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Sample records for american intensively managed

  1. Biology and management of insect pests in North American intensively managed hardwood forest systems.

    Energy Technology Data Exchange (ETDEWEB)

    Coyle, David R.; Nebeker, T., E.; Hart, E., R.; Mattson, W., J.

    2005-01-01

    Annu. Rev. Entomol. 50:1-29. Abstract Increasing demand for wood and wood products is putting stress on traditional forest production areas, leading to long-term economic and environmental concerns. Intensively managed hardwood forest systems (IMHFS), grown using conventional agricultural as well as forestry methods, can help alleviate potential problems in natural forest production areas. Although IMHFS can produce more biomass per hectare per year than natural forests, the ecologically simplified, monocultural systems may greatly increase the crops susceptibility to pests. Species in the genera Populus and Salix comprise the greatest acreage in IMHFS in North America, but other species, including Liquidambar styracifua and Platanus occidentalis, are also important. We discuss life histories, realized and potential damage, and management options for the most economically infuential pests that affect these hardwood species. The substantial inherent challenges associated with pest management in the monocultural environments created by IMHFS are reviewed. Finally, we discuss ways to design IMHFS that may reduce their susceptibility to pests, increase their growth and productivity potential, and create a more sustainable environment.

  2. American Society for Pain Management Nursing Position Statement: Prescribing and Administering Opioid Doses Based Solely on Pain Intensity.

    Science.gov (United States)

    Pasero, Chris; Quinlan-Colwell, Ann; Rae, Diana; Broglio, Kathleen; Drew, Debra

    2016-06-01

    The foundation of safe and effective pain management is an individualized, comprehensive pain assessment, which includes, but is not limited to, determining the intensity of pain if the patient is able to report it. An unforeseen consequence of the widespread use of pain intensity rating scales is the practice of prescribing specific doses of opioid analgesics based solely on specific pain intensity. Many factors in addition to pain intensity influence opioid requirements, and there is no research showing that a specific opioid dose will relieve pain of a specific intensity in all patients. The American Society for Pain Management Nursing (ASPMN) holds the position that the practice of prescribing doses of opioid analgesics based solely on a patient's pain intensity should be prohibited because it disregards the relevance of other essential elements of assessment and may contribute to untoward patient outcomes. PMID:27108082

  3. Erythroneura lawsoni abundance and feeding injury levels are influenced by foliar nutrient status in intensively managed American sycamore.

    Energy Technology Data Exchange (ETDEWEB)

    Coyle, David, Robert: Aubrey, Doug, Patric; Bentz, Jo-Ann

    2010-01-01

    Abstract 1 Abundance and feeding injury of the leafhopper Erythroneura lawsoni Robinson was measured in an intensively-managed American sycamore Platanus occidentalis L. plantation. Trees were planted in spring 2000 in a randomized complete block design, and received one of three annual treatments: (i) fertilization (120 kg N/ha/year); (ii) irrigation (3.0 cm/week); (iii) fertilization + irrigation; or (iv) control (no treatment). 2 Foliar nutrient concentrations were significantly influenced by the treatments because only sulphur and manganese levels were not statistically greater in trees receiving fertilization. 3 Over 116 000 E. lawsoni were captured on sticky traps during the study. Leafhopper abundance was highest on nonfertilized trees for the majority of the season, and was positively correlated with foliar nutrient concentrations. Significant temporal variation in E. lawsoni abundance occurred, suggesting five discrete generations in South Carolina. 4 Significant temporal variation occurred in E. lawsoni foliar injury levels, with the highest injury ratings occurring in late June and August. Foliar injury was negatively correlated with foliar nutrient content, and higher levels of injury occurred more frequently on nonfertilized trees. 5 The results obtained in the present study indicated that increased E. lawsoni abundance occurred on trees that did not receive fertilization. Nonfertilized trees experienced greater foliar injury, suggesting that lower foliar nutrient status may have led to increased levels of compensatory feeding.

  4. 75 FR 23245 - American Lobster Fishery Management

    Science.gov (United States)

    2010-05-03

    ... National Oceanic and Atmospheric Administration RIN 0648-AT31 American Lobster Fishery Management AGENCY... impact statement (DEIS) that identifies several proposed management actions and alternatives for the American lobster fishery in Federal waters. The management actions are based on recommendations to NMFS...

  5. Managing the Knowledge-Intensive Firm

    CERN Document Server

    Ejler, Nicolaj; Czerniawska, Fiona

    2011-01-01

    Over the last decade, there has been a substantial rise in the number of knowledge-intensive firms. The core assets of these businesses are the people themselves and so, successful managers of knowledge-intensive firms must inspire their employees and target their individual ambitions, to ensure high performance.This book examines what sets knowledge-intensive firms apart from other types of organizations, and the resultant organizational and strategic differences in business models, talent management, and client-handling approaches. A new model for transforming the management of knowledge-int

  6. American Samoa ESI: MGT (Management Area Polygons)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains management area data for special management areas, marine parks, marine sanctuaries, national parks, and wildlife refuges in American Samoa....

  7. Medicare Managed Care Spillovers and Treatment Intensity.

    Science.gov (United States)

    Callison, Kevin

    2016-07-01

    Evidence suggests that the share of Medicare managed care enrollees in a region affects the costs of treating traditional fee-for-service (FFS) Medicare beneficiaries; however, little is known about the mechanisms through which these 'spillover effects' operate. This paper examines the relationship between Medicare managed care penetration and treatment intensity for FFS enrollees hospitalized with a primary diagnosis of AMI. I find that increased Medicare managed care penetration is associated with a reduction in both the costs and the treatment intensity of FFS AMI patients. Specifically, as Medicare managed care penetration increases, FFS AMI patients are less likely to receive surgical reperfusion and mechanical ventilation and to experience an overall reduction in the number of inpatient procedures. Copyright © 2015 John Wiley & Sons, Ltd. PMID:25960418

  8. Management Studies, Cultural Criticism and American Dreams

    DEFF Research Database (Denmark)

    Guthey, Eric

    2005-01-01

    The article reviews three books related to industrial management, including "False Prophets: The Gurus Who Created Modern Management and Why Their Ideas Are Bad for Business Today," by James Hoopes, "Organization and Innovation: Guru Schemes and American Dreams," by David Knights and Darren Mc...

  9. American Health Information Management Association

    Science.gov (United States)

    ... advance your organization, and drive excellence in health information management (HIM). Plan your 2017 education and training with ... initiative to build a framework to transform health information management (HIM) and position professionals for the future. How ...

  10. Conservation and management of the American crocodile

    Science.gov (United States)

    Kushlan, James A.

    1988-11-01

    The American crocodile is a rare and endangered species, the range of which has contracted to disjunct locations such as Hispaniola, Jamaica, Cuba, Panama, and southern Florida. In an attempt to determine what factors might be limiting population growth, an extensive collaborative research program was conducted in 1978 82 in southern Florida. Limiting factors explicitly studied included climate, hurricanes, population dispersion, nesting habitat, fertility, predation, nest chamber environment, juvenile survivorship, artificial mortality, disturbance, and environmental contamination. No single natural factor limits the population, although in concert various factors result in low adult recruitment rates. Such natural limitations explain the natural rarity of this tropical species at the temperate limits of its range. Two artificial sources of mortality are death of adults on roads and the flooding of nests by high groundwater tables. These sources of mortality are potentially controllable by the appropriate management agencies. Active management, by such means as protection of individuals, habitat preservation and enhancement, nest site protection, and captive breeding, is also appropriate for assuring the survival of a rare species. The American crocodile has survived in southern Florida in face of extensive human occupancy of parts of its former nesting habitat, demonstrating the resilience of a threatened species. This case history illustrates the efficacy of conducting research aimed at testing specific management hypotheses, the importance of considering biographical constraints limiting population status in peripheral populations, the need for active management of rare species, and the role of multiple reserves in a conservation and management strategy.

  11. Intensive case management for severe mental illness

    Science.gov (United States)

    Dieterich, Marina; Irving, Claire B; Park, Bert; Marshall, Max

    2014-01-01

    Background Intensive Case Management (ICM) is a community based package of care, aiming to provide long term care for severely mentally ill people who do not require immediate admission. ICM evolved from two original community models of care, Assertive Community Treatment (ACT) and Case Management (CM), where ICM emphasises the importance of small caseload (less than 20) and high intensity input. Objectives To assess the effects of Intensive Case Management (caseload Management (caseload > 20) and with standard community care in people with severe mental illness. To evaluate whether the effect of ICM on hospitalisation depends on its fidelity to the ACT model and on the setting. Search methods For the current update of this review we searched the Cochrane Schizophrenia Group Trials Register (February 2009), which is compiled by systematic searches of major databases, hand searches and conference proceedings. Selection criteria All relevant randomised clinical trials focusing on people with severe mental illness, aged 18 to 65 years and treated in the community-care setting, where Intensive Case Management, non-Intensive Case Management or standard care were compared. Outcomes such as service use, adverse effects, global state, social functioning, mental state, behaviour, quality of life, satisfaction and costs were sought. Data collection and analysis We extracted data independently. For binary outcomes we calculated relative risk (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data we estimated mean difference (MD) between groups and its 95% confidence interval (CI). We employed a random-effects model for analyses. We performed a random-effects meta-regression analysis to examine the association of the intervention’s fidelity to the ACT model and the rate of hospital use in the setting where the trial was conducted with the treatment effect. Main results We included 38 trials (7328 participants) in this review. The

  12. It's All About Relationships: African-American and European-American Women's Hotel Management Careers

    OpenAIRE

    Farrar, Angela L.

    1996-01-01

    Among the 44000-plus general managers employed in United States' hotels in 1993, there were only 100 women, 15 African-Americans, and three African-American women. Additionally, less than 0.5 percent of corporate hospitality managers were women. Given this relative underrepresentation of European-American women and African-Americans, combined with the increasing diversity of hotel clientele and service p...

  13. Evolution of Sustainability in American Forest Resource Management Planning in the Context of the American Forest Management Textbook

    OpenAIRE

    Thomas J. Straka

    2009-01-01

    American forest resource management and planning goes back to the European roots of American Forestry. Timber management plans, documents based on forest regulation for timber production, were the foundation of American forestry. These types of management plans predominated until World War II. Multiple use forestry developed after World War II and issues like recreation, wildlife, water quality, and wilderness became more important. In the 1970’s harvest scheduling became part of the planni...

  14. Innovation Management Practices in Production-Intensive Service Firms

    OpenAIRE

    Aas, Tor Helge; Breunig, Karl Joachim; Hydle, Katja Maria; Pedersen, Per Egil

    2015-01-01

    This paper posits that innovation management practices are contingent upon the type of industry, and examines the innovation management practices in a distinctive set of service firms: production-intensive service firms. Production-intensive services are standardised services produced at a large scale. These services have received little attention from prior comprehensive qualitative innovation management practices research. The examination in this paper is based on in-depth interviews with 2...

  15. Asthma Management Disparities: A Photovoice Investigation with African American Youth

    Science.gov (United States)

    Evans-Agnew, Robin

    2016-01-01

    Disparities in asthma management are a burden on African American youth. The objective of this study is to describe and compare the discourses of asthma management disparities (AMDs) in African American adolescents in Seattle to existing youth-related asthma policies in Washington State. Adolescents participated in a three-session photovoice…

  16. Novel margin management to enhance Auchenorrhyncha biodiversity in intensive grasslands

    OpenAIRE

    Blake, R.J.; Woodcock, B.A.; Ramsay, A. J.; Pilgrim, E.S.; Brown, V. K.; Tallowin, J.R.; Potts, Simon

    2011-01-01

    Agricultural intensification, including changes in cutting, grazing and fertilizer regimes, has led to declines in UK and NW European grassland biodiversity. We aimed to develop field margin management practices that would support invertebrate diversity and abundance on intensively managed grassland farms, focusing on planthoppers and leafhoppers (Auchenorrhyncha). Replicated across four farms in south-west England, we manipulated conventional management practices (inorganic fertilizer, cutti...

  17. Cerebral vasospasm: Aetiopathogenesis and intensive care management

    Directory of Open Access Journals (Sweden)

    Murthy T

    2005-01-01

    Full Text Available Cerebral vasospasm is the prolonged, intense constriction of the larger conducting arteries in the subarachnoid space which are initially surrounded by subarachnoid clot. Significant narrowing develops gradually over the first few days after the aneurysmal rupture. The spasm usually is maximal in about a week′s time following haemorrhage. Vasospasm is the one of the leading causes of death after the aneurysmal rupture along with the effect of the initial haemorrhage and latter rebleeding. The purpose of this article is to outline the importance in early diagnosis and aggressive treatment of this otherwise challenging clinical entity.

  18. Management Planning and Control: Supporting Knowledge-Intensive Organizations

    Science.gov (United States)

    Herremans, Irene M.; Isaac, Robert G.

    2005-01-01

    Purpose: The purpose of this paper is to develop propositions for empirical validation regarding appropriate management planning and control systems (MPACS) in knowledge-intensive organizations. Design/methodology/approach: The propositions were developed from interviews with members of a knowledge-intensive virtual organization that is known for…

  19. The World's Best Anglo-American Universities' Knowledge Management Attributes

    Science.gov (United States)

    Tower, Greg; Plummer, Julie; Ridgewell, Brenda; Goforth, Emily; Tower, Spence

    2009-01-01

    Key knowledge management attributes of the world's most prestigious Anglo-American universities are surprisingly under-reported especially by best ranked USA institutions. This leads to calls for more transparency.

  20. Nursing management and organizational ethics in the intensive care unit.

    Science.gov (United States)

    Wlody, Ginger Schafer

    2007-02-01

    This article describes organizational ethics issues involved in nursing management of an intensive care unit. The intensive care team and medical center management have the dual responsibility to create an ethical environment in which to provide optimum patient care. Addressing organizational ethics is key to creating that ethical environment in the intensive care unit. During the past 15-20 yrs, increasing costs in health care, competitive markets, the effect of high technology, and global business changes have set the stage for business and healthcare organizational conflicts that affect the ethical environment. Studies show that critical care nurses experience moral distress and are affected by the ethical climate of both the intensive care unit and the larger organization. Thus, nursing moral distress may result in problems related to recruitment and retention of staff. Other issues with organizational ethics ramifications that may occur in the intensive care unit include patient safety issues (including those related to disruptive behavior), intensive care unit leadership style, research ethics, allocation of resources, triage, and other economic issues. Current organizational ethics conflicts are discussed, a professional practice model is described, and multidisciplinary recommendations are put forth. PMID:17242604

  1. A Writing-Intensive Program for Teaching Retail Management.

    Science.gov (United States)

    Darian, Jean C.; And Others

    1992-01-01

    Presents the writing-intensive design for a retailing management course developed by its instructor in accordance with writing-across-the-curriculum principles. Provides an overview of the semester-long project. Details project procedures for preparatory activities, field research, and writing the marketing plan. (SR)

  2. A Comparison between American and Chinese Classroom Management

    Institute of Scientific and Technical Information of China (English)

    CHAI Xue-ting; FAN Xiao-bin

    2016-01-01

    The classroom is an episode of the school culture, a stage to show the idea of school, and a transmission position to spread national education philosophy. There are obvious differences in terms of American and Chinese classroom management in three aspects:the teaching objectives, the teaching environment, the solution of the classroom problem behavior, and these dif-ferences are caused by the distinction in values and culture. The comparison between American and Chinese classroom manage-ment is of great significance for learning from teaching experience of foreign countries and promoting students' comprehensive development.

  3. Management intensity and topography determined plant diversity in vineyards.

    Directory of Open Access Journals (Sweden)

    Juri Nascimbene

    Full Text Available Vineyards are amongst the most intensive forms of agriculture often resulting in simplified landscapes where semi-natural vegetation is restricted to small scattered patches. However, a tendency toward a more sustainable management is stimulating research on biodiversity in these poorly investigated agro-ecosystems. The main aim of this study was to test the effect on plant diversity of management intensity and topography in vineyards located in a homogenous intensive hilly landscape. Specifically, this study evaluated the role of slope, mowing and herbicide treatments frequency, and nitrogen supply in shaping plant diversity and composition of life-history traits. The study was carried out in 25 vineyards located in the area of the Conegliano-Valdobbiadene DOCG (Veneto, NE Italy. In each vineyard, 10 plots were placed and the abundance of all vascular plants was recorded in each plot. Linear multiple regression was used to test the effect of management and topography on plant diversity. Management intensity and topography were both relevant drivers of plant species diversity patterns in our vineyards. The two most important factors were slope and mowing frequency that respectively yielded positive and negative effects on plant diversity. A significant interaction between these two factors was also demonstrated, warning against the detrimental effects of increasing mowing intensity on steep slope where plant communities are more diverse. The response of plant communities to mowing frequency is mediated by a process of selection of resistant growth forms, such in the case of rosulate and reptant species. The other two management-related factors tested in this study, number of herbicide treatments and N fertilization, were less influential. In general, our study corroborates the idea that some simple changes in farming activities, which are compatible with grape production, should be encouraged for improving the natural and cultural value of the

  4. Management intensity and topography determined plant diversity in vineyards.

    Science.gov (United States)

    Nascimbene, Juri; Marini, Lorenzo; Ivan, Diego; Zottini, Michela

    2013-01-01

    Vineyards are amongst the most intensive forms of agriculture often resulting in simplified landscapes where semi-natural vegetation is restricted to small scattered patches. However, a tendency toward a more sustainable management is stimulating research on biodiversity in these poorly investigated agro-ecosystems. The main aim of this study was to test the effect on plant diversity of management intensity and topography in vineyards located in a homogenous intensive hilly landscape. Specifically, this study evaluated the role of slope, mowing and herbicide treatments frequency, and nitrogen supply in shaping plant diversity and composition of life-history traits. The study was carried out in 25 vineyards located in the area of the Conegliano-Valdobbiadene DOCG (Veneto, NE Italy). In each vineyard, 10 plots were placed and the abundance of all vascular plants was recorded in each plot. Linear multiple regression was used to test the effect of management and topography on plant diversity. Management intensity and topography were both relevant drivers of plant species diversity patterns in our vineyards. The two most important factors were slope and mowing frequency that respectively yielded positive and negative effects on plant diversity. A significant interaction between these two factors was also demonstrated, warning against the detrimental effects of increasing mowing intensity on steep slope where plant communities are more diverse. The response of plant communities to mowing frequency is mediated by a process of selection of resistant growth forms, such in the case of rosulate and reptant species. The other two management-related factors tested in this study, number of herbicide treatments and N fertilization, were less influential. In general, our study corroborates the idea that some simple changes in farming activities, which are compatible with grape production, should be encouraged for improving the natural and cultural value of the landscape by

  5. Forest Management Intensity Affects Aquatic Communities in Artificial Tree Holes.

    Science.gov (United States)

    Petermann, Jana S; Rohland, Anja; Sichardt, Nora; Lade, Peggy; Guidetti, Brenda; Weisser, Wolfgang W; Gossner, Martin M

    2016-01-01

    Forest management could potentially affect organisms in all forest habitats. However, aquatic communities in water-filled tree-holes may be especially sensitive because of small population sizes, the risk of drought and potential dispersal limitation. We set up artificial tree holes in forest stands subject to different management intensities in two regions in Germany and assessed the influence of local environmental properties (tree-hole opening type, tree diameter, water volume and water temperature) as well as regional drivers (forest management intensity, tree-hole density) on tree-hole insect communities (not considering other organisms such as nematodes or rotifers), detritus content, oxygen and nutrient concentrations. In addition, we compared data from artificial tree holes with data from natural tree holes in the same area to evaluate the methodological approach of using tree-hole analogues. We found that forest management had strong effects on communities in artificial tree holes in both regions and across the season. Abundance and species richness declined, community composition shifted and detritus content declined with increasing forest management intensity. Environmental variables, such as tree-hole density and tree diameter partly explained these changes. However, dispersal limitation, indicated by effects of tree-hole density, generally showed rather weak impacts on communities. Artificial tree holes had higher water temperatures (on average 2°C higher) and oxygen concentrations (on average 25% higher) than natural tree holes. The abundance of organisms was higher but species richness was lower in artificial tree holes. Community composition differed between artificial and natural tree holes. Negative management effects were detectable in both tree-hole systems, despite their abiotic and biotic differences. Our results indicate that forest management has substantial and pervasive effects on tree-hole communities and may alter their structure and

  6. Lessons learned from past experience with intensive livestock management systems.

    Science.gov (United States)

    Cronin, G M; Rault, J L; Glatz, P C

    2014-04-01

    The main impetus for 'modern' intensive animal production occurred after the Second World War, when Western governments developed policies to increase the availability of cheap, safe food for their populations. Livestock benefit under intensive husbandry by protection from environmental extremes and predators, and better nutritional and health management. Nevertheless, there are costs to the animal, such as impaired social behaviour, limited choice of living environment or pen mates, poor environmental stimulation and behavioural restrictions. The rapid progress in genetic selection of production traits has also, in some cases, adversely affected welfare by creating anatomical and metabolic problems. Above all, the intensively housed animal is heavily reliant on the stockperson and, therefore, inadequate care and husbandry practices by the stockperson may be the largest welfare risk. In a future in which the food supply may be limited as the world's population grows and land availability shrinks, intensive animal production is likely to expand. At the same time, ethical considerations surrounding intensive farming practices may also become more prominent. Novel technologies provide the opportunity to enhance both the productivity and welfare of intensively kept animals. Developing countries are also establishing more intensive commercial systems to meet their growing need for animal protein. Intensive livestock production in such countries has the potential for major expansion, particularly if such developments address the key constraints of poor welfare, inadequate nutrition, poor reproduction, poor housing, and high mortality often seen with traditional systems, and if farmer access to emerging market opportunities is improved. However, as shown by previous experience, inadequate regulation and staff who lack the appropriate training to care for the welfare of intensively housed livestock can be major challenges to overcome.

  7. Difficult airway management from Emergency Department till Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Debasis Pradhan

    2015-01-01

    Full Text Available We report a case of "can ventilate but can′t intubate" situation which was successfully managed in the Emergency Department and Intensive Care Unit by the use of ProSeal laryngeal mask airway and Frova Intubating Introducer as bridging rescue devices. Use of appropriate technique while strictly following the difficult airway algorithm is the mainstay of airway management in unanticipated difficult airway situations. Although the multiple airway devices were used but each step took not more than 2 min and "don′t struggle, skip to the next step principle" was followed. With the availability of many advanced airway management tools, the intensivists should have a training and experience along with preparedness in order to perform such lifesaving airway managements.

  8. Management of Acute Myeloid Leukemia in the Intensive Care Setting.

    Science.gov (United States)

    Cowan, Andrew J; Altemeier, William A; Johnston, Christine; Gernsheimer, Terry; Becker, Pamela S

    2015-10-01

    Patients with acute myeloid leukemia (AML) who are newly diagnosed or relapsed and those who are receiving cytotoxic chemotherapy are predisposed to conditions such as sepsis due to bacterial and fungal infections, coagulopathies, hemorrhage, metabolic abnormalities, and respiratory and renal failure. These conditions are common reasons for patients with AML to be managed in the intensive care unit (ICU). For patients with AML in the ICU, providers need to be aware of common problems and how to manage them. Understanding the pathophysiology of complications and the recent advances in risk stratification as well as newer therapy for AML are relevant to the critical care provider. PMID:24756309

  9. Energy resource management for energy-intensive manufacturing industries

    Energy Technology Data Exchange (ETDEWEB)

    Brenner, C.W.; Levangie, J.

    1981-10-01

    A program to introduce energy resource management into an energy-intensive manufacturing industry is presented. The food industry (SIC No. 20) was chosen and 20 companies were selected for interviews, but thirteen were actually visited. The methodology for this program is detailed. Reasons for choosing the food industry are described. The substance of the information gained and the principal conclusions drawn from the interviews are given. Results of the model Energy Resource Management Plan applied to three companies are compiled at length. Strategies for dissemination of the information gained are described. (MCW)

  10. Enhancing the Biodiversity of Ditches in Intensively Managed UK Farmland.

    Science.gov (United States)

    Shaw, Rosalind F; Johnson, Paul J; Macdonald, David W; Feber, Ruth E

    2015-01-01

    Drainage ditches, either seasonally flooded or permanent, are commonly found on intensively managed lowland farmland in the UK. They are potentially important for wetland biodiversity but, despite their ubiquity, information on their biodiversity and management in the wider countryside is scarce. We surveyed 175 ditches for their physical and chemical characteristics, spatial connectivity, plant communities and aquatic invertebrates in an area of intensively managed farmland in Oxfordshire, UK and collected information on ditch management from farmer interviews. Water depth and shade had a small impact on the diversity of plant and invertebrate communities in ditches. Increased shade over the ditch channel resulted in reduced taxonomic richness of both channel vegetation and aquatic invertebrates and channel vegetation cover was lower at shaded sites. Invertebrate taxonomic richness was higher when water was deeper. Spatial connectivity had no detectable impact on the aquatic invertebrate or plant communities found in ditches. The number of families within the orders Ephemeroptera, Plecoptera and Trichoptera (EPT), which contain many pollution-sensitive species, declined with decreasing pH of ditch water. As time since dredging increased, the number of EPT families increased in permanent ditches but decreased in temporary ditches. Whether or not a ditch was in an agri-environment scheme had little impact on the reported management regime or biodiversity value of the ditch. Measures for increasing the amount of water in ditches, by increasing the water depth or promoting retention of water in ditches, could increase the biodiversity value of ditches in agricultural land. Some temporary ditches for specialised species should be retained. Reducing the amount of shade over narrow ditches by managing adjacent hedgerows is also likely to increase the species diversity of plant and invertebrate communities within the ditch. We recommend that to preserve or enhance the

  11. Environmental management in North American mining sector.

    Science.gov (United States)

    Asif, Zunaira; Chen, Zhi

    2016-01-01

    This paper reviews the environmental issues and management practices in the mining sector in the North America. The sustainable measures on waste management are recognized as one of the most serious environmental concerns in the mining industry. For mining activities, it will be no surprise that the metal recovery reagents and acid effluents are a threat to the ecosystem as well as hazards to human health. In addition, poor air quality and ventilation in underground mines can lead to occupational illness and death of workers. Electricity usage and fuel consumption are major factors that contribute to greenhouse gases. On the other hand, many sustainability challenges are faced in the management of tailings and disposal of waste rock. This paper aims to highlight the problems that arise due to poor air quality and acid mine drainage. The paper also addresses some of the advantages and limitations of tailing and waste rock management that still have to be studied in context of the mining sector. This paper suggests that implementation of suitable environmental management tools like life cycle assessment (LCA), cleaner production technologies (CPTs), and multicriteria decision analysis (MCD) are important as it ultimately lead to improve environmental performance and enabling a mine to focus on the next stage of sustainability. PMID:26527335

  12. Gender and Homework Management Reported by African American Students

    Science.gov (United States)

    Xu, Jianzhong

    2010-01-01

    The present study linked gender and grade level to homework management strategies and homework completion behaviours. The participants were 685 African American students in the south-eastern USA, including 370 eighth graders and 315 eleventh graders. Gender appeared related to the majority of homework measures examined in the present study.…

  13. Guidelines for a Business Management Training Program for Native Americans.

    Science.gov (United States)

    Patton, C. Duane; Hollow, Anton

    The culmination of a 1975-76 Washington project aimed at providing American Indians with a model business management training program (post secondary level), this report includes: (1) an overview of the project's purpose/approach (development of a training program to provide interface between the socioeconomic phenomena of the Indian Community and…

  14. Strategic Management of Quality: An American and British Perspective.

    Science.gov (United States)

    Weller, L. David; McElwee, Gerard

    1997-01-01

    Total Quality Management is being implemented in American and British schools to improve educational outcomes. The 14 points of Deming's quality model and Porter's models of competition and drivers of cost provide a systematic, structured template to promote educational excellence and meet the demands of social, political, and economic forces.…

  15. Comparison of intensive case management for psychotic and nonpsychotic patients.

    Science.gov (United States)

    Mohamed, Somaia

    2016-02-01

    While the original goal of intensive community-based service programs such as assertive community treatment (ACT) was reduction of hospital use, this goal has diminished in importance because of the extensive reduction in inpatient bed availability and use. This study sought to identify target populations that benefit most from such programs, hypothesizing that those with psychotic symptoms would show more benefits than others because of improved medication compliance. Administrative outcome data from the Department of Veterans Affairs Mental Health Intensive Case Management program from 2008-2011 were compared among 3 groups: (a) veterans clinically diagnosed with a psychotic disorder who also exhibited at least moderately severe psychotic symptoms (N = 2,502); (b) veterans with a psychotic disorder who did not exhibit such symptoms (N = 2,338); and (c) veterans with no psychotic diagnoses (N = 820). Baseline characteristics were compared to identify potentially confounding differences between the groups. Analysis of covariance (ANCOVA) was used to compare changes in symptoms, substance use, and community functioning 6 months after entry. Two significant differences were observed between the 3 groups after controlling for baseline measures, but not in the hypothesized direction, thus failing to confirm our hypothesis. Although we did not find evidence that patients with psychotic symptoms benefit any more from intensive community-based care than other participants, this study highlights a need to clarify the role of intensive case management (ICM) services in a context in which minimizing inpatient care plays is a less central objective, and tends to encourage offering ACT to selected patients with nonpsychotic disorders. PMID:26168139

  16. Response of antibiotics and resistance genes to high-intensity and low-intensity manure management.

    Science.gov (United States)

    Storteboom, Heather N; Kim, Sung-Chul; Doesken, Kathy C; Carlson, Kenneth H; Davis, Jessica G; Pruden, Amy

    2007-01-01

    The purpose of this study was to determine the response of antibiotics and antibiotic resistance genes (ARG) to manure management. A pilot field study was conducted using horse manure containing no antibiotics, into which chlortetracycline (CTC), tylosin (TYL), and monensin (MON) were spiked and compared to unspiked controls. Subsequently, a large-scale field study was conducted comparing manure from a dairy with minimal use of antibiotics and a feedlot with regular subtherapeutic use of antibiotics. The manures were subjected to high-intensity management (HIM) (amending, watering, and turning) and low-intensity management (LIM) (no amending, watering, or turning) and were monitored for antibiotic concentrations and levels of tetracycline ARG [tet(W) and tet(O)] using quantitative real-time polymerase chain reaction. All three antibiotics in the pilot study dissipated more rapidly in HIM manure, with half-lives ranging from 4 to 15 d, compared to LIM manure, with half-lives ranging from 8 to 30 d. Levels of tet(W) were significantly higher after 141 d of treatment, but levels of tet(O) were significantly lower in all treatments. In the large-scale study, the feedlot manure had higher initial concentrations than the dairy manure of tetracycline (TC), oxytetracycline (OTC), and CTC as well as tet(W) and tet(O). Tetracycline and OTC dissipated more rapidly in HIM manure, with half-lives ranging from 6 to 15 d, compared to LIM manure, with half-lives ranging from 7 to 31 d. After 6 mo of treatment, tet(W) and tet(O) decreased significantly in feedlot manure, whereas dairy manure required only 4 mo of treatment for similar results.

  17. Crop manuring and intensive land management by Europe's first farmers.

    Science.gov (United States)

    Bogaard, Amy; Fraser, Rebecca; Heaton, Tim H E; Wallace, Michael; Vaiglova, Petra; Charles, Michael; Jones, Glynis; Evershed, Richard P; Styring, Amy K; Andersen, Niels H; Arbogast, Rose-Marie; Bartosiewicz, László; Gardeisen, Armelle; Kanstrup, Marie; Maier, Ursula; Marinova, Elena; Ninov, Lazar; Schäfer, Marguerita; Stephan, Elisabeth

    2013-07-30

    The spread of farming from western Asia to Europe had profound long-term social and ecological impacts, but identification of the specific nature of Neolithic land management practices and the dietary contribution of early crops has been problematic. Here, we present previously undescribed stable isotope determinations of charred cereals and pulses from 13 Neolithic sites across Europe (dating ca. 5900-2400 cal B.C.), which show that early farmers used livestock manure and water management to enhance crop yields. Intensive manuring inextricably linked plant cultivation and animal herding and contributed to the remarkable resilience of these combined practices across diverse climatic zones. Critically, our findings suggest that commonly applied paleodietary interpretations of human and herbivore δ(15)N values have systematically underestimated the contribution of crop-derived protein to early farmer diets.

  18. The agrodiversity experiment : three years of data from a multisite study in intensively managed grasslands

    NARCIS (Netherlands)

    Kirwan, L.; Connolly, J.; Brophy, C.; Elgersma, A.

    2014-01-01

    Intensively managed grasslands are globally prominent ecosystems. We investigated whether experimental increases in plant diversity in intensively managed grassland communities can increase their resource use efficiency. This work consisted of a coordinated, continental-scale 33-site experiment. The

  19. Cluster based parallel database management system for data intensive computing

    Institute of Scientific and Technical Information of China (English)

    Jianzhong LI; Wei ZHANG

    2009-01-01

    This paper describes a computer-cluster based parallel database management system (DBMS), InfiniteDB, developed by the authors. InfiniteDB aims at efficiently sup-port data intensive computing in response to the rapid grow-ing in database size and the need of high performance ana-lyzing of massive databases. It can be efficiently executed in the computing system composed by thousands of computers such as cloud computing system. It supports the parallelisms of intra-query, inter-query, intra-operation, inter-operation and pipelining. It provides effective strategies for managing massive databases including the multiple data declustering methods, the declustering-aware algorithms for relational operations and other database operations, and the adaptive query optimization method. It also provides the functions of parallel data warehousing and data mining, the coordinator-wrapper mechanism to support the integration of heteroge-neous information resources on the Internet, and the fault tol-erant and resilient infrastructures. It has been used in many applications and has proved quite effective for data intensive computing.

  20. Additives in ensiling palisade grass managed under grazing intensities

    Directory of Open Access Journals (Sweden)

    Felipe Barros Macedo

    2015-10-01

    Full Text Available Conservation of summer forage excess represents a management strategy to meet animals' needs for dry matter in the shortage period, but has been poorly studied. Silage can be used for this purpose. This study analyzed the production of palisade grass silage from pasture subjected to different grazing intensities with and without additive, determining losses by gases and effluents and chemical composition of silage. The experiment was a 4 x 3 factorial completely randomized design, with four replications. The factors were: 1st – herbage allowance of 5% (5 kg dry matter 100 kg-1 of animal weight day-1, 10, 15 and 20%. The pasture was managed under rotational stocking with 35-day grazing cycles (7 days of occupation and 28 days of rest and 2nd - additives: a control; b citrus pulp pellets; c biological inoculant for grass silage. The forage of palisade grass harvested from pastures subjected to low-intensity grazing showed quantitative and qualitative characteristics for ensiling. However, high humidity and low fermentable carbohydrate require the use of additive, favor the fermentation process and increase the nutritional quality of silage.

  1. EFFECTS OF HIGH AND LOW MANAGEMENT INTENSITY ON PROFITABILITY FOR THREE WATERMELON GENOTYPES

    OpenAIRE

    Taylor, Merritt J.; Lu, Wenhua; Duthie, James A; Roberts, B. Warren; Edelson, Jonathan V.

    2003-01-01

    A replicated, small plot study on watermelon [Citrullus lanatus (Thunberg) Matsumura and Nakai] in 1997, 1999, and 2000 revealed that production management intensity affected yields and profitability of watermelon, in Oklahoma. Management intensity was based on a combination of cultural practices and levels of use of production methods. Low intensity management (LM) consisted of use of soil fertilization and weed control. High intensity management (HM) included the same weed control and ferti...

  2. IML-CZO: Critical Zone Observatory for Intensively Managed Landscapes

    Science.gov (United States)

    Kumar, Praveen; Papanicolaou, Thanos

    2014-05-01

    Intensively managed landscapes, regions of significant land use change, serve as a cradle for economic prosperity. However, the intensity of change is responsible for unintended deterioration of our land and water environments. By understanding present day dynamics in the context of long-term co-evolution of the Critical Zone comprising of the landscape, soil and biota, IML-CZO aims to support the assessment of short- and long-term resilience of the crucial ecological, hydrological and climatic services provided by the Critical Zone. An observational network of three sites in Illinois, Iowa, and Minnesota that capture the geological diversity of the low relief, glaciated, and tile-drained landscape will drive novel scientific and technological advances. IML-CZO will provide leadership in developing the next generation of scientists and practitioners, and informing management strategies aimed at reducing the vulnerability of the system to present and emerging trends in human activities. IML-CZO, one of the nine observatories funded by the United States National Science Foundation (NSF), consists of two core sites: the 3,690- sq. km. Upper Sangamon River Basin in Illinois and 270-sq. km. Clear Creek Watershed in Iowa, along with the 44,000- sq. km. Minnesota River Basin as third participating site. These sites together are characterized by low-relief landscapes with poorly drained soils and represent a broad range of physiographic variations found throughout the glaciated Midwest, and thereby provide an opportunity to advance understanding of the CZO in this important region. Through novel measurements, analysis and modeling, IML-CZO aims to address the following questions: • How do different time scales of geologic evolution and anthropogenic influence interact to determine the trajectory of CZ structure and function? • How is the co-evolution of biota, consisting of both vegetation and microbes, and soil affected due to intensive management? • How have

  3. Data-intensive management and analysis for scientifc simulations.

    Energy Technology Data Exchange (ETDEWEB)

    Hudson, R.; Norris, J.; Reid, L. B.; Cal Jordan IV, G.; Weide, K.; Papka, M. E. (CLS-CI); ( MCS); (Western Australian Geothemal Centre of Excellence, CSIRO); (School of Environmental Systems Engineering, University of Western Australia)

    2011-01-01

    Scientific simulations can produce enormous amounts of data, making the analysis of results and management of files a difficult task for scientists. The simulation management and analysis system (Smaash) described here is designed to allow scientists to easily capture, store, organize, monitor, and analyze simulation results. The system is automatic, standardized, and secure. Smaash was built using open-source tools and modularized to be independent of the scientific simulation. The web-based front-end allows the scientist to easily interact with the data, and has proved its usefulness in improving the efficiency of a scientific team's workflow. High performance parallel computing allows scientists to solve complex physical problems through computer simulation. However, the massive amounts of data generated and the complex computing environment can create additional complications. A recent review by Ludaescher et al.(2009) describes how scientific workflows can assist scientists in extracting knowledge from these data-intensive operations by automating components within pipelines. Within the fusion community, Klasky et al.(2008) and colleagues have developed a system that handles the storage management, data movement, metadata generation and management, and a means to analyze the results. In response to scientists needs, a simulation management and analysis system (Smaash) was developed at the University of Chicago and Argonne National Laboratory (USA). Smaash provides an integrated way to monitor simulations and analyze computational results; catalog, store, and retrieve simulations; and prepare output for publications. The system is independent of the particular simulation code, accessible from many HPC and browser-based platforms, and built around open-source software tools. Data security and provenance is considered throughout. The analysis components are hidden behind a web-based front end, enabling scientists to focus on their results and not get bogged

  4. Enrichment Ratio and Aggregate Stability Dynamics in Intensely Managed Landscapes

    Science.gov (United States)

    Wacha, K.; Papanicolaou, T.; Filley, T. R.; Hou, T.; Abban, B. K.; Wilson, C. G.; Boys, J.

    2015-12-01

    Challenges in understanding the soil carbon dynamics within intensely managed landscapes (IMLs), found throughout much the US Midwest, is highly complex due to the presence of heterogeneous landscape features and properties, as well as a mosaic of physical and biogeochemical processes occurring at different time scales. In addition, rainfall events exacerbate the effects of tillage by the impact of raindrops, which break down aggregates that encase carbon and dislodge and entrain soil particles and aggregates along the downslope. The redistribution of soil and carbon can have huge implications on biogeochemical cycling and overall carbon budgeting. In this study, we provide some rare field data on the mechanisms impacting aggregate stability, enrichment ratio values to estimate fluxes of carbon, as well as lignin chemistry to see influences on oxidation/mineralization rates. Rainfall simulation experiments were conducted within agricultural fields. Experiments were performed on the midslope (eroding) and toeslope (depositional) sections of representative hillslopes, under a variety of land managements, including row crop (conventional and conservation) and restored grasslands. Sensors were utilized to capture the evolution of soil moisture, temperature, microbial respiration pulses, and discharge rates to identify pseudo-steady state conditions. Samples collected at the weir outlet were tested for sediment concentrations and size fractions, as well as carbon and lignin fluxes. Preliminary findings show that conservation management practices have higher aggregate stability and decreased mass fluxes of carbon in the downslope than conventional tillage techniques.

  5. Performance Management in Self-Managing Teams : A case study of a knowledge-intensive company

    OpenAIRE

    Eriksson, Emelie; Öjersson, Emelie

    2012-01-01

    For many companies, especially the ones that are knowledge-intensive such as consulting companies or service delivery firms, it has been increasingly popular to organize the employees in so called self-managing teams. These teams have proven to increase efficiency as they reduce overhead costs by not having the need of being supervised by a manager. These teams should handle the daily work tasks by themselves as well as make decisions, handle the teams’ development in line with company desire...

  6. Managed care and its impact on American urology.

    Science.gov (United States)

    Holtgrewe, H L

    1998-05-01

    America's health care is undergoing a revolution. A previous private, fee-for-service, delivery system chiefly centered around hospital specialty care is rapidly being replaced by a commercialized system of managed care, controlled by businessmen whose prime motive is profit. Increasing emphasis of these managed care organizations is upon primary physicians who function as gatekeepers. While this new commercialized method of health care has been attended with reductions in the previous omnipresent health care inflation our country has experienced for the past several decades, its impact on quality of care and patient choice of physician remain a great concern. Especially vulnerable in this new system are our nation's academic centers, which, burdened with responsibility for education and research, are at a disadvantage in the competitive cost-based bidding for managed care contracts. Urology work force issues and the number of urologists in our nation remain another concern for urologists as they compete for access to patients in this new highly competitive environment. In a 1995 survey of a cohort of urologists in seven states, the respondents reported 35.8% of gross income came from managed care contracts, 86% reported the need for preservice approval for many diagnostic and therapeutic undertakings, 87% reported an inability to refer complex cases outside the Managed Care Organization (MCO) network, and 23% reported they were required to retain patients for treatment who they would have otherwise referred to a more qualified urologist. The majority of American urologists are reporting dropping gross revenues and increasing overhead in their dealings with managed care contracts. The advent of managed care is being attended with dropping gross revenues, increasing overhead costs and interference with the practice patterns of American urologists.

  7. More cultivation with lower intensity in the South American Chaco: A double hydrological challenge

    Science.gov (United States)

    Jobbagy, E. G.; Gimenez, R.; Mercau, J. L.; Houspanossian, J.; Baldi, G.; Kuppel, S.

    2014-12-01

    As in other semi-arid plains of the world, long-scale deforestation to establish croplands in the South American Chaco may disrupt the regional water balance. As annual crops use less water than the native perennial system, water in excess usually translates into serious degradation processes such as run-off driven erosion, or the onset of groundwater recharge which can develop flooding and dryland salinization. Agriculturally, water excess could be reduced by using more intensive crop systems which consume water exhaustively. We used MODIS imagery (2000-present) from Bandera, Argentina (28.8S 62.2W), a major agricultural cluster in the region, to assess deforestation, to identify the main crop systems, and to analyze the impact of crop expansion and phenological shifts on the regional water balance. Three cover classes (Dry Forest DF, Agriculture AG, and Pastures PA) and five AG crop types were distinguished (winter W, spring Sp,summer S, and late-summer LS single crops, winter/summer DCWS and spring/summer DCSpS double crops). Each season, water use (annual evapotranspiration, ET) for each cover/crop type (10 pixels/class) was computed with a daily water balance based on meteorological data and 2 remote sensing-derived indices: Normalized Difference Vegetation Index, to capture canopy conditions, and Dead Fuel Index to represent mulch cover conditions. Throughout 14 crop seasons AG expanded from 20 to 50% of the study area (1M ha) mostly replacing DF. Also, AG gradually evolved from a more intensive and diversified pattern dominated by DC (45-50%), S (28%) and Sp (16%) systems, to a more water-conservative system dominated by LS (60-80% in the last 3 seasons). Crop type differences in ET (DCWS≈DCSpS≈FG>S>Sp>LS≈W) were stronger in wet years (>1000mm) but nil in dry ones (crop types in the driest year to >250mm for the less intensive W and LS in wet years. Weighting each cover/crop class by their area, we found that the current expansion and reduced intensity

  8. New cholesterol guidelines for the management of atherosclerotic cardiovascular disease risk: a comparison of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines with the 2014 National Lipid Association recommendations for patient-centered management of dyslipidemia.

    Science.gov (United States)

    Adhyaru, Bhavin B; Jacobson, Terry A

    2015-05-01

    This review discusses the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults and compares it with the 2014 National Lipid Association (NLA) Recommendations for Patient-Centered Management of Dyslipidemia. The review discusses some of the distinctions between the guidelines, including how to determine a patient's atherosclerotic cardiovascular disease risk, the role of lipoprotein treatment targets, the importance of moderate- and high-intensity statin therapy, and the use of nonstatin therapy in light of the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) trial.

  9. Amplification and Damping of Environmental Signals in Intensively Managed Landscapes

    Science.gov (United States)

    Belmont, P.; Kumarasamy, K.; Kelly, S. A.; Vaughan, A. A.; Call, B.

    2015-12-01

    Landscapes transmit pulses of water, sediment and solutes through the terrestrial environment and network of stream channels. The timing, frequency and magnitude of these pulses depend on inputs of water, energy and rock/soil as well as a multitude of critical zone processes that may modulate the signal. Therefore, the potential for a landscape to generate and transmit these pulses changes over long timescales, primarily as a function of climate and local base level rise or fall. Humans have profoundly altered many critical zone processes that govern these environmental signals, often targeting rate-limiting processes for the purpose of enhancing economic productivity and/or reducing financial risk. These alterations are especially evident in the intensively managed landscapes of the Midwestern US, where vegetation change, soil tillage, and pervasive modifications of the surface and subsurface drainage system have substantially changed water, sediment and nutrient fluxes. Effects, in terms of amplification or damping of environmental signals, are strongly dependent on landscape setting, and often non-linear. Hysteresis and sensitivity may hinder the return to the initial state when perturbations have reached a certain threshold. We draw from multiple examples in the upper Midwestern US to illustrate, at a basic level, the mechanisms by which landscape evolution establishes the template for generation and transmission of environmental signals and furthermore how humans have altered critical zone processes to optimize specific landscape outputs, often at the expense of modifying the rate and/or magnitude of many other landscape outputs. We present a conceptual model and discuss implications for mathematical modeling of water, sediment and nutrient fluxes to guide watershed management and restoration.

  10. The residence time of intensively managed agricultural landscapes

    Science.gov (United States)

    Bowling, Laura; Cherkauer, Keith; Chiu, Chun-mei; Rahman, Sanoar

    2015-04-01

    Much of the agricultural landscape across the Midwestern United States is intensively managed through numerous surface and subsurface drainage improvements, and the growing extraction of groundwater resources. The relatively recent glaciation of the North Central region means that the landscape is less dissected and hydrologically connected than older till areas. Low topographic gradients and underlying dense till which restricts vertical water movement, as well as kettle depressions, have led to poorly drained soils and extensive wetlands within the landscape. Large areas of this land could only be farmed once the excess water was removed through artificial surface and subsurface drainage. Conventional wisdom in the region maintains that subsurface tile drainage reduces the occurrence of peak flow events by increasing soil water storage capacity. At the watershed scale, this view does not take into account the coincident increase in surface drainage and reduction in residence time in surface depressions. This paper explores to what degree water management and irrigation has changed surface and subsurface water storage and residence time over the last century and how this has impacted flow duration throughout the Wabash River system in Indiana, USA. The effects of subsurface tile drains, wetlands and aquifer storage are explicitly represented within the Variable Infiltration Capacity (VIC) macroscale hydrology model. We maintain a focus on the entire Wabash River, a river system of historic importance that is also representative of many similar areas in the till plain region of the agricultural Midwest, which contribute to water quality and flood dynamics of the Mississippi river system. By lowering the water table, surface and subsurface drainage improvements have increased the subsurface storage capacity at the beginning of rain events, but this is overwhelmed by the decrease in surface storage capacity for intermediate to large events, decreasing the current

  11. Stormwater management the American way: why no policy transfer?

    Directory of Open Access Journals (Sweden)

    David P. Dolowitz

    2015-09-01

    Full Text Available From the 1940s until the 1980s the federal government gradually extended its authority over the structure of the American stormwater management system. The goal was to improve the water quality of the nation’s waterways by regulating the pollution loads entering the system, primarily through the use of gray infrastructure. However during the1980s the Environmental Protection Agency (EPA began to explore new approaches toward the regulation of stormwater pollution. Instead of focusing only on gray mechanisms, the EPA began developing and promoting the use of low impact development (LID techniques as an element municipal governments could use to achieve their total maxim daily load of pollutants allowable under the National Pollutant Discharge Elimination System permit system. In light of the incentive offered by the EPA for the use of LID in the management of stormwater, it should be expected to provide a perfect area to observe policy transfer between federal, state and local governments; but it does not. This article will establish why the EPA began promoting a green approach to stormwater management and why this has not led to a widespread transfer of best management practices in the ways the literatures associated with federalism and policy transfer would suggest.

  12. Maximizing Conservation and Production with Intensive Forest Management: It's All About Location

    Science.gov (United States)

    Tittler, Rebecca; Filotas, Élise; Kroese, Jasmin; Messier, Christian

    2015-11-01

    Functional zoning has been suggested as a way to balance the needs of a viable forest industry with those of healthy ecosystems. Under this system, part of the forest is set aside for protected areas, counterbalanced by intensive and extensive management of the rest of the forest. Studies indicate this may provide adequate timber while minimizing road construction and favoring the development of large mature and old stands. However, it is unclear how the spatial arrangement of intensive management areas may affect the success of this zoning. Should these areas be agglomerated or dispersed throughout the forest landscape? Should managers prioritize (a) proximity to existing roads, (b) distance from protected areas, or (c) site-specific productivity? We use a spatially explicit landscape simulation model to examine the effects of different spatial scenarios on landscape structure, connectivity for native forest wildlife, stand diversity, harvest volume, and road construction: (1) random placement of intensive management areas, and (2-8) all possible combinations of rules (a)-(c). Results favor the agglomeration of intensive management areas. For most wildlife species, connectivity was the highest when intensive management was far from the protected areas. This scenario also resulted in relatively high harvest volumes. Maximizing distance of intensive management areas from protected areas may therefore be the best way to maximize the benefits of intensive management areas while minimizing their potentially negative effects on forest structure and biodiversity.

  13. Conflict management styles of Asian and Asian American nurses: implications for the nurse manager.

    Science.gov (United States)

    Xu, Yu; Davidhizar, Ruth

    2004-01-01

    Foreign nurses and American nurses who are culturally diverse make up an increasing number of the US nursing workforce. Of foreign nurses, Asians constitute the largest number. Conflict is an inevitable aspect of human relations in health care settings. Nurses and other health team members with diverse cultural background bring to the workplace different conflict behaviors that directly impact the outcomes of conflicts. It is essential for health care team members and managers to be cognizant of different conflict behaviors as well as different conflict management styles so that strategies can be designed to build a culturally diverse health care team that is able to effectively achieve group and organizational objectives. PMID:15035348

  14. Reading and analysis on management guidelines for hyperthyroidism published in 2011 by American Thyroid Association and American Association of Clinical Endocrinologists

    International Nuclear Information System (INIS)

    Recently, the American Thyroid Association and American Association of Clinical Endocrinologists published 'Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists', and created 100 evidence-based recommendations. The guideline systematically introduced the diagnoses and therapies of hyperthyroidism, emphasizing the indications, contraindications, preparations, methodologies and follow-up strategies. The guideline also provided detailed management principles for hyperthyroidism in children and pregnancy, Graves' ophthalmopathy and some unusual causes of hyperthyroidism. (authors)

  15. Importance of recognizing and managing delirium in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    XIE Guo-hao; FANG Xiang-ming

    2009-01-01

    @@ Delirium is an acute and fluctuating change in mental status, with inattention and altered levels of consciousness. It is a common comorbidity in intensive care units (ICU), resulting in delayed withdrawal of mechanical ventilation, prolonged length of stay in ICU, increased ICU mortality and impaired long-term cognitive function of the survivors.

  16. Hydrologic and Water Quality Assessment from an Intensively Managed Watershed Scale Turfgrass System

    Science.gov (United States)

    Managed turf accounts for approximately 17 million hectares of land in the U.S. and is the most intensively managed system in the urban landscape. The primary objective of this research effort was to assess the watershed scale hydrologic and surface water quality impact from a well managed golf cour...

  17. Utilization and environmental management of residues from intensive animal production

    Science.gov (United States)

    Animal manures are traditional sources of nutrients in agriculture. Under proper management, manures provide nutrients to soil, reducing or eliminating the use of commercial fertilizers, as well as organic carbon that improves soil physical properties and soil health. However, excessive application ...

  18. Simulation of the Effect of Intensive Forest Management on Forest Production in Sweden

    OpenAIRE

    Ola Rosvall; Anders Lundström; Ulf Johansson; Nils Fahlvik; Urban Nilsson

    2011-01-01

    The effects of intensifying the management of 15% of the Swedish forest land on potential future forest production over a 100-year period were investigated in a simulation study. The intensive management treatments, which were introduced over a period of 50 years, were: intensive fertilization of Norway spruce (IntFert); bulking-up Norway spruce elite populations using somatic embryogenesis (SE-seedlings); planting of lodgepole pine, hybrid larch, and Sitka spruce (Contorta, Larch, and Sitka)...

  19. Surgical Management of Severe Colitis in the Intensive Care Unit.

    Science.gov (United States)

    Halaweish, Ihab; Alam, Hasan B

    2015-12-01

    Severe colitis, an umbrella encompassing several entities, is one of the most common acute gastrointestinal disorders resulting in critical illness. Clostridium difficile infection is responsible for the majority of nosocomial diarrhea with fulminant C difficile colitis (CDC) carrying a high mortality. Optimal outcomes can be achieved by early identification and treatment of fulminant CDC, with appropriate surgical intervention when indicated. Ischemic colitis, on the other hand, is uncommon with a range of etiological factors including abdominal aortic surgery, inotropic drugs, rheumatoid diseases, or often no obvious triggering factor. Most cases resolve with nonsurgical management; however, prompt recognition of full-thickness necrosis and gangrene is crucial for good patient outcomes. Fulminant colitis is a severe disease secondary to progressive ulcerative colitis with systemic deterioration. Surgical intervention is indicated for hemorrhage, perforation, or peritonitis and failure of medical therapy to control the disease. Although, failure of medical management is the most common indication, it can be difficult to define objectively and requires a collaborative multidisciplinary approach. This article proposes some simple management algorithms for these clinical entities, with a focus on critically ill patients.

  20. Current Soil Nutrient Status of Intensively Managed Greenhouses

    Institute of Scientific and Technical Information of China (English)

    HU Yun-Cai; SONG Zhi-Wen; LU Wen-Long; C.POSCHENRIEDER; U.SCHMIDHALTER

    2012-01-01

    Nine districts covering the main greenhouse vegetable areas in Tianjin Municipality of the North China Plain were selected for the soil investigation in 2010 to survey the current soil nutrient status (soil available N,P and K),acidification and salinization due to excessive input of fertilizers in greenhouses in Tianjin. The study showed that,in particular,soil available P content increased with the age of greenhouses.In contrast,our results did not reveal higher K accumulation and lowered pH in the greenhouse soils compared with cultivation in open fields.Over-fertilization,causing high NO3- accumulation,most likely resulted in salinity problems in the greenhouses.Ninety percent of the investigated greenhouse soils had electrical conductivity values of saturated paste extracts of 2-10 d S m-1,which might affect the yields of vegetable crops like green bean,pepper,cabbage,carrot,eggplant,lettuce,spinach,celery,cucumber and tomato. The findings of our survey of the current fertility and salinity problems in greenhouse soils suggest that there is an urgent need to improve the farmers' practices and strategies in fertilization management in greenhouses of China.Because education and the agricultural technical extension services may play a more important role in avoiding overuse of fertilizers,we suggest that current nutrient management practices should be improved in the near future through training of local farmers in farmers' schools and through strengthening the agricultural extension services with practical techniques.

  1. Root Zone Sensors for Irrigation Management in Intensive Agriculture

    Directory of Open Access Journals (Sweden)

    Jochen Hemming

    2009-04-01

    Full Text Available Crop irrigation uses more than 70% of the world’s water, and thus, improving irrigation efficiency is decisive to sustain the food demand from a fast-growing world population. This objective may be accomplished by cultivating more water-efficient crop species and/or through the application of efficient irrigation systems, which includes the implementation of a suitable method for precise scheduling. At the farm level, irrigation is generally scheduled based on the grower’s experience or on the determination of soil water balance (weather-based method. An alternative approach entails the measurement of soil water status. Expensive and sophisticated root zone sensors (RZS, such as neutron probes, are available for the use of soil and plant scientists, while cheap and practical devices are needed for irrigation management in commercial crops. The paper illustrates the main features of RZS’ (for both soil moisture and salinity marketed for the irrigation industry and discusses how such sensors may be integrated in a wireless network for computer-controlled irrigation and used for innovative irrigation strategies, such as deficit or dual-water irrigation. The paper also consider the main results of recent or current research works conducted by the authors in Tuscany (Italy on the irrigation management of container-grown ornamental plants, which is an important agricultural sector in Italy.

  2. Carbon dynamics of intensively managed forest along a full rotation

    Science.gov (United States)

    Moreaux, V.; Bosc, A.; Bonnefond, J.; Burlett, R.; Lamaud, E.; Sartore, M.; Trichet, P.; Chipeaux, C.; Lambrot, C.; Kowalski, A. S.; Loustau, D.

    2012-12-01

    Temperate and tropical forests are increasingly exploited for wood and biomass extraction and only one third of forest area was considered as primary in the recent FRA in 2010. Management practices affect the soil-forest-atmosphere continuum through various effects on soil and surface properties. They result ultimately in either positive or negative changes in the biomass and soil carbon pools but, if any, few datasets or modeling tools are available for quantifying their impacts on the net carbon balance of forest stands. To analyse these effects, the net half-hourly fluxes of CO2, water vapour and heat exchanges were monitored for 23 years in two closed stands of maritime pines in southwestern France. Carbon content of the aboveground biomass was measured annually and soil pools 10-early in the younger stand and 5-yearly in the mature stand. For analysing the data collected and disentangling the climate and management effects, we used the three components process-based model GRAECO+ (Loustau et al. this session) linking a 3D radiative transfer and photosynthesis model, MAESTRA, a soil carbon model adapted from ROTH-C and a plant growth model. Eddy flux data were processed, gapfilled and partitioned using the methodological recommendations (Aubinet et al. 2000, Adv. Eco. Res:30, 114-173, Falge et al. 2001, Agr. For. Meteo. : 107, 43-69, Reichstein et al. 2005, Glob. Change Biol., 11:1424-1439). Analysis of the sequence showed that, whether by an increased sensitivity to soil drought compared to the pines or by a rapid re-colonization of the inter-row after understorey removal and plowing, the weeded vegetation contributed to create specific intra-annual dynamics of the fluxes and therefore, controls the dynamics of carbon balance of the stand. After three growing seasons, the stand was already a carbon sink, but the impact of thinning and weeded vegetation removal at the age of 5-year brought the balance to almost neutral. We interpret this change as the combined

  3. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015 – short version

    Directory of Open Access Journals (Sweden)

    DAS-Taskforce 2015

    2015-11-01

    Full Text Available In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine, twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM in conjunction with Society of Critical Care Medicine (SCCM and American Society of Health-System Pharmacists (ASHP from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade “A” (strong recommendation, Grade “B” (recommendation and Grade “0” (open recommendation. The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine.

  4. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) – short version

    Science.gov (United States)

    Baron, Ralf; Binder, Andreas; Biniek, Rolf; Braune, Stephan; Buerkle, Hartmut; Dall, Peter; Demirakca, Sueha; Eckardt, Rahel; Eggers, Verena; Eichler, Ingolf; Fietze, Ingo; Freys, Stephan; Fründ, Andreas; Garten, Lars; Gohrbandt, Bernhard; Harth, Irene; Hartl, Wolfgang; Heppner, Hans-Jürgen; Horter, Johannes; Huth, Ralf; Janssens, Uwe; Jungk, Christine; Kaeuper, Kristin Maria; Kessler, Paul; Kleinschmidt, Stefan; Kochanek, Matthias; Kumpf, Matthias; Meiser, Andreas; Mueller, Anika; Orth, Maritta; Putensen, Christian; Roth, Bernd; Schaefer, Michael; Schaefers, Rainhild; Schellongowski, Peter; Schindler, Monika; Schmitt, Reinhard; Scholz, Jens; Schroeder, Stefan; Schwarzmann, Gerhard; Spies, Claudia; Stingele, Robert; Tonner, Peter; Trieschmann, Uwe; Tryba, Michael; Wappler, Frank; Waydhas, Christian; Weiss, Bjoern; Weisshaar, Guido

    2015-01-01

    In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM) in conjunction with Society of Critical Care Medicine (SCCM) and American Society of Health-System Pharmacists (ASHP) from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade “A” (strong recommendation), Grade “B” (recommendation) and Grade “0” (open recommendation). The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine. PMID:26609286

  5. Bridging the Gap: An Exploration of American and Norwegian communication and management patterns in the workplace

    OpenAIRE

    Kokonaski, Natassja

    2015-01-01

    The purpose of this study is to explore the nuances of Norwegian-American manager-employee relationships, particularly as they relate to the influence of cultural background upon workplace environment, management tactics, and communication efforts in each group. As globalization continues to be a driving force in the international market, American and Norwegian professionals are becoming increasingly interconnected. While these cultures may seem similar at a glance, subtle differences exis...

  6. RISK MANAGEMENT AND THE ENVIRONMENT: IMPACTS AT THE INTENSIVE AND EXTENSIVE MARGINS

    OpenAIRE

    Soule, Meredith J.; Nimon, R. Wesley; Mullarkey, Daniel J.

    2001-01-01

    Risk management programs, such as subsidized crop insurance, affect production decisions at both the intensive (input use) and extensive(land use) margins. The production decisions in turn affect the environment. This paper reviews and synthesizes the literature linking risk management policies and environmental outcomes and points to future research needs.

  7. Progress and Outcomes for Children with Autism Receiving Parent-Managed Intensive Interventions.

    Science.gov (United States)

    Eikeseth, Svein; Martin, Neil T.; Mudford, Oliver C.; Reeves, David

    2001-01-01

    Data were analyzed from 66 young children with autism served by 25 different early intervention consultants and receiving parent-managed interventions. Parent-managed intensive interventions resulted in progress for 60 children for mental age, adaptive behavior, and language skills. Interventions did not reproduce results from clinic-based…

  8. Marx’s Agricultural Intensive Management Thought and Its Guiding Significance

    Institute of Scientific and Technical Information of China (English)

    2012-01-01

    Through analyzing Marx’s agricultural intensive management thought,this paper points out that the existence and development of agricultural management mode experience historical course and the development of agricultural intensification depends on many objective conditions.On the basis of this,it discusses the guiding significance of Marx’s agricultural intensive management thought to China’s agricultural development.It is required to fully realize basic current situations of China’s agriculture,widely popularize agricultural mechanization and electrification,speed up artificial transformation of soil structure,promote chemical application of agriculture,make rational use of water resource,and spread improved seeds.

  9. Regional anesthesia for management of acute pain in the intensive care unit

    OpenAIRE

    Pinto, Mario; Dagal, Armagan; O’Donnell, Brendan; Stogicza, Agnes; Chiu, Sheila; Edwards, William Thomas

    2015-01-01

    Pain is a major problem for Intensive Care Unit (ICU) patients. Despite numerous improvements it is estimated that as many as 70% of the patients experience moderate-to-severe postoperative pain during their stay in the ICU. Effective pain management means not only decreasing pain intensity, but also reducing the opioids’ side effects. Minimizing nausea, vomiting, urinary retention, and sedation may indeed facilitate patient recovery and it is likely to shorten the ICU and hospital stay. Adeq...

  10. (Dis) connections between management and care in a surgical intensive care unit

    OpenAIRE

    Borges, Maria Cristina Leite Araujo; Silva, Lucilane Maria Sales da

    2013-01-01

    Objective: The objective was to understand the perception of the nursing team on the (dis)connections between management actions and care performed by nurses in a surgical intensive care unit. Method: Exploratory research with qualitative approach carried out in a surgical intensive care unit of a hospital in the public net of Fortaleza-CE, Brazil. Data was collected between March and July 2011, through semi-structured interviews and systematic observations, with 20 nursing ...

  11. Towards a physiological basis for intensive culture of American sycamore, Platanus occidentalis L

    International Nuclear Information System (INIS)

    The light environment of forest canopies is complex leading to differentiation in morphological development and alteration of physiological processes that are important for the proper combination of genotype and site factors to maximize final yield. To select leaves and plants of a uniform age plastochron and leaf plastochron indices were developed for American sycamore Platanus occidentalis L. The application of these indices was useful in selecting a population of plants of uniform age and, morphological development, and useful in selecting leaves of uniform age within the zone of leaf development. Labeling studies in which leaves of specific ages were fed 14CO2 indicated that leaves of this species undergo transitions in degree and direction of export. Acropetal export of photosynthates conforms to a phyllotactic sequence, suggesting a relationship between arrangement of vascular bundles and phyllotaxy. Examination of the 14CO2 labeling patterns in source leaves (LPI 2.0) showed rapid incorporation of label into amino acid, sugar, and organic acid chemical pools that can be used to in situ synthesis of proteins, lipids, and other structural components. However as the irradiance regime under which the plants were grown decreased, leaves partitioned more fixed 14CO2 into starch than into the water soluble fraction from which metabolic and structural components as well as a transport species could be synthesized

  12. 77 FR 32420 - Atlantic Coastal Fisheries Cooperative Management Act Provisions; American Lobster Fishery

    Science.gov (United States)

    2012-06-01

    ... National Oceanic and Atmospheric Administration 50 CFR Part 697 RIN 0648-BA56 Atlantic Coastal Fisheries Cooperative Management Act Provisions; American Lobster Fishery AGENCY: National Marine Fisheries Service... section 803(b) of the Atlantic Coastal Fisheries Cooperative Management Act (Atlantic Coastal Act) 16...

  13. Home-Based Diabetes Symptom Self-Management Education for Mexican Americans with Type 2 Diabetes

    Science.gov (United States)

    García, Alexandra A.; Brown, Sharon A.; Horner, Sharon D.; Zuñiga, Julie; Arheart, Kristopher L.

    2015-01-01

    This pilot study evaluated an innovative diabetes symptom awareness and self-management educational program for Mexican Americans, a fast growing minority population experiencing a diabetes epidemic. Patients with diabetes need assistance interpreting and managing symptoms, which are often annoying and potentially life-threatening. A repeated…

  14. Native American Technical Assistance and Training for Renewable Energy Resource Development and Electrical Generation Facilities Management

    Energy Technology Data Exchange (ETDEWEB)

    A. David Lester

    2008-10-17

    The Council of Energy Resource Tribes (CERT) will facilitate technical expertise and training of Native Americans in renewable energy resource development for electrical generation facilities, and distributed generation options contributing to feasibility studies, strategic planning and visioning. CERT will also provide information to Tribes on energy efficiency and energy management techniques.This project will provide facilitation and coordination of expertise from government agencies and private industries to interact with Native Americans in ways that will result in renewable energy resource development, energy efficiency program development, and electrical generation facilities management by Tribal entities. The intent of this cooperative agreement is to help build capacity within the Tribes to manage these important resources.

  15. Evaluation of waterfowl conservation under the North American Waterfowl Management Plan

    Science.gov (United States)

    Williams, B.K.; Koneff, M.D.; Stith, David A.

    1999-01-01

    In 1986, the North American Waterfowl Management Plan (Plan) was signed by the U.S. Secretary of the Interior and the Canadian Minister of the Environment, with a goal of restoring waterfowl populations to levels of the 1970s via habitat conservation. Central to the Plan is a set of ambitious continental population goals and habitat objectives to be met through broad-based public-private partnerships. Inadequate attention has been paid to evaluation of the Plan, despite the fact that Plan delivery can be enhanced via improved understanding of the effects of habitat conservation on waterfowl population dynamics. Several factors confound the effort to evaluate the Plan at regional and continental levels, including difficulties in accounting for national land-use policies. To date, evaluation has proceeded along 2 avenues of investigation: (1) the study of conservation actions at local-regional levels, and (2) statistical assessment of Plan assumptions. Among other things, results thus far indicate duck production from the U.S. Northern Great Plains has increased in recent years, and intensive treatments such as planted cover have had positive effects on local reproductive success. Many duck species currently exceed Plan population goals; however, population levels of some species, most notably northern pintail (Anas acuta), remain below expectations based on historic relationships with precipitation. Management implications include the need for ongoing and more carefully prioritized conservation efforts, broader partnerships, and improved understanding of the linkages between habitats and biological processes. Delivery of the Plan must involve collaboration among the Continental Evaluation Team, joint Venture partners, the Adaptive Management and Assessment Team of the U.S. Fish and Wildlife Service, and other conservation groups. Although the challenges and projected costs of Plan conservation efforts are considerable, the long-term potential benefits to waterfowl

  16. Does management intensity in inter rows effect soil physical properties in Austrian and Romanian vineyards?

    Science.gov (United States)

    Bauer, Thomas; Strauss, Peter; Stiper, Katrin; Klipa, Vladimir; Popescu, Daniela; Winter, Silvia; Zaller, Johann G.

    2016-04-01

    Successful viticulture is mainly influenced by soil and climate. The availability of water during the growing season highly influences wine quality and quantity. To protect soil from being eroded most of the winegrowers keep the inter row zones of the vineyards green. Greening also helps to provide water-stress to the grapes for harvesting high quality wines. However, these greening strategies concerning the intensity of inter row management differ from farm to farm and are mainly based on personal experience of the winegrowers. However to what extent different inter row management practices affect soil physical properties are not clearly understood yet. To measure possible effects of inter row management in vineyards on soil physical parameters we selected paired vineyards with different inter row management in Austria and Romania. In total more than 7000 soil analysis were conducted for saturated and unsaturated hydraulic conductivity, soil water retention, water stable aggregates, total organic carbon, cation exchange capacity, potassium, phosphorous, soil texture, bulk density and water infiltration. The comparison between high intensity management with at least one soil disturbance per year, medium intensity with one soil disturbance every second inter row per year and low intensity management with no soil disturbance since at least 5 years indicates that investigated soil physical properties did not improve for the upper soil layer (3-8cm). This is in contrast to general perceptions of improved soil physical properties due to low intensity of inter row management, i.e. permanent vegetated inter rows. This may be attributed to long term and high frequency mechanical stress by agricultural machinery in inter rows.

  17. African-American lesbian identity management and identity development in the context of family and community.

    Science.gov (United States)

    Miller, Shannon J

    2011-01-01

    Don't Ask, Don't Tell is gaining attention in family studies literature as a cultural specific context to understand lesbian, gay, and bisexual visibility in African-American families and communities. This policy suggests that sexual minorities are accepted within African-American families and communities as long as they do not label themselves or acknowledge publicly that they engage in same-sex relationships. The narratives of two African-American lesbians (aged 26 and 27 years) are chronicled in the present study to reveal their lesbian identity development, lesbian identity management, and how they defined and navigated Don't Ask, Don't Tell. They encountered challenges and successes in a quest to find communities that would embrace and affirm their multiple marginalized identities. Their stories are offered as a point of entry to further inquiry concerning African-American lesbian visibility and identity proclamation within African-American families and communities.

  18. International Transfers of Managers in North American and European MNEs

    OpenAIRE

    Daniel Ondrack

    1985-01-01

    Global-scale MNEs require a network of managers to direct and control operations around the world. Managerial resources for these jobs can be managers from the headquarters country, host and third countries. International transfers can be for specific staffing needs, for management development and for organization development. The general hypothesis examined in this paper was the global scale MNEs would operate in a regio-or geocentric fashion with full integration of the world pool of manage...

  19. Effectiveness of a telemonitoring intensive strategy in early rheumatoid arthritis: comparison with the conventional management approach

    OpenAIRE

    Salaffi, Fausto; Carotti, Marina; Ciapetti, Alessandro; Di Carlo, Marco; Gasparini, Stefania; Farah, Sonia; Gutierrez, Marwin

    2016-01-01

    Background The advent of Internet and World Wide Web has created new perspectives toward interaction between patients and healthcare professionals. Telemonitoring patients with rheumatoid arthritis (RA) is an emerging concept to guide the collaborative management treatment and improve outcomes in patients. The objective of this study was to investigate whether an intensive treatment strategy, according to a telemonitoring protocol, is more effective than conventional management strategy in re...

  20. Attention-Deficit/Hyperactivity Disorder: Presentation and Management in the Haitian American Child

    OpenAIRE

    Prudent, Nicole; Johnson, Peggy; Carroll, Jennifer; Culpepper, Larry

    2005-01-01

    A case study of a young Haitian American is presented that is illustrative of cultural issues that influence care of those with attention-deficit/hyperactivity disorder (ADHD). Medications are the preferred treatment for ADHD and can be combined with psychological intervention. However, many Haitians and Haitian Americans see psychoactive medications as leading to substance abuse or mental illness. Efficacious psychosocial treatments include contingency management, parent training, and behavi...

  1. Chinese American Parents’ Acculturation and Enculturation, Bicultural Management Difficulty, Depressive Symptoms, and Parenting

    OpenAIRE

    Kim, Su Yeong; Shen, Yishan; Huang, Xuan; Wang, Yijie; Orozco-Lapray, Diana

    2014-01-01

    This study examined whether Chinese American parents’ acculturation and enculturation were related to parenting practices (punitive parenting, democratic child participation, and inductive reasoning) indirectly through the mediation of parents’ bicultural management difficulty and parental depressed mood. Data came from a two-wave study of Chinese American families in Northern California. Mothers and fathers were assessed when their children were in early adolescence and then again in middle ...

  2. Machismo as a Factor Affecting the Use of Power and Communication in the Managing of Personnel Disputes: Brazilian Versus American Men Managers.

    Science.gov (United States)

    Rossi, Ana M.; Todd-Mancillas, William R.

    Acknowledging that the Latin American cultural concept of "machismo" influences the way in which Brazilian managers tend to use authority rather than communication when resolving disputes with subordinates, a study compared Brazilian and American male managers' self-reported preferences for resolving disputes with employees and peer managers.…

  3. Crew resource management training in the intensive care unit: a multisite controlled before-after study.

    NARCIS (Netherlands)

    Kemper, P.F.; Bruijne, M. de; Dyck, C. van; So, R.L.; Tangkau, P.; Wagner, C.

    2016-01-01

    Introduction There is a growing awareness today that adverse events in the intensive care unit (ICU) are more often caused by problems related to non-technical skills than by a lack of technical, or clinical, expertise. Team training, such as crew resource management (CRM), aims to improve these non

  4. An Analysis of Intensive Mode Pedagogy in Management Education in India

    Science.gov (United States)

    Mishra, Sita; Nargundkar, Rajendra

    2015-01-01

    Purpose: Management education is at its peak in India. But pedagogy and modes of delivery are not always innovative compared to top international Business Schools. It is through experimentation that the paper may be able to discover what works best in our context. The purpose of this paper is to determine the effectiveness of intensive mode of…

  5. Forest Management and Forest Sector of Russia: Conditions and Ways for Transition to Intensive Model

    Directory of Open Access Journals (Sweden)

    N. A. Moiseev

    2014-02-01

    Full Text Available The causes for protracted crisis at the system of forest management and development of forest sector in Russia are discussed in the paper and recommendations for recovery from recession have been done based on transition from extensive to the intensive model of development.

  6. Ultimate biochemical oxygen demand in semi-intensively managed shrimp pond waters

    Science.gov (United States)

    Three independent studies were conducted to quantified ultimate biochemical oxygen demand (UBOD) and the corresponding decomposition rate constant for production pond (average 21.5 ha each) waters and effluents on six semi-intensively managed marine shrimp (Litopenaeus vannamei) farms in Honduras. S...

  7. Nutrient management for intensive animal agriculture: policies and practices for sustainability

    NARCIS (Netherlands)

    Sims, J.L.; Bergstrom, L.F.; Bowden, B.T.; Oenema, O.

    2005-01-01

    The intensity of animal production around the world has increased substantially during the last half-century, which has led to large problems with the disposal of manures and waste waters. The focus of this paper is on the development of national policies to improve the nutrient management of concen

  8. Challenges in participatory primary stress management interventions in knowledge intensive SMEs

    DEFF Research Database (Denmark)

    Gish, Liv; Ipsen, Christine

    2013-01-01

    While knowledge intensive SMEs have recognized the need for change with respect to productivity and wellbeing, and to some extend have access to tools and methods for enabling this, they still lack process competences and are uncertain about how to approach primary stress interventions and initiate...... relevant change processes. This paper presents the outline of our research and development project on participatory primary stress management interventions in knowledge intensive SMEs, as well as the preliminary results and related implications. The research and development project is conducted in order...... to develop an operational model which SMEs can use when they want to initiate participatory primary stress management interventions in their company. The development project builds on a process model for participatory primary interventions in larger knowledge intensive companies and the premises behind...

  9. Management accounting and control systems used by R&D intensive firms in different organizational life-cycle stages

    OpenAIRE

    Silvola, H. (Hanna)

    2007-01-01

    Abstract This dissertation investigates the use of management accounting and control systems in R&D intensive firms in different organizational life-cycle stages. The thesis consists of four essays focusing on two categories of management accounting and control systems: capital budgeting decisions and management control systems. First, we investigate the evaluation and financing of investment projects in R&D intensive firms. Second, we moreover investigate how R&D intensive fir...

  10. A Scoping Review of Behavioral Weight Management Interventions in Overweight/Obese African American Females.

    Science.gov (United States)

    Sutton, Suzanne M; Magwood, Gayenell S; Jenkins, Carolyn H; Nemeth, Lynne S

    2016-08-01

    African American females are adversely affected by overweight and obesity and accompanying physical, psychosocial, and economic consequences. Behavioral weight management interventions are less effective in addressing the needs of overweight and obese African American females. The objective of this scoping review was to explore weight management research in this population to identify key concepts, gaps in the literature, and implications for future research. Analyses revealed a broad array in purpose, theoretical frameworks, settings, study designs, interventions, intervention strategies, and outcome variables, making comparison difficult. Many of the articles included in this review did not provide a rich description of methods, which hinder their use in the development of future studies. Consistent application of a combined theory may address the gaps identified in this review by providing a reliable method for assessing needs, developing interventions, and evaluating the effectiveness and fidelity of behavioral weight management interventions in overweight and obese African American females. PMID:26927607

  11. Evaluation of corporate energy management practices of energy intensive industries in Turkey

    International Nuclear Information System (INIS)

    Turkey is one of a number of countries who still lack a national management standard for energy. Industrial energy consumption accounts for 42% of Turkey's total energy consumption. With the help of a questionnaire and analytical framework, this paper investigates Industrial Energy Management Practice in Turkey and highlights significant bottlenecks and shortcomings of energy intensive industries in terms of energy management application. The survey was carried out as a multiple case study of the Turkish iron, steel, cement, paper, ceramics and textile industries. Outcomes of the questionnaire are evaluated according to the analytical framework which covers company characteristics, regulations, external relations of the companies and internal organizational conditions. After analyzing these elements on the basis of a minimum requirement list, it was found that only 22% of the surveyed companies actually practice corporate energy management in Turkey. The main barriers to proper energy management implementation were identified as lack of synergy between the stakeholders, the extent and scope of energy manager courses, and inadequate awareness of and lack of financial support for energy management activities. As a guideline to overcome present obstacles, a set of policy options are offered: strengthening and restructuring of legal and institutional frameworks, promotion of energy efficiency, education, training and capacity building and facilitating implementation of the international energy management standard ISO 50001. -- Highlights: ► Developing an analytical scheme to assess degree of Energy Management Application. ► Investigation of Energy Management Practices in Turkish Energy Intensive Industries. ► Analysis of challenges which hinder full implementation of energy management in Turkey. ► Presenting a set of essential policy options thought for all stakeholders.

  12. Novel predictors of sepsis outperform the American Burn Association sepsis criteria in the burn intensive care unit patient.

    Science.gov (United States)

    Mann-Salinas, Elizabeth A; Baun, Mara M; Meininger, Janet C; Murray, Clinton K; Aden, James K; Wolf, Steven E; Wade, Charles E

    2013-01-01

    The purpose of this study was to determine whether systemic inflammatory response syndrome (SIRS) and American Burn Association (ABA) criteria predict sepsis in the burn patient and develop a model representing the best combination of novel clinical sepsis predictors. A retrospective, case-controlled, within-patient comparison of burn patients admitted to a single intensive care unit from January 2005 to September 2010 was made. Blood culture results were paired with documented sepsis: positive-sick, negative-sick (collectively defined as sick), and negative-not sick. Data for all predictors were collected for the 72 hours before blood culture. Variables were evaluated using regression and area under the curve (AUC) analyses. Fifty-nine subjects represented 177 culture periods. SIRS criteria were not discriminative: 98% of the subjects met criteria. ABA sepsis criteria were different on the day before (P = .004). The six best-fit variables identified for the model included heart rate > 130 beats per min, mean arterial pressure 150 mg/dl. The model was significant in predicting positive-sick and sick, with an AUC of 0.775 (P burn patient.

  13. Fisheries Management of Mexican and Central American Estuaries

    Energy Technology Data Exchange (ETDEWEB)

    Amezcua-Martinez, Felipe; Bellgraph, Brian J.

    2014-09-14

    The contributed papers in this book provide research undertaken in estuarine systems of Mexico and Central America that aim to provide a scientific basis for proper estuarine management. The book is divided in three parts that cover topics associated with fisheries management and regulations: physicochemical studies, ecological studies and socioeconomic studies. This introduction outlines the contents of this book in relation to the management of coastal ecosystems, which have a high socioeconomic importance for a large proportion of the population in this area of the world. Rather than be a definitive suite of papers for the regulation of these habitats, the goal of this book is to outline the urgent need to continue research of threatened coastal ecosystems of Mexico and Central America.

  14. Risk Management in Financial Institutions: a Study on the American Investment Banks in the Financial Crisis

    OpenAIRE

    Husjainova, Elmira; Chen, Guang; Lin, Manlu

    2011-01-01

    This paper, as it’s titled, is about risk management in investment banks. To put it more broadly, we try to illustrate to what extent the traditional risk management approaches could work in the modern financial world along with the expansion of financial derivatives, tools and activities. We take the American financial market and step into the topic by the case analysis on Lehman Brothers and Goldman Sachs. Besides, we explain the other relevant concepts and players such as short selling and...

  15. Cardiovascular Risk Reduction for African-American Men through Health Empowerment and Anger Management

    Science.gov (United States)

    Stephens, Torrance; Braithwaite, Harold; Johnson, Larry; Harris, Catrell; Katkowsky, Steven; Troutman, Adewale

    2008-01-01

    Objective: To examine impact of CVD risk reduction intervention for African-American men in the Atlanta Empowerment Zone (AEZ) designed to target anger management. Design: Wilcoxon Signed-Rank Test was employed as a non-parametric alternative to the t-test for independent samples. This test was employed because the data used in this analysis…

  16. 78 FR 35217 - Atlantic Coastal Fisheries Cooperative Management Act Provisions; American Lobster Fishery

    Science.gov (United States)

    2013-06-12

    ... National Oceanic and Atmospheric Administration 50 CFR Part 697 RIN 0648-AT31 Atlantic Coastal Fisheries Cooperative Management Act Provisions; American Lobster Fishery AGENCY: National Marine Fisheries Service... measures in the Exclusive Economic Zone (EEZ) under the authority of section 803(b) of the Atlantic...

  17. It Takes a Community To Create an American Indian Business and Management Course.

    Science.gov (United States)

    Muller, Helen Juliette

    2000-01-01

    Within the context of tribal economic development, a business management course was developed by faculty and American Indian students. The course integrates culture and business through case studies of organizations that developed their own culturally relevant business practices. Community involvement is an essential element. (SK)

  18. School-Based Management: The Changing Locus of Control in American Public Education.

    Science.gov (United States)

    Drury, Darrel; Levin, Douglas

    School-based management is a reinvention and countermovement to a broader historical trend to centralize and standardize American education. The present study represents one component of the Organisation for Economic Cooperation and Development's project to investigate how schools in 12 member nations can most effectively respond to recent…

  19. Breeding bird community response to establishing intercropped switchgrass in intensively-managed pine stands

    Science.gov (United States)

    Loman, Zachary G.; Riffell, Samuel K.; Wheat, Bradley R.; Miller, Darrin A.; Martin, James A.; Vilella, Francisco

    2014-01-01

    Intercropping switchgrass (Panicum virgatum L.) between tree rows within young pine (Pinus spp.) plantations is a potential method to generate lignocellulosic biofuel feedstocks within intensively managed forests. Intensively managed pine supports a diverse avian assemblage potentially affected by establishment and maintenance of an annual biomass feedstock via changes in plant communities, dead wood resources, and habitat structure. We sought to understand how establishing switchgrass on an operational scale affects bird communities within intercropped plantations as compared to typical intensively managed loblolly pine (Pinus taeda L.) forest. We conducted breeding bird point counts using distance sampling for three years (2011–2013) following establishment of intercropped switchgrass stands (6 replicates), traditionally-managed pine plantations, and switchgrass-only plots (0.1 km2 minimum) in Kemper Co., MS. We detected 59 breeding bird species from 11,195 detections. Neotropical migrants and forest-edge associated species were less abundant in intercropped plots than controls the first two years after establishment and more abundant in year three. Short distance migrants and residents were scarce in intercropped and control plots initially, and did not differ between these two treatments in any year. Species associated with pine-grass habitat structure were less abundant initially in intercropped plots, but converged with pine controls in subsequent years. Switchgrass monocultures provided minimal resources for birds. If songbird conservation is a management priority, managers should consider potential reductions of some breeding birds for one to two years following intercropping. It is unclear how these relationships may change outside the breeding season and as stands age.

  20. An Official American Thoracic Society/European Respiratory Society Workshop Report: Evaluation of Respiratory Mechanics and Function in the Pediatric and Neonatal Intensive Care Units.

    Science.gov (United States)

    Peterson-Carmichael, Stacey; Seddon, Paul C; Cheifetz, Ira M; Frerichs, Inéz; Hall, Graham L; Hammer, Jürg; Hantos, Zoltán; van Kaam, Anton H; McEvoy, Cindy T; Newth, Christopher J L; Pillow, J Jane; Rafferty, Gerrard F; Rosenfeld, Margaret; Stocks, Janet; Ranganathan, Sarath C

    2016-02-01

    Ready access to physiologic measures, including respiratory mechanics, lung volumes, and ventilation/perfusion inhomogeneity, could optimize the clinical management of the critically ill pediatric or neonatal patient and minimize lung injury. There are many techniques for measuring respiratory function in infants and children but very limited information on the technical ease and applicability of these tests in the pediatric and neonatal intensive care unit (PICU, NICU) environments. This report summarizes the proceedings of a 2011 American Thoracic Society Workshop critically reviewing techniques available for ventilated and spontaneously breathing infants and children in the ICU. It outlines for each test how readily it is performed at the bedside and how it may impact patient management as well as indicating future areas of potential research collaboration. From expert panel discussions and literature reviews, we conclude that many of the techniques can aid in optimizing respiratory support in the PICU and NICU, quantifying the effect of therapeutic interventions, and guiding ventilator weaning and extubation. Most techniques now have commercially available equipment for the PICU and NICU, and many can generate continuous data points to help with ventilator weaning and other interventions. Technical and validation studies in the PICU and NICU are published for the majority of techniques; some have been used as outcome measures in clinical trials, but few have been assessed specifically for their ability to improve clinical outcomes. Although they show considerable promise, these techniques still require further study in the PICU and NICU together with increased availability of commercial equipment before wider incorporation into daily clinical practice. PMID:26848609

  1. An Official American Thoracic Society/European Respiratory Society Workshop Report: Evaluation of Respiratory Mechanics and Function in the Pediatric and Neonatal Intensive Care Units.

    Science.gov (United States)

    Peterson-Carmichael, Stacey; Seddon, Paul C; Cheifetz, Ira M; Frerichs, Inéz; Hall, Graham L; Hammer, Jürg; Hantos, Zoltán; van Kaam, Anton H; McEvoy, Cindy T; Newth, Christopher J L; Pillow, J Jane; Rafferty, Gerrard F; Rosenfeld, Margaret; Stocks, Janet; Ranganathan, Sarath C

    2016-02-01

    Ready access to physiologic measures, including respiratory mechanics, lung volumes, and ventilation/perfusion inhomogeneity, could optimize the clinical management of the critically ill pediatric or neonatal patient and minimize lung injury. There are many techniques for measuring respiratory function in infants and children but very limited information on the technical ease and applicability of these tests in the pediatric and neonatal intensive care unit (PICU, NICU) environments. This report summarizes the proceedings of a 2011 American Thoracic Society Workshop critically reviewing techniques available for ventilated and spontaneously breathing infants and children in the ICU. It outlines for each test how readily it is performed at the bedside and how it may impact patient management as well as indicating future areas of potential research collaboration. From expert panel discussions and literature reviews, we conclude that many of the techniques can aid in optimizing respiratory support in the PICU and NICU, quantifying the effect of therapeutic interventions, and guiding ventilator weaning and extubation. Most techniques now have commercially available equipment for the PICU and NICU, and many can generate continuous data points to help with ventilator weaning and other interventions. Technical and validation studies in the PICU and NICU are published for the majority of techniques; some have been used as outcome measures in clinical trials, but few have been assessed specifically for their ability to improve clinical outcomes. Although they show considerable promise, these techniques still require further study in the PICU and NICU together with increased availability of commercial equipment before wider incorporation into daily clinical practice.

  2. [Management of quality in an Intensive Care Unit: implementation of ISO 9001:2008 international standard].

    Science.gov (United States)

    Lorenzo Torrent, R; Sánchez Palacios, M; Santana Cabrera, L; Cobian Martinez, J L; García del Rosario, C

    2010-10-01

    The Quality Management Systems make it possible to prioritize actions to maintain the safety and efficacy of health technologies. The Intensive Care Unit of our hospital has implemented a quality management plan, which has obtained accreditation as "Service Certificate that manages its activities according to UNE-EN ISO 9001:2008" standard. With the application of quality management system, it has been possible to detect the needs that the Service can cover in order to obtain the satisfaction of the patient, relative or health personnel of the other services of the hospital, to improve communications inside and outside of service, to secure greater understanding of the processes of the organization and control of risk, to delimit responsibilities clearly to all the personnel, to make better use of the time and resources and, finally, to improve the motivation of the personnel.

  3. Management of infections in critically ill returning travellers in the intensive care unit-II

    DEFF Research Database (Denmark)

    Rello, Jordi; Manuel, Oriol; Eggimann, Philippe;

    2016-01-01

    This position paper is the second ESCMID Consensus Document on this subject and aims to provide intensivists, infectious disease specialists, and emergency physicians with a standardized approach to the management of serious travel-related infections in the intensive care unit (ICU) or the emerge......This position paper is the second ESCMID Consensus Document on this subject and aims to provide intensivists, infectious disease specialists, and emergency physicians with a standardized approach to the management of serious travel-related infections in the intensive care unit (ICU......) or the emergency department. This document is a cooperative effort between members of two European Society of Clinical Microbiology and Infectious Diseases (ESCMID) study groups and was coordinated by Hakan Leblebicioglu and Jordi Rello for ESGITM (ESCMID Study Group for Infections in Travellers and Migrants...

  4. Knowledge Management in Knowledge Intensive Service Networks: A Strategic Management Perspective

    OpenAIRE

    Günther Blaich; Heiner Evanschitzky; Peter Kenning; Dieter Ahlert

    2004-01-01

    Knowledge is the key to gaining and sustaining competitive advantage. Driven by a change in consumer needs towards “comprehensive service solutions”, more and more services are offered through networks. By so doing, individual firms can concentrate on their distinctive competencies and by combining these with those of partner firms such a network is able to offer complex, knowledge-intensive services at high quality and at reasonable prices. It is clear that the success of such knowledge inte...

  5. EGG PRODUCTION AND HATCHABILITY OF LOCAL DUCKS UNDER SEMI INTENSIVE VS EXTENSIVE MANAGEMENTS

    Directory of Open Access Journals (Sweden)

    P. Widiyaningrum

    2016-05-01

    Full Text Available The study aimed to compare the egg production and hatchability of local ducks under different management systems, namely semi-intensive and extensive. The research conducted was an experimental one-way classification with two treatments. Each treatment used 15 male and 120 females (mating ratio 1:8, and ducks aged 13-14 months. Eggs production was recorded during three weeks period. About 300 eggs were selected from each treatment to be hatched. Fertility was observed at 4th days of hatching process using egg candler. Data of eggs production, eggs weight, fertility, and hatchability were analyzed using unpaired two sample Student’s t-test. The results showed that average of egg weight, fertility and hatchability were not different under two management system, but egg production in the semi-intensive maintenance was significantly higher (P<0.05 than those in the extensive system. Egg production in the semi-intensive was 12.3% higher than those in the extensive. In conclusion, the semi-intensive system that is applied in this study the number of eggs production but did not affect the average of egg weight, fertility and hatchability. 

  6. Intensive olive orchards on sloping land: good water and pest management are essential.

    Science.gov (United States)

    Metzidakis, I; Martinez-Vilela, A; Castro Nieto, G; Basso, B

    2008-11-01

    There is intensive cultivation of olives on sloping land in Jaen-Granada (Spain), Basilicata (Italy) and Western Crete (Greece). The intensive olive groves here are characterised by a tree density of about 250treesha(-1), yearly fertilisation and pruning, several chemical sprays for pest control, soil tillage once to thrice per year and irrigation up to 2700m3ha(-1)yr(-1). Intensive management results in high yields of 3600-6500kgha(-1) but also higher labour costs of 1154-1590euroha(-1)yr(-1), varying per area. The major environmental concerns in this system are related to chemical residues in the fruit, the extinction of useful insects, the depletion of groundwater resources, the pollution of soil and water and the erosion of soil. This paper describes the impact of intensive orchard management on natural resources and gives recommendations for soil and water conservation, reduction of chemicals use and biodiversity enhancement. The specific recommendations for the relevant stakeholders--farmers, technicians, agricultural services and policy makers--are based on the experimental evaluation of different agricultural practices and a socio-economic analysis of local and global production and markets.

  7. EGG PRODUCTION AND HATCHABILITY OF LOCAL DUCKS UNDER SEMI INTENSIVE VS EXTENSIVE MANAGEMENTS

    Directory of Open Access Journals (Sweden)

    P. Widiyaningrum

    2016-06-01

    Full Text Available The study aimed to compare the egg production and hatchability of local ducks under different management systems, namely semi-intensive and extensive. The research conducted was an experimental one-way classification with two treatments. Each treatment used 15 male and 120 females (mating ratio 1:8, and ducks aged 13-14 months. Eggs production was recorded during three weeks period. About 300 eggs were selected from each treatment to be hatched. Fertility was observed at 4th days of hatching process using egg candler. Data of eggs production, eggs weight, fertility, and hatchability were analyzed using unpaired two sample Student’s t-test. The results showed that average of egg weight, fertility and hatchability were not different under two management system, but egg production in the semi-intensive maintenance was significantly higher (P<0.05 than those in the extensive system. Egg production in the semi-intensive was 12.3% higher than those in the extensive. In conclusion, the semi-intensive system that is applied in this study the number of eggs production but did not affect the average of egg weight, fertility and hatchability.

  8. Scanning tour USA. Traffic management: the American blend

    NARCIS (Netherlands)

    Immers, B.; Taale, H.; Wilmink, I.R.; Katwijk, R.T. van; Schuurman, H.; Hoogendoorn, S.; Wilmink, A.

    2013-01-01

    In The Netherlands traffic management is being considered a serious policy option to deal with traffic congestion and its negative impact on safety, economy and livability. Building new roads is often not feasible due to a lack of space, environmental and funding issues. Also, pricing is not an opti

  9. Compare the Chinese and American Accounting Management System

    Institute of Scientific and Technical Information of China (English)

    刘晨

    2014-01-01

    Cultureplays an important role in the development of accounting. Dif erent culture environments foster dif erent accountants, andthen dif erent accounting subcultures, which wil have dif erent influence on the choice of accounting systems. Dif erent cultures in China and the United States influenced the two countries accounting system, which lead to dif erent management system.

  10. Effect of peer education on the noise management in Iranian neonatal intensive care unit

    OpenAIRE

    Biabanakigoortani, Azam; Namnabati, Mahboobeh; Abdeyazdan, Zahra; Badii, Zohreh

    2016-01-01

    Background: Advancements in neonatal intensive care unit (NICU) science and technology have increased the survival rate of preterm infants. Despite these advances, they are still facing with neurobehavioral problems. Noise level in NICU is a potential source of stress for preterm infants. It should be decreased to the standard level as much as possible. The purpose of this study was to evaluate the effect of peer education on the performance of staff in noise management in the NICU. Materials...

  11. [Critically ill patients with decompensated liver cirrhosis - New aspects and intensive care management].

    Science.gov (United States)

    Maschmeier, Miriam; Hüsing, Anna; Schmidt, Hartmut; Kabar, Iyad

    2015-10-01

    The prevalence of liver cirrhosis in the German population is about 1 %. Clinically, compensated liver cirrhosis should be distinguished from decompensated cirrhosis with poor prognosis. Decompensated cirrhosis is defined by the occurrence of complications and consequences of portal hypertension (such as ascites, variceal bleeding, hepatic encephalopathy and hepatorenal syndrome) and progressive liver failure. Optimizing the management of these patients in the intensive care unit could essentially improve their outcome. PMID:26445254

  12. Intensity, productivity and efficiency in agriculture in Finland and implications for N and P fertiliser management

    OpenAIRE

    BÀckman, Stefan

    2008-01-01

    The purpose of this study was to evaluate intensity, productivity and efficiency in agriculture in Finland and show implications for N and P fertiliser management. Environmental concerns relating to agricultural production have been and still are focused on arguments about policies that affect agriculture. These policies constrain production while demand for agricultural products such as food, fibre and energy continuously increase. Therefore the importance of increasing productivity is a gre...

  13. Consequences of More Intensive Forestry for the Sustainable Management of Forest Soils and Waters

    OpenAIRE

    Eva Ring; Peter Högberg; Anneli Ågren; Gustaf Egnell; Kevin Bishop; Lucas, Richard W.; Futter, Martyn N.; Sponseller, Ryan A.; Hjalmar Laudon

    2011-01-01

    Additions of nutrients, faster growing tree varieties, more intense harvest practices, and a changing climate all have the potential to increase forest production in Sweden, thereby mitigating climate change through carbon sequestration and fossil fuel substitution. However, the effects of management strategies for increased biomass production on soil resources and water quality at landscape scales are inadequately understood. Key knowledge gaps also remain regarding the sustainability of sho...

  14. American cutaneous leishmaniasis: presentation and problems of patient management

    Directory of Open Access Journals (Sweden)

    Jeffrey D. Chulay

    1988-12-01

    Full Text Available We report our experience with the diagnosis and treatment of 60 patients with American cutaneous leishmaniasis. They were infected in Panama (55, Brazil (4 or Colombia (I. Among 35 patients with a 3 week exposure in Panama, the mean maximum incubation period was 33 days (range 4-81 days. Diagnosis was delayed an average of 93 days after onset of skin lesions, due to the patient's delay in seeking medical attention (31 days, medical personnel's delay in considering the diagnosis (45 days, and the laboratory's delay in confirming the diagnosis (17 days. Forty-four patients (73% developed ulcers typical of cutaneous leishmaniasis. Sixteen additional patients (27% had atypical macular, papular, squamous, verrucous or acneiform skin lesions that were diagnosed only because leishmanial cultures were obtained. Of the 59 patients treated with pentavalent antimonial drugs, only 34 (58% were cured after the first course of treatment. Lesions which were at least 2 cm in diameter, ulcerated, or caused by Leishmania braziliensis were less likely to be cured after a single course of treatment than were lesions smaller than 2 cm, nonulcerated or caused by Leishmania mexicana or Leishmania donovani.

  15. Report by a special panel of the American Nuclear Society: Protection and management of plutonium

    International Nuclear Information System (INIS)

    The American Nuclear Society (ANS) established an independent and prestigious panel several months ago to take the matter up where the US National Academy of Science (NAS) left off. The challenge was to look at the broader issue of what to do with civil plutonium, as well as excess weapons material. In terms of approach, the report focused on several short- and long-term issues. The short-term focus was on the disposition of excess weapons plutonium, while the longer-range issue concerned the disposition of the plutonium being produced in the civil nuclear fuel cycle. For the short term, the ANS panel strongly endorsed the concept that all plutonium scheduled for release from the US and Russian weapons stocks should be converted to a form that is intensively radioactive in order to protect the plutonium from theft of seizure (the spent fuel standard). However, since the conversion will at best take several years to complete, the panel has concluded that immediate emphasis should be placed on the assurance that all unconverted materials are protected as securely as when they were part of the active weapon stockpiles. More importantly, the panel also recommended prompt implementation of the so-called reactor option for disposing of surplus US and Russian weapons plutonium. The longer-term issues covered by the panel were those posed by the growing stocks of both separated plutonium and spent fuel generated in the world's civil nuclear power programs. These issues included what fuel cycle policies should be prudently pursued in light of proliferation risks and likely future energy needs, what steps should be taken in regard to the increase in the demand for nuclear power in the future, and how civil plutonium in its various forms should be protected and managed to minimize proliferation. Overall, the panel concluded that plutonium is an energy resource that should be used and not a waste material to be disposed of

  16. Challenges encountered by critical care unit managers in the large intensive care units

    Directory of Open Access Journals (Sweden)

    Mokgadi C. Matlakala

    2014-02-01

    Full Text Available Background: Nurses in intensive care units (ICUs are exposed regularly to huge demands interms of fulfilling the many roles that are placed upon them. Unit managers, in particular, are responsible for the efficient management of the units and have the responsibilities of planning, organising, leading and controlling the daily activities in order to facilitate the achievement of the unit objectives.Objectives: The objective of this study was to explore and present the challenges encountered by ICU managers in the management of large ICUs.Method: A qualitative, exploratory and descriptive study was conducted at five hospital ICUs in Gauteng province, South Africa. Data were collected through individual interviews from purposively-selected critical care unit managers, then analysed using the matic coding.Results: Five themes emerged from the data: challenges related to the layout and structure of the unit, human resources provision and staffing, provision of material resources, stressors in the unit and visitors in the ICU.Conclusion: Unit managers in large ICUs face multifaceted challenges which include the demand for efficient and sufficient specialised nurses; lack of or inadequate equipment that goes along with technology in ICU and supplies; and stressors in the ICU that limit the efficiency to plan, organise, lead and control the daily activities in the unit. The challenges identified call for multiple strategies to assist in the efficient management of large ICUs.

  17. Managing Diversity: Afghan-Americans And The Aftermath Of The Twin Towers Tragedy

    Directory of Open Access Journals (Sweden)

    Belal A. Kaifi

    2011-07-01

    Full Text Available Ethnic and religious diversity is part of each society in the modern world and being an Afghan is another dimension of these differences in the United States. The research question for this study was to see if Afghan-Americans are experiencing more discriminatory practices as a result of the 9/11 events. The results of 502 Afghan-Americans demonstrated that they do report more discrimination in the post-9/11 era. Specifically, Afghan men have experienced more discrimination in the workplace and Afghan women have experienced more discrimination in public. Implications and recommendations are offered for effective diversity management.

  18. Effects of coffee management intensity on composition, structure and regeneration status of Ethiopian moist evergreen Afromontane forests

    OpenAIRE

    Hundera, Kitessa; Aerts, Raf; Fontaine, M; Mechelen, M. van; Gijbels, Pieter; Honnay, Olivier; Muys, Bart

    2013-01-01

    The effect of arabica coffee management intensity on composition, structure and regeneration of moist evergreen Afromontane forests was studied in three traditional coffee management systems of Southwest Ethiopia: semi-plantation coffee (SPC), semi-forest coffee (SFC) and forest coffee (FC). Vegetation and environmental data were collected in 84 plots from forests varying in intensity of coffee management. After controlling for environmental variation (altitude, aspect, slope, soil nutrient a...

  19. PanDA Beyond ATLAS: Workload Management for Data Intensive Science

    CERN Document Server

    Schovancova, J; The ATLAS collaboration; Klimentov, A; Maeno, T; Nilsson, P; Oleynik, D; Panitkin, S; Petrosyan, A; Vaniachine, A; Wenaus, T; Yu, D

    2013-01-01

    The PanDA Production ANd Distributed Analysis system has been developed by ATLAS to meet the experiment's requirements for a data-driven workload management system for production and distributed analysis processing capable of operating at LHC data processing scale. After 7 years of impressively successful PanDA operation in ATLAS there are also other experiments which can benefit from PanDA in the Big Data challenge, with several at various stages of evaluation and adoption. The new project "Next Generation Workload Management and Analysis System for Big Data" is extending PanDA to meet the needs of other data intensive scientific applications in HEP, astro-particle and astrophysics communities, bio-informatics and other fields as a general solution to large scale workload management. PanDA can utilize dedicated or opportunistic computing resources such as grids, clouds, and High Performance Computing facilities, and is being extended to leverage next generation intelligent networks in automated workflow mana...

  20. How does vineyard management intensity affect ecosystem services and disservices - insights from a meta-analysis

    Science.gov (United States)

    Winter, Silvia; Zaller, Johann G.; Kratschmer, Sophie; Pachinger, Bärbel; Strauss, Peter; Bauer, Thomas; Paredes, Daniel; Gómez, José A.; Guzmán, Gema; Landa, Blanca; Nicolai, Annegret; Burel, Francoise; Cluzeau, Daniel; Popescu, Daniela; Bunea, Claudiu-Ioan; Potthoff, Martin; Guernion, Muriel; Batáry, Péter

    2016-04-01

    Viticultural agro-ecosystems provide a range of different ecosystem services which are affected by management decisions of winegrowers. At the global scale, vineyards are often high intensity agricultural systems with bare soil or inter-row vegetation consisting of only a few plant species. These systems primarily aim at optimizing wine production by reducing competition for water and nutrients between grapevines and weeds and by preventing the outbreak of pests and diseases. At the same time, this kind of management is often associated with ecosystem disservices such as high rates of soil erosion, degradation of soil structure and fertility, contamination of groundwater and decline of biodiversity. Recently, several initiatives across the world tried to overcome detrimental effects of that management style by creating biodiversity friendly vineyards. The consequences of establishing divers cover crop mixes or tolerating spontaneous vegetation in vineyards for ecosystem services (including yield) overstretching local case studies has not been investigated yet. This meta-analysis will provide an overview of all published studies comparing the effects of different vineyard management practices on a range of different ecosystem services like biodiversity, pest control, pollination, soil conservation and carbon sequestration. The aggregated effect size will point out which management measures can provide the best overall net sum of ecosystem services. This meta-analysis is part of the transdisciplinary BiodivERsA project VineDivers and will ultimately lead into management and policy recommendations for various stakeholder groups engaged in viticulture.

  1. Simulation of the Effect of Intensive Forest Management on Forest Production in Sweden

    Directory of Open Access Journals (Sweden)

    Ola Rosvall

    2011-03-01

    Full Text Available The effects of intensifying the management of 15% of the Swedish forest land on potential future forest production over a 100-year period were investigated in a simulation study. The intensive management treatments, which were introduced over a period of 50 years, were: intensive fertilization of Norway spruce (IntFert; bulking-up Norway spruce elite populations using somatic embryogenesis (SE-seedlings; planting of lodgepole pine, hybrid larch, and Sitka spruce (Contorta, Larch, and Sitka; fertilization with wood ash on peatlands (Wood ash; and conventional fertilization in mature forests (ConFert. Potential sites for applying intensive forest management (IFM to sites with low nature conservation values were determined with a nature conservation score (NCS. Four different scenarios were simulated: “Base scenario”, which aimed at reducing the negative impact on nature conservation values, “Fast implementation”, “No IntFert” (IntFert was not used, and “Large Forest Companies”, where the majority of plots were selected on company land. Total yields during the 100-year simulation period were about 85–92% higher for the intensive forest management scenarios than for the reference scenario (business as usual. In the “No IntFert” scenario total production was 1.8% lower and in the “Large Forest Companies” scenario total production was 4.8% lower than in the “Base scenario”. “Fast implementation” of IFM increased yield by 15% compared to the “Base scenario”. Norway spruce SE-seedlings and IntFert gave the highest yields, measured as total production during the 100-year simulation period, but relative to the yields in the reference scenario, the highest increases in yield were for Contorta. The “Base scenario” and “No IntFert” gave the highest yields for plots with the lowest NCS, but plots with higher NCS had to be used in the “Fast implementation” and “Large Forest Companies” scenarios. More than

  2. Talent Management Programmes at British, American and Canadian Universities: Comparative Study

    Directory of Open Access Journals (Sweden)

    Boichenko Maryna

    2015-12-01

    Full Text Available The article deals with the peculiarities of talent management programmes implementation at the top British, American and Canadian universities. The essence of the main concepts of research - talent and talent management - has been revealed. Talent management is referred to as the systematic attraction, identification, development, engagement, retention and deployment of those individuals who are of particular value to an organization, either in view of their “high potential” for the future or because they are fulfilling business/ operation-critical roles. The factors that drive the development of talent management at the universities have been defined. The benefits that can be obtained as a result of talent management programmes implementation in higher education institutions have been pointed out. The differences in talent management programmes implementation at the universities of Great Britain, the USA and Canada have been found out. These differences depend mainly on the human resources policy of the institution represented in its strategic plan. It has been concluded that most top British and American higher education institutions run talent development programmes, but the target categories and forms of their implementation greatly differ. Canadian universities in the human resources policy focus on professional development of staff and faculty, but do not have special talent management programmes. Progressive conceptual ideas of foreign experience that can be used in practice of Ukrainian universities have been considered.

  3. Evaluation of organic, conventional and intensive beef farm systems: health, management and animal production.

    Science.gov (United States)

    Blanco-Penedo, I; López-Alonso, M; Shore, R F; Miranda, M; Castillo, C; Hernández, J; Benedito, J L

    2012-09-01

    The overall aim of the present study was to analyse and compare organic beef cattle farming in Spain with intensive and conventional systems. An on-farm study comparing farm management practices and animal health was carried out. The study also focussed on a slaughterhouse analysis by comparing impacts on the safety and quality of the cattle products. Twenty-four organic and 26 conventional farms were inspected, and farmers responded to a questionnaire that covered all basic data on their husbandry practices, farm management, veterinary treatments and reproductive performance during 2007. Furthermore, data on the hygiene and quality of 244, 2596 and 3021 carcasses of calves from organic, intensive and conventional farms, respectively, were retrieved from the official yearbook (2007) of a slaughterhouse. Differences found between organic and conventional farms across the farm analysis did not substantially reflect differences between both farm types in the predominant diseases that usually occur on beef cattle farms. However, calves reared organically presented fewer condemnations at slaughter compared with intensive and to a lesser extent with conventionally reared calves. Carcass performance also reflected differences between farm type and breed and was not necessarily better in organic farms.

  4. Linking nursery nutritional status and water availability post-planting under intense summer drought: the case of a South American Mediterranean tree species

    OpenAIRE

    Ovalle JF; Arellano EC; Oliet JA; Becerra P; Ginocchio R

    2016-01-01

    Drought-avoidance traits of South American Mediterranean tree species are crucial attributes to be considered in nursery practices aimed at improving the performance of seedlings exposed to intense summer drought in dryland reforestation projects. In this study, we determined the relation between nursery fertilization doses and the development of drought-avoidance traits of the soapbark tree Quillaja saponaria (Mol.) under contrasting watering regimes following post-planting. Seedlings were g...

  5. American cutaneous leishmaniasis: presentation and problems of patient management

    Directory of Open Access Journals (Sweden)

    Jeffrey D. Chulay

    1988-12-01

    Full Text Available We report our experience with the diagnosis and treatment of 60 patients with American cutaneous leishmaniasis. They were infected in Panama (55, Brazil (4 or Colombia (I. Among 35 patients with a 3 week exposure in Panama, the mean maximum incubation period was 33 days (range 4-81 days. Diagnosis was delayed an average of 93 days after onset of skin lesions, due to the patient's delay in seeking medical attention (31 days, medical personnel's delay in considering the diagnosis (45 days, and the laboratory's delay in confirming the diagnosis (17 days. Forty-four patients (73% developed ulcers typical of cutaneous leishmaniasis. Sixteen additional patients (27% had atypical macular, papular, squamous, verrucous or acneiform skin lesions that were diagnosed only because leishmanial cultures were obtained. Of the 59 patients treated with pentavalent antimonial drugs, only 34 (58% were cured after the first course of treatment. Lesions which were at least 2 cm in diameter, ulcerated, or caused by Leishmania braziliensis were less likely to be cured after a single course of treatment than were lesions smaller than 2 cm, nonulcerated or caused by Leishmania mexicana or Leishmania donovani.Relatamos nossa experiência em 60 pacientes com leishmaniose tegumentar americana diagnosticada e tratada entre 1977 e 1982. Cinqüenta e cinco pacientes foram infectados no Panamá, 4 no Brasil, e 1 na Colômbia. Entre 35 pacientes com uma exposição de 3 semanas no Panamá, a média do período de incubação foi 33 dias (limite sobre 4 e 81 dias. O diagnóstico foi feito, em média, 93 dias depois do início das lesões de pele, devido a demora do paciente em procurar o serviço médico (31 dias, a demora do médico em considerar o diagnóstico (45 dias, e a demora do laboratório em confirmar o diagnóstico (17 dias. Quarenta e quatro pacientes (73% desenvolveram úlceras típicas de leishmaniose cutânea. Porém, 16 pacientes (27% tiveram lesões de pele at

  6. The Bariatric Patient in the Intensive Care Unit: Pitfalls and Management.

    Science.gov (United States)

    Pompilio, Carlos E; Pelosi, Paolo; Castro, Melina G

    2016-09-01

    The increasing number of bariatric/metabolic operations as important alternatives for the treatment of obesity and type 2 diabetes brought several concerns about the intensive care of patients undergoing those procedures. Intensive Care Unit admission criteria are needed in order to better allocate resources and avoid unnecessary interventions. Furthermore, well-established protocols, helpful in many clinical situations, are not directly applicable to obese patients. Indeed, difficult airway management, mechanical ventilation, fluid therapy protocols, prophylaxis, and treatment of venous thromboembolic events have unique aspects that should be taken into consideration. Finally, new data related to planning nutrition therapy of the critically obese have been highlighted and deserve consideration. In this review, we provide an outline of recent studies related to those important aspects of the care of the bariatric/metabolic patients in critical conditions. PMID:27464648

  7. Consequences of More Intensive Forestry for the Sustainable Management of Forest Soils and Waters

    Directory of Open Access Journals (Sweden)

    Eva Ring

    2011-02-01

    Full Text Available Additions of nutrients, faster growing tree varieties, more intense harvest practices, and a changing climate all have the potential to increase forest production in Sweden, thereby mitigating climate change through carbon sequestration and fossil fuel substitution. However, the effects of management strategies for increased biomass production on soil resources and water quality at landscape scales are inadequately understood. Key knowledge gaps also remain regarding the sustainability of shorter rotation periods and more intensive biomass harvests. This includes effects of fertilization on the long-term weathering and supply of base cations and the consequences of changing mineral availability for future forest production. Furthermore, because soils and surface waters are closely connected, management efforts in the terrestrial landscape will potentially have consequences for water quality and the ecology of streams, rivers, and lakes. Here, we review and discuss some of the most pertinent questions related to how increased forest biomass production in Sweden could affect soils and surface waters, and how contemporary forestry goals can be met while minimizing the loss of other ecosystem services. We suggest that the development of management plans to promote the sustainable use of soil resources and water quality, while maximizing biomass production, will require a holistic ecosystem approach that is placed within a broader landscape perspective.

  8. Regional anesthesia for management of acute pain in the intensive care unit.

    Science.gov (United States)

    De Pinto, Mario; Dagal, Armagan; O'Donnell, Brendan; Stogicza, Agnes; Chiu, Sheila; Edwards, William Thomas

    2015-01-01

    Pain is a major problem for Intensive Care Unit (ICU) patients. Despite numerous improvements it is estimated that as many as 70% of the patients experience moderate-to-severe postoperative pain during their stay in the ICU. Effective pain management means not only decreasing pain intensity, but also reducing the opioids' side effects. Minimizing nausea, vomiting, urinary retention, and sedation may indeed facilitate patient recovery and it is likely to shorten the ICU and hospital stay. Adequate postoperative and post-trauma pain management is also crucial for the achievement of effective rehabilitation. Furthermore, recent studies suggest that effective acute pain management may be helpful in reducing the development of chronic pain. When used appropriately, and in combination with other treatment modalities, regional analgesia techniques (neuraxial and peripheral nerve blocks) have the potential to reduce or eliminate the physiological stress response to surgery and trauma, decreasing the possibility of surgical complications and improving the outcomes. Also they may reduce the total amount of opioid analgesics necessary to achieve adequate pain control and the development of potentially dangerous side effects. PMID:26557482

  9. Intensive use of an intertidal mudflat by foraging adult American horseshoe crabs Limulus polyphemus in the Great Bay estuary, New Hampshire

    Directory of Open Access Journals (Sweden)

    Wan-Jean LEE

    2010-10-01

    Full Text Available Although concerns about harvesting levels of the American Horseshoe Crab, Limulus polyphemus have prompted increased research into its ecology, current understanding of the species’ foraging ecology is mostly limited to mid-Atlantic populations. This study elucidates the spatial and temporal pattern of Limulus foraging on an intertidal mudflat of a northern New England estuary. A novel survey method was used to monitor Limulus foraging activity without disturbing the sediment. A fixed 50 m´2 m transect was monitored with monthly surveys of the number of Limulus feeding pits from June to October 2009, May and June 2010. Snorkelling surveys were also carried out to observe individual behavior and examine the spatial scale of activity of individual animals. Results showed frequent and intensive use of the mudflat by foraging Limulus. Limulus were actively foraging within the survey area during all months surveyed. Foraging patterns exhibited a seasonal pattern with activity levels peaking in August 2009 and increased significantly towards the end of the study in June 2010. It was also shown that Limulus intertidal foraging persisted and peaked after the spring breeding season. Observations of foraging Limulus revealed that individual predators dig multiple pits within a single high tide, with little disturbance to the sediment in between. In addition to altering the perception of Limulus as a subtidal predator outside of the breeding season, findings from this study suggests a segregation of spawning and feeding habitats, thus underscoring the need to consider a wider range of critical habitats in the management of Limulus populations [Current Zoology 56 (5: 611–617, 2010].

  10. The response of sward-dwelling arthropod communities to reduced grassland management intensity in pastures

    Directory of Open Access Journals (Sweden)

    Helden Alvin J.

    2015-12-01

    Full Text Available We compared arthropod taxon richness, diversity and community structure of two replicated grassland husbandry experiments to investigate effects of reduced management intensity, as measured by nutrient input levels (390, 224 and 0 kg/ha per year N in one experiment, and 225 and 88 kg/ha per year N in another. Suction sampling was used to collect Araneae, Coleoptera, Hemiptera and Hymenoptera, with Araneae and Coleoptera also sampled with pitfall trapping. Univariate analyses found no significant differences in abundance and species density between treatments. However, with multivariate analysis, there were significant differences in arthropod community structure between treatments in both experiments.

  11. Successful nonsurgical management of post-orthodontic gingival enlargement with intensive cause-related periodontal therapy.

    Science.gov (United States)

    Kwon, TaeHyun; Kim, David M; Levin, Liran

    2015-03-01

    Successful nonsurgical management of severe postorthodontic gingival enlargement and erythema in a 24-year-old male is presented. The patient received an intensive cause-related periodontal therapy, consisting of oral hygiene instruction, scaling and root planing, and weekly recall visits. At week five, complete resolution of the lesions was achieved. By targeting the primary etiologic factor, i.e., plaque, periodontal health was restored without needing surgical intervention. Reducing the bacterial load will give the biologic natural healing capacity of the body the opportunity to stabilize the periodontal condition and, thus, should be considered as the first line of intervention before a surgical approach is taken. PMID:25928969

  12. Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Intensive care management of pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    M. Ali Al-Azem

    2014-01-01

    Full Text Available Pulmonary hypertension (PH in the Intensive Care Unit (ICU may be due to preexisting pulmonary vascular lung disease, liver disease, or cardiac diseases. PH also may be caused by critical illnesses, such as acute respiratory distress syndrome (ARDS, acute left ventricular dysfunction and pulmonary embolism, or may occur after cardiac or thoracic surgery. Regardless of the underlying cause of PH, the final common pathway for hemodynamic deterioration and death is RV failure, which is the most challenging aspect of patient management. Therapy is thus aimed at acutely relieving RV overload by decreasing PVR and reversing RV failure with pulmonary vasodilators and inotropes.

  13. How the American, Degree-Granting For-Profit Higher Education Sector Manages the Regulatory Environment: An Intrinsic Case Study

    Science.gov (United States)

    Barron, Caulyne Nichole

    2013-01-01

    This intrinsic case study examined the context of the American, degree-granting for-profit higher education sector between 2009 and 2012, applying institutional theory and resource dependency theory to develop an understanding of how the degree-granting for-profit sector of American higher education manages regulatory pressures. The study examines…

  14. Physical and Hydrologic Responses of an Intensively Managed Loblolly Pine Plantation to Forest Harvesting and Site Preparation

    OpenAIRE

    Miwa, Masato

    1999-01-01

    The Southeastern Lower Coastal Plain wet pine flats include thousands of acres of jurisdictional wetlands that are economically, socially, and environmentally important. These highly productive forests have been intensively managed as pine plantations for the past few decades. More recently, harvesting and site preparation practices have become a concern among natural resource managers because intensive forestry practices may alter soil physical properties and site hydrology. These alterat...

  15. Raccoon spatial requirements and multi-scale habitat selection within an intensively managed central Appalachian forest

    Science.gov (United States)

    Owen, Sheldon F.; Berl, Jacob L.; Edwards, John W.; Ford, W. Mark; Wood, Petra Bohall

    2015-01-01

    We studied a raccoon (Procyon lotor) population within a managed central Appalachian hardwood forest in West Virginia to investigate the effects of intensive forest management on raccoon spatial requirements and habitat selection. Raccoon home-range (95% utilization distribution) and core-area (50% utilization distribution) size differed between sexes with males maintaining larger (2×) home ranges and core areas than females. Home-range and core-area size did not differ between seasons for either sex. We used compositional analysis to quantify raccoon selection of six different habitat types at multiple spatial scales. Raccoons selected riparian corridors (riparian management zones [RMZ]) and intact forests (> 70 y old) at the core-area spatial scale. RMZs likely were used by raccoons because they provided abundant denning resources (i.e., large-diameter trees) as well as access to water. Habitat composition associated with raccoon foraging locations indicated selection for intact forests, riparian areas, and regenerating harvest (stands managed forests in the central Appalachians.

  16. On-farm habitat restoration counters biotic homogenization in intensively managed agriculture.

    Science.gov (United States)

    Ponisio, Lauren C; M'Gonigle, Leithen K; Kremen, Claire

    2016-02-01

    To slow the rate of global species loss, it is imperative to understand how to restore and maintain native biodiversity in agricultural landscapes. Currently, agriculture is associated with lower spatial heterogeneity and turnover in community composition (β-diversity). While some techniques are known to enhance α-diversity, it is unclear whether habitat restoration can re-establish β-diversity. Using a long-term pollinator dataset, comprising ∼9,800 specimens collected from the intensively managed agricultural landscape of the Central Valley of California, we show that on-farm habitat restoration in the form of native plant 'hedgerows', when replicated across a landscape, can boost β-diversity by approximately 14% relative to unrestored field margins, to levels similar to some natural communities. Hedgerows restore β-diversity by promoting the assembly of phenotypically diverse communities. Intensively managed agriculture imposes a strong ecological filter that negatively affects several important dimensions of community trait diversity, distribution, and uniqueness. However, by helping to restore phenotypically diverse pollinator communities, small-scale restorations such as hedgerows provide a valuable tool for conserving biodiversity and promoting ecosystem services.

  17. PanDA Beyond ATLAS : A Scalable Workload Management System For Data Intensive Science

    CERN Document Server

    Borodin, M; The ATLAS collaboration; Jha, S; Golubkov, D; Klimentov, A; Maeno, T; Nilsson, P; Oleynik, D; Panitkin, S; Petrosyan, A; Schovancova, J; Vaniachine, A; Wenaus, T

    2014-01-01

    The LHC experiments are today at the leading edge of large scale distributed data-intensive computational science. The LHC's ATLAS experiment processes data volumes which are particularly extreme, over 140 PB to date, distributed worldwide at over of 120 sites. An important element in the success of the exciting physics results from ATLAS is the highly scalable integrated workflow and dataflow management afforded by the PanDA workload management system, used for all the distributed computing needs of the experiment. The PanDA design is not experiment specific and PanDA is now being extended to support other data intensive scientific applications. PanDA was cited as an example of "a high performance, fault tolerant software for fast, scalable access to data repositories of many kinds" during the "Big Data Research and Development Initiative" announcement, a 200 million USD U.S. government investment in tools to handle huge volumes of digital data needed to spur science and engineering discoveries. In this talk...

  18. On-farm habitat restoration counters biotic homogenization in intensively managed agriculture.

    Science.gov (United States)

    Ponisio, Lauren C; M'Gonigle, Leithen K; Kremen, Claire

    2016-02-01

    To slow the rate of global species loss, it is imperative to understand how to restore and maintain native biodiversity in agricultural landscapes. Currently, agriculture is associated with lower spatial heterogeneity and turnover in community composition (β-diversity). While some techniques are known to enhance α-diversity, it is unclear whether habitat restoration can re-establish β-diversity. Using a long-term pollinator dataset, comprising ∼9,800 specimens collected from the intensively managed agricultural landscape of the Central Valley of California, we show that on-farm habitat restoration in the form of native plant 'hedgerows', when replicated across a landscape, can boost β-diversity by approximately 14% relative to unrestored field margins, to levels similar to some natural communities. Hedgerows restore β-diversity by promoting the assembly of phenotypically diverse communities. Intensively managed agriculture imposes a strong ecological filter that negatively affects several important dimensions of community trait diversity, distribution, and uniqueness. However, by helping to restore phenotypically diverse pollinator communities, small-scale restorations such as hedgerows provide a valuable tool for conserving biodiversity and promoting ecosystem services. PMID:26542192

  19. Closed-loop control for cardiopulmonary management and intensive care unit sedation using digital imaging

    Science.gov (United States)

    Gholami, Behnood

    This dissertation introduces a new problem in the delivery of healthcare, which could result in lower cost and a higher quality of medical care as compared to the current healthcare practice. In particular, a framework is developed for sedation and cardiopulmonary management for patients in the intensive care unit. A method is introduced to automatically detect pain and agitation in nonverbal patients, specifically in sedated patients in the intensive care unit, using their facial expressions. Furthermore, deterministic as well as probabilistic expert systems are developed to suggest the appropriate drug dose based on patient sedation level. Patients in the intensive care unit who require mechanical ventilation due to acute respiratory failure also frequently require the administration of sedative agents. The need for sedation arises both from patient anxiety due to the loss of personal control and the unfamiliar and intrusive environment of the intensive care unit, and also due to pain or other variants of noxious stimuli. In this dissertation, we develop a rule-based expert system for cardiopulmonary management and intensive care unit sedation. Furthermore, we use probability theory to quantify uncertainty and to extend the proposed rule-based expert system to deal with more realistic situations. Pain assessment in patients who are unable to verbally communicate is a challenging problem. The fundamental limitations in pain assessment stem from subjective assessment criteria, rather than quantifiable, measurable data. The relevance vector machine (RVM) classification technique is a Bayesian extension of the support vector machine (SVM) algorithm which achieves comparable performance to SVM while providing posterior probabilities for class memberships and a sparser model. In this dissertation, we use the RVM classification technique to distinguish pain from non-pain as well as assess pain intensity levels. We also correlate our results with the pain intensity

  20. Pursuing the American Dream: The Effect of Immigrant Settlement among Asian Americans and Occupational Disparities in Management

    Directory of Open Access Journals (Sweden)

    Hideki Morooka

    2013-06-01

    Full Text Available It is well established that Asian Americans are fairly represented in professional occupations due to their high educational attainment. However, the representation of Asian Americans in managerial occupations is still small. Despite the dramatic increase of Asian Americans as a percentage of the population in recent decades, not many studies have been conducted to investigate the association between immigrant settlement and occupational disparities in managerial occupations of Asian Americans by ethnicities as well as immigrant generations. In this paper, I examine the characteristics that influence Asian Americans who embark on managerial occupations as compared to other occupations by nativity and the length of their residence in the United States. I also compare trends of native-born Asian Americans with those of native-born non-Hispanic whites to examine whether an occupational disparity has been approaching convergence.

  1. Performance analysis of data intensive cloud systems based on data management and replication: a survey

    Energy Technology Data Exchange (ETDEWEB)

    Malik, Saif; Khan, Samee U.; Ewen, Sam J.; Tziritas, Nikos; Kolodziej, Joanna; Zomaya, Albert; Madani, Sajjad A.; Min-Allah, Nasro; Wang, Lizhe; Xu, Cheng-Zhong; Malluhi, Qutaibah M.; Pecero, Jonathan; Balaji, Pavan; Vishnu, Abhinav; Ranjan, Rajiv; Zeadally, Sherali; Li, Hongziang

    2015-03-14

    As we delve deeper into the ‘Digital Age’, we witness an explosive growth in the volume, velocity, and variety of the data available on the Internet. For example, in 2012 about 2.5 quintillion bytes of data was created on a daily basis that originated from myriad of sources and applications including mobiledevices, sensors, individual archives, social networks, Internet of Things, enterprises, cameras, software logs, etc. Such ‘Data Explosions’ has led to one of the most challenging research issues of the current Information and Communication Technology era: how to optimally manage (e.g., store, replicated, filter, and the like) such large amount of data and identify new ways to analyze large amounts of data for unlocking information. It is clear that such large data streams cannot be managed by setting up on-premises enterprise database systems as it leads to a large up-front cost in buying and administering the hardware and software systems. Therefore, next generation data management systems must be deployed on cloud. The cloud computing paradigm provides scalable and elastic resources, such as data and services accessible over the Internet Every Cloud Service Provider must assure that data is efficiently processed and distributed in a way that does not compromise end-users’ Quality of Service (QoS) in terms of data availability, data search delay, data analysis delay, and the like. In the aforementioned perspective, data replication is used in the cloud for improving the performance (e.g., read and write delay) of applications that access data. Through replication a data intensive application or system can achieve high availability, better fault tolerance, and data recovery. In this paper, we survey data management and replication approaches (from 2007 to 2011) that are developed by both industrial and research communities. The focus of the survey is to discuss and characterize the existing approaches of data replication and management that tackle the

  2. Reproductive Performance of Saanen Goats under Rural or Intensive Management Systems in Elazığ Region, Turkey

    Directory of Open Access Journals (Sweden)

    Yaşar Akar

    2013-01-01

    Full Text Available This study was carried out to compare the reproductive performance of Saanen goats under rural (n:75 and intensive (n:206 management systems in Elazığ region. Single and multiple births, stillbirth, dystocia, abortion and kids survival rates were determined in both the goat flocks between February 1 and April 30 2011. Percentages of single and multiple births, stillbirth, dystocia and abortion were not statistically different between the flocks. However, the kids survival rates of intensive management system (74.05% were lower than rural management system (88.88%, (P<0.003. Overall percentage of single and multiple births, stillbirth, dystocia, abortion and kids survival in all goats were 45.08, 54.92, 17.62, 12.29, 13.16 and 78.40%, respectively. Our results show that rural and intensive management systems do not have an important effect on reproductive performance of Saanen goats.

  3. Hydrologic and biogeochemical functioning of intensively managed catchments: A synthesis of top-down analyses

    Science.gov (United States)

    Basu, Nandita B.; Thompson, Sally E.; Rao, P. Suresh C.

    2011-10-01

    This paper synthesizes a 3-year collaborative effort to characterize the biogeochemical and hydrological features of intensively managed agricultural catchments by combining data analysis, modeling, and preliminary hypothesis testing. The specific focus was on the Midwestern region of the United States. The results suggest that: (1) water management, specifically the homogenization of evapotranspiration losses driven by mono-cultural vegetation cover, and the homogenization of runoff generation driven by artificial drainage, has created engineered, predictable hydrologic systems; (2) nutrient and pesticide management, specifically their regular applications have created two kinds of biogeochemical export regimes: chemostatic (low variability in concentration as exhibited by nitrate) and episodic (high variability in concentration as exhibited by pesticides); (3) coupled mass-balance models for water and solutes reproduce these two regimes as a function of chemical rate constants. Phosphorus transport regimes were found to be episodic at smaller spatial scales, but chemostatic at larger scales. Chemostatic response dominates in transport-limited catchments that have internal sources of the solute to buffer the periodicity in episodic inputs, while episodic response dominates in source-limited catchments. The shift from episodic nitrate export in pristine catchments to chemostatic regimes in managed watersheds was attributed to legacy stores of nitrogen (built from continued fertilizer applications) that buffer interannual variations in biogeochemical processing. Fast degradation kinetics of pesticides prevents the build-up of legacy sources, and leads to episodic export. Analytical expressions were derived for the probability density functions of solute delivery ratio as a function of the stochastics of rainfall-runoff events and biogeochemical controls.

  4. How to improve your knowledge intensive organisation : implementing a knowledge management scan within public and private sector organisations

    OpenAIRE

    Koolmees, Hans; Smeijsters, Henk; Schoenmakers, Sylvia

    2009-01-01

    The Centre of Research in Knowledge Organisations and Knowledge Management of Zuyd University has developed a knowledge management scan. The scan initiates from two models. The first model is based on the Value Based Knowledge Management approach (Tissen, Andriessen & Lekanne Deprez, 1998) and includes 6 basic abilities of a knowledge-intensive organisation that will enable the organisation to operate successfully in a knowledge based economy (.The second model, developed by Wierdsma and Swie...

  5. Impact of Hydrologic Variability on Nutrient Age Distribution in Intensively Managed Landscapes

    Science.gov (United States)

    Kumar, P.; Woo, D. K.

    2014-12-01

    The distribution, concentration, and transport of nutrients in agricultural landscapes are of significant societal concern. Our interests in reactive nitrogen and the nitrogen cycle have shifted from increasing the efficiency of nitrogen delivery to target crop species to decreasing environmental damage caused by intensive agricultural practices. Enhancing the reactive nitrogen use efficiency to increase food production to meet future demand inevitably contributes to an increase in the reactive nitrogen load in the ecosystem, and damaging the environment. However, due to the complexity of the nitrogen cycle, the dynamics of nitrogen in soils and its interactions with ecohydrological processes at the watershed and regional scales are not well understood to enable adequate remedial measures. To unravel the complexity of this dynamics we have developed a model for characterizing the nitrogen age (elapsed time) distribution. The goal of our study is to develop and analyze the dynamics of nitrogen in the context of age and transit times resulting from advection, mixing, and production/destruction processes; evaluate the effects of micro-topographic variability on the nitrogen age distributions; and investigate how the temporal dynamics of the nitrogen age distribution are affected by changes in the variability of climate drivers. Our study is performed for the Upper Sangamon River Basin in the Critical Zone Observatory for Intensively Managed Landscapes (IML-CZO).

  6. Latin America’s Subtle Racism: Salient Managerial Implications For Non-Latin American Managers

    Directory of Open Access Journals (Sweden)

    Rutilio Martinez

    2011-03-01

    Full Text Available Since the mid nineteen nineties most Latin American nations have implemented free market policies. The ensuing economic stability has attracted investment from non-Latin corporations, thereby causing the transfer of non-Latin executives to Latin nations. For many of these executives, their Latin assignments include an unexpected challenge: Dealing with Latin America’s subtle but pervasive racism. Such racism contributes to the mistreatment of labor and influences the promotion and hiring of executives. These behaviors, although unapologetically accepted in Latin America, hurt productivity. Non-Latin managers should, therefore, treat workers fairly and hire and promote executives based exclusively upon job related factors.  

  7. Blood metabolites and some fertility parameters in dairy cows under intensive management system

    International Nuclear Information System (INIS)

    Dairy farms (1, 2, 3 and 4) of the intensive management system were selected. They are located 50 kilometers south of Khartoum state in a semi-arid zone. The effect of management on some fertility parameters, blood metabolites and minerals were investigated. Changes in blood metabolites with stage of lactation were also monitored. Other parameters studied were body weight, body condition score at calving. The results revealed that days to first P4 rise after calving and number of services per conception (NSPC) were lower in the farm s contained the cross-bred (Fresian X Zebu) compared to the farm contained the pure Fresian breed. The pure Fresian cows showed heavier weights and less body score at calving compared to the cross breed. Blood metabolites reflected the nutritional status of the dairy cows under study, plasma total protein, albumin, globulin, urea and Glucose did not show significant changes either either either between farms or in response to lactation stages. However, high levels of Globulins might indicate inflammation due to some diseases such as mastitis, metritis and lameness. Plasma level of Calcium and Phosphorous did not change significantly either between farms or due to stages of lactation.(Author)

  8. Risk Management and Insurance Implications Associated with the Americans with Disabilities Act: Accessibility to Places of Public Accommodation

    OpenAIRE

    Robert J. Aalberts; Donald W. Hardigree

    1992-01-01

    The authors provided an analysis of Title Ill of the Americans with Disabilities Act and its impact on risk managers. They explained the issue of accessibility to public accommodations, along with the requirements for conforming with the Title III requirements of the Act. Potential insurance and risk management implications are addressed, with an analysis of possible loss control actions or remedies and insurance coverages.

  9. Family predictors of disease management over one year in Latino and European American patients with type 2 diabetes.

    Science.gov (United States)

    Chesla, Catherine A; Fisher, Lawrence; Skaff, Marilyn M; Mullan, Joseph T; Gilliss, Catherine L; Kanter, Richard

    2003-01-01

    Family context is thought to influence chronic disease management but few studies have longitudinally examined these relationships. Research on families and chronic illness has focused almost exclusively on European American families. In this prospective study we tested a multidimensional model of family influence on disease management in type 2 diabetes in a bi-ethnic sample of European Americans and Latinos. Specifically, we tested how baseline family characteristics (structure, world view, and emotion management) predicted change in disease management over one year in 104 European American and 57 Latino patients with type 2 diabetes. We found that emotion management predicted change in disease management in both groups of patients as hypothesized, while family world view predicted change in both ethnic groups but in the predicted direction only for European Americans. Examining family context within ethnic groups is required to elucidate unique cultural patterns. Attending to culturally unique interpretations of constructs and measures is warranted. The import of family emotion management, specifically conflict resolution, in disease management deserves further study to support clinical intervention development. Examining multiple domains of family life and multidimensional health outcomes strengthens our capacity to develop theory about family contexts and individual health.

  10. Spirituality, Religiosity, and Weight Management Among African American Adolescent Males: The Jackson Heart KIDS Pilot Study.

    Science.gov (United States)

    Bruce, Marino A; Beech, Bettina M; Griffith, Derek M; Thorpe, Roland J

    2016-01-01

    Spirituality and religion have been identified as important determinants of health for adults; however, the impact of faith-oriented factors on health behaviors and outcomes among African American adolescent males has not been well studied. The purpose of this study is to examine the relationship between religiosity and spirituality and obesity-related behaviors among 12-19 year old African American males (N = 105) in the Jackson Heart KIDS Pilot Study. Key variables of interest are church attendance, prayer, daily spirituality, weight status, attempts to lose weight, nutrition, physical activity, and stress. Daily spirituality is associated with whether an individual attempts to lose weight. The results from logistic regression models suggest that daily spirituality increases the odds that African American male adolescents attempt to lose weight (OR = 1.22, CI: 1.07-1.41) and have a history of diet-focused weight management (OR = 1.13, CI: 1.02-1.26). Future studies are needed to further explore the association between religion, spirituality, and obesity-related behaviors. PMID:27337622

  11. Spirituality, Religiosity, and Weight Management Among African American Adolescent Males: The Jackson Heart KIDS Pilot Study.

    Science.gov (United States)

    Bruce, Marino A; Beech, Bettina M; Griffith, Derek M; Thorpe, Roland J

    2016-01-01

    Spirituality and religion have been identified as important determinants of health for adults; however, the impact of faith-oriented factors on health behaviors and outcomes among African American adolescent males has not been well studied. The purpose of this study is to examine the relationship between religiosity and spirituality and obesity-related behaviors among 12-19 year old African American males (N = 105) in the Jackson Heart KIDS Pilot Study. Key variables of interest are church attendance, prayer, daily spirituality, weight status, attempts to lose weight, nutrition, physical activity, and stress. Daily spirituality is associated with whether an individual attempts to lose weight. The results from logistic regression models suggest that daily spirituality increases the odds that African American male adolescents attempt to lose weight (OR = 1.22, CI: 1.07-1.41) and have a history of diet-focused weight management (OR = 1.13, CI: 1.02-1.26). Future studies are needed to further explore the association between religion, spirituality, and obesity-related behaviors.

  12. Presentation and management of organophosphate poisoning in an intensive care unit

    International Nuclear Information System (INIS)

    To determine the various demographic factors, clinical features, management and outcome of organophosphate poisoning in an intensive care unit (ICU) setting. Study Design: Descriptive quantitative study. Place and Duration of study: ICU of PNS Shifa hospital, Karachi. From February 2008-February 2010. Patients and Methods: Total of 40 patients were admitted in the ICU of PNS Shifa hospital, Karachi from Feb 2008- Feb 2010 with the history of organophosphate (OP) ingestion. A complete history was taken from the patients and relatives. Baseline laboratory investigations were done. All the data was tabulated on a structured performed after tasking consent from the relatives. Variables of the study were demographic factors as gender, age, cause and mode of poisoning, clinical course, ICU management and its outcome. Results: Out of 40 patients 32 (80%) were females and 8 (20%) were males. The age varied from 12-56 years. Twenty eight (70%) were in the 14-28 years age group. Twenty nine (72%) had poison for suicidal purpose and rest had the insecticide accidently. Twenty six (62%) of them were unmarried. In 38 (95%) patients the clinical features of parasympathetic overactivity was observed. All these patients were given atropine and pralidoxime. Fifteen (37%) patients required mechanical ventilation. Five (12%) out of these patients developed ventilator associated pneumonia. The time duration of mechanical ventilation was 1-3 weeks. All the patients were successfully recovered. Total duration of hospital stay on our patients was 2-4 weeks. Conclusion: Early and aggressive management of organophosphate poisoning in an ICU setting reduces not only the mortality but also decreases the duration of hospital stay. (author)

  13. Clinical management of potential ibuprofen toxicosis in a South American red-footed tortoise (Geochelone carbonaria).

    Science.gov (United States)

    Gladden, Juliet N

    2006-09-01

    This article describes the clinical management of potential ibuprofen toxicosis in South American red-footed tortoise (Geochelone carbonaria). A 2.5-year-old, 0.78-kg Geochelone carbonaria tortoise was presented to the emergency clinic after ingesting solubilized ibuprofen (200 mg) in a gelatin capsule. Treatment on initial presentation consisted of esophagostomy tube placement for gastric lavage and activated charcoal administration, intravenous and intraosseous fluid therapy, and administration of gastrointestinal protectants (sucralfate and famotidine). The tortoise was discharged to the owners. Although follow-up diagnostic monitoring was minimal because of owner compliance, the patient was noted to be alive and in reasonable health 1 year after initial presentation. This is the first report on the management of potential nonsteroidal anti-inflammatory drug toxicosis in any chelonian species. PMID:16931380

  14. Spanish recruitment programmes for Latin Americans in countries of origin: a flexible management framework

    Directory of Open Access Journals (Sweden)

    Ana Mª López-Sala

    2014-09-01

    Full Text Available In the past decade, countries whose markets needed seasonal labour have sought new ways of importing foreign workers through channelling and recruitment programmes in countries of origin. This article seeks to demonstrate that, in the case of Spain, the effective development of this process has only been possible because of a flexible and dynamic system in which bilateral agreements have played a major role, among them those signed with some Latin American countries. Flexible management of these programmes has been implemented via legislation, via the institutions and actors involved, and via the immigrants themselves, who have managed (or been forced to adapt to the changes of a labour market conditioned by the globalisation of labour and capital.

  15. Effects of inter-row management intensity on wild bee, plant and soil biota diversity in vineyards

    Science.gov (United States)

    Kratschmer, Sophie; Pachinger, Bärbel; Winter, Silvia; Zaller, Johann G.; Buchholz, Jacob; Querner, Pascal; Strauß, Peter; Bauer, Thomas; Stiper, Katrin

    2016-04-01

    Vineyards may provide a range of essential ecosystem services, which interact with a diverse community of above- and belowground organisms. Intensive soil management like frequent tilling has resulted in the degradation of habitat quality with consequences on biodiversity and ecosystem services. This study is part of the European BiodivERsA project "VineDivers - Biodiversity-based ecosystem services in vineyards". We study the effects of different soil management intensities on above- and below-ground biodiversity (plants, insect pollinators, and soil biota), their interactions and the consequences for ecosystem services. We investigated 16 vineyards in Austria assessing the diversity of (1) wild bees using a semi-quantitative transect method, (2) earthworms by hand sorting, (3) Collembola (springtails) via pitfall trapping and soil coring, (4) plants by relevés and (5) litter decomposition (tea bag method). Management intensity differed in tillage frequency from intermediate intensity resulting in temporary vegetation cover to no tillage in permanent vegetation cover systems. First results show opposed relationships between the biodiversity of selected species groups and management intensity. We will discuss possible explanations and evaluate ecological interactions between wild bee, plant and soil biota diversity.

  16. An enhanced Bayesian fingerprinting framework for studying sediment source dynamics in intensively managed landscapes

    Science.gov (United States)

    Abban, B.; (Thanos) Papanicolaou, A. N.; Cowles, M. K.; Wilson, C. G.; Abaci, O.; Wacha, K.; Schilling, K.; Schnoebelen, D.

    2016-06-01

    An enhanced revision of the Fox and Papanicolaou (hereafter referred to as "F-P") (2008a) Bayesian, Markov Chain Monte Carlo fingerprinting framework for estimating sediment source contributions and their associated uncertainties is presented. The F-P framework included two key deterministic parameters, α and β, that, respectively, reflected the spatial origin attributes of sources and the time history of eroded material delivered to and collected at the watershed outlet. However, the deterministic treatment of α and β is limited to cases with well-defined spatial partitioning of sources, high sediment delivery, and relatively short travel times with little variability in transport within the watershed. For event-based studies in intensively managed landscapes, this may be inadequate since landscape heterogeneity results in variabilities in source contributions, their pathways, delivery times, and storage within the watershed. Thus, probabilistic treatments of α and β are implemented in the enhanced framework to account for these variabilities. To evaluate the effects of the treatments of α and β on source partitioning, both frameworks are applied to the South Amana Subwatershed (SASW) in the U.S. midwest. The enhanced framework is found to estimate mean source contributions that are in good agreement with estimates from other studies in SASW. The enhanced framework is also able to produce expected trends in uncertainty during the study period, unlike the F-P framework, which does not perform as expected. Overall, the enhanced framework is found to be less sensitive to changes in α and β than the F-P framework, and, therefore, is more robust and desirable from a management standpoint.

  17. [Invasive candidiasis in non-neutropenic adults : Guideline-based management in the intensive care unit].

    Science.gov (United States)

    Glöckner, A; Cornely, O A

    2013-12-01

    Invasive Candida infections represent a diagnostic and therapeutic challenge for clinicians particularly in the intensive care unit (ICU). Despite substantial advances in antifungal agents and treatment strategies, invasive candidiasis remains associated with a high mortality. Recent guideline recommendations on the management of invasive candidiasis by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) from 2012, the German Speaking Mycological Society and the Paul Ehrlich Society for Chemotherapy (DMykG/PEG) from 2011 and the Infectious Diseases Society of America (IDSA) from 2009 provide valuable guidance for diagnostic procedures and treatment of these infections but need to be interpreted in the light of the individual situation of the patient and the local epidemiology of fungal pathogens. The following recommendations for management of candidemia are common to all three guidelines. Any positive blood culture for Candida indicates disseminated infection or deep organ infection and requires antifungal therapy. Treatment should be initiated as soon as possible. Removal or changing of central venous catheters or other foreign material in the bloodstream is recommended whenever possible. Ophthalmological examination for exclusion of endophthalmitis and follow-up blood cultures during therapy are also recommended. Duration of therapy should be 14 days after clearance of blood cultures and resolution of symptoms. Consideration of surgical options and a prolonged antifungal treatment (weeks to months) are required when there is organ involvement. During the last decade several new antifungal agents were introduced into clinical practice. These innovative drugs showed convincing efficacy and favorable safety in randomized clinical trials. Consequently, they were integrated in recent therapeutic guidelines, often replacing former standard drugs as first-line options. Echinocandins have emerged as the generally preferred primary treatment in

  18. The Impact of Supply Chain Management Practices on Supply Chain Performance in Jordan: The Moderating Effect of Competitive Intensity

    OpenAIRE

    Ayman Bahjat Abdallah; Bader Yousef Obeidat; Noor Osama Aqqad

    2014-01-01

    The purpose of this study is to test the impact of supply chain management practices on supply chainperformance in terms of supply chain efficiency and supply chain effectiveness. Additionally, we investigate themoderating effect of competitive intensity on the relationship between supply chain management practices andsupply chain performance. Data for this research were collected from 104 manufacturing companies in Jordan.Hierarchical regressions were used to test the hypothesized relationsh...

  19. [Energy flux and energy balance closure of intensively managed lei bamboo forest ecosystem].

    Science.gov (United States)

    Chen, Yun-fei; Jiang, Hong; Zhou, Guo-mo; Sun, Cheng; Chen, Jian

    2013-04-01

    By using open-path eddy covariance system and meteorological instruments, an observation was conducted on the sensitive heat flux, latent heat flux, net radiation, soil heat flux, air temperature, ground temperature, and precipitation in a intensively managed Lei bamboo forest ecosystem in 2011, with the diurnal and monthly variations of energy flux as well as the distribution pattern of each energy component analyzed, and the Bowen ratio and energy balance closure calculated. The yearly net radiation of the forest ecosystem was 2928. 92 MJ m-2, and the latent heat flux, sensitive heat flux, and soil heat flux were 1384.90, 927.54, and -28.27 MJ m-2, respectively. Both the daily and the monthly variations of the energy components showed a single peak curve. The sensible and latent heat fluxes were 31.7% and 47.3% of the net radiation, respectively, indicating that latent heat flux was the main form of energy loss. The Bowen ratio followed the "U"-shaped pattern, and fluctuated from 0. 285 to 2. 062, suggesting that soil was a heat source. The yearly energy balance closure of the forest ecosystem was 0. 782, and the monthly average was 0.808.

  20. High-intensity interval training without weight loss improves exercise but not basal or insulin-induced metabolism in overweight/obese African American women.

    Science.gov (United States)

    Arad, Avigdor D; DiMenna, Fred J; Thomas, Naketa; Tamis-Holland, Jacqueline; Weil, Richard; Geliebter, Allan; Albu, Jeanine B

    2015-08-15

    The purpose of this randomized controlled clinical trial was to determine the effect of a 14-week high-intensity interval training (HIIT) intervention with weight stability on metabolic flexibility, insulin sensitivity, and cardiorespiratory fitness in sedentary, premenopausal, nondiabetic, overweight/obese African American women. Twenty-eight subjects were allocated to one of two groups: HIIT, which performed three sessions per week of four high-intensity cycling intervals, or a control group (CON), which maintained their normal level of physical activity. Diet was controlled for all subjects to ensure weight stability. Pre- and postintervention (pre/post), subjects completed an incremental cycling test to limit of tolerance and, following a 10-day high-fat controlled feeding period, a euglycemic-hyperinsulinemic clamp to determine insulin sensitivity and substrate oxidation. Nine members of HIIT (age, 29 ± 4 yr; body mass, 90.1 ± 13.8 kg) and eleven members of CON (age, 30 ± 7 yr; body mass, 85.5 ± 10.7 kg) completed the study. HIIT experienced an increased limit of tolerance (post, 1,124 ± 202 s; pre, 987 ± 146 s; P High-intensity interval training with weight stability increased exercise fat oxidation and tolerance in subjects at risk for diabetic progression, but did not improve insulin sensitivity or fat oxidation in the postabsorptive or insulin-stimulated state.

  1. An official American Thoracic Society workshop report: assessment and palliative management of dyspnea crisis.

    Science.gov (United States)

    Mularski, Richard A; Reinke, Lynn F; Carrieri-Kohlman, Virginia; Fischer, Mark D; Campbell, Margaret L; Rocker, Graeme; Schneidman, Ann; Jacobs, Susan S; Arnold, Robert; Benditt, Joshua O; Booth, Sara; Byock, Ira; Chan, Garrett K; Curtis, J Randall; Donesky, Doranne; Hansen-Flaschen, John; Heffner, John; Klein, Russell; Limberg, Trina M; Manning, Harold L; Morrison, R Sean; Ries, Andrew L; Schmidt, Gregory A; Selecky, Paul A; Truog, Robert D; Wang, Angela C C; White, Douglas B

    2013-10-01

    In 2009, the American Thoracic Society (ATS) funded an assembly project, Palliative Management of Dyspnea Crisis, to focus on identification, management, and optimal resource utilization for effective palliation of acute episodes of dyspnea. We conducted a comprehensive search of the medical literature and evaluated available evidence from systematic evidence-based reviews (SEBRs) using a modified AMSTAR approach and then summarized the palliative management knowledge base for participants to use in discourse at a 2009 ATS workshop. We used an informal consensus process to develop a working definition of this novel entity and established an Ad Hoc Committee on Palliative Management of Dyspnea Crisis to further develop an official ATS document on the topic. The Ad Hoc Committee members defined dyspnea crisis as "sustained and severe resting breathing discomfort that occurs in patients with advanced, often life-limiting illness and overwhelms the patient and caregivers' ability to achieve symptom relief." Dyspnea crisis can occur suddenly and is characteristically without a reversible etiology. The workshop participants focused on dyspnea crisis management for patients in whom the goals of care are focused on palliation and for whom endotracheal intubation and mechanical ventilation are not consistent with articulated preferences. However, approaches to dyspnea crisis may also be appropriate for patients electing life-sustaining treatment. The Ad Hoc Committee developed a Workshop Report concerning assessment of dyspnea crisis; ethical and professional considerations; efficient utilization, communication, and care coordination; clinical management of dyspnea crisis; development of patient education and provider aid products; and enhancing implementation with audit and quality improvement. PMID:24161068

  2. An official American Thoracic Society workshop report: assessment and palliative management of dyspnea crisis.

    Science.gov (United States)

    Mularski, Richard A; Reinke, Lynn F; Carrieri-Kohlman, Virginia; Fischer, Mark D; Campbell, Margaret L; Rocker, Graeme; Schneidman, Ann; Jacobs, Susan S; Arnold, Robert; Benditt, Joshua O; Booth, Sara; Byock, Ira; Chan, Garrett K; Curtis, J Randall; Donesky, Doranne; Hansen-Flaschen, John; Heffner, John; Klein, Russell; Limberg, Trina M; Manning, Harold L; Morrison, R Sean; Ries, Andrew L; Schmidt, Gregory A; Selecky, Paul A; Truog, Robert D; Wang, Angela C C; White, Douglas B

    2013-10-01

    In 2009, the American Thoracic Society (ATS) funded an assembly project, Palliative Management of Dyspnea Crisis, to focus on identification, management, and optimal resource utilization for effective palliation of acute episodes of dyspnea. We conducted a comprehensive search of the medical literature and evaluated available evidence from systematic evidence-based reviews (SEBRs) using a modified AMSTAR approach and then summarized the palliative management knowledge base for participants to use in discourse at a 2009 ATS workshop. We used an informal consensus process to develop a working definition of this novel entity and established an Ad Hoc Committee on Palliative Management of Dyspnea Crisis to further develop an official ATS document on the topic. The Ad Hoc Committee members defined dyspnea crisis as "sustained and severe resting breathing discomfort that occurs in patients with advanced, often life-limiting illness and overwhelms the patient and caregivers' ability to achieve symptom relief." Dyspnea crisis can occur suddenly and is characteristically without a reversible etiology. The workshop participants focused on dyspnea crisis management for patients in whom the goals of care are focused on palliation and for whom endotracheal intubation and mechanical ventilation are not consistent with articulated preferences. However, approaches to dyspnea crisis may also be appropriate for patients electing life-sustaining treatment. The Ad Hoc Committee developed a Workshop Report concerning assessment of dyspnea crisis; ethical and professional considerations; efficient utilization, communication, and care coordination; clinical management of dyspnea crisis; development of patient education and provider aid products; and enhancing implementation with audit and quality improvement.

  3. Effectiveness of classroom based crew resource management training in the intensive care unit: study design of a controlled trial.

    NARCIS (Netherlands)

    Kemper, P.F.; Bruijne, M. de; Dyck, C. van; Wagner, C.

    2011-01-01

    Background: Crew resource management (CRM) has the potential to enhance patient safety in intensive care units (ICU) by improving the use of non-technical skills. However, CRM evaluation studies in health care are inconclusive with regard to the effect of this training on behaviour and organizationa

  4. Diabetes rehabilitation : development and first results of a Multidisciplinary Intensive Education Program for patients with prolonged self-management difficulties

    NARCIS (Netherlands)

    Keers, JC; Blaauwwiekel, EE; Hania, M; Bouma, J; Scholten-Jaegers, SMHJ; Sanderman, R; Links, TP

    2004-01-01

    For a number of diabetes patients regular care may be insufficient. A Multidisciplinary Intensive Education Program (MIEP), based on the empowerment approach, has been developed to help patients obtain their treatment goals (adequate self-management, glycemic control and quality of life). The aim of

  5. Diabetes rehabilitation : Effects of a Multidisciplinary Intensive Education Programme for diabetic patients with prolonged self-management difficulties

    NARCIS (Netherlands)

    Keers, JC; Links, TP; Bouma, J; Scholten-Jaegers, SMHJ; Gans, ROB; Sanderman, R

    2005-01-01

    This study aimed to determine effects of a Multidisciplinary Intensive Education Programme (MIEP) based on the empowerment approach for diabetic patients with prolonged self-management difficulties. In 89 participants, glycaemic control (HbA1c), health related quality of life (HR-QoL) and indicators

  6. Comparison of net global warming potential and greenhouse gas intensity affected by management practices in two dryland cropping sites

    Science.gov (United States)

    Little is known about the effect of management practices on net global warming potential (GWP) and greenhouse gas intensity (GHGI) that account for all sources and sinks of greenhouse gas (GHG) emissions in dryland cropping systems. The objective of this study was to compare the effect of a combinat...

  7. Database Management System Construction for the Evaluation Results of Intensive Land Use in the Development Areas of Hunan Province

    Institute of Scientific and Technical Information of China (English)

    Mingliang; LIU

    2013-01-01

    Using spatial data integration and database technology,analyzing and integrating the assessment results in all the development zones at different time in Hunan Province,the paper is intended to construct the database and managerial system for the assessment results of land use intensity in development zones,thus formulating"one map"of Hunan Development zones and realizing the integrated management and application of the assessment results in all the development zones at any time of Hunan above the provincial level.It has been proved that the system has good application effect and promising development in land management for land management departments and development zones.

  8. Systolic blood pressure response after high-intensity interval exercise is independently related to decreased small arterial elasticity in normotensive African American women.

    Science.gov (United States)

    Carter, Stephen J; Goldsby, TaShauna U; Fisher, Gordon; Plaisance, Eric P; Gower, Barbara A; Glasser, Stephen P; Hunter, Gary R

    2016-05-01

    Aerobic exercise transiently lowers blood pressure. However, limited research has concurrently evaluated blood pressure and small arterial elasticity (SAE), an index of endothelial function, among African American (AA) and European American (EA) women the morning after (i.e., ≈22 h later) acute bouts of moderate-intensity continuous (MIC) and high-intensity interval (HII) exercise matched for total work. Because of greater gradients of shear stress, it was hypothesized that HII exercise would elicit a greater reduction in systolic blood pressure (SBP) compared to MIC exercise. After baseline, 22 AA and EA women initiated aerobic exercise training 3 times/week. Beginning at week 8, three follow-up assessments were conducted over the next 8 weeks at random to measure resting blood pressure and SAE. In total all participants completed 16 weeks of training. Follow-up evaluations were made: (i) in the trained state (TS; 8-16 weeks of aerobic training); (ii) ≈22 h after an acute bout of MIC exercise; and (iii) ≈22 h after an acute bout of HII exercise. Among AAs, the acute bout of HII exercise incited a significant increase in SBP (mm Hg) (TS, 121 ± 14 versus HII, 128 ± 14; p = 0.01) whereas responses (TS, 116 ± 12 versus HII, 113 ± 9; p = 0.34) did not differ in EAs. After adjusting for race, changes in SAE were associated (partial r = -0.533; p = 0.01) with changes in SBP following HII exercise. These data demonstrate an acute, unaccustomed bout of HII exercise produces physiological perturbations resulting in a significant increase in SBP that are independently associated with decreased SAE among AA women, but not EA women.

  9. Emerging Themes in the Ecology and Management of North American Forests

    Directory of Open Access Journals (Sweden)

    Terry L. Sharik

    2010-01-01

    Full Text Available The 7th North American Forest Ecology Workshop, consisting of 149 presentations in 16 oral sessions and a poster session, reflected a broad range of topical areas currently under investigation in forest ecology and management. There was an overarching emphasis on the role of disturbance, both natural and anthropogenic, in the dynamics of forest ecosystems, and the recognition that legacies from past disturbances strongly influence future trajectories. Climate was invoked as a major driver of ecosystem change. An emphasis was placed on application of research findings for predicting system responses to changing forest management initiatives. Several “needs” emerged from the discussions regarding approaches to the study of forest ecosystems, including (1 consideration of variable spatial and temporal scales, (2 long-term monitoring, (3 development of universal databases more encompassing of time and space to facilitate meta-analyses, (4 combining field studies and modeling approaches, (5 standardizing methods of measurement and assessment, (6 guarding against oversimplification or overgeneralization from limited site-specific results, (7 greater emphasis on plant-animal interactions, and (8 better alignment of needs and communication of results between researchers and managers.

  10. Customized recommendations for production management clusters of North American automatic milking systems.

    Science.gov (United States)

    Tremblay, Marlène; Hess, Justin P; Christenson, Brock M; McIntyre, Kolby K; Smink, Ben; van der Kamp, Arjen J; de Jong, Lisanne G; Döpfer, Dörte

    2016-07-01

    Automatic milking systems (AMS) are implemented in a variety of situations and environments. Consequently, there is a need to characterize individual farming practices and regional challenges to streamline management advice and objectives for producers. Benchmarking is often used in the dairy industry to compare farms by computing percentile ranks of the production values of groups of farms. Grouping for conventional benchmarking is commonly limited to the use of a few factors such as farms' geographic region or breed of cattle. We hypothesized that herds' production data and management information could be clustered in a meaningful way using cluster analysis and that this clustering approach would yield better peer groups of farms than benchmarking methods based on criteria such as country, region, breed, or breed and region. By applying mixed latent-class model-based cluster analysis to 529 North American AMS dairy farms with respect to 18 significant risk factors, 6 clusters were identified. Each cluster (i.e., peer group) represented unique management styles, challenges, and production patterns. When compared with peer groups based on criteria similar to the conventional benchmarking standards, the 6 clusters better predicted milk produced (kilograms) per robot per day. Each cluster represented a unique management and production pattern that requires specialized advice. For example, cluster 1 farms were those that recently installed AMS robots, whereas cluster 3 farms (the most northern farms) fed high amounts of concentrates through the robot to compensate for low-energy feed in the bunk. In addition to general recommendations for farms within a cluster, individual farms can generate their own specific goals by comparing themselves to farms within their cluster. This is very comparable to benchmarking but adds the specific characteristics of the peer group, resulting in better farm management advice. The improvement that cluster analysis allows for is

  11. Customized recommendations for production management clusters of North American automatic milking systems.

    Science.gov (United States)

    Tremblay, Marlène; Hess, Justin P; Christenson, Brock M; McIntyre, Kolby K; Smink, Ben; van der Kamp, Arjen J; de Jong, Lisanne G; Döpfer, Dörte

    2016-07-01

    Automatic milking systems (AMS) are implemented in a variety of situations and environments. Consequently, there is a need to characterize individual farming practices and regional challenges to streamline management advice and objectives for producers. Benchmarking is often used in the dairy industry to compare farms by computing percentile ranks of the production values of groups of farms. Grouping for conventional benchmarking is commonly limited to the use of a few factors such as farms' geographic region or breed of cattle. We hypothesized that herds' production data and management information could be clustered in a meaningful way using cluster analysis and that this clustering approach would yield better peer groups of farms than benchmarking methods based on criteria such as country, region, breed, or breed and region. By applying mixed latent-class model-based cluster analysis to 529 North American AMS dairy farms with respect to 18 significant risk factors, 6 clusters were identified. Each cluster (i.e., peer group) represented unique management styles, challenges, and production patterns. When compared with peer groups based on criteria similar to the conventional benchmarking standards, the 6 clusters better predicted milk produced (kilograms) per robot per day. Each cluster represented a unique management and production pattern that requires specialized advice. For example, cluster 1 farms were those that recently installed AMS robots, whereas cluster 3 farms (the most northern farms) fed high amounts of concentrates through the robot to compensate for low-energy feed in the bunk. In addition to general recommendations for farms within a cluster, individual farms can generate their own specific goals by comparing themselves to farms within their cluster. This is very comparable to benchmarking but adds the specific characteristics of the peer group, resulting in better farm management advice. The improvement that cluster analysis allows for is

  12. Overview of the 2015 American Thyroid Association guidelines for managing thyroid nodules and differentiated thyroid cancer.

    Science.gov (United States)

    Matti, Bashar; Cohen-Hallaleh, Ruben

    2016-01-01

    The last few years have witnessed numerous publications addressing the management of thyroid nodules and differentiated thyroid cancers. The purpose of this review is to provide a simplified summary of the newly released guidelines by the American Thyroid Association. A systematic approach has been recommended to evaluate a thyroid nodule through clinical assessment, measurement of serum Thyroid Stimulating Hormone, neck ultrasonography and Fine Needle Aspiration where appropriate. This is followed by cytology analysis using the Bethesda scoring system to detect malignancy. Once diagnosed, thyroid cancers need to be staged and risk stratification needs to be applied to develop further treatment plans. Lastly, several recommendations have been presented to assure proper follow-up and support for thyroid cancer patients regardless of the treatment received. PMID:27607088

  13. Personalized Weight Management Interventions for Cardiovascular Risk Reduction: A Viable Option for African-American Women.

    Science.gov (United States)

    Franklin, Nina C; Arena, Ross

    2016-01-01

    Obesity is an independent contributor to cardiovascular disease (CVD) and a major driving force behind racial/ethnic and gender disparities in risk. Due to a multitude of interrelating factors (i.e., personal, social, cultural, economic and environmental), African-American (AA) women are disproportionately obese and twice as likely to succumb to CVD, yet they are significantly underrepresented in behavioral weight management interventions. In this selective review we highlight components of the limited interventions shown to enhance weight loss outcomes in this population and make a case for leveraging Web-based technology and artificial intelligence techniques to deliver personalized programs aimed at obesity treatment and CVD risk reduction. Although many of the approaches discussed are generally applicable across populations burdened by disparate rates of obesity and CVD, we specifically focus on AA women due to the disproportionate impact of these non-communicable diseases and the general paucity of interventions targeted to this high-risk group. PMID:26908050

  14. Protocol management of severe traumatic brain injury in intensive care units: a systematic review.

    Science.gov (United States)

    English, Shane W; Turgeon, Alexis F; Owen, Elliott; Doucette, Steve; Pagliarello, Giuseppe; McIntyre, Lauralyn

    2013-02-01

    To examine clinical trials and observational studies that compared use of management protocols (MPs) versus usual care for adult intensive care unit (ICU) patients with acute severe traumatic brain injury (TBI) on 6-month neurologic outcome (Glasgow Outcome Scale, GOS) and mortality, major electronic databases were searched from 1950 to April 18, 2011. Abstracts from major international meetings were searched to identify gray literature. A total of 6,151 articles were identified; 488 were reviewed in full and 13 studies were included. Data on patient and MP characteristics, outcomes and methodological quality were extracted. All 13 included studies were observational. A random effects model showed that use of MPs was associated with a favorable neurologic outcome (GOS 4 or 5) at 6 months (odds ratio [OR] and 95 % confidence interval [CI] 3.84 (2.47-5.96)) but not 12 months (OR, 95 % CI 0.87 (0.56-1.36)). Use of MPs was associated with reduced mortality at hospital discharge and 6 months (OR and 95 % CI 0.72 (0.45-1.14) and 0.33 (0.13-0.82) respectively), but not 12 months (OR, 95 % CI 0.79 (0.5-1.24)). Sources of heterogeneity included variation in study design, methodological quality, MP design, MP neurophysiologic endpoints, and type of ICU. MPs for severe TBI were associated with reductions in death and improved neurologic outcome. Although no definitive conclusions about the efficacy of MPs for severe TBI can be drawn from our study, these results should encourage the conduct of randomized controlled trials to more rigorously examine the efficacy of MPs for severe TBI.

  15. Management of Differentiated Thyroid Cancer in Children: Focus on the American Thyroid Association Pediatric Guidelines.

    Science.gov (United States)

    Parisi, Marguerite T; Eslamy, Hedieh; Mankoff, David

    2016-03-01

    First introduced in 1946, radioactive iodine (I-131) produces short-range beta radiation with a half-life of 8 days. The physical properties of I-131 combined with the high degree of uptake in the differentiated thyroid cancers (DTCs) led to the use of I-131 as a therapeutic agent for DTC in adults. There are two indications for the potential use of I-131 therapy in pediatric thyroid disorders: nonsurgical treatment of hyperthyroidism owing to Graves' disease and the treatment of children with intermediate- and high-risk DTC. However, children are not just miniature adults. Not only are children and the pediatric thyroid gland more sensitive to radiation than adults but also the biologic behavior of DTC differs between children and adults as well. As opposed to adults, children with DTC typically present with advanced disease at diagnosis; yet, they respond rapidly to therapy and have an excellent prognosis that is significantly better than that in adult counterparts with advanced disease. Unfortunately, there are also higher rates of local and distant disease recurrence in children with DTC compared with adults, mandating lifelong surveillance. Further, children have a longer life expectancy during which the adverse effects of I-131 therapy may become manifest. Recognizing the differences between adults and children with DTC, the American Thyroid Association commissioned a task force of experts who developed and recently published a guideline to address the unique issues related to the management of thyroid nodules and DTC in children. This article reviews the epidemiology, diagnosis, staging, treatment, therapy-related effects, and suggestions for surveillance in children with DTC, focusing not only on the differences between adults and children with this disease but also on the latest recommendations from the inaugural pediatric management guidelines of the American Thyroid Association.

  16. Disparities in lipid management for African Americans and Caucasians with coronary artery disease: A national cross-sectional study

    Directory of Open Access Journals (Sweden)

    Carter-Edwards Lori

    2004-08-01

    Full Text Available Abstract Background Individuals with coronary artery disease are at high risk for adverse health outcomes. This risk can be diminished by aggressive lipid management, but adherence to lipid management guidelines is far from ideal and substantial racial disparities in care have been reported. Lipid treatment and goal attainment information is not readily available for large patient populations seen in the fee-for-service setting. As a result, national programs to improve lipid management in this setting may focus on lipid testing as an indicator of lipid management. We describe the detection, treatment, and control of dyslipdemia for African Americans and Caucasians with coronary artery disease to evaluate whether public health programs focusing on lipid testing can eliminate racial disparities in lipid management. Methods Physicians and medical practices with high numbers of prescriptions for coronary artery disease medications were invited to participate in the Quality Assurance Program. Medical records were reviewed from a random sample of patients with coronary artery disease seen from 1995 through 1998. Data related to the detection, treatment, and control of dyslipidemia were abstracted from the medical record and evaluated in cross-sectional stratified and logistic regression analyses using generalized estimation equations. Results Data from the medical records of 1,046 African Americans and 22,077 Caucasians seen in outpatient medical practices in 23 states were analyzed. African-American patients were younger, more likely to be women and to have diabetes, heart failure, and hypertension. The low density lipoprotein cholesterol (LDL-C testing rate for Caucasian men was over 1.4 times higher than that for African-American women and about 1.3 times higher than that for African-American men. Almost 60% of tested Caucasian men and less than half of tested African Americans were prescribed lipid-lowering drugs. Tested and treated Caucasian men

  17. Birth weight and weaning weight of Boer kids under an intensive management system

    International Nuclear Information System (INIS)

    In Malaysia, mutton (as chevon is called locally) is one of the main red meat consumed. The total mutton demand in 2007 was 20,000 mT. However, its output for the year was only 1750 mT, a mere 8.75% self-sufficiency. The demand is met by import of mutton and live animals, especially from Australia. However, with stimulus provided under the National Agricultural Policy and the recent introduction of the Boer goats with excellent body conformation, growth rate and carcass quality, the goat industry is rapidly developing. Many medium to large Boer goat farms are being established with purebred Boer goats and crosses imported from Australia and South African as breeding animals. Many of the farmers are new to the farming industry and have acquired knowledge and skills through short courses, publications, government extension workers, local and foreign stock suppliers, or hired consultants. To ensure the economic viability of the industry, good management systems, quality and cost-effective feed resources, and highly productive animals are essential. However, there is little information on the growth and reproductive performance of Boer goats in Malaysia. In addition, the effects of genetic and non-genetic factors influencing the traits of interest have yet to be evaluated. A project was undertaken to evaluate the growth performance of the Boer goats under intensive management system. This reports the preliminary results, focusing on the effects of year of birth, sex of kid and litter type on birth and weaning weights in one of the newly established Boer goat farms. The data is from 397 purebred Boer kids, offspring of 174 does and 16 bucks imported from Australia, in a medium sized (300-1000 heads), commercial farm. The kids were raised with their dams in group pens in raised, wooden sheds. They were fed fresh Napier grass, provided twice daily, supplemented with concentrated feed. The kids were weaned at about 90 d of age. The GLM procedure of SAS 9.1 was used to

  18. International Human Resources Management of Japanese, American, and European Firms in Asia : The Roles of Headquarters and Subsidiaries

    OpenAIRE

    Hiromichi Shibata; Andrew Doyle

    2006-01-01

    The main role of the headquarters international human resources departments/business units of seven Japanese firms we researched is to manage the Japanese expatriates at their subsidiaries in Asia; they have little involvement with the management of local employees. The headquarters international human resources departments/business units at five researched American firms tend to maintain strong company value/mission that drives use of their performance appraisal/promotion systems for employe...

  19. Classroom Management Training for Teachers in Urban Environments Serving Predominately African American Students: A Review of the Literature

    Science.gov (United States)

    Larson, Kristine E.

    2016-01-01

    The purpose of this paper was to review the literature in terms of professional development activities that researchers have enlisted to reduce student problem behaviors and improve classroom management competencies among teachers who work in urban environments serving predominately African American students. First, the author conducted a…

  20. Stress Management-Augmented Behavioral Weight Loss Intervention for African American Women: A Pilot, Randomized Controlled Trial

    Science.gov (United States)

    Cox, Tiffany L.; Krukowski, Rebecca; Love, ShaRhonda J.; Eddings, Kenya; DiCarlo, Marisha; Chang, Jason Y.; Prewitt, T. Elaine; West, Delia Smith

    2013-01-01

    The relationship between chronic stress and weight management efforts may be a concern for African American (AA) women, who have a high prevalence of obesity, high stress levels, and modest response to obesity treatment. This pilot study randomly assigned 44 overweight/obese AA women with moderate to high stress levels to either a 12-week…

  1. "No More Mr. Nice Guy": Preservice Teachers' Conflict with Classroom Management in a Predominantly African-American Urban Elementary School

    Science.gov (United States)

    Higgins, Karen M.; Moule, Jean

    2009-01-01

    Using methods of naturalistic inquiry, this study examines preservice teachers' conflict with classroom management strategies used in a predominantly African-American urban elementary school. It highlights the theory/practice dilemma, focusing on the tensions between the democratic strategies taught in university classes and the more authoritarian…

  2. Identification of Elizabethkingia meningoseptica from American bullfrog (Rana catesbeiana) farmed in Sabah, Malaysia using PCR method and future management of outbreak

    OpenAIRE

    Zainuri, N.; Ransangan, J.; Lal, T. M.; Jintoni, B.; Chung, V. S.

    2013-01-01

    Aims: High demand for frog meat in Malaysia especially the American bullfrog (Rana catesbeiana) has promoted intensive farming of the animal. However, the farming of American bullfrog is restricted by the occurrence of diseases. This study reports the first isolation of Elizabethkingia meningoseptica from specimens of American bullfrog that suffer from cataract and ‘red-leg’ syndrome.Methodology and Result: The pathogen was isolated from eyes and internal organs (liver, kidney and spleen) of ...

  3. Recommendations for responsible monitoring and regulation of clinical software systems. American Medical Informatics Association, Computer-based Patient Record Institute, Medical Library Association, Association of Academic Health Science Libraries, American Health Information Management Association, American Nurses Association.

    Science.gov (United States)

    Miller, R A; Gardner, R M

    1997-01-01

    In mid-1996, the FDA called for discussions on regulation of clinical software programs as medical devices. In response, a consortium of organizations dedicated to improving health care through information technology has developed recommendations for the responsible regulation and monitoring of clinical software systems by users, vendors, and regulatory agencies. Organizations assisting in development of recommendations, or endorsing the consortium position include the American Medical Informatics Association, the Computer-based Patient Record Institute, the Medical Library Association, the Association of Academic Health Sciences Libraries, the American Health Information Management Association, the American Nurses Association, the Center for Healthcare Information Management, and the American College of Physicians. The consortium proposes four categories of clinical system risks and four classes of measured monitoring and regulatory actions that can be applied strategically based on the level of risk in a given setting. The consortium recommends local oversight of clinical software systems, and adoption by healthcare information system developers of a code of good business practices. Budgetary and other constraints limit the type and number of systems that the FDA can regulate effectively. FDA regulation should exempt most clinical software systems and focus on those systems posing highest clinical risk, with limited opportunities for competent human intervention. PMID:9391932

  4. Recommendations for responsible monitoring and regulation of clinical software systems. American Medical Informatics Association, Computer-based Patient Record Institute, Medical Library Association, Association of Academic Health Science Libraries, American Health Information Management Association, American Nurses Association.

    Science.gov (United States)

    Miller, R A; Gardner, R M

    1997-01-01

    In mid-1996, the FDA called for discussions on regulation of clinical software programs as medical devices. In response, a consortium of organizations dedicated to improving health care through information technology has developed recommendations for the responsible regulation and monitoring of clinical software systems by users, vendors, and regulatory agencies. Organizations assisting in development of recommendations, or endorsing the consortium position include the American Medical Informatics Association, the Computer-based Patient Record Institute, the Medical Library Association, the Association of Academic Health Sciences Libraries, the American Health Information Management Association, the American Nurses Association, the Center for Healthcare Information Management, and the American College of Physicians. The consortium proposes four categories of clinical system risks and four classes of measured monitoring and regulatory actions that can be applied strategically based on the level of risk in a given setting. The consortium recommends local oversight of clinical software systems, and adoption by healthcare information system developers of a code of good business practices. Budgetary and other constraints limit the type and number of systems that the FDA can regulate effectively. FDA regulation should exempt most clinical software systems and focus on those systems posing highest clinical risk, with limited opportunities for competent human intervention.

  5. The influence of abiotic controls and management intensity on phosphorus cycling in established grassland and forest ecosystems

    Science.gov (United States)

    Alt, F.; Oelmann, Y.; Wilcke, W.

    2011-12-01

    It is commonly assumed that the bioavailability and cycling of phosphorus (P) is mainly controlled by abiotic soil properties including soil pH and the concentrations and reactivities of clay minerals, CaCO3 and Al/Fe oxides In managed ecosystems, kind, timing and duration of P additions and type and amount of harvested biomass are the major input and output fluxes. Our objective was to disentangle the effects of abiotic controls, and type and intensity of management on the P cycle in soils of temperate grasslands and forests of different management intensity in three regions across Germany in the frame of the Biodiversity Exploratories project. The pH value was the most important variable explaining P concentrations and partitioning in soil and changes in pH are the main mechanism how land-use is affecting the P cycle. However, after the influence of pH was accounted for in a sequential statistical approach, land-use intensity, classified according to the extent of annual biomass removal, explained a significant (P soils of highly diverse systems (up to 57 plant species) in one of the study regions, the Schwäbische Alb, a mid-range mountain area on limestone where soils showed a limited variation in pH in the carbonate buffer range, pedogenic Fe oxide concentrations, fertilizer-P application rates, and TP concentrations in soil explained more than half of the variation in bioavailable inorganic (Pi) concentrations extracted with NaHCO3 in soil. Our results demonstrate that mainly soil pH and mineralogical composition, and intensity of management of the managed ecosystems are significant controls of the P cycle determining the size of bioavailable P pool in soil.

  6. High-intensity interval training without weight loss improves exercise but not basal or insulin-induced metabolism in overweight/obese African American women.

    Science.gov (United States)

    Arad, Avigdor D; DiMenna, Fred J; Thomas, Naketa; Tamis-Holland, Jacqueline; Weil, Richard; Geliebter, Allan; Albu, Jeanine B

    2015-08-15

    The purpose of this randomized controlled clinical trial was to determine the effect of a 14-week high-intensity interval training (HIIT) intervention with weight stability on metabolic flexibility, insulin sensitivity, and cardiorespiratory fitness in sedentary, premenopausal, nondiabetic, overweight/obese African American women. Twenty-eight subjects were allocated to one of two groups: HIIT, which performed three sessions per week of four high-intensity cycling intervals, or a control group (CON), which maintained their normal level of physical activity. Diet was controlled for all subjects to ensure weight stability. Pre- and postintervention (pre/post), subjects completed an incremental cycling test to limit of tolerance and, following a 10-day high-fat controlled feeding period, a euglycemic-hyperinsulinemic clamp to determine insulin sensitivity and substrate oxidation. Nine members of HIIT (age, 29 ± 4 yr; body mass, 90.1 ± 13.8 kg) and eleven members of CON (age, 30 ± 7 yr; body mass, 85.5 ± 10.7 kg) completed the study. HIIT experienced an increased limit of tolerance (post, 1,124 ± 202 s; pre, 987 ± 146 s; P < 0.05), gas exchange threshold (post, 1.29 ± 0.34 liters/min; pre, 0.97 ± 0.23 liters/min; P < 0.05), and fat oxidation at the same absolute submaximal work rate compared with CON (P < 0.05 for group-by-time interaction in all cases). However, changes in peak oxygen consumption (V̇o2peak), insulin sensitivity, free fatty acid suppression during insulin stimulation, and metabolic flexibility were not different in HIIT compared with CON. High-intensity interval training with weight stability increased exercise fat oxidation and tolerance in subjects at risk for diabetic progression, but did not improve insulin sensitivity or fat oxidation in the postabsorptive or insulin-stimulated state. PMID:26112241

  7. Consensus recommendations from the American acne & rosacea society on the management of rosacea, part 4: a status report on physical modalities and devices.

    Science.gov (United States)

    Tanghetti, Emil; Del Rosso, James Q; Thiboutot, Diane; Gallo, Richard; Webster, Guy; Eichenfield, Lawrence F; Stein-Gold, Linda; Berson, Diane; Zaenglein, Andrea

    2014-02-01

    The fourth article in this 5-part series reviews physical modalities and devices used to treat cutaneous rosacea based on consensus recommendations from the American Acne & Rosacea Society (AARS) on the management of the common presentations of cutaneous rosacea. The major therapeutic uses of physical modalities and devices, especially laser and light-based systems, are for treatment of telangiectases and persistent facial erythema (background erythema). Phymas, especially rhinophyma, also are treated with physical modalities such as ablative lasers or surgical devices (eg, electrosurgical loop). Appropriately selected and properly used lasers and intense pulsed light (IPL) devices can successfully address specific clinical manifestations of rosacea that exhibit limited or no response to available medical therapies, such as telangiectases and background centrofacial erythema. Rosacea-associated symptoms also may improve. In most cases, treatment will need to be repeated intermittently to sustain improvement.

  8. European and North American lung cancer screening experience and implications for pulmonary nodule management

    Energy Technology Data Exchange (ETDEWEB)

    Nair, Arjun [St. Georges Hospital, Department of Radiology, London (United Kingdom); Hansell, David M. [Royal Brompton Hospital, Department of Radiology, London (United Kingdom)

    2011-12-15

    The potential for low dose computed tomography (LDCT) to act as an effective tool in screening for lung cancer is currently the subject of several randomised control trials. It has recently been given prominence by interim results released by the North American National Lung Screening Trial (NLST). Several other trials assessing LDCT as a screening tool are currently underway in Europe, and are due to report their final results in the next few years. These include the NELSON, DLSCT, DANTE, ITALUNG, MILD and LUSI trials. Although slow to instigate a trial of its own, the UK Lung Screen (UKLS) trial will shortly commence. The knowledge gained from the newer trials has mostly reinforced and refined previous concepts that have formed the basis of existing nodule management guidelines. This article takes the opportunity to summarise the main aspects and initial results of the trials presently underway, assess the status of current collaborative efforts and the scope for future collaboration, and analyse observations from these studies that may usefully inform the management of the indeterminate pulmonary nodule. (orig.)

  9. European and North American lung cancer screening experience and implications for pulmonary nodule management

    International Nuclear Information System (INIS)

    The potential for low dose computed tomography (LDCT) to act as an effective tool in screening for lung cancer is currently the subject of several randomised control trials. It has recently been given prominence by interim results released by the North American National Lung Screening Trial (NLST). Several other trials assessing LDCT as a screening tool are currently underway in Europe, and are due to report their final results in the next few years. These include the NELSON, DLSCT, DANTE, ITALUNG, MILD and LUSI trials. Although slow to instigate a trial of its own, the UK Lung Screen (UKLS) trial will shortly commence. The knowledge gained from the newer trials has mostly reinforced and refined previous concepts that have formed the basis of existing nodule management guidelines. This article takes the opportunity to summarise the main aspects and initial results of the trials presently underway, assess the status of current collaborative efforts and the scope for future collaboration, and analyse observations from these studies that may usefully inform the management of the indeterminate pulmonary nodule. (orig.)

  10. Coastal activities in American Samoa in 2012 for use in coastal management

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The American Samoa Coastal use Participatory Mapping Project was developed through a partnership between the American Samoa Government's Department of Commerce...

  11. Management of nurse shortage and its impact on pathogen dissemination in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Jordi Ferrer

    2014-12-01

    Conclusions: Agent-based models with explicit staff management such as the model presented may prove useful to design staff management policies that mitigate the risk of healthcare-associated infections under episodes of increased nurse shortage.

  12. Problems in Knowledge Management: A Case Study of a Knowledge-Intensive Company

    NARCIS (Netherlands)

    Zolingen, van S.J.; Streumer, J.N.; Stooker, M.

    2001-01-01

    Knowledge management has become an important tool in staying ahead in the competition between companies. In this article five different phases of the knowledge management process are distinguished: acquiring knowledge, codifying knowledge, disseminating knowledge, developing knowledge and applying k

  13. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association task force on practice guidelines

    Science.gov (United States)

    The goals of the American College of Cardiology (ACC) and the American Heart Association (AHA) are to prevent cardiovascular (CV) diseases, improve the management of people who have these diseases through professional education and research, and develop guidelines, standards and policies that promot...

  14. PATIENT DATA MANAGEMENT SYSTEM IN INTENSIVE CARE UNIT (ICU) USING LABVIEW

    OpenAIRE

    Amritjot Kaur*, Shimi S. L

    2016-01-01

    This paper proposes a new system that takes the benefits of data flow technology. Its objective is to collect the data from monitoring system in the intensive care unit (ICU) and store that data for further analysis. Then it will be available for medical personnel to analyze data and take the suitable medication for patients. In fact, the monitoring system in intensive care unit provides a large amount of data quickly and continuously. Most units operate with a very limited storage capacity w...

  15. Intensive Care Unit–Acquired Weakness: Implications for Physical Therapist Management

    OpenAIRE

    Nordon-Craft, Amy; Moss, Marc; Quan, Dianna; Schenkman, Margaret

    2012-01-01

    Patients admitted to the intensive care unit (ICU) can develop a condition referred to as “ICU-acquired weakness.” This condition is characterized by profound weakness that is greater than might be expected to result from prolonged bed rest. Intensive care unit–acquired weakness often is accompanied by dysfunction of multiple organ systems. Individuals with ICU-acquired weakness typically have significant activity limitations, often requiring physical assistance for even the...

  16. The Role of Dietary Protein and Fat in Glycaemic Control in Type 1 Diabetes: Implications for Intensive Diabetes Management

    OpenAIRE

    Paterson, Megan; Bell, Kirstine J.; O’Connell, Susan M.; Smart, Carmel E.; Shafat, Amir; King, Bruce

    2015-01-01

    A primary focus of the management of type 1 diabetes has been on matching prandial insulin therapy with carbohydrate amount consumed. However, even with the introduction of more flexible intensive insulin regimes, people with type 1 diabetes still struggle to achieve optimal glycaemic control. More recently, dietary fat and protein have been recognised as having a significant impact on postprandial blood glucose levels. Fat and protein independently increase the postprandial glucose excursion...

  17. Diabetes rehabilitation: development and first results of a Multidisciplinary Intensive Education Program for patients with prolonged self-management difficulties

    OpenAIRE

    Keers, JC; Blaauwwiekel, EE; Hania, M; J. Bouma; Scholten-Jaegers, SMHJ; Sanderman, R.; Links, TP

    2004-01-01

    For a number of diabetes patients regular care may be insufficient. A Multidisciplinary Intensive Education Program (MIEP), based on the empowerment approach, has been developed to help patients obtain their treatment goals (adequate self-management, glycemic control and quality of life). The aim of this pilot study is to determine the effects of MIEP and it's mechanisms of influence. MIEP consisted of 12 days group-sessions and individual counseling. At baseline and 3-months follow-up, blood...

  18. KPI-focused Simulation and Management System for Eco-Efficient Design of Energy-Intensive Production Systems

    OpenAIRE

    Riexinger, Günther; Holtewert, Philipp; Bruns, Axel; Wahren, Sylvia; Tran, Khoi; Bauernhansl, Thomas

    2015-01-01

    The optimal eco-efficient design of production processes guarantees sustainable and resource-efficient manufacturing systems. Within the scope of the European project "DAPhNE", Fraunhofer IPA enables eco-efficient design with a new integrated system for the simulation and management of energy-intensive production systems as well as related key performance indicators (KPIs). The approach presented in this paper is based on a holistic production model and simulation system including dynamic KPI...

  19. Database Management System Construction for the Evaluation Results of Intensive Land Use in the Development Areas of Hunan Province

    OpenAIRE

    Liu, Mingliang

    2013-01-01

    Using spatial data integration and database technology, analyzing and integrating the assessment results in all the development zones at different time in Hunan Province, the paper is intended to construct the database and managerial system for the assessment results of land use intensity in development zones, thus formulating “one map†of Hunan Development zones and realizing the integrated management and application of the assessment results in all the development zones at any time of Hu...

  20. Historical changes in channel network extent and channel planform in an intensively managed landscape: Natural versus human-induced effects

    Science.gov (United States)

    Rhoads, Bruce L.; Lewis, Quinn W.; Andresen, William

    2016-01-01

    Humans have become major geomorphological agents, effecting substantial change in the characteristics of Earth's physical landscapes. The agricultural Midwest of the United States is a region marked by pronounced human influence at the landscape scale. Humans undoubtedly have strongly influenced critical zone processes, including fluvial processes, in intensively managed agricultural landscapes, yet the exact nature of human alteration of these processes is unknown. This study documents historical changes in the extent of the stream channel network and in channel planform within the upper Sangamon River basin - an intensively managed agricultural watershed in Illinois. Results indicate that the modern channel network is nearly three times more extensive than the channel network in the 1820s. Most change in drainage density has occurred in headwater portions of the basin where numerous drainage ditches have been added to the network to drain flat uplands. No detectable change in channel position is evident between 1940 and 2012 along about 60% of the total length of the Sangamon River and its major tributaries. Nearly 30% of the total length exhibits change related to meander dynamics (cutoffs and lateral migration), whereas about 8% has changed as a result of channelization. Channelized sections typically remain straight for decades following human modification, supporting the notion that humans produce long-lasting catastrophic change in channel planform in this region. The findings confirm that humans are effective agents of morphological change in fluvial systems in this intensively managed watershed. Documenting human-induced versus natural changes in fluvial systems is important for evaluating how other critical zone processes in intensively managed landscapes have been affected by these changes. Human-induced changes in channel extent and planform most likely have altered this landscape from one dominated by biogeochemical transformations and storage of water

  1. Innovation management in knowledge intensive service companies : a case study of Det Norske Veritas and TrygVesta

    OpenAIRE

    2007-01-01

    Innovation has always remained a significant factor in the growth and development of the companies. Both manufacturing and service industries have been striving to innovate and enhance their business performance. With regards to innovation management, manufacturing companies have remained the prime subject of analysis. Despite the significant growth and value creation of the service industries generally speaking, and knowledge intensive services in particular, a major focus of research has be...

  2. Combined effects of constant versus variable intensity simulated rainfall and reduced tillage management on cotton preemergence herbicide runoff.

    Science.gov (United States)

    Potter, Thomas L; Truman, Clint C; Strickland, Timothy C; Bosch, David D; Webster, Theodore M; Franklin, Dorcas H; Bednarz, Craig W

    2006-01-01

    Pesticide runoff research relies heavily on rainfall simulation experiments. Most are conducted at a constant intensity, i.e., at a fixed rainfall rate; however, large differences in natural rainfall intensity is common. To assess implications we quantified runoff of two herbicides, fluometuron and pendimethalin, and applied preemergence after planting cotton on Tifton loamy sand. Rainfall at constant and variable intensity patterns representative of late spring thunderstorms in the Atlantic Coastal Plain region of Georgia (USA) were simulated on 6-m2 plots under strip- (ST) and conventional-tillage (CT) management. The variable pattern produced significantly higher runoff rates of both compounds from CT but not ST plots. However, on an event-basis, runoff totals (% applied) were not significantly different, with one exception: fluometuron runoff from CT plots. There was about 25% more fluometuron runoff with the variable versus the constant intensity pattern (P = 0.10). Study results suggest that conduct of simulations using variable intensity storm patterns may provide more representative rainfall simulation-based estimates of pesticide runoff and that the greatest impacts will be observed with CT. The study also found significantly more fluometuron in runoff from ST than CT plots. Further work is needed to determine whether this behavior may be generalized to other active ingredients with similar properties [low K(oc) (organic carbon partition coefficient) approximately 100 mL g(-1); high water solubility approximately 100 mg L(-1)]. If so, it should be considered when making tillage-specific herbicide recommendations to reduce runoff potential.

  3. A survey of airway and ventilator management strategies in North American pediatric burn units.

    Science.gov (United States)

    Silver, Geoffrey M; Freiburg, Carter; Halerz, Marcia; Tojong, Jonathan; Supple, Kathy; Gamelli, Richard L

    2004-01-01

    A survey was used to gather information regarding airway management patterns in thermally injured children. North American pediatric burn centers listed by the American Burn Association were sent a survey designed to examine patterns of pediatric airway management in children with acute respiratory failure. The sample population means for the number of patients ventilated more than 48 hours and the number of patients ventilated more than 48 hours with inhalation injury were used to separate centers into large and small pediatric burn centers. Small pediatric burn centers had less than 50 patients who were intubated during a 5-year period. A five-point nominal scale was used to facilitate statistical analysis. Twenty-five pediatric burn centers included in the analysis estimated that 11,494 children were admitted during the 5-year period. There was no statistically dominant ventilator mode being used in the setting of acute respiratory failure identified by this survey. Large pediatric burn centers reported more frequent use of cuffed endotracheal tubes and more frequent change from an uncuffed to a cuffed endotracheal tube in patients who were difficult to ventilate because of an excess leak. Large pediatric burn centers reported a higher prevalence of tracheomalacia then small pediatric burn centers. Steroids were used by most centers before extubation in patients with persistent airway edema. No centers reported complications from steroid use. There is lack of clear consensus regarding the application of various ventilator modes in the setting of acute respiratory failure irrespective of center volume. There were divergent of practice patterns between large and small pediatric burn centers regarding the use of cuffed endotracheal tubes and the timing of tracheostomy. There was agreement between large and small pediatric burn centers in tracheostomy use in children older the age of 7 and the use of steroids as an adjunct to extubation in patients with lingering

  4. Intensive interdisciplinary outpatient pain management program for chronic back pain: a pilot study

    Directory of Open Access Journals (Sweden)

    Artner J

    2012-07-01

    Full Text Available Juraj Artner, Stephan Kurz, Balkan Cakir, Heiko Reichel, Friederike LattigDepartment of Orthopaedic Surgery, University of Ulm, RKU, GermanyBackground: Chronic back pain is relatively resistant to unimodal therapy regimes. The aim of this study was to introduce and evaluate the short-term outcome of a three-week intensive multidisciplinary outpatient program for patients with back pain and sciatica, measured according to decrease of functional impairment and pain.Methods: The program was designed for patients suffering from chronic back pain to provide intensive interdisciplinary therapy in an outpatient setting, consisting of interventional injection techniques, medication, exercise therapy, back education, ergotherapy, traction, massage therapy, medical training, transcutaneous electrical nerve stimulation, aquatraining, and relaxation.Results: Based on Oswestry Disability Index (ODI and Numeric Rating Scale (NRS scores, a significant improvement in pain intensity and functionality of 66.83% NRS and an ODI of 33.33% were achieved by our pain program within 3 weeks.Conclusion: This paper describes the organization and short-term outcome of an intensive multidisciplinary program for chronic back pain on an outpatient basis provided by our orthopedic department, with clinically significant results.Keywords: chronic back pain, intense, multidisciplinary, program, outpatient

  5. Quantification and Physiology of Carbon Dynamics in Intensively Managed Loblolly Pine (Pinus taeda L.)

    OpenAIRE

    Gough, Christopher Michael

    2003-01-01

    Loblolly pine (Pinus taeda L.) occupies 13 million hectares in the United States and represents a critical component of the global carbon (C) cycle. Forest management alters C dynamics, affecting the C sequestration capacity of a site. Identifying drivers that influence C cycling, quantifying C fluxes, and determining how management alters processes involved in C cycling will allow for an understanding of C sequestration capacity in managed forests. Objectives of the first study included (...

  6. Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF).

    Science.gov (United States)

    Schnell, David; Azoulay, Elie; Benoit, Dominique; Clouzeau, Benjamin; Demaret, Pierre; Ducassou, Stéphane; Frange, Pierre; Lafaurie, Matthieu; Legrand, Matthieu; Meert, Anne-Pascale; Mokart, Djamel; Naudin, Jérôme; Pene, Frédéric; Rabbat, Antoine; Raffoux, Emmanuel; Ribaud, Patricia; Richard, Jean-Christophe; Vincent, François; Zahar, Jean-Ralph; Darmon, Michael

    2016-12-01

    Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society. Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: (1) ICU admission and prognosis, (2) protective isolation and prophylaxis, (3) management of acute respiratory failure, (4) organ failure and organ support, (5) antibiotic management and source control, and (6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were, however, associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management, and timing surgery in patients with typhlitis.

  7. Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF).

    Science.gov (United States)

    Schnell, David; Azoulay, Elie; Benoit, Dominique; Clouzeau, Benjamin; Demaret, Pierre; Ducassou, Stéphane; Frange, Pierre; Lafaurie, Matthieu; Legrand, Matthieu; Meert, Anne-Pascale; Mokart, Djamel; Naudin, Jérôme; Pene, Frédéric; Rabbat, Antoine; Raffoux, Emmanuel; Ribaud, Patricia; Richard, Jean-Christophe; Vincent, François; Zahar, Jean-Ralph; Darmon, Michael

    2016-12-01

    Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society. Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: (1) ICU admission and prognosis, (2) protective isolation and prophylaxis, (3) management of acute respiratory failure, (4) organ failure and organ support, (5) antibiotic management and source control, and (6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were, however, associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management, and timing surgery in patients with typhlitis. PMID:27638133

  8. [Managed care. Its impact on health care in the USA, especially on anesthesia and intensive care].

    Science.gov (United States)

    Bauer, M; Bach, A

    1998-06-01

    Managed care, i.e., the integration of health insurance and delivery of care under the direction of one organization, is gaining importance in the USA health market. The initial effects consisted of a decrease in insurance premiums, a very attractive feature for employers. Managed care promises to contain expenditures for health care. Given the shrinking public resources in Germany, managed care seems attractive for the German health system, too. In this review the development of managed care, the principal elements, forms of organisation and practical tools are outlined. The regulation of the delivery of care by means of controlling and financial incentives threatens the autonomy of physicians: the physician must act as a "double agent", caring for the interest for the individual patient and being restricted by the contract with the managed care organisation. Cost containment by managed care was achieved by reducing the fees for physicians and hospitals (and partly by restricting care for patients). Only a fraction of this cost reduction was handed over to the enrollee or employer, and most of the money was returned with profit to the shareholders of the managed care organisations. The preeminent role of primary care physicians as gatekeepers of the health network led to a reduced demand for specialist services in general and for university hospitals and anesthesiologists in particular. The paradigm of managed care, i.e., to guide the patient and the care giver through the health care system in order to achieve cost-effective and high quality care, seems very attractive. The stress on cost minimization by any means in the daily practice of managed care makes it doubtful if managed care should be an option for the German health system, in particular because there are a number of restrictions on it in German law. PMID:9676303

  9. Heel blood sampling in European neonatal intensive care units: compliance with pain management guidelines

    DEFF Research Database (Denmark)

    Losacco, Valentina; Cuttini, Marina; Greisen, Gorm;

    2011-01-01

    Objective To describe the use of heel blood sampling and non-pharmacological analgesia in a large representative sample of neonatal intensive care units (NICUs) in eight European countries, and compare their self-reported practices with evidence-based recommendations. Methods Information on use...... with published guidelines is needed for clinical and ethical reasons....

  10. The impacts of a community forestry program on forest conditions, management intensity and revenue generation in the Dang district of Nepal

    OpenAIRE

    Narayan Raj Poudel; Nobuhiko Fuwa; Keijiro Otsuka

    2014-01-01

    A growing literature documents the positive impact of community management on non-timber forest conservation, but not on the management of timber forests which require higher management intensity than do non-timber forests. We find in Nepal that better market access encourages felling of mature timber trees before but not after the community management began and that population pressure leads to deforestation, which would have taken place under government management, but encourages forest man...

  11. Strategic threat management: an exploration of nursing strategies in the pediatric intensive care unit.

    Science.gov (United States)

    Durso, Francis T; Ferguson, Ashley N; Kazi, Sadaf; Cunningham, Charlene; Ryan, Christina

    2015-03-01

    Part of the work of a critical care nurse is to manage the threats that arise that could impede efficient and effective job performance. Nurses manage threats by employing various strategies to keep performance high and workload manageable. We investigated strategic threat management by using the Threat-Strategy Interview. Threats frequently involved technology, staff, or organizational components. The threats were managed by a toolbox of multifaceted strategies, the most frequent of which involved staff-, treatment- (patient + technology), examination- (patient + clinician), and patient-oriented strategies. The profile of strategies for a particular threat often leveraged work facets similar to the work facet that characterized the threat. In such cases, the nurse's strategy was directed at eliminating the threat (not working around it). A description at both a domain invariant level - useful for understanding strategic threat management generally - and a description at an operational, specific level - useful for guiding interventions-- are presented. A structural description of the relationship among threats, strategies, and the cues that trigger them is presented in the form of an evidence accumulation framework of strategic threat management.

  12. Strategic threat management: an exploration of nursing strategies in the pediatric intensive care unit.

    Science.gov (United States)

    Durso, Francis T; Ferguson, Ashley N; Kazi, Sadaf; Cunningham, Charlene; Ryan, Christina

    2015-03-01

    Part of the work of a critical care nurse is to manage the threats that arise that could impede efficient and effective job performance. Nurses manage threats by employing various strategies to keep performance high and workload manageable. We investigated strategic threat management by using the Threat-Strategy Interview. Threats frequently involved technology, staff, or organizational components. The threats were managed by a toolbox of multifaceted strategies, the most frequent of which involved staff-, treatment- (patient + technology), examination- (patient + clinician), and patient-oriented strategies. The profile of strategies for a particular threat often leveraged work facets similar to the work facet that characterized the threat. In such cases, the nurse's strategy was directed at eliminating the threat (not working around it). A description at both a domain invariant level - useful for understanding strategic threat management generally - and a description at an operational, specific level - useful for guiding interventions-- are presented. A structural description of the relationship among threats, strategies, and the cues that trigger them is presented in the form of an evidence accumulation framework of strategic threat management. PMID:25287275

  13. Managing U.S. climate risk through mitigation: Insights from the American Climate Prospectus

    Science.gov (United States)

    Kopp, R. E., III; Hsiang, S. M.; Houser, T.; Larsen, K.; Rasmussen, D. M., Jr.; Jina, A.; Rising, J.; Delgado, M.; Mohan, S.; Muir-Wood, R.; Wilson, P. S.

    2014-12-01

    The American Climate Prospectus (ACP), the technical analysis underlying the Risky Business project, quantitatively assessed the economic risks posed to the United States by six categories of climate change impacts: crop yield, energy demand, coastal storm damage, criminal activity, labor productivity, and mortality [1]. At a national level, measured by impact on gross domestic product, increased mortality and decreased labor productivity pose the large risks, followed by increased energy demand and coastal damages. Changes in crop yield and crime have smaller impacts. The ACP was not intended to conduct a benefit-cost analysis of climate change mitigation. It assessed the economic consequences of future impacts on an economy with a structure equivalent to that of the current economy, not accounting for socio-economic development and adaptation, and did not assess the cost of mitigation. One of its primary goals was to inform adaptation decisions that are conventionally considered 'endogenous' in economic analyses of climate change. Nonetheless, its results provide insight into the potential of mitigation to manage climate risk. Differences between RCP 8.5 (moderately-high business-as-usual emissions), RCP 4.5 (moderate mitigation) and RCP 2.6 (extremely strong mitigation) are not apparent until mid-century and become significant only late in the century. For all impacts except coastal damages, mitigation significantly reduces uncertainty in late-century impact estimates. Nationally, mitigation significantly and monotonically reduces median projected labor productivity losses and violent crime. Switching from RCP 8.5 to RCP 4.5 also significantly reduces median projections of mortality and energy demand, but the domestic value to the U.S. of further mitigation to RCP 2.6 is less clear. The marginal benefits decline in part because some regions of the country (especially the Northwest) may experience increased crop yields, reduced mortality, and reduced energy

  14. Ethical guidance in the era of managed care: an analysis of the American College of Healthcare Executives' Code of Ethics.

    Science.gov (United States)

    Higgins, W

    2000-01-01

    Market competition and the rise of managed care are transforming the healthcare system from a physician-dominated cottage industry into a manager-dominated corporate enterprise. The managed care revolution is also undermining the safe-guards offered by medical ethics and raising serious public concerns. These trends highlight the growing importance of ethical standards for managers. The most comprehensive ethical guidance for health service managers is contained in the American College of Healthcare Executives' (ACHE) Code of Ethics. An analysis of the ACHE Code suggests that it does not adequately address several ethical concerns associated with managed care. The ACHE may wish to develop a supplemental statement regarding ethical issues in managed care. A supplemental statement that provides more specific guidance in the areas of financial incentives to reduce utilization, social mission, consumer/patient information, and the health service manager's responsibility to patients could be extremely valuable in today's complex and rapidly changing environment. More specific ethical guidelines would not ensure individual or organizational compliance. However, they would provide professional standards that could guide decision making and help managers evaluate performance in managed care settings. PMID:11066951

  15. Guideline concordant detection and management of depression among Alaska Native and American Indian people in primary care

    Directory of Open Access Journals (Sweden)

    Vanessa Y. Hiratsuka

    2015-10-01

    Full Text Available Background: A tribal health organization in Alaska implemented a primary care depression screening, detection and management initiative amongst 55,000 Alaska Native/American Indian people (AN/AIs. Objectives: (a To describe the proportion of AN/AIs screening positive for depression with depression noted or diagnosed and proportion with guideline concordant management and (b to assess whether management varied by patient and provider factors. Research design: Secondary analysis of electronic and paper medical record information of 400 AN/AIs. Measures: Provider variables, patient demographics and patient clinical factors were electronically queried. Manual chart audits assessed depression notation, diagnoses and management within 12 weeks of positive screening. Multilevel ordinal logistic modelling assessed management by patient and provider factors. Results: A depression diagnosis was present in 141 (35% charts and 151 (38% had depressive symptoms noted. Detection was higher among AN/AIs with moderate and severe depression (p<0.001. In total, 258 patients (66% received guideline concordant management, 32 (8% had some management, and 110 (28% received no management. Younger patient age and increased provider tenure increased odds of management. Conclusions: Most AN/AIs screening positive for depression received initial guideline concordant management. Additional outreach to older patients and additional support for providers newer to practices appears warranted.

  16. Outpatient management of intensively treated acute leukemia patients-the patients' perspective

    DEFF Research Database (Denmark)

    Jepsen, Lene Østergaard; Høybye, Mette Terp; Hansen, Dorte Gilså;

    2016-01-01

    PURPOSE: In recent years, patients with acute leukemia (AL) have, to a greater extent, been managed in an outpatient setting where they live at home but appear every other day for follow-up visits at hospital. This qualitative article elucidates how patients with AL experience the different....... This may suggest a potential for extending the outpatient management further and also for patient involvement in own care....

  17. EFFECT OF FLOOR TYPE ON BEHAVIOURAL ACTIVITIES OF INTENSIVELY MANAGED OSTRICHES

    OpenAIRE

    Dan SEABO; Esu WAUGH; Chistopher TSOPITO; Funnie COOPER

    2015-01-01

    Effects of providing grit on daily behavioural activities of intensively kept ostriches were investigated at the Botswana College of Agriculture. Two groups of ostriches were each housed in a 30 x 6m pen. Each group had seven ostriches in it. Each member of the group was identified by a number tag attached to its neck. Activities studied were feeding, picking objects, walking about, sparring, standing rest, sitting rest, grooming self, and grooming others. The study lasted 30 days. The result...

  18. Measuring and Managing Answer Quality for Online Data-Intensive Services

    OpenAIRE

    Kelley, Jaimie; Stewart, Christopher; Morris, Nathaniel; Tiwari, Devesh; He, Yuxiong; Elnikety, Sameh

    2015-01-01

    Online data-intensive services parallelize query execution across distributed software components. Interactive response time is a priority, so online query executions return answers without waiting for slow running components to finish. However, data from these slow components could lead to better answers. We propose Ubora, an approach to measure the effect of slow running components on the quality of answers. Ubora randomly samples online queries and executes them twice. The first execution ...

  19. A Rectourethral Fistula due to Transrectal High-Intensity Focused Ultrasound Treatment: Diagnosis and Management

    OpenAIRE

    Valeria Fiaschetti; Guglielmo Manenti; Isabelle Di Poce; Maria Fornari; Aurora Ricci; Enrico Finazzi Agrò; Giovanni Simonetti

    2012-01-01

    Colovesical fistula (CVF) is an abnormal connection between the enteric and the urinary systems. The rectourethral fistula (RUF) is a possible but extremely rare complication of treatment of prostate cancer with “transrectal High-Intensity Focused Ultrasound (HIFU) treatment.” We present a case of CVF due to HIFU treatment of recurrent prostate cancer. The case was assessed with cystography completed with a pelvic CT scan—with MPR, MIP, and VR reconstruction—before emptying the bladder. Since...

  20. Levothyroxine absorption and difficult management of hypothyroid patients in the intensive care unit: two case reports and a literature review.

    Science.gov (United States)

    Vinagre, Ana Lúcia Marinho; Souza, Marcus Vinícius Leitão de

    2011-06-01

    Levothyroxine absorption in hypothyroid patients can be influenced by several factors, particularly medications and concomitant food administration. This is especially evident in intensive care unit patients, where a continual enteral diet and the administration of multiple medications changes its absorption. Changes or adaptations in the hypothalamic-pituitary-thyroid axis, in conjunction with clinical abnormalities possibly related to under-treatment of hypothyroidism, render levothyroxine replacement therapy very challenging. Here, we report two intensive care hypothyroidism patients and their respective levothyroxine replacement management issues, focusing on a number of controversial issues, such as the optimal replacement dose, how fast the levothyroxine doses should be increased, triiodothyronine requirements, the interference of an enteral diet with absorption, and finally, the possible consequences of undertreated hypothyroidism and levothyroxine replacement monitoring useful clinical/laboratory parameters. PMID:25299727

  1. Work Incapacity and Treatment Costs After Severe Accidents: Standard Versus Intensive Case Management in a 6-Year Randomized Controlled Trial.

    Science.gov (United States)

    Scholz, Stefan M; Andermatt, Peter; Tobler, Benno L; Spinnler, Dieter

    2016-09-01

    Purpose Case management is widely accepted as an effective method to support medical rehabilitation and vocational reintegration of accident victims with musculoskeletal injuries. This study investigates whether more intensive case management improves outcomes such as work incapacity and treatment costs for severely injured patients. Methods 8,050 patients were randomly allocated either to standard case management (SCM, administered by claims specialists) or intensive case management (ICM, administered by case managers). These study groups differ mainly by caseload, which was approximately 100 cases in SCM and 35 in ICM. The setting is equivalent to a prospective randomized controlled trial. A 6-year follow-up period was chosen in order to encompass both short-term insurance benefits and permanent disability costs. All data were extracted from administrative insurance databases. Results Average work incapacity over the 6-year follow-up, including contributions from daily allowances and permanent losses from disability, was slightly but insignificantly higher under ICM than under SCM (21.6 vs. 21.3 % of pre-accident work capacity). Remaining work incapacity after 6 years of follow-up showed no difference between ICM and SCM (8.9 vs. 8.8 % of pre-accident work incapacity). Treatment costs were 43,500 Swiss Francs (CHF) in ICM compared to 39,800 in SCM (+9.4 %, p = 0.01). The number of care providers involved in ICM was 10.5 compared to 10.0 in ICM (+5.0 %, p reintegration of accident victims. PMID:26687330

  2. Native American Values and Management Education: Envisioning an Inclusive Virtuous Circle

    Science.gov (United States)

    Verbos, Amy Klemm; Gladstone, Joe S.; Kennedy, Deanna M.

    2011-01-01

    Circles are symbols of interconnectedness. Behavioral circles can be vicious or virtuous. Many American Indians are caught in a vicious circle of exclusion from the purported benefits of Westernization, entrapment in its negative elements, and the ongoing undermining of their culture and thus their identities. Yet Native Americans, along with many…

  3. Managing Family Conflict over Career Decisions: The Experience of Asian Americans

    Science.gov (United States)

    Ma, Pei-Wen Winnie; Desai, Uttara; George, Login S.; San Filippo, Alyssa A.; Varon, Samantha

    2014-01-01

    Conflict over career decisions is a main source of intergenerational conflict among Asian American families. This qualitative study explored the topic using consensual qualitative research methodology in a sample of eight Asian Americans. Results indicated that participants experienced feelings of guilt and indebtedness due to conflicting values,…

  4. Management strategies to effect change in intensive care units: lessons from the world of business. Part II. Quality-improvement strategies.

    Science.gov (United States)

    Gershengorn, Hayley B; Kocher, Robert; Factor, Phillip

    2014-03-01

    The success of quality-improvement projects relies heavily on both project design and the metrics chosen to assess change. In Part II of this three-part American Thoracic Society Seminars series, we begin by describing methods for determining which data to collect, tools for data presentation, and strategies for data dissemination. As Avedis Donabedian detailed a half century ago, defining metrics in healthcare can be challenging; algorithmic determination of the best type of metric (outcome, process, or structure) can help intensive care unit (ICU) managers begin this process. Choosing appropriate graphical data displays (e.g., run charts) can prompt discussions about and promote quality improvement. Similarly, dashboards/scorecards are useful in presenting performance improvement data either publicly or privately in a visually appealing manner. To have compelling data to show, ICU managers must plan quality-improvement projects well. The second portion of this review details four quality-improvement tools-checklists, Six Sigma methodology, lean thinking, and Kaizen. Checklists have become commonplace in many ICUs to improve care quality; thinking about how to maximize their effectiveness is now of prime importance. Six Sigma methodology, lean thinking, and Kaizen are techniques that use multidisciplinary teams to organize thinking about process improvement, formalize change strategies, actualize initiatives, and measure progress. None originated within healthcare, but each has been used in the hospital environment with success. To conclude this part of the series, we demonstrate how to use these tools through an example of improving the timely administration of antibiotics to patients with sepsis. PMID:24601668

  5. Management strategies to effect change in intensive care units: lessons from the world of business. Part II. Quality-improvement strategies.

    Science.gov (United States)

    Gershengorn, Hayley B; Kocher, Robert; Factor, Phillip

    2014-03-01

    The success of quality-improvement projects relies heavily on both project design and the metrics chosen to assess change. In Part II of this three-part American Thoracic Society Seminars series, we begin by describing methods for determining which data to collect, tools for data presentation, and strategies for data dissemination. As Avedis Donabedian detailed a half century ago, defining metrics in healthcare can be challenging; algorithmic determination of the best type of metric (outcome, process, or structure) can help intensive care unit (ICU) managers begin this process. Choosing appropriate graphical data displays (e.g., run charts) can prompt discussions about and promote quality improvement. Similarly, dashboards/scorecards are useful in presenting performance improvement data either publicly or privately in a visually appealing manner. To have compelling data to show, ICU managers must plan quality-improvement projects well. The second portion of this review details four quality-improvement tools-checklists, Six Sigma methodology, lean thinking, and Kaizen. Checklists have become commonplace in many ICUs to improve care quality; thinking about how to maximize their effectiveness is now of prime importance. Six Sigma methodology, lean thinking, and Kaizen are techniques that use multidisciplinary teams to organize thinking about process improvement, formalize change strategies, actualize initiatives, and measure progress. None originated within healthcare, but each has been used in the hospital environment with success. To conclude this part of the series, we demonstrate how to use these tools through an example of improving the timely administration of antibiotics to patients with sepsis.

  6. Managing new oral anticoagulants in the perioperative and intensive care unit setting.

    Science.gov (United States)

    Levy, Jerrold H; Faraoni, David; Spring, Jenna L; Douketis, James D; Samama, Charles M

    2013-06-01

    Managing patients in the perioperative setting receiving novel oral anticoagulation agents for thromboprophylaxis or stroke prevention with atrial fibrillation is an important consideration for clinicians. The novel oral anticoagulation agents include direct Factor Xa inhibitors rivaroxaban and apixaban, and the direct thrombin inhibitor dabigatran. In elective surgery, discontinuing their use is important, but renal function must also be considered because elimination is highly dependent on renal elimination. If bleeding occurs in patients who have received these agents, common principles of bleeding management as with any anticoagulant (including the known principles for warfarin) should be considered. This review summarizes the available data regarding the management of bleeding with novel oral anticoagulation agents. Hemodialysis is a therapeutic option for dabigatran-related bleeding, while in vitro studies showed that prothrombin complex concentrates are reported to be useful for rivaroxaban-related bleeding. Additional clinical studies are needed to determine the best method for reversal of the novel oral anticoagulation agents when bleeding occurs. PMID:23416382

  7. A Catchment Systems Engineering (CSE) approach to managing intensively farmed land

    Science.gov (United States)

    Jonczyk, Jennine; Quinn, Paul; Barber, Nicholas; Wilkinson, Mark; ODonnell, Greg

    2014-05-01

    Rural land management practices can have a significant impact on the hydrological and nutrient dynamics within a catchment which can dramatically alter the way it processes water, exacerbating nutrient losses from the system. A collaborative and holistic approach for managing potential conflicts between land management activity for food production alongside the aspiration to achieve good water quality and the need to make space for water can ensure the long-term sustainability of our agricultural catchments. Catchment System Engineering (CSE) is an interventionist approach to altering the catchment scale runoff regime through the manipulation of hydrological flow pathways throughout the catchment. By targeting hydrological flow pathways at source, such as overland flow, field drain and ditch function, a significant component of the runoff generation can be managed, greatly reducing erosive soil losses. Coupled with management of farm nutrients at source many runoff attenuation features or measures can be co-located to achieve benefits for water quality. Examples of community-led mitigation measures using the CSE approach will be presented from two catchments in Northumberland, Northern England, that demonstrate the generic framework for identification of multipurpose features that slow, store and filter runoff at strategic locations in the landscape. Measures include within-field barriers, edge of field traps and within-field sediment filters and sediment traps which demonstrate how sediment can be trapped locally (including silt and clay fractions) and be recovered for use back on the land. Deliverables from this CSE approach includes the reduction of downstream flood risk and capturing of sediment and associated nutrients. The CSE approach allows for a more natural flood and nutrient management approach which helps to restore vital catchment functions to re-establish a healthy catchment system.

  8. Energy resource management under the influence of the weekend transition considering an intensive use of electric vehicles

    DEFF Research Database (Denmark)

    Sousa, T.; Morais, Hugo; Pinto, T.;

    2015-01-01

    Energy resource scheduling is becoming increasingly important, as the use of distributed resources is intensified and of massive electric vehicle is envisaged. The present paper proposes a methodology for day-ahead energy resource scheduling for smart grids considering the intensive use...... of distributed generation and Vehicle-to-Grid (V2G). This method considers that the energy resources are managed by a Virtual Power Player (VPP) which established contracts with their owners. It takes into account these contracts, the users' requirements subjected to the VPP, and several discharge price steps...

  9. Cross-Cultural Communication And Dimensions: A Hybrid Analysis Of Horizontal And Vertical Individualist And Collectivist Tendencies Among African American And European American Management Students

    Directory of Open Access Journals (Sweden)

    Ephraim Okoro

    2011-11-01

    Full Text Available This article describes research about horizontal and vertical individualism and collectivism (HVIC among African American and European American university students. The survey is based on the work of Harry Triandis (1995, one of the seminal researchers of individualism and collectivism (I-C. The survey of attitude and scenario items, developed by Harry Triandis (1995, was administered to undergraduate management students in three universities in the Eastern and Southeastern United States. Many of the attitude and scenario survey items directly address preferred communication patterns. The findings are also interpreted in terms of situational preferences about I-C, including the following contexts: social events, workplace decisions, and group and work dynamics. The research is unique in that it measures four types of the I-C dimension: horizontal individualism, vertical individualism, horizontal collectivism, and vertical collectivism, as conceptualized by Triandis (1995. Furthermore, it emerges from the premise that cultures are neither strictly collectivist nor individualist; rather, cultures have profiles in which individualist tendencies are prominent in some circumstances whereas collectivist tendencies are emphasized in others. Also, this article provides findings that can easily be converted into training about cross-cultural similarities and differences. Related recommendations for future research and implications for teaching are provided.

  10. Consensus recommendations from the American Acne & Rosacea Society on the management of rosacea, part 5: a guide on the management of rosacea.

    Science.gov (United States)

    Del Rosso, James Q; Thiboutot, Diane; Gallo, Richard; Webster, Guy; Tanghetti, Emil; Eichenfield, Lawrence F; Stein-Gold, Linda; Berson, Diane; Zaenglein, Andrea

    2014-03-01

    The last article in this 5-part series provides a final overview of consensus recommendations from the American Acne & Rosacea Society (AARS) on the management of the common presentations of cutaneous rosacea. Optimal management of rosacea requires careful assessment of the patient's clinical features with integration of therapies that adequately treat the presenting signs and symptoms. The treatment consensus recommendations from the AARS are based on 2 major common clinical presentations of rosacea: (1) centrofacial erythema with papulopustular lesions, and (2) centrofacial erythema without papulopustular lesions. The recommendations provided here serve to guide clinicians in their clinical practice.

  11. A Lightweight, High-performance I/O Management Package for Data-intensive Computing

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Jun

    2011-06-22

    Our group has been working with ANL collaborators on the topic bridging the gap between parallel file system and local file system during the course of this project period. We visited Argonne National Lab -- Dr. Robert Ross's group for one week in the past summer 2007. We looked over our current project progress and planned the activities for the incoming years 2008-09. The PI met Dr. Robert Ross several times such as HEC FSIO workshop 08, SC08 and SC10. We explored the opportunities to develop a production system by leveraging our current prototype to (SOGP+PVFS) a new PVFS version. We delivered SOGP+PVFS codes to ANL PVFS2 group in 2008.We also talked about exploring a potential project on developing new parallel programming models and runtime systems for data-intensive scalable computing (DISC). The methodology is to evolve MPI towards DISC by incorporating some functions of Google MapReduce parallel programming model. More recently, we are together exploring how to leverage existing works to perform (1) coordination/aggregation of local I/O operations prior to movement over the WAN, (2) efficient bulk data movement over the WAN, (3) latency hiding techniques for latency-intensive operations. Since 2009, we start applying Hadoop/MapReduce to some HEC applications with LANL scientists John Bent and Salman Habib. Another on-going work is to improve checkpoint performance at I/O forwarding Layer for the Road Runner super computer with James Nuetz and Gary Gridder at LANL. Two senior undergraduates from our research group did summer internships about high-performance file and storage system projects in LANL since 2008 for consecutive three years. Both of them are now pursuing Ph.D. degree in our group and will be 4th year in the PhD program in Fall 2011 and go to LANL to advance two above-mentioned works during this winter break. Since 2009, we have been collaborating with several computer scientists (Gary Grider, John bent, Parks Fields, James Nunez, Hsing

  12. Management of Endometrial Cancer at Mayo Clinic: Intensive Surgical Staging and Disease-based Postoperative Treatment

    NARCIS (Netherlands)

    Mariani, A.

    2006-01-01

    Chapter 1 is a general introduction, while chapter 8 is the final discussion and conclusions. The remaining chapters (from 2 to 7) are composed by a brief introduction, followed by the published article(s) that form(s) the structure of the chapter. Management of Endometrial Cancer at Mayo Clinic: I

  13. Towards Sustainable Mineral-Intensive Growth in Orissa : Managing Environmental and Social Impacts

    OpenAIRE

    World Bank

    2007-01-01

    The study's objective was to support the socio-economic development program of the Government of Orissa by helping to analyze and formulate practical strategies for strengthening an institutional and regulatory framework with respect to managing the environmental and social impacts of investments in the mining and industry sectors. This study, conducted for about a year, focused on two set...

  14. Accounting for residual effects of previously applied nitrogen fertilizer on intensively managed grasslands

    NARCIS (Netherlands)

    Vellinga, Th.V.; Andre, G.; Schils, R.L.M.; Kraak, T.; Oenema, O.

    2010-01-01

    Only 0·20–0·70 of the fertilizer-nitrogen (N) applied to grassland is taken up in herbage in the harvest directly following application. Residual effects at subsequent harvests can be large but are poorly quantified, and rarely taken into account in current management practices. An increased underst

  15. Continuous EEG monitoring in the intensive care unit: beta scientific and management scientific aspects

    NARCIS (Netherlands)

    Sanders, P.M.H.; van Putten, M.J.A.M.; Jarm, T.; Kramar, P.; Zupanic, A.

    2007-01-01

    Due to various technological advances, it is now possible to continuously monitor critically ill patients using EEG, including the extraction of various quantitative features. In this study, several beta scientific and management scientific aspects of the implementation and use of cEEg on the ICU wi

  16. IBM, CERN join to create a data-intensive management system

    CERN Multimedia

    2003-01-01

    "IBM, White Plains, N.Y., has agreed to collaborate with the European Organization for Nuclear Research's (CERN), Geneva, Switzerland, openlab for a DataGrid project. The aim is to develop a vast data-management system based on Grid computing to investigate the origins of the universe (1/2 page).

  17. The Role of Dietary Protein and Fat in Glycaemic Control in Type 1 Diabetes: Implications for Intensive Diabetes Management.

    Science.gov (United States)

    Paterson, Megan; Bell, Kirstine J; O'Connell, Susan M; Smart, Carmel E; Shafat, Amir; King, Bruce

    2015-09-01

    A primary focus of the management of type 1 diabetes has been on matching prandial insulin therapy with carbohydrate amount consumed. However, even with the introduction of more flexible intensive insulin regimes, people with type 1 diabetes still struggle to achieve optimal glycaemic control. More recently, dietary fat and protein have been recognised as having a significant impact on postprandial blood glucose levels. Fat and protein independently increase the postprandial glucose excursions and together their effect is additive. This article reviews how the fat and protein in a meal impact the postprandial glycaemic response and discusses practical approaches to managing this in clinical practice. These insights have significant implications for patient education, mealtime insulin dose calculations and dosing strategies. PMID:26202844

  18. Eighth joint national committee (JNC-8 guidelines and the outpatient management of hypertension in the African-American population

    Directory of Open Access Journals (Sweden)

    Nicole Abel

    2015-01-01

    Full Text Available Background: Hypertension is a common medical disease, occurring in about one third of young adults and almost two thirds of individuals over the age of 60. With the release of the Eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment (JNC-8 guidelines, there have been major changes in blood pressure management in the various subgroups. Aim: Optimal blood pressure management and markers of end-organ damage in African-American adult patients were compared between patients who were managed according to the JNC-8 hypertension management guidelines and those who were treated with other regimens. Materials and Methods: African-American patients aged 18 years or older with an established diagnosis of hypertension were included in the study who were followed up in our internal medicine clinic between January 1, 2013 and December 31, 2103; the data on their systolic and diastolic blood pressure readings, heart rate, body mass index (BMI, age, gender, comorbidities, and medications were recorded. Patients were divided into four groups based on the antihypertensive therapy as follows - Group 1: Diuretic only; Group 2: Calcium channel blocker (CCB only; Group 3: Diuretic and CCB; Group 4: Other antihypertensive agent. Their blood pressure control, comorbidities, and associated target organ damage were analyzed. Results: In all 323 patients, blood pressures were optimally controlled. The majority of the patients (79.6% were treated with either a diuretic, a CCB, or both. Intergroup comparison analysis showed no statistically significant difference in the mean systolic blood pressure, mean diastolic blood pressure, associated comorbidities, or frequency of target organ damage. Conclusion: Although diuretics or CCBs are recommended as first-line agents in African-American patients, we found no significant difference in the optimal control of blood pressure and frequency of end-organ damage compared to management with other agents.

  19. Conceptual framework of knowledge management for ethical decision-making support in neonatal intensive care.

    Science.gov (United States)

    Frize, Monique; Yang, Lan; Walker, Robin C; O'Connor, Annette M

    2005-06-01

    This research is built on the belief that artificial intelligence estimations need to be integrated into clinical social context to create value for health-care decisions. In sophisticated neonatal intensive care units (NICUs), decisions to continue or discontinue aggressive treatment are an integral part of clinical practice. High-quality evidence supports clinical decision-making, and a decision-aid tool based on specific outcome information for individual NICU patients will provide significant support for parents and caregivers in making difficult "ethical" treatment decisions. In our approach, information on a newborn patient's likely outcomes is integrated with the physician's interpretation and parents' perspectives into codified knowledge. Context-sensitive content adaptation delivers personalized and customized information to a variety of users, from physicians to parents. The system provides structuralized knowledge translation and exchange between all participants in the decision, facilitating collaborative decision-making that involves parents at every stage on whether to initiate, continue, limit, or terminate intensive care for their infant.

  20. Linking nursery nutritional status and water availability post-planting under intense summer drought: the case of a South American Mediterranean tree species

    Directory of Open Access Journals (Sweden)

    Ovalle JF

    2016-10-01

    Full Text Available Drought-avoidance traits of South American Mediterranean tree species are crucial attributes to be considered in nursery practices aimed at improving the performance of seedlings exposed to intense summer drought in dryland reforestation projects. In this study, we determined the relation between nursery fertilization doses and the development of drought-avoidance traits of the soapbark tree Quillaja saponaria (Mol. under contrasting watering regimes following post-planting. Seedlings were grown for 6 months using four increasing doses of controlled-release fertilizer (0, 3, 6, and 12 g L-1 of Basacote® Plus 15:8:12. After outplanting, half of the seedlings were watered weekly and the other half were left unwatered for one growing season from September 2011 to May 2012. Seedlings were periodically measured for morphological and ecophysiological parameters, and carefully harvested for root measurements at the end of the study. Our results showed that high fertilization doses produced significantly larger seedlings in the nursery with high nitrogen and phosphorous foliar concentrations, which resulted in a significantly higher shoot dry mass after outplanting. Unfertilized seedlings grown with water application had a significantly higher stem diameter, root dry mass and lower shoot/root compared with seedlings with high fertilizer dose. These results highlight the ability of this species to maintain drought-avoidance traits, such as high xylem water potential and chlorophyll fluorescence, during the first 3 months of the 7-month drought period. High nutrient loading, although resulting in improved shoot productivity after outplanting, did not make a significant contribution to the early development of drought-avoidance traits in Q. saponaria.

  1. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) – short version

    OpenAIRE

    DAS-Taskforce 2015; Baron, Ralf; Binder, Andreas; Biniek, Rolf; Braune, Stephan; Buerkle, Hartmut; Dall, Peter; Demirakca, Sueha; Eckardt, Rahel; Eggers, Verena; Eichler, Ingolf; Fietze, Ingo; Freys, Stephan; Fründ, Andreas; Garten, Lars

    2015-01-01

    In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from th...

  2. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version

    OpenAIRE

    Baron, R.; Binder, A.; Biniek, R; Braune, S; Buerkle, H; Dall, P.; Demirakca, S; Eckardt, R; Eggers, V; Eichler, I; Fietze, I.; Freys, S; Fründ, A; Garten, L; Gohrbandt, B

    2015-01-01

    In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the "Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care". Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from th...

  3. Using the health belief model to develop culturally appropriate weight-management materials for African-American women.

    Science.gov (United States)

    James, Delores C S; Pobee, Joseph W; Oxidine, D'lauren; Brown, Latonya; Joshi, Gungeet

    2012-05-01

    African-American women have the highest prevalence of adult obesity in the United States. They are less likely to participate in weight-loss programs and tend to have a low success rate when they do so. The goal of this project was to explore the use of the Health Belief Model in developing culturally appropriate weight-management programs for African-American women. Seven focus groups were conducted with 50 African-American women. The Health Belief Model was used as the study's theoretical framework. Participants made a clear delineation between the terms healthy weight, overweight, and obese. Sexy, flirtatious words, such as thick, stacked, and curvy were often used to describe their extra weight. Participants accurately described the health risks of obesity. Most believed that culture and genetics made them more susceptible to obesity. The perceived benefits of losing weight included reduced risk for health problems, improved physical appearance, and living life to the fullest. Perceived barriers included a lack of motivation, reliable dieting information, and social support. Motivators to lose weight included being diagnosed with a health problem, physical appearance, and saving money on clothes. Self-efficacy was primarily affected by a frustrated history of dieting. The data themes suggest areas that should be addressed when developing culturally appropriate weight-loss messages, programs, and materials for African-American women. PMID:22709771

  4. Factors that guide nurse managers regarding the staffing of agency nurses in intensive care units at private hospitals in Pretoria

    Directory of Open Access Journals (Sweden)

    Karien Jooste

    2013-03-01

    Full Text Available Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse perceive the staffing of agency nurses in intensive care units (ICUs. The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n =124. One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.

  5. The alfalfa leafcutting bee, Megachile rotundata: the world's most intensively managed solitary bee.

    Science.gov (United States)

    Pitts-Singer, Theresa L; Cane, James H

    2011-01-01

    The alfalfa leafcutting bee (ALCB), Megachile rotundata F. (Megachildae), was accidentally introduced into the United States by the 1940s. Nest management of this Eurasian nonsocial pollinator transformed the alfalfa seed industry in North America, tripling seed production. The most common ALCB management practice is the loose cell system, in which cocooned bees are removed from nesting cavities for cleaning and storage. Traits of ALCBs that favored their commercialization include gregarious nesting; use of leaves for lining nests; ready acceptance of affordable, mass-produced nesting materials; alfalfa pollination efficacy; and emergence synchrony with alfalfa bloom. The ALCB became a commercial success because much of its natural history was understood, targeted research was pursued, and producer ingenuity was encouraged. The ALCB presents a model system for commercializing other solitary bees and for advancing new testable hypotheses in diverse biological disciplines. PMID:20809804

  6. The role of metrics and measurements in a software intensive total quality management environment

    Science.gov (United States)

    Daniels, Charles B.

    1992-01-01

    Paramax Space Systems began its mission as a member of the Rockwell Space Operations Company (RSOC) team which was the successful bidder on a massive operations consolidation contract for the Mission Operations Directorate (MOD) at JSC. The contract awarded to the team was the Space Transportation System Operations Contract (STSOC). Our initial challenge was to accept responsibility for a very large, highly complex and fragmented collection of software from eleven different contractors and transform it into a coherent, operational baseline. Concurrently, we had to integrate a diverse group of people from eleven different companies into a single, cohesive team. Paramax executives recognized the absolute necessity to develop a business culture based on the concept of employee involvement to execute and improve the complex process of our new environment. Our executives clearly understood that management needed to set the example and lead the way to quality improvement. The total quality management policy and the metrics used in this endeavor are presented.

  7. Sustaining the Productivity and Function of Intensively Managed Forests - Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Burger, James A.; Xu, Yi-Jun

    2001-03-23

    The main goal of this study is to ensure sustainable management of wetland forests in the southeastern United States. The study is projected to measure soil, hydrology, and forest responses to several management scenarios across a complete forest cycle. From August 1997 to August 2000 the study has received funding as one of the Agenda 2020 projects, from the U.S. Department of Energy (Cooperative Agreement Number DE-FC07-97ID13551), the National Council of the Paper Industry for Air and Stream Improvement, and Westvac Corporation. Quarterly progress reports were submitted regularly to the Department and all project participants. This final report summarizes the project results and progress achieved during this 3-year period. Over the past three years all research objectives planned for this project were completed.

  8. Grassland Resistance and Resilience after Drought Depends on Management Intensity and Species Richness

    OpenAIRE

    Anja Vogel; Michael Scherer-Lorenzen; Alexandra Weigelt

    2012-01-01

    The degree to which biodiversity may promote the stability of grasslands in the light of climatic variability, such as prolonged summer drought, has attracted considerable interest. Studies so far yielded inconsistent results and in addition, the effect of different grassland management practices on their response to drought remains an open question. We experimentally combined the manipulation of prolonged summer drought (sheltered vs. unsheltered sites), plant species loss (6 levels of 60 do...

  9. Intensive pig production and manure management in Beijing, North China Plain

    OpenAIRE

    Mendoza Huaitalla, Roxana

    2014-01-01

    China, at the forefront of the livestock revolution, has experienced a more industrialized change, with an increment of the large livestock farms and of the decoupling between the livestock and arable land. Meat production in China is dominated by pork, which comprises approximately 50% of worldwide pig production. The description of the pig husbandry and manure management systems in the large animal operations of the NCP is not widely available. In order to describe the status quo o...

  10. Patient safety in the Intensive Care Unit : With special reference to Airway management and Nursing procedures

    OpenAIRE

    Engström, Joakim

    2016-01-01

    The overall aim of the present thesis was to study aspects of patient safety in critically ill patients with special focus on airway management, respiratory complications and nursing procedures. Study I describes a method called pharyngeal oxygen administration during intubation in an experimental acute lung injury model. The study showed that pharyngeal oxygenation prevented or considerably increased the time to life-threatening hypoxemia at shunt fractions by at least up to 25% and that thi...

  11. Time-series analysis reveals genetic responses to intensive management of razorback sucker (Xyrauchen texanus)

    OpenAIRE

    Thomas E Dowling; Turner, Thomas F.; Carson, Evan W; Saltzgiver, Melody J; Adams, Deborah; Kesner, Brian; Paul C Marsh

    2013-01-01

    Time-series analysis is used widely in ecology to study complex phenomena and may have considerable potential to clarify relationships of genetic and demographic processes in natural and exploited populations. We explored the utility of this approach to evaluate population responses to management in razorback sucker, a long-lived and fecund, but declining freshwater fish species. A core population in Lake Mohave (Arizona-Nevada, USA) has experienced no natural recruitment for decades and is m...

  12. The influence of tillage on N2O fluxes from an intensively managed grazed grassland in Scotland

    Science.gov (United States)

    Cowan, Nicholas J.; Levy, Peter E.; Famulari, Daniela; Anderson, Margaret; Drewer, Julia; Carozzi, Marco; Reay, David S.; Skiba, Ute M.

    2016-08-01

    Intensively managed grass production in high-rainfall temperate climate zones is a globally important source of N2O. Many of these grasslands are occasionally tilled to rejuvenate the sward, and this can lead to increased N2O emissions. This was investigated by comparing N2O fluxes from two adjacent intensively managed grazed grasslands in Scotland, one of which was tilled. A combination of eddy covariance, high-resolution dynamic chamber and static chamber methods was used. N2O emissions from the tilled field increased significantly for several days immediately after ploughing and remained elevated for approximately 2 months after the tillage event contributing to an estimated increase in N2O fluxes of 0.85 ± 0.11 kg N2O-N ha-1. However, any influence on N2O emissions after this period appears to be minimal. The cumulative N2O emissions associated with the tillage event and a fertiliser application of 70 kg N ammonia nitrate from one field were not significantly different from the adjacent untilled field, in which two fertiliser applications of 70 kg N ammonia nitrate occurred during the same period. Total cumulative fluxes calculated for the tilled and untilled fields over the entire 175-day measurement period were 2.14 ± 0.18 and 1.65 ± 1.02 kg N2O-N ha-1, respectively.

  13. Clinical Decision Support and Closed-Loop Control for Cardiopulmonary Management and Intensive Care Unit Sedation Using Expert Systems.

    Science.gov (United States)

    Gholami, Behnood; Bailey, James M; Haddad, Wassim M; Tannenbaum, Allen R

    2012-03-01

    Patients in the intensive care unit (ICU) who require mechanical ventilation due to acute respiratory failure also frequently require the administration of sedative agents. The need for sedation arises both from patient anxiety due to the loss of personal control and the unfamiliar and intrusive environment of the ICU, and also due to pain or other variants of noxious stimuli. While physicians select the agent(s) used for sedation and cardiovascular function, the actual administration of these agents is the responsibility of the nursing staff. If clinical decision support systems and closed-loop control systems could be developed for critical care monitoring and lifesaving interventions as well as the administration of sedation and cardiopulmonary management, the ICU nurse could be released from the intense monitoring of sedation, allowing her/him to focus on other critical tasks. One particularly attractive strategy is to utilize the knowledge and experience of skilled clinicians, capturing explicitly the rules expert clinicians use to decide on how to titrate drug doses depending on the level of sedation. In this paper, we extend the deterministic rule-based expert system for cardiopulmonary management and ICU sedation framework presented in [1] to a stochastic setting by using probability theory to quantify uncertainty and hence deal with more realistic clinical situations.

  14. Diagnosis & Correction of Soil Nutrient Limitations in Intensively managed southern pine forests

    Energy Technology Data Exchange (ETDEWEB)

    University of Florida

    2002-10-25

    Forest productivity is one manner to sequester carbon and it is a renewable energy source. Likewise, efficient use of fertilization can be a significant energy savings. To date, site-specific use of fertilization for the purpose of maximizing forest productivity has not been well developed. Site evaluation of nutrient deficiencies is primarily based on empirical approaches to soil testing and plot fertilizer tests with little consideration for soil water regimes and contributing site factors. This project uses mass flow diffusion theory in a modeling context, combined with process level knowledge of soil chemistry, to evaluate nutrient bioavailability to fast-growing juvenile forest stands growing on coastal plain Spodosols of the southeastern U.S. The model is not soil or site specific and should be useful for a wide range of soil management/nutrient management conditions. In order to use the model, field data of fast-growing southern pine needed to be measured and used in the validation of the model. The field aspect of the study was mainly to provide data that could be used to verify the model. However, we learned much about the growth and development of fast growing loblolly. Carbon allocation patterns, root shoot relationships and leaf area root relationships proved to be new, important information. The Project Objectives were to: (1) Develop a mechanistic nutrient management model based on the COMP8 uptake model. (2) Collect field data that could be used to verify and test the model. (3) Model testing.

  15. Impact of an intensive management on soil biochemical and biological properties in an agricultural soil of Southern Italy

    Science.gov (United States)

    Scotti, R.; D'Ascoli, R.; Rao, M. A.; Marzaioli, R.; Rutigliano, F. A.; Gianfreda, L.

    2009-04-01

    An intensive management of agricultural soils is widely carried out to increase vegetation productivity. Nevertheless, the large use of machineries, chemical fertilizers and pesticides can often cause, in time, a substantial decline in soil fertility by affecting soil physical and chemical properties and, in turn, growth and activity of soil microbial community. In fact, alteration in soil structure, nutrient losses and, in particular, changes in quality and quantity of soil organic matter are some of the principal soil degradation processes deriving from an intensive agricultural management that can affect, in different ways, soil biochemical and biological properties. The aim of this research was to assess the impact of intensive management on agricultural soils by measuring soil physical, chemical and biochemical/biological properties. The use of appropriate indicators as quantitative tools could allow to assess soil quality. Moreover, although soil physical and chemical properties have received great attention, soil biochemical/biological properties, such as enzyme activities and microbial biomass, functionally related properties involved in the nutrient cycles, can be considered as sensitive indicators of soil quality and health changes because, they show a faster turn over compared to soil organic matter. Our attention was focused on the Plane of Sele river (Campania region, Italy), an area characterized by an intensive agriculture and greenhouse cultures. Twenty-five farms were chosen, with the aid of regional soil map, in order to get soils with different physical and chemical properties. As common trait, the selected farms, all with greenhouse cultures, used no organic amendments but only mineral compounds to fertilize soils. Moreover, to better understand the impact of intensive agricultural practices on soil of each farm, control soils from orchards or uncultivated plots were chosen. In each farm soil samples were collected in three different plots

  16. A Rectourethral Fistula due to Transrectal High-Intensity Focused Ultrasound Treatment: Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    Valeria Fiaschetti

    2012-01-01

    Full Text Available Colovesical fistula (CVF is an abnormal connection between the enteric and the urinary systems. The rectourethral fistula (RUF is a possible but extremely rare complication of treatment of prostate cancer with “transrectal High-Intensity Focused Ultrasound (HIFU treatment.” We present a case of CVF due to HIFU treatment of recurrent prostate cancer. The case was assessed with cystography completed with a pelvic CT scan—with MPR, MIP, and VR reconstruction—before emptying the bladder. Since the CT scan confirmed that the fistula involved solely the urethra and excluded even a minimal involvement of the bladder, it was possible to employ a conservative treatment by positioning a Foley catheter of monthly duration, in order to allow the urethra to rest. Still today, after 6 months, the patient is in a good clinical condition and has not shown yet signs of a recurrence of the fistula.

  17. American Association of Dental Schools Curricular Guidelines for Practice Management and for Preventive Dentistry.

    Science.gov (United States)

    Journal of Dental Education, 1980

    1980-01-01

    Curricular guidelines developed by the American Association of Dental Schools for use by individual educational institutions as curriculum development aids are provided. The guidelines were developed by the Sections on Community and Preventive Dentistry and Practice Administration. (MLW)

  18. Research on American Library Crisis Management%美国图书馆危机管理研究

    Institute of Scientific and Technical Information of China (English)

    柳莎

    2011-01-01

    This paper analyzes theory and practice about crisis management of American library,discusses the content of American Library crisis management,including disaster crisis,collection crisis,financial crisis,network security crisis,the crisis of violence and accidents and social status crisis,in order to provide valuable advice about crisis management for our country libraries,thus improve theory research and practice level about the crisis management of our country libraries.%分析美国图书馆危机管理的理论与实践,讨论美国图书馆危机管理内容,包括灾难危机、馆藏危机、财政危机、网络安全危机、暴力事故危机、图书馆社会地位危机,从中找出对我国图书馆危机管理提供可借鉴的经验,从而提高我国图书馆危机管理的理论研究和实践水平。

  19. Microbial Development in Soils Under Intensively Managed Bamboo (Phyllostachys praecox) Stands

    Institute of Scientific and Technical Information of China (English)

    XU Qiu-Fang; JIANG Pei-Kun

    2005-01-01

    Phyllostachys praecox C. D. Chu et C. S. Chao, a favored bamboo shoot species, has been widely planted in recent years. Four stands with different historical management practices were selected for this study to understand the evolution of soil microbial ecology by determining the effects of a new mulching and heavy fertilization practice on soil quality using microbiological parameters. Compared with the traditional practice (index 1), microbial biomass carbon (MBC) and soil microbial respiration carbon (MRC) with the new management practice significantly decreased (P < 0.01 and P < 0.05,respectively) with 1-2 years of mulching (index 2) and then for continued mulching significantly increased (P < 0.05). The ratios of MBC/TOC (total organic carbon) and MRC/TOC also significantly diminished (P < 0.05) with mulching. The average well color development (AWCD) and Shannon index decreased with mulching time, and the significant decrease(P < 0.05) in Shannon index occurred from index 2 to index 3. The results from a principal components analysis (PCA)showed that the scores of the first principal component for indexes 1 and 2 were significantly larger (P < 0.05) than soils mulched 3-4 years or 5-6 years. Also, the second principal component scores for index 1 were larger than those for index 2, suggesting that the ability of soil microorganisms to utilize soil carbon was decreasing with longer use of the new management practice and causing a deterioration of soil biological properties.

  20. AMERICAN COLLEGE OF CARDIOLOGY, AMERICAN HEART ASSOCIATION AND EUROPEAN SOCIETY OF CARDIOLOGY GUIDELINES (2006 FOR THE MANAGEMENT OF PATIENTS WITH ATRIAL FIBRILLATION (ENDING

    Directory of Open Access Journals (Sweden)

    V. Fuster

    2015-12-01

    Full Text Available A report of the American College of Cardiology, American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for practice guidelines.

  1. AMERICAN COLLEGE OF CARDIOLOGY, AMERICAN HEART ASSOCIATION AND EUROPEAN SOCIETY OF CARDIOLOGY GUIDELINES (2006 FOR THE MANAGEMENT OF PATIENTS WITH ATRIAL FIBRILLATION (ENDING

    Directory of Open Access Journals (Sweden)

    V. Fuster

    2007-01-01

    Full Text Available A report of the American College of Cardiology, American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for practice guidelines.

  2. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES--2016 UPDATE.

    Science.gov (United States)

    Gharib, Hossein; Papini, Enrico; Garber, Jeffrey R; Duick, Daniel S; Harrell, R Mack; Hegedüs, Laszlo; Paschke, Ralf; Valcavi, Roberto; Vitti, Paolo

    2016-05-01

    Thyroid nodules are detected in up to 50 to 60% of healthy subjects. Most nodules do not cause clinically significant symptoms, and as a result, the main challenge in their management is to rule out malignancy, with ultrasonography (US) and fine-needle aspiration (FNA) biopsy serving as diagnostic cornerstones. The key issues discussed in these guidelines are as follows: (1) US-based categorization of the malignancy risk and indications for US-guided FNA (henceforth, FNA), (2) cytologic classification of FNA samples, (3) the roles of immunocytochemistry and molecular testing applied to thyroid FNA, (4) therapeutic options, and (5) follow-up strategy. Thyroid nodule management during pregnancy and in children are also addressed. On the basis of US features, thyroid nodules may be categorized into 3 groups: low-, intermediate-and high-malignancy risk. FNA should be considered for nodules ≤10 mm diameter only when suspicious US signs are present, while nodules ≤5 mm should be monitored rather than biopsied. A classification scheme of 5 categories (nondiagnostic, benign, indeterminate, suspicious for malignancy, or malignant) is recommended for the cytologic report. Indeterminate lesions are further subdivided into 2 subclasses to more accurately stratify the risk of malignancy. At present, no single cytochemical or genetic marker can definitely rule out malignancy in indeterminate nodules. Nevertheless, these tools should be considered together with clinical data, US signs, elastographic pattern, or results of other imaging techniques to improve the management of these lesions. Most thyroid nodules do not require any treatment, and levothyroxine (LT4) suppressive therapy is not recommended. Percutaneous ethanol injection (PEI) should be the first-line treatment option for relapsing, benign cystic lesions, while US-guided thermal ablation treatments may be considered for solid or mixed symptomatic benign thyroid nodules. Surgery remains the treatment of choice for

  3. THE PERFORMANCE OF JAVA AND ONGOLE CROSSBRED BULL UNDER INTENSIVE FEEDING MANAGEMENT

    Directory of Open Access Journals (Sweden)

    C.M.S. Lestari

    2014-10-01

    Full Text Available This study was set up to evaluate the performance of Java and Ongole Crossbred (OC bulls fedconcentrate and rice straw. A total of four Java bulls and four OC bulls were used in this experiment. Thebulls were fed concentrates (50% of the total dry matter feed requirement and rice straw (ad libitum.The concentrates were consisted of rice bran, beer waste product, copra meal, minerals, with crudeprotein (CP and total digestible nutrients (TDN contents of 15.32% and 73.09%, respectively. Theaverage daily gain (ADG, dry matter intake (DMI, protein and energy intake, and feed conversion ratio(FCR were observed. The results of this study showed that the ADG, DMI, CP and TDN intake, andFCR were not significantly different (p> 0.05. The ADG of Java and OC bulls were 0.58 kg and 0.78kg, respectively. The averages of DMI, CP and TDN intake were 6.59 kg (2.09% of BW, 0.81 kg and4.34 kg for Java bulls whereas for OC bulls were 6.42 kg (2.11% of BW, 0.78 kg, and 4.20 kg,respectively. The FCR of Java bulls was 11.49 and those of OC bulls was 9.21. It can be concluded thatJava and OC bulls raised intensively and fed concentrate and rice straw had the similar performance.

  4. THE PERFORMANCE OF JAVA AND ONGOLE CROSSBRED BULL UNDER INTENSIVE FEEDING MANAGEMENT

    Directory of Open Access Journals (Sweden)

    C.M.S. Lestari

    2011-06-01

    Full Text Available This study was set up to evaluate the performance of Java and Ongole Crossbred (OC bulls fed concentrate and rice straw. A total of four Java bulls and four OC bulls were used in this experiment. The bulls were fed concentrates (50% of the total dry matter feed requirement and rice straw (ad libitum. The concentrates were consisted of rice bran, beer waste product, copra meal, minerals, with crude protein (CP and total digestible nutrients (TDN contents of 15.32% and 73.09%, respectively. The average daily gain (ADG, dry matter intake (DMI, protein and energy intake, and feed conversion ratio (FCR were observed. The results of this study showed that the ADG, DMI, CP and TDN intake, and FCR were not significantly different (p> 0.05. The ADG of Java and OC bulls were 0.58 kg and 0.78 kg, respectively. The averages of DMI, CP and TDN intake were 6.59 kg (2.09% of BW, 0.81 kg and 4.34 kg for Java bulls whereas for OC bulls were 6.42 kg (2.11% of BW, 0.78 kg, and 4.20 kg, respectively. The FCR of Java bulls was 11.49 and those of OC bulls was 9.21. It can be concluded that Java and OC bulls raised intensively and fed concentrate and rice straw had the similar performance.

  5. Adaptive harvest management of North American waterfowl populations: a brief history and future prospects

    Science.gov (United States)

    Nichols, J.D.; Runge, M.C.; Johnson, F.A.; Williams, B.K.

    2007-01-01

    Since 1995, the US Fish and Wildlife Service has used an adaptive approach to the management of sport harvest of mid-continent Mallard ducks (Anas platyrhynchos) in North America. This approach differs from many current approaches to conservation and management in requiring close collaboration between managers and scientists. Key elements of this process are objectives, alternative management actions, models permitting prediction of system responses, and a monitoring program. The iterative process produces optimal management decisions and leads to reduction in uncertainty about response of populations to management. This general approach to management has a number of desirable features and is recommended for use in many other programs of management and conservation.

  6. Ionospheric F region effects observed in the American and African sectors during the intense geomagnetic storm of September-October 2012

    Science.gov (United States)

    De Jesus, Rodolfo; Gende, Mauricio; Fagundes, Paulo Roberto; Coster, Anthea; Bolaji, Segun; Kavutarapu, Venkatesh; De Abreu, Alessandro; Sobral, J. H. A.; Pillat, Valdir Gil; Batista, Inez S.

    This study presents an investigation of geomagnetic disturbance effects on the equatorial, low- and mid-latitude ionospheric F region over the American and African sectors during the intense geomagnetic storm (maximum Kp index of 6.7) that occurred on 30th September, 2012 and 1st October, 2012. In this study digital ionosonde and Global Positioning System (GPS) data are simultaneously utilized from 30th September to 3rd October 2012. The diurnal variability over this four day period observed from both the digital ionosonde and from ground based GPS units can be characterized as quiet, slightly disturbed, and strongly disturbed periods. This time period includes the sudden commencement of the storm (SCS), the main phase (MPS), and the recovery phase of the storm (RPS). During the period of investigation, ionospheric parameters F-region critical frequency (foF2) and minimum F-region virtual height ('hF) were obtained at Jicamarca, São Luís, Fortaleza, Palmas and Port Stanley at the following geographical coordinates, respectively: 12.0ºS 76.8ºW, 2.6ºS 44.2ºW, 3.8ºS 38ºW, 10.2ºS 48.8ºW and 51.6ºS 57.9ºW. In this study, we also used observations of 20 GPS stations located at Greenbelt (39.0ºN, 76.8ºW), Cambridge (38.6ºN, 76.1ºW), Virgin Islands (17.6ºN, 64.6ºW), Eusebio (03.9ºS, 38.4ºW), Iquitos (03.8ºS, 73.3 ºW), Arequipa (16.5ºS, 71.5ºW), Cachoeira Paulista (22.7ºS, 45.0ºW), Copiapo (27.4ºS, 70.4ºW), La Plata (34.9ºS, 57.9ºW), Concepcion (36.8ºS, 73.0ºW), Rio Grande (53.8ºS, 67.8ºW), Dakar (14.7ºN, 17.4ºW), Addis (09.0ºN, 38.8ºE), Cotonou (06.4ºN, 02.5ºE), Libreville (00.4ºN, 09.7ºE), Mbarara (00.6ºS, 30.7ºE), Lusaka (15.4ºS, 28.3ºE), Windhoek (22.6ºS, 17.1ºE), Springbok (29.7ºS, 17.9ºE) and Sutherland (32.4ºS, 20.8ºE). Vertical Total Electron Content (VTEC) and TEC fluctuations (ROT, rate of change of TEC) are calculated from GPS data using the measured Slant Total Electron Content (STEC) records from the 20 GPS

  7. Improving Performance of Replacement Heifers in Hot Arid Environment Under Intensive Management

    Directory of Open Access Journals (Sweden)

    M. A. Razzaque

    2009-01-01

    Full Text Available Problem statement: Imported Holstein Friesian dairy cattle are exposed to hot arid climate in feedlot management in Kuwait. Desert climate is extreme reaching high 45-50°C in summer and low -4°C in winter at day and night respectively. High calf mortality, poor reproduction and milk yields were main constraints to viable dairying. The objectives of this study were to assess the magnitude of calf mortality, its causes; implement strategic intervention measures for improving calf survival rates and evaluate dairy herd performance. Approach: Two scenarios were used: (1 studying dairy herd performance without applying intervention measures and (2 introducing improved management with interventions. Performance of the herds of situations 1 and 2 were compared. Three classes of dairy herds, pre-weaned calves, heifers and first lactation cows born in Kuwait were used. Results: Implementing intervention measures resulted in significant (p = 0.001 reduction of crude calf mortality rates from a mean of 43.6% to a low 4.67%. Growth rates of calves and heifers increased significantly, resulting in breeding of locally raised heifers at 15 mo age instead of usual practice of breeding at 18-22 mo. Feed cost was significantly reduced by 14-25% by early breeding of heifers. Herd culling rate was reduced from 62-33% and conception rates increased by 41%. The milk yield was increased by 1.25-1.50 fold through replacing the imported cows by locally born heifers. Adult cattle mortality rates reduced from high 9 to a low 1%. Case study showed that locally born and reared dairy herd formed a mean of 65.8% of total dairy cattle in cooperating farms. Conclusion: A systematic applied research studies in the commercial dairy farms had resulted in a visible improvement in the performance of all categories of locally born dairy herds and they were better adapted to the local hostile climate.

  8. Review of Alternative Management Options of Vegetable Crop Residues to Reduce Nitrate Leaching in Intensive Vegetable Rotations

    Directory of Open Access Journals (Sweden)

    Laura Agneessens

    2014-12-01

    Full Text Available Vegetable crop residues take a particular position relative to arable crops due to often large amounts of biomass with a N content up to 200 kg N ha−1 left behind on the field. An important amount of vegetable crops are harvested during late autumn and despite decreasing soil temperatures during autumn, high rates of N mineralization and nitrification still occur. Vegetable crop residues may lead to considerable N losses through leaching during winter and pose a threat to meeting water quality objectives. However, at the same time vegetable crop residues are a vital link in closing the nutrient and organic matter cycle of soils. Appropriate and sustainable management is needed to harness the full potential of vegetable crop residues. Two fundamentally different crop residue management strategies to reduce N losses during winter in intensive vegetable rotations are reviewed, namely (i on-field management options and modifications to crop rotations and (ii removal of crop residues, followed by a useful and profitable application.

  9. EFFECT OF FLOOR TYPE ON BEHAVIOURAL ACTIVITIES OF INTENSIVELY MANAGED OSTRICHES

    Directory of Open Access Journals (Sweden)

    Dan SEABO

    2015-09-01

    Full Text Available Effects of providing grit on daily behavioural activities of intensively kept ostriches were investigated at the Botswana College of Agriculture. Two groups of ostriches were each housed in a 30 x 6m pen. Each group had seven ostriches in it. Each member of the group was identified by a number tag attached to its neck. Activities studied were feeding, picking objects, walking about, sparring, standing rest, sitting rest, grooming self, and grooming others. The study lasted 30 days. The results of the study show that during the mornings and afternoons, ostriches without access to grit allocated significantly (P<0.05 greater proportion of their activity time to feeding than did those with access to grit. The proportion of time allocated to morning feeding by the non-grit group was 23.1% as opposed to 13.9% for the grit group. In the afternoon, the non-grit group of ostriches continued allocating significantly more time (13.3 % to feeding than the grit group which only allocated 4.8% of their activity to the same activity. This trend in apportioning activity time by the two groups of ostriches was maintained with regards to the proportion of time allocated to walking about in the pens. The non-grit group allocated significantly (P<0.05 greater proportions of time to walking than the grit group. In the morning, non-grit ostriches allocated 25.8% of their daily activity to walking about in the pen while their grit counterparts allocated 19.9% to the same activity. The grit-fed group of ostriches rested more as they allocated significantly higher proportion (28.1% of their afternoon time to resting while standing than the proportion (17.7% allocated to the same by the non-grit group. Both treatment groups allocated higher proportions of their activity times to morning feeding. The group with access to grit spent 35.2% of the morning time feeding while allocating only 22.5% for the same activity in the afternoon feeding. The non-grit group allocated 24

  10. Precision livestock farming technologies for welfare management in intensive livestock systems.

    Science.gov (United States)

    Berckmans, D

    2014-04-01

    The worldwide demand for meat and animal products is expected to increase by at least 40% in the next 15 years. The first question is how to achieve high-quality, sustainable and safe meat production that can meet this demand. At the same time, livestock production is currently facing serious problems. Concerns about animal health in relation to food safety and human health are increasing. The European Union wants improved animal welfare and has made a significant investment in it. At the same time, the environmental impact of the livestock sector is a major issue. Finally, it is necessary to ask how the farmer, who is the central figure in this process, will make a living from more sustainable livestock production systems. One tool that might provide real opportunities is precision livestock farming (PLF). In contrast to previous approaches, PLF systems aim to offer a real-time monitoring and management system that focuses on improving the life of the animals by warning when problems arise so that the farmer may take immediate action. Continuous, fully automatic monitoring and improvement of animal health and welfare, product yields and environmental impacts should become possible. This paper presents examples of systems that have already been developed in order to demonstrate the potential benefits of this technology.

  11. Time-series analysis reveals genetic responses to intensive management of razorback sucker (Xyrauchen texanus).

    Science.gov (United States)

    Dowling, Thomas E; Turner, Thomas F; Carson, Evan W; Saltzgiver, Melody J; Adams, Deborah; Kesner, Brian; Marsh, Paul C

    2014-03-01

    Time-series analysis is used widely in ecology to study complex phenomena and may have considerable potential to clarify relationships of genetic and demographic processes in natural and exploited populations. We explored the utility of this approach to evaluate population responses to management in razorback sucker, a long-lived and fecund, but declining freshwater fish species. A core population in Lake Mohave (Arizona-Nevada, USA) has experienced no natural recruitment for decades and is maintained by harvesting naturally produced larvae from the lake, rearing them in protective custody, and repatriating them at sizes less vulnerable to predation. Analyses of mtDNA and 15 microsatellites characterized for sequential larval cohorts collected over a 15-year time series revealed no changes in geographic structuring but indicated significant increase in mtDNA diversity for the entire population over time. Likewise, ratios of annual effective breeders to annual census size (N b /N a) increased significantly despite sevenfold reduction of N a. These results indicated that conservation actions diminished near-term extinction risk due to genetic factors and should now focus on increasing numbers of fish in Lake Mohave to ameliorate longer-term risks. More generally, time-series analysis permitted robust testing of trends in genetic diversity, despite low precision of some metrics. PMID:24665337

  12. Management of swine-flu patients in the intensive care unit: Our experience

    Directory of Open Access Journals (Sweden)

    Raktima Anand

    2012-01-01

    Full Text Available Background: H1N1 pandemic in 2009-2010 created a state of panic not only in India, but in the whole world. The clinical picture seen with H1N1 is different from the seasonal influenza involving healthy young adults. Critical care management of such patients imposes a challenge for anesthesiologist. Materials and Methods: A retrospective analysis of hospitalized positive H1N1 patients was performed from July 2009-June 2010. Those requiring the ventilatory support were included in the study. Result: 54 patients were admitted in the swine-flu ward during the study period out of which 19 required ventilatory support. The average day of presentation to the health care facility was 6 th day causing delay in initiation of antiviral therapy and increased severity of the disease. 65% of the ventilated patients were having associated comorbidities. Mortality was 74% among ventilated patients. Conclusion: Positive H1N1 with severe disease profile have a poor outcome. Early identification of high-risk factors and thus early intervention in the form of antiretroviral therapy and respiratory care will help in reducing the overall mortality.

  13. Study on performance analysis of Holstein Fresien cattle under intensive management at government dairy farm, Pishin, Balochistan

    Directory of Open Access Journals (Sweden)

    Yousaf H. Barozai

    2011-06-01

    Full Text Available The study was carried out to analyze the productive and reproductive performance ofHolstein Friesian cattle under intensive management at Government Dairy Farm, Pishin (Balochistanexploring the ten years performance records from 1997-2007. Parameters were productive traits(birth weight, lactation length, lactation milk yield, reproductive traits (age at first conception, age atfirst calving, service period, dry period, calving interval and effect of calving season on (milk yield,calving interval, birth weight, dry period on the Holstein Fresein cattle. Analysis of data revealedsignificant difference in all the productive traits (P0.05 in higher birth weight of calves, dry period,calving interval and milk yield of cows, respectively.

  14. Intensive management program to improve glycosylated hemoglobin levels and adherence to diet in patients with type 2 diabetes.

    Science.gov (United States)

    Song, Min-Sun; Kim, Hee-Seung

    2009-02-01

    This study investigated the effects of a diabetes outpatient intensive management program (DOIMP) on glycosylated hemoglobin (HbA(1)c) levels and adherence to diabetes control recommendations over a 12-week follow-up period for patients with diabetes. The DOIMP was composed of multidisciplinary diabetes education, complication monitoring, and telephone counseling. Twenty-five patients in the intervention group participated in the DOIMP, whereas 24 in the control group were briefed on the conventional description of diabetes mellitus by diabetes education nurses. Patients in the intervention group decreased their mean HbA(1)c levels by 2.3%, as compared with 0.4% in the control group. There was a significant increase in adherence to diet for the intervention group as compared with the control group. These findings indicate that the DOIMP can improve HbA(1)c levels and adherence to diet in patients with type 2 diabetes.

  15. Development and Pilot of a Checklist for Management of Acute Liver Failure in the Intensive Care Unit.

    Directory of Open Access Journals (Sweden)

    Oren K Fix

    Full Text Available Acute liver failure (ALF is an ideal condition for use of a checklist. Our aims were to develop a checklist for the management of ALF in the intensive care unit (ICU and assess the usability of the checklist among multiple providers.The initial checklist was developed from published guidelines and expert opinion. The checklist underwent pilot testing at 11 academic liver transplant centers in the US and Canada. An anonymous, written survey was used to assess the usability and quality of the checklist. Written comments were used to improve the checklist following the pilot testing period.We received 81 surveys involving the management of 116 patients during the pilot testing period. The overall quality of the checklist was judged to be above average to excellent by 94% of users. On a 5-point Likert scale, the majority of survey respondents agreed or agreed strongly with the following checklist characteristics: the checklist was easy to read (99% agreed/agreed strongly, easy to use (97%, items are categorized logically (98%, time to complete the checklist did not interfere with delivery of appropriate and safe patient care (94% and was not excessively burdensome (92%, the checklist allowed the user the freedom to use his or her clinical judgment (80%, it is a useful tool in the management of acute liver failure (98%. Web-based and mobile apps were developed for use of the checklist at the point of care.The checklist for the management of ALF in the ICU was shown in this pilot study to be easy to use, helpful and accepted by a wide variety of practitioners at multiple sites in the US and Canada.

  16. Feasibility of Adapting Multisystemic Therapy to Improve Illness Management Behaviors and Reduce Asthma Morbidity in High Risk African American Youth: A Case Series

    Science.gov (United States)

    Naar-King, Sylvie; Ellis, Deborah; Kolmodin, Karen; Cunningham, Phillippe; Secord, Elizabeth

    2009-01-01

    African-American adolescents have the highest rates of asthma morbidity and mortality, yet there are few successful behavioral interventions to improve illness management for this group. Mental health providers have an opportunity to expand their services and impact by targeting adolescents with poor asthma management. We describe the adaptation…

  17. A Comparative Study of the Relationships between Conflict Management Styles and Job Satisfaction, Organizational Commitment, and Propensity to Leave the Job among Saudi and American Universities' Faculty Members

    Science.gov (United States)

    Alzahrani, Mohammed

    2013-01-01

    This study used Rahim Organizational Conflict Inventory-II, Form C to examine the preference for conflict management styles among Saudi and American faculty members. Additionally, the study examined the relationships between conflict management styles and job satisfaction, organizational commitment, and propensity to leave the job. A random sample…

  18. [Treatment of arterial and venous brain ischemia. Experts' recommendations: stroke management in the intensive care unit].

    Science.gov (United States)

    Calvet, D; Bracard, S; Mas, J-L

    2012-06-01

    With thrombolysis, intravenous alteplase (0.9 mg/kg body weight, maximum 90 mg), with 10% of the dose given as a bolus followed by a 60-minute infusion, is recommended within 4.5 hours of onset of ischemic stroke. When indicated, intravenous thrombolysis must be initiated as soon as possible. It is possible to use intravenous alteplase in patients with seizures at stroke onset, if the neurological deficit is related to acute cerebral ischemia. Intravenous alteplase can be discussed for use on a case-by-case basis, according to risk of bleeding, in selected patients under 18 years and over 80 years of age, although for the current European recommendations this would be an off-label use. In hospitals with a stroke unit, intravenous thrombolysis is prescribed by a neurologist (current French labelling) or a physician having the French certification for neurovascular diseases (outside the current French labelling). The patient must be monitored in the stroke unit or in case of multiple organ failure in an intensive and critical care unit. In hospitals without a stroke unit, thrombolysis must be decided by the neurologist from the corresponding stroke unit via telemedicine. It is recommended to perform brain imaging 24 hours after thromboysis. Intra-arterial thrombolysis can be contemplated on a case-by-case basis after multidisciplinary discussion within a 6-hour time window for patients with acute middle cerebral artery or carotid occlusions, and within a larger time window for patients with basilar artery occlusion, because of their very poor spontaneous prognosis. Mechanical thrombectomy can also be contemplated in the same situations. With antiplatelet agents, it is recommended that patients receive aspirin (160 mg-325 mg) within 48 hours of ischemic stroke onset. When thrombolysis is performed or contemplated, it is recommended to delay the initiation of aspirin or other antithrombotic drugs for 24 hours. The use of antiplatelet agents that inhibit the

  19. Interactions into Opportunities: Career Management for Low-Income, First-Generation African American College Students

    Science.gov (United States)

    Parks-Yancy, Rochelle

    2012-01-01

    This study explores how low-income, African American college students obtain social capital resources from university contacts to set and achieve career goals. Students knew little about career options available to future college graduates beyond jobs that were related to their current jobs. Few students utilized the information, influence, and…

  20. Management of North American Culicoides biting midges: Current knowledge and research needs

    Science.gov (United States)

    Culicoides biting midges (Diptera: Ceratopogonidae) are biological vectors of two important viruses infecting North American ruminants: bluetongue (BTV) and epizootic hemorrhagic disease (EHDV). While these viruses have been identified for over 60 years, we still lack an adequate understanding of t...

  1. Managing Regional Collaboration in Higher Education: The Case of the North American Free Trade Agreement (NAFTA).

    Science.gov (United States)

    Crespo, Manuel

    2000-01-01

    Describes accomplishments in increasing collaboration in higher education within the North American Free Trade Agreement (NAFTA). Analyzes procedures for determining equivalencies of courses and degrees and for improving transnational mobility of students and professors. Also discusses the role of the private sector in research, education and…

  2. Greenhouse gas exchange in grasslands: impacts of climate, intensity of management and other factors

    Science.gov (United States)

    Smith, K. A.

    2003-04-01

    Grasslands occupy some 40% of the terrestrial land surface. They are generally categorised as natural (occurring mainly in those regions where the rainfall is too low to support forest ecosystems), semi-natural (where management, mainly by grazing, has changed the vegetation composition), and artificial (where forests have been cleared to create new pasture land). The soils of the natural and semi-natural grasslands constitute a large reservoir of carbon, and make a substantial contribution to the soil sink for atmospheric CH_4. The conversion of much of the natural temperate grassland to arable agriculture, e.g. in North America and Europe, resulted in a considerable decrease in soil organic carbon, and its release to the atmosphere as CO_2 has made a substantial contribution to the total atmospheric concentration of this gas. The associated increase in cycling of soil N (released from the organic matter) will have contributed to N_2O emissions, and land disturbance and fertilisation has resulted in a depletion of the soil CH_4 sink. Conversion of tropical forests to pastures has also been a major source of CO_2, and these pastures show elevated emissions of N_2O for some years after conversion. Seasonally flooded tropical grasslands are a significant source of CH_4 emissions. Consideration of grassland ecosystems in their entirety, in relation to GHG exchange, necessitates the inclusion of CH_4 production by fauna - domesticated livestock and wild herbivores, as well as some species of termites - in the overall assessment. Stocking rates on pasture land have increased, and the total CH_4 emissions likewise. The relationship between animal production and CH_4 emissions is dependent on the nutritional quality of the vegetation, as well as on animal numbers. In both temperate and tropical regions, increased N inputs as synthetic fertilisers and manures (and increased N deposition) are producing possibly a more-than-linear response in terms of emissions of N_2O. In

  3. Intensive Eucalyptus plantation management in Brazil: Long-term effects on soil carbon dynamics across 300 sites

    Science.gov (United States)

    Cook, R. L.; Stape, J.; Binkley, D.

    2011-12-01

    Intensively managed forest plantations now cover more than 6 million hectares in Brazil, and another 20 million hectares in other tropical regions. Although aboveground biomass, and therefore carbon, is well monitored due to commercial interest, the belowground carbon dynamics and site sustainability remain poorly understood. So, how does intensive silviculture change the storage of carbon in soils? Trends in soil organic carbon from land-use change indicate that conversion from pastures to Eucalyptus plantations should maintain soil carbon stocks. However, comprehensive, long-term studies are needed to understand the variability in these trends to better manage these systems for sustainable productivity across a highly variable landscape, as well as to understand the role that soils may play in sequestering carbon for climate change mitigation. In this unique, long-term soil study, soil samples were collected in the 1980s/90s, 2001, and 2010 across 300 intensively managed Eucalyptus plantation sites located in the states of Bahia, Espirito Santo, and Sao Paulo, Brazil. Natural ecosystems for these states include Savannah-Dry Forest, Atlantic Forest, and Savanna, respectively. The sampling covered at least three complete rotations of Eucalyptus at each site; climate, past land use, productivity, and soil characteristics vary across this geographic gradient. Across the two periods, both Espirito Santo (P<0.001) and Bahia (P=0.05) showed a decrease in soil carbon concentrations, while Sao Paulo saw no change over time. For the 0-30 cm layer, plantations in Espirito Santo state had the largest decrease in soil carbon concentration up to 2001, decreasing soil carbon stocks at an average rate of 1.3 Mg C ha-1 year-1. This, however, was followed by no significant change from 2001 to 2010 which may indicate stabilization of soil carbon stocks under the new land use. The Eucalyptus in Bahia created no change in the first sampling period, but saw a decline of 0.35 Mg C ha-1

  4. Critical review of the current knowledge of the biology of the American woodcock and its management on the breeding grounds

    Science.gov (United States)

    Sepik, G.F.; McAuley, D.G.; Longcore, J.R.

    1993-01-01

    We critiqued previous work on the biology and management of the American woodcock (Scolopax minor) on the breeding grounds. We determined that little is known about habitat variables and weather extremes that may limit the population. Most investigators who attempted to define habitat requirements of the woodcock used inadequate sample sizes, limited the duration of their studies, did not account for effects of weather, or failed to adequately measure habitat variables. Furthermore, the effects of hunting on local or regional populations has never been adequately studied. We concluded that obtaining data to understand the biology of the woodcock and the effects of hunting is essential before managers can reverse the long-term decline of woodcock numbers.

  5. Management of Respiratory Motion in Extracorporeal High-Intensity Focused Ultrasound Treatment in Upper Abdominal Organs: Current Status and Perspectives

    Energy Technology Data Exchange (ETDEWEB)

    Muller, A., E-mail: arnaud.muller@chu-lyon.fr [Centre Hospitalier Lyon Sud, Service de Radiologie, Hospices Civils de Lyon (France); Petrusca, L.; Auboiroux, V. [University of Geneva, Department of Radiology, Faculty of Medicine (Switzerland); Valette, P. J. [Centre Hospitalier Lyon Sud, Service de Radiologie, Hospices Civils de Lyon (France); Salomir, R. [University of Geneva, Department of Radiology, Faculty of Medicine (Switzerland); Cotton, F. [Centre Hospitalier Lyon Sud, Service de Radiologie, Hospices Civils de Lyon (France)

    2013-12-15

    Extracorporeal high-intensity focused ultrasound (HIFU) is a minimally invasive therapy considered with increased interest for the ablation of small tumors in deeply located organs while sparing surrounding critical tissues. A multitude of preclinical and clinical studies have showed the feasibility of the method; however, concurrently they showed several obstacles, among which the management of respiratory motion of abdominal organs is at the forefront. The aim of this review is to describe the different methods that have been proposed for managing respiratory motion and to identify their advantages and weaknesses. First, we specify the characteristics of respiratory motion for the liver, kidneys, and pancreas and the problems it causes during HIFU planning, treatment, and monitoring. Second, we make an inventory of the preclinical and clinical approaches used to overcome the problem of organ motion. Third, we analyze their respective benefits and drawbacks to identify the remaining physical, technological, and clinical challenges. We thereby consider the outlook of motion compensation techniques and those that would be the most suitable for clinical use, particularly under magnetic resonance thermometry monitoring.

  6. Nitrogen excess in North American ecosystems: Predisposing factors, ecosystem responses, and management strategies

    Science.gov (United States)

    Fenn, M.E.; Poth, M.A.; Aber, J.D.; Baron, J.S.; Bormann, B.T.; Johnson, D.W.; Lemly, A.D.; McNulty, S.G.; Ryan, D.F.; Stottlemyer, R.

    1998-01-01

    , illustrating that ecosystems vary widely in the capacity to retain N inputs. Overly mature forests with high N deposition, high soil N stores, and low soil C:N ratios are prone to N saturation and NO3/- leaching. Additional characteristics favoring low N retention capacity include a short growing season (reduced plant N demand) and reduced contact time between drainage water and soil (i.e., porous coarse-textured soils, exposed bedrock or talus). Temporal patterns of hydrologic fluxes interact with biotic uptake and internal cycling patterns in determining ecosystem N retention. Soils are the largest storage pool for N inputs, although vegetation uptake is also important. Recent studies indicate that nitrification may be widespread in undisturbed ecosystems, and that microbial assimilation of NO3/- may be a significant N retention mechanism, contrary to previous assumptions. Further studies are needed to elucidate the sites, forms, and mechanisms of N retention and incorporation into soil organic matter, and to test potential management options for mitigating N losses from forests. Implementation of intensive management practices in N-saturated ecosystems may only be feasible in high-priority areas and on a limited scale. Reduction of N emissions would be a preferable solution, although major reductions in the near future are unlikely in many areas due to economic, energy-use, policy, and demographic considerations.

  7. Effects of the intense geomagnetic storm of September-October 2012 on the equatorial, low- and mid-latitude F region in the American and African sector during the unusual 24th solar cycle

    Science.gov (United States)

    de Jesus, R.; Fagundes, P. R.; Coster, A.; Bolaji, O. S.; Sobral, J. H. A.; Batista, I. S.; de Abreu, A. J.; Venkatesh, K.; Gende, M.; Abalde, J. R.; Sumod, S. G.

    2016-02-01

    The main purpose of this paper is to investigate the response of the ionospheric F layer in the American and African sectors during the intense geomagnetic storm which occurred on 30 September-01 October 2012. In this work, we used observations from a chain of 20 GPS stations in the equatorial, low- and mid-latitude regions in the American and African sectors. Also, in this study ionospheric sounding data obtained during 29th September to 2nd October, 2012 at Jicamarca (JIC), Peru, São Luis (SL), Fortaleza (FZ), Brazil, and Port Stanley (PST), are presented. On the night of 30 September-01 October, in the main and recovery phase, the h´F variations showed an unusual uplifting of the F region at equatorial (JIC, SL and FZ) and mid- (PST) latitude stations related with the propagations of traveling ionospheric disturbances (TIDs) generated by Joule heating at auroral regions. On 30 September, the VTEC variations and foF2 observations at mid-latitude stations (American sector) showed a long-duration positive ionospheric storm (over 6 h of enhancement) associated with large-scale wind circulations and equatorward neutral winds. Also, on 01 October, a long-duration positive ionospheric storm was observed at equatorial, low- and mid- latitude stations in the African sector, related with the large-scale wind circulations and equatorward neutral winds. On 01 and 02 October, positive ionospheric storms were observed at equatorial, low- and mid-latitude stations in the American sector, possibly associated with the TIDs and an equatorward neutral wind. Also, on 01 October negative ionospheric storms were observed at equatorial, low- and mid-latitude regions in the American sector, probably associated with the changes in the O/N2 ratio. On the night of 30 September-01 October, ionospheric plasma bubbles were observed at equatorial, low- and mid- latitude stations in the South American sector, possibly associated with the occurrence of geomagnetic storm.

  8. Can Efficient Irrigation and Nitrogen Management Practices Contribute to Nitrate Reduction in Groundwater under Intensive Farmer-Managed Vegetable Fields in Slovenia Catchments?

    International Nuclear Information System (INIS)

    Groundwater is a very important source of drinking water in Slovenia. However, the intensification of agriculture through the use of nitrogen (N) fertilizers and organic manure from livestock (pig farms) to enhance crop yields may be one of the causes of groundwater contamination through nitrate leaching. It is predicted that intensive vegetable production is the major cause of nitrate contamination in the Ljubljana aquifer which is the major source of drinking water in Ljubljana, Slovenia. The Project. Slovenia aims to meet the EU Water Framework Directive (2000/60/EC) and national standards for good quality groundwater status by 2013 while maintaining an intensive agriculture production. A Technical Cooperation Project (TCP) SLO5002 was funded by IAEA to help improve the capabilities of the Slovenia Counterpart institutes to address nitrate (and also) pesticides in drinking water by establishing a monitoring system for soil water balance, and for pesticide and nitrate leaching from agricultural benchmark sites in Slovenia catchments. The objective of the study is to assess how different irrigation, nitrogen and cropping system management strategies could help reduce nitrate leaching while sustaining yields in a farmer-managed vegetable field using farmers' (one time fertilizer application before planting and irrigating shortly after planting) and improved practices (scheduled irrigation and fertilization) in a benchmark site in Sneberje, Slovenia. The project also aims to transfer knowledge to the stakeholders. Nitrogen-15 fertilizer was used as a tracer to monitor N acquisition by plants and nitrate movement in the soil. Soil water was monitored using 2 capacitance probes (EnviroScan and the Time Domain Reflectometer). The IAEA provided experts, training, equipment, stable and radioactive tracers and consumables and the Government of Slovenia executed the Project

  9. American hospital emergency management model%美国医院的应急管理模式

    Institute of Scientific and Technical Information of China (English)

    辛衍涛

    2008-01-01

    美国21世纪发生的恐怖活动、自然灾害、传染病疫情使人们认识到建立一种全新医院应急管理模式的迫切性.政府对医院应急管理的组织领导,指挥和协调、应急准备、应急培训、应急演练、物资管理、通讯和信息传递都提出了明确的要求.美国的大多数医院都采用医院应急管理规划的模式来推动应急管理工作,主要包括:设置专人负责医院的应急管理工作;建立医院应急管理委员会;制定应对突发事件的综合预案;进行脆弱性分析;制定应对突发事件的专项预案;进行必要的应急准备.加强与外部机构的协调和寻求专业支持;开展应急培训和演练;定期进行回顾与评估.专门用于医院应对各类突发事件的医院突发事件指挥系统在美国的医院中被普遍采用.%The events of terror activities, natural disasters and infectious disease epidemics in the 21st century in the USA alert an urgent need to establish a novel hospital emergency management model. The federal government has proposed specific requirements for hospital emergency management in terms of organization, commanding and coordinating, emergency preparedness, training and rehearsal, resource management, communication and information transmission, Most of the American hospitals have adopted the model of hospital emergency management planning and preparedness, including mainly, assigning specialized personnel to hospital emergency management; establishment of an emergency management committee; formulation of an overall preparedness protocol for emergent events; performing fragility analysis; strengthening the coordination with extramural organizations and seeking expertise support; carrying out emergency preparedness training and rehearsal; and regular review and evaluation of the management. The commanding system set up especially to deal with various hospital emergent events is universally applied in American hospitals.

  10. Facilitators and barriers to hypertension self-management in urban African Americans: perspectives of patients and family members

    Directory of Open Access Journals (Sweden)

    Flynn SJ

    2013-08-01

    Full Text Available Sarah J Flynn,1,2 Jessica M Ameling,1,2 Felicia Hill-Briggs,1–3 Jennifer L Wolff,4,5 Lee R Bone,1,3 David M Levine,1,4 Debra L Roter,3 LaPricia Lewis-Boyer,1,2 Annette R Fisher,6 Leon Purnell,6 Patti L Ephraim,2,7 Jeffrey Barbers,1,2 Stephanie L Fitzpatrick,1,2 Michael C Albert,1,8 Lisa A Cooper,1,2 Peter J Fagan,9,10 Destiny Martin,1 Hema C Ramamurthi,1,2 L Ebony Boulware1,2,7 1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; 3Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 4Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 5Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 6Community and Provider Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA; 7Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 8Johns Hopkins Community Physicians, Johns Hopkins Medical Institutions, Baltimore, MD, USA; 9Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 10Johns Hopkins HealthCare LLC, Glen Burnie, MD, USA Introduction: We aimed to inform the design of behavioral interventions by identifying patients’ and their family members’ perceived facilitators and barriers to hypertension self-management. Materials and methods: We conducted focus groups of African American patients with hypertension and their family members to elicit their views about factors influencing patients’ hypertension self-management. We recruited African American patients with hypertension (n = 18 and their family members (n = 12 from an urban, community-based clinical

  11. Irrigation and fertilization effects on Nantucket Pine Tip Moth (Lepidoptera: Tortricidae) Damage levels and pupal weight in an intensively-managed pine plantation.

    Energy Technology Data Exchange (ETDEWEB)

    Coyle, David, R.; Nowak, John, T.; Fettig, Christopher, J.

    2003-10-01

    The widespread application of intensive forest management practices throughout the southeastern U.S. has increased loblolly pine, Pinus taeda L., yields and shortened conventional rotation lengths. Fluctuations in Nantucket pine tip moth, Rhyacionia frustrana (Comstock), population density and subsequent damage levels have been linked to variations in management intensity. We examined the effects of two practices, irrigation and fertilization, on R. frustrana damage levels and pupal weights in an intensively-managed P. taeda plantation in South Carolina. Trees received intensive weed control and one of the following treatments; irrigation only. fertilization only, irrigation + fertilization, or control. Mean whole-tree tip moth damage levels ranged from <1 to 48% during this study. Damage levels differed significantly among treatments in two tip moth generations in 2001, but not 2000. Pupal weight was significantly heavier in fertilization compared to the irrigation treatment in 2000, but no significant differences were observed in 2001. Tree diameter. height. and aboveground volume were significantly greater in the irrigation + fertilization than in the irrigation treatment after two growing seasons. Our data suggest that intensive management practices that include irrigation and fertilization do not consistently increase R. frustrana damage levels and pupal weights as is commonly believed. However, tip moth suppression efforts in areas adjacent to our study may have partially reduced the potential impacts of R. frustrana on this experiment.

  12. Spatial distribution of soils determines export of nitrogen and dissolved organic carbon from an intensively managed agricultural landscape

    Directory of Open Access Journals (Sweden)

    T. Wohlfart

    2012-11-01

    Full Text Available The surrounding landscape of a stream has crucial impacts on the aquatic environment. This study pictures the hydro-biogeochemical situation of the Tyrebækken creek catchment in central Jutland, Denmark. The intensively managed agricultural landscape is dominated by rotational croplands. The small catchment mainly consist of sandy soil types besides organic soils along the streams. The aim of the study was to characterise the relative influence of soil type and land use on stream water quality. Nine snapshot sampling campaigns were undertaken during the growing season of 2009. Total dissolved nitrogen (TDN, nitrate (NO3, ammonium nitrogen and dissolved organic carbon (DOC concentrations were measured, and dissolved organic nitrogen (DON was calculated for each grabbed sample. Electrical conductivity, pH and flow velocity were measured during sampling. Statistical analyses showed significant differences between the northern, southern and converged stream parts, especially for NO3 concentrations with average values between 1.4 mg N l−1 and 9.6 mg N l−1. Furthermore, throughout the sampling period DON concentrations increased to 2.8 mg N l−1 in the northern stream contributing up to 81% to TDN. Multiple-linear regression analyses performed between chemical data and landscape characteristics showed a significant negative influence of organic soils on instream N concentrations and corresponding losses in spite of their overall minor share of the agricultural land (12.9%. On the other hand, organic soil frequency was positively correlated to the corresponding DOC concentrations. Croplands also had a significant influence but with weaker correlations. For our case study we conclude that the fractions of coarse textured and organic soils have a major influence on N and DOC export in this intensively used landscape. Meanwhile, the contribution of DON to the total N

  13. Intensive diabetes management and goal setting are key aspects of improving metabolic control in children and young people with type 1 diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    Astha; Soni; Sze; May; Ng

    2014-01-01

    Diabetes control in children remains poor in spite of advances in treatment for last 10 years. The aim of this review was to look at various aspects of intensive therapy in the management of type 1 diabetes such as insulin regimes, role of target setting, psycho-educational approaches and self-management. To achieve good metabolic control, clear goal setting with adequate support for self-management are essential. Psycho-educational and behavioural interventions aimed at specific areas of management have shown significant improvement in quality of life and diabetes control.

  14. Effects of intramammary antibiotic therapy during the dry period on the performance of Lacaune dairy sheep under intensive management.

    Science.gov (United States)

    Hernandez, Fernando; Elvira, Laura; Fernández, Beatriz; Egea, Marta; Gonzalez-Bulnes, Antonio; Gonzalez-Martin, Juan V; Astiz, Susana

    2015-02-01

    Often the only way to ensure profitability of Lacaune dairy sheep is intensive management, which requires appropriate dry-period treatment to ensure animal productivity and health. The present study aimed to investigate the effects of intramammary antibiotic dry therapy on the performance and health of Lacaune sheep under intensive management. We recorded data for 5981 complete lactation periods that followed a dry period. A total of 2402 lactation periods were preceded by a dry period involving intramammary administration of 300 mg of cephapirin benzathine (antibiotic group) and 3579 lactation periods were preceded by dry periods with no treatment (control group). The following on-farm yield data were collected for individual lactation periods: length of the subsequent lactation period; total milk yield per lactation period; daily milk yield and length of the subsequent dry period. Data on confounding factors that might affect productivity were also recorded, including the individual ewe, number of lactation periods and length of the previous dry period. Milk quality was assessed using data on somatic cell count (SCC) and content of protein and fat taken from the Spanish National Official Milk Yield Recording System. Antibiotic dry therapy significantly improved total yield per lactation period, which was 429±151·1 l in the antibiotic group and 412±165·5 l in the control group, as well as the daily milk yield, which was 1986±497·0 and 1851±543·2 ml/d, respectively (both P<0·0001). The initial dry period was significantly longer in the antibiotic group than in the control group, and dry period length correlated inversely with yield variables such us total yield per lactation period (r=-0·055; P<0·0001) and yield per day in milk (r=-0·039; P<0·0001). As a result, milk yield records systematically underestimated the positive effects of antibiotic dry therapy. Antibiotic dry therapy also significantly improved milk quality. Milk from the antibiotic

  15. Effects of fire management on the richness and abundance of central North American grassland land snail faunas

    Directory of Open Access Journals (Sweden)

    Nekola, J. C.

    2002-01-01

    Full Text Available The land snail faunas from 72 upland and lowland grassland sites from central North America were analyzed. Sixteen of these had been exposed to fire management within the last 15 years, while the remainder had not. A total of 91,074 individuals in 72 different species were observed. Richness was reduced by approximately 30% on burned sites, while abundance was reduced by 50-90%. One-way ANOVA of all sites (using management type as the independent variable, a full 2-way ANOVA (using management and grassland type of all sites, and a 2-way ANOVA limited to 26 sites paired according to their habitat type and geographic location, demonstrated in all cases a highly significant (up to p < 0.0005 reduction in richness and abundance on fire managed sites. Contingency table analysis of individual species demonstrated that 44% experienced a significant reduction in abundance on fire-managed sites. Only six species positively responded to fire. Comparisons of fire response to the general ecological preferences of these species demonstrated that fully 72% of turf-specialists were negatively impacted by fire, while 67% of duff-specialists demonstrated no significant response. These differences were highly significant (p = 0.0006. Thus, frequent use of fire management represents a significant threat to the health and diversity of North American grassland land snail communities. Protecting this fauna will require the preservation of site organic litter layers, which will require the increase of fire return intervals to 15+ years in conjunction with use of more diversified methods to remove woody and invasive plants.

  16. Functional management of ankle sprains: what volume and intensity of walking is undertaken in the first week postinjury:what volume and intensity of walking is undertaken in the first week postinjury

    OpenAIRE

    Tully, Mark; Bleakley, C M; O'Connor, S.R.; McDonough, S.M.

    2012-01-01

    BACKGROUND: Acute ankle sprains are usually managed functionally, with advice to undertake progressive weight-bearing and walking. Mechanical loading is an important modular of tissue repair; therefore, the clinical effectiveness of walking after ankle sprain may be dose dependent. The intensity, magnitude and duration of load associated with current functional treatments for ankle sprain are unclear.AIM: To describe physical activity (PA) in the first week after ankle sprain and to compare r...

  17. Prediction of Job Performance for Black, Mexican-American, and Caucasian Inventory Management Specialists.

    Science.gov (United States)

    Crooks, Lois A.; Mahoney, Margaret H.

    This report is a description of the instrumentation, methodology, and sample obtained for the final phase of the study concerned with the Occupational Inventory Management Specialist. Inventory managers were asked to keep a Daily Activity Log for five days and to record the range of activities and interaction with others in the process of…

  18. Elephant Management in North American Zoos: Environmental Enrichment, Feeding, Exercise, and Training.

    Science.gov (United States)

    Greco, Brian J; Meehan, Cheryl L; Miller, Lance J; Shepherdson, David J; Morfeld, Kari A; Andrews, Jeff; Baker, Anne M; Carlstead, Kathy; Mench, Joy A

    2016-01-01

    The management of African (Loxodonta africana) and Asian (Elephas maximus) elephants in zoos involves a range of practices including feeding, exercise, training, and environmental enrichment. These practices are necessary to meet the elephants' nutritional, healthcare, and husbandry needs. However, these practices are not standardized, resulting in likely variation among zoos as well as differences in the way they are applied to individual elephants within a zoo. To characterize elephant management in North America, we collected survey data from zoos accredited by the Association of Zoos and Aquariums, developed 26 variables, generated population level descriptive statistics, and analyzed them to identify differences attributable to sex and species. Sixty-seven zoos submitted surveys describing the management of 224 elephants and the training experiences of 227 elephants. Asian elephants spent more time managed (defined as interacting directly with staff) than Africans (mean time managed: Asians = 56.9%; Africans = 48.6%; pelephant welfare analyses. PMID:27414654

  19. Evaluation of American Indian Health Service Training in Pain Management and Opioid Substance Use Disorder.

    Science.gov (United States)

    Katzman, Joanna G; Fore, Chris; Bhatt, Snehal; Greenberg, Nina; Griffin Salvador, Julie; Comerci, George C; Camarata, Christopher; Marr, Lisa; Monette, Rebecca; Arora, Sanjeev; Bradford, Andrea; Taylor, Denise; Dillow, Jenny; Karol, Susan

    2016-08-01

    We examined the benefits of a collaboration between the Indian Health Service and an academic medical center to address the high rates of unintentional drug overdose in American Indians/Alaska Natives. In January 2015, the Indian Health Service became the first federal agency to mandate training in pain and opioid substance use disorder for all prescribing clinicians. More than 1300 Indian Health Service clinicians were trained in 7 possible 5-hour courses specific to pain and addiction. We noted positive changes in pre- and postcourse knowledge, self-efficacy, and attitudes as well as thematic responses showing the trainings to be comprehensive, interactive, and convenient. PMID:27196642

  20. Knowledge, attitudes, beliefs and behaviour intentions for three bowel management practices in intensive care: effects of a targeted protocol implementation for nursing and medical staff

    OpenAIRE

    Knowles, Serena; Lam, Lawrence T; McInnes, Elizabeth; Elliott, Doug; Hardy, Jennifer; Middleton, Sandy

    2015-01-01

    Background Bowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians’ intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs’ knowledge, attitude, subjectiv...

  1. A Technical Evaluation of Wireless Connectivity from Patient Monitors to an Anesthesia Information Management System During Intensive Care Unit Surgery.

    Science.gov (United States)

    Simpao, Allan F; Galvez, Jorge A; England, W Randall; Wartman, Elicia C; Scott, James H; Hamid, Michael M; Rehman, Mohamed A; Epstein, Richard H

    2016-02-01

    Surgical procedures performed at the bedside in the neonatal intensive care unit (NICU) at The Children's Hospital of Philadelphia were documented using paper anesthesia records in contrast to the operating rooms, where an anesthesia information management system (AIMS) was used for all cases. This was largely because of logistical problems related to connecting cables between the bedside monitors and our portable AIMS workstations. We implemented an AIMS for documentation in the NICU using wireless adapters to transmit data from bedside monitoring equipment to a portable AIMS workstation. Testing of the wireless AIMS during simulation in the presence of an electrosurgical generator showed no evidence of interference with data transmission. Thirty NICU surgical procedures were documented via the wireless AIMS. Two wireless cases exhibited brief periods of data loss; one case had an extended data gap because of adapter power failure. In comparison, in a control group of 30 surgical cases in which wired connections were used, there were no data gaps. The wireless AIMS provided a simple, unobtrusive, portable alternative to paper records for documenting anesthesia records during NICU bedside procedures. PMID:26797553

  2. Reproductive parameters in the critically endangered Blue-throated Macaw: limits to the recovery of a parrot under intensive management.

    Directory of Open Access Journals (Sweden)

    Igor Berkunsky

    Full Text Available Rediscovered in the wild twenty years ago, the breeding biology of wild Blue-throated Macaws remains largely unexplored, yet is essential to its effective conservation and recovery. Here, we analyse reproductive parameters in an intensively managed wild population of Blue-throated Macaws, providing the first data on the breeding biology of this critically endangered species. During the six-year study period, 2007-2012, the number of active breeding pairs either remained constant or decreased, depending on the site, and no new breeding pairs were discovered despite extensive searching. We documented nesting attempts in natural cavities in dead palms or live hardwoods, and artificial nest boxes. Egg-laying was concentrated during the end of dry season and the beginning of the wet season, August through December. Hatching failure was the greatest cause of egg losses. Half of the breeding attempts of Blue-throated Macaws produced at least one fledging, on average two, after a 85 days nestling period. An average of 4.3 nestlings per year fledged from all known wild nests combined. Each pair lost roughly 65% of its initial reproductive investment at each nesting attempt. In most successful nesting attempts of individualized pairs, a new nesting attempt was not detected the following year. All monitored breeding pairs showed high nest site fidelity, reusing hardwood-tree cavities and nest boxes. Our findings will aid conservation efforts by refining current actions and prompting new approaches towards the conservation and recovery of the Blue-throated Macaw.

  3. A Technical Evaluation of Wireless Connectivity from Patient Monitors to an Anesthesia Information Management System During Intensive Care Unit Surgery.

    Science.gov (United States)

    Simpao, Allan F; Galvez, Jorge A; England, W Randall; Wartman, Elicia C; Scott, James H; Hamid, Michael M; Rehman, Mohamed A; Epstein, Richard H

    2016-02-01

    Surgical procedures performed at the bedside in the neonatal intensive care unit (NICU) at The Children's Hospital of Philadelphia were documented using paper anesthesia records in contrast to the operating rooms, where an anesthesia information management system (AIMS) was used for all cases. This was largely because of logistical problems related to connecting cables between the bedside monitors and our portable AIMS workstations. We implemented an AIMS for documentation in the NICU using wireless adapters to transmit data from bedside monitoring equipment to a portable AIMS workstation. Testing of the wireless AIMS during simulation in the presence of an electrosurgical generator showed no evidence of interference with data transmission. Thirty NICU surgical procedures were documented via the wireless AIMS. Two wireless cases exhibited brief periods of data loss; one case had an extended data gap because of adapter power failure. In comparison, in a control group of 30 surgical cases in which wired connections were used, there were no data gaps. The wireless AIMS provided a simple, unobtrusive, portable alternative to paper records for documenting anesthesia records during NICU bedside procedures.

  4. Short-Term Efficacy and Correlates of Change in Health Weight Management Program for Chinese American Children.

    Science.gov (United States)

    Chen, Jyu-Lin; Kwan, Monica

    2016-05-01

    A pretest and posttest study design was used to test a healthy weight management intervention with overweight and/or obese Chinese American children. Children attended 8-weekly small group sessions while parents attended a single 2-hour parent workshop. Children had their weight, height, blood pressure, waist and hip circumference, and fast lipids data assessed and completed several questions questionnaires regarding food choices, self-efficacy, and knowledge at baseline, 2 months, and 6 months. Parents completed questionnaires regarding demographic, acculturation level and family environment. We found significant reduction of body mass index, waist/hip ratio, systolic blood pressure and improvement of child's eating style, physical activity knowledge, self-efficacy, and children's quality of life at 6-month follow-up. In addition, significant improvement of high-density lipoprotein cholesterol and decrease in triglyceride were found at 6-month follow-up. Improvement of nutrition self-efficacy and decreased stimulus environment were associated with decreased body mass index in overweight and obese Chinese American children. PMID:26149851

  5. No Memory Effects of Restoration on N2O Exchange above an intensively managed Grassland in Switzerland

    Science.gov (United States)

    Merbold, L.; Decock, C.; Hörtnagl, L. J.; Fuchs, K.; Eugster, W.

    2015-12-01

    Here we present 3 consecutive years of EC flux measurements of N2O, CH4 and CO2) carried out in intensively managed grassland in Switzerland. Our measurements of greenhouse gas (GHG) concentrations were based on a recently developed CW-QCL absorption spectrometer to measure the concentrations of N2O and CH4 and an infrared gas analyzer to measure the concentrations of CO2 and H2O. We investigated the magnitude of trace gas emissions during a year of major disturbance (grassland restoration - including ploughing and fertilization in 2012) and the two following years representing business as usual (up to 6 harvests per year which are followed by fertilizer application, 2013 and 2014). We observed large peaks of N2O (up to 50 nmol m-2 s-1) in 2012 during thawing of the soil after the winter period and after re-sowing as well as inorganic fertilizer application at the beginning of summer. N2O emissions following harvest and fertilizer application ranged between 2 and 7 nmol m-2 s-1 and background fluxes were no larger than 1 nmol m-2 s-1. Fluxes of N2O were primarily controlled by soil water content and temperature, while management activities lead to larger variation of N2O fluxes during several days after the management event when compared to the background flux measurements. Annual flux budgets were dominated by CO2 emissions and N2O emissions contributed largely to the annual budget in 2012 but to a much lesser extend in the post-disturbance years (2013/2014). CH4 flux contribution to the annual budget was negligible. We conclude that grassland restoration results in large N2O emissions, while not leading to larger N2O emissions in subsequent years. Still, such specific time periods of enhanced N2O emissions need to be considered in decadal greenhouse gas budget estimates due to the fact that a single year can offset previous carbon and nitrogen sinks.

  6. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and other causes of Thyrotoxicosis

    DEFF Research Database (Denmark)

    Ross, Douglas S; Burch, Henry B; Cooper, David S;

    2016-01-01

    BACKGROUND: Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This article describes evidence-based clinical guidelines for the management...

  7. The North American Bats and Mines Project: a cooperative approach for integrating wildlife, ecosystem management, and mine land reclamation

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, D.A.R. [Bat Conservation International, Austin, TX (United States)

    1995-06-01

    Abandoned underground mines in North America provide a habitat for bats. Closure of mines without conducting biological surveys can endanger bat species that are abundant. The North American Bats and Mines Project (NABMP) has been created by the U.S. Bureau of Land Management and Bat Conservation International to provide coordination among government and conservation organizations and the mining industry in order to minimize the loss of bats living in mines. NABMP provides coordination through education on the importance of mines for bat populations by providing training on mine assessment and closure methods, by assisting with protection and improvement of abandoned mine roosts, and by developing methods for creating new bat habitat. 1 tab.

  8. Ecosystem function enhanced by combining four functional types of plant species in intensively managed grassland mixtures: a 3-year continental-scale field experiment

    NARCIS (Netherlands)

    Finn, J.A.; Connolly, J.; Sebastià, M.T.; Elgersma, A.

    2013-01-01

    1.A coordinated continental-scale field experiment across 31 sites was used to compare the biomass yield of monocultures and four species mixtures associated with intensively managed agricultural grassland systems. To increase complementarity in resource use, each of the four species in the experime

  9. The management of response time Stark echo and its intensity in the presence of non-resonant laser pulses with spatial inhomogeneity

    International Nuclear Information System (INIS)

    The possibility of management of the response time Stark echo and the influence of a transverse irreversible relaxation on its intensity by change of the mutual orientation of external spatial non-uniform non-resonant laser pulses are analyzed. (paper)

  10. Intensive use of an intertidal mudflat by foraging adult American horseshoe crabs Limulus polyphemus in the Great Bay estuary, New Hampshire

    OpenAIRE

    Wan-Jean LEE

    2010-01-01

    Although concerns about harvesting levels of the American Horseshoe Crab, Limulus polyphemus have prompted increased research into its ecology, current understanding of the species’ foraging ecology is mostly limited to mid-Atlantic populations. This study elucidates the spatial and temporal pattern of Limulus foraging on an intertidal mudflat of a northern New England estuary. A novel survey method was used to monitor Limulus foraging activity without disturbing the sediment. A fixed 50 ...

  11. Elephant Management in North American Zoos: Environmental Enrichment, Feeding, Exercise, and Training.

    Directory of Open Access Journals (Sweden)

    Brian J Greco

    Full Text Available The management of African (Loxodonta africana and Asian (Elephas maximus elephants in zoos involves a range of practices including feeding, exercise, training, and environmental enrichment. These practices are necessary to meet the elephants' nutritional, healthcare, and husbandry needs. However, these practices are not standardized, resulting in likely variation among zoos as well as differences in the way they are applied to individual elephants within a zoo. To characterize elephant management in North America, we collected survey data from zoos accredited by the Association of Zoos and Aquariums, developed 26 variables, generated population level descriptive statistics, and analyzed them to identify differences attributable to sex and species. Sixty-seven zoos submitted surveys describing the management of 224 elephants and the training experiences of 227 elephants. Asian elephants spent more time managed (defined as interacting directly with staff than Africans (mean time managed: Asians = 56.9%; Africans = 48.6%; p<0.001, and managed time increased by 20.2% for every year of age for both species. Enrichment, feeding, and exercise programs were evaluated using diversity indices, with mean scores across zoos in the midrange for these measures. There were an average of 7.2 feedings every 24-hour period, with only 1.2 occurring during the nighttime. Feeding schedules were predictable at 47.5% of zoos. We also calculated the relative use of rewarding and aversive techniques employed during training interactions. The population median was seven on a scale from one (representing only aversive stimuli to nine (representing only rewarding stimuli. The results of our study provide essential information for understanding management variation that could be relevant to welfare. Furthermore, the variables we created have been used in subsequent elephant welfare analyses.

  12. Active Surveillance for the Management of Localized Prostate Cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement

    OpenAIRE

    Chen, RC; Rumble, RB; Loblaw, DA; Finelli, A.; Ehdaie, B; Cooperberg, MR; Morgan, SC; Tyldesley, S; Haluschak, JJ; Tan, W.; Justman, S; Jain, S

    2016-01-01

    To endorse Cancer Care Ontario's guideline on Active Surveillance for the Management of Localized Prostate Cancer. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines developed by other professional organizations.The Active Surveillance for the Management of Localized Prostate Cancer guideline was reviewed for developmental rigor by methodologists. The ASCO Endorsement Panel then reviewed the content and the recommenda...

  13. 美国医院ICU管理介绍%Introduction of ICU management in American hospital

    Institute of Scientific and Technical Information of China (English)

    苏茂生; 董家鸿; 段伟东; 江颖; 何蕾; 马焕先; 赵庆华; 孟翔飞; 刘哲; 王敬

    2015-01-01

    Although there are different national conditions and institution of hospital ICU between America and China, some management and operation experience in which are still worth to learn for us. Based on experience from Miami Jakson Memorial Hospital ICU of America, this article attempts to compare and explain ICU manage-ment from the management system, family visits, medical equipment, staff categories, daily work flow and 10 aspects of ICU professional content including monitoring, capacity adjusting and maintaining, hemodynamic and airway man-agement, infection control, sedation and analgesia, nutrition support, anti coagulation and blood glucose control, physi-cal training, safety management and humanization and training, aiming to provide some insights worthy learning.%美国医院ICU遵循的国情制度虽与我国不同,但一些管理和运行经验仍值得借鉴。本文从美国Miami Jakson Memorial Hospital ICU的管理制度、家属探视、医护设备、人员类别、日常工作流程以及ICU专业内容,包括监测、容量维持、调整及血流动力学、气道管理、感染控制、镇静镇痛、营养支持、抗凝及血糖控制、物理训练、安全管理和人性化和学习培训等十个方面逐一进行比对讲解,希望能为提高我国ICU医护水平起到启示作用。

  14. Elephant Management in North American Zoos: Environmental Enrichment, Feeding, Exercise, and Training

    Science.gov (United States)

    Greco, Brian J.; Meehan, Cheryl L.; Miller, Lance J.; Shepherdson, David J.; Morfeld, Kari A.; Andrews, Jeff; Baker, Anne M.; Carlstead, Kathy; Mench, Joy A.

    2016-01-01

    The management of African (Loxodonta africana) and Asian (Elephas maximus) elephants in zoos involves a range of practices including feeding, exercise, training, and environmental enrichment. These practices are necessary to meet the elephants’ nutritional, healthcare, and husbandry needs. However, these practices are not standardized, resulting in likely variation among zoos as well as differences in the way they are applied to individual elephants within a zoo. To characterize elephant management in North America, we collected survey data from zoos accredited by the Association of Zoos and Aquariums, developed 26 variables, generated population level descriptive statistics, and analyzed them to identify differences attributable to sex and species. Sixty-seven zoos submitted surveys describing the management of 224 elephants and the training experiences of 227 elephants. Asian elephants spent more time managed (defined as interacting directly with staff) than Africans (mean time managed: Asians = 56.9%; Africans = 48.6%; pzoos in the midrange for these measures. There were an average of 7.2 feedings every 24-hour period, with only 1.2 occurring during the nighttime. Feeding schedules were predictable at 47.5% of zoos. We also calculated the relative use of rewarding and aversive techniques employed during training interactions. The population median was seven on a scale from one (representing only aversive stimuli) to nine (representing only rewarding stimuli). The results of our study provide essential information for understanding management variation that could be relevant to welfare. Furthermore, the variables we created have been used in subsequent elephant welfare analyses. PMID:27414654

  15. A holistic life cycle analysis of waste management scenarios at increasing source segregation intensity: the case of an Italian urban area.

    Science.gov (United States)

    Di Maria, Francesco; Micale, Caterina

    2014-11-01

    Life cycle analysis of several waste management scenarios for an Italian urban area was performed on the basis of different source segregation collection (SS) intensities from 0% up to 52%. Source segregated waste was recycled and or/recovered by composting. Residual waste management options were by landfilling, incineration with energy recovery or solid recovered fuel (SRF) production to substitute for coal. The increase in fuel and materials consumption due to increase in SS had negligible influence on the environmental impact of the system. Recycling operations such as incineration and SRF were always advantageous for impact reduction. There was lower impact for an SS of 52% even though the difference with the SS intensity of 35% was quite limited, about 15%. In all the configurations analyzed, the best environmental performance was achieved for the management system producing SRF by the biodrying process.

  16. A holistic life cycle analysis of waste management scenarios at increasing source segregation intensity: the case of an Italian urban area.

    Science.gov (United States)

    Di Maria, Francesco; Micale, Caterina

    2014-11-01

    Life cycle analysis of several waste management scenarios for an Italian urban area was performed on the basis of different source segregation collection (SS) intensities from 0% up to 52%. Source segregated waste was recycled and or/recovered by composting. Residual waste management options were by landfilling, incineration with energy recovery or solid recovered fuel (SRF) production to substitute for coal. The increase in fuel and materials consumption due to increase in SS had negligible influence on the environmental impact of the system. Recycling operations such as incineration and SRF were always advantageous for impact reduction. There was lower impact for an SS of 52% even though the difference with the SS intensity of 35% was quite limited, about 15%. In all the configurations analyzed, the best environmental performance was achieved for the management system producing SRF by the biodrying process. PMID:25008299

  17. A summary of the update on cardiovascular implantable electronic device infections and their management A scientific statement from the American Heart Association

    NARCIS (Netherlands)

    Baddour, Larry M.; Epstein, Andrew E.; Erickson, Christopher C.; Knight, Bradley P.; Levison, Matthew E.; Lockhart, Peter B.; Masoudi, Frederick A.; Okum, Eric J.; Wilson, Walter R.; Beerman, Lee B.; Bolger, Ann F.; Estes, N. A. Mark; Gewitz, Michael; Newburger, Jane W.; Schron, Eleanor B.; Taubert, Kathryn A.

    2011-01-01

    Background. The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for cardiovascular implantable electronic device (CIED) infections and their management, which were last published in 2003. Methods and Results. The AHA commissioned this scientific sta

  18. Effectiveness of classroom based crew resource management training in the intensive care unit: study design of a controlled trial

    Directory of Open Access Journals (Sweden)

    Kemper Peter F

    2011-11-01

    Full Text Available Abstract Background Crew resource management (CRM has the potential to enhance patient safety in intensive care units (ICU by improving the use of non-technical skills. However, CRM evaluation studies in health care are inconclusive with regard to the effect of this training on behaviour and organizational outcomes, due to weak study designs and the scarce use of direct observations. Therefore, the aim of this study is to determine the effectiveness and cost-effectiveness of CRM training on attitude, behaviour and organization after one year, using a multi-method approach and matched control units. The purpose of the present article is to describe the study protocol and the underlying choices of this evaluation study of CRM in the ICU in detail. Methods/Design Six ICUs participated in a paired controlled trial, with one pre-test and two post test measurements (respectively three months and one year after the training. Three ICUs were trained and compared to matched control ICUs. The 2-day classroom-based training was delivered to multidisciplinary groups. Typical CRM topics on the individual, team and organizational level were discussed, such as situational awareness, leadership and communication. All levels of Kirkpatrick's evaluation framework (reaction, learning, behaviour and organisation were assessed using questionnaires, direct observations, interviews and routine ICU administration data. Discussion It is expected that the CRM training acts as a generic intervention that stimulates specific interventions. Besides effectiveness and cost-effectiveness, the assessment of the barriers and facilitators will provide insight in the implementation process of CRM. Trial registration Netherlands Trial Register (NTR: NTR1976

  19. Managing for Development Results at the Inter-American Development Bank

    OpenAIRE

    Koldo Echebarría

    2011-01-01

    This presentation provides effective management strategies and instruments to measure results of interventions at the project and country level. The presenter includes portions of the Development Effectiveness Matrix as well as a review of the Progress Monitoring Report and results-based budgeting.

  20. Selling Out (In) Sport Management: Practically Evaluating the State of the American (Sporting) Union

    Science.gov (United States)

    Wiest, Amber; King-White, Ryan

    2013-01-01

    When teaching in Sport Management programs professors are often forced to respond to the actions and teachings of professionals in the field. According to the study by Kincheloe & Steinberg many of these normalized and, indeed celebrated, behaviors are actions that are part and parcel of the "recovery movement" which (re)inscribe new…

  1. Taking Care of Business: Walter Carpenter and the Management of American Enterprise.

    Science.gov (United States)

    Cheape, Charles W.

    1996-01-01

    Evaluates the life and career of DuPont corporate executive, Walter Carpenter, and uses it to illustrate the rise of the managerial class. Neither owners nor entrepreneurs, managers like Carpenter used their intelligence and skill to reorganize and expand the companies the companies where they worked. (MJP)

  2. Helping African American Children Self-Manage Asthma: The Importance of Self-Efficacy

    Science.gov (United States)

    Kaul, Teri

    2011-01-01

    Background: Asthma is the leading cause of chronic illness among children in the United States, with a disproportionately higher incidence among minority children. In an attempt to increase understanding of the factors that may influence self-management of chronic disease, the study examined the relationship between self-efficacy belief and asthma…

  3. Sociodemographic Factors, Acculturation, and Nutrition Management among Hispanic American Adults with Self-reported Diabetes.

    Science.gov (United States)

    Yoshida, Yilin Xu; Simonsen, Neal; Chen, Liwei; Zhang, L U; Scribner, Richard; Tseng, Tung-Sung

    2016-01-01

    This study aimed to examine whether sociodemographic factors and acculturation affect achievement of selected American Diabetes Association (ADA) nutrition therapy recommendations among Hispanics with diabetes. Cross-sectional data for Hispanics with diabetes in the National Health and Nutrition Examination Survey (NHANES) 2003-2010 were used. Achievements of the ADA recommendation for five nutrition components were examined (i.e., daily intake of saturated fat, cholesterol, sodium, and fiber, and daily servings of alcohol). Acculturation measurement derived from language use, country of birth, and length of residence in the U.S. Logistic regressions were performed. Only 49% of Hispanics with diabetes met three or more recommended criteria. Male gender and younger age (≤45) predicted poor recommendation adherence. More acculturated individuals had around 50% lower odds to achieve saturated fat [OR 0.5, CI 0.2-0.7], fiber [OR 0.5, CI 0.2-0.9], sodium [OR 0.5, CI 0.3-0.9] and cholesterol intake [OR 0.5, CI 0.3-0.8] recommendations than their less acculturated counterparts.

  4. Sociodemographic Factors, Acculturation, and Nutrition Management among Hispanic American Adults with Self-reported Diabetes.

    Science.gov (United States)

    Yoshida, Yilin Xu; Simonsen, Neal; Chen, Liwei; Zhang, L U; Scribner, Richard; Tseng, Tung-Sung

    2016-01-01

    This study aimed to examine whether sociodemographic factors and acculturation affect achievement of selected American Diabetes Association (ADA) nutrition therapy recommendations among Hispanics with diabetes. Cross-sectional data for Hispanics with diabetes in the National Health and Nutrition Examination Survey (NHANES) 2003-2010 were used. Achievements of the ADA recommendation for five nutrition components were examined (i.e., daily intake of saturated fat, cholesterol, sodium, and fiber, and daily servings of alcohol). Acculturation measurement derived from language use, country of birth, and length of residence in the U.S. Logistic regressions were performed. Only 49% of Hispanics with diabetes met three or more recommended criteria. Male gender and younger age (≤45) predicted poor recommendation adherence. More acculturated individuals had around 50% lower odds to achieve saturated fat [OR 0.5, CI 0.2-0.7], fiber [OR 0.5, CI 0.2-0.9], sodium [OR 0.5, CI 0.3-0.9] and cholesterol intake [OR 0.5, CI 0.3-0.8] recommendations than their less acculturated counterparts. PMID:27524787

  5. Provider Adherence to National Guidelines for Managing Hypertension in African Americans

    Directory of Open Access Journals (Sweden)

    Jeanette Sessoms

    2015-01-01

    Full Text Available Purpose. To evaluate provider adherence to national guidelines for the treatment of hypertension in African Americans. Design. A descriptive, preexperimental, quantitative method. Methods. Electronic medical records were reviewed and data were obtained from 62 charts. Clinical data collected included blood pressure readings, medications prescribed, laboratory studies, lifestyle modification, referral to hypertension specialist, and follow-up care. Findings. Overall provider adherence was 75%. Weight loss, sodium restriction, and physical activity recommendations were documented on 82.3% of patients. DASH diet and alcohol consumption were documented in 6.5% of participants. Follow-up was documented in 96.6% of the patients with controlled blood pressure and 9.1% in patients with uncontrolled blood pressure. Adherence in prescribing ACEIs in patients with a comorbidity of DM was documented in 70% of participants. Microalbumin levels were ordered in 15.2% of participants. Laboratory adherence prior to prescribing medications was documented in 0% of the patients and biannual routine labs were documented in 65% of participants. Conclusion. Provider adherence overall was moderate. Despite moderate provider adherence, BP outcomes and provider adherence were not related. Contributing factors that may explain this lack of correlation include patient barriers such as nonadherence to medication and lifestyle modification recommendations and lack of adequate follow-up. Further research is warranted.

  6. Management Employment-Relations Strategies: Perspectives from Studies of European (and American) Airlines

    OpenAIRE

    Greg J. Bamber; Gittell, Jody Hoffer; Kochan, Thomas Anton; von Nordenflycht, Andrew

    2009-01-01

    We discuss deregulation (liberalisation) and some of the international institutions that influence the management of people in airlines. As a point of departure, we summarise contrasting models from successful ‘new entrant’ airlines: Ryanair and Southwest. We consider examples of various categories of airlines in different ‘ideal types’ of institutional context: liberal-market economies and coordinated-market economies. These are two varieties of advanced capitalism. The former include the U...

  7. The role of population monitoring in the management of North American waterfowl

    Science.gov (United States)

    Nichols, J.D.; Williams, B.K.; Johnson, F.A.

    2000-01-01

    Despite the effort and expense devoted to large-scale monitoring programs, few existing programs have been designed with specific objectives in mind and few permit strong inferences about the dynamics of monitored systems. The waterfowl population monitoring programs of the U.S. Fish and Wildlife Service, Canadian Wildlife Service and state and provincial agencies provide a nice example with respect to program objectives, design and implementation. The May Breeding Grounds Survey provides an estimate of system state (population size) that serves two primary purposes in the adaptive management process: identifying the appropriate time-specific management actions and updating the information state (model weights) by providing a basis for evaluating predictions of competing models. Other waterfowl monitoring programs (e.g., banding program, hunter questionnaire survey, parts collection survey, winter survey) provide estimates of vital rates (rates of survival, reproduction and movement) associated with system dynamics and variables associated with management objectives (e.g., harvest). The reliability of estimates resulting from monitoring programs depends strongly on whether considerations about spatial variation and detection probability have been adequately incorporated into program design and implementation. Certain waterfowl surveys again provide nice examples of monitoring programs that incorporate these considerations.

  8. Deny, Distance, or Dismantle? How White Americans Manage a Privileged Identity.

    Science.gov (United States)

    Knowles, Eric D; Lowery, Brian S; Chow, Rosalind M; Unzueta, Miguel M

    2014-11-01

    Social scientists have traditionally argued that whiteness-the attribute of being recognized and treated as a White person in society-is powerful because it is invisible. On this view, members of the racially dominant group have the unique luxury of rarely noticing their race or the privileges it confers. This article challenges this "invisibility thesis," arguing that Whites frequently regard themselves as racial actors. We further argue that whiteness defines a problematic social identity that confronts Whites with 2 psychological threats: the possibility that their accomplishments in life were not fully earned (meritocratic threat) and the association with a group that benefits from unfair social advantages (group-image threat). We theorize that Whites manage their racial identity to dispel these threats. According to our deny, distance, or dismantle (3D) model of White identity management, dominant-group members have three strategies at their disposal: deny the existence of privilege, distance their own self-concepts from the White category, or strive to dismantle systems of privilege. Whereas denial and distancing promote insensitivity and inaction with respect to racial inequality, dismantling reduces threat by relinquishing privileges. We suggest that interventions aimed at reducing inequality should attempt to leverage dismantling as a strategy of White identity management. PMID:26186110

  9. A holistic life cycle analysis of waste management scenarios at increasing source segregation intensity: The case of an Italian urban area

    International Nuclear Information System (INIS)

    Highlights: • Waste management scenarios starting from different SS intensity were analyzed by LCA. • Several experimental data were utilized for the inventory. • Collection activities influences marginally global impact. • Maximum global environmental gain was achieved by SRF for coke substitution. - Abstract: Life cycle analysis of several waste management scenarios for an Italian urban area was performed on the basis of different source segregation collection (SS) intensities from 0% up to 52%. Source segregated waste was recycled and or/recovered by composting. Residual waste management options were by landfilling, incineration with energy recovery or solid recovered fuel (SRF) production to substitute for coal. The increase in fuel and materials consumption due to increase in SS had negligible influence on the environmental impact of the system. Recycling operations such as incineration and SRF were always advantageous for impact reduction. There was lower impact for an SS of 52% even though the difference with the SS intensity of 35% was quite limited, about 15%. In all the configurations analyzed, the best environmental performance was achieved for the management system producing SRF by the biodrying process

  10. Reading and analysis on management guidelines for hypothyroidism published in 2012 by American thyroid association and American association of clinical endocrinologists

    International Nuclear Information System (INIS)

    Recently, American Thyroid Association and American Association of Clinical Endocrinologists published Clinical Guideline for Hypothyroidism. The authors took an evidence-based medicine approach, and created 52 recommendations on 15 issues. The guideline emphasized that serum thyrotropin is the single best screening test for primary thyroid dysfunction for the vast majority of outpatient clinical situations. The standard treatment for hypothyroidism is replacement with L-thyroxine. The decision to treat subclinical hypothyroidism when the serum thyrotropin is less than 10 mIU/L should be tailored to the individual patient. (authors)

  11. Radiotherapy Technical Considerations in the Management of Locally Advanced Pancreatic Cancer: American-French Consensus Recommendations

    Energy Technology Data Exchange (ETDEWEB)

    Huguet, Florence, E-mail: florence.huguet@tnn.aphp.fr [Department of Radiation Oncology, Tenon Hospital, APHP, University Paris VI, Paris (France); Goodman, Karyn A. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Azria, David [Department of Radiation Oncology, CRLC Val d' Aurelle-Paul Lamarque, Montpellier (France); Racadot, Severine [Department of Radiation Oncology, CRLC Leon Berard, Lyon (France); Abrams, Ross A. [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States)

    2012-08-01

    Summary: Pancreatic carcinoma is a leading cause of cancer-related mortality. Approximately 30% of pancreatic cancer patients present with locally advanced, unresectable nonmetastatic disease. For these patients, two therapeutic options exist: systemic chemotherapy or chemoradiotherapy. Within this context, the optimal technique for pancreatic irradiation is not clearly defined. A search to identify relevant studies was undertaken using the Medline database. All Phase III randomized trials evaluating the modalities of radiotherapy in locally advanced pancreatic cancer were included, as were some noncontrolled Phase II and retrospective studies. An expert panel convened with members of the Radiation Therapy Oncology Group and GERCOR cooperative groups to review identified studies and prepare the guidelines. Each member of the working group independently evaluated five endpoints: total dose, target volume definition, radiotherapy planning technique, dose constraints to organs at risk, and quality assurance. Based on this analysis of the literature, we recommend either three-dimensional conformal radiation therapy or intensity-modulated radiation therapy to a total dose of 50 to 54 Gy at 1.8 to 2 Gy per fraction. We propose gross tumor volume identification to be followed by an expansion of 1.5 to 2 cm anteriorly, posteriorly, and laterally, and 2 to 3 cm craniocaudally to generate the planning target volume. The craniocaudal margins can be reduced with the use of respiratory gating. Organs at risk are liver, kidneys, spinal cord, stomach, and small bowel. Stereotactic body radiation therapy should not be used for pancreatic cancer outside of clinical trials. Radiotherapy quality assurance is mandatory in clinical trials. These consensus recommendations are proposed for use in the development of future trials testing new chemotherapy combinations with radiotherapy. Not all of these recommendations will be appropriate for trials testing radiotherapy dose or dose

  12. Radiotherapy technical considerations in the management of locally advanced pancreatic cancer: American-French consensus recommendations.

    Science.gov (United States)

    Huguet, Florence; Goodman, Karyn A; Azria, David; Racadot, Severine; Abrams, Ross A

    2012-08-01

    Pancreatic carcinoma is a leading cause of cancer-related mortality. Approximately 30% of pancreatic cancer patients present with locally advanced, unresectable nonmetastatic disease. For these patients, two therapeutic options exist: systemic chemotherapy or chemoradiotherapy. Within this context, the optimal technique for pancreatic irradiation is not clearly defined. A search to identify relevant studies was undertaken using the Medline database. All Phase III randomized trials evaluating the modalities of radiotherapy in locally advanced pancreatic cancer were included, as were some noncontrolled Phase II and retrospective studies. An expert panel convened with members of the Radiation Therapy Oncology Group and GERCOR cooperative groups to review identified studies and prepare the guidelines. Each member of the working group independently evaluated five endpoints: total dose, target volume definition, radiotherapy planning technique, dose constraints to organs at risk, and quality assurance. Based on this analysis of the literature, we recommend either three-dimensional conformal radiation therapy or intensity-modulated radiation therapy to a total dose of 50 to 54 Gy at 1.8 to 2 Gy per fraction. We propose gross tumor volume identification to be followed by an expansion of 1.5 to 2 cm anteriorly, posteriorly, and laterally, and 2 to 3 cm craniocaudally to generate the planning target volume. The craniocaudal margins can be reduced with the use of respiratory gating. Organs at risk are liver, kidneys, spinal cord, stomach, and small bowel. Stereotactic body radiation therapy should not be used for pancreatic cancer outside of clinical trials. Radiotherapy quality assurance is mandatory in clinical trials. These consensus recommendations are proposed for use in the development of future trials testing new chemotherapy combinations with radiotherapy. Not all of these recommendations will be appropriate for trials testing radiotherapy dose or dose intensity

  13. Evaluation of an mHealth Medication Regimen Self-Management Program for African American and Hispanic Uncontrolled Hypertensives

    Directory of Open Access Journals (Sweden)

    Tatiana M. Davidson

    2015-11-01

    Full Text Available African Americans and Hispanics have disproportionate rates of uncontrolled essential hypertension (EH compared to Non-Hispanic Whites. Medication non-adherence (MNA is the leading modifiable behavior to improved blood pressure (BP control. The Smartphone Medication Adherence Stops Hypertension (SMASH program was developed using a patient-centered, theory-guided, iterative design process. Electronic medication trays provided reminder signals, and Short Message Service [SMS] messaging reminded subjects to monitor BP with Bluetooth-enabled monitors. Motivational and reinforcement text messages were sent to participants based upon levels of adherence. Thirty-eight African-American (18 and Hispanic (20 uncontrolled hypertensives completed clinic-based anthropometric and resting BP evaluations prior to randomization, and again at months 1, 3 and 6. Generalized linear mixed modeling (GLMM revealed statistically significant time-by-treatment interactions (p < 0.0001 indicating significant reductions in resting systolic blood pressure (SBP and diastolic blood pressure (DBP for the SMASH group vs. the standard care (SC control group across all time points. 70.6% of SMASH subjects vs. 15.8% of the SC group reached BP control (< 140/90 mmH at month 1 (p < 0.001. At month 6, 94.4% of the SMASH vs. 41.2% of the SC group exhibited controlled BP (p < 0.003. Our findings provide encouraging evidence that efficacious mHealth, chronic disease, medical regimen, self-management programs can be developed following principles of patient-centered, theory-guided design.

  14. Role of 3D PET-FDG in the Management of Lymphomas. The Latin American Experience

    International Nuclear Information System (INIS)

    Aim: To assess the role that 3D PET and FDG played in the management of patients referred to our institution (last two years) for either initial staging (IS), intra-treatment evaluation (IT), or post treatment (PT) evaluation of patients with Hodgkin (HL) or Non Hodgkin lymphomas (NHL). Material and Methods: Fifty-four studies were performed to 42 patients (15 HL; 27 NHL) for IS (9), IT (12) or PT (33). Most patients had previously performed conventional imaging procedures (CT, Gallium-SPECT, MRI) during staging or clinical follow up (median 18 months.) Biopsy was done when relevant. At least 6-hour fasting and glucose serum level ≤ 1.2 g/l was required before IV injection of 50 to 60 microCi /Kg of [18F]-Fluorodeoxiglucose (FDG.) After a 60 to 90-minute uptake period, a whole body PET scan was performed, 5-minute acquisition and 2-minute transmission per bed, 5 to 7 beds, with an average scanning time of 1 hour. Localized images (15 minutes) were done when deemed relevant. Results: FDG PET showed: 1) IS: 9 unsuspected sites in 4 patients, upstaging 2 of them (22.2%) -1 HL from II to III and 1 NHL from III to IV-. 2) IT: it helped to change the management previously decided by conventional imaging in 41.6% of patients (either stop or continue therapy.) 3) PT (Chemotherapy or EBRT): it helped to change the management of patients based on conventional imagining to a more aggressive (21.9%) or conservative one (20.6%.) Overall, either biopsy or follow up confirmed two false negative and 3 false positive PET studies. Conclusions: This ongoing clinical study of HL and NHL patients showed that 3D PET-FDG was as good as 2D PET in the management of Lymphoma. Besides being more accurate than conventional imaging for initial staging, it had a major impact in assessing treatment (IT or PT), and it helped to improve the management in more than 40% of patients. Besides, additional advantages were reported by patients and referrals when compared PET to Gallium-SPECT: mainly

  15. Effect of Intensive Atropine Doses (Rapid Incremental Loading and Titration for Management of Organophosphorus Pesticide Poisoning: a Case Series

    Directory of Open Access Journals (Sweden)

    Abu Saleh Ahmed

    2014-03-01

    , Basher A, Amin MR, Faiz MA. Effect of Intensive Atropine Doses (Rapid Incremental Loading and Titration for Management of Organophosphorus Pesticide Poisoning: a Case Series. Asia Pac J Med Toxicol 2014;3:23-6.

  16. How to improve your knowledge intensive organisation : implementing a knowledge management scan within public and private sector organisations

    NARCIS (Netherlands)

    Koolmees, Hans; Smeijsters, Henk; Schoenmakers, Sylvia

    2009-01-01

    The Centre of Research in Knowledge Organisations and Knowledge Management of Zuyd University has developed a knowledge management scan. The scan initiates from two models. The first model is based on the Value Based Knowledge Management approach (Tissen, Andriessen & Lekanne Deprez, 1998) and inclu

  17. Intensive care management of patients with liver disease: proceedings of a single-topic conference sponsored by the Brazilian Society of Hepatology.

    Science.gov (United States)

    Bittencourt, Paulo Lisboa; Terra, Carlos; Parise, Edison Roberto; Farias, Alberto Queiroz; Arroyo, Vincent; Fernandez, Javier; Pereira, Gustavo; Maubouisson, Luiz Marcelo; Andrade, Guilherme Marques; Costa, Fernando Gomes de Barros; Codes, Liana; Andrade, Antônio Ricardo; Matos, Angelo; Torres, André; Couto, Fernanda; Zyngier, Ivan

    2015-12-01

    Survival rates of critically ill patients with liver disease has sharply increased in recent years due to several improvements in the management of decompensated cirrhosis and acute liver failure. This is ascribed to the incorporation of evidence-based strategies from clinical trials aiming to reduce mortality. In order to discuss the cutting-edge evidence regarding critical care of patients with liver disease, a joint single topic conference was recently sponsored by the Brazilian Society of Hepatology in cooperation with the Brazilian Society of Intensive Care Medicine and the Brazilian Association for Organ Transplantation. This paper summarizes the proceedings of the aforementioned meeting and it is intended to guide intensive care physicians, gastroenterologists and hepatologists in the care management of patients with liver disease.

  18. Spatiotemporal Pattern and Driving Forces of Arable Land-Use Intensity in China: Toward Sustainable Land Management Using Emergy Analysis

    OpenAIRE

    Hualin Xie; Jinlang Zou; Hailing Jiang; Ning Zhang; Yongrok Choi

    2014-01-01

    The level of arable land-use intensity has important impacts on food security and rural sustainable development. Using the emergy method, we investigate the spatial disparities and driving forces of arable land-use intensity in China from 1999 to 2008 at the national, regional and provincial levels. The empirical results show that chemical fertilizer was the largest component of agricultural inputs and that agricultural diesel oil recorded the highest growth rate. The degree of heterogeneitie...

  19. 浅谈高校预算科学化精细化管理%A Study on the Scientific and Intensive Management of College Budget

    Institute of Scientific and Technical Information of China (English)

    王卫兵

    2012-01-01

      文章阐述了高校预算科学化精细化管理的内涵,指出了当前高校预算管理中存在的问题,并从优化财政预算编制、减少固定指标的费用项目、改革现有预算管理环境、建立预算管理信息系统等八个方面详细论述加强高校预算科学化精细化管理的具体对策,具有一定的指导意义。%  Based on a brief introduction of scientific and intensive management of college budget, this article analyzes the existing problems in current college budget management. In addition, it puts forward countermeasures to strengthen scientific and intensive management of college budget from the aspects of optimizing financial budget, decreasing expense projects with fixed index, reforming the current environment of budget management as well as establishing the information system of budget management, which is expected to be of significance in guidance.

  20. American Head and Neck Society

    Science.gov (United States)

    American Head & Neck Society Head and Neck Cancer Research & Education American Head & Neck Society | AHNS Head and Neck Cancer Research & Education About AHNS ... and Announcements Copyright ©2016 · American Head and Neck Society · Privacy and Return Policy Managed by BSC Management, ...

  1. Extreme hypernatremic dehydration due to potential sodium intoxication: consequences and management for an infant with diarrhea at an urban intensive care unit in Bangladesh: a case report

    OpenAIRE

    Das, Sumon Kumar; Afroze, Farzana; Ahmed, Tahmeed; Faruque, Abu Syed Golam; Sarker, Shafiqul Alam; Huq, Sayeeda; Islam, M. Munirul; Shahrin, Lubaba; Matin, Fariha Bushra; Chisti, Mohammod Jobayer

    2015-01-01

    Introduction Hypernatremia (serum sodium ≥150mmol/L) is one of the most life-threatening complications of childhood diarrhea, and its management remains challenging, even in a highly advanced critical care setting. This case report describes the acute clinical course and 3-month neurological follow-up after discharge of an infant with extreme hypernatremia in an intensive care unit in Dhaka, Bangladesh. Case presentation A 6-month-old Asian Bangladeshi girl of middle-class socioeconomic statu...

  2. Pain in hospitalized children: A prospective cross-sectional survey of pain prevalence, intensity, assessment and management in a Canadian pediatric teaching hospital

    OpenAIRE

    Taylor, Elsa M; Kristina Boyer; Campbell, Fiona A

    2008-01-01

    BACKGROUND: Pain is under-recognised and undertreated. Although standards now exist for pain management, it is not known if this has improved care of hospitalized children.OBJECTIVES: To benchmark pain prevalence, pain intensity, pain assessment documentation and pharmacological treatment of pain. The aim was to highlight areas of good practice, identify areas for improvement and inform development of hospital standards, education, future audits and the research agenda.METHODS: The present pr...

  3. Study protocol for Women of Color and Asthma Control: A randomized controlled trial of an asthma-management intervention for African American women

    Directory of Open Access Journals (Sweden)

    Janevic Mary R

    2012-01-01

    Full Text Available Abstract Background Among adults in the United States, asthma prevalence is disproportionately high among African American women; this group also experiences the highest levels of asthma-linked mortality and asthma-related health care utilization. Factors linked to biological sex (e.g., hormonal fluctuations, gender roles (e.g., exposure to certain triggers and race (e.g., inadequate access to care all contribute to the excess asthma burden in this group, and also shape the context within which African American women manage their condition. No prior interventions for improving asthma self-management have specifically targeted this vulnerable group of asthma patients. The current study aims to evaluate the efficacy of a culturally- and gender-relevant asthma-management intervention among African American women. Methods/Design A randomized controlled trial will be used to compare a five-session asthma-management intervention with usual care. This intervention is delivered over the telephone by a trained health educator. Intervention content is informed by the principles of self-regulation for disease management, and all program activities and materials are designed to be responsive to the specific needs of African American women. We will recruit 420 female participants who self-identify as African American, and who have seen a clinician for persistent asthma in the last year. Half of these will receive the intervention. The primary outcomes, upon which the target sample size is based, are number of asthma-related emergency department visits and overnight hospitalizations in the last 12 months. We will also assess the effect of the intervention on asthma symptoms and asthma-related quality of life. Data will be collected via telephone survey and medical record review at baseline, and 12 and 24 months from baseline. Discussion We seek to decrease asthma-related health care utilization and improve asthma-related quality of life in African American

  4. A Knowledge Management System in a KnowledgeIntensive Business: An Exploratory Study in a GlobalICT Company

    OpenAIRE

    GREFBERG, HJALMAR; Netzell, Lucas

    2016-01-01

    To increase competitive advantage, organizations are developing how they manage internalknowledge. This has been tackled by implementing various Knowledge Management Systems,which have been developed based on the needs of specific teams and/or latest trends. Suchapproach is problematic since it does not take into consideration what the users currentKnowledge Management practices are, nor if the system is relevant for a larger mass.The purpose of this thesis is to identify what requirements fr...

  5. Correlation of American Burn Association sepsis criteria with the presence of bacteremia in burned patients admitted to the intensive care unit.

    Science.gov (United States)

    Hogan, Brian K; Wolf, Steven E; Hospenthal, Duane R; D'Avignon, Laurie C; Chung, Kevin K; Yun, Heather C; Mann, Elizabeth A; Murray, Clinton K

    2012-01-01

    Severe burn injury is accompanied by a systemic inflammatory response, making traditional indicators of sepsis both insensitive and nonspecific. To address this, the American Burn Association (ABA) published diagnostic criteria in 2007 to standardize the definition of sepsis in these patients. These criteria include temperature (>39°C or 110 beats per minute), progressive tachypnea (>25 breaths per minute not ventilated or minute ventilation >12 L/minute ventilated), thrombocytopenia (200 mg/dl, >7 units of insulin/hr intravenous drip, or >25% increase in insulin requirements over 24 hours), and feed intolerance >24 hours (abdominal distension, residuals two times the feeding rate, or diarrhea >2500 ml/day). Meeting >3 of these criteria should "trigger" concern for infection. In this initial assessment of the ABA sepsis criteria correlation with infection, the authors evaluated the ABA sepsis criteria's correlation with bacteremia because bacteremia is not associated with inherent issues of diagnosis as occurs with pneumonia or soft tissue infections, and blood cultures are typically obtained due to concern for ongoing infections falling within the definition of "septic." A retrospective electronic records review was performed to evaluate episodes of bacteremia in the United States Army Institute of Research from 2006 through 2007. A total of 196 patients were admitted during the study period who met inclusion criteria. The first positive and negative cultures, if present, from each patient were evaluated. This totaled 101 positive and 181 negative cultures. Temperature, heart rate, insulin resistance, and feed intolerance criteria were significant on univariate analysis. Only heart rate and temperature were found to significantly correlate with bacteremia on multivariate analysis. The receiver operating characteristic curve area for meeting >3 ABA sepsis criteria is 0.638 (95% confidence interval 0.573-0.704; P burn patients, the ABA trigger for sepsis did not

  6. American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression.

    Science.gov (United States)

    Jarzyna, Donna; Jungquist, Carla R; Pasero, Chris; Willens, Joyce S; Nisbet, Allison; Oakes, Linda; Dempsey, Susan J; Santangelo, Diane; Polomano, Rosemary C

    2011-09-01

    result, there are considerable variations in screening for risk and monitoring practices. All of these factors prompted the American Society for Pain Management Nursing to approve the formation of an expert consensus panel to examine the scientific basis and state of practice for assessment and monitoring practices for adult hospitalized patients receiving opioid analgesics for pain control and to propose recommendations for patient care, education, and systems-level changes that promote quality care and patient safety. PMID:21893302

  7. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules

    DEFF Research Database (Denmark)

    Gharib, H; Papini, E; Paschke, R;

    2010-01-01

    American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules are systematically developed statements to assist health care professionals in medical...... decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes...

  8. Emerging resistance among bacterial pathogens in the intensive care unit – a European and North American Surveillance study (2000–2002

    Directory of Open Access Journals (Sweden)

    Thornsberry Clyde

    2004-07-01

    Full Text Available Abstract Background Globally ICUs are encountering emergence and spread of antibiotic-resistant pathogens and for some pathogens there are few therapeutic options available. Methods Antibiotic in vitro susceptibility data of predominant ICU pathogens during 2000–2 were analyzed using data from The Surveillance Network (TSN Databases in Europe (France, Germany and Italy, Canada, and the United States (US. Results Oxacillin resistance rates among Staphylococcus aureus isolates ranged from 19.7% to 59.4%. Penicillin resistance rates among Streptococcus pneumoniae varied from 2.0% in Germany to as high as 20.2% in the US; however, ceftriaxone resistance rates were comparably lower, ranging from 0% in Germany to 3.4% in Italy. Vancomycin resistance rates among Enterococcus faecalis were ≤ 4.5%; however, among Enterococcus faecium vancomycin resistance rates were more frequent ranging from 0.8% in France to 76.3% in the United States. Putative rates of extended-spectrum β-lactamase (ESBL production among Enterobacteriaceae were low, Escherichia coli in the five countries studied. Ceftriaxone resistance rates were generally lower than or similar to piperacillin-tazobactam for most of the Enterobacteriaceae species examined. Fluoroquinolone resistance rates were generally higher for E. coli (6.5% – 13.9%, Proteus mirabilis (0–34.7%, and Morganella morganii (1.6–20.7% than other Enterobacteriaceae spp (1.5–21.3%. P. aeruginosa demonstrated marked variation in β-lactam resistance rates among countries. Imipenem was the most active compound tested against Acinetobacter spp., based on resistance rates. Conclusion There was a wide distribution in resistance patterns among the five countries. Compared with other countries, Italy showed the highest resistance rates to all the organisms with the exception of Enterococcus spp., which were highest in the US. This data highlights the differences in resistance encountered in intensive care units in

  9. Challenges in Individualizing Drug Dosage for Intensive Care Unit Patients: Is Augmented Renal Clearance What We Really Want to Know? Some Suggested Management Approaches and Clinical Software Tools.

    Science.gov (United States)

    Jelliffe, Roger

    2016-08-01

    Acutely ill intensive care unit (ICU) patients often have large apparent volumes of distribution of drugs and, because of this, their drug clearance (CL) is usually also increased. 'Augmented renal Cl' is a current issue in the management of drug therapy for acutely ill and unstable ICU patients; however, Cl, the product of volume and the rate constant for excretion, describes only a theoretical volume of drug cleared per unit of time. Information of the actual rate of movement of the drug itself is obscured. It is suggested that the most useful clinical information is given by describing drug volume and elimination rate constant separately. This also permits better understanding of the patient's separate issues of fluid balance and drug elimination, especially when dialysis, renal replacement therapy, or extracorporeal membrane oxygenation (ECMO) may be used, and facilitates management of these two important separate clinical issues. Optimal management of drug therapy also requires optimal methods embodied in clinical software to describe drug behavior in these highly unstable patients, and considerably more data than for ordinary patients. The interacting multiple model (IMM) clinical software facilitates management of both fluid balance and drug therapy in these unstable patients. Illustrative cases are discussed, and new monitoring and management strategies are suggested. Like other ICU skills, physicians need to learn optimal tools for managing drug therapy in the ICU. Further work should help evaluate these new approaches. PMID:26914772

  10. A hybrid simulated annealing approach to handle energy resource management considering an intensive use of electric vehicles

    DEFF Research Database (Denmark)

    Sousa, Tiago; Vale, Zita; Carvalho, Joao Paulo;

    2014-01-01

    The massification of electric vehicles (EVs) can have a significant impact on the power system, requiring a new approach for the energy resource management. The energy resource management has the objective to obtain the optimal scheduling of the available resources considering distributed...... to determine the best solution in a reasonable amount of time. This paper presents a hybrid artificial intelligence technique to solve a complex energy resource management problem with a large number of resources, including EVs, connected to the electric network. The hybrid approach combines simulated...... generators, storage units, demand response and EVs. The large number of resources causes more complexity in the energy resource management, taking several hours to reach the optimal solution which requires a quick solution for the next day. Therefore, it is necessary to use adequate optimization techniques...

  11. Prevalence of gastrointestinal helminths in Banaraja fowls reared in semi-intensive system of management in Mayurbhanj district of Odisha

    OpenAIRE

    Ananta Hembram; M. R. Panda; B. N. Mohanty; Pradhan, C. R.; Dehuri, M.; Sahu, A.; Behera, M.

    2015-01-01

    Aim: Studies on the prevalence of gastrointestinal helminths infection in Banaraja fowls of three blocks (Chandua, Shamakhunta and Bangriposi) of Mayurbhanj district in Odisha with respect to semi-intensive system of rearing. Materials and Methods: A total of 160 Banaraja birds (30 males and 130 females) belonging to two age groups (below 1 month age and above 1 month) were examined for the presence of different species of gastrointestinal helminth infection over a period of 1-year. The metho...

  12. Tree mortality, fire scar formation and regeneration 8 years after low-intensity fire in managed Pinus sylvestris stands

    OpenAIRE

    Piha, Aura

    2011-01-01

    Fire is an important driver of the boreal forest ecosystem, and a useful tool for the restoration of degraded forests. However, we lack knowledge on the ecological processes initiated by prescribed fires, and whether they bring about the desired restoration effects. The purpose of this study was to investigate the impacts of low-intensity experimental prescribed fires on four ecological processes in young commercial Scots pine (Pinus sylvestris) stands eight years after the burning. The proce...

  13. Spatiotemporal Pattern and Driving Forces of Arable Land-Use Intensity in China: Toward Sustainable Land Management Using Emergy Analysis

    Directory of Open Access Journals (Sweden)

    Hualin Xie

    2014-05-01

    Full Text Available The level of arable land-use intensity has important impacts on food security and rural sustainable development. Using the emergy method, we investigate the spatial disparities and driving forces of arable land-use intensity in China from 1999 to 2008 at the national, regional and provincial levels. The empirical results show that chemical fertilizer was the largest component of agricultural inputs and that agricultural diesel oil recorded the highest growth rate. The degree of heterogeneities in arable land-use intensity in China showed a decreasing trend, which resulted mainly from the differences among the eastern, northeastern, central and western regions. The regional disparities in labor, pesticides and plastic sheeting decreased from 1999 to 2008. The per capita annual net incomes of household operations and the agricultural policies had a significant positive correlation with total inputs, fertilizer inputs, pesticide inputs and agricultural plastic sheeting. In addition, the nonagricultural population had a greater impact on agricultural plastic sheeting. Finally, we suggest that there is an urgent need to focus on the effects of chemical fertilizer and pesticide inputs on the ecological environment. Agricultural support policies should be introduced for the poor agricultural production provinces.

  14. Safety Management of a Clinical Process Using Failure Mode and Effect Analysis: Continuous Renal Replacement Therapies in Intensive Care Unit Patients.

    Science.gov (United States)

    Sanchez-Izquierdo-Riera, Jose Angel; Molano-Alvarez, Esteban; Saez-de la Fuente, Ignacio; Maynar-Moliner, Javier; Marín-Mateos, Helena; Chacón-Alves, Silvia

    2016-01-01

    The failure mode and effect analysis (FMEA) may improve the safety of the continuous renal replacement therapies (CRRT) in the intensive care unit. We use this tool in three phases: 1) Retrospective observational study. 2) A process FMEA, with implementation of the improvement measures identified. 3) Cohort study after FMEA. We included 54 patients in the pre-FMEA group and 72 patients in the post-FMEA group. Comparing the risks frequencies per patient in both groups, we got less cases of under 24 hours of filter survival time in the post-FMEA group (31 patients 57.4% vs. 21 patients 29.6%; p process FMEA, there were several improvements in the management of intensive care unit patients receiving CRRT, and we consider it a useful tool for improving the safety of critically ill patients.

  15. Benefits of a self-management program in low-income African-American women with systemic lupus erythematosus: results of a pilot test.

    Science.gov (United States)

    Drenkard, C; Dunlop-Thomas, C; Easley, K; Bao, G; Brady, T; Lim, S S

    2012-12-01

    Minorities with systemic lupus erythematosus (SLE) are at high risk of poor disease outcomes and may face challenges in effectively self-managing multiple health problems. The Chronic Disease Self-Management Program (CDSMP) is an evidence-based intervention that improves the health of people with chronic illnesses. Although the CDSMP is offered by organizations throughout the United States and many countries around the world, it has not been tested among SLE patients. We pilot tested the benefits of the CDSMP in low-income African American patients with SLE. CDSMP workshops were delivered to 49 African American women with SLE who received medical care at a public lupus clinic in Atlanta, Georgia, US. We compared pre-post CDSMP changes (from baseline to 4 months after the start of the intervention) in health status, self-efficacy and self-management behaviors using self-reported measures. Additionally, we assessed health care utilization changes using electronic administrative records in the 6-month periods before and after the intervention. We observed significant improvements post-intervention in the SF-36 physical health component summary (mean change = 2.4, p = 0.032); self-efficacy (mean change = 0.5, p = 0.035); and several self-management behaviors: cognitive symptoms management (mean change = 0.3, p = 0.036); communication with physicians (mean change = 0.4, p = 0.01); and treatment adherence (mean change = 0.4, p = 0.01). The median number of outpatient visits decreased from 3 to 1 (p < .0001). The CDSMP is a promising intervention for low-income African Americans with SLE. It is an inexpensive program with growing availability around the world that should be further evaluated as a resource to improve patient-centered outcomes and decrease health service utilization among SLE patients. PMID:22936126

  16. Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology position statement on dyslipidemia management. Differences between the European and American guidelines.

    Science.gov (United States)

    Lobos Bejarano, José María; Galve, Enrique; Royo-Bordonada, Miguel Ángel; Alegría Ezquerra, Eduardo; Armario, Pedro; Brotons Cuixart, Carlos; Camafort Babkowski, Miguel; Cordero Fort, Alberto; Maiques Galán, Antonio; Mantilla Morató, Teresa; Pérez Pérez, Antonio; Pedro-Botet, Juan; Villar Álvarez, Fernando; González-Juanatey, José Ramón

    2014-11-01

    The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention.

  17. [Spanish interdisciplinary committee for cardiovascular disease prevention and the spanish society of cardiology position statement on dyslipidemia management. Differences between the European and american guidelines].

    Science.gov (United States)

    Lobos Bejarano, José María; Galve, Enrique; Royo-Bordonada, Miguel Ángel; Alegría Ezquerra, Eduardo; Armario, Pedro; Brotons Cuixart, Carlos; Camafort Babkowski, Miguel; Cordero Fort, Alberto; Maiques Galán, Antonio; Mantilla Morató, Teresa; Pérez Pérez, Antonio; Pedro-Botet, Juan; Villar Álvarez, Fernando; González-Juanatey, José Ramón

    2015-04-01

    The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention.

  18. Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology Position Statement on Dyslipidemia Management: differences between the European and American Guidelines.

    Science.gov (United States)

    Lobos Bejarano, José María; Galve, Enrique; Royo-Bordonada, Miguel Ángel; Alegría Ezquerra, Eduardo; Armario, Pedro; Brotons Cuixart, Carlos; Camafort Babkowski, Miguel; Cordero Fort, Alberto; Maiques Galán, Antonio; Mantilla Morató, Teresa; Pérez Pérez, Antonio; Pedro-Botet, Juan; Villar Álvarez, Fernando; González-Juanatey, José Ramón

    2015-01-01

    The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention.

  19. [Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology position statement on dyslipidemia management. Differences between the European and American guidelines].

    Science.gov (United States)

    Lobos Bejarano, José María; Galve, Enrique; Royo-Bordonada, Miguel Ángel; Alegría Ezquerra, Eduardo; Armario, Pedro; Brotons Cuixart, Carlos; Camafort Babkowski, Miguel; Cordero Fort, Alberto; Maiques Galán, Antonio; Mantilla Morató, Teresa; Pérez Pérez, Antonio; Pedro-Botet, Juan; Villar Álvarez, Fernando; González-Juanatey, José Ramón

    2015-01-01

    The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention. Full English text available from:www.revespcardiol.org/en.

  20. Implementation of the American College of Cardiology/American Heart Association 2008 Guidelines for the Management of Adults With Congenital Heart Disease.

    Science.gov (United States)

    Goossens, Eva; Fernandes, Susan M; Landzberg, Michael J; Moons, Philip

    2015-08-01

    Although different guidelines on adult congenital heart disease (ACHD) care advocate for lifetime cardiac follow-up, a critical appraisal of the guideline implementation is lacking. We investigated the implementation of the American College of Cardiology/American Heart Association 2008 guidelines for ACHD follow-up by investigating the type of health care professional, care setting, and frequency of outpatient visits in young adults with CHD. Furthermore, correlates for care in line with the recommendations or untraceability were investigated. A cross-sectional observational study was conducted, including 306 patients with CHD who had a documented outpatient visit at pediatric cardiology before age 18 years. In all, 210 patients (68.6%) were in cardiac follow-up; 20 (6.5%) withdrew from follow-up and 76 (24.9%) were untraceable. Overall, 198 patients were followed up in tertiary care, 1/4 (n = 52) of which were seen at a formalized ACHD care program and 3/4 (n = 146) remained at pediatric cardiology. Of those followed in formalized ACHD and pediatric cardiology care, the recommended frequency was implemented in 94.2% and 89%, respectively (p = 0.412). No predictors for the implementation of the guidelines were identified. Risk factors for becoming untraceable were none or lower number of heart surgeries, health insurance issues, and nonwhite ethnicity. In conclusion, a significant number of adults continue to be cared for by pediatric cardiologists, indicating that transfer to adult-oriented care was not standard practice. Frequency of follow-up for most patients was in line with the ACC/AHA 2008 guidelines. A considerable proportion of young adults were untraceable in the system, which makes them vulnerable for discontinuation of care.

  1. Outbreak of carbapenem-resistant Acinetobacter baumannii in the intensive care unit: a multi-level strategic management approach.

    Science.gov (United States)

    Molter, G; Seifert, H; Mandraka, F; Kasper, G; Weidmann, B; Hornei, B; Öhler, M; Schwimmbeck, P; Kröschel, P; Higgins, P G; Reuter, S

    2016-02-01

    An outbreak of carbapenem-resistant Acinetobacter baumannii (CRAb) occurred in an interdisciplinary intensive care unit, affecting 10 patients. Within hours of recognition of the spread of CRAb an intervention team was instituted for collection of available data, decision-making, communication and monitoring of all interventions performed, including cohorting, temporary stop of admissions, staff education, and enforcement of infection control measures. An area was defined for cohortation of patients colonized with CRAb, with a separate nursing team and a second set of mobile equipment. New transmissions were no longer observed after only four days into the institution of enhanced infection control measures. PMID:26778130

  2. The Swiss agri-environment scheme enhances pollinator diversity and plant reproductive succes in nearby intensively managed farmland

    NARCIS (Netherlands)

    Albrecht, M.; Duelli, P.; Müller, C.; Kleijn, D.; Schmid, B.

    2007-01-01

    1. Agri-environment schemes attempt to counteract the loss of biodiversity and associated ecosystem services such as pollination and natural pest control in agro-ecosystems. However, only a few studies have evaluated whether these attempts are successful. 2. We studied the effects of managing meadow

  3. Method and timing of grassland renovation affects herbage yield, nitrate leaching, and nitrous oxide emission in intensively managed grasslands

    NARCIS (Netherlands)

    Velthof, G.L.; Hoving, I.E.; Dolfing, J.; Smit, A.; Kuikman, P.J.; Oenema, O.

    2010-01-01

    Managed grasslands are occasionally ploughed up and reseeded in order to maintain or increase the sward productivity. It has been reported that this renovation of grassland is associated with a flush of soil organic nitrogen (N) mineralization and with a temporary increase in soil mineral N contents

  4. American College of Chest Physicians

    Science.gov (United States)

    ... American College of Chest Physicians and Sunovion announce strategic initiative focused on the importance of drug delivery in the management of COPD Sunovion Pharmaceuticals, Inc. (Sunovion) and the ...

  5. American Tinnitus Association

    Science.gov (United States)

    American Tinnitus Association Donate Become A Member Member Login Find A Provider Search form Search Menu Close Understanding The Facts Managing Your Tinnitus Research Toward A Cure About Us Initiatives News & ...

  6. Effect of climate change, CO2 trends, nitrogen addition, and land-cover and management intensity changes on the carbon balance of European grasslands.

    Science.gov (United States)

    Chang, Jinfeng; Ciais, Philippe; Viovy, Nicolas; Vuichard, Nicolas; Herrero, Mario; Havlík, Petr; Wang, Xuhui; Sultan, Benjamin; Soussana, Jean-François

    2016-01-01

    Several lines of evidence point to European managed grassland ecosystems being a sink of carbon. In this study, we apply ORCHIDEE-GM a process-based carbon cycle model that describes specific management practices of pastures and the dynamics of carbon cycling in response to changes in climatic and biogeochemical drivers. The model is used to simulate changes in the carbon balance [i.e., net biome production (NBP)] of European grasslands over 1991-2010 on a 25 km × 25 km grid. The modeled average trend in NBP is 1.8-2.0 g C m(-2)  yr(-2) during the past two decades. Attribution of this trend suggests management intensity as the dominant driver explaining NBP trends in the model (36-43% of the trend due to all drivers). A major change in grassland management intensity has occurred across Europe resulting from reduced livestock numbers. This change has 'inadvertently' enhanced soil C sequestration and reduced N2 O and CH4 emissions by 1.2-1.5 Gt CO2 -equivalent, offsetting more than 7% of greenhouse gas emissions in the whole European agricultural sector during the period 1991-2010. Land-cover change, climate change and rising CO2 also make positive and moderate contributions to the NBP trend (between 24% and 31% of the trend due to all drivers). Changes in nitrogen addition (including fertilization and atmospheric deposition) are found to have only marginal net effect on NBP trends. However, this may not reflect reality because our model has only a very simple parameterization of nitrogen effects on photosynthesis. The sum of NBP trends from each driver is larger than the trend obtained when all drivers are varied together, leaving a residual - nonattributed - term (22-26% of the trend due to all drivers) indicating negative interactions between drivers.

  7. A Global Meta-Analysis on the Impact of Management Practices on Net Global Warming Potential and Greenhouse Gas Intensity from Cropland Soils.

    Directory of Open Access Journals (Sweden)

    Upendra M Sainju

    Full Text Available Management practices, such as tillage, crop rotation, and N fertilization, may affect net global warming potential (GWP and greenhouse gas intensity (GHGI, but their global impact on cropland soils under different soil and climatic conditions need further evaluation. Available global data from 57 experiments and 225 treatments were evaluated for individual and combined effects of tillage, cropping systems, and N fertilization rates on GWP and GHGI which accounted for CO2 equivalents from N2O and CH4 emissions with or without equivalents from soil C sequestration rate (ΔSOC, farm operations, and N fertilization. The GWP and GHGI were 66 to 71% lower with no-till than conventional till and 168 to 215% lower with perennial than annual cropping systems, but 41 to 46% greater with crop rotation than monocroppping. With no-till vs. conventional till, GWP and GHGI were 2.6- to 7.4-fold lower when partial than full accounting of all sources and sinks of greenhouse gases (GHGs were considered. With 100 kg N ha-1, GWP and GHGI were 3.2 to 11.4 times greater with partial than full accounting. Both GWP and GHGI increased curvilinearly with increased N fertilization rate. Net GWP and GHGI were 70 to 87% lower in the improved combined management that included no-till, crop rotation/perennial crop, and reduced N rate than the traditional combined management that included conventional till, monocopping/annual crop, and recommended N rate. An alternative soil respiration method, which replaces ΔSOC by soil respiration and crop residue returned to soil in the previous year, similarly reduced GWP and GHGI by 133 to 158% in the improved vs. the traditional combined management. Changes in GWP and GHGI due to improved vs. traditional management varied with the duration of the experiment and inclusion of soil and climatic factors in multiple linear regressions improved their relationships. Improved management practices reduced GWP and GHGI compared with traditional

  8. A Global Meta-Analysis on the Impact of Management Practices on Net Global Warming Potential and Greenhouse Gas Intensity from Cropland Soils.

    Science.gov (United States)

    Sainju, Upendra M

    2016-01-01

    Management practices, such as tillage, crop rotation, and N fertilization, may affect net global warming potential (GWP) and greenhouse gas intensity (GHGI), but their global impact on cropland soils under different soil and climatic conditions need further evaluation. Available global data from 57 experiments and 225 treatments were evaluated for individual and combined effects of tillage, cropping systems, and N fertilization rates on GWP and GHGI which accounted for CO2 equivalents from N2O and CH4 emissions with or without equivalents from soil C sequestration rate (ΔSOC), farm operations, and N fertilization. The GWP and GHGI were 66 to 71% lower with no-till than conventional till and 168 to 215% lower with perennial than annual cropping systems, but 41 to 46% greater with crop rotation than monocroppping. With no-till vs. conventional till, GWP and GHGI were 2.6- to 7.4-fold lower when partial than full accounting of all sources and sinks of greenhouse gases (GHGs) were considered. With 100 kg N ha-1, GWP and GHGI were 3.2 to 11.4 times greater with partial than full accounting. Both GWP and GHGI increased curvilinearly with increased N fertilization rate. Net GWP and GHGI were 70 to 87% lower in the improved combined management that included no-till, crop rotation/perennial crop, and reduced N rate than the traditional combined management that included conventional till, monocopping/annual crop, and recommended N rate. An alternative soil respiration method, which replaces ΔSOC by soil respiration and crop residue returned to soil in the previous year, similarly reduced GWP and GHGI by 133 to 158% in the improved vs. the traditional combined management. Changes in GWP and GHGI due to improved vs. traditional management varied with the duration of the experiment and inclusion of soil and climatic factors in multiple linear regressions improved their relationships. Improved management practices reduced GWP and GHGI compared with traditional management

  9. A Global Meta-Analysis on the Impact of Management Practices on Net Global Warming Potential and Greenhouse Gas Intensity from Cropland Soils.

    Science.gov (United States)

    Sainju, Upendra M

    2016-01-01

    Management practices, such as tillage, crop rotation, and N fertilization, may affect net global warming potential (GWP) and greenhouse gas intensity (GHGI), but their global impact on cropland soils under different soil and climatic conditions need further evaluation. Available global data from 57 experiments and 225 treatments were evaluated for individual and combined effects of tillage, cropping systems, and N fertilization rates on GWP and GHGI which accounted for CO2 equivalents from N2O and CH4 emissions with or without equivalents from soil C sequestration rate (ΔSOC), farm operations, and N fertilization. The GWP and GHGI were 66 to 71% lower with no-till than conventional till and 168 to 215% lower with perennial than annual cropping systems, but 41 to 46% greater with crop rotation than monocroppping. With no-till vs. conventional till, GWP and GHGI were 2.6- to 7.4-fold lower when partial than full accounting of all sources and sinks of greenhouse gases (GHGs) were considered. With 100 kg N ha-1, GWP and GHGI were 3.2 to 11.4 times greater with partial than full accounting. Both GWP and GHGI increased curvilinearly with increased N fertilization rate. Net GWP and GHGI were 70 to 87% lower in the improved combined management that included no-till, crop rotation/perennial crop, and reduced N rate than the traditional combined management that included conventional till, monocopping/annual crop, and recommended N rate. An alternative soil respiration method, which replaces ΔSOC by soil respiration and crop residue returned to soil in the previous year, similarly reduced GWP and GHGI by 133 to 158% in the improved vs. the traditional combined management. Changes in GWP and GHGI due to improved vs. traditional management varied with the duration of the experiment and inclusion of soil and climatic factors in multiple linear regressions improved their relationships. Improved management practices reduced GWP and GHGI compared with traditional management

  10. Food habits of American black bears as a metric for direct management of humanbear conflict in Yosemite Valley, Yosemite National Park, California

    Science.gov (United States)

    Greenleaf, S.S.; Matthews, S.M.; Wright, R.G.; Beecham, J.J.; Leithead, H.M.

    2009-01-01

    The management of human-American black bear (Ursus americanus) conflict has been of significant concern for Yosemite National Park (YNP) personnel since the 1920s. Park managers implemented the YNP Human-Bear Management Plan in 1975 in an effort to reduce human-bear conflicts, especially in the extensively developed Yosemite Valley (YV). We used scat analysis to estimate annual and seasonal food habits of black bears in YV during 2001-02. We assessed the success of efforts to reduce the availability of anthropogenic foods, including garbage, by examining changes in the diet compared to a study from 1974-78 (Graber 1981). We also quantified consumption of non-native fruit to address its possible contribution to human-bear conflicts. The annual percent volume of human-provided food and garbage in black bear scats in YV decreased from 21% to 6% between 1978 and 2002, indicating YNP efforts have been effective. We found high use of non-native apples by bears throughout YV. Non-native food sources could be contributing to habituation and food conditioning, given their proximity to developed areas of YV. We recommend that YNP managers continue to (1) adapt and improve their management tools to address changing circumstances, (2) quantify the success of new management tools, and (3) reduce the availability of non-native food sources. ?? 2009 International Association for Bear Research and Management.

  11. Effects of organic fertilizer on net global warming potential under an intensively managed vegetable field in southeastern China: A three-year field study

    Science.gov (United States)

    Zhang, M.; Li, B.; Xiong, Z. Q.

    2016-11-01

    Organic fertilizer may not only improve soil quality but may also contribute to climate protection by increasing carbon sequestration in agricultural ecosystems. A 3-yr study was conducted with ten consecutive vegetable crops in intensively managed vegetable cropping systems in southeastern China to examine the effects of organic fertilizer application (ORGA) on net global warming potential (net GWP) after accounting for carbon dioxide equivalent emissions from all sources including methane (CH4) and nitrous oxide (N2O) emissions, agrochemical inputs and farm operations and sinks (i.e., soil organic carbon (SOC) sequestration derived from the net ecosystem carbon budget). Results indicated that ORGA significantly increased ecosystem respiration by 13.9% without obvious effects on CH4 and N2O emissions as compared to local conventional chemical fertilization (CHEM). The SOC sequestration rates during the 3-year observation period were estimated at -0.52 t C ha-1 for the control, -0.42 t C ha-1 for the CHEM plot and 0.27 t C ha-1 for the ORGA plot, respectively, and thus contributed significantly to the net GWP. Overall, compared with CHEM, the ORGA significantly decreased net GWP and greenhouse gas intensity by 15.3% and 27.4%, respectively. Our findings suggest that higher yields and lower greenhouse gas intensities and carbon costs can be achieved by substituting chemical nitrogen fertilizers with organic fertilization strategies.

  12. The Role of Individual Variables, Organizational Variables and Moral Intensity Dimensions in Libyan Management Accountants’ Ethical Decision Making

    OpenAIRE

    Musbah, Ahmed; Cowton, Christopher J.; Tyfa, David

    2016-01-01

    This study investigates the association of a broad set of variables with the ethical decision making of management accountants in Libya. Adopting a cross-sectional methodology, a questionnaire including four different ethical scenarios was used to gather data from 229 participants. For each scenario, ethical decision making was examined in terms of the recognition, judgment and intention stages of Rest’s model. A significant relationship was found between ethical recognition and ethical judgm...

  13. Climate and Humans as Amplifiers of Hydro-Ecologic Change: Science and Policy Implications for Intensively Managed Landscapes

    Science.gov (United States)

    Foufoula-Georgiou, E.; Czuba, J. A.; Belmont, P.; Wilcock, P. R.; Gran, K. B.; Kumar, P.

    2015-12-01

    Climatic trends and agricultural intensification in Midwestern U.S. landscapes has contributed to hydrologic regime shifts and a cascade of changes to water quality and river ecosystems. Informing management and policy to mitigate undesired consequences requires a careful scientific analysis that includes data-based inference and conceptual/physical modeling. It also calls for a systems approach that sees beyond a single stream to the whole watershed, favoring the adoption of minimal complexity rather than highly parameterized models for scenario evaluation and comparison. Minimal complexity models can focus on key dynamic processes of the system of interest, reducing problems of model structure bias and equifinality. Here we present a comprehensive analysis of climatic, hydrologic, and ecologic trends in the Minnesota River basin, a 45,000 km2 basin undergoing continuous agricultural intensification and suffering from declining water quality and aquatic biodiversity. We show that: (a) it is easy to arrive at an erroneous view of the system using traditional analyses and modeling tools; (b) even with a well-founded understanding of the key drivers and processes contributing to the problem, there are multiple pathways for minimizing/reversing environmental degradation; and (c) addressing the underlying driver of change (i.e., increased streamflows and reduced water storage due to agricultural drainage practices) by restoring a small amount of water storage in the landscape results in multiple non-linear improvements in downstream water quality. We argue that "optimization" between ecosystem services and economic considerations requires simple modeling frameworks, which include the most essential elements of the whole system and allow for evaluation of alternative management scenarios. Science-based approaches informing management and policy are urgent in this region calling for a new era of watershed management to new and accelerating stressors at the intersection

  14. A comparison of crown attributes for six genotypes on Pinus taeda as affected by site and management intensity

    OpenAIRE

    Carbaugh, Eric Douglas

    2015-01-01

    This study was designed to investigate the development of the crown architecture of six genotypes of loblolly pine across a variety of growing conditions, and also to investigate the stability of the crown ideotype for these genotypes over a range of site and silvicultural management regimes. The objectives were to determine whether the crown dimensions that determine the crown ideotype of four clones, a mass-control-pollinated family, and an open-pollinated family of Pinus taeda L. are cons...

  15. Use of web services for computerized medical decision support, including infection control and antibiotic management, in the intensive care unit.

    Science.gov (United States)

    Steurbaut, Kristof; Van Hoecke, Sofie; Colpaert, Kirsten; Lamont, Kristof; Taveirne, Kristof; Depuydt, Pieter; Benoit, Dominique; Decruyenaere, Johan; De Turck, Filip

    2010-01-01

    The increasing complexity of procedures in the intensive care unit (ICU) requires complex software services, to reduce improper use of antibiotics and inappropriate therapies, and to offer earlier and more accurate detection of infections and antibiotic resistance. We investigated whether web-based software can facilitate the computerization of complex medical processes in the ICU. The COSARA application contains the following modules: Infection overview, Thorax, Microbiology, Antibiotic therapy overview, Admission cause with comorbidity and admission diagnosis, Infection linking and registration, and Feedback. After the implementation and test phase, the COSARA software was installed on a physician's office PC and then on the bedside PCs of the patients. Initial evaluation indicated that the services had been integrated easily into the daily clinical workflow of the medical staff. The use of a service oriented architecture with web service technology for the development of advanced decision support in the ICU offers several advantages over classical software design approaches. PMID:20086264

  16. American Religion

    Institute of Scientific and Technical Information of China (English)

    田甜

    2008-01-01

    It is said that American religion,as a great part of American culture,plays an important role in American culture. It is hoped that some ideas can be obtained from this research paper,which focuses on analyzing the great impact is produced to American culture by American religion. Finally, this essay gives two useful standpoints to English learners:Understunding American religion will help understand the American history, culture and American people,and help you to communic.ate with them better. Understanding American religion will help you understand English better.

  17. Profit and loss analysis for an intensive care unit (ICU in Japan: a tool for strategic management

    Directory of Open Access Journals (Sweden)

    Abe Toshikazu

    2006-01-01

    Full Text Available Abstract Background Accurate cost estimate and a profit and loss analysis are necessary for health care practice. We performed an actual financial analysis for an intensive care unit (ICU of a university hospital in Japan, and tried to discuss the health care policy and resource allocation decisions that have an impact on critical intensive care. Methods The costs were estimated by a department level activity based costing method, and the profit and loss analysis was based on a break-even point analysis. The data used included the monthly number of patients, the revenue, and the direct and indirect costs of the ICU in 2003. Results The results of this analysis showed that the total costs of US$ 2,678,052 of the ICU were mainly incurred due to direct costs of 88.8%. On the other hand, the actual annual total patient days in the ICU were 1,549 which resulted in revenues of US$ 2,295,044. However, it was determined that the ICU required at least 1,986 patient days within one fiscal year based on a break-even point analysis. As a result, an annual deficit of US$ 383,008 has occurred in the ICU. Conclusion These methods are useful for determining the profits or losses for the ICU practice, and how to evaluate and to improve it. In this study, the results indicate that most ICUs in Japanese hospitals may not be profitable at the present time. As a result, in order to increase the income to make up for this deficit, an increase of 437 patient days in the ICU in one fiscal year is needed, and the number of patients admitted to the ICU should thus be increased without increasing the number of beds or staff members. Increasing the number of patients referred from cooperating hospitals and clinics therefore appears to be the best strategy for achieving these goals.

  18. Identification of Elizabethkingia meningoseptica from American bullfrog (Rana catesbeiana farmed in Sabah, Malaysia using PCR method and future management of outbreak

    Directory of Open Access Journals (Sweden)

    Zainuri, N.

    2013-01-01

    Full Text Available Aims: High demand for frog meat in Malaysia especially the American bullfrog (Rana catesbeiana has promoted intensive farming of the animal. However, the farming of American bullfrog is restricted by the occurrence of diseases. This study reports the first isolation of Elizabethkingia meningoseptica from specimens of American bullfrog that suffer from cataract and ‘red-leg’ syndrome.Methodology and Result: The pathogen was isolated from eyes and internal organs (liver, kidney and spleen of thediseased bullfrog specimens. All the bacterial isolates were subjected to phenotypic characterization and antibiotic susceptibility assay, and further identified by using the 16S rDNA sequencing analysis. We designed two pair of specific PCR primers (22-25 mers which are complimentary to the β-lactamase gene in the reference strain ofE. meningoseptica ATCC49470. The result showed all the bacterial isolates shared similar phenotypic characters and antibiotic susceptibility. BLAST analysis of the 16S rDNA sequences indicated that the bacterial isolates had very high sequence homology (100% with E. meningospetica ATCC49470 and E. meningoseptica isolates from mosquito. The two PCR primers were very specific to E. meningoseptica isolates of this study. Conclusion, significance and impact of study: This is the first isolation and characterization of bacterial pathogen, E. meningoseptica in cultured American bullfrog (Rana catesbeina that suffered from eye cataract and ‘red-leg’syndrome in Sabah, Malaysia. It is suspected that one of the possible transmission routes of the bacterial pathogen could be via mosquito bites. The findings suggest that there is urgent requirement for standard guideline of good farming practice to be adopted in frog farms throughout the country. Such a guideline can help in minimizing economic losses, preventing transmission of the zoonotic bacterial pathogen to farm workers, and sustaining the industry in Malaysia andupgrading

  19. Options for managing animal welfare on intensive pig farms confined by movement restrictions during an outbreak of foot and mouth disease.

    Science.gov (United States)

    East, I J; Roche, S E; Wicks, R M; de Witte, K; Garner, M G

    2014-12-01

    An outbreak of foot and mouth disease in Australia would trigger a major disease control and eradication program that would include restriction of movement of live animals within defined disease control zones. Experiences from outbreaks in other countries show that restrictions that limit the ability to turn off stock can lead to animal welfare compromise on intensively managed farms that are not infected with the disease. Intensive pig farms are considered to be at high risk of developing welfare problems during a control program due to the imposed movement restrictions and limited space available to house growing pigs. This study was designed to investigate strategies that could be used to mitigate animal welfare problems on intensive pig farms during a simulated outbreak of foot and mouth disease in a livestock dense region of Australia. Three strategies for managing farms affected by animal welfare problems were assessed, including on-farm culling of grower and finisher pigs, on-farm culling of finisher pigs only, and permit-based movement of finisher pigs to slaughter at abattoir. Under traditional approaches of giving infected premises (IP) priority over culling of farms with welfare problems (WP), delays of up to 25 days were experienced prior to culling of WPs. Deployment of vaccination did little to reduce the delay to culling of WPs. These delays were sensitive to resources available for control, with reduced resources increasing the time until welfare problems were addressed. Assigning equal priority to all farms requiring culling regardless of status as IP or WP and culling each as they arose reduced the delay to culling of WPs to no more than 4 days without large increases in either the duration or the size of the outbreaks observed.

  20. The SmartH2O project: a platform supporting residential water management through smart meters and data intensive modeling

    Science.gov (United States)

    Cominola, A.; Nanda, R.; Giuliani, M.; Piga, D.; Castelletti, A.; Rizzoli, A. E.; Maziotis, A.; Garrone, P.; Harou, J. J.

    2014-12-01

    Designing effective urban water demand management strategies at the household level does require a deep understanding of the determinants of users' consumption. Low resolution data on residential water consumption, as traditionally metered, can only be used to model consumers' behavior at an aggregate level whereas end uses breakdown and the motivations and individual attitudes of consumers are hidden. The recent advent of smart meters allows gathering high frequency consumption data that can be used both to provide instantaneous information to water utilities on the state of the network and continuously inform the users on their consumption and savings. Smart metered data also allow for the characterization of water end uses: this information, coupled with users' psychographic variables, constitutes the knowledge basis for developing individual and multi users models, through which water utilities can test the impact of different management strategies. SmartH2O is an EU funded project which aims at creating an ICT platform able to (i) capture and store quasi real time, high resolution residential water usage data measured with smart meters, (ii) infer the main determinants of residential water end uses and build customers' behavioral models and (iii) predict how the customer behavior can be influenced by various water demand management strategies, spanning from dynamic water pricing schemes to social awareness campaigns. The project exploits a social computing approach for raising users' awareness about water consumption and pursuing water savings in the residential sector. In this work, we first present the SmartH2O platform and data collection, storage and analysis components. We then introduce some preliminary models and results on total water consumption disaggregation into end uses and single user behaviors using innovative fully automated algorithms and overcoming the need of invasive metering campaigns at the fixture level.

  1. Managing end-of-life decision making in intensive care medicine--a perspective from Charite Hospital, Germany.

    Directory of Open Access Journals (Sweden)

    Jan A Graw

    Full Text Available INTRODUCTION: End-of-life-decisions (EOLD have become an important part of modern intensive care medicine. With increasing therapeutic possibilities on the one hand and many ICU-patients lacking decision making capacity or an advance directive on the other the decision making process is a major challenge on the intensive care unit (ICU. Currently, data are poor on factors associated with EOLD in Germany. In 2009, a new law on advance directives binding physicians and the patient's surrogate decision makers was enacted in Germany. So far it is unknown if this law influenced proceedings of EOLD making on the ICU. METHODS: A retrospective analysis was conducted on all deceased patients (n = 224 in a 22-bed surgical ICU of a German university medical center from 08/2008 to 09/2010. Patient characteristics were compared between patients with an EOLD and those without an EOLD. Patients with an EOLD admitted before and after change of legislation were compared with respect to frequencies of EOLD performance as well as advance directive rates. RESULTS: In total, 166 (74.1% of deaths occurred after an EOLD. Compared to patients without an EOLD, comorbidities, ICU severity scores, and organ replacement technology did not differ significantly. EOLDs were shared within the caregiverteam and with the patient's surrogate decision makers. After law enacting, no differences in EOLD performance or frequency of advance directives (8.9% vs. 9.9%; p = 0.807 were observed except an increase of documentation efforts associated with EOLDs (18.7% vs. 43.6%; p<0.001. CONCLUSIONS: In our ICU EOLD proceedings were performed patient-individually. But EOLDs follow a standard of shared decision making within the caregiverteam and the patient's surrogate decision makers. Enacting a law on advance directives has not affected the decision making-process in EOLDs nor has it affected population's advance care planning habits. However, it has led to increased EOLD

  2. MANAGEMENT OF PHYSICAL EXERCISE IN INTENSIVE INSULIN THERAPY FOR CHILDREN WITH TYPE 1 DIABETES MELLITUS CASE REPORT

    Directory of Open Access Journals (Sweden)

    Niewiadomska Monika

    2011-08-01

    Full Text Available Physical activity as a very active method of type I diabetes mellitus (DM complex therapy must be systematic and load-graduated. For patients with diabetes mellitus (DM they are strictly graded to each patient. This work presents our study data about effects of three-month physical training in 8-year old girl with type 1 DM. In her case with well compensated type 1 DM, the physical training brought about improvement of her health status and insulin dose reduction. Control over exercising is essential. Heart rate (HR measuring was done not only before and after training. A continuous HR monitoring was conducted during whole workout in order to make, if necessary, a correction of load volume and intensity. The control testing conducted after 3- month use of physical exercises against a background of insulin therapy and balanced diet in the 8-year old patient showed that there took place a definite organism's adaptation to physical training. The length of distance in 6-min walking test increased from 700 to 780 m. The heart rate during test performance reduced from 165 to148 beats/min. The glycolyzed haemoglobin level reduced from 6.891% to 6.570 %.

  3. Role of Focal Therapy with High-Intensity Focused Ultrasound in the Management of Clinically Localized Prostate Cancer.

    Science.gov (United States)

    Kuru, Timur H; van Essen, Julius; Pfister, David; Porres, Daniel

    2015-01-01

    Overtreatment of prostate cancer (PC) remains one of the main burdens in uro-oncology. Focal therapy may be a reasonable alternative with less side effects and morbidity. Application of high-intensity focused ultrasound (HIFU) induces immediate and irreversible coagulation. The treatment leads to consecutive necrosis with sharply delineated margins, making HIFU a promising tool for the focal therapy of localized PC. Unlike radiation, the treatment leaves no collateral damage outside of the heated tissue, allowing repeated use of HIFU, if necessary. In case of non-organ-confined relapse, additional radical salvage therapy can be performed. This review gives an overview of the existing evidence on focal HIFU. Today, 3 HIFU devices are approved for the treatment of localized PC: Sonablate™, Ablatherm™ and the FocalOne™ device. In summary, the first published results of focal HIFU are promising. The quality of life and potency of the patients are well preserved. Therefore, HIFU treatment, and especially focal ablation of tumor foci, seems to be a safe alternative to standard treatment, with low side effects. The oncologic results seem satisfactory but need further follow-up to validate this practice of PC control. PMID:26632846

  4. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES - 2016 UPDATE

    DEFF Research Database (Denmark)

    Gharib, Hossein; Papini, Enrico; Garber, Jeffrey R;

    2016-01-01

    ≤10 mm diameter only when suspicious US signs are present, while nodules ≤5 mm should be monitored rather than biopsied. A classification scheme of 5 categories (nondiagnostic, benign, indeterminate, suspicious for malignancy, or malignant) is recommended for the cytologic report. Indeterminate......, elastographic pattern, or results of other imaging techniques to improve the management of these lesions. Most thyroid nodules do not require any treatment, and levothyroxine (LT4) suppressive therapy is not recommended. Percutaneous ethanol injection (PEI) should be the first-line treatment option...

  5. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules

    DEFF Research Database (Denmark)

    Gharib, Hossein; Papini, Enrico; Paschke, Ralf;

    2010-01-01

    American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules are systematically developed statements to assist health care professionals in medical...... decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied.These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area...

  6. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of thyroid Nodules

    DEFF Research Database (Denmark)

    Gharib, Hossein; Papini, Enrico; Paschke, Ralf;

    2010-01-01

    American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules are systematically developed statements to assist health care professionals in medical...... decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied.These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area...

  7. What do the recent American Heart Association/American College of Cardiology Foundation Clinical Practice Guidelines tell us about the evolving management of coronary heart disease in older adults?

    Institute of Scientific and Technical Information of China (English)

    Daniel Forman; Nanette K Wenger

    2013-01-01

    Biological aging predisposes older adults to increased cardiovascular disease (CHD) and greater disease complexity. Given the high age-related prevalence of CHD and age-related compounding factors, the recently updated American Heart Association/American College of Cardiology Foundation CHD-related guidelines increased their focus on older patients. These guidelines are predominately evidence-based (using data from quality randomized clinical trials) and are organized to delineate medications and procedures that best treat particular cardiovascular diseases. While such rationale and thought work well in young and middle aged adults, they become problematic in patients who are very old. Data pertaining to adults aged ≥ 80 are virtually absent from most randomized clinical trials, and even in the instances when very old patients were included, eligibility criteria typically excluded candidates with co-morbidities and complexities of customary CHD patients. While medications and interventions yielding benefit in clinical trials should theoretically produce the greatest benefits for patients with high intrinsic risk, age-related cardiovascular complexities also increase iatrogenic risks. Navigating between the potential for high benefit and high risk in "evidence-based" cardiovascular management remains a key Geriatric Cardiology challenge. In this review we consider the expanded Geriatric Cardiology content of current guidelines, acknowledging both the progress that has been made, as well as the work that still needs to be accomplished to truly address the patient-centered priorities of older CHD patients.

  8. Management strategies to effect change in intensive care units: lessons from the world of business. Part III. Effectively effecting and sustaining change.

    Science.gov (United States)

    Gershengorn, Hayley B; Kocher, Robert; Factor, Phillip

    2014-03-01

    Reaping the optimal rewards from any quality improvement project mandates sustainability after the initial implementation. In Part III of this three-part ATS Seminars series, we discuss strategies to create a culture for change, improve cooperation and interaction between multidisciplinary teams of clinicians, and position the intensive care unit (ICU) optimally within the hospital environment. Coaches are used throughout other industries to help professionals assess and continually improve upon their practice; use of this strategy is as of yet infrequent in health care, but would be easily transferable and potentially beneficial to ICU managers and clinicians alike. Similarly, activities focused on improving teamwork are commonplace outside of health care. Simulation training and classroom education about key components of successful team functioning are known to result in improvements. In addition to creating an ICU environment in which individuals and teams of clinicians perform well, ICU managers must position the ICU to function well within the hospital system. It is important to move away from the notion of a standalone ("siloed") ICU to one that is well integrated into the rest of the institution. Creating a "pull-system" (in which participants are active in searching out needed resources and admitting patients) can help ICU managers both provide better care for the critically ill and strengthen relationships with non-ICU staff. Although not necessary, there is potential upside to creating a unified critical care service to assist with achieving these ends. PMID:24601653

  9. Management strategies to effect change in intensive care units: lessons from the world of business. Part III. Effectively effecting and sustaining change.

    Science.gov (United States)

    Gershengorn, Hayley B; Kocher, Robert; Factor, Phillip

    2014-03-01

    Reaping the optimal rewards from any quality improvement project mandates sustainability after the initial implementation. In Part III of this three-part ATS Seminars series, we discuss strategies to create a culture for change, improve cooperation and interaction between multidisciplinary teams of clinicians, and position the intensive care unit (ICU) optimally within the hospital environment. Coaches are used throughout other industries to help professionals assess and continually improve upon their practice; use of this strategy is as of yet infrequent in health care, but would be easily transferable and potentially beneficial to ICU managers and clinicians alike. Similarly, activities focused on improving teamwork are commonplace outside of health care. Simulation training and classroom education about key components of successful team functioning are known to result in improvements. In addition to creating an ICU environment in which individuals and teams of clinicians perform well, ICU managers must position the ICU to function well within the hospital system. It is important to move away from the notion of a standalone ("siloed") ICU to one that is well integrated into the rest of the institution. Creating a "pull-system" (in which participants are active in searching out needed resources and admitting patients) can help ICU managers both provide better care for the critically ill and strengthen relationships with non-ICU staff. Although not necessary, there is potential upside to creating a unified critical care service to assist with achieving these ends.

  10. Prevalence of gastrointestinal helminths in Banaraja fowls reared in semi-intensive system of management in Mayurbhanj district of Odisha

    Directory of Open Access Journals (Sweden)

    Ananta Hembram

    2015-06-01

    Full Text Available Aim: Studies on the prevalence of gastrointestinal helminths infection in Banaraja fowls of Mayurbhanj district in Odisha with respect to semi-intensive system of rearing. Materials and Methods: A total of 160 Banaraja birds (30 males and 130 females belonging to two age groups (below 1 month age and above 1 month were examined for the presence of different species of gastrointestinal helminth infection over a period of 1-year. The method of investigation included collection of fecal sample and gastrointestinal tracts, examination of fecal sample of birds, collection of parasites from different part of gastrointestinal tract, counting of parasites, and examination of the collected parasites by standard parasitological techniques followed by morphological identification as far as possible up to the species level. Results: Overall, 58.75% birds were found infected with various gastrointestinal helminths. Total five species of parasites were detected that included Ascaridia galli (25.63%, Heterakis gallinarum (33.75%, Raillietina tetragona (46.25%, Raillietina echinobothrida (11.87%, and Echinostoma revolutum (1.87%. Both single (19.15% as well as mixed (80.85% infection were observed. Highest incidence of infection was observed during rainy season (68.88% followed by winter (66.66% and least in summer season (41.81%. Sex-wise incidence revealed slightly higher occurrence among females (59.23% than males (56.67%. Age-wise prevalence revealed that chicks were more susceptible (77.77% than adults (51.30% to gastrointestinal helminths infection. Conclusions: Present study revealed that mixed infection with gastrointestinal helminths of different species was more common than infection with single species and season-wise prevalence was higher in rainy season followed by winter and summer. Chicks were found to be more prone to this parasitic infection and a slight higher prevalence among female birds was observed.

  11. Arbuscular mycorrhizal fungi in soil and roots respond differently to phosphorus inputs in an intensively managed calcareous agricultural soil.

    Science.gov (United States)

    Liu, Wei; Zhang, Yunlong; Jiang, Shanshan; Deng, Yan; Christie, Peter; Murray, Philip J; Li, Xiaolin; Zhang, Junling

    2016-01-01

    Understanding the diversity and community structure of arbuscular mycorrhizal fungi (AMF) is important for potentially optimizing their role in mining phosphorus (P) in agricultural ecosystems. Here, we conduct a comprehensive study to investigate the vertical distribution of AMF in a calcareous field and their temporal structure in maize-roots with fertilizer P application over a three-year period. The results showed that soil available-P response to P fertilization but maize yields did not. Phosphorus fertilization had no-significant effect on richness of AMF except at greater soil-depths. High P-supply reduced root colonization while optimum-P tended to increase colonization and fungal richness on all sampling occasions. Crop phenology might override P-supply in determining the community composition of active root inhabiting fungi. Significant differences in the community structure of soil AMF were observed between the controls and P treatments in surface soil and the community shift was attributable mainly to available-P, N/P and pH. Vertical distribution was related mainly to soil electrical conductivity and Na content. Our results indicate that the structure of AMF community assemblages is correlated with P fertilization, soil depth and crop phenology. Importantly, phosphorus management must be integrated with other agricultural-practices to ensure the sustainability of agricultural production in salinized soils. PMID:27102357

  12. Management of kyphoscoliosis patients with respiratory failure in the intensive care unit and during long term follow up

    Directory of Open Access Journals (Sweden)

    Adıgüzel Nalan

    2012-09-01

    Full Text Available Abstract Background We aimed to evaluate the ICU management and long-term outcomes of kyphoscoliosis patients with respiratory failure. Methods A retrospective observational cohort study was performed in a respiratory ICU and outpatient clinic from 2002–2011. We enrolled all kyphoscoliosis patients admitted to the ICU and followed-up at regular intervals after discharge. Reasons for acute respiratory failure (ARF, ICU data, mortality, length of ICU stay and outpatient clinic data, non-invasive ventilation (NIV device settings, and compliance were recorded. NIV failure in the ICU and the long term effect of NIV on pulmonary performance were analyzed. Results Sixty-two consecutive ICU kyphoscoliosis patients with ARF were enrolled in the study. NIV was initially applied to 55 patients, 11 (20% patients were intubated, and the majority had sepsis and septic shock (p  Conclusions We strongly discourage the use of NIV in the case of septic shock in ICU kyphoscoliosis patients with ARF. Pulmonary performance improved with NIV during long term follow up.

  13. Assessment of Body Condition in African (Loxodonta africana and Asian (Elephas maximus Elephants in North American Zoos and Management Practices Associated with High Body Condition Scores.

    Directory of Open Access Journals (Sweden)

    Kari A Morfeld

    Full Text Available Obesity has a negative effect on health and welfare of many species, and has been speculated to be a problem for zoo elephants. To address this concern, we assessed the body condition of 240 elephants housed in North American zoos based on a set of standardized photographs using a 5-point Body Condition Score index (1 = thinnest; 5 = fattest. A multi-variable regression analysis was then used to determine how demographic, management, housing, and social factors were associated with an elevated body condition score in 132 African (Loxodonta africana and 108 Asian (Elephas maximus elephants. The highest BCS of 5, suggestive of obesity, was observed in 34% of zoo elephants. In both species, the majority of elephants had elevated BCS, with 74% in the BCS 4 (40% and 5 (34% categories. Only 22% of elephants had BCS 3, and less than 5% of the population was assigned the lowest BCS categories (BCS 1 and 2. The strongest multi-variable model demonstrated that staff-directed walking exercise of 14 hours or more per week and highly unpredictable feeding schedules were associated with decreased risk of BCS 4 or 5, while increased diversity in feeding methods and being female was associated with increased risk of BCS 4 or 5. Our data suggest that high body condition is prevalent among North American zoo elephants, and management strategies that help prevent and mitigate obesity may lead to improvements in welfare of zoo elephants.

  14. Assessment of Body Condition in African (Loxodonta africana) and Asian (Elephas maximus) Elephants in North American Zoos and Management Practices Associated with High Body Condition Scores

    Science.gov (United States)

    Morfeld, Kari A.; Meehan, Cheryl L.; Hogan, Jennifer N.; Brown, Janine L.

    2016-01-01

    Obesity has a negative effect on health and welfare of many species, and has been speculated to be a problem for zoo elephants. To address this concern, we assessed the body condition of 240 elephants housed in North American zoos based on a set of standardized photographs using a 5-point Body Condition Score index (1 = thinnest; 5 = fattest). A multi-variable regression analysis was then used to determine how demographic, management, housing, and social factors were associated with an elevated body condition score in 132 African (Loxodonta africana) and 108 Asian (Elephas maximus) elephants. The highest BCS of 5, suggestive of obesity, was observed in 34% of zoo elephants. In both species, the majority of elephants had elevated BCS, with 74% in the BCS 4 (40%) and 5 (34%) categories. Only 22% of elephants had BCS 3, and less than 5% of the population was assigned the lowest BCS categories (BCS 1 and 2). The strongest multi-variable model demonstrated that staff-directed walking exercise of 14 hours or more per week and highly unpredictable feeding schedules were associated with decreased risk of BCS 4 or 5, while increased diversity in feeding methods and being female was associated with increased risk of BCS 4 or 5. Our data suggest that high body condition is prevalent among North American zoo elephants, and management strategies that help prevent and mitigate obesity may lead to improvements in welfare of zoo elephants. PMID:27415629

  15. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass—Temperature Management during Cardiopulmonary Bypass

    Science.gov (United States)

    Engelman, Richard; Baker, Robert A.; Likosky, Donald S.; Grigore, Alina; Dickinson, Timothy A.; Shore-Lesserson, Linda; Hammon, John W.

    2015-01-01

    Abstract: To improve our understanding of the evidence-based literature supporting temperature management during adult cardiopulmonary bypass, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiology and the American Society of ExtraCorporeal Technology tasked the authors to conduct a review of the peer-reviewed literature, including 1) optimal site for temperature monitoring, 2) avoidance of hyperthermia, 3) peak cooling temperature gradient and cooling rate, and 4) peak warming temperature gradient and rewarming rate. Authors adopted the American College of Cardiology/American Heart Association method for development clinical practice guidelines, and arrived at the following recommendation. PMID:26543248

  16. Evaluation of an mHealth Medication Regimen Self-Management Program for African American and Hispanic Uncontrolled Hypertensives.

    Science.gov (United States)

    Davidson, Tatiana M; McGillicuddy, John; Mueller, Martina; Brunner-Jackson, Brenda; Favella, April; Anderson, Ashley; Torres, Magaly; Ruggiero, Kenneth J; Treiber, Frank A

    2015-01-01

    African Americans and Hispanics have disproportionate rates of uncontrolled essential hypertension (EH) compared to Non-Hispanic Whites. Medication non-adherence (MNA) is the leading modifiable behavior to improved blood pressure (BP) control. The Smartphone Medication Adherence Stops Hypertension (SMASH) program was developed using a patient-centered, theory-guided, iterative design process. Electronic medication trays provided reminder signals, and Short Message Service [SMS] messaging reminded subjects to monitor BP with Bluetooth-enabled monitors. Motivational and reinforcement text messages were sent to participants based upon levels of adherence. Thirty-eight African-American (18) and Hispanic (20) uncontrolled hypertensives completed clinic-based anthropometric and resting BP evaluations prior to randomization, and again at months 1, 3 and 6. Generalized linear mixed modeling (GLMM) revealed statistically significant time-by-treatment interactions (p theory-guided design. PMID:26593951

  17. Gifted Asian American Women.

    Science.gov (United States)

    Kitano, Margie K.

    1997-01-01

    Presents an analysis of personal, socialization, and structural factors affecting the lifespan achievement of 15 Asian American women identified as gifted. Their families' intense focus on educational achievement and hard work are described, and the need for better preparation to overcome obstacles in the workplace is discussed. (Author/CR)

  18. 营销服务集约化管理初步探索与实践%Exploration and Practice on the Intensive Management of Marketing Service

    Institute of Scientific and Technical Information of China (English)

    罗晓伊

    2011-01-01

    为深入落实国家电网公司"三集五大"发展战略和四川省电力公司"营销五化"(管控集约化、业务专业化、作业标准化、管理精益化,手段高度信息化)建设要求,四川省电力公司营销运行监控中心和95598投诉举报服务中心于2010年2月10日正式成立.本文主要介绍营销运行监控中心和95598投诉举报服务中心运行实践经验.%In order to thoroughly implement the construction requirement of "Three Intensive Management and Five Expansion" development strategy of State Grid Corporation and" Five Marketing Strategy" (control intensification, business specialization, operation standardization, management lean and means highly informationization) of Sichuan Electric Power Company, Marketing Operation Monitoring Center and 95598 Complaints Report Service Center of Sichuan Electric Pwer Company were formally established in 10th February 2010. This paper mainly introduced the experience in operation practice of Marketing Operation Monitoring Center and 95598 Complaints Report Service Center of Sichuan Electric Pwer Company.

  19. First real-time measurements of N2O isotopic signatures above intensively managed grassland: analytical performance, validation and illustrative examples

    Science.gov (United States)

    Wolf, Benjamin; Tuzson, Béla; Merbold, Lutz; Decock, Charlotte; Emmenegger, Lukas; Mohn, Joachim

    2014-05-01

    Measurement of the four main N2O isotopic species (14N15N16O / 15N14N16O / 14N14N18O / 14N14N16O) has been suggested as a powerful tool to trace the biogeochemical cycle of N2O and to allocate its emission sources. Studies carried out with microbial pure cultures and mixed population systems (Wunderlin et al. 2012) allowed the determination of characteristic isotopic signatures for the most important production processes. These characteristic signatures have been applied to identify relevant sources at different scales (Park et al. 2012). However, current studies suffer from limited spatial and temporal resolution due to the combination of discrete flask sampling in conjunction with laboratory-based mass spectrometric analysis. We recently demonstrated that a quantum cascade laser (QCL) based absorption spectrometer is capable of simultaneously measuring the three main N2O isotopomers at trace levels (Waechter et al. 2008). Furthermore, its potential for in-situ measurements in conjunction with a liquid nitrogen-free preconcentration unit has been proven (Mohn et al. 2012). Here we present results from the first long-term field measurement campaign conducted on intensively managed grassland in central Switzerland during three months. A modified state-of-the-art laser spectrometer (Aerodyne Research, Inc.) employing a mid-infrared cw-QCL (4.54 μm) and a novel astigmatic multipass cell with 204 m optical path-length was connected to a N2O preconcentration unit. High analytical performance in combination with the applied calibration strategy resulted in excellent long-term precision of 0.20, 0.12 and 0.11o for δ15Nα, δ15Nβ and δ18O which was determined from repeated preconcentration and measurement of target gas from a compressed air tank. This instrumental setup allowed investigating responses of isotopic composition in soil-emitted N2O to management events and weather influences. The accompanying measurements of soil temperature, soil water content, ammonia

  20. Net global warming potential and greenhouse gas intensity in a double cropping cereal rotation as affected by nitrogen and straw management

    Directory of Open Access Journals (Sweden)

    T. Huang

    2013-08-01

    Full Text Available The effects of nitrogen and straw management on global warming potential (GWP and greenhouse gas intensity (GHGI in a winter wheat–summer maize double-cropping system on the North China Plain were investigated. We measured nitrous oxide (N2O emissions and studied net GWP (NGWP and GHGI by calculating the net exchange of CO2 equivalent (CO2-eq from greenhouse gas emissions, agricultural inputs and management practices, and changes in soil organic carbon (SOC, based on a long-term field experiment established in 2006. The field experiment includes six treatments with three fertilizer N levels (zero-N control, optimum and conventional N and straw removal (i.e. N0, Nopt and Ncon or return (i.e. N0, Nopt and SNcon. Optimum N management (Nopt, SNopt saved roughly half of the fertilizer N compared to conventional agricultural practice (Ncon, SNcon with no significant effect on grain yields. Annual mean N2O emissions reached 3.90 kg N2O-N ha−1 in Ncon and SNcon, and N2O emissions were reduced by 46.9% by optimizing N management of Nopt and SNopt. Straw return increased annual mean N2O emissions by 27.9%. Annual SOC sequestration was 0.40–1.44 Mg C ha−1 yr−1 in plots with N application and/or straw return. Compared to the conventional N treatments the optimum N treatments reduced NGWP by 51%, comprising 25% from decreasing N2O emissions and 75% from reducing N fertilizer application rates. Straw return treatments reduced NGWP by 30% compared to no straw return because the GWP from increments of SOC offset the GWP from higher emissions of N2O, N fertilizer and fuel after straw return. The GHGI trends from the different nitrogen and straw management practices were similar to the NGWP. In conclusion, optimum N and straw return significantly reduced NGWP and GHGI and concomitantly achieved relatively high grain yields in this important winter wheat–summer maize double-cropping system.

  1. The contribution of quality to health services. Application of the quality management system ISO 9001:2008 in Intensive Care Unit of the General Hospital of Larissa

    Directory of Open Access Journals (Sweden)

    Dimitrios Patsios

    2014-10-01

    Full Text Available In our country there have been many efforts in recent years to introduce laws that lead to the introduction of the concept of quality in the field of public hospitals. The implementation of health quality systems contributes to health care improvement, while the assessment of quality services is a basic tool in quality management. Purpose: The purpose of the study was to describe the benefits that can be gained by a public institute of health when a quality model is applied. Material and methods: This paper focus on the application of the ISO 9001:2008 standard in the Intensive Care Unit of the General Hospital of Larissa during the years 2010-2012. The results and benefits of its implementation, recorded by measuring satisfaction of the relatives of the patients. The questionnaire Family Satisfaction with Care in the Intensive Care Unit (FS-ICU 24 and quality indicators were applied. The study sample was all the relatives of the patients hospitalized in ICU during 2010-2012. Descriptive statistics was performed. Results: Quality indicators were considerably improved after ISO implementation with SMR falling to 35% in 2012 (from 58% in 2007, thus being one of the lowest in Greece and below European ICU’s SMR mean value. Over 80% of patients’ relatives answered that Nursing and Medical care was “excellent” and over 10% characterized it as “very good”. Family members’ total satisfaction surpassed 90%. Medical and Nursing care were highly appreciated by family members (very positive attitude expressed by over 90% of participants and satisfaction from nursing services approaches 100%. Conclusion: The implementation of quality systems in healthcare organizations is not easy and has many dimensions. However, it offers competitive advantage, improves the efficiency and effectiveness of the health care service providers and substantially contributes to the improvement of the delivered heath care.

  2. Impact of climate change on GHG emissions of (pre-) alpine grassland ecosystems under intensive and extensive management - a climate sequence lysimeter study

    Science.gov (United States)

    Kiese, Ralf; Lu, Haiyan; Fu, Jin; Diaz-Pines, Eugenio; Gasche, Rainer; Dannenmann, Michael; Butterbach-Bahl, Klaus

    2015-04-01

    Due to cool and moist climatic conditions alpine grassland soils of moderate elevation are rich in soil organic carbon and associated nitrogen. In the framework of an in-situ climate change experiment we test the hypothesis that soil organic carbon and nitrogen are either volatilized (GHG emissions) or leached with seepage water due to increase in temperature. Field investigations are carried out in the (Pre-) Alpine TERENO Observatory covering several research sites (including ICOS sites) in South-Bavaria, Germany. IMK-IFU has installed 36 weighable lysimeters with undisturbed intact grassland soil cores (diameter 1m, depth 1.4m) and is operating them at three sites differing in altitude and thus climatic conditions (850m, 750m, 600m) since 2011. Lysimeters were partly translocated from higher elevation to sites at lower elevation and other soil cores still staying at the sites as controls. In addition to the space for time in-situ climate change approach the total of 36 lysimeters are split into treatments of intensive and extensive grassland management. GHG exchange was measured by manual (850m site) but also with two novel automatic robot chamber systems (750m, 600m) connected to QCLs for simultaneous detection of CO2, N2O, and CH4 concentration changes in chamber headspace. GHG flux monitoring was supplemented by NEE measurements with transparent chambers since 2014. Climate change, generally stimulated plant growth (according to biomass sampling after cutting events) and soil C and N turnover leading to increased soil CO2 emissions and an increased uptake of atmospheric CH4. N2O emission were generally low and slightly increased in spring, summer and autumn but significantly decreased during the winter period under global change conditions, the latter due to lower intensity and frequency of frost-thaw events. The main gaseous nitrogen component emitted from the grassland ecosystems was N2 which also showed a much stronger increase with climate change than N2O

  3. Integrating community health workers into a patient-centered medical home to support disease self-management among Vietnamese Americans: lessons learned.

    Science.gov (United States)

    Wennerstrom, Ashley; Bui, Tap; Harden-Barrios, Jewel; Price-Haywood, Eboni G

    2015-01-01

    There is evidence that patient-centered medical homes (PCMHs) and community health workers (CHWs) improve chronic disease management. There are few models for integrating CHWs into PCMHs in order to enhance disease self-management support among diverse populations. In this article, we describe how a community-based nonprofit agency, a PCMH, and academic partners collaborated to develop and implement the Patient Resource and Education Program (PREP). We employed CHWs as PCMH care team members to provide health education and support to Vietnamese American patients with uncontrolled diabetes and/or hypertension. We began by conducting focus groups to assess patient knowledge, desire for support, and availability of community resources. Based on findings, we developed PREP with CHW guidance on cultural tailoring of educational materials and methods. CHWs received training in core competencies related to self-management support principles and conducted the 4-month intervention for PCMH patients. Throughout the program, we conducted process evaluation through structured team meetings and patient satisfaction surveys. We describe successes and challenges associated with PREP delivery including patient recruitment, structuring/documenting visits, and establishing effective care team integration, work flow, and communication. Strategies for mitigating these issues are presented, and we make recommendations for other PCMHs seeking to integrate CHWs into care teams.

  4. Consensus recommendations from the American Acne & Rosacea Society on the management of rosacea, part 3: a status report on systemic therapies.

    Science.gov (United States)

    Del Rosso, James Q; Thiboutot, Diane; Gallo, Richard; Webster, Guy; Tanghetti, Emil; Eichenfield, Lawrence F; Stein-Gold, Linda; Berson, Diane; Zaenglein, Andrea

    2014-01-01

    The third article in this 5-part series reviews systemic therapies used to treat cutaneous rosacea based on consensus recommendations from the American Acne & Rosacea Society (AARS) on the management of the common presentations of cutaneous rosacea. The consensus recommendations are based on current understanding of research that describes pathophysiologic mechanisms that appear to be operative in rosacea, correlation of these underlying pathophysiologic mechanisms with specific clinical manifestations of rosacea, and outcomes from clinical trials that evaluate therapies for rosacea both as monotherapy and in combination with other agents. Systemic agents used for treatment of rosacea have been administered as oral formulations (ie, tablets, capsules). The only oral agent for rosacea approved by the US Food and Drug Administration (FDA) is a modified-release doxycycline 40-mg capsule. Other non-FDA-approved oral agents also are discussed including other tetracyclines, macrolides, metronidazole, and isotretinoin.

  5. An American Plague: Pro-Market Believers in Health Policy Comment on “On Health Policy and Management (HPAM: Mind the Theory-Policypractice Gap”

    Directory of Open Access Journals (Sweden)

    Jean de Kervasdoué

    2015-02-01

    Full Text Available Although American health policy debates address similar problems to other developed nations, it has factual and ideological specificities. I agree with Chinitz and Rodwin on the dominance of micro-economics thinking. However, I am not certain that learning from management theory or modifying medical education will be powerful enough to change the system. The vested interests of the stakeholders are too powerful, the more so when they are supported by economists who ideologically reinforce them and by neglecting the fact that the basic premises of market ideology are false when applied to medical care. There is enough empirical evidence to support that but, apparently, these facts do not dent these beliefs.

  6. Response of aquatic plants of peat pits to eutrophication processes resulted from intensive management and overdrying of surrounding them peat meadows

    Science.gov (United States)

    Gołdyn, H.; Arczyńska-Chudy, E.

    2009-04-01

    Aquatic and wetland habitats belong to the most precious nature elements of rural environment. At the same time they are very sensitive to eutrophication and diverse impacts caused by intensive agriculture. If protected and well kept they may enrich plant diversity in agricultural landscape. One of the most important reasons of degradation of waters within the lowland landscape is intensive agriculture. Drainage of marshes, which was especially intensive in the last two centuries, has changed hydrological conditions and modified relationships in many aquatic and terrestrial ecosystems. This resulted in eutrophication of aquatic habitats. The presented study are the part of investigations on the changes of aquatic and marsh vegetation during the last thirty years period within agricultural landscape of Gen. Chlapowski Landscape Park in Wielkopolska Region. Their goal was to analyse changes in aquatic plant communities within the peat pits, which are situated among the meadows. Vegetation of these ecosystems was first studied from 1976 to 1979 and investigations were repeated in 2007. This allowed to evaluate the transformation of vegetation during the last 30 years. Analyses of the chemical composition of water showed a gradual increase in its trophic state. The strongest increase was observed in the concentrations of phosphates and ammonium nitrogen. It was a consequence of intensive management of the surrounding meadows and drainage, led to their overdrying in the 1980s, which simultaneously effected the transformation of meadow vegetation. These changes caused the acceleration of peat mineralization, which was the reason of the increased leaching of nutrients and enrichment of water stored in the peat pits. The diversity of aquatic plant communities revealed significant transformations during the last 30 years. Species diversity, measured by the Shannon index (H') increased from 3.09 to 3.45. The increase in the number of identified plant species and associations

  7. To burn or not to burn? Effect of management strategy on North American prairie vegetation for public urban areas in Germany.

    Science.gov (United States)

    Schmithals, Anja; Kühn, Norbert

    2014-01-01

    North American prairie vegetation has been a role model for designing highly attractive plantings for German urban green spaces for the past decade. In combination with gravel mulch top layers on planting sites and non-selective maintenance techniques like mowing or burning, prairie plantings are considered to be cost-effective and low-maintenance. This study was undertaken to assess the impact of different maintenance strategies and especially the necessity of fire management on the development success of ornamental prairie plantings in central Europe. A four factorial split-plot-block design was set up for investigation of different mixtures of prairie species under varying management conditions (mow-only, mowing plus selective weeding, mowing plus weeding and burning) on two differing soil types (in-situ topsoil and in-situ topsoil with a graywacke gravel mulch top layer) over three years. Significant effects of maintenance strategy on mortality rates and vitality were documented for a number of target species, which responded species specifically, either being slightly affected by the burning or thriving on it. Those effects were mostly restricted to topsoil sites. A strong impact on weed species presence and abundance and resulting maintenance times was found on both soil types. On topsoil sites, mow-only treatment resulted in a short-term loss of the original planting due to extensive weed growth. Corresponding gravel mulch sites were generally less colonised and visually dominated by weeds. Differences between weeded and weeded plus burned sites were minor. Unexpectedly, weed species populations were mostly unaffected by the additional burning treatment, while maintenance times and costs increased. No overall benefit of fire management for the establishment of prairie plantings was documented. The most effective management combination proved to be mowing plus regular selective weeding measures on gravel mulched planting sites.

  8. To burn or not to burn? Effect of management strategy on North American prairie vegetation for public urban areas in Germany.

    Directory of Open Access Journals (Sweden)

    Anja Schmithals

    Full Text Available North American prairie vegetation has been a role model for designing highly attractive plantings for German urban green spaces for the past decade. In combination with gravel mulch top layers on planting sites and non-selective maintenance techniques like mowing or burning, prairie plantings are considered to be cost-effective and low-maintenance. This study was undertaken to assess the impact of different maintenance strategies and especially the necessity of fire management on the development success of ornamental prairie plantings in central Europe. A four factorial split-plot-block design was set up for investigation of different mixtures of prairie species under varying management conditions (mow-only, mowing plus selective weeding, mowing plus weeding and burning on two differing soil types (in-situ topsoil and in-situ topsoil with a graywacke gravel mulch top layer over three years. Significant effects of maintenance strategy on mortality rates and vitality were documented for a number of target species, which responded species specifically, either being slightly affected by the burning or thriving on it. Those effects were mostly restricted to topsoil sites. A strong impact on weed species presence and abundance and resulting maintenance times was found on both soil types. On topsoil sites, mow-only treatment resulted in a short-term loss of the original planting due to extensive weed growth. Corresponding gravel mulch sites were generally less colonised and visually dominated by weeds. Differences between weeded and weeded plus burned sites were minor. Unexpectedly, weed species populations were mostly unaffected by the additional burning treatment, while maintenance times and costs increased. No overall benefit of fire management for the establishment of prairie plantings was documented. The most effective management combination proved to be mowing plus regular selective weeding measures on gravel mulched planting sites.

  9. Prevalence of acute post-operative pain in patients in adult age-group undergoing inpatient abdominal surgery and correlation of intensity of pain and satisfaction with analgesic management: A cross-sectional single institute-based study

    Science.gov (United States)

    Singh, Prashant Kumar; Saikia, Priyam; Lahakar, Mangala

    2016-01-01

    Background and Aims: Considering the paucity of regional data, this study was designed to investigate the prevalence of post-operative pain and determine if there exists any correlation between the intensity of post-operative pain and patient's level of satisfaction with their pain management after inpatient abdominal surgery at an academic tertiary care government centre. Methods: Pain intensity was measured in 120 patients with numeric rating scale at the fifth post-operative hour, second and third post-operative day. A questionnaire was used to measure the level of satisfaction with nurse's and doctor's response to their pain and overall pain management. Results: The prevalence of post-operative pain was 84.17%, 92.5% and 96.66% at the fifth post-operative hour, second and third post-operative day, respectively. Less number of patients experienced severe intensity pain on the third post-operative day (P = 0.00046), whereas the number of patients experiencing mild pain increased (P management was − 0.0218 (P = 0.8107), 0.1307 (P = 0.1553) and 0.0743 (P = 0.4195), respectively. Conclusion: There is a high prevalence of acute post-operative pain in patients undergoing inpatient abdominal surgery at our institute. There is a weak correlation between the intensity of pain and level of satisfaction with pain management.

  10. Intensive mobilities:

    DEFF Research Database (Denmark)

    Vannini, Phillip; Bissell, David; Jensen, Ole B.

    This paper explores the intensities of long distance commuting journeys as a way of exploring how bodily sensibilities are being changed by the mobilities that they undertake. The context of this paper is that many people are travelling further to work than ever before owing to a variety of factors...... with fieldwork conducted in Canada, Denmark and Australia to develop our understanding of the experiential politics of long distance workers. Rather than focusing on the extensive dimensions of mobilities that are implicated in patterns and trends, our paper turns to the intensive dimensions of this experience....... By exploring how experiences of long-distance workers become constituted by a range of different material forces enables us to more sensitively consider the practical, technical, and political implications of this increasingly prevalent yet underexplored regime of work....

  11. Nurse middle managers' dispositions of habitus a bourdieusian analysis of supporting role behaviors in Dutch and American hospitals

    NARCIS (Netherlands)

    Lalleman, P. C B; Smid, G. A C; Lagerwey, M. D.; Oldenhof, L.; Schuurmans, M. J.

    2015-01-01

    A Magnet-related program has been recently adopted in the Netherlands. Support for staff nurses from nurse middle managers (NMMs) is a key component of such a program. A Bourdieusian ethnographic organizational case study in 4 hospitals in the Netherlands and the United States (Magnet, Magnet-relate

  12. Team Performance and Error Management in Chinese and American Simulated Flight Crews: The Role of Cultural and Individual Differences

    Science.gov (United States)

    Davis, Donald D.; Bryant, Janet L.; Tedrow, Lara; Liu, Ying; Selgrade, Katherine A.; Downey, Heather J.

    2005-01-01

    This report describes results of a study conducted for NASA-Langley Research Center. This study is part of a program of research conducted for NASA-LARC that has focused on identifying the influence of national culture on the performance of flight crews. We first reviewed the literature devoted to models of teamwork and team performance, crew resource management, error management, and cross-cultural psychology. Davis (1999) reported the results of this review and presented a model that depicted how national culture could influence teamwork and performance in flight crews. The second study in this research program examined accident investigations of foreign airlines in the United States conducted by the National Transportation Safety Board (NTSB). The ability of cross-cultural values to explain national differences in flight outcomes was examined. Cultural values were found to covary in a predicted way with national differences, but the absence of necessary data in the NTSB reports and limitations in the research method that was used prevented a clear understanding of the causal impact of cultural values. Moreover, individual differences such as personality traits were not examined in this study. Davis and Kuang (2001) report results of this second study. The research summarized in the current report extends this previous research by directly assessing cultural and individual differences among students from the United States and China who were trained to fly in a flight simulator using desktop computer workstations. The research design used in this study allowed delineation of the impact of national origin, cultural values, personality traits, cognitive style, shared mental model, and task workload on teamwork, error management and flight outcomes. We briefly review the literature that documents the importance of teamwork and error management and its impact on flight crew performance. We next examine teamwork and crew resource management training designed to improve

  13. Human Resource Intensive Management of Power Collective Enterprise in “Three Sets of Five” System%“三集五大”体系下电力集体企业人力资源集约化管理

    Institute of Scientific and Technical Information of China (English)

    邵桑

    2012-01-01

    在"三集五大"体系下市级供电公司下属单位的集体企业在人力资源管理工作中存在明显不足,本文详细阐述了人力资源集约化管理的概念,并提出提升人力资源集约管理水平的主要措施。%In the ″three sets of five″ system,the collective enterprises of subordinate units of municipal power supply company in human resource management are obviously insufficient.The article elaborates the concept of human resource intensive management,and proposes the main measures to improve human resource intensive management level.

  14. Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association.

    Science.gov (United States)

    Munshi, Medha N; Florez, Hermes; Huang, Elbert S; Kalyani, Rita R; Mupanomunda, Maria; Pandya, Naushira; Swift, Carrie S; Taveira, Tracey H; Haas, Linda B

    2016-02-01

    Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life.

  15. Rapid Assessment of Logging-Associated Sediment-Delivery Pathways in an Intensively-Managed Forested Watershed in the Southern Cascades, Northern California

    Science.gov (United States)

    Coe, D. B.; Wopat, M. A.; Lindsay, D.; Stanish, S.; Boone, M.; Beck, B.; Wyman, A.; Bull, J.

    2012-12-01

    The potential for water-quality impacts in intensively-managed forested watersheds depends partly upon the frequency of overland flow paths linking logging-related hillslope sediment sources to the channel network, as well as the volume of sediment delivered along these flow paths. In response to public concerns over perceived water-quality impacts from clearcut timber harvesting, the Battle Creek Task Force, composed of subject-matter experts from 4 different state agencies, performed a rapid assessment for visible evidence of sediment delivery pathways from multiple logging-associated features in the upper Battle Creek watershed - an area underlain predominantly by Holocene- and Late Pleistocene-aged volcanic rock types, with highly permeable soils, and relatively few streams. Logging-associated features were selected for assessment based on erosion potential and proximity to stream channels. Identified sediment-delivery pathways were then characterized by dominant erosion process and the relative magnitude of sediment delivery (i.e., low, moderate, and high) was estimated. Approximately 26 km of stream buffers adjacent to 55 clearcut harvest units were assessed, and the single detected instance of sediment delivery was found to be of low magnitude and the result of illegal encroachment by logging equipment into a 5-m wide stream-adjacent equipment-limitation zone. The proportion of sampled sites delivering sediment was found to be highest for tractor-stream crossings, followed by road-stream crossings, stream-adjacent road segments, stream-adjacent landings, and clearcut harvest units, respectively. All 5 tractor-stream crossings delivered sediment, but were generally delivering a low magnitude of sediment derived from sheetwash and rilling. Road-stream crossings (n=39) and stream-adjacent road segments (n=24) delivered observable sediment 69 and 67 percent of the time, respectively. The highest magnitudes of sediment delivery from roads were associated with

  16. Processes and factors controlling N{sub 2}O production in an intensively managed low carbon calcareous soil under sub-humid monsoon conditions

    Energy Technology Data Exchange (ETDEWEB)

    Ju Xiaotang; Lu Xing [Key Laboratory of Plant Nutrition, Chinese Ministry of Agriculture, and College of Resources and Environmental Sciences, China Agricultural University, 2 Yuanmingyuan West Road, Beijing 100193 (China); Gao Zhiling [College of Agricultural Resources and Environmental Sciences, Hebei Agricultural University, Baoding 071001 (China); Chen Xinping; Su Fang [Key Laboratory of Plant Nutrition, Chinese Ministry of Agriculture, and College of Resources and Environmental Sciences, China Agricultural University, 2 Yuanmingyuan West Road, Beijing 100193 (China); Kogge, Martin; Roemheld, Volker [Institute for Plant Nutrition, University of Hohenheim, Stuttgart 70599 (Germany); Christie, Peter [Key Laboratory of Plant Nutrition, Chinese Ministry of Agriculture, and College of Resources and Environmental Sciences, China Agricultural University, 2 Yuanmingyuan West Road, Beijing 100193 (China); Agri-Environment Branch, Agri-Food and Biosciences Institute, BelfastBT9 5PX (United Kingdom); Zhang Fusuo, E-mail: zhangfs@cau.edu.cn [Key Laboratory of Plant Nutrition, Chinese Ministry of Agriculture, and College of Resources and Environmental Sciences, China Agricultural University, 2 Yuanmingyuan West Road, Beijing 100193 (China)

    2011-04-15

    An automated system for continuous measurement of N{sub 2}O fluxes on an hourly basis was employed to study N{sub 2}O emissions in an intensively managed low carbon calcareous soil under sub-humid temperate monsoon conditions. N{sub 2}O emissions occurred mainly within two weeks of application of NH{sub 4}{sup +}-based fertilizer and total N{sub 2}O emissions in wheat (average 0.35 or 0.21 kg N ha{sup -1} season{sup -1}) and maize (average 1.47 or 0.49 kg N ha{sup -1} season{sup -1}) under conventional and optimum N fertilization (300 and 50-122 kg N ha{sup -1}, respectively) were lower than previously reported from low frequency measurements. Results from closed static chamber showed that N{sub 2}O was produced mainly from nitrification of NH{sub 4}{sup +}-based fertilizer, with little denitrification occurring due to limited readily oxidizable carbon and low soil moisture despite consistently high soil nitrate-N concentrations. Significant reductions in N{sub 2}O emissions can be achieved by optimizing fertilizer N rates, using nitrification inhibitors, or changing from NH{sub 4}{sup +}- to NO{sub 3}{sup -}-based fertilizers. - Research highlights: > N{sub 2}O was produced mainly from nitrification of NH{sub 4}{sup +} based fertilizers. > Denitrification played minor role on N{sub 2}O emission due to C and soil moisture limitation. > Using NO{sub 3}{sup -} base fertilizer or NI is an effective way to reduce N{sub 2}O emission. - Nitrification of NH{sub 4}{sup +}-based fertilizer is the main N{sub 2}O production process with little denitrification due to limited readily oxidizable carbon and low soil moisture.

  17. Status report from the American Acne & Rosacea Society on medical management of acne in adult women, part 3: oral therapies.

    Science.gov (United States)

    Del Rosso, James Q; Harper, Julie C; Graber, Emmy M; Thiboutot, Diane; Silverberg, Nanette B; Eichenfield, Lawrence F

    2015-12-01

    Parts 1 and 2 of this 3-part series provided an overview of the epidemiology, visible patterns, and important considerations for clinical and laboratory evaluation of acne vulgaris (AV) in adult women and reviewed the role of proper skin care and topical therapies in this patient population. In Part 3, oral therapies including combination oral contraceptives, spironolactone, antibiotics, and isotretinoin are discussed along with important considerations that clinicians should keep in mind when selecting oral agents for management of AV in adult women. PMID:26761932

  18. Nurse Middle Managers' Dispositions of Habitus: A Bourdieusian Analysis of Supporting Role Behaviors in Dutch and American Hospitals.

    Science.gov (United States)

    Lalleman, P C B; Smid, G A C; Lagerwey, M D; Oldenhof, L; Schuurmans, M J

    2015-01-01

    A Magnet-related program has been recently adopted in the Netherlands. Support for staff nurses from nurse middle managers (NMMs) is a key component of such a program. A Bourdieusian ethnographic organizational case study in 4 hospitals in the Netherlands and the United States (Magnet, Magnet-related, and non-Magnet) was conducted to explore NMMs' supporting role behavior. Bourdieus concepts of habitus, field, and capital guided the analysis. Eight dispositions constitute NMMs habitus. A caring, clinical, and scientific disposition enhances NMMs' capital in particular organizations-as-fields. Further research is necessary to link Magnet (-related) program characteristics to various configurations of dispositions of NMMs habitus.

  19. Reforming Municipal Budgeting and Financial Management in a South American City: A Case Study of Asuncion, Paraguay

    Directory of Open Access Journals (Sweden)

    Rachel BALLARD

    2000-01-01

    Full Text Available With increasing frequency, the two highly interrelated subjects of municipal budgeting and effective financial management are becoming ever more central to discussions of local governance reform in Latin America. Among the most important factors contributing to this are the growing concern throughout the hemisphere about the decentralization of governmental services and the expanding influence of elected mayors. For at least a decade, governments from Mexico to Argentina, have been discussing and, in some cases, actually carrying out, efforts to decentralize to the local level public service provision in such important program areas as economic development, education, health services and housing.

  20. Handbook of data intensive computing

    CERN Document Server

    Furht, Borko

    2011-01-01

    Data Intensive Computing refers to capturing, managing, analyzing, and understanding data at volumes and rates that push the frontiers of current technologies. The challenge of data intensive computing is to provide the hardware architectures and related software systems and techniques which are capable of transforming ultra-large data into valuable knowledge. Handbook of Data Intensive Computing is written by leading international experts in the field. Experts from academia, research laboratories and private industry address both theory and application. Data intensive computing demands a fund

  1. Management of a comprehensive radiation safety program in a major American University and affiliated academic medical center

    International Nuclear Information System (INIS)

    lectures, and instituting a seminar series. Progress made at the institutional level includes; (a) implementing training programs; (b) developing an in-house TLD program; (c) initiating in-house diagnostic x-ray machine testing for units outside the Radiology Department; (d) centralizing radioactive package distribution; (e) simplifying the radiation licensing application process; (f) implementing written lab operating procedures in individual labs; (g) developing radioactive package order and receipt software; (h) implementing special shielding design and radioiodine patient waste management projects. We conclude: (1) involvement of executive management is critical for radiation protection management in multidisciplinary institutions; (2) consultant review is useful in guiding management support of RSO initiatives; (3) increased visibility of the radiation safety program, through training sessions and grand rounds, increases cooperation from users and subsequently improves regulatory compliance; (4) radiation safety division quality assurance meetings help identify weaknesses and provide motivation for improvement; (5) a clear chain of authority is critical in program oversight; (6) open participation in division projects by staff members fosters an intellectually stimulating environment in the group; (7) participation of senior administrators from Occupational and Environmental Safety Office (OESO) in the radiation safety staff meetings helps maintain a professional working relationship between the Radiation Safety Officer and the Director of OESO. (author)

  2. Effectiveness of Housing First with Intensive Case Management in an Ethnically Diverse Sample of Homeless Adults with Mental Illness: A Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Vicky Stergiopoulos

    Full Text Available Housing First (HF is being widely disseminated in efforts to end homelessness among homeless adults with psychiatric disabilities. This study evaluates the effectiveness of HF with Intensive Case Management (ICM among ethnically diverse homeless adults in an urban setting. 378 participants were randomized to HF with ICM or treatment-as-usual (TAU in Toronto (Canada, and followed for 24 months. Measures of effectiveness included housing stability, physical (EQ5D-VAS and mental (CSI, GAIN-SS health, social functioning (MCAS, quality of life (QoLI20, and health service use. Two-thirds of the sample (63% was from racialized groups and half (50% were born outside Canada. Over the 24 months of follow-up, HF participants spent a significantly greater percentage of time in stable residences compared to TAU participants (75.1% 95% CI 70.5 to 79.7 vs. 39.3% 95% CI 34.3 to 44.2, respectively. Similarly, community functioning (MCAS improved significantly from baseline in HF compared to TAU participants (change in mean difference = +1.67 95% CI 0.04 to 3.30. There was a significant reduction in the number of days spent experiencing alcohol problems among the HF compared to TAU participants at 24 months (ratio of rate ratios = 0.47 95% CI 0.22 to 0.99 relative to baseline, a reduction of 53%. Although the number of emergency department visits and days in hospital over 24 months did not differ significantly between HF and TAU participants, fewer HF participants compared to TAU participants had 1 or more hospitalizations during this period (70.4% vs. 81.1%, respectively; P=0.044. Compared to non-racialized HF participants, racialized HF participants saw an increase in the amount of money spent on alcohol (change in mean difference = $112.90 95% CI 5.84 to 219.96 and a reduction in physical community integration (ratio of rate ratios = 0.67 95% CI 0.47 to 0.96 from baseline to 24 months. Secondary analyses found a significant reduction in the number of days

  3. Position of the American Dietetic Association: dietetics professionals can implement practices to conserve natural resources and protect the environment. (Previously titled "natural resource conservation and waste management").

    Science.gov (United States)

    2001-10-01

    It is the position of the American Dietetic Association to encourage environmentally responsible practices that conserve natural resources, minimize the quantity of waste that is generated, and have the least adverse affect on the health of all living organisms and the environment. All components of the food system, from farmer to consumer, are affected by the availability and cost of energy and the availability and quality of water. Outdoor and indoor air quality significantly impacts the health of all living organisms. Decisions that dietetics professionals make as practitioners and consumers can affect the quantity and type of solid waste generated. The demand for natural resources should be evaluated when selecting the most cost-effective, environmentally sensitive approach to the management of solid waste. Special precautions are needed when using and disposing of hazardous and medical waste to protect the safety of our clients and employees. This position paper provides information and resources for dietetics professionals for addressing the complexity of the environmental issue presented. Conservation strategies are identified that dietetics professionals can use in their worksites and at home. These conservation practices may reduce cost and decrease the environmental impact we have on our communities and the world. PMID:11678498

  4. Can intense forest fertilization be considered a sustainable management practice in the context of greenhouse gas exchange between soils and the atmosphere?

    Science.gov (United States)

    Oquist, Mats G.; Egnell, Gustaf; Nilsson, Mats

    2016-04-01

    The demand for forest biomass is increasing and there is large potential for increasing biomass production of northern forest ecosystems by various management strategies involving N fertilization. Increased biomass production also leads to more atmospheric carbon sequestration that potentially can mitigate climate change. N fertilization has been shown to increase biomass production and to decrease soil respiration rates. However, the potential increase in N2O emissions following N addition may counteract the sustainability of such management practices in terms of its impact on the sink/source relationship of greenhouse gases. Here we evaluate the effect of various N addition intensities on the soil-atmosphere exchange of CO2 and N2O in a long-term field experiment in a boreal Scots pine (Pinus sylvestris) forest stand. The stand was planted in 1953 and the experiment was established in 1974 with annual N addition at four levels (N0, N1, N2, and N3 receiving 0, 35, 70, and 110 kg N ha-1 year-1, respectively) organized in a randomized block design (n=3) in plots of 30x30m. The high (N3) and intermediate (N2) N addition levels were terminated in 1990 and 2006, respectively, and offered an opportunity to investigate recovery of greenhouse gas exchange following high N loading. Soil-atmosphere exchange of GHGs were estimated weekly during 2010-2011 based on static chamber measurements during the snow free period and snow concentration gradients during winter. In the ongoing treatment (N1) the annual N2O emissions were 25 mg N2O m-2 yr-1, as compared to 6 mg N2O m-2 yr-1 in the control plots, representing a ca 4-fold significant increase due to N-addition. The N2O-N loss from the treatment corresponded to ca 0.5% of the annually added N (35 kg N ha-1). In the N2 treatment (terminated in 2006) annual N2O emissions were 15 mg N2O m-2 yr-1, while in the N3 treatment N2O emissions were the same as in the control plots with no N-additions. Thus the system has capacity to

  5. Reading and analysis on management guidelines for hyperthyroidism published in 2011 by American Thyroid Association and American Association of Clinical Endocrinologists%解读美国甲状腺协会和临床内分泌医师协会2011年甲亢诊治指南

    Institute of Scientific and Technical Information of China (English)

    孟召伟; 谭建

    2011-01-01

    最近,美国甲状腺协会和临床内分泌医师协会联合发表了甲亢诊治指南,总共提出了100项指南性的参考建议.该指南系统介绍了甲亢的诊断和治疗,重点强调了131I治疗、抗甲状腺药物治疗和手术治疗的适应证、禁忌证、治疗准备、治疗方法和随诊策略,并详细介绍了儿童甲亢、妊娠期甲亢、甲亢突眼和一些少见甲亢的诊治原则.%Recently,the American Thyroid Association and American Association of Clinical Endocrinologists published"Hyperthyroidism and other causes of thyrotoxicosis:management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists",and created 100 evidencebased recommendations.The guideline systematically introduced the diagnoses and therapies of hyperthyroidism,emphasizing the indications,contraindications,preparations,methodologies and follow-up strategies.The guideline also provided detailed management principles for hyperthyroidism in children and pregnancy,Graves' ophthalmopathy and some unusual causes of hyperthyroidism.

  6. Four years of North American registry home parenteral nutrition outcome data and their implications for patient management

    Energy Technology Data Exchange (ETDEWEB)

    Howard, L.; Heaphey, L.; Fleming, C.R.; Lininger, L.; Steiger, E. (Division of Clinical Nutrition, Albany Medical Center, New York (United States))

    1991-07-01

    The OASIS Registry started annual collection of longitudinal data on patients on home parenteral nutrition (HPN) in 1984. This report describes outcome profiles on 1594 HPN patients in seven disease categories. Analysis showed clinical outcome was principally a reflection of the underlying diagnosis. Patients with Crohn's disease, ischemic bowel disease, motility disorders, radiation enteritis, and congenital bowel dysfunction all had a fairly long-term clinical outcome, whereas those with active cancer and acquired immunodeficiency syndrome (AIDS) had a short-term outcome. The long-term group had a 3-year survival rate of 65 to 80%, they averaged 2.6 complications requiring hospitalization per year, and 49% experienced complete rehabilitation. The short-term group had a mean survival of 6 months; they averaged 4.6 complications per year and about 15% experienced complete rehabilitation. The registry data also indicated HPN was used for 19,700 patients in 1987 with therapy growth averaging about 8% per year. This growth was chiefly from new cancer patients. The number of new patients with long-term disorders in whom HPN was initiated appeared rather constant. The authors conclude that these clinical outcome assessments justify HPN for long-term patients, but the utility and appropriateness of HPN for the cancer and AIDS patients remains uncertain and requires further study. Medical, social, and fiscal aspects of HPN management in long-term and short-term patients appear to involve quite separate considerations.

  7. Resistance to antimicrobial agents in campylobacter isolated from chickens raised in intensive and organic farms and its implications for the management of risk to human health

    OpenAIRE

    Soonthornchaikul, Nantika

    2006-01-01

    The use of antimicrobials in poultry may lead to the emergence of resistant micro-organisms that could cause additional health risk to humans through food consumption. This study aims to investigate the relative health risks from Campylobacter and its antimicrobial resistance associated with chicken raised in organic and intensive rearing systems. Three groups of chicken were tested, pre-packaged intensively reared (PIC) and pre-packaged organically reared chickens (POC) both purchased fro...

  8. Audit Report on "Management Controls over the Department of Energy's American Recovery and Reinvestment Act - Louisiana State Energy Program"

    Energy Technology Data Exchange (ETDEWEB)

    None

    2010-05-01

    The Department of Energy's (Department) Office of Energy Efficiency and Renewable Energy (EERE) provides grants to states, territories and the District of Columbia (states) to support their energy priorities through the State Energy Program (SEP). Federal funding is based on a grant formula that considers the population and energy consumption in each state, and amounted to $25 million for Fiscal Year (FY) 2009. The American Recovery and Reinvestment Act of 2009 (Recovery Act) expanded the SEP by authorizing an additional $3.1 billion to states using the existing grant formula. EERE made grant awards to states after reviewing plans that summarize the activities states will undertake to achieve SEP Recovery Act objectives, including preserving and creating jobs; saving energy; increasing renewable energy sources; and, reducing greenhouse gas emissions. EERE program guidance emphasizes that states are responsible for administering SEP within each state, and requires each state to implement internal controls over the use of Recovery Act funds. The State of Louisiana received $71.6 million in SEP Recovery Act funds; a 164-fold increase over its FY 2009 SEP grant of $437,000. As part of the Office of Inspector General's strategy for reviewing the Department's implementation of the Recovery Act, we initiated this review to determine whether the Louisiana State Energy Office had internal controls in place to efficiently and effectively administer Recovery Act funds provided for its SEP program. Louisiana developed a strategy for SEP Recovery Act funding that focused on improving energy efficiency in state buildings, housing and small businesses; increasing Energy Star appliance rebates; and, expanding the use of alternative fuels and renewable energy. Due to a statewide hiring freeze, Louisiana outsourced management of the majority of its projects ($63.3 million) to one general contractor. Louisiana plans to internally manage one project, Education and

  9. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: Executive Summary of recommendations

    DEFF Research Database (Denmark)

    Gharib, H; Papini, E; Paschke, R;

    2010-01-01

    American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules are systematically developed statements to assist health care professionals in medical...... decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes...

  10. Manuseio da síndrome compartimental abdominal em unidade de tratamento intensivo Intensive care management of the abdominal compartment syndrome

    Directory of Open Access Journals (Sweden)

    Luiz Carlos Von Bahten

    2006-06-01

    Full Text Available A síndrome compartimental abdominal (SCA decorre de um aumento agudo na pressão intra-abdominal (PIA, promovendo alterações fisiológicas adversas devido ao acometimento dos principais sistemas orgânicos, podendo levar a falência orgânica e óbito. OBJETIVO: Avaliar a SCA em pacientes com hipertensão intra-abdominal (HIA admitidos na unidade de terapia intensiva (UTI. MÉTODO: Foi realizado um estudo de 548 pacientes submetidos a laparotomia, necessitando de UTI, durante o período de janeiro de 1997 a março de 2001. RESULTADOS: A SCA foi identificada em 29 pacientes (5,29%. Analisando-se o valor máximo de PIA, 9 (31,03% foram grau II, 10 (34,48% foram grau III e 10 (34,48% foram grau IV. Dezoito (62,07% foram reoperados e o fechamento temporário foi realizado em 6 (20,69%. A mortalidade global foi de 68,97%, sendo que a SCA grau II teve 55,56% de mortalidade; a de grau III, 50%; a de grau IV, 100% e a mortalidade dos pacientes reoperados, 61,11%. CONCLUSÕES: A SCA acarreta elevada mortalidade, mesmo com a reoperação precoce e adequado manejo em UTI, devendo-se manter maiores cuidados na sua identificação e prevenção.Abdominal compartment syndrome (ACS is attributed to acute increase in the intra-abdominal pressure (IAP, leading to adverse physiologic alterations because of involving the main organic systems and can lead to organic failure and obit. BACKGROUND: the purpose of this work is to evaluate the intra-abdominal hypertension (IAH and ACS conduct in patients submitted to intensive care unit (ICU. METHODS: in this retrospective work were analysed 548 patients submitted to laparotomy and ICU, during the period from 1997, january to 2001, march. RESULTS: ACS was noted in 29 patients (5.29%. Analysing the maximum IAP value, 9 (31.03% were grade II, 10 (34.48% were grade III and 10 were grade IV. Eighteen (62.07% were submitted to reoperation and temporary closure was used in 6 (20.69%. The global mortality was 68.97%, the

  11. Investigation and management of multidrug-resistant Acinetobacter baumannii spread in a French medical intensive care unit: one outbreak may hide another.

    Science.gov (United States)

    Bourigault, Céline; Corvec, Stéphane; Bretonnière, Cédric; Guillouzouic, Aurélie; Crémet, Lise; Marraillac, Julie; Juvin, Marie-Emmanuelle; Bemer, Pascale; Le Gallou, Florence; Reynaud, Alain; Boutoille, David; Villers, Daniel; Lepelletier, Didier

    2013-07-01

    An outbreak in a medical intensive care unit was due to an OXA-23-producing Acinetobacter baumannii strain imported from a repatriate hospitalized in Singapore. This outbreak revealed another multidrug resistant epidemic strain that had been present in the hospital for 2 years. Both outbreaks were controlled after 9 months of an extensive infection control program.

  12. Intensive upper limb intervention with self-management training is feasible and promising for older children and adolescents with unilateral cerebral palsy

    NARCIS (Netherlands)

    Geerdink, Y.; Aarts, P.; Burg, J. van der; Steenbergen, B.; Geurts, A.C.H.

    2015-01-01

    This study explored the feasibility and preliminary effectiveness of a short (one week) intensive intervention combining Constraint Induced Movement Therapy (CIMT) and bimanual training (BiT) to improve upper limb capacity and bimanual performance guided by individual goal setting in children and ad

  13. A global meta-analysis on the impact of management practices on net global warming potential and greenhouse gas intensity from cropland soils

    Science.gov (United States)

    Agricultural practices contribute significant amount of greenhouse gas (GHG) emissions, but little is known about their effects on net global warming potential (GWP) and greenhouse gas intensity (GHGI) that account for all sources and sinks of carbon dioxide emissions per unit area or crop yield. Se...

  14. A Cross-Cultural Examination of SNS Usage Intensity and Managing Interpersonal Relationships Online: The Role of Culture and the Autonomous-Related Self-Construal.

    Science.gov (United States)

    Lee, Soon Li; Kim, Jung-Ae; Golden, Karen Jennifer; Kim, Jae-Hwi; Park, Miriam Sang-Ah

    2016-01-01

    Perception of the autonomy and relatedness of the self may be influenced by one's experiences and social expectations within a particular cultural setting. The present research examined the role of culture and the Autonomous-Related self-construal in predicting for different aspects of Social Networking Sites (SNS) usage in three Asian countries, especially focusing on those aspects serving interpersonal goals. Participants in this cross-cultural study included 305 university students from Malaysia (n = 105), South Korea (n = 113), and China (n = 87). The study explored specific social and interpersonal behaviors on SNS, such as browsing the contacts' profiles, checking for updates, and improving contact with SNS contacts, as well as the intensity of SNS use, hypothesizing that those with high intensity of use in the Asian context may be doing so to achieve the social goal of maintaining contact and keeping updated with friends. Two scales measuring activities on other users' profiles and contact with friends' profiles were developed and validated. As predicted, some cross-cultural differences were found. Koreans were more likely to use SNS to increase contact but tended to spend less time browsing contacts' profiles than the Malaysians and Chinese. The intensity of SNS use differed between the countries as well, where Malaysians reported higher intensity than Koreans and Chinese. Consistent with study predictions, Koreans were found with the highest Autonomous-Related self-construal scores. The Autonomous-Related self-construal predicted SNS intensity. The findings suggest that cultural contexts, along with the way the self is construed in different cultures, may encourage different types of SNS usage. The authors discuss study implications and suggest future research directions. PMID:27148100

  15. A Cross-cultural Examination of SNS Usage Intensity and Managing Interpersonal Relationships Online: The Role of Culture and the Autonomous-Related Self-Construal

    Directory of Open Access Journals (Sweden)

    Lee eSoon Li

    2016-04-01

    Full Text Available Perception of the autonomy and relatedness of the self may be influenced by one’s experiences and social expectations within a particular cultural setting. The present research examined the role of culture and the Autonomous-Related self-construal in predicting for different aspects of Social Networking Sites (SNS usage in three Asian countries, especially focusing on those aspects serving interpersonal goals. Participants in this cross-cultural study included 305 university students from Malaysia (n = 105, South Korea (n = 113, and China (n = 87. The study explored specific social and interpersonal behaviors on SNS, such as browsing the contacts’ profiles, checking for updates, and improving contact with SNS contacts, as well as the intensity of SNS use, hypothesizing that those with high intensity of use in the Asian context may be doing so to achieve the social goal of maintaining contact and keeping updated with friends. Two scales measuring activities on other users’ profiles and contact with friends’ profiles were developed and validated. As predicted, some cross-cultural differences were found. Koreans were more likely to use SNS to increase contact but tended to spend less time browsing contacts’ profiles than the Malaysians and Chinese. The intensity of SNS use differed between the countries as well, where Malaysians reported higher intensity than Koreans and Chinese. Consistent with study predictions, Koreans were found with the highest Autonomous-Related self-construal scores. The Autonomous-Related self-construal predicted SNS intensity. The findings suggest that cultural contexts, along with the way the self is construed in different cultures, may encourage different types of SNS usage. The authors discuss study implications and suggest future research directions.

  16. A Cross-Cultural Examination of SNS Usage Intensity and Managing Interpersonal Relationships Online: The Role of Culture and the Autonomous-Related Self-Construal.

    Science.gov (United States)

    Lee, Soon Li; Kim, Jung-Ae; Golden, Karen Jennifer; Kim, Jae-Hwi; Park, Miriam Sang-Ah

    2016-01-01

    Perception of the autonomy and relatedness of the self may be influenced by one's experiences and social expectations within a particular cultural setting. The present research examined the role of culture and the Autonomous-Related self-construal in predicting for different aspects of Social Networking Sites (SNS) usage in three Asian countries, especially focusing on those aspects serving interpersonal goals. Participants in this cross-cultural study included 305 university students from Malaysia (n = 105), South Korea (n = 113), and China (n = 87). The study explored specific social and interpersonal behaviors on SNS, such as browsing the contacts' profiles, checking for updates, and improving contact with SNS contacts, as well as the intensity of SNS use, hypothesizing that those with high intensity of use in the Asian context may be doing so to achieve the social goal of maintaining contact and keeping updated with friends. Two scales measuring activities on other users' profiles and contact with friends' profiles were developed and validated. As predicted, some cross-cultural differences were found. Koreans were more likely to use SNS to increase contact but tended to spend less time browsing contacts' profiles than the Malaysians and Chinese. The intensity of SNS use differed between the countries as well, where Malaysians reported higher intensity than Koreans and Chinese. Consistent with study predictions, Koreans were found with the highest Autonomous-Related self-construal scores. The Autonomous-Related self-construal predicted SNS intensity. The findings suggest that cultural contexts, along with the way the self is construed in different cultures, may encourage different types of SNS usage. The authors discuss study implications and suggest future research directions.

  17. Managerial Concerns and Hispanic Culture in the American Workplace.

    Science.gov (United States)

    Cellini, Alva V.

    With changing social and economic realities, certain cultural differences in the management of Hispanic workers must be accepted and accommodated in the American workplace, where the scientific approach to management is the general rule. The scientific view of management is hardly accepted by Latin Americans whose management philosophy is more…

  18. American Dream in Early American Literatuer

    Institute of Scientific and Technical Information of China (English)

    屈彩娥; 李小玺

    2008-01-01

    American dream has often been closely rehted to American literature.Many say that the American literary history can be seen as the history of American dreams.In most periods in history,writers,whose dreams have been infused in a variety of characters create the American literature.While in Early American literature,American dream had been presented in a dif-ferent way.

  19. Probabilistic Projections of Future Sea-Level Change and Their Implications for Flood Risk Management: Insights from the American Climate Prospectus

    Science.gov (United States)

    Kopp, R. E., III; Delgado, M.; Horton, R. M.; Houser, T.; Little, C. M.; Muir-Wood, R.; Oppenheimer, M.; Rasmussen, D. M., Jr.; Strauss, B.; Tebaldi, C.

    2014-12-01

    damage by 2.6-5.2 billion (1-in-20 chance of >7 billion). Projected increases in tropical cyclone intensity would further increase damages [2]. References: [1] R. E. Kopp et al. (2014), Earth's Future, doi:10.1002/2014EF000239. [2] T. Houser et al. (2014), American Climate Prospectus, www.climateprospectus.org.

  20. Moving On: Farmer Education in Integrated Insect Pest and Disease Management

    NARCIS (Netherlands)

    Jiggins, J.L.S.; Mancini, F.

    2009-01-01

    This chapter explores intensive hands-on occupational education for farmers in selected European, African, Latin American countries and in south India. An Indian case study of Farmer Field Schools for Integrated Pest and Production Management (IPPM) to ensure food security and livelihood improvement

  1. Colorado Plateau Rapid Ecoregion Assessment Management Question H1: Where are high-use recreation sites, developments, roads, infrastructure or areas of intensive recreation use located (including boating)?

    Data.gov (United States)

    Bureau of Land Management, Department of the Interior — This map shows areas of high-use recreation, including recreation sites compiled from USFS and BLM, recreation areas (including OHV areas), water-based recreation...

  2. Integration of fertility management and planting distance on diseases incidence, crop yield and fruit quality in intensive organic ap-ple production systems.

    OpenAIRE

    Pedersen, Senior scientist Hanne Lindhard

    2006-01-01

    To optimise the fruit quality and yield, timing and type of nitrogen supply were investigated in a low input organic system with intensive planting densi-ties. Six fertiliser treatments and 3 planting densities were combined for the apple cultivar ‘Discovery’ in 2004 and 2005. No differences appeared between yields due to soil treatments. Mulching with straw reduced the available nitrogen in the soil and low nitrogen uptake caused less trees infected with fruit tree canker. Mechanical weed cl...

  3. Management intensity effects on growth and physiological responses of loblolly pine varieties and families growing in the Virginia Piedmont and North Carolina Coastal Plain of the United States

    OpenAIRE

    Yanez Arce, Marco Aliro

    2014-01-01

    Varietal forestry may increase the productivity of loblolly pine (Pinus taeda L.) in the Southern United Sates. However, the effects of these genetic x environment interactions are still poorly understood. In this study we examined the responses in growth, stand uniformity and leaf level physiology of loblolly pine clonal varieties and families to silvicultural intensity and site effects. We also looked for patterns in observed traits that were consistent between crown ideo...

  4. French intensive truck garden

    Energy Technology Data Exchange (ETDEWEB)

    Edwards, T D

    1983-01-01

    The French Intensive approach to truck gardening has the potential to provide substantially higher yields and lower per acre costs than do conventional farming techniques. It was the intent of this grant to show that there is the potential to accomplish the gains that the French Intensive method has to offer. It is obvious that locally grown food can greatly reduce transportation energy costs but when there is the consideration of higher efficiencies there will also be energy cost reductions due to lower fertilizer and pesticide useage. As with any farming technique, there is a substantial time interval for complete soil recovery after there have been made substantial soil modifications. There were major crop improvements even though there was such a short time since the soil had been greatly disturbed. It was also the intent of this grant to accomplish two other major objectives: first, the garden was managed under organic techniques which meant that there were no chemical fertilizers or synthetic pesticides to be used. Second, the garden was constructed so that a handicapped person in a wheelchair could manage and have a higher degree of self sufficiency with the garden. As an overall result, I would say that the garden has taken the first step of success and each year should become better.

  5. American Culture Reflected in American English

    Institute of Scientific and Technical Information of China (English)

    李华芳

    2013-01-01

    Language is a vehicle for culture. It is also a key component of culture. It not only reflects culture but also influences culture. As a variety of British English, American English, especially American words and expressions can reflect American culture from many aspects. This paper studies some typical traits of American culture reflected in words and expressions of American Eng-lish.

  6. Management

    OpenAIRE

    Pípalová, Jana

    2013-01-01

    This bachelor's thesis deals with the topic "Management in the Organisation". The term "management" is explained with several definitions by various authors and subsequently analysed in theoretical basis the environmental influences which affect the organization are described and explained in this work. The history of the management is also included, in which every historical period is briefly described, and important representatives are mentioned. Another part deals with the term manager. T...

  7. Simulation of Species Diversity in Phyllostachys edulis Forest Responses to the Habitat Destruction due to Intensive Management%毛竹林物种多样性对集约经营的响应模型

    Institute of Scientific and Technical Information of China (English)

    杨清培; 时培建; 王兵; 赵广东; 郭起荣; 杨光耀

    2011-01-01

    From a landscape perspective and based on the theory of island biogeography and its species -area relationship: S = cAz, mathematic ecological models were established to analyze the changes of species diversity in Phyllostachys edulis forests or woody forests responses to the habitat destruction due to intensive management. Here the activity range of species apart from the borders of forests is also considered as a part of the area in the species - area formula. The followings were found: ( 1 ) intensive management had an influence on species diversity in the Ph. edulis forest ( i. e. the larger the area of forest was, the larger the species loss was;the smaller the area of forest was, the smaller the species loss was during intensive management); (2) the expansion to woody forest of the Ph. edulis forest fulfilled the Logistic equation, and the loss of species diversity could reach its limit as time went on.%根据岛屿生物地理学理论及其物种-面积关系:S=cAz,构建数学生态模型,研究集约经营对毛竹林物种多样性的影响.得出两点:(1)竹林生物多样性对集约经营的响应具有一定的面积效应,即原粗放经营竹林的面积越大,物种减少幅度就越大,原竹林越小,物种减少幅度就越小;(2)毛竹林诱导扩张过程符合Logistic方程,随着时间的延长,竹林内物种多样性会达到极限.

  8. Aliki Varvogli, Travel and Dislocation in Contemporary American Fiction.

    OpenAIRE

    Feleki, Despoina

    2015-01-01

    Travel and Dislocation in Contemporary American Fiction by Aliki Varvogli is the latest addition in the Routledge “Transnational Perspectives on American Literature” series. The writer’s ambitions to trace latest writing trends in American letters and update concerns about narratives of immigration in a post-Nelson Mandela era are expressed from the onset. Within the context of travel narratives and theories of dislocation, the book manages to show how the idea of the American in American let...

  9. American Houses

    Institute of Scientific and Technical Information of China (English)

    张梦华

    2004-01-01

    American houses usually have private kitchens,a living room and sometimes separate areas for eating and watching television,A house usually has its own mailbox,a yard with plants or perhaps a lawn,and a place to store garbage out of sight.

  10. American Occupation

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    Angry Americans across the country are protesting against inequality, greed and corruption The "Occupy Wall Street" protests have grown from an insignificant lower Manhattan gathering of around 1,500 people to tens of thousands of people across the United States, from Anchorage,

  11. Comparative Evaluation of American Cancer Society and American Lung Association Smoking Cessation Clinics.

    Science.gov (United States)

    Lando, Harry A.; And Others

    1990-01-01

    Compared the effectiveness of the American Cancer Society's "FreshStart," the American Lung Association's "Freedom from Smoking," and a laboratory smoking cessation clinic. A one-year followup favored the more intensive laboratory and "Freedom from Smoking" clinics over the "FreshStart" method. (FMW)

  12. MEDUCATE trial : effectiveness of an intensive EDUCATional intervention for IT-mediated MEDication management in the outpatient clinic - study protocol for a cluster randomized controlled trial

    NARCIS (Netherlands)

    van Stiphout, F; Zwart-van Rijkom, J E F; Aarts, J E C M; Koffijberg, H; Klarenbeek-deJonge, E; Krulder, M; Roes, K C B; Egberts, A C G; ter Braak, E W M T

    2015-01-01

    BACKGROUND: Using information technology for medication management is an opportunity to help physicians to improve the quality of their documentation and communication and ultimately to improve patient care and patient safety. Physician education is necessary to take full advantage of information te

  13. MEDUCATE trial: effectiveness of an intensive EDUCATional intervention for IT-mediated MEDication management in the outpatient clinic – study protocol for a cluster randomized controlled trial

    NARCIS (Netherlands)

    Stiphout, van F.; Zwart-van Rijkom, J.E.F.; Aarts, J.E.C.M.; Koffijberg, H.; Klarenbeek-de Jonge, E.; Krulder, M.; Roes, K.C.B.; Egberts, A.C.G.; Braak, ter E.W.M.T.

    2015-01-01

    Background Using information technology for medication management is an opportunity to help physicians to improve the quality of their documentation and communication and ultimately to improve patient care and patient safety. Physician education is necessary to take full advantage of information tec

  14. MEDUCATE trial: Effectiveness of an intensive EDUCATional intervention for IT-mediated MEDication management in the outpatient clinic - study protocol for a cluster randomized controlled trial

    NARCIS (Netherlands)

    F. van Stiphout; J.E.F. Zwart-van Rijkom (Jeannette); J.E.C.M. Aarts (Jos); H. Koffijberg (Hendrik); E. Klarenbeek-deJonge; M. Krulder; K.C. Roes (Kit); A.C.G. Egberts (Antoine); E.W.M.T. ter Braak

    2015-01-01

    textabstractBackground: Using information technology for medication management is an opportunity to help physicians to improve the quality of their documentation and communication and ultimately to improve patient care and patient safety. Physician education is necessary to take full advantage of in

  15. Erratum to "Progress and Outcomes for Children with Autism Receiving Parent-Managed Intensive Interventions" [Research in Developmental Disabilities 22 (2001) 425-447].

    Science.gov (United States)

    Bibby, Peter; Eikeseth, Svein; Martin, Neil T.; Mudford, Oliver C.; Reeves, David

    2002-01-01

    This corrected article on parent-managed interventions with children with autism reports on analysis of data on 66 children. Findings generally indicated that, after 31.6 months of intervention, IQ scores had not changed but adaptive behavior scores had increased significantly (n=21). However, overall interventions did not reproduce results from…

  16. Cancer and African Americans

    Science.gov (United States)

    ... Population Profiles > Black/African American > Cancer Cancer and African Americans African Americans have the highest mortality rate ... 65MB] At a glance – Top Cancer Sites for African Americans (2008-2012) Cancer Incidence Rates per 100, ...

  17. American Sign Language

    Science.gov (United States)

    ... Health Info » Voice, Speech, and Language American Sign Language On this page: What is American Sign Language? ... signs "I love you." What is American Sign Language? American Sign Language (ASL) is a complete, complex ...

  18. Classification of knowledge-intensive organizations

    Science.gov (United States)

    Marquart, Edward J.

    Managing knowledge workers in knowledge-intensive organizations has become important because knowledge itself is emerging as a primary sustainable competitive advantage. This dissertation traces the development of two important items related to knowledge-intensive organizations. First, it documents a careful study of the literature which allows for the construction of a Knowledge-Intensity Continuum. This continuum then forms the basis for the development of a Knowledge-Intensity Assessment survey instrument which allows an organization to be placed along this continuum. A cross-section of research, consulting, and manufacturing organizations was surveyed using this instrument. The findings provided evidence that supports the validity of the Knowledge-Intensity Continuum. Additionally, onsite interviews provided evidence that the Knowledge-Intensity Assessment survey can be used as a tool to locate any organization on this continuum. Using this survey to clearly identify knowledge-intensive organizations will allow for further research into effective management systems for knowledge workers in these organizations.

  19. Controlling anxiety in physicians and nurses working in intensive care units using emotional intelligence items as an anxiety management tool in Iran

    Directory of Open Access Journals (Sweden)

    Nooryan K

    2012-01-01

    Full Text Available Kheirollah Nooryan1, K Gasparyan2, F Sharif3, M Zoladl11Yasouj University of Medical Sciences Yasouj, Iran; 2Yerevan University of Medical Sciences, Yerevan, Armenia; 3Shiraz University of Medical Sciences, Shiraz, Fars, IranIntroduction: Today, anxiety is one of the most common problems of mankind, to the extent that we could claim that it predisposes human to many physical illnesses, mental disorders, behavioral disturbances, and inappropriate reactions. The intensive care unit is a stressful environment for its staff, especially physicians and nurses. These stresses may have negative effects on the mental health and performance of the nurses and physicians. But the complications caused by this stress can be prevented by training emotional intelligence components. In this study, the impact of training emotional intelligence components on stress and anxiety in nurses and expert physicians is examined.Methodology: A cross-interventional, pre- to post-, case and control group design was used and inferential study design was implemented. Our study included 150 registered hospitals physicians and nurses, who were widely distributed. In the study, a ten-question demographic questionnaire, a 20-question situational anxiety Berger (overt questionnaire, and a 133-question Bar-on emotional intelligence questionnaire were used.Results: Research results indicate that average score for the situational anxiety of the case group in nurses was 47.20 before the intervention and it was reduced to 42.00 after the intervention, and in physicians was 40.46 before the intervention and it decreased to 33.66 after implementation of training items of emotional intelligence, which indicates the impact of training of emotional intelligence components on reduction of situational anxiety. The average score of situational anxiety of control group nurses was 46.73 before the intervention and it decreased to 45.70. In physicians, it was 38.33 before the intervention and it

  20. Time to rethink the management intensity in a Mediterranean oak woodland: the response of insectivorous birds and leaf-chewing defoliators as key groups in the forest ecosystem

    OpenAIRE

    Pereira, Pedro; Godinho, Carlos; Roque, Inês; Marques, Ana; Branco, Manuela; Rabaça, João E.

    2012-01-01

    International audience & Context The Iberian cork oak Quercus suber montados are dynamic agro-silvo-pastoral systems, contrasting with the abandonment trend of other Mediterranean forested areas. & Aims We aimed to identify the effect of management type and vegetation features on breeding insectivorous birds and leaf-chewing defoliator insects. & Methods In central Portugal, we selected two groups of 20 sites: dense montados (DM, high cover of cork oaks and low cattle impact) and sparse mo...

  1. Advocating for Whole Health: The Role of the Mental Health Professional in Promoting Diet, Nutrition, and Management of Physical Disease with American Indian Clients

    Science.gov (United States)

    Harper, Faith G.

    2010-01-01

    A strong correlation between mental health issues, substance abuse issues, and diabetes has been found within the American Indian (AI) community. This multimorbidity exists at higher rates than any other population within the United States. As research shows that more AI are living outside of tribal statistical areas and opting to receive services…

  2. A mixed methods inquiry: How dairy farmers perceive the value(s of their involvement in an intensive dairy herd health management program

    Directory of Open Access Journals (Sweden)

    Kristensen Erling

    2008-12-01

    Full Text Available Abstract Background Research has been scarce when it comes to the motivational and behavioral sides of farmers' expectations related to dairy herd health management programs. The objectives of this study were to explore farmers' expectations related to participation in a health management program by: 1 identifying important ambitions, goals and subjective well-being among farmers, 2 submitting those data to a quantitative analysis thereby characterizing perspective(s of value added by health management programs among farmers; and 3 to characterize perceptions of farmers' goals among veterinarians. Methods The subject was initially explored by means of literature, interviews and discussions with farmers, herd health management consultants and researchers to provide an understanding (a concourse of the research entity. The concourse was then broken down into 46 statements. Sixteen Danish dairy farmers and 18 veterinarians associated with one large nationwide veterinary practice were asked to rank the 46 statements that defined the concourse. Next, a principal component analysis was applied to identify correlated statements and thus families of perspectives between respondents. Q-methodology was utilized to represent each of the statements by one row and each respondent by one column in the matrix. A subset of the farmers participated in a series of semi-structured interviews to face validate the concourse and to discuss subjects like animal welfare, veterinarians' competences as experienced by the farmers and time constraints in the farmers' everyday life. Results Farmers' views could be described by four families of perspectives: Teamwork, Animal welfare, Knowledge dissemination, and Production. Veterinarians believed that farmers' primary focus was on production and profit, however, farmers' valued teamwork and animal welfare more. Conclusion The veterinarians in this study appear to focus too much on financial performance and increased

  3. Management of infections in critically ill returning travellers in the intensive care unit-I: considerations on infection control and transmission of resistance.

    Science.gov (United States)

    Leblebicioglu, Hakan; Rodriguez-Morales, Alfonso J; Rossolini, Gian Maria; López-Vélez, Rogelio; Zahar, Jean-Ralph; Rello, Jordi

    2016-07-01

    Depending on their destinations and activities, international travellers are at a significant risk of contracting both communicable and non-communicable diseases. On return to their home countries, such travellers may require intensive care. The emergence of severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), and more recently Ebola haemorrhagic fever, has highlighted the risks. Other well-known communicable pathogens such as methicillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae have been described previously. However, malaria remains by far the most important cause of death. The issues related to imported antibiotic resistance and protection from highly contagious diseases are reviewed here. Surveillance strategies based on epidemiological data (country visited, duration of travel, and time elapsed since return) and clinical syndromes, together with systematic search policies, are usually mandatory to limit the risk of an outbreak. Single-bed hospital rooms and isolation according to symptoms should be the rule while awaiting laboratory test results. Because person-to-person contact is the main route of transmission, healthcare workers should implement specific prevention strategies. PMID:27134158

  4. Effect of high-intensity laser therapy in the management of myofascial pain syndrome of the trapezius: a double-blind, placebo-controlled study.

    Science.gov (United States)

    Dundar, Umit; Turkmen, Utku; Toktas, Hasan; Solak, Ozlem; Ulasli, Alper Murat

    2015-01-01

    Myofascial pain syndrome (MPS) of the trapezius muscle is one of the main causes of neck pain. In this randomized, double-blind study, we evaluated the effects of high-intensity laser therapy (HILT) in female patients with chronic MPS of the trapezius muscle. The patients were assigned to two groups. The HILT group was treated with HILT and exercise, and the sham therapy group was treated with placebo HILT and exercise. The patients were assessed for pain, cervical active range of motion, disability, and quality of life. Evaluations were performed before treatment (week 0) and after treatment (weeks 4 and 12). Both groups showed significant improvement in all parameters at weeks 4 and 12. However, in a comparison of the percentage changes in the parameters at weeks 4 and 12 relative to pretreatment values, the HILT group showed greater improvement in pain scores, the neck disability index, and several subparts of the short-form 36 health survey (SF-36) (physical functioning, role limitations due to physical functioning, bodily pain, general health perceptions, social functioning, and role limitations due to emotional problems) than did the sham therapy group. We conclude that HILT is an effective therapeutic method in the treatment of patients with chronic MPS of the trapezius muscle.

  5. Management of infections in critically ill returning travellers in the intensive care unit—I: considerations on infection control and transmission of resistance

    Directory of Open Access Journals (Sweden)

    Hakan Leblebicioglu

    2016-07-01

    Full Text Available Depending on their destinations and activities, international travellers are at a significant risk of contracting both communicable and non-communicable diseases. On return to their home countries, such travellers may require intensive care. The emergence of severe acute respiratory syndrome coronavirus (SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV, and more recently Ebola haemorrhagic fever, has highlighted the risks. Other well-known communicable pathogens such as methicillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae have been described previously. However, malaria remains by far the most important cause of death. The issues related to imported antibiotic resistance and protection from highly contagious diseases are reviewed here. Surveillance strategies based on epidemiological data (country visited, duration of travel, and time elapsed since return and clinical syndromes, together with systematic search policies, are usually mandatory to limit the risk of an outbreak. Single-bed hospital rooms and isolation according to symptoms should be the rule while awaiting laboratory test results. Because person-to-person contact is the main route of transmission, healthcare workers should implement specific prevention strategies.

  6. Preliminary Audit Report on "Management Controls over the Commonwealth of Virginia's Efforts to Implement the American Recovery and Reinvestment Act Weatherization Assistance Program"

    Energy Technology Data Exchange (ETDEWEB)

    None

    2010-05-01

    The Department of Energy's (Department) Weatherization Assistance Program received $5 billion under the American Recovery and Reinvestment Act of 2009 (Recovery Act) to improve the energy efficiency of homes, multi-family rental units and mobile homes owned or occupied by low-income persons. Subsequently, the Department awarded a three-year Weatherization Assistance Program grant for $94 million to the Commonwealth of Virginia (Virginia). This grant provided more than a ten-fold increase in funds available to Virginia for weatherization over that authorized in Fiscal Year (FY) 2009. Corresponding to the increase in funding, the Recovery Act increased the limit on the average amount spent to weatherize a home (unit) from $2,500 to $6,500. Virginia's Department of Housing and Community Development (DHCD) administers the Recovery Act grant through 22 local community action agencies. These agencies (sub-grantees) are responsible for determining applicant eligibility, weatherizing homes, and conducting home assessments and inspections. Typical weatherization services include installing insulation; sealing ducts; tuning and repairing furnaces; and, mitigating heat loss through windows, doors and other infiltration points. Virginia plans to use its Recovery Act Weatherization funding to weatherize about 9,193 units over the life of the grant - a significant increase over the 1,475 housing units that were planned to be completed in FY 2009. Given the significant increase in funding and the demands associated with weatherizing thousands of homes, we initiated this audit to determine if Virginia had adequate safeguards in place to ensure that the Weatherization Program was managed efficiently and effectively. The State of Virginia's DHCD had not implemented financial and reporting controls needed to ensure Weatherization Program funds are spent effectively and efficiently. Specifically, DHCD had not: (1) Performed on-site financial monitoring of any of its sub

  7. Management

    OpenAIRE

    Ughetto, Pascal

    2012-01-01

    International audience Quand il s'agit de rendre compte du travail et de ses conditions, le management exerce autant un fort pouvoir de séduction que de répulsion. Le travail d'aujourd'hui est directement confronté à l'empire des dispositifs de gestion. Il importe de reconstituer les mondes sociaux du management - le top management, les directions spécialisées, les cadres de terrain - si l'on veut comprendre où et comment se jouent les marges de manoeuvre accordées à l'activité de travail ...

  8. Management

    OpenAIRE

    2008-01-01

    La globalisation des activités avec son lot de relocalisations, d’alliances stratégiques par-delà les frontières, défie les pratiques traditionnelles du management, nécessairement construites sur les systèmes nationaux. Cas pratiques à l’appui (dont Aventis, BASF, Novartis ou Siemens), les auteurs, tous deux professeurs de management international, détaillent en les analysant les nouveaux impératifs de management et d’organisation que doivent affronter les entreprises. Ils distinguent clairem...

  9. American Speech-Language-Hearing Association

    Science.gov (United States)

    ... Practice Management Research American Speech-Language-Hearing Association (ASHA) Making effective communication, a human right, accessible and ... for focused information and more. Join a SIG ASHA Corporate Partners Become A Corporate Partner Policies  About ...

  10. South American perspectives

    Energy Technology Data Exchange (ETDEWEB)

    Moxon, S.

    1999-03-01

    South America still has enormous potential for the further development of hydroelectric power. The reasons why much of the potential remains untapped are discussed and here environmental considerations are prominent: to a lesser extent, war, military coups, corruption, bad management and hyperinflation have all contributed. Some examples of disastrous South American hydro projects are given. Argentina sees a possible solution in using international contractors. However, privatisation has produced some success stories, notably the Canon del Plato hydro plant in Peru and the Duqueco project in Chile. (UK)

  11. 2012年美国非酒精性脂肪性肝病诊疗指南解读%A clinical interpretation of 2012 American guideline on the diagnosis and management of nonalcoholic fatty liver disease

    Institute of Scientific and Technical Information of China (English)

    沈峰; 范建高

    2012-01-01

    近10年来,随着对非酒精性脂肪性肝病流行病学和自然史认识的持续加深、诊断技术的飞速进步以及治疗手段的不断更新,针对非酒精性脂肪性肝病的诊疗取得了巨大进展.2012年,美国肝病学会、胃肠病学院和胃肠病学会对非酒精性脂肪性肝病诊疗相关问题进行总结,明确了大量临床工作中的具体问题.文章对指南中重点结论进行归纳,并与现有非酒精性脂肪性肝病的指南进行比较,以促进非酒精性脂肪性肝病诊疗的规范化.%Based on the increasingly growing knowledge of the epidemiology and natural history of nonalcoholic fatty liver disease (NAFI.D) .noticeable advances have been made in diagnostic procedures,therapeutic and preventative approaches, and clinical management for NAFLD patients in the past decade. In 2012,the American association for the study of liver diseases , American College of Gastroenterology, and the American Gastroenterological Association issued practice guideline on the diagnosis and management of NAFLD. The paper summarizes key points of this guideline and compare it with other guidelines on NAFLD to assist physicians and other health care providers in the clinical decision-making process.

  12. 中、美、欧企业人力资源管理差异与中国本土企业人力资源管理应用研究%A Study on the Differences of Human Resource Management among Chinese, American and European Companies and Human Resource Management Application in Chinese Local Companies

    Institute of Scientific and Technical Information of China (English)

    赵曙明

    2012-01-01

    Through the analysis of human resource management characteristics in Chinese, American and European companies and their strengths and weaknesses respectively, this paper compares differences in culture, philosophy, system and standard of human resource management in Chinese, American and European companies. It also studies current human resource management of Chinese local firms under the transitional economy, explores human resource management application and improvement in Chinese local firms, and provides guidance for conducting research on human resource management and practical application under the Chinese transitional economy.%通过对中、美、欧企业人力资源管理特征及各自优劣势的分析,对中、美、欧企业人力资源管理存在的文化差异性、理念差异性、制度差异性、标准差异性进行比较,并结合我国经济转型时期本土企业人力资源管理现状,对中国本土企业人力资源管理应用与水平提高进行探讨,以期为我国转型经济时期人力资源管理理论研究和具体实践提供借鉴.

  13. A computer-assisted recording, diagnosis and management of the medically ill system for use in the intensive care unit: A preliminary report

    Directory of Open Access Journals (Sweden)

    John George

    2009-01-01

    Full Text Available Background: Computerized medical information systems have been popularized over the last two decades to improve quality and safety, and for decreasing medical errors. Aim: To develop a clinician-friendly computer-based support system in the intensive care unit (ICU that incorporates recording, reminders, alerts, checklists and diagnostic differentials for common conditions encountered in critical care. Materials and Methods: This project was carried out at the Medical ICU CMC Hospital, Vellore, in collaboration with the Computer Science Department, VIT University. The first phase was to design and develop monitoring and medication sheets. Terminologies such as checklists (intervention list that pops up at defined times for all patients, reminders (intervention unique to each patient and alerts (time-based, value-based, trend-based were defined. The diagnostic and intervention bundles were characterized in the second phase. The accuracy and reliability of the software to generate alerts, reminders and diagnoses was tested in the third phase. The fourth phase will be to integrate this with the hospital information system and the bedside monitors. Results: Alpha testing was performed using six scenarios written by intensivists. The software generated real-time alerts and reminders and provided diagnostic differentials relevant to critical care. Predefined interventions for each diagnostic possibility appeared as pop-ups. Problems identified during alpha testing were rectified prior to beta testing. Conclusions: The use of a computer-assisted monitoring, recording and diagnostic system appears promising. It is envisaged that further software refinements following beta testing would facilitate the improvement of quality and safety in the critical care environment.

  14. American Houses

    Institute of Scientific and Technical Information of China (English)

    严双红

    2008-01-01

    <正>American houses usually have private kitchens,a living room and sometimes separate areas for eating and watching television.A house usually has its own mailbox,a yard with plants or perhaps a lawn,and a place to store garbage.美国住房通常有私人厨房,一间起居室,有时吃饭和看电视的地方是分开的。一所房子通常有自己的邮箱,一个种有植物或者有草坪的院子,还有存放垃圾的地方。

  15. Influence of airway management strategy on "no-flow-time" during an "Advanced life support course" for intensive care nurses – A single rescuer resuscitation manikin study

    Directory of Open Access Journals (Sweden)

    Bahr Jan

    2008-04-01

    Full Text Available Abstract Background In 1999, the laryngeal tube (VBM Medizintechnik, Sulz, Germany was introduced as a new supraglottic airway. It was designed to allow either spontaneous breathing or controlled ventilation during anaesthesia; additionally it may serve as an alternative to endotracheal intubation, or bag-mask ventilation during resuscitation. Several variations of this supraglottic airway exist. In our study, we compared ventilation with the laryngeal tube suction for single use (LTS-D and a bag-mask device. One of the main points of the revised ERC 2005 guidelines is a low no-flow-time (NFT. The NFT is defined as the time during which no chest compression occurs. Traditionally during the first few minutes of resuscitation NFT is very high. We evaluated the hypothesis that utilization of the LTS-D could reduce the NFT compared to bag-mask ventilation (BMV during simulated cardiac arrest in a single rescuer manikin study. Methods Participants were studied during a one day advanced life support (ALS course. Two scenarios of arrhythmias requiring defibrillation were simulated in a manikin. One scenario required subjects to establish the airway with a LTS-D; alternatively, the second scenario required them to use BMV. The scenario duration was 430 seconds for the LTS-D scenario, and 420 seconds for the BMV scenario, respectively. Experienced ICU nurses were recruited as study subjects. Participants were randomly assigned to one of the two groups first (LTS-D and BMV to establish the airway. Endpoints were the total NFT during the scenario, the successful airway management using the respective device, and participants' preference of one of the two strategies for airway management. Results Utilization of the LTS-D reduced NFT significantly (p Conclusion In our manikin study, NFT was reduced significantly when using LTS-D compared to BMV. During cardiac arrest, the LTS-D might be a good alternative to BMV for providing and maintaining a patent airway

  16. Effect of Increasing Experience on Dosimetric and Clinical Outcomes in the Management of Malignant Pleural Mesothelioma With Intensity-Modulated Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Pretesh R., E-mail: patel073@mc.duke.edu [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Yoo, Sua [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Broadwater, Gloria [Cancer Center Biostatistics, Duke University Medical Center, Durham, North Carolina (United States); Marks, Lawrence B. [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States); Miles, Edward F. [Naval Medical Center, Portsmouth, Virginia (United States); D' Amico, Thomas A.; Harpole, David [Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina (United States); Kelsey, Chris R. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)

    2012-05-01

    Purpose: To assess the impact of increasing experience with intensity-modulated radiation therapy (IMRT) after extrapleural pneumonectomy (EPP) for malignant pleural mesothelioma (MPM). Methods and Materials: The records of all patients who received IMRT following EPP at Duke University Medical Center between 2005 and 2010 were reviewed. Target volumes included the preoperative extent of the pleural space, chest wall incisions, involved nodal stations, and a boost to close/positive surgical margins if applicable. Patients were typically treated with 9-11 beams with gantry angles, collimator rotations, and beam apertures manually fixed to avoid the contalateral lung and to optimize target coverage. Toxicity was graded retrospectively using National Cancer Institute common toxicity criteria version 4.0. Target coverage and contralateral lung irradiation were evaluated over time by using linear regression. Local control, disease-free survival, and overall survival rates were estimated using the Kaplan-Meier method. Results: Thirty patients received IMRT following EPP; 21 patients also received systemic chemotherapy. Median follow-up was 15 months. The median dose prescribed to the entire ipsilateral hemithorax was 45 Gy (range, 40-50.4 Gy) with a boost of 8-25 Gy in 9 patients. Median survival was 23.2 months. Two-year local control, disease-free survival, and overall survival rates were 47%, 34%, and 50%, respectively. Increasing experience planning MPM cases was associated with improved coverage of planning target volumes (P=.04). Similarly, mean lung dose (P<.01) and lung V5 (volume receiving 5 Gy or more; P<.01) values decreased with increasing experience. Lung toxicity developed after IMRT in 4 (13%) patients at a median of 2.2 months after RT (three grade 3-4 and one grade 5). Lung toxicity developed in 4 of the initial 15 patients vs none of the last 15 patients treated. Conclusions: With increasing experience, target volume coverage improved and dose to the

  17. Interplay of climate and land-use change on transport dynamics of intensively managed landscapes: a catchment travel time distribution analysis

    Science.gov (United States)

    Danesh Yazdi, M.; Foufoula-Georgiou, E.; Karwan, D. L.

    2015-12-01

    Climatic trends and extensive implementation of drainage tiles in poorly drained agricultural lands have left significant fingerprints on the hydrology and water quality of the receiving streams. Tiles were initially designed to increase the crop productivity by removing excess soil moisture and improving field conditions. However, their hydro-ecological consequences have gradually emerged through observations of enhanced rates of nitrate and phosphorus delivered to the streams, as well as altered runoff volumes and timing. The Redwood River Basin (a 1,800 km2 basin located in southwest Minnesota) is an example of such a system where a considerable switch from small grains to row crops has taken place since 1970's, driving intensive tile installation culminating in a doubling of tiled length in the past two decades. Long-term hydrologic analysis of this basin shows that the daily streamflow has increased in all months after the land-use change period, and rising limbs of daily hydrographs exhibit increased dependence on precipitation during May-June. In this study we employ the recently developed theory of time-variant travel time distributions within the storage selection function framework to examine the interplay of climate and land-use change on transport dynamics. Comparison of two periods representing the tiled and untiled conditions demonstrates 18-38 days decrease in the mean travel time due to tile drainage during spring-summer, while almost no change is observed during winter showing an overall cyclic behavior over a year. Statistics of the marginal distributions also show less variability in the mean travel time for the tiled period, probably revealing the response of the more constrained engineered system. Furthermore, the relative impact of the climate and the spatial heterogeneity of the soil properties on the travel times are investigated via numerical experiments performed on nested sub-basins under untiled condition. The simulations suggest that

  18. ICU重症患者的肠内营养的护理管理%Of Enteral Nutrition in Patients with ICU Intensive Care Management

    Institute of Scientific and Technical Information of China (English)

    徐静

    2015-01-01

    因为重症监护病人代谢状态非常高,有很大概率会发生免疫衰竭和代谢障碍状况,从而增加感染几率,甚至引起细胞功能的损坏。一般情况下这种病人不能自主进食,常选择肠内营养补给办法确保病人摄取营养。针对这种情况,该研究分析了ICU重症病房患者肠内营养护理管理效果。%Because ICU patients’s metabolism is fast, the probability of immune failure and metabolic disorders is high as a result of increasing the risk of infection and even lead to the damage of cellular function. Generally speaking,patients can-not eat independently,so we can choose enteral nutrition supply method to ensure their nutrition intake ability. According to this situation, this thesis analyzes the effect of enteral nutrition for ICU patients of nursing management.

  19. Of Enteral Nutrition in Patients with ICU Intensive Care Management%ICU重症患者的肠内营养的护理管理

    Institute of Scientific and Technical Information of China (English)

    徐静

    2015-01-01

    因为重症监护病人代谢状态非常高,有很大概率会发生免疫衰竭和代谢障碍状况,从而增加感染几率,甚至引起细胞功能的损坏。一般情况下这种病人不能自主进食,常选择肠内营养补给办法确保病人摄取营养。针对这种情况,该研究分析了ICU重症病房患者肠内营养护理管理效果。%Because ICU patients’s metabolism is fast, the probability of immune failure and metabolic disorders is high as a result of increasing the risk of infection and even lead to the damage of cellular function. Generally speaking,patients can-not eat independently,so we can choose enteral nutrition supply method to ensure their nutrition intake ability. According to this situation, this thesis analyzes the effect of enteral nutrition for ICU patients of nursing management.

  20. 大检修模式下检修集约化管理实践%Maintenance Intensive Management Practice in Overhaul Mode

    Institute of Scientific and Technical Information of China (English)

    王华胜

    2015-01-01

    To adapt to the requirements of high maintenance mode,Jinan Steel’s maintenance engineering company have improved the effective amount of work performance evaluation mechanism, established personal management mechanism for staff who possess skills for many needs on a position, strengthened technical training, and realized cross sharing on resources. The effective implementation of these measures, have improved the work efficiency of maintenance staff, guaranteed the development routine of cross regional work.%济钢检修工程公司为适应大检修模式要求,完善了有效工时量绩效考核机制,制定一岗多能用人办法,加强技术培训,实现跨区资源共享,这些措施的有效实施,提高了检修职工的工作效率,保证了日常跨区作业的开展。

  1. 浅析“三集五大”体系下县级供电企业管理工作的探讨%Management of County-level Power Supply Enterprise under the"Three-Intensive Management and Five-Large Scale Development"System

    Institute of Scientific and Technical Information of China (English)

    张曙光

    2013-01-01

    China State Grid Corp vigorously promotes the"new countryside, new power, new service"development strategy and"Three-Intensive Management and Five-Large Scale Development"key work, which requires grass-roots power supply company to innovate the new mechanism of rural power management. Many power companies constructed the new mechanism of rural power management from new management idea, standard construction, training management, special rectification and performance management in view of the reality, and had achieved obvious effects through practical application. "Three-Intensive Management and Five-Large Scale Development" is put forward in the company's development strategy, and it implements two changes: changing the mode of enterprise development, changing the mode of power grid development. According to the requirements of group operation, intensive development, lean management, and standardization construction, they should implement the intensive management to human resources, financial, and materials, and construct large-scale planning, construction, operation, production, marketing system, and realize the transformation of the development mode of the company, as well as construct strong and smart grid with the backbone of UHV power grid and coordinated development of power at all levels and with informatization, automation, interactive features to realize the transformation of development mode. This paper made analysis on how to carry out the management work of electric power enterprise in the system reform of"Three-Intensive Management and Five-Large Scale Development".%  国家电网公司大力推进“新农村、新电力、新服务”发展战略和“三集五大”重点工作,要求基层供电公司创新农电管理新机制。很多电力公司针对现实情况,从新的管理理念宣贯、标准建设、培训管理、专项整治和绩效管理等五方面初步构建了农电管理新机制,通过实际应用取得了明显的

  2. Weight loss maintenance in African American women: a systematic review of the behavioral lifestyle intervention literature.

    Science.gov (United States)

    Tussing-Humphreys, Lisa M; Fitzgibbon, Marian L; Kong, Angela; Odoms-Young, Angela

    2013-01-01

    We performed a systematic review of the behavioral lifestyle intervention trials conducted in the United States published between 1990 and 2011 that included a maintenance phase of at least six months, to identify intervention features that promote weight loss maintenance in African American women. Seventeen studies met the inclusion criteria. Generally, African American women lost less weight during the intensive weight loss phase and maintained a lower % of their weight loss compared to Caucasian women. The majority of studies failed to describe the specific strategies used in the delivery of the maintenance intervention, adherence to those strategies, and did not incorporate a maintenance phase process evaluation making it difficult to identify intervention characteristics associated with better weight loss maintenance. However, the inclusion of cultural adaptations, particularly in studies with a mixed ethnicity/race sample, resulted in less % weight regain for African American women. Studies with a formal maintenance intervention and weight management as the primary intervention focus reported more positive weight maintenance outcomes for African American women. Nonetheless, our results present both the difficulty in weight loss and maintenance experienced by African American women in behavioral lifestyle interventions.

  3. Sediment Fingerprinting in Intensively Managed Landscapes: Application of an Enhanced Bayesian Un-mixing Framework that accounts for Spatiotemporal Heterogeneity to Study Intra-Seasonal Trends in Source Contributions

    Science.gov (United States)

    Abban, B. K.; Papanicolaou, T.; Wilson, C. G.; Abaci, O.; Wacha, K.; Schnoebelen, D. J.; Rhoads, B. L.; Yu, M.

    2015-12-01

    We apply an enhanced revision of a Bayesian un-mixing framework for estimating sediment source contributions to an intensively managed watershed in the US Midwest that is characterized by spatiotemporal heterogeneity. The framework has two key parameters, namely a and b, that account for spatial origin attributes and the time history of sediments delivered to the watershed outlet, respectively. The probabilistic treatment of these parameters incorporates variability in source erosion processes, as well as the delivery times and storage of eroded material within the watershed. Uncertainty in source contribution estimates in our approach is quantified naturally through the use of Markov Chain Monte Carlo simulations for estimating the posterior probability density functions. The studied watershed is the 26 km² South Amana Sub-Watershed located within the Clear Creek Watershed (CCW), IA, which is part of the Critical Zone Observatory for Intensively Managed Landscapes (IML-CZO). Utilizing stable isotopes of C and N, the Bayesian framework predicted trends in mean source contributions and uncertainty that were in agreement with observations from other studies. Terrestrial sources were found to dominate sediment contributions in the earlier stages of the growing season when land cover was small and the hydrologic forcing was large. Instream sources became more dominate during the latter stages when land cover was well-established and more extensive. Also, the effects of spatial heterogeneity and sediment travel time and delivery on uncertainty in sources contribution estimates were adequately captured. The results clearly showed a reduction in uncertainty when watershed connectivity was greatest and considerable amounts of material were delivered to the collection point at the outlet. On-going application of the framework to the Upper Sangamon River Basin (USRB), which also part of the IML-CZO and has distinct features from CCW, is expected to shed more light on the

  4. Update in the Management of Intensive Care Medicine%重症医学治疗措施调整临床研究进展

    Institute of Scientific and Technical Information of China (English)

    刘相德

    2014-01-01

    近年来,新的临床随机试验结果提示,目前重症医学领域应用的一些传统治疗方法需要调整。本文通过收集整理近年来报道的随机临床试验研究结果,归纳了需要调整的一些治疗方法:(1)控制液体输入量对急性呼吸窘迫综合征(ARDS)患者有益。肺动脉插管不再是ARDS的常规应用方法。(2)尽管激素能改善氧合作用,如果ARDS发病14 d以后才开始应用激素治疗,其最终治疗效果不佳。(3)对于机械通气的患者,每日试着终止应用镇静药物,并尽早让患者处于清醒状态,有助于获得良好治疗效果。(4)休克患者大量应用胰岛素可能导致低血糖症,并可能导致多种并发症。(5)对于脓毒症休克患者,激素可能有助于快速逆转休克的恶化,但是对病死率的改善作用仍有争议。(6)垂体后叶素有助于改善休克患者血流动力学,但是与降低病死率无关。(7)与去甲肾上腺素相比,多巴胺对于休克患者心脏的副作用更大。%Findings of recent new clinical trials in critically ill patients indicate that several traditional treatment strategies in critical care need to be modified.The author reviewed recent literatures of clinical trials on critically ill patients and summa-rized as following changes in the practice.(1 )In patients with ARDS,fluid restriction gives better outcomes than a liberal fluid policy.A pulmonary arterial catheter is no longer necessary to be a routine procedure in ARDS.(2)Although cortico-steroids may improve oxygenation,late use of corticosteroids in ARDS patients (>14 days after diagnosis)is not indicated and may increase risk of death.(3)Daily interruption of sedation and early awakening of mechanically ventilated patients is safe and may shorten the length of ventilation.(4)Intensive insulin therapy in shock patient is associated with hypoglycemia and can cause many complications.(5

  5. Gerenciamento de tecnologia em terapia intensiva Gerenciamiento de tecnología en terapia intensiva Management of technology in Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Cátia Romano Madureira

    2000-12-01

    especificaciones técnico- operacionales de los manuales de los equipos.The lives of hospitalized patients depend on diagnostic-therapeutic procedures and on the care provided by the health team. It also depends on the quality and availability of factors such as: physical structure and material and human and financial resources. The need to optimize these resources and re-establish patients' health has brought about the Intensive Care Units (ICU, whose design must consider the physical environment and clinical equipment which are indispensable in health care. Aiming at identifying the level of knowledge of health professionals as to technical and operational information in equipment manuals and the perception of the interviewed professionals in relation to the adequacy of the physical and electrical installations of such units, we conducted a descriptive study in an ICU of a public hospital in Salvador, Brazil. The results show that such installations were considered to be unsuitable for the safe development of activities and that most of the health team members did not know the technical or operational specifications in the equipment manuals.

  6. Self-Management in Pediatric Inflammatory Bowel Disease: A Clinical Report of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

    OpenAIRE

    Hommel, Kevin A.; Greenley, Rachel N.; Maddux, Michele Herzer; Gray, Wendy N.; Mackner, Laura M.

    2013-01-01

    This clinical report aims to review key self-management and adherence issues in pediatric inflammatory bowel disease (IBD) and to provide recommendations for health care providers regarding evidence-based assessment and treatment approaches to promote optimal self-management. Self-management difficulties in the form of nonadherence to treatment regimens are common in pediatric IBD and are influenced by various disease-related, individual, family, and health-professional relationship factors. ...

  7. Management

    OpenAIRE

    2009-01-01

    L’internationalisation des entreprises a fait naître de nouveaux défis managériaux, qu’ils soient notamment d’ordre environnemental ou culturel. Le manuel d’OESTERLE/SCHMID les intègre ici dans une nouvelle approche du management international. Son évolution en tant que discipline d’enseignement et de recherche à part entière, voisine de la gestion d’entreprise (Betriebswirtschaftslehre), est ici traitée par des responsables scientifiques et économiques de haut rang. On découvrira par ailleur...

  8. How Active Are Older Americans?

    Directory of Open Access Journals (Sweden)

    Judy Kruger, PhD

    2007-07-01

    Full Text Available IntroductionRegular physical activity can reduce age-related functional decline, as well people’s risk for chronic diseases such as coronary heart disease, hypertension, colon cancer, and diabetes. The objective of this study was to estimate the level of participation in aerobic, muscle-strengthening, and flexibility activities among Americans aged 50 years or older.MethodsUsing population-based data from the 2001 National Health Interview Survey, we classified qualified respondents (N = 11,969 according to whether they met the activity criteria used in Healthy People 2010 goals for leisure-time participation in regular aerobic physical activity, vigorous-intensity aerobic activity, strength-training activity, and flexibility activity. We also classified respondents according to their level of aerobic activity (i.e., inactive, insufficiently active, and regularly active.ResultsWe estimated that 46.4% of older Americans engaged in no leisure-time aerobic activity; that 26.1% were regularly active (participated in light- to moderate-intensity aerobic activities at least 5 days per week for at least 30 minutes or vigorous-intensity activities at least 3 days per week for at least 20 minutes; that 16.2% participated in vigorous-intensity aerobic activities at least 3 days per week for at least 20 minutes; that 13.7% participated in strength-training activities at least 2 days per week; and that 24.5% participated in flexibility activities at least 1 day per week. Among the 26.1% of older Americans who were regularly active, 30.5% engaged in strengthen-training activities at least 2 days per week. Overall, only 8.2% of older Americans met the criteria for both aerobic and strength-training activity.ConclusionAs of 2001, the percentage of older Americans who met recommended activity levels of physical activity were well below the goals for U.S. adults in Healthy People 2010. Further efforts are needed to encourage older Americans to engage in

  9. Review on the Disillusionment of Gatsby’s American Dream

    Institute of Scientific and Technical Information of China (English)

    王艳丽

    2014-01-01

    As a spokesperson of the Jazz Age, the American famous novelist F· Scott Fitzgerald who published his masterpiece The Great Gatsby in 1925 is recognized as one of the most important novelists in American literature history. With profound meaning, it is considered as a classic novel revealing the ilusory essence of the American dream. By narrating Gatsby's life, the author skilfuly interprets the conflict between the dream and reality as wel as the intense clash of the spiritual desire and substantial desire in real life. And ultimately Gatsby’s destruction in such conflicts is linked with American history, which implies national tragedy of the United States and satirizes ilusion of American dream.

  10. Obesity and African Americans

    Science.gov (United States)

    ... Data > Minority Population Profiles > Black/African American > Obesity Obesity and African Americans African American women have the ... ss6304.pdf [PDF | 3.38MB] HEALTH IMPACT OF OBESITY More than 80 percent of people with type ...

  11. Dengue e dengue hemorrágico: aspectos do manejo na unidade de terapia intensiva Dengue and dengue hemorrhagic fever: management issues in an intensive care unit

    Directory of Open Access Journals (Sweden)

    Sunit Singhi

    2007-05-01

    this review, a literature search was made on Pubmed and on the World Health Organization (WHO and PAHO websites using the terms dengue and dengue shock syndrome. This information was complemented with personal practice. SUMMARY OF THE FINDINGS: Dengue is the most important arthropod-borne viral disease of humans. Its presentation is protean and varies from an undifferentiated viral syndrome to hemorrhagic fever and severe shock. Dengue fever is a self-limiting, nonspecific illness characterized by fever, headache, myalgia, and constitutional symptoms. Its severe forms (hemorrhagic fever and shock syndrome may lead to multisystem involvement and death. Early diagnosis, close monitoring for deterioration and response to treatment are necessary in all cases. WHO has provided a stepwise approach to management that is useful for milder forms and early shock. In the more severe forms aggressive fluid resuscitation and support for failing organs is necessary for the critically ill patient. Research addressing pathophysiological differences between dengue shock and septic shock, choice of fluids, inotropes and techniques of organ support are likely to yield benefits for the critically ill. CONCLUSIONS: There is no specific therapy for dengue infections. Good supportive care may be lifesaving, but ultimately initiatives aimed at vector control and prevention of mosquito bites may provide the greatest benefits.

  12. American Recovery and Reinvestment Act (ARRA) Federal Energy Management Program Technical Assistance Project 282 Renewable Energy Opportunities at Fort Gordon, Georgia

    Energy Technology Data Exchange (ETDEWEB)

    Boyd, Brian K.; Gorrissen, Willy J.; Hand, James R.; Horner, Jacob A.; Orrell, Alice C.; Russo, Bryan J.; Weimar, Mark R.; Williamson, Jennifer L.; Nesse, Ronald J.

    2010-09-30

    This document provides an overview of renewable resource potential at Fort Gordon, based primarily upon analysis of secondary data sources supplemented with limited on-site evaluations. This effort focuses on grid-connected generation of electricity from renewable energy sources and also on ground source heat pumps for heating and cooling buildings. The effort was funded by the American Recovery and Reinvestment Act (ARRA) as follow-on to the 2005 Department of Defense (DoD) Renewables Assessment. The site visit to Fort Gordon took place on March 9, 2010.

  13. Iowa Intensive Archaeological Survey

    Data.gov (United States)

    Iowa State University GIS Support and Research Facility — This shape file contains intensive level archaeological survey areas for the state of Iowa. All intensive Phase I surveys that are submitted to the State Historic...

  14. Sleep in intensive care unit

    DEFF Research Database (Denmark)

    Boyko, Yuliya; Jennum, Poul; Nikolic, Miki;

    2016-01-01

    PURPOSE: To determine if improving intensive care unit (ICU) environment would enhance sleep quality, assessed by polysomnography (PSG), in critically ill mechanically ventilated patients. MATERIALS AND METHODS: Randomized controlled trial, crossover design. The night intervention "quiet routine......" protocol was directed toward improving ICU environment between 10pm and 6am. Noise levels during control and intervention nights were recorded. Patients on mechanical ventilation and able to give consent were eligible for the study. We monitored sleep by PSG.The standard (American Association of Sleep...... Medicine) sleep scoring criteria were insufficient for the assessment of polysomnograms. Modified classification for sleep scoring in critically ill patients, suggested by Watson et al. (Crit Care Med 2013;41:1958-1967), was used. RESULTS: Sound level analysis showed insignificant effect...

  15. The African American Image in American Cinema.

    Science.gov (United States)

    Bourne, St. Clair

    1990-01-01

    Political conditions have influenced the screen images of U.S. cinema, and the images of African Americans have reflected prevailing social stereotypes. The history of African-American representation in films is traced, and it is noted that the tendency to portray African Americans stereotypically has not changed. (SLD)

  16. Historiography, American Theatre, and the First Americans.

    Science.gov (United States)

    Jenkins, Linda Walsh

    American theatre history should include a study of Native American performances, since these performances are rich with "American" symbolic materials such as imagery, symbols, and heraldic visions of animals and landscapes. Indian cultures understood the importance of performance for both the visionary and the community at large. Even the pow-wow…

  17. Intensity modulated proton therapy

    OpenAIRE

    Kooy, H. M.; Grassberger, C

    2015-01-01

    Intensity modulated proton therapy (IMPT) implies the electromagnetic spatial control of well-circumscribed “pencil beams” of protons of variable energy and intensity. Proton pencil beams take advantage of the charged-particle Bragg peak—the characteristic peak of dose at the end of range—combined with the modulation of pencil beam variables to create target-local modulations in dose that achieves the dose objectives. IMPT improves on X-ray intensity modulated beams (intensity modulated radio...

  18. Rainfed intensive crop systems

    DEFF Research Database (Denmark)

    Olesen, Jørgen E

    2014-01-01

    This chapter focuses on the importance of intensive cropping systems in contributing to the world supply of food and feed. The impact of climate change on intensive crop production systems is also discussed.......This chapter focuses on the importance of intensive cropping systems in contributing to the world supply of food and feed. The impact of climate change on intensive crop production systems is also discussed....

  19. American Sammys and French Poilus in the Great War: sport, masculinities and vulnerability.

    Science.gov (United States)

    Terret, Thierry

    2011-01-01

    The violence and duration of fighting throughout the Great War created an intense feeling of vulnerability among the men engaged in battle, which challenged their perception of manliness. When the Americans joined the war in 1917, the balance between the two opposing armies was modified and the psychological crises of French soldiers brought to an end. The confidence shown by the American soldiers and their first successes on the battlefield changed the way the French Poilus perceived their new allies. From scepticism to admiration, Frenchmen's feelings extended beyond the fighting. Indeed, by living with American soldiers in the trenches and camps behind the front, French soldiers discovered a new culture where games and sport played a major role and contributed to building manliness. The Foyers Franco-Americains du Soldat (Franco-American hostels for soldiers) provided an ideal place for the cultural transfer of a model of masculinity from Sammys to Poilus. The foyers were managed by the American YMCA and eventually reached the number of 1,500 in France during the war. These hostels afforded soldiers numerous opportunities to develop cultural and sports practices, by bringing together Americans and Frenchmen. Mainly based on the archives of the American Expeditionary Forces, the YMCA and the French Army, the paper argues that the Foyers du Soldat brought to light a new model of masculinity based on sport, which challenged the Frenchmen's vision. It aims to show the rapid transformation of masculine identity within a context of extreme vulnerability and confirms the changes in representations of men in French society at this time.

  20. 心血管病医院外科ICU护士分层管理体验的质性研究%A qualitative research on the experience of nurse stratified management in surgical intensive care unit in cardiovascular hospital

    Institute of Scientific and Technical Information of China (English)

    薛梅; 李庆印; 石丽; 贾艳; 杨戎

    2013-01-01

    目的 探讨医护人员对外科ICU护士分层管理的体验.方法 采用定性研究方法,对8名从事外科ICU工作的护士长、主任及临床医生进行访谈,并运用Claizzi分析程序进行资料分析.结果 外科ICU护士分层使用模式发挥了管理效能,护理组长任职条件更全面,此模式基本合理,但在普通病区仍不成熟.结论 护士分层使用适用于心血管外科ICU,有利于不同层级护士管理职能的发挥.%Objective To explore the experience of nurse stratified management in surgical intensive care unit (ICU). Methods The qualitative research method was adopted,and 8 experts engaged in surgical ICU,including head nurses,directors and clinical doctors were interviewed. The Claizzi analysis method was employed to analyze the data. Results The nurse stratified model played the management efficiency in surgical ICU. Qualifications of team leaders were more comprehensive. This model was basically reasonable in ICU,but the general ward was still not mature. Conclusion The nurse stratified using is suitable for cardiovascular surgical ICU and in favor of the management functions of nurses in different levels.