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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. 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.

  3. Japanese Management: An American Challenge.

    Science.gov (United States)

    Rehder, Robert R.

    1979-01-01

    In contrast to the American system of management, Japanese management motivates its employees by challenging them with high goals and by providing inhouse training and development opportunities to meet their self-fulfillment needs. (Author/LD)

  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... American lobster fishery in Federal waters. The management actions are based on recommendations to NMFS by... Fishery Management Plan for American Lobster (ISFMP). Two of the three proposed management...

  5. The state of American management.

    Science.gov (United States)

    Wriston, W B

    1990-01-01

    Every year, the president of the United States offers his State of the Union address. Here, from one of the most respected managers in America, is a report on the State of American Management. The state of management, says Walter B. Wriston, is good. Despite the predictions of America's decline, our economy continues to prosper. That is because of this fundamental truth: the United States is the only country in the world that renews itself daily. This is the Age of Pluralism, and U.S. business is based on pluralism. The spirit of the entrepreneur has entered the mainstream of U.S. management, transforming bureaucracy and emphasizing leadership. Today's top executives need to be more like politicians than the number-crunchers of yesterday. At the same time, information is flowing more freely, so corporations are eliminating layers of managers who were really just transmission lines. And top managers are learning to listen to the people who are closest to the work. Everyone today is a knowledge worker. The accelerating pace of knowledge has put a greater premium than ever on talent. Globalization is a big part of this new world. From the manager's viewpoint, globalization means that "you're in a marketplace where you're suddenly waking up with a guy...from a country you're not too sure where it is, who's eating your lunch in your hometown." To understand global competition, managers in large and small companies need broad vision. Finally, to deal with change, U.S. managers must confront some issues at home. For instance, our accounting systems are obsolete, both in companies and in our national accounts.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. 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

  7. American Health Information Management Association

    Science.gov (United States)

    ... Government Corporate & Government Training Signature Partners Sponsorship Exhibitors Advertise With AHIMA Copyright & Permissions RSS LinkedIn Facebook Twitter YouTube Copyright © 2017 by The American Health ...

  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. North American migratory bird management issues

    Science.gov (United States)

    Wilson, M.H.; Ryan, D.A.

    1995-01-01

    As human population and industry have grown in North America, land-use practices have greatly altered the landscape. As a result of this changed landscape, several migratory bird populations have declined in recent years. For waterbirds, there have been several milestones: the 1986 North American Waterfowl Management Plan (NAWMP) and the 1989 North American Wetlands Conservation Act. As a result, the United States and Canada have established 12 habitat and 2 species joint ventures. The primary emphasis of waterfowl management in Canada-U.S. has been land purchase and lease, wetland restoration, and coordination of harvest rates. Because of its different biological and cultural context, Mexico has established other conservation priorities. Mexico has had a long-standing concern to conserve its biodiversity and, in addition, conservation of Mexican resources goes hand in hand with human community development. Unlike Canada-U.S., wetland conservation projects in'Mexico include information gathering, environmental education, and management planning for its 32 priority wetlands. For migratory landbirds' scientists attribute declines in several migrant populations to forest fragmentation on the breeding grounds, deforestation on the wintering grounds, pesticide poisoning, or the cumulative effects of habitat changes. In 1990, the Neotropical Migratory Bird Conservation Program, commonly known as Partners in Flight-Aves de las Americas-was initiated. The next step that is being proposed is the formation of a habitat conservation plan for landbirds modeled after the NAWMP. Management of migratory birds requires a strong international approach in order to coordinate actions for the benefit of migratory birds, their habitats, and the uses they provide.

  10. 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…

  11. 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.

  12. 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…

  13. Cost-effectiveness of Intensive Blood Pressure Management

    DEFF Research Database (Denmark)

    Richman, Ilana B; Fairley, Michael; Jørgensen, Mads Emil

    2016-01-01

    Importance: Among high-risk patients with hypertension, targeting a systolic blood pressure of 120 mm Hg reduces cardiovascular morbidity and mortality compared with a higher target. However, intensive blood pressure management incurs additional costs from treatment and from adverse events......-effectiveness of intensive blood pressure management among 68-year-old high-risk adults with hypertension but not diabetes. We used the Systolic Blood Pressure Intervention Trial (SPRINT) to estimate treatment effects and adverse event rates. We used Centers for Disease Control and Prevention Life Tables to project age....... Interventions: Treatment of hypertension to a systolic blood pressure goal of 120 mm Hg (intensive management) or 140 mm Hg (standard management). Main Outcomes and Measures: Lifetime costs and quality-adjusted life-years (QALYs), discounted at 3% annually. Results: Standard management yielded 9.6 QALYs...

  14. 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.

  15. Myasthenic crisis patients who require intensive care unit management.

    Science.gov (United States)

    Sakaguchi, Hideya; Yamashita, Satoshi; Hirano, Teruyuki; Nakajima, Makoto; Kimura, En; Maeda, Yasushi; Uchino, Makoto

    2012-09-01

    The purpose of this report was to investigate predictive factors that necessitate intensive care in myasthenic crisis (MC). We retrospectively reviewed MC patients at our institution and compared ICU and ward management groups. Higher MG-ADL scale scores, non-ocular initial symptoms, infection-triggered findings, and higher MGFA classification were observed more frequently in the ICU group. In patients with these prognostic factors, better outcomes may be obtained with early institution of intensive care.

  16. Managing the hair and skin of African American pediatric patients.

    Science.gov (United States)

    Smith, W; Burns, C

    1999-01-01

    In Africa, the ancestral home of most African Americans, hair is viewed as the epitome of beauty. However, when Africans were brought to America as slaves, they were unable to care for their hair and skin adequately and were exposed to the predominant white culture, which valued straight hair and light skin. As a result, many African Americans lost self-esteem because of the characteristics of their hair and skin. In this article we examine the anatomic and physiologic features of African American hair and skin and typical African American hair and skin care practices. Common African American hair and skin disorders and their management are discussed. The goal of this article is to help primary care providers understand the special hair and skin care required for African American children (as well as other dark-skinned patients). With good patient education, understanding one's own hair and skin characteristics can also support positive self-esteem.

  17. 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.

  18. 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.

  19. 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

  20. 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

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

    Directory of Open Access Journals (Sweden)

    Jana S Petermann

    Full Text Available 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

  2. 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

  3. 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.

  4. 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)

  5. 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

  6. College and University Planning. Report on a Joint Study by Colgate University and American Foundation for Management Research.

    Science.gov (United States)

    Smith, Robert G.

    In an effort to develop a new approach to comprehensive college and university planning, Colgate University and the American Foundation for Management Research (AFMR) undertook a joint study that involved (1) an intensive investigation of planning practices at selected colleges and universities, (2) a review of the available literature on…

  7. 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.

  8. 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.

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

    OpenAIRE

    David P Dolowitz

    2015-01-01

    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...

  10. Severe ovarian hyperstimulation syndrome: Intensive care management of two cases

    Directory of Open Access Journals (Sweden)

    Praveen Talawar

    2011-01-01

    Full Text Available Severe ovarian hyperstimulation syndrome (OHSS is characterized by increased capillary permeability and fluid retention in the third space. It is generally a complication of assisted reproduction therapy (ART with exogenous gonadotropins, but cases with natural onset of OHSS have been reported. The massive extravascular exudation can cause tense ascites, pleural and pericardial effusion, hypovolemic shock, oliguria, electrolyte imbalance (hyponatremia and hyperkalemia, and hemoconcentration, with a tendency for hypercoagulability and risk of life-threatening thromboembolic complications. The patient can rarely develop multi-organ failure (adult respiratory distress syndrome, renal failure and death. With increasing use of ART, this syndrome may be seen more frequently in the intensive care unit (ICU, requiring multidisciplinary care. We report the management of two cases of severe OHSS, which required admission to the ICU in our hospital.

  11. 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.

  12. 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.

  13. 78 FR 35217 - Atlantic Coastal Fisheries Cooperative Management Act Provisions; American Lobster Fishery

    Science.gov (United States)

    2013-06-12

    ... Cooperative Management Act Provisions; American Lobster Fishery AGENCY: National Marine Fisheries Service... for comments. SUMMARY: NMFS proposes new Federal American lobster regulations that would control lobster trap fishing effort by limiting access into the lobster trap fishery in Lobster...

  14. Position of the American Dietetic Association: weight management.

    Science.gov (United States)

    Seagle, Helen M; Strain, Gladys Witt; Makris, Angela; Reeves, Rebecca S

    2009-02-01

    It is the position of the American Dietetic Association that successful weight management to improve overall health for adults requires a lifelong commitment to healthful lifestyle behaviors emphasizing sustainable and enjoyable eating practices and daily physical activity. Given the increasing incidence of overweight and obesity along with the escalating health care costs associated with weight-related illnesses, health care providers must discover how to effectively treat this complex condition. Food and nutrition professionals should stay current and skilled in weight management to assist clients in preventing weight gain, optimizing individual weight loss interventions, and achieving long-term weight loss maintenance. Using the American Dietetic Association's Evidence Analysis Process and Evidence Analysis Library, this position paper presents the current data and recommendations for weight management. The evidence supporting the value of portion control, eating frequency, meal replacements, and very-low-energy diets are discussed as well as physical activity, behavior therapy, pharmacotherapy, and surgery. Public policy changes to create environments that can assist all populations to achieve and sustain healthful lifestyle behaviors are also reviewed.

  15. 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.

  16. 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

  17. High-intensity interval training vs. moderate-intensity continuous training in the prevention/management of cardiovascular disease

    OpenAIRE

    S Hussain; Macaluso, A; Pearson, S.

    2016-01-01

    Moderate-intensity continuous training (MICT) has long been considered the most effective exercise treatment modality for the prevention and management of cardiovascular disease, but more recently high-intensity interval training (HIIT) has emerged into the clinical environment has been viewed as a potential alternative to MICT in accruing such benefits. HIIT was initially found to induce significant improvements in numerous physiological and health-related indices, to a similar if not superi...

  18. Knowledge intensive organisations: on the frontiers of knowledge management: Guest editorial

    NARCIS (Netherlands)

    Millar, Carla C.J.M.; Lockett, Martin; Mahon, John F.

    2016-01-01

    Purpose This paper aims to further research on leadership and knowledge management through formal knowledge strategies in knowledge-intensive organizations (KIOs), and analyse knowledge management challenges and approaches within KIOs, especially tacit knowledge. Design/methodology/approach This pa

  19. 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.

  20. 76 FR 71501 - Atlantic Coastal Fisheries Cooperative Management Act Provisions; American Lobster Fishery

    Science.gov (United States)

    2011-11-18

    ... Cooperative Management Act Provisions; American Lobster Fishery AGENCY: National Marine Fisheries Service... for comments. SUMMARY: NMFS proposes new Federal American lobster regulations that would limit entry into the lobster trap fishery in Lobster Conservation Management Area 1 (Federal inshore waters-Gulf...

  1. 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.

  2. 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.

  3. Anaesthetic and Intensive Care Management of Traumatic Cervical Spine Injury

    Directory of Open Access Journals (Sweden)

    G S Umamaheswara Rao

    2008-01-01

    Full Text Available Trauma to the cervical spine may have devastating consequences. Timely interventions are essential to prevent avoidable neurological deterioration. In the initial stabilization of patients with acute cervical spine injuries, physiological disturbances, especially those involving cardiac and respiratory function require careful attention. Early surgery, which facilitates rapid mobi-lization of the patient, is fraught with important management considerations in the intraopoerative period and the subsequent critical care. Airway management poses a crucial challenge at this stage. Those patients who survive the injury with quadriplegia or quadriparesis may present themselves for incidental surgical procedures. Chronic systemic manifestations in these patients require attention in providing anaesthesia and postoperative care at this stage. The current review provides an insight into the physiological disturbances and the management issues in both acute and chronic phases of traumatic cervical spine injury.

  4. 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.

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

    Science.gov (United States)

    Boichenko, Maryna

    2015-01-01

    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,…

  6. 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.

  7. 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.

  8. 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

  9. 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.

  10. 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

  11. Development of a Faith-Based Stress Management Intervention in a Rural African American Community

    Science.gov (United States)

    Bryant, Keneshia; Moore, Todd; Willis, Nathaniel; Hadden, Kristie

    2017-01-01

    Background Faith-based mental health interventions developed and implemented using a community-based participatory research (CBPR) approach hold promise for reaching rural African Americans and addressing health disparities. Objectives To describe the development, challenges, and lessons learned from the Trinity Life Management, a faith-based stress management intervention in a rural African American faith community. Methods The researchers used a CBPR approach by partnering with the African American faith community to develop a stress management intervention. Development strategies include working with key informants, focus groups, and a community advisory board (CAB). Results The community identified the key concepts that should be included in a stress management intervention. Conclusions The faith-based “Trinity Life Management” stress management intervention was developed collaboratively by a CAB and an academic research team. The intervention includes stress management techniques that incorporate Biblical principles and information about the stress–distress–depression continuum. PMID:26548794

  12. 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…

  13. 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.

  14. High-Intensity Interval Training Versus Moderate-Intensity Continuous Training in the Prevention/Management of Cardiovascular Disease.

    Science.gov (United States)

    Hussain, Syed R; Macaluso, Andrea; Pearson, Stephen J

    Moderate-intensity continuous training (MICT) has long been considered the most effective exercise treatment modality for the prevention and management of cardiovascular disease (CVD), but more recently high-intensity interval training (HIIT) has been viewed as a potential alternative to MICT in accruing such benefits. HIIT was initially found to induce significant improvements in numerous physiological and health-related indices, to a similar if not superior extent to MICT. Since then, many studies have attempted to explore the potential clinical utility of HIIT, relative to MICT, with respect to treating numerous cardiovascular conditions, such as coronary artery disease, heart failure, stroke, and hypertension. Despite this, however, the efficacy of HIIT in reversing the specific symptoms and risk factors of these cardiovascular pathologies is not well understood. HIIT is often perceived as very strenuous, which could render it unsafe for those at risk of or afflicted with CVD, but these issues are also yet to be reviewed. Furthermore, the optimal HIIT protocol for each of the CVD cohorts has not been established. Thus, the purpose of this review article is to (1) evaluate the efficacy of HIIT relative to MICT in the prevention and management of cardiovascular conditions, and (2) explore any potential safety issues surrounding the suitability and/or tolerability of HIIT for patients with CVD, and the potential optimal prescriptive variables of HIIT for application in the clinical environment.

  15. 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…

  16. 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.

  17. What follows survival of critical illness? Physical therapists' management of patients with post-intensive care syndrome.

    Science.gov (United States)

    Bemis-Dougherty, Anita R; Smith, James M

    2013-02-01

    Historically, the management of patients in the intensive care unit (ICU) has involved immobilization and sedation, with care focused on physiological impairments and survival. Because more ICU patients are now surviving their hospital stay, it is imperative that their ICU care be managed with the goal of long-term health, wellness, and functioning. The evidence confirms that mobilization and exercise are feasible in the ICU and demonstrates that the benefits of early mobilization include reduced length of stay in the ICU and hospital. In 2010, the Society of Critical Care Medicine (SCCM) invited key stakeholder groups, including the American Physical Therapy Association (APTA), to identify strategies to improve long-term consequences following ICU discharge, including early mobilization in the ICU and integration of the physical therapist as a member of the ICU team. This model appears to be successful in some institutions, but there is variation among institutions. The SCCM Task Force developed major areas of focus that require multidisciplinary action to improve long-term outcomes after discharge from an ICU. This article describes physical therapist practice in the management of ICU survivors, the importance of long-term follow-up after ICU discharge, and how APTA is taking steps to address the major areas of focus identified by the SCCM Task Force to improve long-term outcomes after ICU discharge.

  18. Hispanic American Psychocultural Dispositions Relevant to Personnel Management.

    Science.gov (United States)

    1984-07-01

    AD-A144 16 HISPANIC AMERICAN PSYCHOCULTURAL DISPOSITIOS RELEVANT 3 TO PERSONNEL MANAGEMEN(U) INSTIAUE AF COMPARATISE SOCIAL AND CULTURA STADIES INC...girlfriend/amiga the Armed Forces/Fuerza Armadas travel/viajar GOALS GOVERNMENT need/necesidad flat lon/nac ton want/desear society/ sociedad life goals/metas

  19. 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.

  20. Social Relation between Businessman and Community in Management of Intensive Shrimp Pond

    Science.gov (United States)

    Gumay Febryano, Indra; Sinurat, James; Lovinia Salampessy, Messalina

    2017-02-01

    Expansion of aquaculture, especially shrimp culture, is the primary cause of deforestation of mangrove along coastal zone. This phenomenon is pretty much related to social relation between businessman of intensive shrimp pond and community around coastal zone. The objective of this research is to explain social relation between businessman and community in managing intensive shrimp pond. This research is a kind of qualitative research and the method used is a case study. The result of this research shows that the behaviour of the majority of businessman of intensive shrimp pond is not accordingly with environmental concerns as they compelled conversion of mangrove and they disposed waste of shrimp pond into the sea. Such kind of behaviour caused degradation of water ecosystem and marginalizing local community. Corporate Social Responsibility (CSR) which was implemented by businessman of intensive shrimp pond in the area of social, religion, and education can downgrade the coming up of social turbulence. Otherwise, CSR in enabling economic community and environmental management was not conducted yet. CSR in environmental management can be conducted by businessman of intensive shrimp pond by considering the existence of mangrove and pond management and waste in a better way, so that environment around ponds is not polluted and the sustainability of shrimp pond business as well as income of community can be guaranteed. Accordingly with the result of this research, CSR is not only involving businessman of intensive shrimp pond and community, but also involving local government in terms of right and responsibility of citizen as well as management and development of community.

  1. 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...

  2. Management risk factors for calf mortality in intensive Italian dairy farms

    OpenAIRE

    2013-01-01

    High calf mortality is an important factor of economic loss in dairy production. At present, limited data are available on calf rearing practices and calf mortality in Italian dairy farming. The aim of the study was to identify the most important management risk factors for preweaning calf mortality in Italian dairy farms. A group of 28 intensive dairy farms from Lombardy (Italy) were visited to collect information about calf management and calf mortality. Female calf mortality showed high va...

  3. Variation in pupil diameter in North American Gartersnakes (Thamnophis) is regulated by immersion in water, not by light intensity.

    Science.gov (United States)

    Fontenot, Clifford L

    2008-07-01

    A variable pupil generally regulates the amount of incoming light available for image formation on the retina. However, some of the semi-aquatic snakes (North American Gartersnakes, Thamnophis) that forage in relatively low light conditions reduce the pupil aperture in response to submergence underwater at the expense incoming light. Given that these snakes have all-cone retinas, reduction of incoming light because of pupillary constriction upon immersion seems counterintuitive. To test the effect of light and water on pupil aperture, three species of North American Gartersnakes (T. atratus, T. hammondii, and T. sirtalis) were exposed to nine light intensities in air and water. There was no effect of light on relative pupil aperture for any species. However, all three species showed a significant reduction in pupil aperture upon submergence underwater. The lack of a light response is surprising, and may be related to the method of accommodation in snakes. Snakes lack a ciliary muscle, and move the lens by constricting the pupil, which increases pressure in the posterior chamber and pushes the lens forward. Upon submergence, the snakes may be attempting to overcome the change in refractive index and defocus imposed by the water, by constricting the pupil. Thus, having the iris muscle involved in accommodation may preclude it from much of a light regulating function.

  4. Cultural and Family Challenges to Managing Type 2 Diabetes in Immigrant Chinese Americans

    OpenAIRE

    2009-01-01

    OBJECTIVE Although Asians demonstrate elevated levels of type 2 diabetes, little attention has been directed to their unique cultural beliefs and practices regarding diabetes. We describe cultural and family challenges to illness management in foreign-born Chinese American patients with type 2 diabetes and their spouses. RESEARCH DESIGN AND METHODS This was an interpretive comparative interview study with 20 foreign-born Chinese American couples (n = 40) living with type 2 diabetes. Multiple ...

  5. Innovative solutions: sample financial management business plan: neurosurgical intensive care unit.

    Science.gov (United States)

    Villanueva-Baldonado, Analiza; Barrett-Sheridan, Shirley E

    2010-01-01

    This article describes one institution's intention to implement a financial management business plan for a neurosurgical intensive care unit in a level I trauma center. The financial objective of this proposed business plan includes a service increase in the patient population requiring critical care in a way that will help control costs.

  6. 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.

  7. 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...

  8. 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…

  9. 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

  10. Success factors of energy management in energy-intensive industries. Energy performance measurement

    Energy Technology Data Exchange (ETDEWEB)

    Sivill, L.

    2011-10-15

    This thesis explores energy performance measurement in support of energy management in the energy-intensive industries. In general, performance measurement is used in management for raising awareness, evaluating performance, setting targets and offering decision support. These purposes also apply to energy management, defined here as the management of all activities related to the economic and responsible use of energy in an organisation. This thesis answers the following three questions: 1) what is the concept of energy performance in a business organisation? 2) what is the importance of energy performance measurement to energy management in the energy-intensive industries? and 3) what are the subsequent needs for future research and development? A variety of methods are used, ranging from qualitative research to the modelling of energy systems and case demonstrations. The findings indicate that energy management should focus on improving energy performance, not energy efficiency, because this broader view is able to capture both the operational and strategic perspectives of energy management. This is in line with the trends of managerial integration and the adoption of sustainable development into management practice. The domain of energy performance indicators should entail organisational, systemic and temporal dimensions. From the perspective of operational management, performance measurement should address all the three means to improve energy performance, namely technology, operation and process integration. In addition to the operational management, future research and development should define the role of energy performance measurement in all the other management functions. These recommendations provide a wide spectrum of opportunities for the development of energy performance indicators, energy performance measurement systems and their underlying deployment processes in different industrial sectors, organisations and systems. (orig.)

  11. Grand challenges in the management and conservation of North American inland fishes and fisheries

    Science.gov (United States)

    Lynch, Abigail; Cooke, Steven J.; Beard, Douglas; Kao, Yu-Chun; Lorenzen, Kai; Song, Andrew M.; Allen, Micheal S.; Basher, Zeenatul; Bunnell, David; Camp, Edward V.; Cowx, Ian G.; Freedman, Jonathan A.; Nguyen, Vivian M.; Nohner, Joel K.; Rogers, Mark W.; Siders, Zachary A.; Taylor, William W.; Youn, So-Jung

    2017-01-01

    Even with long-standing management and extensive science support, North American inland fish and fisheries still face many conservation and management challenges. We used a grand challenges approach to identify critical roadblocks that if removed would help solve important problems in the management and long-term conservation of North American inland fish and fisheries. We identified seven grand challenges within three themes (valuation, governance, and externalities) and 34 research needs and management actions. The major themes identified are to (1) raise awareness of diverse values associated with inland fish and fisheries, (2) govern inland fish and fisheries to satisfy multiple use and conservation objectives, and (3) ensure productive inland fisheries given nonfishing sector externalities. Addressing these grand challenges will help the broader community understand the diverse values of inland fish and fisheries, promote open forums for engagement of diverse stakeholders in fisheries management, and better integrate the inland fish sector into the greater water and land use policy process.

  12. The American Oystercatcher (Haematopus palliatus) Working Group: 15 years of collaborative focal species research and management

    Science.gov (United States)

    Simons, Theodore R.

    2017-01-01

    The American Oystercatcher (Haematopus palliatus) Working Group formed spontaneously in 2001 as coastal waterbird biologists recognized the potential for American Oystercatchers to serve as focal species for collaborative research and management. Accomplishments over the past 15 years include the establishment of rangewide surveys, color-banding protocols, mark-resight studies, a revision of the Birds of North America species account, and new mechanisms for sharing ideas and data. Collaborations among State, Federal, and private sector scientists, natural resource managers, and dedicated volunteers have provided insights into the biology and conservation of American Oystercatchers in the United States and abroad that would not have been possible without the relationships formed through the Working Group. These accomplishments illustrate how broad collaborative approaches and the engagement of the public are key elements of effective shorebird conservation programs.

  13. [Effects of intensive management on abundance and composition of soil N2-fixing bacteria in Phyllostachys heterocycla stands].

    Science.gov (United States)

    He, Dong-hua; Chen, Jun-hui; Xu, Qiu-fang; Shen, Qiu-lan; Li, Yong-chun; Mao, Xin-wei; Cheng, Min

    2015-10-01

    Denaturing gradient-gel electrophoresis and real-time quantitative PCR (qPCR) were employed to determine the effects of intensive management on soil N2-fixing bacteria in a moso bamboo (Phyllostachys heterocycla) plantation. Soil samples were collected from the moso bamboo stands receiving 0 (CK), 10, 15, 20, and 25 years of intensive management. It was found that intensive management caused a strong decrease in soil pH but a general increase in soil available nutrients. The structure of the N2-fixing bacterial communities in the soils having received 10 and 25 years of intensive management were quite similar to that from the CK; however, those from 15 and 20 years of intensification differed from the CK. With increasing time of intensive management, the abundance and diversity of the nifH gene at first decreased and then increased, with the minimum values being observed after 15 years of intensive management, indicating the eventual resiliency of N2-fixing bacteria to disturbance induced by intensive management. Redundancy analysis indicated that soil available potassium, available nitrogen, nitrite nitrogen, and ammonium nitrogen were more closely related to the changes of N2-fixing bacterial community structure compared with the other soil indices measured. In conclusion, the soil N2-fixing bacterial community was negatively affected by intensive management in the short term, but could recover in the long term.

  14. [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.

  15. 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…

  16. 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.

  17. Endangered Species and North American Waterfowl Management Plan Joint Venture Areas,

    Science.gov (United States)

    1996-10-01

    Recovery Plans that meet the recovery plan requirements; and the percent of Corps acreage included within North American Waterfowl Management Joint ... Venture Implementation Plans where proposed work has been accomplished. This report seeks to provide this information. In summary, the Corps has

  18. 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…

  19. Climate Change and Interacting Stressors: Implications for Coral Reef Management in American Samoa (Final Report)

    Science.gov (United States)

    EPA announced the release of the final document, Climate Change and Interacting Stressors: Implications for Coral Reef Management in American Samoa. This report provides a synthesis of information on the interactive effects of climate change and other stressors on the reef...

  20. Adherence to a multi-component weight management program for Mexican American adolescents

    Science.gov (United States)

    This study examined weight loss among Mexican American students in a weight management program. A total of 358 participants completed a 12-week intervention that incorporated four program components: nutrition education (NE), physical activity (PA), sedentary behavior (SB), and a snacking interventi...

  1. Environmental management and labour productivity: The moderating role of capital intensity.

    Science.gov (United States)

    Lannelongue, Gustavo; Gonzalez-Benito, Javier; Quiroz, Idaisa

    2017-04-01

    Recent years have seen firms improve their environmental practices, although the question still remains as to whether or not investing in such practices is or is not beneficial or simply a matter of image. This study focuses on labour productivity as a measure of performance, and we argue that the impact of greater environmental performance on that productivity is moderated by capital intensity. A sample of 2823 plants provides empirical evidence to support our approach. Specifically, the analyses, making use of estimates based on multiple regression models, reveal that environmental management has a positive impact on labour productivity in organisations with low capital intensity, although that impact becomes negative in cases of high capital intensity.

  2. 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.

  3. Comments on the proposed intensive forest management in the temperate coniferous forests

    Energy Technology Data Exchange (ETDEWEB)

    Khan, A.A.

    1979-01-01

    Intensive forest management is being introduced in the moist temperate forests of the Kaghan Valley, N. Pakistan, based on a combination of a shelterwood system with clear felling of trees down to an advanced growth of up to 12 inches, with artificial regeneration, mainly by planting of Cedrus deodara and Pinus wallichiana. Possible adverse effects of the proposed system (e.g. leaching of soil nutrients following clear felling) are briefly discussed. A more cautious approach, employing natural regeneration, is recommended.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. Management intensity and vegetation complexity affect web-building spiders and their prey.

    Science.gov (United States)

    Diehl, Eva; Mader, Viktoria L; Wolters, Volkmar; Birkhofer, Klaus

    2013-10-01

    Agricultural management and vegetation complexity affect arthropod diversity and may alter trophic interactions between predators and their prey. Web-building spiders are abundant generalist predators and important natural enemies of pests. We analyzed how management intensity (tillage, cutting of the vegetation, grazing by cattle, and synthetic and organic inputs) and vegetation complexity (plant species richness, vegetation height, coverage, and density) affect rarefied richness and composition of web-building spiders and their prey with respect to prey availability and aphid predation in 12 habitats, ranging from an uncut fallow to a conventionally managed maize field. Spiders and prey from webs were collected manually and the potential prey were quantified using sticky traps. The species richness of web-building spiders and the order richness of prey increased with plant diversity and vegetation coverage. Prey order richness was lower at tilled compared to no-till sites. Hemipterans (primarily aphids) were overrepresented, while dipterans, hymenopterans, and thysanopterans were underrepresented in webs compared to sticky traps. The per spider capture efficiency for aphids was higher at tilled than at no-till sites and decreased with vegetation complexity. After accounting for local densities, 1.8 times more aphids were captured at uncut compared to cut sites. Our results emphasize the functional role of web-building spiders in aphid predation, but suggest negative effects of cutting or harvesting. We conclude that reduced management intensity and increased vegetation complexity help to conserve local invertebrate diversity, and that web-building spiders at sites under low management intensity (e.g., semi-natural habitats) contribute to aphid suppression at the landscape scale.

  9. The Challenges of Providing Effective Pain Management for Children in the Pediatric Intensive Care Unit.

    Science.gov (United States)

    Ismail, Ahmad

    2016-12-01

    Providing effective pain management is necessary for all patients in the intensive care unit (ICU). Because of developmental considerations, caring for children may provide additional challenges. The purpose of this literature review is to describe key challenges in providing effective pain management in pediatric intensive care units (PICUs), with the aim of bringing about a better understanding by health care providers caring for children. Challenges of providing effective pain management in the PICU can be categorized into four levels. These levels are informed by the Nursing Pain Management Model and include challenges (1) to be considered before pain assessment, (2) related to pain assessment, (3) related to pain treatment, and (4) related to post-treatment. This review mainly discusses the challenges of the first three levels because the fourth (post-treatment) relates to reassessment of pain, which shares the same challenges of level two, pain assessment. Key challenges of level one are related to health care provider's characteristics, patients and their families' factors, and PICU setting. The main challenges of the assessment and reassessment levels are the child's age and developmental level, ability to self-report, relying on behavioral and physiological indicators of pain, selecting the appropriate pain assessment scale, assessing pain while the patient is being treated with sedative and paralytic agents, mechanical ventilation, and changes in patients' level of consciousness. In the treatment level (level three), nonpharmacological interventions factors; alterations in the pharmacokinetics and pharmacodynamics of medications to be used for pain management in critically ill children; and the complexity of the administration of sedatives, analgesics, and paralytic agents in critically ill children are the main challenges. Health care providers can bear in mind such important challenges in order to provide effective pain management. Health care providers

  10. 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.

  11. 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.

  12. A systematic review of intensive cardiopulmonary management after spinal cord injury.

    Science.gov (United States)

    Casha, Steven; Christie, Sean

    2011-08-01

    Intensive cardiopulmonary management is frequently undertaken in patients with spinal cord injury (SCI), particularly due to the occurrence of neurogenic shock and ventilatory insufficiency and in an attempt to reduce secondary injury. We undertook a systematic review of the literature to examine the evidence that intensive care management improves outcome after SCI and to attempt to define key parameters for cardiopulmonary support/resuscitation. We review the literature in five areas: management of SCI patients in specialized centers, risk in SCI patients of cardiopulmonary complications, parameters for blood pressure and oxygenation/ventilation support following SCI, risk factors for cardiopulmonary insufficiency requiring ICU care after SCI, and preventative strategies to reduce the risks of cardiopulmonary complications in SCI patients. The literature supports that, in light of the significant incidence of cardiorespiratory complications, SCI patients should be managed in a monitored special care unit. There is weak evidence supporting the maintenance of MAP >85 mmHg for a period extending up to 1 week following SCI.

  13. Chinese American Parents' Acculturation and Enculturation, Bicultural Management Difficulty, Depressive Symptoms, and Parenting.

    Science.gov (United States)

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

    2014-12-01

    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 adolescence (407 mothers and 381 fathers at Wave 1; 308 mothers and 281 fathers at Wave 2). For both waves, we examined cross-sectional models encompassing both direct and indirect links from parental cultural orientations to parenting practices. We also used individual fixed-effects techniques to account for selection bias in testing model relationships at Wave 2. At Wave 1, via bicultural management difficulty and depressive symptoms, American orientation was related to less punitive parenting and more inductive reasoning for both parents, and Chinese orientation was related to more punitive parenting and less inductive reasoning for fathers. The findings indicate that bicultural management difficulty and parental depressed mood are important mechanisms to be considered when studying the relation between Chinese American parents' acculturation/enculturation and parenting.

  14. 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.

  15. 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...

  16. Pain prevalence, intensity, assessment and management in a hospitalized pediatric population.

    Science.gov (United States)

    Kozlowski, Lori J; Kost-Byerly, Sabine; Colantuoni, Elizabeth; Thompson, Carol B; Vasquenza, Kelly J; Rothman, Sharon K; Billett, Carol; White, Elizabeth D; Yaster, Myron; Monitto, Constance L

    2014-03-01

    New research, regulatory guidelines, and practice initiatives have improved pain management in infants, children, and adolescents, but obstacles remain. The aim of this study was to identify the prevalence and demographics of pain, as well as pain management practice patterns in hospitalized children in a tertiary-care university hospital. We prospectively collected data including patient demographics, presence/absence and location of pain, pain intensity, pain assessment documentation, analgesic use, side effects of analgesic therapy, and patient/family satisfaction. Two hundred male (58%) and female, medical and surgical (61%) patients, averaging 9 ± 6.2 years were studied. Pain was common (86%) and often moderate to severe (40%). Surgical patients reported pain more frequently when enrolled than did medical patients (99% vs. 65%). Female gender, age ≥ 5 years, and Caucasian race were all associated with higher mean pain scores. Furthermore, females and Caucasian children consumed more opioids than males and non-Caucasians. Identified obstacles to optimal analgesic management include lack of documented physician pain assessment (patient/family dissatisfaction with pain management (2%-7%). The data demonstrated that despite a concentrated focus on improving pain management over the past decade, pain remains common in hospitalized children. Identification of patient populations and characteristics that predispose to increased pain (e.g., female, Caucasian, postoperative patient) as well as obstacles to analgesic management provide a focus for the development of targeted interventions and research to further improve care.

  17. 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.

  18. Critical Zone Services as a Measure for Evaluating the Trade-offs in Intensively Managed Landscapes

    Science.gov (United States)

    Richardson, M.; Kumar, P.

    2015-12-01

    The Critical Zone includes the range of biophysical processes occurring from the top of the vegetation canopy to the weathering zone below the groundwater table. These services (Field et al. 2015) provide a measure to value processes that support the goods and services from our landscapes. In intensively managed landscapes the provisioning and regulating services are being altered through anthropogenic energy inputs so as to derive more agricultural productivity from the landscapes. Land use change and other alterations to the environment result in positive and/or negative net Critical Zone services. Through studies in the Critical Zone Observatory for Intensively Managed Landscapes (IMLCZO), this research seeks to answer questions such as: Are perennial bioenergy crops or annual replaced crops better for the land and surrounding environment? How do we evaluate the products and services from the land for the energy and resources we put in? Before the economic valuation of Critical Zone services, these questions seemed abstract. However, with developments such as Critical Zone services and life cycle assessments, they are more concrete. To evaluate the trade-offs between positive and negative impacts, life cycle assessments are used to create an inventory of all the energy inputs and outputs in a landscape management system. Total energy is computed by summing the mechanical energy used to construct tile drains, fertilizer, and other processes involved in intensely managed landscapes and the chemical energy gained by the production of biofuels from bioenergy crops. A multi-layer canopy model (MLCan) computes soil, water, and nutrient outputs for each crop type, which can be translated into Critical Zone services. These values are then viewed alongside the energy inputs into the system to show the relationship between agricultural practices and their corresponding ecosystem and environmental impacts.

  19. 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.

  20. Pain intensity influences the relationship between anger management style and depression.

    Science.gov (United States)

    Estlander, Ann-Mari; Knaster, Peter; Karlsson, Hasse; Kaprio, Jaakko; Kalso, Eija

    2008-11-30

    There is an abundance of studies concerning depression and pain, while the mechanisms and the relationships of anger expression and pain are less well known. The validity of commonly used depression questionnaires as measures of depression in pain patients has been questioned, as they include items which can be related to the pain problem as well as to signs of depression. The aim of this study was to investigate the relationships between pain severity, various signs of depression, and anger management style. Subjects were 100 consecutive patients referred to the Helsinki University Pain Clinic. Demographic data and pain intensity (VAS) were collected by a questionnaire. Two subscales (negative view and physical function) from the Beck Depression Inventory, and the Anger Expression Scales (Anger-in and Anger-out) from the Spielberg State Trait Anger Expression Inventory 2 were used to assess depression and anger expression, respectively. The results showed that pain severity modulates the relationship between anger expression and physical signs of depression. In patients with more severe pain, the relationships between anger management style, specifically, inhibition of anger and depression were strong, while no such relationships were found in the group of patients with less severe pain. No correlations were found between pain intensity and depression as measured by the sum score of the BDI. However, analysing separately the two subscales of the BDI, negative view and physical function, significant positive relationships between pain intensity and both subscales appeared.

  1. 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.

  2. 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.

  3. 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

  4. 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...... facilitators are important drivers of the change process and that easy-to-use tools are requested from the involved company actors. Given that the interventions in the selected companies are conducted successfully we argue that a new organizational capability to address work-related stress in a collective...... 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...

  5. Theory of Infants' Transition Management from the Neonatal Intensive Care Unit to Home: a Qualitative Study

    Directory of Open Access Journals (Sweden)

    Mahboobeh Namnabati

    2017-01-01

    Full Text Available Background: Infant's transition is a challenge for parents and the health system that requires ongoing assessment and management to improve each newborn`s growth and development. The purpose of this study was to explore the management of infant` transition from neonatal intensive care unit (NICU to home.Materials and Methods: We used a grounded theory study to explore and describe the management of infants’ transition from the NICU to the home. Interviews were conducted with 31 professionals and 20 family members, and participant observations were made in hospitals, clinics, and one physician office. MAXQDA was utilized for coding and categorizing data.Results: The theory illustrated six phenomena: An unexpected separation; A crisis situation; Mother-infant rebonding; Protection of the infant’s health; Promotion of growth and development; and Inadequate management causing disability. Together, these formed a three-phase process consisting of: A threat to the infant's life, Efforts to save the infant's life, and Continuation of life. Conclusion: Development of the theory of  infants transition provides a three phases process ( A threat to the infant’s life, Efforts to save the infant’s life, and Continuation of life, that  can yield   guidelines to  manage  the infant` transition in prevent mother–infant separation, support parents in their role as primary caregivers, and follow up with individual home visits by nurses.

  6. Organic farming and landscape structure: effects on insect-pollinated plant diversity in intensively managed grasslands.

    Science.gov (United States)

    Power, Eileen F; Kelly, Daniel L; Stout, Jane C

    2012-01-01

    Parallel declines in insect-pollinated plants and their pollinators have been reported as a result of agricultural intensification. Intensive arable plant communities have previously been shown to contain higher proportions of self-pollinated plants compared to natural or semi-natural plant communities. Though intensive grasslands are widespread, it is not known whether they show similar patterns to arable systems nor whether local and/or landscape factors are influential. We investigated plant community composition in 10 pairs of organic and conventional dairy farms across Ireland in relation to the local and landscape context. Relationships between plant groups and local factors (farming system, position in field and soil parameters) and landscape factors (e.g. landscape complexity) were investigated. The percentage cover of unimproved grassland was used as an inverse predictor of landscape complexity, as it was negatively correlated with habitat-type diversity. Intensive grasslands (organic and conventional) contained more insect-pollinated forbs than non-insect pollinated forbs. Organic field centres contained more insect-pollinated forbs than conventional field centres. Insect-pollinated forb richness in field edges (but not field centres) increased with increasing landscape complexity (% unimproved grassland) within 1, 3, 4 and 5km radii around sites, whereas non-insect pollinated forb richness was unrelated to landscape complexity. Pollination systems within intensive grassland communities may be different from those in arable systems. Our results indicate that organic management increases plant richness in field centres, but that landscape complexity exerts strong influences in both organic and conventional field edges. Insect-pollinated forb richness, unlike that for non-insect pollinated forbs, showed positive relationships to landscape complexity reflecting what has been documented for bees and other pollinators. The insect-pollinated forbs, their

  7. Brain death and management of a potential organ donor in the intensive care unit.

    Science.gov (United States)

    Youn, Teddy S; Greer, David M

    2014-10-01

    The concept of brain death developed with the advent of mechanical ventilation, and guidelines for determining brain death have been refined over time. Organ donation after brain death is a common source of transplant organs in Western countries. Early identification and notification of organ procurement organizations are essential. Management of potential organ donors must take into consideration specific pathophysiologic changes for medical optimization. Future aims in intensive and neurocritical care medicine must include reducing practice variability in the operational guidelines for brain death determination, as well as improving communication with families about the process of determining brain death.

  8. 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.

  9. 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

    the possibility of maintaining everyday life, which was essential to the patients. The privacy ensured by the home was important to patients, and they accepted the necessary responsibility that came with it. However, time spent together with fellow patients and their relatives was an important and highly valued...... part of their social life. CONCLUSIONS: Approached from the patient perspective, outpatient management provided a motivation for patients as it ensured their presence at home and provided the possibility of taking part in everyday life of the family, despite severe illness and intensive treatment...

  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. Diabetes self-management among Arab Americans: patient and provider perspectives

    OpenAIRE

    Fritz, Heather; DiZazzo-Miller, Rosanne; Bertran, Elizabeth A.; Pociask, Fredrick D.; Tarakji, Sandra; Arnetz, Judith; Lysack, Catherine L.; Jaber, Linda A

    2016-01-01

    Background Arab Americans have a high burden of diabetes and poor outcomes compared to the general U.S. population. Diabetes self-management (DSM) requires a partnership between patients and providers that fosters mutual understanding and shared decision-making. Cultural factors influence this process; however, little is known regarding the cultural impact on DSM or if perceptions differ between patients and providers. Methods Qualitative content analysis was used to analyze five focus groups...

  12. Emerging themes in the ecology and management of North American forests

    OpenAIRE

    Sharik, Terry L.; William Adair; Fred A. Baker; Michael Battaglia; Emily J. Comfort; Anthony W. D'Amato; Craig Delong; R. Justin DeRose; Ducey, Mark J; Mark Harmon; Louise Levy; Jesse A. Logan; Joseph O'Brien; Brian J. Palik; Roberts, Scott D

    2010-01-01

    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 ...

  13. 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].

  14. 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…

  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. Effect of 26 years of intensively managed Carya cathayensis stands on soil organic carbon and fertility.

    Science.gov (United States)

    Wu, Jiasen; Huang, Jianqin; Liu, Dan; Li, Jianwu; Zhang, Jinchi; Wang, Hailong

    2014-01-01

    Chinese hickory (Carya cathayensis), a popular nut food tree species, is mainly distributed in southeastern China. A field study was carried out to investigate the effect of long-term intensive management on fertility of soils under a C. cathayensis forest. Results showed that after 26 years' intensive management, the soil organic carbon (SOC) content of the A and B horizons reduced by 19% and 14%, respectively. The reduced components of SOC are mainly the alkyl C and O-alkyl C, whereas the aromatic C and carbonyl C remain unchanged. The reduction of active organic matter could result in degradation of soil fertility. The pH value of soil in the A horizon had dropped by 0.7 units on average. The concentrations of the major nutrients also showed a decreasing trend. On average the concentrations of total nitrogen (N), phosphorus (P), and potassium (K) of tested soils dropped by 21.8%, 7.6%, and 13.6%, respectively, in the A horizon. To sustain the soil fertility and C. cathayensis production, it is recommended that more organic fertilizers (manures) should be used together with chemical fertilizers. Lime should also be applied to reduce soil acidity.

  17. 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.

  18. 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...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    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

  1. Promoting diabetes self-management among African Americans: an educational intervention.

    Science.gov (United States)

    Walker, Eleanor A; Stevens, Karen A; Persaud, Sabita

    2010-08-01

    Diabetes is a major national health problem that affects African Americans more seriously than other population groups. The purpose of this project was to increase knowledge and self-management of diabetes among African American adults 40 years of age and older diagnosed with type II diabetes. A quasi-experimental pre-test/post-test comparison group design was used. Three educational sessions were provided to participants in the intervention group. Content included information about diabetes and its complications, risk factors, proper diet, recommendations for exercise, medications, and monitoring blood glucose. Teaching strategies included discussion, games, and demonstrations. Patient navigators provided follow-up by phone at the scheduled intervals. Preliminary results indicated significantly increased knowledge among intervention group participants between the pre- and post-test and the pre-test and follow-up. Findings for HbA1c values, body mass index, and weight were not significant.

  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. 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...... admissions per year were included in this analysis. Results Use of heel blood sampling appeared widespread. Most units in the Netherlands, UK, Denmark, Sweden and France predominantly adopted mechanical devices, while manual lance was still in use in the other countries. The two Scandinavian countries...... and France were the most likely, and Belgium and Spain the least likely to employ recommended combinations of evidence-based pain management measures. Conclusions Heel puncture is a common procedure in preterm neonates, but pain appears inadequately treated in many units and countries. Better compliance...

  4. An intensely sympathetic awareness: experiential similarity and cultural norms as means for gaining older African Americans' trust of scientific research.

    Science.gov (United States)

    Sabir, Myra G; Pillemer, Karl A

    2014-04-01

    Well-known trust-building methods are routinely used to recruit and retain older African Americans into scientific research studies, yet the quandary over how to overcome this group's hesitance to participate in research remains. We present two innovative and testable methods for resolving the dilemma around increasing older African Americans' participation in scientific research studies. Certain specific and meaningful experiential similarities between the primary researcher and the participants, as well as clear recognition of the elders' worth and dignity, improved older African Americans' willingness to adhere to a rigorous research design. Steps taken in an intervention study produced a potentially replicable strategy for achieving strong results in recruitment, retention and engagement of this population over three waves of assessment. Sixty-two (n=62) older African Americans were randomized to treatment and control conditions of a reminiscence intervention. Sensitivity to an African American cultural form of respect for elders (recognition of worth and dignity), and intersections between the lived experience of the researcher and participants helped dispel this population's well-documented distrust of scientific research. Results suggest that intentional efforts to honor the worth and dignity of elders through high level hospitality and highlighting meaningful experiential similarities between the researcher and the participants can improve recruitment and retention results. Experiential similarities, in particular, may prove more useful to recruitment and retention than structural similarities such as age, race, or gender, which may not in themselves result in the trust experiential similarities elicit.

  5. Intensive care management of head injury patients without routine intracranial pressure monitoring

    Directory of Open Access Journals (Sweden)

    Santhanam R

    2007-01-01

    Full Text Available Background: Head injury contributes significantly to mortality and morbidity in India. Evaluation of the available trauma care facilities may help improve outcome. Aim: To evaluate the factors influencing the mortality of patients with head injury who had intensive care management and evolve strategies to improve outcome. Setting and Design: Retrospective study in a tertiary hospital where intracranial pressure monitoring (ICPM is not routinely practiced. Materials and Methods: All patients with head injury managed in the intensive care unit in a two-year period were included. The factors evaluated were age, vital signs, Glasgow Coma scale score (GCS at admission, pupillary light reflex (PR, oculocephalic reflex (OCR, hemodynamic stability, computerized tomography (CT findings, diabetes mellitus, anemia, infections and abnormalities of serum sodium. Results: We analyzed 208 patients (202 without ICPM. In-hospital mortality was 64 (31%. Only 24 (11.5% patients were admitted within one hour of injury, while one-third arrived after six hours. The clinical factors (at admission that influenced mortality included age, GCS, PR, OCR and diastolic blood pressure (DBP. Effacement of the basal cisterns in the initial and repeat CT scans, hyperglycemia, hemodynamic instability and serum sodium imbalances were associated with higher mortality. The independent predictors of mortality by logistic regression were initial GCS, DBP, hemodynamic instability and effacement of cisterns on repeat CT. Conclusions: Mortality following head injury is high. Pre-hospital emergency medical services are disorganized. The key to reducing mortality within the limitations of our current trauma system is maintenance of DBP>70 mmHg and SBP> 90 mmHg from the time of first contact.

  6. 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

    2015-06-01

    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 measures randomized controlled trial was conducted with 72 Mexican Americans aged 25-75 years with type 2 diabetes. Experimental condition participants received eight weekly, in-home, one-on-one educational and behavior modification sessions with a registered nurse focusing on symptom awareness, glucose self-testing and appropriate treatments, followed by eight biweekly support telephone sessions. Wait-listed control condition participants served as comparisons at three time points. Hierarchical linear modeling was used to evaluate the effects of the intervention between- and within groups on psychosocial, behavioral and clinical outcomes. Participants were predominantly female, middle-aged, moderately acculturated and in poor glycemic control. Experimental group participants (n = 39) significantly improved glycemic control, blood pressure, symptoms, knowledge, self-efficacy, empowerment and quality of life. Post intervention focus groups reported satisfaction with the symptom focus. Addressing symptoms led to clinical and psychosocial improvements. Symptoms seem to be an important motivator and a useful prompt to engage patients in diabetes self-management behaviors to relieve symptoms and prevent complications.

  7. A dataset to assess providers׳ knowledge and attitudes towards the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline

    OpenAIRE

    Yashashwi Pokharel; Lynne Steinberg; Winston Chan; Akeroyd, Julia M; Jones, Peter H.; Vijay Nambi; Khurram Nasir; Laura Petersen; Ballantyne, Christie M.; Virani, Salim S.

    2016-01-01

    We previously examined provider׳s understanding of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol management guideline (DOI: http://dx.doi.org/10.1016/j.jacl.2015.11.002)(Virani et al., 2013) [1], and also assessed whether a case-based educational intervention could improve providers׳ knowledge gaps and attitudes towards the guideline (DOI: 10.1016/j.atherosclerosis.2015.12.044) (Pokharel, et al., 2016) [2]. Here we describe the dataset that we used t...

  8. A dataset to assess providers׳ knowledge and attitudes towards the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline.

    Science.gov (United States)

    Pokharel, Yashashwi; Steinberg, Lynne; Chan, Winston; Akeroyd, Julia M; Jones, Peter H; Nambi, Vijay; Nasir, Khurram; Petersen, Laura; Ballantyne, Christie M; Virani, Salim S

    2016-06-01

    We previously examined provider׳s understanding of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol management guideline (DOI: http://dx.doi.org/10.1016/j.jacl.2015.11.002)(Virani et al., 2013) [1], and also assessed whether a case-based educational intervention could improve providers׳ knowledge gaps and attitudes towards the guideline (DOI: 10.1016/j.atherosclerosis.2015.12.044) (Pokharel, et al., 2016) [2]. Here we describe the dataset that we used to examine our objectives.

  9. Lion (Panthera leo) populations are declining rapidly across Africa, except in intensively managed areas.

    Science.gov (United States)

    Bauer, Hans; Chapron, Guillaume; Nowell, Kristin; Henschel, Philipp; Funston, Paul; Hunter, Luke T B; Macdonald, David W; Packer, Craig

    2015-12-01

    We compiled all credible repeated lion surveys and present time series data for 47 lion (Panthera leo) populations. We used a Bayesian state space model to estimate growth rate-λ for each population and summed these into three regional sets to provide conservation-relevant estimates of trends since 1990. We found a striking geographical pattern: African lion populations are declining everywhere, except in four southern countries (Botswana, Namibia, South Africa, and Zimbabwe). Population models indicate a 67% chance that lions in West and Central Africa decline by one-half, while estimating a 37% chance that lions in East Africa also decline by one-half over two decades. We recommend separate regional assessments of the lion in the World Conservation Union (IUCN) Red List of Threatened Species: already recognized as critically endangered in West Africa, our analysis supports listing as regionally endangered in Central and East Africa and least concern in southern Africa. Almost all lion populations that historically exceeded ∼ 500 individuals are declining, but lion conservation is successful in southern Africa, in part because of the proliferation of reintroduced lions in small, fenced, intensively managed, and funded reserves. If management budgets for wild lands cannot keep pace with mounting levels of threat, the species may rely increasingly on these southern African areas and may no longer be a flagship species of the once vast natural ecosystems across the rest of the continent.

  10. Management risk factors for calf mortality in intensive Italian dairy farms

    Directory of Open Access Journals (Sweden)

    Maddalena Zucali

    2013-04-01

    Full Text Available High calf mortality is an important factor of economic loss in dairy production. At present, limited data are available on calf rearing practices and calf mortality in Italian dairy farming. The aim of the study was to identify the most important management risk factors for preweaning calf mortality in Italian dairy farms. A group of 28 intensive dairy farms from Lombardy (Italy were visited to collect information about calf management and calf mortality. Female calf mortality showed high variability among herds and in many cases the percentage of calves dead within the preweaning period was very high. The average perinatal mortality (during calving and within 24 h after birth was 8.82% of total females born with a maximum value of 30.8%, whereas average early mortality (from 24 h to weaning was 8.9±7.9%, with a maximum value of 28%. The herd size did not significantly affect calf mortality although the number of calves cared per operator in the big farms was higher than in the small ones. Multivariate logistic analysis showed that feeding first colostrum meal beyond three hours after birth, group housing before 30 d of age and feeding daily less than 5 L of milk or milk replacer per calf multiply the risk to have early mortality higher than 10%. The study showed that early calf mortality could be strongly reduced by paying more attention to a very limited number of operations.

  11. 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.  

  12. Habitat Management for Wintering American Woodcock on Southeastern Bottomland Refuges: Basic Management Guidelines and Strategies

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Basic guidelines for management of habitat in winter for woodcock on refuges in the SE is presented along with consideration for use of the desired forestry conditons.

  13. 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.

  14. [The implementation of an independent and differentiated pain management SOP (Standard Operating Procedure) for the interdisciplinary intensive care unit].

    Science.gov (United States)

    Aust, Hansjörg; Wulf, Hinnerk; Vassiliou, Timon

    2013-03-01

    Up to the present day, pain management in the ICU (Intensive Care Units) is a unresolved clinical problem due to patient heterogeneity with complex variation in etiopathology and treatment of the underlying diseases. Therefore, therapeutic strategies in terms of standard operating procedure (SOP) are a necessary to improve the pain management for intensive care patients. Common guidelines for analgosedation are often inadequate to reflect the clinical situation. In particular, for an ICU setting without permanent presence of a physician a missing pain management SOP resulting in delayed pain therapy caused by a therapeutic uncertainty of the nurse staff. In addition to our pre-existing SOP for analgosedation we implemented a pain management SOP for our interdisciplinary, anaesthesiologic ICU. A exploratory survey among the nurse staff was conducted to assess the efficacy of the SOP. The results of the evaluation after a 6 month follow-up indicated a faster onset of pain management and good acceptance by the nursing staff.

  15. A multi-taxon approach reveals the effect of management intensity on biodiversity in Alpine larch grasslands.

    Science.gov (United States)

    Nascimbene, Juri; Fontana, Veronika; Spitale, Daniel

    2014-07-15

    In the Alps, larch grasslands form one of the most pleasing aspects of the landscape. However, their effectiveness in contributing to biodiversity conservation may depend on the intensity of their management. We used a multi-taxon approach to evaluate the effects of the intensification of management practices and those of abandonment on the biodiversity of the main autotrophic organisms hosted in this habitat, including vascular plants, bryophytes, and lichens. The study was carried out in the eastern part of South Tyrol, in the Italian Alps, where the diversity patterns of these three organismal groups were compared among intensively managed, extensively managed, and abandoned stands. The management intensity was found to strongly influence the biodiversity of the organisms, with a general pattern indicating the best conditions in extensively managed stands. Both abandonment and management intensification were detrimental to biodiversity through different mechanisms that led to species loss or to major shifts in species composition. However, the most negative effects were related to management intensification, mainly due to the high nitrogen supply, providing evidence for the increasing impact of eutrophication on Alpine environments.

  16. Optimal Multi-scale Demand-side Management for Continuous Power-Intensive Processes

    Science.gov (United States)

    Mitra, Sumit

    With the advent of deregulation in electricity markets and an increasing share of intermittent power generation sources, the profitability of industrial consumers that operate power-intensive processes has become directly linked to the variability in energy prices. Thus, for industrial consumers that are able to adjust to the fluctuations, time-sensitive electricity prices (as part of so-called Demand-Side Management (DSM) in the smart grid) offer potential economical incentives. In this thesis, we introduce optimization models and decomposition strategies for the multi-scale Demand-Side Management of continuous power-intensive processes. On an operational level, we derive a mode formulation for scheduling under time-sensitive electricity prices. The formulation is applied to air separation plants and cement plants to minimize the operating cost. We also describe how a mode formulation can be used for industrial combined heat and power plants that are co-located at integrated chemical sites to increase operating profit by adjusting their steam and electricity production according to their inherent flexibility. Furthermore, a robust optimization formulation is developed to address the uncertainty in electricity prices by accounting for correlations and multiple ranges in the realization of the random variables. On a strategic level, we introduce a multi-scale model that provides an understanding of the value of flexibility of the current plant configuration and the value of additional flexibility in terms of retrofits for Demand-Side Management under product demand uncertainty. The integration of multiple time scales leads to large-scale two-stage stochastic programming problems, for which we need to apply decomposition strategies in order to obtain a good solution within a reasonable amount of time. Hence, we describe two decomposition schemes that can be applied to solve two-stage stochastic programming problems: First, a hybrid bi-level decomposition scheme with

  17. Intensive care and pregnancy: Epidemiology and general principles of management of obstetrics ICU patients during pregnancy.

    Science.gov (United States)

    Zieleskiewicz, Laurent; Chantry, Anne; Duclos, Gary; Bourgoin, Aurelie; Mignon, Alexandre; Deneux-Tharaux, Catherine; Leone, Marc

    2016-10-01

    In developed countries, the rate of obstetric ICU admissions (admission during pregnancy or the postpartum period) is between 0.5 and 4 per 1000 deliveries and the overall case-fatality rate is about 2%. The most two common causes of obstetric ICU admissions concerned direct obstetric pathologies: obstetric hemorrhage and hypertensive disorders of pregnancy. This review summarized the principles of management of critically ill pregnant patient. Its imply taking care of two patients in the same time. A coordinated multidisciplinary team including intensivists, anesthesiologists, obstetricians, pediatricians and pharmacists is therefore necessary. This team must work effectively together with regular staff aiming to evaluate daily the need to maintain the patient in intensive care unit or to prompt delivery. Keeping mother and baby together and fetal well-being must be balanced with the need of specialized advanced life support for the mother. The maternal physiological changes imply various consequences on management. The uterus aorto-caval compression implies tilting left the parturient. In case of cardiac arrest, uterus displacement and urgent cesarean delivery are needed. The high risk of aspiration and difficult tracheal intubation must be anticipated. Even during acute respiratory distress syndrome, hypoxemia and permissive hypercapnia must be avoided due to their negative impact on the fetus. Careful analysis of the benefit-risk ratio is needed before all drug administration. Streptococcal toxic shock syndrome and perineal fasciitis must be feared and a high level of suspicion of sepsis must be maintained. Finally the potential benefits of an ultrasound-based management are detailed.

  18. 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.

  19. 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.

  20. [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

  1. [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.

  2. Milk production, raw milk quality and fertility of dromedary camels (Camelus Dromedarius) under intensive management.

    Science.gov (United States)

    Nagy, Péter; Thomas, Sonia; Markó, Orsolya; Juhász, Jutka

    2013-03-01

    In many arid countries, dromedaries play an important role as a milk source in rural areas. However, the milk and meat production potential of this species is not well understood and documented. A large-scale camel dairy farm was established in 2006 in the United Arab Emirates. This study summarises the most important data on milk production, raw milk quality and reproductive efficiency collected on this farm during the first three years of operation. The average daily milk production, the mean length of lactation and the mean total milk production per lactation of 174 dromedaries were 6.0 ± 0.12 kg (± SEM), 586 ± 11.0 days (± SEM) and 3314 ± 98.5 kg (± SEM), respectively. The lactation curve reached its peak during the 4th month after parturition (mean ± SEM, 8.9 ± 0.04 kg), then it declined gradually, falling to 50% of the maximum by the 16th month postpartum (mean ± SEM, 4.3 ± 0.06 kg). Milking three times a day did not increase daily milk production compared to two times milking. Mean total viable bacterial count (TVC) and mean somatic cell count (SCC, ± SEM) of bulk raw camel milk were 4,403 ± 94 CFU/cm3 and 392,602 ± 5,999 cells/cm3 for a one-year period, respectively. There was a significant difference among months (P dromedary camel, under an intensive management system.

  3. Integration Of PanDA Workload Management System With Supercomputers for ATLAS and Data Intensive Science

    Energy Technology Data Exchange (ETDEWEB)

    De, K [University of Texas at Arlington; Jha, S [Rutgers University; Klimentov, A [Brookhaven National Laboratory (BNL); Maeno, T [Brookhaven National Laboratory (BNL); Nilsson, P [Brookhaven National Laboratory (BNL); Oleynik, D [University of Texas at Arlington; Panitkin, S [Brookhaven National Laboratory (BNL); Wells, Jack C [ORNL; Wenaus, T [Brookhaven National Laboratory (BNL)

    2016-01-01

    The Large Hadron Collider (LHC), operating at the international CERN Laboratory in Geneva, Switzerland, is leading Big Data driven scientific explorations. Experiments at the LHC explore the fundamental nature of matter and the basic forces that shape our universe, and were recently credited for the discovery of a Higgs boson. ATLAS, one of the largest collaborations ever assembled in the sciences, is at the forefront of research at the LHC. To address an unprecedented multi-petabyte data processing challenge, the ATLAS experiment is relying on a heterogeneous distributed computational infrastructure. The ATLAS experiment uses PanDA (Production and Data Analysis) Workload Management System for managing the workflow for all data processing on over 150 data centers. Through PanDA, ATLAS physicists see a single computing facility that enables rapid scientific breakthroughs for the experiment, even though the data centers are physically scattered all over the world. While PanDA currently uses more than 250,000 cores with a peak performance of 0.3 petaFLOPS, LHC data taking runs require more resources than Grid computing can possibly provide. To alleviate these challenges, LHC experiments are engaged in an ambitious program to expand the current computing model to include additional resources such as the opportunistic use of supercomputers. We will describe a project aimed at integration of PanDA WMS with supercomputers in United States, Europe and Russia (in particular with Titan supercomputer at Oak Ridge Leadership Computing Facility (OLCF), MIRA supercomputer at Argonne Leadership Computing Facilities (ALCF), Supercomputer at the National Research Center Kurchatov Institute , IT4 in Ostrava and others). Current approach utilizes modified PanDA pilot framework for job submission to the supercomputers batch queues and local data management, with light-weight MPI wrappers to run single threaded workloads in parallel on LCFs multi-core worker nodes. This implementation

  4. Integration Of PanDA Workload Management System With Supercomputers for ATLAS and Data Intensive Science

    Science.gov (United States)

    Klimentov, A.; De, K.; Jha, S.; Maeno, T.; Nilsson, P.; Oleynik, D.; Panitkin, S.; Wells, J.; Wenaus, T.

    2016-10-01

    The.LHC, operating at CERN, is leading Big Data driven scientific explorations. Experiments at the LHC explore the fundamental nature of matter and the basic forces that shape our universe. ATLAS, one of the largest collaborations ever assembled in the sciences, is at the forefront of research at the LHC. To address an unprecedented multi-petabyte data processing challenge, the ATLAS experiment is relying on a heterogeneous distributed computational infrastructure. The ATLAS experiment uses PanDA (Production and Data Analysis) Workload Management System for managing the workflow for all data processing on over 150 data centers. Through PanDA, ATLAS physicists see a single computing facility that enables rapid scientific breakthroughs for the experiment, even though the data centers are physically scattered all over the world. While PanDA currently uses more than 250,000 cores with a peak performance of 0.3 petaFLOPS, LHC data taking runs require more resources than grid can possibly provide. To alleviate these challenges, LHC experiments are engaged in an ambitious program to expand the current computing model to include additional resources such as the opportunistic use of supercomputers. We will describe a project aimed at integration of PanDA WMS with supercomputers in United States, in particular with Titan supercomputer at Oak Ridge Leadership Computing Facility. Current approach utilizes modified PanDA pilot framework for job submission to the supercomputers batch queues and local data management, with light-weight MPI wrappers to run single threaded workloads in parallel on LCFs multi-core worker nodes. This implementation was tested with a variety of Monte-Carlo workloads on several supercomputing platforms for ALICE and ATLAS experiments and it is in full pro duction for the ATLAS since September 2015. We will present our current accomplishments with running PanDA at supercomputers and demonstrate our ability to use PanDA as a portal independent of the

  5. 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.

  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. The annual variation in stomatal ammonia compensation point of rye grass (Lolium perenne L.) leaves in an intensively managed grassland

    NARCIS (Netherlands)

    Hove, van L.W.A.; Heeres, P.; Bossen, M.E.

    2002-01-01

    The stomatal ammonia compensation point for ammonia (NH3) of an intensively managed pasture of rye grass (Lolium perenne L.) was followed from mid January till November 2000. Leaf samples were taken every week. Simultaneously, the ambient NH3 concentration was measured. Meteorological data (temperat

  8. 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

  9. Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part II. Treatment.

    NARCIS (Netherlands)

    Guery, B.P.; Arendrup, M.C.; Auzinger, G.; Azoulay, E.; Borges Sa, M.; Johnson, E.M.; Muller, E.; Putensen, C.; Rotstein, C.; Sganga, G.; Venditti, M.; Zaragoza Crespo, R.; Kullberg, B.J.

    2009-01-01

    BACKGROUND: Invasive candidiasis and candidemia are frequently encountered in the nosocomial setting particularly in the intensive care unit (ICU). OBJECTIVE AND METHODS: To review the current management of invasive candidiasis and candidemia in non-neutropenic adult ICU patients based on a review o

  10. 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.

  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. Emerging themes in the ecology and management of North American forests

    Science.gov (United States)

    Sharik, Terry L.; Adair, William; Baker, Fred A.; Battaglia, Michael; Comfort, Emily J.; D'Amato, Anthony W.; Delong, Craig; DeRose, R. Justin; Ducey, Mark J.; Harmon, Mark; Levy, Louise; Logan, Jesse A.; O'Brien, Joseph; Palik, Brian J.; Roberts, Scott D.; Rogers, Paul C.; Shinneman, Douglas J.; Spies, Thomas; Taylor, Sarah L.; Woodall, Christopher; Youngblood, Andrew

    2010-01-01

    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.

  13. 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.

  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. 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…

  18. "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…

  19. 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…

  20. Pain still hurts : pain assessment and pain management in intensive care patients

    NARCIS (Netherlands)

    S.J.G.M. Ahlers (Sabine)

    2012-01-01

    textabstractIntensive care patients are subject to many factors that may influence the patients’ state of comfort or distress. Pain is the main cause of distress experienced by many adult intensive care patients, which can be caused by different factors like underlying disease, prolonged immobility

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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

  6. Intensive Baking Room Baking on the Intensive Management%密集烤房集约化烘烤管理初议

    Institute of Scientific and Technical Information of China (English)

    马文清

    2012-01-01

      Digest Since the development and application of bulk and intensive flue curing barn from 2005, it was accepted the tobacco barn has unique advantages such as capacity-installing, cost-reducing, energy-saving and lower consumption reduction, etc. Barn in recent years has achieved rapid development in China, in particular, the implementation of Technical standard for barn (No.418 document of National Tobacco Management Department [ the barn, 2009]) has made intensive flue curing technology the leading role among the tobacco curing system in China. By the end of 2011, China has built up more than 700,000 bulk flue curing barn, in which has more than 30,000 serious curing barn and baking workshop connected with the tobacco curing work of 14,000,000 mu. Although the popularization and application of bulk and intensive flue curing barn has been rapidly recognized through the country, resulting in a large number of baking workshop’s establishing. However, the management of bulk flue curing is still an important subject to study..%  自2005年正式开始密集烤房的研发及推广应用以来,公认了密集烤房有装烟量大、减工降本、节能降耗等独特的优势,最近几年密集烤房在我国得到了迅速的发展,特别是国烟办[2009]418号《密集烤房技术标准》的实行,确立了密集烘烤在我国烟叶烘烤体系中的主体地位.到2011年,全国建造密集烤房总量达到70万座以上,其中烤房群和烘烤工场3万多处,承担烤烟面积约93.3万公顷.虽然,密集烤房的推广应用,很快在全国各个烟区得到了普遍认可,产生了一大批烘烤工场.但是,密集烤房的集约化烘烤管理还是一个重要的课题.

  7. 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.)

  8. Contribution of different grass species to plant-atmosphere ammonia exchange in intensively managed grassland

    Science.gov (United States)

    Mattsson, M.; Herrmann, B.; Jones, S.; Neftel, A.; Sutton, M. A.; Schjoerring, J. K.

    2009-01-01

    Species diversity in grasslands usually declines with increasing input of nitrogen from fertilizers or atmospheric deposition. Conversely, species diversity may also impact the build-up of soil and plant nitrogen pools. One important pool is NH3/NH4+ which also can be exchanged between plant leaves and the atmosphere. Limited information is available on how plant-atmosphere ammonia exchange is related to species diversity in grasslands. We have here investigated grass species abundance and different foliar nitrogen pools in 4-year-old intensively managed grassland. Apoplastic pH and NH4+ concentrations of the 8 most abundant species (Lolium perenne, Phleum pratense, Festuca pratensis, Lolium multiflorum, Poa pratensis, Dactylis glomerata, Holcus lanatus, Bromus mollis) were used to calculate stomatal NH3 compensation points. Apoplastic NH4+ concentrations differed considerably among the species, ranging from 13 to 117 μM, with highest values in Festuca pratensis. Also apoplastic pH values varied, from pH 6.0 in Phleum pratense to 6.9 in Dactylis glomerata. The observed differences in apoplastic NH4+ and pH resulted in a large span of predicted values for the stomatal NH3 compensation point which ranged between 0.20 and 6.57 nmol mol-1. Three species (Lolium perenne, Festuca pratensis and Dactylis glomerata) had sufficiently high NH3 compensation point and abundance to contribute to the bi-directional NH3 fluxes recorded over the whole field. The other 5 grass species had NH3 compensation points considerably below the atmospheric NH3 concentration and were thus not likely to contribute to NH3 emission but only to NH3 uptake from the atmosphere. Evaluated across species, leaf bulk-tissue NH4+ concentrations correlated well (r2=0.902) with stomatal NH3 compensation points calculated on the basis of the apoplastic bioassay. This suggests that leaf tissue NH4+ concentrations combined with data for the frequency distribution of the corresponding species can be used for

  9. 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...

  10. 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...

  11. Obstetric hemorrhage in a case of hypertrophic obstructive cardiomyopathy with automatic implantable cardioverter defibrillator: Anaesthesia and intensive care management.

    Science.gov (United States)

    Mishra, Sandeep Kumar; Bhat, Ravindra R; Kavitha, Jayaram; Kundra, Pankaj; Parida, Satyen

    2016-01-01

    The physiological changes occurring during pregnancy and labor may reveal or exacerbate the symptoms of hypertrophic obstructive cardiomyopathy (HOCM). The addition of obstetric hemorrhage to this presents a unique challenge to the anesthesiologists and intensivists managing these patients in the operation theatres and the Intensive Care Units. Here we present a case of HOCM with automatic implantable cardioverter defibrillator in situ and postpartum hemorrhagic shock.

  12. The Management of Pemphigus Vulgaris in a Burn Intensive Care Unit: A Case Report and Treatment Review

    Science.gov (United States)

    2014-10-01

    e357 The diagnosis of pemphigus encompasses a group of potentially fatal, autoimmune blistering diseases of the skin and mucous membranes...047X/2014 DOI: 10.1097/BCR.0000000000000049 Pemphigus vulgaris is a rare, potentially fatal, autoimmune blistering disease of the skin and mucous...Drive, Suite 1, Lackland AFB, Texas 78236. The Management of Pemphigus Vulgaris in a Burn Intensive Care Unit: A Case Report and Treatment Review

  13. Guidelines for the diagnosis and management of neuropathic pain: consensus of a group of Latin American experts.

    Science.gov (United States)

    Acevedo, Juan Carlos; Amaya, Abraham; Casasola, Oscar de León; Chinchilla, Nelson; De Giorgis, Marcelo; Florez, Sandra; Genis, Miguel Angel; Gomez-Barrios, Juan Vicente; Hernández, John Jairo; Ibarra, Eduardo; Moreno, Carlos; Orrillo, Enrique; Pasternak, Danilo; Romero, Sabina; Vallejo, Mariana; Velasco, Maritza; Villalobos, Alberto

    2009-01-01

    These consensus guidelines have been developed by a group of Latin American experts in pain management, to point out patterns and make practical recommendations to guide the diagnosis, identify warning signs (yellow and red flags), and establish comprehensive medical management (pharmacologic and nonpharmacologic treatment) and monitoring plans for patients enduring neuropathic pain. From the viewpoint of pharmacologic management, drugs are classified into groups according to efficacy, availability/accessibility, and safety criteria. Drugs are recommended for use depending on the disease and particular circumstances of each patient, with an approach that favors multimodal treatment while taking into consideration the idiosyncrasies of medical practice in Latin America.

  14. 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 exchange threshold (post, 1.29 ± 0.34 liters/min; pre, 0.97 ± 0.23 liters/min; P rate compared with CON (P 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.

  15. A randomized controlled trial of the effects of nurse case manager and community health worker team interventions in urban African-Americans with type 2 diabetes.

    Science.gov (United States)

    Gary, Tiffany L; Batts-Turner, Marian; Bone, Lee R; Yeh, Hsin-Chieh; Wang, Nae-Yuh; Hill-Briggs, Felicia; Levine, David M; Powe, Neil R; Hill, Martha N; Saudek, Christopher; McGuire, Maura; Brancati, Frederick L

    2004-02-01

    The objective of the study was to determine the effectiveness and cost-effectiveness of primary care and community-oriented interventions in managing HbA1c, blood pressure, and lipids, and reducing hospitalizations and emergency room visits over 2 years. We describe an ongoing, randomized controlled trial of 542 urban African-Americans with type 2 diabetes ages 25 years and older who are members of a university-affiliated managed-care organization in Baltimore, MD. The participants are 74% female, have a mean age of 58 years, and 35% have yearly incomes greater than 7500 US dollars. Participants were randomized to one of two intervention groups for a period of 2 years: (1) usual medical care plus minimal telephone intervention implemented by a trained lay health educator (control group) or (2) usual medical care plus intensive intervention implemented by a nurse case manager (NCM)/community health worker (CHW) team. The intensive NCM/CHW team executes individual plans of care using evidence-based algorithms that focus on traditional diabetes self-management, screening and management of diabetes-related complications, and social issues surrounding diabetes care. Face-to-face NCM visits are conducted in the clinic once per year and CHW visits are conducted in the participant's home one to three times per year, both with additional follow-up contacts as needed. Written and verbal feedback (when necessary) is provided to the participant's primary care physician. All participants are expected to attend a 24-month follow-up visit where data are collected by interviewers blinded to intervention assignment. As of May 1, 2003, recruitment is complete, interventions are being fully implemented, and 24-month follow-up visits are beginning. Baseline sociodemographic characteristics, health-care utilization, health behaviors, and clinical characteristics of the study population are reported. This study is designed to test the hypothesis that a primary-care-based NCM plus CHW

  16. 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.

  17. Management of Complications of End-Stage Liver Disease in the Intensive Care Unit.

    Science.gov (United States)

    DellaVolpe, Jeffrey D; Garavaglia, Jeffrey M; Huang, David T

    2016-02-01

    The management of critically ill patients with end-stage liver disease can be challenging due to the vulnerability of this population and the wide-ranging complications of the disease. This review proposes an approach based on the major organ systems affected, to provide a framework for managing the most common complications. Although considerable practice variation exists, a focus on the evidence behind the most common practices will ensure the development of the optimal skillset to appropriately manage this disease.

  18. 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

  19. 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

  20. [Prehospital management of very elderly patients with ST segment elevation in Paris by mobile intensive care units (Samu)].

    Science.gov (United States)

    Leroy, J E; Bensouda, C; Durand, E; Greffet, A; Scemama, A; Carli, P; Danchin, N; Sauval, P

    2005-03-01

    More and more elderly people are hospitalised with myocardial infarction. Little is known on their pre-hospital management. In 2001 and 2002, 105 patients aged 80 years or more with suspected ST elevation infarction were managed by the mobile intensive care unit system of the SAMU de Paris-Necker. Diagnosis of infarction was confirmed in 92 (88%). Over 60% of the patients were women. Median time delay from symptom onset to call to the emergency service was 127 minutes, longer in nonagenarians (175 vs 101 minutes). Prehospital use of aspirin was 81% and 39% received an intravenous bolus of heparin. A reperfusion strategy was decided in only 30% (primary PCI: 23/26). One-month mortality was 21% and was related to older age, time when the call to the Samu was made, and absence of current smoking. Overall, the prehospital management of very elderly patients with suspected ST elevation infarction appears far from optimal.

  1. 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.

  2. Effectiviteit van een klassieke Crew Resource Management training in de Intensive Care: een gecontroleerde studie.

    NARCIS (Netherlands)

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

    2013-01-01

    Achtergrond: Er is een toenemende bewustwording dat onbedoelde zorg gerelateerde schade in de gezondheidszorg vaker voortvloeit uit problemen met niet-technische vaardigheden, dan door een gebrek in technische, of klinische, vaardigheden. Dit is vooral van belang in de Intensive Care (IC), waar comp

  3. The Role of Leadership: The Challenge of Knowledge Management and Learning in Knowledge-Intensive Organizations

    Science.gov (United States)

    Mas-Machuca, Marta

    2014-01-01

    Knowledge and learning are important driving forces for business success and competitiveness, especially in the knowledge-intensive organizations (KIO's) whose core business is to create and sell knowledge (e.g. education, R&D units, and consultancy organizations, among others). Previous works suggested one of the Critical Success Factor (CSF)…

  4. Clinical management issues of coagulase-negative staphylococcal sepsis in the neonatal intensive care unit

    NARCIS (Netherlands)

    Hemels, M.A.C.

    2011-01-01

    Nosocomial sepsis is a major cause of morbidity in the neonatal intensive care unit (NICU), with coagulase-negative staphylococci (CONS) generally reported to be the most frequent causative micro-organisms. There is substantial evidence for the association between CONS sepsis and indwelling intravas

  5. 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.

  6. Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

    Directory of Open Access Journals (Sweden)

    Emiliana Motta

    Full Text Available Summary Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU, in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols. Objective: Literature review on the main aspects of analgesia and sedation, abstinence syndrome, and delirium in the pediatric intensive care unit, in order to show the importance of the use of protocols on the management of critically ill patients. Method: Articles published in the past 16 years on PubMed, Lilacs, and the Cochrane Library, with the terms analgesia, sedation, abstinence syndrome, mild sedation, daily interruption, and intensive care unit. Results: Seventy-six articles considered relevant were selected to describe the importance of using a protocol of sedation and analgesia. They recommended mild sedation and the use of assessment scales, daily interruptions, and spontaneous breathing test. These measures shorten the time of mechanical ventilation, as well as length of hospital stay, and help to control abstinence and delirium, without increasing the risk of morbidity and morbidity. Conclusion: Despite the lack of controlled and randomized clinical trials in the pediatric setting, the use of protocols, optimizing mild sedation, leads to decreased morbidity.

  7. 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.

  8. A Review of the Experience, Epidemiology, and Management of Pain among American Indian, Alaska Native, and Aboriginal Canadian Peoples

    OpenAIRE

    Jimenez, Nathalia; Garroutte, Eva; Kundu, Anjana; Morales, Leo; Buchwald, Dedra

    2011-01-01

    Substantial literature suggests that diverse biological, psychological, and sociocultural mechanisms account for differences by race and ethnicity in the experience, epidemiology, and management of pain. Many studies have examined differences between Whites and minority populations, but American Indians (AIs), Alaska Natives (ANs), and Aboriginal peoples of Canada have been neglected both in studies of pain and in efforts to understand its bio-psychosocial and cultural determinants. This arti...

  9. 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.

  10. Chronic neuropathic facial pain after intense pulsed light hair removal. Clinical features and pharmacological management

    Science.gov (United States)

    Párraga-Manzol, Gabriela; Sánchez-Torres, Alba; Moreno-Arias, Gerardo

    2015-01-01

    Intense Pulsed Light (IPL) photodepilation is usually performed as a hair removal method. The treatment is recommended to be indicated by a physician, depending on each patient and on its characteristics. However, the use of laser devices by medical laypersons is frequent and it can suppose a risk of damage for the patients. Most side effects associated to IPL photodepilation are transient, minimal and disappear without sequelae. However, permanent side effects can occur. Some of the complications are laser related but many of them are caused by an operator error or mismanagement. In this work, we report a clinical case of a patient that developed a chronic neuropathic facial pain following IPL hair removal for unwanted hair in the upper lip. The specific diagnosis was painful post-traumatic trigeminal neuropathy, reference 13.1.2.3 according to the International Headache Society (IHS). Key words:Neuropathic facial pain, photodepilation, intense pulse light. PMID:26535105

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

    OpenAIRE

    Artner J; Kurz S; Cakir B; Reichel H; Lattig F

    2012-01-01

    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 desi...

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

    OpenAIRE

    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...

  13. Intense Sweeteners, Appetite for the Sweet Taste, and Relationship to Weight Management

    OpenAIRE

    BELLISLE France

    2015-01-01

    High intensity, low-energy sweeteners (LES) are used by many consumers in order to limit energy intake and possibly facilitate body weight control. These beneficial effects are often questioned in the scientific and lay media. LES are frequently accused of stimulating and/or maintaining a liking for sweetness which in turn would be deleterious for adequate body weight control. Evidence for the specific effects of LES use on appetite for sweet products will be extracted from observational stud...

  14. Quantifying And Predicting Wood Quality Of Loblolly And Slash Pine Under Intensive Forest Management Final Technical Report

    Energy Technology Data Exchange (ETDEWEB)

    Richard F. Daniels; Alexander Clark III

    2006-05-04

    The forest industry will increasingly rely on fast-growing intensively managed southern pine plantations to furnish wood and fiber. Intensive silvicultural practices, including competition control, stand density control, fertilization, and genetic improvement are yielding tremendous gains in the quantity of wood production from commercial forest land. How these technologies affect wood properties was heretofore unknown, although there is concern about the suitability of fast-grown wood for traditional forest products. A four year study was undertaken to examine the effects of these intensive practices on the properties of loblolly and slash pine wood by applying a common sampling method over 10 existing field experiments. Early weed control gets young pines off to a rapid start, often with dramatically increased growth rates. This response is all in juvenile wood however, which is low in density and strength. Similar results are found with early Nitrogen fertilization at the time of planting. These treatments increase the proportion of juvenile wood in the tree. Later, mid-rotation fertilization with Nitrogen and Phosphorus can have long term (4-8 year) growth gains. Slight reductions in wood density are short-lived (1-2 years) and occur while the tree is producing dense, stiff mature wood. Impacts of mid-rotation fertilization on wood properties for manufacturing are estimated to be minimal. Genetic differences are evident in wood density and other properties. Single family plantings showed somewhat more uniform properties than bulk improved or unimproved seedlots. Selection of genetic sources with optimal wood properties may counter some of the negative impacts of intensive weed control and fertilization. This work will allow forest managers to better predict the effects of their practices on the quality of their final product.

  15. 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.

  16. 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,…

  17. 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…

  18. 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.

  19. Warehouse Management Urgent Chain Intensive%仓储经营管理亟待连锁集约

    Institute of Scientific and Technical Information of China (English)

    周秀雄

    2015-01-01

    the traditional storage management is inadequate of stated owned warehouse business why the introduction of chain intensive mode,to intensivism and catenation launches the elaboration.%文中就传统的仓储经营存在不足状况进行探析,阐述国有仓储经营为什么要引进连锁集约模式,就如何进行连锁集约展开了论述。

  20. 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...

  1. 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

  2. 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).

  3. 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

  4. 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

  5. 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.

  6. 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.

  7. The role of the intensive care unit in the management of the critically ill surgical patient.

    Science.gov (United States)

    Cuthbertson, B H; Webster, N R

    1999-10-01

    Surgical patients make up 60-70% of the work load of intensive care units in the UK. There is a recognised short fall in the resource allocation for high dependency units (HDUs) and intensive care units (ICUs) in this country, despite repeated national audits urging that this resource be increased. British ICUs admit patients later and with higher severity of illness scores than elsewhere and this leads to higher ICU mortality. How can this situation be improved? Scoring systems that allow selection of appropriate patients for admission to ICU and avoid inappropriate admission are still in development. Pre-operative admission and optimisation in ICU is rare in this country despite increasing evidence to support this practice in high risk surgical patients. Early admission to ICU, with potential improvement in outcomes, could also be achieved using multi-disciplinary medical emergency teams. These teams would be alerted by ward staff in response to set specific conditions and physiological criteria. These proposals are still under trial but may offer benefit by reducing mortality in critically ill surgical patients.

  8. 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.

  9. 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...

  10. 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

    2013-01-01

    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.

  11. Neonatal Intensive Care Nurses' Perceptions of Parental Participation in Infant Pain Management: A Comparative Focus Group Study.

    Science.gov (United States)

    Axelin, Anna; Anderzén-Carlsson, Agneta; Eriksson, Mats; Pölkki, Tarja; Korhonen, Anne; Franck, Linda S

    2015-01-01

    This comparative focus group study explored nurses' experiences and perceptions regarding parental participation in infant pain management in the neonatal intensive care unit (NICU). A total of 87 nurses from 7 NICUs in Finland, Sweden, and the United States participated in focus-group interviews (n = 25). Data were analyzed using deductive and inductive thematic analysis. Nurses' experiences and perceptions varied considerably, from nurses being in control, to nurses sharing some control with parents, to nurse-parent collaboration in infant pain management. When nurses controlled pain management, parents were absent or passive. In these cases, the nurses believed this led to better pain control for infants and protected parents from emotional distress caused by infant pain. When nurses shared control with parents, they provided information and opportunities for participation. They believed parent participation was beneficial, even if it caused nurses or parents anxiety. When nurses collaborated with parents, they negotiated the optimal pain management approach for an individual infant. The collaborative approach was most evident for the nurses in the Swedish NICUs and somewhat evident in the NICUs in Finland and the United States. Further research is needed to address some nurses' perceptions and concerns and to facilitate greater consistency in the application of evidence-based best practices.

  12. 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.

  13. 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.

  14. 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.

  15. 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...

  16. 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.

  17. 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.

  18. 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.

  19. 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。

  20. Anesthesia and Intensive Care Management in a Pregnant Woman with PRES: A Case Report

    Directory of Open Access Journals (Sweden)

    Ismail Demirel

    2012-01-01

    Full Text Available Posterior reversible encephalopathy syndrome (PRES is a temporary condition that is diagnosed clinically, neurologically, and radiologically. Its symptoms vary, and nonspecific headaches, confusion, impairment of consciousness, nausea, vomiting, and visual impairment may occur. Acute hypertension often accompanies these symptoms. Patients can also suffer from convulsions, cortical visual impairment, and coma. Diagnosis can be difficult due to focal neurologic signs. Nevertheless, knowing the clinical risk factors can lead to the right diagnosis. It has been reported that this condition may also occur during organ transplantation, immunosuppressive treatment, and autoimmune diseases and chemotherapy, and also patients with eclampsia. In this paper, a 21-year-old, 31-week pregnant woman, who had been diagnosed with PRES and thanks to early diagnosis and treatment had fully recovered and discharged from the intensive care unit, is presented, and the relevant literature is discussed.

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

    Science.gov (United States)

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

    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 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.

  2. Intense Sweeteners, Appetite for the Sweet Taste, and Relationship to Weight Management.

    Science.gov (United States)

    Bellisle, France

    2015-03-01

    High intensity, low-energy sweeteners (LES) are used by many consumers in order to limit energy intake and possibly facilitate body weight control. These beneficial effects are often questioned in the scientific and lay media. LES are frequently accused of stimulating and/or maintaining a liking for sweetness which in turn would be deleterious for adequate body weight control. Evidence for the specific effects of LES use on appetite for sweet products will be extracted from observational studies, experimental laboratory studies, randomized controlled trials, and finally brain imaging studies. While many of the existing studies cannot identify any causal links between use of LES and appetite for sweetness, randomized trials in children and adults suggest that use of LES tends to reduce rather than increase the intake of sugar-containing foods and to facilitate, rather than impair, weight loss.

  3. 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.

  4. 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.

  5. Management of Sepsis in Patients with Pulmonary Arterial Hypertension in the Intensive Care Unit.

    Science.gov (United States)

    Tartavoulle, Todd M

    2017-03-01

    Pulmonary arterial hypertension is a lethal condition, and the management of sepsis in patients with pulmonary arterial hypertension is challenging. As the disease progresses, the right ventricle is susceptible to failure due to a high pulmonary vascular resistance. The limited ability of the right ventricle to increase cardiac output in septic shock makes it difficult to deliver oxygen to the organ and tissues. Intravascular volume replacement and vasoactive drugs should only be considered after a thorough assessment. Priorities of care include improving cardiac output and oxygen delivery by optimizing preload, reducing afterload, and improving contractility.

  6. 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.

  7. Time Management - New Religion of Our Age: 'Time' In Anglo-American Culture vs. 'Vrijeme' in Croatian Culture

    Directory of Open Access Journals (Sweden)

    Ksenija Juretić

    2004-11-01

    Full Text Available This research on time management within the project ‘Management in Entrepreneurship’ is based both on cognitive linguistics and the cultural dimension of time in international business. In accordance with our conceptualization and relationship to time, culture can be divided into monochronic time (M-time and polychronic time (P-time cultures. While M-time culture, which is best represented by the United States, emphasizes schedules, a precise reckoning of time, and promptness, P-time culture, Croatia, falling into this category, emphasizes the involvement of people rather than a rigid adherence to the clock. The results, so far, show how our conceptualization of time - on a subconscious level - influences our lives and how theories of time management can be transferred into teaching Business English in Croatia where, ‘having done something on time’ is definitely of less importance than to the American society.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. Dynamics of the natural transmission of bovine spongiform encephalopathy within an intensively managed sheep flock.

    Science.gov (United States)

    Jeffrey, Martin; Witz, Janey P; Martin, Stuart; Hawkins, Steve A C; Bellworthy, Sue J; Dexter, Glenda E; Thurston, Lisa; González, Lorenzo

    2015-10-28

    Sheep are susceptible to the bovine spongiform encephalopathy (BSE) agent and in the UK they may have been exposed to BSE via contaminated meat and bone meal. An experimental sheep flock was established to determine whether ovine BSE could be naturally transmitted under conditions of intensive husbandry. The flock consisted of 113 sheep of different breeds and susceptible PRNP genotypes orally dosed with BSE, 159 sheep subsequently born to them and 125 unchallenged sentinel controls. BSE was confirmed in 104 (92%) orally dosed sheep and natural transmission was recorded for 14 of 79 (18%) lambs born to BSE infected dams, with rates varying according to PRNP genotype. The likelihood of natural BSE transmission was linked to stage of incubation period of the dam: the attack rate for lambs born within 100 days of the death of BSE infected dams was significantly higher (9/22, 41%) than for the rest (5/57, 9%). Within the group of ewes lambing close to death, those rearing infected progeny (n = 8, for 9/12 infected lambs) showed a significantly greater involvement of lymphoid tissues than those rearing non-infected offspring (n = 8, for 0/10 infected lambs). Horizontal transmission to the progeny of non-infected mothers was recorded only once (1/205, 0.5%). This low rate of lateral transmission was attributed, at least partly, to an almost complete absence of infected placentas. We conclude that, although BSE can be naturally transmitted through dam-lamb close contact, the infection in this study flock would not have persisted due to low-efficiency maternal and lateral transmissions.

  13. Gap formation in Danish beech (Fagus sylvatica) forests of low management intensity

    DEFF Research Database (Denmark)

    Ritter, Eva; Vesterdal, Lars

    2006-01-01

    -based managed forest, soil solution was collected for 5 years and soil moisture measured in the fourth year after gap formation. Average NO3-N concentrations were significantly higher in the gaps (9.9 and 8.1 mg NO3-N l(-1), respectively) than under closed canopy (0.2 mg l(-1)). In the semi-natural forest....... In the semi-natural forest, advanced regeneration and lateral closure of the gap affected soil moisture levels in the gap in the last year of the study. Author Keywords: gaps; drainage fluxes; Fagus sylvatica L.; nitrate; soil moisture; soil solution; unmanaged forest ecosystems; WATBAL......Soil moisture content (0-90 cm depth) and nitrate-nitrogen (NO3-N) concentrations in soil solution (90 cm depth) were monitored after gap formation (diameter 15-18 m) in three Danish beech-dominated forests on nutrient-rich till soils. NO3-N drainage losses were estimated by the water balance model...

  14. 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.

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. 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…

  20. Impact of Goal Setting and Goal Attainment Methods on Asthma Outcomes: Findings From an Asthma Self-Management Intervention for African American Women

    Science.gov (United States)

    Aaron, Micah; Nelson, Belinda W.; Kaltsas, Elena; Brown, Randall W.; Thomas, Lara J.; Patel, Minal R.

    2017-01-01

    Optimal use of goal-setting strategies in self-management efforts with high-risk individuals with asthma is not well understood. This study aimed to describe factors associated with goal attainment in an asthma self-management intervention for African American women with asthma and determine whether goal attainment methods proved beneficial to…

  1. 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…

  2. Intercomparison of ammonia measurement techniques at an intensively managed grassland site (Oensingen, Switzerland

    Directory of Open Access Journals (Sweden)

    M. Norman

    2008-11-01

    Full Text Available As part of a field campaign in the framework of the NitroEurope project, three different instruments for atmospheric ammonia (NH3 measurements were operated side-by-side on a managed grassland site in Switzerland: a modified Proton Transfer Reaction Mass Spectrometer (PTR-MS, a GRadient of AErosol and Gases Online Registrator (GRAEGOR, and an Automated Ammonia Analyzer (AiRRmonia. The modified PTR-MS approach is based on chemical ionization of NH3 using O2+ instead of H3O+ as ionizing agent, GRAEGOR and AiRRmonia measure NH4+ in liquids after absorption of gaseous NH3 in a rotating wet-annular denuder and through a gas permeable membrane, respectively. Bivariate regression slopes using uncorrected data from all three instruments ranged from 0.78 to 0.97 while measuring ambient NH3 levels between 2 and 25 ppbv during a 5 days intercomparison period. Correlation coefficients r2 were in the range of 0.79 to 0.94 for hourly average concentrations. Observed discrepancies could be partly attributed to temperature effects on the GRAEGOR calibration. Bivariate regression slopes using corrected data ranged 0.92 to 0.95 with offsets ranging from 0.22 to 0.58 ppbv. The intercomparison demonstrated the potential of PTR-MS to resolve short-time NH3 fluctuations which could not be measured by the two other slow-response instruments. During conditions favoring condensation in inlet lines, the PTR-MS underestimated NH3 concentrations, underlining the importance of careful inlet designs as an essential component for any inlet-based instrument.

  3. Intercomparison of ammonia measurement techniques at an intensively managed grassland site (Oensingen, Switzerland

    Directory of Open Access Journals (Sweden)

    M. Norman

    2009-04-01

    Full Text Available As part of a field campaign in the framework of the NitroEurope project, three different instruments for atmospheric ammonia (NH3 measurements were operated side-by-side on a managed grassland site in Switzerland: a modified Proton Transfer Reaction Mass Spectrometer (PTR-MS, a GRadient of AErosol and Gases Online Registrator (GRAEGOR, and an Automated Ammonia Analyzer (AiRRmonia. The modified PTR-MS approach is based on chemical ionization of NH3 using O2+ instead of H3O+ as ionizing agent, GRAEGOR and AiRRmonia measure NH4+ in liquids after absorption of gaseous NH3 in a rotating wet-annular denuder and through a gas permeable membrane, respectively. Bivariate regression slopes using uncorrected data from all three instruments ranged from 0.78 to 0.97 while measuring ambient NH3 levels between 2 and 25 ppbv during a 5 days intercomparison period. Correlation coefficients r2 were in the range of 0.79 to 0.94 for hourly average mixing ratios. Observed discrepancies could be partly attributed to temperature effects on the GRAEGOR calibration. Bivariate regression slopes using corrected data were >0.92 with offsets ranging from 0.22 to 0.58 ppbv. The intercomparison demonstrated the potential of PTR-MS to resolve short-time NH3 fluctuations which could not be measured by the two other slow-response instruments. During conditions favoring condensation in inlet lines, the PTR-MS underestimated NH3 mixing ratios, underlining the importance of careful inlet designs as an essential component for any inlet-based instrument.

  4. 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

  5. Current recognition and management of intra-abdominal hypertension and abdominal compartment syndrome among tertiary Chinese intensive care physicians

    Institute of Scientific and Technical Information of China (English)

    Jian-cang ZHOU; Hong-chen ZHAO; Kong-han PAN; Qiu-ping XU

    2011-01-01

    This survey was designed to clarify the current understanding and clinical management of intra-abdominal hypertension (IAH)/abdominal compartment syndrome (ACS) among intensive care physicians in tertiary Chinese hospitals. A postal twenty-question questionnaire was sent to 141 physicians in different intensive care units (ICUs). A total of 108 (76.6%) questionnaires were returned. Among these, three quarters worked in combined medical-surgical ICUs and nearly 80% had primary training in internal or emergency medicine. Average ICU beds, annual admission,ICU length of stay, acute physiology and chronic health evaluation (APACHE) Ⅱ score, and mortality were 18.2 beds,764.5 cases, 8.3 d, 19.4, and 21.1%, respectively. Of the respondents, 30.6% never measured intra-abdominal pressure (IAP). Although the vast majority of the ICUs adopted the exclusively transvesicular method, the over-whelming majority (88.0%) only measured IAP when there was a clinical suspicion of IAH/ACS and only 29.3% measured either often or routinely. Moreover, 84.0% used the wrong priming saline volume while 88.0% zeroed at reference points which were not in consistence with the standard method for IAP monitoring recommended by the World Society of Abdominal Compartment Syndrome. ACS was suspected mainly when there was a distended ab-domen (92%), worsening oliguria (80%), and increased ventilatory support requirement (68%). Common causes for IAH/ACS were "third-spacing from massive volume resuscitation in different settings" (88%), "intra-abdominal bleed-ing", and "liver failure with ascites" (52% for both). Though 60% respondents would recommend surgical decompres-sion when the IAP exceeded 25 mmHg, accompanied by signs of organ dysfunction, nearly three quarters of re-spondents preferred diuresis and dialysis. A total of 68% of respondents would recommend paracentesis in the treatment for ACS. In conclusion, urgent systematic education is absolutely necessary for most intensive care physi

  6. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and the Postpartum

    DEFF Research Database (Denmark)

    Alexander, Erik K; Pearce, Elizabeth N; Brent, Gregory A

    2017-01-01

    autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy......BACKGROUND: Thyroid disease in pregnancy is a common clinical problem. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines...... is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception and the postpartum period. METHODS: The specific clinical questions addressed in these guidelines were based...

  7. Management of Thyroid Peroxidase Antibody Euthyroid Women in Pregnancy: Comparison of the American Thyroid Association and the Endocrine Society Guidelines

    Directory of Open Access Journals (Sweden)

    L. Mehran

    2013-01-01

    Full Text Available The presence of thyroid autoantibodies is relatively high in women of childbearing age. There is evidence that positive thyroperoxidase antibody even in euthyroid women may increase the risk of spontaneous and recurrent pregnancy loss and preterm delivery. However, the evidence is not enough to justify recommendation on the screening of pregnant women for thyroid autoantibodies or LT4 supplementation for reducing maternal or fetal complications. In this paper we reviewed the related evidence and compared the new guidelines of the American Thyroid Association and Endocrine Society with respect to the screening and management of positive thyroperoxidase antibody in euthyroid pregnant women. As there was no major contradiction or disagreement between the two guidelines, either one of two guidelines may be used by clinicians for the appropriate management of thyroid autoimmunity during pregnancy.

  8. 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.

  9. Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care--short version.

    OpenAIRE

    Kleinschmidt, Stefan; Koppert, Wolfgang; Kessler, Paul; Huth, Ralf; Hartl, Wolfgang; Haase, Ulrike; Garten, Lars; Engelmann, Lothar; Eichler, Ingolf; Eggers, Verena; Dictus, Christine; Dall, Peter; Bürkle, Hartmut; Biniek, Rolf; Bäsell, Katrin

    2010-01-01

    Targeted monitoring of analgesia, sedation and delirium, as well as their appropriate management in critically ill patients is a standard of care in intensive care medicine. With the undisputed advantages of goal-oriented therapy established, there was a need to develop our own guidelines on analgesia and sedation in intensive care in Germany and these were published as 2nd Generation Guidelines in 2005. Through the dissemination of these guidelines in 2006, use of monitoring was shown to hav...

  10. 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.

  11. 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

  12. 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.

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

    OpenAIRE

    Rutilio Martinez; Cris de la Torre

    2011-01-01

    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 e...

  14. 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.

  15. 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

  16. 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.

  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. The Samurai or the Cowboy? Toward an American Model of Quality Management.

    Science.gov (United States)

    Beck, Mark W.

    1994-01-01

    The Japanese model of business management and Total Quality Management principles being applied to higher education as well as businesses are often ineffective because of the application of packaged ideas without consideration of the subtleties of individual organizations. The cowboy model of teamwork stresses the individual's role and better fits…

  19. A Lesson for American Managers: Learning from Japanese Experiences in the U.S.

    Science.gov (United States)

    Nosow, Sigmund

    1984-01-01

    Research finds that, in Japanese-owned plants in America, efforts are made to bring the system around slowly to a Japanese management style through acculturation, communication, and training. Problems engendered by these efforts emerge particularly at the middle management levels. Barriers to corporate unity are far fewer at the plant level. (CT)

  20. Response of the Ionospheric F-region in the Latin American Sector During the Intense Geomagnetic Storm of 21-22 January 2005

    Science.gov (United States)

    Sahai, Y.; Fagundes, P. R.; de Jesus, R.; de Abreu, A. J.; Crowley, G.; Pillat, V. G.; Guarnieri, F. L.; Abalde, J. R.; Bittencourt, J. A.

    2009-12-01

    Ionospheric storms are closely associated with geomagnetic storms and are an extreme example of space weather events. The response of the ionosphere to storms is rather complicated. In the present investigation, we have studied the response of the ionospheric F-region in the Latin American sector during the intense geomagnetic storm of 21-22 January 2005 (with storm sudden commencement (SSC) at 1712 UT on 21 January). This geomagnetic storm is anomalous (minimum Dst reached -105 nT at 0700 UT on 22 January) because the main phase occurred during the northward excursion of the Bz component of interplanetary magnetic fields (IMFs). The monthly mean F10.7 solar flux for the month of January 2005 was 99.0 sfu. The ionospheric F-region parameters observed at Ramey (18.5 N, 67.1 W; RAM), Puerto Rico, Jicamarca (12.0 S, 76.8 W; JIC), Peru, Manaus (2.9 S, 60.0 W; MAN), and São José dos Campos (23.2 S, 45.9 W; SJC), Brazil, during 21-22 January (geomagnetically disturbed) and 25 January (geomagnetically quiet) have been analyzed. Both JIC and MAN, the equatorial stations, show unusually rapid uplifting of the F-region peak heights(hpF2/hmF2) and a decrease in the NmF2 coincident with the time of SSC. At both RAM and SJC an uplifting of the F-region peak height is observed at about 2000 UT. The low-latitude station SJC shows a coincident decrease in NmF2 with the uplifting, whereas the mid-latitude station RAM shows a decrease in NmF2 earlier than the uplifting. Also, the observed variations in the F-region ionospheric parameters are compared with the TIMEGCM model run for 21-22 January and the model results show both similarities and differences from the observed results. Average GPS-TEC (21-22 and 25 January) and phase fluctuations (21, 22, 25, 26 January) observed at Belem (1.5 S, 48.5 W; BELE), Brasilia (15.9 S, 47.9 W; BRAZ), Presidente Prudente (22.3o S, 51.4 W; UEPP), and Porto Alegre (30.1 S, 51.1 W; POAL), Brazil, are also presented. These GPS stations belong to

  1. 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.

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

    Science.gov (United States)

    Berkunsky, Igor; Daniele, Gonzalo; Kacoliris, Federico P; Díaz-Luque, José A; Silva Frias, Carmen P; Aramburu, Rosana M; Gilardi, James D

    2014-01-01

    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. Reproductive Parameters in the Critically Endangered Blue-Throated Macaw: Limits to the Recovery of a Parrot under Intensive Management

    Science.gov (United States)

    Berkunsky, Igor; Daniele, Gonzalo; Kacoliris, Federico P.; Díaz-Luque, José A.; Silva Frias, Carmen P.; Aramburu, Rosana M.; Gilardi, James D.

    2014-01-01

    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. PMID:24941317

  4. 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.

  5. Management of a cutaneous squamous cell carcinoma in an American flamingo (Phoenicopterus ruber).

    Science.gov (United States)

    Abu, Jalila; Wünschmann, Arno; Redig, Patrick T; Feeney, Daniel

    2009-03-01

    A 32-year-old female American flamingo (Phoenicopterus ruber) was presented with a squamous cell carcinoma of the middle digit of the right foot. No clinical, hematologic, or radiologic evidence of metastasis was present. Salvage amputation of the digit resulted in complete cure, whereas previous electrosurgery and radiation therapy were unsuccessful. Three years later, another squamous cell carcinoma was diagnosed in the middle digit of the left foot. The digit was also amputated. Seven months after the second amputation, the bird did not have any recurrence or signs of metastasis.

  6. Novel interventions for HIV self-management in African American women: a systematic review of mHealth interventions.

    Science.gov (United States)

    Tufts, Kimberly Adams; Johnson, Kaprea F; Shepherd, Jewel Goodman; Lee, Ju-Young; Bait Ajzoon, Muna S; Mahan, Lauren B; Kim, Miyong T

    2015-01-01

    The purpose of this systematic review was to assess the quality of interventions using mobile health (mHealth) technology being developed for and trialed with HIV-infected African American (AA) women. We aimed to assess rigor and to ascertain if these interventions have been expanded to include the broad domain of self-management. After an extensive search using the PRISMA approach and reviewing 450 records (411 published studies and 39 ongoing trials at clinicaltrials.gov), we found little completed research that tested mHealth HIV self-management interventions for AA women. At clinicaltrials.gov, we found several mHealth HIV intervention studies designed for women in general, forecasting a promising future. However, most studies were exploratory in nature and focused on a single narrow outcome, such as medication adherence. Given that cultural adaptation is the key to successfully implementing any effective self-management intervention, culturally relevant, gender-specific mHealth interventions focusing on HIV-infected AA women are warranted for the future.

  7. Intellectual Capital at Risk: Data Management Practices and Data Loss by Faculty Members at Five American Universities

    Directory of Open Access Journals (Sweden)

    Jaime Schumacher

    2015-06-01

    Full Text Available A study of 56 professors at five American universities found that a majority had little understanding of principles, well-known in the field of data curation, informing the ongoing administration of digital materials and chose to manage and store work-related data by relying on the use of their own storage devices and cloud accounts. It also found that a majority of them had experienced the loss of at least one work-related digital object that they considered to be important in the course of their professional career. Despite such a rate of loss, a majority of respondents expressed at least a moderate level of confidence that they would be able to make use of their digital objects in 25 years. The data suggest that many faculty members are unaware that their data is at risk. They also indicate a strong correlation between faculty members’ digital object loss and their data management practices. University professors producing digital objects can help themselves by becoming aware that these materials are subject to loss. They can also benefit from awareness and use of better personal data management practices, as well as participation in university-level programmatic digital curation efforts and the availability of more readily accessible, robust infrastructure for the storage of digital materials.

  8. Guided Imagery for Stress and Symptom Management in Pregnant African American Women

    Directory of Open Access Journals (Sweden)

    Nancy Jallo

    2014-01-01

    Full Text Available The purpose of this study was to evaluate the efficacy of a guided imagery (GI intervention for stress reduction in pregnant African American women beginning early in the second trimester. This prospective longitudinal study of 72 women used a randomized controlled experimental design with two groups conducted over 12 weeks. The intervention was a CD with 4 professionally recorded tracts designed and sequenced to influence study variables. Participants in both GI and usual care (UC completed measures and donated 5 cc of blood at baseline, 8 weeks and 12 weeks. Participants also completed a daily stress scale. A mixed-effects linear model tested for differences between groups for self-reported measures of stress, anxiety, and fatigue as well as corticotrophin releasing hormone (CRH, a biologic marker of stress. Significant differences in perceived stress daily scores and at week 8 but not week 12 were found in the GI group compared to UC group. The GI group reported significantly less fatigue and anxiety than the UC group at week 8 but not week 12. There were no significant differences in CRH levels between groups. Results suggest that GI intervention may be effective in reducing perceived stress, anxiety, and fatigue measures among pregnant African American women.

  9. 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...

  10. 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%; 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. PMID:27414654

  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. 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.

  13. 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

  14. Foundations of data-intensive science: Technology and practice for high throughput, widely distributed, data management and analysis systems

    Science.gov (United States)

    Johnston, William; Ernst, M.; Dart, E.; Tierney, B.

    2014-04-01

    Today's large-scale science projects involve world-wide collaborations depend on moving massive amounts of data from an instrument to potentially thousands of computing and storage systems at hundreds of collaborating institutions to accomplish their science. This is true for ATLAS and CMS at the LHC, and it is true for the climate sciences, Belle-II at the KEK collider, genome sciences, the SKA radio telescope, and ITER, the international fusion energy experiment. DOE's Office of Science has been collecting science discipline and instrument requirements for network based data management and analysis for more than a decade. As a result of this certain key issues are seen across essentially all science disciplines that rely on the network for significant data transfer, even if the data quantities are modest compared to projects like the LHC experiments. These issues are what this talk will address; to wit: 1. Optical signal transport advances enabling 100 Gb/s circuits that span the globe on optical fiber with each carrying 100 such channels; 2. Network router and switch requirements to support high-speed international data transfer; 3. Data transport (TCP is still the norm) requirements to support high-speed international data transfer (e.g. error-free transmission); 4. Network monitoring and testing techniques and infrastructure to maintain the required error-free operation of the many R&E networks involved in international collaborations; 5. Operating system evolution to support very high-speed network I/O; 6. New network architectures and services in the LAN (campus) and WAN networks to support data-intensive science; 7. Data movement and management techniques and software that can maximize the throughput on the network connections between distributed data handling systems, and; 8. New approaches to widely distributed workflow systems that can support the data movement and analysis required by the science. All of these areas must be addressed to enable large

  15. 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。

  16. ACOG educational bulletin. Management of isoimmunization in pregnancy. American College of Obstetricians and Gynecologists.

    Science.gov (United States)

    1996-11-01

    Isoimmunization is diagnosed by a positive antibody screen and requires identification of the specific antigen responsible, classification of the antigen into either a clinically significant or a benign group, and titration of the level of antibody response. The paternal antigen status and zygosity should be determined whenever possible. Repetitive amniocentesis or fetal blood sampling may be required to monitor the fetal condition adequately. Early and continued consultation with experts in the management of this condition is key to developing an appropriate therapeutic plan that includes proper management at delivery and optimal neonatal support. New technologies and expertise now allow better outcome for severely affected fetuses.

  17. 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

  18. The annual variation in stomatal ammonia compensation point of rye grass ( Lolium perenne L.) leaves in an intensively managed grassland

    Science.gov (United States)

    van Hove, L. W. A.; Heeres, P.; Bossen, M. E.

    The stomatal ammonia compensation point for ammonia (NH 3) of an intensively managed pasture of rye grass ( Lolium perenne L.) was followed from mid January till November 2000. Leaf samples were taken every week. Simultaneously, the ambient NH 3 concentration was measured. Meteorological data (temperature, wind speed, rainfall and radiance) were collected from a nearby field station. The vacuum infiltration technique was used to isolate the apoplastic solution of the leaves. From the determined ammonium (NH 4+) concentration and pH in the apoplast, the gaseous NH 3 concentration inside the leaves was calculated, i.e. the so-called stomatal compensation point ( χs). Temperature appeared to have a predominant effect on χs, partly by affecting the equilibrium between gaseous NH 3 inside the leaf and NH 3 dissolved in the apoplast and partly by affecting physiological processes influencing the NH 4+ concentration in the apoplast. Results of the present study suggest that these temperature effects were counteracting. On one hand temperature increase during early spring stimulated NH 3 volatilisation from the apoplast, on the other hand it led to a decline in apoplastic NH 4+ from 0.9 to 0.2 mM, thereby diminishing the emission potential of the leaf. The low NH 4+ concentrations during spring and summer coincided with a low total leaf N content (rye grass leaves. No annual trend was found for the apoplast pH. With a few exceptions, pH varied between 5.9 and 6.5 throughout the experimental period. The calculated values for χs varied between 0.5 and 4 μg m -3. The gaseous NH 3 concentrations inside the grass leaves were, with a few exceptions, always smaller than the measured ambient NH 3 concentrations. The present study indicates that under the current ambient NH 3 concentrations in the Netherlands, the grass canopy is unlikely to be a major source of NH 3 emission.

  19. 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…

  20. American college of gastroenterology monograph on the management of irritable bowel syndrome.

    Science.gov (United States)

    Camilleri, Michael

    2015-04-01

    This editorial reviews a recently published guideline on management of irritable bowel syndrome. The guideline illustrates problems arising from the quality of clinical trials used in systematic reviews and the potential impact of the inherent weaknesses of those trials on rating the strength of evidence and the resulting recommendations.

  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. Is the self-selected resistance exercise intensity by older women consistent with the American College of Sports Medicine guidelines to improve muscular fitness?

    Science.gov (United States)

    Elsangedy, Hassan M; Krause, Maressa P; Krinski, Kleverton; Alves, Ragami C; Hsin Nery Chao, Cheng; da Silva, Sergio G

    2013-07-01

    The purpose of this study was to verify the self-selected intensity during resistance training (RT) in older women. Twenty healthy women (mean age, 65.6 years) underwent a 2-week familiarization period followed by 3 experimental sessions. During the first session, anthropometric measurements were taken. The second session involved completion of a 1 repetition maximum (1RM) test for the following exercises: chest press, leg press, lat pull-down, leg extension, lateral shoulder raise, leg curl, biceps curl, and triceps pushdown. Last, a single RT session was performed at a self-selected intensity. During the RT session, participants were instructed to self-select a load for performing 3 sets of 10-15 repetitions. Data were analyzed by mean (SD) and analysis of variance with repeated measures (p 0.05). These results indicate that inactive older women self-selected an intensity exercise during RT below the recommendation for improvements on muscle fitness in apparently healthy older adults. However, this intensity is recommended for very deconditioned individuals. Nevertheless, the use of self-selection strategy during an exercise program can have greater advantages because of its easy applicability, its positive relation with exercise adherence, and for promoting initial muscle conditioning in older adults. Furthermore, it is crucial to gradually increase the RT load to guarantee better and sustainable effects on muscle fitness. Finally, future studies are needed to establish the chronic effects of RT at self-selected intensity on muscle fitness and the functional health of older adults.

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

    Energy Technology Data Exchange (ETDEWEB)

    Di Maria, Francesco, E-mail: francesco.dimaria@unipg.it; Micale, Caterina

    2014-11-15

    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.

  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. 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.

  7. Management of trans-boundary water resources: comparing Russian and American experiences

    OpenAIRE

    Lanko Dmitry

    2013-01-01

    This article is based on a comparative analysis of Russia and US’s experience of participation in international cooperation in the field of trans-boundary water management. The author showcases the work of Russian-Estonian Commission for Protection and Rational Use of Trans-Boundary Waters and the US-Canadian International Joint Commission. The Russian-Estonian Commission works in accordance with the principle of intergovernmentalism, whereas transnationalism is the founding principle of the ...

  8. 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.

  9. 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.

  10. 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

  11. 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

  12. Productive performance of Creole chickens and their crosses raised under semi-intensive management conditions in Yucatan, Mexico.

    Science.gov (United States)

    Segura-Correa, J C; Sarmiento-Franco, L; Magaña-Monforte, J G; Santos-Ricalde, R

    2004-06-01

    1. The productive performance of 4 chicken breed groups managed under semi-intensive conditions in Yucatan, Mexico was evaluated. Thirty-six mixed chickens, one week of age of each of the 4 breed groups (Creole, F1 Hubbard x Creole, 7/8 Hubbard x 1/8 Creole and Hubbard) were used. 2. During 1 to 3 weeks of age all birds were fed on a diet containing 210 g/kg crude protein (CP) and 12.95 MJ/kg metabolisable energy (ME). From weeks 4 to 7, they were given a diet with 190 g/kg CP and 12.55 MJ/kg ME. Food consumption and live body weight were recorded weekly. Statistical analysis of the data was performed according to complete randomised design and means comparison using Tukey test was carried out when necessary. 3. Creole chicks had the lightest weights at all ages as compared to their crosses and the Hubbard birds. At 7 weeks of age, Creole chicks were 2.11, 2.44 and 2.90 times lighter than their contemporary F1, 7/8 Hubbard x 1/8 Creole and Hubbard birds, respectively. Hubbard birds were heavier than F1 and 7/8 commercial x 1/8 Creole birds, and the latter group heavier than the F1 birds. Similarly, Creole chicks had the lowest growth rate compared to the other genetic groups. Heterosis for body weight up to 7 weeks of age was 8.2%. 4. Feed consumption was also lower for the Creole chicks at all ages. Food:gain ratio, however, was higher for the Creole chicks at all ages. Food:gain ratios from weeks 2 to 7 were 2.18, 2.65, 3.04 and 4.36 for the Hubbard, 7/8 Hubbard x 1/8 Creole, F1 and Creole birds, respectively. Heterosis for food:gain ratio from 2 to 7 weeks of age was -7.0%. 5. Crossbreeding of Mexican Creole birds with commercial type broilers might improve productive performance.

  13. 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.

  14. 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

  15. 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.

  16. 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.

  17. Management of Trans-boundary Water Resources: Comparing Russian and American Experiences

    Directory of Open Access Journals (Sweden)

    Lanko Dmitry

    2013-03-01

    Full Text Available This article is based on a comparative analysis of Russia and US’s experience of participation in international cooperation in the field of trans-boundary water management. The author showcases the work of Russian-Estonian Commission for Protection and Rational Use of Trans-Boundary Waters and the US-Canadian International Joint Commission. The Russian-Estonian Commission works in accordance with the principle of intergovernmentalism, whereas transnationalism is the founding principle of the International Joint Commission in North America. Though the Russian-Estonian Commission is more efficient in water quality improvement in its area of responsibility, it is early still to claim that intergovernmental cooperation is more effective than transnational cooperation. However, it gives a reason to question the conclusions of the proponents of transnationalism in the international relations theory, who claim that the latter is more efficient. Practical significance of this paper is in the proposed recommendations for further modernization of international cooperation in the field of trans-boundary water management.

  18. On the Edge of Life, I: Assessment of, Reaction to, and Management of the Terminally Ill Recorded in an Intensive Care Unit Journal.

    Science.gov (United States)

    Sekeres, Mikkael A.; Stern, Theodore A.

    2002-10-01

    BACKGROUND: In a general hospital, few clinical settings match the intensity of the intensive care unit (ICU) experience. Clinical rotations in ICUs elicit and emphasize the struggles house officers face on a daily basis throughout their training. METHOD: These struggles were recorded by hundreds of residents in a journal maintained in the Massachusetts General Hospital's Medical ICU for the past 20 years. We systematically reviewed these unsolicited entries to define and to illustrate how house officers respond to caring for terminally ill patients. The 3 overarching topics that surfaced repeatedly were assessment of terminally ill patients, reaction to their prognosis, and management of their disease or their eventual demise. RESULTS: House officers record affective reactions and cognitive assessments to cope with the stress and dysfunction associated with the care of the critically ill and to facilitate their management of these patients. Journal entries by residents reveal a deep concern for the welfare of their patients, conflict about the technological advances and limitations of the system, and reflection on how involved physicians should become with their patients. CONCLUSION: House officer journal entries reflect a combination of newly gained medical knowledge and coping strategies in managing terminally ill patients. House officers also demonstrate a deep concern for the welfare of their patients. Insight from years of reflection from past house officers can help prepare trainees and residency programs for the breadth and intensity of the ICU experience and for work in clinical practice settings that follow completion of training.

  19. 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)

    2012-06-01

    documentation by the physi- cians and nurses who took care of the patients. There was also no clear guidance on ventilator modes such as HFPV and how their...Presence of Bacteremia in Burned Patients Admitted to the Intensive Care Unit Brian K. Hogan, MD,*†‡ Steven E. Wolf, MD,*‡§ Duane R. Hospenthal, MD...criteria’s correlation with bacteremia because bacteremia is not associated with inherent issues of diagnosis as occurs with pneumonia or soft tissue

  20. Quantifying Glosair™ 400 efficacy for surface disinfection of American Type Culture Collection strains and micro-organisms recently isolated from intensive care unit patients.

    Science.gov (United States)

    Herruzo, R; Vizcaíno, M J; Herruzo, I

    2014-07-01

    Microbial contamination of hospital surfaces may be a source of infection for hospitalized patients. We evaluated the efficacy of Glosair™ 400 against two American Type Culture Collection strains and 18 clinical isolates, placed on glass germ-carriers. Carriers were left to air-dry for 60 min and then exposed to a cycle before detection of any surviving micro-organisms. Antibiotic-susceptible Gram-negative bacilli were less susceptible (although not significantly) to this technique than resistant Gram-negative bacilli or Gram-positive cocci and yeasts (3, 3.4 and 4.6 log10 reduction, respectively). In conclusion, in areas that had not been cleaned, aerosolized hydrogen peroxide obtained >3 log10 mean destruction of patients' micro-organisms.

  1. Red blood cell exchange: 2015 American Society for Apheresis consensus conference on the management of patients with sickle cell disease.

    Science.gov (United States)

    Sarode, Ravi; Ballas, Samir K; Garcia, Alicia; Kim, Haewon C; King, Karen; Sachais, Bruce; Williams, Lance A

    2016-10-09

    The American Society for Apheresis (ASFA) conducted a one-day consensus conference on red blood cell exchange (RBCx) in sickle cell disease (SCD) during its annual meeting in San Antonio, TX, on May 5, 2015. The authors of this article, a subcommittee of ASFA's Clinical Applications Committee, developed several questions with regard to pathophysiology of SCD and use of RBCx in the management of various complications. These questions were provided to the seven invited speakers who are the experts in the field of SCD. Two experts in the field moderated the proceedings of the conference, which was attended by more than 150 participants. After each presentation, there was a summary of the main points by the moderators and an open discussion with questions from the audience. A video recording of the proceedings, as well as each presentation, was made available to the authors. Each author's summary was reviewed and approved by the respective speaker before submission of this manuscript. The subcommittee also developed several key questions to generate a consensus amongst the speakers on key issues for using RBCx for patients with SCD.

  2. 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...

  3. 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...

  4. Changes in willingness to self-manage pain among children and adolescents and their parents enrolled in an intensive interdisciplinary pediatric pain treatment program.

    Science.gov (United States)

    Logan, Deirdre E; Conroy, Caitlin; Sieberg, Christine B; Simons, Laura E

    2012-09-01

    The importance of willingness to adopt a self-management approach to chronic pain has been demonstrated in the context of cognitive-behaviorally oriented interdisciplinary pain treatment programs for adults, both as a treatment outcome and as a process that facilitates functional improvements. Willingness to self-manage pain has not been studied in pediatric interdisciplinary pain treatment settings. Study aims were (1) to investigate willingness to self-manage pain among children and parents undergoing intensive interdisciplinary pain treatment and (2) to determine whether increased willingness to self-manage pain influenced functional treatment outcomes. A total of 157 children ages 10 to 18 and their parents enrolled in a pediatric pain rehabilitation program completed the Pain Stages of Change Questionnaire (PSOCQ youth and parent versions) at pretreatment, posttreatment, and short-term follow-up. They also reported on pain, functional disability, depressive symptoms, fear of pain, and use of passive and accommodative coping strategies. Results show that willingness to self-manage pain increased during treatment among both children and parents, with gains maintained at follow-up. Increases in children's readiness to self-manage pain from pretreatment to posttreatment were associated with decreases in functional disability, depressive symptoms, fear of pain, and use of adaptive coping strategies. Increases in parents' readiness to adopt a pain self-management approach were associated with changes in parent-reported fear of pain but not with other child outcomes. Few associations emerged between pretreatment willingness to self-manage pain and posttreatment outcomes. Findings suggest that interdisciplinary pediatric pain rehabilitation may facilitate increased willingness to self-manage pain, which is associated with improvements in function and psychological well-being.

  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. 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.

  7. 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

  8. The perioperative management of antithrombotic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).

    Science.gov (United States)

    Douketis, James D; Berger, Peter B; Dunn, Andrew S; Jaffer, Amir K; Spyropoulos, Alex C; Becker, Richard C; Ansell, Jack

    2008-06-01

    This article discusses the perioperative management of antithrombotic therapy and is part of the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). The primary objectives of this article are the following: (1) to address the perioperative management of patients who are receiving vitamin K antagonists (VKAs) or antiplatelet drugs, such as aspirin and clopidogrel, and require an elective surgical or other invasive procedures; and (2) to address the perioperative use of bridging anticoagulation, typically with low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH). A secondary objective is to address the perioperative management of such patients who require urgent surgery. The recommendations in this article incorporate the grading system that is discussed in this supplement (Guyatt G et al, CHEST 2008; 133:123S-131S). Briefly, Grade 1 recommendations are considered strong and indicate that the benefits do (or do not) outweigh risks, burden, and costs, whereas Grade 2 recommendations are referred to as suggestions and imply that individual patient values may lead to different management choices. The key recommendations in this article include the following: in patients with a mechanical heart valve or atrial fibrillation or venous thromboembolism (VTE) at high risk for thromboembolism, we recommend bridging anticoagulation with therapeutic-dose subcutaneous (SC) LMWH or IV UFH over no bridging during temporary interruption of VKA therapy (Grade 1C); in patients with a mechanical heart valve or atrial fibrillation or VTE at moderate risk for thromboembolism, we suggest bridging anticoagulation with therapeutic-dose SC LMWH, therapeutic-dose IV UFH, or low-dose SC LMWH over no bridging during temporary interruption of VKA therapy (Grade 2C); in patients with a mechanical heart valve or atrial fibrillation or VTE at low risk for thromboembolism, we suggest low-dose SC LMWH or no bridging over bridging with

  9. [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.

  10. 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.

  11. [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.

  12. 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.

  13. Bispectral index monitoring in the management of sedation in an intensive care unit patient with locked-in syndrome.

    Science.gov (United States)

    Quraishi, Sadeq A; Blosser, Sandralee A; Cherry, Robert A

    2011-11-01

    Locked-in syndrome is an extremely rare neurological state caused by injury of the ventral pons. The syndrome is characterized by quadriplegia and anarthria with concomitant preservation of cortical function. When a reversible underlying pathological abnormality is identified and managed aggressively, meaningful recovery is possible. Because patients retain consciousness throughout their illness, a dependable method for titrating sedation may improve their quality of life. The case presented suggests that bispectral index monitoring may be a cost-effective and reliable method for managing sedation in patients with locked-in syndrome.

  14. 强化护理管理对护患关系的影响%Effect of Intensive Nursing Management on Nurse Patient Relationship

    Institute of Scientific and Technical Information of China (English)

    李芬

    2016-01-01

    Objective To investigate the effect of intensive nursing management on the relationship between nurses and patients. Methods 150 patients were taken to strengthen the nursing care, and 150 people were strengthened after nursing management. Divided into observation group and control group, two groups. Results The satisfaction of the control group was higher than that of the observation group.%目的:探讨强化护理管理对护患关系的影响。方法抽取强化护理管前150例,强化护理管理后150例。分为观察组和对照组两组。结果对照组满意度高于观察组。

  15. 美国大学战略管理发展及启示——读《大学战略与规划:美国高等教育管理革命》%Development and Revelation of American Strategic Management of Universities——Reading the Book "Academic Strategy: the Management Revolution in American Higher Education"

    Institute of Scientific and Technical Information of China (English)

    李雄鹰

    2011-01-01

    American higher education has been into a dilemma of development in the 1980s.However,in the process of dealing with the dilemma,American universities and academies successfully introduce the strategic management into higher education,and explore the successful experience of university implementing the strategic management,which is imitated by universities of countries in the world.Through reading a book of American strategic management of universities,we know the developing process and characteristics of American strategic management of universities,which contributes to knowing the essence of strategic management and researching the current strategic management of universities in China.%美国高等教育在20世纪80年代陷入发展困境,但就是在应对困境的过程中,美国大学和学院成功地将战略管理引用到高等教育领域,探索出了大学实施战略管理的成功经验,被世界各国大学效仿。通过读美国大学战略管理方面的著作,了解美国大学战略管理的发展历程及特点,有助于我们了解战略管理的实质,也有助于研究我国当前的大学战略管理。

  16. Tree fruit IPM programs in the western United States: the challenge of enhancing biological control through intensive management

    Science.gov (United States)

    The work of Stern and colleagues on integrated control has had long-lasting effects on development of IPM programs in orchard systems. Management systems based solely on pesticides have proven to be unstable, and the success of IPM systems in orchards has been driven by the conservation of natural ...

  17. 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

  18. 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.

  19. 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.

  20. 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.

  1. 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

  2. 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

  3. Influence of thinning intensity and canopy type on Scots pine stand and growth dynamics in a mixed managed forest

    Energy Technology Data Exchange (ETDEWEB)

    Primicia, I.; Artázcoz, R.; Imbert, J.B.; Puertas, F.; Traver, M.C.; Castillo, F.J.

    2016-07-01

    Aim of the study: We analysed the effects of thinning intensity and canopy type on Scots pine growth and stand dynamics in a mixed Scots pine-beech forest. Area of the study: Western Pyrenees. Material and methods: Three thinning intensities were applied in 1999 (0, 20 and 30% basal area removed) and 2009 (0, 20 and 40%) on 9 plots. Within each plot, pure pine and mixed pine-beech patches are distinguished. All pine trees were inventoried in 1999, 2009 and 2014. The effects of treatments on the tree and stand structure variables (density, basal area, stand and tree volume), on the periodic annual increment in basal area and stand and tree volume, and on mortality rates, were analysed using linear mixed effects models. Main Results: The enhancement of tree growth was mainly noticeable after the second thinning. Growth rates following thinning were similar or higher in the moderate than in the severe thinning. Periodic stand volume annual increments were higher in the thinned than in the unthinned plots, but no differences were observed between the thinned treatments. We observed an increase in the differences of the Tree volume annual increment between canopy types (mixed < pure) over time in the unthinned plots, as beech crowns developed. Research highlights: Moderate thinning is suggested as an appropriate forest practice at early pine age in these mixed forests, since it produced higher tree growth rates than the severe thinning and it counteracted the negative effect of beech on pine growth observed in the unthinned plots. (Author)

  4. 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.

  5. 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

  6. 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 < 0.05); less patients suffered circuit coagulation with inability to return the blood to the patient (25 patients [46.3%] vs. 16 patients [22.2%]; p < 0.05); 54 patients (100%) versus 5 (6.94%) did not get phosphorus levels monitoring (p < 0.05); in 14 patients (25.9%) versus 0 (0%), the CRRT prescription did not appear on medical orders. As a measure of improvement, we adopt a dynamic dosage management. After the 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.

  7. Birth to weaning kid traits from a complete diallel of Boer, Kiko, and Spanish meat goat breeds semi-intensively managed on humid subtropical pasture.

    Science.gov (United States)

    Browning, R; Leite-Browning, M L

    2011-09-01

    Boer, Kiko, and Spanish meat goats were semi-intensively managed in a complete 3-breed diallel mating scheme to evaluate genetic effects on preweaning kid performance. Over a 6-yr period, 1,547 kids were born in March and May with 1,173 kids raised by their dams to weaning at 3 mo of age. March-born kids were lighter (P Kiko and Spanish. The direct Kiko effect for preweaning ADG was positive (P 0.10). Maternal Boer effects were negative (P Kiko effects were significantly (P 0.5) for preweaning ADG or weaning weight. Heterosis for birth weight was exhibited (P Kiko for ADG and weaning weight. Kiko and Spanish dams had greater (P Kiko or Spanish for preweaning kid performance when semi-intensively managed on humid, subtropical pasture. Kiko should be a preferred breed and to a lesser extent Spanish for enhancing birth to weaning kid performance. Findings of this study emphasize the importance of proper doe breed selection in achieving desired kid performance to weaning in meat goats.

  8. Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care – short version

    Directory of Open Access Journals (Sweden)

    Kleinschmidt, Stefan

    2010-02-01

    Full Text Available Targeted monitoring of analgesia, sedation and delirium, as well as their appropriate management in critically ill patients is a standard of care in intensive care medicine. With the undisputed advantages of goal-oriented therapy established, there was a need to develop our own guidelines on analgesia and sedation in intensive care in Germany and these were published as 2nd Generation Guidelines in 2005. Through the dissemination of these guidelines in 2006, use of monitoring was shown to have improved from 8 to 51% and the use of protocol-based approaches increased to 46% (from 21%.Between 2006–2009, the existing guidelines from the DGAI (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin and DIVI (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin were developed into 3rd Generation Guidelines for the securing and optimization of quality of analgesia, sedation and delirium management in the intensive care unit (ICU. In collaboration with another 10 professional societies, the literature has been reviewed using the criteria of the Oxford Center of Evidence Based Medicine. Using data from 671 reference works, text, diagrams and recommendations were drawn up. In the recommendations, Grade “A” (very strong recommendation, Grade “B” (strong recommendation and Grade “0” (open recommendation were agreed.As a result of this process we now have an interdisciplinary and consensus-based set of 3rd Generation Guidelines that take into account all critically illness patient populations.The use of protocols for analgesia, sedation and treatment of delirium are repeatedly demonstrated. These guidelines offer treatment recommendations for the ICU team. The implementation of scores and protocols into routine ICU practice is necessary for their success.

  9. Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care – short version

    Science.gov (United States)

    Martin, Jörg; Heymann, Anja; Bäsell, Katrin; Baron, Ralf; Biniek, Rolf; Bürkle, Hartmut; Dall, Peter; Dictus, Christine; Eggers, Verena; Eichler, Ingolf; Engelmann, Lothar; Garten, Lars; Hartl, Wolfgang; Haase, Ulrike; Huth, Ralf; Kessler, Paul; Kleinschmidt, Stefan; Koppert, Wolfgang; Kretz, Franz-Josef; Laubenthal, Heinz; Marggraf, Guenter; Meiser, Andreas; Neugebauer, Edmund; Neuhaus, Ulrike; Putensen, Christian; Quintel, Michael; Reske, Alexander; Roth, Bernard; Scholz, Jens; Schröder, Stefan; Schreiter, Dierk; Schüttler, Jürgen; Schwarzmann, Gerhard; Stingele, Robert; Tonner, Peter; Tränkle, Philip; Treede, Rolf Detlef; Trupkovic, Tomislav; Tryba, Michael; Wappler, Frank; Waydhas, Christian; Spies, Claudia

    2010-01-01

    Targeted monitoring of analgesia, sedation and delirium, as well as their appropriate management in critically ill patients is a standard of care in intensive care medicine. With the undisputed advantages of goal-oriented therapy established, there was a need to develop our own guidelines on analgesia and sedation in intensive care in Germany and these were published as 2nd Generation Guidelines in 2005. Through the dissemination of these guidelines in 2006, use of monitoring was shown to have improved from 8 to 51% and the use of protocol-based approaches increased to 46% (from 21%). Between 2006–2009, the existing guidelines from the DGAI (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin) and DIVI (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin) were developed into 3rd Generation Guidelines for the securing and optimization of quality of analgesia, sedation and delirium management in the intensive care unit (ICU). In collaboration with another 10 professional societies, the literature has been reviewed using the criteria of the Oxford Center of Evidence Based Medicine. Using data from 671 reference works, text, diagrams and recommendations were drawn up. In the recommendations, Grade “A” (very strong recommendation), Grade “B” (strong recommendation) and Grade “0” (open recommendation) were agreed. As a result of this process we now have an interdisciplinary and consensus-based set of 3rd Generation Guidelines that take into account all critically illness patient populations. The use of protocols for analgesia, sedation and treatment of delirium are repeatedly demonstrated. These guidelines offer treatment recommendations for the ICU team. The implementation of scores and protocols into routine ICU practice is necessary for their success. PMID:20200655

  10. 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.

  11. 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.

  12. 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

  13. Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. American Academy of Allergy, Asthma, and Immunology.

    Science.gov (United States)

    Dykewicz, M S; Fineman, S; Skoner, D P; Nicklas, R; Lee, R; Blessing-Moore, J; Li, J T; Bernstein, I L; Berger, W; Spector, S; Schuller, D

    1998-11-01

    This document contains complete guidelines for diagnosis and management of rhinitis developed by the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology, representing the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology and the Joint Council on Allergy, Asthma and Immunology. The guidelines are comprehensive and begin with statements on clinical characteristics and diagnosis of different forms of rhinitis (allergic, non-allergic, occupational rhinitis, hormonal rhinitis [pregnancy and hypothyroidism], drug-induced rhinitis, rhinitis from food ingestion), and other conditions that may be confused with rhinitis. Recommendations on patient evaluation discuss appropriate use of history, physical examination, and diagnostic testing, as well as unproven or inappropriate techniques that should not be used. Parameters on management include use of environmental control measures, pharmacologic therapy including recently introduced therapies and allergen immunotherapy. Because of the risks to patients and society from sedation and performance impairment caused by first generation antihistamines, second generation antihistamines that reduce or eliminate these side effects should usually be considered before first generation antihistamines for the treatment of allergic rhinitis. The document emphasizes the importance of rhinitis management for comorbid conditions (asthma, sinusitis, otitis media). Guidelines are also presented on special considerations in patients subsets (children, the elderly, pregnancy, athletes and patients with rhinitis medicamentosa); and when consultation with an allergist-immunologist should be considered.

  14. 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.

  15. 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...

  16. 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...

  17. 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.

  18. 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.

  19. American Red Cross Digital Operations Center (DigiDOC): an essential emergency management tool for the digital age.

    Science.gov (United States)

    Markenson, David; Howe, Laura

    2014-10-01

    Social media is becoming the first source of information and also the first way to communicate messages. Because social media users will take action based on the information they are seeing, it is important that organizations like the Red Cross be active in the social space. We describe the American Red Cross's concept for a Digital Operations Center (DigiDOC) that we believe should become an essential part of all emergency operations centers and a key piece of all agencies that operate in disasters. The American Red Cross approach is a practical and logical approach that other agencies can use as a model.

  20. 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...

  1. 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.

  2. 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.

  3. Management of the Potential Organ Donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement.

    Science.gov (United States)

    Kotloff, Robert M; Blosser, Sandralee; Fulda, Gerard J; Malinoski, Darren; Ahya, Vivek N; Angel, Luis; Byrnes, Matthew C; DeVita, Michael A; Grissom, Thomas E; Halpern, Scott D; Nakagawa, Thomas A; Stock, Peter G; Sudan, Debra L; Wood, Kenneth E; Anillo, Sergio J; Bleck, Thomas P; Eidbo, Elling E; Fowler, Richard A; Glazier, Alexandra K; Gries, Cynthia; Hasz, Richard; Herr, Dan; Khan, Akhtar; Landsberg, David; Lebovitz, Daniel J; Levine, Deborah Jo; Mathur, Mudit; Naik, Priyumvada; Niemann, Claus U; Nunley, David R; O'Connor, Kevin J; Pelletier, Shawn J; Rahman, Omar; Ranjan, Dinesh; Salim, Ali; Sawyer, Robert G; Shafer, Teresa; Sonneti, David; Spiro, Peter; Valapour, Maryam; Vikraman-Sushama, Deepak; Whelan, Timothy P M

    2015-06-01

    This document was developed through the collaborative efforts of the Society of Critical Care Medicine, the American College of Chest Physicians, and the Association of Organ Procurement Organizations. Under the auspices of these societies, a multidisciplinary, multi-institutional task force was convened, incorporating expertise in critical care medicine, organ donor management, and transplantation. Members of the task force were divided into 13 subcommittees, each focused on one of the following general or organ-specific areas: death determination using neurologic criteria, donation after circulatory death determination, authorization process, general contraindications to donation, hemodynamic management, endocrine dysfunction and hormone replacement therapy, pediatric donor management, cardiac donation, lung donation, liver donation, kidney donation, small bowel donation, and pancreas donation. Subcommittees were charged with generating a series of management-related questions related to their topic. For each question, subcommittees provided a summary of relevant literature and specific recommendations. The specific recommendations were approved by all members of the task force and then assembled into a complete document. Because the available literature was overwhelmingly comprised of observational studies and case series, representing low-quality evidence, a decision was made that the document would assume the form of a consensus statement rather than a formally graded guideline. The goal of this document is to provide critical care practitioners with essential information and practical recommendations related to management of the potential organ donor, based on the available literature and expert consensus.

  4. Geostatistical approach for management of soil nutrients with special emphasis on different forms of potassium considering their spatial variation in intensive cropping system of West Bengal, India.

    Science.gov (United States)

    Chatterjee, Sourov; Santra, Priyabrata; Majumdar, Kaushik; Ghosh, Debjani; Das, Indranil; Sanyal, S K

    2015-04-01

    indicates reserve native K exploitation under intensive cultivation. These maps highlight the necessity of estimating the other soil K fractions as well for better understanding of soil K supplying capacity and K fertilization strategy rather than the current recommendations, based on the plant-available K alone. In conclusion, the present study revealed that the variability of nutrient distribution was a consequence of complex interactions between the cropping system, nutrient application rates, and the native soil characteristics, and such interactions could be utilized to develop the nutrient management strategies for intensive small-holder system.

  5. 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.

  6. 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.

  7. Medical advice and diabetes self-management reported by Mexican-American, Black- and White-non-Hispanic adults across the United States

    Directory of Open Access Journals (Sweden)

    Vaccaro Joan A

    2012-03-01

    Full Text Available Abstract Background Diabetes has reached epidemic proportions in the United States, particularly among minorities, and if improperly managed can lead to medical complications and death. Healthcare providers play vital roles in communicating standards of care, which include guidance on diabetes self-management. The background of the client may play a role in the patient-provider communication process. The aim of this study was to determine the association between medical advice and diabetes self care management behaviors for a nationally representative sample of adults with diabetes. Moreover, we sought to establish whether or not race/ethnicity was a modifier for reported medical advice received and diabetes self-management behaviors. Methods We analyzed data from 654 adults aged 21 years and over with diagnosed diabetes [130 Mexican-Americans; 224 Black non-Hispanics; and, 300 White non-Hispanics] and an additional 161 with 'undiagnosed diabetes' [N = 815(171 MA, 281 BNH and 364 WNH] who participated in the National Health and Nutrition Examination Survey (NHANES 2007-2008. Logistic regression models were used to evaluate whether medical advice to engage in particular self-management behaviors (reduce fat or calories, increase physical activity or exercise, and control or lose weight predicted actually engaging in the particular behavior and whether the impact of medical advice on engaging in the behavior differed by race/ethnicity. Additional analyses examined whether these relationships were maintained when other factors potentially related to engaging in diabetes self management such as participants' diabetes education, sociodemographics and physical characteristics were controlled. Sample weights were used to account for the complex sample design. Results Although medical advice to the patient is considered a standard of care for diabetes, approximately one-third of the sample reported not receiving dietary, weight management, or physical

  8. Case Report: Use of reinforced buccal mucosa graft over gracilis muscle flap in management of post high intensity focused ultrasound (HIFU) rectourethral fistula

    Science.gov (United States)

    Jai, Shrikant; Ganpule, Arvind; Singh, Abhishek; Vijaykumar, Mohankumar; Bopaiah, Vinod; Sabnis, Ravindra; Desai, Mahesh

    2017-01-01

    High intensity focused ultrasound (HIFU) has come forward as alternative treatment for carcinoma of the prostate. Though minimally invasive,HIFUhas potential side effects. Urethrorectal fistula is one such rare side effect. Management of these fistulas has been described by Vanni et al. This case report describes points of technique that will help successful management of resilient rectourethral fistula. Urinary and faecal diversion in the form of suprapubic catheter and colostomy is vital. Adequate time between stoma formation, fistula closure and then finally stoma closure is needed. Lithotomy position and perineal approach gives best exposure to the fistula. The rectum should be dissected 2cm above the fistula; this aids in tension free closure of the rectal defect. Similarly buccal mucosal graft was used on the urethra to achieve tension free closure. A good vascular pedicle gracilis muscle flap is used to interpose between the two repairs. This not only provides a physical barrier but also provides a vascular bed for BMG uptake. Perfect haemostasis is essential, as any collection may become a site of infection thus compromising results.  We strongly recommend rectourethral fistula be directly repaired with gracilis muscle flap with reinforced buccal mucosa graft without attempting any less invasive repairs because the “first chance is the best chance”. PMID:28299181

  9. 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.

  10. A Study of 358 Cases of Locally Advanced Nasopharyngeal Carcinoma Receiving Intensity-Modulated Radiation Therapy: Improving the Seventh Edition of the American Joint Committee on Cancer T-Staging System

    Directory of Open Access Journals (Sweden)

    Qin Zhou

    2017-01-01

    Full Text Available To evaluate the rationality and limitations of the seventh edition of the American Joint Committee on Cancer (the 7th AJCC edition T-staging system for locally advanced nasopharyngeal carcinoma (NPC. The prognosis of 358 patients with stage T3/T4 NPC treated with intensity-modulated radiotherapy (IMRT was analyzed with the Kaplan–Meier method or the log-rank test. The 7th AJCC staging system of NPC has some limitations in that the T category is neither the significant factor in OS/LRFS nor the independent prognostic factor in OS/LRFS/DMFS/DFS (P>0.05. After adjustment by anatomic structures, univariate analysis has shown that the adjusted-T category has statistical significance between T3 and T4 for OS (86.4% and 71.3%, P=0.002, LRFS (97% and 90.9%, P=0.048, DMFS (90.9% and 77.2%, P=0.001, and DFS (86.2% and 67.5%, P=0.000, and multivariate analysis has shown that the adjusted-T category is an independent prognostic factor for OS/DMFS/DFS (with the exception of LRFS. Then, GTV-P was taken into consideration. Multivariate analysis showed that these nT categories serve as suitable independent prognostic factors for OS/DMFS/DFS (P<0.001 and LRFS (HR = 3.131; 95% CI, 1.090–8.990; P=0.043. The 7th AJCC staging system has limitations and should be improved by including the modifications suggested, such as anatomic structures and tumor volume adjustment.

  11. 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.

  12. 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.

  13. Sound Intensity

    DEFF Research Database (Denmark)

    Crocker, M.J.; Jacobsen, Finn

    1997-01-01

    This chapter is an overview, intended for readers with no special knowledge about this particular topic. The chapter deals with all aspects of sound intensity and its measurement from the fundamental theoretical background to practical applications of the measurement technique....

  14. The combined effects of nitrification inhibitor and biochar incorporation on yield-scaled N2O emissions from an intensively managed vegetable field in southeastern China

    Science.gov (United States)

    Li, B.; Fan, C. H.; Xiong, Z. Q.; Li, Q. L.; Zhang, M.

    2015-03-01

    An experiment was conducted to study the influences of nitrification inhibitor (NI) and biochar incorporation on yield-scaled N2O using the static chamber method and gas chromatography in an intensively managed vegetable field with seven consecutive vegetable crops from 2012 to 2014 in southeastern China. With an equal annual nitrogen (N) application rate (1217 kg N ha-1 yr-1), six treatments under three biochar amendment rates - namely, 0 t ha-1 (C0), 20 t ha-1 (C1) and 40 t ha-1 (C2) - with compound fertilizer (CF) or urea mixed with NI of nitrapyrin as chlorinated pyridine (CP) were studied in these field experiments. The results showed that, although there was no significant influence on soil organic carbon (SOC) content or total nitrogen (TN), nitrapyrin could result in a significant increase in soil pH during the experimental period. Nitrapyrin significantly decreased cumulative N2O emissions by 15.9-32.1% while increasing vegetable yield by 9.8-41.9%. Thus, it also decreased yield-scaled N2O emissions significantly. In addition to the differential responses of the soil pH, biochar amendment significantly increased SOC and TN. Compared with the treatments without biochar addition, the cumulative N2O emissions showed no significant difference in the CF or the CP group treatments but increased slightly (not significantly) by 7.9-18.3% in the CP group treatments. Vegetable yield was enhanced by 7.1-49.5% in the CF group treatments compared with the treatments without biochar amendment, while there was no significant difference in the CP group treatments, and the yield-scaled N2O emissions were thus decreased significantly. Furthermore, treatments involving with nitrapyrin and biochar incorporation slightly increased yield-scaled N2O emissions by 9.4%, on average, compared with CP-C0. Therefore, the application of nitrapyrin could serve as an appropriate practice for increasing vegetable yield and mitigating N2O emissions in intensively managed vegetable fields

  15. The combined effects of nitrification inhibitor and biochar incorporation on yield-scaled N2O emissions from an intensively managed vegetable field in southeastern China

    Directory of Open Access Journals (Sweden)

    B. Li

    2014-10-01

    Full Text Available The influences of nitrification inhibitor (NI and biochar incorporation on yield-scaled N2O in a vegetable field were studied using the static chamber method and gas chromatography. An experiment was conducted in an intensively managed vegetable field with 7 consecutive vegetable crops in 2012–2014 in southeastern China. With equal annual amounts of N (1217.3 kg N ha−1 yr−1, 6 treatments under 3 biochar amendment rates, namely, 0 t ha−1 (C0, 20 t ha−1 (C1, and 40 t ha−1 (C2, with compound fertilizer (CF or urea mixed with chlorinated pyridine (CP as NI, were studied in these field experiments. The results showed that although no significant influence on soil organic carbon (SOC content or total nitrogen (TN, CP could result in a significant increase in soil pH during the experimental period. CP significantly decreased cumulative N2O emissions by 15.9–32.1% while increasing vegetable yield by 9.8–41.9%. Thus, it also decreased yield-scaled N2O emissions significantly. In addition to the differential responses of the soil pH, biochar amendment significantly increased SOC and TN. Additionally, compared with the treatments without biochar addition, cumulative N2O emissions showed no significant difference in the CF or the CP group treatments but increased slightly (but not significantly by 7.9–18.3% in the CP group treatments. Vegetable yield was enhanced by 7.1–49.5% compared with the treatments without biochar amendment, and the yield-scaled N2O emissions were thus decreased significantly. Furthermore, treatments applied with CP and biochar incorporation slightly increased yield-scaled N2O emissions by 9.4%, on average, compared with CP-C0. Therefore, the incorporation of CP could serve as an appropriate practice for increasing vegetable yield and mitigating N2O emissions in intensively managed vegetable fields and should be further examined in various agroecosystems.

  16. 美国高校管理队伍建设的经验与借鉴%Experience and Reference of American University Management Team Building

    Institute of Scientific and Technical Information of China (English)

    王为民

    2016-01-01

    American colleges and universities have accumulated a lot of experiences in the management team building, so we can draw lessons from the precious experience during the process of our management team building in universities and combine it with actual situation in Chinese higher education, so as to explore a suitable path for China's university management team building.%美国高校在管理队伍建设过程中,积累了许多丰富的经验,如美国的一些高校,在选聘制度、分类制度、考评制度和培训制度等四个方面都有非常好的做法。我国高校应结合我国国情及校情,借鉴其宝贵的经验,通过改革分类制度、转换用人机制,完善考核评价管理体系等,探索一条适合我国高校管理队伍建设的道路。

  17. A randomized clinical trial of diabetes self-management for Mexican Americans: Are there serendipitous health benefits for supporters of study participants?

    Directory of Open Access Journals (Sweden)

    Sharon A Brown

    2017-01-01

    Full Text Available Objectives: Studies of social support in diabetes have focused on the effects of support on the person with type 2 diabetes. We explored diabetes prevention effects of a culturally tailored diabetes self-management intervention in individuals without diabetes who were supporters of intervention participants. Methods: This is a secondary analysis of data from a randomized clinical trial that involved 256 Mexican Americans with diabetes. Each study participant designated a supporter—spouse, relative, friend—who attended intervention sessions and assisted participants in attaining effective diabetes self-management. Supporter’s glycosylated hemoglobin (A1C data were tracked for 1 year to determine diabetes conversion rates in supporters without diabetes at baseline. Results: Fewer individuals in the intervention group (n = 9 converted to an A1C above the 7% threshold, compared to the 1-year wait-listed control group (n = 16. We found a statistically significant difference (p = .021 at 12 months in the number of individuals whose A1C was ⩽8%, with fewer supporters above threshold in the intervention group (reduction of 48%. Supporters in the intervention group with prediabetes, based on baseline A1C, experienced a slight reduction in A1C, while control group supporters with prediabetes experienced an increase. Discussion: The results suggest that there are potential benefits for family members and other supporters of persons with diabetes who participated in diabetes self-management programs.

  18. 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.

  19. 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.

  20. Intracranial Pressure Monitoring as a Part of Multimodal Monitoring Management of Patients with Critical Polytrauma: Correlation between Optimised Intensive Therapy According to Intracranial Pressure Parameters and Clinical Picture

    Science.gov (United States)

    Luca, Loredana; Rogobete, Alexandru Florin; Bedreag, Ovidiu Horea; Sarandan, Mirela; Cradigati, Carmen Alina; Papurica, Marius; Gruneantu, Anelore; Patrut, Raluca; Vernic, Corina; Dumbuleu, Corina Maria; Sandesc, Dorel

    2015-01-01

    Objective Trauma patient requires a complex therapeutic management because of multiple severe injuries or secondary complications. The most significant injury found in patients with trauma is head injury, which has the greatest impact on mortality. Intracranial pressure (ICP) monitoring is required in severe traumatic head injury because it optimises treatment based on ICP values and cerebral perfusion pressure (CPP). Methods From a total of 64 patients admitted in the intensive care unit (ICU) ‘Casa Austria’, from the Polytraumatology Clinic of the Emergency County Hospital “Pius Brinzeu” Timisoara, Romania, between January 2014 and December 2014; only patients who underwent ICP monitoring (n=10) were analysed. The study population was divided into several categories depending on the time passed since trauma to the time of installation of ICP monitoring (24 h). Comparisons were made in terms of the number of days admitted in the ICU and mortality between patients with head injury who benefited and those who did not benefit from ICP monitoring. Results The results show the positive influence of ICP monitoring on the number of admission days in ICU because of the possibility that the number of admission days to augment therapeutic effects in patients who benefited from ICP monitoring reduces by 1.93 days compared with those who did not undergo ICP monitoring. Conclusion ICP monitoring and optimizing therapy according to the ICP and CPP has significant influence on the rate of survival. ICP monitoring is necessary in all patients with head trauma injury according to recent guidelines. The main therapeutic goal in the management of the trauma patient with head injury is to minimize the destructive effects of the associated side effects. PMID:27366538

  1. A Brief Cognitive-Behavioral Psycho-Education (B-CBE Program for Managing Stress and Anxiety of Main Family Caregivers of Patients in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Vico Chung Lim Chiang

    2016-09-01

    Full Text Available Having a loved one in the intensive care unit (ICU is a stressful event, which may cause a high level of anxiety to the family members. This could threaten their wellbeing and ability to support the patients in, or after discharge from, the ICU. To investigate the outcomes of a brief cognitive-behavioral psycho-education program (B-CBE to manage stress and anxiety of the main family caregivers (MFCs, a pragmatic quasi-experimental study involving 45 participants (treatment group: 24; control group: 21 was conducted in an ICU. The Depression and Anxiety Stress Scale and the Critical Care Family Need Inventory were used to evaluate the primary outcomes on stress and anxiety, and satisfaction with family needs. The treatment group reported significantly better improvement in the information satisfaction score compared to the control group (p < 0.05; η2 = 0.09. Overall main effects were observed on the stress (p < 0.01; η2 = 0.20, anxiety (p < 0.01; η2 = 0.18, depression (p < 0.05; η2 = 0.13, support satisfaction (p < 0.05; η2 = 0.13, and comfort satisfaction (p < 0.05; η2 = 0.11 scores. The experience of this study suggest that MFCs are in great need of additional support like B-CBE to manage their stress and anxiety. Given the brevity of B-CBE, it is practical for critical care nurses to deliver and MFCs to take within the industrious context of an ICU. More studies are needed to investigate these types of brief psychological interventions.

  2. 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.

  3. 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.

  4. 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.

  5. 重症监护室护理风险分析与防范管理%Risk Analysis and Prevention Management in Intensive Care Nursing

    Institute of Scientific and Technical Information of China (English)

    靳晶

    2015-01-01

    目的:分析重症监护室(ICU)存在的护理风险,探讨降低风险的管理措施。方法对ICU护理人员进行严格、系统的专业培训,强化其护理风险防范意识以及护理风险管理措施的实施并考核。比较干预前后的护理质量(基本理论水平、实践操作技能、护理记录的书写质量、患者满意度)和护理风险发生率(医疗差错发生率、院内感染发生率)。结果护理风险管理措施实施后,护理人员的基本理论水平、实践操作技能、护理记录的书写质量、患者满意度均明显提高(P<0.05)。医疗差错发生率、院内感染发生率明显下降(P<0.05)。结论 ICU科室加强护理风险防范管理,可提高护理业务水平,降低护理风险,减少医疗差错、降低院内感染的发生率,提高患者满意度。%Objective To analyze the nursing risk in Intensive Care Unit (ICU) of hospital, explore the management measures of nursing risk.Methods Nursing staff in ICU strict were accepted with systematic and comprehensive professional knowledge training, strengthen their nursing risk awareness and implemented the nursing risk management measures and then inspected it’s results. Compare the results of nursing risk management measures between the before and after, including the ICU nursing quality indicators (indexes: basic theoretical level and practical operation skills, writing of nursing record quality, patient satisfaction) and the incidence of nursing risk ( indexes: medical error rates, incidence of nosocomial infection).Results By the implementation of nursing risk management measures, the basic theory level of nursing staff and their practical operation skills, also nursing record writing quality and patient satisfaction were all increased significantly (P<0.05). Medical error rates, incidence of nosocomial infection were decreased significantly(P<0.05).Conclusion Implementing the nursing risk management

  6. Impact of parental weight status on a school-based weight management programme designed for Mexican-American children

    Science.gov (United States)

    While overweight and obese children are more likely to have overweight or obese parents, less is known about the effect of parental weight status on children's success in weight management programmes. This study was a secondary data analysis of a randomized controlled trial and investigated the impa...

  7. 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

  8. Hydrological Modeling of Storm Water Drainage System due to Frequent and Intense Precipitation of Dhaka city using Storm Water Management Model (SWMM)

    Science.gov (United States)

    Hossain, S., Jr.

    2015-12-01

    Rainfall induced flooding during rainy season is a regular phenomenon in Dhaka City. Almost every year a significant part of the city suffers badly with drainage congestion. There are some highly dense areas with lower ground elevation which submerge under water even with an intense precipitation of few hours. The higher areas also suffer with the drainage problem due to inadequate maintenance of the system and encroachment or illegal filling up of the drainage canals and lakes. Most part of the city suffered from long term urban flooding during historical extreme rainfall events in September 2004, 2007 and July 2009. The situation is likely to worsen in the future due to Climate Change, which may lead to more frequent and intense precipitation. To assess the major and minor drainage systems and elements of the urban basins using the hydrodynamic modelling and, through this, identifying the flooding events and areas, taking into account the current situation and future flood or drainage scenarios. Stormwater modeling has a major role in preventing issues such as flash floods and urban water-quality problems. Stormwater models of a lowered spatial resolution would thus appear valuable if only their ability to provide realistic results could be proved. The present scenario of urban morphology of Dhaka city and existing drainage system is complex for hydrological and hydrodynamic modeling. Furthermore limitations of background data and uncertain future urban scenarios may confine the potential outputs of a model. Although several studies were carried out including modeling for drainage master planning, a detail model for whole DAP (Detaile Area Plan) of Dhaka city area is not available. The model developed under this study is covering the existing drainage system in the study area as well as natural flows in the fringe area. A good number of models are available for hydrological and hydraulic analysis of urban areas. These are MIKE 11, MOUSE, HEC-RAS, HEC HMS and EPA

  9. 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

  10. The Development of Legalization of Student Management in American Public Universities and Its Revelation:From the Perspective of In Loco Parentis Extinction%Journal of Higher Education Management

    Institute of Scientific and Technical Information of China (English)

    桂敏

    2016-01-01

    The doctrine of In Loco Parentis was the dominant doctrine in the legal history of the rela-tionship between American universities & colleges and students for a long time.Until 1960s this doc-trine moves to demise gradually.In this paper,the author briefly describes the history of In Loco Pa-rentis,uses typical cases to analyze the process of judicial review intervention of student management in American public universities,and finds that judicial review will not violate the autonomy of univer-sity necessarily,whereas limited judicial review can help student management become more constitu-tional and rational,and thus protect students′rights more effectively.In this paper,the author also generalizes the experience of student management in American public universities and provides advice to complete relative laws in China.%在美国高校与学生的法律关系史上“代理父母地位说”长期处于主导地位,直到20世纪60年代其地位才发生了动摇,并走向衰亡。文章从“代理父母地位说”发展历史入手,选取典型案例,对司法审查介入美国公立大学的学生管理程序进行分析,认为司法审查并不必然破坏大学的自治权,有限的司法监督可以帮助大学的治理程序合理合宪,有效保障学生权利。同时文章通过总结美国公立大学学生管理的有效经验,进而为我国完善相关立法提供一定的借鉴。

  11. Carcass yield traits of kids from a complete diallel of Boer, Kiko, and Spanish meat goat breeds semi-intensively managed on humid subtropical pasture.

    Science.gov (United States)

    Browning, R; Phelps, O; Chisley, C; Getz, W R; Hollis, T; Leite-Browning, M L

    2012-03-01

    Bucklings (n = 275) from a complete diallel of Boer, Kiko, and Spanish meat goats were slaughtered at 7 mo of age (4 mo postweaning) to evaluate genetic effects on carcass yield. Breed of sire did not affect (P > 0.05) live, carcass, and primal weights. Conversely, breed of dam was a consistently significant source of variation for carcass weight traits. Kiko dams produced kids with heavier (P Kiko with the significance of differences varying by trait. Cold carcass dressing percent was affected (P Kiko and Spanish sires. Dressing percent was also less (P Kiko dams; Spanish dams were intermediate and did not differ (P > 0.05) from Boer or Kiko. Subjective conformation scores for muscularity were affected (P Kiko-sired kids. Progeny of Boer dams had better (P Kiko-sired and Spanish-sired kids. Breed differences for primal cut proportions were negligible. Proportional boneless meat yields did not vary (P > 0.05) by breeds of sire or dam. Direct effects of Boer were negative for carcass weight, dressing percent, and shoulder weight and positive for proportional leg weight. Direct effects of Kiko were positive for carcass weight and shoulder weight and negative for proportional leg weight. Direct effects of Spanish did not differ (P > 0.10) from 0 for any trait tested. Heterosis levels were similar among breed pairings. Heterosis was substantial (P ≤ 0.05) for live, carcass, and primal weights (5 to 9%) but not for dressing percent, proportional boneless meat yield, or primal weight proportions (Kiko or Spanish germplasm for carcass yield when semi-intensively managed on humid, subtropical pasture. Results emphasize the importance of comparative breed evaluations to provide industry with reliable information on carcass yield among goat genotypes.

  12. Performance and Parasitology of Semi-intensively Managed West African Dwarf Sheep Exposed to Gastrointestinal Helminth Infect-ed Paddocks and Varied Protein-energy Feeds

    Directory of Open Access Journals (Sweden)

    Adekayode Olarinwaju SONIBARE

    2016-12-01

    Full Text Available Background: The performance and parasitology of semi-intensively managed West African dwarf (WAD lambs were evaluated following exposure to gastrointestinal helminth infected paddock and varied protein-energy feeds.Methods: Twenty four lambs obtained from the Department of Animal Breeding and Genetics and brought to Directorate of University farm (DUFARM of Federal University of Agriculture Abeokuta, Ogun state, Nigeria, where the research was carried out in 2014, were grouped into four each containing six animals based on different energy-protein feed combination thus; group 1(G1 low energy low protein, group 2 (G2 low energy high protein, group 3 (G3 high energy low protein and group 4 (G4 high energy high protein. Experimental animals were supplemented with concentrate feed after grazing on daily in a nematode infected paddock. Clinical signs of infection were monitored. Live weight, faecal egg count (FEC, worm counts, packed cell volume (PCV, haemoglobin concentration (Hb and red blood cell count (RBC were determined using standard methods.Results: Anorexia and intermittent diarrhea were the observed signs. Worm counts did not differ significantly (P=0.309 among the groups. The weight and FEC differed significantly (P˂0.05 across the days and among the groups, while haematological parameters increased significantly (P˂0.05 across the days and among the groups.Conclusion: Lambs in G2 followed by G4 showed improved parameters and superior performance when compared to the other groups. It is therefore recommended that feed high in protein content is capable of mitigating deleterious effect of gastrointestinal helminth parasitism.

  13. 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.

  14. 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.

  15. The Effects of Disease Management on Glycemic Control and Adherence to American Diabetes Association Guidelines in an Air Force Population

    Science.gov (United States)

    2001-04-24

    diagnosis , a higher proportion of type 2 diabetics demonstrate microalbuminuria and overt nephropathy shortly after diagnosis . This is strong evidence of the...Management 3 In pregnancy , diabetes is associated with fetal birth abnormalities, newborn death, macrosomia (large birth weight), hydramnios (excess amniotic...fluid), and toxemia of pregnancy . Optimal blood glucose control from conception through birth is essential for the health of the mother and baby

  16. 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.

  17. Status report from the American Acne & Rosacea Society on medical management of acne in adult women, part 2: topical therapies.

    Science.gov (United States)

    Del Rosso, James Q; Harper, Julie C; Graber, Emmy M; Thiboutot, Diane; Silverberg, Nanette B; Eichenfield, Lawrence F

    2015-11-01

    In part 1 of this 3-part series, an overview of the epidemiology, visible patterns, and important considerations for clinical and laboratory evaluation of acne vulgaris (AV) in adult women was provided. Proper selection and integration of skin care products is important in the management of AV in this patient population. Part 2 of this series includes a discussion of over-the-counter and prescription topical therapies for adult women with AV. A summary of key randomized controlled trials also is provided. Further well-designed studies are needed, as data on the use of topical agents in this subpopulation are limited.

  18. 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 facto....... 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....... which relate to transport, housing and employment. Yet we argue that the experiential dimensions of long distance mobilities have not received the attention that they deserve within geographical research on mobilities. This paper combines ideas from mobilities research and contemporary social theory...... 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...

  19. 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

  20. 集约经营雷竹林分结构特征%Structure characteristics of intensive managed Phyllostachys praecon stand

    Institute of Scientific and Technical Information of China (English)

    肖宋高; 陈明亮; 江雄波; 胡云; 张卓文

    2012-01-01

    以湖北省崇阳县雷竹林为研究对象,对集约经营雷竹林分结构及各器官生物量分配特征进行了调查与分析,结果表明:集约经营雷竹笋用林立竹在林地上分布均匀,调查的雷竹林分平均胸径为2.55cm,通过胸径计算得到的适宜经营密度约为15000株/hm2(1000株/667m2);林分中立竹处于年青状态,1年生、2年生、3年生及4年生、5年生立竹数依次为3000、4660、3880、460、20株/hm2,所占的百分率依次为24.59%、38.20%、31.80%、3.77%及1.60%;钩梢有利于雷竹林分抗雪压,虽然钩梢后立竹留盘数减少,冠幅减小,但平均每枝叶面积指数增大;生产中每年通过在林地上均匀保留健壮的笋体而形成新立竹,因而林木株数按径阶的分布不符合正态分布规律,出现向右偏态;农事活动使枝下高也发生变异;雷竹林各器官生物量大小依次为杆>竹蔸>竹鞭>叶>枝,钩梢使各器官生物量大小发生变化.%Research had been carried out into the structure and the biomass for different organs of Phyllostachys praecon stands located at Chongyang County, Hubei Province,which were intensive managed, the results showed that bamboo stems were uniform distributed in ground, the average DBH of plots studied was 2. 55 cm,the management density calculated according to the average DBH was 15 000 stems per hm2(1000 stems per 667 m2);all stands studied were very young and in good health, stems density for 1,2,3,4 and 5 a were 3 000 stems per hm2,4 660 stems per hm2,3 880 stems per hm2 ,460 stems per hm2and 20 stems per hm2 with 24. 59%,38. 20%,31. 80%,3. 77% and 1. 60%,respectively; for anti-snow pressure,although tip hooking made the stem shorted,branch round decreased and crown width dwindled,leaf area index increased. When harvesting bamboo shoots, big and strong shoots were kept uniform in a stand ground which would grow as new stems,so the distribution of DBH was not a normal one, but a

  1. 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

  2. Land-use history and management intensity as drivers of spatial variability in soil greenhouse gas fluxes in a poplar bioenergy plantation

    Science.gov (United States)

    Görres, Carolyn-Monika; Ceulemans, Reinhart

    2014-05-01

    Bioenergy crops are considered to be carbon-neutral because biomass combustion releases only carbon which has previously been extracted from the atmosphere by the plants. However, during crop growth, a significant amount of the greenhouse gases (GHG) CO2, CH4 and N2O can be produced by soil microorganisms and released to the atmosphere. Depending on crop type and management intensity, soil GHG fluxes might be so substantial that bioenergy crops could overall emit more GHG than the same amount of fossil fuels. The present knowledge about soil GHG fluxes from bioenergy crops is not sufficient to accurately quantify them. This is especially true for short rotation woody crops (SRWC) which might become more important in the future because they have a relatively high GHG mitigation potential. However, before pursuing the use of SRWC plantations for carbon sequestration and fossil fuel replacement, it is necessary to accurately assess their uptake and release of all major GHG to prevent the unconscious widespread deployment of unsustainable cultivation practices. The aim of this project is to identify drivers of spatial variability in soil GHG fluxes in a poplar SRWC plantation with special emphasis on the legacy effect of former land-use. The plantation has been established partly on former pasture and partly on former cropland, offering the unique opportunity to study soil GHG flux dynamics with respect to their dependency on former land-use type under identical climate and management conditions. The plantation is currently in its fifth vegetation season and in the first year of its third rotation. Simultaneous monitoring of soil CO2, CH4 and N2O fluxes will take place with a custom-made automated chamber system throughout the entire third rotation (three years) accompanied by soil gas concentration profile measurements. In parallel, community composition of functional groups of soil microorganisms (denitrifiers, ammonia oxidizers, methanogens) and total soil microbial

  3. 美国非营利组织的运作管理及其启示%The Management of Nonprofit Organization in American and Its Inspiration

    Institute of Scientific and Technical Information of China (English)

    黄亚惠

    2011-01-01

    This paper introduces relatively the management of Nonprofit Organization in American.Nonprofit Organization has active functions in promoting social autonomy and harmonizing her relations with the government and its people.In addition,the author gives us some references for developing Nonprofit Organization in China.%美国的非营利组织在美国社会的文化教育、技术进步、医疗保健、市场监督、环境保护等方方面面发挥作用,在整个国家经济发展和社会保障中占据着非常重要的位置。考察美国的非营利组织的发展与管理,从中吸取有益的经验做法,有助于加快中国非营利组织的健康发展。

  4. 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.

  5. 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.

  6. Adherence to the 2012 American College of Rheumatology (ACR Guidelines for Management of Gout: A Survey of Brazilian Rheumatologists.

    Directory of Open Access Journals (Sweden)

    Ana Beatriz Vargas-Santos

    Full Text Available To describe the current pharmacological approach to gout treatment reported by rheumatologists in Brazil.We performed a cross-sectional survey study using an online questionnaire e-mailed to 395 rheumatologists, randomly selected, from among the members of the Brazilian Society of Rheumatology.Three hundred and nine rheumatologists (78.2% responded to the survey. For acute gout attacks, combination therapy (NSAIDs or steroid + colchicine was often used, even in monoarticular involvement, and colchicine was commonly started as monotherapy after 36 hours or more from onset of attack. During an acute attack, urate-lowering therapy (ULT was withdrawn by approximately a third of rheumatologists. Anti-inflammatory prophylaxis (98% colchicine was initiated when ULT was started in most cases (92.4%, but its duration was varied. Most (70% respondents considered the target serum uric acid level to be less than 6 mg/dl. Approximately 50% of rheumatologists reported starting allopurinol at doses of 100 mg daily or less and 42% reported the initial dose to be 300 mg daily in patients with normal renal function. ULT was maintained indefinitely in 76% of gout patients with tophi whereas in gout patients without tophi its use was kept indefinitely in 39.6%.This is the first study evaluating gout treatment in a representative, random sample of Brazilian rheumatologists describing common treatment practices among these specialists. We identified several gaps in reported gout management, mainly concerning the use of colchicine and ULT and the duration of anti-inflammatory prophylaxis and ULT. Since rheumatologists are considered as opinion leaders in this disease, a program for improving quality of care for gout patients should focus on increasing their knowledge in this common disease.

  7. The Berry Amendment: A Comprehensive Look at the History and Implications for Program Managers of Hand- and Measuring-Tool-Intensive Programs

    Science.gov (United States)

    2014-09-01

    were covered in the restrictions. Berry’s amendment expanded the DOD’s Buy American restrictions to cover all clothing, cotton and wool. The final...wording of the Amendment prohibited use of appropriated funds to procure any article of food, clothing, cotton or wool whether in the form of fabric or...firms from the People’s Republic of China , Sri Lanka, and Romania. The Defense Logistics Agency issued two Berry Amendment waivers to meet the Army’s

  8. 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...

  9. Physical properties of soils under intensive agricultural management Propriedades físicas de solos submetidos a práticas intensivas de manejo

    Directory of Open Access Journals (Sweden)

    Jorge Luís Nascimento Soares

    2005-04-01

    Full Text Available Pedologic alterations after long-term sugar cane (Saccharum officinarum cropping cycles under traditional soil management systems were studied on a farm in Bariri, SP, Brazil. A toposequence was established to evaluate the effects of the soil position in the relief in changing soil physical attributes. Morphological field descriptions and laboratory analyses were carried out on vertical profiles of the upper, middle and lower thirds of a Typic Haplorthox slope. Soil bulk density and macroporosity changed along the toposequence reflecting on soil hydrodynamics, especially in the lower slope parts. At sites with high clay levels, empty spaces were filled forming block shaped structures together with the micro-aggregate structure. The intensive cultivation induced the greatest soil structure alterations, even at the deepest layers. The study pointed out the importance of performing detailed morphological observations in vertical profiles, due to the great variation on pedological attributes over short distances. Compacted soil sections were observed side-by-side with desaggregated mottles in the same soil profile. This fact evidenced that both vertical (in each profile and horizontal gradients (along a toposequence need to be considered in studies of time sequence variation of pedological parameters.O presente trabalho foi realizado numa propriedade agrícola situada no município de Bariri, SP, em área cultivada com cana-de-açúcar (Saccharum officinarum, onde foram estudadas algumas alterações pedológicas decorrentes de um longo período de exploração agrícola com sistema tradicional de manejo do solo. Foi estabelecida uma condição de toposseqüência para que pudesse ser avaliada a importância da posição dos solos no relevo sobre as modificações de alguns dos seus atributos físicos. As observações foram realizadas em campo e laboratório, em perfis verticais situados nos terços superior, médio e inferior da encosta em um

  10. Helping Labor and Management Set Up a Quality-of-Worklife Program.

    Science.gov (United States)

    Maccoby, Michael

    1984-01-01

    American Telephone and Telegraph (AT&T) and the union representing its workers--Communications Workers of America--have cooperated in a quality of work life program unique in scope and intensity: a labor-management agreement in which 40,000 Bell System employees have participated. Commitment to the program has survived a 1983 strike and the…

  11. 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

  12. A Seven-Year Survey of Management of Coagulase-Negative Staphylococcal Sepsis in the Neonatal Intensive Care Unit : Vancomycin May Not Be Necessary as Empiric Therapy

    NARCIS (Netherlands)

    Hemels, Marieke A. C.; van den Hoogen, Agnes; Verboon-Maciolek, Malgorzata A.; Fleer, Andre; Krediet, Tannette G.

    2011-01-01

    Background: The typical empiric therapy for coagulase-negative staphylococcal (CONS) sepsis includes vancomycin. In our neonatal intensive care unit, we have consistently avoided the use of vancomycin to treat CONS sepsis, except for specific cases, and have used instead cefazolin as empiric agent.

  13. 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

  14. Single session of high-intensity focused ultrasound therapy for the management of organ-confined prostate cancer: A single-institute experience

    Directory of Open Access Journals (Sweden)

    Yu-Cing Juho

    2016-12-01

    Conclusion: High-intensity focused ultrasound is an alternative therapy for patients with localized prostate cancer. In combination with preceding transurethral resection of the prostate, this treatment shows promise in disease control with a low complication rate in short-term follow-up.

  15. 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.

  16. 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...

  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. 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.

  19. 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.

  20. American ginseng

    Science.gov (United States)

    ... and inflammation of the lining of the stomach (gastritis). American ginseng is also used for low iron ... Dizziness. Pregnancy and childbirth complications. Stress. Anemia. Insomnia. Gastritis. Impotence. Fever. Hangover symptoms. Headaches. Swine flu. Aging. ...

  1. 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.

  2. Study of the physical, chemical and biological processes in semi-intensive fishponds: development of a mathematical model as a tool for managing white seabream (Diplodus sargus) production

    OpenAIRE

    2011-01-01

    Semi-intensive aquaculture has been recognised as an “environmentally friendly” option. However, the low profitability and competitiveness of these systems compromise their economic viability. The optimization of production is thereby crucial for the sustainability of semiintensive pond aquaculture, and implies that fish yields are maximized with minimum impacts on the environment. Understanding the physical, chemical and biological processes occurring in fishponds is of outmos...

  3. Efficacy of focused low-intensity pulsed ultrasound therapy for the management of knee osteoarthritis: a randomized, double blind, placebo-controlled trial

    OpenAIRE

    2016-01-01

    The aim of this study was to investigate the effects of focused low-intensity pulsed ultrasound (FLIPUS) therapy on the functional and health status of patients with knee osteoarthritis (KOA). A total of 106 subjects with bilateral KOA were randomized sequentially into two groups. Group I received FLIPUS + diclofenac sodium, and group II received sham FLIPUS + diclofenac sodium. The therapeutic effects of the interventions were evaluated by measuring changes in VAS pain, the WOMAC scores, and...

  4. 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.

  5. 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.

  6. Management guidelines of hyperthyroidism and other causes of thyrotoxicosis issued by the American Thyroid Association and American Association of Clinical Endocrinologists%2011版ATA/AACE《甲亢和其他病因甲状腺毒症诊治指南》解读

    Institute of Scientific and Technical Information of China (English)

    阮茂美; 陈立波

    2011-01-01

    The American Thyroid Association (ATA) and American Association of Clinical Endocrinologists (AACE) published "Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American of Clinical Endocrinologists" in June, 2011. The new guideline offers 100 proposals on the initial evaluation and management of Graves disease, toxic multi-nodular goiter or toxic adenoma including radioactive iodine, anti-thyroid drugs and surgery therapy. Besides, the guideline involves the diagnosis and treatment of Graves disease in children, adolescents or pregnant patients, Graves ophthalmopathy, subclinical hyperthyroidism and drug related hyperthyroidism. This review interprets the guideline about diagnosis and treatment of hyperthyroidism and other causes of the thyrotoxicosis.%美国甲状腺学会和临床内分泌医师学会在2011年6月联合发表新版.指南共提出100条建议,涵盖Graves病、毒性结节性甲状腺肿和毒性甲状腺腺瘤等疾病的病因学诊断和对症处理、131I、抗甲状腺药物和外科手术等治疗手段.另外,新指南还涉及到未成年甲亢、妊娠期甲亢、Graves眼病、亚临床甲亢和药物相关性甲状腺毒症等的诊治.本文解读指南中有关甲亢和其他病因甲状腺毒症的诊治建议.

  7. 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…

  8. 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.

  9. American Connections

    DEFF Research Database (Denmark)

    Petersen, Anne Ring

    2015-01-01

    The Danish artist Thomas Bang spent his early years in the USA. The works he created in this formative period were thus profoundly shaped by the contemporary movements in American art of the 1960s and 1970s when sculpture, or to be more precise, three-dimensional work became a hotbed of expansive...... experiments. This article traces how Bang made a radical move from painting to sculpture, which was characteristic of that time, and how he developed his artistic idiom by taking an active part in some of the seminal new departures in American art, in particular process art and post-minimalism. By leaping...... to the lasting impact of Bang's American period, which remains the key to understanding his works....

  10. 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.

  11. 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.

  12. Decrease in diversity and changes in community composition of arbuscular mycorrhizal fungi in roots of apple trees with increasing orchard management intensity across a regional scale.

    Science.gov (United States)

    van Geel, Maarten; Ceustermans, An; van Hemelrijck, Wendy; Lievens, Bart; Honnay, Olivier

    2015-02-01

    Understanding which factors drive the diversity and community composition of arbuscular mycorrhizal fungi (AMF) is important due to the role of these soil micro-organisms in ecosystem functioning and current environmental threats to AMF biodiversity. Additionally, in agro-ecosystems, this knowledge may help to evaluate their use in making agriculture more sustainable. Here, we used 454-pyrosequencing of small subunit rRNA gene amplicons to quantify AMF diversity and community composition in the roots of cultivated apple trees across 24 orchards in central Belgium. We aimed at identifying the factors (soil chemical variables, organic vs. conventional farming, and geographical location) that affect AMF diversity and community composition. In total, 110 AMF OTUs were detected, of which the majority belonged to the Glomeraceae (73%) and the Claroideoglomeraceae (19%). We show that soil characteristics and farming system, rather than the geographical location of the orchards, shape AMF communities on apple trees. Particularly, plant-available P content of the soil was associated with lower AMF diversity. In orchards with a lower plant-available P content of the soil (P diversity in organically managed orchards as compared to conventionally managed orchards. Finally, the degree of nestedness of the AMF communities was related to plant-available P and N content of the soil, pointing at a progressive loss of AMF taxa with increasing fertilization. Overall, we conclude that a combination of organic orchard management and moderate fertilization may preserve diverse AMF communities on apple trees and that AMF in the roots of apple trees appear not to be dispersal limited at the scale of central Belgium.

  13. 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

  14. 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

    OpenAIRE

    Dimitrios Patsios; Apostolos Komnos; Charilaos Apostolidis; Anastasia Mpalasopoulou

    2014-01-01

    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 meth...

  15. Differences in Net Ecosystem Exchange for an intensely managed watershed using a lumped, regional model and a mechanistic, hillslope-scale model

    Science.gov (United States)

    Wilson, C. G.; Wacha, K.; Papanicolaou, T.; Stanier, C. O.; Jamroensan, A.

    2014-12-01

    In this study, Net Ecosystem Exchange (NEE), and its components Gross Ecosystem Exchange (GEE) and Ecosystem Respiration (RESP), were compared from a lumped, regional model and a mechanistic, hillslope-scale model to determine if the effects of land management on the carbon cycle are captured by larger-scale biosphere models that determine CO2 sources and sinks. WRF-VPRM (Weather Research & Forecasting - Vegetation Photosynthesis & Respiration Model) is a regional-scale model that uses simulated downward shortwave radiation and surface temperatures, along with satellite-derived land cover indices and eddy flux tower-derived parameters to estimate biosphere CO2 fluxes with empirical equations. The DAYCENT biogeochemical model coupled with the Watershed Erosion Prediction Project model (WEPP), which simulates changes in soil carbon stocks due to different land management and the resulting enhanced erosion, can also quantify biosphere CO2 fluxes. Both models (i.e., WRF-VPRM and WEPP-DAYCENT) were used to quantify GEE, RESP, and NEE for the summer of 2008 in the IML-CZO Clear Creek watershed of the U.S. Midwest to examine the role of land management heterogeneity in CO2 exchanges between the biosphere and atmosphere. Comparing average daily GEE rates from WRF-VPRM (-11.0 ± 5.2 g C/m2/d) with WEPP-DAYCENT average values weighted per land use area in the watershed (-10.2 ± 1.5 g C/m2/d) showed no significant differences (t-test; p=0.08). In contrast, daily RESP values were different between the two models. Daily respiration rates were relatively constant for WRF-VPRM (6.0 ± 0.8 g C/m2/d), while WEPP-DAYCENT values for each management practice were significantly greater (7.2 ± 1.8 g C/m2/d; t-test, prates from WRF-VPRM (-5.0 ± 5.3 g C/m2/d) with WEPP-DAYCENT average weighted values (-3.0 ± 1.8 g C/m2/d) also showed significant differences (t-test; p<0.001).

  16. 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.

  17. 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.

  18. 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

  19. 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.

  20. 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

  1. 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

  2. Control of a Reassortant Pandemic 2009 H1N1 Influenza Virus Outbreak in an Intensive Swine Breeding Farm: Effect of Vaccination and Enhanced Farm Management Practices.

    Science.gov (United States)

    Mughini-Gras, Lapo; Beato, Maria Serena; Angeloni, Giorgia; Monne, Isabella; Buniolo, Filippo; Zuliani, Federica; Morini, Matteo; Castellan, Alberto; Bonfanti, Lebana; Marangon, Stefano

    2015-04-13

    Influenza A viruses in swine cause considerable economic losses and raise concerns about their zoonotic potential. The current paucity of thorough empirical assessments of influenza A virus infection levels in swine herds under different control interventions hinders our understanding of their effectiveness. Between 2012 and 2013, recurrent outbreaks of respiratory disease caused by a reassortant pandemic 2009 H1N1 (H1N1pdm) virus were registered in a swine breeding farm in North-East Italy, providing the opportunity to assess an outbreak response plan based on vaccination and enhanced farm management. All sows/gilts were vaccinated with a H1N1pdm-specific vaccine, biosecurity was enhanced, weaning cycles were lengthened, and cross-fostering of piglets was banned. All tested piglets had maternally-derived antibodies at 30 days of age and were detectable in 5.3% of ~90 day-old piglets. There was a significant reduction in H1N1pdm RT-PCR detections after the intervention. Although our study could not fully determine the extent to which the observed trends in seropositivity or RT-PCR positivity among piglets were due to the intervention or to the natural course of the disease in the herd, we provided suggestive evidence that the applied measures were useful in controlling the outbreak, even without an all-in/all-out system, while keeping farm productivity at full.

  3. 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.

  4. 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

  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. 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.

  7. The patient experience of intensive care

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Bergbom, Ingegerd; Lindahl, Berit

    2015-01-01

    countries have been particularly close to goals of lighter or no sedation and a more humane approach to intensive care. OBJECTIVES: The aim of our study was to systematically review and reinterpret newer Nordic studies of the patient experience of intensive care to obtain a contemporary description of human......: Nordic intensive care units. PARTICIPANTS: Patients in Nordic intensive care units. METHODS: We performed a literature search of qualitative studies of the patient experience of intensive care based on Nordic publications in 2000-2013. We searched the following databases: PubMed, CINAHL, Scopus, and Psyc......BACKGROUND: Sedation practices in the intensive care unit have evolved from deep sedation and paralysis toward lighter sedation and better pain management. The new paradigm of sedation has enabled early mobilization and optimized mechanical ventilator weaning. Intensive care units in the Nordic...

  8. Self-management in pediatric inflammatory bowel disease: A clinical report of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

    Science.gov (United States)

    Hommel, Kevin A; Greenley, Rachel N; Maddux, Michele Herzer; Gray, Wendy N; Mackner, Laura M

    2013-08-01

    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. To promote adaptive self-management, health care providers are encouraged to adopt a long-term preventive orientation, which includes routine screening of barriers to self-management and nonadherence in the context of routine clinic appointments. The use of a multimethod approach to assessment that incorporates objective measures (eg, pill counts or bioassays) may be particularly advantageous. Individualized treatment approaches that incorporate evidence-based practices, such as providing written treatment plans and offering opportunities to practice and receive feedback on skills, may help to ameliorate minor self-management concerns; however, more severe or chronic self-management problems may require a referral for behavioral health intervention. Additional research to broaden our understanding of self-management in domains beyond medication adherence and to evaluate the effect of clinic-based interventions is imperative.

  9. 提升苏州内河港口岸线集约化管理水平的探讨%Method of Promoting Intensive Management Level of Suzhou Inland Port Shoreline

    Institute of Scientific and Technical Information of China (English)

    陈广杰

    2012-01-01

    Port shoreline is a kind of non-renewable scarce resources and plays an important role in the social economic development. Taking Suzhou city as a example, this paper introduces the situation of Suzhou inland port shoreline and analyzes the management deficiencies by comparing the utilization current situation of surrounding area. At last, the methods of promoting the intensive management level under the background of the construction of modem inland waterway system was given.%港口岸线是不可再生的稀缺资源,在社会经济发展中发挥着重要作用。文章以苏州市为分析样本.介绍了苏州内河港口岸线利用现状,通过与周边地区进行对照,分析了当前苏州内河港口岸线管理方面存在的不足.并提出了在建设现代化内河水运体系的背景下,提升苏州内河港口岸线集约化管理水平的途径。

  10. 严重多发伤的ICU治疗及预后相关因素分析%Intensive care and management for severe polytrauma

    Institute of Scientific and Technical Information of China (English)

    马渝; 鲁力; 文玉明; 程黎; 胡平; 都定元

    2011-01-01

    Objective To evaluate the prognosis - related factors and significance of treatment strategies of multiple trauma in ICU. Methods The clinical data of 50 patients admitted to our central ICU from Jan. 2009 to May. 2010 were studied retrospectively. The ISS score and the APACHE Ⅱ score were calculated within 24 hours of admission. The ISS score and APACHE Ⅱ score of death group and survival group were compared. Results Totally 44 patients survived and 6 patients died of hemorrhagic shock, acute respiratory distress syndrome( ARDS) and multiple organ dysfunction syndrome ( MODS). There was no significant difference of ISS score between death group and survival group( P >0.05 ) ,but the APACHE Ⅱ score in death group was higher than that in survival group( P <0.01 ). Conclusion APACHE Ⅱ is more relevant to the prognosis of the severe multiple trauma patients ( ISS ≥25 ). It has higher specificity value in disease severity and prognosis. About the treatment strategies in ICU,early limited fluid resuscitation, blood glucose management, infection prevention and treatment are important issues of concern.%目的 探讨严重多发伤病情评估与预后相关性及ICU救治的策略特点.方法 回顾性分析我院中心ICU 2009年1月~2010年5月收治的严重多发伤病人50例临床资料,计算入院24小时内ISS评分和急性生理慢性健康评分(APACHEⅡ),对死亡组、存活组的ISS值及APACHEⅡ分值进行比较.结果 死亡6例,死亡率12%; 早期死亡2例,主要原因为失血性休克及急性呼吸窘迫综合征(ARDS),后期死亡4例,主要死因为多器官功能损害(MODS).死亡组与存活组ISS值差别无统计学意义(P>0.05),而APACHEⅡ分值前者明显高于后者(P<0.01).结论 在极危重多发伤(ISS≥25)为主的人群中,APACHEⅡ分值与病人最终的预后相关, APACHEⅡ评分在其严重程度及预后相关性上有较高价值; ICU的救治和病情预后相关策略中,早期限制性液体复苏

  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. The role of interdisciplinary team approach in the management of the diabetic foot: a joint statement from the Society for Vascular Surgery and the American Podiatric Medical Association.

    Science.gov (United States)

    Sumpio, Bauer E; Armstrong, David G; Lavery, Lawrence A; Andros, George

    2010-01-01

    The Society for Vascular Surgery (SVS) and the American Podiatric Medical Association (APMA) recognize the beneficial impact of a multidisciplinary team approach on the care of patients with critical limb ischemia, especially in the diabetic population. As a first step in identifying clinical issues and questions important to both memberships, and to work together to find solutions that will benefit the shared patient, the two organizations appointed a representative group to write a joint statement on the importance of multidisciplinary team approach to the care of the diabetic foot.

  13. 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.

  14. 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

  15. 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.

  16. Native Americans with Diabetes

    Science.gov (United States)

    ... Read the MMWR Science Clips Native Americans with Diabetes Better diabetes care can decrease kidney failure Language: ... between 1996 and 2013. Problem Kidney failure from diabetes was highest among Native Americans. Native Americans are ...

  17. 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 ...

  18. 美国公共图书馆管理者认证项目的借鉴与思考%Thinking and Learning of the Manager Accreditation Program of American Public Library

    Institute of Scientific and Technical Information of China (English)

    徐欣禄

    2011-01-01

    The library manager plays an important role in the library development, and decides the future and efficiency of the library to the great extent. Therefore, we should learn from the Manager Accreditation Program of American Public Library, make clear knowledge structure, professional quality and business skill of library managers, in order to improve the professional quality of library mangers and make them obtain better professional opportunities.%在图书馆事业发展中,图书馆管理者起着至关重要的作用,在很大程度上决定着图书馆的发展好坏,决定着图书馆办馆效益的发挥。因此,我国公共图书馆可以借鉴美国公共图书馆管理者认证项目对管理者知识结构、职业素养和业务技能提出的要求,对图书馆管理者进行培训,从而提高管理者的专业素质,使其获得更多的就业机会。

  19. Knowledge Sharing in Knowledge-Intensive Firms

    DEFF Research Database (Denmark)

    Gupta, Akshey; Michailova, Snejina

    2004-01-01

    This paper is a study of the knowledge-sharing difficulties experienced by three departments in a knowledge-intensive firm. The case organization is a global consulting firm that has been on the forefront of knowledge management and has won several knowledge management related international accla...

  20. The CEO of Anglo American on getting serious about safety.

    Science.gov (United States)

    Carroll, Cynthia

    2012-06-01

    When Carroll became the EO of Anglo American, in 2007, the company had suffered 200 worker fatalities over the previous five years. Some company veterans insisted that deaths were inevitable at such a large mining company, given the dangerous nature of the business. Carroll fundamentally rejected that assumption. She undertook a tour of operations in Australia, Chile, Colombia, Venezuela, and South Africa. The platinum business in South Africa had the worst track record in terms of safety, and Carroll was troubled by her conversations with its local managers. Immediately after her visit, another worker died. That was it. She ordered the world's largest platinum mine, which employed 30,000 people, to be shut down immediately. Intensive retraining began, and 3,000 leaders and 12,000 line managers, supervisors, and frontline employees have been through the program since 2008. Carroll also initiated the Tripartite Alliance, a collaboration with the South African Department of Mineral Resources and the National Union of Mineworkers, to study global best practices in safety and make recommendations. By 2011 she had reduced fatalities at Anglo American by 62% and had cut time lost owing to injuries by half.

  1. 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.

  2. Sleep in intensive care unit

    DEFF Research Database (Denmark)

    Boyko, Yuliya; Jennum, Poul; Nikolic, Miki

    2017-01-01

    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...

  3. 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...

  4. 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....

  5. A modeling framework for integrated harvest and habitat management of North American waterfowl: Case-study of northern pintail metapopulation dynamics

    Science.gov (United States)

    Mattsson, Brady J.; Runge, M.C.; Devries, J.H.; Boomer, G.S.; Eadie, J.M.; Haukos, D.A.; Fleskes, J.P.; Koons, D.N.; Thogmartin, W.E.; Clark, R.G.

    2012-01-01

    We developed and evaluated the performance of a metapopulation model enabling managers to examine, for the first time, the consequences of alternative management strategies involving habitat conditions and hunting on both harvest opportunity and carrying capacity (i.e., equilibrium population size in the absence of harvest) for migratory waterfowl at a continental scale. Our focus is on the northern pintail (Anas acuta; hereafter, pintail), which serves as a useful model species to examine the potential for integrating waterfowl harvest and habitat management in North America. We developed submodel structure capturing important processes for pintail populations during breeding, fall migration, winter, and spring migration while encompassing spatial structure representing three core breeding areas and two core nonbreeding areas. A number of continental-scale predictions from our baseline parameterization (e.g., carrying capacity of 5.5 million, equilibrium population size of 2.9 million and harvest rate of 12% at maximum sustained yield [MSY]) were within 10% of those from the pintail harvest strategy under current use by the U.S. Fish and Wildlife Service. To begin investigating the interaction of harvest and habitat management, we examined equilibrium population conditions for pintail at the continental scale across a range of harvest rates while perturbing model parameters to represent: (1) a 10% increase in breeding habitat quality in the Prairie Pothole population (PR); and (2) a 10% increase in nonbreeding habitat quantity along in the Gulf Coast (GC). Based on our model and analysis, a greater increase in carrying capacity and sustainable harvest was seen when increasing a proxy for habitat quality in the Prairie Pothole population. This finding and underlying assumptions must be critically evaluated, however, before specific management recommendations can be made. To make such recommendations, we require (1) extended, refined submodels with additional

  6. International training programs in reproductive sciences for conservation of Latin American felids.

    Science.gov (United States)

    Swanson, W F; Brown, J L

    2004-07-01

    Survival of the ten non-domestic felid species endemic to Latin America is imperiled by habitat loss, poaching and poor captive management. Over the past 10 years, conservation of these felids has been the primary focus of a reproductive research and training program conducted in Brazil, Mexico, and the USA. The objectives of this program were to: (1) provide intensive training in reproductive sciences to Latin American scientists, (2) conduct collaborative studies investigating basic and applied reproduction in endangered felids, and (3) establish a highly-trained scientific cohort to conduct independent conservation-based research. Four formal training courses, consisting of didactic lectures and hands-on instruction in research techniques, including semen collection, sperm cryopreservation and laparoscopic artificial insemination (AI), were taught in Brazil and Mexico between 1995 and 1998. Several of these scientists received further training in conducting fecal hormone analysis in the USA, and a number of research studies, many in collaboration with American scientists, were initiated in Latin American felids. Research findings have characterized basal reproductive traits in several felid species, including ocelots, margay, tigrinas and jaguars, and established that Latin American felids exhibit only minimal seasonal variation in most reproductive traits. Other studies have explored the impact of acute and chronic stressors on adrenocortical activity and demonstrated the importance of environmental enrichment in captivity, especially in small felids. Additional research has examined ovarian and immunological responsiveness of Latin American felids to exogenous gonadotropins and assessed the impact of nutrition on sperm production and oocyte quality. Applied reproductive studies have investigated sperm cryopreservation in both captive and wild felid populations and demonstrated the production of viable offspring in ocelots and tigrinas following laparoscopic AI

  7. Utilizing findings from a gender-based analysis to address chronic disease prevention and management among African-American women in a Michigan community.

    Science.gov (United States)

    Lombard, Wendy; Burke, Jodi; Waddell, Sandra; Franke, Arthur

    2015-08-01

    This research note underscores the importance of including strategies to address gender-based disparities when planning and implementing community health improvement programs. Working in collaboration with the Inkster Partnership for a Healthier Community (IPHC), the National Kidney Foundation of Michigan conducted a gender-based analysis as part of its broader community health needs assessment efforts in Inkster, MI. The findings from these studies revealed significant challenges impacting women that were not being adequately addressed within the community. In response to these findings, the IPHC created a strategic action plan to respond to the highest priority needs by increasing community awareness of and linkages to resources that provide supportive services for low-income African-American women.

  8. Ammonia volatilization from intensively managed dairy pastures.

    NARCIS (Netherlands)

    Bussink, D.W.

    1996-01-01

    The objectives of this thesis are (i) to quantify NH 3 volatilization from grassland, (ii) to gain understanding of the NH3 volatilization processes on grassland and (iii) to study measures how to reduce NH 3 volatilization from gra

  9. Intensive care management of status epilepticus

    Directory of Open Access Journals (Sweden)

    Nidhi Gupta

    2016-01-01

    Full Text Available Status epilepticus (SE is a life-threatening neurological emergency that requires prompt diagnosis and treatment. SE may be classified into convulsive and non-convulsive types, based on the presence of rhythmic jerking of the extremities. Clinically, tonic-clonic convulsive SE (CSE is divided into four subsequent stages: Early, established, refractory and super-refractory. Initial elements of resuscitation include airway protection, haemodynamic resuscitation and seizure control. Further treatment should then be guided by the diagnostic workup. Rapid treatment of early SE is achieved with intravenous (IV lorazepam or intramuscular midazolam. In established SE, IV antiepileptic drugs (AEDs (phenytoin/fosphenytoin, valproate, levetiracetam, phenobarbital are most commonly used, but there is no Class I evidence for choosing one over the other. Considered overall, cumulative data from the literature are consistent with valproate and levetiracetam, being a safe and effective therapeutic alternative to phenobarbital and phenytoin for treatment of established SE. Refractory SE (RSE and super-RSE are treated with anaesthetic medications (propofol, midazolam, thiopental/pentobarbital, ketamine, non-anaesthetic drugs (lidocaine, magnesium, pyridoxine, AEDs (levetiracetam, lacosamide, topiramate, lacosamide, pregabalin, gabapentin and other cause-directed treatments with low success rates. Potential non-pharmacologic interventions to be considered in super-RSE include hypothermia, electroconvulsive therapy, ketogenic diet, immunomodulatory treatments, emergency resective epilepsy surgery, cerebrospinal fluid drainage and vagal nerve or deep brain stimulation or transcranial magnetic stimulation. Diagnosis of non-CSE requires continuous electroencephalography and involves a high index of suspicion in all patients with an altered mental status of unclear cause or with a prolonged postictal state. Treatment options include addressing underlying causes and aggressive pharmacologic interventions with a benzodiazepine, phenytoin and valproate.

  10. Intensive care management of status epilepticus

    OpenAIRE

    2016-01-01

    Status epilepticus (SE) is a life-threatening neurological emergency that requires prompt diagnosis and treatment. SE may be classified into convulsive and non-convulsive types, based on the presence of rhythmic jerking of the extremities. Clinically, tonic-clonic convulsive SE (CSE) is divided into four subsequent stages: Early, established, refractory and super-refractory. Initial elements of resuscitation include airway protection, haemodynamic resuscitation and seizure control. Further tr...

  11. Application of PDCA cycle management on hand hygiene of medical staff in Intensive Care Unit%浅谈PDCA循环管理在ICU医务人员手卫生管理工作中的应用效果

    Institute of Scientific and Technical Information of China (English)

    卢孝莉; 何芳; 肖池兵

    2014-01-01

    目的:探讨分析PDCA循环管理在ICU医务人员手卫生规范管理工作中的应用效果。方法:在我院ICU医务人员手卫生管理工作中实施PDCA(计划-实施-检查-处理)循环管理,观察对比实施该方案前后的管理效果,并将对比的结果进行回顾性的分析。结果:实施PDCA循环管理后,ICU医务人员在洗手的依从性、手卫生知识的知晓率及手卫生合格率等方面均较实施之前有显著的提高(P<0.01),具有统计学意义。结论:在ICU医务人员手卫生管理工作中实施PDCA循环管理可有效提高ICU医务人员的手卫生状况,值得在临床上推广应用。%Objective To explore the application of PDCA cycle management on hand hygiene compliance of medical staff in the Intensive Care Unit. Results The hand washing compliance,knowledge of hand hygiene and qualified rate of hand hygiene were improved after the implementation of PDCA cycle management(P<0.01).Conclusion The application of PDCA cycle of planning-doing-check-action on continuous quality improvement can improve hand hygiene of medical staff effectively.

  12. The application of risk management in the subject of intensive care medicine for teaching practice nurses%护理风险管理在ICU实习护士带教中的应用

    Institute of Scientific and Technical Information of China (English)

    梁秀

    2013-01-01

    Objective To investigate the effect of applying the nursing risk management in the subjects of Intensive Care Medicine (ICU)when teaching practice nurses,so as to prevent or reduce adverse events dominated by practice nurses, and improve the quality of nursing teaching. Methods 138 nurses are divided into the experimental group and the control group. Traditional teaching method in clinical nursing is applied in the control group ,while the risk management methods are applied in practice nurse teaching in the experimental group,namely,to assess the potential risk factors in teaching, and then formulate the corresponding preventive measures. Compare results of professional theory exam and technical exam, and the incidence of adverse events led by practice nurses before and after applying the nursing risk management. Results the practice nurses applied nursing risk management have better results in professional theory exam and technical exam, and the incidence of adverse events led by them are lower than those applied traditional teaching methods.The comparison of before and after application of risk management: P<0.05,the difference is statistically significant. Conclusion The application of risk management can improve the quality of teaching and effectively reduce the occurrence of adverse events led by the practice nurse in the ICU nurse teaching.%目的:探讨护理风险管理在重症监护室(ICU)实习护士带教中的应用效果,降低不良事件发生率,提高护理带教质量。方法将138名实习护士分为试验组和对照组,对照组运用传统临床护理教学法,试验组将风险管理方法应用于实习护士的带教工作中,对实习护士带教中潜在危险因素进行风险评估,并制订相应的防范措施。比较实施风险管理前后实习护士的专科理论考核和技术考核成绩、实习护士主导不良事件的发生率。结果试验组实习护士专科理论和技术操作考核成绩均

  13. 78 FR 75392 - American Beacon Funds, et al.; Notice of Application

    Science.gov (United States)

    2013-12-11

    ...-Advised Fund as follows: (a) American Beacon Acadian Emerging Markets Managed Volatility Fund-- Acadian...--Bridgeway Capital Management, Inc.; (d) American Beacon Earnest Partners Emerging Markets Equity Fund--EARNEST Partners, LLC; (e) American Beacon Emerging Markets Fund--Brandes Investment Partners, LP,...

  14. A Cross-Cultural Study of Teachers' Beliefs and Strategies on Classroom Behavior Management in Urban American and Korean School Systems

    Science.gov (United States)

    Shin, Sunwoo; Koh, Myung-Sook

    2007-01-01

    The purpose of this study is to investigate teachers' beliefs on classroom behavior management strategies for students in urban public high schools between teachers in the United States and the Republic of Korea. This study incorporates data collected from teacher self-reported survey questionnaire, which is the Attitudes and Beliefs on Classroom…

  15. African-American Biography.

    Science.gov (United States)

    Martin, Ron

    1995-01-01

    Suggests sources of information for African American History Month for library media specialists who work with students in grades four through eight. Gale Research's "African-American Reference Library," which includes "African-America Biography,""African-American Chronology," and "African-American Almanac,"…

  16. The Financing Management Research on American Universities and Its Inspiration to China%美国高校融资管理研究及对我国的启示

    Institute of Scientific and Technical Information of China (English)

    汪剑鲲

    2015-01-01

    With the enhancement of education consciousness and the gradual popularization of higher ed-ucation,it has been difficult for government funding to fully meet the requirements of the higher education de-velopment. In this situation,it has been imminent for the university to actively explore and find other financing channels. Meanwhile,the continuous development of Chinese captial market creates good external environment for financing channels. The paper takes the financing management of American University as the research ob-ject,analyzes the financing channels and the fund management,hoping to provide reference for China univer-sity.%随着国人教育意识的增强与大学的不断扩招,政府拨款已很难完全满足高等教育发展的需求。在这种形势下,大学积极找寻其他融资渠道已迫在眉睫。同时,我国资本市场的不断发展也为高校融资创造了良好的外部环境。文章以美国大学的融资管理为研究对象,通过对其融资渠道和基金管理的研究,以期为我国高校的融资管理提供借鉴。

  17. Activty- versus Variability-Based Management Accounting

    DEFF Research Database (Denmark)

    Israelsen, Poul

    Bogen var blandt finalisterne til modtagelse af 1994-prisen “Contribution to Management Accounting Literature Award”, som uddeles af "The Management Accounting Section of the American Accounting Association"......Bogen var blandt finalisterne til modtagelse af 1994-prisen “Contribution to Management Accounting Literature Award”, som uddeles af "The Management Accounting Section of the American Accounting Association"...

  18. POISSON COUNT MODELS TO EXPLAIN THE ADOPTION OF AGRICULTURAL AND NATURAL RESOURCE MANAGEMENT TECHNOLOGIES BY SMALL FARMERS IN CENTRAL AMERICAN COUNTRIES

    OpenAIRE

    Ramirez, Octavio A.; Schultz, Steven D.

    2000-01-01

    Evaluations of the factors influencing the adoption of agricultural and natural resource management technologies among small farmers in developing countries have been mostly limited to qualitative discussions or simple descriptive statistics resulting in superficial and inconclusive findings. This study introduces the use of Poisson Count Regressions as a statistically appropriate procedure to analyze certain common types of adoption data. It uses them to assess the impact of key socio-econom...

  19. Stochastic conditional intensity processes

    DEFF Research Database (Denmark)

    Bauwens, Luc; Hautsch, Nikolaus

    2006-01-01

    In this article, we introduce the so-called stochastic conditional intensity (SCI) model by extending Russell’s (1999) autoregressive conditional intensity (ACI) model by a latent common dynamic factor that jointly drives the individual intensity components. We show by simulations that the proposed...... model allows for a wide range of (cross-)autocorrelation structures in multivariate point processes. The model is estimated by simulated maximum likelihood (SML) using the efficient importance sampling (EIS) technique. By modeling price intensities based on NYSE trading, we provide significant evidence...

  20. 78 FR 68095 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; American...

    Science.gov (United States)

    2013-11-13

    ... Information Collection Activities; Submission for OMB Review; Comment Request; American Recovery and... Training Administration (ETA) sponsored information collection request (ICR) titled, ``American Recovery... Information and Regulatory Affairs, Attn: OMB Desk Officer for DOL-ETA, Office of Management and Budget,...

  1. Monitoring and Modeling Carbon Dynamics at a Network of Intensive Sites in the USA and Mexico

    Science.gov (United States)

    Birdsey, R.; Wayson, C.; Johnson, K. D.; Pan, Y.; Angeles, G.; De Jong, B. H.; Andrade, J. L.; Dai, Z.

    2013-05-01

    The Forest Services of the USA and Mexico, supported by NASA and USAID, have begun to establish a network of intensive forest carbon monitoring sites. These sites are used for research and teaching, developing forest management practices, and forging links to the needs of communities. Several of the sites have installed eddy flux towers to basic meteorology data and daily estimates of forest carbon uptake and release, the processes that determine forest growth. Field sampling locations at each site provide estimates of forest biomass and carbon stocks, and monitor forest dynamic processes such as growth and mortality rates. Remote sensing facilitates scaling up to the surrounding landscapes. The sites support information requirements for implementing programs such as Reducing Emissions from Deforestation and Forest Degradation (REDD+), enabling communities to receive payments for ecosystem services such as reduced carbon emissions or improved forest management. In addition to providing benchmark data for REDD+ projects, the sites are valuable for validating state and national estimates from satellite remote sensing and the national forest inventory. Data from the sites provide parameters for forest models that support strategic management analysis, and support student training and graduate projects. The intensive monitoring sites may be a model for other countries in Latin America. Coordination among sites in the USA, Mexico and other Latin American countries can ensure harmonization of approaches and data, and share experiences and knowledge among countries with emerging opportunities for implementing REDD+ and other conservation programs.

  2. 美国一流大学跨学科研究的战略管理%Strategic Management of Interdisciplinary Research in American First class Universities

    Institute of Scientific and Technical Information of China (English)

    闫树涛

    2015-01-01

    Since the 1 980s,an important representation of American first class universities’rapid development is the generation of a larger number of interdisciplinary research organizations and deep de-velopment of interdisciplinary research activities, in order to adapt to and lead the trend of the development of modern science and technology innovation.In order to advance the development of inter-disciplinary research,recognition and support of the overall development goals and positioning of the u-niversity is needed to make interdisciplinary research become an important part of the overall strategy of the university really;effective strategic leadership is needed to provide strong resource support and achieve positive interaction with the external environment.%20世纪80年代以来,美国一流大学快速成长的一个重要表征是大量跨学科研究组织的应运而生,跨学科研究活动的深入开展,引领了现代学科的发展和技术的创新。推进跨学科研究的发展,需要学校整体发展目标和定位的认同与支持,使跨学科研究真正成为学校整体战略的重要组成部分,并实施有效的战略领导,提供有力的资源支持,实现与外部环境的良性互动。

  3. 美国健身俱乐部经营特性研究%Research on Management Characteristics of American Fitness Clubs

    Institute of Scientific and Technical Information of China (English)

    梁华伟

    2016-01-01

    为探讨美国地区健身俱乐部的经营特性,通过检索国际健康球类运动俱乐部协会( IHRSA , Inter-national Health, Racquet and Sports Club Association)的统计资料,阐述美国地区健身产业的发展现状,梳理美国地区健身俱乐部的会员特性与内部设施、课程特性等,建议中国健身俱乐部产业,除了需要积极面对客户投诉问题之外,还要随时掌握美国健身产业的发展走势,以理解产业走向,跟上时代变化的脚步?%On the purpose of discussing the operational characteristics of fitness club in America, the statistical ma-terials of International Health, Racquet and Sports Club Association ( IHRSA) were retrieved to expound the devel-opmental status of the fitness industry in America, to sort out the membership characteristics, internal facilities and course features in the fitness club of America.It’ s proposed that besides to proactively dealing with the customer complaints, the developmental trend of the American fitness club should be known timely in China’ fitness club in-dustry to better understand the industrial trend as well as to keep up with the pace of times.

  4. 美国医院开展客户体验管理的经验和启示%Experience and enlightenment of customer experience management in American hospital

    Institute of Scientific and Technical Information of China (English)

    朱江华; 张莉颖

    2015-01-01

    Through learning and understanding the customer experience management in American hospital, the neces-sity and urgency of carrying out the customer experience management in Chinese hospitals are analysed, combining with the condition in Chinese hospitals, four main ways of customer experience management in Chinese hospitals are put forward:improving interpersonal experience, enhancing the comprehensive sensory experience, improving the family care experience, improving patients' participation experience; set up an effective mode of hospital customer experience management which was guided by the demands of patients and the goal of patient satisfaction, by means of effective communication. A closed loop of continuous improvement of the patients experience is formed, which consists of pa-tients experience requirements, patients experience analysis, design and implementation and patients experience con-trol, and suggestions of carrying out customer experience management for hospitals are put forward. Through all of these, the quality of patients' medical experience will be improved, and also the loyalty of the patients and the value of hospital brand.%通过对美国医院开展客户体验管理的学习和了解,分析了当前中国医院开展客户体验管理的必要性和紧迫性,并结合中国医院实际情况,提出中国医院开展客户体验管理的四个主要途径,即院提升人际交往体验、提升综合感官体验、提升亲情关怀体验、提升患者参与体验;建立起一个以患者的需求为导向、以有效沟通为手段、以患者满意为目标的医院开展客户体验管理的有效模式,由患者体验需求、患者体验分析、患者体验设计与实施、患者体验控制等四个步骤组成患者就医体验持续改进闭环;并对医院开展客户体验管理提出了建议。通过这些,将提升患者的就医体验,从而提升患者忠诚度和医院品牌价值。

  5. Native Americans, regional drought and tree Island evolution in the Florida Everglades

    Science.gov (United States)

    Bernhardt, C.

    2011-01-01

    This study uses palynologic data to determine the effects of regional climate variability and human activity on the formation and development of tree islands during the last ~4000 years. Although prolonged periods of aridity have been invoked as one mechanism for their formation, Native American land use has also been hypothesized as a driver of tree island development. Using pollen assemblages from head and near tail sediments collected on two tree islands and documented archeological data, the relative roles of Native Americans, climate variability, and recent water-management practices in forming and structuring Everglades tree islands are examined. The timing of changes recorded in the pollen record indicates that tree islands developed from sawgrass marshes ~3800 cal. yr BP, prior to human occupation. Major tree island expansion, recorded near tail sediments, occurred ~1000 years after initial tree island formation. Comparison of the timing of pollen assemblages with other proxy records indicates that tree island expansion is related to regional and global aridity correlated with southward migration of the Intertropical Convergence Zone. Local fire associated with droughts may also have influenced tree island expansion. This work suggests that Native American occupation did not significantly influence tree island formation and that the most important factors governing tree island expansion are extreme hydrologic events due to droughts and intense twentieth century water management.

  6. Pediatric intensive care.

    Science.gov (United States)

    Macintire, D K

    1999-07-01

    To provide optimal care, a veterinarian in a pediatric intensive care situation for a puppy or kitten should be familiar with normal and abnormal vital signs, nursing care and monitoring considerations, and probable diseases. This article is a brief discussion of the pediatric intensive care commonly required to treat puppies or kittens in emergency situations and for canine parvovirus type 2 enteritis.

  7. Neutron intensity of fast reactor spent fuel

    Energy Technology Data Exchange (ETDEWEB)

    Takamatsu, Misao; Aoyama, Takafumi [Power Reactor and Nuclear Fuel Development Corp., Oarai, Ibaraki (Japan). Oarai Engineering Center

    1998-03-01

    Neutron intensity of spent fuel of the JOYO Mk-II core with a burnup of 62,500 MWd/t and cooling time of 5.2 years was measured at the spent fuel storage pond. The measured data were compared with the calculated values based on the JOYO core management code system `MAGI`, and the average C/E approximately 1.2 was obtained. It was found that the axial neutron intensity didn`t simply follow the burnup distribution, and the neutron intensity was locally increased at the bottom end of the fuel region due to an accumulation of {sup 244}Cm. (author)

  8. The monitoring and management for patients following lung transplatation surgery during early stage in intensive care unit: 9 cases report%肺移植术后早期的重症监护及处理

    Institute of Scientific and Technical Information of China (English)

    李强; 马旭晨; 卢家凯; 张京岚

    2012-01-01

    目的 总结同种异体原位肺移植术后早期监护与治疗经验,以提高肺移植手术的成功率.方法 对2005年5月至2011年5月9例原位肺移植术患者的临床资料进行回顾性分析.结果 本组男5例,女4例;年龄21 ~ 67岁,平均(46.1 ±14.1)岁;生存6例.病因为肺纤维化4例,肺淋巴管平滑肌瘤病3例,双侧支气管扩张(支扩)2例;行单纯左肺移植1例,右肺移植3例,双侧单肺序贯式肺移植5例.术后呼吸机辅助2 ~32天;监护室停留3~42天;术后住院3~60天;术后并发急性排斥反应2例.肺感染4例(3例使用体外膜氧合辅助治疗);死亡3例,死因为感染2例,循环衰竭1例.6例生存,生存率66.7%.结论 肺移植术后早期处理应重视血流动力学监测和处理,合理应用血管活性药和利尿药物,通过药物和通气调整肺循环阻力,应用肺保护机械通气策略,降低机械通气和带管时间,控制术后肺感染的患病率,对于肺移植患者安全度过围术期至关重要.%Objective To summarize the experience during early stage of postoperative monitoring and treatment for the patients follwing lung transplantation in surgical intensive care unit,and to improve the patient's outcome of lung transplantation.Methods A retrospective analysis of 9 cases of orthotopic lung transplantation admitted to surgical intensive care unit (SICU) of Beijing Anzhen Hospital from May 2005 to May 2011 was made.Results There 5 male patients and 4 female patients with the age 21 -67 (46.1 ± 14.1 ) years old in present group,and among them 6 patients survived (survival rate:66.7% ).The etiological indication of admission were idiopathic pulmonary fibrosis (n =4),pulmonary lymphangioleiomyomatosis ( n =3 ),and bronehiectasis ( n =2).Bilateral sequential lung transplantation ( n =5 ),single left lung transplantation ( n =1 ) and single rigbt lung transplantation ( n =3) were performed.The postoperative duration of mechanical ventilation

  9. Ethical aspects in the management of the terminally ill patient in the pediatric intensive care unit Aspectos éticos na abordagem do paciente terminal em unidade de terapia intensiva pediátrica

    Directory of Open Access Journals (Sweden)

    Lara de Araújo Torreão

    2004-02-01

    Full Text Available OBJECTIVE: To identify the prevalence of management plans and decision-making processes for terminal care patients in pediatric intensive care units. METHODOLOGY: Evidence-based medicine was done by a systematic review using an electronic data base (LILACS, 1982 through 2000 and (MEDLINE, 1966 through 2000. The key words used are listed and age limits (0 to 18 years were used. RESULTS: One hundred and eighty two articles were found and after selection according to the exclusion/inclusion criteria and objectives 17 relevant papers were identified. The most common decisions found were do-not-resuscitation orders and withdrawal or withholding life support care. The justifications for these were "imminent death" and "unsatisfatory quality of life". CONCLUSION: Care management was based on ethical principles aiming at improving benefits, avoiding harm, and when possible, respecting the autonomy of the terminally ill patient.OBJETIVO: Identificar a prevalência das condutas e o processo de decisão na abordagem do paciente terminal na UTI pediátrica. METODOLOGIA: Revisão sistemática da literatura. seguindo os critérios da medicina baseada em evidências. nas seguintes bases de dados: LILACS (1982-2000 e MEDLINE (1966-2000. usando os descritores abaixos limitados para a idade (0 a 18 anos. RESULTADOS: Foram selecionados 183 artigos e após análise dos critérios de exclusão / inclusão e os objetivos restaram 17 artigos. As condutas mais prevalentes foram: ordem de não ressuscitar. omissão e/ou suspensão de suporte de vida. As justificativas mais encontradas para tais condutas foram: "morte iminente" e "qualidade de vida insatisfatória". CONCLUSÃO: A abordagem tem base nos princípios éticos e visa maximizar o benefício e evitar a distanásia. se possível. respeitando a autonomia do paciente terminal.

  10. Upravlenie transgranichnymi vodnymi resursami: sravnitel'nyj analiz rossijskogo i amerikanskogo opyta [Management of Trans-boundary Water Resources: Comparing Russian and American Experiences

    Directory of Open Access Journals (Sweden)

    Lanko Dmitry

    2013-01-01

    Full Text Available This article is based on a comparative analysis of Russia and US’s experience of participation in international cooperation in the field of trans-boundary water management. The author showcases the work of Russian-Estonian Commission for Protection and Rational Use of Trans-Boundary Waters and the US-Canadian International Joint Commission. The Russian-Estonian Commission works in accordance with the principle of intergovernmentalism, whereas transnationalism is the founding principle of the International Joint Commission in North America. Though the Russian-Estonian Commission is more efficient in water quality improvement in its area of responsibility, it is early still to claim that intergovernmental cooperation is more effective than transnational cooperation. However, it gives a reason to question the conclusions of the proponents of transnationalism in the international relations theory, who claim that the latter is more efficient. Practical significance of this paper is in the proposed recommendations for further modernization of international cooperation in the field of trans-boundary water management.

  11. Effective Public Management

    Science.gov (United States)

    Bower, Joseph L.

    1977-01-01

    Argues that public management differs from private management not just in degree but in quality, so that American business is an inappropriate analogy for evaluating public management. In particular, "purpose,""organization," and "people" have different meaning and significance in public agencies and private businesses. (JG)

  12. Low-intensity beam diagnostics with particle detectors

    Energy Technology Data Exchange (ETDEWEB)

    Rovelli, A.; Ciavola, G.; Cuttone, G.; Finocchiaro, P.; Raia, G. [INFN-LNS, Via S. Sofia 44/A Catania, 95125 (Italy); De Martinis, C.; Giove, D. [INFN-LASA, Via F.lli Cervi 201 Segrate (Midway Islands), 20090 (Italy)

    1997-01-01

    The measure of low intensity beams at low-medium energy is one of the major challenge in beam diagnostics. This subject is of great interest for the design of accelerator-based medical and radioactive beam facilities. In this paper we discuss new developments in image-based devices to measure low-intensity beams. All the investigated devices must guarantee measurement of the total beam current and its transverse distribution. {copyright} {ital 1997 American Institute of Physics.}

  13. Divergent models of diabetes among American Indian elders.

    Science.gov (United States)

    Henderson, Linda Carson

    2010-12-01

    The purpose of this study was to examine belief systems about diabetes in American Indian elders, and the effects of culture on care-seeking, adherence, and diabetes self-care. Health belief theory predicts that care-seeking and medical adherence are a function of culturally mediated beliefs that result in behaviors that effect health status. In order to elicit cultural meanings of diabetes, in-depth interviews were conducted with an intensity sample of 30 American Indian diabetic elders (55+). Two models of diabetes were identified, divergent in terms of 1) health behaviors, and 2) cultural identification. One model was characterized by delayed care-seeking, and a non-valuing of adherence to diabetes self-care. Non-adherence to medical recommendations was perceived as being socially desirable, because adherence placed the elder outside their peer group. The second model was characterized by early care-seeking and improved adherence to diabetes self-care. These divergent models of diabetes, in which care-seeking, diabetes self-care, and adherence vary as a function of cultural immersion, has implications for health education and disease management and may contribute substantially to health disparities.

  14. Quality indicators for the management of Barrett's esophagus, dysplasia, and esophageal adenocarcinoma: international consensus recommendations from the American Gastroenterological Association Symposium.

    Science.gov (United States)

    Sharma, Prateek; Katzka, David A; Gupta, Neil; Ajani, Jaffer; Buttar, Navtej; Chak, Amitabh; Corley, Douglas; El-Serag, Hashem; Falk, Gary W; Fitzgerald, Rebecca; Goldblum, John; Gress, Frank; Ilson, David H; Inadomi, John M; Kuipers, Ernest J; Lynch, John P; McKeon, Frank; Metz, David; Pasricha, Pankaj J; Pech, Oliver; Peek, Richard; Peters, Jeffrey H; Repici, Alessandro; Seewald, Stefan; Shaheen, Nicholas J; Souza, Rhonda F; Spechler, Stuart J; Vennalaganti, Prashanth; Wang, Kenneth

    2015-11-01

    The development of and adherence to quality indicators in gastroenterology, as in all of medicine, is increasing in importance to ensure that patients receive consistent high-quality care. In addition, government-based and private insurers will be expecting documentation of the parameters by which we measure quality, which will likely affect reimbursements. Barrett's esophagus remains a particularly important disease entity for which we should maintain up-to-date guidelines, given its commonality, potentially lethal outcomes, and controversies regarding screening and surveillance. To achieve this goal, a relatively large group of international experts was assembled and, using the modified Delphi method, evaluated the validity of multiple candidate quality indicators for the diagnosis and management of Barrett's esophagus. Several candidate quality indicators achieved >80% agreement. These statements are intended to serve as a consensus on candidate quality indicators for those who treat patients with Barrett's esophagus.

  15. Consensus recommendations from the American Acne & Rosacea Society on the management of rosacea, part 1: a status report on the disease state, general measures, and adjunctive skin care.

    Science.gov (United States)

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

    2013-11-01

    Rosacea is a common clinical diagnosis that encompasses a variety of presentations, predominantly involving the centrofacial skin. Reported to present most commonly in adults of Northern European heritage with fair skin, rosacea can affect males and females of all ethnicities and skin types. Pathophysiologic mechanisms that appear to correlate with the manifestation of rosacea have been the focus of multiple research studies, with outcomes providing a better understanding of why some individuals are affected and how their visible signs and symptoms develop. A better appreciation of the pathophysiologic mechanisms and inflammatory pathways of rosacea has allowed therapeutic strategies to be optimally incorporated. Part 1 of this 5-part series discusses the rosacea disease state with an emphasis on clinical correlation, reviews adjunctive skin care for cutaneous rosacea, and provides management caveats.

  16. Intensity Biased PSP Measurement

    Science.gov (United States)

    Subramanian, Chelakara S.; Amer, Tahani R.; Oglesby, Donald M.; Burkett, Cecil G., Jr.

    2000-01-01

    The current pressure sensitive paint (PSP) technique assumes a linear relationship (Stern-Volmer Equation) between intensity ratio (I(sub o)/I) and pressure ratio (P/P(sub o)) over a wide range of pressures (vacuum to ambient or higher). Although this may be valid for some PSPs, in most PSPs the relationship is nonlinear, particularly at low pressures (less than 0.2 psia when the oxygen level is low). This non-linearity can be attributed to variations in the oxygen quenching (de-activation) rates (which otherwise is assumed constant) at these pressures. Other studies suggest that some paints also have non-linear calibrations at high pressures; because of heterogeneous (non-uniform) oxygen diffusion and quenching. Moreover, pressure sensitive paints require correction for the output intensity due to light intensity variation, paint coating variation, model dynamics, wind-off reference pressure variation, and temperature sensitivity. Therefore to minimize the measurement uncertainties due to these causes, an insitu intensity correction method was developed. A non-oxygen quenched paint (which provides a constant intensity at all pressures, called non-pressure sensitive paint, NPSP) was used for the reference intensity (I(sub NPSP) with respect to which all the PSP intensities (I) were measured. The results of this study show that in order to fully reap the benefits of this technique, a totally oxygen impermeable NPSP must be available.

  17. Diarrhea in neonatal intensive care unit

    Institute of Scientific and Technical Information of China (English)

    Annalisa; Passariello; Gianluca; Terrin; Maria; Elisabetta; Baldassarre; Mario; De; Curtis; Roberto; Paludetto; Roberto; Berni; Canani

    2010-01-01

    AIM:To investigate the frequency,etiology,and current management strategies for diarrhea in newborn.METHODS:Retrospective,nationwide study involving 5801 subjects observed in neonatal intensive care units during 3 years.The main anamnesis and demographic characteristics,etiology and characteristics of diarrhea,nutritional and therapeutic management,clinical outcomes were evaluated.RESULTS:Thirty-nine cases of diarrhea(36 acute,3 chronic) were identified.The occurrence rate of diarrhea was 6.72 per 1000 hosp...

  18. American Vitiligo Research Foundation

    Science.gov (United States)

    ... life can acquire vitiligo Welcome to The American Vitiligo Foundation 2017 AVRF Calendars Order your calendar with ... animal testing. Please Visit Our Donations Page American Vitiligo Research Foundation "We Walk By Faith, Not By ...

  19. Depression and African Americans

    Science.gov (United States)

    ... You are here Home » Depression And African Americans Depression And African Americans Not “Just the Blues” Clinical ... or spiritual communities. Commonly Asked Questions about Clinical Depression How do I get help for clinical depression? ...

  20. American Hospice Foundation

    Science.gov (United States)

    American Hospice Foundation Skip to content Home Caregiving Learning About Hospice Grief Grieving Children Grief at School Grief at ... for all who come after us. The American Hospice Foundation (AHF) closed its doors in June 2014. ...

  1. Obesity and Hispanic Americans

    Science.gov (United States)

    ... and Data > Minority Population Profiles > Hispanic/Latino > Obesity Obesity and Hispanic Americans Among Mexican American women, 77 ... ss6304.pdf [PDF | 3.38MB] HEALTH IMPACT OF OBESITY More than 80 percent of people with type ...

  2. Obesity and Asian Americans

    Science.gov (United States)

    ... and Data > Minority Population Profiles > Asian American > Obesity Obesity and Asian Americans Non-Hispanic whites are 60% ... youthonline . [Accessed 05/25/2016] HEALTH IMPACT OF OBESITY More than 80 percent of people with type ...

  3. American Society of Echocardiography

    Science.gov (United States)

    American Society of Echocardiography Join Ase Member Portal Log In Membership Member Portal Log In Join ASE Renew Benefits Rates FASE – Fellow of the American Society of Echocardiography Member Referral Program FAQs Initiatives Advocacy ...

  4. American Urogynecologic Society

    Science.gov (United States)

    ... Patient Site » PFD Registry » Contact Us American Urogynecologic Society 1100 Wayne Avenue, Suite 670 Silver Spring, MD ... Us | Privacy Policy | HONcode Accredited © 2016 American Urogynecologic Society. All rights reserved.

  5. Asthma and Hispanic Americans

    Science.gov (United States)

    ... and Data > Minority Population Profiles > Hispanic/Latino > Asthma Asthma and Hispanic Americans In 2014, 2.1 million Hispanics reported that they currently have asthma. Puerto Rican Americans have almost twice the asthma ...

  6. On the Inherent Logic of American Public Security Management Policy and its Evolution%美国公共安全管理政策的内在逻辑及其变迁机制研究

    Institute of Scientific and Technical Information of China (English)

    吴月

    2011-01-01

    进入21世纪以来,以美国对其公共安全管理政策进行了一系列重大调整,日益显示出极具攻击性的一面。关于这一现象可以从现实主义理论和建构主义理论的视角出发来阐释。现实主义理论认为:国际政治冲突的本质和无政府状态下国家所要达到的安全目标是制定美国公共安全政策的理论基石;而建构主义理论则认为:从文化观念认同这一视角出发可以解释美国所选择的攻击目标。%Since 21st century,the phenomenon of international terrorism draws wide attention from the governments in the world.As a result,the U.S.government has made a series of adjustments in its public security management policy and its aggressiveness tends to be obvious.This paper tries to interpret this phenomenon from the perspective of realist theory and constructivism theory.Realist theory holds that the essence of international political conflicts and the security goal gained by anarchy countries are the theoretical base of American public security management policy.Constructivism theory holds that the attacking targets America choose can be interpreted from the perspective culture identity.

  7. Analysis on Standards of American AIAA Wind Tunnel Test Management and Practitioners%美国AIAA风洞试验管理标准与从业者标准浅析

    Institute of Scientific and Technical Information of China (English)

    战培国

    2013-01-01

    This paper introduces the background of wind tunnel test development, summarizes the developing process and contents of the AIAA wind tunnel standards, expounds the thoughts, management method and the recommended practice of wind tunnel test project in standards, analyzes the advancements of American wind tunnel test techniques reflected from the standards, as well as discusses the inspirations from the usual practive of standards to improve domestic wind tunnel test.%本文归纳了风洞试验发展的历史背景,简述了美国AIAA风洞试验管理标准和从业者标准制定的过程和内容,重点阐述了标准中风洞试验的理念、管理和推荐的风洞试验具体做法,分析了标准中映射出的美国风洞试验技术的先进点,探讨了标准对改进国内风洞试验通常做法的启示。

  8. VaIues RefIected in American University Student Affairs Management%美国高校学生事务管理的价值观探究

    Institute of Scientific and Technical Information of China (English)

    壮国桢

    2015-01-01

    American culture is distinctively diverse and open ,characterized by individualism ,concept of equality and utilitarianism .University student affairs management in America is profoundly influ-enced by cultural factors with individualism as its value orientation ,concept of equality as the corner-stone of its system design and utilitarianism as the guide to its pragmatic and efficient actions .%美国文化具有多元开放的鲜明特点,主要表现为个人主义、平等观念、实用主义等特征。文化因素深刻影响着美国高校学生事务管理,学生事务管理的价值取向是个人主义,学生事务管理制度设计的理念基石是平等观念,学生事务管理务实高效的行动指南是实用主义。

  9. Colonial American Astronomy

    Science.gov (United States)

    Yeomans, Donald K.

    2007-12-01

    While a foundation of German scientific methods enabled the rapid growth of North American Astronomy in the nineteenth century, during the seventeenth and most of the eighteenth centuries, the colonial men of science looked only to the English mother country for scientific patronage and guidance. An essay on fundamental astronomy appeared in one of the annual colonial almanacs as early as 1656, telescopic observations were made about 1660 and the first original colonial astronomical work was published by Thomas Danforth on the comet of 1664. By 1671 the Copernican ideas were so espoused at Harvard College that a physics class refused to read a Ptolemaic textbook when it was assigned to them by a senior instructor. At least in the Cambridge-Boston area, contemporary colonialist had access to the most recent scientific publications from the mother country. Observations of the great comet of 1680 by the Almanac maker, John Foster, reached Isaac Newton and were used and gratefully acknowledged in his Principia. During the seventeenth century the colonial interest in astronomy was more intense than it was for other sciences but colonists still occupied a position in the scientific backwater when compared with contemporary European scientists. Nevertheless, the science of astronomy was successfully transplanted from England to North America in the seventeenth century.

  10. Heart Disease and African Americans

    Science.gov (United States)

    ... Minority Population Profiles > Black/African American > Heart Disease Heart Disease and African Americans Although African American adults are ... were 30 percent more likely to die from heart disease than non-Hispanic whites. African American women are ...

  11. [Intensive medicine in Spain].

    Science.gov (United States)

    2011-03-01

    Intensive care medicine is a medical specialty that was officially established in our country in 1978, with a 5-year training program including two years of common core training followed by three years of specific training in an intensive care unit accredited for training. During this 32-year period, intensive care medicine has carried out an intense and varied activity, which has allowed its positioning as an attractive and with future specialty in the hospital setting. This document summarizes the history of the specialty, its current situation, the key role played in the programs of organ donation and transplantation of the National Transplant Organization (after more than 20 years of mutual collaboration), its training activities with the development of the National Plan of Cardiopulmonary Resuscitation, with a trajectory of more than 25 years, its interest in providing care based on quality and safety programs for the severely ill patient. It also describes the development of reference registries due to the need for reliable data on the care process for the most prevalent diseases, such as ischemic heart disease or ICU-acquired infections, based on long-term experience (more than 15 years), which results in the availability of epidemiological information and characteristics of care that may affect the practical patient's care. Moreover, features of its scientific society (SEMICYUC) are reported, an organization that agglutinates the interests of more than 280 ICUs and more than 2700 intensivists, with reference to the journal Medicina Intensiva, the official journal of the society and the Panamerican and Iberian Federation of Critical Medicine and Intensive Care Societies. Medicina Intensiva is indexed in the Thompson Reuters products of Science Citation Index Expanded (Scisearch(®)) and Journal Citation Reports, Science Edition. The important contribution of the Spanish intensive care medicine to the scientific community is also analyzed, and in relation to

  12. Data-intensive science

    CERN Document Server

    Critchlow, Terence

    2013-01-01

    Data-intensive science has the potential to transform scientific research and quickly translate scientific progress into complete solutions, policies, and economic success. But this collaborative science is still lacking the effective access and exchange of knowledge among scientists, researchers, and policy makers across a range of disciplines. Bringing together leaders from multiple scientific disciplines, Data-Intensive Science shows how a comprehensive integration of various techniques and technological advances can effectively harness the vast amount of data being generated and significan

  13. Towards higher intensities

    CERN Multimedia

    CERN Bulletin

    2010-01-01

    Over the past 2 weeks, commissioning of the machine protection system has advanced significantly, opening up the possibility of higher intensity collisions at 3.5 TeV. The intensity has been increased from 2 bunches of 1010 protons to 6 bunches of 2x1010 protons. Luminosities of 6x1028 cm-2s-1 have been achieved at the start of fills, a factor of 60 higher than those provided for the first collisions on 30 March.   The recent increase in LHC luminosity as recorded by the experiments. (Graph courtesy of the experiments and M. Ferro-Luzzi) To increase the luminosity further, the commissioning crews are now trying to push up the intensity of the individual proton bunches. After the successful injection of nominal intensity bunches containing 1.1x1011 protons, collisions were subsequently achieved at 450 GeV with these intensities. However, half-way through the first ramping of these nominal intensity bunches to 3.5 TeV on 15 May, a beam instability was observed, leading to partial beam loss...

  14. North American amphibians: distribution and diversity

    Science.gov (United States)

    : Green, David M.; Weir, Linda A.; Casper, Gary S.; Lannoo, Michael

    2014-01-01

    Some 300 species of amphibians inhabit North America. The past two decades have seen an enormous growth in interest about amphibians and an increased intensity of scientific research into their fascinating biology and continent-wide distribution. This atlas presents the spectacular diversity of North American amphibians in a geographic context. It covers all formally recognized amphibian species found in the United States and Canada, many of which are endangered or threatened with extinction. Illustrated with maps and photos, the species accounts provide current information about distribution, habitat, and conservation. Researchers, professional herpetologists, and anyone intrigued by amphibians will value North American Amphibians as a guide and reference.

  15. American mines, methods and men

    Energy Technology Data Exchange (ETDEWEB)

    Walker, S.C.A. (Thames Water Utilities (UK))

    1992-04-01

    The paper is based on the author's visits to a number of American mines, to see their mining machinery and to discuss with mine management their industrial relations problems. The paper gives a brief review of American mines, methods and men and is in the form of a diary. Mines visited are: Ohio Valley Coal Company; Big John Mine; Pittsburgh Research Center of the US Bureau of Mines; Martinka Mine; Robin Hood Complex No 9 Mine (Boone County, West Virginia), Green Briar Mine (Virginia); Martin County Coal (Kentucky); Wabash Mine (Keensburgh, Illinois); Galatia Mine (Harrisburgh, Illinois); and William Station Mine (Sturgis, Kentucky). Details given include mining methods productivity and staffing levels. The mining machinery is described in detail in a separate article. 5 figs.

  16. The future of intensive care medicine.

    Science.gov (United States)

    Blanch, L; Annane, D; Antonelli, M; Chiche, J D; Cuñat, J; Girard, T D; Jiménez, E J; Quintel, M; Ugarte, S; Mancebo, J

    2013-03-01

    Intensive care medical training, whether as a primary specialty or as secondary add-on training, should include key competences to ensure a uniform standard of care, and the number of intensive care physicians needs to increase to keep pace with the growing and anticipated need. The organisation of intensive care in multiple specialty or central units is heterogeneous and evolving, but appropriate early treatment and access to a trained intensivist should be assured at all times, and intensivists should play a pivotal role in ensuring communication and high-quality care across hospital departments. Structures now exist to support clinical research in intensive care medicine, which should become part of routine patient management. However, more translational research is urgently needed to identify areas that show clinical promise and to apply research principles to the real-life clinical setting. Likewise, electronic networks can be used to share expertise and support research. Individuals, physicians and policy makers need to allow for individual choices and priorities in the management of critically ill patients while remaining within the limits of economic reality. Professional scientific societies play a pivotal role in supporting the establishment of a defined minimum level of intensive health care and in ensuring standardised levels of training and patient care by promoting interaction between physicians and policy makers. The perception of intensive care medicine among the general public could be improved by concerted efforts to increase awareness of the services provided and of the successes achieved.

  17. Trading intensity and real estate performance

    NARCIS (Netherlands)

    D. Brounen (Dirk); P.M.A. Eichholtz (Piet); D. Ling (David)

    2007-01-01

    textabstractThis paper investigates whether it is possible to create value through the active management of direct property portfolios. Using data from the USA, the UK and Australia, we examine whether trading intensity and portfolio growth explain the risk and return characteristics of listed prope

  18. Barriers to blood pressure control in African Americans. Overcoming obstacles is challenging, but target goals can be attained.

    Science.gov (United States)

    Douglas, Janice G; Ferdinand, Keith C; Bakris, George L; Sowers, James R

    2002-10-01

    Outdated and biased attitudes and care standards impede optimal care of hypertension in African Americans. The negative expectations that blood pressure targets cannot be reached must be overcome by systematic and appropriate education and treatment. However, physicians should expect that (1) African American patients with elevated blood pressure benefit from early and intensive management, (2) blood pressure can be maintained at goal with appropriate therapeutic lifestyle changes and medications, and (3) complications related to high blood pressure can be avoided. To bring blood pressure down to the target goal, combination pharmacologic therapy is often required. When extensive efforts to achieve blood pressure control prove unattainable in the primary care setting, consultation with a hypertension specialist should be considered.

  19. 50 CFR 665.100 - American Samoa bottomfish fisheries. [Reserved

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false American Samoa bottomfish fisheries. 665.100 Section 665.100 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE (CONTINUED) FISHERIES IN THE WESTERN PACIFIC American...

  20. 50 CFR 665.140 - American Samoa Crustacean Fisheries. [Reserved

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false American Samoa Crustacean Fisheries. 665.140 Section 665.140 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE (CONTINUED) FISHERIES IN THE WESTERN PACIFIC American...