The Price-Anderson Act Adopted by US Congress in 1957 as the world's first national nuclear liability regime. It is a comprehensive, complicated and unique system and stems from special features of US legal regime and federal system of government. It differs from other systems by providing for 'economic', not legal; channeling of liability to facility operator and not recommended as model for other states, but most features adopted by other states and international conventions
Cozzani, F.; Mahajan, S.
The effect of the parallel equilibrium current on the linear stability of the drift-tearing mode in the collisional regime is investigated analytically. In the appropriate parameter regime, a new unstable mode, driven by equilibrium current, is found and its relevance to tokamak discharges is discussed
Li, Chuan Zhong; Villasante, Sebastian; Zhu, Xueqin
We investigate the role of potential regime shifts in Argentinean hake fishery and the inter-linkage between ecological and economic resilience. We develop a theoretical model incorporated with the hazard function for resource management under alternative conditions, and derive the corrective
Kleperis, J.; Blums, J.; Vanags, M.
Full text: Electrochemical impedance and volt-amperic methods were used to compare an efficiency of water electrolysis for different materials and different electrode configurations. Two and three electrode measurements were made, using standard calomel reference electrode. Non-standard capacitative electrolysis was analyzed in special cell made from cylindrical steel electrodes. Volt-amperic measurements from - 15V to +15V DC didn't indicated the presence of oxidation - reduction reactions when distilled water was used as electrolyte. Impedance measurements showed unusual frequency behavior when the AC voltage increased till 0.5V. Different nickel and carbon electrodes (plate, porous and textile - type) were used to learn classical Faraday electrolysis in strong alkali solutions. Flying increase of current was indicator of the presence of electrolysis, and characteristic potential was used differ between materials accordingly they effectiveness for usage in an electrolyser device. (Aithors)
Full Text Available The paper analyzes the legal regime of water management facilities in the light of Serbian, foreign and European law. Different divisions of water management facilities are carried out (to public and private ones, natural and artificial ones, etc., with determination of their legal relevance. Account is taken of the issue of protection from harmful effects of waters to such facilities, as well. The paper points also to rules on the water management facilities, from acts of planning, to individual administrative acts and measures for maintenance of required qualitative and quantitative condition of waters, depending on their purpose (general use or special, commercial use o waters. Albeit special rules on water management facilities exist, due to the natural interlocking between all the components of the environment (water, air and soil, a comprehensive approach is required. A reference is made to other basic principles of protection of water management facilities as well, such as the principle of prevention, principle of sustainable development and the principle "polluter pays". The last one represents the achievement of contemporary law, which deviates from the idea accepted in the second half of 20th century that supported the socialization of risk from harmful effects of waters.
Halsey, Thomas C.; Kumar, Amit; Perillo, Mauricio M.
Turbidity currents are one of the most significant means by which sediment is moved from the continents into the deep ocean; their properties are interesting both as elements of the global sediment cycle and due to their role in contributing to the formation of deep water oil and gas reservoirs. One of the simplest models of the dynamics of turbidity current flow was introduced three decades ago, and is based on depth-averaging of the fluid mechanical equations governing the turbulent gravity-driven flow of relatively dilute turbidity currents. We examine the sedimentological regimes of a simplified version of this model, focusing on the role of the Richardson number Ri [dimensionless inertia] and Rouse number Ro [dimensionless sedimentation velocity] in determining whether a current is net depositional or net erosional. We find that for large Rouse numbers, the currents are strongly net depositional due to the disappearance of local equilibria between erosion and deposition. At lower Rouse numbers, the Richardson number also plays a role in determining the degree of erosion versus deposition. The currents become more erosive at lower values of the product Ro × Ri, due to the effect of clear water entrainment. At higher values of this product, the turbulence becomes insufficient to maintain the sediment in suspension, as first pointed out by Knapp and Bagnold. We speculate on the potential for two-layer solutions in this insufficiently turbulent regime, which would comprise substantial bedload flow with an overlying turbidity current.
While all non-proliferation, arms control and disarmament (NACD) regimes must address the issue of information management, this area has remained an under-explored part of the arms control field. This paper compares information management processes across a variety of NACD regimes for the purpose of identifying potential synergies between regimes and suggesting means by which to strengthen future arms control verification efforts. The paper explores the information management systems of the International Atomic Energy Agency (IAEA), the United Nations Special Commission in Iraq (UNSCOM), the Conventional Forces in Europe Agreement (CFE), and the Comprehensive Test Ban Treaty (CTBT). (author)
Anderson, R. F.; Fleisher, M. Q.; Pavia, F. J.; Vivancos, S. M.; Lu, Y.; Zhang, P.; Cheng, H.; Edwards, R. L.
We use data from two US GEOTRACES expeditions to compare boundary scavenging intensity in two eastern boundary current systems: the Canary Current off Mauritania and the Humboldt Current off Peru. Boundary scavenging refers to the enhanced removal of trace elements from the ocean by sorption to sinking particles in regions of greater than average particle abundance. Both regimes experience high rates of biological productivity and generation of biogenic particles, with rates of productivity potentially a little greater off Peru, whereas dust fluxes are an order of magnitude greater off NW Africa (see presentation by Vivancos et al., this meeting). Despite greater productivity off Peru, we find greater intensity of scavenging off NW Africa as measured by the residence time of dissolved 230Th integrated from the surface to a depth of 2500 m (10-11 years off NW Africa vs. 15-17 years off Peru). Dissolved 231Pa/230Th ratios off NW Africa (Hayes et al., Deep Sea Res.-II 116 (2015) 29-41) are nearly twice the values observed off Peru. We attribute this difference to the well-known tendency for lithogenic phases (dust) to strongly fractionate in favor of Th uptake during scavenging and removal, leaving the dissolved phase enriched in Pa. This behavior needs to be considered when interpreting sedimentary 231Pa/230Th ratios as a paleo proxy.
Wohl, Ellen E.; Bledsoe, Brian P.; Jacobson, Robert B.; Poff, N. LeRoy; Rathburn, Sara L.; Walters, David M.; Wilcox, Andrew C.
Water and sediment inputs are fundamental drivers of river ecosystems, but river management tends to emphasize flow regime at the expense of sediment regime. In an effort to frame a more inclusive paradigm for river management, we discuss sediment inputs, transport, and storage within river systems; interactions among water, sediment, and valley context; and the need to broaden the natural flow regime concept. Explicitly incorporating sediment is challenging, because sediment is supplied, transported, and stored by nonlinear and episodic processes operating at different temporal and spatial scales than water and because sediment regimes have been highly altered by humans. Nevertheless, managing for a desired balance between sediment supply and transport capacity is not only tractable, given current geomorphic process knowledge, but also essential because of the importance of sediment regimes to aquatic and riparian ecosystems, the physical template of which depends on sediment-driven river structure and function.
Stein Ringen's theory of democratic purpose cannot do the work expected of it. Ringen's own criteria oscillate between being too vague to be useful (i.e. "freedom") or, when specified more fully, conflicting, so that almost all democracies will seem to be potentially at cross-purposes with themselves rather than their purposes or sub-purposes being mutually reinforcing. This reflects a bigger and more theoretical problem. Disagreement about the purpose of democracy is built into democracy itself. The whole point of many (perhaps all) of our democratic institutions is to arrive at conditionally legitimate decisions in spite of such disagreement. So-called regime bias, i.e. the tendency to assess democracies according to the form and stability of their institutions rather than their results or their ability to serve certain purposes, does not in fact arise from bias. It arises on the contrary from a determination to avoid the bias inherent in giving some-inevitably partisan-ideals of what democracies should do pride of place over others in a scheme of measurement or evaluation. And even a regime-based definition of democracy must itself make simplifying assumptions that elide possible normative controversies over how the democratic game is best played. Vindicating one's preferred set of democratic ideals against alternatives is a completely legitimate enterprise and lends richness to debates within and across democracies. But it is an inherently ideological and political enterprise, not a neutral or scholarly one.
John-Pascal Berrill; Kevin O' Hara
Variable retention is a flexible silvicultural system that provides forest managers with an alternative to clearcutting. While much of the standing volume is removed in one harvesting operation, residual stems are retained to provide structural complexity and wildlife habitat functions, or to accrue volume before removal during subsequent stand entries. The residual...
The IAEA and its safeguards system is placed into a historical perspective. A personal perspective on the nonproliferation regime and on the Agency's role in it is then presented. This is done initially by discussing some of the landmark events in the history of the nonproliferation regime. Subsequently some of the history of arms control agreements and of the role of the IAEA are noted. Then political motivations of state and ways the Agency has an impact in the political nonproliferation sphere are addressed
Brown, Lee E; Palmer, Sheila M; Johnston, Kerrylyn; Holden, Joseph
Vegetation removal with fire can alter the thermal regime of the land surface, leading to significant changes in biogeochemistry (e.g. carbon cycling) and soil hydrology. In the UK, large expanses of carbon-rich upland environments are managed to encourage increased abundance of red grouse (Lagopus lagopus scotica) by rotational burning of shrub vegetation. To date, though, there has not been any consideration of whether prescribed vegetation burning on peatlands modifies the thermal regime of the soil mass in the years after fire. In this study thermal regime was monitored across 12 burned peatland soil plots over an 18-month period, with the aim of (i) quantifying thermal dynamics between burned plots of different ages (from post burning), and (ii) developing statistical models to determine the magnitude of thermal change caused by vegetation management. Compared to plots burned 15 + years previously, plots recently burned (management effects. Temperatures measured in soil plots burned vegetation regrows. Our findings that prescribed peatland vegetation burning alters soil thermal regime should provide an impetus for further research to understand the consequences of thermal regime change for carbon processing and release, and hydrological processes, in these peatlands. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
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.
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.
Kristiansen, Mads Bøge; Dahler-Larsen, Peter; Ghin, Eva Moll
The ambition of this article is to gain a better understanding of the endogenous dynamics of performance management regimes. Based on a review of the literature, we develop a framework that enables us to grasp dimensions and mechanisms of escalation. Hereafter, we demonstrate the use of our frame...
Steel, E. Ashley; Beechie, Timothy J.; Torgersen, Christian E.; Fullerton, Aimee H.
Water temperatures fluctuate in time and space, creating diverse thermal regimes on river networks. Temporal variability in these thermal landscapes has important biological and ecological consequences because of nonlinearities in physiological reactions; spatial diversity in thermal landscapes provides aquatic organisms with options to maximize growth and survival. However, human activities and climate change threaten to alter the dynamics of riverine thermal regimes. New data and tools can identify particular facets of the thermal landscape that describe ecological and management concerns and that are linked to human actions. The emerging complexity of thermal landscapes demands innovations in communication, opens the door to exciting research opportunities on the human impacts to and biological consequences of thermal variability, suggests improvements in monitoring programs to better capture empirical patterns, provides a framework for suites of actions to restore and protect the natural processes that drive thermal complexity, and indicates opportunities for better managing thermal landscapes.
Christophersen, Knut-Andreas; Elstad, Eyvind; Turmo, Are
This article focuses on the comparison of organizational antecedents of teachers' fostering of students' effort in two quite different accountability regimes: one management regime with an external-accountability system and one with no external accountability devices. The methodology involves cross-sectional surveys from two different management…
Full Text Available The literature on transboundary river management suggests that institutions play an important role in bringing about cooperation. However, knowledge about how such institutions should be designed in order to do so remains limited. One way to learn more about adequate institutional design is to assess the effectiveness of existing regimes, and to trace the causal relationships that lead to the respective outcomes. In order to gain further insights into the relationship between institutional design and regime effectiveness, this paper presents a study on the water quality regime of the International Commission for the Protection of the Elbe (ICPE. The analysis is based on a review of pertinent documents and ten qualitative interviews with Czech and German Commission members and NGO representatives. Particular emphasis has been put on determining the ICPE's specific contribution and the no-regime counterfactual as well as on the perceived expediency of the institutional arrangements. The study shows overall that the countries were relatively successful in improving water quality in the Elbe basin. However, this outcome can only partly be attributed to the ICPE itself. Furthermore, the ICPE's contribution towards achieving the various goals varied significantly between the different areas of activity: it was relatively significant where the main responsibility for action lay with the public authorities, such as in the area of wastewater treatment and the establishment of an international alarm plan and model, but was practically non-existent in the reduction of non-point pollution from agriculture, where success depended on the behavior of individual private actors (farmers. The commission contributed towards problem solving by serving as a forum for the joint identification of priorities for action from a basin-wide perspective. The resulting international obligations increased the power of national water administrations and their access to funds
Barcelona, Aina; Serra, Teresa; Colomer, Jordi
Coastal ecosystems (marine littoral regions, wetlands, and deltas) are regions of high biological productivity. However, they are also one of the world's most threatened ecosystems. Wetlands are characterized by aquatic vegetation adapted to high salinity levels and climatic variations. Wetland canopies buffer these hydrodynamic and atmospheric variations and help retain sediment by reducing current velocity during sea storms or runoff after periods of rain. This work focuses on the effect of the presence of a gap (i.e., nonvegetated zone) parallel to the direction of the main current has on the sedimentation and hydrodynamics of a gravity current. The study aims to (1) address the behavior of a gravity current in a vegetated region compared to one without vegetation (i.e., the gap), (2) determine the effect gap size has on how a gravity current evolves, and 3) determine the effect gap sizes have on the sedimentary rates from a gravity current. Laboratory experiments were carried out in a flume using four different sediment concentrations, four different canopy densities (884, 354, 177, and 0 plants·m-2) and three different gap widths (H/2, H, and 1.5H, where H is the height of the water). This work shows that a gravity current's evolution and its sedimentary rates depend on the fractional volume occupied by the vegetation. While current dynamics in experiments with wider gaps are similar to the nonvegetated case, for smaller gaps the dynamics are closer to the fully vegetated case. Nonetheless, the gravity current exhibits the same behavior in both the vegetated region and the gap.
Carr, M. E.; Kearns, E. J.
High productivity (maxima 3 g C m(sup -2)day(sup -1)) of the Eastern Boundary Currents (EBCs), i.e. the California, Peru-Humboldt, Canary and Benguela Currents, is driven by a combination of local forcing and large-scale circulation. The characteristics of the deep water brought to the surface by upwelling favorable winds depend on the large-scale circulation patterns. Here we use a new hydrographic and nutrient climatology together with satellite measurements ofthe wind vector, sea-surface temperature (SST), chlorophyll concentration, and primary production modeled from ocean color to quantify the meridional and seasonal patterns of upwelling dynamics and biological response. The unprecedented combination of data sets allows us to describe objectively the variability for small regions within each current and to characterize the governing factors for biological production. The temporal and spatial environmental variability was due in most regions to large-scale circulation, alone or in combination with offshore transport (local forcing). The observed meridional and seasonal patterns of biomass and primary production were most highlycorrelated to components representing large-scale circulation. The biomass sustained by a given nutrient concentration in the Atlantic EBCs was twice as large as that of the Pacific EBCs. This apparent greater efficiency may be due toavailability of iron, physical retention, or differences in planktonic community structure.
Jucker Riva, Matteo; Schwilch, Gudrun; Liniger, Hanspeter
Regime shifts, defined as a radical and persistent reconfiguration of an ecosystem following a disturbance, have been acknowledged by scientists as a very important aspect of the dynamic of ecosystems. However, their consideration in land management planning remains marginal and limited to specific processes and systems. Current research focuses on mathematical modeling and statistical analysis of spatio-temporal data for specific environmental variables. These methods do not fulfill the needs of land managers, who are confronted with a multitude of processes and pressure types and require clear and simple strategies to prevent regime shift or to increase the resilience of their environment. The EU-FP7 CASCADE project is looking at regime shifts of dryland ecosystems in southern Europe and specifically focuses on rangeland and forest systems which are prone to various land degradation threats. One of the aims of the project is to evaluate the impact of different management practices on the dynamic of the environment in a participatory manner, including a multi-stakeholder evaluation of the state of the environment and of the management potential. To achieve this objective we have organized several stakeholder meetings and we have compiled a review of management practices using the WOCAT methodology, which enables merging scientific and land users knowledge. We highlight here the main challenges we have encountered in applying the notion of regime shift to real world socio-ecological systems and in translating related concepts such as tipping points, stable states, hysteresis and resilience to land managers, using concrete examples from CASCADE study sites. Secondly, we explore the advantages of including land users' knowledge in the scientific understanding of regime shifts. Moreover, we discuss useful alternative concepts and lessons learnt that will allow us to build a participatory method for the assessment of resilient management practices in specific socio
Full Text Available The global demand for agricultural products is surging due to population growth, more meat-based diets, and the increasing role of bioenergy. Three strategies can increase agricultural production: (1 expanding agriculture into natural ecosystems; (2 intensifying existing farmland; or (3 recultivating abandoned farmland. Because agricultural expansion entails substantial environmental trade-offs, intensification and recultivation are currently gaining increasing attention. Assessing where these strategies may be pursued, however, requires improved spatial information on land use intensity, including where farmland is active and fallow. We developed a framework to integrate optical and radar data in order to advance the mapping of three farmland management regimes: (1 large-scale, mechanized agriculture; (2 small-scale, subsistence agriculture; and (3 fallow or abandoned farmland. We applied this framework to our study area in western Ukraine, a region characterized by marked spatial heterogeneity in management intensity due to the legacies from Soviet land management, the breakdown of the Soviet Union in 1991, and the recent integration of this region into world markets. We mapped land management regimes using a hierarchical, object-based framework. Image segmentation for delineating objects was performed by using the Superpixel Contour algorithm. We then applied Random Forest classification to map land management regimes and validated our map using randomly sampled in-situ data, obtained during an extensive field campaign. Our results showed that farmland management regimes were mapped reliably, resulting in a final map with an overall accuracy of 83.4%. Comparing our land management regimes map with a soil map revealed that most fallow land occurred on soils marginally suited for agriculture, but some areas within our study region contained considerable potential for recultivation. Overall, our study highlights the potential for an improved
Fulé, Peter Z; Ramos-Gómez, Mauro; Cortés-Montaño, Citlali; Miller, Andrew M
The Rarámuri (Tarahumara) people live in the mountains and canyons of the Sierra Madre Occidental of Chihuahua, Mexico. They base their subsistence on multiple-use strategies of their natural resources, including agriculture, pastoralism, and harvesting of native plants and wildlife. Pino Gordo is a Rarámuri settlement in a remote location where the forest has not been commercially logged. We reconstructed the forest fire regime from fire-scarred trees, measured the structure of the never-logged forest, and interviewed community members about fire use. Fire occurrence was consistent throughout the 19th and 20th centuries up to our fire scar collection in 2004. This is the least interrupted surface-fire regime reported to date in North America. Studies from other relict sites such as nature reserves in Mexico or the USA have all shown some recent alterations associated with industrialized society. At Pino Gordo, fires recurred frequently at the three study sites, with a composite mean fire interval of 1.9 years (all fires) to 7.6 years (fires scarring 25% or more of samples). Per-sample fire intervals averaged 10-14 years at the three sites. Approximately two-thirds of fires burned in the season of cambial dormancy, probably during the pre-monsoonal drought. Forests were dominated by pines and contained many large living trees and snags, in contrast to two nearby similar forests that have been logged. Community residents reported using fire for many purposes, consistent with previous literature on fire use by indigenous people. Pino Gordo is a valuable example of a continuing frequent-fire regime in a never-harvested forest. The Rarámuri people have actively conserved this forest through their traditional livelihood and management techniques, as opposed to logging the forest, and have also facilitated the fire regime by burning. The data contribute to a better understanding of the interactions of humans who live in pine forests and the fire regimes of these
Rempen, I.S.; Khramov, A.E.
The effect of the delayed feedback on the complex oscillation regimes in the electron flux with the overcritical current in the Pierce diode is studied. The possibility of controlling the oscillation regimes through changing the feedback parameters is shown. The finite-dimensional model, describing the behavior of the electron flux in the Pierce diode hydrodynamic model, is constructed. Its behavior under the effect of the delayed feedback is studied [ru
Kirkman, Stephen P.; Yemane, Dawit; Atkinson, Lara J.
Using long‐term survey data, changes in demersal faunal communities in the Benguela Current Large Marine Ecosystem were analysed at community and population levels to provide a comparative overview of the occurrence and timing of regime shifts. For South Africa, the timing of a community‐level sh......Using long‐term survey data, changes in demersal faunal communities in the Benguela Current Large Marine Ecosystem were analysed at community and population levels to provide a comparative overview of the occurrence and timing of regime shifts. For South Africa, the timing of a community...
G.T. (Tom Raadgever
Full Text Available River basin management is faced with complex problems that are characterized by uncertainty and change. In transboundary river basins, historical, legal, and cultural differences add to the complexity. The literature on adaptive management gives several suggestions for handling this complexity. It recognizes the importance of management regimes as enabling or limiting adaptive management, but there is no comprehensive overview of regime features that support adaptive management. This paper presents such an overview, focused on transboundary river basin management. It inventories the features that have been claimed to be central to effective transboundary river basin management and refines them using adaptive management literature. It then collates these features into a framework describing actor networks, policy processes, information management, and legal and financial aspects. Subsequently, this framework is applied to the Orange and Rhine basins. The paper concludes that the framework provides a consistent and comprehensive perspective on transboundary river basin management regimes, and can be used for assessing their capacity to support adaptive management.
Hiroshi Goda; Seungjin Kim; Ye Mi; Finch, Joshua P.; Mamoru Ishii; Jennifer Uhle
Flow regime identification for an adiabatic vertical co-current downward air-water two-phase flow in the 25.4 mm ID and the 50.8 mm ID round tubes was performed by employing an impedance void meter coupled with the neural network classification approach. This approach minimizes the subjective judgment in determining the flow regimes. The signals obtained by an impedance void meter were applied to train the self-organizing neural network to categorize these impedance signals into a certain number of groups. The characteristic parameters set into the neural network classification included the mean, standard deviation and skewness of impedance signals in the present experiment. The classification categories adopted in the present investigation were four widely accepted flow regimes, viz. bubbly, slug, churn-turbulent, and annular flows. These four flow regimes were recognized based upon the conventional flow visualization approach by a high-speed motion analyzer. The resulting flow regime maps classified by the neural network were compared with the results obtained through the flow visualization method, and consequently the efficiency of the neural network classification for flow regime identification was demonstrated. (authors)
Oudenhoven, van A.P.E.; Siahainenia, A.J.; Sualia, I.; Tonneijck, F.H.; Ploeg, van der S.; Groot, de R.S.; Alkemade, J.R.M.; Leemans, R.
Over half of the mangroves in Indonesia have been degraded or converted for aquaculture. We assessed the consequences of management decisions by studying the effects of different management regimes on mangrove ecosystem services in Java, Indonesia. A novel typology of management regimes
Jepsen, Martin Rudbeck; Kuemmerle, Tobias; Müller, Daniel
, and how they play out in different environmental, socio-economic and cultural contexts, is therefore important for identifying effective policies to successfully address these challenges. In this regard, much can be learned from studying long-term land-use change. We examined the evolution of European...... countries in Europe. We qualitatively grouped drivers into land-management regimes, and compared changes in management regimes across Europe. Our results allowed discerning seven land-management regimes, and highlighted marked heterogeneity regarding the types of management regimes occurring in a particular...
Baksht, F.G.; Borodin, V.S.; Zhuravlev, V.N.
Virtual cathode (VC) regime in a non-stationary high-current hydrogen arch is constructed. Basic calculational characteristics of the near-the-cathode layer are presented. The calculation was conducted for a 1 cm long cathode under 2x10 4 A/cm 2 current density in pulse and 10 atm. pressure. A rectangular current pulse was considered. It is shown that VC formation is caused by electron temperature reduction in the near-the-cathode area. This results in the reduction of ion flux from plasma to the cathode surface and finally in the change of a sign of space charge and field intensity near the surface. Under the transition to VC regime only the cathode temperature and its effective work function are practically changed, while the rest of parameters remain approximately constant
Carbonnel, François; David, Michel; Norton, Joanna; Bourrel, Gérard; Boulenger, Jean-Philippe; Capdevielle, Delphine
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.
Cresti, Alessandro; Farchioni, Riccardo; Grosso, Giuseppe; Parravicini, Giuseppe Pastori
Charge transport of a two-dimensional electron gas in the presence of a magnetic field is studied by means of the Keldysh-Green function formalism and the tight-binding method. We evaluate the spatial distributions of persistent (equilibrium) and transport (nonequilibrium) currents, and give a vivid picture of their profiles. In the quantum Hall regime, we find exact conductance quantization both for persistent currents and for transport currents, even in the presence of impurity scattering centres and moderate disorder. (letter to the editor)
Cresti, Alessandro [NEST-INFM and Dipartimento di Fisica ' E Fermi' , Universita di Pisa, via F Buonarroti 2, I-56127 Pisa (Italy); Farchioni, Riccardo [NEST-INFM and Dipartimento di Fisica ' E Fermi' , Universita di Pisa, via F Buonarroti 2, I-56127 Pisa (Italy); Grosso, Giuseppe [NEST-INFM and Dipartimento di Fisica ' E Fermi' , Universita di Pisa, via F Buonarroti 2, I-56127 Pisa (Italy); Parravicini, Giuseppe Pastori [NEST-INFM and Dipartimento di Fisica ' A Volta' , Universita di Pavia, via A Bassi 6, I-27100 Pavia (Italy)
Charge transport of a two-dimensional electron gas in the presence of a magnetic field is studied by means of the Keldysh-Green function formalism and the tight-binding method. We evaluate the spatial distributions of persistent (equilibrium) and transport (nonequilibrium) currents, and give a vivid picture of their profiles. In the quantum Hall regime, we find exact conductance quantization both for persistent currents and for transport currents, even in the presence of impurity scattering centres and moderate disorder. (letter to the editor)
Arnas Capeau, C.; Bachet, G.; Doveil, F.
Experimental observations of self-oscillations occurring in the so-called ''temperature-limited current regime'' of a hot cathode discharge are presented. Their frequency and amplitude are strongly dependent on the discharge parameters. The scaling laws of their variation and an example of a period-doubling route to chaos are reported. A two probe experiment showing that the plasma behavior is closely related to the hot cathode sheath stability is also reported. copyright 1995 American Institute of Physics
Dimitrov, Aleksandar; Paunovic, Perica; Popovski, Orce
Abstract: This work is concerned with the use of reverse current regimes in order to form small-grained and compact silver deposits during the electrorefining process. Several parameters were varied, i.e., i) anodic overpotential,ii) cathodic vs. anodic time ratio and iii) duration of the anodic pulse. After optimization of these parameters, phosphate ions were added and the electrolyte was stirred. The effects of a rise of the anodic overpotential on the grain sizes of the silver depos...
Full Text Available The end of a bipolar regime after the collapse of the Soviet Union diverted the world economies to globalization regime, where economic freedom and liberalization were adopted as most powerful and popular philosophies of the economic welfare and development. The origination of a free trade regime, decentralization in public finance, and revival of the classical school of thought in economic policies are the natural outcomes of the global failure of centrally controlled economic planning experiences. Autonomy of the central banks, market-oriented exchange rates, convertibility of the currencies, privatization, deregulation, and free trade are the banners of classical economic thoughts in the present regime. Meanwhile, the International Monetary Fund (IMF came into force when the world was divided into left and right arms. The IMF conditionality and recommended measures are still based on demand management mechanism where most of the advices belong to exchange rate mechanism (devaluation, increase in interest rate, increase in tax revenue, reduction in subsidies, transfer payments, so on. The core objective of this study is to review the IMF policies and practices in the contemporary world where supply-side policies and classical theories are regaining their importance in post-Soviet regime. Before any recommendation and contemplating the role of the IMF in the contemporary world, it will be appropriate to review and analyze the current practices of the IMF by three dimensions: History and cause of the creation of the IMF, its governance and financial structure, and its role in global economy and lending activities. The study suggests the change in the IMF governance structure and the coordination between World Trade Organization (WTO, World Economic Forum (WEF, and IMF policies.
Vasilenko, O.I.; Voronin, V.S.; Lebedev, A.N.
Steady states of the electron current in a high-voltage diode and of the transmission line of conical configuration at emission current restriction by the space are considered on the basis of the self-consistant kinetic description in connection with the prospects of controlled thermonuclear synthesis. Proceeding from the magnetic self-insulation principle solved are the problems of controling the emission electron current in the double-electron geometry to prevent it from being present on the anode in the line regime and to achieve its maximum focusing in the diode regime. The motion of plasma boundaries as well as the probable contribution of the ion component of the current were not taken into consideration. It is shown that the beam focusing on the system axis takes place at sufficiently strong currents. It is connected with the fact that some part of the full diode current runs on the cathode surface. The results were compared with existing approximate diode models and with the experimetal data on focusien of strong-current beams
Jacquinot, J.; Adams, J.M.; Altmann, H.
by pellet injection. A value of n(d) tau-E T(i) = 7.8 x 10(20) m-3 s keV was obtained in this mode with T(e) approximately T(i) approximately 11 keV. In the L-mode regime, a regime, a record (140 kW) D-He-3 fusion power was generated with 10 - 14 MW of ICRH at the He-3 cyclotron frequency. Experiments were....... Paradoxically, LHCD induces central heating particularly in combination with ICRH. Finally we present the first observations of the synergistic acceleration of fast electrons by Transit Time Magnetic Pumping (TTMP) (from ICRH) and Electron Landau Damping (ELD) (from LHCD). The synergism generates TTMP current...
Chen, Shu-tao; Zhu, Da-wei; Niu, Chuan-po; Zou, Jian-wen; Wang, Chao; Sun, Wen-juan
In order to examine the effects of management regime, such as nitrogen application and plowing method, on soil respiration from farmland, the static opaque chamber-gas chromatograph method was used to measure soil CO2 fluxes in situ. The field measurement was carried out for 5 growing seasons, which were the 2002-2003 wheat, 2003 maize and soybean, 2003-2004 wheat, 2004 maize and 2004-2005 wheat seasons. Our results showed that soil respiration increased in fertilizer-applied treatments compared with no fertilizer treatment after 3 times of fertilizer application on 9 November 2002, 14 February and 26 March 2003. And the most obvious increase appeared following the third fertilizer application. No significant difference in soil respiration was found among several fertilizer application treatments. The effect of plowing depth on soil respiration was contingent on preceding cropping practice. Over the 2003-2004 wheat-growing seasons (its preceding cropping practice was rice paddy), mean soil respiration rates were not significant different (p > 0.05) between no plowing treatment and shallow plowing treatment. The shallow plowing treatment CT2 led to higher soil CO2 losses compared with no plowing treatment of NT2 in the 2004 maize-growing season, however, the significant higher (p soil respiration rates occurred with no plowing treatment of NT3 in the following 2004-2005 wheat-growing season. Intensive plowing (25 cm depth), compared with no plowing practice (NT4), increased soil respiration significantly during the 2004-2005 wheat-growing season. Regression analysis showed that the exponential function could be employed to fit the relationship between soil respiration and temperature. The exponential relationship yielded the Q10 values which were varied from 1.26 to 3.60, with a mean value of 2.08. To evaluate the effect of temperature on soil respiration, the CO2 emission fluxes were normalized for each treatment and each crop growing season. Plotting the
Nakajima, Noriyoshi; Okamoto, Masao.
Beam currents driven by a neutral particle injection in a helical system (stellarator, heliotron/torsatron) are studied in the 1/ν collisionality regime. The general expression for the beam-driven current is obtained for arbitrary magnetic field configurations by solving the drift kinetic equation for electrons. It is found that F = J(net)/J(b) (J(net) is the net current and J(b) is the fast ion beam current) increases as f(t) and Zeff where f(t) is the fraction of trapped electrons and Zeff is the effective ionic charge number. Especially, for Zeff ≅ 1 the effect of trapped electrons is large and F is roughly proportional to f(t). On the other hand, if Zeff > or approx 3 the effect of trapped electrons becomes small. (author)
Ma, Deqiang; Fang, Qinhua; Guan, Song
In 2004, the United Nations launched an Ad Hoc Open-ended Informal Working Group to study issues relating to the conservation and sustainable use of marine biological diversity in areas beyond national jurisdiction. Since then, the topic of governing marine areas beyond national jurisdiction (ABNJ) has been widely discussed by politicians, policy makers and scholars. As one of management tools to protect marine biodiversity in ABNJ, environmental impact assessment (EIA) has been widely recognized and accepted by the international community, however, the biggest challenge is how to effectively implement the EIA regime in ABNJ. This paper explores the impacts of anthropogenic activities in ABNJ on marine ecosystems, reviews the existing legal regime for EIA in ABNJ and discusses possible measures to strengthen the implementation of EIA in ABNJ. - Highlights: • We identify human activities in ABNJ and their impacts on marine ecosystems. • We analyze the characters and gaps of the existing legal regime for EIA in ABNJ. • We analyze the pros and cons of alternative approaches of EIA in ABNJ.
Ma, Deqiang [Fujian Provincial Key Laboratory for Coastal Ecology and Environmental Studies, Xiamen University, 361102 (China); Coastal and Ocean Management Institute, Xiamen University, 361102 (China); Fang, Qinhua, E-mail: email@example.com [Fujian Provincial Key Laboratory for Coastal Ecology and Environmental Studies, Xiamen University, 361102 (China); Coastal and Ocean Management Institute, Xiamen University, 361102 (China); Guan, Song [Coastal and Ocean Management Institute, Xiamen University, 361102 (China)
In 2004, the United Nations launched an Ad Hoc Open-ended Informal Working Group to study issues relating to the conservation and sustainable use of marine biological diversity in areas beyond national jurisdiction. Since then, the topic of governing marine areas beyond national jurisdiction (ABNJ) has been widely discussed by politicians, policy makers and scholars. As one of management tools to protect marine biodiversity in ABNJ, environmental impact assessment (EIA) has been widely recognized and accepted by the international community, however, the biggest challenge is how to effectively implement the EIA regime in ABNJ. This paper explores the impacts of anthropogenic activities in ABNJ on marine ecosystems, reviews the existing legal regime for EIA in ABNJ and discusses possible measures to strengthen the implementation of EIA in ABNJ. - Highlights: • We identify human activities in ABNJ and their impacts on marine ecosystems. • We analyze the characters and gaps of the existing legal regime for EIA in ABNJ. • We analyze the pros and cons of alternative approaches of EIA in ABNJ.
Woodward, Andrea; Jenni, Karen
Landscape Conservation Cooperatives (LCCs) are a network of 22 public-private partnerships, defined by ecoregion, that share and provide science to ensure the sustainability of land, water, wildlife, and cultural resources in North America. LCCs were established by the U.S. Department of the Interior (DOI) in recognition of the fact that response to climate change must be coordinated on a landscape-level basis because important resources, ecosystem processes, and resource management challenges extend beyond most of the boundaries considered in current natural resource management. The North Pacific LCC (NPLCC) covers the range of the Pacific coastal temperate rainforest, including an area of 528,360 km2 spanning 22 degrees of latitude from the Kenai Peninsula, Alaska, to Bodega Bay, California. The coverage area includes parts of four States, two Canadian provinces, and more than 100 Tribes and First Nation language groups. It extends from alpine areas at the crest of coastal mountains across subalpine, montane, and lowland forests to the nearshore marine environment. This wide range of latitudes and elevation zones; terrestrial, freshwater, and marine habitats; and complex jurisdictional boundaries hosts a diversity of natural resources and their corresponding management issues are equally diverse. As evidenced by the Science and Traditional Ecological Knowledge (S-TEK) Strategy guiding principles, identifying and responding to the needs of resource managers is key to the success of the NPLCC. To help achieve this goal of the NPLCC, the U.S. Geological Survey (USGS) has organized several workshops with resource managers and resource scientists to identify management information needs relevant to the priority topics identified in the S-TEK Strategy. Here, we detail the results from a first workshop to address the effects of changes in hydrologic regime on rivers, streams, and riparian corridors. The workshop focused on a subset of the full NPLCC geography and was
Full Text Available This paper reports the results on the impact of the current visa regime policy on tourism recovery and development in Zimbabwe. The focus was on finding out how the visa regime could impact on efforts to bring into the country more visitors following the decline in visitor inflows from 2000 to 2008. Data was collected from selected visitors from different member states which require visas to enter into the county in the period between January 2010 and July 2010.The findings shows that visa restrictions play a small part in discouraging visitors to visit Zimbabwe. The visa regime policy was designed in such a way that it was easy for passport holders from traditional markets to have relatively easy passage into Zimbabwe. It was also discovered that visa restrictions were part of international travel conditions but how to get the visa became the competitive advantage or disadvantage a destination can have compared with its competitors. Zimbabwe’s traditional markets believed that the visa was not difficult to get nor was it too expensive as to scare away visitors. However, the emerging markets such as China who are in Group C had problems getting the visa as they were required to apply for the visa before traveling to Zimbabwe.
Full Text Available This article looks at the current international regime that pertains to the African lion, a species that needs adequate protection across its range (a range that does not adhere to state boundaries. This analysis comes at a time when threats such as habitat and prey loss, retaliatory killing, trophy hunting and trade, are all impacting the remaining populations of African lions. The species is in danger of rapid population decline and possible extinction in the near future. Two decades ago there was an abundance of African lions, roughly 100 000, on the continent. But at present there are less than 32 000, while some believe there to be as little as 15 000 left. This decline is mainly due to the threats noted above. African lions are currently listed as "vulnerable" on the International Union for Conservation of Nature Red List of Threatened Species. This listing is being contested by commentators who believe that the species now requires an "endangered" status. African lion populations, and the threats to the species, extend across state boundaries. Therefore, international law is of particular importance in providing conservation and protection measures to the species. Creating conservation obligations at a global level allows for more uniform action, implementation and enforcement of legislation at regional and local levels. Therefore this article looks at each threat to African lion populations in detail and then assesses the international legal regime pertaining to each of these threats, and whether that regime is adequate. The Convention on Biological Diversity, Convention on the Conservation of Migratory Species, Convention on International Trade in Endangered Species of Wild Fauna and Flora and the Convention on Wetlands of International Importance are but some of the international instruments that are analysed. This article outlines the arguments that the international legal framework is not acceptable for the protection of the species
ALEKSANDAR T. DIMITROV; PERICA PAUNOVIĆ; ORCE POPOVSKI; DRAGAN SLAVKOV; ŽELJKO KAMBEROVIĆ; SVETOMIR HADŽI JORDANOV
This work is concerned with the use of reverse current regimes in order to form small-grained and compact silver deposits during the electro-refining process. Several parameters were varied, i.e., i) anodic overpotential, ii) cathodic vs. anodic time ratio and iii) duration of the anodic pulse. After optimization of these parameters, phosphate ions were added and the electrolyte was stirred. The effects of a rise of the anodic overpotential on the grain sizes of the silver deposit and compact...
Ramkishen S. Rajan
Full Text Available This paper revisits the issue of exchange rate regimes in emerging Asia over the decade 1999–2009. It finds that while Asia is home to a wide array of exchange rate regimes, there are signs of gradual movement toward somewhat greater exchange rate flexibility in many of the regional countries. There appears to be evidence of an apparent “fear of appreciation” which is manifested in asymmetric exchange rate intervention—i.e., a willingness to allow depreciations but reluctance to allow appreciations. This policy of effective exchange rate undervaluation is rather unorthodox from a neoclassical sense, but is consistent with a development policy centered on suppressing the price of non-tradable goods relative to tradables (i.e., real exchange rate undervaluation.
ALEKSANDAR T. DIMITROV
Full Text Available This work is concerned with the use of reverse current regimes in order to form small-grained and compact silver deposits during the electro-refining process. Several parameters were varied, i.e., i anodic overpotential, ii cathodic vs. anodic time ratio and iii duration of the anodic pulse. After optimization of these parameters, phosphate ions were added and the electrolyte was stirred. The effects of a rise of the anodic overpotential on the grain sizes of the silver deposit and compactness were studied. Prolongation of the anodic time had a similar influence but with a decrease in current efficiency. An increase of the cathodic vs. anodic time ratio caused an enlargement of the grains and a decrease in the compactness of the deposit. Optimal morphological characteristics were obtained when PO43- was added and the electrolyte was stirred.
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.
Frost, Hans Staby; Hoff, Ayoe
The European Union adopted a landing obligation in 2015 implying that all catches of fish subject to quota management must be landed. We compare and contrast the economic consequences for fisheries of the landing obligation in view of the management system on which it is super-imposed. Four types...... the strongest influence on both industry profitability and catch of unwanted species in the case of management with shared non-transferable quotas. In addition, the move from management with shared quotas to individual transferable quotas (ITQ) increases industry profitability and reduces unwanted catches...
Meis, J.F.G.M.; Verweij, P.E.
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,
Longhurst, J. W. S.; Irwin, J. G.; Chatterton, T. J.; Hayes, E. T.; Leksmono, N. S.; Symons, J. K.
This paper considers the evolution of attempts to control and manage air pollution, principally but not exclusively focussing upon the challenge of managing air pollution in urban environments. The development and implementation of a range of air pollution control measures are considered. Initially the measures implemented primarily addressed point sources, a small number of fuel types and a limited number of pollutants. The adequacy of such a source-control approach is assessed within the context of a changing and challenging air pollution climate. An assessment of air quality management in the United Kingdom over a 50-year timeframe exemplifies the range of issues and challenges in contemporary air quality management. The need for new approaches is explored and the development and implementation of an effects-based, risk management system for air quality regulation is evaluated.
Belikov, V.S.; Kolesnichenko, Ya.I.; Plotnik, I.S.
The use of travelling waves for the steady-state current drive in an axisymmetric toroidal plasma in the banana regime is studied. The treatment is based on a quasi-linear equation for the electron distribution function averaged over the period of the particle motion along the small azimuth of the torus. It is show that the trapped electrons do not absorb the energy of the monochromatic (over frequency) RF field and thus only the circulating electrons contribute to the driving current and to the absorbed RF power. The current and the absorbed power are calculated by using the electron distribution function obtained for the case of narrow wave packet, both the toroidal magnetic field and the distortion of the electron distribution over transverse velocities being taken into consideration. The significant role of the barely carculating electrons is revealed. It is pointed out that the toroidal satellite resonances can affect the RF current drive by spreading and splitting the region of the wave-marticle interaction
Cristina Geambaşu; Liviu Geambaşu; Iulia Jianu
The present financial crises determines an increase in analysing the application of regime switching over portfolio investments. We applied the switching regimes to measurement of risk as presented in post-modern portfolio management theory. Post-modern portfolio theory include investor’s tendency to measure risk as the chance to obtain from the investment performed a return lower than the minimum expected by him. The investor, as presented by behavioural finance, is more concerned about his ...
Bate, Andrew M; Jones, Glyn; Kleczkowski, Adam; Naylor, Rebecca; Timmis, Jon; White, Piran C L; Touza, Julia
The maintenance of livestock health depends on the combined actions of many different actors, both within and across different regulatory frameworks. Prior work recognised that private risk management choices have the ability to reduce the spread of infection to trading partners. We evaluate the efficiency of farmers' alternative biosecurity choices in terms of their own-benefits from unilateral strategies and quantify the impact they may have in filtering the disease externality of trade. We use bovine viral diarrhoea (BVD) in England and Scotland as a case study, since this provides an example of a situation where contrasting strategies for BVD management occur between selling and purchasing farms. We use an agent-based bioeconomic model to assess the payoff dependence of farmers connected by trade but using different BVD management strategies. We compare three disease management actions: test-cull, test-cull with vaccination and vaccination alone. For a two-farm trading situation, all actions carried out by the selling farm provide substantial benefits to the purchasing farm in terms of disease avoided, with the greatest benefit resulting from test-culling with vaccination on the selling farm. Likewise, unilateral disease strategies by purchasers can be effective in reducing disease risks created through trade. We conclude that regulation needs to balance the trade-off between private gains from those bearing the disease management costs and the positive spillover effects on others.
Brandt, Jodi S; Allendorf, Teri; Radeloff, Volker; Brooks, Jeremy
Globally, deforestation continues, and although protected areas effectively protect forests, the majority of forests are not in protected areas. Thus, how effective are different management regimes to avoid deforestation in non-protected forests? We sought to assess the effectiveness of different national forest-management regimes to safeguard forests outside protected areas. We compared 2000-2014 deforestation rates across the temperate forests of 5 countries in the Himalaya (Bhutan, Nepal, China, India, and Myanmar) of which 13% are protected. We reviewed the literature to characterize forest management regimes in each country and conducted a quasi-experimental analysis to measure differences in deforestation of unprotected forests among countries and states in India. Countries varied in both overarching forest-management goals and specific tenure arrangements and policies for unprotected forests, from policies emphasizing economic development to those focused on forest conservation. Deforestation rates differed up to 1.4% between countries, even after accounting for local determinants of deforestation, such as human population density, market access, and topography. The highest deforestation rates were associated with forest policies aimed at maximizing profits and unstable tenure regimes. Deforestation in national forest-management regimes that emphasized conservation and community management were relatively low. In India results were consistent with the national-level results. We interpreted our results in the context of the broader literature on decentralized, community-based natural resource management, and our findings emphasize that the type and quality of community-based forestry programs and the degree to which they are oriented toward sustainable use rather than economic development are important for forest protection. Our cross-national results are consistent with results from site- and regional-scale studies that show forest-management regimes that
Full Text Available There is a large value added tax fraud in the European Union. The current value added tax system is universal as tax is applied to all parties involved in the chain transactions, thus creating a risk of tax losses if one of the parties involved in the chain transaction does not pay tax in good faith. There is the action plan to introduce the definitive value added tax to prevent tax fraud in intra-community transactions. However, in order to ensure normal value added tax administration in all member states, a number of measures are needed to be done. It is necessary to develop a mutual settlement mechanism in cases of intra-community transactions. The aim of this research is to develop a possible solution for the management of tax payments under the definitive value added tax regime. The results of the research show that to manage tax payments, several payment management systems can be used. However, as a solution, a special clearing system could be introduced. Quantitative research methods such as statistical methods were used in order to analyze the situation of tax fraud in EU and its main causes, as well as mathematical modeling methods to analyze the definitive VAT system and to calculate the balance between countries in an example for clearing mechanism.
Recent DIII-D experiments have advanced the normalized fusion performance of the high bootstrap current fraction tokamak regime toward reactor-relevant steady state operation. The experiments, conducted by a joint team of researchers from the DIII-D and EAST tokamaks, developed a fully noninductive scenario that could be extended on EAST to a demonstration of long pulse steady-state tokamak operation. Fully noninductive plasmas with extremely high values of the poloidal beta, βp >= 4 , have been sustained at βT >= 2 % for long durations with excellent energy confinement quality (H98y,2 >= 1 . 5) and internal transport barriers (ITBs) generated at large minor radius (>= 0 . 6) in all channels (Te, Ti, ne, VTf). Large bootstrap fraction (fBS ~ 80 %) has been obtained with high βp. ITBs have been shown to be compatible with steady state operation. Because of the unusually large ITB radius, normalized pressure is not limited to low βN values by internal ITB-driven modes. βN up to ~4.3 has been obtained by optimizing the plasma-wall distance. The scenario is robust against several variations, including replacing some on-axis with off-axis neutral beam injection (NBI), adding electron cyclotron (EC) heating, and reducing the NBI torque by a factor of 2. This latter observation is particularly promising for extension of the scenario to EAST, where maximum power is obtained with balanced NBI injection, and to a reactor, expected to have low rotation. However, modeling of this regime has provided new challenges to state-of-the-art modeling capabilities: quasilinear models can dramatically underpredict the electron transport, and the Sauter bootstrap current can be insufficient. The analysis shows first-principle NEO is in good agreement with experiments for the bootstrap current calculation and ETG modes with a larger saturated amplitude or EM modes may provide the missing electron transport. Work supported in part by the US DOE under DE-FC02-04ER54698, DE-AC52-07NA
Pedro Rodríguez Vargas
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.
Tabrizian, Parissa; Roayaie, Sasan; Schwartz, Myron E
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
Gottrup, F; Karlsmark, T
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....
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.
Honma, Toshihisa; Kaji, Ikuo; Fukai, Ichiro; Kito, Masafumi.
In the toroidal coordinates, a stability analysis is presented for very low-aspect-ratio tokamaks with circular cross section which is described by a surface current model (SCM) of axisymmetric equilibria. The energy principle determining the stability of plasma is treated without any expansion of aspect ratio. Numerical results show that, owing to the occurrence of the non-axisymmetric (n=1) unstable modes, there exists no MHD-stable ideal SCM spheromak characterized by zero external toroidal vacuum field. Instead, a stable spheromak-type plasma which comes to the ideal SCM spheromak is provided by the configuration with a very weak external toroidal field. Close to the spheromak regime (1.0 1 aspect ratio< = 1.1), the minimum safety factor and the critical β-values increase mo notonically with aspect ratio decreasing from a large value, and curves of βsub(p) versus β in the marginal stability approach to an ideal SCM spheromak line βsub(p)=β. (author)
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
Romero-Reyes, Marcela; Uyanik, James M
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.
de Groot, W. J.; Flannigan, M. D.; Cantin, A.
The effects of future fire regimes altered by climate change, and fire management in adaptation to climate change were studied in the boreal forest region of western Canada. Present (1975-90) and future (2080-2100) fire regimes were simulated for several National Parks using data from the Canadian (CGCM1) and Hadley (HadCM3) Global Climate Models (GCM) in separate simulation scenarios. The long-term effects of the different fire regimes on forests were simulated using a stand-level, boreal fire effects model (BORFIRE). Changes in forest composition and biomass storage due to future altered fire regimes were determined by comparing current and future simulation results. This was used to assess the ecological impact of altered fire regimes on boreal forests, and the future role of these forests as carbon sinks or sources. Additional future simulations were run using adapted fire management strategies, including increased fire suppression and the use of prescribed fire to meet fire cycle objectives. Future forest composition, carbon storage and emissions under current and adapted fire management strategies were also compared to determine the impact of various future fire management options. Both of the GCM's showed more severe burning conditions under future fire regimes. This includes fires with higher intensity, greater depth of burn, greater total fuel consumption and shorter fire cycles (or higher rates of annual area burned). The Canadian GCM indicated burning conditions more severe than the Hadley GCM. Shorter fire cycles of future fire regimes generally favoured aspen, birch, and jack pine because it provided more frequent regeneration opportunity for these pioneer species. Black spruce was only minimally influenced by future fire regimes, although white spruce declined sharply. Maintaining representation of pure and mixed white spruce ecosystems in natural areas will be a concern under future fire regimes. Active fire suppression is required in these areas. In
Cartwright, Rufus; Renganathan, Arasee; Cardozo, Linda
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.
van de Griendt, W.E.
In this paper it is proposed to analyse legal regimes for integrated management of estuaries with the help of institutional legal theory and the Schlager & Ostrom framework for types of ownership. Estuaries are highly valued and valuable and therefore need protection. The problem is that they
Fortini, Lucas B.; Cropper, Wendell P.; Zarin, Daniel J.
At the Amazon estuary, the oldest logging frontier in the Amazon, no studies have comprehensively explored the potential long-term population and yield consequences of multiple timber harvests over time. Matrix population modeling is one way to simulate long-term impacts of tree harvests, but this approach has often ignored common impacts of tree harvests including incidental damage, changes in post-harvest demography, shifts in the distribution of merchantable trees, and shifts in stand composition. We designed a matrix-based forest management model that incorporates these harvest-related impacts so resulting simulations reflect forest stand dynamics under repeated timber harvests as well as the realities of local smallholder timber management systems. Using a wide range of values for management criteria (e.g., length of cutting cycle, minimum cut diameter), we projected the long-term population dynamics and yields of hundreds of timber management regimes in the Amazon estuary, where small-scale, unmechanized logging is an important economic activity. These results were then compared to find optimal stand-level and species-specific sustainable timber management (STM) regimes using a set of timber yield and population growth indicators. Prospects for STM in Amazonian tidal floodplain forests are better than for many other tropical forests. However, generally high stock recovery rates between harvests are due to the comparatively high projected mean annualized yields from fast-growing species that effectively counterbalance the projected yield declines from other species. For Amazonian tidal floodplain forests, national management guidelines provide neither the highest yields nor the highest sustained population growth for species under management. Our research shows that management guidelines specific to a region’s ecological settings can be further refined to consider differences in species demographic responses to repeated harvests. In principle, such fine
Vicca, S.; Bahn, M.; Estiarte, M.
dependencies of SCE. Hence, the most justified answer to the question of whether current moisture responses of SCE can be extrapolated to predict SCE under altered precipitation regimes is 'no' - as based on the most reliable data sets available. We strongly recommend that future experiments focus more...
Full Text Available INTRODUCTION : The safety and efficacy of low dose Magnesium Sulphate regime in the management of Antepartum / Intrapartum / Postpartum eclampsia patients. METHODS : This study was conducted at Bowring and Ladycurzon Hospital in the Department of Obstetrics and Gynaecology BMCRI Bengaluru during the period of April 2013 to April 2014 100 eclampsia patients including antepartum eclampsia, intrapartum eclampsia, post - partum eclampsia were included for the purpose of this study. Magnesium Sulphate was used for the management of eclampsia. 50 eclamptic patients were treated with Pritchard regimen and other 50 with Dhaka regimen. Hypertension is treated with antihypertensive drugs. A detailed history, examination was done. In the present study 25 patients were below 20 years. In the study group 26 patients were between 28 to 37 weeks. 18 were more than 37 weeks. 6 patients were below 28 weeks. In patients treated under Pritchard regimen 44 were admitted in conscious state. Under Dhaka regimen 44 were conscious. In Dhaka regimen 28 patients had systolic BP above 161 mm Hg, under Pritchard 22 had systolic BP above 161 mm Hg. 18 Patients under Dhaka regimen had more than 110 mm Hg diastolic BP. In Pritchard regime 19 patients had diastolic BP more than 110 mm Hg. In patients treated with Dhaka regimen 26 underwent LSCS / Hysterectomy . In patients treated with Pritchard 26 were underwent LSCS. In Dhaka regimen 2 patients had abruption, 1 had HELLP and 5 had pulmonary edema. One patient developed occipital lobe infarct. In Pritchard regime 2 had abruption. 1 patient had HELLP and 2 had pulmonary edema. Out of the 100 patients, 98 were discharged from the hospital without any sequlae. 2 patients died due to complication of eclampsia. 10 perinatal death in Dhaka regime, 13 perinatal death in Pritchard regime. RESULTS : This present study compared the efficacy of low dose MgSO 4 with standard Pritchard regime. This study showed that recurrence of fits
Dunne, M. G.; Rathgeber, S.; Burckhart, A.; Fischer, R.; Giannone, L.; McCarthy, P. J.; Schneider, P. A.; Wolfrum, E.; the ASDEX Upgrade Team
ELM resolved edge current density profiles are reconstructed using the CLISTE equilibrium code. As input, highly spatially and temporally resolved edge electron temperature and density profiles are used in addition to data from the extensive set of external poloidal field measurements available at ASDEX Upgrade, flux loop difference measurements, and current measurements in the scrape-off layer. Both the local and flux surface averaged current density profiles are analysed for several ELM mitigation regimes. The focus throughout is on the impact of altered temperature and density profiles on the current density. In particular, many ELM mitigation regimes rely on operation at high density. Two reference plasmas with type-I ELMs are analysed, one with a deuterium gas puff and one without, in order to provide a reference for the behaviour in type-II ELMy regimes and high density ELM mitigation with external magnetic perturbations at ASDEX Upgrade. For type-II ELMs it is found that while a similar pedestal top pressure is sustained at the higher density, the temperature gradient decreases in the pedestal. This results in lower local and flux surface averaged current densities in these phases, which reduces the drive for the peeling mode. No significant differences between the current density measured in the type-I phase and ELM mitigated phase is seen when external perturbations are applied, though the pedestal top density was increased. Finally, ELMs during the nitrogen seeded phase of a high performance discharge are analysed and compared to ELMs in the reference phase. An increased pedestal pressure gradient, which is the source of confinement improvement in impurity seeded discharges, causes a local current density increase. However, the increased Zeff in the pedestal acts to reduce the flux surface averaged current density. This dichotomy, which is not observed in other mitigation regimes, could act to stabilize both the ballooning mode and the peeling mode at the
Jardel, E.; Alvarado, E.; Perez-Salicrup, D.; Morfín-Rios, J.
Knowledge and understanding of fire regimes is fundamental to design sound fire management practices. The high ecosystem diversity of Mexico offers a great challenge to characterize the fire regime variation at the landscape level. A conceptual model was developed considering the main factors controlling fire regimes: climate and vegetation cover. We classified landscape units combining bioclimatic zones from the Holdridge life-zone system and actual vegetation cover. Since bioclimatic conditions control primary productivity and biomass accumulation (potential fuel), each landscape unit was considered as a fuel bed with a particular fire intensity and behavior potential. Climate is also a determinant factor of post-fire recovery rates of fuel beds, and climate seasonality (length of the dry and wet seasons) influences fire probability (available fuel and ignition efficiency). These two factors influence potential fire frequency. Potential fire severity can be inferred from fire frequency, fire intensity and behavior, and vegetation composition and structure. Based in the conceptual model, an exhaustive literature review and expert opinion, we developed rules to assign a potential fire regime (PFR) defined by frequency, intensity and severity (i.e. fire regime) to each bioclimatic-vegetation landscape unit. Three groups and eight types of potential fire regimes were identified. In Group A are fire-prone ecosystems with frequent low severity surface fires in grasslands (PFR type I) or forests with long dry season (II) and infrequent high-severity fires in chaparral (III), wet temperate forests (IV, fire restricted by humidity), and dry temperate forests (V, fire restricted by fuel recovery rate). Group B includes fire-reluctant ecosystems with very infrequent or occasional mixed severity surface fires limited by moisture in tropical rain forests (VI) or fuel availability in seasonally dry tropical forests (VII). Group C and PFR VIII include fire-free environments
Sanford, T.W.L.; Welch, D.R.; Mock, R.C.
Measurements and analysis show that the 13 TW, Hermes-III [J. J. Ramirez et al., Digest of Technical Papers, 6th IEEE Pulsed Power Conference (Institute of Electrical and Electronic Engineers, New York, 1987), p. 294], pulsed, electron beam has two windows of stable transport in long drift cells filled with N 2 gas terminated by a bremsstrahlung producing target: a low-pressure window (between ∼1 and ∼100 mTorr) that is dominated by propagation in the semicollisionless ion-focused regime (IFR), and a high-pressure window (between ∼1 and ∼100 Torr) that is dominated by propagation in the resistive collisional regime. In the transition region between the two windows, beam plasma--electron instabilities significantly disrupt propagation. Propagation in both regimes (the IFR at early time and the collisional at later time) is observed from ∼5 to ∼100 mTorr, which produces two distinct bremsstrahlung pulses from the single injected beam pulse. As the pressure increases, two-stream instabilities terminate IFR propagation and the associated bremsstrahlung pulse earlier and earlier in time. Above 5 mTorr, the instability is sufficiently quenched by gas collisions that propagation in the collisional regime back in the beam body occurs, leading to a second propagation and associated bremsstrahlung pulse. Above 200 mTorr, the gas breaks down too rapidly for a significant IFR pulse to form, and for higher pressures only a single pulse in the collisional regime is propagated. Reasonable stability in the collisional regime is not achieved until pressures exceed 1 Torr
Ma, Hongyuan; Yang, Haoyu; Liang, Zhengwei; Ooi, Mark K. J.
Background Management regimes for vegetation restoration of degraded grasslands can significantly affect the process of ecological succession. However, few studies have focused on variation in the soil seed bank during vegetation restoration under different management regimes, especially in saline-alkaline grassland habitats. Our aim was to provide insights into the ecological effects of grassland management regimes on soil seed bank composition and vegetation establishment in mown, fenced, transplanted and natural grassland sites, all dominated by the perennial rhizomatous grass Leymus chinensis. Methodology We studied species composition and diversity in both the soil seed bank and aboveground vegetation in differently managed grasslands in Northeast China. An NMDS (nonmetric multidimensional scaling) was used to evaluate the relationship between species composition, soil seed banks, aboveground vegetation and soil properties. Principal Findings Fenced and mown grassland sites had high density and species richness in both the soil seed bank and aboveground vegetation. The Transplanted treatment exhibited the highest vegetation growth and seed production of the target species L. chinensis. Seeds of L. chinensis in the soil occurred only in transplanted and natural grassland. Based on the NMDS analysis, the number of species in both the soil seed bank and aboveground vegetation were significantly related to soil Na+, Cl-, RSC (residual sodium carbonate), alkalinity, ESP (exchangeable sodium percentage) and AP (available phosphorus). Conclusions Soil seed bank composition and diversity in the saline-alkaline grassland were significantly affected by the management regimes implemented, and were also significantly related to the aboveground vegetation and several soil properties. Based on vegetative growth, reproductive output and maintenance of soil seed bank, the transplanting was identified as the most effective method for relatively rapid restoration of the target
Lokanathan, Manojkumar [School of Mechanical Engineering, Purdue University, 585 Purdue Mall, West Lafayette, IN 47907-2088 (United States); Hibiki, Takashi [School of Nuclear Engineering, Purdue University, 400 Central Drive, West Lafayette, IN 47907-2017 (United States)
Highlights: • Downward flow regime maps and models were studied for 25.4 to 101.6 mm pipe diameters. • Effect of flow inlet on flow transition, void & interfacial area profile were studied. • Bubble void profiles were associated with the interfacial forces for downward flow. • Flow regime pressure drop and interfacial friction factor were studied. • The most applicable and accurate downward drift-flux correlation was determined. - Abstract: Downward two-phase flow is observed in light water reactor accident scenarios such as loss of coolant accident (LOCA) and loss of heat sink accident (LOHS) due to loss of feed water or a secondary pipe break. Hence, a comprehensive literature review has been performed for the co-current downward two-phase flow with information on the flow regime transitions and flow characteristics for each regime in the downward flow. The review compares the experimental data of the flow regime map and the current available transition models. Objectivity of the data varies on the method utilized as a certain degree of subjectivity is still present in the most objective method. Nevertheless, experimental data through subjective methods such as direct visualization or analysis of a wire mesh sensor (WMS) data were still studied in this review. Despite the wide range of flow regime data for numerous pipe sizes, a consensus was not reached for the effect of pipe sizes on flow regime transition. However, it is known that a larger pipe results in greater degree of coalescence at lower gas flow rates (Hibiki et al., 2004). The introduction of a flow straightener at the inlet led to less coring and fluid rotation and inevitably, reduced bubble coalescence. This also resulted in the disappearance of the kinematic shock wave phenomenon, contrary to an inlet without a flow straightener. The effect of flow inlet, flow location, pipe diameter and bubble interfacial forces on the radial distribution as well as bubble coalescence and breakup rate
Li, Jianrui; Xu, Yingming
We examined in situ remediation of sepiolite on cadmium-polluted soils with diverse water regimes, and several variables including brown rice Cd, exchangeable Cd, pH, and available Fe/P. pH, available Fe/P in soils increased gradually during continuous flooding, which contributed to Cd absorption on colloids. In control group (untreated soils), compared to conventional irrigation, brown rice Cd in continuous flooding reduced by 37.9%, and that in wetting irrigation increased by 31.0% (psoils reduced by 44.4%, 34.5% and 36.8% under continuous flooding, conventional irrigation and wetting irrigation (psoils reduced by 27.5-49.0%, 14.3-40.5%, and 24.9-32.8% under three water management regimes (psoils were higher in continuous flooding than in conventional irrigation and wetting irrigation. Continuous flooding management promoted soil Cd immobilization by sepiolite. Copyright © 2017. Published by Elsevier Inc.
Shivani Agarwal; Harini Nagendra; Rucha Ghate
This research examines the impact of forest management regimes, with various degrees of restriction, on forest conservation in a dry deciduous Indian forest landscape. Forest change is mapped using Landsat satellite images from 1977, 1990, 1999, and 2011. The landscape studied has lost 1478 km2 of dense forest cover between 1977 and 2011, with a maximum loss of 1002 km2 of dense forest between 1977 and 1990. The number of protected forest areas has increased, concomitant with an increase in r...
Tautenhahn, Susanne; Lichstein, Jeremy W; Jung, Martin; Kattge, Jens; Bohlman, Stephanie A; Heilmeier, Hermann; Prokushkin, Anatoly; Kahl, Anja; Wirth, Christian
Fire is a primary driver of boreal forest dynamics. Intensifying fire regimes due to climate change may cause a shift in boreal forest composition toward reduced dominance of conifers and greater abundance of deciduous hardwoods, with potential biogeochemical and biophysical feedbacks to regional and global climate. This shift has already been observed in some North American boreal forests and has been attributed to changes in site conditions. However, it is unknown if the mechanisms controlling fire-induced changes in deciduous hardwood cover are similar among different boreal forests, which differ in the ecological traits of the dominant tree species. To better understand the consequences of intensifying fire regimes in boreal forests, we studied postfire regeneration in five burns in the Central Siberian dark taiga, a vast but poorly studied boreal region. We combined field measurements, dendrochronological analysis, and seed-source maps derived from high-resolution satellite images to quantify the importance of site conditions (e.g., organic layer depth) vs. seed availability in shaping postfire regeneration. We show that dispersal limitation of evergreen conifers was the main factor determining postfire regeneration composition and density. Site conditions had significant but weaker effects. We used information on postfire regeneration to develop a classification scheme for successional pathways, representing the dominance of deciduous hardwoods vs. evergreen conifers at different successional stages. We estimated the spatial distribution of different successional pathways under alternative fire regime scenarios. Under intensified fire regimes, dispersal limitation of evergreen conifers is predicted to become more severe, primarily due to reduced abundance of surviving seed sources within burned areas. Increased dispersal limitation of evergreen conifers, in turn, is predicted to increase the prevalence of successional pathways dominated by deciduous hardwoods
The nuclear non-proliferation regime, despite being frequently criticised for an alleged lack of effectiveness, is in fact an amazing success story. The number of states which had conducted nuclear weapons activities in various stages but which have terminated them at one point surpasses the number of Nuclear-Weapon States (NWSs) by far. At the apex of its success, however, the regime is threatened by erosion from three different directions. A small number of rule-breakers and outsiders under-mine its central objective: to stop the spread of nuclear weapons. The refusal of the official NWSs to fulfil their undertaking of nuclear disarmament violates the principle of justice enshrined in the treaty and thereby destroys its legitimacy, as does the perceived readiness by nuclear suppliers to impede the development of nuclear technology in developing countries. The Gordian Knot can presumably only be cut by a u-turn towards a world without nuclear weapons. This insight has meanwhile reached the mainstream security establishment of the United States, the president included. Whether this road will really be taken will determine the future of the regime-with far-reaching consequences for global security. (author)
Drury, Colin; Tait, Gavin R
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
Bryceland, James K; Drury, Colin; Tait, Gavin R
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.
The management of technical knowledge is becoming one of the key issues and challenges in strengthening global nuclear safety. The success of the industry depends on how to optimize knowledge acquisition, transfer and deployment. In this presentation, joint conduct of large-scale R and D work, assurance of free flow of safety-related knowledge from developed to developing nations, and potential imposition of a trade agreement between nuclear exporting and importing nations are discussed. The introduction of a 'Global Nuclear Safety Treaty' could be an excellent mechanism for achieving effective knowledge management and eventually enforcing a global safety regime. (author)
Tørning, Kristian; Jaffari, Zeshan Ali; Vatrapu, Ravi
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...
Lee, Tau Hong; Lee, Linda Kay; Lye, David Chien; Leo, Yee Sin
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.
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.
Sampson, Michael J.
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.
Chirica, T.; Chiripus, V.
The regime of civil liability for nuclear damages in the Romanian legislation is defined by Law no. 703/2001 on civil liability for nuclear damages, as well as Government Decision no. 894/2003 for the approval of the Norms for the enforcement of Law no. 703/2001. These two documents constitute the legal framework that regulates the third party civil liability for nuclear damages. The paper aims at presenting to the audience the main elements of the relatively recent legal framework, namely: the scope of Law no. 703/2001, as well as the subjects to whom such law applies, the regime of civil liability for nuclear damages in Romania (with special emphasis on the relevant responsibilities of nuclear operators), the Romanian nuclear damages compensation system, statute of limitation for claims, types of insurance and financial guarantees covering against civil liability for nuclear damages, limits of nuclear operators' liability, specific requirements regarding the insurance, responsibilities of control and supervision bodies, assessment of nuclear damage.(author)
Fernando dos Santos Gomes
Full Text Available This study presented an economic analysis of management systems in unthinned and thinned Pinus taeda L. stands, where the objective was pulpwood and veneer yield. Simulation resultswere obtained by a growth and yield simulator called “PISAPRO”, developed from data collectedfrom continuous inventories at the PISA Florestal company. Simulations in unthinned standsconsidered: (a initial densities: 2000, 1667, 1333 and 1111 stems per hectare; and, (b rotation ages:from 9 until 20 years. The regimes simulated with one thinning considered: (a initial densities: 2,000,1,667, 1,333 and 1,111 stems per hectare; (b thinning ages: 6, 9 and 12 years; (c densities afterthinning: 400, 700 and 1,000 stems per hectare; and, (d rotation ages: 15, 18 and 21 years. Themanagement systems were simulated for five conditions of site. The sensitivity analysis of profitability,carried out with a program called “INVEST”, considered: (a discount rates: 6% and 8% p.a.; (bharvesting costs: in stands with good harvest conditions (flat and stands with steep terrain; (cpulpwood and veneer transportation distances: 15 km, 50 km and 85 km; and, (d veneer log prices:medium prices and increase of 20%. Site index and prices and costs parameters produced remarkableeffect on the best management system. Pulpwood transportation cost had highly expressive effect onthe profitability than veneer transportation cost. The best thinned regime allowed higher profitabilitythan the best unthinned regime, in all the simulated conditions of sensitive analysis. This superiority ofoncethinned regimes was greater under best sites and best costs and prices conditions considered inthe sensitivity analysis. .
Briffod, G.; Hoang, G.T.
On a tokamak in a current drive operation with a hybrid wave, the R.F. current is estimated from the voltage drop by plasma turn generated by R.F. power application. This estimated current is not proportional to the injected power. There still exists in the plasma an electric field corresponding to the current part produced by induction. The role evaluation of this parameter on the current drive efficiency is important. In this report the relation voltage-R.F. current is studied on Petula and results on the voltage evolution by turn on different machines are compared [fr
Hanson, Jacob J; Lorimer, Craig G
Moderate-severity disturbances appear to be common throughout much of North America, but they have received relatively little detailed study compared to catastrophic disturbances and small gap dynamics. In this study, we examined the immediate impact of moderate-intensity wind storms on stand structure, opening sizes, and light regimes in three hemlock-hardwood forests of northeastern Wisconsin. These were compared to three stands managed by single-tree and group selection, the predominant forest management system for northern hardwoods in the region. Wind storms removed an average of 41% of the stand basal area, compared to 27% removed by uneven-aged harvests, but both disturbances removed trees from a wide range of size classes. The removal of nearly half of the large trees by wind in two old-growth stands caused partial retrogression to mature forest structure, which has been hypothesized to be a major disturbance pathway in the region. Wind storms resulted in residual stand conditions that were much more heterogeneous than in managed stands. Gap sizes ranged from less than 10 m2 up to 5000 m2 in wind-disturbed stands, whereas the largest opening observed in managed stands was only 200 m2. Wind-disturbed stands had, on average, double the available solar radiation at the forest floor compared to managed stands. Solar radiation levels were also more heterogeneous in wind-disturbed stands, with six times more variability at small scales (0.1225 ha) and 15 times more variability at the whole-stand level. Modification of uneven-aged management regimes to include occasional harvests of variable intensity and spatial pattern may help avoid the decline in species diversity that tends to occur after many decades of conventional uneven-aged management. At the same time, a multi-cohort system with these properties would retain a high degree of average crown cover, promote structural heterogeneity typical of old-growth forests, and maintain dominance by late
We invoke the time-dependent noncrossing approximation in order to study the effects of the density of states of gold contacts on the instantaneous conductance of a single electron transistor which is abruptly moved into the Kondo regime by means of a gate voltage. For an asymmetrically coupled system, we observe that the instantaneous conductance in the Kondo time scale exhibits beating with distinct frequencies, which are proportional to the separation between the Fermi level and the sharp features in the density of states of gold. Increasing the ambient temperature or bias quenches the amplitude of the oscillations. We attribute the oscillations to interference between the emerging Kondo resonance and van-Hove singularities in the density of state. In addition, we propose an experimental realization of this model.
Vasilenko, O.I.; Voronin, V.S.; Lebedev, A.N.
A self-consistent kinematic model of a steady-state electron flow between two electrodes of a high-current diode has been considered with a tapered configuration. All the electrons have presumably been released from the cathode with a zero velocity and some portion of the total current flows along the cathode surface as the conduction current. A set of volt-ampere characteristics has been obtained for the tapered diode with a flat anode. At a preset cathode current the thickness and current of the electron layer increase as the voltage goes up. The considered kinematic model substantiates and specifies a model of the Brillouin parapotential flow
Pablo F Recinos
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.
Full Text Available The new solvency regime Solvency II represents a solid and harmonized prudential framework applicable by insurance companies in the European area. Solvency II was implemented in the European Union by adopting Directives 2009/138/EC respectively 2014/51/EU, replacing existing directives regulating solvency former regime, known as Solvency I. Thus, the new European legislation in insurance, applicable from 1 January 2016, was aimed at unifying the main European insurance market and ensuring consumer protection. The responsible authority at EU level with the implementation of the new solvency regime is EIOPA - European Insurance and Occupational Pensions Authority, which dealt in previous periods of testing the European market insurance through organizing quantitative impact studies (last exercise - QIS5, organized in 2011. The main standards derived from Solvency II and also the new IFRS accounting provisions, intended to increase the transparency of risk management and investment, in order to pricing insurance products and profitability of the different classes of insurance rates. Solvency II brings both challenges and opportunities for companies, changing the concept of building protection programs for insured and generating additional concerns about capital requirements in the determination of own funds (basic, auxiliary and surplus that can be used to meet this requirement. Also estimate realistic and prudent risk assumed by insurance contracts concluded transposed to the insurance companies by recording every technical reserves represent a very important element in order to establish an optimal balance of financial resources. Given the significant overlap between IFRS and Solvency II, insurers will have to improve disclosure requirements of additional information and adjust planning and forecasting. All these measures will increase the efficiency of financial management, a series of operational measures and by providing documented and tested
Wemheuer, Franziska; Kaiser, Kristin; Karlovsky, Petr; Daniel, Rolf; Vidal, Stefan; Wemheuer, Bernd
Endophytic bacteria are critical for plant growth and health. However, compositional and functional responses of bacterial endophyte communities towards agricultural practices are still poorly understood. Hence, we analyzed the influence of fertilizer application and mowing frequency on bacterial endophytes in three agriculturally important grass species. For this purpose, we examined bacterial endophytic communities in aerial plant parts of Dactylis glomerata L., Festuca rubra L., and Lolium perenne L. by pyrotag sequencing of bacterial 16S rRNA genes over two consecutive years. Although management regimes influenced endophyte communities, observed responses were grass species-specific. This might be attributed to several bacteria specifically associated with a single grass species. We further predicted functional profiles from obtained 16S rRNA data. These profiles revealed that predicted abundances of genes involved in plant growth promotion or nitrogen metabolism differed between grass species and between management regimes. Moreover, structural and functional community patterns showed no correlation to each other indicating that plant species-specific selection of endophytes is driven by functional rather than phylogenetic traits. The unique combination of 16S rRNA data and functional profiles provided a holistic picture of compositional and functional responses of bacterial endophytes in agricultural relevant grass species towards management practices.
Kim, Byong Joo; Sohn, Byung Hu; Jeong, Si Young
A study of counter-current two-phase flow in narrow rectangular channels has been performed. Two-phase flow regimes were experimentally investigated in a 760 mm long and 100 mm wide test section with 2.0 and 5.0 mm gap widths. The resulting flow regime maps were compared with the existing transition criteria. The experimental data and the transition criteria of the models showed relatively good agreement. However, the discrepancies between the experimental data and the model predictions of the flow regime transition became pronounced as the gap width increased. As the gap width increased the transition gas superficial velocities increased. The critical void fraction for the bubbly-to-slug transition was observed to be about 0.25. The two-phase distribution parameter for the slug flow was larger for the narrower channel. The uncertainties in the distribution parameter could lead to a disagreement in slug-to-churn transition between the experimental findings and the transition criteria. For the transition from churn to annular flow the effect of liquid superficial velocity was found to be insignificant
Supra-thermal ions can contribute to the steady-state current in future large tokamak machines like NET or ITER. The fast-ion population is generated by collisional slowing-down of high-energy ions which were injected as neutral atoms in quasi-tangential direction and ionized by plasma interactions. Depending on the initial beam shape these fast ions can excite microinstabilities of the Alfven-wave type which are driven by the gradients in velocity-space. The ensuring plasma turbulence is expected to slow down the fast ions very quickly. This effect reduces the current drive efficiency which otherwise is comparable to that of other current drive schemes like lower hybrid waves where the toroidal current is carried by high-energy resonant electrons. (author) 3 refs., 1 fig
This article analyzes the historical process related to the international organization of responsibilities and the management of the damages in case of a nuclear disaster. The author shows that the political and legal settings on which the discourse of an 'international regime of civil responsibility' (that emerged in the 1960's) relies, have globally aimed at maintaining a 'historical and spectacular gap' between the damages the nuclear operators are taking responsibility for, and the real and extensive damages engendered by a major accident. She argues that the existence of such a 'gap' is inherent to the nuclear sector, that it is a form of government (both of economic affairs and of the public space) which was historically constructed, and that the existence of such a gap is crucial for the survival of the nuclear industry itself. Thus the notion of 'responsibility' in the nuclear sector appears to serve mainly as a discursive regime, as a means to organize not only responsibilities but also irresponsibilities, whatever the geographic scale (national or international) at which they should be managed
Internal boundaries in multiphase flow greatly complicate fluid-dynamic and heat-transfer descriptions. Different flow regimes or topological configurations can have radically dissimilar interfacial and wall mass, momentum, and energy exchanges. To model the flow dynamics properly requires estimates of these rates. In this paper the common flow regimes for gas-liquid systems are defined and the techniques used to estimate the extent of a particular regime are described. Also, the current computer-code procedures are delineated and introduce a potentially better method is introduced
Yap, Adrian U.; Chua, Ai Ping
Bruxism is defined as the repetitive jaw muscle activity characterized by the clenching or grinding of teeth. It can be categorized into awake and sleep bruxism (SB). Frequent SB occurs in about 13% of adults. The exact etiology of SB is still unknown and probably multifactorial in nature. Current literature suggests that SB is regulated centrally (pathophysiological and psychosocial factors) and not peripherally (morphological factors). Cited consequences of SB include temporomandibular disorders, headaches, tooth wear/fracture, implant, and other restoration failure. Chairside recognition of SB involves the use of subjective reports, clinical examinations, and trial oral splints. Definitive diagnosis of SB can only be achieved using electrophysiological tools. Pharmacological, psychological, and dental strategies had been employed to manage SB. There is at present, no effective treatment that “cures” or “stops” SB permanently. Management is usually directed toward tooth/restoration protection, reduction of bruxism activity, and pain relief. PMID:27656052
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
Yap, Adrian U; Chua, Ai Ping
Bruxism is defined as the repetitive jaw muscle activity characterized by the clenching or grinding of teeth. It can be categorized into awake and sleep bruxism (SB). Frequent SB occurs in about 13% of adults. The exact etiology of SB is still unknown and probably multifactorial in nature. Current literature suggests that SB is regulated centrally (pathophysiological and psychosocial factors) and not peripherally (morphological factors). Cited consequences of SB include temporomandibular disorders, headaches, tooth wear/fracture, implant, and other restoration failure. Chairside recognition of SB involves the use of subjective reports, clinical examinations, and trial oral splints. Definitive diagnosis of SB can only be achieved using electrophysiological tools. Pharmacological, psychological, and dental strategies had been employed to manage SB. There is at present, no effective treatment that "cures" or "stops" SB permanently. Management is usually directed toward tooth/restoration protection, reduction of bruxism activity, and pain relief.
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.
Taeb, Abdalsamih M; Hooper, Michael H; Marik, Paul E
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.
Mehrtens, Ilayna K; Crapanzano, Kathleen; Tynes, L Lee
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.
le Bars, D.L.B.; de Ruijter, W.P.M.; Dijkstra, H.A.
An analysis of the Indian Ocean circulation and the Agulhas Current retroflection is carried out using a primitive equation model with simplified coastline and flat bottom. Four configurations with 0.258 and 0.18 horizontal resolution and in barotropic and baroclinic cases are considered. The wind
George R. Parker; Charles M. Ruffner
We review the historical and current status of forests in the Hoosier-Shawnee Ecological Assessment Area. Native American people influenced the vegetation through fire and agricultural clearing across the region until the early 1800s when European settlers arrived. Clearing of the land for agriculture peaked in the early 1900s after which badly eroded land was...
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
Fox, R; Nash, R; Liu, Z-W; Singh, A
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.
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
Andersen, Stine Linding; Laurberg, Peter
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.
Andersen, Stine Linding; Laurberg, Peter
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
Oudenhoven, van A.P.E.; Veerkamp, C.J.; Alkemade, Rob; Leemans, Rik
Over one billion people's livelihoods depend on dry rangelands through livestock grazing and agriculture. Livestock grazing and other management activities can cause soil erosion, increase surface runoff and reduce water availability. We studied the effects of different management regimes on soil
Dennis C Odion
Full Text Available There is widespread concern that fire exclusion has led to an unprecedented threat of uncharacteristically severe fires in ponderosa pine (Pinus ponderosa Dougl. ex. Laws and mixed-conifer forests of western North America. These extensive montane forests are considered to be adapted to a low/moderate-severity fire regime that maintained stands of relatively old trees. However, there is increasing recognition from landscape-scale assessments that, prior to any significant effects of fire exclusion, fires and forest structure were more variable in these forests. Biota in these forests are also dependent on the resources made available by higher-severity fire. A better understanding of historical fire regimes in the ponderosa pine and mixed-conifer forests of western North America is therefore needed to define reference conditions and help maintain characteristic ecological diversity of these systems. We compiled landscape-scale evidence of historical fire severity patterns in the ponderosa pine and mixed-conifer forests from published literature sources and stand ages available from the Forest Inventory and Analysis program in the USA. The consensus from this evidence is that the traditional reference conditions of low-severity fire regimes are inaccurate for most forests of western North America. Instead, most forests appear to have been characterized by mixed-severity fire that included ecologically significant amounts of weather-driven, high-severity fire. Diverse forests in different stages of succession, with a high proportion in relatively young stages, occurred prior to fire exclusion. Over the past century, successional diversity created by fire decreased. Our findings suggest that ecological management goals that incorporate successional diversity created by fire may support characteristic biodiversity, whereas current attempts to "restore" forests to open, low-severity fire conditions may not align with historical reference conditions in
Odion, Dennis C; Hanson, Chad T; Arsenault, André; Baker, William L; Dellasala, Dominick A; Hutto, Richard L; Klenner, Walt; Moritz, Max A; Sherriff, Rosemary L; Veblen, Thomas T; Williams, Mark A
There is widespread concern that fire exclusion has led to an unprecedented threat of uncharacteristically severe fires in ponderosa pine (Pinus ponderosa Dougl. ex. Laws) and mixed-conifer forests of western North America. These extensive montane forests are considered to be adapted to a low/moderate-severity fire regime that maintained stands of relatively old trees. However, there is increasing recognition from landscape-scale assessments that, prior to any significant effects of fire exclusion, fires and forest structure were more variable in these forests. Biota in these forests are also dependent on the resources made available by higher-severity fire. A better understanding of historical fire regimes in the ponderosa pine and mixed-conifer forests of western North America is therefore needed to define reference conditions and help maintain characteristic ecological diversity of these systems. We compiled landscape-scale evidence of historical fire severity patterns in the ponderosa pine and mixed-conifer forests from published literature sources and stand ages available from the Forest Inventory and Analysis program in the USA. The consensus from this evidence is that the traditional reference conditions of low-severity fire regimes are inaccurate for most forests of western North America. Instead, most forests appear to have been characterized by mixed-severity fire that included ecologically significant amounts of weather-driven, high-severity fire. Diverse forests in different stages of succession, with a high proportion in relatively young stages, occurred prior to fire exclusion. Over the past century, successional diversity created by fire decreased. Our findings suggest that ecological management goals that incorporate successional diversity created by fire may support characteristic biodiversity, whereas current attempts to "restore" forests to open, low-severity fire conditions may not align with historical reference conditions in most ponderosa
Powell, W.J.; Brown, R.G.; Galbraith, J.; Jensen, C.; Place, D.E.; Reddick, G.W.; Zuroff, W.; Brothers, A.J.
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
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.
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.
Full Text Available Water quality describes the physicochemical characteristics of the water body. These vary naturally with the weather and with the spatiotemporal variation of the water flow, i.e., the flow regime. Worldwide, biota have adapted to the variation in these variables. River channels and their riparian zones contain a rich selection of adapted species and have been able to offer goods and services for sustaining human civilizations. Many human impacts on natural riverine environments have been destructive and present opportunities for rehabilitation. It is a big challenge to satisfy the needs of both humans and nature, without sacrificing one or the other. New ways of thinking, new policies, and institutional commitment are needed to make improvements, both in the ways water flow is modified in rivers by dam operations and direct extractions, and in the ways runoff from adjacent land is affected by land-use practices. Originally, prescribed flows were relatively static, but precepts have been developed to encompass variation, specifically on how water could be shared over the year to become most useful to ecosystems and humans. A key aspect is how allocations of water interact with physicochemical variation of water. An important applied question is how waste releases and discharge can be managed to reduce ecological and sanitary problems that might arise from inappropriate combinations of flow variation and physicochemical characteristics of water. We review knowledge in this field, provide examples on how the flow regime and the water quality can impact ecosystem processes, and conclude that most problems are associated with low-flow conditions. Given that reduced flows represent an escalating problem in an increasing number of rivers worldwide, managers are facing enormous challenges.
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
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
Cellular properties of slug flow in vertical co-current gas-liquid flow: slug-churn transition; Caracteristiques cellulaires du regime a poches en ecoulement gaz-liquide co-courant vertical. Transition vers le regime destructure
This research thesis reports the study and description of the structure of a slug flow regime in a co-current vertical cylindrical duct, and the characterization and prediction of its transition towards a slug-churn (de-structured) regime. Flow physical mechanisms highlighted by the measurement of two important dynamics variables (wall friction and thickness of liquid films) are related to hypotheses of cellular models. The author first proposes an overview of slug flow regimes: theoretical steady and one-dimensional analysis, mass assessment equations of cellular models, application to the assessment of the flow rate and of the thickness of the film surrounding the gas slug. In the second part, the author addresses the slug flow regime transition towards the slug-churn regime: assessment of the evolution of flow dynamic properties, use of average wall friction analysis to obtain a relevant transition criterion. The third part presents experimental conditions, and measurement methods: conductometry for thickness measurement, polarography for wall friction measurement, and gas phase detection by using an optic barrier or optic fibres [French] Les ecoulements gaz-liquide en conduite verticale presentent quatre configurations ou regimes d'ecoulement. Ce travail porte sur le regime a poches et sur la transition vers la configuration qui lui succede: le regime destructure (churn flow). Les mesures sont effectuees a 200D du point d'injection du gaz, dans une conduite de 12.2 mm de diametre et pour le couple de fluides eau-azote. Les deux principales grandeurs mesurees en fonction des flux d'entree sont: le frottement parietal instantane (methode electrochimique) et l'epaisseur de film instantanee (methode conductimetrique). Une detection optique simultanee de la presence des phases permet un traitement conditionnel de la base de donnees. Les caracteristiques de la cellule moyenne representative de chaque point de fonctionnement en sont deduites: longueur de la cellule
Prevosto, L.; Mancinelli, B.; Chamorro, J. C.; Cejas, E.; Kelly, H.
Low-frequency (100 Hz), intermediate-current (50 to 200 mA) glow discharges were experimentally investigated in atmospheric pressure air between blunt copper electrodes. Voltage–current characteristics and images of the discharge for different inter-electrode distances are reported. A cathode-fall voltage close to 360 V and a current density at the cathode surface of about 11 A/cm 2 , both independent of the discharge current, were found. The visible emissive structure of the discharge resembles to that of a typical low-pressure glow, thus suggesting a glow-like electric field distribution in the discharge. A kinetic model for the discharge ionization processes is also presented with the aim of identifying the main physical processes ruling the discharge behavior. The numerical results indicate the presence of a non-equilibrium plasma with rather high gas temperature (above 4000 K) leading to the production of components such as NO, O, and N which are usually absent in low-current glows. Hence, the ionization by electron-impact is replaced by associative ionization, which is independent of the reduced electric field. This leads to a negative current-voltage characteristic curve, in spite of the glow-like features of the discharge. On the other hand, several estimations show that the discharge seems to be stabilized by heat conduction; being thermally stable due to its reduced size. All the quoted results indicate that although this discharge regime might be considered to be close to an arc, it is still a glow discharge as demonstrated by its overall properties, supported also by the presence of thermal non-equilibrium
Full Text Available Pattern formation, i.e., the generation of an inhomogeneous spatial activity distribution in a dynamical system with translation invariant structure, is a well-studied phenomenon in neuronal network dynamics,specifically in neural field models. These are population models to describe the spatio-temporal dynamics of large groups of neurons in terms of macroscopic variables such as population firing rates. Though neural field models are often deduced from and equipped with biophysically meaningfulproperties, a direct mapping to simulations of individual spiking neuron populations is rarely considered. Neurons have a distinct identity defined by their action on their postsynaptic targets. In its simplest form they act either excitatorily or inhibitorily.When the distribution of neuron identities is assumed to be periodic, pattern formation can be observed, given the coupling strength is supercritical, i.e., larger than a critical weight. We find that this critical weight is strongly dependent on the characteristics of the neuronal input, i.e., depends on whether neurons are mean- orfluctuation driven, and different limits in linearizing the full non-linear system apply in order to assess stability.In particular, if neurons are mean-driven, the linearization has a very simple form and becomesindependent of both the fixed point firing rate and the variance of the input current, while in the very strongly fluctuation-driven regime the fixed point rate, as well as the input mean and variance areimportant parameters in the determination of the critical weight.We demonstrate that interestingly even in ``intermediate'' regimes, when the system is technically fluctuation-driven, the simple linearization neglecting the variance of the input can yield the better prediction of the critical couplingstrength. We moreover analyze the effects of structural randomness by rewiring individualsynapses or redistributing weights, as well as coarse-graining on pattern
Kriener, Birgit; Helias, Moritz; Rotter, Stefan; Diesmann, Markus; Einevoll, Gaute T
Pattern formation, i.e., the generation of an inhomogeneous spatial activity distribution in a dynamical system with translation invariant structure, is a well-studied phenomenon in neuronal network dynamics, specifically in neural field models. These are population models to describe the spatio-temporal dynamics of large groups of neurons in terms of macroscopic variables such as population firing rates. Though neural field models are often deduced from and equipped with biophysically meaningful properties, a direct mapping to simulations of individual spiking neuron populations is rarely considered. Neurons have a distinct identity defined by their action on their postsynaptic targets. In its simplest form they act either excitatorily or inhibitorily. When the distribution of neuron identities is assumed to be periodic, pattern formation can be observed, given the coupling strength is supracritical, i.e., larger than a critical weight. We find that this critical weight is strongly dependent on the characteristics of the neuronal input, i.e., depends on whether neurons are mean- or fluctuation driven, and different limits in linearizing the full non-linear system apply in order to assess stability. In particular, if neurons are mean-driven, the linearization has a very simple form and becomes independent of both the fixed point firing rate and the variance of the input current, while in the very strongly fluctuation-driven regime the fixed point rate, as well as the input mean and variance are important parameters in the determination of the critical weight. We demonstrate that interestingly even in "intermediate" regimes, when the system is technically fluctuation-driven, the simple linearization neglecting the variance of the input can yield the better prediction of the critical coupling strength. We moreover analyze the effects of structural randomness by rewiring individual synapses or redistributing weights, as well as coarse-graining on the formation of
Burriel-Valencia, Jordi; Puche-Panadero, Ruben; Martinez-Roman, Javier; Sapena-Bano, Angel; Pineda-Sanchez, Manuel
The aim of this paper is to introduce a new methodology for the fault diagnosis of induction machines working in the transient regime, when time-frequency analysis tools are used. The proposed method relies on the use of the optimized Slepian window for performing the short time Fourier transform (STFT) of the stator current signal. It is shown that for a given sequence length of finite duration, the Slepian window has the maximum concentration of energy, greater than can be reached with a gated Gaussian window, which is usually used as the analysis window. In this paper, the use and optimization of the Slepian window for fault diagnosis of induction machines is theoretically introduced and experimentally validated through the test of a 3.15-MW induction motor with broken bars during the start-up transient. The theoretical analysis and the experimental results show that the use of the Slepian window can highlight the fault components in the current's spectrogram with a significant reduction of the required computational resources.
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
Matanic, R.; Lebegner, J.
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)
Full Text Available The aim of this paper is to introduce a new methodology for the fault diagnosis of induction machines working in the transient regime, when time-frequency analysis tools are used. The proposed method relies on the use of the optimized Slepian window for performing the short time Fourier transform (STFT of the stator current signal. It is shown that for a given sequence length of finite duration, the Slepian window has the maximum concentration of energy, greater than can be reached with a gated Gaussian window, which is usually used as the analysis window. In this paper, the use and optimization of the Slepian window for fault diagnosis of induction machines is theoretically introduced and experimentally validated through the test of a 3.15-MW induction motor with broken bars during the start-up transient. The theoretical analysis and the experimental results show that the use of the Slepian window can highlight the fault components in the current’s spectrogram with a significant reduction of the required computational resources.
Li, M. H.; Ding, B. J.; Zhang, J. Z.; Gan, K. F.; Wang, H. Q.; Zhang, L.; Wei, W.; Li, Y. C.; Wu, Z. G.; Ma, W. D.; Jia, H.; Chen, M.; Yang, Y.; Feng, J. Q.; Wang, M.; Xu, H. D.; Shan, J. F.; Liu, F. K.; Peysson, Y.
Significant progress on both L- and H-mode long-pulse discharges has been made recently in Experimental Advanced Superconducting Tokamak (EAST) with lower hybrid current drive (LHCD) [J. Li et al., Nature Phys. 9, 817 (2013) And B. N. Wan et al., Nucl. Fusion 53, 104006 (2013).]. In this paper, LHCD experiments at high density in L-mode plasmas have been investigated in order to explore possible methods of improving current drive (CD) efficiency, thus to extend the operational space in long-pulse and high performance plasma regime. It is observed that the normalized bremsstrahlung emission falls much more steeply than 1/n e-av (line-averaged density) above n e-av = 2.2 × 10 19 m −3 indicating anomalous loss of CD efficiency. A large broadening of the operating line frequency (f = 2.45 GHz), measured by a radio frequency (RF) probe located outside the EAST vacuum vessel, is generally observed during high density cases, which is found to be one of the physical mechanisms resulting in the unfavorable CD efficiency. Collisional absorption of lower hybrid wave in the scrape off layer (SOL) may be another cause, but this assertion needs more experimental evidence and numerical analysis. It is found that plasmas with strong lithiation can improve CD efficiency largely, which should be benefited from the changes of edge parameters. In addition, several possible methods are proposed to recover good efficiency in future experiments for EAST
The Large Helical Device (LHD) has shown the advantages of heliotron plasma for fusion reactor from operational point of view not only such as disruption free and steady state operation, but also as high density and stable high beta operation. Since the last Fusion Energy Conference in Daejon in 2010 (Yamada, 2011 Nucl. Fusion 51 094021), physical understanding as well as parameter improvement of net-current free helical plasmas has progressed successively. The current efforts are focused on optimization of plasma edge condition to extend the operation regime towards higher ion temperature and more stable high density. In LHD a part of open helical divertors are being modified to the baffle-structured closed ones to aim at active control of the edge plasma. It has been demonstrated that the neutral pressure in the closed helical divertor was more than 10 times higher than that in the open helical divertor. The central ion temperature has exceeded 7 keV. This high-T i plasma was obtained by a carbon pellet injection and the kinetic-energy confinement was improved by a factor of 1.5. Transport analysis of the high-T i plasmas has shown that the ion-thermal conductivity and the viscosity reduced after the pellet injection. Study of physics in 3-D geometry is highlighted in the topics of the response to Resonant Magnetic Perturbation such as ELM mitigation and divertor detachment. Novel approaches of non-local and non-diffusive transport have also been advanced. In this paper, highlighted results in these two years are overviewed. (author)
Pablo F. Méndez
Full Text Available Traditional policies for water resources management and wetland conservation are often based on command-and-control approaches. The latter tend to drive the human-wetland-water system into pathological states, characterized by more vulnerable ecosystems and rigid institutions for governance. The overcoming of these states may rest in the development of flexible and adaptive institutional regimes that rely on adaptive governance and management. Because past factors might constrain the implementation of more flexible adaptive approaches to management, it is important to understand the historical mechanisms underlying the genesis of institutional rigidity. We first present the results of a historical analysis of Doñana, which can be characterized as a pathological water socio-ecosystem governed through rigid institutional regimes for water resources management and wetland conservation. In a second step, we analyze the advances achieved during a recent, large-scale restoration program for the Doñana wetlands, which adhered explicitly to the tenets of adaptive management. Our analysis indicated that the historical persistence of command-and-control approaches has been a path-dependent process that led to the emergence of a rigid institutional regime and caused it to enter a rigidity trap. However, the achievements of the restoration program suggest that a more flexible and adaptive regime could be developed through the introduction of adaptive management at the operational levels, using specifically tailored action research programs. To conclude, we speculate that the research strategy outlined could be extended to comply with, or complement, the requirements of the EU's Water Framework Directive in other European water socio-ecosystems.
Tailor, Vijay; Bossi, Manuela; Greenwood, John A; Dahlmann-Noor, Annegret
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: firstname.lastname@example.org.
Senn, Charles L.
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)
Istrate Costin; Badea Dumitru
The new solvency regime Solvency II represents a solid and harmonized prudential framework applicable by insurance companies in the European area. Solvency II was implemented in the European Union by adopting Directives 2009/138/EC respectively 2014/51/EU, replacing existing directives regulating solvency former regime, known as Solvency I. Thus, the new European legislation in insurance, applicable from 1 January 2016, was aimed at unifying the main European insurance market and ensuring con...
Pilat, Joseph F.; Budlong-Sylvester, K.W.
Following the 1998 nuclear tests in South Asia and later reinforced by revelations about North Korean and Iraqi nuclear activities, there has been growing concern about increasing proliferation dangers. At the same time, the prospects of radiological/nuclear terrorism are seen to be rising - since 9/11, concern over a proliferation/terrorism nexus has never been higher. In the face of this growing danger, there are urgent calls for stronger measures to strengthen the current international nuclear nonproliferation regime, including recommendations to place civilian processing of weapon-useable material under multinational control. As well, there are calls for entirely new tools, including military options. As proliferation and terrorism concerns grow, the regime is under pressure and there is a temptation to consider fundamental changes to the regime. In this context, this paper will address the following: Do we need to change the regime centered on the Treaty on the Nonproliferation of Nuclear Weapons (NPT) and the International Atomic Energy Agency (IAEA)? What improvements could ensure it will be the foundation for the proliferation resistance and physical protection needed if nuclear power grows? What will make it a viable centerpiece of future nonproliferation and counterterrorism approaches?
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 ...
Nielsen, Mette Bak; Laurberg, Søren; Holm, Thorbjörn
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...
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
McGann, Patrick T.; Nero, Alecia C.; Ware, Russell E.
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
Thomas G Smith
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.
Lect. Dr. Chirimbu Sebastian
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.
Babu, Kalpana; Mahendradas, Padmamalini
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.
Balakumaran, K; Hugenholtz, P G
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.
Feldman, D.L.; Tennessee Univ., Knoxville, TN
This paper contends that an iterative ''functionalist'' regime -- comprised of international organizations that monitor the global climate and perform scientific and policy research on prevention, mitigation, and adaptation strategies for response to possible global warming -- has developed over the past decade. A common global effort by scientists, diplomats, and others to negotiate a framework convention that would reduce emissions of carbon dioxide and other ''greenhouse gases'' has been brought about by this regime. Individuals that participate in this regime are engaged in several cooperative activities including: (1) international research on the causes and consequences of global change; (2) global environmental monitoring and standard-setting for analyses of climate data; and (3) negotiating a framework convention that places limits on greenhouse gas emissions by countries. The implications of this iterative approach for successful implementation of a treaty to forestall global climate change are discussed
Bosscher, Marianne R F; van Leeuwen, Barbara L; Hoekstra, Harald J
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.
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
Siqueira, M. B.; Mota, F. C. M.
Before the large people influx and development of the central part of Brazil in the sixties, due to new capital Brasília, Cerrado, a typical Brazilian savanna-type vegetation, used to occupy about 2 million km2, going from the Amazon tropical forest, in the north, to the edges of what used to be the Atlantic forest in the southeast. Today, somewhat 50% of this area has given place to agriculture, pasture and managed forests. Understanding how Cerrado interacts with the atmosphere and how this interaction will be modified with this land-use change is a crucial step towards improving predictions of future climate-change scenarios. Cerrado is a vegetation adapted to a climate characterized by two distinct seasons, a wet season (Nov-Mar) and dry season (May-Ago), with April and October being transitions between seasons. Typically, 75% of precipitation happens in the wet-season months and only 5% during dry-season. In this study, it is investigated the potential impacts of the substitution of Cerrado to the eco-hydrological characteristics of the region. The focus here is Eucalyptus plantation, which has increased substantially in the last decade due to government incentives. Two eddy-covariance (EC) systems were installed, one in an undisturbed Cerrado Stricto area and other in a recently-established Eucalyptus plantation. The two areas are 1,400m apart and are subjected to the same meteorology and similar edaphic conditions. Besides instrumentation typical of EC towers, a soil-moisture profiling system was installed in each site. Surface flux data from the eddy-covariance towers, along with daily upper air sounding profiles collected at the Brasília International Airport (located 10Km from the towers), were used to drive a simplified Atmospheric Boundary Layer (ABL) slab model in order to investigate possible consequences of a large-scale shift from Cerrado to Eucalyptus to precipitation regimes in the region. Preliminary results show that replacing Cerrado for
Chi, C.C.; Vanneste, C.
A comprehensive picture of the dc current-voltage (I-V) characteristics of rf-driven Josephson junctions in the low-frequency regime is presented. The boundary of the low-frequency regime is roughly defined by the junction characteristic frequency for overdamped junctions, and by the inverse of the junction damping time for underdamped junctions. An adiabatic model valid for the low-frequency regime is used to describe the overall shapes of the I-V curves, which is in good agreement with both the numerical simulations and the experimental results. For underdamped junctions, the Shapiro steps are the prominent features on the I-V curves if the rf frequency is sufficiently below the boundary. As the rf frequency is increased towards the boundary, large negatively-going tails on top of the Shapiro steps are observed both experimentally and numerically. Numerical simulations using the resistively- and capacitively-shunted-junction model (RCSJ model) reveal that the negatively-going tail is a signature of the low-frequency boundary of the junction chaotic regime. With use of the adiabatic model and the existence of plasma oscillations for underdamped junctions, the onset of chaos and its effect on the Shapiro steps can be fully explained. The high-frequency limit of the adiabatic model and the chaotic behavior of the Josephson junctions beyond the low-frequency regime are also briefly discussed
Velz, Julia; Bozinov, Oliver; Sarnthein, Johannes; Regli, Luca; Bellut, David
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
Ul Haq, E.; Aslam, M.; Orfi, S.D.
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)
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.
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
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.
Taylor, Robert A; Weigele, John B; Kasner, Scott E
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.
Smith, Thomas G.
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
Khrizman, Marina; Pakalnis, Ann
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.
Iavazzo, Christos; Minis, Evelyn Eleni; Gkegkes, Ioannis D
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.
Spielmann, P M; Yu, R; Neeff, M
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.
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.
Eduardo Mekitarian Filho
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
Rizzo, Enrico; Heller, Reinhard; Richard, Laura Savoldi; Zanino, Roberto
Highlights: • The laminar regime in the meander flow geometry has been analysed with a previously validated computational strategy. • Several meander flow geometries as well as flow conditions have been analysed. • A range for the Reynolds number has been defined in which the flow can be considered laminar. • Correlations for the pressure drop and the heat transfer coefficients in the laminar regime have been derived. • A comparison between the computed the experimental pressure drop of the W7-X HTS current lead prototype is presented. -- Abstract: The Karlsruhe Institute of Technology and the Politecnico di Torino have developed and validated a computational thermal-fluid dynamics (CtFD) strategy for the systematic analysis of the thermal-hydraulics inside the meander flow heat exchanger used in high-temperature superconducting current leads for fusion applications. In the recent past, the application of this CtFD technique has shown that some operating conditions occurring in these devices may not reach the turbulent regime region. With that motivation, the CtFD analysis of the helium thermal-fluid dynamics inside different meander flow geometries is extended here to the laminar flow regime. Our first aim is to clarify under which operative conditions the flow regime can be considered laminar and how the pressure drop as well as the heat transfer are related to the geometrical parameters and to the flow conditions. From the results of this analysis, correlations for the pressure drop and for the heat transfer coefficient in the meander flow geometry have been derived, which are applicable with good accuracy to the design of meander flow heat exchangers over a broad range of geometrical parameters
Rizzo, Enrico, E-mail: email@example.com [Institute for Technical Physics, Karlsruhe Institute of Technology, 76021 Karlsruhe (Germany); Heller, Reinhard [Institute for Technical Physics, Karlsruhe Institute of Technology, 76021 Karlsruhe (Germany); Richard, Laura Savoldi; Zanino, Roberto [Dipartimento Energia, Politecnico di Torino, 10129 Torino (Italy)
Highlights: • The laminar regime in the meander flow geometry has been analysed with a previously validated computational strategy. • Several meander flow geometries as well as flow conditions have been analysed. • A range for the Reynolds number has been defined in which the flow can be considered laminar. • Correlations for the pressure drop and the heat transfer coefficients in the laminar regime have been derived. • A comparison between the computed the experimental pressure drop of the W7-X HTS current lead prototype is presented. -- Abstract: The Karlsruhe Institute of Technology and the Politecnico di Torino have developed and validated a computational thermal-fluid dynamics (CtFD) strategy for the systematic analysis of the thermal-hydraulics inside the meander flow heat exchanger used in high-temperature superconducting current leads for fusion applications. In the recent past, the application of this CtFD technique has shown that some operating conditions occurring in these devices may not reach the turbulent regime region. With that motivation, the CtFD analysis of the helium thermal-fluid dynamics inside different meander flow geometries is extended here to the laminar flow regime. Our first aim is to clarify under which operative conditions the flow regime can be considered laminar and how the pressure drop as well as the heat transfer are related to the geometrical parameters and to the flow conditions. From the results of this analysis, correlations for the pressure drop and for the heat transfer coefficient in the meander flow geometry have been derived, which are applicable with good accuracy to the design of meander flow heat exchangers over a broad range of geometrical parameters.
Van Wynsberge, Simon; Andréfouët, Serge; Gaertner-Mazouni, Nabila; Remoissenet, Georges
Despite actions to manage sustainably tropical Pacific Ocean reef fisheries, managers have faced failures and frustrations because of unpredicted mass mortality events triggered by climate variability. The consequences of these events on the long-term population dynamics of living resources need to be better understood for better management decisions. Here, we use a giant clam (Tridacna maxima) spatially explicit population model to compare the efficiency of several management strategies under various scenarios of natural mortality, including mass mortality due to climatic anomalies. The model was parameterized by in situ estimations of growth and mortality and fishing effort, and was validated by historical and new in situ surveys of giant clam stocks in two French Polynesia lagoons. Projections on the long run (100 years) suggested that the best management strategy was a decrease of fishing pressure through quota implementation, regardless of the mortality regime considered. In contrast, increasing the minimum legal size of catch and closing areas to fishing were less efficient. When high mortality occurred due to climate variability, the efficiency of all management scenarios decreased markedly. Simulating El Niño Southern Oscillation event by adding temporal autocorrelation in natural mortality rates increased the natural variability of stocks, and also decreased the efficiency of management. These results highlight the difficulties that managers in small Pacific islands can expect in the future in the face of global warming, climate anomalies and new mass mortalities. Copyright © 2017 Elsevier Inc. All rights reserved.
Chen, Zhipei; Koleva, D.A.; van Breugel, K.
Stray current arising from direct current electrified traction systems and then circulat-ing in reinforced concrete structures may initiate corrosion or even accelerate existing corrosion processes on embedded reinforcement. Therefore, stray-current induced corrosion of nearby reinforced concrete
Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew
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.
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.
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 ...
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 ...
Gomes Campelo Filho, Eulalio
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.
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 ...
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
Vicca, S.; Bahn, M.; Estiarte, M.
to fluctuations in soil temperature and soil water content can be used to predict SCE under altered rainfall patterns. Of the 58 experiments for which we gathered SCE data, 20 were discarded because either too few data were available or inconsistencies precluded their incorporation in the analyses. The 38...... remaining experiments were used to test the hypothesis that a model parameterized with data from the control plots (using soil temperature and water content as predictor variables) could adequately predict SCE measured in the manipulated treatment. Only for 7 of these 38 experiments was this hypothesis...... strongly on establishing response functions across a broader range of precipitation regimes and soil moisture conditions. Such experiments should make accurate measurements of water availability, should conduct high-frequency SCE measurements, and should consider both instantaneous responses...
Mutlu, A. Gizem
to describe aggregation and architectural evolution in nitritation/anammox reactors, incorporating the possible influences of intermediates formed with intermittent aeration. Community analysis revealed an abundant fraction of heterotrophic types despite the absence of organic carbon in the feed. The aerobic...... and anaerobic ammonia oxidizing guilds were dominated by fast-growing Nitrosomonas spp. and Ca. Brocadia spp., while the nitrite oxidizing guild was dominated by high affinity Nitrospira spp. Emission of nitrous oxide (N2O) was evaluated from both reactors under dynamic aeration regimes. Contrary to the widely...... impacts could be isolated, increasing process understanding. It was demonstrated that aeration strategy can be used as a powerful tool to manipulate the microbial community composition, its architecture and reactor performance. We suggest operation via intermittent aeration with short aerated periods...
Salles, Joanna; van Elsas, J.D.; Van Veen, J.A.
The main objective of this study was to determine the Burkholderia community structure associated with areas under different agricultural management and to evaluate to which extent this community structure is affected by changes in agricultural management. Two fields with distinct soil history
Salles, J.F.; Elsas, van J.D.; Veen, van J.A.
The main objective of this study was to determine the Burkholderia community structure associated with areas under different agricultural management and to evaluate to which extent this community structure is affected by changes in agricultural management. Two fields with distinct soil history
Salles, J. F.; van Elsas, J. D.; van Veen, J. A.
The main objective of this study was to determine the Burkholderia community structure associated with areas under different agricultural management and to evaluate to which extent this community structure is affected by changes in agricultural management. Two fields with distinct soil history
Lubbe, S.K.; Snoo, de G.R.
Aim To identify differences in Swallow abundance between organically and conventionally managed dairy farms, by examining three factors: farm buildings, food availability and farmer attitudes to Swallows. Methods Organic and conventional dairy farm holdings were compared in pairwise fashion. On
Kwak, Sung Woo; Jang, Sung Soon; Lee, Joung Hoon; Yoo, Ho Sik
Since 1990s, some events - detection of a dirty bomb in a Russian nation park in 1995, 9/11 terrorist attack to WTC in 2001, discovery of Al-Qaeda's experimentation to build a dirty bomb in 2003 etc - have showed that nuclear or radiological terrorism relating to radioactive materials (hereinafter 'radioactive materials' is referred to as 'nuclear material, nuclear spent fuel and radioactive source') is not incredible but serious and credible threat. Thus, to respond to the new threat, the international community has not only strengthened security and physical protection of radioactive materials but also established prevention of and response to illicit trafficking of radioactive materials. In this regard, our government has enacted or revised the national regulatory framework with a view to improving security of radioactive materials and joined the international convention or agreement to meet this international trend. For the purpose of prevention of nuclear/radiological terrorism, this paper reviews physical characteristics of nuclear material and existing detection instruments used for prevention of illicit trafficking. Finally, national detection regime against nuclear/radiological terrorism based on paths of the smuggled radioactive materials to terrorist's target building/area, national topography and road networks, and defence-in-depth concept is suggested in this paper. This study should contribute to protect people's health, safety and environment from nuclear/radiological terrorism
Gloos, K.; Utko, P.; Aagesen, M.
We investigate the I(V) characteristics (current versus bias voltage) of side-gated quantum-point contacts, defined in GaAs/AlxGa1-xAs heterostructures. These point contacts are operated in the closed-channel regime, that is, at fixed gate voltages below zero-bias pinch-off for conductance. Our....... Such a built-in energy-voltage calibration allows us to distinguish between the different contributions to the electron transport across the pinched-off contact due to thermal activation or quantum tunneling. The first involves the height of the barrier, and the latter also its length. In the model that we...
Rajan, Renju; Robin, Delvin T; M, Vandanarani
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.
Narendra Kumar Bhatia
Full Text Available With regard to forest management, rural livelihood, and poverty in India, it is often debated that JFM regime is not delivering livelihood functions of the forests to their dependents. This paper examines the state and scale of two decades old people-centric JFM system of India, and analyses the reasons with their indicators to shade off its shine in reducing povertyamong forest dependent people in several parts of the country. Paper also iscuss, how and to what extent, adoption of a multi-agency linked Collaborative Forest Management (CFM system could be a better strategy over JFM regime to reassure delivery of livelihood functions of the forests to their dependents in rural India. Arguments in this communication are intended to provide forest managers and policy-makers with necessary input to consider some location specific forest based entrepreneurial activities in CFM mode to provide a continuous source of small income to forest dependent people to ensure long lasting success of their forest management endeavours. Paper concludes with a recommendation to convert unviable JFM areas of India into a multiagency linked CFM system in a phased manner.
Full Text Available Innovative ways to manage the urban water cycle are required to deal with an ageing drinking and waste water infrastructure and new societal imperatives. This paper examines the influence of water governance in enabling transformations and technological innovation uptake in urban water management. A governance assessment framework is developed and applied in three case-studies, examining different scales and types of innovations used to tackle challenges in European urban water management. The methodology combines documentary analysis and interviews to reconstruct historical storylines of the shift in the water governance of urban water management for each site. The research provides detailed empirical observations on the factors conducive to innovation uptake at the local level. Critical governance factors such as commitment to compromise, the necessity to build political support, and the role of “entrepreneurs” and coalitions are highlighted. The paper also explores the role of discursive strategies and partnership design, as well as that of regulative, economic and communicative instruments, in creating barriers and opportunities to initiate and secure change. A number of recommendations targeted at innovators and water managers are presented in the conclusion.
Quitzau, Maj-Britt; Jensen, Jens Stissing; Elle, Morten
The endogenous agency that urban governments increasingly portray by making conscious and planned efforts to adjust the regimes they operate within is currently not well captured in transition studies. There is a need to acknowledge the ambiguity of regime enactment at the urban scale. This direc...
Piovesan, P.; Zuin, M.; Alfier, A.; Bonfiglio, D.; Bonomo, F.; Canton, A.; Cappello, S.; Carraro, L.; Cavazzana, R.; Fassina, A.; Gobbin, M.; Lorenzini, R.; Marrelli, L.; Martin, P.; Martines, E.; Pasqualotto, R.; Puiatti, M.E.; Spolaore, M.; Valisa, M.; Escande, D.F.
The RFX-mod machine (Sonato et al 2003 Fusion Eng. Des. 66 161) recently achieved, for the first time in a reversed-field pinch, high plasma current up to 1.6 MA with good confinement. Magnetic feedback control of magnetohydrodynamic instabilities was essential to reach the goal. As the current is raised, the plasma spontaneously accesses a new helical state, starting from turbulent multi-helical conditions. Together with this raise, the ratio between the dominant and the secondary mode amplitudes increases in a continuous way. This brings a significant improvement in the magnetic field topology, with the formation of helical flux surfaces in the core. As a consequence, strong helical transport barriers with maximum electron temperature around 1 keV develop in this region. The energy confinement time increases by a factor of 4 with respect to the lower-current, multi-helical conditions. The properties of the new helical state scale favourably with the current, thus opening promising perspectives for the higher current experiments planned for the near future.
Mašková, Z.; Doležal, J.; Květ, Jan; Zemek, František
Roč. 12, č. 132 (2009), s. 192-202 ISSN 0167-8809 R&D Projects: GA MZe QH92034 Institutional research plan: CEZ:AV0Z60870520 Keywords : Šumava National Park and Biosphere Reserve * grassland management * plant biomass Subject RIV: EF - Botanics Impact factor: 3.130, year: 2009
M. North; W Keeton
Sustainable forest management integrates ecological, social, and economic objectives. To achieve the former, researchers and practitioners are modifying silvicultural practices based on concepts from successional and landscape ecology to provide a broader array of ecosystem functions than is associated with conventional approaches. One...
Conservation implications: Wildfires are likely to remain dominant in eastern coastal fynbos, whilst large-scale implementation of prescribed burning is unattainable. Fires occurring in any season are not a reason for concern, although other constraints remain: the need for sufficient fire intensity, safety requirements, and integration of fire and invasive alien plant management.
Hophmayer Tokich, Sharon
In the state of Israel wastewater management (WWM), the legal responsibility of municipalities, was neglected for decades, resulting in pollution of the scarce water resources and the environment. This trend was reversed during the 1990s. This paper analyses the evolution process of the national WWM
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 ...
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.
Michael G. Patterson
Full Text Available A three year field experiment was conducted to evaluate the role of soil-inversion, cover crops and herbicide regimes for Palmer amaranth between-row (BR and within-row (WR management in glufosinate-resistant cotton. The main plots were two soil-inversion treatments: fall inversion tillage (IT and non-inversion tillage (NIT. The subplots were three cover crop treatments: crimson clover, cereal rye and winter fallow; and sub subplots were four herbicide regimes: preemergence (PRE alone, postemergence (POST alone, PRE + POST and a no herbicide check (None. The PRE herbicide regime consisted of a single application of pendimethalin at 0.84 kg ae ha−1 plus fomesafen at 0.28 kg ai ha−1. The POST herbicide regime consisted of a single application of glufosinate at 0.60 kg ai ha−1 plus S-metolachlor at 0.54 kg ai ha−1 and the PRE + POST regime combined the prior two components. At 2 weeks after planting (WAP cotton, Palmer amaranth densities, both BR and WR, were reduced ≥90% following all cover crop treatments in the IT. In the NIT, crimson clover reduced Palmer amaranth densities >65% and 50% compared to winter fallow and cereal rye covers, respectively. At 6 WAP, the PRE and PRE + POST herbicide regimes in both IT and NIT reduced BR and WR Palmer amaranth densities >96% over the three years. Additionally, the BR density was reduced ≥59% in no-herbicide (None following either cereal rye or crimson clover when compared to no-herbicide in the winter fallow. In IT, PRE, POST and PRE + POST herbicide regimes controlled Palmer amaranth >95% 6 WAP. In NIT, Palmer amaranth was controlled ≥79% in PRE and ≥95% in PRE + POST herbicide regimes over three years. POST herbicide regime following NIT was not very consistent. Averaged across three years, Palmer amaranth controlled ≥94% in PRE and PRE + POST herbicide regimes regardless of cover crop. Herbicide regime effect on cotton yield was highly significant; the maximum cotton yield was
S. Vicca; M. Bahn; M. Estiarte; E. E. van Loon; R. Vargas; G. Alberti; P. Ambus; M. A. Arain; C. Beier; L. P. Bentley; W. Borken; N. Buchmann; S. L. Collins; G. de Dato; J. S. Dukes; C. Escolar; P. Fay; G. Guidolotti; P. J. Hanson; A. Kahmen; G. Kröel-Dulay; T. Ladreiter-Knauss; K. S. Larsen; E. Lellei-Kovacs; E. Lebrija-Trejos; F. T. Maestre; S. Marhan; M. Marshall; P. Meir; Y. Miao; J. Muhr; P. A. Niklaus; R. Ogaya; J. Peñuelas; C. Poll; L. E. Rustad; K. Savage; A. Schindlbacher; I. K. Schmidt; A. R. Smith; E. D. Sotta; V. Suseela; A. Tietema; N. van Gestel; O. van Straaten; S. Wan; U. Weber; I. A. Janssens
As a key component of the carbon cycle, soil CO2 efflux (SCE) is being increasingly studied to improve our mechanistic understanding of this important carbon flux. Predicting ecosystem responses to climate change often depends an extrapolation of current relationships between ecosystem processes and their climatic drivers to conditions not yet experienced by the...
Burchfield, E. K.
The island nation of Sri Lanka is divided into two agro-climatic zones: the southwestern wet zone and the northeastern dry zone. The dry zone is exposed to drought-like conditions for several months each year. Due to the sporadic nature of rainfall, dry zone livelihoods depend on the successful storage, capture, and distribution of water. Traditionally, water has been captured in rain-fed tanks and distributed through a system of dug canals. Recently, the Sri Lankan government has diverted the waters of the nation's largest river through a system of centrally managed reservoirs and canals and resettled farmers to cultivate this newly irrigated land. This study uses remotely sensed MODIS and LANDSAT imagery to compare vegetation health and cropping patterns in these distinct water management regimes under different conditions of water scarcity. Of particular interest are the socioeconomic, infrastructural, and institutional factors that affect cropping patterns, including field position, water storage capacity, and control of water resources. Results suggest that under known conditions of water scarcity, farmers cultivate other field crops in lieu of paddy. Cultivation changes depend to a large extent on the institutional distance between water users and water managers as well as the fragmentation of water resources within the system.
Tang, Long; Gao, Yang; Wang, Cheng-Huan; Li, Bo; Chen, Jia-Kuan; Zhao, Bin
Invasive species have to be managed to prevent adverse consequences. Spartina alterniflora has invaded many marshes where salinity and inundation are often key factors affecting vegetation. The former was surface clipped twice and native Phragmites australis was planted in invaded zones to examine the effects of habitat properties on the efficacy of invader control and native restoration. The results showed that two clipping treatments almost eliminated S. alterniflora in the zones with long inundation periods of 80 h/15 d but stimulated compensatory growth of S. alterniflora in the zones with short inundation periods. Transplanted P. australis performed better over time in zones with low salinity (removal of the above-ground parts of S. alterniflora should be used only in the middle tidal zones and that native vegetation should be planted in zones above the mean high water level while the others zones in the saltmarsh should be restored to mud flats. Usually, invasive plants can flourish in highly heterogeneous habitats, which can influence management efficacy by influencing the re-growth of treated invaders and the performance of restored native species. Therefore, habitat-specific management regimes for invasive species can be expected to be more efficient because of their dependence on specific habitats.
In the past century, technological development has stimulated tremendous advances in manufacturing productivity and raised living standards throughout the many industrialized nations of the modern world. Only in the last quarter century, however, has the global community begun to recognize the environmental costs of this technological progress. Of principal concern is the large-scale generation by virtually all commercial and industrial sources of waste by-products posing substantial risks to human health or the environment. Methods of the appropriate management of these hazardous or toxic waste streams have received considerable attention in most developed states during the past two decades. More recently, the international community has recognized that hazardous waste management practices adopted by individual nations may pose significant transboundary environmental concerns. Extra-territorial impacts may arise directly, from the exportation of hazardous waste from one state to another, or indirectly, from the contamination of open-quotes migratory mediaclose quotes like air resources and water supplies. Recognition in the scientific community of hazardous waste's contribution to global pollution has progressed at the same time that a new sense of responsibility for the global environment has evolved in the international legal community. Accordingly, the international community has recently initiated several efforts to address the transboundary nature of hazardous waste management practices
van Doorn - Hoekveld, Willemijn
In the Netherlands, the history of water management and water safety especially, goes back centuries. Compensation of damage caused by lawful acts of an administrative body (no-fault liability) is developed mostly in the field of water management and has quite a long history as well. The
Nemov, V V; Kalyuzhnyj, V N; Kasilov, S V; Drevlak, M; Nuehrenberg, J; Kernbichler, W; Reiman, A; Monticello, D
For the magnetic field of the Wendelstein 7-X (W7-X) standard high-mirror configuration, computed by the PIES code, taking into account real coil geometry, neoclassical transport and bootstrap current are analysed in the 1/upsilon regime using methods based on the integration along magnetic field lines in a given magnetic field. The zero beta and (beta) = 1% cases are studied. The results are compared to the corresponding results for the vacuum magnetic field directly produced by modular coils. A significant advantage of W7-X over a conventional stellarator resulting from reduced neoclassical transport and from reduced bootstrap current follows from the computations although the neoclassical transport is somewhat larger than that previously obtained for the ideal W7-X model configuration
Eisted, Rasmus; Christensen, Thomas Højlund
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...
Yushkov, Georgy Yu.; Anders, A.
Metal ions were extracted from pulsed discharge plasmas operating in the transition region between vacuum spark (transient high voltage of kV) and vacuum arc (arc voltage ∼ 20 V). At a peak current of about 4 kA, and with a pulse duration of 8 (micro)s, we observed mean ion charges states of about 6 for several cathode materials. In the case of platinum, the highest average charge state was 6.74 with ions of charge states as high as 10 present. For gold we found traces of charge state 11, with the highest average charge state of 7.25. At currents higher than 5 kA, non-metallic contaminations started to dominate the ion beam, preventing further enhancement of the metal charge states
Apte, Aruna U; Apte, Uday M; Rendon, Rene G
.... 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...
Wilhite, E.L.; Dolenc, M.R.; Shupe, M.W.; Waldo, L.C.
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
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
Ian O’ Boyle
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.
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.
Willemijn van Doorn-Hoekveld
Full Text Available In the Netherlands, the history of water management and water safety especially, goes back centuries. Compensation of damage caused by lawful acts of an administrative body (no-fault liability is developed mostly in the field of water management and has quite a long history as well. The compensation of no-fault liability in the Netherlands since its introduction has been part of public law and not of civil law. This does not mean that the administration cannot be held liable for wrongful actions, in which case private law is applied. There is a strict distinction between wrongful and lawful acts of the administration: both can cause damage, but the way they are compensated differs: for lawful acts, public law is applied and for wrongful acts civil law (tort law is applied. This article only considers public law, because it is the most important branch of law for the compensation of damage caused in the field of water safety. The field of water safety and flood risk management has seen many new developments, of which integration is the latest one. However, the course of flood risk management tends towards more segmentation of responsibilities. No-fault liability and other questions of compensation are also areas that are developing towards more integration. Assessment of no-fault liability in the field of water safety management cannot be made without taking into consideration the historical development of the responsibility of the state for water management tasks in general. In this contribution, the author addresses the historical development of responsibilities of the state for water management tasks, recent developments in this area and the system of no-fault liability regarding measures to prevent flooding.
An introduction into the problem of two-phase flows is presented. Flow regimes arizing in two-phase flows are described, and classification of these regimes is given. Structures of vertical and horizontal two-phase flows and a method of their identification using regime maps are considered. The limits of this method application are discussed. The flooding phenomena and phenomena of direction change (flow reversal) of the flow and interrelation of these phenomena as well as transitions from slug regime to churn one and from churn one to annular one in vertical flows are described. Problems of phase transitions and equilibrium are discussed. Flow regimes in tubes where evaporating liquid is running, are described [ru
In the frame of radioactive waste management, this work aims to study the flow around a heating wall-mounted cylinder in crossflow in URANS approach. Well-known limitations of first order turbulence models lead us to consider second order turbulence modelling. In that frame, a heat transfer model is developed and validated on academic test cases. To begin with, when mixed convection regime is dominant, these simulations, completed by an isotherm one, all performed with low-Reynolds k-w SST model, give prominence to several eddy structures registered by the bibliography. One simulation is also performed with the high-Reynolds Rij-epsilon SSG model. With the k-w SST model, the heat transfer is correctly reproduced compared to the VALIDA experiment lead by the CEA, though with the Rij-epsilon SSG model, it is strongly under-estimated. It is supposed that it comes from the use of wall functions. Subsequently, when natural convection is predominant, flow topology becomes completely different and the heat transfer becomes less accurate to the VALIDA experiment. Following Durbin's approach, the Elliptic Blending-Renolds Stress Model EBRSM, consists in accounting for wall effects, and in wall blockage in particular. Following this formalism, an Elliptic Blending-Algebraic Flux Model is developed, the EBAFM. With this model, a priori tests in the three convection regimes and then simulations on the same test cases show major improvements in flow predictions. This leads to an interesting perspective to an intermediate model between SGDH and transport equations. (author)
Schroeder, Natalia Mariel; Castillo, Alicia
Dilemmas of natural resources governance have been a central concern for scholars, policy makers, and users. Major debates occur over the implications of property rights for common resources management. After the Mexican Revolution (1910-1917), land was distributed mainly as ejidos conceived as a hereditary but unalienable collective form of property. In 1992, a new Agrarian Law was decreed that allows individual ownership by removing various restrictions over the transfer of land. Scholars have examined the reform mainly focusing on land-tenure changes and environmental fragmentation. This study examines how the new ownership regime is affecting collective decision-making in ejidos located in a tropical dry forest (TDF) ecosystem. Information on decision-making processes before and after the 1992 reform was gathered through 52 interviews conducted in four ejidos selected along a gradient including agricultural, cattle-raising, and TDF use. The new individualized land property system reduced collective action in ejidos but did not trigger it. Collective action responses to the 1992 reform were buffered by self-organization each ejido already had. Heterogeneous users who shared a short history and showed little understanding of TDF and low dependence on its resources seemed to explain why ejidos have not been able to share a sense of community that would shape the construction of institutions for the collective management of forest resources. However, when a resource is scarce and highly valuable such as water the same users showed capacities for undertaking costly co-operative activities.
McGovern RP; Martin RL
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...
V. P. Bulatov
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.
Ord, R A; Blanchaert, R H
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.
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.
Schepaschenko, Dmitry; Shvidenko, Anatoly
The current state and trajectories of future development of natural landscapes in high latitudes of Northern Eurasia are defined inter alia by (1) current unsatisfactory social and economic situation in boreal Northern Eurasia; (2) the dramatic magnitude of on-going and expected climatic change (warming up to 10-12oC under global warming at 4oC); (3) increasing anthropogenic pressure, particularly in regions of intensive oil and gas exploration and extraction; (4) large areas of sparsely populated and practically unmanaged land; (5) vulnerability of northern ecosystems which historically developed under cold climates and buffering capacity of which is not well known; (6) risk of catastrophic natural disturbances (fire, insect outbreaks) whose frequency and severity have accelerated during recent decades; and (7) high probability of irreversible changes of vegetation cover. These specifics are overlapped with insufficient governance of natural renewable resources (e.g., forests) and destructed practice of industrial development of new territories (oil and gas extraction and exploration, metallurgy etc.). Based on a full carbon account for terrestrial vegetation ecosystems of Northern Eurasia, we analyze the relative impacts of major drivers on magnitude and uncertainty of the Net Ecosystem Carbon Balance (NECB) under current and expected climate and environment. Dynamic trends and interannual variability of NECB are mostly dependent on weather conditions during growth seasons of individual years, regimes of natural disturbances, and anthropogenic impacts on ecosystems. In a short term, disturbances and human impacts cause a theoretically 'manageable' part of the full carbon account, which on average is estimated to be of about 20% of annual net primary production. In a long term, thawing of permafrost and change of hydrological regimes of vast territories may result in a catastrophic decline of the forested area and wide distribution of 'green desertification'. The
Boehmel, Ute Constanze
management on quality parameters and (iv) environmentally benign crop rotation systems. Differently maturing maize varieties were grown in six different crop rotation systems (continuous maize with and without an undersown grass, maize as a main crop partially preceded by different winter catch crops and followed by winter wheat) and tested at two sites. Additional factors were sowing and/or harvest dates. Maize and cumulative biomass yields of the crop rotation systems were compared. Specific methane yield measurements were carried out to evaluate the energy performance of the tested crops. Quality was assessed either by measurements of the dry matter content or by using the near infrared reflectance spectroscopy for the determination of chemical composition. Results indicate that an environmentally benign crop rotation system requires nearly year-round soil cover to minimize nitrogen leaching. This can be achieved through the cultivation of undersown or catch crops and additional main crops alongside maize, such as winter wheat. Late maturing maize varieties can be cultivated at a site where the maize can build adequate dry matter contents due to a long growth period (late harvest date). The energy generation in terms of methane production was primarily dependent on high biomass yields. It could be further shown that the specific methane yield of maize increased with increasing starch content, digestibility and decreasing fiber content. To conclude, selected site-specific energy crops and crop rotation systems, with suitable crop management, (fertilizer and soil tillage) can produce high quality biomass and the highest net energy return. Lignocellulosic biomass can be optimized for combustion. Wet biomass is an optimal substrate for anaerobic digestion. Profitable energy production is characterized by a high land and energy use efficiency and especially high net energy yields. (orig.)
Kjonegaard, Rebecca; Fields, Willa; King, Major L
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.
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.
Cosgrove, William J.; Loucks, Daniel P.
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.
Christian Bugge. Henriksen
Full Text Available The Intergovernmental Panel on Climate Change (IPCC has identified a number of soil-management strategies that can be implemented to reduce GHG emissions. However, before deciding which of these strategies are most appropriate in any given situation, it is important to investigate how these strategies affect other aspects of sustainable development. For instance, some attempts to sequester carbon in the landscape could alter the soil's capacity to filter water. Alternatively, other strategies could unintentionally increase net energy consumption through greater fertilizer use. Focusing specifically on opportunities to implement soil-management strategies in the European Union (EU, we discuss the synergies and trade-offs of those strategies with respect to water resources management and energy security. The focus of the analysis is two-fold: first, we analyze the net benefit of strategies such as crop management, nutrient management, tillage and residue management, water management, and bioenergy vis-a-vis their implications for water resources and energy security; second, we undertake an assessment of the EU's relevant policy frameworks to assess whether the potential synergies from various soil-management strategies are being encouraged or, conversely, where perverse outcomes or trade-offs are likely. Our findings suggest there is much scope to encourage soil-management strategies in Europe that would mitigate greenhouse gas emissions, but these synergies are currently not fully exploited at the EU policy level. We identify a number of options for better policy integration among the Common Agricultural Policy, the Water Framework Directive, and the Climate Action and Renewable Energy Package.
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.
Dobreanu, Dan; Svendsen, Jesper Hastrup; Lewalter, Thorsten
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...
Reinhardt, John W
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."
Supply in fisheries is traditionally known for its backward bending nature, owing to externalities in production. Such a supply regime, however, exist only for pure open access fisheries. Since most fisheries worldwide are neither pure open access, nor optimally managed, rather between the extremes......, the traditional understanding of supply regimes in fisheries needs modification. This paper identifies through a case study of the East Baltic cod fishery supply regimes in fisheries, taking alternative fisheries management schemes and mesh size limitations into account. An age-structured Beverton-Holt based bio......-economic supply model with mesh sizes is developed. It is found that in the presence of realistic management schemes, the supply curves are close to vertical in the relevant range. Also, the supply curve under open access with mesh size limitations is almost vertical in the relevant range, owing to constant...
Motojima, O.; Yamada, H.; Komori, A.; Ohyabu, N.; Mutoh, T.; Kaneko, O.; Kawahata, K.; Mito, T.; Ida, K.; Imagawa, S.; Nagayama, Y.; Shimozuma, T.; Watanabe, K.Y.; Masuzaki, S.; Miyazawa, J.; Morisaki, T.; Morita, S.; Ohdachi, S.; Ohno, N.; Saito, K.; Sakakibara, S.; Takeiri, Y.; Tamura, N.; Toi, K.; Tokitani, M.; Yokoyama, M.; Yoshinuma, M.; Ikeda, K.; Isayama, A.; Ishii, K.; Kubo, S.; Murakami, S.; Nagasaki, K.; Seki, T.; Takahata, K.; Takenaga, H.
The performance of net-current free heliotron plasmas has been developed by findings of innovative operational scenarios in conjunction with an upgrade of the heating power and the pumping/fuelling capability in the Large Helical Device (LHD). Consequently, the operational regime has been extended, in particular, with regard to high density, long pulse length and high beta. Diversified studies in LHD have elucidated the advantages of net-current free heliotron plasmas. In particular, an internal diffusion barrier (IDB) by a combination of efficient pumping of the local island divertor function and core fuelling by pellet injection has realized a super dense core as high as 5 x 10 20 m -3 , which stimulates an attractive super dense core reactor. Achievements of a volume averaged beta of 4.5% and a discharge duration of 54 min with a total input energy of 1.6 GJ (490 kW on average) are also highlighted. The progress of LHD experiments in these two years is overviewed by highlighting IDB, high β and long pulse
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
Aljateeli, Manar; Fu, Jia-Hui; Wang, Hom-Lay
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.
Ramasamy, A; Hill, A M; Clasper, J C
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.
Investigating the mechanisms responsible for ecological thresholds is essential to understanding processes leading to ecosystem regime shifts. Dryland ecosystems are especially prone to threshold behavior wherein stressor-mediated alteration of patterns and processes can shift systems to alternative...
Beattie, Clare; Newton, Alex; Longhurst, Jim [University of the West of England, Air Quality Research Group, Bristol (United Kingdom)
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)
Shankar, Roopa Kanakatti; Backeljauw, Philippe F.
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
Silverman, Enid; Ebright, Linda; Kwiatkowski, Marianne; Cullina, Joanne
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.
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.
Goff, Christopher J; Allred, Carly; Glade, Robert S
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.
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.
Raghu, Ganesh; Richeldi, Luca
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.
Jordan, Natasha; D’Cruz, David
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
Ichii, T.; Nishikawa, H.; Igarashi, H.; Okamura, H.; Mahapatra, K.; Sakai, M.; Wakabayashi, T.; Inagake, D.; Okada, Y.
We investigated the impacts of extensive anthropogenic (high seas driftnet squid fishery) and natural (late 1990s major climate regime shift) events on dominant epipelagic fish, squid, and shark in the central North Pacific Transition Region based on a driftnet survey covering the years 1979-2006. Fishing was conducted by Japan, Korea and Taiwan to target neon flying squid in the period 1979-1992, resulting in a decline in stocks of the target species and non-target species (Pacific pomfret and juvenile blue shark), which were by-catch of this fishery. The catch was found to be at the maximum sustainable yield (MSY) level for neon flying squid, the underfished level for juvenile blue shark, but the overfished level for Pacific pomfret. The MSY of Pacific pomfret indicated that this species is more susceptible to exploitation than previously considered. In response to the late 1990s regime shift, neon flying squid and Pacific saury showed low stock levels in 1999-2002 and 1998-2002, respectively, as a result of reduced productivity in their nursery grounds (the Subtropical Frontal Zone and Kuroshio Extension Bifurcation Region, respectively). On the other hand, Pacific pomfret showed no decreasing trend in stock during the low- and intermediate-productivity regimes because of the high productivity of their main spawning/nursery ground (Transition Zone Chlorophyll Front), which was independent of the regime shifts. Thus, squid and saury appear to be more susceptible to the regime shift than pomfret. We discuss the implications for stock management of the species-specific responses to the fishery and the regime shift.
Ridolfi, Danielle R.; Hayes, Jacqueline F.; St Paul, Michelle; Wilfley, Denise E.
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
Behnam Saberi; Alia S.Dadabhai; Yoon-Young Jang; Ahmet Gurakar; Esteban Mezey
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.
Danilo Icaza Ortiz
Full Text Available This paper is a review of the competition regime works of various authors, published under the auspices of the University of the Hemispheres and the Corporation for Studies and Publications. Analyzes the structure, the general concepts, case law taken for development. Includes comments on the usefulness of this work for the study of competition law and the contribution to the lawyers who want to practice in this branch of economic law.
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
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
Phillips, Elizabeth; Kieley, Sam; Johnson, Elizabeth B; Monga, Manoj
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.
Bahlai, C.A.; Werf, van der W.; O'Neal, M.; Hemerik, L.; Landis, D.A.
The spread and impact of invasive species may vary over time in relation to changes in the species itself, the biological community of which it is part, or external controls on the system. Here we investigate whether there have been changes in dynamic regimes over the last 20 years of two invasive
Bonebrake, Timothy C; Syphard, Alexandra D; Franklin, Janet; Anderson, Kurt E; Akçakaya, H Resit; Mizerek, Toni; Winchell, Clark; Regan, Helen M
Most species face multiple anthropogenic disruptions. Few studies have quantified the cumulative influence of multiple threats on species of conservation concern, and far fewer have quantified the potential relative value of multiple conservation interventions in light of these threats. We linked spatial distribution and population viability models to explore conservation interventions under projected climate change, urbanization, and changes in fire regime on a long-lived obligate seeding plant species sensitive to high fire frequencies, a dominant plant functional type in many fire-prone ecosystems, including the biodiversity hotspots of Mediterranean-type ecosystems. First, we investigated the relative risk of population decline for plant populations in landscapes with and without land protection under an existing habitat conservation plan. Second, we modeled the effectiveness of relocating both seedlings and seeds from a large patch with predicted declines in habitat area to 2 unoccupied recipient patches with increasing habitat area under 2 projected climate change scenarios. Finally, we modeled 8 fire return intervals (FRIs) approximating the outcomes of different management strategies that effectively control fire frequency. Invariably, long-lived obligate seeding populations remained viable only when FRIs were maintained at or above a minimum level. Land conservation and seedling relocation efforts lessened the impact of climate change and land-use change on obligate seeding populations to differing degrees depending on the climate change scenario, but neither of these efforts was as generally effective as frequent translocation of seeds. While none of the modeled strategies fully compensated for the effects of land-use and climate change, an integrative approach managing multiple threats may diminish population declines for species in complex landscapes. Conservation plans designed to mitigate the impacts of a single threat are likely to fail if additional
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
McGovern, Ryan P; Martin, RobRoy L
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
Hobbs, Jonathan G; Young, Jacob S; Bailes, Julian E
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.
Liñán, C; Del Rosal, Y; Carrasco, F; Vadillo, I; Benavente, J; Ojeda, L
This study shows the utilization of the air CO 2 exhaled by a very high number of visitors in the Nerja Cave as both a tracer and an additional tool to precisely evaluate the air circulation through the entire karst system, which includes non-touristic passages, originally free of anthropogenic CO 2 . The analysis of the temporal - spatial evolution of the CO 2 content and other monitoring data measured from January 2015 to December 2016 in the Nerja-Pintada system, including air microbiological controls, has allowed us to define a new general ventilation model, of great interest for the conservation of the subterranean environment. During the annual cycle four different ventilation regimes and two ventilation modes (UAF-mode and DAF-mode) exist which determine the significance of the anthropogenic impact within the caves. During the winter regime, the strong ventilation regime and the airflow directions from the lowest to the highest entrance (UAF-mode) contribute to the rapid elimination of anthropogenic CO 2 , and this affects the whole karstic system. During the summer regime the DAF-mode ventilation (with airflows from the highest to the lowest entrances) is activated. Although the number of visitors is maximum and the natural ventilation of the karstic system is the lowest of the annual cycle, the anthropogenic impact only affects the Tourist Galleries. The transitional ventilation regimes -spring and autumn- are the most complex of the annual cycle, with changing air-flow directions (from UAF-mode to DAF-mode and vice versa) at diurnal and poly diurnal scale, which conditions the range of the anthropogenic impact in each sector of the karst system. The activation of the DAF-mode has been observed when the temperature difference between the external and air cave is higher than 5°C. Copyright © 2018 Elsevier B.V. All rights reserved.
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
van den Bosch, A.L.M.
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.
Evgenii V. Ohotskii
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
Alvarado, Swanni T; Silva, Thiago Sanna Freire; Archibald, Sally
Humans can alter fire dynamics in grassland systems by changing fire frequency, fire seasonality and fuel conditions. These changes have effects on vegetation structure and recovery, species composition, and ecosystem function. Understanding how human management can affect fire regimes is vital to detect potential changes in the resilience of plant communities, and to predict vegetation responses to human interventions. We evaluated the fire regimes of two recently protected areas in Madagascar (Ibity and Itremo NPA) and one in Brazil (Serra do Cipó NP) before and after livestock exclusion and fire suppression policies. We compare the pre- and post-management fire history in these areas and analyze differences in terms of total annual burned area, density of ignitions, burn scar size distribution, fire return period and seasonal fire distribution. More than 90% of total park areas were burned at least once during the studied period, for all parks. We observed a significant reduction in the number of ignitions for Ibity NPA and Serra do Cipó NP after livestock exclusion and active fire suppression, but no significant change in total burned area for each protected area. We also observed a seasonal shift in burning, with fires happening later in the fire season (October-November) after management intervention. However, the protected areas in Madagascar had shorter fire return intervals (3.23 and 1.82 years) than those in Brazil (7.91 years). Our results demonstrate that fire exclusion is unattainable, and probably unwarranted in tropical grassland conservation areas, but show how human intervention in fire and vegetation patterns can alter various aspects of the fire regimes. This information can help with formulating realistic and effective fire management policies in these valuable conservation areas. Copyright © 2018 Elsevier Ltd. All rights reserved.
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
Shah, Adarsh P; Mourad, Moustafa M; Bramhall, Simon R
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
ANDREEA PAULA DUMITRU
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.
Pan Feng Ming
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.
Angarita, Fernando A; Dueck, Andrew D; Azouz, Solomon M
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.
Beno, J.H.; Weldon, W.F.
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
Taviloglu, Korhan; Yanar, Hakan
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.
Prof. Ph.D. Gheorghe Popescu
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.
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 ...
Linda Tedrow; Wendel J. Hann
The Fire Regime Condition Class (FRCC) is a composite departure measure that compares current vegetation structure and fire regime to historical reference conditions. FRCC is computed as the average of: 1) Vegetation departure (VDEP) and 2) Regime (frequency and severity) departure (RDEP). In addition to the FRCC rating, the Vegetation Condition Class (VCC) and Regime...
Reports effects of institutional regimes on levels of dependency among residents of public homes for the elderly in England. Differences in management practices and caring routines did not affect the creation or reduction of dependency among residents. Questions the rationale that informs some current notions of good practice in residential work.…
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.
Vartanian, Lenny R
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.
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.
Proclemer, Alessandro; Dobreanu, Dan; Pison, Laurent
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....
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.
Biagi, K.; Oswald, C.; Nicholls, E.; Carey, S.
Bitumen extraction via surface mining in the Athabasca Oil Sands Region (AOSR) results in permanent alteration of the landscape once rich in boreal forest and wetlands. As part of their legal requirements, oil companies must reclaim disturbed landscapes into functioning ecosystems, and to date only two pilot wetland-peatland systems have been constructed. Peatland reclamation is challenging as they must be completely reconstructed with few guidelines or previous work in this region. Furthermore, the variable sub-humid climate and salinity of waste-materials are obstacles to the success of peatland creation. In 2012, Syncrude Canada Ltd. constructed a 52 ha upland-wetland system, the Sandhill Fen Watershed (SFW), which was designed with a pump and underdrain system to provide freshwater and enhance drainage to limit salinization from underlying waste materials that have elevated electrical conductivity (EC) and Na+. The objective of this research is to understand the hydrochemical response of a constructed wetland to variations in hydrological management with respect to sources, flow pathways and major chemical transformations of water in the three years following commissioning. EC, major ions and stable isotopes were collected using a combination of high frequency and discrete water sampling from 2013-2015. Results indicate that high activity of both inflow and outflow pumps in 2013 kept the EC relatively low, with most wetland sites 1000 µS/cm in 2014 and >2000 µS/cm in 2015. Most wetland sites remained Ca+2 dominant where Ca+2 and Na+ averaged 200 and 130 mg/L, respectively. However, the most notable change in 2014 and 2015 was the emergence of several Na+ "hotspots" in the margins where Na+ concentrations averaged 450 mg/L while Ca+2 averaged 250 mg/L. Stable isotope data confirm that the "hotspots" match the underlying waste water and provide evidence of its upward transport and seepage under a natural hydrologic regime. Minimizing salinization is critical
Chinnery, G E; Madiba, T E
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.
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
Brian D. Duty
Full Text Available Introduction. Complications following renal transplantation include ureteral obstruction, urinary leak and fistula, urinary retention, urolithiasis, and vesicoureteral reflux. These complications have traditionally been managed with open surgical correction, but minimally invasive techniques are being utilized frequently. Materials and Methods. A literature review was performed on the use of endourologic techniques for the management of urologic transplant complications. Results. Ureterovesical anastomotic stricture is the most common long-term urologic complication following renal transplantation. Direct vision endoureterotomy is successful in up to 79% of cases. Urinary leak is the most frequent renal transplant complication early in the postoperative period. Up to 62% of patients have been successfully treated with maximal decompression (nephrostomy tube, ureteral stent, and Foley catheter. Excellent outcomes have been reported following transurethral resection of the prostate shortly after transplantation for patients with urinary retention. Vesicoureteral reflux after renal transplant is common. Deflux injection has been shown to resolve reflux in up to 90% of patients with low-grade disease in the absence of high pressure voiding. Donor-gifted and de novo transplant calculi may be managed with shock wave, ureteroscopic, or percutaneous lithotripsy. Conclusions. Recent advances in equipment and technique have allowed many transplant patients with complications to be effectively managed endoscopically.
Bali, Rajeev K; Dwivedi, Ashish
This chapter outlines contributions to a workshop for ICMCC 2005. We details some of the central issues surrounding the incorporation of the Knowledge Management (KM) paradigm for the healthcare and clinical sectors. The complex nature of KM is discussed, together with some essential theories and some contemporary applications of the tools and techniques are presented.
level as sickle cell disease. Sickle cell anemia is due to the substitution of thymine for adenine ..... and local instillation of vaso-active drugs, shunting ... oral pseudoephedrine at night as an attempt to ..... Management of Cancer. Pain. Clinical ...
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 ...
Chondrichthyans (sharks, skates, rays and chimaeras) are captured in many marine fisheries. Management and research efforts directed at chondrichthyan fishing are often neglected because of low product value, taxonomic uncertainty, low capture rates, and harvesting by multiple fisheries. In South Africa's diverse fishery ...
Broek, A.M. van den; Feenstra, L.; Baat, C. de
Halitosis is an unpleasant or offensive odour, emanating from the oral cavity. In approximately 80% of all cases, halitosis is caused by microbial degradation of oral organic substrates. Major degradation products are volatile sulphur-containing compounds. In this review, the available management
Issues identified as important to the future of information resources management and use in higher education include information policy in a networked environment, distributed computing, integrating information resources and college planning, benchmarking information technology, integrated digital libraries, technology integration in teaching,…
Introduction: Sudan is one of the developing countries that face a great challenge with cancer management. About 5700 cases had been seen during year 2007 in Radiation and Isotope Center- Khartoum (RICK) and Institute of Nuclear medicine, Molecular biology, and Oncology (INMO) Wadmedani which are the only ...
Al Ariss, A.; Cascio, W.F.; Paauwe, J.
Research on Talent Management (TM) has been lagging behind businesses in offering vision and leadership in this field. After sketching a comprehensive outline of knowledge about TM, theoretical as well as practical, we introduce the papers in this special issue and their important contributions.
Full Text Available Mrica Reservoir is one of many reservoirs located in Central Java that experienced a considerably high sedimentation during the last ten years. This condition has caused a rapid decrease in reservoir capacity. Various countermeasures have been introduced to reduce the rate of the reservoir sedimentation through catchment management and reservoir operation by means of flushing and/or dredging. However, the sedimentation remains intensive so that the fulfillment of water demand for electrical power generation was seriously affected. This paper presents the results of evaluation on the dynamics of the purpose of this research is to evaluate the sediment balance of the Mrica Reservoir based on two different scenarios, i.e. the existing condition and another certain type of reservoir management. The study on sediment balance was carried out by estimating the sediment inflow applying sheet erosion method in combination with the analysis of sediment rating curve. The measurement of the deposited sediment rate in the reservoir was conducted through the periodic echo sounding, whereas identification of the number of sediment that has been released from the reservoir was carried out through the observation on both flushing and dredging activities. The results show that during the last decade, the rate of the sediment inflow was approximately 5.869 MCM/year, whereas the released sediment from the reservoir was 4.097 MCM/year. In order to maintain the reservoir capacity, therefore, at least 1.772 MCM/year should be released from the reservoir by means of either flushing or dredging. Sedimentation management may prolong the reservoir’s service life to exceed the design life. Without sediment management, the lifetime of the reservoir would have finished by 2016, whereas with the proper management the lifetime may be extended to 2025.
Brenda B. Lin
Full Text Available Managing terrestrial systems has become increasingly difficult under climate change as unidirectional shifts in climate conditions challenge the resilience of ecosystems to maintain their compositional structure and function. Despite the increased attention of resilience management to guide transformational change, questions remain as to how to apply resilience to manage transitions. Rather than pushing systems across thresholds into alternative states, climate change may create a stepwise progression of unknown transitional states that track changing climate conditions. Because of this uncertainty, we must find ways to guide transitioning systems across climate boundaries towards states that are socially and environmentally desirable. We propose to ease the uncertainty of managing shifting systems by providing an approach to adaptive management that we call guided transition, where socially and environmentally important ecosystem functions are preserved through transitions by considering and maintaining the species and structures needed for the desired functions. Scientifically, it will require a better understanding of the relationships between structure, species composition, and function for specific systems. Managers will also need to identify important functions at the local, regional, and national scale, and to determine how best to transition systems to a desired state based on existing scientific knowledge. Guided transition, therefore, helps guide the process of adaptive management by specifying a function-based management pathway that guides transitions through climatic changes.
Molokhia, Mariam; Majeed, Azeem
Because of ageing populations, the growth in the number of people with multi-morbidity and greater compliance with disease-specific guidelines, polypharmacy is becoming increasingly common. Although the correct drug treatment in patients with complex medical problems can improve clinical outcomes, quality of life and life expectancy, polypharmacy is also associated with an increased risk of adverse drug events, some severe enough to result in hospital admission and even death. Hence, having systems in place to ensure that medications are started only when there is a suitable indication, ensuring patients are fully aware of the benefits and complications that may arise from their treatment, and reviewing patients regularly to ensure their medication regime remains appropriate, are essential. The development and rapid uptake of electronic patient records - particularly in primary care settings where the majority of prescribing takes place - makes monitoring of patients more straightforward than in the past; and allows identification of sub-groups of patients at particularly high risk of adverse drug events and complications. It also facilitates 'deprescribing' the process by which medications are reviewed and stopped if not clinically beneficial. In recent years, we have also seen the development of smartphone 'apps' to improve communication between patients and healthcare professionals, improve people's understanding of their conditions and their treatment, and maintain a record of changes made to patient's medication. In the longer term, developments such as the introduction of artificial intelligence and clinical decision support systems also have the potential to improve prescribing and minimise the risks from polypharmacy. Finally, there is considerable scope to improve the quality of prescribing and reduce risks from poly-pharmacy using non-medical groups such as pharmacists, specialist nurses and physician assistants. Polypharmacy has increased in recent
Carter, E; French, S [Manchester Business School, University of Manchester, Booth Street West, Manchester M15 6PB (United Kingdom)
We describe the results of process mapping of nuclear emergency management procedures in four European countries. We find clear differences and explore these in relation to their suitability for building a shared understanding across the emergency management team of the evolving situation and a balanced appreciation of the uncertainties. Our findings indicate that there are some issues that cause concern in that the procedures may run smoothly and efficiently but they may also risk underestimating uncertainty or ignore key issues that have only been identified by a minority of experts or models. We are concerned that they do not facilitate the building of shared mental models that the literature such as that on highly reliable organisations has shown is important.
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.
Kapoor, Uditi; Sharma, Gaurav; Juneja, Manish; Nagpal, Archna
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
Burns, E.R.; Bates, A.L.; Webb, D.H.
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.
Carter, E; French, S
We describe the results of process mapping of nuclear emergency management procedures in four European countries. We find clear differences and explore these in relation to their suitability for building a shared understanding across the emergency management team of the evolving situation and a balanced appreciation of the uncertainties. Our findings indicate that there are some issues that cause concern in that the procedures may run smoothly and efficiently but they may also risk underestimating uncertainty or ignore key issues that have only been identified by a minority of experts or models. We are concerned that they do not facilitate the building of shared mental models that the literature such as that on highly reliable organisations has shown is important
Syed, Jamil S; Javier-Desloges, Juan; Tatzel, Stephanie; Bhagat, Ansh; Nguyen, Kevin A; Hwang, Kevin; Kim, Sarah; Sprenkle, Preston C
Active surveillance has been increasingly utilized as a strategy for the management of favorable-risk, localized prostate cancer. In this review, we describe contemporary management strategies of active surveillance, with a focus on traditional stratification schemes, new prognostic tools, and patient outcomes. Patient selection, follow-up strategy, and indication for delayed intervention for active surveillance remain centered around PSA, digital rectal exam, and biopsy findings. Novel tools which include imaging, biomarkers, and genetic assays have been investigated as potential prognostic adjuncts; however, their role in active surveillance remains institutionally dependent. Although 30-50% of patients on active surveillance ultimately undergo delayed treatment, the vast majority will remain free of metastasis with a low risk of dying from prostate cancer. The optimal method for patient selection into active surveillance is unknown; however, cancer-specific mortality rates remain excellent. New prognostication tools are promising, and long-term prospective, randomized data regarding their use in active surveillance will be beneficial.
In this paper, the development of nuclear power in China, its status of operating nuclear power plants and progress of on-going NPP projects are described. With the arising of spent fuel from NPPs, a national policy of a closed nuclear fuel cycle has been determined. Following storage at reactor sites for at least 5 years (generally maximum 10 years), spent fuel will be transferred to an away-from-reactor pool type centralized storage facility. Adjacent to the storage facility, a multi-purpose reprocessing pilot plant will be set up by the end of this century. An industrial scale reprocessing plant would be succeeded around the year 2020. China's spent fuel management activities include at-reactor storage, transportation, away-from-reactor storage and reprocessing. Relatively detailed description of the work done up to now on spent fuel management and plans for the future are described. It should be noted that activities related to the management of high level radioactive waste are not included here. (author)
Ha, Kyoung Hwa; Kim, Dae Jung
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.
Monti, Elena; Mottes, Monica; Fraschini, Paolo; Brunelli, PierCarlo; Forlino, Antonella; Venturi, Giacomo; Doro, Francesco; Perlini, Silvia; Cavarzere, Paolo; Antoniazzi, Franco
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
van der Pol, R.J.
Pediatric gastroesophageal reflux disease (GERD) is a disorder difficult to diagnose and to treat. Due to the current definition of GERD, i.e. gastroesophageal reflux (GER) causing bothersome symptoms and/or complications, diagnosis is subject to broad interpretation. This thesis consists of studies
Malfroot, Anne; Adam, Georgios; Ciofu, Oana
for palivizumab in CF as an alternative but expensive prophylaxis. Anti-bacterial vaccinations protecting directly against Pseudomonas aeruginosa colonisation are promising for the future, potential candidates are currently being assessed in phase III clinical trials. More studies are needed to complete...
Annals of African Medicine. Journal Home · ABOUT · 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 · Download this PDF file. The PDF file you selected should load here if your Web ...
Møller, Jan Kloppenborg; Carstensen, Jacob; Madsen, Henrik
the physical and biological knowledge of the system, and nonlinearities introduced here can generate regime shifts or enhance the probability of regime shifts in the case of stochastic models, typically characterized by a threshold value for the known driver. A simple model for light competition between...... definition and stability of regimes become less subtle. Ecological regime shifts and their modeling must be viewed in a probabilistic manner, particularly if such model results are to be used in ecosystem management....
Aimakhu, C O; Olayemi, O; Iwe, C A B; Oluyemi, F A; Ojoko, I E; Shoretire, K A; Adeniji, R A; Aimakhu, V E
Violence against women is an important health and human rights issue. It carries with it both short- and long-term sequelae for women that can affect both their physical and psychological wellbeing. Every day obstetric providers treat patients who have been assaulted. Timely identification can interrupt the cycle of violence, prevent further injury and initiate the help-seeking process. The objectives of this study were to survey how often Nigerian obstetrician-gynaecologists see these patients in their practice and to describe the demographics and management of their most recent case so as to give an idea of the extent of the problem. This is especially important as abuse is grossly under-reported because the victims are afraid to report it because of male dominance in society and the fear of losing their homes. We used a self-administered questionnaire survey of 138 practising obstetricians and gynaecologists in Nigeria. Questions were asked about the yearly estimation of cases seen and how recently a case was seen. The type of abuse, risk factors and management of their most recent case was also documented. Most (98.6%) obstetricians surveyed had previously managed a case of violence. The mean estimate of abused women seen was 7.0 per year. Details of the last case managed were recollected by 91.3% of respondents. The majority (51.6%) of patients were pregnant. The assailant was the husband in 69.8% of cases and the most common factor for abuse was as a result of women requesting money for the family needs from their husbands. The most common type of abuse was physical (79.4%), with 34.9% of patients sustaining cuts. Treatment and counselling were the forms of management in most cases. The police were informed in 9.5% of cases and one obstetrician had to give evidence in court. Of the pregnant abused women, 73.8% had live births. Better job opportunities and female empowerment can reduce the risk of violence. Obstetricians should screen routinely for battery
Modeling of an eddy-current ferrite-cored probe response in time harmonic regime; Modelisation de la reponse d'un capteur a courants de Foucault comportant un noyau ferromagnetique en regime harmonique
In aeronautics, non destructive evaluation by eddy-current is commonly used to detect corrosion area or cracks in structures. Eddy-current testing by using ferrite-cored probes is effective to detect these kind of defects. So, having a model able to predict these probes responses is a major endeavor. Our work consisted in developing a model determining the ferrite-cored probes response to a defect. To model fields inside both the core and the defect, an integral formulation has been used resulting from the application of the Green theorem onto the equations of propagation. Simulation results have been compared to synthetic data obtained by a finite-element method and they have been validated by comparison with measured impedance data. However as this model may be computationally costly, the use of the so-called non-linear approximation has been tested to tackle the case of long defects. The model has been integrated inside the CIVA platform developed by the CEA. (author)
Jiang, Jianguo; Lou, Zhiying; Ng, Silo; Luobu, Ciren; Ji, Duo
The Tibetan Plateau has an average altitude of more than 4,000 m. The total area of Tibetan Plateau is 2,400,000 km2, which occupies 25% of the area of China. Due to the high altitude, the environment has low atmospheric pressure, low oxygen content, and low temperature, and is also fragile. Investigations concerning MSW generation and characteristics, MSW management, collection and transportation, and treatment and disposal of MSW covered four representative cities, including the urban areas of Lhasa city, Shigatse, Nedong of Lhoka and Bayi of Nyingtri. The results show that MSW generation in the urban areas of Lhasa city and Tibet were 450 t/d and 3,597 t/d, respectively, in 2006. However, accelerated economic development and flourishing tourism caused by the opening of the Qinghai-Tibet Railway (QTR) have greatly increased solid waste generation to a new high. It is predicted that MSW generation in Tibet will reach 4,026 t/d in 2010 and 4,942 t/d in 2020. MSW management and disposal lag behind MSW generation due to a number of factors such as equipment shortage, insufficient maintenance, exhaustion of waste treatment capacity and low recycling efficiency. Still, MSW in most areas is dumped in the open with no controls. Because no appropriate collection and treatment systems for leachate and landfill gas exist, untreated leachate is discharged directly into the environment, causing serious secondary pollution. Some suggestions on improving the MSW management system are presented in this paper.
Jiang Jianguo; Lou Zhiying; Ng Silo; Luobu Ciren; Ji Duo
The Tibetan Plateau has an average altitude of more than 4,000 m. The total area of Tibetan Plateau is 2,400,000 km 2 , which occupies 25% of the area of China. Due to the high altitude, the environment has low atmospheric pressure, low oxygen content, and low temperature, and is also fragile. Investigations concerning MSW generation and characteristics, MSW management, collection and transportation, and treatment and disposal of MSW covered four representative cities, including the urban areas of Lhasa city, Shigatse, Nedong of Lhoka and Bayi of Nyingtri. The results show that MSW generation in the urban areas of Lhasa city and Tibet were 450 t/d and 3,597 t/d, respectively, in 2006. However, accelerated economic development and flourishing tourism caused by the opening of the Qinghai-Tibet Railway (QTR) have greatly increased solid waste generation to a new high. It is predicted that MSW generation in Tibet will reach 4,026 t/d in 2010 and 4,942 t/d in 2020. MSW management and disposal lag behind MSW generation due to a number of factors such as equipment shortage, insufficient maintenance, exhaustion of waste treatment capacity and low recycling efficiency. Still, MSW in most areas is dumped in the open with no controls. Because no appropriate collection and treatment systems for leachate and landfill gas exist, untreated leachate is discharged directly into the environment, causing serious secondary pollution. Some suggestions on improving the MSW management system are presented in this paper
Evangelos P. Misiakos
Full Text Available Necrotizing fasciitis is a severe, rare, potentially lethal soft tissue infection that develops in the scrotum and perineum, the abdominal wall or the extremities. The infection progresses rapidly, and septic shock may ensue; hence, the mortality rate is high (median mortality 32.2%. Prognosis becomes poorer in the presence of co-morbidities, such as diabetes mellitus, immunosuppression, chronic alcohol disease, chronic renal failure and liver cirrhosis. Necrotizing fasciitis is classified into four types, depending on microbiological findings. Most cases are polymicrobial, classed as type I. The clinical status of the patient varies from erythema, swelling and tenderness in the early stage to skin ischemia with blisters and bullae in the advanced stage of infection. In its fulminant form, the patient is critically ill with signs and symptoms of severe septic shock and multiple organ dysfunction. The clinical condition is the most important clue for diagnosis. However, in equivocal cases, the diagnosis and severity of the infection can be secured with laboratory-based scoring systems, such as the LRINEC score or FGSI score, especially in regard to Fournier’s gangrene. Computed tomography or ultrasonography can be helpful, but definitive diagnosis is attained by exploratory surgery at the infected sites.Management of the infection begins with broad spectrum antibiotics, but early and aggressive drainage and meticulous debridement constitute the mainstay of treatment. Postoperative management of the surgical wound is also important for the patient’s survival, along with proper nutrition. The vacuum-assisted closure system has proved to be helpful in wound management, with its combined benefits of continuous cleansing of the wound and the formation of granulation tissue.
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
Full Text Available Elizabeth F Sutton, Leanne M Redman Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA Abstract: The development and dissemination of smart devices has cultivated a global environment of hyperconnectivity and increased our access to information. The paralleled launch and success of the Mobile Health industry has created a market of commercially available applications or “apps” along with tools or sensors, which allow the user to receive and collect personal health information. Apps and accompanying tools now allow an individual to “self-digitize” and, pertaining to weight management, monitor their body weight, caloric intake, physical activity, and more. These products possess the ability to improve the scalability of traditional in-person weight management services considering their near ubiquity, affordability, and capability to deliver information directly and personally to the user. However, similar to the dietary supplement market, the anecdotal value of these products has driven their popularity and acceptance by the general public without requirement of scientific validation or, in the area of weight management or diet/exercise, validation of the safety and efficacy by the Food and Drug Administration prior to market launch. By conducting a literature and clinical trial search, we found remarkably few active, completed, or published studies testing the efficacy of smart device applications using randomized controlled trials. Research efforts must be focused on illuminating the efficacy of behavioral interventions and remote self-monitoring for weight loss/maintenance treatment with true, randomized controlled trials. Keywords: smartphone, mobile phone, application, app, weight, weight loss, weight maintenance
Wilby, R.; Johnson, M. F.
Water temperature is an important determinant of river ecosystem function and health. Hence, there is growing concern about rising surface water temperatures as a consequence of global warming and human modifications to river regimes. Some agencies are advocating riparian shade management as a means of `keeping rivers cool'. As appealing as this policy might seem, there are a host of practical considerations such as which species to plant, where to plant, and how much to plant? Moreover, there can be unintended consequences for groundwater recharge, flood risk and nutrient fluxes through the buffer zone. The thermal benefits of tree-planting may also be hard to detect amidst the integrated, downstream effects of landscape shade and flows from springs. Yet, to truly evaluate shade management as an adaptation to climate change, clear evidence is needed of the costs and benefits of this local intervention. What has this got to do with natural modes of climate variability? Continental scale, hydrological impacts of ENSO, the PDO and NAO have been widely reported - these periodic variations in ocean-atmosphere circulations are often blamed for floods, droughts, wildfire, crop failures, and the like. But there is emerging evidence that such phenomena also drive inter-annual variations in the heat flux of rivers. This matters because the underlying signal can confound field and model experiments intended to test adaptation options. Here, we present evidence of NAO signatures in the water temperature regime of the River Dove, UK. We compare the amplitude of these thermal variations with the expected benefit of tree planting. We demonstrate that the difference in maximum summer water temperature between strongly positive and strongly negative NAO phases can be about 2.5°C. This is equivalent to the thermal benefit of more than 2 km of riparian shade for the river studied. So, whilst modes of climate variability undoubtedly have a global footprint, let us not forget that
Brady, Sean M; Shapiro, Lee; Mousa, Shaker A
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.
Radioactive wastes in Thailand are mainly from the nuclear application in medicine, industry, agriculture, education and research reactor operation. The quantities of radioactive waste each year are relatively small. About 90 m 3 of processed waste and 7 m 3 unprocessed wastes are now stored at the waste storage facilities in the OAP. Recently the regulation on radioactive waste management was drafted and proposed to the cabinet for approval and to be promulgated as a ministerial regulation. A new nuclear research center, r which comprises 10 MW Research Reactor, Radioisotope Production and Centralized Waste Processing and Storage Facilities, is to be established at Ongkarak district in Nakornnayok province in the future. (author)
Zitt, Emanuel; Lhotta, Karl
Parathyroidectomy still presents an adequate and efficient therapeutic option for the management of refractory secondary hyperparathyroidism (sHPT). Dependent on the selected surgical technique it allows the highest rate of "laboratory cure" of sHPT. The question remains as to whether these improvements translate into clinical long-term benefits regarding the sHPT-associated vascular calcification and the increased risk for cardiovascular morbidity and mortality as well as overall mortality. Recent large observational studies point in this direction but definite evidence through prospective randomized controlled trials is still lacking.
Williamson, Jennifer F; Huynh, Kyle; Weaver, Mark A; Davis, Richard M
To assess the perceptions of eye care providers regarding the clinical management of dry eye. Invitations to complete a 17-question online survey were mailed to 400 members of the North Carolina Ophthalmology and Optometry Associations including community optometrists, comprehensive ophthalmologists, and cornea specialists. The survey was completed by 100 eye care providers (25% response rate). Providers reported burning (46.5%) as the most frequent symptom described by patients, followed by foreign body sensation (30.3%) and tearing (17.2%). Most respondents (80.8%) listed artificial tears as the recommended first-line treatment, even though providers reported high failure rates for both artificial tears and cyclosporine A (Restasis). Rheumatoid arthritis, Sjögren syndrome, affective disorders such as anxiety and depression, history of photorefractive surgery, smoking, and thyroid disease were acknowledged as common comorbid conditions. The survey provided an informative snapshot into the preferences of eye care providers concerning the diagnosis and management of dry eye disease. Overall, burning was the most common symptom reported by patients. Providers relied more on patient history in guiding their clinical decisions than objective signs. The survey underscores the incongruence when comparing subjective symptoms with objective signs, thereby highlighting the urgent need for the development of reliable metrics to better quantify dry eye symptoms and also the development of a more sensitive and specific test that can be used as the gold standard to diagnose dry eye.
Akroyd, D; Wold, B
As the healthcare delivery system changes, it is imperative to assess the skills of practitioners to ensure consistency between educational preparation and work place needs. The purpose of this study was to examine radiology managers' perception of selected workplace skills and new radiography graduates' ability to perform them. A random sample of 1,932 members of the American Healthcare Radiology Administrators (AHRA) received a questionnaire containing 35 skills categorized as basic, intermediate or advanced. Skills were ranked by the magnitude of the difference between managers' rating of importance of each skill and their rating of graduates' ability to perform that skill satisfactorily. In the basic skill area, the four top-ranked skills represented problem-solving ability or critical thinking. Of the five highest-ranked intermediate skills, the top three were patient care skills: venipuncture, taking vital signs and monitoring patient equipment. In the advanced skill area, six skills exhibited high values for the difference between importance and ability. Two of those related to patient care, three were non-technical and the sixth was the ability to perform CT in addition to basic radiography. Employers and educators should work together to seek educational methods that produce radiographers who are better prepared for the fast-changing workplace.
Spent fuel management has always been one of the most important stages in the nuclear fuel cycle and it is still one of the most vital problems common to all countries with nuclear reactors. It begins with the discharge of spent fuel from a power or a research reactor and ends with its ultimate disposition, either by direct disposal or by reprocessing of the spent fuel. Two options exist at present - an open, once-through cycle with direct disposal of the spent fuel and a closed cycle with reprocessing of the spent fuel and recycling of plutonium and uranium in new mixed oxide fuels. The selection of a spent fuel strategy is a complex procedure in which many factors have to be weighed, including political, economic and safeguards issues as well as protection of the environment. Continuous attention is being given by the IAEA to the collection, analysis and exchange of information on spent fuel management. Its role in this area is to provide a forum for the exchange of information and to co-ordinate and to encourage closer co-operation among Member States in certain research an development activities that are of common interest. Refs, figs and tabs
Ciccolini, Joseph; Fanciullino, Raphaelle; Serdjebi, Cindy; Milano, Gérard
Breast cancer has benefited from a number of innovative therapeutics over the last decade. Cytotoxics, hormone therapy, targeted therapies and biologics can now be given to ensure optimal management of patients. As life expectancy of breast cancer patients has been significantly stretched and that several lines of treatment are now made available, determining the best drug or drug combinations to be primarily given and the best dosing and scheduling for each patient is critical for ensuring an optimal toxicity/efficacy balance. Defining patient's characteristics at the tumor level (pharmacogenomics) and the constitutional level (pharmacogenetics) is a rising trend in oncology. This review covers the latest strategies based upon the search of relevant biomarkers for efficacy, resistance and toxicity to be undertaken at the bedside to shift towards precision medicine in breast cancer patients. In the expanding era of bioguided medicine, identifying relevant and clinically validated biomarkers from the plethora of published material remains an uneasy task. Sorting the variety of genetic and molecular markers that have been investigated over the last decade on their level of evidence and addressing the issue of drug exposure should help to improve the management of breast cancer therapy.
Bowyer, G W; Cooper, G J; Rice, P
The majority of war wounds are caused by antipersonnel fragments from munitions such as mortars and bomblets. Modern munitions aim to incapacitate soldiers with multiple wounds from very small fragments of low available kinetic energy. Many of these fragments may be stopped by helmets and body armour and this has led to a predominance of multiple wounds to limbs in those casualties requiring surgery. The development of an appropriate management strategy for these multiple wounds requires knowledge of the contamination and extent of soft tissue injury; conservative management may be appropriate. The extent of skin and muscle damage associated with a small fragment wound, the way in which these wounds may progress without intervention and their colonisation by bacteria has been determined in an experimental animal model. Results from 12 animals are presented. There was a very small (approximately 1 mm) margin of nonviable skin around the entrance wound. The amount of devitalised muscle in the wound tract was a few hundred milligrams. Some muscles peripheral to the wound track also showed signs of damage 1 h after wounding, but this improved over 24 h; the proportion of fragmented muscle fibres in the tissue around the track decreased as time went on. There was no clinical sign or bacteriological evidence of the track becoming infected up to 24 h after wounding. This preliminary work suggests that, in the absence of infection, the amount of muscle damage caused by small fragment wounds begins to resolve in the first 24 h after injury, even without surgical intervention.
Pascal C. Sanginga
Full Text Available Increasingly, social capital, defined as shared norms, trust, and the horizontal and vertical social networks that facilitate coordination and cooperation for mutually beneficial collective action, is seen as an important asset upon which people rely to manage natural resources and resolve conflicts. This paper uses empirical data from households and community surveys and case studies, to examine the role, strengths, and limits of social capital in managing conflicts over the use and management of natural resources. We inventoried over 700 cases ranging from conflicts between multiple resource users to supra-community conflicts between local communities concerns for better livelihoods and national/international concerns for environment conservation. Results show how different types of social capital are used in preventing and managing conflicts. Endowment in certain dimensions of social capital significantly decreased the occurrence of conflicts and played a significant role in managing them. However, social capital mechanisms have some limits, and are not always effective in resolving some types of conflicts. For such conflicts, people rely on formal mechanisms for arbitration and adjudication. In many cases, these have resulted in exclusion, coercion, and violence. Results show that policies or social capital alone do not possess the resources needed to promote broad-based and sustainable conflict resolution strategies. Rather, people use a range of conflict management strategies of different types and combinations of social capital and local polices. This synergy between social capital and local policy is based on complementarity and embededness: mutually supportive relations between local government and local communities, and the nature and extent of the ties connecting people and communities and public institutions. Better understanding of how this synergy between social capital and local policy can be strengthened is crucial to minimize
Weng, R.; Oehmen, Josef; Ben-Daya, M.
Managing portfolios of development and engineering projects currently presents significant challenges to companies. This is even more the case in the management of portfolio risks, where both industry and academia currently lack a clear conceptual understanding of what portfolio risks are and what...
The article reviews the book "Current Issues in International Human Resource Management and Strategy Research," edited by Marion Festing and Susanne Royer.......The article reviews the book "Current Issues in International Human Resource Management and Strategy Research," edited by Marion Festing and Susanne Royer....
Chatterjee, Sudesna; Davies, Melanie J
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
M. Shabeena Begam
Full Text Available All manufacturing industry has put in continuous efforts for its survival in the current impulsive and competitive economy. In order to handle the critical situation, manufacturers are trying to implement new and innovative techniques in their manufacturing process by making it more effective and efficient. A detailed literature survey has been conducted to identify the lean practices in various manufacturing industry. The results revealed that the status of Lean Manufacturing (LM implementation in still in thriving stage. This paper will further assist the organizations to improve its process, align it to the requirements of its customers and relentless contribution to manufacturing sector to enhance productivity, quality and competitiveness is immense.
Holt, Helle; Hvid, Helge
This article examines how employee control is affected by the ongoing erosion of boundaries in work organization and established boundaries in the relationship between employees and management. One assumption is that the erosion of boundaries offers potential for increased employee control, meaning...... increased autonomy or self-determination at work (employee control how and when to do what). This assumption is supported by theories on the psychosocial working environment. Another assumption is that the erosion of boundaries threatens the frontiers from where employees can defend their interests......, and consequently reduces employees’ control of their work (what and how much to do). This assumption is supported by “labor process theory.” This article studies control and the erosion of boundaries in two case factories in the food industry. Two perspectives are applied: the psychosocial working environment...
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.
Spent fuel storage is a common issue in all IAEA Member States with nuclear reactors. Whatever strategy is selected for the back-end of the nuclear fuel cycle, the storage of spent fuel will be an increasingly significant consideration. Notwithstanding considerable efforts to increase the efficient use of nuclear fuel and to optimize storage capacity, delays in plans for geological repositories or in implementing reprocessing result in increased spent fuel storage capacity needs in combination with longer storage durations over the foreseeable future. As storage inventories and durations increase, issues associated with long term storage compel more attention...monitoring for potential degradation mechanisms, records retention, maintenance, efficiencies through burnup credit. Since the IAEA contribution to ICNC'99 focused exclusively on IAEA burnup credit activities including requirements and methods, this paper provides a broader perspective on IAEA activities in response to the above trends in spent fuel management, while also describing efforts to disseminate information regarding burnup credit applications. (author)
Holt, Helle; Hvid, Helge
, and consequently reduces employees’ control of their work (what and how much to do). This assumption is supported by “labor process theory.” This article studies control and the erosion of boundaries in two case factories in the food industry. Two perspectives are applied: the psychosocial working environment......This article examines how employee control is affected by the ongoing erosion of boundaries in work organization and established boundaries in the relationship between employees and management. One assumption is that the erosion of boundaries offers potential for increased employee control, meaning...... increased autonomy or self-determination at work (employee control how and when to do what). This assumption is supported by theories on the psychosocial working environment. Another assumption is that the erosion of boundaries threatens the frontiers from where employees can defend their interests...
Boyko, Tatiana V.; Longaker, Michael T.; Yang, George P.
Significance: The incidence of pressure ulcers is increasing due to our aging population and the increase in the elderly living with disability. Learning how to manage pressure ulcers appropriately is increasingly important for all professionals in wound care. Recent Advances: Many new dressings and treatment modalities have been developed over the recent years and the goal of this review is to highlight their benefits and drawbacks to help providers choose their tools appropriately. Critical Issues: Despite an increased number of therapies available on the market, none has demonstrated any clear benefit over the others and pressure ulcer treatment remains frustrating and time-consuming. Future Directions: Additional research is needed to develop products more effective in prevention and treatment of pressure ulcers. PMID:29392094
Akhtar, Nahid; Haqqi, Tariq M
Osteoarthritis (OA) is a progressive degenerative joint disease that has a major impact on joint function and quality of life. Nutraceuticals and dietary supplements derived from herbs have long been used in traditional medicine and there is considerable evidence that nutraceuticals may play an important role in inflammation and joint destruction in OA. We review the biological effects of some medicinal fruits and herbs - pomegranate, green tea, cat's claw, devil's claw, ginger, Indian olibaum, turmeric and ananas - in an attempt to understand the pivotal molecular targets involved in inflammation and the joint destruction process and to summarize their toxicities and efficacy for OA management. So far there is insufficient reliable evidence on the effectiveness of ginger, turmeric and ananas. Pomegranate and green tea only have preclinical evidence of efficacy due to the lack of clinical data. In vivo and clinical studies are required to understand their targets and efficacy in OA. Limited in vitro and in vivo evidence is available for cat's claw and Indian olibaum. More extensive studies are required before long-term controlled trials of whole cat's claw and Indian olibaum extracts, or isolated active compounds, are carried out in patients with OA to determine their long-term efficacy and safety. Devil's claw has not been rigorously tested to determine its antiarthritic potential in in vitro and in vivo models. There is strong clinical evidence of the effectiveness of devil's claw in pain reduction. However, high-quality clinical trials are needed to determine its effectiveness. No serious side effects have been reported for any fruits and herbs. Overall, these studies identify and support the use of nutraceuticals to provide symptomatic relief to patients with OA and to be used as adjunct therapy for OA management. More high-quality trials are needed to provide definitive answers to questions related to their efficacy and safety for OA prevention and
Solomon, B.; Glinoer, D.; Lagasse, R.; Wartofsky, L. (Walter Reed Army Medical Center, Washington, DC (USA))
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.
Full Text Available Currently, there are numerous choices for the treatment of pediatric glaucoma depending on the type of glaucoma, the age of the patient, and other particularities of the condition discussed in this review. Traditionally, goniotomy and trabeculotomy ab externo have been the preferred choices of treatment for congenital glaucoma, and a variety of adult procedures adapted to children have been utilized for other types of pediatric glaucoma with variable results and complications. More recently, seton implantations of different types have become more popular to use in children, and newer techniques have become available including visualized cannulation and opening of Schlemm’s canal, deep sclerectomy, trabectome, and milder more directed cyclodestructive procedures such as endolaser and transcleral diode laser cyclophotocoagulation. This paper reviews the different surgical techniques currently available, their indications, results, and most common complications to allow the surgeon treating these conditions to make a more informed choice in each particular case. Although the outcome of surgical treatment in pediatric glaucoma has improved significantly, its treatment remains challenging.
Burger, Robert H.; Kaufman, Paula T.; Atkinson, Amy L.
Financial management skills are necessary for responsible library management. In light of the profession's current emphasis on financial literacy, the authors posed four questions: (1) to what extent are library and information science schools providing courses in financial management for their graduates; (2) what is the quality and quantity of…
Epelboin, Sylvie; Dulioust, Emmanuel; Epelboin, Loïc; Benachi, Alexandra; Merlet, Françoise; Patrat, Catherine
Zika virus (ZIKV) is an arthropod-borne virus of the family Flaviviridae, genus Flavivirus. ZIKV is currently the focus of an ongoing pandemic and worldwide public health emergency. Although originally isolated in 1947, its pathogenesis was poorly known and very few documented infections were published until recently. Its route of transmission and its impact on reproduction and pregnancy have only recently begun to be disclosed. This review summarizes the most recent knowledge about ZIKV infection and pathogenesis and focuses on its impacts on male and female genital tracts, including the risks of sexual transmission and to pregnancy. The consequences of ZIKV infection for pregnancy planning and ART are also discussed. The PubMed and EMBASE databases were inter-rogated using specific terms, such as 'ZIKV', 'transmission', 'male', 'female', fertility', 'pregnancy, 'semen', 'testis', 'ovary' and 'genital tract', up to 17 March 2017. ZIKV has long been considered a harmless virus, but increasing evidence suggests that it has adverse effects on the neurological system and on pregnancy outcomes. In mice, ZIKV slows foetal growth and damages the foetal brain. In humans, the virus is able to cross the placental barrier and to induce foetal death and major anomalies, such as microcephaly, brain defects and long-term neurologic sequelae, i.e. the 'congenital Zika syndrome'. In addition to its transmission by mosquitoes, ZIKV may be transmitted sexually. Currently available data indicate that ZIKV RNA can remain detectable in semen for several months, whereas shedding in the female genital tract appears to be rare and of short duration. Current guidance on preventing the sexual transmission of ZIKV is based on the assumption that transmission occurs from a male partner to a receptive partner. Furthermore, in mouse models, the virus can actively replicate in male genital organs and induce severe orchitis, which raises concerns about its possible impact on human male fertility
Vinther, Johan L; Jacobsen, Rikke K; Jørgensen, Torben
Background Health checks of the general population are widely used to prevent cardiovascular diseases, but are the current clinical guidelines from the European Society of Cardiology (ESC) suitable for screening the general population? Design A cross-sectional, population-based study of 978 men...... and women aged 40-65 years examined in 2010-2011 was used to estimate the proportion of the general Danish population fulfilling the criteria from the clinical guidelines from the ESC on medical treatment and lifestyle intervention to prevent cardiovascular disease. Methods The ESC criteria for medical...... treatment and lifestyle intervention were applied to a general population using information on previous cardiovascular diseases, known diabetes, urinalbumin, smoking, total cholesterol, systolic and diabolic blood pressure, low-density lipoprotein cholesterol and a multifactor risk score (SCORE). Results...
Barry, Robert J; Nguyen, Quan Dong; Lee, Richard W; Murray, Philip I; Denniston, Alastair K
Uveitis, a group of conditions characterized by intraocular inflammation, is a major cause of sight loss in the working population. Most uveitis seen in Western countries is noninfectious and appears to be autoimmune or autoinflammatory in nature, requiring treatment with immunosuppressive and/or anti-inflammatory drugs. In this educational review, we outline the ideal characteristics of drugs for uveitis and review the data to support the use of current and emerging therapies in this context. It is crucial that we continue to develop new therapies for use in uveitis that aim to suppress disease activity, prevent accumulation of damage, and preserve visual function for patients with the minimum possible side effects. PMID:25284976
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
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.
Full Text Available Ann R FalseyUniversity of Rochester, Rochester General Hospital, Rochester, NY, USAAbstract: Parainfluenza viruses (PIV are common respiratory viruses that belong to the Paramyxoviridae family. PIV infection can lead to a wide variety of clinical syndromes ranging from mild upper respiratory illness to severe pneumonia. Severe disease can be seen in elderly or chronically ill persons and may be fatal in persons with compromised immune systems, particularly children with severe combined immunodeficiency disease syndrome and hematopathic stem cell transplant recipients. At present, there are no licensed antiviral agents for the treatment of PIV infection. Aerosolized or systemic ribavirin in combination with intravenous gamma globulin has been reported in small, uncontrolled series and case reports of immunocompromised patients. A number of agents show antiviral activity in vitro and in animals, but none are currently approved for human use.Keywords: parainfluenza virus, antiviral agents, immunocompromised host
Full Text Available Brianna L Norton, David P HollandDepartment of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USAAbstract: Tuberculosis remains the world’s second leading infectious cause of death, with nearly one-third of the global population latently infected. Treatment of latent tuberculosis infection is a mainstay of tuberculosis-control efforts in low-to medium-incidence countries. Isoniazid monotherapy has been the standard of care for decades, but its utility is impaired by poor completion rates. However, new, shorter-course regimens using rifamycins improve completion rates and are cost-saving compared with standard isoniazid monotherapy. We review the currently available therapies for latent tuberculosis infection and their toxicities and include a brief economic comparison of the different regimens.Keywords: isoniazid, rifampin, rifapentine, tuberculin skin test, interferon-gamma release assay
John H. Cissel; Frederick J. Swanson; Gordon E. Grant; Deanna H. Olson; Gregory V. Stanley; Steven L. Garman; Linda R. Ashkenas; Matthew G. Hunter; Jane A. Kertis; James H. Mayo; Michelle D. McSwain; Sam G. Swetland; Keith A. Swindle; David O. Wallin
The Augusta Creek project was initiated to establish and integrate landscape and watershed objectives into a landscape plan to guide management activities within a 7600-hectare (19,000-acre) planning area in western Oregon. Primary objectives included the maintenance of native species, ecosystem processes and structures, and long-term ecosystem productivity in a...
Didion, M.P.; Fortin, M.J.; Fall, A.
Effective forest ecosystem-based management requires a thorough understanding of the interactions between anthropogenic and natural disturbance processes over larger spatial and temporal scales than stands and rotation ages. Because harvesting does not preclude fire, it is important to evaluate the
In most developed countries of the world, deregulation of electricity markets has been established: competition is fierce, and utilities have to improve the competitiveness of their plants. It is an important challenge for nuclear power plants: a smart way to deal with this problem is life extension of existing units. The financial stakes associated with maintaining or extending the lifetime of nuclear power stations are very high; thus, if their lifetime is shortened by about ten years, dismantling and renewal would be brought forward which would increase their costs by several tens of billions of French francs. Furthermore, every extra year of operation of a 900 MWe unit should save about 500 million French francs per year on financial charges that would be necessary for a new investment, provided that maintenance costs do not become excessive. In order to succeed, utilities must improve their knowledge of ageing mechanisms, demonstrate to safety authorities the feasibility of life extension (especially taking into account critical components), operate existing units in an exemplary way, manage and master the long-term evolution of the safety reference state. (author)
Kuratani, Norifumi; Kikuchi, Hirosato
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.
Full Text Available Joseph T Krill, Rishi D Naik, Michael F Vaezi Division of Gastroenterology, Hepatology, and Nutrition, Center for Swallowing and Esophageal Disorders, Vanderbilt University Medical Center, Nashville, TN, USA Abstract: Achalasia is a primary disorder of esophageal motility. It classically presents with dysphagia to both solids and liquids but may be accompanied by regurgitation and chest pain. The gold standard for the diagnosis of achalasia is esophageal motility testing with manometry, which often reveals aperistalsis of the esophageal body and incomplete lower esophageal sphincter relaxation. The diagnosis is aided by complimentary tests, such as esophagogastroduodenoscopy and contrast radiography. Esophagogastroduodenoscopy is indicated to rule out mimickers of the disease known as “pseudoachalasia” (eg, malignancy. Endoscopic appearance of a dilated esophagus with retained food or saliva and a puckered lower esophageal sphincter should raise suspicion for achalasia. Additionally, barium esophagography may reveal a dilated esophagus with a distal tapering giving it a “bird’s beak” appearance. Multiple therapeutic modalities aid in the management of achalasia, the decision of which depends on operative risk factors. Conventional treatments include medical therapy, botulinum toxin injection, pneumatic dilation, and Heller myotomy. The last two are defined as the most definitive treatment options. New emerging therapies include peroral endoscopic myotomy, placement of self-expanding metallic stents, and endoscopic sclerotherapy. Keywords: achalasia, pseudoachalasia, pneumatic dilation, Heller myotomy, botulinum toxin injection, peroral endoscopic myotomy
Krill, Joseph T; Naik, Rishi D; Vaezi, Michael F
Achalasia is a primary disorder of esophageal motility. It classically presents with dysphagia to both solids and liquids but may be accompanied by regurgitation and chest pain. The gold standard for the diagnosis of achalasia is esophageal motility testing with manometry, which often reveals aperistalsis of the esophageal body and incomplete lower esophageal sphincter relaxation. The diagnosis is aided by complimentary tests, such as esophagogastroduodenoscopy and contrast radiography. Esophagogastroduodenoscopy is indicated to rule out mimickers of the disease known as “pseudoachalasia” (eg, malignancy). Endoscopic appearance of a dilated esophagus with retained food or saliva and a puckered lower esophageal sphincter should raise suspicion for achalasia. Additionally, barium esophagography may reveal a dilated esophagus with a distal tapering giving it a “bird’s beak” appearance. Multiple therapeutic modalities aid in the management of achalasia, the decision of which depends on operative risk factors. Conventional treatments include medical therapy, botulinum toxin injection, pneumatic dilation, and Heller myotomy. The last two are defined as the most definitive treatment options. New emerging therapies include peroral endoscopic myotomy, placement of self-expanding metallic stents, and endoscopic sclerotherapy. PMID:27110134
Pollack, Ian F; Jakacki, Regina I
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.
The Paks Nuclear Power Plant Ltd. operates the only NPP of Hungary, consisting of a 4 WWER-440 type units. Since 1989, approximately 40-50 % of the total yearly electricity generation of the country has been supplied by this plant. The fresh fuel is imported from Russia (previously from the Soviet Union) and the spent fuel assemblies are shipped back to Russia for later reprocessing after 5 years of decay storage in the spent fuel pools of the plant. Seeing the political and economical changes that started in Russia, the Paks NPP's management made a decision in 1990 to study the implementation of an independent spent fuel storage facility (ISFSF) at the Paks site and in 1992 to choose the GEC-ALSTHOM's MVDS. On the basis of the Construction License issued by the HAEC, the construction of the ISFSF was started in March 1995. The paper gives general information on the spent fuel arisings, the storage at the site, the shipment to Russia and on the implementation of the ISFSF. (author). 3 refs
The radioimmunoassay for T 3 is now widely available and is a useful diagnostic tool for hyperthyroidism, especially in T 3 -thyrotoxicosis. It is an essential tool in the management of hyperthyroidism that persists after treatment with normal T 4 serum levels or, in euthyroid cases, with low T 4 serum levels. In these conditions, it reflects the metabolic state more accurately than serum levels of T 4 . A promising new test is the response of radioimmunoassayable TSH to protirelin relin (TRH) administration. An absent response indicates pituitary suppression and thyroid autonomy as seen in frank hyperthyroidism or euthyroid Graves disease, treated or untreated. It is safer and quicker than the conventional T 3 suppression test of thyroid radioactive iodine uptake and may replace it at least partly in the future. The recently recognized sharp decline in the remission rate of patients subjected to thyroid drug therapy in the last decade has made this treatment much less efficacious. By necessity, it will probably lead to greater reliance on treatment with radioactive iodine in the majority of the patients with the hyperthyroidism of Graves disease
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
Full Text Available Nadia M Hijaz, Craig A Friesen Division of Gastroenterology, Hepatology, and Nutrition, Children’s Mercy Kansas City, Kansas City, MO, USA Abstract: Acute abdominal pain in pediatric patients has been a challenge for providers because of the nonspecific nature of symptoms and difficulty in the assessment and physical examination in children. Although most children with acute abdominal pain have self-limited benign conditions, pain may be a manifestation of an urgent surgical or medical condition where the biggest challenge is making a timely diagnosis so that appropriate treatment can be initiated without any diagnostic delays that increase morbidity. This is weighed against the need to decrease radiation exposure and avoid unnecessary operations. Across all age groups, there are numerous conditions that present with abdominal pain ranging from a very simple viral illness to a life-threatening surgical condition. It is proposed that the history, physical examination, laboratory tests, and imaging studies should initially be directed at differentiating surgical versus nonsurgical conditions both categorized as urgent versus nonurgent. The features of the history including patient’s age, physical examination focused toward serious conditions, and appropriate tests are highlighted in the context of making these differentiations. Initial testing and management is also discussed with an emphasis on making use of surgeon and radiologist consultation and the need for adequate follow-up and reevaluation of the patient. Keywords: acute abdominal pain, surgical abdomen, ultrasound
Full Text Available Fibrous dysplasia is a pathologic condition of bone of unknown etiology with no apparent familial, hereditary or congenital basis. Lichtenstein first coined the term in 1938 and in 1942 he and Jaffe separated it from other fibro-osseous lesions. It is a bone tumor that, although benign, has the potential to cause significant cosmetic and functional disturbance, particularly in the craniofacial skeleton. Its management poses significant challenges to the surgeon. Craniofacial fibrous dysplasia is 1 of 3 types of fibrous dysplasia that can affect the bones of the craniofacial complex, including the mandible and maxilla. Fibrous dysplasia is a skeletal developmental disorder of the bone-forming mesenchyme that manifests as a defect in osteoblastic differentiation and maturation. It is a lesion of unknown etiology, uncertain pathogenesis, and diverse histopathology. Fibrous dysplasia represents about 2, 5% of all bone tumors and over 7% of all benign tumours. Over the years, we have gained a better understanding of its etiology, clinical behavior, and both surgical and non-surgical treatments.
Patel, Amit R; Campbell, Steven C
This article provides a review of bladder cancer etiology, diagnosis, and management for WOC nurses. Bladder cancer incidence continues to rise yearly in the United States, and patients with bladder cancer comprise some of the most challenging cases in urologic oncology. Nurses are involved with all aspects of the processes of care for the patient with bladder cancer, from initial diagnosis and treatment to postsurgical care and follow-up. For nonmuscle invasive bladder cancer, treatment includes transurethral resection followed by intravesical chemotherapy or immunotherapy to prevent recurrence or progression. Radical cystectomy along with chemotherapy protocols provides a survival advantage for muscle invasive bladder cancer, although the timing of chemotherapy remains controversial. Numerous factors are considered when determining the type of urinary diversion used at the time of radical cystectomy, but patient, family, surgeon, and nursing input are essential for preserving an optimal health-related quality of life and reducing morbidity. Patients with metastatic bladder cancer are generally treated with a cisplatin-based chemotherapy but continue to have a poor prognosis. Newer therapies involving novel molecular-targeted agents provide hope for the future for patients with metastatic disease.
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Noda, T.; Tajima, K.; Ishikawa, M.; Koyama, M.
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)
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.
techniques have more rapid remission and relapse less frequently than patients treated only pharmacologically.Keywords: schizophrenia, support management, nonpharmacological treatment, cognitive behavioral therapy
Full Text Available Matthew Pinder,1 Katie Lummis,1 Christian P Selinger1,2 1Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, 2University of Leeds, Leeds, UK Abstract: Inflammatory bowel disease (IBD affects many women of childbearing age. The course of IBD is closely related to pregnancy outcomes with poorly controlled IBD increasing the risk of prematurity, low weight for gestation, and fetal loss. As such, women with IBD face complex decision making weighing the risks of active disease versus those of medical treatments. This review summarizes the current evidence regarding the safety and efficacy of IBD treatments during pregnancy and lactation aiming to provide up-to-date guidance for clinicians. Over 50% of women have poor IBD- and pregnancy-related knowledge, which is associated with views contrary to medical evidence and voluntary childlessness. This review highlights the effects of poor patient knowledge and critically evaluates interventions for improving patient knowledge and outcomes. Keywords: pregnancy, breast feeding, nursing, inflammatory bowel disease, Crohn’s disease, ulcerative colitis
Full Text Available Osteoarthritis (OA is progressive joint disease characterized by joint inflammation and a reparative bone response and is one of the top five most disabling conditions that affects more than one-third of persons > 65 years of age, with an average estimation of about 30 million Americans currently affected by this disease. Global estimates reveal more than 100 million people are affected by OA. The financial expenditures for the care of persons with OA are estimated at a total annual national cost estimate of $15.5-$28.6 billion per year. As the number of people >65 years increases, so does the prevalence of OA and the need for cost-effective treatment and care. Developing a treatment strategy which encompasses the underlying physiology of degenerative joint disease is crucial, but it should be considerate to the different age ranges and different population needs. This paper focuses on different exercise and treatment protocols (pharmacological and non-pharmacological, the outcomes of a rehabilitation center, clinician-directed program versus an at home directed individual program to view what parameters are best at reducing pain, increasing functional independence, and reducing cost for persons diagnosed with knee OA.
Yim, Hyung Joon; Suh, Sang Jun; Um, Soon Ho
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer death, especially in Eastern areas. With advancements in diagnosis and treatment modalities for HCC, the survival and prognosis of HCC patients are improving. However, treatment patterns are not uniform between areas despite efforts to promote a common protocol. Although many hepatologists in Asian countries may adopt the principles of the Barcelona Clinic Liver Cancer staging system, they are also independently making an effort to expand the indications of each treatment and to combine therapies for better outcomes. Several expanded criteria for liver transplantation in HCC have been developed in Asian countries. Living donor liver transplantation is much more commonly performed in these countries than deceased donor liver transplantation, and it may be preceded by other treatments such as the down-staging of tumors. Local ablation therapies are often combined with transarterial chemoembolization (TACE) and the outcome is comparable to that of surgical resection. The indications of TACE are expanding, and there are new types of transarterial therapies. Although data on drug-eluting beads, TACE, and radioembolization in Asian countries are still relatively sparse compared with Western countries, these methods are gradually gaining popularity because of better tolerability and the possibility of improved response rates. Hepatic arterial infusion chemotherapy and radiotherapy are not included in Western guidelines, but are currently being used actively in several Asian countries. For more advanced HCCs, appropriate combinations of TACE, radiotherapy, and sorafenib can be considered, and emerging data indicate improved outcomes of combination therapies compared with single therapies. To include these paradigm shifts into newer treatment guidelines, more studies may be needed, but they are certainly in progress. PMID:25852267
Whayne, Thomas F
The history of proprotein convertase subtilisin/kexin type 9 (PCSK9) in medical science is fascinating and the evolution of knowledge of its function has resulted in new medications of major importance for the cardiovascular (CV) patient. PCSK9 functions as a negative control or feedback for the cell surface receptors for low-density lipoprotein including its component of cholesterol (LDL-C). The initial and key findings were that different abnormalities of PCSK9 can result in an increase or a decrease of LDL-C because of more or less suppression of cell surface receptors. These observations gave hints and awoke interest that it might be possible to prepare monoclonal antibodies to PCSK9 and decrease its activity, after which there should be more active LDL-C cell receptors. The rest is a fascinating story that currently has resulted in two PCSK9 inhibitors, alirocumab and evolocumab, which, on average, decrease LDL-C approximately 50%. Nevertheless, if there are no contraindications, statins remain the standard of prevention for the high-risk CV patient and this includes both secondary and primary prevention. The new inhibitors are for the patient that does not attain the desired target for LDL-C reduction while taking a maximum statin dose or who does not tolerate any statin dose whatsoever. Atherosclerosis can be considered a metabolic disease and the clinician needs to realize this and think more and more of CV prevention. These inhibitors can contribute to both the stabilization and regression of atherosclerotic plaques and thereby avoid or delay major adverse cardiac events. (United States). Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.
Alexander, H Richard; Li, Claire Yue; Kennedy, Timothy J
Diffuse malignant peritoneal mesothelioma (MPM) is a rare and ultimately fatal cancer that was first described just over a century ago. It is a diffuse malignancy arising from the mesothelial lining of the peritoneum; morbidity and mortality from MPM is due to its propensity to progress locoregionally within the abdominal cavity. The purpose of this article is to review the current state-of-the-science related to the diagnosis, staging, and treatment of MPM. The condition afflicts men and women equally and the peak incidence is between 55 and 60 years of age although it can arise in the young and elderly. Patients afflicted with MPM most commonly present with nonspecific abdominal symptoms that usually lead to diagnosis when the condition is relatively advanced. Historically, median overall survival for MPM patients without treatment is < 1 year. The couplet of systemic pemetrexed and cisplatin has an overall response rate of approximately 25% and a median overall survival of approximately 1 year. The available data, almost all retrospective in nature, have shown that in selected patients, operative cytoreduction (CRS) and regional chemotherapy administered as hyperthermic intraoperative peritoneal chemotherapy (HIPEC) or early postoperative intraperitoneal chemotherapy (EPIC) is associated with long-term survival. Studies on the molecular biology of MPM have yielded new insights relating to the potentially important role of the phosphoinsitide-3-kinase/mammalian target of rapamycin (PI3 K/mTOR) pathways and immune checkpoint inhibitors that may translate into new therapeutic options for patients with diffuse MPM.
Full Text Available Júlio César Rocha,1-3 Anita MacDonald4 1Centro de Genética Médica, Centro Hospitalar do Porto – CHP, 2Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, 3Center for Health Technology and Services Research (CINTESIS, Porto, Portugal; 4The Children’s Hospital, Birmingham, UK Abstract: Phenylketonuria (PKU is a well-described inborn error of amino acid metabolism that has been treated for >60 years. Enzyme deficiency causes accumulation of phenylalanine (Phe and if left untreated will lead to profound and irreversible intellectual disability in most children. Traditionally, it has been managed with a low-Phe diet supplemented with a Phe-free protein substitute although newer treatment options mainly in combination with diet are available for some subgroups of patients with PKU, for example, sapropterin, large neutral amino acids, and glycomacropeptide. The diet consists of three parts: 1 severe restriction of dietary Phe; 2 replacement of non-Phe L-amino acids with a protein substitute commonly supplemented with essential fatty acids and other micronutrients; and 3 low-protein foods from fruits, some vegetables, sugars, fats and oil, and special low-protein foods (SLPF. The prescription of diet is challenging for health professionals. The high-carbohydrate diet supplied by a limited range of foods may program food preferences and contribute to obesity in later life. Abnormal tasting and satiety-promoting protein substitutes are administered to coincide with peak appetite times to ensure their consumption, but this practice may impede appetite for other important foods. Intermittent dosing of micronutrients when combined with L-amino acid supplements may lead to their poor bioavailability. Much work is required on the ideal nutritional profiling for special SLPF and Phe-free L-amino acid supplements. Although non-diet treatments are being studied, it is important to continue to fully understand all the consequences of diet
The nuclear facilities that exist throughout Romania perform a broad range of missions from research to nuclear materials production to radioactive waste management, and to deactivation and decommissioning. As a consequence, there is a broad array of external regulations and internal requirements that potentially applies to a facility or activity. Therefore, the management of radioactive waste occurs within a larger context of managing hazards, both radiological and industrial, at these facilities. At the same time, concern for upgrading existing facilities used for radioactive waste management, as called for in Article 12, fits into a larger framework of safety management. The primary objective of the Romanian Nuclear Regulatory Body-CNCAN on legislation and regulatory infrastructure for the safety of radioactive waste management is to protect human health and the environment now and in the future. It is unanimously recognized that a well developed regulated system for the management and disposal of radioactive waste is a prerequisite for both public and market acceptance of nuclear energy. It is to underline that the continuing internationalization of the nuclear industry following terrorist attacks of 11 September 2001 stresses the need for national legislation and regulatory infrastructure to be based on internationally endorsed principles and safety standards. The paper presents some aspects of the Romanian experience on the national legislative and regulatory system related to the followings aspects of the safety aspects of radioactive waste management: definition of responsibilities; nuclear and radiation safety requirements; siting and licensing procedures; regulatory functions; international co-operation and coherence on strategies and criteria in the area of safety of radioactive waste management. Finally, prescriptive and goal oriented national as well international regimes in the field of the safety of radioactive waste management are briefly commented
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
Jones, Benjamin M; Arp, Christopher D; Hinkel, Kenneth M; Beck, Richard A; Schmutz, Joel A; Winston, Barry
Lakes are dominant landforms in the National Petroleum Reserve Alaska (NPRA) as well as important social and ecological resources. Of recent importance is the management of these freshwater ecosystems because lakes deeper than maximum ice thickness provide an important and often sole source of liquid water for aquatic biota, villages, and industry during winter. To better understand seasonal and annual hydrodynamics in the context of lake morphometry, we analyzed lakes in two adjacent areas where winter water use is expected to increase in the near future because of industrial expansion. Landsat Thematic Mapper and Enhanced Thematic Mapper Plus imagery acquired between 1985 and 2007 were analyzed and compared with climate data to understand interannual variability. Measured changes in lake area extent varied by 0.6% and were significantly correlated to total precipitation in the preceding 12 months (p water-level monitoring, and lake-ice thickness measurements and growth models were used to better understand seasonal hydrodynamics, surface area-to-volume relations, winter water availability, and more permanent changes related to geomorphic change. Together, these results describe how lakes vary seasonally and annually in two critical areas of the NPRA and provide simple models to help better predict variation in lake-water supply. Our findings suggest that both overestimation and underestimation of actual available winter water volume may occur regularly, and this understanding may help better inform management strategies as future resource use expands in the NPRA.
Jones, Benjamin M.; Arp, C.D.; Hinkel, Kenneth M.; Beck, R.A.; Schmutz, J.A.; Winston, B.
Lakes are dominant landforms in the National Petroleum Reserve Alaska (NPRA) as well as important social and ecological resources. Of recent importance is the management of these freshwater ecosystems because lakes deeper than maximum ice thickness provide an important and often sole source of liquid water for aquatic biota, villages, and industry during winter. To better understand seasonal and annual hydrodynamics in the context of lake morphometry, we analyzed lakes in two adjacent areas where winter water use is expected to increase in the near future because of industrial expansion. Landsat Thematic Mapper and Enhanced Thematic Mapper Plus imagery acquired between 1985 and 2007 were analyzed and compared with climate data to understand interannual variability. Measured changes in lake area extent varied by 0.6% and were significantly correlated to total precipitation in the preceding 12 months (p modeled lake area extent from 1985 to 2007 showed no long-term trends. In addition, high-resolution aerial photography, bathymetric surveys, water-level monitoring, and lake-ice thickness measurements and growth models were used to better understand seasonal hydrodynamics, surface area-to-volume relations, winter water availability, and more permanent changes related to geomorphic change. Together, these results describe how lakes vary seasonally and annually in two critical areas of the NPRA and provide simple models to help better predict variation in lake-water supply. Our findings suggest that both overestimation and underestimation of actual available winter water volume may occur regularly, and this understanding may help better inform management strategies as future resource use expands in the NPRA. ?? 2008 Springer Science+Business Media, LLC.
Theissen, Kevin M.; Hobbs, William O.; Hobbs, Joy M. Ramstack; Zimmer, Kyle D.; Domine, Leah M.; Cotner, James B.; Sugita, Shinya
We collected two sediment cores and modern submerged aquatic plants and phytoplankton from two sub-basins of Lake Christina, a large shallow lake in west-central Minnesota, and used stable isotopic and elemental proxies from sedimentary organic matter to explore questions about the pre- and post-settlement ecology of the lake. The two morphologically distinct sub-basins vary in their sensitivities to internal and external perturbations offering different paleoecological information. The record from the shallower and much larger western sub-basin reflects its strong response to internal processes, while the smaller and deeper eastern sub-basin record primarily reflects external processes including important post-settlement land-use changes in the area. A significant increase in organic carbon accumulation (3–4 times pre-settlement rates) and long-term trends in δ 13 C, organic carbon to nitrogen ratios (C/N), and biogenic silica concentrations shows that primary production has increased and the lake has become increasingly phytoplankton-dominated in the post-settlement period. Significant shifts in δ 15 N values reflect land-clearing and agricultural practices in the region and support the idea that nutrient inputs have played an important role in triggering changes in the trophic status of the lake. Our examination of hydroclimatic data for the region over the last century suggests that natural forcings on lake ecology have diminished in their importance as human management of the lake increased in the mid-1900s. In the last 50 years, three chemical biomanipulations have temporarily shifted the lake from the turbid, algal-dominated condition into a desired clear water regime. Two of our proxies (δ 13 C and BSi) measured from the higher resolution eastern basin record responded significantly to these known regime shifts. -- Highlights: ► We explore the sediment geochemistry from Lake Christina's two distinct sub-basins. ► Our geochemical data show
Full Text Available Management of forest genetic resources requires experimental data related to the genetic variation of the species and populations under different climatic conditions. Foresters also demand to know how the main selective drivers will influence the adaptability of the genetic resources. To assess the inter- and intraspecific variation and plasticity in seedling drought tolerance at a relevant genetic resource management scale, we tested the changes in growth and biomass allocation of seedlings of Pinus oocarpa, P. patula and P. pseudostrobus under two contrasting watering regimes. We found general significant intraspecific variation and intraspecific differences in plasticity, since both population and watering by population interaction were significant for all three species. All the species and populations share a common general avoidance mechanism (allometric adjustment of shoot/root biomass. However, the intraspecific variation and differences in phenotypic plasticity among populations modify the adaptation strategies of the species to drought. Some of the differences are related to the climatic conditions of the location of origin. We confirmed that even at reduced geographical scales, Mexican pines present differences in the response to water stress. The differences among species and populations are relevant in afforestation programs as well as in genetic conservation activities.
McGregor, Hugh W; Legge, Sarah; Jones, Menna E; Johnson, Christopher N
Intensification of fires and grazing by large herbivores has caused population declines in small vertebrates in many ecosystems worldwide. Impacts are rarely direct, and usually appear driven via indirect pathways, such as changes to predator-prey dynamics. Fire events and grazing may improve habitat and/or hunting success for the predators of small mammals, however, such impacts have not been documented. To test for such an interaction, we investigated fine-scale habitat selection by feral cats in relation to fire, grazing and small-mammal abundance. Our study was conducted in north-western Australia, where small mammal populations are sensitive to changes in fire and grazing management. We deployed GPS collars on 32 cats in landscapes with contrasting fire and grazing treatments. Fine-scale habitat selection was determined using discrete choice modelling of cat movements. We found that cats selected areas with open grass cover, including heavily-grazed areas. They strongly selected for areas recently burnt by intense fires, but only in habitats that typically support high abundance of small mammals. Intense fires and grazing by introduced herbivores created conditions that are favoured by cats, probably because their hunting success is improved. This mechanism could explain why, in northern Australia, impacts of feral cats on small mammals might have increased. Our results suggest the impact of feral cats could be reduced in most ecosystems by maximising grass cover, minimising the incidence of intense fires, and reducing grazing by large herbivores.
Hugh W McGregor
Full Text Available Intensification of fires and grazing by large herbivores has caused population declines in small vertebrates in many ecosystems worldwide. Impacts are rarely direct, and usually appear driven via indirect pathways, such as changes to predator-prey dynamics. Fire events and grazing may improve habitat and/or hunting success for the predators of small mammals, however, such impacts have not been documented. To test for such an interaction, we investigated fine-scale habitat selection by feral cats in relation to fire, grazing and small-mammal abundance. Our study was conducted in north-western Australia, where small mammal populations are sensitive to changes in fire and grazing management. We deployed GPS collars on 32 cats in landscapes with contrasting fire and grazing treatments. Fine-scale habitat selection was determined using discrete choice modelling of cat movements. We found that cats selected areas with open grass cover, including heavily-grazed areas. They strongly selected for areas recently burnt by intense fires, but only in habitats that typically support high abundance of small mammals. Intense fires and grazing by introduced herbivores created conditions that are favoured by cats, probably because their hunting success is improved. This mechanism could explain why, in northern Australia, impacts of feral cats on small mammals might have increased. Our results suggest the impact of feral cats could be reduced in most ecosystems by maximising grass cover, minimising the incidence of intense fires, and reducing grazing by large herbivores.
Full Text Available Comparisons of the potential outcomes of multiple land management strategies and an understanding of the influence of potential increases in climate-related disturbances on these outcomes are essential for long term land management and conservation planning. To provide these insights, we developed an approach that uses collaborative scenario development and state-and-transition simulation modeling to provide land managers and conservation practitioners with a comparison of potential landscapes resulting from alternative management scenarios and climate conditions, and we have applied this approach in the Wild Rivers Legacy Forest (WRLF area in northeastern Wisconsin. Three management scenarios were developed with input from local land managers, scientists, and conservation practitioners: 1 continuation of current management, 2 expanded working forest conservation easements, and 3 cooperative ecological forestry. Scenarios were modeled under current climate with contemporary probabilities of natural disturbance and under increased probability of windthrow and wildfire that may result from climate change in this region. All scenarios were modeled for 100 years using the VDDT/TELSA modeling suite. Results showed that landscape composition and configuration were relatively similar among scenarios, and that management had a stronger effect than increased probability of windthrow and wildfire. These findings suggest that the scale of the landscape analysis used here and the lack of differences in predominant management strategies between ownerships in this region play significant roles in scenario outcomes. The approach used here does not rely on complex mechanistic modeling of uncertain dynamics and can therefore be used as starting point for planning and further analysis.
Thi, Ngoc Bao Dung; Kumar, Gopalakrishnan; Lin, Chiu-Yue
Food waste (FW) related issues in developing countries is currently considered to be a major threatening factor for sustainable development and FW management systems. Due to incomplete FW management systems, many developing countries are facing challenges, such as environmental and sanitary problems that are caused by FW. The difference in FW generation trends between developing countries and developed countries was reviewed in this work, which demonstrated that the effects of income level, population growth, and public participation in FW management are very important. Thus, this work aimed to provide an overview of recycling activities, related regulations, and current FW treatment technology in developing countries by following some case studies. Taiwan, has been suggested as being a successful case in terms of FW management, and is therefore a typical model for developing countries to follow. Finally, an integrative management system as a suitable model for FW management has been suggested for developing countries. Copyright © 2015 Elsevier Ltd. All rights reserved.
Full Text Available This paper, a continuation and expansion of the work of Muzenda et al, 2012  looks at the current waste generation and management trends in South Africa. The waste tyre problem in South Africa is also briefly discussed. Solid waste management...
Aprilia, A.; Tezuka, T.; Spaargaren, G.
This article focuses on household waste management in Indonesia, with particular emphasis on inorganic and hazardous waste. It seeks to identify the current situation and also aims to provide a review of the existing policies that are particularly related to inorganic and hazardous waste management.
Klein, Amarolinda Zanela; Freitas, Angilberto; Machado, Lisiane; da Silva Freitas, José Carlos, Jr.; Graziola, Paulo Gaspar; Schlemmer, Eliane
Frequently, research on management education does not take into account the role of Information Technology as a key resource to support teaching and learning processes. In this article, the authors explore the current applications of Three Dimensional Virtual Worlds (3DVW) for Management education. The authors researched the educational…
Andreu-Cazenave, Miguel; Subida, Maria Dulce; Fernandez, Miriam
There is an urgent need to quantify the impacts of artisanal fisheries and define management practices that allow for the recovery and conservation of exploited stocks. The extent of illegal catch is particularly critical as a driver of overexploitation in artisanal fisheries. However, the lack of data at proper spatial scales limits the evaluation of illegal fishing and effectiveness of management practices. We used a catch curve analysis to estimate total instantaneous mortality as a proxy of fishing pressure in the artisanal benthic fishery in central Chile. We compared the patterns of total mortality in fishing grounds under the well-studied territorial use rights for fisheries system (TURF) immersed in a landscape of open access areas (OAA; no access restriction), and from these patterns determined the extent of illegal fishing in open access areas focusing on the two most frequently extracted resources: locos (Concholepas concholepas) and keyhole limpets (Fissurella spp.). The beauty of this seascape is the presence of the no-take (NT) area of Las Cruces as control (no fishing), allowing us to estimate natural mortality. Loco exploitation is banned in OAAs. However, loco mortality in OAAs was 92% higher than in the NT, and 42% higher than in TURFs. Keyhole limpet mortality was similar between TURFs and the NT, but doubled in OAAs. We also found strong differences in mortality among fishing grounds with the same level of protection (i.e. TURFs), and over time. Our results highlight (a) the high level of illegal fishing that may occur in artisanal fisheries under traditional management regimes, and (b) that TURFs can be effective to reduce fishing mortality. However, large variability among TURFs suggests the need for a deeper understanding of the drivers of success of TURFs. PMID:28666013
Andreu-Cazenave, Miguel; Subida, Maria Dulce; Fernandez, Miriam
There is an urgent need to quantify the impacts of artisanal fisheries and define management practices that allow for the recovery and conservation of exploited stocks. The extent of illegal catch is particularly critical as a driver of overexploitation in artisanal fisheries. However, the lack of data at proper spatial scales limits the evaluation of illegal fishing and effectiveness of management practices. We used a catch curve analysis to estimate total instantaneous mortality as a proxy of fishing pressure in the artisanal benthic fishery in central Chile. We compared the patterns of total mortality in fishing grounds under the well-studied territorial use rights for fisheries system (TURF) immersed in a landscape of open access areas (OAA; no access restriction), and from these patterns determined the extent of illegal fishing in open access areas focusing on the two most frequently extracted resources: locos (Concholepas concholepas) and keyhole limpets (Fissurella spp.). The beauty of this seascape is the presence of the no-take (NT) area of Las Cruces as control (no fishing), allowing us to estimate natural mortality. Loco exploitation is banned in OAAs. However, loco mortality in OAAs was 92% higher than in the NT, and 42% higher than in TURFs. Keyhole limpet mortality was similar between TURFs and the NT, but doubled in OAAs. We also found strong differences in mortality among fishing grounds with the same level of protection (i.e. TURFs), and over time. Our results highlight (a) the high level of illegal fishing that may occur in artisanal fisheries under traditional management regimes, and (b) that TURFs can be effective to reduce fishing mortality. However, large variability among TURFs suggests the need for a deeper understanding of the drivers of success of TURFs.
Full Text Available There is an urgent need to quantify the impacts of artisanal fisheries and define management practices that allow for the recovery and conservation of exploited stocks. The extent of illegal catch is particularly critical as a driver of overexploitation in artisanal fisheries. However, the lack of data at proper spatial scales limits the evaluation of illegal fishing and effectiveness of management practices. We used a catch curve analysis to estimate total instantaneous mortality as a proxy of fishing pressure in the artisanal benthic fishery in central Chile. We compared the patterns of total mortality in fishing grounds under the well-studied territorial use rights for fisheries system (TURF immersed in a landscape of open access areas (OAA; no access restriction, and from these patterns determined the extent of illegal fishing in open access areas focusing on the two most frequently extracted resources: locos (Concholepas concholepas and keyhole limpets (Fissurella spp.. The beauty of this seascape is the presence of the no-take (NT area of Las Cruces as control (no fishing, allowing us to estimate natural mortality. Loco exploitation is banned in OAAs. However, loco mortality in OAAs was 92% higher than in the NT, and 42% higher than in TURFs. Keyhole limpet mortality was similar between TURFs and the NT, but doubled in OAAs. We also found strong differences in mortality among fishing grounds with the same level of protection (i.e. TURFs, and over time. Our results highlight (a the high level of illegal fishing that may occur in artisanal fisheries under traditional management regimes, and (b that TURFs can be effective to reduce fishing mortality. However, large variability among TURFs suggests the need for a deeper understanding of the drivers of success of TURFs.
Lubyanaya, Alexandra V.; Izmailov, Airat M.; Nikulina, Ekaterina Y.; Shaposhnikov, Vladislav A.
The purpose of this article is to investigate the problem, which stems from non-current fixed assets affecting profitability and asset management efficiency. Tangible assets, intangible assets and financial assets are all included in non-current fixed assets. The aim of the research is to identify the impact of estimates and valuation in…
Beattie, C.I.; Ling, K.; Longhurst, J.W.S. [Univ. of the West of England, Faculty of Applied Sciences, Bristol (GB)] [and others
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)
Koontz, Lynne; Lambert, Heather
The National Wildlife Refuge System Improvement Act of 1997 requires all units of the National Wildlife Refuge System to be managed under a Comprehensive Conservation Plan (CCP). The CCP must describe the desired future conditions of a Refuge and provide long range guidance and management direction to achieve Refuge purposes. Sand Lake National Wildlife Refuge (NWR), located 27 miles northeast of Aberdeen, South Dakota, is in the process of developing a range of management goals, objectives, and strategies for the CCP. The CCP for Sand Lake NWR must contain an analysis of expected effects associated with current and proposed Refuge management strategies.
Koontz, Lynne; Lambert, Heather
The National Wildlife Refuge System Improvement Act of 1997 requires all units of the National Wildlife Refuge System to be managed under a Comprehensive Conservation Plan (CCP). The CCP must describe the desired future conditions of a Refuge and provide long range guidance and management direction to achieve Refuge purposes. Arrowwood National Wildlife Refuge (NWR), located along the James River in east central North Dakota, is in the process of developing a range of management goals, objectives, and strategies for the CCP. The CCP for Arrowwood NWR must contain an analysis of expected effects associated with current and proposed Refuge management strategies.
This work estimates Z-pinch driven hohlraums capabilities to obtain high temperatures (>200 eV). Simple models are proposed to calculate the performances offered by currents of 5 to 100 MA in 100 ns. The one dimensional physics of the Z-pinch at the length scale of its thickness and the hydrodynamics instabilities are studied. Then the enhancement of hohlraums performances with double nested Z-pinches or the use of an axial magnetic field is analysed. Z-pinch direct drive approach for inertial confinement fusion is finally considered. All the presented results are based on theoretical and 2D numerical approach and on the analysis of experimental results which were obtained on the american 'Z' generator. Annexes recall radiation MHD equations and check their validity for Z-pinch implosion. (author)
Catherine, Quiblier; Susanna, Wood; Isidora, Echenique-Subiabre; Mark, Heath; Aurélie, Villeneuve; Jean-François, Humbert
Benthic cyanobacteria are found globally in plethora of environments. Although they have received less attention than their planktonic freshwater counterparts, it is now well established that they produce toxins and reports of their involvement in animal poisonings have increased markedly during the last decade. Most of the known cyanotoxins have been identified from benthic cyanobacteria including: the hepatotoxic microcystins, nodularins and cylindrospermopsins, the neurotoxic saxitoxins, anatoxin-a and homoanatoxin-a and dermatotoxins, such as lyngbyatoxin. In most countries, observations of toxic benthic cyanobacteria are fragmented, descriptive and in response to animal toxicosis events. Only a limited number of long-term studies have aimed to understand why benthic proliferations occur, and/or how toxin production is regulated. These studies have shown that benthic cyanobacterial blooms are commonly a mixture of toxic and non-toxic genotypes and that toxin concentrations can be highly variable spatially and temporally. Physiochemical parameters responsible for benthic proliferation vary among habitat type with physical disturbance (e.g., flow regimes, wave action) and nutrients commonly identified as important. As climatic conditions change and anthropogenic pressures on waterways increase, it seems likely that the prevalence of blooms of benthic cyanobacteria will increase. In this article we review current knowledge on benthic cyanobacteria: ecology, toxin-producing species, variables that regulate toxin production and bloom formation, their impact on aquatic and terrestrial organisms and current monitoring and management strategies. We suggest research needs that will assist in filling knowledge gaps and ultimately allow more robust monitoring and management protocols to be developed. Copyright © 2013 Elsevier Ltd. All rights reserved.
Spatio-Temporal Analysis of Vegetation Dynamics in Relation to Shifting Inundation and Fire Regimes: Disentangling Environmental Variability from Land Management Decisions in a Southern African Transboundary Watershed
Narcisa G. Pricope
Full Text Available Increasing temperatures and wildfire incidence and decreasing precipitation and river runoff in southern Africa are predicted to have a variety of impacts on the ecology, structure, and function of semi-arid savannas, which provide innumerable livelihood resources for millions of people. This paper builds on previous research that documents change in inundation and fire regimes in the Chobe River Basin (CRB in Namibia and Botswana and proposes to demonstrate a methodology that can be applied to disentangle the effect of environmental variability from land management decisions on changing and ecologically sensitive savanna ecosystems in transboundary contexts. We characterized the temporal dynamics (1985–2010 of vegetation productivity for the CRB using proxies of vegetation productivity and examine the relative importance of shifts in flooding and fire patterns to vegetation dynamics and effects of the association of phases of the El Niño—Southern Oscillation (ENSO on vegetation greenness. Our results indicate that vegetation in these semi-arid environments is highly responsive to climatic fluctuations and the long-term trend is one of increased but heterogeneous vegetation cover. The increased cover and heterogeneity during the growing season is especially noted in communally-managed areas of Botswana where long-term fire suppression has been instituted, in contrast to communal areas in Namibia where heterogeneity in vegetation cover is mostly increasing primarily outside of the growing season and may correspond to mosaic early dry season burns. Observed patterns of increased vegetation productivity and heterogeneity may relate to more frequent and intense burning and higher spatial variability in surface water availability from both precipitation and regional inundation patterns, with implications for global environmental change and adaptation in subsistence-based communities.
Ramstack Hobbs, Joy M; Hobbs, William O; Edlund, Mark B; Zimmer, Kyle D; Theissen, Kevin M; Hoidal, Natalie; Domine, Leah M; Hanson, Mark A; Herwig, Brian R; Cotner, James B
Ecological shifts in shallow lakes from clear-water macrophyte-dominated to turbid-water phytoplankton-dominated are generally thought of as rapid short-term transitions. Diatom remains in sediment records from shallow lakes in the Prairie Pothole Region of North America provide new evidence that the long-term ecological stability of these lakes is defined by the legacy of large regime shifts. We examine the modern and historical stability of 11 shallow lakes. Currently, four of the lakes are in a clear-water state, three are consistently turbid-water, and four have been observed to change state from year to year (transitional). Lake sediment records spanning the past 150-200 yr suggest that (1) the diatom assemblage is characteristic of either clear or turbid lakes, (2) prior to significant landscape alteration, all of the lakes existed in a regime of a stable clear-water state, (3) lakes that are currently classified as turbid or transitional have experienced one strong regime shift over the past 150-200 yr and have since remained in a regime where turbid-water predominates, and (4) top-down impacts to the lake food-web from fish introductions appear to be the dominant driver of strong regime shifts and not increased nutrient availability. Based on our findings we demonstrate a method that could be used by lake managers to identify lakes that have an ecological history close to the clear-turbid regime threshold; such lakes might more easily be returned to a clear-water state through biomanipulation. The unfortunate reality is that many of these lakes are now part of a managed landscape and will likely require continued intervention. © 2016 by the Ecological Society of America.
Essen, Jonte van
The ambiguous position of de facto regimes in international law has long been the subject of scholarly debate and a source of political conflict. An assessment of the current standing of these regimes in international law and the consequences of actions by international actors on this status has, however, been long overdue. The manner in which de facto regimes are regarded internationally has serious consequences for the individuals under the influence of this legal grey area. Therefore, the ...
OF CONTENTS I. INTRODUCTION ........................................................................................................1 II. LITERATURE...LEFT BLANK 1 I. INTRODUCTION Marine Corps Information Management is performed in accordance with Marine Corps Warfighting Publication (MCWP) 3...November 13). Air Force Center of Excellence for Knowledge Mangement Briefing. Washington, D.C. Alavi, M., & Leidner, D. E. (2001). Review: Knowledge
Conklin, Annalijn; Nolte, Ellen
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 ...
Quesada Mena, Luis Diego
Available literary evidence is reviewed on the current management of hypertrophic cardiomyopathy. The bibliographical search is carried out in physical and online texts, cardiology journals, databases (MEDLINE), original studies, reviews and metaanalysis. Literature in English and Spanish is included from the first descriptions of the disease in the fifties, until the date of the investigation. Clinical management of patients is compared and recommendations published by consensus groups of international associations [es
Norton, Jeffrey A; Kim, Teresa; Kim, Joseph; McCarter, Martin D; Kelly, Kaitlyn J; Wong, Joyce; Sicklick, Jason K
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.
Masood, Maryam; Barlow, Claire Y; Wilson, David C
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.
Counsell, Allyce B; Nguyen, Amy D; Baysari, Melissa T; Kannangara, Diluk R W; McLachlan, Andrew J; Day, Richard O
Gout is an increasingly prevalent form of inflammatory arthritis. Although effective treatments for gout exist, current management is suboptimal due to low medication adherence rates and treatments that are non-concordant with guidelines. Medications are the mainstay and most effective form of gout management. Thus, there is potential for community pharmacists to play an important primary health care role in gout management, however their current role and their potential to improve management of gout treatment is currently unclear. The purpose of the study is to explore the views of Australian pharmacists on their roles in gout management and to identify factors influencing their involvement in gout management. A convenience sample of community pharmacists were invited to participate using a snowballing recruitment strategy. Semi-structured, face-to-face interviews were conducted with 15 pharmacists of varying age, gender and pharmacy experience. Interviews focused on pharmacists' experiences of managing gout, interactions with people living with gout and their perceived roles and responsibilities in gout management. Interviews were transcribed verbatim and independently analysed by two reviewers to identify themes. The main role of pharmacists reported in gout management was providing patient education. The greatest facilitator to pharmacists involvement in gout management was identified to be pharmacists' good understanding of gout and its management. Barriers to pharmacists involvement were identified to be difficulties in monitoring adherence to gout medications, low priority given to gout in the pharmacy compared to other chronic health conditions, and lack of specific training and/or continuing education in gout prevention and management. Pharmacists can expand their primary health care role in gout management, particularly in the area of ongoing provision of education to people living with gout and in monitoring medication adherence in patients. However, a
Gupta, Neha; Yadav, Krishna Kumar; Kumar, Vinit
Municipal solid waste management is a major environmental issue in India. Due to rapid increase in urbanization, industrialization and population, the generation rate of municipal solid waste in Indian cities and towns is also increased. Mismanagement of municipal solid waste can cause adverse environmental impacts, public health risk and other socio-economic problem. This paper presents an overview of current status of solid waste management in India which can help the competent authorities responsible for municipal solid waste management and researchers to prepare more efficient plans. Copyright © 2015. Published by Elsevier B.V.
Alp, E.; Aksoy, M. N.; Koçer, B.
As the effects of climate change becomes more prominent, current challenges related to water and wastewater management is becoming more serious. Providing water that satisfies environmental and safety standards in terms of quantity and quality is needed to maintain human life without compromising the need of future generations. Besides providing safe and affordable water, necessary treatment should be achieved according to several important factors such as receiving body standards, discharge standards, water reuse options. Therefore, management of water becomes more crucial than ever that states have to provide accessibility of safe water with affordable cost to its citizens with the means of effective utility management, including water treatment facilities, wastewater treatment facilities, water supply facilities and water distribution systems. Water utilities encounter with several challenges related to cost, infrastructure, population, legislation, workforce and resource. This study aims to determine the current situation and the necessary strategies to improve utility management in Turkish municipalities in a sustainable manner. US Environment Protection Agency (EPA) has formed a tool on effective utility management that assists utilities to provide a solution for both current and future challenges. In this study, we used EPA's guidelines and developed a survey consists of 60 questions under 10 sub-topics (Product Quality, Employee & Leadership Development, Stakeholder Understanding & Support, Operational Optimization, Infrastructure Stability, Financial Viability, Community Sustainability, Customer Satisfaction, Operational Resiliency, and Water Resource Adequacy). This survey was sent to the managers of 25 metropolitan municipalities in Turkey to assess the current condition of municipalities. After the evaluation of the survey results for each topic, including the importance given by managers, facilities were rated according to their level of achievement
Dölarslan, Emre Sahin
This paper reviews the effects of six post-modern management concepts as applied to Turkish forestry. Up to now, Turkish forestry has been constrained, both in terms of its operations and internal organization, by a highly bureaucratic system. The application of new thinking in forestry management, however, has recently resulted in new organizational and production concepts that promise to address problems specific to this Turkish industry and bring about positive changes. This paper will elucidate these specific issues and demonstrate how post-modern management thinking is influencing the administration and operational capacity of Turkish forestry within its current structure.
Lassala, Carlos; Ripoll Feliu, Vicente
On January 27, 2016, an agreement was signed with OmniaScience to select articles to be published in the journal Intangible Capital, in a special issue titled "Current Trends in Research in Accounting, Finance and Management Control." The agreement was reached within the framework of three events at the University of Valencia, from June 27 to 30, 2016: XXI Workshop on Accounting and Management Control. “Memorial Raymond Konopka”, X Iberoamerican Congress of Management Accounting, III Int...
Hottenrott, G.; Mirschinka, V.
An overview is given about the main points of the agreement between the four utility companies and the German government on June 11, 2001, concerning waste management and disposal. The current waste management situation is compared with the effects of the agreement on the future development of the German waste management concept. Major innovations are the discontinuation of reprocessing, the establishment of local intermediate storage facilities for fuel elements and the suspension of the exploration works conducted on the salt dome at Gorleben. (orig.)
AMALIA VENERA TODORUŢ
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
AbstractLeaf area and its spatial distribution are key parameters in describing canopy characteristics. They determine radiation regimes and influence mass and energy exchange with the atmosphere. The evaluation of leaf area in conifer stands is particularly challengi...
A. N. Rousseau
Full Text Available Hydrological and pollutant fate models have long been developed for research purposes. Today, they find an application in integrated watershed management, as decision support systems (DSS. GIBSI is such a DSS designed to assist stakeholders in watershed management. It includes a watershed database coupled to a GIS and accessible through a user-friendly interface, as well as modelling tools that simulate, on a daily time step, hydrological processes such as evapotranspiration, runoff, soil erosion, agricultural pollutant transport and surface water quality. Therefore, GIBSI can be used to assess a priori the effect of management scenarios (reservoirs, land use, waste water effluents, diffuse sources of pollution that is agricultural pollution on surface hydrology and water quality. For illustration purposes, this paper presents several management-oriented applications using GIBSI on the 6680 km2 Chaudière River watershed, located near Quebec City (Canada. They include impact assessments of: (i municipal clean water program; (ii agricultural nutrient management scenarios; (iii past and future land use changes, as well as (iv determination of achievable performance standards of pesticides management practices. Current and future developments of GIBSI are also presented as these will extend current uses of this tool and make it useable and applicable by stakeholders on other watersheds. Finally, the conclusion emphasizes some of the challenges that remain for a better use of DSS in integrated watershed management.
Puig, Alba; Olguín Salinas, Héctor F; Borús, Juan A
Alterations in flow regimes of large rivers may originate or increase risks to ecosystems and humans. The Paraná River basin (South America) undergoes human pressures (e.g., heavy damming in the upper basin, deforestation, and mixed pollution) that may affect the water quantity and quality of its terminal Delta (Argentina). In this study, after applying univariate and multivariate change-point detection and trend analyses to the daily data series of flows incoming to the Delta (Paraná-Santa Fe section), flow characteristics were compared by Indicators of Hydrologic Alteration (IHA) and Environmental Flow Components (EFC). Some flood characteristics were also compared from hydrometric levels in the middle Delta (San Pedro station). Chemical and microbiological water variables in the main rivers of the "Paraná Delta" Biosphere Reserve were examined during two extreme hydrologic years (October 2008 to July 2010) to detect potential risk factors in association with hydrologic conditions. In the Lower Paraná River, a historical period (1903-1972) and two more altered periods (1973-1999 wet period and 2000-2014 dry period) were identified. Flow duration curves evidenced different changes in both altered periods, reflecting the joint effect of climatic variability and human influence. The most evident alterations in the flow regime were the lack of record of the extreme-low-flow component, the attenuation of monthly flow seasonality, and the increase in the number of reversals (dry period) and in the variability of maximum and minimum flow dates. These alterations are consistent with the monthly and daily flow regulation by upstream dams evidenced by available data from the current dry period. In the middle Delta, the marked monthly seasonality in flood days decreased only in the wet period. The proportion between the number of flood days exceeding the evacuation level and that of those exceeding the warning level doubled in the wet period but decreased only
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.
Memisoglu, Salih Pasa
The aim of this study is to evaluate the new regulations and current practices in terms of how they apply--to the selection, training and instatement of school administrators in Turkey. The successful implementation of Turkish National Development Plans is closely related to the knowledge and skills of managers working at various levels in every…
Nielsen, J. Rasmus; Ulrich, Clara; Hegland, Troels J.
The present report is an EU-FP7-SOCIOEC Report giving an overview and critical evaluation of the current management measures implemented for the North Sea mixed demersal fisheries and the fish stocks involved in this. Also, this involves review and critical evaluation of the scientific advice...
Koontz, Lynne; Sexton, Natalie; Ishizaki, Asuka; Ritten, John
The National Wildlife Refuge System Improvement Act of 1997 requires all units of the National Wildlife Refuge System to be managed under a Comprehensive Conservation Plan (CCP). The CCP must describe the desired future conditions of a refuge and provide long-range guidance and management direction to achieve refuge purposes. Charles M. Russell (CMR) National Wildlife Refuge, located in north-central Montana, is in the process of developing a range of management goals, objectives, and strategies for the CCP. The CCP for the Refuge must contain an analysis of expected effects associated with current and proposed refuge-management strategies. For refuge CCP planning, an economic analysis provides a means of estimating how current management (No Action Alternative) and proposed management activities (Alternatives) affect the local economy. This type of analysis provides two critical pieces of information: (1) it illustrates a refuge’s contribution to the local community; and (2) it can help in determining whether economic effects are or are not a real concern in choosing among management alternatives. It is important to note that the economic value of a refuge encompasses more than just the impacts on the regional economy. Refuges also provide substantial nonmarket values (values for items not exchanged in established markets) such as maintaining endangered species, preserving wetlands, educating future generations, and adding stability to the ecosystem (Carver and Caudill, 2007). However, quantifying these types of nonmarket values is beyond the scope of this study. This report first presents a description of the local community and economy near the Refuge. Next, the methods used to conduct a regional economic impact analysis are described. An analysis of the final CCP management strategies that could affect stakeholders and residents and the local economy is then presented. The refuge management activities of economic concern in this analysis are:
Min, D.K.; You, G.S.; Ro, S.G.; Park, H.S.
Due to the lack of indigenous energy sources in Korea, the government selected nuclear energy as one of the major sources of electricity generation. According to the Korean government programme of a nuclear power development, currently, 14 nuclear power plants (NPPs) are in operation and 4 NPPs are under construction. In addition, further 10 NPPs are planned to be in operation by the year 2015. The large amount of spent fuel discharged from the nuclear power plants is accumulated in at-reactor (AR) storage pools. Due to the limited capacity of these AR storage pools, the safe and economic management of spent fuel is to be resolved. The spent fuel management strategy in Korea, basically depends on the interim storage in wet and dry storage facilities, including expansion of storage capacity. This paper describes the current status and plans of the spent fuel management in Korea. (author)
Full Text Available One of the key components of the management system is the organizational structure of management. This report presents the current trends of development and improvement of organizational structures of management. The semantics of the term "organizational structure" used in the report is clarified. Key aspects of structural policy of organizations are discussed, as well as the introduction of flexible organizational forms. The main directions for analysis of organizational policy of organizations are also mentioned. It is stressed that the analysis of current trends for the future development of organizational structures of management should be an integral component of the management policy of every organization. The trends are flexibility and adaptability of the organizational structure, rational proportion between centralization and decentralization, an appropriate balance between the rights, duties and responsibilities, reducing regulations, rules and other normative documents. A recommendetaion is made that organizational governance structures must be adapted constantly in accordance with changes in the overall management system, as they are one of its main components.
Taghipour, Hassan; Nowrouz, Parviz; Jafarabadi, Mohamad Asghari; Nazari, Jalil; Hashemi, Ahmad Asl; Mosaferi, Mohammad; Dehghanzadeh, Reza
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
Ecosystems often exhibit transitions between multiple dynamic regimes (or steady states). As ecosystems experience perturbations of varying regularity and intensity, they may either remain within the state space neighborhood of the current regime, or ?flip? into the neighborhood ...
Wooten, Kevin C; Dann, Sara M; Finnerty, Celeste C; Kotarba, Joseph A
The development of leadership and project management skills is increasingly important to the evolution of translational science and team-based endeavors. Team science is dependent upon individuals at various stages in their careers, inclusive of postdocs. Data from case histories, as well as from interviews with current and former postdocs, and those supervising postdocs, indicate six essential tasks required of project managers in multidisciplinary translational teams, along with eight skill-related themes critical to their success. To optimize the opportunities available and to ensure sequential development of team project management skills, a life cycle model for the development of translational team skills is proposed, ranging from graduate trainees, postdocs, assistant professors, and finally to mature scientists. Specific goals, challenges and project management roles and tasks are recommended for each stage for the life cycle.
Laghari, A. N.; Vanham, D.; Rauch, W.
The Indus basin is one of the regions in the world that is faced with major challenges for its water sector, due to population growth, rapid urbanisation and industrialisation, environmental degradation, unregulated utilization of the resources, inefficient water use and poverty, all aggravated by climate change. The Indus Basin is shared by 4 countries - Pakistan, India, Afghanistan and China. With a current population of 237 million people which is projected to increase to 319 million in 2025 and 383 million in 2050, already today water resources are abstracted almost entirely (more than 95% for irrigation). Climate change will result in increased water availability in the short term. However in the long term water availability will decrease. Some current aspects in the basin need to be re-evaluated. During the past decades water abstractions - and especially groundwater extractions - have augmented continuously to support a rice-wheat system where rice is grown during the kharif (wet, summer) season (as well as sugar cane, cotton, maize and other crops) and wheat during the rabi (dry, winter) season. However, the sustainability of this system in its current form is questionable. Additional water for domestic and industrial purposes is required for the future and should be made available by a reduction in irrigation requirements. This paper gives a comprehensive listing and description of available options for current and future sustainable water resources management (WRM) within the basin. Sustainable WRM practices include both water supply management and water demand management options. Water supply management options include: (1) reservoir management as the basin is characterised by a strong seasonal behaviour in water availability (monsoon and meltwater) and water demands; (2) water quality conservation and investment in wastewater infrastructure; (3) the use of alternative water resources like the recycling of wastewater and desalination; (4) land use
A. N. Laghari
Full Text Available The Indus basin is one of the regions in the world that is faced with major challenges for its water sector, due to population growth, rapid urbanisation and industrialisation, environmental degradation, unregulated utilization of the resources, inefficient water use and poverty, all aggravated by climate change. The Indus Basin is shared by 4 countries – Pakistan, India, Afghanistan and China. With a current population of 237 million people which is projected to increase to 319 million in 2025 and 383 million in 2050, already today water resources are abstracted almost entirely (more than 95% for irrigation. Climate change will result in increased water availability in the short term. However in the long term water availability will decrease. Some current aspects in the basin need to be re-evaluated. During the past decades water abstractions – and especially groundwater extractions – have augmented continuously to support a rice-wheat system where rice is grown during the kharif (wet, summer season (as well as sugar cane, cotton, maize and other crops and wheat during the rabi (dry, winter season. However, the sustainability of this system in its current form is questionable. Additional water for domestic and industrial purposes is required for the future and should be made available by a reduction in irrigation requirements. This paper gives a comprehensive listing and description of available options for current and future sustainable water resources management (WRM within the basin. Sustainable WRM practices include both water supply management and water demand management options. Water supply management options include: (1 reservoir management as the basin is characterised by a strong seasonal behaviour in water availability (monsoon and meltwater and water demands; (2 water quality conservation and investment in wastewater infrastructure; (3 the use of alternative water resources like the recycling of wastewater and desalination; (4
Pereira, Paulo; Westgard, James O; Encarnação, Pedro; Seghatchian, Jerard; de Sousa, Gracinda
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.
Ram Prabhakar, J.; Ragavan, K.
This article proposes new power management based current control strategy for integrated wind-solar-hydro system equipped with battery storage mechanism. In this control technique, an indirect estimation of load current is done, through energy balance model, DC-link voltage control and droop control. This system features simpler energy management strategy and necessitates few power electronic converters, thereby minimizing the cost of the system. The generation-demand (G-D) management diagram is formulated based on the stochastic weather conditions and demand, which would likely moderate the gap between both. The features of management strategy deploying energy balance model include (1) regulating DC-link voltage within specified tolerances, (2) isolated operation without relying on external electric power transmission network, (3) indirect current control of hydro turbine driven induction generator and (4) seamless transition between grid-connected and off-grid operation modes. Furthermore, structuring of the hybrid system with appropriate selection of control variables enables power sharing among each energy conversion systems and battery storage mechanism. By addressing these intricacies, it is viable to regulate the frequency and voltage of the remote network at load end. The performance of the proposed composite scheme is demonstrated through time-domain simulation in MATLAB/Simulink environment.
Staveski, Sandra L; Pickler, Rita H; Lin, Li; Shaw, Richard J; Meinzen-Derr, Jareen; Redington, Andrew; Curley, Martha A Q
The purpose of this study was to describe how pediatric cardiac intensive care clinicians assess and manage delirium in patients following cardiac surgery. Descriptive self-report survey. A web-based survey of pediatric cardiac intensive care clinicians who are members of the Pediatric Cardiac Intensive Care Society. Pediatric cardiac intensive care clinicians (physicians and nurses). None. One-hundred seventy-three clinicians practicing in 71 different institutions located in 13 countries completed the survey. Respondents described their clinical impression of the occurrence of delirium to be approximately 25%. Most respondents (75%) reported that their ICU does not routinely screen for delirium. Over half of the respondents (61%) have never attended a lecture on delirium. The majority of respondents (86%) were not satisfied with current delirium screening, diagnosis, and management practices. Promotion of day/night cycle, exposure to natural light, deintensification of care, sleep hygiene, and reorientation to prevent or manage delirium were among nonpharmacologic interventions reported along with the use of anxiolytic, antipsychotic, and medications for insomnia. Clinicians responding to the survey reported a range of delirium assessment and management practices in postoperative pediatric cardiac surgery patients. Study results highlight the need for improvement in delirium education for pediatric cardiac intensive care clinicians as well as the need for systematic evaluation of current delirium assessment and management practices.
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
Full Text Available The article examines the current state of the insurance system as a component of managing the consequences of emergencies. The researches are presented in the following areas: the insurance against accidents and fire risks and risks of natural disasters; property insurance (property, goods and agricultural products; the insurance of transport (by modes; liability insurance (by liability. So, the author made the statistical and analytical assessment of consequences of emergencies that was learned through the study of modern insurance system, which enabled to identify the complex of accounting objects in the management of consequences of emergencies.
Liu, Yungui; Yao, Ying; Shangguan, Shihao; Gu, Qun; Gao, Wuming; Chen, Yaoshui
Study the current quality management situation of enterprises marketing corneal contact lens via systemic investigations and explore effective administration countermeasures in the future. The quality management indicators of sixty-two corneal contact lens marketing enterprises in Xuhui district of Shanghai were systematically investigated and enterprises of different operation models was compared and analyzed. Wholesale enterprises and retail chain enterprises are apparently better than independent enterprises almost in all facets. Facilitate market accession of corneal contact lens marketing enterprises, encourage the business model of retail chain, enhance supervision of corneal contact lens marketing enterprises, especially independent franchisors.
Arakeri, Gururaj; Rai, Kirthi Kumar; Boraks, George; Patil, Shekar Gowda; Aljabab, Abdulsalam S; Merkx, M A W; Carrozzo, Marco; Brennan, Peter A
Oral submucous fibrosis (OSMF) is a debilitating condition of oral cavity which has significant potential for malignant transformation. In spite of over 20 years of research, the pathogenesis of the condition is still obscure and no single management modality is effective. Many OSMF treatment protocols have been proposed to alleviate the signs and symptoms of the disorder and there is overwhelming evidence that as areca nut is primary cause, stopping its use may have a considerable effect on symptoms rather than reversing pre-existing fibrosis. We present a review of the current protocols for managing OSMF. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Fjermeros, Morten; Ilstad, Kristine
In Norway, the present taxation regime for electric power is very complex. The power companies are currently charged with ordinary tax on profits, tax on economic rent, tax on natural resources and land tax. In addition there are the rules about licence fees, yield of power due to concession conditions, and reversion. The Norwegian Electricity Industry Association (EBL), assisted by a firm of lawyers, has proposed an improvement over the current taxation regime
Kaplan, Isaac C.; Horne, Peter J.; Levin, Phillip S.
End-to-end marine ecosystem models link climate and oceanography to the food web and human activities. These models can be used as forecasting tools, to strategically evaluate management options and to support ecosystem-based management. Here we report the results of such forecasts in the California Current, using an Atlantis end-to-end model. We worked collaboratively with fishery managers at NOAA’s regional offices and staff at the National Marine Sanctuaries (NMS) to explore the impact of fishery policies on management objectives at different spatial scales, from single Marine Sanctuaries to the entire Northern California Current. In addition to examining Status Quo management, we explored the consequences of several gear switching and spatial management scenarios. Of the scenarios that involved large scale management changes, no single scenario maximized all performance metrics. Any policy choice would involve trade-offs between stakeholder groups and policy goals. For example, a coast-wide 25% gear shift from trawl to pot or longline appeared to be one possible compromise between an increase in spatial management (which sacrificed revenue) and scenarios such as the one consolidating bottom impacts to deeper areas (which did not perform substantially differently from Status Quo). Judged on a coast-wide scale, most of the scenarios that involved minor or local management changes (e.g. within Monterey Bay NMS only) yielded results similar to Status Quo. When impacts did occur in these cases, they often involved local interactions that were difficult to predict a priori based solely on fishing patterns. However, judged on the local scale, deviation from Status Quo did emerge, particularly for metrics related to stationary species or variables (i.e. habitat and local metrics of landed value or bycatch). We also found that isolated management actions within Monterey Bay NMS would cause local fishers to pay a cost for conservation, in terms of reductions in landed
A regulação do uso de animais no Brasil do século XX e o processo de formação do atual regime aplicado à pesquisa biomédica Regulation of the use of animals in Brazil in the twentieth century and the process of forming the current regime applied to biomedical research
Carlos José Saldanha Machado
Full Text Available O artigo analisa a política pública e regulatória do Brasil sobre o uso de animais no ensino e na pesquisa biomédica. Aborda o arcabouço institucional-legal e a situação jurídica da proteção dos animais no país, além do debate legislativo que resultou na promulgação da lei 11.794/2008, que estabelece procedimentos para o uso científico de animais. Ressalta algumas características do atual regime regulatório e tece considerações de ordem teórico-metodológica, voltadas para a ampliação do entendimento do fenômeno investigado.The article analyzes Brazilian public policy and legislation concerning the use of animals in teaching and biomedical research. It examines the institutional and judicial framework and legal status of animal protection in Brazil, including the legislative debate that preceded enactment of Law 11.794/2008, which defined procedures to be employed in the scientific use of animals. It underscores certain features of current regulatory practice and also explores considerations of a theoretical and methodological nature, with a view to broadening our understanding of the question.
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.
First page Back Continue Last page Overview Graphics. Flux scaling: Ultimate regime. With the Nusselt number and the mixing length scales, we get the Nusselt number and Reynolds number (w'd/ν) scalings: and or. and. scaling expected to occur at extremely high Ra Rayleigh-Benard convection. Get the ultimate regime ...
Pedersen, John Storm; Aagaard, Peter
How managers try to adapt their organizations to the new performance landscape shaped by the current austerity by new forms of change management in Denmark, in the public sector of citizens with disabilities and socially disadvantaged people.......How managers try to adapt their organizations to the new performance landscape shaped by the current austerity by new forms of change management in Denmark, in the public sector of citizens with disabilities and socially disadvantaged people....
Prince, Ethan A; Murphy, Timothy P; Dhangana, Raj; Soares, Gregory M; Ahn, Sun H; Dubel, Gregory J
Traditionally, surgeons have served as primary consultants for patients with peripheral vascular disease for whom revascularization is considered. An important component of care for patients with peripheral artery disease (PAD) is risk factor management. The present study was undertaken to determine current management practices of interventional radiologists for patients with PAD and compare them to published data for vascular surgeons. If PAD patient management practices are similar, this would support direct referral of PAD patients who are considered for revascularization from primary care doctors to interventional radiologists. An online survey was administered to full members of the Society of Interventional Radiology with e-mail addresses on file. Filtering was done to examine and compare interactions among several responses. The margin of error for the survey was +/-2%, based on 95% CIs for the entire surveyed population (N=2,371). Seventy-five percent of respondents see PAD patients in ambulatory office settings. Only eight percent see themselves as the physician responsible for risk factor management, similar to reported results of vascular surgeons (10%). Other variables examined, such as frequency of inquiring about Framingham risk factors, indicate similar practices to those previously reported for vascular surgeons. For interventional radiologists who accept direct referrals for medical management of patients with PAD, disease management by interventional radiologists is similar to that previously reported for vascular surgeons. This supports the role of interventional radiologists who accept direct referrals of patients with PAD as primary consultants to primary care doctors.
Nawaz, Muhammad Sarfraz; Shah, Kifayat Ullah; Khan, Tahir Mehmood; Rehman, Asim Ur; Rashid, Haroon Ur; Mahmood, Sajid; Khan, Shahzeb; Farrukh, Muhammad Junaid
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.
Power Reactor and Nuclear Fuel Development Corporation (PNC) was designated as a leading organization for the Pu-contaminated waste technology program in Japan. For this purpose, number of efforts in the research and development are proceeding. That is, Pu-contaminated waste technology including volume reduction system and the immobilization of wastes is being developed. The design of a Pu-contaminated waste treatment facility (PWTF) is being made for the demonstration of the technology developed. Studies are in progress to find the criteria for waste products in disposal. The current procedures and strategy for the management of Pu-contaminated wastes at PNC are described as follows: current and future management; technology development including controlled air incineration, acid digestion, immobilization melting, dismantling, and liquid waste treatment; the Pu-contaminated waste treatment facility. (J.P.N.)
Full Text Available This paper evaluates some of current financial investment selection methodologies for capital projects. The proc ess (and criteria of capital investment decisions is reviewed. The capital budget for most organisations is prepared annually by a committee of senior managers who then present it for approval by the board of directors. Investment proposals are usually subjected to two financial tests, "payback" and "internal rate of return (IRR". The management committee usually decides on the tests and acceptance criteria vary according to the type of project. Some shortcomings of these most frequently used current tests (Payback & IRR are identified and it is recommended that the Net Present Value (NPV should be used as the primary method for analysing, comparing and selecting capital projects.
Tanriverdi, F; Agha, A; Aimaretti, G
Traumatic brain injury (TBI)-induced hypopituitarism remains a relevant medical problem, because it may affect a significant proportion of the population. In the last decade important studies have been published investigating pituitary dysfunction after TBI. Recently, a group of experts gathered...... and revisited the topic of TBI-induced hypopituitarism. During the 2-day meeting, the main issues of this topic were presented and discussed, and current understanding and management of TBI-induced hypopituitarism are summarized here....
Today's prescriptions for treating spasticity may include pharmacological, surgical, or physical procedures. All derive their rationale from the classical concepts of decerebrate rigidity and of brain organization as discussed in Part I. This paper describes the advantages and disadvantages of these current treatment procedures and proposes that recent discoveries about the "recovery" capabilities of the central nervous system may influence the means for managing spasticity in the future.
Traumatic brain injury (TBI)-induced hypopituitarism remains a relevant medical problem, because it may affect a significant proportion of the population. In the last decade important studies have been published investigating pituitary dysfunction after TBI. Recently, a group of experts gathered and revisited the topic of TBI-induced hypopituitarism. During the 2-day meeting, the main issues of this topic were presented and discussed, and current understanding and management of TBI-induced hypopituitarism are summarized here.
Hornbostel, Marc D.; Krishnan, Gopala N.; Sanjurjo, Angel
The invention relates to contactors suitable for use, for example, in manufacturing and chemical refinement processes. In an aspect is a hybrid indirect/direct contactor for thermal management of counter-current processes, the contactor comprising a vertical reactor column, an array of interconnected heat transfer tubes within the reactor column, and a plurality of stream path diverters, wherein the tubes and diverters are configured to block all straight-line paths from the top to bottom ends of the reactor column.
Full Text Available Security is a major problem of the banking industry, which bases its whole system on the reputation the bank manages to establish and then maintain among its customers. With the manifestation of information security issues and in interdependence with them, the need for internal control also developed, both of them being associated with modern risk management practices. As the concept of internal control has been rising as a major concern of management and corporate governance, there are attempts to classify it and distinguish it in different categories, dual control being a result of this process. The authors of this study attempt to present the concept of dual control as it is currently applied in the banking system, trying to analyze contextually its capacities of fraud detection, its consequences in terms of risk and costs as well as its effects on bank performance.
Minnullina, Anna; Abdrazakov, Rais
The authors’ expert assessment of the current state of the energy management system in the company is proposed in the article. The experts are invited to assess the status of the energy management system in the following categories: energy policy, organizational structure, training, motivation, control, communication, investment, and energy consumption culture. For the purposes of interpretation of the results of the expert evaluation obtained, a gradation based on a possible range of values is proposed. The expert evaluation allows representing the status of the energy management system in general and at each of its individual levels, which makes it possible to identify the problem areas more accurately. To confirm the applied nature of the proposed methodology, the authors assessed the opinions of 8 experts, employed by the road construction company of the Tyumen Region and related in one way or another to the process of energy consumption in the company due to the nature of their activities.
Eisenhower, B.M.; Oakes, T.W.; Coobs, J.H.; Weeter, D.W.
The need for efficient management of industrial chemical wastes, especially those considered hazardous or radioactive, is receiving increased attention in the United States. During the past five years, several federal laws have addressed the establishment of stronger programs for the control of hazardous and residual wastes. At a facility such as Oak Ridge National Laboratory (ORNL), an efficient waste management program is an absolute necessity to ensure protection of human health and compliance with regulatory requirements addressing the treatment and disposal of hazardous, nonhazardous, and radioactive wastes. This report highlights the major regulatory requirements under which the Laboratory must operate and their impact on ORNL facilities. Individual waste streams, estimates of quantities of waste, and current waste management operations are discussed.
Industrial activities are regarded as safe even though a small risk always exists. The philosophy of radiation protection accepts this and recognises that some level of risk will also be associated with safe radioactive waste management. Therefore the objective of radioactive waste management is to look for a strategy which, taken as a whole, is considered safe and provides an acceptable balance of all the radiological, technical, social, political and economic considerations. The RWMC's appraisal underlines the need for such a balance while concentrating on radiological and technical factors, particularly on the long term safety aspects of radioactive waste management. The fundamental conclusion is that detailed short and long term safety assessments can now be made which give confidence that radiation protection objectives can be met with currently available technology for most waste types, and at a cost which is only a small fraction of the overall cost of nuclear-generated power
Eisenhower, B.M.; Oakes, T.W.; Coobs, J.H.; Weeter, D.W.
The need for efficient management of industrial chemical wastes, especially those considered hazardous or radioactive, is receiving increased attention in the United States. During the past five years, several federal laws have addressed the establishment of stronger programs for the control of hazardous and residual wastes. At a facility such as Oak Ridge National Laboratory (ORNL), an efficient waste management program is an absolute necessity to ensure protection of human health and compliance with regulatory requirements addressing the treatment and disposal of hazardous, nonhazardous, and radioactive wastes. This report highlights the major regulatory requirements under which the Laboratory must operate and their impact on ORNL facilities. Individual waste streams, estimates of quantities of waste, and current waste management operations are discussed
Kim, Soyoung; Yoon, Jihyun; Kwon, Sooyoun; Kim, Jihyun; Han, Youngshin
Recently the need to manage food allergies in schools has been growing. This study aimed to examine the current status of managing food allergies in schools in Seoul, Korea. A questionnaire survey was conducted in cooperation with the School Dietician Association during April 2009. Among the participating 154 schools, a total of 109 (71%) were determining students' food allergy status through parental surveys based on self-reported food allergies. A total of 72 (47%) had experienced student visits to a school health room due to food allergies within one year before the survey. Over 80 percent of the schools relied on self-care only without any school-wide measures for food allergies in place. Among the 890 menu items most frequently served in school lunch programs, a total of 664 (75%) were found to contain more than one food allergen. It is highly suggested that preventive plans and treatment measures should be established to manage food allergies in schools.
Klaess, Cynthia C; Jungquist, Carla R
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.
Ysunza, Pablo Antonio; Repetto, Gabriela M.; Pamplona, Maria Carmen; Calderon, Juan F.; Shaheen, Kenneth; Chaiyasate, Konkgrit; Rontal, Matthew
Background. One of the most controversial topics concerning cleft palate is the diagnosis and treatment of velopharyngeal insufficiency (VPI). Objective. This paper reviews current genetic aspects of cleft palate, imaging diagnosis of VPI, the planning of operations for restoring velopharyngeal function during speech, and strategies for speech pathology treatment of articulation disorders in patients with cleft palate. Materials and Methods. An updated review of the scientific literature concerning genetic aspects of cleft palate was carried out. Current strategies for assessing and treating articulation disorders associated with cleft palate were analyzed. Imaging procedures for assessing velopharyngeal closure during speech were reviewed, including a recent method for performing intraoperative videonasopharyngoscopy. Results. Conclusions from the analysis of genetic aspects of syndromic and nonsyndromic cleft palate and their use in its diagnosis and management are presented. Strategies for classifying and treating articulation disorders in patients with cleft palate are presented. Preliminary results of the use of multiplanar videofluoroscopy as an outpatient procedure and intraoperative endoscopy for the planning of operations which aimed to correct VPI are presented. Conclusion. This paper presents current aspects of the diagnosis and management of patients with cleft palate and VPI including 3 main aspects: genetics and genomics, speech pathology and imaging diagnosis, and surgical management. PMID:26273595
Pablo Antonio Ysunza
Full Text Available Background. One of the most controversial topics concerning cleft palate is the diagnosis and treatment of velopharyngeal insufficiency (VPI. Objective. This paper reviews current genetic aspects of cleft palate, imaging diagnosis of VPI, the planning of operations for restoring velopharyngeal function during speech, and strategies for speech pathology treatment of articulation disorders in patients with cleft palate. Materials and Methods. An updated review of the scientific literature concerning genetic aspects of cleft palate was carried out. Current strategies for assessing and treating articulation disorders associated with cleft palate were analyzed. Imaging procedures for assessing velopharyngeal closure during speech were reviewed, including a recent method for performing intraoperative videonasopharyngoscopy. Results. Conclusions from the analysis of genetic aspects of syndromic and nonsyndromic cleft palate and their use in its diagnosis and management are presented. Strategies for classifying and treating articulation disorders in patients with cleft palate are presented. Preliminary results of the use of multiplanar videofluoroscopy as an outpatient procedure and intraoperative endoscopy for the planning of operations which aimed to correct VPI are presented. Conclusion. This paper presents current aspects of the diagnosis and management of patients with cleft palate and VPI including 3 main aspects: genetics and genomics, speech pathology and imaging diagnosis, and surgical management.
Spent fuel management has always been one of the important stages in the nuclear fuel cycle and it is still most vital problems common to all countries with nuclear reactors. It begins with the discharge of spent fuel from a power or a research reactor and ends with its ultimate disposition. Two options exist - an open, once-through cycle with direct disposal of the spent fuel and a closed cycle with reprocessing of the spent fuel, recycling of reprocessed plutonium and uranium in new mixed oxide fuels and disposal of the radioactive waste. Continuous attention is being given by the IAEA to the collection, analysis and exchange of information on spent fuel management. Its role in this area is to provide a forum for exchanging information and to co-ordinate and to encourage closer co-operation among Member States in certain research and development activities that are of common interest. Spent fuel management is recognized as a high priority IAEA activity. The Regular Advisory Group on Spent Fuel Management was established in 1982. The objective of the Regular Advisory Group is to serve as a means of exchanging information on the current status and progress of national programmes on spent fuel management and to provide advice to the IAEA. The results of the last Regular Advisory Group meeting (9-12 September 1997) are reflected in this report. It gives an overview of the status of spent fuel management programmes in a number of countries, a description of the current status and prospects of activities in this field and recommendations of the participants
Full Text Available Zhongjun Xia Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, ChinaPurpose: Cancer pain can seriously impact the quality of life (QoL of patients, and optimal management practices are therefore of paramount importance. The ACHEON survey queried physicians and patients from 10 Asian countries/regions to assess current clinical practices in cancer pain management in Asia. This study presents the data obtained for cancer pain management in mainland China, with an emphasis on practices related to opioid drugs.Materials and methods: In several tertiary hospitals across China, 250 patients experiencing cancer pain and 100 physicians were surveyed on questions designed to assess current cancer pain management practices and cancer pain impact on QoL.Results: The patient survey showed that 88% of patients reported moderate-to-severe cancer pain, with a median duration of 6 months. The physician survey showed that medical school/residency training with regard to cancer pain management was inadequate in ~80% of physicians. A total of 80% of physicians and 67.2% of patients reported that pain scale was used during pain assessment; 84% of physicians expressed that physician-perceived pain severity was not completely consistent with actual pain the patient experienced. Of the 147 patients who recalled the medication received, 83.7% were administered opioid prescriptions. Of the 240 patients who received treatment, 43.8% perceived the inadequacy of controlling pain. The primary barriers from physicians perceived to optimal pain management included patients’ fear of side effects (58%, patients’ fear of addiction (53%, patients’ reluctance to report pain (43%, physicians’ reluctance to prescribe (29%, physicians’ inadequacy of pain assessment (27% and excessive regulation of opioid analgesics (47%.Conclusion: Knowledge of cancer pain management should be strengthened among physicians. Quantitative pain assessment and principle-based pain
Koontz, Lynne; Sexton, Natalie; Donovan, Ryan
The National Wildlife Refuge System Improvement Act of 1997 requires all units of the National Wildlife Refuge System to be managed under a Comprehensive Conservation Plan. The Comprehensive Conservation Plan must describe the desired future conditions of a refuge and provide long-range guidance and management direction to achieve refuge purposes. The Rappahannock River Valley National Wildlife Refuge (refuge) is in the process of developing a range of management goals, objectives, and strategies for the Comprehensive Conservation Plan. The Comprehensive Conservation Plan for the refuge must contain an analysis of expected effects associated with current and proposed refuge management strategies. The purpose of this study was to assess the regional economic implications associated with draft Comprehensive Conservation Plan management strategies. Special interest groups and local residents often criticize a change in refuge management, especially if there is a perceived negative impact to the local economy. Having objective data on economic impacts may show that these fears are overstated. Quite often, the extent of economic benefits a refuge provides to a local community is not fully recognized, yet at the same time the effects of negative changes is overstated. Spending associated with refuge recreational activities, such as wildlife viewing and hunting, can generate considerable tourist activity for surrounding communities. Additionally, refuge personnel typically spend considerable amounts of money purchasing supplies in local stores, repairing equipment and purchasing fuel at the local service stations, and reside and spend their salaries in the local community. For refuge Comprehensive Conservation Plan planning, a regional economic assessment provides a means of estimating how current management (no action alternative) and proposed management activities (alternatives) could affect the local economy. This type of analysis provides two critical pieces of
Conklin, Annalijn; Nolte, Ellen
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.
Prognostics and health management is not a new concept. It has been used in relatively mature industries, such as aviation and electronics, to help improve operation and maintenance (O&M) practices. In the wind industry, prognostics and health management is relatively new. The level for both wind industry applications and research and development (R&D) has increased in recent years because of its potential for reducing O&M cost of wind power, especially for turbines installed offshore. The majority of wind industry application efforts has been focused on diagnosis based on various sensing and feature extraction techniques. For R&D, activities are being conducted in almost all areas of a typical prognostics and health management framework (i.e., sensing, data collection, feature extraction, diagnosis, prognosis, and maintenance scheduling). This presentation provides an overview of the current status of wind turbine prognostics and health management that focuses on drivetrain condition monitoring through vibration, oil debris, and oil condition analysis techniques. It also discusses turbine component health diagnosis through data mining and modeling based on supervisory control and data acquisition system data. Finally, it provides a brief survey of R&D activities for wind turbine prognostics and health management, along with future opportunities.
Rodriguez, J L; Peterson, D J; Muehlstedt, S G; Zera, R T; West, M A; Bubrick, M P
Managed care and governmental policies have restructured hospital reimbursement. We examined reimbursement trends in trauma care to assess the impact of this market driven change on an urban academic health center. Patients injured between January 1997 and December 1999 were analyzed for Injury Severity Score (ISS), length of hospital stay, hospital cost, payer, and reimbursement. Between 1997 and 1999, the volume of patients with an ISS less than 9 increased and length of stay decreased. In addition, overall cost, payment, and profit margin increased. Commercially insured patients accounted for this margin increase, because the margins of managed care and government insured patients experienced double-digit decreases. Patients with ISS of 9 or greater also experienced a volume increase and a reduction in length of stay; however, costs within this group increased greater than payments, thereby reducing profit margin. Whereas commercially insured patients maintained their margin, managed care and government insured patients did not (double- and triple-digit decreases). Managed care and current governmental policies have a negative impact on urban academic health center reimbursement. Commercial insurers subsidize not only the uninsured but also the government insured and managed care patients as well. National awareness of this issue and policy action are paramount to urban academic health centers and may also benefit commercial insurers.
Kriticos, Darren J; Brunel, Sarah
Understanding and managing the biological invasion threats posed by aquatic plants under current and future climates is a growing challenge for biosecurity and land management agencies worldwide. Eichhornia crassipes is one of the world's worst aquatic weeds. Presently, it threatens aquatic ecosystems, and hinders the management and delivery of freshwater services in both developed and developing parts of the world. A niche model was fitted using CLIMEX, to estimate the potential distribution of E. crassipes under historical and future climate scenarios. Under two future greenhouse gas emission scenarios for 2080 simulated with three Global Climate Models, the area with a favourable temperature regime appears set to shift polewards. The greatest potential for future range expansion lies in Europe. Elsewhere in the northern hemisphere temperature gradients are too steep for significant geographical range expansion under the climate scenarios explored here. In the Southern Hemisphere, the southern range boundary for E. crassipes is set to expand southwards in Argentina, Australia and New Zealand; under current climate conditions it is already able to invade the southern limits of Africa. The opportunity exists to prevent its spread into the islands of Tasmania in Australia and the South Island of New Zealand, both of which depend upon hydroelectric facilities that would be threatened by the presence of E. crassipes. In Europe, efforts to slow or stop the spread of E. crassipes will face the challenge of limited internal biosecurity capacity. The modelling technique demonstrated here is the first application of niche modelling for an aquatic weed under historical and projected future climates. It provides biosecurity agencies with a spatial tool to foresee and manage the emerging invasion threats in a manner that can be included in the international standard for pest risk assessments. It should also support more detailed local and regional management.
Darren J Kriticos
Full Text Available Understanding and managing the biological invasion threats posed by aquatic plants under current and future climates is a growing challenge for biosecurity and land management agencies worldwide. Eichhornia crassipes is one of the world's worst aquatic weeds. Presently, it threatens aquatic ecosystems, and hinders the management and delivery of freshwater services in both developed and developing parts of the world. A niche model was fitted using CLIMEX, to estimate the potential distribution of E. crassipes under historical and future climate scenarios. Under two future greenhouse gas emission scenarios for 2080 simulated with three Global Climate Models, the area with a favourable temperature regime appears set to shift polewards. The greatest potential for future range expansion lies in Europe. Elsewhere in the northern hemisphere temperature gradients are too steep for significant geographical range expansion under the climate scenarios explored here. In the Southern Hemisphere, the southern range boundary for E. crassipes is set to expand southwards in Argentina, Australia and New Zealand; under current climate conditions it is already able to invade the southern limits of Africa. The opportunity exists to prevent its spread into the islands of Tasmania in Australia and the South Island of New Zealand, both of which depend upon hydroelectric facilities that would be threatened by the presence of E. crassipes. In Europe, efforts to slow or stop the spread of E. crassipes will face the challenge of limited internal biosecurity capacity. The modelling technique demonstrated here is the first application of niche modelling for an aquatic weed under historical and projected future climates. It provides biosecurity agencies with a spatial tool to foresee and manage the emerging invasion threats in a manner that can be included in the international standard for pest risk assessments. It should also support more detailed local and regional
Nuclear power plant decommissioning is a mandatory operation for which financial arrangements have been defined. Current European decommissioning reserve find management models were designed in a context of operator monopolies and public property regime. Because of electricity sector restructuring; businesses are no longer protected from market sanctions and stock market volatility (affecting firm's financial viability). These potential sanctions create uncertainty on the decommission in financing mechanism. Thus, the form of decommissioning funds management (internal or external) appears as the main compatibility determinant with the electricity competition regimes. In a market risks environment, external management solutions improve credibility of operator's decommissioning commitment. (authors)
Lindegren, Martin; Dakos, Vasilis; Groeger, Joachim P.
methods may have limited utility in ecosystem-based management as they show no or weak potential for early-warning. We therefore propose a multiple method approach for early detection of ecosystem regime shifts in monitoring data that may be useful in informing timely management actions in the face...
Heeley Emma L
Full Text Available Abstract Background We aimed to examine current practice of the management and secondary prevention of intracerebral haemorrhage (ICH in China where the disease is more common than in Western populations. Methods Data on baseline characteristics, management in-hospital and post-stroke, and outcome of ICH patients are from the ChinaQUEST (QUality Evaluation of Stroke Care and Treatment study, a multi-centre, prospective, 62 hospital registry in China during 2006-07. Results Nearly all ICH patients (n = 1572 received an intravenous haemodiluting agent such as mannitol (96% or a neuroprotectant (72%, and there was high use of intravenous traditional Chinese medicine (TCM (42%. Neurosurgery was undertaken in 137 (9% patients; being overweight, having a low Glasgow Coma Scale (GCS score on admission, and Total Anterior Circulation Syndrome (TACS clinical pattern on admission, were the only baseline factors associated with this intervention in multivariate analyses. Neurosurgery was associated with nearly three times higher risk of death/disability at 3 months post-stroke (odd ratio [OR] 2.60, p Conclusions The management of ICH in China is characterised by high rates of use of intravenous haemodiluting agents, neuroprotectants, and TCM, and of antihypertensives for secondary prevention. The controversial efficacy of these therapies, coupled with the current lack of treatments of proven benefit, is a call for action for more outcomes based research in ICH.
de Rauville, Ingrid; Chetty, Sandhya; Pahl, Jenny
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.
Hosmane, Sharath; Birla, Rashmi; Marchbank, Adrian
The Audit and Guidelines Committee of the European Association for Cardio-Thoracic Surgery recently published a guideline on antiplatelet and anticoagulation management in cardiac surgery. We aimed to assess the awareness of the current guideline and adherence to it in the National Health Service through this National Audit. We designed a questionnaire consisting of nine questions covering various aspects of antiplatelet and anticoagulation management in post-cardiac surgery patients. A telephonic survey of the on-call cardiothoracic registrars in all the cardiothoracic centres across the UK was performed. All 37 National Health Service hospitals in the UK with 242 consultants providing adult cardiac surgical service were contacted. Twenty (54%) hospitals had a unit protocol for antiplatelet and anticoagulation management in post-cardiac surgery. Only 23 (62.2%) registrars were aware of current European Association for Cardio-Thoracic Surgery guidelines. Antiplatelet therapy is variable in the cardiac surgical units across the country. Low-dose aspirin is commonly used despite the recommendation of 150-300 mg. The loading dose of aspirin within 24 h as recommended by the guideline is followed only by 60.7% of surgeons. There was not much deviation from the guideline with respect to the anticoagulation therapy.
Melissa M Foley
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.
Wassink, G J; George, T R N; Kaler, J; Green, L E
The aims of this research were to identify management practices that sheep farmers currently use to treat and prevent footrot in sheep and whether they consider that these are successful management tools and to find out how sheep farmers would ideally like to manage footrot in their flock. Over 90% of lameness in sheep in the UK is caused by Dichelobacter nodosus, which presents clinically as interdigital dermatitis (ID) alone or with separation of hoof horn (FR). A questionnaire was sent to 265 farmers to investigate their current management and their satisfaction with current management of the spectrum of clinical presentations of footrot. Farmers were also asked their ideal management of footrot and their interest in, and sources of information for, change. Approximately 160 farmers responded. Farmers satisfied with current management reported a prevalence of lameness 5%. These farmers practised routine foot trimming, footbathing and vaccination against footrot. Whilst 89% of farmers said they were satisfied with their management of FR over 34% were interested in changing management. Farmers identified veterinarians as the most influential source for new information. Farmers reported that ideally they would control FR by culling/isolating lame sheep, sourcing replacements from non-lame parents, trimming feet less, using antibacterial treatments less and using vaccination more. Footbathing was a commonly used management that was linked with dissatisfaction and that also was listed highly as an ideal management. Consequently, some of the ideal managements are in agreement with our understanding of disease control (culling and isolation, sourcing healthy replacements) but others are in contrast with our current knowledge of management and farmers self-reporting of satisfaction of management of footrot (less use of antibacterial treatment, more footbathing and vaccination). One explanation for this is the theory of cognitive dissonance where belief follows behaviour
Hanks, G.E.; Kramer, S.
Consensus of best current management developed by a rational and deliberative process can provide the basis for clinical quality assessment. When it is possible to arrive at consensus in a specific disease, this consensus should detail appropriate pretreatment evaluation and the details of the treatment. Committees of experts for each specific disease site can formulate the consensus and must document their decision based on information from the current world literature. The authors have observed that individuals formulating consensus of best current management do not strictly follow their own criteria, and that compliance in various strata of practice throughout the United States shows a greater deviation from consensus than anticipated and indeed this deviation crosses all types of practice. The authors have observed quite different outcomes for two groups of patients with Hodgkin's disease treated with the same processes (i.e., mantle field technology and adequate radiation dose, etc.). They were unable to identify the reason for an increased failure rate in one group of these patients until they looked at each individual mantle port film from the two groups of patients. They identified that one facility was not including the Hodgkin's disease in the treatment portal due to poor technical performance. This program of process verification may be important in evaluating quality for any disease site
Mohee, Romeela; Mauthoor, Sumayya; Bundhoo, Zumar M.A.; Somaroo, Geeta; Soobhany, Nuhaa; Gunasee, Sanjana
Highlights: • Waste management is a matter of great concern for small island developing states. • On average, waste generation rate in these islands amounts to 1.29 kg/capita/day. • Illegal dumping and landfilling prevail in most small island developing states. • Sustainable waste management practices, previously absent, are now emerging. • However, many challenges still hinder the implementation of these practices. - Abstract: This article reviews the current status of waste management in Small Island Developing States (SIDS) and the challenges that are faced in solid waste management. The waste generation rates of SIDS were compared within the three geographic regions namely Caribbean SIDS, Pacific SIDS and Atlantic, Indian Ocean, Mediterranean and South China (AIMS) SIDS and with countries of the Organisation for Economic Co-Operation and Development (OECD). Only Pacific SIDS had a waste generation rate less than 1 kg/capita/day. The waste generation rates for the three SIDS regions averaged 1.29 kg/capita/day while that for OECD countries was at a mean value of 1.35 kg/capita/day. The waste compositions in the different SIDS regions were almost similar owing to comparable consumption patterns while these differed to a large extent with wastes generated in OECD countries. In SIDS, the major fraction of MSW comprised of organics (44%) followed by recyclables namely paper, plastics, glass and metals (total: 43%). In contrast, MSW in OECD countries consisted mainly of recyclables (43%) followed by organics (37%). This article also reviewed the other functional elements of the waste management systems in SIDS. Several shortcomings were noted in the process of waste collection, transfer and transport namely the fact of having outdated collection vehicles and narrow roads which are inaccessible. Among the waste management practices in SIDS, waste disposal via landfilling, illegal dumping and backyard burning were favoured most of the time at the expense of
Mohee, Romeela [University of Mauritius, Réduit (Mauritius); Mauthoor, Sumayya, E-mail: firstname.lastname@example.org [Department of Chemical & Environmental Engineering, University of Mauritius, Réduit (Mauritius); Bundhoo, Zumar M.A.; Somaroo, Geeta; Soobhany, Nuhaa; Gunasee, Sanjana [Department of Chemical & Environmental Engineering, University of Mauritius, Réduit (Mauritius)
Highlights: • Waste management is a matter of great concern for small island developing states. • On average, waste generation rate in these islands amounts to 1.29 kg/capita/day. • Illegal dumping and landfilling prevail in most small island developing states. • Sustainable waste management practices, previously absent, are now emerging. • However, many challenges still hinder the implementation of these practices. - Abstract: This article reviews the current status of waste management in Small Island Developing States (SIDS) and the challenges that are faced in solid waste management. The waste generation rates of SIDS were compared within the three geographic regions namely Caribbean SIDS, Pacific SIDS and Atlantic, Indian Ocean, Mediterranean and South China (AIMS) SIDS and with countries of the Organisation for Economic Co-Operation and Development (OECD). Only Pacific SIDS had a waste generation rate less than 1 kg/capita/day. The waste generation rates for the three SIDS regions averaged 1.29 kg/capita/day while that for OECD countries was at a mean value of 1.35 kg/capita/day. The waste compositions in the different SIDS regions were almost similar owing to comparable consumption patterns while these differed to a large extent with wastes generated in OECD countries. In SIDS, the major fraction of MSW comprised of organics (44%) followed by recyclables namely paper, plastics, glass and metals (total: 43%). In contrast, MSW in OECD countries consisted mainly of recyclables (43%) followed by organics (37%). This article also reviewed the other functional elements of the waste management systems in SIDS. Several shortcomings were noted in the process of waste collection, transfer and transport namely the fact of having outdated collection vehicles and narrow roads which are inaccessible. Among the waste management practices in SIDS, waste disposal via landfilling, illegal dumping and backyard burning were favoured most of the time at the expense of
Jonte van Essen
Full Text Available The ambiguous position of de facto regimes in international law has long been the subject of scholarly debate and a source of political conflict. An assessment of the current standing of these regimes in international law and the consequences of actions by international actors on this status has, however, been long overdue. The manner in which de facto regimes are regarded internationally has serious consequences for the individuals under the influence of this legal grey area. Therefore, the study into this problem and possible solutions is of great significance. The 2011 developments in Northern Africa underline the need of contemporary research into this area. This essay aims to clarify the position of de facto regimes in international law and the influence on their status by actions of international actors. The author first argues that de facto regimes have rights and obligations under international law, which provide them with (some form of international legal personality. He then pleads for a reconsideration of the contemporary legal treatment of these regimes. The author argues against the current system of government recognition and proposes a system that better addresses the needs of both de facto regimes and the international community.
Jensen, Jens Stissing
This article suggests that transition strategies are always formulated in the context of specific representations of the regime and the challenges it faces. It is argued that the framing of a regime affects the envisioning of transition strategies. An analysis of the current development agenda...... for the housing construction sector in Denmark reveals the relevance and impacts of different regime framings. It is proposed that the ability to cope with framing issues as situated and political processes is at the core of the governance of transitions....
Fetal and neonatal allo-immune thrombocytopenia (FNAIT) is considered as a rare disease due to the incidence (1/1000-1/2000 births). The major complication of severe thrombocytopenia is bleeding and particularly intra-cranial hemorrhage and neurologic sequelae following. Serology and molecular biology developments have reconfigured the platelet immunology diagnosis. Anti-HPA-1a allo-immunisation is responsible for more than 80% FNAIT cases with a high recurrence rate of severe bleeding complications. Therapeutic management has changed over the coming years from an invasive concept associating fetal blood sampling and in utero platelet transfusion to a non invasive treatment by intravenous immunoglobulins injection (IVIg). The purpose of this article is to provide an update on FNAIT management in the light of current developments over the past 30years. Copyright © 2017. Published by Elsevier SAS.
Sang Doug Park
Korea has selected nuclear energy as the major source for the electric power generation due to the insufficiency of energy resources in Korea. in compliance with the policy, Korea Electric Power Corporation (KEPCO) has expanded the nuclear power programme and faced the significant arisings of spent fuel. The interim At Reactor(AR) storage pools have very limited capacities and temporary expansion of this capacity has been taken such as re-racking and dry storage construction. There was a plan, to construct a centralized spent fuel storage facility, which was postponed officially by the government. Under the current situation, it is hard to establish the long-term spent fuel management strategy. 'Wait and See' is no more applicable to Korea. because of storage shortage. Within R and D, dry storage construction and DUPIC fuel cycle are being considered. In this paper, the spent fuel management programme of Korea is briefly reviewed. (author)
Hospitals developed over the period of time when positivism become a predominant world view. Positivism was founded by four Western trends: preponderance of hierarchy and autocracy, popularization of bureaucracy, extensive application of a machine orientation to work and predominance of "scientific" inquiry. Organizational theory developed largely from quantitative research findings arising from a positivistic world view. A case study, analyzing a current nursing organizational structure at one large hospital, is presented. Nursing management was found to be based upon the positivistic paradigm. The predominance of a machine orientation, and an autocratic and bureaucratic structure are evidence of this. A change to shared governance had been attempted, indicating a shift to a more modern organizational structure based on a different paradigm. The article concludes by emphasizing that managers are largely responsible for facilitating change; change that will meet internal human resource needs and the cost-effectiveness crises of hospitals today through more effective use of human resources.
Kruger, Erwin A.; Pires, Marilyn; Ngann, Yvette; Sterling, Michelle; Rubayi, Salah
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
Starostina, Vlada; Damgaard, Anders; Rechberger, Helmut
The municipal waste management system of the region of Irkutsk is described and a life cycle assessment (LCA) performed to assess the environmental performance of the system. Annually about 500 000 tons of waste are managed. The waste originates from three sources: household waste (27%), commercial...... waste (23%) and office & institutional waste (44%). Other waste of unknown composition constitutes 6%. Only 3% of the waste is recycled; 97% of the municipal waste is disposed of at the old Alexandrovsky landfill. The environmental impact from the current system is dominated by the landfill, which has...... no gas or leachate collection system. The global warming contribution is due to the emission of methane of the order of 420 000 tons CO2-equivalents per year. Collection and transport of the waste are insignificant compared with impacts from the landfill. As the old landfill runs out of capacity in a few...
Modelo para prognose do crescimento e da produção e análise econômica de regimes de manejo para Pinus taeda L. Growth and yield prognosis model and economic evaluation of several management regimes for Pinus taeda L.
Fausto Weimar Acerbi Jr.
adotados; arrendar terras para plantar Pinus taeda é uma opção lucrativa, contudo, para o estudo em questão, o plantio de Pinus taeda em terras próprias é mais lucrativo que o plantio em terras arrendadas; a densidade inicial de plantio ideal é de 833 árvores/ha, podendo-se também adotar 1.111 árvores/ha como alternativa; e a lucratividade dos regimes de manejo aumenta bastante quando se considera a elevação do preço da madeira, devido à melhoria de sua qualidade promovida pela desrama das árvores.This study aimed to develop a prognosis system for growth and yield of Pinus taeda L. to simulate and evaluate several management regimes for the production of multiple use clearwood to analyze the economic feasibility for several sites, spacings, and wood discount rates and prices, based on owned and rented land plantations. The developed model was based on the compatibility of stand basal area model and diametric class model. The Weibull distribution was chosen to allow the prognosis for several strata and stand ages. A thinning simulator is then applied to obtain the desired remaining stand. A new prognosis is then made and a new thinning simulation applied. This procedure is repeated up to Pinus sp. the final cutting, using the SPPinus (Prognosis Yield System for Pinus sp.. For the economic analysis, two scenarios were compared, using various numbers, periods and thinning intensities, based on different initial planting intensities and various yield levels. A sensitivity analysis of the economic performance was conducted for each management regime, considering three discount rate levels, two wood price levels and the option of owing or renting land. It was concluded that: the model proposed did not present bias in volume and growth estimates; the management regime with a pre-commercial followed by two commercial thinnings should be adopted; renting land for Pinus sp. plantation is economically feasible but owing land is more profitable; the initial spacing
Full Text Available Background Guidelines for early detection of chronic kidney disease (CKD emphasise regular testing of kidney health in high-risk individuals. However, evidence suggests that CKD is not being adequately detected or appropriately managed in primary care. Aims Assess Australian general practitioners’ (GP current practice in relation to CKD detection and management. Methods This was a cross-sectional study utilising a random sample of GPs identified by interrogation of the national online telephone directory, and stratified by geographical location. Data collection occurred between October 2014 and January 2015. Of 2,815 eligible contacts, the final response rate was 23 per cent. Results Of the 656 respondents, over 90 per cent assessed kidney health at least annually in people with diabetes or high blood pressure, and 71 per cent correctly assessed kidney health every 3–6 months in a patient with Stage 3b CKD. The tests most commonly used to assess kidney health were serum creatinine (with eGFR, blood pressure and urine albumin creatinine ratio. The most commonly reported CKD management strategies were ‘blood pressure reduction using pharmacological agents’ (81 per cent and ‘glycaemic control if diabetes present’ (64 per cent. Knowledge testing highlighted that 32 per cent of respondents were not able to correctly identify how to properly assess absolute cardiovascular risk, and this was significantly more common in more experienced GPs (p=0.003. Conclusion The results indicate that Australian GPs are mainly practising in accordance with current guidelines for detection and management of patients with CKD, but with room for improvement in some areas
Sekimoto, Hiroshi; Nagata, Akito
CANDLE (Constant Axial shape of Neutron flux, nuclide densities and power shape During Life of Energy producing reactor) burnup strategy can derive many merits. From safety point of view, the change of excess reactivity along burnup is theoretically zero, and the core characteristics, such as power feedback coefficients and power peaking factor, are not changed along burnup. Application of this burnup strategy to neutron rich fast reactors makes excellent performances. Only natural or depleted uranium is required for the replacing fuels. About 40% of natural or depleted uranium undergoes fission without the conventional reprocessing and enrichment. If the LWR produced energy of X Joules, the CANDLE reactor can produce about 50X Joules from the depleted uranium left at the enrichment facility for the LWR fuel. If we can say LWRs have produced energy sufficient for full 20 years, we can produce the energy for 1000 years by using the CANDLE reactors with depleted uranium. We need not mine any uranium ore, and do not need reprocessing facility. The burnup of spent fuel becomes 10 times. Therefore, the spent fuel amount per produced energy is also reduced to one-tenth. The details of the scenario of CANDLE burnup regime after LWR regime will be presented at the symposium. (author)
Suraweera, Duminda; Sundaram, Vinay; Saab, Sammy
Hepatic encephalopathy is a spectrum of neurocognitive manifestations often seen in patients with liver injury or rarely in patients with portosystemic shunting without liver injury. It can be divided into minimal (covert) hepatic encephalopathy and overt hepatic encephalopathy, depending on the severity. Patients with hepatic encephalopathy have compromised clinical outcomes, decreased quality of life, and increased healthcare utilization, often resulting in a heavy financial and personal burden on caregivers. The diagnosis remains largely clinical, with the exclusion of possible other causes for the altered mental status. Current treatment strategies include nonabsorbable disaccharides and antibiotics. This review will focus on the diagnosis, management and clinical impact of hepatic encephalopathy. PMID:27377741
A series of changes have been proposed for Canada's current marine oil spill preparedness and response regimes which were established in August 1995 in an effort to develop a more integrated approach to managing oil spill preparedness and response. The proposed amendments aim to address the deficiencies of the regime through some regulatory change, a stronger accountability structure, and clear management guidelines. Some of the issues that should be addressed to strengthen the effectiveness of the regime as a whole include: (1) transparency of response organization (RO) preparedness and response fees, (2) level of wildlife contingency planning, (3) payment of Canadian Coast Guard response costs, and (4) ensuring a strong national system of preparedness and response. In terms of governance, a stronger role is recommended for the Regional Advisory Councils. The establishment of a User Committee and of a National Advisory Council are also recommended. figs
The motion management in stereotactic body radiation therapy (SBRT) is a key to success for a SBRT program, and still an on-going challenging task. A major factor is that moving structures behave differently than standing structures when examined by imaging modalities, and thus require special considerations and employments. Understanding the motion effects to these different imaging processes is a prerequisite for a decent motion management program. The commonly used motion control techniques to physically restrict tumor motion, if adopted correctly, effectively increase the conformity and accuracy of hypofractionated treatment. The effective application of such requires one to understand the mechanics of the application and the related physiology especially related to respiration. The image-guided radiation beam control, or tumor tracking, further realized the endeavor for precision-targeting. During tumor tracking, the respiratory motion is often constantly monitored by non-ionizing beam sources using the body surface as its surrogate. This then has to synchronize with the actual internal tumor motion. The latter is often accomplished by stereo X-ray imaging or similar techniques. With these advanced technologies, one may drastically reduce the treated volume and increase the clinicians’ confidence for a high fractional ablative radiation dose. However, the challenges in implementing the motion management may not be trivial and is dependent on each clinic case. This session of presentations is intended to provide an overview of the current techniques used in managing the tumor motion in SBRT, specifically for routine lung SBRT, proton based treatments, and newly-developed MR guided RT. Learning Objectives: Through this presentation, the audience will understand basic roles of commonly used imaging modalities for lung cancer studies; familiarize the major advantages and limitations of each discussed motion control methods; familiarize the major advantages and
Sundstrom, Shana M.; Eason, Tarsha; Nelson, R. John; Angeler, David G.; Barichievy, Chris; Garmestani, Ahjond S.; Graham, Nicholas A.J.; Granholm, Dean; Gunderson, Lance; Knutson, Melinda; Nash, Kirsty L.; Spanbauer, Trisha; Stow, Craig A.; Allen, Craig R.
Research on early warning indicators has generally focused on assessing temporal transitions with limited application of these methods to detecting spatial regimes. Traditional spatial boundary detection procedures that result in ecoregion maps are typically based on ecological potential (i.e. potential vegetation), and often fail to account for ongoing changes due to stressors such as land use change and climate change and their effects on plant and animal communities. We use Fisher information, an information theory-based method, on both terrestrial and aquatic animal data (U.S. Breeding Bird Survey and marine zooplankton) to identify ecological boundaries, and compare our results to traditional early warning indicators, conventional ecoregion maps and multivariate analyses such as nMDS and cluster analysis. We successfully detected spatial regimes and transitions in both terrestrial and aquatic systems using Fisher information. Furthermore, Fisher information provided explicit spatial information about community change that is absent from other multivariate approaches. Our results suggest that defining spatial regimes based on animal communities may better reflect ecological reality than do traditional ecoregion maps, especially in our current era of rapid and unpredictable ecological change.
Proshutinsky, Andrey; Dukhovskoy, Dmitry; Timmermans, Mary-Louise; Krishfield, Richard; Bamber, Jonathan L
Between 1948 and 1996, mean annual environmental parameters in the Arctic experienced a well-pronounced decadal variability with two basic circulation patterns: cyclonic and anticyclonic alternating at 5 to 7 year intervals. During cyclonic regimes, low sea-level atmospheric pressure (SLP) dominated over the Arctic Ocean driving sea ice and the upper ocean counterclockwise; the Arctic atmosphere was relatively warm and humid, and freshwater flux from the Arctic Ocean towards the subarctic seas was intensified. By contrast, during anticylonic circulation regimes, high SLP dominated driving sea ice and the upper ocean clockwise. Meanwhile, the atmosphere was cold and dry and the freshwater flux from the Arctic to the subarctic seas was reduced. Since 1997, however, the Arctic system has been under the influence of an anticyclonic circulation regime (17 years) with a set of environmental parameters that are atypical for this regime. We discuss a hypothesis explaining the causes and mechanisms regulating the intensity and duration of Arctic circulation regimes, and speculate how changes in freshwater fluxes from the Arctic Ocean and Greenland impact environmental conditions and interrupt their decadal variability. © 2015 The Authors.
Full Text Available The influenced flow regimes. The presence and activities ofhumanity influences the uniform environmental system, and in this context, therivers water resources. In concordance with this, the natural runoff regime suffersbigger and deeper changes. The nature of these changes depending on the type anddegree of water uses. The multitude of the use cause different types of influence,whit different quantitative aspects. In the same time, the influences havequalitative connotations, too, regarding to the modifications of the yearly watervolume runoff. So the natural runoff regime is modified. After analyzing thedistribution laws of the monthly runoff, there have been differenced four types ofinfluenced runoff regimes. In the excess type the influenced runoff is bigger thanthe natural, continuously in the whole year. The deficient type is characterized byinverse rapports like the first type, in the whole year. In the sinusoidal type, theinfluenced runoff is smaller than the natural in the period when the water isretained in the lake reservoirs, and in the depletion period the situation inverts. Atthe irregular type the ratio between influenced and natural runoff is changeable ina random meaner monthly. The recognition of the influenced regime and the gradeof influence are necessary in the evaluation and analysis of the usable hydrologicalriver resources, in the flood defence activities, in the complex scheme of thehydrographic basins, in the environment design and so on.
Bartlett, John M S; Nofech-Moses, Sharon; Rakovitch, Eileen
Screening for invasive cancer has led to a marked increase in the detection of ductal carcinoma in situ (DCIS). DCIS is, if appropriately managed, a low-risk disease which has a small chance of impacting on patient life expectancy. However, despite significant advances in prognostic marker development in invasive breast cancer, there are no validated diagnostic assays to inform treatment choice for women with DCIS. Therefore we are unable to target effective treatment strategies to women at high risk and avoid over-treatment of women at low risk of progression to invasive breast cancer. Paradoxically, one effect of this uncertainty is undertreatment of some women. We review current practice and research in the field to identify key challenges in the management of DCIS. The impact of clinical research, particularly on the over and undertreatment of women with DCIS is assessed. We note slow progress toward development of diagnostic biomarkers and highlight key opportunities to accelerate advances in this area. DCIS is a low-risk disease, its incidence is increasing, and current treatment is effective. However, many women are either over- or undertreated. Despite repeated calls for development of diagnostic biomarkers, progress in this area has been slow, reflecting a relative lack of investment of research effort and funding. Given the low event rate in treated patients and the lateness of recurrences, many previous studies have only limited power to identify independent prognostic and predictive biomarkers. However, the potential for such biomarkers to personalize treatment for DCIS is extremely high.
Schlussel, Andrew T; Cherng, Nicole B; Alavi, Karim
Crohn's disease is an aggressive chronic inflammatory disorder, and despite medical advances no cure exists. There is a great risk of requiring an operative intervention, with evidence of recurrence developing in up to 80-90% of cases. Therefore, we sought to systematically review the current status in the postoperative medical management of Crohn's disease. A systematic literature review of medications administered following respective therapy for Crohn's disease was performed from 1979 through 2016. Twenty-six prospective articles provided directed guidelines for recommendations and these were graded based on the level of evidence. The postoperative management of Crohn's disease faces multiple challenges. Current indicated medications in this setting include: antibiotics, aminosalicylates, immunomodulators, and biologics. Each drug has inherent risks and benefits, and the optimal regimen is still unknown. Initiating therapy in a prophylactic fashion compared to endoscopic findings, or escalating therapy versus treating with the most potent drug first is debated. Although a definitive consensus on postoperative treatment is necessary, aggressive and early endoluminal surveillance is paramount in the treatment of these complicated patients. Copyright © 2017 Elsevier Inc. All rights reserved.
Thode, Andrea E.; van Wagtendonk, Jan W.; Miller, Jay D.; Quinn, James F.
This paper quantifies current fire severity distributions for 19 different fire-regime types in Yosemite National Park, California, USA. Landsat Thematic Mapper remote sensing data are used to map burn severity for 99 fires (cumulatively over 97 000 ha) that burned in Yosemite over a 20-year period. These maps are used to quantify the frequency distributions of fire severity by fire-regime type. A classification is created for the resultant distributions and they are discussed within the context of four vegetation zones: the foothill shrub and woodland zone; the lower montane forest zone; the upper montane forest zone and the subalpine forest zone. The severity distributions can form a building block from which to discuss current fire regimes across the Sierra Nevada in California. This work establishes a framework for comparing the effects of current fires on our landscapes with our notions of how fires historically burned, and how current fire severity distributions differ from our desired future conditions. As this process is refined, a new set of information will be available to researchers and land managers to help understand how fire regimes have changed from the past and how we might attempt to manage them in the future.
Mazza, Danielle; Harrison, Christopher; Taft, Angela; Brijnath, Bianca; Britt, Helena; Hobbs, Melissa; Stewart, Kay; Hussainy, Safeera
To determine current contraceptive management by general practitioners in Australia. Analysis of data from a random sample of 3910 Australian GPs who participated in the Bettering the Evaluation and Care of Health (BEACH) survey, a continuous cross-sectional survey of GP activity, between April 2007 and March 2011. Consultations with female patients aged 12-54 years that involved all forms of contraception were analysed. GP and patient characteristics associated with the management of contraception; types of contraception used; rates of encounters involving emergency contraception. Increased age, ethnicity, Indigenous status and holding a Commonwealth Health Care Card were significantly associated with low rates of encounters involving management of contraception. The combined oral contraceptive pill was the most frequently prescribed method of contraception, with moderate prescription of long-acting reversible contraception (LARC), especially among women aged 34-54 years. Rates of consultations concerned with emergency contraception were low, but involved high rates of counselling, advice or education (48%) compared with encounters for general contraception (> 20%). A shift towards prescribing LARC, as recommended in clinical guidelines, has yet to occur in Australian general practice. Better understanding of patient and GP perspectives on contraceptive choices could lead to more effective contraceptive use.
Ishida, Haku; Nakamura, Junji; Yoshida, Hiroshi; Koike, Masaru; Inoue, Yuji
We conducted a questionnaire survey regarding the current activities for protecting patients' privacy and the security of information systems (IS) related to the clinical laboratory departments of university hospitals, certified training facilities for clinical laboratories, and general hospitals in Yamaguchi Prefecture. The response rate was 47% from 215 medical institutions, including three commercial clinical laboratory centers. The results showed that there were some differences in management activities among facilities with respect to continuing education, the documentation or regulation of operational management for paper records, electronic information, remaining samples, genetic testing, and laboratory information for secondary use. They were suggested to be caused by differences in functions between university and general hospitals, differences in the scale of hospitals, or whether or not hospitals have received accreditation or ISO 15189. Regarding the IS, although the majority of facilities had sufficiently employed the access control to IS, there was some room for improvement in the management of special cases such as VIPs and patients with HIV infection. Furthermore, there were issues regarding the login method for computers shared by multiple staff, the showing of the names of personnel in charge of reports, and the risks associated with direct connections to systems and the Internet and the use of portable media such as USB memory sticks. These results indicated that further efforts are necessary for each facility to continue self-assessment and make improvements.
Tuason, Joshua; Inoue, Haruhiro
Achalasia is a rare esophageal motility disorder that is characterized by loss of peristalsis and failure of relaxation of the lower esophageal sphincter (LES), particularly during swallowing. This review focuses on the diagnosis of esophageal motility disorders as defined by the Chicago Classification ver 3.0, and presents management options with regard to per-oral endoscopic myotomy (POEM) as the treatment of choice. A concise review of literature was performed for articles related to the management of achalasia, and this was contrasted with our institution's current practice. Achalasia is still incompletely understood, and management is focused on establishing a proper diagnosis, and relieving the obstructive symptoms. Achalasia should be considered when dysphagia is present, and not otherwise caused by an obstruction or inflammation, and when criteria is met as per the Chicago Classification ver 3.0. Lowering LES tone and disruption of LES can be accomplished by various methods, most notably pneumatic balloon dilatation and surgical myotomy. POEM has been gaining momentum as a first line therapy for achalasia symptoms, and can be considered an important tool for motility disorders of the esophagus.
Antonius Priyo Nugroho Sulami
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.
Chighizola, Cecilia Beatrice; Ubiali, Tania; Meroni, Pier Luigi
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.
Full Text Available Aim: There exists a variation in practice in the management of tumours around the splenic flexure. We aim to determine the current opinion regarding the management of these tumours. Methods: An anonymised 10-part online questionnaire was sent to all members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI. Results: The response rate was 24% (111/464 with approximately half of respondents performing laparoscopic surgery. Electively, an extended right hemicolectomy is the preferred option by 63% of respondents followed by left hemicolectomy (23% and segmental resection (14%. The upper sigmoid and rectosigmoid is the preferred site of anastomosis by 90% and 10% of respondents respectively. There were no significant differences in the type of operations performed by surgeons who practice laparoscopic or open surgery (p=0.10. A hand-sewn end-to-end anastomosis is most commonly performed (51% followed by a stapled side-to-side (36% and a stapled end-to-end (13% technique. Extended right hemicolectomy is also the preferred option in obstructing tumours. Of surgeons who perform segmental resections, 27% perform an on-table lavage and 9% perform a defunctioning stoma. Internal herniation following laparoscopic resection was only reported by a handful of surgeons. Conclusion: Opinion and practice in the management of patients with tumours around the splenic flexure are divided. Further trials are indicated to determine the best practice.
Qin, X Y
Thanks to the progress of surgical theory and skills, as well as the application of modern medical devices in general surgery, both the occurrence of perioperative complications and mortality of gastrointestinal surgery have significantly reduced recently. However, it is still far from optimal in terms of the perioperative venous thromboembolism (VTE) management in gastrointestinal cancer, and what is responsible for that? This paper aims at finding out the reasons contributing to the current status, giving suggestions for how to make improvement at both disease level and hospital management level. At the same time, while paying attention for the prophylaxis of VTE, there have been more and more patients receiving antithrombotic treatment require elective or emergent surgery in clinical practice, due to aging and increased incidence of cardiovascular disease year by year. How to balance the bleeding and thrombosis risk for these patients during perioperative periods is also a question we are going to discuss. In conclusion, as to the issue of the management of perioperative thrombosis, there will be a long way for Chinese doctors to go. Our peers should pay more attention to this problem and take more efforts, so that the thrombotic complications in surgical patients can be reduced.
VanLeeuwen, Crystal; Torondel, Belen
Management of menstruation in contexts of humanitarian emergencies can be challenging. A lack of empirical research about effective interventions which improve menstrual hygiene management (MHM) among female populations in humanitarian emergencies and a lack of clarity about which sectors within a humanitarian response should deliver MHM interventions can both be attributable to the lack of clear guidance on design and delivery of culturally appropriate MHM intervention in settings of humanitarian emergencies. The objective of this review was to collate, summarize, and appraise existing peer-reviewed and gray literature that describes the current scenario of MHM in emergency contexts in order to describe the breadth and depth of current policies, guidelines, empirical research, and humanitarian aid activities addressing populations' menstrual needs. A structured-search strategy was conducted for peer-reviewed and gray literature to identify studies, published reports, guidelines, and policy papers related to menstrual response in emergency humanitarian contexts. Of the 51 articles included in the review, 16 were peer-reviewed papers and 35 were gray literature. Most of the literature agreed that hardware interventions should focus on the supply of adequate material (not only absorbent material but also other supportive material) and adequate sanitation facilities, with access to water and private space for washing, changing, drying, and disposing menstrual materials. Software interventions should focus on education in the usage of materials to manage menstruation hygienically and education about the female body's biological processes. There was clear agreement that the needs of the target population should be assessed before designing any intervention. Although there is insight about which factors should be included in an effective menstrual hygiene intervention, there is insufficient empirical evidence to establish which interventions are most effective in
Pettigrew, Melissa; Xie, Yan; Kang, Aili; Rao, Madhu; Goodrich, John; Liu, Tong; Berger, Joshua
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.
Freer-Smith, Peter; Carnus, Jean-Michel
The loss of forest area globally due to change of land use, the importance of forests in the conservation of biodiversity and in carbon and other biogeochemical cycles, together with the threat to forests from pollution and from the impacts of climate change, place forestry policy and practice at the center of global environmental and sustainability strategy. Forests provide important economic, environmental, social, and cultural benefits, so that in forestry, as in other areas of environmental policy and management, there are tensions between economic development and environmental protection. In this article we review the current information on global forest cover and condition, examine the international processes that relate to forest protection and to sustainable forest management, and look at the main forest certification schemes. We consider the link between the international processes and certification schemes and also their combined effectiveness. We conclude that in some regions of the world neither mechanism is achieving forest protection, while in others local or regional implementation is occurring and is having a significant impact. Choice of certification scheme and implementation of management standards are often influenced by a consideration of the associated costs, and there are some major issues over the monitoring of agreed actions and of the criteria and indicators of sustainability. There are currently a number of initiatives seeking to improve the operation of the international forestry framework (e.g., The Montreal Process, the Ministerial Convention of the Protection of Forests in Europe and European Union actions in Europe, the African Timber Organisation and International Tropical Timber Organisation initiative for African tropical forest, and the development of a worldwide voluntary agreement on forestry in the United Nations Forum on Forests). We suggest that there is a need to improve the connections between scientific understanding
Abdulrasheed A. Nasir
Full Text Available Background: Although there are several modalities of treatment for Hirschsprung′s disease (HD, there are presently no clear guidelines on treatment of the condition by paediatric surgeons in Nigeria. This survey determines the current approach to treatment among Nigerian paediatric surgeons and should help in establishing a consensus and guidelines for care in this and similar setting. Materials and Methods: An online questionnaire was designed using survey Monkey ® to determine current clinical and operative management of patients with HD by consultant paediatric surgeons practicing in the Nigeria. The paediatric surgeons were notified by E-mail, which included a link to the survey on survey Monkey ® . The survey was also administered at the 12 th annual meeting of Association of Paediatric Surgeons of Nigeria in September, 2013, to capture those who did not complete the online survey. Thirty-one paediatric surgeons from 21 different tertiary paediatric surgery centres completed the survey. Results: Sixteen (52% respondents see up to 20% of their patients with HD in the neonatal period. Twenty-six (84% respondents do routine barium enema. Twenty six (84% respondents do full thickness rectal biopsy under general anaesthesia (GA. There was no consistency in operative techniques, with transabominal Swenson′s operation being practiced by 17 (57% respondents and 11 (37% transanal endorectal pull through. 14 (45% do pull through at any age. 12 (39% respondents do more than half of their patient as primary pull through. Conclusion: Full thickness rectal biopsy under GA is still the vogue with variations in the surgical technique for management of Hirshsprung′s disease in Nigeria. Primary pull through procedures is becoming increasingly popular. There′s a need for Paediatric Surgeons in Nigeria to come up with a guideline on management of HD, to guide trainees and other surgeons in the care of these patients.
Tollenaar, Lisanne S A; Slaghekke, Femke; Middeldorp, Johanna M; Klumper, Frans J; Haak, Monique C; Oepkes, Dick; Lopriore, Enrico
Monochorionic twins share a single placenta and are connected with each other through vascular anastomoses. Unbalanced inter-twin blood transfusion may lead to various complications, including twin-to-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS). TAPS was first described less than a decade ago, and the pathogenesis of TAPS results from slow blood transfusion from donor to recipient through a few minuscule vascular anastomoses. This gradually leads to anemia in the donor and polycythemia in the recipient, in the absence of twin oligo-polyhydramnios sequence (TOPS). TAPS may occur spontaneously in 3-5% of monochorionic twins or after laser surgery for TTTS. The prevalence of post-laser TAPS varies from 2% to 16% of TTTS cases, depending on the rate of residual anastomoses. Pre-natal diagnosis of TAPS is currently based on discordant measurements of the middle cerebral artery peak systolic velocity (MCA-PSV; >1.5 multiples of the median [MoM] in donors and 8 g/dL), and at least one of the following: reticulocyte count ratio >1.7 or minuscule placental anastomoses. Management includes expectant management, and intra-uterine blood transfusion (IUT) with or without partial exchange transfusion (PET) or fetoscopic laser surgery. Post-laser TAPS can be prevented by using the Solomon laser surgery technique. Short-term neonatal outcome ranges from isolated inter-twin Hb differences to severe neonatal morbidity and neonatal death. Long-term neonatal outcome in post-laser TAPS is comparable with long-term outcome after treated TTTS. This review summarizes the current knowledge after 10 years of research on the pathogenesis, diagnosis, management, and outcome in TAPS.
Berthaud, P.; Cavard, D.; Criqui, P.
This article deals with the different modalities that exist to manage a problem of collective action in the field of climate negotiation. It uses two concepts of the International Political Economy (IPE): the concept of International Regime (IR) and the concept of Hegemony and / or Leadership. The course the international negotiation has taken between 1992 (Rio Convention) and march 2001 (the US rejection of the Kyoto Protocol of 1997) leads us, first, to question the conditions of existence as well as the viability of a non-hegemonic International Regime (Part One). Then, we discuss the perspectives for the 'post - Kyoto' era. After having examined the preferences of the three most active actors in the negotiation (USA, Europe, G77 + China) combined with the leadership capacities they possess, we identify three scenarios for the future: i) anarchy, ii) an international regime under the American hegemony, iii) an international regime under the European leadership (Part Two). (author)
Full Text Available Abstract Ethiopia is facing rapid urbanization leading to overcrowding and the development of slums and informal settlements with poor waste management practices. Urban dwellers generally consume more resources than rural dwellers and so generate huge quantities of solid wastes. This study is focused on the overall assessment of the existing MSWM service of Gondar town. The overall objective of this study was assessing the current solid waste management service of Gondar town. Both primary and secondary sources were used to achieve the objectives. The analysis of this study was carried out using both qualitative and quantitative techniques. The findings of this study revealed that the present system of MSWM in Gondar town entirely relied on the municipality which provided the full range of waste collection transportation and disposal service. But the provision of this service is not kept in pace with the town solid waste generation. Based on the findings of this study the town households dominantly produced biodegradable solid wastes with generation rate of 0.21kgpersonday. This made the daily total solid waste generation of households to be 8140Kg. Together with other four solid waste sources the total daily solid waste generation of the town is about 11660 kg. So that MSWM of the town is found in very low status and spatial coverage. This poor status of MSWM is also intensified by three critical factors i.e poor institutional structure and capacity of Sanitation and beautification limited participation and contribution of stakeholders and poor households solid waste management practices. This study concluded that there should be sustainable solid waste management systems reuse recycle composting and incineration through awareness creation and training improvement of SB institutional structure and capacity and implementation of integrated MSWM approach which recognizes and comprises all stakeholders in the town.
Sackley, Catherine; Hoppitt, Thomas J; Calvert, Melanie; Gill, Paramjit; Eaton, Benjamin; Yao, Guiqing; Pall, Hardev
Recent debate suggests Huntington's disease (HD) may be more prevalent than previously reported. In addition, relatively little is known about current disease management. This study aims to provide epidemiological data and describe the pharmacological management of HD in the United Kingdom. A primary care research database was accessed to identify incident and prevalent HD cases between January 1, 2004, and December 31, 2008. Patients with Read codes denoting a definite diagnosis or possible diagnosis, and undiagnosed patients with a positive family history were identified. A subset of patients with a definite diagnosis and prescribed medication indicating symptom onset was also identified. Epidemiological data were estimated. Pharmacological prescriptions to HD patients from 2004 to 2008 were identified, and prescription frequencies were grouped according to the British National Formulary categories. HD incidence estimates ranged from 0.44 to 0.78 per 100,000 person-years, and HD prevalence ranged from 5.96 to 6.54 per 100,000 of the population. Forty-four percent of pharmacological prescriptions targeted the central nervous system. Nearly half of the HD patients were prescribed antidepressants, and over 40% were prescribed analgesics. Although prevalence estimates fell short of figures suggested in recent debate, it is feasible that the true prevalence may be much higher than previously reported. Pharmacological management appears to rely heavily on central nervous system drugs and nutrition support. Many of these drugs are prescribed to HD patients for reasons other than the medication's primary use. Further work is required to evaluate the impact of alternative management strategies, such as therapist intervention, counselling, and organisation support, on the patients' quality of life. Copyright © 2011 S. Karger AG, Basel.
Mohee, Romeela; Mauthoor, Sumayya; Bundhoo, Zumar M A; Somaroo, Geeta; Soobhany, Nuhaa; Gunasee, Sanjana
This article reviews the current status of waste management in Small Island Developing States (SIDS) and the challenges that are faced in solid waste management. The waste generation rates of SIDS were compared within the three geographic regions namely Caribbean SIDS, Pacific SIDS and Atlantic, Indian Ocean, Mediterranean and South China (AIMS) SIDS and with countries of the Organisation for Economic Co-Operation and Development (OECD). Only Pacific SIDS had a waste generation rate less than 1kg/capita/day. The waste generation rates for the three SIDS regions averaged 1.29kg/capita/day while that for OECD countries was at a mean value of 1.35kg/capita/day. The waste compositions in the different SIDS regions were almost similar owing to comparable consumption patterns while these differed to a large extent with wastes generated in OECD countries. In SIDS, the major fraction of MSW comprised of organics (44%) followed by recyclables namely paper, plastics, glass and metals (total: 43%). In contrast, MSW in OECD countries consisted mainly of recyclables (43%) followed by organics (37%). This article also reviewed the other functional elements of the waste management systems in SIDS. Several shortcomings were noted in the process of waste collection, transfer and transport namely the fact of having outdated collection vehicles and narrow roads which are inaccessible. Among the waste management practices in SIDS, waste disposal via landfilling, illegal dumping and backyard burning were favoured most of the time at the expense of sustainable waste treatment technologies such as composting, anaerobic digestion and recycling. Copyright © 2015 Elsevier Ltd. All rights reserved.
There are at present at least three international regimes of maritime cargo liability in force in different countries of the world - the original Hague rules (1924), the updated version known as the Hague-Visby rules (1968, further amended 1979), and...
Six, Frédérique; Verhoest, Koen
Within political and administrative sciences generally, trust as a concept is contested, especially in the field of regulatory governance. This groundbreaking book is the first to systematically explore the role and dynamics of trust within regulatory regimes. Conceptualizing, mapping and analyzing
The paper asks if East Asian welfare regimes are still productivist and Confucian? And, have they developed public care policies? The literature is split on the first question but (mostly) confirmative on the second. Care has to a large, but insufficient extent, been rolled out in the region...
A. V. Malov
Full Text Available The review article reveals the content of the concept of Food Regime, which is little-known in the Russian academic reference. The author monitored and codified the semantic dynamic of the terminological unit from its original interpretations to modern formulations based on the retrospective analysis. The rehabilitation of the academic merits of D. Puchala and R. Hopkins — authors who used the concept Food Regime for a few years before its universally recognized origin and official scientific debut, was accomplished with help of historical and comparative methods. The author implemented the method of ascension from the abstract to the concrete to demonstrating the classification of Food Regimes compiled on the basis of geopolitical interests in the sphere of international production, consumption, and distribution of foodstuffs. The characteristic features of historically formed Food Regime were described in the chronological order, as well as modern tendencies possessing reformist potential were identified. In particular, it has been established that the idea of Food Sovereignty (which is an alternative to the modern Corporate Food Regime is the subject for acute academic disputes. The discussion between P. McMichael P. and H. Bernstein devoted to the “peasant question” — mobilization frame of the Food Sovereignty strategy was analyzed using the secondary data processing method. Due to the critical analysis, the author comes to the conclusion that it is necessary to follow the principles of the Food Sovereignty strategy to prevent the catastrophic prospects associated with ecosystem degradation, accelerated erosion of soils, the complete disappearance of biodiversity and corporate autoc racy successfully. The author is convinced that the idea of Food Sovereignty can ward off energetic liberalization of nature, intensive privatization of life and rapid monetization of unconditioned human reflexes.
van Doorn-Hoekveld, Willemijn|info:eu-repo/dai/nl/344848752
Flood risk management is an eminent example of a policy field in which the distribution of burdens and benefits takes place. Flood risks are distributed unequally among society and measures that reduce or prevent flood risks also distribute burdens and benefits. Flood risk management measures may
Christopher A. Armatas; Tyron J. Venn; Brooke B. McBride; Alan E. Watson; Steve J. Carver
The field of adaptive management has been embraced by researchers and managers in the United States as an approach to improve natural resource stewardship in the face of uncertainty and complex environmental problems. Integrating multiple knowledge sources and feedback mechanisms is an important step in this approach. Our objective is to contribute to the...
Zidan, Priscila M.; Silva, Joao C.P.; Echternacht, Marcus V.
As its own legal responsibility, Nuclear Engineering Institute - IEN has received radioactive wastes generated in Rio de Janeiro and Espirito Santo states. But, from July 1997 to June 1999, IEN was not able to receive wastes because of the lack of space in the temporary repository. Recent studies show that increasing the treatment facilities could contribute to optimize the disposal of wastes. According to National Commission of Nuclear Energy resolutions, IEN was several times requested for discarding of lightning rods containing Am-241 and Ra-226. This fact motivated IEN to look for options to make possible the receiving of wastes until a new deposit were built. A temporary place was prepared and since last July it has been receiving wastes again. In this paper it is described the current structure of radioactive waste management at IEN, objectives and goals to be reached until December 2000. (author)
Rostas, J.W.; Dyess, D.L.
Surgical resection was the first effective treatment for breast cancer and remains the most important treatment modality for curative intent. Refinements in operative techniques along with the use of adjuvant radiotherapy and advanced chemotherapeutic agents have facilitated increasingly focused breast cancer operations. Surgical management of breast cancer has shifted from extensive and highly morbid procedures, to the modern concept obtaining the best possible cosmetic result in tandem with the appropriate oncological resection. An ever-growing comprehension of breast cancer biology has led to substantial advances in molecular diagnosis and targeted therapies. An emerging frontier involves the breast cancer microenvironment, as a thorough understanding, while currently lacking, represents a critical opportunity for diagnosis and treatment. Collectively, these improvements will continue to push all therapeutic interventions, including operative, toward the goal of becoming more focused, targeted, and less morbid