The management of vocal fold nodules in children: a national survey of speech-language pathologists.

PubMed

Signorelli, Monique E; Madill, Catherine J; McCabe, Patricia

2011-06-01

The purpose of this study was to determine the management options and voice therapy techniques currently being used by practicing speech-language pathologists (SLPs) to treat vocal fold nodules (VFNs) in children. The sources used by SLPs to inform and guide their clinical decisions when managing VFNs in children were also explored. Sixty-two SLPs completed a 23-item web-based survey. Data was analysed using frequency counts, content analyses, and supplementary analyses. SLPs reported using a range of management options and voice therapy techniques to treat VFNs in children. Voice therapy was reportedly the most frequently used management option across all respondents, with the majority of SLPs using a combination of indirect and direct voice therapy techniques. When selecting voice therapy techniques, the majority of SLPs reported that they did not use the limited external evidence available to guide their clinical decisions. Additionally, the majority of SLPs reported that they frequently relied on lower levels of evidence or non-evidence-based sources to guide clinical practice both in the presence and absence of higher quality evidence. Further research needs to investigate strategies to remove the barriers that impede SLPs use of external evidence when managing VFNs in children.

Assessing the Value of Information for Identifying Optimal Floodplain Management Portfolios

NASA Astrophysics Data System (ADS)

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

2014-12-01

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

Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation.

PubMed

Patel, Maxine X; Sethi, Faisil N; Barnes, Thomas Re; Dix, Roland; Dratcu, Luiz; Fox, Bernard; Garriga, Marina; Haste, Julie C; Kahl, Kai G; Lingford-Hughes, Anne; McAllister-Williams, Hamish; O'Brien, Aileen; Parker, Caroline; Paterson, Brodie; Paton, Carol; Posporelis, Sotiris; Taylor, David M; Vieta, Eduard; Völlm, Birgit; Wilson-Jones, Charlotte; Woods, Laura

2018-06-01

The British Association for Psychopharmacology and the National Association of Psychiatric Intensive Care and Low Secure Units developed this joint evidence-based consensus guideline for the clinical management of acute disturbance. It includes recommendations for clinical practice and an algorithm to guide treatment by healthcare professionals with various options outlined according to their route of administration and category of evidence. Fundamental overarching principles are included and highlight the importance of treating the underlying disorder. There is a focus on three key interventions: de-escalation, pharmacological interventions pre-rapid tranquillisation and rapid tranquillisation (intramuscular and intravenous). Most of the evidence reviewed relates to emergency psychiatric care or acute psychiatric adult inpatient care, although we also sought evidence relevant to other common clinical settings including the general acute hospital and forensic psychiatry. We conclude that the variety of options available for the management of acute disturbance goes beyond the standard choices of lorazepam, haloperidol and promethazine and includes oral-inhaled loxapine, buccal midazolam, as well as a number of oral antipsychotics in addition to parenteral options of intramuscular aripiprazole, intramuscular droperidol and intramuscular olanzapine. Intravenous options, for settings where resuscitation equipment and trained staff are available to manage medical emergencies, are also included.

Soils Investigation for Infiltration-based Green Infrastructure for Sewershed Management (Omaha NE)

EPA Science Inventory

EPA Report Abstract: Infiltration-based green infrastructure and related retrofits for sewershed-level rainfall and stormwater volume capture (e.g., rain gardens, cisterns, etc.) are increasingly being recognized as management options to reduce stormwater volume contribution into...

A prototype knowledge-based decision support system for industrial waste management. Part 1: The decision support system

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

Boyle, C.A.; Baetz, B.W.

1998-12-31

Although there are a number of expert systems available which are designed to assist in resolving environmental problems, there is still a need for a system which would assist managers in determining waste management options for all types of wastes from one or more industrial plants, giving priority to sustainable use of resources, reuse and recycling. A prototype model was developed to determine the potentials for reuse and recycling of waste materials, to select the treatments needed to recycle waste materials or for treatment before disposal, and to determine potentials for co-treatment of wastes. A knowledge-based decision support system wasmore » then designed using this model. This paper describes the prototype model, the developed knowledge-based decision support system, the input and storage of data within the system and the inference engine developed for the system to determine the treatment options for the wastes. Options for sorting and selecting treatment trains are described, along with a discussion of the limitations of the approach and future developments needed for the system.« less

Sound therapy for tinnitus management: practicable options.

PubMed

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

2014-01-01

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

Management Options for Biochemically Recurrent Prostate Cancer.

PubMed

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

2017-05-01

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

An algorithmic approach for the treatment of severe uncontrolled asthma

PubMed Central

Zervas, Eleftherios; Samitas, Konstantinos; Papaioannou, Andriana I.; Bakakos, Petros; Loukides, Stelios; Gaga, Mina

2018-01-01

A small subgroup of patients with asthma suffers from severe disease that is either partially controlled or uncontrolled despite intensive, guideline-based treatment. These patients have significantly impaired quality of life and although they constitute <5% of all asthma patients, they are responsible for more than half of asthma-related healthcare costs. Here, we review a definition for severe asthma and present all therapeutic options currently available for these severe asthma patients. Moreover, we suggest a specific algorithmic treatment approach for the management of severe, difficult-to-treat asthma based on specific phenotype characteristics and biomarkers. The diagnosis and management of severe asthma requires specialised experience, time and effort to comprehend the needs and expectations of each individual patient and incorporate those as well as his/her specific phenotype characteristics into the management planning. Although some new treatment options are currently available for these patients, there is still a need for further research into severe asthma and yet more treatment options. PMID:29531957

Risk-Based Approach for Microbiological Food Safety Management in the Dairy Industry: The Case of Listeria monocytogenes in Soft Cheese Made from Pasteurized Milk.

PubMed

Tenenhaus-Aziza, Fanny; Daudin, Jean-Jacques; Maffre, Alexandre; Sanaa, Moez

2014-01-01

According to Codex Alimentarius Commission recommendations, management options applied at the process production level should be based on good hygiene practices, HACCP system, and new risk management metrics such as the food safety objective. To follow this last recommendation, the use of quantitative microbiological risk assessment is an appealing approach to link new risk-based metrics to management options that may be applied by food operators. Through a specific case study, Listeria monocytogenes in soft cheese made from pasteurized milk, the objective of the present article is to practically show how quantitative risk assessment could be used to direct potential intervention strategies at different food processing steps. Based on many assumptions, the model developed estimates the risk of listeriosis at the moment of consumption taking into account the entire manufacturing process and potential sources of contamination. From pasteurization to consumption, the amplification of a primo-contamination event of the milk, the fresh cheese or the process environment is simulated, over time, space, and between products, accounting for the impact of management options, such as hygienic operations and sampling plans. A sensitivity analysis of the model will help orientating data to be collected prioritarily for the improvement and the validation of the model. What-if scenarios were simulated and allowed for the identification of major parameters contributing to the risk of listeriosis and the optimization of preventive and corrective measures. © 2013 Society for Risk Analysis.

Water Management Planning: A Case Study at Blue Grass Army Depot

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

Solana, Amy E.; Mcmordie, Katherine

2006-04-03

Executive Order 13123, Greening the Government Through Efficient Energy Management, mandates an aggressive policy for reducing potable water consumption at federal facilities. Implementation guid¬ance from the U.S. Department of Energy (DOE) set a requirement for each federal agency to “reduce potable water usage by implementing life cycle, cost-effective water efficiency programs that include a water management plan, and not less than four Federal Energy Management Program (FEMP) Best Manage¬ment Practices (BMPs).” The objective of this plan is to gain full compliance with Executive Order 13123 and associated DOE implementation guidance on behalf of Blue Grass Army Depot (BGAD), Richmond, Kentucky.more » In accordance with this plan, BGAD must: • Incorporate the plan as a component of the Installation energy conservation plan • Investigate the water savings potential and life-cycle cost effectiveness of the Operations and Maintenance (O&M) and retrofit/replacement options associated with the ten FEMP BMPs • Put into practice all applicable O&M options • Identify retrofit/replacement options appropriate for implementation (based upon calculation of the simple payback periods) • Establish a schedule for implementation of applicable and cost-effective retrofit/replacement options.« less

Balance and Gait Impairment: Sensor-Based Assessment for Patients With Peripheral Neuropathy.

PubMed

Campbell, Grace; Skubic, Marjorie A

2018-06-01

Individuals with peripheral neuropathy (PN) frequently experience balance and gait impairments that can lead to poor physical function, falls, and injury. Nurses are aware that patients with cancer experience balance and gait impairments but are unsure of optimal assessment and management strategies. This article reviews options for balance and gait assessment for patients diagnosed with cancer experiencing PN, describes advantages and limitations of the various options, and highlights innovative, clinically feasible technologies to improve clinical assessment and management. The literature was reviewed to identify and assess the gold standard quantitative measures for assessing balance and gait. Gold standard quantitative measures are burdensome for patients and not often used in clinical practice. Sensor-based technologies improve balance and gait assessment options by calculating precise impairment measures during performance of simple clinical tests at the point of care.

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

PubMed Central

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

2016-01-01

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

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

Selected Energy Management Options for Small Business and Local Government.

ERIC Educational Resources Information Center

Wert, Jonathan M.; Worthington, Barry K.

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

Simulation of groundwater flow and analysis of the effects of water-management options in the North Platte Natural Resources District, Nebraska

USGS Publications Warehouse

Peterson, Steven M.; Flynn, Amanda T.; Vrabel, Joseph; Ryter, Derek W.

2015-08-12

The calibrated groundwater-flow model was used with the Groundwater-Management Process for the 2005 version of the U.S. Geological Survey modular three-dimensional groundwater model, MODFLOW–2005, to provide a tool for the NPNRD to better understand how water-management decisions could affect stream base flows of the North Platte River at Bridgeport, Nebr., streamgage in a future period from 2008 to 2019 under varying climatic conditions. The simulation-optimization model was constructed to analyze the maximum increase in simulated stream base flow that could be obtained with the minimum amount of reductions in groundwater withdrawals for irrigation. A second analysis extended the first to analyze the simulated base-flow benefit of groundwater withdrawals along with application of intentional recharge, that is, water from canals being released into rangeland areas with sandy soils. With optimized groundwater withdrawals and intentional recharge, the maximum simulated stream base flow was 15–23 cubic feet per second (ft3/s) greater than with no management at all, or 10–15 ft3/s larger than with managed groundwater withdrawals only. These results indicate not only the amount that simulated stream base flow can be increased by these management options, but also the locations where the management options provide the most or least benefit to the simulated stream base flow. For the analyses in this report, simulated base flow was best optimized by reductions in groundwater withdrawals north of the North Platte River and in the western half of the area. Intentional recharge sites selected by the optimization had a complex distribution but were more likely to be closer to the North Platte River or its tributaries. Future users of the simulation-optimization model will be able to modify the input files as to type, location, and timing of constraints, decision variables of groundwater withdrawals by zone, and other variables to explore other feasible management scenarios that may yield different increases in simulated future base flow of the North Platte River.

Towards more sustainable management of European food waste: Methodological approach and numerical application.

PubMed

Manfredi, Simone; Cristobal, Jorge

2016-09-01

Trying to respond to the latest policy needs, the work presented in this article aims at developing a life-cycle based framework methodology to quantitatively evaluate the environmental and economic sustainability of European food waste management options. The methodology is structured into six steps aimed at defining boundaries and scope of the evaluation, evaluating environmental and economic impacts and identifying best performing options. The methodology is able to accommodate additional assessment criteria, for example the social dimension of sustainability, thus moving towards a comprehensive sustainability assessment framework. A numerical case study is also developed to provide an example of application of the proposed methodology to an average European context. Different options for food waste treatment are compared, including landfilling, composting, anaerobic digestion and incineration. The environmental dimension is evaluated with the software EASETECH, while the economic assessment is conducted based on different indicators expressing the costs associated with food waste management. Results show that the proposed methodology allows for a straightforward identification of the most sustainable options for food waste, thus can provide factual support to decision/policy making. However, it was also observed that results markedly depend on a number of user-defined assumptions, for example on the choice of the indicators to express the environmental and economic performance. © The Author(s) 2016.

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

PubMed

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

2016-11-01

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

Exposure Assessment of Livestock Carcass Management ...

EPA Pesticide Factsheets

Technical Brief This research brief summarizes an evaluation of livestock carcass management options following a natural disaster through a comparative exposure assessment. This assessment helps to inform a scientifically-based selection of environmentally protective methods in times of emergency.

Medical and Endoscopic Management of Gastric Varices

PubMed Central

Al-Osaimi, Abdullah M. S.; Caldwell, Stephen H.

2011-01-01

In the past 20 years, our understanding of the pathophysiology and management options among patients with gastric varices (GV) has changed significantly. GV are the most common cause of upper gastrointestinal bleeding in patients with portal hypertension after esophageal varices (EV) and generally have more severe bleeding than EV. In the United States, the majority of GV patients have underlying portal hypertension rather than splenic vein thrombosis. The widely used classifications are the Sarin Endoscopic Classification and the Japanese Vascular Classifications. The former is based on the endoscopic appearance and location of the varices, while the Japanese classification is based on the underlying vascular anatomy. In this article, the authors address the current concepts of classification, epidemiology, pathophysiology, and emerging management options of gastric varices. They describe the stepwise approach to patients with gastric varices, including the different available modalities, and the pearls, pitfalls, and stop-gap measures useful in managing patients with gastric variceal bleed. PMID:22942544

Giant trochanteric pressure sore: Use of a pedicled chimeric perforator flap for cover

PubMed Central

Mehrotra, Sandeep

2009-01-01

Pressure sores are increasing in frequency commensurate with an ageing population with multi-system disorders and trauma. Numerous classic options are described for providing stable wound cover. With the burgeoning knowledge on perforator anatomy, recent approaches focus on the use of perforator-based flaps in bedsore surgery. A giant neglected trochanteric pressure sore in a paraplegic is presented. Since conventional options of reconstruction appeared remote, the massive ulcer was successfully managed by a chimeric perforator-based flap. The combined muscle and fasciocutaneous flaps were raised as separate paddles based on the anterolateral thigh perforator branches and provided stable cover without complications. Perforators allow versatility in managing complex wounds without compromising on established principles. PMID:19881035

Alternatives to neonicotinoid insecticides for pest control: case studies in agriculture and forestry.

PubMed

Furlan, Lorenzo; Kreutzweiser, David

2015-01-01

Neonicotinoid insecticides are widely used for control of insect pests around the world and are especially pervasive in agricultural pest management. There is a growing body of evidence indicating that the broad-scale and prophylactic uses of neonicotinoids pose serious risks of harm to beneficial organisms and their ecological function. This provides the impetus for exploring alternatives to neonicotinoid insecticides for controlling insect pests. We draw from examples of alternative pest control options in Italian maize production and Canadian forestry to illustrate the principles of applying alternatives to neonicotinoids under an integrated pest management (IPM) strategy. An IPM approach considers all relevant and available information to make informed management decisions, providing pest control options based on actual need. We explore the benefits and challenges of several options for management of three insect pests in maize crops and an invasive insect pest in forests, including diversifying crop rotations, altering the timing of planting, tillage and irrigation, using less sensitive crops in infested areas, applying biological control agents, and turning to alternative reduced risk insecticides. Continued research into alternatives is warranted, but equally pressing is the need for information transfer and training for farmers and pest managers and the need for policies and regulations to encourage the adoption of IPM strategies and their alternative pest control options.

Secondary prevention of cervical cancer part 3: evidence-based management of women with cervical intraepithelial neoplasia.

PubMed

Guido, Richard; Lonky, Neal M; Diedrich, Justin

2014-06-01

The management of cervical intraepithelial neoplasia has evolved over the last 20 years. Observation has replaced aggressive therapy in many cases. Evidence based guidelines now guide therapy. This chapter presents an overview of various treatment options, as well as the most recent guidelines of therapy.

Deriving fair incentives for management of hardwood timber stands

Treesearch

David A. Gansner; W. Herrick Owen; David N. Larsen; David N. Larsen

1973-01-01

The authors present a practical method for deriving timber-management incentive payments and demonstrate its application in forest stands of upland hardwoods. The suggested incentive payment is based on the differences between discounted costs and returns of deliberate forest management and the "harvest and let grow" option.

Evaluating ecosystem-based management options: Effects of trawling in Torres Strait, Australia

NASA Astrophysics Data System (ADS)

Ellis, Nick; Pantus, Francis; Welna, Andrzej; Butler, Alan

2008-09-01

A suite of management options for a prawn trawl fishery in Torres Strait, Australia was assessed for impacts on the benthic fauna using a dynamic management strategy evaluation approach. The specification of the management options was gained through consultation with stakeholders. Data for the model was drawn from several sources: the fleet data from fishery logbooks and satellite vessel monitoring systems, benthic depletion rates from trawl-down experiments, benthic recovery rates from post-experiment recovery monitoring studies, and benthic distribution from large-scale benthic surveys. Although there were large uncertainties in the resulting indicators, robust measures relevant to management were obtained by taking ratios relative to the status quo. The management control with the biggest effect was total effort; reducing trawl effort always led to increases in benthic faunal density of up to 10%. Spatial closures had a smaller benefit of up to 2%. The effect of closing a set of buffer zones around reefs to trawling was indistinguishable from the status quo option. Closing a larger area, however, was largely beneficial especially for sea cucumbers. When the spatial distributions of fauna prior to fishing were accounted for, fauna with distributions positively correlated with effort improved relative to those negatively correlated. The reduction in prawn catch under effort reduction scenarios could be ameliorated by introducing temporal closures over the full-moon period.

CAD/CAM data management needs, requirements and options

NASA Technical Reports Server (NTRS)

Lopatka, R. S.; Johnson, T. G.

1978-01-01

The requirements for a data management system in support of technical or scientific applications and possible courses of action were reviewed. Specific requirements were evolved while working towards higher level integration impacting all phases of the current design process and through examination of commercially marketed systems and related data base research. Arguments are proposed for varied approaches in implementing data base systems ranging from no action necessary to immediate procurement of an existing data base management system.

The Cheetah data management system

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

Kunz, P.F.; Word, G.B.

1992-09-01

Cheetah is a data management system based on the C programming language, with support for other languages. Its main goal is to transfer data between memory and I/O steams in a general way. The streams are either associated with disk files or are network data stems. Cheetah provides optional convenience functions to assist in the management of C structures. Cheetah steams are self-describing so that general purpose applications can fully understand an incoming steam. This information can be used to display the data in an incoming steam to the user of an interactive general application, complete with variable names andmore » optional comments.« less

Adaptations to climate change: Colville and Okanogan-Wenatchee National Forests

Treesearch

William L. Gaines; David W. Peterson; Cameron A. Thomas; Richy J. Harrod

2012-01-01

Forest managers are seeking practical guidance on how to adapt their current practices and, if necessary, their management goals, in response to climate change. Science-management collaboration was initiated on national forests in eastern Washington where resource managers showed a keen interest in science-based options for adapting to climate change at a 2-day...

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-02

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

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

PubMed

Lesage, Pascal; Deschênes, Louise; Samson, Réjean

2007-08-01

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

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

NASA Astrophysics Data System (ADS)

Lesage, Pascal; Deschênes, Louise; Samson, Réjean

2007-08-01

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

Tree injury and mortality in fires: developing process-based models

Treesearch

Bret W. Butler; Matthew B. Dickinson

2010-01-01

Wildland fire managers are often required to predict tree injury and mortality when planning a prescribed burn or when considering wildfire management options; and, currently, statistical models based on post-fire observations are the only tools available for this purpose. Implicit in the derivation of statistical models is the assumption that they are strictly...

Managing an established tree invader: developing control methods for Chinese tallow (Triadica sebifera) in maritime forests

Treesearch

Lauren S. Pile; G. Geoff Wang; Thomas A. Waldrop; Joan L. Walker; William C. Bridges; Patricia A. Layton

2017-01-01

Biological invasions by woody species in forested ecosystems can have significant impacts on forest management and conservation. We designed and tested several management options based on the physiology of Chinese tallow (Triadica sebifera [L.] Small). Specifically, we tested four treatments, including mastication, foliar herbicide, and fire (MH...

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

Treesearch

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

2013-01-01

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

Meadow management and treatment options [chapter 8

Treesearch

Jeanne C. Chambers; Jerry R. Miller

2011-01-01

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

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

Code of Federal Regulations, 2010 CFR

2010-01-01

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

A Protocol-Based Decision for Choosing a Proper Surgical Treatment Option for Carotid Artery Stenosis.

PubMed

Jang, E-Wook; Chung, Joonho; Seo, Kwon-Duk; Suh, Sang Hyun; Kim, Yong Bae; Lee, Kyung-Yul

2015-06-01

There are two established surgical treatment options for carotid artery stenosis. Carotid endarterectomy (CEA) has been accepted as a gold standard for surgical treatment while carotid artery stenting (CAS) has recently become an alternative option. Each treatment option has advantages and disadvantages for the treatment outcomes. We propose a protocol for selection of a proper surgical treatment option for carotid artery stenosis. A total of 192 published articles on management of carotid artery stenosis were reviewed. Preoperatively considerable factors which had been repeatedly noted in those articles for the risk/benefits of CEA or CAS were selected. According to those factors, a protocol with four categories was established. CEA or CAS is indicated when the patient has a symptomatic stenosis ≥ 50%, or when the patient has an asymptomatic stenosis ≥ 80%. Each treatment option has absolute indications and favorable indications. Each absolute indication is scored with three points, and each favorable indication, one point. Based on the highest scores, a proper treatment option (CEA or CAS) is selected. We have been treating patients according to this protocol and evaluating the outcomes of our protocol-based decision because this protocol might be helpful in assessment of risk/benefit for selection of a proper surgical treatment option in patients with carotid artery stenosis.

Efficient Trajectory Options Allocation for the Collaborative Trajectory Options Program

NASA Technical Reports Server (NTRS)

Rodionova, Olga; Arneson, Heather; Sridhar, Banavar; Evans, Antony

2017-01-01

The Collaborative Trajectory Options Program (CTOP) is a Traffic Management Initiative (TMI) intended to control the air traffic flow rates at multiple specified Flow Constrained Areas (FCAs), where demand exceeds capacity. CTOP allows flight operators to submit the desired Trajectory Options Set (TOS) for each affected flight with associated Relative Trajectory Cost (RTC) for each option. CTOP then creates a feasible schedule that complies with capacity constraints by assigning affected flights with routes and departure delays in such a way as to minimize the total cost while maintaining equity across flight operators. The current version of CTOP implements a Ration-by-Schedule (RBS) scheme, which assigns the best available options to flights based on a First-Scheduled-First-Served heuristic. In the present study, an alternative flight scheduling approach is developed based on linear optimization. Results suggest that such an approach can significantly reduce flight delays, in the deterministic case, while maintaining equity as defined using a Max-Min fairness scheme.

Management of scars: updated practical guidelines and use of silicones.

PubMed

Meaume, Sylvie; Le Pillouer-Prost, Anne; Richert, Bertrand; Roseeuw, Diane; Vadoud, Javid

2014-01-01

Hypertrophic scars and keloids resulting from surgery, burns, trauma and infection can be associated with substantial physical and psychological distress. Various non-invasive and invasive options are currently available for the prevention and treatment of these scars. Recently, an international multidisciplinary group of 24 experts on scar management (dermatologists; plastic and reconstructive surgeons; general surgeons; physical medicine, rehabilitation and burns specialists; psychosocial and behavioural researchers; epidemiologists; beauticians) convened to update a set of practical guidelines for the prevention and treatment of hypertrophic and keloid scars on the basis of the latest published clinical evidence on existing scar management options. Silicone-based products such as sheets and gels are recommended as the gold standard, first-line, non-invasive option for both the prevention and treatment of scars. Other general scar preventative measures include avoiding sun exposure, compression therapy, taping and the use of moisturisers. Invasive treatment options include intralesional injections of corticosteroids and/or 5-fluorouracil, cryotherapy, radiotherapy, laser therapy and surgical excision. All of these options may be used alone or as part of combination therapy. Of utmost importance is the regular re-evaluation of patients every four to eight weeks to evaluate whether additional treatment is warranted. The amount of scar management measures that are applied to each wound depends on the patient's risk of developing a scar and their level of concern about the scar's appearance. The practical advice presented in the current guidelines should be combined with clinical judgement when deciding on the most appropriate scar management measures for an individual patient.

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

PubMed

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

2009-12-01

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

Chronobiology of epilepsy: diagnostic and therapeutic implications of chrono-epileptology.

PubMed

Loddenkemper, Tobias; Lockley, Steven W; Kaleyias, Joseph; Kothare, Sanjeev V

2011-04-01

The combination of chronobiology and epilepsy offers novel diagnostic and therapeutic management options. Knowledge of the interactions between circadian periodicity, entrainment, sleep patterns, and epilepsy may provide additional diagnostic options beyond sleep deprivation and extended release medication formulations. It may also provide novel insights into the physiologic, biochemical, and genetic regulation processes of epilepsy and the circadian clock, rendering new treatment options. Temporal fluctuations of seizure susceptibility based on sleep homeostasis and circadian phase in selected epilepsies may provide predictability based on mathematical models. Chrono-epileptology offers opportunities for individualized patient-oriented treatment paradigms based on chrono-pharmacology, differential medication dosing, chrono-drug delivery systems, and utilization of "zeitgebers" such as chronobiotics or light-therapy and desynchronization strategies among others.

Poststernotomy mediastinitis: a classification to initiate and evaluate reconstructive management based on evidence from a structured review.

PubMed

van Wingerden, Jan J; Ubbink, Dirk T; van der Horst, Chantal M A M; de Mol, Bas A J M

2014-11-23

Early recognition and, where possible, avoidance of risk factors that contribute to the development of poststernotomy mediastinitis (PSM) form the basis for successful prevention. Once the presence of PSM is diagnosed, the known risk factors have been shown to have limited influence on management decisions. Evidence-based knowledge on treatment decisions, which include the extent and type of surgical intervention (other than debridement), timing and others is available but has not yet been incorporated into a classification on management decisions regarding PSM. Ours is a first attempt at developing a classification system for management of PSM, taking the various evidence-based reconstructive options into consideration. The classification is simple to introduce (there are four Types) and relies on the careful establishment of two variables (sternal stability and sternal bone viability and stock) prior to deciding on the best available reconstructive option. It should allow better insight into why treatment decisions fail or have to be altered and will allow better comparison of treatment outcomes between various institutions.

Perturbations and 3R in carbon management.

PubMed

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

2017-02-01

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

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

PubMed

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

2017-06-01

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

Multi-objective optimization of riparian buffer networks; valuing present and future benefits

EPA Science Inventory

Multi-objective optimization has emerged as a popular approach to support water resources planning and management. This approach provides decision-makers with a suite of management options which are generated based on metrics that represent different social, economic, and environ...

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

NASA Astrophysics Data System (ADS)

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

2016-12-01

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

Stress urinary incontinence in women: Current and emerging therapeutic options

PubMed Central

Shamout, Samer; Campeau, Lysanne

2017-01-01

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

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

NASA Astrophysics Data System (ADS)

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

2012-04-01

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

Esotropia

MedlinePlus

... assessed. What are the treatment options for esotropia? Management of esotropia is based on a number of factors. The overriding principles are: • Re-establishment of ocular alignment • Maximization of ...

Fungating wounds: management and treatment options.

PubMed

Tandler, Suzanne; Stephen-Haynes, Jackie

2017-06-22

This article defines fungating wounds and considers the underlying cause, location and presentation. The clinical challenges presented by fungating wounds are discussed, with reference to evidence-based care delivery. This includes wound assessment, cleansing, debridement and management of malodour, infection, bleeding and exudate. Guidance on the use of wound management dressings is considered in relation to symptom management. The importance of clinical decision-making and educational preparation in the delivery of evidenced-based care for those with fungating wounds is emphasised. A conclusion is made that the clinician can support the patient with a fungating wound by the delivery of evidenced-based care.

Lennie: a smartphone application with novel implications for the management of animal colonies.

PubMed

Allwood, M A; Griffith, D; Allen, C; Reed, J; Mahmoud, Q H; Brunt, K R; Simpson, J A

2015-07-01

Researchers rely on animals for their clinical applicability and ease of monitoring. However, careful management is required to ensure the animal and financial costs are minimized. The incorporation of 'smartphone' technology in research has increased exponentially, with a focus on the development of innovative research-based applications. We have developed a smartphone application designed to address the needs of modern researchers in the management of their colonies. 'Lennie' introduces a new method for the management of small to medium-sized animal colonies. Lennie allows users wireless access to their colonies with the ability to create and edit from virtually anywhere. Lennie also offers the ability to manage colonies based on experiments by assigning animals based on priority. Experimental time-points are also recorded with integrated scheduling options using the calendar function. Lennie represents an alternative to current large-scale software options, as the application design is simple, and requires no training or manuals. As the technological landscape is constantly evolving, we must continue to find ways to improve upon current practices to ensure that research is completed with efficiency and efficacy. With this new method of animal management, researchers are able to spend less time record keeping and can focus their efforts on continued innovation. © The Author(s) 2015.

Making real options really work.

PubMed

van Putten, Alexander B; MacMillan, Ian C

2004-12-01

As a way to value growth opportunities, real options have had a difficult time catching on with managers. Many CFOs believe the method ensures the overvaluation of risky projects. This concern is legitimate, but abandoning real options as a valuation model isn't the solution. Companies that rely solely on discounted cash flow (DCF) analysis underestimate the value of their projects and may fail to invest enough in uncertain but highly promising opportunities. CFOs need not--and should not--choose one approach over the other. Far from being a replacement for DCF analysis, real options are an essential complement, and a project's total value should encompass both. DCF captures a base estimate of value; real options take into account the potential for big gains. This is not to say that there aren't problems with real options. As currently applied, they focus almost exclusively on the risks associated with revenues, ignoring the risks associated with a project's costs. It's also true that option valuations almost always ignore assets that an initial investment in a subsequently abandoned project will often leave the company. In this article, the authors present a simple formula for combining DCF and option valuations that addresses these two problems. Using an integrated approach, managers will, in the long run, select better projects than their more timid competitors while keeping risk under control. Thus, they will outperform their rivals in both the product and the capital markets.

Concierge: Personal Database Software for Managing Digital Research Resources

PubMed Central

Sakai, Hiroyuki; Aoyama, Toshihiro; Yamaji, Kazutsuna; Usui, Shiro

2007-01-01

This article introduces a desktop application, named Concierge, for managing personal digital research resources. Using simple operations, it enables storage of various types of files and indexes them based on content descriptions. A key feature of the software is a high level of extensibility. By installing optional plug-ins, users can customize and extend the usability of the software based on their needs. In this paper, we also introduce a few optional plug-ins: literature management, electronic laboratory notebook, and XooNlps client plug-ins. XooNIps is a content management system developed to share digital research resources among neuroscience communities. It has been adopted as the standard database system in Japanese neuroinformatics projects. Concierge, therefore, offers comprehensive support from management of personal digital research resources to their sharing in open-access neuroinformatics databases such as XooNIps. This interaction between personal and open-access neuroinformatics databases is expected to enhance the dissemination of digital research resources. Concierge is developed as an open source project; Mac OS X and Windows XP versions have been released at the official site (http://concierge.sourceforge.jp). PMID:18974800

A multi-criteria decision analysis assessment of waste paper management options.

PubMed

Hanan, Deirdre; Burnley, Stephen; Cooke, David

2013-03-01

The use of Multi-criteria Decision Analysis (MCDA) was investigated in an exercise using a panel of local residents and stakeholders to assess the options for managing waste paper on the Isle of Wight. Seven recycling, recovery and disposal options were considered by the panel who evaluated each option against seven environmental, financial and social criteria. The panel preferred options where the waste was managed on the island with gasification and recycling achieving the highest scores. Exporting the waste to the English mainland for incineration or landfill proved to be the least preferred options. This research has demonstrated that MCDA is an effective way of involving community groups in waste management decision making. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

PubMed

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

2010-05-01

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

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

NASA Astrophysics Data System (ADS)

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

2010-05-01

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

23 CFR 500.104 - State option.

Code of Federal Regulations, 2010 CFR

2010-04-01

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

Secure transport and adaptation of MC-EZBC video utilizing H.264-based transport protocols☆

PubMed Central

Hellwagner, Hermann; Hofbauer, Heinz; Kuschnig, Robert; Stütz, Thomas; Uhl, Andreas

2012-01-01

Universal Multimedia Access (UMA) calls for solutions where content is created once and subsequently adapted to given requirements. With regard to UMA and scalability, which is required often due to a wide variety of end clients, the best suited codecs are wavelet based (like the MC-EZBC) due to their inherent high number of scaling options. However, most transport technologies for delivering videos to end clients are targeted toward the H.264/AVC standard or, if scalability is required, the H.264/SVC. In this paper we will introduce a mapping of the MC-EZBC bitstream to existing H.264/SVC based streaming and scaling protocols. This enables the use of highly scalable wavelet based codecs on the one hand and the utilization of already existing network technologies without accruing high implementation costs on the other hand. Furthermore, we will evaluate different scaling options in order to choose the best option for given requirements. Additionally, we will evaluate different encryption options based on transport and bitstream encryption for use cases where digital rights management is required. PMID:26869746

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

PubMed

Lee, Mary; Sharifi, Roohollah

2018-03-01

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

Diagnosed a Patient with Central Serous Chorioretinopathy? Now What?: Management of Central Serous Chorioretinopathy.

PubMed

Goldhagen, Brian E; Goldhardt, Raquel

2017-06-01

The goal of this paper is to provide a comprehensive review of the management options for central serous chorioretinopathy (CSCR). The majority of cases of acute CSCR may be managed with observation and cessation of corticosteroids, if possible, as well as life-style modifications including stress reduction and control of hypertension. The management of chronic disease is more challenging and may include either medication or laser-based treatment. Management of CSCR necessitates an individualized and selective treatment approach. There is overall poor evidence for the use of systemic and intravitreal medications. From this class of treatments, mineralocorticoid receptor antagonists appear to have the greatest potential. Although conventional thermal photocoagulation may be used in select cases, the most promising treatment options at this time for chronic CSCR are photodynamic therapy, either half-dose or half-fluence, and non-damaging (subthreshold) retinal laser therapy.

76 FR 53413 - South Atlantic Fishery Management Council Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-26

...; Spiny Lobster Committee; Law Enforcement Committee; Ecosystem-Based Management Committee; Executive... AP and develop actions and options for Shrimp Amendment 9. 3. Spiny Lobster Committee Meeting: September 13, 2011, 1:30 p.m. until 3 p.m. The Spiny Lobster Committee will receive a report on actions...

EVALUATING HYDROLOGICAL RESPONSE TO FORECASTED LAND-USE CHANGE: SCENARIO TESTING WITH THE AUTOMATED GEOSPATIAL WATERSHED ASSESSMENT TOOL

EPA Science Inventory

Studies of future management and policy options based on different assumptions provide a mechanism to examine possible outcomes and especially their likely benefits or consequences. Planning and assessment in land and water resource management are evolving toward complex, spatia...

Management/Technical Interaction in Integrated Information System Development.

ERIC Educational Resources Information Center

Bagley, Clarence H.; Gardner, Don E.

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

Alternative to Blood Replacement in the Critically Ill.

PubMed

Tolich, Deborah J; McCoy, Kelly

2017-09-01

This article reviews treatments and strategies that can be used to reduce, or as adjuncts to, blood transfusion to manage blood volumes in patients who are critically ill. Areas addressed include iatrogenic anemia, fluid management, pharmaceutical agents, hemostatic agents, hemoglobin-based oxygen carriers, and management of patients for whom blood is not an option. Copyright © 2017 Elsevier Inc. All rights reserved.

Making effective referrals: a knowledge-management approach.

PubMed Central

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

1997-01-01

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

Weighing the options for limiting surplus animals.

PubMed

Asa, Cheryl

2016-05-01

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

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

PubMed

Ulsido, Mihret D; Li, Meng

2016-07-01

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

41 CFR 101-39.004 - Optional operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

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

Assessing the environmental burdens of anaerobic digestion in comparison to alternative options for managing the biodegradable fraction of municipal solid wastes.

PubMed

Haight, M

2005-01-01

Biological treatment processes including anaerobic digestion (biogasification) and composting are increasingly being considered by waste management officials and planners as alternatives for managing the mainly organic residues of municipal solid wastes (MSW). The integrated waste management model which is based upon the application of life-cycle analysis was employed to compare the environmental burdens of landfilling, composting and anaerobic digestion of MSW at a mid-sized Canadian community. Energy consumption (or recovery), residue recoveries and emissions to air and water were quantified. Scenario comparisons were analyzed to demonstrate that the environmental burdens associated with anaerobic digestion are reduced in comparison with the alternative options. The major benefit occurs as a result of the electricity produced from burning the biogas and then supplying the 'green power' to the local electrical grid.

Evidence-based practice in Behçet’s disease: identifying areas of unmet need for 2014

PubMed Central

2014-01-01

Background Behçet’s Disease (BD) is characterized by a relapsing-remitting course, with symptoms of varying severity across almost all organ systems. There is a diverse array of therapeutic options with no universally accepted treatment regime, and it is thus important that clinical practice is evidence-based. We reviewed all currently available literature describing management of BD, and investigated whether evidence-based practice is possible for all disease manifestations, and assessed the range of therapeutic options tested. Methods We conducted an internet search of all literature describing management of BD up to August 2013, including pharmacological and non-pharmacological interventions. We recorded treatment options investigated and disease manifestations reported as primary and secondary study outcomes. Quality of data was assessed according to the Scottish Intercollegiate Guideline Network (SIGN) hierarchy of evidence. Results Whilst there is much literature describing treatment of ocular and mucocutaneous disease, there is little to guide management of rheumatoid, cardiovascular and neurological disease. This broadly reflects the prevalence of disease manifestations of BD, but not the severity. Biologic therapies are the most commonly investigated intervention. The proportion of SIGN-1 graded studies is declining, and there are no SIGN-1 graded studies investigating neurological or gastrointestinal manifestations of BD. Conclusions This is the first study to investigate trends in published literature for management of BD over time. It identifies neurological, cardiovascular and gastro-intestinal disease as particular areas of unmet need and suggests that overall quality of evidence is declining. Future research should be designed to address these areas of insufficiency to facilitate evidence-based practice in BD. PMID:24475935

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

PubMed Central

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

2015-01-01

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

How can primary care providers manage pediatric obesity in the real world?

PubMed

Hopkins, Kristy F; Decristofaro, Claire; Elliott, Lydia

2011-06-01

To provide information regarding evidence-based interventions and clinical practice guidelines as a basis for a clinical toolkit utilizing a step management approach for the primary care provider in managing childhood obesity. Evidence-based literature including original clinical trials, literature reviews, and clinical practice guidelines. Interventions can be stratified based on initial screening of children and adolescents so that selection of treatment options is optimized. For all treatments, lifestyle modifications include attention to diet and activity level. Levels of initial success, as well as maintenance of target body mass index, may be related to the intensity and duration of interventions; involvement of family may increase success rates. For failed lifestyle interventions, or for patients with extreme obesity and/or certain comorbidities, pharmacologic or surgical options should be considered. Many intensive programs have shown success, but the resources required for these approaches may be unavailable to the typical community provider and family. However, using current guidelines, the primary care provider can initiate and manage ongoing interventions in pediatric obesity. A toolkit for primary care implementation and maintenance interventions is provided. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.

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

NASA Astrophysics Data System (ADS)

Sharuga, S. M.; Reams, M.

2016-02-01

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

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

NASA Astrophysics Data System (ADS)

Sharuga, S. M.; Reams, M.

2016-12-01

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

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

PubMed

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

2017-09-29

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

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

PubMed

Nelson, Rohan; Howden, Mark; Hayman, Peter

2013-07-30

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

The management of women at high risk for the development of breast cancer: risk estimation and preventative strategies.

PubMed

Sakorafas, George H

2003-04-01

Despite recent progress in the diagnostic and therapeutic approaches to the management of women with breast cancer, at least one third of these women will ultimately die from their disease. This resulted in a new focus on breast cancer prevention, especially for the woman designed as "high-risk". The continuing challenge is to identify reliable markers to accurately recognize this group of women, who are more likely to develop breast cancer. This will allow a targeted specific counseling and the application of preventative measures. Management options in high-risk women include intensive cancer surveillance, chemoprevention (mainly using tamoxifen), and prophylactic surgery (preferentially total mastectomy). Cancer surveillance is the most preferred management option. Currently, no data exists comparing prophylactic mastectomy vs. surveillance vs. chemoprevention. Thus, despite significant advances in our understanding of the biology of breast cancer, many questions remain unanswered concerning the optimal management of the high-risk woman. Patient counseling has a central role in the decision-making process and should be based on a multidisciplinary approach. The individual woman will make the final decision based on the amount of risk she is willing to accept. It is hoped that other preventative methods, such as gene therapy based on an accurate identification of specific genetic changes, will be developed in the future.

Effectiveness of a publicly-funded demonstration program to promote management of dryland salinity.

PubMed

Robertson, M J; Measham, T G; Batchelor, G; George, R; Kingwell, R; Hosking, K

2009-07-01

Community and catchment-based approaches to salinity management continue to attract interest in Australia. In one such approach, Catchment Demonstration Initiative (CDI) projects were established by the Western Australian (WA) Government in 2000 for targeted investment in large-scale catchment-based demonstrations of integrated salinity management practices. The aim was to promote a process for technically-informed salinity management by landholders. This paper offers an evaluation of the effectiveness of one CDI project in the central wheatbelt of WA, covering issues including: its role in fostering adoption of salinity management options, the role of research and the technical requirements for design and implementation of on-ground works, the role of monitoring and evaluation, the identification and measurement of public and private benefits, comparison and identification of the place and value of plant-based and engineering-based options, reliance on social processes and impacts of constraints on capacity, management of governance and administration requirements and an appreciation of the value of group-based approaches. A number of factors may reduce the effectiveness of CDI-type approaches in facilitating landholder action to address salinity, many of these are socially-based. Such approaches can create considerable demands on landholders, can be expensive (because of the planning and accountability required) on the basis of dollars per hectare impacted, and can be difficult to garner ownership from all involved. An additional problem could be that few community groups would have the capacity to run such programs and disseminate the new knowledge so that the CDI-type projects can impact outside the focus catchment. In common with many publicly-funded approaches to salinity, we found that direct benefits on public assets are smaller than planned and that results from science-based requirements of monitoring and evaluation have long lead times, causing farmers to either wait for the information or act sooner and take risks based on initial results. We also found that often it is a clear outline of the process that is of most importance in decision making as opposed to the actual results. We identified limitations in regulatory processes and the capacity for local government to engage in the CDI. The opportunities that CDI-type approaches provide centre around the value of its group-based approach. We conclude that they can overcome knowledge constraints in managing salinity by fostering group-based learning, offer a structured process of trialling options so that the costs and benefits can be clearly and transparently quantified, and avoid the costly mistakes and "learning failures" of the past.

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

Combining analytical frameworks to assess livelihood vulnerability to climate change and analyse adaptation options.

PubMed

Reed, M S; Podesta, G; Fazey, I; Geeson, N; Hessel, R; Hubacek, K; Letson, D; Nainggolan, D; Prell, C; Rickenbach, M G; Ritsema, C; Schwilch, G; Stringer, L C; Thomas, A D

2013-10-01

Experts working on behalf of international development organisations need better tools to assist land managers in developing countries maintain their livelihoods, as climate change puts pressure on the ecosystem services that they depend upon. However, current understanding of livelihood vulnerability to climate change is based on a fractured and disparate set of theories and methods. This review therefore combines theoretical insights from sustainable livelihoods analysis with other analytical frameworks (including the ecosystem services framework, diffusion theory, social learning, adaptive management and transitions management) to assess the vulnerability of rural livelihoods to climate change. This integrated analytical framework helps diagnose vulnerability to climate change, whilst identifying and comparing adaptation options that could reduce vulnerability, following four broad steps: i) determine likely level of exposure to climate change, and how climate change might interact with existing stresses and other future drivers of change; ii) determine the sensitivity of stocks of capital assets and flows of ecosystem services to climate change; iii) identify factors influencing decisions to develop and/or adopt different adaptation strategies, based on innovation or the use/substitution of existing assets; and iv) identify and evaluate potential trade-offs between adaptation options. The paper concludes by identifying interdisciplinary research needs for assessing the vulnerability of livelihoods to climate change.

Pediatric portal hypertension

PubMed Central

Vogel, Clarissa Barbon

2017-01-01

Abstract: Pediatric portal hypertension management is a team approach between the patient, the patient's family, the primary caregiver, and specialty providers. Evidence-based practice guidelines have not been established in pediatrics. This article serves as a review for the primary care NP in the management of pediatric portal hypertension, discussing the etiology, pathophysiology, and clinical presentation of pediatric portal hypertension, diagnostic tests, and treatment and management options. PMID:28406835

Adapting to a Changing Colorado River: Making Future Water Deliveries More Reliable Through Robust Management Strategies

NASA Astrophysics Data System (ADS)

Groves, D.; Bloom, E.; Fischbach, J. R.; Knopman, D.

2013-12-01

The U.S. Bureau of Reclamation and water management agencies representing the seven Colorado River Basin States initiated the Colorado River Basin Study in January 2010 to evaluate the resiliency of the Colorado River system over the next 50 years and compare different options for ensuring successful management of the river's resources. RAND was asked to join this Basin Study Team in January 2012 to help develop an analytic approach to identify key vulnerabilities in managing the Colorado River basin over the coming decades and to evaluate different options that could reduce this vulnerability. Using a quantitative approach for planning under uncertainty called Robust Decision Making (RDM), the RAND team assisted the Basin Study by: identifying future vulnerable conditions that could lead to imbalances that could cause the basin to be unable to meet its water delivery objectives; developing a computer-based tool to define 'portfolios' of management options reflecting different strategies for reducing basin imbalances; evaluating these portfolios across thousands of future scenarios to determine how much they could improve basin outcomes; and analyzing the results from the system simulations to identify key tradeoffs among the portfolios. This talk will describe RAND's contribution to the Basin Study, focusing on the methodologies used to to identify vulnerabilities for Upper Basin and Lower Basin water supply reliability and to compare portfolios of options. Several key findings emerged from the study. Future Streamflow and Climate Conditions Are Key: - Vulnerable conditions arise in a majority of scenarios where streamflows are lower than historical averages and where drought conditions persist for eight years or more. - Depending where the shortages occur, problems will arise for delivery obligations for the upper river basin and the lower river basin. The lower river basin is vulnerable to a broader range of plausible future conditions. Additional Investments in Infrastructure and Efficiency Could Improve Performance and Reduce Risk: - Different portfolios of water-supply and demand-reduction options offer performance trade-offs. - Different types of options in the portfolios, such as conservation, desalination, or water banking, would affect future outcomes and costs of implementation. - Analysis of all the portfolios identified important near-term, high-priority options that should be implemented in the near future, including municipal, industrial, and agricultural conservation. Other Solutions May Be Required: - If future hydrologic conditions develop in a manner consistent with the more pessimistic projections, the Basin is increasingly likely to face vulnerable conditions. The region may need to consider additional management options.

Clinicians' Views on Management and Terminology for Papillary Thyroid Microcarcinoma: A Qualitative Study.

PubMed

Nickel, Brooke; Brito, Juan P; Barratt, Alexandra; Jordan, Susan; Moynihan, Ray; McCaffery, Kirsten

2017-05-01

There is growing acceptance that the increase in thyroid cancer incidence is in part a result of overdiagnosis of small low-risk papillary microcarcinomas (PMCs) with indolent clinical course. Although surgery is the cornerstone treatment for patients with PMCs, recent management guidelines are shifting toward inclusion of more conservative treatments such as active surveillance. There is little evidence on clinicians' experience in managing PMC patients and their attitudes toward treatment options, including their willingness to accept a nonsurgical option. The aim of this study was to understand how clinicians perceive a diagnosis of PMC, potential changes to terminology, and the treatment options available to patients. This was a qualitative study using semi-structured interviews conducted between November 2015 and May 2016 with 22 clinicians (seven endocrinologists and 15 thyroid surgeons). Transcribed audio-recordings were thematically coded, and a framework method was used to analyze the data. Across a sample of clinicians who manage thyroid cancer patients, awareness of overdiagnosis and overtreatment of PMC was common. However, there was little acceptance of active surveillance to manage these patients. Clinicians did not feel comfortable recommending this management approach, as they were worried about the risk of metastases, did not feel that evidence to support this approach was strong enough, and also believed that patients currently have a high preference for surgery. The majority of clinicians did not believe that changing the terminology of this diagnosis was a viable strategy to reduce patients' anxiety and their perceived preference for more aggressive treatments. However, most clinicians felt that thyroid nodules <1 cm should not be biopsied, which could help minimize the risk of overdiagnosis of PMC. This study, based on a non-representative sample of 22 clinicians, which remains an important limitation, provides revealing insight into clinicians' management preferences and decision making for small low-risk thyroid cancers at a time when management guidelines and practices are evolving. It suggests that clinicians may not be ready to accept nonsurgical options, or changes in terminology, until evidence to support these options and changes is stronger.

Instructional Design as Knowledge Management: A Knowledge-in-Practice Approach to Choosing Instructional Methods

ERIC Educational Resources Information Center

McIver, Derrick; Fitzsimmons, Stacey; Flanagan, David

2016-01-01

Decisions about instructional methods are becoming more complex, with options ranging from problem sets to experiential service-learning projects. However, instructors not trained in instructional design may make these important decisions based on convenience, comfort, or trends. Instead, this article draws on the knowledge management literature…

Economic evaluation of an internet-based weight management program

USDA-ARS?s Scientific Manuscript database

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

Implications of observed and simulated soil carbon sequestration for management options in corn-based rotations

USDA-ARS?s Scientific Manuscript database

Managing cropping systems to sequester soil organic carbon (SOC) improves soil health and a system’s resiliency to impacts of changing climate. Our objectives were to 1) monitor SOC from a bio-energy cropping study in central Pennsylvania that included a corn-soybean-alfalfa rotation, switchgrass, a...

76 FR 2665 - Caribbean Fishery Management Council; Scoping Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-14

... time series of catch data that is considered to be consistently reliable across all islands as defined... based on what the Council considers to be the longest time series of catch data that is consistently... preferred management reference point time series. Action 3b. Recreational Bag Limits Option 1: No action. Do...

Implications of observed and simulated soil carbon sequestration for management options in corn-based rotations

USDA-ARS?s Scientific Manuscript database

Managing cropping systems to sequester soil organic carbon (SOC) improves soil health and a system’s resiliency to impacts of changing climate. Our objectives were to 1) monitor SOC from a bio-energy cropping study in central Pennsylvania that included a corn-soybean-alfalfa rotation, switchgrass, ...

Antagonist molecules in the treatment of angina

PubMed Central

Gupta, Ashish K.; Winchester, David; Pepine, Carl J.

2017-01-01

Introduction Management of chronic angina has evolved dramatically in the last few decades with several options for pharmacotherapy outlined in various evidence-based guidelines. Areas covered There is a growing list of drugs that are currently being investigated for treatment of chronic angina. These also include several herbal medications, which are now being scientifically evaluated as potential alternative or even adjunctive therapy for angina. Gene- and cell-based therapies have opened yet another avenue for management of chronic refractory angina in ‘no-option’ patients who are not candidates for either percutaneous or surgical revascularization and are on optimal medical therapy. An extensive review of literature using PUBMED, Cochrane database, clinical trial databases of USA and European Union was done and summarized in this review. This review will attempt to discuss the traditional as well as novel therapeutic agents for angina. Expert opinion Several pharmacological and non-pharmacological therapeutic options are now available for treatment and management of chronic refractory angina. Renewed interest in traditional therapies and cell- and gene-based modalities with targeted drug delivery systems will open the doors for personalized therapy for patients with chronic refractory angina. PMID:24047238

Contemporary management of cancer of the oral cavity

PubMed Central

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

2010-01-01

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

Sustainable water use and management options in a water-stressed river basin in Kenya

NASA Astrophysics Data System (ADS)

Hirpa, Feyera; Dadson, Simon; Dyer, Ellen; Barbour, Emily; Charles, Katrina; Hope, Robert

2017-04-01

Sustainable water resource is critical for maintaining healthy ecosystems and supporting socio-economic sectors. Hydro-climatic change and variability, population growth as well as new infrastructure developments create water security risks. Therefore, evidence-based management decisions are necessary to improve water security and meet the future water demands of multiple competing sectors. In this work we perform water resource modelling in order to investigate the impact of increasing water demand (expanding agriculture, booming industry, growing population) on the sustainable water use in Turkwel river basin, located in arid north-western Kenya. We test different management options to determine those that meet the water demands of the concerned sectors whilst minimising environmental impact. We perform scenario analysis using Water Evaluation And Planning (WEAP) model to explore different ranges of climate conditions, population growth rates, irrigation scale, reservoir operations, and economic development. The results can be used as a scientific guideline for the policy makers who decide the alternative management options that ensure the sustainable water use in the basin. The work is part of the REACH - improving water security for the poor program (http://reachwater.org.uk/), aiming to support a pathway to sustainable growth and poverty reduction

Recognising and Managing Refractory Coeliac Disease: A Tertiary Centre Experience.

PubMed

Nasr, Ikram; Nasr, Iman; Beyers, Carl; Chang, Fuju; Donnelly, Suzanne; Ciclitira, Paul J

2015-12-01

Refractory coeliac disease (RCD) is a rare complication of coeliac disease (CD) and involves malabsorption and villous atrophy despite adherence to a strict gluten-free diet (GFD) for at least 12 months in the absence of another cause. RCD is classified based on the T-cells in the intra-epithelial lymphocyte (IEL) morphology into type 1 with normal IEL and type 2 with aberrant IEL (clonal) by PCR (polymerase chain reaction) for T cell receptors (TCR) at the β/γ loci. RCD type 1 is managed with strict nutritional and pharmacological management. RCD type 2 can be complicated by ulcerative jejunitis or enteropathy associated lymphoma (EATL), the latter having a five-year mortality of 50%. Management options for RCD type 2 and response to treatment differs across centres and there have been debates over the best treatment option. Treatment options that have been used include azathioprine and steroids, methotrexate, cyclosporine, campath (an anti CD-52 monoclonal antibody), and cladribine or fluadribine with or without autologous stem cell transplantation. We present a tertiary centre's experience in the treatment of RCD type 2 where treatment with prednisolone and azathioprine was used, and our results show good response with histological recovery in 56.6% of treated individuals.

Pharmacological pain management in chronic pancreatitis

PubMed Central

Olesen, Søren S; Juel, Jacob; Graversen, Carina; Kolesnikov, Yuri; Wilder-Smith, Oliver HG; Drewes, Asbjørn M

2013-01-01

Intense abdominal pain is a prominent feature of chronic pancreatitis and its treatment remains a major clinical challenge. Basic studies of pancreatic nerves and experimental human pain research have provided evidence that pain processing is abnormal in these patients and in many cases resembles that seen in neuropathic and chronic pain disorders. An important ultimate outcome of such aberrant pain processing is that once the disease has advanced and the pathophysiological processes are firmly established, the generation of pain can become self-perpetuating and independent of the initial peripheral nociceptive drive. Consequently, the management of pain by traditional methods based on nociceptive deafferentation (e.g., surgery and visceral nerve blockade) becomes difficult and often ineffective. This novel and improved understanding of pain aetiology requires a paradigm shift in pain management of chronic pancreatitis. Modern mechanism based pain treatments taking into account altered pain processing are likely to increasingly replace invasive therapies targeting the nociceptive source, which should be reserved for special and carefully selected cases. In this review, we offer an overview of the current available pharmacological options for pain management in chronic pancreatitis. In addition, future options for pain management are discussed with special emphasis on personalized pain medicine and multidisciplinarity. PMID:24259960

Develop a Prototype Personal Health Record Application (PHR-A) that Captures Information About Daily Living Important for Diabetes and Provides Decision Support with Actionable Advice for Diabetes Self Care

DTIC Science & Technology

2014-10-01

designed an Internet-based and mobile application (software) to assist with the following domains pertinent to diabetes self-management: 1...management that provides education, reminders, and support. The new tool is an internet-based and mobile application (software), now called Tracking...is mobile , provides decision support with actionable options, and is based on user input, will enhance diabetes self-care, improve glycemic control

Modeling Off-Nominal Recovery in NextGen Terminal-Area Operations

NASA Technical Reports Server (NTRS)

Callantine, Todd J.

2011-01-01

Robust schedule-based arrival management requires efficient recovery from off-nominal situations. This paper presents research on modeling off-nominal situations and plans for recovering from them using TRAC, a route/airspace design, fast-time simulation, and analysis tool for studying NextGen trajectory-based operations. The paper provides an overview of a schedule-based arrival-management concept and supporting controller tools, then describes TRAC implementations of methods for constructing off-nominal scenarios, generating trajectory options to meet scheduling constraints, and automatically producing recovery plans.

MERINOVA: Meteorological risks as drivers of environmental innovation in agro-ecosystem management

NASA Astrophysics Data System (ADS)

Gobin, Anne; Oger, Robert; Marlier, Catherine; Van De Vijver, Hans; Vandermeulen, Valerie; Van Huylenbroeck, Guido; Zamani, Sepideh; Curnel, Yannick; Mettepenningen, Evi

2013-04-01

The BELSPO funded project 'MERINOVA' deals with risks associated with extreme weather phenomena and with risks of biological origin such as pests and diseases. The major objectives of the proposed project are to characterise extreme meteorological events, assess the impact on Belgian agro-ecosystems, characterise their vulnerability and resilience to these events, and explore innovative adaptation options to agricultural risk management. The project comprises of five major parts that reflect the chain of risks: (i) Hazard: Assessing the likely frequency and magnitude of extreme meteorological events by means of probability density functions; (ii) Impact: Analysing the potential bio-physical and socio-economic impact of extreme weather events on agro-ecosystems in Belgium using process-based modelling techniques commensurate with the regional scale; (iii) Vulnerability: Identifying the most vulnerable agro-ecosystems using fuzzy multi-criteria and spatial analysis; (iv) Risk Management: Uncovering innovative risk management and adaptation options using actor-network theory and fuzzy cognitive mapping techniques; and, (v) Communication: Communicating to research, policy and practitioner communities using web-based techniques. The different tasks of the MERINOVA project require expertise in several scientific disciplines: meteorology, statistics, spatial database management, agronomy, bio-physical impact modelling, socio-economic modelling, actor-network theory, fuzzy cognitive mapping techniques. These expertises are shared by the four scientific partners who each lead one work package. The MERINOVA project will concentrate on promoting a robust and flexible framework by demonstrating its performance across Belgian agro-ecosystems, and by ensuring its relevance to policy makers and practitioners. Impacts developed from physically based models will not only provide information on the state of the damage at any given time, but also assist in understanding the links between different factors causing damage and determining bio-physical vulnerability. Socio-economic impacts will enlarge the basis for vulnerability mapping, risk management and adaptation options. A strong expert and end-user network will be established to help disseminating and exploiting project results to meet user needs.

Management of statin-intolerant high-risk patients.

PubMed

Tziomalos, Konstantinos; Athyros, Vasilios G; Karagiannis, Asterios; Mikhailidis, Dimitri P

2010-09-01

Statins are an essential part of the management of patients at high vascular risk and are generally well-tolerated. However, statin intolerance will be observed more frequently as more stringent low density lipoprotein cholesterol (LDL-C) targets are pursued in an ever increasing number of patients. We review the management options for high-risk patients intolerant to statin treatment. Potential strategies include switching to a different statin, reducing the frequency of statin administration, substituting statins with other LDL-C-lowering agents (e.g. ezetimibe, colesevelam or nicotinic acid) and combining low-dose statin treatment with other lipid-modifying drugs. A limited number of studies specifically assessed statin-intolerant patients and most were small and of short duration. It is therefore difficult to make evidence-based recommendations for the management of this population. In addition, all treatment options have limitations in terms of safety and/or efficacy.

Tool for Ranking Research Options

NASA Technical Reports Server (NTRS)

Ortiz, James N.; Scott, Kelly; Smith, Harold

2005-01-01

Tool for Research Enhancement Decision Support (TREDS) is a computer program developed to assist managers in ranking options for research aboard the International Space Station (ISS). It could likely also be adapted to perform similar decision-support functions in industrial and academic settings. TREDS provides a ranking of the options, based on a quantifiable assessment of all the relevant programmatic decision factors of benefit, cost, and risk. The computation of the benefit for each option is based on a figure of merit (FOM) for ISS research capacity that incorporates both quantitative and qualitative inputs. Qualitative inputs are gathered and partly quantified by use of the time-tested analytical hierarchical process and used to set weighting factors in the FOM corresponding to priorities determined by the cognizant decision maker(s). Then by use of algorithms developed specifically for this application, TREDS adjusts the projected benefit for each option on the basis of levels of technical implementation, cost, and schedule risk. Based partly on Excel spreadsheets, TREDS provides screens for entering cost, benefit, and risk information. Drop-down boxes are provided for entry of qualitative information. TREDS produces graphical output in multiple formats that can be tailored by users.

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

NASA Astrophysics Data System (ADS)

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

2012-12-01

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

Disaster waste management: a review article.

PubMed

Brown, Charlotte; Milke, Mark; Seville, Erica

2011-06-01

Depending on their nature and severity, disasters can create large volumes of debris and waste. The waste can overwhelm existing solid waste management facilities and impact on other emergency response and recovery activities. If poorly managed, the waste can have significant environmental and public health impacts and can affect the overall recovery process. This paper presents a system overview of disaster waste management based on existing literature. The main literature available to date comprises disaster waste management plans or guidelines and isolated case studies. There is ample discussion on technical management options such as temporary storage sites, recycling, disposal, etc.; however, there is little or no guidance on how these various management options are selected post-disaster. The literature does not specifically address the impact or appropriateness of existing legislation, organisational structures and funding mechanisms on disaster waste management programmes, nor does it satisfactorily cover the social impact of disaster waste management programmes. It is envisaged that the discussion presented in this paper, and the literature gaps identified, will form a basis for future comprehensive and cohesive research on disaster waste management. In turn, research will lead to better preparedness and response to disaster waste management problems. Copyright © 2011 Elsevier Ltd. All rights reserved.

Disaster waste management: A review article

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

Brown, Charlotte, E-mail: charlotte.brown@pg.canterbury.ac.nz; Milke, Mark, E-mail: mark.milke@canterbury.ac.nz; Seville, Erica, E-mail: erica.seville@canterbury.ac.nz

2011-06-15

Depending on their nature and severity, disasters can create large volumes of debris and waste. The waste can overwhelm existing solid waste management facilities and impact on other emergency response and recovery activities. If poorly managed, the waste can have significant environmental and public health impacts and can affect the overall recovery process. This paper presents a system overview of disaster waste management based on existing literature. The main literature available to date comprises disaster waste management plans or guidelines and isolated case studies. There is ample discussion on technical management options such as temporary storage sites, recycling, disposal, etc.;more » however, there is little or no guidance on how these various management options are selected post-disaster. The literature does not specifically address the impact or appropriateness of existing legislation, organisational structures and funding mechanisms on disaster waste management programmes, nor does it satisfactorily cover the social impact of disaster waste management programmes. It is envisaged that the discussion presented in this paper, and the literature gaps identified, will form a basis for future comprehensive and cohesive research on disaster waste management. In turn, research will lead to better preparedness and response to disaster waste management problems.« less

Integrating a Detailed Agricultural Model in a Global Economic Framework: New methods for assessment of climate mitigation and adaptation opportunities

NASA Astrophysics Data System (ADS)

Thomson, A. M.; Izaurralde, R. C.; Calvin, K.; Zhang, X.; Wise, M.; West, T. O.

2010-12-01

Climate change and food security are global issues increasingly linked through human decision making that takes place across all scales from on-farm management actions to international climate negotiations. Understanding how agricultural systems can respond to climate change, through mitigation or adaptation, while still supplying sufficient food to feed a growing global population, thus requires a multi-sector tool in a global economic framework. Integrated assessment models are one such tool, however they are typically driven by historical aggregate statistics of production in combination with exogenous assumptions of future trends in agricultural productivity; they are not yet capable of exploring agricultural management practices as climate adaptation or mitigation strategies. Yet there are agricultural models capable of detailed biophysical modeling of farm management and climate impacts on crop yield, soil erosion and C and greenhouse gas emissions, although these are typically applied at point scales that are incompatible with coarse resolution integrated assessment modeling. To combine the relative strengths of these modeling systems, we are using the agricultural model EPIC (Environmental Policy Integrated Climate), applied in a geographic data framework for regional analyses, to provide input to the global economic model GCAM (Global Change Assessment Model). The initial phase of our approach focuses on a pilot region of the Midwest United States, a highly productive agricultural area. We apply EPIC, a point based biophysical process model, at 60 m spatial resolution within this domain and aggregate the results to GCAM agriculture and land use subregions for the United States. GCAM is then initialized with multiple management options for key food and bioenergy crops. Using EPIC to distinguish these management options based on grain yield, residue yield, soil C change and cost differences, GCAM then simulates the optimum distribution of the available management options to meet demands for food and energy over the next century. The coupled models provide a new platform for evaluating future changes in agricultural management based on food demand, bioenergy demand, and changes in crop yield and soil C under a changing climate. This framework can be applied to evaluate the economically and biophysically optimal distribution of management under future climates.

Indications and interventional options for non-resectable tracheal stenosis

PubMed Central

Bacon, Jenny Louise; Patterson, Caroline Marie

2014-01-01

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

Sustainable development of process facilities: state-of-the-art review of pollution prevention frameworks.

PubMed

Hossain, Khandoker A; Khan, Faisal I; Hawboldt, Kelly

2008-01-15

Pollution prevention (P2) strategy is receiving significant attention in industries all over the world, over end-of-pipe pollution control and management strategy. This paper is a review of the existing pollution prevention frameworks. The reviewed frameworks contributed significantly to bring the P2 approach into practice and gradually improved it towards a sustainable solution; nevertheless, some objectives are yet to be achieved. In this context, the paper has proposed a P2 framework 'IP2M' addressing the limitations for systematic implementation of the P2 program in industries at design as well as retrofit stages. The main features of the proposed framework are that, firstly, it has integrated cradle-to-gate life cycle assessment (LCA) tool with other adequate P2 opportunity analysis tools in P2 opportunity analysis phase and secondly, it has re-used the risk-based cradle-to-gate LCA during the environmental evaluation of different P2 options. Furthermore, in multi-objective optimization phase, it simultaneously considers the P2 options with available end-of-pipe control options in order to select the sustainable environmental management option.

The Fundamental Uncertainty of Business: Real Options

NASA Astrophysics Data System (ADS)

Dyer, James S.

The purpose of this paper is to discuss the manner in which uncertainty is currently evaluated in business, with an emphasis on economic measures. In recent years, the accepted approach for the valuation of capital investment decisions has become one based on the theory of real options. From the standpoint of this workshop, the interesting aspect of real options is its focus on the flexibility of management to respond to changes in the environment as a feature of an alternative that has unique value, known as "option value." While this may not be surprising to most participants in this workshop, it does represent a radical change in traditional thinking about risk in business, where efforts have primarily been focused on the elimination of risk when possible.

Principles of Burn Pain Management.

PubMed

James, Dominika Lipowska; Jowza, Maryam

2017-10-01

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

Life-cycle assessment of selected management options for air pollution control residues from waste incineration.

PubMed

Fruergaard, Thilde; Hyks, Jiri; Astrup, Thomas

2010-09-15

Based on available technology and emission data seven selected management options for air-pollution-control (APC) residues from waste incineration were evaluated by life-cycle assessment (LCA) using the EASEWASTE model. Scenarios were evaluated with respect to both non-toxicity impact categories (e.g. global warming) and toxicity related impact categories (e.g. ecotoxicity and human toxicity). The assessment addressed treatment and final placement of 1 tonne of APC residue in seven scenarios: 1) direct landfilling without treatment (baseline), 2) backfilling in salt mines, 3) neutralization of waste acid, 4) filler material in asphalt, 5) Ferrox stabilization, 6) vitrification, and 7) melting with automobile shredder residues (ASR). The management scenarios were selected as examples of the wide range of different technologies available worldwide while at the same time using realistic technology data. Results from the LCA were discussed with respect to importance of: energy consumption/substitution, material substitution, leaching, air emissions, time horizon aspects for the assessment, and transportation distances. The LCA modeling showed that thermal processes were associated with the highest loads in the non-toxicity categories (energy consumption), while differences between the remaining alternatives were small and generally considered insignificant. In the toxicity categories, all treatment/utilization options were significantly better than direct landfilling without treatment (lower leaching), although the thermal processes had somewhat higher impacts than the others options (air emissions). Transportation distances did not affect the overall ranking of the management alternatives. Copyright 2010 Elsevier B.V. All rights reserved.

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

ERIC Educational Resources Information Center

2001

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

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

PubMed

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

2012-02-01

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

Review of Systemic Treatment Options for Adult Atopic Dermatitis.

PubMed

Gooderham, Melinda; Lynde, Charles W; Papp, Kim; Bourcier, Marc; Guenther, Lyn; Gulliver, Wayne; Hong, Chih-Ho; Poulin, Yves; Sussman, Gordon; Vender, Ronald

Atopic dermatitis (AD) is a chronic, pruritic inflammatory skin disease resulting from defects in skin barrier and aberrant immune responses. AD significantly affects the quality of life. Not all patients respond to topical therapies, and often systemic therapy is required to control the disease. To review the treatment options for adult AD patients including those options for patients who do not respond adequately or have contraindications to oral systemic therapy. A working group of clinicians with experience managing AD was convened to review the current literature on treatment options for adult AD patients. This review is based on the best available evidence from a published systematic review and an additional literature search. Current treatments for AD are reviewed, including options for adult AD patients who do not respond or have contraindications to current systemic therapies. A new approach with targeted therapies is reviewed based on best available evidence. Many AD patients respond satisfactorily to topical or systemic treatments, but for those patients who do not respond or have contraindications, new biologic agents appear to be promising therapies.

Opportunities for strategic use of e-learning in scaling up disaster management capacity in Eastern Africa: a descriptive analysis.

PubMed

William, Mayega Roy; Elzie, D; Sebuwufu, D; Kiguli, J; Bazeyo, W

2013-06-01

The growing need for disaster management skills at all levels in Eastern Africa requires innovative approaches to training planners at all levels. While information technology tools provide a viable option, few studies have assessed the capacity for training institutions to use technology for cascading disaster management skills. The design was an explorative survey. A pre-training survey was conducted among 16 faculty members (9 academic staff and 7 information technology (IT) staff) from 7 schools of public health in Eastern Africa. Key informant interviews with 4 students and 4 staff members were conducted at the school of public health in Makerere. IT staff also conducted observations on trends of use of information technology infrastructure. Current levels of use of ICT among teaching and IT staff is variable. On-site use of the internet is high, but off-site access is low. Personal computers, e-mail, discussion forums and other web-based learning management platforms and open education resources (OERs) have been variably used by faculty and students to facilitate learning. On the other hand, videos, web-conferencing, social media, web-based document management tools, and mobile telephone applications were much less frequently used. A disaster management short course produced by the Health Emergencies Management Project (HEMP) has been adapted to a web-based open education resource and an interactive CD-ROM. Challenges included low levels of awareness and skills in technology options among students and faculty and access to reliable internet. Despite the existing challenges, technology tools are a viable platform for cascading disaster management skills in Eastern Africa.

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

PubMed

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

2017-02-01

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

SYNTHESIS OF SPATIAL DATA FOR DECISION-MAKING

EPA Science Inventory

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

Options for management of municipal solid waste in New York City: A preliminary comparison of health risks and policy implications

PubMed Central

Moy, Pearl; Krishnan, Nikhil; Ulloa, Priscilla; Cohen, Steven; Brandt-Rauf, Paul W.

2008-01-01

Landfill disposal and waste-to-energy (WTE) incineration remain the two principal options for managing municipal solid waste (MSW). One critical determinant of the acceptability of these options is the different health risks associated with each. In this analysis relying on published data and exposure modeling, we have performed health risk assessments for landfill disposal versus WTE treatment options for the management of New York City’s MSW. These are based on the realistic scenario of using a waste transfer station (WTS) in Brooklyn and then transporting the untreated MSW by truck to a landfill in Pennsylvania or using a WTE facility in Brooklyn and then transporting the resultant ash by truck to a landfill in Pennsylvania. The overall results indicate that the individual cancer risks for both options would be considered generally acceptable, although the risk from landfilling is approximately 5 times greater than from WTE treatment; the individual non-cancer health risks for both options would be considered generally unacceptable, although once again the risk from landfilling is approximately 5 times greater than from WTE treatment. If one considers only the population in Brooklyn that would be directly affected by the siting of either a WTS or a WTE facility in their immediate neighborhood, individual cancer and non-cancer health risks for both options would be considered generally acceptable, but risks for the former remain considerably higher than for the latter. These results should be considered preliminary due to several limitations of this study such as: consideration of risks only from inhalation exposures; assumption that only volume and not composition of the waste stream is altered by WTE treatment; reliance on data from the literature rather than actual measurements of the sites considered, assuming comparability of the sites. However, the results of studies such as this, in conjunction with ecological, socioeconomic and equity considerations, should prove useful to environmental managers, regulators, policy makers, community representatives and other stakeholders in making sound and acceptable decisions regarding the optimal handling of MSW. PMID:17379391

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

PubMed Central

Lemieux-Charles, L

1994-01-01

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

Potential for reduced methane and carbon dioxide emissions from livestock and pasture management in the tropics

PubMed Central

Thornton, Philip K.; Herrero, Mario

2010-01-01

We estimate the potential reductions in methane and carbon dioxide emissions from several livestock and pasture management options in the mixed and rangeland-based production systems in the tropics. The impacts of adoption of improved pastures, intensifying ruminant diets, changes in land-use practices, and changing breeds of large ruminants on the production of methane and carbon dioxide are calculated for two levels of adoption: complete adoption, to estimate the upper limit to reductions in these greenhouse gases (GHGs), and optimistic but plausible adoption rates taken from the literature, where these exist. Results are expressed both in GHG per ton of livestock product and in Gt CO2-eq. We estimate that the maximum mitigation potential of these options in the land-based livestock systems in the tropics amounts to approximately 7% of the global agricultural mitigation potential to 2030. Using historical adoption rates from the literature, the plausible mitigation potential of these options could contribute approximately 4% of global agricultural GHG mitigation. This could be worth on the order of $1.3 billion per year at a price of $20 per t CO2-eq. The household-level and sociocultural impacts of some of these options warrant further study, however, because livestock have multiple roles in tropical systems that often go far beyond their productive utility. PMID:20823225

Management strategies in hospitals: scenario planning.

PubMed

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

2015-01-01

Instead of waiting for challenges to confront hospital management, doctors and managers should act in advance to optimize and sustain value-based health. This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed to. Based on literature analysis as well as on personal interviews with stakeholders we propose an elaborated definition of stakeholders and designed a questionnaire that integrated the following influence factors, which have relevant impact on hospital management: political/legal, economic, social, technological and environmental forces. These influence factors are examined to develop the so-called critical uncertainties. Thorough identification of uncertainties was based on a "Stakeholder Feedback". Two key uncertainties were identified and considered in this study: the development of workload for the medical staff the profit oriented performance of the medical staff. According to the developed scenarios, complementary education of the medical staff as well as of non-medical top executives and managers of hospitals was the recommended core strategy. Complementary scenario-specific strategic options should be considered whenever needed to optimize dealing with a specific future development of the health care environment. Strategic planning in hospitals is essential to ensure sustainable success. It considers multiple situations and integrates internal and external insights and perspectives in addition to identifying weak signals and "blind spots". This flows into a sound planning for multiple strategic options. It is a state of the art tool that allows dealing with the increasing challenges facing hospital management.

Ecological Intensification Through Pesticide Reduction: Weed Control, Weed Biodiversity and Sustainability in Arable Farming.

PubMed

Petit, Sandrine; Munier-Jolain, Nicolas; Bretagnolle, Vincent; Bockstaller, Christian; Gaba, Sabrina; Cordeau, Stéphane; Lechenet, Martin; Mézière, Delphine; Colbach, Nathalie

2015-11-01

Amongst the biodiversity components of agriculture, weeds are an interesting model for exploring management options relying on the principle of ecological intensification in arable farming. Weeds can cause severe crop yield losses, contribute to farmland functional biodiversity and are strongly associated with the generic issue of pesticide use. In this paper, we address the impacts of herbicide reduction following a causal framework starting with herbicide reduction and triggering changes in (i) the management options required to control weeds, (ii) the weed communities and functions they provide and (iii) the overall performance and sustainability of the implemented land management options. The three components of this framework were analysed in a multidisciplinary project that was conducted on 55 experimental and farmer's fields that included conventional, integrated and organic cropping systems. Our results indicate that the reduction of herbicide use is not antagonistic with crop production, provided that alternative practices are put into place. Herbicide reduction and associated land management modified the composition of in-field weed communities and thus the functions of weeds related to biodiversity and production. Through a long-term simulation of weed communities based on alternative (?) cropping systems, some specific management pathways were identified that delivered high biodiversity gains and limited the negative impacts of weeds on crop production. Finally, the multi-criteria assessment of the environmental, economic and societal sustainability of the 55 systems suggests that integrated weed management systems fared better than their conventional and organic counterparts. These outcomes suggest that sustainable management could possibly be achieved through changes in weed management, along a pathway starting with herbicide reduction.

Ecological Intensification Through Pesticide Reduction: Weed Control, Weed Biodiversity and Sustainability in Arable Farming

NASA Astrophysics Data System (ADS)

Petit, Sandrine; Munier-Jolain, Nicolas; Bretagnolle, Vincent; Bockstaller, Christian; Gaba, Sabrina; Cordeau, Stéphane; Lechenet, Martin; Mézière, Delphine; Colbach, Nathalie

2015-11-01

Amongst the biodiversity components of agriculture, weeds are an interesting model for exploring management options relying on the principle of ecological intensification in arable farming. Weeds can cause severe crop yield losses, contribute to farmland functional biodiversity and are strongly associated with the generic issue of pesticide use. In this paper, we address the impacts of herbicide reduction following a causal framework starting with herbicide reduction and triggering changes in (i) the management options required to control weeds, (ii) the weed communities and functions they provide and (iii) the overall performance and sustainability of the implemented land management options. The three components of this framework were analysed in a multidisciplinary project that was conducted on 55 experimental and farmer's fields that included conventional, integrated and organic cropping systems. Our results indicate that the reduction of herbicide use is not antagonistic with crop production, provided that alternative practices are put into place. Herbicide reduction and associated land management modified the composition of in-field weed communities and thus the functions of weeds related to biodiversity and production. Through a long-term simulation of weed communities based on alternative (?) cropping systems, some specific management pathways were identified that delivered high biodiversity gains and limited the negative impacts of weeds on crop production. Finally, the multi-criteria assessment of the environmental, economic and societal sustainability of the 55 systems suggests that integrated weed management systems fared better than their conventional and organic counterparts. These outcomes suggest that sustainable management could possibly be achieved through changes in weed management, along a pathway starting with herbicide reduction.

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

Employer-based coverage and medical travel options: lessons for healthcare managers.

PubMed

Karuppan, Corinne Marie

2014-01-01

Outbound medical travel (MT) involves U.S. patients going abroad to seek medical care. Over the past decade, there has been much discussion about MT's broadening appeal to several segments of U.S. healthcare consumers, but little is known about its penetration in the employer-based coverage (EBC) marketplace. The objectives of this article are to fill this gap and identify (1) the current status of MT options in EBC, (2) the differences between adopters and nonadopters of MT options, and (3) the factors that impede adoption. The results were obtained from a nationwide survey of human resources (HR) professionals making decisions regarding medical benefits. In this sample (n = 608), 16.8% of the respondents offered outbound MT options to their employees, often bypassing their insurance providers. Besides benefiting from a strong HR function, these organizations tended to be more involved in global business transactions, more open to change, more sensitive to cost savings, and more flexible in implementing administrative innovations than nonadopters were. An organizational climate conducive to innovation may explain their propensity to downplay the importance of well-known obstacles to implementation, such as the effort required to make changes, an emphasis on short-term goals, and the fear of liability. The lessons to be learned by U.S. healthcare managers are clear. To attract a value-conscious market, they must offer an attractive package of outstanding quality (clinical outcomes and patient experience) at competitive costs. Operational excellence may thus be the key to slowing the inevitable diffusion of MT options in EBC and maintaining or even expanding the U.S. market share of elective surgeries.

43 CFR 46.145 - Using adaptive management.

Code of Federal Regulations, 2011 CFR

2011-10-01

... implementation decisions. The NEPA analysis conducted in the context of an adaptive management approach should identify the range of management options that may be taken in response to the results of monitoring and should analyze the effects of such options. The environmental effects of any adaptive management strategy...

43 CFR 46.145 - Using adaptive management.

Code of Federal Regulations, 2010 CFR

2010-10-01

... implementation decisions. The NEPA analysis conducted in the context of an adaptive management approach should identify the range of management options that may be taken in response to the results of monitoring and should analyze the effects of such options. The environmental effects of any adaptive management strategy...

Management of hereditary breast and ovarian cancer.

PubMed

Yamauchi, Hideko; Takei, Junko

2018-02-01

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

Recognising and Managing Refractory Coeliac Disease: A Tertiary Centre Experience

PubMed Central

Nasr, Ikram; Nasr, Iman; Beyers, Carl; Chang, Fuju; Donnelly, Suzanne; Ciclitira, Paul J.

2015-01-01

Refractory coeliac disease (RCD) is a rare complication of coeliac disease (CD) and involves malabsorption and villous atrophy despite adherence to a strict gluten-free diet (GFD) for at least 12 months in the absence of another cause. RCD is classified based on the T-cells in the intra-epithelial lymphocyte (IEL) morphology into type 1 with normal IEL and type 2 with aberrant IEL (clonal) by PCR (polymerase chain reaction) for T cell receptors (TCR) at the β/γ loci. RCD type 1 is managed with strict nutritional and pharmacological management. RCD type 2 can be complicated by ulcerative jejunitis or enteropathy associated lymphoma (EATL), the latter having a five-year mortality of 50%. Management options for RCD type 2 and response to treatment differs across centres and there have been debates over the best treatment option. Treatment options that have been used include azathioprine and steroids, methotrexate, cyclosporine, campath (an anti CD-52 monoclonal antibody), and cladribine or fluadribine with or without autologous stem cell transplantation. We present a tertiary centre’s experience in the treatment of RCD type 2 where treatment with prednisolone and azathioprine was used, and our results show good response with histological recovery in 56.6% of treated individuals. PMID:26633478

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

Treesearch

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

2011-01-01

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

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

Treesearch

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

2014-01-01

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

Assessing the spatial implications of interactions among strategic forest management options using a Windows-based harvest simulator.

Treesearch

Eric J. Gustafson; Luke V. Rasmussen

2002-01-01

Forest management planners must develop strategies to produce timber in ways that do not compromise ecological integrity or sustainability. These strategies often involve modifications to the spatial and temporal scheduling of harvest activities, and these strategies may interact in unexpected ways. We used a timber harvest simulator (HARVEST 6.0) to determine the...

Systems engineering approach to environmental risk management: A case study of depleted uranium at test area C-64, Eglin Air Force Base, Florida. Master`s thesis

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

Carter, C.M.; Fortmann, K.M.; Hill, S.W.

1994-12-01

Environmental restoration is an area of concern in an environmentally conscious world. Much effort is required to clean up the environment and promote environmentally sound methods for managing current land use. In light of the public consciousness with the latter topic, the United States Air Force must also take an active role in addressing these environmental issues with respect to current and future USAF base land use. This thesis uses the systems engineering technique to assess human health risks and to evaluate risk management options with respect to depleted uranium contamination in the sampled region of Test Area (TA) C-64more » at Eglin Air Force Base (AFB). The research combines the disciplines of environmental data collection, DU soil concentration distribution modeling, ground water modeling, particle resuspension modeling, exposure assessment, health hazard assessment, and uncertainty analysis to characterize the test area. These disciplines are required to quantify current and future health risks, as well as to recommend cost effective ways to increase confidence in health risk assessment and remediation options.« less

Opportunities for disease state management in prostate cancer.

PubMed

Pickard, A Simon; Hung, Shih-Ying; McKoy, June M; Witt, Whitney P; Arseven, Adnan; Sharifi, Roohollah; Wu, Zhigang; Knight, Sara J; McWilliams, Norene; Schumock, Glen T; Bennett, Charles L

2005-08-01

In this paper, we examine how the management of prostate cancer lends itself to a disease state management (DSM)-based approach, and propose a framework that emphasizes the patient-provider-caregiver triad in managing the long-term implications of the condition. There is often no clearly superior approach to the management of patients with prostate cancer (eg, watchful waiting and hormonal therapy), and each option entails different trade-offs in quality of life. Ideally, the physician and patient discuss the options, issues, and patient preferences for treatment through the shared decision-making process. A family caregiver such as the spouse of the patient is often involved in the treatment decision and in the long-term management of the cancer experience. In order to develop a DSM program supporting both patient and caregiver, educational, psychosocial, and health care system support needs should be tailored to each phase of cancer treatment/management. To embrace the unique aspects of prostate cancer management, the proposed framework emphasizes communication among the patient-caregiver-provider triad, inclusion of family caregivers in the program, cancer phase-specific support, and psychosocial services as a basis for implementation and evaluation of a DSM program in prostate cancer.

Groundwater regulation and integrated planning

USGS Publications Warehouse

Quevauviller, Philippe; Batelaan, Okke; Hunt, Randall J.

2016-01-01

The complex nature of groundwater and the diversity of uses and environmental interactions call for emerging groundwater problems to be addressed through integrated management and planning approaches. Planning requires different levels of integration dealing with: the hydrologic cycle (the physical process) including the temporal dimension; river basins and aquifers (spatial integration); socioeconomic considerations at regional, national and international levels; and scientific knowledge. The great natural variation in groundwater conditions obviously affects planning needs and options as well as perceptions from highly localised to regionally-based approaches. The scale at which planning is done therefore needs to be carefully evaluated against available policy choices and options in each particular setting. A solid planning approach is based on River Basin Management Planning (RBMP), which covers: (1) objectives that management planning are designed to address; (2) the way various types of measures fit into the overall management planning; and (3) the criteria against which the success or failure of specific strategies or interventions can be evaluated (e.g. compliance with environmental quality standards). A management planning framework is to be conceived as a “living” or iterated document that can be updated, refined and if necessary changed as information and experience are gained. This chapter discusses these aspects, providing an insight into European Union (EU), United States and Australia groundwater planning practices.

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

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

PubMed

Katwa, Umakanth; Rivera, Estefania

2018-03-10

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

Data base management system and display software for the National Geophysical Data Center geomagnetic CD-ROM's

NASA Technical Reports Server (NTRS)

Papitashvili, N. E.; Papitashvili, V. O.; Allen, J. H.; Morris, L. D.

1995-01-01

The National Geophysical Data Center has the largest collection of geomagnetic data from the worldwide network of magnetic observatories. The data base management system and retrieval/display software have been developed for the archived geomagnetic data (annual means, monthly, daily, hourly, and 1-minute values) and placed on the center's CD-ROM's to provide users with 'user-oriented' and 'user-friendly' support. This system is described in this paper with a brief outline of provided options.

Managing Cancer Care: a psycho-educational intervention to improve knowledge of care options and breast cancer self-management.

PubMed

Schulman-Green, Dena; Jeon, Sangchoon

2017-02-01

We tested the feasibility and acceptability of a psycho-educational self-management intervention, Managing Cancer Care: A Personal Guide (MCC), to improve knowledge of care options (curative, palliative, and hospice care) among a range of breast cancer self-management skills. We conducted a one-group, pre-post-test study among women with non-metastatic breast cancer (n = 105). We gave participants the printed, self-guided, seven-module intervention following enrollment. At baseline and 2  months, we measured knowledge of care options, desired and actual role in self-management, medical communication skills, experience and management of transitions, anxiety, depression, uncertainty, and self-efficacy. We conducted interviews to obtain module ratings and qualitative data on strengths and limitations of MCC. Knowledge of care options (δ = 0.40 (1.11), p = 0.0005) and desired role in self-management (δ = -0.28 (1.08), p = 0.0177) significantly improved. Less skilled medical communicators significantly improved their communication (δ = 3.47, standard deviation = 6.58, p = 0.0449). Multivariate modeling showed that changes in our primary outcomes of medical communication and management of transitions seemed to drive positive changes in our secondary outcomes of anxiety, depression, uncertainty, and self-efficacy. Participants highly rated MCC and reported the importance of understanding care options despite non-metastatic disease. MCC is a feasible and acceptable means of improving knowledge of care options and other aspects of breast cancer self-management. The combination of modules offered in MCC appears to have beneficial interactive effects. We are currently testing MCC more rigorously in a randomized controlled trial to explore mediating and moderating relationships. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Integrated Research on the Development of Global Climate Risk Management Strategies - Framework and Initial Results of the Research Project ICA-RUS

NASA Astrophysics Data System (ADS)

Emori, Seita; Takahashi, Kiyoshi; Yamagata, Yoshiki; Oki, Taikan; Mori, Shunsuke; Fujigaki, Yuko

2013-04-01

With the aim of proposing strategies of global climate risk management, we have launched a five-year research project called ICA-RUS (Integrated Climate Assessment - Risks, Uncertainties and Society). In this project with the phrase "risk management" in its title, we aspire for a comprehensive assessment of climate change risks, explicit consideration of uncertainties, utilization of best available information, and consideration of every possible conditions and options. We also regard the problem as one of decision-making at the human level, which involves social value judgments and adapts to future changes in circumstances. The ICA-RUS project consists of the following five themes: 1) Synthesis of global climate risk management strategies, 2) Optimization of land, water and ecosystem uses for climate risk management, 3) Identification and analysis of critical climate risks, 4) Evaluation of climate risk management options under technological, social and economic uncertainties and 5) Interactions between scientific and social rationalities in climate risk management (see also: http://www.nies.go.jp/ica-rus/en/). For the integration of quantitative knowledge of climate change risks and responses, we apply a tool named AIM/Impact [Policy], which consists of an energy-economic model, a simplified climate model and impact projection modules. At the same time, in order to make use of qualitative knowledge as well, we hold monthly project meetings for the discussion of risk management strategies and publish annual reports based on the quantitative and qualitative information. To enhance the comprehensiveness of the analyses, we maintain an inventory of risks and risk management options. The inventory is revised iteratively through interactive meetings with stakeholders such as policymakers, government officials and industrial representatives.

Current management of hepatocellular carcinoma

PubMed Central

Tabrizian, Parissa; Roayaie, Sasan; Schwartz, Myron E

2014-01-01

Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide and leading cause of death among patients with cirrhosis. Treatment guidelines are based according to the Barcelona Clinic Liver Cancer staging system. The choice among therapeutic options that include liver resection, liver transplantation, locoregional, and systemic treatments must be individualized for each patient. The aim of this paper is to review the outcomes that can be achieved in the treatment of HCC with the heterogeneous therapeutic options currently available in clinical practice. PMID:25132740

Chemical hazards associated with treatment of waste electrical and electronic equipment

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

Tsydenova, Oyuna; Bengtsson, Magnus, E-mail: bengtsson@iges.or.jp

2011-01-15

This review paper summarizes the existing knowledge on the chemical hazards associated with recycling and other end-of-life treatment options of waste electrical and electronic equipment (e-waste). The hazards arise from the presence of heavy metals (e.g., mercury, cadmium, lead, etc.), flame retardants (e.g., pentabromophenol, polybrominated diphenyl ethers (PBDEs), tetrabromobisphenol-A (TBBPA), etc.) and other potentially harmful substances in e-waste. If improperly managed, the substances may pose significant human and environmental health risks. The review describes the potentially hazardous content of e-waste, examines the existing e-waste management practices and presents scientific data on human exposure to chemicals, workplace and environmental pollution associatedmore » with the three major e-waste management options, i.e., recycling, incineration and landfilling. The existing e-waste management practices and associated hazards are reviewed separately for developed and developing countries. Finally, based on this review, the paper identifies gaps in the existing knowledge and makes some recommendations for future research.« less

Options of system integrated environment modelling in the predicated dynamic cyberspace

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

Janková, Martina; Dvořák, Jiří

In this article there are briefly mentioned some selected options of contemporary conception of cybernetic system models in the corresponding and possible integratable environment with modern system dynamics thinking and all this in the cyberspace of possible projecting of predicted system characteristics. The key to new capabilities of system integration modelling in the considered cyberspace is mainly the ability to improve the environment and the system integration options, all this with the aim of modern control in the hierarchically arranged dynamic cyberspace, e.g. in the currently desired electronic business with information. The aim of this article is to assess generallymore » the trends in the use of modern modelling methods considering the cybernetics applications verified in practice, modern concept of project management and also the potential integration of artificial intelligence in the new projecting and project management of integratable and intelligent models, e.g. with the optimal structures and adaptable behaviour.The article results from the solution of a specific research partial task at the faculty; especially the moments proving that the new economics will be based more and more on information, knowledge system defined cyberspace of modern management, are stressed in the text.« less

Designing cost effective water demand management programs in Australia.

PubMed

White, S B; Fane, S A

2002-01-01

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

Traffic Management in ATM Networks Over Satellite Links

NASA Technical Reports Server (NTRS)

Goyal, Rohit; Jain, Raj; Goyal, Mukul; Fahmy, Sonia; Vandalore, Bobby; vonDeak, Thomas

1999-01-01

This report presents a survey of the traffic management Issues in the design and implementation of satellite Asynchronous Transfer Mode (ATM) networks. The report focuses on the efficient transport of Transmission Control Protocol (TCP) traffic over satellite ATM. First, a reference satellite ATM network architecture is presented along with an overview of the service categories available in ATM networks. A delay model for satellite networks and the major components of delay and delay variation are described. A survey of design options for TCP over Unspecified Bit Rate (UBR), Guaranteed Frame Rate (GFR) and Available Bit Rate (ABR) services in ATM is presented. The main focus is on traffic management issues. Several recommendations on the design options for efficiently carrying data services over satellite ATM networks are presented. Most of the results are based on experiments performed on Geosynchronous (GEO) latencies. Some results for Low Earth Orbits (LEO) and Medium Earth Orbit (MEO) latencies are also provided.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-19

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

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

PubMed

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

2010-12-01

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

Power management and distribution considerations for a lunar base

NASA Technical Reports Server (NTRS)

Kenny, Barbara H.; Coleman, Anthony S.

1991-01-01

Design philosophies and technology needs for the power management and distribution (PMAD) portion of a lunar base power system are discussed. A process is described whereby mission planners may proceed from a knowledge of the PMAD functions and mission performance requirements to a definition of design options and technology needs. Current research efforts at the NASA LRC to meet the PMAD system needs for a Lunar base are described. Based on the requirements, the lunar base PMAD is seen as best being accomplished by a utility like system, although with some additional demands including autonomous operation and scheduling and accurate, predictive modeling during the design process.

GIS-Based Education Course for Bachelor of Management Program in the Lomonosov Moscow State University Business School

NASA Astrophysics Data System (ADS)

Pirogov, A.

2014-04-01

An optional course, "Geographical Aspects of Business" in the framework of the Bachelor of management program in the Lomonosov Moscow State University Business School is setting the goal to introduce future discipline specialists with geographical topics of current interest for management and provide knowledge, skills and expertise of geospatial analysis and the use of geoinformation technologies in finding solutions to economic and managerial tasks. The students' feedback shows interest and demand for such a course for management students. The course has an interdisciplinary links with the main subjects such as marketing, public administration, visual communication, etc., and is based on the set of business cases dealing with Web-GIS Services, LBS, Geomarketing, Spatial analysis, etc. Open Data and corporate geodata sets are used. The pragmatist approach is selected for successful accomplishment of the course's goal, which is based on using Web-GIS tools. The Geomixer - a free web- GIS product by the company SCANEX - is chosen to be one of them. The principle "I do - I analyze" helps to minimize the theoretic constituent of the course improving the outcome of the classes. Owing to innovative methods of teaching, the educational goal of the course is achieved to the full scope despite the small number of allocated hours. The classes surely improve both the general level of geographic competence of students and provide them with the skills to work with GIS. Such optional courses will undoubtedly contribute to the development of GIS-education in management administration.

SMARTE: HELPING COMMUNITIES EVALUATE REUSE OPTIONS AND OVERCOME REVITALIZATION OBSTACLES

EPA Science Inventory

SMARTe (Sustainable Management Approaches and Revitalization Tools electronic) is a web-based decision support tool being developed by the Office of Research and Development (ORD) in partnership with the Office of Brownfields and Land Revitalization (OBLR), the Interstate Techn...

ISSUES IN SEDIMENT TOXICITY AND ECOLOGICAL RISK ASSESSMENT

EPA Science Inventory

This paper is based on a facilitated Workshop and Roundtable Discussion of key issues in sediment toxicology and ecological risk assessment (ERA) as applied to sediments that was held at the Conference on Dredged Material Management: Options and Environmental Considerations. The ...

New Options in Constipation Management.

PubMed

Davis, Mellar; Gamier, Pamela

2015-12-01

Constipation is common in the general population and for those on opioids and/or who are suffering from advanced cancer. Self-management consists of dietary changes, exercise, and laxatives. However, responses to self-management efforts are often inadequate to relieve the subjective and objective experience of constipation. Multiple new anti-constipating medications have recently been tested in randomized trials and the following are available commercially: probiotics, prucalopride, lubiprostone, linaclotide, elobixibat, antidepressants, methylnaltrexone, alvimopan, and naloxegol. This review will discuss the evidence-based benefits of these medications and outline an approach to managing constipation.

41 CFR 101-39.004 - Optional operations.

Code of Federal Regulations, 2011 CFR

2011-07-01

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

41 CFR 101-39.004 - Optional operations.

Code of Federal Regulations, 2013 CFR

2013-07-01

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

School Management Options for American Indians.

ERIC Educational Resources Information Center

Streiff, Paul R.

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

Management strategies in hospitals: scenario planning

PubMed Central

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

2015-01-01

Background: Instead of waiting for challenges to confront hospital management, doctors and managers should act in advance to optimize and sustain value-based health. This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed to. Methodology: Based on literature analysis as well as on personal interviews with stakeholders we propose an elaborated definition of stakeholders and designed a questionnaire that integrated the following influence factors, which have relevant impact on hospital management: political/legal, economic, social, technological and environmental forces. These influence factors are examined to develop the so-called critical uncertainties. Thorough identification of uncertainties was based on a “Stakeholder Feedback”. Results: Two key uncertainties were identified and considered in this study: the development of workload for the medical staff the profit oriented performance of the medical staff. According to the developed scenarios, complementary education of the medical staff as well as of non-medical top executives and managers of hospitals was the recommended core strategy. Complementary scenario-specific strategic options should be considered whenever needed to optimize dealing with a specific future development of the health care environment. Conclusion: Strategic planning in hospitals is essential to ensure sustainable success. It considers multiple situations and integrates internal and external insights and perspectives in addition to identifying weak signals and “blind spots”. This flows into a sound planning for multiple strategic options. It is a state of the art tool that allows dealing with the increasing challenges facing hospital management. PMID:26504735

Risk-based decision-making framework for the selection of sediment dredging option.

PubMed

Manap, Norpadzlihatun; Voulvoulis, Nikolaos

2014-10-15

The aim of this study was to develop a risk-based decision-making framework for the selection of sediment dredging option. Descriptions using case studies of the newly integrated, holistic and staged framework were followed. The first stage utilized the historical dredging monitoring data and the contamination level in media data into Ecological Risk Assessment phases, which have been altered for benefits in cost, time and simplicity. How Multi-Criteria Decision Analysis (MCDA) can be used to analyze and prioritize dredging areas based on environmental, socio-economic and managerial criteria was described for the next stage. The results from MCDA will be integrated into Ecological Risk Assessment to characterize the degree of contamination in the prioritized areas. The last stage was later described using these findings and analyzed using MCDA, in order to identify the best sediment dredging option, accounting for the economic, environmental and technical aspects of dredging, which is beneficial for dredging and sediment management industries. Copyright © 2014 Elsevier B.V. All rights reserved.

Assessment of applicability index for better management of municipal solid waste: a case study of Dhanbad, India.

PubMed

Yadav, Pooja; Samadder, S R

2018-06-01

Selection of suitable municipal solid waste management (MSWM) options is one of the major challenges in urban areas of the developing countries. Success of MSWM requires accurate data of generation rate, composition and physico-chemical characteristics of solid wastes. Improper handling of solid waste can have significant environmental and aesthetical impacts. The present study proposes a new method (applicability index - P ik values) for identifying the most appropriate disposal option with the help of applicability values of Composting-C P , Incineration-I P and Landfill-L P for individual components of MSW based on the results of the physico-chemical analysis of the collected representative solid waste samples from the study area, Dhanbad, India. The mean values of moisture content, carbon, hydrogen, oxygen, nitrogen, sulfur, volatile organic carbon, fixed carbon, ash content, density and calorific values (CV) of individual components were used as input values in this process. Based on the proposed applicability index (P ik ), the highest P ik values were obtained for incineration (I P ) for plastics, polythene, paper, coconut shell, wood, cardboard, textile, thermocol (polystyrene), rubber, sugarcane bagasse, cow dung and leather wastes (I P  > C P  > L P ) due to high CV of these solid waste components; the highest P ik values were obtained for composting (C P ) of kitchen waste (C P  > I P  > L P ); and the highest P ik values for inert wastes were obtained for landfill option (L P  > I P  > C P ). The highest P ik value for a particular waste for a specific treatment option signifies that the waste is suitable for treatment/disposal using that option.

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

Treesearch

Frederick C. Hall

1985-01-01

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

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

Code of Federal Regulations, 2010 CFR

2010-01-01

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

Long-Term Management Strategy for Dredged Material Disposal for Naval Weapons Station, Yorktown, Yorktown, Virginia; Naval Supply Center, Cheatham Annex, Williamsburg, Virginia; and Naval Amphibious Base, Little Creek, Norfolk, Virginia. Phase 2: Formulation of Alternatives

DTIC Science & Technology

1993-03-01

Regulatory Framework and Management Strategy ... .......... 11 Need for Criteria ............... ........................ .. 12 Criteria for Open-Water... Framework and Managetent Strategy 19. Because the Phase I results indicated that there is insufficient confined disposal capacity, the assessment of open...regulatory framework established for Sections 103 and 404. 11 20. All disposal options considered for this LTMS were examined using the Corps Management

Roadwaste : issues and options.

DOT National Transportation Integrated Search

1998-06-01

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

41 CFR 101-26.302 - Standard and optional forms.

Code of Federal Regulations, 2013 CFR

2013-07-01

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

41 CFR 101-26.302 - Standard and optional forms.

Code of Federal Regulations, 2011 CFR

2011-07-01

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

41 CFR 101-26.302 - Standard and optional forms.

Code of Federal Regulations, 2012 CFR

2012-07-01

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

41 CFR 101-26.302 - Standard and optional forms.

Code of Federal Regulations, 2010 CFR

2010-07-01

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

41 CFR 101-26.302 - Standard and optional forms.

Code of Federal Regulations, 2014 CFR

2014-07-01

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

Management options of non-syndromic sagittal craniosynostosis.

PubMed

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

2017-05-01

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

Siting and Routing Assessment for Solid Waste Management Under Uncertainty Using the Grey Mini-Max Regret Criterion

NASA Astrophysics Data System (ADS)

Chang, Ni-Bin; Davila, Eric

2006-10-01

Solid waste management (SWM) is at the forefront of environmental concerns in the Lower Rio Grande Valley (LRGV), South Texas. The complexity in SWM drives area decision makers to look for innovative and forward-looking solutions to address various waste management options. In decision analysis, it is not uncommon for decision makers to go by an option that may minimize the maximum regret when some determinant factors are vague, ambiguous, or unclear. This article presents an innovative optimization model using the grey mini-max regret (GMMR) integer programming algorithm to outline an optimal regional coordination of solid waste routing and possible landfill/incinerator construction under an uncertain environment. The LRGV is an ideal location to apply the GMMR model for SWM planning because of its constant urban expansion, dwindling landfill space, and insufficient data availability signifying the planning uncertainty combined with vagueness in decision-making. The results give local decision makers hedged sets of options that consider various forms of systematic and event-based uncertainty. By extending the dimension of decision-making, this may lead to identifying a variety of beneficial solutions with efficient waste routing and facility siting for the time frame of 2005 through 2010 in LRGV. The results show the ability of the GMMR model to open insightful scenario planning that can handle situational and data-driven uncertainty in a way that was previously unavailable. Research findings also indicate that the large capital investment of incineration facilities makes such an option less competitive among municipal options for landfills. It is evident that the investment from a municipal standpoint is out of the question, but possible public-private partnerships may alleviate this obstacle.

Option contracts for allocating water in inter-basin transfers: the case of the Tagus-Segura Transfer in Spain

NASA Astrophysics Data System (ADS)

Rey, Dolores; Garrido, Alberto; Calatraba, Javier

2014-05-01

Users in the Mediterranean region face significant water supply risks. Water markets mechanisms can provide flexibility to water systems run in tight situations. The largest water infrastructure in the Iberian Peninsula connects the Segura and Tagus Basins. Stakeholders and politicians in the Tagus Basin have asked that water transfers between the two basins be eventually phased out. The need to increase the statutory minimum environmental flow in the middle Tagus and to meet new urban demands is going to result in a redefinition of the Transfer's management rules, leading to a reduction in the transferable volumes. To minimise the consequences of such restrictions to irrigators in the Segura Basin who depend on the transferred volumes, we propose the establishment of water option contracts between both basins that represents an institutional innovation with respect to previous inter-basin spot market experiences. Based on the draft of the new Tagus Basin Plan, we propose both a modification of the Transfer's management rule and an innovative inter-basin option contract. The main goal of the paper is to define this contract and evaluate it with respect to non-market scenarios. We also assess the resulting impact on environmental flows in the Tagus River and water availability for users in the Segura Basin, together with the economic impacts of such contract on both basins. Our results show that the proposed option contract would reduce the impact of a change in the transfer's management rule, and reduce the supply risks of the recipient area. Keywords: environmental flow, inter-basin transfer, option contracts, Tagus-Segura, water markets, water supply reliability.

Current treatment for vitreous floaters.

PubMed

Sendrowski, David P; Bronstein, Mark A

2010-03-01

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

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

PubMed

Kumar, Atul; Samadder, S R

2017-11-01

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

Management for adaptation

Treesearch

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

2009-01-01

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

Bt: One Option for Gypsy Moth Management

Treesearch

Deborah C. Mccullough; Leah S. Bauer

2000-01-01

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

Patient Perceptions About Prediabetes and Preferences for Diabetes Prevention.

PubMed

O'Brien, Matthew J; Moran, Margaret R; Tang, Joyce W; Vargas, Maria C; Talen, Mary; Zimmermann, Laura J; Ackermann, Ronald T; Kandula, Namratha R

2016-12-01

The purpose of this study was to explore how adults with prediabetes perceive their risk of developing diabetes and examine their preferences for evidence-based treatment options to prevent diabetes. A qualitative study was conducted in 2 large Midwest primary care practices, involving in-depth semistructured interviews with 35 adult patients with prediabetes. This ethnically diverse (77% nonwhite) sample of middle-aged primary care patients exhibited multiple diabetes risk factors. Knowledge gaps about prediabetes and its medical management were pervasive. Most patients overestimated the risk of developing diabetes and were not familiar with evidence-based treatment options for prediabetes. They suggested that receiving brief, yet specific information about these topics during the study interview motivated them to act. The majority of participants considered both intensive lifestyle intervention and metformin acceptable treatment options. Many preferred initial treatment with intensive lifestyle intervention but would take metformin if their efforts at lifestyle change failed and their primary care physician recommended it. Some participants expressed wanting to combine both treatments. This qualitative study highlights potential opportunities to promote patient-centered dialogue about prediabetes in primary care settings. Providing patients specific information about the risk of developing diabetes and evidence-based treatment options to prevent or delay its onset may encourage action. Physicians' prediabetes counseling efforts should be informed by the finding that most patients consider both intensive lifestyle intervention and metformin acceptable treatment options. © 2016 The Author(s).

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

PubMed

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

2012-05-01

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

Cross-scale interactions affect tree growth and intrinsic water use efficiency and highlight the importance of spatial context in managing forests under global change

Treesearch

Kenneth J. Ruzicka; Klaus J. Puettmann; J. Renée Brooks

2017-01-01

Summary1. We investigated the potential of cross-scale interactions to affect the outcome of density reduction in a large-scale silvicultural experiment to better understand options for managing forests under climate change. 2. We measured tree growth and intrinsic water-use efficiency (iWUE) based on stable carbon isotopes (δ...

Financial valuation of incentive arrangements in managed care contracts: a real options approach.

PubMed

Maurer, R T

2001-01-01

Managed care provider contracts with risk-based compensation arrangements are similar to derivative securities in that the value of a contract depends on the value of a more fundamental asset: the health plan's investment in the provider's member panel. As such, the financial value of the incentive to avoid investing in the health of the member panel can be modeled using financial engineering techniques.

Using the Viability Theory to Assess the Flexibility of Forest Managers Under Ecological Intensification

NASA Astrophysics Data System (ADS)

Mathias, Jean-Denis; Bonté, Bruno; Cordonnier, Thomas; de Morogues, Francis

2015-11-01

Greater demand for wood material has converged with greater demand for biodiversity conservation to make balancing forest ecosystem services a key societal issue. Forest managers, owners, or policymakers need new approaches and methods to evaluate their ability to adapt to this dual objective. We analyze the ability of forest owners to define sustainable forest management options based on viability theory and a new flexibility index. This new indicator gauges the adaptive capacity of forest owners based on the number of sustainable actions available to them at a given time. Here we study a public forest owner who regulates harvest intensity and frequency in order to meet demand for timber wood at forest scale and to meet a biodiversity recommendation via a minimum permanently maintained volume of deadwood per hectare at stand scale. Dynamical systems theory was used to model uneven-aged forest dynamics—including deadwood dynamics—and the dynamics of timber wood demand and tree removals. Uneven-aged silver fir forest management in the "Quatre Montagnes region" (Vercors, France) is used as an illustrative example. The results explain situations where a joint increase in wood production and deadwood retention does not reduce the flexibility index more than increasing either one dimension alone, thus opening up ecological intensification options. To conclude, we discuss the value of the new flexibility index for addressing environmental management and ecological intensification issues.

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

PubMed

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

2016-06-01

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

Modelling coastal processes and morphological changes of the UK east coast in support of coastal decision-making

NASA Astrophysics Data System (ADS)

Li, Xiaorong; Leonardi, Nicoletta; Brown, Jennifer; Plater, Andy

2017-04-01

The coastline of Eastern England is home to about one quarter of the UK's coastal habitats, including intertidal salt marshes, tidal flats and sand dunes. These geomorphic features are of great importance to the local wildlife, global biodiversity, marine environment and human society and economy. Due to sea-level rise and the occurrence of extreme weather conditions, the coastline of Eastern England is under high risk of erosion and recession, which could lead to tidal inundation of sites such as the RSPB Minsmere Reserve and power generation infrastructure at Sizewell. This research responds to the need for sustainable shoreline management plans of the UK east coast through sensitivity studies at the Dunwich-Sizewell area, Suffolk, UK. Particular interest is on the long-term morphodynamic response of the study area to possible environmental variations associated with global climate change. Key coastal processes, i.e. current, waves and sediment transport, and morphological evolution are studied using a process-based numerical model under the following scenarios: current mean sea level + calm wave conditions, current mean sea level + storms, sea level rise + calm wave conditions, and sea level rise + storms, all with a 'do nothing' management plan which allows the coastal environment to exist and respond dynamically. As a further aspect of this research, rules will be generalized for reduced-complexity, system-based modelling. Alternative management plans, including 'managed realignment' and 'advance the line', are also investigated in this research under the same environmental forcing scenarios, for the purposes of protection of infrastructure of national importance and conservation of wetland habitats. Both 'hard' and 'soft' engineering options, such as groynes and beach nourishment respectively, are considered. A more ecohydrological option which utilizes aquatic plant communities for wave energy dissipation and sediment trapping is also studied. The last option requires the numerical models to be modified based on understandings obtained through analysis of on-site observations and laboratory measurements.

ESTIMATION OF EXPOSURE DOSES FOR THE SAFE MANAGEMENT OF NORM WASTE DISPOSAL.

PubMed

Jeong, Jongtae; Ko, Nak Yul; Cho, Dong-Keun; Baik, Min Hoon; Yoon, Ki-Hoon

2018-03-16

Naturally occurring radioactive materials (NORM) wastes with different radiological characteristics are generated in several industries. The appropriate options for NORM waste management including disposal options should be discussed and established based on the act and regulation guidelines. Several studies calculated the exposure dose and mass of NORM waste to be disposed in landfill site by considering the activity concentration level and exposure dose. In 2012, the Korean government promulgated an act on the safety control of NORM around living environments to protect human health and the environment. For the successful implementation of this act, we suggest a reference design for a landfill for the disposal of NORM waste. Based on this reference landfill, we estimate the maximum exposure doses and the relative impact of each pathway to exposure dose for three scenarios: a reference scenario, an ingestion pathway exclusion scenario, and a low leach rate scenario. Also, we estimate the possible quantity of NORM waste disposal into a landfill as a function of the activity concentration level of U series, Th series and 40K and two kinds of exposure dose levels, 1 and 0.3 mSv/y. The results of this study can be used to support the establishment of technical bases of the management strategy for the safe disposal of NORM waste.

A prototype knowledge-based decision support system for industrial waste management. Part 2: Application to a Trinidadian industrial estate case study

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

Boyle, C.A.; Baetz, B.W.

1998-09-01

A knowledge-based decision support system (KBDSS) has been developed to examine the potentials for reuse, co-treatment, recycling and disposal of wastes from different industrial facilities. Four plants on the Point Lisas Industrial Estate in Trinidad were selected to test this KBDSS; a gas processing plant, a methanol plant, a fertilizer/ammonia plant and a steel processing plant. A total of 77 wastes were produced by the plants (51,481,500 t year{sup {minus}1}) with the majority being released into the ocean or emitted into the air. Seventeen wastes were already being recycled off-site so were not included in the database. Using a knowledgemore » base of 25 possible treatment processes, the KBDSS generated over 4,600 treatment train options for managing the plant wastes. The developed system was able to determine treatment options for the wastes which would minimize the number of treatments and the amount of secondary wastes produced and maximize the potential for reuse, recycling and co-treatment of wastes.« less

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

PubMed

Smith, Jonathan W N; Kerrison, Gavin

2013-01-01

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

Alternative strategies for Medicare payment of outpatient prescription drugs--Part B and beyond.

PubMed

Danzon, Patricia M; Wilensky, Gail R; Means, Kathleen E

2005-03-01

Reimbursement options for pharmaceuticals reimbursed under Medicare Part B (physician-dispensed drugs) are changing and the new comprehensive Part D Medicare outpatient drug benefit brings further changes. The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) replaces traditional policy, of reimbursing Part B drugs at 95% of average wholesale price (AWP, a list price), with a percentage markup over the manufacturer's average selling price; in 2005 an indirect competitive procurement option will be introduced. In our view, although AWP-based reimbursement has been fraught with problems in the past, these could be fixed by constraining growth in AWP and periodically adjusting the discount off AWP. With these revisions, an AWP-based rule would preserve incentives for competitive discounting and deliver savings to Medicare. By contrast, basing Medicare reimbursement on a manufacturer's average selling price undermines incentives for discounting and, like any cost-based reimbursement rule, may result in higher prices to both public and private purchasers. Indirect competitive procurement for drugs alone, using specialty pharmacies, pharmacy benefit managers, or prescription drug plans, is unlikely to constrain costs to acceptable levels unless contractors retain flexibility to use standard benefit management tools. Folding Part B and Part D into comprehensive contracting with health plans for full health services is likely to offer the most efficient approach to managing the drug benefit.

Leachate water quality from soils amended with swine manure based biochars

USDA-ARS?s Scientific Manuscript database

In the face of the rising level of manure production from concentrated animal feeding operations (CAFOs), management options are being sought that can provide nutrient recycling for plant growth and improved soil conditions with minimal environmental impacts. Alternatives to direct manure applicatio...

BROAD-BASED ENVIRONMENTAL LIFE CYCLE ASSESSMENT

EPA Science Inventory

Pollution prevention through Life Cycle Assessment (LCA) is a departure from evaluating waste management options that look mainly at single issues such as recyclability or reduced toxicity. An LCA is a snapshot in time of inputs and outputs. It can be used as an objective technic...

Leachate water quality of soils amended with different swine manure-based amendments

EPA Science Inventory

In the face of the rising level of manure production from concentrated animal feeding operations (CAFOs), management options are being sought that can provide nutrient recycling for plant growth and improved soil conditions with minimal environmental impacts. Alternatives to dire...

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

Code of Federal Regulations, 2010 CFR

2010-04-01

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

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

PubMed

Matzkin, Elizabeth

2018-05-01

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

Preeradication vaccine policy options for poliovirus infection and disease control.

PubMed

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

2013-04-01

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

Surgical management of corneal infections.

PubMed

Tuli, Sonal; Gray, Matthew

2016-07-01

The purpose of this review is to discuss the options for, and recent developments in, the surgical treatment of corneal infections. Although the mainstay of treatment of corneal infections is topical antimicrobial agents, surgical intervention may be necessary in a number of cases. These include advanced disease at presentation, resistant infections, and progressive ulceration despite appropriate treatment. Prompt and appropriate treatment can make the difference between a good outcome and loss of vision or the eye. There are a number of surgical therapies available for corneal infections. Preferred therapeutic modalities differ based on the size, causation, and location of the infection but consist of either replacement of the infected tissue or structural support of the tissue to allow healing. Although there are no completely novel therapies that have been developed recently, there have been incremental improvements in the existing treatment modalities making them more effective, easier, and safer. Several options are available for surgically managing corneal infections. Ophthalmologists should select the optimal procedure based on the individual patient's situation. http://links.lww.com/COOP/A20.

Surgical management of corneal infections

PubMed Central

Tuli, Sonal; Gray, Matthew

2016-01-01

Purpose of review The purpose of this review is to discuss the options for, and recent developments in, the surgical treatment of corneal infections. While the mainstay of treatment of corneal infections is topical antimicrobial agents, surgical intervention may be necessary in a number of cases. These include advanced disease at presentation, resistant infections, and progressive ulceration despite appropriate treatment. Prompt and appropriate treatment can make the difference between a good outcome and loss of vision or the eye. Recent findings There are a number of surgical therapies available for corneal infections. Preferred therapeutic modalities differ based on the size, causation, and location of the infection but consist of either replacement of the infected tissue or structural support of the tissue to allow healing. While there are no completely novel therapies that have been developed recently, there have been incremental improvements in the existing treatment modalities making them more effective, easier, and safer. Summary Several options are available for surgically managing corneal infections. Ophthalmologists should select the optimal procedure based on the individual patient’s situation. PMID:27096375

Surgical management of herpetic keratitis.

PubMed

Tuli, Sonal; Gray, Matthew; Shah, Ankit

2018-07-01

The purpose of this review is to discuss the options for, and recent developments in, the surgical treatment of herpes keratitis. Although the mainstay of treatment of herpetic keratitis is topical or oral antiviral agents, surgical intervention may be necessary for corneal melting or long-term complications such as scarring, lipid keratopathy, necrotizing keratitis, and neurotrophic keratitis. There are a number of surgical therapies available for herpes keratitis. Preferred therapeutic modalities differ based on the size, causation, and location of the infection but consist of either replacement of the infected tissue or structural support of the tissue to allow healing. Incremental improvements in the existing treatment modalities have made them more effective, easier, and safer, whereas novel therapies such as corneal neurotization are starting to be described in ophthalmic literature. Several options are available for surgically managing the complications of herpes keratitis. Ophthalmologists should select the optimal procedure based on the individual patient's situation. VIDEO ABSTRACT: http://links.lww.com/COOP/A28.

Research on Agricultural Product Options Pricing Based on Lévy Copula

NASA Astrophysics Data System (ADS)

Qiu, Hong

2017-11-01

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

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-20

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

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

Treesearch

Michelle M. Cram; Stephen W. Fraedrich

2005-01-01

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

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

EPA Science Inventory

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

Options for change in the NHS consultant contract.

PubMed

Clarke, R W; Gray, C

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

Options for change in the NHS consultant contract.

PubMed Central

Clarke, R. W.; Gray, C.

1994-01-01

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

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

PubMed

Willuweit, Lars; O'Sullivan, John J

2013-12-15

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

The Virtual Desktop: Options and Challenges in Selecting a Secure Desktop Infrastructure Based on Virtualization

DTIC Science & Technology

2011-10-01

Fortunately, some products offer centralized management and deployment tools for local desktop implementation . Figure 5 illustrates the... implementation of a secure desktop infrastructure based on virtualization. It includes an overview of desktop virtualization, including an in-depth...environment in the data centre, whereas LHVD places it on the endpoint itself. Desktop virtualization implementation considerations and potential

Options for diabetes management in sub-Saharan Africa with an electronic medical record system.

PubMed

Kouematchoua Tchuitcheu, G; Rienhoff, O

2011-01-01

An increase of diabetes prevalence of up to 80% is predicted in sub-Saharan Africa (SSA) by 2025 exceeding the worldwide 55%. Mortality rates of diabetes and HIV/AIDS are similar. Diabetes shares several common factors with HIV/AIDS and multidrug-resistant tuberculosis (MDR-TB). The latter two health problems have been efficiently managed by an open source electronic medical record system (EMRS) in Latin America. Therefore a similar solution for diabetes in SSA could be extremely helpful. The aim was to design and validate a conceptual model for an EMRS to improve diabetes management in SSA making use of the HIV and TB experience. A review of the literature addressed diabetes care and management in SSA as well as existing examples of information and communication technology (ICT) use in SSA. Based on a need assessment conducted in SSA a conceptual model based on the traditionally structured healthcare system in SSA was mapped into a three-layer structure. Application modules were derived and a demonstrator programmed based on an open source EMRS. Then the approach was validated by SSA experts. A conceptual model could be specified and validated which enhances a problem-oriented approach to diabetes management processes. The prototyp EMRS demonstrates options for a patient portal and simulation tools for education of health professional and patients in SSA. It is possible to find IT solutions for diabetes care in SSA which follow the same efficiency concepts as HIV or TB modules in Latin America. The local efficiency and sustainability of the solution will, however, depend on training and changes in work behavior.

Using Watershed Models and Human Behavioral Analyses to identify Management Options to Reduce Lake Erie's Harmful Algal Blooms

NASA Astrophysics Data System (ADS)

Martin, J.; Wilson, R. S.; Aloysius, N.; Kalcic, M. M.; Roe, B.; Howard, G.; Irwin, E.; Zhang, W.; Liu, H.

2017-12-01

In early 2016, the United States and Canada formally agreed to reduce phosphorus inputs to Lake Erie by 40% to reduce the severity of annual Harmful Algal Blooms (HABs). These blooms have become more severe, with record events occurring in 2011 and 2015, and have compromised public safety, shut down drinking water supplies, and negatively impacted the economy of the western Lake Erie basin. Now, a key question is what management options should be pursued to reach the 40% reduction. This presentation will highlight interdisciplinary research to compare the amount and types of practices needed for this reduction to the current and projected levels of adoption. Multiple models of the Maumee watershed identified management plans and adoption rates needed to reach the reduction targets. For example, one successful scenario estimated necessary adoption rates of 50% for subsurface application of fertilizer on row crops, 58% for cover crops, and 78% for buffer strips. Current adoption is below these levels, but future projections based on farmer surveys shows these levels are possible. This information was then used to guide another round of watershed modeling analysis to evaluate scenarios that represented more realistic scenarios based on potential levels of management adoption. In general, these results show that accelerated adoption of management plans is needed compared to past adoption rates, and that some of these greater adoption levels are possible based on likely adoption rates. Increasing the perceived efficacy of the practices is one method that will support greater voluntary rates of adoption.

Minimizing the cost of keeping options open for conservation in a changing climate

USGS Publications Warehouse

Mills, Morena; Nicol, Samuel; Wells, Jessie A.; Lahoz-Monfort, José J.; Wintle, Brendan; Bode, Michael; Wardrop, Martin; Walshe, Terry; Probert, William J. M.; Runge, Michael C.; Possingham, Hugh P.; McDonald Madden, Eve

2014-01-01

Policy documents advocate that managers should keep their options open while planning to protect coastal ecosystems from climate-change impacts. However, the actual costs and benefits of maintaining flexibility remain largely unexplored, and alternative approaches for decision making under uncertainty may lead to better joint outcomes for conservation and other societal goals. For example, keeping options open for coastal ecosystems incurs opportunity costs for developers. We devised a decision framework that integrates these costs and benefits with probabilistic forecasts for the extent of sea-level rise to find a balance between coastal ecosystem protection and moderate coastal development. Here, we suggest that instead of keeping their options open managers should incorporate uncertain sea-level rise predictions into a decision-making framework that evaluates the benefits and costs of conservation and development. In our example, based on plausible scenarios for sea-level rise and assuming a risk-neutral decision maker, we found that substantial development could be accommodated with negligible loss of environmental assets. Characterization of the Pareto efficiency of conservation and development outcomes provides valuable insight into the intensity of trade-offs between development and conservation. However, additional work is required to improve understanding of the consequences of alternative spatial plans and the value judgments and risk preferences of decision makers and stakeholders.

Phytoremediation of landfill leachate.

PubMed

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

2006-01-01

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

Perioperative management in myasthenia gravis: republication of a systematic review and a proposal by the guideline committee of the Japanese Association for Chest Surgery 2014.

PubMed

Kadota, Yoshihisa; Horio, Hirotoshi; Mori, Takeshi; Sawabata, Noriyoshi; Goto, Taichiro; Yamashita, Shin-ichi; Nagayasu, Takeshi; Iwasaki, Akinori

2015-04-01

Thymectomy is regarded as a useful therapeutic option for myasthenia gravis (MG), though perioperative management in MG patients is largely empirical. While evidence-based medicine is limited in the perioperative management of MG patients, treatment guidelines are required as a benchmark. We selected issues faced by physicians in clinical practice in the perioperative management of extended thymectomy for MG, and examined them with a review of the literature. The present guidelines have reached the stage of consensus within the Japanese Association for Chest Surgery.

Environmental assessment of gas management options at the Old Ammässuo landfill (Finland) by means of LCA-modeling (EASEWASTE).

PubMed

Manfredi, Simone; Niskanen, Antti; Christensen, Thomas H

2009-05-01

The current landfill gas (LFG) management (based on flaring and utilization for heat generation of the collected gas) and three potential future gas management options (LFG flaring, heat generation and combined heat and power generation) for the Old Ammässuo landfill (Espoo, Finland) were evaluated by life-cycle assessment modeling. The evaluation accounts for all resource utilization and emissions to the environment related to the gas generation and management for a life-cycle time horizon of 100 yr. The assessment criteria comprise standard impact categories (global warming, photo-chemical ozone formation, stratospheric ozone depletion, acidification and nutrient enrichment) and toxicity-related impact categories (human toxicity via soil, via water and via air, eco-toxicity in soil and in water chronic). The results of the life-cycle impact assessment show that disperse emissions of LFG from the landfill surface determine the highest potential impacts in terms of global warming, stratospheric ozone depletion, and human toxicity via soil. Conversely, the impact potentials estimated for other categories are numerically-negative when the collected LFG is utilized for energy generation, demonstrating that net environmental savings can be obtained. Such savings are proportional to the amount of gas utilized for energy generation and the gas energy recovery efficiency achieved, which thus have to be regarded as key parameters. As a result, the overall best performance is found for the heat generation option - as it has the highest LFG utilization/energy recovery rates - whereas the worst performance is estimated for the LFG flaring option, as no LFG is here utilized for energy generation. Therefore, to reduce the environmental burdens caused by the current gas management strategy, more LFG should be used for energy generation. This inherently requires a superior LFG capture rate that, in addition, would reduce fugitive emissions of LFG from the landfill surface, bringing further environmental benefits.

[Rupture of membranes: pathophysiology, diagnosis, consequences and management].

PubMed

Blanchon, L; Accoceberry, M; Belville, C; Delabaere, A; Prat, C; Lemery, D; Sapin, V; Gallot, D

2013-04-01

Rupture of membranes (ROM) depends on mechanical stretch, extracellular matrix components imbalance and increased apoptosis. It occurs in 2 to 3% of all pregnancies before 37 weeks' gestation (WG) and in up to 10% at term. Main consequences are labor induction and risk of maternal-fetal infection. ROM is associated with one third of preterm births and about 20% of perinatal mortality. This review deals with recent knowledge concerning ROM including diagnosis and management. In many cases, ROM is easily identified by clinical examination. In other cases, the use of vaginal pH appears to be less efficient than the use of immunochromatographic strips based on IGFBP-1 or PAMG-1 detection. Before 34WG, conservative management consists in in utero transfer, antibioprophylaxis and corticosteroids. After 37WG, delivery is the most appropriate option. Between 34 and 37WG, recent studies demonstrate that induction of labour does not improve pregnancy outcomes. Therefore, expectant management can be the first option between 34 and 37WG when no active infection is suspected especially in case of unfavourable cervix. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Computerizing Your Program.

ERIC Educational Resources Information Center

Curtis, Rick

This paper summarizes information about using computer hardware and software to aid in making purchase decisions that are based on user needs. The two major options in hardware are IBM-compatible machines and the Apple Macintosh line. The three basic software applications include word processing, database management, and spreadsheet applications.…

78 FR 69048 - Caribbean Fishery Management Council; Public Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-18

.... Kate Quigley Comprehensive Island Based FMP Update --Discussion of Option Paper Comprehensive Amendment... completion of discussion relevant to the agenda items. To further accommodate discussion and completion of... in this notice. The meetings are open to the public, and will be conducted in English. Fishers and...

Leachate water quality of soils amended with different swine manure-based amendments

USDA-ARS?s Scientific Manuscript database

In the face of the rising level of manure production from concentrated animal feeding operations (CAFOs), management options are being sought that can provide nutrient recycling for plant growth and improved soil conditions with minimal environmental impacts. Alternatives to direct manure applicatio...

Updates in the management of stable chronic obstructive pulmonary disease.

PubMed

Narsingam, Saiprasad; Bozarth, Andrew L; Abdeljalil, Asem

2015-01-01

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease state characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory process. It is increasingly recognized as a major public health problem, affecting more than 20 million adults in the US. It is also recognized as a leading cause of hospitalizations and is the fourth leading cause of death in the US. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) operates to promote evidence-based management of COPD, increase awareness and encourage research. In 2011, GOLD published a consensus report detailing evidence-based management strategies for COPD, which were last updated in 2015. In recent years, newer strategies and a growing number of new pharmacologic agents to treat symptoms of COPD have also been introduced and show promise in improving the management of COPD. We aim to provide an evidence-based review of the available and upcoming pharmacologic and non-pharmacologic treatment options for stable COPD, with continued emphasis on evidence-based management.

Diagnosis and management of symptomatic hemorrhoids.

PubMed

Sneider, Erica B; Maykel, Justin A

2010-02-01

Hemorrhoidal disease is a common problem that is managed by various physicians, ranging from primary care providers to surgeons. This article reviews the pathophysiology, clinical presentation, and updated treatment of hemorrhoids, including nonoperative options, office-based procedures, and surgical interventions from standard excision to stapled hemorrhoidopexy and Doppler-guided ligation. The article also covers complications and provides guidance for special circumstances, such as pregnancy, hemorrhoidal crisis, and inflammatory bowel disease. Copyright 2010 Elsevier Inc. All rights reserved.

MODELING CONCEPTS FOR BMP/LID SIMULATION

EPA Science Inventory

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

State-and-transition prototype model of riparian vegetation downstream of Glen Canyon Dam, Arizona

USGS Publications Warehouse

Ralston, Barbara E.; Starfield, Anthony M.; Black, Ronald S.; Van Lonkhuyzen, Robert A.

2014-01-01

Facing an altered riparian plant community dominated by nonnative species, resource managers are increasingly interested in understanding how to manage and promote healthy riparian habitats in which native species dominate. For regulated rivers, managing flows is one tool resource managers consider to achieve these goals. Among many factors that can influence riparian community composition, hydrology is a primary forcing variable. Frame-based models, used successfully in grassland systems, provide an opportunity for stakeholders concerned with riparian systems to evaluate potential riparian vegetation responses to alternative flows. Frame-based, state-and-transition models of riparian vegetation for reattachment bars, separation bars, and the channel margin found on the Colorado River downstream of Glen Canyon Dam were constructed using information from the literature. Frame-based models can be simple spreadsheet models (created in Microsoft® Excel) or developed further with programming languages (for example, C-sharp). The models described here include seven community states and five dam operations that cause transitions between states. Each model divides operations into growing (April–September) and non-growing seasons (October–March) and incorporates upper and lower bar models, using stage elevation as a division. The inputs (operations) can be used by stakeholders to evaluate flows that may promote dynamic riparian vegetation states, or identify those flow options that may promote less desirable states (for example, Tamarisk [Tamarix sp.] temporarily flooded shrubland). This prototype model, although simple, can still elicit discussion about operational options and vegetation response.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-13

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

Chondrosarcoma third metacarpal: Diagnosis and management options.

PubMed

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

2018-01-01

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

[Fasciocutaneous flap reliable by deep femoral artery perforator for the treatment of ischial pressure ulcers].

PubMed

Gebert, L; Boucher, F; Lari, A; Braye, F; Mojallal, A; Ismaïl, M

2018-04-01

The surgical management of pressure ulcers in the paraplegic or quadriplegic population is marked by the high risk of recurrence in the long-term. In the current era of perforator flaps, newer reconstructive options are available for the management of pressure ulcers, decreasing the need to use the classically described muscular or musculocutaneous locoregional flaps. The coverage of ischial sores described in this article by a pedicled flap based on a deep femoral artery perforator, appears to be an effective first-line reconstructive option for the management of limited size pressure ulcers. A number of fifteen paraplegic or quadriplegic patients having at least one ischial bed sore with underlying osteomyelitis were included in this series. The approximate location of the deep femoral artery perforator was initially identified using the "The Atlas of the perforator arteries of the skin, the trunk and limbs", which was confirmed, with the use of a Doppler device. A fasciocutaneous transposition flap was elevated, with the pivot point based on the cutaneous bridge centered on the perforator, and then transposed to cover the area of tissue loss. The donor site was closed primarily. A total of fifteen patients were operated from November 2015 to November 2016. The series comprised of 16 first presentations of a stage 4 pressure ulcers associated with underlying osteomyelitis that were subsequently reconstructed by the pedicled deep femoral artery perforator flap. The healing rate and functional results were both satisfactory. Fasciocutaneous flap reliable by deep femoral artery perforator appears to have a promising role in the treatment of ischial pressure sores. It is an attractive option to spare the use of musculocutaneous flaps in the area. Thus this flap could be used as a first-line option to cover ischial pressure ulcers of limited size. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

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

PubMed Central

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

2013-01-01

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

Judgment skills, a missing component in health literacy: development of a tool for asthma patients in the Italian-speaking region of Switzerland.

PubMed

Moreno Londoño, Ana Maria; Schulz, Peter J

2014-04-01

Health literacy has been recognized as an important factor influencing health behaviors and health outcomes. However, its definition is still evolving, and the tools available for its measurement are limited in scope. Based on the conceptualization of health literacy within the Health Empowerment Model, the present study developed and validated a tool to assess patient's health knowledge use, within the context of asthma self-management. A review of scientific literature on asthma self-management, and several interviews with pulmonologists and asthma patients were conducted. From these, 19 scenarios with 4 response options each were drafted and assembled in a scenario-based questionnaire. Furthermore, a three round Delphi procedure was carried out, to validate the tool with the participation of 12 specialists in lung diseases. The face and content validity of the tool were achieved by face-to-face interviews with 2 pulmonologists and 5 patients. Consensus among the specialists on the adequacy of the response options was achieved after the three round Delphi procedure. The final tool has a 0.97 intra-class correlation coefficient (ICC), indicating a strong level of agreement among experts on the ratings of the response options. The ICC for single scenarios, range from 0.92 to 0.99. The newly developed tool provides a final score representing patient's health knowledge use, based on the specialist's consensus. This tool contributes to enriching the measurement of a more advanced health literacy dimension.

Information systems for material flow management in construction processes

NASA Astrophysics Data System (ADS)

Mesároš, P.; Mandičák, T.

2015-01-01

The article describes the options for the management of material flows in the construction process. Management and resource planning is one of the key factors influencing the effectiveness of construction project. It is very difficult to set these flows correctly. The current period offers several options and tools to do this. Information systems and their modules can be used just for the management of materials in the construction process.

The How-To for Type 2: An Overview of Diagnosis and Management of Type 2 Diabetes Mellitus.

PubMed

Dodds, Seliece

2017-12-01

This article presents an overview of type 2 diabetes diagnosis and management. A brief discussion of epidemiology, including incidence, prevalence, and etiology, provides the basis for the importance of the discussion. The review then proceeds to outline diagnostic criteria and follow-up monitoring guidelines. Recommendations for evidence-based lifestyle measures and current pharmacologic options are addressed. A priority on individualized, holistic care with patient-specified goals and the management of comorbidities is emphasized. Copyright © 2017 Elsevier Inc. All rights reserved.

Treatment of hepatocellular carcinoma with portal vein tumor thrombus: advances and challenges.

PubMed

Jiang, Jin-Fang; Lao, Yong-Cong; Yuan, Bao-Hong; Yin, Jun; Liu, Xin; Chen, Long; Zhong, Jian-Hong

2017-05-16

Portal vein tumor thrombus is a frequent, challenging complication in hepatocellular carcinoma. Hepatocellular carcinoma patients with portal vein tumor thrombus may show worse liver function, less treatment tolerance and worse prognosis than patients without portal vein tumor thrombus, and they may be at higher risk of comorbidity related to portal hypertension. Western and some Asian guidelines stratify hepatocellular carcinoma with portal vein tumor thrombus together with metastatic hepatocellular carcinoma and therefore recommend only palliative treatment with sorafenib or other systemic agents. In recent years, more treatment options have become available for hepatocellular carcinoma patients with portal vein tumor thrombus, and an evidence-based approach to optimizing disease management and treatment has become more widespread. Nevertheless, consensus policies for managing hepatocellular carcinoma with portal vein tumor thrombus have not been established. This comprehensive literature review, drawing primarily on studies published after 2010, examines currently available management options for patients with hepatocellular carcinoma and portal vein tumor thrombus.

Management Strategy for Patients With Chronic Subclavian Vein Thrombosis.

PubMed

Keir, Graham; Marshall, M Blair

2017-02-01

We performed a systematic review to determine best practice for the management of patients with chronic or subacute subclavian vein thrombosis. This condition is best managed with surgical excision of the first rib followed by long-term anticoagulation. Interventional techniques aimed at restoring patency are ineffective beyond 2 weeks postthrombosis. Additional therapeutic options should be made based on the severity of symptoms as well as vein status. Patients with milder symptoms are given decompression surgery followed by anticoagulation whereas patients with more severe symptoms are considered for either a jugular vein transposition or saphenous patch based on the vein characteristics. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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

NASA Astrophysics Data System (ADS)

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

2016-02-01

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

Management and marketing for the general practice dental office.

PubMed

Clarkson, Earl; Bhatia, Sanjeev

2008-07-01

This article reviews trends in the dental marketplace. Marketing is an essential element of dentistry. Communicating treatment options with patients is one aspect of marketing. Treatment planning helps patients understand the relationships between oral health, occlusion, temporomandibular joint function, and systemic health. Through marketing, dental practice owners inform patients of ever-changing treatment modalities. Understanding treatment options allows patients to make better, informed choices. More options leads to a higher level of care and more comprehensive dental treatment. Managing a practice requires tracking its financial health. Economic statistics measure the effect of management decisions that mark the direction of a dental practice.

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

PubMed

2015-10-28

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

Parental Preference Assessment for Vesicoureteral Reflux Management in Children.

PubMed

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

2017-03-01

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

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

PubMed

Chitchumnong, Piyayut; Horan, Richard D

2018-03-16

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

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

NASA Astrophysics Data System (ADS)

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

2015-12-01

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

Back to the future: total system management (organic, sustainable)

USDA-ARS?s Scientific Manuscript database

Many soil disinfestation programs are implemented prior to crop cultivation due to the paucity of therapeutic interventions for controlling soilborne pests. In the 1950’s a proliferation of chemical control options ushered in an era of soilborne pest control based upon a single or limited group of ...

Technologically Enhanced Archival Collections: Using the Buddy System

ERIC Educational Resources Information Center

Holz, Dayna

2006-01-01

Based in the context of challenges faced by archives when managing digital projects, this article explores options of looking outside the existing expertise of archives staff to find collaborative partners. In teaming up with other departments and organizations, the potential scope of traditional archival digitization projects is expanded beyond…

Preschool Adequacy and Efficiency in California. Issues, Policy Options, and Recommendations

DTIC Science & Technology

2009-01-01

the classroom environment that focus on emotional support, classroom management, and student engagement . The high rate overall of participation in...Organization, and Student Engagement domains of the CLASS, all of which were close to or exceeded an average score of 5 for all children in center-based

Microcomputer Applications for Library Instruction: Automation of Test and Assignment Scoring, and Student Record Keeping.

ERIC Educational Resources Information Center

Sugranes, Maria R.; Snider, Larry C.

1985-01-01

Describes the development of an automated library instruction records management system using microcomputer technology. Development described includes assessment of need, exploration of options, system design, and operational development. System products are identified and operational results are reported based on actual system performance.…

E.QUALITY@BT...

ERIC Educational Resources Information Center

Macmillan, Roderick H.

1996-01-01

Describes a management system developed by BT Laboratories (United Kingdom) that is based on ISO 9001 using the World Wide Web, a hypermedia system, and part of the Internet. Subject matter is presented as an alphabetical list of linked entries, numerous navigational techniques are available, and searching options function within an index file.…

Restructuring American Schools: The Promise and the Pitfalls. Conference Paper No. 10.

ERIC Educational Resources Information Center

McDonnell, Lorraine M.

Poor educational performance and the changing nature of work and workers have prompted calls for a major restructuring of American schools. The following broad categories of restructuring options are discussed and supporting research is reviewed: (1) decentralizing authority over schooling through school-based management, more professional…

SCENARIO ANALYSIS FOR THE SAN PEDRO RIVER, ANALYZING HYDROLOGICAL CONSEQUENCES FOR A FUTURE ENVIRONMENT

EPA Science Inventory

Studies of future management and policy options based on different assumptions provide a mechanism to examine possible outcomes and especially their likely benefits and consequences. The San Pedro River in Arizona and Sonora, Mexico is an area that has undergone rapid changes in ...

NORTHWEST OREGON PILOT STUDY AREA (USA): A WATERSHED ASSESSMENT OF LANDSCAPE CHANGE AND IMPACTS TO AQUATIC RESOURCES

EPA Science Inventory

Studies of future management and policy options based on different assumptions provide a mechanism to examine possible outcomes and especially their likely benefits and consequences. The Northwest Oregon Pilot Study Area encompasses approximately 59,167 km2 and comprises a mixtur...

Documentation of a spatial data-base management system for monitoring pesticide application in Washington

USGS Publications Warehouse

Schurr, K.M.; Cox, S.E.

1994-01-01

The Pesticide-Application Data-Base Management System was created as a demonstration project and was tested with data submitted to the Washington State Department of Agriculture by pesticide applicators from a small geographic area. These data were entered into the Department's relational data-base system and uploaded into the system's ARC/INFO files. Locations for pesticide applica- tions are assigned within the Public Land Survey System grids, and ARC/INFO programs in the Pesticide-Application Data-Base Management System can subdivide each survey section into sixteen idealized quarter-quarter sections for display map grids. The system provides data retrieval and geographic information system plotting capabilities from a menu of seven basic retrieval options. Additionally, ARC/INFO coverages can be created from the retrieved data when required for particular applications. The Pesticide-Application Data-Base Management System, or the general principles used in the system, could be adapted to other applica- tions or to other states.

Mass discharge estimation from contaminated sites: Multi-model solutions for assessment of conceptual uncertainty

NASA Astrophysics Data System (ADS)

Thomsen, N. I.; Troldborg, M.; McKnight, U. S.; Binning, P. J.; Bjerg, P. L.

2012-04-01

Mass discharge estimates are increasingly being used in the management of contaminated sites. Such estimates have proven useful for supporting decisions related to the prioritization of contaminated sites in a groundwater catchment. Potential management options can be categorised as follows: (1) leave as is, (2) clean up, or (3) further investigation needed. However, mass discharge estimates are often very uncertain, which may hamper the management decisions. If option 1 is incorrectly chosen soil and water quality will decrease, threatening or destroying drinking water resources. The risk of choosing option 2 is to spend money on remediating a site that does not pose a problem. Choosing option 3 will often be safest, but may not be the optimal economic solution. Quantification of the uncertainty in mass discharge estimates can therefore greatly improve the foundation for selecting the appropriate management option. The uncertainty of mass discharge estimates depends greatly on the extent of the site characterization. A good approach for uncertainty estimation will be flexible with respect to the investigation level, and account for both parameter and conceptual model uncertainty. We propose a method for quantifying the uncertainty of dynamic mass discharge estimates from contaminant point sources on the local scale. The method considers both parameter and conceptual uncertainty through a multi-model approach. The multi-model approach evaluates multiple conceptual models for the same site. The different conceptual models consider different source characterizations and hydrogeological descriptions. The idea is to include a set of essentially different conceptual models where each model is believed to be realistic representation of the given site, based on the current level of information. Parameter uncertainty is quantified using Monte Carlo simulations. For each conceptual model we calculate a transient mass discharge estimate with uncertainty bounds resulting from the parametric uncertainty. To quantify the conceptual uncertainty from a given site, we combine the outputs from the different conceptual models using Bayesian model averaging. The weight for each model is obtained by integrating available data and expert knowledge using Bayesian belief networks. The multi-model approach is applied to a contaminated site. At the site a DNAPL (dense non aqueous phase liquid) spill consisting of PCE (perchloroethylene) has contaminated a fractured clay till aquitard overlaying a limestone aquifer. The exact shape and nature of the source is unknown and so is the importance of transport in the fractures. The result of the multi-model approach is a visual representation of the uncertainty of the mass discharge estimates for the site which can be used to support the management options.

Linear feature extraction from radar imagery: SBIR (Small Business Innovative Research) phase 2, option 1

NASA Astrophysics Data System (ADS)

Conner, Gary D.; Milgram, David L.; Lawton, Daryl T.; McConnell, Christopher C.

1988-04-01

The goal of this effort is to develop and demonstrate prototype processing capabilities for a knowledge-based system to automatically extract and analyze linear features from synthetic aperture radar (SAR) imagery. This effort constitutes Phase 2 funding through the Defense Small Business Innovative Research (SBIR) Program. Previous work examined the feasibility of the technology issues involved in the development of an automatedlinear feature extraction system. This Option 1 Final Report documents this examination and the technologies involved in automating this image understanding task. In particular, it reports on a major software delivery containing an image processing algorithmic base, a perceptual structures manipulation package, a preliminary hypothesis management framework and an enhanced user interface.

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

NASA Astrophysics Data System (ADS)

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

2016-12-01

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

Cash and counseling: a promising option for consumer direction of home- and community-based services and supports.

PubMed

Mahoney, Kevin J; Simon-Rusinowitz, Lori; Simone, Kristin; Zgoda, Karen

2006-01-01

The Cash and Counseling Demonstration began as a 3-state social experiment to test the claims of members of the disability community that, if they had more control over their services, their lives would improve and costs would be no higher. The 2004 expansion to 12 states brings us closer to the tipping point when this option will be broadly available. The original demonstration was a controlled experiment with randomized assignment, supplemented by an ethnographic study and a process evaluation. Consumers managing flexible, individualized budgets were much more satisfied, had fewer unmet needs, and had comparable health outcomes. Access to service and supports was greatly improved. Consumer direction is increasingly accepted as a desirable option in home and community services.

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

DTIC Science & Technology

1984-06-26

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

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

NASA Astrophysics Data System (ADS)

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

2010-04-01

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

[Independent medical processing enterprises as innovative organizational model for market of medical services].

PubMed

Shevchenko, Iu L; Matveev, S A; Makhnev, D A; Korsun, K Iu

2006-01-01

In Russia, current stage of health care development is characterized by occurrence of various problems. Most of them are related to cooperation between participators of market of medical services. Different options are proposed to resolve cooperation problems embedded into medical services market with emphasis on development of ultimately different medical processing enterprise with brand-new organizational and functional structure. Its functioning is based on process management logistics. The company broad professional experience allows to implement above-mentioned managerial structure and make it function as well as claims positive perspectives of described option.

Roadwaste : Issues and Options : appendices.

DOT National Transportation Integrated Search

1998-06-01

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

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

PubMed

Lemieux, Christopher J; Scott, Daniel J

2011-10-01

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

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

NASA Astrophysics Data System (ADS)

Lemieux, Christopher J.; Scott, Daniel J.

2011-10-01

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

Conservative care as a treatment option for patients aged 75 years and older with CKD stage V: a National survey in the Netherlands.

PubMed

Susanto, Christopher; Kooman, J; Courtens, A M; Konings, C J A M

2018-01-01

Conservative care for patients aged 75 years and older with CKD stage 5 as a treatment option besides dialysis was proposed officially in the Netherlands in October 2016. This national survey showed the current implementation of this option in Netherlands nephrology departments. A web-based survey was sent to medical managers of 60 nephrology departments in the Netherlands in August 2016. Twenty-one medical managers (35%) completed the survey. The term "conservative care" is frequently used and well known. The estimated number of patients in whom the decision for maximal conservative care was made in 2015 was 310 of 2249 patients with CKD stage 5 age 75 years and older (range 5-50 patients per department). 164 patients became symptomatic and received no dialysis. There is no official registration for this treatment option and patient category. The practice patterns vary widely. Only one of 21 respondents reported a conservative care outpatient clinic. Formal training or education regarding conservative care is not available in most of departments. 95% of respondents discussed this treatment option with their patients. General practitioners are always being informed about their patient's decision. Their main role is providing or organizing palliative care support at the end of life and discussing advance care planning. Most respondents (86%) considered to include their patients in a prospective multicentre observational study, conservative care versus dialysis. Conservative care as a treatment option for patients with CKD stage 5 aged 75 years and older is well established. The practice patterns are varied in the Netherlands. Follow-up studies are needed to see whether the new multidisciplinary guideline facilitates harmonization of practice pattern. Funding is needed to optimize the implementation of conservative care.

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

DTIC Science & Technology

2008-09-01

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

Evidence-based practice: management of glottic cancer.

PubMed

Hartl, Dana M

2012-10-01

The main issue in the management of glottic squamous cell carcinoma, as for all cancers, is adequate disease control while optimizing functional outcomes and minimizing morbidity. This is true for early-stage disease as for advanced tumors. This article evaluates the current evidence for the diagnostic and pretherapeutic workup for glottic squamous cell carcinoma and the evidence concerning different treatment options for glottic carcinoma, from early-stage to advanced-stage disease. Copyright © 2012 Elsevier Inc. All rights reserved.

GUIDELINES OF CARE FOR THE MANAGEMENT OF ATOPIC DERMATITIS

PubMed Central

Sidbury, Robert; Davis, Dawn M.; Cohen, David E.; Cordoro, Kelly M.; Berger, Timothy G.; Bergman, James N.; Chamlin, Sarah L.; Cooper, Kevin D.; Feldman, Steven R.; Hanifin, Jon M.; Krol, Alfons; Margolis, David J.; Paller, Amy S.; Schwarzenberger, Kathryn; Silverman, Robert A.; Simpson, Eric L.; Tom, Wynnis L.; Williams, Hywel C.; Elmets, Craig A.; Block, Julie; Harrod, Christopher G.; Begolka, Wendy Smith; Eichenfield, Lawrence F.

2014-01-01

Atopic dermatitis (AD) is a chronic, pruritic inflammatory dermatosis that affects up to 25% of children and 2-3% of adults. This guideline addresses important clinical questions that arise in AD management and care, providing recommendations based on the available evidence. In this third of four sections, treatment of AD with phototherapy and systemic immunomodulators, antimicrobials, and antihistamines is reviewed, including indications for use and the risk-benefit profile of each treatment option. PMID:24813298

Modelling marine protected areas: insights and hurdles

PubMed Central

Fulton, Elizabeth A.; Bax, Nicholas J.; Bustamante, Rodrigo H.; Dambacher, Jeffrey M.; Dichmont, Catherine; Dunstan, Piers K.; Hayes, Keith R.; Hobday, Alistair J.; Pitcher, Roland; Plagányi, Éva E.; Punt, André E.; Savina-Rolland, Marie; Smith, Anthony D. M.; Smith, David C.

2015-01-01

Models provide useful insights into conservation and resource management issues and solutions. Their use to date has highlighted conditions under which no-take marine protected areas (MPAs) may help us to achieve the goals of ecosystem-based management by reducing pressures, and where they might fail to achieve desired goals. For example, static reserve designs are unlikely to achieve desired objectives when applied to mobile species or when compromised by climate-related ecosystem restructuring and range shifts. Modelling tools allow planners to explore a range of options, such as basing MPAs on the presence of dynamic oceanic features, and to evaluate the potential future impacts of alternative interventions compared with ‘no-action’ counterfactuals, under a range of environmental and development scenarios. The modelling environment allows the analyst to test if indicators and management strategies are robust to uncertainties in how the ecosystem (and the broader human–ecosystem combination) operates, including the direct and indirect ecological effects of protection. Moreover, modelling results can be presented at multiple spatial and temporal scales, and relative to ecological, economic and social objectives. This helps to reveal potential ‘surprises', such as regime shifts, trophic cascades and bottlenecks in human responses. Using illustrative examples, this paper briefly covers the history of the use of simulation models for evaluating MPA options, and discusses their utility and limitations for informing protected area management in the marine realm. PMID:26460131

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

PubMed

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

2016-04-01

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

Managing the risks of disease transmission through trade: a commodities-based approach?

PubMed

Brückner, G K

2011-04-01

Since its founding in 1924, the World Organisation for Animal Health (OIE) has facilitated safe trade in animals and animal products by developing effective standards to prevent the spread of animal diseases across the globe. A protocol for recognising the disease-free status of countries is an integral part of this process and has been adopted and advanced through the years to assist OIE Member Countries in placing disease-free animals and their products on the international market. Options such as trade from disease-free zones and disease-free compartments are now available to Members and have proven to be a positive mechanism for facilitating trade. A further option is trading in safe commodities, i.e. animals and animal products that have been identified as safe to trade even in the presence of disease, either with or without applying risk mitigation measures before export. Although most Members have incorporated the acceptance of disease-free countries or zones into their animal health policies and sanitary measures, there still appears to be a reluctance to trade in commodities from infected countries, despite clear, scientifically based risk management standards that can be applied if needed. This paper offers some examples reflecting the apparent reluctance to trade in commodities and discusses how the standards in the OIE's Terrestrial Animal Health Code could be used to apply scientifically based risk management practices to review outdated policies.

Diabetes management and hypoglycemia in safety sensitive jobs.

PubMed

Lee, See-Muah; Koh, David; Chui, Winnie Kl; Sum, Chee-Fang

2011-03-01

The majority of people diagnosed with diabetes mellitus are in the working age group in developing countries. The interrelationship of diabetes and work, that is, diabetes affecting work and work affecting diabetes, becomes an important issue for these people. Therapeutic options for the diabetic worker have been developed, and currently include various insulins, insulin sensitizers and secretagogues, incretin mimetics and enhancers, and alpha glucosidase inhibitors. Hypoglycemia and hypoglycaemic unawareness are important and unwanted treatment side effects. The risk they pose with respect to cognitive impairment can have safety implications. The understanding of the therapeutic options in the management of diabetic workers, blood glucose awareness training, and self-monitoring blood glucose will help to mitigate this risk. Employment decisions must also take into account the extent to which the jobs performed by the worker are safety sensitive. A risk assessment matrix, based on the extent to which a job is considered safety sensitive and based on the severity of the hypoglycaemia, may assist in determining one's fitness to work. Support at the workplace, such as a provision of healthy food options and arrangements for affected workers will be helpful for such workers. Arrangements include permission to carry and consume emergency sugar, flexible meal times, self-monitoring blood glucose when required, storage/disposal facilities for medicine such as insulin and needles, time off for medical appointments, and structured self-help programs.

Diabetes Management and Hypoglycemia in Safety Sensitive Jobs

PubMed Central

Koh, David; Chui, Winnie KL; Sum, Chee-Fang

2011-01-01

The majority of people diagnosed with diabetes mellitus are in the working age group in developing countries. The interrelationship of diabetes and work, that is, diabetes affecting work and work affecting diabetes, becomes an important issue for these people. Therapeutic options for the diabetic worker have been developed, and currently include various insulins, insulin sensitizers and secretagogues, incretin mimetics and enhancers, and alpha glucosidase inhibitors. Hypoglycemia and hypoglycaemic unawareness are important and unwanted treatment side effects. The risk they pose with respect to cognitive impairment can have safety implications. The understanding of the therapeutic options in the management of diabetic workers, blood glucose awareness training, and self-monitoring blood glucose will help to mitigate this risk. Employment decisions must also take into account the extent to which the jobs performed by the worker are safety sensitive. A risk assessment matrix, based on the extent to which a job is considered safety sensitive and based on the severity of the hypoglycaemia, may assist in determining one's fitness to work. Support at the workplace, such as a provision of healthy food options and arrangements for affected workers will be helpful for such workers. Arrangements include permission to carry and consume emergency sugar, flexible meal times, self-monitoring blood glucose when required, storage/disposal facilities for medicine such as insulin and needles, time off for medical appointments, and structured self-help programs. PMID:22953182

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

PubMed

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

2018-01-01

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

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

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-25

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

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

PubMed

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

2016-12-15

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

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

Code of Federal Regulations, 2010 CFR

2010-10-01

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

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

PubMed

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

2015-09-15

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

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

PubMed

Eriksson, Mattias; Spångberg, Johanna

2017-02-01

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

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

NASA Astrophysics Data System (ADS)

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

2016-04-01

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

30 CFR 204.203 - What is the other relief option?

Code of Federal Regulations, 2010 CFR

2010-07-01

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

Health care professionals' attitudes towards population-based genetic testing and risk-stratification for ovarian cancer: a cross-sectional survey.

PubMed

Hann, Katie E J; Fraser, Lindsay; Side, Lucy; Gessler, Sue; Waller, Jo; Sanderson, Saskia C; Freeman, Madeleine; Jacobs, Ian; Lanceley, Anne

2017-12-16

Ovarian cancer is usually diagnosed at a late stage when outcomes are poor. Personalised ovarian cancer risk prediction, based on genetic and epidemiological information and risk stratified management in adult women could improve outcomes. Examining health care professionals' (HCP) attitudes to ovarian cancer risk stratified management, willingness to support women, self-efficacy (belief in one's own ability to successfully complete a task), and knowledge about ovarian cancer will help identify training needs in anticipation of personalised ovarian cancer risk prediction being introduced. An anonymous survey was distributed online to HCPs via relevant professional organisations in the UK. Kruskal-Wallis tests and pairwise comparisons were used to compare knowledge and self-efficacy scores between different types of HCPs, and attitudes toward population-based genetic testing and risk stratified management were described. Content analysis was undertaken of free text responses concerning HCPs willingness to discuss risk management options with women. One hundred forty-six eligible HCPs completed the survey: oncologists (31%); genetics clinicians (30%); general practitioners (22%); gynaecologists (10%); nurses (4%); and 'others'. Scores for knowledge of ovarian cancer and genetics, and self-efficacy in conducting a cancer risk consultation were generally high but significantly lower for general practitioners compared to genetics clinicians, oncologists, and gynaecologists. Support for population-based genetic testing was not high (<50%). Attitudes towards ovarian cancer risk stratification were mixed, although the majority of participants indicated a willingness to discuss management options with patients. Larger samples are required to investigate attitudes to population-based genetic testing for ovarian cancer risk and to establish why some HCPs are hesitant to offer testing to all adult female patients. If ovarian cancer risk assessment using genetic testing and non-genetic information including epidemiological information is rolled out on a population basis, training will be needed for HCPs in primary care to enable them to provide appropriate support to women at each stage of the process.

Development of an integrated model for the Campaspe catchment: a tool to help improve understanding of the interaction between society, policy, farming decision, ecology, hydrology and climate

NASA Astrophysics Data System (ADS)

Iwanaga, Takuya; Zare, Fateme; Croke, Barry; Fu, Baihua; Merritt, Wendy; Partington, Daniel; Ticehurst, Jenifer; Jakeman, Anthony

2018-06-01

Management of water resources requires understanding of the hydrology and hydrogeology, as well as the policy and human drivers and their impacts. This understanding requires relevant inputs from a wide range of disciplines, which will vary depending on the specific case study. One approach to gain understanding of the impact of climate and society on water resources is through the use of an integrated modelling process that engages stakeholders and experts in specifics of problem framing, co-design of the underpinning conceptual model, and discussion of the ensuing results. In this study, we have developed such an integrated modelling process for the Campaspe basin in northern Victoria, Australia. The numerical model built has a number of components:

• - Node/link based surface water hydrology module based on the IHACRES rainfall-streamflow model
• - Distributed groundwater model for the lower catchment (MODFLOW)
• - Farm decision optimisation module (to determine irrigation requirements)
• - Policy module (setting conditions on availability of water based on existing rules)
• - Ecology module (determining the impacts of available streamflow on platypus, fish and river red gum trees)

Dialysis-associated steal syndrome (DASS).

PubMed

Mohamed, Ahmed S; Peden, Eric K

2017-03-06

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

Acceptability and Feasibility of a Mobile Phone-Based Case Management Intervention to Retain Mothers and Infants from an Option B+ Program in Postpartum HIV Care.

PubMed

Schwartz, Sheree R; Clouse, Kate; Yende, Nompumelelo; Van Rie, Annelies; Bassett, Jean; Ratshefola, Mamothe; Pettifor, Audrey

2015-09-01

The objective of this study was to assess the acceptability and feasibility of a cell phone based case manager intervention targeting HIV-infected pregnant women on highly-active antiretroviral therapy (HAART). Pregnant women ≥36 weeks gestation attending antenatal care and receiving HAART through the Option B+ program at a primary care clinic in South Africa were enrolled into a prospective pilot intervention to receive text messages and telephone calls from a case manager through 6 weeks postpartum. Acceptability and feasibility of the intervention were assessed along with infant HIV testing rates and 10-week and 12-month postpartum maternal retention in care. Retention outcomes were compared to women of similar eligibility receiving care prior to the intervention. Fifty women were enrolled into the pilot from May to July 2013. Most (70%) were HAART-naive at time of conception and started HAART during antenatal care. During the intervention, the case manager sent 482 text messages and completed 202 telephone calls, for a median of 10 text messages and 4 calls/woman. Ninety-six percent completed the postpartum interview and 47/48 (98%) endorsed the utility of the intervention. Engagement in 10-week postpartum maternal HIV care was >90% in the pre-intervention (n = 50) and intervention (n = 50) periods; by 12-months retention fell to 72% and was the same across periods. More infants received HIV-testing by 10-weeks in the intervention period as compared to pre-intervention (90.0 vs. 63.3%, p < 0.01). Maternal support through a cell phone based case manager approach was highly acceptable among South African HIV infected women on HAART and feasible, warranting further assessment of effectiveness.

Understanding Consistency Maintenance in Service Discovery Architectures during Communication Failure

DTIC Science & Technology

2002-07-01

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

Complications of transplantation. Part 1: renal transplants.

PubMed

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

2014-10-01

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

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

Treesearch

Sarah M. McCaffrey; Alan Rhodes

2009-01-01

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

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

EPA Science Inventory

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

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-25

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

Consider Creating a Channel Management Strategy with Both Colleagues and Patients

PubMed Central

Felkey, Bill G.; Fox, Brent I.

2013-01-01

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

Challenging Obesity: Patient, Provider, and Expert Perspectives on the Roles of Available and Emerging Nonsurgical Therapies

PubMed Central

Apovian, Caroline M.; Garvey, W. Timothy; Ryan, Donna H.

2015-01-01

Objective Adult obesity is recognized as a chronic disease. According to principles of chronic disease management, healthcare professionals should work collaboratively with patients to determine appropriate therapeutic strategies that address overweight and obesity, specifically considering a patient’s disease status in addition to their individual needs, preferences, and attitudes regarding treatment. A central role and responsibility of healthcare professionals in this process is to inform and educate patients about their treatment options. Although current recommendations for the management of adult obesity provide general guidance regarding safe and proper implementation of lifestyle, pharmacological, and surgical interventions, healthcare professionals need awareness of specific evidence-based information that supports individualized clinical application of these therapies. More specifically, healthcare professionals should be up-to-date on approaches that promote successful lifestyle management and be knowledgeable about newer weight loss pharmacotherapies, so they can offer patients with obesity a wide range of options to personalize their treatment. Accordingly, this educational activity has been developed to provide participants with the latest information on treatment recommendations and therapeutic advances in lifestyle intervention and pharmacotherapy for adult obesity management. Design and Methods This supplement is based on the content presented at a live CME symposium held in conjunction with ObesityWeek 2014. Results This supplement provides an expert summary of current treatment recommendations and recent advances in nonsurgical therapies for the management of adult obesity. Patient and provider perspectives on obesity management are highlighted in embedded video clips available via QR codes, and new evidence will be applied using clinically relevant case studies. Conclusions This supplement provides a topical update of obesity management, including clinical practice examples, for healthcare professionals who treat or provide care for adults with obesity. PMID:26154880

Unruptured Cerebral Aneurysms: Evaluation and Management

PubMed Central

Chalouhi, Nohra; Starke, Robert M.; Bell, Rodney

2015-01-01

The evolution of imaging techniques and their increased use in clinical practice have led to a higher detection rate of unruptured intracranial aneurysms. The diagnosis of an unruptured intracranial aneurysm is a source of significant stress to the patient because of the concerns for aneurysmal rupture, which is associated with substantial rates of morbidity and mortality. Therefore, it is important that decisions regarding optimum management are made based on the comparison of the risk of aneurysmal rupture with the risk associated with intervention. This review provides a comprehensive overview of the epidemiology, pathophysiology, natural history, clinical presentation, diagnosis, and management options for unruptured intracranial aneurysms based on the current evidence in the literature. Furthermore, the authors discuss the genetic abnormalities associated with intracranial aneurysm and current guidelines for screening in patients with a family history of intracranial aneurysms. Since there is significant controversy in the optimum management of small unruptured intracranial aneurysms, we provided a systematic approach to their management based on patient and aneurysm characteristics as well as the risks and benefits of intervention. PMID:26146657

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

PubMed

Beylot, Antoine; Villeneuve, Jacques; Bellenfant, Gaël

2013-02-01

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

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

NASA Astrophysics Data System (ADS)

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

2006-12-01

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

Minimizing the cost of keeping options open for conservation in a changing climate.

PubMed

Mills, Morena; Nicol, Sam; Wells, Jessie A; Lahoz-Monfort, José J; Wintle, Brendan; Bode, Michael; Wardrop, Martin; Walshe, Terry; Probert, William J M; Runge, Michael C; Possingham, Hugh P; Madden, Eve McDonald

2014-06-01

Policy documents advocate that managers should keep their options open while planning to protect coastal ecosystems from climate-change impacts. However, the actual costs and benefits of maintaining flexibility remain largely unexplored, and alternative approaches for decision making under uncertainty may lead to better joint outcomes for conservation and other societal goals. For example, keeping options open for coastal ecosystems incurs opportunity costs for developers. We devised a decision framework that integrates these costs and benefits with probabilistic forecasts for the extent of sea-level rise to find a balance between coastal ecosystem protection and moderate coastal development. Here, we suggest that instead of keeping their options open managers should incorporate uncertain sea-level rise predictions into a decision-making framework that evaluates the benefits and costs of conservation and development. In our example, based on plausible scenarios for sea-level rise and assuming a risk-neutral decision maker, we found that substantial development could be accommodated with negligible loss of environmental assets. Characterization of the Pareto efficiency of conservation and development outcomes provides valuable insight into the intensity of trade-offs between development and conservation. However, additional work is required to improve understanding of the consequences of alternative spatial plans and the value judgments and risk preferences of decision makers and stakeholders. © 2014 Society for Conservation Biology.

High resolution crop growth simulation for identification of potential adaptation strategies under climate change

NASA Astrophysics Data System (ADS)

Kim, K. S.; Yoo, B. H.

2016-12-01

Impact assessment of climate change on crop production would facilitate planning of adaptation strategies. Because socio-environmental conditions would differ by local areas, it would be advantageous to assess potential adaptation measures at a specific area. The objectives of this study was to develop a crop growth simulation system at a very high spatial resolution, e.g., 30 m, and to assess different adaptation options including shift of planting date and use of different cultivars. The Decision Support System for Agrotechnology Transfer (DSSAT) model was used to predict yields of soybean and maize in Korea. Gridded data for climate and soil were used to prepare input data for the DSSAT model. Weather input data were prepared at the resolution of 30 m using bilinear interpolation from gridded climate scenario data. Those climate data were obtained from Korean Meteorology Administration. Spatial resolution of temperature and precipitation was 1 km whereas that of solar radiation was 12.5 km. Soil series data at the 30 m resolution were obtained from the soil database operated by Rural Development Administration, Korea. The SOL file, which is a soil input file for the DSSAT model was prepared using physical and chemical properties of a given soil series, which were available from the soil database. Crop yields were predicted by potential adaptation options based on planting date and cultivar. For example, 10 planting dates and three cultivars were used to identify ideal management options for climate change adaptation. In prediction of maize yield, combination of 20 planting dates and two cultivars was used as management options. Predicted crop yields differed by site even within a relatively small region. For example, the maximum of average yields for 2001-2010 seasons differed by sites In a county of which areas is 520 km2 (Fig. 1). There was also spatial variation in the ideal management option in the region (Fig. 2). These results suggested that local assessment of climate change impact on crop production would be useful for planning adaptation options.

Phytoremediation of landfill leachate

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

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

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

Optimal management of idiopathic macular holes

PubMed Central

Madi, Haifa A; Masri, Ibrahim; Steel, David H

2016-01-01

This review evaluates the current surgical options for the management of idiopathic macular holes (IMHs), including vitrectomy, ocriplasmin (OCP), and expansile gas use, and discusses key background information to inform the choice of treatment. An evidence-based approach to selecting the best treatment option for the individual patient based on IMH characteristics and patient-specific factors is suggested. For holes without vitreomacular attachment (VMA), vitrectomy is the only option with three key surgical variables: whether to peel the inner limiting membrane (ILM), the type of tamponade agent to be used, and the requirement for postoperative face-down posturing. There is a general consensus that ILM peeling improves primary anatomical hole closure rate; however, in small holes (<250 µm), it is uncertain whether peeling is always required. It has been increasingly recognized that long-acting gas and face-down positioning are not always necessary in patients with small- and medium-sized holes, but large (>400 µm) and chronic holes (>1-year history) are usually treated with long-acting gas and posturing. Several studies on posturing and gas choice were carried out in combination with ILM peeling, which may also influence the gas and posturing requirement. Combined phacovitrectomy appears to offer more rapid visual recovery without affecting the long-term outcomes of vitrectomy for IMH. OCP is licensed for use in patients with small- or medium-sized holes and VMA. A greater success rate in using OCP has been reported in smaller holes, but further predictive factors for its success are needed to refine its use. It is important to counsel patients realistically regarding the rates of success with intravitreal OCP and its potential complications. Expansile gas can be considered as a further option in small holes with VMA; however, larger studies are required to provide guidance on its use. PMID:26834454

Optimal management of idiopathic macular holes.

PubMed

Madi, Haifa A; Masri, Ibrahim; Steel, David H

2016-01-01

This review evaluates the current surgical options for the management of idiopathic macular holes (IMHs), including vitrectomy, ocriplasmin (OCP), and expansile gas use, and discusses key background information to inform the choice of treatment. An evidence-based approach to selecting the best treatment option for the individual patient based on IMH characteristics and patient-specific factors is suggested. For holes without vitreomacular attachment (VMA), vitrectomy is the only option with three key surgical variables: whether to peel the inner limiting membrane (ILM), the type of tamponade agent to be used, and the requirement for postoperative face-down posturing. There is a general consensus that ILM peeling improves primary anatomical hole closure rate; however, in small holes (<250 µm), it is uncertain whether peeling is always required. It has been increasingly recognized that long-acting gas and face-down positioning are not always necessary in patients with small- and medium-sized holes, but large (>400 µm) and chronic holes (>1-year history) are usually treated with long-acting gas and posturing. Several studies on posturing and gas choice were carried out in combination with ILM peeling, which may also influence the gas and posturing requirement. Combined phacovitrectomy appears to offer more rapid visual recovery without affecting the long-term outcomes of vitrectomy for IMH. OCP is licensed for use in patients with small- or medium-sized holes and VMA. A greater success rate in using OCP has been reported in smaller holes, but further predictive factors for its success are needed to refine its use. It is important to counsel patients realistically regarding the rates of success with intravitreal OCP and its potential complications. Expansile gas can be considered as a further option in small holes with VMA; however, larger studies are required to provide guidance on its use.

Contingency Management and Deliberative Decision-Making Processes.

PubMed

Regier, Paul S; Redish, A David

2015-01-01

Contingency management is an effective treatment for drug addiction. The current explanation for its success is rooted in alternative reinforcement theory. We suggest that alternative reinforcement theory is inadequate to explain the success of contingency management and produce a model based on demand curves that show how little the monetary rewards offered in this treatment would affect drug use. Instead, we offer an explanation of its success based on the concept that it accesses deliberative decision-making processes. We suggest that contingency management is effective because it offers a concrete and immediate alternative to using drugs, which engages deliberative processes, improves the ability of those deliberative processes to attend to non-drug options, and offsets more automatic action-selection systems. This theory makes explicit predictions that can be tested, suggests which users will be most helped by contingency management, and suggests improvements in its implementation.

Contingency Management and Deliberative Decision-Making Processes

PubMed Central

Regier, Paul S.; Redish, A. David

2015-01-01

Contingency management is an effective treatment for drug addiction. The current explanation for its success is rooted in alternative reinforcement theory. We suggest that alternative reinforcement theory is inadequate to explain the success of contingency management and produce a model based on demand curves that show how little the monetary rewards offered in this treatment would affect drug use. Instead, we offer an explanation of its success based on the concept that it accesses deliberative decision-making processes. We suggest that contingency management is effective because it offers a concrete and immediate alternative to using drugs, which engages deliberative processes, improves the ability of those deliberative processes to attend to non-drug options, and offsets more automatic action-selection systems. This theory makes explicit predictions that can be tested, suggests which users will be most helped by contingency management, and suggests improvements in its implementation. PMID:26082725

Designing Effective Projects: Decision Options for Maximizing Learning and Project Success

ERIC Educational Resources Information Center

Volkema, Roger J.

2010-01-01

In recent years, more and more business schools have introduced team-based projects into their curricula as a means of addressing corporate, small business, and community-service issues while teaching students a variety of project management skills (technical and sociocultural). In designing a project-oriented course, an instructor has a number of…

Youth Risk Assessment in Complex Agency Practice

ERIC Educational Resources Information Center

Groner, Mark R.; Solomon, Jean

2007-01-01

Advancements in the delivery of community-based services and tight utilization management of high-cost treatment options result in youths with serious behavior problems receiving intervention in lower levels of care than was true ten or fifteen years ago. This shift in where services tend to be delivered necessitates enhancement of risk assessment…

Site Management and Productivity in Tropical Forest Plantations

Treesearch

A. Tiarks; E.K.S. Nambiar; C. Cossalter

1998-01-01

Tropical countries are expanding plantation forestry to develop sustainable woodproduction systems. Much of this is based on short rotations of exotic species. These systems require large capital investments, represent intensive land use and increase the demands on the soil. To develop options for maintaining or increasing productivity a partner-project was initiated...

Fighting for Excellence: The Case of the Federal University of Pelotas

ERIC Educational Resources Information Center

Santana, Silvina; Moreira, Cristiane; Roberto, Teresa; Azambuja, Flavia

2010-01-01

This paper investigates the implementation and evaluation of quality management systems within the higher education sector in Brazil. It is based on Institutional and Neo Institutional theories and presents the case of the Federal University of Pelotas, to discuss higher education institutions' options in a context of wide and complex…

The Theoretical and Empirical Basis for Meditation as an Intervention for PTSD

ERIC Educational Resources Information Center

Lang, Ariel J.; Strauss, Jennifer L.; Bomyea, Jessica; Bormann, Jill E.; Hickman, Steven D.; Good, Raquel C.; Essex, Michael

2012-01-01

In spite of the existence of good empirically supported treatments for posttraumatic stress disorder (PTSD), consumers and providers continue to ask for more options for managing this common and often chronic condition. Meditation-based approaches are being widely implemented, but there is minimal research rigorously assessing their effectiveness.…

How to diagnose and treat focal therapy failure and recurrence?

PubMed

Barret, Eric; Harvey-Bryan, Kadi-Ann; Sanchez-Salas, Rafael; Rozet, Francois; Galiano, Marc; Cathelineau, Xavier

2014-05-01

Focal therapy presents an alternative option for disease-targeted therapy while preserving erectile and urinary function without compromising oncological outcome. Such treatment, which preserves normal prostate parenchyma, presents a clinical challenge to the urologist, as typical disease surveillance parameters are not as reliable in post-ablation follow-up. We propose an integrated approach to post-ablation surveillance to identify treatment failure as well as recurrence. Post-ablation prostate-specific antigen kinetics, imaging based on multiparametric MRI and control biopsies are the tools currently used to follow patients after focal therapy. Good treatment response is indicated by a negative control biopsy, absence of persistent lesion on post-treatment imaging and a reduction in prostate-specific antigen of at least 50%. When histological evidence of therapeutic failure or recurrence is present, different options of management may be proposed to the patient including active surveillance, focal salvage therapy or radical salvage treatment, depending on the characteristics of the lesion found. A recommended post-ablation surveillance protocol is presented as well as a discussion of management strategies based on the data currently available.

Combining analytical frameworks to assess livelihood vulnerability to climate change and analyse adaptation options☆

PubMed Central

Reed, M.S.; Podesta, G.; Fazey, I.; Geeson, N.; Hessel, R.; Hubacek, K.; Letson, D.; Nainggolan, D.; Prell, C.; Rickenbach, M.G.; Ritsema, C.; Schwilch, G.; Stringer, L.C.; Thomas, A.D.

2013-01-01

Experts working on behalf of international development organisations need better tools to assist land managers in developing countries maintain their livelihoods, as climate change puts pressure on the ecosystem services that they depend upon. However, current understanding of livelihood vulnerability to climate change is based on a fractured and disparate set of theories and methods. This review therefore combines theoretical insights from sustainable livelihoods analysis with other analytical frameworks (including the ecosystem services framework, diffusion theory, social learning, adaptive management and transitions management) to assess the vulnerability of rural livelihoods to climate change. This integrated analytical framework helps diagnose vulnerability to climate change, whilst identifying and comparing adaptation options that could reduce vulnerability, following four broad steps: i) determine likely level of exposure to climate change, and how climate change might interact with existing stresses and other future drivers of change; ii) determine the sensitivity of stocks of capital assets and flows of ecosystem services to climate change; iii) identify factors influencing decisions to develop and/or adopt different adaptation strategies, based on innovation or the use/substitution of existing assets; and iv) identify and evaluate potential trade-offs between adaptation options. The paper concludes by identifying interdisciplinary research needs for assessing the vulnerability of livelihoods to climate change. PMID:25844020

Cyber Risk Management for Critical Infrastructure: A Risk Analysis Model and Three Case Studies.

PubMed

Paté-Cornell, M-Elisabeth; Kuypers, Marshall; Smith, Matthew; Keller, Philip

2018-02-01

Managing cyber security in an organization involves allocating the protection budget across a spectrum of possible options. This requires assessing the benefits and the costs of these options. The risk analyses presented here are statistical when relevant data are available, and system-based for high-consequence events that have not happened yet. This article presents, first, a general probabilistic risk analysis framework for cyber security in an organization to be specified. It then describes three examples of forward-looking analyses motivated by recent cyber attacks. The first one is the statistical analysis of an actual database, extended at the upper end of the loss distribution by a Bayesian analysis of possible, high-consequence attack scenarios that may happen in the future. The second is a systems analysis of cyber risks for a smart, connected electric grid, showing that there is an optimal level of connectivity. The third is an analysis of sequential decisions to upgrade the software of an existing cyber security system or to adopt a new one to stay ahead of adversaries trying to find their way in. The results are distributions of losses to cyber attacks, with and without some considered countermeasures in support of risk management decisions based both on past data and anticipated incidents. © 2017 Society for Risk Analysis.

Distributed Energy Implementation Options

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

Shah, Chandralata N

2017-09-13

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

Pedicled Extranasal Flaps in Skull Base Reconstruction

PubMed Central

Kim, Grace G.; Hang, Anna X.; Mitchell, Candace; Zanation, Adam M.

2013-01-01

Cerebrospinal fluid (CSF) leaks most commonly arise during or after skull base surgery, although they occasionally present spontaneously. Recent advances in the repair of CSF leaks have enabled endoscopic endonasal surgery to become the preferred option for management of skull base pathology. Small defects (<1cm) can be repaired by multilayered free grafts. For large defects (>3cm), pedicled vascular flaps are the repair method of choice, resulting in much lower rates of postoperative CSF leaks. The pedicled nasoseptal flap (NSF) constitutes the primary reconstructive option for the vast majority of skull base defects. It has a large area of potential coverage and high rates of success. However, preoperative planning is required to avoid sacrificing the NSF during resection. In cases where the NSF is unavailable, often due to tumor involvement of the septum or previous resection removing or compromising the flap, other flaps may be considered. These flaps include intranasal options—inferior turbinate (IT) or middle turbinate (MT) flaps—as well as regional pedicled flaps: pericranial flap (PCF), temporoparietal fascial flap (TPFF), or palatal flap (PF). More recently, novel alternatives such as the pedicled facial buccinator flap (FAB) and the pedicled occipital galeopericranial flap (OGP) have been added to the arsenal of options for skull base reconstruction. Characteristics of and appropriate uses for each flap are described. PMID:23257554

Green supply chain management strategy selection using analytic network process: case study at PT XYZ

NASA Astrophysics Data System (ADS)

Adelina, W.; Kusumastuti, R. D.

2017-01-01

This study is about business strategy selection for green supply chain management (GSCM) for PT XYZ by using Analytic Network Process (ANP). GSCM is initiated as a response to reduce environmental impacts from industrial activities. The purposes of this study are identifying criteria and sub criteria in selecting GSCM Strategy, and analysing a suitable GSCM strategy for PT XYZ. This study proposes ANP network with 6 criteria and 29 sub criteria, which are obtained from the literature and experts’ judgements. One of the six criteria contains GSCM strategy options, namely risk-based strategy, efficiency-based strategy, innovation-based strategy, and closed loop strategy. ANP solves complex GSCM strategy-selection by using a more structured process and considering green perspectives from experts. The result indicates that innovation-based strategy is the most suitable green supply chain management strategy for PT XYZ.

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

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

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

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

Space station systems analysis study. Part 2, Volume 3: Appendixes, Book 1. Program requirements documentation

NASA Technical Reports Server (NTRS)

1977-01-01

The objective elements representative of the kinds of space activities that will be supported by the space construction base (SCB) are discussed in (1) a brief mission overview including the primary purpose and general objectives; (2) descriptions of the processes involved (where applicable), the mission hardware, the principal activities to be undertaken, the test requirements, and the principal tests; and (3) the SCB requirements including such items as special devices (e.g., fabrication modules, assembly or construction fixtures, cranes, and airlocks), power, data management and communications, waste management, environmental control, safety, and logistics. Each program option is then described in terms of the objective elements it supports, its orbit, the general makeup of the SCB, the transportation approach, and the program schedule goals. The specific requirements that are imposed on the SCB in order to support program option L are given.

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

USDA-ARS?s Scientific Manuscript database

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

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

Treesearch

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

2015-01-01

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

Longleaf Pine: Natural Regeneration and Management

Treesearch

William D. Boyer

1999-01-01

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

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-23

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

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

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-10

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

12 CFR 350.4 - Contents of annual disclosure statement.

Code of Federal Regulations, 2010 CFR

2010-01-01

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

12 CFR 18.4 - Contents of annual disclosure statement.

Code of Federal Regulations, 2010 CFR

2010-01-01

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

Current approaches to the management of new-onset ulcerative colitis

PubMed Central

Marchioni Beery, Renée; Kane, Sunanda

2014-01-01

Ulcerative colitis (UC) is an idiopathic, inflammatory gastrointestinal disease of the colon. As a chronic condition, UC follows a relapsing and remitting course with medical maintenance during periods of quiescent disease and appropriate escalation of therapy during times of flare. Initial treatment strategies must not only take into account current clinical presentation (with specific regard for extent and severity of disease activity) but must also take into consideration treatment options for the long-term. The following review offers an approach to new-onset UC with a focus on early treatment strategies. An introduction to the disease entity is provided along with an approach to initial diagnosis. Stratification of patients based on clinical parameters, disease extent, and severity of illness is paramount to determining course of therapy. Frequent assessments are required to determine clinical response, and treatment intensification may be warranted if expected improvement goals are not appropriately reached. Mild-to- moderate UC can be managed with aminosalicylates, mesalamine, and topical corticosteroids with oral corticosteroids reserved for unresponsive cases. Moderate-to-severe UC generally requires oral or intravenous corticosteroids in the short-term with consideration of long-term management options such as biologic agents (as initial therapy or in transition from steroids) or thiopurines (as bridging therapy). Patients with severe or fulminant UC who are recalcitrant to medical therapy or who develop disease complications (such as toxic megacolon) should be considered for colectomy. Early surgical referral in severe or refractory UC is crucial, and colectomy may be a life-saving procedure. The authors provide a comprehensive evidence-based approach to current treatment options for new-onset UC with discussion of long-term therapeutic efficacy and safety, patient-centered perspectives including quality of life and medication compliance, and future directions in related inflammatory bowel disease care. PMID:24872716

Dietary Management of Obesity: Cornerstones of Healthy Eating Patterns.

PubMed

Smethers, Alissa D; Rolls, Barbara J

2018-01-01

Several dietary patterns, both macronutrient and food based, can lead to weight loss. A key strategy for weight management that can be applied across dietary patterns is to reduce energy density. Clinical trials show that reducing energy density is effective for weight loss and weight loss maintenance. A variety of practical strategies and tools can help facilitate successful weight management by reducing energy density, providing portion control, and improving diet quality. The flexibility of energy density gives patients options to tailor and personalize their dietary pattern to reduce energy intake for sustainable weight loss. Copyright © 2017 Elsevier Inc. All rights reserved.

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.

German disease management guidelines: surgical therapies for chronic heart failure.

PubMed

Sindermann, J R; Klotz, S; Rahbar, K; Hoffmeier, A; Drees, G

2010-02-01

The German Disease Management Guideline "Chronic Heart Failure" intends to guide physicians working in the field of diagnosis and treatment of heart failure. The guideline provides a tool on the background of evidence based medicine. The following short review wants to give insights into the role of some surgical treatment options to improve heart failure, such as revascularization, ventricular reconstruction and aneurysmectomy, mitral valve reconstruction, ventricular assist devices and heart transplantation. (c) Georg Thieme Verlag KG Stuttgart-New York.

The Air Force’s Experience with Should-Cost Reviews and Options for Enhancing Its Capability to Conduct Them

DTIC Science & Technology

2012-01-01

Patterson Air Force Base, Ohio: Air Force Institute of Technology, 1972. Williams , Robert Leon, A Review of the “Should Cost” Process and Management Issues...We thank William Bartlebaugh of the Air Force Cost Analysis Agency; David Dudley of the Air Force Electronics System Center; Tommy Gilbert of Warner...better performance. The program experienced large cost overruns. Air Force Deputy for Management Systems A. Ernest Fitzgerald, on the staff of the

Twelve evidence-based principles for implementing self-management support in primary care.

PubMed

Battersby, Malcolm; Von Korff, Michael; Schaefer, Judith; Davis, Connie; Ludman, Evette; Greene, Sarah M; Parkerton, Melissa; Wagner, Edward H

2010-12-01

Recommendations to improve self-management support and health outcomes for people with chronic conditions in primary care settings are provided on the basis of expert opinion supported by evidence for practices and processes. Practices and processes that could improve self-management support in primary care were identified through a nominal group process. In a targeted search strategy, reviews and meta-analyses were then identifed using terms from a wide range of chronic conditions and behavioral risk factors in combination with Self-Care, Self-Management, and Primary Care. On the basis of these reviews, evidence-based principles for self-management support were developed. The evidence is organized within the framework of the Chronic Care Model. Evidence-based principles in 12 areas were associated with improved patient self-management and/or health outcomes: (1) brief targeted assessment, (2) evidence-based information to guide shared decision-making, (3) use of a nonjudgmental approach, (4) collaborative priority and goal setting, (5) collaborative problem solving, (6) self-management support by diverse providers, (7) self-management interventions delivered by diverse formats, (8) patient self-efficacy, (9) active followup, (10) guideline-based case management for selected patients, (11) linkages to evidence-based community programs, and (12) multifaceted interventions. A framework is provided for implementing these principles in three phases of the primary care visit: enhanced previsit assessment, a focused clinical encounter, and expanded postvisit options. There is a growing evidence base for how self-management support for chronic conditions can be integrated into routine health care.

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

DTIC Science & Technology

2002-07-01

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

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

Code of Federal Regulations, 2010 CFR

2010-04-01

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

Calcific tendinitis of the rotator cuff: management options.

PubMed

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

2014-11-01

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

The Global Spine Care Initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities.

PubMed

Chou, Roger; Côté, Pierre; Randhawa, Kristi; Torres, Paola; Yu, Hainan; Nordin, Margareta; Hurwitz, Eric L; Haldeman, Scott; Cedraschi, Christine

2018-02-19

The purpose of this review was to develop recommendations for the management of spinal disorders in low-income communities, with a focus on non-invasive pharmacological and non-pharmacological therapies for non-specific low back and neck pain. We synthesized two evidence-based clinical practice guidelines for the management of low back and neck pain. Our recommendations considered benefits, harms, quality of evidence, and costs, with attention to feasibility in medically underserved areas and low- and middle-income countries. Clinicians should provide education and reassurance, advise patients to remain active, and provide information about self-care options. For acute low back and neck pain without serious pathology, primary conservative treatment options are exercise, manual therapy, superficial heat, and nonsteroidal anti-inflammatory drugs (NSAIDs). For patients with chronic low back and neck pain without serious pathology, primary treatment options are exercise, yoga, cognitive behavioral therapies, acupuncture, biofeedback, progressive relaxation, massage, manual therapy, interdisciplinary rehabilitation, NSAIDs, acetaminophen, and antidepressants. For patients with spinal pain with radiculopathy, clinicians may consider exercise, spinal manipulation, or NSAIDs; use of other interventions requires extrapolation from evidence regarding effectiveness for non-radicular spinal pain. Clinicians should not offer treatments that are not effective, including benzodiazepines, botulinum toxin injection, systemic corticosteroids, cervical collar, electrical muscle stimulation, short-wave diathermy, transcutaneous electrical nerve stimulation, and traction. Guidelines developed for high-income settings were adapted to inform a care pathway and model of care for medically underserved areas and low- and middle-income countries by considering factors such as costs and feasibility, in addition to benefits, harms, and the quality of underlying evidence. The selection of recommended conservative treatments must be finalized through discussion with the involved community and based on a biopsychosocial approach. Decision determinants for selecting recommended treatments include costs, availability of interventions, and cultural and patient preferences. These slides can be retrieved under Electronic Supplementary Material.

Linking Domain-Specific Models to Describe the Complex Dynamics and Management Options of a Saline Floodplain

NASA Astrophysics Data System (ADS)

Woods, J.; Laattoe, T.

2016-12-01

Complex hydrological environments present management challenges where surface water-groundwater interactions involve interlinked processes at multiple scales. One example is Australia's River Murray, which flows through a semi-arid landscape with highly saline groundwater. In this region, the floodplain ecology depends on freshwater provided from the main river channel, anabranches, and floodwaters. However, in the past century access to freshwater has been further limited due to river regulation, land clearance, and irrigation. A programme to improve ecosystem health at Pike Floodplain, South Australia, is evaluating management options such as environmental watering and groundwater pumping. Due to the complicated interdependencies between processes moving water and salt within the floodplain, a series of inter-linked models were developed to assist with management decisions. The models differ by hydrological domain, scale, and dimensionality. Together they simulate surface water, the unsaturated zone, and groundwater on regional, floodplain, and local scales. Outputs from regional models provide boundary conditions for floodplain models, which in turn provide inputs for the local scale models. The results are interpreted based on (i) ecohydrological requirements for key species of tree and fish, and (ii) impacts on river salinity for downstream users. When combined, the models provide an integrated and interdiscplinary understanding of the hydrology and management of saline floodplains.

Obesity disease management opportunities and barriers.

PubMed

Sidorov, Jaan E; Fitzner, Karen

2006-04-01

Disease management, a system of coordinated health care interventions and communications for chronically ill populations, relies on patient education and case management to engage individuals in the management of their condition. Disease management also aims to enhance the quality of interactions between doctors and patients and advance evidence-based medicine. Because these programs' interventions frequently include helping individuals who suffer comorbidities associated with obesity to reduce their BMI, adaptation of disease management to populations with obesity seems a viable option. A major barrier for implementing disease management for obesity, however, is the lack of proven return on investment, which limits health plan and disease management organization interest. Purchaser demand may overcome this reluctance. Further research is needed to objectively test whether disease management interventions would be clinically effective for obese populations, produce positive financial outcomes for insurers, and enhance workplace productivity.

A Flexible Online Metadata Editing and Management System

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

Aguilar, Raul; Pan, Jerry Yun; Gries, Corinna

2010-01-01

A metadata editing and management system is being developed employing state of the art XML technologies. A modular and distributed design was chosen for scalability, flexibility, options for customizations, and the possibility to add more functionality at a later stage. The system consists of a desktop design tool or schema walker used to generate code for the actual online editor, a native XML database, and an online user access management application. The design tool is a Java Swing application that reads an XML schema, provides the designer with options to combine input fields into online forms and give the fieldsmore » user friendly tags. Based on design decisions, the tool generates code for the online metadata editor. The code generated is an implementation of the XForms standard using the Orbeon Framework. The design tool fulfills two requirements: First, data entry forms based on one schema may be customized at design time and second data entry applications may be generated for any valid XML schema without relying on custom information in the schema. However, the customized information generated at design time is saved in a configuration file which may be re-used and changed again in the design tool. Future developments will add functionality to the design tool to integrate help text, tool tips, project specific keyword lists, and thesaurus services. Additional styling of the finished editor is accomplished via cascading style sheets which may be further customized and different look-and-feels may be accumulated through the community process. The customized editor produces XML files in compliance with the original schema, however, data from the current page is saved into a native XML database whenever the user moves to the next screen or pushes the save button independently of validity. Currently the system uses the open source XML database eXist for storage and management, which comes with third party online and desktop management tools. However, access to metadata files in the application introduced here is managed in a custom online module, using a MySQL backend accessed by a simple Java Server Faces front end. A flexible system with three grouping options, organization, group and single editing access is provided. Three levels were chosen to distribute administrative responsibilities and handle the common situation of an information manager entering the bulk of the metadata but leave specifics to the actual data provider.« less

New options in the management of tendinopathy

PubMed Central

Maffulli, Nicola; Longo, Umile Giuseppe; Loppini, Mattia; Spiezia, Filippo; Denaro, Vincenzo

2010-01-01

Tendon injuries can be acute or chronic, and caused by intrinsic or extrinsic factors, either alone or in combination. Tendinopathies are a common cause of disability in occupational medicine and account for a substantial proportion of overuse injuries in sports. Tendinopathy is essentially a failed healing response, with haphazard proliferation of tenocytes, abnormalities in tenocytes, with disruption of collagen fibres and subsequent increase in noncollagenous matrix. The scientific evidence base for managing tendinopathies is limited. What may appear clinically as an “acute tendinopathy” is actually a well advanced failure of a chronic healing response in which there is neither histologic nor biochemical evidence of inflammation. In this review we report the new options for the management of tendinopathy, including eccentric exercises, extracorporeal shockwave therapy, injections (intratendinous injections of corticosteroids, aprotinin, polidocanol platelet-rich plasma, autologous blood injection, high-volume injections) and surgery. Open surgery aims to excise fibrotic adhesions, remove areas of failed healing and make multiple longitudinal incisions in the tendon to detect intratendinous lesions, and to restore vascularity and possibly stimulate the remaining viable cells to initiate cell matrix response and healing. New surgical techniques aim to disrupt the abnormal neoinnervation to interfere with the pain sensation caused by tendinopathy. These procedures are intrinsically different from the classical ones in present use, because they do not attempt to address directly the pathologic lesion, but act only to denervate them. They include endoscopy, electrocoagulation, and minimally invasive stripping. Further randomized controlled trials are necessary to clarify better the best therapeutic options for the management of tendinopathy. PMID:24198540

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

PubMed

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

2016-01-01

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

Spirituality, religiosity and addiction recovery: current perspectives.

PubMed

Castaldelli-Maia, Joao Mauricio; Beraldo, Livia; Ventriglio, Antonio; de Andrade, Arthur Guerra; da Silva, Antonio Geraldo; Torales, Julio; Goncalves, Priscila Dib; Bhugra, Dinesh

2018-06-11

Substance use disorders are an important public health problem with a multifactorial etiology and limited effective treatment options. Within this context, spirituality-based approaches may provide interesting and useful options in managing substance use disorders. This kind of intervention can have positive effects in alleviating some core symptoms associated with substance use, such as aggressiveness. Improvement in cessation rates for alcohol, cocaine and opioid use disorders have also been described in some clinical studies. However, spirituality may not play a beneficial role in some subgroups, such as among individuals with crack cocaine and cannabis use disorders. A widely available intervention for alcohol use disorders is Alcoholics Anonymous (AA), which can be seen as a spirituality-based intervention. Spirituality also seems to be especially beneficial for minorities such as Latinos, African-Americans and Native-Americans. Moreover, spiritual-based interventions are also helpful alternatives in many rural environments where conventional healthcare for substance use disorders may not be easily available. However, spiritual-based interventions may be considered as a possible adjunctive therapeutic option to conventional treatments. There is a need for prospective studies outside U.S., especially where spiritual-based approaches are available. It may be difficult to carry out randomized controlled trials because of the nature of the spiritual/religious dimensions. However, prospective studies that evaluate mediation effect of spirituality and religiosity on recovery would be helpful. Qualitative studies combined with quantitative design offer excellent options to evaluate the recovery process, especially among special populations. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Executing Medical Guidelines on the Web: Towards Next Generation Healthcare

NASA Astrophysics Data System (ADS)

Argüello, M.; Des, J.; Fernandez-Prieto, M. J.; Perez, R.; Paniagua, H.

There is still a lack of full integration between current Electronic Health Records (EHRs) and medical guidelines that encapsulate evidence-based medicine. Thus, general practitioners (GPs) and specialised physicians still have to read document-based medical guidelines and decide among various options for managing common non-life-threatening conditions where the selection of the most appropriate therapeutic option for each individual patient can be a difficult task. This paper presents a simulation framework and computational test-bed, called V.A.F. Framework, for supporting simulations of clinical situations that boosted the integration between Health Level Seven (HL7) and Semantic Web technologies (OWL, SWRL, and OWL-S) to achieve content layer interoperability between online clinical cases and medical guidelines, and therefore, it proves that higher integration between EHRs and evidence-based medicine can be accomplished which could lead to a next generation of healthcare systems that provide more support to physicians and increase patients' safety.

Comparison of the Treatment Guidelines for Actinic Keratosis: A Critical Appraisal and Review.

PubMed

Fleming, Patrick; Zhou, Stephanie; Bobotsis, Robert; Lynde, Charles

There are currently several reputable guidelines on the treatment of actinic keratosis (AK) from groups in Canada, the United Kingdom, and Europe. These recommendations, based on evidence or expert consensus, offer clinicians a variety of treatment options for the different clinical presentations of AKs. Although the guidelines are similar in some regards, variations exist in treatment options, duration, and strength of recommendation. Some guidelines also lack input on specific therapies and certain types of AK, such as hypertrophic or thin presentations. The purpose of this article is to review and compare guidelines published by Canadian, UK, and European groups for the management of AKs in patients.

The Decision Support Matrix (DSM) Approach to Reducing Risk of Flooding and Water Pollution in Farmed Landscapes

NASA Astrophysics Data System (ADS)

Hewett, Caspar J. M.; Quinn, Paul; Wilkinson, Mark

2014-05-01

Intense farming plays a key role in contributing to problems such as increased flood risk, soil erosion and poor water quality. This means that there is great potential for agricultural practitioners to play a major part in reducing multiple risks through better land-use management. Greater understanding by farmers, land managers, practitioners and policy-makers of the ways in which farmed landscapes contribute to risks and the ways in which those risks might be mitigated can be an essential component in improving practice. The Decision Support Matrix (DSM) approach involves the development of a range of visualization and communication tools to help compare the risks associated with different farming practices and explore options to manage runoff. DSMs are simple decision support systems intended for use by the non-expert which combine expert hydrological evidence with local knowledge of runoff patterns. They are developed through direct engagement with stakeholders, ensuring that the examples and language used makes sense to end-users. A key element of the tools is that they show the current conditions of the land and describe extremes of land-use management within a hydrological and agricultural land-management context. The tools include conceptual models of a series of pre-determined runoff scenarios, providing the end-user with a variety of potential land management practices and runoff management options. Visual examples of different farming practices are used to illustrate the impact of good and bad practice on specific problems such as nutrient export or risk of flooding. These show both how current conditions cause problems downstream and how systems are vulnerable to changes in climate and land-use intensification. The level of risk associated with a particular land management option is represented by a mapping on a two- or three-dimensional matrix. Interactive spreadsheet-based tools are developed in which multiple questions allow the user to explore different management options and see the impact of decisions plotted as a risk level on the DSM. They employ a ranking methodology combined with a simple mapping of information onto a visual matrix. A nominal scoring system is used to rank higher or lower runoff risk. The end-user can then assess numerous land use and runoff management options to lower risk. The objective is to encourage policy makers, catchment managers and farmers to produce resilient local landscapes at minimal cost. A number of DSMs have been developed successfully over a number of years working with a variety of stakeholders in the UK, including the Phosphorus Export Risk Matrix (PERM), The Nitrate Export Risk Matrix (NO3RM) and arable and livestock versions of the Floods and Agriculture Risk Matrix (FARM) (available from http://research.ncl.ac.uk/thefarm). Despite uncertainty, the tools do contribute to stakeholders having greater confidence in making decisions to make landscapes more resilient. DSMs have been taken up widely in the UK by bodies such as the Environment Agency and Defra, and have been successfully employed within wider decision support frameworks alongside modelling at multiple scales. Such tools could be used in similar farmed landscapes internationally.

Application of Remote Sensing for Forest Management in Nepal

NASA Astrophysics Data System (ADS)

Bajracharya, B.; Matin, M. A.

2016-12-01

Large area of the Hindu Kush Himalayan (HKH) region is covered by forest that is playing a vital role to address the challenges of climate change and livelihood options for a growing population. Effective management of forest cover needs establishment of regular monitoring system for forest. Supporting REDD assessment needs reliable baseline assessment of forest biomass and its monitoring at multiple scale. Adaptation of forest to climate change needs understanding vulnerability of forests and dependence of local communities on these forest. We present here different forest monitoring products developed under the SERVIR-Himalaya programme to address these issues. Landsat 30 meter images were used for decadal land cover change assessment and annual forest change hotspot monitoring. Methodology developed for biomass estimation at national and sub-national level biomass estimation. Decision support system was developed for analysis of forest vulnerability and dependence and selection of adaptation options based on resource availability. These products are forming the basis for development of an integrated system that will be very useful for comprehensive forest monitoring and long term strategy development for sustainable forest management.

78 FR 49565 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-14

... new Options Floor Broker Management System. II. Self-Regulatory Organization's Statement of the... SECURITIES AND EXCHANGE COMMISSION [Release No. 34-70141; File No. SR-Phlx-2013-83] Self... Change To Delay the Implementation of the Options Floor Broker Management System Until the End of...

76 FR 40969 - Self-Regulatory Organizations; Notice of Filing and Immediate Effectiveness of a Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-12

... risk management strategies and decisions. Furthermore, the Exchange has had to eliminate option classes... additional short term option classes for investment, trading, and risk management purposes. Finally, the... that various strategies that the investor put into play were disrupted and eliminated when the class...

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-19

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

Integrated dynamic policy management methodology and system for strategic environmental assessment of golf course installation policy in Taiwan

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

Chen, Ching-Ho, E-mail: chchen@tea.ntue.edu.t; Liu, Wei-Lin, E-mail: wlliu@nanya.edu.t; Graduate Institute of Environmental Engineering, National Central University, Jungli, Taoyuan 320, Taiwan

Strategic environmental assessment (SEA) focuses primarily on assessing how policies, plans, and programs (PPPs) influence the sustainability of the involved regions. However, the processes of assessing policies and developing management strategies for pollution load and resource use are usually separate in the current SEA system. This study developed a policy management methodology to overcome the defects generated during the above processes. This work first devised a dynamic management framework using the methods of systems thinking, system dynamics, and Managing for Results (MFRs). Furthermore, a driving force-pressure-state-impact-response (DPSIR) indicator system was developed. The golf course installation policy was applied as amore » case study. Taiwan, counties of Taiwan, and the golf courses within those individual counties were identified as a system, subsystems, and objects, respectively. This study identified an object-linked double-layer framework with multi-stage-option to simultaneously to quantify golf courses in each subsystem and determine ratios of abatement and allocation for pollution load and resource use of each golf course. The DPSIR indicator values for each item of each golf course in each subsystem are calculated based on the options taken in the two decision layers. The summation of indicator values for all items of all golf courses in all subsystems according to various options is defined as the sustainability value of the policy. An optimization model and a system (IDPMS) were developed to obtain the greatest sustainability value of the policy, while golf course quantity, human activity intensity, total quantities of pollution load and resource use are simultaneously obtained. The solution method based on enumeration of multiple bounds for objectives and constraints (EMBOC) was developed for the problem with 1.95 x 10{sup 128} combinations of possible options to solve the optimal solution in ten minutes using a personal computer with 3.0 GHz CPU. This study obtain the policy with the optimal environmental sustainability value in Taiwan is 102 golf courses. Human activity intensity and total quantities of pollution load and resource use which are concurrently obtained are less than those of the existing policy and the existing quantities in 2006. The optimal solution remains unchanged under most sensitivity analysis conditions, unless the weights and constraints are extremely changed. The analytical results indicate that the proposed methodology can be used to assist the authorities for simultaneously generating and assessing the policy during the SEA process.« less

The Role of Proteomics in the Diagnosis and Treatment of Women's Cancers: Current Trends in Technology and Future Opportunities

PubMed Central

Breuer, Eun-Kyoung Yim; Murph, Mandi M.

2011-01-01

Technological and scientific innovations over the last decade have greatly contributed to improved diagnostics, predictive models, and prognosis among cancers affecting women. In fact, an explosion of information in these areas has almost assured future generations that outcomes in cancer will continue to improve. Herein we discuss the current status of breast, cervical, and ovarian cancers as it relates to screening, disease diagnosis, and treatment options. Among the differences in these cancers, it is striking that breast cancer has multiple predictive tests based upon tumor biomarkers and sophisticated, individualized options for prescription therapeutics while ovarian cancer lacks these tools. In addition, cervical cancer leads the way in innovative, cancer-preventative vaccines and multiple screening options to prevent disease progression. For each of these malignancies, emerging proteomic technologies based upon mass spectrometry, stable isotope labeling with amino acids, high-throughput ELISA, tissue or protein microarray techniques, and click chemistry in the pursuit of activity-based profiling can pioneer the next generation of discovery. We will discuss six of the latest techniques to understand proteomics in cancer and highlight research utilizing these techniques with the goal of improvement in the management of women's cancers. PMID:21886869

Collaborative Decision Model on Stockpile Material of a Traditional Market Infrastructure using Value-Based HBU

NASA Astrophysics Data System (ADS)

Utomo, C.; Rahmawati, Y.; Pararta, D. L.; Ariesta, A.

2017-11-01

Readiness of infrastructure establishment is needed in the early phase of real estate development. To meet the needs of retail property in the form of traditional markets, the Government prepares to build a new 1300 units. Traditional market development requires infrastructure development. One of it is the preparation of sand material embankment as much as ± 200,000 m3. With a distance of 30 km, sand material can be delivered to the project site by dump trucks that can only be operated by 2 trip per day. The material is managed by using stockpile method. Decision of stockpile location requires multi person and multi criteria in a collaborative environment. The highest and the best use (HBU) criteria was used to construct a value-based decision hierarchy. Decision makers from five stakeholders analyzed the best of three locations by giving their own preference of development cost and HBU function. Analytical Hierarchy Process (AHP) based on satisfying options and cooperative game was applied for agreement options and coalition formation on collaborative decision. The result indicates that not all solutions become a possible location for the stockpile material. It shows the ‘best fit’ options process for all decision makers.

Pain and pain management in dermatology.

PubMed

Beiteke, Ulrike; Bigge, Stefan; Reichenberger, Christina; Gralow, Ingrid

2015-10-01

It is estimated that 23 million Germans suffer from chronic pain. A recent survey has revealed that 30 % of chronic pain patients are dissatisfied with their pain management. Furthermore, five million Germans suffer from neuropathic pain, 20 % of whom are inadequately treated. Pain is also a symptom of many dermatologic diseases, which is mostly somatic and may be classified as mild in the majority of cases. Nevertheless, research on the quality of life (QoL) has increasingly shown a marked impairment of QoL by moderate pain such as in psoriatic arthritis. -Severe pain is associated with herpes zoster (shingles), leg ulcers, and pyoderma gangrenosum. This article addresses the basics of pain classification and, in a short excerpt, pain transduction/transmission and modulation. The use of standardized diagnostic -scales is recommended for the purpose of recording and monitoring pain intensity, which allows for the optimization of therapy and consistent interdisciplinary -communication. Any dermatology residency program includes the acquisition of knowledge and skills in pain management. This review therefore aims to present fundamental therapeutic concepts based on the expanded WHO analgesic ladder, and describes a step-wise therapeutic approach and combination therapies. The article focuses on the pain management of the above-mentioned severely painful, conservatively treated dermatoses. Besides well-established therapeutic agents and current -therapeutic standards, it discusses specific options based on guidelines (where available). Current knowledge on peri- and postoperative pain management is briefly outlined. This article addresses: ▸ The fundamentals of the classification and neurophysiology of pain; ▸ Standards for pain documentation in children and adults; ▸ General standards for pharmaceutical pain management; ▸ Current specific treatment options for postherpetic neuralgia, leg ulcers, and -pyoderma gangrenosum in conjunction with the expanded WHO analgesic -ladder. © 2015 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Water security and its challenges for Malaysia

NASA Astrophysics Data System (ADS)

Malek, M. A.; Nor, M. A. M.; P, Leong Y.

2013-06-01

Water Security in Malaysia is a national issue. The Malaysian water services industry faces issues which need to be tackled immediately for it to be viable and sustainable. Among them are the decentralized water services sector, ineffective governance structure, unsustainable tariffs, huge investments required to develop the water supply and sewerage infrastructure, inefficient operation by the operators and high non-revenue water (NRW) losses. In Malaysia, the "Sectorial" approach embedded in the present water management system and its transformation towards "Integrated Water Resources Management" (IWRM), is still in a state of inertia. This paper presents the need to transform, from a "Supply" Management mode (a characteristic of a developing country) to a "Water Demand" Management mode (a characteristic of a developed country). Issues on "Water Demand" Management for the Environment which can be a threat to the need for sustainable development for biodiversity are highlighted here. Reliable water accounting systems are found still lacking in this country, especially in the Agriculture and Environmental Sectors, where figures are still highly based on "traditional" assumptions. Water Quality deterioration remains an issue especially for the Water Supply and Environment Sectors. Available surface water resource is depleting in many regions and states in the Peninsular. Apart from the Reduce, Reuse and Recycle (3R) option for surface water, another option would be to begin a concerted effort for groundwater exploitation. However there are still grey areas of knowledge in the groundwater resources in this country for affirmative decisions and development of appropriate policies. It is also found that, there are no concerted plans to prepare the public for the change from "Supply" Management to "Demand" Management. In a developed nation, this change is through stakeholder platforms and supported by appropriate policies, rules and regulations that are based on validated Sciences, Technologies and Innovations (STI). Transforming from "Supply" Management to "Demand" Management is a formidable task. This requires the wisdom and knowledge of all experts in the Water Resources Sector.

Designing CIS to improve decisions in depression disease management: a discourse analysis of front line practice.

PubMed

Mirel, Barbara; Ackerman, Mark S; Kerber, Kevin; Klinkman, Michael

2006-01-01

Clinical care management promises to help diminish the major health problem of depression. To realize this promise, front line clinicians must know which care management interventions are best for which patients and act accordingly. Unfortunately, the detailed intervention data required for such differentiated assessments are missing in most clinical information systems (CIS). To determine frontline clinicians' needs for these data and to identify the data that CIS should keep, we conducted an 18 month ethnographic study and discourse analysis of telehealth depression care management. Results show care managers need data-based evidence to choose best options, and discourse analysis suggests some personalized interventions that CIS should and can feasibly capture for evidence.

Acquiring Enterprise Systems as a Portfolio of Real Options

DTIC Science & Technology

2012-04-30

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

Primary care physician management, referral, and relations with specialists concerning patients at risk for cancer due to family history.

PubMed

Wood, M E; Flynn, B S; Stockdale, A

2013-01-01

Risk stratification based on family history is a feature of screening guidelines for a number of cancers and referral guidelines for genetic counseling/testing for cancer risk. Our aim was to describe primary care physician perceptions of their role in managing cancer risk based on family history. Structured interviews were conducted by a medical anthropologist with primary care physicians in 3 settings in 2 north-eastern states. Transcripts were systematically analyzed by a research team to identify major themes expressed by participants. Forty interviews were conducted from May 2003 through May 2006. Physicians provided a diversity of views on roles in management of cancer risk based on family history, management practices and patient responses to risk information. They also provided a wide range of perspectives on criteria used for referral to specialists, types of specialists referred to and expected management roles for referred patients. Some primary care physicians appeared to make effective use of family history information for cancer risk management, but many in this sample did not. Increased focus on efficient assessment tools based on recognized guidelines, accessible guides to management options, and patient education and decision aids may be useful directions to facilitate broader use of family history information for cancer risk management. Copyright © 2013 S. Karger AG, Basel.

A Delphi study and ranking exercise to support commissioning services: future delivery of Thrombectomy services in England.

PubMed

Halvorsrud, Kristoffer; Flynn, Darren; Ford, Gary A; McMeekin, Peter; Bhalla, Ajay; Balami, Joyce; Craig, Dawn; White, Phil

2018-02-22

Intra-arterial thrombectomy is the gold standard treatment for large artery occlusive stroke. However, the evidence of its benefits is almost entirely based on trials delivered by experienced neurointerventionists working in established teams in neuroscience centres. Those responsible for the design and prospective reconfiguration of services need access to a comprehensive and complementary array of information on which to base their decisions. This will help to ensure the demonstrated effects from trials may be realised in practice and account for regional/local variations in resources and skill-sets. One approach to elucidate the implementation preferences and considerations of key experts is a Delphi survey. In order to support commissioning decisions, we aimed using an electronic Delphi survey to establish consensus on the options for future organisation of thrombectomy services among physicians with clinical experience in managing large artery occlusive stroke. A Delphi survey was developed with 12 options for future organisation of thrombectomy services in England. A purposive sampling strategy established an expert panel of stroke physicians from the British Association of Stroke Physicians (BASP) Clinical Standards and/or Executive Membership that deliver 24/7 intravenous thrombolysis. Options with aggregate scores falling within the lowest quartile were removed from the subsequent Delphi round. Options reaching consensus following the two Delphi rounds were then ranked in a final exercise by both the wider BASP membership and the British Society of Neuroradiologists (BSNR). Eleven stroke physicians from BASP completed the initial two Delphi rounds. Three options achieved consensus, with subsequently wider BASP (97%, n = 43) and BSNR members (86%, n = 21) assigning the highest approval rankings in the final exercise for transferring large artery occlusive stroke patients to nearest neuroscience centre for thrombectomy based on local CT/CT Angiography. The initial Delphi rounds ensured optimal reduction of options by an expert panel of stroke physicians, while subsequent ranking exercises allowed remaining options to be ranked by a wider group of experts within stroke to reach consensus. The preferred implementation option for thrombectomy is investigating suspected acute stroke patients by CT/CT Angiography and secondary transfer of large artery occlusive stroke patients to the nearest neuroscience (thrombectomy) centre.

Creating Regional Futures: A Scenario-Based Inter- and Transdisciplinary Case Study as a Model for Applied Student-Centred Learning in Geography

ERIC Educational Resources Information Center

Fromhold-Eisebith, Martina; Freyer, Bernhard; Mose, Ingo; Muhar, Andreas; Vilsmaier, Ulli

2009-01-01

Human geography students face changing qualification requirements due to a shift towards new topics, educational tasks and professional options regarding issues of spatial development. This "practical turn" raises the importance of inter- and transdisciplinary work, management and capability building skills, with case study projects and…

Options for small-diameter hardwood utilization: past and present

Treesearch

Matthew S. Bumgardner; Bruce G. Hansen; Albert T. Schuler; Philip A. Araman

2000-01-01

Effective and maximum value use of small-diameter hardwood timber has long been of interest to forest managers and researchers. In addition to being a significant component of the standing forest base, small-diameter hardwoods often are available after thinning or other tending operations. Although the use of this material is important to achieving healthy and...

Options for Small-Diameter Hardwood Utilization: Past and Present

Treesearch

Matthew S. Bumgardner; Bruce G. Hansen; Albert T. Schuler; Philip A. Araman; Philip A. Araman

2001-01-01

Effective and maximum value use of small-diameter hardwood timber has long been of interest to forest managers and researchers. In addition to being a significant component of the standing forest base, small-diameter hardwoods often are available after thinning or other tending operations. Although the use of this material is important to achieving healthy and...

An evidence-based approach to nurses week celebrations.

PubMed

Hensinger, Barbara; Parry, Juanita; Calarco, Margaret M; Fuhrmann, Sarah

2008-04-01

It is time to examine nurses week investments. With expenses increasingly scrutinized, healthcare leaders require data-driven decisions. Managing by instinct and intuition is both inadequate and reckless. This survey of 727 registered nurses identifies celebratory options for nurses week that nurses find meaningful. Knowing what registered nurses value will guide approaches to an effective nurses week activity planning.

One Course, One Web Site--Of Course? Maybe Not!

ERIC Educational Resources Information Center

Cohn, Ellen R.

2004-01-01

Colleges and universities increasingly employ commercial Web-based course management systems (such as Blackboard and WebCT). How is it, then, that these institutions unquestioningly allocate a unique Web site to each class? Why establish one Web site for one course when other options provide so many benefits? Why isn't there a clamor for…

The effectiveness of competency-based education in equipping primary health care workers to manage chronic disease in Australian general practice settings.

PubMed

Glasgow, Nicholas J; Wells, Robert; Butler, James; Gear, Anna

2008-04-21

To review the literature on the effectiveness of competency-based education (CBE) as a means of equipping the Australian general practice workforce to deliver optimal chronic disease outcomes to articulate policy options for the Australian context. Systematic review of the literature (1991-2005) using a narrative approach followed by analysis of the findings using the actors/context/ processes/content framework of Buse et al. Few high-quality studies were identified. National policy options include incorporating clear statements about education and training, research and evaluation in any policy document targeting chronic disease; and provision of funding to enhance general practice teaching facilities and/or facilitate the development of supportive coordinating and administrative structures for training practices. Designers of CBE should consider five key questions: Are the educational objectives of the CBE clearly aligned with the chronic disease or workforce-related outcomes of interest? Is the design of the CBE sound? Have similar educational programs targeting the same outcomes been identified and every attempt made to maximise synergies between programs? Are the educational designers fully aware of and working within the existing complexity of the training environment? Are all involved in the program actively managing the process of change? Policy options range from those relatively simple and achievable to more complex and difficult. The full report is available at http://www.anu.edu.au/aphcri/Domain/Workforce/final_25_glasgow.pdf.

An expert system shell for inferring vegetation characteristics: The learning system (tasks C and D)

NASA Technical Reports Server (NTRS)

Harrison, P. Ann; Harrison, Patrick R.

1992-01-01

This report describes the implementation of a learning system that uses a data base of historical cover type reflectance data taken at different solar zenith angles and wavelengths to learn class descriptions of classes of cover types. It has been integrated with the VEG system and requires that the VEG system be loaded to operate. VEG is the NASA VEGetation workbench - an expert system for inferring vegetation characteristics from reflectance data. The learning system provides three basic options. Using option one, the system learns class descriptions of one or more classes. Using option two, the system learns class descriptions of one or more classes and then uses the learned classes to classify an unknown sample. Using option three, the user can test the system's classification performance. The learning system can also be run in an automatic mode. In this mode, options two and three are executed on each sample from an input file. The system was developed using KEE. It is menu driven and contains a sophisticated window and mouse driven interface which guides the user through various computations. Input and output file management and data formatting facilities are also provided.

How We Manage Adenosine Deaminase-Deficient Severe Combined Immune Deficiency (ADA SCID).

PubMed

Kohn, Donald B; Gaspar, H Bobby

2017-05-01

Adenosine deaminase-deficient severe combined immune deficiency (ADA SCID) accounts for 10-15% of cases of human SCID. From what was once a uniformly fatal disease, the prognosis for infants with ADA SCID has improved greatly based on the development of multiple therapeutic options, coupled with more frequent early diagnosis due to implementation of newborn screening for SCID. We review the various treatment approaches for ADA SCID including allogeneic hematopoietic stem cell transplantation (HSCT) from a human leukocyte antigen-matched sibling or family member or from a matched unrelated donor or a haplo-identical donor, autologous HSCT with gene correction of the hematopoietic stem cells (gene therapy-GT), and enzyme replacement therapy (ERT) with polyethylene glycol-conjugated adenosine deaminase. Based on growing evidence of safety and efficacy from GT, we propose a treatment algorithm for patients with ADA SCID that recommends HSCT from a matched family donor, when available, as a first choice, followed by GT as the next option, with allogeneic HSCT from an unrelated or haplo-identical donor or long-term ERT as other options.

On providing the fault-tolerant operation of information systems based on open content management systems

NASA Astrophysics Data System (ADS)

Kratov, Sergey

2018-01-01

Modern information systems designed to service a wide range of users, regardless of their subject area, are increasingly based on Web technologies and are available to users via Internet. The article discusses the issues of providing the fault-tolerant operation of such information systems, based on free and open source content management systems. The toolkit available to administrators of similar systems is shown; the scenarios for using these tools are described. Options for organizing backups and restoring the operability of systems after failures are suggested. Application of the proposed methods and approaches allows providing continuous monitoring of the state of systems, timely response to the emergence of possible problems and their prompt solution.

Insurer and employer views on pediatric obesity treatment: a qualitative study.

PubMed

Hampl, S E; Davis, A M; Sampilo, M L; Stephens, K L; Dean, K

2013-04-01

The effectiveness of group-based comprehensive, multidisciplinary (stage 3) pediatric weight management programs is backed by a growing body of literature, yet insurance coverage of these programs is scarce to nonexistent, limiting their reach and long-term survival. The objective of this study was to better understand the perspectives of insurers and large employers on the issue of group-based treatment coverage. The authors performed a qualitative study utilizing structured interviews with these stakeholders, following accepted techniques. Six major themes emerged: cost, program effectiveness, corporate social responsibility, secondary parental (employee) benefits, coverage options and new benefit determination. Future efforts to secure payment for group-based pediatric weight management programs should address these key themes. Copyright © 2012 The Obesity Society.

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

Treesearch

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

2004-01-01

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

National Forest management options in response to climate change

Treesearch

Forest Service U.S. Department of Agriculture

2009-01-01

The effect of climate change on ecosystem structure, function, and services will depend on the ecosystem's degree of sensitivity to climate change, the natural ability of plants and animals to adapt, and the availability of effective management options. Sensitivity to climate change is a function of ecosystem health and environmental stresses such as air pollution...

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

Treesearch

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

1997-01-01

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

Developing management options for longleaf communities of the gulf coastal plain

Treesearch

Kenneth W. Outcalt

2003-01-01

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

Developing fire management mixes for fire program planning

Treesearch

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

1986-01-01

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

Carnegie Mellon University's MMM program: management education for 21st-century physicians.

PubMed

Korevaar, W C; Pearson, R W

2001-01-01

The number and types of executive and graduate-level management programs for physicians have exploded in recent years. These programs take on a variety of formats, ranging from executive seminars to master's-level degree programs. Options for physicians obtaining the master's degree tend to be either regionally based programs in traditional evening classes or nationally based programs that combine executive education formats with distance education. This paper examines a nationally based program - the Master of Medical Management (MMM) - from the perspectives of an administrator and a graduate of the program. It offers reasons for the growth of similar programs and data from students enrolled in the Carnegie Mellon University MMM program. The paper also examines educational outcomes in the form of behavioral competencies that the physicians acquired in the program. It concludes with reflections on the future of the MMM and related programs for physician executives in the 21st century.

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

PubMed

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

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

Optimization of European call options considering physical delivery network and reservoir operation rules

NASA Astrophysics Data System (ADS)

Cheng, Wei-Chen; Hsu, Nien-Sheng; Cheng, Wen-Ming; Yeh, William W.-G.

2011-10-01

This paper develops alternative strategies for European call options for water purchase under hydrological uncertainties that can be used by water resources managers for decision making. Each alternative strategy maximizes its own objective over a selected sequence of future hydrology that is characterized by exceedance probability. Water trade provides flexibility and enhances water distribution system reliability. However, water trade between two parties in a regional water distribution system involves many issues, such as delivery network, reservoir operation rules, storage space, demand, water availability, uncertainty, and any existing contracts. An option is a security giving the right to buy or sell an asset; in our case, the asset is water. We extend a flow path-based water distribution model to include reservoir operation rules. The model simultaneously considers both the physical distribution network as well as the relationships between water sellers and buyers. We first test the model extension. Then we apply the proposed optimization model for European call options to the Tainan water distribution system in southern Taiwan. The formulation lends itself to a mixed integer linear programming model. We use the weighing method to formulate a composite function for a multiobjective problem. The proposed methodology provides water resources managers with an overall picture of water trade strategies and the consequence of each strategy. The results from the case study indicate that the strategy associated with a streamflow exceedence probability of 50% or smaller should be adopted as the reference strategy for the Tainan water distribution system.

Alopecia areata update: part II. Treatment.

PubMed

Alkhalifah, Abdullah; Alsantali, Adel; Wang, Eddy; McElwee, Kevin J; Shapiro, Jerry

2010-02-01

Various therapeutic agents have been described for the treatment of alopecia areata (AA), but none are curative or preventive. The aim of AA treatment is to suppress the activity of the disease. The high rate of spontaneous remission and the paucity of randomized, double-blind, placebo-controlled studies make the evidence-based assessment of these therapies difficult. The second part of this two-part series on AA discusses treatment options in detail and suggests treatment plans according to specific disease presentation. It also reviews recently reported experimental treatment options and potential directions for future disease management. After completing this learning activity, participants should be able to compare the efficacy and safety of various treatment options, formulate a treatment plan tailored to individual patients, and recognize recently described treatments and potential therapeutic approaches. Copyright (c) 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Efficacy and Safety of Remifentanil as an Alternative Labor Analgesic

PubMed Central

Devabhakthuni, Sandeep

2013-01-01

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

Circular economy and waste to energy

NASA Astrophysics Data System (ADS)

Rada, E. C.; Ragazzi, M.; Torretta, V.; Castagna, G.; Adami, L.; Cioca, L. I.

2018-05-01

Waste management in European Union has long being regulated by the 4Rs principle, i.e. reduction, reuse, recycling, recovery, with landfill disposal as the last option. This vision recently led the European Union (especially since 2015) to the introduction of virtuous goals based on the rejection of linear economy in favour of circular economy strongly founded on materials recovery. In this scenario, landfill disposal option will disappear, while energy recovery may appear controversial when not applied to biogas production from anaerobic digestion. The present work aims to analyse the effects that circular economy principles introduced in the European Union context will have on the thermochemical waste treatment plants design. Results demonstrate that indirect combustion (gasification + combustion) along with integrated vitrification of the non-combustible fraction of treated waste will have a more relevant role in the field of waste treatment than in the past, thanks to the compliance of this option with the principles of circular economy.

Urolift - minimally invasive surgical BPH management.

PubMed

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

2017-03-01

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

Taking action against ocean acidification: a review of management and policy options.

PubMed

Billé, Raphaël; Kelly, Ryan; Biastoch, Arne; Harrould-Kolieb, Ellycia; Herr, Dorothée; Joos, Fortunat; Kroeker, Kristy; Laffoley, Dan; Oschlies, Andreas; Gattuso, Jean-Pierre

2013-10-01

Ocean acidification has emerged over the last two decades as one of the largest threats to marine organisms and ecosystems. However, most research efforts on ocean acidification have so far neglected management and related policy issues to focus instead on understanding its ecological and biogeochemical implications. This shortfall is addressed here with a systematic, international and critical review of management and policy options. In particular, we investigate the assumption that fighting acidification is mainly, but not only, about reducing CO2 emissions, and explore the leeway that this emerging problem may open in old environmental issues. We review nine types of management responses, initially grouped under four categories: preventing ocean acidification; strengthening ecosystem resilience; adapting human activities; and repairing damages. Connecting and comparing options leads to classifying them, in a qualitative way, according to their potential and feasibility. While reducing CO2 emissions is confirmed as the key action that must be taken against acidification, some of the other options appear to have the potential to buy time, e.g. by relieving the pressure of other stressors, and help marine life face unavoidable acidification. Although the existing legal basis to take action shows few gaps, policy challenges are significant: tackling them will mean succeeding in various areas of environmental management where we failed to a large extent so far.

Taking Action Against Ocean Acidification: A Review of Management and Policy Options

NASA Astrophysics Data System (ADS)

Billé, Raphaël; Kelly, Ryan; Biastoch, Arne; Harrould-Kolieb, Ellycia; Herr, Dorothée; Joos, Fortunat; Kroeker, Kristy; Laffoley, Dan; Oschlies, Andreas; Gattuso, Jean-Pierre

2013-10-01

Ocean acidification has emerged over the last two decades as one of the largest threats to marine organisms and ecosystems. However, most research efforts on ocean acidification have so far neglected management and related policy issues to focus instead on understanding its ecological and biogeochemical implications. This shortfall is addressed here with a systematic, international and critical review of management and policy options. In particular, we investigate the assumption that fighting acidification is mainly, but not only, about reducing CO2 emissions, and explore the leeway that this emerging problem may open in old environmental issues. We review nine types of management responses, initially grouped under four categories: preventing ocean acidification; strengthening ecosystem resilience; adapting human activities; and repairing damages. Connecting and comparing options leads to classifying them, in a qualitative way, according to their potential and feasibility. While reducing CO2 emissions is confirmed as the key action that must be taken against acidification, some of the other options appear to have the potential to buy time, e.g. by relieving the pressure of other stressors, and help marine life face unavoidable acidification. Although the existing legal basis to take action shows few gaps, policy challenges are significant: tackling them will mean succeeding in various areas of environmental management where we failed to a large extent so far.

Decision analysis and drug development portfolio management: uncovering the real options value of your projects.

PubMed

Rosati, Nicoletta

2002-04-01

Project selection and portfolio management are particularly challenging in the pharmaceutical industry due to the high risk - high stake nature of the drug development process. In the recent years, scholars and industry experts have agreed that traditional Net-Present-Value evaluation of the projects fails to capture the value of managerial flexibility, and encouraged adopting a real options approach to recover the missed value. In this paper, we take a closer look at the drug development process and at the indices currently used to rank projects. We discuss the economic value of information and of real options arising in drug development and present decision analysis as an ideal framework for the implementation of real options valuation.

Advanced Management of Severe Keloids.

PubMed

Hagele, Thomas; Nyanda, Hoka; Patel, Nishit; Russell, Nicole; Cohen, George; Nelson, Christopher

2017-01-01

Keloids negatively impact the health and quality of life of many affected dermatologic patients. Treating keloids is often difficult, and suboptimal responses are frequent. Fortunately, there are many treatment options available to the clinician that may lead to improved clinical outcomes. We present a review of currently available therapeutic options. Intralesional steroid injection remains the first-line treatment for keloids. Imiquimod, direct interferon therapy, or intralesional 5-flurouracil may alleviate the need for excessive corticosteroid therapy. Radiation and laser therapy are emerging therapeutic options that have demonstrated efficacy in reviewed studies. Given the unsatisfactory outcomes associated with pressure dressings, vitamin E, ablative laser, and surgical excision, these options should be avoided in keloid management. Further research is needed to evaluate the efficacy and recurrence associated with the reviewed therapeutics.

Joint Peru/United States report on Peru/United States cooperative energy assessment. Volume 4 of 4 Volumes Annexes 8-11

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

Not Available

1979-08-01

A comprehensive assessment of the biofuel potential of Peru is presented. Topics discussed cover current biofuel utilization practices; evaluation of Peruvian biomass productivity; identification of Peruvian agricultural and forestry resources; assessment of resource development and management concerns; identification of market considerations; description of biofuel technological options; and regional identification of biofuel technology applications. The discussion of current biofuel utilization centers on a qualitative description of the main conversion approaches now being practiced in Peru. Biomass productivity is evaluated in the context of the terrain, soil, and climatic conditions found in Peru. A quantitative description of the energy potential that couldmore » be realized from agricultural and forestry resources of Peru follows. A regional picture is given for the production of agricultural residues and forest resources that could potentially supply energy. The assessment of resource development and management concerns focuses on harvesting, reforestation, training, and the environmental consequences of utilization of forest resources. Market factors assessed include: importation, internal market development, external market development, energy policy and pricing, and transportation. Ten biofuel technology options for Peru were identified: small- to medium-scale gasification, a wood waste inventory, stationary and mobile charcoal production systems, wood distillation, forest resource development and management, electrical cogeneration, anaerobic digestion technology, development of ethanol production capabilities, and agricultural strategies for fuel production.Based upon these biofuel options, nine applications were identified for the Costa Region, eight for the Sierra Region, and ten for the Selva Region.« less

Assessment of Peruvian biofuel resources and alternatives

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

Harper, J.P.; Smith, W.; Mariani, E.

1979-08-01

Comprehensive assessment of the biofuel potential of Peru is based on: determination of current biofuel utilization practices, evauation of Peruvian biomass productivity, identification of Peruvian agricultural and forestry resources, assessment of resource development and management concerns, identification of market considerations, description of biofuel technological options, and identification of regional biofuel technology applications. Discussion of current biofuel utilization centers on a qualitative description of the main conversion approaches currently being practiced in Peru. Biomass productivity evaluations consider the terrain and soil, and climatic conditions found in Peru. The potential energy from Peruvian agricultural and forestry resources is described quantitatively. Potental regionalmore » production of agricultural residues and forest resources that could supply energy are identified. Assessment of resource development and management concerns focuses on harvesting, reforestation, training, and environmental consequences of utilization of forest resources. Market factors assessed include: importation, internal market development, external market development, energy policy and pricing, and transportation. Nine biofuel technology options for Peru are identified: (1) small-to-medium-scale gasification, (2) a wood waste inventory, (3) stationary and mobile charcoal production systems, (4) wood distillation, (5) forest resource development and management, (6) electrical cogeneration, (7) anaerobic digestion technology, (8) development of ethanol production capabilities, and (9) agricultural strategies for fuel production. Applications of these biofuel options are identified for each of the three major regions - nine applications for the Costa Region, eight for the Sierra Region, and ten for the Selva Region.« less

Evidence and practice in the self-management of low back pain: findings from an Australian internet-based survey.

PubMed

Wilk, Victor; Palmer, Hazel Denise; Stosic, Rodney G; McLachlan, Andrew J

2010-01-01

Low back pain (LBP) is common, but sufferers pursue a range of management options and only some seek professional advice. This study examines how Australian consumers report that they manage LBP, with emphasis on the extent to which their practices match clinical recommendations and guidelines. A self-reported cross-sectional online survey comprising 29 questions in English (see Supplemental Digital Content 1, http://links.lww.com/CJP/A13) was conducted in February 2009. The internet-based survey sample was matched with national population proportions; 1220 respondents were screened and 1001 met the inclusion criteria (age >18 y and having suffered from back pain in the previous 6 mo). A total of 570 (57%) participants had experienced LBP, of whom half (307; 54%) sought healthcare advice. Although 126 (41%) respondents reported receiving advice to exercise or stretch, only 107 (19%) reported that their initial response was to follow this advice. One-third maintained normal activity levels and 15% took bed rest, mostly for less than 1 day. A large proportion of respondents were overweight or obese (391, 68%); only 8% were active currently undertaking a weight loss regime. Taking analgesic medication was the most common initial action to LBP (449, 78% respondents); paracetamol was the predominant choice. Under-dosing was evident among users of over-the-counter analgesics. The self-care choices that some people with LBP are making are not in line with the current evidence-based guidelines. This may lead to delayed recovery and the risk of medication-related problems. The provision of education about the nonpharmacologic management options for LBP, optimal information about appropriate medicines choices, and about medication contraindications is essential.

Improving team information sharing with a structured call-out in anaesthetic emergencies: a randomized controlled trial.

PubMed

Weller, J M; Torrie, J; Boyd, M; Frengley, R; Garden, A; Ng, W L; Frampton, C

2014-06-01

Sharing information with the team is critical in developing a shared mental model in an emergency, and fundamental to effective teamwork. We developed a structured call-out tool, encapsulated in the acronym 'SNAPPI': Stop; Notify; Assessment; Plan; Priorities; Invite ideas. We explored whether a video-based intervention could improve structured call-outs during simulated crises and if this would improve information sharing and medical management. In a simulation-based randomized, blinded study, we evaluated the effect of the video-intervention teaching SNAPPI on scores for SNAPPI, information sharing, and medical management using baseline and follow-up crisis simulations. We assessed information sharing using a probe technique where nurses and technicians received unique, clinically relevant information probes before the simulation. Shared knowledge of probes was measured in a written, post-simulation test. We also scored sharing of diagnostic options with the team and medical management. Anaesthetists' scores for SNAPPI were significantly improved, as was the number of diagnostic options they shared. We found a non-significant trend to improve information-probe sharing and medical management in the intervention group, and across all simulations, a significant correlation between SNAPPI and information-probe sharing. Of note, only 27% of the clinically relevant information about the patient provided to the nurse and technician in the pre-simulation information probes was subsequently learnt by the anaesthetist. We developed a structured communication tool, SNAPPI, to improve information sharing between anaesthetists and their team, taught it using a video-based intervention, and provide initial evidence to support its value for improving communication in a crisis. © The Author [2014]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

42 CFR 438.356 - State contract options.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false State contract options. 438.356 Section 438.356 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE External Quality Review § 438.356 State contract options...

Expensing options solves nothing.

PubMed

Sahlman, William A

2002-12-01

The use of stock options for executive compensation has become a lightning rod for public anger, and it's easy to see why. Many top executives grew hugely rich on the back of the gains they made on their options, profits they've been able to keep even as the value they were supposed to create disappeared. The supposed scam works like this: Current accounting regulations let companies ignore the cost of option grants on their income statements, so they can award valuable option packages without affecting reported earnings. Not charging the cost of the grants supposedly leads to overstated earnings, which purportedly translate into unrealistically high share prices, permitting top executives to realize big gains when they exercise their options. If an accounting anomaly is the problem, then the solution seems obvious: Write off executive share options against the current year's revenues. The trouble is, Sahlman writes, expensing option grants won't give us a more accurate view of earnings, won't add any information not already included in the financial statements, and won't even lead to equal treatment of different forms of executive pay. Far worse, expensing evades the real issue, which is whether compensation (options and other-wise) does what it's supposed to do--namely, help a company recruit, retain, and provide the right people with appropriate performance incentives. Any performance-based compensation system has the potential to encourage cheating. Only ethical management, sensible governance, adequate internal control systems, and comprehensive disclosure will save the investor from disaster. If, Sahlman warns, we pass laws that require the expensing of options, thinking that's fixed the fundamental flaws in corporate America's accounting, we will have missed a golden opportunity to focus on the much more extensive defects in the present system.

45 CFR 1306.33 - Home-based program option.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 4 2013-10-01 2013-10-01 false Home-based program option. 1306.33 Section 1306.33... PROGRAM HEAD START STAFFING REQUIREMENTS AND PROGRAM OPTIONS Head Start Program Options § 1306.33 Home-based program option. (a) Grantees implementing a home-based program option must: (1) Provide one home...

45 CFR 1306.33 - Home-based program option.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 4 2014-10-01 2014-10-01 false Home-based program option. 1306.33 Section 1306.33... PROGRAM HEAD START STAFFING REQUIREMENTS AND PROGRAM OPTIONS Head Start Program Options § 1306.33 Home-based program option. (a) Grantees implementing a home-based program option must: (1) Provide one home...

45 CFR 1306.33 - Home-based program option.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 4 2012-10-01 2012-10-01 false Home-based program option. 1306.33 Section 1306.33... PROGRAM HEAD START STAFFING REQUIREMENTS AND PROGRAM OPTIONS Head Start Program Options § 1306.33 Home-based program option. (a) Grantees implementing a home-based program option must: (1) Provide one home...

Contemporary understanding and management of reflux and constipation in the general population and pregnancy: a consensus meeting.

PubMed

Tytgat, G N; Heading, R C; Müller-Lissner, S; Kamm, M A; Schölmerich, J; Berstad, A; Fried, M; Chaussade, S; Jewell, D; Briggs, A

2003-08-01

Gastro-oesophageal reflux disease (GERD) and constipation have a major impact on public health; however, the wide variety of treatment options presents difficulties for recommending therapy. Lack of definitive guidelines in pharmacy and general practice medicine further exacerbates the decision dilemma. To address these issues, a panel of experts discussed the principles and practice of treating GERD and constipation in the general population and in pregnancy, with the aim of developing respective treatment guidelines. The panel recommended antacids 'on-demand' as the first-line over-the-counter treatment in reflux, and as rescue medication for immediate relief when reflux breaks through with proton pump inhibitors. Calcium/magnesium-based antacids were recommended as the treatment of choice for pregnant women because of their good safety profile. In constipation, current data do not distinguish a hierarchy between polyethylene glycol (PEG)-based laxatives and other first-line treatments, although limitations are associated with stimulant- and bulk-forming laxatives. Where data are available, PEG is superior to lactulose in terms of efficacy. In pregnancy, PEG-based laxatives meet the criteria for the ideal treatment. The experts developed algorithms that present healthcare professionals with clear treatment options and management strategies for GERD and constipation in pharmacy and general practice medicine.

Surgical Management of Hemorrhoids

PubMed Central

Agbo, S. P.

2011-01-01

Hemorrhoids are common human afflictions known since the dawn of history. Surgical management of this condition has made tremendous progress from complex ligation and excision procedures in the past to simpler techniques that allow the patient to return to normal life within a short period. Newer techniques try to improve on the post-operative complications of older ones. The surgical options for the management of hemorrhoids today are many. Capturing all in a single article may be difficult if not impossible. The aim of this study therefore is to present in a concise form some of the common surgical options in current literature, highlighting some important post operative complications. Current literature is searched using MEDLINE, EMBASE and the Cochrane library. The conclusion is that even though there are many surgical options in the management of hemorrhoids today, most employ the ligature and excision technique with newer ones having reduced post operative pain and bleeding. PMID:22413048

Design Evolution Study - Aging Options

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

P. McDaniel

The purpose of this study is to identify options and issues for aging commercial spent nuclear fuel received for disposal at the Yucca Mountain Mined Geologic Repository. Some early shipments of commercial spent nuclear fuel to the repository may be received with high-heat-output (younger) fuel assemblies that will need to be managed to meet thermal goals for emplacement. The capability to age as much as 40,000 metric tons of heavy metal of commercial spent nuclear he1 would provide more flexibility in the design to manage this younger fuel and to decouple waste receipt and waste emplacement. The following potential agingmore » location options are evaluated: (1) Surface aging at four locations near the North Portal; (2) Subsurface aging in the permanent emplacement drifts; and (3) Subsurface aging in a new subsurface area. The following aging container options are evaluated: (1) Complete Waste Package; (2) Stainless Steel inner liner of the waste package; (3) Dual Purpose Canisters; (4) Multi-Purpose Canisters; and (5) New disposable canister for uncanistered commercial spent nuclear fuel. Each option is compared to a ''Base Case,'' which is the expected normal waste packaging process without aging. A Value Engineering approach is used to score each option against nine technical criteria and rank the options. Open issues with each of the options and suggested future actions are also presented. Costs for aging containers and aging locations are evaluated separately. Capital costs are developed for direct costs and distributable field costs. To the extent practical, unit costs are presented. Indirect costs, operating costs, and total system life cycle costs will be evaluated outside of this study. Three recommendations for aging commercial spent nuclear fuel--subsurface, surface, and combined surface and subsurface are presented for further review in the overall design re-evaluation effort. Options that were evaluated but not recommended are: subsurface aging in a new subsurface area (high cost); surface aging in the complete waste package (risk to the waste package and impact on the Waste Handling Facility); and aging in the stainless steel liner (impact on the waste package design and new high risk operations added to the waste packaging process). The selection of a design basis for aging will be made in conjunction with the other design re-evaluation studies.« less

A decision analysis approach to climate adaptation: comparing multiple pathways for multi-decadal decision making

NASA Astrophysics Data System (ADS)

Lin, B. B.; Little, L.

2013-12-01

Policy planners around the world are required to consider the implications of adapting to climatic change across spatial contexts and decadal timeframes. However, local level information for planning is often poorly defined, even though climate adaptation decision-making is made at this scale. This is especially true when considering sea level rise and coastal impacts of climate change. We present a simple approach using sea level rise simulations paired with adaptation scenarios to assess a range of adaptation options available to local councils dealing with issues of beach recession under present and future sea level rise and storm surge. Erosion and beach recession pose a large socioeconomic risk to coastal communities because of the loss of key coastal infrastructure. We examine the well-known adaptation technique of beach nourishment and assess various timings and amounts of beach nourishment at decadal time spans in relation to beach recession impacts. The objective was to identify an adaptation strategy that would allow for a low frequency of management interventions, the maintenance of beach width, and the ability to minimize variation in beach width over the 2010 to 2100 simulation period. 1000 replications of each adaptation option were produced against the 90 year simulation in order to model the ability each adaptation option to achieve the three key objectives. Three sets of adaptation scenarios were identified. Within each scenario, a number of adaptation options were tested. The three scenarios were: 1) Fixed periodic beach replenishment of specific amounts at 20 and 50 year intervals, 2) Beach replenishment to the initial beach width based on trigger levels of recession (5m, 10m, 20m), and 3) Fixed period beach replenishment of a variable amount at decadal intervals (every 10, 20, 30, 40, 50 years). For each adaptation option, we show the effectiveness of each beach replenishment scenario to maintain beach width and consider the implications of more frequent replenishment with that of implementation cost. We determine that a business as usual scenario, where no adaptation is implemented, would lead to an average beach recession of 12.02 meters and a maximum beach recession of 33.23 meters during the period of 2010-2100. The best adaptation option modeled was a fixed replenishment of 5 meters every 20 years leading to 4 replenishment events with an average beach recession of 2.99 meters and a maximum beach recession of 15.02 meters during the period of 2010-2100. The presented simulations explicitly address the uncertainty of future impacts due to sea level rise and storm surge and show a range of options that could be considered by a local council to meet their policy objectives. The simulation runs provide managers the ability to consider the utility of various adaptation options and the timing and costs of implementation. Such information provides an evidence-based practice to decision-making and allows policy makers to transparently make decisions based on best estimates of modeled climate change.

Trinitromethyl Heterocyclic Oxidizers as a Solid Propellant Ingredient Final Report CRADA No TC02146.0

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

Pagoria, P.; Racoveanu, A.

This was a collaborative effort between Lawrence Livermore National Security, LLC as manager and operator of Lawrence Livermore National Laboratory (LLNL) and Physical Sciences, Inc. (PSI), to develop a synthesis of two novel energetic heterocyclic oxidizers as possible replacements for ammonium perchlorate (AP) in rocket propellant formulations. This CRADA resulted from the award of the Phase I Small Business Technology Transfer (STTR) from DOD. The CRADA consisted of two phases. The goal for Phase 1 was to produce a new oxidizer called TNMDNP. Phase 2 is optional (based on the success of Phase 1) and the goal of Phase 2more » (optional) was to produce a new oxidizer called TNMDNT. Phase 2 tasks would be performed based on the successful results of Phase 1.« less

Watchful waiting or induction of labour--a matter of informed choice: identification, analysis and critical appraisal of decision aids and patient information regarding care options for women with uncomplicated singleton late and post term pregnancies: a review.

PubMed

Berger, Bettina; Schwarz, Christiane; Heusser, Peter

2015-05-07

Decision-making during pregnancy regarding different options of care can be difficult, particularly when risks of intervention versus no intervention for mother and baby are unclear. Unbiased information and support for decision making may be beneficial in these situations. The management of normal pregnancies at and beyond term is an example of such a situation. In order to determine the need to develop an evidence-based decision aid this paper searches, analyses and appraises patient decision aids and patient information leaflets regarding care options in cases of late term and post-term pregnancies, including complementary and alternative medicine (CAM). A literature search was carried out in a variety of lay and medical databases. written information related to uncomplicated singleton pregnancies and targeted at lay people. Analysis and appraisal of included material by means of quality criteria was set up based on the International Patient Decision Aid Standards accounting for evidence-basing of CAM options. Inclusion of two decision aids and eleven leaflets from four decision aids and sixteen leaflets. One decision aid met the quality criteria almost completely, the other one only insufficiently despite providing some helpful information. Only one leaflet is of good quality, but cannot substitute a decision aid. There is an urgent need for the design of an evidence-based decision aid of good quality for late-term or post-term pregnancy, particularly in German language.

Cost-utility evaluation of vortioxetine in patients with Major Depressive Disorder experiencing inadequate response to alternative antidepressants in the United Kingdom.

PubMed

Young, A H; Evitt, L; Brignone, M; Diamand, F; Atsou, K; Campbell, R; Cure, S; Danchenko, N

2017-08-15

Patients frequently require several lines of therapy for treatment of major depressive episodes. This economic analysis details the management of patients who responded inadequately due to lack of efficacy or intolerability to two previous antidepressants in the UK. The model included a decision tree and a Markov component. Health states considered in the decision tree were remission, response, no response, withdrawal due to adverse events, relapse, recovery, and recurrence. The time horizon was 24 months. Patients were on third-line treatment for up to a 3-month acute phase and a 6-month maintenance phase. As third-line efficacy data were not available, inputs were calculated by adjusting original second-line data to third-line based on proportionate reductions observed in STAR*D. Equivalent efficacy was assumed for all comparators. Healthcare resource use and utilities were based on UK estimates. Vortioxetine was a cost-effective treatment option at a threshold of £20,000/QALY vs. escitalopram, citalopram, sertraline, and was associated with more health benefits, less costs (was dominant) versus relevant third-line comparators venlafaxine and duloxetine. Agomelatine was found not to be a cost-effective option. The 22-month maintenance phase treatment scenario results were similar to the 6-month base case. Third-line efficacy data were not available. This highlights the need for studies in patients receiving third-line treatment. This model provides an overview for the management of patients receiving third-line treatment where limited evidence currently exists. Vortioxetine, with its novel mechanism of action, is expected to be a dominant treatment option versus relevant comparators in the UK. Copyright © 2017. Published by Elsevier B.V.

Integrating Ecosystem-Based Management Principles of Adaptive Management and Stakeholder Engagement in California Fisheries

NASA Astrophysics Data System (ADS)

Erickson, A.; Martone, R. G.; Hazen, L.; Mease, L.; Gourlie, D.; Le Cornu, E.; Ourens, R.; Micheli, F.

2016-12-01

California's fisheries management law, the Marine Life Management Act (MLMA) of 1998, signaled a transformative shift from traditional single-species management to an ecosystem-based approach. In response, the fisheries management community in California is striving to integrate new science and management innovations while maximizing its limited capacity. However, data gaps, high compliance costs, capacity constraints, and limited access to the best available data and technologies persist. Here we present two decision support tools being developed to aid California fisheries managers as they continue to implement ecosystem-based management (EBM). First, to practice adaptive management, a key principle of EBM, managers must know whether and how their decisions are meeting their management objectives over time. Based on a cross-walk of MLMA goals with metrics and indicators from sustainable fishery certification programs, we present a flexible and practical tool for tracking fishery management performance in California. We showcase a draft series of decision trees and questionnaires managers can use to quantitatively or qualitatively measure both ecological and social outcomes, helping them to prioritize management options and limited resources. Second, state fisheries managers acknowledge the need for more effective stakeholder engagement to facilitate and inform decision-making and long-term outcomes, another key principle of EBM. Here, we present a pilot version of a decision-support tool to aid managers in choosing the most appropriate stakeholder engagement strategies in various types of decision contexts. This online tool will help staff identify their engagement goals, when they can strategically engage stakeholders based on their needs, and the fishery characteristics that will inform how engagement strategies are tailored to specific contexts. We also share opportunities to expand these EBM tools to other resource management contexts and scales.

Integrating Ecosystem-Based Management Principles of Adaptive Management and Stakeholder Engagement in California Fisheries

NASA Astrophysics Data System (ADS)

Erickson, A.; Martone, R. G.; Hazen, L.; Mease, L.; Gourlie, D.; Le Cornu, E.; Ourens, R.; Micheli, F.

2016-02-01

California's fisheries management law, the Marine Life Management Act (MLMA) of 1998, signaled a transformative shift from traditional single-species management to an ecosystem-based approach. In response, the fisheries management community in California is striving to integrate new science and management innovations while maximizing its limited capacity. However, data gaps, high compliance costs, capacity constraints, and limited access to the best available data and technologies persist. Here we present two decision support tools being developed to aid California fisheries managers as they continue to implement ecosystem-based management (EBM). First, to practice adaptive management, a key principle of EBM, managers must know whether and how their decisions are meeting their management objectives over time. Based on a cross-walk of MLMA goals with metrics and indicators from sustainable fishery certification programs, we present a flexible and practical tool for tracking fishery management performance in California. We showcase a draft series of decision trees and questionnaires managers can use to quantitatively or qualitatively measure both ecological and social outcomes, helping them to prioritize management options and limited resources. Second, state fisheries managers acknowledge the need for more effective stakeholder engagement to facilitate and inform decision-making and long-term outcomes, another key principle of EBM. Here, we present a pilot version of a decision-support tool to aid managers in choosing the most appropriate stakeholder engagement strategies in various types of decision contexts. This online tool will help staff identify their engagement goals, when they can strategically engage stakeholders based on their needs, and the fishery characteristics that will inform how engagement strategies are tailored to specific contexts. We also share opportunities to expand these EBM tools to other resource management contexts and scales.

Incorporating Green Infrastructure into Water Resources Management Plans to Address Water Quality Impairments

NASA Astrophysics Data System (ADS)

Piscopo, A. N.; Detenbeck, N. E.

2017-12-01

Managers of urban watersheds with excessive nutrient loads are more frequently turning to green infrastructure (GI) to manage their water quality impairments. The effectiveness of GI is dependent on a number of factors, including (1) the type and placement of GI within the watershed, (2) the specific nutrients to be treated, and (3) the uncertainty in future climates. Although many studies have investigated the effectiveness of individual GI units for different types of nutrients, relatively few have considered the effectiveness of GI on a watershed scale, the scale most relevant to management plans. At the watershed scale, endless combinations of GI type and location are possible, each with different effectiveness in reducing nutrient loads, minimizing costs, and maximizing co-benefits such as reducing runoff. To efficiently generate management plan options that balance the tradeoffs between these objectives, we simulate candidate options using EPA's Stormwater Management Model for multiple future climates and determine the Pareto optimal set of solution options using a multi-objective evolutionary algorithm. Our approach is demonstrated for an urban watershed in Rockville, Maryland.

Sickle Cell Disease: Management Options and Challenges in Developing Countries

PubMed Central

Ansong, Daniel; Akoto, Alex Osei; Ocloo, Delaena; Ohene-Frempong, Kwaku

2013-01-01

Sickle Cell Disease (SCD) is the most common genetic disorder of haemoglobin in sub-Saharan Africa. This commentary focuses on the management options available and the challenges that health care professionals in developing countries face in caring for patients with SCD. In a developing countries like Ghana, new-born screening is now about to be implemented on a national scale. Common and important morbidities associated with SCD are vaso-occlusive episodes, infections, Acute Chest Syndrome (ACS), Stroke and hip necrosis. Approaches to the management of these morbidities are far advanced in the developed countries. The differences in setting and resource limitations in developing countries bring challenges that have a major influence in management options in developing countries. Obviously clinicians in developing countries face challenges in managing SCD patients. However understanding the disease, its progression, and instituting the appropriate preventive methods are paramount in its management. Emphasis should be placed on early counselling, new-born screening, anti-microbial prophylaxis, vaccination against infections, and training of healthcare workers, patients and caregivers. These interventions are affordable in developing countries. PMID:24363877

Context based configuration management system

NASA Technical Reports Server (NTRS)

Gurram, Mohana M. (Inventor); Maluf, David A. (Inventor); Mederos, Luis A. (Inventor); Gawdiak, Yuri O. (Inventor)

2010-01-01

A computer-based system for configuring and displaying information on changes in, and present status of, a collection of events associated with a project. Classes of icons for decision events, configurations and feedback mechanisms, and time lines (sequential and/or simultaneous) for related events are displayed. Metadata for each icon in each class is displayed by choosing and activating the corresponding icon. Access control (viewing, reading, writing, editing, deleting, etc.) is optionally imposed for metadata and other displayed information.

Management of fibromyalgia syndrome – an interdisciplinary evidence-based guideline

PubMed Central

Häuser, Winfried; Arnold, Bernhard; Eich, Wolfgang; Felde, Eva; Flügge, Christl; Henningsen, Peter; Herrmann, Markus; Köllner, Volker; Kühn, Edeltraud; Nutzinger, Detlev; Offenbächer, Martin; Schiltenwolf, Marcus; Sommer, Claudia; Thieme, Kati; Kopp, Ina

2008-01-01

The prevalence of fibromyalgia syndrome (FMS) of 1–2% in the general population associated with high disease-related costs and the conflicting data on treatment effectiveness had led to the development of evidence-based guidelines designed to provide patients and physicians guidance in selecting among the alternatives. Until now no evidence-based interdisciplinary (including patients) guideline for the management of FMS was available in Europe. Therefore a guideline for the management of fibromyalgia syndrome (FMS) was developed by 13 German medical and psychological associations and two patient self-help organisations. The task was coordinated by two German scientific umbrella organisations, the Association of the Scientific Medical Societies in Germany AWMF and the German Interdisciplinary Association of Pain Therapy DIVS. A systematic search of the literature including all controlled studies, systematic reviews and meta-analyses of pharmacological and non-pharmacological treatments of FMS was performed in the Cochrane Library (1993–12/2006), Medline (1980–12/2006), PsychInfo (1966–12/2006) and Scopus (1980–12/ 2006). Levels of evidence were assigned according to the classification system of the Oxford-Centre for Evidence Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures were used to reach a consensus on recommendations. The guideline was reviewed and finally approved by the boards of the societies involved and published online by the AWMF on april 25, 2008: http://www.uni-duesseldorf.de/AWMF/ll/041-004.htm. A short version of the guideline for patients is available as well: http://www.uni-duesseldorf.de/AWMF/ll/041-004p.htm. The following procedures in the management of FMS were strongly recommended: information on diagnosis and therapeutic options and patient-centered communication, aerobic exercise, cognitive and operant behavioural therapy, multicomponent treatment and amitriptyline. Based on expert opinion, a stepwise FMS-management was proposed. Step 1 comprises confirming the diagnosis and patient education and treatment of physical or mental comorbidities or aerobic exercise or cognitive behavioural therapy or amitriptyline. Step 2 includes multicomponent treatment. Step 3 comprises no further treatment or self-management (aerobic exercise, stress management) and/or booster multicomponent therapy and/or pharmacological therapy (duloxetine or fluoxetine or paroxetine or pregabalin or tramadol/aminoacetophen) and/or psychotherapy (hypnotherapy or written emotional disclosure) and/or physical therapy (balneotherapy or whole body heat therapy) and/or complementary therapies (homoeopathy or vegetarian diet). The choice of treatment options should be based on informed decision-making and respect of the patients’ preferences. PMID:19675740

43 CFR 2654.1 - Exercise of option.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Exercise of option. 2654.1 Section 2654.1 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT... Exercise of option. (a) Any village corporation which has not, by December 18, 1973, elected to acquire...

43 CFR 2654.1 - Exercise of option.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Exercise of option. 2654.1 Section 2654.1 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT... Exercise of option. (a) Any village corporation which has not, by December 18, 1973, elected to acquire...

43 CFR 2654.1 - Exercise of option.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Exercise of option. 2654.1 Section 2654.1 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT... Exercise of option. (a) Any village corporation which has not, by December 18, 1973, elected to acquire...

43 CFR 2654.1 - Exercise of option.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Exercise of option. 2654.1 Section 2654.1 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT... Exercise of option. (a) Any village corporation which has not, by December 18, 1973, elected to acquire...

17 CFR 33.7 - Disclosure.

Code of Federal Regulations, 2010 CFR

2010-04-01

... introducing broker shall be deemed to be an option customer. (Approved by the Office of Management and Budget..., may open or cause the opening of a commodity option account for an option customer, other than for a customer specified in § 1.55(f) of this chapter, unless the futures commission merchant or introducing...

77 FR 16879 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Order Granting Approval of Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-22

... financial information for investment advisory services, fund administration, portfolio management, financial... the Exchange will be European-style exercise.\\17\\ Upon exercise, holders of options contracts would... Corporation (``OCC'').\\19\\ \\17\\ Unlike American style options, European style options may be exercised only on...

The Implications of Real Options on ERP-Enabled Adoption

ERIC Educational Resources Information Center

Nwankpa, Joseph K.

2012-01-01

Current research on Enterprise Resource Planning (ERP) systems and real options focuses on valuation and justification issues that manager's face prior to project approval with existing literature attempting to demonstrate that ERP systems as technology positioning investments have option-like characteristics thus making such ERP systems…

17 CFR 33.7 - Disclosure.

Code of Federal Regulations, 2011 CFR

2011-04-01

... introducing broker shall be deemed to be an option customer. (Approved by the Office of Management and Budget..., may open or cause the opening of a commodity option account for an option customer, other than for a customer specified in § 1.55(f) of this chapter, unless the futures commission merchant or introducing...

17 CFR 33.7 - Disclosure.

Code of Federal Regulations, 2012 CFR

2012-04-01

... introducing broker shall be deemed to be an option customer. (Approved by the Office of Management and Budget..., may open or cause the opening of a commodity option account for an option customer, other than for a customer specified in § 1.55(f) of this chapter, unless the futures commission merchant or introducing...

Municipal solid waste management health risk assessment from air emissions for China by applying life cycle analysis.

PubMed

Li, Hua; Nitivattananon, Vilas; Li, Peng

2015-05-01

This study is to quantify and objectively evaluate the extent of environmental health risks from three waste treatment options suggested by the national municipal solid waste management enhancing strategy (No [2011] 9 of the State Council, promulgated on 19 April 2011), which includes sanitary landfill, waste-to-energy incineration and compost, together with the material recovery facility through a case study in Zhangqiu City of China. It addresses potential chronic health risks from air emissions to residential receptors in the impacted area. It combines field survey, analogue survey, design documents and life cycle inventory methods in defining the source strength of chemicals of potential concern. The modelling of life cycle inventory and air dispersion is via integrated waste management(IWM)-2 and Screening Air Dispersion Model (Version 3.0) (SCREEN3). The health risk assessment is in accordance with United States Environmental Protection Agency guidance Risk Assessment Guidance for Superfund (RAGS), Volume I: Human Health Evaluation Manual (Part F, Supplemental Guidance for Inhalation Risk Assessment). The exposure concentration is based on long-term exposure to the maximum ground level contaminant in air under the 'reasonable worst situation' emissions and then directly compared with reference for concentration and unit risk factor/cancer slope factor derived from the national air quality standard (for a conventional pollutant) and toxicological studies (for a specific pollutant). Results from this study suggest that the option of compost with material recovery facility treatment may pose less negative health impacts than other options; the sensitivity analysis shows that the landfill integrated waste management collection rate has a great influence on the impact results. Further investigation is needed to validate or challenge the findings of this study. © The Author(s) 2015.

Management options for songbirds using the oak shelterwood-burn technique in upland forests of the Southeastern United States

Treesearch

J. Drew Lanham; Patrick D. Keyser; Patrick H. Brose; David H. Van Lear

2002-01-01

The shelterwood-burn technique is a novel method for regenerating oak-dominated stands on some upland sites while simultaneously minimizing undesirable hardwood intrusion with prescribed fire. Management options available within an oak shelterwood-burn regime will create variably structured habitats that may potentially harbor avian communities of mature forest and...

Managing forest structure and fire hazard--a tool for planners.

Treesearch

M.C. Johnson; D.L. Peterson; C.L. Raymond

2006-01-01

Fire planners and other resource managers need to examine a range of potential fuel and vegetation treatments to select options that will lead to desired outcomes for fire hazard and natural resource conditions. A new approach to this issue integrates concepts and tools from silviculture and fuel science to quantify outcomes for a large number of treatment options in...

Simulating the effectiveness of three potential management options to slow the spread of emerald ash borer (Agrilus planipennis) populations in localized outlier sites

Treesearch

Rodrigo J. Mercader; Nathan W. Siegert; Andrew M. Liebhold; Deborah G. McCullough

2011-01-01

The emerald ash borer, Agrilus planipennis Fairmaire (Coleoptera: Buprestidae), is a devastating, invasive insect pest of ash trees, Fraxinus spp., in North America. Using a simulation model, we evaluated three potential management options to slow the spread of A. planipennis in discrete outlier sites: (i)...

Mission Options Scoping Tool for Mars Orbiters: Mass Cost Calculator (MC2)

NASA Technical Reports Server (NTRS)

Sturm, Eric J., II; Deutsch, Marie-Jose; Harmon, Corey; Nakagawa, Roy; Kinsey, Robert; Lopez, Nino; Kudrle, Paul; Evans, Alex

2007-01-01

Prior to developing the details of an advanced mission study, the mission architecture trade space is typically explored to assess the scope of feasible options. This paper describes the main features of an Excel-based tool, called the Mass-Cost-Calculator (MC2 ), which is used to perform rapid, high-level mass and cost options analyses of Mars orbiter missions. MC2 consists of a combination of databases, analytical solutions, and parametric relationships to enable quick evaluation of new mission concepts and comparison of multiple architecture options. The tool's outputs provide program management and planning teams with answers to "what if" queries, as well as an understanding of the driving mission elements, during the pre-project planning phase. These outputs have been validated against the outputs generated by the Advanced Projects Design Team (Team X) at NASA's Jet Propulsion Laboratory (JPL). The architecture of the tool allows for future expansion to other orbiters beyond Mars, and to non-orbiter missions, such as those involving fly-by spacecraft, probes, landers, rovers, or other mission elements.

Thermal management system options for high power space platforms

NASA Technical Reports Server (NTRS)

Sadunas, J. A.; Lehtinen, A.; Parish, R.

1985-01-01

Thermal Management System (TMS) design options for a high power (75kWe), low earth orbit, multimodule space platform were investigated. The approach taken was to establish a baseline TMS representative of current technology, and to make incremental improvements through successive subsystem trades that lead to a candidate TMS. The TMS trades included centralized and decentralized transport, single-phase and two-phase transport, alternate working fluids, liquid loop and heat pipe radiators, deployed fixed, body mounted and steerable radiators, and thermal storage. The subsystem options were evaluated against criteria such as weight, TMS power requirement, reliability, system isothermality penalty, and growth potential.

Applying management modeling to assess the feasibility of accelerating landscape restoration on federal forests in Eastern Oregon

Treesearch

Sara Loreno; Jeremy S. Fried; Andrew Yost

2015-01-01

The state of Oregon recently invested in exploring options for increasing the extent of forest restoration activity. This initiative aims to reduce the incidence, effects, and expense of catastrophic fire events and restore economic stability to rural communities by enhancing the supply of raw materials for wood processing facilities and wood-based, renewable energy...

Multicore Considerations for Legacy Flight Software Migration

NASA Technical Reports Server (NTRS)

Vines, Kenneth; Day, Len

2013-01-01

In this paper we will discuss potential benefits and pitfalls when considering a migration from an existing single core code base to a multicore processor implementation. The results of this study present options that should be considered before migrating fault managers, device handlers and tasks with time-constrained requirements to a multicore flight software environment. Possible future multicore test bed demonstrations are also discussed.

The Philippine Bases: Continuing Utility in a Changing Strategic Context,

DTIC Science & Technology

1980-02-01

economy. One study has shown that the total impact of such spending (local purchases , construction, wages to Filipinos, and various US private spending...results of research studies in selected areas of national strategy formulation and management of national security resources. Unless otherwise noted...NTENDINI WSJ.......: .3 Background .. . . . . . . . . . . . . . . . . .3 The Forward Strategy Concept ./..:*....**’* 5 The "Failback" Option to Gua

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

Treesearch

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

2015-01-01

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

DOD Joint Bases: Implementation Challenges Demonstrate Need to Reevaluate the Program

DTIC Science & Technology

2014-09-01

members on Guam regarding available housing options on the island . According to the officials, this effort will result in reducing the need for...The Honorable Tim Johnson Chairman The Honorable Mark Kirk Ranking Member Subcommittee on Military Construction, Veterans Affairs, and...installation management function · to Commander, U aval Forces, Marianas Islands , Guam. SECRETARY OF DEFENSE JUSTIFICATION All installations employ

76 FR 579 - Privacy Act of 1974; Computer Matching Program Between the Department of Housing and Urban...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-05

... Payment Accuracy Through a ``Do Not Pay List'' (June 18, 2010); 3. Office of Management and Budget M-10-13... operating Public Housing programs may now offer tenants the option to pay a flat rent, or an income-based... all cases, program administrators will resolve income discrepancies in consultation with tenants...

Default options and neonatal resuscitation decisions.

PubMed

Haward, Marlyse Frieda; Murphy, Ryan O; Lorenz, John M

2012-12-01

To determine whether presenting delivery room management options as defaults influences decisions to resuscitate extremely premature infants. Adult volunteers recruited from the world wide web were randomised to receive either resuscitation or comfort care as the delivery room management default option for a hypothetical delivery of a 23-week gestation infant. Participants were required to check a box to opt out of the default. The primary outcome measure was the proportion of respondents electing resuscitation. Data were analysed using χ(2) tests and multivariate logistic regression. Participants who were told the delivery room management default option was resuscitation were more likely to opt for resuscitation (OR 6.54 95% CI 3.85 to 11.11, p<0.001). This effect persisted on multivariate regression analysis (OR 7.00, 95% CI 3.97 to 12.36, p<0.001). Female gender, being married or in a committed relationship, being highly religious, experiences with prematurity, and favouring sanctity of life were significantly associated with decisions to resuscitate. Presenting delivery room options for extremely premature infants as defaults exert a significant effect on decision makers. The information structure of the choice task may act as a subtle form of manipulation. Further, this effect may operate in ways that a decision maker is not aware of and this raises questions of patient autonomy. Presenting delivery room options for extremely premature infants as defaults may compromise autonomous decision-making.

Office Procedures in Refractory Chronic Rhinosinusitis.

PubMed

Thamboo, Andrew; Patel, Zara M

2017-02-01

Office procedures in chronic rhinosinusitis (CRS) can be considered before and after medical management, as well as before and after surgical management. This article focuses specifically on refractory CRS, meaning those patients who have failed medical and surgical management already. The options available in the management of refractory CRS depend on the personnel, equipment, and instrumentation available in the office setting; surgeon experience; and patient suitability and tolerability. This article provides readers with possible procedural options that can be done in their clinics with indications, patient selection, potential complications, and postoperative considerations. Copyright © 2016 Elsevier Inc. All rights reserved.

S3 Guideline for the treatment of psoriasis vulgaris, update - Short version part 1 - Systemic treatment.

PubMed

Nast, Alexander; Amelunxen, Lasse; Augustin, Matthias; Boehncke, Wolf-Henning; Dressler, Corinna; Gaskins, Matthew; Härle, Peter; Hoffstadt, Bernd; Klaus, Joachim; Koza, Joachim; Mrowietz, Ulrich; Ockenfels, Hans-Michael; Philipp, Sandra; Reich, Kristian; Rosenbach, Thomas; Rzany, Berthold; Schlaeger, Martin; Schmid-Ott, Gerhard; Sebastian, Michael; von Kiedrowski, Ralph; Weberschock, Tobias

2018-05-01

The German guideline for the treatment of psoriasis vulgaris was updated using GRADE methodology. The guideline is based on a systematic literature review completed on December 1, 2016, and on a formal consensus and approval process. The first section of this short version of the guideline covers systemic treatment options considered relevant by the expert panel and approved in Germany at the time of the consensus conference (acitretin, adalimumab, apremilast, cyclosporine, etanercept, fumaric acid esters, infliximab, methotrexate, secukinumab and ustekinumab). Detailed information is provided on the management and monitoring of the included treatment options. © 2018 The Authors | Journal compilation © Blackwell Verlag GmbH, Berlin.

Blunt Cerebrovascular Injuries: Advances in Screening, Imaging, and Management Trends.

PubMed

Nagpal, P; Policeni, B A; Bathla, G; Khandelwal, A; Derdeyn, C; Skeete, D

2017-10-12

Blunt cerebrovascular injury is a relatively uncommon but sometimes life-threatening injury, particularly in patients presenting with ischemic symptoms in that vascular territory. The decision to pursue vascular imaging (generally CT angiography) is based on clinical and imaging findings. Several grading scales or screening criteria have been developed to guide the decision to pursue vascular imaging, as well as to recommend different treatment options for various injuries. The data supporting many of these guidelines and options are limited however. The purpose of this article is to review and compare these scales and criteria and the data supporting clinical efficacy and to make recommendations for future research in this area. © 2017 by American Journal of Neuroradiology.

Classification, prevention and management of entero-atmospheric fistula: a state-of-the-art review.

PubMed

Di Saverio, Salomone; Tarasconi, Antonio; Walczak, Dominik A; Cirocchi, Roberto; Mandrioli, Matteo; Birindelli, Arianna; Tugnoli, Gregorio

2016-02-01

Entero-atmospheric fistula (EAF) is an enteric fistula occurring in the setting of an open abdomen, thus creating a communication between the GI tract and the external atmosphere. Management and nursing of patients suffering EAF carries several challenges, and prevention of EAF should be the first and best treatment option. Here, we present a novel modified classification of EAF and review the current state of the art in its prevention and management including nutritional issues and feeding strategies. We also provide an overview on surgical management principles, highlighting several surgical techniques for dealing with EAF that have been reported in the literature throughout the years. The treatment strategy for EAF should be multidisciplinary and multifaceted. Surgical treatment is most often multistep and should be tailored to the single patient, based on the type and characteristics of the EAF, following its correct identification and classification. The specific experience of surgeons and nursing staff in the management of EAF could be enhanced, applying distinct simulation-based ex vivo training models.

Summary of the 2008 BTS/SIGN British Guideline on the management of asthma.

PubMed

Levy, Mark L; Thomas, Mike; Small, Iain; Pearce, Linda; Pinnock, Hilary; Stephenson, Paul

2009-01-01

The 2008 BTS/SIGN British Guideline on the management of asthma provides comprehensive updated evidence-based guidance on asthma management for healthcare professionals. This primary care-focussed summary has been produced to aid dissemination and implementation of the key guideline messages into primary care. The section on diagnosis emphasises the new integrated symptom-based approach with clinicians using their deductive skills to determine the probability that the patient has asthma. The various tools used for monitoring asthma are discussed. There are sections on both non-pharmacological and pharmacological management of chronic asthma in adults and children. Treatment options for children are subdivided into the under-5s and children aged 5-12 years. Poor asthma control is manifested by exacerbations and acute asthma. Personalised asthma action plans for guided self management should be provided and used when levels of asthma control change. There are sections on difficult asthma and the treatment of exacerbations and acute severe asthma. Various outcome measures for auditing the quality of asthma care are discussed.

Aquifer-yield continuum as a guide and typology for science-based groundwater management

NASA Astrophysics Data System (ADS)

Pierce, Suzanne A.; Sharp, John M.; Guillaume, Joseph H. A.; Mace, Robert E.; Eaton, David J.

2013-03-01

Groundwater availability is at the core of hydrogeology as a discipline and, simultaneously, the concept is the source of ambiguity for management and policy. Aquifer yield has undergone multiple definitions resulting in a range of scientific methods to calculate and model availability reflecting the complexity of combined scientific, management, policy, and stakeholder processes. The concept of an aquifer-yield continuum provides an approach to classify groundwater yields along a spectrum, from non-use through permissive sustained, sustainable, maximum sustained, safe, permissive mining to maximum mining yields, that builds on existing literature. Additionally, the aquifer-yield continuum provides a systems view of groundwater availability to integrate physical and social aspects in assessing management options across aquifer settings. Operational yield describes the candidate solutions for operational or technical implementation of policy, often relating to a consensus yield that incorporates human dimensions through participatory or adaptive governance processes. The concepts of operational and consensus yield address both the social and the technical nature of science-based groundwater management and governance.

Experimental study of an air-cooled thermal management system for high capacity lithium-titanate batteries

NASA Astrophysics Data System (ADS)

Giuliano, Michael R.; Prasad, Ajay K.; Advani, Suresh G.

2012-10-01

Lithium-titanate batteries have become an attractive option for battery electric vehicles and hybrid electric vehicles. In order to maintain safe operating temperatures, these batteries must be actively cooled during operation. Liquid-cooled systems typically employed for this purpose are inefficient due to the parasitic power consumed by the on-board chiller unit and the coolant pump. A more efficient option would be to circulate ambient air through the battery bank and directly reject the heat to the ambient. We designed and fabricated such an air-cooled thermal management system employing metal-foam based heat exchanger plates for sufficient heat removal capacity. Experiments were conducted with Altairnano's 50 Ah cells over a range of charge-discharge cycle currents at two air flow rates. It was found that an airflow of 1100 mls-1 per cell restricts the temperature rise of the coolant air to less than 10 °C over ambient even for 200 A charge-discharge cycles. Furthermore, it was shown that the power required to drive the air through the heat exchanger was less than a conventional liquid-cooled thermal management system. The results indicate that air-cooled systems can be an effective and efficient method for the thermal management of automotive battery packs.

NY TBO Research: Integrated Demand Management (IDM): IDM Concept, Tools, and Training Package

NASA Technical Reports Server (NTRS)

Smith, Nancy

2016-01-01

A series of human-in-the-loop simulation sessions were conducted in the Airspace Operations Laboratory (AOL) to evaluate a new traffic management concept called Integrated Demand Management (IDM). The simulation explored how to address chronic equity, throughput and delay issues associated with New Yorks high-volume airports by operationally integrating three current and NextGen capabilities the Collaborative Trajectory Options Program (CTOP), Time-Based Flow Management (TBFM) and Required Time of Arrival (RTA) in order to better manage traffic demand within the National Air Traffic System. A package of presentation slides was developed to describe the concept, tools, and training materials used in the simulation sessions. The package will be used to outbrief our stakeholders by both presenting orally and disseminating of the materials via email.

A model to minimize joint total costs for industrial waste producers and waste management companies.

PubMed

Tietze-Stöckinger, Ingela; Fichtner, Wolf; Rentz, Otto

2004-12-01

The model LINKopt is a mixed-integer, linear programming model for mid- and long-term planning of waste management options on an inter-company level. There has been a large increase in the transportation of waste material in Germany, which has been attributed to the implementation of the European Directive 75/442/EEC on waste. Similar situations are expected to emerge in other European countries. The model LINKopt has been developed to determine a waste management system with minimal decision-relevant costs considering transportation, handling, storage and treatment of waste materials. The model can serve as a tool to evaluate various waste management strategies and to obtain the optimal combination of investment options. In addition to costs, ecological aspects are considered by determining the total mileage associated with the waste management system. The model has been applied to a German case study evaluating different investment options for a co-operation between Daimler-Chrysler AG at Rastatt, its suppliers, and the waste management company SITA P+R GmbH. The results show that the installation of waste management facilities at the premises of the waste producer would lead to significant reductions in costs and transportation.

Design and analysis of simple choice surveys for natural resource management

USGS Publications Warehouse

Fieberg, John; Cornicelli, Louis; Fulton, David C.; Grund, Marrett D.

2010-01-01

We used a simple yet powerful method for judging public support for management actions from randomized surveys. We asked respondents to rank choices (representing management regulations under consideration) according to their preference, and we then used discrete choice models to estimate probability of choosing among options (conditional on the set of options presented to respondents). Because choices may share similar unmodeled characteristics, the multinomial logit model, commonly applied to discrete choice data, may not be appropriate. We introduced the nested logit model, which offers a simple approach for incorporating correlation among choices. This forced choice survey approach provides a useful method of gathering public input; it is relatively easy to apply in practice, and the data are likely to be more informative than asking constituents to rate attractiveness of each option separately.

Air traffic management evaluation tool

NASA Technical Reports Server (NTRS)

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

2010-01-01

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

Cracked tooth syndrome: A report of three cases.

PubMed

Sadasiva, Kadandale; Ramalingam, Sathishmuthukumar; Rajaram, Krishnaraj; Meiyappan, Alagappan

2015-08-01

Cracked tooth syndrome (CTS), the term was coined by Cameron in 1964, which refers to an incomplete fracture of a vital posterior tooth extending to the dentin and occasionally into the pulp. CTS has always been a nightmare to the patient because of its unpredictable symptoms and a diagnostic dilemma for the dental practitioner due to its variable, bizarre clinical presentation. The treatment planning and management of CTS has also given problems and challenges the dentist as there is no specific treatment option. The management of CTS varies from one case to another or from one tooth to another in the same individual based on the severity of the symptoms and depth of tooth structure involved. After all, the prognosis of such tooth is still questionable and requires continuous evaluation. This article aims at presenting a series three cases of CTS with an overview on the clinical presentation, diagnosis and the different treatment options that varies from one case to another.

Cracked tooth syndrome: A report of three cases

PubMed Central

Sadasiva, Kadandale; Ramalingam, Sathishmuthukumar; Rajaram, Krishnaraj; Meiyappan, Alagappan

2015-01-01

Cracked tooth syndrome (CTS), the term was coined by Cameron in 1964, which refers to an incomplete fracture of a vital posterior tooth extending to the dentin and occasionally into the pulp. CTS has always been a nightmare to the patient because of its unpredictable symptoms and a diagnostic dilemma for the dental practitioner due to its variable, bizarre clinical presentation. The treatment planning and management of CTS has also given problems and challenges the dentist as there is no specific treatment option. The management of CTS varies from one case to another or from one tooth to another in the same individual based on the severity of the symptoms and depth of tooth structure involved. After all, the prognosis of such tooth is still questionable and requires continuous evaluation. This article aims at presenting a series three cases of CTS with an overview on the clinical presentation, diagnosis and the different treatment options that varies from one case to another. PMID:26538947

Osteoarthritis: A Critical Review

PubMed Central

Onishi, Kentaro; Utturkar, Amol; Chang, Eric; Panush, Richard; Hata, Justin; Perret-Karimi, Danielle

2015-01-01

Patients with osteoarthritis (OA) are faced with a barrage of treatment options, from recommendations from friends and social media to medications prescribed by the primary care physician. The purpose of this article is to critically review current approaches to generalized or monoarticular OA based on available evidence and to illustrate multidisciplinary and multimodal treatment strategies for the management of OA. Treatment options assessed for efficacy include patient education; oral and topical pharmacological agents; complementary and alternative medicine; surgery; manual medicine; acupuncture; interventional procedures (corticosteroid injection, viscosupplementation, and pulsed radiofrequency); bracing; assistive devices; physical therapy; and physical modalities. Multidisciplinary and multimodal treatment strategies combined with early detection and prevention strategies provide the best benefit to patients. This review also illustrates that traditional and alternative modalities of treatment can be both synergistic and beneficial. Physicians should be aware of the variety of tools available for the management of OA and the associated symptoms. Those healthcare providers who can best individualize treatment plans for specific patients and inspire their patients to embrace healthy lifestyle modifications will achieve the best results. PMID:25750483

Hypertension in pregnancy: natural history and treatment options.

PubMed

Foo, L; Tay, J; Lees, C C; McEniery, C M; Wilkinson, I B

2015-05-01

Hypertensive disorders of pregnancy affect approximately 5-10% of all maternities and are major contributors of maternal and neonatal morbidity and mortality worldwide. This group of disorders encompasses chronic hypertension, as well as conditions that arise de novo in pregnancy: gestational hypertension and pre-eclampsia. The latter group is thought to be part of the same continuum but with arbitrary division. Research into the aetiology of hypertension in pregnancy have largely been focused on pre-eclampsia, with a majority of studies exploring either pregnancy-associated factors such as placental-derived or immunologic responses to pregnancy tissue, or maternal constitutional factors such as cardiovascular health and endothelial dysfunction. The evidence base for the pathophysiology and progression of hypertensive disorders in pregnancy, particularly pre-eclampsia, is reviewed. Clinical algorithms and pharmacological agents for the management of hypertension in pregnancy are summarised, with a brief focus on post-partum considerations and long-term health implications. Novel therapeutic options for the management of pre-eclampsia are also explored.

A Comprehensive Review of Topical Odor-Controlling Treatment Options for Chronic Wounds

PubMed Central

Akhmetova, Alma; Allan, Iain U.; Illsley, Matthew J.; Nurgozhin, Talgat; Mikhalovsky, Sergey

2016-01-01

The process of wound healing is often accompanied by bacterial infection or critical colonization, resulting in protracted inflammation, delayed reepithelization, and production of pungent odors. The malodor produced by these wounds may lower health-related quality of life and produce psychological discomfort and social isolation. Current management focuses on reducing bacterial activity within the wound site and absorbing malodorous gases. For example, charcoal-based materials have been incorporated into dressing for direct adsorption of the responsible gases. In addition, multiple topical agents, including silver, iodine, honey, sugar, and essential oils, have been suggested for incorporation into dressings in an attempt to control the underlying bacterial infection. This review describes options for controlling malodor in chronic wounds, the benefits and drawbacks of each topical agent, and their mode of action. We also discuss the use of subjective odor evaluation techniques to assess the efficacy of odor-controlling therapies. The perspectives of employing novel biomaterials and technologies for wound odor management are also presented. PMID:27684356

A Comprehensive Review of Topical Odor-Controlling Treatment Options for Chronic Wounds.

PubMed

Akhmetova, Alma; Saliev, Timur; Allan, Iain U; Illsley, Matthew J; Nurgozhin, Talgat; Mikhalovsky, Sergey

The process of wound healing is often accompanied by bacterial infection or critical colonization, resulting in protracted inflammation, delayed reepithelization, and production of pungent odors. The malodor produced by these wounds may lower health-related quality of life and produce psychological discomfort and social isolation. Current management focuses on reducing bacterial activity within the wound site and absorbing malodorous gases. For example, charcoal-based materials have been incorporated into dressing for direct adsorption of the responsible gases. In addition, multiple topical agents, including silver, iodine, honey, sugar, and essential oils, have been suggested for incorporation into dressings in an attempt to control the underlying bacterial infection. This review describes options for controlling malodor in chronic wounds, the benefits and drawbacks of each topical agent, and their mode of action. We also discuss the use of subjective odor evaluation techniques to assess the efficacy of odor-controlling therapies. The perspectives of employing novel biomaterials and technologies for wound odor management are also presented.

Supporting chronic pain management across provincial and territorial health systems in Canada: Findings from two stakeholder dialogues.

PubMed

Wilson, Michael G; Lavis, John N; Ellen, Moriah E

2015-01-01

Chronic pain is a serious health problem given its prevalence, associated disability, impact on quality of life and the costs associated with the extensive use of health care services by individuals living with it. To summarize the research evidence and elicit health system policymakers', stakeholders' and researchers' tacit knowledge and views about improving chronic pain management in Canada and engaging provincial and territorial health system decision makers in supporting comprehensive chronic pain management in Canada. For these two topics, the global and local research evidence regarding each of the two problems were synthesized in evidence briefs. Three options were generated for addressing each problem, and implementation considerations were assessed. A stakeholder dialogue regarding each topic was convened (with 29 participants in total) and the deliberations were synthesized. To inform the first stakeholder dialogue, the authors found that systematic reviews supported the use of evidence-based tools for strengthening chronic pain management, including patient education, self-management supports, interventions to implement guidelines and multidisciplinary approaches to pain management. While research evidence about patient registries/treatment-monitoring systems is limited, many dialogue participants argued that a registrysystem is needed. Many saw a registry as a precondition for moving forward with other options, including creating a national network of chronic pain centres with a coordinating 'hub' to provide chronic pain-related decision support and a cross-payer, cross-discipline model of patient-centred primary health care-based chronic pain management. For the second dialogue, systematic reviews indicated that traditional media can be used to positively influence individual health-related behaviours, and that multistakeholder partnerships can contribute to increasing attention devoted to issues on policy agendas. Dialogue participants emphasized the need to mobilize behind an effort to build a national network that would bring together existing organizations and committed individuals. Developing a national network and, thereafter, a national pain strategy are important initiatives that garnered broad-based support during the dialogues. Efforts toward achieving this goal have been made since convening the dialogues.

Environmental impacts and benefits of state-of-the-art technologies for E-waste management.

PubMed

Ikhlayel, Mahdi

2017-10-01

This study aims to evaluate the environmental impacts and benefits of state-of-the-art technologies for proper e-waste handling using Jordan as a case study. Life Cycle Assessment (LCA) was employed to evaluate five advanced management systems represent state-of-the-art treatment technologies, including sanitary landfilling; proper recycling of metals, materials, and precious metals (PMs); and incineration of plastic and the hazardous portion of printed circuit boards (PCBs). Six e-waste products that contribute the most to the e-waste in Jordan were included in the assessment of each scenario, which resulted in 30 total cases of e-waste management. The findings indicated that landfills for the entire components of the e-waste stream are the worst option and should be avoided. The most promising e-waste management scenario features integrated e-waste processes based on the concept of Integrated Waste Management (IWM), including recycling materials such as non-PMs and PMs, incinerating plastic and the hazardous content of PCBs using the energy recovered from incineration, and using sanitary landfills of residues. For this scenario, the best environmental performance was obtained for the treatment of mobile phones. Incineration of the portion of hazardous waste using energy recovery is an option that deserves attention. Because scenario implementation depends on more than just the environmental benefits (e.g., economic cost and technical aspects), the study proposes a systematic approach founded on the IWM concept for e-waste management scenario selection. Copyright © 2017 Elsevier Ltd. All rights reserved.

Assessing landowners' attitudes toward wild hogs and support for control options.

PubMed

Caplenor, Carlotta A; Poudyal, Neelam C; Muller, Lisa I; Yoest, Chuck

2017-10-01

Wild hogs (Sus scrofa) are an invasive species with destructive habits, particularly rooting and wallowing, which can directly impact agricultural crops, pasture land, and water quality. Considering wild hogs are widely dispersed across the landscape, they are extremely difficult to control. Disagreements can arise among different stakeholders over whether and how their populations should be managed. The purpose of this article was to examine Tennessee, United States landowners' attitudes toward wild hogs, to compare acceptability of control methods, and to evaluate factors significantly influencing public support for regulations to control wild hogs. Logistic regression was employed to analyze data collected from a statewide survey of rural landowners in the fall of 2015. Landowners had overwhelmingly negative attitudes towards wild hogs, and were concerned about their impact on the natural environment and rural economy. Although landowners showed support for controlling wild hogs, levels of acceptability for management options varied. Respondents favored active management and supported education and incentive-based control programs to control wild hogs. Cognitive concepts such as social and personal norms and awareness of consequences, as well as demographic characteristics, significantly predicted landowners' support for state regulations to control wild hogs in Tennessee. Findings increase our understanding of the human dimensions of wild hog management and that of other similarly invasive animals, and may guide resource managers in designing effective and socially acceptable management strategies to control wild hog populations in Tennessee and elsewhere. Copyright © 2017 Elsevier Ltd. All rights reserved.

Role of extracorporeal shock wave therapy in management of Peyronie's disease: A preliminary report

PubMed Central

Shimpi, Rajendra Kashinath; Jain, Ravi Jineshkumar

2016-01-01

Introduction: Peyronie's Disease (PD) is a disease causing psycho social trauma to the patient. Multiple treatment options are available with variable results. Extra Corporeal Shock Wave Therapy (ESWT) is a new insight into the non invasive modality of management. It focuses on the mechanism of inducing angiogenesis in the penile cavernous tissue. Materials and Methods: The aim of the study is to determine the role of ESWT in the management of PD. The objectives include demonstrating the improvement in mean International Index of Erectile Function Score (IIEFS), improvement in pain score by Visual Analogue Scale (VAS), change in cavernosal artery flow on colour penile Doppler, reduction in plaque size, and improvement in penile curvature degree after the therapy. 30 patients, between 25-65 years, who were non responders to conservative line of management, were treated with ESWT. The results were evaluated at baseline and 18-24 weeks after the therapy. Results: ESWT significantly improves the cavernosal artery velocity, thereby supporting the theory of angiogenesis. ESWT improves all the domains of IIEF including Erectile Function, Sexual Desire, Sexual Satisfaction, Orgasm and Overall Satisfaction. There is a significant improvement in the pain and penile curvature, and reduction in the plaque size. No adverse effects have been recorded. Conclusion: ESWT offers a safe, minimally invasive, OPD based option to the management of the patients of PD in the stable phase of the disease. Patients who do not respond to the conservative line of management can be really benefited by ESWT. PMID:28057983

Greenhouse gas emission mitigation relevant to changes in municipal solid waste management system.

PubMed

Pikoń, Krzysztof; Gaska, Krzysztof

2010-07-01

Standard methods for assessing the environmental impact of waste management systems are needed to underpin the development and implementation of sustainable waste management practice. Life cycle assessment (LCA) is a tool for comprehensively ensuring such assessment and covers all impacts associated with waste management. LCA is often called "from cradle to grave" analysis. This paper integrates information on the greenhouse gas (GHG) implications of various management options for some of the most common materials in municipal solid waste (MSW). Different waste treatment options for MSW were studied in a system analysis. Different combinations of recycling (cardboard, plastics, glass, metals), biological treatment (composting), and incineration as well as land-filling were studied. The index of environmental burden in the global warming impact category was calculated. The calculations are based on LCA methodology. All emissions taking place in the whole life cycle system were taken into account. The analysis included "own emissions," or emissions from the system at all stages of the life cycle, and "linked emissions," or emissions from other sources linked with the system in an indirect way. Avoided emissions caused by recycling and energy recovery were included in the analysis. Displaced emissions of GHGs originate from the substitution of energy or materials derived from waste for alternative sources. The complex analysis of the environmental impact of municipal waste management systems before and after application of changes in MSW systems according to European Union regulations is presented in this paper. The evaluation is made for MSW systems in Poland.

Material and energy recovery in integrated waste management systems: a life-cycle costing approach.

PubMed

Massarutto, Antonio; de Carli, Alessandro; Graffi, Matteo

2011-01-01

A critical assumption of studies assessing comparatively waste management options concerns the constant average cost for selective collection regardless the source separation level (SSL) reached, and the neglect of the mass constraint. The present study compares alternative waste management scenarios through the development of a desktop model that tries to remove the above assumption. Several alternative scenarios based on different combinations of energy and materials recovery are applied to two imaginary areas modelled in order to represent a typical Northern Italian setting. External costs and benefits implied by scenarios are also considered. Scenarios are compared on the base of the full cost for treating the total waste generated in the area. The model investigates the factors that influence the relative convenience of alternative scenarios. Copyright © 2011 Elsevier Ltd. All rights reserved.

An explicit closed-form analytical solution for European options under the CGMY model

NASA Astrophysics Data System (ADS)

Chen, Wenting; Du, Meiyu; Xu, Xiang

2017-01-01

In this paper, we consider the analytical pricing of European path-independent options under the CGMY model, which is a particular type of pure jump Le´vy process, and agrees well with many observed properties of the real market data by allowing the diffusions and jumps to have both finite and infinite activity and variation. It is shown that, under this model, the option price is governed by a fractional partial differential equation (FPDE) with both the left-side and right-side spatial-fractional derivatives. In comparison to derivatives of integer order, fractional derivatives at a point not only involve properties of the function at that particular point, but also the information of the function in a certain subset of the entire domain of definition. This ;globalness; of the fractional derivatives has added an additional degree of difficulty when either analytical methods or numerical solutions are attempted. Albeit difficult, we still have managed to derive an explicit closed-form analytical solution for European options under the CGMY model. Based on our solution, the asymptotic behaviors of the option price and the put-call parity under the CGMY model are further discussed. Practically, a reliable numerical evaluation technique for the current formula is proposed. With the numerical results, some analyses of impacts of four key parameters of the CGMY model on European option prices are also provided.

Study of Agricultural Product Options Pricing

NASA Astrophysics Data System (ADS)

HONG, Qiu

2017-09-01

China is a large agricultural country, and the healthy development of agriculture is related to the stability of the whole society. The agricultural production and management of agricultural products are confronted with many risks, especially the market risks. Option contract is the object of option market transaction, so it is very important to study the option contract of agricultural products. Option trading separates the risk and profit, so that the trader can avoid the risk while retaining the opportunity to obtain income. The option has the characteristics of low transaction cost, simple and efficient, so it is suitable for small and medium investors.

Designing flexible engineering systems utilizing embedded architecture options

NASA Astrophysics Data System (ADS)

Pierce, Jeff G.

This dissertation develops and applies an integrated framework for embedding flexibility in an engineered system architecture. Systems are constantly faced with unpredictability in the operational environment, threats from competing systems, obsolescence of technology, and general uncertainty in future system demands. Current systems engineering and risk management practices have focused almost exclusively on mitigating or preventing the negative consequences of uncertainty. This research recognizes that high uncertainty also presents an opportunity to design systems that can flexibly respond to changing requirements and capture additional value throughout the design life. There does not exist however a formalized approach to designing appropriately flexible systems. This research develops a three stage integrated flexibility framework based on the concept of architecture options embedded in the system design. Stage One defines an eight step systems engineering process to identify candidate architecture options. This process encapsulates the operational uncertainty though scenario development, traces new functional requirements to the affected design variables, and clusters the variables most sensitive to change. The resulting clusters can generate insight into the most promising regions in the architecture to embed flexibility in the form of architecture options. Stage Two develops a quantitative option valuation technique, grounded in real options theory, which is able to value embedded architecture options that exhibit variable expiration behavior. Stage Three proposes a portfolio optimization algorithm, for both discrete and continuous options, to select the optimal subset of architecture options, subject to budget and risk constraints. Finally, the feasibility, extensibility and limitations of the framework are assessed by its application to a reconnaissance satellite system development problem. Detailed technical data, performance models, and cost estimates were compiled for the Tactical Imaging Constellation Architecture Study and leveraged to complete a realistic proof-of-concept.

Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care: the Consortium Pain Task Force White Paper.

PubMed

Tick, Heather; Nielsen, Arya; Pelletier, Kenneth R; Bonakdar, Robert; Simmons, Samantha; Glick, Ronald; Ratner, Emily; Lemmon, Russell L; Wayne, Peter; Zador, Veronica

2018-03-01

Consortium Pain Taskforce White Paper Summary Evidence-based Nonpharmacologic Strategies for Comprehensive Pain Care Supplementary information can be found in the online version at https://doi.org/10.1016/j.explore.2018.02.001. Medical pain management is in crisis; from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addiction, diversion and overdose deaths. The rising costs of pain care and managing adverse effects of that care have prompted action from state and federal agencies including the DOD, VHA, NIH, FDA and CDC. There is pressure for pain medicine to shift away from reliance on opioids, ineffective procedures and surgeries toward comprehensive pain management that includes evidence-based nonpharmacologic options. This White Paper details the historical context and magnitude of the current pain problem including individual, social and economic impacts as well as the challenges of pain management for patients and a healthcare workforce engaging prevalent strategies not entirely based in current evidence. Detailed here is the evidence-base for nonpharmacologic therapies effective in postsurgical pain with opioid sparing, acute non-surgical pain, cancer pain and chronic pain. Therapies reviewed include acupuncture therapy, massage therapy, osteopathic and chiropractic manipulation, meditative movement therapies Tai chi and yoga, mind body behavioral interventions, dietary components and self-care/self-efficacy strategies. Transforming the system of pain care to a responsive comprehensive model necessitates that options for treatment and collaborative care must be evidence-based and include effective nonpharmacologic strategies that have the advantage of reduced risks of adverse events and addiction liability. The evidence demands a call to action to increase awareness of effective nonpharmacologic treatments for pain, to train healthcare practitioners and administrators in the evidence base of effective nonpharmacologic practice, to advocate for policy initiatives that remedy system and reimbursement barriers to evidence-informed comprehensive pain care, and to promote ongoing research and dissemination of the role of effective nonpharmacologic treatments in pain, focused on the short- and long-term therapeutic and economic impact of comprehensive care practices. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

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

Code of Federal Regulations, 2014 CFR

2014-04-01

... 17 Commodity and Securities Exchanges 3 2014-04-01 2014-04-01 false Open option contracts written. 210.12-12B Section 210.12-12B Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION... AND CONSERVATION ACT OF 1975 For Management Investment Companies § 210.12-12B Open option contracts...

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

Code of Federal Regulations, 2011 CFR

2011-04-01

... 17 Commodity and Securities Exchanges 2 2011-04-01 2011-04-01 false Open option contracts written. 210.12-12B Section 210.12-12B Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION... § 210.12-12B Open option contracts written. [For management investment companies only] Col. A Col. B Col...

5 CFR 875.302 - What are the options for making premium payments?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false What are the options for making premium payments? 875.302 Section 875.302 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL... options for making premium payments? (a) Premium payments may be made by Federal payroll or annuity...

78 FR 70961 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Notice to...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-27

... for OMB Review; Comment Request; Notice to Employees of Coverage Options Under Fair Labor Standards... Employees of Coverage Options Under Fair Labor Standards Act Section 18B,'' to the Office of Management and... and a related model notice of healthcare coverage options available under the Patient Protection and...

NASA's EOSDIS: options for data providers

NASA Astrophysics Data System (ADS)

Khalsa, Siri J.; Ujhazy, John E.

1995-12-01

EOSDIS, the data and information system being developed by NASA to support interdisciplinary earth science research into the 21st century, will do more than manage and distribute data from EOS-era satellites. It will also promote the exchange of data, tools, and research results across disciplinary, agency, and national boundaries. This paper describes the options that data providers will have for interacting with the EOSDIS Core System (ECS), the infrastructure of EOSDIS. The options include: using the ECS advertising service to announce the availability of data at the provider's site; submitting a candidate data set to one of the Distributed Active Archive Centers (DAACs); establishing a data server that will make the data accessible via ECS and establishing Local Information Manager (LIM) which would make the data available for multi-site searches. One additional option is through custom gateway interfaces which would provide access to existing data archives. The gateway, data server, and LIM options require the implementation of ECS code at the provider site to insure proper protocols. The advertisement and ingest options require no part of ECS design to reside at the provider site.

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

USGS Publications Warehouse

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

2014-01-01

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

Flexibility in flood management design: proactive planning under uncertainty

NASA Astrophysics Data System (ADS)

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

2016-12-01

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

An initial evaluation of potential options for managing riparian reserves of the Aquatic Conservation Strategy of the Northwest Forest Plan

Treesearch

Gordon H. Reeves; Brian R. Pickard; K. Norman Johnson

2016-01-01

The Aquatic Conservation Strategy (ACS) of the Northwest Forest Plan guides management of riparian and aquatic ecosystems on federal lands in western Oregon, western Washington, and northern California. We applied new scientific findings and tools to evaluate two potential options, A and B, for refining interim riparian reserves to meet ACS goals and likely challenges...

Evaluation Report of the Presidential/Secretarial Objective -- School Management Options Available to Indian People. Research and Evaluation Report Series No. 29.08.

ERIC Educational Resources Information Center

National Indian Training and Research Center, Tempe, AZ.

Presenting evaluations of the Bureau of Indian Affairs' (BIA) implementation of the School Management Option Project, a project designed to further American Indian control of schools and elevated to the status of Presidential/Secretarial Objective (P/SO) in 1974, this report includes separate evaluations by the National Indian Training and…

An economic evaluation of precommercial thinning in predominately paper birch stands

Treesearch

Orris D. McCauley; David P. Worley

1969-01-01

Before timber managers invest their time and money in precommercial thinnings in paper birch stands, they should know what thinning options are open to them and should have some idea of the response they might expect from the alternatives. Equipped with a knowledge of these options, the manager can select the monetary and output goals that best suit his own situation...

Acting on uncertainty in landscape management—options forestry.

Treesearch

Jonathan Thompson

2005-01-01

In response to the highly uncertain outcomes inherent in forest management, “options forestry” has been introduced as a novel approach that includes an honest appraisal of uncertainties and learning as a specific objective. The strategy is unique in that it uses a variety of management pathways, all designed to reach the same goal, and structures them in a rigorous...

A Web-based Tool for Transparent, Collaborative Urban Water System Planning for Monterrey, Mexico

NASA Astrophysics Data System (ADS)

Rheinheimer, D. E.; Medellin-Azuara, J.; Garza Díaz, L. E.; Ramírez, A. I.

2017-12-01

Recent rapid advances in web technologies and cloud computing show great promise for facilitating collaboration and transparency in water planning efforts. Water resources planning is increasingly in the context of a rapidly urbanizing world, particularly in developing countries. In such countries with democratic traditions, the degree of transparency and collaboration in water planning can mean the difference between success and failure of water planning efforts. This is exemplified in the city of Monterrey, Mexico, where an effort to build a new long-distance aqueduct to increase water supply to the city dramatically failed due to lack of transparency and top-down planning. To help address, we used a new, web-based water system modeling platform, called OpenAgua, to develop a prototype decision support system for water planning in Monterrey. OpenAgua is designed to promote transparency and collaboration, as well as provide strong, cloud-based, water system modeling capabilities. We developed and assessed five water management options intended to increase water supply yield and/or reliability, a dominant water management concern in Latin America generally: 1) a new long-distance source (the previously-rejected project), 2) a new nearby reservoir, 3) expansion/re-operation of an existing major canal, 4) desalination, and 5) industrial water reuse. Using the integrated modeling and analytic capabilities of OpenAgua, and some customization, we assessed the performance of these options for water supply yield and reliability to help identify the most promising ones. In presenting this assessment, we demonstrate the viability of using online, cloud-based modeling systems for improving transparency and collaboration in decision making, reducing the gap between citizens, policy makers and water managers, and future directions.

Incontinence Treatment: Newer Treatment Options

MedlinePlus

... Living with Incontinence Incontinence and Relationships Incontinence and Aging Managing Incontinence Managing Incontinence: A Survey The Patient's ... Living with Incontinence Incontinence and Relationships Incontinence and Aging Managing Incontinence Managing Incontinence: A Survey The Patient's ...

Integration of MOOCs in Advanced Mining Training Programmes

NASA Astrophysics Data System (ADS)

Saveleva, Irina; Greenwald, Oksana; Kolomiets, Svetlana; Medvedeva, Elena

2017-11-01

The paper covers the concept of innovative approaches in education based on incorporating MOOCs options into traditional classroom. It takes a look at the ways higher education instructors working with the mining engineers enrolled in advanced training programmes can brighten, upgrade and facilitate the learning process. The shift of higher education from in-class to online format has changed the learning environment and the methods of teaching including professional retraining courses. In addition, the need of mining companies for managers of a new kind obligates high school retraining centres rapidly move towards the 21st century skill framework. One of widely recognized innovations in the sphere of e-learning is MOOCs (Massive Open Online Courses) that can be used as an effective teaching tool for organizing professional training of managing staff of mining companies within the walls of a university. The authors share their instructional experience and show the benefits of introducing MOOCs options at the courses designed for retraining mining engineers and senior managers of coal enterprises. Though in recent researches the pedagogical value of MOOCs is highly questioned and even negated this invention of the 21st century can become an essential and truly helpful instrument in the hands of educators.

Management options for cholestatic liver disease in children.

PubMed

Catzola, Andrea; Vajro, Pietro

2017-11-01

Due to a peculiar age-dependent increased susceptibility, neonatal cholestasis affects the liver of approximately 1 in every 2500 term infants. A high index of suspicion is the key to an early diagnosis, and to implement timely, often life-saving treatments. Even when specific treatment is not available or curative, prompt medical management and optimization of nutrition are of paramount importance to survival and avoidance of complications. Areas covered: The present article will prominently focus on a series of newer diagnostic and therapeutic options of cholestasis in neonates and infants blended with consolidated established paradigms. The overview of strategies for the management reported here is based on a systematic literature search published in English using accessible databases (PubMed, MEDLINE) with the keywords biliary atresia, choleretics and neonatal cholestasis. References lists from retrieved articles were also reviewed. Expert commentary: A large number of uncommon and rare hepatobiliary disorders may present with cholestasis during the neonatal and infantile period. Potentially life-saving disease-specific pharmacological and surgical therapeutic approaches are currently available. Advances in hepatobiliary transport mechanisms have started clarifying fundamental aspects of inherited and acquired cholestasis, laying the foundation for the development of possibly more effective specific therapies.

American power conference: Proceedings

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

Not Available

1994-01-01

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

A decision framework for managing risk to airports from terrorist attack.

PubMed

Shafieezadeh, Abdollah; Cha, Eun J; Ellingwood, Bruce R

2015-02-01

This article presents an asset-level security risk management framework to assist stakeholders of critical assets with allocating limited budgets for enhancing their safety and security against terrorist attack. The proposed framework models the security system of an asset, considers various threat scenarios, and models the sequential decision framework of attackers during the attack. Its novel contributions are the introduction of the notion of partial neutralization of attackers by defenders, estimation of total loss from successful, partially successful, and unsuccessful actions of attackers at various stages of an attack, and inclusion of the effects of these losses on the choices made by terrorists at various stages of the attack. The application of the proposed method is demonstrated in an example dealing with security risk management of a U.S. commercial airport, in which a set of plausible threat scenarios and risk mitigation options are considered. It is found that a combination of providing blast-resistant cargo containers and a video surveillance system on the airport perimeter fence is the best option based on minimum expected life-cycle cost considering a 10-year service period. © 2014 Society for Risk Analysis.

Phytoremediation as a management option for contaminated sediments in tidal marshes, flood control areas and dredged sediment landfill sites.

PubMed

Bert, Valérie; Seuntjens, Piet; Dejonghe, Winnie; Lacherez, Sophie; Thuy, Hoang Thi Thanh; Vandecasteele, Bart

2009-11-01

Polluted sediments in rivers may be transported by the river to the sea, spread over river banks and tidal marshes or managed, i.e. actively dredged and disposed of on land. Once sedimented on tidal marshes, alluvial areas or control flood areas, the polluted sediments enter semi-terrestrial ecosystems or agro-ecosystems and may pose a risk. Disposal of polluted dredged sediments on land may also lead to certain risks. Up to a few years ago, contaminated dredged sediments were placed in confined disposal facilities. The European policy encourages sediment valorisation and this will be a technological challenge for the near future. Currently, contaminated dredged sediments are often not valorisable due to their high content of contaminants and their consequent hazardous properties. In addition, it is generally admitted that treatment and re-use of heavily contaminated dredged sediments is not a cost-effective alternative to confined disposal. For contaminated sediments and associated disposal facilities used in the past, a realistic, low cost, safe, ecologically sound and sustainable management option is required. In this context, phytoremediation is proposed in the literature as a management option. The aim of this paper is to review the current knowledge on management, (phyto)remediation and associated risks in the particular case of sediments contaminated with organic and inorganic pollutants. This paper deals with the following features: (1) management and remediation of contaminated sediments and associated risk assessment; (2) management options for ecosystems on polluted sediments, based on phytoremediation of contaminated sediments with focus on phytoextraction, phytostabilisation and phytoremediation of organic pollutants and (3) microbial and mycorrhizal processes occurring in contaminated sediments during phytoremediation. In this review, an overview is given of phytoremediation as a management option for semi-terrestrial and terrestrial ecosystems affected by polluted sediments, and the processes affecting pollutant bioavailability in the sediments. Studies that combine contaminated sediment and phytoremediation are relatively recent and are increasing in number since few years. Several papers suggest including phytoremediation in a management scheme for contaminated dredged sediments and state that phytoremediation can contribute to the revaluation of land-disposed contaminated sediments. The status of sediments, i.e. reduced or oxidised, highly influences contaminant mobility, its (eco)toxicity and the success of phytoremediation. Studies are performed either on near-fresh sediment or on sediment-derived soil. Field studies show temporal negative effects on plant growth due to oxidation and subsequent ageing of contaminated sediments disposed on land. The review shows that a large variety of plants and trees are able to colonise or develop on contaminated dredged sediment in particular conditions or events (e.g. high level of organic matter, clay and moisture content, flooding, seasonal hydrological variations). Depending on the studies, trees, high-biomass crop species and graminaceous species could be used to degrade organic pollutants, to extract or to stabilise inorganic pollutants. Water content of sediment is a limiting factor for mycorrhizal development. In sediment, specific bacteria may enhance the mobilisation of inorganic contaminants whereas others may participate in their immobilisation. Bacteria are also able to degrade organic pollutants. Their actions may be increased in the presence of plants. Choice of plants is particularly crucial for phytoremediation success on contaminated sediments. Extremely few studies are long-term field-based studies. Short-term effects and resilience of ecosystems is observed in long-term studies, i.e. due to degradation and stabilisation of pollutants. Terrestrial ecosystems affected by polluted sediments range from riverine tidal marshes with several interacting processes and vegetation development mainly determined by hydrology, over alluvial soils affected by overbank sedimentation (including flood control areas), to dredged sediment disposal facilities where hydrology and vegetation might be affected or managed by human intervention. This gradient is also a gradient of systems with highly variable soil and hydrological conditions in a temporal scale (tidal marshes) versus systems with a distinct soil development over time (dredged sediment landfill sites). In some circumstances (e.g. to avoid flooding or to ensure navigation) dredging operations are necessary. Management and remediation of contaminated sediments are necessary to reduce the ecological risks and risks associated with food chain contamination and leaching. Besides disposal, classical remediation technologies for contaminated sediment also extract or destroy contaminants. These techniques imply the sediment structure deterioration and prohibitive costs. On the contrary, phytoremediation could be a low-cost option, particularly suited to in situ remediation of large sites and environmentally friendly. However, phytoremediation is rarely included in the management scheme of contaminated sediment and accepted as a viable option. Phytoremediation is still an emerging technology that has to prove its sustainability at field scale. Research needs to focus on optimisations to enhance applicability and to address the economic feasibility of phytoremediation.

Thermometers: Understand the Options

MedlinePlus

... the options Thermometers come in a variety of styles. Understand the different types of thermometers and how ... MA. Fever in infants and children: Pathophysiology and management. http://www.uptodate.com/home. Accessed July 23, ...

What weight loss treatment options do geriatric patients with overweight and obesity want to consider?

PubMed

MacMillan, M; Cummins, K; Fujioka, K

2016-12-01

Since the 1990s, a number of weight loss medications have been removed from the USA and or European market because of adverse events associated with these medications. These medications include fenfluramine (heart valve thickening), sibutramine (cardiovascular risk) and rimonabant (depression). This history may affect a patient's desire to consider weight loss medications as an option for weight management. This descriptive study was designed to observe what treatment options the geriatric patient (age 65 or higher) seeking weight loss would like to consider, as well as the reasons they felt they struggled with overweight or obesity. A questionnaire was given to 102 geriatric patients with overweight or obesity before starting a weight loss programme at a weight management centre. The questionnaire asked the patient why they felt they were overweight or obese and what treatment options they wished to consider. The geriatric patients were matched with younger patients in body mass index and sex. The three most common perceptions that geriatric patients felt were causes of their increased weight were 'lack of exercise' (76.2%), 'poor food choices' (59.4%) and 'cravings' (47.5%). When geriatric patients were asked what treatment options they would like to discuss, the four most common options requested were 'diet and healthy eating' (67.3%), weight loss medications (57.4%), a request for a 'metabolic work up' (55.4%) and 'exercise' (53.5%). These responses were no different from their younger cohorts. When geriatric patients with a body mass index of 35 or higher were given bariatric surgery as a treatment option, 21.9% marked it as a treatment option they would like to consider. Over half of geriatric patients desired to discuss weight loss medications as a treatment option. Diet and exercise were also of strong interest, which is in line with current weight management guidelines.

Selection bias between 2 Medicare capitated benefit programs.

PubMed

Leutz, Walter; Brody, Kathleen K; Nonnenkamp, Lucy L; Perrin, Nancy A

2007-04-01

To assess enrollment selection bias between a standard Medicare health maintenance organization (HMO) and a higher-priced social health maintenance organization (SHMO) offering full prescription drug and unique home-based and community-based benefits and to assess how adverse selection was handled through SHMO finances. Kaiser Permanente Northwest offered the dual-choice option in the greater Portland region from 1985 to 2002. Analysis focused on 3 "choice points" when options were clear and highlighted for beneficiaries. Data collected included age and sex, utilization 1 year before and after the choice points, health status data at enrollment (1999-2002 only), mortality, and cost and revenues. Data were extracted from health plan databases. Hospital, pharmacy, and nursing facility utilization for 1 year before and after the choice points are compared for HMO and SHMO choosers. Health and functional status data are compared from 1999 to 2002. Utilization and mortality data are controlled by age and sex. SHMO joiners evidenced adverse selection, while healthier members tended to stay in the HMO, with leaner benefits. Despite adverse selection, the health plan maintained margins in the SHMO, assisted by frailty-adjusted Medicare payments and member premiums. This high-low option strategy sought to offer the "right care at the right time" and may be a model for managed care organizations to serve aging and disabled beneficiaries under Medicare's new special needs plan option.

Threshold values and management options for nutrients in a catchment of a temperate estuary with poor ecological status

NASA Astrophysics Data System (ADS)

Hinsby, K.; Markager, S.; Kronvang, B.; Windolf, J.; Sonnenborg, T. O.; Thorling, L.

2012-02-01

Intensive farming has severe impacts on the chemical status of groundwater and streams and consequently on the ecological status of dependent ecosystems. Eutrophication is a widespread problem in lakes and marine waters. Common problems are hypoxia, algal blooms and fish kills, and loss of water clarity, underwater vegetation, biodiversity, and recreational value. In this paper we evaluate the nitrogen (N) and phosphorus (P) chemistry of groundwater and surface water in a coastal catchment, the loadings and sources of N and P and their effect on the ecological status of an estuary. We calculate the necessary reductions in N and P loadings to the estuary for obtaining a good ecological status, which we define based on the number of days with N and P limitation, and the equivalent stream and groundwater threshold values assuming two different management options. The calculations are performed by the combined use of empirical models and a physically based 3-D integrated hydrological model of the whole catchment. The assessment of the ecological status indicates that the N and P loads to the investigated estuary should be reduced by a factor of 0.52 and 0.56, respectively, to restore good ecological status. Model estimates show that threshold total N concentrations should be in the range of 2.9 to 3.1 mg l-1 in inlet freshwater to Horsens Estuary and 6.0 to 9.3 mg l-1 in shallow aerobic groundwater (∼27-41 mg l-1 of nitrate), depending on the management measures implemented in the catchment. The situation for total P is more complex but data indicate that groundwater threshold values are not needed. The inlet freshwater threshold value for total P to Horsens Estuary for the selected management options is 0.084 mg l-1. Regional climate models project increasing winter precipitation and runoff in the investigated region resulting in increasing runoff and nutrient loads to coastal waters if present land use and farming practices continue. Hence, lower threshold values are required in the future to ensure good status of all water bodies and ecosystems.

Threshold values and management options for nutrients in a catchment of a temperate estuary with poor ecological status

NASA Astrophysics Data System (ADS)

Hinsby, K.; Markager, S.; Kronvang, B.; Windolf, J.; Sonnenborg, T. O.; Thorling, L.

2012-08-01

Intensive farming has severe impacts on the chemical status of groundwater and streams and consequently on the ecological status of dependent ecosystems. Eutrophication is a widespread problem in lakes and marine waters. Common problems are hypoxia, algal blooms, fish kills, and loss of water clarity, underwater vegetation, biodiversity and recreational value. In this paper we evaluate the nitrogen (N) and phosphorus (P) concentrations of groundwater and surface water in a coastal catchment, the loadings and sources of N and P, and their effect on the ecological status of an estuary. We calculate the necessary reductions in N and P loadings to the estuary for obtaining a good ecological status, which we define based on the number of days with N and P limitation, and the corresponding stream and groundwater threshold values assuming two different management options. The calculations are performed by the combined use of empirical models and a physically based 3-D integrated hydrological model of the whole catchment. The assessment of the ecological status indicates that the N and P loads to the investigated estuary should be reduced to levels corresponding to 52 and 56% of the current loads, respectively, to restore good ecological status. Model estimates show that threshold total N (TN) concentrations should be in the range of 2.9 to 3.1 mg l-1 in inlet freshwater (streams) to Horsens estuary and 6.0 to 9.3 mg l-1 in shallow aerobic groundwater (∼ 27-41 mg l-1 of nitrate), depending on the management measures implemented in the catchment. The situation for total P (TP) is more complex, but data indicate that groundwater threshold values are not needed. The stream threshold value for TP to Horsens estuary for the selected management options is 0.084 mg l-1. Regional climate models project increasing winter precipitation and runoff in the investigated region resulting in increasing runoff and nutrient loads to the Horsens estuary and many other coastal waters if present land use and farming practices continue. Hence, lower threshold values are required in many coastal catchments in the future to ensure good status of water bodies and ecosystems.

A microcomputer based traffic evacuation modeling system for emergency planning application

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

Rathi, A.K.

1994-12-01

Vehicular evacuation is one of the major and often preferred protective action options available for emergency management in a real or anticipated disaster. Computer simulation models of evacuation traffic flow are used to estimate the time required for the affected populations to evacuate to safer areas, to evaluate effectiveness of vehicular evacuations as a protective action option. and to develop comprehensive evacuation plans when required. Following a review of the past efforts to simulate traffic flow during emergency evacuations, an overview of the key features in Version 2.0 of the Oak Ridge Evacuation Modeling System (OREMS) are presented in thismore » paper. OREMS is a microcomputer-based model developed to simulate traffic flow during regional emergency evacuations. OREMS integrates a state-of-the-art dynamic traffic flow and simulation model with advanced data editing and output display programs operating under a MS-Windows environment.« less

A general practice approach to Bell's palsy.

PubMed

Phan, Nga T; Panizza, Benedict; Wallwork, Benjamin

2016-11-01

Bell's palsy is characterised by an acute onset of unilateral, lower motor neuron weakness of the facial nerve in the absence of an identifiable cause. Establishing the correct diagnosis is imperative and choosing the correct treatment options can optimise the likelihood of recovery. This article summarises our understanding of Bell's palsy and the evidence-based management options available for adult patients. The basic assessment should include a thorough history and physical examination as the diagnosis of Bell's palsy is based on exclusion. For confirmed cases of Bell's palsy, corticosteroids are the mainstay of treatment and should be initiated within 72 hours of symptom onset. Antiviral therapy in combination with corticosteroid therapy may confer a small benefit and may be offered on the basis of shared decision making. Currently, no recommendations can be made for acupuncture, physical therapy, electrotherapy or surgical decompression because well-designed studies are lacking and available data are of low quality.

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

PubMed

Lavery, Hugh J; Cooperberg, Matthew R

2017-02-01

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

Study of the Cherokee Nuclear Station: projected impacts, monitoring plan, and mitigation options for Cherokee County, South Carolina

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

Peelle, E.; Schweitzer, M.; Scharre, P.

1979-07-01

This report inventories Cherokee County's capabilities and CNS project characteristics, projects expected impacts from the interaction of the two defines four options for Cherokee County decision makers, and presents a range of possible mitigation and monitoring plans for dealing with the problems identified. The four options and general implementation guidelines for each are presented after reviewing pertinent features of other mitigation and monitoring plans. The four options include (1) no action, (2) preventing impacts by preventing growth, (3) selective growth in designated areas as services can be supplied, and (4) maximum growth designed to attract as many in-movers as possiblemore » through a major program of capital investiments in public and private services. With the exception of the no action option, all plans deal with impacts according to some strategy determined by how the County wishes to manage growth. Solutions for impact problems depend on which growth strategy is selected and what additional resources are secured during the impact period. A monitoring program deals with the problems of data and projections uncertainty, while direct action is proposed to deal with the institutional problems of delay of the needed access road, timeing and location problems from the tax base mismatch, and lack of local planning capability.« less

Erectile dysfunction management options in Nigeria.

PubMed

Afolayan, Anthony Jide; Yakubu, Musa Toyin

2009-04-01

In Nigeria, the prevalence of erectile dysfunction (ED) among patients attending primary care clinics, age-standardized to the U.S. population in 2000 is 57.4%. This is considered high enough to warrant the attention of scientist for critical studies and analysis. The high ED prevalence is associated with etiologies such as psychosexual factors, chronic medical conditions, and some lifestyles. ED constitutes a major public health problem, influencing the patient's well-being and quality of life. It also leads to broken homes and marriages, psychological, social, and physical morbidity. To give an account of various ED management options in Nigeria. Review of peer-reviewed literature, questionnaire, and ethnobotanical survey to some indigenous herb sellers and herbalists. Cross cultural perspectives of ED management in Nigeria. The review suggests that traditional (phytotherapy, zootherapy, and occultism) and nontraditional, orthodox practice (drug therapy, psychological, and behavioral counseling) are applicable to ED management in Nigeria. This review should help in creating awareness into various options available for managing ED in the country, but does not recommend self medication of any form, be it the use of orthodox or herbal remedy.

Beauty and the beast: management of breast cancer after plastic surgery.

PubMed

Bleicher, Richard J; Topham, Neal S; Morrow, Monica

2008-04-01

Cosmetic surgery procedures increase in incidence annually, with 11 million performed in 2006. Because breast cancer is the most frequently occurring malignancy in women, a personal history of cosmetic surgery in those undergoing treatment for breast cancer is becoming more common. This review identified key studies from the PubMed database, to consolidate existing data related to treatment of breast cancer after plastic surgery. Data were reviewed for factors affecting breast cancer treatment after breast augmentation, breast reduction, abdominoplasty, and suction lipectomy. There are little comprehensive data on the management of breast cancer after plastic surgical procedures. Plastic surgery may affect diagnostic imaging, surgical options, and radiotherapy management. Breast augmentation and reduction are two of the most common cosmetic procedures performed and knowledge of their influence on the incidence, diagnosis, and treatment of breast cancer is important for proper management. Plastic surgery does not significantly affect breast cancer outcomes but does present management challenges that must be anticipated when deciding various treatment options. Knowledge of the existing literature may be helpful in discussing those options with patients and planning the multidisciplinary approach to this malignancy.

Stereotactic Body Radiotherapy in the Management of Oligometastatic Disease.

PubMed

Ahmed, Kamran A; Torres-Roca, Javier F

2016-01-01

The treatment of oligometastatic disease has become common as imaging techniques have advanced and the management of systemic disease has improved. Use of highly targeted, hypofractionated regimens of stereotactic body radiotherapy (SBRT) is now a primary management option for patients with oligometastatic disease. The properties of SBRT are summarized and the results of retrospective and prospective studies of SBRT use in the management of oligometastases are reviewed. Future directions of SBRT, including optimizing dose and fractionation schedules, are also discussed. SBRT can deliver highly conformal, dosed radiation treatments for ablative tumors in a few treatment sessions. Phase 1/2 trials and retrospective institutional results support use of SBRT as a treatment option for oligometastatic disease metastasized to the lung, liver, and spine, and SBRT offers adequate toxicity profiles with good rates of local control. Future directions will involve optimizing dose and fractionation schedules for select histologies to improve rates of local control while limiting toxicity to normal structures. SBRT offers an excellent management option for patients with oligometastases. However, additional research is still needed to optimize dose and fractionation schedules.

Neurogenic detrusor overactivity in patients with spinal cord injury: evaluation and management.

PubMed

Sahai, Arun; Cortes, Eduardo; Seth, Jai; Khan, Muhammad Shamim; Panicker, Jalesh; Kelleher, Cornelius; Kessler, Thomas M; Fowler, Clare J; Dasgupta, Prokar

2011-12-01

Lower urinary tract dysfunction can have a significant impact on patients with spinal cord injury. Over the years, many treatment options have become available. This article reviews the assessment and management of neurogenic detrusor overactivity, with a particular focus on articles from the recent literature. Recent guidelines on the subject will be discussed. Management options include antimuscarinics and bladder emptying measures, botulinum toxin A, and neuromodulation in refractory cases and surgery for intractable cases. Recent and relevant publications in these areas will be summarized and discussed.

Treatment Principles for the Management of Mold Infections

PubMed Central

Kontoyiannis, Dimitrios P.; Lewis, Russell E.

2015-01-01

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

Chronic Achilles Tendon Disorders: Tendinopathy and Chronic Rupture.

PubMed

Maffulli, Nicola; Via, Alessio Giai; Oliva, Francesco

2015-10-01

Tendinopathy of the Achilles tendon involves clinical conditions in and around the tendon and it is the result of a failure of a chronic healing response. Although several conservative therapeutic options have been proposed, few of them are supported by randomized controlled trials. The management is primarily conservative and many patients respond well to conservative measures. If clinical conditions do not improve after 6 months of conservative management, surgery is recommended. The management of chronic ruptures is different from that of acute ruptures. The optimal surgical procedure is still debated. In this article chronic Achilles tendon disorders are debated and evidence-based medicine treatment strategies are discussed. Copyright © 2015 Elsevier Inc. All rights reserved.

Treatment of primary hip osteoarthritis for the primary care physician and the indications for total hip arthroplasty.

PubMed

Levine, Mathew E; Nace, James; Kapadia, Bhaveen H; Issa, Kimona; Banerjee, Samik; Cherian, Jeffery J; Mont, Michael A

2013-01-01

Osteoarthritis is a degenerative condition that commonly affects knees and hips with an annual incidence of 88 in 100,000 people in the United States. The purpose of this study was to review the clinical presentation of osteoarthritis of the hip as well as the available management options. We reviewed the recent literature in regard to epidemiology, presentation, and treatment options available to patients. Nonoperative treatments include weight loss and low-impact, aerobic exercises. Along with weight loss and exercise, nonsteroidal anti-inflammatory drugs (NSAIDS), narcotics, and intra-articular steroid injections have been used to improve patient's symptoms. Surgical intervention is a viable option; however, indications such as severe pain that is refractory to nonsurgical management, osteophytes, or joint space narrowing on radiographic films, or impairment of function should be present. The most common surgical option, total hip arthroplasty, has been shown to improve a patient's physical and psychological well-being. However, inherent risks are present with surgery and these should be addressed with the patient so a sound decision can be made. Osteoarthritis of the hip can be bothersome to patients, but physicians can begin management with lifestyle changes or pharmaceuticals. In the event nonoperative measures fail to markedly improve quality of life, total hip arthroplasty remains a viable option.

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

Kelly, K.; Gonzales, J.

Many fleet managers have opted to incorporate alternative fuels and advanced vehicles into their lineup. Original equipment manufacturers (OEMs) offer a variety of choices, and there are additional options offered by aftermarket companies. There are also a myriad of ways that existing vehicles can be modified to utilize alternative fuels and other advanced technologies. Vehicle conversions and retrofit packages, along with engine repower options, can offer an ideal way to lower vehicle operating costs. This can result in long term return on investment, in addition to helping fleet managers achieve emissions and environmental goals. This report summarizes the various factorsmore » to consider when pursuing a conversion, retrofit, or repower option.« less

Clinical Equipoise and Shared Decision-making in Pulmonary Nodule Management. A Survey of American Thoracic Society Clinicians.

PubMed

Iaccarino, Jonathan M; Simmons, James; Gould, Michael K; Slatore, Christopher G; Woloshin, Steven; Schwartz, Lisa M; Wiener, Renda Soylemez

2017-06-01

Guidelines for pulmonary nodule evaluation suggest a variety of strategies, reflecting the lack of high-quality evidence demonstrating the superiority of any one approach. It is unclear whether clinicians agree that multiple management options are appropriate at different levels of risk and whether this impacts their decision-making approaches with patients. To assess clinicians' perceptions of the appropriateness of various diagnostic strategies, approach to decision-making, and perceived clinical equipoise in pulmonary nodule evaluation. We developed and administered a web-based survey in March and April, 2014 to clinician members of the American Thoracic Society. The primary outcome was perceived appropriateness of pulmonary nodule evaluation strategies in three clinical vignettes with different malignancy risk. We compared responses to guideline recommendations and analyzed clinician characteristics associated with a reported shared decision-making approach. We also assessed clinicians' likelihood to enroll patients in hypothetical randomized trials comparing nodule evaluation strategies. Of 5,872 American Thoracic Society members e-mailed, 1,444 opened the e-mail and 428 eligible clinicians participated in the survey (response rate, 30.0% among those who opened the invitation; 7% overall). The mean number of options considered appropriate increased with pretest probability of cancer, ranging from 1.8 (SD, 1.2) for the low-risk case to 3.5 (1.1) for the high-risk case (P < 0.0001). As recommended by guidelines, the proportion that deemed surgical resection as an appropriate option also increased with cancer risk (P < 0.0001). One-half of clinicians (50.4%) reported engaging in shared decision-making with patients for pulmonary nodule management; this was more commonly reported by clinicians with more years of experience (P = 0.01) and those who reported greater comfort in managing pulmonary nodules (P = 0.005). Although one-half (49.9%) deemed the evidence for pulmonary nodule evaluation to be strong, most clinicians were willing to enroll patients in randomized trials to compare nodule management strategies in all risk categories (low risk, 87.6%; moderate risk, 89.7%; high risk, 63.0%). Consistent with guideline recommendations, clinicians embrace multiple options for pulmonary nodule evaluation and many are open to shared decision-making. Clinicians support the need for randomized clinical trials to strengthen the evidence for nodule evaluation, which will further improve decision-making.

Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society.

PubMed

2015-11-01

To update and expand The North American Menopause Society's evidence-based position on nonhormonal management of menopause-associated vasomotor symptoms (VMS), previously a portion of the position statement on the management of VMS. NAMS enlisted clinical and research experts in the field and a reference librarian to identify and review available evidence. Five different electronic search engines were used to cull relevant literature. Using the literature, experts created a document for final approval by the NAMS Board of Trustees. Nonhormonal management of VMS is an important consideration when hormone therapy is not an option, either because of medical contraindications or a woman's personal choice. Nonhormonal therapies include lifestyle changes, mind-body techniques, dietary management and supplements, prescription therapies, and others. The costs, time, and effort involved as well as adverse effects, lack of long-term studies, and potential interactions with medications all need to be carefully weighed against potential effectiveness during decision making. Clinicians need to be well informed about the level of evidence available for the wide array of nonhormonal management options currently available to midlife women to help prevent underuse of effective therapies or use of inappropriate or ineffective therapies. Recommended: Cognitive-behavioral therapy and, to a lesser extent, clinical hypnosis have been shown to be effective in reducing VMS. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS, although other selective serotonin reuptake/norepinephrine reuptake inhibitors, gabapentinoids, and clonidine show evidence of efficacy. Recommend with caution: Some therapies that may be beneficial for alleviating VMS are weight loss, mindfulness-based stress reduction, the S-equol derivatives of soy isoflavones, and stellate ganglion block, but additional studies of these therapies are warranted. Do not recommend at this time: There are negative, insufficient, or inconclusive data suggesting the following should not be recommended as proven therapies for managing VMS: cooling techniques, avoidance of triggers, exercise, yoga, paced respiration, relaxation, over-the-counter supplements and herbal therapies, acupuncture, calibration of neural oscillations, and chiropractic interventions. Incorporating the available evidence into clinical practice will help ensure that women receive evidence-based recommendations along with appropriate cautions for appropriate and timely management of VMS.

Options for accounting carbon sequestration in German forests

PubMed Central

Krug, Joachim; Koehl, Michael; Riedel, Thomas; Bormann, Kristin; Rueter, Sebastian; Elsasser, Peter

2009-01-01

Background The Accra climate change talks held from 21–27 August 2008 in Accra, Ghana, were part of an ongoing series of meetings leading up to the Copenhagen meeting in December 2009. During the meeting a set of options for accounting carbon sequestration in forestry on a post-2012 framework was presented. The options include gross-net and net-net accounting and approaches for establishing baselines. Results This article demonstrates the embedded consequences of Accra Accounting Options for the case study of German national GHG accounting. It presents the most current assessment of sequestration rates by forest management for the period 1990 – 2007, provides an outlook of future emissions and removals (up to the year 2042) as related to three different management scenarios, and shows that implementation of some Accra options may reverse sources to sinks, or sinks to sources. Conclusion The results of the study highlight the importance of elaborating an accounting system that would prioritize the climate convention goals, not national preferences. PMID:19650896

Options for accounting carbon sequestration in German forests.

PubMed

Krug, Joachim; Koehl, Michael; Riedel, Thomas; Bormann, Kristin; Rueter, Sebastian; Elsasser, Peter

2009-08-03

The Accra climate change talks held from 21-27 August 2008 in Accra, Ghana, were part of an ongoing series of meetings leading up to the Copenhagen meeting in December 2009. During the meeting a set of options for accounting carbon sequestration in forestry on a post-2012 framework was presented. The options include gross-net and net-net accounting and approaches for establishing baselines. This article demonstrates the embedded consequences of Accra Accounting Options for the case study of German national GHG accounting. It presents the most current assessment of sequestration rates by forest management for the period 1990 - 2007, provides an outlook of future emissions and removals (up to the year 2042) as related to three different management scenarios, and shows that implementation of some Accra options may reverse sources to sinks, or sinks to sources. The results of the study highlight the importance of elaborating an accounting system that would prioritize the climate convention goals, not national preferences.

Management of urinary incontinence in residential care.

PubMed

Lim, David S

2016-07-01

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

Cost Considerations in Cloud Computing

DTIC Science & Technology

2014-01-01

investments. 2. Database Options The potential promise that “ big data ” analytics holds for many enterprise mission areas makes relevant the question of the...development of a range of new distributed file systems and data - bases that have better scalability properties than traditional SQL databases. Hadoop ... data . Many systems exist that extend or supplement Hadoop —such as Apache Accumulo, which provides a highly granular mechanism for managing security

CADASIL: Treatment and Management Options.

PubMed

Bersano, Anna; Bedini, Gloria; Oskam, Joshua; Mariotti, Caterina; Taroni, Franco; Baratta, Silvia; Parati, Eugenio Agostino

2017-09-01

CADASIL is a life-threatening and disabling disease. Despite the progress achieved so far, no therapies able to limit the disease progression have been found and only empiric treatments can be employed to relieve the main disease symptoms. Further in vivo studies as well as data aggregation and multi-centre controlled clinical trials are needed to confirm the emerging findings in order to identify evidence-based therapies for CADASIL.

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

PubMed

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

2013-11-01

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

Waste Management Options for Long-Duration Space Missions: When to Reject, Reuse, or Recycle

NASA Technical Reports Server (NTRS)

Linne, Diane L.; Palaszewski, Bryan A.; Gokoglu, Suleyman; Gallo, Christopher A.; Balasubramaniam, Ramaswamy; Hegde, Uday G.

2014-01-01

The amount of waste generated on long-duration space missions away from Earth orbit creates the daunting challenge of how to manage the waste through reuse, rejection, or recycle. The option to merely dispose of the solid waste through an airlock to space was studied for both Earth-moon libration point missions and crewed Mars missions. Although the unique dynamic characteristics of an orbit around L2 might allow some discarded waste to intersect the lunar surface before re-impacting the spacecraft, the large amount of waste needed to be managed and potential hazards associated with volatiles recondensing on the spacecraft surfaces make this option problematic. A second option evaluated is to process the waste into useful gases to be either vented to space or used in various propulsion systems. These propellants could then be used to provide the yearly station-keeping needs at an L2 orbit, or if processed into oxygen and methane propellants, could be used to augment science exploration by enabling lunar mini landers to the far side of the moon.

Renewables-to-reefs? - Decommissioning options for the offshore wind power industry.

PubMed

Smyth, Katie; Christie, Nikki; Burdon, Daryl; Atkins, Jonathan P; Barnes, Richard; Elliott, Michael

2015-01-15

The offshore wind power industry is relatively new but increasing globally, hence it is important that the whole life-cycle is managed. The construction-operation-decommissioning cycle is likely to take 20-30 years and whilst decommissioning may not be undertaken for many years, its management needs to be addressed in both current and future marine management regimes. This can be defined within a Drivers-Activities-Pressures-State Changes-Impacts (on human Welfare)-Responses framework. This paper considers the main decommissioning options - partial or complete removal of all components. A SWOT analysis shows environmental and economic benefits in partial as opposed to complete removal, especially if habitat created on the structures has conservation or commercial value. Benefits (and repercussions) are defined in terms of losses and gains of ecosystem services and societal benefits. The legal precedents and repercussions of both options are considered in terms of the 10-tenets of sustainable marine management. Finally a 'renewables-to-reefs' programme is proposed. Copyright © 2014 Elsevier Ltd. All rights reserved.

78 FR 30367 - Self-Regulatory Organizations; BOX Options Exchange LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-22

... mitigate risk in managing large portfolios, particularly for institutional investors.'' \\7\\ \\7\\ Id. The... next four most actively traded options was: Apple Inc. (option symbol AAPL)--1,074,351; S&P 500 Index... listed solely on the Exchange, the Exchange operates in a highly competitive market compromised of eleven...

Inadequate management of pregnancy-associated listeriosis: lessons from four case reports.

PubMed

Charlier, C; Goffinet, F; Azria, E; Leclercq, A; Lecuit, M

2014-03-01

Listeria monocytogenes infection during pregnancy can lead to dramatic fetal or neonatal outcomes. No clinical trial has evaluated treatment options, and retrospective studies of cases are therefore important to define optimal regimens. We report four cases of materno-neonatal listeriosis illustrating inadequate antimicrobial therapy management and discuss recommended treatment options. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

41 CFR 302-3.405 - If my agency authorizes a TCS, do I have the option of electing payment of per diem expenses...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false If my agency authorizes...? 302-3.405 Section 302-3.405 Public Contracts and Property Management Federal Travel Regulation System... Change Of Station § 302-3.405 If my agency authorizes a TCS, do I have the option of electing payment of...