment strategy that may include positive airway pressure devices, oral appliances, behavioral treatments, surgery, and/or adjunctive treatments. OSA should be approached as a chronic disease requiring long-term, multidisciplinary management. For each treatment option, appropriate outcome

  5. Long-term Strategic Planning for a Resilient Metro Colombo: An Economic Case for Wetland Conservation and Management

    NASA Astrophysics Data System (ADS)

    Rozenberg, J.

    2015-12-01

    Colombo faces recurrent floods that threaten its long-term economic development. Its urban wetlands have been identified by local agencies as a critical component of its flood reduction system, but they have declined rapidly in recent years due to continuous infilling, unmanaged land development and dredging to create lakes. In collaboration with government agencies, NGOs and local universities, the World Bank has carried out a Robust Decision Making analysis to examine the value of Colombo urban wetlands, both in the short-term and long-term, and identify what are the most viable strategies available to increase the city's flood resilience in an unclear future (in terms of climate change and patterns of urban development). This has involved the use of numerous hydrological and socio-economic scenarios as well as the evaluation of some wetlands benefits, like ecosystem services, wastewater treatment, or recreational services. The analysis has determined that if all urban wetlands across the Colombo catchment were lost, in some scenarios the metropolitan area would have to cope with an annual average flood loss of approximately 1% of Colombo GDP in the near future. For long-term strategies, trade-offs between urban development, lake creation and wetland conservation were analyzed and it was concluded that an active management of urban wetlands was the lowest regret option. Finally, the analysis also revealed that in the future, with climate change and fast urban development, wetlands will not be sufficient to protect Colombo against severe floods. Pro-active urban planning and land-use management are therefore necessary, both to protect existing wetlands and to reduce future exposure. The use of many different scenarios, the consideration of several policy options, and the open participatory process ensured policy-makers' buy-in and lead to the decision to actively protect urban wetlands in Colombo.

  6. Short- and Long-Term Stroke Risk after Urgent Management of Transient Ischaemic Attack: The Bologna TIA Clinical Pathway.

    PubMed

    Guarino, Maria; Rondelli, Francesca; Favaretto, Elisabetta; Stracciari, Andrea; Filippini, Massimo; Rinaldi, Rita; Zele, Ivana; Sartori, Michelangelo; Faggioli, Gianluca; Mondini, Susanna; Donti, Andrea; Strocchi, Enrico; Degli Esposti, Daniela; Muscari, Antonio; Veronesi, Maddalena; D'Addato, Sergio; Spinardi, Luca; Faccioli, Luca; Pastore Trossello, Marco; Cirignotta, Fabio

    2015-01-01

    Rapid management can reduce the short stroke risk after transient ischaemic attack (TIA), but the long-term effect is still little known. We evaluated 3-year vascular outcomes in patients with TIA after urgent care. We prospectively enrolled all consecutive patients with TIA diagnosed by a vascular neurologist and referred to our emergency department (ED). Expedited assessment and best secondary prevention was within 24 h. Endpoints were stroke within 90 days, and stroke, myocardial infarction, and vascular death at 12, 24 and 36 months. Between August 2010 and July 2013, we evaluated 686 patients with suspected TIA; 433 (63%) patients had confirmed TIA. Stroke at 90 days was 2.07% (95% confidence interval (CI), 1.1-3.9) compared with the ABCD2-predicted risk of 9.1%. The long-term stroke risk was 2.6% (95% CI, 1.1-4.2), 3.7% (95% CI, 1.6-5.9) and 4.4% (95% CI, 1.9-6.8) at 12, 24 and 36 months, respectively. The composite outcome of stroke, myocardial infarction, and vascular death was 3.5% (95% CI, 1.7-5.1), 4.9% (95% CI, 2.5-7.4), and 5.6% (95% CI, 2.8-8.3) at 12, 24, and 36 months, respectively. TIA expedited management driven by vascular neurologists was associated with a marked reduction in the expected early stroke risk and low long-term risk of stroke and other vascular events. © 2015 S. Karger AG, Basel.

  7. Long-term efficacy and safety of otilonium bromide in the management of irritable bowel syndrome: a literature review

    PubMed Central

    Triantafillidis, John K; Malgarinos, George

    2014-01-01

    Irritable bowel syndrome (IBS) is a very common functional gastrointestinal disorder characterized by abdominal pain or discomfort and altered bowel habits. The disease affects a large part of the world population. The clinical course is mostly characterized by a cyclic recurrence of symptoms. Therefore, IBS patients should receive, as an initial therapeutic approach, a short course of treatment, and long-term treatment should be reserved for those patients with recurrent symptoms. The available clinical trials show that significant improvement of the symptoms over placebo could be achieved with various drugs, although this improvement is frequently time dependent and with high relapse rates after the cessation of the treatment. In a proportion of patients, clinically obvious relapse could appear long after stopping the treatment. Some of the available pharmacologic agents, including otilonium bromide (OB), are able to significantly prolong the time to the appearance of relapse, compared with placebo. As a consequence, some authors suggest that a cyclic treatment could be of benefit. Antispasmodic drugs have been used for many years in an effort to control the symptoms of IBS. OB is a poorly absorbed spasmolytic drug, exerting significantly greater control of the symptoms of IBS compared with placebo. Recent data suggest that the drug could effectively be used for the long-term management of patients with IBS. The aim of this review is to provide the reader with an evidence-based overview of the efficacy and tolerability of OB in the long-term management of IBS patients, based on the results of the clinical trials published so far. PMID:24741324

  8. Long-term efficacy and safety of otilonium bromide in the management of irritable bowel syndrome: a literature review.

    PubMed

    Triantafillidis, John K; Malgarinos, George

    2014-01-01

    Irritable bowel syndrome (IBS) is a very common functional gastrointestinal disorder characterized by abdominal pain or discomfort and altered bowel habits. The disease affects a large part of the world population. The clinical course is mostly characterized by a cyclic recurrence of symptoms. Therefore, IBS patients should receive, as an initial therapeutic approach, a short course of treatment, and long-term treatment should be reserved for those patients with recurrent symptoms. The available clinical trials show that significant improvement of the symptoms over placebo could be achieved with various drugs, although this improvement is frequently time dependent and with high relapse rates after the cessation of the treatment. In a proportion of patients, clinically obvious relapse could appear long after stopping the treatment. Some of the available pharmacologic agents, including otilonium bromide (OB), are able to significantly prolong the time to the appearance of relapse, compared with placebo. As a consequence, some authors suggest that a cyclic treatment could be of benefit. Antispasmodic drugs have been used for many years in an effort to control the symptoms of IBS. OB is a poorly absorbed spasmolytic drug, exerting significantly greater control of the symptoms of IBS compared with placebo. Recent data suggest that the drug could effectively be used for the long-term management of patients with IBS. The aim of this review is to provide the reader with an evidence-based overview of the efficacy and tolerability of OB in the long-term management of IBS patients, based on the results of the clinical trials published so far.

  9. Long-term sediment yield from small catchment in southern Brazil affected by land use and soil management changes.

    NASA Astrophysics Data System (ADS)

    Gomes Minella, Jean Paolo; Henrique Merten, Gustavo; Alessandra Peixoto de Barros, Claudia; Dalbianco, Leandro; Ramon, Rafael; Schlesner, Alexandre

    2015-04-01

    Soil erosion and sediment yield are the main cause of soil degradation in Brazil. Despite this, there is a lack of information about the effects of the soil management on the hydrology and sediment yield at catchment scale. This study aimed to investigate the long-term relationship between the land use and sediment yield in a small catchment with significant changes in soil management, and its impacts on soil erosion and sediment yield. To account the anthropogenic and climatic effects on sediment yield were monitored precipitation, stream flow and suspended sediment concentration during thirteen years (2002 and 2014) at 10 minutes interval and the changes that occurred each year in the land use and soil management. Despite the influence of climate on the sediment yield, the results clearly show three distinct periods affected by the land use and soil management changes during this this period. In the first four years (2002-2004) the predominant land use was the tobacco with traditional soil management, where the soils are plough every year and without winter cover crop. In this period the sediment yield reached the order of 160 t.ha-1.y-1. In the period of 2005-2009, a soil conservation program introduced the adoption of minimum tillage in the catchment and the sediment yield decrease to 70 t.ha-1.y-1. In the last period (2010-2014) there was a partial return to the traditional soil management practices with an increase trend in sediment yield. However, there was also an increase in reforestation areas with positive effect in reducing erosion and sediment yield. The magnitude order of sediment yield in this period was 100 t.ha-1.y-1. The long term sediment yield data was able to demonstrate the impact of the improved management practices in reducing soil erosion and sediment yield. The results allowed a good understanding of the changing sediment dynamics and soil erosion at catchment scale.

  10. Contingency Management in the Classroom Treatment of Long-Term Elective Mutism: A Case Report

    ERIC Educational Resources Information Center

    Colligan, Ross W.; And Others

    1977-01-01

    An 11-year-old boy with a six-year history of elective mutism in school was successfully treated with operant reinforcement and contingency management techniques. The plan was carried out by the classroom teacher with a minimum amount of management consultation. (Author)

  11. The scenic impact of key forest attributes and long-term management alternatives for hardwood forests

    Treesearch

    R.G. Ribe

    1991-01-01

    The problem of identifying the scenic value of forest attributes and management plans is empirically explored. A sample of hardwood forests in Wisconsin, representing a diversity of management histories, is analyzed through photographs and field inventories. Scenic beauty judgements of the photographs by a diversity of respondents yield general scenic beauty estimates...

  12. Long-term effects of grazing management and buffer strips on soil erosion from pastures

    USDA-ARS?s Scientific Manuscript database

    High grazing pressure can lead to soil erosion in pastures by compacting soil and increasing runoff and sediment delivery to waterways. Limited information exists on the effects of grazing management and best management practices (BMPs), such as buffer strips, on soil erosion from pastures. The obje...

  13. RANGE RAM: a long-term planning method for managing grazing lands

    Treesearch

    Henricus C. Jansen

    1976-01-01

    Range RAM (Resource Allocation Method) is a computerized planning method designed to assist range managers in developing and selecting alternatives in spatial and temporal allocation of resources. The technique is applicable at the frest or district management levels, or their equivalents. Range RAM can help formulate plans that maximize the production of range outputs...

  14. Waste management progress report

    SciTech Connect

    1997-06-01

    During the Cold War era, when DOE and its predecessor agencies produced nuclear weapons and components, and conducted nuclear research, a variety of wastes were generated (both radioactive and hazardous). DOE now has the task of managing these wastes so that they are not a threat to human health and the environment. This document is the Waste Management Progress Report for the U.S. Department of Energy dated June 1997. This progress report contains a radioactive and hazardous waste inventory and waste management program mission, a section describing progress toward mission completion, mid-year 1997 accomplishments, and the future outlook for waste management.

  15. Long-term extracorporeal circulation management: the role of low- and high-range heparin ACT tests.

    PubMed

    Herbst, Daniel; Najm, Hani K; Jha, Kumar Neerod

    2008-12-01

    Modern management of extracorporeal circulation, especially during long-term support of post-cardiac surgical patients, remains challenging and requires optimal care of the patient's fluid balance and coagulation hemostasis for its successful outcome. The activated clotting time assay is one of the tests used to manage extracorporeal circulation and is available in a low- and high-range level. The question of which assay is more appropriate for procedures that require low to moderate heparin dosing is still unclear. We report our experience with a neonate diagnosed with hypoplastic left heart syndrome who needed emergent extracorporeal membrane oxygenation support for 13 days after Norwood stage I palliation using a Sano shunt. Although successful, bleeding complications prompted us to review our strategy for management of coagulation hemostasis.

  16. [Case management in long-term care--the task of individual related and family-oriented support for people in need of care and its realization through the reform of long-term care insurance].

    PubMed

    Klie, Thomas; Monzer, Michael

    2008-04-01

    The introduction of standardized Case Management structures to improve coordination and cooperation of all involved in care, such as cost units, service providers, voluntary organizations, families and the different occupational categories involved in nursing, is the main concern of the current reform of German long-term care insurance. In this article, demands on Case Management in care are enunciated and the basics found in expert talks, needed for efficient support of care, assembled. In doing so, the role and function of Case Management is differentiated, the different levels (case, organizational and system levels) distinguished and options and conditions needed to settle such an organization are introduced.

  17. Soil phosphorus depletion and shifts in plant communities change bacterial community structure in a long-term grassland management trial.

    PubMed

    Adair, Karen L; Wratten, Steve; Lear, Gavin

    2013-06-01

    Agricultural systems rely on healthy soils and their sustainability requires understanding the long-term impacts of agricultural practices on soils, including microbial communities. We examined the impact of 17 years of land management on soil bacterial communities in a New Zealand randomized-block pasture trial. Significant variation in bacterial community structure related to mowing and plant biomass removal, while nitrogen fertilizer had no effect. Changes in soil chemistry and legume abundance described 52% of the observed variation in the bacterial community structure. Legumes (Trifolium species) were absent in unmanaged plots but increased in abundance with management intensity; 11% of the variation in soil bacterial community structure was attributed to this shift in the plant community. Olsen P explained 10% of the observed heterogeneity, which is likely due to persistent biomass removal resulting in P limitation; Olsen P was significantly lower in plots with biomass removed (14 mg kg(-1) ± 1.3SE) compared with plots that were not mown, or where biomass was left after mowing (32 mg kg(-1) ± 1.6SE). Our results suggest that removal of plant biomass and associated phosphorus, as well as shifts in the plant community, have greater long-term impacts on soil bacterial community structure than application of nitrogen fertilizers.

  18. Management of Facial Nerve in Surgical Treatment of Previously Untreated Fisch Class C Tympanojugular Paragangliomas: Long-Term Results

    PubMed Central

    Bacciu, Andrea; Ait Mimoune, Hassan; D'Orazio, Flavia; Vitullo, Francesca; Russo, Alessandra; Sanna, Mario

    2013-01-01

    The aim of this study was to evaluate the long-term facial nerve outcome according to management of the facial nerve in patients undergoing surgery for Fisch class C tympanojugular paragangliomas. The study population consisted of 122 patients. The infratemporal type A approach was the most common surgical procedure. The facial nerve was left in place in 2 (1.6%) of the 122 patients, anteriorly rerouted in 97 (79.5%), anteriorly rerouted with segmental resection of the epineurium in 7 (5.7%), and sacrificed and reconstructed in 15 (12.3%). One patient underwent cross-face nerve grafting. At last follow-up, House-Brackmann grade I to II was achieved in 51.5% of patients who underwent anterior rerouting and in 28.5% of those who underwent anterior rerouting with resection of the epineurium. A House-Brackmann grade III was achieved in 73.3% of patients who underwent cable nerve graft interposition. The two patients in whom the facial nerve was left in place experienced grade I and grade III, respectively. The patient who underwent cross-face nerve grafting had grade III. Gross total resection was achieved in 105 cases (86%). Management of the facial nerve in tympanojugular paraganglioma surgery can be expected to ensure satisfactory facial function long-term outcome. PMID:24498582

  19. A Strategy for Maintenance of the Long-Term Performance Assessment of Immobilized Low-Activity Waste Glass

    SciTech Connect

    Ryan, Joseph V.; Freedman, Vicky L.

    2016-09-28

    Approximately 50 million gallons of high-level radioactive mixed waste has accumulated in 177 buried single- and double-shell tanks at the Hanford Site in southeastern Washington State as a result of the past production of nuclear materials, primarily for defense uses. The United States Department of Energy (DOE) is proceeding with plans to permanently dispose of this waste. Plans call for separating the tank waste into high-level waste (HLW) and low-activity waste (LAW) fractions, which will be vitrified at the Hanford Waste Treatment and Immobilization Plant (WTP). Principal radionuclides of concern in LAW are 99Tc, 129I, and U, while non-radioactive contaminants of concern are Cr and nitrate/nitrite. HLW glass will be sent off-site to an undetermined federal site for deep geological disposal while the much larger volume of immobilized low-activity waste will be placed in the on-site, near-surface Integrated Disposal Facility (IDF).

  20. Projected long-term response of Southeastern birds to forest management

    USGS Publications Warehouse

    Mitchell, M.S.; Reynolds-Hogland, M. J.; Smith, M.L.; Wood, P.B.; Beebe, J.A.; Keyser, P.D.; Loehle, C.; Reynolds, C.J.; Van Deusen, P.; White, D.

    2008-01-01

    Numerous studies have explored the influence of forest management on avian communities empirically, but uncertainty about causal relationships between landscape patterns and temporal dynamics of bird communities calls into question how observed historical patterns can be projected into the future, particularly to assess consequences of differing management alternatives. We used the Habplan harvest scheduler to project forest conditions under several management scenarios mapped at 5-year time steps over a 40-year time span. We used empirical models of overall avian richness, richness of selected guilds, and probability of presence for selected species to predict avian community characteristics for each of the mapped landscapes generated for each 5-year time step for each management scenario. We then used time series analyses to quantify relationships between changes in avian community characteristics and management-induced changes to forest landscapes over time. Our models of avian community and species characteristics indicated habitat associations at multiple spatial scales, although landscape-level measures of habitat were generally more important than stand-level measures. Our projections showed overall avian richness, richness of Neotropical migrants, and the presence of Blue-gray Gnatcatchers and Eastern Wood-pewees varied little among management scenarios, corresponding closely to broad, overall landscape changes over time. By contrast, richness of canopy nesters, richness of cavity nesters, richness of scrub-successional associates, and the presence of Common Yellowthroats showed high temporal variability among management scenarios, likely corresponding to short-term, fine-scale changes in the landscape. Predicted temporal variability of both interior-forest and early successional birds was low in the unharvested landscape relative to that in the harvested landscape. Our results also suggested that early successional species can be sensitive to both

  1. How to treat climate evolution in the assessment of the long-term safety of disposal facilities for radioactive waste: examples from Belgium

    NASA Astrophysics Data System (ADS)

    van Geet, M.; de Craen, M.; Mallants, D.; Wemaere, I.; Wouters, L.; Cool, W.

    2009-02-01

    In order to protect man and the environment, long-lasting, passive solutions are needed for the different categories of radioactive waste. In Belgium, three main categories of conditioned radioactive waste (termed A, B and C) are defined by radiological and thermal power criteria. It is expected that Category A waste - low and intermediate level short-lived waste - will be disposed in a near-surface facility, whereas Category B and C wastes - high-level and other long-lived radioactive waste - will be disposed in a deep geological repository. In both cases, the long-term safety of a given disposal facility is evaluated. Different scenarios and assessment cases are developed illustrating the range of possibilities for the evolution and performance of a disposal system without trying to predict its precise behaviour. Within these scenarios, the evolution of the climate will play a major role as the time scales of the evaluation and long term climate evolution overlap. In case of a near-surface facility (Category A waste), ONDRAF/NIRAS is considering the conclusions of the IPCC, demonstrating that a global warming is nearly unavoidable. The consequences of such a global warming and the longer term evolutions on the evolution of the near-surface facility are considered. In case of a geological repository, in which much longer time frames are considered, even larger uncertainties exist in the various climate models. Therefore, the robustness of the geological disposal system towards the possible results of a spectrum of potential climate changes and their time of occurrence will be evaluated. The results of climate modelling and knowledge of past climate changes will merely be used as guidance of the extremes of climate changes to be considered and their consequences.

  2. Radioactive Waste Management Basis

    SciTech Connect

    Perkins, B K

    2009-06-03

    The purpose of this Radioactive Waste Management Basis is to describe the systematic approach for planning, executing, and evaluating the management of radioactive waste at LLNL. The implementation of this document will ensure that waste management activities at LLNL are conducted in compliance with the requirements of DOE Order 435.1, Radioactive Waste Management, and the Implementation Guide for DOE Manual 435.1-1, Radioactive Waste Management Manual. Technical justification is provided where methods for meeting the requirements of DOE Order 435.1 deviate from the DOE Manual 435.1-1 and Implementation Guide.

  3. Incidence, Management, and Immediate- and Long-Term Outcomes After Iatrogenic Aortic Dissection During Diagnostic or Interventional Coronary Procedures.

    PubMed

    Núñez-Gil, Iván J; Bautista, Daniel; Cerrato, Enrico; Salinas, Pablo; Varbella, Ferdinando; Omedè, Pierluigi; Ugo, Fabrizio; Ielasi, Alfonso; Giammaria, Massimo; Moreno, Raúl; Pérez-Vizcayno, María José; Escaned, Javier; De Agustin, José Alberto; Feltes, Gisela; Macaya, Carlos; Fernández-Ortiz, Antonio

    2015-06-16

    Aortic dissection type A is a disease with high mortality. Iatrogenic aortic dissection after interventional procedures is infrequent, and prognostic data are scarce. Our objective was to analyze its incidence, patient profile, and long-term prognosis. Between 2000 and 2014, we retrospectively analyzed 74 patients with dissection of the ascending aorta. Clinical and procedural data were reviewed, and later, we performed a prospective clinical follow-up by telephone or in the office. The incidence of aortic dissection was 0.06%. Our patients, predominantly male (67.6%), had a mean age of 66.9±10.8 years. With multiple cardiovascular risk factors, the main reason for cardiac catheterization was an acute coronary syndrome (n=54). The complication was detected acutely in all, trying to engage the right coronary artery in 47 and the left main artery in 30 and after other maneuvers in 2, mostly complex therapeutic procedures (78.4%). A coronary artery was involved in 45 patients (60.8%). Thirty-five patients underwent an angioplasty and stent implantation; 3 had cardiac surgery; and 36 were managed conservatively. Two patients died of cardiogenic shock after the dissection. After a median follow-up of 51.2 months (range, 16.4-104.8 months), none of the remaining patients developed complications as a result of the dissection, progression, ischemia, pain, or dissection recurrence. Iatrogenic catheter dissection of the aorta is a rare complication that carries an excellent short- and long-term prognosis with the adoption of a conservative approach. When a coronary artery is involved as an entry point, it usually can be safely sealed with a stent with good long-term outcomes. © 2015 American Heart Association, Inc.

  4. Role of future scenarios in understanding deep uncertainty in long-term air quality management.

    PubMed

    Gamas, Julia; Dodder, Rebecca; Loughlin, Dan; Gage, Cynthia

    2015-11-01

    The environment and its interactions with human systems, whether economic, social, or political, are complex. Relevant drivers may disrupt system dynamics in unforeseen ways, making it difficult to predict future conditions. This kind of "deep uncertainty" presents a challenge to organizations faced with making decisions about the future, including those involved in air quality management. Scenario Planning is a structured process that involves the development of narratives describing alternative future states of the world, designed to differ with respect to the most critical and uncertain drivers. The resulting scenarios are then used to understand the consequences of those futures and to prepare for them with robust management strategies. We demonstrate a novel air quality management application of Scenario Planning. Through a series of workshops, important air quality drivers were identified. The most critical and uncertain drivers were found to be "technological development" and "change in societal paradigms." These drivers were used as a basis to develop four distinct scenario storylines. The energy and emissions implications of each storyline were then modeled using the MARKAL energy system model. NOx emissions were found to decrease for all scenarios, largely a response to existing air quality regulations, whereas SO2 emissions ranged from 12% greater to 7% lower than 2015 emissions levels. Future-year emissions differed considerably from one scenario to another, however, with key differentiating factors being transition to cleaner fuels and energy demand reductions. Application of scenarios in air quality management provides a structured means of sifting through and understanding the dynamics of the many complex driving forces affecting future air quality. Further, scenarios provide a means to identify opportunities and challenges for future air quality management, as well as a platform for testing the efficacy and robustness of particular management

  5. Effects of Long-Term Forest Management on a Regional Avifauna

    SciTech Connect

    Kilgo, J.C.; Franzreb, K.E.; Gauthreaux, S.A.; Miller, K.V.; Chapman, B.R.

    2000-01-01

    Bird populations on and off the SRS were compared to determine the effects that management practices have had on regional populations. Relative abundances were assessed from BBS routes off SRS and three surrogate routes generated on SRS from point count data. The number of species per route did not differ. The total number of birds was greater off SRS than on SRS. 23 species were more abundant on SRS and 33 species were more abundant off SRS primarily those that preferred agricultural and urban habitats. Those more abundant on SRS preferred mature forest habitat. Management at SRS support species not common in the regional landscape.

  6. Climate change and long-term fire management impacts on Australian savannas.

    PubMed

    Scheiter, Simon; Higgins, Steven I; Beringer, Jason; Hutley, Lindsay B

    2015-02-01

    Tropical savannas cover a large proportion of the Earth's land surface and many people are dependent on the ecosystem services that savannas supply. Their sustainable management is crucial. Owing to the complexity of savanna vegetation dynamics, climate change and land use impacts on savannas are highly uncertain. We used a dynamic vegetation model, the adaptive dynamic global vegetation model (aDGVM), to project how climate change and fire management might influence future vegetation in northern Australian savannas. Under future climate conditions, vegetation can store more carbon than under ambient conditions. Changes in rainfall seasonality influence future carbon storage but do not turn vegetation into a carbon source, suggesting that CO₂ fertilization is the main driver of vegetation change. The application of prescribed fires with varying return intervals and burning season influences vegetation and fire impacts. Carbon sequestration is maximized with early dry season fires and long fire return intervals, while grass productivity is maximized with late dry season fires and intermediate fire return intervals. The study has implications for management policy across Australian savannas because it identifies how fire management strategies may influence grazing yield, carbon sequestration and greenhouse gas emissions. This knowledge is crucial to maintaining important ecosystem services of Australian savannas.

  7. Consumer Direction in Managed Long-Term Care: An Exploratory Survey of Practices and Perceptions

    ERIC Educational Resources Information Center

    Meiners, Mark R.; Mahoney, Kevin J.; Shoop, Dawn M.; Squillace, Marie R.

    2002-01-01

    Purpose: This article presents results of a survey of the attitudes and practices of managed care organizations (MCOs) concerning consumer direction. The study focused on understanding several alternative measures of consumer direction and the factors that are associated with the MCOs concerning those measures. Design and Methods: The MCOs that…

  8. Management filters and species traits: Weed community assembly in long-term organic and conventional systems

    USDA-ARS?s Scientific Manuscript database

    Community assembly theory provides a useful framework to assess the response of weed communities to agricultural management systems and to improve the predictive power of weed science. Under this framework, weed community assembly is constrained by abiotic and biotic "filters" that act on species tr...

  9. Effects of long-term forest management on a regional avifauna

    Treesearch

    John C. Kilgo; Kathleen E. Franzreb; Sidney A. Gauthreaux; Karl V. Miller; Brian R. Chapman

    2000-01-01

    We compared breeding bird populations on and off of the Savannah River Site, SC, to determine whether management practices have affected abundance and composition of the resident avifauna. We assessed relative abundance by comparing Breeding Bird Survey (BBS) data from six routes off the Savannah River Site with three surrogate routes generated using point-count data...

  10. The Biggest Loser Thinks Long-Term: Recency as a Predictor of Success in Weight Management

    PubMed Central

    Koritzky, Gilly; Rice, Chantelle; Dieterle, Camille; Bechara, Antoine

    2015-01-01

    Only a minority of participants in behavioral weight management lose weight significantly. The ability to predict who is likely to benefit from weight management can improve the efficiency of obesity treatment. Identifying predictors of weight loss can also reveal potential ways to improve existing treatments. We propose a neuro-psychological model that is focused on recency: the reliance on recent information at the expense of time-distant information. Forty-four weight-management patients completed a decision-making task and their recency level was estimated by a mathematical model. Impulsivity and risk-taking were also measured for comparison. Weight loss was measured in the end of the 16-week intervention. Consistent with our hypothesis, successful dieters (n = 12) had lower recency scores than unsuccessful ones (n = 32; p = 0.006). Successful and unsuccessful dieters were similar in their demographics, intelligence, risk taking, impulsivity, and delay of gratification. We conclude that dieters who process time-distant information in their decision making are more likely to lose weight than those who are high in recency. We argue that having low recency facilitates future-oriented thinking, and thereby contributes to behavior change treatment adherence. Our findings underline the importance of choosing the right treatment for every individual, and outline a way to improve weight-management processes for more patients. PMID:26696930

  11. Effects of Long-Term Nitrogen Management on Nitrogen Budgets of Irrigated No-till Corn

    USDA-ARS?s Scientific Manuscript database

    Effects of nitrogen management on irrigated no-till (NT) corn (Zea Mays L) yields were studied from the 1999 to 2015 growing seasons in a Fort Collins clay loam soil at the CSU ARDEC near Fort Collins, CO. The NT N fertilizer rates averaged 0, 34, 67, 134, 202 and 246 kg N ha-1. Fifteen corn plants...

  12. Computerized Information Management in Long-Term Care: A Case Study. Technical Report No. 303.

    ERIC Educational Resources Information Center

    Zawadski, Rick T.; Gee, Stephen

    This technical report describes the computerized information management system used at the Community Care Organization for Dependent Adults (CCODA) of the On Lok Senior Health Services in San Francisco's Chinatown (California). A background perspective on information systems in business, government, hospitals, and local community service agencies…

  13. Summary of the cost analysis report for the long-term management of depleted uranium hexafluoride

    SciTech Connect

    Dubrin, J.W.; Rahm-Crites, L.

    1997-09-01

    This report is a summary of the Cost Analysis Report which provides comparative cost data for the management strategy alternatives. The PEIS and the Cost Analysis Report will help DOE select a management strategy. The Record of Decision, expected in 1998, will complete the first part of the Depleted Uranium Hexafluoride Management Program. The second part of the Program will look at specific sites and technologies for carrying out the selected strategy. The Cost Analysis Report estimates the primary capital and operating costs for the different alternatives. It reflects the costs of technology development construction of facilities, operation, and decontamination and decommissioning. It also includes potential revenues from the sale of by-products such as anhydrous hydrogen fluoride (ABF). These estimates are based on early designs. They are intended to help in comparing alternatives, rather than to indicate absolute costs for project budgets or bidding purposes. More detailed estimates and specific funding sources will be considered in part two of the Depleted Uranium Hexafluoride Management Program.

  14. Case Management Agency Systems of Administering Long-Term Care: Evidence from the Channeling Demonstration.

    ERIC Educational Resources Information Center

    Kemper, Peter

    1990-01-01

    Examines what was learned from channeling demonstration about potential of case management agency systems for administering home care benefits. Considers both advantages (substitution of lower cost for higher cost services, negotiation of lower prices for services, quality assurance) and disadvantages (difficulty controlling participation rates,…

  15. Climate Change and Long-Term Fire Management Impacts on Australian Savanna

    NASA Astrophysics Data System (ADS)

    Scheiter, S.; Higgins, S. I.; Beringer, J.; Hutley, L. B.

    2014-12-01

    Tropical savannas cover a large proportion of the Earth's land surface and many people are dependent on the ecosystem services that savannas supply. Their sustainable management is therefore crucial. Due to the complexity of vegetation dynamics, the impacts of climate change and land use on savannas are highly uncertain. Here, we use a dynamic vegetation model, the aDGVM, to project how climate change and fire management influence vegetation in northern Australian savannas in 2100. We show that under future climate conditions, vegetation can store more carbon than under ambient conditions, despite substantial changes in fire regimes. Changes in rainfall seasonality influence future carbon storage but do not turn vegetation into a carbon source, suggesting that CO2 fertilization is the main driver of vegetation change. The application of prescribed fires with varying return intervals and burning season, influences vegetation dynamics and fire induced carbon and greenhouse gas emissions. Carbon sequestration is maximized with early dry season fires and long fire return intervals, grass productivity is maximized with late dry season fires at an intermediate fire return intervals. The study has implications for management policy across Australian savannas because it can contribute to identifying fire management strategies that optimize grazing yield, carbon sequestration and greenhouse gas emissions. This knowledge is crucial to maintain important ecosystem services of Australian savannas.

  16. Conservation management in cotton production: long-term soil biological, chemical, and physical changes

    USDA-ARS?s Scientific Manuscript database

    Conservation practices are an increasingly important component of sustainable management systems, and information about their influence on soil characteristics is needed. Various soil parameters were studied in a no-tillage (NT) or minimum tillage (MT) cotton (Gossypium hirsutum L.) production stud...

  17. Long-Term Outcomes of Patients with Non-Surgically Managed Uncomplicated Appendicitis

    PubMed Central

    McCutcheon, Brandon A; Chang, David C; Marcus, Logan P; Inui, Tazo; Noorbakhsh, Abraham; Schallhorn, Craig; Parina, Ralitza; Salazar, Francesca R; Talamini, Mark A.

    2014-01-01

    Background Emerging literature has supported the safety of non-operative management of uncomplicated appendicitis. Study Design Patients with emergent, uncomplicated appendicitis were identified by appropriate ICD-9 diagnosis codes in the California Office of Statewide Health Planning and Development (OSHPD) database from 1997 to 2008. Rates of treatment failure, recurrence, and perforation following non-surgical management were calculated. Factors associated with treatment failure, recurrence, and perforation were identified using multivariable logistic regression. Mortality, length of stay, and total charges were compared between treatment cohorts using matched propensity score analysis. Results Among 231,678 patients with uncomplicated appendicitis, the majority (98.5%) were managed operatively. Among the 3,236 non-surgically managed patients who survived to discharge without an interval appendectomy, 5.9% and 4.4% experienced treatment failure or recurrence, respectively, over a median duration of follow up of greater than seven years. There were no mortalities associated with treatment failure or recurrence. The risk of perforation after discharge was approximately 3%. Using multivariable analysis, race and age were significantly associated with the odds of treatment failure. Gender, age, and hospital teaching status were significantly associated with the odds of recurrence. Age and hospital teaching status were significantly associated with the odds of perforation. Matched propensity score analysis indicated that after risk adjustment mortality rates (0.1% vs. 0.3%, p=0.65) and total charges ($23,243 vs. $24,793, p=0.70) were not statistically different between operative and non-operative patients, however, length of stay was significantly greater amongst the non-operative treatment group (2.1 vs. 3.2 days, p<0.001). Conclusions This study suggests that non-operative management of uncomplicated appendicitis may be safe, and prompts further investigations

  18. Change management and partnership: achieving a solution to provide peritoneal dialysis in a long-term care setting.

    PubMed

    Yang, Charlie; Campbell, Jill

    2009-01-01

    Health care organizations must respond quickly to today's volatile and changing environment. This article describes how St. Michael's Hospital (acute care hospital) and the Drs. Paul and John Rekai Centre (long-term care facility) collaborated to use an innovative approach to address pressures of change affecting peritoneal dialysis (PD) care delivery for the elderly. The collaborative applied Galpin's (1996) nine-stage Change Management Model to implement the organizational change. Both organizations generated a shared vision to improve timely access to nursing homes for patients requiring both placement and ongoing peritoneal dialysis. They analyzed their current status and committed resources for the collaboration. Both organizations generated general and detailed recommendations for PD care delivery processes. A pilot was implemented and refinement of the collaboration occurred prior to formal roll out. This application of a change management model to establish organizational partnership may be of interest to those seeking to establish similar collaborations.

  19. Potential Impacts of Arrested Environmental Trajectories on Long-term Geomorphic Form: Implications to River Management and Restoration

    NASA Astrophysics Data System (ADS)

    James, A.

    2016-12-01

    Environmental trajectories are important factors in river management and restoration because they can incorporate non-linear dynamics operating over extended time frames. Although large uncertainties arise when trajectories are considered, the alternative practice of assuming self-regulating systems under dynamic equilibrium underestimates uncertainties over decadal time periods or under conditions of climate or anthropogenic change. Negative feedbacks that damp out variations may fail to constrain adjustments under conditions of altered boundary conditions. Recognition of trajectories, provides an improved understanding of fluvial systems. Going further, however, recognition of changes in trajectories and arrested trajectories that prevent change improves the viability of long-term management and restoration efforts. At the watershed scale, a shift from aggrading positive sediment budgets (input>>output), to degrading negative sediment budgets (input<

  20. Heparin in the long-term management of ligneous conjunctivitis: a case report and review of literature.

    PubMed

    Hiremath, Mandira; Elder, James; Newall, Fiona; Mitchell, Susan; Dyas, Roxanne; Monagle, Paul

    2011-10-01

    Ligneous conjunctivitis, secondary to inherited homozygous plasminogen deficiency, is a poorly understood condition that has the potential to hinder normal childhood development if not managed adequately. We report the clinical progression of a child with ligneous conjunctivitis, controlled with daily heparin eye drops, postsurgical excision, for a duration of approximately 5 years at a cost of approximately 30 USD per month. During this time, the patient's progress has been complicated by one occurrence of periorbital cellulitis and also otitis media. The patient has also experienced ocular complications due to the remaining membranous lesion. This case indicates that individual patient factors including plasminogen levels and exposure to triggers of ocular inflammation may influence the clinical progression of ligneous conjunctivitis. Furthermore, this study is one of the first to present over 5-year follow-up of a patient with ligneous conjunctivitis effectively managed with long-term heparin eye drops.

  1. Evaluating long-term nitrogen- versus phosphorus-based nutrient management of poultry litter.

    PubMed

    Maguire, Rory O; Mullins, Greg L; Brosius, Mike

    2008-01-01

    Environmental concerns are driving manure management in many areas from a traditional nitrogen (N) basis toward phosphorus (P)-based nutrient management plans. We investigated how changing nutrient management from an N to a P basis affected crop yields and soil properties in high P soils over a 7-yr period. Three sites were established on farmers' fields, and at each site the same six treatments were applied for 6 or 7 yr. These treatments were (i) no P; (ii) poultry litter applied on an N basis; (iii) inorganic P, equal to the P applied in treatment 2; (iv) poultry litter applied on an estimated annual crop P removal basis; (v) inorganic P, equal to the P applied in treatment iv; and (vi) poultry litter applied once every 2 or 3 yr at a 2- or 3-yr crop removal P rate. All treatments received the same rate of plant-available N. Yields, P balance, soil pH, Mehlich 1 P, and water-soluble P (WSP) were monitored during the experiment. Over the course of the experiment, litter had the beneficial effect of raising soil pH relative to the inorganic treatments. After 7 yr, Mehlich 1 P and WSP were greatest in soils under the N-based treatments, smallest in the no P treatment, and intermediate in the P-based treatments. For example, at the Shenandoah site, Mehlich 1 P decreased by 35 mg kg(-1) under the no P treatment and increased by 36 mg kg(-1) under the inorganic N-based treatment. There were no significant differences between inorganic fertilizer and poultry litter nutrient sources. The results of this study show that soil test P can be decreased in high-P soils over a few years by changing from an N-based to a P-based nutrient management plan or stopping P applications without negatively affecting yields.

  2. Does conservative management for brain stem cavernomas have better long-term outcome?

    PubMed

    Tarnaris, A; Fernandes, R P; Kitchen, N D

    2008-12-01

    There has been a controversy in the last 15 years on the correct management of brain stem cavernomas. We have reviewed our experience of the last 10 years in a single Institution and reviewed related literature published in the last 15 years. We recorded the demographics, clinical presentation, rebleeding episodes, incidence of neurological events and outcome assessed by recording the change of the modified Rankin scale in 21 cases. Univariate analysis was applied to test the effect of demographics, and presentation on the incidence and timing of rebleeding, chance of having a new neurological event, the number of subsequent neurological events and outcomes. Six cases were treated with surgery and 15 cases were managed conservatively. We obtained follow-up data in 20 patients (95%). Mean follow-up period was 79.7 months (range: 6-244, median 70 months). There were 0.05 rebleeding events per patient-year and 0.1 episodes of neurological deterioration per patient-year. No mortality was noted in either the surgical or the non-surgical group. Three of the six surgical cases had a reoperation. The outcome was improved in one patient, unchanged in 1, and worse in 3 surgical patients. In the case of conservative management the outcome was improved in two patients, unchanged in five patients, and worse in eight patients. Outcome was worse in the case of multiple cavernomas (p = 0.012). Our findings suggest that conservative management may be appropriate in individual cases when compared with surgery, but this difference was not statistically significant enough in order to support a change in practice. The natural history of brain stem cavernomas appears more benign than previously thought.

  3. Non-invasive methods applied to the case of Municipal Solid Waste landfills (MSW): analysis of long-term data

    NASA Astrophysics Data System (ADS)

    Scozzari, A.

    2008-11-01

    This work presents and discusses a methodology for modeling the behavior of a landfill system in terms of biogas release to the atmosphere, relating this quantity to local meteorological parameters. One of the most important goals in the study of MSW sites lies in the optimization of biogas collection, thus minimizing its release to the atmosphere. After an introductory part, that presents the context of non-invasive measurements for the assessment of biogas release, the concepts of survey mapping and automatic flux monitoring are introduced. Objective of this work is to make use of time series coming from long-term flux monitoring campaigns in order to assess the trend of gas release from the MSW site. A key aspect in processing such data is the modeling of the effect of meteorological parameters over such measurements; this is accomplished by modeling the system behavior with a set of Input/Output data to characterize it without prior knowledge (system identification). The system identification approach presented here is based on an adaptive simulation concept, where a set of Input/Output data help training a "black box" model, without necessarily a prior analytical knowledge. The adaptive concept is based on an Artificial Neural Network scheme, which is trained by real-world data coming from a long-term monitoring campaign; such data are also used to test the real forecasting capability of the model. In this particular framework, the technique presented in this paper appears to be very attractive for the evaluation of biogas releases on a long term basis, by simulating the effects of meteorological parameters over the flux measurement, thus enhancing the extraction of the useful information in terms of a gas "flux" quantity.

  4. Antiobesity Pharmacotherapy for Patients with Type 2 Diabetes: Focus on Long-Term Management

    PubMed Central

    Jeon, Won Seon

    2014-01-01

    Type 2 diabetes and obesity have a complex relationship; obesity is linked to insulin resistance, the precursor to type 2 diabetes. The management of obesity is an important method to delay onset of diabetes and improve the glycemic durability of antidiabetic agents. However, insulin and some of the oral hypoglycemic agents used to treat diabetes cause significant weight gain, and it is difficult for patients with diabetes to reduce and maintain their weight by life-style changes alone. Thus, antiobesity medications or bariatric surgery may be a necessary adjunct for certain obese patients with diabetes. In 2012, the U.S. Food and Drug Administration (FDA) approved lorcaserin and phentermine/topiramate extended-release for the management of chronic weight, and approval for naltrexone/bupropion sustained-release as an adjunct to exercise and reduced caloric intake followed in 2014. Liraglutide is pending FDA approval for antiobesity drug. Here we review the efficacy of approved and new promising drugs for the management of obesity. PMID:25559569

  5. Long-term impact of farm management and crops on soil microorganisms assessed by combined DGGE and PLFA analyses

    PubMed Central

    Stagnari, Fabio; Perpetuini, Giorgia; Tofalo, Rosanna; Campanelli, Gabriele; Leteo, Fabrizio; Della Vella, Umberto; Schirone, Maria; Suzzi, Giovanna; Pisante, Michele

    2014-01-01

    In the present study, long-term organic and conventional managements were compared at the experimental field of Monsampolo del Tronto (Marche region, Italy) with the aim of investigating soil chemical fertility and microbial community structure. A polyphasic approach, combining soil fertility indicators with microbiological analyses (plate counts, PCR-denaturing gradient gel electrophoresis [DGGE] and phospholipid fatty acid analysis [PLFA]) was applied. Organic matter, N as well as some important macro and micronutrients (K, P, Mg, Mn, Cu, and Zn) for crop growth, were more available under organic management. Bacterial counts were higher in organic management. A significant influence of management system and management x crop interaction was observed for total mesophilic bacteria, nitrogen fixing bacteria and actinobacteria. Interestingly, cultivable fungi were not detected in all analyzed samples. PLFA biomass was higher in the organic and Gram positive bacteria dominated the microbial community in both systems. Even if fungal biomass was higher in organic management, fungal PCR-DGGE fingerprinting revealed that the two systems were very similar in terms of fungal species suggesting that 10 years were not enough to establish a new dynamic equilibrium among ecosystem components. A better knowledge of soil biota and in particular of fungal community structure will be useful for the development of sustainable management strategies. PMID:25540640

  6. Implant prosthodontic management of anterior partial edentulism: long-term follow-up of a prospective study.

    PubMed

    Zarb, John P; Zarb, George A

    2002-02-01

    This paper reports on the long-term outcome of patients with Kennedy Class IV partial edentulism treated in the Implant Prosthodontic Unit (IPU) at the University of Toronto, Toronto, Ontario. The information for this paper was gathered from the charts of the first 30 consecutive, partially edentulous patients treated at the IPU. These patients all had Class IV edentulism and formed part of the original prospective clinical studies that were initiated in 1983. The patients' dental history suggested maladaptive experiences with traditional removable prostheses or a reluctance to have intact or quasi-intact teeth prepared as retainers for fixed prostheses. Fifteen men and 15 women treated with 94 Br nemark dental implants, supporting 34 prostheses, were followed until June 2000 (25 patients) or until they were lost to follow-up (5 patients). The multiple missing teeth occurred in 19 maxillae and 15 mandibles. The original prosthodontic treatments were intended to result in 33 fixed partial prostheses and 1 overdenture. At the time of this report, 25 patients with 86 implants supporting 31 fixed prostheses and 3 overdentures had been followed for an average of 12 years (range 7 16 years). The overall survival of implants was 92%. The difference between men (94%) and women (89%) was not statistically significant. This report is an interim update on an ongoing long-term prospective study. The results so far demonstrate a high survival rate for Br nemark implants supporting tissue-integrated prostheses for the management of anterior partial edentulism.

  7. Long-term opioid contract use for chronic pain management in primary care practice. A five year experience.

    PubMed

    Hariharan, Jaishree; Lamb, Geoffrey C; Neuner, Joan M

    2007-04-01

    The use of opioid medications to manage chronic pain is complex and challenging, especially in primary care settings. Medication contracts are increasingly being used to monitor patient adherence, but little is known about the long-term outcomes of such contracts. To describe the long-term outcomes of a medication contract agreement for patients receiving opioid medications in a primary care setting. Retrospective cohort study. All patients placed on a contract for opioid medication between 1998 and 2003 in an academic General Internal Medicine teaching clinic. Demographics, diagnoses, opiates prescribed, urine drug screens, and reasons for contract cancellation were recorded. The association of physician contract cancellation with patient factors and medication types were examined using the Chi-square test and multivariate logistic regression. A total of 330 patients constituting 4% of the clinic population were placed on contracts during the study period. Seventy percent were on indigent care programs. The majority had low back pain (38%) or fibromyalgia (23%). Contracts were discontinued in 37%. Only 17% were cancelled for substance abuse and noncompliance. Twenty percent discontinued contract voluntarily. Urine toxicology screens were obtained in 42% of patients of whom 38% were positive for illicit substances. Over 60% of patients adhered to the contract agreement for opioids with a median follow-up of 22.5 months. Our experience provides insight into establishing a systematic approach to opioid administration and monitoring in primary care practices. A more structured drug testing strategy is needed to identify nonadherent patients.

  8. Cost estimate report for the long-term management of depleted uranium hexafluoride : storage of depleted uranium metal.

    SciTech Connect

    Folga, S.M.; Kier, P.H.; Thimmapuram, P.R.

    2001-01-24

    This report contains a cost analysis of the long-term storage of depleted uranium in the form of uranium metal. Three options are considered for storage of the depleted uranium. These options are aboveground buildings, partly underground vaults, and mined cavities. Three cases are presented. In the first case, all the depleted uranium metal that would be produced from the conversion of depleted uranium hexafluoride (UF{sub 6}) generated by the US Department of Energy (DOE) prior to July 1993 would be stored at the storage facility (100% Case). In the second case, half the depleted uranium metal would be stored at this storage facility (50% Case). In the third case, one-quarter of the depleted uranium metal would be stored at the storage facility (25% Case). The technical basis for the cost analysis presented in this report is principally found in the companion report, ANL/EAD/TM-100, ''Engineering Analysis Report for the Long-Term Management of Depleted Uranium Hexafluoride: Storage of Depleted Uranium Metal'', prepared by Argonne National Laboratory.

  9. Management of solid waste

    SciTech Connect

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

    1980-04-16

    Compliance with the latest regulatory requirements addressing disposal of radioactive, hazardous, and sanitary solid waste requires the application of numerous qualitative and quantitative criteria in the selection, design, and operation of solid waste management facilities. Due to the state of flux of these regulatory requirements from EPA and NRC, several waste management options were identified as being applicable to the management of the various types of solid waste. This paper highlights the current regulatory constraints and the design and operational requirements for construction of both storage and disposal facilities for use in management of DOE-ORO solid waste. Capital and operational costs are included for both disposal and storage options.

  10. Managing the cryogenic systems of SCUBA-2 for long term operation

    NASA Astrophysics Data System (ADS)

    Cookson, Jamie L.; Bintley, Dan

    2016-07-01

    SCUBA-2 has been operational on JCMT producing excellent science for almost 5 years. We describe the strategy and methods that we have evolved to keep one of the world's first "dry dilution refrigerators" and the other cryogenic systems working effectively at the summit of Mauna Kea, keeping the instrument functioning at peak efficiency for extended periods (over 12 months at a time), with minimum downtime. We discuss new plans to reduce day-to-day operational costs and to add remote management of the gas handling systems, as we look to the future and envisage another ten years of SCUBA-2 science.

  11. Conservative surgical management of in situ subungual melanoma: long-term follow-up*

    PubMed Central

    Anda-Juárez, Mariana Catalina De; Martínez-Velasco, María Abril; Fonte-Ávalos, Verónica; Toussaint-Caire, Sonia; Domínguez-Cherit, Judith

    2016-01-01

    Subungual melanoma represents 20% of all melanomas in Hispanic population. Here, we report the outcome of 15 patients with in situ subungual melanoma treated with resection of the nail unit with a 5-mm margin without amputation, followed up for 55.93 ± 43.08 months. The most common complications included inclusion cysts and nail spicules. We found no evidence of local or distant recurrences at the last visit of our follow up. Functional outcome was good, with only one patient reporting persistent mild pain. These results support functional, non-amputative surgical management of in situ subungual melanomas. PMID:28099619

  12. Local government involvement in long term resource planning for community energy systems. Demand side management

    SciTech Connect

    Not Available

    1992-03-01

    A program was developed to coordinate governmental, research, utility, and business energy savings efforts, and to evaluate future potential actions, based on actual field data obtained during the implementation of Phase I of the State Resource Plan. This has lead to the establishment of a state conservation and energy efficiency fund for the purpose of establishing a DSM Program. By taking a state wide perspective on resource planning, additional savings, including environmental benefits, can be achieved through further conservation and demand management. This effort has already blossomed into a state directive for DSM programs for the natural gas industry.

  13. SERDP and ESTCP Workshop on Long Term Management of Contaminated Groundwater Sites

    DTIC Science & Technology

    2013-11-01

    attenuation EACO Enhanced Attenuation: Chlorinated Organics EDB ethylene dibromide EI/EC Emerging Issues and Emerging Contaminants ESTCP Environmental...Plumes of Chlorinated Ethylenes Frank Schwartz (The Ohio State University) 1685-09 Coupled Diffusion & Reaction Processes in Rock Matrices...Potential Impact of Changes in the Toxicity and Regulatory Standards of  Chlorinated  Solvents on Long Term Site Management, Remediation Efficiency and Cost

  14. Nuclear waste management

    NASA Astrophysics Data System (ADS)

    Chikalla, T. D.; Powell, J. A.

    1981-09-01

    Reports and summaries are presented for the following: high-level waste process development; alternative waste forms; TMI zeolite vitrification demonstration program; nuclear waste materials characterization center; TRU waste immobilization; TRU waste decontamination; krypton implantation; thermal outgassing; iodine-129 fixation; NWVP off-gas analysis; monitoring and physical characterization of unsaturated zone transport; well-logging instrumentation development; verification instrument development; mobility of organic complexes of radionuclides in soils; handbook of methods to decrease the generation of low-level waste; waste management system studies; waste management safety studies; assessment of effectiveness of geologic isolation systems; waste/rock interactions technology program; high-level waste form preparation; development of backfill materials; development of structural engineered barriers; disposal charge analysis; and analysis of spent fuel policy implementation.

  15. Impact of agricultural management practices on DOC leaching - results of a long-term lysimeter study

    NASA Astrophysics Data System (ADS)

    Wagner, A.; Ollesch, G.; Seeger, J.; Meißner, R.; Rode, M.

    2009-04-01

    Dissolved organic carbon (DOC) fluxes are recently increasing in surface waters of humid climate regions. Due to its substantial importance for leaching processes, aquatic foodwebs, and drinking water purification a better understanding of sources and pathways of DOC is needed. Therefore this study aims to analyse and simulate DOC fluxes in agricultural ecosystems with selected crop rotations. A data set of 24 lysimeters of the UFZ Lysimeter station at Falkenberg (Saxony-Anhalt) covering nine years of DOC investigation has been selected and examined. The data set covers a wide range of climatic conditions with deviating management practices for grasslands and agricultural crop rotations. The monthly DOC concentrations assessed in the leached water range from 2.4 to 34.1 mg /l. DOC concentrations depend on temperature, precipitation and discharge. The type of crop grown on the lysimeter is an important trigger for DOC leaching - especially lysimeters used as pasture, or planted with rape and carrots exhibit high DOC concentrations. Management practices and fertilizer application modify the leaching of DOC and offer potentials to reduce DOC losses. The results form the basis of further process simulation studies and upscaling of the results to the small catchment scale.

  16. Long-term grassland management effects on soil Phosphorus status on rewetted Histosols

    NASA Astrophysics Data System (ADS)

    Heller, Sebastian; Müller, Jürgen; Kayser, Manfred

    2017-04-01

    Since the Neolithic Period, the cultivation of wetlands has played a significant role for the settlement of Humans northwest Germany. A continuing drainage of the wetlands over the centuries and an intensified soil cultivation during the last decades has caused irreversible peat degradation and led to fundamental changes in the landscape. Nowadays, almost 70 % of the 4345 km2 peatland of Lower Saxony is altered by agriculture. For the revitalization of wetland ecosystems, permanent rewetting is an integral component to preserve the functions of organic soils and achieve resilient, speciesrich wetlands. However, permanent rewetting measures are not always feasible. In our study area at the Osterfeiner Moor, a fen located in the Dümmer lowlands near Osnabrück, intensive forage cropping areas were converted into extensive permanent grasslands accompanied by temporary rewetting during winter. This management practice combined with zero fertilization and a low mowing and grazing intensity aims at mitigating mineralisation of peat layers and creating a habitat for endangered meadow bird species. In this semi-natural ecosystem soil phosphorus (P) dynamics play a crucial role. However, longterm research results on P availability of degraded and rewetted fens are still lacking. Thus, we investigated the interaction of different grassland uses and P dynamics in the soil. We described P depletion of the topsoil over a time scale of 17 years after the implementation of restoration measures. Our study site comprises of 180 ha protected grassland divided into 52 management plots. According to the management system, we divided the plots into meadows, pastures and combinations of cutting and grazing. The soils in our study area can be characterised as drained organic soils, WRB: Rheic Sapric Histosols (Drainic), with drastic degradation properties through moorsh forming processes. Plant-available P (double lactate extraction method: PDL) was analysed from representative topsoil

  17. Long-Term Care

    MedlinePlus

    ... this page please turn Javascript on. Long-Term Care What Is Long-Term Care? Long-term care involves a variety of services ... the Escape (Esc) button on your keyboard.) Most Care Provided at Home Long-term care is provided ...

  18. [Analysis on long-term compliance of anticoagulation treatment and demands of disease management in patients with atrial fibrillation].

    PubMed

    Zuo, Hui-juan; Su, Jiang-lian; Lin, Yun; Zeng, Zhe-chun; Wang, Jin-wen

    2010-08-24

    To analyze the long-term compliance of oral anticoagulant therapy and the demands of disease management in patient with atrial fibrillation (AF). Inpatients with AF taking warfarin were collected from Department of Internal Medicine from January 1 to December 31, 2008. Inpatients from departments of surgery, ophthalmology, otorhinolaryngology, dermatology and pediatrics and those on a previous warfarin therapy were excluded. The data of patient profiles, medical history and anticoagulant treatment were collected from electronic medical record. And the status of anticoagulant treatment one year later and demands of disease management were inquired by telephone. A total of 268 AF patients received a telephone survey. Among them, 145 patients (54.1%) continued taking warfarin. Gender, age, type of AF, duration of AF and history of ischemic stroke was not significantly associated with the compliance of anticoagulant treatment. The odds ratio was 1.74 (95%CI: 0.67-4.47), 0.87 (95%CI: 0.30-2.53), 1.59 (95%CI: 0.35-1.09), 1.09 (95%CI: 0.61-1.93) and 0.44 (95%CI: 0.12-1.60) respectively. Among patients on warfarin, INR was monitored monthly in 88 patients (60.7%) and 70 patients (48.3%) had an INR value of 2.0-3.0. Among 123 withdrawal patients, 88 patients (71.5%) terminated treatment within 6 month. The common reasons included patient ignorance about long-term anticoagulant treatment (35.0%) and switching to aspirin because of a poor effect (24.4%). About 80% of patients wished to obtain instructions about INR monitoring and adjustment of drug dosage. Among them, 196/268 patients (73.1%) wished for a regular follow-up. And 176/196 patients (89.8%) opted for a telephone follow-up and 150/176 patients (85.2%) wanted to receive monthly instructions. The compliance of anticoagulation treatment and the target-meeting proportion of INR value are relative low. And the common reasons of withdrawal are patient ignorance about long-term anticoagulant treatment and switching to

  19. Long-term effects of soil management on ecosystem services and soil loss estimation in olive grove top soils.

    PubMed

    Parras-Alcántara, Luis; Lozano-García, Beatriz; Keesstra, Saskia; Cerdà, Artemi; Brevik, Eric C

    2016-11-15

    Soil management has important effects on soil properties, runoff, soil losses and soil quality. Traditional olive grove (OG) management is based on reduced tree density, canopy size shaped by pruning and weed control by ploughing. In addition, over the last several decades, herbicide use has been introduced into conventional OG management. These management strategies cause the soil surface to be almost bare and subsequently high erosion rates take place. To avoid these high erosion rates several soil management strategies can be applied. In this study, three strategies were assessed in OG with conventional tillage in three plots of 1ha each. Soil properties were measured and soil erosion rates were estimated by means of the RUSLE model. One plot was managed with no amendments (control), and the other two were treated with olive leaves mulch and oil mill pomace applied yearly from 2003 until 2013. The control plot experienced the greatest soil loss while the use of olive leaves as mulch and olive mill pomace as an amendment resulted in a soil loss reduction of 89.4% and 65.4% respectively (assuming a 5% slope). In addition, the chemical and physical soil properties were improved with the amendments. This combined effect will created a higher quality soil over the long term that it is more resilient to erosion and can provide better ecosystem services, as its functions are improved. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. Long-term environmental drivers of DOC fluxes: Linkages between management, hydrology and climate in a subtropical coastal estuary

    NASA Astrophysics Data System (ADS)

    Regier, Peter; Briceño, Henry; Jaffé, Rudolf

    2016-12-01

    Urban and agricultural development of the South Florida peninsula has disrupted historic freshwater flow in the Everglades, a hydrologically connected ecosystem stretching from central Florida to the Gulf of Mexico, USA. Current system-scale restoration efforts aim to restore natural hydrologic regimes to reestablish pre-drainage ecosystem functioning through increased water availability, quality and timing. Aquatic transport of carbon in this ecosystem, primarily as dissolved organic carbon (DOC), plays a critical role in biogeochemical cycling and food-web dynamics, and will be affected both by water management policies and climate change. To better understand DOC dynamics in South Florida estuaries and how hydrology, climate and water management may affect them, 14 years of monthly data collected in the Shark River estuary were used to examine DOC flux dynamics in a broader environmental context. Multivariate statistical methods were applied to long-term datasets for hydrology, water quality and climate to untangle the interconnected environmental drivers that control DOC export at monthly and annual scales. DOC fluxes were determined to be primarily controlled by hydrology but also by seasonality and long-term climate patterns and episodic weather events. A four-component model (salinity, rainfall, inflow, Atlantic Multidecadal Oscillation) capable of predicting DOC fluxes (R2 = 0.84, p < 0.0001, n = 155) was established and applied to potential climate change scenarios for the Everglades to assess DOC flux response to climate and restoration variables. The majority of scenario runs indicated that DOC export from the Everglades is expected to decrease due to future changes in rainfall, water management and salinity.

  1. Integration of long-term fish kill data with ambient water quality monitoring data and application to water quality management

    NASA Astrophysics Data System (ADS)

    Trim, Alan H.; Marcus, James M.

    1990-05-01

    Almost half (354) of all fish kills (805) in South Carolina, USA, between 1978 and 1988 occurred in the coastal zone. These kills were analyzed for causative, spatial, and temporal associations as a distinct data set and as one integrated with ambient water quality monitoring data. Estuarine kills as a result of natural causes accounted for 42.8% followed by man-induced (35.1%) and undetermined causes (22.1%). Although general pesticide usage was responsible for 53.9% of man-induced kills, weed control activities around resorts and municipal areas accounted for slightly more kills (20.9%) than did agricultural (19.8%) or vector control (13.2%) uses. A dramatic decline in agricultural-related kills has been observed since 1986 as the integrated pest management approach was adopted by many farmers. When taken with the few kills (12.0%) resulting from wastewaters, this suggests that these two land-use activities have been successfully managed via existing programs (IPM and NPDES, respectively) to minimize their contributions to estuarine fish kills. Ambient trend monitoring data demonstrated no coastal-wide dispersion of pesticide pollution. These data confirmed the nature of fish kills to be site-specific, near-field events most closely associated with the contiguous land-use practices and intensities. Typically, fish kill data are considered as event-specific data limited to the bounds of that event only. Our analysis has shown, however, that a long-term data set, when integrated with ambient water quality data, can assist in regulatory and resource management decisions for both short- and long-term planning and protection applications.

  2. Abdominal wall defects: prenatal diagnosis, newborn management, and long-term outcomes.

    PubMed

    Gamba, Piergiorgio; Midrio, Paola

    2014-10-01

    Omphalocele and gastroschisis represent the most frequent congenital abdominal wall defects a pediatric surgeon is called to treat. There has been an increased reported incidence in the past 10 years mainly due to the diffuse use of prenatal ultrasound. The early detection of these malformations, and related associated anomalies, allows a multidisciplinary counseling and planning of delivery in a center equipped with high-risk pregnancy assistance, pediatric surgery, and neonatology. At present times, closure of defects, even in multiple stages, is always possible as well as management of most of cardiac-, urinary-, and gastrointestinal-associated malformations. The progress, herein discussed, in the care of newborns with abdominal wall defects assures most of them survive and reach adulthood. Some aspects of transition of medical care will also be considered, including fertility and cosmesis.

  3. Long-term efficacy, safety and tolerability of Remoxy for the management of chronic pain.

    PubMed

    Pergolizzi, Joseph V; Zampogna, Gianpietro; Taylor, Robert; Raffa, Robert B

    2015-03-01

    Historically, chronic pain generally went under-treated for a variety of objective and subjective reasons, including difficulty to objectively diagnose and manage over a long period of time, potential serious adverse effects of commonly available medications, and patient, healthcare and societal concerns over opioid medications. More recently, in an effort to redress the under-treatment of pain, the number of prescriptions of opioid analgesics has risen dramatically. However, paralleling the increased legitimate use has been a concomitant increase in opioid abuse, misuse and diversion. Pharmaceutical companies have responded by developing a variety of opioid formulations designed to deter abuse by making the products more difficult to tamper with. One such product is Remoxy(®), an extended-release formulation of the strong opioid oxycodone. We review the efficacy, safety and tolerability of this formulation based on the available published literature.

  4. Efficacy of multidisciplinary outpatient management (MOM) program in long term heart failure care.

    PubMed

    Jain, Rahul; Evenson, Ariana; Jain, Rohit; Biddison, Elizabeth; Dalal, Darshan; Kelly, Kathleen M; Karmand, Arezo J; Hullsiek, Heide; Punnam, Jyothi; Plantholt, Stephen

    2010-02-01

    Heart failure (HF) management programs worldwide have reported conflicting outcomes in the past. We sought to determine retrospectively whether the multidisciplinary outpatient management (MOM) program [heart failure clinic (HFC)], decreased readmission rates (RR), duration of hospital stay, and/or mortality in HF patients. Records of 138 HF patients who had their first encounter either as admission for HF at St. Agnes Hospital or visit to HFC during the period June 2005 through June 2006 were evaluated for outcomes through September 2007. Twenty-seven patients were followed in the HFC and 111 were in the non-HFC group. During follow up, 39 of the non-HFC group patients crossed over to the HFC group. All baseline parameters, except age (P = 0.006), were similar in both groups. In the HFC group 4 patients had a total of 5 readmissions, whereas 85 patients had a total of 187 readmissions (P < 0.001) in the non-HFC group. Average lengths of hospitalization were 5.2 +/- 4.8 days and 4.2 +/- 3.2 days (P = 0.18) and the number of readmissions/patient/year was 0.3 and 1.45 (P < 0.001) in the HFC and non-HFC groups, respectively. In the subgroup analysis of cross overs (n = 39), there was a 60% reduction in the readmission rate after crossing over to the HFC group. The significance of decreased mortality in the HFC group could not be assessed due to the small sample size. The study suggests that the MOM program can significantly reduce RR secondary to HF.

  5. Long-term Effects of Grazing Management and Buffer Strips on Soil Erosion from Pastures.

    PubMed

    Pilon, C; Moore, P A; Pote, D H; Pennington, J H; Martin, J W; Brauer, D K; Raper, R L; Dabney, S M; Lee, J

    2017-03-01

    High grazing pressure can lead to soil erosion in pastures, causing increased sediment delivery to waterways. The objectives of this research were to evaluate the impact of grazing management and buffer strips on soil erosion by assessing soil physical properties, hydrology, and sediment loads from pastures fertilized with broiler litter. Field studies were conducted for 12 yr on 15 small watersheds. Five management strategies were evaluated: hayed (H), continuously grazed (CG), rotationally grazed (R), rotationally grazed with a buffer strip (RB), and rotationally grazed with a fenced riparian buffer (RBR). Broiler litter was applied every year at a rate of 5.6 Mg ha. Bulk density and penetration resistance were highest for CG watersheds. Runoff volumes, sediment concentrations, and loads were lowest for the H and RBR treatments and highest for CG. Average runoff amounts were 48, 84, 77, 60, and 81 mm yr for the H, R, RB, RBR, and CG treatments, respectively. Annual average sediment loads were 25, 30, 58, 71, and 110 kg ha for H, RBR, R, RB, and CG, respectively. The Revised Universal Soil Loss Equation, Version 2 was reasonably effective at predicting soil loss for the R, RB, and RBR treatments, but it greatly overpredicted soil loss from the CG and H treatments. Converting a pasture to a hay field or using rotational grazing in conjunction with a fenced riparian buffer appear to be effective options for reducing soil erosion and runoff to waterways from pasture soils. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  6. Pemphigus vulgaris: the manifestations and long-term management of 55 patients with oral lesions.

    PubMed

    Scully, C; Paes De Almeida, O; Porter, S R; Gilkes, J J

    1999-01-01

    Perhaps surprisingly, the manifestations and management of patients with pemphigus vulgaris and oral lesions have been detailed only infrequently. The present study has examined the clinical features, diagnosis and management of a cohort of 55 patients, including three adolescents, with pemphigus vulgaris predominantly affecting the oral mucosa. There was about a 6-month delay from the onset of symptoms until presentation for diagnosis, longer in men than in women. Patients typically had multiple lesions affecting mainly the buccal and/or palatal mucosae, and over half the patients had lesions affecting non-oral mucosal sites. Nearly one-quarter (24%) had cutaneous involvement. Most patients were otherwise healthy with no other autoimmune disorders. Classical histopathological features of pemphigus vulgaris were present in all patients, as well as IgG intraepithelial deposits in all patients tested and circulating epithelial antibodies in most. Thirty-two patients were treated in the clinic, four responding to topical immunosuppressive therapy, the remainder needing and responding, at least in part, to systemic immunosuppression. Systemic corticosteroids often with adjunctive immunosuppressives, particularly azathioprine, were required in 87% of patients. In 18% of the patients, the disease resolved in 3 months, but 76% had recalcitrant disease. Adverse effects were seen in 78%, and two patients died, at least one as a consequence of immunosuppressive therapy. It is concluded that pemphigus vulgaris affecting the oral mucosa is still diagnosed only after considerable delay because patients, especially men, present late; it has a chronic course; it is often associated with lesions in other mucosae and/or skin; it can be resistant to currently available therapies; and immunosuppressive therapy frequently produces adverse effects, occasionally lethal.

  7. Translation research in long-term care: improving pain management in nursing homes.

    PubMed

    Jones, Katherine R; Fink, Regina; Vojir, Carol; Pepper, Ginny; Hutt, Evelyn; Clark, Lauren; Scott, Jill; Martinez, Ruby; Vincent, Deborah; Mellis, B Karen

    2004-01-01

    Pain prevalence in nursing homes remains high, with multiple resident, staff, and physician barriers presenting serious challenges to its improvement. The study aims were to (1) develop and test a multifaceted, culturally competent intervention to improve nursing home pain practices; (2) improve staff, resident, and physician knowledge and attitudes about pain and its management; (3) improve actual pain practices in nursing homes; and (4) improve nursing home policies and procedures related to pain. A multifaceted, culturally competent intervention was developed and tested in six Colorado nursing homes, with another six nursing homes serving as control sites. Both educational and behavioral change strategies were employed. The intervention was successful in improving the percentage of residents reporting constant pain in the treatment homes. Contextual factors (implementation of Medicare's Nursing Home Compare report card) appeared to exert a positive influence on pain documentation. There was no reduction in the percentage of residents reporting pain or reporting moderate/severe pain. Multiple challenges to quality improvement exist in nursing homes. Turnover of nursing staff reduced actual exposure to the intervention, and turnover of directors of nursing influenced constancy of message and overall facility stability. Residents often failed to report their pain, and physicians were reluctant to alter their prescribing practices. Any intervention to improve pain management in nursing homes must target explicitly the residents, nursing home staff, and primary care physicians. Implementation strategies need to accommodate the high turnover rates among staff, as well as the changes among the nursing home leadership. Pain is a complex problem in the nursing home setting. Multiple factors must be considered in both the design and implementation of interventions to improve pain practices and reduce pain prevalence in nursing homes.

  8. Acromegaly: the disease, its impact on patients, and managing the burden of long-term treatment

    PubMed Central

    Adelman, Daphne T; Liebert, Karen JP; Nachtigall, Lisa B; Lamerson, Michele; Bakker, Bert

    2013-01-01

    Acromegaly is a rare disease most often caused by the prolonged secretion of excess growth hormone from a pituitary adenoma. The disease is associated with multiple significant comorbidities and increased mortality. The delay to diagnosis is often long. This may be because of low disease awareness among health care professionals, the insidious onset of differentiating features, and because patients are likely to present with complaints typical of other conditions more frequently seen in primary care. Early identification of acromegaly facilitates prompt treatment initiation and may minimize the permanent effects of excess growth hormone. The primary treatment for many patients will be pituitary surgery, although not all patients will be eligible for surgery or achieve a surgical cure. If biochemical control is not achieved following surgery, other treatment options include medical therapy and radiation therapy. Improved biochemical control may only alleviate rather than reverse the associated comorbidities. Thus, lifelong monitoring of patient health is needed, with particular attention to the management of cardiovascular risk factors. It is additionally important to consider the impact of both disease and treatment on patients’ quality of life and minimize that impact where possible, but particularly for chronic therapies. For the majority of patients, chronic therapy is likely to include somatostatin analog injections. In some circumstances, it may be possible to extend the dosing interval of the analog once good biochemical control is achieved. Additional convenience may be gained from the possibility of self-/partner administration of treatment or administration of treatment by a health care professional at home. Overall, it is clear that the care of patients with acromegaly requires a highly coordinated approach involving numerous specialties (eg, endocrinology, surgery, cardiology). Further, patients’ needs must be at the core of management and every

  9. Presentation, Management and Long-Term Outcome of Ureteropelvic Junction Obstruction in Duplex Kidneys.

    PubMed

    Rubenwolf, Peter; Ziesel, Christopher; Beetz, Rolf; Kamal, Mohamed M; Thüroff, Joachim W; Stein, Raimund

    2015-08-01

    Ureteropelvic junction obstruction in association with a duplex collecting system is a rare but challenging upper urinary tract pathology. We report our 21-year experience with this anomaly in terms of presentation, diagnostic evaluation and management. We retrospectively identified all patients with ureteropelvic junction obstruction in a duplex collecting system between 1991 and 2012. We reviewed each case for presenting symptoms, anatomy and management. Median followup was 10.8 years (range 2 to 22). Ureteropelvic junction obstruction in duplex kidneys was diagnosed in 21 patients. Ten patients presented with clinical symptoms such as flank pain and urinary tract infection but 11 were asymptomatic. Six patients were diagnosed by prenatal ultrasound. The lower pole and the upper pole were affected in 22 and 3 renal units, respectively. Bilateral ureteropelvic junction obstruction was found in 4 cases. Duplication was complete in 5 patients, incomplete in 11 and undetermined in 5. Surgery was performed in 14 patients, including pyelopyelostomy or ureteropyelostomy in 7, dismembered pyeloplasty in 6 and heminephrectomy in 1. Reintervention was required in 1 case. Conservative treatment was adopted in 7 patients with clinically insignificant obstruction and unimpaired renal function. In all of these patients upper urinary tract dilatation gradually improved during 3 years. Ureteropelvic junction obstruction in a duplex kidney is a rare but challenging anomaly that requires careful evaluation. Treatment should be individualized according to clinical presentation (symptomatic/asymptomatic), anatomy (lower/upper pole), duplication type (complete/incomplete) and obstruction with time (severity/development) on dynamic renogram. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  10. Long-term changes in nutrient availability after prescribed fire management in a Mediterranean soil

    NASA Astrophysics Data System (ADS)

    Alcañiz, Meritxell; Outeiro, Luis; Francos, Marcos; Farguell, Joaquim; Úbeda, Xavier

    2016-04-01

    The study area is located in the Tivissa Ranges (NE Iberian Peninsula) and the slope is ~35%, at 615 m.a.s.l. The natural vegetation before prescribed fire was composed of the three stratums in which trees (1% of the plot) were Pinus halepensis, shrubs were Ulex parviflorus, Cistus albidus, Rosmarinus officinallis, Erica multiflora and Quercus coccifera (75% of the plot), and herbs (24%) manly composed of Brachypodium retusum. The firemen had two main forest management objectives with the prescribed fire that was carried out on April 2002: (1) to change the dominance from Ulex to Cistus which is less flammable specie, and which would (2) permit the livestock into this area. Nine years after the prescribed fire our study plot was burned again with a low severity fire to manage the accumulation of vegetation. The aim of this study is a) to see the evolution of nutrient availability in the soil during 13 years since the first prescribed fire, and b) to evaluate the use of prescribed fire as a forest management tool. We have five sampling moments: (1) before the first prescribed fire; (2) after; (3) one year after; (4) three years after and (5) thirteen years after. Within the study area was placed a sampling plot with a rectangular 4×18 m structure. The study was carried out with 30 unstructured soil samples which were air-dried and passed through a 2 mm sieve. After that, fine material was prepared to measure different chemicals parameters of soil studied: soil pH [1:2.5], electrical conductivity [1:2.5], potassium, calcium and magnesium. The results show that, while pH is stable during the period studied, electrical conductivity increased after the prescribed fire as it was expected. However, thirteen years after the first prescribed fire the value (167 μS/cm) was markedly lower than before the prescribed fire (326 μS/cm). Changes in nutrient availability depend on the cation valence. Divalent cations (calcium and magnesium) decreased just after the prescribed

  11. Management attitudes and technology adoption in long-term care facilities.

    PubMed

    Bezboruah, Karabi C; Paulson, Darla; Smith, Jason

    2014-01-01

    The purpose of this paper is to explore the attitudes of nursing home administrators and key managerial staff toward health information technology (health IT). This research is exploratory in nature, and applies qualitative case-study methodology to further understand health IT adoption by nursing homes through multiple in-depth semi-structured interviews of management, and direct observations of employee behavior at each participating facility. A modified Technology Acceptance Model is used to examine the attitudes and perceptions of administrators. This study finds that there are differences in the level of health IT adoption by nursing homes. While some administrators are aware of health IT and are implementing or updating their IT systems in a gradual but haphazard manner, others exhibited a lack of interest in implementing change. Overall, there is a lack of systematic planning and decision-making toward health IT adoption. Adoption is not evidence-based, instead driven primarily by real and perceived regulatory requirements combined with a lack of information about, or consideration of, the real costs and benefits of implementing health IT. Including six in-depth case studies, the sample for this study is small for generalizing the findings. Yet, it contributes to the literature on the slow process of health IT adoption by nursing homes. Moreover, the findings provide guidelines for future research. This study demonstrates that nursing home administrators must systematically plan the adoption of health IT, and such decision making should be evidenced-based and participatory so that employees can voice their opinions that could prevent future resistance. This study is original and advances knowledge on the reasons for the slow adoption of health IT in nursing homes. It finds that lack of adequate information regarding the utility and benefits of health IT in management adoption decisions can result in haphazard implementation or no adoption at all. This

  12. Analytical approximations for the long-term decay behavior of spent fuel and high-level waste

    SciTech Connect

    Malbrain, C.M.; Deutch, J.M.; Lester, R.K.

    1982-05-01

    Simple analytical approximations are presented that describe the radioactivity and radiogenic decay heat behavior of high-level wastes (HLWs) from various nuclear fuel cycles during the first 100,000 years of waste life. The correlations are based on detailed computations of HLW properties carried out with the isotope generation and depletion code ORIGEN 2. The ambiguities encountered in using simple comparisons of the hazards posed by HLWs and naturally occurring mineral deposits to establish the longevity requirements for geologic waste disposal schemes are discussed.

  13. Time to rethink long-term rehabilitation management of stroke patients.

    PubMed

    Teasell, Robert; Mehta, Swati; Pereira, Shelialah; McIntyre, Amanda; Janzen, Shannon; Allen, Laura; Lobo, Liane; Viana, Ricardo

    2012-01-01

    It has long been assumed that stroke patients plateau in their recovery within 3 to 6 months of their stroke, and evidence for rehabilitation during the chronic stage is limited. As a consequence, rehabilitation resources for the management of chronic stroke are minimal. The primary objective was to identify randomized controlled trials (RCTs) across the continuum of stroke rehabilitation for interventions initiated 6 months or more following the onset of stroke. The secondary objective was to determine whether treatments provided post 6 moths are effective in improving outcomes among stroke survivors. Multiple databases were used to identify all RCTs published from 1970 to June 2012 in English language where the stroke interventions were initiated more than 6 months after the onset of the stroke. Data abstraction was performed using standardized data abstraction form that included general citation information, study participant characteristics, methodology, outcomes accessed, and overall findings. The results of our analysis revealed 339 RCTs. The mean number of subjects per study was 73. Two hundred fifty-six RCTs were related to motor recovery, 39 to cognitive function, and only 19 to psychosocial issues and community reintegration. The majority of the RCT s demonstrated a significant positive benefit. There is a robust evidence-base for stroke rehabilitation interventions in chronic stroke. This research synthesis reveals a paradox, whereby an impressive evidence-base contrasts with the limited optimism and resources available for rehabilitation in chronic stroke.

  14. Long-term management of severe ocular surface injury due to methamphetamine production accidents.

    PubMed

    Movahedan, Asadolah; Genereux, Brad M; Darvish-Zargar, Mahshad; Shah, Kevin J; Holland, Edward J

    2015-04-01

    The aim of this study was to report the clinical features and management of patients with ocular surface damage during methamphetamine production accidents. This is a retrospective noncomparative interventional case series of 5 patients with methamphetamine production-related ocular injuries referred to the Cincinnati Eye Institute between 1999 and 2014. Four of 5 cases were white young men with severe bilateral ocular injury and extremely poor vision. All except 1 eye (9 of 10) were diagnosed with total or near-total ocular surface failure. Limbal stem cell transplantation was performed in 8 of 10 eyes. Keratolimbal allograft was followed by penetrating keratoplasty in 7 of 10 eyes. Ocular surface stability was achieved in 7 of 10 eyes after keratolimabl allograft. Postoperative visual acuity was better than 20/200 in 4 of 10 of eyes. Keratolimbal graft rejection occurred in 3 of 10 eyes; the rate of rejection of penetrating keratoplasty was also 3 out of 10 eyes. Methamphetamine-related accidents can lead to severe bilateral ocular injuries. Although stem cell transplantation procedure success is guarded in most of these patients because of severe conjunctival inflammation and accompanying ocular comorbidities, as well as personality issues, compliant patients can achieve good visual function with ocular surface transplantation and subsequent keratoplasty.

  15. Complete practice operating systems: the long-term solution to practice management.

    PubMed

    Havill, J

    2001-10-01

    A carefully structured, well thought-out CPOS based on a successful prototype(s) that has proven itself over time is probably the fastest and most reliable way to get your practice on the road to profitability that can be sustained and built upon over the life of the practice. If you rely on "bits and pieces" of practice management ideas and extraneous methods that of themselves may be effective, they may, when integrated into your existing operating structure or system, actually have a negative impact. When addressing something as important as your practice operations, and hence, your livelihood, carefully determine if the changes advocated will be effective, and how these changes will interface with your existing systems. If your existing systems are faulty, building on them may be futile. Look closely and carefully examine the knowledge, credibility, and expertise of anyone who is suggesting and implementing change in your practice. Further, and equally important, ask these two questions: (1) Is the operating system you are considering designed and built from a successful prototype? (2) Can the system's success be documented in terms of sustained increase in production, collections, and net income over time? If the answer is "no" to either or both of the above, tread lightly. You may actually be making things worse. Look for an operating system that has made other dental practices successful, and you can have the great practice you've always wanted!

  16. Relevance of biotic pathways to the long-term regulation of nuclear waste disposal. A report on Tasks 1 and 2 of Phase I. [Shallow land burial

    SciTech Connect

    McKenzie, D.H.; Cadwell, L.L.; Cushing, C.E. Jr.; Harty, R.; Kennedy, W.E. Jr.; Simmons, M.A.; Soldat, J.K.; Swartzman, B.

    1982-07-01

    The purpose of the work reported here was to evaluate the relevance of biotic transport to the assessment of impacts and licensing of low-level waste disposal sites. Available computer models and their recent applications at low-level waste disposal sites are considered. Biotic transport mechanisms and processes for both terrestrial and aquatic systems are presented with examples from existing waste disposal sites. Following a proposed system for ranking radionuclides by their potential for biotic transport, recommendations for completing Phase I research are presented. To evaluate the long-term importance of biotic transport at low-level waste sites, scenarios for biotic pathways and mechanisms need to be developed. Scenarios should begin with a description of the waste form and should include a description of biotic processes and mechanisms, approximations of the magnitude of materials transported, and a linkage to processes or mechanisms in existing models. Once these scenarios are in place, existing models could be used to evaluate impacts resulting from biotic transport and to assess the relevance to site selection and licensing of low-level waste disposal sites.

  17. Long-term monitoring of UK river basins: the disconnections between the timescales of hydrological processes and watershed management planning

    NASA Astrophysics Data System (ADS)

    Howden, N. J. K.; Burt, T.; Worrall, F.

    2016-12-01

    The UK has a wealth of hydrological monitoring data that has both good coverage in space since the early 1970s, and also a few locations where records have been kept continuously for almost 150 years. Such datasets offer unique opportunities for the hydrologist to consider how the concepts of stationarity, change, and definitions of "baseline" resources should be used to shape how we build models of these systems, and how we devise appropriate and sustainable watershed management strategies. In this paper we consider some of the UK's longest hydrological and biogeochemical records, to explore how long records can be used to shape such understanding and, in some cases, how they can be used to identify new modes of behaviour that need to be incorporated into management planning, from the scale of individual watersheds right up to the national scale. We also consider how key timescales of hydrological responses that are evident within the data may pose major problems for watershed management unless appropriate attention is paid to the potential impacts of processes that work over decadal timescales - much longer than sub-decadal water industry investment cycles or short-term projects for watershed management planning. We use our long-term records to show how key processes can be identified, and to illustrate how careful interpretation of shorter term records will improve decision-making for water resource management.

  18. The Management of Long-Term Sickness Absence in Large Public Sector Healthcare Organisations: A Realist Evaluation Using Mixed Methods.

    PubMed

    Higgins, Angela; O'Halloran, Peter; Porter, Sam

    2015-09-01

    The success of measures to reduce long-term sickness absence (LTSA) in public sector organisations is contingent on organisational context. This realist evaluation investigates how interventions interact with context to influence successful management of LTSA. Multi-method case study in three Health and Social Care Trusts in Northern Ireland comprising realist literature review, semi-structured interviews (61 participants), Process-Mapping and feedback meetings (59 participants), observation of training, analysis of documents. Important activities included early intervention; workplace-based occupational rehabilitation; robust sickness absence policies with clear trigger points for action. Used appropriately, in a context of good interpersonal and interdepartmental communication and shared goals, these are able to increase the motivation of staff to return to work. Line managers are encouraged to take a proactive approach when senior managers provide support and accountability. Hindering factors: delayed intervention; inconsistent implementation of policy and procedure; lack of resources; organisational complexity; stakeholders misunderstanding each other's goals and motives. Different mechanisms have the potential to encourage common motivations for earlier return from LTSA, such as employees feeling that they have the support of their line manager to return to work and having the confidence to do so. Line managers' proactively engage when they have confidence in the support of seniors and in their own ability to address LTSA. Fostering these motivations calls for a thoughtful, diagnostic process, taking into account the contextual factors (and whether they can be modified) and considering how a given intervention can be used to trigger the appropriate mechanisms.

  19. Long-term management of ventilated-assisted individuals: the Boston University experience.

    PubMed

    Make, B J

    1986-04-01

    In the 4 1/2 years beginning in January 1981, the University Hospital at the Boston University Medical Center admitted 46 ventilator-assisted individuals to its Respiratory Care Center and discharged 38 of them to their homes with ventilators. Of the 46 admitted, 23 had COPD and 23 had neuromuscular or skeletal disorders. All the latter were successfully sent home, and 15 of the 23 with COPD went home. At follow-up in 1985, of the 38 patients managed at home for periods of 1 to 51 months, 30 were surviving and 4 with COPD and 4 with neuromuscular disorders had died. One died immediately after discharge, one who had amyotrophic lateral sclerosis lived 9 months at home before dying, and the other 6 lived at home a year or more before dying. These results were made possible by an inpatient facility that had the goal of improving the quality of life of ventilator-assisted persons. This was done by the use of portable ventilators on motorized wheelchairs, by the use of traditional rehabilitation techniques, and by encouraging and training patients to become independent and responsible for their own personal and respiratory care. The hospital-based Respiratory Care Center is staffed by a team from physical therapy, occupational therapy, respiratory therapy, rehabilitation nursing, social service, psychiatry, rehabilitation medicine, and otolaryngology. A pulmonary physician directs the program and a respiratory nurse specialist is co-director and oversees its daily operation. The rehabilitation process has six stages: Stage 1 is stabilization, Stage II is evaluation, Stage III is rehabilitation planning, Stage IV is rehabilitation training, Stage V is discharge planning.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. Long-term changes to flood conditions due to varying management strategies, Rock River, WI

    NASA Astrophysics Data System (ADS)

    Fredrick, K. C.

    2015-12-01

    The Rock River is a 300-mile tributary of the Mississippi River in southern Wisconsin. Its source is a protected migratory bird habitat called the Horicon National Wildlife Refuge. Below the refuge, the Rock River flows through mostly rural, agricultural areas, with wide floodplain of mixed land use. Between the dam at Horicon and a hydroelectric dam in Watertown, WI, lie the townships of Lebanon, Ashippun, and Ixonia. These rural townships boast productive agricultural lands of mostly corn, soybeans, and alfalfa. Large portions of their land are within the floodplain, underlain by vast expanses of outwash sands and gravels, glaciolacustrine deposits, and tills. Throughout the region, spring floods are common from snowmelt and spring rain. These annual floods may be exacerbated by frozen ground and slow infiltration, making it an accepted part of life for residents. Over the last 8 years, and possibly as many as 20, this segment of the Rock River has seen an increase in flooding both in periodicity and retention of flood waters. Due to the delicate habitat of the wildlife refuge and the commissioned hydroelectric installation at the upper dam in Watertown, the residents and local governments of the Lebanon/Ashippun/Ixonia segment of the river have mostly been left to their own devices to monitor and manage flood events. Lebanon Township has been recording water levels for several years. Recent events at the hydroelectric plant seem to indicate that it may be playing a more important role in the flooding. High water events and flood retention do not correlate well with precipitation for the region. It appears that releases at the dam, or periods of water retention, are driving the long flooding periods upstream. Negative impacts to the region from the flooding include property damage, loss of arable land, and environmental effects.

  1. Clinicopathologic features and long-term outcome of patients with medullary breast carcinoma managed with breast-conserving therapy (BCT)

    SciTech Connect

    Ha Vu-Nishino; Tavassoli, Fattaneh A.; Ahrens, Willam A.; Haffty, Bruce G. . E-mail: hafftybg@umdnj.edu

    2005-07-15

    Purpose: The purpose of this study is to compare the clinical characteristics and outcome of medullary carcinoma to infiltrating ductal carcinoma of the breast in a large cohort of conservatively managed patients with long-term follow-up. Methods and Materials: Chart records of patients with invasive breast cancer managed with breast-conserving therapy (BCT) at the therapeutic radiology facilities of Yale University School of Medicine before 2001 were reviewed. Forty-six cases (1971-2001) were identified with medullary histology; 1,444 patients with infiltrating ductal carcinoma served as a control group. Results: The medullary cohort presented at a younger age with a higher percentage of patients in the 35 years or younger age group (26.1% vs. 6.6%, p < 0.00001). Twelve patients with medullary histology underwent genetic screening, and 6 patients were identified with deleterious mutations. This group showed greater association with BRCA1/2 mutations compared with screened patients in the control group (50.0% vs. 15.8%, p 0.0035). The medullary cohort was also significantly associated with greater T stage and tumor size (37.0% vs. 17.2% T2, mean size 3.2 vs. 2.5 cm, p 0.00097) as well as negative ER (84.9% vs. 37.6%, p < 0.00001) and PR (87.5% vs. 48.1%, p = 0.00001) status. As of February 2003, median follow-up times for the medullary and control groups were 13.9 and 14.0 years, respectively. Although breast relapse-free rates were not significantly different (76.7% vs. 85.2%), 10-year distant relapse-free survival in the medullary cohort was significantly better than in the control group (94.9% vs. 77.5%, p = 0.028). Conclusions: Despite poor clinicopathologic features, patients with medullary histology demonstrate favorable long-term distant relapse-free survival. Local control rates of patients with medullary and infiltrating ductal carcinoma are comparable. These findings suggest that patients diagnosed with medullary carcinoma are appropriate candidates for

  2. Implant prosthodontic management of posterior partial edentulism: long-term follow-up of a prospective study.

    PubMed

    Attard, Nikolai; Zarb, George A

    2002-02-01

    This paper reports on the long-term outcome of implant-supported posterior-zone prostheses in the first 35 consecutive, partially edentulous patients treated in the Implant Prosthodontic Unit (IPU) at the University of Toronto, Toronto, Ontario. A total of 106 Brånemark dental implants were placed in 46 posterior edentulous spans in 35 patients for the management of multiple missing teeth; the patients were followed prospectively. Treatment planning principles involved a minimum of 2 or 3 implants at each edentulous site and scrupulous occlusal prosthodontic designs. The overall survival of posterior implants was 94%. No factors in the patients' history adversely affected implant survival. This clinical update suggests that the use of Brånemark implants in the rehabilitation of patients who are partially edentulous in the posterior zone is highly effective and that survival of the implants is excellent.

  3. Reforming Management of Behavior Symptoms and Psychiatric Conditions in Long-Term Care Facilities: A Different Perspective.

    PubMed

    Levenson, Steven A; Desai, Abhilash K

    2017-02-24

    Despite much attention including national initiatives, concerns remain about the approaches to managing behavior symptoms and psychiatric conditions across all settings, including in long-term care settings such as nursing homes and assisted living facilities. One key reason why problems persist is because most efforts to "reform" and "correct" the situation have failed to explore or address root causes and instead have promoted inadequate piecemeal "solutions." Further improvement requires jumping off the bandwagon and rethinking the entire issue, including recognizing and applying key concepts of clinical reasoning and the care delivery process to every situation. The huge negative impact of cognitive biases and rote approaches on related clinical problem solving and decision making and patient outcomes also must be addressed.

  4. Water quality in the inshore Great Barrier Reef lagoon: Implications for long-term monitoring and management.

    PubMed

    Schaffelke, Britta; Carleton, John; Skuza, Michele; Zagorskis, Irena; Furnas, Miles J

    2012-01-01

    Coastal and inshore areas of the Great Barrier Reef lagoon receive substantial amounts of material from adjacent developed catchments, which can affect the ecological integrity of coral reefs and other inshore ecosystems. A 5-year water quality monitoring dataset provides a 'base range' of water quality conditions for the inshore GBR lagoon and illustrates the considerable temporal and spatial variability in this system. Typical at many sites were high turbidity levels and elevated chlorophyll a and phosphorus concentrations, especially close to river mouths. Water quality variability was mainly driven by seasonal processes such as river floods and sporadic wind-driven resuspension as well as by regional differences such as land use. Extreme events, such as floods, caused large and sustained increases in water quality variables. Given the highly variable climate in the GBR region, long-term monitoring of marine water quality will be essential to detect future changes due to improved catchment management. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. Research Opportunities in Corrosion Science for Long-Term Prediction of Materials Performance: A Report of the DOE Workshop on “Corrosion Issues of Relevance to the Yucca Mountain Waste Repository”.

    SciTech Connect

    Payer, Joe H.; Scully, John R.

    2003-07-29

    The report summarizes the findings of a U.S. Department of Energy workshop on “Corrosion Issues of Relevance to the Yucca Mountain Waste Repository”. The workshop was held on July 29-30, 2003 in Bethesda, MD, and was co-sponsored by the Office of Basic Energy Sciences and Office of Civilian Radioactive Waste Management. The workshop focus was corrosion science relevant to long-term prediction of materials performance in hostile environments, with special focus on relevance to the permanent disposal of nuclear waste at the Yucca Mountain Repository. The culmination of the workshop is this report that identifies both generic and Yucca Mountain Project-specific research opportunities in basic and applied topic areas. The research opportunities would be realized well after the U.S. Nuclear Regulatory Commission’s initial construction-authorization licensing process. At the workshop, twenty-three invited scientists deliberated on basic and applied science opportunities in corrosion science relevant to long-term prediction of damage accumulation by corrosive processes that affect materials performance.

  6. The role of natural glasses as analogues in projecting the long-term alteration of high-level nuclear waste glasses: Part 1

    SciTech Connect

    Mazer, J.J.

    1993-12-31

    The common observation of glasses persisting in natural environments for long periods of time (up to tens of millions of years) provides compelling evidence that these materials can be kinetically stable in a variety of subsurface environments. This paper reviews how natural and historical synthesized glasses can be employed as natural analogues for understanding and projecting the long-term alteration of high-level nuclear waste glasses. The corrosion of basaltic glass results in many of the same alteration features found in laboratory testing of the corrosion of high-level radioactive waste glasses. Evidence has also been found indicating similarities in the rate controlling processes, such as the effects of silica concentration on corrosion in groundwater and in laboratory leachates. Naturally altered rhyolitic glasses and tektites provide additional evidence that can be used to constrain estimates of long-term waste glass alteration. When reacted under conditions where water is plentiful, the corrosion for these glasses is dominated by network hydrolysis, while the corrosion is dominated by molecular water diffusion and secondary mineral formation under conditions where water contact is intermittent or where water is relatively scarce. Synthesized glasses that have been naturally altered result in alkali-depleted alteration features that are similar to those found for natural glasses and for nuclear waste glasses. The characteristics of these alteration features appear to be dependent on the alteration conditions which affect the dominant reaction processes during weathering. In all cases, care must be taken to ensure that the information being provided by natural analogues is related to nuclear waste glass corrosion in a clear and meaningful way.

  7. Effect of different agronomic management practices on greenhouse gas emissions and nutrient cycling in a long-term field trial

    NASA Astrophysics Data System (ADS)

    Koal, Philipp; Schilling, Rolf; Gerl, Georg; Pritsch, Karin; Munch, Jean Charles

    2015-04-01

    In order to achieve a reduction of greenhouse gas emissions, modern agronomic management practices need to be established. Therefore, to assess the effect of different farming practices on greenhouse gas emissions, reliable data are required. The experiment covers and compares two main aspects of agricultural management for a better implementation of sustainable land use. The focus lies on the determination and interpretation of greenhouse gas emissions, however, regarding in each case a different agricultural management system, namely an organic farming system and an integrated farming system where the effect of diverse tillage systems and fertilisation practices are observed. In addition, with analysis of the alterable biological, physical and chemical soil properties a link between the impact of different management systems on greenhouse gas emissions and the observed cycle of matter in the soil, especially the nitrogen and carbon cycle, will be enabled. Measurements have been carried out on long-term field trials at the Research Farm Scheyern located in a Tertiary hilly landscape approximately 40 km north of Munich (South Germany). The long-term field trials of the organic and integrated farming system were started in 1992. Since then parcels of land (each around 0.2-0.4 ha) with a particular interior plot set-up have been conducted with the same crop rotation, tillage and fertilisation practice referring to organic and integrated farming management. Thus, the management impacts on the soil of more than 20 years are being examined. Fluxes of CH4, N2O and CO2 have been monitored since 2007 for the integrated farming system trial and since 2012 for the organic farming system trial using an automated system which consists of chambers (0.4 m2 area) with a motor-driven lid, an automated gas sampling unit, an on-line gas chromatographic analysis system, and a control and data logging unit. Precipitation and temperature data have been observed for each experimental

  8. Long-term thermophilic mono-digestion of rendering wastes and co-digestion with potato pulp

    SciTech Connect

    Bayr, S. Ojanperä, M.; Kaparaju, P.; Rintala, J.

    2014-10-15

    Highlights: • Rendering wastes’ mono-digestion and co-digestion with potato pulp were studied. • CSTR process with OLR of 1.5 kg VS/m{sup 3} d, HRT of 50 d was unstable in mono-digestion. • Free NH{sub 3} inhibited mono-digestion of rendering wastes. • CSTR process with OLR of 1.5 kg VS/m{sup 3} d, HRT of 50 d was stable in co-digestion. • Co-digestion increased methane yield somewhat compared to mono-digestion. - Abstract: In this study, mono-digestion of rendering wastes and co-digestion of rendering wastes with potato pulp were studied for the first time in continuous stirred tank reactor (CSTR) experiments at 55 °C. Rendering wastes have high protein and lipid contents and are considered good substrates for methane production. However, accumulation of digestion intermediate products viz., volatile fatty acids (VFAs), long chain fatty acids (LCFAs) and ammonia nitrogen (NH{sub 4}-N and/or free NH{sub 3}) can cause process imbalance during the digestion. Mono-digestion of rendering wastes at an organic loading rate (OLR) of 1.5 kg volatile solids (VS)/m{sup 3} d and hydraulic retention time (HRT) of 50 d was unstable and resulted in methane yields of 450 dm{sup 3}/kg VS{sub fed}. On the other hand, co-digestion of rendering wastes with potato pulp (60% wet weight, WW) at the same OLR and HRT improved the process stability and increased methane yields (500–680 dm{sup 3}/kg VS{sub fed}). Thus, it can be concluded that co-digestion of rendering wastes with potato pulp could improve the process stability and methane yields from these difficult to treat industrial waste materials.

  9. The significance of certain Rustler aquifer parameters for predicting long-term radiation doses from WIPP (Waste Isolation Pilot Plant)

    SciTech Connect

    Wofsy, C.

    1980-09-01

    The purpose of the Environmental Evaluation Group (EEG) is to conduct an independent technical evaluation of the potential radiation exposure to people from the Waste Isolation Pilot Plant (WIPP), a Federal radioactive waste repository proposed for construction underground in an area near Carlsbad, New Mexico. The objective of the EEG evaluation is to protect the public health and safety and ensure that there is no environmental degradation. 9 refs., 4 figs., 2 tabs.

  10. Life Cycle Management Considerations of Remotely Sensed Geospatial Data and Documentation for Long Term Preservation

    NASA Technical Reports Server (NTRS)

    Khayat, Mohammad G.; Kempler, Steven J.

    2015-01-01

    As geospatial missions age, one of the challenges for the usability of data is the availability of relevant and updated metadata with sufficient documentation that can be used by future generations of users to gain knowledge from the original data. Given that remote sensing data undergo many intermediate processing steps, for example, an understanding of the exact algorithms employed and the quality of that data produced, could be key considerations for these users. As interest in global climate data is increasing, documentation about older data, their origins, and provenance are valuable to first time users attempting to perform historical climate research or comparative analysis of global change. Incomplete or missing documentation could be what stands in the way of a new researcher attempting to use the data. Therefore, preservation of documentation and related metadata is sometimes just as critical as the preservation of the original observational data. The Goddard Earth Sciences - Data and Information Service Center (GES DISC), a NASA Earth science Distributed Active Archive Center (DAAC), that falls under the management structure of the Earth Science Data and Information System (ESDIS), is actively pursuing the preservation of all necessary artifacts needed by future users. In this paper we will detail the data custodial planning and the data lifecycle process developed for content preservation, our implementation of a Preservation System to safeguard documents and associated artifacts from legacy (older) missions, as well as detail lessons learned regarding access rights and confidentiality of information issues. We also elaborate on key points that made our preservation effort successful; the primary points being: the drafting of a governing baseline for historical data preservation from satellite missions, and using the historical baseline as a guide to content filtering of what documents to preserve. The Preservation System currently archives

  11. Management of solid waste

    NASA Astrophysics Data System (ADS)

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

    1980-04-01

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

  12. Gradient analysis reveals a copper paradox on floodplain soils under long-term pollution by mining waste.

    PubMed

    Nikolic, Nina; Nikolic, Miroslav

    2012-05-15

    Arable alluvial soils are a globally important resource under increasing pressure from both industrial pollution and intensified agricultural land use. Quality of agricultural soils is ultimately defined by crop yields; it is however seldom feasible to study the consequences of complex soil pollution on crops under field conditions. This work analyses the long term effects of two gradients: spatial (relative distance from the water channel) and land use intensity (cropping frequency) on soil properties and model crop (barley) response. On an exceptional model locality in Eastern Serbia, degraded by fluvial deposition of sulphidic copper tailings during 50 years, multivariate analysis shows that land use accelerates the substitution of high plant available Cu by nutrient deficiency (primarily P and microelements) and excessive exchangeable Al. Though agronomic soil quality might not differ along the land use gradient, the environmental consequences do drastically change. The observed apparent "paradoxes" (e.g. soil Cu decreases towards the pollution source; higher yields might coincide with higher soil and leaf Cu concentrations; and leaching of Cu does not restore soils agronomic quality) can be explained by a) the Cu retention patterns along the transects, b) importance of higher SOM and nutrient availability for modifications of Cu toxicity, and c) the existence of plant adaptation mechanisms which can considerably counteract the adverse soil conditions. Land use-induced nutrient deficiency can counteract the positive effects of decreased Cu levels. In a long run, accelerated Cu mobilisation is likely to increase vulnerability of these soils to further environmental hazards. This study demonstrates the clear and consistent patterns in soil properties and plant response along the gradients and points out the probable long-term environmental trends in a "would be" scenario for agricultural use of similar polluted soils. Copyright © 2012 Elsevier B.V. All rights

  13. Waste management in Sweden

    SciTech Connect

    Hartlen, J.

    1996-12-31

    The paper presents waste management in Sweden and is primarily based on the annual report presented by The Swedish Association of Waste Management. RVF is an association of municipal members representing 92% of the country`s population. The traditional classification of