WorldWideScience

Sample records for current management approaches

  1. Multidisciplinary management of intrahepatic cholangiocarcinoma: Current approaches.

    Science.gov (United States)

    Guro, Hanisah; Kim, Jin Won; Choi, YoungRok; Cho, Jai Young; Yoon, Yoo-Seok; Han, Ho-Seong

    2017-06-01

    Intrahepatic cholangiocarcinoma (ICC) is a common primary hepatic tumor. However, its outcomes are usually worse than those of hepatocellular carcinoma owing to its non-specific presentation and detection at an advanced stage. The most widely used serum marker, carbohydrate antigen 19-9, is non-specific. Furthermore, imaging studies rarely identify any pathognomonic features. Surgery is the only treatment option that offers a chance of long-term survival. However, the resectability rate is low owing to the high frequencies of intrahepatic metastases, peritoneal carcinomatosis, or extrahepatic metastases. Surgical treatment should be tailored according to the macroscopic classification of ICC (e.g. mass-forming, periductal infiltrating, and intraductal growth types) because it reflects the tumor's dissemination pattern. Although lymph node metastasis is a negative prognostic factor, the importance and extent of lymph node dissection is still controversial. To improve patient survival, liver transplantation is considered in some patients with unresectable ICC, especially in those with an insufficient remnant liver volume. Minimally invasive procedures, including laparoscopic and robotic liver resection, have been tested and achieved comparable outcomes to conventional surgery in preliminary studies. No randomized trials have confirmed the efficacy of adjuvant chemotherapy in ICC, and several trials have evaluated molecular-targeted agents as monotherapy or in combination with cytotoxic chemotherapy. Multidisciplinary approaches are necessary to improve the outcomes of ICC. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Current management of oral cancer. A multidisciplinary approach.

    Science.gov (United States)

    Ord, R A; Blanchaert, R H

    2001-11-01

    Recent basic science discoveries have contributed to our understanding of the etiology of oral cancer and allowed us to consider innovative approaches to therapy. The authors evaluated and summarized current approaches to the management of oral cancer, emphasizing the multidisciplinary team approach to coordinate surgery, radiation therapy and chemotherapy. Current concepts in management, including complications of therapy, are described. State-of-the-art surgical techniques can spare patients with oral cancer from much of the morbidity and complications common in the past. The refinement of treatment strategies reduces complications and improves efficacy. Many exciting new clinical trials in the areas of gene therapy and immunomodulation are showing promise. Management of oral cancer has undergone radical change in the past 10 years and continues to evolve rapidly. Discoveries in molecular biology, diagnosis, surgery, radiation therapy and medical oncology have altered many traditional concepts and practices. General dental practitioners need to understand current treatment modalities for oral and pharyngeal cancers to determine to whom they should refer patients for the most appropriate treatment, and to make recommendations regarding complications associated with these cancers.

  3. Current approach to diagnosis and management of osteoarthritis ...

    African Journals Online (AJOL)

    There is extreme variability in presentation at different joint sites and between individuals. Management of OA involves a comprehensive approach consisting of preventative measures and numerous therapeutic modalities which should be tailored to individual needs. The family practitioner plays a vital role in the diagnosis ...

  4. Pancreaticoduodenal injuries: re-evaluating current management approaches.

    Science.gov (United States)

    Chinnery, G E; Madiba, T E

    2010-02-01

    Pancreaticoduodenal injuries are uncommon owing to the protected position of the pancreas and duodenum in the retroperitoneum. Management depends on the extent of injury. This study was undertaken to document outcome of pancreaticoduodenal injuries and to re-evaluate our approach. A prospective study of all patients treated for pancreaticoduodenal trauma in one surgical ward at King Edward VIII hospital over a 7-year period (1998 - 2004). Demographic data, clinical presentation, findings at laparotomy and outcome were documented. Prophylactic antibiotics were given at induction of anaesthesia. A total of 488 patients underwent laparotomy over this period, 43 (9%) of whom (all males) had pancreatic and duodenal injuries. Injury mechanisms were gunshot (30), stabbing (10) and blunt trauma (3). Their mean age was 30.1+9.6 years. Delay before laparotomy was 12.8+29.1 hours. Seven were admitted in shock. Mean Injury Severity Score (ISS) was 14+8.6. Management of 20 duodenal injuries was primary repair (14), repair and pyloric exclusion (3) and conservative (3). Management of 15 pancreatic injuries was drainage alone (13), conservative management of pseudocyst (1) and distal pancreatectomy (1). Management of 8 combined pancreaticoduodenal injuries was primary duodenal repair and pancreatic drainage (5) and repair with pyloric exclusion of duodenal injury and pancreatic drainage (3). Twenty-one patients (49%) developed complications, and 28 required ICU admission with a median ICU stay of 4 days. Ten patients died (23%). Mean hospital stay was 18.3+24.4 days. The overall mortality was comparable with that in the world literature. We still recommend adequate exploration of the pancreas and duodenum and conservative operative management where possible.

  5. Current approaches to the management of idiopathic pulmonary fibrosis.

    Science.gov (United States)

    Raghu, Ganesh; Richeldi, Luca

    2017-08-01

    Idiopathic pulmonary fibrosis (IPF) is a progressive and ultimately fatal lung disease associated with dyspnoea, cough and impaired quality of life. Currently, the aims of patient care are to improve outcomes for patients by slowing the progression of the disease, extending life, and improving quality of life. A prompt, accurate diagnosis is important to enable patients to receive treatment early in the course of the disease and to be considered for lung transplantation. Two anti-fibrotic drugs, nintedanib and pirfenidone, have been shown to reduce decline in lung function in patients with IPF. In addition to pharmacological therapy, optimal management of IPF includes treatment of comorbidities, symptom relief, pulmonary rehabilitation, and palliative care. Patient education is important to enable patients to make decisions about their care and to help them manage their disease and the side-effects of anti-fibrotic drugs. Research continues into new treatments and combinations of treatments that may improve outcomes for patients with this devastating disease. Copyright © 2017. Published by Elsevier Ltd.

  6. Current Approaches to the Management of Pediatric Overweight and Obesity

    Science.gov (United States)

    Ridolfi, Danielle R.; Hayes, Jacqueline F.; St Paul, Michelle; Wilfley, Denise E.

    2015-01-01

    Opinion Statement Family-based behavioral intervention has been demonstrated to be an effective and safe treatment for childhood obesity and should be considered a first-line treatment option. However, access to such intensive evidence-based treatment is limited and, currently, obesity care is dominated by high intensity behavioral treatment implemented in specialty clinics or less effective, low intensity treatments implemented in primary care. However, capitalizing on the established and ongoing relationship between primary care providers and families, primary care providers hold an invaluable role in early identification of overweight and obesity, and subsequent referral to an evidence-based treatment. key aspects of effective treatment include: early intervention, moderate- to high-intensity intervention of sufficient duration, multi-component intervention targeting dietary modification, physical activity and behavioral strategies, family involvement and goals targeting family members, and follow-up contact during maintenance. The purpose of this review is to present the current empirically supported treatment options for pediatric obesity including primary care-based interventions and diagnostic tools, multi-component behavioral intervention with a focus on family-based behavioral intervention, immersion treatment, and pharmacologic and surgical management. PMID:25205083

  7. Current approaches to nuclear power plant life management in Japan

    International Nuclear Information System (INIS)

    Noda, T.; Tajima, K.; Ishikawa, M.; Koyama, M.

    2002-01-01

    extracted additional maintenance measures and incorporated them into their long-term maintenance plans, thereby reinforcing their current maintenance activities. Considering the latest information including domestic and overseas operating experiences and knowledge of academics and experts consigned by the Minister of Economy, Trade and Industry (METI), the Nuclear and Industry Safety Agency (NISA) of the METI reviewed and studied the technical evaluation and long-term maintenance plans of these electric utility companies. This paper describes the outlines of the NISA's report and related activities on current approaches to cope with the ageing of nuclear power plants in Japan. (Note) In 2001, the MITI was reorganized to the Ministry of Economy, Trade and Industry (METI). (author)

  8. Ewing Sarcoma: Current Management and Future Approaches Through Collaboration

    NARCIS (Netherlands)

    Gaspar, Nathalie; Hawkins, Douglas S.; Dirksen, Uta; Lewis, Ian J.; Ferrari, Stefano; Le Deley, Marie-Cecile; Kovar, Heinrich; Grimer, Robert; Whelan, Jeremy; Claude, Line; Delattre, Olivier; Paulussen, Michael; Picci, Piero; Sundby Hall, Kirsten; van den Berg, Hendrik; Ladenstein, Ruth; Michon, Jean; Hjorth, Lars; Judson, Ian; Luksch, Roberto; Bernstein, Mark L.; Marec-Bérard, Perrine; Brennan, Bernadette; Craft, Alan W.; Womer, Richard B.; Juergens, Heribert; Oberlin, Odile

    2015-01-01

    Ewing sarcoma (ES) is an aggressive sarcoma of bone and soft tissue occurring at any age with a peak incidence in adolescents and young adults. The treatment of ES relies on a multidisciplinary approach, coupling risk-adapted intensive neoadjuvant and adjuvant chemotherapies with surgery and/or

  9. Current approach to masked hypertension: From diagnosis to clinical management.

    LENUS (Irish Health Repository)

    Dolan, Eamon

    2013-11-28

    The term masked hypertension phenomenon was first described by the late Professor Thomas Pickering and is commonly defined as having a normal clinic blood pressure (BP) but an elevated "out of office" reading. In the main these elevated readings have been provided through ambulatory blood pressure monitoring (ABPM) but sometimes home BP monitoring is used. It is now largely accepted that ABPM gives a better classification of risk than clinic BP. Thus the elevated ABPM levels should relate to higher cardiovascular risk and it follows that these people might be regarded as being genuinely hypertensive and at higher cardiovascular risk. The problem for clinical practice is how to identify and manage these subjects. The phenomenon should be suspected in subjects who have had an elevated clinic BP at some time, in young subjects with normal or normal-high clinic BP who have early left ventricular hypertrophy, in subjects with a family history of hypertension in both parents, patients with multiple risks for cardiovascular disease and perhaps diabetic patients. It appears to be more prevalent in subjects of male gender, with younger age, higher heart rate, obesity or high cholesterol levels and in smokers. Those with masked hypertension are at higher risk of events such as stroke and have a higher prevalence of target organ damage, for example, nephropathy. In conclusion most of the debate around this topic relates to its reliable identification. Given the higher ambulatory readings there is an increases cardiovascular risk making this diagnosis important. This article is protected by copyright. All rights reserved.

  10. VALUE-BASED APPROACH TO MANAGING CURRENT ASSETS OF CORPORATE CONSTRUCTION COMPANIES

    Directory of Open Access Journals (Sweden)

    Galyna Shapoval

    2017-09-01

    Full Text Available In modern conditions of management, the value of an enterprise becomes the main indicator, which is learned not only by scientists, but also by owners of enterprise and potential investors. Current assets take a very important place among the factors that affect the value of an enterprise, so management of current assets becomes more acute from the point of their impact on enterprise value. The purpose of the paper is to develop a system of value-based management of corporate construction companies’ current assets. The main tasks are: the study of current assets impact on the value of corporate construction companies, the definition of value-based approach to managing current assets of corporate enterprises and development of value-based management system of corporate construction companies’ current assets by elements. General scientific and special research methods were used while writing the work. Value-based management of current assets involves value-based management of the elements of current assets. The value-based inventory management includes the following stages of management: the assessment of reliability and choice of supplier according to the criterion of cash flow maximization, the classification of stocks in management accounting according to the rhythm of supply and the establishment of periodicity of supplies in accordance with the needs of the construction process. The value-based management of accounts receivable includes the following stages of management: assessment of the efficiency of investment of working capital into accounts receivable, the assessment of customers' loyalty and the definition of credit conditions and monitoring of receivables by construction and debt instruments. Value-based cash management involves determining the required level of cash to ensure the continuity of the construction process, assessing the effectiveness of cash use according to the criterion of maximizing cash flow, as well as budget

  11. Quality management in European screening laboratories in blood establishments: A view of current approaches and trends.

    Science.gov (United States)

    Pereira, Paulo; Westgard, James O; Encarnação, Pedro; Seghatchian, Jerard; de Sousa, Gracinda

    2015-04-01

    The screening laboratory has a critical role in the post-transfusion safety. The success of its targets and efficiency depends on the management system used. Even though the European Union directive 2002/98/EC requires a quality management system in blood establishments, its requirements for screening laboratories are generic. Complementary approaches are needed to implement a quality management system focused on screening laboratories. This article briefly discusses the current good manufacturing practices and good laboratory practices, as well as the trends in quality management system standards. ISO 9001 is widely accepted in some European Union blood establishments as the quality management standard, however this is not synonymous of its successful application. The ISO "risk-based thinking" is interrelated with the quality risk-management process of the EuBIS "Standards and criteria for the inspection of blood establishments". ISO 15189 should be the next step on the quality assurance of a screening laboratory, since it is focused on medical laboratory. To standardize the quality management systems in blood establishments' screening laboratories, new national and European claims focused on technical requirements following ISO 15189 is needed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Treatment of Thrombotic Antiphospholipid Syndrome: The Rationale of Current Management-An Insight into Future Approaches.

    Science.gov (United States)

    Chighizola, Cecilia Beatrice; Ubiali, Tania; Meroni, Pier Luigi

    2015-01-01

    Vascular thrombosis and pregnancy morbidity represent the clinical manifestations of antiphospholipid syndrome (APS), which is serologically characterized by the persistent positivity of antiphospholipid antibodies (aPL). Antiplatelet and anticoagulant agents currently provide the mainstay of APS treatment. However, the debate is still open: controversies involve the intensity and the duration of anticoagulation and the treatment of stroke and refractory cases. Unfortunately, the literature cannot provide definite answers to these controversial issues as it is flawed by many limitations, mainly due to the recruitment of patients not fulfilling laboratory and clinical criteria for APS. The recommended therapeutic management of different aPL-related clinical manifestations is hereby presented, with a critical appraisal of the evidence supporting such approaches. Cutting edge therapeutic strategies are also discussed, presenting the pioneer reports about the efficacy of novel pharmacological agents in APS. Thanks to a better understanding of aPL pathogenic mechanisms, new therapeutic targets will soon be explored. Much work is still to be done to unravel the most controversial issues about APS management: future studies are warranted to define the optimal management according to aPL risk profile and to assess the impact of a strict control of cardiovascular risk factors on disease control.

  13. Human-carnivore conflict in China: a review of current approaches with recommendations for improved management.

    Science.gov (United States)

    Pettigrew, Melissa; Xie, Yan; Kang, Aili; Rao, Madhu; Goodrich, John; Liu, Tong; Berger, Joshua

    2012-06-01

    Human-wildlife conflict (HWC) is a conservation concern that increasingly threatens the continued existence of some of the world's most endangered species. With an increase in human population, urban sprawl and subsequent encroachment on wild land, human and wildlife interaction has become inevitable. In the majority of cases, this interaction results in a negative outcome for humans, wildlife or both. In China, these key elements, along with a decrease in wild prey species, have resulted in the expansion of HWC encounters, and the need for alleviating this conflict has become a conservation priority. Loss of human life, livestock and/or crops is most often the catalysts that fuel HWC. Techniques to alleviate conflict around the world have included preventative measures and mitigation techniques, such as financial compensation and other incentive programs. Both types of measures have had variable success. We review the current status of human-carnivore conflict management in China, and, drawing lessons from around the globe, we make recommendations for improving conservation management in China. For example, an increase in law enforcement in nature reserves is vital to reducing human disturbance in prime carnivore habitat, thereby reducing conflict encounters. Also, modifications to current wildlife compensation programs, so that they are linked with preventative measures, will ensure that moral hazards are avoided. Furthermore, investigating the potential for a community self-financed insurance scheme to fund compensation and increasing efforts to restore wild prey populations will improve the outcome for wildlife conservation. Ultimately, HWC management in China will greatly benefit from an integrative approach. © 2012 ISZS, Blackwell Publishing and IOZ/CAS.

  14. Weight management in type 2 diabetes: current and emerging approaches to treatment.

    Science.gov (United States)

    Van Gaal, Luc; Scheen, André

    2015-06-01

    Diabetes is a growing global health concern, as is obesity. Diabetes and obesity are intrinsically linked: obesity increases the risk of diabetes and also contributes to disease progression and cardiovascular disease. Although the benefits of weight loss in the prevention of diabetes and as a critical component of managing the condition are well established, weight reduction remains challenging for individuals with type 2 diabetes due to a host of metabolic and psychological factors. For many patients, lifestyle intervention is not enough to achieve weight loss, and alternative options, such as pharmacotherapy, need to be considered. However, many traditional glucose-lowering medications may lead to weight gain. This article focuses on the potential of currently available pharmacological strategies and on emerging approaches in development to support the glycemic and weight-loss goals of individuals with type 2 diabetes. Two pharmacotherapy types are considered: those developed primarily for blood glucose control that have a favorable effect on body weight and those developed primarily to induce weight loss that have a favorable effect on blood glucose control. Finally, the potential of combination therapies for the management of obese patients with type 2 diabetes is discussed. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  15. Approaches to chronic disease management evaluation in use in Europe : A review of current methods and performance measures

    NARCIS (Netherlands)

    Conklin, A.; Nolte, E.; Vrijhoef, H.J.M.

    2013-01-01

    Objectives: An overview was produced of approaches currently used to evaluate chronic disease management in selected European countries. The study aims to describe the methods and metrics used in Europe as a first to help advance the methodological basis for their assessment. Methods: A common

  16. Current approaches to cyanotoxin risk assessment and risk management around the globe

    Science.gov (United States)

    Ibelings, Bas W.; Backer, Lorraine C.; Kardinaal, W. Edwin A.; Chorus, Ingrid

    2015-01-01

    Toxic cyanobacteria became more widely recognized as a potential health hazard in the 1990s, and in 1998 the World Health Organization (WHO) first published a provisional Guideline Value of 1 μg L−1 for microcystin-LR in drinking-water. In this publication we compare risk assessment and risk management of toxic cyanobacteria in 17 countries across all five continents. We focus on the three main (oral) exposure vehicles to cyanotoxins: drinking-water, water related recreational and freshwater seafood. Most countries have implemented the provisional WHO Guideline Value, some as legally binding standard, to ensure the distribution of safe drinking-water with respect to microcystins. Regulation, however, also needs to address the possible presence of a wide range of other cyanotoxins and bioactive compounds, for which no guideline values can be derived due to insufficient toxicological data. The presence of microcystins (commonly expressed as microcystin-LR equivalents) may be used as proxy for overall guidance on risk management, but this simplification may miss certain risks, for instance from dissolved fractions of cylindrospermopsin and cyanobacterial neurotoxins. An alternative approach, often taken for risk assessment and management in recreational waters, is to regulate cyanobacterial presence – as cell numbers or biomass – rather than individual toxins. Here, many countries have implemented a two or three tier alert level system with incremental severity. These systems define the levels where responses are switched from Surveillance to Alert and finally to Action Mode and they specify the short-term actions that follow. Surface bloom formation is commonly judged to be a significant risk because of the elevated concentration of microcystins in a scum. Countries have based their derivations of legally binding standards, guideline values, maximally allowed concentrations (or limits named otherwise) on very similar scientific methodology, but underlying

  17. Current approaches to cyanotoxin risk assessment and risk management around the globe.

    Science.gov (United States)

    Ibelings, Bas W; Backer, Lorraine C; Kardinaal, W Edwin A; Chorus, Ingrid

    2015-12-01

    Toxic cyanobacteria became more widely recognized as a potential health hazard in the 1990s, and in 1998 the World Health Organization (WHO) first published a provisional Guideline Value of 1 μg L -1 for microcystin-LR in drinking-water. In this publication we compare risk assessment and risk management of toxic cyanobacteria in 17 countries across all five continents. We focus on the three main (oral) exposure vehicles to cyanotoxins: drinking-water, water related recreational and freshwater seafood. Most countries have implemented the provisional WHO Guideline Value, some as legally binding standard, to ensure the distribution of safe drinking-water with respect to microcystins. Regulation, however, also needs to address the possible presence of a wide range of other cyanotoxins and bioactive compounds, for which no guideline values can be derived due to insufficient toxicological data. The presence of microcystins (commonly expressed as microcystin-LR equivalents) may be used as proxy for overall guidance on risk management, but this simplification may miss certain risks, for instance from dissolved fractions of cylindrospermopsin and cyanobacterial neurotoxins. An alternative approach, often taken for risk assessment and management in recreational waters, is to regulate cyanobacterial presence - as cell numbers or biomass - rather than individual toxins. Here, many countries have implemented a two or three tier alert level system with incremental severity. These systems define the levels where responses are switched from Surveillance to Alert and finally to Action Mode and they specify the short-term actions that follow. Surface bloom formation is commonly judged to be a significant risk because of the elevated concentration of microcystins in a scum. Countries have based their derivations of legally binding standards, guideline values, maximally allowed concentrations (or limits named otherwise) on very similar scientific methodology, but underlying

  18. The unique entity of nodular lymphocyte-predominant Hodgkin lymphoma: current approaches to diagnosis and management.

    Science.gov (United States)

    Hawkes, Eliza A; Wotherspoon, Andrew; Cunningham, David

    2012-03-01

    Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare disease constituting only 3-8% of all Hodgkin lymphoma. It has a distinct histological and clinical presentation as well as significantly different natural history compared to the classical form of Hodgkin lymphoma. Presenting most often as early-stage disease, NLPHL is characterized by frequent relapses, but paradoxically an overall good prognosis. The approach to management should therefore reflect this pattern and focus on attaining prolonged remissions, with long-term follow-up paramount. Due to the rarity of the disease, few prospective data exist. Options for treatment include radiotherapy, chemotherapy or combined chemotherapy plus radiotherapy and targeted anti-CD20 antibody therapy, as well as observation in selected patients.

  19. Bacterial Diseases of Bananas and Enset: Current State of Knowledge and Integrated Approaches Toward Sustainable Management

    Directory of Open Access Journals (Sweden)

    Guy Blomme

    2017-07-01

    Full Text Available Bacterial diseases of bananas and enset have not received, until recently, an equal amount of attention compared to other major threats to banana production such as the fungal diseases black leaf streak (Mycosphaerella fijiensis and Fusarium wilt (Fusarium oxysporum f. sp. cubense. However, bacteria cause significant impacts on bananas globally and management practices are not always well known or adopted by farmers. Bacterial diseases in bananas and enset can be divided into three groups: (1 Ralstonia-associated diseases (Moko/Bugtok disease caused by Ralstonia solanacearum and banana blood disease caused by R. syzygii subsp. celebesensis; (2 Xanthomonas wilt of banana and enset, caused by Xanthomonas campestris pv. musacearum and (3 Erwinia-associated diseases (bacterial head rot or tip-over disease Erwinia carotovora ssp. carotovora and E. chrysanthemi, bacterial rhizome and pseudostem wet rot (Dickeya paradisiaca formerly E. chrysanthemi pv. paradisiaca. Other bacterial diseases of less widespread importance include: bacterial wilt of abaca, Javanese vascular wilt and bacterial fingertip rot (probably caused by Ralstonia spp., unconfirmed. This review describes global distribution, symptoms, pathogenic diversity, epidemiology and the state of the art for sustainable disease management of the major bacterial wilts currently affecting banana and enset.

  20. Management of Neuropsychiatric Systemic Lupus Erythematosus: Current Approaches and Future Perspectives.

    Science.gov (United States)

    Magro-Checa, César; Zirkzee, Elisabeth J; Huizinga, Tom W; Steup-Beekman, Gerda M

    2016-03-01

    Neuropsychiatric systemic lupus erythematosus (NPSLE) is a generic definition referring to a series of neurological and psychiatric symptoms directly related to systemic lupus erythematosus (SLE). NPSLE includes heterogeneous and rare neuropsychiatric (NP) manifestations involving both the central and peripheral nervous system. Due to the lack of a gold standard, the attribution of NP symptoms to SLE represents a clinical challenge that obligates the strict exclusion of any other potential cause. In the acute setting, management of these patients does not differ from other non-SLE subjects presenting with the same NP manifestation. Afterwards, an individualized therapeutic strategy, depending on the presenting manifestation and severity of symptoms, must be started. Clinical trials in NPSLE are scarce and most of the data are extracted from case series and case reports. High-dose glucocorticoids and intravenous cyclophosphamide remain the cornerstone for patients with severe symptoms that are thought to reflect inflammation or an underlying autoimmune process. Rituximab, intravenous immunoglobulins, or plasmapheresis may be used if response is not achieved. When patients present with mild to moderate NP manifestations, or when maintenance therapy is warranted, azathioprine and mycophenolate may be considered. When symptoms are thought to reflect a thrombotic underlying process, anticoagulation and antiplatelet agents are the mainstay of therapy, especially if antiphospholipid antibodies or antiphospholipid syndrome are present. Recent trials on SLE using new biologicals, based on newly understood SLE mechanisms, have shown promising results. Based on what we currently know about its pathogenesis, it is tempting to speculate how these new therapies may affect the management of NPSLE patients. This article provides a comprehensive and critical review of the literature on the epidemiology, pathophysiology, diagnosis, and management of NPSLE. We describe the most

  1. Post-operative complications after removal of sporadic vestibular schwannoma via retrosigmoid-suboccipital approach: current diagnosis and management.

    Science.gov (United States)

    Charalampakis, Stylianos; Koutsimpelas, Dimitrios; Gouveris, Haralampos; Mann, Wolf

    2011-05-01

    The retrosigmoid (suboccipital) approach is one of four surgical approaches for the treatment of vestibular schwannomas (acoustic neuromas). It is increasingly used by otologic surgeons, and in experienced hands is associated with improved results and more limited complications. Mortality rates are minimal and often zero, while postoperative sequelae, on the other hand, are not rare. In order to not only save the patient's life, but also to assure good quality of life after the surgery, one must consider many different aspects of management of the respective complications. In this review the issues of current management of CSF leak and meningitis, facial paresis, headache, hearing loss, unsteadiness, disequilibrium, vertigo, tinnitus, cerebellar and brain stem injuries or abscess, vascular complications and venous air embolism after retrosigmoid approach for removal of vestibular schwannomas are presented. © Springer-Verlag 2011

  2. Nanotechnology Based Theranostic Approaches in Alzheimer's Disease Management: Current Status and Future Perspective.

    Science.gov (United States)

    Ahmad, Javed; Akhter, Sohail; Rizwanullah, Md; Khan, Mohammad Ahmed; Pigeon, Lucie; Addo, Richard T; Greig, Nigel H; Midoux, Patrick; Pichon, Chantal; Kamal, Mohammad Amjad

    2017-01-01

    Alzheimer's disease (AD), a cognitive dysfunction/dementia state amongst the elders is characterized by irreversible neurodegeneration due to varied pathophysiology. Up till now, anti-AD drugs having different pharmacology have been developed and used in clinic. Yet, these medications are not curative and only lowering the AD associated symptoms. Improvement in treatment outcome required drug targeting across the blood-brain barrier (BBB) to the central nervous system (CNS) in optimal therapeutic concentration. Nanotechnology based diagnostic tools, drug carriers and theranostics offer highly sensitive molecular detection, effective drug targeting and their combination. Over the past decade, significant works have been done in this area and we have seen very remarkable outocome in AD therapy. Various nanoparticles from organic and inorganic nanomaterial category have successfully been investigated against AD. This paper discussed the role of nanoparticles in early detection of AD, effective drug targeting to brain and theranostic (diagnosis and therapy) approaches in AD's management. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  3. Financial Management: An Organic Approach

    Science.gov (United States)

    Laux, Judy

    2013-01-01

    Although textbooks present corporate finance using a topical approach, good financial management requires an organic approach that integrates the various assignments financial managers confront every day. Breaking the tasks into meaningful subcategories, the current article offers one approach.

  4. Fournier's gangrene current approaches.

    Science.gov (United States)

    Ozkan, Omer F; Koksal, Neset; Altinli, Ediz; Celik, Atilla; Uzun, Mehmet A; Cıkman, Oztekin; Akbas, Alpaslan; Ergun, Ersin; Kiraz, Hasan A; Karaayvaz, Muammer

    2016-10-01

    Fournier's gangrene is a rare but highly mortal infectious disease characterised by fulminant necrotising fasciitis involving the genital and perineal regions. The objective of this study is to analyse the demographics, clinical feature and treatment approaches as well as outcomes of Fournier's gangrene. Data were collected retrospectively from medical records and operative notes. Patient data were analysed by demographics, aetiological factors, clinical features, treatment approaches and outcomes. Twelve patients (five female and seven male) were enrolled in this study. The most common aetiology was perianal abscess (41·6%). Wound cultures showed a mixture of microorganisms in six (50%) patients. For faecal diversion, while colostomy was performed in six cases (50%), Flexi-Seal was used in two cases (16·6%). In four patients (33·4%), no faecal diversion was performed. Negative pressure wound therapy (NPWT) system was effective in the last four patients (33·4%). The mean hospitalisation period in patients who used NPWT was 18 days, while it was 20 days in the others. NPWT in Fournier's gangrene is a safe dressing method. It promotes granulation formation. Flexi-Seal faecal management is an alternative method to colostomy and provides protection from its associated complications. The combination of two devices (Flexi-Seal and NPWT) is an effective and comfortable method in the management of Fournier's gangrene in appropriate patients. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  5. Approaches to chronic disease management evaluation in use in Europe: a review of current methods and performance measures.

    Science.gov (United States)

    Conklin, Annalijn; Nolte, Ellen; Vrijhoef, Hubertus

    2013-01-01

    An overview was produced of approaches currently used to evaluate chronic disease management in selected European countries. The study aims to describe the methods and metrics used in Europe as a first to help advance the methodological basis for their assessment. A common template for collection of evaluation methods and performance measures was sent to key informants in twelve European countries; responses were summarized in tables based on template evaluation categories. Extracted data were descriptively analyzed. Approaches to the evaluation of chronic disease management vary widely in objectives, designs, metrics, observation period, and data collection methods. Half of the reported studies used noncontrolled designs. The majority measure clinical process measures, patient behavior and satisfaction, cost and utilization; several also used a range of structural indicators. Effects are usually observed over 1 or 3 years on patient populations with a single, commonly prevalent, chronic disease. There is wide variation within and between European countries on approaches to evaluating chronic disease management in their objectives, designs, indicators, target audiences, and actors involved. This study is the first extensive, international overview of the area reported in the literature.

  6. General Biology and Current Management Approaches of Soft Scale Pests (Hemiptera: Coccidae).

    Science.gov (United States)

    Camacho, Ernesto Robayo; Chong, Juang-Horng

    We summarize the economic importance, biology, and management of soft scales, focusing on pests of agricultural, horticultural, and silvicultural crops in outdoor production systems and urban landscapes. We also provide summaries on voltinism, crawler emergence timing, and predictive models for crawler emergence to assist in developing soft scale management programs. Phloem-feeding soft scale pests cause direct (e.g., injuries to plant tissues and removal of nutrients) and indirect damage (e.g., reduction in photosynthesis and aesthetic value by honeydew and sooty mold). Variations in life cycle, reproduction, fecundity, and behavior exist among congenerics due to host, environmental, climatic, and geographical variations. Sampling of soft scale pests involves sighting the insects or their damage, and assessing their abundance. Crawlers of most univoltine species emerge in the spring and the summer. Degree-day models and plant phenological indicators help determine the initiation of sampling and treatment against crawlers (the life stage most vulnerable to contact insecticides). The efficacy of cultural management tactics, such as fertilization, pruning, and irrigation, in reducing soft scale abundance is poorly documented. A large number of parasitoids and predators attack soft scale populations in the field; therefore, natural enemy conservation by using selective insecticides is important. Systemic insecticides provide greater flexibility in application method and timing, and have longer residual longevity than contact insecticides. Application timing of contact insecticides that coincides with crawler emergence is most effective in reducing soft scale abundance.

  7. Sepsis in Internal Medicine wards: current knowledge, uncertainties and new approaches for management optimization.

    Science.gov (United States)

    Zaccone, Vincenzo; Tosoni, Alberto; Passaro, Giovanna; Vallone, Carla Vincenza; Impagnatiello, Michele; Li Puma, Domenica Donatella; De Cosmo, Salvatore; Landolfi, Raffaele; Mirijello, Antonio

    2017-11-01

    Sepsis represents a global health problem in terms of morbidity, mortality, social and economic costs. Although usually managed in Intensive Care Units, sepsis showed an increased prevalence among Internal Medicine wards in the last decade. This is substantially due to the ageing of population and to multi-morbidity. These characteristics represent both a risk factor for sepsis and a relative contra-indication for the admission to Intensive Care Units. Although there is a lack of literature on the management of sepsis in Internal Medicine, the outcome of these patients seems to be gradually improving. This is due to Internists' increased adherence to guidelines and "bundles". The routine use of SOFA score helps physicians in the definition of septic patients, even if the optimal score has still to come. Point-of-care ultrasonography, lactates, procalcitonin and beta-d-glucan are of help for treatment optimization. The purpose of this narrative review is to focus on the management of sepsis in Internal Medicine departments, particularly on crucial concepts regarding diagnosis, risk assessment and treatment. Key Messages Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. The prevalence of sepsis is constantly increasing, affecting more hospital patients than any other disease. At least half of patients affected by sepsis are admitted to Internal Medicine wards. Adherence to guidelines, routine use of clinical and lab scores and point-of-care ultrasonography are of help for early recognition of septic patients and treatment optimization.

  8. Current approaches on the management of disused sealed sources in Bulgaria

    International Nuclear Information System (INIS)

    Benitez-Navarro, J. C.; Canizares, J.; Asuar, O.; Tapia, J.; Demireva, E.; Yordanova, O.; Stefanova, I.; Karadzhov, S.

    2005-01-01

    The main options for the safe management of existing Disused Sealed Radioactive Sources (DSRS) in Bulgaria are discussed. The specific installations for handling and conditioning of all type of DSRS are being designed. The necessary equipment and materials for all conditioning operations have been defined. As the final disposal route for the radioactive wastes in Bulgaria is not defined yet, the proposed conditioning process for the DSRS ensures that end-point disposal of DSRS is not jeopardized by actions taken at present. All the DSRS would be packaged in secure, safe, monitorable and retrievable manner for interim storage

  9. Current Approaches for Phenotyping as a Target for Precision Medicine in COPD Management.

    Science.gov (United States)

    Lopez-Campos, Jose Luis; Centanni, Stefano

    2018-03-20

    The study of airway diseases continues to present several challenges for modern medicine. The different disease presentations with variables and overlapping features may result in a real challenge for the clinician. In this context, the concept of precision medicine has started to emerge in order to give answers to some of these challenges from a diagnostic and therapeutic point of view. The main reasons to target for precision medicine in chronic obstructive pulmonary disease (COPD) include that there is variability in the clinical presentation, there is no correlation between the different clinical variables at the patient level, there are a number of relevant clinical variables associated with outcomes, we do have specific therapies for specific patient types, and that there is variability in the clinical response to different therapies. To bring precision medicine into clinical practice several approaches have been used, including the use of independent variables to identify subjects, the use of multidimensional indexes, the so-called clinical phenotypes, and the approximation by the so-called treatable traits. All these approaches have their strengths and weaknesses which are reviewed in the present document. Although there is no universally accepted proposal, the available initiatives provide us with a framework on which to start working and move toward precision medicine in COPD, with the ultimate goal of bringing the best possible medicine to each patient in particular.

  10. Analysis of the Current Nutrient Management Practices in Semi-Arid Areas of Eastern Kenya: A Nutmon Approach

    International Nuclear Information System (INIS)

    Karuku, A.M.

    2002-01-01

    Declining soil fertility caused mainly by continuous cultivation without adequate replenishment of nutrients, is a major factor contributing to low crop yields in the arid and semi arid areas of Kenya. Development of appropriate nutrient management strategies for suitable agricultural production in these areas is, therefore, a priority issue. in the study reported here, analyses of the current nutrient management practices were carried out using the nutrient monitoring (NUTMON) approach in order to create farm house-hold awareness on nutrient management aspects. The procedure involved participatory soil and nutrient flow maps and soil sampling at farm level. laboratory analysis of the soil samples was later carried out. Structured questionnaires were used for systematic collection of information on farm management practices in order to quantify flows of materials with emphasis on soil nutrients and cash. Results of the laboratory soil analysis were also presented to the farmers and discussed during feedback sessions. The test was carried out in three places namely, Kibwezi, Kasikeu and Kiomo. In all the three clusters, off-farm income was an important component of the total family income. Farm net cash flow was highest in Kibwezi cluster due to horticultural crop production activities. Household net cash flow was highest in Kasikeu, largely originating from off-farm income. It was concluded that NUTMON methodology appeared a suitable tool for the diagnostic of the farming system analysis and design in the arid and semi-arid lands of Kenya

  11. Current Approaches and New Developments in the Pharmacological Management of Tourette Syndrome.

    Science.gov (United States)

    Quezada, Julio; Coffman, Keith A

    2018-01-01

    Tourette syndrome (TS) is a neurodevelopmental disorder of unknown etiology characterized by spontaneous, involuntary movements and vocalizations called tics. Once thought to be rare, TS affects 0.3-1% of the population. Tics can cause physical discomfort, emotional distress, social difficulties, and can interfere with education and desired activities. The pharmacologic treatment of TS is particularly challenging, as currently the genetics, neurophysiology, and neuropathology of this disorder are still largely unknown. However, clinical experience gained from treating TS has helped us better understand its pathogenesis and, as a result, derive treatment options. The strongest data exist for the antipsychotic agents, both typical and atypical, although their use is often limited in children and adolescents due to their side-effect profiles. There are agents in a variety of other pharmacologic categories that have evidence for the treatment of TS and whose side-effect profiles are more tolerable than the antipsychotics; these include clonidine, guanfacine, baclofen, topiramate, botulinum toxin A, tetrabenazine, and deutetrabenazine. A number of new agents are being developed and tested as potential treatments for TS. These include valbenazine, delta-9-tetrahydrocannabidiol, and ecopipam. Additionally, there are agents with insufficient data for efficacy, as well as agents that have been shown to be ineffective. Those without sufficient data for efficacy include clonazepam, ningdong granule, 5-ling granule, omega-3 fatty acids, and n-acetylcysteine. The agents that have been shown to be ineffective include pramipexole and metoclopramide. We will review all of the established pharmacologic treatments, and discuss those presently in development.

  12. Contaminated land in Colombia: A critical review of current status and future approach for the management of contaminated sites.

    Science.gov (United States)

    Arias Espana, Victor Andres; Rodriguez Pinilla, Alfonso R; Bardos, Paul; Naidu, Ravi

    2018-03-15

    Environmental contaminants can have negative effects on human health and land, air and water resources. Consequently, there have been significant advances in regulation for protecting the environment in developed countries including the development of remediation frameworks and guidelines. On the other hand, fewer studies have been reported on the risks and health effects of contaminants in developing regions and there is scarce information regarding contaminated land assessment and environmental remediation. Colombia is an important emerging economy and has started to take the first steps towards the development of a framework for the management of contaminated sites and there are opportunities for the country to learn from countries with well-established frameworks such as the United States (US) and the United Kingdom (UK) and for international collaboration with organisations such as CRC for Contamination Assessment and Remediation of the Environment (CARE). We review main pollution issues, current status of contaminated land management in Colombia to identify the gaps in policy and regulation. We also review the UK and US contaminated land policies and regulations to identify the elements of those experiences that could support progress in the country. Finally, we propose recommendations (e.g. risk based approach, soil screening criteria, clean-up funding, liability) for Colombia that could support further development and implementation of a more effective contaminated land management framework. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Brain abscess: Current management

    Directory of Open Access Journals (Sweden)

    Hernando Alvis-Miranda

    2013-01-01

    Full Text Available Brain abscess (BA is defined as a focal infection within the brain parenchyma, which starts as a localized area of cerebritis, which is subsequently converted into a collection of pus within a well-vascularized capsule. BA must be differentiated from parameningeal infections, including epidural abscess and subdural empyema. The BA is a challenge for the neurosurgeon because it is needed good clinical, pharmacological, and surgical skills for providing good clinical outcomes and prognosis to BA patients. Considered an infrequent brain infection, BA could be a devastator entity that easily left the patient into dead. The aim of this work is to review the current concepts regarding epidemiology, pathophysiology, etiology, clinical presentation, diagnosis, and management of BA.

  14. [Current management of epilepsy].

    Science.gov (United States)

    Mizobuchi, Masahiro

    2013-09-01

    Epilepsy is one of the most common neurological disorders. Global neurological knowledge is essential for differential diagnosis of epileptic syndromes due to the diversity of ictal semiology, causes and syndromes. Neurologists play an important role in planning the medical care for patients with epilepsy, as medication is the most fundamental therapeutic strategy. Some patients with early-onset epilepsy require joint care by pediatric neurologists, those with intractable epilepsy by neurosurgeons, and those with psychological comorbidity by psychiatrists, and neurologists should play a coordinating role. While there is a great need for neurologists to participate in epilepsy care, neurologists in Japan currently do not participate substantially in the epilepsy management system. It is necessary to train more neurologists who can provide epilepsy care and conduct basic and clinical research on epilepsy by providing continuous education on epilepsy for general neurologists as well as pre- and post-graduate medical students. Most of the patients who require long-term treatment experience many medical problems and social handicaps, such as adverse effects of medication, social stigma, educational disadvantages and difficulties in obtaining driver's license. To improve the quality of life of patients with epilepsy, it is desirable to build broad medical-social networks participated by patients, doctors, neurological nurses, psychologists, social workers, school teachers, managers of employment support facilities and care givers.

  15. Management of Current Psychiatric Disorders

    Science.gov (United States)

    Carbonnel, François; David, Michel; Norton, Joanna; Bourrel, Gérard; Boulenger, Jean-Philippe; Capdevielle, Delphine

    2016-01-01

    Objective: Describe and analyse the experience of family physicians in managing current psychiatric disorders to obtain a better understanding of the underlying reasons of under-detection and inadequate prescribing identified in studies. Methods: A qualitative study using in-depth interviews. Sample of 15 practicing family physicians, recruited by telephone from a precedent cohort (Sesame1) with a maximum variation: sex, age, single or group practice, urban or rural. Qualitative method is inspired by the completed grounded theory of a verbatim semiopragmatic analysis from 2 experts in this approach. Results: Family physicians found that current psychiatric disorders were related to psychological symptoms in reaction to life events. Their role was to make patients aware of a psychiatric symptom rather than establish a diagnosis. Their management responsibility was considered in contrasting ways: it was claimed or endured. They defined their position as facilitating compliance to psychiatrist consultations, while assuring a complementary psychotherapeutic approach. Prescribing medication was not a priority for them. Conclusions: The identified under-detection is essentially due to inherent frontline conditions and complexity of clinical forms. The family physician role, facilitating compliance to psychiatrist consultations while assuring a support psychotherapy is the main result of this study. More studies should be conducted to define more accurately the clinical reality, management and course of current psychiatric disorders in primary care.

  16. Current approach to liver traumas.

    Science.gov (United States)

    Kaptanoglu, Levent; Kurt, Necmi; Sikar, Hasan Ediz

    2017-03-01

    out of 300). A multidisciplinary approach to the management of hepatic injuries has evolved over the last few decades, but the basic principles of trauma continue to be observed. Diagnostic and therapeutic endeavors are chosen based mainly on the stability of the patient. Stable patients with reliable examinations and available resources can be managed nonoperatively. Unstable patients require surgery. Our current approach to liver traumas is non operative technique, if possible. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  17. Advancing current approaches to disease management evaluation: capitalizing on heterogeneity to understand what works and for whom.

    Science.gov (United States)

    Elissen, Arianne M J; Adams, John L; Spreeuwenberg, Marieke; Duimel-Peeters, Inge G P; Spreeuwenberg, Cor; Linden, Ariel; Vrijhoef, Hubertus J M

    2013-03-14

    Evaluating large-scale disease management interventions implemented in actual health care settings is a complex undertaking for which universally accepted methods do not exist. Fundamental issues, such as a lack of control patients and limited generalizability, hamper the use of the 'gold-standard' randomized controlled trial, while methodological shortcomings restrict the value of observational designs. Advancing methods for disease management evaluation in practice is pivotal to learn more about the impact of population-wide approaches. Methods must account for the presence of heterogeneity in effects, which necessitates a more granular assessment of outcomes. This paper introduces multilevel regression methods as valuable techniques to evaluate 'real-world' disease management approaches in a manner that produces meaningful findings for everyday practice. In a worked example, these methods are applied to retrospectively gathered routine health care data covering a cohort of 105,056 diabetes patients who receive disease management for type 2 diabetes mellitus in the Netherlands. Multivariable, multilevel regression models are fitted to identify trends in clinical outcomes and correct for differences in characteristics of patients (age, disease duration, health status, diabetes complications, smoking status) and the intervention (measurement frequency and range, length of follow-up). After a median one year follow-up, the Dutch disease management approach was associated with small average improvements in systolic blood pressure and low-density lipoprotein, while a slight deterioration occurred in glycated hemoglobin. Differential findings suggest that patients with poorly controlled diabetes tend to benefit most from disease management in terms of improved clinical measures. Additionally, a greater measurement frequency was associated with better outcomes, while longer length of follow-up was accompanied by less positive results. Despite concerted efforts to adjust

  18. Systemic Right Ventricle in Adults With Congenital Heart Disease: Anatomic and Phenotypic Spectrum and Current Approach to Management.

    Science.gov (United States)

    Brida, Margarita; Diller, Gerhard-Paul; Gatzoulis, Michael A

    2018-01-30

    The systemic right ventricle (SRV) is commonly encountered in congenital heart disease representing a distinctly different model in terms of its anatomic spectrum, adaptation, clinical phenotype, and variable, but overall guarded prognosis. The most common clinical scenarios where an SRV is encountered are complete transposition of the great arteries with previous atrial switch repair, congenitally corrected transposition of the great arteries, double inlet right ventricle mostly with previous Fontan palliation, and hypoplastic left heart syndrome palliated with the Norwood-Fontan protocol. The reasons for the guarded prognosis of the SRV in comparison with the systemic left ventricle are multifactorial, including distinct fibromuscular architecture, shape and function, coronary artery supply mismatch, intrinsic abnormalities of the tricuspid valve, intrinsic or acquired conduction abnormalities, and varied SRV adaptation to pressure or volume overload. Management of the SRV remains an ongoing challenge because SRV dysfunction has implications on short- and long-term outcomes for all patients irrespective of underlying cardiac morphology. SRV dysfunction can be subclinical, underscoring the need for tertiary follow-up and timely management of target hemodynamic lesions. Catheter interventions and surgery have an established role in selected patients. Cardiac resynchronization therapy is increasingly used, whereas pharmacological therapy is largely empirical. Mechanical assist device and heart transplantation remain options in end-stage heart failure when other management strategies have been exhausted. The present report focuses on the SRV with its pathological subtypes, pathophysiology, clinical features, current management strategies, and long-term sequelae. Although our article touches on issues applicable to neonates and children, its main focus is on adults with SRV. © 2018 American Heart Association, Inc.

  19. Nanorobotics current approaches and techniques

    CERN Document Server

    Ferreira, Antoine

    2013-01-01

    Nanorobot devices now perform a wide variety of tasks at the nanoscale in a wide variety of fields including but not limited to fields such as manufacturing, medicine, supply chain, biology, and outer space. Nanorobotics: Current Approaches and Techniques is a comprehensive overview of this interdisciplinary field with a wide ranging discussion that includes nano-manipulation and industrial nanorobotics, nanorobotics in biology and medicine, nanorobotic sensing, navigation and swarm behavior, and protein and DNA-based nanorobotics. Also included is the latest on topics such as bio-nano-actuators and propulsion and navigation of nanorobotic systems using magnetic fields. Nanorobotics: Current Approaches and Techniques is an ideal book for scientists, researchers, and engineers actively involved in applied and robotic research and development.

  20. Low current approach to ignition

    International Nuclear Information System (INIS)

    Cenacchi, G.; Sugiyama, L.; Airoldi, A.; Coppi, B.

    1996-01-01

    The open-quotes standardclose quotes path to achieve ignition conditions so far has been that of producing plasmas with the maximum current and poloidal field that axe compatible with the applied toroidal field and the geometry of the adopted configuration (the low q a approach.) The other approach is that motivated by recent experiments with reversed shear configurations, with relatively low currents and high fields corresponding to high values of q a (e-g., q a ≅ 6). While the first approach can be pursued with ohmic heating alone, the second one necessarily involves an auxiliary heating system. One of the advantages of this approach is that the onset of large scale internal modes can be avoided as q(ψ) is kept above 1 over the entire plasma column. Since quite peaked density profiles are produced in the regimes where enhanced confinement is observed, the α-particle power levels for which ignition can be reached and therefore the thermal wall loading on the first wall, can be reduced relatively to the standard, low q a , approach. The possibility is considered that ignition is reached in the reversed shear, high q a , regime and that this is followed by a transition to non-reversed profiles, or even the low q a regime, assuming that the excitation of modes involving magnetic reconnection will not undermine the needed degree of confinement. These results have been demonstrated by numerical transport simulation for the Ignitor-Ult machine, but are applicable to all high field ignition experiments

  1. The Branding Management Approaches

    Institute of Scientific and Technical Information of China (English)

    YAKOUBI; Mohamed Lamine

    2014-01-01

    [Abstract]We wil try to present,through the display of the various branding concepts and theories, the different branding management approaches.This wil present the different visions of the discipline depending on the author to try and demonstrate their differences,at first, and their complementarities at last to help the different branding management practitioners (brand managers,marketing managers,advertisers,media-planners……) apprehend the right brand positioning strategy to engage.

  2. Advancing current approaches to disease management evaluation : Capitalizing on heterogeneity to understand what works and for whom

    NARCIS (Netherlands)

    Elissen, A.M.J.; Adams, J.L.; Spreeuwenberg, M.D.; Duimel-Peeters, I.G.P.; Spreeuwenberg, C.; Linden, A.; Vrijhoef, H.J.M.

    2013-01-01

    Background Evaluating large-scale disease management interventions implemented in actual health care settings is a complex undertaking for which universally accepted methods do not exist. Fundamental issues, such as a lack of control patients and limited generalizability, hamper the use of the

  3. The Role of Dog Population Management in Rabies Elimination—A Review of Current Approaches and Future Opportunities

    Science.gov (United States)

    Taylor, Louise H.; Wallace, Ryan M.; Balaram, Deepashree; Lindenmayer, Joann M.; Eckery, Douglas C.; Mutonono-Watkiss, Beryl; Parravani, Ellie; Nel, Louis H.

    2017-01-01

    Free-roaming dogs and rabies transmission are integrally linked across many low-income countries, and large unmanaged dog populations can be daunting to rabies control program planners. Dog population management (DPM) is a multifaceted concept that aims to improve the health and well-being of free-roaming dogs, reduce problems they may cause, and may also aim to reduce dog population size. In theory, DPM can facilitate more effective rabies control. Community engagement focused on promoting responsible dog ownership and better veterinary care could improve the health of individual animals and dog vaccination coverage, thus reducing rabies transmission. Humane DPM tools, such as sterilization, could theoretically reduce dog population turnover and size, allowing rabies vaccination coverage to be maintained more easily. However, it is important to understand local dog populations and community attitudes toward them in order to determine whether and how DPM might contribute to rabies control and which DPM tools would be most successful. In practice, there is very limited evidence of DPM tools achieving reductions in the size or turnover of dog populations in canine rabies-endemic areas. Different DPM tools are frequently used together and combined with rabies vaccinations, but full impact assessments of DPM programs are not usually available, and therefore, evaluation of tools is difficult. Surgical sterilization is the most frequently documented tool and has successfully reduced dog population size and turnover in a few low-income settings. However, DPM programs are mostly conducted in urban settings and are usually not government funded, raising concerns about their applicability in rural settings and sustainability over time. Technical demands, costs, and the time necessary to achieve population-level impacts are major barriers. Given their potential value, we urgently need more evidence of the effectiveness of DPM tools in the context of canine rabies control

  4. The Role of Dog Population Management in Rabies Elimination—A Review of Current Approaches and Future Opportunities

    Directory of Open Access Journals (Sweden)

    Louise H. Taylor

    2017-07-01

    Full Text Available Free-roaming dogs and rabies transmission are integrally linked across many low-income countries, and large unmanaged dog populations can be daunting to rabies control program planners. Dog population management (DPM is a multifaceted concept that aims to improve the health and well-being of free-roaming dogs, reduce problems they may cause, and may also aim to reduce dog population size. In theory, DPM can facilitate more effective rabies control. Community engagement focused on promoting responsible dog ownership and better veterinary care could improve the health of individual animals and dog vaccination coverage, thus reducing rabies transmission. Humane DPM tools, such as sterilization, could theoretically reduce dog population turnover and size, allowing rabies vaccination coverage to be maintained more easily. However, it is important to understand local dog populations and community attitudes toward them in order to determine whether and how DPM might contribute to rabies control and which DPM tools would be most successful. In practice, there is very limited evidence of DPM tools achieving reductions in the size or turnover of dog populations in canine rabies-endemic areas. Different DPM tools are frequently used together and combined with rabies vaccinations, but full impact assessments of DPM programs are not usually available, and therefore, evaluation of tools is difficult. Surgical sterilization is the most frequently documented tool and has successfully reduced dog population size and turnover in a few low-income settings. However, DPM programs are mostly conducted in urban settings and are usually not government funded, raising concerns about their applicability in rural settings and sustainability over time. Technical demands, costs, and the time necessary to achieve population-level impacts are major barriers. Given their potential value, we urgently need more evidence of the effectiveness of DPM tools in the context of canine

  5. Cancer pain management-current status

    Directory of Open Access Journals (Sweden)

    Deepak Thapa

    2011-01-01

    Full Text Available Cancer pain is still one of the most feared entities in cancer and about 75% of these patients require treatment with opioids for severe pain. The cancer pain relief is difficult to manage in patients with episodic or incidental pain, neuropathic pain, substance abuse and with impaired cognitive or communication skills. This non-systematic review article aims to discuss reasons for under treatment, tools of pain assessment, cancer pain and anxiety and possibly carve new approaches for cancer pain management in future. The current status of World Health Organization analgesic ladder has also been reviewed. A thorough literature search was carried out from 1998 to 2010 for current status in cancer pain management in MEDLINE, WHO guidelines and published literature and relevant articles have been included.

  6. Current and Future Parts Management at NASA

    Science.gov (United States)

    Sampson, Michael J.

    2011-01-01

    This presentation provides a high level view of current and future electronic parts management at NASA. It describes a current perspective of the new human space flight direction that NASA is beginning to take and how that could influence parts management in the future. It provides an overview of current NASA electronic parts policy and how that is implemented at the NASA flight Centers. It also describes some of the technical challenges that lie ahead and suggests approaches for their mitigation. These challenges include: advanced packaging, obsolescence and counterfeits, the global supply chain and Commercial Crew, a new direction by which NASA will utilize commercial launch vehicles to get astronauts to the International Space Station.

  7. PROJECT APPROACH TO ENERGY MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Інга Борисівна СЕМКО

    2016-02-01

    Full Text Available Project management is widely used around the world as a tool to improve business performance. Correct implementation of the program of implementation of energy efficiency is accompanied by the adoption of an appropriate legislative framework, support programs, the approval of market-based instruments. Currently, it is paying enough attention to the effective application of market-based instruments, although most of the activities in the field of energy efficiency from the economic side are quite profitable. The authors suggested the use of the methodology of project management to the management of energy-saving measures, new approaches to the place and role of project management in the hierarchy of guidance. As a result, this innovation can improve the competitiveness of enterprises. The conclusions that the energy-saving project management allows you to get the best results for their implementation by reducing the time, resources, risk reduction.

  8. Current Approaches for Carotid Endarterectomy

    Directory of Open Access Journals (Sweden)

    Cengiz Köksal

    2010-12-01

    Full Text Available Permanent neurologic injuries and death following stroke, necessitates more vigorous treatment of carotid disease. Carotid stenting and carotid endarterectomy are treatment options in many centers besides medical treatment. Whether the patient is symptomatic or asymtomatic, indications and management strategies for treatment remain controversial. Despite the debate, carotid endarterectomy is still accepted to be the most efficientintervention to decrease risk of stroke due to carotid artery stenosis.

  9. Reconciling current approaches to blindsight

    DEFF Research Database (Denmark)

    Overgaard, Morten; Mogensen, Jesper

    2015-01-01

    After decades of research, blindsight is still a mysterious and controversial topic in consciousness research. Currently, many researchers tend to think of it as an ideal phenomenon to investigate neural correlates of consciousness, whereas others believe that blindsight is in fact a kind...... of degraded vision rather than "truly blind". This article considers both perspectives and finds that both have difficulties understanding all existing evidence about blindsight. In order to reconcile the perspectives, we suggest two specific criteria for a good model of blindsight, able to encompass all...

  10. [Current management of thalassemia intermedia].

    Science.gov (United States)

    Thuret, I

    2014-11-01

    Thalassemia intermedia is a clinical entity where anemia is mild or moderate, requiring no or occasional transfusion. Non-transfusion-dependent thalassemia encompasses 3 main clinical forms: beta-thalassemia intermedia, hemoglobin E/beta-thalassemia and alpha-thalassemia intermedia (HbH disease). Clinical severity of thalassemia intermedia increases with age, with more severe anemia and more frequent complications such as extramedullary hematopoiesis and iron overload mainly related to increased intestinal absorption. Numerous adverse events including pulmonary hypertension and hypercoagulability have been associated with splenectomy, often performed in thalassemia intermedia patients. The potential preventive benefit of transfusion and chelation therapies on the occurrence of numerous complications supports the strategy of an earlier therapeutic intervention. Increasing knowledge about pathophysiological mechanisms involved in thalassemia erythropoiesis and related iron overload is currently translating in novel therapeutic approaches. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  11. Managing the Services Supply Chain in the Department of Defense: An Empirical Study of Current Management Practices

    National Research Council Canada - National Science Library

    Apte, Aruna U; Apte, Uday M; Rendon, Rene G

    2008-01-01

    .... Specifically, we studied the current management practices in such areas as life cycle approach, project management, organization/ management structure, and training provided to services acquisition personnel...

  12. Current Approach to Child Rights

    Directory of Open Access Journals (Sweden)

    Huseyin Dag

    2015-03-01

    Full Text Available Rights of children, legally or morally all over the world that children are born with; education, health, life, shelter; physical, psychological or sexual exploitation protection of such rights is universal concept used to describethemall. Rights of children is an issue that should be addressed in the concept of human rights. Today, there are many parts of the world that human rights violations, child-size and grew broader, more difficult to intervene in a way that is situated. The idea that children than in adults of different physical, physiological, behavioral and psychological characteristics that continuous growth and improve dawareness that the establishment of thecare of children a society where the problem is and scientific approach everyone with this responsibility should be installed is shaped in Geneva Declaration of Childrens Rights. Today, the international document related to childrens rights is the United Nations Convention on the Rights of the Child adoptedand approved by 193 countries. Child policy in Turkey where 25 million children live is an issue that should be seriously considered. Thus, childrens rights, children working in coordination with the contract on the basis of a policy should be implemented fully. [Cukurova Med J 2015; 40(1.000: 1-5

  13. Orofacial pain management: current perspectives

    Directory of Open Access Journals (Sweden)

    Romero-Reyes M

    2014-02-01

    Full Text Available Marcela Romero-Reyes, James M Uyanik Orofacial and Head Pain Service, Department of Oral and Maxillofacial Pathology Radiology and Medicine, New York University College of Dentistry, New York, NY, USA Abstract: Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures. Orofacial pain (OFP can arise from different regions and etiologies. Temporomandibular disorders (TMD are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities. Keywords: pain, orofacial, neuropathic, TMD, trigeminal, headache

  14. Orofacial pain management: current perspectives.

    Science.gov (United States)

    Romero-Reyes, Marcela; Uyanik, James M

    2014-01-01

    Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). Orofacial pain (OFP) can arise from different regions and etiologies. Temporomandibular disorders (TMD) are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities.

  15. Sepsis: Current Definition, Pathophysiology, Diagnosis, and Management.

    Science.gov (United States)

    Taeb, Abdalsamih M; Hooper, Michael H; Marik, Paul E

    2017-06-01

    Sepsis is a clinical syndrome that results from the dysregulated inflammatory response to infection that leads to organ dysfunction. The resulting losses to society in terms of financial burden, morbidity, and mortality are enormous. We provide a review of sepsis, its underlying pathophysiology, and guidance for diagnosis and management of this common disease. Current established treatments include appropriate antimicrobial agents to target the underlying infection, optimization of intravascular volume to improve stroke volume, vasopressors to counteract vasoplegic shock, and high-quality supportive care. Appropriate implementation of established treatments combined with novel therapeutic approaches promises to continue to decrease the impact of this disease.

  16. An international approach to radioactive waste management

    International Nuclear Information System (INIS)

    Barlett, J.W.

    1994-01-01

    Needs and opportunities for an international approach to management and disposal of radioactive wastes are discussed. Deficiencies in current national radioactive waste management programs are described, and the impacts of management of fissile materials from nuclear weapons on waste management are addressed. Value-added services that can be provided by an international organization for waste management are identified, and candidate organizations that could provide these services are also identified

  17. Current Chemical Risk Management Activities

    Science.gov (United States)

    EPA's existing chemicals programs address pollution prevention, risk assessment, hazard and exposure assessment and/or characterization, and risk management for chemicals substances in commercial use.

  18. Current management of fungal infections.

    NARCIS (Netherlands)

    Meis, J.F.G.M.; Verweij, P.E.

    2001-01-01

    The management of superficial fungal infections differs significantly from the management of systemic fungal infections. Most superficial infections are treated with topical antifungal agents, the choice of agent being determined by the site and extent of the infection and by the causative organism,

  19. Current diagnostic approaches to subarachnoid haemorrhage

    International Nuclear Information System (INIS)

    U-King-Im, Jean Marie; Koo, Brendan; Trivedi, Rikin A.; Higgins, Nicholas J.; Tay, Keng Y.; Cross, Justin J.; Antoun, Nagui M.; Gillard, Jonathan H.

    2005-01-01

    Over the past decade, significant advances have been made in the field of subarachnoid haemorrhage (SAH). Prompt diagnosis with high-resolution CT and intensive critical care support remain key aspects of good patient management. Early identification and definitive treatment of underlying ruptured aneurysms is generally advocated to reduce the risk of re-bleeding, a complication with high mortality and morbidity. Although intra-arterial digital subtraction angiography (DSA) is still considered the gold standard for sourcing aneurysms, CT angiography, especially with the evolution of multi-slice technology, is slowly gaining acceptance as a rapid, accessible and minimally invasive method which appears likely to replace DSA as first-line modality in the future. Furthermore, the advent of Guglielmi detachable coils and the ISAT trial have revolutionised the treatment of ruptured aneurysms, with a significant trend towards endovascular coiling away from operative clipping. Improvements in clinical experience, coiling technology and assistive devices now allow interventionalists to potentially treat the majority of aneurysms, including wide-necked or complex lesions. The uncertain long-term results of coiling, however, still fuel strong debate and controversy. This review summarises current diagnostic approaches to SAH from a radiological perspective, with an emphasis on aneurysmal SAH and an evidence-based approach to the role of imaging and interventional radiology in diagnosis, treatment and follow-up. (orig.)

  20. Current diagnostic approaches to subarachnoid haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    U-King-Im, Jean Marie; Koo, Brendan; Trivedi, Rikin A.; Higgins, Nicholas J.; Tay, Keng Y.; Cross, Justin J.; Antoun, Nagui M.; Gillard, Jonathan H. [Addenbrooke' s Hospital, University Department of Radiology, Cambridge (United Kingdom)

    2005-06-01

    Over the past decade, significant advances have been made in the field of subarachnoid haemorrhage (SAH). Prompt diagnosis with high-resolution CT and intensive critical care support remain key aspects of good patient management. Early identification and definitive treatment of underlying ruptured aneurysms is generally advocated to reduce the risk of re-bleeding, a complication with high mortality and morbidity. Although intra-arterial digital subtraction angiography (DSA) is still considered the gold standard for sourcing aneurysms, CT angiography, especially with the evolution of multi-slice technology, is slowly gaining acceptance as a rapid, accessible and minimally invasive method which appears likely to replace DSA as first-line modality in the future. Furthermore, the advent of Guglielmi detachable coils and the ISAT trial have revolutionised the treatment of ruptured aneurysms, with a significant trend towards endovascular coiling away from operative clipping. Improvements in clinical experience, coiling technology and assistive devices now allow interventionalists to potentially treat the majority of aneurysms, including wide-necked or complex lesions. The uncertain long-term results of coiling, however, still fuel strong debate and controversy. This review summarises current diagnostic approaches to SAH from a radiological perspective, with an emphasis on aneurysmal SAH and an evidence-based approach to the role of imaging and interventional radiology in diagnosis, treatment and follow-up. (orig.)

  1. Review of current severe accident management approaches in Europe and identification of related modelling requirements for the computer code ASTEC V2.1

    International Nuclear Information System (INIS)

    Hermsmeyer, S.

    2015-01-01

    The severe accident at the Fukushima-Daiichi nuclear power plant (NPP) has led to a worldwide review of nuclear safety approaches and is bringing a refocussing of R and D in the field. To support these efforts several new Euratom FP7 projects have been launched. The CESAM project focuses on the improvement of the ASTEC computer code. ASTEC is jointly developed by IRSN and GRS and is considered as the European reference code for Severe Accident Analyses since it capitalizes knowledge from the extensive Euro-pean R and D in the field. The project aims at the code's enhancement and extension for use in Severe Accident Management (SAM) analysis of the NPPs of Generation II-III presently under operation or foreseen in the near future in Europe, spent fuel pools included. The work reported here is concerned with the importance, for the further development of the code, of SAM strategies to be simulated. To this end, SAM strategies applied in the EU have been compiled. This compilation is mainly based on the public information made available in the frame of the EU ''stress tests'' for NPPs and has been complemented by information pro-vided by the different CESAM partners. The context of SAM is explained and the strategies are presented. The modelling capabilities for the simulation of these strategies in the current production version 2.0 of ASTEC are discussed. Furthermore, the requirements for the next version of ASTEC V2.1 that is supported in the CESAM project are highlighted. They are a necessary complement to the list of code improvements that is drawn from consolidating new fields of application, like SFP and BWR model enhancements, and from new experimental results on severe accident phenomena.

  2. Review of current severe accident management approaches in Europe and identification of related modelling requirements for the computer code ASTEC V2.1

    Energy Technology Data Exchange (ETDEWEB)

    Hermsmeyer, S. [European Commission JRC, Petten (Netherlands). Inst. for Energy and Transport; Herranz, L.E.; Iglesias, R. [CIEMAT, Madrid (Spain); and others

    2015-07-15

    The severe accident at the Fukushima-Daiichi nuclear power plant (NPP) has led to a worldwide review of nuclear safety approaches and is bringing a refocussing of R and D in the field. To support these efforts several new Euratom FP7 projects have been launched. The CESAM project focuses on the improvement of the ASTEC computer code. ASTEC is jointly developed by IRSN and GRS and is considered as the European reference code for Severe Accident Analyses since it capitalizes knowledge from the extensive Euro-pean R and D in the field. The project aims at the code's enhancement and extension for use in Severe Accident Management (SAM) analysis of the NPPs of Generation II-III presently under operation or foreseen in the near future in Europe, spent fuel pools included. The work reported here is concerned with the importance, for the further development of the code, of SAM strategies to be simulated. To this end, SAM strategies applied in the EU have been compiled. This compilation is mainly based on the public information made available in the frame of the EU ''stress tests'' for NPPs and has been complemented by information pro-vided by the different CESAM partners. The context of SAM is explained and the strategies are presented. The modelling capabilities for the simulation of these strategies in the current production version 2.0 of ASTEC are discussed. Furthermore, the requirements for the next version of ASTEC V2.1 that is supported in the CESAM project are highlighted. They are a necessary complement to the list of code improvements that is drawn from consolidating new fields of application, like SFP and BWR model enhancements, and from new experimental results on severe accident phenomena.

  3. Peculiarities of the risk management system organization in current conditions

    OpenAIRE

    MIKHIN P.O.

    2014-01-01

    Risk-management system organization problem is topical nowadays. The innovation activity is defined as an activity vulnerable to risk and needs more attention. The basic approaches and elements of organization structure development in risk-management system are considered to find out the best structure for business modelling usage. Balance and combination of risk-management system types are required in current conditions.

  4. Current Risk Management Practices in Psychotherapy Supervision.

    Science.gov (United States)

    Mehrtens, Ilayna K; Crapanzano, Kathleen; Tynes, L Lee

    2017-12-01

    Psychotherapy competence is a core skill for psychiatry residents, and psychotherapy supervision is a time-honored approach to teaching this skill. To explore the current supervision practices of psychiatry training programs, a 24-item questionnaire was sent to all program directors of Accreditation Council for Graduate Medical Education (ACGME)-approved adult psychiatry programs. The questionnaire included items regarding adherence to recently proposed therapy supervision practices aimed at reducing potential liability risk. The results suggested that current therapy supervision practices do not include sufficient management of the potential liability involved in therapy supervision. Better protections for patients, residents, supervisors and the institutions would be possible with improved credentialing practices and better documentation of informed consent and supervision policies and procedures. © 2017 American Academy of Psychiatry and the Law.

  5. Narcolepsy: current treatment options and future approaches

    Science.gov (United States)

    Billiard, Michel

    2008-01-01

    The management of narcolepsy is presently at a turning point. Three main avenues are considered in this review: 1) Two tendencies characterize the conventional treatment of narcolepsy. Modafinil has replaced methylphenidate and amphetamine as the first-line treatment of excessive daytime sleepiness (EDS) and sleep attacks, based on randomized, double blind, placebo-controlled clinical trials of modafinil, but on no direct comparison of modafinil versus traditional stimulants. For cataplexy, sleep paralysis, and hypnagogic hallucinations, new antidepressants tend to replace tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) in spite of a lack of randomized, double blind, placebo-controlled clinical trials of these compounds; 2) The conventional treatment of narcolepsy is now challenged by sodium oxybate, the sodium salt of gammahydroxybutyrate, based on a series of randomized, double-blind, placebo-controlled clinical trials and a long-term open label study. This treatment has a fairly good efficacy and is active on all symptoms of narcolepsy. Careful titration up to an adequate level is essential both to obtain positive results and avoid adverse effects; 3) A series of new treatments are currently being tested, either in animal models or in humans, They include novel stimulant and anticataplectic drugs, endocrine therapy, and, more attractively, totally new approaches based on the present state of knowledge of the pathophysiology of narcolepsy with cataplexy, hypocretine-based therapies, and immunotherapy. PMID:18830438

  6. Challenges for current University management

    Directory of Open Access Journals (Sweden)

    Pedro Rodríguez Vargas

    2016-03-01

    Full Text Available The Ecuadorian university through a change of era, this complex pathway mediated by globalization imposes imminently. The aim of this paper is to present a review of literature on the main aspects of management that are generated for the interaction University - context. This scan was performed on secondary sources, and grounded in scienti?c data abstraction. College education is an information and training process that allows the scientific, technological, economic, political, social and cultural development of a region or country; however, some phenomena such as globalization, technological revolution or multiculturalism are key to this, same that can be considered as a problem or a challenge.

  7. Current management of hepatocellular carcinoma

    Science.gov (United States)

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

    2014-01-01

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

  8. Current management of wound healing

    DEFF Research Database (Denmark)

    Gottrup, F; Karlsmark, T

    2009-01-01

    in the next decade. It is the hope that increasing parts of the new knowledge from basic wound healing research will be implemented in daily clinical practice. The development of new treatment products will also continue, and especially new technologies with combined types of dressing materials or dressing......While the understanding of wound pathophysiology has progressed considerably over the past decades the improvements in clinical treatment has occurred to a minor degree. During the last years, however, new trends and initiatives have been launched, and we will continue to attain new information...... containing active substances will be accentuated. Further developments in the management structure and education will also continue and consensus of treatment guidelines, recommendations and organization models will hopefully be achieved....

  9. Management of infantile hemangiomas: Current trends

    Directory of Open Access Journals (Sweden)

    Gomathy Sethuraman

    2014-01-01

    Full Text Available Infantile hemangiomas (IH are common vascular tumours. IH have a characteristic natural course. They proliferate rapidly during the early infantile period followed by a period of gradual regression over several years. Most of the uncomplicated IH undergo spontaneous involution, with a small proportion of cases requiring intervention. These are children with IH in life-threatening locations, local complications like haemorrhage, ulceration and necrosis and functional or cosmetic disfigurements. Systemic corticosteroids have been the first line of treatment for many years. Recently, non-selective beta-blockers, such as oral propranalol and topical timolol, have emerged as promising and safer therapies. Other treatment options include interferon α and vincristine which are reserved for life-threatening haemangiomas that are unresponsive to conventional therapy. This review mainly focuses on the current trends and evidence-based approach in the management of IH.

  10. Current management of overactive bladder.

    Science.gov (United States)

    Cartwright, Rufus; Renganathan, Arasee; Cardozo, Linda

    2008-10-01

    The concept of overactive bladder has helped us address the problem of urgency and urge incontinence from a symptomatic perspective. In this review, we provide a critical summary of clinically relevant recent publications, focusing in particular on advances in our understanding of assessment methods and therapeutic interventions for overactive bladder in women. According to current definitions, the prevalence of overactive bladder in western nations is now estimated as 13.0%. Although the prevalence increases with age, the symptoms of overactive bladder may follow a relapsing and remitting course. There has been a proliferation of validated symptom and quality of life measures and increasing sophistication in the analysis of bladder diaries. The role of urodynamics in the evaluation of urgency remains uncertain, with many trials showing limited benefit as a preoperative investigation. Fluid restriction and bladder retraining remain important first-line interventions. Many new anticholinergic medications have been licensed, with limited benefits compared with existing preparations. Intravesical botulinum toxin has become a popular alternative for patients who fail oral therapies. Although there have been few important therapeutic innovations, recent publications have led to greater sophistication in assessment methods and a clearer understanding of the role of existing interventions.

  11. Current management of peptic ulcer perforations

    International Nuclear Information System (INIS)

    Menakuru, S.R.

    2004-01-01

    Perforation is a life-threatening complication of peptic ulcer disease. Smoking and use of non-steroidal anti-inflammatory drugs are important risk factors for perforation. Diagnosis is made clinically and confirmed by the presence of pneumoperitoneum on radiographs. Nonoperative management is successful in patients identified to have a spontaneously sealed perforation proven by water-soluble contrast gastroduodenogram. Operative management consists of the time-honoured practice of mental patch closure, but now this can be done by laparoscopic methods. The practice of addition of acid-reducing procedures is currently being debated though it continues to be recommended in good-risk patients. Laparoscopic approaches to closure of duodenal perforation are now being applied widely and may become the gold standard in the future especially in patients with < 10 mm perforation size presenting within the first 24 hours of onset of pain. The role of Helicobacter pylori in duodenal ulcer perforation is controversial and more studies are needed to answer this question though recent indirect evidence suggests that eradicating H pylori may reduce the necessity for adding acid reducing procedures and the associated morbidity. Perforation is a life-threatening complication of peptic ulcer disease. The management of peptic ulcer disease has evolved over the decades, due to advances in operative techniques, bacteriology and pharmacology. While the recognition of the role of Helicobacter pylori (H. pylori) in peptic ulceration has resulted in a paradigm shift in the management of uncomplicated peptic ulcers, debate continues about the appropriate management of perforated duodenal bulb and prepyloric ulcers. A new dimension has been added to this controversy by the advent of laparoscopic techniques for closing the perforation. A Medline search of all articles dealing with the management of peptic ulcer perforation published after 1985 was undertaken. The short listed articles were

  12. Narcolepsy: current treatment options and future approaches

    Directory of Open Access Journals (Sweden)

    Michel Billiard

    2008-06-01

    Full Text Available Michel BilliardDepartment of Neurology, Gui de Chauliac Hospital, Montpellier, FranceAbstract: The management of narcolepsy is presently at a turning point. Three main avenues are considered in this review: 1 Two tendencies characterize the conventional treatment of narcolepsy. Modafinil has replaced methylphenidate and amphetamine as the first-line treatment of excessive daytime sleepiness (EDS and sleep attacks, based on randomized, double blind, placebo-controlled clinical trials of modafinil, but on no direct comparison of modafinil versus traditional stimulants. For cataplexy, sleep paralysis, and hypnagogic hallucinations, new antidepressants tend to replace tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs in spite of a lack of randomized, double blind, placebo-controlled clinical trials of these compounds; 2 The conventional treatment of narcolepsy is now challenged by sodium oxybate, the sodium salt of gammahydroxybutyrate, based on a series of randomized, double-blind, placebo-controlled clinical trials and a long-term open label study. This treatment has a fairly good efficacy and is active on all symptoms of narcolepsy. Careful titration up to an adequate level is essential both to obtain positive results and avoid adverse effects; 3 A series of new treatments are currently being tested, either in animal models or in humans, They include novel stimulant and anticataplectic drugs, endocrine therapy, and, more attractively, totally new approaches based on the present state of knowledge of the pathophysiology of narcolepsy with cataplexy, hypocretine-based therapies, and immunotherapy.Keywords: narcolepsy, treatment, conventional drugs, modafinil, sodium oxybate, future treatments

  13. Current management of Hirschsprung's disease in Egypt: A survey ...

    African Journals Online (AJOL)

    Background/purpose Significant progress has been made in the management of Hirschsprung's disease (HD). The choice of the management plan, surgical approach, and operative details is still variable among pediatric surgeons. This survey aims to determine the current preferences of Egyptian pediatric surgeons in the ...

  14. Childhood obesity: Current and novel approaches.

    Science.gov (United States)

    Sabin, Matthew A; Kiess, Wieland

    2015-06-01

    The prevalence of childhood obesity has increased over the last fifty years by approximately 5% per decade, and approximately a quarter of all children are now either overweight or obese. These children have a significantly increased risk of many future health problems including adult obesity, type 2 diabetes and heart disease. Despite this relentless increase, common-sense approaches aimed at prevention and treatment have failed to solve the problem. Current approaches at prevention have faced major challenges with some progress in implementing smaller scale programs and social marketing, but little action on broad public policy approaches which often appears unpalatable to society or individual governments. Meanwhile, treatment approaches have mainly focused on lifestyle change, and novel approaches are urgently needed. Prevention needs to shift to improving maternal health prior to conception, with more research focussed on the impact of early years in programming offspring to future overweight/obesity. Likewise, treatment paradigms need to move from simply thinking that obesity can be solved by readdressing diet and activity levels. Novel approaches are needed which take into consideration the complex physiology which regulates early childhood growth and the development of obesity in susceptible individuals. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Managing projects using a project management approach

    Directory of Open Access Journals (Sweden)

    Marko D. Andrejić

    2011-04-01

    Full Text Available Modern management theory treats all complex tasks and duties like projects and make these projects possible to be managed by a particular organizational-management concept in order to achieve a goal effectively. A large number of jobs and tasks performed in the system of defense or for defense purposes have the characteristics of projects. Project management is both a skill and a science of monitoring human, material, financial, energy and other resources to achieve required objectives within the given limits: deadlines, time, budget, possibility of realization and the satisfaction of the interests of all project participants. Project management is a traditional area of applied (or functional management focused on managing complex and uncertain situations with defined goals. Introduction In conditions of rapid change and high uncertainty, only adaptive organizations survive, i. e. those that are able not only to react quickly to changes but also to proactively take advantage of changes. Development of project management The biggest influence on the development of the area had complex jobs within the engineering profession. In parallel with the traditional approach new approaches began to develop, while the traditional one still remained in use. Contrary to the traditional engineering approach, a dynamic model first developed in order to respond to demands for greater control of costs. Project management Project management is a skill and knowledge of human and material resources to achieve set objectives within prescribed limits: deadlines, time, budget, possibility of realization, and the satisfaction of all participants in the project. In order to realize a project effectively, it is necessary to manage it rationally. Planning and project management A project plan is a document that allows all team members insight on where to go, when to start and when to arrive, what is necessary to be done in order to achieve the project objectives and what

  16. Stress Management: A Rational Approach.

    Science.gov (United States)

    Reeves, Cecil

    This workbook was designed for use as the primary resource tool during a l-day participatory stress management seminar in which participants identify stressful situations, conduct analyses, and develop approaches to manage the stressful situations more effectively. Small group warm-up activities designed to introduce participants, encourage…

  17. Current approaches in atrial fibrillation treatment

    Directory of Open Access Journals (Sweden)

    Cenk Sarı

    2014-09-01

    Full Text Available Atrial fibrillation (AF is the most common sustained arrhythmia encountered in clinical practice. Its incidence increases with age. AF is classified into subtypes according to the duration and/or able to provide sinus rhytym. İnitially, patients should be evaluated for rhythm or rate control for appropriate treatment. Second stage of strategy aimed to investigate the feasibility of anticoagulation therapy. Recently, due to the progress made in treatment with rhythm control and anticoagulation therapy, either American or European guidelines have been renovated. These developments have taken place in the newly published guide. In this article, the current change in the management of AF is discussed.

  18. Operations management approach to hospitals.

    Science.gov (United States)

    Harvey, J; Duguay, C R

    1988-06-01

    An operations management systems approach can be a useful tool for coordinating and planning in a complex organization. The authors argue for adapting such an approach to health care from the manufacturing industries in order to facilitate strategy formulation, communication and implementation.

  19. APPROACHES TO QUALITY MANAGEMENT AT EUROPEAN LEVEL

    OpenAIRE

    Salagean Horatiu Catalin; Ilies Radu; Gherman Mihai; Cioban Bogdan

    2013-01-01

    In the current economic context, quality has become a source of competitive advantage and organizations must perceive quality as something natural and human in order to achieve excellence. The proper question for the context of the internationalisation of the economy is whether the culture of the regions, states or nations affects the development in the quality management field and the quality approach. The present study tries to give a theoretical approach of how culture influences the quali...

  20. Pancreaticoduodenal injuries: Re-evaluating current management ...

    African Journals Online (AJOL)

    Background. Pancreaticoduodenal injuries are uncommon owing to the protected position of the pancreas and duodenum in the retroperitoneum. Management depends on the extent of injury. This study was undertaken to document outcome of pancreaticoduodenal injuries and to re-evaluate our approach. Patients and ...

  1. Current Challenges in Social Media Management

    DEFF Research Database (Denmark)

    Tørning, Kristian; Jaffari, Zeshan Ali; Vatrapu, Ravi

    2015-01-01

    and sales, customer support, product innovation etc. To investigate current social media managerial practices, we conducted a multiple case study, employing structured in-depth interviews with social media managers at some of the leading multi-national companies headquartered in Denmark (LEGO®, Mærsk...

  2. Current management of severe dengue infection.

    Science.gov (United States)

    Lee, Tau Hong; Lee, Linda Kay; Lye, David Chien; Leo, Yee Sin

    2017-01-01

    Traditionally a disease mainly affecting the pediatric population, dengue burden has increased significantly in recent decades and adults with severe disease may become more common. There is currently no effective anti-viral agent available for the treatment of dengue and supportive care is the mainstay of management. Areas covered: We present a review of current literature on dengue severity classification systems and the management of severe dengue in adults. In particular, emphasis was placed on organ impairment in dengue and management of elderly individuals with multiple medical problems. Expert commentary: There is an urgent need to search for an effective anti-viral agent to treat infected individuals. The commercial availability of a dengue vaccine in older children has provided optimism in reducing the disease burden but long term efficacy and safety are unknown. The results from phase III trials of two new candidate vaccines are eagerly awaited.

  3. Comparing Teaching Approaches About Maxwell's Displacement Current

    Science.gov (United States)

    Karam, Ricardo; Coimbra, Debora; Pietrocola, Maurício

    2014-08-01

    Due to its fundamental role for the consolidation of Maxwell's equations, the displacement current is one of the most important topics of any introductory course on electromagnetism. Moreover, this episode is widely used by historians and philosophers of science as a case study to investigate several issues (e.g. the theory-experiment relationship). Despite the consensus among physics educators concerning the relevance of the topic, there are many possible ways to interpret and justify the need for the displacement current term. With the goal of understanding the didactical transposition of this topic more deeply, we investigate three of its domains: (1) The historical development of Maxwell's reasoning; (2) Different approaches to justify the term insertion in physics textbooks; and (3) Four lectures devoted to introduce the topic in undergraduate level given by four different professors. By reflecting on the differences between these three domains, significant evidence for the knowledge transformation caused by the didactization of this episode is provided. The main purpose of this comparative analysis is to assist physics educators in developing an epistemological surveillance regarding the teaching and learning of the displacement current.

  4. Accident management approach in Armenia

    International Nuclear Information System (INIS)

    Ghazaryan, K.

    1999-01-01

    In this lecture the accident management approach in Armenian NPP (ANPP) Unit 2 is described. List of BDBAs had been developed by OKB Gydropress in 1994. 13 accident sequences were included in this list. The relevant analyses had been performed in VNIIAES and the 'Guidelines on operator actions for beyond design basis accident (BDBA) management at ANPP Unit 2' had been prepared. These instructions are discussed

  5. A multilayer approach for turbidity currents

    Science.gov (United States)

    Fernandez-Nieto, Enrique; Castro Díaz, Manuel J.; Morales de Luna, Tomás

    2017-04-01

    When a river that carries sediment in suspension enters into a lake or the ocean it can form a plume that can be classified as hyperpycnal or hypopycnal. Hypopycnal plumes occurs if the combined density of the sediment and interstitial fluid is lower than that of the ambient. Hyperpycnal plumes are a class of sediment-laden gravity current commonly referred to as turbidity currents [7,9]. Some layer-averaged models have been previously developed (see [3, 4, 8] among others). Although this layer-averaged approach gives a fast and valuable information, it has the disadvantage that the vertical distribution of the sediment in suspension is lost. A recent technique based on a multilayer approach [1, 2, 6] has shown to be specially useful to generalize shallow water type models in order to keep track of the vertical components of the averaged variables in the classical shallow water equations. In [5] multilayer model is obtained using a vertical discontinuous Galerkin approach for which the vertical velocity is supposed to be piecewise linear and the horizontal velocity is supposed to be piecewise constant. In this work the technique introduced in [5] is generalized to derive a model for turbidity currents. This model allows to simulate hyperpycnal as well as hypopycnal plumes. Several numerical tests will be presented. References [1] E. Audusse, M. Bristeau, B. Perthame, and J. Sainte-Marie. A multilayer Saint-Venant system with mass exchanges for shallow water flows. derivation and numerical validation. ESAIM: Mathematical Modelling and Numerical Analysis, 45(1):169-200, (2010). [2] E. Audusse, M.-O. Bristeau, M. Pelanti, and J. Sainte-Marie. Approximation of the hydrostatic Navier–Stokes system for density stratified flows by a multilayer model: Kinetic interpretation and numerical solution. Journal of Computational Physics, 230(9):3453-3478, (2011). [3] S. F. Bradford and N. D. Katopodes. Hydrodynamics of turbid underflows. i: Formulation and numerical

  6. Computational approaches to analogical reasoning current trends

    CERN Document Server

    Richard, Gilles

    2014-01-01

    Analogical reasoning is known as a powerful mode for drawing plausible conclusions and solving problems. It has been the topic of a huge number of works by philosophers, anthropologists, linguists, psychologists, and computer scientists. As such, it has been early studied in artificial intelligence, with a particular renewal of interest in the last decade. The present volume provides a structured view of current research trends on computational approaches to analogical reasoning. It starts with an overview of the field, with an extensive bibliography. The 14 collected contributions cover a large scope of issues. First, the use of analogical proportions and analogies is explained and discussed in various natural language processing problems, as well as in automated deduction. Then, different formal frameworks for handling analogies are presented, dealing with case-based reasoning, heuristic-driven theory projection, commonsense reasoning about incomplete rule bases, logical proportions induced by similarity an...

  7. Current Therapeutic Strategies and Novel Approaches in Osteosarcoma

    International Nuclear Information System (INIS)

    Ando, Kosei; Heymann, Marie-Françoise; Stresing, Verena; Mori, Kanji; Rédini, Françoise; Heymann, Dominique

    2013-01-01

    Osteosarcoma is the most frequent malignant primary bone tumor and a main cause of cancer-related death in children and adolescents. Although long-term survival in localized osteosarcoma has improved to about 60% during the 1960s and 1970s, long-term survival in both localized and metastatic osteosarcoma has stagnated in the past several decades. Thus, current conventional therapy consists of multi-agent chemotherapy, surgery and radiation, which is not fully adequate for osteosarcoma treatment. Innovative drugs and approaches are needed to further improve outcome in osteosarcoma patients. This review describes the current management of osteosarcoma as well as potential new therapies

  8. Fuel management approach in IRIS Reactor

    International Nuclear Information System (INIS)

    Petrovic, B.; Franceschini, F.

    2004-01-01

    This paper provides an overview of fuel management approach employed in IRIS (International Reactor Innovative and Secure). It introduces the initial, rather ambitious, fuel management goals and discusses their evolution that reflected the fast pace of progress of the overall project. The updated objectives rely on using currently licensed fuel technology, thus enabling near-term deployment of IRIS, while still providing improved fuel utilization. The paper focuses on the reference core design and fuel management strategy that is considered in pre-application licensing, which enables extended cycle of three to four years. The extended cycle reduces maintenance outage time and increases capacity factor, thus reducing the cost of electricity. Approaches to achieving this goal are discussed, including use of different reloading strategies. Additional fuel management options, which are not part of the licensing process, but are pursued as long-term research for possible future implementation, are presented as well. (Author)

  9. Individual Performance Management: A Review of Current Practices

    Directory of Open Access Journals (Sweden)

    Ian O’ Boyle

    2013-05-01

    Full Text Available This paper provides a review of current practice in relation to individual performance management systems and process within the traditional business environment. There is a consensus that the role of the individual is central to the overall performance of any organization and how individual performances are managed and evaluated can have significant impacts on overall organizational success. Many organizations employ the traditional performance appraisal in order to monitor and assess individual employee performances. However, new approaches, such as 360-degree feedback have also become commonplace within the business environment. An analysis of each approach including benefits and challenges associated with each process is presented within this paper.

  10. Brainstem tumors: Current management and future directions

    Directory of Open Access Journals (Sweden)

    Pablo F Recinos

    2012-01-01

    Full Text Available Tumors arising in the brainstem comprise 10-20% of all pediatric central nervous system (CNS tumors and account for a small percentage in adults. The prognosis for these tumors was considered uniformly poor prior to the era of modern neuroimaging and the location was fraught with disaster being considered a ′no man′s land′ for neurosurgeons. Following the introduction of advanced imaging modalities and neurophysiological monitoring, striking progress has occurred in the management of these lesions. Brainstem tumors are presently classified based on their anatomic location, focality, and histopathology. This article reviews the current classification of brainstem tumors, current management options, and future directions in the treatment for these rare tumors.

  11. Current management of urethral stricture disease

    Directory of Open Access Journals (Sweden)

    Thomas G Smith

    2016-01-01

    Conclusions: Progress is being made toward consistent terminology, and nomenclature which will, in turn, help to standardize treatment within the field of urology. Treatment for urethral stricture and stenosis remains inconsistent between reconstructive and nonreconstructive urologists due to varying treatment algorithms and approaches to disease management. Tissue engineering appears to be future for reconstructive urethral surgery with reports demonstrating feasibility in the use of different tissue substitutes and grafts.

  12. Systems approach in energy management

    International Nuclear Information System (INIS)

    Dutta-Choudhury, K.

    1993-01-01

    Several years ago when the author was working in the chemicals division of a paper company in Instrumentation and Controls, one experience had a lasting impact on his work approach which is systems approach. The maintenance manager told the author that a very important piece of boiler instrument of the power plant had broken down and delivery of the replacement needed to be expedited. The instrument was ordered over the phone in another city. The purchase order was personally delivered at the supplier's office and arrangements were made so the instrument was put on the next flight. A week later the maintenance manager indicated that the particular instrument still had not arrived in the plant and he could not run the power plant. Thus the company incurred substantial losses. Further inquiries showed that the instrument did indeed arrive at the plant stores on time. But, in the absence of any instructions thereon, the instrument was not delivered to the power plant. The sense of urgency was lost in the existing delivery process. In other words, the process or system failed. The whole process from requisitioning to delivery of ordered items was analyzed and corrective procedures were incorporated to prevent future repetitions. This brings up the subject of systems approach in engineering management in general and energy management in particular. This involves defining an objective and designing a system for an effective way of getting there

  13. Current Management of Sickle Cell Anemia

    Science.gov (United States)

    McGann, Patrick T.; Nero, Alecia C.; Ware, Russell E.

    2013-01-01

    Proper management of sickle cell anemia (SCA) begins with establishing the correct diagnosis early in life, ideally during the newborn period. The identification of affected infants by neonatal screening programs allows early initiation of prophylactic penicillin and pneumococcal immunizations, which help prevent overwhelming sepsis. Ongoing education of families promotes the early recognition of disease-released complications, which allows prompt and appropriate medical evaluation and therapeutic intervention. Periodic evaluation by trained specialists helps provide comprehensive care, including transcranial Doppler examinations to identify children at risk for primary stroke, plus assessments for other parenchymal organ damage as patients become teens and adults. Treatment approaches that previously highlighted acute vaso-occlusive events are now evolving to the concept of preventive therapy. Liberalized use of blood transfusions and early consideration of hydroxyurea treatment represent a new treatment paradigm for SCA management. PMID:23709685

  14. Environmental management: A system approach

    Science.gov (United States)

    Petak, William J.

    1981-05-01

    This paper presents a system framework whose purpose is to improve understanding of environmental management. By analyzing the links between elements of the environmental management system, it is possible to construct a model that aids thinking systematically about the decision-making subsystem, and other subsystems, of the entire environmental management system. Through a multidisciplinary environmental approach, each of the individual subsystems is able to adapt to threats and opportunities. The fields of government, market economics, social responsibility and ecology, for example, are so complex that it is extremely difficult to develop a framework that gives full consideration to all aspects. This paper, through the application of a highly idealized system framework, attempts to show the general relationships that exist between complex system elements.

  15. Sleep bruxism: Current knowledge and contemporary management

    Science.gov (United States)

    Yap, Adrian U.; Chua, Ai Ping

    2016-01-01

    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

  16. Management of scalp psoriasis: current perspectives

    Directory of Open Access Journals (Sweden)

    Blakely K

    2016-03-01

    Full Text Available Kim Blakely,1 Melinda Gooderham2 1Faculty of Medicine, University of Toronto, Toronto, ON, Canada; 2Skin Centre for Dermatology, Peterborough, ON, Canada Abstract: Psoriasis is a chronic inflammatory condition. The age of onset, chronicity, physical, and psychosocial consequences of the disease cause psoriasis to have a significant impact on patient quality of life. Scalp psoriasis is no different, and effective treatment results in an improvement in quality of life. Successful management of scalp psoriasis includes topical therapies that are acceptable to the patient for mild-to-moderate disease, and systemic therapies for recalcitrant or moderate-to-severe disease. The most effective topical therapies are corticosteroid products, or combination products with calcipotriol and corticosteroid. Newer vehicle options provide more attractive and pleasing products for patients and may improve adherence. The current perspectives for management of scalp psoriasis are discussed including available data for systemic therapy of severe disease. Keywords: psoriasis, scalp psoriasis, topical therapies, systemic therapies, biologics

  17. Sleep bruxism: Current knowledge and contemporary management.

    Science.gov (United States)

    Yap, Adrian U; Chua, Ai Ping

    2016-01-01

    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.

  18. Linearized dynamical approach to current algebra

    International Nuclear Information System (INIS)

    Scadron, M.D.

    1995-07-01

    We study the original motivations searching for a nonlinear chiral Lagrangian to replace the linear sigma model while manifesting all the successful properties of current algebra and partial conservation of axial currents (PCAC). (author). 26 refs

  19. Current possibilities in occlusal caries management

    Directory of Open Access Journals (Sweden)

    Hrvoje Jurić

    2013-11-01

    Full Text Available Dental caries is a multifactorial disease that affects most populations throughout the world and it is still the primary cause of oral pain and tooth loss. The occlusal surfaces of posterior teeth are the most vulnerable sites for dental caries due to their anatomy. Therefore, the aim of the following article is to summarize current knowledge on occlusal caries development and the possibilities of its prevention. Although the overall caries rate today has fallen for populations in industrialized countries, the rate of occlusal surface caries has not decreased. This may be explained with fact that topically applied fluorides and their mode of action prevent caries better on smooth than on occlusal surfaces. As we know, tooth decay of first permanent molars causes a great deal of different short and long term difficulties for patients. Therefore, there is a continuous need for implementation of programs for caries prevention in permanent teeth. Nowadays, we like to treat our patients by minimally invasive methods. A very important step in our effective preventive treatment is sealing pits and fissures as a cornerstone of occlusal caries management. Reliable assessment of caries activity is also very important for defining treatment needs and plans. A very important decision, which should be made during occlusal caries management, is the selection of restorative material according to the treatment plan. Conclusion. Current possibilities in occlusal caries prevention and management are very effective. Therefore, dentists today do not have any excuse for avoiding the philosophy of Minimally Invasive Dentistry, especially when we talk about caries management of occlusal surfaces in permanent molars.

  20. Breast cancer treatment: historical review and current approaches

    International Nuclear Information System (INIS)

    Kulakowski, A.

    1994-01-01

    The evolution and development of opinions on the diagnosis and treatment of breast cancer since Galen to present time is presented. The concept of breast cancer as a local disease has been replaced by the understanding of its systemic character. On this background described are the methods of surgical treatment beginning from early - supraradical, to present -conservative approaches. The ''milestones'' in diagnosis and treatment of breast cancer of the last 40 years are presented. Current methods of breast cancer management include correct diagnosis (clinical examination, mammography, ultrasound, fine needle aspiration biopsy), TNM staging, adequate loco-regional therapy, systemic therapy, rehabilitation, reconstruction and careful follow-up. (author)

  1. Epistaxis management: current understanding amongst junior doctors.

    Science.gov (United States)

    Fox, R; Nash, R; Liu, Z-W; Singh, A

    2016-03-01

    Epistaxis is a common and potentially life-threatening emergency. This survey assesses understanding and confidence in epistaxis management amongst current junior doctors. A cross-sectional study was conducted of foundation year one and two doctors based at three National Health Service trusts within a single region of the UK, assessing basic understanding and procedural confidence. A total of 111 foundation doctors completed this survey. The average duration of undergraduate exposure to otolaryngology was 8.1 days. Forty-one per cent of respondents stated that they would apply pressure to the nasal bones to control epistaxis. Seventy-five per cent lacked confidence in their ability to manage epistaxis. Those with two weeks or more of undergraduate exposure to otolaryngology were more confident than those with one week or less of exposure (p epistaxis management, with patient safety implications. Confidence is associated with the duration of undergraduate exposure to otolaryngology. A minimum emergency safe competency should be a priority during foundation training if not achieved in UK medical schools.

  2. Managing three approaches to organizational behaviour for ...

    African Journals Online (AJOL)

    Managing three approaches to organizational behaviour for effectiveness and ... job description, productivity, individual performance and management matters. ... having attained a high productivity level, the organization starts going down.

  3. Managing hyperthyroidism in pregnancy: current perspectives

    Directory of Open Access Journals (Sweden)

    Andersen SL

    2016-09-01

    Full Text Available Stine Linding Andersen,1,2 Peter Laurberg1,3,† 1Department of Endocrinology, Aalborg University Hospital, 2Department of Clinical Biochemistry, Aalborg University Hospital, 3Department of Clinical Medicine, Aalborg University, Aalborg, Denmark †Peter Laurberg passed away on June 20, 2016 Abstract: Hyperthyroidism in women who are of childbearing age is predominantly of autoimmune origin and caused by Graves’ disease. The physiological changes in the maternal immune system during a pregnancy may influence the development of this and other autoimmune diseases. Furthermore, pregnancy-associated physiological changes influence the synthesis and metabolism of thyroid hormones and challenge the interpretation of thyroid function tests in pregnancy. Thyroid hormones are crucial regulators of early development and play an important role in the maintenance of a normal pregnancy and in the development of the fetus, particularly the fetal brain. Untreated or inadequately treated hyperthyroidism is associated with pregnancy complications and may even program the fetus to long-term development of disease. Thus, hyperthyroidism in pregnant women should be carefully managed and controlled, and proper management involves different medical specialties. The treatment of choice in pregnancy is antithyroid drugs (ATDs. These drugs are effective in the control of maternal hyperthyroidism, but they all cross the placenta, and so need careful management and control during the second half of pregnancy considering the risk of fetal hyper- or hypothyroidism. An important aspect in the early pregnancy is that the predominant side effect to the use of ATDs in weeks 6–10 of pregnancy is birth defects that may develop after exposure to available types of ATDs and may be severe. This review focuses on four current perspectives in the management of overt hyperthyroidism in pregnancy, including the etiology and incidence of the disease, how the diagnosis is made, the

  4. Managing hyperthyroidism in pregnancy: current perspectives.

    Science.gov (United States)

    Andersen, Stine Linding; Laurberg, Peter

    2016-01-01

    Hyperthyroidism in women who are of childbearing age is predominantly of autoimmune origin and caused by Graves' disease. The physiological changes in the maternal immune system during a pregnancy may influence the development of this and other autoimmune diseases. Furthermore, pregnancy-associated physiological changes influence the synthesis and metabolism of thyroid hormones and challenge the interpretation of thyroid function tests in pregnancy. Thyroid hormones are crucial regulators of early development and play an important role in the maintenance of a normal pregnancy and in the development of the fetus, particularly the fetal brain. Untreated or inadequately treated hyperthyroidism is associated with pregnancy complications and may even program the fetus to long-term development of disease. Thus, hyperthyroidism in pregnant women should be carefully managed and controlled, and proper management involves different medical specialties. The treatment of choice in pregnancy is antithyroid drugs (ATDs). These drugs are effective in the control of maternal hyperthyroidism, but they all cross the placenta, and so need careful management and control during the second half of pregnancy considering the risk of fetal hyper- or hypothyroidism. An important aspect in the early pregnancy is that the predominant side effect to the use of ATDs in weeks 6-10 of pregnancy is birth defects that may develop after exposure to available types of ATDs and may be severe. This review focuses on four current perspectives in the management of overt hyperthyroidism in pregnancy, including the etiology and incidence of the disease, how the diagnosis is made, the consequences of untreated or inadequately treated disease, and finally how to treat overt hyperthyroidism in pregnancy.

  5. Managing hyperthyroidism in pregnancy: current perspectives

    Science.gov (United States)

    Andersen, Stine Linding; Laurberg, Peter

    2016-01-01

    Hyperthyroidism in women who are of childbearing age is predominantly of autoimmune origin and caused by Graves’ disease. The physiological changes in the maternal immune system during a pregnancy may influence the development of this and other autoimmune diseases. Furthermore, pregnancy-associated physiological changes influence the synthesis and metabolism of thyroid hormones and challenge the interpretation of thyroid function tests in pregnancy. Thyroid hormones are crucial regulators of early development and play an important role in the maintenance of a normal pregnancy and in the development of the fetus, particularly the fetal brain. Untreated or inadequately treated hyperthyroidism is associated with pregnancy complications and may even program the fetus to long-term development of disease. Thus, hyperthyroidism in pregnant women should be carefully managed and controlled, and proper management involves different medical specialties. The treatment of choice in pregnancy is antithyroid drugs (ATDs). These drugs are effective in the control of maternal hyperthyroidism, but they all cross the placenta, and so need careful management and control during the second half of pregnancy considering the risk of fetal hyper- or hypothyroidism. An important aspect in the early pregnancy is that the predominant side effect to the use of ATDs in weeks 6–10 of pregnancy is birth defects that may develop after exposure to available types of ATDs and may be severe. This review focuses on four current perspectives in the management of overt hyperthyroidism in pregnancy, including the etiology and incidence of the disease, how the diagnosis is made, the consequences of untreated or inadequately treated disease, and finally how to treat overt hyperthyroidism in pregnancy. PMID:27698567

  6. The current management of spinal cord cavernoma.

    Science.gov (United States)

    Velz, Julia; Bozinov, Oliver; Sarnthein, Johannes; Regli, Luca; Bellut, David

    2018-01-04

    Spinal cavernous malformations (SCM) were once thought to be rare lesions of the spinal cord. However, with the broad use of modern imaging techniques the incidence of SCM has significantly increased over the last decades. Management of both symptomatic and incidental findings is therefore of growing importance. However, experience with treatment and follow-up is very limited. We performed a single institution retrospective review of consecutive patients with SCM treated at our Department between 2006-2016 and discuss the clinical features as well as surgical versus conservative outcomes. We further provide a systematic literature search and discuss the best management of SCM, analyzing recent publications on SCM imaging techniques, surgical approaches and natural history. From a total number of 406 consecutive patients with cavernous malformations (CM) treated at our Department between 2006-2016, 29 (7.1 %) were found to be affected by SCM. The localization was cervical in 10 (34.5 %), cervicothoracic in 3 (10.4 %) and thoracic in 16 (55.2 %) patients. In 90 % of patients (n = 26) the diagnosis was made after onset of clinical symptoms. Conservative management was performed for 8 patients, whereas 21 patients underwent surgical removal of the lesion via a posterior approach using (hemi-) laminectomy or laminoplasty. Functional status improved in 15 patients (62. 5%) and remained unchanged in 6 patients (28.5 %) in the operative group, whereas 2 patients (25 %) improved and 6 patients (75 %) remained unchanged in the conservative group during long-term follow-up. Gross-total resection is the only definitive treatment option for symptomatic SCM. Surgical extirpation of the symptomatic SCM lesion through an unilateral laminectomy ( = hemilaminectomy) approach within 3 months of presentation seems to be good treatment option with an acceptable risk of complications and good long-term outcomes. Conservative treatment should be performed in asymptomatic patients and

  7. Current approaches to assessing intangible assets

    OpenAIRE

    Урусова, Зінаїда Петрівна

    2013-01-01

    The article analyzes methods of assessing intangible assets in Ukraine as well as in accordance with International Financial Reporting Standards. Contemporary approaches to assessing intangible assets have been researched.

  8. The management object in risk management approaches

    OpenAIRE

    Christiansen, Ulrik

    2013-01-01

    Using a systematic review of the last 55 years of research within risk management this paper explores how risk management as a management technology (methodologies, tools and frameworks to mitigate or manage risks) singles out risks as an object for management in order to make action possible. The paper synthesise by developing a framework of how different views on risk management enable and constrain the knowledge about risk and thus frame the possibilities to measure, analyse an...

  9. ECAPS - Eddy Current Approach and Proximity Satellites

    Data.gov (United States)

    National Aeronautics and Space Administration — Multiple, energized coils in a small satellite will generate eddy currents in the skin of the International Space Station (ISS). This will create repulsive forces...

  10. A holistic approach to the mycetoma management.

    Science.gov (United States)

    Bakhiet, Sahar Mubarak; Fahal, Ahmed Hassan; Musa, Ahmed Mudawi; Mohamed, El Samani Wadaa; Omer, Rowa Fathelrahman; Ahmed, Eiman Siddig; El Nour, Mustafa; Mustafa, El Rayah Mohamed; Sheikh A Rahman, Manar El; Suliman, Suliman Hussein; El Mamoun, Mohamed A Gadir; El Amin, Hajo Mohamed

    2018-05-01

    Mycetoma, one of the badly neglected tropical diseases, it is a localised chronic granulomatous inflammatory disease characterised by painless subcutaneous mass and formation of multiple sinuses that produce purulent discharge and grains. If untreated early and appropriately, it usually spread to affect the deep structures and bone resulting in massive damage, deformities and disabilities. It can also spread via the lymphatics and blood leading to distant secondary satellites associated with high morbidity and mortality. To date and despite progress in mycetoma research, a huge knowledge gap remains in mycetoma pathogenesis and epidemiology resulting in the lack of objective and effective control programmes. Currently, the available disease control method is early case detection and proper management. However, the majority of patients present late with immense disease and for many of them, heroic substantial deforming surgical excisions or amputation are the only prevailing treatment options. In this communication, the Mycetoma Research Center (MRC), Sudan shares its experience in implementing a new holistic approach to manage mycetoma patients locally at the village level. The MRC in collaboration with Sennar State Ministry of Health, Sudan had established a region mycetoma centre in one of the endemic mycetoma villages in the state. The patients were treated locally in that centre, the local medical and health personals were trained on early case detection and management, the local community was trained on mycetoma advocacy, and environmental conditions improvement. This comprehensive approach had also addressed the patients' socioeconomic constraints that hinder early presentation and treatment. This approach has also included the active local health authorities, community and civil society participation and contributions to deliver the best management. This holistic approach for mycetoma patients' management proved to be effective for early case detection and

  11. Neutralized current acid waste consolidation management plan

    International Nuclear Information System (INIS)

    Powell, W.J.; Brown, R.G.; Galbraith, J.; Jensen, C.; Place, D.E.; Reddick, G.W.; Zuroff, W.; Brothers, A.J.

    1996-01-01

    The scope of this evaluation is to recommend a management plan for the high-heat tank waste, including neutralized current acid waste (NCAW) in AY and AZ Tank Farms, and tank C-106 waste. The movement of solids, liquids and salt cake in the designated tank farms is included. Decision analysis techniques were used to determine a recommended alternative. The recommended course of action was replacement of a 75-hp mixer pump in tank AY-102 and in-tank concentration of tank AZ-102 supernate. The alternative includes transfer fo tank C-106 sludge to tank AY-102, then transfer to tank AY-102 and tank C-106 sludge to tank AZ-101 using the new 75-hp mixer pump installed in tank AY-102. Tank AZ-101 becomes a storage tank for high-level waste (HLW) sludge, with the capacity to mix and transfer sludge as desired

  12. Optimal management of genital herpes: current perspectives.

    Science.gov (United States)

    Sauerbrei, Andreas

    2016-01-01

    As one of the most common sexually transmitted diseases, genital herpes is a global medical problem with significant physical and psychological morbidity. Genital herpes is caused by herpes simplex virus type 1 or type 2 and can manifest as primary and/or recurrent infection. This manuscript provides an overview about the fundamental knowledge on the virus, its epidemiology, and infection. Furthermore, the current possibilities of antiviral therapeutic interventions and laboratory diagnosis of genital herpes as well as the present situation and perspectives for the treatment by novel antivirals and prevention of disease by vaccination are presented. Since the medical management of patients with genital herpes simplex virus infection is often unsatisfactory, this review aims at all physicians and health professionals who are involved in the care of patients with genital herpes. The information provided would help to improve the counseling of affected patients and to optimize the diagnosis, treatment, and prevention of this particular disease.

  13. Optimizing nitrogen fertilizer use: Current approaches and simulation models

    International Nuclear Information System (INIS)

    Baethgen, W.E.

    2000-01-01

    Nitrogen (N) is the most common limiting nutrient in agricultural systems throughout the world. Crops need sufficient available N to achieve optimum yields and adequate grain-protein content. Consequently, sub-optimal rates of N fertilizers typically cause lower economical benefits for farmers. On the other hand, excessive N fertilizer use may result in environmental problems such as nitrate contamination of groundwater and emission of N 2 O and NO. In spite of the economical and environmental importance of good N fertilizer management, the development of optimum fertilizer recommendations is still a major challenge in most agricultural systems. This article reviews the approaches most commonly used for making N recommendations: expected yield level, soil testing and plant analysis (including quick tests). The paper introduces the application of simulation models that complement traditional approaches, and includes some examples of current applications in Africa and South America. (author)

  14. Optimal management of chronic osteomyelitis: current perspectives

    Directory of Open Access Journals (Sweden)

    Pande KC

    2015-08-01

    Full Text Available Ketan C Pande Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BruneiAbstract: Chronic osteomyelitis is a challenging condition to treat. It is seen mostly after open fractures or in implant-related infections following treatment of fractures and prosthetic joint replacements. Recurrence of infection is well known, and successful treatment requires a multidisciplinary team approach with surgical debridement and appropriate antimicrobial therapy as the cornerstone of treatment. Staging of the disease and identification of the causative microorganism is essential before initiation of treatment. Important surgical steps include radical debridement of necrotic and devitalized tissue, removal of implants, management of resultant dead space, soft-tissue coverage, and skeletal stabilization or management of skeletal defects. The route of administration and duration of antimicrobial therapy continues to be debated. The role of biofilm is now clearly established in the chronicity of bone infection, and newer modalities are being developed to address various issues related to biofilm formation. The present review addresses various aspects of chronic osteomyelitis of long bones seen in adults, with a review of recent developments. Keywords: osteomyelitis, infection, biofilm, bone, therapy, treatment

  15. Current Trends in the Management of Retinoblastoma

    Directory of Open Access Journals (Sweden)

    Hayyam Kıratlı

    2014-09-01

    Full Text Available Retinoblastoma is the most common primary intraocular malignant tumor of early childhood, and 95% of all cases are diagnosed before the age of 5 years. Tumors are evaluated and classified based on laterality, genetic features, the number, location and size of foci. Currently, systemic and intaarterial chemotherapy are the most commonly used management options worldwide. Group A tumors are treated with focal techniques including transpupillary thermotherapy, cryotherapy, or laser photocoagulation. Groups B and C tumors are managed with systemic chemotherapy and focal consolidation techniques. Group D lesions are best treated with systemic chemotherapy, subtenon carboplatin injection or external beam radiotherapy. Alternatively, groups B, C and D tumors can be primarily treated with intraarterial chemotherapy. Intravitreal melphalan injection can be an alternative treatment for eyes with recurrent or persistent vitreous seeding. Group E eyes are often enucleated, however, depending on the fellow eye, systemic or intraarterial chemotherapy may be administered. Systemic chemotherapy is also mandatory if high-risk histopathological features are found after enucleation. (Turk J Ophthalmol 2014; 44: Supplement 22-8

  16. Current management of obsessive and phobic states

    Directory of Open Access Journals (Sweden)

    Goljevscek S

    2011-09-01

    Full Text Available Serena Goljevscek1, Livia A Carvalho21Psychiatric Clinic, University of Udine, Udine, Italy; 2Health Science Research Centre, Department of Life Sciences, Roehampton University, London, UKAbstract: Obsessional states show an average point prevalence of 1%–3% and a lifetime prevalence of 2%–2.5%. Most treatment-seeking patients with obsessions continue to experience significant symptoms after 2 years of prospective follow-up. A significant burden of impairment, distress, and comorbidity characterize the course of the illness, leading to an increased need for a better understanding of the nature and management of this condition. This review aims to give a representation of the current pharmacological and psychotherapeutic strategies used in the treatment of obsessive-compulsive disorder. Antidepressants (clomipramine and selective serotonin reuptake inhibitors are generally the first-line choice used to handle obsessional states, showing good response rates and long-term positive outcomes. About 40% of patients fail to respond to selective serotonin reuptake inhibitors. So far, additional pharmacological treatment strategies have been shown to be effective, ie, administration of high doses of selective serotonin reuptake inhibitors, as well as combinations of different drugs, such as dopamine antagonists, are considered efficacious and well tolerated strategies in terms of symptom remission and side effects. Psychotherapy also plays an important role in the management of obsessive-compulsive disorder, being effective for a wide range of symptoms, and many studies have assessed its long-term efficacy, especially when added to appropriate pharmacotherapy. In this paper, we also give a description of the clinical and psychological features likely to characterize patients refractory to treatment for this illness, with the aim of highlighting the need for greater attention to more patient-oriented management of the disease.Keywords: obsessive

  17. RISK MANAGEMENT APPROACHES AND PRACTICES IN IT PROJECTS

    Directory of Open Access Journals (Sweden)

    BRANDAS Claudiu

    2012-07-01

    Full Text Available Risk is identified in project management literature as an important factor influencing IT projects success, and it is relevant for both academic and practitionersn#8217; communities. The paper presents the past and current approaches to risk management in IT projects. The objective of this paper is to compare the different approaches and relate them to existing practices. Project management literature and practice have brought different approaches to risk management, and as a result, many projects ended in failure. We present how risk management is considered in the literature, and we compare the main two approaches: the evaluation approach and the management approach. The contingency approach does not consider risk management to be a specific process as it is an embedded process in the other project management processes. Then, we present the main practices in risk management. The methodology applied is based on documentary study review and analysis of the concepts used by the literature. We analyzed the literature published between 1978 and 2011 from the main journals for IT project management and found out that the essence of project management is risk management. The risk management practices have a considerable influence on stakeholdersn#8217; perception of project success. But, regardless of the chosen approach, a standard method for identifying, assessing, and responding to risks should be included in any project as this influences the outcome of the project.

  18. Current Perspectives on Desmoid Tumors: The Mayo Clinic Approach

    Directory of Open Access Journals (Sweden)

    Scott Okuno

    2011-08-01

    Full Text Available Desmoid tumors are a rare group of locally aggressive, non malignant tumors of fibroblastic origin that can lead to significant morbidity due to local invasion. Despite advances in the understanding of these tumors, their natural history is incompletely understood and the optimal treatment is still a matter of debate. Local control is the main goal of treatment and there has been a change in philosophy regarding the management of these tumors from aggressive surgical resection to function preservation. A multidisciplinary approach is essential to plan local control with acceptable morbidity. The current Mayo Clinic algorithm for the treatment of these tumors is based on institutional experience and the available evidence in the literature: asymptomatic/non progressive lesions away from vital structures are managed with observation and regular imaging; primary or recurrent desmoid tumors which are symptomatic or progressive or near vital structures are managed with wide surgical resection when wide surgical margins are possible with minimal functional and cosmetic loss. When positive or close surgical margins are likely, surgical resection with adjuvant radiotherapy or definitive radiotherapy is preferred. If likely functional or cosmetic deficit is unacceptable, radiotherapy is the treatment of choice. Unresectable lesions are considered for radiotherapy, chemotherapy or newer modalities however an unresectable lesion associated with a painful, functionless, infected extremity is managed with an amputation.

  19. Current Perspectives on Desmoid Tumors: The Mayo Clinic Approach

    International Nuclear Information System (INIS)

    Joglekar, Siddharth B.; Rose, Peter S.; Sim, Franklin; Okuno, Scott; Petersen, Ivy

    2011-01-01

    Desmoid tumors are a rare group of locally aggressive, non malignant tumors of fibroblastic origin that can lead to significant morbidity due to local invasion. Despite advances in the understanding of these tumors, their natural history is incompletely understood and the optimal treatment is still a matter of debate. Local control is the main goal of treatment and there has been a change in philosophy regarding the management of these tumors from aggressive surgical resection to function preservation. A multidisciplinary approach is essential to plan local control with acceptable morbidity. The current Mayo Clinic algorithm for the treatment of these tumors is based on institutional experience and the available evidence in the literature: asymptomatic/non progressive lesions away from vital structures are managed with observation and regular imaging; primary or recurrent desmoid tumors which are symptomatic or progressive or near vital structures are managed with wide surgical resection when wide surgical margins are possible with minimal functional and cosmetic loss. When positive or close surgical margins are likely, surgical resection with adjuvant radiotherapy or definitive radiotherapy is preferred. If likely functional or cosmetic deficit is unacceptable, radiotherapy is the treatment of choice. Unresectable lesions are considered for radiotherapy, chemotherapy or newer modalities however an unresectable lesion associated with a painful, functionless, infected extremity is managed with an amputation

  20. Current approaches to gene regulatory network modelling

    Directory of Open Access Journals (Sweden)

    Brazma Alvis

    2007-09-01

    Full Text Available Abstract Many different approaches have been developed to model and simulate gene regulatory networks. We proposed the following categories for gene regulatory network models: network parts lists, network topology models, network control logic models, and dynamic models. Here we will describe some examples for each of these categories. We will study the topology of gene regulatory networks in yeast in more detail, comparing a direct network derived from transcription factor binding data and an indirect network derived from genome-wide expression data in mutants. Regarding the network dynamics we briefly describe discrete and continuous approaches to network modelling, then describe a hybrid model called Finite State Linear Model and demonstrate that some simple network dynamics can be simulated in this model.

  1. Strategic PSYOP Management: A Marketing Management Approach

    National Research Council Canada - National Science Library

    Sokoloski, Joseph A., III

    2005-01-01

    .... The opportunity derived from this study is to adapt principles of civilian marketing management to provide a framework and tools to develop PSYOP campaign management into a more efficient, target audience based mechanism.

  2. Current DOE direction in low-level waste management

    International Nuclear Information System (INIS)

    Wilhite, E.L.; Dolenc, M.R.; Shupe, M.W.; Waldo, L.C.

    1989-01-01

    The U.S. Department of Energy (DOE) is implementing revised DOE Order 5820.2A Radioactive Waste Management. Chapter III of the revised order provides prescriptive requirements for managing low-level waste and is the subject of this paper. The revised order requires that all DOE low-level radioactive and mixed waste be systematically managed, using an approach that considers the combination of waste management practices used in waste generation reduction, segregation, treatment, packaging, storage, and disposal. The Order defines performance objectives for protecting groundwater, for protecting against intrusion, and for maintaining adequate operational practices. A performance assessment will be required to ensure that waste management operations comply with these performance objectives. DOE implementation of the revised Order includes work in the areas of leach testing, waste stabilization, waste certification, facility monitoring, and management of unique waste streams. This paper summarizes the status of this work and the current direction DOE is taking in managing low-level waste under DOE 5820.2A

  3. The Management Object in Risk Management Approaches

    DEFF Research Database (Denmark)

    Christiansen, Ulrik

    Using a systematic review of the last 55 years of research within risk management this paper explores how risk management as a management technology (methodologies, tools and frameworks to mitigate or manage risks) singles out risks as an object for management in order to make action possible....... The paper synthesise by developing a framework of how different views on risk management enable and constrain the knowledge about risk and thus frame the possibilities to measure, analyse and calculate uncertainty and risk. Inspired by social studies of finance and accounting, the paper finally develops...... three propositions that illustrate how the framing of risk establishes a boundary for how managers might understand value creation and the possible future and how this impacts the possible responses to risk....

  4. Assessment and applicability of evaluation tools: Current practice in a sample of European countries and steps towards a state-of-the-art approach. Road Infrastructure Safety Management Evaluation Tools (RISMET), Deliverables No. 4 and 5.

    NARCIS (Netherlands)

    Elvik, R.

    2014-01-01

    This report surveys current practice in a sample of European countries with respect to the use of ten different tools for safety management of road systems. The report also proposes steps that can be taken to bring the use of these management tools closer to their state-of-the-art versions. These

  5. Current management of urethral stricture disease

    Science.gov (United States)

    Smith, Thomas G.

    2016-01-01

    Introduction: Broadly defined, urethral strictures are narrowing of the urethral lumen that is surrounded by corpus spongiosum, i.e., urethral meatus through the bulbar urethra. Urethral stenosis is narrowing of the posterior urethra, i.e., membranous urethra through bladder neck/prostate junction, which is not enveloped by corpus spongiosum. The disease has significant quality of life ramifications because many times younger patients are affected by this compared to many other urological diseases. Methods: A review of the scientific literature concerning urethral stricture, stenosis, treatment, and outcomes was performed using Medline and PubMed (U.S. National Library of Medicine and the National Institutes of Health). Abstracts from scientific meetings were included in this review. Results: There is level 3 evidence regarding the etiology and epidemiology of urethral strictures, stenoses, and pelvic fracture urethral injuries. Outcomes data from literature regarding intervention for urethral stricture are largely limited to level 3 evidence and expert opinion. There is a single level 1 study comparing urethral dilation and direct vision internal urethrotomy. Urethroplasty outcomes data are limited to level 3 case series. Conclusions: Progress is being made toward consistent terminology, and nomenclature which will, in turn, help to standardize treatment within the field of urology. Treatment for urethral stricture and stenosis remains inconsistent between reconstructive and nonreconstructive urologists due to varying treatment algorithms and approaches to disease management. Tissue engineering appears to be future for reconstructive urethral surgery with reports demonstrating feasibility in the use of different tissue substitutes and grafts. PMID:26941491

  6. Electronic resource management systems a workflow approach

    CERN Document Server

    Anderson, Elsa K

    2014-01-01

    To get to the bottom of a successful approach to Electronic Resource Management (ERM), Anderson interviewed staff at 11 institutions about their ERM implementations. Among her conclusions, presented in this issue of Library Technology Reports, is that grasping the intricacies of your workflow-analyzing each step to reveal the gaps and problems-at the beginning is crucial to selecting and implementing an ERM. Whether the system will be used to fill a gap, aggregate critical data, or replace a tedious manual process, the best solution for your library depends on factors such as your current soft

  7. Managing plutonium in Britain. Current options

    International Nuclear Information System (INIS)

    1998-01-01

    This is the report of a two day meeting to discuss issues arising from the reprocessing of plutonium and production of mixed oxide nuclear fuels in Britain. It was held at Charney Manor, near Oxford, on June 25 and 26, 1998, and was attended by 35 participants, including government officials, scientists, policy analysts, representatives of interested NGO's, journalists, a Member of Parliament, and visiting representatives from the US and Irish governments. The topic of managing plutonium has been a consistent thread within ORG's work, and was the subject of one of our previous reports, CDR 12. This particular seminar arose out of discussions earlier in the year between Dr. Frank Barnaby and the Rt. Hon. Michael Meacher MP, Minister for the Environment. With important decisions about the management of plutonium in Britain pending, ORG undertook to hold a seminar at which all aspects of the subject could be aired. A number of on-going events formed the background to this initiative. The first was British Nuclear Fuels' [BNFL] application to the Environment Agency to commission a mixed oxide fuel [MOX] plant at Sellafield. The second was BNFL's application to vary radioactive discharge limits at Sellafield. Thirdly, a House of Lords Select Committee was in process of taking evidence, on the disposal of radioactive waste. Fourthly, the Royal Society, in a recent report entitled Management of Separated Plutonium, recommended that 'the Government should commission a comprehensive review... of the options for the management of plutonium'. Four formal presentations were made to the meeting, on the subjects of Britain's plutonium policy, commercial prospects for plutonium use, problems of plutonium accountancy, and the danger of nuclear terrorism, by experts from outside the nuclear industry. It was hoped that the industry's viewpoint would also be heard, and BNFL were invited to present a paper, but declined on the grounds that they were 'currently involved in a formal

  8. CURRENT APPROACHES TO CHEMORADIOTHERAPY FOR MALIGNANT GLIOMAS

    Directory of Open Access Journals (Sweden)

    Ye. L. Choinzonov

    2014-01-01

    Full Text Available High-grade malignant gliomas (WHO grade G III–IV account for more than 50% of all primary brain tumors. Despite aggressive treatment, survival rates are still very low with a median reported survival of no more than 1.5 years.Radiation therapy is an integral part of the combined treatment, but often does not influence lethally on resistant tumor cells. Thereby, in recent decades there has been an active search for novel approaches to the treatment of malignant gliomas (chemotherapeutic drugs, biological modifiers, local hyperthermia. Experimental data showed that the effect of high temperatures has both a direct damaging effect on tumor cells and a sensitizing effect. Significant advantages are achieved when the complex treatment of different malignant tumorsincludes local hyperthermia. However data on the treatment of patients with primary and recurrent gliomas G III–IV using local hyperthermia are scarce.The literature review is given in the article provides an overview of the existing treatment methods for brain tumors.

  9. Pulp regeneration: Current approaches and future challenges

    Directory of Open Access Journals (Sweden)

    Jingwen eYANG

    2016-03-01

    Full Text Available Regenerative endodontics aims to replace inflamed/necrotic pulp tissues with regenerated pulp-like tissues to revitalize teeth and improve life quality. Pulp revascularization case reports, which showed successful clinical and radiographic outcomes, indicated the possible clinical application of pulp regeneration via cell homing strategy. From a clinical point of view, functional pulp-like tissues should be regenerated with the characterization of vascularization, re-innervation, and dentin deposition with a regulated rate similar to that of normal pulp. Efficient root canal disinfection and proper size of the apical foramen are the two requisite preconditions for pulp regeneration. Progress has been made on pulp regeneration via cell homing strategies. This review focused on the requisite preconditions and cell homing strategies for pulp regeneration. In addition to the traditionally used mechanical preparation and irrigation, antibiotics, irrigation assisted with EndoVac apical negative-pressure system, and ultrasonic and laser irradiation are now being used in root canal disinfection. In addition, pulp-like tissues could be formed with the apical foramen less than 1 mm, although more studies are needed to determine the appropriate size. Moreover, signaling molecules including stromal cell derived factor (SDF-1α, basic Fibroblast Growth Factor (bFGF, Platelet Derived Growth Factor (PDGF, stem cell factor (SCF, and Granulocyte Colony-Stimulating Factor (G-CSF were used to achieve pulp-like tissue formation via a cell homing strategy. Studies on the cell sources of pulp regeneration might give some indications on the signaling molecular selection. The active recruitment of endogenous cells into root canals to regenerate pulp-like tissues is a novel concept that may offer an unprecedented opportunity for the near-term clinical translation of current biology-based therapies for dental pulp regeneration.

  10. Croatian radioactive waste management program: Current status

    International Nuclear Information System (INIS)

    Matanic, R.; Lebegner, J.

    2001-01-01

    Croatia has a responsibility to develop a radioactive waste management program partly due to co-ownership of Krsko nuclear power plant (Slovenia) and partly because of its own medical and industrial radioactive waste. The total amount of generated radioactive waste in Croatia is stored in temporary storages located at two national research institutes, while radioactive waste from Krsko remains in temporary storage on site. National power utility Hrvatska Elektroprivreda (HEP) and Hazardous Waste Management Agency (APO) coordinate the work regarding decommissioning, spent fuel management and low and intermediate level radioactive waste (LILRW) management in Croatia. Since the majority of work has been done in developing the LILRW management program, the paper focuses on this part of radioactive waste management. Issues of site selection, repository design, safety assessment and public acceptance are being discussed. A short description of the national radioactive waste management infrastructure has also been presented. (author)

  11. Data management in HEP: An approach

    CERN Document Server

    Furano, F

    2011-01-01

    In this work we describe an approach to data access and data management in High Energy Physics (HEP), which privileges performance, simplicity and scalability, in storage systems that co-operate. We also show why the typical HEP workload is well positioned to access geographically distributed data repositories and then weigh the advantages and disadvantages of accessing data across the Wide Area Network. We discuss some points related to the architecture that a data access/management system should have in order to exploit these possibilities. Currently, this kind of methods were explored by using the xrootd/Scalla software suite, that is a workable example of a distributed non-transactional data repository for the HEP environment. The Scalla architecture naturally allows us to build globally federated repositories congruent with diverse HEP collaborations and their data access needs. These methodologies, however, are based on the concept of caching associated to a performant messaging system and to an efficie...

  12. Effective emergency management: reconsidering the bureaucratic approach.

    Science.gov (United States)

    Neal, D M; Phillips, B D

    1995-12-01

    The command and control approach is compared with the Emergent Human Resources Model (EHRM) approach to emergency management. Four decades of systematic research shows that a rigid, bureaucratic command and control approach to emergency management generally leads to an ineffective emergency response. Previous studies and our own research suggest that flexible, malleable, loosely coupled, organizational configurations can create a more effective disaster response.

  13. Approaches of Improving University Assets Management Efficiency

    Science.gov (United States)

    Wang, Jingliang

    2015-01-01

    University assets management, as an important content of modern university management, is generally confronted with the issue of low efficiency. Currently, to address the problems exposed in university assets management and take appropriate modification measures is an urgent issue in front of Chinese university assets management sectors. In this…

  14. An approach to pavement management in Virginia.

    Science.gov (United States)

    1981-01-01

    The report summarizes the objectives and benefits of formal pavement management systems and outlines an approach believed by the author to be practical for Virginia. The management of Virginia interstate pavements and a proposed random-sampling plan ...

  15. Treasury Financial Management company in the current economic crisis

    Directory of Open Access Journals (Sweden)

    FLOAREA GEORGESCU

    2015-03-01

    Full Text Available Abstract. Any management decision has a direct monetary impact on the structure uses and sources of cash. Cash Management aims to permanently maintain a balance between inflows and outflows of cash and cash to predict the impact of any operational decisions that could affect these flows. The success of any business requires good management of all these flows. The principle of this approach is relatively simple: using a minimum of ores to obtain maximum performance in a given period. Cash management is an extremely complex issue, and balancing receipts and payments flow is a constant struggle for survival of firms. In It work we will focus on how they are oriented in a going concern basis, cash inflows and financing needs of current operations. Managers should understand and know the specific movements of cash within the business system, driven daily decisions on operating, investing or financing, and a variety of external circumstances which affect the company. Such decisions and events can affect the company's ability to pay its obligations to obtain credit from suppliers, banks or credit institutions and to maintain an operational level in line with the company's products and services through investments.

  16. Time management: a realistic approach.

    Science.gov (United States)

    Jackson, Valerie P

    2009-06-01

    Realistic time management and organization plans can improve productivity and the quality of life. However, these skills can be difficult to develop and maintain. The key elements of time management are goals, organization, delegation, and relaxation. The author addresses each of these components and provides suggestions for successful time management.

  17. Pubertal induction in hypogonadism: Current approaches including use of gonadotrophins.

    Science.gov (United States)

    Zacharin, Margaret

    2015-06-01

    Primary disorders of the gonad or those secondary to abnormalities of the hypothalamic pituitary axis result in hypogonadism. The range of health problems of childhood and adolescence that affect this axis has increased, as most children now survive chronic illness, but many have persisting deficits in gonadal function as a result of their underlying condition or its treatment. An integrated approach to hormone replacement is needed to optimize adult hormonal and bone health, and to offer opportunities for fertility induction and preservation that were not considered possible in the past. Timing of presentation ranges from birth, with disorders of sexual development, through adolescent pubertal failure, to adult fertility problems. This review addresses diagnosis and management of hypogonadism and focuses on new management strategies to address current concerns with fertility preservation. These include Turner syndrome, and fertility presevation prior to childhood cancer treatment. New strategies for male hormone replacement therapy that may impinge upon future fertility are emphasized. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Current Status of On-Site Wastewater Management

    Science.gov (United States)

    Senn, Charles L.

    1978-01-01

    Wastewater management is becoming an important environmental issue nationally. This article reports the history and current status of wastewater management. Regulatory programs are discussed with specific state examples. Needs assessment is also included. (MA)

  19. ECOSYSTEM APPROACH TO FISHERIES MANAGEMENT IN THE ...

    African Journals Online (AJOL)

    To date, fisheries management has been based largely on a single-stock approach, but Namibia is committed to implement, in addition, an ecosystem approach to fisheries (EAF) management. The work leading to this implementation is described, in particular an ecosystem modelling study undertaken to summarize the ...

  20. Current concepts in the management of acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Gautham Srinivasan

    2016-01-01

    Full Text Available Guidelines for the management of acute pancreatitis (AP are based on the Western experience, which may be difficult to extrapolate in India due to socioeconomic constraints. Hence, modifications based on the available resources and referral patterns should be introduced so as to ensure appropriate care. We reviewed the current literature on the management of AP available in English on Medline and proposed guidelines locally applicable. Patients of AP presenting with systemic inflammatory response syndrome are at risk of moderate-severe pancreatitis and hence, should be referred to a tertiary center early. The vast majority of patients with AP have mild disease and can be managed at smaller centers. Early aggressive fluid resuscitation with controlled fluid expansion, early enteral nutrition, and culture-directed antibiotics improve outcomes in AP. Infected pancreatic necrosis should be managed in a tertiary care hospital within a multidisciplinary setup. The “step up” approach involving antibiotics, percutaneous drainage, and minimally invasive necrosectomy instituted sequentially based on clinical response has improved the outcomes in this subgroup of patients.

  1. Current management of locally recurrent rectal cancer

    DEFF Research Database (Denmark)

    Nielsen, Mette Bak; Laurberg, Søren; Holm, Thorbjörn

    2011-01-01

    ABSTRACT Objective: A review of the literature was undertaken to provide an overview of the surgical management of locally recurrent rectal cancer (LRRC) after the introduction of total mesorectal excision (TME). Method: A systematic literature search was undertaken using PubMed, Embase, Web...

  2. Spent fuel management: Current status and prospects

    International Nuclear Information System (INIS)

    1988-12-01

    The main objective of the Advisory Group on Spent Fuel Management is to review the world-wide situation in Spent Fuel Management, to define the most important directions of national efforts and international cooperation in this area, to exchange information on the present status and progress in performing the back-end of Nuclear Fuel Cycle and to elaborate the general recommendations for future Agency programmes in the field of spent fuel management. This report which is a result of the third IAEA Advisory Group Meeting (the first and second were held in 1984 and 1986) is intended to provide the reader with an overview of the status of spent fuel management programmes in a number of leading countries, with a description of the past and present IAEA activities in this field of Nuclear Fuel Cycle and with the Agency's plans for the next years, based on the proposals and recommendations of Member States. A separate abstract was prepared for each of 14 papers presented at the advisory group meeting. Refs, figs and tabs

  3. A review of Spacelab mission management approach

    Science.gov (United States)

    Craft, H. G., Jr.

    1979-01-01

    The Spacelab development program is a joint undertaking of the NASA and ESA. The paper addresses the initial concept of Spacelab payload mission management, the lessons learned, and modifications made as a result of the actual implementation of Spacelab Mission 1. The discussion covers mission management responsibilities, program control, science management, payload definition and interfaces, integrated payload mission planning, integration requirements, payload specialist training, payload and launch site integration, payload flight/mission operations, and postmission activities. After 3.5 years the outlined overall mission manager approach has proven to be most successful. The approach does allow the mission manager to maintain the lowest overall mission cost.

  4. Technical approach to aging management

    International Nuclear Information System (INIS)

    Vora, J.P.; Johnson, A.B. Jr.; Allen, R.P.

    1992-10-01

    Systematic and effective control of age-related degradation of safety-related components, systems, and structures in nuclear power plants (NPPs) is an important challenge to plant operators. Several data bases, available to provide guidance on aging management, are summarized. However, the ultimate consideration is: How effectively is aging management being implemented at individual plants? Illustrated here is a specific strategy that served to develop the technical data base for the Nuclear Plant Aging Research Program. The strategy is comprehensive, systematic, and adaptable. Effective aging management at NPPs could be facilitated by a parallel strategy. The elements of a strategy are suggested

  5. Organizational change and current trends in management

    Directory of Open Access Journals (Sweden)

    Lect. Dr. Chirimbu Sebastian

    2011-05-01

    Full Text Available The challenge is to manage the organization's culture so that you can tap the company's strenghts to chieve superior performance and identify it's weaknesses in time to overcome them before they cause serious damage." Successful adaptation to change is as crucial within an organization as it is in the natural world. Just like plants and animals, organizations and the individuals in them inevitably encounter changing conditions that they are powerless to control.

  6. APPROACHES TO QUALITY MANAGEMENT AT EUROPEAN LEVEL

    Directory of Open Access Journals (Sweden)

    Salagean Horatiu Catalin

    2013-07-01

    Full Text Available In the current economic context, quality has become a source of competitive advantage and organizations must perceive quality as something natural and human in order to achieve excellence. The proper question for the context of the internationalisation of the economy is whether the culture of the regions, states or nations affects the development in the quality management field and the quality approach. The present study tries to give a theoretical approach of how culture influences the quality approach at the European level. The study deals only with the European quality approach, beacuse at European level one could meet a great variety of models and methodologies. In the U.S.A. and Japan one could identify a specific cultural approach regarding quality. At the European level, we cannot discuss in the same terms, because each country has a different cultural specifics in terms of quality. In order to determine the cultural specificity of the countries surveyed, the study has used the most popular analysis tool of cultural dimensions, namely the Dutch Professor Geert Hofstede\\'s model. The model illustrates according to a survey, the organizational behavior of several countries and was able to identify a set of variables and fundamental dimensions, that differentiates one culture from another. An attempt was made to see if there are connections between the values of Hofestede \\'s cultural dimensions and the quality characteristics in the analysed countries. The study, describes on the one hand,the quality evolution from quality control to Total Quality Management and on the other hand, focuses on the quality approach modalities at European level. The second part of the paper is structured into two parts, addressing on the one hand the quality in countries of Western Europe, such as United Kingdom, France and Germany,because these three countries are considered to be the exponents of quality development in Western Europe. In the same time, the

  7. Medical Management of Uveitis ? Current Trends

    OpenAIRE

    Babu, Kalpana; Mahendradas, Padmamalini

    2013-01-01

    Uveitis is a challenging disease to treat. Corticosteroids have been used in the treatment of uveitis for many years. Immunosuppressives are gaining momentum in recent years in the treatment of uveitis. In this article we present an overview of current treatment of uveitis and the major breakthroughs and advances in drugs and ocular drug delivery systems in the treatment of uveitis.

  8. relationship between principals' management approaches

    African Journals Online (AJOL)

    Admin

    Data were collected using a self-administered questionnaire from a sample of. 211 teachers, 28 principals and 22 chairpersons of parent- teachers association. Data were ..... their role expectation in discipline management. Data from the 20 ...

  9. Cardiogenic shock. Current concepts in management.

    Science.gov (United States)

    Balakumaran, K; Hugenholtz, P G

    1986-10-01

    This article presents a categorisation of circulatory shock and discusses the causes, haemodynamics, and clinical recognition of cardiogenic shock. The first step in the management strategy in cardiogenic shock is to guide the patient from the state of shock to one of managed haemodynamic stability. The therapeutic manoeuvres of this first step constitute the management tactics, which can be grouped under 3 general headings: (a) making the most of a malfunctioning heart; (b) improving the state of the heart; and (c) reducing the demands on the heart. In order to make the most of the heart, i.e. to get the highest possible output at the lowest possible cost, clinicians need to use their judgement in stimulating an overtaxed heart on the one hand, and in manipulating the loads on it (the preload and afterload) on the other, for although these methods may be advantageous, they are not without their pitfalls. Efforts to improve the state of the heart often necessitate surgical (e.g. mitral valve replacement) or semisurgical (e.g. coronary angiography and recanalisation) techniques, although intravenous antithrombotic agents may achieve comparable results in a few cases at the bedside. Reducing the demands on the heart is an active process involving the takeover of at least a part of the work of the heart by ancillary devices such as the intra-aortic balloon pump, and of the work of breathing by intubation and artificial ventilation. The individuality of each case of cardiogenic shock emphasises the need for empirical modulation of therapy based on feedback information obtained by haemodynamic monitoring.

  10. Exploring Academics' Approaches to Managing Team Assessment

    Science.gov (United States)

    Augar, Naomi; Woodley, Carolyn J.; Whitefield, Despina; Winchester, Maxwell

    2016-01-01

    Purpose: The purpose of this paper is to develop an understanding of academics' approaches to managing team assessment at an Australian University with a view to informing policy development and assessment design. Design/methodology/approach: The research was conducted using a single exploratory case study approach focussing on the team assessment…

  11. Exploring Conflict Management Using Qualitative Approach

    OpenAIRE

    Yazid, Zaleha

    2015-01-01

    This paper focuses on qualitative methods in researching the area of conflict management, specifically in Self-Managed Project Team (SMPT). The research aims to explore the evolvement of conflict management strategies in SMPT as this type of team is given the responsibility to solve problems and make decision by themselves. The inductive approach will overcome the limitation of quantitative method in management research as one of its objectives is to explain the different elements of the expl...

  12. Current management of surgical oncologic emergencies.

    Science.gov (United States)

    Bosscher, Marianne R F; van Leeuwen, Barbara L; Hoekstra, Harald J

    2015-01-01

    For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC). In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed. A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days. In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%. In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy.

  13. Waste classification: a management approach

    International Nuclear Information System (INIS)

    Wickham, L.E.

    1984-01-01

    A waste classification system designed to quantify the total hazard of a waste has been developed by the Low-Level Waste Management Program. As originally conceived, the system was designed to deal with mixed radioactive waste. The methodology has been developed and successfully applied to radiological and chemical wastes, both individually and mixed together. Management options to help evaluate the financial and safety trade-offs between waste segregation, waste treatment, container types, and site factors are described. Using the system provides a very simple and cost effective way of making quick assessments of a site's capabilities to contain waste materials. 3 references

  14. Current waste management practices at PINSTECH

    International Nuclear Information System (INIS)

    Ul Haq, E.; Aslam, M.; Orfi, S.D.

    2002-01-01

    The waste being generated at PINSTECH is of the intermediate and low level Category that is in the form of gas, liquid and solids. It is collected, monitored, segregated, treated, packed and immobilized for its final disposal. Basic concepts of delay decay, disposal and containment of radioactive waste are followed to prevent its direct contact with human and its environment. PINSTECH follows shallow ground disposal in the restricted area. The disposal site has favorable characteristics e.g. sun shine dry climate and high evaporation rate. The gaseous waste is directed towards stack, where it passes through charcoal and HEPA filters and then released to the atmosphere. Post disposal monitoring of the disposal area is performed to check leaching/migration of radionuclides from disposal locations to the surrounding environment. No migration of radioactivity has been detected indicating satisfactory performance of the waste management system. (author)

  15. Current management of surgical oncologic emergencies.

    Directory of Open Access Journals (Sweden)

    Marianne R F Bosscher

    Full Text Available For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC. In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed.A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days.In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%.In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy.

  16. Current and future perspectives in clinical management

    International Nuclear Information System (INIS)

    Willett, Christopher

    1996-01-01

    In the past several years, there has been significant progress and controversy in the clinical management of patients with rectal cancer as well as important advances in the understanding the biology of these tumors. The panel will highlight relevant biologic and clinical developments. One of major advances has been in the understanding of the molecular basis for the development of colon and rectal cancer with many of the events leading to cancer development having been determined. Although there is much to be learned, there is now a much improved understanding of colon and rectal carcinogenesis with the prospect of being able to define high risk patient populations and the possibility of early detection (before cancer formation) now a real possibility. In addition, the identification of favorable or unfavorable subsets of patients wit rectal cancer based on molecular markers is under active investigation. These exciting developments will be summarized. In the clinical arena, there are a number of controversial issues in the management of patients with rectal cancer. For patients with distal rectal cancer, the goals of therapy have evolved from cure to cure with sphincter preservation. The role of resection with coloanal anastomosis as an alternative to an abdominoperineal resection is also being defined. A wide array of treatment programs of radiation therapy and chemotherapy and sphincter sparing surgery are under active investigation. The relative merits of preoperative chemo-irradiation versus postoperative chemo-irradiation continues to be debated. The utility of total mesorectal excision is being evaluated and the need for adjuvant therapy is being questioned. These clinical issues will be highlighted

  17. Management of reprocessed uranium. Current status and future prospects

    International Nuclear Information System (INIS)

    2007-02-01

    There is worldwide interest in developing advanced and innovative technologies for nuclear fuel cycles, minimizing waste and environmental impacts. As of the beginning of 2003, about 171000 tonnes heavy metal spent nuclear fuel is in storage, while smaller amounts have been reprocessed. In several countries, including France, India, Japan and the Russian Federation, spent fuel has been viewed as a national energy resource. Some countries hold reprocessed uranium as the result of their commercial reprocessing service contracts for reprocessing the spent fuel of others. Reprocessed uranium has a potential value for recycling either directly or after appropriate treatment. This report analyses the existing options, approaches and developments in the management of reprocessed uranium. It includes the technical issues involved in managing reprocessed uranium which are RepU arisings, storage, chemical conversion, re-enrichment, fuel fabrication, transport, reactor irradiation, subsequent reprocessing and disposal options, as well as assessment of holistic environmental impacts. The objective of this document is to overview the information on the current status and future trends in the management of RepU and to identify major issues to be considered for future projects

  18. Managing peri-implant bone loss: current understanding.

    Science.gov (United States)

    Aljateeli, Manar; Fu, Jia-Hui; Wang, Hom-Lay

    2012-05-01

    With the improved macro- and micro-designs, dental implants enjoy a high survival rate. However, peri-implant bone loss has recently emerged to be the focus of implant therapy. As such, researchers and clinicians are in need of finding predictable techniques to treat peri-implant bone loss and stop its progression. Literature search on the currently available treatment modalities was performed and a brief description of each modality was provided. Numerous techniques have been proposed and none has been shown to be superior and effective in managing peri-implant bone loss. This may be because of the complex of etiological factors acting on the implant-supported prosthesis hence the treatment approach has to be individually tailored. Due to the lack of high-level clinical evidence on the management of peri-implant bone loss, the authors, through a literature review, attempt to suggest a decision tree or guideline, based on sound periodontal surgical principles, to aid clinicians in managing peri-implantitis associated bone loss. © 2011 Wiley Periodicals, Inc.

  19. Managing Plagiarism: A Preventative Approach

    Science.gov (United States)

    Insley, Robert

    2011-01-01

    Plagiarism is a reality in most college classes where some students plagiarize unknowingly and others do so knowingly. This situation requires instructors to decide how to manage the situation. Some may take the easy way out by ignoring the problem, simply pretending that none of their students plagiarize. In contrast, other instructors embrace…

  20. Managing projects a team-based approach

    CERN Document Server

    Brown, Karen A

    2010-01-01

    Students today are likely to be assigned to project teams or to be project managers almost immediately in their first job. Managing Projects: A Team-Based Approach was written for a wide range of stakeholders, including project managers, project team members, support personnel, functional mangers who provide resources for projects, project customers (and customer representatives), project sponsors, project subcontractors, and anyone who plays a role in the project delivery process. The need for project management is on the rise as product life cycles compress, demand for IT systems increases, and business takes on an increasingly global character. This book adds to the project management knowledge base in a way that fills an unmet need—it shows how teams can apply many of the standard project management tools, as well as several tools that are relatively new to the field. Managing Projects: A Team-Based Approach offers the academic rigor found in most textbooks along with the practical attributes often foun...

  1. Current management of symptomatic intracranial stenosis.

    Science.gov (United States)

    Taylor, Robert A; Weigele, John B; Kasner, Scott E

    2011-08-01

    Intracranial arterial stenosis (IAS) is the cause of about 10% of all ischemic strokes in the United States, but may account for about 40% of strokes in some populations. After a stroke or transient ischemic attack due to IAS, patients face a 12% annual risk of recurrent stroke on medical therapy, with most strokes occurring in the first year. Warfarin is no better than aspirin in preventing recurrent strokes but poses a higher risk of serious bleeding and death. Groups with the highest risk of recurrent stroke are those with high-grade (≥ 70%) stenosis, those with recent symptom onset, those with symptoms precipitated by hemodynamic maneuvers, and women. Endovascular treatment of IAS is a rapidly evolving therapeutic option. Antiplatelet agents are currently recommended as the primary treatment for symptomatic IAS, with endovascular therapy reserved for appropriate high-risk cases refractory to medical therapy.

  2. Current best practice in the management of Turner syndrome

    Science.gov (United States)

    Shankar, Roopa Kanakatti; Backeljauw, Philippe F.

    2017-01-01

    Turner syndrome (TS) is characterized by partial or complete loss of the second X-chromosome in phenotypic females resulting in a constellation of clinical findings that may include lymphedema, cardiac anomalies, short stature, primary ovarian failure and neurocognitive difficulties. Optimizing health care delivery is important to enable these individuals achieve their full potential. We review the current best practice management recommendations for individuals with TS focusing on the latest consensus opinion in regard to genetic diagnosis, treatment of short stature, estrogen supplementation, addressing psychosocial issues, as well screening for other comorbidities. A multidisciplinary approach and a well-planned transition to adult follow-up care will improve health care delivery significantly for this population. PMID:29344338

  3. Management of Pediatric Migraine: Current Therapies.

    Science.gov (United States)

    Khrizman, Marina; Pakalnis, Ann

    2018-02-01

    Migraine is one of the most common neurologic conditions in pediatrics. It can be a significant stressor, causing absences from school and interruption of parents' work and family schedules. The mainstay of treatment remains educating patients about healthy lifestyle practices and the influences of sleep, stressors, and hydration on triggering migraine attacks. Psychological therapies such as biofeedback or cognitive-behavioral therapy may be beneficial in some patients, especially those with prominent psychological comorbidities. New advances in the pathophysiology of migraine and additional pediatric approval of abortive therapy with triptans have led to significant advances in the management of migraine in children. Some challenges to preventive therapy were recently noted with the negative results obtained in the Childhood and Adolescent Migraine Prevention Study, which compared prescription drugs to placebo. Inherent differences between adult and pediatric headaches, with shorter duration of pediatric migraine and prominent placebo effect, present recurring challenges for clinicians. [Pediatr Ann. 2018;47(2):e55-e60.]. Copyright 2018, SLACK Incorporated.

  4. Current management of gynecologic cancer in pregnancy.

    Science.gov (United States)

    Iavazzo, Christos; Minis, Evelyn Eleni; Gkegkes, Ioannis D

    2018-04-27

    Cancer during pregnancy is a particularly challenging complication. The incidence has increased in recent years due to childbering at an advanced maternal age due to career choices and/or the development of reproductive technology. Approximately two thirds of cancer cases during pregnancy are comprised of invasive cervical cancers and breast cancer. Cancer during gestation is characterized by a need for specialized treatment due to major changes in the hormonal profile (estrogen-progesterone), metabolism (enhancement of anabolism), hemodynamic changes (hyperdynamic circulation), immunologic changes (cell mediated and humoral immunity), increased angiogenesis (increased blood flow towards the uterus). Moreover, the management of such patients is based on the trimester of pregnancy, type and stage of cancer and informed consent of the mother based on her wishes. The optimal treatment of cancer during pregnancy remains elusive, as there are limited data from retrospective studies with small samples. As a result, it is crucial that data regarding survival of the women and long-term follow up of the children from different cancer centres and registries be shared. This need is dictated by the fact that the incidence of cancer during pregnancy will continue to rise as child-bearing age continues to increase.

  5. Skull base osteomyelitis: current microbiology and management.

    Science.gov (United States)

    Spielmann, P M; Yu, R; Neeff, M

    2013-01-01

    Skull base osteomyelitis typically presents in an immunocompromised patient with severe otalgia and otorrhoea. Pseudomonas aeruginosa is the commonest pathogenic micro-organism, and reports of resistance to fluoroquinolones are now emerging, complicating management. We reviewed our experience of this condition, and of the local pathogenic organisms. A retrospective review from 2004 to 2011 was performed. Patients were identified by their admission diagnostic code, and computerised records examined. Twenty patients were identified. A facial palsy was present in 12 patients (60 per cent). Blood cultures were uniformly negative, and culture of ear canal granulations was non-diagnostic in 71 per cent of cases. Pseudomonas aeruginosa was isolated in only 10 (50 per cent) cases; one strain was resistant to ciprofloxacin but all were sensitive to ceftazidime. Two cases of fungal skull base osteomyelitis were identified. The mortality rate was 15 per cent. The patients' treatment algorithm is presented. Our treatment algorithm reflects the need for multidisciplinary input, early microbial culture of specimens, appropriate imaging, and prolonged and systemic antimicrobial treatment. Resolution of infection must be confirmed by close follow up and imaging.

  6. LIQUIDITY MANAGING A CURRENT JOB OF BANKING MANAGEMENT

    Directory of Open Access Journals (Sweden)

    MEDAR LUCIAN-ION

    2014-02-01

    Full Text Available A credit institution liquidity managing, concerns on currency flows and operative funding needs, for customer satisfaction. Correlating bank liabilities and assets reflects the overall picture of the liquidity situation. The purpose of an efficient management of bank liquidity is to ensure the normal course of banking intermediation, to protect the interests of customers on one side and of the shareholders on the other side. Through an efficient bank liquidity management, are ensured reserve requirements and especially reasonable banking capacity of deposits reimbursement to customers, correlated with period in which they are or there are not returned to the credit institution, investments in the loans and other assets.

  7. Partnerships: Labour/management approaches

    International Nuclear Information System (INIS)

    Thompson, T.

    1995-01-01

    Changes in the workplace that can be expected in light of the changes occurring in the electric utility industry and the private sector in general, were discussed. Increased pressure to be productive due to competition, continuous technological changes, the changing labour force and regulatory environments were identified as some of the forces responsible for the changes.. The old labour relations practices were reviewed and criticized for having been too confrontational and not focusing on common interests. Sharing of information was emphasized as a means to build a foundation of trust between unions and management. Worker participation in the direction of the company was said to be necessary for good relations. It was suggested that this should occur in the early stages of program/policy development so that the workers don't feel by-passed. Examples of initiatives and benefits resulting from cooperation of the union and management were described. It was concluded that while there would always be issues that union and management would not agree on, focusing on common interests will act as a strong motivator to resolving contentious issues to protect the mutually beneficial relationship between the two sides

  8. German approach to VLLW management

    International Nuclear Information System (INIS)

    Broecking, D.

    1997-01-01

    Waste generated in German nuclear facilities is exhaustively and selectively manage through a system adapted to the waste's characteristics. The management of the waste ensures that the impact on the workers, population and the environment is acceptable. This is done through a detailed documentation and quality assurance program which applies not only to radioactive waste but also to cleanable material used within a licensed practice. In Germany the producer is responsible for the waste generated in a licensed facility and is therefore responsible for the correct disposal, which depends on the waste's characteristics. Since the waste producer requires a license for all activities involving radioactive substances, the atomic authority is continuously informed and can therefore monitor the producer for compliance with the regulations. The use and disposal of all material in a licensed practice is documented and can therefore be traced by the authorities. Clearance is seen in Germany as the best way of managing non-radioactive material in a licensed practice. Germany has developed clearance procedures which guarantee that after clearance the radiological impact is negligible. (author)

  9. Current management of occult bacteremia in infants

    Directory of Open Access Journals (Sweden)

    Eduardo Mekitarian Filho

    2015-11-01

    Full Text Available Objectives: To summarize the main clinical entities associated with fever without source (FWS in infants, as well as the clinical management of children with occult bacteremia, emphasizing laboratory tests and empirical antibiotics. Sources: A non-systematic review was conducted in the following databases – PubMed, EMBASE, and SciELO, between 2006 and 2015. Summary of the findings: The prevalence of occult bacteremia has been decreasing dramatically in the past few years, due to conjugated vaccination against Streptococcus pneumoniae and Neisseria meningitidis. Additionally, fewer requests for complete blood count and blood cultures have been made for children older than 3 months presenting with FWS. Urinary tract infection is the most prevalent bacterial infection in children with FWS. Some known algorithms, such as Boston and Rochester, can guide the initial risk stratification for occult bacteremia in febrile infants younger than 3 months. Conclusions: There is no single algorithm to estimate the risk of occult bacteremia in febrile infants, but pediatricians should strongly consider outpatient management in fully vaccinated infants older than 3 months with FWS and good general status. Updated data about the incidence of occult bacteremia in this environment after conjugated vaccination are needed. Resumo: Objetivos: Listar as principais entidades clínicas associadas a quadros de febre sem sinais localizatórios (FSSL em lactentes, bem como o manejo dos casos de bacteremia oculta com ênfase na avaliação laboratorial e na antibioticoterapia empírica. Fonte dos dados: Foi realizada revisão não sistemática da literatura nas bases de dados PubMed, EMBASE e Scielo no período de 2006 a 2015. Síntese dos dados: A ocorrência de bacteremia oculta vem diminuindo sensivelmente em lactentes com FSSL, principalmente devido à introdução da vacinação conjugada contra Streptococcus pneumoniae e Neisseria meningitidis nos últimos anos

  10. Congenital anophthalmia: current concepts in management.

    Science.gov (United States)

    Quaranta-Leoni, Francesco M

    2011-09-01

    The introduction of hydrogel socket and orbital expanders has modified the approach towards the rehabilitation of congenital anophthalmia. This study highlights the most recent advances for the treatment of congenital anophthalmia based on personal experience and the review of recent literature. Hydrogel socket expanders may be positioned as an out-patient procedure with topical anaesthesia, using cyanoacrylate glue as opposed to temporary tarsorraphy. Increased orbital volume has been confirmed by computed tomography (CT) scan or magnetic resonance imaging (MRI) following early dermis-fat graft in children with congenital anophthalmia. An orbital tissue expander made of an inflatable silicone globe sliding on a titanium T-plate and secured to the lateral orbital rim appears to be effective to stimulate orbital bone growth and development. Congenital anophthalmia has a complex cause with both genetic and environmental factors involved. The ideal treatment is simultaneous expansion of the eyelids, socket and orbital bones, and it should begin after birth as soon as possible. Socket expansion with self-inflating expanders is a useful technique, although custom-made conformers may produce similar results. Dermis-fat grafts are another reasonable option as an orbital implant, following adequate lid and socket expansion.

  11. Childhood amblyopia: current management and new trends.

    Science.gov (United States)

    Tailor, Vijay; Bossi, Manuela; Greenwood, John A; Dahlmann-Noor, Annegret

    2016-09-01

    With a prevalence of 2-5%, amblyopia is the most common vision deficit in children in the UK and the second most common cause of functional low vision in children in low-income countries. Pubmed, Cochrane library and clinical trial registries (clinicaltrials.gov, ISRCTN, UKCRN portfolio database). Screening and treatment at the age of 4-5 years are cost efficient and clinically effective. Optical treatment (glasses) alone can improve visual acuity, with residual amblyopia treated by part-time occlusion or pharmacological blurring of the better-seeing eye. Treatment after the end of the conventional 'critical period' can improve vision, but in strabismic amblyopia carries a low risk of double vision. It is not clear whether earlier vision screening would be cost efficient and associated with better outcomes. Optimization of treatment by individualized patching regimes or early start of occlusion, and novel binocular treatment approaches may enhance adherence to treatment, provide better outcomes and shorten treatment duration. Binocular treatments for amblyopia. Impact of amblyopia on education and quality of life; optimal screening timing and tests; optimal administration of conventional treatments; development of child-friendly, effective and safe binocular treatments. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  12. Transient management using the safety function approach

    International Nuclear Information System (INIS)

    Corcoran, W.R.; Barrow, J.H.; Bischoff, G.C.; Callaghan, V.M.; Pearce, R.T.

    1984-01-01

    The safety function approach is described. Its use in the development of a transient management procedures system includes optimal recovery procedures tailored to specific, anticipated symptom sets and a functional recovery procedure which is more general. Simulator evaluations are described

  13. Regulatory approach to accident management in Sweden

    International Nuclear Information System (INIS)

    Hoegberg, L.

    1989-01-01

    The Swedish accident management program includes the following components: definition of overall safety and radiation protection objectives for the program; definition of appropriate accident management strategies to reach these objectives, based on plant-specific severe accident analysis; development and installation of appropriate accident management systems and associated management procedure; definition of roles and resposibilities for plant staff involved in accident management and implementation of appropriate training programs. The discussion of these components tries to highlight the basic technical concepts and approaches and the underlying safety philosophy rather than going into design details. 5 figs., 7 refs

  14. The process approach to service quality management

    OpenAIRE

    Kamila Kowalik; Dorota Klimecka-Tatar

    2018-01-01

    In this paper a model of service quality management based on the process approach has been presented. The first part of the article contains the theoretical framework of service quality and the process approach in management. Next, quality of service process has been presented in reference to a process-based definition in quoted literature. Finally, the outcomes of a customer questionnaire concerning the validity of particular quality attributes has been presented. The collected data in relat...

  15. Chiropractic approach to the management of children

    Directory of Open Access Journals (Sweden)

    Miller Joyce

    2010-06-01

    Full Text Available Abstract Background Chiropractic (Greek: done by hand is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual techniques, including joint adjustment and/or manipulation, with a particular focus on joint subluxation (World Health Organization 2005 or mechanical lesion and restoring function. The chiropractor's role in wellness care, prevention and treatment of injury or illness is based on education in anatomy and physiology, nutrition, exercise and healthy lifestyle counseling as well as referral to other health practitioners. Depending on education, geographic location, scope of practice, as well as consumer preference, chiropractors may assume the role of primary care for families who are pursuing a more natural and holistic approach to health care for their families. Objective To present a perspective on current management of the paediatric patient by members of the chiropractic profession and to make recommendations as to how the profession can safely and effectively manage the paediatric patient. Discussion The chiropractic profession holds the responsibility of ethical and safe practice and requires the cultivation and mastery of both an academic foundation and clinical expertise that distinguishes chiropractic from other disciplines. Research into the effectiveness of chiropractic care for paediatric patients has lagged behind that of adult care, but this is being addressed through educational programs where research is now being incorporated into academic tracks to attain advanced chiropractic degrees. Conclusion Studies in the United States show that over the last several decades, chiropractors are the most common complementary and alternative medicine providers visited by children and adolescents. Chiropractors continue to seek integration with other healthcare providers to

  16. Child and Youth Care Approaches to Management

    Science.gov (United States)

    Gharabaghi, Kiaras

    2008-01-01

    This article explores the themes and issues related to child and youth care approaches to management. The profession is significantly underrepresented at the management level. To some extent, this reflects the challenges of being recognized in the broader human services sector as a profession, but perhaps more so, it reflects an underdevelopment…

  17. Integrated Approach to User Account Management

    Science.gov (United States)

    Kesselman, Glenn; Smith, William

    2007-01-01

    IT environments consist of both Windows and other platforms. Providing user account management for this model has become increasingly diffi cult. If Microsoft#s Active Directory could be enhanced to extend a W indows identity for authentication services for Unix, Linux, Java and Macintosh systems, then an integrated approach to user account manag ement could be realized.

  18. A partial Hamiltonian approach for current value Hamiltonian systems

    Science.gov (United States)

    Naz, R.; Mahomed, F. M.; Chaudhry, Azam

    2014-10-01

    We develop a partial Hamiltonian framework to obtain reductions and closed-form solutions via first integrals of current value Hamiltonian systems of ordinary differential equations (ODEs). The approach is algorithmic and applies to many state and costate variables of the current value Hamiltonian. However, we apply the method to models with one control, one state and one costate variable to illustrate its effectiveness. The current value Hamiltonian systems arise in economic growth theory and other economic models. We explain our approach with the help of a simple illustrative example and then apply it to two widely used economic growth models: the Ramsey model with a constant relative risk aversion (CRRA) utility function and Cobb Douglas technology and a one-sector AK model of endogenous growth are considered. We show that our newly developed systematic approach can be used to deduce results given in the literature and also to find new solutions.

  19. [Psychological approaches in hypertension management].

    Science.gov (United States)

    Abgrall-Barbry, Gaëlle; Consoli, Silla M

    2006-06-01

    Stress factors, especially high levels of occupational stress, are associated with hypertension. Several so-called psychological techniques have been applied to hypertension: biofeedback, relaxation techniques (Schultz' autogenic training, Jacobson's progressive relaxation), transcendental meditation, and cognitive behavioral techniques for stress management. Randomized studies show that the best results come from cognitive behavioral methods, whether or not they include relaxation techniques. Other forms of psychotherapy (such as psychoanalysis) may be useful, although their benefits for blood pressure have not been tested in controlled trials. Patients should be informed about the personal benefits they may obtain from psychological treatment. Indications are hyperreactivity to stress, high levels of occupational stress, and difficulty in tolerating or complying with antihypertensive drugs.

  20. Risk assessment and management approaches on mental health units.

    Science.gov (United States)

    Woods, P

    2013-11-01

    This exploratory and descriptive study took place in one Canadian province. The study aimed to: (1) to identify and describe the nature and extent of current risk assessment and management approaches used in the adult inpatient mental health and forensic units; and (2) to identify good practice and shortfalls in the nature and extent of the approaches currently utilized. Data were collected from 48 participants through nine focus groups. Participants reported that they used a clinical approach to risk assessment. They had also not considered risk assessment and management as a proactive structured process. Education and training was also limited and skills were developed over time through practice. Five keys issues are discussed as important: reliance on clinical judgement alone is not the best choice to make; the need to consider risk as a whole concept; risk management being more reactive than proactive; education and training; and client involvement in risk assessment. © 2012 John Wiley & Sons Ltd.

  1. ECOSYSTEM APPROACH TO FISHERIES MANAGEMENT IN THE ...

    African Journals Online (AJOL)

    A workshop was held in Cape Town in December 2002 to introduce the concept of an ecosystem approach to fisheries (EAF) management in the southern Benguela, and to examine the options for implementing an EAF in. South Africa. The workshop considered alternative modelling approaches that may have potential for ...

  2. Adjoint current-based approaches to prostate brachytherapy optimization

    International Nuclear Information System (INIS)

    Roberts, J. A.; Henderson, D. L.

    2009-01-01

    This paper builds on previous work done at the Univ. of Wisconsin - Madison to employ the adjoint concept of nuclear reactor physics in the so-called greedy heuristic of brachytherapy optimization. Whereas that previous work focused on the adjoint flux, i.e. the importance, this work has included use of the adjoint current to increase the amount of information available in optimizing. Two current-based approaches were developed for 2-D problems, and each was compared to the most recent form of the flux-based methodology. The first method aimed to take a treatment plan from the flux-based greedy heuristic and adjust via application of the current-displacement, or a vector displacement based on a combination of tissue (adjoint) and seed (forward) currents acting as forces on a seed. This method showed promise in improving key urethral and rectal dosimetric quantities. The second method uses the normed current-displacement as the greedy criterion such that seeds are placed in regions of least force. This method, coupled with the dose-update scheme, generated treatment plans with better target irradiation and sparing of the urethra and normal tissues than the flux-based approach. Tables of these parameters are given for both approaches. In summary, these preliminary results indicate adjoint current methods are useful in optimization and further work in 3-D should be performed. (authors)

  3. Pain management in primary care – current perspectives | Meyer ...

    African Journals Online (AJOL)

    According to a 1998 World Health Organization Survey of 26 000 primary care ... in pain medicine and continue to follow the biomedical approach, which ... The modern paradigm of pain management has moved from this biomedical to the ...

  4. Supporting self-management of chronic health conditions: common approaches.

    Science.gov (United States)

    Lawn, Sharon; Schoo, Adrian

    2010-08-01

    The aims of this paper are to provide a description of the principles of chronic condition self-management, common approaches to support currently used in Australian health services, and benefits and challenges associated with using these approaches. We examined literature in this field in Australia and drew also from our own practice experience of implementing these approaches and providing education and training to primary health care professionals and organizations in the field. Using common examples of programs, advantages and disadvantages of peer-led groups (Stanford Courses), care planning (The Flinders Program), a brief primary care approach (the 5As), motivational interviewing and health coaching are explored. There are a number of common approaches used to enhance self-management. No one approach is superior to other approaches; in fact, they are often complimentary. The nature and context for patients' contact with services, and patients' specific needs and preferences are what must be considered when deciding on the most appropriate support mode to effectively engage patients and promote self-management. Choice of approach will also be determined by organizational factors and service structures. Whatever self-management support approaches used, of importance is how health services work together to provide support. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

  5. A Balanced Scorecard Approach to Public Relations Management Assessment.

    Science.gov (United States)

    Fleisher, Craig S.; Mahaffy, Darren

    1997-01-01

    Describes a new managerial approach to assessing public relations/communications (PR/C) performance using a "balanced scorecard." Reviews the current state of PR/C management assessment; illustrates the balanced scorecard framework; highlights its strengths and weaknesses; describes the process of applying the scorecard to PR/C units;…

  6. COMMON APPROACH ON WASTE MANAGEMENT

    Directory of Open Access Journals (Sweden)

    ANDREESCU Nicoleta Alina

    2017-05-01

    Full Text Available The world population has doubled since the 60’s, now reaching 7 billion – it is estimated it will continue growing. If in more advanced economies, the population is starting to grow old and even reduce in numbers, in less developed countries, population numbers are registering a fast growth. Across the world, the ecosystems are exposed to critical levels of pollution in more and more complex combinations. Human activities, population growth and shifting patterns in consumer nature are the main factors that are at the base of thin ever-growing burden on our environment. Globalization means that the consumer and production patterns from a country or a region contribute to the pressures on the environment in totally different parts of the world. With the rise of environmental problems, the search for solutions also begun, such as methods and actions aimed to protect the environment and to lead to a better correlation between economic growth and the environment. The common goals of these endeavors from participating states was to come up with medium and long term regulations that would lead to successfully solving environmental issues. In this paper, we have analyzed the way in which countries started collaborating in the 1970’s at an international level in order to come up with a common policy that would have a positive impact on the environment. The European Union has come up with its own common policy, a policy that each member state must implement. In this context, Romania has developed its National Strategy for Waste Management, a program that Romania wishes to use to reduce the quantity of waste and better dispose of it.

  7. Healthcare waste management: current practices in selected healthcare facilities, Botswana.

    Science.gov (United States)

    Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew

    2008-01-01

    Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

  8. E-waste: Environmental Problems and Current Management

    Directory of Open Access Journals (Sweden)

    D. Aktsoglou

    2010-01-01

    Full Text Available In this paper the environmental problems related with the discarded electronic appliances, known as e-waste, are reviewed.Moreover, the current and the future production of e-waste, the potential environmental problems associated with theirdisposal and management practices are discussed whereas the existing e-waste management schemes in Greece and othercountries (Japan, Switzerland are also quoted.

  9. Current management of anorectal malformation in Egypt: a survey of ...

    African Journals Online (AJOL)

    Background/aim: Anorectal malformation (ARM) represents a wide spectrum of anomalies. Its management includes various strategies. This survey aims at detecting the current preferences of Egyptian pediatric surgeons regarding the management of ARM. Materials and methods: A survey was circulated individually to the ...

  10. Analysis of Current Supplier Relationship Management Practices: A Solution Proposal

    OpenAIRE

    Gomes Campelo Filho, Eulalio

    2009-01-01

    The work contributes with the existing literature by investigating current SRM practices. Based on the research, the author has designed an information system framework, which provides companies with an innovative SRM solution to manage their indirect material purchasing process through an environment that supports companies entire plan-to-order activities, including functionalities such as central data management, spend data management, e-sourcing and the usual e-procurement features.

  11. Current management of Parkinson's disease | Salawu | Annals of ...

    African Journals Online (AJOL)

    Annals of African Medicine. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 9, No 2 (2010) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Current management of Parkinson's disease. F Salawu, A ...

  12. A functional approach for managing ITER operations

    International Nuclear Information System (INIS)

    Houtte, Didier van; Sagot, François; Okayama, Katsumi; Blackler, Kenneth

    2012-01-01

    Highlights: ► A function-oriented approach for defining and organizing all the functions required to perform the mission has been developed. ► A Functional Breakdown Structure providing a complete hierarchy of functions on multiple levels is presented. ► The FBS is used for giving a good visibility of ITER project needs and requirements. ► Reliability (R) and Inherent Availability (A I ) of basic functions are calculated from data on the structures, systems and components (failure rate and time to repair) for obtaining the Availability objectives of the ITER project. - Abstract: ITER is currently the most ambitious project on nuclear fusion research. Its objective is to demonstrate the feasibility of fusion as an energy source for the future. The complexity of the systems required to meet this challenge present many opportunities for omissions or incorrect assumptions. System engineering allows the engineer to deal with such a complexity by developing a Functional Breakdown Structure (FBS). Unlike a Plant Breakdown Structure (PBS), the FBS is a function-oriented tree, not a product-oriented tree. It details operations or activities that have to be performed as needed functions of the architecture, allowing identification of any missing elements, defining the personnel skills required to operate the architecture and managing the machine availability.

  13. CURRENT APPROACHES FOR RESEARCH OF MULTIPLE SCLEROSIS BIOMARKERS

    Directory of Open Access Journals (Sweden)

    Kolyada T.I

    2016-12-01

    Full Text Available Current data concerning features of multiple sclerosis (MS etiology, pathogenesis, clinical course and treatment of disease indicate the necessity of personalized approach to the management of MS patients. These features are the variety of possible etiological factors and mechanisms that trigger the development of MS, different courses of disease, and significant differences in treatment efficiency. Phenotypic and pathogenetic heterogeneity of MS requires, on the one hand, the stratification of patients into groups with different treatment depending on a number of criteria including genetic characteristics, disease course, stage of the pathological process, and forms of the disease. On the other hand, it requires the use of modern methods for assessment of individual risk of developing MS, its early diagnosis, evaluation and prognosis of the disease course and the treatment efficiency. This approach is based on the identification and determination of biomarkers of MS including the use of systems biology technology platforms such as genomics, proteomics, metabolomics and bioinformatics. Research and practical use of biomarkers of MS in clinical and laboratory practice requires the use of a wide range of modern medical and biological, mathematical and physicochemical methods. The group of "classical" methods used to study MS biomarkers includes physicochemical and immunological methods aimed at the selection and identification of single molecular biomarkers, as well as methods of molecular genetic analysis. This group of methods includes ELISA, western blotting, isoelectric focusing, immunohistochemical methods, flow cytometry, spectrophotometric and nephelometric methods. These techniques make it possible to carry out both qualitative and quantitative assay of molecular biomarkers. The group of "classical methods" can also include methods based on polymerase chain reaction (including multiplex and allele-specific PCR and genome sequencing

  14. DOE waste management program-current and future

    International Nuclear Information System (INIS)

    Coleman, J.A.

    1993-01-01

    The back end of the nuclear fuel cycle, as well as many operations in the Department of Energy, involves management of radioactive and hazardous waste and spent nuclear fuel. Described herein is the current and anticipated Department's Waste Management Program and general information about the Program for managing and disposing of waste that will illustrate the importance of air cleaning and treatment in assuring protection of the public and our environment. The structure and responsibilities of the Office of Environmental Restoration and Waste Management (EM) are described. The categories of waste managed by the Office of Waste Management (OWM) are defined. The problems of waste management, waste minimization, and waste treatment, storage, and disposal are discussed. 4 figs

  15. Management Approach for Earth Venture Instrument

    Science.gov (United States)

    Hope, Diane L.; Dutta, Sanghamitra

    2013-01-01

    The Earth Venture Instrument (EVI) element of the Earth Venture Program calls for developing instruments for participation on a NASA-arranged spaceflight mission of opportunity to conduct innovative, integrated, hypothesis or scientific question-driven approaches to pressing Earth system science issues. This paper discusses the EVI element and the management approach being used to manage both an instrument development activity as well as the host accommodations activity. In particular the focus will be on the approach being used for the first EVI (EVI-1) selected instrument, Tropospheric Emissions: Monitoring of Pollution (TEMPO), which will be hosted on a commercial GEO satellite and some of the challenges encountered to date and corresponding mitigations that are associated with the management structure for the TEMPO Mission and the architecture of EVI.

  16. Approach to transaction management for Space Station Freedom

    Science.gov (United States)

    Easton, C. R.; Cressy, Phil; Ohnesorge, T. E.; Hector, Garland

    1989-01-01

    An approach to managing the operations of the Space Station Freedom based on their external effects is described. It is assumed that there is a conflict-free schedule that, if followed, will allow only appropriate operations to occur. The problem is then reduced to that of ensuring that the operations initiated are within the limits allowed by the schedule, or that the external effects of such operations are within those allowed by the schedule. The main features of the currently adopted transaction management approach are discussed.

  17. A partnership approach to research data management

    OpenAIRE

    Brown, Mark L.; White, Wendy

    2013-01-01

    This outlines developments to support and enhance research data management policy and practice at the University of Southampton. It details a research-led approach to identify institutional challenges and priorities and use of this evidence-base to inform the creation of a 10 year roadmap and policy framework. The particular issues relating to workflow, storage, security and archiving are discussed and examples are given of both pilot and embedded services including data management planning s...

  18. Developing a holistic approach to obesity management.

    Science.gov (United States)

    Brown, Jenny; Wimpenny, Peter

    2011-02-01

    The aim of this paper is to discuss the theoretical background and relevance of a holistic approach to obesity management by nurses. There is a global rise in the number of people with obesity, such that it now represents one of the major health challenges. However, nurses are often influenced by physical and dietetic focused approaches and could fail to acknowledge a range of other factors that can impact on weight management. As part of the development of a holistic approach to obesity a literature search was undertaken to establish relevant theoretical perspectives that underpin practice in physical, psychological and social aspects of care (focused on the period 1995-2005). In addition, experiences of working in a secondary care weight management clinic were also drawn upon. Psychobiological, attribution and social support theories were identified that could contribute to a better understanding of obesity. If these theoretical perspectives and supporting evidence can be integrated in a holistic approach to care and management it might be possible to promote better health and well-being in those with obesity. Creating a greater understanding of the range of theoretical perspectives and supporting evidence related to obesity could, it is argued, provide enhanced care and management. © 2011 Blackwell Publishing Asia Pty Ltd.

  19. Sustainable operations management: A typological approach

    Directory of Open Access Journals (Sweden)

    Lawrence Michael Corbett

    2009-07-01

    Full Text Available This paper discusses the nature of sustainability and sustainable development as they relate to operations management. It proposes a typology for sustainable operations management that is based on the life cycle stages of a product and the three dimensions of corporate social responsibility. The aim is to show how this typology development could provide a useful approach to integrating the diverse strands of sustainability in operations, using industrial ecology and carbon neutrality as examples. It does this by providing a focused subset of environmental concerns for an industrial ecology approach, and some research propositions for the issue of carbon neutrality.

  20. Systems approach to project risk management

    Energy Technology Data Exchange (ETDEWEB)

    Kindinger, J. P. (John P.)

    2002-01-01

    This paper describes the need for better performance in the planning and execution of projects and examines the capabilities of two different project risk analysis methods for improving project performance. A quantitative approach based on concepts and tools adopted from the disciplines of systems analysis, probabilistic risk analysis, and other fields is advocated for managing risk in large and complex research & development projects. This paper also provides an overview of how this system analysis approach for project risk management is being used at Los Alamos National Laboratory along with examples of quantitative risk analysis results and their application to improve project performance.

  1. Holistic approach to fraud management in health insurance

    Directory of Open Access Journals (Sweden)

    Štefan Furlan

    2008-12-01

    Full Text Available Fraud present an immense problem for health insurance companies and the only way to fight fraud is by using specialized fraud management systems. The current research community focussed great efforts on different fraud detection techniques while neglecting other also important activities of fraud management. We propose a holistic approach that focuses on all 6 activities of fraud management, namely, (1 deterrence, (2 prevention, (3 detection, (4 investigation, (5 sanction and redress, and (6 monitoring. The main contribution of the paper are 15 key characteristics of a fraud management system, which enable construction of a fraud management system that provides effective and efficient support to all fraud management activities. We base our research on literature review, interviews with experts from different fields, and a case study. The case study provides additional confirmation to expert opinions, as it puts our holistic framework into practice.

  2. CANDU plant life management - An integrated approach

    International Nuclear Information System (INIS)

    Charlebois, P.; Hart, R.S.; Hopkins, J.R.

    1998-01-01

    Commercial versions of CANDU reactors were put into service starting more than 25 years ago. The first unit of Ontario Hydro's Pickering A station was put into service in 1971, and Bruce A in 1977. Most CANDU reactors, however, are only now approaching their mid-life of 15 to 20 years of operation. In particular, the first series of CANDU 6 plants which entered service in the early 1980's were designed for a 30 year life and are now approaching mid life. The current CANDU 6 design is based on a 40 year life as a result of advancement in design and materials through research and development. In order to assure safe and economic operation of these reactors, a comprehensive CANDU Plant Life Management (PLIM) program is being developed from the knowledge gained during the operation of Ontario Hydro's Pickering, Bruce, and Darlington stations, worldwide information from CANDU 6 stations, CANDU research and development programs, and other national and international sources. This integration began its first phase in 1994, with the identification of most of the critical systems structures and components in these stations, and a preliminary assessment of degradation and mechanisms that could affect their fitness for service for their planned life. Most of these preliminary assessments are now complete, together with the production of the first iteration of Life Management Plans for several of the systems and components. The Generic CANDU 6 PLIM program is now reaching its maturity, with formal processes to systematically identify and evaluate the major CSSCs in the station, and a plan to ensure that the plant surveillance, operation, and maintenance programs monitor and control component degradation well within the original design specifications essential for the plant life attainment. A Technology Watch program is being established to ensure that degradation mechanisms which could impact on plant life are promptly investigated and mitigating programs established. The

  3. A progressive approach to discrete trial teaching: Some current guidelines

    Directory of Open Access Journals (Sweden)

    Justin B. Leaf

    2016-12-01

    Full Text Available Discrete trial teaching (DTT is one of the cornerstones of applied behavior analysis (ABA based interventions. Conventionally, DTT is commonly implemented within a prescribed, fixed manner in which the therapist is governed by a strict set of rules. In contrast to conventional DTT, a progressive approach to DTT allows the therapist to remain flexible, making in-the-moment analyses and changes based on several variables (e.g., individual responding, current and previous history. The present paper will describe some guidelines to a progressive approach to DTT. The guidelines presented here should not be taken as a set of rules or as an exhaustive list.

  4. A Progressive Approach to Discrete Trial Teaching: Some Current Guidelines

    Directory of Open Access Journals (Sweden)

    Justin B. LEAF

    2016-12-01

    Full Text Available Discrete trial teaching (DTT is one of the cornerstones of applied behavior analysis (ABA based interventions. Conventionally, DTT is commonly implemented within a prescribed, fixed manner in which the therapist is governed by a strict set of rules. In contrast to conventional DTT, a progressive approach to DTT allows the therapist to remain flexible, making in-the-moment analyses and changes based on several variables (e.g., individual responding, current and previous history. The present paper will describe some guidelines to a progressive approach to DTT. The guidelines presented here should not be taken as a set of rules or as an exhaustive list.

  5. Improvement of radiology services based on the process management approach

    International Nuclear Information System (INIS)

    Amaral, Creusa Sayuri Tahara; Rozenfeld, Henrique; Costa, Janaina Mascarenhas Hornos; Magon, Maria de Fatima de Andrade; Mascarenhas, Yvone Maria

    2011-01-01

    The health sector requires continuous investments to ensure the improvement of products and services from a technological standpoint, the use of new materials, equipment and tools, and the application of process management methods. Methods associated with the process management approach, such as the development of reference models of business processes, can provide significant innovations in the health sector and respond to the current market trend for modern management in this sector (Gunderman et al. (2008) ). This article proposes a process model for diagnostic medical X-ray imaging, from which it derives a primary reference model and describes how this information leads to gains in quality and improvements.

  6. Neuroeconomics and Management Educations: Perspectives for New Applications and Approaches

    Directory of Open Access Journals (Sweden)

    Titov Sergei

    2016-01-01

    Full Text Available Since the 1990s economics started importing interesting insights from psychology and the new discipline of behavioral economics elaborated many interesting models that changed the traditional economic and management theories. Nowadays the applications from neuroscience are extensively used in economics which led to the birth of neuroeconomics. The article attempts to overview the current state and topics in neuroscience and neuroeconomics in order to elaborate the suggestions pertaining to management education. The article is based on several examples of the neuroeconomic research and formulates new applications and approaches to management training curriculum and methods of learning.

  7. A Landscape Approach to Invasive Species Management.

    Directory of Open Access Journals (Sweden)

    Miguel Lurgi

    distributed links. Our modelling framework provides a simple approach for identifying the best possible management strategy for invasive species based on metapopulation structure and control capacity. This information can be used by managers trying to devise efficient landscape-oriented management strategies for invasive species and can also generate insights for conservation purposes.

  8. A Landscape Approach to Invasive Species Management.

    Science.gov (United States)

    Lurgi, Miguel; Wells, Konstans; Kennedy, Malcolm; Campbell, Susan; Fordham, Damien A

    2016-01-01

    modelling framework provides a simple approach for identifying the best possible management strategy for invasive species based on metapopulation structure and control capacity. This information can be used by managers trying to devise efficient landscape-oriented management strategies for invasive species and can also generate insights for conservation purposes.

  9. Exploring Conflict Management Using Qualitative Approach

    Directory of Open Access Journals (Sweden)

    Zaleha Yazid

    2015-04-01

    Full Text Available This paper focuses on qualitative methods in researching the area of conflict management, specifically in Self-Managed Project Team (SMPT. The research aims to explore the evolvement of conflict management strategies in SMPT as this type of team is given the responsibility to solve problems and make decision by themselves. The inductive approach will overcome the limitation of quantitative method in management research as one of its objectives is to explain the different elements of the explored social system and their interconnection. Hence, it aims at the contextual understanding of social behavior rather than extensive measurement. This paper also includes the research activities in details such as the data collection methods which involved semi-structured interviews and weekly telephone interviews. The findings of the research proposed that conflict management strategies in SMPT changes over time from confrontation and cooperative style towards avoidance due to the issues of reputation and the deadline.

  10. RISK MANAGEMENT: AN INTEGRATED APPROACH TO RISK MANAGEMENT AND ASSESSMENT

    OpenAIRE

    Szabo Alina

    2012-01-01

    Purpose: The objective of this paper is to offer an overview over risk management cycle by focusing on prioritization and treatment, in order to ensure an integrated approach to risk management and assessment, and establish the ‘top 8-12’ risks report within the organization. The interface with Internal Audit is ensured by the implementation of the scoring method to prioritize risks collected from previous generated risk report. Methodology/approach: Using evidence from other research in ...

  11. Evolution of an approach to configuration management

    International Nuclear Information System (INIS)

    Bowes, E.V.

    1988-01-01

    Virginia Power is currently in the process of developing and implementing an automated Equipment Data System/Bill of Materials (EDS/BOM) which will support many aspects of maintenance management, including planning, component tracking, materials management and historical reporting. The EDS/BOM system is being developed as an application of a comprehensive automated Work Planning and Tracking System (WPTS) which has become the main system for use in station maintenance management. In addition to these programs, the Company has also developed a Cost Planning and Tracking System (CPTS) and has invested over $20 million in an equipment mark numbering and drawing update program. As these programs have matured, the need has been recognized for a structured configuration management program to protect the multi-million dollar investment in documents and data, and to assure the existence of reliable information as a foundation for improved efficiency in maintenance management and engineering

  12. THE SYSTEMATIC APPROACH TO MANAGEMENT IN EDUCATION

    Directory of Open Access Journals (Sweden)

    Nikita S. Iskrin

    2015-01-01

    Full Text Available The purpose of this article is to study the potential of a systematic approach as the basic element of the course content in system training of managers in education. Methods. Methods involve analysis of the theory and practice of application of the system approach to management challenges in education; positions of the general systems’ theory; synergetic approach as «the optimum control mechanism of complex systems»; adaptation of administrative technologies for an education sphere, implemented before and mainly in economy; questioning of educators of an education system of different levels. Results. The authors have proved the necessity of formation of managers’ systems thinking, with the specialization – a variety of educational services rendering. Managerial process characteristics of educational institution are defined. The course as training variant «Education of Managers» is proposed on the basis of the analysis of a historiography and summary results of questioning. Scientific novelty. Theoretical blocks of retraining and reorientation program to new paradigms of educators’ service or activities of are specified. The systematic approach to activity operations management has become the basis of the proposed program. Practical significance. Developed on the basis of results of research and approved course « Systematic approach in educational institution practice: technologies and management issues» helps get over some thinking and the stereotypes that generate the problems in education system development; promotes understanding of management methods in accordance with principles of systematic thinking; realizes and sets the abilities of interrelations revealing between external and internal processes and phenomena in relation to the system; develops an ability to predict the future systems behaviour and readiness to change structure of system, cohesion between its elements and functions.

  13. German Approach to Spent Fuel Management

    International Nuclear Information System (INIS)

    Jussofie, A.; Graf, R.; Filbert, W.

    2010-01-01

    The management of spent fuel was based on two powerful columns until 30 June 2005, i. e. reprocessing and direct disposal. After this date any delivery of spent fuel to reprocessing plants was prohibited so that the direct disposal of unreprocessed spent fuel is the only available option in Germany today. The main steps of the current concept are: (i) Intermediate storage of spent fuel, which is the only step in practice. After the first cooling period in spent fuel storage pools it continues into cask-receiving dry storage facilities. Identification of casks, 'freezing' of inventories in terms of continuity of knowledge, monitoring the access to spent fuel, verifying nuclear material movements in terms of cask transfers and ensurance against diversion of nuclear material belong to the fundamental safeguards goals which have been achieved in the intermediate storage facilities by containment and surveillance techniques in unattended mode. (ii) Conditioning of spent fuel assemblies by separating the fuel rods from structural elements. Since the pilot conditioning facility in Gorleben has not yet come into operation, the underlying safeguards approach which focuses on safeguarding the key measurement points - the spent fuel related way in and out of the facility - has not been applied yet. (iii) Disposal in deep geological formations, but no decision has been made so far neither regarding the location of a geological repository nor regarding the safeguards approach for the disposal concept of spent fuel. The situation was complicated by a moratorium which suspended the underground exploration of the Gorleben salt dome as potential geological repository for spent fuel. The moratorium expires in October 2010. Nevertheless, considerable progress has been made in the development of disposal concepts. According to the basic, so-called POLLUX (registered) -concept spent fuel assemblies are to be conditioned after dry storage and reloaded into the POLLUX (registered) -cask

  14. Streamlined approach to waste management at CRL

    International Nuclear Information System (INIS)

    Adams, L.; Campbell, B.

    2011-01-01

    Radioactive, mixed, hazardous and non-hazardous wastes have been and continue to be generated at Chalk River Laboratories (CRL) as a result of research and development activities and operations since the 1940s. Over the years, the wastes produced as a byproduct of activities delivering the core missions of the CRL site have been of many types, and today, over thirty distinct waste streams have been identified, all requiring efficient management. With the commencement of decommissioning of the legacy created as part of the development of the Canadian nuclear industry, the volumes and range of wastes to be managed have been increasing in the near term, and this trend will continue into the future. The development of a streamlined approach to waste management is a key to successful waste management at CRL. Waste management guidelines that address all of the requirements have become complex, and so have the various waste management groups receiving waste, with their many different processes and capabilities. This has led to difficulties for waste generators in understanding all of the requirements to be satisfied for the various CRL waste receivers, whose primary concerns are to be safe and in compliance with their acceptance criteria and license conditions. As a result, waste movement on site can often be very slow, especially for non-routine waste types. Recognizing an opportunity for improvement, the Waste Management organization at CRL has implemented a more streamlined approach with emphasis on early identification of waste type and possible disposition path. This paper presents a streamlined approach to waste identification and waste management at CRL, the implementation methodology applied and the early results achieved from this process improvement. (author)

  15. Rehabilitation Medicine Approaches to Pain Management.

    Science.gov (United States)

    Cheville, Andrea L; Smith, Sean R; Basford, Jeffrey R

    2018-06-01

    Rehabilitation medicine offers strategies that reduce musculoskeletal pain, targeted approaches to alleviate movement-related pain, and interventions to optimize patients' function despite the persistence of pain. These approaches fall into four categories: modulating nociception, stabilizing and unloading painful structures, influencing pain perception, and alleviating soft tissue musculotendinous pain. Incorporating these interventions into individualized, comprehensive pain management programs offers the potential to empower patients and limit pain associated with mobility and required daily activities. Rehabilitative approach may be particularly helpful for patients with refractory movement-associated pain and functional vulnerability, and for those who do not wish for, or cannot, tolerate pharmacoanalgesia. Copyright © 2018 Elsevier Inc. All rights reserved.

  16. Project Management Approaches for Online Learning Design

    Science.gov (United States)

    Eby, Gulsun; Yuzer, T. Volkan

    2013-01-01

    Developments in online learning and its design are areas that continue to grow in order to enhance students' learning environments and experiences. However, in the implementation of new technologies, the importance of properly and fairly overseeing these courses is often undervalued. "Project Management Approaches for Online Learning Design"…

  17. Comprehending Elementary School Teachers' Classroom Management Approaches

    Science.gov (United States)

    Sahin, Ali E.

    2015-01-01

    This study intends to determine elementary school teachers' degree of classroom control, which constitutes the consistency in their classroom management and discipline-related behaviour. The major research question was as follows: Is the control approach adopted by teachers related to certain variables (gender, age, subject area, experience)? The…

  18. Economic versus technical approaches to frequency management

    DEFF Research Database (Denmark)

    Falch, Morten; Tadayoni, Reza

    2004-01-01

    to demonstrate how regulators could incorporate an econmic dimension into frequency allocation. The paper concludes that a free market approach is still not possible for some parts of the frequency management process; in short term, regulators must therefore continue to prioritize between applications....

  19. Breast Cancer In Pregnancy: Management Approach

    African Journals Online (AJOL)

    reflecting the more advanced stage of the disease at diagnosis. An approach to the management of breast cancer in pregnancy is presented by a case illustration and a review of literature. KEY WORDS: Breast Cancer, ... function tests, haemogram and ultra— sound. She delivered a live female baby weighing 2.8 kilogram's ...

  20. Residents' values and fuels management approaches

    Science.gov (United States)

    Gwo-Bao Liou; Christine Vogt; Greg Winter; Sarah McCaffrey

    2008-01-01

    The research utilizes the Forest Value and Salient Value Similarity Scales to examine homeowners' value orientations and relate them to attitudes toward and support for fuels management approaches. Data were collected from homeowners living in the wildland-urban interface of the Huron- Manistee National Forest at two time periods, in 2002 and 2006. The panel data...

  1. Approach to accident management in RBMK-1500

    International Nuclear Information System (INIS)

    Kaliatka, A.; Urbonavicius, E.; Uspuras, E.

    2008-01-01

    In order to ensure the safe operation of the nuclear power plants accident management programs are being developed around the world. These accident management programs cover the whole spectrum of accidents, including severe accidents. A lot of work is done to investigate the severe accident phenomena and implement severe accident management in NPPs with vessel-type reactors, while less attention is paid to channel-type reactors CANDU and RBMK. Ignalina NPP with RBMK-1500 reactor has implemented symptom based emergency operation procedures, which cover management of accidents until the core damage and do not extend to core damage region. In order to ensure coverage of the whole spectrum of accidents and meet the requirements of IAEA the severe accident management guidelines have to be developed. This paper presents the basic principles and approach to management of beyond design basis accidents at Ignalina NPP. In general, this approach could be applied to NPPs with RBMK-1000 reactors that are available in Russia, but the design differences should be taken into account

  2. Strategic Niche Management and Transition Management: different but complementary approaches

    NARCIS (Netherlands)

    D.A. Loorbach (Derk); R. van Raak (Ronald)

    2006-01-01

    textabstractThis discussion paper sets out to compare two different, yet related, approaches to achieve sustainable development and (technological) innovation. Strategic Niche Management (SNM) (Kemp, Schot et al. 1998; Weber 1999) emerged as a novel concept by the end of the 1990’s and is presented

  3. Biomedical waste management in Ayurveda hospitals - current practices & future prospectives.

    Science.gov (United States)

    Rajan, Renju; Robin, Delvin T; M, Vandanarani

    2018-03-16

    Biomedical waste management is an integral part of traditional and contemporary system of health care. The paper focuses on the identification and classification of biomedical wastes in Ayurvedic hospitals, current practices of its management in Ayurveda hospitals and its future prospective. Databases like PubMed (1975-2017 Feb), Scopus (1960-2017), AYUSH Portal, DOAJ, DHARA and Google scholar were searched. We used the medical subject headings 'biomedical waste' and 'health care waste' for identification and classification. The terms 'biomedical waste management', 'health care waste management' alone and combined with 'Ayurveda' or 'Ayurvedic' for current practices and recent advances in the treatment of these wastes were used. We made a humble attempt to categorize the biomedical wastes from Ayurvedic hospitals as the available data about its grouping is very scarce. Proper biomedical waste management is the mainstay of hospital cleanliness, hospital hygiene and maintenance activities. Current disposal techniques adopted for Ayurveda biomedical wastes are - sewage/drains, incineration and land fill. But these methods are having some merits as well as demerits. Our review has identified a number of interesting areas for future research such as the logical application of bioremediation techniques in biomedical waste management and the usage of effective micro-organisms and solar energy in waste disposal. Copyright © 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Published by Elsevier B.V. All rights reserved.

  4. Approaches to the mathematical description of NPP operational safety management and oversight

    International Nuclear Information System (INIS)

    Bilej, D.V.; Berzhanskij, S.V.

    2014-01-01

    The paper presents analysis of features related to NPP operational safety management and oversight. According to analysis results, approaches are proposed to perform mathematical description of specific processes and to develop a scale for management to the current safety level as regards NPP power generation. Proposed approaches are making experimental equations and process approach of ISO-9001 quality system

  5. Current approach for urinary system stone disease in pregnant women

    Directory of Open Access Journals (Sweden)

    Orcun Celik

    2016-01-01

    Full Text Available Urinary system stones can be classified according to size, location, X-ray characteristics, aetiology of formation, composition, and risk of recurrence. Especially urolithiasis during pregnancy is a diagnostic and therapeutic challenge. In most cases, it becomes symptomatic in the second or third trimester. Diagnostic options in pregnant women are limited due to the possible teratogenic, carcinogenic, and mutagenic risk of foetal radiation exposure. Clinical management of a pregnant urolithiasis patient is complex and demands close collaboration between patient, obstetrician and urologist. We would like to review current diagnosis and treatment modalities of stone disease of pregnant woman.

  6. Approach on origin management of nuclear materials at KAERI

    International Nuclear Information System (INIS)

    Kim, Hyun-Jo; Lee, Sung-Ho; Lee, Byung-Doo; Kim, In-Chul; Kim, Hyun-Sook; Jung, Juang

    2017-01-01

    This paper describes the current origin management approach and reviews the requirement to be reflected to meet the bilateral agreements. KAERI developed the origin management system to efficiently and effectively manage the origin information. The system is connected with KASIS to share the information on the inventory changes of nuclear material. After development of the system, however, the new concept of obligated nuclear material is introduced according to the amended ROK-US agreement. Also, the origin management system based on IAEA accounting reports needs to revise to include the nuclear material exempted from safeguards. Therefore KAERI will improve the origin management system to meet the requirement of bilateral agreements and NSSC notice to be revised.

  7. The screening approach for review of accident management programmes

    International Nuclear Information System (INIS)

    Misak, J.

    1999-01-01

    In this lecture the screening approach for review of accident management programmes are presented. It contains objective trees for accident management: logic structure of the approach; objectives and safety functions for accident management; safety principles

  8. Current problems regarding abortion, prenatal genetic testing and managing pregnancy

    Directory of Open Access Journals (Sweden)

    Klajn-Tatić Vesna

    2011-01-01

    Full Text Available Current ethical and legal issues with regard to abortion, prenatal genetic testing and managing pregnancy are discussed in this paper. These problems are considered from the legal theory point of view as well as from the standpoint of the Serbian Law, the European Convention for the Protection of Human Rights and Fundamental Freedoms, European Court of Human Rights, legal regulations of several EU countries, the USA, Japan, and their judicial practice. First, the pregnancy termination standards that exist in Serbia are introduced. Then the following issues are explained separately: the pro life and pro choice approaches to abortion; abortion according to the legal approach as a way of survival; the moral and legal status of the fetus; prenatal genetic testing, and finally matters regarding managing pregnancy today. Moral and legal principals of autonomy, namely freedom of choice of the individual, privacy and self-determination give women the right to terminate unwanted pregnancies. In addition, the basic question is whether the right of the woman to abortion clashes with the rights of others. Firstly, with the right of the "fetus to life". Secondly, with the right of the state to intervene in the interest of protecting "the life of the fetus". Third, with the rights of the woman’s partner. The fetus has the moral right to life, but less in relation to the same right of the woman as well as in relation to her right to control her life and her physical and moral integrity. On the other hand, the value of the life of the fetus increases morally and legally with the maturity of gestation; from the third trimester, the interest of the state prevails in the protection of the "life of the fetus" except when the life or health of the pregnant woman are at risk. As regards the rights of the woman’s partner, namely the husband’s opinion, there is no legal significance. The law does not request his participation in the decision on abortion because

  9. A total system approach to sustainable pest management

    Science.gov (United States)

    Lewis, W. J.; van Lenteren, J. C.; Phatak, Sharad C.; Tumlinson, J. H.

    1997-01-01

    A fundamental shift to a total system approach for crop protection is urgently needed to resolve escalating economic and environmental consequences of combating agricultural pests. Pest management strategies have long been dominated by quests for “silver bullet” products to control pest outbreaks. However, managing undesired variables in ecosystems is similar to that for other systems, including the human body and social orders. Experience in these fields substantiates the fact that therapeutic interventions into any system are effective only for short term relief because these externalities are soon “neutralized” by countermoves within the system. Long term resolutions can be achieved only by restructuring and managing these systems in ways that maximize the array of “built-in” preventive strengths, with therapeutic tactics serving strictly as backups to these natural regulators. To date, we have failed to incorporate this basic principle into the mainstream of pest management science and continue to regress into a foot race with nature. In this report, we establish why a total system approach is essential as the guiding premise of pest management and provide arguments as to how earlier attempts for change and current mainstream initiatives generally fail to follow this principle. We then draw on emerging knowledge about multitrophic level interactions and other specific findings about management of ecosystems to propose a pivotal redirection of pest management strategies that would honor this principle and, thus, be sustainable. Finally, we discuss the potential immense benefits of such a central shift in pest management philosophy. PMID:9356432

  10. Controllable Load Management Approaches in Smart Grids

    Directory of Open Access Journals (Sweden)

    Jingshuang Shen

    2015-10-01

    Full Text Available With rapid smart grid technology development, the customer can actively participate in demand-side management (DSM with the mutual information communication between the distributor operation company and the smart devices in real-time. Controllable load management not only has the advantage of peak shaving, load balance, frequency regulation, and voltage stability, but is also effective at providing fast balancing services to the renewable energy grid in the distributed power system. The load management faces an enormous challenge as the customer has a large number of both small residential loads and dispersed renewable sources. In this paper, various controllable load management approaches are discussed. The traditional controllable load approaches such as the end users’ controllable appliances, storage battery, Vehicle-to-Grid (V2G, and heat storage are reviewed. The “broad controllable loads” management, such as the microgrid, Virtual Power Plant (VPP, and the load aggregator are also presented. Furthermore, the load characteristics, control strategies, and control effectiveness are analyzed.

  11. Obesity in Nigeria: Current trends and management | Akpa ...

    African Journals Online (AJOL)

    The objective of the study is to review the current knowledge on the problems associated with obesity, as well as the measures and strategies that have evolved in its management. A review of the literature on the subject of obesity, its epidemiology, risk factors, clinical complications and treatment (using Medline computer ...

  12. Current Standards in the Management of Cerebral Metastases

    Directory of Open Access Journals (Sweden)

    Pablo Goetz

    2012-01-01

    Full Text Available The last 30 years have seen major changes in attitude toward patients with cerebral metastases. This paper aims to outline the major landmarks in this transition and the therapeutic strategies currently used. The controversies surrounding control of brain disease are discussed, and two emerging management trends are reviewed: tumor bed radiosurgery and salvage radiation.

  13. Distributed Database Management Systems A Practical Approach

    CERN Document Server

    Rahimi, Saeed K

    2010-01-01

    This book addresses issues related to managing data across a distributed database system. It is unique because it covers traditional database theory and current research, explaining the difficulties in providing a unified user interface and global data dictionary. The book gives implementers guidance on hiding discrepancies across systems and creating the illusion of a single repository for users. It also includes three sample frameworksâ€"implemented using J2SE with JMS, J2EE, and Microsoft .Netâ€"that readers can use to learn how to implement a distributed database management system. IT and

  14. Low-energy hadronic interactions beyond the current algebra approach

    International Nuclear Information System (INIS)

    Ivanov, A.N.; Troitskaya, N.I.; Nagy, M.

    1993-06-01

    The new low-energy AP 3 -interaction, which is produced by convergent box-constituent-quark-loop diagrams, is obtained within chiral perturbation theory at the quark level (CHPT) q with linear realization of chiral U(3) x U(3) symmetry. Its contributions to processes of low-energy interactions of low-lying mesons are investigated. The new interaction goes beyond the framework of the low-energy current algebra approach and of the effective chiral Lagrangians with linear realization of chiral symmetry, constructed at the hadronic level. (author). 17 refs, 3 figs

  15. Electrostatic Discharge Current Linear Approach and Circuit Design Method

    Directory of Open Access Journals (Sweden)

    Pavlos K. Katsivelis

    2010-11-01

    Full Text Available The Electrostatic Discharge phenomenon is a great threat to all electronic devices and ICs. An electric charge passing rapidly from a charged body to another can seriously harm the last one. However, there is a lack in a linear mathematical approach which will make it possible to design a circuit capable of producing such a sophisticated current waveform. The commonly accepted Electrostatic Discharge current waveform is the one set by the IEC 61000-4-2. However, the over-simplified circuit included in the same standard is incapable of producing such a waveform. Treating the Electrostatic Discharge current waveform of the IEC 61000-4-2 as reference, an approximation method, based on Prony’s method, is developed and applied in order to obtain a linear system’s response. Considering a known input, a method to design a circuit, able to generate this ESD current waveform in presented. The circuit synthesis assumes ideal active elements. A simulation is carried out using the PSpice software.

  16. A management systems approach to pipeline integrity

    Energy Technology Data Exchange (ETDEWEB)

    Abes, J. [CC Technologies Canada, Calgary, AB (Canada)

    2008-07-01

    A management systems approach to pipeline integrity was discussed in terms of accident causation models, lessons from accidents, and management systems. Accident causation models include the Heinrich domino theory; epidemiological models; event chain models; and system-based models. A review of the Bellingham pipeline accident showed that if the pipeline had not been weakened by external damage, it likely would have been able to withstand the pressure that occurred on the day of the rupture, and the accident would not have happened. It was also determined that there was inadequate inspection of excavation work during the water treatment plant project and consequently, there was a failure to identify and repair the damage done to the pipeline. The presentation also addressed other findings, such as inaccurate evaluation of in-line pipeline inspection data; failure to manage and protect the supervisory control and data acquisition system (SCADA); and ineffective management oversight of construction and activation of products terminal. The Carlsbad pipeline explosion was also presented as another example of an accident. Several violations by El Paso were cited, including failure to ensure that qualified personnel performed internal corrosion control procedures; failure to perform necessary tests for corrosion; and failure to follow procedures for continuing surveillance of its facilities. Last, the presentation provided a definition of management systems and discussed the characteristics and elements of a management system. These elements included policy and leadership commitment; organizational structure and responsibilities; management of resources; communication plan; document and records management; operational controls; management of change; and continual improvement. 1 fig.

  17. Disease Management Evaluation: A Comprehensive Review of Current State of the Art

    OpenAIRE

    Conklin, Annalijn; Nolte, Ellen

    2011-01-01

    Many countries across Europe and elsewhere have been experimenting with various structured approaches to manage patients with chronic illness as a way to improve quality of care, reduce costs and lead to better population health outcomes in the long run. Despite a body of studies of disease management interventions, uncertainty about the effects of these remains not least because current guidance on evaluation methods and metrics require further development to enhance scientific rigour while ...

  18. Nursing approaches in the postoperative pain management

    Directory of Open Access Journals (Sweden)

    Sevilay Yüceer

    2011-12-01

    Full Text Available Patients frequently experience moderate to severe pain inthe postoperative period. Although the pain managementis an integral and important part of the nursing care, studiessuggest that, nursing management of postoperativepain remains inadequate.Postoperative care nurses are responsible to assess thepatient’s pain, teach the patient strategies to deal with thepain, apply the analgesic treatment plan, monitor the resultsof treatment, educate the patient and the family onpain management and document the pain managementoutcomes. The nurses’ holistic approach to pain managementminimizes the patients’ discomfort caused by pain inthe postoperative period after the surgery. In this article,nurses’ approaches to postoperative pain managementare discussed. J Clin Exp Invest 2011; 2 (4: 474-478

  19. On the ALARP approach to risk management

    International Nuclear Information System (INIS)

    Melchers, R.E.

    2001-01-01

    There is an increasing trend by regulatory authorities for the introduction of the as low as reasonably practicable (ALARP) approach in dealing with risk management of proposed or existing complex hazardous systems. For these, decisions about acceptability or tolerability of risks and consequences can have very significant financial, economic and other consequences for the proponents. Conversely, there may be very significant social and socio-economic implications. ALARP as a guide to achieving a satisfactory outcome has a certain intuitive appeal for the practical management of industrial and other risks. However, as suggested herein, there are a number of areas of concern about the validity of this approach. These include representativeness, morality, philosophy, political reality and practicality. An important, and in some respects fundamental, difficulty is that the risk acceptance criteria are not fully open to public scrutiny and can appear to be settled by negotiation

  20. Comparisons on International Approaches of Business and Project Risk Management

    OpenAIRE

    Nadia Carmen ENE

    2005-01-01

    In this article we intend to present a comparative approach between three recognized international methodologies for risk management: RISKMAN, Project Management Institute Methodology-PMBoK and Project Risk Analysis and Management Guide (produced by Association for Project Management).

  1. MULTIFACETED APPROACH TO NATURAL RESOURCE MANAGEMENT: ETHNOLOGY, GEOGRAPHY, CULTURE

    Directory of Open Access Journals (Sweden)

    Mikhail Slipenchuk

    2016-12-01

    Full Text Available Nowadays, the issue of interaction between man and nature is one of the most pressing challenges. One of the aspects of this interaction, as well as one of the prior scientific directions and use of natural resources, is natural resource management. A limited amount of many resources and the limits of environmental capacity of nature raise questions of equity to the interests of different generations, which implies the need to decide on the optimal use of natural resource potential of territories currently and in the future. The complex nature of the relationships that form the structure of resources management as a complex system, dictates the need for a comprehensive approach to its study. System analysis is this type of approach. It allows holding studies of the functions of resources management and identifying problems to its development.

  2. Sun Protection; A risk management approach

    Science.gov (United States)

    Diffey, Brian

    2017-10-01

    Sun Protection differentiates itself from other texts by adopting a risk-management approach to determine whether, how, and in what circumstances, harm might be caused, and to explore the feasibility of various strategies in controlling exposure to solar UV radiation. This multi-disciplinary book covers topics from climatology through human exposure to sunlight, as well as biological and clinical effects of UV radiation to physical and chemical strategies for photoprotection.

  3. CANDU plant life management - An integrated approach

    International Nuclear Information System (INIS)

    Hopkins, J.R.

    1998-01-01

    An integrated approach to plant life management has been developed for CANDU reactors. Strategies, methods, and procedures have been developed for assessment of critical systems structures and components and for implementing a reliability centred maintenance program. A Technology Watch program is being implemented to eliminate 'surprises'. Specific work has been identified for 1998. AECL is working on the integrated program with CANDU owners and seeks participation from other CANDU owners

  4. Waste management in Greenland: current situation and challenges

    DEFF Research Database (Denmark)

    Eisted, Rasmus; Christensen, Thomas Højlund

    2011-01-01

    Waste management in Greenland (56 000 inhabitants) is characterized by landfilling, incineration and export to Denmark of small quantities of metals and hazardous waste. The annual amount of waste is estimated to about 50 000 tons but actual data are scarce. Data on the waste composition is basic...... are small and equipped with only moderate flue gas cleaning technology. This report summarizes the current waste management situation in Greenland and identifies important challenges in improving the waste management....... is basically lacking. The scattered small towns and settlements, the climate and the long transport distances between towns and also to recycling industries abroad constitute a complex situation with respect to waste management. The landfills have no collection of gas and leachate and the incinerators...

  5. Respiratory sensitization and allergy: Current research approaches and needs

    International Nuclear Information System (INIS)

    Boverhof, Darrell R.; Billington, Richard; Gollapudi, B. Bhaskar; Hotchkiss, John A.; Krieger, Shannon M.; Poole, Alan; Wiescinski, Connie M.; Woolhiser, Michael R.

    2008-01-01

    There are currently no accepted regulatory models for assessing the potential of a substance to cause respiratory sensitization and allergy. In contrast, a number of models exist for the assessment of contact sensitization and allergic contact dermatitis (ACD). Research indicates that respiratory sensitizers may be identified through contact sensitization assays such as the local lymph node assay, although only a small subset of the compounds that yield positive results in these assays are actually respiratory sensitizers. Due to the increasing health concerns associated with occupational asthma and the impending directives on the regulation of respiratory sensitizers and allergens, an approach which can identify these compounds and distinguish them from contact sensitizers is required. This report discusses some of the important contrasts between respiratory allergy and ACD, and highlights several prominent in vivo, in vitro and in silico approaches that are being applied or could be further developed to identify compounds capable of causing respiratory allergy. Although a number of animal models have been used for researching respiratory sensitization and allergy, protocols and endpoints for these approaches are often inconsistent, costly and difficult to reproduce, thereby limiting meaningful comparisons of data between laboratories and development of a consensus approach. A number of emerging in vitro and in silico models show promise for use in the characterization of contact sensitization potential and should be further explored for their ability to identify and differentiate contact and respiratory sensitizers. Ultimately, the development of a consistent, accurate and cost-effective model will likely incorporate a number of these approaches and will require effective communication, collaboration and consensus among all stakeholders

  6. Approach to Spacelab Payload mission management

    Science.gov (United States)

    Craft, H. G.; Lester, R. C.

    1978-01-01

    The nucleus of the approach to Spacelab Payload mission management is the establishment of a single point of authority for the entire payload on a given mission. This single point mission manager will serve as a 'broker' between the individual experiments and the STS, negotiating agreements by two-part interaction. The payload mission manager, along with a small support team, will represent the users in negotiating use of STS accommodations. He will provide the support needed by each individual experimenter to meet the scientific, technological, and applications objectives of the mission with minimum cost and maximum efficiency. The investigator will assume complete responsibility for his experiment hardware definition and development and will take an active role in the integration and operation of his experiment.

  7. Nuclear Knowledge Management: the IAEA Approach

    International Nuclear Information System (INIS)

    Sbaffoni, M.; De Grosbois, J.

    2015-01-01

    Knowledge in an organization is residing in people, processes and technology. Adequate awareness of their knowledge assets and of the risk of losing them is vital for safe and secure operations of nuclear installations. Senior managers understand this important linkage, and in the last years there is an increasing tendency in nuclear organizations to implement knowledge management strategies to ensure that the adequate and necessary knowledge is available at the right time, in the right place. Specific and advanced levels of knowledge are clearly required to achieve and maintain technical expertise, and experience must be developed and be available throughout the nuclear technology lifecycle. If a nuclear organization does not possess or have access to the required technical knowledge, a full understanding of the potential consequences of decisions and actions may not be possible, and safety, security and safeguards might be compromised. Effective decision making during design, licencing, procurement, construction, commissioning, operation, maintenance, refurbishment, and decommissioning of nuclear facilities needs to be risk-informed and knowledge-driven. Nuclear technology is complex and brings with it inherent and unique risks that must be managed to acceptably low levels. Nuclear managers have a responsibility not only to establish adequate technical knowledge and experience in their nuclear organizations but also to maintain it. The consequences of failing to manage the organizations key knowledge assets can result in serious degradations or accidents. The IAEA Nuclear Knowledge Management (NKM) sub-programme was established more than 10 years ago to support Nuclear Organizations, at Member States request, in the implementation and dissemination of the NKM methodology, through the development of guidance and tools, and by providing knowledge management services and assistance. The paper will briefly present IAEA understanding of and approach to knowledge

  8. Best practice in English Local Air Quality Management: principles illustrated by some examples of current practice

    Energy Technology Data Exchange (ETDEWEB)

    Beattie, C.I.; Ling, K.; Longhurst, J.W.S. [Univ. of the West of England, Faculty of Applied Sciences, Bristol (GB)] [and others

    1999-07-01

    The Local Air Quality Management (LAQM) process, a holistic approach to management, is well underway in England. The process aims to tackle air pollution problems from a variety of diverse sources, operating over different time scales and spatial areas. Although technical guidance from the Government has been published over the last two years, little guidance has been available for the management aspects of the process. Arguably, the management of air quality will be the crucial test of the LAQM process. Only by collaboration can technologies and policy actions, such as traffic management schemes, be put into effective action. The authors present an overview of the process, including a model of current LAQM procedures in the UK. Current practice is illustrated by way of results from a questionnaire survey of local authorities, health authorities and the Environment Agency and also by reference to specific examples from local authorities. (Author)

  9. Postoperative electrolyte management: Current practice patterns of surgeons and residents.

    Science.gov (United States)

    Angarita, Fernando A; Dueck, Andrew D; Azouz, Solomon M

    2015-07-01

    Managing postoperative electrolyte imbalances often is driven by dogma. To identify areas of improvement, we assessed the practice pattern of postoperative electrolyte management among surgeons and residents. An online survey was distributed among attending surgeons and surgical residents at the University of Toronto. The survey was designed according to a systematic approach for formulating self-administered questionnaires. Questions addressed workload, decision making in hypothetical clinical scenarios, and improvement strategies. Of 232 surveys distributed, 156 were completed (response rate: 67%). The majority stated that junior residents were responsible for managing electrolytes at 13 University of Toronto-affiliated hospitals. Supervision was carried out predominately by senior residents (75%). Thirteen percent reported management went unsupervised. Approximately 59% of residents were unaware how often attending surgeons assessed patients' electrolytes. Despite the majority of residents (53.7%) reporting they were never given tools or trained in electrolyte replacement, they considered themselves moderately or extremely confident. The management of hypothetical clinical scenarios differed between residents and attending surgeons. The majority (50.5%) of respondents considered that an electrolyte replacement protocol is the most appropriate improvement strategy. Electrolyte replacement represents an important component of surgeons' workload. Despite reporting that formal training in electrolyte management is limited, residents consider themselves competent; however, their practice is highly variable and often differs from pharmacologic-directed recommendations. Optimizing how postoperative electrolytes are managed in surgical wards requires building a framework that improves knowledge, training, and limits unnecessary interventions. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Management of Candida infections in liver transplant recipients: current perspectives

    Directory of Open Access Journals (Sweden)

    Lingegowda PB

    2014-07-01

    Full Text Available Pushpalatha B Lingegowda,1–3 Tan Ban Hock1,2,4,5 1Department of Infectious Diseases, Singapore General Hospital, 2DUKE-NUS Graduate Medical School, 3Yong Loo Lin School of Medicine, National University of Singapore, 4SingHealth Internal Medicine Residency Program, 5Faculty of Medicine, National University of Singapore, Singapore Abstract: Liver transplantation has emerged as a widely accepted lifesaving therapeutic option for many patients with a variety of liver diseases. Improved surgical and medical management has led to significant improvements in post-transplant survival rates with a 1 year and 5 year patient survival of 87% and 73%, respectively. A high mortality rate due to infections during the first post-transplant year persists. Invasive candidiasis is recognized as a significant problem associated with high morbidity and mortality. Recent surveillance data has helped to understand the changes in the epidemiology and the evolving trends in the use of antifungal agents for prophylaxis and treatment combined with the challenges of managing these invasive fungal infections, which has led the transplant community to explore the best management strategies. The emergence of resistant fungi and excess costs in managing these invasive fungal infections has added to the complexities of management. In this context, current perspectives in the management of Candida infections in liver transplant recipients will be reviewed. Keywords: Candida infections, management, liver transplant

  11. RISK MANAGEMENT: AN INTEGRATED APPROACH TO RISK MANAGEMENT AND ASSESSMENT

    Directory of Open Access Journals (Sweden)

    Szabo Alina

    2012-12-01

    Full Text Available Purpose: The objective of this paper is to offer an overview over risk management cycle by focusing on prioritization and treatment, in order to ensure an integrated approach to risk management and assessment, and establish the ‘top 8-12’ risks report within the organization. The interface with Internal Audit is ensured by the implementation of the scoring method to prioritize risks collected from previous generated risk report. Methodology/approach: Using evidence from other research in the area and the professional expertise, this article outlines an integrated approach to risk assessment and risk management reporting processes, by separating the risk in two main categories: strategic and operational risks. The focus is on risk prioritization and scoring; the final output will comprise a mix of strategic and operational (‘top 8-12’ risks, which should be used to establish the annual Internal Audit plan. Originality/value: By using an integrated approach to risk assessment and risk management will eliminate the need for a separate Internal Audit risk assessment over prevailing risks. It will reduce the level of risk assessment overlap by different functions (Tax, Treasury, Information System over the same risk categories as a single methodology, is used and will align timings of risk assessment exercises. The risk prioritization by usage of risk and control scoring criteria highlights the combination between financial and non-financial impact criteria allowing risks that do not naturally lend themselves to a financial amount to be also assessed consistently. It is emphasized the usage of score method to prioritize the risks included in the annual audit plan in order to increase accuracy and timelines.

  12. Current Approaches to the Establishment of Credit Risk Specific Provisions

    Directory of Open Access Journals (Sweden)

    Ion Nitu

    2008-10-01

    Full Text Available The aim of the new Basel II and IFRS approaches is to make the operations of financial institutions more transparent and thus to create a better basis for the market participants and supervisory authorities to acquire information and make decisions. In the banking sector, a continuous debate is being led, related to the similarities and differences between IFRS approach on loan loss provisions and Basel II approach on calculating the capital requirements, judging against the classical method regarding loan provisions, currently used by the Romanian banks following the Central Bank’s regulations.Banks must take into consideration that IFRS and Basel II objectives are fundamentally different. While IFRS aims to ensure that the financial papers reflect adequately the losses recorded at each balance sheet date, the Basel II objective is to ensure that the bank has enough provisions or capital in order to face expected losses in the next 12 months and eventual unexpected losses.Consequently, there are clear differences between the objectives of the two models. Basel II works on statistical modeling of expected losses while IFRS, although allowing statistical models, requires a trigger event to have occurred before they can be used. IAS 39 specifically states that losses that are expected as a result of future events, no matter how likely, are not recognized. This is a clear and fundamental area of difference between the two frameworks.

  13. Towards an Airframe Noise Prediction Methodology: Survey of Current Approaches

    Science.gov (United States)

    Farassat, Fereidoun; Casper, Jay H.

    2006-01-01

    In this paper, we present a critical survey of the current airframe noise (AFN) prediction methodologies. Four methodologies are recognized. These are the fully analytic method, CFD combined with the acoustic analogy, the semi-empirical method and fully numerical method. It is argued that for the immediate need of the aircraft industry, the semi-empirical method based on recent high quality acoustic database is the best available method. The method based on CFD and the Ffowcs William- Hawkings (FW-H) equation with penetrable data surface (FW-Hpds ) has advanced considerably and much experience has been gained in its use. However, more research is needed in the near future particularly in the area of turbulence simulation. The fully numerical method will take longer to reach maturity. Based on the current trends, it is predicted that this method will eventually develop into the method of choice. Both the turbulence simulation and propagation methods need to develop more for this method to become useful. Nonetheless, the authors propose that the method based on a combination of numerical and analytical techniques, e.g., CFD combined with FW-H equation, should also be worked on. In this effort, the current symbolic algebra software will allow more analytical approaches to be incorporated into AFN prediction methods.

  14. Biographical approach to human resource management

    Directory of Open Access Journals (Sweden)

    Ratković-Njegovan Biljana

    2015-01-01

    Full Text Available The paper discusses the importance of biographical approach to managing human resources, which is especially important in the first, anticipatory stage of organizational socialization, in which interview for the job is performed. Biographical principle is based on a broader and more complex approach to the candidate, which enables him to present his working career, personal qualities, professional knowledge and skills, social skills, interests and aspirations. Biographical approach allows an individual who has applied for a certain job to reflect, identify and present their work and life path in their own way.. The organization, in turn, through the biographical method receives valid information to predict the future behavior of candidates and their performance.

  15. A comprehensive approach to managing hazardous materials

    International Nuclear Information System (INIS)

    Donovan, A.

    1990-01-01

    An increased emphasis on the need for environmental protection indicates that engineers must now consider the disposition of unused hazardous materials as waste. Before specifying and ordering materials, the engineer must consider the impact of the Resource Conservation and Recovery Act (RCRA) and the Occupational Safety and Health Administration's (OSHA's) Hazard Communication Standard. Many commonly used materials such as paint, solvents, glues, and sealants fall under the requirements of these regulations. This paper presents a plant to manage hazardous materials at the US Department of Energy's (DOE's) Waste Isolation Pilot Plant (WIPP), which is managed and operated by Westinghouse Electric Corporation. The basic elements of the plan are training, hazard communication, storage and handling, tracking, and disposal. Steps to be taken to develop the plan are outlined, problems and successes are addressed, and interactions among all affected departments are identified. The benefits of an organized and comprehensive approach to managing hazardous materials are decreased worker injuries, reduction of accidental releases, minimization of waste, and compliance with federal, state, and local safety and environmental laws. In summary, the benefits of an organized program for the management of hazardous materials include compliance with the Environmental Protection Agency's (EPA's) requirements, demonstration of Westinghouse's role as a responsible corporate entity, and reduction of waste management costs

  16. FINANCIAL ASPECTS OF CURRENT ASSETS MANAGEMENT IN SERBIAN ECONOMY

    Directory of Open Access Journals (Sweden)

    Jugoslav Aničić

    2017-04-01

    Full Text Available Efficient current assets management should provide optimum level of company’s net current assets as interrelation between current assets and short-term liabilities. The companies whose short-term liabilities are not proportionate to cashable current assets face the problem of insolvency and all negative consequences caused by insolvency. Rate of return to total assets measures how good is the management’s use of the company property for the purpose of creating operating profit, regardless of the fact how these assets are financed. Serbian economy is burdened by insolvency and significant indebtedness under unfavorable loan terms, so adequate attention has to be dedicated to the matters of the structure of operating property and its financing in order to improve competitiveness and efficiency of business.

  17. An approach to systematic structural lifetime management

    International Nuclear Information System (INIS)

    Talja, H.; Solin, J.; Rintamaa, R.

    2000-01-01

    Many utilities are currently developing preventive maintenance and plant life management systems for their own use. Consideration of plant specific design and integrity problems support use of tailored programs and/or data bases for plant life management. The final applications will be developed on plant type, utility, plant or system level. However, common features can be included in the systems. The project Plant life management XVO conducted at VTT deals - as a whole - with systematic component lifetime management, operational loads in normal steady state operation and in transients, especially piping vibrations and integrity, NDE, materials ageing, interactions of coolant and materials, environmentally assisted cracking and ageing of reactor internals. One of the major challenges in the project is to define, how these multidisciplinary results should be integrated such that quantitative assessments on remaining safe life and failure risks are possible. In this paper a brief overview on the project is given. The work performed on piping vibration and integrity management is presented in more detail. (author)

  18. Current approaches to challenging scenarios in myeloproliferative neoplasms.

    Science.gov (United States)

    Zimran, Eran; Hoffman, Ronald; Kremyanskaya, Marina

    2018-06-01

    The Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) including polycythemia vera, essential thrombocythemia and primary myelofibrosis are clonal hematological malignancies that originate at the level of the hematopoietic stem cell, and are characterized by excessive proliferation of cells belonging to one or more of the myeloid lineages. Central to the pathogenesis of the MPNs is constitutive activation of the JAK/STAT signaling pathway due to a family of driver mutations affecting JAK2, CALR or MPL. These disorders share common clinical and laboratory features, a significant burden of systemic symptoms, increased risk of developing arterial and venous thrombotic events, and the potential to progress to myelofibrosis and acute leukemia. Areas covered: We identified four clinical situations which represent challenging management dilemmas for patients with MPNs. Our conclusions and recommendations are based on a literature search using MEDLINE and recent meeting abstracts using the keywords, focusing on publications directly addressing these scenarios and on recent contributions to the field. Expert commentary: Multi-center efforts to study large cohorts of MPN patients have led to more uniform and evidence-based approaches to key aspects in MPN management. However, treatment strategies to deal with specific clinical scenarios are lacking.

  19. Radioactive waste management approaches for developed countries

    Energy Technology Data Exchange (ETDEWEB)

    Patricia Paviet-Hartmann; Anthony Hechanova; Catherine Riddle

    2013-07-01

    Nuclear power has demonstrated over the last 30 years its capacity to produce base-load electricity at a low, predictable and stable cost due to the very low economic dependence on the price of uranium. However the management of used nuclear fuel remains the “Achilles’ Heel” of this energy source since the storage of used nuclear fuel is increasing as evidenced by the following number with 2,000 tons of UNF produced each year by the 104 US nuclear reactor units which equates to a total of 62,000 spent fuel assemblies stored in dry cask and 88,000 stored in pools. Two options adopted by several countries will be presented. The first one adopted by Europe, Japan and Russia consists of recycling the used nuclear fuel after irradiation in a nuclear reactor. Ninety six percent of uranium and plutonium contained in the spent fuel could be reused to produce electricity and are worth recycling. The separation of uranium and plutonium from the wastes is realized through the industrial PUREX process so that they can be recycled for re-use in a nuclear reactor as a mixed oxide (MOX) fuel. The second option undertaken by Finland, Sweden and the United States implies the direct disposal of used nuclear fuel into a geologic formation. One has to remind that only 30% of the worldwide used nuclear fuel are currently recycled, the larger part being stored (70% in pool) waiting for scientific or political decisions. A third option is emerging with a closed fuel cycle which will improve the global sustainability of nuclear energy. This option will not only decrease the volume amount of nuclear waste but also the long-term radiotoxicity of the final waste, as well as improving the long-term safety and the heat-loading of the final repository. At the present time, numerous countries are focusing on the R&D recycling activities of the ultimate waste composed of fission products and minor actinides (americium and curium). Several new chemical extraction processes, such as TRUSPEAK

  20. Language Management Theory as One Approach in Language Policy and Planning

    Science.gov (United States)

    Nekvapil, Jirí

    2016-01-01

    Language Policy and Planning is currently a significantly diversified research area and thus it is not easy to find common denominators that help to define basic approaches within it. Richard B. Baldauf attempted to do so by differentiating between four basic approaches: (1) the classical approach, (2) the language management approach (Language…

  1. Current Approaches for Control Room I and C Modernization

    International Nuclear Information System (INIS)

    Lopez, Alberto; Jimenez, Alfonso

    2002-01-01

    In general, instrumentation and control (I and C) systems for nuclear power plants were made using analogic systems and relays, since this was the only technology available by the time these systems were designed. This fact impacts on the operational and maintenance capabilities required to these systems. For this reason, nuclear power plants are facing nowadays two challenges: on one hand, the obsolescence of these systems contributes to the increase in the operation and maintenance costs - due to the difficulties for getting spare parts and support from the system vendors -. On the other hand, there has been an increase in the utilities competitiveness due to the electric power market liberalization. All this, of course, along with the commitment to maintain the current safety levels and meet the new requirements and standards that may arise in the near future. The application of current technologies, especially digital technology, solves the obsolescence problems and allows for a more functional and updated human-machine interface. Nevertheless, the cost associated to these modifications makes it necessary to develop strategies to determine which systems need to be modified and how to implement modifications effectively, so that these systems can work jointly with others using different technologies. Other issues inherent to digital technology must be considered, such as verification and validation of the software and of the human-machine interface, which are required for its licensing. This presentation describes the current approaches for I and C modernization, the main reasons, technologies and implementation plans, focusing on the control room and on the impact on operations. The main issues to be considered for developing a specific modernization plan are analysed. The goals and status of the 'Feasibility Study of the Control Room I and C Modernization' are described. This study is currently being developed by Endesa, Iberdrola and Tecnatom, and is included

  2. Macrosystems management approach to nuclear technology transfer

    International Nuclear Information System (INIS)

    Angelo, J.A. Jr.; Maultsby, T.E.

    1978-01-01

    The world of the 1980s will be a world of diminishing resources, shifting economic bases, rapidly changing cultural and societal structures, and an ever increasing demand for energy. A major driving function in this massive redistribution of global power is man's ability to transfer technology, including nuclear technology, to the developing nations. The major task facing policy makers in planning and managing technology transfer is to avoid the difficulties inherent in such technology exploitation, while maximizing the technical, economic, social, and cultural benefits brought about by the technology itself. But today's policy makers, using industrial-style planning, cannot adequately deal with all the complex, closely-coupled issues involved in technology transfer. Yet, policy makers within the developing nations must be capable of tackling the full spectrum of issues associated with technology transfer before committing to a particular course of action. The transfer and acceptance of complex technology would be significantly enhanced if policy makers followed a macrosystems management approach. Macrosystems management is a decision making methodology based on the techniques of macrosystems analysis. Macrosystems analysis combines the best quantitative methods in systems analysis with the best qualitative evaluations provided by multidisciplined task teams. These are focused in a project management structure to produce solution-oriented advice to the policy makers. The general relationships and management approach offered by macrosystems analysis are examined. Nowhere are the nuclear power option problems and issues more complex than in the transfer of this technology to developing nations. Although many critical variables of interest in the analysis are generic to a particular importer/exporter relationship, two specific issues that have universally impacted the nuclear power option, namely the fuel cycle, and manpower and training, are examined in the light of

  3. Current UK practices in the management of subacromial impingement

    Science.gov (United States)

    Drury, Colin; Tait, Gavin R

    2015-01-01

    Background Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients. Methods BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. Results Physiotherapy is an integral part of management for 93% of surgeons with a minimum period of 12 weeks being most popular prior to consideration of arthroscopic subacromial decompression. Subacromial steroid injection is used by 95% and 86% repeat this if the patient has failed to respond to a previous injection by the general practioner. From initial presentation, 77% felt there should be at least 3 months of conservative management before proceeding to surgery. Good but transient response to subacromial injection was considered the best predictor of good surgical outcome by 77%. The coracoacromial ligament is fully released by 78%, although there was greater variation in how aggressive surgeons were with acromioplasty. Most (59%) do not include the nontender acromioclavicular joint to any extent in routine acromioplasty. Hospital physiotherapy protocols are used by 63% for postoperative rehabilitation. Conclusions Variation exists in the management regimes offered to patients with subacromial impingement, but most employ a minimum period of 12 weeks of conservative management incorporating physiotherapy and at least 2 subacromial steriod injections. PMID:27582972

  4. Current UK practices in the management of subacromial impingement.

    Science.gov (United States)

    Bryceland, James K; Drury, Colin; Tait, Gavin R

    2015-07-01

    Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients. BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. Physiotherapy is an integral part of management for 93% of surgeons with a minimum period of 12 weeks being most popular prior to consideration of arthroscopic subacromial decompression. Subacromial steroid injection is used by 95% and 86% repeat this if the patient has failed to respond to a previous injection by the general practioner. From initial presentation, 77% felt there should be at least 3 months of conservative management before proceeding to surgery. Good but transient response to subacromial injection was considered the best predictor of good surgical outcome by 77%. The coracoacromial ligament is fully released by 78%, although there was greater variation in how aggressive surgeons were with acromioplasty. Most (59%) do not include the nontender acromioclavicular joint to any extent in routine acromioplasty. Hospital physiotherapy protocols are used by 63% for postoperative rehabilitation. Variation exists in the management regimes offered to patients with subacromial impingement, but most employ a minimum period of 12 weeks of conservative management incorporating physiotherapy and at least 2 subacromial steriod injections.

  5. A bayesian approach to laboratory utilization management

    Directory of Open Access Journals (Sweden)

    Ronald G Hauser

    2015-01-01

    Full Text Available Background: Laboratory utilization management describes a process designed to increase healthcare value by altering requests for laboratory services. A typical approach to monitor and prioritize interventions involves audits of laboratory orders against specific criteria, defined as rule-based laboratory utilization management. This approach has inherent limitations. First, rules are inflexible. They adapt poorly to the ambiguity of medical decision-making. Second, rules judge the context of a decision instead of the patient outcome allowing an order to simultaneously save a life and break a rule. Third, rules can threaten physician autonomy when used in a performance evaluation. Methods: We developed an alternative to rule-based laboratory utilization. The core idea comes from a formula used in epidemiology to estimate disease prevalence. The equation relates four terms: the prevalence of disease, the proportion of positive tests, test sensitivity and test specificity. When applied to a laboratory utilization audit, the formula estimates the prevalence of disease (pretest probability [PTP] in the patients tested. The comparison of PTPs among different providers, provider groups, or patient cohorts produces an objective evaluation of laboratory requests. We demonstrate the model in a review of tests for enterovirus (EV meningitis. Results: The model identified subpopulations within the cohort with a low prevalence of disease. These low prevalence groups shared demographic and seasonal factors known to protect against EV meningitis. This suggests too many orders occurred from patients at low risk for EV. Conclusion: We introduce a new method for laboratory utilization management programs to audit laboratory services.

  6. Sustainable Groundwater Management Using Economic Incentive Approach

    Science.gov (United States)

    Yan, T.; Shih, J.; Sanchirico, J. N.

    2006-12-01

    Although groundwater accounts for about 20% of the water consumption in the US, recent urban development, land use changes and agricultural activities in many regions (for example, Chesapeake Bay and eastern shore of Maryland) have resulted in deleterious impacts on groundwater quality. These impacts have dramatically increased potential human health and ecological system risks. One example is nitrogen pollution delivered to local waterways from septic systems via groundwater. Conventional approaches for nitrogen removal, such as pumping and treatment (nitrification-denitrification) process, tend to be expensive. On the other hand, economic incentive approaches (such as marketable permits) have the potential to increase the efficiency of environmental policy by reducing compliance costs for regulated entities and individuals and/or achieving otherwise uneconomical pollution reduction. The success of the sulfur dioxide trading market has led to the creation of trading markets for other pollutants, especially at the regional, state, and smaller (e.g. watershed) scales. In this paper, we develop an integrated framework, which includes a groundwater flow and transport model, and a conceptual management model. We apply this framework to a synthetic set up which includes one farm and two development areas in order to investigate the potential of using economic incentive approaches for groundwater quality management. The policy analysis is carried out by setting up the objective of the modeling framework to minimize the total cost of achieving groundwater quality goals at specific observation point using either a transferable development right (TDR) system between development areas and/or using a tax for fertilizer usage in the farm area. The TDR system consists of a planning agency delineating a region into restricted-use (e.g., agriculture, open space) and high intensity zones (e.g., residential, commercial uses). The agency then endows landowners in the restricted area

  7. Two complementary approaches to right-handed currents

    International Nuclear Information System (INIS)

    Gemmler, Katrin M.

    2012-01-01

    Flavour observables impose strong constraints on models of new physics. We study whether right-handed currents can provide a realistic extension to the Standard Model. We analyse two complementary models. These setups lead to new flavour violating interactions in the right-handed sector. We first consider a bottom-up approach assuming a left-right symmetric flavour group broken only by the Yukawa couplings. In this model the vertical stroke V ub vertical stroke problem can be solved. Secondly we study the Left-Right Model. We perform a comprehensive numerical analysis, including all known experimental constraints from ΔF=2 observables and the decay B →X s γ simultaneously. We observe that there exist regions in parameter space in accordance with the all data. In this model all flavour anomalies can be resolved except the vertical stroke V ub vertical stroke problem.

  8. OSTEOARTHRITIS: CURRENT CLINICAL CONCEPT AND SOME PROMISING THERAPEUTIC APPROACHES

    Directory of Open Access Journals (Sweden)

    A. E. Karateev

    2018-01-01

    Full Text Available In recent years, there has been a trend toward changing the clinical concept of osteoarthritis (OA. This disease has been considered as an age-related disease and the long-term result of a current pathological process for a very long time. However, many experts are now inclined to consider it necessary to identify the early, pre-X-ray stage of OA, when adequate treatment may not only halt the progression, but also achieve the regression of joint structural changes. This review deals with a number of pathogenetic and clinical aspects of the early stages of OA, which are important for timely diagnosis and pathogenetic therapy choice. It also considers some therapeutic approaches, both a "classic" and recently actively discussed methods for using platelet-rich plasma and autologous chondrocyte transplantation.

  9. Two complementary approaches to right-handed currents

    Energy Technology Data Exchange (ETDEWEB)

    Gemmler, Katrin M.

    2012-04-17

    Flavour observables impose strong constraints on models of new physics. We study whether right-handed currents can provide a realistic extension to the Standard Model. We analyse two complementary models. These setups lead to new flavour violating interactions in the right-handed sector. We first consider a bottom-up approach assuming a left-right symmetric flavour group broken only by the Yukawa couplings. In this model the vertical stroke V{sub ub} vertical stroke problem can be solved. Secondly we study the Left-Right Model. We perform a comprehensive numerical analysis, including all known experimental constraints from {Delta}F=2 observables and the decay B {yields}X{sub s}{gamma} simultaneously. We observe that there exist regions in parameter space in accordance with the all data. In this model all flavour anomalies can be resolved except the vertical stroke V{sub ub} vertical stroke problem.

  10. DIABETIC POLYNEUROPATHY: CURRENT APPROACHES TO DIAGNOSIS AND PATHOGENETIC THERAPY

    Directory of Open Access Journals (Sweden)

    O. S. Levin

    2014-07-01

    Full Text Available The paper considers the current views of the prevalence, clinical picture, approaches to the diagnosis and treatment of one of the most commonneurological complications of diabetes mellitus – diabetic polyneuropathy, and both its somatic and autonomous manifestations. Neuropathy ismost common in diabetic patients and its clinical forms reflect the severe course of diabetes mellitus and serve as an unfavorable prognostic signthat is associated with an approximately 5-fold increase in mortality. At the same time, the timely detection and adequate correction of the manifestations of neuropathy may substantially improve quality of life in the patients. The possibilities of pathogenetic therapy for diabetic polyneuropathy associated mainly with the use of benfotiamine and alpha-lipoic acid, as well as symptomatic therapy for its individual manifestationsare considered.

  11. DIABETIC POLYNEUROPATHY: CURRENT APPROACHES TO DIAGNOSIS AND PATHOGENETIC THERAPY

    Directory of Open Access Journals (Sweden)

    O. S. Levin

    2013-01-01

    Full Text Available The paper considers the current views of the prevalence, clinical picture, approaches to the diagnosis and treatment of one of the most commonneurological complications of diabetes mellitus – diabetic polyneuropathy, and both its somatic and autonomous manifestations. Neuropathy ismost common in diabetic patients and its clinical forms reflect the severe course of diabetes mellitus and serve as an unfavorable prognostic signthat is associated with an approximately 5-fold increase in mortality. At the same time, the timely detection and adequate correction of the manifestations of neuropathy may substantially improve quality of life in the patients. The possibilities of pathogenetic therapy for diabetic polyneuropathy associated mainly with the use of benfotiamine and alpha-lipoic acid, as well as symptomatic therapy for its individual manifestationsare considered.

  12. Managing ankle ligament sprains and tears: current opinion

    OpenAIRE

    McGovern RP; Martin RL

    2016-01-01

    Ryan P McGovern,1 RobRoy L Martin,1,2 1Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, 2Centers for Sports Medicine – University of Pittsburgh, Pittsburgh, PA, USA Abstract: The purpose of this paper is to present a current review of pathoanatomical features, differential diagnosis, objective assessment, intervention, and clinical course associated with managing lateral ankle ligament sprains. Proper diagnosis and identification of affected st...

  13. Current guidelines for management of children with functional constipation

    Directory of Open Access Journals (Sweden)

    V. P. Bulatov

    2015-01-01

    Full Text Available Despite the fact that functional constipations are a common and hence relevant problem of pediatrics, there are difficulties in managing this category of patients. The paper presents the current guidelines for the diagnosis and treatment of functional constipation in children, which rely on the principles of evidence-based medicine. Particular attention is given to the age-related aspects of constipation in childhood.

  14. Impression management and food intake. Current directions in research.

    Science.gov (United States)

    Vartanian, Lenny R

    2015-03-01

    This paper reviews recent research on consumption stereotypes (judgments of others based on what they eat) and impression management (modifying one's eating behavior in order to create a particular impression). A major recent focus in the literature has been on masculinity and meat eating, with research showing that meat is strongly associated with masculinity, and that individuals who follow a meat-based diet are perceived as more masculine than are individuals who follow a vegetarian diet. Although direct evidence for impression management through food intake remains sparse, a number of methodological approaches (including priming techniques and ecological valid assessments) are described that could be used in future research to identify the motives underlying people's eating behavior. Consumption stereotypes and impression management may be important influences on people's eating behavior, but the complexities of how, when, and for whom these factors influence food intake are still not well understood. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Knowledge Management in healthcare libraries: the current picture.

    Science.gov (United States)

    Hopkins, Emily

    2017-06-01

    Knowledge management has seen something of a resurgence in attention amongst health librarians recently. Of course it has never ceased to exist, but now many library staff are becoming more involved in organisational knowledge management, and positioning themselves as key players in the sphere. No single model of knowledge management is proliferating, but approaches that best fit the organisation's size, structure and culture, and a blending of evidence based practice and knowledge sharing. Whatever it is called and whatever models are used, it's clear that for librarians and information professionals, the importance of putting knowledge and evidence into practice, sharing knowledge well and capturing it effectively, are still what we will continue to do. © 2017 Health Libraries Group.

  16. Systems approaches to integrated solid waste management in developing countries

    International Nuclear Information System (INIS)

    Marshall, Rachael E.; Farahbakhsh, Khosrow

    2013-01-01

    Highlights: ► Five drivers led developed countries to current solid waste management paradigm. ► Many unique factors challenge developing country solid waste management. ► Limited transferability of developed country approaches to developing countries. ► High uncertainties and decision stakes call for post-normal approaches. ► Systems thinking needed for multi-scale, self-organizing eco-social waste systems. - Abstract: Solid waste management (SWM) has become an issue of increasing global concern as urban populations continue to rise and consumption patterns change. The health and environmental implications associated with SWM are mounting in urgency, particularly in the context of developing countries. While systems analyses largely targeting well-defined, engineered systems have been used to help SWM agencies in industrialized countries since the 1960s, collection and removal dominate the SWM sector in developing countries. This review contrasts the history and current paradigms of SWM practices and policies in industrialized countries with the current challenges and complexities faced in developing country SWM. In industrialized countries, public health, environment, resource scarcity, climate change, and public awareness and participation have acted as SWM drivers towards the current paradigm of integrated SWM. However, urbanization, inequality, and economic growth; cultural and socio-economic aspects; policy, governance, and institutional issues; and international influences have complicated SWM in developing countries. This has limited the applicability of approaches that were successful along the SWM development trajectories of industrialized countries. This review demonstrates the importance of founding new SWM approaches for developing country contexts in post-normal science and complex, adaptive systems thinking

  17. Systems approaches to integrated solid waste management in developing countries

    Energy Technology Data Exchange (ETDEWEB)

    Marshall, Rachael E., E-mail: rmarsh01@uoguelph.ca [School of Engineering, University of Guelph, Albert A. Thornbrough Building, Guelph, ON, Canada N1G 2W1 (Canada); Farahbakhsh, Khosrow, E-mail: khosrowf@uoguelph.ca [School of Engineering, University of Guelph, Albert A. Thornbrough Building, Guelph, ON, Canada N1G 2W1 (Canada)

    2013-04-15

    Highlights: ► Five drivers led developed countries to current solid waste management paradigm. ► Many unique factors challenge developing country solid waste management. ► Limited transferability of developed country approaches to developing countries. ► High uncertainties and decision stakes call for post-normal approaches. ► Systems thinking needed for multi-scale, self-organizing eco-social waste systems. - Abstract: Solid waste management (SWM) has become an issue of increasing global concern as urban populations continue to rise and consumption patterns change. The health and environmental implications associated with SWM are mounting in urgency, particularly in the context of developing countries. While systems analyses largely targeting well-defined, engineered systems have been used to help SWM agencies in industrialized countries since the 1960s, collection and removal dominate the SWM sector in developing countries. This review contrasts the history and current paradigms of SWM practices and policies in industrialized countries with the current challenges and complexities faced in developing country SWM. In industrialized countries, public health, environment, resource scarcity, climate change, and public awareness and participation have acted as SWM drivers towards the current paradigm of integrated SWM. However, urbanization, inequality, and economic growth; cultural and socio-economic aspects; policy, governance, and institutional issues; and international influences have complicated SWM in developing countries. This has limited the applicability of approaches that were successful along the SWM development trajectories of industrialized countries. This review demonstrates the importance of founding new SWM approaches for developing country contexts in post-normal science and complex, adaptive systems thinking.

  18. China's spent nuclear fuel management: Current practices and future strategies

    International Nuclear Information System (INIS)

    Zhou Yun

    2011-01-01

    Although China's nuclear power industry is relatively young and the management of its spent nuclear fuel is not yet a concern, China's commitment to nuclear energy and its rapid pace of development require detailed analyses of its future spent fuel management policies. The purpose of this study is to provide an overview of China's fuel cycle program and its reprocessing policy, and to suggest strategies for managing its future fuel cycle program. The study is broken into four sections. The first reviews China's current nuclear fuel cycle program and facilities. The second discusses China's current spent fuel management methods and the storage capability of China's 13 operational nuclear power plants. The third estimates China's total accumulated spent fuel, its required spent fuel storage from present day until 2035, when China expects its first commercialized fast neutron reactors to be operational, and its likely demand for uranium resources. The fourth examines several spent fuel management scenarios for the present period up until 2035; the financial cost and proliferation risk of each scenario is evaluated. The study concludes that China can and should maintain a reprocessing operation to meet its R and D activities before its fast reactor program is further developed. - Highlights: → This study provides an overview of China's fuel cycle program and its reprocessing policy.→ This study suggests strategies for managing its future fuel cycle program.→ China will experience no pressure to lessen the burden of spent fuel storage in the next 30 years.→ China should maintain sufficient reprocessing operations to meet its demands for R and D activities.→ China should actively invest on R and D activities of both fuel cycling and fast reactor programs.

  19. Electronic waste management approaches: An overview

    Energy Technology Data Exchange (ETDEWEB)

    Kiddee, Peeranart [Centre for Environmental Risk Assessment and Remediation, University of South Australia, Mawson Lakes Campus, Adelaide, SA 5095 (Australia); Cooperative Research Centre for Contamination Assessment and Remediation of the Environment, Mawson Lakes Campus, Adelaide, SA 5095 (Australia); Naidu, Ravi, E-mail: ravi.naidu@crccare.com [Centre for Environmental Risk Assessment and Remediation, University of South Australia, Mawson Lakes Campus, Adelaide, SA 5095 (Australia); Cooperative Research Centre for Contamination Assessment and Remediation of the Environment, Mawson Lakes Campus, Adelaide, SA 5095 (Australia); Wong, Ming H. [Croucher Institute for Environmental Sciences, Department of Biology, Hong Kong Baptist University, Kowloon Tong (China)

    2013-05-15

    Highlights: ► Human toxicity of hazardous substances in e-waste. ► Environmental impacts of e-waste from disposal processes. ► Life Cycle Assessment (LCA), Material Flow Analysis (MFA), Multi Criteria Analysis (MCA) and Extended Producer Responsibility (EPR) to and solve e-waste problems. ► Key issues relating to tools managing e-waste for sustainable e-waste management. - Abstract: Electronic waste (e-waste) is one of the fastest-growing pollution problems worldwide given the presence if a variety of toxic substances which can contaminate the environment and threaten human health, if disposal protocols are not meticulously managed. This paper presents an overview of toxic substances present in e-waste, their potential environmental and human health impacts together with management strategies currently being used in certain countries. Several tools including Life Cycle Assessment (LCA), Material Flow Analysis (MFA), Multi Criteria Analysis (MCA) and Extended Producer Responsibility (EPR) have been developed to manage e-wastes especially in developed countries. The key to success in terms of e-waste management is to develop eco-design devices, properly collect e-waste, recover and recycle material by safe methods, dispose of e-waste by suitable techniques, forbid the transfer of used electronic devices to developing countries, and raise awareness of the impact of e-waste. No single tool is adequate but together they can complement each other to solve this issue. A national scheme such as EPR is a good policy in solving the growing e-waste problems.

  20. Electronic waste management approaches: An overview

    International Nuclear Information System (INIS)

    Kiddee, Peeranart; Naidu, Ravi; Wong, Ming H.

    2013-01-01

    Highlights: ► Human toxicity of hazardous substances in e-waste. ► Environmental impacts of e-waste from disposal processes. ► Life Cycle Assessment (LCA), Material Flow Analysis (MFA), Multi Criteria Analysis (MCA) and Extended Producer Responsibility (EPR) to and solve e-waste problems. ► Key issues relating to tools managing e-waste for sustainable e-waste management. - Abstract: Electronic waste (e-waste) is one of the fastest-growing pollution problems worldwide given the presence if a variety of toxic substances which can contaminate the environment and threaten human health, if disposal protocols are not meticulously managed. This paper presents an overview of toxic substances present in e-waste, their potential environmental and human health impacts together with management strategies currently being used in certain countries. Several tools including Life Cycle Assessment (LCA), Material Flow Analysis (MFA), Multi Criteria Analysis (MCA) and Extended Producer Responsibility (EPR) have been developed to manage e-wastes especially in developed countries. The key to success in terms of e-waste management is to develop eco-design devices, properly collect e-waste, recover and recycle material by safe methods, dispose of e-waste by suitable techniques, forbid the transfer of used electronic devices to developing countries, and raise awareness of the impact of e-waste. No single tool is adequate but together they can complement each other to solve this issue. A national scheme such as EPR is a good policy in solving the growing e-waste problems

  1. SSAT State-of-the-Art Conference: Current Surgical Management of Gastric Tumors.

    Science.gov (United States)

    Norton, Jeffrey A; Kim, Teresa; Kim, Joseph; McCarter, Martin D; Kelly, Kaitlyn J; Wong, Joyce; Sicklick, Jason K

    2018-01-01

    The current era of gastric surgery is marked by low morbidity and mortality rates, innovative strategies to approach resections with a minimally invasive fashion or hyperthermic intraperitoneal chemotherapy (HIPEC), as well as improved understanding of the biology of sporadic and hereditary stromal, neuroendocrine, and epithelial malignancies. In 2017, the Society for Surgery of the Alimentary Tract convened a State-of-the-Art Conference on Current Surgical Management of Gastric Tumors with both international experts and emerging leaders in the field of gastric surgery. Martin D. McCarter, MD of the University of Colorado discussed the current management of gastric gastrointestinal stromal tumors (GIST). Kaitlyn J. Kelly, MD of the University of California, San Diego discussed the management of gastric carcinoid tumors. Jeffrey A. Norton of Stanford University discussed recent advances in the management of gastric adenocarcinoma including a focus on hereditary diffuse gastric cancer (HDGC). Joseph Kim, MD of Stony Brook University discussed a systematic approach to minimally invasive gastrectomy for cancer. Joyce Wong, MD of Pennsylvania State University discussed the role for cytoreductive surgery (CRS) and HIPEC for gastric adenocarcinoma. This review provides gastrointestinal surgeons with a concise update on the current surgical management of gastric tumors.

  2. Management of adenovirus infection in patients after haematopoietic stem cell transplantation: State-of-the-art and real-life current approach: A position statement on behalf of the Infectious Diseases Working Party of the European Society of Blood and Marrow Transplantation.

    Science.gov (United States)

    Hiwarkar, Prashant; Kosulin, Karin; Cesaro, Simone; Mikulska, Malgorzata; Styczynski, Jan; Wynn, Robert; Lion, Thomas

    2018-05-01

    The important insights gained over the past years in diagnosis and treatment of invasive adenoviral infections provide new paradigms for the monitoring and clinical management of these life-threatening complications. A meeting was held to discuss and subsequently disseminate the current advances in our understanding of the aetiology/pathogenesis and future treatment options facilitating effective control or prevention of adenovirus-related diseases in the allogeneic haematopoietic stem cell transplant setting. Invited experts in the field discussed recent progress with leading members of the Infectious Diseases Working Party of the European Society of Blood and Marrow Transplantation at the "State-of-the-art" Meeting in Poznan, Poland, in October 2017. In this review article, the panel of experts presents a concise summary of the current evidence based on published data from the last 15 years and on recent achievements resulting from real-life practice. The present position statement reflects an expert opinion on current approaches to clinical management of adenovirus infections in patients undergoing allogeneic haematopoietic stem cell transplant and provides graded recommendations of the panel for diagnostic approaches and preemptive therapy reflecting the present state of knowledge. Copyright © 2018 John Wiley & Sons, Ltd.

  3. Electronic waste management approaches: an overview.

    Science.gov (United States)

    Kiddee, Peeranart; Naidu, Ravi; Wong, Ming H

    2013-05-01

    Electronic waste (e-waste) is one of the fastest-growing pollution problems worldwide given the presence if a variety of toxic substances which can contaminate the environment and threaten human health, if disposal protocols are not meticulously managed. This paper presents an overview of toxic substances present in e-waste, their potential environmental and human health impacts together with management strategies currently being used in certain countries. Several tools including life cycle assessment (LCA), material flow analysis (MFA), multi criteria analysis (MCA) and extended producer responsibility (EPR) have been developed to manage e-wastes especially in developed countries. The key to success in terms of e-waste management is to develop eco-design devices, properly collect e-waste, recover and recycle material by safe methods, dispose of e-waste by suitable techniques, forbid the transfer of used electronic devices to developing countries, and raise awareness of the impact of e-waste. No single tool is adequate but together they can complement each other to solve this issue. A national scheme such as EPR is a good policy in solving the growing e-waste problems. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  4. Sustainable Approaches for Materials Management in Remote ...

    Science.gov (United States)

    Remote, economically challenged areas in the Commonwealth of the Northern Marianas Islands (CNMI) and American Samoa in the US Pacific island territories face unique challenges with respect to solid waste management. These islands are remote and isolated, with some islands supporting only small populations, thus limiting options for pooling resources among communities in the form of regional waste management facilities, as is common on the US mainland. This isolation also results in greater costs for waste management compared to those encountered in the mainland US, a consequence of, among other factors, more expensive construction and maintenance costs because of the necessary transport of facility components (e.g., landfill liner materials) and the decreased attractiveness of waste recovery for recycling because of lower commodity prices after off-island transportation. Adding to these economic limitations, the gross domestic product and per capita income of the Pacific territories is less than half what it is in parts of the US. The first section of this report outlines a snapshot of the current state of solid waste management overall in the US Pacific island territories, primarily based on site visits.. Steps involved in this work included a review of selected existing published information related to the subject; site visits to Guam, Saipan, Tinian, Rota, Tutuila, and Apia; an assessment of the technical and economic feasibility of different solid waste

  5. Sistemic Approach - a Complexity Management Instrument

    Directory of Open Access Journals (Sweden)

    Vadim Dumitrascu

    2006-04-01

    Full Text Available he systemic principle uses the deduction and the induction, analyse and synthesis, inferency and proferency, in order to find out the interdependencies and the inner connections that make mooving the complex organized entities. The true valences of this approach can be found neither in the simplist models of the “in-out” type, nor in the “circular” models that fill in the Economics and Management handbooks, and that consecrate another kind of formalism, but in the constructiviste-reflexive strategies, used in order to explain the economic and social structures.

  6. Approaches to Resource Management for the Nexus

    OpenAIRE

    Kumar Navneet; Gerber Nicolas

    2015-01-01

    This report attempts to draw out the main messages covered during a session on “Approaches to Resource Management for the Nexus” (International conference on Sustainability in the Water-Energy-Food Nexus. Synergies and Tradeoffs: Governance and Tools at various Scales held in Bonn, Germany, on 19th and 20th of May 2014). In this session, the audience was reminded of the importance to think about geography and topography to understand trade-offs in the WEF Nexus, and in particular to consider ...

  7. Sistemic Approach – a Complexity Management Instrument

    Directory of Open Access Journals (Sweden)

    Vadim Dumitrascu

    2006-02-01

    Full Text Available The systemic principle uses the deduction and the induction, analyse and synthesis, inferency and proferency, in order to find out the interdependencies and the inner connections that make mooving the complex organized entities. The true valences of this approach can be found neither in the simplist models of the “in-out” type, nor in the “circular” models that fill in the Economics and Management handbooks, and that consecrate another kind of formalism, but in the constructiviste-reflexive strategies, used in order to explain the economic and social structures.

  8. Current practice in airway management: A descriptive evaluation.

    Science.gov (United States)

    Kjonegaard, Rebecca; Fields, Willa; King, Major L

    2010-03-01

    Ventilator-associated pneumonia, a common complication of mechanical ventilation, could be reduced if health care workers implemented evidence-based practices that decrease the risk for this complication. To determine current practice and differences in practices between registered nurses and respiratory therapists in managing patients receiving mechanical ventilation. A descriptive comparative design was used. A convenience sample of 41 registered nurses and 25 respiratory therapists who manage critical care patients treated with mechanical ventilation at Sharp Grossmont Hospital, La Mesa, California, completed a survey on suctioning techniques and airway management practices. Descriptive and inferential statistics were used to analyze the data. Significant differences existed between nurses and respiratory therapists for hyperoxygenation before suctioning (P =.03). In the 2 groups, nurses used the ventilator for hyper-oxygenation more often, and respiratory therapists used a bag-valve device more often (P =.03). Respiratory therapists instilled saline (P <.001) and rinsed the closed system with saline after suctioning (P =.003) more often than nurses did. Nurses suctioned oral secretions (P <.001) and the nose of orally intubated patients (P =.01), brushed patients' teeth with a toothbrush (P<.001), and used oral swabs to clean the mouth (P <.001) more frequently than respiratory therapists did. Nurses and respiratory therapists differed significantly in the management of patients receiving mechanical ventilation. To reduce the risk of ventilator-associated pneumonia, both nurses and respiratory therapists must be consistent in using best practices when managing patients treated with mechanical ventilation.

  9. Approach for systematic evaluation of transuranic waste management alternatives

    International Nuclear Information System (INIS)

    Hong, K.; Koebnick, B.; Kotek, T.

    1994-01-01

    This paper describes an approach for systematic evaluation of management alternatives that are being considered for the treatment, storage, and disposal of transuranic waste (TRUW) at U.S. Department of Energy sites. The approach, which is currently under development, would apply WASTE-MGMT, a database application model developed at Argonne National Laboratory, to estimate projected environmental releases and would evaluate impact measures such as health risk and costs associated with each of the waste management alternatives. The customized application would combine site-specific TRUW inventory and characterization data with treatment and transportation parameters to estimate the quantities and characteristics of the wastes to be treated, emissions of hazardous substances from the treatment facilities, and the quantities and characteristics of the wastes to be shipped between sites. These data would then be used to estimate for several TRUW management scenarios the costs and health risks of constructing and operating the required treatment facilities and of transporting TRUW for treatment and final disposal. Treatment, storage, and disposal of TRUW at DOE sites is composed of many variables and options at each stage. The approach described in this paper would provide for efficient consideration of all of these facets when evaluating potentially feasible TRUW management alternatives. By expanding existing databases, this model could eventually be adapted to accommodate the introduction of new treatment technologies, updated TRUW characterization data, and/or revised waste acceptance criteria

  10. Current and emerging treatments for the management of osteogenesis imperfecta

    Science.gov (United States)

    Monti, Elena; Mottes, Monica; Fraschini, Paolo; Brunelli, PierCarlo; Forlino, Antonella; Venturi, Giacomo; Doro, Francesco; Perlini, Silvia; Cavarzere, Paolo; Antoniazzi, Franco

    2010-01-01

    Osteogenesis imperfecta (OI) is the most common bone genetic disorder and it is characterized by bone brittleness and various degrees of growth disorder. Clinical severity varies widely; nowadays eight types are distinguished and two new forms have been recently described although not yet classified. The approach to such a variable and heterogeneous disease should be global and therefore multidisciplinary. For simplicity, the objectives of treatment can be reduced to three typical situations: the lethal perinatal form (type II), in which the problem is survival at birth; the severe and moderate forms (types III–IX), in which the objective is ‘autonomy’; and the mild form (type I), in which the aim is to reach ‘normal life’. Three types of treatment are available: non-surgical management (physical therapy, rehabilitation, bracing and splinting), surgical management (intramedullary rod positioning, spinal and basilar impression surgery) and medical-pharmacological management (drugs to increase the strength of bone and decrease the number of fractures as bisphosphonates or growth hormone, depending on the type of OI). Suggestions and guidelines for a therapeutic approach are indicated and updated with the most recent findings in OI diagnosis and treatment. PMID:20856683

  11. Current approaches to diagnosing and treating major neurocognitive disorder

    Directory of Open Access Journals (Sweden)

    A. A. Kulesh

    2017-01-01

    Full Text Available The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 replaces the term «dementia» with «major neurocognitive disorder» (MNCD, which can reduce the  stigmatization of patients and focus the attention of specialists on  the preserved abilities of patients rather than deficit symptoms. In  the next 35 years, the number of patients with MNCD in the world is  predicted to almost triple. The article considers the concept,  epidemiology, and etiological pattern of this syndrome. It  characterizes in detail Alzheimer's disease (AD that is a cause of  MNCD in 50–70% of cases. The current diagnostic criteria and  clinical presentations of the disease are given. The presence of early and significant episodic memory disorders as both alone or  concurrent with other cognitive and behavioral changes reflects the  main clinical phenotype of AD. Magnetic resonance morphometry,  amyloid positron emission tomography, and estimation of  cerebrospinal fluid β-amyloid and tau protein levels find increasing  applications in research and routine practice. Drug and non-drug  treatments for MNCD are considered. The use of akatinol memantine to treat this disorder and the issues related to the comprehensive management of patients with severe cognitive impairment are analyzed.

  12. Ocular Behçet disease: current therapeutic approaches.

    Science.gov (United States)

    Evereklioglu, Cem

    2011-11-01

    To alert physician to timely recognition and current treatment of recurrent hypopyon iridocyclitis or panuveitis in ocular Behçet disease (OBD). Interferon-α, rituximab, intravitreal triamcinolone, and biological response modifiers by tumor necrosis factor inhibitors such as infliximab and adalimumab are being used increasingly for the treatment of severe sight-threatening ocular inflammation including retinal vasculitis and cystoid macular edema (CME). Biological agents offer tremendous potential in the treatment of OBD. Given that OBD predominantly afflicts the younger adults in their most productive years, dermatologist, rheumatologist, internist, or general practitioners supervising patients with oculo-articulo-oromucocutaneous syndromes should be aware of systemic Behçet disease. Early recognition of ocular involvement is important and such patients should strongly be instructed to visit immediately an ophthalmologist, as uveitis management differs from extraocular involvements with high ocular morbidity from sight-threatening complications due to relapsing inflammatory attacks in the posterior segment of the eye. A single infliximab infusion should be considered for the control of acute panuveitis, whereas repeated long-term infliximab infusions were proved to be more effective in reducing the number of episodes in refractory uveoretinitis with faster regression and complete remission of CME.

  13. Water management: Current and future challenges and research directions

    Science.gov (United States)

    Cosgrove, William J.; Loucks, Daniel P.

    2015-06-01

    Water distinguishes our planet compared to all the others we know about. While the global supply of available freshwater is more than adequate to meet all current and foreseeable water demands, its spatial and temporal distributions are not. There are many regions where our freshwater resources are inadequate to meet domestic, economic development and environmental needs. In such regions, the lack of adequate clean water to meet human drinking water and sanitation needs is indeed a constraint on human health and productivity and hence on economic development as well as on the maintenance of a clean environment and healthy ecosystems. All of us involved in research must find ways to remove these constraints. We face multiple challenges in doing that, especially given a changing and uncertain future climate, and a rapidly growing population that is driving increased social and economic development, globalization, and urbanization. How best to meet these challenges requires research in all aspects of water management. Since 1965, the journal Water Resources Research has played an important role in reporting and disseminating current research related to managing the quantity and quality and cost of this resource. This paper identifies the issues facing water managers today and future research needed to better inform those who strive to create a more sustainable and desirable future.

  14. A Design Thinking Approach to Teaching Knowledge Management

    Science.gov (United States)

    Wang, Shouhong; Wang, Hai

    2008-01-01

    Pedagogies for knowledge management courses are still undeveloped. This Teaching Tip introduces a design thinking approach to teaching knowledge management. An induction model used to guide students' real-life projects for knowledge management is presented. (Contains 1 figure.)

  15. Utilizing a disease management approach to improve ESRD patient outcomes.

    Science.gov (United States)

    Anand, Shaan; Nissenson, Allen R

    2002-01-01

    In this era of processes and systems to improve quality, disease management is one methodology to improve care delivery and outcomes for patients with chronic kidney disease (CKD). In most disease management systems a senior renal nurse coordinates all aspects of the patient's care and ensures that the prescribed and necessary care is delivered for both CKD-related and comorbid conditions. The nurse also continually monitors outcomes on quality indicators and key performance measures. These outcome data are then aggregated and analyzed, are compared with local and national benchmarks, and drive the continuous quality improvement (CQI) process. Such a system attempts to centralize the currently fragmented care delivery system, continually improve patient outcomes, and conserve scarce economic resources. Early data suggest a disease management approach may improve both the morbidity and mortality of CKD patients.

  16. Approaches to the management of antenatally diagnosed congenital tumours

    International Nuclear Information System (INIS)

    Mahony, Rhona; McParland, Peter

    2009-01-01

    Congenital fetal tumours are rare, but current imaging modalities including US and MRI facilitate antenatal diagnosis and investigation, allowing a presumptive diagnosis and management strategy. Although the prevalence of fetal tumours is difficult to ascertain, an incidence of 7.2 per 100,000 live births has previously been reported, with the incidence of neonatal malignancy estimated at 36.5 per million births. Teratomas and neuroblastomas are the most common solid tumours described. Tumours may be very large or associated with severe hydrops leading to significant dystocia with the potential for difficult vaginal or caesarean delivery. Once the diagnosis of a fetal tumour is made, optimal management incorporates a multidisciplinary approach including obstetrician, neonatologist, paediatric surgeon and paediatric oncologist so that counselling is appropriate and a clear management plan is in place for parents. (orig.)

  17. Product family approach in e-waste management

    DEFF Research Database (Denmark)

    Parajuly, Keshav; Wenzel, Henrik

    2017-01-01

    As the need for a more circular model is being increasingly pronounced, a fundamental change in the end-of-life (EoL) management of electrical and electronic products (e-products) is required in order to prevent the resource losses and to promote the reuse of products and components with remaining...... functionality. However, the diversity of product types, design features, and material compositions pose serious challenges for the EoL managers and legislators alike. In order to address these challenges, we propose a framework that is based on the ‘product family’ philosophy, which has been used...... in the manufacturing sector for a long time. For this, the product families can be built based on intrinsic and extrinsic attributes of e-products as well as of the EoL management system. Such an approach has the potential to improve the current EoL practices and to support designers in making EoL thinking operational...

  18. Approaches to the management of antenatally diagnosed congenital tumours

    Energy Technology Data Exchange (ETDEWEB)

    Mahony, Rhona; McParland, Peter [National Maternity Hospital, Department of Fetal and Maternal Medicine, Dublin (Ireland)

    2009-11-15

    Congenital fetal tumours are rare, but current imaging modalities including US and MRI facilitate antenatal diagnosis and investigation, allowing a presumptive diagnosis and management strategy. Although the prevalence of fetal tumours is difficult to ascertain, an incidence of 7.2 per 100,000 live births has previously been reported, with the incidence of neonatal malignancy estimated at 36.5 per million births. Teratomas and neuroblastomas are the most common solid tumours described. Tumours may be very large or associated with severe hydrops leading to significant dystocia with the potential for difficult vaginal or caesarean delivery. Once the diagnosis of a fetal tumour is made, optimal management incorporates a multidisciplinary approach including obstetrician, neonatologist, paediatric surgeon and paediatric oncologist so that counselling is appropriate and a clear management plan is in place for parents. (orig.)

  19. Improvement of radiology services based on the process management approach.

    Science.gov (United States)

    Amaral, Creusa Sayuri Tahara; Rozenfeld, Henrique; Costa, Janaina Mascarenhas Hornos; Magon, Maria de Fátima de Andrade; Mascarenhas, Yvone Maria

    2011-06-01

    The health sector requires continuous investments to ensure the improvement of products and services from a technological standpoint, the use of new materials, equipment and tools, and the application of process management methods. Methods associated with the process management approach, such as the development of reference models of business processes, can provide significant innovations in the health sector and respond to the current market trend for modern management in this sector (Gunderman et al. (2008) [4]). This article proposes a process model for diagnostic medical X-ray imaging, from which it derives a primary reference model and describes how this information leads to gains in quality and improvements. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  20. Enhancing Critical Thinking by Teaching Two Distinct Approaches to Management

    Science.gov (United States)

    Dyck, Bruno; Walker, Kent; Starke, Frederick A.; Uggerslev, Krista

    2012-01-01

    The authors explore the effect on students' critical thinking of teaching only one approach to management versus teaching two approaches to management. Results from a quasiexperiment--which included a survey, interviews, and case analysis--suggest that compared with students who are taught only a conventional approach to management (which…

  1. Multinational approaches relevant to spent fuel management

    International Nuclear Information System (INIS)

    Pellaud, B.

    2007-01-01

    The storage of spent fuel is a suitable candidate for a multilateral approach, primarily at the regional level. Small countries with only a few nuclear power plants would benefit economically from large joint facilities. The storage of special nuclear materials in a few safe and secure facilities would also enhance safeguards and physical protection. However, the final disposal of spent fuel and high level radioactive waste is the best candidate for a multilateral approach. It would offer major economic benefits and substantial non-proliferation benefits in spite of the legal, political and public acceptance challenges to be expected in most countries. The transfer of nuclear waste from the exporting country to the host country of an interim storage facility or of a final repository would be done under bilateral or multilateral agreements at the commercial and governmental levels, in accordance with the Joint Convention on the Safety of Spent Fuel Management and on the Safety of Radioactive Waste Management. Bilateral or international oversight of joint facilities should be arranged, as needed, to achieve the confidence of the partners as to the safety and physical security of the proposed facility. Such monitoring should cover the adequacy of the technical design, its safety features, its environmental impact, the physical security of nuclear materials and possibly the financial management of the joint venture. After the initial choice of bilateral arrangements, some kind of international monitoring may become appropriate. Various organizations could fulfil such a function, in particular, the IAEA. Such monitoring would have nothing to do with nuclear safeguards; repository monitoring would be a parallel but independent activity of the IAEA. (author)

  2. Sustainable supply chain management: current debate and future directions

    Directory of Open Access Journals (Sweden)

    Bruno Silvestre

    Full Text Available Abstract This paper is a research brief on sustainable supply chain management and covers some of the key elements of literature’s past debate and trends for future directions. It highlights the growth of this research area and reinforces the importance of a full consideration of all three key dimensions of sustainability when managing sustainable supply chains, i.e., the financial, environmental and social dimensions. Therefore, supply chain decision makers need to unequivocally assess the impact of their decisions on the financial, environmental and social performances of their supply chains. This paper also argues that risks and opportunities are the key drivers for supply chain decision makers to adopt sustainability within their operations, and that barriers to sustainability adoption exist. This research highlights that, depending on the focus adopted, supply chains can evolve and shift from more traditional to more sustainable approaches over time. The paper concludes with some promising avenues for future investigation.

  3. Halitosis: Current concepts on etiology, diagnosis and management

    Science.gov (United States)

    Kapoor, Uditi; Sharma, Gaurav; Juneja, Manish; Nagpal, Archna

    2016-01-01

    Halitosis or oral malodor is an offensive odor originating from the oral cavity, leading to anxiety and psychosocial embarrassment. A patient with halitosis is most likely to contact primary care practitioner for the diagnosis and management. With proper diagnosis, identification of the etiology and timely referrals certain steps are taken to create a successful individualized therapeutic approach for each patient seeking assistance. It is significant to highlight the necessity of an interdisciplinary method for the treatment of halitosis to prevent misdiagnosis or unnecessary treatment. The literature on halitosis, especially with randomized clinical trials, is scarce and additional studies are required. This article succinctly focuses on the development of a systematic flow of events to come to the best management of the halitosis from the primary care practitioner's point of view. PMID:27095913

  4. Aquatic Plant Management Program current status and seasonal workplan

    Energy Technology Data Exchange (ETDEWEB)

    Burns, E.R.; Bates, A.L.; Webb, D.H.

    1993-07-01

    The objective of the TVA Aquatic Plant Management Program is to support in an environmentally and economically responsible manner, the balanced multiple uses of the water resource of the Tennessee Valley. This is accomplished by following an integrated approach to prevent introduction and spread of noxious species, documenting occurrence and spread of existing species, and suppressing or eliminating problems in designated high use areas. It is not the TVA objective, nor is it biologically feasible and prudent to eliminate all aquatic vegetation. Aerial photography, helicopter reconnaissance, and field surveys are used to assess distributions and abundance of various aquatic macrophytes. Water level fluctuations are supplemented by herbicide applications to control undesirable vegetation. Investigations are conducted to evaluate water level fluctuation schemes, as well as biological, mechanical, and alternative chemical control techniques which offer potential for more environmentally compatible and cost-effective management operations.

  5. Exploring the current application of professional competencies in human resource management in the South African context

    Directory of Open Access Journals (Sweden)

    Nico Schutte

    2015-11-01

    Full Text Available Orientation: Human research (HR practitioners have an important role to play in the sustainability and competitiveness of organisations. Yet their strategic contribution and the value they add remain unrecognised. Research purpose: The main objective of this research was to explore the extent to which HR practitioners are currently allowed to display HR competencies in the workplace, and whether any significant differences exist between perceived HR competencies, based on the respondents’ demographic characteristics. Motivation for the study: Limited empirical research exists on the extent to which HR practitioners are allowed to display key competencies in the South African workplace. Research approach, design, and method: A quantitative research approach was followed. A Human Resource Management Professional Competence Questionnaire was administered to HR practitioners and managers (N = 481. Main findings: The results showed that HR competencies are poorly applied in selected South African workplaces. The competencies that were indicated as having the poorest application were talent management, HR metrics, HR business knowledge, and innovation. The white ethic group experienced a poorer application of all human research management (HRM competencies compared to the black African ethnic group. Practical/managerial implications: The findings of the research highlighted the need for management to evaluate the current application of HR practices in the workplace and also the extent to which HR professionals are involved as strategic business partners. Contribution/value-add: This research highlights the need for the current application of HR competencies in South African workplaces to be improved.

  6. Lean management in the current context of evolution of an organization

    Directory of Open Access Journals (Sweden)

    AMALIA VENERA TODORUŢ

    2011-06-01

    Full Text Available In this paper I have approached issues concerning the importance of Lean Management method in the current context of evolution of an organization. With roots in the just in time method, Lean Management model focuses on the process of changes evolving and adapting to them and regards issues such as: the dimensioning of life cycle, the dimensioning of processes, the dimensioning of ranges of products. I have also presented the relationship between Lean Management method and the human factor as a determinant in forming an organizational culture which leads to the formation and development of Lean thinking. Relevant factors which determine the change and interact with the Lean Management method are: training, motivation, teamwork spirit, communication methods, training and motivation. An important aspect of this paper is to integrate Lean Management with Six Sigma, and with other managerial techniques leading to getting quality products at low costs

  7. Current practice for diagnosis and management of silent atrial fibrillation

    DEFF Research Database (Denmark)

    Dobreanu, Dan; Svendsen, Jesper Hastrup; Lewalter, Thorsten

    2013-01-01

    for the diagnosis and management of silent AF. This survey is based on an electronic questionnaire sent to the European Heart Rhythm Association Research Network partners. Responses were received from 33 centres in 16 countries. The preferred screening methods for silent AF in patients with rhythm control...... for such patients. Most responders preferred rate control over rhythm control in patients with silent AF, although some favoured pulmonary vein isolation in young patients. However, oral anticoagulant therapy in patients at high thromboembolic risk was considered mandatory by most, provided that at least one......Although it is well known that silent atrial fibrillation (AF) is associated with morbidity and mortality rates similar to those of symptomatic AF, no specific strategy for screening and management of this form of AF has been advocated. The purpose of this survey was to identify current practices...

  8. Current and future direction in the management of scleroderma.

    Science.gov (United States)

    Brady, Sean M; Shapiro, Lee; Mousa, Shaker A

    2016-09-01

    Scleroderma is a heterogeneous disease with a complex etiology. As more information is gained about the underlying mechanisms and the improved classifications of scleroderma subtypes, treatments can be better personalized. Improving scleroderma patients' early diagnosis before end organ manifestations occur should improve clinical trial design and outcomes. Two recently FDA-approved antifibrotics for idiopathic pulmonary fibrosis may be effective treatments in patients with pulmonary fibrosis secondary to scleroderma after further investigation. The potential impact of Nanobiotechnology in improving the efficacy and safety of existing antifibrotics and immunomodulators might present an exciting new approach in the management of scleroderma.

  9. Current Status of Operation and Management of Dental School Clinics.

    Science.gov (United States)

    Reinhardt, John W

    2017-08-01

    This article summarizes the current status of the operation and management of dental school clinics as schools strive to provide excellent patient-centered care in an environment that is educationally sound, efficient, and financially strong. Clinical education is a large component of dental education and an area in which many dental schools have an opportunity to enhance revenue. Clinical efficiencies and alternative models of clinical education are evolving in U.S. dental schools, and this article describes some of those evolutionary changes. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

  10. An Approach for Implementation of Project Management Information Systems

    Science.gov (United States)

    Běrziša, Solvita; Grabis, Jānis

    Project management is governed by project management methodologies, standards, and other regulatory requirements. This chapter proposes an approach for implementing and configuring project management information systems according to requirements defined by these methodologies. The approach uses a project management specification framework to describe project management methodologies in a standardized manner. This specification is used to automatically configure the project management information system by applying appropriate transformation mechanisms. Development of the standardized framework is based on analysis of typical project management concepts and process and existing XML-based representations of project management. A demonstration example of project management information system's configuration is provided.

  11. Integrated Approach for Pain Management in Parkinson Disease.

    Science.gov (United States)

    Geroin, Christian; Gandolfi, Marialuisa; Bruno, Veronica; Smania, Nicola; Tinazzi, Michele

    2016-04-01

    Pain, one of the most frequent nonmotor symptoms of Parkinson disease (PD), is recognized as an important component of the illness that adversely affects patient quality of life. The aims of this review are to summarize the current knowledge on the clinical assessment and to provide a detailed overview of the evidence-based pharmacologic and nonpharmacologic approaches to treating pain. Results of a literature search include studies investigating pain/sensory abnormalities in PD. The effects of levodopa administration, deep brain stimulation (DBS), pallidotomy, spinal cord stimulation, rehabilitation, and complementary/alternative medicine are reviewed critically. PD patients have altered pain and sensory thresholds; levodopa and DBS improve pain and change sensory abnormalities toward normal levels through antinociceptive and/or modulatory effects that remain unknown. A wide range of nonpharmacologic approaches require further investigation. A multidisciplinary approach is fundamental in managing pain syndromes in PD.

  12. Marketing Approach to Management of Spatial Development

    Directory of Open Access Journals (Sweden)

    Daniil Petrovich Frolov

    2013-06-01

    Full Text Available Marketing of territories is a modern mechanism of management of spatial entities› development (cities, regions, etc., which is based on the principles of regulated self-organization and cultivation of self-generating trends. In this paper territories are considered as socially responsible multistakeholder quasi-corporations that produce specific goods and promote their own brands. But it is not clear yet what marketing of territories is – the function or ideology of regional administration? How do regional marketing and branding correlate? What is «the product of the territory» and who are its› consumers? Why are instituting territorial goods so important? How do the traditional socio- economic development strategy and marketing strategy of the region relate? What is the action mechanism of the regional marketing? The article presents the author›s answers to these and other issues of theory and practice of regional marketing in the context of new methodological approaches

  13. AN APPROACH TO FRAUD RISK MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Monica PUIU

    2014-11-01

    Full Text Available Nowadays, globalisation and business internalisation have led to an increased number of frauds in organisations worldwide. The most affected are the multinational corporations because of the geographical distance, different fiscal systems and local factors that consist in tremendous opportunities for employees and/or managers to involve in fraud schemes. Starting from recent studies and prior efforts of international organisations or countries to stop fraud by imposing regulations to be respected for the economic environment, the purpose of the paper is finding the key factors for detecting and preventing fraud in the organisations. In our approach we use several proposals for a conceptual framework developed by two companies of “The big four”, KPMG and Deloitte. The results indicate that for the number of fraud to decrease, any organisation needs to develop and implement a strong anti-fraud plan, by covering all logical steps to be made in this matter.

  14. Investigation of Integrated Vehicle Health Management Approaches

    Science.gov (United States)

    Paris, Deidre

    2005-01-01

    This report is to present the work that was performed during the summer in the Advance Computing Application office. The NFFP (NASA Faculty Fellow Program) had ten summer faculty members working on IVHM (Integrated Vehicle Health Management) technologies. The objective of this project was two-fold: 1) to become familiar with IVHM concepts and key demonstrated IVHM technologies; and 2) to integrate the research that has been performed by IVHM faculty members into the MASTLAB (Marshall Avionic Software Test Lab). IVHM is a NASA-wide effort to coordinate, integrate and apply advanced software, sensors and design technologies to increase the level of intelligence, autonomy, and health state of future vehicles. IVHM is an important concept because it is consistent with the current plan for NASA to go to the moon, mars, and beyond. In order for NASA to become more involved in deep exploration, avionic systems will need to be highly adaptable and autonomous.

  15. Nasal juvenile angiofibroma: Current perspectives with emphasis on management.

    Science.gov (United States)

    López, Fernando; Triantafyllou, Asterios; Snyderman, Carl H; Hunt, Jennifer L; Suárez, Carlos; Lund, Valerie J; Strojan, Primož; Saba, Nabil F; Nixon, Iain J; Devaney, Kenneth O; Alobid, Isam; Bernal-Sprekelsen, Manuel; Hanna, Ehab Y; Rinaldo, Alessandra; Ferlito, Alfio

    2017-05-01

    Juvenile angiofibroma is an uncommon, benign, locally aggressive vascular tumor. It is found almost exclusively in young men. Common presenting symptoms include nasal obstruction and epistaxis. More advanced tumors may present with facial swelling and visual or neurological disturbances. The evaluation of patients with juvenile angiofibroma relies on diagnostic imaging. Preoperative biopsy is not recommended. The mainstay of treatment is resection combined with preoperative embolization. Endoscopic surgery is the approach of choice in early stages, whereas, in advanced stages, open or endoscopic approaches are feasible in expert hands. Postoperative radiotherapy (RT) or stereotactic radiosurgery seem valuable in long-term control of juvenile angiofibroma, particularly those that extend to anatomically critical areas unsuitable for complete resection. Chemotherapy and hormone therapy are ineffective. The purpose of the present review was to update current aspects of knowledge related to this rare and challenging disease. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1033-1045, 2017. © 2017 Wiley Periodicals, Inc.

  16. Current status of managing diabetes mellitus in Korea.

    Science.gov (United States)

    Ha, Kyoung Hwa; Kim, Dae Jung

    2016-09-01

    Diabetes mellitus is an increasing global health problem. Guidelines for diabetic care recommend management of lifestyle and risk factors (glucose, blood pressure, and cholesterol), as well as regular screening for complications associated with treatment of the conditions related to diabetes. The prevalence of diabetes increased from 8.6% to 11.0% from 2001 to 2013. According to the diabetes fact sheet 2015, the proportion of patients with diabetes treated with antihypertensive medications increased from 56.0% to 62.5% from 2006 to 2013, and 49.5% of those with diabetes were being treated with lipid-lowering medications in 2013, a 1.8-fold increase since 2006. According to the 2014 Korea National Health and Nutrition Examination Survey data, 45.6% of patients with diabetes achieved a hemoglobin A1c level of diabetes had good control of all three of these parameters. Despite improvements in health promotion efforts, the rates of adherence to medication and risk-factor control are low. Therefore, a systematic approach to managing diabetes, including self-management education, is needed to prevent or delay complications. The government needs to establish a long-term policy to address the growing burden of diabetes.

  17. Current and emerging treatments for the management of osteogenesis imperfecta

    Directory of Open Access Journals (Sweden)

    Elena Monti

    2010-08-01

    Full Text Available Elena Monti1, Monica Mottes1, Paolo Fraschini2, PierCarlo Brunelli3, Antonella Forlino4, Giacomo Venturi1, Francesco Doro1, Silvia Perlini1, Paolo Cavarzere1, Franco Antoniazzi11Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy; 2Istituto Di Ricovero e Cura a Carattere Scientifico, ‘E. Medea’, Associazione La Nostra Famiglia, Bosisio Parini (LC, Italy; 3Divisione di Ortopedia Pediatrica, Spedali Civili, Brescia, Italy; 4Department of Biochemistry “A. Castellani”, University of Pavia, ItalyAbstract: Osteogenesis imperfecta (OI is the most common bone genetic disorder and it is characterized by bone brittleness and various degrees of growth disorder. Clinical severity varies widely; nowadays eight types are distinguished and two new forms have been recently described although not yet classified. The approach to such a variable and heterogeneous disease should be global and therefore multidisciplinary. For simplicity, the objectives of treatment can be reduced to three typical situations: the lethal perinatal form (type II, in which the problem is survival at birth; the severe and moderate forms (types III–IX, in which the objective is ‘autonomy’; and the mild form (type I, in which the aim is to reach ‘normal life’. Three types of treatment are available: non-surgical management (physical therapy, rehabilitation, bracing and splinting, surgical management (intramedullary rod positioning, spinal and basilar impression surgery and medical-pharmacological management (drugs to increase the strength of bone and decrease the number of fractures as bisphosphonates or growth hormone, depending on the type of OI. Suggestions and guidelines for a therapeutic approach are indicated and updated with the most recent findings in OI diagnosis and treatment.Keywords: osteogenesis imperfecta, bone genetic disorder, bone brittleness, “brittle bone disease”, connective tissue malfunction, short

  18. Improvised explosive devices: pathophysiology, injury profiles and current medical management.

    Science.gov (United States)

    Ramasamy, A; Hill, A M; Clasper, J C

    2009-12-01

    The improvised explosive device (IED), in all its forms, has become the most significant threat to troops operating in Afghanistan and Iraq. These devices range from rudimentary home made explosives to sophisticated weapon systems containing high-grade explosives. Within this broad definition they may be classified as roadside explosives and blast mines, explosive formed pojectile (EFP) devices and suicide bombings. Each of these groups causeinjury through a number of different mechanisms and can result in vastly different injury profiles. The "Global War on Terror" has meant that incidents which were previously exclusively seen in conflict areas, can occur anywhere, and clinicians who are involved in emergency trauma care may be required to manage casualties from similar terrorist attacks. An understanding of the types of devices and their pathophysiological effects is necessary to allow proper planning of mass casualty events and to allow appropriate management of the complex poly-trauma casualties they invariably cause. The aim of this review article is to firstly describe the physics and injury profile from these different devices and secondly to present the current clinical evidence that underpins their medical management.

  19. Managing environmental radioactivity monitoring data: a geographic information system approach

    International Nuclear Information System (INIS)

    Heywood, I.; Cornelius, S.

    1993-01-01

    An overview of the current British approach to environmental radiation monitoring is presented here, followed by a discussion of the major issues which would have to be considered in formulating a geographical information system (GIS) for the management of radiation monitoring data. Finally, examples illustrating the use of spatial data handling and automated cartographic techniques are provided from work undertaken by the authors. These examples are discussed in the context of developing a National Radiological Spatial Information System (NRSIS) demonstrator utilising GIS technology. (Author)

  20. Integrated NPP life cycle management - Agency's approach

    International Nuclear Information System (INIS)

    Gueorguiev, B.

    2002-01-01

    Full text: The number of nuclear power plants (NPPs) operating in the world has been roughly constant for the past seven years. There are 438 reactors of 353,489 MW(e) capacity in the world and they generated 2448.9 TWh in 2001 giving a total world operating experience with nuclear power of 10,363 years. About 230 units have reached already over 15 years of operation and significant number of these plants are fully depreciated. Share of nuclear power in electricity production sector in Member States utilising nuclear power plants represents a meaningful amount and in 14 countries it exceeds 30%. Therefore, a loss of this share should be covered by new installed capacities either from conventional or alternative sources of electricity generation. Recent forecasts, for nuclear power use over the next two decades range from ∼350 to ∼500 GW(e) worldwide. While assessing the need for any nuclear power related programmes there are several important factors that must be considered since even 350 GW(e) is a very large programme requiring several hundred thousand highly qualified personnel and a substantial infrastructure to assure its continued safe, reliable and cost-effective operation. It is important to assure reliable, safe and economic beneficial performance of the plant, which requires in turn an appropriated management of any activity connected with any taken period of a plant life starting from design and ending by the decided mode of decommissioning. The period between the first and the last payment for the activities connected with the existence of a plant could be defined as a life cycle of the plant. Such integrated approach requires considering the life cycle of the plant in a much broader sense than just operational life and is characterized by the variety of activities and their management represents in a whole a plant life management programme (PLIM). Therefore PLIM could be defined as an aggregate (totality) of technical, financial, economical and

  1. Management of Laryngoceles by Transoral Robotic Approach.

    Science.gov (United States)

    Kayhan, Fatma Tülin; Güneş, Selçuk; Koç, Arzu Karaman; Yiğider, Ayşe Pelin; Kaya, Kamil Hakan

    2016-06-01

    Laryngoceles are air-filled sacs which communicate with the laryngeal lumen. When filled with mucus or pus, they are called laryngomucoceles and laryngopyoceles, respectively. Transoral robotic surgery (TORS) is a new and remarkable technique that expands its usefullness in otorhinolaryngology. Conventional treatments for laryngoceles were previously performed using external approaches, with aesthetically unfavorable and less function-sparing results. Transoral laser microsurgical approaches for laryngoceles were seldom reported. It is aimed to present authors' clinical experience on laryngocele management with TORS which is a rather new technique. A retrospective patient serial. Patients were evaluated for demographic data, type of lesion, reasons for hospital admittance, complaint duration, and previous surgery. Robotic surgery panel including anesthesia time, duration of surgery, need for tracheotomy, postoperative care, follow-up, and recurrence rates were also summarized. Six men (mean age 51.7 years; range 41-62) with laryngoceles underwent successful TORS. Dyspnea and hoarseness were the main complaints. Two patients had undergone previous laryngeal surgery due to laryngeal cancer, with no recurrence of malignancy at admittance for laryngocele. Three had simple laryngocele, 2 had laryngomucocele, and 1 had laryngopyocele. No laryngoceles recurred and no complication such as dysphonia or prolonged dysphagia occurred. Transoral robotic surgery was found superior in safety, technical feasibility and curative effectiveness, when compared with classical methods, especially due to absence of skin incisions. Surgical modalities for laryngocele excision should be directed toward a curative target including cosmetic and functional success, technical achievability, and surgically curative methods. Transoral robotic surgery provided all these features.

  2. Management approach recommendations. Earth Observatory Satellite system definition study (EOS)

    Science.gov (United States)

    1974-01-01

    Management analyses and tradeoffs were performed to determine the most cost effective management approach for the Earth Observatory Satellite (EOS) Phase C/D. The basic objectives of the management approach are identified. Some of the subjects considered are as follows: (1) contract startup phase, (2) project management control system, (3) configuration management, (4) quality control and reliability engineering requirements, and (5) the parts procurement program.

  3. An assessment of the current municipal solid waste management system in Lahore, Pakistan.

    Science.gov (United States)

    Masood, Maryam; Barlow, Claire Y; Wilson, David C

    2014-09-01

    The current status of solid waste management in Lahore, a metropolitan city of Pakistan, is reviewed in this article using an existing approach, the UN-Habitat city profile. This involves a systematic quantitative and qualitative assessment of physical components and governance features of the current waste management system. A material flow diagram (MFD) is developed, which allows visualisation of the current waste management system with all related inputs and outputs. This study shows that in the current system, waste collection and transportation is the main focus, however the collection coverage is only about 68%. There is no controlled or even semi-controlled waste disposal facility in Lahore. There is no official recycling system in the city. It is estimated that currently ~27% of waste by weight is being recycled through the informal sector. Making use of the organic content of the waste, a composting facility is operative in the city, producing 47,230 tonnes year(-1) of organic compost. Lahore does not perform very well in governance features. Inclusivity of users and providers of the waste management system is low in the city, as not all stakeholders are consulted in the decision making processes. Waste management costs US$20 per tonne of waste, where the main focus is only on waste collection, and the current user fees are much lower than the actual costs. This study recommends that recycling should be promoted by increasing public awareness and integrating the informal sector to make the current system sustainable and financially viable. © The Author(s) 2014.

  4. Comprehensive change management concepts. Development of a participatory approach.

    Science.gov (United States)

    Zink, Klaus J; Steimle, Ulrich; Schröder, Delia

    2008-07-01

    During the last years, many change projects in organizations did not have the planned success. Therefore at first, the causes for these failures and the success factors contributing to organizational change have to be discussed. To get better results, a comprehensive change management concept has been developed and tested in an ongoing research project. By using concepts for an integrated assessment and design of organizations, an approach for analyzing the current situation has been elaborated to identify "lack of integration" in the change initiatives of a company. To realize an integrated overall approach of modernization by harmonizing different methods and concepts, first, one has to prove their relationship to policy and strategy (vertical harmonization). The second step is to take into account the fact that there has to be a logical fit between the single concepts (horizontal harmonization). But even if all elements are logically coherent, that does not mean that the people working in the company also see this coherence. Therefore, in addition to the "logical fit", one has to examine the "psychological fit". In the end, a concept for analyzing the status quo in an organization as a result of "objective data" and "subjective data" originated. Subsequently, instruments for harmonizing different modernizing concepts have been applied. As part of the comprehensive change management concept participatory ergonomic approaches have been used during the project. The present study shows this approach in the case of one company.

  5. Simple engineering design for complex thermoelectric generators based on reduced current approach

    DEFF Research Database (Denmark)

    Wijesooriyage, Waruna Dissanayaka; Rezaniakolaei, Alireza; Rosendahl, Lasse

    2015-01-01

    Thermoelectric generators (TEGs) are niche candidate for the field of energy management as electrical generator devices. Generally, comprehensive and accurate design techniques for TEGs (thermoelectric generators), such as reduced current approach (RCA), are complex and time consuming processes....... This study develops a simple, comprehensive and accurate TEG designing technique based on RCA. The proposed method can predict the most efficient TEG architecture with more than 97% accuracy comparing to the RCA over wide range of possible temperature and zT for present TEG applications. Moreover...

  6. The Aalborg Approach to Environmental Management

    DEFF Research Database (Denmark)

    Jamison, Andrew; Nielsen, Eskild Holm

    2002-01-01

    The Article Briefly Presents the Master Programme in Environmental Management at Aalborg University......The Article Briefly Presents the Master Programme in Environmental Management at Aalborg University...

  7. MELiSSA Food Characterization general approach and current status

    Science.gov (United States)

    Weihreter, Martin; Chaerle, Laury; Secco, Benjamin; Molders, Katrien; van der Straeten, Dominique; Duliere, Eric; Pieters, Serge; Maclean, Heather; Dochain, Denis; Quinet, Muriel; Lutts, Stanley; Graham, Thomas; Stasiak, Michael; Rondeau Vuk, Theresa; Zheng, Youbin; Dixon, Mike; Laniau, Martine; Larreture, Alain; Timsit, Michel; Aronne, Giovanna; Barbieri, Giancarlo; Buonomo, Roberta; Veronica; Paradiso, Roberta; de Pascale, Stafania; Galbiati, Massimo; Troia, A. R.; Nobili, Matteo; Bucchieri, Lorenzo; Page, Valérie; Feller, Urs; Lasseur, Christophe

    . Available MELiSSA closed environment crop growth data were used to develop a first photosynthetic model representing the basic carbon fixation mechanisms. This model will be further elaborated in the course of this study to predict yield, oxygen production and transpi-ration. As an ultimate goal the model is intended to simulate the composition of the different plant organs (root, shoot, fruit/seed or tuber) for each crop under various conditions. For the validation of this model an extensive amount of data sets are needed. Current plant growth bench test setups will provide part of the required data. To gain more precise and detailed datasets, a highly closed plant growth chamber (Plant Characterization Unit, PCU) is under development. The PCU will provide accurate mass balances for carbon, water, oxygen and other elements with statistical reliability. This reliability is achieved through a high degree of closure and environment homogeneity. The PCU will also provide data for the above described plant characterization studies. The general work approach, the current status and future steps will be illustrated.

  8. The multidisciplinary approach to the management toxic epidermal ...

    African Journals Online (AJOL)

    Complete haematological and biochemical tests were carried out and management was symptomatic. This report shows the multidisciplinary approach to the management and highlights the role of the dental surgeon in the management. It concludes that multidisciplinary approach to healthcare provision will be of benefit to ...

  9. Current management and prognostic features for gastrointestinal stromal tumor (GIST

    Directory of Open Access Journals (Sweden)

    Lamba Gurpreet

    2012-06-01

    Full Text Available Abstract Stromal or mesenchymal neoplasms affecting the gastrointestinal (GI tract have undergone a remarkable evolution in how they are perceived, classified, approached, diagnosed and managed over the last 30 years. Gastrointestinal stromal tumors (GIST account for approximately 1% to 3% of all malignant GI tumors. The clinical features can vary depending on the anatomic location, size and aggressiveness of the tumor. Metastatic GIST represents a successful example of molecular targeted therapy. In this comprehensive review, we discuss the epidemiology, clinical features and diagnostic modalities for GIST. We also describe treatment options for early stage, locally advanced and metastatic GIST. Indications for neoadjuvant and adjuvant therapy along with duration of therapy are also explained. A brief discussion of latest biomarkers and updates from recent meetings is also provided.

  10. Beyond (eco)design : Current approaches to sustainable packaging design

    NARCIS (Netherlands)

    Wever, R.

    2014-01-01

    Packaging has always received a lot of attention within the field of design for sustainability. The classical approach has been to mainly focus on reducing the impact of the packaging. This approach stems from the ill-informed position that packaging is superfluous, or at best there only for

  11. Local air quality management: some evidence of current practices

    Energy Technology Data Exchange (ETDEWEB)

    Beattie, Clare; Newton, Alex; Longhurst, Jim [University of the West of England, Air Quality Research Group, Bristol (United Kingdom)

    1998-12-01

    The recent legislative changes, notably the Environment Act 1995 and resultant National Air Quality Strategy have brought new powers and obligations to local authorities to reach specified air quality standards and objectives. Initially this will involve local authorities carrying out a review and assessment of air quality in their locality by December 1999. This paper will outline a project currently being undertaken within the University of the West of England investigating how this legislation is being put into practice and present the results from a nation-wide questionnaire survey of environmental health officers. The study found that local authorities are still at an early stage of the process. It seems probable that one possible barrier to the implementation of Air Quality Management will be communication and cooperation within local authorities. (Author)

  12. Current management of bronchiectasis: review and 3 case studies.

    Science.gov (United States)

    Silverman, Enid; Ebright, Linda; Kwiatkowski, Marianne; Cullina, Joanne

    2003-01-01

    Bronchiectasis is the abnormal, irreversible dilatation of diseased bronchi. Permanently dilated airways, usually in the medium-sized bronchi, are inflamed and often obstructed with thick, purulent secretions. Known causative factors include postinfection bronchial damage, postinhalation injury, hypersensitivity reactions, and congenital airway obstructive disorders. Typical symptoms include sputum overproduction, fever, pleurisy, dyspnea, and chronic cough. Diagnosis involves radiographic studies and pulmonary function testing. Treatment includes oral, aerosolized, or intravenous antibiotic therapy according to the severity of the exacerbation, and mucus clearance by means of bronchial hygiene assistive devices, chest physiotherapy, postural drainage, and high-frequency chest compression. We present a review of bronchiectasis and offer 3 case studies illustrating current management of different presentations, including use of aerosolized antibiotics for patients infected with Pseudomonas aeruginosa. Although an adjunctive program of pulmonary rehabilitation may be useful for patients with bronchiectasis, no confirming studies have been performed to date, and additional research in this area is warranted.

  13. Cutaneous Scar Prevention and Management; Overview of current therapies

    Directory of Open Access Journals (Sweden)

    Sultan Al-Shaqsi

    2016-02-01

    Full Text Available Cutaneous scarring is common after trauma, surgery and infection and occurs when normal skin tissue is replaced by fibroblastic tissue during the healing process. The pathophysiology of scar formation is not yet fully understood, although the degree of tension across the wound edges and the speed of cell growth are believed to play central roles. Prevention of scars is essential and can be achieved by attention to surgical techniques and the use of measures to reduce cell growth. Grading and classifying scars is important to determine available treatment strategies. This article presents an overview of the current therapies available for the prevention and treatment of scars. It is intended to be a practical guide for surgeons and other health professionals involved with and interested in scar management.

  14. Structural transformation of the machine-building enterprises: management approaches

    OpenAIRE

    Obydiennova, T.

    2014-01-01

    The article considers the «classical» approach to the issues of enterprise management: process, system, situational, concrete, functional, resource, factorial approach. Outlines the definitions of each of the approaches to the management of the enterprise, as well as advantages and disadvantages. The author suggests the schematic image of the aspects of the system approach and its application; a scheme of contents resource and functional approaches. For research on the structural transformati...

  15. Forest Resource Management Plans: A Sustainability Approach

    Science.gov (United States)

    Pile, Lauren S.; Watts, Christine M.; Straka, Thomas J.

    2012-01-01

    Forest Resource Management Plans is the capstone course in many forestry and natural resource management curricula. The management plans are developed by senior forestry students. Early management plans courses were commonly technical exercises, often performed on contrived forest "tracts" on university-owned or other public lands, with a goal of…

  16. Current management of congenital branchial cleft cysts, sinuses, and fistulae.

    Science.gov (United States)

    Goff, Christopher J; Allred, Carly; Glade, Robert S

    2012-12-01

    Branchial anomalies comprise approximately 20% of pediatric congenital head and neck lesions. This study reviews current literature detailing the diagnosis and management of first, second, third and fourth branchial cysts, sinuses and fistulae. Branchial anomalies remain classified as first, second, third and fourth cysts, sinuses and fistulae. Management varies on the basis of classification. The imaging study of choice remains controversial. Computed tomography fistulography likely best demonstrates the complete course of the tract if a cutaneous opening is present. Treatment of all lesions has historically been by complete surgical excision of the entire tract. Studies of less invasive procedures for several anomalies are promising including sclerotherapy and endoscopic excision of second branchial cysts, and endoscopic cauterization or sclerotherapy at the piriform opening for third and fourth branchial sinuses. An increased risk of complications in children less than 8 years is reported in children undergoing open excision of third and fourth branchial anomalies. Branchial anomalies are common congenital pediatric head and neck lesions but are comprised by several diverse anomalies. Treatment must be tailored depending on which branchial arch is involved and whether a cyst mass or sinus/fistula tract is present.

  17. Management of anaphylaxis in Latin America: current situation

    Directory of Open Access Journals (Sweden)

    Victoria Cardona

    2017-06-01

    Full Text Available Background: Anaphylaxis is a systemic and severe allergic reaction, which can be fatal. The first-line treatment of choice, according to international guidelines, is intramuscular adrenaline. However, different studies show that the performance of health professionals managing anaphylaxis is often inadequate Objective: To assess the current resources available in Latin American countries for the diagnosis and treatment of anaphylaxis. Methods: Online survey promoted by the Latin American Society of Allergy and Immunology to representatives of the national allergy societies of Latin American countries. Results: Responses were received from 10 countries out of the 14 countries invited to participate. Only five of the countries have clinical practice guidelines in anaphylaxis. Adrenaline autoinjectors are available only in two countries, Argentina and Brazil, but are not subsidized by public health systems. In all countries, adrenaline is available in ampoules, which is the presentation usually prescribed to patients for self-administration. The use of adrenaline was estimated to be less than 50 % of cases in five countries, while antihistamines and corticosteroids are almost always used. The determination of serum tryptase is possible in some health centers, often private, in five of the countries surveyed. Conclusion: It is necessary to improve resources related to the diagnosis and management of anaphylaxis in Latin American countries.

  18. Current and emerging treatment options in the management of lupus

    Science.gov (United States)

    Jordan, Natasha; D’Cruz, David

    2016-01-01

    Systemic lupus erythematosus (SLE) is a complex autoimmune disease with variable clinical manifestations. While the clearest guidelines for the treatment of SLE exist in the context of lupus nephritis, patients with other lupus manifestations such as neuropsychiatric, hematologic, musculoskeletal, and severe cutaneous lupus frequently require immunosuppression and/or biologic therapy. Conventional immunosuppressive agents such as mycophenolate mofetil, azathioprine, and cyclophosphamide are widely used in the management of SLE with current more rationalized treatment regimens optimizing the use of these agents while minimizing potential toxicity. The advent of biologic therapies has advanced the treatment of SLE particularly in patients with refractory disease. The CD20 monoclonal antibody rituximab and the anti-BLyS agent belimumab are now widely in use in clinical practice. Several other biologic agents are in ongoing clinical trials. While immunosuppressive and biologic agents are the foundation of inflammatory disease control in SLE, the importance of managing comorbidities such as cardiovascular risk factors, bone health, and minimizing susceptibility to infection should not be neglected. PMID:27529058

  19. Current management of diabetes mellitus and future directions in care.

    Science.gov (United States)

    Chatterjee, Sudesna; Davies, Melanie J

    2015-11-01

    The last 90 years have seen considerable advances in the management of type 1 and type 2 diabetes. Prof MacLean of Guy's Hospital wrote in the Postgraduate Medical Journal in 1926 about the numerous challenges that faced patients and their healthcare professionals in delivering safe and effective diabetes care at that time. The discovery of insulin in 1922 heralded a new age in enabling long-term glycaemic control, which reduced morbidity and mortality. Thirty years later, the first oral agents for diabetes, the biguanides and sulfonylureas, appeared and freed type 2 patients from having to inject insulin following diagnosis. Improvements in insulin formulations over the decades, including rapid-acting and long-acting insulin analogues that more closely mimic physiological insulin secretion, have increased the flexibility and efficacy of type 1 diabetes management. The last two decades have seen major advances in technology, which has manifested in more accurate glucose monitoring systems and insulin delivery devices ('insulin pump'). Increased understanding of the pathophysiological deficits underlying type 2 diabetes has led to the development of targeted therapeutic approaches such as on the small intestine (glucagon-like peptide-1 receptor analogues and dipeptidyl-peptidase IV inhibitors) and kidneys (sodium-glucose cotransporter-2 inhibitors). A patient-centred approach delivered by a multidisciplinary team is now advocated. Glycaemic targets are set according to individual circumstances, taking into account factors such as weight, hypoglycaemia risk and patient preference. Stepwise treatment guidelines devised by international diabetes organisations standardise and rationalise management. Structured education programmes and psychological support are now well-established as essential for improving patient motivation and self-empowerment. Large multicentre randomised trials have confirmed the effectiveness of intensive glycaemic control on microvascular

  20. Current Management of Alcoholic Hepatitis and Future Therapies

    Institute of Scientific and Technical Information of China (English)

    Behnam Saberi; Alia S.Dadabhai; Yoon-Young Jang; Ahmet Gurakar; Esteban Mezey

    2016-01-01

    Alcohol is one of the most common etiologies of liver disease,and alcoholic liver disease overall is the second most common indication for liver transplantation in the United States.It encompasses a spectrum of disease,including fatty liver disease,alcoholic hepatitis (AH),and alcoholic cirrhosis.AH can range from mild to severe disease,with severe disease being defined as:Discriminant Function (DF) ≥ 32,or Model for End-stage Liver Disease (MELD) ≥ 21,or presence of hepatic encephalopathy.Management of the mild disease consists mainly of abstinence and supportive care.Severe AH is associated with significant mortality.Currently,there is no ideal medical treatment for this condition.Besides alcohol cessation,corticosteroids have been used with conflicting results and are associated with an inherent risk of infection.Overall steroids have shown short term benefit when compared to placebo,but they have no obvious long term benefits.Pentoxifylline does not improve survival in patients with severe AH and is no longer recommended based on the results of the STOPAH (Steroid Or Pentoxifylline for Alcoholic Hepatitis) trial.Anti-tumor necrosis factor (TNF) agents are associated with increased risk of life threatening infections and death.Currently,early stage trials are underway,mainly targeting novel pathways based on disease pathogenesis,including modulation of innate immune system,inhibition of gut-liver axis and cell death pathways,and activation of transcription factor farnesyl X receptor (FXR).Future treatment may lie in human induced pluripotent stem cell (iPSC)technology,which is currently under investigation for the study of pathogenesis,drug discovery,and stem cell transplantation.Liver transplantation has been reported with good results in highly selected patients but is controversial due to limited organ Suppply.

  1. Zenker's Diverticulum: Diagnostic Approach and Surgical Management

    Directory of Open Access Journals (Sweden)

    Carlos M. Nuño-Guzmán

    2014-11-01

    Full Text Available Zenker's diverticulum (ZD, also known as cricopharyngeal, pharyngoesophageal or hypopharyngeal diverticulum, is a rare condition characterized by an acquired outpouching of the mucosal and submucosal layers originating from the pharyngoesophageal junction. This false and pulsion diverticulum occurs dorsally at the pharyngoesophageal wall between the inferior pharyngeal constrictor and the cricopharyngeus muscle. The pathophysiology of ZD involves altered compliance of the cricopharyngeus muscle and raised intrabolus pressure. Decreased compliance of the upper esophageal sphincter and failure to open completely for effective bolus clearance both lead to an increase in the hypopharyngeal pressure gradient. Different open surgical techniques and transoral endoscopic approaches have been described for the management of ZD, although there is no consensus about the best option. We report the case of a 61-year-old patient with a 7-year history of dysphagia and odynophagia for solid food, which after 2 months progressed to dysphagia for liquids and after 4 months to regurgitation 2-6 h after meals. The patient experienced a 12-kg weight loss. Diagnosis was established by esophagogram, which showed a diverticulum through the posterior pharyngeal wall, suggestive of a ZD. Esophagogastroduodenoscopy showed a pouch with erythematous mucosa. Under general anesthesia, diverticulectomy and myotomy were performed. After an uneventful recovery and adequate oral intake, the patient remains free of symptoms at 4 months of follow-up.

  2. Developing disaster management modules: a collaborative approach.

    Science.gov (United States)

    Douglas, Valerie

    Disasters, whether natural or human induced, can strike when least expected. The events of 9/11 in the US, the 7/7 bombings in the UK, and the anthrax incident in the US on 10th October 2001 indicate that there is a need to have a nursing workforce who is able to respond effectively to mass casualty events and incidents involving chemical, biological, radiological and nuclear substances. Multi-agency collaboration is one of the fundamental principles of disaster preparedness and response. It was therefore necessary to take a similar multi-agency collaborative approach to develop modules on the management of mass casualty events and incidents involving hazardous substances. The modules are offered to registered nurses and registered paramedics. They can be taken independently or as part of a BSc in nursing or health pathway, on a part-time basis. Since the commencement of the modules in September 2004, registered paramedics and registered nurses who work in a wide range of specialties have accessed them.

  3. A holistic approach to managing a patient with heart failure.

    Science.gov (United States)

    Duncan, Alison; Cunnington, Colin

    2013-03-01

    Despite varied and complex therapeutic strategies for managing patients with heart failure, the prognosis may remain poor in certain groups. Recognition that patients with heart failure frequently require input from many care groups formed the basis of The British Society of Heart Failure Annual Autumn Meeting in London (UK), in November 2012, entitled: 'Heart failure: a multidisciplinary approach'. Experts in cardiology, cardiac surgery, general practice, care of the elderly, palliative care and cardiac imaging shared their knowledge and expertise. The 2-day symposium was attended by over 500 participants from the UK, Europe and North America, and hosted physicians, nurses, scientists, trainees and representatives from the industry, as well as patient and community groups. The symposium, accredited by the Royal College of Physicians and the Royal College of Nursing, focused on the multidisciplinary approach to heart failure, in particular, current therapeutic advances, cardiac remodeling, palliative care, atrial fibrillation, heart rate-lowering therapies, management of acute heart failure and the management of patients with mitral regurgitation and heart failure.

  4. Structured ecosystem-scale approach to marine water quality management

    CSIR Research Space (South Africa)

    Taljaard, Susan

    2006-10-01

    Full Text Available and implement environmental management programmes. A structured ecosystem-scale approach for the design and implementation of marine water quality management programmes developed by the CSIR (South Africa) in response to recent advances in policies...

  5. Unmanned Aircraft Systems Traffic Management (UTM): Conflict Mitigation Approach

    Science.gov (United States)

    Johnson, Marcus

    2018-01-01

    This is a presentation that describes the UAS Traffic Management Approach to an alternate means of compliance with 91.113 right of way regulations. UTM is an "air traffic management" ecosystem for uncontrolled operations.

  6. Novel approach to information security management of confidential ...

    African Journals Online (AJOL)

    Novel approach to information security management of confidential and propriety information ... Journal of Fundamental and Applied Sciences ... valuable information by using steganography it can have a major impact security management.

  7. OSSA - An optimized approach to severe accident management: EPR application

    International Nuclear Information System (INIS)

    Sauvage, E. C.; Prior, R.; Coffey, K.; Mazurkiewicz, S. M.

    2006-01-01

    There is a recognized need to provide nuclear power plant technical staff with structured guidance for response to a potential severe accident condition involving core damage and potential release of fission products to the environment. Over the past ten years, many plants worldwide have implemented such guidance for their emergency technical support center teams either by following one of the generic approaches, or by developing fully independent approaches. There are many lessons to be learned from the experience of the past decade, in developing, implementing, and validating severe accident management guidance. Also, though numerous basic approaches exist which share common principles, there are differences in the methodology and application of the guidelines. AREVA/Framatome-ANP is developing an optimized approach to severe accident management guidance in a project called OSSA ('Operating Strategies for Severe Accidents'). There are still numerous operating power plants which have yet to implement severe accident management programs. For these, the option to use an updated approach which makes full use of lessons learned and experience, is seen as a major advantage. Very few of the current approaches covers all operating plant states, including shutdown states with the primary system closed and open. Although it is not necessary to develop an entirely new approach in order to add this capability, the opportunity has been taken to develop revised full scope guidance covering all plant states in addition to the fuel in the fuel building. The EPR includes at the design phase systems and measures to minimize the risk of severe accident and to mitigate such potential scenarios. This presents a difference in comparison with existing plant, for which severe accidents where not considered in the design. Thought developed for all type of plants, OSSA will also be applied on the EPR, with adaptations designed to take into account its favourable situation in that field

  8. Using ecological thresholds to inform resource management: current options and future possibilities

    Directory of Open Access Journals (Sweden)

    Melissa M Foley

    2015-11-01

    Full Text Available In the face of growing human impacts on ecosystems, scientists and managers recognize the need to better understand thresholds and nonlinear dynamics in ecological systems to help set management targets. However, our understanding of the factors that drive threshold dynamics, and when and how rapidly thresholds will be crossed is currently limited in many systems. In spite of these limitations, there are approaches available to practitioners today—including ecosystem monitoring, statistical methods to identify thresholds and indicators, and threshold-based adaptive management—that can be used to help avoid ecological thresholds or restore systems that have crossed them. We briefly review the current state of knowledge and then use real-world examples to demonstrate how resource managers can use available approaches to avoid crossing ecological thresholds. We also highlight new tools and indicators being developed that have the potential to enhance our ability to detect change, predict when a system is approaching an ecological threshold, or restore systems that have already crossed a tipping point.

  9. Current approaches to the diagnosis, treatment, and reporting of trichomoniasis and candidosis.

    Science.gov (United States)

    O'Connor, B H; Adler, M W

    1979-02-01

    The current approach to the management of trichomoniasis and candidosis in sexually transmitted disease (STD) clinics in England and Wales is described. Microscopy alone was used in the diagnosis of trichomoniasis in 44% of clinics and of candidosis in 35% of clinics. Oral metronidazole was used for the treatment of trichomoniasis in women in 92% of clinics. Vaginal pessaries containing nystatin or clotrimazole were routinely used to treat candidosis in 95% of clinics. Male sexual contacts of female patients with candidosis and trichomoniasis were invited to attend for examination in 88% of clinics. Physicians in 81% of clinics prescribed treatment on epidemiological grounds for male contacts of female patients with trichomoniasis. A more uniform approach to the diagnostic categories used for the quarterly returns for cases treated epidemiologically is recommended.

  10. New Approaches to Circulating Current Controllers for Modular Multilevel Converters

    Directory of Open Access Journals (Sweden)

    Miguel Moranchel

    2017-01-01

    Full Text Available In the next years, modular multilevel converters (MMCs are going to be a next generation multilevel converters for medium to high voltage conversion applications, such as medium voltage motor drives, medium voltage flexible AC transmission systems (FACTS and high voltage direct current transmission. They provide advantages such as high modularity, availability, low generation of harmonics, etc. However, the circulating current distorts the leg currents and increases the rated current of power devices, which further increases system cost. This paper focuses on analysis and suppression of these currents in a MMC using two algorithms for tracking of harmonics. For this work resonant controllers and repetitive controllers have been selected. Both controllers are analyzed and simulations results are presented. Moreover, the controllers have been tested and validated for a three phase MMC operating as an inverter using a real processing platform based on Zynq by Xilinx and designed to control large multilevel converters and in a real MMC prototype. These results are provided to demonstrate the feasibility of the proposed method.

  11. Management of Technology - a political process approach

    DEFF Research Database (Denmark)

    Koch, Christian

    1999-01-01

    Most management of technology writings fail to address enterprise developments as political processes, where visions, coalitions and emergence are central features. The paper report of a participants observation study of management of technology processes.......Most management of technology writings fail to address enterprise developments as political processes, where visions, coalitions and emergence are central features. The paper report of a participants observation study of management of technology processes....

  12. An evaluation of current approaches to nursing home capital reimbursement.

    Science.gov (United States)

    Cohen, J; Holahan, J

    1986-01-01

    One of the more controversial issues in reimbursement policy is how to set the capital cost component of facilities rates. In this article we examine in detail the various approaches used by states to reimburse nursing homes for capital costs. We conclude that newer approaches that recognize the increasing value of nursing home assets over time, commonly called fair rental systems, are preferable to the methodologies that have been used historically in both the Medicare and the Medicaid programs to set capital rates. When properly designed, fair rental systems should provide more rational incentives and less encouragement of property manipulation than do more traditional systems, with little or no increase in state costs.

  13. Hypertensive crisis: an update on clinical approach and management.

    Science.gov (United States)

    Ipek, Emrah; Oktay, Ahmet Afşin; Krim, Selim R

    2017-07-01

    Here, we review current concepts on hypertensive crisis (HTN-C) with a focus on epidemiology, causes, pathophysiology and prognosis. We also offer a practical approach to the management of HTN-C. HTN-C is characterized by a severe and abrupt increase in blood pressure (BP) with impending or progressive acute end-organ damage (EOD). HTN-C can be divided into hypertensive emergency (HTN-E) and hypertensive urgency (HTN-U) based on the presence or absence of acute EOD, respectively. Recent retrospective studies have demonstrated that emergency department (ED) referrals from an outpatient clinic or rapid BP-lowering strategies in the ED do not lead to improved outcomes in patients with HTN-U. HTN-C can be a de-novo manifestation or a complication of essential or secondary HTN. The presence of acute EOD is a major poor prognostic indicator in HTN-C. The main objectives of the management of HTN-C are distinction of HTN-E from HTN-U and appropriate risk stratification, prevention or regression of acute EOD due to severely elevated BP, prevention of recurrence of HTN-C with an effective long-term management plan and avoidance of rapid lowering of BP except in some special circumstances. The majority of patients with asymptomatic HTN-U can be safely managed in the outpatient setting without exposing them to the risks of aggressive BP lowering. However, patients with HTN-E require hospitalization, prompt treatment and close monitoring.

  14. Current trends in the management of Graves' disease

    Energy Technology Data Exchange (ETDEWEB)

    Solomon, B.; Glinoer, D.; Lagasse, R.; Wartofsky, L. (Walter Reed Army Medical Center, Washington, DC (USA))

    1990-06-01

    Members of the American Thyroid Association were invited to participate in a survey of the management of Graves' disease. One primary case and several variations were provided, which differed in respect to age, sex, goiter size, severity, etc. The questionnaire was based on the format used in a similar survey of members of the European Thyroid Association. The aim of the survey was to determine (1) how expert thyroidologist employ diagnostic procedures for this disorder, and (2) the choice of therapy of the three treatment options and its manner of implementation. Questionnaires were sent only to clinically active members. The overall response rate was 62%. Data analysis was possible on 52% of members surveyed and was performed using SPSS and a specific Fortran program. In the laboratory evaluation of the primary case a radioiodine uptake, scan, serum total T4, and basal TSH were requested by 92%, 47%, 83%, and 66%, respectively, with 84% of respondents using an ultrasensitive TSH assay. For management of the primary case, radioiodine treatment was the first choice of 69% of the respondents. Antithyroid drugs were used briefly (3-7 days) before 131I by 28%, whereas 41% said they would employ thioureas after 131I. Of those using 131I, 66% tailored the dose to achieve euthyroidism as the goal of therapy, while 34% aimed for hypothyroidism requiring T4 replacement. Only 30% of respondents chose thioureas as a first line of treatment (72% propylthiouracil; 28% tapazole). The duration of drug therapy was a predetermined fixed interval for 80% of the respondents, with 90% treating for 1-2 yr. Other specific trends in diagnostic approach and therapeutic preferences were identified for the eight variations on the primary case problem.

  15. Monogenic hyperinsulinemic hypoglycemia: current insights into the pathogenesis and management

    Directory of Open Access Journals (Sweden)

    Lord Katherine

    2013-02-01

    Full Text Available Abstract Hyperinsulinism (HI is the leading cause of persistent hypoglycemia in children, which if unrecognized may lead to development delays and permanent neurologic damage. Prompt recognition and appropriate treatment of HI are essential to avoid these sequelae. Major advances have been made over the past two decades in understanding the molecular basis of hyperinsulinism and mutations in nine genes are currently known to cause HI. Inactivating KATP channel mutations cause the most common and severe type of HI, which occurs in both a focal and a diffuse form. Activating mutations of glutamate dehydrogenase (GDH lead to hyperinsulinism/hyperammonemia syndrome, while activating mutations of glucokinase (GK, the “glucose sensor” of the beta cell, causes hyperinsulinism with a variable clinical phenotype. More recently identified genetic causes include mutations in the genes encoding short-chain 3-hydroxyacyl-CoA (SCHAD, uncoupling protein 2 (UCP2, hepatocyte nuclear factor 4-alpha (HNF-4α, hepatocyte nuclear factor 1-alpha (HNF-1α, and monocarboyxlate transporter 1 (MCT-1, which results in a very rare form of HI triggered by exercise. For a timely diagnosis, a critical sample and a glucagon stimulation test should be done when plasma glucose is ATP channel agonist, suggests a KATP defect, which frequently requires pancreatectomy. Surgery is palliative for children with diffuse KATPHI, but children with focal KATPHI are cured with a limited pancreatectomy. Therefore, distinguishing between diffuse and focal disease and localizing the focal lesion in the pancreas are crucial aspects of HI management. Since 2003, 18 F-DOPA PET scans have been used to differentiate diffuse and focal disease and localize focal lesions with higher sensitivity and specificity than more invasive interventional radiology techniques. Hyperinsulinism remains a challenging disorder, but recent advances in the understanding of its genetic basis and breakthroughs in

  16. Diagnosis and management of microscopic colitis: current perspectives

    Directory of Open Access Journals (Sweden)

    Bohr J

    2014-08-01

    Full Text Available Johan Bohr,1,3 Anna Wickbom,1,3 Agnes Hegedus,2 Nils Nyhlin,1,3 Elisabeth Hultgren Hörnquist,3 Curt Tysk1,3 1Division of Gastroenterology, Department of Medicine, 2Department of Laboratory Medicine/Pathology, Örebro University Hospital, Örebro, 3School of Health and Medical Sciences, Örebro University, Örebro, Sweden Abstract: Collagenous colitis and lymphocytic colitis, together constituting microscopic colitis, are common causes of chronic diarrhea. They are characterized clinically by chronic nonbloody diarrhea and a macroscopically normal colonic mucosa where characteristic histopathological findings are seen. Previously considered rare, they now have emerged as common disorders that need to be considered in the investigation of the patient with chronic diarrhea. The annual incidence of each disorder is five to ten per 100,000 inhabitants, with a peak incidence in 60- to 70-year-old individuals and a predominance of female patients in collagenous colitis. The etiology and pathophysiology are not well understood, and the current view suggests an uncontrolled mucosal immune reaction to various luminal agents in predisposed individuals. Clinical symptoms comprise chronic diarrhea, abdominal pain, fatigue, weight loss, and fecal incontinence that may impair the patient's health-related quality of life. An association is reported with other autoimmune disorders, such as celiac disease, thyroid disorders, diabetes mellitus, and arthritis. The best-documented treatment, both short-term and long-term, is budesonide, which induces clinical remission in up to 80% of patients after 8 weeks' treatment. However, after successful budesonide therapy is ended, recurrence of clinical symptoms is common, and the best possible long-term management deserves further study. The long-term prognosis is good, and the risk of complications, including colonic cancer, is low. We present an update of the epidemiology, pathogenesis, diagnosis, and management of

  17. Emergency room management of ureteral calculi: current practices.

    Science.gov (United States)

    Phillips, Elizabeth; Kieley, Sam; Johnson, Elizabeth B; Monga, Manoj

    2009-06-01

    To evaluate current practice patterns in U.S. emergency departments (EDs) for the diagnosis, treatment, and counseling of patients with ureteral calculi. Hospital-based ED physicians were invited by e-mail to participate in a Survey-Monkey survey. E-mails were delivered in March 2008 by Direct Medical Data using a listserv provided by the American Medical Association. Of the e-mails sent, 173 e-mails were opened, and 135 physicians responded. Physicians were compensated with a $10 Amazon.com gift card. Ninety percent of ED physicians use noncontrast CT as their initial imaging modality, and 63% use alpha-blockers for medical expulsive therapy. Only 13% of evaluated EDs have guidelines for the management of renal colic, and only 58% of these guidelines that recommend the use of an alpha-blocker. Alpha-blocker use was more common with physicians who have been practicing fewer than 5 years (81%) compared with those with more than 10 years of experience (56%). The majority of physicians used ketorolac and morphine to achieve effective analgesia. Although the average responses concerning the chance of spontaneous stone passage for stones 4 mm (44%) were close to evidence-based values, great variation in the answers was noted (standard deviations: 12% and 22%, respectively). Indeed, 38% of respondents stated that stones 95% chance of passage. Twenty-eight percent of ED physicians would arrange follow-up with a primary care physician, while the remainder would arrange follow-up with a urologist. This study establishes a need for educational opportunities for ED physicians in the management of renal colic. The development of collaborative practice guidelines between urology and emergency medicine associations may be warranted.

  18. A Progressive Approach to Discrete Trial Teaching: Some Current Guidelines

    Science.gov (United States)

    Leaf, Justin B.; Cihon, Joseph H.; Leaf, Ronald; McEachin, John; Taubman, Mitchell

    2016-01-01

    Discrete trial teaching (DTT) is one of the cornerstones of applied behavior analysis (ABA) based interventions. Conventionally, DTT is commonly implemented within a prescribed, fixed manner in which the therapist is governed by a strict set of rules. In contrast to conventional DTT, a progressive approach to DTT allows the therapist to remain…

  19. Program Management Approach to the Territorial Development of Small Business

    Directory of Open Access Journals (Sweden)

    Natalia Aleksandrovna Knysh

    2016-06-01

    Full Text Available This article presents the results of the research of the application on a state level of the program management approach to the territorial development of small business. Studying the main mechanism of the state policy implementation in the sphere of small business on a regional level, the authors have revealed the necessity to take into account the territorial specificity while the government programs of small business development are being formed. The analysis of the national practice of utilizing the program management mechanism in the regional system of the government support of small entrepreneurship was conducted on the example of Omsk region. The results of the analysis have shown the inefficiency of the current support system for small business and have determined the need to create an integrated model of territorial programming, which would not only contribute to the qualitative development of small business, but also provide the functioning efficiency of program management mechanism. As a result, the authors have created the two-level model of the programming of the territorial development of small business, which allows to satisfy purposefully the needs of entrepreneurship taking into account the specificity of the internal and external environment of the region. The first level of the model is methodological one and it is based on the marketing approach (the concepts of place marketing and relationship marketing to the operation of the program management mechanism. The second level of the model is methodical one. It offers the combination of the flexible methods of management of programming procedure (benchmarking, foresight, crowdsourcing and outsourcing. The given model raises the efficiency of the management decisions of the state structures in the sphere of small business. Therefore, it is interesting for the government authorities, which are responsible for the regional and municipal support programs of small business, as well

  20. Experimental typography : reviewing the modernist and the current approaches

    OpenAIRE

    Makal, Eray

    1993-01-01

    Ankara : The Department of Graphic Design and Institute of Fine Arts, Bilkent Univ., 1993. Thesis (Master's) -- Bilkent University, 1993. Includes bibliographical references leaves 65-66. The intention of this study is to evaluate the experimental typography within the history of graphic design by taking in consideration of two epochs. The Modernist and The Current. Makal, Eray M.S.

  1. Forecasting Water Waves and Currents: A Space-time Approach

    NARCIS (Netherlands)

    Ambati, V.R.

    2008-01-01

    Forecasting water waves and currents in near shore and off shore regions of the seas and oceans is essential to maintain and protect our environment and man made structures. In wave hydrodynamics, waves can be classified as shallow and deep water waves based on its water depth. The mathematical

  2. Online Learning Integrity Approaches: Current Practices and Future Solutions

    Science.gov (United States)

    Lee-Post, Anita; Hapke, Holly

    2017-01-01

    The primary objective of this paper is to help institutions respond to the stipulation of the Higher Education Opportunity Act of 2008 by adopting cost-effective academic integrity solutions without compromising the convenience and flexibility of online learning. Current user authentication solutions such as user ID and password, security…

  3. Methodological Approaches in Conducting Overviews: Current State in HTA Agencies

    Science.gov (United States)

    Pieper, Dawid; Antoine, Sunya-Lee; Morfeld, Jana-Carina; Mathes, Tim; Eikermann, Michaela

    2014-01-01

    Objectives: Overviews search for reviews rather than for primary studies. They might have the potential to support decision making within a shorter time frame by reducing production time. We aimed to summarize available instructions for authors intending to conduct overviews as well as the currently applied methodology of overviews in…

  4. Laparoscopic approach for inflammatory bowel disease surgical managment.

    Science.gov (United States)

    Maggiori, Léon; Panis, Yves

    2012-01-01

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

  5. Current approaches to managing aggressive incidents among in ...

    African Journals Online (AJOL)

    Background: Aggressive behavior and incidents in psychiatric wards are ... Results: Seventy five people were admitted in the acute psychiatric wards during this ... Although the study sample is small and convenience-based, the dearth of ...

  6. Current approach in diagnosis and management of anterior uveitis

    OpenAIRE

    Agrawal, Rupesh V; Murthy, Somasheila; Sangwan, Virender; Biswas, Jyotirmay

    2010-01-01

    Uveitis is composed of a diverse group of disease entities, which in total has been estimated to cause approximately 10% of blindness. Uveitis is broadly classified into anterior, intermediate, posterior and panuveitis based on the anatomical involvement of the eye. Anterior uveitis is, however, the commonest form of uveitis with varying incidences reported in worldwide literature. Anterior uveitis can be very benign to present with but often can lead to severe morbidity if not treated...

  7. current approach in the management of diarrhea in children

    African Journals Online (AJOL)

    KEY WORDS: Low osmolarity oral rehydration salts – Zinc – Diarrhea – Children. PRISE EN .... three-dimensional configurations stimulating growth in- utero ..... Oral rehydration salts. Production of the new ORS. WHO/FCH/CAH/06.1. 17.

  8. Current Concepts and Management Approaches in Nonalcoholic Fatty Liver Disease

    Directory of Open Access Journals (Sweden)

    Bashar M. Attar

    2013-01-01

    Full Text Available Nonalcoholic fatty liver disease (NAFLD is the most common cause of liver dysfunction worldwide. NAFLD may progress to nonalcoholic steatohepatitis (NASH and in turn cirrhosis. Importantly, hepatic cancer can occur in NASH in the absence of cirrhosis. The cardinal histologic feature of NAFLD is the presence of an excessive accumulation of triacylglycerols and diacylglycerols in hepatocytes. The presence of obesity and insulin resistance lead to an increased hepatic-free fatty acid (FFA flux creating an environment appropriate for the development of NAFLD. The generation of toxic reactive oxygen species with the production of hepatic injury and inflammation as a consequence of FFA oxidation will ultimately lead to the initiation and progression of fibrosis. Lifestyle modifications specifically weight loss, physical exercise, and cognitive behavior therapy have been recommended as treatments for NASH. Dietary fructose is an independent risk factor for the development of NAFLD. Pioglitazone can be used to treat biopsy-proven NASH; however, its safety risks should be considered carefully. Greater consumption for coffee, independent of its caffeine component, has been associated with a significant reduced risk of advanced fibrosis in NASH. Additional data are needed before recommending bariatric surgery as an established option for the specific treatment of NASH.

  9. Current approaches to the management of internally contaminated persons

    International Nuclear Information System (INIS)

    Voelz, G.L.

    1979-01-01

    Appropriate treatment for internal depositions of some radionuclides can reduce the radiation doses by as much as factors of two to ten. While at first thought that may seem a relatively small therapeutic effect, it is a useful gain for the patient in reducing the dose and may be a significant help in preventing late effects from the radiation. The list of important available treatments include agents that reduce gastrointestinal absorption, blocking and diluting compounds, mobilizing agents, and chelating drugs. Wound irrigation or excision and lung lavage are mechanical techniques that can reduce radionuclide depositions. Successful treatment depends on early application of these drugs and techniques following exposure. This must be done usually on the basis of very limited exposure information, which emphasizes the need for preplanning the medical emergency program if internal radioactive contamination is possible. In most cases, the risks of treatment are well identified. Since the exposure risks are often poorly understood when the decision for treatment must be made, the omission of treatment can be more serious than proceeding with a low or no risk therapeutic regimen

  10. A BIM-based approach to reusing construction firm’s management information

    Directory of Open Access Journals (Sweden)

    Zhiliang Ma

    2012-12-01

    Full Text Available Nowadays most construction firms have begun to use information management systems in their business to work more efficiently. At the same time, a lot of management information is being accumulated and some of the information can be reused to support the decision-making. Up to now, the information has not been reused so effectively in construction firms as expected. This paper introduces a new approach to reusing construction firm’s management information, which is based on BIM (Building Information Modeling technology. In the paper, the current approaches are reviewed at first, and then the framework of the new approach is described. Next, the key issues of the new approach are clarified. Finally, a use case of the new approach is demonstrated. It is concluded that the new approach can be used in construction firms to better reuse the accumulated management information.

  11. The national approach to radioactive waste management: the Philippine experience

    International Nuclear Information System (INIS)

    Valdezco, E.M.; Marcelo, E.A.; Junio, J.B.; Alamares, A.L.; Salom, D.S.

    1996-01-01

    The Philippine Nuclear Research Institute (PNRI), under the Department of Science and Technology (DOST) is tasked, among others, with the legally-mandated twin function of advancing and regulating the beneficial uses of nuclear energy and radiation technology. The PNRI is also responsible, among others, for the safe management of radioactive wastes generated by all licensed users of radioisotopes, including about 100 medical and industrial users. This papers describes the efforts taken by the PNRI, with technical assistance provided by the International Atomic Energy Agency to establish a low level radioactive waste management facility in the country and the subsequent upgrading of its waste management infrastructure. The conceptual approach and sebsequent implementation of the work programme is presented. Problems attendant to these efforts are briefly outlined including treatment methodologies for specific wastes. The commissioning and operational experiences using a batch type chemical precipitation plant appropriate for the volume of liquid wastes generated in the country is also presented. Data on radioactive waste arisings from 1980 are also presented including anticipated or projected wastes arisings should the repair of the PRR-1 (Philippine Research Reactor-1) research reactor be completed. The government initiatives towards the organizational development of a centralized waste management facility for low level wastes are also discussed. The formulation and adoption of a waste acceptance criteria and the R and D activities on various treatment procedures are also described. The current activities of the PNRI, as the lead agency in two important areas, one of which is in radioactive waste management, will be reported. National, regional and international cooperation in radioactive waste management will also be presented

  12. A systems engineering management approach to resource management applications

    Science.gov (United States)

    Hornstein, Rhoda Shaller

    1989-01-01

    The author presents a program management response to the following question: How can the traditional practice of systems engineering management, including requirements specification, be adapted, enhanced, or modified to build future planning and scheduling systems for effective operations? The systems engineering management process, as traditionally practiced, is examined. Extensible resource management systems are discussed. It is concluded that extensible systems are a partial solution to problems presented by requirements that are incomplete, partially immeasurable, and often dynamic. There are positive indications that resource management systems have been characterized and modeled sufficiently to allow their implementation as extensible systems.

  13. E-waste management challenges in Iran: presenting some strategies for improvement of current conditions.

    Science.gov (United States)

    Taghipour, Hassan; Nowrouz, Parviz; Jafarabadi, Mohamad Asghari; Nazari, Jalil; Hashemi, Ahmad Asl; Mosaferi, Mohammad; Dehghanzadeh, Reza

    2012-11-01

    E-waste is one of the fastest-growing waste streams in Iran, owing to an increase in consumption of electrical and electronic equipment. Nevertheless, as is the case in some other countries, E-waste management has not received sufficient attention. For the successful implementation of any waste management plan (including an E-waste management plan), the availability of sufficient and accurate information on the quantities and composition of the waste generated and on current management conditions is a fundamental prerequisite. At present, in Iran, there is no available and accurate information that describes the characteristics and generation rate of E-waste or the actual practice of management and handling of the waste. For this initial study, eight electronic products were selected for the determination of their E-waste generation rate in the country, and two cities, Tehran and Tabriz, were selected for assessment of the current condition of E-waste management. The study found that the amount of E-waste generation in the country for the eight selected electronic items alone was 115,286, 112,914 and 115,151 metric tons in 2008, 2009 and 2010, respectively. Of the types of electronic items included in the study, televisions, with an average of 42.42%, and PCs, with an average of 32.66% accounted for the greatest proportions of the total mass of E-waste generated during 2008-2010. Currently, despite the fact that primary legislation for E-waste management (as part of general waste legislation) exists in Iran, this primary legislation has not yet been implemented. In practical terms, there is no definite policy or plan for the allocation of funds to prepare suitable equipment and facilities for the management and recycling of E-waste at the end of the products' useful life. Proposed improvements in current conditions are identified, first by considering other countries' experiences and then suggesting specific practical policies, rules, and regulations that should be

  14. [Current concepts in perioperative management of children : preface and comments].

    Science.gov (United States)

    Kuratani, Norifumi; Kikuchi, Hirosato

    2007-05-01

    In the past few years, pediatric anesthesia management changed rapidly to more evidence-based and patient-oriented practice. It has been emphasized that "focused and individualized" pre-anesthesia evaluation is preferred to routine screening of laboratory tests and X-rays. Anesthesia induction should be less stressful for children through the use of various approaches, such as preoperative preparation, sedative premedication, and parent-present induction. Cuffed tracheal tube is becoming popular for small children, and its indication should be considered individually. Laryngeal mask airway is frequently used for simple short cases. Perioperative fluid infusion therapy has been a controversial issue. Traditional therapeutic regimen using hypotonic solution with glucose is criticized as a result of the growing evidence of hyponatremia and hyperglycemia. New ventilatory modes and sedative medications are now available for pediatric patients, and lung-protective ventilatory strategy should be considered to protect immature lung from ventilator-induced lung injury. Emergence agitation from general anesthesia is an evolving problem. Sevoflurane is known to be a major risk factor for stormy wake-up. Pediatric anesthesiologists should pursue high quality of anesthesia emergence. All anesthesia residency programs should include pediatric rotation; otherwise anesthesia residents will lose opportunities to learn basic concepts of pediatric anesthesia.

  15. Childhood brain tumors: epidemiology, current management and future directions.

    Science.gov (United States)

    Pollack, Ian F; Jakacki, Regina I

    2011-07-26

    Brain tumors are the most common solid tumors in children. With the increasingly widespread availability of MRI, the incidence of childhood brain tumors seemed to rise in the 1980s, but has subsequently remained relatively stable. However, management of brain tumors in children has evolved substantially during this time, reflecting refinements in classification of tumors, delineation of risk groups within histological subsets of tumors, and incorporation of molecular techniques to further define tumor subgroups. Although considerable progress has been made in the outcomes of certain tumors, prognosis in other childhood brain tumor types is poor. Among the tumor groups with more-favorable outcomes, attention has been focused on reducing long-term morbidity without sacrificing survival rates. Studies for high-risk groups have examined the use of intensive therapy or novel, molecularly targeted approaches to improve disease control rates. In addition to reviewing the literature and providing an overview of the complexities in diagnosing childhood brain tumors, we will discuss advances in the treatment and categorization of several tumor types in which progress has been most apparent, as well as those in which improvements have been lacking. The latest insights from molecular correlative studies that hold potential for future refinements in therapy will also be discussed.

  16. Classification and Current Management of Inner Ear Malformations

    Directory of Open Access Journals (Sweden)

    Levent Sennaroğlu

    2017-10-01

    Full Text Available Morphologically congenital sensorineural hearing loss can be investigated under two categories. Majority of the congenital hearing loss (80% are membranous malformations. Here the pathology involves inner ear hair cells. There is no gross bony abnormality and therefore, in these cases, high resolution computerized tomography and MRI of the temporal bone reveal normal findings. Remaining 20% have various malformations involving the bony labyrinth and therefore, can be radiologically demonstrated by CT and MRI. The latter group involves surgical challenges as well as problems in decision making. Some cases may be managed by hearing aid, some need cochlear implantation while some cases are candidates for an auditory brainstem implantation. During cochlear implantation, there may be facial nerve abnormalities, cerebrospinal fluid leakage, electrode misplacement or difficulty in finding the cochlea itself. During the surgery for inner ear malformations, surgeon must be ready to modify the surgical approach or choose special electrodes for surgery. In the present review article inner ear malformations are classified according to the differences observed in the cochlea. Hearing and language outcome after various implantation methods is closely related to the status of cochlear nerve and a practical classification of the cochlear nerve deficiency is also provided

  17. Data Management in Metagenomics: A Risk Management Approach

    Directory of Open Access Journals (Sweden)

    Filipe Ferreira

    2014-07-01

    Full Text Available In eScience, where vast data collections are processed in scientific workflows, new risks and challenges are emerging. Those challenges are changing the eScience paradigm, mainly regarding digital preservation and scientific workflows. To address specific concerns with data management in these scenarios, the concept of the Data Management Plan was established, serving as a tool for enabling digital preservation in eScience research projects. We claim risk management can be jointly used with a Data Management Plan, so new risks and challenges can be easily tackled. Therefore, we propose an analysis process for eScience projects using a Data Management Plan and ISO 31000 in order to create a Risk Management Plan that can complement the Data Management Plan. The motivation, requirements and validation of this proposal are explored in the MetaGen-FRAME project, focused in Metagenomics.

  18. Religious Approaches on Business Ethics: Current Situation and Future Perspectives

    OpenAIRE

    Melé, Domènec

    2015-01-01

    The Business Ethics Movement began in the mid-1970s. For the first two decades philosophical theories were dominant, but in recent years an increasing presence of religious approaches, in both empirical and conceptual research, can be noted, in spite of some objections to the presence of religions in the business ethics field. Empirical research, generally based on psychological and sociological studies, shows the influence of religious faith on several business issues. Conceptual research in...

  19. Current diagnostic approach of bone tumors in childhood

    International Nuclear Information System (INIS)

    Torre, Marcia Barbosa; Scatigno Neto, Andre

    1995-01-01

    The authors analyze the magnetic resonance imaging (MRI) as the imaging modality of choice for evaluation of patients with bone tumors or soft tissue tumors. The advent of such a sensitive imaging modality is fortuitous and coincides with a recent change in the therapeutic approach to primary bone tumors. MRI is extremely valuable in monitoring the tumor response to the initial chemotherapy and is accurate defining the margins of tumor, facilitating planning of limb salvage surgical procedures. (author). 5 refs., 8 figs

  20. APPLICATION OF PROJECT MANAGEMENT APPROACHES AT A SMALL BUSINESSES ENTERPRISES

    OpenAIRE

    Sergey V. Rajewski

    2016-01-01

    This article discusses the types of organizational structures of project management and their application in project management in small and medium-sized enterprises. Among the approaches and methods to organize projects emphasizing project management as part of the existing functional structure of the enterprise. Analyzed the most relevant organizational tools of project management in small business: a network schedule; matrix distribution of administrative and management tasks of the projec...

  1. Management strategies of enterovirus D68 outbreaks: current perspectives

    Directory of Open Access Journals (Sweden)

    Milhano N

    2018-03-01

    Full Text Available Natacha Milhano, Kaja Sverdrup Borge, Karoline Bragstad, Susanne G Dudman Domain for Environmental Health and Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway Abstract: Following its discovery in California in 1962, enterovirus D68 (EV-D68 was reported only sporadically around the world. In August 2014, a marked increase of EV-D68 cases in young children with severe respiratory infections was reported in the USA and Canada and later in Europe and Asia. Some of these cases were also found to be associated with acute flaccid paralysis, which exacerbated public health concern, and has since triggered international efforts to strengthen both EV-D68 and acute flaccid paralysis surveillance systems. This review summarizes the current knowledge on EV-D68, offering an overview of EV-D68 epidemiology, clinical presentations, diagnostic methodologies, and treatment strategies, as well as surveillance and outbreak management. Keywords: enterovirus D68, AFP, diagnostics, treatment, surveillance, outbreak 

  2. Managing ankle ligament sprains and tears: current opinion

    Science.gov (United States)

    McGovern, Ryan P; Martin, RobRoy L

    2016-01-01

    The purpose of this paper is to present a current review of pathoanatomical features, differential diagnosis, objective assessment, intervention, and clinical course associated with managing lateral ankle ligament sprains. Proper diagnosis and identification of affected structures should be obtained through history and objective assessment. From this information, an individualized evidence-based intervention plan can be developed to enable recovery while decreasing the risk of reinjury. An appropriate evaluation is needed not only to determine the correct diagnosis but also to allow for grading and determining the prognosis of the injury in those with an acute lateral ankle sprain. Examination should include an assessment of impairments as well as a measure of activity and participation. Evidence-based interventions for those with an acute lateral ankle sprain should include weight bearing with bracing, manual therapy, progressive therapeutic exercises, and cryotherapy. For those with chronic ankle instability (CAI), interventions should include manual therapy and a comprehensive rehabilitation program. It is essential to understand the normal clinical course for athletes who sustain a lateral ankle sprain as well as risk factors for an acute injury and CAI. Risk factors for both an acute lateral ankle sprain and CAI include not using an external support and not participating in an appropriate exercise program. Incorporating the latest evidence-based rehabilitation techniques provides the best course of treatment for athletes with an acute ankle sprain or CAI. PMID:27042147

  3. Sports-related concussions: diagnosis, complications, and current management strategies.

    Science.gov (United States)

    Hobbs, Jonathan G; Young, Jacob S; Bailes, Julian E

    2016-04-01

    Sports-related concussions (SRCs) are traumatic events that affect up to 3.8 million athletes per year. The initial diagnosis and management is often instituted on the field of play by coaches, athletic trainers, and team physicians. SRCs are usually transient episodes of neurological dysfunction following a traumatic impact, with most symptoms resolving in 7-10 days; however, a small percentage of patients will suffer protracted symptoms for years after the event and may develop chronic neurodegenerative disease. Rarely, SRCs are associated with complications, such as skull fractures, epidural or subdural hematomas, and edema requiring neurosurgical evaluation. Current standards of care are based on a paradigm of rest and gradual return to play, with decisions driven by subjective and objective information gleaned from a detailed history and physical examination. Advanced imaging techniques such as functional MRI, and detailed understanding of the complex pathophysiological process underlying SRCs and how they affect the athletes acutely and long-term, may change the way physicians treat athletes who suffer a concussion. It is hoped that these advances will allow a more accurate assessment of when an athlete is truly safe to return to play, decreasing the risk of secondary impact injuries, and provide avenues for therapeutic strategies targeting the complex biochemical cascade that results from a traumatic injury to the brain.

  4. Current treatment approaches in patients with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Bilal Elbey

    2015-03-01

    Full Text Available Ankylosing spondylitis (AS is a chronic, inflammatory, rheumatic disease that mainly affects sacroiliac joints and spine. AS predominantly occurs more often in males and typically begins in the second or third decade. The mainstay of therapy in AS are nonsteroidal anti-inflammatory drugs, which reduce inflammation and pain. Disease modifying antirheumatic drugs (DMARD did not have enough evidence to prove their effect in AS treatment. The use of DMARD may not sufficient to improve the treatment and symptoms. Currently, TNF-blockers such as, Golimumab Etanersept Adalimumab İnfliksimab have promising results in the treatment of AS. TNF-blockers improve the clinical signs and symptoms, and improve the patients’ physical function and quality of life. This manuscript is focused that Current pharmacological treatments in patients with ankylosing spondylitis.

  5. Implementation of the RCM approach at EDF NPPs: Current status

    International Nuclear Information System (INIS)

    Dubreuil-Chambardel, A.; Martin-Onraet, M.; Degrave, C.

    2001-01-01

    To ensure safest possible operation and to get best overall economic performance of its Nuclear Power Plants, 10 years ago Electricite de France launched a Reliability Centered Maintenance (RCM) project to optimize the preventive maintenance programs. The principles underlying the RCM approach are based on common sense: failures must be prevented by preventive maintenance operations in all cases when the repercussions for the installation could be serious or critical in term of safety, availability or maintenance costs. The approach is a 3-phases process: 1. Evaluation of the functional consequences of failures 2. Evaluation of performances based on the analysis of experience feedback 3. Optimization of the preventive maintenance tasks The new preventive maintenance programs are presently almost completed and progressively implemented. Here and now, the implementation of the RCM approach allows to emphasize some benefits: 1. Same or increased level of safety 2. Same or increased level of plant availability 3. ALARA principles better taken into account 4. Cost control 5. Positive change in maintenance culture. Some new studies are in progress, such as the development of a 'Risk Based In Service Inspection' for passive components. (author)

  6. Treatment for spasmodic dysphonia: limitations of current approaches

    Science.gov (United States)

    Ludlow, Christy L.

    2009-01-01

    Purpose of review Although botulinum toxin injection is the gold standard for treatment of spasmodic dysphonia, surgical approaches aimed at providing long-term symptom control have been advancing over recent years. Recent findings When surgical approaches provide greater long-term benefits to symptom control, they also increase the initial period of side effects of breathiness and swallowing difficulties. However, recent analyses of quality-of-life questionnaires in patients undergoing regular injections of botulinum toxin demonstrate that a large proportion of patients have limited relief for relatively short periods due to early breathiness and loss-of-benefit before reinjection. Summary Most medical and surgical approaches to the treatment of spasmodic dysphonia have been aimed at denervation of the laryngeal muscles to block symptom expression in the voice, and have both adverse effects as well as treatment benefits. Research is needed to identify the central neuropathophysiology responsible for the laryngeal muscle spasms in order target treatment towards the central neurological abnormality responsible for producing symptoms. PMID:19337127

  7. Current clinical approach to patients with disorders of consciousness

    Directory of Open Access Journals (Sweden)

    Robson Luis Oliveira de Amorim

    Full Text Available Summary In clinical practice, hospital admission of patients with altered level of consciousness, sleepy or in a non-responsive state is extremely common. This clinical condition requires an effective investigation and early treatment. Performing a focused and objective evaluation is critical, with quality history taking and physical examination capable to locate the lesion and define conducts. Imaging and laboratory exams have played an increasingly important role in supporting clinical research. In this review, the main types of changes in consciousness are discussed as well as the essential points that should be evaluated in the clinical management of these patients.

  8. Strengthening the Focus on Business Results: The Need for Systems Approaches in Organizational Behavior Management

    Science.gov (United States)

    Hyten, Cloyd

    2009-01-01

    Current Organizational Behavior Management (OBM) research and practice may be characterized as either behavior focused or results focused. These two approaches stem from different origins and have different characteristics. The behavior-focused approach stems from applied behavior analysis (ABA) methods and emphasizes direct observation of and…

  9. A new approach in Business Process Management

    OpenAIRE

    Hurbean, Luminita

    2008-01-01

    The new wave of BPM (Business Process Management) is not Business Process Reenginering, enterprise application integration, workflow management or another packaged application – it's the synthesis and extension of all these technologies and techniques into a unified whole. This unified whole becomes a new foundation upon which the enterprise is built, an enterprise more in tune with the true nature of business processes and their management. In a competitive economy, where margins continu...

  10. Healthcare waste management: an interpretive structural modeling approach.

    Science.gov (United States)

    Thakur, Vikas; Anbanandam, Ramesh

    2016-06-13

    Purpose - The World Health Organization identified infectious healthcare waste as a threat to the environment and human health. India's current medical waste management system has limitations, which lead to ineffective and inefficient waste handling practices. Hence, the purpose of this paper is to: first, identify the important barriers that hinder India's healthcare waste management (HCWM) systems; second, classify operational, tactical and strategical issues to discuss the managerial implications at different management levels; and third, define all barriers into four quadrants depending upon their driving and dependence power. Design/methodology/approach - India's HCWM system barriers were identified through the literature, field surveys and brainstorming sessions. Interrelationships among all the barriers were analyzed using interpretive structural modeling (ISM). Fuzzy-Matrice d'Impacts Croisés Multiplication Appliquée á un Classement (MICMAC) analysis was used to classify HCWM barriers into four groups. Findings - In total, 25 HCWM system barriers were identified and placed in 12 different ISM model hierarchy levels. Fuzzy-MICMAC analysis placed eight barriers in the second quadrant, five in third and 12 in fourth quadrant to define their relative ISM model importance. Research limitations/implications - The study's main limitation is that all the barriers were identified through a field survey and barnstorming sessions conducted only in Uttarakhand, Northern State, India. The problems in implementing HCWM practices may differ with the region, hence, the current study needs to be replicated in different Indian states to define the waste disposal strategies for hospitals. Practical implications - The model will help hospital managers and Pollution Control Boards, to plan their resources accordingly and make policies, targeting key performance areas. Originality/value - The study is the first attempt to identify India's HCWM system barriers and prioritize

  11. Certifying leaders? high-quality management practices and healthy organisations: an ISO-9000 based standardisation approach.

    Science.gov (United States)

    Montano, Diego

    2016-08-05

    The present study proposes a set of quality requirements to management practices by taking into account the empirical evidence on their potential effects on health, the systemic nature of social organisations, and the current conceptualisations of management functions within the framework of comprehensive quality management systems. Systematic reviews and meta-analyses focusing on the associations between leadership and/or supervision and health in occupational settings are evaluated, and the core elements of an ISO 9001 standardisation approach are presented. Six major occupational health requirements to high-quality management practices are identified pertaining to communication processes, organisational justice, role clarity, decision making, social influence processes and management support. It is concluded that the quality of management practices may be improved by developing a quality management system of management practices that ensures not only conformity to product but also to occupational safety and health requirements. Further research may evaluate the practicability of the proposed approach.

  12. Corporate visual identity management: current practices, impact, and assessment

    NARCIS (Netherlands)

    van den Bosch, A.L.M.

    2005-01-01

    This dissertation is about Corporate Visual Identity (CVI) management. Its purpose is to gain more insight into activities associated with managing CVI and the impact of these activities on the outcome: the degree of consistency in CVI.

  13. An interdisciplinary review of current and future approaches to improving human-predator relations.

    Science.gov (United States)

    Pooley, S; Barua, M; Beinart, W; Dickman, A; Holmes, G; Lorimer, J; Loveridge, A J; Macdonald, D W; Marvin, G; Redpath, S; Sillero-Zubiri, C; Zimmermann, A; Milner-Gulland, E J

    2017-06-01

    In a world of shrinking habitats and increasing competition for natural resources, potentially dangerous predators bring the challenges of coexisting with wildlife sharply into focus. Through interdisciplinary collaboration among authors trained in the humanities, social sciences, and natural sciences, we reviewed current approaches to mitigating adverse human-predator encounters and devised a vision for future approaches to understanding and mitigating such encounters. Limitations to current approaches to mitigation include too much focus on negative impacts; oversimplified equating of levels of damage with levels of conflict; and unsuccessful technical fixes resulting from failure to engage locals, address hidden costs, or understand cultural (nonscientific) explanations of the causality of attacks. An emerging interdisciplinary literature suggests that to better frame and successfully mitigate negative human-predator relations conservation professionals need to consider dispensing with conflict as the dominant framework for thinking about human-predator encounters; work out what conflicts are really about (they may be human-human conflicts); unravel the historical contexts of particular conflicts; and explore different cultural ways of thinking about animals. The idea of cosmopolitan natures may help conservation professionals think more clearly about human-predator relations in both local and global context. These new perspectives for future research practice include a recommendation for focused interdisciplinary research and the use of new approaches, including human-animal geography, multispecies ethnography, and approaches from the environmental humanities notably environmental history. Managers should think carefully about how they engage with local cultural beliefs about wildlife, work with all parties to agree on what constitutes good evidence, develop processes and methods to mitigate conflicts, and decide how to monitor and evaluate these. Demand for

  14. Managing the Cumulative Impacts of Land Uses in the Western Canadian Sedimentary Basin: A Modeling Approach

    OpenAIRE

    Richard, R. Schneider; J. Brad Stelfox; Stan Boutin; Shawn Wasel

    2003-01-01

    This case study from northeastern Alberta, Canada, demonstrates a fundamentally different approach to forest management in which stakeholders balance conservation and economic objectives by weighing current management options from the point of view of their long-term effects on the forest. ALCES®, a landscape-scale simulation model, is used to quantify the effects of the current regulatory framework and typical industrial practices on a suite of ecological and economic indicators over the nex...

  15. Treatment for primary hypothyroidism: current approaches and future possibilities

    Science.gov (United States)

    Chakera, Ali J; Pearce, Simon HS; Vaidya, Bijay

    2012-01-01

    Primary hypothyroidism is the most common endocrine disease. Although the diagnosis and treatment of hypothyroidism is often considered simple, there are large numbers of people with this condition who are suboptimally treated. Even in those people with hypothyroidism who are biochemically euthyroid on levothyroxine replacement there is a significant proportion who report poorer quality of life. This review explores the historical and current treatment options for hypothyroidism, reasons for and potential solutions to suboptimal treatment, and future possibilities in the treatment of hypothyroidism. PMID:22291465

  16. Current approaches to antithrombotic therapy in patients with cardioembolic stroke

    Directory of Open Access Journals (Sweden)

    Oleg Ivanovich Vinogradov

    2013-01-01

    Full Text Available The rate of cardiogenic embolism among all ischemic strokes is as high as 38%. Cardioembolic strokes are characterized by the higher magnitude of neurological deficit, the high risk of recurrent acute stroke, and a lethal outcome. This review deals with the etiopathogenesis of thrombus formation in the heart chambers, with current criteria for the verification of cardioembolic strokes, with the results of trials of new oral anticoagulants, and latest guidelines for antithrombotic therapy to prevent stroke. Special focus is given to secondary stroke prevention in patients with nonvalvular atrial fibrillation since it is atrial fibrillation that is the most common cause of cardioembolic stroke.

  17. United States high-level radioactive waste management program: Current status and plans

    International Nuclear Information System (INIS)

    Williams, J.

    1992-01-01

    The inventory of spent fuel in storage at reactor sites in the United States is approximately 20,000 metric tons heavy metal (MTHM). It is increasing at a rate of 1700 to 2100 MTHM per year. According to current projections, by the time the last license for the current generation of nuclear reactors expires, there will be an estimated total of 84,000 MTHm. No commercial reprocessing capacity exists or is planned in the US. Therefore, the continued storage of spent fuel is required. The majority of spent fuel remains in the spent fuel pools of the utilities that generated it. Three utilities are presently supplementing pool capacity with on-site dry storage technologies, and four others are planning dry storage. Commercial utilities are responsible for managing their spent fuel until the Federal waste management system, now under development, accepts spent fuel for storage and disposal. Federal legislation charges the Office of Civilian Radioactive Waste Management (OCRWM) within the US Department of Energy (DOE) with responsibility for developing a system to permanently dispose of spent fuel and high level radioactive waste in a manner that protects the health and safety of the public and the quality of the environment. We are developing a waste management system consisting for three components: a mined geologic repository, with a projected start date of 2010; a monitored retrievable storage facility (MRS), scheduled to begin waste acceptance in 1998; and a transportation system to support MRS and repository operations. This paper discusses the background and framework for the program, as well as the current status and plans for management of spent nuclear fuel at commercial utilities; the OCRWM's development of a permanent geologic repository, an MRS, and a transportation system; the OCRWM's safety approach; the OCRWM's program management initiatives; and the OCRWM's external relations activities

  18. Information and Knowledge Management: Dimensions and Approaches

    Science.gov (United States)

    Schlögl, Christian

    2005-01-01

    Introduction: Though literature on information and knowledge management is vast, there is much confusion concerning the meaning of these terms. Hence, this article should give some orientation and work out the main aspects of information and knowledge management. Method: An author co-citation analysis, which identified the main dimensions of…

  19. An integrated approach to plant life management

    International Nuclear Information System (INIS)

    Fredlund, L.

    1998-01-01

    Plant life is no longer determined by components, almost everything can be replaced. A plant life management program should aim at actions and replacements being performed at the right time. In order to manage this there is need for experience feedback systems, a plant specific risk study and safety upgrades. (author)

  20. Current concepts and future approaches to vestibular rehabilitation.

    Science.gov (United States)

    Tjernström, Fredrik; Zur, Oz; Jahn, Klaus

    2016-04-01

    Over the last decades methods of vestibular rehabilitation to enhance adaptation to vestibular loss, habituation to changing sensory conditions, and sensory reweighting in the compensation process have been developed. However, the use of these techniques still depends to a large part on the educational background of the therapist. Individualized assessment of deficits and specific therapeutic programs for different disorders are sparse. Currently, vestibular rehabilitation is often used in an unspecific way in dizzy patients irrespective of the clinical findings. When predicting the future of vestibular rehabilitation, it is tempting to foretell advances in technology for assessment and treatment only, but the current intense exchange between clinicians and basic scientists also predicts advances in truly understanding the complex interactions between the peripheral senses and central adaptation mechanisms. More research is needed to develop reliable techniques to measure sensory dependence and to learn how this knowledge can be best used--by playing off the patient's sensory strength or working on the weakness. To be able using the emerging concepts, the neuro-otological community must strive to educate physicians, physiotherapists and nurses to perform the correct examinations for assessment of individual deficits and to look for factors that might impede rehabilitation.

  1. Open Source Approach to Project Management Tools

    Directory of Open Access Journals (Sweden)

    Romeo MARGEA

    2011-01-01

    Full Text Available Managing large projects involving different groups of people and complex tasks can be challenging. The solution is to use Project management software, which allows a more efficient management of projects. However, famous project management systems can be costly and may require expensive custom servers. Even if free software is not as complex as Microsoft Project, is noteworthy to think that not all projects need all the features, amenities and power of such systems. There are free and open source software alternatives that meet the needs of most projects, and that allow Web access based on different platforms and locations. A starting stage in adopting an OSS in-house is finding and identifying existing open source solution. In this paper we present an overview of Open Source Project Management Software (OSPMS based on articles, reviews, books and developers’ web sites, about those that seem to be the most popular software in this category.

  2. APPLICATION OF PROJECT MANAGEMENT APPROACHES AT A SMALL BUSINESSES ENTERPRISES

    Directory of Open Access Journals (Sweden)

    Sergey V. Rajewski

    2016-01-01

    Full Text Available This article discusses the types of organizational structures of project management and their application in project management in small and medium-sized enterprises. Among the approaches and methods to organize projects emphasizing project management as part of the existing functional structure of the enterprise. Analyzed the most relevant organizational tools of project management in small business: a network schedule; matrix distribution of administrative and management tasks of the project; schedule of the project plan; information and technological methods and models used in the process of project management; software applications for project management, used in the sphere of small business.

  3. Evaluation of current trends and recent development in insulin therapy for management of diabetes mellitus.

    Science.gov (United States)

    Nawaz, Muhammad Sarfraz; Shah, Kifayat Ullah; Khan, Tahir Mehmood; Rehman, Asim Ur; Rashid, Haroon Ur; Mahmood, Sajid; Khan, Shahzeb; Farrukh, Muhammad Junaid

    2017-12-01

    Diabetes mellitus is a major health problem in developing countries. There are various insulin therapies to manage diabetes mellitus. This systematic review evaluates various insulin therapies for management of diabetes mellitus worldwide. This review also focuses on recent developments being explored for better management of diabetes mellitus. We reviewed a number of published articles from 2002 to 2016 to find out the appropriate management of diabetes mellitus. The paramount parameters of the selected studies include the insulin type & its dose, type of diabetes, duration and comparison of different insulin protocols. In addition, various newly developed approaches for insulin delivery with potential output have also been evaluated. A great variability was observed in managing diabetes mellitus through insulin therapy and the important controlling factors found for this therapy include; dose titration, duration of insulin use, type of insulin used and combination therapy of different insulin. A range of research articles on current trends and recent advances in insulin has been summarized, which led us to the conclusion that multiple daily insulin injections or continuous subcutaneous insulin infusion (insulin pump) is the best method to manage diabetes mellitus. In future perspectives, development of the oral and inhalant insulin would be a tremendous breakthrough in Insulin therapy. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  4. PUBLIC ADMINISTRATION: MODERNIZING THE CURRENT MODEL OF STATE MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Evgenii V. Ohotskii

    2014-01-01

    Full Text Available Applying the method of retrospective analysis the article deals with the process of forming the scientific fundamentals and the search by the international community of effective and adequate to the current stage of social development public administration system. The author attempts to analyze, in a number of cases in terms of models, features of public administration systems at different stages of historical development, drawing attention to reasons why the Soviet model of public administration did not manage to meet competition, did not provide the required social effect and as a natural result suffered a defeat in the global confrontation between the two social systems. Current models and theoretical concepts of public administration, especially the "new public administration", which became scientific basis for administrative reforms implemented in many countries, are the particular subject of scientific analysis. The author draws attention to major comprehensive characteristics of modern state public administration: making it impossible to absolutize principles of traditional hierarchy system of forced administration; globalization - gradual destruction of boundaries between national and international levels of administration, the growing role of supranational subjects of administration relations; informatization - increasing importance of information and communication technologies and of political networks: development of civil society, especially political parties and non-governmental organizations, growing public involvement in discussion and adoption of the most important administrative decisions; making the state policy more pluralistic and which will result in the formation of nonlinear - humanistic social consciousness as the intellectual basis of modern social governance. The author's position is that Russia is yet to solve the issue of choosing a public administration model that would be effective for further administrative

  5. Ebola virus vaccines: an overview of current approaches

    Science.gov (United States)

    Marzi, Andrea; Feldmann, Heinz

    2016-01-01

    Ebola hemorrhagic fever is one of the most fatal viral diseases worldwide affecting humans and nonhuman primates. Although infections only occur frequently in Central Africa, the virus has the potential to spread globally and is classified as a category A pathogen that could be misused as a bioterrorism agent. As of today there is no vaccine or treatment licensed to counteract Ebola virus infections. DNA, subunit and several viral vector approaches, replicating and non-replicating, have been tested as potential vaccine platforms and their protective efficacy has been evaluated in nonhuman primate models for Ebola virus infections, which closely resemble disease progression in humans. Though these vaccine platforms seem to confer protection through different mechanisms, several of them are efficacious against lethal disease in nonhuman primates attesting that vaccination against Ebola virus infections is feasible. PMID:24575870

  6. Support management in schizophrenia: a systematic review of current literature

    Directory of Open Access Journals (Sweden)

    Pompili M

    2012-12-01

    Full Text Available Maurizio Pompili,1 Franco Montebovi,1 Alberto Forte,1 Mario Palermo,1 Henry Stefani,1 Ludovica Telesforo,1 Sandra Campi,1 Gloria Giordano,1 Lucia Longo,1 Dorian A Lamis,2 Gianluca Serafini,1 Paolo Girardi11Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy; 2Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USABackground: Schizophrenia is generally considered a chronic disorder characterized by psychotic symptoms and relatively stable neurocognitive and interpersonal deficits. Antipsychotic medication has proven beneficial in reducing psychotic symptoms, but is often not enough to treat cognitive or functional impairments. Residual cognitive impairments are barriers to a patient’s full recovery from schizophrenia. Rehabilitation is an alternative and important approach which may be useful, and encompasses a variety of treatments including social skills training and psychoeducational and cognitive behavioral treatments.Objective: To investigate the efficacy of psychosocial treatments in schizophrenia, evaluating its effects in the short and long term, comparing psychosocial treatments with pharmacotherapy, and assessing the effects of treatment and the main indications for use in patients with schizophrenia.Methods: A careful MEDLINE®, Excerpta Medica, PsycLIT®, PsycINFO®, and Index Medicus search was performed to identify all papers and book chapters in English for the period 1970–2012.Results: Findings from the studies included in this qualitative analysis suggest that social skills therapy, cognitive behavioral therapy, family intervention therapy, cognitive remediation therapy, and other nonpharmacological therapeutic strategies may be beneficial for patients with significant functional and symptomatic impairments.Conclusion: Schizophrenic patients treated with nonpharmacological

  7. [Our current approach in the treatment of sigmoid colon volvulus].

    Science.gov (United States)

    Taviloğlu, Korhan; Aydin, Erol; Ertekin, Cemalettin; Güloğlu, Recep; Kurtoğlu, Mehmet

    2002-04-01

    Our aim was to emphasize the role of endoscopic detorsion in the treatment of sigmoid colon volvulus, which we currently apply in the majority of our cases. The data of 37 patients were analyzed in a retrospective manner, during a 86-month period, between May 1994 and July 2001. The patients were classified into three groups. The first group consisted of 9 patients with resection and anastomosis, the second group consisted of 20 patients with Hartmann's procedure, and the third group consisted of 8 patients with endoscopic detorsion. Complications were encountered in 7 patients (19%), and 3 patients (8%) died following treatment. We favor colonic resection following endoscopic treatment. Resection should be preferred, if endoscopic detorsion is not successful or in the presence of a complication.

  8. Current approaches and future directions in the treatment of leprosy

    Directory of Open Access Journals (Sweden)

    Worobec SM

    2012-08-01

    Full Text Available Sophie M WorobecDepartment of Dermatology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USAAbstract: This review surveys current treatments and future treatment trends in leprosy from a clinical perspective. The World Health Organization provides a multidrug treatment regimen that targets the Mycobacterium leprae bacillus which causes leprosy. Several investigational drugs are available for the treatment of drug-resistant M. leprae. Future directions in leprosy treatment will focus on: the molecular signaling mechanism M. leprae uses to avoid triggering an immune response; prospective studies of the side effects experienced during multiple-drug therapy; recognition of relapse rates post-completion of designated treatments; combating multidrug resistance; vaccine development; development of new diagnostic tests; and the implications of the recent discovery of a genetically distinct leprosy-causing bacillus, Mycobacterium lepromatosis.Keywords: epidemiology, leprosy, Hansen’s disease, multidrug resistance, multidrug therapy

  9. Do diabetes-specialty clinics differ in management approach and ...

    African Journals Online (AJOL)

    Objectives: To evaluate management approach and outcome in two endocrinologist-managed clinics using data on treatment adherence, diabetes specific parameters, prescribed medications and self-management practices among ambulatory type 2 diabetes patients. Opinion on cause(s) and perceived fear about ...

  10. Silvicultural approaches to animal damage management in Pacific Northwest forests.

    Science.gov (United States)

    Hugh C. Black

    1992-01-01

    This book examines the potential of Silvicultural approaches for managing animal damage in forests at two levels: management of free-to-grow stands and sitespecific practices that foster prompt and successful regeneration. Introductory chapters provide a historical perspective of animal damage management in the Pacific Northwest, describe the elements of an integrated...

  11. Managing ankle ligament sprains and tears: current opinion

    Directory of Open Access Journals (Sweden)

    McGovern RP

    2016-03-01

    Full Text Available Ryan P McGovern,1 RobRoy L Martin,1,2 1Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, 2Centers for Sports Medicine – University of Pittsburgh, Pittsburgh, PA, USA Abstract: The purpose of this paper is to present a current review of pathoanatomical features, differential diagnosis, objective assessment, intervention, and clinical course associated with managing lateral ankle ligament sprains. Proper diagnosis and identification of affected structures should be obtained through history and objective assessment. From this information, an individualized evidence-based intervention plan can be developed to enable recovery while decreasing the risk of reinjury. An appropriate evaluation is needed not only to determine the correct diagnosis but also to allow for grading and determining the prognosis of the injury in those with an acute lateral ankle sprain. Examination should include an assessment of impairments as well as a measure of activity and participation. Evidence-based interventions for those with an acute lateral ankle sprain should include weight bearing with bracing, manual therapy, progressive therapeutic exercises, and cryotherapy. For those with chronic ankle instability (CAI, interventions should include manual therapy and a comprehensive rehabilitation program. It is essential to understand the normal clinical course for athletes who sustain a lateral ankle sprain as well as risk factors for an acute injury and CAI. Risk factors for both an acute lateral ankle sprain and CAI include not using an external support and not participating in an appropriate exercise program. Incorporating the latest evidence-based rehabilitation techniques provides the best course of treatment for athletes with an acute ankle sprain or CAI. Keywords: reinjury, chronic ankle instability, rehabilitation techniques, diagnosis, intervention, athlete

  12. Medication therapy disease management: Geisinger's approach to population health management.

    Science.gov (United States)

    Jones, Laney K; Greskovic, Gerard; Grassi, Dante M; Graham, Jove; Sun, Haiyan; Gionfriddo, Michael R; Murray, Michael F; Manickam, Kandamurugu; Nathanson, Douglas C; Wright, Eric A; Evans, Michael A

    2017-09-15

    Pharmacists' involvement in a population health initiative focused on chronic disease management is described. Geisinger Health System has cultivated a culture of innovation in population health management, as highlighted by its ambulatory care pharmacy program, the Medication Therapy Disease Management (MTDM) program. Initiated in 1996, the MTDM program leverages pharmacists' pharmacotherapy expertise to optimize care and improve outcomes. MTDM program pharmacists are trained and credentialed to manage over 16 conditions, including atrial fibrillation (AF) and multiple sclerosis (MS). Over a 15-year period, Geisinger Health Plan (GHP)-insured patients with AF whose warfarin therapy was managed by the MTDM program had, on average, 18% fewer emergency department (ED) visits and 18% fewer hospitalizations per year than GHP enrollees with AF who did not receive MTDM services, with 23% lower annual total care costs. Over a 2-year period, GHP-insured patients with MS whose pharmacotherapy was managed by pharmacists averaged 28% fewer annual ED visits than non-pharmacist-managed patients; however, the mean annual total care cost was 21% higher among MTDM clinic patients. The Geisinger MTDM program has evolved over 20 years from a single pharmacist-run anticoagulation clinic into a large program focused on managing the health of an ever-growing population. Initial challenges in integrating pharmacists into the Geisinger patient care framework as clinical experts were overcome by demonstrating the MTDM program's positive impact on patient outcomes. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  13. Integrated, regional approach to risk management of industrial systems

    International Nuclear Information System (INIS)

    Chakraborty, S.

    1992-01-01

    This paper focuses on the following four main issues: (1) necessity for an integrated, regional approach to risk management of industrial systems; (2) principles of risk management; (3) integrated approach and overall methodology; and (4) implementation of risk management strategies on a regional basis. The U.N. Interagency project on risk management for large industrial areas, which is a pioneer type of international initiative for an integrated approach to risk management, is discussed in this context. Another encouraging activity for further development of overall methodologies for risk management is the ongoing project on the risk and safety of technical systems at the Swiss Federal Institute of Technology in Aurich. The concept of integral risk management takes into account multidimensional factors including technical, economic, political, social, and ethical considerations to allow a well-balanced decision-making process

  14. Financial Service of Wealth Management Banking: Balanced Scorecard Approach

    OpenAIRE

    Cheng-Ru Wu; Chin-Tsai Lin; Pei-Hsuan Tsai

    2008-01-01

    Problem Statement: There are four main banking business sectors in Taiwan, involving the areas of consumer, corporate, wealth management, and investment banking. The wealth management banking sector is actively promoted for reaping a risk-free premium. In the proposed model, the dimensions of financial services for wealth management banks have been taken from four perspectives derived from balanced scorecard approach, viz. finance, customer, internal business, learning and growth. Approach: T...

  15. An Investigation on the Current Situation of Management Information Systems Discipline in Turkey

    Directory of Open Access Journals (Sweden)

    Serdar YARLIKAŞ

    2015-09-01

    Full Text Available The purpose of this research is to investigate the development of management information systems field by evaluating the theses conducted at universities in Turkey in the departments of management information systems and science of management information systems. First, this study aims to determine the distribution of the theses in terms of years, subjects and the research methods used. Another purpose of this study was to determine which of the related disciplines of management information systems are used most in the theses. In addition, as a result of the study, the compatibility degree between the theses written and the courses taught in the graduate programs of management information systems were determined. In this research, content analysis method is used. Through this method, each of the theses was evaluated with a 10-question ‘thesis evaluation question set' constructed towards the purpose of the study. Through this evaluation, the current situation of the field was determined. It was observed that the number of doctoral theses associated with the field was less. Using the combination of qualitative and quantitative techniques most in the theses denoted that the interdisciplinary approaches were adopted in the theses associated with management information systems. It was observed that the literature analysis and survey techniques were the most studied research methods in the theses. Besides, statistical techniques were used highly in the theses. As a result of this study, it was concluded that out of the associated disciplines of management information systems, management science, computer science and statistics disciplines were more associated with the investigated theses. When the study results were evaluated as a whole, it was seen that significant progress was made in the discipline of management information systems compared to the early 2000s.

  16. A Communications Approach to Teaching Project Management

    DEFF Research Database (Denmark)

    Kampf, Constance Elizabeth

    2012-01-01

    in the Bachelor of Marketing and Management Communication at Aarhus University is examined and analyzed. The presence of the three Design Science Research Cycles combined with both process and product, highlights the critical role of communication in both understanding Project Management and applying Design...... to both frame the learners’ audience for Project Management Writing assignments, and to provide a concrete organizational context to aid in communication practices such as stakeholder analysis, and the development of a critical internal monitor for quality in the learner’s mind. The relevance of Design...

  17. Current approaches to the treatment of Parkinson’s disease

    Directory of Open Access Journals (Sweden)

    Joseph Jankovic

    2008-09-01

    Full Text Available Joseph Jankovic, L Giselle AguilarParkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of MedicineAbstract: Enormous progress has been made in the treatment of Parkinson’s disease (PD. As a result of advances in experimental therapeutics, many promising therapies for PD are emerging. Levodopa remains the most potent drug for controlling PD symptoms, yet is associated with significant complications such as the “wearing off” effect, levodopa-induced dyskinesias and other motor complications. Catechol-o-methyl-transferase inhibitors, dopamine agonists and nondopaminergic therapy are alternative modalities in the management of PD and may be used concomitantly with levodopa or one another. The neurosurgical treatment, focusing on deep brain stimulation, is reviewed briefly. Although this review has attempted to highlight the most recent advances in the treatment of PD, it is important to note that new treatments are not necessarily better than the established conventional therapy and that the treatment options must be individualized and tailored to the needs of each individual patient.Keywords: Parkinson’s disease, levodopa, medical treatment, pallidotomy, deep brain stimulation

  18. METHODICAL APPROACHES TO THE COST MANAGEMENT OF INDUSTRIAL ENTERPRISES

    Directory of Open Access Journals (Sweden)

    Trunina Iryna

    2018-03-01

    Full Text Available Introduction. The paper deals with the actual issues of managing the costs of industrial enterprises, because in the conditions of an unstable market environment the financial performance depends on the efficiency of the cost management system, competitiveness, financial sustainability and investment attractiveness of any subject of economic activity. Purpose of the article is analys is of approaches to cost management, theoretical substantiation and development of recommendations regarding the formation of strategic cost management. Results. The economic content of cost management in the treatment of different authors and on different approaches: functional, process-oriented and system approaches has been considered. Their essence and features, the direction for operational or strategic management of expenses of the enterprise, ways of spending management in different approaches are determined. It is stated that all considered approaches to cost management of enterprises are aimed at optimal use of resources and ensuring the growth of the efficiency of enterprises. Conclusions. Based on the review of methodological approaches to cost management, recommendations are developed for expanding the implementation of cost management at various levels of enterprise management and the formation of strategic cost management within the framework of strategic management of an enterprise. The strategic cost management is complex category aimed at achieving a rational level of costs in the long run, which allows for the consideration of competitive cost advantages and increase the competitiveness of an industrial enterprise. The implementation of cost reduction strategies should be a constant and important part of the company’s work, while the strategy of cost reduction should be integrated into the overall business strategy of the enterprise.

  19. Management of sexual problems: the approach of mindfulness.

    Science.gov (United States)

    Vilarinho, Sandra

    2017-11-01

    During the last 10 years mindfulness has been progressively integrated into protocols for the management of sexual problems. The purpose of this study is to systematize potential benefits of mindfulness in sexual well-being (considering mind, emotion, and body), and to shortly review current applications and effectiveness of mindfulness-based interventions to the treatment of sexual problems. The majority of evidence available focuses on women's sexual desire and arousal problems, although there are also preliminary findings for the effectiveness of mindfulness-based interventions in enhancing other components of the sexual response. Relationship issues, sexual pain, sexual abuse, and sexual distress have also revealed to benefit from mindfulness-based interventions. The practice of mindfulness is a promising clinical approach with encouraging results for women's sexual problems. Further empirical research with different populations and greater methodological rigour is still needed to clarify the effectiveness of mindfulness as a specific component and the mechanisms contributing to therapeutic change.

  20. Epistaxis in children: approach and management

    African Journals Online (AJOL)

    Chantel

    of epistaxis by the age of 5 years. In the age group 6 -. 10 years the incidence increases to. 56%. Although .... Digital (nose picking). Foreign body/ rhinolith .... Ointment. Advice. Refer to haematologist. Manage accordingly/. Refer to ENT surgeon.

  1. Secure information management using linguistic threshold approach

    CERN Document Server

    Ogiela, Marek R

    2013-01-01

    This book details linguistic threshold schemes for information sharing. It examines the opportunities of using these techniques to create new models of managing strategic information shared within a commercial organisation or a state institution.

  2. Managing Cybersecurity Research and Experimental Development: The REVO Approach

    OpenAIRE

    Dan Craigen; Drew Vandeth; D’Arcy Walsh

    2013-01-01

    We present a systematic approach for managing a research and experimental development cybersecurity program that must be responsive to continuously evolving cybersecurity, and other, operational concerns. The approach will be of interest to research-program managers, academe, corporate leads, government leads, chief information officers, chief technology officers, and social and technology policy analysts. The approach is compatible with international standards and procedures published by the...

  3. Organizational design approaches in management consulting

    NARCIS (Netherlands)

    Visscher, Klaasjan; Visscher-Voerman, Irene

    2010-01-01

    Purpose: The purpose of this paper is to map the variety in organizational design approaches, to clarify their differences, and to find out what constitutes good designing in practice. - Design/methodology/approach: A series of in-depth interviews with experienced, high-reputation consultants is

  4. New Approaches of Supplier Relationship Management

    OpenAIRE

    Cârstea Gheorghe; Pãun Oana; Pãun Sorin

    2014-01-01

    In a strong competitive environment, based on an increased degree of risk and uncertainty, supplier relationship management is considered to be a strategic value-adding process, able to contribute to the success of the organization. Supplier relationship management must also the development of a collaborative environment, based on trust between partners, so that both parties can achieve mutually beneficial objectives through joint effort and time investment.

  5. Nursing approaches in the postoperative pain management

    OpenAIRE

    Sevilay Yüceer

    2011-01-01

    Patients frequently experience moderate to severe pain inthe postoperative period. Although the pain managementis an integral and important part of the nursing care, studiessuggest that, nursing management of postoperativepain remains inadequate.Postoperative care nurses are responsible to assess thepatient’s pain, teach the patient strategies to deal with thepain, apply the analgesic treatment plan, monitor the resultsof treatment, educate the patient and the family onpain management and doc...

  6. Space Station overall management approach for operations

    Science.gov (United States)

    Paules, G.

    1986-01-01

    An Operations Management Concept developed by NASA for its Space Station Program is discussed. The operational goals, themes, and design principles established during program development are summarized. The major operations functions are described, including: space systems operations, user support operations, prelaunch/postlanding operations, logistics support operations, market research, and cost/financial management. Strategic, tactical, and execution levels of operational decision-making are defined.

  7. Current approaches to gastric cancer in Peru and Mexico.

    Science.gov (United States)

    Santos, Erlan

    2017-01-01

    In Peru, the incidence of gastric cancer is reported to be around 15.8 per 100,000 inhabitants and it is the second most common oncological disease in men and the third one in women. Additionally, a high mortality index was reported, especially among poor people. To address this issue, in 2008, Peru initiated several insurance treatment plans of oncological diseases with promising results. In Mexico, there is a high predominance of gastric cancer in male gender compared to female gender, even reaching a 2/1 ratio, and the detection rate of early gastric cancer is low (10% to 20%) which results in a mainly palliative treatment with an overall survival rate in 5 years about 10% to 15% only. In Peru, the average age at diagnosis is around 62.96±14.75 years old and the most frequent symptoms includes abdominal pain, indigestion, loss of appetite, weight loss and gastrointestinal bleeding, while in Mexico, some studies reported an average age at diagnosis around 60.3±4.1 years old (range, 23-78 years old) and the most frequent symptoms were postprandial fullness (74.4%), abdominal pain (37.2%), weight loss (18.6%), and melena (4.6%). The anemia rate was 65.1% with a mean Hb level of 6.14 g/dL. In Peru, the most common gastric cancer type is the intestinal-type adenocarcinoma (around 34%), followed by the diffuse-type adenocarcinoma (18.7%), whilst among Mexicans, the diffuse-type was reported in 55.2% of cases, the intestinal-type was reported in 28.2% and the undifferentiated-type corresponded to 6%. In both, Peru and Mexico, 90% of the associated factors includes tabaquismo, diets rich in salt, smoked foods, and a sedentary lifestyle. Family inheritance and advanced age and pharmacological-resistant Helicobacter pylori infection are also important. Poverty has been heavily associated with a higher incidence of gastric cancer. The management of gastric cancer patients in Peru is carried out by general surgeons or general surgical oncologists. In recent years, efforts

  8. Current approach to the treatment of chronic myeloid leukaemia.

    Science.gov (United States)

    Pasic, Ivan; Lipton, Jeffrey H

    2017-04-01

    Of all the cancers, chronic myeloid leukaemia (CML) has witnessed the most rapid evolution of the therapeutic milieu in recent decades. The introduction of tyrosine kinase inhibitors (TKIs) as a therapeutic option has profoundly changed patient experience and outcome. The availability of multiple new highly effective therapies has increasingly underscored the importance of a good understanding of the underlying pathophysiological basis in CML, as well as patient-specific factors in choosing the right treatment for every individual. The treatment of CML has migrated in many jurisdictions from the office of a highly specialized malignant hematologist to the general hematologist or even a general practitioner. The goal of this review is to offer an overview of the modern approach to the treatment of CML, with an emphasis on chronic phase (CP) CML, including both TKI-based therapies such as imatinib, dasatinib, nilotinib, bosutinib and ponatinib, and non-TKI medications, such as omacetaxine. We discuss evidence behind each drug, most common and material adverse reactions and outline how this information can be used in selecting the right drug for the right patient. We also discuss evidence as it relates to other therapies, including stem cell transplant (SCT), and patients in accelerated (AP) and blastic phase (BP). Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. New approaches to business cycle theory in current economic science

    Directory of Open Access Journals (Sweden)

    Monica DOBRESCU

    2012-07-01

    Full Text Available In modern economies, current research generally acknowledges that the central issues in macroeconomics are essentially the same as those identified by Keynes in the General Theory of Employment, Interest and Money. One way or the other, economists are trying to address the same macroeconomic issues that they did seven decades ago: How can we account for the different growth rates and various fluctuations observed in national economies? Which are the economic policies most suitable to solve the issues of growth and cyclic behavior? Both the new classicals and the new Keynesians have made considerable progress within their research paradigms: to explain economic fluctuations, the new classicals focus on technological perturbations, the intertemporal substitution of leisure and real business cycles; on the other hand, the new Keynesians speak in terms of monopolistic competition, menu costs or efficiency wages. On the whole, the new classicals believe that the business cycle can best be understood within the market-clearing model, whereas the new keynesians believe that business fluctuations are due to certain market failures of various sorts.The present paper focuses on the main directions of research of the new classical school on the business cycle, given that the theoretical progress in this field has been significant and relevant for economic policy during the past four decades.

  10. Treatment of cutaneous melanoma: current approaches and future prospects

    International Nuclear Information System (INIS)

    Algazi, Alain P; Soon, Christopher W; Daud, Adil I

    2010-01-01

    Melanoma is the most aggressive and deadly type of skin cancer. Surgical resection with or without lymph node sampling is the standard of care for primary cutaneous melanoma. Adjuvant therapy decisions may be informed by careful consideration of prognostic factors. High-dose adjuvant interferon alpha-2b increases disease-free survival and may modestly improve overall survival. Less toxic alternatives for adjuvant therapy are currently under study. External beam radiation therapy is an option for nodal beds where the risk of local recurrence is very high. In-transit melanoma metastases may be treated locally with surgery, immunotherapy, radiation, or heated limb perfusion. For metastatic melanoma, the options include chemotherapy or immunotherapy; targeted anti-BRAF and anti-KIT therapy is under active investigation. Standard chemotherapy yields objective tumor responses in approximately 10%–20% of patients, and sustained remissions are uncommon. Immunotherapy with high-dose interleukin-2 yields objective tumor responses in a minority of patients; however, some of these responses may be durable. Identification of activating mutations of BRAF, NRAS, c-KIT, and GNAQ in distinct clinical subtypes of melanoma suggest that these are molecularly distinct. Emerging data from clinical trials suggest that substantial improvements in the standard of care for melanoma may be possible

  11. The aetiology ofautism spectrum disorders. An overview of current approaches

    Directory of Open Access Journals (Sweden)

    Paulina Gołaska

    2013-03-01

    Full Text Available Despite the great popularity of autism among researchers, its main cause still remains unknown. However, there are many theories which describe the mechanisms of this disorder. On the other hand, one who tries to integrate them seems to be helpless according to their contradictory and – in most cases – hypothetical status. In a context of this inac‑ curacy, focusing only on one of the concepts would be probably very disadvantageous. As many researchers suggest, the etiology of autism is complex and it is the interaction of multiple factors which implies the disorder appears. It seems that the nature of autism is equifinal and heterogeneous. Thus, the aim of this article is to present a review of current biological theories of autism etiology and to indicate the environmental as well as innate risk factors which may disturb the natural pathway of child development: prenatal (which increase the probability of autism emergence as early as in the first or second year of life or perinatal ones (low birth weight, hypoxia, age of the mother, her educational sta‑ tus. The foetal testosterone theory of autism and its general consequences for the child development will be described also. Finally, the neurological, neurochemical and neuroanatomical dysfunctions in autism will be presented.

  12. Acute pancreatitis: current perspectives on diagnosis and management

    Science.gov (United States)

    Shah, Adarsh P; Mourad, Moustafa M; Bramhall, Simon R

    2018-01-01

    The last two decades have seen the emergence of significant evidence that has altered certain aspects of the management of acute pancreatitis. While most cases of acute pancreatitis are mild, the challenge remains in managing the severe cases and the complications associated with acute pancreatitis. Gallstones are still the most common cause with epidemiological trends indicating a rising incidence. The surgical management of acute gallstone pancreatitis has evolved. In this article, we revisit and review the methods in diagnosing acute pancreatitis. We present the evidence for the supportive management of the condition, and then discuss the management of acute gallstone pancreatitis. Based on the evidence, our local institutional pathways, and clinical experience, we have produced an outline to guide clinicians in the management of acute gallstone pancreatitis. PMID:29563826

  13. Radioactive waste management centers: an approach

    International Nuclear Information System (INIS)

    Lotts, A.L.

    1980-01-01

    Radioactive waste management centers would satisfy the need for a cost-effective, sound management system for nuclear wastes by the industry and would provide a well integrated solution which could be understood by the public. The future demands for nuclear waste processing and disposal by industry and institutions outside the United States Government are such that a number of such facilities are required between now and the year 2000. Waste management centers can be organized around two general needs in the commercial sector: (1) the need for management of low-level waste generated by nuclear power plants, the once-through nuclear fuel cycle production facilities, from hospitals, and other institutions; and (2) more comprehensive centers handling all categories of nuclear wastes that would be generated by a nuclear fuel recycle industry. The basic technology for radioactive waste management will be available by the time such facilities can be deployed. This paper discusses the technical, economic, and social aspects of organizing radioactive waste managment centers and presents a strategy for stimulating their development

  14. Energy management - The delayed flap approach

    Science.gov (United States)

    Bull, J. S.

    1976-01-01

    Flight test evaluation of a Delayed Flap approach procedure intended to provide reductions in noise and fuel consumption is underway using the NASA CV-990 test aircraft. Approach is initiated at a high airspeed (240 kt) and in a drag configuration that allows for low thrust. The aircraft is flown along the conventional ILS glide slope. A Fast/Slow message display signals the pilot when to extend approach flaps, landing gear, and land flaps. Implementation of the procedure in commercial service may require the addition of a DME navigation aid co-located with the ILS glide slope transmitter. The Delayed Flap approach saves 250 lb of fuel over the Reduced Flap approach, with a 95 EPNdB noise contour only 43% as large.

  15. A VIEWPOINT ON THE CURRENT STATE OF KNOWLEDGE MANAGEMENT INSTRUMENTS

    Directory of Open Access Journals (Sweden)

    ANDREEA PAULA DUMITRU

    2011-04-01

    Full Text Available Knowledge management is seeking solutions to harmonize the objectives of organizations of the human group, which need to rationalize, to provide policy makers and to implement. This article aims to provide readers with an introduction to knowledge management basic definitions, theories and concepts such as types of knowledge, the differences between data, information and knowledge, etc, are given. But, why we need a knowledge management ? This article justified the need for companies to focus management efforts on their intangible elements and provides the five enabling conditions for knowledge creation.

  16. Current Situation of Highway Daily Maintenance Management in Beijing

    Directory of Open Access Journals (Sweden)

    Pan Feng Ming

    2016-01-01

    Full Text Available Combined with the industry property, characteristics and management needs of highway maintenance project in Beijing, through investigation and research of the highway daily maintenance management, the present situation of highway repair and maintenance is expounded from the aspects such as the determination of maintenance funds and plan, maintenance management mode, and so on. Then in order to explore the new mechanisms for market management of highway maintenance, the advantages and disadvantages of highway maintenance and minor repairment of Beijing are analyzed.

  17. A systems approach to risk management through leading safety indicators

    International Nuclear Information System (INIS)

    Leveson, Nancy

    2015-01-01

    The goal of leading indicators for safety is to identify the potential for an accident before it occurs. Past efforts have focused on identifying general leading indicators, such as maintenance backlog, that apply widely in an industry or even across industries. Other recommendations produce more system-specific leading indicators, but start from system hazard analysis and thus are limited by the causes considered by the traditional hazard analysis techniques. Most rely on quantitative metrics, often based on probabilistic risk assessments. This paper describes a new and different approach to identifying system-specific leading indicators and provides guidance in designing a risk management structure to generate, monitor and use the results. The approach is based on the STAMP (System-Theoretic Accident Model and Processes) model of accident causation and tools that have been designed to build on that model. STAMP extends current accident causality to include more complex causes than simply component failures and chains of failure events or deviations from operational expectations. It incorporates basic principles of systems thinking and is based on systems theory rather than traditional reliability theory. - Highlights: • Much effort has gone into developing leading indicators with only limited success. • A systems-theoretic, assumption-based approach may be more successful. • Leading indicators are warning signals of an assumption’s changing vulnerability. • Heuristic biases can be controlled by using plausibility rather than likelihood

  18. Treatment of Thrombotic Antiphospholipid Syndrome: The Rationale of Current Management—An Insight into Future Approaches

    Science.gov (United States)

    Ubiali, Tania; Meroni, Pier Luigi

    2015-01-01

    Vascular thrombosis and pregnancy morbidity represent the clinical manifestations of antiphospholipid syndrome (APS), which is serologically characterized by the persistent positivity of antiphospholipid antibodies (aPL). Antiplatelet and anticoagulant agents currently provide the mainstay of APS treatment. However, the debate is still open: controversies involve the intensity and the duration of anticoagulation and the treatment of stroke and refractory cases. Unfortunately, the literature cannot provide definite answers to these controversial issues as it is flawed by many limitations, mainly due to the recruitment of patients not fulfilling laboratory and clinical criteria for APS. The recommended therapeutic management of different aPL-related clinical manifestations is hereby presented, with a critical appraisal of the evidence supporting such approaches. Cutting edge therapeutic strategies are also discussed, presenting the pioneer reports about the efficacy of novel pharmacological agents in APS. Thanks to a better understanding of aPL pathogenic mechanisms, new therapeutic targets will soon be explored. Much work is still to be done to unravel the most controversial issues about APS management: future studies are warranted to define the optimal management according to aPL risk profile and to assess the impact of a strict control of cardiovascular risk factors on disease control. PMID:26075289

  19. Vendor Managed Inventory: A new approach to supply chain management

    OpenAIRE

    Gandhi, Ujval

    2003-01-01

    The Global Supply Chain Forum (Stanford Global Supply Chain Forum Web Resource, http://www.stanford.edu/groups/scforum) defines supply chain management (SCM) as “Supply chain management is the integration of key business processes from end user through original suppliers that provides products, services and information that add value for customer and other stakeholders.” The rapid development of the Internet has dramatically changed the traditional definitions of manufacturer, suppliers and c...

  20. Methodical approach to financial stimulation of logistics managers

    OpenAIRE

    Melnykova Kateryna V.

    2014-01-01

    The article offers a methodical approach to financial stimulation of logistics managers, which allows calculation of the incentive amount with consideration of profit obtained from introduction of optimisation logistics solutions. The author generalises measures, which would allow increase of stimulation of labour of logistics managers by the enterprise top managers. The article marks out motivation factors, which exert influence upon relation of logistics managers to execution of optimisatio...

  1. Cough in Children: Current Approaches to the Treatment

    Directory of Open Access Journals (Sweden)

    O.O. Rechkina

    2016-03-01

    Full Text Available Introduction. Cough is one of the most common symptoms in the practice of doctors of various specialties, including pediatricians. Cough treatment should be started with the identification of its cause and correct diagnosis. Most often, cough in children is due to the increased viscosity of bronchial secretions, i.e. violation of sputum transport in the bronchial tree, and insufficient activity of ciliated epithelium. The main objective of the treatment of productive cough is dilution of sputum, bronchial secretion and excretion, thus necessitating the administration of mucolytics. Currently, one of the most famous mucolytics is acetylcysteine, cysteine amino acid product, such as ACC®. However, today the question of ACC® (acetylcysteine application in infants and young children is still debatable. This article presents a study whose objective was to evaluate the therapeutic efficacy and tolerability of ACC® (20 mg/ml solution in the treatment of bronchopulmonary diseases in children aged 2 to 6 years. Materials and methods. The study involved 60 children with acute tracheitis, simple bronchitis, acute obstructive bronchitis, recurrent bronchitis in the acute phase, community-acquired pneumonia, asthma exacerbation, cystic fibrosis. Patients of the main groups (n = 40 received ACC® (20 mg/ml solution at the age-specific dosage 3 times a day in combined treatment. Therapy of patients in the control group (n = 20 was conducted without ACC®. Results. During follow-up, patients who received ACC® had significant positive changes in the nature of cough, sputum viscosity and its amount as opposed to a comparison group of patients. Complete disappearance of cough was achieved on day 5–8 from the beginning of treatment, while in the control group patients, this time was longer. The evaluation of the effectiveness of the study drug showed that very good efficacy was achieved in 75 % of patients and good — in 20 %, and among patients who

  2. THE DEVELOPMENT OF THE PROCESS-BASED APPROACH TO MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Urij V. Lyandau

    2013-01-01

    Full Text Available This article considers the timeline of the approaches to management of the industrial processes and organizations in general.The Adam Smith’s idea of specialization, the Henry Ford’s conveyor and Frederick Taylor’s scientific approach created functional corporations, in which specialized departments consisted of specialized workers. Such organizational chart was optimized for every department’s tasks, which are necessary to perform.During the life cycle evolution of industrial and then informational ages external conditions of production has changed. In consequence, there was born the necessity to change key factors of the management paradigm. These changes are the transfer from the functional management to the process-based approach. The functional management was the basic type of management in many organizations during the 20th century. Only in the end of 1990 companies started to integrate the process-based approach. This conversion was born cause of special conditions that the informational age created.

  3. Managing corporate capabilities:theory and industry approaches.

    Energy Technology Data Exchange (ETDEWEB)

    Slavin, Adam M.

    2007-02-01

    This study characterizes theoretical and industry approaches to organizational capabilities management and ascertains whether there is a distinct ''best practice'' in this regard. We consider both physical capabilities, such as technical disciplines and infrastructure, and non-physical capabilities such as corporate culture and organizational procedures. We examine Resource-Based Theory (RBT), which is the predominant organizational management theory focused on capabilities. RBT seeks to explain the effect of capabilities on competitiveness, and thus provide a basis for investment/divestment decisions. We then analyze industry approaches described to us in interviews with representatives from Goodyear, 3M, Intel, Ford, NASA, Lockheed Martin, and Boeing. We found diversity amongst the industry capability management approaches. Although all organizations manage capabilities and consider them to some degree in their strategies, no two approaches that we observed were identical. Furthermore, we observed that theory is not a strong driver in this regard. No organization used the term ''Resource-Based Theory'', nor did any organization mention any other guiding theory or practice from the organizational management literature when explaining their capabilities management approaches. As such, we concluded that there is no single best practice for capabilities management. Nevertheless, we believe that RBT and the diverse industry experiences described herein can provide useful insights to support development of capabilities management approaches.

  4. Current Ketamine Practice: Results of the 2016 American Society of Pain Management Nursing Survey on Ketamine.

    Science.gov (United States)

    Klaess, Cynthia C; Jungquist, Carla R

    2018-06-01

    Ketamine is increasingly utilized for a variety of pain management challenges. Audience comments from a ketamine presentation at the 2015 American Society of Pain Management Nursing (ASPMN) Conference reflected wide variation in ketamine practices as well as barriers to use. The goal was to gain a greater understanding of ASPMN member practice patterns and barriers related to ketamine as adjunctive therapy for pain management. A questionnaire survey design was used. Respondents represented 35 states and 2 countries. The participants were 146 respondents from ASPMN membership (1,485 members). The survey was distributed by ASPMN on SurveyMonkey. Practice setting and ketamine administration practices were assessed with areas for comments. Results were reviewed using frequencies to describe responses and formatted into tables. Comments were individually reviewed and grouped into common themes. Administration of ketamine as an analgesic was reported by 63% of respondents. Continuous intravenous ketamine infusions were the most common route of administration (65%); however, wide variability in dosing and length of therapy was reported. A wide variety of practices and challenges related to ketamine utilization were noted. Numerous studies have indicated the analgesic benefits of ketamine in pain management. The lack of practice standardization has created challenges to its consistent use and outcome measurement. Additionally, the off-label use of ketamine for pain management creates its own unique challenges. However, given the current national climate with intense focus on pain management, interdisciplinary practitioners have an ideal opportunity to evaluate ketamine's use in a comprehensive approach to pain management. Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  5. Recapturing time: a practical approach to time management for physicians.

    Science.gov (United States)

    Gordon, Craig E; Borkan, Steven C

    2014-05-01

    Increasing pressures on physicians demand effective time management and jeopardise professional satisfaction. Effective time management potentially increases productivity, promotes advancement, limits burnout and improves both professional and personal satisfaction. However, strategies for improving time management are lacking in the current medical literature. Adapting time management techniques from the medical and non-medical literature may improve physician time management habits. These techniques can be divided into four categories: (1) setting short and long-term goals; (2) setting priorities among competing responsibilities; (3) planning and organising activities; and (4) minimising 'time wasters'. Efforts to improve time management can increase physician productivity and enhance career satisfaction.

  6. Management of GHG, a successful business approach

    International Nuclear Information System (INIS)

    Gagnier, D.

    2003-01-01

    This PowerPoint presentation provided a brief overview of Alcan, an aluminium producer with operations in Quebec and in several other markets and countries. Alcan's strategy regarding climate change involves both short term and long term objectives and a public commitment to reducing the emissions of greenhouse gases (GHG). Alcan has implemented a company-wide GHG management program called TARGET, which involves measuring, monitoring and better management of emissions inventory. The TARGET program includes: measurement of data, quality assurance and reports; communications and public relations; improved processes; risk management systems; development of emissions trading systems; and support of functional groups. Alcan has also implemented voluntary GHG emissions reductions measures, encourages broad participation of GHG emissions reduction initiatives, and promotes economic growth and long term durability. figs

  7. Disease Management Evaluation: A Comprehensive Review of Current State of the Art.

    Science.gov (United States)

    Conklin, Annalijn; Nolte, Ellen

    2011-01-01

    Many countries across Europe and elsewhere have been experimenting with various structured approaches to manage patients with chronic illness as a way to improve quality of care, reduce costs and lead to better population health outcomes in the long run. Despite a body of studies of disease management interventions, uncertainty about the effects of these remains not least because current guidance on evaluation methods and metrics require further development to enhance scientific rigour while also being practical in routine operations. This article provides details from a report that reviews the academic and grey literature to help advance the task of improving the science of assessing disease management initiatives in Europe. Challenges identified are methodological, analytical and conceptual in nature, with a key issue being the establishment of the counterfactual. An array of sophisticated statistical techniques and analytical frameworks can assist in the construction of a sound comparison strategy when a randomised controlled trial is not possible. Issues to consider include: a clear framework of the mechanisms of action and expected effects of disease management; an understanding of the characteristics of disease management (scope, content, dose, context), and of the intervention and target populations (disease type, severity, case-mix); a period of observation over multiple years; and a logical link between performance measures and the intervention's aims and underlying theory of behaviour change.

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

    Science.gov (United States)

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

    2015-10-01

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

  9. Comprehensive management of pressure ulcers in spinal cord injury: Current concepts and future trends

    Science.gov (United States)

    Kruger, Erwin A.; Pires, Marilyn; Ngann, Yvette; Sterling, Michelle; Rubayi, Salah

    2013-01-01

    Pressure ulcers in spinal cord injury represent a challenging problem for patients, their caregivers, and their physicians. They often lead to recurrent hospitalizations, multiple surgeries, and potentially devastating complications. They present a significant cost to the healthcare system, they require a multidisciplinary team approach to manage well, and outcomes directly depend on patients' education, prevention, and compliance with conservative and surgical protocols. With so many factors involved in the successful treatment of pressure ulcers, an update on their comprehensive management in spinal cord injury is warranted. Current concepts of local wound care, surgical options, as well as future trends from the latest wound healing research are reviewed to aid medical professionals in treating patients with this difficult problem. PMID:24090179

  10. Active current management for four-rail railguns

    International Nuclear Information System (INIS)

    Beno, J.H.; Weldon, W.F.

    1991-01-01

    In this paper a system of auxiliary conductors designed to reduce current density peaks in railgun rails for four-rail, round-bore railguns is described. The effects on rail current density and projectile force are discussed. Railgun cross-sectional designs are presented for round-bore, four-rail railguns which operate at lower peak current densities and develop greater projectile forces than conventional two-rail, round-bore railguns

  11. DISASTER MANAGEMENT CYCLE – A THEORETICAL APPROACH

    Directory of Open Access Journals (Sweden)

    Himayatullah KHAN

    2008-01-01

    Full Text Available The present study explains the various concepts used in disastermanagement. The concepts explained include: Disaster, Hazard,Vulnerability, Capacity, Risk and Disaster Management Cycle. In addition tothe terminologies, the study also seeks to explain various types of disasters.

  12. Recognizing and Managing Multiple Organizational Approaches.

    Science.gov (United States)

    Giesecke, Joan

    1994-01-01

    Discusses a framework for identifying organizational processes or models within the context of the organization's decision-making processes. Five organizational models appropriate to academic libraries are presented: rational, political bargaining, garbage can, bureaucratic, and participatory. Guidelines for managers include how to distinguish…

  13. A Biobehavioral Approach to Managing Childhood Asthma.

    Science.gov (United States)

    Kohen, Daniel P.

    1987-01-01

    Describes childhood asthma and a program which teaches relaxation and mental imagery (RMI) exercises to children and adolescents as an adjunct in the management of asthma. Clinical experience indicates children who learn RMI rate their asthma as significantly reduced in severity, miss fewer days of school, and make fewer visits to emergency rooms.…

  14. A legal approach to radioactive waste management

    International Nuclear Information System (INIS)

    Derche, B.; Rocamora, P.; Salelles, A.

    1983-01-01

    The authors of this paper review the major legal problems raised by radioactive waste management. They stress the complexity of such problems by posing three main queries: surveillance or no surveillance; liability or no liability and finally internationalisation or national jurisdiction. This analysis seeks to provide food for thought on each point rather than a solution to the questions reviewed. (NEA) [fr

  15. An Innovative Approach to Discipline and Management.

    Science.gov (United States)

    Yenchko, Anne; DeBeal, Marshall Kirk

    The Effective Classroom Management and Discipline Strategies Graduate Program for Educators is organized around a series of core modules designed for use in inservice teacher education. The basic skills learned in these series of modules are communication (feedback, nonverbal, listening, self disclosure, problem solving, and conflict resolution),…

  16. Review: Current trends in coral transplantation – an approach to preserve biodiversity

    Directory of Open Access Journals (Sweden)

    ABDELNABY ORABI

    2013-04-01

    Full Text Available Ammar MSA,El-Gammal F, Nassar M, Belal A, Farag W, El-Mesiry G, El-Haddad K, Orabi A, Abdelreheem A, Shaaban A. 2013. Review: Current trends in coral transplantation – an approach to preserve biodiversity. Biodiversitas 14: 43-53. The increasing rates of coral mortality associated with the rise in stress factors and the lack of adequate recovery worldwide have urged recent calls for actions by the scientific, conservation, and reef management communities. This work reviews the current trends in coral transplantation. Transplantation of coral colonies or fragments, whether from aqua-, mariculture or harvesting from a healthy colony, has been the most frequently recommended action for increasing coral abundance on damaged or degraded reefs and for conserving listed or “at-risk” species. Phytoplanktons are important for providing transplanted corals with complex organic compounds through photosynthesis. Artificial surfaces like concrete blocks, wrecks or other purpose-designed structures can be introduced for larval settlement. New surfaces can also be created through electrolysis. Molecular biological tools can be used to select sites for rehabilitation by asexual recruits. Surface chemistry and possible inputs of toxic leachate from artificial substrates are considered as important factors affecting natural recruitment. Transplants should be carefully maintained , revisited and reattached at least weekly in the first month and at least fortnightly in the next three months. Studies on survivorship and the reproductive ability of transplanted coral fragments are important for coral reef restoration. A coral nursery may be considered as a pool for local species that supplies reef-managers with unlimited coral colonies for sustainable management. Transplanting corals for making artificial reefs can be useful for increasing biodiversity, providing tourist diving, fishing and surfing; creating new artisanal and commercial fishing opportunities

  17. Current Trends in the Management of Blunt Solid Organ Injuries.

    Science.gov (United States)

    Taviloglu, Korhan; Yanar, Hakan

    2009-04-01

    The management of patients with solid organ injuries has changed since the introduction of technically advanced imaging tools, such as ultrasonography and multiple scan computerized tomography, interventional radiological techniques and modern intensive care units. In spite of this development in the management of these patients, major solid organ traumas can still be challenging. There has been great improvement in the non-operative management (NOM) of intra-abdominal solid organ injury in recent decades. In most cases treatment of injuries has shifted from early surgical treatment to NOM.

  18. System approach for the management of radioactive waste

    International Nuclear Information System (INIS)

    Fearnley, I.G.

    1997-01-01

    An integrated approach to Waste Management and Decommissioning, which takes account of the lifetime implications (safety, dose uptake, discharges and cost) is an important strategic process in forward planning. This type of approach is particularly relevant when making decisions concerning waste minimisation and segregation, packaging and surface storage of high and intermediate level waste in advance of the existence of disposal facilities. Such a systematic approach forms an integral part of a process which enable progress to be assessed and plans to be updated in response to changing demands upon business operations and can continually be applied to waste management policy and to optimise the detailed waste management plans. (author)

  19. A system approach for the management of radioactive waste

    Energy Technology Data Exchange (ETDEWEB)

    Fearnley, I.G. [British Nuclear Fuels plc, Warrington, Cheshire (United Kingdom)

    1995-12-31

    An integrated approach to Waste Management and Decommissioning, which takes account of the lifetime implications (safety, dose uptake, discharges and cost) is an important strategic process in forward planning. This type of approach is particularly relevant when making decisions concerning waste minimization and segregation, packaging and surface storage of high and intermediate level waste in advance of the existence of disposal facilities. Such a systematic approach forms an integral part of a process which enables progress to be assessed and plans to be updated in response to changing demands upon business operations and can continually be applied to waste management policy and to optimise the detailed waste management plans. (author)

  20. A system approach for the management of radioactive waste

    International Nuclear Information System (INIS)

    Fearnley, I.G.

    1995-01-01

    An integrated approach to Waste Management and Decommissioning, which takes account of the lifetime implications (safety, dose uptake, discharges and cost) is an important strategic process in forward planning. This type of approach is particularly relevant when making decisions concerning waste minimization and segregation, packaging and surface storage of high and intermediate level waste in advance of the existence of disposal facilities. Such a systematic approach forms an integral part of a process which enables progress to be assessed and plans to be updated in response to changing demands upon business operations and can continually be applied to waste management policy and to optimise the detailed waste management plans. (author)

  1. Challenges of Environmental Management Accounting –- Current Accounting Practices

    Directory of Open Access Journals (Sweden)

    Prof. Ph.D. Gheorghe Popescu

    2008-12-01

    Full Text Available The goal of our paper is to reduce some of the international confusion generated on such animportant topic by providing a general framework and set of definitions for Environmental ManagementAccounting (EMA.Environmental Management Accounting is a relatively new tool in environmental management definedas the identification, collection, estimation, analysis, internal reporting, and use of materials and energyflow information, environmental cost information, and other cost information for both conventionaland environmental decision-making within an organization.Due to their special role, accountants, since they are the ones with access to the important monetarydata and information systems needed for management accounting activities, must to improve both theirability to verify the quality of such information and the skills to use that information for decision making.

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

    OpenAIRE

    Koutsoukis, Nikitas-Spiros

    2010-01-01

    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...

  3. COMPARATIVE STUDY BETWEEN TRADITIONAL AND ENTERPRISE RISK MANAGEMENT -A THEORETICAL APPROACH

    Directory of Open Access Journals (Sweden)

    Cican Simona-Iulia

    2014-07-01

    Full Text Available The complexity, volatility and unpredictability of the current economic environment are a daily reminder that organizations face many risks. The traditional approach, according to which risk is a necessary evil which must be removed, is no longer sufficient and that is why companies nowadays are forced to spend significant resources to manage risks. Risk transparency is what one looks for; therefore, identification and management of risks within an organization become increasingly necessary for success and longevity. Risk approach has a major role in a company’s ability to avoid, reduce and turn risks into opportunities. Enterprise risk management is a new concept that revolutionizes the traditional approach and summarizes risk management in an integrated, comprehensive and strategic system. Studies use several synonyms for enterprise risk management such as integrated risk management, holistic risk management, global risk management and strategic risk management. Enterprise risk management implements at the end of the last century a new way to deal with risks: the holistic approach. This risks approach – i.e. interaction of several types of risks which become increasingly threatening and varied and may cause more damage than individual risk – brings forward the need of risk management and raises issues at the highest level of company management. For a proper view on company risks, each individual risk and the possibility of risk interaction must be understood. This is essential to establish a risk classification according to their impact on the company. Traditional approach on risk management, as a management function, is limited to only threats and losses, so relatively few organizations see risks as potential earning-generated opportunities. However, risk management process is not radically changed. Enterprise risk management is an improved version of the traditional risk management, created by expanding its scope. The new risk

  4. A Systematic Knowledge Management Approach Using Object-Oriented Theory in Customer Complaint Management

    Directory of Open Access Journals (Sweden)

    Wusheng Zhang

    2010-12-01

    Full Text Available Research into the effectiveness of customer complaint management has attracted researchers, yet there has been little discussion on customer complaint management in the context of systematic knowledge management approach particularly in the domain of hotel industry. This paper aims to address such gap through the application of object-oriented theory for which the notation of unified modelling language has been adopted for the representation of the concepts, objects, relationships and vocabularies in the domain. The paper used data from forty seven hotel management staff and academics in hospitalitymanagement to investigate lessons learned and best practices in customer complaint management and knowledge management. By providing insights into the potential of a knowledge management approach using object oriented theory, this study advances our understanding on how a knowledge management approach can systematically support the management of hotel customer complaints.

  5. Chronic dry cough: Diagnostic and management approaches

    Directory of Open Access Journals (Sweden)

    Ashok Mahashur

    2015-01-01

    Full Text Available Cough is the most common symptom for which medical treatment is sought in the outpatient setting. Chronic dry cough poses a great diagnostic and management challenge due to myriad etiologies. Chronic cough has been commonly considered to be caused by gastroesophageal reflux, post-nasal drip or asthma. However, recent evidences suggest that many patients with these conditions do not have cough, and in those with cough, the response to specific treatments is unpredictable at best. This raises questions about the concept of a triad of treatable causes for chronic cough. This article discusses the mechanism and etiology of cough, along with recent advances in the field of cough, highlighting some of the diagnostic and management challenges.

  6. Lean management beyond manufacturing a holistic approach

    CERN Document Server

    Bhasin, Sanjay

    2015-01-01

    Exploring Lean manufacturing in a holistic manner, this book helps organizations to implement Lean principles successfully by offering theoretical, empirical and practical knowledge. It empirically demonstrates how a successful Lean initiative can improve organizational efficiency, and incorporates valuable primary research to substantiate findings. It argues that Lean principles need to be applied throughout the value chain in order to be successful , and suggests that these tools need to be aligned with culture and change management. Chapters examine issues including Lean cultures, impediments to Lean, Lean and performance measurement, and the impact of Lean. Viewing Lean as a never-ending journey, this book provides a valuable resource to practising Lean managers, and specialist researchers and students, and also offers an important reference for organizations embarking on their Lean voyage.

  7. A test management approach for structured testing

    NARCIS (Netherlands)

    Veenendaal, van E.P.W.M.; Pol, M.; Veenendaal, van E.P.W.M.; McMullan, J.

    1997-01-01

    Despite encouraging results with various quality improvement approaches, the IT industry is still far from achieving zero defect software. Testing will remain an important activity within software development and maintenance, often taking more than 30 - 40% of the total budget. Both the increasing

  8. ORION - A Global Approach to Waste Management.

    Science.gov (United States)

    Heinzelmann, Elsbeth

    2015-01-01

    In the ORION project supported by the European Commission, 20 partners work together to manage organic waste from agro-food industries. The goal is to develop a small, automatic and user-friendly digestion machine to facilitate the domestic on-site treatment of a wide range of organic waste from around 100 and up to 5000 tonnes per year at low cost and with limited maintenance. Simon Crelier at the HES-SO Valais/Wallis is part of the network.

  9. Approaches to quality management in hotel industry

    OpenAIRE

    Kateřina Ryglová; Ida Vajčnerová; Jakub Šácha

    2013-01-01

    The aim of the paper is to present possibilities and specifics of quality management in hotel services with the focus on the Servqual model. Servqual works on the definition of five dimensions of service quality: tangibles, reliability, responsiveness, assurance and empathy. Demonstrating the practical application of Servqual in selected hotels in the Czech Republic is also a part of the paper. Input data have been gained by force of a primary field-research with the help of a quantitative re...

  10. An approach for management of geometry data

    Science.gov (United States)

    Dube, R. P.; Herron, G. J.; Schweitzer, J. E.; Warkentine, E. R.

    1980-01-01

    The strategies for managing Integrated Programs for Aerospace Design (IPAD) computer-based geometry are described. The computer model of geometry is the basis for communication, manipulation, and analysis of shape information. IPAD's data base system makes this information available to all authorized departments in a company. A discussion of the data structures and algorithms required to support geometry in IPIP (IPAD's data base management system) is presented. Through the use of IPIP's data definition language, the structure of the geometry components is defined. The data manipulation language is the vehicle by which a user defines an instance of the geometry. The manipulation language also allows a user to edit, query, and manage the geometry. The selection of canonical forms is a very important part of the IPAD geometry. IPAD has a canonical form for each entity and provides transformations to alternate forms; in particular, IPAD will provide a transformation to the ANSI standard. The DBMS schemas required to support IPAD geometry are explained.

  11. Expedient Approaches for the Management of Wastes ...

    Science.gov (United States)

    Report The current study sought to determine waste decontamination conditions that would achieve complete kill for all material types. For these tests, more stringent decontamination procedures were evaluated specifically using pAB amended with a surfactant and/or waste submersion procedures involving agitation.

  12. Current Issues and Situation of Producer Responsibility in Waste Management in Indonesia

    Directory of Open Access Journals (Sweden)

    Antonius Priyo Nugroho Sulami

    2017-11-01

    Full Text Available Producer responsibility for wastes has been encouraged in Indonesia since 2008. The Ministry of Environment of the Republic of Indonesia also promoted the reduce, reuse, and recycle (3R concept using the community-based approach of waste banks integrated with the extended producer responsibility (EPR concept. However, related research and implementation are still limited. This study aims to identify the challenges of fulfilling producer responsibility in waste management and determine whether the integration concept could generate outcomes expected from the EPR concept. A semi-structured interview survey of several stakeholders from the government, industrial, and waste management sectors was conducted and the data generated was used to simulate an integration scheme using a system dynamics approach. Secondary data and information from Bandung municipality were used as input for the simulation. The interview survey found that the concerns and issues of fulfilling producer responsibility in waste management include lack of awareness, unavailability of clear guidelines, and the limited capacity of the current recycling sector. The results of the simulation suggested that if the integration scheme is applied, each business entity might bear the responsibility of IDR 29.4 million per year and 14.7 tons of waste per year for the scope of four sectors and IDR 34.1 million per year and 17 tons of waste per year for the scope of two sectors.

  13. PROACTIVE APPROACH TO THE INCIDENT AND PROBLEM MANAGEMENT IN COMMUNICATION NETWORKS

    Directory of Open Access Journals (Sweden)

    Vjeran Strahonja

    2007-06-01

    Full Text Available Proactive approach to communication network maintenance has the capability of enhancing the integrity and reliability of communication networks, as well as of reducing maintenance costs and overall number of incidents. This paper presents approaches to problem and incident prevention with the help of root-cause analysis, aligning that with the goal to foresee software performance. Implementation of proactive approach requires recognition of enterprise's current level of maintenance better insights into available approaches and tools, as well as their comparison, interoperability, integration and further development. The approach we are proposing and elaborating in this paper lies on the construction of a metamodel of the problem management of information technology, particularly the proactive problem management. The metamodel is derived from the original ITIL specification and presented in an object-oriented fashion by using structure (class diagrams conform to UML notation. Based on current research, appropriate metrics based on the concept of Key Performance Indicators is suggested.

  14. Current management for word finding difficulties by speech-language therapists in South African remedial schools.

    Science.gov (United States)

    de Rauville, Ingrid; Chetty, Sandhya; Pahl, Jenny

    2006-01-01

    Word finding difficulties frequently found in learners with language learning difficulties (Casby, 1992) are an integral part of Speech-Language Therapists' management role when working with learning disabled children. This study investigated current management for word finding difficulties by 70 Speech-Language Therapists in South African remedial schools. A descriptive survey design using a quantitative and qualitative approach was used. A questionnaire and follow-up focus group discussion were used to collect data. Results highlighted the use of the Renfrew Word Finding Scale (Renfrew, 1972, 1995) as the most frequently used formal assessment tool. Language sample analysis and discourse analysis were the most frequently used informal assessment procedures. Formal intervention programmes were generally not used. Phonetic, phonemic or phonological cueing were the most frequently used therapeutic strategies. The authors note strengths and raise concerns about current management for word finding difficulties in South African remedial schools, particularly in terms of bilingualism. Opportunities are highlighted regarding the development of assessment and intervention measures relevant to the diverse learning disabled population in South Africa.

  15. Survey process quality: a question of healthcare manager approach.

    Science.gov (United States)

    Nilsson, Petra; Blomqvist, Kerstin

    2017-08-14

    Purpose The purpose of this paper is to explore how healthcare first-line managers think about and act regarding workplace survey processes. Design/methodology/approach This interview study was performed at a hospital in south Sweden. First-line healthcare managers ( n=24) volunteered. The analysis was inspired by phenomenography, which aims to describe the ways in which different people experience a phenomenon. The phenomenon was a workplace health promotion (WHP) survey processes. Findings Four main WHP survey process approaches were identified among the managers: as a possibility, as a competition, as a work task among others and as an imposition. For each, three common subcategories emerged; how managers: stated challenges and support from hospital management; described their own work group and collaboration with other managers; and expressed themselves and their situation in their roles as first-line managers. Practical implications Insights into how hospital management can understand their first-line managers' motivation for survey processes and practical suggestions and how managers can work proactively at organizational, group and individual level are presented. Originality/value Usually these studies focus on those who should respond to a survey; not those who should run the survey process. Focusing on managers and not co-workers can lead to more committed and empowered managers and thereby success in survey processes.

  16. Effective approaches for managing electronic records and archives

    CERN Document Server

    Dearstyne, Bruce W

    2006-01-01

    This is a book of fresh insights, perspectives, strategies, and approaches for managing electronic records and archives. The authors draw on first-hand experience to present practical solutions, including recommendations for building and sustaining strong electronic records programs.

  17. Homeland Security: A Risk Management Approach Can Guide Preparedness Efforts

    National Research Council Canada - National Science Library

    Decker, Raymond

    2001-01-01

    .... Mail and postal workers. As requested, my testimony will focus on the work we have done over the past five years on combating terrorism and our recommendations advocating a risk management approach for such programs...

  18. Understanding Approaches for Managing Diversity in the Workplace

    DEFF Research Database (Denmark)

    Ravazzani, Silvia

    2016-01-01

    Purpose – This paper aims to enhance understanding of how companies actually implement diversity management, and of factors that may explain their approach. It does this by framing a tripartite model that articulates a combination of indicators, and by using this model to investigate the prevalent...... approach for managing diversity in Italy and the contingent factors at play. Design/methodology/approach – The paper presents data from a survey conducted among 90 Italian companies, and two focus groups consisting of experts and managers. Findings – The most common approach among Italian companies...... in Italy, where interest in diversity is growing due to the increased participation of women and immigrants in the labor market and the initiatives inspired by the EU and multinational companies. In addition, the research model used in this study integrates existing typologies of diversity management...

  19. Towards a macrosystems approach for successful coastal management

    Science.gov (United States)

    Managing coastal resources for resiliency and sustainability often requires integrative, multi-disciplinary approaches across varying spatial and temporal scales to engage stakeholders and inform decision-makers. We discuss case studies integrating wetland ecology, economics, soc...

  20. A practical approach to the diagnosis and management of ...

    African Journals Online (AJOL)

    A practical approach to the diagnosis and management of paradoxical tuberculosis immune reconstitution inflammatory syndrome: TB-associated immune reconstitution inflammatory syndrome is seen after the initiation of antiretroviral therapy.

  1. A proactive and holistic information management approach is crucial ...

    African Journals Online (AJOL)

    ESARBICA Journal: Journal of the Eastern and Southern Africa Regional Branch of ... holistic information management approach is crucial to e-government development ... and to develop new electronic services hence boosting innovation.

  2. MULTI-DIMENSIONAL APPROACH TO CRISIS MANAGEMENT IN ...

    African Journals Online (AJOL)

    HP

    ; and ... multidisciplinary approaches to the management of conflict in the church while still .... classifies them into three: Inherency (Micro), contingency (Macro) and, .... Contemporary Evangelicals are fairly accused of uncritically importing ...

  3. Three-dimensional GIS approach for management of assets

    Science.gov (United States)

    Lee, S. Y.; Yee, S. X.; Majid, Z.; Setan, H.

    2014-02-01

    Assets play an important role in human life, especially to an organization. Organizations strive and put more effort to improve its operation and assets management. The development of GIS technology has become a powerful tool in management as it is able to provide a complete inventory for managing assets with location-based information. Spatial information is one of the requirements in decision making in various areas, including asset management in the buildings. This paper describes a 3D GIS approach for management of assets. An asset management system was developed by integrating GIS concept and 3D model assets. The purposes of 3D visualization to manage assets are to facilitate the analysis and understanding in the complex environment. Behind the 3D model of assets is a database to store the asset information. A user-friendly interface was also designed for more easier to operate the application. In the application developed, location of each individual asset can be easily tracked according to the referring spatial information and 3D viewing. The 3D GIS approach described in this paper is certainly would be useful in asset management. Systematic management of assets can be carried out and this will lead to less-time consuming and cost-effective. The results in this paper will show a new approach to improve asset management.

  4. Three-dimensional GIS approach for management of assets

    International Nuclear Information System (INIS)

    Lee, S Y; Yee, S X; Majid, Z; Setan, H

    2014-01-01

    Assets play an important role in human life, especially to an organization. Organizations strive and put more effort to improve its operation and assets management. The development of GIS technology has become a powerful tool in management as it is able to provide a complete inventory for managing assets with location-based information. Spatial information is one of the requirements in decision making in various areas, including asset management in the buildings. This paper describes a 3D GIS approach for management of assets. An asset management system was developed by integrating GIS concept and 3D model assets. The purposes of 3D visualization to manage assets are to facilitate the analysis and understanding in the complex environment. Behind the 3D model of assets is a database to store the asset information. A user-friendly interface was also designed for more easier to operate the application. In the application developed, location of each individual asset can be easily tracked according to the referring spatial information and 3D viewing. The 3D GIS approach described in this paper is certainly would be useful in asset management. Systematic management of assets can be carried out and this will lead to less-time consuming and cost-effective. The results in this paper will show a new approach to improve asset management

  5. Pain management in primary care – current perspectives

    African Journals Online (AJOL)

    vances in pain medicine and continue to follow the biomedical approach, which regards a specific pathway as ... factors, present and past psychological ... patients where no peripheral abnormal- ..... chronic pain: An integrative model for the.

  6. Prognostics and Health Management of Wind Turbines: Current Status and Future Opportunities

    Energy Technology Data Exchange (ETDEWEB)

    Sheng, Shuangwen

    2016-10-04

    This presentation was given at the 2016 Annual Conference of the Prognostics and Health Management Society. It covers the current status and challenges and opportunities of prognostics and health management of wind turbines.

  7. Current practice in out-of-hospital cardiac arrest management

    DEFF Research Database (Denmark)

    Proclemer, Alessandro; Dobreanu, Dan; Pison, Laurent

    2012-01-01

    AIMS: The purpose of this EP wire is to examine clinical practice in the field of out-of-hospital cardiac arrest (OHCA) management, with special focus on in-hospital diagnostic and therapeutic strategies. METHODS AND RESULTS: Fifty-three European centres, all members of the EHRA-EP Research network......, completed the questions of the survey. A dedicated strategy for OHCA management is active in 85% of the centres. Shockable tachyarrhythmias such as initial OHCA rhythm are reported in >70% of the patients in 64% of the centres. In-hospital therapeutic hypothermia was applied in >50% of the patients in 53...... management strategy, including coronary angiography/PCI and implantable cardioverter defibrillator therapy, while therapeutic hypothermia appears to be underused....

  8. Current management of chronic hepatitis B: review | Cariem | South ...

    African Journals Online (AJOL)

    South African Gastroenterology Review. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 2, No 2 (2004) >. Log in or Register to get access to full text downloads.

  9. A comprehensive approach to quality management of intensive care services.

    Science.gov (United States)

    Hariharan, Seetharaman; Dey, Prasanta Kumar

    2010-01-01

    The purpose of this paper is to develop a comprehensive framework for improving intensive care unit performance. The study introduces a quality management framework by combining cause and effect diagram and logical framework. An intensive care unit was identified for the study on the basis of its performance. The reasons for not achieving the desired performance were identified using a cause and effect diagram with the stakeholder involvement. A logical framework was developed using information from the cause and effect diagram and a detailed project plan was developed. The improvement projects were implemented and evaluated. Stakeholders identified various intensive care unit issues. Managerial performance, organizational processes and insufficient staff were considered major issues. A logical framework was developed to plan an improvement project to resolve issues raised by clinicians and patients. Improved infrastructure, state-of-the-art equipment, well maintained facilities, IT-based communication, motivated doctors, nurses and support staff, improved patient care and improved drug availability were considered the main project outputs for improving performance. The proposed framework is currently being used as a continuous quality improvement tool, providing a planning, implementing, monitoring and evaluating framework for the quality improvement measures on a sustainable basis. The combined cause and effect diagram and logical framework analysis is a novel and effective approach to improving intensive care performance. Similar approaches could be adopted in any intensive care unit. The paper focuses on a uniform model that can be applied to most intensive care units.

  10. Successful management of vaginismus: An eclectic approach.

    Science.gov (United States)

    Harish, Thippeswamy; Muliyala, Krishnaprasad; Murthy, Pratima

    2011-04-01

    Vaginismus is defined as recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina, which interferes with coitus and causes distress and interpersonal difficulty. In this report, we describe the successful treatment of vaginismus in a 25-year-old lady based on a model proposed by Keith Hawton. The eclectic approach involved education, graded insertion of fingers, Kegel's exercises and usage of local anesthesia with vaginal containment along with the prescription of Escitalopram.

  11. Successful management of vaginismus: An eclectic approach

    OpenAIRE

    Harish, T.; Prasad, M. Krishna; Murthy, Pratima

    2012-01-01

    Vaginismus is defined as recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina, which interferes with coitus and causes distress and interpersonal difficulty. In this report, we describe the successful treatment of vaginismus in a 25-year-old lady based on a model proposed by Keith Hawton. The eclectic approach involved education, graded insertion of fingers, Kegel's exercises and usage of local anesthesia with vaginal containment along with the prescri...

  12. Real estate management : oil spot approach

    NARCIS (Netherlands)

    Huisman, Maikel; van der Wiel, Bert

    2008-01-01

    To solve big problems, usually one needs a lot of money to start with. For the ‘Oil Spot’ Approach you don’t need lots of money, you just need a little money to start it up.  A big master plan to improve a whole area costs a lot of money. But it is not necessary to improve the whole area with a

  13. A risk management approach to CAIS development

    Science.gov (United States)

    Hart, Hal; Kerner, Judy; Alden, Tony; Belz, Frank; Tadman, Frank

    1986-01-01

    The proposed DoD standard Common APSE Interface Set (CAIS) was developed as a framework set of interfaces that will support the transportability and interoperability of tools in the support environments of the future. While the current CAIS version is a promising start toward fulfilling those goals and current prototypes provide adequate testbeds for investigations in support of completing specifications for a full CAIS, there are many reasons why the proposed CAIS might fail to become a usable product and the foundation of next-generation (1990'S) project support environments such as NASA's Space Station software support environment. The most critical threats to the viability and acceptance of the CAIS include performance issues (especially in piggybacked implementations), transportability, and security requirements. To make the situation worse, the solution to some of these threats appears to be at conflict with the solutions to others.

  14. Management of opioid addiction with buprenorphine: French history and current management

    Directory of Open Access Journals (Sweden)

    Poloméni P

    2014-03-01

    pathophysiologic mechanisms of the disease, better knowledge of the pharmacology of opioid substitution treatments, and clear definition of short-, medium- and long-term treatment objectives. Data related to the management of opioid addiction by general practitioners in France have been published in 2005. Since then, the context has changed, other drugs were launched on the market such as generics of buprenorphine, methadone capsule, and Suboxone. Thus, an update seems necessary. This paper provides a description of opioid addiction management objectives and treatment modalities for general practitioners, based on currently available knowledge. Keywords: opioid addiction, withdrawal, opioid substitution treatment, buprenorphine, naloxone, general medicine

  15. Error Management in ATLAS TDAQ: An Intelligent Systems approach

    CERN Document Server

    Slopper, John Erik

    2010-01-01

    This thesis is concerned with the use of intelligent system techniques (IST) within a large distributed software system, specically the ATLAS TDAQ system which has been developed and is currently in use at the European Laboratory for Particle Physics(CERN). The overall aim is to investigate and evaluate a range of ITS techniques in order to improve the error management system (EMS) currently used within the TDAQ system via error detection and classication. The thesis work will provide a reference for future research and development of such methods in the TDAQ system. The thesis begins by describing the TDAQ system and the existing EMS, with a focus on the underlying expert system approach, in order to identify areas where improvements can be made using IST techniques. It then discusses measures of evaluating error detection and classication techniques and the factors specic to the TDAQ system. Error conditions are then simulated in a controlled manner using an experimental setup and datasets were gathered fro...

  16. Novel approaches in management of perioperative coagulopathy.

    Science.gov (United States)

    Tanaka, Kenichi A; Bader, Stephen O; Görlinger, Klaus

    2014-02-01

    The recent advances in hemostatic monitoring, and discussion of the clinical implications of hemostatic therapies based on different blood components and factor concentrates. Implementing suitable laboratory tests and transfusion protocols is highly recommended because the laboratory test guided, protocol-driven transfusion approach reduces blood component utilization, and possibly leads to improved outcomes. Timely assessment of coagulation has been difficult using conventional coagulation tests, but thrombocytopenia, fibrin polymerization defects, and fibrinolysis can be quickly assessed on thromboelastometry. The latter testing can be applied to guide the dosing of fibrinogen and prothrombin complex concentrate, which are selectively used to correct fibrinogen deficiency, and improve thrombin generation in acquired coagulopathy. These therapeutic approaches are novel, and potentially effective in reducing the exposure to allogeneic components (e.g., plasma and platelets) and side-effects of transfusion. Although the accessibility of different therapies among different countries, tranexamic acid is widely available, and is an effective blood conservation measure with a good safety profile in various surgical settings. Our understanding of perioperative coagulopathy, diagnostic tools, and therapeutic approaches has evolved in recent years. Additional multidisciplinary efforts are required to understand the optimal combinations, cost-effectiveness, and safety profiles of allogeneic components, and available factor concentrates.

  17. [Multidisciplinar approach to the management of gliomas].

    Science.gov (United States)

    Moura, Bianca; Migliorini, Denis; Bourhis, Jean; Daniel, Roy; Levivier, Marc; Hottinger, Andreas F

    2016-04-27

    Gliomas represent two thirds of all primary brain tumors. Their prognosis depends directly upon their level of differentiation. On MRI, tumoral aggressivity is highlighted by contrast uptake and the infiltrative nature of the lesion. Clinical suspicion must however be confirmed by histology and molecular markers become essential to refine the diagnosis and tailor the treatment. Isocytrate dehydrogenase (IDH) mutations, codeletion of 1p and 19q and the presence of methylation of the MGMT promoter identify a subgroup of gliomas with better prognosis and may help predict response to treatment. Management of patients with primary brain tumors should always be defined in multidisciplinar tumor boards involving neurosurgeons, oncologists, radiation oncologists, neuropathologists and neuroradiologists.

  18. Project management a systems approach to planning, scheduling, and controlling

    CERN Document Server

    Kerzner, Harold

    2017-01-01

    Project Management is the bestselling text for students and professionals, presenting a streamlined approach to project management functions in full alignment with PMI(r)'s latest Project Management Body of Knowledge (PMBOK(r)). This new 12th edition has been updated to reflect the latest changes found in the PMBOK(r) Guide--Sixth Edition, and features new coverage of emerging topics including global stakeholder management, causes of failure, agile project management, project governance failure, customer approval milestones, classifying project metrics, and more. Supplementary materials are available for students, working professionals, and instructors. * Understand organizational structures and project management functions * Learn how to control costs, manage risk, and analyze trade-offs * Examine different methods used for planning, scheduling, QA, and more * Work effectively with customers and stakeholders from around the globe Project Management is the comprehensive reference to keep within arm's reach. ...

  19. Quality management, a directive approach to patient safety.

    Science.gov (United States)

    Ayuso-Murillo, Diego; de Andrés-Gimeno, Begoña; Noriega-Matanza, Concha; López-Suárez, Rafael Jesús; Herrera-Peco, Ivan

    Nowadays the implementation of effective quality management systems and external evaluation in healthcare is a necessity to ensure not only transparency in activities related to health but also access to health and patient safety. The key to correctly implementing a quality management system is support from the managers of health facilities, since it is managers who design and communicate to health professionals the strategies of action involved in quality management systems. This article focuses on nursing managers' approach to quality management through the implementation of cycles of continuous improvement, participation of improvement groups, monitoring systems and external evaluation quality models (EFQM, ISO). The implementation of a quality management system will enable preventable adverse effects to be minimized or eliminated, and promote patient safety and safe practice by health professionals. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  20. Management of diabetic complications: a chemical constituents based approach.

    Science.gov (United States)

    Singh, Randhir; Kaur, Navpreet; Kishore, Lalit; Gupta, Girish Kumar

    2013-10-28

    Long term hyperglycemia leads to development of complications associated with diabetes. Diabetic complications are now a global health problem without effective therapeutic approach. Hyperglycemia and oxidative stress are important components for the development of diabetic complications. Over the past few decades, herbal medicines have attracted much attention as potential therapeutic agents in the prevention and treatment of diabetic complications due to their multiple targets and less toxic side effects. This review aims to assess the current available knowledge of medicinal herbs for attenuation and management of diabetic complications and their underlying mechanisms. Bibliographic investigation was carried out by scrutinizing classical text books and peer reviewed papers, consulting worldwide accepted scientific databases (SCOPUS, PUBMED, SCIELO, NISCAIR, Google Scholar) to retrieve available published literature. The inclusion criteria for the selection of plants were based upon all medicinal herbs and their active compounds with attributed potentials in relieving diabetic complications. Moreover, plants which have potential effect in ameliorating oxidative stress in diabetic animals have been included. Overall, 238 articles were reviewed for plant literature and out of the reviewed literature, 127 articles were selected for the study. Various medicinal plants/plant extracts containing flavonoids, alkaloids, phenolic compounds, terpenoids, saponins and phytosterol type chemical constituents were found to be effective in the management of diabetic complications. This effect might be attributed to amelioration of persistent hyperglycemia, oxidative stress and modulation of various metabolic pathways involved in the pathogenesis of diabetic complications. Screening chemical candidate from herbal medicine might be a promising approach for new drug discovery to treat the diabetic complications. There is still a dire need to explore the mechanism of action of