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Sample records for conservative bowel management

  1. Clinical outcome in acute small bowel obstruction after surgical or conservative management.

    Science.gov (United States)

    Meier, Raphael P H; de Saussure, Wassila Oulhaci; Orci, Lorenzo A; Gutzwiller, Eveline M; Morel, Philippe; Ris, Frédéric; Schwenter, Frank

    2014-12-01

    Small bowel obstruction (SBO) is characterized by a high rate of recurrence. In the present study, we aimed to compare the outcomes of patients managed either by conservative treatment or surgical operation for an episode of SBO. The outcomes of all patients hospitalized at a single center for acute SBO between 2004 and 2007 were assessed. The occurrence of recurrent hospitalization, surgery, SBO symptoms at home, and mortality was determined. Among 221 patients admitted with SBO, 136 underwent a surgical procedure (surgical group) and 85 were managed conservatively (conservative group). Baseline characteristics were similar between treatment groups. The median follow-up time (interquartile range) was 4.7 (3.7-5.8) years. Nineteen patients (14.0 %) of the surgical group were hospitalized for recurrent SBO versus 25 (29.4 %) of the conservative group [hazard ratio (HR), 0.5; 95 % CI, 0.3-0.9]. The need for a surgical management of a new SBO episode was similar between the two groups, ten patients (7.4 %) in the surgical group and six patients (7.1 %) in the conservative group (HR, 1.1; 95 % CI, 0.4-3.1). Five-year mortality from the date of hospital discharge was not significantly different between the two groups (age- and sex-adjusted HR, 1.1; 95 % CI, 0.6-2.1). A follow-up evaluation was obtained for 130 patients. Among them, 24 patients (34.8 %) of the surgical group and 35 patients (57.4 %) of the conservative group had recurrent SBO symptoms (odds ratio, 0.4; 95 % CI, 0.2-0.8). The recurrence of SBO symptoms and new hospitalizations were significantly lower after surgical management of SBO compared with conservative treatment.

  2. ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding.

    Science.gov (United States)

    Gerson, Lauren B; Fidler, Jeff L; Cave, David R; Leighton, Jonathan A

    2015-09-01

    Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended

  3. Irritable bowel syndrome: contemporary nutrition management strategies.

    Science.gov (United States)

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

    2014-09-01

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

  4. Palliative management of malignant bowel obstruction in terminally Ill patient

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    Darshit A Thaker

    2010-01-01

    Full Text Available Mr. P was a 57-year-old man who presented with symptoms of bowel obstruction in the setting of a known metastatic pancreatic cancer. Diagnosis of malignant bowel obstruction was made clinically and radiologically and he was treated conservatively (non-operativelywith octreotide, metoclopromide and dexamethasone, which provided good control over symptoms and allowed him to have quality time with family until he died few weeks later with liver failure. Bowel obstruction in patients with abdominal malignancy requires careful assessment. The patient and family should always be involved in decision making. The ultimate goals of palliative care (symptom management, quality of life and dignity of death should never be forgotten during decision making for any patient.

  5. Managing neonatal bowel obstruction: clinical perspectives

    Directory of Open Access Journals (Sweden)

    Desoky SM

    2018-02-01

    Full Text Available Sarah M Desoky,1 Ranjit I Kylat,2 Unni Udayasankar,1 Dorothy Gilbertson-Dahdal1 1Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, USA; 2Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Arizona College of Medicine, Tucson, AZ, USA Abstract: Neonatal intestinal obstruction is a common surgical emergency and occurs in approximately 1 in 2,000 live births. The causes of obstruction are diverse with varied embryological origins, and some underlying etiologies are not yet well described. Some findings of neonatal bowel obstruction can be detected prenatally on ultrasound imaging. The obstruction is classified as “high” when the level of obstruction is proximal to the ileum, and “low” when the level of obstruction is at the ileum or colon. Early diagnosis of the type of intestinal obstruction and localization of the obstructive bowel segment guides timely and appropriate management of the underlying pathologic entity. Neonatal bowel obstructions are ideally managed at specialized centers with a large volume of neonatal surgery and dedicated pediatric surgical and anesthesia expertise. Although surgical intervention is necessary in most cases, initial management strategies often target underlying metabolic, cardiac, or respiratory abnormalities. Imaging plays a key role in early and accurate diagnosis of the abnormalities. When bowel obstruction is suspected clinically, initial imaging workup usually involves abdominal radiography, which may direct further evaluation with fluoroscopic examination such as upper gastrointestinal (UGI contrast study or contrast enema. This article provides a comprehensive review of clinical and radiological features of common and less common causes of intestinal obstruction in the neonatal age group, including esophageal atresia, enteric duplication cysts, gastric volvulus, congenital microgastria, hypertrophic pyloric stenosis, duodenal atresia

  6. Resource conservation management

    International Nuclear Information System (INIS)

    Miller, W.

    1999-01-01

    Resource conservation management is a management program similar to financial management in that its success requires commitment by all levels of the organization to the process as well as an accounting procedure and auditing of critical components. Resource conservation management provides a framework for all elements of efficient building operations and maintenance. The savings connected with the program are principally connected with changes in the way buildings are operated and maintained. Given the reduction in rebates for the installation of energy-efficient equipment, this approach has considerable promise. This paper discusses the evolution of the resource conservation management service and the savings associated with a two-year pilot effort with seven school districts, as well as the critical components of a successful program

  7. Management of inflammatory bowel disease in pregnancy.

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    Smith, M A; Sanderson, J D

    2010-06-01

    Inflammatory bowel disease (IBD) affects body image, relationships, family planning, fertility and pregnancy outcomes. However, the common misconception that IBD is a contraindication, or serious concern, in pregnancy is essentially a myth. Most patients with IBD can expect to have uneventful pregnancies. We present an overview of the management of IBD during pregnancy, including management in those planning pregnancy, the suitability of relevant medication during pregnancy and breast feeding, investigation and monitoring of IBD during pregnancy, surgical management and considerations relating to delivery. While there are some definite alterations required in the management of IBD during pregnancy, management is essentially unchanged. With close attention to aspects such as nutrition and smoking cessation, and optimal disease control in the run-up to and during pregnancy, we have an opportunity to help our patients with IBD achieve good pregnancy outcomes.

  8. Understanding and managing conservation conflicts.

    Science.gov (United States)

    Redpath, Steve M; Young, Juliette; Evely, Anna; Adams, William M; Sutherland, William J; Whitehouse, Andrew; Amar, Arjun; Lambert, Robert A; Linnell, John D C; Watt, Allan; Gutiérrez, R J

    2013-02-01

    Conservation conflicts are increasing and need to be managed to minimise negative impacts on biodiversity, human livelihoods, and human well-being. Here, we explore strategies and case studies that highlight the long-term, dynamic nature of conflicts and the challenges to their management. Conflict management requires parties to recognise problems as shared ones, and engage with clear goals, a transparent evidence base, and an awareness of trade-offs. We hypothesise that conservation outcomes will be less durable when conservationists assert their interests to the detriment of others. Effective conflict management and long-term conservation benefit will be enhanced by better integration of the underpinning social context with the material impacts and evaluation of the efficacy of alternative conflict management approaches. Copyright © 2012 Elsevier Ltd. All rights reserved.

  9. Conservative Management of Placenta Accreta in a Multiparous Woman

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    Jennifer C. Hunt

    2010-01-01

    Full Text Available Placenta accreta refers to any abnormally invasive placental implantation. Diagnosis is suspected postpartum with failed delivery of a retained placenta. Massive obstetrical hemorrhage is a known complication, often requiring peripartum hysterectomy. We report a case of presumed placenta accreta in a patient following failed manual removal of a retained placenta. We describe an attempt at conservative management with methotrexate in a stable patient desiring future fertility. Treatment was unsuccessful and led to the development of a disseminated intrauterine infection complicated by a bowel obstruction, requiring both a hysterectomy and small bowel resection. In hemodynamically stable patients, conservative management of placenta accreta may involve leaving placental tissue in situ with subsequent administration of methotrexate. However, ongoing close observation is required to identify complications.

  10. Conserving and managing the subnivium.

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    Zuckerberg, Benjamin; Pauli, Jonathan N

    2018-02-08

    In regions where snowfall historically has been a defining seasonal characteristic of the landscape, warming winters have reduced the depth, duration, and extent of snowpack. However, most management and conservation has focused on how aboveground wildlife will be affected by altered snow conditions, even though the majority of species that persist through the winter do so under the snowpack in a thermally stable refugium: the subnivium. Shortened winters, forest management practices, and winter recreation can alter subnivium conditions by increasing snow compaction and compromising thermal stability at the soil-snow interface. To help slow the loss of the subnivium in the face of rapidly changing winter conditions, we suggest managers adopt regional conservation plans for identifying threatened snow-covered environments; measure and predict the effects land cover and habitat management has on local subnivium conditions; and control the timing and distribution of activities that disturb and compact snow cover (e.g., silvicultural practices, snow recreation, and road and trail maintenance). As a case study, we developed a spatially explicit model of subnivium presence in a working landscape of the Chequamegon National Forest, Wisconsin. We identified landscapes where winter recreation and management practices could threaten potentially important areas for subnivium persistence. Similar modeling approaches could inform management decisions related to subnivium conservation. Current climate projections predict that snow seasons will change rapidly in many regions, and as result, we advocate for the immediate recognition, conservation, and management of the subnivium and its dependent species. © 2018 Society for Conservation Biology.

  11. Irritable bowel syndrome and its psychological management

    Directory of Open Access Journals (Sweden)

    Ravikesh Tripathi

    2015-01-01

    Full Text Available Irritable Bowel Syndrome (IBS is a chronic and disabling gastrointestinal problem that affects psychosocial functioning as well as the quality of life. This case study reports the utility of cognitive behavior therapy as a psychological intervention procedure in a chronic case of IBS. The use of psychological intervention was found to result in a reduction of anxiety; amelioration of the symptoms associated with IBS and improved functioning.

  12. Guidelines on the irritable bowel syndrome: mechanisms and practical management

    Science.gov (United States)

    Spiller, R; Aziz, Q; Creed, F; Emmanuel, A; Houghton, L; Hungin, P; Jones, R; Kumar, D; Rubin, G; Trudgill, N; Whorwell, P

    2007-01-01

    Background IBS affects 5–11% of the population of most countries. Prevalence peaks in the third and fourth decades, with a female predominance. Aim To provide a guide for the assessment and management of adult patients with irritable bowel syndrome. Methods Members of the Clinical Services Committee of The British Society of Gastroenterology were allocated particular areas to produce review documents. Literature searching included systematic searches using electronic databases such as Pubmed, EMBASE, MEDLINE, Web of Science, and Cochrane databases and extensive personal reference databases. Results Patients can usefully be classified by predominant bowel habit. Few investigations are needed except when diarrhoea is a prominent feature. Alarm features may warrant further investigation. Adverse psychological features and somatisation are often present. Ascertaining the patients' concerns and explaining symptoms in simple terms improves outcome. IBS is a heterogeneous condition with a range of treatments, each of which benefits a small proportion of patients. Treatment of associated anxiety and depression often improves bowel and other symptoms. Randomised placebo controlled trials show benefit as follows: cognitive behavioural therapy and psychodynamic interpersonal therapy improve coping; hypnotherapy benefits global symptoms in otherwise refractory patients; antispasmodics and tricyclic antidepressants improve pain; ispaghula improves pain and bowel habit; 5‐HT3 antagonists improve global symptoms, diarrhoea, and pain but may rarely cause unexplained colitis; 5‐HT4 agonists improve global symptoms, constipation, and bloating; selective serotonin reuptake inhibitors improve global symptoms. Conclusions Better ways of identifying which patients will respond to specific treatments are urgently needed. PMID:17488783

  13. Built heritage monitoring conservation management

    CERN Document Server

    Boriani, Maurizio; Guidi, Gabriele

    2015-01-01

    This book provides a comprehensive, up-to-date overview on the most pressing issues in the conservation and management of archaeological, architectural, and urban landscapes. Multidisciplinary research is presented on a wide range of built heritage sites, from archaeological ruins and historic centers through to twentieth century and industrial architectural heritage. The role of ICT and new technologies, including those used for digital archiving, surveying, modeling, and monitoring, is extensively discussed, in recognition of their importance for professionals working in the field. Detailed attention is also paid to materials and treatments employed in preventive conservation and management. With contributions from leading experts, including university researchers, professionals, and policy makers, the book will be invaluable for all who seek to understand, and solve, the challenges faced in the protection and enhancement of the built heritage.

  14. Small bowel obstruction: the role of computed tomography in its diagnosis and management with reference to other imaging modalities

    International Nuclear Information System (INIS)

    Burkill, G.; Bell, J.; Healy, J.

    2001-01-01

    Small bowel obstruction is a leading cause of acute surgical admissions for abdominal pain. There is an increasing tendency for initial conservative management rather than immediate operative intervention, as a proportion of cases will resolve spontaneously. This has resulted in a growing reliance on radiological investigations to reassure the surgeon that medical therapy can be safely instituted. The onus therefore rests with radiologists to guide their surgical colleagues by correctly interpreting the plain abdominal radiograph and suggesting appropriate further investigation if warranted. Recently, computed tomography (CT) has been proposed as the test of choice to define the level and cause of acute small bowel obstruction and to identify complications such as ischaemia and perforation which will prompt surgical intervention. This review will discuss the utility of early CT in the diagnosis of acute small bowel obstruction and outline its impact on patient management. (orig.)

  15. Clinico-Pathological Profile and Management of Acute Mechanical Small Bowel Obstruction: A Prospective Study

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    Tahir Saleem Khan

    2013-06-01

    Conclusion: Abdominal pain and distention of the abdomen are the most common symptoms and physical findings in patients presenting with acute mechanical small bowel obstruction (SBO. Worm (ascaridial obstruction is the most common cause of obstruction followed by postoperative adhesions. Although all patients were managed conservatively to start with, the operative rate in our series remained very high because it is very difficult to distinguish simple from strangulation obstruction on clinical, biochemical and/or radiological grounds with certainty. [Arch Clin Exp Surg 2013; 2(3.000: 154-160

  16. Intestinal microbiota in pathophysiology and management of irritable bowel syndrome

    Science.gov (United States)

    Lee, Kang Nyeong; Lee, Oh Young

    2014-01-01

    Irritable bowel syndrome (IBS) is a functional bowel disorder without any structural or metabolic abnormalities that sufficiently explain the symptoms, which include abdominal pain and discomfort, and bowel habit changes such as diarrhea and constipation. Its pathogenesis is multifactorial: visceral hypersensitivity, dysmotility, psychosocial factors, genetic or environmental factors, dysregulation of the brain-gut axis, and altered intestinal microbiota have all been proposed as possible causes. The human intestinal microbiota are composed of more than 1000 different bacterial species and 1014 cells, and are essential for the development, function, and homeostasis of the intestine, and for individual health. The putative mechanisms that explain the role of microbiota in the development of IBS include altered composition or metabolic activity of the microbiota, mucosal immune activation and inflammation, increased intestinal permeability and impaired mucosal barrier function, sensory-motor disturbances provoked by the microbiota, and a disturbed gut-microbiota-brain axis. Therefore, modulation of the intestinal microbiota through dietary changes, and use of antibiotics, probiotics, and anti-inflammatory agents has been suggested as strategies for managing IBS symptoms. This review summarizes and discusses the accumulating evidence that intestinal microbiota play a role in the pathophysiology and management of IBS. PMID:25083061

  17. Intestinal microbiota in pathophysiology and management of irritable bowel syndrome.

    Science.gov (United States)

    Lee, Kang Nyeong; Lee, Oh Young

    2014-07-21

    Irritable bowel syndrome (IBS) is a functional bowel disorder without any structural or metabolic abnormalities that sufficiently explain the symptoms, which include abdominal pain and discomfort, and bowel habit changes such as diarrhea and constipation. Its pathogenesis is multifactorial: visceral hypersensitivity, dysmotility, psychosocial factors, genetic or environmental factors, dysregulation of the brain-gut axis, and altered intestinal microbiota have all been proposed as possible causes. The human intestinal microbiota are composed of more than 1000 different bacterial species and 10(14) cells, and are essential for the development, function, and homeostasis of the intestine, and for individual health. The putative mechanisms that explain the role of microbiota in the development of IBS include altered composition or metabolic activity of the microbiota, mucosal immune activation and inflammation, increased intestinal permeability and impaired mucosal barrier function, sensory-motor disturbances provoked by the microbiota, and a disturbed gut-microbiota-brain axis. Therefore, modulation of the intestinal microbiota through dietary changes, and use of antibiotics, probiotics, and anti-inflammatory agents has been suggested as strategies for managing IBS symptoms. This review summarizes and discusses the accumulating evidence that intestinal microbiota play a role in the pathophysiology and management of IBS.

  18. Adhesions small bowel obstruction in emergency setting: conservative or operative treatment?

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    Assenza, M; De Gruttola, I; Rossi, D; Castaldi, S; Falaschi, F; Giuliano, G

    2016-01-01

    Adhesions small bowel obstructions (aSBO) are among the leading causes of emergency operative intervention. About the 80% of aSBO cases resolve without a surgical treatment. It's important to identify which patients could undergo a conservative treatment to prevent an useless surgery The aim of this study is to determine findings that can indicate whether patients with aSBO should undergo a conservative or a surgical treatment. 313 patients with diagnosis of submission of aSBO were restudied. Patients were divided into two groups based on the different type of treatment received, 225 patients who underwent surgical treatment within 24 hours after admission, 88 patients which underwent conservative treatment successfully. For each patient, clinical, hematochemical and radiological findings have been analysed. The treatment of aSBO should be, at the beginning, conservative except that cases that presents clinical and/or CT-scan findings predictive for a surgical treatment (free peritoneal fluid, mesenterial edema, transitional point) or a peritonitis (pneumatosis intestinalis, pneumoperitoneum).

  19. Spontaneous cervical epidural hematoma: Report of a case managed conservatively

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    Halim Tariq

    2008-01-01

    Full Text Available Spontaneous spinal epidural hematoma is a rare cause of acute spinal cord compression. A 25-year-old male presented with a history of sudden onset of complete quadriplegia with sensory loss below the neck along with loss of bowel and bladder control. He had no history of any constitutional symptoms. He reported 10 days later. He was managed conservatively and after two weeks of intensive rehabilitation he had complete neural recovery. The spontaneous recovery of neurological impairment is attributed to the spreading of the hematoma throughout the epidural space, thus decreasing the pressure with partial neural recovery. Conservative treatment is a fair option in young patients who present late and show neurological improvement. The neurological status on presentation will guide the further approach to management.

  20. Conservative management of fracture scaphoid

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    Mittal V

    2006-01-01

    Full Text Available Background : Conservative management of fracture scaphoid with cast is still the most common modality of management, but the results following this protocol are not always satisfactory. Methods : Twenty five patients with fracture scaphoid were treated with a below elbow scaphoid cast and were followed up for minimum duration of one year. On follow up patients were examined clinicoradiologically and functional results were evaluated using the modification of the Mayo wrist scoring chart. Results : Nineteen fractures showed union, two were malunited and five went for nonunion. Two fractures developed avascular necrosis and three patients had wrist arthritis on follow up. Nineteen patients had excellent functional results, one had good results and six patients had poor results. Patients with delayed diagnosis had nonunion and poor functional results. Patients with premature removal of cast had comparatively inferior results Conclusion : For displaced unstable fracture, open reduction and internal fixation should be the preferred modality of treatment as cast treatment gives unacceptably high rate of malunion and nonunion with poor functional results.

  1. Gastrografin in the management of adhesive small bowel ...

    African Journals Online (AJOL)

    stay time. Results An oral administration of gastrografin successfully completed the conservative management in eight of 12 patients (66.6%), thus avoiding surgery and subsequently reducing hospital stay. Conclusion Gastrografin may have a valuable role in the management of ASBO, whether diagnostic or therapeutic,.

  2. Bowel management systems in critical care: a service evaluation.

    Science.gov (United States)

    Ritzema, Jennifer

    2017-01-25

    Aim Many patients who are critically ill develop faecal incontinence associated with diarrhoea, and require a bowel management system (BMS) to prevent skin excoriation. Following guidelines produced by the National Institute for Health and Care Excellence, early rehabilitation has resulted in a reduction in the number of days that patients receive mechanical ventilation. However, patients with a BMS are potentially mechanically ventilated for longer because they are cared for in bed. The aim of this evaluation was to investigate whether patients with a BMS are mechanically ventilated for longer than those without a BMS. Method This was a retrospective service evaluation, in which a database search was conducted to identify patients admitted to the critical care department in one healthcare organisation during 2013. The search was narrowed to identify patients admitted to the critical care department who had received advanced respiratory support (mechanical ventilation), to compare the mean number of mechanically ventilated days between patients with and without a BMS (n = 122). Data were analysed using the Mann-Whitney U test. Results There was a significant difference in the number of mechanically ventilated days (Pcritically ill patients with a BMS are placed in a sitting position for short periods of time. Further research should explore alternative bowel care options for patients who are critically ill.

  3. Energy conservation prospects through electric load management

    Energy Technology Data Exchange (ETDEWEB)

    El-Shirbeeny, E H.T.

    1984-04-01

    In this paper, concepts of electric load management are discussed for effective energy conservation. It is shown that the conservation program must be comprehensive to provide solutions to the problems facing the electric consumer, the electric utility and the society by reducing the rate of growth of energy consumption and power system peak demand requirements. The impact of energy management programs on electric energy conservation is examined, with emphasis on efficiency, storage, cogeneration and controls with computers.

  4. Extraintestinal manifestations of inflammatory bowel disease: epidemiology, diagnosis, and management

    DEFF Research Database (Denmark)

    Larsen, Signe; Bendtzen, Klaus; Nielsen, Ole Haagen

    2010-01-01

    Abstract Extraintestinal manifestations occur rather frequently in inflammatory bowel disease (IBD), e.g. ulcerative colitis (UC) and Crohn's disease (CD). The present paper provides an overview of the epidemiology, clinical characteristics, diagnostic process, and management of rheumatic......, metabolic, dermatologic (mucocutaneous), ophthalmologic, hepatobiliary, hematologic, thromboembolic, urinary tract, pulmonary, and pancreatic extraintestinal manifestations related to IBD. Articles were identified through search of the PubMed and Embase databases, the Cochrane Library, and the web sites......', 'thromboembolism', and 'treatment'. The search was performed on English-language reviews, practical guidelines, letters, and editorials. Articles were selected based on their relevance, and additional papers were retrieved from their reference lists. Since some of the diseases discussed are uncommon, valid...

  5. Management of Iron-Deficiency Anemia in Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Nielsen, Ole Haagen; Ainsworth, Mark; Coskun, Mehmet

    2015-01-01

    Anemia is the most frequent complication of inflammatory bowel disease (IBD), but anemia, mostly due to iron deficiency, has long been neglected in these patients. The aim was to briefly present the pathophysiology, followed by a balanced overview of the different forms of iron replacement...... available, and subsequently, to perform a systematic review of studies performed in the last decade on the treatment of iron-deficiency anemia in IBD. Given that intravenous therapies have been introduced in the last decade, a systematic review performed in PubMed, EMBASE, the Cochrane Library......, and the websites of WHO, FDA, and EMA covered prospective trials investigating the management of iron-deficiency anemia in IBD published since 2004. A total of 632 articles were reviewed, and 13 articles (2906 patients) with unique content were included. In general, oral supplementation in iron-deficiency anemia...

  6. Changing treatment paradigms for the management of inflammatory bowel disease.

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    Im, Jong Pil; Ye, Byong Duk; Kim, You Sun; Kim, Joo Sung

    2018-01-01

    Inflammatory bowel disease (IBD) is a chronic and progressive inf lammatory condition of the gastrointestinal tract causing bowel damage, hospitalizations, surgeries, and disability. Although there has been much progress in the management of IBD with established and evolving therapies, most current approaches have failed to change the natural course. Therefore, the treatment approach and follow-up of patients with IBD have undergone a significant change. Usage of immunosuppressants and/or biologics early during the course of the disease, known as top-down or accelerated step-up approach, was shown to be superior to conventional management in patients who had been recently diagnosed with IBD. This approach can be applied to selected groups based on prognostic factors to control disease activity and prevent progressive disease. Therapeutic targets have been shifted from clinical remission mainly based on symptoms to objective parameters such as endoscopic healing due to the discrepancies observed between symptoms, objectively evaluated inf lammatory activity, and intestinal damage. The concept of treat-to-target in IBD has been supported by population-based cohort studies, post hoc analysis of clinical trials, and meta-analysis, but more evidence is needed to support this concept to be applied to the clinical practice. In addition, individualized approach with tight monitoring of non-invasive biomarker such as C-reactive protein and fecal calprotectin and drug concentration has shown to improve clinical and endoscopic outcomes. An appropriate de-escalation strategy is considered based on patient demographics, disease features, current disease status, and patients' preferences.

  7. Conservation, management, and restoration of coral reefs.

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    Chavanich, Suchana; Soong, Keryea; Zvuloni, Assaf; Rinkevich, Baruch; Alino, Porfirio

    2015-04-01

    The 8th International Conference on Coelenterate Biology (ICCB 8) was held in Eilat, Israel from December 1st to 5th 2013. The conference included 15 sessions, one of which discussed the latest information on the conservation, management, and restoration of Coelenterata in different parts of the world. A total of 16 oral presentations and 5 posters were presented in this session. Of these 21 papers, 11 were related to conservation issues, 7 described management, and 3 discussed restoration. This session provided insights on the current conservation, management, and restoration of coelenterates in different parts of the world. Copyright © 2015 Elsevier GmbH. All rights reserved.

  8. Assessment of management effectiveness of Lekki conservation ...

    African Journals Online (AJOL)

    This study was carried out in the Lekki Conservation Centre (LCC), a private ... questionnaires for three categories of respondents – tourists, NCF and LCC ... awareness education and resource management are some of the strengths of LCC.

  9. Conservative Management of Colonoscopic Perforation: A Case Report.

    Science.gov (United States)

    Parsa, Hossein; Miroliaee, Arash; Doagoo, Zafar; Sina, Saeed

    2017-07-01

    Colonoscopy is widely used for the diagnosis, treatment and a follow up of colorectal diseases. Perforation of the large bowel during elective colonoscopy is rare but serious life threatening complication. We report a 51-year-old woman who experienced recto sigmoid perforation during diagnostic colonoscopy. During 8 days of total hospitalization, she spent 3 days in ICU with gastrointestinal rest. The patient was hydrated and took intravenous antibiotics. In take-output and temperature were closely monitored. Serial abdominal examinations were performed to rule out peritonitis. After transferring to surgery ward in the day 4, liquid diet started slowly, and she was ambulated. At the day 8, she was discharged with the good clinical condition. Conservative management of the patients with early diagnosis of perforation and no signs and symptoms of peritonitis or sepsis could be the modality of choice.

  10. The challenges of managing and following-up a case of short bowel in eastern europe

    Directory of Open Access Journals (Sweden)

    Henry Ifeanyi Osakwe

    2016-01-01

    Conclusion: The lack of sufficient mucosal surface followed by long time intestinal adaptation process is crucial in determining bowel functional capacity. Long time hospital stay and cost was reduced through a parental home healthcare management training scheme.

  11. Comparison of Diverting Colostomy and Bowel Management Catheter Applications in Fournier Gangrene Cases Requiring Fecal Diversion.

    Science.gov (United States)

    Eray, Ismail Cem; Alabaz, Omer; Akcam, Atilgan Tolga; Ulku, Abdullah; Parsak, Cem Kaan; Sakman, Gurhan; Seydaoglu, Gulsah

    2015-12-01

    In some patients of Fournier gangrene originated from perianal region, it is important to prevent fecal contamination in order to provide healing without wound infection. For this purposes, diverting colostomy or bowel management catheter methods were performed. In this study, it is aimed to carry out a comparison of prognosis and cost efficiency between diverting colostomy and bowel management catheter methods applied for preventing fecal contamination in Fournier's gangrene patients. Fourty-eight patients with diagnosis of Fournier's gangrene, serious perianal infections, and preserved sphincters and without rectum injury after debridement were included in the study. The cases were divided into two groups as patients who were subjected to colostomy for fecal diversion and who were subjected to bowel management catheter without colostomy. Then, the groups were compared in terms of age, predisposing factors, duration of hospital stay, mortality, additional surgery requirements, and cost. Fourty-eight patients were included the study. Sixteen patients were treated without colostomy. Decreased duration of total hospital stay, additional surgery requirements, and hospital expense in bowel management catheter group has determined. It is thought that preferring bowel management catheter method instead of colostomy in patients without rectum injury, who require diverting colostomy and have undamaged anal sphincters, can relieve patients, patients' relatives, healthcare organizations, and the national economy of a serious burden. In addition, although patients' satisfaction and workforce loss factors are not taken into consideration in this study, the bowel management catheter method is thought to have positive effects also on these parameters.

  12. Management of inflammatory bowel disease with Clostridium difficile infection.

    Science.gov (United States)

    D'Aoust, Julie; Battat, Robert; Bessissow, Talat

    2017-07-21

    To address the management of Clostridium difficile ( C. difficile ) infection (CDI) in the setting of suspected inflammatory bowel disease (IBD)-flare. A systematic search of the Ovid MEDLINE and EMBASE databases by independent reviewers identified 70 articles including a total of 932141 IBD patients or IBD-related hospitalizations. In those with IBD, CDI is associated with increased morbidity, including subsequent escalation in IBD medical therapy, urgent colectomy and increased hospitalization, as well as excess mortality. Vancomycin-containing regimens are effective first-line therapies for CDI in IBD inpatients. No prospective data exists with regards to the safety or efficacy of initiating or maintaining corticosteroid, immunomodulator, or biologic therapy to treat IBD in the setting of CDI. Corticosteroid use is a risk factor for the development of CDI, while immunomodulators and biologics are not. Strong recommendations regarding when to initiate IBD specific therapy in those with CDI are precluded by a lack of evidence. However, based on expert opinion and observational data, initiation or resumption of immunosuppressive therapy after 48-72 h of targeted antibiotic treatment for CDI may be considered.

  13. Surgical management of irradiation-induced small bowel damage

    Energy Technology Data Exchange (ETDEWEB)

    Smith, S.T.; Seski, J.C.; Copeland, L.J.; Gershenson, D.M.; Edwards, C.L.; Herson, J.

    1985-04-01

    Seventy-seven patients, presenting with radiation small bowel injuries at the University of Texas M. D. Anderson Hospital and Tumor Institute at Houston between 1962 and 1978, were analyzed retrospectively. The patients were divided into two categories: bowel bypass without resection, and resection of irradiated bowel. Each group was then analyzed for its short- and long-term complications. Ileocolectomy with end-to-end anastomosis was the surgical procedure of choice in those people undergoing resection. There was no difference in short-term complications noted between the two groups. The long-term complications of fistula formation and continued small bowel necrosis could be prevented by resection, as a primary procedure. The surgical details of ileocolectomy with end-to-end anastomosis are presented, along with an analysis of the complications encountered in both groups.

  14. Surgical management of irradiation-induced small bowel damage

    International Nuclear Information System (INIS)

    Smith, S.T.; Seski, J.C.; Copeland, L.J.; Gershenson, D.M.; Edwards, C.L.; Herson, J.

    1985-01-01

    Seventy-seven patients, presenting with radiation small bowel injuries at the University of Texas M. D. Anderson Hospital and Tumor Institute at Houston between 1962 and 1978, were analyzed retrospectively. The patients were divided into two categories: bowel bypass without resection, and resection of irradiated bowel. Each group was then analyzed for its short- and long-term complications. Ileocolectomy with end-to-end anastomosis was the surgical procedure of choice in those people undergoing resection. There was no difference in short-term complications noted between the two groups. The long-term complications of fistula formation and continued small bowel necrosis could be prevented by resection, as a primary procedure. The surgical details of ileocolectomy with end-to-end anastomosis are presented, along with an analysis of the complications encountered in both groups

  15. River use, conservation and management among riverine ...

    African Journals Online (AJOL)

    However the problem remains that many water resource planning and management regimes do not capture the views of the myriad of stakeholders and the many benefits of ecological services. This paper examines river use, conservation and management among riverine communities in South Eastern Nigeria using ...

  16. Management of Iron-Deficiency Anemia in Inflammatory Bowel Disease

    Science.gov (United States)

    Nielsen, Ole Haagen; Ainsworth, Mark; Coskun, Mehmet; Weiss, Günter

    2015-01-01

    Abstract Anemia is the most frequent complication of inflammatory bowel disease (IBD), but anemia, mostly due to iron deficiency, has long been neglected in these patients. The aim was to briefly present the pathophysiology, followed by a balanced overview of the different forms of iron replacement available, and subsequently, to perform a systematic review of studies performed in the last decade on the treatment of iron-deficiency anemia in IBD. Given that intravenous therapies have been introduced in the last decade, a systematic review performed in PubMed, EMBASE, the Cochrane Library, and the websites of WHO, FDA, and EMA covered prospective trials investigating the management of iron-deficiency anemia in IBD published since 2004. A total of 632 articles were reviewed, and 13 articles (2906 patients) with unique content were included. In general, oral supplementation in iron-deficiency anemia should be administered with a target to restore/replenish the iron stores and the hemoglobin level in a suitable way. However, in patients with IBD flares and inadequate responses to or side effects with oral preparations, intravenous iron supplementation is the therapy of choice. Neither oral nor intravenous therapy seems to exacerbate the clinical course of IBD, and intravenous iron therapy can be administered even in active disease stages and concomitantly with biologics. In conclusion, because many physicians are in doubt as to how to manage anemia and iron deficiency in IBD, there is a clear need for the implementation of evidence-based recommendations on this matter. Based on the data presented, oral iron therapy should be preferred for patients with quiescent disease stages and trivial iron deficiency anemia unless such patients are intolerant or have an inadequate response, whereas intravenous iron supplementation may be of advantage in patients with aggravated anemia or flares of IBD because inflammation hampers intestinal absorption of iron. PMID:26061331

  17. Effectiveness of an organized bowel management program in the management of severe chronic constipation in children.

    Science.gov (United States)

    Russell, Katie W; Barnhart, Douglas C; Zobell, Sarah; Scaife, Eric R; Rollins, Michael D

    2015-03-01

    Chronic constipation is a common problem in children. The cause of constipation is often idiopathic, when no anatomic or physiologic etiology can be identified. In severe cases, low dose laxatives, stool softeners and small volume enemas are ineffective. The purpose of this study was to assess the effectiveness of a structured bowel management program in these children. We retrospectively reviewed children with chronic constipation without a history of anorectal malformation, Hirschsprung's disease or other anatomical lesions seen in our pediatric colorectal center. Our bowel management program consists of an intensive week where treatment is assessed and tailored based on clinical response and daily radiographs. Once a successful treatment plan is established, children are followed longitudinally. The number of patients requiring hospital admission during the year prior to and year after initiation of bowel management was compared using Fisher's exact test. Forty-four children with refractory constipation have been followed in our colorectal center for greater than a year. Fifty percent had at least one hospitalization the year prior to treatment for obstructive symptoms. Children were treated with either high-dose laxatives starting at 2mg/kg of senna or enemas starting at 20ml/kg of normal saline. Treatment regimens were adjusted based on response to therapy. The admission rate one-year after enrollment was 9% including both adherent and nonadherent patients. This represents an 82% reduction in hospital admissions (phospital admissions in children with severe chronic constipation. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Organizational determinants of energy-conservation management

    Energy Technology Data Exchange (ETDEWEB)

    Selmer, J. (Hong Kong Baptist Coll., Kowloon (Hong Kong). Dept. of Management)

    1994-10-01

    Energy-conservation activities require new functional and technical activities in all participating organizations and the prospects of effectively managing such activities are contingent upon the specific organizational setting. Based on a previous large-scale investigation in which we identified five organizational archetypes, in-depth longitudinal case studies were undertaken of five organizations in Sweden during 5 years, each organization representing a different archetype. The five organizations have distinct organizational prerequisites and separate basic motivations to engage and succeed in energy-conservation management. Implications for government policy and managerial action are discussed in detail. (author)

  19. Energy conservation: its planning and management

    International Nuclear Information System (INIS)

    Nanda, K.S.; Patra, K.C.

    1995-01-01

    Energy conservation, its planning and management and the development of renewable energy systems of proven design are very worthy challenges for all. Energy education at various levels is most important particularly in the development of renewable energy technology. 2 refs., 3 tabs

  20. Management of Anemia in Patients with Inflammatory Bowel Disease (IBD).

    Science.gov (United States)

    Patel, Dhruvan; Trivedi, Chinmay; Khan, Nabeel

    2018-03-01

    Anemia is the most common complication as well as an extra intestinal manifestation of inflammatory bowel disease (IBD). It is associated with a significant impact on patient's quality of life (QoL); as well it represents a common cause of frequent hospitalization, delay of hospital inpatient discharge and overall increased healthcare burden. In spite of all these, anemia is still often underdiagnosed and undertreated. Our aim in this review is to provide a pathway for physicians to help them achieve early diagnosis as well as timely and appropriate treatment of anemia which in turn would hopefully reduce the prevalence and subsequent complications of this condition among IBD patients. The etiology of anemia among IBD patients is most commonly due to iron deficiency anemia (IDA) followed by anemia of chronic disease. Despite this, more than a third of anemic ulcerative colitis (UC) patients are not tested for IDA and among those tested and diagnosed with IDA, a quarter are not treated with iron replacement therapy. A new algorithm has been validated to predict who will develop moderate to severe anemia at the time of UC diagnosis. While oral iron is effective for the treatment of mild iron deficiency-related anemia, the absorption of iron is influenced by chronic inflammatory states as a consequence of the presence of elevated levels of hepcidin. Also, it is important to recognize that ferritin is elevated in chronic inflammatory states and among patients with active IBD, ferritin levels less than 100 are considered to be diagnostic of iron deficiency. Newer formulations of intra-venous (IV) iron have a good safety profile and can be used for replenishment of iron stores and prevention of iron deficiency in the future. Routine screening for anemia is important among patients with IBD. The cornerstone for the accurate management of anemia in IBD patients lies in accurately diagnosing the type of anemia. All IBD patients with IDA should be considered appropriate for

  1. Adaptive social impact management for conservation and environmental management.

    Science.gov (United States)

    Kaplan-Hallam, Maery; Bennett, Nathan J

    2018-04-01

    Concerns about the social consequences of conservation have spurred increased attention the monitoring and evaluation of the social impacts of conservation projects. This has resulted in a growing body of research that demonstrates how conservation can produce both positive and negative social, economic, cultural, health, and governance consequences for local communities. Yet, the results of social monitoring efforts are seldom applied to adaptively manage conservation projects. Greater attention is needed to incorporating the results of social impact assessments in long-term conservation management to minimize negative social consequences and maximize social benefits. We bring together insights from social impact assessment, adaptive management, social learning, knowledge coproduction, cross-scale governance, and environmental planning to propose a definition and framework for adaptive social impact management (ASIM). We define ASIM as the cyclical process of monitoring and adaptively managing social impacts over the life-span of an initiative through the 4 stages of profiling, learning, planning, and implementing. We outline 14 steps associated with the 4 stages of the ASIM cycle and provide guidance and potential methods for social-indicator development, predictive assessments of social impacts, monitoring and evaluation, communication of results, and identification and prioritization of management responses. Successful ASIM will be aided by engaging with best practices - including local engagement and collaboration in the process, transparent communication of results to stakeholders, collective deliberation on and choice of interventions, documentation of shared learning at the site level, and the scaling up of insights to inform higher-level conservation policies-to increase accountability, trust, and perceived legitimacy among stakeholders. The ASIM process is broadly applicable to conservation, environmental management, and development initiatives at various

  2. What Are the Targets of Inflammatory Bowel Disease Management.

    Science.gov (United States)

    Lega, Sara; Dubinsky, Marla C

    2018-04-25

    With recent evidence suggesting that keeping the inflammatory process under tight control prevents long-term disability, the aim of treatments in inflammatory bowel disease (IBD) has shifted from symptom control toward the resolution of bowel inflammation. Mucosal healing is currently recognized as the principal treatment target to be used in a "treat to target" paradigm, whereas histologic healing and normalization of biomarkers are being evaluated as potential future targets. Although symptom relief is no longer a sufficient target, patient experience with the disease is of unquestionable importance and should be assessed in the form of patient-reported outcomes, to be used as a co-primary target with an objective measure of disease activity. IBD in is a heterogeneous disease; thus besides defining common treatment targets, every effort should be made to deliver a personalized treatment plan based on the risk factors for disease progression and individual drug metabolism to improve treatment success.

  3. The localization of bleeding small bowel lesions for conservative resection: a simple radiographic technique

    International Nuclear Information System (INIS)

    Stevens, J.M.; Northover, J.M.A.; Raphael, M.J.; Slack, W.W.

    1981-01-01

    Haemorrhage from the small bowel is a serious diagnostic and therapeutic problem. The value of selective superior mesenteric angiography to localize the source accurately does not require emphasizing. However, many of the lesions demonstrated are notoriously difficult to find at operation unless they are actively bleeding at the time. A simple method of intra-operative angiography is described which, because demonstration of the bleeding lesion on the operative films is not an essential requirement, does not involve the use of specialized angiographic equipment. Although only one case is offered to illustrate the method, it seems to possess sufficient versatility to be useful in most situations where intra-operative assistance in isolating a specific loop of small bowel for resection is anticipated. (author)

  4. Localization of bleeding small bowel lesions for conservative resection: a simple radiographic technique

    Energy Technology Data Exchange (ETDEWEB)

    Stevens, J M; Northover, J M.A.; Raphael, M J; Slack, W W [Middlesex Hospital, London (UK)

    1981-10-01

    Haemorrhage from the small bowel is a serious diagnostic and therapeutic problem. The value of selective superior mesenteric angiography to localize the source accurately does not require emphasizing. However, many of the lesions demonstrated are notoriously difficult to find at operation unless they are actively bleeding at the time. A simple method of intra-operative angiography is described which, because demonstration of the bleeding lesion on the operative films is not an essential requirement, does not involve the use of specialized angiographic equipment. Although only one case is offered to illustrate the method, it seems to possess sufficient versatility to be useful in most situations where intra-operative assistance in isolating a specific loop of small bowel for resection is anticipated.

  5. Pelvic actinomycosis presenting with a large abscess and bowel stenosis with marked response to conservative treatment: a case report

    Directory of Open Access Journals (Sweden)

    Nozawa Hiroaki

    2007-11-01

    Full Text Available Abstract Pelvic actinomycosis is a rare disease that can result in abscess formation, bowel obstruction, and other serious complications. Moreover, the correct diagnosis can seldom be established before radical surgery because the disease often mimics pelvic neoplasms. It has been recently recognized that pelvic actinomycosis is associated with long-term use of an intrauterine contraceptive device. We report a woman with a long-standing intrauterine contraceptive device who visited our hospital complaining of symptoms mimicking large bowel ileus with a subacute course. X-ray fluorography and sigmoidoscopy showed marked stenosis in the sigmoid colon but rejected the possibility of colon cancers. Abdomino-pelvic CT and MRI revealed a huge abscess lying over the urinary bladder and anterior to the uterus. Furthermore, a cervical Papanicolaou smear disclosed Actinomyces species. We removed the intrauterine device from the patient. Subsequent high-dose ampicillin administration led to dramatic shrinkage of the abscess and improved the management of the bowel movement quickly. This is a successful case of symptomatic pelvic actinomycosis that was correctly diagnosed and treated without unnecessary surgical intervention.

  6. Maximizing conservation benefit for grassland species with contrasting management requirements

    NARCIS (Netherlands)

    Teeffelen, van A.J.A.; Cabeza, M.; Poyry, J.; Raatikainen, K.; Kuussaari, M.

    2008-01-01

    Conservation management often encompasses multiple, alternative management actions on a given site, involving habitat restoration and maintenance for example. Which actions are preferable depends on the conservation goals, the expected outcomes of actions, and their associated costs. When actions

  7. Inflammatory pathways of importance for management of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Pedersen, Jannie; Coskun, Mehmet; Soendergaard, Christoffer

    2014-01-01

    Inflammatory bowel disease (IBD) is a group of chronic disorders of the gastrointestinal tract comprising Crohn's disease (CD) and ulcerative colitis (UC). Their etiologies are unknown, but they are characterised by an imbalanced production of pro-inflammatory mediators, e.g., tumor necrosis factor......-inflammatory cytokines, antibodies targeting integrins, and small anti-adhesion molecules that block adhesion between leukocytes and the intestinal vascular endothelium, reducing their infiltration into the inflamed mucosa. In this review we have elucidated the major signaling pathways of clinical importance for IBD...

  8. 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.

  9. Irritable Bowel Syndrome: Clinical Manifestations, Dietary Influences, and Management

    Directory of Open Access Journals (Sweden)

    Ronald Ikechi

    2017-04-01

    Full Text Available Irritable bowel syndrome (IBS is a functional gastrointestinal disorder that is characterized by symptoms of chronic abdominal pain and altered bowel habits in the absence of an overtly identifiable cause. It is the most commonly diagnosed functional gastrointestinal disorder, accounting for about one third of gastroenterology visits. It generally presents as a complex of symptoms, including psychological dysfunction. Hypersensitivity to certain foods, especially foods that contain high amounts of fructose, plays a role in the pathophysiology of IBS. Elevated consumption of high-fructose corn syrup (HFCS has been discussed in this aspect. The treatment options for IBS are challenging and varied. In addition to dietary restrictions for HFCS-induced IBS, such as low-FODMAP (Fermentable Oligosaccharides, Disaccharide, Monosaccharides, and Polyols diets, existing drug therapies are administered based on the predominant symptoms and IBS-subtype. Patients with IBS are likely to suffer from issues, such as anxiety, depression, and post-traumatic-stress disorder. Biopsychosocial factors particularly socioeconomic status, sex, and race should, thus, be considered for diagnostic evaluation of patients with IBS.

  10. Managing inflammatory bowel disease in pregnancy: current perspectives

    Directory of Open Access Journals (Sweden)

    Pinder M

    2016-10-01

    Full Text Available Matthew Pinder,1 Katie Lummis,1 Christian P Selinger1,2 1Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, 2University of Leeds, Leeds, UK Abstract: Inflammatory bowel disease (IBD affects many women of childbearing age. The course of IBD is closely related to pregnancy outcomes with poorly controlled IBD increasing the risk of prematurity, low weight for gestation, and fetal loss. As such, women with IBD face complex decision making weighing the risks of active disease versus those of medical treatments. This review summarizes the current evidence regarding the safety and efficacy of IBD treatments during pregnancy and lactation aiming to provide up-to-date guidance for clinicians. Over 50% of women have poor IBD- and pregnancy-related knowledge, which is associated with views contrary to medical evidence and voluntary childlessness. This review highlights the effects of poor patient knowledge and critically evaluates interventions for improving patient knowledge and outcomes. Keywords: pregnancy, breast feeding, nursing, inflammatory bowel disease, Crohn’s disease, ulcerative colitis

  11. CONSERVATION MANAGEMENT AND LEGISLATION THE UK EXPERIENCE

    Directory of Open Access Journals (Sweden)

    SIBLEY P. J.

    2003-04-01

    Full Text Available Underpinning the conservation management of Austropotamobius pallipes in the UK is the process of monitoring and reporting crayfish distribution. Should the current trend in the decline of A. pallipes continue, the species could be virtually extinct in mainland Britain within 30 years (SIBLEY, 2003. Conversely, if the increase in the distribution of non-indigenous crayfish species (NICS continues at its current rate, the distribution (by 10 km squares of these species could double within 15 years. These forward projections are based on a number of possibly unreliable assumptions; they illustrate however the magnitude of the challenge facing those concerned with the conservation of A. pallipes in the UK at this time. Recent work in crayfish conservation management in the UK has yielded guidance in several areas including monitoring, habitat enhancement and a re-introduction protocol for A. pallipes (KEMP and HILEY, 2003. Similarly, scientific research continues to inform our understanding of the movement and behaviour of NICS and explores new methods for the potential management of these species. In addition, the protection afforded to A. pallipes by current legislation is key to the long-term survival prospects of the species, albeit with a probable fragmented distribution, across the British Isles and continental Europe. Legal provisions in the UK derive in part from European instructions (e.g. EC Habitats and Species Directive and also from national legislation (e.g. Salmon and Freshwater Fisheries Act (1975 and the Wildlife and Countryside Act (1981. Also, a raft of “quasi-legislation” exists which requires responsible organisations in the UK to implement the white-clawed crayfish biodiversity action plan (BAP. Altogether these provisions constitute a considerable volume of legal protection for crayfish and provide the legal framework on which UK management policy and practice are based.

  12. Bowel Management and Quality of Life in Children With Spina Bifida in South Korea.

    Science.gov (United States)

    Choi, Eun Kyoung; Im, Young Jae; Han, Sang Won

    Bowel management is a concern in patients with spina bifida. We evaluated the status of bowel management in children with spina bifida (SB) and the effects on quality of life (QoL) of children and their caregivers. Data were collected from 173 children with SB between January and June 2011, whose bowel management status and QoL were assessed using a self-administered questionnaire. Of the 173 children, 38 (22.0%) reported normal defecation, 73 (42.2%) reported constipation only, and 62 (35.8%) reported fecal incontinence with/without constipation. For defecation, 59 children (34.1%) used digital stimulation or manual extraction, 28 (16.2%) used suppositories or enemas, 35 (20.3%) used laxatives, 4 (2.3%) used an antegrade continence enema, and 3 (1.7%) used transanal irrigation. There were significant differences in QoL, depending on defecation symptoms. Children with fecal incontinence and their caregivers had difficulties in travel and socialization (p children with SB and their caregivers. Therefore, more attention should be paid to bowel problems and help should be provided to children and their caregivers to improve QoL.

  13. A Community Perspective on Bowel Management and Quality of Life after Spinal Cord Injury: The Influence of Autonomic Dysreflexia.

    Science.gov (United States)

    Inskip, Jessica A; Lucci, Vera-Ellen M; McGrath, Maureen S; Willms, Rhonda; Claydon, Victoria E

    2018-05-01

    Autonomic dysfunction is common in individuals with spinal cord injury (SCI) and leads to numerous abnormalities, including profound cardiovascular and bowel dysfunction. In those with high-level lesions, bowel management is a common trigger for autonomic dysreflexia (AD; hypertension provoked by sensory stimuli below the injury level). Improving bowel care is integral for enhancing quality of life (QoL). We aimed to describe the relationships between bowel care, AD, and QoL in individuals with SCI. We performed an online community survey of individuals with SCI. Those with injury at or above T7 were considered at risk for AD. Responses were received from 287 individuals with SCI (injury levels C1-sacral and average duration of injury 17.1 ± 12.9 [standard deviation] years). Survey completion rate was 73% (n = 210). Bowel management was a problem for 78%: it interfered with personal relationships (60%) and prevented staying (62%) and working (41%) away from home. The normal bowel care duration was >60 min in 24% and most used digital rectal stimulation (59%); 33% reported bowel incontinence at least monthly. Of those at risk for AD (n = 163), 74% had AD symptoms during bowel care; 32% described palpitations. AD interfered with activities of daily living in 51%. Longer durations of bowel care (p < 0.001) and more severe AD (p = 0.04) were associated with lower QoL. Bowel management is a key concern for individuals with SCI and is commonly associated with symptoms of AD. Further studies should explore ways to manage bowel dysfunction, increase self-efficacy, and ameliorate the impact of AD to improve QoL.

  14. Long-term bladder and bowel management after spinal cord injury: a 20-year longitudinal study.

    Science.gov (United States)

    Savic, Gordana; Frankel, Hans L; Jamous, Mohamed Ali; Soni, Bakulesh M; Charlifue, Susan

    2018-02-16

    Prospective observational. The aim of this study was to analyse changes in bladder and bowel management methods in persons with long-standing spinal cord injury (SCI). Two spinal centres in UK. Data were collected through interviews and examinations between 1990 and 2010 in a sample of persons injured more than 20 years prior to 1990. For the 85 participants who completed the 2010 follow-up, the mean age was 67.7 years and the mean duration of injury was 46.3 years, 80% were male, 37.7% had tetraplegia AIS grade A, B, or C, 44.7% paraplegia AIS A, B, or C, and 17.6% an AIS D grade regardless of level. In all, 50.6% reported having changed their bladder method, 63.1% their bowel method, and 40.5% both methods since they enroled in the study. The reasons for change were a combination of medical and practical. In men, condom drainage remained the most frequent bladder method, and in women, suprapubic catheter replaced straining/expressing as the most frequent method. The use of condom drainage and straining/expressing bladder methods decreased, whereas the use of suprapubic and intermittent catheters increased. Manual evacuation remained the most frequent bowel management method. The percentage of participants on spontaneous/voluntary bowel emptying, straining and medications alone decreased, whereas the use of colostomy and transanal irrigation increased over time. More than half the sample, all living with SCI for more than 40 years, required change in their bladder and bowel management methods, for either medical or practical reasons. Regular follow-ups ensure adequate change of method if/when needed.

  15. Oak woodland conservation management planning in southern CA - lessons learned

    Science.gov (United States)

    Rosi Dagit

    2015-01-01

    The California Oak Woodlands Conservation Act (AB 242 2001) established requirements for the preservation and protection of oak woodlands and trees, and allocated funding managed by the Wildlife Conservation Board. In order to qualify to use these funds, counties and cities need to adopt an oak conservation management plan. Between 2008 and 2011, a team of concerned...

  16. Irritable bowel syndrome: role of food in pathogenesis and management.

    LENUS (Irish Health Repository)

    Morcos, Ashraf

    2009-11-01

    Patients with the irritable bowel syndrome (IBS) commonly report the precipitation of symptoms on food ingestion. Though the role of dietary constituents in IBS has not been extensively studied, food could contribute to symptom onset or even the causation of IBS through a number of mechanisms. First, the physiological response of the intestine to food ingestion could precipitate symptoms in predisposed individuals; second, there is some evidence that allergy or intolerance to a particular food can produce IBS-like symptoms, third, certain foods may alter the composition of the luminal milieu, either directly or indirectly through effects on bacterial metabolism, and thus induce symptoms and, finally, IBS may develop following exposure to food-borne pathogens. Anticipatory, psychological factors generated by previous negative experiences with food ingestion or other factors may also contribute though their contribution has been scarcely quantified. Not surprisingly, there is considerable interest in the potential roles of diet and food supplements in the therapy of IBS; for the most part, the evidence base for such recommendations remains slim though certain probiotics show considerable promise.

  17. Biosimilars for the management of inflammatory bowel diseases: economic considerations.

    Science.gov (United States)

    Gulacsi, Laszlo; Pentek, Marta; Rencz, Fanni; Brodszky, Valentin; Baji, Petra; Vegh, Zsuzsanna; Gecse, Krisztina B; Danese, Silvio; Peyrin-Biroulet, Laurent; Lakatos, Peter L

    2017-04-06

    Biological drugs revolutionized the treatment of inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis. However, not all clinically eligible patients have access to biologicals, due to significant costs and budget impact. Biosimilars are highly comparable to their originator product in terms of clinical efficacy and safety. Biosimilars are priced 15-75% lower than their reference product, which makes them a less costly alternative and is expected to offer better patients access to biologicals. The total projected cost savings are significant. If the achieved budget savings were used to cover more biological therapy, several additional IBD patients could be treated. Currently, the main barriers to the increasing uptake of biosimilars are the few incentives of the key stakeholders, while physicians' and patients' skepticism towards biosimilars seems to be changing. Over the coming years, biosimilars are expected to gain a growing importance in the treatment of IBD, contributing to a better access to treatment, improving population-level health gain and sustainability of health systems. This review summarizes the results of the literature on the economic considerations of biosimilars in IBD and the role of biosimilar infliximab in the treatment of IBD. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  18. Surgical management of malignant bowel obstruction in recurrent pancreatic cancer

    Directory of Open Access Journals (Sweden)

    Hyung Sun Kim

    2017-01-01

    Discussion and conclusion: Palliative surgery improves quality of life in recurrent pancreatic cancer patients and can continue patient’s palliative management. In selected patients, palliative surgery may effective management for progress of survival and quality of life.

  19. The impact of stoma for bowel management after spinal cord injury.

    Science.gov (United States)

    Coggrave, M J; Ingram, R M; Gardner, B P; Norton, C S

    2012-11-01

    Multi-centre, retrospective self-report postal survey. To characterise spinal cord injured (SCI) individuals with a stoma, their stoma management and outcomes, to identify sources of information and support for decision making and to explore the impact of a stoma on life satisfaction. Five UK spinal cord injury centres. A study-specific questionnaire accompanied by self-concept, life satisfaction and mood measures, and three simple rating scales for satisfaction, impact and restriction on life were sent to all known ostomates at five participating centres. Respondents were 92 individuals, mean age 56 years, mean duration of injury 26 years, 91% with colostomy. Multiple sources of information were utilised in deciding on surgery; discussion with other SCI ostomates was important. Duration of bowel care, faecal incontinence, bowel-related autonomic dysreflexia, dietary manipulation and laxative use were all significantly reduced following surgery. Rectal mucous discharge was the most common and bothersome post-stoma problem. Satisfaction with stoma was high; provision of sufficient information preoperatively was important, those with ileostomy were more dependent and less satisfied. Life satisfaction and physical self-concept were both lower in this sample than in previously reported samples of SCI individuals without reported bowel difficulties or stoma. The findings of this study of self-selected respondents with a stoma for bowel management after SCI emphasised the benefits of stoma in selected individuals and the importance of timely intervention, the complexity of the associated decision-making and of preoperative counselling. The impact of bowel dysfunction on physical self-concept warrants investigation.

  20. Inflammatory pathways of importance for management of inflammatory bowel disease.

    Science.gov (United States)

    Pedersen, Jannie; Coskun, Mehmet; Soendergaard, Christoffer; Salem, Mohammad; Nielsen, Ole Haagen

    2014-01-07

    Inflammatory bowel disease (IBD) is a group of chronic disorders of the gastrointestinal tract comprising Crohn's disease (CD) and ulcerative colitis (UC). Their etiologies are unknown, but they are characterised by an imbalanced production of pro-inflammatory mediators, e.g., tumor necrosis factor (TNF)-α, as well as increased recruitment of leukocytes to the site of inflammation. Advantages in understanding the role of the inflammatory pathways in IBD and an inadequate response to conventional therapy in a large portion of patients, has over the last two decades lead to new therapies which includes the TNF inhibitors (TNFi), designed to target and neutralise the effect of TNF-α. TNFi have shown to be efficient in treating moderate to severe CD and UC. However, convenient alternative therapeutics targeting other immune pathways are needed for patients with IBD refractory to conventional therapy including TNFi. Indeed, several therapeutics are currently under development, and have shown success in clinical trials. These include antibodies targeting and neutralising interleukin-12/23, small pharmacologic Janus kinase inhibitors designed to block intracellular signaling of several pro-inflammatory cytokines, antibodies targeting integrins, and small anti-adhesion molecules that block adhesion between leukocytes and the intestinal vascular endothelium, reducing their infiltration into the inflamed mucosa. In this review we have elucidated the major signaling pathways of clinical importance for IBD therapy and highlighted the new promising therapies available. As stated in this paper several new treatment options are under development for the treatment of CD and UC, however, no drug fits all patients. Hence, optimisations of treatment regimens are warranted for the benefit of the patients either through biomarker establishment or other rationales to maximise the effect of the broad range of mode-of-actions of the present and future drugs in IBD.

  1. Managing neurogenic bowel dysfunction: what do patients prefer? A discrete choice experiment of patient preferences for transanal irrigation and standard bowel management

    Directory of Open Access Journals (Sweden)

    Nafees B

    2016-02-01

    Full Text Available Beenish Nafees,1 Andrew J Lloyd,2 Rachel S Ballinger,2 Anton Emmanuel3 1Health Outcomes Research, Nafees Consulting Limited, London, 2Patient-Reported Outcomes Research, ICON plc, Oxford, 3Department of Gastroenterology and Nutrition, University College Hospital, London, UK Background: Most patients with bowel dysfunction secondary to neurological illness are managed by a range of nonsurgical methods, including dietary changes, laxatives, and suppository use to transanal irrigation (TAI. The aim of the present study was to explore individuals’ preferences regarding TAI devices and furthermore investigate willingness to pay (WTP for attributes in devices in the UK. Methods: A discrete choice experiment survey was conducted to evaluate the patients’ perceived value of TAI devices. Attributes were selected based upon a literature review and input from clinicians. Interviews were conducted with three clinicians and the survey was developed and finalized with the input from both patients and professionals. The final attributes were “risk of urinary tract infections” (UTIs, “risk of fecal incontinence” (FI, “frequency of use”, “time spent on toilet”, “ease of use”, “level of control/independence”, and “cost”. Participants were recruited by a patient panel of TAI device users in the UK. Data were analyzed using the conditional logit model whereby the coefficients obtained from the model provided an estimate of the (log odds ratios (ORs of preference for attributes. WTP was also estimated for each attribute. Results: A total of 129 participants were included in the final analyses. Sixty two percent of the participants had suffered from three UTIs in the preceding year and 58% of patients reported currently experiencing FI using their current device. All attributes were significant predictors of choice. The most important attributes for participants were the “risk of FI”, “frequency of use”, and “risk of UTIs

  2. Pharmacological Approach for Managing Pain in Irritable Bowel Syndrome: A Review Article

    OpenAIRE

    Chen, Longtu; Ilham, Sheikh J.; Feng, Bin

    2017-01-01

    Context Visceral pain is a leading symptom for patients with irritable bowel syndrome (IBS) that affects 10% - 20 % of the world population. Conventional pharmacological treatments to manage IBS-related visceral pain is unsatisfactory. Recently, medications have emerged to treat IBS patients by targeting the gastrointestinal (GI) tract and peripheral nerves to alleviate visceral pain while avoiding adverse effects on the central nervous system (CNS). Several investigational drugs for IBS also...

  3. Psychosocial and Behavioral Factors Associated with Bowel and Bladder Management after SCI

    Science.gov (United States)

    2013-10-01

    qualitative methods and Dr. Cathy Lysak, Associate Professor at Wayne State University with an occupational therapy background and experience in SCI...family in the Jersey Shore and we stopped in Hershey, Pennsylvania. We stopped there for the night and we were thinking we’d go tour the chocolate ...such as medical or therapy appointment)? (If YES, please describe briefly) SECTION 3: BOWEL AND BLADDER MANAGEMENT ACTIVITIES: We interested in

  4. Using perceptions as evidence to improve conservation and environmental management.

    Science.gov (United States)

    Bennett, Nathan James

    2016-06-01

    The conservation community is increasingly focusing on the monitoring and evaluation of management, governance, ecological, and social considerations as part of a broader move toward adaptive management and evidence-based conservation. Evidence is any information that can be used to come to a conclusion and support a judgment or, in this case, to make decisions that will improve conservation policies, actions, and outcomes. Perceptions are one type of information that is often dismissed as anecdotal by those arguing for evidence-based conservation. In this paper, I clarify the contributions of research on perceptions of conservation to improving adaptive and evidence-based conservation. Studies of the perceptions of local people can provide important insights into observations, understandings and interpretations of the social impacts, and ecological outcomes of conservation; the legitimacy of conservation governance; and the social acceptability of environmental management. Perceptions of these factors contribute to positive or negative local evaluations of conservation initiatives. It is positive perceptions, not just objective scientific evidence of effectiveness, that ultimately ensure the support of local constituents thus enabling the long-term success of conservation. Research on perceptions can inform courses of action to improve conservation and governance at scales ranging from individual initiatives to national and international policies. Better incorporation of evidence from across the social and natural sciences and integration of a plurality of methods into monitoring and evaluation will provide a more complete picture on which to base conservation decisions and environmental management. © 2016 Society for Conservation Biology.

  5. Medical malpractice in the management of small bowel obstruction: A 33-year review of case law.

    Science.gov (United States)

    Choudhry, Asad J; Haddad, Nadeem N; Rivera, Mariela; Morris, David S; Zietlow, Scott P; Schiller, Henry J; Jenkins, Donald H; Chowdhury, Naadia M; Zielinski, Martin D

    2016-10-01

    Annually, 15% of practicing general surgeons face a malpractice claim. Small bowel obstruction accounts for 12-16% of all surgical admissions. Our objective was to analyze malpractice related to small bowel obstruction. Using the search terms "medical malpractice" and "small bowel obstruction," we searched through all jury verdicts and settlements for Westlaw. Information was collected on case demographics, alleged reasons for malpractice, and case outcomes. The search criteria yielded 359 initial case briefs; 156 met inclusion criteria. The most common reason for litigation was failure to diagnose and timely manage the small bowel obstruction (69%, n = 107). Overall, 54% (n = 84) of cases were decided in favor of the defendant (physician). Mortality was noted in 61% (n = 96) of cases. Eighty-six percent (42/49) of cases litigated as a result of failing to diagnose and manage the small bowel obstruction in a timely manner, resulting in patient mortality, had a verdict with an award payout for the plaintiff (patient). The median award payout was $1,136,220 (range, $29,575-$12,535,000). A majority of malpractice cases were decided in favor of the defendants; however, cases with an award payout were costly. Timely intervention may prevent a substantial number of medical malpractice lawsuits in small bowel obstruction, arguing in favor of small bowel obstruction management protocols. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Blunt bowel and mesenteric trauma: role of clinical signs along with CT findings in patients' management.

    Science.gov (United States)

    Firetto, Maria Cristina; Sala, Francesco; Petrini, Marcello; Lemos, Alessandro A; Canini, Tiberio; Magnone, Stefano; Fornoni, Gianluca; Cortinovis, Ivan; Sironi, Sandro; Biondetti, Pietro R

    2018-04-27

    Bowel and/or mesentery injuries represent the third most common injury among patients with blunt abdominal trauma. Delayed diagnosis increases morbidity and mortality. The aim of our study was to evaluate the role of clinical signs along with CT findings as predictors of early surgical repair. Between March 2014 and February 2017, charts and CT scans of consecutive patients treated for blunt abdominal trauma in two different trauma centers were reread by two experienced radiologists. We included all adult patients who underwent contrast-enhanced CT of the abdomen and pelvis with CT findings of blunt bowel and/or mesenteric injury (BBMI). We divided CT findings into two groups: the first included three highly specific CT signs and the second included six less specific CT signs indicated as "minor CT findings." The presence of abdominal guarding and/or abdominal pain was considered as "clinical signs." Reference standards included surgically proven BBMI and clinical follow-up. Association was evaluated by the chi-square test. A logistic regression model was used to estimate odds ratio (OR) and confidence intervals (CI). Thirty-four (4.1%) out of 831 patients who sustained blunt abdominal trauma had BBMI at CT. Twenty-one out of thirty-four patients (61.8%) underwent surgical repair; the remaining 13 were treated conservatively. Free fluid had a significant statistical association with surgery (p = 0.0044). The presence of three or more minor CT findings was statistically associated with surgery (OR = 8.1; 95% CI, 1.2-53.7). Abdominal guarding along with bowel wall discontinuity and extraluminal air had the highest positive predictive value (100 and 83.3%, respectively). In patients without solid organ injury (SOI), the presence of free fluid along with abdominal guarding and three or more "minor CT findings" is a significant predictor of early surgical repair. The association of bowel wall discontinuity with extraluminal air warrants exploratory laparotomy.

  7. SOIL AND WATER CONSERVATION MANAGEMENT THROUGH ...

    African Journals Online (AJOL)

    Osondu

    socio-cultural, economic system constraints for the implementation and maintenance of conservation .... Purpose of natural resource conservation is therefore ... the soil and water resources through traditional and ..... “Integrated Natural.

  8. Conservative management of anal and rectal cancer

    International Nuclear Information System (INIS)

    Gerard, J.P.; Romestaing, P.; Montbarbon, X.

    1989-01-01

    The role of irradiation in the management of anal and rectal cancer has changed during the past ten years. In small epidermoid carcinomas of the anal canal (T1 T2) irradiation is in most departments considered the primary treatment, giving a 5-year survival rate of between 60 and 80% with good sphincter preservation. Even in larger tumors, irradiation can still offer some chance of cure without colostomy. Surgery remains the basic treatment of rectal cancer but irradiation is used in association with surgery in many cases. Radiotherapy is of value in the conservative management of cancer of the rectum in three situations: In small polypoid cancers contact X-ray therapy can give local control in about 90%. In cancers of the middle rectum, preoperative external irradiation may increase the chances of restorative surgery and reduce the risk of local relapse. In inoperable patients, external radiotherapy and/or intracavitary irradiation may cure some patients with infiltrating tumors (T2 T3) without colostomy. (orig.)

  9. Laparoscopic approach for inflammatory bowel disease surgical managment.

    Science.gov (United States)

    Maggiori, Léon; Panis, Yves

    2012-01-01

    For IBD surgical management, laparoscopic approach offers several theoretical advantages over the open approach. However, the frequent presence of adhesions from previous surgery and the high rate of inflammatory lesions have initially questioned its feasibility and safety. In the present review article, we will discuss the role of laparoscopic approach for IBD surgical management, along with its potential benefits as compared to the open approach.

  10. Managing Inflammatory Bowel Diseases as a Young Adult

    Science.gov (United States)

    ... your 26th birthday. If you are a full-time college student, you are protected by Michelle’s Law. This ... what.” “when,” and “where” for each flare. Over time, patterns may emerge ... for successful management. Along with hard copies of doctor’s and laboratory ...

  11. The nursing management of diarrhoea and constipation before and after the implementation of a bowel management protocol.

    Science.gov (United States)

    McKenna, S; Wallis, M; Brannelly, A; Cawood, J

    2001-02-01

    Intensive care unit (ICU) patients frequently suffer problems associated with both diarrhoea and constipation. Strategies to optimise the management of these conditions need to focus on improving the communication between staff and ensuring effective treatment is implemented. The team involved in this study developed a Bowel Management Protocol (BMP). The effect of this BMP on the documentation of assessment and management of diarrhoea and constipation was evaluated using a quasi-experimental research design. Data were collected via a retrospective audit of medical records. Two groups of patient records were randomly sampled. The records of 60 patients who were admitted to ICU in the 6 months before the introduction of the BMP were accessed together with the records of 60 patients admitted in the 6 months following the introduction of the BMP. Data were collected regarding patient demographics and the assessment and management of bowel function before and after BMP introduction. The results indicated that a BMP improved documentation of the assessment of bowel function. In addition, there was an improvement in the documentation of nursing intervention in the presence of constipation and diarrhoea. These results have to be interpreted with caution because, despite random sampling over two 6 month periods, there were statistically significant differences in age, length of stay, method of feeding and medical diagnosis between the two groups. Further research into the effectiveness of using a BMP is recommended.

  12. Conservative management of small renal tumors

    International Nuclear Information System (INIS)

    Matsuzaki, Masato; Kawano, Yoshiyuki; Morikawa, Hirofumi; Shiga, Yoshiyuki; Murata, Hirokatsu; Komatsu, Hideki

    2007-01-01

    With the widespread use of imaging modalities, incidentally discovered small renal cell carcinomas have increased. Some patients, however, are too old or weak due to various diseases to undergo surgery and other patients occasionally refuse surgery. To investigate the natural history of small renal cell carcinoma, we retrospectively reviewed patients with small renal tumors suggestive of carcinoma. We retrospectively reviewed 15 patients with contrast-enhancing renal masses less than 4.0 cm in diameter who were observed without treatment. The mean follow-up period was 38 months (range, 8-91). The average patient age was 67 years (range, 44-87). The initial average tumor diameter was 2.2 cm (range, 1.0-3.9). The average growth rate was 0.06 cm per year (range, -0.09-0.28). Only 4 tumors grew obviously during the follow-up period. Three tumors were removed surgically by radical nephrectomy, and all tumors were pathologically diagnosed as renal cell carcinoma. None of the patients developed metastases during the follow-up period or after surgery. Two patients died of other causes. Nonsurgical watchful waiting may be an acceptable treatment option for elderly or severely comorbid patients; however, it is not known whether this conservative management can he applied to young or otherwise healthy patients. (author)

  13. Tools for primary care management of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Bennett, Alice L; Munkholm, Pia; Andrews, Jane M

    2015-01-01

    Healthcare systems throughout the world continue to face emerging challenges associated with chronic disease management. Due to the likely increase in chronic conditions in the future it is now vital that cooperation and support between specialists, generalists and primary health care physicians ...... supportive literature. The purpose of this review is to investigate what non-specialist tools, action plans or guidelines for IBD are published in readily searchable medical literature and compare these to those which exist for other chronic conditions....... are helpful but they are not designed for the primary care setting. Few non-expert IBD management tools or guidelines exist compared with those used for other chronic diseases such as asthma and scant data have been published regarding the usefulness of such tools including IBD action plans and associated...

  14. Effectiveness of alternative management strategies in meeting conservation objectives

    Science.gov (United States)

    Richards S. Holthausen; Carolyn Hull Sieg

    2007-01-01

    This chapter evaluates how well various management strategies meet a variety of conservation objectives, summarizes their effectiveness in meeting objectives for rare or little-known (RLK) species, and proposes ways to combine strategies to meet overall conservation objectives. We address two broad categories of management strategies. Species approaches result in...

  15. Dietary and Behavioral Adjustments to Manage Bowel Dysfunction After Surgery in Long-Term Colorectal Cancer Survviors

    Science.gov (United States)

    Sun, Virginia; Grant, Marcia; Wendel, Christopher S.; McMullen, Carmit K.; Bulkley, Joanna E.; Altschuler, Andrea; Ramirez, Michelle; Baldwin, Carol M.; Herrinton, Lisa J.; Hornbrook, Mark C.; Krouse, Robert S.

    2015-01-01

    BACKGROUND Bowel dysfunction is a known complication of colorectal cancer (CRC) surgery. Poor bowel control has a detrimental impact on survivors’ health-related quality of life (HRQOL). This analysis describes the dietary and behavioral adjustments used by CRC survivors to manage bowel dysfunction and compares adjustments used by survivors with permanent ostomy to those with anastomosis. METHODS This mixed-methods analysis included pooled data from several studies that assessed HRQOL in CRC survivors. In all studies, CRC survivors with or without permanent ostomies (N=856) were surveyed using the City of Hope Quality of Life Colorectal Cancer tool. Dietary adjustments were compared by ostomy status and by overall HRQOL score (high versus low). Qualitative data from 13 focus groups and 30 interviews were analyzed to explore specific strategies used by survivors to manage bowel dysfunction. RESULTS CRC survivors made substantial, permanent dietary and behavioral adjustments after surgery, regardless of ostomy status. Survivors who took longer after surgery to become comfortable with their diet or regain their appetite were more likely to report worse HRQOL. Adjustments to control bowel function were divided into four major strategies: dietary adjustments, behavioral adjustments, exercise, and medication use. CONCLUSIONS CRC survivors struggled with unpredictable bowel function and may fail to find a set of management strategies to achieve regularity. Understanding the myriad adjustments used by CRC survivors may lead to evidence-based interventions to foster positive adjustments after surgery and through long-term survivorship. PMID:26159443

  16. Dietary and Behavioral Adjustments to Manage Bowel Dysfunction After Surgery in Long-Term Colorectal Cancer Survivors.

    Science.gov (United States)

    Sun, Virginia; Grant, Marcia; Wendel, Christopher S; McMullen, Carmit K; Bulkley, Joanna E; Altschuler, Andrea; Ramirez, Michelle; Baldwin, Carol M; Herrinton, Lisa J; Hornbrook, Mark C; Krouse, Robert S

    2015-12-01

    Bowel dysfunction is a known complication of colorectal cancer (CRC) surgery. Poor bowel control has a detrimental impact on survivors' health-related quality of life (HRQOL). This analysis describes the dietary and behavioral adjustments used by CRC survivors to manage bowel dysfunction and compares adjustments used by survivors with permanent ostomy to those with anastomosis. This mixed-methods analysis included pooled data from several studies that assessed HRQOL in CRC survivors. In all studies, CRC survivors with or without permanent ostomies (N = 856) were surveyed using the City of Hope Quality of Life Colorectal Cancer tool. Dietary adjustments were compared by ostomy status and by overall HRQOL score (high vs. low). Qualitative data from 13 focus groups and 30 interviews were analyzed to explore specific strategies used by survivors to manage bowel dysfunction. CRC survivors made substantial, permanent dietary, and behavioral adjustments after surgery, regardless of ostomy status. Survivors who took longer after surgery to become comfortable with their diet or regain their appetite were more likely to report worse HRQOL. Adjustments to control bowel function were divided into four major strategies: dietary adjustments, behavioral adjustments, exercise, and medication use. CRC survivors struggled with unpredictable bowel function and may fail to find a set of management strategies to achieve regularity. Understanding the myriad adjustments used by CRC survivors may lead to evidence-based interventions to foster positive adjustments after surgery and through long-term survivorship.

  17. Surgical management of inflammatory bowel disease: A low prevalence, developing country perspective.

    Science.gov (United States)

    Nasim, Sana; Chawla, Tabish; Murtaza, Ghulam

    2016-03-01

    To determine the outcomes of surgical management of inflammatory bowel disease. The retrospective case series was conducted at Aga Khan University Hospital, Karachi, and comprised medical record of adult patients operated between January 1986 and December 2010 for inflammatory bowel disease. Outcomes consisted of complications till last follow-up and 30-day mortality (disease or procedure related). Functional status of patients with ileal pouch was determined via telephone. SPSS 16 was used to analyse data. Of the 36 patients whose records were reviewed, 21(58%) were males, and body mass index was less than 23 in 34(91%). A total of 27(75%) patients underwent elective surgery for their condition. Ileal pouch was formed in 9(25%). Overall mortality was 14(38.8%). Overall incidence of complications was 26(72%), with wound infection being the most common early morbidity in 11(30.5%). Late morbidity included pouchitisin 4/9 (44.9%) and strictures 2/36 (5.5%).On telephonic follow-up, 6 of the remaining 7patients (85%) with ileal pouch were satisfied with the functional results of the procedure. The retrospective case series represents results from a developing country with low prevalence of inflammatory bowel disease and hence limited experience.

  18. [Conservative management option in elderly patients].

    Science.gov (United States)

    Guienne, Véronique; Parahy, Sophie; Testa, Angelo

    2016-04-01

    "Conservative management" is as an alternative care pathway offered to patients who elect not to start dialysis often because of a heavy burden of comorbid illness and advanced ages. Our research, characterized by a transdisciplinary medical and social investigation and based on a case by case analysis, intends to understand the reasons and the context in which this choice has to be made. On the first hand, the results show that all the studied cases can be explained by two variables, the latter can be combined: when the patient is suffering from important clinical pathologies; when the patient lives with this renal failure as a trouble linked to the age. On the second hand, two important questions are raised: the first one is about the medical practices and stems from the influence of criteria always present in the decisions to take (the paramedical exams and the clinical information from the interview, the patient's examination and the discussion with his/her close family member). The second one is about the patient's autonomy and can be analyzed regarding to his/her capacity to express his/her choices and share it with his close family. But also, to live in according to his age, that is to say the relation he/she has with his/her edged body and to the limits of his/her existence. The key notion of shared decision-making renewed is to refer in the consultation and the choices to take to the question of the advantages/drawbacks for the patient's life and not only to the question of the connection between the results and the medical risks, in order to exchange view with the patient on his/her future life and not only on the condition of his failed organ. Copyright © 2015 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  19. Synthesis and review: delivering on conservation promises: the challenges of managing and measuring conservation outcomes

    International Nuclear Information System (INIS)

    Adams, Vanessa M; Game, Edward T; Bode, Michael

    2014-01-01

    Growing threats and limited resources have always been the financial realities of biodiversity conservation. As the conservation sector has matured, however, the accountability of conservation investments has become an increasingly debated topic, with two key topics being driven to the forefront of the discourse: understanding how to manage the risks associated with our conservation investments and demonstrating that our investments are making a difference through evidence-based analyses. A better understanding of the uncertainties associated with conservation decisions is a central component of managing risks to investments that is often neglected. This focus issue presents both theoretical and applied approaches to quantifying and managing risks. Furthermore, transparent and replicable approaches to measuring impacts of conservation investments are noticeably absent in many conservation programs globally. This focus issue contains state of the art conservation program impact evaluations that both demonstrate how these methods can be used to measure outcomes as well as directing future investments. This focus issue thus brings together current thinking and case studies that can provide a valuable resource for directing future conservation investments. (paper)

  20. Synthesis and review: delivering on conservation promises: the challenges of managing and measuring conservation outcomes

    Science.gov (United States)

    Adams, Vanessa M.; Game, Edward T.; Bode, Michael

    2014-08-01

    Growing threats and limited resources have always been the financial realities of biodiversity conservation. As the conservation sector has matured, however, the accountability of conservation investments has become an increasingly debated topic, with two key topics being driven to the forefront of the discourse: understanding how to manage the risks associated with our conservation investments and demonstrating that our investments are making a difference through evidence-based analyses. A better understanding of the uncertainties associated with conservation decisions is a central component of managing risks to investments that is often neglected. This focus issue presents both theoretical and applied approaches to quantifying and managing risks. Furthermore, transparent and replicable approaches to measuring impacts of conservation investments are noticeably absent in many conservation programs globally. This focus issue contains state of the art conservation program impact evaluations that both demonstrate how these methods can be used to measure outcomes as well as directing future investments. This focus issue thus brings together current thinking and case studies that can provide a valuable resource for directing future conservation investments.

  1. Conservative therapeutic management of carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Roberto Sérgio Martins

    Full Text Available ABSTRACT Carpal tunnel syndrome is the most prevalent nerve compression and can be clinically or surgically treated. In most cases, the first therapeutic alternative is conservative treatment but there is still much controversy regarding the most effective modality of this treatment. In this study, we critically evaluated the options of conservative treatment for carpal tunnel syndrome, aiming to guide the reader through the conventional options used in this therapy.

  2. Pain management in patients with inflammatory bowel disease: insights for the clinician

    Science.gov (United States)

    Srinath, Arvind Iyengar; Walter, Chelsea; Newara, Melissa C.

    2012-01-01

    Abdominal pain is a common symptom in patients with inflammatory bowel disease (IBD) and has a profound negative impact on patients’ lives. There are growing data suggesting that pain is variably related to the degree of active inflammation. Given the multifactorial etiologies underlying the pain, the treatment of abdominal pain in the IBD population is best accomplished by individualized plans. This review covers four clinically relevant categories of abdominal pain in patients with IBD, namely, inflammation, surgical complications, bacterial overgrowth, and neurobiological processes and how pain management can be addressed in each of these cases. The role of genetic factors, psychological factors, and psychosocial stress in pain perception and treatment will also be addressed. Lastly, psychosocial, pharmacological, and procedural pain management techniques will be discussed. An extensive review of the existing literature reveals a paucity of data regarding pain management specific to IBD. In addition, there is growing consensus suggesting a spectrum between IBD and irritable bowel syndrome (IBS) symptoms. Thus, this review for adult and pediatric clinicians also incorporates the literature for the treatment of functional abdominal pain and the clinical consensus from IBD and IBS experts on pharmacological, behavioral, and procedural methods to treat abdominal pain in this population. PMID:22973418

  3. The role of laparoscopic surgery in the management of children and adolescents with inflammatory bowel disease.

    Science.gov (United States)

    Page, Anna E; Sashittal, Shikha G; Chatzizacharias, Nikolaos A; Davies, R Justin

    2015-05-01

    Although laparoscopic surgery is readily used in the management of inflammatory bowel disease (IBD) in adults, its role in the surgical treatment of IBD in the pediatric population is not well established. The aim of this narrative review was to analyze the published evidence comparing laparoscopic and open resection in the management of children and adolescents with IBD. The Pubmed and Embase databases were searched using the terms "inflammatory bowel disease," "children," "adolescents," "laparoscopic," and "colectomy." The review identified 10 appropriate studies. Even though laparoscopic surgery generally resulted in longer operating times (between a mean of 40 and 140 min), benefits included reduced postoperative pain (mean duration of opiate use 3 vs 6 days) and reduced length of stay (median length of stay 5-8 vs 10.5-19 days) compared with open surgery. Postoperative complication rates were similar following both approaches. Due to the limited available data and the small sample size of the published series, definite recommendations are not able to be drawn. Nevertheless, current evidence indicates that laparoscopic colorectal resection is safe and feasible in the management of IBD in the paediatric population, with reductions in postoperative pain and length of hospital stay achievable.

  4. Effectiveness of the bowel management program in children with constipation secondary to anorectal malformations

    Directory of Open Access Journals (Sweden)

    Santos Jasso Karla A.

    2014-07-01

    Full Text Available Introduction: One thousand children with anorectal malformation (ARM are born in Mexico every year. In spite of surgical correction, these children continue to present functional fecal problems (constipation and fecal incontinence. We conducted an Intestinal Rehabilitation Program (IRP which consists of an initial rectal disimpaction followed by administration of stimulant-type laxative (senna, with favorable results. The objective of this paper is to describe the effectiveness of the Intestinal Rehabilitation Program/bowel management program (IRP/BMP in children with constipation secondary to surgically corrected ARM. Materials and methods: A descriptive, retrospective, cross-sectional study, describing which was the IRP effectiveness in children with constipation secondary to ARM. The effectiveness was measured by means of a construct of three variables (presence of daily bowel movements, absence of fecal staining, and having a plain abdominal radiograph without fecal residue in left colon and rectum after passing stool. All children who had surgically corrected ARM and constipation in two referral centers were included. Results. One hundred and fifty one children with ARM were included: 21.85% had fecal incontinence, and 67.33% had constipation. Of this group 88.1% showed good response to the BMP. The mean dose of sennoside was 8.45 mg/kg, 95% CI: 5.94-11.12 mg/kg (199.5 mg total dose, 95% CI: 139.50-259.50 mg. Colicky abdominal pain occurred in 5.8% of the patients. Discussion. The use of sennoside has had a positive impact on our patients by means of colonic and rectal emptying without fecal soiling. Key words: Constipation, Anorrectal Malformation, Bowel Managment Program, Sennoside.

  5. Bowel obstruction and delirium: managing difficult symptoms at the end of life.

    Science.gov (United States)

    Lynch, Maureen; Dahlin, Constance; Bakitas, Marie

    2012-08-01

    Palliative care has become an essential component of oncology care, with a focus on maximizing quality of life and optimizing function, as well as promoting pain and symptom management. This article focuses on the care of a patient experiencing bowel obstruction and delirium, two common issues in patients with advanced cancer, and demonstrates the integration of palliative care and oncology care to achieve an individualized care plan. Management focuses on identifying and treating reversible causes and improving quality of life while respecting the patient's values and goals. Sometimes the causes are not easily identified or treatment of the cause may impair quality of life, at least temporarily. At other times, the causes may be irreversible and the focus is exclusively on quality of life. Determination of best care for individual patients requires synthesis of data from holistic assessment, including the patient's goals of care and values, as well as knowledge of the patient's disease state with evidence-based approaches to management.

  6. Kirtland's Warbler Wildlife Management Area Comprehensive Conservation Plan

    Data.gov (United States)

    Department of the Interior — The Comprehensive Conservation Plan (CCP) for Kirtland’s Warbler Wildlife Management Area (WMA) was signed on September 10, 2009, completing a planning process that...

  7. Septic Shock after Conservative Management for Placenta Accreta

    Directory of Open Access Journals (Sweden)

    Ying-Cheng Chiang

    2006-03-01

    Conclusion: At present, there is no consensus about the optimal treatment for placenta accreta. Conservative treatment appears to be an alternative in selected patients, but the complications such as sepsis should be carefully identified and appropriately managed.

  8. Anaesthetic Management of a patient with Myasthenia Gravis and Small Bowel Intussusception for Jejuno-Ileal Anastomoses

    Directory of Open Access Journals (Sweden)

    Pawan Kumar Jain

    2016-01-01

    Full Text Available Myasthenia gravis is a chronic autoimmune disease affecting voluntary skeletal muscles. The altered sensitivity of acetylcholine receptors to muscle relaxants and concomitant treatment with anticholinesterase in these patients affect their anaesthetic management. Patients who have undergone bowel anastomosis and are on regular anticholinesterase treatment are susceptible to anastomotic leaks. We report successful anaesthetic management of class I myasthenic patient with coexisting small bowel intussusception operated for jejuno-ileal anastomoses using regional, inhalational and intravenous (i.v anaesthesia based on train of four responses, and avoiding the use of reversal (anticholinesterase.

  9. Implementation of Quality Management System for Historical Building Conservation

    Directory of Open Access Journals (Sweden)

    Zahari N.F.

    2014-01-01

    Full Text Available The main objectives of this study are twofold. Firstly, to identify the implementation of ISO 9001 procedures being used as references for conservation works and the development of Quality Management System (QMS guidelines. Data were solicited from three (3 conservation areas. The analysis involved of descriptive approach and statistical methods. The findings revealed that QMS is not structurally established, implemented and enforced as part of conservation practice in Malaysia. From the findings, the authors hope to give clear perception to the reader on current preservation practice and the existence of QMS with reference to ISO 9001 for future conservation mechanism.

  10. 76 FR 28954 - International Conservation and Management Measures Recognized by the United States

    Science.gov (United States)

    2011-05-19

    ... International Conservation and Management Measures Recognized by the United States AGENCY: National Marine... international conservation and management measures recognized by the United States. To fulfill this requirement, a list of agreements resulting in international conservation and management measures was first...

  11. Incidence, management, and course of cancer in patients with inflammatory bowel disease.

    Science.gov (United States)

    Algaba, Alicia; Guerra, Iván; Marín-Jiménez, Ignacio; Quintanilla, Elvira; López-Serrano, Pilar; García-Sánchez, María Concepción; Casis, Begoña; Taxonera, Carlos; Moral, Ignacio; Chaparro, María; Martín-Rodríguez, Daniel; Martín-Arranz, María Dolores; Manceñido, Noemí; Menchén, Luis; López-Sanromán, Antonio; Castaño, Ángel; Bermejo, Fernando

    2015-04-01

    Patients with inflammatory bowel disease [IBD] are at increased risk for developing some types of neoplasia. Our aims were to determin the risk for cancer in patients with IBD and to describe the relationship with immunosuppressive therapies and clinical management after tumor diagnosis. Retrospective, multicenter, observational, 5-year follow-up, cohort study. Relative risk [RR] of cancer in the IBD cohort and the background population, therapeutic strategies, and cancer evolution were analyzed. A total of 145 cancers were diagnosed in 133 of 9100 patients with IBD (global cumulative incidence 1.6% vs 2.4% in local population; RR = 0.67; 95% confidence interval [CI]: 0.57-0.78). Patients with IBD had a significantly increased RR of non-melanoma skin cancer [RR = 3.85; 2.53-5.80] and small bowel cancer [RR = 3.70; 1.23-11.13]. After cancer diagnosis, IBD treatment was maintained in 13 of 27 [48.1%] patients on thiopurines, in 2 of 3 on methotrexate [66.6%], none on anti-TNF-α monotherapy [n = 6] and 4 of 12 [33.3%] patients on combined therapy. Rate of death and cancer remission during follow-up did not differ [p > 0.05] between patients who maintained the treatment compared with patients who withdrew [5% vs 8% and 95% vs 74%, respectively]. An association between thiopurines [p = 0.20] or anti-TNF-α drugs [p = 0.77] and cancer was not found. Patients with IBD have an increased risk for non-melanoma skin cancer and small bowel cancer. Immunosuppresive therapy is not related to a higher overall risk for cancer or worse tumor evolution in patients who maintain these drugs after cancer diagnosis. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  12. Review article: gut-directed hypnotherapy in the management of irritable bowel syndrome and inflammatory bowel disease.

    Science.gov (United States)

    Peters, S L; Muir, J G; Gibson, P R

    2015-06-01

    Gut-directed hypnotherapy is being increasingly applied to patients with irritable bowel syndrome (IBS) and to a lesser extent, inflammatory bowel disease (IBD). To review the technique, mechanisms of action and evidence for efficacy, and to identify gaps in the understanding of gut-directed hypnotherapy as a treatment for IBS and IBD. A review of published literature and a systematic review of clinical trials in its application to patients with IBS and IBD were performed. Gut-directed hypnotherapy is a clearly described technique. Its potential mechanisms of action on the brain-gut axis are multiple with evidence spanning psychological effects through to physiological gastrointestinal modifications. Six of seven randomised IBS studies reported a significant reduction (all P hypnotherapy ranged between 24% and 73%. Efficacy was maintained long-term in four of five studies. A therapeutic effect was also observed in the maintenance of clinical remission in patients with ulcerative colitis. Uncontrolled trials supported the efficacy and durability of gut-directed hypnotherapy in IBS. Gaps in understanding included to whom and when it should be applied, the paucity of adequately trained hypnotherapists, and the difficulties in designing well controlled-trials. Gut-directed hypnotherapy has durable efficacy in patients with IBS and possibly ulcerative colitis. Whether it sits in the therapeutic arsenal as a primary and/or adjunctive therapy cannot be ascertained on the current evidence base. Further research into efficacy, mechanisms of action and predictors of response is required. © 2015 John Wiley & Sons Ltd.

  13. Management of perforated essure with migration into small and large bowel mesentery.

    Science.gov (United States)

    Braginsky, Lena; George, Sean T; Locher, Stephen R

    2015-01-01

    The Essure permanent birth control system (Conceptus Inc, San Carlos, CA) is currently the only Food and Drug Administration-approved hysteroscopic sterilization method and has been widely accepted as a safe and effective procedure. We present a rare case of tubal perforation, coil fragmentation, and distal migration into small and large bowel mesentery 8 days after the insertion of the Essure device. We describe the successful management of this complication using laparoscopy and intraoperative fluoroscopy. Providers using Essure must be aware of the possibility of fragmentation of the Essure coils. Intraoperative imaging, ideally fluoroscopy, should be strongly considered in the management of Essure migration to ensure localization and full retrieval of Essure material. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

  14. Management of inflammatory bowel disease flares in the emergency department [digest].

    Science.gov (United States)

    Burg, Michael D; Riccoboni, Steven T; Nusbaum, Jeffrey; Gupta, Nachi

    2017-11-22

    Because of the chronic relapsing nature of inflammatory bowel disease (IBD), emergency clinicians frequently manage patients with acute flares and complications. IBD patients present with an often-broad range of nonspecific signs and symptoms, and it is essential to differentiate a mild flare from a life-threatening intra-abdominal process. Recognizing extraintestinal manifestations and the presence of infection are critical. This issue reviews the literature on management of IBD flares in the emergency department, including laboratory testing, imaging, and identification of surgical emergencies, emphasizing the importance of coordination of care with specialists on treatment plans and offering patients resources for ongoing support. [Points & Pearls is a digest of Emergency Medicine Practice.].

  15. Endoscopic management of intraoperative small bowel laceration during natural orifice translumenal endoscopic surgery: a blinded porcine study.

    Science.gov (United States)

    Fyock, Christopher J; Forsmark, Chris E; Wagh, Mihir S

    2011-01-01

    Natural orifice translumenal endoscopic surgery (NOTES) has recently gained great enthusiasm, but there is concern regarding the ability to endoscopically manage complications purely via natural orifices. To assess the feasibility of endoscopically managing enteral perforation during NOTES using currently available endoscopic accessories. Twelve pigs underwent transgastric or transcolonic endoscopic exploration. Full-thickness enterotomies were intentionally created to mimic accidental small bowel lacerations during NOTES. These lacerations were then closed with endoclips. In the blinded arm of the study, small bowel repair was performed by a second blinded endoscopist. Adequate closure of the laceration was confirmed with a leak test. Primary access sites were closed with endoclips or T-anchors. At necropsy, the peritoneal cavity was inspected for abscesses, bleeding, or damage to surrounding structures. The enterotomy site was examined for adequacy of closure, adhesions, or evidence of infection. Fifteen small bowel lacerations were performed in 12 animals. Successful closure was achieved in all 10 cases in the nonblinded arm. Survival animals had an uncomplicated postoperative course and all enterotomy sites were well healed without evidence of necrosis, adhesions, abscess, or bleeding at necropsy. Leak test was negative in all animals. In the blinded arm, both small intestinal lacerations could not be identified by the blinded endoscopist. Necropsy revealed open small bowel lacerations. Small intestinal injuries are difficult to localize with currently available flexible endoscopes and accessories. Endoscopic clips, however, may be adequate for closure of small bowel lacerations if the site of injury is known.

  16. Pharmacological Approach for Managing Pain in Irritable Bowel Syndrome: A Review Article

    Science.gov (United States)

    Chen, Longtu; Ilham, Sheikh J.; Feng, Bin

    2017-01-01

    Context Visceral pain is a leading symptom for patients with irritable bowel syndrome (IBS) that affects 10% - 20 % of the world population. Conventional pharmacological treatments to manage IBS-related visceral pain is unsatisfactory. Recently, medications have emerged to treat IBS patients by targeting the gastrointestinal (GI) tract and peripheral nerves to alleviate visceral pain while avoiding adverse effects on the central nervous system (CNS). Several investigational drugs for IBS also target the periphery with minimal CNS effects. Evidence of Acquisition In this paper, reputable internet databases from 1960 - 2016 were searched including Pubmed and ClinicalTrials.org, and 97 original articles analyzed. Search was performed based on the following keywords and combinations: irritable bowel syndrome, clinical trial, pain, visceral pain, narcotics, opioid, chloride channel, neuropathy, primary afferent, intestine, microbiota, gut barrier, inflammation, diarrhea, constipation, serotonin, visceral hypersensitivity, nociceptor, sensitization, hyperalgesia. Results Certain conventional pain managing drugs do not effectively improve IBS symptoms, including NSAIDs, acetaminophen, aspirin, and various narcotics. Anxiolytic and antidepressant drugs (Benzodiazepines, TCAs, SSRI and SNRI) can attenuate pain in IBS patients with relevant comorbidities. Clonidine, gabapentin and pregabalin can moderately improve IBS symptoms. Lubiprostone relieves constipation predominant IBS (IBS-C) while loperamide improves diarrhea predominant IBS (IBS-D). Alosetron, granisetron and ondansetron can generally treat pain in IBS-D patients, of which alosetron needs to be used with caution due to cardiovascular toxicity. The optimal drugs for managing pain in IBS-D and IBS-C appear to be eluxadoline and linaclotide, respectively, both of which target peripheral GI tract. Conclusions Conventional pain managing drugs are in general not suitable for treating IBS pain. Medications that target

  17. Impact of introduction of an acute surgical unit on management and outcomes of small bowel obstruction.

    Science.gov (United States)

    Musiienko, Anton M; Shakerian, Rose; Gorelik, Alexandra; Thomson, Benjamin N J; Skandarajah, Anita R

    2016-10-01

    The acute surgical unit (ASU) is a recently established model of care in Australasia and worldwide. Limited data are available regarding its effect on the management of small bowel obstruction. We compared the management of small bowel obstruction before and after introduction of ASU at a major tertiary referral centre. We hypothesized that introduction of ASU would correlate with improved patient outcomes. A retrospective review of prospectively maintained databases was performed over two separate 2-year periods, before and after the introduction of ASU. Data collected included demographics, co-morbidity status, use of water-soluble contrast agent and computed tomography. Outcome measures included surgical intervention, time to surgery, hospital length of stay, complications, 30-day readmissions, use of total parenteral nutrition, intensive care unit admissions and overall mortality. Total emergency admissions to the ASU increased from 2640 to 4575 between the two time periods. A total of 481 cases were identified (225 prior and 256 after introduction of ASU). Mortality decreased from 5.8% to 2.0% (P = 0.03), which remained significant after controlling for confounders with multivariate analysis (odds ratio = 0.24, 95% confidence interval 0.08-0.73, P = 0.012). The proportion of surgically managed patients increased (20.9% versus 32.0%, P = 0.003) and more operations were performed within 5 days from presentation (76.6% versus 91.5%, P = 0.02). Fewer patients received water-soluble contrast agent (27.1% versus 18.4%, P = 0.02), but more patients were investigated with a computed tomography (70.7% versus 79.7%, P = 0.02). The ASU model of care resulted in decreased mortality, shorter time to intervention and increased surgical management. Overall complications rate and length of stay did not change. © 2015 Royal Australasian College of Surgeons.

  18. Laparoscopic Conservative Management Of A Spontaneously ...

    African Journals Online (AJOL)

    A case of an acute abdomen secondary to a ruptured spleen managed laparoscopically is presented. Laparoscopy is currently widely used for the initial diagnosis and management of such cases as an alternative to laparotomy due to the numerous advantages of the minimal access techniques. With widespread availability ...

  19. Conservative management of epithelial ovarian cancer.

    Science.gov (United States)

    Dexeus, S; Labastida, R; Dexeus, D

    2005-01-01

    We are currently faced with a progressive delay in the age at which women conceive for the first time. This raises the possibility of the appearance of gynecologic disorders that may affect fertility, including neoplasms of the ovary. Fertility-sparing surgery is defined as the preservation of ovarian tissue in one or both adnexa and/or the uterus. Borderline ovarian tumor should be treated with conservative surgery. Salpingo-oophorectomy, or even ovarian cystectomy, are the procedures of choice, with recurrence rates of 2-3% and up to 20% if a simple cystectomy is performed. Cystectomy is indicated in patients with bilateral borderline tumors or in patients with a residual ovary. Borderline tumors with invasive peritoneal implants behave as an invasive cancer in 10-30% of cases with a survival rate of 10-66% compared with 100% in borderline tumors without invasive implants. Prophylactic oophorectomy is recommended when desire of conception has been accomplished. Conservative surgery in invasive epithelial ovarian cancer is limited to Stage IA, grade 1 tumor, and in some highly selected grade 2 tumors of serous, mucinous or endometrioid type, well-encapsulated and free of adhesions. The standard oncological surgical procedure with preservation of the uterus and normal appearing ovary is recommended. This includes salpingo-oophorectomy, excision of any suspicious peritoneal lesion, multiple peritoneal biopsies, appendectomy (particularly in mucinous tumors), and pelvic and paraaortic lymphadenectomy.

  20. Understanding and managing compliance in the nature conservation context.

    Science.gov (United States)

    Arias, Adrian

    2015-04-15

    Nature conservation relies largely on peoples' rule adherence. However, noncompliance in the conservation context is common: it is one of the largest illegal activities in the world, degrading societies, economies and the environment. Understanding and managing compliance is key for ensuring effective conservation, nevertheless crucial concepts and tools are scattered in a wide array of literature. Here I review and integrate these concepts and tools in an effort to guide compliance management in the conservation context. First, I address the understanding of compliance by breaking it down into five key questions: who?, what?, when?, where? and why?. A special focus is given to 'why?' because the answer to this question explains the reasons for compliance and noncompliance, providing critical information for management interventions. Second, I review compliance management strategies, from voluntary compliance to coerced compliance. Finally, I suggest a system, initially proposed for tax compliance, to balance these multiple compliance management strategies. This paper differs from others by providing a broad yet practical scope on theory and tools for understanding and managing compliance in the nature conservation context. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Laparoscopic management of a small bowel obstruction secondary to Elipse intragastric balloon migration: A case report

    Directory of Open Access Journals (Sweden)

    Saud Al-Subaie

    Full Text Available Introduction: The Elipse™ intragastric balloon (IGB for weight loss is a swallowable capsule that is filled with 550 mL of fluid and resides in the stomach for four months before being excreted from the gastrointestinal tract. Although initial data showed that use of this device is safe and free from serious complications, we report for the first time the successful management of an Elipse™ IGB-related adverse event. Presentation of case: A 41-year-old woman presented to our emergency department following two days of abdominal pain, vomiting, and constipation. Her medical history included four caesarean sections and insertion of the Elipse™ IGB 16 weeks prior to presentation. The patient was vitally stable at presentation and abdominal examination revealed a mildly distended abdomen. Plain X-ray revealed a small bowel obstruction (SBO, and a double contrast computed tomography scan showed a dilated small bowel with mild free fluid proximal to a transition zone at the distal jejunum. Laparoscopic enterotomy was performed just proximal to the obstruction site, and the balloon was visualized and extracted after it had been incised and emptied. The enterotomy incision was closed with an intracorporeal continuous absorbable suture. The patient’s recovery was uneventful and she was discharged on postoperative day 4. Discussion: We discuss the possible etiologies of SBO following Elipse™ IGB insertion, and present a brief literature review regarding surgical and nonsurgical management options for such cases. Conclusion: Although initial data showed the Elipse™ IGB to be safe, complications can occur and be managed successfully. Keywords: Elipse, Intragastric balloon, Capsule, Obesity, Case report

  2. Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation)

    International Nuclear Information System (INIS)

    Poletti, Pierre-Alexandre; Becker, Christoph D.; Wintermark, Max; Schnyder, Pierre

    2002-01-01

    Abdominal US and CT play an important role in the initial management of blunt trauma in adults. Ultrasound is an excellent method for detection of free intra-abdominal fluid. It is the modality of choice for initial screening and enables selection of hemodynamically unstable trauma victims with severe hemoperitoneum for immediate surgery. However, even in experienced hands, US is not sufficient to rule out organ injuries reliably. Computed tomography, and particularly multislice CT (MSCT), has several major advantages over US and is currently unsurpassed for the detection of blunt visceral injuries in the abdomen. Computed tomography has a high sensitivity for the detection of parenchymal splenic and hepatic injuries. Injuries of the gastrointestinal tract may be detected with good sensitivity provided that adequate examination technique and careful diagnostic interpretation are combined. The value of CT-based injury-grading systems for predicting the outcome of conservative treatment remains unproven; however, demonstration of direct vascular injuries with CT, e.g., the intrasplenic ''contrast blush'' sign, may indicate a high likelihood that conservative treatment will fail, thus warranting angiographic embolization or surgery. Monitoring of conservatively treated trauma victims by means of repeat CT studies enables early detection of a variety of delayed, clinically silent complications of trauma, e.g., posttraumatic biloma or bowel devascularization. Catheter angiography may be reserved to selected cases with vascular injuries proven on CT. (orig.)

  3. Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation)

    Energy Technology Data Exchange (ETDEWEB)

    Poletti, Pierre-Alexandre; Becker, Christoph D. [Division of Diagnostic and Interventional Radiology, Geneva University Hospital, Geneva (Switzerland); Wintermark, Max; Schnyder, Pierre [Department of Diagnostic and Interventional Radiology, CHUV, Lausanne (Switzerland)

    2002-05-01

    Abdominal US and CT play an important role in the initial management of blunt trauma in adults. Ultrasound is an excellent method for detection of free intra-abdominal fluid. It is the modality of choice for initial screening and enables selection of hemodynamically unstable trauma victims with severe hemoperitoneum for immediate surgery. However, even in experienced hands, US is not sufficient to rule out organ injuries reliably. Computed tomography, and particularly multislice CT (MSCT), has several major advantages over US and is currently unsurpassed for the detection of blunt visceral injuries in the abdomen. Computed tomography has a high sensitivity for the detection of parenchymal splenic and hepatic injuries. Injuries of the gastrointestinal tract may be detected with good sensitivity provided that adequate examination technique and careful diagnostic interpretation are combined. The value of CT-based injury-grading systems for predicting the outcome of conservative treatment remains unproven; however, demonstration of direct vascular injuries with CT, e.g., the intrasplenic ''contrast blush'' sign, may indicate a high likelihood that conservative treatment will fail, thus warranting angiographic embolization or surgery. Monitoring of conservatively treated trauma victims by means of repeat CT studies enables early detection of a variety of delayed, clinically silent complications of trauma, e.g., posttraumatic biloma or bowel devascularization. Catheter angiography may be reserved to selected cases with vascular injuries proven on CT. (orig.)

  4. Managing Climate Change Refugia for Biodiversity Conservation

    Science.gov (United States)

    Climate change threatens to create fundamental shifts in in the distributions and abundances of species. Given projected losses, increased emphasis on management for ecosystem resilience to help buffer fish and wildlife populations against climate change is emerging. Such effort...

  5. Engaging recreational fishers in management and conservation: global case studies.

    Science.gov (United States)

    Granek, E F; Madin, E M P; Brown, M A; Figueira, W; Cameron, D S; Hogan, Z; Kristianson, G; de Villiers, P; Williams, J E; Post, J; Zahn, S; Arlinghaus, R

    2008-10-01

    Globally, the number of recreational fishers is sizeable and increasing in many countries. Associated with this trend is the potential for negative impacts on fish stocks through exploitation or management measures such as stocking and introduction of non-native fishes. Nevertheless, recreational fishers can be instrumental in successful fisheries conservation through active involvement in, or initiation of, conservation projects to reduce both direct and external stressors contributing to fishery declines. Understanding fishers' concerns for sustained access to the resource and developing methods for their meaningful participation can have positive impacts on conservation efforts. We examined a suite of case studies that demonstrate successful involvement of recreational fishers in conservation and management activities that span developed and developing countries, temperate and tropical regions, marine and freshwater systems, and open- and closed-access fisheries. To illustrate potential benefits and challenges of involving recreational fishers in fisheries management and conservation, we examined the socioeconomic and ecological contexts of each case study. We devised a conceptual framework for the engagement of recreational fishers that targets particular types of involvement (enforcement, advocacy, conservation, management design [type and location], research, and monitoring) on the basis of degree of stakeholder stewardship, scale of the fishery, and source of impacts (internal or external). These activities can be enhanced by incorporating local knowledge and traditions, taking advantage of leadership and regional networks, and creating collaborations among various stakeholder groups, scientists, and agencies to maximize the probability of recreational fisher involvement and project success.

  6. Outcome of Conservative Management of Burns: Critical Review ...

    African Journals Online (AJOL)

    Background: Management of burn continues to be a great challenge. Dressing and ... The state of depression was assessed using Beck classification of ... depression. Conclusion: Conservative management of burns is associated with more wound complications. Sudan Joural of Medical Studies Vol. 2 (1) 2007: pp. 25-28 ...

  7. Surgical management of short bowel syndrome by construction of an isoperistaltic intestinal valve: an experimental study in dogs.

    Science.gov (United States)

    Papaziogas, T; Tassiopoulos, A; Papaziogas, B; Koutsias, S; Alexandrakis, A; Sakellaridis, D; Galanis, N

    1999-08-01

    To develop of an isoperistaltic invaginated valve for the treatment of short bowel syndrome. Randomised experimental study University Hospital, Greece 8 mongrel dogs 90% resection of the small bowel, followed by construction of an invaginated valve one month later. weight loss, fat excretion in the faeces, radiographic and histological examination of the valve, pressure curve along the valve. Weight loss and steatorrhoea were reversed over a period of 2-3 months without evidence of intestinal obstruction in any of the animals. The construction of an isoperistaltic invaginated valve could be a solution to the management of the short gut syndrome.

  8. The effect of scientific evidence on conservation practitioners' management decisions.

    Science.gov (United States)

    Walsh, Jessica C; Dicks, Lynn V; Sutherland, William J

    2015-02-01

    A major justification of environmental management research is that it helps practitioners, yet previous studies show it is rarely used to inform their decisions. We tested whether conservation practitioners focusing on bird management were willing to use a synopsis of relevant scientific literature to inform their management decisions. This allowed us to examine whether the limited use of scientific information in management is due to a lack of access to the scientific literature or whether it is because practitioners are either not interested or unable to incorporate the research into their decisions. In on-line surveys, we asked 92 conservation managers, predominantly from Australia, New Zealand, and the United Kingdom, to provide opinions on 28 management techniques that could be applied to reduce predation on birds. We asked their opinions before and after giving them a summary of the literature about the interventions' effectiveness. We scored the overall effectiveness and certainty of evidence for each intervention through an expert elicitation process-the Delphi method. We used the effectiveness scores to assess the practitioners' level of understanding and awareness of the literature. On average, each survey participant changed their likelihood of using 45.7% of the interventions after reading the synopsis of the evidence. They were more likely to implement effective interventions and avoid ineffective actions, suggesting that their intended future management strategies may be more successful than current practice. More experienced practitioners were less likely to change their management practices than those with less experience, even though they were not more aware of the existing scientific information than less experienced practitioners. The practitioners' willingness to change their management choices when provided with summarized scientific evidence suggests that improved accessibility to scientific information would benefit conservation management

  9. Efficacy and safety of bisphosphonates in management of low bone density in inflammatory bowel disease

    Science.gov (United States)

    Yao, Liwei; Wang, Haiqing; Dong, Wenwei; Liu, Zhenxin; Mao, Haijiao

    2017-01-01

    Abstract This study aims to determine whether bisphosphonates are safe, as well as effective against bone mineral loss in inflammatory bowel disease (IBD). A computerized search of electronic databases from 1966 to 2016 was performed. Randomized controlled trials (RCTs) were included in this review to evaluate the role of bisphosphonates in the management of osteoporosis in IBD patients. A revised 7-point Jadad scale was used to evaluate the quality of each study. Overall, 13 RCTs and 923 patients met the inclusion criteria of this meta-analysis. The result showed that bisphosphonates decreased bone mass density (BMD) loss at the lumbar spine (P = 0.0002), reduced the risk of new fractures (P = 0.01), and retained the similar adverse events (P = 0.86). Bisphosphonates may provide protection and safety against bone mineral loss in IBD patients. PMID:28099343

  10. Mangrove ecosystem of India: Conservation and management

    Digital Repository Service at National Institute of Oceanography (India)

    Jagtap, T.G.; Murthy, P.S.; Komarpant, D.S.

    groups of islands in the Bay of Bengal and the Arabian Sea respectively. Coastal wetlands area of about 63,600 sq km in the country hardly includes about 5% of mangrove cover. Due to unawareness regarding the importance and lack of management in the past...

  11. Conservative management of primary postpartum haemorrhage

    International Nuclear Information System (INIS)

    Naqvi, S.; Makhdoom, T.

    2004-01-01

    Severe postpartum haemorrhage (PPH) is a serious obstetrical emergency. Two cases of severe PPH due to uterine atony are described which were managed by uterine packing with sterile ribbon gauze by vaginal route under general anesthesia. Along with supportive measures, it resulted in marked improvement in controlling haemorrhage and infectious morbidity. This is an effective treatment for severe PPH and should be practiced at tertiary care level in woman who wishes to preserve fertility. (author)

  12. Riparian Meadow Response to Modern Conservation Grazing Management

    Science.gov (United States)

    Oles, Kristin M.; Weixelman, Dave A.; Lile, David F.; Tate, Kenneth W.; Snell, Laura K.; Roche, Leslie M.

    2017-09-01

    Riparian meadows occupy a small proportion of the public lands in the western United States but they provide numerous ecosystem services, including the production of high-quality forage for livestock grazing. Modern conservation management strategies (e.g., reductions in livestock stocking rates and adoption of new riparian grazing standards) have been implemented to better balance riparian conservation and livestock production objectives on publicly managed lands. We examined potential relationships between long-term changes in plant community, livestock grazing pressure and environmental conditions at two spatial scales in meadows grazed under conservation management strategies. Changes in plant community were not associated with either livestock stocking rate or precipitation at the grazing allotment (i.e., administrative) scale. Alternatively, both grazing pressure and precipitation had significant, albeit modest, associations with changes in plant community at the meadow (i.e., ecological site) scale. These results suggest that reductions in stocking rate have improved the balance between riparian conservation and livestock production goals. However, associations between elevation, site wetness, precipitation, and changes in plant community suggest that changing climate conditions (e.g., reduced snowpack and changes in timing of snowmelt) could trigger shifts in plant communities, potentially impacting both conservation and agricultural services (e.g., livestock and forage production). Therefore, adaptive, site-specific management strategies are required to meet grazing pressure limits and safeguard ecosystem services within individual meadows, especially under more variable climate conditions.

  13. Diagnosis and conservative management of female stress urinary incontinence

    Directory of Open Access Journals (Sweden)

    Anil Krishna Dass

    2013-05-01

    Full Text Available Urinary incontinence affects 17–45% of women worldwide and stress urinary incontinence is responsible for 48% of all cases. Detailed history, physical examination and investigations are crucial to identify the diagnosis underlying the incontinence symptoms to select effective therapy. Although mid-urethral sling procedures are considered to be ‘gold standard’ treatment of SUI, conservative treatment with pelvic floor muscle training and lifestyle modification is still the first line of management. This article discusses the diagnosis and conservative management of female SUI.

  14. Effects of threat management interactions on conservation priorities.

    Science.gov (United States)

    Auerbach, Nancy A; Wilson, Kerrie A; Tulloch, Ayesha I T; Rhodes, Jonathan R; Hanson, Jeffrey O; Possingham, Hugh P

    2015-12-01

    Decisions need to be made about which biodiversity management actions are undertaken to mitigate threats and about where these actions are implemented. However, management actions can interact; that is, the cost, benefit, and feasibility of one action can change when another action is undertaken. There is little guidance on how to explicitly and efficiently prioritize management for multiple threats, including deciding where to act. Integrated management could focus on one management action to abate a dominant threat or on a strategy comprising multiple actions to abate multiple threats. Furthermore management could be undertaken at sites that are in close proximity to reduce costs. We used cost-effectiveness analysis to prioritize investments in fire management, controlling invasive predators, and reducing grazing pressure in a bio-diverse region of southeastern Queensland, Australia. We compared outcomes of 5 management approaches based on different assumptions about interactions and quantified how investment needed, benefits expected, and the locations prioritized for implementation differed when interactions were taken into account. Managing for interactions altered decisions about where to invest and in which actions to invest and had the potential to deliver increased investment efficiency. Differences in high priority locations and actions were greatest between the approaches when we made different assumptions about how management actions deliver benefits through threat abatement: either all threats must be managed to conserve species or only one management action may be required. Threatened species management that does not consider interactions between actions may result in misplaced investments or misguided expectations of the effort required to mitigate threats to species. © 2015 The Authors. Conservation Biology published by Wiley Periodicals, Inc., on behalf of Society for Conservation Biology.

  15. Percutaneous endoscopic sigmoid colostomy for irrigation in the management of bowel dysfunction of adults with central neurologic disease.

    Science.gov (United States)

    Ramwell, A; Rice-Oxley, M; Bond, A; Simson, J N L

    2011-10-01

    Bowel dysfunction results in a major lifestyle disruption for many patients with severe central neurologic disease. Percutaneous endoscopic sigmoid colostomy for irrigation (PESCI) allows antegrade irrigation of the distal large bowel for the management of both incontinence and constipation. This study prospectively assessed the safety and efficacy of PESCI. A PESCI tube was placed endoscopically in the sigmoid colon of 25 patients to allow antegrade irrigation. Control of constipation and fecal incontinence was improved for 21 (84%) of the 25 patients. These patients were followed up for 6-83 months (mean, 43 months), with long-term success for 19 (90%) of the patients. No PESCI had to be removed for technical reasons or for PESCI complications. Late removal of the PESCI was necessary for 2 of the 21 patients. A modified St. Marks Fecal Incontinence Score to assess bowel function before and after PESCI showed a highly significant improvement (P irrigation in the management bowel dysfunction for selected patients with central neurologic disease. A successful PESCI is very likely to continue functioning satisfactorily for a long time without technical problems or local complications.

  16. Management of craniopharyngiomas: Role of conservative strategies

    Directory of Open Access Journals (Sweden)

    Shibu Pillai

    2013-01-01

    Full Text Available Craniopharyngiomas are uncommon tumors and their management remains controversial. Despite gross total resection, recurrences can occur in 15-43% during long-term follow-up of more than 10 years. Furthermore, radical surgery can be associated with complications associated with hypothalamic damage, which can lead to a poor quality-of-life. Limited surgery followed by adjuvant radiotherapy (RT can provide excellent long-term tumor control with minimum complications and good functional outcome. RT can however, produce insidious onset of hypopituitarism and vasculopathy. Secondary malignancies are a rare complication of RT. Modern radiation techniques and intracystic radiation can reduce these complications. Intracystic radiation is highly effective for cystic craniopharyngiomas. Intracystic bleomycin (ICB and interferon alpha (IFN are rarely curative, but can produce long lasting control of tumor cysts and this is very useful in very young children who may not tolerate radical surgery or RT. IFN has fewer toxicity issues compared to ICB.

  17. Management of Inflammatory Bowel Disease in the Elderly Patient: Challenges and Opportunities.

    Science.gov (United States)

    Ananthakrishnan, Ashwin N; Donaldson, Tamara; Lasch, Karen; Yajnik, Vijay

    2017-06-01

    The population of older patients with inflammatory bowel disease (IBD) continues to grow, partly reflecting the aging global population in general. The debilitating effects of IBD compound age-related decrements in health and functional capacity, and make the medical management of older patients with Crohn's disease and ulcerative colitis distinctly challenging to clinicians. Here, we review the recent literature describing the pharmacologic management of IBD in this population, with focus on the safety, tolerability, and efficacy of common treatment options, such as steroids, immunomodulators, tumor necrosis factor-α antagonists, and integrin antagonists; surgical interventions in older patients are also discussed. Few studies have systematically and prospectively evaluated the clinical challenges in the medical management of IBD in this patient population, leaving a limited evidence base to which clinicians can turn to for guidance. Treatment patterns may thus be suboptimal. For example, prolonged steroid use in the elderly was found to be common, causing significant morbidity from side effects in a particularly vulnerable population. Finally, within the context of a limited evidence base, we discuss common treatment scenarios to define the parameters within which physicians can individualize care for older patients with IBD. Overall, older patients with IBD are at higher risk of adverse events and less treatment responsiveness compared with younger patients, underscoring the need for future studies to fully characterize appropriate treatment courses for this population.

  18. Setting conservation management thresholds using a novel participatory modeling approach.

    Science.gov (United States)

    Addison, P F E; de Bie, K; Rumpff, L

    2015-10-01

    We devised a participatory modeling approach for setting management thresholds that show when management intervention is required to address undesirable ecosystem changes. This approach was designed to be used when management thresholds: must be set for environmental indicators in the face of multiple competing objectives; need to incorporate scientific understanding and value judgments; and will be set by participants with limited modeling experience. We applied our approach to a case study where management thresholds were set for a mat-forming brown alga, Hormosira banksii, in a protected area management context. Participants, including management staff and scientists, were involved in a workshop to test the approach, and set management thresholds to address the threat of trampling by visitors to an intertidal rocky reef. The approach involved trading off the environmental objective, to maintain the condition of intertidal reef communities, with social and economic objectives to ensure management intervention was cost-effective. Ecological scenarios, developed using scenario planning, were a key feature that provided the foundation for where to set management thresholds. The scenarios developed represented declines in percent cover of H. banksii that may occur under increased threatening processes. Participants defined 4 discrete management alternatives to address the threat of trampling and estimated the effect of these alternatives on the objectives under each ecological scenario. A weighted additive model was used to aggregate participants' consequence estimates. Model outputs (decision scores) clearly expressed uncertainty, which can be considered by decision makers and used to inform where to set management thresholds. This approach encourages a proactive form of conservation, where management thresholds and associated actions are defined a priori for ecological indicators, rather than reacting to unexpected ecosystem changes in the future. © 2015 The

  19. Biochemical genetics in marine fisheries management and conservation

    Digital Repository Service at National Institute of Oceanography (India)

    Menezes, M.R.

    - 403004 NBDBlDBTSponsored Training on Taxonomy, GOIdia turd Gme Bturking o/Coastal and Marine Bloresources, CIFE, Mumbal BIOCHEMICAL GENETICS IN MARINE FISHERIES MANAGEMENT AND CONSERVATION Maria R. Menezes Introduction . Species of fish, like most... population structure may have evolved and been maintained in species of fish ofeconomic interest has led to the concept of 'stock'. The stock concept dominates much of marine fisheries management, theory and practice because the identification of discrete...

  20. Load building versus conservation as demand-side management objectives

    International Nuclear Information System (INIS)

    Kexel, D.T.

    1994-01-01

    This paper examines the economics of load building versus conservation as demand-side management objectives. Economic criteria to be used in evaluating each type of program from the perspectives of all impacted parties are provided. The impact of DSM programs on electric rates is shown to be a key focal point of a thorough evaluation

  1. Community-managed conservation efforts at Tsingy Mahaloka ...

    African Journals Online (AJOL)

    ... for habitat protection; (ii) create economic incentives and benefits for residents; and, ... KOFAMA, as the local organization to be responsible for management of the ... rising 80–100 metres above a flat coastal plain), a diverse endemic avifauna, ... et enfin une structure destinée à faciliter les efforts de conservation qui sont ...

  2. Basic Energy Conservation and Management--Part 2: HVAC

    Science.gov (United States)

    Krueger, Glenn

    2012-01-01

    Reducing school district energy expenditures has become a universal goal, and new technologies have brought greater energy efficiencies to the school environment. In Part 1 of this two-part series, the author discussed the steps required to establish an energy conservation and management program with an emphasis on lighting. In this article, he…

  3. Multidisciplinary conservative management in classical Volkmann's contracture: A case report

    NARCIS (Netherlands)

    Reinders, M.F.; Geertzen, J.H.B.; Eisma, W.H.

    1996-01-01

    This clinical note describes the case of a nine-year-old girl with classical Volkmann's contracture of the left forearm. The report demonstrates the results and follow-up of conservative orthotic management used as a mode of treatment by a multidisciplinary team. When using an orthosis it is

  4. The 5C Concept and 5S Principles in Inflammatory Bowel Disease Management.

    Science.gov (United States)

    Hibi, Toshifumi; Panaccione, Remo; Katafuchi, Miiko; Yokoyama, Kaoru; Watanabe, Kenji; Matsui, Toshiyuki; Matsumoto, Takayuki; Travis, Simon; Suzuki, Yasuo

    2017-10-27

    The international Inflammatory Bowel Disease [IBD] Expert Alliance initiative [2012-2015] served as a platform to define and support areas of best practice in IBD management to help improve outcomes for all patients with IBD. During the programme, IBD specialists from around the world established by consensus two best practice charters: the 5S Principles and the 5C Concept. The 5S Principles were conceived to provide health care providers with key guidance for improving clinical practice based on best management approaches. They comprise the following categories: Stage the disease; Stratify patients; Set treatment goals; Select appropriate treatment; and Supervise therapy. Optimised management of patients with IBD based on the 5S Principles can be achieved most effectively within an optimised clinical care environment. Guidance on optimising the clinical care setting in IBD management is provided through the 5C Concept, which encompasses: Comprehensive IBD care; Collaboration; Communication; Clinical nurse specialists; and Care pathways. Together, the 5C Concept and 5S Principles provide structured recommendations on organising the clinical care setting and developing best-practice approaches in IBD management. Consideration and application of these two dimensions could help health care providers optimise their IBD centres and collaborate more effectively with their multidisciplinary team colleagues and patients, to provide improved IBD care in daily clinical practice. Ultimately, this could lead to improved outcomes for patients with IBD. Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com

  5. How Stakeholder Co-management Reproduces Conservation Conflicts: Revealing Rationality Problems in Swedish Wolf Conservation

    Directory of Open Access Journals (Sweden)

    Erica von Essen

    2015-01-01

    Full Text Available 'Stakeholder' has become the primary category of political actor in decision-making, not least within nature conservation. Drawing from Habermas' theory on communicative action, this article argues that there are democratic deficits to the stakeholder model that promote citizens to remain locked in predetermined, polarized positions. It contends that the stakeholder model must, hence, be scrutinized with respect to its potential role in perpetuating conservation conflicts in modernity. Using the case study of stakeholder-based game management delegations (GMDs in Sweden, our research identifies four barriers, which tie to the instrumental basis and liberal democratic legacy of the stakeholder approach: 1 strong sense of accountability; 2 overly purposive atmosphere; 3 overemphasis on decision as final outcome; and 4 perceived inability on the part of the delegates to influence science-led decision-making. The article suggests that these democratic deficits preclude the deliberation and contestation necessary to legitimate conservation policy. Indeed, stakeholder rationality causes citizens to become inert, instrumental agents who approach discussion with strategic rather than communicative rationality. We conclude that the deficits of the stakeholder model currently: 1 restrict democratic freedom for citizens; 2 engender a crisis of legitimacy of management; and 3 reproduce the conflict, which in Sweden relates to the conservation of wolves.

  6. Ageing with neurogenic bowel dysfunction

    DEFF Research Database (Denmark)

    Nielsen, S D; Faaborg, Pia Møller; Finnerup, Nanna Brix

    2017-01-01

    The aim of this longitudinal study with postal survey was to describe changes in the patterns of neurogenic bowel dysfunction and bowel management in a population of people with spinal cord injury (SCI) followed for two decades. In 1996, a validated questionnaire on bowel function was sent to the...

  7. Systematic review: interventions for abdominal pain management in inflammatory bowel disease.

    Science.gov (United States)

    Norton, C; Czuber-Dochan, W; Artom, M; Sweeney, L; Hart, A

    2017-07-01

    Abdominal pain is frequently reported by people with inflammatory bowel disease (IBD), including in remission. Pain is an under-treated symptom. To systematically review evidence on interventions (excluding disease-modifying interventions) for abdominal pain management in IBD. Databases (MEDLINE, EMBASE, PsycInfo, CINAHL, Scopus, Cochrane Library) were searched (February 2016). Two researchers independently screened references and extracted data. Fifteen papers were included: 13 intervention studies and two cross-sectional surveys. A variety of psychological, dietary and pharmacological interventions were reported. Four of six studies reported pain reduction with psychological intervention including individualised and group-based relaxation, disease anxiety-related Cognitive Behavioural Therapy and stress management. Both psychologist-led and self-directed stress management in inactive Crohn's disease reduced pain compared with controls (symptom frequency reduction index=-26.7, -11.3 and 17.2 at 6-month follow-up, respectively). Two dietary interventions (alcoholic drinks with high sugar content and fermentable carbohydrate with prebiotic properties) had an effect on abdominal pain. Antibiotics (for patients with bacterial overgrowth) and transdermal nicotine patches reduced abdominal pain. Current and past cannabis users report it relieves pain. One controlled trial of cannabis reduced SF-36 and EQ-5D pain scores (1.84 and 0.7, respectively). These results must be treated with caution: data were derived from predominantly small uncontrolled studies of moderate to low quality. Few interventions have been tested for IBD abdominal pain. The limited evidence suggests that relaxation and changing cognitions are promising, possibly with individualised dietary changes. There is a need to develop interventions for abdominal pain management in IBD. © 2017 John Wiley & Sons Ltd.

  8. Fertility and obstetric outcome after conservative management of placenta accreta.

    Science.gov (United States)

    Provansal, Magali; Courbiere, Blandine; Agostini, Aubert; D'Ercole, Claude; Boubli, Léon; Bretelle, Florence

    2010-05-01

    To determine the fertility and obstetric outcomes after conservative management of placenta accreta. A retrospective observational cohort study of all identified cases of placenta accreta from 1993 to 2007 in 2 tertiary university hospitals in France. For patients treated conservatively, maternal and fetal morbidity, reproductive function, fertility, and subsequent pregnancies were recorded. During the study period, 46 patients were treated by conservative management; 6 patients underwent a secondary hysterectomy. Of the remaining 40 patients, 35 were followed up for a median of 65 months (range 18-156 months). Patients resumed their menstrual cycles after a median of 130 days (range 48-176 days). Menses were irregular in 11 patients (31%), but none had amenorrhea. Twelve of the 14 patients desiring another pregnancy achieved a total of 15 pregnancies; 2 patients had recurrent placenta accreta. Five spontaneous abortions and 1 termination of pregnancy occurred during the first trimester. The median term at delivery was 37 weeks (range, 35-40 weeks). Four patients delivered prematurely. Conservative management of placenta accreta can preserve fertility, although the risk of recurrent placenta accreta appears to be high. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  9. Evidence, models, conservation programs and limits to management

    Science.gov (United States)

    Nichols, J.D.

    2012-01-01

    Walsh et al. (2012) emphasized the importance of obtaining evidence to assess the effects of management actions on state variables relevant to objectives of conservation programs. They focused on malleefowl Leipoa ocellata, ground-dwelling Australian megapodes listed as vulnerable. They noted that although fox Vulpes vulpes baiting is the main management action used in malleefowl conservation throughout southern Australia, evidence of the effectiveness of this action is limited and currently debated. Walsh et al. (2012) then used data from 64 sites monitored for malleefowl and foxes over 23 years to assess key functional relationships relevant to fox control as a conservation action for malleefowl. In one set of analyses, Walsh et al. (2012) focused on two relationships: fox baiting investment versus fox presence, and fox presence versus malleefowl population size and rate of population change. Results led to the counterintuitive conclusion that increases in investments in fox control produced slight decreases in malleefowl population size and growth. In a second set of analyses, Walsh et al. (2012) directly assessed the relationship between investment in fox baiting and malleefowl population size and rate of population change. This set of analyses showed no significant relationship between investment in fox population control and malleefowl population growth. Both sets of analyses benefited from the incorporation of key environmental covariates hypothesized to influence these management relationships. Walsh et al. (2012) concluded that "in most situations, malleefowl conservation did not effectively benefit from fox baiting at current levels of investment." In this commentary, I discuss the work of Walsh et al. (2012) using the conceptual framework of structured decision making (SDM). In doing so, I accept their analytic results and associated conclusions as accurate and discuss basic ideas about evidence, conservation and limits to management.

  10. Conservation markets for wildlife management with case studies from whaling.

    Science.gov (United States)

    Gerber, Leah R; Costello, Christopher; Gaines, Steven D

    2014-01-01

    Although market-based incentives have helped resolve many environmental challenges, conservation markets still play a relatively minor role in wildlife management. Establishing property rights for environmental goods and allowing trade between resource extractors and resource conservationists may offer a path forward in conserving charismatic species like whales, wolves, turtles, and sharks. In this paper, we provide a conceptual model for implementing a conservation market for wildlife and evaluate how such a market could be applied to three case studies for whales (minke [Balaenoptera acutorostrata], bowhead [Balaena mysticetus], and gray [Eschrictius robustus]). We show that, if designed and operated properly, such a market could ensure persistence of imperiled populations, while simultaneously improving the welfare of resource harvesters.

  11. Conservative fluid management prevents age-associated ventilator induced mortality.

    Science.gov (United States)

    Herbert, Joseph A; Valentine, Michael S; Saravanan, Nivi; Schneck, Matthew B; Pidaparti, Ramana; Fowler, Alpha A; Reynolds, Angela M; Heise, Rebecca L

    2016-08-01

    Approximately 800 thousand patients require mechanical ventilation in the United States annually with an in-hospital mortality rate of over 30%. The majority of patients requiring mechanical ventilation are over the age of 65 and advanced age is known to increase the severity of ventilator-induced lung injury (VILI) and in-hospital mortality rates. However, the mechanisms which predispose aging ventilator patients to increased mortality rates are not fully understood. Ventilation with conservative fluid management decreases mortality rates in acute respiratory distress patients, but to date there has been no investigation of the effect of conservative fluid management on VILI and ventilator associated mortality rates. We hypothesized that age-associated increases in susceptibility and incidence of pulmonary edema strongly promote age-related increases in ventilator associated mortality. 2month old and 20month old male C57BL6 mice were mechanically ventilated with either high tidal volume (HVT) or low tidal volume (LVT) for up to 4h with either liberal or conservative fluid support. During ventilation, lung compliance, total lung capacity, and hysteresis curves were quantified. Following ventilation, bronchoalveolar lavage fluid was analyzed for total protein content and inflammatory cell infiltration. Wet to dry ratios were used to directly measure edema in excised lungs. Lung histology was performed to quantify alveolar barrier damage/destruction. Age matched non-ventilated mice were used as controls. At 4h, both advanced age and HVT ventilation significantly increased markers of inflammation and injury, degraded pulmonary mechanics, and decreased survival rates. Conservative fluid support significantly diminished pulmonary edema and improved pulmonary mechanics by 1h in advanced age HVT subjects. In 4h ventilations, conservative fluid support significantly diminished pulmonary edema, improved lung mechanics, and resulted in significantly lower mortality rates in

  12. Fenced and Fragmented: Conservation Value of Managed Metapopulations

    Science.gov (United States)

    Miller, Susan M.; Harper, Cindy K.; Bloomer, Paulette; Hofmeyr, Jennifer; Funston, Paul J.

    2015-01-01

    Population fragmentation is threatening biodiversity worldwide. Species that once roamed vast areas are increasingly being conserved in small, isolated areas. Modern management approaches must adapt to ensure the continued survival and conservation value of these populations. In South Africa, a managed metapopulation approach has been adopted for several large carnivore species, all protected in isolated, relatively small, reserves that are fenced. As far as possible these approaches are based on natural metapopulation structures. In this network, over the past 25 years, African lions (Panthera leo) were reintroduced into 44 fenced reserves with little attention given to maintaining genetic diversity. To examine the situation, we investigated the current genetic provenance and diversity of these lions. We found that overall genetic diversity was similar to that in a large national park, and included a mixture of four different southern African evolutionarily significant units (ESUs). This mixing of ESUs, while not ideal, provides a unique opportunity to study the impact of mixing ESUs over the long term. We propose a strategic managed metapopulation plan to ensure the maintenance of genetic diversity and improve the long-term conservation value of these lions. This managed metapopulation approach could be applied to other species under similar ecological constraints around the globe. PMID:26699333

  13. Conservative Management of Azygous Vein Rupture in Blunt Thoracic Trauma

    Directory of Open Access Journals (Sweden)

    Cian McDermott

    2012-01-01

    Full Text Available We report a case of successful conservative management of acute traumatic rupture of the azygous vein. A 48-year-old male was involved in a motor vehicle collision. Primary survey revealed acute right intrathoracic haemorrhage. He remained haemodynamically stable with rapid infusion of warmed crystalloid solution and blood. Computed tomographic imaging showed a contained haematoma of the azygous vein. The patient was managed conservatively in the intensive care. Azygous vein laceration resulting from blunt thoracic trauma is a rare condition that carries a universally poor prognosis unless the appropriate treatment is instituted. Clinical features include acute hypovolaemic shock, widened mediastinum on chest radiograph, and a right-sided haemothorax. Haemodynamic collapse necessitates immediate resuscitative thoracotomy. Interest in this injury stems from the severity of the clinical condition, difficulty in diagnosis, the onset of a rapidly deteriorating clinical course all of which can be promptly reversed by timely and appropriate treatment. Although it is a rare cause of intramediastinal haemorrhage, it is proposed that a ruptured azygous vein should be considered in every trauma case causing a right-sided haemothorax or widened mediastinum. All cases described in the literature to date involved operative management. We present a case of successful conservative management of this condition.

  14. Role of Conservative Management in Emphysematous Pyelonephritis - A Retrospective Study

    Science.gov (United States)

    Irom, Keshorjit Singh; Khumallambam, Ibomcha Singh; Sinam, Rajendra Singh

    2015-01-01

    Introduction Emphysematous pyelophritis (EPN) is a serious condition with significant mortality. The prognosis of patients with EPN has changed over the years. Mortality has declined with prompt and aggressive medical management and minimally invasive strategies. Aim To identify the prognostic factors and assess the outcome of conservative management of emphysematous pyelonephritis. Settings and Design This was a retrospective study of 8 consecutive patients who were diagnosed with EPN in two medical institutes between July 2010 and June 2015. Materials and Methods Eight consecutive patients diagnosed with emphysematous pyelonephritis between July 2010 and June 2015 was studied retrospectively. On the basis of Computerised tomographic scan findings they were grouped into four classes (1 to 4) according the modified classification recommended by Huang and Tseng. The management was conservative (combination of percutaneous drainage and antibiotics), immediate nephrectomy or delayed nephrectomy (when conservative management failed). Demographic, clinical, biochemical and radiological characteristics were assessed and compared between survivors and nonsurvivors. Results Seven (87.5%) of a total of 8 patients had diabetes mellitus. Escherichia coli (71.4 %) was the most common offending pathogen identified in pus culture. With conservative management in 7 patients (combination of percutaneous drainage and antibiotics), treatment was successful in 57.14 % and with immediate nephrectomy (one patient), the success rate was 100%. The risk factors for mortality were thrombocytopenia, shock and altered sensorium at presentation. The mortality rate in class 1, 2 and 3 was 0%, 33.3% and 66.7%. None of the patient had class 4 EPN. Conclusion A combination of percutaneous drainage with antibiotics offers an effective therapy for emphysematous pyelonephritis. PMID:26675196

  15. Gut microbiota and inflammatory bowel disease: the role of antibiotics in disease management.

    Science.gov (United States)

    Kerman, David H; Deshpande, Amar R

    2014-07-01

    Imbalances in the composition and number of bacteria in the gut microbiota have been implicated in inflammatory bowel disease (IBD), and modulation of the gut microbiota by probiotics and antibiotics in IBD has been an active area of research, with mixed results. This narrative review summarizes the findings of relevant publications identified using the PubMed database. Although antibiotics have been associated with an increased risk of IBD development and flares, several meta-analyses demonstrate that antibiotics are efficacious for the induction of remission and treatment of flares in patients with IBD. Data supporting their use include a large number of antibiotic studies in Crohn's disease and evidence suggests antibiotics are efficacious in both Crohn's disease and ulcerative colitis, although there are fewer studies of the latter. For Crohn's disease, antibiotics have been shown to be useful for the induction of remission and in the postoperative management of patients undergoing surgery. Additionally, patients with fistulizing disease, particularly perianal, can benefit from antibiotics administered short term. Both antimicrobials and probiotics have been shown to be useful for the treatment of pouchitis. Additional randomized controlled trials are needed to further elucidate the role of bacteria in IBD and to better inform clinicians about appropriate antibiotic therapies.

  16. Rational Management of Iron-Deficiency Anaemia in Inflammatory Bowel Disease

    Science.gov (United States)

    Vikner, Malene Elbaek; Weiss, Günter

    2018-01-01

    Anaemia is the most frequent, though often neglected, comorbidity of inflammatory bowel disease (IBD). Here we want to briefly present (1) the burden of anaemia in IBD, (2) its pathophysiology, which mostly arises from bleeding-associated iron deficiency, followed by (3) diagnostic evaluation of anaemia, (4) a balanced overview of the different modes of iron replacement therapy, (5) evidence for their therapeutic efficacy and subsequently, (6) an updated recommendation for the practical management of anaemia in IBD. Following the introduction of various intravenous iron preparations over the last decade, questions persist about when to use these preparations as opposed to traditional and other novel oral iron therapeutic agents. At present, oral iron therapy is generally preferred for patients with quiescent IBD and mild iron-deficiency anaemia. However, in patients with flaring IBD that hampers intestinal iron absorption and in those with inadequate responses to or side effects with oral preparations, intravenous iron supplementation is the therapy of choice, although information on the efficacy of intravenous iron in patients with active IBD and anaemia is scare. Importantly, anaemia in IBD is often multifactorial and a careful diagnostic workup is mandatory for optimized treatment. Nevertheless, limited information is available on optimal therapeutic start and end points for treatment of anaemia. Of note, neither oral nor intravenous therapies seem to exacerbate the clinical course of IBD. However, additional prospective studies are still warranted to determine the optimal therapy in complex conditions such as IBD. PMID:29342861

  17. Pediatric irritable bowel syndrome patient and parental characteristics differ by care management type

    Science.gov (United States)

    This study evaluates whether certain patient or parental characteristics are associated with gastroenterology (GI) referral versus primary pediatrics care for pediatric irritable bowel syndrome (IBS). A retrospective clinical trial sample of patients meeting pediatric Rome III IBS criteria was assem...

  18. Chondrichthyan Diversity, Conservation Status, and Management Challenges in Costa Rica

    Directory of Open Access Journals (Sweden)

    Mario Espinoza

    2018-03-01

    Full Text Available Understanding key aspects of the biology and ecology of chondrichthyan fishes (sharks, rays, and chimeras, as well as the range of threats affecting their populations is crucial given the rapid rate at which some species are declining. In the Eastern Tropical Pacific (ETP, the lack of knowledge, unreliable (or non-existent landing statistics, and limited enforcement of existing fisheries regulations has hindered management and conservation efforts for chondrichthyan species. This review evaluated our current understanding of Costa Rican chondrichthyans and their conservation status. Specifically, we (1 provide an updated checklist on the species richness, habitat use, and distribution patterns, (2 summarize the most relevant chondrichthyan studies (scientific publications, theses, and official technical reports, (3 identify knowledge gaps, (4 discuss fisheries-related threats, and (5 highlight the management challenges and research needs to effectively protect their populations. A total of 99 chondrichthyan species are formally recorded in Costa Rican waters, from which 15% are threatened with extinction and 41% are “Data Deficient” based on the IUCN (International Union for Conservation of Nature Red List. A total of 121 studies were published between 1891 and 2017; 82% in the Pacific (24% from Isla del Coco and only 18% from the Caribbean Sea. These results highlight the need to redirect research efforts on specific taxonomic groups and geographic regions (i.e., Caribbean. Based on our review, improving the quality and quantity of fisheries landing statistics, as well as determining the degree of overlap between chondrichthyans and Costa Rican fisheries remains a priority. We proposed an adaptive management framework for chondrichthyan fisheries in data-poor countries where management goals/targets are clearly defined. This framework could strengthen the conservation of chondrichthyan populations in Costa Rica and the region.

  19. Pacemaker lead erosion simulating "Loch Ness Monster": conservative management.

    Science.gov (United States)

    Garg, Naveen; Moorthy, Nagaraja

    2012-12-01

    The majority of pacemaker pocket or lead erosions are due to either mechanical erosion by the bulky pulse generator or secondary to pacemaker pocket infection. We describe an unusual case of delayed pacemaker lead erosion causing extrusion of a portion of the pacing lead, with separate entry and exit points, with the gap filled with new skin formation, simulating the "Loch Ness Monster", which was successfully managed conservatively by surgical reinsertion.

  20. Conservatively managed pineal apoplexy in an anticoagulated patient

    International Nuclear Information System (INIS)

    Werder, Gabriel M.; Razdan, Rahul S.; Gagliardi, Joseph A.; Chaddha, Shashi K.B.

    2008-01-01

    We present a case of pineal apoplexy in an anticoagulated and hypertensive 56-year-old Hispanic male. At presentation, the patient's international normalized ratio (INR) was 10.51 and his blood pressure was 200/130 mmHg. His presenting symptoms included acute onset of headache, chest pain, nausea, vomiting, vertigo, and visual disturbance. Neuroimaging demonstrated hemorrhage into a morphologically normal pineal gland. Under conservative management, the patient experienced gradual resolution of all symptoms excluding the disturbance of upward gaze

  1. Conservative Management of Placenta Accreta in a Multiparous Woman

    OpenAIRE

    Jennifer C. Hunt

    2010-01-01

    Placenta accreta refers to any abnormally invasive placental implantation. Diagnosis is suspected postpartum with failed delivery of a retained placenta. Massive obstetrical hemorrhage is a known complication, often requiring peripartum hysterectomy. We report a case of presumed placenta accreta in a patient following failed manual removal of a retained placenta. We describe an attempt at conservative management with methotrexate in a stable patient desiring future fertility. Treatment was ...

  2. Maternal outcome after conservative management of abnormally invasive placenta

    Directory of Open Access Journals (Sweden)

    Hsiu-Wei Su

    2017-06-01

    Conclusion: In this small series, we observed a low successful uterine preservation rate and a high maternal complication rate. We recommend that primary cesarean hysterectomy should be used as the treatment of choice for mild to severe abnormally invasive placenta. Conservative management should be reserved for women with a strong fertility desire and women with extensive disease that precludes primary hysterectomy due to surgical difficulty.

  3. Blowhole colostomy for the urgent management of distal large bowel obstruction.

    Science.gov (United States)

    Kasten, Kevin R; Midura, Emily F; Davis, Bradley R; Rafferty, Janice F; Paquette, Ian M

    2014-05-01

    Complete obstruction of the distal colon or rectum often presents as a surgical emergency. This study evaluated the efficacy of blowhole colostomy versus transverse loop colostomy for the emergent management of distal large intestinal obstruction. Retrospective chart review of all colostomy procedures (CPT 44320) performed for complete distal large bowel obstruction during the past 6 y in a university hospital practice was undertaken. Blowhole was compared with loop colostomy with a primary endpoint of successful colonic decompression. One hundred forty-one patients underwent colostomy creation during the study period. Of these, 61 were completed for acute obstruction of the distal colon or rectum (19 blowhole versus 42 loop colostomy). No differences between study groups were seen in age, gender, body mass index, malnutrition, American Society of Anesthesiology class, time to liquid or regular diet, 30-d or inhospital mortality, or rates of complications. Patients undergoing blowhole colostomy had significantly higher cecal diameters at diagnosis (9.14 versus 7.31 cm, P = 0.0035). Operative time was shorter in blowhole procedures (43 versus 51 min, P = 0.017). Postoperative length of stay was significantly shorter for blowhole colostomy (6 versus 8 d, P = 0.014). The primary endpoint of successful colonic decompression was met in all colostomy patients. Diverting blowhole colostomy is a safe, quick, and effective procedure for the urgent management of distal colonic obstruction associated with obstipation and massive distention. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Management of Iron-Deficiency Anemia in Inflammatory Bowel Disease: A Systematic Review.

    Science.gov (United States)

    Nielsen, Ole Haagen; Ainsworth, Mark; Coskun, Mehmet; Weiss, Günter

    2015-06-01

    Anemia is the most frequent complication of inflammatory bowel disease (IBD), but anemia, mostly due to iron deficiency, has long been neglected in these patients. The aim was to briefly present the pathophysiology, followed by a balanced overview of the different forms of iron replacement available, and subsequently, to perform a systematic review of studies performed in the last decade on the treatment of iron-deficiency anemia in IBD. Given that intravenous therapies have been introduced in the last decade, a systematic review performed in PubMed, EMBASE, the Cochrane Library, and the websites of WHO, FDA, and EMA covered prospective trials investigating the management of iron-deficiency anemia in IBD published since 2004. A total of 632 articles were reviewed, and 13 articles (2906 patients) with unique content were included. In general, oral supplementation in iron-deficiency anemia should be administered with a target to restore/replenish the iron stores and the hemoglobin level in a suitable way. However, in patients with IBD flares and inadequate responses to or side effects with oral preparations, intravenous iron supplementation is the therapy of choice. Neither oral nor intravenous therapy seems to exacerbate the clinical course of IBD, and intravenous iron therapy can be administered even in active disease stages and concomitantly with biologics. In conclusion, because many physicians are in doubt as to how to manage anemia and iron deficiency in IBD, there is a clear need for the implementation of evidence-based recommendations on this matter. Based on the data presented, oral iron therapy should be preferred for patients with quiescent disease stages and trivial iron deficiency anemia unless such patients are intolerant or have an inadequate response, whereas intravenous iron supplementation may be of advantage in patients with aggravated anemia or flares of IBD because inflammation hampers intestinal absorption of iron.

  5. Conservative Management of Placenta Accreta/Increta after Vaginal Birth

    Science.gov (United States)

    Peiffer, S.; Reinhard, J.; Reitter, A.; Louwen, F.

    2012-01-01

    Aim: Aim of the study was to show that conservative management with preservation of the uterus and of fertility is possible in patients with placenta accreta/increta after vaginal delivery. Method: A retrospective analysis of patients with placental attachment disorders after vaginal delivery was done in a perinatal centre between November 2009 and April 2011. The patient collective was identified using the ICD-10 codes for placenta accreta/increta/percreta, and patient records were analysed for risk factors, maternal morbidity, preservation of the uterus and of fertility, and neonatal outcome. Results: Three cases of placenta increta were identified in the last 1.5 years out of a total of 1457 vaginal deliveries, and all 3 cases were treated conservatively. Mean maternal age was 35.3 years; gestational age ranged from 39 to 41 weeks, and mean duration between delivery of the child and delivery of the placenta was 44.67 days (range: 14–100 days). Two patients developed symptoms of endomyometritis, including fever, leukocytosis and increased CRP levels. All 3 women were successfully managed with preservation of the uterus. Conclusion: In selected cases with placenta accreta/increta after vaginal delivery, it is possible to avoid surgical procedures, particularly hysterectomy procedures, and successfully manage these patients conservatively with preservation of the uterus. PMID:25308979

  6. Preliminary guidelines for electricity distributor conservation and demand management activities : a guide for conservation and demand management investment

    International Nuclear Information System (INIS)

    2004-01-01

    In May 2004, electricity distributors in Ontario were asked to submit deferral accounts to the Ontario Energy Board to track expenditures on conservation and demand management initiatives. The deferral accounts must be established before the distributor could recover the costs through the next installment of the allowable return on equity in March 2004. The Board will determine the appropriateness of the actual expenditures. These guidelines offer short-term assistance to distributors in establishing conservation and demand management plans and initiatives. The following specific measures may be supported by the Board: energy efficiency; operational changes to smart control systems; load management measures which facilitate interruptible and dispatchable loads, dual fuel applications, thermal storage and demand response; fuel switching measures; programs targeted to low income and hard to reach consumers; and, distributed energy options such as tri-generation, cogeneration, ground source heat pumps, wind and biomass systems. These guidelines described the regulatory treatment of conservation and demand management investments along with cost effectiveness, allocation of costs, monitoring, evaluation, and implementation. 1 appendix

  7. DNA in the conservation and management of African antelope

    DEFF Research Database (Denmark)

    Lorenzen, Eline

    2016-01-01

    tool in informed species conservation and sustainable wildlife management. The movement of antelope through translocations, reintroductions, and population augmentations is common practice in wildlife management. DNA-led species identification using genetic barcoding is an effective use of genetic data...... within forensics. DNA barcoding is a taxonomic method that uses a short genetic marker in an organism's DNA to identify it as belonging to a particular species....... databases, and represents a valuable reference database of antelope DNA diversity. For the evolution of antelope, sub-Saharan Africa is a region of particular intrigue. The geographic regions of sub-Saharan Africa represent unique evolutionary scenarios. Molecular data have become an increasingly important...

  8. Long-term efficacy and safety of otilonium bromide in the management of irritable bowel syndrome: a literature review

    Directory of Open Access Journals (Sweden)

    Triantafillidis JK

    2014-04-01

    Full Text Available John K Triantafillidis, George Malgarinos Inflammatory Bowel Disease Unit, IASO General Hospital, Athens, Greece Abstract: Irritable bowel syndrome (IBS is a very common functional gastrointestinal disorder characterized by abdominal pain or discomfort and altered bowel habits. The disease affects a large part of the world population. The clinical course is mostly characterized by a cyclic recurrence of symptoms. Therefore, IBS patients should receive, as an initial therapeutic approach, a short course of treatment, and long-term treatment should be reserved for those patients with recurrent symptoms. The available clinical trials show that significant improvement of the symptoms over placebo could be achieved with various drugs, although this improvement is frequently time dependent and with high relapse rates after the cessation of the treatment. In a proportion of patients, clinically obvious relapse could appear long after stopping the treatment. Some of the available pharmacologic agents, including otilonium bromide (OB, are able to significantly prolong the time to the appearance of relapse, compared with placebo. As a consequence, some authors suggest that a cyclic treatment could be of benefit. Antispasmodic drugs have been used for many years in an effort to control the symptoms of IBS. OB is a poorly absorbed spasmolytic drug, exerting significantly greater control of the symptoms of IBS compared with placebo. Recent data suggest that the drug could effectively be used for the long-term management of patients with IBS. The aim of this review is to provide the reader with an evidence-based overview of the efficacy and tolerability of OB in the long-term management of IBS patients, based on the results of the clinical trials published so far. Keywords: irritable bowel syndrome, IBS, treatment, otilonium bromide

  9. The inflammatory bowel disease (IBD susceptibility genes NOD1 and NOD2 have conserved anti-bacterial roles in zebrafish

    Directory of Open Access Journals (Sweden)

    Stefan H. Oehlers

    2011-11-01

    Inflammatory bowel disease (IBD, in the form of Crohn’s disease (CD or ulcerative colitis (UC, is a debilitating chronic immune disorder of the intestine. A complex etiology resulting from dysfunctional interactions between the intestinal immune system and its microflora, influenced by host genetic susceptibility, makes disease modeling challenging. Mutations in NOD2 have the highest disease-specific risk association for CD, and a related gene, NOD1, is associated with UC. NOD1 and NOD2 encode intracellular bacterial sensor proteins acting as innate immune triggers, and represent promising therapeutic targets. The zebrafish has the potential to aid in modeling genetic and environmental aspects of IBD pathogenesis. Here, we report the characterization of the Nod signaling components in the zebrafish larval intestine. The nod1 and nod2 genes are expressed in intestinal epithelial cells and neutrophils together with the Nod signaling pathway genes ripk2, a20, aamp, cd147, centaurin b1, erbin and grim-19. Using a zebrafish embryo Salmonella infection model, morpholino-mediated depletion of Nod1 or Nod2 reduced the ability of embryos to control systemic infection. Depletion of Nod1 or Nod2 decreased expression of dual oxidase in the intestinal epithelium and impaired the ability of larvae to reduce intracellular bacterial burden. This work highlights the potential use of zebrafish larvae in the study of components of IBD pathogenesis.

  10. Contribution of multi-detector row CT (MDCT) to decision making in the management of patients with small bowel obstruction or ileus

    International Nuclear Information System (INIS)

    Osada, Hisato; Watanabe, Wataru; Okada, Taketomo

    2007-01-01

    We retrospectively evaluated the contribution of multi-detector row CT (MDCT) to patient management decisions in 62 patients with small bowel obstruction or ileus. The sensitivity and specificity of MDCT diagnosis of small bowel obstruction with strangulation or closed loop were 78.9% (15/19) and 93.0% (40/43), respectively. In 19 patients with small bowel obstruction with strangulation or closed loop, the median interval between CT examination and the commencement of surgery was significantly longer in misdiagnosed patients than in those correctly diagnosed (43.3 vs. 4.5 hours, p<0.05). Only two patients displayed severe physical signs that required urgent surgical treatment. Our results suggest that MDCT plays a key role in the management of patients with small bowel obstruction. (author)

  11. Green campus management based on conservation program in Universitas Negeri Semarang

    Science.gov (United States)

    Prihanto, Teguh

    2018-03-01

    Universitas Negeri Semarang (UNNES) has a great commitment in the development of higher education programs in line with its vision as a conservation - minded and internationally reputable university. Implementation of conservation programs with respect to the rules or conservation aspects of sustainable use, preservation, provisioning, protection, restoration and conservation of nature. In order to support the implementation of UNNES conservation program more focused, development strategies and development programs for each conservation scope are covered: (1) Biodiversity management; (2) Internal transportation management; (3) energy management; (4) Green building management; (5) Waste and water management; (6) Cultural conservation management. All related to conservation development strategies and programs are managed in the form of green campus management aimed at realizing UNNES as a green campus, characterized and reputable at the regional and global level.

  12. Bowel Movement

    Science.gov (United States)

    A bowel movement is the last stop in the movement of food through your digestive tract. Your stool passes out of ... what you eat and drink. Sometimes a bowel movement isn't normal. Diarrhea happens when stool passes ...

  13. [Towards new therapeutic paradigms beyond symptom control in the management of inflammatory bowel diseases.

    Science.gov (United States)

    Festa, Stefano; Zerboni, Giulia; Aratari, Annalisa; Ballanti, Riccardo; Papi, Claudio

    2018-01-01

    Inflammatory bowel diseases, Crohn's disease and ulcerative colitis are chronic relapsing conditions that may result in progressive bowel damage, high risk of complications, surgery and permanent disability. The conventional therapeutic approach for inflammatory bowel diseases is based mainly on symptom control. Unfortunately, a symptom-based therapeutic approach has little impact on major long-term disease outcomes. In other chronic disabling conditions such as diabetes, hypertension and rheumatoid arthritis, the development of new therapeutic approaches has led to better outcomes. In this context a "treat to target" strategy has been developed. This strategy is based on identification of high-risk patients, regular assessment of disease activity by means of objective measures, adjustment of treatment to reach the pre-defined target. A treat to target approach has recently been proposed for inflammatory bowel disease with the aim at modifying the natural history of the disease. In this review, the evidence and the limitations of the treat to target paradigm in inflammatory bowel disease are analyzed and discussed.

  14. Role of new endoscopic techniques in inflammatory bowel disease management: Has the change come?

    Science.gov (United States)

    Goran, Loredana; Negreanu, Lucian; Negreanu, Ana Maria

    2017-06-28

    Despite significant therapeutic progress in recent years, inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, remains a challenge regarding its pathogenesis and long-term complications. New concepts have emerged in the management of this disease, such as the "treat-to-target" concept, in which mucosal healing plays a key role in the evolution of IBD, the risk of recurrence and the need for surgery. Endoscopy is essential for the assessment of mucosal inflammation and plays a pivotal role in the analysis of mucosal healing in patients with IBD. Endoscopy is also essential in the detection of dysplasia and in the identification of the risk of colon cancer. The current surveillance strategy for dysplasia in IBD patients indicates white-light endoscopy with non-targeted biopsies. The new chromoendoscopy techniques provide substantial benefits for both clinicians and patients. Narrow-band imaging (NBI) has similar rates of dysplastic lesion detection as white-light endoscopy, and it seems that NBI identifies more adenoma-like lesions. Because it is used instinctively by many endoscopists, the combination of these two techniques might improve the rate of dysplasia detection. Flexible spectral imaging color enhancement can help differentiate dysplastic and non-dysplastic lesions and can also predict the risk of recurrence, which allows us to modulate the treatment to gain better control of the disease. The combination of non-invasive serum and stool biomarkers with endoscopy will improve the monitoring and limit the evolution of IBD because it enables the use of a personalized approach to each patient based on that patient's history and risk factors.

  15. The role of self-efficacy in inflammatory bowel disease management: preliminary validation of a disease-specific measure.

    Science.gov (United States)

    Keefer, Laurie; Kiebles, Jennifer L; Taft, Tiffany H

    2011-02-01

    Inflammatory bowel diseases (IBDs) require self-management skills that may be influenced by self-efficacy (SE). Self-efficacy represents an individual's perception of his or her ability to organize and execute the behaviors necessary to manage disease. The goal of this study was to develop a valid and reliable measure of IBD-specific SE that can be used in clinical and research contexts. One hundred and twenty-two adults with a verified IBD diagnosis participated in the study. Data were pooled from 2 sources: patients from an outpatient university gastroenterology clinic (n=42) and a sample of online respondents (n=80). All participants (N=122) completed the IBD Self-Efficacy Scale (IBD-SES) and the Inflammatory Bowel Disease Questionnaire. Additionally, online participants completed the Brief Symptom Inventory-18 and the Rosenberg Self-Esteem Scale, whereas those in the clinic sample completed the Perceived Health Competence Scale, the Perceived Stress Questionnaire, and the Short Form Version 2 Health Survey. The IBD-SES was initially constructed to identify 4 distinct theoretical domains of self-efficacy: (1) managing stress and emotions, (2) managing medical care, (3) managing symptoms and disease, and (4) maintaining remission. The 29-item IBD-SES has high internal consistency (r=0.96), high test-retest reliability (r=0.90), and demonstrates strong construct and concurrent validity with established measures. The IBD-SES is a critical first step toward addressing an important psychological construct that could influence treatment outcomes in IBD.

  16. The role of computed tomography in the diagnosis and management of clinically occult post-traumatic small bowel perforation

    International Nuclear Information System (INIS)

    Ahmed, I.; Ahmed, N.; Bell, D.J.; Hughes, D.V.; Evans, G.H.; Howlett, D.C.

    2009-01-01

    Purpose: To evaluate the use of computed tomography [CT] in the diagnosis of occult post-traumatic small bowel perforation and to discuss the role of CT in the management of this patient group. Method: This review includes three patients who presented with mild abdominal symptoms following minor blunt abdominal trauma. Initial radiographs and laboratory investigations were unremarkable but their symptoms failed to resolve and contrast-enhanced CT was performed for further evaluation. Results: In each case the CT appearances were indicative of localised small bowel perforation, with no evidence of other visceral injury. In two patients pockets of free intraperitoneal air were present closely related to the second part of the duodenum suggesting injury at this site. In the third case, a thickened proximal jejunal loop was demonstrated with free air and fluid in the adjacent mesentery consistent with a focal perforation. These CT findings were subsequently confirmed at laparotomy. Conclusion: CT is an accurate diagnostic tool in the assessment of clinically and radiologically occult traumatic small bowel injury. The use of CT should be considered in patients who have unresolving abdominal symptoms even after apparently insignificant abdominal trauma.

  17. Evaluation of conservation-oriented management on grayish brown soil

    Directory of Open Access Journals (Sweden)

    Consuelo E. Hernández Rodríguez

    2015-03-01

    Full Text Available Conservation and improvement actions were taken to ensure the soil preservation in agricultural areas affected by erosion on a grayish brown soil of Sarduy farm in Cumanayagua, Cuba. The technology that was used included strip-till, crop rotation, live and/or dead barriers, channel terraces, contour farming and the addition of organic matter and biofertilizers. The implementation of the soil conservation-oriented management had an influence on the yield increase of 10.6% - 20.2%, on the decrease of the erosive processes with a retention of soils to 13.33 t.ha -1, on maintaining the soil pH and on the increment of the assimilable P2O5 contents and soil organic matter.

  18. Use of Peristeen® transanal colonic irrigation for bowel management in children: a single-center experience.

    Science.gov (United States)

    Pacilli, Maurizio; Pallot, David; Andrews, Afiya; Downer, Angela; Dale, Louiza; Willetts, Ian

    2014-02-01

    Transanal colonic irrigation has been shown to be effective in bowel management program in adults. However, there exist limited data in children. We appraised the effectiveness of this technique in a series of children with incontinence or constipation and overflow soiling. Following ethical approval, a review of children with incontinence or constipation on a bowel management program with Peristeen® transanal colonic irrigation treated between 2007 and 2012 was performed. Irrigations were performed with a volume of 10-20 ml/kg of water with schedules depending on patient response. Data are reported as median (range). Twenty-three patients were reviewed. Median age at commencement of irrigations was 7 (2-15) years. Median follow-up is 2 (0.7-3.4) years. Diagnoses include the following: spina bifida (n=11), anorectal anomaly (n=6), Hirschsprung's (n=1), and other complex anomalies (n=5). Sixteen (70%) patients had associated anomalies. Twelve (52%) had constipation and overflow soiling, and 11 (48%) had fecal incontinence. Twenty (87%) had associated urinary wetting. Sixteen (70%) children used alternate-day irrigations, 4 (17%) daily irrigations, and 3 (13%) every third-day irrigations. Nine (39%) patients were taking oral laxatives. Sixteen (70%) reported to be clean and 3 (13%) reported a significant improvement, although were having occasional soiling. Four patients (17%) did not tolerate the irrigations and underwent subsequent colostomy formation for intractable soiling. In our experience, Peristeen® transanal colonic irrigation is an effective method of managing patients with focal soiling in childhood. Majority (83%) of children achieve social fecal continence or a significant improvement with occasional soiling. This was accompanied by high parental satisfaction. Peristeen® transanal colonic irrigation is a valid alternative to invasive surgical procedures and should be considered the first line of treatment for bowel management in children with soiling

  19. Operative and conservative management of primary gastric lymphoma: interim results of a German multicenter study

    International Nuclear Information System (INIS)

    Willich, Normann A.; Reinartz, Gabriele; Horst, Ekkehard J.; Delker, Georg; Reers, Berthold; Hiddemann, Wolfgang; Tiemann, Markus; Parwaresch, Reza; Grothaus-Pinke, Bernward; Kocik, Juergen; Koch, Peter

    2000-01-01

    Purpose/Objective: Biology and appropriate management of gastrointestinal (GI) lymphomas are matters of an ongoing controversial debate. To evaluate histological features, sites of involvement and management of primary GI-lymphomas, a prospective multicentric study was initiated in 10/1992. Aim of study was the further standardization of operative and conservative treatment modalities. Materials and Methods: Study started 10/1992 and was closed 11/1996. A total of 381 evaluable patients had been accrued then. Standardized diagnostic workup included endoscopic and radiological evaluation of the complete GI-tract as well as a central histological review. Diagnosis was established after Lewin, stage classification was made after Musshoff, and histological classification was made after Isaacson. Treatment decision concerning operative or conservative management was due to the initially acting physician. Patients with resection of low grade lymphoma received total abdominal irradiation 30 Gy + 10 Gy boost to incompletely resected areas. After resection of high grade lymphoma CHOP chemotherapy (4 cycles for stage IE, 6 cycles for higher stages) after McKelvy was followed by total abdominal irradiation 30 Gy for stage IE respectively involved field irradiation 30 Gy for higher stages with 10 Gy boost to incompletely resected areas. Primary conservative treatment consisted of six cycles COP chemotherapy after Bagley for low grade lymphomas stage >IE and total abdominal irradiation 30 Gy + 10 Gy boost to involved areas for all stages. Patients with high grade lymphomas received 4 x CHOP followed by total abdominal irradiation 30 Gy + 10 Gy boost to involved areas or 6 x CHOP plus involved field radiation therapy with 40 Gy. 257 patients are considered for analysis due to exclusion criteria of the study, 190 of them were suffered from gastric lymphoma. Their median observation time is 29 months, maximum observation time is 68 months. Results: Sites of involvement were

  20. When will community management conserve biodiversity? Evidence from Malawi

    Directory of Open Access Journals (Sweden)

    Joy E. Hecht

    2008-12-01

    Full Text Available Both development practitioners and conservation organizations are focused on community ownership and management of natural resources as a way to create incentives for the conservation of biodiversity. This has led to the implementation of a number of large community-based conservation projects in sub-Saharan Africa, in countries including Namibia, Zimbabwe, Malawi, Zambia, and Rwanda. While the concept is logical, and valuation studies may suggest that conservation is more valuable than other uses of the resources in some areas, there has been little detailed analysis of the financial costs and benefits to the communities, to determine whether they would actually have an incentive to conserve if they had more extensive legal rights to the resources. This paper assesses the conditions under which this approach may be viable, based on a valuation study of the resources of Mount Mulanje in southern Malawi.Les spécialistes du développement et les organisations de conservation s’intéressent à la propriété et à la gestion communautaire des ressources naturelles comme moyen de créer des mesures d’incitation en faveur de la conservation de la biodiversité. Cette approche a conduit à la mise en œuvre d’un certain nombre de grands projets de conservation communautaires en Afrique subsaharienne, notamment en Namibie, au Zimbabwe, au Malawi, en Zambie et au Rwanda. Même si cette approche est logique et si les études d’évaluation semblent suggérer que, dans certaines régions, la conservation est plus utile que l’exploitation des ressources, il existe peu d’analyses détaillées sur les coûts et les avantages financiers que cela engendrerait pour les communautés, analyses qui permettraient de déterminer si le développement des droits légaux des communautés sur ces ressources les inciterait à les conserver. Ce rapport évalue les conditions de viabilité de cette approche sur la base d’une étude d’évaluation des

  1. Conservative Management of Theca Lutein Cyst Accident: A Case Report

    Directory of Open Access Journals (Sweden)

    Radha Bai Prabhu T

    2017-10-01

    Full Text Available Theca lutein cysts can occur in 20-25% of molar pregnancies. These cysts can undergo complications such as torsion, rupture, and haemorrhage. As these are functional cysts, when there are complications such as torsion they can be managed conservatively by aspirating the cysts under ultrasound guidance or by detorsion at the time of laparoscopy. By simple detorsion, ovaries can be preserved in 80-90% of cases. In order to prevent recurrence adnexal fixation can be undertaken by plicating the ovarian ligament.

  2. Conservatively managed pineal apoplexy in an anticoagulated patient

    Energy Technology Data Exchange (ETDEWEB)

    Werder, Gabriel M. [William Beaumont Hospital, Department of Radiology, 3600 West Thirteen Mile Road, Royal Oak, MI 48073 (United States); St Christopher Iba Mar Diop College of Medicine, Luton (United Kingdom)], E-mail: gabriel_werder@yahoo.com; Razdan, Rahul S.; Gagliardi, Joseph A.; Chaddha, Shashi K.B. [St Vincent' s Medical Center, Bridgeport, CT (United States)

    2008-02-15

    We present a case of pineal apoplexy in an anticoagulated and hypertensive 56-year-old Hispanic male. At presentation, the patient's international normalized ratio (INR) was 10.51 and his blood pressure was 200/130 mmHg. His presenting symptoms included acute onset of headache, chest pain, nausea, vomiting, vertigo, and visual disturbance. Neuroimaging demonstrated hemorrhage into a morphologically normal pineal gland. Under conservative management, the patient experienced gradual resolution of all symptoms excluding the disturbance of upward gaze.

  3. Spinal cord anomalies in patients with anorectal malformations without severe sacral abnormalities or meningomyelocele: outcomes after expectant, conservative management.

    Science.gov (United States)

    Kyrklund, Kristiina; Pakarinen, Mikko P; Taskinen, Seppo; Kivisaari, Reetta; Rintala, Risto J

    2016-12-01

    OBJECTIVE The goal of this study was to determine the significance of spinal cord anomalies (SCAs) in patients with anorectal malformations (ARMs) by comparing the outcomes for bowel function, lower urinary tract symptoms (LUTS), and lower-limb neurological abnormalities to these outcomes in patients with similar ARMs and a normal spinal cord. METHODS The spinal cord MRI records of female patients treated for vestibular and perineal fistula (VF/PF) and male patients with rectourethral fistula (RUF) at a single center between 1983 and 2006 were reviewed. Bowel function and LUTS were assessed by questionnaire. Patients with extensive sacral anomalies or meningomyelocele were excluded. RESULTS Of 89 patients (median age 15 years, range 5-29 years), MRI was available in 90% (n = 80; 40 male patients with RUF), and 80% of patients returned the questionnaire (n = 64; 31 male patients with RUF). Spinal cord anomalies were found in 34%, comprising a filum terminale lipoma in 30%, low conus medullaris in 10%, and thoracolumbar syrinx in 6%. Bowel functional outcomes between patients with SCAs (n = 23) and those with a normal spinal cord (n = 41) were not significantly different for soiling (70% vs 63%), fecal accidents (43% vs 34%), and constipation (57% vs 39%; p = not significant for all). The LUTS, including urge (65% vs 54%), urge incontinence (39% vs 24%), stress incontinence (17% vs 22%), and straining (32% vs 29%) were also comparable between groups (p = not significant for all). No patients developed lower-limb neurological abnormalities. CONCLUSIONS The results suggest that the long-term functional outcomes for patients with SCAs who had VF/PF and RUF may not differ significantly from patients with the same type of ARMs and a normal spinal cord. The results favor a conservative approach to their management in the absence of abnormal neurological findings in the lower limbs.

  4. Medico-legal significance of service difficulties and clinical errors in the management of patients with inflammatory bowel diseases.

    Science.gov (United States)

    Farrukh, Affifa; Mayberry, John F

    2015-03-01

    There is a significant growth in medical litigation, and cases involving the care and management of patients with inflammatory bowel disease are becoming common. There is no central register of such cases, and the majority are settled before court proceedings. As a result, there is no specific case law related to such conditions, and secrecy usually surrounds the outcome with "no admission of guilt" by the defendant and a clause about non-disclosure and discussion linked to the financial compensation received by the claimant. This review discusses common areas of potential litigation. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  5. Velocity of climate change algorithms for guiding conservation and management.

    Science.gov (United States)

    Hamann, Andreas; Roberts, David R; Barber, Quinn E; Carroll, Carlos; Nielsen, Scott E

    2015-02-01

    The velocity of climate change is an elegant analytical concept that can be used to evaluate the exposure of organisms to climate change. In essence, one divides the rate of climate change by the rate of spatial climate variability to obtain a speed at which species must migrate over the surface of the earth to maintain constant climate conditions. However, to apply the algorithm for conservation and management purposes, additional information is needed to improve realism at local scales. For example, destination information is needed to ensure that vectors describing speed and direction of required migration do not point toward a climatic cul-de-sac by pointing beyond mountain tops. Here, we present an analytical approach that conforms to standard velocity algorithms if climate equivalents are nearby. Otherwise, the algorithm extends the search for climate refugia, which can be expanded to search for multivariate climate matches. With source and destination information available, forward and backward velocities can be calculated allowing useful inferences about conservation of species (present-to-future velocities) and management of species populations (future-to-present velocities). © 2014 The Authors. Global Change Biology Published by John Wiley & Sons Ltd.

  6. Conservation

    NARCIS (Netherlands)

    Noteboom, H.P.

    1985-01-01

    The IUCN/WWF Plants Conservation Programme 1984 — 1985. World Wildlife Fund chose plants to be the subject of their fund-raising campaign in the period 1984 — 1985. The objectives were to: 1. Use information techniques to achieve the conservation objectives of the Plants Programme – to save plants;

  7. Conservation.

    Science.gov (United States)

    National Audubon Society, New York, NY.

    This set of teaching aids consists of seven Audubon Nature Bulletins, providing the teacher and student with informational reading on various topics in conservation. The bulletins have these titles: Plants as Makers of Soil, Water Pollution Control, The Ground Water Table, Conservation--To Keep This Earth Habitable, Our Threatened Air Supply,…

  8. Self-management of older adolescents with inflammatory bowel disease: a pilot study of behavior and knowledge as prelude to transition

    NARCIS (Netherlands)

    Fishman, Laurie N.; Barendse, Renée M.; Hait, Elizabeth; Burdick, Cynthia; Arnold, Janis

    2010-01-01

    Patients gradually assume responsibility for self-management. This study sought to determine whether adolescents with inflammatory bowel disease (IBD) have developed key skills of self-management prior to the age at which many transfer to adult care. Adolescents aged 16 to 18 years old in the

  9. Integration of environmental flow assessment and freshwater conservation planning: a new era in catchment management

    CSIR Research Space (South Africa)

    Nel, JL

    2011-03-01

    Full Text Available Integrated water resources management offers an ideal platform for addressing the goals of freshwater conservation and climate change adaptation. Environmental flow assessment and systematic conservation planning have evolved separately...

  10. Unintended consequences of conservation actions: managing disease in complex ecosystems.

    Directory of Open Access Journals (Sweden)

    Aliénor L M Chauvenet

    Full Text Available Infectious diseases are increasingly recognised to be a major threat to biodiversity. Disease management tools such as control of animal movements and vaccination can be used to mitigate the impact and spread of diseases in targeted species. They can reduce the risk of epidemics and in turn the risks of population decline and extinction. However, all species are embedded in communities and interactions between species can be complex, hence increasing the chance of survival of one species can have repercussions on the whole community structure. In this study, we use an example from the Serengeti ecosystem in Tanzania to explore how a vaccination campaign against Canine Distemper Virus (CDV targeted at conserving the African lion (Panthera leo, could affect the viability of a coexisting threatened species, the cheetah (Acinonyx jubatus. Assuming that CDV plays a role in lion regulation, our results suggest that a vaccination programme, if successful, risks destabilising the simple two-species system considered, as simulations show that vaccination interventions could almost double the probability of extinction of an isolated cheetah population over the next 60 years. This work uses a simple example to illustrate how predictive modelling can be a useful tool in examining the consequence of vaccination interventions on non-target species. It also highlights the importance of carefully considering linkages between human-intervention, species viability and community structure when planning species-based conservation actions.

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

    Science.gov (United States)

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

    2015-01-01

    Bowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians' intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs' knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices. A descriptive before and after survey using a self-administered questionnaire sent to nursing and medical staff working within three intensive care units before and after implementation of our bowel management protocol (pre: May - June 2008; post: Feb - May 2009). Participants had significantly higher knowledge scores post-implementation of our protocol (pre mean score 17.6; post mean score 19.3; p = 0.004). Post-implementation there was a significant increase in: self-reported past behaviour (pre mean score 5.38; post mean score 7.11; p = 0.002) and subjective norms scores (pre mean score 3.62; post mean score 4.18; p = 0.016) for bowel assessment; and behaviour intention (pre mean score 5.22; post mean score 5.65; p = 0.048) for administration of enema. This evaluation, informed by the theory of planned behaviour, has provided useful insights into factors that influence clinician intentions to perform evidence-based bowel management practices in intensive care. Addressing factors such as knowledge, attitudes and beliefs can assist in targeting implementation strategies to positively affect clinician behaviour change. Despite an increase in clinicians' knowledge scores, our implementation strategy did not, however, significantly change clinician behaviour intentions for all three bowel management practices. Further research is

  12. Surgery versus conservative management of endometriomas in subfertile women

    DEFF Research Database (Denmark)

    Brink Laursen, Jacob; Schroll, Jeppe Bennekou; Macklon, Kirsten T

    2017-01-01

    INTRODUCTION: Endometriomas are present in up to 44% of all women with endometriosis and have a detrimental effect on fertility. However, it is controversial whether endometriomas should be surgically removed before assisted reproduction technology (ART). Our purpose was to evaluate whether...... surgical stripping of endometriomas in subfertile women improves the chance of a live birth. Secondary outcomes were impact on ovarian reserve and pain. Material and methods We conducted a systematic review and metaanalysis with results reported in accordance to the PRISMA guidelines. Summary of findings...... with conservative management before in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI)) was 0.87 (95% CI; 0.64-1.18, six studies, I(2) = 3%; ⨁◯◯◯, VERY LOW quality). The mean difference of antral follicle count was -2.09 (95% CI; -4.84 - +0.67, four studies). No difference was observed regarding...

  13. Science priorities for seamounts: research links to conservation and management.

    Directory of Open Access Journals (Sweden)

    Malcolm R Clark

    Full Text Available Seamounts shape the topography of all ocean basins and can be hotspots of biological activity in the deep sea. The Census of Marine Life on Seamounts (CenSeam was a field program that examined seamounts as part of the global Census of Marine Life (CoML initiative from 2005 to 2010. CenSeam progressed seamount science by collating historical data, collecting new data, undertaking regional and global analyses of seamount biodiversity, mapping species and habitat distributions, challenging established paradigms of seamount ecology, developing new hypotheses, and documenting the impacts of human activities on seamounts. However, because of the large number of seamounts globally, much about the structure, function and connectivity of seamount ecosystems remains unexplored and unknown. Continual, and potentially increasing, threats to seamount resources from fishing and seabed mining are creating a pressing demand for research to inform conservation and management strategies. To meet this need, intensive science effort in the following areas will be needed: 1 Improved physical and biological data; of particular importance is information on seamount location, physical characteristics (e.g. habitat heterogeneity and complexity, more complete and intensive biodiversity inventories, and increased understanding of seamount connectivity and faunal dispersal; 2 New human impact data; these shall encompass better studies on the effects of human activities on seamount ecosystems, as well as monitoring long-term changes in seamount assemblages following impacts (e.g. recovery; 3 Global data repositories; there is a pressing need for more comprehensive fisheries catch and effort data, especially on the high seas, and compilation or maintenance of geological and biodiversity databases that underpin regional and global analyses; 4 Application of support tools in a data-poor environment; conservation and management will have to increasingly rely on predictive

  14. Science priorities for seamounts: research links to conservation and management.

    Science.gov (United States)

    Clark, Malcolm R; Schlacher, Thomas A; Rowden, Ashley A; Stocks, Karen I; Consalvey, Mireille

    2012-01-01

    Seamounts shape the topography of all ocean basins and can be hotspots of biological activity in the deep sea. The Census of Marine Life on Seamounts (CenSeam) was a field program that examined seamounts as part of the global Census of Marine Life (CoML) initiative from 2005 to 2010. CenSeam progressed seamount science by collating historical data, collecting new data, undertaking regional and global analyses of seamount biodiversity, mapping species and habitat distributions, challenging established paradigms of seamount ecology, developing new hypotheses, and documenting the impacts of human activities on seamounts. However, because of the large number of seamounts globally, much about the structure, function and connectivity of seamount ecosystems remains unexplored and unknown. Continual, and potentially increasing, threats to seamount resources from fishing and seabed mining are creating a pressing demand for research to inform conservation and management strategies. To meet this need, intensive science effort in the following areas will be needed: 1) Improved physical and biological data; of particular importance is information on seamount location, physical characteristics (e.g. habitat heterogeneity and complexity), more complete and intensive biodiversity inventories, and increased understanding of seamount connectivity and faunal dispersal; 2) New human impact data; these shall encompass better studies on the effects of human activities on seamount ecosystems, as well as monitoring long-term changes in seamount assemblages following impacts (e.g. recovery); 3) Global data repositories; there is a pressing need for more comprehensive fisheries catch and effort data, especially on the high seas, and compilation or maintenance of geological and biodiversity databases that underpin regional and global analyses; 4) Application of support tools in a data-poor environment; conservation and management will have to increasingly rely on predictive modelling

  15. Evidence Based Conservative Management of Patello-femoral Syndrome

    Directory of Open Access Journals (Sweden)

    E. Carlos Rodriguez-Merchan

    2014-03-01

    Full Text Available Background:   Patellofemoral pain syndrome (PFPS is defined as pain surrounding the patella when sitting with bent knees for prolonged periods of time or when performing activities like ascending or descending stairs, squatting or   athletic activities. Patella dislocation is not included in PFPS.     Purpose:   This review analyzes the evidence based conservative management of PFPS.   Methods:   A Cochrane Library search related to PFPS was performed until 18 January 2014. The key words were: patellofemoral pain syndrome. Eight papers were found, of which three were reviewed because they were focused   on the topic of the article. We also searched the PubMed using the following keywords: evidence based conservative   management of patellofemoral pain syndrome. Twelve articles were found, of which seven were reviewed because   they were focused on the topic of the article. Overall ten articles were analyzed.     Results:   Different treatments can be tried for PFPS, including pharmacotherapy, therapeutic ultrasound, exercise therapy, and taping and braces.     Conclusions:   Non-steroidal anti-inflammatory drugs (NSAIDs may reduce pain in the short term, but pain does not improve after three months. Therapeutic ultrasound appears not to have a clinically important effect on pain relief for   patients with PFPS. The evidence that exercise therapy is more effective in treating PFPS than no exercise is limited   with respect to pain reduction, and conflicting with respect to functional improvement. No significant difference has   been found between taping and non-taping. The role of knee braces is still controversial. More well-designed studies are needed.    

  16. Science Priorities for Seamounts: Research Links to Conservation and Management

    Science.gov (United States)

    Clark, Malcolm R.; Schlacher, Thomas A.; Rowden, Ashley A.; Stocks, Karen I.; Consalvey, Mireille

    2012-01-01

    Seamounts shape the topography of all ocean basins and can be hotspots of biological activity in the deep sea. The Census of Marine Life on Seamounts (CenSeam) was a field program that examined seamounts as part of the global Census of Marine Life (CoML) initiative from 2005 to 2010. CenSeam progressed seamount science by collating historical data, collecting new data, undertaking regional and global analyses of seamount biodiversity, mapping species and habitat distributions, challenging established paradigms of seamount ecology, developing new hypotheses, and documenting the impacts of human activities on seamounts. However, because of the large number of seamounts globally, much about the structure, function and connectivity of seamount ecosystems remains unexplored and unknown. Continual, and potentially increasing, threats to seamount resources from fishing and seabed mining are creating a pressing demand for research to inform conservation and management strategies. To meet this need, intensive science effort in the following areas will be needed: 1) Improved physical and biological data; of particular importance is information on seamount location, physical characteristics (e.g. habitat heterogeneity and complexity), more complete and intensive biodiversity inventories, and increased understanding of seamount connectivity and faunal dispersal; 2) New human impact data; these shall encompass better studies on the effects of human activities on seamount ecosystems, as well as monitoring long-term changes in seamount assemblages following impacts (e.g. recovery); 3) Global data repositories; there is a pressing need for more comprehensive fisheries catch and effort data, especially on the high seas, and compilation or maintenance of geological and biodiversity databases that underpin regional and global analyses; 4) Application of support tools in a data-poor environment; conservation and management will have to increasingly rely on predictive modelling

  17. Review article: the gut microbiome in inflammatory bowel disease-avenues for microbial management.

    Science.gov (United States)

    McIlroy, J; Ianiro, G; Mukhopadhya, I; Hansen, R; Hold, G L

    2018-01-01

    The concept of an altered collective gut microbiota rather than identification of a single culprit is possibly the most significant development in inflammatory bowel disease research. We have entered the "omics" era, which now allows us to undertake large-scale/high-throughput microbiota analysis which may well define how we approach diagnosis and treatment of inflammatory bowel disease (IBD) in the future, with a strong steer towards personalised therapeutics. To assess current epidemiological, experimental and clinical evidence of the current status of knowledge relating to the gut microbiome, and its role in IBD, with emphasis on reviewing the evidence relating to microbial therapeutics and future microbiome modulating therapeutics. A Medline search including items 'intestinal microbiota/microbiome', 'inflammatory bowel disease', 'ulcerative colitis', 'Crohn's disease', 'faecal microbial transplantation', 'dietary manipulation' was performed. Disease remission and relapse are associated with microbial changes in both mucosal and luminal samples. In particular, a loss of species richness in Crohn's disease has been widely observed. Existing therapeutic approaches broadly fall into 3 categories, namely: accession, reduction or indirect modulation of the microbiome. In terms of microbial therapeutics, faecal microbial transplantation appears to hold the most promise; however, differences in study design/methodology mean it is currently challenging to elegantly translate results into clinical practice. Existing approaches to modulate the gut microbiome are relatively unrefined. Looking forward, the future of microbiome-modulating therapeutics looks bright with several novel strategies/technologies on the horizon. Taken collectively, it is clear that ignoring the microbiome in IBD is not an option. © 2017 John Wiley & Sons Ltd.

  18. Development of quality standards in inflammatory bowel disease management and design of an evaluation tool of nursing care.

    Science.gov (United States)

    Torrejón, Antonio; Oltra, Lorena; Hernández-Sampelayo, Paloma; Marín, Laura; García-Sánchez, Valle; Casellas, Francesc; Alfaro, Noelia; Lázaro, Pablo; Vera, María Isabel

    2013-01-01

    nursing management of inflammatory bowel disease (IBD) is highly relevant for patient care and outcomes. However, there is evidence of substantial variability in clinical practices. The objectives of this study were to develop standards of healthcare quality for nursing management of IBD and elaborate the evaluation tool "Nursing Care Quality in IBD Assessment" (NCQ-IBD) based on these standards. a 178-item healthcare quality questionnaire was developed based on a systematic review of IBD nursing management literature. The questionnaire was used to perform two 2-round Delphi studies: Delphi A included 27 IBD healthcare professionals and Delphi B involved 12 patients. The NCQ-IBD was developed from the list of items resulting from both Delphi studies combined with the Scientific Committee´s expert opinion. the final NCQ-IBD consists of 90 items, organized in13 sections measuring the following aspects of nursing management of IBD: infrastructure, services, human resources, type of organization, nursing responsibilities, nurse-provided information to the patient, nurses training, annual audits of nursing activities, and nursing research in IBD. Using the NCQ-IBD to evaluate these components allows the rating of healthcare quality for nursing management of IBD into 4 categories: A (highest quality) through D (lowest quality). the use of the NCQ-IBD tool to evaluate nursing management quality of IBD identifies areas in need of improvement and thus contribute to an enhancement of care quality and reduction in clinical practice variations.

  19. The effect of scientific evidence on conservation practitioners’ management decisions

    Science.gov (United States)

    Walsh, Jessica C; Dicks, Lynn V; Sutherland, William J

    2015-01-01

    A major justification of environmental management research is that it helps practitioners, yet previous studies show it is rarely used to inform their decisions. We tested whether conservation practitioners focusing on bird management were willing to use a synopsis of relevant scientific literature to inform their management decisions. This allowed us to examine whether the limited use of scientific information in management is due to a lack of access to the scientific literature or whether it is because practitioners are either not interested or unable to incorporate the research into their decisions. In on-line surveys, we asked 92 conservation managers, predominantly from Australia, New Zealand, and the United Kingdom, to provide opinions on 28 management techniques that could be applied to reduce predation on birds. We asked their opinions before and after giving them a summary of the literature about the interventions’ effectiveness. We scored the overall effectiveness and certainty of evidence for each intervention through an expert elicitation process—the Delphi method. We used the effectiveness scores to assess the practitioners’ level of understanding and awareness of the literature. On average, each survey participant changed their likelihood of using 45.7% of the interventions after reading the synopsis of the evidence. They were more likely to implement effective interventions and avoid ineffective actions, suggesting that their intended future management strategies may be more successful than current practice. More experienced practitioners were less likely to change their management practices than those with less experience, even though they were not more aware of the existing scientific information than less experienced practitioners. The practitioners’ willingness to change their management choices when provided with summarized scientific evidence suggests that improved accessibility to scientific information would benefit conservation

  20. Conservative Management of Mechanical Neck Pain in a Helicopter Pilot.

    Science.gov (United States)

    Alagha, Babak

    2015-10-01

    Acute and chronic spinal symptoms such as neck pain may limit flying performance significantly and disqualify the pilot from flight duty. Mechanical neck pain is very common among pilots because of their exposure to vibration, +GZ forces, helmet weight, poor neck posture during air combat maneuvers, previous neck injuries, and poor treatment plans for such injuries. Successful treatment of such injuries requires appropriate therapeutic procedures as well as an aeromedical assessment. The aim of this case study was to demonstrate the benefits of conservative procedures such as spinal manipulation and mobilization therapy (SMMT) and exercise therapy (ET) in treating chronic mechanical neck pain in an Iranian commercial helicopter pilot. A 36-yr-old male patient presented to the clinic with moderate, intermittent nonradicular chronic neck pain and limited range of motion over a 2-yr period. The patient was treated with cervical and upper thoracic SMMT followed by home ET for 5 wk. After this period, the patient reported significant recovery and improvement in range of motion in his neck. Mechanical neck pain is very common among helicopter pilots. Although Air Force and Navy waiver guides recommend nonsteroidal anti-inflammatory medications as well as SMMT and ET, there are currently very few published studies that examine the benefits of manual and exercise therapy for treating mechanical neck pain in commercial and military pilots. Based on the results of this study, it seems that SMMT and ET may be a safe and effective in treatment of uncomplicated mechanical neck pain in helicopter pilots. Alagha B. Conservative management of mechanical neck pain in a helicopter pilot.

  1. Short bowel syndrome in infants: the critical role of luminal nutrients in a management program.

    Science.gov (United States)

    Roy, Claude C; Groleau, Véronique; Bouthillier, Lise; Pineault, Marjolain; Thibault, Maxime; Marchand, Valérie

    2014-07-01

    Short bowel syndrome develops when the remnant mass of functioning enterocytes following massive resections cannot support growth or maintain fluid-electrolyte balance and requires parenteral nutrition. Resection itself stimulates the intestine's inherent ability to adapt morphologically and functionally. The capacity to change is very much related to the high turnover rate of enterocytes and is mediated by several signals; these signals are mediated in large part by enteral nutrition. Early initiation of enteral feeding, close clinical monitoring, and ongoing assessment of intestinal adaptation are key to the prevention of irreversible intestinal failure. The length of the functional small bowel remnant is the most important variable affecting outcome. The major objective of intestinal rehabilitation programs is to achieve early oral nutritional autonomy while maintaining normal growth and nutrition status and minimizing total parenteral nutrition related comorbidities such as chronic progressive liver disease. Remarkable progress has been made in terms of survivability and quality of life, especially in the context of coordinated multidisciplinary programs, but much work remains to be done.

  2. Beliefs about personal control and self-management in 30-40 year olds living with Inflammatory Bowel Disease: a qualitative study.

    Science.gov (United States)

    Cooper, Joanne M; Collier, Jacqueline; James, Veronica; Hawkey, Christopher J

    2010-12-01

    Inflammatory Bowel Disease is a collective term for two distinct long term conditions: Ulcerative Colitis and Crohn's disease. There is increasing emphasis on patients taking greater personal control and self-management of this condition, reflecting earlier research into the management of chronic illness. Nurses play a pivotal role in this process, yet how optimal personal control is self-assessed and self-managed in Inflammatory Bowel Disease is poorly understood. This study set out to explore beliefs about personal control and self-management of Inflammatory Bowel Disease. It focused on the role of physical, psychological and socio-economic factors within the individual's life experience. A qualitative approach was used comprising 24, one-to-one, semi-structured interviews with participants aged 30-40 years. Participants with a histological diagnosis of Inflammatory Bowel Disease for at least 12 months were eligible and recruited by gastrointestinal specialist staff from outpatient clinics at a large National Health Service Trust in the United Kingdom. Interviews were transcribed verbatim. Data analysis was informed by existing theories of personal control and used the 'systematic framework analysis' approach. In addition to existing theories of personal control, self-discrepancy theory helped to explain how people viewed the control and self-management of Inflammatory Bowel Disease. One main theme emerged from the findings: 'Reconciliation of the self in IBD', this was supported by three sub-themes and eight basic themes. Some participants found that being unable to control and predict the course of their condition was distressing, however for others this limited control was not viewed as a negative outcome. Being able to share control of IBD with specialist health care staff was beneficial, and participants stated that other priorities in life were as equally important to manage and control. A key barrier to ensuring greater personal control and self-management

  3. Implementing a self-management strategy in inflammatory bowel disease (IBD): patient perceptions, clinical outcomes and the impact on service.

    Science.gov (United States)

    Squires, Seth Ian; Boal, Allan John; Lamont, Selina; Naismith, Graham D

    2017-10-01

    Patient self-management and its service integration is not a new concept but it may be a key component in the long-term sustainability of inflammatory bowel disease (IBD) service provision, when considering growing disease prevalence and limited resources. The IBD team at the Royal Alexandra and Vale of Leven Hospitals in the Clyde Valley region developed a self-management tool, called the 'flare card'. Patients were asked to complete a questionnaire which reflected their opinion on its viability as a self-management intervention. In addition, its utility in terms of service use over a 10-month period in 2016 was compared with a similar cohort of patients over 10 months in 2015. Patients overall felt that the 'flare card' was a viable self-management tool. Positive feedback identified that the intervention could help them aid control over their IBD, improve medication adherence, reduce symptoms and reflected a feeling of patient-centred IBD care. The comparison between 2015 and 2016 service use revealed a significant reduction in IBD and non-IBD service usage, Steroid prescribing and unscheduled IBD care in the flare card supported cohort. IBD services must continue to adapt to changes within the National Health Service bearing in mind long-term sustainability and continued care provision. The 'flare card' goes further in an attempt to optimise Crohn's disease and ulcerative colitis management by harmonising clinician evaluation and patient's self-initiation of therapy and investigation.

  4. Individualized Infliximab Treatment Guided by Patient-managed eHealth in Children and Adolescents with Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Carlsen, Katrine; Houen, Gunnar; Jakobsen, Christian

    2017-01-01

    BACKGROUND: To individualize timing of infliximab (IFX) treatment in children and adolescents with inflammatory bowel disease (IBD) using a patient-managed eHealth program. METHODS: Patients with IBD, 10 to 17 years old, treated with IFX were prospectively included. Starting 4 weeks after...... their last infusion, patients reported a weekly symptom score and provided a stool sample for fecal calprotectin analysis. Based on symptom scores and fecal calprotectin results, the eHealth program calculated a total inflammation burden score that determined the timing of the next IFX infusion (4-12 wk...... after the previous infusion). Quality of Life was scored by IMPACT III. A control group was included to compare trough levels of IFX antibodies and concentrations and treatment intervals. Patients and their parents evaluated the eHealth program. RESULTS: There were 29 patients with IBD in the eHealth...

  5. Efficacy and safety of bisphosphonates in management of low bone density in inflammatory bowel disease: A meta-analysis.

    Science.gov (United States)

    Yao, Liwei; Wang, Haiqing; Dong, Wenwei; Liu, Zhenxin; Mao, Haijiao

    2017-01-01

    This study aims to determine whether bisphosphonates are safe, as well as effective against bone mineral loss in inflammatory bowel disease (IBD). A computerized search of electronic databases from 1966 to 2016 was performed. Randomized controlled trials (RCTs) were included in this review to evaluate the role of bisphosphonates in the management of osteoporosis in IBD patients. A revised 7-point Jadad scale was used to evaluate the quality of each study. Overall, 13 RCTs and 923 patients met the inclusion criteria of this meta-analysis. The result showed that bisphosphonates decreased bone mass density (BMD) loss at the lumbar spine (P = 0.0002), reduced the risk of new fractures (P = 0.01), and retained the similar adverse events (P = 0.86). Bisphosphonates may provide protection and safety against bone mineral loss in IBD patients.

  6. Using a Treat-to-Target Management Strategy to Improve the Doctor-Patient Relationship in Inflammatory Bowel Disease.

    Science.gov (United States)

    Rubin, David T; Krugliak Cleveland, Noa

    2015-09-01

    The doctor-patient relationship (DPR) in inflammatory bowel disease (IBD) has been facing new challenges, in part due to the substantial progress in medical and surgical management and also due to the rapid expansion of patient access to medical information. Not surprisingly, the complexity of IBD care and heterogeneity of the disease types may lead to conflict between a physician's therapeutic recommendations and the patient's wishes. In this commentary, we propose that the so-called "treat-to-target" approach of objective targets of disease control and serial adjustments to therapies can also strengthen the DPR in IBD by enabling defined trials of alternative approaches, followed by a more objective assessment and reconsideration of treatments. We contend that such respect for patient autonomy and the use of objective markers of disease activity improves the DPR by fostering trust and both engaging and empowering patients and physicians with the information necessary to make shared decisions about therapies.

  7. US features of transient small bowel intussusception in pediatric patients

    International Nuclear Information System (INIS)

    Kim, Ji Hye

    2004-01-01

    To describe the sonographic (US) and clinical features of spontaneously reduced small bowel intussusception, and to discuss the management options for small bowel intussusception based on US findings with clinical correlation. During a five years of period, 34 small bowel intussusceptions were diagnosed on US in 32 infants and children. The clinical presentations and imaging findings of the patients were reviewed. The clinical presentations included abdominal pain or irritability (n = 25), vomiting (n 5), diarrhea (n = 3), bloody stool (n = 1), and abdominal distension (n = 1), in combination or alone. US showed multi-layered round masses of small (mean, 1.5 ± 0.3 cm) diameters and with thin (mean, 3.5 ± 1 mm) outer rims along the course of the small bowel. The mean length was 1.8 ± 0.5 cm and peristalsis was seen on the video records. There were no visible lead points. The vascular flow signal appeared on color Doppler images in all 21 patients examined. Spontaneous reduction was confirmed by combinations of US (n = 28), small bowel series (n = 6), CT scan (n = 3), and surgical exploration (n 2). All patients discharged with improved condition. Typical US findings of the transient small bowel intussusception included 1) small size without wall swelling, 2) short segment, 3) preserved wall motion, and 4) absence of the lead point. Conservative management with US monitoring rather than an immediate operation is recommended for those patient with typical transient small bowel intussusceptions. Atypical US findings or clinical deterioration of the patient with persistent intussusception warrant surgical exploration

  8. Management of Clostridium difficile Infection in Inflammatory Bowel Disease: Expert Review from the Clinical Practice Updates Committee of the AGA Institute.

    Science.gov (United States)

    Khanna, Sahil; Shin, Andrea; Kelly, Ciarán P

    2017-02-01

    The purpose of this expert review is to synthesize the existing evidence on the management of Clostridium difficile infection in patients with underlying inflammatory bowel disease. The evidence reviewed in this article is a summation of relevant scientific publications, expert opinion statements, and current practice guidelines. This review is a summary of expert opinion in the field without a formal systematic review of evidence. Best Practice Advice 1: Clinicians should test patients who present with a flare of underlying inflammatory bowel disease for Clostridium difficile infection. Best Practice Advice 2: Clinicians should screen for recurrent C difficile infection if diarrhea or other symptoms of colitis persist or return after antibiotic treatment for C difficile infection. Best Practice Advice 3: Clinicians should consider treating C difficile infection in inflammatory bowel disease patients with vancomycin instead of metronidazole. Best Practice Advice 4: Clinicians strongly should consider hospitalization for close monitoring and aggressive management for inflammatory bowel disease patients with C difficile infection who have profuse diarrhea, severe abdominal pain, a markedly increased peripheral blood leukocyte count, or other evidence of sepsis. Best Practice Advice 5: Clinicians may postpone escalation of steroids and other immunosuppression agents during acute C difficile infection until therapy for C difficile infection has been initiated. However, the decision to withhold or continue immunosuppression in inflammatory bowel disease patients with C difficile infection should be individualized because there is insufficient existing robust literature on which to develop firm recommendations. Best Practice Advice 6: Clinicians should offer a referral for fecal microbiota transplantation to inflammatory bowel disease patients with recurrent C difficile infection. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

  9. Help Desk Answers: Surgery vs conservative management for AC joint repair: How do the 2 compare?

    Science.gov (United States)

    Matchin, Bruce; Yee, Bruce; Mott, Timothy

    2016-04-01

    When not considering the grade of acromioclavicular (AC) joint dislocation, both conservative and surgical management lead to positive outcomes, although surgically managed patients require more time out of work.

  10. Management Approaches to Accomplish Contemporary Livestock Production-Conservation Objectives in Shortgrass Steppe

    Science.gov (United States)

    Traditional rangeland management in the shortgrass steppe has emphasized livestock production with moderate stocking rates, but alternative approaches will be needed to meet production objectives under increasing demands for conservation-oriented management. We investigated the utility of very inten...

  11. Development and psychometric characteristics of the SCI-QOL Bladder Management Difficulties and Bowel Management Difficulties item banks and short forms and the SCI-QOL Bladder Complications scale.

    Science.gov (United States)

    Tulsky, David S; Kisala, Pamela A; Tate, Denise G; Spungen, Ann M; Kirshblum, Steven C

    2015-05-01

    To describe the development and psychometric properties of the Spinal Cord Injury--Quality of Life (SCI-QOL) Bladder Management Difficulties and Bowel Management Difficulties item banks and Bladder Complications scale. Using a mixed-methods design, a pool of items assessing bladder and bowel-related concerns were developed using focus groups with individuals with spinal cord injury (SCI) and SCI clinicians, cognitive interviews, and item response theory (IRT) analytic approaches, including tests of model fit and differential item functioning. Thirty-eight bladder items and 52 bowel items were tested at the University of Michigan, Kessler Foundation Research Center, the Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital, and the James J. Peters VA Medical Center, Bronx, NY. Seven hundred fifty-seven adults with traumatic SCI. The final item banks demonstrated unidimensionality (Bladder Management Difficulties CFI=0.965; RMSEA=0.093; Bowel Management Difficulties CFI=0.955; RMSEA=0.078) and acceptable fit to a graded response IRT model. The final calibrated Bladder Management Difficulties bank includes 15 items, and the final Bowel Management Difficulties item bank consists of 26 items. Additionally, 5 items related to urinary tract infections (UTI) did not fit with the larger Bladder Management Difficulties item bank but performed relatively well independently (CFI=0.992, RMSEA=0.050) and were thus retained as a separate scale. The SCI-QOL Bladder Management Difficulties and Bowel Management Difficulties item banks are psychometrically robust and are available as computer adaptive tests or short forms. The SCI-QOL Bladder Complications scale is a brief, fixed-length outcomes instrument for individuals with a UTI.

  12. Self-managed eHealth Disease Monitoring in Children and Adolescents with Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Carlsen, Katrine; Jakobsen, Christian; Houen, Gunnar

    2017-01-01

    BACKGROUND: To evaluate the impact of eHealth on disease activity, the need for hospital contacts, and medical adherence in children and adolescents with inflammatory bowel disease (IBD). Furthermore, to assess eHealth's influence on school attendance and quality of life (QoL). METHODS: Patients...... with IBD, 10 to 17 years attending a public university hospital, were prospectively randomized to a 2-year open label case-controlled eHealth intervention. The eHealth-group used the web-application young.constant-care.com (YCC) on a monthly basis and in case of flare-ups, and were seen at one annual......: Fifty-three patients in nonbiological treatment were included (27 eHealth/26 control). We found no differences between the groups regarding escalation in treatment and disease activity (symptoms, fecal calprotectin, and blood). The number of total outpatient visits (mean: eHealth 3.26, SEM 0.51; control...

  13. Management of Irritable Bowel Syndrome: Novel Approaches to the Pharmacology of Gut Motility

    Directory of Open Access Journals (Sweden)

    Carmelo Scarpignato

    1999-01-01

    Full Text Available Although it is unclear to what extent irritable bowel syndrome (IBS symptoms represent a normal perception of abnormal function or an abnormal perception of normal function, many believe that IBS constitutes the clinical expression of an underlying motility disorder, affecting primarily the mid- and lower gut. Indeed, transit and contractile abnormalities have been demonstrated with sophisticated techniques in a subset of patients with IBS. As a consequence, drugs affecting gastrointestinal (GI motility have been widely employed with the aim of correcting the major IBS manifestations, ie, pain and altered bowel function. Unfortunately, no single drug has proven to be effective in treating IBS symptom complex. In addition, the use of some medications has often been associated with unpleasant side effects. Therefore, the search for a truly effective and safe drug to control motility disturbances in IBS continues. Several classes of drugs look promising and are under evaluation. Among the motor- inhibiting drugs, gut selective muscarinic antagonists (such as zamifenacin and darifenacin, neurokinin2 antagonists (such as MEN-10627 and MEN-11420, beta3-adrenoreceptor agonists (eg, SR-58611A and GI-selective calcium channel blockers (eg, pinaverium bromide and octylonium are able to decrease painful contractile activity in the gut (antispasmodic effect, without significantly affecting other body functions. Novel mechanisms to stimulate GI motility and transit include blockade of cholecystokinin (CCKA receptors and stimulation of motilin receptors. Loxiglumide (and its dextroisomer, dexloxiglumide is the only CCKA receptor antagonist that is being evaluated clinically. This drug accelerates gastric emptying and colonic transit, thereby increasing the number of bowel movements in patients with chronic constipation. It is also able to reduce visceral perception. Erythromycin and related 14-member macrolide compounds inhibit the binding of motilin to its

  14. Management of functional abdominal pain and irritable bowel syndrome in children and adolescents.

    Science.gov (United States)

    Chiou, Eric; Nurko, Samuel

    2010-06-01

    Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are among the most commonly diagnosed medical problems in pediatrics. Symptom-based Rome III criteria for FAP and IBS have been validated and help the clinician in making a positive diagnosis. The majority of patients with mild complaints improve with reassurance and time. For a distinct subset of patients with more severe and disabling illness, finding effective treatment for these disorders remains a challenge. Over the years, a wide range of therapies have been proposed and studied. The lack of a single, proven intervention highlights the complex interplay of biopsychosocial factors probably involved in the development of childhood FAP and IBS, and the need for a multidisciplinary, integrated approach. This article reviews the current literature on the efficacy of pharmacologic, dietary and psychosocial interventions for FAP and IBS in children and adolescents.

  15. How genetic testing can lead to targeted management of XIAP deficiency-related inflammatory bowel disease

    DEFF Research Database (Denmark)

    Nielsen, Ole Haagen; LaCasse, Eric Charles

    2017-01-01

    infections, such as Epstein-Barr virus (EBV). Children with XIAP-related XLP-2 may present with either familial hemophagocytic lymphohistiocytosis, often triggered in response to EBV infection, or with a treatment-refractory severe pediatric form of inflammatory bowel disease (IBD) that might be diagnosed...... treatment history and patient morbidity/mortality since its original identification in 2006. Since XLP-2 is rare, cases are probably undergiagnosed or misdiagnosed. Consideration of XLP-2 in children with severe symptoms of IBD can prevent serious morbidities and mortality, avoid unnecessary procedures......, and expedite specific targeted therapy.Genet Med advance online publication 14 July 2016Genetics in Medicine (2016); doi:10.1038/gim.2016.82....

  16. The use of GIS and modelling approaches in squirrel population management and conservation: A review

    Science.gov (United States)

    P. W. W. Lurz; J. L. Koprowski; D. J. A. Wood

    2008-01-01

    We review modelling approaches in relation to three key areas of sciurid ecology: management, disease risk assessments and conservation. Models enable us to explore different scenarios to develop effective management and conservation strategies. They may also assist in identifying and targeting research needs for tree and flying squirrels. However, there is a need to...

  17. Concentrating or scattering management in agricultural landscapes : Examining the effectiveness and efficiency of conservation measures

    NARCIS (Netherlands)

    Hammers, Martijn; Muskens, Gerard; Van Kats, Ruud J. M.; Teunissen, Wolf A.; Kleijn, David

    A key issue in conservation is where and how much management should be implemented to obtain optimal biodiversity benefits. Cost-effective conservation requires knowledge on whether biodiversity benefits are higher when management is concentrated in a few core areas or scattered across the

  18. The ecology, distribution, conservation and management of large old trees.

    Science.gov (United States)

    Lindenmayer, David B; Laurance, William F

    2017-08-01

    Large old trees are some of the most iconic biota on earth and are integral parts of many terrestrial ecosystems including those in tropical, temperate and boreal forests, deserts, savannas, agro-ecological areas, and urban environments. In this review, we provide new insights into the ecology, function, evolution and management of large old trees through broad cross-disciplinary perspectives from literatures in plant physiology, growth and development, evolution, habitat value for fauna and flora, and conservation management. Our review reveals that the diameter, height and longevity of large old trees varies greatly on an inter-specific basis, thereby creating serious challenges in defining large old trees and demanding an ecosystem- and species-specific definition that will only rarely be readily transferable to other species or ecosystems. Such variation is also manifested by marked inter-specific differences in the key attributes of large old trees (beyond diameter and height) such as the extent of buttressing, canopy architecture, the extent of bark micro-environments and the prevalence of cavities. We found that large old trees play an extraordinary range of critical ecological roles including in hydrological regimes, nutrient cycles and numerous ecosystem processes. Large old trees strongly influence the spatial and temporal distribution and abundance of individuals of the same species and populations of numerous other plant and animal species. We suggest many key characteristics of large old trees such as extreme height, prolonged lifespans, and the presence of cavities - which confer competitive and evolutionary advantages in undisturbed environments - can render such trees highly susceptible to a range of human influences. Large old trees are vulnerable to threats ranging from droughts, fire, pests and pathogens, to logging, land clearing, landscape fragmentation and climate change. Tackling such diverse threats is challenging because they often

  19. Stakeholder-led science: engaging resource managers to identify science needs for long-term management of floodplain conservation lands

    Science.gov (United States)

    Bouska, Kristin L.; Lindner, Garth; Paukert, Craig P.; Jacobson, Robert B.

    2016-01-01

    Floodplains pose challenges to managers of conservation lands because of constantly changing interactions with their rivers. Although scientific knowledge and understanding of the dynamics and drivers of river-floodplain systems can provide guidance to floodplain managers, the scientific process often occurs in isolation from management. Further, communication barriers between scientists and managers can be obstacles to appropriate application of scientific knowledge. With the coproduction of science in mind, our objectives were the following: (1) to document management priorities of floodplain conservation lands, and (2) identify science needs required to better manage the identified management priorities under nonstationary conditions, i.e., climate change, through stakeholder queries and interactions. We conducted an online survey with 80 resource managers of floodplain conservation lands along the Upper and Middle Mississippi River and Lower Missouri River, USA, to evaluate management priority, management intensity, and available scientific information for management objectives and conservation targets. Management objectives with the least information available relative to priority included controlling invasive species, maintaining respectful relationships with neighbors, and managing native, nongame species. Conservation targets with the least information available to manage relative to management priority included pollinators, marsh birds, reptiles, and shore birds. A follow-up workshop and survey focused on clarifying science needs to achieve management objectives under nonstationary conditions. Managers agreed that metrics of inundation, including depth and extent of inundation, and frequency, duration, and timing of inundation would be the most useful metrics for management of floodplain conservation lands with multiple objectives. This assessment provides guidance for developing relevant and accessible science products to inform management of highly

  20. Managing iron deficiency and iron deficiency anemia in inflammatory bowel disease. The results of the "Gestiona hierro-EII" survey.

    Science.gov (United States)

    Casellas Jordá, Francesc; Vera Mendoza, Isabel; Barreiro-de Acosta, Manuel; Vázquez Morón, Juan María; López Román, Javier; Júdez Gutiérrez, Javier

    2018-03-01

    iron deficiency anemia is a common and very relevant manifestation of inflammatory bowel disease (IBD). Although clinical practice guidelines have been published and updated on this subject, the management in the daily practice of this complication is far from optimal. to determine the actual management, needs and limitations of anemia in IBD by means of a survey of gastroenterology specialists. a self-administered telematic survey was carried out between April and May 2017 and was sent to SEPD members. The survey included four sections: participant demographics, monitoring, treatment and limitations/needs. a total of 122 evaluable surveys were received from all Spanish autonomous communities. Iron deficiency anemia is considered as a frequent manifestation of IBD and is monitored in all patients via the measurement of hemoglobin and ferritin. In the case of anemia, the survey respondents found it necessary to rule out the presence of IBD activity. However, only 14.8% prescribed intravenous iron when IBD was active. The required dose of intravenous iron is mainly calculated according to patient needs but only 33.1% of clinicians infused doses of 1 g or more. the "Gestiona Hierro EII" survey on the management of anemia in IBD demonstrated a high quality of care, even though some aspects need to be improved. These included the prescription of intravenous iron for patients with disease activity, the use of high-dose intravenous iron and the implementation of algorithms into clinical practice.

  1. Management of the Psychological Impact of Inflammatory Bowel Disease: Perspective of Doctors and Patients-The ENMENTE Project.

    Science.gov (United States)

    Marín-Jiménez, Ignacio; Gobbo Montoya, Milena; Panadero, Abel; Cañas, Mercedes; Modino, Yolanda; Romero de Santos, Cristina; Guardiola, Jordi; Carmona, Loreto; Barreiro-de Acosta, Manuel

    2017-09-01

    To explore the perception of patients and gastroenterologists specialized in inflammatory bowel disease (IBD) on the impact of psychological factors on IBD course and its management. Online surveys were sent to patients with IBD recruited from a national patient association and IBD specialists recruited from a national scientific society. These surveys were based on the results of a focus group and discussion group that explored the psychological aspects of IBD. Descriptive statistical analyses were performed, and the physicians' responses regarding impact and management were compared with those of a random patient sample. Responses were obtained from 170 physicians and 903 patients. Most patients emphasized the impact of psychological aspects, namely anxiety and depression, related to suffering from IBD, with 28% declaring that they perceived health professionals to not be interested in this area. A third of the physicians declared not feeling qualified to detect psychological problems. Although 50% of doctors stated that they regularly enquire about these aspects in their clinics, the patients perceived that this was done only 25% of the time. Both groups agreed on the need of a psychologist in IBD care teams. A discrepancy exists between physician and patient perceptions of the impact of psychological aspects in IBD, with patients perceiving higher impact and more under treatment than physicians. Given the influence of these aspects on patient well-being, it seems advisable to enrich professionals' training, improve the clinical management of psychological aspects of IBD, and probably include psychologists in IBD care teams.

  2. The Tasmanian devil microbiome-implications for conservation and management.

    Science.gov (United States)

    Cheng, Yuanyuan; Fox, Samantha; Pemberton, David; Hogg, Carolyn; Papenfuss, Anthony T; Belov, Katherine

    2015-12-21

    The Tasmanian devil, the world's largest carnivorous marsupial, is at risk of extinction due to devil facial tumour disease (DFTD), a fatal contagious cancer. The Save the Tasmanian Devil Program has established an insurance population, which currently holds over 600 devils in captive facilities across Australia. Microbes are known to play a crucial role in the health and well-being of humans and other animals, and increasing evidence suggests that changes in the microbiota can influence various aspects of host physiology and development. To improve our understanding of devils and facilitate management and conservation of the species, we characterised the microbiome of wild devils and investigated differences in the composition of microbial community between captive and wild individuals. A total of 1,223,550 bacterial 16S ribosomal RNA (rRNA) sequences were generated via Roche 454 sequencing from 56 samples, including 17 gut, 15 skin, 18 pouch and 6 oral samples. The devil's gut microbiome was dominated by Firmicutes and showed a high Firmicutes-to-Bacteroidetes ratio, which appears to be a common feature of many carnivorous mammals. Metabolisms of carbohydrates, amino acids, energy, cofactors and vitamins, nucleotides and lipids were predicted as the most prominent metabolic pathways that the devil's gut flora contributed to. The microbiota inside the female's pouch outside lactation was highly similar to that of the skin, both co-dominated by Firmicutes and Proteobacteria. The oral microbiome had similar proportions of Proteobacteria, Bacteroidetes, Firmicutes and Fusobacteria. Compositional differences were observed in all four types of microbiota between devils from captive and wild populations. Certain captive devils had significantly lower levels of gut bacterial diversity than wild individuals, and the two groups differed in the proportion of gut bacteria accounting for the metabolism of glycan, amino acids and cofactors and vitamins. Further studies are

  3. Outcomes for conservative management of traumatic conductive hearing loss.

    Science.gov (United States)

    Grant, Jonathan R; Arganbright, Jill; Friedland, David R

    2008-04-01

    To evaluate the natural history of traumatic conductive hearing loss. Retrospective chart review. Otologic and audiometric evaluations of patients in the early posttraumatic phase were compared with evaluations at follow-up. Assessment included etiologies of trauma, classification of hearing loss, factors causing conductive loss, and analyses of changes in air-bone gaps, pure-tone averages and hearing loss class. There were 45 patients, representing 47 ears, with sufficient initial and follow-up documentation to analyze the natural history of traumatic conductive hearing loss. Overall, 77% of ears showed an improvement in pure-tone averages without surgical intervention. Air-bone gaps closed from an average of 24.8 +/- 12.1 to 13.2 +/- 11.1 dB. Only 11% of ears demonstrated a decrease in pure-tone averages, and 12% showed no change in thresholds. All forms of injury contributing to the conductive hearing loss had good outcomes. Specifically, tympanic membrane perforations showed final air-bone gaps of 14.9 +/- 11.2 dB; cases of hemotympanum had final air-bone gaps of 10.0 +/- 8.1 dB; and suspected ossicular chain disruptions had final air-bone gaps of 13.9 +/- 12.3 dB. Only 5 of 47 ears ultimately required surgical intervention for persistent pathology. Patients with all forms of traumatic conductive hearing loss can be initially managed conservatively. Even suspected ossicular chain disruptions have a high rate of spontaneous reparation. Surgical intervention for perforation or conductive hearing loss should be undertaken in the rare cases when these conditions persist greater than 6 months.

  4. goal management as an attempt to evaluate nature conservation

    African Journals Online (AJOL)

    the efficiency of environmental education campaigns in. Southern Africa. ... practical model for evaluation research in the field of .... also involve themselves in issues such as the development if an environmental and conservation ethic.

  5. Conservative management of mechanical neck disorders: a systematic review

    NARCIS (Netherlands)

    Gross, Anita R.; Goldsmith, Charlie; Hoving, Jan L.; Haines, Ted; Peloso, Paul; Aker, Peter; Santaguida, Pasqualina; Myers, Cynthia

    2007-01-01

    OBJECTIVE: To determine if conservative treatments (manual therapies, physical medicine methods, medication, and patient education) relieved pain or improved function/disability, patient satisfaction, and global perceived effect in adults with acute, subacute, and chronic mechanical neck disorders

  6. Focus groups for developing a peer mentoring program to improve self-management in pediatric inflammatory bowel disease.

    Science.gov (United States)

    Mackner, Laura M; Ruff, Jessica M; Vannatta, Kathryn

    2014-10-01

    Inflammatory bowel disease (IBD) presents challenges for self-management in many areas. A peer mentoring program may offer advantages over other forms of self-management interventions because youth may be more receptive to learning self-management skills from a peer than from a parent or professional. The purpose of the present study was to identify themes from focus groups to inform development of a peer mentoring program for improving self-management in pediatric IBD. Focus groups were conducted for youth ages 12 to 17, stratified by age (3 groups; n = 14), young adults ages 18 to 20 (1 group; n = 5), and parents of the youth (3 groups; n = 17). Broad questions covered program goals, general program characteristics, mentor/mentee characteristics, and family involvement, and transcriptions were analyzed via directed content analysis, with the a priori codes specified as the broad questions above. Participants identified the primary goals of a program as support, role model, information/education, and fun. They described a program that would include a year-long, 1-on-1 mentor relationship with a peer who has had IBD for at least a year, educational group activities, fun activities that are not focused on IBD, expectations for in-person contact 1 to 2 times per month, and mentor-to-mentor and parent support. Many of the suggestions from the focus groups correspond with research findings associated with successful mentoring programs. Using participants' suggestions and empirically based best practices for mentoring may result in an effective peer mentoring program for improving self-management in youth with IBD.

  7. Is non-operative management still justified in the treatment of adhesive small bowel obstruction in children?

    Science.gov (United States)

    Nasir, Abdulrasheed A; Abdur-Rahman, Lukman O; Bamigbola, Kayode T; Oyinloye, Adewale O; Abdulraheem, Nurudeen T; Adeniran, James O

    2013-01-01

    Adhesive small bowel obstruction (ASBO) is a feared complication after abdominal operations in both children and adults. The optimal management of ASBO in the pediatric population is debated. The aim of the present study was to examine the safety and effectiveness of non-operative management in ASBO. A retrospective review of 33 patients who were admitted for ASBO over a 5-year period was carried out. Follow-up data were available for 29 patients. Demographic, clinical, and operative details and outcomes were collected for these patients. Data analysis was done with SPSS version 15.0. P ≤ 0.05 was regarded as significant. Out of 618 abdominal surgeries within the 5-year period, 34 admissions were recorded from 29 patients at the follow-up period of 1-28 months. There were 19 boys (65.5%). The median age of patients was 4.5 years. Typhoid intestinal perforation (n = 7), intussusception (n = 6), intestinal malrotation (n = 5), and appendicitis (n = 4) were the major indications for a prior abdominal surgery leading to ASBO. Twenty-five patients (73.5%) developed SBO due to adhesions within the first year of the primary procedure. Of the 34 patients admitted with ASBO, 18 (53%) underwent operative intervention and 16 (47%) were successfully managed non-operatively. There were no differences in sex (P = 0.24), initial procedure (P = 0.12), age, duration of symptoms, and time to re-admission between the patients who responded to non-operative management and those who underwent operative intervention. However, the length of hospital stay was significantly shorter in the non-operative group (P operative management is still a safe and preferred approach in selected patients with ASBO. However, 53% eventually required surgery.

  8. Predicting outcomes to optimize disease management in inflammatory bowel disease in Japan: their differences and similarities to Western countries.

    Science.gov (United States)

    Kobayashi, Taku; Hisamatsu, Tadakazu; Suzuki, Yasuo; Ogata, Haruhiko; Andoh, Akira; Araki, Toshimitsu; Hokari, Ryota; Iijima, Hideki; Ikeuchi, Hiroki; Ishiguro, Yoh; Kato, Shingo; Kunisaki, Reiko; Matsumoto, Takayuki; Motoya, Satoshi; Nagahori, Masakazu; Nakamura, Shiro; Nakase, Hiroshi; Tsujikawa, Tomoyuki; Sasaki, Makoto; Yokoyama, Kaoru; Yoshimura, Naoki; Watanabe, Kenji; Katafuchi, Miiko; Watanabe, Mamoru; Hibi, Toshifumi

    2018-04-01

    Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is a chronic inflammatory disease of the gastrointestinal tract, with increasing prevalence worldwide. IBD Ahead is an international educational program that aims to explore questions commonly raised by clinicians about various areas of IBD care and to consolidate available published evidence and expert opinion into a consensus for the optimization of IBD management. Given differences in the epidemiology, clinical and genetic characteristics, management, and prognosis of IBD between patients in Japan and the rest of the world, this statement was formulated as the result of literature reviews and discussions among Japanese experts as part of the IBD Ahead program to consolidate statements of factors for disease prognosis in IBD. Evidence levels were assigned to summary statements in the following categories: disease progression in CD and UC; surgery, hospitalization, intestinal failure, and permanent stoma in CD; acute severe UC; colectomy in UC; and colorectal carcinoma and dysplasia in IBD. The goal is that this statement can aid in the optimization of the treatment strategy for Japanese patients with IBD and help identify high-risk patients that require early intervention, to provide a better long-term prognosis in these patients.

  9. Management and conservation options for Indian coral reefs

    Digital Repository Service at National Institute of Oceanography (India)

    Wafar, M.V.M.

    for management of the reefs. The approaches proposed for management of Indian reefs are (1) decision on the need for management, (2) preparation of a use and impact analysis chart, to evaluate the type of management approach needed, (3) preparation of management...

  10. AN ANALYTICAL STUDY IN ADHESIVE BOWEL OBSTRUCTION

    Directory of Open Access Journals (Sweden)

    Gerald Anand Raja

    2017-04-01

    Full Text Available BACKGROUND Peritoneal adhesions can be defined as abnormal fibrous bands between organs or tissues or both in the abdominal cavity that are normally separated. Adhesions may be acquired or congenital; however, most are acquired as a result of peritoneal injury, the most common cause of which is abdominopelvic surgery. Less commonly, adhesions may form as the result of inflammatory conditions, intraperitoneal infection or abdominal trauma. The extent of adhesion formation varies from one patient to another and is most dependent on the type and magnitude of surgery performed as well as whether any postoperative complications develop. Fortunately, most patients with adhesions do not experience any overt clinical symptoms. For others, adhesions may lead to any one of a host of problems and can be the cause of significant morbidity and mortality. MATERIALS AND METHODS This is a retrospective study of 50 patients admitted in Government Royapettah Hospital with adhesive bowel obstruction between September 2008 to September 2010. All patients were admitted and managed either conservatively or surgically. RESULTS 1. Adhesive bowel disease is the most common cause for bowel obstruction followed by hernias. 2. Increased incidence is noted in females. 3. Increased incidence of adhesions was documented in gynaecological and colorectal surgeries. 4. Below umbilical incisions have higher propensity for adhesion formation. 5. Laparotomies done for infective aetiology have higher adhesion risks. 6. Most of adhesive obstructions can be managed conservatively. 7. Adhesiolysis preferably laparoscopic can be done. For gangrenous bowel resection and anastomosis or ostomy done. 8. Given the above risk factors, adhesive bowel disease can be prevented to a certain extent. CONCLUSION The formation of peritoneal adhesions continues to plague patients, surgeons and society. Although, research in this area is ongoing, there is currently no method that is 100% effective in

  11. Land Management Restrictions and Options for Change in Perpetual Conservation Easements

    Science.gov (United States)

    Rissman, Adena; Bihari, Menka; Hamilton, Christopher; Locke, Christina; Lowenstein, David; Motew, Melissa; Price, Jessica; Smail, Robert

    2013-07-01

    Conservation organizations rely on conservation easements for diverse purposes, including protection of species and natural communities, working forests, and open space. This research investigated how perpetual conservation easements incorporated property rights, responsibilities, and options for change over time in land management. We compared 34 conservation easements held by one federal, three state, and four nonprofit organizations in Wisconsin. They incorporated six mechanisms for ongoing land management decision-making: management plans (74 %), modifications to permitted landowner uses with discretionary consent (65 %), amendment clauses (53 %), easement holder rights to conduct land management (50 %), reference to laws or policies as compliance terms (47 %), and conditional use permits (12 %). Easements with purposes to protect species and natural communities had more ecological monitoring rights, organizational control over land management, and mechanisms for change than easements with general open space purposes. Forestry purposes were associated with mechanisms for change but not necessarily with ecological monitoring rights or organizational control over land management. The Natural Resources Conservation Service-Wetland Reserve Program had a particularly consistent approach with high control over land use and some discretion to modify uses through permits. Conservation staff perceived a need to respond to changing social and ecological conditions but were divided on whether climate change was likely to negatively impact their conservation easements. Many conservation easements involved significant constraints on easement holders' options for altering land management to achieve conservation purposes over time. This study suggests the need for greater attention to easement drafting, monitoring, and ongoing decision processes to ensure the public benefits of land conservation in changing landscapes.

  12. Translating conservation genetics into management: Pan-European minimum requirements for dynamic conservation units of forest tree genetic diversity

    OpenAIRE

    Koskela, Jarkko; Lefèvre, François; Schueler, Silvio; Kraigher, Hojka; Olrik, Ditte C.; Hubert, Jason; Longauer, Roman; Bozzano, Michele; Yrjänä, Leena; Alizoti, Paraskevi; Rotach, Peter; Vietto, Lorenzo; Bordács, Sándor; Myking, Tor; Eysteinsson, Thröstur

    2013-01-01

    This paper provides a review of theoretical and practical aspects related to genetic management of forest trees. The implementation of international commitments on forest genetic diversity has been slow and partly neglected. Conservation of forest genetic diversity is still riddled with problems, and complexities of national legal and administrative structures. Europe is an example of a complex region where the dis- tribution ranges of tree species extend across large geographical areas with ...

  13. The recurrence risk of placenta accreta following uterine conserving management.

    Science.gov (United States)

    Cunningham, K M; Anwar, A; Lindow, S W

    2015-01-01

    Placenta accreta is a condition of abnormal placental attachment that was usually treated by hysterectomy. Techniques to conserve the uterus are now commonly used and series of subsequent pregnancy outcomes have been reported. The recurrence risk of placenta accreta is now a relevant detail and is currently not known. This work was performed to calculate the recurrence risk by reviewing the published literature. A literature search using the terms "placenta accreta", "placenta percreta", "placenta increta", "abnormal placental attachment" and "placental attachment disorder" followed by hand-searching identified 6 papers that contained data concerning recurrence of placenta accreta in subsequent pregnancies following initial conservative treatment. Overall 407 pregnancies were recorded and 85.7% of women reported achieved a subsequent pregnancy following conservative treatment. The risk of recurrence of placental attachment disorder in a subsequent pregnancy was 19.9% (weighted mean, 95% CI 12.2-27.7). The recurrence risk of placental attachment disorder following uterine conservation treatments is 20% . This risk should be discussed with women with an antenatal diagnosis of a placental attachment disorder who may be considering uterine conservation in order to retain the option of a future pregnancy.

  14. Building on Two Decades of Ecosystem Management and Biodiversity Conservation under the Northwest Forest Plan, USA

    Directory of Open Access Journals (Sweden)

    Dominick A. DellaSala

    2015-09-01

    Full Text Available The 1994 Northwest Forest Plan (NWFP shifted federal lands management from a focus on timber production to ecosystem management and biodiversity conservation. The plan established a network of conservation reserves and an ecosystem management strategy on ~10 million hectares from northern California to Washington State, USA, within the range of the federally threatened northern spotted owl (Strix occidentalis caurina. Several subsequent assessments—and 20 years of data from monitoring programs established under the plan—have demonstrated the effectiveness of this reserve network and ecosystem management approach in making progress toward attaining many of the plan’s conservation and ecosystem management goals. This paper (1 showcases the fundamental conservation biology and ecosystem management principles underpinning the NWFP as a case study for managers interested in large-landscape conservation; and (2 recommends improvements to the plan’s strategy in response to unprecedented climate change and land-use threats. Twenty years into plan implementation, however, the U.S. Forest Service and Bureau of Land Management, under pressure for increased timber harvest, are retreating from conservation measures. We believe that federal agencies should instead build on the NWFP to ensure continuing success in the Pacific Northwest. We urge federal land managers to (1 protect all remaining late-successional/old-growth forests; (2 identify climate refugia for at-risk species; (3 maintain or increase stream buffers and landscape connectivity; (4 decommission and repair failing roads to improve water quality; (5 reduce fire risk in fire-prone tree plantations; and (6 prevent logging after fires in areas of high conservation value. In many respects, the NWFP is instructive for managers considering similar large-scale conservation efforts.

  15. Conservative Management of Central Cemento-Ossifying Fibroma.

    Science.gov (United States)

    Gomes-Ferreira, Pedro Henrique Silva; Carrasco, Leandro Carlos; de Oliveira, Danila; Pereira, Járede Carvalho; Alcalde, Luis Fernando Azambuja; Faverani, Leonardo Perez

    2017-01-01

    Central cemento-ossifying fibroma is characterized by the combined production of osteoid and cementoid tissue. Radiographically, this lesion is presented as an outlined cortical and variable radiopaque spots, also can be present complete radiolucent or different degrees of radiopacity. The recommended treatment is curettage or enucleation, and the recurrence rate is less than 5%. Considering that surgical treatment is invasive, mainly in large lesions, this study aims to report a patient in whom conservative treatment was carried out by involving the preservation of teeth, with a long-term follow-up. A 48-year-old black female patient, diagnosed with central cemento-ossifying fibroma in mandible, treated conservatively and a 2 years of follow-up. It was concluded that the conservative treatment with a long term of follow-up for maintaining teeth was satisfactory.

  16. Genetic characterization of Western European noble crayfish populations (Astacus astacus) for advanced conservation management strategies

    NARCIS (Netherlands)

    Schrimpf, A.; Piscione, M.; Cammaerts, R.; Collas, M.; Herman, D.; Jung, A.; Ottburg, F.; Roessink, I.; Rollin, X.; Schulz, R.; Theissinger, K.

    2017-01-01

    One central goal of conservation biology is to conserve the genetic diversity of species in order to protect their adaptive potential. The main objective of this study was to identify management units (MUs) for the threatened noble crayfish (Astacus astacus) in Western Europe by utilizing

  17. Incentives for biodiversity conservation beyond the best management practices: are forestland owners interested

    Science.gov (United States)

    Jagannadha R. Matta; Janaki R. R. Alavalapati; D. Evan Mercer

    2009-01-01

    With the growing recognition of the role of environmental services rendered by private lands, landowner involvement has become a critical component of landscape-level strategies to conserve biodiversity. In this paper, we examine the willingness of private forest owners to participate in a conservation program that requires adopting management regimes beyond...

  18. Clinical potential of naloxegol in the management of opioid-induced bowel dysfunction

    Directory of Open Access Journals (Sweden)

    Poulsen JL

    2014-09-01

    Full Text Available Jakob Lykke Poulsen,1 Christina Brock,1,2 Anne Estrup Olesen,1,2 Matias Nilsson,1 Asbjørn Mohr Drewes1,3 1Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; 2Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark; 3Department of Clinical Medicine, Aalborg University, Aalborg, DenmarkAbstract: Opioid-induced bowel dysfunction (OIBD is a burdensome condition which limits the therapeutic benefit of analgesia. It affects the entire gastrointestinal tract, predominantly by activating opioid receptors in the enteric nervous system, resulting in a wide range of symptoms, such as reflux, bloating, abdominal cramping, hard, dry stools, and incomplete evacuation. The majority of studies evaluating OIBD focus on constipation experienced in approximately 60% of patients. Nevertheless, other presentations of OIBD seem to be equally frequent. Furthermore, laxative treatment is often insufficient, which in many patients results in decreased quality of life and discontinuation of opioid treatment. Novel mechanism-based pharmacological approaches targeting the gastrointestinal opioid receptors have been marketed recently and even more are in the pipeline. One strategy is prolonged release formulation of the opioid antagonist naloxone (which has limited systemic absorption and oxycodone in a combined tablet. Another approach is peripherally acting, µ-opioid receptor antagonists (PAMORAs that selectively target µ-opioid receptors in the gastrointestinal tract. However, in Europe the only PAMORA approved for OIBD is the subcutaneously administered methylnaltrexone. Alvimopan is an oral PAMORA, but only approved in the US for postoperative ileus in hospitalized patients. Finally, naloxegol is a novel, oral PAMORA expected to be approved soon. In this review, the prevalence and pathophysiology of OIBD is presented. As PAMORAs seem to be a promising approach, their potential

  19. Styrene maleic acid encapsulated raloxifene micelles for management of inflammatory bowel disease.

    Science.gov (United States)

    Greish, Khaled; Taha, Safa; Jasim, Anfal; Elghany, Sara Abd; Sultan, Ameera; AlKhateeb, Ali; Othman, Manal; Jun, Fang; Taurin, Sebastien; Bakhiet, Moiz

    2017-12-01

    Inflammatory bowel disease (IBD) comprises a group of disorders that manifest through chronic inflammation of the colon and small intestine. Although the exact cause of IBD is still unclear, dysfunctional immunoregulation involving overproduction of inflammatory cytokines such as TNF-α, and IL-6 have been implicated in pathogenesis. Current therapy relies on immunosuppression, cytotoxic drugs, and monoclonal antibodies against TNF-α. These classes of drugs have severe side-effects, especially when used for long duration. Our previous work with raloxifene, a selective estrogen receptor modulator, has shown that the drug, and to a greater extent its micellar formulation, has a significant suppressive effect on NF-κB, an essential immune-regulator. This finding directed the current work towards testing the anti-inflammatory and immunomodulatory effects of raloxifene using cell lines, as well as testing the potential use of the styrene maleic acid (SMA) micelles loaded with raloxifene (SMA-Ral) against dextran sulfate sodium (DSS) induced colitis in an in vivo model of IBD. Treatment of MCF-7 cells with TNF-α was shown to protect the cells from the cytotoxic effect of raloxifene (42 vs. 10% cell death, with TNF-α. Treating CaCo-2 cells with both free and SMA-Ral improved cell survival after exposure to 2% DDS with significantly higher protection with SMA-Ral. Treatment of U-937 with SMA-Ral and free-Ral resulted in down-regulation of TNF-α, IL-1β, IL-6, and MIP1α, with greater inhibition of the SMA-Ral, compared to free Ral. Balb/c mice treated with raloxifene and SMA-Ral showed weight gain at 14 days, compared to the control group (122, and 115% respectively). Treatment with raloxifene prevented DSS-induced diarrhea in 6/6 of free raloxifene treated mice and in 5/6 mice treated with SMA-Ral. Control group of DSS-treated mice showed average colon length of 7.4 cm compared to 13 cm in the control group. The average colon length was 12.3 and 11.5 cm for

  20. New probiotic strains for inflammatory bowel disease management identified by combining in vitro and in vivo approaches.

    Science.gov (United States)

    Alard, J; Peucelle, V; Boutillier, D; Breton, J; Kuylle, S; Pot, B; Holowacz, S; Grangette, C

    2018-02-27

    Alterations in the gut microbiota composition play a key role in the development of chronic diseases such as inflammatory bowel disease (IBD). The potential use of probiotics therefore gained attention, although outcomes were sometimes conflicting and results largely strain-dependent. The present study aimed to identify new probiotic strains that have a high potential for the management of this type of pathologies. Strains were selected from a large collection by combining different in vitro and in vivo approaches, addressing both anti-inflammatory potential and ability to improve the gut barrier function. We identified six strains with an interesting anti-inflammatory profile on peripheral blood mononuclear cells and with the ability to restore the gut barrier using a gut permeability model based on Caco-2 cells sensitized with hydrogen peroxide. The in vivo evaluation in two 2,4,6-trinitrobenzene sulfonic acid-induced murine models of colitis highlighted that some of the strains exhibited beneficial activities against acute colitis while others improved chronic colitis. Bifidobacterium bifidum PI22, the strain that exhibited the most protective capacities against acute colitis was only slightly efficacious against chronic colitis, while Bifidobacterium lactis LA804 which was less efficacious in the acute model was the most protective against chronic colitis. Lactobacillus helveticus PI5 was not anti-inflammatory in vitro but the best in strengthening the epithelial barrier and as such able to significantly dampen murine acute colitis. Interestingly, Lactobacillus salivarius LA307 protected mice significantly against both types of colitis. This work provides crucial clues for selecting the best strains for more efficacious therapeutic approaches in the management of chronic inflammatory diseases. The strategy employed allowed us to identify four strains with different characteristics and a high potential for the management of inflammatory diseases, such as IBD.

  1. Community-managed conservation efforts at Tsingy Mahaloka ...

    African Journals Online (AJOL)

    conservation action plan (2013–2016), and can allow rural communities to (i) secure ... needs tourists; this has proven to be a problem for KOFAMA and the Tsingy ... limestone cliffs rising 80–100 metres above a flat coastal plain), a ... Indian Ocean e-Ink .... President of KOFAMA and the regional Peace Corps volunteer, the.

  2. 76 FR 56985 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

    Science.gov (United States)

    2011-09-15

    ... to estimate total haddock catch by the herring midwater trawl fleet in these herring management areas.... 110627355-1539-02] RIN 0648-BB08 Magnuson-Stevens Fishery Conservation and Management Act Provisions... the NE Multispecies Fishery Management Plan (FMP), which increases the haddock incidental catch cap...

  3. 76 FR 43745 - Magnuson-Stevens Fishery Conservation and Management Act (MSA) Provisions; Fisheries of the...

    Science.gov (United States)

    2011-07-21

    ... during the course of the FY. Management uncertainty for the LAGC IFQ fleet is considered very low because... incorporate ACT into the LAGC IFQ fleet allocation, but chose not to apply any management uncertainty buffer... Atmospheric Administration 50 CFR Part 648 Magnuson-Stevens Fishery Conservation and Management Act (MSA...

  4. 77 FR 16942 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

    Science.gov (United States)

    2012-03-23

    ... Multispecies Fishery Management Plan which was approved on March 8, 2012. This action amends the Northeast Multispecies Fishery Management Plan to explicitly define and facilitate the effective operation of state.... 110901552-20494-02] RIN 0648-BB34 Magnuson-Stevens Fishery Conservation and Management Act Provisions...

  5. South-South exchanges enhance resource management and biodiversity conservation at various scales

    Directory of Open Access Journals (Sweden)

    William D Heyman

    2011-01-01

    Full Text Available International conservation organisations have invested considerable resources in fostering biodiversity conservation programs in the humid tropics, the most biologically diverse areas on earth. Recent approaches to conservation have centered on integrated conservation and development projects and participatory resource management programs, co-managed between governments and local communities. But these programs have had only mixed success and often suffer from insufficient quantity or quality of participation by local communities. We pose that participatory resource management is more likely to succeed when community members, 1 gain a global perspective on how their social, economic and environmental conditions compare with peer communities in other similar areas of the world, and thus better understand issues of relative scarcity and the benefits of sustainable resource management, and 2 engage as decision-makers at every stage of the conservation process up to reflective program evaluation. This paper examines the role of South-South exchanges as a tool to achieve these intermediate goals that ultimately foster more effective and participatory conservation and support sustainable local livelihoods. The data are extracted from the initiatives of the authors in two different environments- marine and coastal communities in Central America and the Caribbean, and lowland rainforest communities in the western Amazon of South America. We conclude that the exchanges are effective ways to build stakeholder comprehension about, and meaningful engagement in, resource management. South-South exchanges may also help build multi-local coalitions from various remote areas that together support biodiversity conservation at regional and global scales.

  6. The plight of Indian sea horses: Need for conservation and management

    Digital Repository Service at National Institute of Oceanography (India)

    Sreepada, R.A.; Desai, U.M.; Naik, S.

    along the Indian coast in the last decade has been alarming. Conservation and management are currently limited by the absence of data on the abundance and distribution of seahorses species in the region. This paper highlights the plight of Indian...

  7. Environmental impact assessment - A management tool for conservation of large marine ecosystems

    Digital Repository Service at National Institute of Oceanography (India)

    Nair, V.R.

    and conservation of natural resources. The problem has become crucial and the only alternative is the implementation of Environment Impact Assessment (EIA) to evolve environmental management strategies for optimum use of a given coastal area without disturbing...

  8. Multifunctional management of mountain forests - Compromises between the protection and conservation functions

    Directory of Open Access Journals (Sweden)

    Marc Fuhr, Nicolas Clouet, Thomas Cordonnier and Frédéric Berger

    2011-03-01

    Full Text Available How can the balance between protection against natural hazards and biodiversity conservation be determined at each stage in forest development? This study provides a number of answers in view of improving multifunctional management.

  9. Individualized Infliximab Treatment Guided by Patient-managed eHealth in Children and Adolescents with Inflammatory Bowel Disease.

    Science.gov (United States)

    Carlsen, Katrine; Houen, Gunnar; Jakobsen, Christian; Kallemose, Thomas; Paerregaard, Anders; Riis, Lene B; Munkholm, Pia; Wewer, Vibeke

    2017-09-01

    To individualize timing of infliximab (IFX) treatment in children and adolescents with inflammatory bowel disease (IBD) using a patient-managed eHealth program. Patients with IBD, 10 to 17 years old, treated with IFX were prospectively included. Starting 4 weeks after their last infusion, patients reported a weekly symptom score and provided a stool sample for fecal calprotectin analysis. Based on symptom scores and fecal calprotectin results, the eHealth program calculated a total inflammation burden score that determined the timing of the next IFX infusion (4-12 wk after the previous infusion). Quality of Life was scored by IMPACT III. A control group was included to compare trough levels of IFX antibodies and concentrations and treatment intervals. Patients and their parents evaluated the eHealth program. There were 29 patients with IBD in the eHealth group and 21 patients with IBD in the control group. During the control period, 94 infusions were provided in the eHealth group (mean interval 9.5 wk; SD 2.3) versus 105 infusions in the control group (mean interval 6.9 wk; SD 1.4). Treatment intervals were longer in the eHealth group (P eHealth-individualized timing of IFX treatments, with treatment intervals of 4 to 12 weeks, was accompanied by no significant development of IFX antibodies. Patients reported better control and improved knowledge of their IBD.

  10. Patterns of Internet use by gastroenterologists in the management and education of patients with inflammatory bowel disease.

    Science.gov (United States)

    Nguyen, Douglas L; Rasheed, Sarah; Parekh, Nimisha K

    2014-05-01

    To define the patterns of Internet use among physicians who treat inflammatory bowel disease (IBD) and physicians' perceptions of their patients' Internet use. An online survey about physician and patient use of the Internet was created and e-mailed to gastroenterologists nationwide. Surveys were distributed and collected via an online database and a subsequent statistical analysis was performed. Of the 1000 e-mail invitations sent to practicing gastroenterologists in the United States, 223 participants (22.3%) completed the survey. A total of 183 (82.1%) physicians reported using an Internet-based reference to assist them in deriving management strategies for their patients with IBD, with the most commonly utilized resource being UpToDate followed by PubMed and the Crohn's and Colitis Foundation of America Web site. Although nearly 80% of gastroenterologists believed that using the Internet helped them facilitate clinical discussions, 183 participants (82.1%) believed that inaccurate information found online could sometimes result in increased clinic time because physicians must spend more time dispelling misleading information. Despite a study design biased toward selecting gastroenterologists who commonly used the Internet, we demonstrated that only 60% of the providers routinely refer their patients to the Internet. This underscores the fact that it is important to have a centralized "physician-certified" online resource to which physicians could readily refer their patients to navigate through various disease-specific resources without concern that their patients are receiving unreliable or misleading information.

  11. Balance of Autonomic Nervous System Predicts Who Benefits from a Self-management Intervention Program for Irritable Bowel Syndrome.

    Science.gov (United States)

    Jarrett, Monica E; Cain, Kevin C; Barney, Pamela G; Burr, Robert L; Naliboff, Bruce D; Shulman, Robert; Zia, Jasmine; Heitkemper, Margaret M

    2016-01-31

    To determine if potential biomarkers can be used to identify subgroups of people with irritable bowel syndrome (IBS) who will benefit the most or the least from a comprehensive self-management (CSM) intervention. In a two-armed randomized controlled trial a CSM (n = 46) was compared to a usual care (n = 46) group with follow-up at 3 and 6 months post randomization. Biomarkers obtained at baseline included heart rate variability, salivary cortisol, interleukin-10 produced by unstimulated peripheral blood mononuclear cells, and lactulose/mannitol ratio. Linear mixed models were used to test whether these biomarkers predicted improvements in the primary outcomes including daily abdominal pain, Gastrointestinal Symptom score and IBS-specific quality of life. The nurse-delivered 8-session CSM intervention is more effective than usual care in reducing abdominal pain, reducing Gastrointestinal Symptom score, and enhancing quality of life. Participants with lower nighttime high frequency heart rate variability (vagal modulation) and increased low frequency/high frequency ratio (sympathovagal balance) had less benefit from CSM on abdominal pain. Salivary cortisol, IL-10, and lactulose/mannitol ratio were not statistically significant in predicting CSM benefit. Baseline symptom severity interacts with treatment, namely the benefit of CSM is greater in those with higher baseline symptoms. Cognitively-focused therapies may be less effective in reducing abdominal pain in IBS patients with higher sympathetic tone. Whether this a centrally-mediated patient characteristic or related to heightened arousal remains to be determined.

  12. Fetal bowel anomalies - US and MR assessment

    Energy Technology Data Exchange (ETDEWEB)

    Rubesova, Erika [Stanford University, Department of Radiology, Lucile Packard Children' s Hospital, Stanford, CA (United States)

    2012-01-15

    The technical quality of prenatal US and fetal MRI has significantly improved during the last decade and allows an accurate diagnosis of bowel pathology prenatally. Accurate diagnosis of bowel pathology in utero is important for parental counseling and postnatal management. It is essential to recognize the US presentation of bowel pathology in the fetus in order to refer the patient for further evaluation or follow-up. Fetal MRI has been shown to offer some advantages over US for specific bowel abnormalities. In this paper, we review the normal appearance of the fetal bowel on US and MRI as well as the typical presentations of bowel pathologies. We discuss more specifically the importance of recognizing on fetal MRI the abnormalities of size and T1-weighted signal of the meconium-filled distal bowel. (orig.)

  13. Management of irritable bowel syndrome in primary care: feasibility randomised controlled trial of mebeverine, methylcellulose, placebo and a patient self-management cognitive behavioural therapy website. (MIBS trial

    Directory of Open Access Journals (Sweden)

    Yardley Lucy

    2010-11-01

    Full Text Available Abstract Background IBS affects 10-22% of the UK population. Abdominal pain, bloating and altered bowel habit affect quality of life, social functioning and time off work. Current GP treatment relies on a positive diagnosis, reassurance, lifestyle advice and drug therapies, but many suffer ongoing symptoms. A recent Cochrane review highlighted the lack of research evidence for IBS drugs. Neither GPs, nor patients have good evidence to inform prescribing decisions. However, IBS drugs are widely used: In 2005 the NHS costs were nearly £10 million for mebeverine and over £8 million for fibre-based bulking agents. CBT and self-management can be helpful, but poor availability in the NHS restricts their use. We have developed a web-based CBT self-management programme, Regul8, based on an existing evidence based self-management manual and in partnership with patients. This could increase access with minimal increased costs. Methods/Design The aim is to undertake a feasibility factorial RCT to assess the effectiveness of the commonly prescribed medications in UK general practice for IBS: mebeverine (anti-spasmodic and methylcellulose (bulking-agent and Regul8, the CBT based self-management website. 135 patients aged 16 to 60 years with IBS symptoms fulfilling Rome III criteria, recruited via GP practices, will be randomised to 1 of 3 levels of the drug condition: mebeverine, methylcellulose or placebo for 6 weeks and to 1 of 3 levels of the website condition, Regul8 with a nurse telephone session and email support, Regul8 with minimal email support, or no website, thus creating 9 groups. Outcomes: Irritable bowel symptom severity scale and IBS-QOL will be measured at baseline, 6 and 12 weeks as the primary outcomes. An intention to treat analysis will be undertaken by ANCOVA for a factorial trial. Discussion This pilot will provide valuable information for a larger trial. Determining the effectiveness of commonly used drug treatments will help

  14. Bringing genetic diversity to the forefront of conservation policy and management

    DEFF Research Database (Denmark)

    Hoban, S.M.; Hauffe, H.C.; Pérez-Espona, S.

    2013-01-01

    In this essay we explore questions on how to increase the visibility and utility of genetic information for biodiversity managers and policy makers. This is discussed in the light of Aichi CBD Target 13, which for the first time impels signatories to minimise genetic erosion and safeguard genetic...... genetics. We then discuss the implications of these findings for academics involved in conservation genetics and suggest that a much closer partnership between academic conservation geneticists and conservation practitioners is necessary if the full potential of genetic tools in conservation...

  15. Fecal Calprotectin Is Not Affected by Pregnancy: Clinical Implications for the Management of Pregnant Patients with Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Julsgaard, Mette; Hvas, Christian L; Gearry, Richard B

    2017-01-01

    Background: Noninvasive biomarkers of inflammation for monitoring inflammatory bowel disease (IBD) are important in pregnancy. Clinical and laboratory markers are often affected by the physiological adaption that occurs during pregnancy, although, few, if any, data exist on fecal calprotectin (FC...

  16. 41 CFR 102-74.155 - What energy conservation policy must Federal agencies follow in the management of facilities?

    Science.gov (United States)

    2010-07-01

    ... policy must Federal agencies follow in the management of facilities? 102-74.155 Section 102-74.155 Public... MANAGEMENT REGULATION REAL PROPERTY 74-FACILITY MANAGEMENT Facility Management Energy Conservation § 102-74.155 What energy conservation policy must Federal agencies follow in the management of facilities...

  17. Management strategies for the conservation of forest birds

    Science.gov (United States)

    Kathleen E. Franzreb; Deborah M. Finch; Petra Bohall Wood; David E. Capen

    1999-01-01

    We recommend that managers of forest-associated bird species follow a five-step hierarchy in establishing and implementing management programs. In essence, a manager must evaluate the composition and physiognomy of the landscape mosaic in the context of the regional and subregional goals and objectives. Then he/she can explore alternatives that allow manipulation of...

  18. Mobile Phone Apps for Inflammatory Bowel Disease Self-Management: A Systematic Assessment of Content and Tools

    Science.gov (United States)

    Con, Danny

    2016-01-01

    Background The rising incidence of inflammatory bowel disease (IBD) over the past decade has resulted in increased health care utilization and longer IBD outpatient waiting lists. Self-management is recognized as an important aspect of chronic disease management but its application to IBD has been limited. The age of IBD onset in a majority of patients is in their 20s to 30s. Mobile phone apps are a technology familiar to young adults and represent an opportunity to explore self-management as a new model of health care delivery for IBD. Objective The aim of this study was to explore the content and tools of existing IBD apps to identify functionalities that may facilitate patient self-management. Methods We systematically assessed apps targeted at IBD patients via searches of Google (Android devices) and Apple (iOS devices) app stores with pre-defined inclusion and exclusion criteria. Apps were assessed for specific functionalities; presence of professional medical involvement; consistency with international IBD guidelines based on “complete,” “partial,” or “absent” coverage of consensus statements derived from the European Crohn’s and Colitis Organisation, American College of Gastroenterology, and the Gastroenterology Society of Australia; comprehensiveness of data that could be entered; and average pricing. Results Of the 238 apps screened, 26 apps were assessed, including 10 available on Android platforms, 8 on iOS platforms, and 8 on both. Over half (14/26, 54%) of the apps had diary functionalities; over a third (10/26, 39%) provided health information about IBD. None of the apps offered decision support to facilitate the self-initiation of medical therapy. Five of 26 (19%) had professional medical involvement in their design. Apps demonstrated “complete” coverage of only 38% of the international consensus statements explored. The average price of the apps was AUD$1.37. Conclusions Apps may provide a useful adjunct to the management of IBD

  19. Mobile Phone Apps for Inflammatory Bowel Disease Self-Management: A Systematic Assessment of Content and Tools.

    Science.gov (United States)

    Con, Danny; De Cruz, Peter

    2016-02-01

    The rising incidence of inflammatory bowel disease (IBD) over the past decade has resulted in increased health care utilization and longer IBD outpatient waiting lists. Self-management is recognized as an important aspect of chronic disease management but its application to IBD has been limited. The age of IBD onset in a majority of patients is in their 20s to 30s. Mobile phone apps are a technology familiar to young adults and represent an opportunity to explore self-management as a new model of health care delivery for IBD. The aim of this study was to explore the content and tools of existing IBD apps to identify functionalities that may facilitate patient self-management. We systematically assessed apps targeted at IBD patients via searches of Google (Android devices) and Apple (iOS devices) app stores with pre-defined inclusion and exclusion criteria. Apps were assessed for specific functionalities; presence of professional medical involvement; consistency with international IBD guidelines based on "complete," "partial," or "absent" coverage of consensus statements derived from the European Crohn's and Colitis Organisation, American College of Gastroenterology, and the Gastroenterology Society of Australia; comprehensiveness of data that could be entered; and average pricing. Of the 238 apps screened, 26 apps were assessed, including 10 available on Android platforms, 8 on iOS platforms, and 8 on both. Over half (14/26, 54%) of the apps had diary functionalities; over a third (10/26, 39%) provided health information about IBD. None of the apps offered decision support to facilitate the self-initiation of medical therapy. Five of 26 (19%) had professional medical involvement in their design. Apps demonstrated "complete" coverage of only 38% of the international consensus statements explored. The average price of the apps was AUD$1.37. Apps may provide a useful adjunct to the management of IBD patients. However, a majority of current apps suffer from a lack of

  20. Diet in irritable bowel syndrome

    OpenAIRE

    El-Salhy, Magdy; Gundersen, Doris Irene

    2015-01-01

    Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder that is characterized by intermittent abdominal pain/discomfort, altered bowel habits and abdominal bloating/distension. This review aimed at presenting the recent developments concerning the role of diet in the pathophysiology and management of IBS. There is no convincing evidence that IBS patients suffer from food allergy/intolerance, and there is no evidence that gluten causes the debated new diagnosis of non-coel...

  1. Bowel Ultrasonography in the Management of Crohn's Disease. A Review with Recommendations of an International Panel of Experts.

    Science.gov (United States)

    Calabrese, Emma; Maaser, Christian; Zorzi, Francesca; Kannengiesser, Klaus; Hanauer, Stephen B; Bruining, David H; Iacucci, Marietta; Maconi, Giovanni; Novak, Kerri L; Panaccione, Remo; Strobel, Deike; Wilson, Stephanie R; Watanabe, Mamoru; Pallone, Francesco; Ghosh, Subrata

    2016-05-01

    Bowel ultrasonography (US) is considered a useful technique for assessing mural inflammation and complications in Crohn's disease (CD). The aim of this review is to appraise the evidence on the accuracy of bowel US for CD. In addition, we aim to provide recommendations for its optimal use. Publications were identified by literature search from 1992 to 2014 and selected based on predefined criteria: 15 or more patients; bowel US for diagnosing CD, complications, postoperative recurrence, activity; adequate reference standards; prospective study design; data reported to allow calculation of sensitivity, specificity, agreement, or correlation values; articles published in English. The search yielded 655 articles, of which 63 were found to be eligible and retrieved as full-text articles for analysis. Bowel US showed 79.7% sensitivity and 96.7% specificity for the diagnosis of suspected CD, and 89% sensitivity and 94.3% specificity for initial assessment in established patients with CD. Bowel US identified ileal CD with 92.7% sensitivity, 88.2% specificity, and colon CD with 81.8% sensitivity, 95.3% specificity, with lower accuracy for detecting proximal lesions. The oral contrast agent improves the sensitivity and specificity in determining CD lesions and in assessing sites and extent. Bowel US is a tool for evaluation of CD lesions in terms of complications, postoperative recurrence, and monitoring response to medical therapy; it reliably detects postoperative recurrence and complications, as well as offers the possibility of monitoring disease progression.

  2. Diet, Gut Microbiome and Epigenetics: Emerging Links with Inflammatory Bowel Diseases and Prospects for Management and Prevention.

    Science.gov (United States)

    Aleksandrova, Krasimira; Romero-Mosquera, Beatriz; Hernandez, Vicent

    2017-08-30

    Inflammatory bowel diseases (IBD) represent a growing public health concern due to increasing incidence worldwide. The current notion on the pathogenesis of IBD is that genetically susceptible individuals develop intolerance to dysregulated gut microflora (dysbiosis) and chronic inflammation develops as a result of environmental triggers. Among the environmental factors associated with IBD, diet plays an important role in modulating the gut microbiome, influencing epigenetic changes, and, therefore, could be applied as a therapeutic tool to improve the disease course. Nevertheless, the current dietary recommendations for disease prevention and management are scarce and have weak evidence. This review summarises the current knowledge on the complex interactions between diet, microbiome and epigenetics in IBD. Whereas an overabundance of calories and some macronutrients increase gut inflammation, several micronutrients have the potential to modulate it. Immunonutrition has emerged as a new concept putting forward the importance of vitamins such as vitamins A, C, E, and D, folic acid, beta carotene and trace elements such as zinc, selenium, manganese and iron. However, when assessed in clinical trials, specific micronutrients exerted a limited benefit. Beyond nutrients, an anti-inflammatory dietary pattern as a complex intervention approach has become popular in recent years. Hence, exclusive enteral nutrition in paediatric Crohn's disease is the only nutritional intervention currently recommended as a first-line therapy. Other nutritional interventions or specific diets including the Specific Carbohydrate Diet (SCD), the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyol (FODMAP) diet and, most recently, the Mediterranean diet have shown strong anti-inflammatory properties and show promise for improving disease symptoms. More work is required to evaluate the role of individual food compounds and complex nutritional interventions with the

  3. Characteristics and management of patients with inflammatory bowel disease between a secondary and tertiary hospitals: a propensity score analysis

    Directory of Open Access Journals (Sweden)

    Ki Hwan Song

    2018-04-01

    Full Text Available Background/Aims : This study aimed to compare the clinical characteristics and management patterns of inflammatory bowel disease (IBD patients in a secondary hospital (SH with those in tertiary referral centers (TRC. Methods : Data from IBD patients in SH and 2 TRCs were retrospectively reviewed. The cumulative thiopurine use rate was compared between hospitals after controlling for different baseline characteristics using propensity score matching. Results : Among the total of 447 patients with IBD, 178 Crohn's disease (CD and 269 ulcerative colitis (UC patients were included. Regarding initial CD symptoms, patients from SH were more likely to show perianal symptoms, such as anal pain or discharge (56.6% vs. 34.3%, P=0.003, whereas those from TRCs more often had luminal symptoms, such as abdominal pain (54.9% vs. 17.1%, P<0.001, diarrhea (44.1% vs. 18.4%, P<0.001, and body weight loss (9.8% vs. 1.3%, P=0.025. Complicating behaviors, such as stricturing and penetrating, were significantly higher in TRCs, while perianal disease was more common in SH. Ileal location was more frequently observed in TRCs. For UC, SH had a more limited extent of disease (proctitis 58.8% vs. 21.2%, P<0.001. The cumulative azathioprine use rate in SH was significantly lower than that in TRCs in both CD and UC patients after controlling for disease behavior, location, and perianal disease of CD and extent of UC. Conclusions : The clinical characteristics and management of the IBD patients in SH were substantially different from those in TRCs. Thiopurine treatment was less commonly used for SH patients.

  4. Research priorities for conservation and natural resource management in Oceania's small-island developing states.

    Science.gov (United States)

    Weeks, R; Adams, V M

    2018-02-01

    For conservation science to effectively inform management, research must focus on creating the scientific knowledge required to solve conservation problems. We identified research questions that, if answered, would increase the effectiveness of conservation and natural resource management practice and policy in Oceania's small-island developing states. We asked conservation professionals from academia, governmental, and nongovernmental organizations across the region to propose such questions and then identify which were of high priority in an online survey. We compared the high-priority questions with research questions identified globally and for other regions. Of 270 questions proposed by respondents, 38 were considered high priority, including: What are the highest priority areas for conservation in the face of increasing resource demand and climate change? How should marine protected areas be networked to account for connectivity and climate change? What are the most effective fisheries management policies that contribute to sustainable coral reef fisheries? High-priority questions related to the particular challenges of undertaking conservation on small-island developing states and the need for a research agenda that is responsive to the sociocultural context of Oceania. Research priorities for Oceania relative to elsewhere were broadly similar but differed in specific issues relevant to particular conservation contexts. These differences emphasize the importance of involving local practitioners in the identification of research priorities. Priorities were reasonably well aligned among sectoral groups. Only a few questions were widely considered answered, which may indicate a smaller-than-expected knowledge-action gap. We believe these questions can be used to strengthen research collaborations between scientists and practitioners working to further conservation and natural resource management in this region. © 2017 The Authors. Conservation Biology

  5. eHealth for inflammatory bowel disease self-management - the patient perspective.

    Science.gov (United States)

    Con, Danny; Jackson, Belinda; Gray, Kathleen; De Cruz, Peter

    2017-09-01

    Electronic health (eHealth) solutions may help address the growing pressure on IBD outpatient services as they encompass a component of self-management. However, information regarding patients' attitudes towards the use of eHealth solutions in IBD is lacking. The aim of this study was to evaluate eHealth technology use and explore the perspectives of IBD patients on what constitutes the ideal eHealth solution to facilitate self-management. A mixed methods qualitative and quantitative analysis of the outcomes of a discussion forum and an online survey conducted at a tertiary hospital in Melbourne, Australia between November 2015 and January 2016 was undertaken. Eighteen IBD patients and parents participated in the discussion forum. IBD patients expressed interest in eHealth tools that are convenient and improve access to care, communication, disease monitoring and adherence. Eighty six patients with IBD responded to the online survey. A majority of patients owned a mobile phone (98.8%), had access to the internet (97.7%), and felt confident entering data onto a phone or computer (73.3%). Most patients (98.8%) were willing to use at least one form of information and communication technology to help manage their IBD. Smartphone apps and internet websites were the two most preferred technologies to facilitate IBD self-management. This study demonstrates the willifngness of patients to engage with eHealth as a potential solution to facilitate IBD self-management. Future development and testing of eHealth solutions should be informed by all major stakeholders including patients to maximise their uptake and efficacy to facilitate IBD self-management.

  6. Physiology can contribute to better understanding, management, and conservation of coral reef fishes.

    Science.gov (United States)

    Illing, Björn; Rummer, Jodie L

    2017-01-01

    Coral reef fishes, like many other marine organisms, are affected by anthropogenic stressors such as fishing and pollution and, owing to climate change, are experiencing increasing water temperatures and ocean acidification. Against the backdrop of these various stressors, a mechanistic understanding of processes governing individual organismal performance is the first step for identifying drivers of coral reef fish population dynamics. In fact, physiological measurements can help to reveal potential cause-and-effect relationships and enable physiologists to advise conservation management by upscaling results from cellular and individual organismal levels to population levels. Here, we highlight studies that include physiological measurements of coral reef fishes and those that give advice for their conservation. A literature search using combined physiological, conservation and coral reef fish key words resulted in ~1900 studies, of which only 99 matched predefined requirements. We observed that, over the last 20 years, the combination of physiological and conservation aspects in studies on coral reef fishes has received increased attention. Most of the selected studies made their physiological observations at the whole organism level and used their findings to give conservation advice on population dynamics, habitat use or the potential effects of climate change. The precision of the recommendations differed greatly and, not surprisingly, was least concrete when studies examined the effects of projected climate change scenarios. Although more and more physiological studies on coral reef fishes include conservation aspects, there is still a lack of concrete advice for conservation managers, with only very few published examples of physiological findings leading to improved management practices. We conclude with a call to action to foster better knowledge exchange between natural scientists and conservation managers to translate physiological findings more

  7. A statistically rigorous sampling design to integrate avian monitoring and management within Bird Conservation Regions.

    Science.gov (United States)

    Pavlacky, David C; Lukacs, Paul M; Blakesley, Jennifer A; Skorkowsky, Robert C; Klute, David S; Hahn, Beth A; Dreitz, Victoria J; George, T Luke; Hanni, David J

    2017-01-01

    Monitoring is an essential component of wildlife management and conservation. However, the usefulness of monitoring data is often undermined by the lack of 1) coordination across organizations and regions, 2) meaningful management and conservation objectives, and 3) rigorous sampling designs. Although many improvements to avian monitoring have been discussed, the recommendations have been slow to emerge in large-scale programs. We introduce the Integrated Monitoring in Bird Conservation Regions (IMBCR) program designed to overcome the above limitations. Our objectives are to outline the development of a statistically defensible sampling design to increase the value of large-scale monitoring data and provide example applications to demonstrate the ability of the design to meet multiple conservation and management objectives. We outline the sampling process for the IMBCR program with a focus on the Badlands and Prairies Bird Conservation Region (BCR 17). We provide two examples for the Brewer's sparrow (Spizella breweri) in BCR 17 demonstrating the ability of the design to 1) determine hierarchical population responses to landscape change and 2) estimate hierarchical habitat relationships to predict the response of the Brewer's sparrow to conservation efforts at multiple spatial scales. The collaboration across organizations and regions provided economy of scale by leveraging a common data platform over large spatial scales to promote the efficient use of monitoring resources. We designed the IMBCR program to address the information needs and core conservation and management objectives of the participating partner organizations. Although it has been argued that probabilistic sampling designs are not practical for large-scale monitoring, the IMBCR program provides a precedent for implementing a statistically defensible sampling design from local to bioregional scales. We demonstrate that integrating conservation and management objectives with rigorous statistical

  8. A statistically rigorous sampling design to integrate avian monitoring and management within Bird Conservation Regions.

    Directory of Open Access Journals (Sweden)

    David C Pavlacky

    Full Text Available Monitoring is an essential component of wildlife management and conservation. However, the usefulness of monitoring data is often undermined by the lack of 1 coordination across organizations and regions, 2 meaningful management and conservation objectives, and 3 rigorous sampling designs. Although many improvements to avian monitoring have been discussed, the recommendations have been slow to emerge in large-scale programs. We introduce the Integrated Monitoring in Bird Conservation Regions (IMBCR program designed to overcome the above limitations. Our objectives are to outline the development of a statistically defensible sampling design to increase the value of large-scale monitoring data and provide example applications to demonstrate the ability of the design to meet multiple conservation and management objectives. We outline the sampling process for the IMBCR program with a focus on the Badlands and Prairies Bird Conservation Region (BCR 17. We provide two examples for the Brewer's sparrow (Spizella breweri in BCR 17 demonstrating the ability of the design to 1 determine hierarchical population responses to landscape change and 2 estimate hierarchical habitat relationships to predict the response of the Brewer's sparrow to conservation efforts at multiple spatial scales. The collaboration across organizations and regions provided economy of scale by leveraging a common data platform over large spatial scales to promote the efficient use of monitoring resources. We designed the IMBCR program to address the information needs and core conservation and management objectives of the participating partner organizations. Although it has been argued that probabilistic sampling designs are not practical for large-scale monitoring, the IMBCR program provides a precedent for implementing a statistically defensible sampling design from local to bioregional scales. We demonstrate that integrating conservation and management objectives with rigorous

  9. Conservation implications of weed management of lake reservoirs ...

    African Journals Online (AJOL)

    Management of weeds around lake reservoirs is often implemented to reduce any possibility of siltation. However, machineries used in weed management have resulted in habitat degradation and geometrical multiplication of weeds by chopping rhizomes and scattering seeds. In general, the removal offers some feedbacks ...

  10. Short bowel syndrome.

    LENUS (Irish Health Repository)

    Donohoe, Claire L

    2012-02-01

    The short bowel syndrome (SBS) is a state of malabsorption following intestinal resection where there is less than 200 cm of intestinal length. The management of short bowel syndrome can be challenging and is best managed by a specialised multidisciplinary team. A good understanding of the pathophysiological consequences of resection of different portions of the small intestine is necessary to anticipate and prevent, where possible, consequences of SBS. Nutrient absorption and fluid and electrolyte management in the initial stages are critical to stabilisation of the patient and to facilitate the process of adaptation. Pharmacological adjuncts to promote adaptation are in the early stages of development. Primary restoration of bowel continuity, if possible, is the principle mode of surgical treatment. Surgical procedures to increase the surface area of the small intestine or improve its function may be of benefit in experienced hands, particularly in the paediatric population. Intestinal transplant is indicated at present for patients who have failed to tolerate long-term parenteral nutrition but with increasing experience, there may be a potentially expanded role for its use in the future.

  11. WHAT TO CONSERVE? Heritage, Memory, and Management of Meanings

    Directory of Open Access Journals (Sweden)

    Ehab KAMEL-AHMED

    2015-03-01

    Full Text Available This Paper explores and criticizes different theories and perceptions concerning ‘cultural heritage’ to explore the definitions of ‘heritage’ throughout history, and questions how the conflicts in considering and identifying ‘heritage’ might have affected the approaches to its conservation. In such process, the paper investigates the relation between ‘place’ and ‘memory’ and how place has been always the medium through which history was written, resulting in two inseparable faces, tangible and the intangible, forming the two-faced coin of ‘cultural heritage’. This research assists understanding the complex construct of heritage places; stressing the growing awareness of intangible heritage’s importance, which represents a remarkable turn in heritage conservation realm in the twenty-first century, and emphasizing the notion of heritage as a coefficient of society, which is understood through experience, learnt through performance, and represented through ‘activities’ formed in the present maintaining and developing the identity of place and preserving its spirit, rather than a past oriented vision that tends to ‘pickle’ images from the past in a picturesque manner that is only tourism-oriented.

  12. Conservative Management of Invasive Cervical Resorption: A Case Report

    Directory of Open Access Journals (Sweden)

    Farhan Raza Khan

    2013-01-01

    Full Text Available Invasive cervical resorption is a condition that affects the root surface area below the epithelial attachment. Multiple treatment modalities are advocated, involving exposure of the invasive defect, removal of the granulation tissue and sealing with various restorative materials. This report demonstrates conservative treatment of a patient presenting with peri-apical periodontitis in upper right central and lateral incisors, along with Class II invasive resorption defect cervically on the mesial aspect of the central incisor, as a result of trauma. As the patient was not willing for any surgical intervention, only ortho-grade root canal treatment was carried out in both teeth, with Calcium hydroxide as intra-canal medicament. At three year follow-up, the patient remains asymptomatic demonstrating radiographic evidence of infilling of defect with bone-like tissue.Within the limitations of this report, it was seen that this conservative method for halting the progression of invasive cervical resorption could be under taken in patients who are un-willing for surgical intervention or in whom surgery is contra-indicated.

  13. Energy conservation and management system using efficient building automation

    Science.gov (United States)

    Ahmed, S. Faiz; Hazry, D.; Tanveer, M. Hassan; Joyo, M. Kamran; Warsi, Faizan A.; Kamarudin, H.; Wan, Khairunizam; Razlan, Zuradzman M.; Shahriman A., B.; Hussain, A. T.

    2015-05-01

    In countries where the demand and supply gap of electricity is huge and the people are forced to endure increasing hours of load shedding, unnecessary consumption of electricity makes matters even worse. So the importance and need for electricity conservation increases exponentially. This paper outlines a step towards the conservation of energy in general and electricity in particular by employing efficient Building Automation technique. It should be noted that by careful designing and implementation of the Building Automation System, up to 30% to 40% of energy consumption can be reduced, which makes a huge difference for energy saving. In this study above mentioned concept is verified by performing experiment on a prototype experimental room and by implementing efficient building automation technique. For the sake of this efficient automation, Programmable Logic Controller (PLC) is employed as a main controller, monitoring various system parameters and controlling appliances as per required. The hardware test run and experimental findings further clarifies and proved the concept. The added advantage of this project is that it can be implemented to both small and medium level domestic homes thus greatly reducing the overall unnecessary load on the Utility provider.

  14. Use of monitoring data to support conservation management and policy decisions in Micronesia.

    Science.gov (United States)

    Montambault, Jensen Reitz; Wongbusarakum, Supin; Leberer, Trina; Joseph, Eugene; Andrew, Wayne; Castro, Fran; Nevitt, Brooke; Golbuu, Yimnang; Oldiais, Noelle W; Groves, Craig R; Kostka, Willy; Houk, Peter

    2015-10-01

    Adaptive management implies a continuous knowledge-based decision-making process in conservation. Yet, the coupling of scientific monitoring and management frameworks remains rare in practice because formal and informal communication pathways are lacking. We examined 4 cases in Micronesia where conservation practitioners are using new knowledge in the form of monitoring data to advance marine conservation. These cases were drawn from projects in Micronesia Challenge jurisdictions that received funding for coupled monitoring-to-management frameworks and encompassed all segments of adaptive management. Monitoring in Helen Reef, Republic of Palau, was catalyzed by coral bleaching and revealed evidence of overfishing that led to increased enforcement and outreach. In Nimpal Channel, Yap, Federated States of Micronesia (FSM), monitoring the recovery of marine food resources after customary restrictions were put in place led to new, more effective enforcement approaches. Monitoring in Laolao Bay, Saipan, Commonwealth of the Northern Mariana Islands, was catalyzed by observable sediment loads from poor land-use practices and resulted in actions that reduced land-based threats, particularly littering and illegal burning, and revealed additional threats from overfishing. Pohnpei (FSM) began monitoring after observed declines in grouper spawning aggregations. This data led to adjusting marine conservation area boundaries and implementing market-based size class restrictions. Two themes emerged from these cases. First, in each case monitoring was conducted in a manner relevant to the social and ecological systems and integrated into the decision-making process. Second, conservation practitioners and scientists in these cases integrated culturally appropriate stakeholder engagement throughout all phases of the adaptive management cycle. More broadly, our study suggests, when describing adaptive management, providing more details on how monitoring and management activities are

  15. Small Bowel Bleeding

    Science.gov (United States)

    ... pouchings in the wall of the colon), or cancer. Upper GI (esophagus, stomach, or duodenum) bleeding is most often due ... begins transmitting images of the inside of the esophagus, stomach, and small bowel to a ... Bowel Disease Irritable Bowel Syndrome ...

  16. Systematic Planning and Ecosystem-Based Management as Strategies to Reconcile Mangrove Conservation with Resource Use

    Directory of Open Access Journals (Sweden)

    Rebecca Borges

    2017-11-01

    Full Text Available About 120 million people worldwide live within 10 km of large mangrove forests, and many of them directly depend on the goods and services provided by these ecosystems. However, it remains unclear how to synchronize ecological definitions and legal conservation strategies regarding mangroves, especially in developing countries, such as Brazil. The influence of human populations' socio-economic context in mangrove conservation policies, as well associated challenges in incorporating this influence, are underestimated or, often, largely ignored. Considering the recent threats emerging from changes in legislation and the lack of spatial and social-ecological integrated data to plan mangrove conservation in Brazil, this paper aims to answer the following questions: (1 What suitable measures could managers and other decision makers adopt for efficient mangrove conservation planning?; (2 What are the site-specific, social-ecological aspects that need to be taken into account when deciding on conservation and management strategies?; and (3 How could science contribute to the development of these measures? In order to achieve an ecosystem-based management approach, mangrove ecosystems should not be divided into sub-systems, but instead treated as an integrated system. Furthermore, interconnections with other coastal ecosystems must be assessed and taken into account. This is crucial for effective systematic conservation planning. Also, most of the particular social-ecological aspects in the different types of mangrove ecosystems along the Brazilian coast, and how those differences might be considered while planning for conservation, remain poorly understood. Based on similar drivers of change, geological features, and likely impacts of climate change, a macro-unit approach is proposed to group mangrove systems along the Brazilian coast and guide national policies. This paper draws parallels with management approaches worldwide to find common points and

  17. Self-managed eHealth Disease Monitoring in Children and Adolescents with Inflammatory Bowel Disease: A Randomized Controlled Trial.

    Science.gov (United States)

    Carlsen, Katrine; Jakobsen, Christian; Houen, Gunnar; Kallemose, Thomas; Paerregaard, Anders; Riis, Lene B; Munkholm, Pia; Wewer, Vibeke

    2017-03-01

    To evaluate the impact of eHealth on disease activity, the need for hospital contacts, and medical adherence in children and adolescents with inflammatory bowel disease (IBD). Furthermore, to assess eHealth's influence on school attendance and quality of life (QoL). Patients with IBD, 10 to 17 years attending a public university hospital, were prospectively randomized to a 2-year open label case-controlled eHealth intervention. The eHealth-group used the web-application young.constant-care.com (YCC) on a monthly basis and in case of flare-ups, and were seen at one annual preplanned outpatient visit. The control-group continued standard visits every third month. Every 3 months, both groups had blood and fecal calprotectin tested and the following were assessed: escalation in medication, disease activity, hospital contacts, medical adherence, school absence, and QoL. Fifty-three patients in nonbiological treatment were included (27 eHealth/26 control). We found no differences between the groups regarding escalation in treatment and disease activity (symptoms, fecal calprotectin, and blood). The number of total outpatient visits (mean: eHealth 3.26, SEM 0.51; control 7.31, SEM 0.69; P eHealth 1.6, SEM 0.5; control 16.5, SEM 4.4; P eHealth-group. No differences in medical adherence and QoL were found. Adherence to YCC was 81% (384 of the 475 expected entries). None of the patients or parents felt unsafe using the eHealth system. The use of eHealth in children and adolescents with IBD is feasible, does not lead to impaired disease control, and can be managed by the patients without risk of increased disease activity.

  18. Multidisciplinary Team Meetings appear to be effective in Inflammatory Bowel Disease Management: An audit of process and outcomes.

    Science.gov (United States)

    Ferman, Mutaz; Lim, Amanda H; Hossain, Monowar; Siow, Glenn W; Andrews, Jane M

    2018-05-14

    Multidisciplinary team meetings (MDTMs) have proven efficacy in cancer management. Whilst widely implemented in inflammatory bowel disease (IBD) care, their value is yet to be investigated. We reviewed the performance of MDTMs for IBD patients. Retrospective review of MDTMs from March 2013 to July 2016. Each patient's first MDTM was considered. Data collected included: report production and location, disease factors, recommendation(s), implementation and barriers to implementation. The MDTM process was considered successful when at least top-level recommendations were implemented within 6 months. MDTM attendance included IBD gastroenterologist, surgeons, radiologist, nurses, dieticians, psychologists and clinical trial staff. Initial MDTM encounters for 166 patients were reviewed: 86 females; mean age 40 years; 140 (84.3%) with Crohn's disease; mean disease duration 10.8 years (interquartile range 15 years). Electronic reports were filed for all patients; hard copies in 84%. In 151/166 episodes, all (n=127) or top-line (n=24) recommendations were implemented, although there was a delay beyond 6 months in 5. Of 146 patients with a successful MDTM, 85 (58.2%) were in clinical remission at last review (median follow-up 27 months). Amongst patients with unsuccessful MDTMs (n=13), only 2 (15.4%) were in clinical remission at follow-up. Barriers to implementation included patients declining recommendations and loss to follow-up. The majority of MDTM encounters were successful from both a process and clinical outcome perspective. System opportunities to improve the process include ensuring 100% reports are available and addressing implementation delays. Patient factors to address include improved engagement and understanding reasons for declining recommendations. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  19. Compression Dressing Using Dental Impression Compound for Conservative Management of Sialocele.

    Science.gov (United States)

    Kudva, Adarsh; Carriappa, K M; Kamath, Abhay; Chithra, A

    2016-12-01

    A Sialocele or salivary pseudocyst is due to extravasation of saliva into periglandular tissue due to disruption of gland parenchyma. Various techniques of management have been described in literature; both conservative and surgical management have been documented. We report a simple economical and efficient method to deal with sailocele presenting after neck dissection.

  20. 75 FR 27182 - Energy Conservation Program: Web-Based Compliance and Certification Management System

    Science.gov (United States)

    2010-05-14

    ... Conservation Program: Web-Based Compliance and Certification Management System AGENCY: Office of Energy... following means: 1. Compliance and Certification Management System (CCMS)--via the Web portal: http... certification reports to the Department of Energy (DOE) through an electronic Web-based tool, the Compliance and...

  1. Groundwater resources: conservation and management: proceedings of the sixteenth national symposium on environment

    International Nuclear Information System (INIS)

    Puranik, V.D.; Ramachandran, T.V.; Saradhi, I.V.; Sahu, S.K.; Prathibha, P.

    2008-01-01

    The main theme of this volume is conservation and management of groundwater resources. The topics covered are groundwater for sustainable development, problems perspectives and challenges, monitoring and modeling of pollutants and their transport, waste management, environmental radioactivity and environmental awareness and biodiversity. Papers relevant to INIS are indexed separately

  2. Integrating In-Situ and Ex-Situ Data Management Processes for Biodiversity Conservation

    Directory of Open Access Journals (Sweden)

    Karin R. Schwartz

    2017-10-01

    Full Text Available There is an increasing need for a “one plan approach” for conservation strategies that integrate in-situ and ex-situ management processes. Zoological institutions contribute directly to threatened species conservation through paradigms, such as reintroduction, head-starting, supplementation, or rescue/rehabilitation/release. This in-situ/ex-situ integration necessitates collaboration at all levels of conservation action including planning, implementation, monitoring and assessment to drive adaptive management processes. Each component is dependent on the availability and accuracy of data for evidence to facilitate evaluation and adaptive management processes. The Zoological Information Management System (ZIMS, managed by Species360, is a centralized web-based information system used in zoological institutions worldwide to pool life history, behavior and health data and facilitate animal husbandry, health, and breeding management processes. Currently used for few integrated conservation programs, ZIMS is an innovative tool that offers a new opportunity to link data management processes for animals that spend a part of their lives under human care and part in their natural environment and has great potential for use in managed wild populations.

  3. 75 FR 24549 - Merchant Marine Act and Magnuson-Stevens Fishery Conservation and Management Act (Magnuson...

    Science.gov (United States)

    2010-05-05

    ... Management Act (Magnuson-Stevens Act) Provisions; Fishing Vessel, Fishing Facility and Individual Fishing... Fisheries Finance Program (FFP or the Program) provides long-term financing to the commercial fishing and...) lending program, 16 U.S.C. 1855(i)(1). The Magnuson-Stevens Fishery Conservation and Management...

  4. Administrative Co-management: The Case of Special-Use Forest Conservation in Vietnam

    NARCIS (Netherlands)

    Nguyen, T.K.D.; Bush, S.R.; Mol, A.P.J.

    2013-01-01

    Special-use forests (SUFs) are nature protected areas in Vietnam used to conserve nature and its biodiversity. While the Vietnamese government has managed to increase the size and number of SUFs, biodiversity within these areas continues to decline. To improve protection of these SUFs, co-management

  5. Spectrum of dysfunctional uterine bleeding and its conservative management

    International Nuclear Information System (INIS)

    Siddiqui, S.H.

    2003-01-01

    To find out the proportion of dysfunctional uterine bleeding (DUB) and the response of patients of DUB to medical treatment at Abbasi Shaheed Hospital. Results: Two hundred and ten out of 1300 patients were diagnosed as having DUB with the proportion of 16.1%. Response rate was 20 - 30 % with oral mafenamic acid, 50% with capsule tranexamic acid, 60% and 50% respectively with oral contraceptive pills containing ethinylestradiol and norethisterone, and norethisterone alone. The response rate with capsulated micronised flavonoid and derivative of ethinyltestosterone was 90% and 75% respectively. Conclusion: The patients in adolescent age group are good responders to conservative treatment. Most of the patients preferred micronised flavonoid over derivative of ethinyltestosterone for some misconceptions regarding this medicine. The former was better tolerated with less side effects. (author)

  6. Disease course and management strategy of pouch neoplasia in patients with underlying inflammatory bowel diseases.

    Science.gov (United States)

    Wu, Xian-Rui; Remzi, Feza H; Liu, Xiu-Li; Lian, Lei; Stocchi, Luca; Ashburn, Jean; Shen, Bo

    2014-11-01

    To evaluate the disease course and management strategy for pouch neoplasia. Patients undergoing ileal pouch surgery for underlying ulcerative colitis who developed low-grade dysplasia (LGD), high-grade dysplasia, or adenocarcinoma in the pouch were identified. All eligible 44 patients were evaluated. Of the 22 patients with initial diagnosis of pouch LGD, 6 (27.3%) had persistence or progression after a median follow-up of 9.5 (4.1-17.6) years. Family history of colorectal cancer was shown to be a risk factor associated with persistence or progression of LGD (P = 0.03). Of the 12 patients with pouch high-grade dysplasia, 5 (41.7%) had a history of (n = 2, 16.7%) or synchronous (n = 4, 33.3%) pouch LGD. Pouch high-grade dysplasia either persisted or progressed in 3 patients (25.0%) after the initial management, during a median time interval of 5.4 (2.2-9.2) years. Of the 14 patients with pouch adenocarcinoma, 12 (85.7%) had a history of (n = 2, 14.3%) or synchronous dysplasia (n = 12, 85.7%). After a median follow-up of 2.1 (0.6-5.2) years, 6 patients with pouch cancer (42.9%) died. Comparison of patients with a final diagnosis of pouch adenocarcinoma (14, 32.6%), and those with dysplasia (29, 67.4%) showed that patients with adenocarcinoma were older (P = 0.04) and had a longer duration from IBD diagnosis or pouch construction to the detection of pouch neoplasia (P = 0.007 and P = 0.0013). The risk for progression of pouch dysplasia can be stratified. The presence of family history of colorectal cancer seemed to increase the risk for persistence or progression for patients with pouch LGD. The prognosis for pouch adenocarcinoma was poor.

  7. Cheap and Nasty? The Potential Perils of Using Management Costs to Identify Global Conservation Priorities

    Science.gov (United States)

    McCreless, Erin; Visconti, Piero; Carwardine, Josie; Wilcox, Chris; Smith, Robert J.

    2013-01-01

    The financial cost of biodiversity conservation varies widely around the world and such costs should be considered when identifying countries to best focus conservation investments. Previous global prioritizations have been based on global models for protected area management costs, but this metric may be related to other factors that negatively influence the effectiveness and social impacts of conservation. Here we investigate such relationships and first show that countries with low predicted costs are less politically stable. Local support and capacity can mitigate the impacts of such instability, but we also found that these countries have less civil society involvement in conservation. Therefore, externally funded projects in these countries must rely on government agencies for implementation. This can be problematic, as our analyses show that governments in countries with low predicted costs score poorly on indices of corruption, bureaucratic quality and human rights. Taken together, our results demonstrate that using national-level estimates for protected area management costs to set global conservation priorities is simplistic, as projects in apparently low-cost countries are less likely to succeed and more likely to have negative impacts on people. We identify the need for an improved approach to develop global conservation cost metrics that better capture the true costs of avoiding or overcoming such problems. Critically, conservation scientists must engage with practitioners to better understand and implement context-specific solutions. This approach assumes that measures of conservation costs, like measures of conservation value, are organization specific, and would bring a much-needed focus on reducing the negative impacts of conservation to develop projects that benefit people and biodiversity. PMID:24260502

  8. Cheap and nasty? The potential perils of using management costs to identify global conservation priorities.

    Directory of Open Access Journals (Sweden)

    Erin McCreless

    Full Text Available The financial cost of biodiversity conservation varies widely around the world and such costs should be considered when identifying countries to best focus conservation investments. Previous global prioritizations have been based on global models for protected area management costs, but this metric may be related to other factors that negatively influence the effectiveness and social impacts of conservation. Here we investigate such relationships and first show that countries with low predicted costs are less politically stable. Local support and capacity can mitigate the impacts of such instability, but we also found that these countries have less civil society involvement in conservation. Therefore, externally funded projects in these countries must rely on government agencies for implementation. This can be problematic, as our analyses show that governments in countries with low predicted costs score poorly on indices of corruption, bureaucratic quality and human rights. Taken together, our results demonstrate that using national-level estimates for protected area management costs to set global conservation priorities is simplistic, as projects in apparently low-cost countries are less likely to succeed and more likely to have negative impacts on people. We identify the need for an improved approach to develop global conservation cost metrics that better capture the true costs of avoiding or overcoming such problems. Critically, conservation scientists must engage with practitioners to better understand and implement context-specific solutions. This approach assumes that measures of conservation costs, like measures of conservation value, are organization specific, and would bring a much-needed focus on reducing the negative impacts of conservation to develop projects that benefit people and biodiversity.

  9. Cheap and nasty? The potential perils of using management costs to identify global conservation priorities.

    Science.gov (United States)

    McCreless, Erin; Visconti, Piero; Carwardine, Josie; Wilcox, Chris; Smith, Robert J

    2013-01-01

    The financial cost of biodiversity conservation varies widely around the world and such costs should be considered when identifying countries to best focus conservation investments. Previous global prioritizations have been based on global models for protected area management costs, but this metric may be related to other factors that negatively influence the effectiveness and social impacts of conservation. Here we investigate such relationships and first show that countries with low predicted costs are less politically stable. Local support and capacity can mitigate the impacts of such instability, but we also found that these countries have less civil society involvement in conservation. Therefore, externally funded projects in these countries must rely on government agencies for implementation. This can be problematic, as our analyses show that governments in countries with low predicted costs score poorly on indices of corruption, bureaucratic quality and human rights. Taken together, our results demonstrate that using national-level estimates for protected area management costs to set global conservation priorities is simplistic, as projects in apparently low-cost countries are less likely to succeed and more likely to have negative impacts on people. We identify the need for an improved approach to develop global conservation cost metrics that better capture the true costs of avoiding or overcoming such problems. Critically, conservation scientists must engage with practitioners to better understand and implement context-specific solutions. This approach assumes that measures of conservation costs, like measures of conservation value, are organization specific, and would bring a much-needed focus on reducing the negative impacts of conservation to develop projects that benefit people and biodiversity.

  10. Subclavian artery dissection during diagnostic cardiac catheterization: the role of conservative management.

    Science.gov (United States)

    Frohwein, S; Ververis, J J; Marshall, J J

    1995-04-01

    Dissection of the subclavian artery during routine cardiac catheterization while obtaining cannulation to the left internal mammary artery is an unusual complication and to our knowledge has never been reported. Conservative management of this vascular injury can avoid the sequelae of high-risk surgical repairs made difficult by a complex operative exposure. We describe a case in which dissection of the left subclavian artery was treated conservatively with an excellent outcome.

  11. Conservative Management of an Epicardial Collateral Perforation During Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention.

    Science.gov (United States)

    Ngo, Christian; Christopoulos, George; Brilakis, Emmanouil S

    2016-01-01

    Coronary artery perforation is a highly feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and can lead to pericardial effusion, tamponade, and, rarely, emergent cardiac surgery. Perforation of epicardial collaterals during retrograde CTO-PCI may be particularly challenging to treat, as embolization from both sides of the perforation may be required to control the bleeding. However, conservative measures can occasionally be effective. We present a case of epicardial collateral vessel perforation that was managed conservatively with anticoagulation reversal.

  12. Oral water soluble contrast for malignant bowel obstruction.

    Science.gov (United States)

    Syrmis, William; Richard, Russell; Jenkins-Marsh, Sue; Chia, Siew C; Good, Phillip

    2018-03-07

    Malignant bowel obstruction (MBO) is a common problem in patients with intra-abdominal cancer. Oral water soluble contrast (OWSC) has been shown to be useful in the management of adhesive small bowel obstruction in identifying patients who will recover with conservative management alone and also in reducing the length of hospital stay. It is not clear whether the benefits of OWSC in adhesive small bowel obstruction are also seen in patients with MBO. To determine the reliability of OWSC media and follow-up abdominal radiographs in predicting the success of conservative treatment in resolving inoperable MBO with conservative management.To determine the efficacy and safety of OWSC media in reducing the duration of obstruction and reducing hospital stay in people with MBO. We identified studies from searching Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in Process, Embase, CINAHL, Science Citation Index (Web of Science) and Conference Proceedings Citation Index - Science (Web of Science). We also searched registries of clinical trials and the CareSearch Grey Literature database. The date of the search was the 6 June 2017. Randomised controlled trials (RCTs), or prospective controlled studies, that evaluated the diagnostic potential of OWSC in predicting which malignant bowel obstructions will resolve with conservative treatment.RCTs, or prospective controlled studies, that assessed the therapeutic potential of OWSC in managing MBO at any level compared with placebo, no intervention or usual treatment or supportive care. We used standard methodological procedures expected by Cochrane. We assessed risk of bias and assessed the evidence using GRADE and created a 'Summary of findings' table. We found only one RCT meeting the selection criteria for the second objective (therapeutic potential) of this review. This study recruited nine participants. It compared the use of gastrografin versus placebo in adult patients with MBO with no

  13. Using landscape limnology to classify freshwater ecosystems for multi-ecosystem management and conservation

    Science.gov (United States)

    Soranno, Patricia A.; Cheruvelil, Kendra Spence; Webster, Katherine E.; Bremigan, Mary T.; Wagner, Tyler; Stow, Craig A.

    2010-01-01

    Governmental entities are responsible for managing and conserving large numbers of lake, river, and wetland ecosystems that can be addressed only rarely on a case-by-case basis. We present a system for predictive classification modeling, grounded in the theoretical foundation of landscape limnology, that creates a tractable number of ecosystem classes to which management actions may be tailored. We demonstrate our system by applying two types of predictive classification modeling approaches to develop nutrient criteria for eutrophication management in 1998 north temperate lakes. Our predictive classification system promotes the effective management of multiple ecosystems across broad geographic scales by explicitly connecting management and conservation goals to the classification modeling approach, considering multiple spatial scales as drivers of ecosystem dynamics, and acknowledging the hierarchical structure of freshwater ecosystems. Such a system is critical for adaptive management of complex mosaics of freshwater ecosystems and for balancing competing needs for ecosystem services in a changing world.

  14. Perthes Disease, Results of Conservative Management at Soba ...

    African Journals Online (AJOL)

    Ideal way of treatment remains controversial. Objectives: To study patterns of presentations and outcome of management of patients with LCPD treated at Soba University Hospital. Materials and Methods: Records of patients with LCPD who were treated at Soba University Hospital between 2005 and 2013 were reviewed.

  15. Conservation of biodiversity: a useful paradigm for forest ecosystem management.

    Science.gov (United States)

    A.B. Carey; R.O. Curtis

    1996-01-01

    The coniferous forests of the Western Hemlock Zone of western Oregon and western Washington are remarkable in the longevity and stature of their trees, long intervals between stand-replacing events, capacity to produce timber, diversity of life forms and species, and controversy over their management. The controversy is hardly new (Overton and Hunt 1974). But the...

  16. Integrating Quaternary science research in land management, restoration, and conservation

    Science.gov (United States)

    C.I. Millar; W.B. Woolfenden

    2001-01-01

    Most of us have come to expect that the general public will ignore the primary message of Quaternary science that change happens. A flurry, however, of recent media attention to 20th-century global warming and its anomalies from climates of the last millennium has brought climate science at least momentarily into popular focus. Similarly, public land-managing agencies...

  17. An adaptive management process for forest soil conservation.

    Science.gov (United States)

    Michael P. Curran; Douglas G. Maynard; Ronald L. Heninger; Thomas A. Terry; Steven W. Howes; Douglas M. Stone; Thomas Niemann; Richard E. Miller; Robert F. Powers

    2005-01-01

    Soil disturbance guidelines should be based on comparable disturbance categories adapted to specific local soil conditions, validated by monitoring and research. Guidelines, standards, and practices should be continually improved based on an adaptive management process, which is presented in this paper. Core components of this process include: reliable monitoring...

  18. Prioritising species for research, conservation and management: a ...

    African Journals Online (AJOL)

    This is especially true in multispecies fisheries where personnel and funding limitations often create the dilemma over which species should be the first to receive management and research attention. This study uses a multicriteria decision analysis approach to prioritise 176 South African linefish species on the basis of a ...

  19. Conservation Reserve Program effects on floodplain land cover management.

    Science.gov (United States)

    Jobe, Addison; Kalra, Ajay; Ibendahl, Elise

    2018-05-15

    Growing populations and industrialized agriculture practices have eradicated much of the United States wetlands along river floodplains. One program available for the restoration of floodplains is the Conservation Reserve Program (CRP). The current research explores the effects CRP land change has on flooding zones, utilizing Flood Modeller and HEC-RAS. Flood Modeller is proven a viable tool for flood modeling within the United States when compared to HEC-RAS. Application of the software is used in the Nodaway River system located in the western halves of Iowa and Missouri to model effects of introducing new forest areas within the region. Flood stage during the conversion first decreases in the early years, before rising to produce greater heights. Flow velocities where CRP land is present are reduced for long-term scopes. Velocity reduction occurs as the Manning's roughness increases due to tree diameter and brush density. Flood zones become more widespread with the implementation of CRP. Future model implementations are recommended to witness the effects of smaller flood recurrence intervals. Copyright © 2018 Elsevier Ltd. All rights reserved.

  20. Structure and content components of self-management interventions that improve health-related quality of life in people with inflammatory bowel disease: a systematic review, meta-analysis and meta-regression.

    Science.gov (United States)

    Tu, Wenjing; Xu, Guihua; Du, Shizheng

    2015-10-01

    The purpose of this review was to identify and categorise the components of the content and structure of effective self-management interventions for patients with inflammatory bowel disease. Inflammatory bowel diseases are chronic gastrointestinal disorders impacting health-related quality of life. Although the efficacy of self-management interventions has been demonstrated in previous studies, the most effective components of the content and structure of these interventions remain unknown. A systematic review, meta-analysis and meta-regression of randomised controlled trials was used. A systematic search of six electronic databases, including Pubmed, Embase, Cochrane central register of controlled trials, Web of Science, Cumulative Index of Nursing and Allied Health Literature and Chinese Biomedical Literature Database, was conducted. Content analysis was used to categorise the components of the content and structure of effective self-management interventions for inflammatory bowel disease. Clinically important and statistically significant beneficial effects on health-related quality of life were explored, by comparing the association between effect sizes and various components of self-management interventions such as the presence or absence of specific content and different delivery methods. Fifteen randomised controlled trials were included in this review. Distance or remote self-management interventions demonstrated a larger effect size. However, there is no evidence for a positive effect associated with specific content component of self-management interventions in adult patients with inflammatory bowel disease in general. The results showed that self-management interventions have positive effects on health-related quality of life in patients with inflammatory bowel disease, and distance or remote self-management programmes had better outcomes than other types of interventions. This review provides useful information to clinician and researchers when

  1. Inflammatory Bowel Disease in Primary Immunodeficiencies.

    Science.gov (United States)

    Kelsen, Judith R; Sullivan, Kathleen E

    2017-08-01

    Inflammatory bowel disease is most often a polygenic disorder with contributions from the intestinal microbiome, defects in barrier function, and dysregulated host responses to microbial stimulation. There is, however, increasing recognition of single gene defects that underlie a subset of patients with inflammatory bowel disease, particularly those with early-onset disease, and this review focuses on the primary immunodeficiencies associated with early-onset inflammatory bowel disease. The advent of next-generation sequencing has led to an improved recognition of single gene defects underlying some cases of inflammatory bowel disease. Among single gene defects, immune response genes are the most frequent category identified. This is also true of common genetic variants associated with inflammatory bowel disease, supporting a pivotal role for host responses in the pathogenesis. This review focuses on practical aspects related to diagnosis and management of children with inflammatory bowel disease who have underlying primary immunodeficiencies.

  2. Annual report to Congress on Federal Government Energy Management and Conservation Programs

    Energy Technology Data Exchange (ETDEWEB)

    1994-02-01

    This report on Federal Energy Management for Fiscal year (FY) 1992 provides information on energy consumption in Federal buildings and operations and documents activities conducted by Federal agencies to meet the statutory requirements of Title V, Part 3, of the National Energy Conservation Policy Act (NECPA), as amended, 42 U.S.C. 8251-8261, and Title VIII of NECPA, 42 U.S.C. 8287-8287b. This report also describes the energy conservation and management activities of the Federal Government under the authorization of section 381 of the Energy Policy and Conservation Act (EPCA), as amended, 42 U.S.C. 6361. Implementation activities undertaken during FY 1992 by the Federal agencies under Executive Order 12759 on Federal Energy Management are also described in this report.

  3. Managing scuba divers to meet ecological goals for coral reef conservation.

    Science.gov (United States)

    Sorice, Michael G; Oh, Chi-Ok; Ditton, Robert B

    2007-06-01

    Marine protected areas increasingly are challenged to maintain or increase tourism benefits while adequately protecting resources. Although carrying capacity strategies can be used to cope with use-related impacts, there is little understanding of divers themselves, their management preferences, and how preferences relate to conservation goals. By using a stated preference choice modeling approach, we investigated the choices divers make in selecting diving trips to marine protected areas as defined by use level, access, level of supervision, fees, conservation education, and diving expectations. Logit models showed that divers preferred a more restrictive management scenario over the status quo. Divers favored reductions in the level of site use and increased levels of conservation education. Divers did not favor fees to access protected areas, having less access to the resource, or extensive supervision. Finally, divers were much more willing to accept increasingly restrictive management scenarios when they could expect to see increased marine life.

  4. Conservative Management of Unilateral Fractures of the Mandibular Rami in Horses.

    Science.gov (United States)

    Jansson, Nicolai

    2016-11-01

    To report the outcome of conservative management of unilateral fractures of the mandibular rami in horses. Retrospective case series. 24 client-owned horses with unilateral mandibular fractures METHODS: Medical records (January 2000-January 2014) of horses with unilateral mandibular ramus fractures were retrieved. Only conservatively managed horses with follow-up information were included. Follow-up information on clinical outcome was retrieved from the medical records (n=11) or obtained by telephone interviews with the owners or trainers (n=13). Twenty-three horses (96%) returned to their previous or intended use and had no clinically evident masticatory or fracture healing-related problems at the time of follow-up. The owner of 1 horse (4%) reported it had tooth loosening, feed impaction, and masticatory problems. Conservative management of unilateral fractures of the mandibular rami is a treatment option in horses. © Copyright 2016 by The American College of Veterinary Surgeons.

  5. A COMPARATIVE STUDY OF CONSERVATIVE MANAGEMENT VS. EXTERNAL FIXATION OF COMMINUTED DISTAL RADIUS FRACTURES

    Directory of Open Access Journals (Sweden)

    Sanjeev Kumar Kare

    2016-12-01

    Full Text Available BACKGROUND Fracture of the distal radius (‘broken wrist’ is a common clinical problem. It can be treated conservatively usually involving wrist immobilisation in a plaster cast or surgically. A key method of surgical fixation is external fixation. MATERIALS AND METHODS A prospective study was carried out on 66 patients admitted between June 2014 to May 2016 for evaluation of conservative and surgical management of distal radius fractures. RESULTS Excellent, fair or good result was noticed in around 85% of cases managed conservatively and in above 90% of cases managed by external fixator. CONCLUSION There is some evidence to support the use of external fixation for dorsally displaced fractures of the distal radius in adults. Though, there is insufficient evidence to confirm a better functional outcome, external fixation reduces redisplacement gives improved anatomical results and most of the excess surgically-related complications are minor.

  6. Managing post-therapy fatigue for cancer survivors using energy conservation training.

    Science.gov (United States)

    Yuen, Hon Keung; Mitcham, Maralynne; Morgan, Larissa

    2006-01-01

    This pilot study evaluated the effectiveness of energy conservation training to help post-therapy cancer survivors manage their fatigue. Twelve post-therapy cancer survivors were randomly assigned to an energy conservation training or usual care control (6 in each group). Participants in the intervention group received 1 to 2 hours of individual, face-to-face energy conservation training from an occupational therapist followed by once-a-week telephone monitoring sessions in the subsequent three weeks. Participants in the control group received standard care from their oncologist. Analysis of pre- and post-training data from the Piper Fatigue Scale (PFS) revealed significant reduction only in the sensory subscale of the PFS (Z = 2.21; p = 0.027) for the intervention group; but no significant reduction in the four subscale or total scores of the PFS for the control group. Findings demonstrate partial support for the effectiveness of energy conservation training in helping post-therapy cancer survivors manage their fatigue. Energy conservation training seems to be a viable strategy for managing cancer-related fatigue, though its efficacy is modest. Incorporating specific energy restoration strategies such as relaxation and meditation for future research may help advance the growing body of knowledge in symptom management for post-therapy cancer survivors.

  7. Self-Management Education for Rehabilitation Inpatients Suffering from Inflammatory Bowel Disease: A Cluster-Randomized Controlled Trial

    Science.gov (United States)

    Reusch, A.; Weiland, R.; Gerlich, C.; Dreger, K.; Derra, C.; Mainos, D.; Tuschhoff, T.; Berding, A.; Witte, C.; Kaltz, B.; Faller, H.

    2016-01-01

    Although inflammatory bowel disease (IBD) affects patients' psychological well-being, previous educational programs have failed to demonstrate effects on psychosocial outcomes and quality of life. Therefore, we developed a group-based psychoeducational program that combined provision of both medical information and psychological self-management…

  8. Energy conservation and management strategies in Heavy Water Plants

    International Nuclear Information System (INIS)

    Kamath, H.S.

    2002-01-01

    In the competitive industrial environment it is essential that cost of the product is kept at the minimum possible. Energy conservation is an important aspect in achieving this as energy is one of the key recourses for growth and survival of industry. The process of heavy water production being very complex and energy intensive, Heavy Water board has given a focussed attention for initiating various measures for reducing the specific energy consumption in all the plants. The initiative resulted in substantial reduction in specific energy consumption and brought in savings in cost. The cumulative reduction of specific energy consumption has been over 30% over the last seven years and the total savings for the last three years on account of the same has been about Rs. 190 crore. The paper describes the strategies adopted in the heavy water plants for effecting the above achievements. The paper covers the details of some of the energy saving schemes carried out at different heavy water plants through case studies. The case studies of schemes implemented at HWPs are general in nature and is applicable for any other industry. The case studies cover the modifications with re-optimisation of the process parameters, improvements effected in utility units like refrigeration and cooling water systems, improvements in captive power plant cycle and improved recycle scheme for water leading to reduced consumptions. The paper also mentions the innovative ammonia absorption refrigeration with improved coefficient of performance and HWB's efforts in development of the system as an integrated unit of the ammonia water deuterium exchange process for heavy water production. HWB also has taken up R and D on various other schemes for improvements in energy consumption for future activities covering utilisation of low grade energy for generation of refrigeration. (author)

  9. Assessing the components of adaptive capacity to improve conservation and management efforts under global change.

    Science.gov (United States)

    Nicotra, Adrienne B; Beever, Erik A; Robertson, Amanda L; Hofmann, Gretchen E; O'Leary, John

    2015-10-01

    Natural-resource managers and other conservation practitioners are under unprecedented pressure to categorize and quantify the vulnerability of natural systems based on assessment of the exposure, sensitivity, and adaptive capacity of species to climate change. Despite the urgent need for these assessments, neither the theoretical basis of adaptive capacity nor the practical issues underlying its quantification has been articulated in a manner that is directly applicable to natural-resource management. Both are critical for researchers, managers, and other conservation practitioners to develop reliable strategies for assessing adaptive capacity. Drawing from principles of classical and contemporary research and examples from terrestrial, marine, plant, and animal systems, we examined broadly the theory behind the concept of adaptive capacity. We then considered how interdisciplinary, trait- and triage-based approaches encompassing the oft-overlooked interactions among components of adaptive capacity can be used to identify species and populations likely to have higher (or lower) adaptive capacity. We identified the challenges and value of such endeavors and argue for a concerted interdisciplinary research approach that combines ecology, ecological genetics, and eco-physiology to reflect the interacting components of adaptive capacity. We aimed to provide a basis for constructive discussion between natural-resource managers and researchers, discussions urgently needed to identify research directions that will deliver answers to real-world questions facing resource managers, other conservation practitioners, and policy makers. Directing research to both seek general patterns and identify ways to facilitate adaptive capacity of key species and populations within species, will enable conservation ecologists and resource managers to maximize returns on research and management investment and arrive at novel and dynamic management and policy decisions. © 2015 Society for

  10. The effect of platelet-rich plasma injection on lateral epicondylitis following failed conservative management.

    Science.gov (United States)

    Brkljac, Milos; Kumar, Shyam; Kalloo, Dale; Hirehal, Kiran

    2015-12-01

    We assessed the effect PRP injection on pain and function in patients with lateral epicondylitis where conservative management had failed. We prospectively reviewed 34 patients. The mean follow-up was 26 weeks (range 6-114 weeks). We used the Oxford Elbow Score (OES) and progression to surgery to assess outcomes. 88.2% improved their OES. 8.8% reported symptom progression. One patient had no change. No patients suffered adverse reactions. Two patients underwent an open release procedure. One had the injection repeated. An injection of PRP improves pain and function in patients suffering from LE where conservative management has failed.

  11. Incompletely characterized incidental renal masses: emerging data support conservative management.

    Science.gov (United States)

    Silverman, Stuart G; Israel, Gary M; Trinh, Quoc-Dien

    2015-04-01

    With imaging, most incidental renal masses can be diagnosed promptly and with confidence as being either benign or malignant. For those that cannot, management recommendations can be devised on the basis of a thorough evaluation of imaging features. However, most renal masses are either too small to characterize completely or are detected initially in imaging examinations that are not designed for full evaluation of them. These masses constitute a group of masses that are considered incompletely characterized. On the basis of current published guidelines, many masses warrant additional imaging. However, while the diagnosis of renal cancer at a curable stage remains the first priority, there is the additional need to reduce unnecessary healthcare costs and radiation exposure. As such, emerging data now support foregoing additional imaging for many incompletely characterized renal masses. These data include the low risk of progression to metastases or death for small renal masses that have undergone active surveillance (including biopsy-proven cancers) and a better understanding of how specific imaging features can be used to diagnose their origins. These developments support (a) avoidance of imaging entirely for those incompletely characterized renal masses that are highly likely to be benign cysts and (b) delay of further imaging of small solid masses in selected patients. Although more evidence-based data are needed and comprehensive management algorithms have yet to be defined, these recommendations are medically appropriate and practical, while limiting the imaging of many incompletely characterized incidental renal masses.

  12. The comparative analyses of selected aspects of conservation and management of Vietnam’s national parks

    Directory of Open Access Journals (Sweden)

    Le Thanh An

    2018-01-01

    Full Text Available The national parks in Vietnam are protected areas in the national system of special-use forests created to protect natural resources and biodiversity. In order to improve the effectiveness of management of national parks, the study assesses some current aspects of conservation and management of natural resources with respect to management plans, financial sources, staff, cooperative activities, causes of limited management capacity and threats to natural resources. Out of the total of 30 national parks, six are under the responsibility of the Vietnam Administration of Forestry (VNFOREST and 24 national parks are managed by provincial authorities. It was found that most of the national parks have updated their management plans. Financial sources of funding for national parks mainly originated from the central and provincial budgets, with an average of 51% and 76% respectively. Fifty percent of national parks spent 40–60% of their total funding on conservation activities. About 85% of national parks’ staff had academic degrees, typically in the fields of forestry, agriculture and fisheries. Biodiversity conservation was considered a priority cooperative action in national parks with scientific institutes. Major causes of a limited management capacity of national parks included human population growth and pressure associated with resources use, lack of funding, limited human and institutional capacity and land use conflict/land grab. Illegal hunting, trapping, poaching and fishing, the illegal wildlife trade, illegal logging and firewood collecting appeared to be the most serious threats to the conservation and management of natural resources. In addition to these results, significant differences were found between the VNFOREST and provincial parks in terms of financial sources, staff and the threat of illegal logging and firewood collecting. The authors’ findings offer useful information for national park planners and managers, as well as

  13. Positives and pathologies of natural resource management on private land-conservation areas.

    Science.gov (United States)

    Clements, Hayley S; Cumming, Graeme S

    2017-06-01

    In managed natural resource systems, such as fisheries and rangelands, there is a recognized trade-off between managing for short-term benefits and managing for longer term resilience. Management actions that stabilize ecological attributes or processes can improve productivity in the supply of ecosystem goods and services in the short term but erode system resilience at longer time scales. For example, fire suppression in rangelands can increase grass biomass initially but ultimately result in an undesirable, shrub-dominated system. Analyses of this phenomenon have focused largely on how management actions influence slow-changing biophysical system attributes (such as vegetation composition). Data on the frequency of management actions that reduce natural ecological variation on 66 private land-conservation areas (PLCAs) in South Africa were used to investigate how management actions are influenced by manager decision-making approaches, a largely ignored part of the problem. The pathology of natural resource management was evident on some PLCAs: increased focus on revenue-generation in decision making resulted in an increased frequency of actions to stabilize short-term variation in large mammal populations, which led to increased revenues from ecotourism or hunting. On many PLCAs, these management actions corresponded with a reduced focus on ecological monitoring and an increase in overstocking of game (i.e., ungulate species) and stocking of extralimitals (i.e., game species outside their historical range). Positives in natural resource management also existed. Some managers monitored slower changing ecological attributes, which resulted in less-intensive management, fewer extralimital species, and lower stocking rates. Our unique, empirical investigation of monitoring-management relationships illustrates that management decisions informed by revenue monitoring versus ecological monitoring can have opposing consequences for natural resource productivity and

  14. Breaking through the crisis in marine conservation and management: insights from the philosophies of Ed Ricketts.

    Science.gov (United States)

    Sagarin, Raphael D; Crowder, Larry B

    2009-02-01

    Over the last decade, 2 major U.S. commissions on ocean policy and a wide range of independent sources have argued that ocean ecosystems are in a period of crisis and that current policies are inadequate to prevent further ecological damage. These sources have advocated ecosystem-based management as an approach to address conservation issues in the oceans, but managers remain uncertain as to how to implement ecosystem-based approaches in the real world. We argue that the philosophies of Edward F. Ricketts, a mid-20th-century marine ecologist, offer a framework and clear guidance for taking an ecosystem approach to marine conservation. Ricketts' philosophies, which were grounded in basic observations of natural history, espoused building a holistic picture of the natural world, including the influence of humans, through repeated observation. This approach, when applied to conservation, grounds management in what is observable in nature, encourages early action in the face of uncertainty, and supports an adaptive approach to management as new information becomes available. Ricketts' philosophy of "breaking through," which focuses on getting beyond crisis and conflict through honest debate of different parties' needs (rather than forcing compromise of differing positions), emphasizes the social dimension of natural resource management. New observational technologies, long-term ecological data sets, and especially advances in the social sciences made available since Ricketts' time greatly enhance the utility of Ricketts' philosophy of marine conservation.

  15. Where and how to manage: Optimal selection of conservation actions for multiple species.

    Directory of Open Access Journals (Sweden)

    Astrid van Teeffelen

    2008-01-01

    Full Text Available Multiple alternative options are frequently available for the protection, maintenance or restoration of conservation areas. The choice of a particular management action can have large effects on the species occurring in the area, because different actions have different effects on different species. Together with the fact that conservation funds are limited and particular management actions are costly, it would be desirable to be able to identify where, and what kind of management should be applied to maximize conservation benefits. Currently available site-selection algorithms can identify the optimal set of sites for a reserve network. However, these algorithms have not been designed to answer what kind of action would be most beneficial at these sites when multiple alternative actions are available. We describe an algorithm capable of solving multi-species planning problems with multiple management options per site. The algorithm is based on benefit functions, which translate the effect of a management action on species representation levels into a value, in order to identify the most beneficial option. We test the performance of this algorithm with simulated data for different types of benefit functions and show that the algorithm’s solutions are optimal, or very near globally optimal, partially depending on the type of benefit function used. The good performance of the proposed algorithm suggests that it could be profitably used for large multi-action multi-species conservation planning problems.

  16. The contribution of agent-based simulations to conservation management on a Natura 2000 site.

    Science.gov (United States)

    Dupont, Hélène; Gourmelon, Françoise; Rouan, Mathias; Le Viol, Isabelle; Kerbiriou, Christian

    2016-03-01

    The conservation of biodiversity today must include the participation and support of local stakeholders. Natura 2000 can be considered as a conservation system that, in its application in most EU countries, relies on the participation of local stakeholders. Our study proposes a scientific method for participatory modelling, with the aim of contributing to the conservation management of habitats and species at a Natura 2000 site (Crozon Peninsula, Bretagne, France) that is representative of in landuse changes in coastal areas. We make use of companion modelling and its associated tools (scenario-planning, GIS, multi-agent modelling and simulations) to consider possible futures through the co-construction of management scenarios and the understanding of their consequences on different indicators of biodiversity status (habitats, avifauna, flora). The maintenance of human activities as they have been carried out since the creation of the Natura 2000s zone allows the biodiversity values to remain stable. Extensive agricultural activities have been shown to be essential to this maintenance, whereas management sustained by the multiplication of conservation actions brings about variable results according to the indicators. None of the scenarios has a positive incidence on the set of indicators. However, an understanding of the modelling system and the results of the simulations allow for the refining of the selection of conservation actions in relation to the species to be preserved. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Scientifically defensible fish conservation and recovery plans: Addressing diffuse threats and developing rigorous adaptive management plans

    Science.gov (United States)

    Maas-Hebner, Kathleen G.; Schreck, Carl B.; Hughes, Robert M.; Yeakley, Alan; Molina, Nancy

    2016-01-01

    We discuss the importance of addressing diffuse threats to long-term species and habitat viability in fish conservation and recovery planning. In the Pacific Northwest, USA, salmonid management plans have typically focused on degraded freshwater habitat, dams, fish passage, harvest rates, and hatchery releases. However, such plans inadequately address threats related to human population and economic growth, intra- and interspecific competition, and changes in climate, ocean, and estuarine conditions. Based on reviews conducted on eight conservation and/or recovery plans, we found that though threats resulting from such changes are difficult to model and/or predict, they are especially important for wide-ranging diadromous species. Adaptive management is also a critical but often inadequately constructed component of those plans. Adaptive management should be designed to respond to evolving knowledge about the fish and their supporting ecosystems; if done properly, it should help improve conservation efforts by decreasing uncertainty regarding known and diffuse threats. We conclude with a general call for environmental managers and planners to reinvigorate the adaptive management process in future management plans, including more explicitly identifying critical uncertainties, implementing monitoring programs to reduce those uncertainties, and explicitly stating what management actions will occur when pre-identified trigger points are reached.

  18. Studying citizen science through adaptive management and learning feedbacks as mechanisms for improving conservation.

    Science.gov (United States)

    Jordan, Rebecca; Gray, Steven; Sorensen, Amanda; Newman, Greg; Mellor, David; Newman, Greg; Hmelo-Silver, Cindy; LaDeau, Shannon; Biehler, Dawn; Crall, Alycia

    2016-06-01

    Citizen science has generated a growing interest among scientists and community groups, and citizen science programs have been created specifically for conservation. We examined collaborative science, a highly interactive form of citizen science, which we developed within a theoretically informed framework. In this essay, we focused on 2 aspects of our framework: social learning and adaptive management. Social learning, in contrast to individual-based learning, stresses collaborative and generative insight making and is well-suited for adaptive management. Adaptive-management integrates feedback loops that are informed by what is learned and is guided by iterative decision making. Participants engaged in citizen science are able to add to what they are learning through primary data collection, which can result in the real-time information that is often necessary for conservation. Our work is particularly timely because research publications consistently report a lack of established frameworks and evaluation plans to address the extent of conservation outcomes in citizen science. To illustrate how our framework supports conservation through citizen science, we examined how 2 programs enacted our collaborative science framework. Further, we inspected preliminary conservation outcomes of our case-study programs. These programs, despite their recent implementation, are demonstrating promise with regard to positive conservation outcomes. To date, they are independently earning funds to support research, earning buy-in from local partners to engage in experimentation, and, in the absence of leading scientists, are collecting data to test ideas. We argue that this success is due to citizen scientists being organized around local issues and engaging in iterative, collaborative, and adaptive learning. © 2016 Society for Conservation Biology.

  19. Management in a neotropical show cave: planning for invertebrates conservation

    Directory of Open Access Journals (Sweden)

    Thais Giovannini Pellegrini

    2012-07-01

    Full Text Available Lapa Nova is a dolomitic cave about 4.5 km long located in northwestern Minas Gerais state, Brazil. The cave experiences intense tourism, concentrated over a single period of the year, during the Feast of Our Lady of Lapa. In order to evaluate the impacts felt by the invertebrate community from this tourism, a new methodology was proposed. Four types of areas (intense visitation area, outlying visitation areas, moderate visitation areas and no-visitation areas were sampled for invertebrates. There was one sampling prior and another on the last day of the 128th feast, to evaluate the effects of visitation on cave-dwelling invertebrates. Results show that invertebrate populations residing in more intensely visited areas of the cave undergo changes in distribution following the event. As a consequence of tourism, invertebrates shift to outlying locations from the visited area, which serve as refuges to the communities. Apparently, the fact that there are places inside Lapa Nova inaccessible to tourists reduces the impact suffered by the invertebrate community, as those sites serve as refuges for cave-dwelling organisms during the pilgrimage. A proper management plan was devised for the tourism/religious use of the cave. It consists basically of delimiting marked pathways for tourists, allowing invertebrates to seek shelter at locations outside visited areas and keeping no-visitation areas off-limits to tourism based on the results of the visitation effects on cave-dwelling invertebrates.

  20. Conservative management of extra-axial hematomas diagnosed by CT

    International Nuclear Information System (INIS)

    Muszynski, C.A.; Hayman, L.A.; Weingarten, K.; Prow, H.W.; Cole, J.W.; Contant, C.F.

    1999-01-01

    Our purpose was to assess the role of serial CT in recently traumatized patients with clinically stable extra-axial intracranial hematomas (EACH) and a midline shift of less than 0.5 cm. A retrospective review of 91 imaging studies in 41 patients (with 45 EACH) was done to assess the time between trauma and CT; the presence and type of skull fracture; the volume, type, and location of the EACH; the presence of associated edema and/or contusion. Over a 19-day follow-up, 11 % of the dense EACH increased in volume and 27 % decreased. An adjacent skull fracture was seen most frequently in patients with a decrease in EACH volume. Clinical data remain the key to determining the need for neurosurgical intervention in patients with EACH. Follow-up CT afforded no data which altered the medical management of these patients. However, it may be said to have alerted the clinician to an increase in the size of the EACH in 11 % of cases, which could mandate close observation of this group. (orig.)

  1. Novel and Conservative Approaches Towards Effective Management of Plantar Fasciitis

    Science.gov (United States)

    Ahmad, Awaiz; Kiani, Immad; Ghani, Usman; Wadhera, Vikram; Tom, Todd N

    2016-01-01

    We assessed the effectiveness of the different treatments for plantar fasciitis (PF) based on the changes in functional outcomes. A systematic literature search was carried out and studies from 2010 to 2016 were included in this review. The databases from Google Scholar, PubMed and Cochrane were used for the various treatment modalities of plantar fasciitis. The objectives measured included visual analog scale (VAS), Roles and Maudsley scale, foot function index (FFI), plantar fascia thickness and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot scale as the tools to predict the improvement in symptoms of pain and discomfort. Eight randomized controlled trails that met the selection criteria were included in this review. Extracorporeal shock wave lithotripsy (ESWL) with botulinum toxin type A, corticosteroid injections, autologous whole blood and plasma treatment, novel treatments like cryopreserved human amniotic membrane, effect of placebo, platelet rich plasma injections and corticosteroid injections, physiotherapy and high strength training were analyzed. All the treatment modalities applied did lead to the reduction in pain scores, but for long term management autologous condition plasma and platelet rich plasma are the preferred treatment options. Impact of physiotherapy and high strength training is equivalent to corticosteroid injections and hence is suited for patients avoiding invasive forms of treatment.  PMID:28083457

  2. Protected River. A new concept for conservation management of fluvial systems in Colombia

    International Nuclear Information System (INIS)

    Andrade; German I

    2011-01-01

    Based upon the concept of Ecological Integrity, relevant geophysical, bio- ecological and social attributes for river systems area identified. It is argued that current conservation and environmental management instruments in Colombia, do not take into account the identified IE attributes simultaneously. The concept of Protected River, PR, is then presented, as a necessary complement for conservation strategies. The PR concept would be defined for the maintenance of the attributes of EI in some representative river systems, as a part of the biodiversity conservation objectives within the Convention of Biological Diversity. Some attributes and indicators, and thresholds of undesired change are discussed. A typology for PR is proposed, following the international protected area management categories.

  3. An evaluation of flora from coastal sand dunes of India: Rationale for conservation and management

    Digital Repository Service at National Institute of Oceanography (India)

    Rodrigues, R.S.; Mascarenhas, A.; Jagtap, T.G.

    stream_size 37100 stream_content_type text/plain stream_name Ocean_Coast_Manage_54_181a.pdf.txt stream_source_info Ocean_Coast_Manage_54_181a.pdf.txt Content-Encoding UTF-8 Content-Type text/plain; charset=UTF-8 1... Author version: Ocean & Coastal Management, vol.54(2); 2011; 181-188 An evaluation of flora from coastal sand dunes of India: Rationale for conservation and management Rouchelle S. Rodrigues, Antonio Mascarenhas, Tanaji G. Jagtap * National...

  4. Inflammatory bowel disease.

    Science.gov (United States)

    Gibson, Peter R; Iser, John

    2005-04-01

    Inflammatory bowel disease (IBD) is increasing in frequency in Australia. General practitioners play an important role in early diagnosis and in a multidisciplinary approach to managing such patients. Keeping abreast of evolving concepts, particularly in treatment, is challenging. This article aims to address key issues in diagnosis and management to better equip general practitioners for their role in multidisciplinary management of patients with IBD. Making the diagnosis can be difficult, but is facilitated by appropriate clinical suspicion and sensible judgment as to who undergoes diagnostic tests such as colonoscopy. Treatment of ulcerative colitis has changed little in recent years, except for our improved ability to deliver mesalazine to the large bowel via the recent availability of several oral and rectal preparations. Prevention of relapse using these is an important strategy in the majority of patients. Treatment of Crohn disease is changing due to more realistic concepts of the natural history of the disease and the development of new, powerful anti-inflammatory therapies. Attention to issues other than intestinal inflammation such as nutrition, education and counselling, remain important in achieving optimal management.

  5. Stricturoplasty—a bowel-sparing option for long segment small bowel Crohn's disease

    OpenAIRE

    Limmer, Alexandra M.; Koh, Hoey C.; Gilmore, Andrew

    2017-01-01

    Abstract Stricturoplasty is a surgical option for management of severe stricturing Crohn's disease of the small bowel. It avoids the need for small bowel resection and the associated metabolic complications. This report contrasts the indications and technical aspects of two different stricturoplasty techniques. Case 1 describes an extensive Michelassi (side-to-side isoperistaltic) stricturoplasty performed for a 100 cm segment of diseased small bowel in a 45-year-old patient. Case 2 describes...

  6. Assessing the components of adaptive capacity to improve conservation and management efforts under global change

    Science.gov (United States)

    Nicotra, Adrienne; Beever, Erik; Robertson, Amanda; Hofmann, Gretchen; O’Leary, John

    2015-01-01

    Natural-resource managers and other conservation practitioners are under unprecedented pressure to categorize and quantify the vulnerability of natural systems based on assessment of the exposure, sensitivity, and adaptive capacity of species to climate change. Despite the urgent need for these assessments, neither the theoretical basis of adaptive capacity nor the practical issues underlying its quantification has been articulated in a manner that is directly applicable to natural-resource management. Both are critical for researchers, managers, and other conservation practitioners to develop reliable strategies for assessing adaptive capacity. Drawing from principles of classical and contemporary research and examples from terrestrial, marine, plant, and animal systems, we examined broadly the theory behind the concept of adaptive capacity. We then considered how interdisciplinary, trait- and triage-based approaches encompassing the oft-overlooked interactions among components of adaptive capacity can be used to identify species and populations likely to have higher (or lower) adaptive capacity. We identified the challenges and value of such endeavors and argue for a concerted interdisciplinary research approach that combines ecology, ecological genetics, and eco-physiology to reflect the interacting components of adaptive capacity. We aimed to provide a basis for constructive discussion between natural-resource managers and researchers, discussions urgently needed to identify research directions that will deliver answers to real-world questions facing resource managers, other conservation practitioners, and policy makers. Directing research to both seek general patterns and identify ways to facilitate adaptive capacity of key species and populations within species, will enable conservation ecologists and resource managers to maximize returns on research and management investment and arrive at novel and dynamic management and policy decisions.

  7. Understanding the local socio-political processes affecting conservation management outcomes in Corbett Tiger Reserve, India.

    Science.gov (United States)

    Rastogi, Archi; Hickey, Gordon M; Badola, Ruchi; Hussain, Syed Ainul

    2014-05-01

    Several measures have been recommended to guarantee a sustainable population of tigers: sufficient inviolate spaces for a viable population, sufficient prey populations, trained and skilled manpower to guard against poaching and intrusion, banning trade in tiger products to reduce poaching, and importantly, the political will to precipitate these recommendations into implementation. Of these, the creation of sufficient inviolate spaces (generally in the form of protected areas) has created the most issues with local resource-dependent communities, often resulting in significant challenges for tiger conservation policy and management. Very little empirical research has, however, been done to understand and contextualize the local-level socio-political interactions that may influence the efficacy of tiger conservation in India. In this paper, we present the results of exploratory research into the ways in which local-stakeholder groups affect the management of Corbett Tiger Reserve (CTR). Using a combined grounded theory-case study research design, and the Institutional Analysis and Development framework for analysis, we identify the socio-political processes through which local-stakeholder groups are able to articulate their issues and elicit desirable actions from the management of CTR. Increasing our awareness of these processes can help inform the design and implementation of more effective tiger conservation management and policy strategies that have the potential to create more supportive coalitions of tiger conservation stakeholders at the local level.

  8. Understanding the Local Socio-political Processes Affecting Conservation Management Outcomes in Corbett Tiger Reserve, India

    Science.gov (United States)

    Rastogi, Archi; Hickey, Gordon M.; Badola, Ruchi; Hussain, Syed Ainul

    2014-05-01

    Several measures have been recommended to guarantee a sustainable population of tigers: sufficient inviolate spaces for a viable population, sufficient prey populations, trained and skilled manpower to guard against poaching and intrusion, banning trade in tiger products to reduce poaching, and importantly, the political will to precipitate these recommendations into implementation. Of these, the creation of sufficient inviolate spaces (generally in the form of protected areas) has created the most issues with local resource-dependent communities, often resulting in significant challenges for tiger conservation policy and management. Very little empirical research has, however, been done to understand and contextualize the local-level socio-political interactions that may influence the efficacy of tiger conservation in India. In this paper, we present the results of exploratory research into the ways in which local-stakeholder groups affect the management of Corbett Tiger Reserve (CTR). Using a combined grounded theory-case study research design, and the Institutional Analysis and Development framework for analysis, we identify the socio-political processes through which local-stakeholder groups are able to articulate their issues and elicit desirable actions from the management of CTR. Increasing our awareness of these processes can help inform the design and implementation of more effective tiger conservation management and policy strategies that have the potential to create more supportive coalitions of tiger conservation stakeholders at the local level.

  9. Chapter 6: The scientific basis for conserving forest carnivores: considerations for management

    Science.gov (United States)

    L. Jack Lyon; Keith B. Aubry; William J. Zielinski; Steven W. Buskirk; Leonard F. Ruggiero

    1994-01-01

    The reviews presented in previous chapters reveal substantial gaps in our knowledge about marten, fisher, lynx, and wolverine. These gaps severely constrain our ability to design reliable conservation strategies. This problem will be explored in depth in Chapter 7. In this chapter, our objective is to discuss management considerations resulting from what we currently...

  10. Quantifying conservation biological control for management of Bemisia tabaci (Hemiptera: Aleyrodidae) in cotton

    Science.gov (United States)

    Conservation biological control can be an effective tactic for minimizing insect-induced damage to agricultural production. The most effective manner of applying CBC is through an Integrated Pest Management (IPM) strategy, combining many tactics including cultural controls, pest sampling, the use of...

  11. Bringing genetic diversity to the forefront of conservation policy and management

    Czech Academy of Sciences Publication Activity Database

    Hoban, S. M.; Hauffe, H. C.; Pérez-Espona, S.; Arntzen, J. W.; Bertorelle, G.; Bryja, Josef; Frith, K.; Gaggiotti, O. E.; Galbusera, P.; Godoy, J. A.; Hoelzel, A. R.; Nichols, R. A.; Primmer, C. R.; Russo, I.-R.; Segelbacher, G.; Siegismund, H. R.; Sihvonen, M.; Vernesi, C.; Vila, C.; Bruford, M. W.

    2013-01-01

    Roč. 5, č. 2 (2013), s. 593-598 ISSN 1877-7252 Institutional support: RVO:68081766 Keywords : Conservation genetics * Aichi target 13 * ConGRESS * Biodiversity management * Biodiversity policy Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 1.136, year: 2013

  12. Conservative Management for Stable High Ankle Injuries in Professional Football Players.

    Science.gov (United States)

    Knapik, Derrick M; Trem, Anthony; Sheehan, Joseph; Salata, Michael J; Voos, James E

    High ankle "syndesmosis" injuries are common in American football players relative to the general population. At the professional level, syndesmotic sprains represent a challenging and unique injury lacking a standardized rehabilitation protocol during conservative management. PubMed, Biosis Preview, SPORTDiscus, PEDro, and EMBASE databases were searched using the terms syndesmotic injuries, American football, conservative management, and rehabilitation. Clinical review. Level 3. When compared with lateral ankle sprains, syndesmosis injuries result in significantly prolonged recovery times and games lost. For stable syndesmotic injuries, conservative management features a brief period of immobilization and protected weightbearing followed by progressive strengthening exercises and running, and athletes can expect to return to competition in 2 to 6 weeks. Further research investigating the efficacy of dry needling and blood flow restriction therapy is necessary to evaluate the benefit of these techniques in the rehabilitation process. Successful conservative management of stable syndesmotic injuries in professional American football athletes requires a thorough understanding of the anatomy, injury mechanisms, diagnosis, and rehabilitation strategies utilized in elite athletes.

  13. The ecosystem approach to fisheries: management at the dynamic interface between biodiversity conservation and sustainable use.

    Science.gov (United States)

    Jennings, Simon; Smith, Anthony D M; Fulton, Elizabeth A; Smith, David C

    2014-08-01

    The emergence of an ecosystem approach to fisheries (EAF) was characterized by the adoption of objectives for maintaining ecosystem health alongside those for fisheries. The EAF was expected to meet some aspirations for biodiversity conservation, but health was principally linked to sustainable use rather than lower levels of human impact. Consequently, while policies including EAF concepts identified objectives for fisheries management and biodiversity conservation, the wording often reflected unresolved societal and political debates about objectives and gave imprecise guidance on addressing inevitable trade-offs. Despite scientific progress in making trade-offs and consequences explicit, there remain substantial differences in interpretations of acceptable impact, responses to uncertainty and risk, and the use of management measures by groups accountable for fisheries management and biodiversity conservation. Within and among nations and regions, these differences are influenced by the contribution of fisheries, aquaculture, farming, and trade to food security, consumers' options, and other social, economic, and environmental factors. Notwithstanding, mutual understanding of the motivations and norms of fisheries management and biodiversity conservation groups is increasing, and interactions between these groups have likely supported more progress toward meeting their stated objectives than would have otherwise been achievable. © 2014 New York Academy of Sciences.

  14. Cost-effectiveness of endovascular repair, open repair, and conservative management of splenic artery aneurysms

    NARCIS (Netherlands)

    Hogendoorn, Wouter; Lavida, Anthi; Hunink, M. G Myriam; Moll, Frans L.; Geroulakos, George; Muhs, Bart E.; Sumpio, Bauer E.

    2015-01-01

    Objective Open repair (OPEN) and conservative management (CONS) have been the treatments of choice for splenic artery aneurysms (SAAs) for many years. Endovascular repair (EV) has been increasingly used with good short-term results. In this study, we evaluated the cost-effectiveness of OPEN, EV, and

  15. Conservative management of neuromuscular scoliosis: personal experience and review of literature.

    Science.gov (United States)

    Kotwicki, Tomasz; Jozwiak, Marek

    2008-01-01

    The principles of conservative management of neuromuscular scoliosis in childhood and adolescence are presented. Analysis of personal experience and literature review. The topic is discussed separately for patients with flaccid or spastic paresis. These demonstrate that conservative management might be proposed for patients with neuromuscular scoliosis in many clinical situations. In spastic disorders, it maintains the symmetry around the hip joints. Bracing is technically difficult and often is not tolerated well by cerebral palsy children. In patients with flaccid paresis, the fitting and the use of brace is easier than in spastic patients. The flexibility of the spinal curvature is more important. Functional benefits of conservative management of neuromuscular scoliosis comprise stable sitting, easier use of upper limbs, discharge of the abdomen from the collapsing trunk, increased diaphragm excursion, and, not always, prevention of curve progression. Specific natural history and multiple medical problems associated with the disease make the treatment of children with neuromuscular scoliosis an extremely complex issue, best addressed when a team approach is applied. Continuously improving techniques of conservative management, comprising bracing and physiotherapy, together with correctly timed surgery incorporated in the process of rehabilitation, provide the optimal care for patients.

  16. Achievable future conditions as a framework for guiding forest conservation and management

    Science.gov (United States)

    S.W. Golladay; K.L. Martin; J. M. Vose; D. N. Wear; A.P. Covich; R.J. Hobbs; Kier Klepzig; G.E. Likens; R.J. Naiman; A.W. Shearer

    2016-01-01

    We contend that traditional approaches to forest conservation and management will be inadequate given the predicted scale of social-economic and biophysical changes in the 21st century. New approaches, focused on anticipating and guiding ecological responses to change, are urgently needed to ensure the full value of forest ecosystem services for future generations....

  17. Where and how to manage: optimal selection of conservation actions for multiple species

    NARCIS (Netherlands)

    Teeffelen, van A.J.A.; Moilanen, A.

    2008-01-01

    Multiple alternative options are frequently available for the protection, maintenance or restoration of conservation areas. The choice of a particular management action can have large effects on the species occurring in the area, because different actions have different effects on different species.

  18. A climate adaptation strategy for conservation and management of yellowcedar in Alaska

    Science.gov (United States)

    Paul E. Hennon; Carol M. McKenzie; David D' Amore; Dustin T. Wittwer; Robin L. Mulvey; Melinda S. Lamb; Frances E. Biles; Rich C. Cronn

    2016-01-01

    A conservation and management strategy for yellow-cedar in Alaska is presented in the context of climate change. This document has four sections. Section 1 covers the ecology and silvics of yellow-cedar, as well as other background information. Section 2 outlines knowledge on the extensive mortality to yellow-cedar, including the role of climate. Section 3 describes...

  19. Detected peritoneal fluid in small bowel obstruction is associated with the need for surgical intervention.

    LENUS (Irish Health Repository)

    O'Daly, Brendan J

    2009-06-01

    BACKGROUND: Predicting the clinical course in adhesional small bowel obstruction is difficult. There are no validated clinical or radiologic features that allow early identification of patients likely to require surgical intervention. METHODS: We conducted a retrospective review of 100 patients consecutively admitted to a tertiary level teaching hospital over a 3-year period (2002-2004) who had acute adhesional small bowel obstruction and underwent computed tomography (CT). The primary outcomes that we assessed were conservative management or the need for surgical intervention. We investigated time to physiologic gastrointestinal function recovery as a secondary outcome. We examined independent predictors of surgical intervention in a bivariate analysis using a stepwise logistic regression analysis. RESULTS: Of the 100 patients investigated, we excluded 12. Of the 88 remaining patients, 58 (66%) were managed conservatively and 30 (34%) underwent surgery. Peritoneal fluid detected on a CT scan (n = 37) was associated more frequently with surgery than conservative management (46% v. 29%, p = 0.046, chi(2)). Logistical regression identified peritoneal fluid detected on a CT scan as an independent predictor of surgical intervention (odds ratio 3.0, 95% confidence interval 1.15-7.84). CONCLUSION: The presence of peritoneal fluid on a CT scan in patients with adhesional small bowel obstruction is an independent predictor of surgical intervention and should alert the clinician that the patient is 3 times more likely to require surgery.

  20. Cognitive behavioural therapy for the management of inflammatory bowel disease-fatigue with a nested qualitative element: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Artom, Micol; Czuber-Dochan, Wladyslawa; Sturt, Jackie; Norton, Christine

    2017-05-11

    Fatigue is one of the most prevalent and burdensome symptoms for patients with inflammatory bowel disease (IBD). Although fatigue increases during periods of inflammation, for some patients it persists when disease is in remission. Compared to other long-term conditions where fatigue has been extensively researched, optimal management of fatigue in patients with IBD is unknown and fatigue has rarely been the primary outcome in intervention studies. To date, interventions for the management of IBD-fatigue are sparse, have short-term effects and have not been implemented within the existing health system. There is a need to integrate current best evidence across different conditions, patient experience and clinical expertise in order to develop interventions for IBD-fatigue management that are feasible and effective. Modifying an existing intervention for patients with multiple sclerosis, this study aims to assess the feasibility and initial estimates of efficacy of a cognitive behavioural therapy (CBT) intervention for the management of fatigue in patients with IBD. The study will be a two-arm pilot randomised controlled trial. Patients will be recruited from one outpatient IBD clinic and randomised individually to either: Group 1 (CBT manual for the management of fatigue, one 60-min session and seven 30-min telephone/Skype sessions with a therapist over an eight-week period); or Group 2 (fatigue information sheet to use without therapist help). Self-reported IBD-fatigue (Inflammatory Bowel Disease-Fatigue Scale) and IBD-quality of life (United Kingdom Inflammatory Bowel Disease Questionnaire) and self-reported disease activity will be collected at baseline, three, six and 12 months post randomisation. Illness perceptions, daytime sleepiness, anxiety and depression explanatory variables will be collected only at three months post randomisation. Clinical and sociodemographic data will be retrieved from the patients' medical notes. A nested qualitative study will

  1. Dealing with Drought: Decoupling Climatic and Management-Related Drivers of Water Conservation Behavior

    Science.gov (United States)

    Hemati, A.; Rippy, M.; Grant, S. B.

    2015-12-01

    As global populations grow, cities in drought prone regions of the world such as California and South East Australia are faced with escalating water scarcity and water security challenges. The management approaches geared towards addressing these challenges are diverse. Given the myriad of possible approaches and the tendency to apply them in combination, successful management actions can be difficult to identify. Background climactic variability further complicates the story, making transfer of management lessons from one drought stressed region to another difficult. Here we use Melbourne, a city of 4.3 million people in South East Australia that recently faced and overcame a > 10 year "Millennium" drought, as a test case for evaluating the relative importance of various management-related and climactic factors in driving reductions in municipal water consumption (~60% in 12 years). Our analysis suggests that Melbourne's declining municipal consumption cannot be explained by potable substitution alone, as reductions in municipal consumption were not matched by increased use of alternative sources (e.g., urban rain or recycled water). Thus, water conservation behavior (not source switching) may be responsible for the majority of demand reduction in Melbourne. Interestingly, while voluntary or mandatory water restrictions appear to have substantially altered the rate of change of consumption near the end of Melbourne's Millennium drought (e.g., forcing a period of intense conservation), overall conservation behavior precedes these restrictions. This suggests that other rapidly implemented (and hither too unquantified) management approaches such as advertising or newspapers may have driven water conservation behavior early in the drought. Climatic factors, particularly precipitation may also have influenced conservation behavior; changes in precipitation were significantly positively correlated with changes in water consumption at a lag of 18 months. Similar

  2. Generation of priority research questions to inform conservation policy and management at a national level.

    Science.gov (United States)

    Rudd, Murray A; Beazley, Karen F; Cooke, Steven J; Fleishman, Erica; Lane, Daniel E; Mascia, Michael B; Roth, Robin; Tabor, Gary; Bakker, Jiselle A; Bellefontaine, Teresa; Berteaux, Dominique; Cantin, Bernard; Chaulk, Keith G; Cunningham, Kathryn; Dobell, Rod; Fast, Eleanor; Ferrara, Nadia; Findlay, C Scott; Hallstrom, Lars K; Hammond, Thomas; Hermanutz, Luise; Hutchings, Jeffrey A; Lindsay, Kathryn E; Marta, Tim J; Nguyen, Vivian M; Northey, Greg; Prior, Kent; Ramirez-Sanchez, Saudiel; Rice, Jake; Sleep, Darren J H; Szabo, Nora D; Trottier, Geneviève; Toussaint, Jean-Patrick; Veilleux, Jean-Philippe

    2011-06-01

    Integrating knowledge from across the natural and social sciences is necessary to effectively address societal tradeoffs between human use of biological diversity and its preservation. Collaborative processes can change the ways decision makers think about scientific evidence, enhance levels of mutual trust and credibility, and advance the conservation policy discourse. Canada has responsibility for a large fraction of some major ecosystems, such as boreal forests, Arctic tundra, wetlands, and temperate and Arctic oceans. Stressors to biological diversity within these ecosystems arise from activities of the country's resource-based economy, as well as external drivers of environmental change. Effective management is complicated by incongruence between ecological and political boundaries and conflicting perspectives on social and economic goals. Many knowledge gaps about stressors and their management might be reduced through targeted, timely research. We identify 40 questions that, if addressed or answered, would advance research that has a high probability of supporting development of effective policies and management strategies for species, ecosystems, and ecological processes in Canada. A total of 396 candidate questions drawn from natural and social science disciplines were contributed by individuals with diverse organizational affiliations. These were collaboratively winnowed to 40 by our team of collaborators. The questions emphasize understanding ecosystems, the effects and mitigation of climate change, coordinating governance and management efforts across multiple jurisdictions, and examining relations between conservation policy and the social and economic well-being of Aboriginal peoples. The questions we identified provide potential links between evidence from the conservation sciences and formulation of policies for conservation and resource management. Our collaborative process of communication and engagement between scientists and decision makers for

  3. Conservative Measures for Managing Constipation in Patients Living With a Colostomy.

    Science.gov (United States)

    Kuczynska, Barbara; Bobkiewicz, Adam; Studniarek, Adam; Szmyt, Krzsztof; Krokowicz, Łukasz; Matysiak, Konrad; Szmeja, Jacek; Walkowiak, Jarosław; Drews, Michał; Banasiewicz, Tomasz

    The purpose of this study was to determine the effect of a conservative regimen for the treatment of constipation in persons living with a colostomy. Prospective, noncontrolled, single-center study. The study sample comprised 35 patients with a colostomy who were diagnosed with constipation. Subjects with morphologic changes causing constipation such as stomal stenosis and neoplastic and inflammatory changes were excluded. The study was conducted in the Proctology and Stoma Outpatient Clinic at Poznan University of Medical Sciences. Patients at our Stoma Outpatient Clinic underwent baseline evaluation, and those with symptoms of constipation (prolonged periods between bowel movements, passage of pasty or hardened fecal effluent, and associated symptoms such as abdominal discomfort or bloating, flatulence, and pain with passage of effluent into the stoma) received individualized dietary recommendations that typically included an increase in dietary fiber and fluid intake, along with increased fluid intake. The outcomes of dietary changes were evaluated during a follow-up visit 3 months later. If dietary changes alone did not improve constipation symptoms, we prescribed a psyllium-based bulk-forming agent, an osmotic stool softener, and a probiotic, with or without a prokinetic agent such as metoclopramide taken 3 times daily. Dietary interventions alone were deemed successful in 60% of study subjects (n = 21); the remaining 14 patients required additional treatment. Dietary modifications alone relieved constipation in more than half of a group of 35 patients with constipation. We therefore recommend a trial of dietary modifications prior to the initiation of pharmacotherapy in patients with a colostomy.

  4. Conservation of the Eastern Taiwan Strait Chinese White Dolphin (Sousa chinensis: Fishers' Perspectives and Management Implications.

    Directory of Open Access Journals (Sweden)

    Ta-Kang Liu

    Full Text Available The abundance of the eastern Taiwan Strait (ETS population of the Chinese white dolphin (Sousa chinensis has been estimated to be less than 100 individuals. It is categorized as critically endangered in the IUCN Red List of Threatened Species. Thus, immediate measures of conservation should be taken to protect it from extinction. Currently, the Taiwanese government plans to designate its habitat as a Major Wildlife Habitat (MWH, a type of marine protected area (MPA for conservation of wildlife species. Although the designation allows continuing the current exploitation, however, it may cause conflicts among multiple stakeholders with competing interests. The study is to explore the attitude and opinions among the stakeholders in order to better manage the MPA. This study employs a semi-structured interview and a questionnaire survey of local fishers. Results from interviews indicated that the subsistence of fishers remains a major problem. It was found that stakeholders have different perceptions of the fishers' attitude towards conservation and also thought that the fishery-related law enforcement could be difficult. Quantitative survey showed that fishers are generally positive towards the conservation of the Chinese white dolphin but are less willing to participate in the planning process. Most fishers considered temporary fishing closure as feasible for conservation. The results of this study provide recommendations for future efforts towards the goal of better conservation for this endangered species.

  5. Effectiveness of conservative management of uncomplicated acute appendicitis: A single hospital based prospective study

    Directory of Open Access Journals (Sweden)

    Mumtaz KH. Alnaser

    Full Text Available Background: Acute appendicitis is one of the commonest causes of acute abdomen. There is a wide discussion and controversy on the surgical and nonsurgical treatment of acute uncomplicated appendicitis. The aim of this study was to evaluate the efficacy and outcomes of the conservative management of selected cases of acute appendicitis with an antibiotic first plan. Patients and methods: This was a single hospital-based prospective study with a duration of 25 months. Patients with clinical and radiological features of acute appendicitis presenting within 72 h of the beginning of abdominal pain with Alvarado score ≥5 were included. The patients received a therapeutic dose of broad-spectrum antibiotics and symptomatic treatment. The follow-up period was 6 months. Results: 90 patients were evaluated, 54 (60% patients were female and 36 (40% patients were male with mean age 34.4 years. Conservative treatment was successful in 68 (75.6% patients and failed in 22 (24.4% patients. No mortality recorded in this study. The main complications which occurred in those patients who failed to respond to conservative treatment were perforated appendicitis (3 patients, appendicular abscess (3 patients and appendicular mass (4 patients. Conclusion: Majority of cases of the first attack of uncomplicated acute appendicitis can be treated successfully by conservative treatment. However, conservative treatment demands precise communication, close monitoring and follow-up to recognize failure which needs to be treated immediately by surgery. Keywords: Acute appendicitis, Conservative treatment, Surgery, Antibiotics

  6. Assessment of the conservation priority status of South African estuaries for use in management and water allocation

    CSIR Research Space (South Africa)

    Turpie, JK

    2002-04-01

    Full Text Available The future health and productivity of South Africa's approximately 250 estuaries is dependent on two main factors; management and freshwater inputs. Both management and water allocation decisions involve trade-offs between conservation and various...

  7. Position paper : Whole bowel irrigation

    NARCIS (Netherlands)

    2004-01-01

    Whole bowel irrigation (WBI) should not be used routinely in the management of the poisoned patient. Although some volunteer studies have shown substantial decreases in the bioavailability of ingested drugs, no controlled clinical trials have been performed and there is no conclusive evidence that

  8. Effectiveness of primary conservative management for infants with obstetric brachial plexus palsy.

    Science.gov (United States)

    Bialocerkowski, Andrea; Kurlowicz, Kirsty; Vladusic, Sharon; Grimmer, Karen

    2005-03-01

    Background  Obstetric brachial plexus palsy, a complication of childbirth, occurs in 1-3 per 1000 live births internationally. Traction and/or compression of the brachial plexus is thought to be the primary mechanism of injury and this may occur in utero, during the descent through the birth canal or during delivery. This results in a spectrum of injuries that vary in severity, extent of damage and functional use of the affected upper limb. Most infants receive treatment, such as conservative management (physiotherapy, occupational therapy) or surgery; however, there is controversy regarding the most appropriate form of management. To date, no synthesised evidence is available regarding the effectiveness of primary conservative management for obstetric brachial plexus palsy. Objectives  The objective of this review was to systematically assess the literature and present the best available evidence that investigated the effectiveness of primary conservative management for infants with obstetric brachial plexus palsy. Search strategy  A systematic literature search was performed using 14 databases: TRIP, MEDLINE, CINAHL, AMED, Web of Science, Proquest 5000, Evidence Based Medicine Reviews, Expanded Academic ASAP, Meditext, Science Direct, Physiotherapy Evidence Database, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Those studies that were reported in English and published over the last decade (July 1992 to June 2003) were included in this review. Selection criteria  Quantitative studies that investigated the effectiveness of primary conservative management for infants with obstetric brachial plexus palsy were eligible for inclusion in this review. This excluded studies that solely investigated the effect of primary surgery for these infants, management of secondary deformities and the investigation of the effects of pharmacological agents, such as botulinum toxin. Data collection and analysis

  9. Ecological Conservation, Ecotourism, and Sustainable Management: The Case of Penang National Park

    Directory of Open Access Journals (Sweden)

    Sara Kaffashi

    2015-07-01

    Full Text Available Penang National Park (PNP, as Malaysia’s smallest national park, is one of the few naturally forested areas left on Penang Island, in Peninsular Malaysia. The main objective was to analyse users’ preferences and willingness to pay to enhance improved management of PNP for the dual aim of conservation and recreation. Structural equation modelling (SEM was used to analyse the formation of attitudes towards different aspects of PNP. Results showed that implementing enforcements with rules and regulations and imposing permits and charges on certain activities were the most influential variables of PNPs’ perceptions. The results of a random parameter logit model (RPL demonstrated that visitors placed the highest value on having adequate information about PNP, and the second-highest value on improvements in the park’s ecological management. The welfare measure for improvement in management of PNP against status quo is estimated at about MYR 9. Results also showed that demand for better conservation and management of PNP is relatively price-inelastic. Simulations of the results showed, under a MYR10 admission fee, that improvement in management would have 96% of market share compared with status quo. This study concluded that visitor entrance fees can and ought to be introduced as a means of financing conservation initiatives and possibly preventing congestion.

  10. Conservative approach to the acute management of a large mesenteric cyst.

    Science.gov (United States)

    Leung, Billy C; Sankey, Ruth; Fronza, Matteo; Maatouk, Mohamed

    2017-09-16

    Mesenteric cysts are rare, benign gastrointestinal cystic lesions, which are often non-troublesome and present as an incidental radiological finding. However, surgery is often performed in the acute setting to remove lesions that are symptomatic. This report highlights the case of a large, symptomatic mesenteric cyst managed successfully with initial conservative measures followed by planned elective surgery. A 44-year-old female presented with a four-day history of generalised abdominal pain associated with distension, fever, diarrhoea and vomiting. Computer tomography revealed a large (21.7 cm × 11.8 cm × 14 cm) mesenteric cyst within the left abdomen cavity. She was admitted and treated conservatively with intravenous fluids and antibiotics for four days, which lead to complete symptom resolution. Follow-up at intervals of one and three months revealed no return of symptoms. An elective laparotomy and excision of the mesenteric cyst was then scheduled and performed safely at nine months after the initial presentation. Compared to acute surgery, acute conservative management followed by planned elective resection of a symptomatic mesenteric cyst may prove safer. The withholding of an immediate operation may potentially avoid unnecessary operative risk and should be considered in patients without obstructive and peritonitic symptoms. Our case demonstrated the safe use of initial conservative management followed by planned elective surgery of a mesenteric cyst found in the acute setting, which was symptomatic but was not obstructive or causing peritonitic symptoms.

  11. The Colorado Plateau V: research, environmental planning, and management for collaborative conservation

    Science.gov (United States)

    Villarreal, Miguel L.; van Riper, Carena J.; Johnson, Matthew J.; van Riper, Charles

    2012-01-01

    Roughly centered on the Four Corners region of the southwestern United States, the Colorado Plateau covers some 130,000 square miles of sparsely vegetated plateaus, mesas, canyons, arches, and cliffs in Arizona, Utah, Colorado, and New Mexico. With elevations ranging from 3,000 to 14,000 feet, the natural systems found within the plateau are dramatically varied, from desert to alpine conditions. This volume, the fifth from the University of Arizona Press and the tenth overall, focuses on adaptation of resource management and conservation to climate change and water scarcity, protecting biodiversity through restructured energy policies, ensuring wildlife habitat connectivity across barriers, building effective conservation networks, and exploring new opportunities for education and leadership in conservation science. An informative read for people interested in the conservation and natural history of the region, the book will also serve as a valuable reference for those people engaged in the management of cultural and biological resources of the Colorado Plateau, as well as scientists interested in methods and tools for land and resource management throughout the West.

  12. Development of a soil conservation standard and guidelines for OHV recreation management in California

    Science.gov (United States)

    Bedrossian, T.L.; Reynolds, S.D.

    2007-01-01

    In 2004, the California State Parks (CSP) agency contracted with the California Geological Survey (CGS) to update the 1991 Soil Conservation Guide-lines/Standards for Off-Highway Vehicle (OHV) Recreation Management. Per state legislation, the 1991 standards were updated to establish a generic and measurable standard at least sufficient to allow restoration of OHV areas and trails. Given the rapid increase in OHV use in California, the updated Soil Conservation Standard and Guidelines for OHV Recreation Management also allowed for sustainability of trail systems and recreation opportunities. A key part of the update was interaction with stakeholders, agencies, and other interest groups through public workshops and a Consulting Agency Review Committee composed of representatives from the U.S. Natural Resources Conservation Service, U.S. Forest Service, U.S. Bureau of Land Management, U.S. Geological Survey, California Department of Conservation, and CSP. CGS also assessed proposed revisions in three representative OHV areas to ensure that the updated Standard and Guidelines provided sufficient flexibility to allow their application to all sites state-wide, ecosystems with multiple geology and soils types, and a variety of vehicle uses. While geology was not the only basis for the guideline revisions, it was a major factor. CGS staff also had the breadth of knowledge and experience in engineering geology, hydrogeology, road and trail construction, erosion control, and OHV riding necessary to coordinate and develop the multidisciplinary and multi-stakeholder effort.

  13. Understanding the threats posed by non-native species: public vs. conservation managers.

    Directory of Open Access Journals (Sweden)

    Rodolphe E Gozlan

    Full Text Available Public perception is a key factor influencing current conservation policy. Therefore, it is important to determine the influence of the public, end-users and scientists on the prioritisation of conservation issues and the direct implications for policy makers. Here, we assessed public attitudes and the perception of conservation managers to five non-native species in the UK, with these supplemented by those of an ecosystem user, freshwater anglers. We found that threat perception was not influenced by the volume of scientific research or by the actual threats posed by the specific non-native species. Media interest also reflected public perception and vice versa. Anglers were most concerned with perceived threats to their recreational activities but their concerns did not correspond to the greatest demonstrated ecological threat. The perception of conservation managers was an amalgamation of public and angler opinions but was mismatched to quantified ecological risks of the species. As this suggests that invasive species management in the UK is vulnerable to a knowledge gap, researchers must consider the intrinsic characteristics of their study species to determine whether raising public perception will be effective. The case study of the topmouth gudgeon Pseudorasbora parva reveals that media pressure and political debate has greater capacity to ignite policy changes and impact studies on non-native species than scientific evidence alone.

  14. Building Virtual Watersheds: A Global Opportunity to Strengthen Resource Management and Conservation

    Science.gov (United States)

    Benda, Lee; Miller, Daniel; Barquin, Jose; McCleary, Richard; Cai, TiJiu; Ji, Y.

    2016-03-01

    Modern land-use planning and conservation strategies at landscape to country scales worldwide require complete and accurate digital representations of river networks, encompassing all channels including the smallest headwaters. The digital river networks, integrated with widely available digital elevation models, also need to have analytical capabilities to support resource management and conservation, including attributing river segments with key stream and watershed data, characterizing topography to identify landforms, discretizing land uses at scales necessary to identify human-environment interactions, and connecting channels downstream and upstream, and to terrestrial environments. We investigate the completeness and analytical capabilities of national to regional scale digital river networks that are available in five countries: Canada, China, Russia, Spain, and United States using actual resource management and conservation projects involving 12 university, agency, and NGO organizations. In addition, we review one pan-European and one global digital river network. Based on our analysis, we conclude that the majority of the regional, national, and global scale digital river networks in our sample lack in network completeness, analytical capabilities or both. To address this limitation, we outline a general framework to build as complete as possible digital river networks and to integrate them with available digital elevation models to create robust analytical capabilities (e.g., virtual watersheds). We believe this presents a global opportunity for in-country agencies, or international players, to support creation of virtual watersheds to increase environmental problem solving, broaden access to the watershed sciences, and strengthen resource management and conservation in countries worldwide.

  15. Evaluating outcomes of management targeting the recovery of a migratory songbird of conservation concern

    Science.gov (United States)

    Streby, Henry M.; Kramer, Gunnar R.; Peterson, Sean M.; Andersen, David

    2018-01-01

    Assessing outcomes of habitat management is critical for informing and adapting conservation plans. From 2013 – 2019, a multi-stage management initiative aims to create >25,000 ha of shrubland and early-successional vegetation to benefit Golden-winged Warblers (Vermivora chrysoptera) in managed forested landscapes of the western Great Lakes region. We studied a dense breeding population of Golden-winged Warblers at Rice Lake National Wildlife Refuge (NWR) in Minnesota, USA, where shrubs and young trees were sheared during the winter of 2014-2015 in a single treatment supported in part by the American Bird Conservancy (ABC) and in part by other funding source(s) to benefit Golden-winged Warblers and other species associated with young forest [e.g., American Woodcock (Scalopax minor)] and as part of maintenance of early successional forest cover on the refuge.

  16. The functional outcome of blow-out fractures managed surgically and conservatively

    DEFF Research Database (Denmark)

    Felding, Ulrik Ascanius; Rasmussen, Janne; Toft, Peter Bjerre

    2016-01-01

    of diplopia and enophthalmus was determined by reviewing the medical records. Data from the patients' initial consultation and their 3-month follow-up were also collected. Of the 60 patients whose data could be analysed, 36 had been managed surgically and 24 conservatively. Of the patients managed surgically......, 25 had diplopia in peripheral gaze before surgery and 12 at 3-month follow-up. Nine had diplopia in primary gaze before surgery and none at 3-month follow-up. Five had enophthalmus before surgery and two at 3-month follow-up. Of the patients managed conservatively, eight had diplopia in peripheral...... gaze initially and seven at 3-month follow-up. Three had diplopia in primary gaze initially and one at 3-month follow-up. One had enophthalmus initially which was still present at 3-month follow-up. Primary gaze diplopia disappeared while secondary gaze diplopia was present in about a third of patients...

  17. Self-management of older adolescents with inflammatory bowel disease: a pilot study of behavior and knowledge as prelude to transition.

    Science.gov (United States)

    Fishman, Laurie N; Barendse, Renée M; Hait, Elizabeth; Burdick, Cynthia; Arnold, Janis

    2010-12-01

    Patients gradually assume responsibility for self-management. This study sought to determine whether adolescents with inflammatory bowel disease (IBD) have developed key skills of self-management prior to the age at which many transfer to adult care. Adolescents aged 16 to 18 years old in the Children's Hospital Boston IBD database (94 total) received a mailed survey assessing knowledge and confidence of their own health information and behaviors. Respondents (43%) could name medication and dose with confidence but had very poor knowledge of important side effects. Most patients deferred responsibility mostly or completely to parents for scheduling appointments (85%), requesting refills (75%), or contacting provider between visits (74%). Older adolescents with IBD have good recall of medications but not of side effects. Parents remain responsible for the majority of tasks related to clinic visits and the acquisition of medications.

  18. Conservation Easements and Management by Family Forest Owners: A Propensity Score Matching Approach with Multi-Imputations of Survey Data

    Science.gov (United States)

    Nianfu Song; Francisco X. Aguilar; Brett J. Butler

    2014-01-01

    Increasingly, private landowners are participating in conservation easement programs, but their effects on land management remain to be addressed. Data from the USDA Forest Service National Woodland Owner Survey for the US Northern Region were used to investigate how conservation easement participation is associated with selected past and future forest management...

  19. Rotation grazing as a conservation management tool : Vegetation changes after six years of application in a salt marsh ecosystem

    NARCIS (Netherlands)

    Lagendijk, D. D. Georgette; Howison, Ruth A.; Esselink, Peter; Ubels, Richard; Smit, Christian

    2017-01-01

    Grazing is commonly used in conservation to promote biodiversity, but the search for a grazing management regime that optimises biodiversity is still ongoing. Rotation grazing, where grazing is followed by a relatively long period of non-grazing, is a relative new tool in conservation management,

  20. Mammal indicator species for protected areas and managed forests in a landscape conservation area in northern India

    Science.gov (United States)

    Pradeep K. Mathur; Harish Kumar; John F. Lehmkuhl; Anshuman Tripathi; Vishwas B. Sawarkar; Rupak. De

    2010-01-01

    There is a realization that managed forests and other natural areas in the landscape matrix can and must make significant contributions to biodiversity conservation. Often, however, there are no consistent baseline vegetation or wildlife data for assessing the status of biodiversity elements across protected and managed areas for conservation planning, nor is there a...

  1. Athletic Population with Spondylolysis: Review of Outcomes following Surgical Repair or Conservative Management

    Science.gov (United States)

    Panteliadis, Pavlos; Nagra, Navraj S.; Edwards, Kimberley L.; Behrbalk, Eyal; Boszczyk, Bronek

    2016-01-01

    Study Design  Narrative review. Objective  The study aims to critically review the outcomes associated with the surgical repair or conservative management of spondylolysis in athletes. Methods  The English literature listed in MEDLINE/PubMed was reviewed to identify related articles using the term “spondylolysis AND athlete.” The criteria for studies to be included were management of spondylolysis in athletes, English text, and no year, follow-up, or study design restrictions. The references of the retrieved articles were also evaluated. The primary outcome was time to return to sport. This search yielded 180 citations, and 25 publications were included in the review. Results  Treatment methods were dichotomized as operative and nonoperative. In the nonoperative group, 390 athletes were included. A combination of bracing with physical therapy and restriction of activities was used. Conservative measures allowed athletes to return to sport in 3.7 months (weighted mean). One hundred seventy-four patients were treated surgically. The most common technique was Buck's, using a compression screw (91/174). All authors reported satisfactory outcomes. Time to return to play was 7.9 months (weighted mean). There were insufficient studies with suitably homogenous subgroups to conduct a meta-analysis. Conclusion  There is no gold standard approach for the management of spondylolysis in the athletic population. The existing literature suggests initial therapy should be a course of conservative management with thoracolumbosacral orthosis brace, physiotherapy, and activity modification. If conservative management fails, surgical intervention should be considered. Two-sided clinical studies are needed to determine an optimal pathway for the management of athletes with spondylolysis. PMID:27556003

  2. Towards adaptive fire management for biodiversity conservation: Experience in South African National Parks

    Directory of Open Access Journals (Sweden)

    Brian W. van Wilgen

    2011-05-01

    Conservation implications: Significant challenges face the managers of fire-prone and fire adapted ecosystems, where the attainment of ecosystem goals may require approaches (like encouraging high-intensity fires at hot and dry times of the year that threaten societal goals related to safety. In addition, approaches to fire management have focused on encouraging particular fire patterns in the absence of a sound understanding of their ecological outcomes. Adaptive management offers a framework for addressing these issues, but will require higher levels of agreement, monitoring and assessment than have been the case to date.

  3. Energy R and D. Conservation planning and management should be strengthened

    International Nuclear Information System (INIS)

    Hale, Richard A.; Fishkin, Christine M.B.; MacLeod, Molly W.; Davis, Alphonse R.; Crawford, John T.; Dowd, Leonard L.; Sisson, John W.; Sugimura, Richard H.

    1990-07-01

    projects. Systematic project reviews and a uniform prioritization methodology would (1) help ensure that ongoing research continues to be relevant and (2) provide information needed for DOE to select the best overall mix of conservation R and D projects. Peer reviews, conducted under Conservation's 'critical review' program, have enhanced DOE R and D management by providing independent, expert guidance to DOE on the continuing relevance of some of Conservation's programs to national and departmental objectives. The peer reviews have recommended changes to many of the programs that have improved them. However, the last peer review was completed in July 1988, and it is likely that the program will be discontinued as an office wide program as a result of the April 1990 reorganization of the Office of Conservation and Renewable Energy

  4. Systematic review: the perceptions, diagnosis and management of irritable bowel syndrome in primary care--a Rome Foundation working team report.

    Science.gov (United States)

    Hungin, A P S; Molloy-Bland, M; Claes, R; Heidelbaugh, J; Cayley, W E; Muris, J; Seifert, B; Rubin, G; de Wit, N

    2014-11-01

    To review studies on the perceptions, diagnosis and management of irritable bowel syndrome (IBS) in primary care. Systematic searches of PubMed and Embase. Of 746 initial search hits, 29 studies were included. Relatively few primary care physicians were aware of (2-36%; nine studies) or used (0-21%; six studies) formal diagnostic criteria for IBS. Nevertheless, most could recognise the key IBS symptoms of abdominal pain, bloating and disturbed defaecation. A minority of primary care physicians [7-32%; one study (six European countries)] preferred to refer patients to a specialist before making an IBS diagnosis, and few patients [4-23%; three studies (two European, one US)] were referred to a gastroenterologist by their primary care physician. Most PCPs were unsure about IBS causes and treatment effectiveness, leading to varied therapeutic approaches and broad but frequent use of diagnostic tests. Diagnostic tests, including colon investigations, were more common in older patients (>45 years) than in younger patients [<45 years; five studies (four European, one US)]. There has been much emphasis about the desirability of an initial positive diagnosis of IBS. While it appears most primary care physicians do make a tentative IBS diagnosis from the start, they still tend to use additional testing to confirm it. Although an early, positive diagnosis has advantages in avoiding unnecessary investigations and costs, until formal diagnostic criteria are conclusively shown to sufficiently exclude organic disease, bowel investigations, such as colonoscopy, will continue to be important to primary care physicians. © 2014 John Wiley & Sons Ltd.

  5. Annual report to Congress on Federal Government energy management and conservation programs, Fiscal year 1994

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-10-06

    This report provides sinformation on energy consumption in Federal buildings and operations and documents activities conducted by Federal agencies to meet statutory requirements of the National Energy Conservation Policy Act. It also describes energy conservation and management activities of the Federal Government under section 381 of the Energy Policy and Conservation Act. Implementation activities undertaken during FY94 by the Federal agencies under the Energy Policy Act of 1992 and Executive Orders 12759 and 12902 are also described. During FY94, total (gross) energy consumption of the US Government, including energy consued to produce, process, and transport energy, was 1.72 quadrillion Btu. This represents {similar_to}2.0% of the total 85.34 quads used in US.

  6. Evaluating outcomes of management targeting the recovery of a migratory songbird of conservation concern.

    Science.gov (United States)

    Streby, Henry M; Kramer, Gunnar R; Peterson, Sean M; Andersen, David E

    2018-01-01

    Assessing outcomes of habitat management is critical for informing and adapting conservation plans. From 2013-2019, a multi-stage management initiative, led by the American Bird Conservancy (ABC), aims to create >25,000 ha of shrubland and early-successional vegetation to benefit Golden-winged Warblers ( Vermivora chrysoptera ) in managed forested landscapes of the western Great Lakes region. We studied a dense breeding population of Golden-winged Warblers at Rice Lake National Wildlife Refuge (NWR) in Minnesota, USA, where ABC initiative management was implemented to benefit the species. We monitored abundance before (2011-2014) and after (2015-2016) management, and we estimated full-season productivity (i.e., young recruited into the fall population) from predictive, spatially explicit models, informed by nest and fledgling survival data collected at sites in the western Great Lakes region, including Rice Lake NWR, during 2011 and 2012. Then, using biologically informed models of bird response to observed and predicted vegetation succession, we estimated the cumulative change in population recruitment over various scenarios of vegetation succession and demographic response. We observed an 32% decline in abundance of breeding pairs and estimated a 27% decline in per-pair full-season productivity following management, compared to no change in a nearby control site. In models that ranged from highly optimistic to progressively more realistic scenarios, we estimated a net loss of 72-460 juvenile Golden-winged Warblers produced from the managed site in the 10-20 years following management. Even if our well-informed and locally validated productivity models produced erroneous estimates and the management resulted in only a temporary reduction in abundance (i.e., no change in productivity), our forecast models still predicted a net loss of 137-260 juvenile Golden-winged Warblers from the managed area over the same time frame. Our study site represents only a small

  7. CONSERVATIVE THERAPY VERSUS EPIDURAL STEROID INFILTRATION IN MANAGEMENT OF CHRONIC LOW BACK ACHE

    Directory of Open Access Journals (Sweden)

    Vivian Roshan D

    2015-11-01

    Full Text Available BACKGROUND: Sciatica due to lumbar intervertebral disc herniation is one of the most common causes of radicular pain in an adult working population. This study aims at studying the effectiveness of conservative management of lumbar disc herniation as an alternative to surgical measures. METHODS: A prospective study of 100 patients with lumbar disc herniations who were treated conservatively were followed up at intervals of 1 month, 6 months and 1 year. Patients planned for conservative treatment were treated with pharmacological therapy, rest and physiotherapy. Those planned for epidural steroid injections were administered a single dose of steroid one level higher than the lesion in the epidural space. The collected data was analyzed by Chi square. RESULTS: Our results showed that in both genders, epidural steroid infiltration yielded better results than conservative treatment. Occupation had no discernible effect on the magnitude of disc herniation. People with sedentary lifestyle recovered better with epidural steroid infiltration as compared to the heavy physical labor group. Irrespective of disc bulge, protrusion or extrusion, the epidural steroid injection group showed significant improvement in symptoms as compared to conservative treatment. Smokers tended to show delay in the recovery as compared with the non-smoker group. The amount of disc herniation is not directly proportional to the outcome of treatment. CONCLUSIONS: Epidural steroid infiltration showed significant improvement in symptoms of lumbar intervertebral disc herniation thereby avoiding disc surgery. Conservative management for atleast 4 to 6 weeks can be recommended followed by epidural steroid in those patients without improvement. Cessation of smoking should be an integral part of the treatment.

  8. Biodiversity conservation and indigenous land management in the era of self-determination.

    Science.gov (United States)

    Schmidt, Paige M; Peterson, Markus J

    2009-12-01

    Indigenous people inhabit approximately 85% of areas designated for biodiversity conservation worldwide. They also continue to struggle for recognition and preservation of cultural identities, lifestyles, and livelihoods--a struggle contingent on control and protection of traditional lands and associated natural resources (hereafter, self-determination). Indigenous lands and the biodiversity they support are increasingly threatened because of human population growth and per capita consumption. Application of the Endangered Species Act (ESA) to tribal lands in the United States provides a rich example of the articulation between biodiversity conservation and indigenous peoples' struggle for self-determination. We found a paradoxical relationship whereby tribal governments are simultaneously and contradictory sovereign nations; yet their communities depend on the U.S. government for protection through the federal-trust doctrine. The unique legal status of tribal lands, their importance for conserving federally protected species, and federal environmental regulations' failure to define applicability to tribal lands creates conflict between tribal sovereignty, self-determination, and constitutional authority. We reviewed Secretarial Order 3206, the U.S. policy on "American Indian tribal rights, federal-tribal trust responsibilities, and the ESA," and evaluated how it influences ESA implementation on tribal lands. We found improved biodiversity conservation and tribal self-determination requires revision of the fiduciary relationship between the federal government and the tribes to establish clear, legal definitions regarding land rights, applicability of environmental laws, and financial responsibilities. Such actions will allow provision of adequate funding and training to tribal leaders and resource managers, government agency personnel responsible for biodiversity conservation and land management, and environmental policy makers. Increased capacity, cooperation, and

  9. Pacific Canada's Rockfish Conservation Areas: using Ostrom's design principles to assess management effectiveness

    Directory of Open Access Journals (Sweden)

    Darienne Lancaster

    2015-09-01

    Full Text Available International declines in marine biodiversity have lead to the creation of marine protected areas and fishery reserve systems. In Canada, 164 Rockfish Conservation Areas (RCAs were implemented between 2003 and 2007 and now cover 4847.2 km² of ocean. These reserves were created in response to widespread concern from fishers and nongovernmental organizations about inshore rockfish (genus Sebastes population declines. We used the design principles for effective common-pool resource management systems, originally developed by Elinor Ostrom, to assess the social and ecological effectiveness of these conservation areas more than 10 years after their initial implementation. We assessed the relative presence or absence of each design principle within current RCA management. We found that 2 of the 11 design principles were moderately present in the recreational fishery. All other design principles were lacking for the recreational sector. We found that 2 design principles were fully present and 5 were moderately present in the commercial sector. Four design principles were lacking in the commercial sector. Based on this analysis, we highlight 4 main areas for management improvement: (1 create an education and outreach campaign to explain RCA rules, regulations, boundaries, and the need for marine conservation; (2 increase monitoring of users and resources to discourage noncompliance and gather the necessary data to create social buy-in for marine conservation; (3 encourage informal nested governance through stakeholder organizations for education and self-regulation (e.g. fisher to fisher; and (4 most importantly, create a formal, decadal RCA review process to gather stakeholder input and make amendments to regulations and RCA boundaries. This information can be used to inform spatial management systems both in Canada and internationally. This analysis also contributes to a growing literature on effectively scaling up small-scale management techniques

  10. Effectiveness and Morbidity Associated With Reirradiation in Conservative Salvage Management of Recurrent Soft-Tissue Sarcoma

    International Nuclear Information System (INIS)

    Indelicato, Daniel J.; Meadows, Kenyon; Gibbs, Charles P.; Morris, Christopher G.; Scarborough, Mark T.; Zlotecki, Robert A.

    2009-01-01

    Purpose: The management of isolated local recurrence of soft-tissue sarcoma is therapeutically complex, and functional conservative management is preferable to radical or amputative salvage surgery. This study reviews University of Florida experience using conservative resection and reirradiation to manage isolated local recurrences of soft-tissue sarcoma. Methods and Materials: Between 1976 and 2005, a total of 14 patients who underwent primary conservative resection and irradiation developed isolated local recurrence and were managed with salvage conservative resection and reirradiation. Of the patients treated, 3 had tumors of the distal extremity, 8 had tumors of the proximal extremity, and 3 had tumors of the trunk. At the time of recurrence, 64% of tumors were greater than 5 cm and 79% were high grade. In combination with gross total resection, 13 of 14 patients received external beam radiotherapy with or without brachytherapy, and 1 patient was treated with brachytherapy alone. Two patients received chemotherapy. Results: The median follow-up was 30 months, and no living patients were lost during follow-up. From retreatment, the 5-year actuarial overall survival, cause-specific survival, and local control rates were 40%, 40%, and 18% respectively. There was a 50% incidence of serious complication requiring either reoperation or leading to permanent functional impairment. Of the 14 patients, only 1 has remained disease free and without significant complications. No treatment factors, including achieving wide surgical margins or delivering higher radiation dosages, seemed to confer an advantage in local control. Conclusions: Salvage therapy for management of locally recurrent soft-tissue sarcoma is challenging, and the effects of reoperation and reirradiation can be severe

  11. Innovation in Management Plans for Community Conserved Areas: Experiences from Australian Indigenous Protected Areas

    Directory of Open Access Journals (Sweden)

    Jocelyn Davies

    2013-06-01

    Full Text Available Increasing attention to formal recognition of indigenous and community conserved areas (ICCAs as part of national and/or global protected area systems is generating novel encounters between the customary institutions through which indigenous peoples and local communities manage these traditional estates and the bureaucratic institutions of protected area management planning. Although management plans are widely considered to be important to effective management of protected areas, little guidance has been available about how their form and content can effectively reflect the distinctive socio-cultural and political characteristics of ICCAs. This gap has been particularly apparent in Australia where a trend to rapidly increased formal engagement of indigenous people in environmental management resulted, by 2012, in 50 indigenous groups voluntarily declaring their intent to manage all or part of their estates for conservation in perpetuity, as an indigenous protected area (IPA. Development and adoption of a management plan is central to the process through which the Australian Government recognizes these voluntary declarations and invests resources in IPA management. We identified four types of innovations, apparent in some recent IPA plans, which reflect the distinctive socio-cultural and political characteristics of ICCAs and support indigenous people as the primary decision makers and drivers of knowledge integration in IPAs. These are (1 a focus on customary institutions in governance; (2 strategic planning approaches that respond to interlinkages of stewardship between people, place, plants, and animals; (3 planning frameworks that bridge scales by considering values and issues across the whole of an indigenous people's territory; and (4 varied communication modes appropriate to varied audiences, including an emphasis on visual and spatial modes. Further research is warranted into how governance and management of IPAs, and the plans that

  12. MIGRATION AND CONSERVATION: FRAMEWORKS, GAPS, AND SYNERGIES IN SCIENCE, LAW, AND MANAGEMENT.

    Science.gov (United States)

    Meretsky, Vicky J; Atwell, Jonathan W; Hyman, Jeffrey B

    2011-01-01

    Migratory animals provide unique spectacles of cultural, ecological, and economic importance. However, the process of migration is a source of risk for migratory species as human actions increasingly destroy and fragment habitat, create obstacles to migration, and increase mortality along the migration corridor. As a result, many migratory species are declining in numbers. In the United States, the Endangered Species Act provides some protection against extinction for such species, but no protection until numbers are severely reduced, and no guarantee of recovery to population levels associated with cultural, ecological, or economic significance. Although groups of species receive some protection from statutes such as the Migratory Bird Treaty Act and Marine Mammal Protection Act, there is no coordinated system for conservation of migratory species. In addition, information needed to protect migratory species is often lacking, limiting options for land and wildlife managers who seek to support these species. In this Article, we outline the existing scientific, legal, and management information and approaches to migratory species. Our objective is to assess present capacity to protect the species and the phenomenon of migration, and we argue that al three disciplines are necessary for effective conservation. We find significant capacity to support conservation in all three disciplines, but no organization around conservation of migration within any discipline or among the three disciplines. Areas of synergy exist among the disciplines but not as a result of any attempt for coordination. As a result, significant gaps in information and capacity exist that must be addressed if effective conservation of migratory species is to be undertaken. We suggest that all three disciplines cooperate to identify the most pressing research needs, so that these can become targets for relevant funding sources. We identify areas of current risk to migratory species that represent gaps

  13. Percutaneous vertebroplasty and conservative management for the treatment of osteoporotic vertebral fractures: a comparative study

    International Nuclear Information System (INIS)

    Liu Wengui; Lu Jinyu; Sun Jianhua; Liang Ding; Li Zhiwei; Wang Hesheng; Guo Shanfeng

    2011-01-01

    Objective: To investigate the better therapeutic measures for painful osteoporotic vertebral compression fractures (OVCF) through comparing the efficacy of percutaneous vertebroplasty (PVP) with that of conservative management. Methods: Forty-three consecutive patients, encountered from December 2009 to December 2010 in authors' hospital, were enrolled in this study. The patients were divided into PVP group (n=22) and conservative group (n=21). Visual analog score (VAS) for pain and Oswestry disability index (ODI) questionnaire scores were assessed before and 1 week, 1, 3, 6, 12 months after the treatment. Patients' activity levels and other information, including complications and new fractures after treatment, were also evaluated. Results: Before the treatment both the VAS and ODI scores showed no statistically significant difference between the two groups. Significant reduction of both VAS and ODI was observed in PVP group at 1 week and at 1 and 3 months after treatment when compared with those in conservative group (P<0.05). Patients' activity levels in PVP group were significantly improved than that in conservative group (P<0.01). One new fracture was observed in the conservative group, while no new fracture was seen in the PVP group. Conclusion: Immediate pain relief and improvement of daily activities after PVP can be achieved in all patients. PVP should be considered as the treatment of first choice for symptomatic osteoporotic vertebral fractures. (authors)

  14. Are we working towards global research priorities for management and conservation of sea turtles?

    Science.gov (United States)

    Rees, A.F.; Alfaro-Shigueto, J.; Barata, P.C.R.; Bjorndal, K.A.; Bolten, A.B.; Bourjea, J.; Broderick, A.C.; Campbell, L.M.; Cardona, L.; Carreras, C.; Casale, P.; Ceriani, S.A.; Dutton, P.H.; Eguchi, T.; Formia, A.; Fuentes, M.M.P.B.; Fuller, W.J.; Girondot, M.; Godfrey, M.H.; Hamann, M.; Hart, Kristen M.; Hays, G.C.; Hochscheid, S.; Kaska, Y.; Jensen, M.P.; Mangel, J.C.; Mortimer, J.A.; Naro-Maciel, E.; Ng, C.K.Y.; Nichols, W.J.; Phillott, A.D.; Reina, R.D.; Revuelta, O.; Schofield, G.; Seminoff, J.A.; Shanker, K.; Tomás, J.; van de Merwe, J.P.; Van Houtan, K.S.; Vander Zanden, H.B.; Wallace, B.P.; Wedemeyer-Strombel, K.R.; Work, Thierry M.; Godley, B.J.

    2016-01-01

    In 2010, an international group of 35 sea turtle researchers refined an initial list of more than 200 research questions into 20 metaquestions that were considered key for management and conservation of sea turtles. These were classified under 5 categories: reproductive biology, biogeography, population ecology, threats and conservation strategies. To obtain a picture of how research is being focused towards these key questions, we undertook a systematic review of the peer-reviewed literature (2014 and 2015) attributing papers to the original 20 questions. In total, we reviewed 605 articles in full and from these 355 (59%) were judged to substantively address the 20 key questions, with others focusing on basic science and monitoring. Progress to answering the 20 questions was not uniform, and there were biases regarding focal turtle species, geographic scope and publication outlet. Whilst it offers some meaningful indications as to effort, quantifying peer-reviewed literature output is obviously not the only, and possibly not the best, metric for understanding progress towards informing key conservation and management goals. Along with the literature review, an international group based on the original project consortium was assigned to critically summarise recent progress towards answering each of the 20 questions. We found that significant research is being expended towards global priorities for management and conservation of sea turtles. Although highly variable, there has been significant progress in all the key questions identified in 2010. Undertaking this critical review has highlighted that it may be timely to undertake one or more new prioritizing exercises. For this to have maximal benefit we make a range of recommendations for its execution. These include a far greater engagement with social sciences, widening the pool of contributors and focussing the questions, perhaps disaggregating ecology and conservation.

  15. Managing consequences of climate-driven species redistribution requires integration of ecology, conservation and social science.

    Science.gov (United States)

    Bonebrake, Timothy C; Brown, Christopher J; Bell, Johann D; Blanchard, Julia L; Chauvenet, Alienor; Champion, Curtis; Chen, I-Ching; Clark, Timothy D; Colwell, Robert K; Danielsen, Finn; Dell, Anthony I; Donelson, Jennifer M; Evengård, Birgitta; Ferrier, Simon; Frusher, Stewart; Garcia, Raquel A; Griffis, Roger B; Hobday, Alistair J; Jarzyna, Marta A; Lee, Emma; Lenoir, Jonathan; Linnetved, Hlif; Martin, Victoria Y; McCormack, Phillipa C; McDonald, Jan; McDonald-Madden, Eve; Mitchell, Nicola; Mustonen, Tero; Pandolfi, John M; Pettorelli, Nathalie; Possingham, Hugh; Pulsifer, Peter; Reynolds, Mark; Scheffers, Brett R; Sorte, Cascade J B; Strugnell, Jan M; Tuanmu, Mao-Ning; Twiname, Samantha; Vergés, Adriana; Villanueva, Cecilia; Wapstra, Erik; Wernberg, Thomas; Pecl, Gretta T

    2018-02-01

    Climate change is driving a pervasive global redistribution of the planet's species. Species redistribution poses new questions for the study of ecosystems, conservation science and human societies that require a coordinated and integrated approach. Here we review recent progress, key gaps and strategic directions in this nascent research area, emphasising emerging themes in species redistribution biology, the importance of understanding underlying drivers and the need to anticipate novel outcomes of changes in species ranges. We highlight that species redistribution has manifest implications across multiple temporal and spatial scales and from genes to ecosystems. Understanding range shifts from ecological, physiological, genetic and biogeographical perspectives is essential for informing changing paradigms in conservation science and for designing conservation strategies that incorporate changing population connectivity and advance adaptation to climate change. Species redistributions present challenges for human well-being, environmental management and sustainable development. By synthesising recent approaches, theories and tools, our review establishes an interdisciplinary foundation for the development of future research on species redistribution. Specifically, we demonstrate how ecological, conservation and social research on species redistribution can best be achieved by working across disciplinary boundaries to develop and implement solutions to climate change challenges. Future studies should therefore integrate existing and complementary scientific frameworks while incorporating social science and human-centred approaches. Finally, we emphasise that the best science will not be useful unless more scientists engage with managers, policy makers and the public to develop responsible and socially acceptable options for the global challenges arising from species redistributions. © 2017 Cambridge Philosophical Society.

  16. Lack of effectiveness of primary conservative management for infants with brachial plexus birth palsy.

    Science.gov (United States)

    Bialocerkowski, Andrea Emmi; Vladusic, Sharon; Moore, Rosemary Patricia

    Brachial plexus birth palsy (BPBP) is the most common peripheral nerve injury in children (prevalence microsurgical repair of the brachial plexus, surgical management of secondary deformities or received other treatments traditionally delivered by surgeons, such as Botulinum toxin injections. The eligibility of each study identified from the database searches was evaluated against the inclusion criteria by two independent reviewers. These studies were then critically appraised for level of evidence using the National Health and Medical Research Council of Australia Hierarchy of Evidence and methodological quality using the Critical Review Form - Quantitative Studies. Data pertaining to the demographic characteristics of study participants, treatments received, main results and outcome measures used were also extracted. Where any disagreement between reviewers occurred, consensus was reached by discussion. Data from the recently published studies were narratively synthesised and then combined with the data gained from our previous systematic review to create a body of evidence on primary conservative management for BPBP infants. Four publications, representing three studies (one comparative study, two case series), were sourced. Methodological quality scores of these studies ranged from 6 to 12 (maximum =16). The current body of evidence (publications from 1992 to 2008) therefore comprises 11 studies, four using a comparative design and seven using a case series design. Six of the 11 studies were classified as being of "poor" methodological quality (score <8). Conservative management mainly consisted of exercise therapy, although splinting, massage and dynamic traction were also used. All studies lacked a clear definition of conservative management sufficient to allow replication of the treatment in a clinical setting. A variety of outcome measures were used, limiting comparability of the studies. Data from the three case studies suggests that conservative

  17. Micro-Credit and Community Wildlife Management: Complementary Strategies to Improve Conservation Outcomes in Serengeti National Park, Tanzania

    Science.gov (United States)

    Kaaya, Emmanuel; Chapman, Margaret

    2017-09-01

    Community wildlife management programs in African protected areas aim to deliver livelihood and social benefits to local communities in order to bolster support for their conservation objectives. Most of these benefits are delivered at the community level. However, many local people are also seeking more individual or household-level livelihood benefits from community wildlife management programs because it is at this level that many of the costs of protected area conservation are borne. Because community wildlife management delivers few benefits at this level, support for their conservation objectives amongst local people often declines. The study investigated the implications of this for reducing poaching in Serengeti National Park, Tanzania. Three community wildlife management initiatives undertaken by Park management were compared with regard to their capacity to deliver the individual and household-level benefits sought by local people: community conservation services, wildlife management areas and community conservation banks. Interviews were carried out with poachers and local people from four villages in the Western Serengeti including members of village conservation banks, as well as a number of key informants. The results suggest that community conservation banks could, as a complementary strategy to existing community wildlife management programs, potentially provide a more effective means of reducing poaching in African protected areas than community wildlife management programs alone.

  18. A conservative approach to pediatric mandibular fracture management: outcome and advantages.

    Science.gov (United States)

    Khatri, Amit; Kalra, Namita

    2011-01-01

    Pediatric mandibular fractures are rare and their treatment remains controversial. Management is extremely complicated in mixed dentition as it is inherently dynamic and unstable. Treatment options include soft diet, intermaxillary fixation with eyelet wires, arch bars, circummandibular wiring, or stents. Alternative options include open reduction and internal fixation through either an intraoral or extraoral approach. This case report describes and evaluates the conservative technique of acrylic splint in the treatment of pediatric mandible fracture in a 12-year-old female child. The patient with isolated mandibular fracture was treated with acrylic splint and interdental wiring followed by evaluation of clinical and radiographic healing as well as the somatosensory status. Patient demonstrated clinical union to her pre-injury occlusion by three to four weeks. Panoramic finding supported the finding of clinical examination throughout the study. High osteogenic potential of the pediatric mandible allowed conservative management to be successful in this case.

  19. A conservative approach to pediatric mandibular fracture management: Outcome and advantages

    Directory of Open Access Journals (Sweden)

    Amit Khatri

    2011-01-01

    Full Text Available Pediatric mandibular fractures are rare and their treatment remains controversial. Management is extremely complicated in mixed dentition as it is inherently dynamic and unstable. Treatment options include soft diet, intermaxillary fixation with eyelet wires, arch bars, circummandibular wiring, or stents. Alternative options include open reduction and internal fixation through either an intraoral or extraoral approach. This case report describes and evaluates the conservative technique of acrylic splint in the treatment of pediatric mandible fracture in a 12-year-old female child. The patient with isolated mandibular fracture was treated with acrylic splint and interdental wiring followed by evaluation of clinical and radiographic healing as well as the somatosensory status. Patient demonstrated clinical union to her pre-injury occlusion by three to four weeks. Panoramic finding supported the finding of clinical examination throughout the study. High osteogenic potential of the pediatric mandible allowed conservative management to be successful in this case.

  20. Adenosine A2B Receptors: An Optional Target for the Management of Irritable Bowel Syndrome with Diarrhea?

    Directory of Open Access Journals (Sweden)

    Teita Asano

    2017-11-01

    Full Text Available Irritable bowel syndrome (IBS is a functional gastrointestinal disorder, with the characteristic symptoms of chronic abdominal pain and altered bowel habits (diarrhea, constipation, or both. IBS is a highly prevalent condition, which negatively affects quality of life and is a significant burden on global healthcare costs. Although many pharmacological medicines have been proposed to treat IBS, including those targeting receptors, channels, and chemical mediators related to visceral hypersensitivity, successful pharmacotherapy for the disease has not been established. Visceral hypersensitivity plays an important role in IBS pathogenesis. Immune activation is observed in diarrhea-predominant patients with IBS and contributes to the development of visceral hypersensitivity. Adenosine is a chemical mediator that regulates many physiological processes, including inflammation and nociception. Among its receptors, the adenosine A2B receptor regulates intestinal secretion, motor function, and the immune response. We recently demonstrated that the adenosine A2B receptor is involved in visceral hypersensitivity in animal models of IBS. In this review, we discuss the possibility of the adenosine A2B receptor as a novel therapeutic target for IBS.

  1. Review article: potential mechanisms of action of rifaximin in the management of irritable bowel syndrome with diarrhoea.

    Science.gov (United States)

    Pimentel, M

    2016-01-01

    The role of gut microbiota in the pathophysiology of irritable bowel syndrome (IBS) is supported by various lines of evidence, including differences in mucosal and faecal microbiota between patients with IBS and healthy individuals, development of post-infectious IBS, and the efficacy of some probiotics and nonsystemic antibiotics (e.g. rifaximin). To review the literature regarding the role of rifaximin in IBS and its potential mechanism(s) of action. A literature search was conducted using the terms 'rifaximin', 'irritable bowel syndrome' and 'mechanism of action'. Rifaximin was approved in 2015 for the treatment of IBS with diarrhoea. In contrast to other currently available IBS therapies that require daily administration to maintain efficacy, 2-week rifaximin treatment achieved symptom improvement that persisted ≥12 weeks post-treatment. The mechanisms of action of rifaximin, therefore, may extend beyond direct bactericidal effects. Data suggest that rifaximin may decrease host proinflammatory responses to bacterial products in patients with IBS. In some cases, small intestinal bacterial overgrowth (SIBO) may play a role in the clinical symptoms of IBS. Because of the high level of solubility of rifaximin in the small intestine, rifaximin may reset microbial diversity in this environment. Consistent with this hypothesis, rifaximin has antibiotic efficacy against isolates derived from patients with SIBO. Resetting microbial diversity via rifaximin use may lead to a decrease in bacterial fermentation and a reduction in the clinical symptoms of IBS. © 2015 John Wiley & Sons Ltd.

  2. Adaptive management for improving species conservation across the captive-wild spectrum

    Science.gov (United States)

    Canessa, Stefano; Guillera-Arroita, Gurutzeta; Lahoz-Monfort, José J.; Southwell, Darren M; Armstrong, Doug P.; Chadès, Iadine; Lacy, Robert C; Converse, Sarah J.

    2016-01-01

    Conservation of endangered species increasingly envisages complex strategies that integrate captive and wild management actions. Management decisions in this context must be made in the face of uncertainty, often with limited capacity to collect information. Adaptive management (AM) combines management and monitoring, with the aim of updating knowledge and improving decision-making over time. We provide a guide for managers who may realize the potential of AM, but are unsure where to start. The urgent need for iterative management decisions, the existence of uncertainty, and the opportunity for learning offered by often highly-controlled captive environments create favorable conditions for AM. However, experiments and monitoring may be complicated by small sample sizes, and the ability to control the system, including stochasticity and observability, may be limited toward the wild end of the spectrum. We illustrate the key steps to implementing AM in threatened species management using four case studies, including the management of captive programs for cheetah (Acinonyx jubatus) and whooping cranes (Grus americana), of a translocation protocol for Arizona cliffroses Purshia subintegra and of ongoing supplementary feeding of reintroduced hihi (Notiomystis cincta) populations. For each case study, we explain (1) how to clarify whether the decision can be improved by learning (i.e. it is iterative and complicated by uncertainty) and what the management objectives are; (2) how to articulate uncertainty via alternative, testable hypotheses such as competing models or parameter distributions; (3) how to formally define how additional information can be collected and incorporated in future management decisions.

  3. A conservative approach to pediatric mandibular fracture management: Outcome and advantages

    OpenAIRE

    Amit Khatri; Namita Kalra

    2011-01-01

    Pediatric mandibular fractures are rare and their treatment remains controversial. Management is extremely complicated in mixed dentition as it is inherently dynamic and unstable. Treatment options include soft diet, intermaxillary fixation with eyelet wires, arch bars, circummandibular wiring, or stents. Alternative options include open reduction and internal fixation through either an intraoral or extraoral approach. This case report describes and evaluates the conservative technique of acr...

  4. Developing conservation governance strategies: holistic management of protected areas in Nepal

    OpenAIRE

    Budhathoki, Prabhu

    2012-01-01

    The Buffer Zone (BZ) concept has been introduced in Nepal as a key component of the national biodiversity conservation strategy to mitigate the impacts of protected areas on local communities, and thereby reduce adverse impacts of local people on protected areas. Unlike traditional Buffer Zone programmes which are mostly limited to creating a protective layer and/or distributing economic benefits to local people, the Buffer Zone management approach in Nepal integrates livelihoods and conserva...

  5. Adaptation of Australia’s Marine Ecosystems to Climate Change: Using Science to Inform Conservation Management

    OpenAIRE

    Johnson, Johanna E.; Holbrook, Neil J.

    2014-01-01

    The challenges that climate change poses for marine ecosystems are already manifesting in impacts at the species, population, and community levels in Australia, particularly in Tasmania and tropical northern Australia. Many species and habitats are already under threat as a result of human activities, and the additional pressure from climate change significantly increases the challenge for marine conservation and management. Climate change impacts are expected to magnify as sea surface temper...

  6. Process of spontaneous resolution in the conservative management of congenital dacryocystocele

    Directory of Open Access Journals (Sweden)

    Mimura M

    2014-02-01

    Full Text Available Masashi Mimura,1,2 Mari Ueki,1 Hidehiro Oku,1 Bunpei Sato,2 Tsunehiko Ikeda11Department of Ophthalmology, Osaka Medical College, Takatsuki, 2Department of Ophthalmology, Osaka Kaisei Hospital, Osaka, JapanPurpose: To assess efficacy of the conservative management of patients with congenital dacryocystocele.Materials and methods: This was a retrospective case series involving six sides of five infants with a dacryocystocele treated at Osaka Kaisei Hospital, Osaka, Japan. The conservative management protocol consisted of the application of warm compresses and massage over the mass, with the addition of antibiotics when dacryocystitis developed. Patient age at the time of resolution, presence of retrograde outflow of contents of dacryocystoceles from the puncta, and development of dacryocystitis were recorded.Results: The dacryocystocele was unilateral in four patients and bilateral in one patient. A nasal cyst was present in four patients without respiratory distress. The median patient age at the time of the diagnosis was 7 days (range 2–10 days. Conservative management was selected in all patients, and the dacryocystocele was resolved in all patients at a median patient age of 14.5 days (range 11–105 days. Two sides developed dacryocystitis, which resolved in a few days with antibiotic treatment. In those two sides, rupture of the dacryocystoceles to the common canaliculus with retrograde discharge of the contents from the puncta before the dacryocystitis developed was noted. For the other four treated sides, no such discharge or development of dacryocystitis was observed.Conclusion: The findings of this study show that a dacryocystocele has a good chance of resolving spontaneously with conservative management and careful observation, and that rupture of the dacryocystocele to the common canaliculus might be an important precursor of dacryocystitis.Keywords: dacryocystitis, congenital lacrimal obstruction, remnant, precursor, retrograde

  7. A roadmap for knowledge exchange and mobilization research in conservation and natural resource management.

    Science.gov (United States)

    Nguyen, Vivian M; Young, Nathan; Cooke, Steven J

    2017-08-01

    Scholars across all disciplines have long been interested in how knowledge moves within and beyond their community of peers. Rapid environmental changes and calls for sustainable management practices mean the best knowledge possible is needed to inform decisions, policies, and practices to protect biodiversity and sustainably manage vulnerable natural resources. Although the conservation literature on knowledge exchange (KE) and knowledge mobilization (KM) has grown in recent years, much of it is based on context-specific case studies. This presents a challenge for learning cumulative lessons from KE and KM research and thus effectively using knowledge in conservation and natural resources management. Although continued research on the gap between knowledge and action is valuable, overarching conceptual frameworks are now needed to enable summaries and comparisons across diverse KE-KM research. We propose a knowledge-action framework that provides a conceptual roadmap for future research and practice in KE/KM with the aim of synthesizing lessons learned from contextual case studies and guiding the development and testing of hypotheses in this domain. Our knowledge-action framework has 3 elements that occur at multiple levels and scales: knowledge production (e.g., academia and government), knowledge mediation (e.g., knowledge networks, actors, relational dimension, and contextual dimension), and knowledge-based action (e.g., instrumental, symbolic, and conceptual). The framework integrates concepts from the sociology of science in particular, and serves as a guide to further comprehensive understanding of knowledge exchange and mobilization in conservation and sustainable natural resource management. © 2016 Society for Conservation Biology.

  8. Impact of biology knowledge on the conservation and management of large pelagic sharks

    OpenAIRE

    Yokoi, Hiroki; Ijima, Hirotaka; Ohshimo, Seiji; Yokawa, Kotaro

    2017-01-01

    Population growth rate, which depends on several biological parameters, is valuable information for the conservation and management of pelagic sharks, such as blue and shortfin mako sharks. However, reported biological parameters for estimating the population growth rates of these sharks differ by sex and display large variability. To estimate the appropriate population growth rate and clarify relationships between growth rate and relevant biological parameters, we developed a two-sex age-str...

  9. Genomic resources for the conservation and management of the harpy eagle (Harpia harpyja, Falconiformes, Accipitridae)

    OpenAIRE

    Banhos, Aureo; Hrbek, Tomas; Gravena, Waleska; Sanaiotti, Tânia; Farias, Izeni P.

    2008-01-01

    We report the characterization and optimization of 45 heterologous microsatellite loci, and the development of a new set of molecular sex markers for the conservation and management of the Neotropical harpy eagle (Harpia harpyja L. 1758). Of the 45 microsatellites tested, 24 were polymorphic, six monomorphic, 10 uncharacterizable due to multiple bands and five did not amplify. The observed gene diversity of the analyzed sample of H. harpyja was low and similar to that of other threatened Falc...

  10. Large bowel resection

    Science.gov (United States)

    ... blockage in the intestine due to scar tissue Colon cancer Diverticular disease (disease of the large bowel) Other reasons for bowel resection are: Familial polyposis (polyps are growths on the lining of the colon or rectum) Injuries that damage the large bowel ...

  11. More hostile dyslipidaemia in chronic kidney disease patients on maintenance haemodialysis than on conservative management.

    Science.gov (United States)

    Rathi, Teerath Kumar; Dhrolia, Murtaza Fakhruddin; Imtiaz, Salman

    2016-08-01

    To study the pattern of dyslipidaemia in patients with stage-V chronic kidney disease on conservative management and those on maintenance haemodialysis. This comparative observational study was conducted at the Jinnah Postgraduate Medical Centre, Karachi, from February to July, 2008, and comprised stage-V chronic kidney disease patients. The patients were divided in two groups. Those who were on conservative management were placed in Group A, and those who were on maintenance haemodialysis were in Group B. Serum total lipid, cholesterol, triglycerides and high-density lipoprotein for both groups were assayed on chemical analyser and low-density lipoprotein was calculated by Friedwald equation. SPSS 17 was used for data analysis. Of the 120 patients, there were 60(50%) in each group. The mean age of patients in Group A was 46.33±14.56 years and in Group B was 43.4±14.1years. Of all, 64(53.3%) were men and 56(46.7%) were women. Mean systolic and diastolic blood pressure was 134±19.58mmHg and 83.6±14.14mmHg in Group A and 129±19.7mmHg and 79.7±12.1mmHg in Group B. Mean serum total lipid was significantly higher (pmaintenance haemodialysis was more hostile than those on conservative management, and posed increased risk of coronary heart disease.

  12. Citizen science can improve conservation science, natural resource management, and environmental protection

    Science.gov (United States)

    McKinley, Duncan C.; Miller-Rushing, Abe J.; Ballard, Heidi L.; Bonney, Rick; Brown, Hutch; Cook-Patton, Susan; Evans, Daniel M.; French, Rebecca A.; Parrish, Julia; Phillips, Tina B.; Ryan, Sean F.; Shanley, Lea A.; Shirk, Jennifer L.; Stepenuck, Kristine F.; Weltzin, Jake F.; Wiggins, Andrea; Boyle, Owen D.; Briggs, Russell D.; Chapin, Stuart F.; Hewitt, David A.; Preuss, Peter W.; Soukup, Michael A.

    2017-01-01

    Citizen science has advanced science for hundreds of years, contributed to many peer-reviewed articles, and informed land management decisions and policies across the United States. Over the last 10 years, citizen science has grown immensely in the United States and many other countries. Here, we show how citizen science is a powerful tool for tackling many of the challenges faced in the field of conservation biology. We describe the two interwoven paths by which citizen science can improve conservation efforts, natural resource management, and environmental protection. The first path includes building scientific knowledge, while the other path involves informing policy and encouraging public action. We explore how citizen science is currently used and describe the investments needed to create a citizen science program. We find that:Citizen science already contributes substantially to many domains of science, including conservation, natural resource, and environmental science. Citizen science informs natural resource management, environmental protection, and policymaking and fosters public input and engagement.Many types of projects can benefit from citizen science, but one must be careful to match the needs for science and public involvement with the right type of citizen science project and the right method of public participation.Citizen science is a rigorous process of scientific discovery, indistinguishable from conventional science apart from the participation of volunteers. When properly designed, carried out, and evaluated, citizen science can provide sound science, efficiently generate high-quality data, and help solve problems.

  13. Conservative management of preterm premature rupture of membranes beyond 32 weeks' gestation: is it worthwhile?

    Science.gov (United States)

    Tsafrir, Z; Margolis, G; Cohen, Y; Cohen, A; Laskov, I; Levin, I; Mandel, D; Many, A

    2015-01-01

    We aimed to investigate whether conservative management of preterm premature rupture of membranes (PPROM) at 32-34 weeks' gestation improves outcome. In this retrospective analysis of singleton pregnancies, the study group included patients with PPROM at 28-34 weeks' gestation and the control group included patients presented with spontaneous preterm delivery at 28-34 weeks' gestation. Both groups were subdivided according to gestational age - early (28-31 weeks' gestation) versus late (32-34 weeks' gestation). Adverse neonatal outcome included neonatal death, intraventricular haemorrhage grade 3/4, respiratory distress syndrome, periventricular leucomalacia and neonatal sepsis. The study and control groups included 94 and 86 women, respectively. The study group had a lower incidence of adverse neonatal outcome at the earlier weeks (28-31), compared with the control group at the same gestational age. In contrast, at 32-34 weeks' gestation no difference in the risk for adverse neonatal outcome was noticed. Additionally, within the study group, chorioamnionitis rate was significantly higher among those who delivered at 32-34 weeks' gestation (p < 0.01). No advantage for conservative management of PPROM was demonstrated beyond 31 weeks' gestation. Moreover, conservative management of PPROM at 32-34 weeks' gestation may expose both mother and neonate to infectious morbidity.

  14. Government conservation policies on Mexican coastal areas: is "top-down" management working?

    Directory of Open Access Journals (Sweden)

    Héctor Nava

    2011-12-01

    Full Text Available Marine and terrestrial ecosystems are declining globally due to environmental degradation and poorly planned resource use. Traditionally, local government agencies have been responsible of the management of natural reserves to preserve biodiversity. Nonetheless, much of these approaches have failed, suggesting the development of more integrative strategies. In order to discuss the importance of a holistic approach in conservation initiatives, coastal and underwater landscape value and biological/environmental indicators of coral reef degradation were assessed using the study case of Zihuatanejo, Guerrero coastal area. This area shelters representative coral reef structures of the Eastern Pacific coast and its terrestrial biodiversity and archaeology enhance the high value of its coastal area. This study explored the landscape value of both terrestrial and marine ecosystems using the geomorphosite approach in two sites on the Zihuatanejo coastal area: Caleta de Chon and Manzanillo Beach. Sedimentation rate, water transparency, chlorophyll and total suspended solids were recorded underwater in each site for environmental characterization. 50 photo-quadrants on five transects were surveyed between 3-4m depth to record coverage (% of living corals, dead corals, algae, sand and rocks. The conservation status of coral reefs was assessed by the coral mortality index (MI. Landscape values showed that both terrestrial and marine ecosystems had important scientific and aesthetic values, being Manzanillo Beach the site with the highest potential for conservation initiatives (TtV=14.2. However, coral reefs face elevated sedimentation rates (up to 1.16kg/m2d and low water transparency (less of 5m generated by coastal land use changes that have increased soil erosion in the adjacent coastal area. High coverage of dead corals (23.6% and algae (up to 29% confirm the low values in conservation status of coral reefs (MI=0.5, reflecting a poorly-planned management

  15. Intestinal diversion (colostomy or ileostomy) in patients with severe bowel dysfunction following spinal cord injury.

    Science.gov (United States)

    Hocevar, Barbara; Gray, Mikel

    2008-01-01

    Spinal cord injury (SCI) affects motor and sensory nervous integrity resulting in paralysis of lower or both upper and lower extremities, as well as autonomic nervous system function resulting in neurogenic bowel. SCI leads to diminished or lost sensations of the need to defecate or inability to distinguish the presence of gas versus liquid versus solid stool in the rectal vault. Sensory loss, incomplete evacuation of stool from the rectal vault, immobility, and reduced anal sphincter tone increase the risk of fecal incontinence. Gastrointestinal symptoms are associated with depression, anxiety, and significant impairments in quality of life (QOL) in a significant portion of persons with SCI. 1. To compare clinical, functional, or quality of life outcomes in spinal cord injured patients with gastrointestinal symptoms managed by conservative measures versus intestinal diversion (colostomy or ileostomy). 2. To identify complications associated with ostomy surgery in patients with bowel dysfunction and SCI. A systematic review of electronic databases MEDLINE and CINAHL (from January 1960 to November 2007) was undertaken using the following key words: (1) ostomy, (2) stoma, (3) colostomy, and (4) ileostomy. Boolean features of these databases were used to combine these terms with the key word "spinal cord injuries." Prospective and retrospective studies that directly compared clinical, functional, QOL outcomes or satisfaction among patients with intestinal diversions to patients managed by conservative means were included. Creation of an ostomy in selected patients provides equivocal or superior QOL outcomes when compared to conservative bowel management strategies. Both colostomy and ileostomy surgery significantly reduce the amount of time required for bowel management. Patients who undergo ostomy surgery tend to be satisfied with their surgery, and a significant portion report a desire to be counseled about this option earlier. There are no clear advantages when

  16. Energy management for the future. A sourcebook of ideas and activities for energy conservation learning programs

    Energy Technology Data Exchange (ETDEWEB)

    1980-01-01

    This book serves as a teaching aid for Canadian school programs in energy conservation and energy management. Suitable curriculum areas and objectives are outlined, and suggestions are presented for organizing thematic study units. References are made throughout to appropriate use of additional media such as filmstrips. Five study units, each with its own classroom activities, are detailed: energy resources, energy and the home, energy and food, energy and leisure, and energy in transportation. Suggestions are given for ongoing energy management educational programs to be tried out once the study units have been completed. 23 figs.

  17. Patterns of Assemblage Structure Indicate a Broader Conservation Potential of Focal Amphibians for Pond Management.

    Directory of Open Access Journals (Sweden)

    Elin Soomets

    Full Text Available Small freshwater ponds host diverse and vulnerable biotic assemblages but relatively few conspicuous, specially protected taxa. In Europe, the amphibians Triturus cristatus and Pelobates fuscus are among a few species whose populations have been successfully restored using pond restoration and management activities at the landscape scale. In this study, we explored whether the ponds constructed for those two target species have wider conservation significance, particularly for other species of conservation concern. We recorded the occurrence of amphibians and selected aquatic macro-invertebrates (dragonflies; damselflies; diving beetles; water scavenger beetles in 66 ponds specially constructed for amphibians (up to 8 years post construction and, for comparison, in 100 man-made ponds (created by local people for cattle or garden watering, peat excavation, etc. and 65 natural ponds in Estonia. We analysed nestedness of the species assemblages and its dependence on the environment, and described the co-occurrence patterns between the target amphibians and other aquatic species. The assemblages in all ponds were significantly nested, but the environmental determinants of nestedness and co-occurrence of particular species differed among pond types. Constructed ponds were most species-rich irrespective of the presence of the target species; however, T. cristatus was frequent in those ponds and rare elsewhere, and it showed nested patterns in every type of pond. We thus conclude that pond construction for the protected amphibians can serve broader habitat conservation aims in the short term. However, the heterogeneity and inconsistent presence of species of conservation concern observed in other types of ponds implies that long-term perspectives on pond management require more explicit consideration of different habitat and biodiversity values. We also highlight nestedness analysis as a tool that can be used for the practical task of selecting focal

  18. Conclusions: The Future of Shark Management and Conservation in the Northeast Pacific Ocean.

    Science.gov (United States)

    Lowry, Dayv

    Human interactions with sharks in the Northeast Pacific Ocean (NEP) have occurred for millennia but were largely limited to nearshore encounters as target and nontarget catch in fisheries. The arrival of Spanish explorers in the mid-1500s, followed by subsequent waves of explorers and colonizers from Europe and Russia, did little to change this relationship, until the mid-1800s. As technological advances conferred the ability to exploit marine fish further offshore and in deeper water, substantial fisheries developed and many of these encountered, and sometimes directly targeted, sharks. As these fisheries rose and fell with market demands and fluctuations in the abundance of target species, the collective consciousness of the nations fishing this region came to realize that adequate management plans with clear policy guidance rooted in conservation were crucial to sustaining both biodiversity and abundance of marine resources. With explicitly defined management regions governed by scientifically informed bodies that consider both societal and ecological needs, systems have been in place to manage and conserve marine species, including sharks, for over four decades now in the NEP. While policy evolution has largely limited directed fishing pressure as a threat for most shark species, bycatch is still a concern. Additionally, habitat degradation and destruction, ocean acidification, and global climate change are anticipated to fundamentally alter the ecosystems sharks are an integral part of in coming decades and centuries. Adequate conservation and management of sharks in the NEP, and around the world, moving into this period of uncertainty will rely upon comprehensive, integrated management of the ecosystem rooted in international coordination and cooperation. Far from being an unattainable goal, steps are being made each day to 'move the needle' in this direction-for the benefit of all. © 2017 Elsevier Ltd All rights reserved.

  19. Attitudes of people with osteoarthritis towards their conservative management: a systematic review and meta-ethnography.

    Science.gov (United States)

    Smith, Toby O; Purdy, Rachel; Lister, Sarah; Salter, Charlotte; Fleetcroft, Robert; Conaghan, Philip G

    2014-03-01

    This paper determines the perceptions of people diagnosed with osteoarthritis towards their conservative management strategies. A systematic review of the published (AMED, CINAHL, EMBASE, PsychINFO, SportsDisc, MEDLINE, Cochrane Clinical Trials Registry, PubMed) and unpublished/trial registry databases (WHO International Clinical Trials Registry Platform, Current Controlled Trials, the United States National Institute of Health Trials Registry, NIHR Clinical Research Portfolio Database) searched from their inception to July 2013. Eligible studies included those which presented the attitudes or perceptions of people with osteoarthritis towards non-operative management strategies. Study quality was appraised using the CASP and the Gough's weight of evidence appraisal tools. Data were analysed through a meta-ethnography approach. Thirty-three studies including 1,314 people with osteoarthritis were sampled; the majority diagnosed with knee osteoarthritis. The overarching themes indicated people with osteoarthritis delay their diagnosis, opting for self-management and informal information gathering. This informal rather than health professional-led guidance is sought and maintained as an important resource throughout the care of this population and is valued. Diagnosis is sought at a 'critical point'. Healthcare interventions largely provided are poorly perceived. The period of subsequent self-management is an expectation before the inevitable requirement for joint replacement. There remains uncertainty regarding when this is required, but the expected failure of conservative treatment to manage pain and symptoms is common. In conclusion, patients should be enthused towards the principles of self-management and clinicians should not trivialise osteoarthritis. This may provide a more valuable perception of non-operative management to promote its adoption and adherence in managing osteoarthritis.

  20. Impact of Canopy Openness on Spider Communities: Implications for Conservation Management of Formerly Coppiced Oak Forests.

    Directory of Open Access Journals (Sweden)

    Ondřej Košulič

    Full Text Available Traditional woodland management created a mosaic of differently aged patches providing favorable conditions for a variety of arthropods. After abandonment of historical ownership patterns and traditional management and the deliberate transformation to high forest after World War II, large forest areas became darker and more homogeneous. This had significant negative consequences for biodiversity. An important question is whether even small-scale habitat structures maintained by different levels of canopy openness in abandoned coppiced forest may constitute conditions suitable for forest as well as open habitat specialists. We investigated the effect of canopy openness in former traditionally coppiced woodlands on the species richness, functional diversity, activity density, conservation value, and degree of rareness of epigeic spiders. In each of the eight studied locations, 60-m-long transect was established consisting of five pitfall traps placed at regular 15 m intervals along the gradient. Spiders were collected from May to July 2012. We recorded 90 spider species, including high proportions of xeric specialists (40% and red-listed threatened species (26%. The peaks of conservation indicators, as well as spider community abundance, were shifted toward more open canopies. On the other hand, functional diversity peaked at more closed canopies followed by a rapid decrease with increasing canopy openness. Species richness was highest in the middle of the canopy openness gradient, suggesting an ecotone effect. Ordinations revealed that species of conservation concern tended to be associated with sparse and partly opened canopy. The results show that the various components of biodiversity peaked at different levels of canopy openness. Therefore, the restoration and suitable forest management of such conditions will retain important diversification of habitats in formerly coppiced oak forest stands. We indicate that permanent presence of small

  1. SUBMONTANE FOREST AT BANTIMURUNG BULUSARAUNG NATIONAL PARK: HOTSPOT OF BIRD DIVERSITY AND ITS MANAGEMENT CONSERVATION

    Directory of Open Access Journals (Sweden)

    Indra A.S.L.P. Putri

    2015-09-01

    Full Text Available Submontane forest is considered as one of the biodiversity hotspot.  Scientific information on bird diversity in this forest, however are lacking.  The aim of this research was to find out submontane forest bird diversity and its conservation management.  The research was carried out in three forests areas at Bantimurung Bulusaraung National Park submontane forest.  Point Count method was used to observe bird population. Data were analyzed using Shannon-Weiner diversity index, Pielou Evenness index, Simpson dominance index, Margalef species richness index, and Sorensen Similarity index. The significance different between the number of individual bird was tested using Kolmogorov-Smirnov test.  The result showed that submontane forest at Bantimurung Bulusaraung National Park is rich in bird diversity, bird endemic species and protected bird species.  There was a significant different on the number of individual bird at several human disturbance levels.  Based on these conditions, it is important to enhance understanding of the local people regarding zonation and develop cooperation with many stakeholders to increase the local community awareness concerning forest conservation. It is also necessary to ensure the sustainability of the National Park’s conservation program to maintain the submontane forest conservation.

  2. Water demand management in times of drought: What matters for water conservation

    Science.gov (United States)

    Maggioni, Elena

    2015-01-01

    Southern California is subject to long droughts and short wet spells. Its water agencies have put in place voluntary, mandatory, and market-based conservation strategies since the 1980s. By analyzing water agencies' data between 2006 and 2010, this research studies whether rebates for water efficient fixtures, water rates, or water ordinances have been effective, and tests whether structural characteristics of water agencies have affected the policy outcome. It finds that mandates to curb outdoor water uses are correlated with reductions in residential per capita water usage, while water rates and subsidies for water saving devices are not. It also confirms that size is a significant policy implementation factor. In a policy perspective, the transition from a water supply to a water demand management-oriented strategy appears guided by mandates and by contextual factors such as the economic cycle and the weather that occur outside the water governance system. Three factors could improve the conservation effort: using prices as a conservation tool, not only as a cost recovering instrument; investing in water efficient tools only when they provide significant water savings; supporting smaller agencies in order to give them opportunities to implement conservation strategies more effectively or to help them consolidate.

  3. Integrating Ecosystem Management, Protected Areas, and Mammal Conservation in the Brazilian Amazon

    Directory of Open Access Journals (Sweden)

    Claudia Azevedo-Ramos

    2006-12-01

    Full Text Available The Amazon forest has been converted to a matrix of pristine and modified habitats. Landscape-scale biodiversity conservation requires an understanding of species' distributions over this matrix to guarantee both effective protection and use for present and future generations. In this study, we evaluated how much of the existing and future planned protected areas (PAs would be contributing to the conservation of Brazilian Amazon mammals (N = 399, including threatened species (N = 51. Currently, almost 37% of Brazilian Amazon is protected and that may increase to 46% if planned PAs are implemented. In the current PA system, 22% are indigenous land and 11% are sustainable use units, e.g., production forests. Only one-fifth of the whole range of mammal species occurring in Brazilian Amazon is actually protected by Brazilian PAs. However, considering only the part of the ranges within the Brazilian Amazon, and therefore under the scope of Brazilian actions, Brazilian PAs assume an important role in the protection of 39% of mammal distribution ranges, particularly the threatened species (39%. These results suggest that an integrated network of protected areas among Amazon countries would be necessary to increase their efficiency in mammal conservation. The need for strengthening of the forest sector and good management practices in Brazil appears critical for the maintenance of large extents of forest and species conservation. Under such a scenario, the contribution of developed nations and international agencies must assume an important role for the maintenance and enlargement of the protected area network in Amazon region.

  4. Structured decision making as a conceptual framework to identify thresholds for conservation and management

    Science.gov (United States)

    Martin, J.; Runge, M.C.; Nichols, J.D.; Lubow, B.C.; Kendall, W.L.

    2009-01-01

    Thresholds and their relevance to conservation have become a major topic of discussion in the ecological literature. Unfortunately, in many cases the lack of a clear conceptual framework for thinking about thresholds may have led to confusion in attempts to apply the concept of thresholds to conservation decisions. Here, we advocate a framework for thinking about thresholds in terms of a structured decision making process. The purpose of this framework is to promote a logical and transparent process for making informed decisions for conservation. Specification of such a framework leads naturally to consideration of definitions and roles of different kinds of thresholds in the process. We distinguish among three categories of thresholds. Ecological thresholds are values of system state variables at which small changes bring about substantial changes in system dynamics. Utility thresholds are components of management objectives (determined by human values) and are values of state or performance variables at which small changes yield substantial changes in the value of the management outcome. Decision thresholds are values of system state variables at which small changes prompt changes in management actions in order to reach specified management objectives. The approach that we present focuses directly on the objectives of management, with an aim to providing decisions that are optimal with respect to those objectives. This approach clearly distinguishes the components of the decision process that are inherently subjective (management objectives, potential management actions) from those that are more objective (system models, estimates of system state). Optimization based on these components then leads to decision matrices specifying optimal actions to be taken at various values of system state variables. Values of state variables separating different actions in such matrices are viewed as decision thresholds. Utility thresholds are included in the objectives

  5. Identifying conservation priorities and management strategies based on ecosystem services to improve urban sustainability in Harbin, China.

    Science.gov (United States)

    Qu, Yi; Lu, Ming

    2018-01-01

    Rapid urbanization and agricultural development has resulted in the degradation of ecosystems, while also negatively impacting ecosystem services (ES) and urban sustainability. Identifying conservation priorities for ES and applying reasonable management strategies have been found to be effective methods for mitigating this phenomenon. The purpose of this study is to propose a comprehensive framework for identifying ES conservation priorities and associated management strategies for these planning areas. First, we incorporated 10 ES indicators within a systematic conservation planning (SCP) methodology in order to identify ES conservation priorities with high irreplaceability values based on conservation target goals associated with the potential distribution of ES indicators. Next, we assessed the efficiency of the ES conservation priorities for meeting the designated conservation target goals. Finally, ES conservation priorities were clustered into groups using a K-means clustering analysis in an effort to identify the dominant ES per location before formulating management strategies. We effectively identified 12 ES priorities to best represent conservation target goals for the ES indicators. These 12 priorities had a total areal coverage of 13,364 km 2 representing 25.16% of the study area. The 12 priorities were further clustered into five significantly different groups ( p -values between groups urban and agricultural areas, thereby preventing urban and agriculture sprawl and guiding sustainable urban development.

  6. WLCI researchers employ new approaches to help managers conserve deer migrations

    Science.gov (United States)

    Allen, Leslie A.; Kauffman, Matthew J.

    2012-01-01

    Elk, mule deer, pronghorn antelope, moose, and bighorn sheep are iconic animals of the American West. These hooved animals, known as ungulates, commonly travel 30–60 miles between seasonal ranges. These migrations between winter and summer ranges are vital for survival and reproduction. As habitat fragmentation continues, the conservation of ungulate migration routes has received considerable attention in the West and across the globe. For example, it is estimated that many ungulate migration routes in the Greater Yellowstone Ecosystem have already been lost. The traditional migration routes of Wyoming ungulates are threatened by unprecedented levels of energy development and by increasing levels of rural ranchette development (including fences, structures, and roads). In the past, migration corridors have been mapped based primarily on the expert opinions of state game managers, but long-term conservation of Wyoming's ungulate migration routes requires a better understanding of migration ecology and more sophisticated management tools. Wyoming Landscape Conservation Initiative (WLCI) researchers investigated the migration of a large mule deer herd across the Dad and Wild Horse winter ranges in southwest Wyoming, where 2,000 gas wells and 1,609 kilometers of pipelines and roads have been proposed for development.

  7. Conservation of greater sage-grouse- a synthesis of current trends and future management

    Science.gov (United States)

    Connelly, John W.; Knick, Steven T.; Braun, Clait E.; Baker, William L.; Beever, Erik A.; Christiansen, Thomas J.; Doherty, Kevin E.; Garton, Edward O.; Hagen, Christian A.; Hanser, Steven E.; Johnson, Douglas H.; Leu, Matthias; Miller, Richard F.; Naugle, David E.; Oyler-McCance, Sara J.; Pyke, David A.; Reese, Kerry P.; Schroeder, Michael A.; Stiver, San J.; Walker, Brett L.; Wisdorn, Michael J.

    2011-01-01

    Recent analyses of Greater Sage-Grouse (Centrocercus urophasianus) populations indicate substantial declines in many areas but relatively stable populations in other portions of the species? range. Sagebrush (Artemisia spp.) habitats neces-sary to support sage-grouse are being burned by large wildfires, invaded by nonnative plants, and developed for energy resources (gas, oil, and wind). Management on public lands, which con-tain 70% of sagebrush habitats, has changed over the last 30 years from large sagebrush control projects directed at enhancing livestock grazing to a greater emphasis on projects that often attempt to improve or restore ecological integrity. Never-theless, the mandate to manage public lands to provide traditional consumptive uses as well as recreation and wilderness values is not likely to change in the near future. Consequently, demand and use of resources contained in sagebrush land-scapes plus the associated infrastructure to sup-port increasing human populations in the western United States will continue to challenge efforts to conserve Greater Sage-Grouse. The continued widespread distribution of sage-grouse, albeit at very low densities in some areas, coupled with large areas of important sagebrush habitat that are relatively unaffected by the human footprint, sug-gest that Greater Sage-Grouse populations may be able to persist into the future. We summarize the status of sage-grouse populations and habitats, provide a synthesis of major threats and chal-lenges to conservation of sage-grouse, and suggest a roadmap to attaining conservation goals.

  8. Conservation genomics of natural and managed populations: building a conceptual and practical framework.

    Science.gov (United States)

    Benestan, Laura Marilyn; Ferchaud, Anne-Laure; Hohenlohe, Paul A; Garner, Brittany A; Naylor, Gavin J P; Baums, Iliana Brigitta; Schwartz, Michael K; Kelley, Joanna L; Luikart, Gordon

    2016-07-01

    The boom of massive parallel sequencing (MPS) technology and its applications in conservation of natural and managed populations brings new opportunities and challenges to meet the scientific questions that can be addressed. Genomic conservation offers a wide range of approaches and analytical techniques, with their respective strengths and weaknesses that rely on several implicit assumptions. However, finding the most suitable approaches and analysis regarding our scientific question are often difficult and time-consuming. To address this gap, a recent workshop entitled 'ConGen 2015' was held at Montana University in order to bring together the knowledge accumulated in this field and to provide training in conceptual and practical aspects of data analysis applied to the field of conservation and evolutionary genomics. Here, we summarize the expertise yield by each instructor that has led us to consider the importance of keeping in mind the scientific question from sampling to management practices along with the selection of appropriate genomics tools and bioinformatics challenges. © 2016 John Wiley & Sons Ltd.

  9. Modeling Parasite Dynamics on Farmed Salmon for Precautionary Conservation Management of Wild Salmon

    Science.gov (United States)

    Rogers, Luke A.; Peacock, Stephanie J.; McKenzie, Peter; DeDominicis, Sharon; Jones, Simon R. M.; Chandler, Peter; Foreman, Michael G. G.; Revie, Crawford W.; Krkošek, Martin

    2013-01-01

    Conservation management of wild fish may include fish health management in sympatric populations of domesticated fish in aquaculture. We developed a mathematical model for the population dynamics of parasitic sea lice (Lepeophtheirus salmonis) on domesticated populations of Atlantic salmon (Salmo salar) in the Broughton Archipelago region of British Columbia. The model was fit to a seven-year dataset of monthly sea louse counts on farms in the area to estimate population growth rates in relation to abiotic factors (temperature and salinity), local host density (measured as cohort surface area), and the use of a parasiticide, emamectin benzoate, on farms. We then used the model to evaluate management scenarios in relation to policy guidelines that seek to keep motile louse abundance below an average three per farmed salmon during the March–June juvenile wild Pacific salmon (Oncorhynchus spp.) migration. Abiotic factors mediated the duration of effectiveness of parasiticide treatments, and results suggest treatment of farmed salmon conducted in January or early February minimized average louse abundance per farmed salmon during the juvenile wild salmon migration. Adapting the management of parasites on farmed salmon according to migrations of wild salmon may therefore provide a precautionary approach to conserving wild salmon populations in salmon farming regions. PMID:23577082

  10. Modeling parasite dynamics on farmed salmon for precautionary conservation management of wild salmon.

    Directory of Open Access Journals (Sweden)

    Luke A Rogers

    Full Text Available Conservation management of wild fish may include fish health management in sympatric populations of domesticated fish in aquaculture. We developed a mathematical model for the population dynamics of parasitic sea lice (Lepeophtheirus salmonis on domesticated populations of Atlantic salmon (Salmo salar in the Broughton Archipelago region of British Columbia. The model was fit to a seven-year dataset of monthly sea louse counts on farms in the area to estimate population growth rates in relation to abiotic factors (temperature and salinity, local host density (measured as cohort surface area, and the use of a parasiticide, emamectin benzoate, on farms. We then used the model to evaluate management scenarios in relation to policy guidelines that seek to keep motile louse abundance below an average three per farmed salmon during the March-June juvenile wild Pacific salmon (Oncorhynchus spp. migration. Abiotic factors mediated the duration of effectiveness of parasiticide treatments, and results suggest treatment of farmed salmon conducted in January or early February minimized average louse abundance per farmed salmon during the juvenile wild salmon migration. Adapting the management of parasites on farmed salmon according to migrations of wild salmon may therefore provide a precautionary approach to conserving wild salmon populations in salmon farming regions.

  11. Institutional Sustainability Barriers of Community Conservation Agreement as a Collaboration Management in Lore Lindu National Park

    Directory of Open Access Journals (Sweden)

    Sudirman Daeng Massiri

    2015-12-01

    Full Text Available The main problem of forest institutional arrangement is the issue of institutional sustainability in achieving sustainable forest ecosystem. This study aimed to explain the barriers of institutional sustainability Community Conservation Agreement (CCA designed in Lore Lindu National Park (LLNP, in Indonesia, as a collaborative management of national parks. This study is of descriptive which used qualitative approach, i.e. asking open-ended questions, reviewing documentation and analyzing textual of community conservation agreements. We found that the institutional sustainability barriers of CCA were the local decisions on collective-choice level and that the rules at operational level arranged in CCA were not in line with formal rules of national park management at the constitutional level. Furthermore, the low capacity of local institutions in heterogeneous villages with many migrants in controlling and regulating the forest use, especially in rehabilitation zone areas, also became a barrier to institutional sustainability of CCA. Therefore, institutional sustainability of CCA requires support of national park management policy that accommodates the sustainability of livelihoods of local communities in national parks, strengthening local institution's capacity, and ultimately integrating institution of CCA as part of LLNP management.

  12. The impact of conservation management on the community composition of multiple organism groups in eutrophic interconnected man-made ponds

    NARCIS (Netherlands)

    Lemmens, P.; Mergeay, J.; Van Wichelen, J.; De Meester, Luc; Declerck, S.A.J.

    2015-01-01

    Ponds throughout the world are subjected to a variety of management measures for purposes of biodiversity conservation. Current conservation efforts typically comprise a combination of multiple measures that directly and indirectly impact a wide range of organism groups. Knowledge of the relative

  13. Successful conservative management of a rare complication of tracheostomy; extensive posterior tracheal false pouch.

    Science.gov (United States)

    Ha, Jennifer F; Ostwani, Waseem; Green, Glenn

    2016-11-01

    With the advent of improved neonatal and pediatric intensive care management, tracheostomy is increasingly performed in children requiring prolonged ventilation. Even though tracheostomy is generally a safe procedure, there remains mortality and morbidity associated with it. We report a rare complication of a tracheostomy tube resulting in extensive erosion and posterior tracheal false pouch secondary to a large tracheostomy tube and high positive end expiratory pressure in a 12-month-old infant. This was managed successfully with conservative treatment. A former 34-week premature infant was transferred to our pediatrics intensive care unit (PICU) with recurrent episodes of cardiopulmonary arrests due to suspected severe tracheobronchomalacia. The patient has bronchopulomonary dysplasia, severe restrictive lung disease and thoracic insufficiency from skeletal dysplasia requiring tracheostomy tube (TT) at two-month-old and mechanical ventilation. The 3.5 NEO TT was gradually upsized to a 5. The PEEP setting at transfer was 18cmH2O. The direct laryngoscopy and bronchoscopy showed moderate tracheomalacia at the innominate artery with a false pouch in the posterior tracheal wall that was 1.1cm below the tracheostomy stoma. A multi-disciplinary discussion including otolaryngology, PICU, Pulmonary Medicine, and Pediatric Surgery decided on conservative management. The false pouch healed and she was transferred back to referring PICU after a 46-day. Tracheal wall erosion resulting in a pouch formation is a rare complication, but it should be considered in patients with long term tracheostomy with difficulty ventilation and oxygenation with positional change. DLB is a useful tool in its diagnosis and conservative management can be successful. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. The cultural significance as guide: the Arts Building and Cloister conservation and management plan

    Directory of Open Access Journals (Sweden)

    César Bargues Ballester

    2017-12-01

    Full Text Available The Arts Building and Cloister (1963-1967 is a rare architecture that brings together building traditions of Japanese and Pennsylvanian influence with innovative engineering in the form of a hyperbolic paraboloid roof. Designed by the Japanese­American architect and woodworker George Nakashima (1905-1990, the building is one of over a dozen residences, workshops and storages built on his property in New Hope, Pennsylvania. The complex and evolving relationship between the historical significance of the site and the furniture business prompted the preparation of a conservation and management plan to ensure its long-term protection and maintenance. This article summarizes the building’s design, its evolution and the main challenges of conservation of a place that is as much informed by its physical design as it is in accommodating its cultural significance as a center for peace and understanding through art and craft.

  15. Energy conservation and management plan for plant facilities at the Livermore site

    Energy Technology Data Exchange (ETDEWEB)

    Ng, W.; Szybalski, S.; Kerr, W. H.; Meyer, H. J.

    1976-03-15

    An energy conservation and management plan for the Livermore site of the Lawrence Livermore Laboratory is presented. The plan defines the energy-conservation goals for the next 10 years and proposes the ways and means of attaining them. The main features contained in this plan are as follows: development of the criteria and underlying assumptions required for long range planning, including energy growth rates and the case for using the concept of the technical-fix energy growth rate, LLL energy outlook and fuel cost projections, and life-cycle-cost criteria; targets of the long-range plan include between 1975 and 1985, an annual energy usage growth equal to 5.8 percent of the 1975 energy consumption, 1985 and thereafter, zero energy growth, a change from the current dependence on natural gas to the use of other fuels for heating, and a doubling of the 30-day strategic oil storage capacity; and cost schedule for the next 10 years.

  16. Definition of Management Zones for Enhancing Cultivated Land Conservation Using Combined Spatial Data

    Science.gov (United States)

    Li, Yan; Shi, Zhou; Wu, Hao-Xiang; Li, Feng; Li, Hong-Yi

    2013-10-01

    The loss of cultivated land has increasingly become an issue of regional and national concern in China. Definition of management zones is an important measure to protect limited cultivated land resource. In this study, combined spatial data were applied to define management zones in Fuyang city, China. The yield of cultivated land was first calculated and evaluated and the spatial distribution pattern mapped; the limiting factors affecting the yield were then explored; and their maps of the spatial variability were presented using geostatistics analysis. Data were jointly analyzed for management zone definition using a combination of principal component analysis with a fuzzy clustering method, two cluster validity functions were used to determine the optimal number of cluster. Finally one-way variance analysis was performed on 3,620 soil sampling points to assess how well the defined management zones reflected the soil properties and productivity level. It was shown that there existed great potential for increasing grain production, and the amount of cultivated land played a key role in maintaining security in grain production. Organic matter, total nitrogen, available phosphorus, elevation, thickness of the plow layer, and probability of irrigation guarantee were the main limiting factors affecting the yield. The optimal number of management zones was three, and there existed significantly statistical differences between the crop yield and field parameters in each defined management zone. Management zone I presented the highest potential crop yield, fertility level, and best agricultural production condition, whereas management zone III lowest. The study showed that the procedures used may be effective in automatically defining management zones; by the development of different management zones, different strategies of cultivated land management and practice in each zone could be determined, which is of great importance to enhance cultivated land conservation

  17. Functional bowel disorders and functional abdominal pain

    OpenAIRE

    Thompson, W; Longstreth, G; Drossman, D; Heaton, K; Irvine, E; Muller-Lissner, S

    1999-01-01

    The Rome diagnostic criteria for the functional bowel disorders and functional abdominal pain are used widely in research and practice. A committee consensus approach, including criticism from multinational expert reviewers, was used to revise the diagnostic criteria and update diagnosis and treatment recommendations, based on research results. The terminology was clarified and the diagnostic criteria and management recommendations were revised. A functional bowel disorder (FBD) is diagnosed ...

  18. 77 FR 62537 - Notice of Waste Management Permit Application Received Under the Antarctic Conservation Act of 1978

    Science.gov (United States)

    2012-10-15

    ... NATIONAL SCIENCE FOUNDATION Notice of Waste Management Permit Application Received Under the Antarctic Conservation Act of 1978 AGENCY: National Science Foundation. ACTION: Notice of a Waste Management... the National Science Foundation (NSF) has received a waste management permit application for Mike...

  19. Ecosystem management and the conservation of caribou habitat in British Columbia

    Directory of Open Access Journals (Sweden)

    Dale R. Seip

    1998-03-01

    Full Text Available Woodland caribou (Rangifer tarandus caribou in British Columbia inhabit a wide variety of forest ecosystems. Numerous research projects have provided information that has been used to develop caribou habitat management recommendations for different areas. Recently, the province has implemented guidelines to protect biodiversity that are based on an ecosystem management strategy of mimicking natural forest conditions. There is a great deal of similarity between caribou management recommendations and biodiversity recommendations within different forest types. In mountain caribou habitat, both approaches recommend maintaining a landscape dominated by old and mature forests, uneven-aged management, small cutblocks, and maintaining mature forest connectivity. In northern caribou habitat, both approaches recommend maintaining some older stands on the landscape (but less than for mountain caribou, even-aged management, and a mosaic of large harvest units and leave areas. The ecosystem management recommendations provide a useful foundation for caribou habitat conservation. More detailed information on caribou and other management objectives can then be used to fine-tune those recommendations.

  20. Conservative surgical management of subungual (matrix derived) melanoma: report of seven cases and literature review.

    Science.gov (United States)

    Sureda, N; Phan, A; Poulalhon, N; Balme, B; Dalle, S; Thomas, L

    2011-10-01

    Subungual melanoma (SUM) is a rare entity, comprising approximately 0·7-3·5% of all melanoma subtypes. SUM histopathologically belongs to the acral lentiginous pathological subtype of malignant melanoma. Its diagnosis is helped by dermoscopy but pathological examination of doubtful cases is required. Classical management of SUM is based on radical surgery, namely distal phalanx amputation. Conservative treatment with nonamputative wide excision of the nail unit followed by a skin graft has been insufficiently reported in the medical literature even though it is performed in many centres. To report a series of patients with in situ or minimally invasive SUM treated by conservative surgery, to investigate the postoperative evolution and to evaluate the outcome with a review of the literature. We performed a retrospective extraction study from our melanoma register of all patients with in situ and minimally invasive SUM treated with conservative surgery in the University Hospital Department of Dermatology, Lyon, France from 2004 to 2009. The patient demographics, disease presentation, delay to diagnosis, histopathology and postoperative evolution were reviewed. Seven cases of SUM treated as such were identified in our melanoma database. All cases had a clinical presentation of melanonychia striata. The mean delay to diagnosis was 2years. Surgical excision of the entire nail unit with a 5-10mm safety margin without bone resection followed by full-thickness skin graft taken from the arm was performed in all cases. No recurrence was observed with a mean follow-up of 45months. Functional results were found satisfactory by all patients and their referring physicians. Sixty-two other cases have been found in the literature and are also discussed. Conservative surgical management in patients with in situ or minimally invasive SUM is a procedure with good cosmetic and functional outcome and, in our cases as well as in the literature, the prognosis is not changed. © 2011

  1. Nature conservation and grazing management. Free-ranging cattle as a driving force for cyclic vegetation seccession

    NARCIS (Netherlands)

    Bokdam, J.

    2003-01-01

    Key-words : biodiversity, herbivory, wilderness, non-linear dynamics, mosaic cycling, grassland, wood encroachment, forest, Bos taurus , Calluna vulgaris , Deschampsia flexuosa.This thesis examines the suitability of controlled and wilderness grazing as conservation management tool for open,

  2. Outcomes of a conservative approach to management in amoebic liver abscess

    Directory of Open Access Journals (Sweden)

    S Kale

    2017-01-01

    Full Text Available Context: Unfortunately, there is confusion among the medical community regarding the management of amoebic liver abscess (ALA. Therapeutic options range from simple pharmacotherapy to use of interventions like a needle or catheter aspiration under ultrasound guidance to surgical intervention. There is a plethora of thresholds for parameters such as the maximum diameter of the abscess and volume on ultrasound examination suggested by various authors to serve as a criterion to help to decide when to use which modality in these cases. Aims: To assess the outcome of patients with uncomplicated ALA treated using a conservative approach. Moreover, to identify factors associated with its failure. Settings and Design: A prospective, observational study was carried out at a large municipal urban health care center over a period of 3-year (2011-2014 in India. Materials and Methods: Patients with uncomplicated ALA were recruited. All patients were managed with pharmacotherapy initially for a period of 72 h. Response to treatment was assessed by resolution of symptoms within the given time frame. Failure to respond was considered an indication for intervention. Needle aspiration was offered to these patients and response assessed within 72 h. Failure to respond to aspiration was considered an indication for catheter drainage. Statistical Analysis Used: Data recorded were entered in a Microsoft Office Excel Sheet and analyzed using the SPSS version 16.0 (IBM. Results: Sixty patients with ALA were included in the study over its duration. Forty-nine (81.67% patients were managed conservatively, while 11 (18.33% patients needed an intervention for relief. Patients who required intervention had deranged liver function at presentation, a larger abscess diameter (10.09 ± 2.23 vs. 6.33 ± 1.69 cm P 7.7 cm was found to be the optimal criterion to predict the need of intervention in cases of ALA. Conclusions: A conservative approach is effective in the management of

  3. Prospects and future of conservative management of beta thalassemia major in a developing country

    International Nuclear Information System (INIS)

    Rahman, M.; Lodhi, Y.

    2004-01-01

    Objective: To assess the efficacy, prospects and future of conservative management of beta thalassemia major patients in a developing country. Design: Patients registered at IHBTS were studied over a period of three years. They consented to being managed on moderate transfusion regimen, aiming to maintain a pre-transfusion haemoglobin(Hgb) level of 9.0 plus minus 1.0 g per dL. We studied their transfusion requirements, status for transfusion transmitted infections (TTls), serum ferritin levels and complications developing as a result of iron overload. Subjects: Initially all registered patients were included in this study. Sporadic patients as well as dropouts occurring due to any reason, (patients concurrently seeking treatment at other centres as well, or complying poorly to advised chelation therapy) were excluded from the study. The data presented here conforms to a cohort of 60 regular patients who adhered best to our selection criteria. Main Outcome Measures: 1) The study highlights the deficiencies and problems of conservative management for beta thalassemia major. 2) The major impact of our study is the message that conservative management in a poor country, like ours, is a no-win situation. 3) There is an urgent need to immediately start a prevention programme. Results: In the younger patients, blood consumption even on the moderate transfusion regimen is 120ml/kg/year, however with ascending age the consumption increases to 240ml/kg/year. A substantive number of the patients are either Hep C (35%) or Hep B (1.7%) positive. There are no HIV positive patients. Serum ferritin levels vary widely and could not be controlled due to poor compliance to chelation. 50% of the patients developed one or other complications of iron overload. The cost of treatment depending on the quality of care, is tremendous and beyond the reach of the common man. Conclusions: Conservative management may be the best alternative and at times the only hope for patients in our country

  4. Identifying conservation priorities and management strategies based on ecosystem services to improve urban sustainability in Harbin, China

    Directory of Open Access Journals (Sweden)

    Yi Qu

    2018-04-01

    Full Text Available Rapid urbanization and agricultural development has resulted in the degradation of ecosystems, while also negatively impacting ecosystem services (ES and urban sustainability. Identifying conservation priorities for ES and applying reasonable management strategies have been found to be effective methods for mitigating this phenomenon. The purpose of this study is to propose a comprehensive framework for identifying ES conservation priorities and associated management strategies for these planning areas. First, we incorporated 10 ES indicators within a systematic conservation planning (SCP methodology in order to identify ES conservation priorities with high irreplaceability values based on conservation target goals associated with the potential distribution of ES indicators. Next, we assessed the efficiency of the ES conservation priorities for meeting the designated conservation target goals. Finally, ES conservation priorities were clustered into groups using a K-means clustering analysis in an effort to identify the dominant ES per location before formulating management strategies. We effectively identified 12 ES priorities to best represent conservation target goals for the ES indicators. These 12 priorities had a total areal coverage of 13,364 km2 representing 25.16% of the study area. The 12 priorities were further clustered into five significantly different groups (p-values between groups < 0.05, which helped to refine management strategies formulated to best enhance ES across the study area. The proposed method allows conservation and management plans to easily adapt to a wide variety of quantitative ES target goals within urban and agricultural areas, thereby preventing urban and agriculture sprawl and guiding sustainable urban development.

  5. Interactive Mapping of Inundation Metrics Using Cloud Computing for Improved Floodplain Conservation and Management

    Science.gov (United States)

    Bulliner, E. A., IV; Lindner, G. A.; Bouska, K.; Paukert, C.; Jacobson, R. B.

    2017-12-01

    Within large-river ecosystems, floodplains serve a variety of important ecological functions. A recent survey of 80 managers of floodplain conservation lands along the Upper and Middle Mississippi and Lower Missouri Rivers in the central United States found that the most critical information needed to improve floodplain management centered on metrics for characterizing depth, extent, frequency, duration, and timing of inundation. These metrics can be delivered to managers efficiently through cloud-based interactive maps. To calculate these metrics, we interpolated an existing one-dimensional hydraulic model for the Lower Missouri River, which simulated water surface elevations at cross sections spaced (step. To translate these water surface elevations to inundation depths, we subtracted a merged terrain model consisting of floodplain LIDAR and bathymetric surveys of the river channel. This approach resulted in a 29000+ day time series of inundation depths across the floodplain using grid cells with 30 m spatial resolution. Initially, we used these data on a local workstation to calculate a suite of nine spatially distributed inundation metrics for the entire model domain. These metrics are calculated on a per pixel basis and encompass a variety of temporal criteria generally relevant to flora and fauna of interest to floodplain managers, including, for example, the average number of days inundated per year within a growing season. Using a local workstation, calculating these metrics for the entire model domain requires several hours. However, for the needs of individual floodplain managers working at site scales, these metrics may be too general and inflexible. Instead of creating a priori a suite of inundation metrics able to satisfy all user needs, we present the usage of Google's cloud-based Earth Engine API to allow users to define and query their own inundation metrics from our dataset and produce maps nearly instantaneously. This approach allows users to

  6. The first “lost year” of Mediterranean sea turtles: dispersal patterns indicate subregional management units for conservation

    DEFF Research Database (Denmark)

    Casale, Paolo; Mariani, Patrizio

    2014-01-01

    Identifying highly frequented areas is a priority for sea turtle conservation, and the distribution of young individuals in open waters represents a major knowledge gap due to methodological biases. The drift of hatchlings from 38 loggerhead and 10 green turtle nesting sites in the Mediterranean......-scale international approach. In-water studies in specific zones are identified as a research priority for improving the current knowledge and inform conservation plans....... The Levantine zone may be particularly key for the conservation of the Mediterranean populations of both species, since it may host the highest concentration of individuals. Subregional management units identified by dispersal patterns may facilitate turtle conservation through a relatively small...

  7. New findings and setting the research agenda for soil and water conservation for sustainable land management

    Science.gov (United States)

    Keesstra, Saskia; Argaman, Eli; Gomez, Jose Alfonso; Quinton, John

    2014-05-01

    The session on soil and water conservation for sustainable land management provides insights into the current research producing viable measures for sustainable land management and enhancing the lands role as provider of ecosystem services. The insights into degradation processes are essential for designing and implementing feasible measures to mitigate against degradation of the land resource and adapt to the changing environment. Land degradation occurs due to multiple pressures on the land, such as population growth, land-use and land-cover changes, climate change and over exploitation of resources, often resulting in soil erosion due to water and wind, which occurs in many parts of the world. Understanding the processes of soil erosion by wind and water and the social and economic constraints faced by farmers forms an essential component of integrated land development projects. Soil and water conservation measures are only viable and sustainable if local environmental and socio-economic conditions are taken into account and proper enabling conditions and policies can be achieved. Land degradation increasingly occurs because land use, and farming systems are subject to rapid environmental and socio-economic changes without implementation of appropriate soil and water conservation technologies. Land use and its management are thus inextricably bound up with development; farmers must adapt in order to sustain the quality of their, and their families, lives. In broader perspective, soil and water conservation is needed as regulating ecosystem service and as a tool to enhance food security and biodiversity. Since land degradation occurs in many parts of the world and threatens food production and environmental stability it affects those countries with poorer soils and resilience in the agriculture sector first. Often these are the least developed countries. Therefore the work from researchers from developing countries together with knowledge from other disciplines

  8. Factors influencing patients with stage 5 chronic kidney disease to opt for conservative management: a practitioner research study

    OpenAIRE

    Johnston, Sheila; Noble, Helen

    2012-01-01

    Aims and objectives. This study explored decision-making experiences of patients with stage 5 chronic kidney disease when opting for conservative management of their renal failure.Background. Dialysis is an invasive treatment, and for some older patients, there is an associated treatment burden of dialysis-related symptoms. An alternative choice is conservative management, but little is known about those who make this decision and how they are supported through the process.Design. Qualitative...

  9. Using in situ management to conserve biodiversity under climate change.

    Science.gov (United States)

    Greenwood, Owen; Mossman, Hannah L; Suggitt, Andrew J; Curtis, Robin J; Maclean, Ilya M D

    2016-06-01

    Successful conservation will increasingly depend on our ability to help species cope with climate change. While there has been much attention on accommodating or assisting range shifts, less has been given to the alternative strategy of helping species survive climate change through in situ management.Here we provide a synthesis of published evidence examining whether habitat management can be used to offset the adverse impacts on biodiversity of changes in temperature, water availability and sea-level rise. Our focus is on practical methods whereby the local environmental conditions experienced by organisms can be made more suitable.Many studies suggest that manipulating vegetation structure can alter the temperature and moisture conditions experienced by organisms, and several demonstrate that these altered conditions benefit species as regional climatic conditions become unsuitable. The effects of topography on local climatic conditions are even better understood, but the alteration of topography as a climate adaptation tool is not ingrained in conservation practice. Trials of topographic alteration in the field should therefore be a priority for future research.Coastal systems have the natural capacity to keep pace with climate change, but require sufficient sediment supplies and space for landward migration to do so. There is an extensive literature on managed realignment. While the underlying rationale is simple, successful implementation requires careful consideration of elevation and past land use. Even with careful management, restored habitats may not attain the physical and biological attributes of natural habitats. Synthesis and applications . The recent literature provides a compelling case that some of the adverse effects of climate change can be offset by appropriate management. However, much of the evidence for this is indirect and too few studies provide empirical tests of the long-term effectiveness of these management interventions. It is clear

  10. Evaluating outcomes of management targeting the recovery of a migratory songbird of conservation concern

    Directory of Open Access Journals (Sweden)

    Henry M. Streby

    2018-01-01

    Full Text Available Background Assessing outcomes of habitat management is critical for informing and adapting conservation plans. From 2013–2019, a multi-stage management initiative, led by the American Bird Conservancy (ABC, aims to create >25,000 ha of shrubland and early-successional vegetation to benefit Golden-winged Warblers (Vermivora chrysoptera in managed forested landscapes of the western Great Lakes region. We studied a dense breeding population of Golden-winged Warblers at Rice Lake National Wildlife Refuge (NWR in Minnesota, USA, where ABC initiative management was implemented to benefit the species. Methods We monitored abundance before (2011–2014 and after (2015–2016 management, and we estimated full-season productivity (i.e., young recruited into the fall population from predictive, spatially explicit models, informed by nest and fledgling survival data collected at sites in the western Great Lakes region, including Rice Lake NWR, during 2011 and 2012. Then, using biologically informed models of bird response to observed and predicted vegetation succession, we estimated the cumulative change in population recruitment over various scenarios of vegetation succession and demographic response. Results We observed an 32% decline in abundance of breeding pairs and estimated a 27% decline in per-pair full-season productivity following management, compared to no change in a nearby control site. In models that ranged from highly optimistic to progressively more realistic scenarios, we estimated a net loss of 72–460 juvenile Golden-winged Warblers produced from the managed site in the 10–20 years following management. Even if our well-informed and locally validated productivity models produced erroneous estimates and the management resulted in only a temporary reduction in abundance (i.e., no change in productivity, our forecast models still predicted a net loss of 137–260 juvenile Golden-winged Warblers from the managed area over the same time

  11. Corals, Canyons, and Conservation: Science Based Fisheries Management Decisions in the Eastern Bering Sea

    Directory of Open Access Journals (Sweden)

    Steve A. MacLean

    2017-05-01

    Full Text Available When making science matter for conservation, marine conservation practitioners, and managers must be prepared to make the appropriate decision based on the results of the best available science used to inform it. For nearly a decade, many stakeholders encouraged the North Pacific Fishery Management Council to enact protections for deep-sea corals in several canyons in the Eastern Bering Sea slope. In 2014, at the request of the Council, the National Marine Fisheries Service, Alaska Fisheries Science Center conducted a strip-transect survey along the Eastern Bering Sea slope to validate the results of a model predicting the occurrence of deep-sea coral habitat. More than 250,000 photos were analyzed to estimate coral, sponge, and sea whip abundance, distribution, height, and vulnerability to anthropogenic damage. The results of the survey confirmed that coral habitat and occurrence was concentrated around Pribilof Canyon and the adjacent slope. The results also confirmed that the densities of corals in the Eastern Bering Sea were low, even where they occurred. After reviewing the best available scientific information, the Council concluded that there is no scientific evidence to suggest that deep-sea corals in the Eastern Bering Sea slope or canyons are at risk from commercial fisheries under the current management structure, and that special protections for deep-sea corals were not warranted.

  12. Practical implementation of optimal management strategies in conservation programmes: a mate selection method

    Directory of Open Access Journals (Sweden)

    Fernández, J.

    2001-12-01

    Full Text Available The maintenance of genetic diversity is, from a genetic point of view, a key objective of conservation programmes. The selection of individuals contributing offspring and the decision of the mating scheme are the steps on which managers can control genetic diversity, specially on ‘ex situ’ programmes. Previous studies have shown that the optimal management strategy is to look for the parents’ contributions that yield minimum group coancestry (overall probability of identity by descent in the population and, then, to arrange mating couples following minimum pairwise coancestry. However, physiological constraints make it necessary to account for mating restrictions when deciding the contributions and, therefore, these should be implemented in a single step along with the mating plan. In the present paper, a single-step method is proposed to optimise the management of a conservation programme when restrictions on the mating scheme exist. The performance of the method is tested by computer simulation. The strategy turns out to be as efficient as the two-step method, regarding both the genetic diversity preserved and the fitness of the population.

  13. Proactive conservation management of an island-endemic bird species in the face of global change

    Science.gov (United States)

    Morrison, S.A.; Sillett, T. Scott; Ghalambor, Cameron K.; Fitzpatrick, J.W.; Graber, D.M.; Bakker, V.J.; Bowman, R.; Collins, C.T.; Collins, P.W.; Delaney, K.S.; Doak, D.F.; Koenig, Walter D.; Laughrin, L.; Lieberman, A.A.; Marzluff, J.M.; Reynolds, M.D.; Scott, J.M.; Stallcup, J.A.; Vickers, W.; Boyce, W.M.

    2011-01-01

    Biodiversity conservation in an era of global change and scarce funding benefits from approaches that simultaneously solve multiple problems. Here, we discuss conservation management of the island scrub-jay (Aphelocoma insularis), the only island-endemic passerine species in the continental United States, which is currently restricted to 250-square-kilometer Santa Cruz Island, California. Although the species is not listed as threatened by state or federal agencies, its viability is nonetheless threatened on multiple fronts. We discuss management actions that could reduce extinction risk, including vaccination, captive propagation, biosecurity measures, and establishing a second free-living population on a neighboring island. Establishing a second population on Santa Rosa Island may have the added benefit of accelerating the restoration and enhancing the resilience of that island's currently highly degraded ecosystem. The proactive management framework for island scrub-jays presented here illustrates how strategies for species protection, ecosystem restoration, and adaptation to and mitigation of climate change can converge into an integrated solution. ?? 2011 by American Institute of Biological Sciences. All rights reserved.

  14. Placenta Previa Percreta: A Case Report of Successful Management via Conservative Surgery

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    Silvia Canonico

    2013-01-01

    Full Text Available Placenta percreta is one of the most serious complications of placenta previa and is frequently associated with severe obstetric hemorrhage usually necessitating hysterectomy. We present a case of placenta previa percreta diagnosed by ultrasound and magnetic resonance imaging techniques, in which we accomplished conservative management of postpartum hemorrhage. The management we propose includes the following steps: preventive catheterization of the descending aorta via transhumeral access; Stark cesarean delivery; uterotonics drugs; Affronti endouterine square hemostatic sutures; intrauterine application of Bakri balloon and partial filling with 100 mL of normal saline; B Lynch suture, hysterorrhaphy, and filling a Bakri balloon with up to 500 mL of normal saline; reversible radiological embolization; and/or surgical ligation of the uterine arteries. The bleeding stopped following placement of Affronti sutures combined with external (B-Lynch suture and internal (Bakri balloon uterine compression. Our experience indicates that this conservative method can be considered an option in the management of selected cases of pregnancy at high risk for intrapartum hemorrhage.

  15. Conservative management of vestibular schwannoma--a prospective cohort study: treatment, symptoms, and quality of life.

    Science.gov (United States)

    Breivik, Cathrine Nansdal; Varughese, Jobin K; Wentzel-Larsen, Tore; Vassbotn, Flemming; Lund-Johansen, Morten

    2012-05-01

    One hundred ninety-three patients with sporadic unilateral vestibular schwannoma given conservative management were enrolled in a prospective study. To evaluate the efficacy of conservative management and to determine the effect of an initial conservative management on the quality of life (QOL) and severity of audio vestibular symptoms. The patients underwent magnetic resonance imaging scans, clinical examination, and QOL assessment by 2 validated questionnaires, the Short Form-36 (SF-36) and Glasgow Benefit Inventory (GBI). Using regression analysis of clustered data, we analyzed possible associations between tumor growth and symptoms and tested whether our earlier finding that vertigo is associated with reduced QOL could be verified. The median follow-up time was 43 months (range, 9-115 months; SD, 21.48 months). Results are based on 703 clinical controls and 642 (SF-36) and 638 (GBI) questionnaires. Seven patients were lost to follow-up. Approximately 40% of patients were in need of treatment during follow-up. We found a statistically significant association between tinnitus and vertigo and tumor growth. Vertigo was found to significantly reduce QOL. There was a significant drop in the Social Function subscales of both SF-36 and GBI, possibly attributable to progressive hearing loss. Otherwise, there was no overall trend toward any change in QOL during the observation period. In addition, QOL seemed to be little affected by treatment. There was a small but statistically significant improvement in vestibular complaints and no change in the occurrence of tinnitus. Except for hearing loss caused by surgery, treatment did not affect symptoms or QOL significantly. Growth was associated with the occurrence of tinnitus and balance problems.

  16. Clinical outcome in children with chronic granulomatous disease managed conservatively or with hematopoietic stem cell transplantation.

    Science.gov (United States)

    Cole, Theresa; Pearce, Mark S; Cant, Andrew J; Cale, Catherine M; Goldblatt, David; Gennery, Andrew R

    2013-11-01

    Chronic granulomatous disease (CGD) is a primary immunodeficiency characterized by serious infections and inflammation. It can be managed conservatively with prophylactic antimicrobial agents or curatively with hematopoietic stem cell transplantation (HSCT). In the United Kingdom and Ireland there are cohorts of children managed both conservatively and curatively. This study aimed to compare clinical outcomes (mortality and morbidity) in children managed conservatively and curatively. Children were identified from specialist centers and advertising through special interest groups. Clinical data were collected from medical records regarding infections, inflammatory complications and growth, other admissions, and curative treatment. Comparisons were made for patients not undergoing HSCT and patients after HSCT. Seventy-three living children were identified, 59 (80%) of whom were recruited. Five deceased children were also identified. Clinical information was available for 62 children (4 deceased). Thirty (48%) children had undergone HSCT. Children who did not undergo transplantation had 0.71 episodes of infection/admission/surgery per CGD life year (95% CI, 0.69-0.75 events per year). Post-HSCT children had 0.15 episodes of infection/admission/surgery per transplant year (95% CI, 0.09-0.21 events per year). The mean z score for height and body mass index (BMI) for age was significantly better in post-HSCT children. Survival in the non-HSCT group was 90% at age 15 years. Survival in the post-HSCT group was 90%. Children with CGD not undergoing transplantation have more serious infections, episodes of surgery, and admissions compared with post-HSCT children. Children undergoing transplantation have better height for age. Survival is good at the end of the pediatric age range and also after HSCT. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

  17. KEYNOTE INVOLVEMENT OF GENETICS IN KNOWLEDGE, STOCK MANAGEMENT AND CONSERVATION OF AUSTROPOTAMOBIUS PALLIPES IN EUROPE

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    SOUTY-GROSSET C.

    2003-04-01

    Full Text Available In the past, conservation programmes for a given species consisted in restoring the habitat and in translocating individuals without knowledge of their taxonomic status. Even if managers wanted to be informed, the “traditional taxonomy”, based on morphological characters, was discouraging because it could indicate several types of classification. This is the case for Austropotamobius pallipes, considered as a species complex. Today, conservation genetics aims to maintain, on one hand, the genetic specificity of populations (genetic integrity principle and, on the other hand, the genetic diversity within and between populations (biodiversity principle, these basic principles being considered both at the level of protection measures and management measures. As an endangered species, A. pallipes is subjected to a loss of genetic diversity, a result of deterioration of water quality responsible for habitat fragmentation, with populations being confined to headwaters of the catchments. Consequently a certain degree of genetic variability must be maintained within the species because it governs the adaptation potential: the populations must be capable of responding to new environmental conditions. In A. pallipes, recent studies from several countries attempt to first describe the distribution of the present natural populations and secondly, by studying mitochondrial DNA, to clarify the taxonomy (number and identification of the present species and subspecies by phylogenetic inferences and to assess the biogeographical history. These two preliminary steps are fundamental before defining conservation units and working at the catchment level, using highly polymorphic nuclear markers. The new approach has provided a good framework for research, with more frequent dialogues between geneticists and managers.

  18. MANIKIN DEMONSTRATION IN TEACHING CONSERVATIVE MANAGEMENT OF POSTPARTUM HAEMORRHAGE: A COMPARISON WITH CONVENTIONAL METHODS

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    Sathi Mangalam Saraswathi

    2016-07-01

    Full Text Available BACKGROUND Even though there are many innovative methods to make classes more interesting and effective, in my department, topics are taught mainly by didactic lectures. This study attempts to compare the effectiveness of manikin demonstration and didactic lectures in teaching conservative management of post-partum haemorrhage. OBJECTIVE To compare the effectiveness of manikin demonstration and didactic lectures in teaching conservative management of postpartum haemorrhage. MATERIALS AND METHODS This is an observational study. Eighty four ninth-semester MBBS students posted in Department of Obstetrics and Gynaecology, Government Medical College, Kottayam were selected. They were divided into 2 groups by lottery method. Pre-test was conducted for both groups. Group A was taught by manikin demonstration. Group B was taught by didactic lecture. Feedback response from the students collected after demonstration class was analysed. Post-test was conducted for both the groups after one week. Gain in knowledge of both the groups were calculated from pre-test and post-test scores and compared by Independent sample t test. RESULTS The mean gain in knowledge in group A was 6.4 when compared to group B which is 4.3 and the difference was found to be statistically significant. All of the students in group A felt satisfied and more confident after the class and wanted more topics to be taken by demonstration. CONCLUSION Manikin demonstration class is more effective in teaching conservative management of post-partum haemorrhage and this method can be adopted to teach similar topics in clinical subjects.

  19. Species Richness and Community Structure on a High Latitude Reef: Implications for Conservation and Management

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    Wayne Houston

    2011-07-01

    Full Text Available In spite of the wealth of research on the Great Barrier Reef, few detailed biodiversity assessments of its inshore coral communities have been conducted. Effective conservation and management of marine ecosystems begins with fine-scale biophysical assessments focused on diversity and the architectural species that build the structural framework of the reef. In this study, we investigate key coral diversity and environmental attributes of an inshore reef system surrounding the Keppel Bay Islands near Rockhampton in Central Queensland, Australia, and assess their implications for conservation and management. The Keppels has much higher coral diversity than previously found. The average species richness for the 19 study sites was ~40 with representatives from 68% of the ~244 species previously described for the southern Great Barrier Reef. Using scleractinian coral species richness, taxonomic distinctiveness and coral cover as the main criteria, we found that five out of 19 sites had particularly high conservation value. A further site was also considered to be of relatively high value. Corals at this site were taxonomically distinct from the others (representatives of two families were found here but not at other sites and a wide range of functionally diverse taxa were present. This site was associated with more stressful conditions such as high temperatures and turbidity. Highly diverse coral communities or biodiversity ‘hotspots’ and taxonomically distinct reefs may act as insurance policies for climatic disturbance, much like Noah’s Arks for reefs. While improving water quality and limiting anthropogenic impacts are clearly important management initiatives to improve the long-term outlook for inshore reefs, identifying, mapping and protecting these coastal ‘refugia’ may be the key for ensuring their regeneration against catastrophic climatic disturbance in the meantime.

  20. Hydrological services and biodiversity conservation under forestation scenarios: comparing options to improve watershed management

    Science.gov (United States)

    Carvalho-Santos, Claudia; Nunes, João Pedro; Sousa-Silva, Rita; Gonçalves, João; Pradinho Honrado, João

    2015-04-01

    Humans rely on ecosystems for the provision of hydrological services, namely water supply and water damage mitigation, and promoting forests is a widely used management strategy for the provision of hydrological services. Therefore, it is important to model how forests will contribute for this provision, taking into account the environmental characteristics of each region, as well as the spatio-temporal patterns of societal demand. In addition, ensuring forest protection and the delivery of forest ecosystem services is one of the aims included in the European Union biodiversity strategy to 2020. On the other hand, forest management for hydrological services must consider possible trade-offs with other services provision, as well as with biodiversity conservation. Accurate modeling and mapping of both hydrological services and biodiversity conservation value is thus important to support spatial planning and land management options involving forests. The objectives of this study were: to analyze the provision and spatial dynamics of hydrological services under two forest cover change scenarios (oak and eucalyptus/pine) compared to the current shrubland-dominated landscape; and to evaluate their spatial trade-offs with biodiversity conservation value. The Vez watershed (250km2), in northwest Portugal, was used as case-study area. SWAT (Soil and Water Assessment Tool) was applied to simulate the provision of hydrological services (water supply quantity, timing and quality; soil erosion and flood regulation), and was calibrated against daily discharge, sediments, nitrates and evapotranspiration. Good agreement was obtained between model predictions and field measurements. The maps for each service under the different scenarios were produced at the Hydrologic Response Unit (HRU) level. Biodiversity conservation value was based on nature protection regimes and on expert valuation applied to a land cover map. Statistical correlations between hydrological services provision

  1. How to maximally support local and regional biodiversity in applied conservation? Insights from pond management.

    Science.gov (United States)

    Lemmens, Pieter; Mergeay, Joachim; De Bie, Tom; Van Wichelen, Jeroen; De Meester, Luc; Declerck, Steven A J

    2013-01-01

    Biodiversity and nature values in anthropogenic landscapes often depend on land use practices and management. Evaluations of the association between management and biodiversity remain, however, comparatively scarce, especially in aquatic systems. Furthermore, studies also tend to focus on a limited set of organism groups at the local scale, whereas a multi-group approach at the landscape scale is to be preferred. This study aims to investigate the effect of pond management on the diversity of multiple aquatic organism groups (e.g. phytoplankton, zooplankton, several groups of macro-invertebrates, submerged and emergent macrophytes) at local and regional spatial scales. For this purpose, we performed a field study of 39 shallow man-made ponds representing five different management types. Our results indicate that fish stock management and periodic pond drainage are crucial drivers of pond biodiversity. Furthermore, this study provides insight in how the management of eutrophied ponds can contribute to aquatic biodiversity. A combination of regular draining of ponds with efforts to keep ponds free of fish seems to be highly beneficial for the biodiversity of many groups of aquatic organisms at local and regional scales. Regular draining combined with a stocking of fish at low biomass is also preferable to infrequent draining and lack of fish stock control. These insights are essential for the development of conservation programs that aim long-term maintenance of regional biodiversity in pond areas across Europe.

  2. Reverse logistics policy – differences between conservative and innovative reverse logistics management

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    Alena Klapalová

    2013-01-01

    Full Text Available One of the of the key barriers that hampers effective and efficient management of reverse flows detected within a number of empirical surveys and case studies focused on reverse logistics and/or return management is business (organisational policy, specifically lack of policy, deficiency in existing policy or inferior policy. Despite this fact, there is a gap in literature which would show some evidence from practice that innovative reverse logistics policy both can pay off and is associated with certain aspects of reverse logistics management. Such proof can have several implications. It can support the call for better understanding and more research of the linkages of reverse logistics with other corporate functions, promote the acceptation of strategic character of reverse logistics and stress the role of RL policy within the rest of overall corporate management.The aim of this paper is to contribute and to enrich the existing body of knowledge concerning the above-mentioned gap through presentation of survey results that was realized in 2012 among managers of 244 Czech firms. The results demonstrate the statistically significant association between the innovativeness of RL policy and profitability of firms, quality of RL planning, perception of RL importance, level of RL knowledge and perception of product innovation importance for firms’ competitiveness and frequency of product innovation. They also reveal statistically significant differences between firms with conservative and innovative RL policy and the perceived existence of some barriers to manage RL.

  3. Soil tillage conservation and its effect on erosion control, water management and carbon sequestration

    Science.gov (United States)

    Rusu, Dr.; Gus, Dr.; Bogdan, Dr.; Moraru, Dr.; Pop, Dr.; Clapa, Dr.; Pop, Drd.

    2009-04-01

    fuel for preparing the germination bed. Presently it is necessary a change concerning the concept of conservation practices and a new approach regarding the control of erosion. The real conservation of soil must be expanded beyond the traditional understanding of soil erosion. The real soil conservation is represented by carbon management. We need to focus to another level concerning conservation by focusing on of soil quality. Carbon management is necessary for a complex of matters including soil, water management, field productivity, biological fuel and climatic change. Profound research is necessary in order to establish the carbon sequestration practices and their implementation impact.

  4. Descending Necrotising Mediastinitis: A Case Report Illustrating a Trend in Conservative Management

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    B. A. P. Jayasekera

    2012-01-01

    Full Text Available The mortality rate from descending necrotising mediastinitis (DNM has declined since its first description in 1938. The decline in mortality has been attributed to earlier diagnosis by way of contrast-enhanced computed tomographic (CT scanning and aggressive surgical intervention in the form of transthoracic drainage. We describe a case of DNM with involvement of anterior and posterior mediastinum down to the diaphragm, managed by cervicotomy and transverse cervical drainage with placement of corrugated drains and a pleural chest drain, with a delayed mediastinoscopy and mediastinal drain placement. We advocate a conservative approach with limited debridement and emphasis on drainage of infection in line with published case series.

  5. An Option of Conservative Management of a Duodenal Injury Following Laparoscopic Cholecystectomy

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    MA Modi

    2014-01-01

    Full Text Available Duodenal injury following laparoscopic cholecystectomy is rare complications with catastrophic sequelae. Most injuries are attributed to thermal burns with electrocautery following adhesiolysis and have a delayed presentation requiring surgical intervention. We present a case of a 47-year-old gentleman operated on for laparoscopic cholecystectomy with a bilious drain postoperatively; for which an ERC was done showing choledocholithiasis with cystic duct stump blow-out and a drain in the duodenum suggestive of an iatrogenic duodenal injury. He was managed conservatively like a duodenal fistula and recovered without undergoing any intervention.

  6. Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review

    Science.gov (United States)

    Brignardello-Petersen, Romina; Guyatt, Gordon H; Buchbinder, Rachelle; Poolman, Rudolf W; Chang, Yaping; Sadeghirad, Behnam; Evaniew, Nathan; Vandvik, Per O

    2017-01-01

    Objective To determine the effects and complications of arthroscopic surgery compared with conservative management strategies in patients with degenerative knee disease. Design Systematic review. Main outcome measures Pain, function, adverse events. Data sources MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar and Open Grey up to August 2016. Eligibility criteria For effects, randomised clinical trials (RCTs) comparing arthroscopic surgery with a conservative management strategy (including sham surgery) in patients with degenerative knee disease. For complications, RCTs and observational studies. Review methods Two reviewers independently extracted data and assessed risk of bias for patient-important outcomes. A parallel guideline committee (BMJ Rapid Recommendations) provided input on the design and interpretation of the systematic review, including selection of patient-important outcomes. We used the GRADE approach to rate the certainty (quality) of the evidence. Results We included 13 RCTs and 12 observational studies. With respect to pain, the review identified high-certainty evidence that knee arthroscopy results in a very small reduction in pain up to 3 months (mean difference =5.4 on a 100-point scale, 95% CI 2.0 to 8.8) and very small or no pain reduction up to 2 years (mean difference =3.1, 95% CI −0.2 to 6.4) when compared with conservative management. With respect to function, the review identified moderate-certainty evidence that knee arthroscopy results in a very small improvement in the short term (mean difference =4.9 on a 100-point scale, 95% CI 1.5 to 8.4) and very small or no improved function up to 2 years (mean difference =3.2, 95% CI −0.5 to 6.8). Alternative presentations of magnitude of effect, and associated sensitivity analyses, were consistent with the findings of the primary analysis. Low-quality evidence suggested a very low probability of serious complications after knee arthroscopy

  7. Developing a conservation strategy to maximize persistence of an endangered freshwater mussel species while considering management effectiveness and cost

    Science.gov (United States)

    Smith, David R.; McRae, Sarah E.; Augspurger, Tom; Ratcliffe, Judith A.; Nichols, Robert B.; Eads, Chris B.; Savidge, Tim; Bogan, Arthur E.

    2015-01-01

    We used a structured decision-making process to develop conservation strategies to increase persistence of Dwarf Wedgemussel (Alasmidonta heterodon) in North Carolina, USA, while accounting for uncertainty in management effectiveness and considering costs. Alternative conservation strategies were portfolios of management actions that differed by location of management actions on the landscape. Objectives of the conservation strategy were to maximize species persistence, maintain genetic diversity, maximize public support, and minimize management costs. We compared 4 conservation strategies: 1) the ‘status quo’ strategy represented current management, 2) the ‘protect the best’ strategy focused on protecting the best populations in the Tar River basin, 3) the ‘expand the distribution’ strategy focused on management of extant populations and establishment of new populations in the Neuse River basin, and 4) the ‘hybrid’ strategy combined elements of each strategy to balance conservation in the Tar and Neuse River basins. A population model informed requirements for population management, and experts projected performance of alternative strategies over a 20-y period. The optimal strategy depended on the relative value placed on competing objectives, which can vary among stakeholders. The protect the best and hybrid strategies were optimal across a wide range of relative values with 2 exceptions: 1) if minimizing management cost was of overriding concern, then status quo was optimal, or 2) if maximizing population persistence in the Neuse River basin was emphasized, then expand the distribution strategy was optimal. The optimal strategy was robust to uncertainty in management effectiveness. Overall, the structured decision process can help identify the most promising strategies for endangered species conservation that maximize conservation benefit given the constraint of limited funding.

  8. The Conservation Measures of NATURA 2000 "Someşul Rece" Site Management Plan

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    Marian Proorocu

    2016-11-01

    Full Text Available Natura 2000 is a European network of protected natural areas including a significant number of natural habitats and wild species for the interest of comunnity. Natura 2000 ROSCI 0233 "Someşul Rece"  Site is situated in the south-western county of Cluj, on the administrative territory of Măguri-Răcătău and Ierii Valley. It has an area of 8529 ha and is a framed area of the Apuseni Mountains Alpine bioregions. The site preserves the following natural habitats: Rough mountain beech forests Asperulo-Fagetum, beech forests of Luzulo-Fagetum, forests acidophilous Picea Abies mountain region and protect important species and active fish fauna, flora and fauna of the Apuseni Mountains. It is also home for several species (mammals, amphibians, fish and beetles like: lynx, wolf or otter. The conservation measures of Natura 2000 Somesul Rece Site, elaborated in order to protect the habitats and the species are part of the management plan. These measures were developed in close connection with the conservation status of habitats and species, but also taking into account the needs of local communities. These measures include: maintaining habitats in favorable conservation status; maintain the current habitat areas; preventing and combating poaching and overfishing;ensuring peace in areas of rock (for large mammals.

  9. Towards Conservation of Omani Local Chicken: Phenotypic Characteristics, Management Practices and Performance Traits

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    B. Al-Qamashoui

    2014-06-01

    Full Text Available Characterizing local chicken types and their mostly rural production systems is prerequisite for designing and implementing development and conservation programs. This study evaluated the management practices of small-scale chicken keepers and the phenotypic and production traits of their chickens in Oman, where conservation programs for local livestock breeds have currently started. Free-range scavenging was the dominant production system, and logistic regression analysis showed that socio-economic factors such as training in poultry keeping, household income, income from farming and gender of chicken owners influenced feeding, housing, and health care practices (p<0.05. A large variation in plumage and shank colors, comb types and other phenotypic traits within and between Omani chicken populations were observed. Male and female body weight differed (p<0.05, being 1.3±0.65 kg and 1.1±0.86 kg respectively. Flock size averaged 22±7.7 birds per household with 4.8 hens per cock. Clutch size was 12.3±2.85 and annual production 64.5±2.85 eggs per hen. Egg hatchability averaged 88±6.0% and annual chicken mortality across all age and sex categories was 16±1.4%. The strong involvement of women in chicken keeping makes them key stakeholders in future development and conservation programs, but the latter should be preceded by a comprehensive study of the genetic diversity of the Omani chicken populations.

  10. Short bowel syndrome

    International Nuclear Information System (INIS)

    Engels, L.G.J.B.

    1983-01-01

    This thesis describes some aspects of short bowel syndrome. When approximately 1 m or less small bowel is retained after extensive resection, a condition called short bowel syndrome is present. Since the advent of parenteral nutrition, the prognosis of patients with a very short bowel has dramatically improved. Patients with 40 to 100 cm remaining jejunum and/or ileum can generally be maintained with oral nutrition due to increased absorption of the small bowel remnant as result of intestinal adaptation. This study reports clinical, biochemical and nutritional aspects of short bowel patients on oral or parenteral nutrition, emphasizing data on absorption of various nutrients and on bone metabolism. Furthermore, some technical apsects concerning long-term parenteral nutrition are discussed. (Auth.)

  11. Public perceptions of snakes and snakebite management: implications for conservation and human health in southern Nepal.

    Science.gov (United States)

    Pandey, Deb Prasad; Subedi Pandey, Gita; Devkota, Kamal; Goode, Matt

    2016-06-02

    Venomous snakebite and its effects are a source of fear for people living in southern Nepal. As a result, people have developed a negative attitude towards snakes, which can lead to human-snake conflicts that result in killing of snakes. Attempting to kill snakes increases the risk of snakebite, and actual killing of snakes contributes to loss of biodiversity. Currently, snake populations in southern Nepal are thought to be declining, but more research is needed to evaluate the conservation status of snakes. Therefore, we assessed attitudes, knowledge, and awareness of snakes and snakebite by Chitwan National Park's (CNP) buffer zone (BZ) inhabitants in an effort to better understand challenges to snake conservation and snakebite management. The results of this study have the potential to promote biodiversity conservation and increase human health in southern Nepal and beyond. We carried out face-to-face interviews of 150 randomly selected CNP BZ inhabitants, adopting a cross-sectional mixed research design and structured and semi-structured questionnaires from January-February 2013. Results indicated that 43 % of respondents disliked snakes, 49 % would exterminate all venomous snakes, and 86 % feared snakes. Farmers were the most negative and teachers were the most ambivalent towards snakes. Respondents were generally unable to identify different snake species, and were almost completely unaware of the need of conserve snakes and how to prevent snakebites. Belief in a snake god, and the ability of snakes to absorb poisonous gases from the atmosphere were among many superstitions that appeared to predispose negativity towards snakes of BZ residents. People with predisposed negativity towards snakes were not proponents of snake conservation. Fear, negativity, ambivalence towards, and ignorance about, snakes and the need for snake conservation were strong indicators of the propensity to harm or kill snakes. It seems that if wanton killing of snakes continues

  12. Examination of Physicians’ Perception of the Indications of Colorectal Stents in the Management of Malignant Large Bowel Obstruction: A Provincial Survey

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    Jean-Frédéric LeBlanc

    2016-01-01

    Full Text Available Introduction. Data are conflicting when assessing indications for colorectal self-expandable metallic stents (SEMS in managing acute malignant large bowel obstruction (MLO. In November 2014, European and American Societies published guidelines to aid in understanding which patients might benefit from colorectal stenting. Yet, there remain marked disparities in clinical practice. Methods. A web-based survey was sent to Gastroenterologists and Surgical Specialists across Quebec to assess physicians’ knowledge and adherence to the indications for colonic SEMS placement in the management of MLO using eight clinical scenarios. Results. Out of 112 respondents, 74% preferred surgical intervention in young, healthy individuals with MLO. Advanced age and comorbidities motivated 56.3% (95% CI 47.1–65.5% of participants to opt for SEMS placement. In palliative settings of patients undergoing chemotherapy including bevacizumab, a minority of respondents followed guidelines, 12.5% (95% CI 6.4–18.6% for young patients and 25.0% for elderly patients (95% CI 17.0–33.0%. The pooled overall adherence to guidelines was 50.4% (95% CI 40.7–59.3%. Conclusion. This survey suggests that guidelines recommendations are not being implemented by at least half of specialists involved in the care of patients with MLO. Future studies should attempt to identify possible barriers responsible for this impaired knowledge translation and tailored educational initiatives planned accordingly.

  13. Land-use history as a guide for forest conservation and management.

    Science.gov (United States)

    Whitlock, Cathy; Colombaroli, Daniele; Conedera, Marco; Tinner, Willy

    2018-02-01

    ecological change, clarify management objectives, and define conservation strategies that seek to protect both natural and cultural elements. © 2017 The Authors. Conservation Biology published by Wiley Periodicals, Inc. on behalf of Society for Conservation Biology.

  14. Integrating Collaboration, Adaptive Management, and Scenario-Planning: Experiences at Las Cienegas National Conservation Area

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    Jeremy K. Caves

    2013-09-01

    Full Text Available There is growing recognition that public lands cannot be managed as islands; rather, land management must address the ecological, social, and temporal complexity that often spans jurisdictions and traditional planning horizons. Collaborative decision making and adaptive management (CAM have been promoted as methods to reconcile competing societal demands and respond to complex ecosystem dynamics. We detail the experiences of land managers and stakeholders in using CAM at Las Cienegas National Conservation Area (LCNCA, a highly valued site under the jurisdiction of the Bureau of Land Management (BLM. The CAM process at Las Cienegas is marked by strong stakeholder engagement, with four core elements: (1 shared watershed goals with measurable resource objectives; (2 relevant and reliable scientific information; (3 mechanisms to incorporate new information into decision making; and (4 shared learning to improve both the process and management actions. The combination of stakeholder engagement and adaptive management has led to agreement on contentious issues, more innovative solutions, and more effective land management. However, the region is now experiencing rapid changes outside managers' control, including climate change, human population growth, and reduced federal budgets, with large but unpredictable impacts on natural resources. Although the CAM experience provides a strong foundation for making the difficult and contentious management decisions that such changes are likely to require, neither collaboration nor adaptive management provides a sufficient structure for addressing the externalities that drive uncontrollable and unpredictable change. As a result, LCNCA is exploring two specific modifications to CAM that may better address emerging challenges, including: (1 creating nested resource objectives to distinguish between those objectives that may be crucial to maintaining ecological resilience from those that may hinder a flexible

  15. Mapping Indigenous land management for threatened species conservation: An Australian case-study.

    Science.gov (United States)

    Renwick, Anna R; Robinson, Catherine J; Garnett, Stephen T; Leiper, Ian; Possingham, Hugh P; Carwardine, Josie

    2017-01-01

    Much biodiversity lives on lands to which Indigenous people retain strong legal and management rights. However this is rarely quantified. Here we provide the first quantitative overview of the importance of Indigenous land for a critical and vulnerable part of biodiversity, threatened species, using the continent of Australia as a case study. We find that three quarters of Australia's 272 terrestrial or freshwater vertebrate species listed as threatened under national legislation have projected ranges that overlap Indigenous lands. On average this overlap represents 45% of the range of each threatened species while Indigenous land is 52% of the country. Hotspots where multiple threatened species ranges overlap occur predominantly in coastal Northern Australia. Our analysis quantifies the vast potential of Indigenous land in Australia for contributing to national level conservation goals, and identifies the main land management arrangements available to Indigenous people which may enable them to deliver those goals should they choose to do so.

  16. Identifying resource manager information needs for the North Pacific Landscape Conservation Cooperative

    Science.gov (United States)

    Woodward, Andrea; Liedtke, Theresa; Jenni, Karen

    2014-01-01

    Landscape Conservation Cooperatives (LCCs) are a network of 22 public-private partnerships, defined by ecoregion, that share and provide science to ensure the sustainability of land, water, wildlife and cultural resources in North America. LLCs were established by the U.S. Department of Interior (DOI) in recognition that response to climate change must be coordinated on a landscape-level basis because important resources, ecosystem processes and resource management challenges extend beyond national wildlife refuges, Bureau of Land Management lands, national parks, and even international boundaries. Therefore, DOI agencies must work with other Federal, State, Tribal (U.S. indigenous peoples), First Nation (Canadian indigenous peoples), and local governments, as well as private landowners, to develop landscape-level strategies for understanding and responding to climate change.

  17. Experience of 49 longitudinal intestinal lengthening procedures for short bowel syndrome.

    Science.gov (United States)

    Hosie, S; Loff, S; Wirth, H; Rapp, H-J; von Buch, C; Waag, K-L

    2006-06-01

    Forty-nine patients with a mean age of 25 months underwent a longitudinal intestinal lengthening procedure for short bowel syndrome (SBS) in our institution. Indications for the operation were dependence on parenteral nutrition in spite of adequate conservative management. The small bowel was lengthened from a mean of 27 cm to a mean of 51 cm. There was no intraoperative mortality. The following early complications occurred in our early series: ischemia of a short bowel segment of 2 cm, requiring resection in two patients, insufficiency of the longitudinal anastomosis in two patients and an intra-abdominal abscess in one. Four of 9 non-survivors died of liver failure and 3 of sepsis. Follow-up showed that 19 patients were weaned from parenteral nutrition after a mean of 9.1 months. Long-term complications encountered were dismotility with malabsorption due to bacterial overgrowth caused by progressive dilatation of the bowel, d-lactic acidosis, cholelithiasis and urolithiasis. A longitudinal intestinal lengthening procedure is an effective and safe surgical approach for SBS, provided it is performed in time, the patient's preoperative condition is optimized and technical surgical details are taken into account.

  18. A study of diagnosis and manegement of mechanical small-bowel obstruction

    International Nuclear Information System (INIS)

    Kawasaki, Masayasu; Kurumi, Yoshimasa; Naitoh, Hiroyuki

    2007-01-01

    We tried to clarify the most appropriate management for simple bowel obstruction and effective methods for diagnosis of strangulated bowel obstruction. Consecutive 252 cases of mechanical small-bowel obstruction treated in the hospital from 2000 to 2005 were assessed retrospectively. There were 219 cases of simple obstructions and 33 cases of strangulated obstruction. Seventy-eight percent of simple obstruction cases were treated conservatively (fasting in 82, decompression tube treatment in 88 and operation in 49). The average duration for indwelling the decompression tube was 5.2 days and the amount of discharge from the tube decreased day by day. In the cases of operation, the operation was performed on the 4.5th day after admission on the average, and the average amount of tube discharge before the operation was more than 450 ml/day. On the other hand, strangulation was most frequently diagnosed by enhanced abdominal CT scan, followed by physical examination, and the properties of decompression tube discharge in this order, and the blood data were only used for reference. Simple small-bowel obstruction should be treated by surgical therapy if symptomatic remission could not be gained by five days after beginning of the treatment. Enhanced abdominal CT scan is the most useful method for diagnosis of strangulation in an early stage of ischemia. (author)

  19. Genetic Diversity and Population Structure of Mesoamerican Jaguars (Panthera onca): Implications for Conservation and Management.

    Science.gov (United States)

    Wultsch, Claudia; Caragiulo, Anthony; Dias-Freedman, Isabela; Quigley, Howard; Rabinowitz, Salisa; Amato, George

    2016-01-01

    Mesoamerican jaguars (Panthera onca) have been extirpated from over 77% of their historic range, inhabiting fragmented landscapes at potentially reduced population sizes. Maintaining and restoring genetic diversity and connectivity across human-altered landscapes has become a major conservation priority; nonetheless large-scale genetic monitoring of natural populations is rare. This is the first regional conservation genetic study of jaguars to primarily use fecal samples collected in the wild across five Mesoamerican countries: Belize, Costa Rica, Guatemala, Honduras, and Mexico. We genotyped 445 jaguar fecal samples and examined patterns of genetic diversity and connectivity among 115 individual jaguars using data from 12 microsatellite loci. Overall, moderate levels of genetic variation were detected (NA = 4.50 ± 1.05, AR = 3.43 ± 0.22, HE = 0.59 ± 0.04), with Mexico having the lowest genetic diversity, followed by Honduras, Guatemala, Belize, and Costa Rica. Population-based gene flow measures (FST = 0.09 to 0.15, Dest = 0.09 to 0.21), principal component analysis, and Bayesian clustering applied in a hierarchical framework revealed significant genetic structure in Mesoamerican jaguars, roughly grouping individuals into four genetic clusters with varying levels of admixture. Gene flow was highest among Selva Maya jaguars (northern Guatemala and central Belize), whereas genetic differentiation among all other sampling sites was moderate. Genetic subdivision was most pronounced between Selva Maya and Honduran jaguars, suggesting limited jaguar movement between these close geographic regions and ultimately refuting the hypothesis of contemporary panmixia. To maintain a critical linkage for jaguars dispersing through the Mesoamerican landscape and ensure long-term viability of this near threatened species, we recommend continued management and maintenance of jaguar corridors. The baseline genetic data provided by this study underscores the importance of

  20. Fecal Calprotectin Is Not Affected by Pregnancy: Clinical Implications for the Management of Pregnant Patients with Inflammatory Bowel Disease.

    Science.gov (United States)

    Julsgaard, Mette; Hvas, Christian L; Gearry, Richard B; Vestergaard, Thea; Fallingborg, Jan; Svenningsen, Lise; Kjeldsen, Jens; Sparrow, Miles P; Wildt, Signe; Kelsen, Jens; Bell, Sally J

    2017-07-01

    Noninvasive biomarkers of inflammation for monitoring inflammatory bowel disease (IBD) are important in pregnancy. Clinical and laboratory markers are often affected by the physiological adaption that occurs during pregnancy, although, few, if any, data exist on fecal calprotectin (FC). We investigated FC concentrations in pregnant controls and IBD women, and whether FC correlated with physician global assessment (PGA), C-reactive protein (CRP), and Harvey-Bradshaw Index (HBI)/Simple Clinical Colitis Activity Index (SCCAI) before and after pregnancy, as well as during each trimester. The study is a prospective multicenter study of 46 pregnant women with and 21 without IBD in Denmark, Australia, and New Zealand. Demographics, clinical parameters, and HBI/SCCAI were recorded. Stool and blood samples were obtained to determine FC and CRP concentrations. From pregnant IBD women and pregnant controls, 174 and 21 fecal samples were collected, respectively. The median FC concentration in pregnant IBD women was 131 μg/g (range 0-3600) and in controls 0 μg/g (range 0-84) (P 0.05). An FC cutoff concentration of 250 μg/g significantly correlated with active disease according to PGA in all 5 periods (P ≤ 0.0002). CRP only significantly correlated with FC (P = 0.0007) and PGA in the second trimester (P = 0.0003). No significant correlation was found between CRP and HBI/SCCAI at any timepoint (P > 0.05). The physiological changes that occur during pregnancy do not affect FC, in contrast to CRP and HBI/SCCAI. The combined use of FC and PGA seems optimal to assess disease activity in IBD during pregnancy.

  1. Adaptation of Australia’s Marine Ecosystems to Climate Change: Using Science to Inform Conservation Management

    Directory of Open Access Journals (Sweden)

    Johanna E. Johnson

    2014-01-01

    Full Text Available The challenges that climate change poses for marine ecosystems are already manifesting in impacts at the species, population, and community levels in Australia, particularly in Tasmania and tropical northern Australia. Many species and habitats are already under threat as a result of human activities, and the additional pressure from climate change significantly increases the challenge for marine conservation and management. Climate change impacts are expected to magnify as sea surface temperatures, ocean chemistry, ocean circulation, sea level, rainfall, and storm patterns continue to change this century. In particular, keystone species that form the foundation of marine habitats, such as coral reefs, kelp beds, and temperate rocky reefs, are projected to pass thresholds with subsequent implications for communities and ecosystems. This review synthesises recent science in this field: the observed impacts and responses of marine ecosystems to climate change, ecological thresholds of change, and strategies for marine conservation to promote adaptation. Increasing observations of climate-related impacts on Australia’s marine ecosystems—both temperate and tropical—are making adaptive management more important than ever before. Our increased understanding of the impacts and responses of marine ecosystems to climate change provides a focus for “no-regrets” adaptations that can be implemented now and refined as knowledge improves.

  2. Perioperative coagulation management and blood conservation in cardiac surgery: a Canadian Survey.

    Science.gov (United States)

    Taneja, Ravi; Fernandes, Philip; Marwaha, Gulshan; Cheng, Davy; Bainbridge, Daniel

    2008-10-01

    To determine which strategies are currently used for (anti)coagulation management and blood conservation during cardiac surgery in Canada. Institutional survey. University hospital. All sites performing cardiac surgery in Canada. None. The response rate was 85%. Anticoagulation with heparin is monitored routinely through the activated coagulation time (ACT). Less than 10% of centers use heparin concentrations (Hepcon HMS, Medtronic), thromboelastography, or other point-of-care tests perioperatively. Eighty percent of centers routinely use tranexamic acid as the primary antifibrinolytic agent; however aprotinin until recently, was used more commonly for patients at increased risk for bleeding. Retrograde autologous prime is commonly used (62%); however, cell savers are uncommon for routine patients undergoing cardiac surgery (29%). Although most hospitals use a hematocrit of 20% to 21% for transfusing red blood cells, more than 50% of intensive care units do not have written guidelines for the administration of protamine, fresh frozen plasma, platelets, or factor VIIa. At least one third of centers do not audit their transfusion practices regularly. The majority of Canadian institutions do not use point-of-care tests other than ACT. Most institutions do not have algorithms for management of bleeding following cardiac surgery and at least 30% do not monitor their transfusion practice perioperatively. Cardiac surgery patients in Canada may benefit from a standardized approach to blood conservation in the perioperative period.

  3. Evaluation of freshwater mussel relocation as a conservation and management strategy

    Science.gov (United States)

    Cope, W. Gregory; Waller, Diane L.

    1995-01-01

    The relocation of unionacean mussels is commonly used as a conservation and management tool in large rivers and streams. Relocation has been used to recolonize areas where mussel populations have been eliminated by prior pollution events, to remove mussels from construction zones and to re-establish populations of endangered species. More recently, relocation has been used to protect native freshwater mussels from colonization by the exotic zebra mussel Dreissena polymorpha. We conducted a literature review of mussel relocations and evaluated their relative success as a conservation and management strategy. We found that 43% of all relocations were conducted because of construction projects that were forced to comply with the Endangered Species Act 1973 and that only 16% were monitored for five or more consecutive years. Most (43%) relocation projects were conducted from July to September, presumably a period when reproductive stress is relatively low for most species and the metabolic rate is sufficient for reburrowing in the substrate. The mortality of relocated mussels was unreported in 27% of projects; reported mortality varied widely among projects and species and was difficult to assess. The mean mortality of relocated mussels was 49% based on an average recovery rate of 43%. There is little guidance on the methods for relocation or for monitoring the subsequent long-term status of relocated mussels. Based on this evaluation, research is needed to develop criteria for selecting a suitable relocation site and to establish appropriate methods and guidelines for conducting relocation projects.

  4. Environmental traditional knowledge in a natural protected area as the basis for management and conservation policies.

    Science.gov (United States)

    Pío-León, Juan Fernando; Delgado-Vargas, Francisco; Murillo-Amador, Bernardo; León-de-la-Luz, José Luís; Vega-Aviña, Rito; Nieto-Garibay, Alejandra; Córdoba-Matson, Miguel; Ortega-Rubio, Alfredo

    2017-10-01

    Ethnobotany is an adequate tool to identify the most import wild edible plants used by local people and to develop strategies for its sustainable use and policy making. This research records the wild edible plants used by the inhabitants of the Sierra la Laguna Biosphere Reserve, in Mexico, and identified priority species for sustainable development. The employed quantitative approach included the application of a food-oriented index named Food Significance Index (FSI), which integrated cultural, agricultural and food parameters; moreover, it used multivariate analysis to identify priority edible species for use and/or conservation. Fifty taxa were identified as the most important wild edible plants in the reserve, integrated into five priority groups. Foods in priority group 1 had the highest culinary diversity by grouping three fruits (Ficus petiolaris, Stenocereus thurberi, and Cyrtocarpa edulis), one almond-like seed (Cnidoscolus maculatus), one vegetable (Matelea cordifolia), and one condiment (Capsicum annuum). Priority groups 2-5 were selective for one or two types of food, such as fruits, teas, or seeds. Since group 1 was the most diverse, the FSI and the employed strategy permitted to identify the priority wild edible plant species with the highest potential for food security. The selected six species should be included in the future management program of the reserve as the priority wild edible plants to develop strategies for conservation, sustainable use, and improvement of the local population income. General policies to manage the selected six species are outlined. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. The Middle Eastern Biodiversity Network: Generating and sharing knowledge for ecosystem management and conservation

    Directory of Open Access Journals (Sweden)

    Friedhelm Krupp

    2009-12-01

    Full Text Available Despite prevailing arid conditions, the diversity of terrestrial and freshwater biota in the Middle East is amazingly high and marine biodiversity is the second highest on Earth. Throughout the region, threats to the environment are moderate to severe. Despite the outstanding economic and ecological importance of biological diversity, the capacity in biodiversity-related research and education is inadequate in most parts of the Middle East. The ";;Middle Eastern Biodiversity Network";; (MEBN, founded in 2006 by six universities and research institutes in Iran, Jordan, Germany, Lebanon and Yemen was designed to fill this gap. An integrated approach is taken to upgrade biodiversity research and education to improve regional ecosystem conservation and management capacities. A wide range of activities are carried out in the framework of the Network, including capacity building in biological collection management and professional natural history curatorship, developing university curricula in biodiversity, conducting scientific research, organising workshops and conferences on Middle Eastern biodiversity, and translating the results of biodiversity research into conservation and sustainable development.

  6. Impact of biology knowledge on the conservation and management of large pelagic sharks.

    Science.gov (United States)

    Yokoi, Hiroki; Ijima, Hirotaka; Ohshimo, Seiji; Yokawa, Kotaro

    2017-09-06

    Population growth rate, which depends on several biological parameters, is valuable information for the conservation and management of pelagic sharks, such as blue and shortfin mako sharks. However, reported biological parameters for estimating the population growth rates of these sharks differ by sex and display large variability. To estimate the appropriate population growth rate and clarify relationships between growth rate and relevant biological parameters, we developed a two-sex age-structured matrix population model and estimated the population growth rate using combinations of biological parameters. We addressed elasticity analysis and clarified the population growth rate sensitivity. For the blue shark, the estimated median population growth rate was 0.384 with a range of minimum and maximum values of 0.195-0.533, whereas those values of the shortfin mako shark were 0.102 and 0.007-0.318, respectively. The maturity age of male sharks had the largest impact for blue sharks, whereas that of female sharks had the largest impact for shortfin mako sharks. Hypotheses for the survival process of sharks also had a large impact on the population growth rate estimation. Both shark maturity age and survival rate were based on ageing validation data, indicating the importance of validating the quality of these data for the conservation and management of large pelagic sharks.

  7. Genomic resources for the conservation and management of the harpy eagle (Harpia harpyja, Falconiformes, Accipitridae

    Directory of Open Access Journals (Sweden)

    Aureo Banhos

    2008-01-01

    Full Text Available We report the characterization and optimization of 45 heterologous microsatellite loci, and the development of a new set of molecular sex markers for the conservation and management of the Neotropical harpy eagle (Harpia harpyja L. 1758. Of the 45 microsatellites tested, 24 were polymorphic, six monomorphic, 10 uncharacterizable due to multiple bands and five did not amplify. The observed gene diversity of the analyzed sample of H. harpyja was low and similar to that of other threatened Falconiformes. While a high proportion of the microsatellite markers were highly variable, individuals of H. harpyja could be differentiated by a joint analysis of just three (p = 2.79 x 10-4 or four markers (p = 2.89 x 10-5. Paternity could be rejected with 95.23% and 97.83% probabilities using the same three and four markers, respectively. The sex determination markers easily and consistently differentiated males from females even with highly degraded DNA extracted from naturally shed feathers. The markers reported in this study potentially provide an excellent set of molecular tools for the conservation and management of wild and captive H. harpyja and they may also prove useful for the enigmatic Neotropical crested eagle (Morphnus guianensis Daudin 1800.

  8. A cost analysis of conservative management of spinal cord-injured patients in Nigeria.

    Science.gov (United States)

    Kawu, A A; Olawepo, A; Salami, A O O; Kuranga, S A; Abdulhameed, S; Esenwah, V C

    2011-11-01

    A prospective study. To determine the cost of acute phase of injury (ASCI) among spinal cord-injured patients managed conservatively in Nigeria. Gwagwalada, Abuja. Over a 1-year period (1 January 2009 to 31 December 2009), the cost of ASCI of consecutive spinal cord-injured patients, gainfully employed preinjury, who paid the hospital bill directly from their purses and could estimate their daily income, and who were managed conservatively for 6 weeks before discharge to rehabilitation, was prospectively examined. A total of 34 cases of spinal cord-injured patients with a mean age of 35.4 ± 12.8 years were included in this study. The mean cost of ASCI over 6 weeks was $1598.29, an average of 6.4-232.8% of patients' annual income where >50% of the people live on less than a dollar a day. The mean cost of hospitalization was 14.9% of the total cost of ASCI in this study. It was significantly more expensive to treat tetraplegics compared with paraplegics. This study identified the cost of acute phase of spinal cord injury in Nigeria to assist clinicians in planning treatment that could reduce financial burden on the patients but optimize patients' care.

  9. Sturgeon in the Sacramento–San Joaquin Watershed: New Insights to Support Conservation and Management

    Directory of Open Access Journals (Sweden)

    A. Peter Klimley

    2015-12-01

    Full Text Available doi: http://dx.doi.org/10.15447/sfews.2015v13iss4art1The goal of a day-long symposium on March 3, 2015, Sturgeon in the Sacramento–San Joaquin Watershed: New Insights to Support Conservation and Management, was to present new information about the physiology, behavior, and ecology of the green (Acipenser medirostris and white sturgeon (Acipenser transmontanus to help guide enhanced management and conservation efforts within the Sacramento–San Joaquin watershed. This symposium identified current unknowns and highlighted new electronic tracking technologies and physiological techniques to address these knowledge gaps. A number of presentations, each reviewing ongoing research on the two species, was followed by a round-table discussion, in which each of the participants was asked to share recom-mendations for future research on sturgeon in the watershed. This article presents an in-depth review of the scientific information presented at the sympo-sium with a summary of recommendations for future research.

  10. Conservative management in ureteric hydronephrosis due to deep endometriosis: Could the levonorgestrel-intrauterine device be an option?

    Science.gov (United States)

    Simón, Elisa; Tejerizo, Álvaro; Muñoz, José Luis; Álvarez, Carmen; Marqueta, Laura; Jiménez, Jesús S

    2017-07-01

    Endometriosis can affect up to 10% of women of reproductive age, in a wide range of clinical presentations that vary from mild to severe or deep endometriosis. Deep endometriosis can affect the urinary tract in 1-5% to 15-25% cases. Even though deep endometriosis' surgeries are usually complex with higher rate of complications, conservative management is not always considered as an option because of its high failure rates. This paper describes two cases of deep endometriosis with ureteric involvement (hydronephrosis) treated conservatively with a double-pigtail stent plus a Levonorgestrel intrauterine device, after conservative surgery, who remained symptom free with no evidence of recurrence at 3 years follow-up, avoiding radical high-risk surgery. Impact statement Several treatments have been described for endometriosis. From a symptomatic perspective, conservative medical management has been proposed with a variable response. Concerning deep endometriosis (affecting the urinary or digestive tract), the definitive treatment has always been thought to be radical surgery. However, this can lead to several complications. To illustrate a possible more conservative approach this paper describes two cases of deep infiltrating endometriosis affecting the ureter, treated conservatively with a temporary pigtail ureter stent plus a Levonorgestrel intrauterine device. The management demonstrates that, in a selected population, conservative treatment solves the urinary disease avoiding the surgical complications and, what is more, improving patients' symptoms in a permanent way. Further prospective studies are needed to confirm whether the introduction of this management in clinical practice would reduce the need for surgery thereby, avoiding high-risk surgery and improving the success rate of conservative management.

  11. Policies for managing urban growth and landscape change: a key to conservation in the 21st century

    Science.gov (United States)

    David N., tech. ed. Bengston

    2005-01-01

    Protecting natural areas in the face of urbanization is one of the most important challenges for conservation in the 21st century. The papers in this collection examine key issues related to growth management and selected approaches to managing urban growth and minimizing its social and environmental costs. They were presented at the 2004 annual meeting of the Society...

  12. Stricturoplasty-a bowel-sparing option for long segment small bowel Crohn's disease.

    Science.gov (United States)

    Limmer, Alexandra M; Koh, Hoey C; Gilmore, Andrew

    2017-08-01

    Stricturoplasty is a surgical option for management of severe stricturing Crohn's disease of the small bowel. It avoids the need for small bowel resection and the associated metabolic complications. This report contrasts the indications and technical aspects of two different stricturoplasty techniques. Case 1 describes an extensive Michelassi (side-to-side isoperistaltic) stricturoplasty performed for a 100 cm segment of diseased small bowel in a 45-year-old patient. Case 2 describes the performance of 12 Heineke-Mikulicz stricturoplasties in a 23-year-old patient with multiple short fibrotic strictures.

  13. Conservative management of idiopathic anterior atlantoaxial subluxation without neurological deficits in an 83-year-old female: A case report.

    Science.gov (United States)

    Marchand, Andrée-Anne; Wong, Jessica J

    2014-03-01

    Atlantoaxial subluxation that is not related to traumatic, congenital, or rheumatological conditions is rare and can be a diagnostic challenge. This case report details a case of anterior atlantoaxial subluxation in an 83-year-old female without history of trauma, congenital, or rheumatological conditions. She presented to the chiropractor with insidious neck pain and headaches, without neurological deficits. Radiographs revealed a widened atlantodental space (measuring 6 mm) indicating anterior atlantoaxial subluxation and potential sagittal atlantoaxial instability. Prompt detection and appropriate conservative management resulted in favourable long-term outcome at 13-months follow-up. Conservative management included education, mobilizations, soft tissue therapy, monitoring for neurological progression, and co-management with the family physician. The purpose of this case report is to heighten awareness of the clinical presentation of idiopathic anterior atlantoaxial subluxation without neurological deficits. Discussion will focus on the incidence, mechanism, clinical presentation, and conservative management of a complex case of anterior atlantoaxial subluxation.

  14. Letting the managers manage: analyzing capacity to conserve biodiversity in a cross-border protected area network

    Directory of Open Access Journals (Sweden)

    Sarah Clement

    2016-09-01

    Full Text Available Biodiversity loss is one of the most significant drivers of ecosystem change and is projected to continue at a rapid rate. While protected areas, such as national parks, are seen as important refuges for biodiversity, their effectiveness in stemming biodiversity decline has been questioned. Public agencies have a critical role in the governance of many such areas, but there are tensions between the need for these agencies to be more "adaptive" and their current operating environment. Our aim is to analyze how institutions enable or constrain capacity to conserve biodiversity in a globally significant cross-border network of protected areas, the Australian Alps. Using a novel conceptual framework for diagnosing biodiversity institutions, our research examined institutional adaptive capacity and more general capacity for conserving biodiversity. Several intertwined issues limit public agencies' capacity to fulfill their conservation responsibilities. Narrowly defined accountability measures constrain adaptive capacity and divert attention away from addressing key biodiversity outcomes. Implications for learning were also evident, with protected area agencies demonstrating successful learning for on-ground issues but less success in applying this learning to deeper policy change. Poor capacity to buffer political and community influences in managing significant cross-border drivers of biodiversity decline signals poor fit with the institutional context and has implications for functional fit. While cooperative federalism provides potential benefits for buffering through diversity, it also means protected area agencies have restricted authority to address cross-border threats. Restrictions on staff authority and discretion, as public servants, have further implications for deploying capacity. This analysis, particularly the possibility of fostering "ambidexterity" - creatively responding to political pressures in a way that also achieves a desirable

  15. Redefining Secondary Forests in the Mexican Forest Code: Implications for Management, Restoration, and Conservation

    Directory of Open Access Journals (Sweden)

    Francisco J. Román-Dañobeytia

    2014-05-01

    Full Text Available The Mexican Forest Code establishes structural reference values to differentiate between secondary and old-growth forests and requires a management plan when secondary forests become old-growth and potentially harvestable forests. The implications of this regulation for forest management, restoration, and conservation were assessed in the context of the Calakmul Biosphere Reserve, which is located in the Yucatan Peninsula. The basal area and stem density thresholds currently used by the legislation to differentiate old-growth from secondary forests are 4 m2/ha and 15 trees/ha (trees with a diameter at breast height of >25 cm; however, our research indicates that these values should be increased to 20 m2/ha and 100 trees/ha, respectively. Given that a management plan is required when secondary forests become old-growth forests, many landowners avoid forest-stand development by engaging slash-and-burn agriculture or cattle grazing. We present evidence that deforestation and land degradation may prevent the natural regeneration of late-successional tree species of high ecological and economic importance. Moreover, we discuss the results of this study in the light of an ongoing debate in the Yucatan Peninsula between policy makers, non-governmental organizations (NGOs, landowners and researchers, regarding the modification of this regulation to redefine the concept of acahual (secondary forest and to facilitate forest management and restoration with valuable timber tree species.

  16. Bounded ranges of variation as a framework for future conservation and fire management.

    Science.gov (United States)

    Moritz, Max A; Hurteau, Matthew D; Suding, Katharine N; D'Antonio, Carla M

    2013-05-01

    Alterations in natural fire patterns have negatively affected fire-prone ecosystems in many ways. The historical range of variability (HRV) concept evolved as a management target for natural vegetation composition and fire regimes in fire-prone ecosystems. HRV-based management inherently assumes that ecosystem resilience is reflected in observed ranges of past vegetation and fire dynamics, typically without knowledge of where thresholds exist beyond these dynamics. Given uncertainty in future conditions, some have argued that HRV may not adequately reflect ecosystem resilience to future fire activity. We suggest a refinement that includes concepts from the thresholds of potential concern (TPC) framework, which emphasizes tipping points at the extremes of ecosystem dynamics and other socially unacceptable outcomes. We propose bounded ranges of variation (BRV), an approach focused on building resilience by using historical information, but also by identifying socio-ecological thresholds to avoid and associated management action triggers. Here, we examine nonnative species and carbon sequestration as examples of how the BRV framework could be used in the context of conservation and fire management. © 2013 New York Academy of Sciences.

  17. Jambak Jambu Kalko: Nature conservation management of the Serampas of Jambi, Sumatra

    Directory of Open Access Journals (Sweden)

    BAMBANG HARIYADI

    2012-01-01

    Full Text Available Hariyadi B. 2012. Jambak Jambu Kalko: Nature conservation management of the Serampas of Jambi, Sumatra. Biodiversitas 13: 40-45. Serampas is an indigenous group that still inhabits forested areas around the Kerinci Seblat National Park (KSNP in the island of Sumatra, Indonesia. The group has occupied the area since several centuries ago, long before the KSNP was officially proclaimed as a national park. The blending of local natural conditions, socio-cultural setting and cosmology has gradually produced a number of local wisdoms and practices to manage the local natural resources. The Serampas traditional resource management practices were not only friendly to the environment, but also encourage the more equitable distribution of natural resources among the members of the Serampas community. Jambak jambu kalko is literally means a list of locally important perennial fruit tree species protected by the Serampas customary system. Beyond the jambak jambu kalko the Serampas also recognize customs, traditions, and values that have important role in managing the local natural resources.

  18. Genetic diversity and conservation status of managed vicuña (Vicugna vicugna) populations in Argentina.

    Science.gov (United States)

    Anello, M; Daverio, M S; Romero, S R; Rigalt, F; Silbestro, M B; Vidal-Rioja, L; Di Rocco, F

    2016-02-01

    The vicuña (Vicugna vicugna) was indiscriminately hunted for more than 400 years and, by the end of 1960s, it was seriously endangered. At that time, a captive breeding program was initiated in Argentina by the National Institute of Agricultural Technology (INTA) with the aim of preserving the species. Nowadays, vicuñas are managed in captivity and in the wild to obtain their valuable fiber. The current genetic status of Argentinean vicuña populations is virtually unknown. Using mitochondrial DNA and microsatellite markers, we assessed levels of genetic diversity of vicuña populations managed in the wild and compared it with a captive population from INTA. Furthermore, we examined levels of genetic structure and evidence for historical bottlenecks. Overall, all populations revealed high genetic variability with no signs of inbreeding. Levels of genetic diversity between captive and wild populations were not significantly different, although the captive population showed the lowest estimates of allelic richness, number of mitochondrial haplotypes, and haplotype diversity. Significant genetic differentiation at microsatellite markers was found between free-living populations from Jujuy and Catamarca provinces. Moreover, microsatellite data also revealed genetic structure within the Catamarca management area. Genetic signatures of past bottlenecks were detected in wild populations by the Garza Williamson test. Results from this study are discussed in relation to the conservation and management of the species.

  19. The evaluation and surgical management of cyclodialysis clefts that have failed to respond to conservative management

    Science.gov (United States)

    Ioannidis, Alexander S; Bunce, Catey; Barton, Keith

    2014-01-01

    Purpose To investigate factors that may influence successful correction of hypotony in a consecutive series of patients with cyclodialysis clefts repaired surgically over a 10-year period. Design Retrospective interventional case series. Methods Interventional case series of consecutive patients with cyclodialysis clefts and hypotony treated surgically after failure of conservative treatment. Results Eighteen patients (18 eyes) of mean (SD) age 48.3 (15.8) years at the time of surgery were included (16 male, 2 female). All were diagnosed using gonioscopy, usually assisted with intracameral viscoelastic injection. Imaging used in three cases was not found to be sufficiently precise to plan surgical intervention, without prior gonioscopic cleft visualisation. The intraocular pressure (IOP) was restored in nine cases (50%) after one procedure with a postoperative IOP (mean±SD) of 13.6±4.5 mm Hg (6/11 who had cyclopexy as a first procedure and 3/6 who had cryopexy). 2–3 procedures were required in the remaining nine patients. There was a trend towards the use of cyclopexy for larger clefts and cryopexy for smaller clefts (NS). We observed a trend for a lower likelihood of successful closure of larger clefts after one intervention. Two eyes that had cyclopexy required later IOP-lowering surgery to achieve IOP control. Conclusions Most clefts were closed with one procedure. A trend towards larger cleft size as a preoperative risk factor for failure to achieve closure with one procedure was observed. In this series, imaging was not found to be sufficiently precise to replace viscoelastic-assisted gonioscopy in the diagnosis and evaluation of cyclodialysis clefts. PMID:24457370

  20. Informing conservation management about structural versus functional connectivity: a case-study of Cross River gorillas.

    Science.gov (United States)

    Imong, Inaoyom; Robbins, Martha M; Mundry, Roger; Bergl, Richard; Kühl, Hjalmar S

    2014-10-01

    Connectivity among subpopulations is vital for the persistence of small and fragmented populations. For management interventions to be effective conservation planners have to make the critical distinction between structural connectivity (based on landscape structure) and functional connectivity (which considers both landscape structure and organism-specific behavioral attributes) which can differ considerably within a given context. We assessed spatial and temporal changes in structural and functional connectivity of the Cross River gorilla Gorilla gorilla diehli (CRG) population in a 12,000 km(2) landscape in the Nigeria-Cameroon border region over a 23-year period, comparing two periods: 1987-2000 and 2000-2010. Despite substantial forest connections between occupied areas, genetic evidence shows that only limited dispersal occurs among CRG subpopulations. We used remotely sensed land-cover data and simulated human pressure (using a spatially explicit agent-based model) to assess human impact on connectivity of the CRG population. We calculated cost-weighted distances between areas occupied by gorillas as measures of connectivity (structural based on land-cover only, functional based on both land-cover and simulated human pressure). Whereas structural connectivity decreased by 5% over the 23-year period, functional connectivity decreased by 11%, with both decreasing more during the latter compared to the earlier period. Our results highlight the increasing threat of isolation of CRG subpopulations due to human disturbance, and provide insight into how increasing human influence may lead to functional isolation of wildlife populations despite habitat continuity, a pressing and common issue in tropical Africa often not accounted for when deciding management interventions. In addition to quantifying threats to connectivity, our study provides crucial evidence for management authorities to identify actions that are more likely to be effective for conservation of

  1. More Than Telemonitoring: Health Provider Use and Nonuse of Life-Log Data in Irritable Bowel Syndrome and Weight Management

    Science.gov (United States)

    Cook, Jonathan; Bales, Elizabeth; Zia, Jasmine; Munson, Sean A

    2015-01-01

    Background The quantified self, self-monitoring or life-logging movement is a trend to incorporate technology into data acquisition on aspects of a person's daily life in terms of inputs (eg food consumed), states (eg mood), and performance (mental and physical). Consumer self-monitoring mobile phone apps have been widely studied and used to promote healthy behavior changes. Data collected through life-logging apps also have the potential to support clinical care. Objective We sought to develop an in-depth understanding of providers’ facilitators and barriers to successfully integrating life-log data into their practices and creating better experiences. We specifically investigated three research questions: How do providers currently use patient-collected life-log data in clinical practice? What are provider concerns and needs with respect to this data? What are the constraints for providers to integrate this type of data into their workflows? Methods We interviewed 21 health care providers—physicians, dietitians, a nurse practitioner, and a behavioral psychologist—who work with obese and irritable bowel syndrome patients. We transcribed and analyzed interviews according to thematic analysis and an affinity diagramming process. Results Providers reported using self-monitoring data to enhance provider-patient communication, develop personalized treatment plans, and to motivate and educate patients, in addition to using them as diagnostic and adherence tools. However, limitations associated with current systems and workflows create barriers to regular and effective review of this data. These barriers include a lack of time to review detailed records, questions about providers' expertise to review it, and skepticism about additional benefits offered by reviewing data. Current self-monitoring tools also often lack flexibility, standardized formats, and mechanisms to share data with providers. Conclusions Variations in provider needs affect tracking and reviewing

  2. Management and conservation of tropical acid soils for sustainable crop production. Proceedings of a consultants meeting

    International Nuclear Information System (INIS)

    2000-06-01

    Forests of the tropics are invaluable ecosystems of global, regional and local importance, particularly in terms of protection and conservation of biodiversity and water resources. The indiscriminate conversion of tropical forests into agricultural land as a result of intense human activities - logging and modem shifting cultivation - continues to cause soil erosion and degradation. However, the acid savannahs of the world, such as the cerrado of Brazil, the Llanos in Venezuela and Colombia, the savannahs of Africa, and the largely anthropic savannahs of tropical Asia, encompass vast areas of potentially arable land. The acid soils of the savannahs are mostly considered marginal because of low inherent fertility and susceptibility to rapid degradation. These constraints for agricultural development are exacerbated by the poverty of new settlers who try to cultivate such areas after deforestation. Low- or minimum-input systems are not sustainable on these tropical acid soils but, with sufficient investment and adequate technologies, they can be highly productive. Thus, there is a need to develop management practices for sustainable agricultural production systems on such savannah acid soils. The Soil and Water Management and Crop Nutrition Sub-programme of the Joint FAO/IAEA Division of Nuclear Techniques in Food and Agriculture strongly supports an integrated approach to soil, water and nutrient management within cropping systems. In this context, nuclear and related techniques can be used to better understand the processes and factors influencing the productivity of agricultural production systems, and improve them through the use of better soil, water and nutrient management practices. A panel of experts actively engaged in field projects on acid soils of savannah agro-ecosystems in the humid and sub-humid tropics convened in March 1999 in Vienna to review and discuss recent research progress, along the following main lines of investigation: (i) utilization of

  3. Adult small bowel obstruction.

    Science.gov (United States)

    Taylor, Mark R; Lalani, Nadim

    2013-06-01

    Small bowel obstruction (SBO) is a clinical condition that is often initially diagnosed and managed in the emergency department (ED). The high rates of potential complications that are associated with an SBO make it essential for the emergency physician (EP) to make a timely and accurate diagnosis. The primary objective was to perform a systematic review and meta-analysis of the history, physical examination, and imaging modalities associated with the diagnosis of SBO. The secondary objectives were to identify the prevalence of SBO in prospective ED-based studies of adult abdominal pain and to apply Pauker and Kassirer's threshold approach to clinical decision-making to the diagnosis and management of SBO. MEDLINE, EMBASE, major emergency medicine (EM) textbooks, and the bibliographies of selected articles were scanned for studies that assessed one or more components of the history, physical examination, or diagnostic imaging modalities used for the diagnosis of SBO. The selected articles underwent a quality assessment by two of the authors using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Data used to compile sensitivities and specificities were obtained from these studies and a meta-analysis was performed on those that examined the same historical component, physical examination technique, or diagnostic test. Separate information on the prevalence and management of SBO was used in conjunction with the meta-analysis findings of computed tomography (CT) to determine the test and treatment threshold. The prevalence of SBO in the ED was determined to be approximately 2% of all patients who present with abdominal pain. Having a previous history of abdominal surgery, constipation, abnormal bowel sounds, and/or abdominal distention on examination were the best history and physical examination predictors of SBO. X-ray was determined to be the least useful imaging modality for the diagnosis of SBO, with a pooled positive likelihood ratio (+LR

  4. Bowel Diseases and Kidneys

    Directory of Open Access Journals (Sweden)

    A.E. Dorofeiev

    2015-09-01

    Full Text Available This review of contemporary publications analyzes the prevalence of combinations of bowel and renal diseases. Special attention is paid to the problem of correlation between bowel diseases and urolithiasis. We consider the possible pathogenic mechanisms of lesions, such as genetically determined violations of intestinal absorption and secretion, changes in the intestinal microbiota, systemic inflammatory response, water and electrolyte disturbances.

  5. Irritable Bowel Syndrome

    Science.gov (United States)

    ... your belly area), constipation (when you can't poop), and diarrhea (when you poop too much). If you have irritable bowel syndrome, ... food particles are also known as stool, a bowel movement, or poop. Here's why an intestine gets "irritable." ...

  6. Resource manager information needs regarding hydrologic regime shifts for the North Pacific Landscape Conservation

    Science.gov (United States)

    Woodward, Andrea; Jenni, Karen

    2014-01-01

    Landscape Conservation Cooperatives (LCCs) are a network of 22 public-private partnerships, defined by ecoregion, that share and provide science to ensure the sustainability of land, water, wildlife, and cultural resources in North America. LCCs were established by the U.S. Department of the Interior (DOI) in recognition of the fact that response to climate change must be coordinated on a landscape-level basis because important resources, ecosystem processes, and resource management challenges extend beyond most of the boundaries considered in current natural resource management. The North Pacific LCC (NPLCC) covers the range of the Pacific coastal temperate rainforest, including an area of 528,360 km2 spanning 22 degrees of latitude from the Kenai Peninsula, Alaska, to Bodega Bay, California. The coverage area includes parts of four States, two Canadian provinces, and more than 100 Tribes and First Nation language groups. It extends from alpine areas at the crest of coastal mountains across subalpine, montane, and lowland forests to the nearshore marine environment. This wide range of latitudes and elevation zones; terrestrial, freshwater, and marine habitats; and complex jurisdictional boundaries hosts a diversity of natural resources and their corresponding management issues are equally diverse. As evidenced by the Science and Traditional Ecological Knowledge (S-TEK) Strategy guiding principles, identifying and responding to the needs of resource managers is key to the success of the NPLCC. To help achieve this goal of the NPLCC, the U.S. Geological Survey (USGS) has organized several workshops with resource managers and resource scientists to identify management information needs relevant to the priority topics identified in the S-TEK Strategy. Here, we detail the results from a first workshop to address the effects of changes in hydrologic regime on rivers, streams, and riparian corridors. The workshop focused on a subset of the full NPLCC geography and was

  7. The Gut-Brain Axis and the Microbiome: Clues to Pathophysiology and Opportunities for Novel Management Strategies in Irritable Bowel Syndrome (IBS

    Directory of Open Access Journals (Sweden)

    Eamonn M.M. Quigley

    2018-01-01

    Full Text Available Irritable bowel syndrome (IBS is one of the most common of all medical disorders worldwide and, while for some it represents no more than a nuisance, for others it imposes significant negative impacts on daily life and activities. IBS is a heterogeneous disorder and may well have a number of causes which may lie anywhere from the external environment to the contents of the gut lumen and from the enteric neuromuscular apparatus and the gut immune system to the central nervous system. Consequently, the paradigm of the gut-brain axis, which includes the participation of these various factors, has proven a useful model to assist clinicians and patients alike in understanding the genesis of symptoms in IBS. Now, given the widespread interest in the gut microbiome in health and disease, in general, reports of disordered enteric bacterial communities in IBS, and experimental data to indicate that components of the gut microbiota can influence brain morphology and function, as well as behavior and cognition, this concept has been extended to encompass the microbiota-gut-brain axis. The implications of this novel concept to the assessment and management of IBS will be explored in this review.

  8. Spontaneous sublingual and intramural small-bowel hematoma in a patient on oral anticoagulation

    Directory of Open Access Journals (Sweden)

    Mohamed Moftah

    2012-08-01

    Full Text Available Spontaneous sublingual hematoma and intramural small bowel hematoma are rare and serious complications of anticoagulant therapy. Though previously reported individually, there has been no previous report of the same two complications occurring in a single patient. A 71-year-old Caucasian man, who was on warfarin for atrial fibrillation, presented with difficulty in swallowing due to a sublingual hematoma. He was observed in our intensive care unit, his warfarin was held and he recovered with conservative management. He represented two months later with a two day history of abdominal pain and distension. An abdominopelvic computed tomography (CT scan now showed small bowel obstruction due to intramural small bowel hematoma and haemorrhagic ascites. Again, this was treated expectantly with a good outcome. In conclusion, life threatening haemorrhagic complications of oral anticoagulant therapy can recur. Conservative treatment is successful in most cases, but an accurate diagnosis is mandatory to avoid unnecessary surgery. CT scan is the investigation of choice for the diagnosis of suspected haemorrhagic complications of over coagulation.

  9. Aggressive or conservative management in extradural hematomas in children – a challenging neurosurgical choice

    Directory of Open Access Journals (Sweden)

    Tascu A.

    2014-12-01

    Full Text Available epidural hematomas (EDH in children appear as a consequence of head trauma. Although emergency surgical intervention was the classical neurosurgical treatment for EDH, lately there has been observed a tendency to replace operation by conservative management, whenever the neurological status and imaging appearance allows it. The aim of this article is to present our experience in treating EDH in children 0-3 years old and to establish a management protocol for EDH in infants, by evaluating the clinical and neuroimaging status, of both surgically and conservatively treated patients, from hospital admission to discharge. Retrospective study includes 52 patients diagnosed with an extradural hematoma, admitted in the First Neurosurgery Department of the Clinical Hospital ‘Bagdasar-Arseni’ in Bucharest, from January 2004 to December 2013. The patients were identified by diagnosis from the clinic’s database; clinical and imaging data was extracted from the patient’s individual records and crosschecked with the operating protocols. Cerebral CT scan was the preferred imaging investigation for diagnosis. Our study includes 52 patients (26 boys and 26 girls, with a mean age of 14.5 months (range 6 weeks - 3 years old. 25 patients were surgically treated, while the other 27 received symptomatic medication and were monitored clinically and by imaging exams. The most frequent clinical manifestations were intracranial hypertension (21 patients and psychomotor agitation (19 patients. The traumatic mechanisms were: accidental falling (38 patients, blunt head trauma (3 patients, road accident (2 patients, unspecified (8 patients other causes (1 patient. Based on the Glasgow Coma Scale classification of TBI, 39 patients suffered a mild TBI, 7 a moderate TBI and 6 patients suffered a severe TBI. Most of the patients had a good recovery; there was a total of two deaths. The most common location for the EDHs was parietal (20 patients and temporal-parietal (11

  10. Conservation Reserve Program (CRP) contributions to wildlife habitat, management issues, challenges and policy choices--an annotated bibliography

    Science.gov (United States)

    Allen, Arthur W.; Vandever, Mark W.

    2012-01-01

    The following bibliography presents brief summaries of documents relevant to Conservation Reserve Program relations to wildlife habitat, habitat management in agriculturally dominated landscapes, and conservation policies potentially affecting wildlife habitats in agricultural ecosystems. Because the literature summaries furnished provide only sweeping overviews, users are urged to obtain and evaluate those papers appearing useful to obtain a more complete understanding of study findings and their implications to conservation in agricultural ecosystems. The bibliography contains references to reports that reach beyond topics that directly relate to the Conservation Reserve Program. Sections addressing grassland management and landowner surveys/opinions, for example, furnish information useful for enhancing development and administration of conservation policies affecting lands beyond those enrolled in conservation programs. Some sections of the bibliography (for example, agricultural conservation policy, economics, soils) are far from inclusive of all relevant material written on the subject. Hopefully, these sections will serve as fundamental introductions to related issues. In a few instances, references may be presented in more than one section of the bibliography. For example, individual papers specifically addressing both non-game and game birds are included in respective sections of the bibliography. Duplication of citations and associated notes has, however, been kept to a minimum.

  11. Energy management: a program of energy conservation for the community college facility. [Handbook

    Energy Technology Data Exchange (ETDEWEB)

    Various Authors

    1978-01-01

    This handbook developes helps for assessing and improving the energy efficiency of the community-college facility. The TEEM approach (Total Educational Energy Management) is a labor-intensive approach which requires the commitment and participation of all segments of the college community. The TEEM program presented here defines a series of tasks selected, ordered, and implemented in such a way as to achieve two basic objectives: (1) reducing campus energy requirements, and (2) meeting those reduced energy requirements more efficiently without adversely affecting the quality of educational programs. This guide to large-scale energy conservation on college campuses includes step-by-step procedures for establishing a program task force, defining specific tasks, and assigning responsibilities. Action plans are developed, energy consumption monitored, goals set, and conservation measures implemented. A series of appendices provides more detailed information, charts, and worksheets related to all aspects of energy use. The TEEM program provides the basic structure for achieving a significant reduction in campus energy costs.

  12. Surgical versus conservative management of Type III acromioclavicular dislocation: a systematic review.

    Science.gov (United States)

    Longo, Umile Giuseppe; Ciuffreda, Mauro; Rizzello, Giacomo; Mannering, Nicholas; Maffulli, Nicola; Denaro, Vincenzo

    2017-06-01

    The management of Type III acromioclavicular (AC) dislocations is still controversial. We wished to compare the rate of recurrence and outcome scores of operative versus non-operative treatment of patients with Type III AC dislocations. A systematic review of the literature was performed by applying the PRISMA guidelines according to the PRISMA checklist and algorithm. A search in Medline, PubMed, Cochrane and CINAHL was performed using combinations of the following keywords: 'dislocation', 'Rockwood', 'type three', 'treatment', 'acromioclavicular' and 'joint'. Fourteen studies were included, evaluating 646 shoulders. The rate of recurrence in the surgical group was 14%. No statistical significant differences were found between conservative and surgical approaches in terms of postoperative osteoarthritis and persistence of pain, although persistence of pain seemed to occur less frequently in patients undergoing a surgical treatment. Persistence of pain seemed to occur less frequently in patients undergoing surgery. Persistence of pain seems to occur less frequently in patients treated surgically for a Type III AC dislocation. There is insufficient evidence to establish the effects of surgical versus conservative treatment on functional outcome of patients with AC dislocation. High-quality randomized controlled clinical trials are needed to establish whether there is a difference in functional outcome. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  13. Conservative surgical management of placenta accreta: a report of 3 cases.

    Science.gov (United States)

    Pliskow, Steven; Dai, Xiaorong; Kohner, Andrew; Kapnick, Jason

    2009-10-01

    Placenta accreta is often diagnosed at the time of delivery and is a cause of postpartum hemorrhage, morbidity and mortality. The standard treatment for placenta accreta is hysterectomy to avoid acute blood loss and shock. A conservative surgical approach to the treatment of placenta accreta will allow immediate cure while preserving the patient's future fertility. A 39-year-old woman with placenta accreta diagnosed at the time of vaginal delivery was successfully treated with resection of the placental implantation site. A 33-year-old woman and a 35-year-old woman with placenta accreta/increta diagnosed at the time of cesarean section were successfully treated with resection of the placental implantation site. One patient has since conceived and given birth. Placenta accreta and placenta increta can be safely and successfully treated, in some well-selected cases, by resection of the placental implantation site and uterine repair. This conservative surgical management provides immediate therapy, reduces blood loss and preserves fertility.

  14. Infantile Short Bowel Syndrome: short and long term evaluation

    NARCIS (Netherlands)

    J.F. Olieman (Joanne)

    2009-01-01

    textabstractInfantile short bowel syndrome is a condition which is characterized by malabsorption of nutrients, as a result of congenital intestinal shortening or massive small bowel resection. Survival rates have improved over the years, but morbidity remains high and clinical management of these

  15. Application of sperm sorting and associated reproductive technology for wildlife management and conservation.

    Science.gov (United States)

    O'Brien, J K; Steinman, K J; Robeck, T R

    2009-01-01

    Efforts toward the conservation and captive breeding of wildlife can be enhanced by sperm sorting and associated reproductive technologies such as sperm cryopreservation and artificial insemination (AI). Sex ratio management is of particular significance to species which naturally exist in female-dominated social groups. A bias of the sex ratio towards females of these species will greatly assist in maintaining socially cohesive groups and minimizing male-male aggression. Another application of this technology potentially exists for endangered species, as the preferential production of females can enable propagation of those species at a faster rate. The particular assisted reproductive technology (ART) used in conjunction with sperm sorting for the production of offspring is largely determined by the quality and quantity of spermatozoa following sorting and preservation processes. Regardless of the ART selected, breeding decisions involving sex-sorted spermatozoa should be made in conjunction with appropriate genetic management. Zoological-based research on reproductive physiology and assisted reproduction, including sperm sorting, is being conducted on numerous terrestrial and marine mammals. The wildlife species for which the technology has undergone the most advance is the bottlenose dolphin. AI using sex-sorted fresh or frozen-thawed spermatozoa has become a valuable tool for the genetic and reproductive management of captive bottlenose dolphins with six pre-sexed calves, all of the predetermined sex born to date.

  16. Determinants of Paracentrotus lividus sea urchin recruitment under oligotrophic conditions: Implications for conservation management.

    Science.gov (United States)

    Oliva, Silvia; Farina, Simone; Pinna, Stefania; Guala, Ivan; Agnetta, Davide; Ariotti, Pierre Antoine; Mura, Francesco; Ceccherelli, Giulia

    2016-06-01

    Sea urchins may deeply shape the structure of macrophyte-dominated communities and require the implementation of sustainable management strategies. In the Mediterranean, the identification of the major recruitment determinants of the keystone sea urchin species Paracentrotus lividus is required, so that source areas of the populations can be identified and exploitation or programmed harvesting can be spatially managed. In this study a collection of eight possible determinants, these encompassing both the biotic (larvae, adult sea urchins, fish, encrusting coralline algae, habitat type and spatial arrangement of habitats) and abiotic (substrate complexity and nutritional status) realms was considered at different spatial scales (site, area, transect and quadrat). Data from a survey including sites subject to different levels of human influence (i.e. from urbanized to protected areas), but all corresponding to an oligotrophic and low-populated region were fitted by means of a generalized linear mixed model. Despite the extensive sampling effort of benthic quadrats, an overall paucity of recruits was found, recruits being aggregated in a very small number of quadrats and in few areas. The analysis of data detected substrate complexity, and adult sea urchin and predatory fish abundances as the momentous determinants of Paracentrotus lividus recruitment. Possible mechanisms of influence are discussed beyond the implications of conservation management. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

    Science.gov (United States)

    Kaminski, Thomas W.; Hertel, Jay; Amendola, Ned; Docherty, Carrie L.; Dolan, Michael G.; Hopkins, J. Ty; Nussbaum, Eric; Poppy, Wendy; Richie, Doug

    2013-01-01

    Objective: To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes. Background: Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short- and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented. Recommendations: The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available. PMID:23855363

  18. Conservative Management of Ovarian Fibroma in A Case of Gorlin-Goltz Syndrome Comorbid with Endometriosis.

    Science.gov (United States)

    Khodaverdi, Sepideh; Nazari, Leila; Mehdizadeh-Kashi, Abolfazl; Vahdat, Mansoureh; Rokhgireh, Samaneh; Farbod, Ali; Tajbakhsh, Banafsheh

    2018-04-01

    Ovarian fibromas are the most common benign solid ovarian tumors, which are often difficult to diagnose preoperatively. Ovarian fibromas, especially in bilateral cases, may be cases of Gorlin-Goltz syndrome (GGS), a rare autosomal dominant disorder with predisposition to basal cell carcinomas (BCCs) and other various benign and malignant tumors. This case report describes a 25 year-old female with GGS, bilateral ovarian fibroma, endometriosis and septated uterus, which was referred to the Gynecology Clinic of Rasoul-e-Akram Hospital in October 2016. This patient had facial asymmetry due to recurrent odontogenic keratocysts. In young cases of ovarian fibromas as reported here, conservative surgical management can preserve ovarian function and fertility. These patients must be followed up by a multidisciplinary team and submitted to periodic tests. Copyright© by Royan Institute. All rights reserved.

  19. Conservative Management of Ovarian Fibroma in A Case of Gorlin-Goltz Syndrome Comorbid with Endometriosis

    Directory of Open Access Journals (Sweden)

    Sepideh Khodaverdi

    2018-01-01

    Full Text Available Ovarian fibromas are the most common benign solid ovarian tumors, which are often difficult to diagnose preoperatively. Ovarian fibromas, especially in bilateral cases, may be cases of Gorlin-Goltz syndrome (GGS, a rare autosomal dominant disorder with predisposition to basal cell carcinomas (BCCs and other various benign and malignant tumors. This case report describes a 25 year-old female with GGS, bilateral ovarian fibroma, endometriosis and septated uterus, which was referred to the Gynecology Clinic of Rasoul-e-Akram Hospital in October 2016. This patient had facial asymmetry due to recurrent odontogenic keratocysts. In young cases of ovarian fibromas as reported here, conservative surgical management can preserve ovarian function and fertility. These patients must be followed up by a multidisciplinary team and submitted to periodic tests.

  20. Conservative Management of Duodenal Perforation with Toothpick in a 9- Year Old Girl; a Case Report

    Directory of Open Access Journals (Sweden)

    Shahsanam Gheibi

    2016-10-01

    Full Text Available Background Foreign body ingestion is a relatively common in children. Most ingested foreign bodies spontaneously pass out of the body via the gastrointestinal (GI system but sharp materials may perforate the GI tract and need to surgical intervention. Case Presentation  The patient was a 9-year-old girl with progressive abdominal pain for one month and admitted with acute abdomen impression. She underwent esogastroduodenoscopy (EGD due to severe epigastric tenderness. Upper GI endoscopy revealed duodenal ulceration and perforation by a toothpick while she had no history of foreign body ingestion. Toothpick was removed by endoscopy. She was successfully managed conservatively and had no abdominal pain during the one month follow-up period. Conclusion We recommend the endoscopic approach as the preferable method for the extraction of duodenal foreign bodies in children, even in the case of intestinal perforation.

  1. Facial nerve function after vestibular schwannoma surgery following failed conservative management

    DEFF Research Database (Denmark)

    Kaltoft, Mikkel; Stangerup, Sven-Eric; Cayé-Thomasen, Per

    2012-01-01

    the risk of impaired facial nerve function post-surgery. OBJECTIVE:: To compare facial nerve function in patients operated soon after diagnosis with patients allocated to conservative management, and the subgroup of these who later had surgery due to tumor growth. METHODS:: 1378 consecutive patients...... patients had normal facial nerve function at the end of observation. Good facial nerve outcome was found in 87 % of patients operated at diagnosis, and in 84 % of patients operated after established tumor growth. For the subgroup of small extrameatal tumors this difference was significant. Pooling all...... to preservation of the facial nerve function. Tumor growth during observation is found in only a minor proportion of the patients, and in these cases surgery or irradiation should be performed immediately....

  2. Residue management practices and planter attachments for corn production in a conservation agriculture system

    Directory of Open Access Journals (Sweden)

    J. Nejadi

    2013-11-01

    Full Text Available Seed placement and failure to establish a uniform plant stand are critical problems associated with production of corn (Zea mays following wheat (Triticum aestivum in a conservation agriculture system in Iran. Our objectives were to evaluate the performance of a corn row- crop planter equipped with two planter attachments (smooth/toothed coulters at six wheat residue management systems (three tillage systems and two levels of surface residue at two forward speeds of 5 and 7 km h-1. Residue retained after planting, seeding depth, emergence rate index (ERI and seed spacing indices were determined. The baled residue plots tilled by chisel plow followed by disc harrow (BRCD resulted in minimum residue after planting as compared to other residue treatments. Furthermore, the maximum values of the ERI and uniformity of plant spacing pertained to this treatment. Other results showed that the ERI increased up to 18% for the toothed coulter as compared to the smooth coulter. The toothed coulter also established a deeper seed placement as compared to the smooth coulter. Planting at forward speed of 5 km h-1 resulted in deeper seeding depth as compared to a forward speed of 7 km h-1. However, lower values of miss and precision indices were obtained at forward speed of 7 km h-1, indicating a more uniformity of plant spacing. Results of this study showed that equipping the conventional planter with toothed coulter and planting in soil prepared under the BRCD residue management system can result in a satisfactory conservation crop production system.