Sample records for contemporary fluid management

  1. Contemporary management of pyloric stenosis. (United States)

    Jobson, Matthew; Hall, Nigel J


    Hypertrophic pyloric stenosis is a common surgical cause of vomiting in infants. Following appropriate fluid resuscitation, the mainstay of treatment is pyloromyotomy. This article reviews the aetiology and pathophysiology of hypertrophic pyloric stenosis, its clinical presentation, the role of imaging, the preoperative and postoperative management, current surgical approaches and non-surgical treatment options. Contemporary postoperative feeding regimens, outcomes and complications are also discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Contemporary security management

    CERN Document Server

    Fay, John


    Contemporary Security Management, 3rd Edition teaches security professionals how to operate an efficient security department and how to integrate smoothly with other groups inside and outside their own organizations. Fay demonstrates the specifics of security management: * how to organize, plan, develop and manage a security operation. * how to identify vulnerabilities. * how to determine the protective resources required to offset threats. * how to implement all necessary physical and IT security measures. Security professionals share the responsibility for mitigating damage, serving as a resource to an Emergency Tactical Center, assisting the return of business continuity, and liaising with local response agencies such as police and fire departments, emergency medical responders, and emergency warning centers. At the organizational level, the book addresses budgeting, employee performance, counseling, hiring and termination, employee theft and other misconduct, and offers sound advice on building constructi...

  3. Contemporary management of subtrochanteric fractures. (United States)

    Joglekar, Siddharth B; Lindvall, Eric M; Martirosian, Armen


    Cephalomedullary interlocking nails that allow for trochanteric entry and minimally invasive fixation have revolutionized the contemporary management of subtrochanteric fractures with improved union rates and decreased incidence of fixation failure. The most successful alternative to intramedullary fixation remains the angled blade plate. Despite biomechanical superiority of contemporary intramedullary implants to previous intramedullary devices, the importance of achieving and maintaining satisfactory fracture reduction prior to and during hardware insertion cannot be overemphasized. In comminuted and more challenging fractures, additional techniques, such as limited open reduction with clamps and/or cables, can allow for canal restoration and more anatomic reductions prior to and/or during nail insertion. Published by Elsevier Inc.

  4. Contemporary management of pericardial diseases. (United States)

    Imazio, Massimo


    Pericardial diseases are relatively common in clinical practice, either as isolated disease or as manifestation of a systemic disorder. The aim of the present study is to review more recent updates on their contemporary management. The cause of pericardial diseases is varied according to the epidemiologic background, patient population, and clinical setting. Most cases remain idiopathic, and empiric anti-inflammatory therapy should be considered as first-line therapy in most cases with the possible adjunct of colchicine in the setting of inflammatory pericardial diseases, especially relapsing or not responding to first-line drugs. A triage has been proposed to select high-risk cases requiring admission and specific cause search. The prognosis of pericardial diseases is essentially determined by the cause. The most feared complication is constriction, the risk of which is higher in bacterial forms, intermediate for postpericardiotomy syndromes and systemic inflammatory diseases, low for viral and idiopathic cases. Chronic constriction has a definite surgical therapy, whereas transient cases should be recognized and may be reversible with empirical anti-inflammatory therapy. Contemporary management of pericardial diseases is largely empirical, although first clinical trials and new studies on diagnostic modalities and prognosis of pericardial diseases are bringing the contemporary management of pericardial diseases along a more evidence-based road. Integrated cardiovascular imaging is required for optimal management of the patient with suspected pericardial disease.

  5. Contemporary Management of Bladder Cancer (United States)

    Bell, David; Fradet, Yves


    Bladder cancer is currently the fifth most common cancer in Western society, and its incidence appears to be increasing. Important advances have recently occurred in both diagnostic and therapeutic approaches to bladder neoplasms. Presentation is not unique, and physician awareness is important to identify patients who are at risk for bladder neoplasia and consequently require further investigation. A diagnostic approach and contemporary management are discussed. ImagesFigure 1Figure 4 PMID:21229043

  6. Contemporary management of Bell palsy. (United States)

    Jowett, Nate; Hadlock, Tessa A


    Bell palsy (BP) is the most common diagnosis in acute and chronic facial palsy. Although most patients fully recover, more than one-quarter will have residual dysfunction. Of these, nearly half will demonstrate severe limitations in facial expression. Though significant attention has been paid to acute management and prognosis, a paucity of literature exists addressing management of the long-term sequelae of BP. This article describes contemporary use of physical therapy, injectables, and static and dynamic surgical procedures in facial reanimation of acute and chronic BP. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  7. Contemporary Management of Vesicoureteral Reflux. (United States)

    Hajiyev, Perviz; Burgu, Berk


    Vesicoureteral reflux (VUR) remains the most interesting topic of pediatric urology due to the dynamic nature of recent controversial publications. Starting from the need for a diagnosis to the necessity and effectiveness of treatment in preventing scars, VUR remains in the mist. Although recent strong evidence helped as fog lights in this blurriness, more data are required for achieving crystal clearance. This article aims to summarize and discuss the current state of the evidence regarding VUR management. To provide a comprehensive synthesis of the main evidence in the literature on the current and contemporary management of VUR in children; to discuss conservative management with continuous antibiotic prophylaxis (CAP), especially its effectiveness and safety; and to review the current evidence regarding contemporary surgical techniques. We conducted a nonsystematic review of the literature using the recent guidelines and PubMed database regarding surveillance, CAP, endoscopic, open, laparoscopic, and robot-assisted ureteral surgical treatment. Despite the striking results of previous studies revealing the ineffectiveness of CAP, more recent studies and their two fresh meta-analyses revealed a positive role for CAP in the contemporary management of VUR. One of the most interesting findings is the redundant rising of endoscopic correction and its final settlement to real indicated cases. Patient individualization in the contemporary management of VUR seems to be the keyword. The evidence in the literature showed a safe and effective use of laparoscopic and robot-assisted laparoscopic reimplantations. The goal of VUR treatment is to prevent the occurrence of febrile urinary tract infections and formation of scars in the renal parenchyma. The approach should be risk adapted and individualized according to current knowledge. Individual risk is influenced by the presentation age, sex, history of pyelonephritis and renal damage, grade of reflux, bladder bowel

  8. Contemporary Management of Sigmoid Volvulus. (United States)

    Dolejs, Scott C; Guzman, Michael J; Fajardo, Alyssa D; Holcomb, Bryan K; Robb, Bruce W; Waters, Joshua A


    Sigmoid volvulus is an uncommon cause of bowel obstruction that is historically associated with high morbidity and mortality. The objective of this study was to evaluate contemporary management of sigmoid volvulus and the safety of primary anastomosis in patients with sigmoid volvulus. The National Surgical Quality Improvement Project from 2012 to 2015 was queried for patients with colonic volvulus who underwent left-sided colonic resection. A propensity score-matched analysis was performed to compare patients with sigmoid volvulus undergoing colectomy with primary anastomosis without proximal diversion to colectomy with end colostomy. Two thousand five hundred thirty-eight patients with sigmoid volvulus were included for analysis. Patients had a median age of 68 years (interquartile range, 55-80) and 79% were fully independent preoperatively. Fifty-one percent of operations were performed emergently. One thousand eight hundred thirteen (71%) patients underwent colectomy with anastomosis, 240 (10%) colectomy with anastomosis and proximal diversion, and 485 (19%) colectomy with end colostomy. Overall, 30-day mortality and morbidity were 5 and 40%, respectively. After propensity score matching, mortality, overall morbidity, and serious morbidity were similar between groups. Sigmoid volvulus occurs in elderly and debilitated patients with significant morbidity, mortality, and lifestyle implications. In selected patients, anastomosis without proximal diversion in patients with sigmoid volvulus results in similar outcomes to colectomy with end colostomy.


    Directory of Open Access Journals (Sweden)

    Ion SARBU


    Full Text Available The evolution of logistics management as a system in the recent decades can be characterized by the influence of the globalization processes and the economic integration in the European Union. Systemic logistic approach ensured revolutionizing the optimization of the logistics chain. Logistics management must be given to permanent forms of the new legal and organizational structure appropriate to the contemporary economy.


    Directory of Open Access Journals (Sweden)

    Ion SARBU


    Full Text Available The evolution of logistics management as a system in the recent decades can be characterized by the influence of the globalization processes and the economic integration in the European Union. Systemic logistic approach ensured revolutionizing the optimization of the logistics chain. Logistics management must be given to permanent forms of the new legal and organizational structure appropriate to the contemporary economy.


    Directory of Open Access Journals (Sweden)

    Ana Argirova


    Full Text Available The modern information society in ever increasing business projects and time limits to achieve the objectives at minimum cost leads to a search for ways to manage them. Today, more and more managers use IT tools for project management, and the term itself is associated with software solutions for the optimization and management of projects in different fields of human activity. The paper examines the main characteristics of project management by means of information technology. Key tasks and processes in the project implementation and management are discussed.

  12. Contemporary management of advanced laryngeal cancer. (United States)

    Britt, Christopher J; Gourin, Christine G


    The treatment of advanced laryngeal cancer has undergone a paradigm shift in recent years, with an increase in chemoradiation for organ preservation and a decrease in primary surgery. This review will summarize the contemporary management of advanced laryngeal cancer and discuss treatment-related toxicity and strategies to improve outcomes. NA.

  13. Contemporary management of flail chest. (United States)

    Vana, P Geoff; Neubauer, Daniel C; Luchette, Fred A


    Thoracic injury is currently the second leading cause of trauma-related death and rib fractures are the most common of these injuries. Flail chest, as defined by fracture of three or more ribs in two or more places, continues to be a clinically challenging problem. The underlying pulmonary contusion with subsequent inflammatory reaction and right-to-left shunting leading to hypoxia continues to result in high mortality for these patients. Surgical stabilization of the fractured ribs remains controversial. We review the history of management for flail chest alone and when combined with pulmonary contusion. Finally, we propose an algorithm for nonoperative and surgical management.

  14. Contemporary management of jugular paragangliomas. (United States)

    Wanna, George B; Sweeney, Alex D; Haynes, David S; Carlson, Matthew L


    Jugular paragangliomas are generally benign slow-growing tumors that can cause pulsatile tinnitus, hearing loss, and cranial nerves neuropathy. Progressive growth can also lead to intracranial extension. Historically, the treatment of choice for these lesions has been gross total resection. However, over the last 15 years, many groups have adopted less invasive management strategies including stereotactic radiation therapy, subtotal resection, and primary observation in order to reduce treatment-associated morbidity. The focus of this article is to review the modern management of jugular paraganglioma, highlighting the evolving treatment paradigm at the Otology Group of Vanderbilt. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Contemporary Management of Ulcerative Colitis. (United States)

    Vanga, Rohini; Long, Millie D


    We discuss the newest evidence-based data on management of ulcerative colitis (UC). We emphasize risk-stratification, optimizing medical therapies, and surgical outcomes of UC. Recent medical advances include introduction of novel agents for UC. Vedolizumab, an anti-adhesion molecule, has demonstrated efficacy in moderate to severe UC. Tofacitinib, a small molecule, has also demonstrated efficacy. Data on optimization of infliximab show the superiority of combination therapy with azathioprine over monotherapy with infliximab or azathioprine alone. Data on anti-tumor necrosis factor-alpha (anti-TNF) therapeutic drug monitoring also hold promise, as do preliminary data on the dose escalation of infliximab in severe hospitalized UC. Surgical outcome data are reassuring, with new fertility data showing the effectiveness of in vitro fertilization. UC management is multi-disciplinary and changing. While novel therapies hold promise, better optimization of our current arsenal will also improve outcomes.

  16. Space Station fluid management logistics (United States)

    Dominick, Sam M.


    Viewgraphs and discussion on space station fluid management logistics are presented. Topics covered include: fluid management logistics - issues for Space Station Freedom evolution; current fluid logistics approach; evolution of Space Station Freedom fluid resupply; launch vehicle evolution; ELV logistics system approach; logistics carrier configuration; expendable fluid/propellant carrier description; fluid carrier design concept; logistics carrier orbital operations; carrier operations at space station; summary/status of orbital fluid transfer techniques; Soviet progress tanker system; and Soviet propellant resupply system observations.

  17. Contemporary management of drug-packers (United States)

    Kelly, J; Corrigan, M; Cahill, RA; Redmond, HP


    Experience with management of drug-packers (mules) is variable among different centres. However, despite a recorded increase in drug trafficking in general, as yet, no unified, clear guidelines exist to guide the medical management of those who only occasionally encounter these individuals. We describe our recent experience with this growing problem and discuss the most salient points concerning the contemporary management of body packers. Our recent experience demonstrates that type IV packages may now be managed conservatively for the most part. PMID:17448234

  18. Organisational culture: A contemporary management perspective

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    Richard Weeks


    Full Text Available Purpose: The purpose of this paper is to analyse the concept "organisational culture from a traditional and a more contemporary management perspective. Problem investigated: The concept organizational culture has assumed a very prominent place within the management literature and has been analysed from diverse multidisciplinary perspectives. Central to the importance attributed to the concept is the fact that it acts as a perceptual and behavioural determinant, which implies that it will have a significant impact on all human related institutional activities and thus the interest in the concept and its management. Researchers and management practitioners have come to assume that while the concept is difficult to manage in practice, it is possible to determine the prevailing culture of an institution, identify what is termed to be a desired culture for an institution and then analyse the cultural gap that exists. Based on the analysis conducted, it is further frequently assumed that the transition from the prevailing to a desired culture can be managed. A more contemporary management perspective, based on complexity theory, would appear to challenge the assumption of being able to actively manage the organisation's culture transformation process to ensure that a desired culture is manifest within the institution. The traditional and more contemporary approaches for dealing with the concept "organisational culture" are the focus of discussion and analysis in this paper. Methodology: A multidisciplinary literature review and analysis is undertaken to gain an insight of traditional and contemporary management theory and practice, as it relates to the concept "organisational culture" and its management. Findings: An important conclusion drawn from the study is that traditional paradigms of organisational culture management, that evolved within a more mechanistic manufacturing economy, is no longer effective for dealing with the unpredictable and

  19. Contemporary disease management in Quebec. (United States)

    Gogovor, Amédé; Savoie, Michelle; Moride, Yola; Krelenbaum, Marilyn; Montague, Terrence


    Health or disease management (DM) has emerged as a promising solution to improve the quality of healthcare and patient outcomes in a cost-efficient way. This solution is particularly relevant in the care of our increasing, and aging, patient populations with multiple chronic diseases. This article reviews the recent history and current status of DM in the province of Quebec and summarizes its evolving perspectives and future prospects. Most DM projects in Quebec have developed from a public-private partnership, and they have addressed several disease states. The results of completed programs confirmed the presence of care gaps--the differences between best and usual care in several disease states. They also identified process changes leading to improved practices and enhanced professional satisfaction among stakeholders. Priorities identified for further research include increased knowledge of the underlying causes of care gaps and greater concentration on the measurement of clinical, humanistic and fiscal outcomes and their causal links to DM structures and processes. Although still embryonic in Quebec and Canada, the available evidence suggests that DM partnerships are practical and functional vehicles to expedite knowledge creation and transfer in the care of whole populations of patients. Future projects offer the promise of updated knowledge and continuously improved care and outcomes.

  20. Cryogenic Fluid Management Facility (United States)

    Eberhardt, R. N.; Bailey, W. J.


    The Cryogenic Fluid Management Facility is a reusable test bed which is designed to be carried within the Shuttle cargo bay to investigate the systems and technologies associated with the efficient management of cryogens in space. Cryogenic fluid management consists of the systems and technologies for: (1) liquid storage and supply, including capillary acquisition/expulsion systems which provide single-phase liquid to the user system, (2) both passive and active thermal control systems, and (3) fluid transfer/resupply systems, including transfer lines and receiver tanks. The facility contains a storage and supply tank, a transfer line and a receiver tank, configured to provide low-g verification of fluid and thermal models of cryogenic storage and transfer processes. The facility will provide design data and criteria for future subcritical cryogenic storage and transfer system applications, such as Space Station life support, attitude control, power and fuel depot supply, resupply tankers, external tank (ET) propellant scavenging, and ground-based and space-based orbit transfer vehicles (OTV).

  1. Contemporary evaluation and management of renal trauma. (United States)

    Chouhan, Jyoti D; Winer, Andrew G; Johnson, Christina; Weiss, Jeffrey P; Hyacinthe, Llewellyn M


    Renal trauma occurs in approximately 1%-5% of all trauma cases. Improvements in imaging and management over the last two decades have caused a shift in the treatment of this clinical condition. A systematic search of PubMed was performed to identify relevant and contemporary articles that referred to the management and evaluation of renal trauma. Computed tomography remains a mainstay of radiological evaluation in hemodynamically stable patients. There is a growing body of literature showing that conservative, non-operative management of renal trauma is safe, even for Grade IV-V renal injuries. If surgical exploration is planned due to other injuries, a conservative approach to the kidney can often be utilized. Follow up imaging may be warranted in certain circumstances. Urinoma, delayed bleeding, and hypertension are complications that require follow up. Appropriate imaging and conservative approaches are a mainstay of current renal trauma management.

  2. Contemporary pain management in total knee arthroplasty. (United States)

    Khanasuk, Yutthana; Ngarmukos, Srihatach


    Pain management has become a very important part of postoperative care for total knee arthroplasty patients. Contemporary pain control has evolved from high-dose opioid in the past to state-of-the-art multimodal regimens. These include multiple non-opioid medication such as NSAIDs, COX-2 inhibitors, and gabapentinoid, and novel anesthetic techniques such as preemptive analgesia and ultrasound-guided peripheral nerve blocks. Another method which is gaining popularity is intraarticular injection of anesthetic cocktail during surgery. Pre-op education can also help patients cope with their pain better.

  3. Knowledge management vs business process management in contemporary enterprises

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    Bitkowska Agnieszka


    Full Text Available The main objective of this paper is to identify the system of knowledge management in contemporary process organizations in business process perspective, especially with regard to technological and social conditions. Methodology is based on literature analysis and case studies. The integration of knowledge management technologies, concepts and methods into organizational business processes is challenging research issue today. The concepts of knowledge management and business process management should be analyzed jointly in the contemporary enterprises. Despite of the growing interest among researchers and practitioners of the concept of the knowledge management referring to business process management there is a lack of articles in this area. Appropriate approach to the modelling of knowledge management processes, as well as the use of IT tools, and a motivation system are of key importance for the introduction of this solution in organizations.

  4. The Contemporary School and Knowledge management

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    Mulej Majtaž


    Full Text Available The school of today faces circumstances that differ very much from the ones in which the current educators have been educated as students, especially in the countries that are new members of the European Union as EU-27. Therefore, in order to manage knowledge in their school of today, one must understand the socio-economic development trends and their impact over the school as a subsystem of the emerging innovative society in which the innovative business leaves little or no room for the routine-loving behaviour of previous decades, centuries, and millennia. This contribution summarizes a dialectical system of this development trends and the resulting newly required attributes of the contemporary schools and teachers, but it does so on the level of provocation for readers’ creative and innovative thinking and action rather than on the level of any final answers. The Bologna Process seems to be an underused opportunity for innovation of higher education in Europe.

  5. Contemporary Management of Acute Type B Dissection. (United States)

    Scott, A J; Bicknell, C D


    Growing confidence in thoracic endovascular aortic repair (TEVAR) for the management of acute type B aortic dissection has resulted in controversies regarding optimum patient selection and the timing of intervention. In this review a clinical vignette to present a practical perspective on the contemporary management of acute type B dissection (ABAD) in a specialist vascular centre with particular focus on areas of debate is used. This is a narrative clinical review. Aggressive anti-impulse therapy is the cornerstone of management of all patients with ABAD. However, 20-30% of patients develop complicated ABAD defined by the presence of malperfusion syndromes, acute aortic dilatation, dissection extension, or persistent pain and hypotension. These complicated patients typically require intervention, and non-randomised series suggest TEVAR to be an effective alternative to open repair with a lower morbidity. There is considerable interest and controversy surrounding the use of TEVAR in uncomplicated ABAD patients for whom the intervention-free survival at 6 years is less than 50% for patients managed with anti-impulse therapy. Data regarding this question are sparse, but two randomised trials (ADSORB and INSTEAD) both demonstrated a higher rate of favourable aortic remodelling in patients managed with TEVAR than medical therapy alone. However, it is unclear whether this positive remodelling translates into a reduction in long-term mortality sufficient to balance the early perioperative hazards of endografting. Despite increasing adeptness at endovascular stenting, the long-term outcomes of patients with ABAD leave significant room for improvement. In particular, the optimum management of patients with uncomplicated disease is unclear and guidance from trials powered for long-term mortality is awaited. Until then, the principals of management of ABAD remain aggressive medical therapy for all patients, with TEVAR primarily reserved for those who develop complications

  6. Ecological Processes and Contemporary Coral Reef Management

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    Angela Dikou


    Full Text Available Top-down controls of complex foodwebs maintain the balance among the critical groups of corals, algae, and herbivores, thus allowing the persistence of corals reefs as three-dimensional, biogenic structures with high biodiversity, heterogeneity, resistance, resilience and connectivity, and the delivery of essential goods and services to societies. On contemporary reefs world-wide, however, top-down controls have been weakened due to reduction in herbivory levels (overfishing or disease outbreak while bottom-up controls have increased due to water quality degradation (increase in sediment and nutrient load and climate forcing (seawater warming and acidification leading to algal-dominated alternate benthic states of coral reefs, which are indicative of a trajectory towards ecological extinction. Management to reverse common trajectories of degradation for coral reefs necessitates a shift from optimization in marine resource use and conservation towards building socio-economic resilience into coral reef systems while attending to the most manageable human impacts (fishing and water quality and the global-scale causes (climate change.

  7. Contemporary Management of Secondary Aortoduodenal Fistula. (United States)

    Howard, Ryan; Kurz, Sarah; Sherman, Matthew A; Underhill, Joshua; Eliason, Jonathan L; Coleman, Dawn M


    Secondary aortoduodenal fistula (SADF) is a rare, life-threatening complication of abdominal aortic reconstruction. Clinical presentation varies and treatment requires complex surgical repair associated with considerable morbidity and mortality. This retrospective study examines the contemporary management of SADF at a tertiary vascular surgical practice. Thirteen patients were managed for SADF between 2004 and 2014. Vascular and duodenal reconstructions were considered. Primary end points included bile leak, major complications, and mortality. Of the 13 patients presenting with SADF, 6 presented with luminal blood loss. During mean follow-up (632 days), the rate of major complication was 77%. Overall, 38% developed duodenal leak. All leaks occurred after graft explantation with extra-anatomic bypass, and the majority of these patients (80%) had no preceding history of acute gastrointestinal (GI) bleed. There were no leaks identified after duodenal exclusion with gastrojejunostomy. Patients that developed duodenal leak had longer mean intensive care unit length of stay (LOS; 7.0 vs. 2.3 days, P = 0.004), longer mean overall hospital LOS (36.6 vs. 18.5 days, P = 0.012), and greater late mortality (40% vs. 13%). There were 2 SADF-related deaths. Overall mortality trended higher in females (67% vs. 20%, P = 0.125) and those that presented without acute GI bleed (43% vs. 17%, P = 0.308). Surgical reconstruction for SADF results in major morbidity. Those presenting with acute GI bleed trended toward better outcomes than those without. Duodenal leak remains a serious complication. Duodenal exclusion may represent a more appropriate and conservative approach for management of the duodenal defect in select patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Penile Cancer: Contemporary Lymph Node Management. (United States)

    O'Brien, Jonathan S; Perera, Marlon; Manning, Todd; Bozin, Mike; Cabarkapa, Sonja; Chen, Emily; Lawrentschuk, Nathan


    In penile cancer, the optimal diagnostics and management of metastatic lymph nodes are not clear. Advances in minimally invasive staging, including dynamic sentinel lymph node biopsy, have widened the diagnostic repertoire of the urologist. We aimed to provide an objective update of the recent trends in the management of penile squamous cell carcinoma, and inguinal and pelvic lymph node metastases. We systematically reviewed several medical databases, including the Web of Science® (with MEDLINE®), Embase® and Cochrane databases, according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines. The search terms used were penile cancer, lymph node, sentinel node, minimally invasive, surgery and outcomes, alone and in combination. Articles pertaining to the management of lymph nodes in penile cancer were reviewed, including original research, reviews and clinical guidelines published between 1980 and 2016. Accurate and minimally invasive lymph node staging is of the utmost importance in the surgical management of penile squamous cell carcinoma. In patients with clinically node negative disease, a growing body of evidence supports the use of sentinel lymph node biopsies. Dynamic sentinel lymph node biopsy exposes the patient to minimal risk, and results in superior sensitivity and specificity profiles compared to alternate nodal staging techniques. In the presence of locoregional disease, improvements in inguinal or pelvic lymphadenectomy have reduced morbidity and improved oncologic outcomes. A multimodal approach of chemotherapy and surgery has demonstrated a survival benefit for patients with advanced disease. Recent developments in lymph node management have occurred in penile cancer, such as minimally invasive lymph node diagnosis and intervention strategies. These advances have been met with a degree of controversy in the contemporary literature. Current data suggest that dynamic sentinel lymph node biopsy provides excellent

  9. Contemporary Management of Localized Resectable Pancreatic Cancer. (United States)

    Kommalapati, Anuhya; Tella, Sri Harsha; Goyal, Gaurav; Ma, Wen Wee; Mahipal, Amit


    Pancreatic cancer is the third most common cause of cancer deaths in the United States. Surgical resection with negative margins still constitutes the cornerstone of potentially curative therapy, but is possible only in 15-20% of patients at the time of initial diagnosis. Accumulating evidence suggests that the neoadjuvant approach may improve R0 resection rate in localized resectable and borderline resectable diseases, and potentially downstage locally advanced disease to achieve surgical resection, though the impact on survival is to be determined. Despite advancements in the last decade in developing effective combinational chemo-radio therapeutic options, preoperative treatment strategies, and better peri-operative care, pancreatic cancer continues to carry a dismal prognosis in the majority. Prodigious efforts are currently being made in optimizing the neoadjuvant therapy with a better toxicity profile, developing novel agents, imaging techniques, and identification of biomarkers for the disease. Advancement in our understanding of the tumor microenvironment and molecular pathology is urgently needed to facilitate the development of novel targeted and immunotherapies for this setting. In this review, we detail the current literature on contemporary management of resectable, borderline resectable and locally advanced pancreatic cancer with a focus on future directions in the field.

  10. The contemporary management of third molars. (United States)

    Hyam, D M


    The management of third molars requires a significant assessment and decision process both for the patient and the clinician. The clinician must always identify the indication for third molar surgery, assess the risks of the proposed procedure, and then modify their plan to account for the patient's current and future health, their social and financial setting, and the patient's tolerance of risk. In doing this, the clinician can tailor a solution to meet the individual patient's needs. This decision to remove a third molar is made in the fluid setting of the patient's quality of life and requires regular review. This article gives the clinician the tools, the matrix, and the confidence to guide patients through this process, and outlines some of the pitfalls and common points of bias within the process. © 2018 Australian Dental Association.

  11. Contemporary management of frontal sinus mucoceles: a meta-analysis. (United States)

    Courson, Andy M; Stankiewicz, James A; Lal, Devyani


    To analyze trends in the surgical management of frontal and fronto-ethmoid mucoceles through meta-analysis. Meta-analysis and case series. A systematic literature review on surgical management of frontal and fronto-ethmoid mucoceles was conducted. Studies were divided into historical (1975-2001) and contemporary (2002-2012) groups. A meta-analysis of these studies was performed. The historical and contemporary cohorts were compared (surgical approach, recurrence, and complications). To study evolution in surgical management, a senior surgeon's experience over 28 years was analyzed separately. Thirty-one studies were included for meta-analysis. The historical cohort included 425 mucoceles from 11 studies. The contemporary cohort included 542 mucoceles from 20 studies. More endoscopic techniques were used in the contemporary versus historical cohort (53.9% vs. 24.7%; P = contemporary). In the historical cohort, higher recurrence was noted in the external group (P = 0.03). Results from endoscopic and open approaches are comparable. Although endoscopic techniques are being increasingly adopted, comparison with our series shows that more cases could potentially be treated endoscopically. Frequent use of open approaches may reflect efficacy, or perhaps lack of expertise and equipment required for endoscopic management. Most contemporary authors favor endoscopic management, limiting open approaches for specific indications (unfavorable anatomy, lateral disease, and scarring). N/A. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  12. Contemporary solutions for managing Class III malocclusion

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    Nathamuni Rengarajan Krishnaswamy


    Full Text Available Although patients with Class III malocclusions constitute a small percentage of the average orthodontic practice, providing them with optimal treatment is a daunting task. The treatment approach is dependent upon the growth status of the individual and the severity of the skeletal dysplasia. For growing individuals, facemask therapy to protract the maxilla is ineffective because of its dependence on dental anchorage to bring forth skeletal correction. Orthodontic camouflage in nongrowing mild skeletal Class III individuals is met with limited success because of the anatomical boundaries and the conventional biomechanics. Orthognathic surgery to correct the maxillomandibular relations is time-consuming, and the facial esthetics is compromised during the orthodontic decompensation period. Contemporary solutions to overcome these limitations are now viable with the use of temporary anchorage devices and by performing surgery prior to orthodontic decompensation. The rationale for employing these contemporary approaches will be discussed in this study with illustrative cases.

  13. A feminine style of management in the contemporary business world


    Nikulina Irina; Khomenko Igor; Sediakina Anna; Kanov Viktor


    The main goal of the article is to provide the insight on the gender management in connection with contemporary management. There have been wide ranges of scientific discussions regarding the question of a specific management style that women use in the business practice. A traditional approach indicates that there is no such way of managing an organization as a feminine management style. The traditional approach emphasise that women tend to use the men’s leading style with slight adjustments...

  14. Resensi Buku Islamic Perspective on Management: Contemporary Issues


    Kusuma, Bayu Mitra Adhyatma


    Judul buku : Islamic Perspective on Management: ContemporaryIssuesPenulis : Nor ‘Azizah Kamri, dkk.Penerbit : YaPEIM Management Academy (kerjasamadengan University of Malaya Press)Tebal : xiv + 463 halamanCetakan pertama : November 2013Kota terbit : Kuala Lumpur

  15. The contemporary management of intracranial atherosclerotic disease. (United States)

    Leng, Xinyi; Wong, Ka Sing; Leung, Thomas W


    Intracranial atherosclerotic disease is the most common cause of cerebral vasculopathy and an important stroke etiology worldwide, with a higher prevalence in Asian, Hispanic and African ethnicities. Symptomatic intracranial atherosclerotic disease portends a recurrent stroke risk as high as 18% at one year. The key to secondary prevention is an understanding of the underlying stroke mechanism and aggressive control of conventional cardiovascular risks. Contemporary treatment includes antiplatelet therapy, optimal glycemic and blood pressure control, statin therapy and lifestyle modifications. For patients with high-grade (70-99%) symptomatic steno-occlusion, short-term dual antiplatelet therapy with aspirin and clopidogrel followed by life-long single antiplatelet therapy may reduce the recurrent risk. Current evidence does not advocate percutaneous transluminal angioplasty and stenting as an initial treatment. External counterpulsation, encephaloduroarteriosynangiosis and remote limb ischemic preconditioning are treatments under investigation. Future studies should aim at predicting patients prone to recurrence despite of medical therapies and testing the efficacy of emerging therapies.

  16. Fluid management in space construction (United States)

    Snyder, Howard


    The low-g fluids management group with the Center for Space Construction is engaged in active research on the following topics: gauging; venting; controlling contamination; sloshing; transfer; acquisition; and two-phase flow. Our basic understanding of each of these topics at present is inadequate to design space structures optimally. A brief report is presented on each topic showing the present status, recent accomplishings by our group and our plans for future research. Reports are presented in graphic and outline form.

  17. The contemporary debate on social management

    Directory of Open Access Journals (Sweden)

    Ademir Alves da Silva


    Full Text Available This text presents a critical reflection about social management trends. In spite of the widespread and generalized use of the expression social management in the 1990’s, it constitutes, under multidisciplinary perspective, the object of professional intervention of the Brazilian Social Work, since the genesis of the profession in Brazil, in the 1930’s, even under different approaches, that have promoted opposite society projects. The social management involves the reproduction of the social life, responding, either direct or indirectly, to demands of the production sphere. Its object is the goods and social services provision, emphasizing the solution of the social demands, in opposition to the mercantile logic. Social management has been the arena of struggles for access to social wealth and social and political participation; it is studied under the perspective of searching alternatives toward an egalitarian and just society.



    Ivica Batinić


    Strong competition in the market has caused the development of a new management approach known as Total Quality Management (TQM). Due to importance that quality plays in achieving competitive advantage, the hotel industry started to apply TQM. During the introduction of these systems, hotel companies may use different approaches to suit their own buseiness requirements. In doing so, 'TQM standards' can be used, or various international standards and models of business ...

  19. Contemporary Trends in Farmer-Based Tree Management and ...

    African Journals Online (AJOL)

    This paper examines the contemporary trends in tree growing and management in the context of changing farmer livelihood systems in southeastern Nigeria. Data were collected in 1998-99 through a field survey involving interviews with 160 households drawn from 8 rural communities across the different agroecological ...

  20. Irritable bowel syndrome: contemporary nutrition management strategies. (United States)

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


    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.


    Directory of Open Access Journals (Sweden)

    Ivica Batinić


    Full Text Available Strong competition in the market has caused the development of a new management approach known as Total Quality Management (TQM. Due to importance that quality plays in achieving competitive advantage, the hotel industry started to apply TQM. During the introduction of these systems, hotel companies may use different approaches to suit their own buseiness requirements. In doing so, 'TQM standards' can be used, or various international standards and models of business excellence Malcolm Balridge National Quality Award and European Quality Award.

  2. Contemporary Management of Primary Distal Urethral Cancer

    NARCIS (Netherlands)

    Traboulsi, S.L.; Witjes, J.A.; Kassouf, W.


    Primary urethral cancer is one of the rare urologic tumors. Distal urethral tumors are usually less advanced at diagnosis compared with proximal tumors and have a good prognosis if treated appropriately. Low-stage distal tumors can be managed successfully with a surgical approach in men or radiation

  3. Contemporary Clinical Management of the Cerebral Complications of Preeclampsia

    Directory of Open Access Journals (Sweden)

    Stefan C. Kane


    Full Text Available The neurological complications of preeclampsia and eclampsia are responsible for a major proportion of the morbidity and mortality arising from these conditions, for women and their infants alike. This paper outlines the evidence base for contemporary management principles pertaining to the neurological sequelae of preeclampsia, primarily from the maternal perspective, but with consideration of fetal and neonatal aspects as well. It concludes with a discussion regarding future directions in the management of this potentially lethal condition.

  4. Sleep bruxism: Current knowledge and contemporary management (United States)

    Yap, Adrian U.; Chua, Ai Ping


    Bruxism is defined as the repetitive jaw muscle activity characterized by the clenching or grinding of teeth. It can be categorized into awake and sleep bruxism (SB). Frequent SB occurs in about 13% of adults. The exact etiology of SB is still unknown and probably multifactorial in nature. Current literature suggests that SB is regulated centrally (pathophysiological and psychosocial factors) and not peripherally (morphological factors). Cited consequences of SB include temporomandibular disorders, headaches, tooth wear/fracture, implant, and other restoration failure. Chairside recognition of SB involves the use of subjective reports, clinical examinations, and trial oral splints. Definitive diagnosis of SB can only be achieved using electrophysiological tools. Pharmacological, psychological, and dental strategies had been employed to manage SB. There is at present, no effective treatment that “cures” or “stops” SB permanently. Management is usually directed toward tooth/restoration protection, reduction of bruxism activity, and pain relief. PMID:27656052

  5. Uterine fibroids: clinical manifestations and contemporary management. (United States)

    Doherty, Leo; Mutlu, Levent; Sinclair, Donna; Taylor, Hugh


    Uterine fibroids (leiomyomata) are extremely common lesions that are associated with detrimental effects including infertility and abnormal uterine bleeding. Fibroids cause molecular changes at the level of endometrium. Abnormal regulation of growth factors and cytokines in fibroid cells may contribute to negative endometrial effects. Understanding of fibroid biology has greatly increased over the last decade. Although the current armamentarium of Food and Drug Administration-approved medical therapies is limited, there are medications approved for use in heavy menstrual bleeding that can be used for the medical management of fibroids. Emergence of the role of growth factors in pathophysiology of fibroids has led researchers to develop novel therapeutics. Despite advances in medical therapies, surgical management remains a mainstay of fibroid treatment. Destruction of fibroids by interventional radiological procedures provides other effective treatments. Further experimental studies and clinical trials are required to determine which therapies will provide the greatest benefits to patients with fibroids. © The Author(s) 2014.

  6. Sleep bruxism: Current knowledge and contemporary management. (United States)

    Yap, Adrian U; Chua, Ai Ping


    Bruxism is defined as the repetitive jaw muscle activity characterized by the clenching or grinding of teeth. It can be categorized into awake and sleep bruxism (SB). Frequent SB occurs in about 13% of adults. The exact etiology of SB is still unknown and probably multifactorial in nature. Current literature suggests that SB is regulated centrally (pathophysiological and psychosocial factors) and not peripherally (morphological factors). Cited consequences of SB include temporomandibular disorders, headaches, tooth wear/fracture, implant, and other restoration failure. Chairside recognition of SB involves the use of subjective reports, clinical examinations, and trial oral splints. Definitive diagnosis of SB can only be achieved using electrophysiological tools. Pharmacological, psychological, and dental strategies had been employed to manage SB. There is at present, no effective treatment that "cures" or "stops" SB permanently. Management is usually directed toward tooth/restoration protection, reduction of bruxism activity, and pain relief.

  7. Contemporary management issues confronting fisheries science (United States)

    Frank, Kenneth T.; Brickman, David


    Stock collapses have occurred worldwide. The most frequently cited cause is over-fishing, suggesting that fisheries management has been ineffective in controlling exploitation rates. The progression of a fishery from an over-exploited to a collapsed state involves impairment of the reproductive capacity of the target species, i.e. recruitment over-fishing. In many cases, this occurs by reduction of the spawning stock biomass (SSB) through the systematic elimination of spawning components within a stock complex. While operational definitions of minimum levels of SSB have been developed, they have seldom been applied and never adopted in a Canadian groundfish management context. The answer to the question of how much is enough to perpetuate a stock under exploitation has been illusive. Serebryakov [J. Cons. Int. Explor. Mer, 47 (1990) 267] has advocated definition of critical levels of SSB based on survival rates (R/SSB). We review his method and discuss the utility of the approach. An alternative approach to the problem of estimating minimum SSB is through a fundamental revision of the traditional stock and recruitment relationship. Explicit theoretical SSB thresholds below which reproduction/recruitment is severely impaired based upon density-dependent mating success (or Allee effects) is considered a superior approach to the question of how much is enough because of its ecological grounding. However, the successful application of this approach will require re-definition of the space/time scales of the management unit. Finally, support is growing for the establishment of closed areas or "no-take zones" as an alternative approach to managing the problems of fishing a stock complex by enabling sub-populations to escape fishing. While the expected benefits of areas protected from fishing are numerous, clear demonstrations of benefits of such areas in marine temperate ecosystems are lacking. In fact, unintended negative consequences may result from such actions.

  8. The contemporary management of penetrating splenic injury. (United States)

    Berg, Regan J; Inaba, Kenji; Okoye, Obi; Pasley, Jason; Teixeira, Pedro G; Esparza, Michael; Demetriades, Demetrios


    Selective non-operative management (NOM) is standard of care for clinically stable patients with blunt splenic trauma and expectant management approaches are increasingly utilised in penetrating abdominal trauma, including in the setting of solid organ injury. Despite this evolution of clinical practice, little is known about the safety and efficacy of NOM in penetrating splenic injury. Trauma registry and medical record review identified all consecutive patients presenting to LAC+USC Medical Center with penetrating splenic injury between January 2001 and December 2011. Associated injuries, incidence and nature of operative intervention, local and systemic complications and mortality were determined. During the study period, 225 patients experienced penetrating splenic trauma. The majority (187/225, 83%) underwent emergent laparotomy. Thirty-eight clinically stable patients underwent a deliberate trial of NOM and 24/38 (63%) were ultimately managed without laparotomy. Amongst patients failing NOM, 3/14 (21%) underwent splenectomy while an additional 6/14 (42%) had splenorrhaphy. Hollow viscus injury (HVI) occurred in 21% of all patients failing NOM. Forty percent of all NOM patients had diaphragmatic injury (DI). All patients undergoing delayed laparotomy for HVI or a splenic procedure presented symptomatically within 24h of the initial injury. No deaths occurred in patients undergoing NOM. Although the vast majority of penetrating splenic trauma requires urgent operative management, a group of patients does present without haemodynamic instability, peritonitis or radiologic evidence of hollow viscus injury. Management of these patients is complicated as over half may remain clinically stable and can avoid laparotomy, making them potential candidates for a trial of NOM. HVI is responsible for NOM failure in up to a fifth of these cases and typically presents within 24h of injury. Delayed laparotomy, within this limited time period, did not appear to increase

  9. Contemporary management of maxillofacial ballistic trauma. (United States)

    Breeze, J; Tong, D; Gibbons, A


    Ballistic maxillofacial trauma in the UK is fortunately relatively rare, and generally involves low velocity handguns and shotguns. Civilian terrorist events have, however, shown that all maxillofacial surgeons need to understand how to treat injuries from improvised explosive devices. Maxillofacial surgeons in the UK have also been responsible for the management of soldiers evacuated from Iraq and Afghanistan, and in this review we describe the newer types of treatment that have evolved from these conflicts, particularly that of damage-control maxillofacial surgery. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  10. Contemporary Management of Primary Distal Urethral Cancer. (United States)

    Traboulsi, Samer L; Witjes, Johannes Alfred; Kassouf, Wassim


    Primary urethral cancer is one of the rare urologic tumors. Distal urethral tumors are usually less advanced at diagnosis compared with proximal tumors and have a good prognosis if treated appropriately. Low-stage distal tumors can be managed successfully with a surgical approach in men or radiation therapy in women. There are no clear-cut indications for the choice of the most appropriate treatment modality. Organ-preserving modalities have shown effective and should be used whenever they do not compromise the oncological safety to decrease the physical and psychological trauma of dismemberment or loss of sexual/urinary function. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Contemporary management of high-grade gliomas. (United States)

    Sim, Hao-Wen; Morgan, Erin R; Mason, Warren P


    High-grade gliomas, including glioblastoma, are the most common malignant brain tumors in adults. Despite intensive efforts to develop new therapies for these diseases, treatment options remain limited and prognosis is poor. Recently, there have been important advances in our understanding of the molecular basis of glioma, leading to refinements in our diagnostic and management approach. There is new evidence to guide the treatment of elderly patients. A multitude of new agents have been investigated, including targeted therapies, immunotherapeutics and tumor-treating fields. This review summarizes the key findings from this research, and presents a perspective on future opportunities to advance the field.

  12. Contemporary Management of Pulmonary Arteriovenous Malformations. (United States)

    Rauh, Nicholas; Gurley, John; Saha, Sibu


    Pulmonary arteriovenous malformations (PAVMs) are atypical vascular structures involving a direct connection between the pulmonary arterial and venous circulations. While PAVMs are a relatively uncommon disorder, unmanaged cases are at risk for the development of serious complications including embolization and infection. Since their first description in 1897, PAVMs have been identified and treated in a variety of ways. Advancements in diagnostic methods and operative techniques have allowed for more effective treatment of the disease. Most recently, the use of vascular plug transcatheter embolization has been described as an effective therapeutic procedure in the management of PAVMs. In this report, we present our experience with nine cases of PAVMs treated at the University of Kentucky, including special consideration of an exemplary case that illustrates the typical course of treatment for the disease.

  13. Contemporary Clinical Management of the Cerebral Complications of Preeclampsia


    Kane, Stefan C.; Dennis, Alicia; da Silva Costa, Fabricio; Kornman, Louise; Brennecke, Shaun


    The neurological complications of preeclampsia and eclampsia are responsible for a major proportion of the morbidity and mortality arising from these conditions, for women and their infants alike. This paper outlines the evidence base for contemporary management principles pertaining to the neurological sequelae of preeclampsia, primarily from the maternal perspective, but with consideration of fetal and neonatal aspects as well. It concludes with a discussion regarding future directions in t...

  14. Contemporary management of human immunodeficiency virus in pregnancy. (United States)

    Donnelly, Meghan; Davies, Jill K


    Contemporary management of HIV in pregnancy remains a moving target. With the development of newer antiretroviral agents with lower side-effect profiles and laboratory methods for detection and monitoring of HIV, considerable progress has been made. This review examines key concepts in the pathophysiology of HIV and pregnancy with emphasis on perinatal transmission and reviews appropriate screening and diagnostic testing for HIV during pregnancy. Current recommendations for medical, pharmacologic, and obstetric management of women newly diagnosed with HIV during pregnancy and for those women with preexisting infection are discussed. Preconception counseling for HIV+ women as well as postpartum issues are addressed. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Management and leadership-features in the contemporary context

    Directory of Open Access Journals (Sweden)

    Eleonora Gabriela Baban


    Full Text Available Currently, management and leadership are considered processes of influencing activitiesat a managerial and organizational level. Management implies the existence of individuals or groups ofindividuals who develop managerial activities. Leadership is a managerial process that aims to influence interpersonal relationships between team members due to the application of management functions. This paper aims to highlight some relevant features that define the concepts of management and leadership in a contemporary context. The main objectives of the study are: 1. presenting the main concepts of management and leadership; 2. analysing the role of leaders and managers in an organization; 3. highlighting main forms of manifestations of management performance; 4.presenting main influences of public management and leadership in the management of public organization. Leadership is not only a specific part of management, but also a state of mind, which creates an adequate framework for the manifestation of creativity and performance of a team led by a good leader in order for its members to succeed professionally and to achieve performance at an organizational level.

  16. [From classical management to contemporary management: understanding new concepts to empower nursing management]. (United States)

    Spagnol, Carla Aparecida


    This theoretical work aimed to study Hospital Administration, focusing on Nursing Management. The author points out contemporary administration concepts, and leads us to think over how those new models of management (already in use in some institutions known as pioneers on this area) may have influence on the Nursing Management practice inserted on the context. The author concludes that Nursing is going through a transition moment, breaking paradigms, trying to get over Classical Administration beliefs and searching for flexible, humanized and shared ways to manage Nursing Care.

  17. Cryogenic fluid management program flight concept definition (United States)

    Kroeger, Erich


    The Lewis Research Center's cryogenic fluid management program flight concept definition is presented in viewgraph form. Diagrams are given of the cryogenic fluid management subpallet and its configuration with the Delta launch vehicle. Information is given in outline form on feasibility studies, requirements definition, and flight experiments design.

  18. The Teacher Within Contemporary Educational Reality. Manager, Bureaucrat or Citizen?

    Directory of Open Access Journals (Sweden)

    Astrid Męczkowska-Christiansen


    Full Text Available The article presents reflections on the role of the teacher in contemporary social reality dominated by neoliberal culture, which involves weakening democratic institutions; a corporate model of functioning in educational institutions; managerial discourse that reduces educational processes to management strategies; and the development of bureaucracy as a governance model. It is argued that “bureaucrat” and “manager” are the two versions of a professional role currently being imposed on teachers, as well as the antithesis of teachers’ civic roles.

  19. Comprehensive Overview of Contemporary Management Strategies for Cerebral Aneurysms. (United States)

    Manhas, Amitoz; Nimjee, Shahid M; Agrawal, Abhishek; Zhang, Jonathan; Diaz, Orlando; Zomorodi, Ali R; Smith, Tony; Powers, Ciarán J; Sauvageau, Eric; Klucznik, Richard P; Ferrell, Andrew; Golshani, Kiarash; Stieg, Philip E; Britz, Gavin W


    Aneurysmal subarachnoid hemorrhage (SAH) remains an important health issue in the United States. Despite recent improvements in the diagnosis and treatment of cerebral aneurysms, the mortality rate following aneurysm rupture. In those patients who survive, up to 50% are left severely disabled. The goal of preventing the hemorrhage or re-hemorrhage can only be achieved by successfully excluding the aneurysm from the circulation. This article is a comprehensive review by contemporary vascular neurosurgeons and interventional neuroradiolgists on the modern management of cerebral aneurysms. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Historical legacies, information and contemporary water science and management (United States)

    Bain, Daniel J.; Arrigo, Jennifer A.S.; Green, Mark B.; Pellerin, Brian A.; Vörösmarty, Charles J.


    Hydrologic science has largely built its understanding of the hydrologic cycle using contemporary data sources (i.e., last 100 years). However, as we try to meet water demand over the next 100 years at scales from local to global, we need to expand our scope and embrace other data that address human activities and the alteration of hydrologic systems. For example, the accumulation of human impacts on water systems requires exploration of incompletely documented eras. When examining these historical periods, basic questions relevant to modern systems arise: (1) How is better information incorporated into water management strategies? (2) Does any point in the past (e.g., colonial/pre-European conditions in North America) provide a suitable restoration target? and (3) How can understanding legacies improve our ability to plan for future conditions? Beginning to answer these questions indicates the vital need to incorporate disparate data and less accepted methods to meet looming water management challenges.

  1. Managing Chemotherapy Side Effects: Swelling (Fluid Retention) (United States)

    N ational C ancer I nstitute Managing Chemotherapy Side Effects Swelling (Fluid retention) “My hands and feet were swollen and puffy. My nurse helped me understand why I had to stop eating salty ...

  2. Contemporary management of infected necrosis complicating severe acute pancreatitis (United States)

    Jamdar, Saurabh; Siriwardena, Ajith K


    Pancreatic necrosis complicating severe acute pancreatitis is a challenging scenario in contemporary critical care practice; it requires multidisciplinary care in a setting where there is a relatively limited evidence base to support decision making. This commentary provides a concise overview of current management of patients with infected necrosis, focusing on detection, the role of pharmacologic intervention, and the timing and nature of surgical interventions. Fine-needle aspiration of necrosis remains the mainstay for establishment of infection. Pharmacological intervention includes antibiotic therapy as an adjunct to surgical debridement/drainage and, more recently, drotrecogin alfa. Specific concerns remain regarding the suitability of drotrecogin alfa in this setting. Early surgical intervention is unhelpful; surgery is indicated when there is strong evidence for infection of necrotic tissue, with the current trend being toward 'less drastic' surgical interventions. PMID:16356213

  3. The Practice of the Motivational Process in Contemporary Management

    Directory of Open Access Journals (Sweden)

    Tukhvatulina Liliya


    Full Text Available The purpose of this paper is to provide an analysis of the contemporary motivation system at the Russian enterprises. The purpose of the analysis is to find out the main motivators at the enterprises; to highlight the advantages and disadvantages of the existing motivation system and to predict the future development of the motivation system. The given research has been developed by using sociological methods, such as interviews, the analysis of the statistics and simulation method. By analyzing the existing works, the authors have identified the main motivators in connection with the management development periods. Tracing the features of these motivators, the authors have defined the period that corresponds to the incentive system at the Russian enterprises. In practical sphere, the proposed research can be used to develop the motivation system at the Russian enterprises, to make it effective and to predict the potential problems that can appear in the future.

  4. Normal tension glaucoma management: a survey of contemporary practice. (United States)

    Symes, Richard J; Mikelberg, Frederick S


    The aim of this study was to investigate contemporary practice patterns with respect to normal tension glaucoma (NTG) management and to determine whether the 2 largest NTG trials have influenced ophthalmologists' clinical practice. A survey questionnaire was sent to ophthalmologists via the American Glaucoma Society, the Canadian Glaucoma Society, and the Canadian Ophthalmological Society. The questionnaire was designed to investigate ophthalmologists' usual practice with respect to NTG and the extent to which practice has been influenced by the Collaborative Normal Tension Glaucoma Study (CNTGS) and the Low pressure Glaucoma Treatment Study (LoGTS). In total, 419 ophthalmologists completed the survey. Of these, 264 respondents were glaucoma subspecialists. The survey showed that 95% and 64% of ophthalmologists were familiar with the CNTGS and the LoGTS, respectively. Of the respondents, 70% indicated that they would initiate treatment in mild-to-moderate NTG without waiting for documented disease progression. Of the respondents, 61% of the total surveyed and 50% of the glaucoma subspecialists felt that the LoGTS results had no impact on their usual clinical practice. The first-choice topical drug for NTG was a prostaglandin analogue (88% of respondents) or brimonidine (10% of respondents). Most ophthalmologists treat NTG more aggressively than recommended by the CTNGS protocol. Most ophthalmologists felt that the LoGTS results had no impact on their normal clinical practice. The prostaglandin analogues are, by far, the most popular choice of drug for contemporary management of NTG. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  5. Managerial competencies in the contex of contemporary management concepts and methods


    Ziębicki, Bernard


    The article presents the required management competences from the perspective of contemporary management concepts. As the main concepts we have presented: knowledge management and learning organization, Total Quality Management, processes management, Kaizen and elimination of waste, virtual and network management and time based management. The most important management competences connected with above concepts are: focus on outside and effectiveness, care about efficie...

  6. Contemporary careers management: critical challenges for human resource management

    Directory of Open Access Journals (Sweden)

    Carlos Fernando Torres Oviedo


    Full Text Available This review article lays out some conceptual guidelines regarding careers in organizations. Special emphasis has been made on the transformation that this practice has experienced since the late twentieth century, given the new working conditions created by the technological, economic, and cultural changes that have taken place. The literature shows a more dynamic and complex stage for people and organizations in the current historical moment. It was found that, under the current conditions, people guide their own careers, aiming at achieving higher levels within and/or outside the organization. This poses new challenges and ways of thinking about managing people, leading to the development of alternative practices. Finally, as a suggestion, some questions to be addressed by those responsible of human management are presented, aimed at building reciprocal relationships that contribute to mutual development.

  7. Contemporary Management of Early-Stage Melanoma: A Systematic Review. (United States)

    Rosko, Andrew J; Vankoevering, Kyle K; McLean, Scott A; Johnson, Timothy M; Moyer, Jeffrey S


    The incidence of melanoma is increasing, with 76 380 new cases of invasive melanoma and 68 480 new cases of melanoma in situ expected in 2016. To review the contemporary management of early-stage melanoma. We searched PubMed, MEDLINE, and the Cochrane Database of Systematic Reviews databases from January 1, 2011, to May 1, 2016, yielding 966 articles. We focused our search on early-stage (melanoma in situ, stage I, and stage II) cutaneous melanoma. After excluding articles, 41 articles were manually reviewed. A review of the bibliographies of selected articles generated additional references. While the majority of recent advances have been in the treatment of advanced melanoma, surgical excision with margins based on the presence and depth of invasion continues to be the cornerstone of management. Sentinel lymph node biopsy plays a central role in the staging and treatment of melanoma. Accurate diagnosis and adequate surgical excision are critical in reducing local recurrences and improving outcomes. Sentinel lymph node biopsy is useful in staging the regional nodal basin and guiding treatment in appropriately selected patients.

  8. Endoscopic management of peripancreatic fluid collections. (United States)

    Goyal, Jatinder; Ramesh, Jayapal


    Peripancreatic fluid collections are a well-known complication of pancreatitis and can vary from fluid-filled collections to entirely necrotic collections. Although most of the fluid-filled pseudocysts tend to resolve spontaneously with conservative management, intervention is necessary in symptomatic patients. Open surgery has been the traditional treatment modality of choice though endoscopic, laparoscopic and transcutaneous techniques offer alternative drainage approaches. During the last decade, improvement in endoscopic ultrasound technology has enabled real-time access and drainage of fluid collections that were previously not amenable to blind transmural drainage. This has initiated a trend towards use of this modality for treatment of pseudocysts. In this review, we have summarised the existing evidence for endoscopic drainage of peripancreatic fluid collections from published studies.

  9. Contemporary post surgical management of differentiated thyroid carcinoma. (United States)

    Tala, H; Tuttle, R M


    Risk assessment is the cornerstone of contemporary management of thyroid cancer. Following thyroid surgery, an initial risk assessment of recurrence and disease-specific mortality is made using important intra-operative findings, histologic characteristics of the tumor, molecular profile of the tumor, post-operative serum thyroglobulin and any available cross-sectional imaging studies. This initial risk assessment is used to guide recommendations regarding the need for remnant ablation, external beam irradiation, systemic therapy, degree of TSH suppression, and follow-up disease detection strategy over the first 2 years after initial therapy. While this initial risk stratification provides valuable information, it is a static representation of the patient in the first few weeks post-operatively that does not change over time. Depending on how the patient responds to our initial therapies, the risk of recurrence and death may change significantly during follow-up. In order to account for differences in response to therapy in individual patients and to incorporate the impact of treatment on our initial risk estimates, we recommend a re-stratification of risk at the 2-year point of follow-up. This re-stratification provides an updated risk estimate that can be used to guide ongoing management recommendations including the frequency and intensity of follow-up, degree of ongoing TSH suppression, and need for additional therapies. Ongoing management recommendations must be tailored to realistic, evolving risk estimates that are actively updated during follow-up. By individualizing therapy on the basis of initial and ongoing risk assessments, we can maximize the beneficial effects of aggressive therapy in patients with thyroid cancer who are likely to benefit from it, while minimizing potential complications and side effects in low-risk patients destined to have a full healthy and productive life after minimal therapeutic intervention. Copyright (c) 2010 The Royal College

  10. Evolutionary space station fluids management strategies (United States)


    Results are summarized for an 11-month study to define fluid storage and handling strategies and requirements for various specific mission case studies and their associated design impacts on the Space Station. There are a variety of fluid users which require a variety of fluids and use rates. Also, the cryogenic propellants required for NASA's STV, Planetary, and Code Z missions are enormous. The storage methods must accommodate fluids ranging from a high pressure gas or supercritical state fluid to a sub-cooled liquid (and superfluid helium). These requirements begin in the year 1994, reach a maximum of nearly 1800 metric tons in the year 2004, and trail off to the year 2018, as currently planned. It is conceivable that the cryogenic propellant needs for the STV and/or Lunar mission models will be met by LTCSF LH2/LO2 tanksets attached to the SS truss structure. Concepts and corresponding transfer and delivery operations have been presented for STV propellant provisioning from the SS. A growth orbit maneuvering vehicle (OMV) and associated servicing capability will be required to move tanksets from delivery launch vehicles to the SS or co-orbiting platforms. Also, appropriate changes to the software used for OMV operation are necessary to allow for the combined operation of the growth OMV. To support fluid management activities at the Space Station for the experimental payloads and propellant provisioning, there must be truss structure space allocated for fluid carriers and propellant tanksets, and substantial beam strengthening may be required. The Station must have two Mobile Remote Manipulator Systems (MRMS) and the growth OMV propellant handling operations for the STV at the SS. Propellant needs for the Planetary Initiatives and Code Z mission models will most likely be provided by co-orbiting propellant platform(s). Space Station impacts for Code Z mission fluid management activities will be minimal.

  11. Contemporary Medical Management of Primary Hyperparathyroidism: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Julius Simoni Leere


    Full Text Available IntroductionPrimary hyperparathyroidism is increasingly an asymptomatic disease at diagnosis, but the recognized guidelines for management are based on evidence obtained from studies on patients with symptomatic disease, and surgery is not always indicated. Other patients are unable to undergo surgery, and thus a medical treatment is warranted. This systematic review provides an overview of the existing literature on contemporary pharmaceutical options available for the medical management of primary hyperparathyroidism.MethodsDatabases of medical literature were searched for articles including terms for primary hyperparathyroidism and each of the included drugs. Data on s-calcium, s-parathyroid hormone, bone turnover markers, bone mineral density (BMD and hard endpoints were extracted and tabulated, and level of evidence was determined. Changes in s-calcium were estimated and a meta-regression analysis was performed.ResultsThe 1,999 articles were screened for eligibility and 54 were included in the review. Weighted mean changes calculated for each drug in s-total calcium (mean change from baseline ± SEM were pamidronate (0.31 ± 0.034 mmol/l; alendronate (0.07 ± 0.05 mmol/l; clodronate (0.20 ± 0.040 mmol/l; mixed bisphosphonates (0.16 ± 0.049 mmol/l; and cinacalcet (0.37 ± 0.013 mmol/l. The meta-analysis revealed a significant decrease of effect on s-calcium with time for the bisphosphonates (Coef. −0.049 ± 0.023, p = 0.035, while cinacalcet proved to maintain its effect on s-calcium over time. Bisphosphonates improved BMD while cinacalcet had no effect.DiscussionThe included studies demonstrate advantages and drawbacks of the available pharmaceutical options that can prove helpful in the clinical setting. The great variation in how primary hyperparathyroidism is manifested requires that management should rely on an individual evaluation when counseling patients. Combining resorptive agents with

  12. Contemporary management of symptomatic primary aortic mural thrombus. (United States)

    Verma, Himanshu; Meda, Narendranadh; Vora, Simit; George, Robbie K; Tripathi, Ramesh K


    Primary aortic mural thrombus (PAMT) is an uncommon condition but an important source of noncardiogenic emboli with a difficult diagnosis and a high rate of complications, including high mortality. We report our experience of thromboembolic disease from PAMT and review its contemporary management. Retrospective analysis of prospectively collected data of all patients who presented with acute occlusion of a limb or visceral vessels between January 2011 and September 2013 was performed. A total of 88 patients presented with acute occlusion of the extremities or visceral arteries. All underwent extensive evaluation for the possible source of the embolism. Of these 88 patients, 19 patients (mean age, 41.2 years; male:female ratio, 1:2.1) were found to have aortic mural thrombus as the source of distal embolism. Thrombus was located in the thoracic aorta in 10 patients, in the perivisceral aorta in three patients, and in the infrarenal aorta in six patients. Thrombus in the thoracic aorta was treated with stent grafts in four patients, bare metal stents in three patients, and anticoagulation alone in two patients. In the suprarenal abdominal aorta, all three patients underwent trapdoor aortic thrombectomy. Infrarenal aortic thrombus was managed by aortobifemoral embolectomy in two patients, aortic stenting in two patients, surgical thrombectomy in one patient, and anticoagulation alone in one patient. Successful treatment, defined as freedom from further embolic events or recurrence of thrombus, was achieved in 14 of 19 patients (76.4%) with a mean follow-up period of 16.2 months (range, 2-28 months). There were four (21%) thrombus-related deaths, all due to primary thromboembolic insults. One patient needed a below-knee amputation because of a recurrent thrombotic episode. Symptomatic PAMT is an uncommon but important source of noncardiogenic embolus. It appears to occur more frequently in young women. Endovascular coverage of the aortic thrombus, when feasible

  13. Contemporary strategies in the diagnosis and management of heart failure. (United States)

    Dunlay, Shannon M; Pereira, Naveen L; Kushwaha, Sudhir S


    Heart failure (HF) is an important public health problem, and strategies are needed to improve outcomes and decrease health care resource utilization and costs. Its prevalence has increased as the population ages, and HF continues to be associated with a high mortality rate and frequent need for hospitalization. The total cost of care for patients with HF was $30.7 billion in 2012, and it is estimated to more than double to $69.8 billion by 2030. Given this reality, there has been recent investigation into ways of identifying and preventing HF in patients at risk (stage A HF) and those with cardiac structural and functional abnormalities but no clinical HF symptoms (stage B). For patients who have symptoms of HF (stage C), there has been important research into the most effective ways to decongest patients hospitalized with acute decompensated HF and prevent future hospital readmissions. Successful strategies to treat patients with HF and preserved ejection fraction, which has increased in prevalence, continue to be sought. We are in the midst of a rapid evolution in our ability to care for patients with end-stage HF (stage D) because of the introduction of and improvements in mechanical circulatory support. Left ventricular assist devices used as destination therapy offer an important therapeutic option to patients who do not qualify for heart transplant because of advanced age or excessive comorbidity. This review provides a thorough update on contemporary strategies in the diagnosis and management of HF by stage (A to D) that have emerged during the past several years. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  14. Australian contemporary management of synchronous metastatic colorectal cancer. (United States)

    Malouf, Phillip; Gibbs, Peter; Shapiro, Jeremy; Sockler, Jim; Bell, Stephen


    This article outlines the current Australian multidisciplinary treatment of synchronous metastatic colorectal adenocarcinoma and assesses the factors that influence patient outcome. This is a retrospective analysis of the prospective 'Treatment of Recurrent and Advanced Colorectal Cancer' registry, describing the patient treatment pathway and documenting the extent of disease, resection of the colorectal primary and metastases, chemotherapy and biological therapy use. Cox regression models for progression-free and overall survival were constructed with a comprehensive set of clinical variables. Analysis was intentionn-ton-treat, quantifying the effect of treatment intent decided at the multidisciplinary team meeting (MDT). One thousand one hundred and nine patients presented with synchronous metastatic disease between July 2009 and November 2015. Median follow-up was 15.8 months; 4.4% (group 1) had already curative resections of primary and metastases prior to MDT, 22.2% (group 2) were considered curative but were referred to MDT for opinion and/or medical oncology treatment prior to resection and 70.2% were considered palliative at MDT (group 3). Overall, 83% received chemotherapy, 55% had their primary resected and 23% had their metastases resected; 13% of resections were synchronous, 20% were staged with primary resected first and 62% had only the colorectal primary managed surgically. Performance status, metastasis resection (R0 versus R1 versus R2 versus no resection), resection of the colorectal primary and treatment intent determined at MDT were the most significant factors for progression-free and overall survival. This is the largest Australian series of synchronous metastatic colorectal adenocarcinoma and offers insight into the nature and utility of contemporary practice. © 2016 Royal Australasian College of Surgeons.

  15. Contemporary diagnosis and management of Fournier’s gangrene (United States)

    Khourdaji, Iyad; Burks, Frank; Killinger, Kim A.


    Fournier’s gangrene, an obliterative endarteritis of the subcutaneous arteries resulting in gangrene of the overlying skin, is a rare but severe infective necrotizing fasciitis of the external genitalia. Mainly associated with men and those over the age of 50, Fournier’s gangrene has been shown to have a predilection for patients with diabetes as well as people who are long-term alcohol misusers. The nidus for the synergistic polymicrobial infection is usually located in the genitourinary tract, lower gastointestinal tract or skin. Early diagnosis remains imperative as rapid progression of the gangrene can lead to multiorgan failure and death. The diagnosis is often made clinically, although radiography can be helpful when the diagnosis or the extent of the disease is difficult to discern. The Laboratory Risk Indicator for Necrotizing Fasciitis score can be used to stratify patients into low, moderate or high risk and the Fournier’s Gangrene Severity Index (FGSI) can also be used to determine the severity and prognosis of Fournier’s gangrene. Mainstays of treatment include rapid and aggressive surgical debridement of necrotized tissue, hemodynamic support with urgent resuscitation with fluids, and broad-spectrum parental antibiotics. After initial radical debridement, open wounds are generally managed with sterile dressings and negative-pressure wound therapy. In cases of severe perineal involvement, colostomy has been used for fecal diversion or alternatively, the Flexi-Seal Fecal Management System can be utilized to prevent fecal contamination of the wound. After extensive debridement, many patients sustain significant defects of the skin and soft tissue, creating a need for reconstructive surgery for satisfactory functional and cosmetic results. PMID:26445600

  16. Software Support for the Classical, Contemporary and Future Project Management


    Jakov Crnkovic; Peter Ross; Sanjay Desai


    The volume and complexity of Project Management (PM) raises many questions for managers. What exactly are we managing? People? Performance? Efficiency? Effectiveness? Cost? Time? At what levels do projects become challenging and worthy of significant management attention? Can some projects be left on auto-pilot? Must others be managed more aggressively? What metrics are useful in Project Management? How can they be integrated with normal performance metrics in the organization? How can metric...

  17. Precision Fluid Management in Continuous Renal Replacement Therapy. (United States)

    Murugan, Raghavan; Hoste, Eric; Mehta, Ravindra L; Samoni, Sara; Ding, Xiaoqiang; Rosner, Mitchell H; Kellum, John A; Ronco, Claudio


    Fluid management during continuous renal replacement therapy (CRRT) in critically ill patients is a dynamic process that encompasses 3 inter-related goals: maintenance of the patency of the CRRT circuit, maintenance of plasma electrolyte and acid-base homeostasis and regulation of patient fluid balance. In this article, we report the consensus recommendations of the 2016 Acute Disease Quality Initiative XVII conference on 'Precision Fluid Management in CRRT'. We discuss the principles of fluid management, describe various prescription methods to achieve circuit integrity and introduce the concept of integrated fluid balance for tailoring fluid balance to the needs of the individual patient. We suggest that these recommendations could serve to develop the best clinical practice and standards of care for fluid management in patients undergoing CRRT. Finally, we identify and highlight areas of uncertainty in fluid management and set an agenda for future research. © 2016 S. Karger AG, Basel.

  18. How To Manage the Emerging Generational Divide in the Contemporary Knowledge-Rich Workplace. (United States)

    Novicevic, Milorad M.; Buckley, M. Ronald


    Addresses the manager's dilemmas and options in resolving emerging latent intergenerational conflict in the contemporary knowledge-rich workplace. Topics include a theoretical framework for generational divide management; the polarization in task requirements; social and environmental factors; differences in employee needs and expectations; and…

  19. Organizational and methodological aspects for contemporary health and safety management system

    Directory of Open Access Journals (Sweden)

    Sugak Evgeny


    Full Text Available Industrial injuries and work-related disorders considerable lowering we are facing in developed countries may be due to switching to a new health and safety management system entitled “Occupational Safety and Health Management System”. The Russian Federation has prepared certain regulatory documents prescribing some suggestions regarding implementing the contemporary system for industrial injuries prevention based upon the methods for professional risks management. However, despite the efforts made by the Russian Government, reformation of the health and safety management system at various companies is being performed rather slowly that may be as well owing to poor competence of managers and specialists regarding contemporary labor safety model content, methodical and organizational novations in the sphere of occupational safety and health management.. The article refers to a number of principal issues distinguishing the new health and safety management system from conventional approach.

  20. Improving Field-Based Experimental Research to Compliment Contemporary Management (United States)

    Rangeland management has long been described as both a science and an art (Stoddart et al. 1975). Certainly, the management of rangeland resources, especially during the last half of the 20th century, can be characterized as practices commonly informed by science. There are a number of management...

  1. Traditional vs. Contemporary Management Control Practices for Developing Public Health Policies. (United States)

    Naranjo-Gil, David; Sánchez-Expósito, María Jesús; Gómez-Ruiz, Laura


    Public health policies must address multiple goals and complex community health needs. Recently, management control practices have emerged to provide a broader type of information for evaluating the effectiveness of healthcare policies, and relate activities and processes to multiple strategic outcomes. This study compares the effect of traditional and contemporary management control practices on the achievement of public health policies. It is also analyzed how two different uses of such practices (enabling vs. coercive) facilitate the achievement of public health policies. Relationships are explored using data collected from managers from public health agencies and public hospitals in Spain. The findings show that contemporary management control practices are more suitable than traditional practices to achieve public health policies. Furthermore, results show that public health policies are better achieved when managers use management control practices in an enabling way rather than in a coercive way.



    Svetlana Vukotić; Jugoslav Aničić; Radovan Vukotić


    Modern business is characterized by risk and uncertainty, and such an environment is reflected in the decisions taken by managers. On the other hand, management consulting is one of the most important management techniques developed over the last fifty years. The secondary effect of this invention is the rapid development of new frameworks, tools, and techniques improving the operations in a number of companies. Exposure of consulting organizations to varying combin...

  3. A contemporary look at Hermann Hankel's 1861 pioneering work on Lagrangian fluid dynamics (United States)

    Frisch, Uriel; Grimberg, Gérard; Villone, Barbara


    The present paper is a companion to the paper by Villone and Rampf (2017), titled "Hermann Hankel's On the general theory of motion of fluids, an essay including an English translation of the complete Preisschrift from 1861" together with connected documents [Eur. Phys. J. H 42, 557-609 (2017)]. Here we give a critical assessment of Hankel's work, which covers many important aspects of fluid dynamics considered from a Lagrangian-coordinates point of view: variational formulation in the spirit of Hamilton for elastic (barotropic) fluids, transport (we would now say Lie transport) of vorticity, the Lagrangian significance of Clebsch variables, etc. Hankel's work is also put in the perspective of previous and future work. Hence, the action spans about two centuries: from Lagrange's 1760-1761 Turin paper on variational approaches to mechanics and fluid mechanics problems to Arnold's 1966 founding paper on the geometrical/variational formulation of incompressible flow. The 22-year-old Hankel - who was to die 12 years later — emerges as a highly innovative master of mathematical fluid dynamics, fully deserving Riemann's assessment that his Preisschrift contains "all manner of good things."

  4. Software Support for the Classical, Contemporary and Future Project Management

    Directory of Open Access Journals (Sweden)

    Jakov Crnkovic


    Full Text Available The volume and complexity of Project Management (PM raises many questions for managers. What exactly are we managing? People? Performance? Efficiency? Effectiveness? Cost? Time? At what levels do projects become challenging and worthy of significant management attention? Can some projects be left on auto-pilot? Must others be managed more aggressively? What metrics are useful in Project Management? How can they be integrated with normal performance metrics in the organization? How can metrics be built into assessment programs that work? How can projects be monitored, re-planned to stay within the original budget and schedule deadlines? How good is the PM software support? Do we really need PM software packages or it should be the integral part of the company's information system (IS? Where is the knowledge about company's previous projects and performance? Are we able to establish company or even industry wide standards for project management? Can we (or should we move from the PMBOK® guidelines and use other approaches? We discussing important questions in PM: software products, responsibilities for concurrently executing several projects (multi-projects with multi objectives and multiple deadlines, introducing a need for initiation, design, execution, and control using a virtual project management and application of the organizational project maturity model.

  5. Wildlife responses to brush management: a contemporary evaluation (United States)

    Brush management has been widely practiced with the general intent of curtailing or reversing the proliferation of shrubs and trees in grasslands and savannas. The traditional aim of brush management has been to increase livestock forage or to improve water yield. Its potential role for restoring h...

  6. The contemporary art of cost management methods during product development

    NARCIS (Netherlands)

    Wouters, M.; Morales, S.; Epstein, M.J.; Lee, J.Y.


    Purpose To provide an overview of research published in the management accounting literature on methods for cost management in new product development, such as a target costing, life cycle costing, component commonality, and modular design. Methodology/approach The structured literature search


    Directory of Open Access Journals (Sweden)

    Svetlana Vukotić


    Full Text Available Modern business is characterized by risk and uncertainty, and such an environment is reflected in the decisions taken by managers. On the other hand, management consulting is one of the most important management techniques developed over the last fifty years. The secondary effect of this invention is the rapid development of new frameworks, tools, and techniques improving the operations in a number of companies. Exposure of consulting organizations to varying combinations of business circumstances and experiences of different companies have allowed for the accumulation of valuable knowledge and business experience. From this coupling, or interaction of knowledge and experience of consulting companies, on the one hand and the needs of management companies to recognize their role and hire consultants, on the other hand, developed the importance of financial consulting and auditing. Rational management processes cannot be imagined without reliable information provided by the audit, especially as the strategic management includes the control phase. The importance and relationship between consulting and management in companies that do business according to modern principles is a central topic of consideration in this paper.

  8. Endosonography guided management of pancreatic fluid collections

    DEFF Research Database (Denmark)

    Vilmann, Andreas S; Menachery, John; Tang, Shou-Jiang


    complications of pancreatitis can include acute peri-pancreatic fluid collection, acute necrotic collection, pseudocyst formation, and walled-off necrosis. Interventional endoscopic ultrasound (EUS) has been increasing utilized in managing these local complications. After performing a PubMed search, the authors...... manually applied pre-defined inclusion criteria or a filter to identify publications relevant to EUS and pancreatic collections (PFCs). The authors then reviewed the utility, efficacy, and risks associated with using therapeutic EUS and involved EUS devices in treating PFCs. Due to the development...... to diagnose PFCs and perform image-guided interventions. After draining a PFC, the amount of tissue necrosis is the most important predictor of a successful outcome. Hence, it seems logical to classify these collections based on their percentage of necrotic component or debris present when viewed by imaging...

  9. Contemporary management practices and challenges: The Scandinavian perspective

    DEFF Research Database (Denmark)

    Ulhøi, John Parm; Madsen, Henning


    Managers are facing the challenge of an ever-changing environment, ranging from increasing globalization, through the technologization of physical processes, to virtual ways of communicating. The response to this has been a gradual shift from rule-based to value-based management styles...... and practices. In order to obtain an insight into how far this development has proceeded, a structured survey of about 1500 top, middle and line managers from the private and public sectors was carried out. Among other interesting results, the study suggests that 'softer' as well as externally oriented roles...... in general are gaining increasing importance at the expense of rules and control. Moreover, managers from the private sector seem to be more steeped in traditional 'hard' managerial roles related to the operational level than their public-sector counterparts. Put another way, evidence supports the conclusion...

  10. Investment risk management by applying contemporary modern portfolio theory

    Directory of Open Access Journals (Sweden)

    Jakšić Milena


    Full Text Available Investment risk is the principal threat to the assets side of the balance sheets of financial institutions. It is evident that investors who concentrate their wealth on one type of securities can rarely be found. Instead, they tend to invest diversified portfolio of securities. This reduces the degree of risk of the expected return, which depends both on the absolute risk of each investment in the portfolio, and the relationship that exists between individual investments within the portfolio. The paper analyzes the investment risk management by using modern portfolio theory in both national and global financial f lows. At the same time, the paper considers the risk management models that ensures efficient portfolio diversification, aiming at investment risk reduction. It is pointed out that the investment risk management in modern financial f lows is a complex process, and that the development of financial theory goes towards improving, soft risk management method.

  11. Academic managers in contemporary university: Challenges and learnings

    Directory of Open Access Journals (Sweden)

    Marita Sánchez-Moreno


    Full Text Available Purpose: The article presents and discusses some findings derived from a research project about University academic management, and it is focused on the identification of principal clues –even related to subjects and methodology– for the design of training programmes on this task. Design/methodology/approach: The research design adopted a qualitative approach and contemplated the development of in-depth interviews to 71 academic managers at the university who were valued as good in that task, in three Spanish Universities –Universidad de Las Palmas de Gran Canaria (ULP, Universidad de Lleida (UdL y Universidad de Sevilla (US. Data were analyzed using MAXQDA.11 and their interpretations were contrasted with the opinions obtained in a second round of interviews with 15 of those managers. Findings: Results allows to identify some kind of “vital cycle” in academic managers, inform about their reasons to continue in their managing charges, about their worries related to interpersonal relationships and conflict management, as well as about the recognized need of receiving a specific training for academic management, based on an active an participative methodology which can promote a practical learning. Research limitations/implications: The most important limitations of the study have to do with two unrelated issues. First of them, from a methodological point of view, is related to the limited number of participants. Second of them derives of the changing environment in which management and government model of Spanish is changing. This could probably affect the value and the interest showed by a academics on University management. Practical implications: According to one of the original mains of the study, a training program for academics in university management was already designed and developed. Social implications: The development of training Programs on University management as the one derived from the commented study would represent a

  12. Doctrine of Chinese management: Lessons for contemporary leaders


    Vrcelj, Nikolina; Jurčić, Ana; Bučalin-Matić, Andrea


    Return to Asian markets would have a beneficial effect on the development of the Serbian economy. An important condition for this is the rediscovery of Asian markets and ways of doing business between business units from different cultural backgrounds. Intercultural management means that companies and individuals have to learn how to cope and manage jobs across national borders and within the framework of foreign cultures. It is a known fact that in practice, business and national culture are...

  13. Contemporary management of carotid blowout syndrome utilizing endovascular techniques. (United States)

    Manzoor, Nauman F; Rezaee, Rod P; Ray, Abhishek; Wick, Cameron C; Blackham, Kristine; Stepnick, David; Lavertu, Pierre; Zender, Chad A


    To illustrate complex interdisciplinary decision making and the utility of modern endovascular techniques in the management of patients with carotid blowout syndrome (CBS). Retrospective chart review. Patients treated with endovascular strategies and/or surgical modalities were included. Control of hemorrhage, neurological, and survival outcomes were studied. Between 2004 and 2014, 33 patients had 38 hemorrhagic events related to head and neck cancer that were managed with endovascular means. Of these, 23 were localized to the external carotid artery (ECA) branches and five localized to the ECA main trunk; nine were related to the common carotid artery (CCA) or internal carotid artery (ICA), and one event was related to the innominate artery. Seven events related to the CCA/ICA or innominate artery were managed with endovascular sacrifice, whereas three cases were managed with a flow-preserving approach (covered stent). Only one patient developed permanent hemiparesis. In two of the three cases where the flow-preserving approach was used, the covered stent eventually became exposed via the overlying soft tissue defect, and definitive management using carotid revascularization or resection was employed to prevent further hemorrhage. In cases of soft tissue necrosis, vascularized tissues were used to cover the great vessels as applicable. The use of modern endovascular approaches for management of acute CBS yields optimal results and should be employed in a coordinated manner by the head and neck surgeon and the neurointerventionalist. 4. Laryngoscope, 2016 127:383-390, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  14. Educational Leadership, Management and Administration in Africa: An Analysis of Contemporary Literature (United States)

    Asuga, Gladys Nyanchama; Scevak, Jill; Eacott, Scott


    Over the past two decades, there have been calls by scholars for a more concerted effort to develop empirically grounded research studies on educational leadership management and administration in an indigenous context rather than hegemonic western contexts. This paper presents a review of contemporary literature on educational leadership from…

  15. Contemporary management of tricuspid regurgitation: an updated clinical review. (United States)

    Taylor, Joshua T; Chidsey, Geoffrey; Disalvo, Thomas G; Byrne, John G; Maltais, Simon


    Tricuspid regurgitation (TR) is a complex and insidious valvular pathology that represents a complex decision and management algorithm for patients. TR is present in a significant proportion of the population and is especially prevalent in patients with advanced heart failure. Patients with TR have been demonstrated to have a decreased survival even with normal left heart function. TR can be a result of pathology that directly affects the valvular structure (i.e., Ebstein anomaly) or as a result of increased forward pressures (ie, pulmonary hypertension, left heart failure). Conservative management of patients with TR is primarily symptomatic relief. Definitive therapy involves surgical repair of the tricuspid valve. Furthermore, as more patients develop advanced heart failure, the management of TR in patients with left ventricular assist devices has become necessary because of the evidence of increased in-hospital morbidity and a trend toward decreased survival.

  16. Contemporary management of civilian penetrating cervicothoracic arterial injuries. (United States)

    Weinberg, Jordan A; Moore, Andrew H; Magnotti, Louis J; Teague, Rebecca J; Ward, Tyler A; Wasmund, Joshua B; Lamb, Elena M P; Schroeppel, Thomas J; Savage, Stephanie A; Minard, Gayle; Maish, George O; Croce, Martin A; Fabian, Timothy C


    The management of arterial injury at the thoracic outlet has long hinged on the fundamental principles of extensile exposure and vascular anastomosis. Nonetheless, treatment options for such injuries have evolved to include both endovascular stent placement and temporary vascular shunts. The purpose of this study was to evaluate our recent experience with penetrating cervicothoracic arterial injuries in light of these developments in trauma care. Patients with penetrating injuries to the innominate, carotid, subclavian, or axillary arteries managed at a single civilian trauma center between 2000 and 2013 were categorized as the modern era (ME) cohort. The management strategies and outcomes pertaining to the ME group were compared to those of previously reported experience (PE) concerning injuries to the innominate, carotid, subclavian, or axillary arteries at the same institution from 1974 to 1988. Over the two eras, there were 202 patients: 110 in the ME group and 92 in the PE group. Most of the injuries in both groups were managed with primary repair (45% vs. 46%; p = 0.89). A similar proportion of injuries in each group was managed with anticoagulation alone (14% vs. 10%; p = 0.40). In the ME group, two cases were managed with temporary shunt placement, and endovascular stent placement was performed in 12 patients. Outcomes were similar between the groups (bivariate comparison): mortality (ME, 15% vs. PE, 14%; p = 0.76), amputation following subclavian or axillary artery injury (ME, 5% vs. PE, 4%; p = 0.58), and posttreatment stroke following carotid injury (ME, 2% vs. PE, 6%; p = 0.57). Experience with penetrating arterial cervicothoracic injuries at a high-volume urban trauma center remained remarkably similar with respect to both anatomic distribution of injury and treatment. Conventional operative exposure and repair remain the cornerstone of treatment for most civilian cervicothoracic arterial injuries. Therapeutic study, level V.

  17. Contemporary Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome. (United States)

    Magistro, Giuseppe; Wagenlehner, Florian M E; Grabe, Magnus; Weidner, Wolfgang; Stief, Christian G; Nickel, J Curtis


    Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition that causes severe symptoms, bother, and quality-of-life impact in the 8.2% of men who are believed to be affected. Research suggests a complex pathophysiology underlying this syndrome that is mirrored by its heterogeneous clinical presentation. Management of patients diagnosed with CP/CPPS has always been a formidable task in clinical practice. Due to its enigmatic etiology, a plethora of clinical trials failed to identify an efficient monotherapy. A comprehensive review of published randomized controlled trials (RCTs) on the treatment of CP/CPPS and practical best evidence recommendations for management. Medline and the Cochrane database were screened for RCTs on the treatment of CP/CPPS from 1998 to December 2014, using the National Institutes of Health Chronic Prostatitis Symptom Index as an objective outcome measure. Published data in concert with expert opinion were used to formulate a practical best evidence statement for the management of CP/CPPS. Twenty-eight RCTs identified were eligible for this review and presented. Trials evaluating antibiotics, α-blockers, anti-inflammatory and immune-modulating substances, hormonal agents, phytotherapeutics, neuromodulatory drugs, agents that modify bladder function, and physical treatment options failed to reveal a clear therapeutic benefit. With its multifactorial pathophysiology and its various clinical presentations, the management of CP/CPPS demands a phenotypic-directed approach addressing the individual clinical profile of each patient. Different categorization algorithms have been proposed. First studies applying the UPOINTs classification system provided promising results. Introducing three index patients with CP/CPPS, we present practical best evidence recommendations for management. Our current understanding of the pathophysiology underlying CP/CPPS resulting in this highly variable syndrome does not speak in favor of a

  18. Contemporary management of pericardial effusion: practical aspects for clinical practice. (United States)

    Imazio, Massimo; Gaido, Luca; Battaglia, Alberto; Gaita, Fiorenzo


    A pericardial effusion (PE) is a relatively common finding in clinical practice. It may be either isolated or associated with pericarditis with or without an underlying disease. The aetiology is varied and may be either infectious (especially tuberculosis as the most common cause in developing countries) or non-infectious (cancer, systemic inflammatory diseases). The management is essentially guided by the hemodynamic effect (presence or absence of cardiac tamponade), the presence of concomitant pericarditis or underlying disease, and its size and duration. The present paper reviews the current knowledge on the aetiology, classification, diagnosis, management, therapy, and prognosis of PE in clinical practice.


    Directory of Open Access Journals (Sweden)

    M. A. Rodionov


    Full Text Available The problematic aspects have been considered with regard to the information and analytical support of a strategic decision making in the modern management. The role and place are clarified in relation to a process of elaboration and making a management decision in strategic planning. The existing approaches are analyzed regarding the estimating of regularities in the course and outcome of strategic processes. The strategic forecasting matters have been studied as well as a decision maker`s attitude to the risks.

  20. Public enterprises: Contemporary strategic management and marketing challenges

    Directory of Open Access Journals (Sweden)

    Vesić Dobrica


    Full Text Available Modern public companies, organizations and services management is a process that influences certain group, resulting in change of reality or function of it reaching certain, previously set objective. A new philosophy and approach to adaptive creativity, emphasize importance and capabilities of creativity improvement for employees, teams and all organizations.

  1. The environmental audit and its importance to contemporary management

    Energy Technology Data Exchange (ETDEWEB)

    Epps, J.M. (Epps and Associates Pty. Ltd. (Australia))


    The environmental audit is a system of review of the environmental management of a mine or facility. The development of environmental audit requirements in Australia is noted and the different types of audit are explained. An example of a mine development in New South Wales is used. 2 tabs.

  2. Themeaning and Role of Projects in contemporary Management

    Directory of Open Access Journals (Sweden)

    Waldemar Walczak


    Full Text Available The aim of the paper is to present and explain the important role and meanings of projects for modern organizations. The particular attention was paid on differing project’s features and premises that substantiate incremental interest of project management methodic of diagnosis key conditionality, which has fundamental meaning for correct planning of project venture. Important element of led analysis was presenting and discussing project limitation and key processes related with project preparation phase. A very significant accent of led consideration are recommendations for management practice related with identifying the needs, expectations and stakeholders influence on project success, as well as calling particular attention on benefits gained by organizations due to realized project.

  3. Management of Periprocedural Anticoagulation: A Survey of Contemporary Practice. (United States)

    Flaker, Greg C; Theriot, Paul; Binder, Lea G; Dobesh, Paul P; Cuker, Adam; Doherty, John U


    Interruption of oral anticoagulation (AC) for surgery or an invasive procedure is a complicated process. Practice guidelines provide only general recommendations, and care of such patients occurs across multiple specialties. The availability of direct oral anticoagulants further complicates decision making and guidance here is limited. To evaluate current practice patterns in the United States for bridging AC, a survey was developed by the American College of Cardiology Anticoagulation Work Group. The goal of the survey was to assess how general and subspecialty cardiologists, internists, gastroenterologists, and orthopedic surgeons currently manage patients who receive AC and undergo surgery or an invasive procedure. The survey was completed by 945 physicians involved in the periprocedural management of AC. The results provide a template for educational and research projects geared toward the development of clinical pathways and point-of-care tools to improve this area of health care. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  4. Contemporary Management of Recurrent Nodal Disease in Differentiated Thyroid Carcinoma (United States)

    Na’ara, Shorook; Amit, Moran; Fridman, Eran; Gil, Ziv


    Differentiated thyroid carcinoma (DTC) comprises over 90% of thyroid tumors and includes papillary and follicular carcinomas. Patients with DTC have an excellent prognosis, with a 10-year survival rate of over 90%. However, the risk of recurrent tumor ranges between 5% and 30% within 10 years of the initial diagnosis. Cervical lymph node disease accounts for the majority of recurrences and in most cases is detected during follow-up by ultrasound or elevated levels of serum thyroglobulin. Recurrent disease is accompanied by increased morbidity. The mainstay of treatment of nodal recurrence is surgical management. We provide an overview of the literature addressing surgical management of recurrent or persistent lymph node disease in patients with DTC. PMID:26886954

  5. Contemporary HIV/AIDS research: Insights from knowledge management theory. (United States)

    Callaghan, Chris William


    Knowledge management as a field is concerned with the management of knowledge, including the management of knowledge in research processes. Knowledge management theory has the potential to support research into problems such as HIV, antibiotic resistance and others, particularly in terms of aspects of scientific research related to the contribution of social science. To date, however, these challenges remain with us, and theoretical contributions that can complement natural science efforts to eradicate these problems are needed. This paper seeks to offer a theoretical contribution grounded in Kuhn's paradigm theory of innovation, and in the argument by Lakatos that scientific research can be fundamentally non-innovative, which suggests that social science aspects of knowledge creation may hold the key to more effective biomedical innovation. Given the consequences of ongoing and emerging global crises, and the failure of knowledge systems of scientific research to solve such problems outright, this paper provides a review of theory and literature arguing for a new paradigm in scientific research, based on the development of global systems to maximise research collaborations. A global systems approach effectively includes social science theory development as an important complement to the natural sciences research process. Arguably, information technology and social media technology have developed to the point at which solutions to knowledge aggregation challenges can enable solutions to knowledge problems on a scale hitherto unimaginable. Expert and non-expert crowdsourced inputs can enable problem-solving through exponentially increasing problem-solving inputs, using the 'crowd,' thereby increasing collaborations dramatically. It is argued that these developments herald a new era of participatory research, or a democratisation of research, which offers new hope for solving global social problems. This paper seeks to contribute to this end, and to the recognition

  6. Contemporary insights into the management of type A aortic dissection. (United States)

    Tolis, George; Sundt, Thoralf M


    Acute Type A Dissection remains a surgical emergency with a relatively high operative mortality despite advances in cardiac surgical techniques and medical management over the past thirty years. In this presentation we will discuss the issues surrounding diagnosis, triage, surgical treatment and perioperative medical management as well as long term surveillance of patients suffering from Acute Type A Dissection and present the literature that supports our management strategies. Expert commentary: The ultimate goal of surgical intervention for patients with Type A Acute Aortic Dissection is an alive patient. A more complicated operation which addresses the root and arch and potentially reduces late complications should be approached with caution since it may increase the operative mortality of the procedure itself. With the recent evolution in endovascular techniques, there is hope that later complications can be reduced without increasing the risk of the primary operation. It remains to be seen whether the improved distal aortic remodeling afforded by a combined open/endovascular approach to Acute Type A Dissection will lead to decreased need for aortic reinterventions and overall long term complications of a residual descending thoracic chronic dissection.

  7. Update on contemporary management of clinically localized renal cell carcinoma. (United States)

    Jorns, J J; Thiel, D D; Castle, E P


    Renal cell carcinoma (RCC) continues to increase in incidence with the largest increase manifesting in small, organ-confined tumors. This review outlines the epidemiology and current data pertaining to the management of clinically-localized RCC. In this manuscript, the current data outlining the benefit of nephron sparing to the overall survival of the patient is described. The data pertaining to minimally invasive nephron sparing is also explained in detail. From laparoscopic and robotic partial nephrectomy to watchful waiting and percutaneous ablation, the urologist is continually assaulted with new data for the management of clinically-localized RCC. The data can be confusing, and much of it is conflicting. The addition of new scoring systems or nomograms may aid in predicting which therapy would be most beneficial in certain patient groups. New scoring systems may also predict the difficulty of surgical resection and predict surgical complications. The limitations of the data pertaining to the management of clinically-localized RCC are also outlined.

  8. Contemporary management of moderate to severe plaque psoriasis. (United States)

    Wu, Jashin J


    Psoriasis is a multisystem inflammatory disease that is often underdiagnosed, leaving many patients untreated. Plaque psoriasis, the most common form of the disease, affects approximately 80% to 90% of patients with psoriasis. Formulating a treatment plan can be complicated when various factors are considered. For example, type of therapy is dependent on the severity of the disease. Topical agents are preferred for mild disease, while phototherapy alone or in combination with systemic agents is recommended for the treatment of moderate to severe plaque psoriasis. Traditional systemic agents have the convenience of oral dosing; however, their toxicity profile can be a limiting factor. Newer biologic agents haven proven efficacious, if not superior to traditional oral agents, but their high cost can be a substantial disadvantage. Psoriasis has also been associated with increased risk of developing comorbidities, such as cardiovascular disease, obesity, and psoriatic arthritis, all of which increase the patient's overall mortality and further worsen their overall physical well-being. Management of these comorbidities is often overlooked. Moreover, psoriasis may affect a patient's psychological and social well-being. Patients with psoriasis are at a higher risk of developing clinical depression than patients without psoriasis. Inadequate management of comorbidities inevitably leads to poor outcomes, which increases the economic burden to the patient and society. Prevention and management of comorbidities, including cardiovascular and mental health, must be addressed as a part of a patient's overall treatment plan. Specialist coordination may be beneficial for patients with psoriasis. Improved patient care may lead to better clinical and economical outcomes.


    Directory of Open Access Journals (Sweden)

    Michał Igielski


    Full Text Available Changes in the twenty-first century are faster and appear unexpectedly. They are not always necessary for the smooth functioning of the company. This is the domain of globalization, where new events - opportunities or threats are challenging the viability against which the questions are now all companies. More and more depends on the intangible assets of the undertaking, its strategic potential. Therefore Przedsiębiorsto creates and develops skills which then turns on competence. It is ond become the basis for competitiveness. The main determinant in this process is not only optimal, but the skillful management of intellectual capital. Its importance in recent years is constantly increasing, and the success of the market determines the joint commitment of all organizational units. Certain types of work require to the larger amount of knowledge, experience and independent thinking, and custom than others. For all employers, it is important to recognize these differences and create a new management principles ketegorią professionals who have knowledge useful for the enterprise - are knowledge workers. Therefore, the purpose of this article is an attempt to show management knowledge workers in modern companies, based on tests carried out in the years 2013 - 2015, in 100 large companies operating in the Baltic Sea Region

  10. Labour Management on Contemporary Kenyan Cut Flower Farms

    DEFF Research Database (Denmark)

    Riisgaard, Lone; Gibbon, Peter


    This paper describes the labour management system applied since around 2005 on farms accounting for the bulk of the output of the Kenyan cut flower sector, and provides an analysis of the foundations of this system. Using categories drawn from convention theory, this system is characterized...... in terms of specific approaches to hiring, training and promotion; labour retention; work organization and worker deployment; payment systems and supervision, as well as to collective bargaining. In convention theory terms, the combination of approaches identified in Kenya embodies a mixture of ‘industrial...

  11. Contemporary concepts in management of acute otitis media in children. (United States)

    Rettig, Eleni; Tunkel, David E


    Acute otitis media (AOM) is a common disease of childhood. AOM is most appropriately diagnosed by careful otoscopy with an understanding of clinical signs and symptoms. The distinction between AOM and chronic otitis media with effusion should be emphasized. Treatment should include pain management, and initial antibiotic treatment should be given to those most likely to benefit, including young children, children with severe symptoms, and those with otorrhea and/or bilateral AOM. Tympanostomy tube placement may be helpful for those who experience frequent episodes of AOM or fail medical therapy. Recent practice guidelines may assist the clinician with such decisions. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Contemporary Evaluation and Management of the Diabetic Foot (United States)

    Sumpio, Bauer E.


    Foot problems in patients with diabetes remain a major public health issue and are the commonest reason for hospitalization of patients with diabetes with prevalence as high as 25%. Ulcers are breaks in the dermal barrier with subsequent erosion of underlying subcutaneous tissue that may extend to muscle and bone, and superimposed infection is a frequent and costly complication. The pathophysiology of diabetic foot disease is multifactorial and includes neuropathy, infection, ischemia, and abnormal foot structure and biomechanics. Early recognition of the etiology of these foot lesions is essential for good functional outcome. Managing the diabetic foot is a complex clinical problem requiring a multidisciplinary collaboration of health care workers to achieve limb salvage. Adequate off-loading, frequent debridement, moist wound care, treatment of infection, and revascularization of ischemic limbs are the mainstays of therapy. Even when properly managed, some of the foot ulcers do not heal and are arrested in a state of chronic inflammation. These wounds can frequently benefit from various adjuvants, such as aggressive debridement, growth factors, bioactive skin equivalents, and negative pressure wound therapy. While these, increasingly expensive, therapies have shown promising results in clinical trials, the results have yet to be translated into widespread clinical practice leaving a huge scope for further research in this field. PMID:24278695

  13. Managing the unmanageable: risk assessment and risk management in contemporary professional practice. (United States)

    Raven, J; Rix, P


    This study sets out to investigate the theories and practices of risk assessment and management in the context of contemporary mental health practice. Although risk assessment and management policies are well established for those working in the field of community mental health care, there are noticeable anomalies and regional variations, in the criteria, procedures and decision-making strategies used. Focus group taped interviews were conducted with over 100 mental health professionals in one NHS Trust. These were compared with an extensive literature review on the topic. The main theme to emerge was lack of resources, which included time and staff in the context of a changing and increasing workload. Another important theme was the lack of access to centralized and accurate information about mental health service provision. It is essential that professionals, clients, their families and the public feel confident in professional judgements and practices to avoid a 'back to the asylum' lobby, for the care and treatment of seriously mentally ill individuals.

  14. Historical perspective and contemporary management of acute coronary syndromes: from MONA to THROMBINS2. (United States)

    Kline, Kristopher P; Conti, C Richard; Winchester, David E


    Acute coronary syndrome (ACS) remains a major burden on morbidity and mortality in the United States. Medical professionals and students often use the mnemonic 'MONA' (morphine, oxygen, nitroglycerin and aspirin) to recall treatments for ACS; however, this list of therapies is outdated. We provide a historical perspective on 'MONA,' attempt to uncover its origin in the medical literature, and demonstrate the myriad changes that have occurred over the last 50 years of ACS management. We have developed a novel mnemonic, 'THROMBINS2' (thienopyridines, heparin/enoxaparin, renin-angiotensin system blockers, oxygen, morphine, beta blocker, intervention, nitroglycerin, statin/salicylate) to help bedside clinicians recall all the elements of contemporary ACS management. We demonstrate the mortality benefit for each component of contemporary ACS management, correlating the continued improvement with historical data on mortality after myocardial infarction. We encourage providers to utilize this mnemonic to explore options and guide treatments in ACS patients.

  15. Contemporary management of stage I and II seminoma. (United States)

    Chung, Peter; Warde, Padraig


    Seminoma represents about 60 % of all testicular germ cell tumors. At presentation about 80 % of patients have stage I and about 15 % have stage II disease. The last three decades have seen a substantial change in the philosophy of management with the success of surveillance as a strategy to minimize unnecessary treatment, recognition of the late effects of radiation therapy, and the success of cisplatin-based chemotherapy as curative treatment either in the first-line or salvage setting. Overall, in stage I disease where 80-85 % are cured with orchiectomy alone, efforts now are directed at reducing the burden of the disease and its diagnosis on patients with increasing utilization of surveillance and decreased employment of adjuvant therapy. For stage II disease, balancing the relative toxicities of radiation and chemotherapy while avoiding the use of multimodality therapy due to the additive long-term toxicity has become the priority.

  16. Pregnancy and cystic fibrosis: Approach to contemporary management (United States)

    Tay, George; Callaway, Leonie; Bell, Scott C


    Over the previous 50 years survival of patients with cystic fibrosis has progressively increased. As a result of improvements in health care, increasing numbers of patients with cystic fibrosis are now considering starting families of their own. For the health care professionals who look after these patients, the assessment of the potential risks, and the process of guiding prospective parents through pregnancy and beyond can be both challenging and rewarding. To facilitate appropriate discussions about pregnancy, health care workers must have a detailed understanding of the various important issues that will ultimately need to be considered for any patient with cystic fibrosis considering parenthood. This review will address these issues. In particular, it will outline pregnancy outcomes for mothers with cystic fibrosis, issues that need to be taken into account when planning a pregnancy and the management of pregnancy for mothers with cystic fibrosis or mothers who have undergone organ transplantation as a result of cystic fibrosis. PMID:27512443

  17. Administration and School Management: Adequacy Guidelines of Contemporary Capitalism

    Directory of Open Access Journals (Sweden)

    Flávio Reis Santos

    Full Text Available The theme of this article despite the fact that the applicant in the context of research in the field of education, gain importance and relevance because of all the reflections set out in the framework of the debate about the conduct of public policies for education to the extent that we note that the old problems remain negatively affecting both educational and school management, as the quality of the training processes that happen inside it. The practical continuity in the formulation and implementation of such policies may reside in the constant adaptation of the education and public school to the heterogeneity of the capitalist market demands in proportion as the Brazilian government underwent orientation and World Bank interference in the administration of social issues.

  18. Contemporary Management of Ischemic Mitral Regurgitation: a Review. (United States)

    Sandoval, Yader; Sorajja, Paul; Harris, Kevin M


    Ischemic mitral regurgitation occurs relatively frequently in patients with coronary artery disease and is associated with an increased long term risk. The pathophysiology of ischemic mitral regurgitation is vexing, and poses both diagnostic and therapeutic challenges, leading to the need for a comprehensive, multidisciplinary approach. The management is largely focused on medical therapy, and for those eligible, coronary revascularization and/or cardiac resynchronization therapy may be considered. In select patients, mitral valve surgery or catheter-based therapy may be undertaken with careful consideration of the underlying pathophysiology, surgical risk, and expected long-term outcomes. The appropriate evaluation of patients with ischemic mitral regurgitation involves a careful multidisciplinary approach that carefully considers symptomatology, the etiology and severity of the mitral regurgitation, as well as the assessment of comorbidities and operative risk to individualize the care of these patients. Copyright © 2018. Published by Elsevier Inc.

  19. Contemporary Management of ST-Elevation Myocardial Infarction. (United States)

    Dind, Ashleigh; Allahwala, Usaid; Asrress, Kaleab N; Jolly, Sanjit S; Bhindi, Ravinay


    Recent advances have caused a major shift in the way ST-elevation myocardial infarctions are managed. This review explores the pharmacological and interventional techniques that have evidence for improving outcomes and the landmark trials that have sparked change. The new P2Y 12 inhibitors, ticagrelor and prasugrel, have been shown to be superior to clopidogrel in STEMI patients undergoing primary percutaneous coronary intervention. Concurrently, many technical aspects of percutaneous coronary intervention have been further clarified by trial data, with bare-metal stents, routine thrombus aspiration and femoral access showing evidence of inferiority. Ongoing trials will provide more information on the role of non-culprit lesion PCI, bioresorbable vascular scaffolds, mechanical devices in persistent ischaemia and early automatic implantable cardioverter-defibrillators for inducible ventricular tachycardia. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

  20. Congenital and childhood atrioventricular blocks: pathophysiology and contemporary management. (United States)

    Baruteau, Alban-Elouen; Pass, Robert H; Thambo, Jean-Benoit; Behaghel, Albin; Le Pennec, Solène; Perdreau, Elodie; Combes, Nicolas; Liberman, Leonardo; McLeod, Christopher J


    Atrioventricular block is classified as congenital if diagnosed in utero, at birth, or within the first month of life. The pathophysiological process is believed to be due to immune-mediated injury of the conduction system, which occurs as a result of transplacental passage of maternal anti-SSA/Ro-SSB/La antibodies. Childhood atrioventricular block is therefore diagnosed between the first month and the 18th year of life. Genetic variants in multiple genes have been described to date in the pathogenesis of inherited progressive cardiac conduction disorders. Indications and techniques of cardiac pacing have also evolved to allow safe permanent cardiac pacing in almost all patients, including those with structural heart abnormalities. Early diagnosis and appropriate management are critical in many cases in order to prevent sudden death, and this review critically assesses our current understanding of the pathogenetic mechanisms, clinical course, and optimal management of congenital and childhood AV block. • Prevalence of congenital heart block of 1 per 15,000 to 20,000 live births. AV block is defined as congenital if diagnosed in utero, at birth, or within the first month of life, whereas childhood AV block is diagnosed between the first month and the 18th year of life. As a result of several different etiologies, congenital and childhood atrioventricular block may occur in an entirely structurally normal heart or in association with concomitant congenital heart disease. Cardiac pacing is indicated in symptomatic patients and has several prophylactic indications in asymptomatic patients to prevent sudden death. • Autoimmune, congenital AV block is associated with a high neonatal mortality rate and development of dilated cardiomyopathy in 5 to 30 % cases. What is New: • Several genes including SCN5A have been implicated in autosomal dominant forms of familial progressive cardiac conduction disorders. • Leadless pacemaker technology and gene therapy for

  1. Application of contemporary integrated manufacture systems to nuclear power plants management

    International Nuclear Information System (INIS)

    Zhou Gang; Wang Lushuai; Tang Yaoyang


    In order to improve the safety, economy and reliability of the operation of a nuclear power plant (NPP), a novel integrated management method is proposed based on the 'integration' concept of the computer and contemporary integrated manufacture systems (CIMS). The design of integrated management system for NPP is studied. In the design of this system, information integration method based on the database and product data management (PDM) technology is adopted. In order to design and integrated management system satisfying the needs of NPP management, all activities of NPP are divided into different categories according to its characteristics. There are subsystems under the general management system to conduct the management work of different categories. All subsystems are interrelated in the environment of CIMS, but relatively independent. The application of CIMS to NPP provides a new way for scientific management of NPP, and makes the best of human, material and information resources. (authors)

  2. Coronary artery disease in Brazil: contemporary management and future perspectives. (United States)

    Polanczyk, C A; Ribeiro, J P


    Cardiovascular diseases are responsible for 32% of total mortality in Brazil, mostly due to cerebrovascular and coronary artery disease. Epidemiological and socio-economical factors play a pivotal role on the distribution, severity and management of coronary artery disease, and the burden is greater in the southeast and south regions of the country, with a higher mortality in low-income populations. The Brazilian healthcare structure is divided into two complementary systems-public and private-but 75% of the population is covered exclusively by the public system. Some Brazilian institutions offer state-of-the-art care to patients with acute and chronic coronary artery disease, but regional inequalities in medical care are still significant. National policies will have to be implemented to fight risk factors, to ensure primary prevention strategies, including assistance on drugs with known protective effects, areas to be tackled by both the private and the public health sectors. Finally, large investments will have to be made to improve tertiary care, to reorganise systems of care for acute patients and mainly to ensure prompt access and continuity of cardiac care and secondary prevention strategies for the whole population.

  3. Epidemiology and contemporary management of abdominal aortic aneurysms. (United States)

    Ullery, Brant W; Hallett, Richard L; Fleischmann, Dominik


    Abdominal aortic aneurysm (AAA) is most commonly defined as a maximal diameter of the abdominal aorta in excess of 3 cm in either anterior-posterior or transverse planes or, alternatively, as a focal dilation ≥ 1.5 times the diameter of the normal adjacent arterial segment. Risk factors for the development of AAA include age > 60, tobacco use, male gender, Caucasian race, and family history of AAA. Aneurysm growth and rupture risk appear to be associated with persistent tobacco use, female gender, and chronic pulmonary disease. The majority of AAAs are asymptomatic and detected incidentally on various imaging studies, including abdominal ultrasound, and computed tomographic angiography. Symptoms associated with AAA may include abdominal or back pain, thromboembolization, atheroembolization, aortic rupture, or development of an arteriovenous or aortoenteric fistula. The Screening Abdominal Aortic Aneurysms Efficiently (SAAAVE) Act provides coverage for a one-time screening abdominal ultrasound at age 65 for men who have smoked at least 100 cigarettes and women who have family history of AAA disease. Medical management is recommended for asymptomatic patients with AAAs  5 mm/6 months), or presence of a fusiform aneurysm with maximum diameter of 5.5 cm or greater. Intervention for AAA includes conventional open surgical repair and endovascular aortic stent graft repair.

  4. The importance of traditional fire use and management practices for contemporary land managers in the American Southwest (United States)

    Carol Raish; Armando Gonzalez-Caban; Carol J. Condie


    Indigenous and traditional peoples worldwide have used fire to manipulate their environment for thousands of years. These longstanding practices still continue and have considerable relevance for today’s land managers. This discussion explores the value of documenting and understanding historic and contemporary fire use attitudes and practices of the varied cultural/...

  5. Fluid overload in the ICU: evaluation and management. (United States)

    Claure-Del Granado, Rolando; Mehta, Ravindra L


    Fluid overload is frequently found in acute kidney injury patients in critical care units. Recent studies have shown the relationship of fluid overload with adverse outcomes; hence, manage and optimization of fluid balance becomes a central component of the management of critically ill patients. In critically ill patients, in order to restore cardiac output, systemic blood pressure and renal perfusion an adequate fluid resuscitation is essential. Achieving an appropriate level of volume management requires knowledge of the underlying pathophysiology, evaluation of volume status, and selection of appropriate solution for volume repletion, and maintenance and modulation of the tissue perfusion. Numerous recent studies have established a correlation between fluid overload and mortality in critically ill patients. Fluid overload recognition and assessment requires an accurate documentation of intakes and outputs; yet, there is a wide difference in how it is evaluated, reviewed and utilized. Accurate volume status evaluation is essential for appropriate therapy since errors of volume evaluation can result in either in lack of essential treatment or unnecessary fluid administration, and both scenarios are associated with increased mortality. There are several methods to evaluate fluid status; however, most of the tests currently used are fairly inaccurate. Diuretics, especially loop diuretics, remain a valid therapeutic alternative. Fluid overload refractory to medical therapy requires the application of extracorporeal therapies. In critically ill patients, fluid overload is related to increased mortality and also lead to several complications like pulmonary edema, cardiac failure, delayed wound healing, tissue breakdown, and impaired bowel function. Therefore, the evaluation of volume status is crucial in the early management of critically ill patients. Diuretics are frequently used as an initial therapy; however, due to their limited effectiveness the use of continuous

  6. Contemporary surgical trends in the management of upper tract calculi. (United States)

    Oberlin, Daniel T; Flum, Andrew S; Bachrach, Laurie; Matulewicz, Richard S; Flury, Sarah C


    Upper tract nephrolithiasis is a common surgical condition that is treated with multiple surgical techniques, including shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy. We analyzed case logs submitted to the ABU by candidates for initial certification and recertification to help elucidate the trends in management of upper tract urinary calculi. Annualized case logs from 2003 to 2012 were analyzed. We used logistic regression models to assess how surgeon specific attributes affected the way that upper tract stones were treated. Cases were identified by the CPT code of the corresponding procedure. A total of 6,620 urologists in 3 certification groups recorded case logs, including 2,275 for initial certification, 2,381 for first recertification and 1,964 for second recertification. A total of 441,162 procedures were logged, of which 54.2% were ureteroscopy, 41.3% were shock wave lithotripsy and 4.5% were percutaneous nephrolithotomy. From 2003 to 2013 there was an increase in ureteroscopy from 40.9% to 59.6% and a corresponding decrease in shock wave lithotripsy from 54% to 36.3%. For new urologists ureteroscopy increased from 47.6% to 70.9% of all stones cases logged and for senior clinicians ureteroscopy increased from 40% to 55%. Endourologists performed a significantly higher proportion of percutaneous nephrolithotomies than nonendourologists (10.6% vs 3.69%, p <0.0001) and a significantly smaller proportion of shock wave lithotripsies (34.2% vs 42.2%, p = 0.001). Junior and senior clinicians showed a dramatic adoption of endoscopic techniques. Treatment of upper tract calculi is an evolving field and provider specific attributes affect how these stones are treated. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  7. Organizational flexibility as a challenge of contemporary management. Determinants and methods of measurement

    Directory of Open Access Journals (Sweden)

    Piotr Buła


    Full Text Available Purpose: This paper has been aimed at defining contemporary management flexibility determinants and the methods of its measurement. Problem investigated: This paper presents an analysis of organizational flexibility determinants related to the contemporary concepts and challenges within the area of management. The discussion includes two types of measurement of organizational flexibility based on declarative tests and quantitative criteria. The described methods are subject to evaluation. The paper also presents authors' own proposal for determinants classification, organizational flexibility assessment and an exemplary application. Methodology: The paper has been based on the results of research on organizational flexibility conducted by the Department of Business Studies Aalborg University (Denmark and Wrocław University of Economics (Poland. Conclusion: Organizational flexibility constitutes one of the major challenges of contemporary management. This issue has already been extensively discussed, however, despite numerous publications and relevant research projects many issues still need to be resolved. One of them is organizational flexibility measurement. In the first place, it needs a description of flexibility determinants relevant to a certain organization. There are no objective methods that would allow a description of the set of determinants since they are dependent on organization's special features and individually set objectives. In addition, it should be noted that those factors are subject to change, in line with the development of theory and concepts of management. The very flexibility measurement requires simultaneous application of various methods of factor analysis and polling stakeholder opinions.

  8. Indian Society of Neuro-Oncology consensus guidelines for the contemporary management of medulloblastoma. (United States)

    Gupta, Tejpal; Sarkar, Chitra; Rajshekhar, Vedantam; Chatterjee, Sandip; Shirsat, Neelam; Muzumdar, Dattatreya; Pungavkar, Sona; Chinnaswamy, Girish; Jalali, Rakesh


    The high success rate in the management medulloblastoma achieved in the western world is not exactly mirrored in developing countries including India. Socio-demographic differences, health-care disparity, and lack in uniformity of care with resultant widespread variations in the clinical practice are some of the reasons that may partly explain this difference in outcomes. Patients with medulloblastoma require a multi-disciplinary team approach involving but not limited to neuro-radiology, neurosurgery; neuropathology, molecular biology, radiation oncology, pediatric medical oncology and rehabilitative services for optimizing outcomes. The Indian Society of Neuro-Oncology (ISNO) constituted an expert multi-disciplinary panel with adequate representation from all stakeholders to prepare national consensus guidelines for the contemporary management of medulloblastoma. Minimum desirable, as well as preferable though optional recommendations (as appropriate), were developed and adopted for the pre-surgical work-up including neuroimaging; neurosurgical management including surgical principles, techniques, and complications; neuropathology reporting and molecular testing; contemporary risk-stratification in the molecular era; appropriate adjuvant therapy (radiotherapy and chemotherapy); and follow-up schedule in medulloblastoma. The current document represents a broad consensus reached amongst various stakeholders within the neuro-oncology community involved in the contemporary curative-intent management of children with medulloblastoma. It provides both general as well as specific guidelines and recommendations to be adopted by physicians and health care providers across India to achieve uniformity of care, improve disease-related outcomes, and compare results between institutions within the country.

  9. Fluid management plan for the Project Shoal Area Offsites Subproject

    International Nuclear Information System (INIS)


    The US Department of Energy, Nevada Operations Office (DOE/NV) has initiated the Offsites Subproject to characterize the hazards posed to human health and the environment as a result of underground nuclear testing activities at facilities other than the Nevada Test Site (NTS). A primary Subproject objective is to gather adequate data to characterize the various Subproject sites through the collection of surface and subsurface soil samples and by drilling several wells for the collection of groundwater data. The Project Shoal Area (PSA) is one of the Subproject's Nevada sites and is subject to the requirements set forth in the Federal Facility Compliance Agreement and Consent Order (FFACO) (DOE, 1996a). In accordance with the FFACO, a Corrective Action Investigation Plan (CAIP) has been developed for work at the PSA (designated as Corrective Action Unit Number 416). This Fluid Management Plan (FMP) provides guidance for the management of fluids generated from wells constructed at the PSA. Long-term monitoring and future activities at the site, if required, will be set forth in additional documents as required by the FFACO. The ultimate method for disposition of fluids generated by site operations depends upon sample analysis and process knowledge in relation to fluid management criteria. Section 2 describes well site operations; Section 3 discusses fluid management criteria; Section 4 includes the fluid monitoring program; Section 5 presents the fluid management strategy; Section 6 provides for fluid management during routine well monitoring; and Section 7 contains reporting criteria

  10. Digitizing dissent: cyborg politics and fluid networks in contemporary Cuban activism

    Directory of Open Access Journals (Sweden)

    Samuel Kellogg


    Full Text Available Communication technologies shape how political activist networks are produced and maintain themselves. In Cuba, despite ideologically and physically oppressive practices by the state, a severe lack of Internet access, and extensive government surveillance, a small network of bloggers and cyberactivists has achieved international visibility and recognition for its critiques of the Cuban government. This qualitative study examines the blogger collective known as Voces Cubanas in Havana, Cuba in 2012, advancing a new approach to the study of transnational activism and the role of technology in the construction of political narrative. Voces Cubanas is analyzed as a network of connections between human and non-human actors that produces and sustains powerful political alliances. Voces Cubanas and its allies work collectively to co-produce contentious political discourses, confronting the dominant ideologies and knowledges produced by the Cuban state. Transnational alliances, the act of translation, and a host of unexpected and improvised technologies play central roles in the production of these narratives, indicating new breed of cyborg sociopolitical action reliant upon fluid and flexible networks and the act of writing. 

  11. Managing the clinical setting for best nursing practice: a brief overview of contemporary initiatives. (United States)

    Henderson, Amanda; Winch, Sarah


    Leadership strategies are important in facilitating the nursing profession to reach their optimum standards in the practice environment. To compare and contrast the central tenets of contemporary quality initiatives that are commensurate with enabling the environment so that best practice can occur. Democratic leadership, accessible and relevant education and professional development, the incorporation of evidence into practice and the ability of facilities to be responsive to change are core considerations for the successful maintenance of practice standards that are consistent with best nursing practice. While different concerns of management drive the adoption of contemporary approaches, there are many similarities in the how these approaches are translated into action in the clinical setting. Managers should focus on core principles of professional nursing that add value to practice rather than business processes.

  12. Bioimpedance-Guided Fluid Management in Hemodialysis Patients (United States)

    Arias-Guillén, Marta; Wabel, Peter; Fontseré, Néstor; Carrera, Montserrat; Campistol, José Maria; Maduell, Francisco


    Summary Background and objectives Achieving and maintaining optimal fluid status remains a major challenge in hemodialysis therapy. The aim of this interventional study was to assess the feasibility and clinical consequences of active fluid management guided by bioimpedance spectroscopy in chronic hemodialysis patients. Design, setting, participants, & measurements Fluid status was optimized prospectively in 55 chronic hemodialysis patients over 3 months (November 2011 to February 2012). Predialysis fluid overload was measured weekly using the Fresenius Body Composition Monitor. Time-averaged fluid overload was calculated as the average between pre- and postdialysis fluid overload. The study aimed to bring the time-averaged fluid overload of all patients into a target range of 0.5±0.75 L within the first month and maintain optimal fluid status until study end. Postweight was adjusted weekly according to a predefined protocol. Results Time-averaged fluid overload in the complete study cohort was 0.9±1.6 L at baseline and 0.6±1.1 L at study end. Time-averaged fluid overload decreased by −1.20±1.32 L (P<0.01) in the fluid-overloaded group (n=17), remained unchanged in the normovolemic group (n=26, P=0.59), and increased by 0.59±0.76 L (P=0.02) in the dehydrated group (n=12). Every 1 L change in fluid overload was accompanied by a 9.9 mmHg/L change in predialysis systolic BP (r=0.55, P<0.001). At study end, 76% of all patients were either on time-averaged fluid overload target or at least closer to target than at study start. The number of intradialytic symptoms did not change significantly in any of the subgroups. Conclusions Active fluid management guided by bioimpedance spectroscopy was associated with an improvement in overall fluid status and BP. PMID:23949235

  13. Managing Fluid and Electrolyte Disorders in Kidney Disease. (United States)

    Langston, Cathy


    Because of the role of the kidneys in maintaining homeostasis in the body, kidney disease leads to derangements of fluid, electrolyte, and acid-base balance. The most effective therapy of a uremic crisis is careful management of fluid balance, which involves thoughtful assessment of hydration, a fluid treatment plan personalized for the specific patient, and repeated and frequent reassessment of fluid and electrolyte balance. Disorders of sodium, chloride, potassium, calcium, and phosphorus are commonly encountered in kidney disease and some may be life-threatening. Treatment of metabolic acidosis and nutritional support is frequently needed. Copyright © 2016 Elsevier Inc. All rights reserved.


    Directory of Open Access Journals (Sweden)

    Rajjan Man Chitrakar


    Full Text Available The lack of management has led to the degrading quality of public space in modern cities around the globe. Contemporary public spaces are facing challenges in terms of maintaining them as a “social space” so that they are accessible and functional for the users. Using Kathmandu as a case study, this paper explores the challenges the contemporary public spaces within urban neighbourhoods are facing in their management. The study reveals that the regulation of use is a major concern of public space management in the new neighbourhoods of Kathmandu as evident in the limited accessibility and utility of public space, due to control and commercialisation. The use of public space has also been affected by the lack of regular maintenance. The root cause of these problems lies in weak urban governance at the neighbourhood level, which has led the local community-based organisations to take a role in neighbourhood management. These findings confirm that the management of public space is a critical issue of urban development with commonalities existing across geographical regions that demand adequate consideration from the stakeholders.

  15. Pediatric Acute Respiratory Distress Syndrome: Fluid Management in the PICU. (United States)

    Ingelse, Sarah A; Wösten-van Asperen, Roelie M; Lemson, Joris; Daams, Joost G; Bem, Reinout A; van Woensel, Job B


    The administration of an appropriate volume of intravenous fluids, while avoiding fluid overload, is a major challenge in the pediatric intensive care unit. Despite our efforts, fluid overload is a very common clinical observation in critically ill children, in particular in those with pediatric acute respiratory distress syndrome (PARDS). Patients with ARDS have widespread damage of the alveolar-capillary barrier, potentially making them vulnerable to fluid overload with the development of pulmonary edema leading to prolonged course of disease. Indeed, studies in adults with ARDS have shown that an increased cumulative fluid balance is associated with adverse outcome. However, age-related differences in the development and consequences of fluid overload in ARDS may exist due to disparities in immunologic response and body water distribution. This systematic review summarizes the current literature on fluid imbalance and management in PARDS, with special emphasis on potential differences with adult patients. It discusses the adverse effects associated with fluid overload and the corresponding possible pathophysiological mechanisms of its development. Our intent is to provide an incentive to develop age-specific fluid management protocols to improve PARDS outcomes.

  16. Pediatric acute respiratory distress syndrome: fluid management in the PICU

    Directory of Open Access Journals (Sweden)

    Sarah A Ingelse


    Full Text Available The administration of an appropriate volume of intravenous fluids, while avoiding fluid overload, is a major challenge in the pediatric intensive care unit. Despite our efforts, fluid overload is a very common clinical observation in critically ill children, in particular in those with pediatric acute respiratory distress syndrome (PARDS. Patients with ARDS have widespread damage of the alveolar capillary barrier, potentially making them vulnerable to fluid overload with the development of pulmonary edema leading to prolonged course of disease. Indeed, studies in adults with ARDS have shown that an increased cumulative fluid balance is associated with adverse outcome. However, age-related differences in the development and consequences of fluid overload in ARDS may exist due to disparities in immunologic response and body water distribution. This systematic review summarizes the current literature on fluid imbalance and management in PARDS, with special emphasis on potential differences with adult patients. It discusses the adverse effects associated with fluid overload and the corresponding possible pathophysiological mechanisms of its development. Our intent is to provide an incentive to develop age-specific fluid management protocols to improve PARDS outcomes.

  17. Fluid management in acute kidney injury

    DEFF Research Database (Denmark)

    Perner, Anders; Prowle, John; Joannidis, Michael


    Acute kidney injury (AKI) and fluids are closely linked through oliguria, which is a marker of the former and a trigger for administration of the latter. Recent progress in this field has challenged the physiological and clinical rational of using oliguria as a trigger for the administration...... of crystalloids and colloids on kidney function and the effect of various resuscitation and de-resuscitation strategies on the course and outcome of AKI....

  18. Endoscopic Management of Pancreatic Fluid Collections in Children. (United States)

    Nabi, Zaheer; Talukdar, Rupjyoti; Reddy, D Nageshwar


    The incidence of acute pancreatitis in children has increased over the last few decades. The development of pancreatic fluid collection is not uncommon after severe acute pancreatitis, although its natural course in children and adolescents is poorly understood. Asymptomatic fluid collections can be safely observed without any intervention. However, the presence of clinically significant symptoms warrants the drainage of these fluid collections. Endoscopic management of pancreatic fluid collection is safe and effective in adults. The use of endoscopic ultrasound (EUS)-guided procedure has improved the efficacy and safety of drainage of pancreatic fluid collections, which have not been well studied in pediatric populations, barring a scant volume of small case series. Excellent results of EUS-guided drainage in adult patients also need to be verified in children and adolescents. Endoprostheses used to drain pancreatic fluid collections include plastic and metal stents. Metal stents have wider lumens and become clogged less often than plastic stents. Fully covered metal stents specifically designed for pancreatic fluid collection are available, and initial studies have shown encouraging results in adult patients. The future of endoscopic management of pancreatic fluid collection in children appears promising. Prospective studies with larger sample sizes are required to establish their definitive role in the pediatric age group.

  19. Fluid management in infants and children during intracranial surgery

    Directory of Open Access Journals (Sweden)

    Hemangi S Karnik


    Full Text Available Fluid management in neurosurgical paediatric patients can be a real challenge due to their different pathophysiology, sensitivity to fluid loss, inability to accurately judge the degree of abnormality and adequacy of replacement in face of limited monitoring. For infants and children undergoing neurosurgical procedures, isotonic fluids should be used for maintenance and replacement to avoid increase in intracranial pressure and maintain cerebral perfusion. Routine use of added dextrose is not needed, but blood glucose monitoring should be done in high risk population. Preoperative deficits and intraoperative blood loss should be closely monitored and treated. Hyponataemia and other electrolyte derangements are common and should be monitored.

  20. Neuroendocrine tumours of the head and neck: anatomical, functional and molecular imaging and contemporary management (United States)

    Subedi, Navaraj; Prestwich, Robin; Chowdhury, Fahmid; Patel, Chirag


    Abstract Neuroendocrine tumours (NETs) of the head and neck are rare neoplasms and can be of epithelial or non-epithelial differentiation. Although the natural history of NETs is variable, it is crucial to establish an early diagnosis of these tumours as they can be potentially curable. Conventional anatomical imaging and functional imaging using radionuclide scintigraphy and positron emission tomography/computed tomography can be complementary for the diagnosis, staging and monitoring of treatment response. This article describes and illustrates the imaging features of head and neck NETs, discusses the potential future role of novel positron-emitting tracers that are emerging into clinical practice and reviews contemporary management of these tumours. Familiarity with the choice of imaging techniques and the variety of imaging patterns and treatment options should help guide radiologists in the management of this rare but important subgroup of head and neck neoplasms. PMID:24240099

  1. Overview of Contemporary Issues of Forest Research and Management in China (United States)

    He, Hong S.; Shifley, Stephen R.; Thompson, Frank R.


    With 207 million ha of forest covering 22% of its land area, China ranks fifth in the world in forest area. Rapid economic growth, climate change, and forest disturbances pose new, complex challenges for forest research and management. Progress in meeting these challenges is relevant beyond China, because China's forests represent 34% of Asia's forests and 5% of the worlds' forests. To provide a broader understanding of these management challenges and of research and policies that address them, we organized this special issue on contemporary forest research and management issues in China. At the national level, papers review major forest types and the evolution of sustainable forestry, the development of China's forest-certification efforts, the establishment of a forest inventory system, and achievements and challenges in insect pest control in China. Papers focused on Northern China address historical, social, and political factors that have shaped the region's forests; the use of forest landscape models to assess how forest management can achieve multiple objectives; and analysis and modeling of fuels and fire behavior. Papers addressing Central and South China describe the "Grain for Green" program, which converts low productivity cropland to grassland and woodland to address erosion and soil carbon sequestration; the potential effects of climate change on CO2 efflux and soil respiration; and relationships between climate and net primary productivity. China shares many forest management and research issues with other countries, but in other cases China's capacity to respond to forest management challenges is unique and bears watching by the rest of the world.

  2. Contemporary Management of Struvite Stones Using Combined Endourologic and Medical Treatment: Predictors of Unfavorable Clinical Outcome. (United States)

    Iqbal, Muhammad Waqas; Youssef, Ramy F; Neisius, Andreas; Kuntz, Nicholas; Hanna, Jonathan; Ferrandino, Michael N; Preminger, Glenn M; Lipkin, Michael E


    Struvite stones have been associated with significant morbidity and mortality, yet there has not been a report on the medical management of struvite stones in almost 20 years. We report on the contemporary outcomes of the surgical and medical management of struvite stones in a contemporary series. A retrospective review of patients who were treated with percutaneous nephrolithotomy (PCNL) for struvite stones at Duke University Medical Center between January 2005 and September 2012 identified a total of 75 patients. Of these, 43 patients had adequate follow-up and were included in this analysis. Stone activity, defined as either stone recurrence or stone-related events, and predictors of activity were evaluated after combined surgical and medical treatment. The study included 43 patients with either pure (35%) or mixed (65%) struvite stones with a median age of 55±15 years (range 21-89 years). The stone-free rate after PCNL was 42%. Stone recurrence occurred in 23% of patients. Postoperatively, 30% of patients had a stone-related event, while 60% of residual stones remained stable with no growth after a median follow-up of 22 months (range 6-67 mos). Kidney function remained stable during follow-up. Independent predictors of stone activity included the presence of residual stones >0.4 cm(2), preoperative large stone burden (>10 cm(2)), and the presence of medical comorbidities (P<0.05). Struvite stones can be managed safely with PCNL followed by medical therapy. The majority of patients with residual fragments demonstrated no evidence of stone growth on medical therapy. With careful follow-up and medical management, kidney function can be maintained and stone morbidity can be minimized. Initial large stone burden, residual stones after surgery, and associated medical comorbidities may have deleterious effect on stone recurrence or residual stone-related events.

  3. Contemporary behavior management techniques in clinical pediatric dentistry: out with the old and in with the new? (United States)

    Oliver, Kelly; Manton, David John


    Effective behavior management guides children through the complex social context of dentistry utilizing techniques based on a current understanding of the social, emotional, and cognitive development of children. Behavior management techniques facilitate effective communication and establish social and behavioral guidelines for the dental environment. Contemporary parenting styles, expectations, and attitudes of modern parents and society have influenced the use of behavior management techniques with a prevailing emphasis on communicative techniques and pharmacological management over aversive techniques.

  4. Oral rehydration therapy for preoperative fluid and electrolyte management. (United States)

    Taniguchi, Hideki; Sasaki, Toshio; Fujita, Hisae


    Preoperative fluid and electrolyte management is usually performed by intravenous therapy. We investigated the safety and effectiveness of oral rehydration therapy (ORT) for preoperative fluid and electrolyte management of surgical patients. The study consisted of two studies, designed as a prospective observational study. In a pilot study, 20 surgical patients consumed 1000 mL of an oral rehydration solution (ORS) until 2 h before induction of general anesthesia. Parameters such as serum electrolyte concentrations, fractional excretion of sodium (FENa) as an index of renal blood flow, volume of esophageal-pharyngeal fluid and gastric fluid (EPGF), and patient satisfaction with ORT were assessed. In a follow-up study to assess the safety of ORT, 1078 surgical patients, who consumed ORS until 2 h before induction of general anesthesia, were assessed. In the pilot study, water, electrolytes, and carbohydrate were effectively and safely supplied by ORT. The FENa value was increased at 2 h following ORT. The volume of EPGF collected following the induction of anesthesia was 5.3±5.6 mL. In the follow-up study, a small amount of vomiting occurred in one patient, and no aspiration occurred in the patients. These results suggest that ORT is a safe and effective therapy for the preoperative fluid and electrolyte management of selected surgical patients.

  5. Life cycle assessment to compare the environmental impact of seven contemporary food waste management systems. (United States)

    Edwards, Joel; Othman, Maazuza; Crossin, Enda; Burn, Stewart


    Municipal food waste (FW) represents 35-45% of household residual waste in Australia, with the nation generating 1.6Tg annually. It is estimated that 91% of this FW ends up in landfill. This study used life cycle assessment to determine and compare the environmental impact of seven contemporary FW management systems for two real-life jurisdictions; incorporating the complete waste service and expanding the system to include inert and garden waste. Although, no system exhibited a best ranking across all impact categories, FW digestion based systems were all revealed to have a lower global warming potential than composting and landfilling systems. Mechanical biological treatment, anaerobic co-digestion, and home composting all demonstrated the lowest environmental impacts for two or more of the environmental impact categories assessed. The assessment included market and technological specific variables and uncertainties providing a framework for robust decision making at a municipality level. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  6. Role of percutaneous mitral valve repair in the contemporary management of mitral regurgitation. (United States)

    Rana, Bushra S; Calvert, Patrick A; Punjabi, Prakash P; Hildick-Smith, David


    Percutaneous mitral valve (MV) repair has been performed in over 20,000 patients worldwide. As clinical experience in this technique grows indications for its use are being defined. Mitral regurgitation (MR) encompasses a complex heterogeneous group and its treatment is governed by determining a clear understanding of the underlying aetiology. Surgical MV repair remains the gold standard therapy for severe MR. However in select groups of high-risk surgical patients, a percutaneous approach to MV repair is establishing its role. This review gives an overview of the published data in percutaneous MV repair and its impact on the contemporary management of MR. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  7. Contemporary management of benign parotid tumours - the increasing evidence for extracapsular dissection. (United States)

    Brennan, P A; Ammar, M; Matharu, J


    Benign parotid tumours have historically often been managed surgically by superficial parotidectomy. While this approach usually gives a generous cuff of surrounding normal parotid tissue to increase tumour margins, it requires a much larger incision than the increasingly used extracapsular dissection (ECD) technique. Furthermore, superficial parotidectomy can result in marked facial hollowing, Frey syndrome and an increased risk of both temporary and permanent facial nerve weakness. ECD has been popularised as a safe alternative to parotidectomy primarily for the removal of mobile, benign parotid tumours with safe outcomes and reduced risk to the facial nerve. In this article, we review the growing body of evidence for ECD and include our own experience confirming the move away from superficial parotidectomy in contemporary practice for the treatment of benign parotid tumours. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Cryogenic Fluid Management Technology for Moon and Mars Missions (United States)

    Doherty, Michael P.; Gaby, Joseph D.; Salerno, Louis J.; Sutherlin, Steven G.


    In support of the U.S. Space Exploration Policy, focused cryogenic fluid management technology efforts are underway within the National Aeronautics and Space Administration. Under the auspices of the Exploration Technology Development Program, cryogenic fluid management technology efforts are being conducted by the Cryogenic Fluid Management Project. Cryogenic Fluid Management Project objectives are to develop storage, transfer, and handling technologies for cryogens to support high performance demands of lunar, and ultimately, Mars missions in the application areas of propulsion, surface systems, and Earth-based ground operations. The targeted use of cryogens and cryogenic technologies for these application areas is anticipated to significantly reduce propellant launch mass and required on-orbit margins, to reduce and even eliminate storage tank boil-off losses for long term missions, to economize ground pad storage and transfer operations, and to expand operational and architectural operations at destination. This paper organizes Cryogenic Fluid Management Project technology efforts according to Exploration Architecture target areas, and discusses the scope of trade studies, analytical modeling, and test efforts presently underway, as well as future plans, to address those target areas. The target areas are: liquid methane/liquid oxygen for propelling the Altair Lander Ascent Stage, liquid hydrogen/liquid oxygen for propelling the Altair Lander Descent Stage and Ares V Earth Departure Stage, liquefaction, zero boil-off, and propellant scavenging for Lunar Surface Systems, cold helium and zero boil-off technologies for Earth-Based Ground Operations, and architecture definition studies for long term storage and on-orbit transfer and pressurization of LH2, cryogenic Mars landing and ascent vehicles, and cryogenic production via in situ resource utilization on Mars.

  9. Contemporary management of median arcuate ligament syndrome provides early symptom improvement (United States)

    Columbo, Jesse A.; Trus, Thadeus; Nolan, Brian; Goodney, Philip; Rzucidlo, Eva; Powell, Richard; Walsh, Daniel; Stone, David


    Objective Optimal diagnosis and management of median arcuate ligament (MAL) syndrome (MALS) remains unclear in contemporary practice. The advent and evolution of laparoscopic and endovascular techniques has redirected management toward a less invasive therapeutic algorithm. This study examined our contemporary outcomes of patients treated for MALS. Methods All patients treated for MALS at Dartmouth-Hitchcock Medical Center from 2000 to 2013 were retrospectively reviewed. Demographics and comorbidities were recorded. Freedom from symptoms and freedom from reintervention were the primary end points. Return to work or school was assessed. Follow-up by clinic visits and telephone allowed quantitative comparisons among the patients. Results During the study interval, 21 patients (24% male), with a median age of 42 years, were treated for MALS. All patients complained of abdominal pain in the presence of a celiac stenosis, 16 (76%) also reported weight loss at the time of presentation, and 57% had a concomitant psychiatric history. Diagnostic imaging most commonly used included duplex ultrasound (81%), computed tomography angiography (66%), angiography (57%), and magnetic resonance angiography (5%). Fourteen patients (67%) underwent multiple diagnostic studies. All patients underwent initial laparoscopic MAL release. Seven patients (33%) underwent subsequent celiac stent placement in the setting of recurrent or unresolved symptoms with persistent celiac stenosis at a mean interval of 49 days. Two patients required surgical bypass after an endovascular intervention failed. The 6-month freedom from symptoms was 75% and freedom from reintervention was 64%. Eighteen patients (81%) reported early symptom improvement and weight gain, and 66% were able to return to work. Conclusions A multidisciplinary treatment approach using initial laparoscopic release and subsequent stent placement and bypass surgery provides symptom improvement in most patients treated for MALS. The

  10. Conservative fluid management prevents age-associated ventilator induced mortality. (United States)

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


    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

  11. Risk Management Standards: Towards a contemporary, organisation-wide management approach


    Koutsoukis, Nikitas-Spiros


    Risk management has been progressively evolving into a systemic approach for organisational decision making in today’s dynamic economic environment of the global era. In this context, risk management is reaching beyond its traditional finance and insurance application context and is entering the sphere of generic, organisation-wide management approaches. In support of this argument we consider four generic risk management standards issued at the institutional, national or international level...

  12. Space system production cost benefits from contemporary philosophies in management and manufacturing (United States)

    Rosmait, Russell L.


    The cost of manufacturing space system hardware has always been expensive. The Engineering Cost Group of the Program Planning office at Marshall is attempting to account for cost savings that result from new technologies in manufacturing and management. The objective is to identify and define contemporary philosophies in manufacturing and management. The seven broad categories that make up the areas where technological advances can assist in reducing space system costs are illustrated. Included within these broad categories is a list of the processes or techniques that specifically provide the cost savings within todays design, test, production and operations environments. The processes and techniques listed achieve savings in the following manner: increased productivity; reduced down time; reduced scrap; reduced rework; reduced man hours; and reduced material costs. In addition, it should be noted that cost savings from production and processing improvements effect 20 to 40 pct. of production costs whereas savings from management improvements effects 60 to 80 of production cost. This is important because most efforts in reducing costs are spent trying to reduce cost in the production.

  13. Sport Management Student as Producer: Embedding Critical Management Studies in Sport through Contemporary Pedagogy


    Zervas, K; Glazzard, J


    In recent years there has been growing interest over the role of major sport events and the sports industry. The aftermath of 2008 global crisis exposed the myth of ‘end of history’ and raised several questions over the role of management and organisational practices and theories in all aspects of human activity, including sport. This article reviews the emergence of critical management studies (CMS) as a field within management and organisational studies. We focus on critical performativity ...

  14. Outcome of Keratoconus Management: Review of the Past 20 Years' Contemporary Treatment Modalities. (United States)

    Mandathara, Preeji S; Stapleton, Fiona J; Willcox, Mark D P


    To describe the past 20 years' contemporary management modalities for keratoconus (KC) and their outcomes and failures and to propose recommendations in reporting their outcomes. A systematic review of the literature on KC management options for the last 20 years was performed. Original articles that reported the outcome of any form of KC management other than full-thickness or lamellar corneal graft were reviewed to collect information on their outcomes and complications and the level of scientific evidence of the study. A total of 1,147 articles retrieved and of those, 241 satisfied the inclusion criteria, and 41.1% of them were prospective case series. The higher level of evidence studies, that is, randomized controlled trials (RCTs), were limited to only one intervention, that is, corneal collagen cross-linking (CXL). However, the quality of most RCTs was limited because of performance and detection bias. Contact lenses (CLs) remain the mainstream of KC management and were associated with reversible and non-sight-threatening complications. Surgical options such as intracorneal segment implantation and phakic intraocular lens are considered in the visual rehabilitation of CL intolerants, and CXL is the only available option to stop or delay the disease progression. Generally, these surgical procedures are associated with transient inflammatory events and permanent sequelae. The published studies on KC management options varied significantly with respect to the study population, age of participants, severity of KC, clinical outcome measurements, and follow-up period. High-quality longer follow-up RCTs are required to evaluate the long-term effects of KC interventions.

  15. Cost-effectiveness in the contemporary management of critical limb ischemia with tissue loss. (United States)

    Barshes, Neal R; Chambers, James D; Cohen, Joshua; Belkin, Michael


    The care of patients with critical limb ischemia (CLI) and tissue loss is notoriously challenging and expensive. We evaluated the cost-effectiveness of various management strategies to identify those that would optimize value to patients. A probabilistic Markov model was used to create a detailed simulation of patient-oriented outcomes, including clinical events, wound healing, functional outcomes, and quality-adjusted life-years (QALYs) after various management strategies in a CLI patient cohort during a 10-year period. Direct and indirect cost estimates for these strategies were obtained using transition cost-accounting methodology. Incremental cost-effectiveness ratios (ICERs), in 2009 U.S. dollars per QALYs, were calculated compared with the most conservative management strategy of local wound care with amputation as needed. With an ICER of $47,735/QALY, an initial surgical bypass with subsequent endovascular revision(s) as needed was the most cost-effective alternative to local wound care alone. Endovascular-first management strategies achieved comparable clinical outcomes but at higher cost (ICERs ≥$101,702/QALY); however, endovascular management did become cost-effective when the initial foot wound closure rate was >37% or when procedural costs were decreased by >42%. Primary amputation was dominated (less effectiveness and more costly than wound care alone). Contemporary clinical effectiveness and cost estimates show an initial surgical bypass is the most cost-effective alternative to local wound care alone for CLI with tissue loss and can be supported even in a cost-averse health care environment. Copyright © 2012. Published by Mosby, Inc.

  16. Thermal management of microelectronics with electrostatic fluid accelerators

    International Nuclear Information System (INIS)

    Wang, Hsiu-Che; Jewell-Larsen, Nels E.; Mamishev, Alexander V.


    Optimal thermal management is critical in modern consumer electronics. Typically, a thermal management scheme for an electronic system involves several physical principles. In many cases, it is highly desirable to enhance heat transfer at the solid-air interface while maintaining small size of the thermal management solution. The enhancement of heat transfer at the solid-air interface can be achieved by several physical principles. One principle that is getting increased attention of thermal management design engineers is electrostatic fluid acceleration. This paper discusses recent breakthroughs in state-of-the-art of electrostatic fluid accelerators (EFAs). The paper compares and contrasts EFAs’ design and performance metrics to those of other airside cooling technologies used in small form factor applications. Since the energy efficiency, flow rate, and acoustic emissions are highly influenced by the scale of the airside cooling devices, the paper also presents the analysis of fundamental effect of scaling laws on heat transfer performance. The presented review and analysis helps drawing conclusions regarding achievable comparative performance and practicality of using different design approaches and physical principles for different applications. -- Highlights: ► Discuss breakthrough in state-of-the-art of electrostatic fluid accelerators (EFA). ► Compare EFAs' performance metrics to those of other airside cooling technologies. ► Show analysis of fundamental effect of scaling laws on heat transfer performance

  17. Barriers to Managing Fertility: Findings From the Understanding Fertility Management in Contemporary Australia Facebook Discussion Group. (United States)

    Holton, Sara; Rowe, Heather; Kirkman, Maggie; Jordan, Lynne; McNamee, Kathleen; Bayly, Christine; McBain, John; Sinnott, Vikki; Fisher, Jane


    As part of research investigating the complexities of managing fertility in Australia, public opinions about how Australians manage their fertility were sought from women and men. To identify public opinion about sexual and reproductive health in Australia. To ensure access to a diverse group of people throughout Australia, an online group was advertised and convened on Facebook from October through December 2013. In a closed-group moderated discussion, participants responded to questions about how people in Australia attempt to manage three aspects of fertility: avoiding pregnancy, achieving pregnancy, and difficulties conceiving. Nonidentifiable demographic information was sought; no personal accounts of fertility management were requested. The discussion transcript was analyzed thematically. There were 61 female and 2 male Facebook users aged 18 to 50 years living in Australia participating in the study. Four main themes about fertility management were identified: access, geographical location, knowledge, and cost. Participants reported that young people and people from rural areas face barriers accessing contraception and fertility services. Limited knowledge about sex and reproduction and the cost of fertility services and contraception were also said to impede effective fertility management. Reasons for inequalities in effective fertility management that are amenable to change were identified. Facebook is an effective method for gaining insights into public opinion about sexual and reproductive health.

  18. Barriers to Managing Fertility: Findings From the Understanding Fertility Management in Contemporary Australia Facebook Discussion Group (United States)

    Rowe, Heather


    Background As part of research investigating the complexities of managing fertility in Australia, public opinions about how Australians manage their fertility were sought from women and men. Objective To identify public opinion about sexual and reproductive health in Australia. Methods To ensure access to a diverse group of people throughout Australia, an online group was advertised and convened on Facebook from October through December 2013. In a closed-group moderated discussion, participants responded to questions about how people in Australia attempt to manage three aspects of fertility: avoiding pregnancy, achieving pregnancy, and difficulties conceiving. Nonidentifiable demographic information was sought; no personal accounts of fertility management were requested. The discussion transcript was analyzed thematically. Results There were 61 female and 2 male Facebook users aged 18 to 50 years living in Australia participating in the study. Four main themes about fertility management were identified: access, geographical location, knowledge, and cost. Participants reported that young people and people from rural areas face barriers accessing contraception and fertility services. Limited knowledge about sex and reproduction and the cost of fertility services and contraception were also said to impede effective fertility management. Conclusions Reasons for inequalities in effective fertility management that are amenable to change were identified. Facebook is an effective method for gaining insights into public opinion about sexual and reproductive health. PMID:26878865

  19. Usefulness of Beta blockade in contemporary management of patients with stable coronary heart disease. (United States)

    Winchester, David E; Pepine, Carl J


    Considerable progress has been made over the last few decades in the management of clinically stable coronary heart disease (SCHD), including improvements in interventions (e.g., percutaneous revascularization), pharmacological management, and risk factor control (e.g., smoking, diet, activity level, hypercholesterolemia, hypertension). Although β blockers have long been used for the treatment of SCHD, their efficacy was established in the era before widespread use of reperfusion interventions, modern medical therapy (e.g., angiotensin-converting enzyme inhibitors, angiotensin receptor blockers), or preventive treatments (e.g., aspirin, statins). On the basis of these older data, β blockers are assumed beneficial, and their use has been extrapolated beyond patients with heart failure and previous myocardial infarction, which provided the best evidence for efficacy. However, there are no randomized clinical trials demonstrating that β blockers decrease clinical events in patients with SCHD in the modern era. Furthermore, these agents are associated with weight gain, problems with glycemic control, fatigue, and bronchospasm, underscoring the fact that their use is not without risk. In conclusion, data are currently lacking to support the widespread use of β blockers for all SCHD patients, but contemporary data suggest that they be reserved for a well-defined high-risk group of patients with evidence of ongoing ischemia, left ventricular dysfunction, heart failure, and perhaps some arrhythmias. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Contemporary management of patients with penile cancer and lymph node metastasis. (United States)

    Leone, Andrew; Diorio, Gregory J; Pettaway, Curtis; Master, Viraj; Spiess, Philippe E


    Penile cancer is a rare disease that causes considerable physical and psychological patient morbidity, especially at advanced stages. Patients with low-stage nodal metastasis can achieve durable survival with surgery alone, but those with extensive locoregional metastasis have overall low survival. Contemporary management strategies for lymph node involvement in penile cancer aim to minimize the morbidity associated with traditional radical inguinal lymphadenectomy through appropriate risk stratification while optimizing oncological outcomes. Modified (or superficial) inguinal lymph node dissection and dynamic sentinel lymph node biopsy are diagnostic modalities that have been recommended in patients with high-risk primary penile tumours and nonpalpable inguinal lymph nodes. In addition, advances in minimally invasive and robot-assisted lymphadenectomy techniques are being investigated in patients with penile cancer and might further decrease lymphadenectomy-related adverse effects. The management of patients with advanced disease has evolved to include multimodal treatment with systemic chemotherapy before surgical intervention and can include adjuvant chemotherapy after pelvic lymphadenectomy. The role of radiotherapy in the neoadjuvant or adjuvant setting remains largely unclear, owing to a lack of high-level evidence of possible benefits. New targeted therapies have shown efficacy in squamous cell carcinomas of other sites and might also prove effective in patients with penile cancer.

  1. Contemporary management of anastomotic leak after colon surgery: assessing the need for reoperation. (United States)

    Moghadamyeghaneh, Zhobin; Hanna, Mark H; Alizadeh, Reza Fazl; Carmichael, Joseph C; Mills, Steven; Pigazzi, Alessio; Stamos, Michael J


    We sought to investigate contemporary management of anastomosis leakage (AL) after colonic anastomosis. The American College of Surgeons National Surgical Quality Improvement Program database 2012 to 2013 was used to identify patients with AL. Multivariate regression analysis was performed to find predictors of the need for surgical intervention in management of AL. A total of 32,280 patients underwent colon resection surgery with 1,240 (3.8%) developing AL. Overall, 43.9% of patients with AL did not require reoperation. Colorectal anastomosis had significantly higher risk of AL compared with ileocolonic anastomosis (adjusted odds ratio [AOR], 1.20; P = .04). However, the rate of need for reoperation was higher for AL in colocolonic anastomosis compared with ileocolonic anastomosis (AOR, 1.48; P = .04). White blood cell count (AOR, 1.07; P < .01), the presence of intra-abdominal infection with leakage (AOR, 1.47; P = .01), and protective stoma (AOR, .43, P = .02) were associated with reoperation after AL. Nonoperative treatment is possible in almost half of the patients with colonic AL. The anatomic location of the anastomosis impacts the risk of AL. Severity of leakage, the presence of a stoma, and general condition of patients determine the need for reoperation. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Endoscopic Management of Peri-Pancreatic Fluid Collections. (United States)

    Yip, Hon Chi; Teoh, Anthony Yuen Bun


    In the past decade, there has been a progressive paradigm shift in the management of peri-pancreatic fluid collections after acute pancreatitis. Refinements in the definitions of fluid collections from the updated Atlanta classification have enabled better communication amongst physicians in an effort to formulate optimal treatments. Endoscopic ultrasound (EUS)-guided drainage of pancreatic pseudocysts has emerged as the procedure of choice over surgical cystogastrostomy. The approach provides similar success rates with low complications and better quality of life compared with surgery. However, an endoscopic "step up" approach in the management of pancreatic walled-off necrosis has also been advocated. Both endoscopic and percutaneous drainage routes may be used depending on the anatomical location of the collections. New-generation large diameter EUS-specific stent systems have also recently been described. The device allows precise and effective drainage of the collections and permits endoscopic necrosectomy through the stents.

  3. Fluid management in the optimization of space construction (United States)

    Snyder, Howard


    Fluid management impacts strongly on the optimization of space construction. Large quantities of liquids are needed for propellants and life support. The mass of propellant liquids is comparable to that required for the structures. There may be a strong dynamic interaction between the stored liquids and the space structure unless the design minimizes the interaction. The constraints of cost and time required optimization of the supply/resupply strategy. The proper selection and design of the fluid management methods for: slosh control; stratification control; acquisition; transfer; gauging; venting; dumping; contamination control; selection of tank configuration and size; the storage state and the control system can improve the entire system performance substantially. Our effort consists of building mathematical/computer models of the various fluid management methods and testing them against the available experimental data. The results of the models are used as inputs to the system operations studies. During the past year, the emphasis has been on modeling: the transfer of cryogens; sloshing and the storage configuration. The work has been intermeshed with ongoing NASA design and development studies to leverage the funds provided by the Center.

  4. Sex differences in the contemporary management of HIV patients admitted for acute myocardial infarction. (United States)

    Ogunbayo, Gbolahan O; Bidwell, Katrina; Misumida, Naoki; Ha, Le Dung; Abdel-Latif, Ahmed; Elayi, Claude S; Smyth, Susan; Messerli, Adrian W


    Studies have reported sex differences in the management of patients with acute myocardial infarction (AMI) in the general population. This observational study is designed to evaluate whether sex differences exist in the contemporary management of human immunodeficiency virus (HIV) patients admitted for diagnosis of AMI. There is no difference in management of HIV patients with AMI. Using the National Inpatient Sample database, we identified patients with a primary diagnosis of AMI and a secondary diagnosis of HIV. We described baseline characteristics and outcomes using NIS documentation. Our primary areas of interest were revascularization and mortality. Among 2 977 387 patients presenting from 2010 to 2014 with a primary diagnosis of AMI, 10907 (0.4%) had HIV (mean age, 54.1 ± 9.3 years; n = 2043 [18.9%] female). Females were younger, more likely to be black, and more likely to have hypertension, diabetes, obesity, and anemia. Although neither males nor females were more likely to undergo coronary angiography in multivariate analysis, revascularization was performed less frequently in females than in males (45.4% vs 62.7%; P < 0.01), driven primarily by lower incidence of PCI. In a multivariate model, females were less likely to undergo revascularization (OR: 0.59, 95% CI: 0.45-0.78, P < 0.01), a finding driven solely by PCI (OR: 0.64, 95% CI: 0.49-0.83, P < 0.01). All-cause mortality was similar in both groups. AMI was more common in males than females with HIV. Females with HIV were more likely to be younger and black and less likely to be revascularized by PCI. © 2018 Wiley Periodicals, Inc.

  5. Contemporary strategic management approach in the defense system by U.S. methodology concept

    Directory of Open Access Journals (Sweden)

    Veselin I. Mrdak


    Full Text Available The paper wants to emphasize the importance of contemporary strategic management approachs in the defense system. Displays the work of American author Leslie Lewis and C. Robert Roll "Strategy-to- tasks: a methodology for resource allocation and management". It were used by parts of the discussion above, in order to describe the strategy-to-tasks methodology for planning, programming and budgeting system (PPBS. In developed Western countries adopted some elements of strategic management to determine and monitor the execution of strategic plans in the defense system. This trend is spreading to other countries as a result of the necessity of obeying certain methodological and technological achievements. The uncritical acceptance of a strategic management approach can cause great confusion and problems, and the terminology and scientific explanation for this trend is of great importance. Introduction PPBS is a resource management framework based on force planning concept. It was developed at the lRand Company during the late eighties and is adapted to the special needs of several DoD organization. The planning, programming and budgeting system (PPBS PPBS is DoD`ş primary system for planning and managing defense resources. It links the overall U.S. national security strategy to specific programs. It was designed to facilitate fiscally-constrained planning, programming and budgeting in terms of complete programs (i.e. forces and systems rather than through artificial budget categories. The goal is to determine forces, systems and program costs. Strategy-to-tasks and the PPBS The Strategy-To-Tasks methodology, regardless of its application, it must be consistent and supportive of each phase of the PPBS. This section describes the basics frameworks of which are adapted to resource allocation and management activities for the Special Operations Command (USSOCOM. The authors have used it during the various phases of the PPBS. The National Security

  6. Contemporary management of men with high-risk localized prostate cancer in the United States. (United States)

    Weiner, A B; Matulewicz, R S; Schaeffer, E M; Liauw, S L; Feinglass, J M; Eggener, S E


    Surgery and radiation-based therapies are standard management options for men with clinically localized high-risk prostate cancer (PCa). Contemporary patterns of care are unknown. We hypothesize the use of surgery has steadily increased in more recent years. Using the National Cancer Data Base for 2004-2013, all men diagnosed with high-risk localized PCa were identified using National Comprehensive Cancer Network criteria. Temporal trends in initial management were assessed. Multivariable logistic regression was used to evaluate demographic and clinical factors associated with undergoing radical prostatectomy (RP). In total, 127 391 men were identified. Use of RP increased from 26% in 2004 to 42% in 2013 (adjusted risk ratio (RR) 1.51, 95% CI 1.42-1.60, P<0.001), while external beam radiation therapy (EBRT) decreased from 49% to 42% (P<0.001). African American men had lower odds of undergoing RP (unadjusted rate of 28%, adjusted RR 0.69, 95% CI 0.66-0.72, <0.001) compared to White men (37%). Age was inversely associated with likelihood of receiving RP. Having private insurance was significantly associated with the increased use of RP (vs Medicare, adjusted odds ratio 1.04, 95% CI 1.01-1.08, P=0.015). Biopsy Gleason scores 8-10 with and without any primary Gleason 5 pattern were associated with decreased odds of RP (vs Gleason score ⩽6, both P<0.001). Academic and comprehensive cancer centers were more likely to perform RP compared to community hospitals (both P<0.001). The likelihood of receiving RP for high-risk PCa dramatically increased from 2004 to 2013. By 2013, the use of RP and EBRT were similar. African American men, elderly men and those without private insurance were less likely to receive RP.

  7. Controversies in pediatric anesthesia: sevoflurane and fluid management. (United States)

    Gueli, Sarah L; Lerman, Jerrold


    To explore the interrelationships among the pharmacokinetics of sevoflurane, epileptiform electroencephalographic (EEG) activity and awareness in children. To also describe the revised perioperative fluid management strategy espoused by Holliday and Segar and noninvasive measures that may predict who will respond positively to fluid loading. The depth of anesthesia during the early washin period with sevoflurane 8% is one-third less than during halothane. Eight percent sevoflurane rarely causes clinical seizures; more commonly, it causes epileptiform EEG activity that only weakly portends seizure activity. When preceded by nitrous oxide, midazolam or normocapnia, the risk of inducing epileptiform activity during spontaneous respiration is exceedingly small. Decreasing the inspired concentration of sevoflurane upon loss of the eyelash reflex to prevent epileptiform activity has not been shown to reduce the risk of clinical seizures, but more importantly, it may increase the risk of awareness if the child is stimulated. Isotonic intravenous solutions should be infused in volumes of 20-40 ml/kg over 2-4 h in children undergoing elective surgery. Postoperatively, these infusions may be continued at rates of 2/1/0.5 ml/kg/h; serum sodium concentration should be measured periodically. Noninvasive measures currently do not reliably identify those children who will respond positively to fluid boluses. Sevoflurane is a well tolerated induction agent that rarely causes seizures in children, but may cause awareness if the inspired concentration is prematurely reduced. Perioperative isotonic fluids should be infused at 20-40 ml/kg over 2-4 h during elective surgery. Noninvasive metrics do not predict a child's responsiveness to fluid loading.

  8. Contemporary Management of Acute Aortic Occlusion Has Evolved but Outcomes Have Not Significantly Improved. (United States)

    Robinson, William P; Patel, Rupal K; Columbo, Jesse A; Flahive, Julie; Aiello, Francesco A; Baril, Donald T; Schanzer, Andres; Messina, Louis M


    Most existing series of acute aortic occlusion (AAO) predate the changes in surgical and endovascular therapy of the last 2 decades. We examined the contemporary management and outcomes of AAO. We reviewed consecutive patients with AAO at a tertiary referral center from 2004 to 2012. Outcomes were stratified and compared according to etiology and procedure performed. AAO in 29 patients was due to in situ thrombosis in 21 (72%) and embolism in 8 (28%) patients. Vascular patients with embolism were on average older (77 ± 7 vs. 66 ± 12 years, P = 0.02) and had higher rates of atrial fibrillation (100% vs. 20%, P = 0.0002) and congestive heart failure (75% vs. 0%, P = 0.0001) in comparison with those with in situ thrombosis. Neurologic deficit was present in 16 (55%) patients. Six patients (21%) presented with bilateral paresis/paralysis secondary to spinal cord or lumbosacral plexus ischemia, and primary neurologic etiology was investigated before vascular consultation was obtained in 4 of these 6 patients. Of the 29 patients, 28 (97%) underwent revascularization including transfemoral embolectomy (n = 6), transperitoneal aortoiliac thrombectomy (n = 2), axillobifemoral bypass (n = 10), aortobifemoral bypass (n = 6), and endovascular therapy including thrombolysis, angioplasty ± stenting (n = 4). In-hospital mortality was 31% and did not vary significantly according to etiology (embolism 38% vs. in situ thrombosis 29%, P = 0.67). In-hospital mortality varied widely according to procedure (transfemoral embolectomy 50%, aortoiliac thrombectomy 100%, axillobifemoral bypass 30%, aortobifemoral bypass 0%, and endovascular therapy 25%, P = 0.08). Major morbidity (59%), length of stay (8.6 ± 8.0 days), and discharge to a rehabilitation facility (50%) did not vary by etiology or procedure. At a media follow-up of 361 ± 460 days (range 3-2014), overall survival was 42%. There were no amputations among 20 survivors of initial

  9. Survey on the Contemporary Management of Intraoperative Urethral Injuries During Penile Prosthesis Implantation. (United States)

    Sexton, Stephanie J; Granieri, Michael A; Lentz, Aaron C


    clean intermittent catheterization dependence. A urethral injury during penile prosthesis implantation might not mandate termination of the procedure despite classic teaching. The strength of this study is that it provides difficult to obtain epidemiologic data on the frequency and management of this clinically significant injury. Limitations include the inherent biases from a survey-based study including response bias and recall bias. The survey response rate could not be obtained. Urethral injury during penile prosthesis implantation is a rare but clinically significant risk of the procedure, with many variations in management of the injury. Termination and delayed implantation might not be necessary after injury, although long-term outcome data are difficult to obtain. Sexton SJ, Granieri MA, Lentz AC. Survey on the Contemporary Management of Intraoperative Urethral Injuries During Penile Prosthesis Implantation. J Sex Med 2018;15:576-581. Copyright © 2018 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

  10. Clinical manifestations and management of prune-belly syndrome in a large contemporary pediatric population. (United States)

    Seidel, Natan E; Arlen, Angela M; Smith, Edwin A; Kirsch, Andrew J


    To review the clinical manifestations and operative management of a large contemporary pediatric cohort of patients with prune-belly syndrome (PBS). PBS patients aged <21 years followed up in our pediatric urology clinic were identified by the International Classification of Diseases, Ninth Revision code (756.71). Demographics, concomitant diagnoses, surgical history, imaging studies, and renal or bladder function were evaluated. Data were available for 46 pediatric patients (44 boys and 2 girls). Mean age was 7.6 ± 4.7 years (range, 0.9-20 years). Average length of clinical follow-up was 6.8 ± 5 years. Forty-five children (97.8%) had hydroureteronephrosis, and 36 of them (78.3%) had vesicoureteral reflux. Five patients (10.9%) had significant pulmonary insufficiency, and 2 patients (4.3%) were oxygen dependent. Eighteen children (39.1%) had other congenital malformations, including cardiac in 4 patients (8.7%) and musculoskeletal anomalies in 10 patients (21.7%). Orchidopexy was the most common surgery, with all boys aged ≥3 years having undergone the procedure. Twenty-two patients (47.8%) had a history of ureteral surgery, 22 (47.8%) had bladder surgery, 11 (23.9%) had renal surgery, and 6 (13%) had urethral procedures. Nineteen patients (41.3%) underwent abdominoplasty. Eighteen children (39.1%) had documented chronic kidney disease, and 8 children (17.4%) underwent renal transplantation. Average age at transplantation was 5.1 ± 2.9 years. The mean nadir creatinine level for patients with end-stage renal disease was 1.4 mg/dL compared with 0.4 mg/dL for those not requiring transplantation (P <.001). Children with PBS have significant comorbidities and require frequent operative intervention, with disease heterogeneity necessitating an individualized management approach. Early end-stage renal disease is prevalent, with approximately 15% of children requiring kidney transplantation. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Contemporary management of spinal AVFs and AVMs: lessons learned from 110 cases. (United States)

    Rangel-Castilla, Leonardo; Russin, Jonathan J; Zaidi, Hasan A; Martinez-Del-Campo, Eduardo; Park, Min S; Albuquerque, Felipe C; McDougall, Cameron G; Nakaji, Peter; Spetzler, Robert F


    Spinal arteriovenous fistulas (AVFs) and arteriovenous malformations (AVMs) are rare, complex spinal vascular lesions that are challenging to manage. Recently, understanding of these lesions has increased thanks to neuroimaging technology. Published reports of surgical results and clinical outcome are limited to small series. The authors present a large contemporary series of patients with spinal AVFs and AVMs who were treated at Barrow Neurological Institute in Phoenix, Arizona. Retrospective detailed review of a prospective vascular database was performed for all patients with spinal AVFs and AVMs treated between 2000 and 2013. Patient demographic data, AVF and AVM characteristics, surgical results, clinical outcomes, complications, and long-term follow-up were reviewed. Between 2000 and 2013, 110 patients (57 male and 53 female) underwent obliteration of spinal AVFs and AVMs. The mean age at presentation was 42.3 years (range 18 months-81 years). There were 44 patients with AVFs and 66 with AVMs. The AVM group included 27 intramedullary, 21 conus medullaris, 12 metameric, and 6 extradural. The most common location was thoracic spine (61%), followed by cervical (22.7%), lumbar (14.5%), and sacral (1.8%). The most common presenting signs and symptoms included paresis/paralysis (75.5%), paresthesias (60%), pain (51.8%), bowel/bladder dysfunction (41.8%), and myelopathy (36.4%). Evidence of rupture was seen in 26.4% of patients. Perioperative embolization was performed in 42% of patients. Resection was performed in 95 patients (86.4%). Embolization alone was the only treatment in 14 patients (12.7%). One patient was treated with radiosurgery alone. Angiographically verified AVF and AVM obliteration was achieved in 92 patients (83.6%). At a mean follow-up duration of 30.5 months (range 1-205 months), 43 patients (97.7%) with AVFs and 57 (86.4%) with AVMs remained functionally independent (McCormick Scale scores ≤ 2). Perioperative complications were seen in 8

  12. Preoperative fluid and electrolyte management with oral rehydration therapy. (United States)

    Taniguchi, Hideki; Sasaki, Toshio; Fujita, Hisae; Takamori, Mina; Kawasaki, Rieko; Momiyama, Yukinori; Takano, Osami; Shibata, Toshinari; Goto, Takahisa


    We hypothesized that oral rehydration therapy using an oral rehydration solution may be effective for preoperative fluid and electrolyte management in surgical patients before the induction of general anesthesia, and we investigated the safety and effectiveness of oral rehydration therapy as compared with intravenous therapy. Fifty female patients who underwent breast surgery were randomly allocated to two groups. Before entry to the operation room and the induction of general anesthesia, 25 patients drank 1000 ml of an oral rehydration solution ("oral group") and 25 patients were infused with 1000 ml of an intravenous electrolyte solution ("intravenous group"). Parameters such as electrolyte concentrations in serum and urine, urine volume, vital signs, vomiting and aspiration, volumes of esophageal-pharyngeal fluid and gastric fluid (EPGF), and patient satisfaction with the therapy (as surveyed by a questionnaire) were assessed. After treatment, the serum sodium concentration and the hematocrit value, which both declined within the normal limits, were significantly higher in the oral group than in the intravenous group (sodium, 140.8 +/- 2.9 mEq x l(-1) in the oral group and 138.7 +/- 1.9 mEq x l(-1) in the intravenous group; P = 0.005; hematocrit, 39.03 +/- 4.16% in the oral group and 36.15 +/- 3.41% in the intravenous group; P = 0.01). No significant difference was observed in serum glucose values. Urine volume was significantly larger in the oral group (864.9 +/- 211.5 ml) than in the intravenous group (561.5 +/- 216.0 ml; P rehydration therapy, as judged by factors such as "feeling of hunger", "occurrence of dry mouth", and "less restriction in physical activity". The volume of EPGF collected following the induction of anesthesia was significantly smaller in the oral group than in the intravenous group (6.03 +/- 9.14 ml in the oral group and 21.76 +/- 30.56 ml in the intravenous group; P rehydration therapy with an oral rehydration solution before surgery is

  13. Technology requirements to be addressed by the NASA Lewis Research Center Cryogenic Fluid Management Facility program (United States)

    Aydelott, J. C.; Rudland, R. S.


    The NASA Lewis Research Center is responsible for the planning and execution of a scientific program which will provide advance in space cryogenic fluid management technology. A number of future space missions were identified that require or could benefit from this technology. These fluid management technology needs were prioritized and a shuttle attached reuseable test bed, the cryogenic fluid management facility (CFMF), is being designed to provide the experimental data necessary for the technology development effort.

  14. Reframing Resolution - Managing Conflict and Resolving Individual Employment Disputes in the Contemporary Workplace


    Saundry, Richard Arthur; Latreille, Paul; Dickens, Linda; Irvine, Charlie; Teague, Paul; Urwin, Peter; Wibberley, Gemma


    The resolution of individual workplace conflict has assumed an increasingly important place in policy debates over contemporary work and employment. This is in part due to the decline in collective industrial action and the parallel rise in the volume of employment tribunal applications. It reflects a growing concern over the\\ud implications of individual employment disputes for those involved but has perhaps been driven by concerns over the cost of litigation and the perceived burden that th...

  15. Contemporary management of cleft lip and palate in the United Kingdom. Have we reached the turning point? (United States)

    Colbert, S D; Green, Ben; Brennan, P A; Mercer, N


    Babies born with clefts of the lip, and the alveolus or palate, or both, require multidisciplinary, highly specialised treatment from birth to early adulthood. We review the contemporary management of clefts and outline the current treatment protocol adopted by cleft networks in the United Kingdom. We also look at the level of evidence and the restructuring of services that has defined current practice. In light of the recent Cleft Care UK study, we ask whether it is now time to adopt a new philosophy towards the surgical techniques that are used. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  16. Pediatric Acute Respiratory Distress Sydnrome : Fluid Management in the PICU

    NARCIS (Netherlands)

    Ingelse, SA; Wösten-van Asperen, RM; Lemson, J; Daams, JG; Bem, R.A.; van Woensel, JB


    The administration of an appropriate volume of intravenous fluids, while avoiding fluid overload, is a major challenge in the pediatric intensive care unit. Despite our efforts, fluid overload is a very common clinical observation in critically ill children, in particular in those with pediatric

  17. Pediatric Acute Respiratory Distress Syndrome: Fluid Management in the PICU

    NARCIS (Netherlands)

    Ingelse, Sarah A.; Wösten-van Asperen, Roelie M.; Lemson, Joris; Daams, Joost G.; Bem, Reinout A.; van Woensel, Job B.


    The administration of an appropriate volume of intravenous fluids, while avoiding fluid overload, is a major challenge in the pediatric intensive care unit. Despite our efforts, fluid overload is a very common clinical observation in critically ill children, in particular in those with pediatric

  18. Computational thermal, chemical, fluid, and solid mechanics for geosystems management.

    Energy Technology Data Exchange (ETDEWEB)

    Davison, Scott; Alger, Nicholas; Turner, Daniel Zack; Subia, Samuel Ramirez; Carnes, Brian; Martinez, Mario J.; Notz, Patrick K.; Klise, Katherine A.; Stone, Charles Michael; Field, Richard V., Jr.; Newell, Pania; Jove-Colon, Carlos F.; Red-Horse, John Robert; Bishop, Joseph E.; Dewers, Thomas A.; Hopkins, Polly L.; Mesh, Mikhail; Bean, James E.; Moffat, Harry K.; Yoon, Hongkyu


    This document summarizes research performed under the SNL LDRD entitled - Computational Mechanics for Geosystems Management to Support the Energy and Natural Resources Mission. The main accomplishment was development of a foundational SNL capability for computational thermal, chemical, fluid, and solid mechanics analysis of geosystems. The code was developed within the SNL Sierra software system. This report summarizes the capabilities of the simulation code and the supporting research and development conducted under this LDRD. The main goal of this project was the development of a foundational capability for coupled thermal, hydrological, mechanical, chemical (THMC) simulation of heterogeneous geosystems utilizing massively parallel processing. To solve these complex issues, this project integrated research in numerical mathematics and algorithms for chemically reactive multiphase systems with computer science research in adaptive coupled solution control and framework architecture. This report summarizes and demonstrates the capabilities that were developed together with the supporting research underlying the models. Key accomplishments are: (1) General capability for modeling nonisothermal, multiphase, multicomponent flow in heterogeneous porous geologic materials; (2) General capability to model multiphase reactive transport of species in heterogeneous porous media; (3) Constitutive models for describing real, general geomaterials under multiphase conditions utilizing laboratory data; (4) General capability to couple nonisothermal reactive flow with geomechanics (THMC); (5) Phase behavior thermodynamics for the CO2-H2O-NaCl system. General implementation enables modeling of other fluid mixtures. Adaptive look-up tables enable thermodynamic capability to other simulators; (6) Capability for statistical modeling of heterogeneity in geologic materials; and (7) Simulator utilizes unstructured grids on parallel processing computers.

  19. Intraoperative Fluids and Fluid Management for Ambulatory Dental Sedation and General Anesthesia. (United States)

    Saraghi, Mana


    Intravenous fluids are administered in virtually every parenteral sedation and general anesthetic. The purpose of this article is to review the physiology of body-water distribution and fluid dynamics at the vascular endothelium, evaluation of fluid status, calculation of fluid requirements, and the clinical rationale for the use of various crystalloid and colloid solutions. In the setting of elective dental outpatient procedures with minor blood loss, isotonic balanced crystalloid solutions are the fluids of choice. Colloids, on the other hand, have no use in outpatient sedation or general anesthesia for dental or minor oral surgery procedures but may have several desirable properties in long and invasive maxillofacial surgical procedures where advanced hemodynamic monitoring may assess the adequacy of intravascular volume.

  20. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. (United States)

    van Diepen, Sean; Katz, Jason N; Albert, Nancy M; Henry, Timothy D; Jacobs, Alice K; Kapur, Navin K; Kilic, Ahmet; Menon, Venu; Ohman, E Magnus; Sweitzer, Nancy K; Thiele, Holger; Washam, Jeffrey B; Cohen, Mauricio G


    Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities. © 2017 American Heart Association, Inc.

  1. Contemporary management and full mouth rehabilitation of a patient with Sjögren syndrome. (United States)

    Fisselier, Francois; Comut, A Alper


    Sjögren syndrome is a chronic autoimmune disorder with xerostomia, increased tooth wear, high rates of caries, and repeated failure of dental restorations as the main oral symptoms. These render the prosthetic treatment challenging. This clinical report describes a contemporary approach to the treatment of a patient with Sjögren syndrome using translucent multilayered monolithic zirconia restorations and focuses on the treatment protocols before, during, and after the prosthetic treatment. Copyright © 2017 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  2. Thermal Performance of a Cryogenic Fluid Management Cubesat Mission (United States)

    Berg, J. J.; Oliveira, J. M.; Congiardo, J. F.; Walls, L. K.; Putman, P. T.; Haberbusch, M. S.


    Development for an in-space demonstration of a CubeS at as a Cryogenic Fluid Management (CFM) test bed is currently underway. The favorable economics of CubeSats make them appealing for technology development activity. While their size limits testing to smaller scales, many of the regimes relevant to CFM can still be achieved. The first demo flight of this concept, CryoCube®-1, will focus on oxygen liquefaction and low-gravity level sensing using Reduced Gravity CryoTracker®. An extensive thermal modeling effort has been underway to both demonstrate concept feasibility and drive the prototype design. The satellite will utilize both a sun- and earth-shield to passively cool its experimental tank below 115 K. An on-board gas generator will create high pressure gaseous oxygen, which will be throttled into a bottle in the experimental node and condensed. The resulting liquid will be used to perform various experiments related to level sensing. Modeling efforts have focused on the spacecraft thermal performance and its effects on condensation in the experimental node. Parametric analyses for both optimal and suboptimal conditions have been considered and are presented herein.

  3. Tube thoracostomy in the management of pleural fluid collections. (United States)

    Nwofor, A M E; Ekwunife, C N


    To determine the demographic pattern, indications and complications associated with tube thoracostomy in Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi. A 5-year review of case records of patients who underwent tube thoracostomy at NAUTH Nnewi between January 1999 and December 2003. Demographic data, clinical features, duration of drainage, complications and outcomes were analyzed. A total of 65 cases were studied, male: female ratio was 2.4:1. Eighteen patients (27.7%) were below 10 years of age. Infective cases accounted for 63.1% (41) of the cases that had tube thoracostomy. Forty-one patients (63.1%) had tube drainage for 10 days or less. Complication rate was 41.5% (27), mostly mild, with dislodgement of the tube accounting for about half. Failure rate of 13.7% (9) was recorded for the procedure. A mortality of 6.2% (4) was recorded but there was no procedure related death. Seven patients (10.8%) required further surgery. Tube thoracostomy is a simple and efficacious procedure for the treatment of pleural space collections. The safety of the procedure can be improved upon by adequate training in the insertion procedure, while proper selection of cases will reduce failure rate and unnecessary morbidity. Early resort to thoracoscopic or open surgery when tube thoracostomy is considered inappropriate or has failed will improve the success rate in the overall management of pleural fluid collections.

  4. Trends and patterns in contemporary management in smaller companies: The Danish perspective


    Ulhøi, John Parm; Madsen, Henning


    This paper reports empirical findings from a recent survey of Danish managers with a special focus on managers from smaller companies. The survey has been initiated in Denmark and it is called the 'Danish Management Barometer'. The project is a joint research program between the Aarhus School of Business and the Danish Association of Managers and Executives. It is based on a structured, pre-tested questionnaire send out to 1500 pre-notified managers in Denmark aiming at establishing a...

  5. Theorethical principles of fluid managment according to physicochemical Stewart approach. (United States)

    Smuszkiewicz, Piotr; Szrama, Jakub


    Interpreting acid base disturbances according to the physicochemical Stewart approach allows the cause of such abnormalities to be discovered. This method is based on three independent variables: SID (strong ion difference), mainly sodium and chloride; weak acids concentration - Atot, mainly albumins and phosphate; and carbon dioxide tension - pCO₂. These three independent variables are responsible for the change of water dissociation and for the change in H+ concentration and, consequently, the change in serum pH value. The SID value of the fluids administered to a patient is responsible for the change of serum SID value and therefore causes a change in the patient's acid base status. During the infusion of a given fluid, the SID value of the serum becomes closer to the SID value of that fluid; on the other hand, the infusion causes a decrease in Atot concentration. In order to avoid acid base disturbances connected with fluid administration, the SID value of fluids being administered should be greater than 0 and lower then the serum SID. It has been suggested that fluids should be given of which the SID value is as close as possible to the actual serum HCO₃ concentration. Knowing the SID value of the fluid administered, and the serum HCO₃ concentration, one can expect a change of serum pH after a fluid infusion. Administering a fluid with a SID greater than the HCO₃ concentration causes a pH increase towards alkalosis. Likewise, administering a a fluid with a SID lower than the HCO₃ concentration causes a pH decrease towards acidosis. It seems that knowledge of the electrolyte concentration and the SID value of an administered fluid is an important factor regarding acid base disturbances.

  6. An Overview of Recent Cryogenic Fluid Management Developments (United States)

    Hedayat, A.; Johnson, W. L.; Stephens, J. R.


    Long-term storage, supply, and transfer of cryogenic fluids are critical capabilities needed to advance the human exploration of space. Technologies and advanced development programs have been pursued to address issues likely to confront the designers and developers of future cryogenic fluid management (CFM) subsystems and propulsion systems. NASA and aerospace industries have continued to conduct research and development for the propulsion applications of cryogenic fluids. From the well known in-space applications, to new applications involving superconducting motors within multiple different aircraft, and a renewed interest in production of oxygen on Mars, NASA continues to probe cryogenic applications within propulsion. This article presents brief reviews of several of the current CFM efforts to support future space missions. NASA GRC is currently focusing on understanding some of the finer points in the application of multilayer insulation. GRC recently finished the activation of a new calorimeter that operates at 20 K with a warm boundary that can operate either around 90 K or at 300 K. Current testing is focused on investigating multiple different seam concepts, initially between temperatures of 300 K and 20 K, and between 20 K and 90 K. One of the larger recent NASA investments has been on the Structural Heat Intercept, Insulation, and Vibration Experiment Rig (SHIIVER). SHIIVER is a 4 m diameter tank that is approximately 1/2 scale of the planned upper stage of the new Space Launch System (SLS) rocket. SHIIVER is focused on demonstrating the thermal benefits of multilayer insulation on the tank domes and boil-off vapor cooling on structural cylinders that hold the tank in-line on the rocket. It will also quantify any damage that may incur during the acoustic environment of over 160 decibels that SLS will experience on its trip to Earth orbit. In support of the possible production of oxygen out of the Mars' atmosphere, a team comprised of four NASA centers

  7. Principles of fluid management and stewardship in septic shock: it is time to consider the four D's and the four phases of fluid therapy. (United States)

    Malbrain, Manu L N G; Van Regenmortel, Niels; Saugel, Bernd; De Tavernier, Brecht; Van Gaal, Pieter-Jan; Joannes-Boyau, Olivier; Teboul, Jean-Louis; Rice, Todd W; Mythen, Monty; Monnet, Xavier


    In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. We are faced with many open questions regarding the type, dose and timing of intravenous fluid administration. There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses including maintenance and replacement of total body water and electrolytes, as carriers for medications and for parenteral nutrition. In this paradigm-shifting review, we discuss different fluid management strategies including early adequate goal-directed fluid management, late conservative fluid management and late goal-directed fluid removal. In addition, we expand on the concept of the "four D's" of fluid therapy, namely drug, dosing, duration and de-escalation. During the treatment of patients with septic shock, four phases of fluid therapy should be considered in order to provide answers to four basic questions. These four phases are the resuscitation phase, the optimization phase, the stabilization phase and the evacuation phase. The four questions are "When to start intravenous fluids?", "When to stop intravenous fluids?", "When to start de-resuscitation or active fluid removal?" and finally "When to stop de-resuscitation?" In analogy to the way we handle antibiotics in critically ill patients, it is time for fluid stewardship.

  8. Contemporary Role of Radiotherapy in the Management of Primary Penile Tumors and Metastatic Disease. (United States)

    Crook, Juanita


    Squamous cell cancer of the penis is a radiocurable malignancy all too often managed solely by partial or total penectomy. Effective management of the primary tumor while preserving penile morphology and function is a priority. External radiotherapy and brachytherapy have a role to play in the definitive management of the primary tumor. Surgical nodal staging remains a cornerstone of management because it is the strongest predictor of survival, and inguinal status determines pelvic management. Postoperative radiotherapy of the regional nodes for high-risk pathology is indicated. Chemoradiotherapy should be considered as neoadjuvant treatment for unresectable nodes or as definitive management. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Management of Educational Paradigms within the Framework of Contemporary Educational Strategies

    Directory of Open Access Journals (Sweden)

    Eduard IONESCU


    Full Text Available Each major pedagogical orientation brings with it a set of certain potential actions, a potential that becomes reality at the level of invariably at the level of educational reality. Assuming a certain pedagogical educational paradigm is thus equivalent to the transposition into practice of a certain type of experimental research and promoting a particular way of conceiving and modeling of human nature. In a world characterized by contradicting realities, by turmoil, fast developing technologies, discussing and deciding on the most appropriate educational paradigms should be a core process in the attempt of conceiving the educational vision and objectives of tomorrow. The present paper aims at discussing the role of educational paradigms within the framework of contemporary educational strategies.

  10. Contemporary Management of Medium-Sized (10-20 mm) Renal Stones: A Retrospective Multicenter Observational Study. (United States)

    Kiremit, Murat Can; Guven, Selcuk; Sarica, Kemal; Ozturk, Ahmet; Buldu, Ibrahim; Kafkasli, Alper; Balasar, Mehmet; Istanbulluoglu, Okan; Horuz, Rahim; Cetinel, Cihangir Ali; Kandemir, Abdulkadir; Albayrak, Selami


    To evaluate contemporary management approaches to medium-sized (10-20 mm) renal stones. A total of 935 patients treated for medium-sized renal stones (10-20 mm) between July 2012 and March 2014 were included in the study program. Contemporary minimally invasive approaches applied in the management of such stones were evaluated and compared. The cohort consisted of 561 male (60%) and 374 female (40%) patients. Of the 935 patients with medium-sized renal calculi, 535 (57.2%) were treated with shockwave lithotripsy (SWL), 201 (21.4%) with retrograde intrarenal surgery (RIRS), 110 (11.7%) with minimally invasive percutaneous nephrolithotomy (miniperc), and the remaining 89 (11.7%) patients with micropercutaneous nephrolithotomy (microperc). In the SWL group, stones were located mostly in the pelvis (51%), while in the miniperc and microperc groups, they were located mainly in the lower pole (46%, 53%, respectively). Stone-free rates after a single session were 77.2%, 86.1%, 88.8%, and 83.6% in the SWL, RIRS, microperc, and miniperc groups, respectively. Although no serious complications (above Clavien level III) were noted in any of the groups evaluated, Clavien I to II complications were common in the miniperc group. Although SWL is the preferred treatment option for patients with medium-sized (10-20 mm) renal stones, endourologic methods also have been found to have a significant role. Relatively lower complication rates along with higher stone-free status observed with the RIRS technique compared with percutaneous approaches have made this method a valuable option in the management of such stones in recent years.

  11. Contemporary management and outcomes of acute type A aortic dissection: An analysis of the STS adult cardiac surgery database. (United States)

    Lee, Teng C; Kon, Zachary; Cheema, Faisal H; Grau-Sepulveda, Maria V; Englum, Brian; Kim, Sunghee; Chaudhuri, Paramita S; Thourani, Vinod H; Ailawadi, Gorav; Hughes, G Chad; Williams, Matthew L; Brennan, J Matthew; Svensson, Lars; Gammie, James S


    Management of acute type A aortic dissection (AAAD) is challenging and operative strategies are varied. We used the STS Adult Cardiac Surgery Database (STS ACSD) to describe contemporary surgical strategies and outcomes for AAAD. Between July 2011 and September 2012, 2982 patients with AAAD underwent operations at 640 centers in North America. In this cohort, median age was 60 years old, 66% were male, and 80% had hypertension. The most common arterial cannulation strategies included femoral (36%), axillary (27%), and direct aortic (19%). The median perfusion and cross-clamp times were 181 and 102 min, respectively. The lowest temperature on bypass showed significant variation. Hypothermic circulatory arrest (HCA) was used in 78% of cases. Among those undergoing HCA, brain protection strategies included antegrade cerebral perfusion (31%), retrograde cerebral perfusion (25%), both (4%), and none (40%). Median HCA plus cerebral perfusion time was 40 min. Major complications included prolonged ventilation (53%), reoperation (19%), renal failure (18%), permanent stroke (11%), and paralysis (3%). Operative mortality was 17%. The median intensive care unit and hospital length of stays were 4.7 and 9.0 days, respectively. Among 640 centers, the median number of cases performed during the study period was three. Resuscitation, unresponsive state, cardiogenic shock, inotrope use, age >70, diabetes, and female sex were found to be independent predictors of mortality. These data describe contemporary patient characteristics, operative strategies, and outcomes for AAAD in North America. Mortality and morbidity for AAAD remain high. © 2018 Wiley Periodicals, Inc.

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

  13. Contemporary Management and Operations Research Graduate Programs: A Review, Recommendations, and Integration. (United States)

    Petrick, Joseph A.; Polak, George G.; Scherer, Robert F.; Munoz, Carmen Gloria


    Criticisms of graduate management education have led to changes in the balance between business and academic standards, strategic leadership, curriculum, faculty performance incentives, graduate proficiencies, and relations with the business community. Operations management/management sciences have similarly changed in terms of curricular…

  14. Numerical analysis and experiment research on fluid orbital performance of vane type propellant management device

    International Nuclear Information System (INIS)

    Hu, Q; Li, Y; Pan, H L; Liu, J T; Zhuang, B T


    Vane type propellant management device (PMD) is one of the key components of the vane-type surface tension tank (STT), and its fluid orbital performance directly determines the STT's success or failure. In present paper, numerical analysis and microgravity experiment study on fluid orbital performance of a vane type PMD were carried out. By using two-phase flow model of volume of fluid (VOF), fluid flow characteristics in the tank with the vane type PMD were numerically calculated, and the rules of fluid transfer and distribution were gotten. A abbreviate model test system of the vane type PMD is established and microgravity drop tower tests were performed, then fluid management and transmission rules of the vane type PMD were obtained under microgravity environment. The analysis and tests results show that the vane type PMD has good and initiative fluid orbital management ability and meets the demands of fluid orbital extrusion in the vane type STT. The results offer valuable guidance for the design and optimization of the new generation of vane type PMD, and also provide a new approach for fluid management and control in space environment

  15. Trends and patterns in contemporary management in smaller companies: The Danish perspective

    DEFF Research Database (Denmark)

    Ulhøi, John Parm; Madsen, Henning


    This paper reports empirical findings from a recent survey of Danish managers with a special focus on managers from smaller companies. The survey has been initiated in Denmark and it is called the 'Danish Management Barometer'. The project is a joint research program between the Aarhus School...... of Business and the Danish Association of Managers and Executives. It is based on a structured, pre-tested questionnaire send out to 1500 pre-notified managers in Denmark aiming at establishing a data base to further monitor and identify interesting changes and patterns within a broad range of managerial...

  16. Passive Devices for Advanced Fluid Management aboard Spacecraft, Phase I (United States)

    National Aeronautics and Space Administration — Acute challenges are faced by the designers of fluid systems for spacecraft because of the persistently unfamiliar and unforgiving low-g environment. For example,...

  17. Contemporary operative caries management: consensus recommendations on minimally invasive caries removal

    NARCIS (Netherlands)

    Banerjee, A.; Frencken, J.E.F.M.; Schwendicke, F.; Innes, N.P.


    The International Caries Consensus Collaboration (ICCC) presented recommendations on terminology, on carious tissue removal and on managing cavitated carious lesions. It identified 'dental caries' as the name of the disease that dentists should manage, and the importance of controlling the activity

  18. Contemporary trends in improvement of organizational-economic mechanism of environmental management (United States)

    Kiseleva, T. V.; Mikhailov, V. G.; Mikhailov, G. S.


    The article deals with the effective functioning of ecological and economic systems of various levels on the basis of an adequate organizational and economic management mechanism. The compliance matrix of the presented innovative elements in the structure of organizational and economic mechanism of environmental management is developed. The practical component of the conducted study can be recommended to municipal, regional and federal authorities, as well as industrial enterprises, to support effective, environmentally reasonable management decisions that are consistent with the global concept of sustainable development.

  19. Contemporary view of the effect of managed care on the ethics in perinatal medicine. (United States)

    Schwartz, Peter A


    Managed care has significantly altered the patient-physician relationship, and these changes have created new ethical challenges within that relationship. The physician's obligation of beneficence has been challenged by his contract with managed care. Physicians have faced increasing apparent and real conflicts of interest. The patient's right of choice has been challenged by her contract with managed care. Within perinatal medicine, those challenges have affected mode of delivery, use of technology, length of stay, and pharmaceutical choices. Additional challenges and opportunities to enhance quality of care lie ahead in the evolution of the health care system.

  20. Goal-oriented Balancing: a New Model of Contemporary Sales Management

    Directory of Open Access Journals (Sweden)

    Lars-Johan Åge


    Full Text Available This study focuses on the substantive area of sales management and it suggests that the main concern of a sales manager is to reach the sales and economical goals of the sales organization. The social process by which this main concern is resolved is called goal-oriented balancing and it describes two complementary organizational dimensions, frame development and individual development that are continuously balanced against each other. That is, the sales manager must establish effective organizational processes and structures as well as find the keys to maximum individual performance. These two processes have to be in balance and supportive of each other.

  1. Key Management Theories ... and What They Have to Say with Regards to Contemporary Headquarters Structures

    DEFF Research Database (Denmark)

    Nell, Phillip Christopher


    Multinational and multibusiness headquarters increasingly structure their headquarters in novel ways. They use several locations spread around the world, differentiate different types of headquarters activities in a very fine-grained way, they temporarily relocate top management teams, or relocate...

  2. Monopolizing, Mutualizing, or Muddling Through: Factions and Party Management in Contemporary Thailand

    Directory of Open Access Journals (Sweden)

    Paul W. Chambers


    Full Text Available In democracies throughout the world, intra-party factions manifest themselves in parties and governments. Formal and informal institutions have, however, proved crucial in managing factionalism. This is especially true in Thailand’s emerging parliamentary democracy where the management of factionalism has become a major objective for Thai parties. This study explores factions and factionalism as well as how different types of parties try to manage intra-party dissension especially in the case of Thailand. The findings suggest that management style tends to be a function of a party’s organization, with parties which practice a collegial style tending to be the more successful in controlling intra-party cliques over time. At the same time, the most important tools which party leaderships can use to control factions are the careful use of constitutional provisions and manipulation of party finance.

  3. Lower Urinary Tract Injuries Following Blunt Trauma: A Review of Contemporary Management (United States)

    Kong, Jennifer P. L; Bultitude, Matthew F; Royce, Peter; Gruen, Russell L; Cato, Alex; Corcoran, Niall M


    Lower urinary tract trauma, although relatively uncommon in blunt trauma, can lead to significant morbidity when diagnosed late or left untreated; urologists may only encounter a handful of these injuries in their career. This article reviews the literature and reports on the management of these injuries, highlighting the issues facing clinicians in this subspecialty. Also presented is a structured review detailing the mechanisms, classification, diagnosis, management, and complications of blunt trauma to the bladder and urethra. The prognosis for bladder rupture is excellent when treated. Significant intraperitoneal rupture or involvement of the bladder neck mandates surgical repair, whereas smaller extraperitoneal lacerations may be managed with catheterization alone. With the push for management of trauma patients in larger centers, urologists in these hospitals are seeing increasing numbers of lower urinary tract injuries. Prospective analysis may be achieved in these centers to address the current lack of Level 1 evidence. PMID:22114545

  4. Contemporary Management Strategies for Chronic Type B Aortic Dissections: A Systematic Review

    NARCIS (Netherlands)

    Kamman, Arnoud V.; de Beaufort, Hector W. L.; van Bogerijen, Guido H W; Nauta, FJH; Heijmen, Robin H.; Moll, Frans L.; van Herwaarden, Joost A.; Trimarchi, Santi


    Background Currently, the optimal management strategy for chronic type B aortic dissections (CBAD) is unknown. Therefore, we systematically reviewed the literature to compare results of open surgical repair (OSR), standard thoracic endovascular aortic repair (TEVAR) or branched and fenestrated TEVAR

  5. Contemporary Review of Risk-Stratified Management in Acute Uncomplicated and Complicated Diverticulitis. (United States)

    Boermeester, Marja A; Humes, David J; Velmahos, George C; Søreide, Kjetil


    Acute colonic diverticulitis is a common clinical condition. Severity of the disease is based on clinical, laboratory, and radiological investigations and dictates the need for medical or surgical intervention. Recent clinical trials have improved the understanding of the natural history of the disease resulting in new approaches to and better evidence for the management of acute diverticulitis. We searched the Cochrane Library (years 2004-2015), MEDLINE (years 2004-2015), and EMBASE (years 2004-2015) databases. We used the search terms "diverticulitis, colonic" or "acute diverticulitis" or "divertic*" in combination with the terms "management," "antibiotics," "non-operative," or "surgery." Registers for clinical trials (such as the WHO registry and the ) were searched for ongoing, recruiting, or closed trials not yet published. Antibiotic treatment can be avoided in simple, non-complicated diverticulitis and outpatient management is safe. The management of complicated disease, ranging from a localized abscess to perforation with diffuse peritonitis, has changed towards either percutaneous or minimally invasive approaches in selected cases. The role of laparoscopic lavage without resection in perforated non-fecal diverticulitis is still debated; however, recent evidence from two randomised controlled trials has found a higher re-intervention in this group of patients. A shift in management has occurred towards conservative management in acute uncomplicated disease. Those with uncomplicated acute diverticulitis may be treated without antibiotics. For complicated diverticulitis with purulent peritonitis, the use of peritoneal lavage appears to be non-superior to resection.

  6. Contemporary, age-based trends in the incidence and management of patients with early-stage kidney cancer. (United States)

    Tan, Hung-Jui; Filson, Christopher P; Litwin, Mark S


    Although kidney cancer incidence and nephrectomy rates have risen in tandem, clinical advances have generated new uncertainty regarding the optimal management of patients with small renal tumors, especially the elderly. To clarify existing practice patterns, we assessed contemporary trends in the incidence and management of patients with early-stage kidney cancer. Using Surveillance, Epidemiology, and End Results data, we identified adult patients diagnosed with T1aN0M0 kidney cancer from 2000 to 2010. We determined age-adjusted and age-specific incidence and management rates (i.e., nonoperative, ablation, partial nephrectomy [PN], and radical nephrectomy) per 100,000 adults and determined the average annual percent change (AAPC). Finally, we compared management groups using multinomial logistic regression accounting for patient characteristics, cancer information, and county-level measures for health. From 2000 to 2010, we identified 41,645 adults diagnosed with T1aN0M0 kidney cancer. Overall incidence increased from 3.7 to 7.0 per 100,000 adults (AAPC = 7.0%, Pmanagement and ablation approached nephrectomy rates for those aged 75 to 84 years and became the predominant strategy for patients older than 84 years. Adjusting for clinical, oncological, and environmental factors, older patients less frequently underwent PN and more often received ablative or nonoperative management (P<0.001). As the incidence of early-stage kidney cancer rises, patients are increasingly treated with nonoperative and nephron-sparing strategies, especially among the most elderly. The broader array of treatment options suggests opportunities to better personalize kidney cancer care for seniors. Published by Elsevier Inc.

  7. Participatory Geographic Information Systems as an organizational platform for the integration of traditional and scientific knowledge in contemporary fire and fuels management (United States)

    Brooke Balauf McBride; Fernando Sanchez-Trigueros; Stephen J Carver; Alan E Watson; Linda Moon Stumpff; Roian Matt; William T. Borrie


    Traditional knowledge about fire and its effects held by indigenous people, who are connected to specific landscapes, holds promise for informing contemporary fire and fuels management strategies and augmenting knowledge and information derived from western science. In practice, however, inadequate means to organize and communicate this traditional knowledge with...

  8. Hypertrophic Cardiomyopathy in Children, Adolescents, and Young Adults Associated With Low Cardiovascular Mortality With Contemporary Management Strategies. (United States)

    Maron, Barry J; Rowin, Ethan J; Casey, Susan A; Lesser, John R; Garberich, Ross F; McGriff, Deepa M; Maron, Martin S


    Youthful age has been considered the time of greatest risk for patients with hypertrophic cardiomyopathy (HCM), largely because of the possibility of sudden death. The last 2 decades have witnessed more reliable identification of at-risk patients and utilization of implantable cardioverter-defibrillators for prevention of sudden death, and other contemporary treatment options. Whether such management advances have significantly altered the considerable mortality rate for young HCM patients remains unresolved. We studied long-term outcome in 474 consecutive HCM patients between 7 and 29 years of age presenting at 2 referral institutions. Over 7.1±5.1 years of follow-up (6.0 [3.0, 10.0]), 452 patients (95%) survived, with 95% experiencing no or mild symptoms. HCM-related death occurred in 18 patients (3%; 0.54%/y): arrhythmic sudden death (n=12), progressive heart failure and heart transplant complications (n=5), or postoperatively (n=1). In contrast, aborted life-threatening events occurred in 63 other high-risk patients (13%) with implantable cardioverter-defibrillator interventions for ventricular tachyarrhythmias (n=31), resuscitated out-of-hospital cardiac arrest (n=20), or heart transplant for advanced heart failure (n=12), 1.8%/y, 3-fold higher than HCM mortality. Five- and 10-year survival (considering only HCM deaths) was high (97% and 94%, respectively), virtually identical to that reported in middle-aged adult HCM patients (98% and 94%, P=0.23). In a large hospital-based cohort of young HCM patients, representing an age group considered at greatest risk, low mortality rates can be achieved with the application of contemporary cardiovascular treatment strategies, largely because of reliable identification of high-risk patients who benefited from implantable cardioverter-defibrillators for sudden death prevention, thereby creating the opportunity for extended longevity and good quality of life. © 2015 American Heart Association, Inc.

  9. The critical care management of spontaneous intracranial hemorrhage: a contemporary review. (United States)

    de Oliveira Manoel, Airton Leonardo; Goffi, Alberto; Zampieri, Fernando Godinho; Turkel-Parrella, David; Duggal, Abhijit; Marotta, Thomas R; Macdonald, R Loch; Abrahamson, Simon


    Spontaneous intracerebral hemorrhage (ICH), defined as nontraumatic bleeding into the brain parenchyma, is the second most common subtype of stroke, with 5.3 million cases and over 3 million deaths reported worldwide in 2010. Case fatality is extremely high (reaching approximately 60 % at 1 year post event). Only 20 % of patients who survive are independent within 6 months. Factors such as chronic hypertension, cerebral amyloid angiopathy, and anticoagulation are commonly associated with ICH. Chronic arterial hypertension represents the major risk factor for bleeding. The incidence of hypertension-related ICH is decreasing in some regions due to improvements in the treatment of chronic hypertension. Anticoagulant-related ICH (vitamin K antagonists and the newer oral anticoagulant drugs) represents an increasing cause of ICH, currently accounting for more than 15 % of all cases. Although questions regarding the optimal medical and surgical management of ICH still remain, recent clinical trials examining hemostatic therapy, blood pressure control, and hematoma evacuation have advanced our understanding of ICH management. Timely and aggressive management in the acute phase may mitigate secondary brain injury. The initial management should include: initial medical stabilization; rapid, accurate neuroimaging to establish the diagnosis and elucidate an etiology; standardized neurologic assessment to determine baseline severity; prevention of hematoma expansion (blood pressure management and reversal of coagulopathy); consideration of early surgical intervention; and prevention of secondary brain injury. This review aims to provide a clinical approach for the practicing clinician.

  10. The contemporary role of renal mass biopsy in the management of small renal tumors

    International Nuclear Information System (INIS)

    Lim, Amy; O'Neil, Brock; Heilbrun, Marta E.; Dechet, Christopher; Lowrance, William T.


    The selective use of percutaneous biopsy for diagnosis in renal masses is a relatively uncommon approach when compared to the management of other solid neoplasms. With recent advancements in imaging techniques and their widespread use, the incidental discovery of asymptomatic, small renal masses (SRM) is on the rise and a substantial percentage of these SRM are benign. Recent advances in diagnostics have significantly improved accuracy rates of renal mass biopsy (RMB), making it a potentially powerful tool in the management of SRM. In this review, we will discuss the current management of SRM, problems with the traditional view of RMB, improvements in the diagnostic power of RMB, cost-effectiveness of RMB, and risks associated with RMB. RMB may offer important information enabling treating clinicians to better risk-stratify patients and ultimately provide a more personalized treatment approach for SRM.

  11. Fluid in the management of the acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Karki S


    Full Text Available Introduction Non-cardiogenic pulmonary edema is the hallmark of the acute respiratory distress syndrome (ARDS. The amount of fluid and which fluid should be used in these patients is controversial. Methods 43 patients with ARDS treated in the intensive care unit (ICU of the Second Hospital, Jilin University between November 1, 2011-November 1, 2012 were prospectively analyzed and was observational. Volume and the type of fluid administered were compared to 90 day mortality and the 24 and 72 hour sequential organ failure assessment (SOFA score, lactate level, oxygenation index (PaO2/FiO2, duration of ICU stay, total ventilator days, and need for continuous renal replacement therapy (CRRT. Results Mortality was increased when hydroxylethyl starch (HES was used in the first day or plasma substitutes were used during the first 3 days (P3000 ml during the first 24 hours or >8000 ml during the first 72 hours were associated with higher SOFA scores at 24 and 72 hours (P<0.05, both comparisons. Colloid, especially higher volume colloid use was also associated with increased SOFA scores at either 24 or 72 hours. Conclusions Limiting the use of colloids and the total amount of fluid administered to patients with ARDS is associated with improved mortality and SOFA scores.

  12. Investigating antecedent factors to job performance: Contemporary evidence from government supply management professionals

    Directory of Open Access Journals (Sweden)

    Chengedzai Mafini


    Full Text Available Purpose: The purpose of the study was to investigate the influence of transformational leadership, organisational citizenship behaviour and quality of work life on job performance amongst supply management professionals employed by the South African government. Rationale: The depressed job performance of supply management professionals in the South African government presents an impetus to generate new empirical information on the subject in order to find solutions. Methodology: A quantitative survey approach was followed using a sample of 264 supply management professionals employed in the South African government and were based in Gauteng Province. A Confirmatory Factor Analysis (CFA was conducted to assess psychometric properties of the measurement instrument. Hypotheses were tested using Structural Equation Modelling (SEM. Findings: Transformational leadership had positive and significant relationships with organisational citizenship behaviour and quality of work life. Quality of work life exerted a greater influence of job performance than organisational citizenship behaviour. Value of research: The study provides current evidence of the influence of transformational leadership on organisational citizenship behaviour and quality of work life, as well as the influence of organisational citizenship behaviour and quality of work life on job performance amongst supply management professionals. Conclusion: Transformational leadership has a positive influence on organisational citizenship behaviour and quality of work life amongst supply management professionals in the government. Both organisational citizenship behaviour and quality of work life exerta positive influence on the job performance of supply management professionals in the government. Future studies should be extended to other professional cohorts in both the private and the government sectors.

  13. Contemporary management of ductal carcinoma in situ and lobular carcinoma in situ. (United States)

    Obeng-Gyasi, Samilia; Ong, Cecilia; Hwang, E Shelley


    The management of in situ lesions ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS) continues to evolve. These diagnoses now comprise a large burden of mammographically diagnosed cancers, and with a global trend towards more population-based screening, the incidence of these lesions will continue to rise. Because outcomes following treatment for DCIS and LCIS are excellent, there is emerging controversy about what extent of treatment is optimal for both diseases. Here we review the current approaches to the diagnosis and treatment of both DCIS and LCIS. In addition, we will consider potential directions for future management of these lesions.

  14. Contemporary management of prostate cancer: a practice survey of Ontario genitourinary radiation oncologists

    International Nuclear Information System (INIS)

    Rodrigues, George; D'Souza, David; Crook, Juanita; Malone, Shawn; Sathya, Jinka; Morton, Gerard


    Objective: To survey radiation oncology practice in the utilization of hormonal and radiation therapy in the primary, adjuvant and salvage treatment of localized prostate cancer. Materials and methods: Genitourinary radiation oncologists practicing in Ontario were invited to participate in a practice survey examining staging, hormonal and radiation management, and radiation technique for a variety of common clinical scenarios. Background demographic information was collected on all respondents. The survey consisted of three cases relating to the hormonal/radiation management of low-, intermediate-, and high-risk prostate cancer as well as two adjuvant and one salvage post-prostatectomy scenarios. The survey response rate was 70% (26/37). Results: Clinicians were more likely to utilize laboratory and imaging studies for staging as the risk categorization increased. Low-risk disease was managed with radiation alone in 26/26 (70 Gy in 65%, 74-79.8 Gy in 35%). Intermediate-risk disease was managed with radiation (70 Gy in 46%, 74-79.8 Gy in 54%) with neoadjuvant hormones in 58%. All respondents managed high-risk disease with adjuvant hormones in addition to radiation therapy (70-71 Gy in 85%, and 76 Gy in 15%). In the pT3a, margin negative (PSA undetectable) scenario, most individuals would not recommend adjuvant radiation (73%). If margins were positive, 30% would still not recommend adjuvant radiation. In the salvage scenario (slowly rising PSA 4 years post-prostatectomy for pT2a close margin disease), all respondents would manage with radiation therapy. Hormones were not routinely recommended in the initial management of the adjuvant and salvage scenarios. Radiation doses utilized for both adjuvant and salvage treatment ranged from 60-70 Gy (median 66 Gy). Conclusions: General agreement exists for the management of low- and high-risk disease and in the post-prostatectomy salvage setting. Use of dose-escalation and neoadjuvant hormones in the intermediate

  15. Contemporary management of stage i testicular seminoma: a survey of Canadian radiation oncologists (United States)

    Samant, R.; Alomary, I.; Genest, P.; Eapen, L.


    Recently published studies clearly indicate that there are now several acceptable options for managing stage i testicular seminoma patients after orchiectomy. We therefore decided to survey Canadian radiation oncologists to determine how they currently manage such patients and to compare the results with previous surveys. Our results demonstrate that adjuvant single-agent chemotherapy is being considered as an option by an increasing proportion of radiation oncologists (although it is not considered the preferred option), the routine use of radiotherapy is declining, and surveillance is becoming increasingly popular and is recommended most often. PMID:18769613

  16. Bladder neck contracture-incidence and management following contemporary robot assisted radical prostatectomy technique

    Directory of Open Access Journals (Sweden)

    Jaspreet Singh Parihar


    Conclusions: BNC was identified in 1.6% of patients in our series following RARP. Intraoperative blood loss was a significant risk factor for BNC. In 20% of BNC patients a migrated foreign body was noted at vesicourethral anastomosis. Primary management of patients with BNC following RARP should be bladder neck incision and self CIC regimen.

  17. Overview of contemporary issues of forest research and management in China (United States)

    Hong S. He; Stephen R. Shifley; Frank R., III Thompson


    With 207 million ha of forest covering 22% of its land area, China ranks fifth in the world in forest area. Rapid economic growth, climate change, and forest disturbances pose new, complex challenges for forest research and management. Progress in meeting these challenges is relevant beyond China, because China's forests represent 34% of Asia's forests and 5...

  18. Contemporary management and surveillance strategy after shunt or endoscopic third ventriculostomy procedures for hydrocephalus. (United States)

    Janjua, M Burhan; Hoffman, Caitlin E; Souweidane, Mark M


    The management of hydrocephalus can be challenging even in expert hands. Due to acute presentation, recurrence, accompanying complications, the need for urgent diagnosis; a robust management plan is an absolute necessity. We devised a novel time efficient surveillance strategy during emergency, and clinic follow up settings which has never been described in the literature. We searched all articles embracing management/surveillance protocol on pediatric hydrocephalus utilizing the terms "hydrocephalus follow up" or "surveillance protocol after hydrocephalus treatment". The authors present their own strategy based on vast experience in the hydrocephalus management at a single institution. The need for the diagnostic laboratory testing, age and presentation based radiological imaging, significance of neuro-opthalmological exam, and when to consider the emergent exploration have been discussed in detail. Moreover, a definitive triaging strategy has been described with the help of flow chart diagrams for clinicians, and the neurosurgeons in practice. The triage starts from detail history, physical exam, necessary labs, radiological imaging depending on the presentation, and the age of the child. A quick head CT scan helps after shunt surgery while, a FAST sequence MRI scan (fsMRI) is important in post ETV patients. The need for neuro-opthalmological exam, and the shunt series stays vital in asymptomatic patients during regular follow up. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Management of Formalised Marketing and Media Activities in Outsourcing Companies in the Age of Competitiveness, with Particular Emphasis on Contemporary Marketing Approach

    Directory of Open Access Journals (Sweden)

    Kozakowski Łukasz


    Full Text Available The article outlines the issues related to the topic of management of formalised marketing and media activities in outsourcing companies in the age of competitiveness, with particular emphasis on contemporary marketing approach. General management of the organisation and management of marketing and media activities, particularly in their formalised form, both have a significant effect on improving company competitiveness in the market. Outsourcing companies constitute a specific sector of services which without a very well-functioning marketing and media activities would not be able to operate and develop in the market. The article presents selected aspects connected with the management of marketing and media activities, with particular emphasis on formalisation of marketing activities in outsourcing companies. The analysis presented below focuses on the efficiency of the implemented formalisation of marketing and media activities in outsourcing companies in relation to their competitiveness, with special recognition of contemporary marketing approach.

  20. Change to earlier surgical interventions: contemporary management of unilateral vocal fold paralysis. (United States)

    Costello, Declan


    The management of unilateral vocal fold paralysis has undergone significant changes in the last 2 decades. This has largely been made possible by advances in endoscope technology and new injectable materials. This article will cover the main changes in management of patients with unilateral vocal fold paralysis and summarize the recent literature in relation to early intervention in this group. Several recent studies have suggested that early vocal fold injection medialization reduces the likelihood of needing open laryngeal framework surgery in future. Early injection medialization appears to give good long-term results with few complications and minimizes the need for future laryngeal framework surgery. It should be considered in centres wherein the equipment and trained staff are available.

  1. Identifying Silence Climate in Organizations in the Framework of Contemporary Management Approaches

    Directory of Open Access Journals (Sweden)

    Mustafa Emre Civelek


    Full Text Available Dynamic competition conditions in present day, bring about the consequence for businesses to face varied problems with each passing day. At this point, current management approaches include studies that would shed light on the new problems of businesses. Organizational Silence, a concept that has recently been being voiced in business world, has come up in such context. Organizational silence could be expressed as the employee behavior of keeping silent about certain negativities due to various reasons in an organization. Since knowledge sharing in modern organizations is of capital importance in terms of responding hastily to the changes in a competitive environment, spread of this behavior of employees to organization culture and climate presents a threat of indifference. In this study, the concept of Organizational Silence is defined and the effects of conceived silence climate on management of organizations are discussed.

  2. Identifying Silence Climate in Organizations in the Framework of Contemporary Management Approaches

    Directory of Open Access Journals (Sweden)

    Mustafa Emre Civelek


    Full Text Available Dynamic competition conditions in present day bring about the consequence for businesses to face varied problems with each passing day. At this point, current management approaches include studies that would shed light on the new problems of businesses. Organizational Silence, a concept that has recently been being voiced in business world, has come up in such context. Organizational silence could be expressed as the employee behavior of keeping silent about certain negativities due to various reasons in an organization. Since knowledge sharing in modern organizations is of capital importance in terms of responding hastily to the changes in a competitive environment, spread of this behavior of employees to organization culture and climate presents a threat of indifference. In this study, the concept of Organizational Silence is defined and the effects of conceived silence climate on management of organizations are discussed.

  3. Pain medicine versus pain management: ethical dilemmas created by contemporary medicine and business. (United States)

    Loeser, John D; Cahana, Alex


    The world of health care and the world of business have fundamentally different ethical standards. In the past decades, business principles have progressively invaded medical territories, leading to often unanticipated consequences for both patients and providers. Multidisciplinary pain management has been shown to be more effective than all other forms of health care for chronic pain patients; yet, fewer and fewer multidisciplinary pain management facilities are available in the United States. The amazing increase in interventional procedures and opioid prescriptions has not led to a lessening of the burden of chronic pain patients. Ethical dilemmas abound in the treatment of chronic pain patients: many are not even thought about by providers, administrators, insurance companies, or patients. We call for increased pain educational experiences for all types of health care providers and the separation of business concepts from pain-related health care.

  4. Contemporary management of locally advanced rectal cancer: Resolving issues, controversies and shifting paradigms. (United States)

    Nacion, Aeris Jane D; Park, Youn Young; Kim, Nam Kyu


    Advancements in rectal cancer treatment have resulted in improvement only in locoregional control and have failed to address distant relapse, which is the predominant mode of treatment failure in rectal cancer. As the efficacy of conventional chemoradiotherapy (CRT) followed by total mesorectal excision (TME) reaches a plateau, the need for alternative strategies in locally advanced rectal cancer (LARC) has grown in relevance. Several novel strategies have been conceptualized to address this issue, including: 1) neoadjuvant induction and consolidation chemotherapy before CRT; 2) neoadjuvant chemotherapy alone to avoid the sequelae of radiation; and 3) nonoperative management for patients who achieved pathological or clinical complete response after CRT. This article explores the issues, recent advances and paradigm shifts in the management of LARC and emphasizes the need for a personalized treatment plan for each patient based on tumor stage, location, gene expression and quality of life.

  5. Theoretical and practical aspects of risk management in contemporary global supply chains

    Directory of Open Access Journals (Sweden)


    Full Text Available Globalization, off-shoring, outsourcing and pressure on cost reduction influence on the increasing complexity of supply chains and lead to higher risk. This may concern supplies, deliveries, manufacturing and transportation. Companies which source from distant countries have to implement risk management system. Examples of companies which use such systems prove, that it is possible to reduce uncertainty. Results concern shorter lead times, better quality and accepted cost level.

  6. Conceptions of authority within contemporary social work practice in managed mental health care organizations. (United States)

    Bransford, Cassandra L


    This article examines how social workers may use their authority to create managed mental health care organizations that support the principles and values of professional social work practice. By exploring research and theoretical contributions from a multidisciplinary perspective, the author suggests ways that social workers may incorporate empowerment strategies into their organizational practices to create more socially responsible and humane mental health organizations. (c) 2005 APA, all rights reserved.

  7. Value of Supraregional Multidisciplinary Review for the Contemporary Management of Testicular Tumors. (United States)

    Purshouse, Karin; Watson, Robert A; Church, David N; Richardson, Charlotte; Crane, Gemma; Traill, Zoe; Sullivan, Mark; Roberts, Ian; Browning, Lisa; Turner, Gareth; Parameshwaran, Vishnu; Johnson, Joseph; Chitnis, Meenali; Protheroe, Andrew; Verrill, Clare


    Testicular cancers are an uncommon and highly curable group of tumors that are typically managed by specialist multidisciplinary teams (MDTs). Although recent guidelines have emphasized the importance of tumor prognostic factors in predicting recurrence and personalizing therapy in early-stage disease, the role of central pathology review in determining these factors is unclear. We compared the referral histopathology reports with those obtained after expert central review for all cases reviewed by the UK Thames Valley Cancer Network testicular tumor MDT from August 2004 to September 2012. For cases in which the findings differed, we recorded the effect of the alteration on the estimates of patient prognosis and predicted clinical management using international (European Society of Medical Oncology [ESMO]) and local guidelines. The histopathology reports were altered after central review in 129 of 465 cases (27.7%) referred to the testicular tumor MDT during the study period. These resulted in changes in the estimation of prognosis for 42 patients (9.0% total), with a predicted affect on management according to the ESMO guidelines in 30 cases (6.5%). These proportions were broadly similar for both seminoma and nonseminoma, although the reasons for the discrepancies differed between the 2 (principally errors in categorization of rete testis invasion in seminoma and of lymphovascular invasion in nonseminoma). Changes to the tumor type were uncommon (2 cases). Central MDT review results in frequent, clinically relevant alterations to testicular tumor histopathology reports for testicular tumors. The results of our study demonstrate the importance of specialist MDTs to inform patient-centered care and ensure best practice in the management of these uncommon cancers. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. An online spatial database of Australian Indigenous Biocultural Knowledge for contemporary natural and cultural resource management. (United States)

    Pert, Petina L; Ens, Emilie J; Locke, John; Clarke, Philip A; Packer, Joanne M; Turpin, Gerry


    With growing international calls for the enhanced involvement of Indigenous peoples and their biocultural knowledge in managing conservation and the sustainable use of physical environment, it is timely to review the available literature and develop cross-cultural approaches to the management of biocultural resources. Online spatial databases are becoming common tools for educating land managers about Indigenous Biocultural Knowledge (IBK), specifically to raise a broad awareness of issues, identify knowledge gaps and opportunities, and to promote collaboration. Here we describe a novel approach to the application of internet and spatial analysis tools that provide an overview of publically available documented Australian IBK (AIBK) and outline the processes used to develop the online resource. By funding an AIBK working group, the Australian Centre for Ecological Analysis and Synthesis (ACEAS) provided a unique opportunity to bring together cross-cultural, cross-disciplinary and trans-organizational contributors who developed these resources. Without such an intentionally collaborative process, this unique tool would not have been developed. The tool developed through this process is derived from a spatial and temporal literature review, case studies and a compilation of methods, as well as other relevant AIBK papers. The online resource illustrates the depth and breadth of documented IBK and identifies opportunities for further work, partnerships and investment for the benefit of not only Indigenous Australians, but all Australians. The database currently includes links to over 1500 publically available IBK documents, of which 568 are geo-referenced and were mapped. It is anticipated that as awareness of the online resource grows, more documents will be provided through the website to build the database. It is envisaged that this will become a well-used tool, integral to future natural and cultural resource management and maintenance. Copyright © 2015. Published

  9. Contemporary Management of Mandibular Fracture Nonunion-A Retrospective Review and Treatment Algorithm. (United States)

    Ostrander, Benjamin T; Wang, Howard D; Cusano, Alessandro; Manson, Paul N; Nam, Arthur J; Dorafshar, Amir H


    Nonunion is an uncommon complication after mandibular fractures. The purpose of this investigation was to compare outcomes of patients with mandibular fracture nonunion who were treated with a 1- versus 2-stage approach and propose a pragmatic treatment algorithm for surgical management based on preoperative characteristics. The authors conducted a retrospective study consisting of patients who presented to 2 level 1 trauma centers for the management of mandibular fracture nonunion over a 10-year period. The primary predictor variable was 1- versus 2-stage treatment. Outcomes were examined to propose a treatment algorithm. Eighteen patients were included in the study. The sample's mean age was 44.0 ± 19.3 years and most were men (88.9%). Mandibular angle and body accounted for 77.8% of cases. A single-stage approach was used in 13 patients (72.2%). Bone grafts or vascularized bone flaps were required in 13 patients (72.2%). Patients who required 2-stage treatments had intraoral soft tissue defects. Mean length of follow-up was 13.3 ± 20.4 months. All patients achieved bony union, with complications occurring in 5 patients (27.8%). The authors' 10-year experience was used to formulate a treatment algorithm based on bony defect size and soft tissue status, which can be used to inform optimal surgical management. Nonunion of mandibular fractures is an infrequent and complex condition requiring careful and deliberate surgical management. A single-stage approach is appropriate in most cases and does not negatively affect outcomes. Bony defect size and soft tissue status are essential parameters for determining the approach and timing of reconstruction. Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Role of coronary physiology in the contemporary management of coronary artery disease (United States)

    Ruparelia, Neil; Kharbanda, Rajesh K


    Coronary artery disease (CAD) remains the leading cause of death worldwide with approximately 1 in 30 patients with stable CAD experiencing death or acute myocardial infarction each year. The presence and extent of resultant myocardial ischaemia has been shown to confer an increased risk of adverse outcomes. Whilst, optimal medical therapy (OMT) forms the cornerstone of the management of patients with stable CAD, a significant number of patients present with ischaemia refractory to OMT. Historically coronary angiography alone has been used to determine coronary lesion severity in both stable and acute settings. It is increasingly clear that this approach fails to accurately identify the haemodynamic significance of lesions; especially those that are visually “intermediate” in severity. Revascularisation based upon angiographic appearances alone may not reduce coronary events above OMT. Technological advances have enabled the measurement of physiological indices including the fractional flow reserve, the index of microcirculatory resistance and the coronary flow reserve. The integration of these parameters into the routine management of patients presenting to the cardiac catheterization laboratory with CAD represents a critical adjunctive tool in the optimal management of these patients by identifying patients that would most benefit from revascularisation and importantly also highlighting patients that would not gain benefit and therefore reducing the likelihood of adverse outcomes associated with coronary revascularisation. Furthermore, these techniques are applicable to a broad range of patients including those with left main stem disease, proximal coronary disease, diabetes mellitus, previous percutaneous coronary intervention and with previous coronary artery bypass grafting. This review will discuss current concepts relevant to coronary physiology assessment, its role in the management of both stable and acute patients and future applications. PMID

  11. Role of coronary physiology in the contemporary management of coronary artery disease. (United States)

    Ruparelia, Neil; Kharbanda, Rajesh K


    Coronary artery disease (CAD) remains the leading cause of death worldwide with approximately 1 in 30 patients with stable CAD experiencing death or acute myocardial infarction each year. The presence and extent of resultant myocardial ischaemia has been shown to confer an increased risk of adverse outcomes. Whilst, optimal medical therapy (OMT) forms the cornerstone of the management of patients with stable CAD, a significant number of patients present with ischaemia refractory to OMT. Historically coronary angiography alone has been used to determine coronary lesion severity in both stable and acute settings. It is increasingly clear that this approach fails to accurately identify the haemodynamic significance of lesions; especially those that are visually "intermediate" in severity. Revascularisation based upon angiographic appearances alone may not reduce coronary events above OMT. Technological advances have enabled the measurement of physiological indices including the fractional flow reserve, the index of microcirculatory resistance and the coronary flow reserve. The integration of these parameters into the routine management of patients presenting to the cardiac catheterization laboratory with CAD represents a critical adjunctive tool in the optimal management of these patients by identifying patients that would most benefit from revascularisation and importantly also highlighting patients that would not gain benefit and therefore reducing the likelihood of adverse outcomes associated with coronary revascularisation. Furthermore, these techniques are applicable to a broad range of patients including those with left main stem disease, proximal coronary disease, diabetes mellitus, previous percutaneous coronary intervention and with previous coronary artery bypass grafting. This review will discuss current concepts relevant to coronary physiology assessment, its role in the management of both stable and acute patients and future applications.

  12. Risk factor management in a contemporary Australian population at increased cardiovascular disease risk. (United States)

    Campbell, D J; Coller, J M; Gong, F F; McGrady, M; Prior, D L; Boffa, U; Shiel, L; Liew, D; Wolfe, R; Owen, A J; Krum, H; Reid, C M


    Effective management of cardiovascular and chronic kidney disease risk factors offers longer, healthier lives and savings in health care. We examined risk factor management in participants of the SCReening Evaluation of the Evolution of New Heart Failure (SCREEN-HF) study, a self-selected population at increased cardiovascular disease risk recruited from members of a health insurance fund in Melbourne and Shepparton, Australia. Inclusion criteria were age ≥60 years with one or more of self-reported ischaemic or other heart disease, irregular or rapid heart rhythm, cerebrovascular disease, renal impairment, or treatment for hypertension or diabetes for ≥2 years. Exclusion criteria were known heart failure or cardiac abnormality on echocardiography or other imaging. Medical history, clinical examination, full blood examination and biochemistry (without lipids and HbA1c) were performed for 3847 participants on enrolment, and blood pressure, lipids and HbA1c were measured 1-2 years after enrolment for 3202 participants. Despite 99% of 3294 participants with hypertension receiving antihypertensive medication, half had blood pressures >140/90 mmHg. Approximately 77% of participants were overweight or obese, with one third obese. Additionally, 74% of participants at high cardiovascular disease risk had low density lipoprotein cholesterol levels ≥2 mmol/l, one third of diabetic participants had HbA1c >7%, 22% had estimated glomerular filtration rate management of modifiable risk factors. This article is protected by copyright. All rights reserved.

  13. A contemporary review of management and prognostic factors of upper tract urothelial carcinoma. (United States)

    Leow, Jeffrey J; Orsola, Anna; Chang, Steven L; Bellmunt, Joaquim


    Upper tract urothelial carcinoma (UTUC) accounts for management and potentially improve outcomes. This article systematically reviews current literature on prognostic factors and management options for UTUC. A comprehensive literature search was performed to identify all studies examining prognostic factors and management options for UTUC. The search included the Medline, Embase, Cochrane Central Register of Controlled Trials databases, and abstracts from the American Society of Clinical Oncology meetings up to November 2014. An updated systematic review was performed. Preoperative prognostic factors for UTUC patients include age, race, performance status, obesity, smoking status, elevated fibrinogen levels, hydronephrosis, tumor size, multi-focality, location, clinical grade and previous/synchronous bladder cancer. Postoperative variables include tumor stage/grade, multifocality, nodal involvement, lympho-vascular invasion, initial ureteral location, necrosis, sessile architecture, variant histologies and presence of tissue ALDH1 and SOX2. Curative treatment of choice is NU, with lymphadenectomy conferring survival benefits. Minimally invasive surgery has equivalent oncologic and better peri-operative outcomes compared to open surgery. Conservative therapy includes adjuvant BCG and intravesical mitomycin C. Two randomized trials investigating postoperative instillation of mitomycin C suggest bladder recurrence benefits. Adjuvant chemo-radiotherapy may be useful for patients with advanced T3/4 and/or N+ disease. Gold-standard treatment for UTUC remains NU, increasingly performed using minimally invasive surgery. Nomograms including pre- and post-operative variables can aid prognostication and guide further therapy. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Microneurosurgical Management of Posterior Communicating Artery Aneurysm: A Contemporary Series from Helsinki. (United States)

    Thiarawat, Peeraphong; Jahromi, Behnam Rezai; Kozyrev, Danil A; Intarakhao, Patcharin; Teo, Mario K; Choque-Velasquez, Joham; Hernesniemi, Juha


    The objectives of this study were to analyze microsurgical techniques and to determine correlations between microsurgical techniques and the radiographic findings in the microneurosurgical treatment of posterior communicating artery aneurysms (PCoAAs). We retrospectively analyzed radiographic findings and videos of surgeries in 64 patients with PCoAAs who underwent microsurgical clipping by the senior author from August 2010 to 2014. From 64 aneurysms, 30 (47%) had acute subarachnoid hemorrhage (SAH) that necessitated lamina terminalis fenestration (odds ratio [OR], 67.67; P < 0.001) and Liliequist membrane fenestration (OR, 19.62; P < 0.001). The low-lying aneurysms significantly necessitated the coagulation of the dura covering the anterior clinoid process (ACP) (OR, 7.43; P = 0.003) or anterior clinoidectomy (OR, 91.0; P < 0.001). We preferred straight clips in 45 (83%) of 54 posterolateral projecting aneurysms (OR, 45.0; P < 0.001), but preferred curved clips for posteromedial projecting aneurysms (OR, 6.39; P = 0.008). The mean operative time from the brain retraction to the final clipping was 17 minutes and 43 seconds. Postoperative computed tomography angiography revealed complete occlusion of 60 (94%) aneurysms. Three (4.6%) patients with acute SAH suffered postoperative lacunar infarction. For ruptured aneurysms, lamina terminalis and Liliequist membrane fenestration are useful for additional cerebrospinal fluid drainage. For low-lying aneurysms, coagulation of the dura covering the ACP or tailored anterior clinoidectomy might be necessary for exposing the proximal aneurysm neck. Type of clips depends on the direction of projection. The microsurgical clipping of the PCoAAs can achieve good immediate complete occlusion rate with low postoperative stroke rate. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Contemporary assumptions on human nature and work and approach to human potential managing

    Directory of Open Access Journals (Sweden)

    Vujić Dobrila


    Full Text Available A general problem of this research is to identify if there is a relationship between the assumption on human nature and work (Mcgregor, Argyris, Schein, Steers and Porter and a general organizational model preference, as well as a mechanism of human resource management? This research was carried out in 2005/2006. The sample consisted of 317 subjects (197 managers, 105 highly educated subordinates and 15 entrepreneurs in 7 big enterprises in a group of small business enterprises differentiating in terms of the entrepreneur’s structure and a type of activity. A general hypothesis "that assumptions on human nature and work are statistically significant in connection to the preference approach (models, of work motivation commitment", has been confirmed. A specific hypothesis have been also confirmed: ·The assumptions on a human as a rational economic being are statistically significant in correlation with only two mechanisms of traditional models, the mechanism of method work control and the working discipline mechanism. ·Statistically significant assumptions on a human as a social being are correlated with all mechanisms of engaging employees, which belong to the model of the human relations, except the mechanism introducing the adequate type of prizes for all employees independently of working results. ·The assumptions on a human as a creative being are statistically significant, positively correlating with preference of two mechanisms belonging to the human resource model by investing into education and training and making conditions for the application of knowledge and skills. The young with assumptions on a human as a creative being prefer much broader repertoire of mechanisms belonging to the human resources model from the remaining category of subjects in the pattern. The connection between the assumption on human nature and preference models of engaging appears especially in the sub-pattern of managers, in the category of young subjects

  16. Contemporary Management of Type B Aortic Dissection in the Endovascular Era. (United States)

    Bannazadeh, Mohsen; Tadros, Rami O; McKinsey, James; Chander, Rajiv; Marin, Michael L; Faries, Peter L


    Aortic dissection (AD) is one of the most common catastrophic pathologies affecting the aorta. Anatomic classification is based on the origin of entry tear and its extension. Type A dissections originate in the ascending aorta, whereas the entry tear in Type B dissections starts distal to the left subclavian artery. The patients with aortic dissection who manifest complications such as rupture, malperfusion, aneurysmal degeneration, and intractable pain are classified as complicated AD. Risk factors for developing aortic dissection include age, male gender, and aortic wall structural abnormalities. The most common presenting symptom of acute aortic dissection is pain. Malperfusion occurs as a result of end-organ ischemia due to involvement of aortic branches from the dissecting process. This can happen in various locations causing mesenteric ischemia (mesenteric vessels), stroke (aortic arch vessels), renal failure (renal arteries), spinal ischemia, and limb ischemia (iliac or subclavian arteries). Aneurysmal degeneration is the most common complication of patients with chronic Type B dissection who are managed with medical therapy. Management of Type B aortic dissection (TBAD) remains controversial. Many groups recommend conservative therapy for newly diagnosed TBAD and reserve surgical management for patients who develop complications such as rupture, malperfusion, aneurysmal dilatation, and refractory pain. The mainstay of medical therapy includes antihypertensive medication to reduced ΔP/ ΔT by lowering blood pressure and heart rate. With the continued success of thoracic endovascular aortic repair (TEVAR), this procedure has been extended to treat TBAD in selected patients. The outcomes of TEVAR are promising, with early mortality rates from 10% to 20%. With promising results from these series, some groups recommend early TEVAR in uncomplicated TBAD to prevent future adverse events. The goals of endovascular treatment of TBAD are to cover the entry tear

  17. Contemporary surgical management of synchronous colorectal liver metastases [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Danielle Collins


    Full Text Available Historically, the 5-year survival rates for patients with stage 4 (metastatic colorectal cancer were extremely poor (5%; however, with advances in systemic chemotherapy combined with an ability to push the boundaries of surgical resection, survival rates in the range of 25–40% can be achieved. This multimodal approach of combining neo-adjuvant strategies with surgical resection has raised a number of questions regarding the optimal management and timing of surgery. For the purpose of this review, we will focus on the treatment of stage 4 colorectal cancer with synchronous liver metastases.

  18. Gastroesophageal reflux disease management according to contemporary international guidelines: a translational study. (United States)

    Pace, Fabio; Riegler, Gabriele; de Leone, Annalisa; Dominici, Patrizia; Grossi, Enzo


    To test the Genval recommendations and the usefulness of a short trial of proton pump inhibitor (PPI) in the initial management and maintenance treatment of gastroesophageal reflux disease (GERD) patients. Five hundred and seventy seven patients with heartburn were recruited. After completing a psychometric tool to assess quality of life (PGWBI) and a previously validated GERD symptom questionnaire (QUID), patients were grouped into those with esophagitis (EE, n = 306) or without mucosal damage (NERD, n = 271) according to endoscopy results. The study started with a 2-wk period of high dose omeprazole (omeprazole test); patients responding to this PPI test entered an acute phase (3 mo) of treatment with any PPI at the standard dose. Finally, those patients with a favorable response to the standard PPI dose were maintained on a half PPI dose for a further 3-mo period. The test was positive in 519 (89.9%) patients, with a greater response in EE patients (96.4%) compared with NERD patients (82.6%) (P = 0.011). Both the percentage of completely asymptomatic patients, at 3 and 6 mo, and the reduction in heartburn intensity were significantly higher in the EE compared with NERD patients (P management of GERD patients. In addition, we observed that the overall response to PPI therapy is lower in NERD compared to EE patients.

  19. Medical management of ischemic stuttering priapism: a contemporary review of the literature. (United States)

    Levey, Helen R; Kutlu, Omer; Bivalacqua, Trinity J


    Priapism is defined as a prolonged and persistent erection of the penis without sexual stimulation. This is a poorly understood disease process with little information on the pathophysiology of this erectile disorder. Complications from this disorder are devastating due to the irreversible erectile damage and resultant erectile dysfunction (ED). Stuttering priapism, though relatively rare, affects a high prevalence of men with sickle-cell disease (SCD) and presents a challenging problem with guidelines for treatment lacking or resulting in permanent ED. The mechanisms involved in the development of priapism in this cohort are poorly characterized; therefore, medical management of priapism represents a therapeutic challenge to urologists. Additional research is warranted, so we can effectively target treatments for these patients with prevention as the goal. This review gives an introduction to stuttering priapism and its clinical significance, specifically with regards to the patient with SCD. Additionally, the proposed mechanisms behind its pathophysiology and a summary of the current and future targets for medical management are discussed.

  20. Contemporary management of voice and swallowing disorders in patients with advanced lung cancer. (United States)

    Brady, Grainne C; Carding, Paul N; Bhosle, Jaishree; Roe, Justin W G


    Advanced lung cancer can cause changes to swallowing and communication function. Direct tumour invasion, dyspnoea and deconditioning can all impact on swallowing function and communication. Cancer treatment, if administered, may cause or compound symptoms. In this study, the nature of swallowing and communication difficulties in patients with advanced lung cancer will be discussed, and management options including medical management, speech and language therapy (SLT) intervention, and surgical interventions will be considered. Advanced lung cancer can result in voice and swallowing difficulties, which can increase symptom burden and significantly impact on quality of life (QOL). There is a growing evidence base to support the use of injection laryngoplasty under local anaesthetic to offer immediate improvement in voice, swallowing and overall QOL. There is limited literature on the nature and extent of voice and swallowing impairment in patients with lung cancer. Well designed studies with robust and sensitive multidimensional dysphagia and dysphonia assessments are required. Outcome studies examining interventions with clearly defined treatment goals are required. These studies should include both functional and patient-reported outcome measures to develop the evidence base and to ensure that interventions are both timely and appropriate.

  1. Contemporary Approach to the Diagnosis and Management of Primary Angle-Closure Disease. (United States)

    Razeghinejad, M Reza; Myers, Jonathan S


    Primary angle closure disease spectrum varies from a narrow angle to advanced glaucoma. A variety of imaging technologies may assist the clinician in determining the pathophysiology and diagnosis of primary angle closure, but gonioscopy remains a mainstay of clinical evaluation. Laser iridotomy effectively eliminates the pupillary block component of angle closure; however, studies show that in many patients the iridocorneal angle remains narrow from underlying anatomic issues, and increasing lens size often leads to further narrowing over time. Recent studies have further characterized the role of the lens in angle closure disease, and cataract or clear lens extraction is increasingly used earlier in its management. As a first surgical step in angle closure glaucoma, lens extraction alone often effectively controls the pressure with less risk of complications than concurrent or stand alone glaucoma surgery, but may not be sufficient in more advanced or severe disease. We provide a comprehensive review on the primary angle-closure disease nomenclature, imaging, and current laser and surgical management. Copyright © 2018. Published by Elsevier Inc.

  2. Hospital readmission after management of appendicitis at freestanding children's hospitals: contemporary trends and financial implications. (United States)

    Rice-Townsend, Samuel; Hall, Matthew; Barnes, Jeff N; Baxter, Jessica K; Rangel, Shawn J


    The purpose of this study was to characterize epidemiologic trends and cost implications of hospital readmission after treatment of pediatric appendicitis. We conducted a 5-year retrospective cohort analysis of 30-day readmission rates for 52,054 patients admitted with appendicitis at 38 children's hospitals participating in the Pediatric Health Information System database. Patients were categorized as "uncomplicated" (postoperative length of stay [LOS] ≤ 2 days) or "complicated" (LOS ≥ 3 days and ≥ 4 consecutive days of antibiotics) and analyzed for demographic data, treatment received during the index admission, readmission rates, and excess LOS and hospital-related costs attributable to readmission encounters. The aggregate 30-day readmission rate was 8.7%, and this varied significantly by disease severity and management approach (uncomplicated appendectomy, 5.6%; complicated appendectomy, 12.8%; drainage, 22.6%; antibiotics only, 24.6%; P management approach (uncomplicated appendectomy, $1946 [31% relative increase]; complicated appendectomy, $6524 [53% increase]; drainage, $6827 [48% increase]; antibiotics only, $5835 [58% increase]; P < .0001). In freestanding children's hospitals, readmission after treatment of pediatric appendicitis is a relatively common and costly occurrence. Collaborative efforts are needed to characterize patient, treatment, and hospital-related risk factors as a basis for developing preventative strategies. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Progress in the contemporary management of hemophilia: The new issue of patient aging. (United States)

    Mannucci, Pier Mannuccio; Iacobelli, Massimo


    The management of inherited coagulation disorders such as hemophilia A and B has witnessed dramatic progresses since the last few decades of the last century. Accordingly, persons with hemophilia (PWH) now enjoy a life expectancy at birth not different from that of males in the general population, at least in high income countries. Nowadays, a substantial proportion of PWH are aging, like their peers in the general population. This outstanding progress is accompanied by problems that are in part similar to those of any old person (multiple concomitant diseases and the resulting intake of multiple drugs other than those specific for hemophilia treatment). In addition, older PWH suffer from the consequences of the comorbidities that developed when their treatment was at the same time poorly available and unsafe. Typical hemophilia comorbidities affect the musculoskeletal system following joint and muscle bleeds, but also the liver and kidney are often impaired due to previous bloodborne infections such as viral hepatitis and HIV. Thus, the comorbidities of hemophilia superimposed on the multimorbidity and polypharmacy associated with aging create peculiar problems in the current management of these patients, that demand the coordinated holistic intervention of internists, geriatricians and clinical pharmacologists in addition to the care traditionally provided by pediatricians and hematologists. Copyright © 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  4. Contemporary management of low--grade glioma: a paradigm shift in neuro-oncology. (United States)

    Hayhurst, Caroline


    Supratentorial diffuse intrinsic low-grade gliomas represent a distinct but heterogenous group of tumours, with the propensity to grow and to differentiate into malignant tumours. They have been historically viewed in the 'benign' spectrum of intrinsic brain tumours, so a watch-and-wait policy was often adopted. With recent advances in our understanding of the natural history of these tumours, combined with advances in surgical technique, an aggressive approach is now recommended. Increasing quality evidence of the impact of tumour resection and multicentre trials of adjuvant radiotherapy and chemotherapy have led to a new algorithm for low-grade glioma management. This review aims to outline the emerging evidence that has shifted neuro-oncology practice. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  5. Marginalised social groups in contemporary weee management within social enterprises investments: A study in Greece

    International Nuclear Information System (INIS)

    Papaoikonomou, K.; Kipouros, S.; Kungolos, A.; Somakos, L.; Aravossis, K.; Antonopoulos, I.; Karagiannidis, A.


    This paper deals with the creation of appropriate conditions aimed at developing social services for reuse and recycling of waste electrical and electronic equipment (WEEE), by the inclusion of handicapped and Roma people in the workforce. Application areas for the project are the Hellenic (Greek) regions of Thessaly and North Aegean, where these groups suffer from professional and social exclusion. The efforts to reduce unemployment in the two aforementioned groups, together with the efforts to implement related Greek and European legislation for sustainable WEEE management, are examined here. Furthermore, networking and cooperation at local, regional and central levels between small enterprises, entrepreneurships and local authorities are examined, so that these social enterprises and their corresponding investments may support the development of the Greek alternative WEEE recycling system

  6. A Contemporary Medicolegal Analysis of Outpatient Medication Management in Chronic Pain. (United States)

    Abrecht, Christopher R; Brovman, Ethan Y; Greenberg, Penny; Song, Ellen; Rathmell, James P; Urman, Richard D


    Opioids are frequently used in chronic pain management but are associated with significant morbidity and mortality in some patient populations. An important avenue for identifying complications-including serious or rare complications-is the study of closed malpractice claims. The present study is intended to complement the existing closed claims literature by drawing on claims from a more recent timeframe through a partnership with a large malpractice carrier, the Controlled Risk Insurance Company (CRICO). The goal of this study was to identify patient medical comorbidities and aberrant drug behaviors, as well as prescriber practices associated with patient injury and malpractice claims. Another objective was to identify claims most likely to result in payments and use this information to propose a strategy for reducing medicolegal risk. The CRICO Strategies Comparative Benchmarking System is a database of claims drawing from >350,000 malpractice claims from Harvard-affiliated institutions and >400 other academic and community institutions across the United States. This database was queried for closed claims from January 1, 2009, to December 31, 2013, and identified 37 cases concerning noninterventional, outpatient chronic pain management. Each file consisted of a narrative summary, including expert witness testimony, as well as coded fields for patient demographics, medical comorbidities, the alleged damaging event, the alleged injurious outcome, the total financial amount incurred, and more. We performed an analysis using these claim files. The mean patient age was 43.5 years, with men representing 59.5% of cases. Payments were made in 27% of cases, with a median payment of $72,500 and a range of $7500-$687,500. The majority of cases related to degenerative joint disease of the spine and failed back surgery syndrome; no patients in this series received treatment of malignant pain. Approximately half (49%) of cases involved a patient death. The use of long

  7. Contemporary management of TMJ involvement in JIA patients and its orofacial consequences. (United States)

    Niibo, Priit; Pruunsild, Chris; Voog-Oras, Ülle; Nikopensius, Tiit; Jagomägi, Triin; Saag, Mare


    Juvenile idiopathic arthritis is the most common chronic rheumatic condition during childhood. Temporomandibular joint arthritis is frequently asymptomatic. When it takes place during childhood, it may affect condylar growth; therefore, these children are at risk of unfavorable long-term outcomes from the associated joint damage. The etiology is not completely understood, but it is considered as multifactorial with both genetic and environmental factors involved. The standardized examination and imaging protocols serve important purpose to diagnose temporomandibular joint (TMJ) arthritis not only to establish an early interventional strategy but also to assess craniofacial growth and the progression of signs and symptoms in those patients. Although the treatment of juvenile idiopathic arthritis (JIA) has changed dramatically over the last decades due to new therapeutic options, TMJ arthritis still can develop during the course of the disease. In clinical experience, TMJs appear to respond less well to the standard of care used to treat other joints. More individualized approach to the patient's treatment serves as the main goal of personalized medicine. It could be achieved by adopting new methods of medical imaging such as conebeam computer tomography as well as developing reliable biomarkers which may assist with predicting disease type, course, or severity and predicting response to medication. This article provides an overview of current information on orofacial complications in JIA and its management. Based on information provided in this review, more precise diagnosis, proper tools for recognizing people at risk, and more efficient treatment approaches could be implemented. This may lead to more personalized treatment management strategies of TMJ complications of JIA patients.

  8. Specific Organ Targeted Vestibular Physiotherapy: The Pivot in the Contemporary Management of Vertigo and Imbalance. (United States)

    Biswas, Anirban; Barui, Bibhas


    Advancements in our understanding of vestibular physiology and how it is changes in different diseases have established that of the three therapeutic approaches to treat disorders of the vestibular system viz. pharmacotherapy, surgery and physical therapy, it is the later i.e., physical therapy which is the most efficacious modality in the management of balance disorders. The futility of vestibular sedatives in the correction of vestibular disorders and in the restoration of balance and the very limited role of surgery has now been recognised. Advancements in vestibulometry now enable us to localise any lesion in the vestibular system with utmost precision and also determine the exact cause of the balance disorder. The site of lesion and the specific organ that is defective can now be very precisely identified. Treatment modalities especially that for physical therapy hence have to be organ specific, and if possible, also disease specific. The study aims at evaluating the efficacy of physiotherapy in the management of balance disorders and also assesses the efficacy of organ targeted physical therapy, a new concept in restoring balance after vestibulometry has identified the offending organ. The study was conducted in the specialised physical therapy unit for balance and gait disorder patients which is a part of Vertigo and Deafness Clinic in Kolkata, India. Special instruments for physical therapy devised by the first author were used for stimulation of specific sense organs in the vestibular labyrinth that were found to be defective in vestibulometry. Specially made Virtual reality programs were used in patients suffering from psychogenic balance disorders. The pre and post therapy status was evaluated by different standard scales to assess balance and dizziness. Very promising results were obtained. Organ targeted physiotherapy where defective sense organs were specifically stimulated showed remarkable improvement in different measures. Virtual reality exercises

  9. Contemporary Management of Borderline Resectable and Locally Advanced Unresectable Pancreatic Cancer. (United States)

    Shaib, Walid L; Ip, Andrew; Cardona, Kenneth; Alese, Olatunji B; Maithel, Shishir K; Kooby, David; Landry, Jerome; El-Rayes, Bassel F


    Adenocarcinoma of the pancreas remains a highly lethal disease, with less than 5% survival at 5 years. Borderline resectable pancreatic cancer (BRPC) and locally advanced unresectable pancreatic cancer (LAPC) account for approximately 30% of newly diagnosed cases of PC. The objective of BRPC therapy is to downstage the tumor to allow resection; the objective of LAPC therapy is to control disease and improve survival. There is no consensus on the definitions of BRPC and LAPC, which leads to major limitations in designing clinical trials and evaluating their results. A multimodality approach is always needed to ensure proper utilization and timing of chemotherapy, radiation, and surgery in the management of this disease. Combination chemotherapy regimens (5-fluorouracil, leucovorin, irinotecan, oxaliplatin, and gemcitabine [FOLFIRINOX] and gemcitabine/nab-paclitaxel) have improved overall survival in metastatic disease. The role of combination chemotherapy regimens in BRPC and LAPC is an area of active investigation. There is no consensus on the dose, modality, and role of radiation therapy in the treatment of BRPC and LAPC. This article reviews the literature and highlights the areas of controversy regarding management of BRPC and LAPC. Pancreatic cancer is one of the worst cancers with regard to survival, even at early stages of the disease. This review evaluates all the evidence for the stages in which the cancer is not primarily resectable with surgery, known as borderline resectable or locally advanced unresectable. Recently, advancements in radiation techniques and use of better combination chemotherapies have improved survival and tolerance. There is no consensus on description of stages or treatment sequences (chemotherapy, chemoradiation, radiation), nor on the best chemotherapy regimen. The evidence behind the treatment paradigm for these stages of pancreatic cancer is summarized. ©AlphaMed Press.

  10. Contemporary management of patients with high-risk non-muscle-invasive bladder cancer who fail intravesical BCG therapy. (United States)

    Yates, D R; Rouprêt, M


    It is advocated that patients with high-risk non-muscle-invasive bladder cancer (NMIBC) receive an adjuvant course of intravesical Bacille Calmette-Guerin (BCG) as first-line treatment. However, a substantial proportion of patients will 'fail' BCG, either early with persistent (refractory) disease or recur late after a long disease-free interval (relapsing). Guideline recommendation in the 'refractory' setting is radical cystectomy, but there are situations when extirpative surgery is not feasible due to competing co-morbidity, a patient's desire for bladder preservation or reluctance to undergo surgery. In this review, we discuss the contemporary management of NMIBC in patients who have failed prior BCG and are not suitable for radical surgery and highlight the potential options available. These options can be categorised as immunotherapy, chemotherapy, device-assisted therapy and combination therapy. However, the current data are still inadequate to formulate definitive recommendations, and data from ongoing trials and maturing studies will give us an insight into whether there is a realistic efficacious second-line treatment for patients who fail intravesical BCG but are not candidates for definitive surgery.

  11. Historical and contemporary population genetic connectivity of the European short-snouted seahorse Hippocampus hippocampus and implications for management. (United States)

    Woodall, L C; Koldewey, H J; Shaw, P W


    This first genetic study of Hippocampus hippocampus covers the species' entire geographic range and employs two mtDNA markers (control region and cytochrome b) to establish patterns of population structuring. A total of 255 specimens from 21 locations were used to obtain 89 concatenated haplotypes. The common haplotype was present in all but one population, however, most haplotypes were unique. The haplotype network had a star-like construction, suggesting expansion from a bottleneck event. F(ST) and AMOVA revealed population subdivision into three geographic regions (English Channel + Bay of Biscay, Mediterranean Sea + Atlantic Ocean Iberian coast + Macaronesian Islands, and West Africa) with barriers to gene flow indentified at Cape Finisterre and the Cape Verde frontal zone. Neutrality tests and nested clade analysis suggest a complex demographic history, with both historic events and contemporary processes shaping patterns of genetic differentiation. The genetic population subdivision detected in this study indicates that H. hippocampus should be managed as three separate units. This is especially pertinent as H. hippocampus populations within the West African region are the only ones known to be specifically targeted for exploitation. © 2011 The Authors. Journal of Fish Biology © 2011 The Fisheries Society of the British Isles.

  12. Liberal Versus Restrictive Fluid Management in Knee Arthroplasty: A Randomized, Double-Blind Study

    DEFF Research Database (Denmark)

    Holte, Kathrine; Kristensen, Billy Bjarne; Valentiner, Lotte


    BACKGROUND: There are few data describing the relationship between amount of perioperative fluid and organ function. In this study we investigated the effects of two levels of intravascular fluid administration ("liberal" versus "restrictive") in knee arthroplasty on physiological recovery...... with a standardized volume of colloid. All other aspects of perioperative management (including anesthesia, preoperative fluid status, and postoperative management) were standardized. Primary outcome variables included pulmonary function (spirometry), exercise capacity ("timed up and go" test), coagulation...... as the primary outcome variable. METHODS: In a double-blind study, 48 ASA I-III patients undergoing fast-track elective knee arthroplasty were randomized to restrictive or liberal perioperative intravascular fluid administration. Patients received a fixed rate infusion of Ringer's lactate solution...

  13. Contemporary management of subclavian and axillary artery injuries-A Western Trauma Association multicenter review. (United States)

    Waller, Christine J; Cogbill, Thomas H; Kallies, Kara J; Ramirez, Luis D; Cardenas, Justin M; Todd, S Rob; Chapman, Kayla J; Beckman, Marshall A; Sperry, Jason L; Anto, Vincent P; Eriksson, Evert A; Leon, Stuart M; Anand, Rahul J; Pearlstein, Maura; Capano-Wehrle, Lisa; Cothren Burlew, Clay; Fox, Charles J; Cullinane, Daniel C; Roberts, Jennifer C; Harrison, Paul B; Berg, Gina M; Haan, James M; Lightwine, Kelly


    Subclavian and axillary artery injuries are uncommon. In addition to many open vascular repairs, endovascular techniques are used for definitive repair or vascular control of these anatomically challenging injuries. The aim of this study was to determine the relative roles of endovascular and open techniques in the management of subclavian and axillary artery injuries comparing hospital outcomes, and long-term limb viability. A multicenter, retrospective review of patients with subclavian or axillary artery injuries from January 1, 2004, to December 31, 2014, was completed at 11 participating Western Trauma Association institutions. Statistical analysis included χ, t-tests, and Cochran-Armitage trend tests. A p value less than 0.05 was significant. Two hundred twenty-three patients were included; mean age was 36 years, 84% were men. An increase in computed tomography angiography and decrease in conventional angiography was observed over time (p = 0.018). There were 120 subclavian and 119 axillary artery injuries. Procedure type was associated with injury grade (p < 0.001). Open operations were performed in 135 (61%) patients, including 93% of greater than 50% circumference lacerations and 83% of vessel transections. Endovascular repairs were performed in 38 (17%) patients; most frequently for pseudoaneurysms. Fourteen (6%) patients underwent a hybrid procedure. Use of endovascular versus open procedures did not increase over the duration of the study (p = 0.248). In-hospital mortality rate was 10%. Graft or stent thrombosis occurred in 7% and graft or stent infection occurred in 3% of patients. Mean follow-up was 1.6 ± 2.4 years (n = 150). Limb salvage was achieved in 216 (97%) patients. The management of subclavian and axillary artery injuries still requires a wide variety of open exposures and procedures, especially for the control of active hemorrhage from more than 50% vessel lacerations and transections. Endovascular repairs were used most often for

  14. Pericardial effusion in patients with cancer: outcome with contemporary management strategies. (United States)

    Laham, R. J.; Cohen, D. J.; Kuntz, R. E.; Baim, D. S.; Lorell, B. H.; Simons, M.


    OBJECTIVE--To investigate the clinical presentation and current management strategies of pericardial effusion in patients with malignancy. DESIGN--Retrospective single centre, consecutive observational study. SETTING--University hospital. PATIENTS--93 consecutive patients with a past or present diagnosis of cancer and a pericardial effusion, including 50 with a pericardial effusion > 1 cm. RESULTS--Of the 50 patients with pericardial effusions > 1 cm, most had stage 4 cancer (64%), were symptomatic at the time of presentation (74%), and had right atrial collapse (74%). Twenty patients were treated conservatively (without pericardiocentesis) and were less symptomatic (55% v 87%, P = 0.012), had smaller pericardial effusions (1.5 (0.4) v 1.8 (0.5), P = 0.02), and less frequent clinical (10% v 40%, P = 0.02) and echocardiographic evidence of tamponade (40% v 97%, P < 0.001) than the 30 patients treated invasively with initial pericardiocentesis (n = 29) or pericardial window placement (n = 1). Pericardial tamponade requiring repeat pericardiocentesis occurred in 18 (62%) of 29 patients after a median of 7 days. In contrast, only four (20%) of 20 patients in the conservative group progressed to frank clinical tamponade and required pericardiocentesis (P = 0.005 v invasive group). The overall median survival was 2 months with a survival rate at 48 months of 26%. Survival, duration of hospital stay, and hospital charges were similar with both strategies. By multivariable analysis, the absence of symptoms was the only independent predictor of long-term survival (relative hazards ratio = 3.2, P = 0.05). Survival was similar in the 43 patients with cancer and pericardial effusions of < or = 1 cm. CONCLUSION--Asymptomatic patients with cancer and pericardial effusion can be managed conservatively with close follow up. In patients with symptoms or clinical cardiac tamponade, pericardiocentesis provides relief of symptoms but does not improve survival and has a high recurrence

  15. Contemporary management and attainment of cholesterol targets for patients with dyslipidemia in China.

    Directory of Open Access Journals (Sweden)

    Fei Gao

    Full Text Available It is well-established that lipid disorder is an important cardiovascular risk factor, and failure to reach optimal lipid levels significantly contributes to the residual cardiovascular risks. However, limited information is available on the management and the attainment of recommended cholesterol targets in real-world practice in China.A nationally representative sample of 12,040 patients with dyslipidemia from 19 provinces and 84 hospitals across China were consecutively enrolled in this survey. Risk stratification and individual cholesterol target was established for all participants. This survey identified a high-risk cohort, with over 50% of patients had hypertension, 37.5% had coronary artery disease, and more than 30% had peripheral artery disease. Thirty-nine percent of all participants received lipid lowering medications. And the majority of them (94.5% had statins (42.5% with atorvastatin, 29.0% with simvastatin, and 15.2% with rosuvastatin. However, the overall attainment for low-density lipoprotein cholesterol (LDL-C target is low (25.8%, especially, in female (22.2%, and in patients with increased body mass index (BMI (38.3% for BMI<18.5, 28.1% for BMI 18.5-24.9, 26.0% for BMI 25.0-29.9, and 17.4% for BMI ≥ 30, P<0.0001. Subgroup analysis also showed the attainment is significantly lower in patients who were stratified into high (19.9% and very high (21.1% risk category. In logistic regression analysis, eight factors (BMI, gender, coronary artery disease, systolic and diastolic blood pressure, hypertension, family history of premature coronary artery disease and current smoking were identified as independent predictors of LDL-C attainment.Despite the proven benefits of lipid-lowering therapies, current management of dyslipidemia continues to be unsatisfied. A considerable proportion of patients failed to achieve guideline-recommended targets in China, and this apparent treatment gap was more pronounced among patients with

  16. Contemporary Management and Attainment of Cholesterol Targets for Patients with Dyslipidemia in China (United States)

    Gao, Fei; Zhou, Yu Jie; Hu, Da Yi; Zhao, Ying Xin; Liu, Yu Yang; Wang, Zhi Jian; Yang, Shi Wei; Liu, Xiao Li


    Aims It is well-established that lipid disorder is an important cardiovascular risk factor, and failure to reach optimal lipid levels significantly contributes to the residual cardiovascular risks. However, limited information is available on the management and the attainment of recommended cholesterol targets in real-world practice in China. Methods and Results A nationally representative sample of 12,040 patients with dyslipidemia from 19 provinces and 84 hospitals across China were consecutively enrolled in this survey. Risk stratification and individual cholesterol target was established for all participants. This survey identified a high-risk cohort, with over 50% of patients had hypertension, 37.5% had coronary artery disease, and more than 30% had peripheral artery disease. Thirty-nine percent of all participants received lipid lowering medications. And the majority of them (94.5%) had statins (42.5% with atorvastatin, 29.0% with simvastatin, and 15.2% with rosuvastatin). However, the overall attainment for low-density lipoprotein cholesterol (LDL-C) target is low (25.8%), especially, in female (22.2%), and in patients with increased body mass index (BMI) (38.3% for BMI<18.5, 28.1% for BMI 18.5–24.9, 26.0% for BMI 25.0–29.9, and 17.4% for BMI≥30, P<0.0001). Subgroup analysis also showed the attainment is significantly lower in patients who were stratified into high (19.9%) and very high (21.1%) risk category. In logistic regression analysis, eight factors (BMI, gender, coronary artery disease, systolic and diastolic blood pressure, hypertension, family history of premature coronary artery disease and current smoking) were identified as independent predictors of LDL-C attainment. Conclusions Despite the proven benefits of lipid-lowering therapies, current management of dyslipidemia continues to be unsatisfied. A considerable proportion of patients failed to achieve guideline-recommended targets in China, and this apparent treatment gap was more

  17. Irrigation and Debridement with Component Retention for Acute Infection After Hip Arthroplasty: Improved Results with Contemporary Management. (United States)

    Bryan, Andrew J; Abdel, Matthew P; Sanders, Thomas L; Fitzgerald, Steven F; Hanssen, Arlen D; Berry, Daniel J


    There are conflicting data on the results of irrigation and debridement with component retention in patients with acute periprosthetic hip infections. The goals of this study were to examine contemporary results of irrigation and debridement with component retention for acute infection after primary hip arthroplasty and to identify host, organism, antibiotic, or implant factors that predict success or failure. Ninety hips (57 total hip arthroplasties and 33 hemiarthroplasties) were diagnosed with acute periprosthetic hip infection (using strict criteria) and were treated with irrigation and debridement and component retention between 2000 and 2012. The mean follow-up was 6 years. Patients were stratified on the basis of McPherson criteria. Hips were managed with irrigation and debridement and retention of well-fixed implants with modular head and liner exchange (70%) or irrigation and debridement alone (30%). Seventy-seven percent of patients were treated with chronic antibiotic suppression. Failure was defined as failure to eradicate infection, characterized by a wound fistula, drainage, intolerable pain, or infection recurrence caused by the same organism strain; subsequent removal of any component for infection; unplanned second wound debridement for ongoing deep infection; and/or occurrence of periprosthetic joint infection-related mortality. Treatment failure occurred in 17% (15 of 90 hips), with component removal secondary to recurrent infection in 10% (9 of 90 hips). Treatment failure occurred in 15% (10 of 66 hips) after early postoperative infection and 21% (5 of 24 hips) after acute hematogenous infection (p = 0.7). Patients with McPherson host grade A had a treatment failure rate of 8%, compared with 16% (p = 0.04) in host grade B and 44% in host grade C (p = 0.006). Most treatment failures (12 of 15 failures) occurred within the initial 6 weeks of treatment; failures subsequent to 6 weeks occurred in 3% of those treated with chronic antibiotic

  18. Data mining for water resource management part 2 - methods and approaches to solving contemporary problems (United States)

    Roehl, Edwin A.; Conrads, Paul


    This is the second of two papers that describe how data mining can aid natural-resource managers with the difficult problem of controlling the interactions between hydrologic and man-made systems. Data mining is a new science that assists scientists in converting large databases into knowledge, and is uniquely able to leverage the large amounts of real-time, multivariate data now being collected for hydrologic systems. Part 1 gives a high-level overview of data mining, and describes several applications that have addressed major water resource issues in South Carolina. This Part 2 paper describes how various data mining methods are integrated to produce predictive models for controlling surface- and groundwater hydraulics and quality. The methods include: - signal processing to remove noise and decompose complex signals into simpler components; - time series clustering that optimally groups hundreds of signals into "classes" that behave similarly for data reduction and (or) divide-and-conquer problem solving; - classification which optimally matches new data to behavioral classes; - artificial neural networks which optimally fit multivariate data to create predictive models; - model response surface visualization that greatly aids in understanding data and physical processes; and, - decision support systems that integrate data, models, and graphics into a single package that is easy to use.

  19. Urban forest management in New England: Towards a contemporary understanding of tree wardens in Massachusetts communities (United States)

    Harper, Richard W.; Bloniarz, David V.; DeStefano, Stephen; Nicolson, Craig


    In the New England states, tree wardens are local officials responsible for the preservation, maintenance and stewardship of municipal public trees. This study explores the emerging professional challenges, duties and responsibilities of tree wardens, from the subject’s point of view, by conducting in-person, semi-structured qualitative research interviews with 50 tree wardens throughout Massachusetts. Many of the findings corroborate previous literature, including that tree wardens are typically housed in a municipal department (often public works or highway), that tree wardens routinely interact with a wide variety of local organisations (representatives from other municipal departments, community volunteer associations) and that as community size increases, tree wardens typically have access to a greater pool of resources to carry out urban forest management. A newer finding is that the subject of urban forest health arose as a topic of great importance for tree wardens, as nearly all interviewees (n = 49) indicated that they monitor for urban forest pests and that they would like further continuing education concerning this subject.

  20. Myanmar in Contemporary Chinese Foreign Policy – Strengthening Common Ground, Managing Differences

    Directory of Open Access Journals (Sweden)

    Robert Sutter


    Full Text Available This assessment first briefly examines recent features of China’s approach to foreign affairs, and then examines in greater detail features in China’s approach to relations with its neighbours, especially in Southeast Asia. It does so in order to discern prevailing patterns in Chinese foreign relations and to determine in the review of salient recent China–Myanmar developments in the concluding section how China’s approach to Myanmar compares with Chinese relations with other regional countries and more broadly. The assessment shows that the strengths and weaknesses of China’s recent relations with Myanmar are more or less consistent with the strengths and weaknesses of China’s broader approach to Southeast Asia and international affairs more generally. On the one hand, China’s approach to Myanmar, like its approach to most of the states around its periphery, has witnessed significant advances and growing interdependence in the post-Cold War period. On the other hand, mutual suspicions stemming from negative historical experiences and salient differences require attentive management by Chinese officials and appear unlikely to fade soon.

  1. Contemporary Management of Patients with Concomitant Coronary and Carotid Artery Disease. (United States)

    Poi, Mun J; Echeverria, Angela; Lin, Peter H


    The ideal management of concomitant carotid and coronary artery occlusive disease remains elusive. Although researchers have advocated the potential benefits of varying treatment strategies based on either concomitant or staged surgical treatment, there is no consensus in treatment guidelines among national or international clinical societies. Clinical studies show that coronary artery bypass grafting (CABG) with either staged or synchronous carotid endarterectomy (CEA) is associated with a high procedural stroke or death rate. Recent clinical studies have found carotid artery stenting (CAS) prior to CABG can lead to superior treatment outcomes in asymptomatic patients who are deemed high risk of CEA. With emerging data suggesting favorable outcome of CAS compared to CEA in patients with critical coronary artery disease, physicians must consider these diverging therapeutic options when treating patients with concurrent carotid and coronary disease. This review examines the available clinical data on therapeutic strategies in patients with concomitant carotid and coronary artery disease. A treatment paradigm for considering CAS or CEA as well as CABG and percutaneous coronary intervention is discussed.

  2. The contemporary management of urethral strictures in men resulting from lichen sclerosus (United States)

    Belsante, Michael J.; Selph, J. Patrick


    Lichen sclerosus (LS) is a chronic, inflammatory disease primarily involving the genital skin and urethra in males. Historically, the treatment of this common condition was a challenge due to its uncertain etiology, variable response to therapy, and predilection to recur. The etiology of LS is still debated and has been linked to autoimmune disease, infection, trauma, and genetics. Today, topical steroids are a mainstay of therapy for patients, even in the presence of advanced disease, and can induce regression of the disease. In advanced cases, surgery may be required and range from circumcision, meatoplasty, or, in the case of advanced stricture disease, urethroplasty or perineal urethrostomy. When urethroplasty is required, the use of genital skin as a graft or flap is to be avoided due to the predilection for recurrence. Surgical management should be approached only after failure of more conservative measures due to the high risk of recurrence of LS in the repaired site despite the use of buccal grafting. LS may be associated with the development of squamous cell carcinoma and for this reason, patients should undergo biopsy when LS is suspected and long-term surveillance is recommended. PMID:26816805

  3. Contemporary management and outcomes in congenitally corrected transposition of the great arteries. (United States)

    Kutty, Shelby; Danford, David A; Diller, Gerhard-Paul; Tutarel, Oktay


    Congenitally corrected transposition of the great arteries (ccTGA) can occur in isolation, or in combination with other structural cardiac anomalies, most commonly ventricular septal defect, pulmonary stenosis and tricuspid valve disease. Clinical recognition can be challenging, so echocardiography is often the means by which definitive diagnosis is made. The tricuspid valve and right ventricle are on the systemic arterial side of the ccTGA circulation, and are therefore subject to progressive functional deterioration. The natural history of ccTGA is also greatly influenced by the nature and severity of accompanying lesions, some of which require surgical repair. Some management strategies leave the right ventricle as the systemic arterial pump, but carry the risk of worsening heart failure. More complex 'double switch' repairs establish the left ventricle as the systemic pump, and include an atrial baffle to redirect venous return in combination with either arterial switch or Rastelli operation (if a suitable ventricular septal defect permits). Occasionally, the anatomic peculiarities of ccTGA do not allow straightforward biventricular repair, and Fontan palliation is a reasonable option. Regardless of the approach selected, late cardiovascular complications are relatively common, so ongoing outpatient surveillance should be established in an age-appropriate facility with expertise in congenital heart disease care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Extended Pancreatectomy: Does It Have a Role in the Contemporary Management of Pancreatic Adenocarcinoma? (United States)

    Kaiser, Joerg; Hackert, Thilo; Büchler, Markus W


    Pancreatic cancer is a low-incident but highly mortal disease. Surgery is still the preferred treatment option for resectable pancreatic cancer as it offers the only realistic chance for cure. As many patients present with locally advanced disease, which is generally considered as not amenable to surgical treatment, it is important to know the limits of surgical therapy in this disease. In this review, the indication and outcomes of extended pancreatectomies as well as the alternative treatment options for locally advanced pancreatic cancer are described. Furthermore, controversies as well as ongoing and future directions for the treatment options of locally advanced pancreatic cancer are discussed. Extended pancreatectomy can be performed with higher morbidity and mortality rates in patients with locally advanced pancreatic cancer compared to patients undergoing formal pancreatic resections. These procedures offer significant advantages with respect to both perioperative results and to long-term outcome when compared to chemotherapy. Due to the higher morbidity and mortality rates, these operations should be limited to specialist units with great experience in pancreatic surgery as well as experience in peri- and post-operative management of patients with pancreatic diseases. © 2017 S. Karger AG, Basel.

  5. Ten-year Survivors After Contemporary Management of Advanced 'Horseshoe' Anterior Commissure Laryngeal Cancer. (United States)

    Ampil, Federico; Caldito, Gloria; Vora, Moiz; Richards, Troy


    Combinations of treatment modalities for locally extensive carcinomas of the larynx constitute the standard of care. Advanced 'horseshoe' anterior commissure laryngeal cancer (HACLC) is a disease entity that has not received much attention in the literature. The aims of this study were to evaluate prolonged survival in patients after standard combined therapy for HACLC and to identify clinicopathological factors influential towards an extended outcome. Fourteen patients (10-year survivors) with stage III or IV laryngeal cancer involving the anterior commissure and both true vocal cords were treated with total laryngectomy (and postoperative radiotherapy in 11 individuals). During follow-up, ranging from 123 to 256 months, locoregional recurrent disease and distant metastasis were not observed. Complications after therapy were manageable and few. The long-term survivors were particularly difficult to characterize. The optimal treatment for advanced HACLC has not been clarified; however, in this study, total laryngectomy and the indicated use of postoperative radiotherapy, were successful in achieving long-term disease-free survival. Predictive factors for longevity were not detected in this limited experience. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  6. Contemporary Management Strategies for Chronic Type B Aortic Dissections: A Systematic Review.

    Directory of Open Access Journals (Sweden)

    Arnoud V Kamman

    Full Text Available Currently, the optimal management strategy for chronic type B aortic dissections (CBAD is unknown. Therefore, we systematically reviewed the literature to compare results of open surgical repair (OSR, standard thoracic endovascular aortic repair (TEVAR or branched and fenestrated TEVAR (BEVAR/FEVAR for CBAD.EMBASE and MEDLINE databases were searched for eligible studies between January 2000 and October 2015. Studies describing outcomes of OSR, TEVAR, B/FEVAR, or all, for CBAD patients initially treated with medical therapy, were included. Primary endpoints were early mortality, and one-year and five-year survival. Secondary endpoints included occurrence of complications. Furthermore, a Time until Treatment Equipoise (TUTE graph was constructed.Thirty-five articles were selected for systematic review. A total of 1081 OSR patients, 1397 TEVAR patients and 61 B/FEVAR patients were identified. Early mortality ranged from 5.6% to 21.0% for OSR, 0.0% to 13.7% for TEVAR, and 0.0% to 9.7% for B/FEVAR. For OSR, one-year and five-year survival ranged 72.0%-92.0% and 53.0%-86.7%, respectively. For TEVAR, one-year survival was 82.9%-100.0% and five-year survival 70.0%-88.9%. For B/FEVAR only one-year survival was available, ranging between 76.4% and 100.0%. Most common postoperative complications included stroke (OSR 0.0%-13.3%, TEVAR 0.0%-11.8%, spinal cord ischemia (OSR 0.0%-16.4%, TEVAR 0.0%-12.5%, B/FEVAR 0.0%-12.9% and acute renal failure (OSR 0.0%-33.3%, TEVAR 0.0%-34.4%, B/FEVAR 0.0%-3.2%. Most common long-term complications after OSR included aneurysm formation (5.8%-20.0% and new type A dissection (1.7-2.2%. Early complications after TEVAR included retrograde dissection (0.0%-7.1%, malperfusion (1.3%-9.4%, cardiac complications (0.0%-5.9% and rupture (0.5%-5.0%. Most common long-term complications after TEVAR were rupture (0.5%-7.1%, endoleaks (0.0%-15.8% and cardiac complications (5.9%-7.1%. No short-term aortic rupture or malperfusion was

  7. Contemporary Management Strategies for Chronic Type B Aortic Dissections: A Systematic Review. (United States)

    Kamman, Arnoud V; de Beaufort, Hector W L; van Bogerijen, Guido H W; Nauta, Foeke J H; Heijmen, Robin H; Moll, Frans L; van Herwaarden, Joost A; Trimarchi, Santi


    Currently, the optimal management strategy for chronic type B aortic dissections (CBAD) is unknown. Therefore, we systematically reviewed the literature to compare results of open surgical repair (OSR), standard thoracic endovascular aortic repair (TEVAR) or branched and fenestrated TEVAR (BEVAR/FEVAR) for CBAD. EMBASE and MEDLINE databases were searched for eligible studies between January 2000 and October 2015. Studies describing outcomes of OSR, TEVAR, B/FEVAR, or all, for CBAD patients initially treated with medical therapy, were included. Primary endpoints were early mortality, and one-year and five-year survival. Secondary endpoints included occurrence of complications. Furthermore, a Time until Treatment Equipoise (TUTE) graph was constructed. Thirty-five articles were selected for systematic review. A total of 1081 OSR patients, 1397 TEVAR patients and 61 B/FEVAR patients were identified. Early mortality ranged from 5.6% to 21.0% for OSR, 0.0% to 13.7% for TEVAR, and 0.0% to 9.7% for B/FEVAR. For OSR, one-year and five-year survival ranged 72.0%-92.0% and 53.0%-86.7%, respectively. For TEVAR, one-year survival was 82.9%-100.0% and five-year survival 70.0%-88.9%. For B/FEVAR only one-year survival was available, ranging between 76.4% and 100.0%. Most common postoperative complications included stroke (OSR 0.0%-13.3%, TEVAR 0.0%-11.8%), spinal cord ischemia (OSR 0.0%-16.4%, TEVAR 0.0%-12.5%, B/FEVAR 0.0%-12.9%) and acute renal failure (OSR 0.0%-33.3%, TEVAR 0.0%-34.4%, B/FEVAR 0.0%-3.2%). Most common long-term complications after OSR included aneurysm formation (5.8%-20.0%) and new type A dissection (1.7-2.2%). Early complications after TEVAR included retrograde dissection (0.0%-7.1%), malperfusion (1.3%-9.4%), cardiac complications (0.0%-5.9%) and rupture (0.5%-5.0%). Most common long-term complications after TEVAR were rupture (0.5%-7.1%), endoleaks (0.0%-15.8%) and cardiac complications (5.9%-7.1%). No short-term aortic rupture or malperfusion was observed

  8. Contemporary Cardiovascular Concerns after Spinal Cord Injury: Mechanisms, Maladaptations, and Management. (United States)

    Phillips, Aaron A; Krassioukov, Andrei V


    Cardiovascular (CV) issues after spinal cord injury (SCI) are of paramount importance considering they are the leading cause of death in this population. Disruption of autonomic pathways leads to a highly unstable CV system, with impaired blood pressure (BP) and heart rate regulation. In addition to low resting BP, on a daily basis the majority of those with SCI suffer from transient episodes of aberrantly low and high BP (termed orthostatic hypotension and autonomic dysreflexia, respectively). In fact, autonomic issues, including resolution of autonomic dysreflexia, are frequently ranked by individuals with high-level SCI to be of greater priority than walking again. Owing to a combination of these autonomic disturbances and a myriad of lifestyle factors, the pernicious process of CV disease is accelerated post-SCI. Unfortunately, these secondary consequences of SCI are only beginning to receive appropriate clinical attention. Immediately after high-level SCI, major CV abnormalities present in the form of neurogenic shock. After subsiding, new issues related to BP instability arise, including orthostatic hypotension and autonomic dysreflexia. This review describes autonomic control over the CV system before injury and the mechanisms underlying CV abnormalities post-SCI, while also detailing the end-organ consequences, including those of the heart, as well as the systemic and cerebral vasculature. The tertiary impact of CV dysfunction will also be discussed, such as the potential impediment of rehabilitation, and impaired cognitive function. In the recent past, our understanding of autonomic dysfunctions post-SCI has been greatly enhanced; however, it is vital to further develop our understanding of the long-term consequences of these conditions, which will equip us to better manage CV disease morbidity and mortality in this population.

  9. Contemporary management of penile cancer: greater than 15 year MSKCC experience. (United States)

    Moses, Kelvin A; Winer, Andrew; Sfakianos, John P; Poon, Stephen A; Kent, Matthew; Bernstein, Melanie; Russo, Paul; Dalbagni, Guido


    Penile cancer is a rare malignancy, and few guidelines are available to define treatment paradigms. For greater understanding of the natural history of surgically treated penile cancer, we analyzed the experience at our institution. Using an institutional database, we identified 127 patients treated for squamous cell carcinoma of the penis from 1995-2011. Cancer-specific survival (CSS) was calculated using the Kaplan-Meier method. Survival data were compared using the log-rank test. The difference in risk of cancer-specific death by lymph node status and histological grade was determined by univariate Cox regression analysis. Five year CSS for pTis, pT1, pT2, and pT3/4 was 100%, 84% (95% CI 58%-95%), 54% (95% CI 33%-71%), and 54% (95% CI 25%-76%), respectively (p ≤ .005). Three year CSS for patients with N0, N+, and Nx disease was 90% (95% CI 47%-99%), 65% (95% CI 47%-79%), and 86% (95% CI 73%-93%), respectively (p = .03). The receipt of neoadjuvant chemotherapy did not change per 5 year period over the 16 years of our study. Median follow up was 2.8 years. Penile cancer patients with advanced disease had poor survival. Tumor stage and nodal status were significant predictors of CSS. Penis-sparing approaches may be considered for most patients; however, pathological stage and grade dictate the management and ultimate outcome. Further studies are necessary to clarify the benefits of chemotherapy in this disease.

  10. Contemporary Management of Penile Cancer: Greater than 15-Year MSKCC Experience (United States)

    Moses, Kelvin A.; Winer, Andrew; Sfakianos, John P.; Poon, Stephen A.; Kent, Matthew; Bernstein, Melanie; Russo, Paul; Dalbagni, Guido


    Introduction Penile cancer is a rare malignancy, and few guidelines are available to define treatment paradigms. For greater understanding of the natural history of surgically treated penile cancer, we analyzed experience at our institution. Materials and Methods Using an institutional database, we identified 127 patients treated for squamous cell carcinoma of the penis from 1995 – 2011. Cancer-specific survival (CSS) was calculated using the Kaplan-Meier method. Survival data were compared using the log-rank test. The difference in risk of cancer-specific death by lymph node status and histological grade was determined by univariate Cox regression analysis. Results Five-year CSS for pTis, pT1, pT2, and pT3/4 was 100%, 84% (95% CI 58%-95%), 54% (95% CI 33%-71%), and 54% (95% CI 25%-76%), respectively (P ≤ .005). Three-year CSS for patients with N0, N+, and Nx disease was 90% (95% CI 47%-99%), 65% (95% CI 47%-79%), and 86% (95% CI 73%-93%), respectively (P = .03). The receipt of neoadjuvant chemotherapy did not change per 5 year period over the 16 years of our study. Median follow-up was 2.8 years. Conclusions Penile cancer patients with advanced disease had poor survival. Tumor stage and nodal status were significant predictors of CSS. Penis-sparing approaches may be considered for most patients; however, pathological stage and grade dictate the management and ultimate outcome. Further studies are necessary to clarify the benefits of chemotherapy in this disease. PMID:24775572

  11. Critical evaluation of contemporary management in a new Pelvic Exenteration Unit: The first 25 consecutive cases. (United States)

    Chew, Min Hoe; Yeh, Yu-Ting; Toh, Ee-Lin; Sumarli, Stephen Aditya; Chew, Ghee Kheng; Lee, Lui Shiong; Tan, Mann Hong; Hennedige, Tiffany Priyanthi; Ng, Shin Yi; Lee, Say Kiat; Chong, Tze Tec; Abdullah, Hairil Rizal; Goh, Terence Lin Hon; Rasheed, Mohamed Zulfikar; Tan, Kok Chai; Tang, Choong Leong


    . One patient experienced grade 4a Clavien-Dindo complication, requiring temporary renal dialysis without long-term disability. The R0 resection rate was 64%. There were 7 post-exenteration recurrences during the follow-up period. No statistically significant relationship was found among histological origin of tumour, microscopic resection margin status and postoperative recurrence ( P = 0.67). Four patients died from sequelae of recurrent disease during follow-up. By utilizing modern assessment and surgical techniques, our PE Unit can manage complex pelvic cancers with acceptable morbidities, zero-rate mortality and equivalent oncologic outcomes.

  12. Molecular analysis of pancreatic cyst fluid changes clinical management. (United States)

    Arner, David M; Corning, Brooke E; Ahmed, Ali M; Ho, Henry C; Weinbaum, Bradley J; Siddiqui, Uzma; Aslanian, Harry; Adams, Reid B; Bauer, Todd W; Wang, Andrew Y; Shami, Vanessa M; Sauer, Bryan G


    DNA molecular analysis has been suggested as a tool to evaluate pancreatic cysts. This study assesses whether the addition of DNA molecular analysis alters clinical management. This is a retrospective review of 46 consecutive patients who underwent EUS-FNA of pancreatic cysts with DNA molecular analysis at two major academic institutions. Cases were presented to two pancreaticobiliary surgeons first without and then with DNA molecular analysis data. The primary outcome was the frequency with which clinical management was altered with the addition of DNA molecular analysis. Forty-six patients with a mean age of 62.0 (±13.4) years and mean cyst size of 3.2 (±2.3) cm were included in the study. Cyst carcinoembryonic antigen (CEA) was available in 30 patients and ranged from 0.4 to 15,927 ng/mL. DNA molecular analysis was described as benign in 23 (50%), statistically indolent in 13 (28%), statistically higher risk in 9 (20%), and indeterminate in 1 (2%). Surgeon #1 changed the management in 13/46 cases (28%) and surgeon #2 changed the management in 12/46 cases (26%) with the addition of DNA molecular analysis. When organized by CEA concentration, those with an intermediate CEA (45-800 ng/mL) or without a CEA concentration had a management changed more frequently (40%) compared to all others (P molecular analysis alters the clinical management of pancreatic cystic lesions most often when CEA levels are intermediate (45-800 ng/mL) or when no CEA concentration is available. Use of DNA molecular analysis can be considered in this cohort. Further study of molecular markers in pancreatic cystic lesions is recommended.

  13. Change Management in Indo-Japanese Cross-Cultural Collaborative Contexts: Parallels between Traditional Indian Philosophy and Contemporary Japanese Management


    Ashok Ashta; Stokes, Peter; Hughes, Paul


    The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link. Abstract Purpose: Within the globalised commercial context, Japanese business activity in India has increased significantly. The purpose of this research paper is to highlight common attitudinal traits that would facilitate orientation of Indian executives towards Japanese management methods through, for instance, ‘reverse adaptation’ using ...

  14. Fluid management in roll-to-roll nanoimprint lithography (United States)

    Jain, A.; Bonnecaze, R. T.


    The key process parameters of UV roll-to-roll nanoimprint lithography are identified from an analysis of the fluid, curing, and peeling dynamics. The process includes merging of droplets of imprint material, curing of the imprint material from a viscous liquid to elastic solid resist, and pattern replication and detachment of the resist from template. The time and distances on the web or rigid substrate over which these processes occur are determined as function of the physical properties of the uncured liquid, the cured solid, and the roller configuration. The upper convected Maxwell equation is used to model the viscoelastic liquid and to calculate the force on the substrate and the torque on the roller. The available exposure time is found to be the rate limiting parameter and it is O(√Rho /uo), where R is the radius of the roller, ho is minimum gap between the roller and web, and uo is the velocity of the web. The residual layer thickness of the resist should be larger than the gap between the roller and the substrate to ensure complete feature filling and optimal pattern replication. For lower residual layer thickness, the droplets may not merge to form a continuous film for pattern transfer.

  15. Atypical Amniotic Fluid Embolism Managed with a Novel Therapeutic Regimen

    Directory of Open Access Journals (Sweden)

    Shadi Rezai


    Full Text Available Amniotic fluid embolism (AFE is the second leading cause of maternal mortality in the USA with an incidence of 1 : 15,200 births. The case fatality rate and perinatal mortality associated with AFE are 13–30% and 9–44%, respectively. This rare but devastating complication can be difficult to diagnose as many of the early signs and symptoms are nonspecific. Compounding this diagnostic challenge is a lack of effective treatment regimens which to date are mostly supportive. We present the case of a 26-year-old woman who suffered from suspected AFE and was successfully treated with the novel regimen of Atropine, Ondansetron, and Ketorolac (A-OK. The authors acknowledge that this case does not meet the new criteria proposed, by Clark in 2016, but feel that it is important to share this case report, due to dramatic patient response to the provided supportive therapy presented in this case report. We hope this case report will prompt further research into this novel approach to treating AFE with Atropine, Ondansetron, and Ketorolac.

  16. Contemporary Trends in the Management and Outcomes of Patients With Familial Hypercholesterolemia in Canada: A Prospective Observational Study. (United States)

    Brunham, Liam R; Cermakova, Lubomira; Lee, Terry; Priecelova, Ida; Alloul, Karine; de Chantal, Marilyn; Francis, Gordon A; Frohlich, Jiri


    Heterozygous familial hypercholesterolemia (HeFH) is one of the most common genetic diseases in the world and an important cause of premature cardiovascular (CV) disease. The purpose of this study was to characterize the clinical features, current treatment patterns, and CV outcomes of patients with HeFH in British Columbia, Canada. We conducted a longitudinal observational study of patients with HeFH attending a specialized lipid clinic. We collected data on lipid levels, medication use, and CV events at baseline and last follow-up. We recruited 339 patients with clinically diagnosed HeFH, with a total of 3700 person-years of follow-up. The mean low-density lipoprotein cholesterol (LDL-C) level was 5.9 mmol/L at baseline and 3.7 mmol/L at last follow-up. Use of lipid-lowering therapy (LLT) increased from 35.7% at baseline to 84.7% at last follow-up. A ≥ 50% reduction in LDL-C level was achieved in 34.5% of patients, and an LDL-C level ≤ 2 mmol/L was seen in 8.3%. The overall CV event rate in this cohort was 33.5/1000 person-years. Among patients who had a CV event during follow-up, 59% experienced a recurrent event within 5 years. These data contribute to our understanding of contemporary trends in the management of patients with HeFH in Canada. Despite a majority of patients receiving LLT, few patients reached high-risk lipid targets. These data highlight important opportunities to improve the care of patients with HeFH. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  17. Molecular insights into the historic demography of bowhead whales: understanding the evolutionary basis of contemporary management practices (United States)

    Phillips, C D; Hoffman, J I; George, J C; Suydam, R S; Huebinger, R M; Patton, J C; Bickham, J W


    Patterns of genetic variation observed within species reflect evolutionary histories that include signatures of past demography. Understanding the demographic component of species' history is fundamental to informed management because changes in effective population size affect response to environmental change and evolvability, the strength of genetic drift, and maintenance of genetic variability. Species experiencing anthropogenic population reductions provide valuable case studies for understanding the genetic response to demographic change because historic changes in the census size are often well documented. A classic example is the bowhead whale, Balaena mysticetus, which experienced dramatic population depletion due to commercial whaling in the late 19th and early 20th centuries. Consequently, we analyzed a large multi-marker dataset of bowhead whales using a variety of analytical methods, including extended Bayesian skyline analysis and approximate Bayesian computation, to characterize genetic signatures of both ancient and contemporary demographic histories. No genetic signature of recent population depletion was recovered through any analysis incorporating realistic mutation assumptions, probably due to the combined influences of long generation time, short bottleneck duration, and the magnitude of population depletion. In contrast, a robust signal of population expansion was detected around 70,000 years ago, followed by a population decline around 15,000 years ago. The timing of these events coincides to a historic glacial period and the onset of warming at the end of the last glacial maximum, respectively. By implication, climate driven long-term variation in Arctic Ocean productivity, rather than recent anthropogenic disturbance, appears to have been the primary driver of historic bowhead whale demography. PMID:23403722

  18. Fluid phases contemporary with sandstone diagenesis tectonic movements and the activity of the natural nuclear reactors in the Oklo deposit, Republic of Gabon

    International Nuclear Information System (INIS)

    Poty, B.


    A research contract was agreed between the IAEA and the Centre de Recherches Petrographiques et Geochimiques of Nancy (France) to analyze some aspects of the fluid phases present during diagenesis of the Precambrian Francevillean sandstones of Gabon, which include the Oklo uranium deposit in which because of the geometry of the ore body, the high ore grade, etc., a natural uranium reactor was formed. The investigation was orientated to define some special characteristics of the fluid inclusions and two main methods were applied for this purpose: The Raman spectroscopy (MOLE microsonde) and microthermometric analysis. The main conclusions of the research are the following: 1. The Francevillean sandstones were buried up to a depth of 4-5 km where the corresponding geothermal temperature was of around 240 0 C but during the Oklo nuclear reaction, the fluid temperatures were higher than 450 0 C and in at least one case (Zone II) up to 600 0 C. 2. The tectonic fracturing has favoured the fluid circulation, which was possibly the responsible of the mineral re-concentration after the Oklo nuclear reaction. 3. The diagenetic fluids were essentially aqueous solutions and no sulphur components were identified. 4. The hydrogen presence in a quartz veinlet is surprising and possibly due to water decomposition by strong irradiation

  19. Standard on microbiological management of fluids for hemodialysis and related therapies by the Japanese Society for Dialysis Therapy 2008. (United States)

    Kawanishi, Hideki; Akiba, Takashi; Masakane, Ikuto; Tomo, Tadashi; Mineshima, Michio; Kawasaki, Tadayuki; Hirakata, Hideki; Akizawa, Tadao


    The Committee of Scientific Academy of the Japanese Society for Dialysis Therapy (JSDT) proposes a new standard on microbiological management of fluids for hemodialysis and related therapies. This standard is within the scope of the International Organization for Standardization (ISO), which is currently under revision. This standard is to be applied to the central dialysis fluid delivery systems (CDDS), which are widely used in Japan. In this standard, microbiological qualities for dialysis water and dialysis fluids are clearly defined by endotoxin level and bacterial count. The qualities of dialysis fluids were classified into three levels: standard, ultrapure, and online prepared substitution fluid. In addition, the therapeutic application of each dialysis fluid is clarified. Since high-performance dialyzers are frequently used in Japan, the standard recommends that ultrapure dialysis fluid be used for all dialysis modalities at all dialysis facilities. It also recommends that the dialysis equipment safety management committee at each facility should validate the microbiological qualities of online prepared substitution fluid.

  20. Hypertrophic Cardiomyopathy in Adulthood Associated With Low Cardiovascular Mortality With Contemporary Management Strategies. (United States)

    Maron, Barry J; Rowin, Ethan J; Casey, Susan A; Link, Mark S; Lesser, John R; Chan, Raymond H M; Garberich, Ross F; Udelson, James E; Maron, Martin S


    Hypertrophic cardiomyopathy (HCM) has been prominently associated with adverse disease complications, including sudden death or heart failure death and a generally adverse prognosis, with annual mortality rates of up to 6%. This study determined whether recent advances in management strategy, including implantable cardioverter-defibrillators (ICDs), heart transplantation, or other therapeutic measures have significantly improved survival and the clinical course of adult HCM patients. We addressed long-term outcomes in 1,000 consecutive adult HCM patients presenting at 30 to 59 years of age (mean 45±8 years) over 7.2±5.2 years of follow-up. Of 1,000 patients, 918 (92%) survived to 53±9.2 years of age (range 32 to 80 years) with 91% experiencing no or only mild symptoms at last evaluation. HCM-related death occurred in 40 patients (4% [0.53%/year]) at 50±10 years from the following events: progressive heart failure (n=17); arrhythmic sudden death (SD) (n=17); and embolic stroke (n=2). In contrast, 56 other high-risk patients (5.6%) survived life-threatening events, most commonly with ICD interventions for ventricular tachyarrhythmias (n=33) or heart transplantation for advanced heart failure (n=18 [0.79%/year]). SD occurred in patients who declined ICD recommendations, had evaluations before application of prophylactic ICDs to HCM, or were without conventional risk factors. The 5- and 10-year survival rates (confined to HCM deaths) were 98% and 94%, respectively, not different from the expected all-cause mortality in the general U.S. population (p=0.25). Multivariate independent predictors of adverse outcome were younger age at diagnosis, female sex, and increased left atrial dimension. In a large longitudinally assessed adult HCM cohort, we have demonstrated that contemporary management strategies and treatment interventions, including ICDs for SD prevention, have significantly altered the clinical course, now resulting in a low disease-related mortality rate of

  1. Opportunities for Intervention Strategies for Weight Management: Global Actions on Fluid Intake Patterns

    Directory of Open Access Journals (Sweden)

    Max Lafontan


    Full Text Available Summary: Water is an essential nutrient for all physiological functions and particularly important for thermoregulation. About 60% of our body weight is made of water. Under standard conditions (18-20 °C and moderate activity, water balance is regulated within 0.2 % of body weight over a 24-hour period. Water requirement varies between individuals and according to environmental conditions. Concerning considerations related to obesity, the health impact of fluid intake is commonly overlooked. Fluid intake advices are missing in most of food pyramids offered to the public, and water requirements and hydration challenges remain often neglected. The purpose of this paper is to emphasize and discuss the role of water consumption in the context of other important public health measures for weight management. Attention will be focused on fluid intake patterns and hydration-related questions in the context of global interventions and/or physical activity programs settled in weight management protocols.

  2. Opportunities for Intervention Strategies for Weight Management: Global Actions on Fluid Intake Patterns (United States)

    Lafontan, Max; Visscher, Tommy L.S.; Farpour-Lambert, Nathalie; Yumuk, Volkan


    Water is an essential nutrient for all physiological functions and particularly important for thermoregulation. About 60% of our body weight is made of water. Under standard conditions (18-20 °C and moderate activity), water balance is regulated within 0.2 % of body weight over a 24-hour period. Water requirement varies between individuals and according to environmental conditions. Concerning considerations related to obesity, the health impact of fluid intake is commonly overlooked. Fluid intake advices are missing in most of food pyramids offered to the public, and water requirements and hydration challenges remain often neglected. The purpose of this paper is to emphasize and discuss the role of water consumption in the context of other important public health measures for weight management. Attention will be focused on fluid intake patterns and hydration-related questions in the context of global interventions and/or physical activity programs settled in weight management protocols. PMID:25765164

  3. Integrated Vehicle Thermal Management - Combining Fluid Loops in Electric Drive Vehicles (Presentation)

    Energy Technology Data Exchange (ETDEWEB)

    Rugh, J. P.


    Plug-in hybrid electric vehicles and electric vehicles have increased vehicle thermal management complexity, using separate coolant loop for advanced power electronics and electric motors. Additional thermal components result in higher costs. Multiple cooling loops lead to reduced range due to increased weight. Energy is required to meet thermal requirements. This presentation for the 2013 Annual Merit Review discusses integrated vehicle thermal management by combining fluid loops in electric drive vehicles.

  4. Contemporary cryptography

    CERN Document Server

    Oppliger, Rolf


    Whether you're new to the field or looking to broaden your knowledge of contemporary cryptography, this newly revised edition of an Artech House classic puts all aspects of this important topic into perspective. Delivering an accurate introduction to the current state-of-the-art in modern cryptography, the book offers you an in-depth understanding of essential tools and applications to help you with your daily work. The second edition has been reorganized and expanded, providing mathematical fundamentals and important cryptography principles in the appropriate appendixes, rather than summarize

  5. Lumen apposing metal stents for pancreatic fluid collections: Recognition and management of complications. (United States)

    DeSimone, Michael L; Asombang, Akwi W; Berzin, Tyler M


    For patients recovering from acute pancreatitis, the development of a pancreatic fluid collection (PFC) predicts a more complex course of recovery, and introduces difficult management decisions with regard to when, whether, and how the collection should be drained. Most PFCs resolve spontaneously and drainage is indicated only in pseudocysts and walled-off pancreatic necrosis when the collections are causing symptoms and/or local complications such as biliary obstruction. Historical approaches to PFC drainage have included surgical (open or laparoscopic cystgastrostomy or pancreatic debridement), and the placement of percutaneous drains. Endoscopic drainage techniques have emerged in the last several years as the preferred approach for most patients, when local expertise is available. Lumen-apposing metal stents (LAMS) have recently been developed as a tool to facilitate potentially safer and easier endoscopic drainage of pancreatic fluid collections, and less commonly, for other indications, such as gallbladder drainage. Physicians considering LAMS placement must be aware of the complications most commonly associated with LAMS including bleeding, migration, buried stent, stent occlusion, and perforation. Because of the patient complexity associated with severe pancreatitis, management of pancreatic fluid collections can be a complex and multidisciplinary endeavor. Successful and safe use of LAMS for patients with pancreatic fluid collections requires that the endoscopist have a full understanding of the potential complications of LAMS techniques, including how to recognize and manage expected complications.

  6. Contemporary Management and Control of Uncomplicated Hypertension in Canada: Insight From the Primary Care Audit of Global Risk Management (PARADIGM) Study. (United States)

    Gupta, Milan; Szmitko, Paul; Singh, Narendra; Tsigoulis, Michelle; Kajil, Mahesh; Stone, James


    Although clinical practice guidelines for the management of hypertension exist in Canada, the rate of contemporary blood pressure (BP) control remains unclear. In the Primary Care Audit of Global Risk Management (PARADIGM) study, 3015 healthy, middle-aged Canadians, free of cardiovascular disease (CVD) or diabetes were evaluated. In this analysis, we characterized the CVD risk factors, treatment patterns, and BP control rates in subjects with uncomplicated hypertension. A total of 917 subjects (30.4%) had a diagnosis of hypertension. The median age was 59 ± 8 years. The mean treated systolic/diastolic BP were 134 ± 14 mm Hg/82 ± 9 mm Hg, respectively. CVD risk factors included past/current smoking (35.9%), abdominal obesity (62.5%), and dyslipidemia (59.4%). Using the Framingham Risk Score, 20.4%, 41.0%, and 38.5% of the subjects were at low, intermediate, and high risk, respectively. Of the 88% with treated hypertension, 46.9%, 38.7%, and 14.3% received 1, 2, or ≥3 drugs, respectively. The rate of BP control was 57.4% (systolic BP Risk Score, and was lower in patients with metabolic syndrome vs those without (P risk factors are prevalent in Canadians with uncomplicated hypertension. BP control was modest (57.4%) and was lowest in patients prescribed diuretic monotherapy and in those at highest CVD risk. Despite the success of national hypertension strategies, enhanced efforts are warranted to improve BP control in Canada. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  7. Pathophysiology and clinical implications of peroperative fluid management in elective surgery

    DEFF Research Database (Denmark)

    Holte, Kathrine


    The purpose of this thesis was to describe pathophysiological aspects of perioperative fluid administration and create a rational background for future, clinical outcome studies. In laparoscopic cholecystectomy, we have found "liberal" crystalloid administration ( approximately 3 liters) to improve....... Based on the current evidence, administration of liters intravenous fluid without specific indication in major surgical procedures should be avoided, while administration of liters in patients with anastomoses may not be recommended, an issue needing clarification in large-scale clinical studies...... perioperative physiology and clinical outcome, which has implication for fluid management in other laparoscopic procedures such as laparoscopic fundoplication, laparoscopic repair of ventral hernia, hysterectomy etc., where 2-3 liters crystalloid should be administered based on the present evidence. That equal...

  8. Applications of nano-fluids to enhance LWR accidents management in in-vessel retention and emergency core cooling systems

    International Nuclear Information System (INIS)

    Chupin, A.; Hu, L. W.; Buongiorno, J.


    Water-based nano-fluid, colloidal dispersions of nano-particles in water; have been shown experimentally to increase the critical heat flux and surface wettability at very low concentrations. The use of nano-fluids to enhance accidents management would allow either to increase the safe margins in case of severe accidents or to upgrade the power of an existing power plant with constant margins. Building on the initial work, computational fluid dynamics simulations of the nano-fluid injection system have been performed to evaluate the feasibility of a nano-fluid injection system for in-vessel retention application. A preliminary assessment was also conducted on the emergency core cooling system of the European Pressurized Reactor (EPR) to implement a nano-fluid injection system for improving the management of loss of coolant accidents. Several design options were compared/or their respective merits and disadvantages based on criteria including time to injection, safety impact, and materials compatibility. (authors)

  9. The Contemporary Consultant

    DEFF Research Database (Denmark)

    Olson, Thomas; Poulfelt, Flemming; Greiner, Larry

    This book complements The handbook of Management Consulting: The Contemporary Consultant: Insights from Leading Experts, 1e but can also be studied separately. The book consists of 20 cases including Harvard and Stanford cases. The cases present the broad range of topics that are pertinent to cur...... current management issues facing consulting firms. These cases, together with the handbook, will prepare consultants and other business managers for a successful future in a highly competitive consulting environment.......This book complements The handbook of Management Consulting: The Contemporary Consultant: Insights from Leading Experts, 1e but can also be studied separately. The book consists of 20 cases including Harvard and Stanford cases. The cases present the broad range of topics that are pertinent...... to current management consulting. Each of the four parts of the text presents a cogent introduction by the editors, delineating topics that are critical for today's consultants to understand. The cases represent major practice areas of consulting and afford new insights into change processes and other...

  10. A Cryogenic Fluid System Simulation in Support of Integrated Systems Health Management (United States)

    Barber, John P.; Johnston, Kyle B.; Daigle, Matthew


    Simulations serve as important tools throughout the design and operation of engineering systems. In the context of sys-tems health management, simulations serve many uses. For one, the underlying physical models can be used by model-based health management tools to develop diagnostic and prognostic models. These simulations should incorporate both nominal and faulty behavior with the ability to inject various faults into the system. Such simulations can there-fore be used for operator training, for both nominal and faulty situations, as well as for developing and prototyping health management algorithms. In this paper, we describe a methodology for building such simulations. We discuss the design decisions and tools used to build a simulation of a cryogenic fluid test bed, and how it serves as a core technology for systems health management development and maturation.

  11. Prehospital management and fluid resuscitation in hypotensive trauma patients admitted to Karolinska University Hospital in Stockholm. (United States)

    Talving, Peep; Pålstedt, Joakim; Riddez, Louis


    Few previous studies have been conducted on the prehospital management of hypotensive trauma patients in Stockholm County. The aim of this study was to describe the prehospital management of hypotensive trauma patients admitted to the largest trauma center in Sweden, and to assess whether prehospital trauma life support (PHTLS) guidelines have been implemented regarding prehospital time intervals and fluid therapy. In addition, the effects of the age, type of injury, injury severity, prehospital time interval, blood pressure, and fluid therapy on outcome were investigated. This is a retrospective, descriptive study on consecutive, hypotensive trauma patients (systolic blood pressure Karolinska University Hospital in Stockholm, Sweden, during 2001-2003. The reported values are medians with interquartile ranges. Basic demographics, prehospital time intervals and interventions, injury severity scores (ISS), type and volumes of prehospital fluid resuscitation, and 30-day mortality were abstracted. The effects of the patient's age, gender, prehospital time interval, type of injury, injury severity, on-scene and emergency department blood pressure, and resuscitation fluid volumes on mortality were analyzed using the exact logistic regression model. In 102 (71 male) adult patients (age > or = 15 years) recruited, the median age was 35.5 years (range: 27-55 years) and 77 patients (75%) had suffered blunt injury. The predominant trauma mechanisms were falls between levels (24%) and motor vehicle crashes (22%) with an ISS of 28.5 (range: 16-50). The on-scene time interval was 19 minutes (range: 12-24 minutes). Fluid therapy was initiated at the scene of injury in the majority of patients (73%) regardless of the type of injury (77 blunt [75%] / 25 penetrating [25%]) or injury severity (ISS: 0-20; 21-40; 41-75). Age (odds ratio (OR) = 1.04), male gender (OR = 3.2), ISS 21-40 (OR = 13.6), and ISS >40 (OR = 43.6) were the significant factors affecting outcome in the exact

  12. Contemporary management of high-grade renal trauma: Results from the American Association for the Surgery of Trauma Genitourinary Trauma study. (United States)

    Keihani, Sorena; Xu, Yizhe; Presson, Angela P; Hotaling, James M; Nirula, Raminder; Piotrowski, Joshua; Dodgion, Christopher M; Black, Cullen M; Mukherjee, Kaushik; Morris, Bradley J; Majercik, Sarah; Smith, Brian P; Schwartz, Ian; Elliott, Sean P; DeSoucy, Erik S; Zakaluzny, Scott; Thomsen, Peter B; Erickson, Bradley A; Baradaran, Nima; Breyer, Benjamin N; Miller, Brandi; Santucci, Richard A; Carrick, Matthew M; Hewitt, Timothy; Burks, Frank N; Kocik, Jurek F; Askari, Reza; Myers, Jeremy B


    The rarity of renal trauma limits its study and the strength of evidence-based guidelines. Although management of renal injuries has shifted toward a nonoperative approach, nephrectomy remains the most common intervention for high-grade renal trauma (HGRT). We aimed to describe the contemporary management of HGRT in the United States and also evaluate clinical factors associated with nephrectomy after HGRT. From 2014 to 2017, data on HGRT (American Association for the Surgery of Trauma grades III-V) were collected from 14 participating Level-1 trauma centers. Data were gathered on demographics, injury characteristics, management, and short-term outcomes. Management was classified into three groups-expectant, conservative/minimally invasive, and open operative. Descriptive statistics were used to report management of renal trauma. Univariate and multivariate logistic mixed effect models with clustering by facility were used to look at associations between proposed risk factors and nephrectomy. A total of 431 adult HGRT were recorded; 79% were male, and mechanism of injury was blunt in 71%. Injuries were graded as III, IV, and V in 236 (55%), 142 (33%), and 53 (12%), respectively. Laparotomy was performed in 169 (39%) patients. Overall, 300 (70%) patients were managed expectantly and 47 (11%) underwent conservative/minimally invasive management. Eighty-four (19%) underwent renal-related open operative management with 55 (67%) of them undergoing nephrectomy. Nephrectomy rates were 15% and 62% for grades IV and V, respectively. Penetrating injuries had significantly higher American Association for the Surgery of Trauma grades and higher rates of nephrectomy. In multivariable analysis, only renal injury grade and penetrating mechanism of injury were significantly associated with undergoing nephrectomy. Expectant and conservative management is currently utilized in 80% of HGRT; however, the rate of nephrectomy remains high. Clinical factors, such as surrogates of

  13. Museology and heritage in contemporary cities: a thesis on city management from the perspective of culture and memory preservation

    Directory of Open Access Journals (Sweden)

    Heloisa Helena Fernandes Gonçalves da Costa


    Full Text Available Essentialy considered a space to live, the contemporary cities are complexes territories where memory and heritage have no effective representative function. The main objective of this paper is to analyze the emergence of the 'cultural health', a new concept supported by the relationship between museology, heritage and citizenship. The research was based on fieldwork experience and on memory studies of adults and elderly people that live in urban areas, where they can observe the symbolic meaning of the monuments and similars objects within the museum cities and the cultural landscapes. The way that museums and monuments are inserted in civil society and their power to produce values and cultural codes make them part of the process to promote identities and citizenship. Also, this process can improve the cultural health, the self-esteem and the quality of social interaction. These elements are essential for the building of healthy cities.

  14. The moral economy of contemporary working-class adolescence: managing symbolic capital in a French public 'Adolescent Centre'. (United States)

    Coutant, Isabelle; Eideliman, Jean-Sébastien


    Working-class adolescents of French urban peripheries are key figures in a new social debate that reactivates the nineteenth century spectre of 'dangerous' classes to be controlled. Since the 1990s, French social counselling has privileged two modalities of response: taking account of suffering and government by listening and speech. We hypothesize that the contemporary moral economy allows for social interactions that go beyond social control and institutional domination. This is partly because professionals engaged in this moral undertaking may keep a critical distance, and partly because the concerned populations aren't necessarily devoid of resources to advance their interests or incapable of resistance. The concept of moral economy, coupled with the ethnographic method, is heuristic for fully comprehending the complexity of these issues and their stakes. Our fieldwork was centred on a French Adolescent Centre in an impoverished commune in Paris's periphery, from January 2010 through March 2011. These institutions were established in the early 2000s to respond to adolescent 'suffering' by crossing social work and psychiatry. Adolescents, parents, and other institutions (especially schools) solicit the professionally diverse staff for assistance, which in turn may take on cases and/or make referrals to other support institutions. By paying attention to all the scenes upon which the story of a counselled adolescent evolves, and bearing more general social evolutions in mind by applying the concept of moral economy, we can consider the multiplicity of seemingly contradictory processes as a whole. We see the destabilization of parents and their loss of symbolic capital, partly due to the norms of contemporary parenthood and partly due to the stigmatization of working-class adolescence. But we also discern possibilities for expressing sentiments of injustice and humiliation, for increasing symbolic capital, and in some cases a reappropriation of the system

  15. Urine and oral fluid drug testing in support of pain management. (United States)

    Kwong, Tai C; Magnani, Barbarajean; Moore, Christine


    In recent years, the abuse of opioid drugs has resulted in greater prevalence of addiction, overdose, and deaths attributable to opioid abuse. The epidemic of opioid abuse has prompted professional and government agencies to issue practice guidelines for prescribing opioids to manage chronic pain. An important tool available to providers is the drug test for use in the initial assessment of patients for possible opioid therapy, subsequent monitoring of compliance, and documentation of suspected aberrant drug behaviors. This review discusses the issues that most affect the clinical utility of drug testing in chronic pain management with opioid therapy. It focuses on the two most commonly used specimen matrices in drug testing: urine and oral fluid. The advantages and disadvantages of urine and oral fluid in the entire testing process, from specimen collection and analytical methodologies to result interpretation are reviewed. The analytical sensitivity and specificity limitations of immunoassays used for testing are examined in detail to draw attention to how these shortcomings can affect result interpretation and influence clinical decision-making in pain management. The need for specific identification and quantitative measurement of the drugs and metabolites present to investigate suspected aberrant drug behavior or unexpected positive results is analyzed. Also presented are recent developments in optimization of test menus and testing strategies, such as the modification of the standard screen and reflexed-confirmation testing model by eliminating some of the initial immunoassay-based tests and proceeding directly to definitive testing by mass spectrometry assays.

  16. Technology for Space Station Evolution. Volume 3: EVA/Manned Systems/Fluid Management System (United States)


    NASA's Office of Aeronautics and Space Technology (OAST) conducted a workshop on technology for space station evolution 16-19 Jan. 1990 in Dallas, Texas. The purpose of this workshop was to collect and clarify Space Station Freedom technology requirements for evolution and to describe technologies that can potentially fill those requirements. These proceedings are organized into an Executive Summary and Overview and five volumes containing the Technology Discipline Presentations. Volume 3 consists of the technology discipline sections for Extravehicular Activity/Manned Systems and the Fluid Management System. For each technology discipline, there is a Level 3 subsystem description, along with the papers.

  17. Diagnostic yield of MRI for audiovestibular dysfunction using contemporary referral criteria: correlation with presenting symptoms and impact on clinical management

    Energy Technology Data Exchange (ETDEWEB)

    Vandervelde, C. [Department of Radiology, Guy' s and St Thomas' NHS Foundation Trust (United Kingdom)], E-mail:; Connor, S E.J. [Department of Radiology, Guy' s and St Thomas' NHS Foundation Trust (United Kingdom); Department of Neuroradiology, King' s College Hospital NHS Foundation Trust, London (United Kingdom)


    Aim: To investigate the diagnostic yield of T2-weighted magnetic resonance imaging (MRI) screening for vestibular schwannoma and other relevant conditions in the setting of audiovestibular symptoms, given the more liberal contemporary referral criteria. To determine whether presenting clinical symptoms correlate with imaging outcome in order to guide future protocols for MRI referral. Materials and methods: Eight hundred and eighty-one consecutive MRI examinations performed in patients with audiovestibular dysfunction were reviewed. Clinical indications and findings were recorded. Case notes were reviewed in patients with positive imaging findings. Two-way, cross-tabulation, Chi-square analysis was performed to assess the relationship between presenting symptoms and imaging outcome. Results: Twelve of the 881 (1.4%) were positive for vestibular schwannoma. A further four of 881 (0.4%) revealed other relevant conditions. Incidental conditions, felt to be irrelevant to the presenting symptoms, were noted in 12 of the 881 (1.4%). In all 12 cases that were positive for vestibular schwannoma, either tinnitus or hearing loss was present. Conclusion: The yield for T2-weighted MRI to diagnose vestibular schwannoma and other relevant retrocochlear conditions was lower than for previous studies, which is likely to reflect trends in referral criteria. No single audiovestibular symptom or combination of symptoms is a statistically significant predictor of imaging outcome.

  18. Diagnostic yield of MRI for audiovestibular dysfunction using contemporary referral criteria: correlation with presenting symptoms and impact on clinical management

    International Nuclear Information System (INIS)

    Vandervelde, C.; Connor, S.E.J.


    Aim: To investigate the diagnostic yield of T2-weighted magnetic resonance imaging (MRI) screening for vestibular schwannoma and other relevant conditions in the setting of audiovestibular symptoms, given the more liberal contemporary referral criteria. To determine whether presenting clinical symptoms correlate with imaging outcome in order to guide future protocols for MRI referral. Materials and methods: Eight hundred and eighty-one consecutive MRI examinations performed in patients with audiovestibular dysfunction were reviewed. Clinical indications and findings were recorded. Case notes were reviewed in patients with positive imaging findings. Two-way, cross-tabulation, Chi-square analysis was performed to assess the relationship between presenting symptoms and imaging outcome. Results: Twelve of the 881 (1.4%) were positive for vestibular schwannoma. A further four of 881 (0.4%) revealed other relevant conditions. Incidental conditions, felt to be irrelevant to the presenting symptoms, were noted in 12 of the 881 (1.4%). In all 12 cases that were positive for vestibular schwannoma, either tinnitus or hearing loss was present. Conclusion: The yield for T2-weighted MRI to diagnose vestibular schwannoma and other relevant retrocochlear conditions was lower than for previous studies, which is likely to reflect trends in referral criteria. No single audiovestibular symptom or combination of symptoms is a statistically significant predictor of imaging outcome

  19. Periprocedural Management of Non-Vitamin K Oral Anticoagulants in Chronic Kidney Disease: A Review of Existing Heterogeneity and Contemporary Evidence. (United States)

    Gunasekaran, Prasad; Parashara, Deepak K


    Non vitamin-K oral anticoagulants (NOAC) have considerably enhanced anticoagulation practice for non-valvular atrial fibrillation with specific advantages of fixed dosing, non-fluctuant therapeutic levels and obviation of therapeutic level monitoring. NOAC pharmacology is remarkable for considerable renal excretion. Heterogeneity in the precise time cut-offs for discontinuation of NOACs prior to elective surgical or percutaneous procedures arise from the non-linear variations of drug excretion with different levels of creatinine clearances as in chronic kidney disease. Multiple authors have suggested cut-offs leading to ambiguity among practicing clinicians. Recent data pertaining to systemic thromboembolism, stroke and major bleeding derived from randomized controlled clinical trials have simplified the periprocedural management of NOACs. This review focusses on heterogeneity in the management of NOACs in patients with CKD in this peculiar scenario and highlights the contemporary evidence to support a unified approach towards perioperative management of NOACs. Multiple antidotes targeted towards binding of specific NOACs have been developed and are in the testing phase, thereby offering immense potential for rapid and complete reversal of NOAC activity in emergent procedures and major bleeding episodes. Targeted research on thromboembolism, stroke and major bleeding following temporary periprocedural interruption of NOACs using multicentric registries could further expand the clinical utility of these agents.

  20. Contemporary Management of Prostate Cancer Patients Suitable for Active Surveillance: A North American Population-based Study. (United States)

    Moschini, Marco; Fossati, Nicola; Sood, Akshay; Lee, Justin K; Sammon, Jesse; Sun, Maxine; Pucheril, Dan; Dalela, Deepansh; Montorsi, Francesco; Karnes, R Jeffrey; Briganti, Alberto; Trinh, Quoc-Dien; Menon, Mani; Abdollah, Firas


    Active surveillance (AS) is increasingly recognized as a recommended treatment option for prostate cancer (PCa) patients with clinically localized, low-risk disease; however, previous studies suggested that its utilization is uncommon in the United States. We evaluated the nationwide utilization rate of AS in the contemporary era. We relied on the 2010-2011 Surveillance Epidemiology and End Results (SEER) database using all 18 SEER-based registries. We identified 9049 patients that fulfilled the University of California, San Francisco AS criteria (prostate-specific antigen level <10ng/ml, clinical T stage ≤2a, Gleason score ≤6 [no pattern 4 or 5], and percentage of positive biopsy cores <33%). Logistic regression analysis tested the relationship between receiving local treatment and all available predictors. Only 32% of AS candidates did not receive any active local treatment. This proportion varied widely among the SEER-based registries, ranging from 13% to 49% (p<0.001). In multivariable analyses, clinical stage T2a (odds ratio [OR]: 1.23; p=0.04) and percentage of positive cores (OR: 1.10 for each 2% increase; p<0.001) were associated with a higher probability of receiving local treatment. Conversely, older age (OR: 0.89 for each 2-yr increase; p<0.001), not being married (OR: 0.64; p<0.001), and uninsured status (OR: 0.55; p=0.008) were associated with a lower probability of receiving active local treatment. The study is limited by the fact that SEER does not distinguish among patients undergoing observation, AS, watchful waiting, or initial hormonal therapy. In the United States, a considerable proportion of patients suitable for AS receive local treatment for PCa. Proportions differ significantly among SEER registries. Having more extensive and palpable disease, having medical insurance, being married, and being younger are associated with an increased probability of receiving local treatment for low-risk prostate cancer. Copyright © 2016 European

  1. UK National Survey of Practice Patterns of Fluid Volume Management in Haemodialysis Patients: A Need for Evidence. (United States)

    Dasgupta, Indranil; Farrington, Ken; Davies, Simon J; Davenport, Andrew; Mitra, Sandip


    Fluid management in haemodialysis (HD) affects patient experience, morbidity and mortality. Standards for best practice are lacking. A national survey of the United Kingdom was undertaken to define prevalent practice. An online questionnaire was distributed to all UK renal centres. Forty-five of 74 centres (173 dialysis units), serving 62% (n = 14,697) of UK HD population responded. Seventy-eight per cent had no agreed policy for managing fluid balance in patients on HD; 44% did not assess fluid status routinely. Clinical assessment was the norm; 27% used bio-impedance-based device. To achieve a target-weight, 53% reduced weight as far as tolerated. Twenty-two per cent measured residual renal function (RRF). Ninety-one per cent had no policy for fluid overload. Sixty-four per cent restricted salt and water. Ninety-three per cent used diuretics in patients with RRF. Thirty-eight per cent felt management was adequate; 77% felt there was a need for better evidence. Ninety-one per cent would participate in a study addressing this. There is an urgent need for establishing an evidence base on the optimal approaches to fluid management. © 2016 S. Karger AG, Basel.

  2. Perfect Partners or Uneasy Bedfellows? Competing Understandings of the Place of Business Management within Contemporary Education Partnerships (United States)

    Woods, Charlotte; Armstrong, Paul; Bragg, Joanna; Pearson, Diana


    This article examines illustrative cases of partnerships from a government-funded programme of experimental projects in England designed to test out the potential of senior business managers to provide leadership across a group of schools. The article places the programme within the context of international public service reforms and, more…

  3. Human Value Management : The influence of contemporary developments of corporate social responsibility and social capital on HRM

    NARCIS (Netherlands)

    Schoemaker, M.; Nijhof, A.H.J.; Jonker, J.


    In both practice-oriented and academic discourses the concepts of corporate social responsibility (CSR) and human resource management (HRM) are often treated separately. It is argued here that this is an outdated approach. Starting from the observation that organisations develop towards open

  4. Human Value Management. The Influence of the Contemporary Developments of Corporate Social Responsibility and Social Capital on HRM

    NARCIS (Netherlands)

    Schoemaker, Michiel; Nijhof, A.H.J.; Jonker, Jan


    In both practice-oriented and academic discourses the concepts of corporate social responsibility (CSR) and human resource management (HRM) are often treated separately. It is argued here that this is an outdated approach. Starting from the observation that organisations develop towards open

  5. Epidemiology and Management of Patients With Acute Coronary Syndromes in Contemporary Real-World Practice: Evolving Trends From the EYESHOT Study to the START-ANTIPLATELET Registry. (United States)

    Calabrò, Paolo; Gragnano, Felice; di Maio, Marco; Patti, Giuseppe; Antonucci, Emilia; Cirillo, Plinio; Gresele, Paolo; Palareti, Gualtiero; Pengo, Vittorio; Pignatelli, Pasquale; Pennacchi, Mauro; Granatelli, Antonino; De Servi, Stefano; De Luca, Leonardo; Marcucci, Rossella


    The epidemiology and management of patients with acute coronary syndromes (ACSs) have evolved. We aimed to describe recent demographics and therapeutic changes in the Italian ACS population. We analyzed data from 2 multicenter consecutive Italian registries (the EYESHOT [EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalised in iTalian cardiac care units] and START-ANTIPLATELET registries) enrolling patients with ACS between December 2013 and June 2016. An overall population of 3756 patients with ACS was enrolled: 2585 in the EYESHOT and 1171 in the START-ANTIPLATELET. Compared with the EYESHOT, patients in the START-ANTIPLATELET registry presented more frequently with ST-segment elevation myocardial infarction and were more often smokers and dyslipidemic (all P START-ANTIPLATELET (all P START-ANTIPLATELET compared with the EYESHOT. The START-ANTIPLATELET and EYESHOT registries provide consecutive snapshots in the contemporary management of patients with ACS in Italy, showing important changes in both demographic characteristics and treatment strategies.

  6. Management and Long-Term Outcome of Acute Coronary Syndrome Patients Presenting with Heart Failure in a Contemporary New Zealand Cohort (ANZACS-QI 4). (United States)

    Kueh, Shaw Hua Anthony; Devlin, Gerry; Lee, Mildred; Doughty, Rob N; Kerr, Andrew J


    Acute heart failure (HF) associated with an acute coronary syndrome (ACS) predicts adverse outcome. There have been important recent improvements in ACS management. Our aim was to describe the management and outcomes in those with and without HF in a contemporary ACS cohort. Consecutive patients presenting with ACS between 2007 and 2011 were enrolled in the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry. Outcomes and medication dispensing were obtained using anonymised linkage to national data sets. A summary pharmacotherapy measure of "quadruple therapy" was defined as dispensing of at least one agent from each of the four evidence-based classes - anti-platelet, statin, angiotensin converting enzyme inhibitor/angiotensin receptor blocker and beta blocker. Of 3743 ACS patients 14% had acute HF. Acute heart failure patients were older (69.2±12.6 vs 62.3±12.8 years, pcoronary angiography (66% vs 86%, pAcute heart failure complicating ACS is associated with heightened risk of short-term and long-term mortality. One in three ACS patients with HF did not have coronary angiography and less than half received quadruple therapy a year after presentation. Copyright © 2016. Published by Elsevier B.V.

  7. The Management of Cerebrospinal Fluid Leak After Anterior Cervical Decompression Surgery. (United States)

    Zhai, Jiliang; Panchal, Ripul R; Tian, Ye; Wang, Shujie; Zhao, Lijuan


    Cerebrospinal fluid (CSF) leak is a rare but potentially troublesome and occasionally catastrophic complication after anterior cervical decompression surgery. There is limited literature describing this complication, and the management of CSF leak varies. The aim of this study was to retrospectively review the treatment of cases with CSF leak and develop a management algorithm. A series of 14 patients with CSF leak from January 2011 to May 2016 were included in this study. Their characteristics, management of CSF leak, and outcomes were documented. There were 5 male and 9 female patients. Mean age at surgery was 57.1±9.9 years (range, 37-76 years). All instances of CSF leak, except 1 noted postoperatively, were indirectly repaired intraoperatively. A closed straight wound drain was placed for all patients. A lumbar subarachnoid drain was placed immediately after surgery in 4 patients and postoperatively in 7 patients. In 1 patient, lumbar drain placement was unsuccessful. In 2 additional patients, the surgeon decided not to place a lumbar drain. One patient developed meningitis and recovered after antibiotic therapy with meropenem and vancomycin. Another patient had a deep wound infection and required a revision surgery. Wound drains and lumbar drains should be immediately considered when CSF leak is identified. Antibiotics also should be considered to prevent intradural infection. [Orthopedics. 2018; 41(2):e283-e288.]. Copyright 2018, SLACK Incorporated.

  8. Conceptual Design of an In-Space Cryogenic Fluid Management Facility (United States)

    Willen, G. S.; Riemer, D. H.; Hustvedt, D. C.


    The conceptual design of a Spacelab experiment to develop the technology associated with low gravity propellant management is presented. The proposed facility consisting of a supply tank, receiver tank, pressurization system, instrumentation, and supporting hardware, is described. The experimental objectives, the receiver tank to be modeled, and constraints imposed on the design by the space shuttle, Spacelab, and scaling requirements, are described. The conceptual design, including the general configurations, flow schematics, insulation systems, instrumentation requirements, and internal tank configurations for the supply tank and the receiver tank, is described. Thermal, structural, fluid, and safety and reliability aspects of the facility are analyzed. The facility development plan, including schedule and cost estimates for the facility, is presented. A program work breakdown structure and master program schedule for a seven year program are included.

  9. Modeling, simulation and control for a cryogenic fluid management facility, preliminary report (United States)

    Turner, Max A.; Vanbuskirk, P. D.


    The synthesis of a control system for a cryogenic fluid management facility was studied. The severe demand for reliability as well as instrumentation and control unique to the Space Station environment are prime considerations. Realizing that the effective control system depends heavily on quantitative description of the facility dynamics, a methodology for process identification and parameter estimation is postulated. A block diagram of the associated control system is also produced. Finally, an on-line adaptive control strategy is developed utilizing optimization of the velocity form control parameters (proportional gains, integration and derivative time constants) in appropriate difference equations for direct digital control. Of special concern are the communications, software and hardware supporting interaction between the ground and orbital systems. It is visualized that specialist in the OSI/ISO utilizing the Ada programming language will influence further development, testing and validation of the simplistic models presented here for adaptation to the actual flight environment.

  10. Contemporary review on the inequities in the management of lung cancer among the African-American population. (United States)

    Kim, Anthony W; Liptay, Michael J; Higgins, Robert S D


    Lung cancer is the leading cause of cancer-related mortality. Nonsmall-cell lung cancer (NSCLC) constitutes approximately 80% of all the lung cancers observed. Despite the aggressive nature of this disease, totally adequate and fully comprehensive treatment yielding outstanding outcomes and survival has yet to be discovered. A uniform means by which to manage NSCLC is only in evolution. Without a universally accepted algorithm upon which clinical decisions can be referenced or compared, differences in the treatment of this disease process can and will exist. Racial bias in the management of NSCLC is being realized as a cause of a substandard delivery of adequate care. Whether this is a newly emerging phenomenon or simply one that is being exposed is unclear. Nevertheless, this inequity in management ranges from the early-to-late stages of NSCLC. The purpose of this manuscript is to explore the reasons behind the differences in the receipt of care for NSCLC that exists between the African-American and Caucasian population.

  11. Forty hours with a traumatic carotid transection: A diagnostic caveat and review of the contemporary management of penetrating neck trauma. (United States)

    Ng, Eugene; Campbell, Ian; Choong, Andrew; Kruger, Allan; Walker, Philip J


    Although penetrating neck trauma (PNT) is uncommon, it is associated with the significant morbidity and mortality. The management of PNT has changed significantly over the past 50 years. A radiological assessment now is a vital part of the management with a traditional surgical exploration. A 22 years old male was assaulted by a screwdriver and sustained multiple penetrating neck injuries. A contrast CT scan revealed a focal pseudoaneurysm in the left common carotid artery bulb. There was no active bleeding or any other vascular injuries and the patient remained haemodynamically stable. In view of these findings, he was initially managed conservatively without an open surgical exploration. However, the patient was noted to have an acute drop in his hemoglobin count overnight post injury and the catheter directed angiography showed active bleeding from the pseudoaneurysm. Surgical exploration 40 hours following the initial injury revealed a penetrating injury through both arterial walls of the left carotid bulb which was repaired with a great saphenous vein patch. A percutaneous drain was inserted in the carotid triangle and a course of intravenous antibiotics for five days was commenced. The patient recovered well with no complications and remained asymptomatic at five months followup. Copyright © 2018 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. All rights reserved.

  12. Contemporary trends in the diagnosis and management of pulmonary arterial hypertension: an initiative to close the care gap. (United States)

    McLaughlin, Vallerie V; Langer, Anatoly; Tan, Mary; Clements, Philip J; Oudiz, Ronald J; Tapson, Victor F; Channick, Richard N; Rubin, Lewis J


    The Pulmonary Arterial Hypertension-Quality Enhancement Research Initiative (PAHQuERI) was created to help clinicians to implement a guidelines-based approach to the diagnosis and management of pulmonary arterial hypertension (PAH). Patients with PAH represent a heterogeneous population, and physician evaluation and treatment paradigms may vary considerably. Using an electronic data management system, participating physicians recorded data on diagnostic workup, disease management, and outcomes of patients with PAH. Queries were generated automatically following each follow-up visit if the tests recommended by the American College of Chest Physicians (ACCP) were not performed at least once. Of 791 patients enrolled in PAH-QuERI, 77% were women; 64% received a diagnosis . 3 months prior to enrollment; 9% were in New York Heart Association functional class I, 39% in II, 48% in III, and 5% in IV; and the median age was 55 years (interquartile range, 45-66 years). At enrollment, all ACCP-recommended tests had been performed in only 6% of patients. The automated program generated 1,530 reminders for 642 patients (81%) with validated enrollment data. The proportion of recommended tests performed was 91% for CBC count, 91% for liver function test, 50% for connective tissue disease screen, 29% for HIV screen, 88% for chest radiograph, 82% for ECG, 97% for two-dimensional echocardiogram, 83% for pulmonary function tests, 41% for oximetry, 57% for ventilation/perfusion scan, 79% for 6-min walk distance, and 90% for right-sided heart catheterization. Regarding management, 78% of patients were on disease specific therapy, and the use of these therapies tended to increase with the functional disability of the patient. One hundred seventy patients were taking calcium channel blockers, 91 specifically for PAH. Only six of 91 patients (7%) who received calcium channel blockers specifically for PAH had met the current guideline for acute vasoreactivity. When comparing reported

  13. The role of thrombocytapheresis in the contemporary management of hyperthrombocytosis in myeloproliferative neoplasms: A case-based review. (United States)

    Boddu, Prajwal; Falchi, Lorenzo; Hosing, Chitra; Newberry, Kate; Bose, Prithviraj; Verstovsek, Srdan


    Extreme thrombocytosis induces an acquired thrombotic-hemorrhagic diathesis, and left uncontrolled is a harbinger of potentially fatal vascular complications. Currently, cytoreduction with medical therapy remains the mainstay of hyperthrombocytosis management. However, it offers a less-than-ideal option in situations where a rapid reduction in platelets is urgently needed, as in the presence of vital end-organ ischemia or to ameliorate of life-threatening hemorrhage. The role of thrombocytapheresis, or plateletpheresis, in hyperthrombocytosis has become increasingly obsolete given the proactive titration of cytoreductive therapies and early identification and correction of reversible causes of reactive thrombocytosis. Despite its narrowed indications, plateletpheresis continues to offer a valuable temporizing measure in platelet count reduction before cytoreductive agents exert their maximal effect. In this context, it is important for the treating physician to be aware of the symptoms and risks associated with hyperthrombocytosis to inform best clinical practices. In this review, we discuss the role of plateletpheresis in the modern-day management of hyperthrombocytosis in patients with myeloproliferative neoplasms through a case based review of the literature. It becomes apparent throughout the discussion that the decision to perform plateletpheresis should be individualized based upon the clinical scenario, degree of thrombocytosis, available infrastructure and every patient's risk profile. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Contemporary management of chronic rhinosinusitis with nasal polyposis in aspirin exacerbated respiratory disease: an evidence-based review with recommendations (United States)

    Levy, Joshua M.; Rudmik, Luke; Peters, Anju T.; Wise, Sarah K.; Rotenberg, Brian W.; Smith, Timothy L.


    Background Chronic rhinosinusitis (CRS) in aspirin exacerbated respiratory disease (AERD) represents a recalcitrant form of sinonasal inflammation for which a multidisciplinary consensus on patient management has not been reached. Several medical interventions have been investigated, but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach for the multidisciplinary management of CRS in AERD. Methods A systematic review of the literature was performed and the guidelines for development of an evidence-based review with recommendations were followed. Study inclusion criteria included: adult population>18 years old; CRS based on published diagnostic criteria and a presumptive diagnosis of AERD. We focused on reporting higher-quality studies (level 2 or higher) when available, but reported lower-quality studies if the topic contained insufficient evidence. Treatment recommendations were based on American Academy of Otolaryngology guidelines, with defined grades of evidence and evaluation of research quality and risk/benefits associated with each treatment. Results This review identified and evaluated the literature on 3 treatment strategies for CRS in AERD: dietary salicylate avoidance, leukotriene modification and desensitization with daily aspirin therapy. Conclusion Based on the available evidence, dietary salicylate avoidance and leukotriene modifying drugs are options following appropriate treatment with nasal corticosteroids and saline irrigation. Desensitization with daily aspirin therapy is recommended following revision ESS. PMID:27480830

  15. The role of lymph node dissection in the contemporary management of renal cell carcinoma: A critical appraisal of the evidence. (United States)

    Brito, Joseph; Gershman, Boris


    The role of lymph node dissection (LND) in the management of renal cell carcinoma has been controversial. Older studies provided initial support to a potential survival benefit in resection of lymph node metastases, and several predictive models were developed to identify patients with lymph node involvement. However, the only randomized trial on the subject did not report a survival benefit to LND in the nonmetastatic setting. Several studies have recently reexplored the therapeutic benefit of LND. In both nonmetastatic and metastatic settings, LND does not appear to be associated with a survival benefit. Moreover, it does not appear that LND confers a survival advantage to patients at increased risk of lymph node metastases, such as those with preoperative radiographic lymphadenopathy or across increasing probability of lymph node disease. Among patients with clinically isolated lymph node metastases, the majority develop disease progression following surgical resection, suggesting a high prevalence of occult systemic disease. Lymph node metastases appear to have prognostic value in both nonmetastatic and metastatic settings. LND may, therefore, have an increasingly important staging role in the management of renal cell carcinoma. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Contemporary Management of Renal Transplant Recipients With De Novo Urolithiasis: A Single Institution Experience and Review of the Literature. (United States)

    Harraz, Ahmed M; Zahran, Mohamed H; Kamal, Ahmed I; El-Hefnawy, Ahmed S; Osman, Yasser; Soliman, Shady A; Kamal, Mohamed M; Ali-El-Dein, Beder; Shokeir, Ahmed A


    We report on the long-term follow-up of managing allograft stones at a single tertiary referral institution and review the relevant literature. A retrospective analysis of renal allograft recipient charts was performed to identify patients who developed allograft lithiasis between 1974 and 2009. Patient and stone characteristics, diagnoses, treatments, and outcomes were described. Sixteen patients developed 22 stones after a median follow-up of 170 months (range, 51-351 mo). The mean (standard deviation) and median diameter of the stones were 13.8 (8.5) mm and 11 mm. Among these, 3 stones were treated conservatively, 3 by shock-wave lithotripsy, and 7 by cystolitholapaxy. Seven patients underwent percutaneous treatment in the form of percutaneous nephrostomy tube fixation and spontaneous passage of stone (1 stone), shock-wave lithotripsy (1 stone), antegrade stenting (1 stone), and percutaneous nephrolithotomy (6 stones). All patients were stone free after treatment, except for 2 patients whose stones were stable and peripheral on long-term follow-up. Allograft lithiasis requires a multimodal treatment tailored according to stone and graft characteristics. Protocols regarding spontaneous passage can be adopted if there is no harm to the graft and the patient is compliant. Careful attention to the anatomy during percutaneous nephrostomy tube placement is mandatory to avoid intestinal loop injury. A more attentive follow-up is required for early stone management.

  17. An Overview of SBIR Phase 2 In-Space Propulsion and Cryogenic Fluids Management (United States)

    Nguyen, Hung D.; Steele, Gynelle C.


    Technological innovation is the overall focus of NASA's Small Business Innovation Research (SBIR) program. The program invests in the development of innovative concepts and technologies to help NASA's mission directorates address critical research and development needs for agency projects. This report highlights innovative SBIR Phase II projects from 2007-2012 specifically addressing Areas in In-Space Propulsion and Cryogenic Fluids Management which is one of six core competencies at NASA Glenn Research Center. There are nineteen technologies featured with emphasis on a wide spectrum of applications such as high-performance Hall thruster support system, thruster discharge power converter, high-performance combustion chamber, ion thruster design tool, green liquid monopropellant thruster, and much more. Each article in this booklet describes an innovation, technical objective, and highlights NASA commercial and industrial applications. This report serves as an opportunity for NASA personnel including engineers, researchers, and program managers to learn of NASA SBIR's capabilities that might be crosscutting into this technology area. As the result, it would cause collaborations and partnerships between the small companies and NASA Programs and Projects resulting in benefit to both SBIR companies and NASA.

  18. Effects of Intraoperative Fluid Management on Postoperative Outcomes : A Hospital Registry Study

    NARCIS (Netherlands)

    Shin, Christina H; Long, Dustin R; McLean, Duncan; Grabitz, Stephanie D; Ladha, Karim; Timm, Fanny P; Thevathasan, Tharusan; Pieretti, Alberto; Ferrone, Cristina; Hoeft, Andreas; Scheeren, Thomas W L; Thompson, Boyd Taylor; Kurth, Tobias; Eikermann, Matthias


    OBJECTIVE: Evaluate the dose-response relationship between intraoperative fluid administration and postoperative outcomes in a large cohort of surgical patients. BACKGROUND: Healthy humans may live in a state of fluid responsiveness without the need for fluid supplementation. Goal-directed protocols

  19. Fluid management in children with diarrhea-related hyponatremic-hypernatremic dehydration: a retrospective study of 83 children. (United States)

    Kocaoglu, Celebi; Selma Solak, Ece; Kilicarslan, Cengizhan; Arslan, Sukru


    To investigate serum creatinine and electrolyte status of children with diarrhea-related hyponatremic or hypernatremic dehydration. Medical history of 83 patients admitted to the Pediatric Intensive Care Unit of the Konya Education and Research Hospital, Konya, Turkey with diarrhea, dehydration and electrolyte imbalance was retrospectively evaluated according to the degree of dehydration, serum creatinine, electrolytes, blood gas, approaches to the treatment such as content of given fluid, HCO3- and acute periotenal dialysis. Of 65 patients with hyponatremia, 44 (67.7%) were given fluids at appropriate concentration according to their age, and 21 (32.3%) were given fluids at higher concentration. Of 18 hypernatremic patients, 11 (61.1%) were given fluids at appropriate concentration for age, and seven (38.9%) were given fluids at higher concentration. Mean duration of amelioration of serum sodium levels for those admitted with hyponatremia and given fluids at appropriate concentration for age and at higher concentration were 33.9 ± 28.3 h and 53.7 ± 31.6 h, respectively. Mean duration of amelioration of serum sodium levels for hypernatremics and given fluids at appropriate concentration for age and at higher concentration were 34.7 ± 22.1 h and 46.3 ± 32 h, respectively. Four (4.8%) hyponatremic patients and three (3.6%) with hypernatremia were treated with acute peritoneal dialysis. Mortality rate was 6% (five of all patients). The children with severe diarrhea should be closely followed-up as to clinical examination, serum electrolytes, creatinine and blood gases, and because no single intravenous fluid management is optimal for all children, intravenous fluid therapy should be individualized for each patient.

  20. Manifestations and management of veno-occlusive disease/sinusoidal obstruction syndrome in the era of contemporary therapies. (United States)

    Tewari, Priti; Wallis, Whitney; Kebriaei, Partow


    The concept of veno-occlusive disease (VOD), along with our understanding of it, has historically been and remains an evolving phenomenon. This review presents a broad view of VOD, also known as sinusoidal obstruction syndrome (SOS), including (1) traditional hematopoietic stem cell transplant-associated VOD/SOS, (2) late-onset VOD/SOS, (3) pulmonary VOD, and (4) VOD/SOS associated with chemotherapy only. Several VOD/SOS management modalities exist that include modes for both prophylaxis and treatment. An extensive review of the literature on monoclonal antibodies, both approved and pending approval by the US Food and Drug Administration, reveals that only a few have been associated with an increased risk for VOD/SOS. In fact, bevacizumab appears to have a protective effect against the development of VOD/SOS. As the landscape of cancer treatment changes, careful attention needs to be focused on how new therapies affect the incidence of VOD/SOS.

  1. To treat or not to treat with testosterone replacement therapy: a contemporary review of management of late-onset hypogonadism and critical issues related to prostate cancer. (United States)

    Kava, Bruce R


    Over the last 10 years there has been a dramatic increase in the number of patients identified and treated with testosterone replacement therapy (TRT) for late-onset hypogonadism (LOH). By virtue of age, race, and family history, many of these patients are concurrently at risk for harboring indolent prostate cancer. Other men are at increased risk for prostate cancer as a result of an elevated serum PSA level or having had a prior prostate biopsy showing prostatic intraepithelial neoplasia (PIN) or atypical small acinar proliferation (ASAP). The clinician is often challenged with the decision whether to initiate TRT in these patients. This review presents a contemporary overview of the rationale for TRT, as well as the relationship between testosterone (endogenous and exogenous) and premalignant and malignant lesions of the prostate. We will discuss preliminary data from several recent series demonstrating that TRT may be safely administered in select patients with certain premalignant and bona fide malignant tumors of the prostate. In the absence of a large randomized clinical trial with long-term outcome data evaluating TRT, we hope that this overview will provide clinicians with an evidence-based approach to managing these anxiety-provoking - and often frustrating - clinical scenarios.

  2. Contemporary management of neonatal alloimmune thrombocytopenia: good outcomes in the intravenous immunoglobulin era: results from the Australian neonatal alloimmune thrombocytopenia registry. (United States)

    Crighton, Gemma L; Scarborough, Ri; McQuilten, Zoe K; Phillips, Louise E; Savoia, Helen F; Williams, Bronwyn; Holdsworth, Rhonda; Henry, Amanda; Wood, Erica M; Cole, Stephen A


    To describe the natural history, antenatal and postnatal therapy, and clinical outcomes of Australian patients with fetomaternal/neonatal alloimmune thrombocytopenia (NAIT) recorded in the Australian NAIT registry. Analysis of registry data of Australian mothers treated antenatally for NAIT and any fetus/newborn with thrombocytopenia (TCP) and maternal human platelet antigen (HPA) antibodies. Ninety four potential cases (91 pregnancies; three twin pregnancies) were registered between December 2004 and September 2015 with 76 confirmed or treated as NAIT. NAIT was frequently unanticipated (44 cases, 58%), whilst 32 cases (42%) were anticipated due to personal or family history. In 70/76 cases, the diagnosis of NAIT was made based on HPA antibody results; anti-HPA-1a was most commonly detected (58/70, 82%), followed by anti-HPA-5b (5/70, 7%). Intracranial haemorrhage (ICH) was detected in seven cases (9%). Maternal antenatal therapy resulted in improved clinical outcomes. For antenatally treated cases, whilst 10/29 (34%) neonates had severe TCP, only one ICH was detected. This study provides data on contemporary "real world" management of Australian mothers and babies with NAIT. Antenatal IVIG therapy was associated with better neonatal outcomes. Maternal side-effects and treatment costs were substantial.

  3. Pre-test probability risk scores and their use in contemporary management of patients with chest pain: One year stress echo cohort study (United States)

    Demarco, Daniela Cassar; Papachristidis, Alexandros; Roper, Damian; Tsironis, Ioannis; Byrne, Jonathan; Monaghan, Mark


    Objectives To compare how patients with chest pain would be investigated, based on the two guidelines available for UK cardiologists, on the management of patients with stable chest pain. The UK National Institute of Clinical Excellence (NICE) guideline which was published in 2010 and the European society of cardiology (ESC) guideline published in 2013. Both guidelines utilise pre-test probability risk scores, to guide the choice of investigation. Design We undertook a large retrospective study to investigate the outcomes of stress echocardiography. Setting A large tertiary centre in the UK in a contemporary clinical practice. Participants Two thirds of the patients in the cohort were referred from our rapid access chest pain clinics. Results We found that the NICE risk score overestimates risk by 20% compared to the ESC Risk score. We also found that based on the NICE guidelines, 44% of the patients presenting with chest pain, in this cohort, would have been investigated invasively, with diagnostic coronary angiography. Using the ESC guidelines, only 0.3% of the patients would be investigated invasively. Conclusion The large discrepancy between the two guidelines can be easily reduced if NICE adopted the ESC risk score. PMID:26673458

  4. Subdural Fluid Collection and Hydrocephalus After Foramen Magnum Decompression for Chiari Malformation Type I: Management Algorithm of a Rare Complication. (United States)

    Rossini, Zefferino; Milani, Davide; Costa, Francesco; Castellani, Carlotta; Lasio, Giovanni; Fornari, Maurizio


    Chiari malformation type I is a hindbrain abnormality characterized by descent of the cerebellar tonsils beneath the foramen magnum, frequently associated with symptoms or brainstem compression, impaired cerebrospinal fluid circulation, and syringomyelia. Foramen magnum decompression represents the most common way of treatment. Rarely, subdural fluid collection and hydrocephalus represent postoperative adverse events. The treatment of this complication is still debated, and physicians are sometimes uncertain when to perform diversion surgery and when to perform more conservative management. We report an unusual occurrence of subdural fluid collection and hydrocephalus that developed in a 23-year-old patient after foramen magnum decompression for Chiari malformation type I. Following a management protocol, based on a step-by-step approach, from conservative therapy to diversion surgery, the patient was managed with urgent external ventricular drainage, and then with conservative management and wound revision. Because of the rarity of this adverse event, previous case reports differ about the form of treatment. In future cases, finding clinical and radiologic features to identify risk factors that are useful in predicting if the patient will benefit from conservative management or will need to undergo diversion surgery is only possible if a uniform form of treatment is used. Therefore, we believe that a management algorithm based on a step-by-step approach will reduce the use of invasive therapies and help to create a standard of care. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Contemporary Atrial Fibrillation Management: A Comparison of the Current AHA/ACC/HRS, CCS, and ESC Guidelines. (United States)

    Andrade, Jason G; Macle, Laurent; Nattel, Stanley; Verma, Atul; Cairns, John


    In this article we compare and contrast the current recommendations, and highlight the important differences, in the American College of Cardiology/American Heart Association/Heart Rhythm Society, European Society of Cardiology, and Canadian Cardiovascular Society atrial fibrillation (AF) guidelines. Although many of the recommendations of the various societies are similar, there are important differences in the methodologies underlying their development and the specific content. Specifically, key differences can be observed in: (1) the definition of nonvalvular AF, which subsequently affects anticoagulation choices and candidacy for non-vitamin K antagonist oral anticoagulants; (2) the symptom score used to guide management decisions and longitudinal patient profiling; (3) the stroke risk stratification algorithm used to determine indications for oral anticoagulant therapy; (4) the role of acetylsalicylic acid in stroke prevention in AF; (5) the antithrombotic regimens used in the context of coronary artery disease, acute coronary syndromes, and percutaneous coronary intervention; (6) the rate control target and medications recommended to achieve the target; and (7) the role of "first-line" catheter ablation, open surgical ablation, and left atrial appendage exclusion. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  6. The Cardiomyopathy Registry of the EURObservational Research Programme of the European Society of Cardiology: baseline data and contemporary management of adult patients with cardiomyopathies. (United States)

    Charron, Philippe; Elliott, Perry M; Gimeno, Juan R; Caforio, Alida L P; Kaski, Juan Pablo; Tavazzi, Luigi; Tendera, Michal; Maupain, Carole; Laroche, Cécile; Rubis, Pawel; Jurcut, Ruxandra; Calò, Leonardo; Heliö, Tiina M; Sinagra, Gianfranco; Zdravkovic, Marija; Kavoliuniene, Aušra; Felix, Stephan B; Grzybowski, Jacek; Losi, Maria-Angela; Asselbergs, Folkert W; García-Pinilla, José Manuel; Salazar-Mendiguchia, Joel; Mizia-Stec, Katarzyna; Maggioni, Aldo P


    The Cardiomyopathy Registry of the EURObservational Research Programme is a prospective, observational, and multinational registry of consecutive patients with four cardiomyopathy subtypes: hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and restrictive cardiomyopathy (RCM). We report the baseline characteristics and management of adults enrolled in the registry. A total of 3208 patients were enrolled by 69 centres in 18 countries [HCM (n = 1739); DCM (n = 1260); ARVC (n = 143); and RCM (n = 66)]. Differences between cardiomyopathy subtypes (P < 0.001) were observed for age at diagnosis, history of familial disease, history of sustained ventricular arrhythmia, use of magnetic resonance imaging or genetic testing, and implantation of defibrillators. When compared with probands, relatives had a lower age at diagnosis (P < 0.001), but a similar rate of symptoms and defibrillators. When compared with the Long-Term phase, patients of the Pilot phase (enrolled in more expert centres) had a more frequent rate of familial disease (P < 0.001), were more frequently diagnosed with a rare underlying disease (P < 0.001), and more frequently implanted with a defibrillator (P = 0.023). Comparing four geographical areas, patients from Southern Europe had a familial disease more frequently (P < 0.001), were more frequently diagnosed in the context of a family screening (P < 0.001), and more frequently diagnosed with a rare underlying disease (P < 0.001). By providing contemporary observational data on characteristics and management of patients with cardiomyopathies, the registry provides a platform for the evaluation of guideline implementation. Potential gaps with existing recommendations are discussed as well as some suggestions for improvement of health care provision in Europe.

  7. Land-Use History and Contemporary Management Inform an Ecological Reference Model for Longleaf Pine Woodland Understory Plant Communities.

    Energy Technology Data Exchange (ETDEWEB)

    Brudvig, Lars A. [Department of Plant Biology, Michigan State University; Orrock, John L. [Department of Zoology, University of Wisconsin; Damschen, Ellen I. [Department of Zoology, University of Wisconsin; et al, et al


    Ecological restoration is frequently guided by reference conditions describing a successfully restored ecosystem; however, the causes and magnitude of ecosystem degradation vary, making simple knowledge of reference conditions insufficient for prioritizing and guiding restoration. Ecological reference models provide further guidance by quantifying reference conditions, as well as conditions at degraded states that deviate from reference conditions. Many reference models remain qualitative, however, limiting their utility. We quantified and evaluated a reference model for southeastern U.S. longleaf pine woodland understory plant communities. We used regression trees to classify 232 longleaf pine woodland sites at three locations along the Atlantic coastal plain based on relationships between understory plant community composition, soils lol(which broadly structure these communities), and factors associated with understory degradation, including fire frequency, agricultural history, and tree basal area. To understand the spatial generality of this model, we classified all sites together. and for each of three study locations separately. Both the regional and location-specific models produced quantifiable degradation gradients–i.e., progressive deviation from conditions at 38 reference sites, based on understory species composition, diversity and total cover, litter depth, and other attributes. Regionally, fire suppression was the most important degrading factor, followed by agricultural history, but at individual locations, agricultural history or tree basal area was most important. At one location, the influence of a degrading factor depended on soil attributes. We suggest that our regional model can help prioritize longleaf pine woodland restoration across our study region; however, due to substantial landscape-to-landscape variation, local management decisions should take into account additional factors (e.g., soil attributes). Our study demonstrates the utility

  8. Land-Use History and Contemporary Management Inform an Ecological Reference Model for Longleaf Pine Woodland Understory Plant Communities (United States)

    Brudvig, Lars A.; Orrock, John L.; Damschen, Ellen I.; Collins, Cathy D.; Hahn, Philip G.; Mattingly, W. Brett; Veldman, Joseph W.; Walker, Joan L.


    Ecological restoration is frequently guided by reference conditions describing a successfully restored ecosystem; however, the causes and magnitude of ecosystem degradation vary, making simple knowledge of reference conditions insufficient for prioritizing and guiding restoration. Ecological reference models provide further guidance by quantifying reference conditions, as well as conditions at degraded states that deviate from reference conditions. Many reference models remain qualitative, however, limiting their utility. We quantified and evaluated a reference model for southeastern U.S. longleaf pine woodland understory plant communities. We used regression trees to classify 232 longleaf pine woodland sites at three locations along the Atlantic coastal plain based on relationships between understory plant community composition, soils (which broadly structure these communities), and factors associated with understory degradation, including fire frequency, agricultural history, and tree basal area. To understand the spatial generality of this model, we classified all sites together and for each of three study locations separately. Both the regional and location-specific models produced quantifiable degradation gradients–i.e., progressive deviation from conditions at 38 reference sites, based on understory species composition, diversity and total cover, litter depth, and other attributes. Regionally, fire suppression was the most important degrading factor, followed by agricultural history, but at individual locations, agricultural history or tree basal area was most important. At one location, the influence of a degrading factor depended on soil attributes. We suggest that our regional model can help prioritize longleaf pine woodland restoration across our study region; however, due to substantial landscape-to-landscape variation, local management decisions should take into account additional factors (e.g., soil attributes). Our study demonstrates the utility of

  9. Land-use history and contemporary management inform an ecological reference model for longleaf pine woodland understory plant communities.

    Directory of Open Access Journals (Sweden)

    Lars A Brudvig

    Full Text Available Ecological restoration is frequently guided by reference conditions describing a successfully restored ecosystem; however, the causes and magnitude of ecosystem degradation vary, making simple knowledge of reference conditions insufficient for prioritizing and guiding restoration. Ecological reference models provide further guidance by quantifying reference conditions, as well as conditions at degraded states that deviate from reference conditions. Many reference models remain qualitative, however, limiting their utility. We quantified and evaluated a reference model for southeastern U.S. longleaf pine woodland understory plant communities. We used regression trees to classify 232 longleaf pine woodland sites at three locations along the Atlantic coastal plain based on relationships between understory plant community composition, soils (which broadly structure these communities, and factors associated with understory degradation, including fire frequency, agricultural history, and tree basal area. To understand the spatial generality of this model, we classified all sites together and for each of three study locations separately. Both the regional and location-specific models produced quantifiable degradation gradients-i.e., progressive deviation from conditions at 38 reference sites, based on understory species composition, diversity and total cover, litter depth, and other attributes. Regionally, fire suppression was the most important degrading factor, followed by agricultural history, but at individual locations, agricultural history or tree basal area was most important. At one location, the influence of a degrading factor depended on soil attributes. We suggest that our regional model can help prioritize longleaf pine woodland restoration across our study region; however, due to substantial landscape-to-landscape variation, local management decisions should take into account additional factors (e.g., soil attributes. Our study demonstrates

  10. Field demonstration of an active reservoir pressure management through fluid injection and displaced fluid extractions at the Rock Springs Uplift, a priority geologic CO2 storage site for Wyoming

    Energy Technology Data Exchange (ETDEWEB)

    Jiao, Zunsheng [Univ. of Wyoming, Laramie, WY (United States)


    This report provides the results from the project entitled Field Demonstration of Reservoir Pressure Management through Fluid Injection and Displaced Fluid Extraction at the Rock Springs Uplift, a Priority Geologic CO2 Storage Site for Wyoming (DE-FE0026159 for both original performance period (September 1, 2015 to August 31, 2016) and no-cost extension (September 1, 2016 to January 6, 2017)).

  11. The Sacred in Contemporary Advertising

    Directory of Open Access Journals (Sweden)

    Cătălin Soreanu


    Full Text Available As part of the contemporary media culture, advertising constantly mediates the relationship between the institutional dimension of religion (namely the church and the community, given the specific position of the Catholic religion: transparent, based on dialogue and the continuous questioning of the relationship between man and divinity. To manage their presence in public life, the church constantly approaches new media and specific forms of communication (posters, street banners and meshes, websites or interactive mobile structures.

  12. Contemporary jewelry definitions

    Directory of Open Access Journals (Sweden)

    Marlon Aparecido Mercaldi


    Full Text Available Contemporary jewelry terminology is open to many criticism and weaknesses as it is confronted with the classic definition of jewelry and also often attached to the historical widespread idea of adornment and jewelry to modernity. Therefore one of the this article issues is to approach about what it is contemporary jewelry and how it can be defined. Thus, we present the topics related to the jewel discussion in contemporary times that are organized into a set of assumptions and approaches that help us provide an overview about the contemporary jewelry.

  13. Advanced parallel strategy for strongly coupled fast transient fluid-structure dynamics with dual management of kinematic constraints

    International Nuclear Information System (INIS)

    Faucher, Vincent


    Simulating fast transient phenomena involving fluids and structures in interaction for safety purposes requires both accurate and robust algorithms, and parallel computing to reduce the calculation time for industrial models. Managing kinematic constraints linking fluid and structural entities is thus a key issue and this contribution promotes a dual approach over the classical penalty approach, introducing arbitrary coefficients in the solution. This choice however severely increases the complexity of the problem, mainly due to non-permanent kinematic constraints. An innovative parallel strategy is therefore described, whose performances are demonstrated on significant examples exhibiting the full complexity of the target industrial simulations. (authors)

  14. Extravascular lung water and pulmonary arterial wedge pressure for fluid management in patients with acute respiratory distress syndrome. (United States)

    Hu, Wei; Lin, Chang-Wen; Liu, Bing-Wei; Hu, Wei-Hang; Zhu, Ying


    Extravascular lung water (EVLW) is a sensitive prognostic indicator of pulmonary edema. Thus, EVLW may be an advantageous method of fluid management. This study aims to evaluate the outcomes of using EVLW and pulmonary artery wedge pressure (PAWP) as strategies for fluid management in patients with acute respiratory distress syndrome (ARDS). Twenty-nine patients were randomly divided into the EVLW and PAWP groups. The survival rate, ICU (Intensive Care Unit) length of stay, duration of mechanical ventilation, acute lung injury scores, and oxygenation index of the EVLW and PAWP groups were compared. No significant difference in the survival rates at 28 and 60 days (d) after treatment was found between the two groups (p = 0.542). The duration of mechanical ventilation and ICU length of stay were significantly lower (p management improved clinical results in patients with ARDS better than PAWP.

  15. The Role of Computational Fluid Dynamics in the Management of Unruptured Intracranial Aneurysms: A Clinicians' View

    Directory of Open Access Journals (Sweden)

    Pankaj K. Singh


    Full Text Available Objective. The importance of hemodynamics in the etiopathogenesis of intracranial aneurysms (IAs is widely accepted. Computational fluid dynamics (CFD is being used increasingly for hemodynamic predictions. However, alogn with the continuing development and validation of these tools, it is imperative to collect the opinion of the clinicians. Methods. A workshop on CFD was conducted during the European Society of Minimally Invasive Neurological Therapy (ESMINT Teaching Course, Lisbon, Portugal. 36 delegates, mostly clinicians, performed supervised CFD analysis for an IA, using the @neuFuse software developed within the European project @neurIST. Feedback on the workshop was collected and analyzed. The performance was assessed on a scale of 1 to 4 and, compared with experts' performance. Results. Current dilemmas in the management of unruptured IAs remained the most important motivating factor to attend the workshop and majority of participants showed interest in participating in a multicentric trial. The participants achieved an average score of 2.52 (range 0–4 which was 63% (range 0–100% of an expert user. Conclusions. Although participants showed a manifest interest in CFD, there was a clear lack of awareness concerning the role of hemodynamics in the etiopathogenesis of IAs and the use of CFD in this context. More efforts therefore are required to enhance understanding of the clinicians in the subject.

  16. Fluid management of hypernatraemic dehydration to prevent cerebral oedema: a retrospective case control study of 97 children in China. (United States)

    Fang, Chengqing; Mao, Jianhua; Dai, Yuwen; Xia, Yonghui; Fu, Haidong; Chen, Yifang; Wang, Yaping; Liu, Aimin


    To compare the fluid management of hypernatraemic dehydration in acute gastroenteritis in those who developed cerebral oedema (cases) versus those who did not (controls). A retrospective study of 97 cases of hypernatraemic dehydration at a tertiary children's hospital in China over five years, in which rehydration regimes of 49 children who developed cerebral oedema were compared with 48 children who made an uneventful recovery. Risk factors for cerebral oedema (vs. no cerebral oedema) were an initial fluid bolus (29/49 vs. 15/48, P=0.006), the mean rate of bolus infusion (14.7+/-2.2 vs. 10.8+/-1.4 mL/kg/hr, Pdehydration were too rapid a rate of rehydration, an initial fluid bolus to rapidly expand plasma volume and the severity of the hypernatraemia. Thus, we conclude that a uniformly slow rate of rehydration is the best way of preventing cerebral oedema.

  17. Contemporary Art from Denmark

    DEFF Research Database (Denmark)

    Bonde, Lisbeth


    Danish contemporary art is currently expanding bot quantitatively and qualitatively to such a degree that we can speak of a new Danish Golden Age. The article introduces some of the most interesting, Danish contemporary artists which are being exposed at the exhibition in the European Central Bank...

  18. Restricting volumes of resuscitation fluid in adults with septic shock after initial management

    DEFF Research Database (Denmark)

    Hjortrup, Peter B; Haase, Nicolai; Bundgaard, Helle


    reactions differed statistically significantly between the groups. Major protocol violations occurred in 27/75 patients in the fluid restriction group. Ischaemic events occurred in 3/75 in the fluid restriction group vs. 9/76 in the standard care group (odds ratio 0.32; 0.08-1.27; p = 0.11), worsening...

  19. Contemporary management of sinonasal cancer

    NARCIS (Netherlands)

    Robbins, K.T.; Ferlito, A.; Silver, C.E.; Takes, R.P.; Strojan, P.; Snyderman, C.H.; Bree, R. de; Haigentz Jr., M.; Langendijk, J.A.; Rinaldo, A.; Shaha, A.R.; Hanna, E.Y.; Werner, J.A.; Suarez, C.


    BACKGROUND: Sinonasal cancer is a relatively uncommon entity encountered by head and neck oncologists, rhinologists, and skull base surgeons. Recent innovations in surgical and nonsurgical therapeutic modalities raise the question of whether there has been any measurable improvement for treatment

  20. Contemporary Management of Prostate Cancer (United States)

    Cotter, Katherine; Konety, Badrinath; Ordonez, Maria A.


    Prostate cancer represents a spectrum ranging from low-grade, localized tumors to devastating metastatic disease. We discuss the general options for treatment and recent developments in the field. PMID:26949522


    NARCIS (Netherlands)

    Robbins, K. Thomas; Ferlito, Alfio; Silver, Carl E.; Takes, Robert P.; Strojan, Primoz; Snyderman, Carl H.; de Bree, Remco; Haigentz, Missak; Langendijk, Johannes A.; Rinaldo, Alessandra; Shaha, Ashok R.; Hanna, Ehab Y.; Werner, Jochen A.; Suarez, Carlos

    Background. Sinonasal cancer is a relatively uncommon entity encountered by head and neck oncologists, rhinologists, and skull base surgeons. Recent innovations in surgical and nonsurgical therapeutic modalities raise the question of whether there has been any measurable improvement for treatment

  2. Effectiveness of a fluid chart in outpatient management of suspected dengue fever: A pilot study. (United States)

    Nasir, Nazrila Hairin; Mohamad, Mohazmi; Lum, Lucy Chai See; Ng, Chirk Jenn


    Dengue infection is the fastest spreading mosquito-borne viral disease in the world. One of the complications of dengue is dehydration which, if not carefully monitored and treated, may lead to shock, particularly in those with dengue haemorrhagic fever. WHO has recommended oral fluid intake of five glasses or more for adults who are suspected to have dengue fever. However, there have been no published studies looking at self-care intervention measures to improve oral fluid intake among patients suspected of dengue fever. To assess the feasibility and effectiveness of using a fluid chart to improve oral fluid intake in patients with suspected dengue fever in a primary care setting. This feasibility study used a randomized controlled study design. The data was collected over two months at a primary care clinic in a teaching hospital. The inclusion criteria were: age > 12 years, patients who were suspected to have dengue fever based on the assessment by the primary healthcare clinician, fever for > three days, and thrombocytopenia (platelets dengue home care card. The intervention group received the fluid chart and a cup (200ml). Baseline clinical and laboratory data, 24-hour fluid recall (control group), and fluid chart were collected. The main outcomes were: hospitalization rates, intravenous fluid requirement and total oral fluid intake. Among the 138 participants who were included in the final analysis, there were fewer hospital admissions in the intervention group (n = 7, 10.0%) than the control group (n = 12, 17.6%) (p = 0.192). Similarly, fewer patients (n = 9, 12.9%) in the intervention group required intravenous fluid compared to the control group (n = 15, 22.1%), (p = 0.154). There was an increase in the amount of daily oral fluid intake in the intervention group (about 3,000 ml) compared to the control group (about 2,500 ml, p = 0.521). However, these differences did not reach statistical significance. This is a feasible and acceptable study to perform in

  3. Investment and Project Economics: Contemporary Lessons for ...

    African Journals Online (AJOL)

    Taking up the contemporary challenge to sensitize and synergize instructional, industrial and governmental functionaries along this line are leading global faculties such as the Academy of Project Management (APM), Project Management Institute (PMI), and Business Analyst (BA) Times, amongst others. This work is ...

  4. The Fertility Management Experiences of Australian Women with a Non-communicable Chronic Disease: Findings from the Understanding Fertility Management in Contemporary Australia Survey. (United States)

    Holton, Sara; Thananjeyan, Aberaami; Rowe, Heather; Kirkman, Maggie; Jordan, Lynne; McNamee, Kathleen; Bayly, Christine; McBain, John; Sinnott, Vikki; Fisher, Jane


    Introduction Despite the considerable and increasing proportion of women of reproductive age with a chronic non-communicable disease (NCD) and the potential adverse implications of many NCDs for childbearing, little is known about the fertility management experiences of women with an NCD, including their contraceptive use, pregnancy experiences and outcomes, and reproductive health care utilisation. The aim of this study was to investigate the fertility management experiences of women with an NCD and draw comparisons with women without an NCD. Method A sample of 18-50 year-old women (n = 1543) was randomly recruited from the Australian electoral roll in 2013. Of these women, 172 women reported a physical, chronic non-communicable disease: diabetes, arthritis, asthma, hypertension, heart disease, thyroid disorders, and cystic fibrosis. Respondents completed an anonymous, self-administered questionnaire. Factors associated with fertility management were identified in multivariable analyses. Results Women who reported having an NCD were significantly more likely than women who did not report an NCD to have ever been pregnant (75.9 vs. 67.5%, p = 0.034), have had an unintended pregnancy (33.47 vs. 25.5%, p = 0.026), and have had an abortion (20.3 vs. 14.2%, p = 0.044); they were less likely to consult a healthcare provider about fertility management (45.0 vs. 54.4%, p = 0.024). Similar proportions were using contraception (48.8 vs. 54.5%, p = 0.138). Conclusion The findings have implications for healthcare providers and women with an NCD and highlight the importance of addressing possible assumptions about the inability of women with an NCD to become pregnant, and ensuring women receive information about suitable methods of contraception and pre-pregnancy care.

  5. Celebrity and contemporary context

    Directory of Open Access Journals (Sweden)

    Paula Guimarães Simões


    Full Text Available This paper discusses the hermeneutic power of a celebrity (seen from the concept of event, seeking to understand what it reveals about the contemporary context. Based on this premise, we attempt to recognize some aspects of contemporary social life that emerge from the trajectory of a specific celebrity: the former soccer player Ronaldo Fenômeno. This analysis brings to light the hermeneutic power of Ronaldo, i.e., how his life story reveals characteristics of contemporary social life. Individualism, machismo, emphasis on a heteronormative ideal, shifts in the construction of romantic relationships, and the overlapping spheres of public and private life, are some important aspects of contemporary society revealed by this analysis.

  6. Contemporary Obstetric Triage. (United States)

    Sandy, Edward Allen; Kaminski, Robert; Simhan, Hygriv; Beigi, Richard


    The role of obstetric triage in the care of pregnant women has expanded significantly. Factors driving this change include the Emergency Medical Treatment and Active Labor Act, improved methods of testing for fetal well-being, increasing litigation risk, and changes in resident duty hour guidelines. The contemporary obstetric triage facility must have processes in place to provide a medical screening examination that complies with regulatory statues while considering both the facility's maternal level of care and available resources. This review examines the history of the development of obstetric triage, current considerations in a contemporary obstetric triage paradigm, and future areas for consideration. An example of a contemporary obstetric triage program at an academic medical center is presented. A successful contemporary obstetric triage paradigm is one that addresses the questions of "sick or not sick" and "labor or no labor," for every obstetric patient that presents for care. Failure to do so risks poor patient outcome, poor patient satisfaction, adverse litigation outcome, regulatory scrutiny, and exclusion from federal payment programs. Understanding the role of contemporary obstetric triage in the current health care environment is important for both providers and health care leadership. This study is for obstetricians and gynecologists as well as family physicians. After completing this activity, the learner should be better able to understand the scope of a medical screening examination within the context of contemporary obstetric triage; understand how a facility's level of maternal care influences clinical decision making in a contemporary obstetric triage setting; and understand the considerations necessary for the systematic evaluation of the 2 basic contemporary obstetric questions, "sick or not sick?" and "labor or no labor?"

  7. Fluid management in the intensive care unit: bioelectrical impedance vector analysis as a tool to assess hydration status and optimal fluid balance in critically ill patients. (United States)

    Basso, Flavio; Berdin, Giovanna; Virzì, Grazia Maria; Mason, Giacomo; Piccinni, Pasquale; Day, Sonya; Cruz, Dinna N; Wjewodzka, Marzena; Giuliani, Anna; Brendolan, Alessandra; Ronco, Claudio


    Fluid balance disorders are a relevant risk factor for morbidity and mortality in critically ill patients. Volume assessment in the intensive care unit (ICU) is thus of great importance, but there are currently few methods to obtain an accurate and timely assessment of hydration status. Our aim was to evaluate the hydration status of ICU patients via bioelectric impedance vector analysis (BIVA) and to investigate the relationship between hydration and mortality. We evaluated 280 BIVA measurements of 64 patients performed daily in the 5 days following their ICU admission. The observation period ranged from a minimum of 72 h up to a maximum of 120 h. We observed the evolution of the hydration status during the ICU stay in this population, and analyzed the relationship between mean and maximum hydration reached and mortality--both in the ICU and at 60 days--using logistic regression. A state of overhydration was observed in the majority of patients (70%) on admission, which persisted during the ICU stay. Patients who required continuous renal replacement therapy (CRRT) were more likely to be overhydrated starting from the 2nd day of observation. Logistic regression showed a strong and significant correlation between mean/maximum hydration reached and mortality, both independently and correcting for severity of prognosis. Fluid overload measured by BIVA is a frequent condition in critically ill patients--whether or not they undergo CRRT--and a significant predictor of mortality. Hence, hydration status should be considered as an additional prognosticator in the clinical management of the critically ill patient. (i) On the day of ICU admittance, patients showed a marked tendency to overhydration (>70% of total). This tendency was more pronounced in patients on CRRT. (ii) Hyperhydration persisted during the ICU stay. Patients who underwent CRRT showed significantly higher hyperhydration from the 2nd day of hospitalization. (iii) Nonsurvivors showed worse hyperhydration

  8. Robotic transgastric cystgastrostomy and pancreatic debridement in the management of pancreatic fluid collections following acute pancreatitis. (United States)

    Kirks, Russell C; Sola, Richard; Iannitti, David A; Martinie, John B; Vrochides, Dionisios


    Pancreatic and peripancreatic fluid collections may develop after severe acute pancreatitis. Organized fluid collections such as pancreatic pseudocyst and walled-off pancreatic necrosis (WOPN) that mature over time may require intervention to treat obstructive or constitutional symptoms related to the size and location of the collection as well as possible infection. Endoscopic, open surgical and minimally invasive techniques are described to treat post-inflammatory pancreatic fluid collections. Surgical intervention may be required to treat collections containing necrotic pancreatic parenchyma or in locations not immediately apposed to the stomach or duodenum. Comprising a blend of the surgical approach and the clinical benefits of minimally invasive surgery, the robot-assisted technique of pancreatic cystgastrostomy with pancreatic debridement is described.

  9. Fluid mechanics in fluids at rest. (United States)

    Brenner, Howard


    Using readily available experimental thermophoretic particle-velocity data it is shown, contrary to current teachings, that for the case of compressible flows independent dye- and particle-tracer velocity measurements of the local fluid velocity at a point in a flowing fluid do not generally result in the same fluid velocity measure. Rather, tracer-velocity equality holds only for incompressible flows. For compressible fluids, each type of tracer is shown to monitor a fundamentally different fluid velocity, with (i) a dye (or any other such molecular-tagging scheme) measuring the fluid's mass velocity v appearing in the continuity equation and (ii) a small, physicochemically and thermally inert, macroscopic (i.e., non-Brownian), solid particle measuring the fluid's volume velocity v(v). The term "compressibility" as used here includes not only pressure effects on density, but also temperature effects thereon. (For example, owing to a liquid's generally nonzero isobaric coefficient of thermal expansion, nonisothermal liquid flows are to be regarded as compressible despite the general perception of liquids as being incompressible.) Recognition of the fact that two independent fluid velocities, mass- and volume-based, are formally required to model continuum fluid behavior impacts on the foundations of contemporary (monovelocity) fluid mechanics. Included therein are the Navier-Stokes-Fourier equations, which are now seen to apply only to incompressible fluids (a fact well-known, empirically, to experimental gas kineticists). The findings of a difference in tracer velocities heralds the introduction into fluid mechanics of a general bipartite theory of fluid mechanics, bivelocity hydrodynamics [Brenner, Int. J. Eng. Sci. 54, 67 (2012)], differing from conventional hydrodynamics in situations entailing compressible flows and reducing to conventional hydrodynamics when the flow is incompressible, while being applicable to both liquids and gases.

  10. Introduction of an Oral Fluid Challenge Protocol in the Management of Children with Acute Gastroenteritis: A Regional Hospital Experience.

    LENUS (Irish Health Repository)

    Umana, E


    Oral rehydration therapy (ORT) remains the ideal first line therapy for acute gastroenteritis (AGE). Our aim was to assess the impact of introducing an Oral Fluid Challenge (OFC) protocol on outcomes such as intravenous fluid use and documentation in our institution. A single centre study with data collected retrospectively pre-implementation (April 2015) of the OFC protocol and post implementation (April 2016). Consecutive sampling of the first 55 patients presenting with GE like symptoms and underwent OFC were recruited. One hundred and ten patients were included in this study with 55 patients per cycle. The rates of IVF use decreased from 22% (12) in cycle one to 18% (10) in cycle two. There was an improvement in documentation by 26% (14) for level of dehydration and 52% (31) for OFC volume from cycle one to two. Overall, the addition of the OFC protocol to the management of patients with uncomplicated AGE would help streamline and improve care.

  11. Pathophysiology and clinical implications of peroperative fluid management in elective surgery

    DEFF Research Database (Denmark)

    Holte, Kathrine


    amounts of fluid caused adverse physiologic effects in healthy volunteers indicates that addition of the surgical trauma per se increases fluid requirements. Volume kinetic analysis applied 4 hours postoperatively was not able to detect the presence of either overhydration or hypovolemia regardless...... mobilization. In major (colonic) surgery with a standardized multimodal rehabilitation regimen, over-all functional recovery was not affected with a "liberal" ( approximately 5 liters) vs. "restrictive" 1.5 liter crystalloid-based regimen, however based on three anastomotic leakages in the "restrictive" group...

  12. Contemporary engineering economics

    CERN Document Server

    Park, Chan S


    Contemporary Engineering Economics, 5/e, is intended for undergraduate engineering students taking introductory engineering economics while appealing to the full range of engineering disciplines for which this course is often required: industrial, civil, mechanical, electrical, computer, aerospace, chemical, and manufacturing engineering, as well as engineering technology. This edition has been thoroughly revised and updated while continuing to adopt a contemporary approach to the subject, and teaching, of engineering economics. This text aims not only to build a sound and comprehensive coverage of engineering economics, but also to address key educational challenges, such as student difficulty in developing the analytical skills required to make informed financial decisions.

  13. Contemporary plasma physics

    International Nuclear Information System (INIS)

    Sodha, M.S.; Tewari, D.P.; Subbarao, D.


    The book consists of review articles on some selected contemporary aspects of plasma physics. The selected topics present a panoramic view of contemporary plasma physics and applications to fusion, space and MHD power generation. Basic non-linear plasma theory is also covered. The book is supposed to be useful for M.S./M.Sc. students specialising in plasma physics and for those beginning research work in plasma physics. It will also serve as a valuable reference book for more advanced research workers. (M.G.B.)

  14. Perspectives on contemporary mysticism. (United States)

    Thayer, N S


    Contemporary mysticism is in continuity with religious mysticism of all ages. Mysticism, like all religion, has an ideological and an experiential dimension. Traditional Freudian theory is inadequate for understanding either the ideological or the cognitive aspect, because it does not adequately account for either the cognitive process or the self-conscious "I." Categories of both ego psychology and the social scientific approach to religion illuminate contemporary mysticism in ways unavailable to the traditional Freudian psychoanalytic approach. The epistemological implications of the mystical attitude are considered, in both the religious and the scientific enterprises.

  15. Internal fluid flow management analysis for Clinch River Breeder Reactor Plant sodium pumps

    International Nuclear Information System (INIS)

    Cho, S.M.; Zury, H.L.; Cook, M.E.; Fair, C.E.


    The Clinch River Breeder Reactor Plant (CRBRP) sodium pumps are currently being designed and the prototype unit is being fabricated. In the design of these large-scale pumps for elevated temperature Liquid Metal Fast Breeder Reactor (LMFBR) service, one major design consideration is the response of the critical parts to severe thermal transients. A detailed internal fluid flow distribution analysis has been performed using a computer code HAFMAT, which solves a network of fluid flow paths. The results of the analytical approach are then compared to the test data obtained on a half-scale pump model which was tested in water. The details are presented of pump internal hydraulic analysis, and test and evaluation of the half-scale model test results

  16. Post-neurosurgical meningitis: Management of cerebrospinal fluid drainage catheters influences the evolution of infection


    Laura Soavi; Manuela Rosina; Roberto Stefini; Alessia Fratianni; Barbara Cadeo; Silvia Magri; Nicola Latronico; Marco Fontanella; Liana Signorini


    Background: In order to better define the pathogenic role of cerebrospinal fluid (CSF) drainage catheters in postoperative patients, we comparatively analyze the clinical course of device and non-device-related meningitis. Methods: This is an observational, partially prospective, study on consecutive adult patients who developed meningitis after undergoing neurosurgical procedures at the Neurosurgery and Neurointensive care Departments, Spedali Civili, Brescia, Italy, between January 1999...

  17. Present Practice of Using Nautical Depth to Manage Navigation Channels in the Presence of Fluid Mud (United States)


    densities ranging from 1,100 to 1,350 grams per liter (g/L). It consists of silt and clay -sized material with clay minerals and organic material in...dynamic viscosity parameters on fluid mud from Zeebrugge, Belgium, it is suggested that the nautical bottom be defined by the transition from • “the...are consequently different from those in pure water.” While density and viscosity are related, that relationship can be complicated by other factors

  18. Management of Inflammatory Fluid Collections and Walled-Off Pancreatic Necrosis. (United States)

    Shah, Apeksha; Denicola, Richard; Edirisuriya, Cynthia; Siddiqui, Ali A


    Pancreatic fluid collections are a frequent complication of acute pancreatitis. The revised Atlanta criterion classifies chronic fluid collections into pseudocysts and walled-off pancreatic necrosis (WON). Symptomatic PFCs require drainage options that include surgical, percutaneous, or endoscopic approaches. With the advent of newer and more advanced endoscopic tools and expertise, minimally invasive endoscopic drainage has now become the preferred approach. An endoscopic ultrasonography (EUS)-guided approach for pancreatic fluid collection drainage is now the preferred endoscopic approach. Both plastic stents and metal stents are efficacious and safe; however, metal stents may offer an advantage, especially in infected pseudocysts and in WON. Direct endoscopic necrosectomy is often required in WON. Lumen apposing metal stents allow for direct endoscopic necrosectomy and debridement through the stent lumen and are now preferred in these patients. Endoscopic retrograde cholangiopancreatography with pancreatic duct exploration should be performed concurrent to PFC drainage in patients with suspected PD disruption. PD disruption is associated with an increased severity of pancreatitis, an increased risk of recurrent attacks of pancreatitis and long-term complications, and a decreased rate of PFC resolution after drainage. Ideally, pancreatic ductal disruption should be bridged with endoscopic stenting.

  19. Management of intraoperative fluid balance and blood conservation techniques in adult cardiac surgery. (United States)

    Vretzakis, George; Kleitsaki, Athina; Aretha, Diamanto; Karanikolas, Menelaos


    Blood transfusions are associated with adverse physiologic effects and increased cost, and therefore reduction of blood product use during surgery is a desirable goal for all patients. Cardiac surgery is a major consumer of donor blood products, especially when cardiopulmonary bypass (CPB) is used, because hematocrit drops precipitously during CPB due to blood loss and blood cell dilution. Advanced age, low preoperative red blood cell volume (preoperative anemia or small body size), preoperative antiplatelet or antithrombotic drugs, complex or re-operative procedures or emergency operations, and patient comorbidities were identified as important transfusion risk indicators in a report recently published by the Society of Cardiovascular Anesthesiologists. This report also identified several pre- and intraoperative interventions that may help reduce blood transfusions, including off-pump procedures, preoperative autologous blood donation, normovolemic hemodilution, and routine cell saver use.A multimodal approach to blood conservation, with high-risk patients receiving all available interventions, may help preserve vital organ perfusion and reduce blood product utilization. In addition, because positive intravenous fluid balance is a significant factor affecting hemodilution during cardiac surgery, especially when CPB is used, strategies aimed at limiting intraoperative fluid balance positiveness may also lead to reduced blood product utilization.This review discusses currently available techniques that can be used intraoperatively in an attempt to avoid or minimize fluid balance positiveness, to preserve the patient's own red blood cells, and to decrease blood product utilization during cardiac surgery.

  20. Contemporary theories of democracy

    Directory of Open Access Journals (Sweden)

    Mladenović Ivan


    Full Text Available The aim of this paper is two-fold: first, to analyze several contemporary theories of democracy, and secondly, to propose a theoretical framework for further investigations based on analyzed theories. The following four theories will be analyzed: pluralism, social choice theory, deliberative democracy and participatory democracy.

  1. Contemporary Famine Analysis

    DEFF Research Database (Denmark)

    Rubin, Olivier

    to the newer economic approaches based on Amartya Sen. While all approaches contribute with important insights on famine dynamics, they also struggle to capture the political dimension of contemporary famines. The Brief develops a political approach capable of addressing this important but messy political...

  2. Heutiges Russisch (Contemporary Russian) (United States)

    Russisch, 1976


    For the purpose of supplying information on actual contemporary Russian usage, this article excerpts sections on noun usage and variations of the genitive ending in the masculine singular from "Stilistik der russischen Sprache" (Russian Language Style) by D. Rosental and M. Telenkowa. (Text is in German.) (FB)

  3. Scientific management and implementation of the geophysical fluid flow cell for Spacelab missions (United States)

    Hart, J.; Toomre, J.


    Scientific support for the spherical convection experiment to be flown on Spacelab 3 was developed. This experiment takes advantage of the zero gravity environment of the orbiting space laboratory to conduct fundamental fluid flow studies concerned with thermally driven motions inside a rotating spherical shell with radial gravity. Such a system is a laboratory analog of large scale atmospheric and solar circulations. The radial body force necessary to model gravity correctly is obtained by using dielectric polarization forces in a radially varying electric field to produce radial accelerations proportional to temperature. This experiment will answer fundamental questions concerned with establishing the preferred modes of large scale motion in planetary and stellar atmospheres.


    DEFF Research Database (Denmark)

    Mackinney-Valentin, Maria


    Explores a spatial approach to trend mechanisms that is argued to be more contemporary than the traditional temporal appraoch.......Explores a spatial approach to trend mechanisms that is argued to be more contemporary than the traditional temporal appraoch....

  5. Applying contemporary statistical techniques

    CERN Document Server

    Wilcox, Rand R


    Applying Contemporary Statistical Techniques explains why traditional statistical methods are often inadequate or outdated when applied to modern problems. Wilcox demonstrates how new and more powerful techniques address these problems far more effectively, making these modern robust methods understandable, practical, and easily accessible.* Assumes no previous training in statistics * Explains how and why modern statistical methods provide more accurate results than conventional methods* Covers the latest developments on multiple comparisons * Includes recent advanc


    Directory of Open Access Journals (Sweden)

    Rosemarie HAINES


    Full Text Available The critical analysis of Habermas’ Public Sphere Theory and the comparative undertaking to the current day enables us to assert that in contemporary society, public sphere is no longer a political public sphere, this dimension being completed by a societal dimension, the public sphere has extended and now we can talk about partial public spheres in an ever more commercial environment. The new rebuilding and communication technologies create a new type of public character: the visible sphere – non-located, non-dialogical and open. Information and communication are more and more involved in the restructuring of capitalism on an international scale and the reorganization of leadership and management systems. The reevaluation of the public sphere, public opinion, communication allows us to define public sphere according to the profound mutations from today’s democratic societies.

  7. Convective Heat Transfer Coefficients of Automatic Transmission Fluid Jets with Implications for Electric Machine Thermal Management: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Bennion, Kevin; Moreno, Gilberto


    Thermal management for electric machines (motors/ generators) is important as the automotive industry continues to transition to more electrically dominant vehicle propulsion systems. Cooling of the electric machine(s) in some electric vehicle traction drive applications is accomplished by impinging automatic transmission fluid (ATF) jets onto the machine's copper windings. In this study, we provide the results of experiments characterizing the thermal performance of ATF jets on surfaces representative of windings, using Ford's Mercon LV ATF. Experiments were carried out at various ATF temperatures and jet velocities to quantify the influence of these parameters on heat transfer coefficients. Fluid temperatures were varied from 50 degrees C to 90 degrees C to encompass potential operating temperatures within an automotive transaxle environment. The jet nozzle velocities were varied from 0.5 to 10 m/s. The experimental ATF heat transfer coefficient results provided in this report are a useful resource for understanding factors that influence the performance of ATF-based cooling systems for electric machines.

  8. Coupled Hydro-Mechanical Simulations of CO2 Storage Supported by Pressure Management Demonstrate Synergy Benefits from Simultaneous Formation Fluid Extraction

    Directory of Open Access Journals (Sweden)

    Kempka Thomas


    Full Text Available We assessed the synergetic benefits of simultaneous formation fluid extraction during CO2 injection for reservoir pressure management by coupled hydro-mechanical simulations at the prospective Vedsted storage site located in northern Denmark. Effectiveness of reservoir pressure management was investigated by simulation of CO2 storage without any fluid extraction as well as with 66% and 100% equivalent volume formation fluid extraction from four wells positioned for geothermal heat recovery. Simulation results demonstrate that a total pressure reduction of up to about 1.1 MPa can be achieved at the injection well. Furthermore, the areal pressure perturbation in the storage reservoir can be significantly decreased compared to the simulation scenario without any formation fluid extraction. Following a stress regime analysis, two stress regimes were considered in the coupled hydro-mechanical simulations indicating that the maximum ground surface uplift is about 0.24 m in the absence of any reservoir pressure management. However, a ground uplift mitigation of up to 37.3% (from 0.24 m to 0.15 m can be achieved at the injection well by 100% equivalent volume formation fluid extraction. Well-based adaptation of fluid extraction rates can support achieving zero displacements at the proposed formation fluid extraction wells located close to urban infrastructure. Since shear and tensile failure do not occur under both stress regimes for all investigated scenarios, it is concluded that a safe operation of CO2 injection with simultaneous formation fluid extraction for geothermal heat recovery can be implemented at the Vedsted site.

  9. Fluid retention associated with imatinib treatment in patients with gastroenterol stromal: Quantitative radiologic assessment and implications for management

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyung Won; Shinagare, Atul B.; Krajewski, Katherine M.; Tirumani, Sree Harsha; Jagannathan, Jyothi P.; Ramaiya, Nikihil H. [Dept. of Imaging, Dana-Farber Cancer Institute, Brigham and Women' s Hospital, Harvard Medical School, Boston (United States); Pyo, Jun Hee [The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston (United States)


    We aimed to describe radiologic signs and time-course of imatinib-associated fluid retention (FR) in patients with gastrointestinal stromal tumor (GIST), and its implications for management. In this Institutional Review Board-approved, retrospective study of 403 patients with GIST treated with imatinib, 15 patients with imaging findings of FR were identified by screening radiology reports, followed by manual confirmation. Subcutaneous edema, ascites, pleural effusion, and pericardial effusion were graded on a four-point scale on CT scans; total score was the sum of these four scores. The most common radiologic sign of FR was subcutaneous edema (15/15, 100%), followed by ascites (12/15, 80%), pleural effusion (11/15, 73%), and pericardial effusion (6/15, 40%) at the time of maximum FR. Two distinct types of FR were observed: 1) acute/progressive FR, characterized by acute aggravation of FR and rapid improvement after management, 2) intermittent/steady FR, characterized by occasional or persistent mild FR. Acute/progressive FR always occurred early after drug initiation/dose escalation (median 1.9 month, range 0.3-4.0 months), while intermittent/steady FR occurred at any time. Compared to intermittent/steady FR, acute/progressive FR was severe (median score, 5 vs. 2.5, p = 0.002), and often required drug-cessation/dose-reduction. Two distinct types (acute/progressive and intermittent/steady FR) of imatinib-associated FR are observed and each type requires different management.


    Directory of Open Access Journals (Sweden)

    S.Y. Lam


    Full Text Available Temperature variations inside a car underhood are largely controlled by the heat originating from the engine block and the exhaust manifold. Excessive temperatures in the underhood can lead to the faster deterioration of engine components and may affect the thermal comfort level inside the passenger cabin. This paper presents computational fluid dynamics investigations to assess the performance of a heat shield in lowering the peak temperature of the engine components and firewall in the underhood region of a typical passenger car. The simulation used the finite volume method with the standard k-ε turbulence model and an isothermal model for the heat transfer calculations. The results show that the heat shield managed to reduce the peak temperature of the engine components and firewall by insulating the intense heat from the engine block and exhaust and regulating the airflow inside the underhood region.

  11. Limitations of nonoperative management of type IIIb blunt hepatic injuries in hemodynamically stable patients after fluid resuscitation

    International Nuclear Information System (INIS)

    Sekine, Kazuhiko; Kitano, Mitsuhide; Shimizu, Masayuki; Matsumoto, Shokei; Yoshii, Hiroshi; Yamazaki, Motoyasu; Aikawa, Naoki


    Nonoperative management (NOM) of hepatic injuries caused by blunt trauma in hemodynamically stable patients is widely accepted, but the feasibility of NOM for severe hepatic injuries has not been fully evaluated. Among all patients with blunt severe hepatic injury (type IIIb) admitted to Saiseikai Kanagawa-ken Hospital and Keio University Hospital from 1988 to 2004, those who had been hemodynamically stable after fluid resuscitation at the emergency department were initially managed nonoperatively. We reviewed demographic, physiological, and laboratory data; computed tomography (CT) findings; 80-day cumulative laparotomy rate; and complications. The anatomical severity of the hepatic injuries was evaluated based on the CT findings, such as hepatic vein injuries and area lacerated according to the Couinaud liver segment. In patients who underwent surgery after admission, the surgical indications and operative findings were reviewed. Overall, 34 consecutive patients were enrolled in this study. Five patients underwent surgery, and all of their surgical indications were attributable to liver-related complications after injury. The indication for surgery was hemodynamic instability in 3 patients with hepatic vein injures in the early phase (<15 hours after estrogen receptor (ER) arrival) and intra-abdominal septic complications in 2 patients in the late phase (hospital days 14 and 64). The cumulative 80-day laparotomy rate in the early phase was significantly higher (p<0.0001) in the patients suspected of having hepatic vein injury, and in the late phase it was higher (p=0.002) in those with injuries in 4 or more segments of hepatic injuries. For the successful NOM of blunt hepatic injury type IIIb in patients who are hemodynamically stable after fluid resuscitation, a strong suspicion of concurrent hepatic vein injury is critical in the early phase, and laceration in 4 or more segments should be noted in the late phase. (author)

  12. Conceptual design of an in-space cryogenic fluid management facility, executive summary (United States)

    Willen, G. S.; Riemer, D. H.; Hustvedt, D. C.


    The conceptual design of a Spacelab experiment to develop the technology associated with low gravity propellant management is summarized. The preliminary facility definition, conceptual design and design analysis, and facility development plan, including schedule and cost estimates for the facility, are presented.

  13. Balancing Venturi and Laissez-Faire Management Styles: Insights from Fluid Mechanical Analogs

    Directory of Open Access Journals (Sweden)

    Ruud Weijermars


    Full Text Available Mobilizing distributed Organizational Intelligence involves managerial efforts whereby the generation of new tacit knowledge requires dissemination of newly codified externalized knowledge. The managerial role in the early stage of knowledge creation is to support and stimulate the process of knowledge generation and to aid the diffusion of knowledge across organizational boundaries. In contrast, the subsequent 'harvesting' and goal-oriented application of knowledge requires convergence of human actors (H as carriers of distributed intelligence (DI. Optimization of the organizational performance and improved workflow efficiency is best effectuated by applying insights from fluid mechanical analogs. Several such analogs are introduced here and these provide insight that helps to funnel tacit and explicit knowledge into tangible asset value. Three sets of managerial lessons are inferred from the analogs: (1 Social bonding between professionals needs to be stimulated because professionals with strong social bonds (S can sustain effective workflows under relatively high pressures, while weak social bonds lead to turbulence and disruption; (2 Effective vision sharing is essential for goal-oriented and accelerated knowledge development in DI systems, and; (3 Managerial pressure may not overheat the critical limit that can be handled by resilient and strongly bonded DI networks, as this would result in disruptive turbulence even in experienced neural networks.

  14. Contemporary evolution strategies

    CERN Document Server

    Bäck, Thomas; Krause, Peter


    Evolution strategies have more than 50 years of history in the field of evolutionary computation. Since the early 1990s, many algorithmic variations of evolution strategies have been developed, characterized by the fact that they use the so-called derandomization concept for strategy parameter adaptation. Most importantly, the covariance matrix adaptation strategy (CMA-ES) and its successors are the key representatives of this group of contemporary evolution strategies. This book provides an overview of the key algorithm developments between 1990 and 2012, including brief descriptions of the a

  15. Globalizing Contemporary War


    Melissa Zisler


    There are a plethora of social problems present throughout theworld in which America has deemed a type of ‘war.’ Some of theseunconventional wars include: The War on Poverty presented in 1964; The War on Drugs announced in 1971; The War on Cancer commencing in1971; The War Against Illiteracy beginning in the 1970s; and afterSeptember 11, 2001 The War on Terror was announced (Raz, 2008).These contemporary ‘wars’ have transformed the meaning of the word‘war.’ Labeling these missions ‘wars,’ pre...

  16. Benchmarking computational fluid dynamics models of lava flow simulation for hazard assessment, forecasting, and risk management (United States)

    Dietterich, Hannah; Lev, Einat; Chen, Jiangzhi; Richardson, Jacob A.; Cashman, Katharine V.


    Numerical simulations of lava flow emplacement are valuable for assessing lava flow hazards, forecasting active flows, designing flow mitigation measures, interpreting past eruptions, and understanding the controls on lava flow behavior. Existing lava flow models vary in simplifying assumptions, physics, dimensionality, and the degree to which they have been validated against analytical solutions, experiments, and natural observations. In order to assess existing models and guide the development of new codes, we conduct a benchmarking study of computational fluid dynamics (CFD) models for lava flow emplacement, including VolcFlow, OpenFOAM, FLOW-3D, COMSOL, and MOLASSES. We model viscous, cooling, and solidifying flows over horizontal planes, sloping surfaces, and into topographic obstacles. We compare model results to physical observations made during well-controlled analogue and molten basalt experiments, and to analytical theory when available. Overall, the models accurately simulate viscous flow with some variability in flow thickness where flows intersect obstacles. OpenFOAM, COMSOL, and FLOW-3D can each reproduce experimental measurements of cooling viscous flows, and OpenFOAM and FLOW-3D simulations with temperature-dependent rheology match results from molten basalt experiments. We assess the goodness-of-fit of the simulation results and the computational cost. Our results guide the selection of numerical simulation codes for different applications, including inferring emplacement conditions of past lava flows, modeling the temporal evolution of ongoing flows during eruption, and probabilistic assessment of lava flow hazard prior to eruption. Finally, we outline potential experiments and desired key observational data from future flows that would extend existing benchmarking data sets.

  17. Extracellular fluid management and hypertension in urban dwelling versus rural dwelling hemodialysis patients. (United States)

    Tonelli, Marcello; Lloyd, Anita; Pannu, Neesh; Klarenbach, Scott; Ravani, Pietro; Jindal, Kailash; MacRae, Jennifer; Unsworth, Larry; Manns, Braden; Hemmelgarn, Brenda


    Rural-dwelling hemodialysis patients have less frequent contact with nephrologists than urban-dwelling patients, and are known to have higher mortality. We hypothesized that rural-dwelling hemodialysis patients would have more evidence of poorly controlled extracellular fluid volume (ECVF) than otherwise similar urban-dwellers. We studied prevalent hemodialysis patients within a single renal program in Alberta, Canada and assessed ECFV using bioimpedance spectroscopy (BIS). Our primary outcome was impedance vector length (ohm/m) as assessed by BIS using the Xitron Hydra 4200 device, where shorter vector length indicated poorer ECFV control. Because poor ECFV control can lead to hypertension, we also assessed pre- and post-dialysis blood pressure. We measured outcomes at baseline. We studied 228 hemodialysis patients, of whom 115 (50.4 %) and 113 (49.6 %) were urban- and rural-dwelling, respectively. There were no differences in volume control in urban versus rural participants; odds ratio (OR) for vector length in the lowest sex-specific quartile of vector length was 0.93 (95 % CI 0.54, 1.59) after adjusting for age, sex, diabetic status, years since dialysis initiation and phase angle. The odds of very poor blood pressure control (pre-dialysis blood pressure ≥180/100) did not differ between urban and rural participants [fully adjusted OR 0.96 (0.36, 2.60)]. Differences in ECFV control do not appear to explain higher mortality among remote- and rural- dwelling hemodialysis patients, compared to urban-dwellers.

  18. A contemporary, single-institutional experience of surgical versus expectant management of congenital heart disease in trisomy 13 and 18 patients. (United States)

    Costello, John P; Weiderhold, Allison; Louis, Clauden; Shaughnessy, Conner; Peer, Syed M; Zurakowski, David; Jonas, Richard A; Nath, Dilip S


    The objective of this study was to examine a large institutional experience of patients with trisomy 13 and trisomy 18 in the setting of comorbid congenital heart disease and present the outcomes of surgical versus expectant management. It is a retrospective single-institution cohort study. Institutional review board approved this study. Thirteen consecutive trisomy 18 patients and three consecutive trisomy 13 patients (sixteen patients in total) with comorbid congenital heart disease who were evaluated by our institution's Division of Cardiovascular Surgery between January 2008 and December 2013 were included in the study. The primary outcome measures evaluated were operative mortality (for patients who received surgical management), overall mortality (for patients who received expectant management), and total length of survival during follow-up. Of the thirteen trisomy 18 patients, seven underwent surgical management and six received expectant management. With surgical management, operative mortality was 29 %, and 80 % of patients were alive after a median follow-up of 116 days. With expectant management, 50 % of patients died before hospital discharge. Of the three patients with trisomy 13, one patient underwent surgical management and two received expectant management. The patient who received surgical management with complete repair was alive at last follow-up over 2 years after surgery; both patients managed expectantly died before hospital discharge. Trisomy 13 and trisomy 18 patients with comorbid congenital heart disease can undergo successful cardiac surgical intervention. In this population, we advocate that nearly all patients with cardiovascular indications for operative congenital heart disease intervention should be offered complete surgical repair over palliative approaches for moderately complex congenital cardiac anomalies.

  19. An Overview of In-Space Propulsion and Cryogenics Fluids Management Efforts for 2014 SBIR Phases I and II (United States)

    Nguyen, Hung D.; Steele, Gynelle C.


    NASA's Small Business Innovation Research (SBIR) program focuses on technological innovation by investing in the development of innovative concepts and technologies to help NASA's mission directorates address critical research and development needs for Agency programs. This report highlights 11 of the innovative SBIR 2014 Phase I and II projects from 2010 to 2012 that focus on one of NASA Glenn Research Center's six core competencies-In-Space Propulsion and Cryogenic Fluids Management. The technologies cover a wide spectrum of applications such as divergent field annular ion engines, miniature nontoxic nitrous oxide-propane propulsion, noncatalytic ignition systems for high-performance advanced monopropellant thrusters, nontoxic storable liquid propulsion, and superconducting electric boost pumps for nuclear thermal propulsion. Each article describes an innovation and technical objective and highlights NASA commercial and industrial applications. This report provides an opportunity for NASA engineers, researchers, and program managers to learn how NASA SBIR technologies could help their programs and projects, and lead to collaborations and partnerships between the small SBIR companies and NASA that would benefit both.


    Energy Technology Data Exchange (ETDEWEB)

    Winniford, Michael D


    Nearly 4 million patient procedures performed annually in US cardiac catheterization laboratories utilize contrast media to achieve vessel opacification. The amount of contrast media used is variable and depends on the complexity of the procedure, the method of contrast delivery as well as the skill-level of the operator. Since the total amount of contrast used for each procedure can have both patient safety and economic implications, it is essential for cardiologists to have the ability to control contrast delivery such that optimal angiographic image quality is achieved using the least amount of contrast. Although the complication rate associated with cardiac catheterization remains low, the most common serious complication, contrast-induced nephropathy (CIN), is associated with poor prognosis and a high mortality rate. Numerous interventional strategies for preventing and reducing the severity of CIN have demonstrated varying degrees of clinical benefit, but none has been shown to reliably prevent this serious complication. To date, the most effective approach for reducing the risk of CIN is to properly hydrate the patient and to minimize the amount of contrast media administered. Automated injection systems are intended for use in virtually all cardiac catheterization procedures and have numerous features which can provide potential advantages over traditional methods. With automated injection technology the operator is able to control and precisely monitor contrast delivery. Additionally, the MEDRAD Avanta Fluid Management Injection System utilizes a sterile contrast reservoir which eliminates the need to discard unused contrast in individual opened containers following each procedure. Considering that an average of 50% of opened contrast media is wasted using manual injection methods, this savings can provide a substantial economic benefit. Automated systems also facilitate the use of smaller (5 French) catheter sizes. Precise flow control and the use of

  1. Bioelectrical impedance spectroscopy as a fluid management system in heart failure

    International Nuclear Information System (INIS)

    Weyer, Sören; Wartzek, Tobias; Leicht, Lennart; Leonhardt, Steffen; Zink, Matthias Daniel; Mischke, Karl; Vollmer, Thomas


    Episodes of hospitalization for heart failure patients are frequent and are often accompanied by fluid accumulations. The change of the body impedance, measured by bioimpendace spectroscopy, is an indicator of the water content. The hypothesis was that it is possible to detect edema from the impedance data. First, a finite integration technique was applied to test the feasibility and allowed a theoretical analysis of current flows through the body. Based on the results of the simulations, a clinical study was designed and conducted. The segmental impedances of 25 patients suffering from heart failure were monitored over their recompensation process. The mean age of the patients was 73.8 and their mean body mass index was 28.6. From these raw data the model parameters from the Cole model were deduced by an automatic fitting algorithm. These model data were used to classify the edema status of the patient. The baseline values of the regression lines of the extra- and intracellular resistance from the transthoracic measurement and the baseline value of the regression line of the extracellular resistance from the foot-to-foot measurement were identified as important parameters for the detection of peripheral edema. The rate of change of the imaginary impedance at the characteristic frequency and the mean intracellular resistance from the foot-to-foot measurement were identified as important parameters for the detection of pulmonary edema. To classify the data, two decision trees were considered: One should detect pulmonary edema (n pulmonary = 13, n none = 12) and the other peripheral edema (n peripheral = 12, n none = 13). Peripheral edema could be detected with a sensitivity of 100% and a specificity of 90%. The detection of pulmonary edema showed a sensitivity of 92.31% and a specificity of 100%. The leave-one-out cross-validation-error for the peripheral edema detection was 12% and 8% for the detection of pulmonary edema. This enables the application of BIS as an

  2. Cases to accompany contemporary strategy analysis


    R. Grant


    This volume represents an ongoing committment to examining the concepts and techniques of business strategy analysis in the context of real business situations. The cases have been written to accompany Contemporary Strategy Analysis textbook. Each case presents issues that illuminate the ideas, concepts, and analytical techniques contained in one or more chapters of the textbook. Most important, the cases promote deep learning by students of strategic management by requiring the application o...

  3. Comparison of clinical profile and management of outpatients with heart failure with reduced left ventricular ejection fraction treated by general practitioners and cardiologists in contemporary Poland: the results from the DATA-HELP registry. (United States)

    Jankowska, Ewa A; Kalicinska, Elzbieta; Drozd, Marcin; Kurian, Beata; Banasiak, Waldemar; Ponikowski, Piotr


    We sought to determine and compare clinical profile and management of outpatients with heart failure with reduced ejection fraction (HFREF) treated by cardiologists and general practitioners (GPs) in Poland. All the 790 randomly selected cardiologists and GPs in the DATA-HELP registry, which included 5563 patients, filled out questionnaires about 10 consecutive outpatients with HFREF. Outpatients managed by GPs were older (69±10 vs 66±12 years), and the prevalence of men was less marked (58% vs 67%). They also had higher left ventricular ejection fraction (38±6% vs 35±8%) and had more pulmonary congestion (63% vs 49%) and peripheral oedema (66% vs 51%), compared with those treated by cardiologists (all p0.2) and digoxin (20% vs 21%, p>0.2) by GPs and cardiologists was similar. In contemporary Poland, most outpatients with HFREF receive drugs that improve survival and undergo revascularisation procedures, although devices are rare, but the clinical profiles and management of those treated by GPs and cardiologists differ. Outpatients treated by GPs are older and have more co-morbidities. Outpatients treated by cardiologists more commonly receive β-blocker, MRA, ICD, and CRT, and undergo coronary revascularisations. Copyright © 2014. Published by Elsevier Ireland Ltd.

  4. [Significance of amnioinfusion and amniotic fluid exchange under continuous internal fetal heart rate monitoring for management of fetal distress during labor]. (United States)

    Zhao, S; Ai, L; Zhang, H


    To discuss the significance of amnioinfusion and amniotic fluid exchange under continuous internal fetal heart rate (FHR) monitoring for management of fetal distress during labor. 136 cases with frequent variable deceleration (VD) and meconium stained amniotic fluid during labor were divided into two groups: the study group (68 cases) and the control group (68 cases). The former were treated by amnioinfusion and amniotic fluid exchange, while oxygen inhalation, change of body position, and intravenous infusion for the control group. In the study group, VD disappeared or relieved in 62 cases obviously, and the efficacy rate reached 91.2% (62/68). 48 cases with II degree meconium stained amniotic fluid were treated by amniotic fluid exchange, amniotic fluid became clear or turned to I degree stained in 39 cases. In the control group, VD relieved in 20 cases, the efficacy rate was 19.4%, significantly lower than that of the study group (P 0.05). Amnioinfusion and AF exchange during labor are one of the effective treatment methods for fetal distress and prevention for MAS.

  5. Trends in contemporary mathematics

    CERN Document Server

    Strickland, Elisabetta


    This book covers a wide spectrum of hot topics and current trends in mathematics, including noncommutative algebra via deformation theory,  optimal transportation, nonlinear potential theory, kinetic theory and gas dynamics, geometric numerical integration, finite simple groups of small essential dimension, optimal control problems, extended Dynkin diagrams, spin glasses, aspherical closed manifolds, Boltzmann systems, birational geometry of projective varieties and directed graphs, nonlinear diffusion, geometric constructions of extremal metrics on complex manifolds, and Pell’s equation in polynomials. The book comprises a selection of contributions by leading international mathematicians who were speakers at the "INdAM Day", an initiative dating back to 2004 at which the most recent developments in contemporary mathematics are presented.

  6. Contemporary Transitional Justice

    DEFF Research Database (Denmark)

    Gissel, Line Engbo


    This article studies the contemporary expression of transitional justice, a field of practice through which global governance is exercised. It argues that transitional justice is being normalised, given the normative and empirical de-legitimisation of its premise of exceptionalism. The article...... theorises exceptionalism and normalcy in transitional justice and identifies three macro-level causes of normalisation: the legalisation, internationalisation, and professionalization of the field. This argument is illustrated by a study of Uganda’s trajectory of transitional justice since 1986. Across five...... phases of transitional justice, processes of legalisation, internationalisation, and professionalization have contributed to the gradual dismantling of the country’s exceptional justice. The case demonstrates, further, that normalization is a contested and incomplete process....

  7. The Contemporary Goffman

    DEFF Research Database (Denmark)

    Despite aversion to famedom, idolatry and cults of intellectual celebrity, Erving Goffman was one of the leading and most original sociologists of the 20th century. This book takes him into the 21st century. The Contemporary Goffman offers a wide range of readings, interpretations and applications...... of the work of Erving Goffman by a host of international scholars. Some chapters grapple with the personal background and academic ascendency of Goffman, while others wrestle with his continued relevance to a variety of disciplines and sub-disciplines. Some of the chapters included deal with developments...... unforeseeable in Goffman's own lifetime such as the invention of the internet and mobile telephones, the rise of global tourism and everyday mobility as well as the emergence of a new cult of individualism, while other chapters locate his perspective within recent developments in social theory...

  8. Endoscopic transmural management of abdominal fluid collection following gastrointestinal, bariatric, and hepato-bilio-pancreatic surgery. (United States)

    Donatelli, Gianfranco; Fuks, David; Cereatti, Fabrizio; Pourcher, Guillaume; Perniceni, Thierry; Dumont, Jean-Loup; Tuszynski, Thierry; Vergeau, Bertrand Marie; Meduri, Bruno; Gayet, Brice


    Post-operative collections are a recognized source of morbidity after abdominal surgery. Percutaneous drainage is currently considered the standard treatment but not all collections are accessible using this method. Since the adoption of EUS, endoscopic transmural drainage has become an attractive option in the management of such complications. The present study aimed to assess the efficacy, safety and modalities of endoscopic transmural drainage in the treatment of post-operative collections. Data of all patients referred to our dedicated multidisciplinary facility from 2014 to 2017 for endoscopic drainage of symptomatic post-operative collections after failure of percutaneous drainage or when it was deemed impossible, were retrospectively analyzed. Thirty-two patients (17 males and 15 females) with a median age of 53 years old (range 31-74) were included. Collections resulted from pancreatic (n = 10), colorectal (n = 6), bariatric (n  = 5), and other type of surgery (n  = 11). Collection size was less than 5 cm in diameter in 10 (31%), between 5 and 10 cm in 17 (53%) ,and more than 10 cm in 5 (16%) patients. The median time from surgery to endoscopic drainage was 38 days (range 6-360). Eight (25%) patients underwent endoscopic guided drainage whereas 24 (75%) patients underwent EUS-guided drainage. Technical success was 100% and clinical success was achieved in 30 (93.4%) after a mean follow-up of 13.5 months (1.2-24.8). Overall complication was 12.5% including four patients who bled following trans-gastric drainage treated with conservative therapy. The present series suggests that endoscopic transmural drainage represents an interesting alternative in the treatment of post-operative collection when percutaneous drainage is not possible or fails.

  9. Validation of The Fluid Intake Appraisal Inventory; a self-efficacy scale for managing fluid allowance among patients on haemodialysis in Denmark

    DEFF Research Database (Denmark)

    Pahus, Jytte; Ludvigsen, Mette Spliid; Lindberg, Magnus

    ) evaluates patients’ SE with regard to fluid intake. FIAI was developed in Sweden and can be used as a screening instrument or as evaluation tool. Objectives The aim of this study was to translate and validate the FIAI for use in Denmark. Methods Following the steps of forward and backward translation...... centre (including four satellite units) completed the Danish FIAI. Analysis of construct validity and internal consistency is ongoing. Conclusions Primarily findings indicate that the Danish FIAI can be used in clinical practice as a screening instrument for SE and evaluation tool among adult...

  10. Endometrial fluid associated with Essure implants placed before in vitro fertilization: Considerations for patient counseling and surgical management. (United States)

    Sills, E Scott; Walsh, David J; Jones, Christopher A; Wood, Samuel H


    Essure (Bayer) received approval from the U.S. Food and Drugs Administration as a permanent non-hormonal contraceptive implant in November 2002. While the use of Essure in the management of hydrosalpinx prior to in vitro fertilization (IVF) remains off-label, it has been used specifically for this purpose since at least 2007. Although most published reports on Essure placement before IVF have been reassuring, clinical experience remains limited, and no randomized studies have demonstrated the safety or efficacy of Essure in this context. In fact, no published guidelines deal with patient selection or counseling regarding the Essure procedure specifically in the context of IVF. Although Essure is an irreversible birth control option, some patients request the surgical removal of the implants for various reasons. While these patients could eventually undergo hysterectomy, at present no standardized technique exists for simple Essure removal with conservation of the uterus. This article emphasizes new aspects of the Essure procedure, as we describe the first known association between the placement of Essure implants and the subsequent development of fluid within the uterine cavity, which resolved after the surgical removal of both devices.

  11. Mogućnosti implementacije savremenih sistema upravljanja saobraćajem u sistem odbrane / Possibilities of implementation of contemporary traffic management systems in the defense system

    Directory of Open Access Journals (Sweden)

    Srđan Ljubojević


    Full Text Available Savremeni trendovi u upravljanju saobraćajem okrenuti su ka efikasnijem iskorišćenju postojećih kapaciteta. Ovaj rad je izraz težnje da se sagleda uloga inteligentnih transportnih sistema u takvom pristupu upravljanju saobraćajem, kao i da se ukaže na budućnost sistema odbrane na tom polju. / The latest trends in traffic management focus on more efficient usage of existing capacities. This paper tries to perceive the role of Intelligent Transportation Systems within such an approach to traffic management as well as to point out to the future of the Defense System in this field.

  12. Contemporary management of rectal injuries at Level I trauma centers: The results of an American Association for the Surgery of Trauma multi-institutional study. (United States)

    Brown, Carlos V R; Teixeira, Pedro G; Furay, Elisa; Sharpe, John P; Musonza, Tashinga; Holcomb, John; Bui, Eric; Bruns, Brandon; Hopper, H Andrew; Truitt, Michael S; Burlew, Clay C; Schellenberg, Morgan; Sava, Jack; VanHorn, John; Eastridge, Pa-C Brian; Cross, Alicia M; Vasak, Richard; Vercruysse, Gary; Curtis, Eleanor E; Haan, James; Coimbra, Raul; Bohan, Phillip; Gale, Stephen; Bendix, Peter G


    Rectal injuries have been historically treated with a combination of modalities including direct repair, resection, proximal diversion, presacral drainage, and distal rectal washout. We hypothesized that intraperitoneal rectal injuries may be selectively managed without diversion and the addition of distal rectal washout and presacral drainage in the management of extraperitoneal injuries are not beneficial. This is an American Association for the Surgery of Trauma multi-institutional retrospective study from 2004 to 2015 of all patients who sustained a traumatic rectal injury and were admitted to one of the 22 participating centers. Demographics, mechanism, location and grade of injury, and management of rectal injury were collected. The primary outcome was abdominal complications (abdominal abscess, pelvic abscess, and fascial dehiscence). After exclusions, there were 785 patients in the cohort. Rectal injuries were intraperitoneal in 32%, extraperitoneal in 58%, both in 9%, and not documented in 1%. Rectal injury severity included the following grades I, 28%; II, 41%; III, 13%; IV, 12%; and V, 5%. Patients with intraperitoneal injury managed with a proximal diversion developed more abdominal complications (22% vs 10%, p = 0.003). Among patients with extraperitoneal injuries, there were more abdominal complications in patients who received proximal diversion (p = 0.0002), presacral drain (p = 0.004), or distal rectal washout (p = 0.002). After multivariate analysis, distal rectal washout [3.4 (1.4-8.5), p = 0.008] and presacral drain [2.6 (1.1-6.1), p = 0.02] were independent risk factors to develop abdominal complications. Most patients with intraperitoneal injuries undergo direct repair or resection as well as diversion, although diversion is not associated with improved outcomes. While 20% of patients with extraperitoneal injuries still receive a presacral drain and/or distal rectal washout, these additional maneuvers are independently associated with a three

  13. Understanding the heterogeneity in volume overload and fluid distribution in decompensated heart failure is key to optimal volume management: role for blood volume quantitation. (United States)

    Miller, Wayne L; Mullan, Brian P


    This study sought to quantitate total blood volume (TBV) in patients hospitalized for decompensated chronic heart failure (DCHF) and to determine the extent of volume overload, and the magnitude and distribution of blood volume and body water changes following diuretic therapy. The accurate assessment and management of volume overload in patients with DCHF remains problematic. TBV was measured by a radiolabeled-albumin dilution technique with intravascular volume, pre-to-post-diuretic therapy, evaluated at hospital admission and at discharge. Change in body weight in relation to quantitated TBV was used to determine interstitial volume contribution to total fluid loss. Twenty-six patients were prospectively evaluated. Two patients had normal TBV at admission. Twenty-four patients were hypervolemic with TBV (7.4 ± 1.6 liters) increased by +39 ± 22% (range, +9.5% to +107%) above the expected normal volume. With diuresis, TBV decreased marginally (+30 ± 16%). Body weight declined by 6.9 ± 5.2 kg, and fluid intake/fluid output was a net negative 8.4 ± 5.2 liters. Interstitial compartment fluid loss was calculated at 6.2 ± 4.0 liters, accounting for 85 ± 15% of the total fluid reduction. TBV analysis demonstrated a wide range in the extent of intravascular overload. Dismissal measurements revealed marginally reduced intravascular volume post-diuretic therapy despite large reductions in body weight. Mobilization of interstitial fluid to the intravascular compartment with diuresis accounted for this disparity. Intravascular volume, however, remained increased at dismissal. The extent, composition, and distribution of volume overload are highly variable in DCHF, and this variability needs to be taken into account in the approach to individualized therapy. TBV quantitation, particularly serial measurements, can facilitate informed volume management with respect to a goal of treating to euvolemia. Copyright © 2014 American College of Cardiology Foundation. Published

  14. Contemporary sensorimotor theory

    CERN Document Server

    Martin, Andrew


    This book analyzes the philosophical foundations of sensorimotor theory and discusses the most recent applications of sensorimotor theory to human computer interaction, child’s play, virtual reality, robotics, and linguistics. Why does a circle look curved and not angular? Why does red not sound like a bell? Why, as I interact with the world, is there something it is like to be me? An analytic philosopher might suggest: ``if we ponder the concept of circle we find that it is the essence of a circle to be round’’. However, where does this definition come from? Was it set in stone by the Gods, in other words by divine arbiters of circleness, redness and consciousness? Particularly, with regard to visual consciousness, a first attempt to explain why our conscious experience of the world appears as it does has been attributed to Kevin O’Regan and Alva Noe, who published their sensorimotor account of vision and visual consciousness in 2001. Starting with a chapter by Kevin O’Regan, Contemporary Sensorimo...

  15. Sadum: Traditional and Contemporary

    Directory of Open Access Journals (Sweden)

    Ratna Panggabean


    Full Text Available Sadum is one of the traditional cloths of the Batak people in North Sumatra. It is woven on a back strap loom with supplementary weft technique. Sadum is a warp faced weaving made of cotton and beads woven into the cloth. Ritually it is used as a shoulder cloth, gifts exchanges, and in dances. It also bears the symbol of good tidings and blessings for the receiver. The cloth has change during times in technique, color, patterns, as well as in functions. But the use as a ritual cloth stays the same. The basic weaving techniques and equipments used to create it hasn’t change, but its material and added techniques has made this cloth become more rich in color, pattern, and texture. Most changes began when the Europeans came to Indonesia and introduced new material such as synthetic fibers and colors. In the 70s traditional cloth of Indonesia got its boost when the government declared batik as Indonesian national attire. This encourages other traditional weavings to develop into contemporary clothing. Later, new techniques and material were introduced to the Sadum weavings including embroidery, silk and golden threads which were never used before.

  16. Ribosomal Antibiotics: Contemporary Challenges

    Directory of Open Access Journals (Sweden)

    Tamar Auerbach-Nevo


    Full Text Available Most ribosomal antibiotics obstruct distinct ribosomal functions. In selected cases, in addition to paralyzing vital ribosomal tasks, some ribosomal antibiotics are involved in cellular regulation. Owing to the global rapid increase in the appearance of multi-drug resistance in pathogenic bacterial strains, and to the extremely slow progress in developing new antibiotics worldwide, it seems that, in addition to the traditional attempts at improving current antibiotics and the intensive screening for additional natural compounds, this field should undergo substantial conceptual revision. Here, we highlight several contemporary issues, including challenging the common preference of broad-range antibiotics; the marginal attention to alterations in the microbiome population resulting from antibiotics usage, and the insufficient awareness of ecological and environmental aspects of antibiotics usage. We also highlight recent advances in the identification of species-specific structural motifs that may be exploited for the design and the creation of novel, environmental friendly, degradable, antibiotic types, with a better distinction between pathogens and useful bacterial species in the microbiome. Thus, these studies are leading towards the design of “pathogen-specific antibiotics,” in contrast to the current preference of broad range antibiotics, partially because it requires significant efforts in speeding up the discovery of the unique species motifs as well as the clinical pathogen identification.

  17. Contemporary sea level rise. (United States)

    Cazenave, Anny; Llovel, William


    Measuring sea level change and understanding its causes has considerably improved in the recent years, essentially because new in situ and remote sensing observations have become available. Here we report on most recent results on contemporary sea level rise. We first present sea level observations from tide gauges over the twentieth century and from satellite altimetry since the early 1990s. We next discuss the most recent progress made in quantifying the processes causing sea level change on timescales ranging from years to decades, i.e., thermal expansion of the oceans, land ice mass loss, and land water-storage change. We show that for the 1993-2007 time span, the sum of climate-related contributions (2.85 +/- 0.35 mm year(-1)) is only slightly less than altimetry-based sea level rise (3.3 +/- 0.4 mm year(-1)): approximately 30% of the observed rate of rise is due to ocean thermal expansion and approximately 55% results from land ice melt. Recent acceleration in glacier melting and ice mass loss from the ice sheets increases the latter contribution up to 80% for the past five years. We also review the main causes of regional variability in sea level trends: The dominant contribution results from nonuniform changes in ocean thermal expansion.

  18. The Borexino Thermal Monitoring & Management System and simulations of the fluid-dynamics of the Borexino detector under asymmetrical, changing boundary conditions (United States)

    Bravo-Berguño, D.; Mereu, R.; Cavalcante, P.; Carlini, M.; Ianni, A.; Goretti, A.; Gabriele, F.; Wright, T.; Yokley, Z.; Vogelaar, R. B.; Calaprice, F.; Inzoli, F.


    A comprehensive monitoring system for the thermal environment inside the Borexino neutrino detector was developed and installed in order to reduce uncertainties in determining temperatures throughout the detector. A complementary thermal management system limits undesirable thermal couplings between the environment and Borexino's active sections. This strategy is bringing improved radioactive background conditions to the region of interest for the physics signal thanks to reduced fluid mixing induced in the liquid scintillator. Although fluid-dynamical equilibrium has not yet been fully reached, and thermal fine-tuning is possible, the system has proven extremely effective at stabilizing the detector's thermal conditions while offering precise insights into its mechanisms of internal thermal transport. Furthermore, a Computational Fluid-Dynamics analysis has been performed, based on the empirical measurements provided by the thermal monitoring system, and providing information into present and future thermal trends. A two-dimensional modeling approach was implemented in order to achieve a proper understanding of the thermal and fluid-dynamics in Borexino. It was optimized for different regions and periods of interest, focusing on the most critical effects that were identified as influencing background concentrations. Literature experimental case studies were reproduced to benchmark the method and settings, and a Borexino-specific benchmark was implemented in order to validate the modeling approach for thermal transport. Finally, fully-convective models were applied to understand general and specific fluid motions impacting the detector's Active Volume.

  19. The contemporary management of prostate cancer in the United States: lessons from the cancer of the prostate strategic urologic research endeavor (CapSURE), a national disease registry. (United States)

    Cooperberg, Matthew R; Broering, Jeanette M; Litwin, Mark S; Lubeck, Deborah P; Mehta, Shilpa S; Henning, James M; Carroll, Peter R


    The epidemiology and treatment of prostate cancer have changed dramatically in the prostate specific antigen era. A large disease registry facilitates the longitudinal observation of trends in disease presentation, management and outcomes. The Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) is a national disease registry of more than 10000 men with prostate cancer accrued at 31 primarily community based sites across the United States. Demographic, clinical, quality of life and resource use variables are collected on each patient. We reviewed key findings from the data base in the last 8 years in the areas of disease management trends, and oncological and quality of life outcomes. Prostate cancer is increasingly diagnosed with low risk clinical characteristics. With time patients have become less likely to receive pretreatment imaging tests, less likely to pursue watchful waiting and more likely to receive brachytherapy or hormonal therapy. Relatively few patients treated with radical prostatectomy in the database are under graded or under staged before surgery, whereas the surgical margin rate is comparable to that in academic series. CaPSURE data confirm the usefulness of percent positive biopsies in risk assessment and they have further been used to validate multiple preoperative nomograms. CaPSURE results strongly affirm the necessity of patient reported quality of life assessment. Multiple studies have compared the quality of life impact of various treatment options, particularly in terms of urinary and sexual function, and bother. The presentation and management of prostate cancer have changed substantially in the last decade. CaPSURE will continue to track these trends as well as oncological and quality of life outcomes, and will continue to be an invaluable resource for the study of prostate cancer at the national level.

  20. Contemporary Management of Coronary Artery Disease and Acute Coronary Syndrome in Patients with Chronic Kidney Disease and End-Stage Renal Disease (United States)

    Huang, Chin-Chou; Chen, Jaw-Wen


    Chronic kidney disease (CKD) and end-stage renal disease (ESRD) have emerged as a worldwide public health problem. Due to the remarkably higher incidence and prevalence of this chronic disease in Taiwan than in other countries, CKD/ESRD has contributed to a significant health burden in Taiwan. Patients with CKD/ESRD have an increased risk of coronary artery disease (CAD) and acute coronary syndrome (ACS) compared to the normal population. Patients with ACS alone can present differently than patients with ACS and CKD/ESRD. Also, due to the lower prevalence of chest pain and ST-segment elevation, CKD/ESRD patients were more difficult to diagnose than other patients. Furthermore, whether advances in ACS management with medical therapy and an early invasive approach could improve patient outcomes with CKD/ESRD is not known. The use of antiplatelets such as aspirin and other antithrombotic agents might reduce the incidence of ACS or stroke in CKD patients. However, such use could also increase bleeding risk and even increase the likelihood of mortality, especially in dialysis patients. While recent clinical data suggest the potential benefit of aggressive management with coronary intervention for CAD and ACS in this category of patients, further clinical studies are still indicated for the proper medical strategy and revascularization therapy to improve the outcomes of CAD and ACS in CKD/ESRD patients, both in Taiwan and worldwide. PMID:27122697

  1. Contemporary management of chronic rhinosinusitis with nasal polyposis in aspirin-exacerbated respiratory disease: an evidence-based review with recommendations. (United States)

    Levy, Joshua M; Rudmik, Luke; Peters, Anju T; Wise, Sarah K; Rotenberg, Brian W; Smith, Timothy L


    Chronic rhinosinusitis (CRS) in aspirin-exacerbated respiratory disease (AERD) represents a recalcitrant form of sinonasal inflammation for which a multidisciplinary consensus on patient management has not been reached. Several medical interventions have been investigated, but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach for the multidisciplinary management of CRS in AERD. A systematic review of the literature was performed and the guidelines for development of an evidence-based review with recommendations were followed. Study inclusion criteria included: adult population >18 years old; CRS based on published diagnostic criteria, and a presumptive diagnosis of AERD. We focused on reporting higher-quality studies (level 2 or higher) when available, but reported lower-quality studies if the topic contained insufficient evidence. Treatment recommendations were based on American Academy of Otolaryngology (AAO) guidelines, with defined grades of evidence and evaluation of research quality and risk/benefits associated with each treatment. This review identified and evaluated the literature on 3 treatment strategies for CRS in AERD: dietary salicylate avoidance, leukotriene modification, and desensitization with daily aspirin therapy. Based on the available evidence, dietary salicylate avoidance and leukotriene-modifying drugs are options following appropriate treatment with nasal corticosteroids and saline irrigation. Desensitization with daily aspirin therapy is recommended following revision endoscopic sinus surgery (ESS). © 2016 ARS-AAOA, LLC.

  2. The Contemporary Gorky Studies

    Directory of Open Access Journals (Sweden)

    Lidya A. Spiridonova


    Full Text Available The A. M. Gorky Institute of World Literature is acknowledged center of the international Gorky Studies. The paper discusses all the stages of the development of the Gorky research from 1937 to the present. The Institute published: Gorky’s collected works in 30 volumes (1949–1955, complete academic edition of his fictional works in 25 volumes, and 10 volumes of their editions (1968–1980. It is publishing a second series of Letters in 24 volumes (18 volumes have come out in the period from 1997 through 2016. Among other publications, there are 12 volumes of the Gorky archives, 3 volumes of his Literary Heritage, and proceedings of the annual “Gorky Readings.” A new phase of Gorky Studies began after the abandonment of a Marxist-Leninist approach to literary studies. This phase is characterized by the objectivity of scholarly analysis, focus on the obscure spots of Gorky’s biography and work, and use of the hitherto unknown archival materials. In parallel to the publication of Letters (a third part of letters in each volume is published for the first time, IWL resumed a series entitled M. Gorky. Materials and Research: in 1998–2016 there were published 13 collections, now two more are getting ready for publication. These editions include Gorky’s correspondence with V. Lenin, I. Stalin, L. Kamenev, G. Zinoviev, G. Berya and others, documentary testimony of the writer’s ailment and death, and hitherto unknown memories of his contemporaries. The serial publication of Gorky Readings reflects the work of the annual academic conferences held in Moscow, Nizhny Novgorod, and Kazan. These proceedings have rendered Gorky Studies to a new methodological level in that they attempt to reveal the face of the “real” Gorky, deprived of both a classical gloss and unjustified denigration.

  3. Contemporary danish landscape research

    DEFF Research Database (Denmark)

    Vejre, H.; Brandt, J.


    Danish landscape research blossomed during the 1990’ies thanks to several transdisciplinary research programmes involving several institutions. The main themes of the programmes encompassed Landscape change, landscape and biological diversity, nature and landscape management, use and monitoring...

  4. Literacy in the contemporary scene

    Directory of Open Access Journals (Sweden)

    Angela B. Kleiman


    Full Text Available In this paper I examine the relationship between literacy and contemporaneity. I take as a point of departure for my discussion school literacy and its links with literacies in other institutions of the contemporary scene, in order to determine the relation between contemporary ends of reading and writing (in other words, the meaning of being literate in contemporary society and the practices and activities effectively realized at school in order to reach those objectives. Using various examples from teaching and learning situations, I discuss digital literacy practices and multimodal texts and multiliteracies from both printed and digital cultures. Throughout, I keep as a background for the discussion the functions and objectives of school literacy and the professional training of teachers who would like to be effective literacy agents in the contemporary world.

  5. Contemporary Journal of African Studies

    African Journals Online (AJOL)

    Contemporary Journal of African Studies. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 3, No 1 (2015) >. Log in or Register to get access to full text downloads.

  6. Study of toluene rotary fluid management device and shear flow condenser performance for a space-based organic Rankine power system (United States)

    Havens, Vance; Ragaller, Dana


    Management of two-phase fluid and control of the heat transfer process in microgravity is a technical challenge that must be addressed for an orbital Organic Rankine Cycle (ORC) application. A test program was performed in 1-g that satisfactorily demonstrated the two-phase management capability of the rotating fluid management device (RFMD) and shear-flow condenser. Operational tests of the RFMD and shear flow condenser in adverse gravity orientations, confirmed that the centrifugal forces in the RFMD and the shear forces in the condenser were capable of overcoming gravity forces. In a microgravity environment, these same forces would not have to compete against gravity and would therefore be dominant. The specific test program covered the required operating range of the Space Station Solar Dynamic Rankine Cycle power system. Review of the test data verified that: fluid was pumped from the RFMD in all attitudes; subcooled states in the condenser were achieved; condensate was pushed uphill against gravity; and noncondensible gases were swept through the condenser.

  7. Randomness in Contemporary Graphic Art


    Zavřelová, Veronika


    Veronika Zavřelová Bachelor thesis Charles University in Prague, Faculty of Education, Department of Art Education Randomness in contemporary graphic art imaginative picture card game ANNOTATION This (bachelor) thesis concerns itself with a connection between verbal and visual character system within the topic of Randomness in contemporary graphic art - imaginative picture card game. The thesis is mainly based on the practical part - exclusively created card game Piktim. The card game uses as...

  8. The contemporary role of ablative treatment approaches in the management of renal cell carcinoma (RCC): focus on radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), and cryoablation. (United States)

    Klatte, Tobias; Kroeger, Nils; Zimmermann, Uwe; Burchardt, Martin; Belldegrun, Arie S; Pantuck, Allan J


    Currently, most of renal tumors are small, low grade, with a slow growth rate, a low metastatic potential, and with up to 30 % of these tumors being benign on the final pathology. Moreover, they are often diagnosed in elderly patients with preexisting medical comorbidities in whom the underlying medical conditions may pose a greater risk of death than the small renal mass. Concerns regarding overdiagnosis and overtreatment of patients with indolent small renal tumors have led to an increasing interest in minimally invasive, ablative as an alternative to extirpative interventions for selected patients. To provide an overview about the state of the art in radiofrequency ablation (RFA), high-intensity focused ultrasound, and cryoablation in the clinical management of renal cell carcinoma. A PubMed wide the literature search of was conducted. International consensus panels recommend ablative techniques in patients who are unfit for surgery, who are not considered candidates for or elect against elective surveillance, and who have small renal masses. The most often used techniques are cryoablation and RFA. These ablative techniques offer potentially curative outcomes while conferring several advantages over extirpative surgery, including improved patient procedural tolerance, faster recovery, preservation of renal function, and reduction in the risk of intraoperative and postsurgical complications. While it is likely that outcomes associated with ablative modalities will improve with further advances in technology, their application will expand to more elective indications as longer-term efficacy data become available. Ablative techniques pose a valid treatment option in selected patients.

  9. Knowledge management in R&D centres, in the field of biomedicine, using contemporary information and communication technology and the methodology of continuous improvement

    Directory of Open Access Journals (Sweden)

    Ryszard Depta


    Full Text Available Some sophisticated medical applications, including advanced therapeutics with monoclonal antibodies, stem cells, and gene therapies are currently available in clinical trials. More revolutionary technologies are coming soon and will be marketed by the best technically advanced companies in the world. R&D companies with a much smaller indicator of technological progress and organizational efficiency, but with a great desire to become a major player in this industry, will also compete for a share of this market. However, in order to become a fixture in the changes initiated, both must constantly learn and be more innovative. In the current market situation, a hypercompetitive economy with the entrepreneurs’ focus on the prosumer, creativity is becoming extremely important in achieving final success. Creativity, which is the result of proper knowledge management, especially in science. The market value of R&D companies and their further future depends to a large extent on the prosperity of knowledge transfer. The most important role in the process of knowledge transfer is played by information and communication technologies (ICT and tools for continuous improvement. If companies implement these efficiently and safely, they can develop and benefit from competitive advantages for a very long period of time. Such an approach would give them the possibility of reducing the cost and time to deliver new products to market, and create a new platform to generate innovative products. This is a new perspective for R&D businesses, and a great opportunity for institutions in the biomedical arena to become part of the upcoming bio-revolution.

  10. Contemporary Arctic Sea Level (United States)

    Cazenave, A. A.


    During recent decades, the Arctic region has warmed at a rate about twice the rest of the globe. Sea ice melting is increasing and the Greenland ice sheet is losing mass at an accelerated rate. Arctic warming, decrease in the sea ice cover and fresh water input to the Arctic ocean may eventually impact the Arctic sea level. In this presentation, we review our current knowledge of contemporary Arctic sea level changes. Until the beginning of the 1990s, Arctic sea level variations were essentially deduced from tide gauges located along the Russian and Norwegian coastlines. Since then, high inclination satellite altimetry missions have allowed measuring sea level over a large portion of the Arctic Ocean (up to 80 degree north). Measuring sea level in the Arctic by satellite altimetry is challenging because the presence of sea ice cover limits the full capacity of this technique. However adapted processing of raw altimetric measurements significantly increases the number of valid data, hence the data coverage, from which regional sea level variations can be extracted. Over the altimetry era, positive trend patterns are observed over the Beaufort Gyre and along the east coast of Greenland, while negative trends are reported along the Siberian shelf. On average over the Arctic region covered by satellite altimetry, the rate of sea level rise since 1992 is slightly less than the global mea sea level rate (of about 3 mm per year). On the other hand, the interannual variability is quite significant. Space gravimetry data from the GRACE mission and ocean reanalyses provide information on the mass and steric contributions to sea level, hence on the sea level budget. Budget studies show that regional sea level trends over the Beaufort Gyre and along the eastern coast of Greenland, are essentially due to salinity changes. However, in terms of regional average, the net steric component contributes little to the observed sea level trend. The sea level budget in the Arctic

  11. Rock Fractures and Fluid Flow: Contemporary Understanding and Applications

    National Research Council Canada - National Science Library

    ...--has grown significantly in the past 20 years. This volume presents a comprehensive report on the state of the field, with an interdisciplinary viewpoint, case studies of fracture sites, illustrations, conclusions, and research recommendations...

  12. Scaling Critical Zone analysis tasks from desktop to the cloud utilizing contemporary distributed computing and data management approaches: A case study for project based learning of Cyberinfrastructure concepts (United States)

    Swetnam, T. L.; Pelletier, J. D.; Merchant, N.; Callahan, N.; Lyons, E.


    Earth science is making rapid advances through effective utilization of large-scale data repositories such as aerial LiDAR and access to NSF-funded cyberinfrastructures (e.g. the data portal, iPlant Collaborative, and XSEDE). Scaling analysis tasks that are traditionally developed using desktops, laptops or computing clusters to effectively leverage national and regional scale cyberinfrastructure pose unique challenges and barriers to adoption. To address some of these challenges in Fall 2014 an 'Applied Cyberinfrastructure Concepts' a project-based learning course (ISTA 420/520) at the University of Arizona focused on developing scalable models of 'Effective Energy and Mass Transfer' (EEMT, MJ m-2 yr-1) for use by the NSF Critical Zone Observatories (CZO) project. EEMT is a quantitative measure of the flux of available energy to the critical zone, and its computation involves inputs that have broad applicability (e.g. solar insolation). The course comprised of 25 students with varying level of computational skills and with no prior domain background in the geosciences, collaborated with domain experts to develop the scalable workflow. The original workflow relying on open-source QGIS platform on a laptop was scaled to effectively utilize cloud environments (Openstack), UA Campus HPC systems, iRODS, and other XSEDE and OSG resources. The project utilizes public data, e.g. DEMs produced by and climate data from Daymet, which are processed using GDAL, GRASS and SAGA and the Makeflow and Work-queue task management software packages. Students were placed into collaborative groups to develop the separate aspects of the project. They were allowed to change teams, alter workflows, and design and develop novel code. The students were able to identify all necessary dependencies, recompile source onto the target execution platforms, and demonstrate a functional workflow, which was further improved upon by one of the group leaders over

  13. Nasal Myiasis in Hinduism and Contemporary Otorhinolaryngology. (United States)

    Bosmia, Anand N; Zimmermann, Terence M; Griessenauer, Christoph J; Shane Tubbs, R; Rosenthal, Eben L


    Various case reports on nasal myiasis written during the 1990s and 2000s state that nasal myiasis, which is known as peenash among South Asian natives, is a form of divine punishment in Hindu mythology, but do not provide citations from Hindu scriptures that would suggest this interpretation. This paper aims to discuss the phenomenon of peenash in a historical context by examining medical literature written during the nineteenth and early twentieth centuries, to identify Hindu texts contributing to the belief of some Hindus that nasal myiasis is a form of divine punishment, and to provide an overview of contemporary treatment for and management of nasal myiasis.

  14. Disappearing fluid?

    International Nuclear Information System (INIS)

    Graney, K.; Chu, J.; Lin, P.C.


    Full text: A 78-year old male in end stage renal failure (ESRF) with a background of NIDDM retinopathy, nephropathy, and undergoing continuous ambulatory peritoneal dialysis (CAPD) presented with anorexia, clinically unwell, decreased mobility and right scrotal swelling. There was no difficulty during CAPD exchange except there was a positive fluid balance Peritoneal dialysates remained clear A CAPD peritoneal study was requested. 100Mbq 99mTc Sulphur Colloid was injected into a standard dialysate bag containing dialysate. Anterior dynamic images were acquired over the abdomen pelvis while the dialysate was infused Static images with anatomical markers were performed 20 mins post infusion, before and after patient ambulation and then after drainage. The study demonstrated communication between the peritoneal cavity and the right scrotal sac. Patient underwent right inguinal herniaplasty with a marlex mesh. A repeat CAPD flow study was performed as follow up and no abnormal connection between the peritoneal cavity and the right scrotal sac was demonstrated post operatively. This case study shows that CAPD flow studies can be undertaken as a simple, minimally invasive method to evaluate abnormal peritoneal fluid flow dynamics in patients undergoing CAPD, and have an impact on dialysis management. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  15. Marketing Management

    DEFF Research Database (Denmark)

    Wilke, Ricky


    Book review of: Christian Homburg, Sabine Kuester, Harley Krohmer, Marketing Management – A Contemporary Perspective, McGraw-Hill Higher Education, 2009......Book review of: Christian Homburg, Sabine Kuester, Harley Krohmer, Marketing Management – A Contemporary Perspective, McGraw-Hill Higher Education, 2009...

  16. Contemporary state and possibilities of improvement of local infrastructures for leisure-time physical activity from the aspect of national policy, planning, building, financing and management - the Impala project, part ii.

    Directory of Open Access Journals (Sweden)

    Filip Neuls


    Full Text Available BACKGROUND: The second part of the IMPALA project was based on a wide discussion dealing with the problem of improving the local infrastructure for leisure time physical activity (LTPA from practical and specific points of view that were represented by invited participants from all Czech regions. One of the results of the IMPALA project was the finding from some experts that physical environment mostly in adults contribute to an increase of physical activity. AIM: The main aim of this part of the IMPALA project is to present specifically discussed problems from the area of national policy, planning, building, financing and management of the infrastructure for LTPA. METHODS: A discussion was held during a national workshop that was organized in June 2010 at the Faculty of Physical Culture, Palacký University in Olomouc and had a strictly structured programme that was announced and prepared by the main project coordinator. A discussion took place firstly in small groups according to each section (planning, building, financing, and management toward the assessment of a contemporary state and later on proposals whether some improvements exist. RESULTS: The biggest problem connected with planning is the non-existence of external as well as an internal evaluation of a planning process. In the building area the main problem is the accessibility of infrastructures in small villages; social-spatial aspects are not taken into account and building is also influenced by land ownership. Financing of local infrastructures for LTPA is very diverse, from public sources to private and also in different business models. Existing financial models are secured by law contracts and taken into account by operating costs. Focusing on management of infrastructures differs according to the owner, to financial sources, and to the type of infrastructure. Overemphasizing of top sport means higher allocation of finance mostly into sport infrastructures that are not or

  17. Ultrasound guided aspiration of hydrosalpinx fluid versus salpingectomy in the management of patients with ultrasound visible hydrosalpinx undergoing IVF-ET: a randomized controlled trial. (United States)

    Fouda, Usama M; Sayed, Ahmed M; Abdelmoty, Hatem I; Elsetohy, Khaled A


    The aim of this study was to compare the efficacy of ultrasound guided aspiration of hydrosalpinx fluid at the time of oocyte retrieval with salpingectomy in the management of patients with ultrasound visible hydrosalpinx undergoing IVF-ET. One hundred and sixty patients with ultrasound visible hydrosalpinx were randomized into salpingectomy group and aspiration group using computer generated randomization list and sequentially numbered sealed envelopes containing allocation information written on a card. The clinical pregnancy rate per started cycle and the implantation rate were non- significantly higher in the salpingectomy group compared with the aspiration group [40% vs. 27.5% (p value = 0.132) and 18.95% vs. 12.82% (p value =0.124), respectively]. In the aspiration group, 34.21% of patients had rapid re-accumulation of the hydrosalpinx fluid (i.e. within first two weeks after embryo transfer). Whereas, the clinical pregnancy rate per transfer cycle and the implantation rate were significantly higher in salpingectomy group compared with the subgroup of patients with rapid re-accumulation of hydrosalpinx fluid [42.67% vs. 19.23% (p value = 0.036) and 18.95% vs. 7.58% (p value = 0.032), respectively], no significant differences were detected between the salpingectomy group and the subgroup of patients with no re-accumulation of hydrosalpinx fluid (42.67% vs. 34% (p value = 0.356) and 18.95% vs. 15.5% (p value = 0.457), respectively). The small sample size could be the cause of failure of detecting significant increase in implantation and pregnancy rates in salpingectomy group compared with aspiration group. Further larger randomized controlled trials are needed to determine whether salpingectomy is more effective than aspiration of hydrosalpinx fluid or not. Moreover, the data presented in this study suggested that rapid re-accumulation of hydrosalpinx fluid is an obstacle against successful implantation and the cause of lower success rate

  18. Contemporary Management of Acute Biliary Pancreatitis

    Directory of Open Access Journals (Sweden)

    Orhan Ozkan


    Full Text Available Acute biliary pancreatitis is one of the major causes of acute pancreatitis.Gallstones, biliary sludge and microlithiasis, especially in pancreatitis without detectable reason, can be the cause of acute pancreatitis. Acute biliary pancreatitis has many controversions in the literature, and its classification and guidelines are being updated very frequently. Atlanta classifications which determine the definitions and guidelines about acute pancreatitis were renewed and published in 2013. It has various clinical aspects, ranging from a mild form which is easily treated, to a severe form that causes complications leading to mortality. The pathogenesis of this disease has not been fully elucidated and several theories have been suggested. New scoring systems and laboratory methods such as proteomics have been suggested for both diagnosis and to predict disease severity, and research on these topics is still in progress. Novel therapeutic approaches with technological developments such as ERCP, ES, MRCP, and EUS are also suggested.

  19. Premenstrual Dysphoric Disorder: Contemporary Diagnosis and Management. (United States)

    Reid, Robert L; Soares, Claudio N


    Most ovulatory women experience premenstrual symptoms (premenstrual syndrome, molimina) which indicate impending menstruation and are of little clinical relevance because they do not affect quality of life. A few women, however, experience significant physical and/or psychological symptoms before menstruation that, if left untreated, would result in deterioration in functioning and relationships. The precise etiology remains elusive, although new theories are gaining support in pre-clinical and early clinical trials. Refined diagnostic criteria allow better discrimination of this condition from other psychiatric diagnoses and the selection of symptom appropriate therapies that afford relief for most women. Pharmacotherapies (particularly selective serotonin reuptake inhibitors and SNRIs) represent the first-line treatment for premenstrual dysphoric disorder and severe, mood-related premenstrual syndrome. Continuous combined oral contraceptives have limited evidence for usefulness in premenstrual dysphoric disorder, whereas medical ovarian suppression is often recommended for patients who fail to respond or cannot tolerate first-line treatments (e.g., selective serotonin reuptake inhibitors). The use of cognitive behavioural therapies is promising, but it remains limited by sparse data and restricted access to trained professionals. A proper diagnosis (particularly the distinction from other underlying psychiatric conditions) is crucial for the implementation of effective therapy and alleviation of this impairing condition. Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

  20. Policy and Management Issues in Contemporary Nigerian ...

    African Journals Online (AJOL)

    AFRREV IJAH: An International Journal of Arts and Humanities. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 2, No 4 (2013) >. Log in or Register to get access to full text downloads.

  1. Contemporary Management of Adult Acquired Buried Penis. (United States)

    Jun, M S; Gallegos, M A; Santucci, R A


    In 2014, The World Health Organization reported that 1.9 billion adults, 39% of the population, were overweight or obese [1]. Unlike most complications of obesity, adult acquired buried penis is an uncomfortable topic which may be overlooked. Patients are often encouraged to lose weight, but this is futile. Simple weight loss will not cure buried penis, as it is a multifactorial condition caused by a combination of: a) overhanging escutcheon from overweight, b) lichen sclerosus, which often contracts and destroys the penile shaft skin, and c) loss of normal penile shaft attachments to the penile skin. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  2. Contemporary management of acute kidney trauma

    Directory of Open Access Journals (Sweden)

    Inês Anselmo da Costa


    Full Text Available Renal injury occurs in 1%–5% of all traumas, causing disability or even death. The American Association for the Surgery of Trauma (AAST renal injury scale should be used when injuries are reported. Although there is a consensus regarding handling of lower-grade injuries conservatively, the same cannot be said for the higher-grades, for which different specialists handle either conservatively or surgically. A search of the MEDLINE database was undertaken by using the following filters: English language articles, full-text availability, last five years, humans. Pediatric studies were excluded. For most renal injuries in hemodynamically stable, patients can be safely handled conservatively. An organized assessment and treatment system can reduce the need for nephrectomy in most other cases, as has occurred in the last two decades. The AAST injury scale should be updated in light of the advancements in imaging techniques, in order to fine tune grading and treatment.

  3. Contemporary Management of Idiopathic Laryngotracheal Stenosis. (United States)

    Donahoe, Laura; Keshavjee, Shaf


    Idiopathic laryngotracheal stenosis is a rare but well-described indication for subglottic tracheal resection. Initially described by Pearson in 1975, the 1-stage subglottic tracheal resection with reconstruction of the airway ensures preservation of the recurrent laryngeal nerves while resulting in an effective and durable repair of the stenosis. Copyright © 2018 Elsevier Inc. All rights reserved.

  4. Contemporary Management of Fibroids in Pregnancy (United States)

    Lee, Hee Joong; Norwitz, Errol R; Shaw, Julia


    Uterine fibroids are a very common finding in women of reproductive age. The majority of fibroids do not change their size during pregnancy, but one-third may grow in the first trimester. Although the data are conflicting and most women with fibroids have uneventful pregnancies, the weight of evidence in the literature suggests that uterine fibroids are associated with an increased rate of spontaneous miscarriage, preterm labor, placenta abruption, malpresentation, labor dystocia, cesarean delivery, and postpartum hemorrhage. PMID:20508779

  5. Contemporary management and classification of hepatic leiomyosarcoma (United States)

    Hamed, Mazin O; Roberts, Keith J; Merchant, William; Lodge, J Peter A


    Background Hepatic leiomyosarcomas are rare soft-tissue tumours. The majority of lesions previously considered as leiomyosarcomas have been identified as gastrointestinal stromal tumours (GISTs). Consequently, understanding of the role of liver resection for true leiomyosarcoma is limited, a fact that is exacerbated by the increasing recognition of leiomyosarcoma subtypes. This study presents data on the outcomes of liver resection for leiomyosarcoma and suggests an algorithm for its pathological assessment and treatment. Methods Patients were identified from a prospectively collected departmental database. All tumours were negative for c-kit expression. Immunohistochemistry was performed to identify the presence of oestrogen or progesterone receptor (OR/PR) expression or Epstein–Barr virus (EBV) and patients were stratified according to this profile. Results Eight patients (of whom seven were female) underwent a total of 11 liver resections over a 12-year period. One patient had a primary hepatic leiomyosarcoma. Of those with metastatic leiomyosarcomas, the primary tumours were located in the mesentery, gynaecological organs and retroperitoneum in four, two and one patient, respectively. Both leiomyosarcomas of gynaecological origin stained positive for OR/PR expression. One patient had previously undergone renal transplantation; this leiomyosarcoma was associated with EBV expression. Median survival was 56 months (range: 22–132 months) and eight, six and four patients remained alive at 1, 3 and 5 years, respectively. Conclusions Hepatic resection for leiomyosarcoma is associated with encouraging rates of 5-year overall and disease-free survival. The worse outcome that had been expected based on data derived from historical cohorts (partly comprising subjects with GIST) was not observed. An algorithm for pathological classification and treatment is suggested. PMID:25418451

  6. Stability of nano-fluids and their use for thermal management of a microprocessor: an experimental and numerical study (United States)

    Shoukat, Ahmad Adnan; Shaban, Muhammad; Israr, Asif; Shah, Owaisur Rahman; Khan, Muhammad Zubair; Anwar, Muhammad


    We investigate the heat transfer effect of different types of Nano-fluids on the pin fin heat sinks used in computer's microprocessor. Nano-particles of Aluminum oxide have been used with volumetric concentrations of 0.002% and Silver oxide with volumetric concentrations of 0.001% in the base fluid of deionized water. We have also used Aluminum oxide with ethylene glycol at volumetric concentrations of 0.002%. We report the cooling rates of Nano-fluids for pin-fin heat to cool the microprocessor and compare these with the cooling rate of pure water. We use a microprocessor heat generator in this investigation. The base temperature is obtained using surface heater of power 130 W. The main purpose of this work is to minimize the base temperature, and increase the heat transfer rate of the water block and radiator. The temperature of the heat sink is maintained at 110 °C which is nearly equal to the observed computer microprocessor temperature. We also provide the base temperature at different Reynolds's number using the above mention Nano-fluids with different volumetric concentrations.

  7. Fluid Mechanics. (United States)

    Drazin, Philip


    Outlines the contents of Volume II of "Principia" by Sir Isaac Newton. Reviews the contributions of subsequent scientists to the physics of fluid dynamics. Discusses the treatment of fluid mechanics in physics curricula. Highlights a few of the problems of modern research in fluid dynamics. Shows that problems still remain. (CW)

  8. Metodología contemporánea de Infraestructuras de Gestión de Proyectos, Prevención de controversias y Análisis de Retrasos = Contemporary Methodology for Infrastructure Project Management, Dispute Avoidance and Delay

    Directory of Open Access Journals (Sweden)

    Yiannis Vacanas


    Full Text Available Las causas de las interrupciones y retrasos en los proyectos de construcción de infraestructura son conocidos pero inevitables, y los métodos actuales de análisis son caros. En este trabajo se propone una metodología moderna para el mantenimiento de registros eficiente y transparente, y para la gestión eficaz de los proyectos y resolución de disputas más barato. Herramientas tecnológicas modernas (imágenes UAV, escaneo láser 3D, tecnologías BIM, visualización 3D, tecnología GNSS y RFID se utilizan para proporcionar información útil e importante a un servidor de Sistema de Información Geográfica (GIS central, que a su vez proporciona informes relacionados con las obras del proyecto. Abstract The causes of disruption and delay to infrastructure construction projects are known but inevitable, and the current methods for delay analysis and dispute resolution are expensive and faced with suspiciousness. In this paper a contemporary methodology is proposed for efficient and transparent record keeping and sharing for effective project management, delay and dispute avoidance and cheaper dispute resolution. Modern technology tools (UAV images, Long-range 3D Laser scanning and BIM technologies can be used for data collection and 3D visual illustration of the milestone works progress; Time lapse camera images can provide visualisation of the daily progress of the works and indication of the conditions and presence of resources in any day; GNSS - Mobile technology can be used to pattern the machinery and human resources presence and motion on site; High resolution satellite images can give periodic images for the general progress of the works, RFID technology can be used for machinery and human resources monitoring and material quantities tracking and management are utilized to provide important and useful information, both spatial and descriptive, to a Geographical Information System (GIS central server, which in turn provides reports

  9. Contemporary pharmacological obesity treatments

    Directory of Open Access Journals (Sweden)

    Kaszubska Katarzyna


    Full Text Available In the last few years, obesity has become a global epidemic. Consequently, worldwide costs associated with managing obesity and obesity-related comorbidities are huge. Numerous studies have focused on discerning the appropriate proper treatment of weight related problems such as overweight and obesity. Moreover, many clinical trials have been conducted for many years in order to introduce effective anti-obesity drugs. The aim of the present review is to provide an overview of current and future pharmacotherapy for obesity, and to provide the reader with a determination of the concentration and composition of long and short term anti-obesity drugs, doing so by placing emphasis on pharmacotherapy and up-to-day solutions. It should be noted that, currently, the worldwide pharmacotherapy is represented by phendimetrazine, benzphetamine and diethylpropion, as well as by orlistat, lorcaserin, phentermine/topiramate, naltrexone/bupropion and liraglutide. In our paper, individual cases of patients’ needs are thoroughly illustrated by way of examples. Medical prescriptions and contraindications are also described.

  10. Contemporary Theories and International Lawmaking

    NARCIS (Netherlands)

    Venzke, I.; Brölmann, C.; Radi, Y.


    Many contemporary theories approach international law-making with a shift in emphasis from the sources of law towards the communicative practices in which a plethora of actors use, claim and speak international law. The contribution proceeds by sketching the move from sources to communicative

  11. Woman's Quest in Contemporary Fiction. (United States)

    Semeiks, Jonna Gormely

    Depending primarily on Joseph Campbell's treatment of the quest or hero myth, this paper provides analyses of recent women's fiction in terms of contemporary women's quests for personal identity and freedom. Following discussions of a proposed definition of myth, its connotations, and its use as a literary device and as a tool for critical…

  12. Contemporary Argentine Cinema during Neoliberalism (United States)

    Rocha, Carolina


    In this article I analyze contemporary Argentine cinematic production assessing the impact of Law 24,377 that was implemented in 1995 and that provided much-needed funds for national productions. By looking at film production and consumption, the emergence of young filmmakers and the performance of both commercial films and those belonging to the…

  13. Contemporary Cambodian: The Social Institutions. (United States)

    Kheang, Lim Hack; And Others

    "Contemporary Cambodian" consists of seven parts: the "Grammatical Sketch," the "Introduction," four intermediate modules, and a Cambodian-English glossary containing all the words in the series. After completing the "Introduction," a student can study the intermediate modules in any order, since each serves as a partial review of the others. This…

  14. Are there any benefits from minimizing fasting and optimization of nutrition and fluid management for patients undergoing day surgery? (United States)

    Nygren, Jonas; Thorell, Anders; Ljungqvist, Olle


    As a result of advances in anaesthesia and surgery, an increasing number of surgical procedures are currently possible in the ambulatory setting. Nausea/vomiting and sedation/drowsiness are often associated with delayed discharge and readmission. These symptoms are also related to pharmacological treatment as well as dehydration and fasting. The evidence that preoperative fasting and dehydration not only reduces preoperative well being, but may also affect postoperative recovery is currently being reviewed. In association with minor surgical procedures, rehydration with approximately 1 l fluid, and in cases with a moderate degree of surgery, such as laparoscopic surgery, 1-3 l fluid, given perioperatively will improve postoperative well being and recovery. Administration of a carbohydrate-rich beverage not only provides fluid but also counteracts the negative effects of preoperative fasting, which in turn reduces preoperative hunger and improves well being. Postoperatively, this treatment reduces insulin resistance, which may be relevant in surgery with significant postoperative stress response. Two studies on laparoscopic cholecystectomy demonstrate different results regarding effects on postoperative outcome and nausea/vomiting and further evaluation is required. When preoperative dehydration is corrected, postoperative well being and clinical outcome improves. Avoiding preoperative fasting by administration of carbohydrate-rich beverages improves preoperative well being while effects on postoperative recovery in patients undergoing ambulatory surgery need to be further evaluated.

  15. Fluids engineering

    International Nuclear Information System (INIS)



    Fluids engineering has played an important role in many applications, from ancient flood control to the design of high-speed compact turbomachinery. New applications of fluids engineering, such as in high-technology materials processing, biotechnology, and advanced combustion systems, have kept up unwaining interest in the subject. More accurate and sophisticated computational and measurement techniques are also constantly being developed and refined. On a more fundamental level, nonlinear dynamics and chaotic behavior of fluid flow are no longer an intellectual curiosity and fluid engineers are increasingly interested in finding practical applications for these emerging sciences. Applications of fluid technology to new areas, as well as the need to improve the design and to enhance the flexibility and reliability of flow-related machines and devices will continue to spur interest in fluids engineering. The objectives of the present seminar were: to exchange current information on arts, science, and technology of fluids engineering; to promote scientific cooperation between the fluids engineering communities of both nations, and to provide an opportunity for the participants and their colleagues to explore possible joint research programs in topics of high priority and mutual interest to both countries. The Seminar provided an excellent forum for reviewing the current state and future needs of fluids engineering for the two nations. With the Seminar ear-marking the first formal scientific exchange between Korea and the United States in the area of fluids engineering, the scope was deliberately left broad and general

  16. Microgravity Fluids for Biology, Workshop (United States)

    Griffin, DeVon; Kohl, Fred; Massa, Gioia D.; Motil, Brian; Parsons-Wingerter, Patricia; Quincy, Charles; Sato, Kevin; Singh, Bhim; Smith, Jeffrey D.; Wheeler, Raymond M.


    Microgravity Fluids for Biology represents an intersection of biology and fluid physics that present exciting research challenges to the Space Life and Physical Sciences Division. Solving and managing the transport processes and fluid mechanics in physiological and biological systems and processes are essential for future space exploration and colonization of space by humans. Adequate understanding of the underlying fluid physics and transport mechanisms will provide new, necessary insights and technologies for analyzing and designing biological systems critical to NASAs mission. To enable this mission, the fluid physics discipline needs to work to enhance the understanding of the influence of gravity on the scales and types of fluids (i.e., non-Newtonian) important to biology and life sciences. In turn, biomimetic, bio-inspired and synthetic biology applications based on physiology and biology can enrich the fluid mechanics and transport phenomena capabilities of the microgravity fluid physics community.

  17. Research on new information service model of the contemporary library

    International Nuclear Information System (INIS)

    Xin Pingping; Lu Yan


    According to the development of the internet and multimedia technology, the information service models in the contemporary library become both of the traditional and digital information service. The libraries in each country do their best to make the voluminous information and the complex technology be High-integrated in the background management, and also make the front interface be more and more convenient to the users. The essential characteristics of the information service of the contemporary library are all-in-one and humanness. In this article, we will describe several new hot information service models of the contemporary library in detail, such as individualized service, reference service, reference service and strategic information service. (authors)

  18. Reconceptualising manual therapy skills in contemporary practice. (United States)

    Rabey, Martin; Hall, Toby; Hebron, Clair; Palsson, Thorvaldur Skuli; Christensen, Steffan Wittrup; Moloney, Niamh


    With conflicting evidence regarding the effectiveness of manual therapy calls have arisen within some quarters of the physiotherapy profession challenging the continued use of manual skills for assessment and treatment. A reconceptualisation of the importance of manual examination findings is put forward, based upon a contemporary understanding of pain science, rather than considering these skills only in terms of how they should "guide" manual therapy interventions. The place for manual examination findings within complex, multidimensional presentations is considered using vignettes describing the presentations of five people with low back pain. As part of multidimensional, individualised management, the balance of evidence relating to the effectiveness, mechanisms of action and rationale for manual skills is discussed. It is concluded that if manual examination and therapeutic skills are used in a manner consistent with a contemporary understanding of pain science, multidimensional patient profiles and a person-centred approach, their selective and judicious use still has an important role. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. The Contemporary Carbon Cycle (United States)

    Houghton, R. A.


    C). Additions of greenhouse gases to the atmosphere from industrial activity, however, are increasing the concentrations of these gases, enhancing the greenhouse effect, and starting to warm the Earth.The rate and extent of the warming depend, in part, on the global carbon cycle. If the rate at which the oceans remove CO2 from the atmosphere were faster, e.g., concentrations of CO2 would have increased less over the last century. If the processes removing carbon from the atmosphere and storing it on land were to diminish, concentrations of CO2 would increase more rapidly than projected on the basis of recent history. The processes responsible for adding carbon to, and withdrawing it from, the atmosphere are not well enough understood to predict future levels of CO2 with great accuracy. These processes are a part of the global carbon cycle.Some of the processes that add carbon to the atmosphere or remove it, such as the combustion of fossil fuels and the establishment of tree plantations, are under direct human control. Others, such as the accumulation of carbon in the oceans or on land as a result of changes in global climate (i.e., feedbacks between the global carbon cycle and climate), are not under direct human control except through controlling rates of greenhouse gas emissions and, hence, climatic change. Because CO2 has been more important than all of the other greenhouse gases under human control, combined, and is expected to continue so in the future, understanding the global carbon cycle is a vital part of managing global climate.This chapter addresses, first, the reservoirs and natural flows of carbon on the earth. It then addresses the sources of carbon to the atmosphere from human uses of land and energy and the sinks of carbon on land and in the oceans that have kept the atmospheric accumulation of CO2 lower than it would otherwise have been. The chapter describes changes in the distribution of carbon among the atmosphere, oceans, and terrestrial ecosystems over

  20. Buffer fluid

    Energy Technology Data Exchange (ETDEWEB)

    Mirzadzhanzade, A Kh; Dedusanko, G Ya; Dinaburg, L S; Markov, Yu M; Rasizade, Ya N; Rozov, V N; Sherstnev, N M


    A drilling fluid is suggested for separating the drilling and plugging fluids which contains as the base increased solution of polyacrylamide and additive. In order to increase the viscoelastic properties of the liquid with simultaneous decrease in the periods of its fabrication, the solution contains as an additive dry bentonite clay. In cases of the use of a buffer fluid under conditions of negative temperatures, it is necessary to add to it table salt or ethylene glycol.

  1. The dream in contemporary psychiatry. (United States)

    Reiser, M F


    This article offers selective reviews of cogent sectors of research regarding the dream in contemporary psychiatry. First, the author discusses relatively recent research (1953-1999) on the neurobiology and clinical psychophysiology of dreaming sleep; second, he reviews experimental cognitive neuroscientific studies of perception, emotion, and memory and the putative interrelationships among them in generating dream imagery; and third, he interprets psychoanalytic studies (1900-1999) on related aspects of dreams and the dream process. Exploration for interrelationships among information from these three areas entails discussion of the mind/brain problem. These considerations illuminate some of the logical and interpretive dilemmas that enter into debates about Freud's theory of the dream. The author proposes a preliminary psychobiologic concept of the dream process and discusses, in light of the foregoing considerations, the importance of collaborative research for developing a realistic perspective concerning the proper place of the dream in contemporary psychiatry.

  2. [Ethical dilemmas of contemporary psychiatry]. (United States)

    Filaković, Pavo; Pozgain, Ivan


    Ethics in the contemporary psychiatry, as well as in medicine in general, is based on the two core ethical traditions: deontological and theological. Good ethical decision takes into the consideration both traditions, and is preceded with ethical dilemmas to provide the best possible care to the patients in that moment. In the article are presented most recent research results of the literature about ethical dilemmas in psychiatry. Ethical dilemmas in everyday practice as well as compliance with the patients, psychiatric consultations, informed consent, treatment of personality disorders, pharmacological investigations, forensic psychiatry, forced hospitalisation, promotion of mental health, and dealing with the stigma of the mental diseases are showed in the article. The authors emphasize the necessity of constant questioning of ethical dilemmas in the contemporary psychiatry, because of the special status of psychiatry as a potentially risky field in practice, and because of intensive pharmacological investigations in psychiatric patients.

  3. Authenticity and its Contemporary Challenges

    DEFF Research Database (Denmark)

    Bork Petersen, Franziska


    In this thesis I investigate what ‘authenticity’ means in a contemporary popular context and how it is used in the staging of bodies. Furthermore, I analyse works of dance and fashion from the past fifteen years with a focus on their strategies of challenging the notion of ‘bodily authenticity...... self’. I scrutinise the staging techniques and the codes of appearance that bodies have to comply with in order to be deemed ‘authentic’ on the shows. To define them and place them in the history of the idea of ‘bodily authenticity’, I complement my study with an outline of how ‘authenticity...... and by a depiction of 'working hard'. But various techniques also mask the hard work, for example by showing a participant ‘having fun’ performing it. Contemporary works of dance and fashion challenge the problematic implications in the notion of ‘bodily authenticity’. I analyse three strategies of undermining...


    Directory of Open Access Journals (Sweden)



    Full Text Available The article deals with instances of the supernatural in Romanian urban legends, namely what we call the strigoi , or poltergeist. Usually, folklorists tend to exclude the supernatural f rom the category of urban legends, however we have decided to take these accounts into consideration based on the fact that the transmitter, the narrators do not distinguish between these elements and the rest of contemporary legends and today’s popular cu lture abounds in such accounts.





    The article deals with instances of the supernatural in Romanian urban legends, namely what we call the strigoi , or poltergeist. Usually, folklorists tend to exclude the supernatural f rom the category of urban legends, however we have decided to take these accounts into consideration based on the fact that the transmitter, the narrators do not distinguish between these elements and the rest of contemporary legends and today’s popular cu lture abounds in such accounts.

  6. Islamic factor in contemporary Russia


    N. M. Shalenna


    Russian Federation, a Eurasian multinational state, has a significant number of indigenous Muslim population (about 10%) that continues to increase not only due to natural growth and conversion of non-Muslims to Islam, but also as a result of intensive immigration from the Central Asian countries and Azerbaijan. Islamic factor significantly predetermined policy of Russia during its historical development. The importance of Islam in contemporary political life has been underlined by many gover...


    Directory of Open Access Journals (Sweden)



    Full Text Available The proposed scientific theme is going to approach and study the hooliganism phenomenon as a contemporary social matter, in terms of conceptual and etiological. The present work has four main purposes: (1- that of explaining the meaning of hooliganism social phenomenon; (2- that of discovering the origins of hooliganism; (3- that of knowing which are the causes that encourages the occurence of the hooliganism; (4- that of knowing how to control and minimize this phenomenon.

  8. Beyond profession: nursing leadership in contemporary healthcare. (United States)

    Sorensen, Roslyn; Iedema, Rick; Severinsson, Elisabeth


    To examine nursing leadership in contemporary health care and its potential contribution to health service organization and management. As the nursing profession repositions itself as an equal partner in health care beside medicine and management, its enhanced nursing standards and clinical knowledge are not leading to a commensurate extension of nursing's power and authority in the organization. An ethnographic study of an ICU in Sydney, Australia, comprising: interviews with unit nursing managers (4); focus groups (3) with less experienced, intermediate and experienced nurses (29 in total); and interviews with senior nurse manager (1). Inter- and intra-professional barriers in the workplace, fragmentation of multidisciplinary clinical systems that collectively deliver care, and clinical and administrative disconnection in resolving organizational problems, prevented nurses articulating a model of intensive and end-of-life care. Professional advocacy skills are needed to overcome barriers and to articulate and operationalize new nursing knowledge and standards if nurses are to enact and embed a leadership role. The profession will need to move beyond a reliance on professional clinical models to become skilled multidisciplinary team members and professional advocates for nurses to take their place as equal partners in health care.

  9. Contemporary Conceptual Approaches in Fluvial Geomorphology

    Directory of Open Access Journals (Sweden)

    Mônica dos Santos Marçal


    Full Text Available Contemporary fluvial geomorphology faces challenging questions, especially as it goes by understanding the Late Holocene/Anthropocene period, which has repercussions today and are intrinsically important to understand the human river disturbance. Given the scale that physical rates operate in complex river systems, two conceptual paths were developed to analyze the spatial and temporal organization. The network view emphasizes controls on catchment-scale and a reach approach focuses on discontinuity and local controls. Fluvial geomorphology has seek to understand the organization of complex river systems from the integrated view of the continuity and discontinuity paradigm. This integrated approach has stimulated within the geomorphology, the emergence of new theoretical-methodological instruments. It is recognized that rivers management is an ongoing process, part of the socio-cultural development, which refers to both a social movement and scientific exercise.

  10. Trade Intelligence and Contemporary Exports Strategy

    Directory of Open Access Journals (Sweden)

    M. Tayfun Gülle


    Full Text Available The book mainly focuses on the divergences in the competitive environment resulting from the entrance of information and communications technologies into commercial life. Denoting that these divergences are rooted, above all, in the differences among countries in historical, social and geographic terms, the book claims that the increased use of trade information combined with these divergences will facilitate obtaining results in trade and that the synergy to emerge will pave the way for trade intelligence. The book also underlines that such trade intelligence, which is actually the natural commercial manner of Turkish entrepreneurs, could be accepted as the Turkish Style in international trade, with the rational management of the export process, and that this would ferment the national competition intelligence, as the strategy of contemporary exports.

  11. The Role of Interdisciplinary Earth Science in the Assessment of Regional Land Subsidence Hazards: Toward Sustainable Management of Global Land and Subsurface-Fluid Resources (United States)

    Galloway, D. L.


    Land-level lowering or land subsidence is a consequence of many local- and regional-scale physical, chemical or biologic processes affecting soils and geologic materials. The principal processes can be natural or anthropogenic, and include consolidation or compaction, karst or pseudokarst, hydrocompaction of collapsible soils, mining, oxidation of organic soils, erosive piping, tectonism, and volcanism. In terms of affected area, there are two principal regional-scale anthropogenic processes—compaction of compressible subsurface materials owing to the extraction of subsurface fluids (principally groundwater, oil and gas) and oxidation and compaction accompanying drainage of organic soils—which cause significant hazards related to flooding and infrastructure damage that are amenable to resource management measures. The importance of even small magnitude (analysis techniques, such as Global Positioning System (GPS), Light Detection and Ranging (LiDAR) and Interferometric Synthetic Aperture Radar (InSAR), which have advanced our capabilities to detect, measure and monitor land-surface motion at multiple scales. Improved means for simulating aquifer-system and hydrocarbon-reservoir deformation, and the oxidation and compaction of organic soils are leading to refined predictive capabilities. The role of interdisciplinary earth science in improving the characterization of land subsidence attributed to subsurface fluid withdrawals and the oxidation and compaction of organic soils is examined. How these improved capabilities are translating into improved sustainable management of regional land and water resources in a few select areas worldwide are presented. The importance of incorporating these improved capabilities in coherent resource management strategies to control the depletion of resources and attendant hazards also are discussed.

  12. Schroedinger fluid

    International Nuclear Information System (INIS)

    Kan, K.K.


    The relationship of nuclear internal flow and collective inertia, the difference of this flow from that of a classical fluid, and the approach of this flow to rigid flow in independent-particle model rotation are elucidated by reviewing the theory of Schroedinger fluid and its implications for collective vibration and rotation. (author)

  13. Intention to comply with post-exposure management among nurses exposed to blood and body fluids in Taiwan: application of the theory of planned behaviour. (United States)

    Ko, N-Y; Yeh, S-H; Tsay, S-L; Ma, H-J; Chen, C-H; Pan, S-M; Feng, M-C; Chiang, M-C; Lee, Y-W; Chang, L-H; Jang, J-F


    Nurses are at significant risk from occupationally acquired bloodborne virus infections following a needlestick and sharps injury. This study aimed to apply the theory of planned behaviour (TPB) to predict nurses' intention to comply with occupational post-exposure management. A cross-sectional survey was applied to select registered nurses who worked in human immunodeficiency virus (HIV)-designated hospitals. An anonymous, self-administered questionnaire based on the TPB was distributed to 1630 nurses and 1134 (69.5%) questionnaires were returned. From these, a total of 802 nurses (71%) reported blood and body fluid exposure incidents during 2003-2005 and this group was used for analysis. Only 44.6% of the 121 exposed nurses who were prescribed post-exposure prophylaxis (PEP) by infectious disease doctors returned to the clinic for interim monitoring, and only 56.6% of exposed nurses confirmed their final serology status. Structural equation modelling was used to test the TPB indicating perceived behavioural control (the perception of the difficulty or ease of PEP management, β=0.58), subjective norm (the perception of social pressure to adhere to PEP, β=0.15), and attitudes (β=0.12) were significant direct effects on nurses' intention to comply with post-exposure management. The hypothesised model test indicated that the model fitted with the expected relationships and directions of theoretical constructs [χ(2) (14, N=802)=23.14, P=0.057, GFI=0.987, RMSEA=0.039]. The TPB model constructs accounted for 54% of the variance in nurses' intention to comply with post-exposure management. The TPB is an appropriate model for predicting nurses' intention to comply with post-exposure management. Healthcare facilities should have policies to decrease the inconvenience of follow-up to encourage nurses to comply with post-exposure management. Copyright © 2010 the Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  14. A randomized controlled trial of long term effect of BCM guided fluid management in MHD patients (BOCOMO study: rationales and study design

    Directory of Open Access Journals (Sweden)

    Liu Li


    Full Text Available Abstract Background Bioimpedance analysis (BIA has been reported as helpful in identifying hypervolemia. Observation data showed that hypervolemic maintenance hemodialysis (MHD patients identified using BIA methods have higher mortality risk. However, it is not known if BIA-guided fluid management can improve MHD patients’ survival. The objectives of the BOCOMO study are to evaluate the outcome of BIA guided fluid management compared with standard care. Methods This is a multicenter, prospective, randomized, controlled trial. More than 1300 participants from 16 clinical sites will be included in the study. The enrolment period will last 6 months, and minimum length of follow-up will be 36 months. MHD patients aged between 18 years and 80 years who have been on MHD for at least 3 months and meet eligibility criteria will be invited to participate in the study. Participants will be randomized to BIA arm or control arm in a 1:1 ratio. A portable whole body bioimpedance spectroscopy device (BCM—Fresenius Medical Care D GmbH will be used for BIA measurement at baseline for both arms of the study. In the BIA arm, additional BCM measurements will be performed every 2 months. The primary intent-to-treat analysis will compare outcomes for a composite endpoint of death, acute myocardial infarction, stroke or incident peripheral arterial occlusive disease between groups. Secondary endpoints will include left ventricular wall thickness, blood pressure, medications, and incidence and length of hospitalization. Discussions Previous results regarding the benefit of strict fluid control are conflicting due to small sample sizes and unstable dry weight estimating methods. To our knowledge this is the first large-scale, multicentre, prospective, randomized controlled trial to assess whether BIS-guided volume management improves outcomes of MHD patients. The endpoints of the BOCOMO study are of utmost importance to health care providers. In order to obtain

  15. A highly self-adaptive cold plate for the single-phase mechanically pumped fluid loop for spacecraft thermal management

    International Nuclear Information System (INIS)

    Wang, Ji-Xiang; Li, Yun-Ze; Zhang, Hong-Sheng; Wang, Sheng-Nan; Liang, Yi-Hao; Guo, Wei; Liu, Yang; Tian, Shao-Ping


    Highlights: • A highly self-adaptive cold plate integrated with paraffin-based actuator is proposed. • Higher operating economy is attained due to an energy-efficient strategy. • A greater compatibility of the current space control system is obtained. • Model was entrenched theoretically to design the system efficiently. • A strong self-adaptability of the cold plate is observed experimentally. - Abstract: Aiming to improve the conventional single-phase mechanically pumped fluid loop applied in spacecraft thermal control system, a novel actively-pumped loop using distributed thermal control strategy was proposed. The flow control system for each branch consists primarily of a thermal control valve integrated with a paraffin-based actuator residing in the front part of each corresponding cold plate, where both coolant’s flow rate and the cold plate’s heat removal capability are well controlled sensitively according to the heat loaded upon the cold plate due to a conversion between thermal and mechanical energies. The operating economy enhances remarkably owing to no energy consumption in flow control process. Additionally, realizing the integration of the sensor, controller and actuator systems, it simplifies structure of the traditional mechanically pumped fluid loop as well. Revolving this novel scheme, mathematical model regarding design process of the highly specialized cold plate was entrenched theoretically. A validating system as a prototype was established on the basis of the design method and the scheduled objective of the controlled temperature (43 °C). Then temperature control performances of the highly self-adaptive cold plate under various operating conditions were tested experimentally. During almost all experiments, the controlled temperature remains within a range of ±2 °C around the set-point. Conclusions can be drawn that this self-driven control system is stable with sufficient fast transient responses and sufficient small steady

  16. Fluid Sounds

    DEFF Research Database (Denmark)

    Explorations and analysis of soundscapes have, since Canadian R. Murray Schafer's work during the early 1970's, developed into various established research - and artistic disciplines. The interest in sonic environments is today present within a broad range of contemporary art projects and in arch......Explorations and analysis of soundscapes have, since Canadian R. Murray Schafer's work during the early 1970's, developed into various established research - and artistic disciplines. The interest in sonic environments is today present within a broad range of contemporary art projects...... and in architectural design. Aesthetics, psychoacoustics, perception, and cognition are all present in this expanding field embracing such categories as soundscape composition, sound art, sonic art, sound design, sound studies and auditory culture. Of greatest significance to the overall field is the investigation...

  17. Modern trends in contemporary chemistry

    International Nuclear Information System (INIS)

    Javed, H.; Pervez, H.; Qadeer, R.


    This publication contains a collection of papers presented at symposium on M odern Trends in Contemporary Chemistry , that was held in Islamabad, Pakistan, March 6-8, 1990. The symposium was divided into five sections for presentation of about 55 scientific and technical papers and 6 review papers. The contents of these papers were of good quality in the widespread concern in new trends of chemistry. The six reviews papers covered fields of ortho metallation reactions, evaluation of heterogeneous electron transfer rate contents, macro reticular ion-exchange resins, spectrochemical analytical techniques, liquid crystal-high technology materials for practical applications and trends in advanced ceramics. (A.B.)

  18. Contemporary Culture and Aesthetic Education

    DEFF Research Database (Denmark)

    Friberg, Carsten


    relation to a specific cultural context, and our acquisition of it comes from being acquainted with cultural products. Aesthetics is thus closely related to hermeneutics, to how we interpret specific situations we find ourselves in. Key words: education, sensorial, judgement, hermeneutics, Kant...... century, a focus we on aesthetic education and communication. Important were arts and letters which still are important but very much on the defensive in our contemporary culture also because aesthetics often is a debate about criticism rather than about the sensorial and bodily aspect of cultural...

  19. Contemporary challenges for intrafamilial relations

    Directory of Open Access Journals (Sweden)

    M. GOTEA


    Full Text Available Nowadays we live in a time of rapid changes, from a social, industrial and technological standpoint. Profound mutations in family institution can be observed, regarding the family structure, lifestyle and the cycle of family life. Today’s tendencies reflect a clear distinction between marriage and the activity of raising children, as we can notice the increased number of marriages without children or the number of single-parent families. That is why, the present paper focus on these two types of intrafamily relationships: couple’s relationship and parent-child relation, pointing out some changes and challenges of contemporary period.

  20. On Detailing in Contemporary Architecture

    DEFF Research Database (Denmark)

    Kristensen, Claus; Kirkegaard, Poul Henning


    Details in architecture have a significant influence on how architecture is experienced. One can touch the materials and analyse the detailing - thus details give valuable information about the architectural scheme as a whole. The absence of perceptual stimulation like details and materiality...... / tactility can blur the meaning of the architecture and turn it into an empty statement. The present paper will outline detailing in contemporary architecture and discuss the issue with respect to architectural quality. Architectural cases considered as sublime piece of architecture will be presented...

  1. Fluid dynamics

    CERN Document Server

    Bernard, Peter S


    This book presents a focused, readable account of the principal physical and mathematical ideas at the heart of fluid dynamics. Graduate students in engineering, applied math, and physics who are taking their first graduate course in fluids will find this book invaluable in providing the background in physics and mathematics necessary to pursue advanced study. The book includes a detailed derivation of the Navier-Stokes and energy equations, followed by many examples of their use in studying the dynamics of fluid flows. Modern tensor analysis is used to simplify the mathematical derivations, thus allowing a clearer view of the physics. Peter Bernard also covers the motivation behind many fundamental concepts such as Bernoulli's equation and the stream function. Many exercises are designed with a view toward using MATLAB or its equivalent to simplify and extend the analysis of fluid motion including developing flow simulations based on techniques described in the book.

  2. Islamic factor in contemporary Russia

    Directory of Open Access Journals (Sweden)

    N. M. Shalenna


    Full Text Available Russian Federation, a Eurasian multinational state, has a significant number of indigenous Muslim population (about 10% that continues to increase not only due to natural growth and conversion of non-Muslims to Islam, but also as a result of intensive immigration from the Central Asian countries and Azerbaijan. Islamic factor significantly predetermined policy of Russia during its historical development. The importance of Islam in contemporary political life has been underlined by many government representatives and by the leaders of social and religious organizations and movements. Russian Muslim Ummah nowadays is far from being homogeneous and integrated, that predisposes some groups to radicalization of sentiments, ideas and activities and inevitably causes significant destabilization in the religious, social and political spheres within certain subjects of the Russian Federation and at the national level. The article focuses on the complex investigation of the influence of Islam on the social and political processes in contemporary Russia. It reveals the main principles of the Russian administration policy in the field of religion in general and towards Muslims in particular. Specific features of Muslim communities’ formation and factors of their institutionalization are determined. This research covers the reasons of major contradictions existing within the Russian Ummah. The article stresses on the importance of this study in the context of Ukrainian-Russian conflict in Crimea and in eastern regions of Ukraine. Current policy of Russia towards the Crimean Tatar population is analyzed.


    Directory of Open Access Journals (Sweden)

    M. Wasileva


    Full Text Available The geography includes rich, diverse and comprehensive themes that give us an understanding of our changing environment and interconnected world. It includes the study of the physical environment and resources; cultures, economies and societies; people and places; and global development and civic participation. As a subject, geography is particularly valuable because it provides information for exploring contemporary issues from a different perspective. This geographical information affects us all at work and in our daily lives and helps us make informed decisions that shape our future. All these facts result in a wide discussion on many topical issues in contemporary geography didactics. Subjects of research are the new geography and economics curriculum as well as construction of modern learning process. The paper presents briefly some of the current trends and key issues of geodidactics. As central notions we consider and analyze the training/educational goals, geography curriculum, target groups and environment of geography training, training methods as well as the information sources used in geography education. We adhere that all the above-mentioned finds its reflection in planning, analysis and assessment of education and thus in its quality and effectiveness.

  4. Contemporary views on selective mutism

    Directory of Open Access Journals (Sweden)

    Dimoski Sanja


    Full Text Available The aim of this paper is to review contemporary literature on selective mutism (SM, available in our language. The paper includes a contemporary definition of the disorder, previous studies of selective mutism, theories about its origin, and treatment. SM is a disorder that occurs in childhood, when a child's speech is selectively lacking in certain social situations. School is the context in which the disorder is typically manifested, which is why SM is often diagnosed only after children start school. The paper gives a historical account of changes in views on this disorder. Modern conceptions emphasize selective inability of children to spontaneously and successfully express themselves verbally. In researching SM, case studies on children who have selective mutism are most commonly published. Etiological factors are not precisely defined, and different conceptions give their interpretations depending on various theoretical frameworks. Some studies consistently indicate a relation between SM and social anxiety, and some with opposing behavior and delays in language development. Based on theoretical explanations of SM, psychological interventions (behavioral and cognitive-behavioral, psychodynamic and projective techniques, counseling and family therapy are created. Modern treatment of selective mutism includes an eclectic approach and emphasizes the role of teachers and school in general. Future studies should deepen the knowledge about selective mutism, specify the methodological procedure and stimulate the individualized treatment of children with SM.


    Directory of Open Access Journals (Sweden)

    Ieva Naikienė


    Full Text Available This article focuses on esotericism in contemporary Lithuanian prose. For the revelation of this topic, Donaldas Kajokas’ novel Ežeras ir kiti jį lydintys asmenys (The Lake and Other Escort Members, 2003 and Jurga Ivanauskaitė’s novel Placebas (Placebo, 2012 have been chosen. The analysed writings reveal the point of view of contemporary Lithuanian writers about esoteric beliefs. In this article, esotericism is related with persons’ feelings but is excluded from occult and parapsychology fields such as alchemy, cabbala, Tarot, etc. This work focuses on the idea that an individual, who has only a few senses, cannot reach actuality. On the other hand, the possibility of acquiring those senses is not rejected. In addition, obtaining those senses would help to reach higher, over-sensational worlds and in that way to discover personal correlation with forms of multiple personal identities. This article establishes an idea that awareness of higher worlds/spheres unlocks the possibilities of revealing the main core of human (as micro-cosmos and the Universe (as macro-cosmos. The possibility to perceive oneself as a micro-cosmos discloses not only personal identity, but also the value of Other’s entity and inevitable entities stratifying.

  6. Contemporary Education for Public Administration

    Directory of Open Access Journals (Sweden)

    Ivan Koprić


    Full Text Available The paper examines the development of contemporary administrative education, as a crucial criterion without which it is not possible to achieve professionalism in public administration. While the term professionalism has a variety of meanings, today it is largely deemed that specific educational preparation is a foundation without which other elements of professionalism in public administration cannot be achieved. The level of professionalism, competence, education and knowledge thus become critical variables of administration reforms in transitional countries. Afterwards, the author examines the trends in the development of contemporary administrative education, pointing particularly to the importance of establishing a coherent, vertically passable system, i.e. a system which encompasses all levels of education – from secondary school education to doctoral studies. In this matter, one of the most important features in the development of administrative studies is their diversification, with simultaneous strengthening of the general administrative profile. Thus, the general administrative profile becomes modified, updated and extended by new teaching disciplines. In the final section of the paper, the author addresses the performance of administrative education in Croatia, pointing to its underdevelopment. Indeed, the author suggests that there are no sustainable results of reforms without the training of staff for administration.

  7. Endometrial fluid associated with Essure implants placed before in vitro fertilization: Considerations for patient counseling and surgical management


    Sills, E Scott; Walsh, David J; Jones, Christopher A; Wood, Samuel H


    Essure (Bayer) received approval from the U.S. Food and Drugs Administration as a permanent non-hormonal contraceptive implant in November 2002. While the use of Essure in the management of hydrosalpinx prior to in vitro fertilization (IVF) remains off-label, it has been used specifically for this purpose since at least 2007. Although most published reports on Essure placement before IVF have been reassuring, clinical experience remains limited, and no randomized studies have demonstrated the...

  8. Contemporary organization and a perspective on integration and development


    Anna Piekarczyk


    A contemporary organization is becoming more and more complex and dynamic. Managing such an organization often requires new solutions in order to face the fast-expanding comprehensiveness in economy, politics and private life. Understanding complex connections between the elements of a system can remedy this situation. Therefore, when planning and making decisions a lot of factors should be taken into consideration and their interdependencies should be seen. Know-why methodology, thanks to wh...

  9. Business Ethics versus Economic Incentives: Contemporary Issues and Dilemmas


    Kulshreshtha Pravin


    This paper is based on my experience with teaching a course on ethical dilemmas faced by individuals, managers and businesses in contemporary societies. Modern economic thinking generally presumes that individuals and businesses in a society follow their own self-interest, or private economic incentives. The course highlighted the importance of ethical considerations for action that are based on consideration of others rather than ones own. Four significant ethical dilemmas of modern societie...

  10. Management of cerebrospinal fluid leakage after anterior decompression for ossification of posterior longitudinal ligament in the thoracic spine: the utilization of a volume-controlled pseudomeningocele. (United States)

    Cho, Ji Young; Chan, Chee Keong; Lee, Sang-Ho; Choi, Won-Chul; Maeng, Dae Hyeon; Lee, Ho-Yeon


    Retrospective review To determine the efficacy of management of cerebrospinal fluid (CSF) leakage after the anterior thoracic approach. CSF leakage after incidental durotomy commonly occurs after anterior thoracic ossification of posterior longitudinal ligament (OPLL) surgery. Pseudomeningocele will invariably form under such circumstances. Among them, uncontrolled CSF leakage with a fistulous condition is problematic. As a solution, we have managed these durotomies with chest drains alone without any CSF drainage by the concept of a "volume-controlled pseudomeningocele." Between 2001 and 2009, CSF leakage occurred in 26 patients (37.7%) of the total 69 patients who underwent anterior decompression for thoracic OPLL. In the initial 11 cases, subarachnoid drainage was utilized as an augmentive measure in combination with chest tube drainage in the postoperative period (group A). In the subsequent 15 cases, the durotomy was managed in a similar manner but in the absence of any subarachnoid drainage (group B). Various parameters such as the duration of postoperative hospital stay, clinical outcome score, drainage output, resolution of CSF leakage, complications, and additional surgery performed were analyzed and compared between the 2 groups. A resolution of the CSF leakage grading system was also proposed for the residual pseudomeningocele that formed in each group. There were statistically no significant differences in the outcome parameters between the 2 groups and also in patients with grade I or grade II residual pseudomeningocele of the new grading system. Two complications occurred in group A. No reexploration for persistent CSF leakage was required in both groups. CSF leakage managed with controlled chest tube drainage can produce a comparable result with those with additional subarachnoid drainage when watertight dural repair is impossible. The concept of controlled pseudomeningocele may be a useful and practical technique for the treatment of CSF leakage

  11. Scattering methods in complex fluids

    CERN Document Server

    Chen, Sow-Hsin


    Summarising recent research on the physics of complex liquids, this in-depth analysis examines the topic of complex liquids from a modern perspective, addressing experimental, computational and theoretical aspects of the field. Selecting only the most interesting contemporary developments in this rich field of research, the authors present multiple examples including aggregation, gel formation and glass transition, in systems undergoing percolation, at criticality, or in supercooled states. Connecting experiments and simulation with key theoretical principles, and covering numerous systems including micelles, micro-emulsions, biological systems, and cement pastes, this unique text is an invaluable resource for graduate students and researchers looking to explore and understand the expanding field of complex fluids.

  12. Social challenges of contemporary psychiatry. (United States)

    Bouras, N


    Psychiatry and society are interrelated and the biopsychosocial model continues to dominate the clinical psychiatric practice. Some doubts have been expressed in recent years about the value and the wide acceptance of the biopsychosocial model. Ghaemi (2009)1 considers it to be anti-humanistic and advocates the use of less eclectic, less generic, and less vague alternatives. The fundamental changes that have been witnessed in our times across the spectrum of biology, psychology and sociology have made necessary that a conceptual clarity should prevail. The remarkable advances in neurosciences, neurobiology and genetics tend to swing the emphasis towards a more biological basis. Psychosis for example is the condition often regarded as being biologically constructed and most independent of the social context. The symptoms, however, of hallucinations and delusions in psychosis have social meaning for the person experiencing them and are primarily defined socially.2 Furthermore, vulnerability is often the result of social trauma, whether in the form of recent stressors that trigger onset, or earlier circumstances that shape cognitive and emotional style. Moreover, the approved treatment and management of long term psychiatric disorders has involved interventions that are either directly social, or psychosocial. Furthermore, doubts have also been raised by the endophenotype project,3 related to the genetics of schizophrenia. Cohen4 suggested that there may be more individual genotypic patterns associated with schizophrenia than people with schizophrenia on the planet. A recent alternative interpretation (network approach) is gaining some support. It suggests that a stressor causes symptoms that activate other symptoms, in a circular, self-reinforcing way.5 This theory moves away from psychiatric disorders being traditionally conceptualised as categorical or dimensional models. While psychiatry has shifted its focus to a more biological approach, social factors still

  13. Contradictions and conflicts of the contemporary Russian education

    Directory of Open Access Journals (Sweden)

    M M Akulich


    Full Text Available The article considers the contradictions and conflicts of the contemporary Russian education focusing on the opportunities for conflict management. The research is based on the institutional and system approaches, in particular on the sociological conceptions of social conflict and social cohesion. The author conducted a historical and sociological analysis of social conflicts and social cohesion in the educational sphere, and such conflicts seem to be the result of the contradictions inherent in this social institution. The article identifies basic types of conflicts in the Russian education, and the ways of resolving them by the subjects of the educational system for such conflicts are manageable, especially within the interaction of educational system and society. To verify the proposed typology of conflicts in the contemporary Russian education the author conducted an empirical study to develop a system of practical measures that will help to improve the quality of learning of pupils and students, and will have a positive impact on the functioning and development of the contemporary Russian society. Thus, the article may be useful to sociologists, teachers, educational managers and readers interested in the specifics of social conflicts and the ways for resolving conflict situations.

  14. Book review: Organisational behaviour: A contemporary South African perspective

    Directory of Open Access Journals (Sweden)

    Andrew Thatcher


    Full Text Available Authors: Helen Schultz (Ed., Jeffrey Bagraim, Tracy Potgieter, Conrad Viedge, Amanda Werner Publisher: Van Schaik Publishers According to the authors the aim of this book is to present an interdisciplinary approach to the understanding of organisational behaviour within the contemporary South African environment. Within this framework, the book targets (senior undergraduate and postgraduate students in Industrial/Organisational Psychology and Human Resources Management. The text is written in a simple, conversational style (as was the intention of the authors that should be suitable for most undergraduate students at English-speaking tertiary institutions. The book is organised into three sections based on a model of four components of organizational behaviour: the individual, the group and the organisation. The fourth component of the model, the environment, refers specifically in the context of this book, to a contemporary South African approach to understanding behaviour in organisations. In the ‘individual’ section, the authors cover topics such as individual differences (e.g. personality, attitudes, perceptions, emotional intelligence, etc., ethics, work motivation, and performance management. In the ‘group’ section, the authors look at issues of group and team dynamics, power and empowerment, communication, decision-making and leadership. Finally, in the ‘organisation’ section, the authors address issues of contemporary organisational design, organisational change and employee well-being (e.g. stress management, job satisfaction, etc..

  15. Managing Public Accountability : How Public Managers Manage Public Accountability

    NARCIS (Netherlands)

    Schillemans, Thomas


    Accountability is of growing importance in contemporary governance. The academic literature on public accountability is fraught with concerned analyses, suggesting that accountability is a problematic issue for public managers. This article investigates how public managers experience accountability

  16. A note on contemporary psychometrics. (United States)

    Vitoratou, Silia; Pickles, Andrew


    Psychometrics provide the mathematical underpinnings for psychological assessment. From the late 19th century, a plethora of methodological research achievements equipped researchers and clinicians with efficient tools whose practical value becomes more evident in the era of the internet and big data. Nowadays, powerful probabilistic models exist for most types of data and research questions. As the usability of the psychometric scales is better comprehended, there is an increased interest in applied research outcomes. Paradoxically, while the interest in applications for psychometric scales increases, publishing research on the development and/or evaluation of those scales per se, is not welcomed by many relevant journals. This special issue in psychometrics is therefore a great opportunity to briefly review the main ideas and methods used in psychometrics, and to discuss the challenges in contemporary applied psychometrics.

  17. Are contemporary tourists consuming distance?

    DEFF Research Database (Denmark)

    Larsen, Gunvor Riber

    2012. Background The background for this research, which explores how tourists represent distance and whether or not distance can be said to be consumed by contemporary tourists, is the increasing leisure mobility of people. Travelling for the purpose of visiting friends and relatives is increasing...... of understanding mobility at a conceptual level, and distance matters to people's manifest mobility: how they travel and how far they travel are central elements of their movements. Therefore leisure mobility (indeed all mobility) is the activity of relating across distance, either through actual corporeal...... metric representation. These representations are the focus for this research. Research Aim and Questions The aim of this research is thus to explore how distance is being represented within the context of leisure mobility. Further the aim is to explore how or whether distance is being consumed...

  18. Prototypical versus contemporary Mediterranean Diet. (United States)

    Rizza, W; De Gara, L; Antonelli Incalzi, R; Pedone, C


    To investigate the evolution of the Mediterranean Diet (MD) in a delimited area of Southern Italy, by comparing the diet adopted 60-70 years ago (Prototypical Mediterranean Diet, PMD) with the contemporary one (Contemporary Mediterranean Diet, CMD), and to verify to what extent they fitted the recommendations of the Italian and the USDA dietary guidelines. We recruited a total of 106 participants, divided in two groups. PMD group included 52 women aged >80 years, with a good cognitive function and full independence in basic and instrumental activities of daily living. CMD group included 20 men and 34 women aged 50-60 years. Food intake was assessed by administering the EPIC food frequency questionnaire to each participant, and an additional survey to the PMD subjects only. Both PMD and CMD showed adequate intakes of macronutrients, although some deficiencies related to micronutrient requirements were evident. CMD showed a slightly greater use of animal products, processed and sugary foods, and higher intakes of simple sugars, animal proteins (49.6 vs 28.3 g/day), animal lipids (37.8 vs 20.1 g/day), saturated fats (25.0 vs 15.8 g/day) and cholesterol (305.0 vs 258.5 g/day). PMD showed many similarities to the original version of the MD in terms of macronutrients distribution and food choices. The documented evolution of the dietary habits over a 70 years timespan suggests that nowadays Mediterranean regions adhere less strictly to the original MD, although nutrients intakes are adequate to LARN and USDA recommendations. Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

  19. Fluid Shifts (United States)

    Stenger, M. B.; Hargens, A. R.; Dulchavsky, S. A.; Arbeille, P.; Danielson, R. W.; Ebert, D. J.; Garcia, K. M.; Johnston, S. L.; Laurie, S. S.; Lee, S. M. C.; hide


    Introduction. NASA's Human Research Program is focused on addressing health risks associated with long-duration missions on the International Space Station (ISS) and future exploration-class missions beyond low Earth orbit. Visual acuity changes observed after short-duration missions were largely transient, but now more than 50 percent of ISS astronauts have experienced more profound, chronic changes with objective structural findings such as optic disc edema, globe flattening and choroidal folds. These structural and functional changes are referred to as the visual impairment and intracranial pressure (VIIP) syndrome. Development of VIIP symptoms may be related to elevated intracranial pressure (ICP) secondary to spaceflight-induced cephalad fluid shifts, but this hypothesis has not been tested. The purpose of this study is to characterize fluid distribution and compartmentalization associated with long-duration spaceflight and to determine if a relation exists with vision changes and other elements of the VIIP syndrome. We also seek to determine whether the magnitude of fluid shifts during spaceflight, as well as any VIIP-related effects of those shifts, are predicted by the crewmember's pre-flight status and responses to acute hemodynamic manipulations, specifically posture changes and lower body negative pressure. Methods. We will examine a variety of physiologic variables in 10 long-duration ISS crewmembers using the test conditions and timeline presented in the figure below. Measures include: (1) fluid compartmentalization (total body water by D2O, extracellular fluid by NaBr, intracellular fluid by calculation, plasma volume by CO rebreathe, interstitial fluid by calculation); (2) forehead/eyelids, tibia, and calcaneus tissue thickness (by ultrasound); (3) vascular dimensions by ultrasound (jugular veins, cerebral and carotid arteries, vertebral arteries and veins, portal vein); (4) vascular dynamics by MRI (head/neck blood flow, cerebrospinal fluid





    ABSTRACT Purpose: Identify the practices adopted by companies to monitor and prevent contemporary slavery and the elements that differentiate companies that adopt monitoring practices for prevention of slavery and those that do not. Originality/value: This question is investigated from the perspective of management, reputation and institutional environment literature, pointing out the reasons that lead companies to adopt or avoid contemporary slavery. Design/methodology/approach: We used s...

  1. School Counselors: A Review of Contemporary Issues (United States)

    Bain, Steve F.


    This article seeks to review the topic of school counselors and the contemporary issues surrounding this profession. An introduction to the profession and overview of its history provides a comprehensive basis on which to understand today's school counseling profession. An examination of contemporary themes of school counseling will include job…

  2. Discussing Global Issues through Contemporary Art (United States)

    Mead, Sarah M.; Ellerbrock, Cheryl R.; Cruz, Bárbara C.


    Contemporary global issues can be examined through the lens of modern photographic art. In an effort to prepare global-ready graduates, this article explores the pressing problems of environmental degradation, urbanization, and homelessness through the work of three contemporary artists. Illustrative works, suggested approaches, and curriculum…

  3. Tradition and Renewal in Contemporary Orthodox Theology

    Directory of Open Access Journals (Sweden)

    Marios Begzos


    Full Text Available This text presents the challenges that the modern world poses for the Orthodox Church. In every historical period, the Church has struggled with internal and external problems. While preserving its traditions and historical foundations, the theology of the Orthodox Church struggles with contemporary problems by showing the current, contemporary teaching about God, man and the world.

  4. Contemporary African philosophy: emergent issues and challenges ...

    African Journals Online (AJOL)

    ... all philosophies remain context-dependent and cultureoriented. A contrary view ignores the proper nature of philosophy. A new phenomenon confronts currently confronts all comers to contemporary African philosophy: an expansive vision of African philosophical discourse. Contemporary African philosophers attempt to ...

  5. Fluid mechanics

    International Nuclear Information System (INIS)

    Granger, R.A.


    This text offers the most comprehensive approach available to fluid mechanics. The author takes great care to insure a physical understanding of concepts grounded in applied mathematics. The presentation of theory is followed by engineering applications, helping students develop problem-solving skills from the perspective of a professional engineer. Extensive use of detailed examples reinforces the understanding of theoretical concepts

  6. Smoking in contemporary American cinema. (United States)

    Omidvari, Karan; Lessnau, Klaus; Kim, Jeannie; Mercante, Donald; Weinacker, Ann; Mason, Carol


    The true prevalence of smoking among characters portrayed in the movies is unknown. This study examines this prevalence objectively. The top 10 movies on the weekly box office charts were reviewed. Whether or not the top five characters in these movies smoked, was documented. It was determined prior to the start of the study that 300 male characters and 300 female characters were needed to detect any significant difference. A total of 447 movies, composed of 193 movies rated restricted (R) [children < 17 years of age must be accompanied by an adult], 131 movies rated PG13 for parental guidance suggested for children < 13 years of age (PG) and 123 movies rated PG for parental guidance suggested, were examined until the sample size was reached. Smoking prevalence is the same in contemporary American movies and in the general US population (23.3% vs 24.8%, respectively). However, there was more smoking in these movies among men than among women (25.5% vs 20.5%, respectively; p < 0.006), among antagonists than among protagonists (35.7% vs 20.6%, respectively; p < 0.001), lower vs middle vs upper socioeconomic class (SEC) [48.2%, 22.9%, and 10.5%, respectively; p < 0.001], among independent vs studio movies (46.2% vs 18.2%, respectively; p < 0.001); and among R-rated vs PG13-rated vs PG-rated movies (37.3%, 16.2%, and 8.1%, respectively; p < 0.001). In R-rated movies, and in both subcategories of R-rated studio movies and R-rated independent movies, smoking prevalence is higher than in the US population (37.3%, 30.5%, and 50.6% vs 24.8%, respectively; p < 0.001 for all). Additionally, compared to the US population, men, women and lower SEC members smoke more in R-rated movies, R-rated studio movies, and R-rated independent movies. In R-rated movies, antagonists smoke more than protagonists (43.9% vs 35.8%, respectively; p < 0.001), and whites smoke more than nonwhites (38.3% vs 26.4%, respectively; p < 0.001). In R-rated studio movies, antagonists smoke more than

  7. Common Property Resource Management, Institutional Change and ...

    African Journals Online (AJOL)

    Common Property Resource Management, Institutional Change and ... Most contemporary discussions on African development since independence forty ... theories on CPR Resource Management in a specific ecological and political setting.

  8. Acute cerebellitis successfully managed with temporary cerebrospinal fluid diversion using a long tunnel external ventricular drain: a long-term radiological follow-up of two cases (United States)

    Waqas, Muhammad; Hadi, Yousaf Bashir; Sheikh, Sadaf; Shamim, Shahzad M


    Acute cerebellitis (AC) is a rare inflammatory childhood disorder. Although there is no consensus on standard treatment for cerebellitis, its outcome is usually favourable. We report two cases of AC in the paediatric age group, successfully managed with long tunnel external ventricular drain (EVD). The first patient was an 8-year-old boy with a history of fever and headache. Sequential MRI showed diffuse cerebellar swelling with tonsillar herniation and resulting hydrocephalus. The second patient was a 6-month-old boy who presented with high-grade fever associated with chills. CT scan of the head showed triventricular hydrocephalus with obliteration of cerebrospinal fluid spaces and cisterns. Both patients underwent immediate emergency right-sided long tunnel EVD insertion. The EVD was removed on the 9th day in the first patient and the 10th day in the second patient; the patients showed no neurological deficits at a follow-up of 2 years and 1 year, respectively. PMID:27166004

  9. Rapid detection of enterovirus in cerebrospinal fluid by a fully-automated PCR assay is associated with improved management of aseptic meningitis in adult patients. (United States)

    Giulieri, Stefano G; Chapuis-Taillard, Caroline; Manuel, Oriol; Hugli, Olivier; Pinget, Christophe; Wasserfallen, Jean-Blaise; Sahli, Roland; Jaton, Katia; Marchetti, Oscar; Meylan, Pascal


    Enterovirus (EV) is the most frequent cause of aseptic meningitis (AM). Lack of microbiological documentation results in unnecessary antimicrobial therapy and hospitalization. To assess the impact of rapid EV detection in cerebrospinal fluid (CSF) by a fully-automated PCR (GeneXpert EV assay, GXEA) on the management of AM. Observational study in adult patients with AM. Three groups were analyzed according to EV documentation in CSF: group A = no PCR or negative PCR (n=17), group B = positive real-time PCR (n = 20), and group C = positive GXEA (n = 22). Clinical, laboratory and health-care costs data were compared. Clinical characteristics were similar in the 3 groups. Median turn-around time of EV PCR decreased from 60 h (IQR (interquartile range) 44-87) in group B to 5h (IQR 4-11) in group C (p<0.0001). Median duration of antibiotics was 1 (IQR 0-6), 1 (0-1.9), and 0.5 days (single dose) in groups A, B, and C, respectively (p < 0.001). Median length of hospitalization was 4 days (2.5-7.5), 2 (1-3.7), and 0.5 (0.3-0.7), respectively (p < 0.001). Median hospitalization costs were $5458 (2676-6274) in group A, $2796 (2062-5726) in group B, and $921 (765-1230) in group C (p < 0.0001). Rapid EV detection in CSF by a fully-automated PCR improves management of AM by significantly reducing antibiotic use, hospitalization length and costs. Copyright © 2014 Elsevier B.V. All rights reserved.

  10. Fluid dynamics of dilatant fluid

    DEFF Research Database (Denmark)

    Nakanishi, Hiizu; Nagahiro, Shin-ichiro; Mitarai, Namiko


    of the state variable, we demonstrate that the model can describe basic features of the dilatant fluid such as the stress-shear rate curve that represents discontinuous severe shear thickening, hysteresis upon changing shear rate, and instantaneous hardening upon external impact. An analysis of the model...

  11. Sculpting light for contemporary biophotonics

    DEFF Research Database (Denmark)

    Glückstad, Jesper

    DTUs IPR portfolio on so-­‐called Generalized Phase Contrast (GPC) covers a family of powerful “light-­‐engine” approaches for generating speckle-­‐free contiguous optical distributions using advanced spatial phase modulation. GPC has been used in applications such as optical trapping and manipul......DTUs IPR portfolio on so-­‐called Generalized Phase Contrast (GPC) covers a family of powerful “light-­‐engine” approaches for generating speckle-­‐free contiguous optical distributions using advanced spatial phase modulation. GPC has been used in applications such as optical trapping...... and manipulation, active microscopy, structured illumination, optical security, parallel laser marking trials and recently in contemporary biophotonics applications such as for real-­‐time parallel two-­‐photon optogenetics and neurophotonics. Our most recent GPC light sculpting developments geared towards...... these applications will be presented. This includes both a static and a dynamic GPC Light Shaper implementation based on our latest theoretical derivations to demonstrate the benefits for typical applications where lasers have to be actively shaped into particular light patterns. We then show the potential of GPC...


    Ljusic, Dragana; Ravanic, Dragan; Filipovic Danic, Snezana; Soldatovic, Ivan; Cvetkovic, Jovana; Stojanovic Tasic, Mirjana


    Suicide remains a significant public health problem worldwide. This study is aimed at analyzing and presenting contemporary methods in suicide prevention in the world as well as at identifying specific risk groups and risk factors in order to explain their importance. in suicide prevention. The literature search covered electronic databases PubMed, Web of Science and Scopus. In order to select the relevant articles, the authors searched for the combination of key-words which included the following medical subject heading terms (suicide or suicide ideation or attempted) and (prevention or risk factors) and (man or elders or mental disorders). Data analysis covered meta-analyses, systematic reviews and original scientific papers with different characteristics of suicide preventions, risk factors and risk groups. Worldwide evidence-based interventions for suicide prevention are divided in universal, selective and indicated interventions. Restricted approach to various methods of committing suicide as well as pharmacotherapy contributes to a lower suicide rate. Suicide risk factors can be categorized as proximal and distal. The following groups are at highest risk of committing suicide: males. older persons and persons with registered psychiatric disorders. There is a lot of evidence that suicide is preventable. It is known that only 28 coun tries in the world have national suicide prevention strategies and Serbia is not one of them.

  13. Contemporary vascular smartphone medical applications. (United States)

    Carter, Thomas; O'Neill, Stephen; Johns, Neil; Brady, Richard R W


    Use of smartphones and medical mHealth applications (apps) within the clinical environment provides a potential means for delivering elements of vascular care. This article reviews the contemporary availability of apps specifically themed to major vascular diseases and the opportunities and concerns regarding their integration into practice. Smartphone apps relating to major vascular diseases were identified from the app stores for the 6 most popular smartphone platforms, including iPhone, Android, Blackberry, Nokia, Windows, and Samsung. Search terms included peripheral artery (arterial) disease, varicose veins, aortic aneurysm, carotid artery disease, amputation, ulcers, hyperhydrosis, thoracic outlet syndrome, vascular malformation, and lymphatic disorders. Forty-nine vascular-themed apps were identified. Sixteen (33%) were free of charge. Fifteen apps (31%) had customer satisfaction ratings, but only 3 (6%) had greater than 100. Only 13 apps (27%) had documented medical professional involvement in their design or content. The integration of apps into the delivery of care has the potential to benefit vascular health care workers and patients. However, high-quality apps designed by clinicians with vascular expertise are currently lacking and represent an area of concern in the mHealth market. Improvement in the quality and reliability of these apps will require the development of robust regulation. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Judicial fiats and contemporary enclosures

    Directory of Open Access Journals (Sweden)

    Thayyil Naveen


    Full Text Available This article examines the problematic processes in a case that has had few parallels in Indian judicial history. The apex court in T. N. Godavarman took upon the responsibility of deciding how forest resources in the country should be accessed and who is (or is not to have such access. Purportedly done to protect the environment, through the ′clarification and fine-tuning′ of national forest-laws, the case has seriously affected the life, livelihood, and habitat of millions of marginal groups. Recent trends demonstrate the wider trend of constitutional courts assuming the roles of adjudication, administration and legislation, all rolled into one, whereby they become problematic sites for creating a hierarchy of conflicting public interests, which claim constitutional validity from different vantage points. Thus, constitutional values of ′protection of environment′ and ′justice - social, political and economic′ ′are pitted against each other′ where unelected courts take it upon themselves to define the legitimate precincts of the theoretical discourse of sustainable use / development; and importantly also implement it into ′everyday′ ′reality, in the way it feels fit′. The article seeks to make sense of this contemporary process of forest governance.

  15. About Security in Contemporary World

    Directory of Open Access Journals (Sweden)

    Ladislav Hofreiter


    Full Text Available The task to ensure security in contemporary world is a complicated political, scientific-technological and socio-economic problem. As the security itself is complicated, multifactor and hierarchized phenomen also its investigation has to be of an interdisciplinary character. The character of security environment, the character of security risks and threats and also the character of tools for their elimination are essentially changing. The basis to security of social subject consisted in arrangement of the conditions for their existence, to surviving in the present time and advancement into the future. Assurance of this condition means it provided ability to the social subjects to eliminated threats that are defined. In situations of asymmetrical security, the threats are not always clearly defined. They often consist of their own structure systems, in relationships and status the subjects of internationals relations. Asymmetrical of security, by our opinion, presents a discrepancy, unbalance, non-parity between subjects of the international security environment. The unbalance, discrepancy, non-parity has political, military, economic, law, social and societal dimensions.

  16. Fluid dynamics

    CERN Document Server

    Ruban, Anatoly I

    This is the first book in a four-part series designed to give a comprehensive and coherent description of Fluid Dynamics, starting with chapters on classical theory suitable for an introductory undergraduate lecture course, and then progressing through more advanced material up to the level of modern research in the field. The present Part 1 consists of four chapters. Chapter 1 begins with a discussion of Continuum Hypothesis, which is followed by an introduction to macroscopic functions, the velocity vector, pressure, density, and enthalpy. We then analyse the forces acting inside a fluid, and deduce the Navier-Stokes equations for incompressible and compressible fluids in Cartesian and curvilinear coordinates. In Chapter 2 we study the properties of a number of flows that are presented by the so-called exact solutions of the Navier-Stokes equations, including the Couette flow between two parallel plates, Hagen-Poiseuille flow through a pipe, and Karman flow above an infinite rotating disk. Chapter 3 is d...

  17. On the contemporary – and contemporary art history. A review of Terry Smith, What Is Contemporary Art

    Directory of Open Access Journals (Sweden)

    Anthony Gardner


    Full Text Available This analysis of Terry Smith’s 'What Is Contemporary Art?' evaluates Smith’s ongoing project to theorise contemporary art around the theme of multiple, interconnected temporalities. It questions how this ‘contemporaneity’ differs from the classic teleologism of modernism and postmodern relativism and suggests that Smith’s categories may be valuable for understanding other cultural areas, such as contemporary music. It then raises methodological problems associated with charting the terrain of contemporary art and how they overlap with economic considerations, arguing that the task implies particular forms of privilege that may threaten the autonomy of critical analysis, but that Smith’s work goes some way toward exposing this problem.

  18. The use of LiDCO based fluid management in patients undergoing hip fracture surgery under spinal anaesthesia: Neck of femur optimisation therapy - targeted stroke volume (NOTTS: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Moran Chris G


    Full Text Available Abstract Background Approximately 70,000 patients/year undergo surgery for repair of a fractured hip in the United Kingdom. This is associated with 30-day mortality of 9% and survivors have a considerable length of acute hospital stay postoperatively (median 26 days. Use of oesophageal Doppler monitoring to guide intra-operative fluid administration in hip fracture repair has previously been associated with a reduction in hospital stay of 4-5 days. Most hip fracture surgery is now performed under spinal anaesthesia. Oesophageal Doppler monitoring may be unreliable in the presence of spinal anaesthesia and most patients would not tolerate the probes. An alternative method of guiding fluid administration (minimally-invasive arterial pulse contour analysis has been shown to reduce length of stay in high-risk surgical patients but has never been studied in hip fracture surgery. Methods Single-centre randomised controlled parallel group trial. Randomisation by website using computer generated concealed tables. Setting: University hospital in UK. Participants: 128 patients with acute primary hip fracture listed for operative repair under spinal anaesthesia and aged > 65 years. Intervention: Stroke volume guided intra-operative fluid management. Continuous measurement of SV recorded by a calibrated cardiac output monitor (LiDCOplus. Maintenance fluid and 250 ml colloid boluses given to achieve sustained 10% increases in stroke volume. Control group: fluid administration at the responsible (blinded anaesthetist's discretion. The intervention terminates at the end of the surgical procedure and post-operative fluid management is at the responsible anaesthetist's discretion. Primary outcome: length of acute hospital stay is determined by a blinded team of clinicians. Secondary outcomes include number of complications and total cost of care. Funding NIHR/RfPB: PB-PG-0407-13073. Trial registration number Trial registration: Current Controlled Trials ISRCTN

  19. Contemporary neuroscience in the media. (United States)

    Racine, Eric; Waldman, Sarah; Rosenberg, Jarett; Illes, Judy


    Technological innovations in neuroscience have opened new windows to the understanding of brain function and the neuronal underpinnings of brain activity in neuropsychiatric disorders and social behavior. Public interest and support for neuroscience research through initiatives like the Decade of the Brain project and increasingly diverse brain-related initiatives have created new interfaces between neuroscience and society. Against this backdrop of dynamic innovation, we set out to examine how different features of neuroscience are depicted in print media. We used the 'guided news' function of the LexisNexis Academic database with keyword searches to find news articles published between 1995 and 2004 in major U.S. and U.K. English-language news sources. We performed searches on headlines, lead paragraphs, and body terms to maximize search yields. All articles were coded for overall tone of coverage, details on reported studies, presence of ethical, legal, and social discussion as well as the emerging interpretations of neuroscience - in the form of neuro-essentialism, neuro-realism, and neuro-policy. We found that print media coverage of the use of neurotechnology for diagnosis or therapy in neuropsychiatric disorders was generally optimistic. We also found that, even within articles that were identified as research reports, many did not provide details about research studies. We also gained additional insights into the previously identified phenomena of neuro-essentialism, neuro-realism, and neuro-policy showing some profound impacts of neuroscience on personal identity and policy-making. Our results highlight the implications of transfer of neuroscience knowledge to society given the substantial and authoritative weight ascribed to neuroscience knowledge in defining who we are. We also discuss the impact of these findings on neuroscience and on the respective contributions of the social sciences and the biological sciences in contemporary psychiatry and mental

  20. Contemporary analysis of practicing otolaryngologists. (United States)

    Harrill, Willard C; Melon, David E; Seshul, Merritt J; Katz, Marc S; Zanation, Adam M


    To investigate contemporary issues facing practicing otolaryngologists including workforce dynamics, ancillary service modeling, otolaryngic allergy integration, ambulatory surgery center utilization, and relevant certificate of need legislation. A cross-sectional survey analysis of academic and private practicing otolaryngologists in North and South Carolina in 2016. A cross-sectional survey was e-mailed to 510 practicing otolaryngologists in North and South Carolina. A 21.3% survey response rate was achieved. Otolaryngology workforce was defined by horizontal aggregation of otolaryngologists into larger group models, with fewer solo practitioners being replaced by younger otolaryngologists or employing otolaryngology extenders. Excluding academic practice, few otolaryngologists have chosen direct hospital employment as a career option, although otolaryngologists with fewer years of practice are pursuing that option with greater frequency. Ancillary services showed audiology and hearing aid services being the most common, followed by otolaryngic allergy, point-of-service computed tomography, and ultrasound. Although otolaryngologists tend to avoid vertical integration, ambulatory surgery center (ASC) ownership trends favor a joint venture model with a hospital system partner. Most otolaryngologists favor changes to certificate of need legislation to improve patient access to these lower-cost facilities, regardless of whether they currently utilize or have access to an ASC. Otolaryngology is uniquely positioned to adapt and respond to current paradigm shifts within ambulatory medicine. Further analysis is needed to prepare current and future otolaryngologists for the demands and opportunities these challenges pose as patient-centered care models and consumer dynamics shape future patient expectations and utilization of healthcare. 5. Laryngoscope, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.