WorldWideScience

Sample records for current management regime

  1. Regime shifts in resource management

    NARCIS (Netherlands)

    de Zeeuw, A.J.

    2014-01-01

    Resource management has to take account of the possibility of tipping points and regime shifts in ecological systems that provide the resources. This article focuses on the typical model of regime shifts in the ecological literature and analyzes optimal management and common-property issues when tra

  2. Global fishery prospects under contrasting management regimes

    Science.gov (United States)

    Costello, Christopher; Ovando, Daniel; Clavelle, Tyler; Strauss, C. Kent; Hilborn, Ray; Melnychuk, Michael C.; Branch, Trevor A.; Gaines, Steven D.; Szuwalski, Cody S.; Cabral, Reniel B.; Rader, Douglas N.; Leland, Amanda

    2016-01-01

    Data from 4,713 fisheries worldwide, representing 78% of global reported fish catch, are analyzed to estimate the status, trends, and benefits of alternative approaches to recovering depleted fisheries. For each fishery, we estimate current biological status and forecast the impacts of contrasting management regimes on catch, profit, and biomass of fish in the sea. We estimate unique recovery targets and trajectories for each fishery, calculate the year-by-year effects of alternative recovery approaches, and model how alternative institutional reforms affect recovery outcomes. Current status is highly heterogeneous—the median fishery is in poor health (overfished, with further overfishing occurring), although 32% of fisheries are in good biological, although not necessarily economic, condition. Our business-as-usual scenario projects further divergence and continued collapse for many of the world’s fisheries. Applying sound management reforms to global fisheries in our dataset could generate annual increases exceeding 16 million metric tons (MMT) in catch, $53 billion in profit, and 619 MMT in biomass relative to business as usual. We also find that, with appropriate reforms, recovery can happen quickly, with the median fishery taking under 10 y to reach recovery targets. Our results show that commonsense reforms to fishery management would dramatically improve overall fish abundance while increasing food security and profits. PMID:27035953

  3. Safety management, under different regimes

    Energy Technology Data Exchange (ETDEWEB)

    Weibye, B.S. [Norske Veritas, Oslo (Norway)

    1996-12-31

    The paper relates to safety management in the North Sea. This presentation will look at the interplay between the forces and factors driving political authorities representing the interest of society on one side and the owners/operators on the other. The maturation process or evolution from a prescriptive to an objective approach will be examined both in Norway with the implementation of the Internal Control philosophy and using the Piper Alpha disaster, Lord Cullen`s public Inquiry and the subsequent enactment of the Offshore Safety Case in the UK as case examples. The impact these regulatory changes had on the Safety Management Systems of operators in the Norwegian and UK sectors of the North Sea will be outlined. Finally the transitions in the North Sea will be examined to determine if they can if they can be used as a model for exporting to other ares or countries. 4 refs.

  4. High current regimes in RFX-mod

    Science.gov (United States)

    Valisa, M.; Bolzonella, T.; Buratti, P.; Carraro, L.; Cavazzana, R.; Dal Bello, S.; Martin, P.; Pasqualotto, R.; Sarff, J. S.; Spolaore, M.; Zanca, P.; Zanotto, L.; Agostini, M.; Alfier, A.; Antoni, V.; Apolloni, L.; Auriemma, F.; Barana, O.; Baruzzo, M.; Bettini, P.; Bonfiglio, D.; Bonomo, F.; Brombin, M.; Buffa, A.; Canton, A.; Cappello, S.; Cavinato, M.; Chitarin, G.; DeLorenzi, A.; DeMasi, G.; Escande, D. F.; Fassina, A.; Franz, P.; Gaio, E.; Gazza, E.; Giudicotti, L.; Gnesotto, F.; Gobbin, M.; Grando, L.; Guazzotto, L.; Guo, S. C.; Igochine, V.; Innocente, P.; Lorenzini, R.; Luchetta, A.; Manduchi, G.; Marchiori, G.; Marcuzzi, D.; Marrelli, L.; Martini, S.; Martines, E.; McCollam, K.; Milani, F.; Moresco, M.; Novello, L.; Ortolani, S.; Paccagnella, R.; Peruzzo, S.; Piovan, R.; Piron, L.; Pizzimenti, A.; Piovesan, P.; Pomaro, N.; Predebon, I.; Puiatti, M. E.; Rostagni, G.; Sattin, F.; Scarin, P.; Serianni, G.; Sonato, P.; Spada, E.; Soppelsa, A.; Spagnolo, S.; Spizzo, G.; Taliercio, C.; Terranova, D.; Toigo, V.; Vianello, N.; Yadikin, D.; Zaccaria, P.; Zaniol, B.; Zilli, E.; Zuin, M.

    2008-12-01

    Optimization of machine operation, including plasma position control, density control and especially feedback control on multiple magnetohydrodynamic modes, has led RFX-mod to operate reliably at 1.5 MA, the highest current ever achieved on a reversed field pinch (RFP). At high current and low density the magnetic topology spontaneously self-organizes in an Ohmical helical symmetry, with the new magnetic axis helically twisting around the geometrical axis of the torus. The separatrix of the island disappears leaving a wide and symmetric thermal structure with large gradients in the electron temperature profile. The new topology still displays an intermittent nature but its overall presence has reached 85% of the current flat-top period. The large gradients in the electron temperature profile appear to be marginal for the destabilization of ion temperature gradient modes on the assumption that ions and electrons have the same gradients. There are indications that higher currents could provide the conditions under which to prove the existence of a true helical equilibrium as the standard RFP configuration.

  5. Legal regime of water management facilities

    Directory of Open Access Journals (Sweden)

    Salma Jožef

    2013-01-01

    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.

  6. Adaptive management of ecosystem services across different land use regimes.

    Science.gov (United States)

    Ruhl, J B

    2016-12-01

    Using adaptive management to manage desired flows of ecosystem services may seem on the surface to be a good fit, but many social, economic, environmental, legal, and political factors influence how good a fit. One strongly influential factor is the land use regime within which the profile of ecosystem services is being managed. Shaped largely by legal mandates, market forces, and social and cultural practices, different land use regimes present different opportunities for and constraints on goals for ecosystem services and pose different decision making environments. Even where all other conditions appear amenable to using adaptive management, therefore, it is essential to consider the constraining (or liberating) effects of different land use regimes when deciding whether to adopt adaptive management to achieve those goals and, if so, how to implement it. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Global fishery prospects under contrasting management regimes

    OpenAIRE

    Costello, Christopher; Ovando, Daniel; Clavelle, Tyler; Strauss, C. Kent; Hilborn, Ray; Melnychuk, Michael C; Branch, Trevor A; Steven D Gaines; Szuwalski, Cody S.; Cabral, Reniel B.; Rader, Douglas N.; Leland, Amanda

    2016-01-01

    What would extensive fishery reform look like? In addition, what would be the benefits and trade-offs of implementing alternative approaches to fisheries management on a worldwide scale? To find out, we assembled the largest-of-its-kind database and coupled it to state-of-the-art bioeconomic models for more than 4,500 fisheries around the world. We find that, in nearly every country of the world, fishery recovery would simultaneously drive increases in food provision, fishery profits, and fis...

  8. Brain abscess: Current management

    Science.gov (United States)

    Alvis Miranda, Hernando; Castellar-Leones, Sandra Milena; Elzain, Mohammed Awad; Moscote-Salazar, Luis Rafael

    2013-01-01

    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. PMID:24174804

  9. Brain abscess: Current management

    Directory of Open Access Journals (Sweden)

    Hernando Alvis-Miranda

    2013-01-01

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

  10. [Current management of epilepsy].

    Science.gov (United States)

    Mizobuchi, Masahiro

    2013-09-01

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

  11. Managing the human component of fire regimes: lessons from Africa.

    Science.gov (United States)

    Archibald, Sally

    2016-06-05

    Human impacts on fire regimes accumulated slowly with the evolution of modern humans able to ignite fires and manipulate landscapes. Today, myriad voices aim to influence fire in grassy ecosystems to different ends, and this is complicated by a colonial past focused on suppressing fire and preventing human ignitions. Here, I review available evidence on the impacts of people on various fire characteristics such as the number and size of fires, fire intensity, fire frequency and seasonality of fire in African grassy ecosystems, with the intention of focusing the debate and identifying areas of uncertainty. Humans alter seasonal patterns of fire in grassy systems but tend to decrease total fire emissions: livestock have replaced fire as the dominant consumer in many parts of Africa, and fragmented landscapes reduce area burned. Humans alter the season and time of day when fires occur, with important implications for fire intensity, tree-grass dynamics and greenhouse gas (GHG) emissions. Late season fires are more common when fire is banned or illegal: these later fires are far more intense but emit fewer GHGs. The types of fires which preserve human livelihoods and biodiversity are not always aligned with the goal of reducing GHG concentrations. Current fire management challenges therefore involve balancing the needs of a large rural population against national and global perspectives on the desirability of different types of fire, but this cannot happen unless the interests of all parties are equally represented. In the future, Africa is expected to urbanize and land use to intensify, which will imply different trajectories for the continent's fire regimes.This article is part of the themed issue 'The interaction of fire and mankind.

  12. Institutional design and regime effectiveness in transboundary river management – the Elbe water quality regime

    Directory of Open Access Journals (Sweden)

    I. Dombrowsky

    2007-06-01

    Full Text Available The literature on transboundary river management suggests that institutions play an important role in bringing cooperation about. However, the knowledge on how they 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 leading to the respective outcomes. In order to gain further insights into the relationship of 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 expedience of the institutional arrangements. The study shows that overall due to external as well as internal institutional factors the ICPE proved relatively successful, and as such it also provides insights into how institutions matter: The commission served as platform for joint problem solving by identifying priorities for action. These international obligations increased the power of national administrations and their access to funds. At the same time, the Commission's reporting to the public served as an enforcement mechanism. However, the ICPE's contribution towards achieving the various goals varied significantly between the different areas of activity. It was high where the main responsibility for action was with the public authorities, such as in the area of wastewater treatment and the establishment of an international alarm plan and model. It was practically non existent in the reduction of non-point pollution from agriculture, where the success depended on the behavior of individual private actors (farmers. From a

  13. Vegetation management with fire modifies peatland soil thermal regime.

    Science.gov (United States)

    Brown, Lee E; Palmer, Sheila M; Johnston, Kerrylyn; Holden, Joseph

    2015-05-01

    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 management. Compared to plots burned 15 + years previously, plots recently burned (soil temperatures, and lower minima. Statistical models (generalised least square regression) were developed to predict daily mean and maximum soil temperature in plots burned 15 + years prior to the study. These models were then applied to predict temperatures of plots burned 2, 4 and 7 years previously, with significant deviations from predicted temperatures illustrating the magnitude of burn management effects. Temperatures measured in soil plots burned Soil temperatures in plots burnt 7 years previously were most similar to plots burned 15 + years ago indicating the potential for soil temperatures to recover as 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.

  14. Envisioning, quantifying, and managing thermal regimes on river networks

    Science.gov (United States)

    Steel, E. Ashley; Beechie, Timothy J.; Torgersen, Christian; Fullerton, Aimee H.

    2017-01-01

    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.

  15. Institutional design and regime effectiveness in transboundary river management – the Elbe water quality regime

    Directory of Open Access Journals (Sweden)

    I. Dombrowsky

    2008-02-01

    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

  16. Challenges in the participatory assessment of sustainable management practices in dryland ecosystems under regime shifts

    Science.gov (United States)

    Jucker Riva, Matteo; Schwilch, Gudrun; Liniger, Hanspeter

    2015-04-01

    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

  17. Current management of presbyopia

    Directory of Open Access Journals (Sweden)

    Pandelis A Papadopoulos

    2014-01-01

    Full Text Available Presbyopia is a physiologic inevitability that causes gradual loss of accommodation during the fifth decade of life. The correction of presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. Different approaches on the cornea, the crystalline lens and the sclera are being pursued to achieve surgical correction of this disability. There are however, a number of limitations and considerations that have prevented widespread acceptance of surgical correction for presbyopia. The quality of vision, optical and visual distortions, regression of effect, complications such as corneal ectasia and haze, anisometropia after monovision correction, impaired distance vision and the invasive nature of the currently techniques have limited the utilization of presbyopia surgery. The purpose of this paper is to provide an update of current procedures available for presbyopia correction and their limitations.

  18. ON THE CURRENT RMB EXCHANGE RATE REGIME AFFECTING THE EFFECTIVENESS OF MONETARY POLICY

    Institute of Scientific and Technical Information of China (English)

    黄燕君

    2001-01-01

    The current exchange rate regime of China is just like the US dollar-pegged exchange rate regime, which weakens the effectiveness of monetary policy but increases the effectiveness of fiscal policy. Since the scope of implementing the fiscal policy is quite narrow, it is necessary to promote the effectiveness of monetary policy by enlarging the elasticity of the RMB exchange rate regime so as to stimulate the rapid development of the Chinese economy effectively.

  19. Unsustainable Groundwater Exploitation and Stochastic Regime Shifts: Converging Management Constraints

    Science.gov (United States)

    Rao, Suresh; Park, Jeryang

    2014-05-01

    Increasing water security concerns arise from projected increases in competing freshwater demands, resulting from rapid urbanization, growing affluent population, and the need for increased production of food and bio-energy. These global trends in concert with the convergence of three groups of threats are likely to exacerbate freshwater security issues: (1) increasing dependency on effectively non-renewable groundwater ("peak water"); (2) increasing groundwater quality impairment("land-use intensification") from larger contaminant loads delivered from the vadose zone and surface water; and (3) increasing uncertainties in groundwater demand/supply from climate change ("stochastic risks"). Here, we present a conceptual framework for exploring water security threats, with a consideration of aquifers as complex hydrological systems with two stable states. Regime shifts in groundwater pumping -- from "sufficient" to "insufficient" -- result from changes in both internal system dynamics and external forcing from stochastic divers (non-stationary demands, hydro-climatic patterns). Examples from recent related work, in groundwater and surface water systems and ecosystems, are briefly reviewed as a prelude to presentation of model simulations of hypothetical scenarios of regime-shifts (tipping points) involving groundwater quantity and quality constraints. In addition to three types of widely recognized tipping points, we introduce a new type, stochastic tipping, that contributes to unexpected, undesirable regime shifts, resulting in inability to meet groundwater pumping needs, even when the perceived precariousness is small and the system is far from bifurcation point (deterministic tipping). Implications to sustainable groundwater management are discussed.

  20. Langmuir probe study in the nonresonant current drive regime of helicon discharge

    Indian Academy of Sciences (India)

    Manash Kumar Paul; Dhiraj Bora

    2008-07-01

    Characterization of the current drive regime is done for helicon wave-generated plasma in a torus, at a very high operating frequency. A radiofrequency-compensated Langmuir probe is designed and used for the measurement of plasma parameters along with the electron energy distributions in radial scans of the plasma. The electron energy distribution patterns obtained in the operational regime suggest that Landau damping cannot be responsible for the efficient helicon discharge in the present study. A typical peaked radial density profile, high plasma temperature and absence of an appreciable amount of energetic electrons for resonant wave–particle interactions, suggest that the chosen operational regime is suitable for the study of nonresonant current drive by helicon wave. Successful and significant current drive achieved in our device clearly demonstrates the capability of nonresonant current drive by helicon waves in the present operational regime.

  1. Numerical Solution of Lock-Release Gravity Current with Viscous Self-Similar Regime

    Institute of Scientific and Technical Information of China (English)

    张立柱; 李行伟; 陈国谦

    2004-01-01

    Lock-release gravity currents with a viscous self-similar regime are simulated by use of the renormalization group (RNG) k - ε model for Reynolds-stress closure. Besides the turbulent regime with initially a slumping phase of a constant current front speed and later an inviscid self-similar phase of front speed decreasing as t-1/3(where t is the time measured from release), the viscous self-similar regime is satisfactorily reproduced with front speed decreasing as t-4/5,consistent with well known experimental observations.

  2. Fire regime in a Mexican forest under indigenous resource management.

    Science.gov (United States)

    Fulé, Peter Z; Ramos-Gómez, Mauro; Cortés-Montaño, Citlali; Miller, Andrew M

    2011-04-01

    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

  3. Assessing the Resilience of a River Management Regime: Informal Learning in a Shadow Network in the Tisza River Basin

    Directory of Open Access Journals (Sweden)

    Jan Sendzimir

    2008-06-01

    Full Text Available Global sources of change offer unprecedented challenges to conventional river management strategies, which no longer appear capable of credibly addressing a trap: the failure of conventional river defense engineering to manage rising trends of disordering extreme events, including frequency and intensity of floods, droughts, and water stagnation in the Hungarian reaches of the Tisza River Basin. Extreme events punctuate trends of stagnation or decline in the ecosystems, economies, and societies of this river basin that extend back decades, and perhaps, centuries. These trends may be the long-term results of defensive strategies of the historical river management regime that reflect a paradigm dating back to the Industrial Revolution: "Protect the Landscape from the River." Since then all policies have defaulted to the imperatives of this paradigm such that it became the convention underlying the current river management regime. As an exponent of this convention the current river management regimes' methods, concepts, infrastructure, and paradigms that reinforce one another in setting the basin's development trajectory, have proven resilient to change from wars, political, and social upheaval for centuries. Failure to address the trap makes the current river management regime's resilience appear detrimental to the region's future development prospects and prompts demand for transformation to a more adaptive river management regime. Starting before transition to democracy, a shadow network has generated multiple dialogues in Hungary, informally exploring the roots of this trap as part of a search for ideas and methods to revitalize the region. We report on how international scientists joined one dialogue, applying system dynamics modeling tools to explore barriers and bridges to transformation of the current river management regime and develop the capacity for participatory science to expand the range of perspectives that inform, monitor, and

  4. Assessing Management Regimes in Transboundary River Basins: Do They Support Adaptive Management?

    Directory of Open Access Journals (Sweden)

    Eduard Interwies

    2008-06-01

    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.

  5. Current management of oral cancer

    Institute of Scientific and Technical Information of China (English)

    Robert Ord

    2008-01-01

    @@ This presentation will summarize some of the current areas of interest in the management of oral cancer. The presentation will be divided into a brief review of epidemiology and diagnosis, with a more extensive discussion regarding the controversial areas in surgery and a review of the adjuvant roles of radiation and chemotherapy.

  6. A New Regime for Studying the High Bootstrap Current Fraction Plasma

    Institute of Scientific and Technical Information of China (English)

    A. Isayama; Y. Kamada; K. Ushigusa; T. Fujita; T. Suzuki; X. Gao

    2001-01-01

    A new experimental regime has recently been studied for achieving the high fraction of the bootstrap current in the JT-60U hydrogen discharges. The high poloidal beta(βp ~ 3.61) plasma was obtained by high-power neutral beam injection heating at a very high edge safety factor (Ip = 0.3 MA, Bt = 3.65 T, qeff = 25 - 35) region, and the bootstrap current fraction (fBS) was correspondingly about 40% using the ACCOME code calculation. It was observed that there were no magnetohydrodynamic instabilities to retard the increase of the βp and fBS parameters in the new regime.

  7. Capacity attributes of future urban water management regimes: projections from Australian sustainability practitioners.

    Science.gov (United States)

    van de Meene, S J; Brown, R R; Farrelly, M A

    2010-01-01

    Transitioning to more sustainable urban water management is widely accepted as an essential societal objective. While there has been significant progress in developing technical solutions to the challenges faced, numerous barriers remain at the regime level, indicating that further investigation into the regime is required. This paper reports on a social research project aimed at identifying capacity attributes of a more sustainable urban water management regime. Attributes were identified for the administrative and regulatory framework, inter- and intra-organisational and individual regime spheres. Over 125 urban water practitioners specialising in sustainability in Sydney and Melbourne were interviewed to identify the attributes of a more sustainable regime. The attributes reveal that a sustainable urban water management regime emphasises learning, diverse policy tools and institutional arrangements, together with interaction among stakeholders and professional disciplines. The interaction is characterised by respect, trust and mutual understanding. The sustainable regime attributes are compared to the traditional regime and reveal that while progress has been made towards a sustainable regime, additional improvement is required. Attributes identified across multiple regime spheres indicate potential focus areas for capacity building programs or reform efforts to more effectively enable regime change towards sustainable urban water management.

  8. Analytical drain current model for amorphous IGZO thin-film transistors in abovethreshold regime

    Institute of Scientific and Technical Information of China (English)

    He Hongyu; Zheng Xueren

    2011-01-01

    An analytical drain current model is presented for amorphous In-Ga-Zn-oxide thin-film transistors in the above-threshold regime,assuming an exponential trap states density within the bandgap.Using a charge sheet approximation,the trapped and free charge expressions are calculated,then the surface potential based drain current expression is developed.Moreover,threshold voltage based drain current expressions are presented using the Taylor expansion to the surface potential based drain current expression.The calculated results of the surface potential based and threshold voltage based drain current expressions are compared with experimental data and good agreements are achieved.

  9. Study of multipass regimes in lower hybrid current drive experiments on Tore Supra

    Energy Technology Data Exchange (ETDEWEB)

    Arslanbekov, R.; Litaudon, X.; Peysson, Y.; Hoang, G.T.; Kazarian, F.; Moreau, D. [Association Euratom-CEA, Centre d`Etudes de Cadarache, 13 - Saint-Paul-lez-Durance (France). Dept. de Recherches sur la Fusion Controlee; Shoucri, M.; Shkarofsky, I.P. [Centre Canadien de Fusion Magnetique, Varennes, PQ (Canada); Baranov, Y. [Commission of the European Communities, Abingdon (United Kingdom). JET Joint Undertaking; Kupfer, K. [General Atomics, San Diego, CA (United States)

    1995-12-31

    This document presents a study of multipass regimes in Lower Hybrid Current Drive on Tore Supra. A statistical model of the plasma wave propagation based on the Fokker-Planck theory is proposed, together with experimental results performed on Tore Supra. (TEC). 9 refs., 4 figs.

  10. Modelling of eddy-current interaction with cracks in the thin-skin regime. Two approaches

    Energy Technology Data Exchange (ETDEWEB)

    Mastorchio, S. [Electricite de France, 78 - Chatou (France). Research and Development Div.; Harfield, N. [Surrey Univ. (United Kingdom). Dept. of Physics

    1998-02-01

    EDF uses TRIFOU code for eddy current testing modelling. This general electromagnetic code is to be further adapted to Non Destructive Testing applications, not only for nuclear NDT but also in other fields such as aeronautical. This paper compares experimental data for aluminium and steel specimens with two methods of solving the forward problem in the thin-skin regime. The first approach is a 3D Finite Element / Boundary Integral Element method (TRIFOU) developed by EDF/RD Division (France). The second approach is specialized for the treatment of surface cracks in the thin-skin regime developed by the University of Surrey (England). In the thin-skin regime, the electromagnetic skin-depth is small compared with the depth of the crack. Such conditions are common in tests on steels and sometimes on aluminium. (K.A.) 4 refs.

  11. Regime shifts in demersal assemblages of the Benguela Current Large Marine Ecosystem: a comparative assessment

    DEFF Research Database (Denmark)

    Kirkman, Stephen P.; Yemane, Dawit; Atkinson, Lara J.

    2015-01-01

    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......‐level shift observed in the early 1990s, and of a lesser shift observed in the mid‐2000s, corresponded well with the results of other studies that showed environmental, community‐level or population‐level changes at similar times, suggesting that environmental forcing had played a role. Several population......‐level shifts were detected for Namibia; these and a regime shift in the overall community identified for this country corresponded well to the timing of severe environmental perturbations and an extensive regime shift in the pelagic ecosystem of this area. However, the interpretation of these shifts...

  12. Population status and regeneration of a tropical clumping bamboo Schizostachyum dullooa under two management regimes

    Institute of Scientific and Technical Information of China (English)

    Arun Jyoti Nath; Ashesh Kumar Das

    2011-01-01

    Schizostachyum dullooa (Gamble) Majumder 'dolu bamboo' is a thin walled sympodial moderate sized to large tufted bamboo, dominant in the successional fallows of northeast India. The impact of resource management on productivity and sustainability of the species was evaluated by investigating the population status and regeneration in Cachar tropical semi evergreen forest under private property resource management (PPRM) and common property resource management (CPRM)regimes. Population status revealed current-year, one-year, two-year and three-year-old culms contribute 54%, 24%, 16% and 6% of the total culms per clump, respectively, under PPRM. Three-year-old culms were absent in CPRM and population status was thus represented by current year (83%), one-year (16%) and two-year (1%) old culms. Net change,rate of change and % gain in population for different age classes showed the prevalence of management practices under CPRM was unscientific.Efficiency of new culm production per clump used as an index of regeneration was 69.7% in PPRM and 59.88% in CPRM. New culms produced under CPRM were small and thin. We conclude that CPRM is inappropriate for a long term economic and ecological sustainability of the species and alternative management protocols are needed for conservation of the species.

  13. Resource manager information needs regarding hydrologic regime shifts for the North Pacific Landscape Conservation

    Science.gov (United States)

    Woodward, Andrea; Jenni, Karen

    2014-01-01

    Landscape Conservation Cooperatives (LCCs) are a network of 22 public-private partnerships, defined by ecoregion, that share and provide science to ensure the sustainability of land, water, wildlife, and cultural resources in North America. LCCs were established by the U.S. Department of the Interior (DOI) in recognition of the fact that response to climate change must be coordinated on a landscape-level basis because important resources, ecosystem processes, and resource management challenges extend beyond most of the boundaries considered in current natural resource management. The North Pacific LCC (NPLCC) covers the range of the Pacific coastal temperate rainforest, including an area of 528,360 km2 spanning 22 degrees of latitude from the Kenai Peninsula, Alaska, to Bodega Bay, California. The coverage area includes parts of four States, two Canadian provinces, and more than 100 Tribes and First Nation language groups. It extends from alpine areas at the crest of coastal mountains across subalpine, montane, and lowland forests to the nearshore marine environment. This wide range of latitudes and elevation zones; terrestrial, freshwater, and marine habitats; and complex jurisdictional boundaries hosts a diversity of natural resources and their corresponding management issues are equally diverse. As evidenced by the Science and Traditional Ecological Knowledge (S-TEK) Strategy guiding principles, identifying and responding to the needs of resource managers is key to the success of the NPLCC. To help achieve this goal of the NPLCC, the U.S. Geological Survey (USGS) has organized several workshops with resource managers and resource scientists to identify management information needs relevant to the priority topics identified in the S-TEK Strategy. Here, we detail the results from a first workshop to address the effects of changes in hydrologic regime on rivers, streams, and riparian corridors. The workshop focused on a subset of the full NPLCC geography and was

  14. Regime shifts of Cruces River wetland ecosystem: current conditions, future uncertainties

    Directory of Open Access Journals (Sweden)

    Víctor H Marín

    2014-03-01

    Full Text Available During April-May 2004 the Cruces River wetland ecosystem, located in Valdivia (40°S, southern Chile, was described as shifting from a clear water regime, dominated by the exotic macrophyte Egeria densa, to turbid waters and absence of submerged macrophytes. We analyzed the trophic status and ecological regime of the wetland from November 2011 through January 2013. The trophic status was determined comparing values of selected variables (nutrients, chlorophyll-a and transparency with OECD criteria. The ecological regime was determined comparing the same variables with the criteria proposed by Ibelings et al. (2007. We further compared the concentration of nutrients and suspended solids with previous measurements. Current trophic status of the wetland is between eutrophic and hypereutrophic, as shown by results, and its ecological regime intermediate, between clear and turbid waters, with a considerable risk of returning to turbid waters. In this article we discuss the potential relationship between the watershed land use (agriculture, cattle feeding and forestry, the change in wetland's trophic level and future conditions.

  15. Dynamics of the Plasmoid-unstable Regime in Different Multiple-current Plasmas

    Science.gov (United States)

    Nemati, M. J.; Wang, Zheng-Xiong; Wei, Lai

    2017-02-01

    The dynamics of plasmoid instability in multiple-current plasmas with different system sizes is investigated by means of resistive magnetohydrodynamic simulations. As the system size is increased, the secondary current sheets become very long, producing more plasmoids. It is found that the dependence on resistivity η of the number of plasmoids changes from no clear scaling for small system size, to scaling in ∼ {η }-1 for large system size. Moreover, increasing the current length of the system weakens the negative dependence of the early growth rate of the monster plasmoid on η. This is qualitatively different from the reconnection rate for a single-current sheet, where it usually has a positive dependence on η or is independent of η. In addition, increasing the current length significantly increases the maximum width of the monster plasmoid in the low-η regime, manifesting a scaling ∼ {η }-0.4.

  16. Management of exchange rate regimes in emerging Asia

    Directory of Open Access Journals (Sweden)

    Ramkishen S. Rajan

    2012-04-01

    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.

  17. Modeling and analysis of sub-surface leakage current in nano-MOSFET under cutoff regime

    Science.gov (United States)

    Swami, Yashu; Rai, Sanjeev

    2017-02-01

    The high leakage current in nano-meter regimes is becoming a significant portion of power dissipation in nano-MOSFET circuits as threshold voltage, channel length, and gate oxide thickness are scaled down to nano-meter range. Precise leakage current valuation and meticulous modeling of the same at nano-meter technology scale is an increasingly a critical work in designing the low power nano-MOSFET circuits. We present a specific compact model for sub-threshold regime leakage current in bulk driven nano-MOSFETs. The proposed logical model is instigated and executed into the latest updated PTM bulk nano-MOSFET model and is found to be in decent accord with technology-CAD simulation data. This paper also reviews various transistor intrinsic leakage mechanisms for nano-MOSFET exclusively in weak inversion, like drain-induced barricade lowering (DIBL), gate-induced drain leakage (GIDL), gate oxide tunneling (GOT) leakage etc. The root cause of the sub-surface leakage current is mainly due to the nano-scale short channel length causing source-drain coupling even in sub-threshold domain. Consequences leading to carriers triumphing the barricade between the source and drain. The enhanced model effectively considers the following parameter dependence in the account for better-quality value-added results like drain-to-source bias (VDS), gate-to-source bias (VGS), channel length (LG), source/drain junction depth (Xj), bulk doping concentration (NBULK), and operating temperature (Top).

  18. The impact of current visa regime policy on tourism recovery and development in Zimbabwe

    Directory of Open Access Journals (Sweden)

    Nelson Zengeni

    2012-12-01

    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.

  19. A post-Kyoto partner: considering the stratospheric ozone regime as a tool to manage nitrous oxide.

    Science.gov (United States)

    Kanter, David; Mauzerall, Denise L; Ravishankara, A R; Daniel, John S; Portmann, Robert W; Grabiel, Peter M; Moomaw, William R; Galloway, James N

    2013-03-19

    Nitrous oxide (N2O) is the largest known remaining anthropogenic threat to the stratospheric ozone layer. However, it is currently only regulated under the 1997 Kyoto Protocol because of its simultaneous ability to warm the climate. The threat N2O poses to the stratospheric ozone layer, coupled with the uncertain future of the international climate regime, motivates our exploration of issues that could be relevant to the Parties to the ozone regime (the 1985 Vienna Convention and its 1987 Montreal Protocol) should they decide to take measures to manage N2O in the future. There are clear legal avenues to regulate N2O under the ozone regime as well as several ways to share authority with the existing and future international climate treaties. N2O mitigation strategies exist to address the most significant anthropogenic sources, including agriculture, where behavioral practices and new technologies could contribute significantly to reducing emissions. Existing policies managing N2O and other forms of reactive nitrogen could be harnessed and built on by the ozone regime to implement N2O controls. There are several challenges and potential cobenefits to N2O control which we discuss here: food security, equity, and implications of the nitrogen cascade. The possible inclusion of N2O in the ozone regime need not be viewed as a sign of failure of the United Nations Framework Convention on Climate Change to adequately deal with climate change. Rather, it could represent an additional valuable tool in sustainable development diplomacy.

  20. Protection of the African Lion: A Critical Analysis of the Current International Legal Regime

    Directory of Open Access Journals (Sweden)

    Samantha Watts

    2016-04-01

    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

  1. Current management of fungal infections.

    NARCIS (Netherlands)

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

    2001-01-01

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

  2. Effects of national forest-management regimes on unprotected forests of the Himalaya.

    Science.gov (United States)

    Brandt, Jodi S; Allendorf, Teri; Radeloff, Volker; Brooks, Jeremy

    2017-03-15

    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

  3. Current management options for tyrosinemia

    Directory of Open Access Journals (Sweden)

    El-Shabrawi MH

    2013-03-01

    Full Text Available Mortada Hassan El-Shabrawi, Naglaa Mohamed KamalPediatric Hepatology, Faculty of Medicine, Cairo University, Cairo, EgyptAbstract: Hypertyrosinemia is observed in three inherited disorders of tyrosine metabolism. Hereditary Tyrosinemia Type I (HTT-I, or hepatorenal tyrosinemia, is an autosomal recessive disorder caused by mutation in the fumarylacetoacetate hydrolase (FAH gene. HTT-I is associated with severe involvement of the liver, kidneys, and central nervous system, and is due to toxic accumulation of metabolites of tyrosine, such as succinylacetone. HTT-I is the inborn error with the highest incidence of progression to hepatocellular carcinoma. Elevated succinylacetone, in dried filter paper blood samples, or in plasma or urine, is pathognomonic and diagnostic for HTT-I and is the most reliable neonatal screening method. Liver transplantation is the definitive management, but the need for this is markedly decreased by the combined dietary and drug management. A diet low in tyrosine and phenylalanine, plus nitisinone (2-[2-nitro-4-trifluoromethylbenzoyl]-1,3-cyclohexanedione (NCTB are considered the gold standard management options. Carnitine and 1,25-OH-vitamin D are adjuvant therapy. Strict follow up with succinylacetone level for monitoring of treatment should be done. Abdominal ultrasonography and abdominal computerized tomography scan or magnetic resonance imaging should also be done for surveillance of the possible development of hepatocellular carcinoma.Keywords: tyrosinemia, management, NTBC, hepatocellular carcinoma

  4. Effects of resource management regimes on project schedule

    NARCIS (Netherlands)

    Al-Jibouri, Saad H.

    2002-01-01

    This paper deals with the problem of resource scheduling within given resource constraints on a sectionalised construction project. A computer model has been developed which realistically simulates the progress of projects. A project has been selected and divided into sections whereby section manage

  5. Role of head of turbulent 3-D density currents in mixing during slumping regime

    Science.gov (United States)

    Bhaganagar, Kiran

    2017-02-01

    A fundamental study was conducted to shed light on entrainment and mixing in buoyancy-driven Boussinesq density currents. Large-eddy simulation was performed on lock-exchange (LE) release density currents—an idealized test bed to generate density currents. As dense fluid was released over a sloping surface into an ambient lighter fluid, the dense fluid slumps to the bottom and forms a characteristic head of the current. The dynamics of the head dictated the mixing processes in LE currents. The key contribution of this study is to resolve an ongoing debate on mixing: We demonstrate that substantial mixing occurs in the early stages of evolution in an LE experiment and that entrainment is highly inhomogeneous and unsteady during the slumping regime. Guided by the flow physics, entrainment is calculated using two different but related perspectives. In the first approach, the entrainment parameter (E) is defined as the fraction of ambient fluid displaced by the head that entrains into the current. It is an indicator of the efficiency in which ambient fluid is displaced into the current and it serves as an important metric to compare the entrainment of dense currents over different types of surfaces, e.g., roughness configuration. In the second approach, E measures the net entrainment in the current at an instantaneous time t over the length of the current. Net entrainment coefficient is a metric to compare the effects of flow dynamical conditions, i.e., lock-aspect ratio that dictates the fraction of buoyancy entering the head, and also the effect of the sloping angle. Together, the entrainment coefficient and the net entrainment coefficient provide an insight into the entrainment process. The "active" head of the current acts as an engine that mixes the ambient fluid with the existing dense fluid, the 3-D lobes and clefts on the frontal end of the current causes recirculation of the ambient fluid into the current, and Kelvin-Helmholtz rolls are the mixers that

  6. Current management of wound healing

    DEFF Research Database (Denmark)

    Gottrup, F; Karlsmark, T

    2009-01-01

    in the next decade. It is the hope that increasing parts of the new knowledge from basic wound healing research will be implemented in daily clinical practice. The development of new treatment products will also continue, and especially new technologies with combined types of dressing materials or dressing...... 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....

  7. Heating, current drive and confinement regimes with the JET ICRH and LHCD systems

    DEFF Research Database (Denmark)

    Jacquinot, J.; Adams, J.M.; Altmann, H.;

    1991-01-01

    During its 1990 operation, 2 large RF systems were available on JET. The Ion Cyclotron Resonance Heating (ICRH) system was equipped with new beryllium screens and with feedback matching systems. Specific impurities generated by ICRH were reduced to negligible levels even in the most stringent H......-mode conditions. A maximum power of 22 MW was coupled to L-mode plasmas. High quality H-modes (tau-E greater-than-or-equal-to 2.5 tau-EG) were achieved using dipole phasing. A new high confinement mode was discovered. It combines the properties of the H-mode regime to the low central diffusivities obtained....... 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...

  8. Coincident polio and Ebola crises expose similar fault lines in the current global health regime.

    Science.gov (United States)

    Calain, Philippe; Abu Sa'Da, Caroline

    2015-01-01

    In 2014, the World Health Organization (WHO) declared two "public health emergencies of international concern", in response to the worldwide polio situation and the Ebola epidemic in West Africa respectively. Both emergencies can be seen as testing moments, challenging the current model of epidemic governance, where two worldviews co-exist: global health security and humanitarian biomedicine. The resurgence of polio and the spread of Ebola in 2014 have not only exposed the weaknesses of national health systems, but also the shortcomings of the current global health regime in dealing with transnational epidemic threats. These shortcomings are of three sorts. Firstly, the global health regime is fragmented and dominated by the domestic security priorities of industrialised nations. Secondly, the WHO has been constrained by constitutional country allegiances, crippling reforms and the limited impact of the (2005) International Health Regulations (IHR) framework. Thirdly, the securitization of infectious diseases and the militarization of humanitarian aid undermine the establishment of credible public health surveillance networks and the capacity to control epidemic threats. The securitization of communicable diseases has so far led foreign aid policies to sideline health systems. It has also been the source of ongoing misperceptions over the aims of global health initiatives. With its strict allegiance to Member States, the WHO mandate is problematic, particularly when it comes to controlling epidemic diseases. In this context, humanitarian medical organizations are expected to palliate the absence of public health services in the most destitute areas, particularly in conflict zones. The militarization of humanitarian aid itself threatens this fragile and imperfect equilibrium. None of the reforms announced by the WHO in the wake of the 68(th) World Health Assembly address these fundamental issues.

  9. Orofacial pain management: current perspectives.

    Science.gov (United States)

    Romero-Reyes, Marcela; Uyanik, James M

    2014-01-01

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

  10. Orofacial pain management: current perspectives

    Science.gov (United States)

    Romero-Reyes, Marcela; Uyanik, James M

    2014-01-01

    Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). Orofacial pain (OFP) can arise from different regions and etiologies. Temporomandibular disorders (TMD) are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities. PMID:24591846

  11. Orofacial pain management: current perspectives

    Directory of Open Access Journals (Sweden)

    Romero-Reyes M

    2014-02-01

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

  12. Ditch water levels manages for environmental aims: effects on field soil water regimes

    Directory of Open Access Journals (Sweden)

    A. Armstrong

    1999-01-01

    Full Text Available The effects of ditch water management regimes on water tables are examined for two test sites in England, Halvergate in the Broads and Southlake Moor in the Somerset Levels and Moors Environmentally Sensitive Areas. It is observed that in some fields the effects of water management are only poorly transferred from the ditch to the field centre, especially where the hydraulic conductivity of the subsoil is small. Where there are large variations in the ditch water levels, reflecting the influence of major ditches subject to pump drainage, field soil water regimes differ significantly. Nevertheless, the effects of even quite small changes in the ditch regime cam be noticeable. Simple modelling studies show that much greater effects can be achieved by increasing the frequency of ditches within wetlands.

  13. Modeling the complex impacts of timber harvests to find optimal management regimes for Amazon tidal floodplain forests

    Science.gov (United States)

    Fortini, Lucas; Cropper, Wendell P.; Zarin, Daniel J.

    2015-01-01

    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

  14. System-focused environmental flow regime prescription, monitoring and adaptive management

    Science.gov (United States)

    Hetherington, David; Lexartza Artza, Irantzu

    2016-04-01

    that more peripheral influencing factors should be given serious consideration when developing environmental flow regimes. These factors could include the development of ice, non-fluvial geomorphic processes such as landslides, connectivity with groundwater and provision for local cottage industries. Even with a thorough appreciation of the holistic system, the value of detailed environmental monitoring and adaptive management plans cannot be underestimated as a means of further managing risk and uncertainty in complex systems. It is suggested that by taking a more holistic and system-focused approach to environmental flow definition, that environmental flow regimes can be tailored to the specificity and complexity of any given location. By improving the way that environmental flow regimes and associated physical mitigation are prescribed, monitored and managed it should be possible to develop more sustainable forms of energy production whilst minimising environmental harm as far as possible.

  15. Benchmark continuum and kinetic simulations of argon microplasmas in the direct current and microwave regimes

    Science.gov (United States)

    Verma, Abhishek Kumar; Alamatsaz, Arghavan; Venkattraman, Ayyaswamy

    2017-10-01

    This study presents benchmark comparisons between continuum and kinetic simulations of argon microplasmas operating in the direct current and microwave regimes. Kinetic simulations using the particle-in-cell with Monte Carlo collisions (PIC-MCC) method and continuum simulations using the full-momentum equation for both ions and electrons are performed at various operating conditions in order to study the influence of product of pressure and gap size, pd (for a given gap size), influence of gap size (for a given value of pd) and operating frequency. It is shown that using the electron energy distribution function (EEDF) predicted by zero-dimensional Boltzmann solvers (such as BOLSIG+) in continuum simulations of direct current microplasmas leads to a significant under-prediction of plasma number densities with continuum simulations based on the Maxwellian EEDF performing better particularly for higher values of pd. The discrepancy between kinetic and continuum simulations is attributed to the presence of hot electrons created as a result of secondary emission and subsequent acceleration in the sheath. On the other hand, simulations performed for argon microwave microplasmas operating at 0.5 GHz, 0.8 GHz, 2 GHz and 4 GHz demonstrated that continuum simulations performed using the rate constants from BOLSIG+  showed excellent agreement with kinetic simulations for the plasma density profiles in spite of over-predicting the voltage/power required to achieve a given plasma density.

  16. A law & economics approach to the study of integrated management regimes of estuaries

    NARCIS (Netherlands)

    Griendt, van de Wim

    2004-01-01

    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 qualif

  17. CURRENT AND FUTURE USE OF MANAGEMENT TOOLS

    National Research Council Canada - National Science Library

    Zlatko Nedelko; Vojko Pototcan; Marina Dabic

    2015-01-01

    .... The authors developed and tested a model for predicting the future use of management tools based on the current use of tools by employees in organizations, underlying assumptions of the theory...

  18. Current climate change effects on the ground thermal regime in Central Yakutia

    Institute of Scientific and Technical Information of China (English)

    Stepan Varlamov; Yuri Skachkov; Pavel Skryabin

    2014-01-01

    The-evolution-of-ground-thermal-state-has-been-studied-to-assess-impacts-of-current-climatic-warming-on-permafrost-in-Central-Yakutia.-The-analysis-of-long-term-data-of-regional-weather-stations-has-revealed-one-of-the-highest-increasing-trends-in-mean-annual-air-temperature-in-northern-Russia.-A-forecast-of-surface-air-temperature-fluctuations-has-been-made-by-applying-a-frequency-analysis-method.-Monitoring-of-ground-thermal-conditions-allows-us-to-identify-inter-annual-and-long-term-variability-among-a-wide-range-of-natural-conditions.-Experimental-research-has-indicated-a-long-term-dynamics-of-ground-thermal-state-evolution:-ground-temperatures-at-the-depth-of-zero-annual-amplitude-and-seasonally-thawed-layer-depth.-Long-term-variability-of-thaw-depth-shows-near-zero-to-weak-positive-trends-in-small-valleys-in-contrast-to-weak-negative-trends-on-slopes.-With-significant-climatic-warming,-the-thermal-state-of-near-surface-layers-of-permafrost-demonstrates-steadiness.-Anthropogenic-impacts-on-ground-thermal-regime-in-various-terrain-types-have-been-qualitatively-evaluated.-Clear-cutting,-ground-cover-stripping,-and-post-fire-deforestation-in-inter-alas-type-terrains-result-in-a-significant-increase-of-temperature-and-seasonal-ground-thaw-depth,-as-well-as-adverse-cryogenic-processes.-The-dynamics-of-mean-annual-ground-temperature-in-slash-and-burn-sites-have-been-evaluated-in-reference-to-stages-of-successive-vegetation-recovery.

  19. Progress toward steady-state tokamak operation exploiting the high bootstrap current fraction regime

    Science.gov (United States)

    Ren, Q. L.; Garofalo, A. M.; Gong, X. Z.; Holcomb, C. T.; Lao, L. L.; McKee, G. R.; Meneghini, O.; Staebler, G. M.; Grierson, B. A.; Qian, J. P.; Solomon, W. M.; Turnbull, A. D.; Holland, C.; Guo, W. F.; Ding, S. Y.; Pan, C. K.; Xu, G. S.; Wan, B. N.

    2016-06-01

    Recent DIII-D experiments have increased 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. Improved understanding of scenario stability has led to the achievement of very high values of βp and βN , despite strong internal transport barriers. Good confinement has been achieved with reduced toroidal rotation. These high βp plasmas challenge the energy transport understanding, especially in the electron energy channel. A new turbulent transport model, named TGLF-SAT1, has been developed which improves the transport prediction. Experiments extending results to long pulse on EAST, based on the physics basis developed at DIII-D, have been conducted. More investigations will be carried out on EAST with more additional auxiliary power to come online in the near term.

  20. Transitions in European land-management regimes between 1800 and 2010

    DEFF Research Database (Denmark)

    Jepsen, Martin Rudbeck; Kuemmerle, Tobias; Müller, Daniel

    2015-01-01

    Abstract Land use is a cornerstone of human civilization, but also intrinsically linked to many global sustainability challenges—from climate change to food security to the ongoing biodiversity crisis. Understanding the underlying technological, institutional and economic drivers of land-use change...... country, the timing and prevalence of regimes, and the conditions that result in observed bifurcations. However, we also found strong similarities across countries in the timing of certain land-management regime shifts, often in relation to institutional reforms (e.g., changes in EU agrarian policies...... or the emergence and collapse of the Soviet land management paradigm) or to technological innovations (e.g., drainage pipes, tillage and harvesting machinery, motorization, and synthetic fertilizers). Land reforms frequently triggered changes in land management, and the location and timing of reforms had...

  1. Towards time-dependent current-density-functional theory in the non-linear regime.

    Science.gov (United States)

    Escartín, J M; Vincendon, M; Romaniello, P; Dinh, P M; Reinhard, P-G; Suraud, E

    2015-02-28

    Time-Dependent Density-Functional Theory (TDDFT) is a well-established theoretical approach to describe and understand irradiation processes in clusters and molecules. However, within the so-called adiabatic local density approximation (ALDA) to the exchange-correlation (xc) potential, TDDFT can show insufficiencies, particularly in violently dynamical processes. This is because within ALDA the xc potential is instantaneous and is a local functional of the density, which means that this approximation neglects memory effects and long-range effects. A way to go beyond ALDA is to use Time-Dependent Current-Density-Functional Theory (TDCDFT), in which the basic quantity is the current density rather than the density as in TDDFT. This has been shown to offer an adequate account of dissipation in the linear domain when the Vignale-Kohn (VK) functional is used. Here, we go beyond the linear regime and we explore this formulation in the time domain. In this case, the equations become very involved making the computation out of reach; we hence propose an approximation to the VK functional which allows us to calculate the dynamics in real time and at the same time to keep most of the physics described by the VK functional. We apply this formulation to the calculation of the time-dependent dipole moment of Ca, Mg and Na2. Our results show trends similar to what was previously observed in model systems or within linear response. In the non-linear domain, our results show that relaxation times do not decrease with increasing deposited excitation energy, which sets some limitations to the practical use of TDCDFT in such a domain of excitations.

  2. A COMPARATIVE CLINICAL STUDY OF DHAKA AND PRITCHARD REGIME IN THE ECLAMPSIA MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Sunanda Bai

    2015-08-01

    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

  3. Current UK practices in the management of subacromial impingement

    Science.gov (United States)

    Drury, Colin; Tait, Gavin R

    2015-01-01

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

  4. Role of manual therapy with exercise regime versus exercise regime alone in the management of non-specific chronic neck pain.

    Science.gov (United States)

    Akhter, Saeed; Khan, Muhammad; Ali, Syed Shahzad; Soomro, Rabial Rani

    2014-11-01

    To evaluate the role of manual therapy with exercise regime versus exercise regime alone in the management of non-specific chronic neck pain. In this 62 subjects randomized controlled trial 31 subjects in group A received manual therapy (manipulation) with supervised exercise regime whilst 31 subjects in group B performed only supervised exercise regime for the period of 3 weeks. Both groups had a home exercise program consisted of strengthening exercises for neck/scapuluar stability, stretching and general range of motion exercises for neck with advice regarding posture awareness and correction for 3 months. The results suggested significant reduction in pain intensity level in both groups; over 3 weeks and 12 weeks' time period in relation to baseline on visual analog scale (p=0.001). Similarly, statistically significant improvements noticed in Neck Disability Index (NDI) (p=0.0001) in both groups while looking at baseline data with reference to 12 weeks' time period. On closer inspection, the manual therapy (manipulation) with exercise regime appeared as a favorable treatment preference compared with exercise regime alone.

  5. Instabilities of dispersion-managed solitons in the normal dispersion regime

    OpenAIRE

    Pelinovsky, Dmitry

    2000-01-01

    Dispersion-managed solitons are reviewed within a Gaussian variational approximation and an integral evolution model. In the normal regime of the dispersion map (when the averaged path dispersion is negative), there are two solitons of different pulse duration and energy at a fixed propagation constant. We show that the short soliton with a larger energy is linearly (exponentially) unstable. The other (long) soliton with a smaller energy is linearly stable but hits a resonance with excitation...

  6. Current Characteristics and Trends of the Tracked Satellite Population in the Human Space Flight Regime

    Science.gov (United States)

    Johnson, Nicholas L.

    2006-01-01

    Since the end of the Apollo program in 1972, human space flight has been restricted to altitudes below 600 km above the Earth s surface with most missions restricted to a ceiling below 400 km. An investigation of the tracked satellite population transiting and influencing the human space flight regime during the past 11 years (equivalent to a full solar cycle) has recently been completed. The overall effects of satellite breakups and solar activity are typically less pronounced in the human space flight regime than other regions of low Earth orbit. As of January 2006 nearly 1500 tracked objects resided in or traversed the human space flight regime, although two-thirds of these objects were in orbits of moderate to high eccentricity, significantly reducing their effect on human space flight safety. During the period investigated, the spatial density of tracked objects in the 350-400 km altitude regime of the International Space Station demonstrated a steady decline, actually decreasing by 50% by the end of the period. On the other hand, the region immediately above 600 km experienced a significant increase in its population density. This regime is important for future risk assessments, since this region represents the reservoir of debris which will influence human space flight safety in the future. The paper seeks to put into sharper perspective the risks posed to human space flight by the tracked satellite population, as well as the influences of solar activity and the effects of compliance with orbital debris mitigation guidelines on human space flight missions. Finally, the methods and successes of characterizing the population of smaller debris at human space flight regimes are addressed.

  7. Current and Future Parts Management at NASA

    Science.gov (United States)

    Sampson, Michael J.

    2011-01-01

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

  8. Flow regime, void fraction and interfacial area transport and characteristics of co-current downward two-phase flow

    Energy Technology Data Exchange (ETDEWEB)

    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)

    2016-10-15

    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

  9. Current Challenges in Social Media Management

    DEFF Research Database (Denmark)

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

    2015-01-01

    Social media management is an emerging field of academic research and organizational practice. It is concerned with the operational issues, managerial challenges, and comparative advantages that ensue from the adoption and use of social media platforms for organizational functions such as marketing...... 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......®, PANDORA®, Novo Nordisk®, and Carlsberg®). Empirical findings uncover the prevailing perceptions about social media amongst the managers, typical managerial challenges tied directly to coordinating social media productions, and uncertainty about the return of investment on social media activities....

  10. Current challenges in social media management

    DEFF Research Database (Denmark)

    Tørning, Kristian; Jaffari, Zeshan; Vatrapu, Ravi

    2015-01-01

    Social media management is an emerging field of academic research and organizational practice. It is concerned with the operational issues, managerial challenges, and comparative advantages that ensue from the adoption and use of social media platforms for organizational functions such as marketing...... 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......®, PANDORA®, Novo Nordisk®, and Carlsberg®). Empirical findings uncover the prevailing perceptions about social media amongst the managers, typical managerial challenges tied directly to coordinating social media productions, and uncertainty about the return of investment on social media activities....

  11. Current challenges in social media management

    DEFF Research Database (Denmark)

    Tørning, Kristian; Jaffari, Zeshan; Vatrapu, Ravi

    2015-01-01

    Social media management is an emerging field of academic research and organizational practice. It is concerned with the operational issues, managerial challenges, and comparative advantages that ensue from the adoption and use of social media platforms for organizational functions such as marketing...... 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......®, PANDORA®, Novo Nordisk®, and Carlsberg®). Empirical findings uncover the prevailing perceptions about social media amongst the managers, typical managerial challenges tied directly to coordinating social media productions, and uncertainty about the return of investment on social media activities....

  12. Current management strategy of hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Bernardino Rampone; Beniamino Schiavone; Antonio Martino; Carmine Viviano; Giuseppe Confuorto

    2009-01-01

    Hepatocellular carcinoma (HCC) still remains a considerable challenge for surgeons. Surgery, including liver transplantation, is the most important therapeutic approach for patients with this disease. HCC is frequently diagnosed at advanced stages and has a poor prognosis with a high mortality rate even when surgical resection has been considered potentially curative. This brief report summarizes the current status of the management of this malignancy and includes a short description of new pharmacological approaches in HCC treatment.

  13. Bacterial endophyte communities of three agricultural important grass species differ in their response towards management regimes

    Science.gov (United States)

    Wemheuer, Franziska; Kaiser, Kristin; Karlovsky, Petr; Daniel, Rolf; Vidal, Stefan; Wemheuer, Bernd

    2017-01-01

    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. PMID:28102323

  14. Bacterial endophyte communities of three agricultural important grass species differ in their response towards management regimes

    Science.gov (United States)

    Wemheuer, Franziska; Kaiser, Kristin; Karlovsky, Petr; Daniel, Rolf; Vidal, Stefan; Wemheuer, Bernd

    2017-01-01

    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.

  15. High-accuracy current generation in the nanoampere regime from a silicon single-trap electron pump

    Science.gov (United States)

    Yamahata, Gento; Giblin, Stephen P.; Kataoka, Masaya; Karasawa, Takeshi; Fujiwara, Akira

    2017-01-01

    A gigahertz single-electron (SE) pump with a semiconductor charge island is promising for a future quantum current standard. However, high-accuracy current in the nanoampere regime is still difficult to achieve because the performance of SE pumps tends to degrade significantly at frequencies exceeding 1 GHz. Here, we demonstrate robust SE pumping via a single-trap level in silicon up to 7.4 GHz, at which the pumping current exceeds 1 nA. An accuracy test with an uncertainty of about one part per million (ppm) reveals that the pumping current deviates from the ideal value by only about 20 ppm at the flattest part of the current plateau. This value is two orders of magnitude better than the best one reported in the nanoampere regime. In addition, the pumping accuracy is almost unchanged up to 7.4 GHz, probably due to strong electron confinement in the trap. These results indicate that trap-mediated SE pumping is promising for achieving the practical operation of the quantum current standard. PMID:28322339

  16. Sleep bruxism: Current knowledge and contemporary management.

    Science.gov (United States)

    Yap, Adrian U; Chua, Ai Ping

    2016-01-01

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

  17. Sleep bruxism: Current knowledge and contemporary management

    Directory of Open Access Journals (Sweden)

    Adrian U.J. Yap

    2016-01-01

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

  18. Current Diagnosis and Management of Thyroid Nodules

    Directory of Open Access Journals (Sweden)

    Tjokorda Gde Dalem Pemayun

    2016-11-01

    Full Text Available Thyroid nodules are frequently found. Although they are often palpable, many are found incidentally during unrelated radiographic studies. Ten to 15% of thyroid nodules represents thyroid malignancy. Clinician suc as an internist/endocrinologist have to  classify the nodule, stratify the risk of thyroid cancer, performed a diagnostic work-up, provide medical / non-surgical therapy, select candidates for surgery and provide appropriate follow-up that should last a lifetime. This article provide an up-date review of diagnostic approach and management of thyroid nodules, focusing on current algorithm in lights of the most recent published American Thyroid Association thyroid nodule and differentiated thyroid cancer management guidelines.

  19. Sleep bruxism: Current knowledge and contemporary management

    Science.gov (United States)

    Yap, Adrian U.; Chua, Ai Ping

    2016-01-01

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

  20. The problem of current toxic chemicals management.

    Science.gov (United States)

    Tickner, Joel; Geiser, Ken

    2004-01-01

    In this article, we explore the limitations of current chemicals management policies worldwide and the evolution of new European, International and U.S. policies to address the problem of toxic chemicals control. It is becoming increasingly apparent that current chemicals management policies in Europe and the United States are inadequate. There is a general lack of toxicity and exposure information on chemicals in commerce and the vast majority of chemicals were considered safe until proven guilty in legislation. Governments must then prove each chemical is dangerous through a slow and resource-intensive risk assessment process. For more than a decade, Nordic countries, such as Denmark and Sweden, have actively promoted integrated chemicals policies to address contamination of critical waterways. They have successfully used a variety of voluntary and mandatory policy tools, such as education, procurement, lists of chemicals of concern, eco-labeling, research and development on safer substitutes, and chemical phase-out requirements, to encourage companies using chemicals to reduce their reliance on harmful substances and to develop safer substitutes. While previously isolated to particular countries, innovative and exciting European-wide policies to promote sustainable chemicals management are now moving forward, including the recently published draft Registration, Evaluation and Authorization of CHemicals (REACH) policy of the European Union. A sweeping change in chemicals management policies in Europe is inevitable and it will ultimately affect manufacturers in the U.S. and globally. The European movement provides an opportunity to initiate a discussion on integrated chemicals policy in the U.S. where some innovative initiatives already are underway.

  1. Current possibilities in occlusal caries management

    Directory of Open Access Journals (Sweden)

    Hrvoje Jurić

    2013-11-01

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

  2. Current clinical management of brainstem cavernomas.

    Science.gov (United States)

    Bozinov, Oliver; Hatano, Taketo; Sarnthein, Johannes; Burkhardt, Jan-Karl; Bertalanffy, Helmut

    2010-11-26

    Over the last two decades a favourable course for treated or nontreated brainstem cavernomas has become possible with enhanced diagnostic tools and clinical experience, as well as minimally invasive microsurgical improvements. Currently, brainstem cavernoma can be treated microsurgically with excellent results and an acceptable morbidity rate. The preferred surgical route has progressively shifted from a dorsal to a lateral approach, but this remains dependent on the location of the lesion in the brainstem. Surgical evaluation and management of all cases of this rare disease should be performed by experienced teams from the outset.

  3. Effects of Previous Crop Management, Fertilization Regime and Water Supply on Potato Tuber Proteome and Yield

    Directory of Open Access Journals (Sweden)

    Carlo Leifert

    2013-01-01

    Full Text Available There is increasing concern about the sustainability and environmental impacts of mineral fertilizer use in agriculture. Increased recycling of nutrients via the use of animal and green manures and fertilizers made from domestic organic waste may reduce reliance on mineral fertilizers. However, the relative availability of nutrients (especially nitrogen is lower in organic compared to mineral fertilizers, which can result in significantly lower yields in nutrient demanding crops such as potato. It is therefore important to gain a better understanding of the factors affecting nutrient use efficiency (yield per unit fertilizer input from organic fertilizers. Here we show that (a previous crop management (organic vs. conventional fertilization and crop protection regimes, (b organic fertilizer type and rate (composted cattle manure vs. composted chicken manure pellets and (c watering regimes (optimized and restricted significantly affected leaf chlorophyll content, potato tuber N-concentration, proteome and yield. Protein inference by gel matching indicated several functional groups significantly affected by previous crop management and organic fertilizer type and rate, including stress/defense response, glycolysis and protein destination and storage. These results indicate genomic pathways controlling crop responses (nutrient use efficiency and yield according to contrasting types and rates of organic fertilizers that can be linked to the respective encoding genes.

  4. Fever management: Evidence vs current practice.

    Science.gov (United States)

    El-Radhi, A Sahib Mehdi

    2012-12-08

    Fever is a very common complaint in children and is the single most common non-trauma-related reason for a visit to the emergency department. Parents are concerned about fever and it's potential complications. The biological value of fever (i.e., whether it is beneficial or harmful) is disputed and it is being vigorously treated with the belief of preventing complications such as brain injury and febrile seizures. The practice of alternating antipyretics has become widespread at home and on paediatric wards without supporting scientific evidence. There is still a significant contrast between the current concept and practice, and the scientific evidence. Why is that the case in such a common complaint like fever The article will discuss the significant contrast between the current concepts and practice of fever management on one hand, and the scientific evidence against such concepts and practice.

  5. Streamflow Regime Variations Following Ecological Management on the Loess Plateau, China

    Directory of Open Access Journals (Sweden)

    Jianjun Zhang

    2015-12-01

    Full Text Available The continuous ecological management of the Loess Plateau is known throughout the world for two strategies: the integrated soil conservation project that began in the 1970s, and the “Grain for Green” project that began in the 1990s. Six sub-catchments nested in the Beiluo River basin were selected to investigate streamflow regime variations during the two project periods. The annual streamflow trends and change points were detected using a bootstrap-based Mann-Kendall test and Pettitt test. Annual streamflow (from the 1950s to 2011 exhibited significantly negative trends in five out of six catchments, varying from −0.15 to −0.30 mm/a. During the integrated soil conservation period, the annual streamflow was reduced due to high flow decreases (5% of time exceeded, whereas in the low flows (95% it increased in all sub-catchments. During the “Grain for Green” period, the annual streamflow decreased due to daily streamflow reductions at four stations. In addition to high flow and low flow decreases at the Wuqi and Liujiahe stations during the “Grain for Green” period, it is significant that the low flows continuously increased. Compared with trends from the forestry area, which includes the Zhangcunyi and Huangling stations, incremental annual streamflow reductions were observed in other sub-catchments, which can be linked to ecological management. This result implies that streamflow can be moderated by appropriate management options, even in semiarid areas. It was concluded that a stable streamflow regime can be achieved in vegetated areas, and streamflow moderation is dependent on ecological management practices.

  6. Prediction of femtosecond oscillations in the transient current of a quantum dot in the Kondo regime

    KAUST Repository

    Goker, A.

    2010-10-11

    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.

  7. Pediatric enteric neuropathies: diagnosis and current management.

    Science.gov (United States)

    Westfal, Maggie L; Goldstein, Allan M

    2017-06-01

    Neurointestinal diseases are increasingly recognized as causes of significant gastrointestinal morbidity in children. This review highlights the most common pediatric enteric neuropathies and their diagnosis and management, emphasizing insights and discoveries from the most recent literature available. The embryologic and histopathologic causes of enteric neuropathies are varied. They range from congenital aganglionosis in Hirschsprung disease, to autoimmune-mediated loss of neuronal subtypes in esophageal achalasia and Chagas disease, to degenerative neuropathies in some cases of chronic intestinal pseudo-obstruction and gastroparesis. Increased awareness of the clinical presentation and diagnostic evaluation of these conditions is essential as it allows for earlier initiation of treatment and improved outcomes. Most current therapies, which include medical management, neurostimulation, and operative intervention, aim to minimize the symptoms caused by these conditions. The evidence base for many of these treatments in children is poor, and multiinstitutional prospective studies are needed. An innovative therapy on the horizon involves using neuronal stem cell transplantation to treat the underlying disorder by replacing the missing or damaged neurons in these diseases. Although recent advances in basic and clinical neurogastroenterology have significantly improved our awareness and understanding of enteric neuropathies, the efficacy of current treatment approaches is limited. The development of novel therapies, including pharmacologic modulators of neurointestinal function, neurostimulation to enhance gut motility, and neuronal cell-based therapies, is essential to improve the long-term outcomes in children with these disorders.

  8. Managing hyperthyroidism in pregnancy: current perspectives

    Directory of Open Access Journals (Sweden)

    Andersen SL

    2016-09-01

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

  9. Managing hyperthyroidism in pregnancy: current perspectives

    Science.gov (United States)

    Andersen, Stine Linding; Laurberg, Peter

    2016-01-01

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

  10. Detecting Current Noise with a Josephson Junction in the Macroscopic Quantum Tunneling Regime

    OpenAIRE

    Peltonen, J. T.; Timofeev, A. V.; Meschke, M.; Pekola, J.P.

    2006-01-01

    We discuss the use of a hysteretic Josephson junction to detect current fluctuations with frequencies below the plasma frequency of the junction. These adiabatic fluctuations are probed by switching measurements observing the noise-affected average rate of macroscopic quantum tunneling of the detector junction out of its zero-voltage state. In a proposed experimental scheme, frequencies of the noise are limited by an on-chip filtering circuit. The third cumulant of current fluctuations at the...

  11. Management of infantile hemangiomas: Current trends

    Directory of Open Access Journals (Sweden)

    Gomathy Sethuraman

    2014-01-01

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

  12. Neutralized current acid waste consolidation management plan

    Energy Technology Data Exchange (ETDEWEB)

    Powell, W.J.; Brown, R.G.; Galbraith, J.; Jensen, C.; Place, D.E.; Reddick, G.W.; Zuroff, W. [Westinghouse Hanford Co., Richland, WA (United States); Brothers, A.J. [Pacific Northwest National Lab., Richland, WA (United States)

    1996-01-01

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

  13. Catastrophic antiphospholipid syndrome: The current management approach.

    Science.gov (United States)

    Rodriguez-Pintó, Ignasi; Espinosa, Gerard; Cervera, Ricard

    2016-04-01

    The current recommendation for catastrophic antiphospholipid syndrome (CAPS) management is the standard triple therapy with anticoagulation (AC), glucocorticoids (GCs), plasma exchange (PE), and/or intravenous immunoglobulins (IVIGs). Of note, only AC has a significant effect on the prognosis of these patients. However, from the experimental or basic point of view, there is only indirect evidence to advocate the use of these immunomodulatory therapies (GC, PE, and IVIG) in CAPS. Recently, there have been reports of severe or refractory CAPS patients treated with the monoclonal antibodies rituximab and eculizumab. The first blocks CD20, a surface protein expressed on the cytoplasmic membrane of B cells, and decreases the generation of pathogenic autoantibodies such as antiphospholipid (aPL) antibodies. The second binds with high affinity to C5 complement protein, inhibiting its cleavage and thus preventing the generation of C5b-C9 complex. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Current diagnosis and management of achalasia.

    Science.gov (United States)

    Moonen, An; Boeckxstaens, Guy

    2014-07-01

    Achalasia is the best characterized primary esophageal motility disorder of the esophagus and typically presents with absent peristalsis of the esophageal body and a failure of the lower esophageal sphincter to relax upon swallowing on manometry, associated with progressively severe dysphagia, regurgitation, aspiration, chest pain, and weight loss. The diagnosis is suggested by barium swallow and endoscopy, and confirmed by manometry. As there is no curative treatment for achalasia, treatment is confined to disruption of the lower esophageal sphincter to improve bolus passage. Treatment modalities available for this purpose include pneumatic dilation, laparoscopic Heller myotomy and since recently peroral endoscopic myotomy or POEM. In this review, we will discuss the current diagnosis, management, and treatment options of achalasia.

  15. Current management of patients with hepatocellularcarcinoma

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    The current management therapies for hepatocellularcarcinoma (HCC) patients are discussed in this review.Despite the development of new therapies, HCCremains a "difficult to treat" cancer because HCCtypically occurs in advanced liver disease or hepaticcirrhosis. The progression of multistep and multicentricHCC hampers the prevention of the recurrence of HCC.Many HCC patients are treated with surgical resectionand radiofrequencyablation (RFA), although thesemodalities should be considered in only selected caseswith a certain HCC number and size. Although there is ashortage of grafts, liver transplantation has the highestsurvival rates for HCC. Several modalities are salvagetreatments; however, intensive care in combinationwith other modalities or in combination with surgicalresection or RFA might offer a better prognosis. Sorafenibis useful for patients with advanced HCC. In the nearfuture, HCC treatment will include stronger moleculartargeted drugs, which will have greater potency andfewer adverse events. Further studies will be ongoing.

  16. Current Trends in the Management of Retinoblastoma

    Directory of Open Access Journals (Sweden)

    Hayyam Kıratlı

    2014-09-01

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

  17. Peripartum cardiomyopathy: current management and future perspectives

    Science.gov (United States)

    Hilfiker-Kleiner, Denise; Haghikia, Arash; Nonhoff, Justus; Bauersachs, Johann

    2015-01-01

    Pregnancy is associated with marked physiological changes challenging the cardiovascular system. Among the more severe pregnancy associated cardiovascular complications, peripartum cardiomyopathy (PPCM) is a potentially life-threatening heart disease emerging towards the end of pregnancy or in the first postpartal months in previously healthy women. A major challenge is to distinguish the peripartum discomforts in healthy women (fatigue, shortness of breath, and oedema) from the pathological symptoms of PPCM. Moreover, pregnancy-related pathologies such as preeclampsia, myocarditis, or underlying genetic disease show overlapping symptoms with PPCM. Difficulties in diagnosis and the discrimination from other pathological conditions in pregnancy may explain why PPCM is still underestimated. Additionally, underlying pathophysiologies are poorly understood, biomarkers are scarce and treatment options in general limited. Experience in long-term prognosis and management including subsequent pregnancies is just beginning to emerge. This review focuses on novel aspects of physiological and pathophysiological changes of the maternal cardiovascular system by comparing normal conditions, hypertensive complications, genetic aspects, and infectious disease in PPCM-pregnancies. It also presents clinical and basic science data on the current state of knowledge on PPCM and brings them in context thereby highlighting promising new insights in diagnostic tools and therapeutic approaches and management. PMID:25636745

  18. Intrahepatic cholangiocarcinoma: current management and emerging therapies.

    Science.gov (United States)

    Rahnemai-Azar, Amir A; Weisbrod, Allison B; Dillhoff, Mary; Schmidt, Carl; Pawlik, Timothy M

    2017-05-01

    Intrahepatic cholangiocarcinoma (iCCA) is a malignancy with an increasing incidence and a high-case fatality. While surgery offers the best hope at long-term survival, only one-third of tumors are amenable to surgical resection at the time of the diagnosis. Unfortunately, conventional chemotherapy offers limited survival benefit in the management of unresectable or metastatic disease. Recent advances in understanding the molecular pathogenesis of iCCA and the use of next-generation sequencing techniques have provided a chance to identify 'target-able' molecular aberrations. These novel molecular therapies offer the promise to personalize therapy for patients with iCCA and, in turn, improve the outcomes of patients. Area covered: We herein review the current management options for iCCA with a focus on defining both established and emerging therapies. Expert commentary: Surgical resection remains as an only hope for cure in iCCA patients. However, frequently the diagnosis is delayed till advanced stages when surgery cannot be offered; signifying the urge for specific diagnostic tumor biomarkers and targeted therapies. New advances in genomic profiling have contributed to a better understanding of the landscape of molecular alterations in iCCA and offer hope for the development of novel diagnostic biomarkers and targeted therapies.

  19. Current management of obsessive and phobic states.

    Science.gov (United States)

    Goljevscek, Serena; Carvalho, Livia A

    2011-01-01

    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.

  20. Current management of obsessive and phobic states

    Directory of Open Access Journals (Sweden)

    Goljevscek S

    2011-09-01

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

  1. Electrodynamic acceleration of dielectric bodies in a rail gun in the constant current regime

    Science.gov (United States)

    Drobyshevskii, E. M.; Zhukov, B. G.; Nazarov, E. V.; Rozov, S. I.; Sokolov, V. M.; Kurakin, R. O.; Savel'Ev, M. A.; Iuferov, S. V.

    1991-04-01

    Rail gun experiments are reported in which dielectric bodies were accelerated magnetohydrodynamically by a plasma piston to velocities at which the kinetic energy per each atom became comparable with or greater than the chemical bond energy. In the constant current approximation, a simple expression is obtained which unambiguously relates the acceleration path length to the amount of electricity passing through the system, irrespective of the acceleration rate and final velocity of the body. Practically constant accelerations of about 3 x 10 exp 6 g were achieved for polycarbonate projectiles with a linear current density close to the limit of explosive electrode evaporation (about 60 kA/mm)

  2. A new regime of the Agulhas Current Retroflection: Turbulent Choking of Indian-Atlantic leakag

    NARCIS (Netherlands)

    le Bars, D.L.B.|info:eu-repo/dai/nl/326165150; de Ruijter, W.P.M.|info:eu-repo/dai/nl/068476760; Dijkstra, H.A.|info:eu-repo/dai/nl/073504467

    2012-01-01

    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

  3. Current and future fire regimes and their influence on natural vegetation in Ethiopia

    DEFF Research Database (Denmark)

    van Breugel, Paulo; Friis, Ib; Demissew, Sebsebe

    2016-01-01

    employed statistical modeling techniques to estimate the distribution of fire and the PNVs under current climatic conditions, and used the calibrated models to project distributions for different climate change scenarios. Results show a clear congruence between distribution patterns of fire and major...

  4. A new regime of the Agulhas Current Retroflection: Turbulent Choking of Indian-Atlantic leakag

    NARCIS (Netherlands)

    le Bars, D.L.B.; de Ruijter, W.P.M.; Dijkstra, H.A.

    2012-01-01

    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 s

  5. Wildland Arson as Clandestine Resource Management: A Space-Time Permutation Analysis and Classification of Informal Fire Management Regimes in Georgia, USA.

    Science.gov (United States)

    Coughlan, Michael R

    2016-05-01

    Forest managers are increasingly recognizing the value of disturbance-based land management techniques such as prescribed burning. Unauthorized, "arson" fires are common in the southeastern United States where a legacy of agrarian cultural heritage persists amidst an increasingly forest-dominated landscape. This paper reexamines unauthorized fire-setting in the state of Georgia, USA from a historical ecology perspective that aims to contribute to historically informed, disturbance-based land management. A space-time permutation analysis is employed to discriminate systematic, management-oriented unauthorized fires from more arbitrary or socially deviant fire-setting behaviors. This paper argues that statistically significant space-time clusters of unauthorized fire occurrence represent informal management regimes linked to the legacy of traditional land management practices. Recent scholarship has pointed out that traditional management has actively promoted sustainable resource use and, in some cases, enhanced biodiversity often through the use of fire. Despite broad-scale displacement of traditional management during the 20th century, informal management practices may locally circumvent more formal and regionally dominant management regimes. Space-time permutation analysis identified 29 statistically significant fire regimes for the state of Georgia. The identified regimes are classified by region and land cover type and their implications for historically informed disturbance-based resource management are discussed.

  6. Wildland Arson as Clandestine Resource Management: A Space-Time Permutation Analysis and Classification of Informal Fire Management Regimes in Georgia, USA

    Science.gov (United States)

    Coughlan, Michael R.

    2016-05-01

    Forest managers are increasingly recognizing the value of disturbance-based land management techniques such as prescribed burning. Unauthorized, "arson" fires are common in the southeastern United States where a legacy of agrarian cultural heritage persists amidst an increasingly forest-dominated landscape. This paper reexamines unauthorized fire-setting in the state of Georgia, USA from a historical ecology perspective that aims to contribute to historically informed, disturbance-based land management. A space-time permutation analysis is employed to discriminate systematic, management-oriented unauthorized fires from more arbitrary or socially deviant fire-setting behaviors. This paper argues that statistically significant space-time clusters of unauthorized fire occurrence represent informal management regimes linked to the legacy of traditional land management practices. Recent scholarship has pointed out that traditional management has actively promoted sustainable resource use and, in some cases, enhanced biodiversity often through the use of fire. Despite broad-scale displacement of traditional management during the 20th century, informal management practices may locally circumvent more formal and regionally dominant management regimes. Space-time permutation analysis identified 29 statistically significant fire regimes for the state of Georgia. The identified regimes are classified by region and land cover type and their implications for historically informed disturbance-based resource management are discussed.

  7. Sub-cycle optical control of current in a semiconductor: from multiphoton to tunneling regime

    CERN Document Server

    Paasch-Colberg, Tim; Sağlam, Özge; Kapser, Stefan; Cabrini, Stefano; Mühlbrandt, Sascha; Reichert, Joachim; Barth, Johannes V; Ernstorfer, Ralph; Kienberger, Reinhard; Yakovlev, Vladislav S; Karpowicz, Nicholas; Schiffrin, Agustin

    2016-01-01

    Nonlinear interactions between ultrashort optical waveforms and solids can be used to induce and steer electric current on a femtosecond (fs) timescale, holding promise for electronic signal processing at PHz frequencies [Nature 493, 70 (2013)]. So far, this approach has been limited to insulators, requiring extremely strong peak electric fields and intensities. Here, we show all-optical generation and control of directly measurable electric current in a semiconductor relevant for high-speed and high-power (opto)electronics, gallium nitride (GaN), within an optical cycle and on a timescale shorter than 2 fs, at intensities at least an order of magnitude lower than those required for dielectrics. Our approach opens the door to PHz electronics and metrology, applicable to low-power (non-amplified) laser pulses, and may lead to future applications in semiconductor and photonic integrated circuit technologies.

  8. Data assimilation in the low noise, accurate observation regime with application to the Kuroshio current

    CERN Document Server

    Vanden-Eijnden, Eric

    2012-01-01

    On-line data assimilation techniques such as ensemble Kalman filters and particle filters tend to loose accuracy dramatically when presented with an unlikely observation. Such an observation may be caused by an unusually large measurement error or reflect a rare fluctuation in the dynamics of the system. Over a long enough span of time it becomes likely that one or several of these events will occur. In some cases they are signatures of the most interesting features of the underlying system and their prediction becomes the primary focus of the data assimilation procedure. The Kuroshio current that runs along the eastern coast of Japan is an example of just such a system. It undergoes infrequent but dramatic changes of state between a small meander during which the current remains close to the coast of Japan, and a large meander during which the current bulges away from the coast. Because of the important role that the Kuroshio plays in distributing heat and salinity in the surrounding region, prediction of th...

  9. The historical disturbance regime of mountain Norway spruce forests in the Western Carpathians and its influence on current forest structure and composition.

    Science.gov (United States)

    Janda, Pavel; Trotsiuk, Volodymyr; Mikoláš, Martin; Bače, Radek; Nagel, Thomas A; Seidl, Rupert; Seedre, Meelis; Morrissey, Robert C; Kucbel, Stanislav; Jaloviar, Peter; Jasík, Marián; Vysoký, Juraj; Šamonil, Pavel; Čada, Vojtěch; Mrhalová, Hana; Lábusová, Jana; Nováková, Markéta H; Rydval, Miloš; Matějů, Lenka; Svoboda, Miroslav

    2017-03-15

    In order to gauge ongoing and future changes to disturbance regimes, it is necessary to establish a solid baseline of historic disturbance patterns against which to evaluate these changes. Further, understanding how forest structure and composition respond to variation in past disturbances may provide insight into future resilience to climate-driven alterations of disturbance regimes. We established 184 plots (mostly 1000 m(2)) in 14 primary mountain Norway spruce forests in the Western Carpathians. On each plot we surveyed live and dead trees and regeneration, and cored around 25 canopy trees. Disturbance history was reconstructed by examining individual tree growth trends. The study plots were further aggregated into five groups based on disturbance history (severity and timing) to evaluate and explain its influence on forest structure. These ecosystems are characterized by a mixed severity disturbance regime with high spatiotemporal variability in severity and frequency. However, periods of synchrony in disturbance activity were also found. Specifically, a peak of canopy disturbance was found for the mid-19th century across the region (about 60% of trees established), with the most important periods of disturbance in the 1820s and from the 1840s to the 1870s. Current stand size and age structure were strongly influenced by past disturbance activity. In contrast, past disturbances did not have a significant effect on current tree density, the amount of coarse woody debris, and regeneration. High mean densities of regeneration with height >50 cm (about 1400 individuals per ha) were observed. Extensive high severity disturbances have recently affected Central European forests, spurring a discussion about the causes and consequences. We found some evidence that forests in the Western Carpathians were predisposed to recent severe disturbance events as a result of synchronized past disturbance activity, which partly homogenized size and age structure and made recent

  10. Niche Management and its Contribution to Regime Change: The Case of Innovation in Sanitation.

    NARCIS (Netherlands)

    Hegger, D.L.T.; Vliet, van J.M.; Vliet, van B.J.M.

    2007-01-01

    Strategic niche management (SNM) implies that new technologies are applied in so-called niches, in which they are protected against mainstream market selection. A major question currently subject to debate is through which processes niches can bring about any wider changes at the level of socio-tech

  11. Management of refractory ischemic priapism: current perspectives.

    Science.gov (United States)

    Capece, Marco; Gillo, Arianna; Cocci, Andrea; Garaffa, Giulio; Timpano, Massimiliano; Falcone, Marco

    2017-01-01

    The aim of the present manuscript is to review the current literature on priapism, focusing on the state-of-the-art knowledge of both the diagnosis and the treatment of the refractory ischemic priapism (IP). Pubmed and EMBASE search engines were used to search for words "priapism", "refractory priapism", "penile prosthesis", "diagnosis priapism", "priapism treatment", "penile fibrosis", "priapism therapy". All the studies were carefully examined by the authors and then included in the review. First-line treatment involves ejaculation, physical exercise and cold shower followed by corporal blood aspiration and injection of α-adrenoceptor agonists. Subsequently, a distal or proximal shunt may be considered. If none of the treatment is effective or the priapism episode lasts >48 hours penile prosthesis implantation could be the only option to solve the priapism and treat the ongoing erectile dysfunction. The management of IP is to achieve detumescence of persistent penile erection and to preserve erectile function after resolution of the priapic episode. On the other hand, penile fibrosis and following shortening should be prevented. Early penile prosthesis implantation in patients with refractory IP is able to solve both the priapic episode and prevent the otherwise certain penile shortening. Penile prosthesis implantation is the actual gold standard of care in cases of refractory IP.

  12. Optimal management of genital herpes: current perspectives

    Directory of Open Access Journals (Sweden)

    Sauerbrei A

    2016-06-01

    Full Text Available Andreas Sauerbrei Institute of Virology and Antiviral Therapy, German Consulting Laboratory for Herpes Simplex Virus and Varicella-Zoster Virus, Jena University Hospital, Friedrich-Schiller University of Jena, Jena, Germany Abstract: 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. Keywords: herpes simplex virus, epidemiology, infection, antiviral therapy, laboratory diagnosis, prevention

  13. Examining historical and current mixed-severity fire regimes in ponderosa pine and mixed-conifer forests of western North America.

    Science.gov (United States)

    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

    2014-01-01

    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

  14. Examining historical and current mixed-severity fire regimes in ponderosa pine and mixed-conifer forests of western North America.

    Directory of Open Access Journals (Sweden)

    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

  15. Variation in fire regimes of the rocky mountains: Implications for avian communities and fire management

    Science.gov (United States)

    Saab, V.A.; Powell, H.D.W.; Kotliar, N.B.; Newlon, K.R.

    2005-01-01

    Information about avian responses to fire in the U.S. Rocky Mountains is based solely on studies of crown fires. However, fire management in this region is based primarily on studies of low-elevation ponderosa pine (Pinus ponderosa) forests maintained largely by frequent understory fires. In contrast to both of these trends, most Rocky Mountain forests are subject to mixed severity fire regimes. As a result, our knowledge of bird responses to fire in the region is incomplete and skewed toward ponderosa pine forests. Research in recent large wildfires across the Rocky Mountains indicates that large burns support diverse avifauna. In the absence of controlled studies of bird responses to fire, we compared reproductive success for six cavity-nesting species using results from studies in burned and unburned habitats. Birds in ponderosa pine forests burned by stand-replacement fire tended to have higher nest success than individuals of the same species in unburned habitats, but unburned areas are needed to serve species dependent upon live woody vegetation, especially foliage gleaners. Over the last century, fire suppression, livestock grazing, and logging altered the structure and composition of many low-elevation forests, leading to larger and more severe burns. In higher elevation forests, changes have been less marked. Traditional low-severity prescribed fire is not likely to replicate historical conditions in these mixed or high-severity fire regimes, which include many mixed coniferous forests and all lodgepole pine (Pinus contorta) and spruce-fir (Picea-Abies) forests. We suggest four research priorities: (1) the effects of fire severity and patch size on species' responses to fire, (2) the possibility that postfire forests are ephemeral sources for some bird species, (3) the effect of salvage logging prescriptions on bird communities, and (4) experiments that illustrate bird responses to prescribed fire and other forest restoration methods. This research is

  16. Limits for the graphene on ferroelectric domain wall p-n-junction rectifier for different regimes of current

    Science.gov (United States)

    Strikha, Maksym V.; Morozovska, Anna N.

    2016-12-01

    Here, we present the theory of the conductivity of a pn junction (pnJ) in a graphene channel, placed on a ferroelectric substrate, caused by the ferroelectric domain wall for the case of the arbitrary current regime: from ballistic to diffusive one. We calculated the ratio of the pnJ conductions for opposite polarities of voltages, applied to source and drain electrodes of the channel, G+to t a l /G-to t a l , as a function of graphene channel length L, electron mean free path λ, and ferroelectric substrate permittivity ɛ33f . We have demonstrated that the small values of G+to t a l /G-to t a l (0.1 and smaller), which correspond to the efficient graphene pnJ based rectifier, can be obtained for the ferroelectrics with high ɛ33f≫100 and for the ratios of L/λ ˜ 1 or smaller. However, for ferroelectrics with extremely high ɛ33f (relaxor or PbZrxTi1-xO3 with the composition x near the morphotropic phase boundary x = 0.52), the ratio G+to t a l /G-to t a l can be essentially smaller than unity for the case of a pronounced diffusive regime of current as well. This makes the ferroelectric substrates with high permittivity excellent candidates for the fabrication of new generation of rectifiers based on the graphene pnJ. The temperature effect on the G+to t a l /G-to t a l ratio was studied within the Landau-Ginzburg-Devonshire approach. We have demonstrated that the rectifying properties of the graphene pnJ become better in the vicinity of Curie temperature. However, for the temperatures higher than the Curie temperature, the rectifying effect vanishes due to the ferroelectric polarization disappearance.

  17. Management of refractory ischemic priapism: current perspectives

    Directory of Open Access Journals (Sweden)

    Capece M

    2017-08-01

    Full Text Available Marco Capece,1 Arianna Gillo,2 Andrea Cocci,3 Giulio Garaffa,1 Massimiliano Timpano,4 Marco Falcone4 1The Institute of Urology, University College of London Hospital (UCLH, London, UK; 2Department of Urology, “Umberto Parini” Hospital, Aosta, 3Department of Urology, Careggi Hospital, Firenze, 4Department of Urology, University of Turin, Città della Salute e della Scienza, Turin, Italy Objectives: The aim of the present manuscript is to review the current literature on priapism, focusing on the state-of-the-art knowledge of both the diagnosis and the treatment of the refractory ischemic priapism (IP.Methods: Pubmed and EMBASE search engines were used to search for words “priapism”, “refractory priapism”, “penile prosthesis”, “diagnosis priapism”, “priapism treatment”, “penile fibrosis”, “priapism therapy”. All the studies were carefully examined by the authors and then included in the review.Results: First-line treatment involves ejaculation, physical exercise and cold shower followed by corporal blood aspiration and injection of α-adrenoceptor agonists. Subsequently, a distal or proximal shunt may be considered. If none of the treatment is effective or the priapism episode lasts >48 hours penile prosthesis implantation could be the only option to solve the priapism and treat the ongoing erectile dysfunction.Conclusion: The management of IP is to achieve detumescence of persistent penile erection and to preserve erectile function after resolution of the priapic episode. On the other hand, penile fibrosis and following shortening should be prevented. Early penile prosthesis implantation in patients with refractory IP is able to solve both the priapic episode and prevent the otherwise certain penile shortening. Penile prosthesis implantation is the actual gold standard of care in cases of refractory IP. Keywords: priapism, ischemic priapism, penile fibrosis, penile prosthesis, shunt 

  18. On the physical processes ruling an atmospheric pressure air glow discharge operating in an intermediate current regime

    Energy Technology Data Exchange (ETDEWEB)

    Prevosto, L., E-mail: prevosto@waycom.com.ar; Mancinelli, B.; Chamorro, J. C.; Cejas, E. [Grupo de Descargas Eléctricas, Departamento Ing. Electromecánica, Facultad Regional Venado Tuerto (UTN), Laprida 651, Venado Tuerto (2600), Santa Fe (Argentina); Kelly, H. [Grupo de Descargas Eléctricas, Departamento Ing. Electromecánica, Facultad Regional Venado Tuerto (UTN), Laprida 651, Venado Tuerto (2600), Santa Fe (Argentina); Instituto de Física del Plasma (CONICET), Facultad de Ciencias Exactas y Naturales (UBA) Ciudad Universitaria Pab. I, 1428, Buenos Aires (Argentina)

    2015-02-15

    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{sup 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.

  19. How pattern formation in ring networks of excitatory and inhibitoryspiking neurons depends on the input current regime

    Directory of Open Access Journals (Sweden)

    Birgit eKriener

    2014-01-01

    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

  20. Polycystic ovary syndrome: current infertility management.

    Science.gov (United States)

    Aubuchon, Mira; Legro, Richard S

    2011-12-01

    This review summarizes the diagnosis of polycystic ovary syndrome and management of associated infertility. The goal is to guide clinicians through basic evaluation, initial treatment, and briefly describe more complex therapies.

  1. The current management of urolithiasis during pregnancy.

    Science.gov (United States)

    Loughlin, Kevin R; Ker, Lindsey A

    2002-08-01

    The management of urolithiasis in pregnancy can present complex challenges to the urologist. However, if the principles discussed above are followed, these difficult clinical problems can be approached in a rational manner.

  2. Current management options for recurrent adrenocortical carcinoma

    Directory of Open Access Journals (Sweden)

    Glover AR

    2013-06-01

    Full Text Available Anthony R Glover,1 Julian C Y Ip,1 Jing Ting Zhao,1 Patsy S H Soon,1,4 Bruce G Robinson,1,3 Stan B Sidhu1,2 1Kolling Institute of Medical Research, Cancer Genetics Laboratory, 2Endocrine Surgical Unit, 3Department of Endocrinology, Royal North Shore Hospital and University of Sydney, St Leonards, 4Department of Surgery, Bankstown Hospital and University of New South Wales, Bankstown, NSW, Australia Abstract: Adrenal cortical carcinoma (ACC is a rare cancer that poses a number of management challenges due to the limited number of effective systemic treatments. Complete surgical resection offers the best chance of long-term survival. However, despite complete resection, ACC is associated with high recurrence rates. This review will discuss the management of recurrent ACC in adults following complete surgical resection. Management should take place in a specialist center and treatment decisions must consider the individual tumor biology of each case of recurrence. Given the fact that ACC commonly recurs, management to prevent recurrence should be considered from initial diagnosis with the use of adjuvant mitotane. Close follow up with clinical examination and imaging is important for early detection of recurrent disease. Locoregional recurrence may be isolated, and repeat surgical resection should be considered along with mitotane. The use of radiotherapy in ACC remains controversial. Systemic recurrence most often involves liver, pulmonary, and bone metastasis and is usually managed with mitotane, with or without combination chemotherapy. There is a limited role for surgical resection in systemic recurrence in selected patients. In all patients with recurrent disease, control of excessive hormone production is an important part of management. Despite intensive management of recurrent ACC, treatment failure is common and the use of clinical trials and novel treatment is an important part of management. Keywords: recurrence, surgery, chemotherapy

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

    African Journals Online (AJOL)

    Obesity in Nigeria: Current trends and management. ... The objective of the study is to review the current knowledge on the problems associated with obesity, ... of obesity, its epidemiology, risk factors, clinical complications and treatment ...

  4. Current trends in management of pediatric asthma.

    Science.gov (United States)

    Kercsmar, Carolyn M

    2003-03-01

    Though asthma cannot be cured, it can be effectively controlled with existing treatments. Management strategies for acute and chronic asthma often vary substantially within and among medical facilities and practices, often driven by physician preference and familiarity rather than by data. The use of carefully designed care paths can improve quality of care and decrease management costs of acute asthma in both the emergency department and in-patient setting. Using newer beta agonists and attention to proper inhalation delivery systems may also improve outcomes and patient satisfaction. Assessment-driven care paths can be safely and effectively administered by respiratory therapists and nurses. The major controversies in the management of chronic asthma center on what to do for the patient who fails to respond to low or moderate doses of inhaled corticosteroids. The addition of a long-acting beta agonist or a leukotriene receptor antagonist may be beneficial.

  5. Childhood amblyopia: current management and new trends.

    Science.gov (United States)

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

    2016-09-01

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

  6. Effects of Different Management Regimes for Cutover Areas on Soil Carbon Storage in Chinese Fir Plantations

    Institute of Scientific and Technical Information of China (English)

    Fang Xi; Tian Dalun; Xiang Wenhua

    2006-01-01

    Based on data collected (through local observations) for several consecutive years,comparative analyses of Chinese fir plantations in Huitong,Hunan,were made.Results show that,before harvesting,carbon storage in forest soils in these 22-year-old plantations (0-60 cm)amounted to 160.38 t/hm2;1 year after a 100%clearcutting,loss of carbon storage in the soil (0-60 cm) of cutover areas was 35.00%;2 years later,the rate was 44.65%;and,after 3 years,the rate was 43.93%compared with a control area of a standing forest.Three years after 50%thinning and 100%clear-cutting,the loss of carbon storage in the soil (0-60 cm) of cutover areas was 16.14 and 45.15%,respectively.There existed an evident difference in carbon storage in the soil (0-60 cm) of cutover areas in four kinds of management regimes,which followed the order:closed Chinese fir forests (108.20 t/hm2)>fallow lands after farming (92.68 t/hm )>commercial forests (85.80 t/hm2)>naturally regenerated forestlands after harvesting.Carbon storage in unbumt soil(0-45 cm) reached 73.36 t/hm2,which was 15.20 t/hm2 higher than that in the soil of burnt areas.A total of 20.7%of carbon storage in the soil (0-45 cm) of burnt areas was lost 40 days after burning.Carbon storage in surface soil (0-15 cm) was higher than in the lower soil layer,which amounted to 30.04%(0-60 cm) and 53.52%(0-30 cm) of total carbon storage in the soil.

  7. Current management of locally recurrent rectal cancer

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  8. Current Research on Effective Classroom Management.

    Science.gov (United States)

    Emmer, Edmund T.

    This presentation provides an overview of research on classroom management, emphasizing results from a program of research conducted at the Research and Development Center for Teacher Education (University of Texas) during the last 5 years. These studies, along with others, provide a basis for describing important dimensions of teacher behavior…

  9. Pediatric asthma self-management: current concepts.

    Science.gov (United States)

    Robinson, L. D.

    1999-01-01

    The concept of asthma self-management began in asthma camps in the 1970s. Today all asthma camps are required to provide an educational asthma self-management program. The interaction between children and educators is brief, and if the children do not continue in an associated program after camp, the benefits may be lost. Open Airways, the first program developed specifically for minority children, has been the prototype for community asthma self-management. School-based intervention programs have incorporated asthma education into the health curriculum. Some asthma education programs include an emphasis on the environment. Another approach is to develop intervention projects with parents, as in the Head Start program. This program has been very effective in increasing early recognition of asthma and decreasing recidivism in a high-risk population. Another type of project addressed the reading ability and reading comprehension of asthmatic children. Improvement in reading skills resulted in a 47% decrease in asthma recidivism. After 18 months, there were only two hospitalizations among the enrolled participants. Asthma self-management programs that are most effective for inner-city children provide an interactive, culturally relevant form of asthma education and address issues such as literacy and continuity. PMID:12653391

  10. Aneurysmal disease – current management concepts

    African Journals Online (AJOL)

    an increase in diameter of ≥50% than that of the 'normal' undilated ... Professor Van Marle has a special interest in the endovascular management of peripheral ... balance the risk of intervention against ... Backache. Leg pain. Ureter obstruction (due to retroperitoneal. Hydro-ureter ... Open surgery is an effective procedure.

  11. Characterization of plasma electrolytic oxidation coatings on Zircaloy-4 formed in different electrolytes with AC current regime

    Energy Technology Data Exchange (ETDEWEB)

    Cheng Yingliang, E-mail: chengyingliang@hnu.edu.cn [College of Materials Science and Engineering, Hunan University, Changsha 410082 (China); Matykina, Enzhe [Dpt. Ciencia de los Materiales e Ingenieria Metalurgica, Facultad de Ciencias Quimicas, Universidad Complutense de Madrid, Madrid 28040 (Spain); Skeldon, Peter; Thompson, George [Corrosion and Protection Centre, School of Materials, University of Manchester, Sackville Street, Manchester M13 9PL (United Kingdom)

    2011-10-01

    Highlights: > ZrO{sub 2} coatings are grown on Zircaloy-4 by AC plasma electrolytic oxidation. > Tetragonal and monoclinic ZrO{sub 2} are formed using silicate electrolyte. > Pyrophosphate electrolyte results in flawed coatings of monoclinic ZrO{sub 2}. > Silicate favours formation of tetragonal ZrO{sub 2}, with coating hardness {approx}8 GPa. > Microstructures are related to temperature gradients and solidification rates. - Abstract: Plasma electrolytic oxidation was undertaken on Zircaloy-4 in alkaline silicate and pyrophosphate electrolytes, with a square waveform AC current regime. The resultant coatings were examined using scanning electron spectroscopy, X-ray diffraction and nanoindentation. The coatings formed in silicate electrolyte comprised mainly a porous inner layer and a more compact outer layer, with characteristic solidification structures being evident following prolonged treatment. The coatings contained monoclinic and tetragonal ZrO{sub 2}, the latter being mainly present in the outer layer, which was of hardness up to {approx}8 GPa. In contrast, extensively cracked coatings resulted from use of pyrophosphate electrolyte; the coating integrity was improved by the addition of silicate to the pyrophosphate electrolyte. The different morphologies of the coatings appeared to be related to the differing nature of the microdischarges and to the incorporation of silicon species that enhanced the formation of t-ZrO{sub 2}.

  12. Current Management of Sickle Cell Anemia

    Science.gov (United States)

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

    2013-01-01

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

  13. Organizational change and current trends in management

    Directory of Open Access Journals (Sweden)

    Lect. Dr. Chirimbu Sebastian

    2011-05-01

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

  14. Current management of the short bowel syndrome.

    Science.gov (United States)

    Thompson, Jon S; Weseman, Rebecca; Rochling, Fedja A; Mercer, David F

    2011-06-01

    Short bowel syndrome is a challenging clinical problem that benefits from a multidisciplinary approach. Much progress has recently been made in all aspects of management. Medical intestinal rehabilitation should be the initial treatment focus, and several new potential pharmacologic agents are being investigated. Surgical rehabilitation using nontransplant procedures in selected patients may further improve intestinal function. Intestinal lengthening procedures are particularly promising. Intestinal transplantation has increasingly been used with improving success in patients with life-threatening complications of intestinal failure.

  15. Current management of urethral stricture disease

    Directory of Open Access Journals (Sweden)

    Thomas G Smith

    2016-01-01

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

  16. Current Models and Innovative Strategies in Management Education in China.

    Science.gov (United States)

    Wang, Zhong-Ming

    1999-01-01

    Current models of management education in China include national training, on-the-job technical training, and the national master's of business administration supervisory committee. Effective strategies being used include teamwork, process skills, action learning, cross-cultural management learning, and competency-based management development. (SK)

  17. Can current moisture responses predict soil CO2 efflux under altered precipitation regimes? A synthesis of manipulation experiments

    Directory of Open Access Journals (Sweden)

    S. Vicca

    2014-01-01

    functions across a broader range of precipitation regimes and soil moisture conditions. Such experiments should make accurate measurements of water availability, they require high-frequency SCE measurements and they should consider both instantaneous responses and the potential legacy effects of climate extremes. This is important, because we demonstrated that at least for some ecosystems, current moisture responses cannot be extrapolated to predict SCE under altered rainfall.

  18. Optimal management of chronic osteomyelitis: current perspectives

    Directory of Open Access Journals (Sweden)

    Pande KC

    2015-08-01

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

  19. The current management of Turner Syndrome.

    Science.gov (United States)

    Kriksciuniene, Ruta; Zilaitiene, Birute; Verkauskiene, Rasa

    2016-03-01

    Turner Syndrome (TS) is a rare disease, with the incidence of 1 of 2500 life born females. Characteristic features are: growth retardation, gonadal dysgenesis and impairment, congenital and acquired cardiovascular disorders. New management possibilities in Turner Syndrome are coming along with the new scientific evidence on the pathogenesis of TS developmental, metabolic, cardiovascular and reproductive issues. Attitude to the growth retardation treatment and hormone replacement therapy is changing. The effectiveness of additional androgen doses for growth improvement and low estrogen doses in the early childhood for better puberty induction and metabolic outcomes has been demonstrated recently. There are some new concerns about pregnancy induced progression of cardiovascular pathology in TS. Inadequate follow-up despite strict and clear guidelines of TS patients is still an issue in the health care system in many countries. This rare disorder requires multidiscipline approach of experienced professionals. The aim of this review is to overview recent studies evaluating TS, to focus on the possibilities to avoid crucial outcomes of this disorder and to improve management and follow-up.

  20. LIQUIDITY MANAGING A CURRENT JOB OF BANKING MANAGEMENT

    Directory of Open Access Journals (Sweden)

    MEDAR LUCIAN-ION

    2014-02-01

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

  1. Current Diagnosis and Management of Gastrojejunocolic Fistula

    Directory of Open Access Journals (Sweden)

    Can Kece

    2010-05-01

    Full Text Available We herein report the case of a 51-year-old man with gastrojejunocolic fistula. It is one of the late severe complications of gastrectomy and gastrojejunostomy and is considered to be induced by a stomal ulcer due to inadequate resection of the stomach and incompleteness of vagotomy. The main clinical presentation of this condition is chronic abdominal pain, weight loss, diarrhea, gastrointestinal bleeding and fecal vomiting. The diagnostic workup should include barium enema, gastroscopy and sometimes colonoscopy and abdominal tomography for excluding and ruling out the possibility of malignant extraluminal disease. The historical approach of the treatment of this rare entity was 2–3-phased operations which included colostomy. However today, medical management has recently been recommended as the first-line therapy, with parenteral and enteral support treatments. The preferred surgical approach is single-stage gastrocolic resection and anastomosis and this has been favored to minimize mortality.

  2. Current management of surgical oncologic emergencies.

    Directory of Open Access Journals (Sweden)

    Marianne R F Bosscher

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

  3. Iterative functionalism and climate management regimes: From intergovernmental panel on climate change to intergovernmental negotiating committee

    Energy Technology Data Exchange (ETDEWEB)

    Feldman, D.L. [Oak Ridge National Lab., TN (United States)]|[Tennessee Univ., Knoxville, TN (United States). Energy, Environment and Resources Center

    1992-06-01

    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.

  4. Iterative functionalism and climate management regimes: From intergovernmental panel on climate change to intergovernmental negotiating committee

    Energy Technology Data Exchange (ETDEWEB)

    Feldman, D.L. (Oak Ridge National Lab., TN (United States) Tennessee Univ., Knoxville, TN (United States). Energy, Environment and Resources Center)

    1992-01-01

    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.

  5. Current management of heparin-induced thrombocytopenia.

    Science.gov (United States)

    Cosmi, Benilde

    2015-12-01

    Heparin-induced thrombocytopenia (HIT) is an immune adverse reaction to heparin (both unfractionated and low-molecular-weight), which is mediated by the formation of IgG antibodies against platelet factor 4-heparin complexes. The IgG/platelet factor 4 immunocomplexes activate platelets with resulting thrombocytopenia, which is not associated with bleeding, but with paradoxical life-threatening thrombotic complications, for coagulation activation. HIT diagnosis requires the assessment of pre-test clinical probability in combination with the measurement of platelet activating antibodies against platelet factor 4-heparin complexes with immunological and functional assays. When HIT is diagnosed, any form of heparin should be stopped and a non-heparin alternative anticoagulant should be started. Argatroban and danaparoid are currently the only drugs licensed for HIT, with different country availability. Bivalirudin is an option in cardiac surgery and procedures in HIT patients.

  6. Urban air quality management - current issues

    Energy Technology Data Exchange (ETDEWEB)

    Chaplin, N. [Sheffield City Council, Sheffield (United Kingdom). Environment and Regulatory Services; Virtanen, T. [Helsinki Metropolitan Area Council, Helsinki (Finland); Mladonicky, P. [National Centre of Health Promotion, Bratislava (Slovakia)

    2002-07-01

    In 1996 the EC adopted the Ambient Air Quality and Assessment Directive, which is designed to provide a comprehensive strategy for the management of air quality in Member States, linking controls on emissions with the attainment of air quality objectives. The subsequent Daughter Directives provide limit values, based on health effects, for specified pollutants. In essence Member States have to monitor and assess air quality and where necessary draw up air pollution minimisation plans. This paper explores the practical issues facing three European cities, Sheffield, Helsinki and Bratislava as they face the challenge of implementing action necessary to bring about improvements in air quality by 2010. There are very different problems to resolve due to each City's particular characteristics, although they all share the same cause of the problem - road traffic. Although the technical solutions appear to be relatively straight forward each city faces the problems of trying to educate its citizens, to bring about changes in individual behaviour so that everyone can benefit from better air quality. Sheffield now faces an added level of complexity as its economic performance is below the European average and it has attained Objective 1 status which will introduce a huge investment to kick start the economy and make sure it continues to thrive. (orig.)

  7. The current management of septic shock.

    Science.gov (United States)

    Russel, J A

    2008-10-01

    This is a review of the management of septic shock that suggests an approach to treatment (ABCDEF: Airway, Breathing, Circulation, Drugs, Evaluate the source of sepsis, Fix the source of sepsis) for clinicians. The incidence of septic shock is increasing and mortality ranges from 30% to 70%. The commonest sources of infection are lung (25%), abdomen (25%), and other sources. Septic shock occurs because of highly complex interactions between the infecting microorganism(s) and the responses of the human host. The innate immune response is rapidly followed by the more specific adaptive immune response. Septic shock is characterized by alterations in the coagulant/anticoagulant balance such that there is a more pro-coagulant phenotype. Lung protective ventilation (which means the use of relatively low tidal volumes of 4 -6 mL/kg ideal body weight) is recommended for treatment of patients who have septic shock. Rivers early goal-directed therapy is recommended because it showed a significant increase in survival. Surviving Sepsis guidelines recommend resuscitation of septic shock with either crystalloid or colloid. Patients who have septic shock should be treated with intravenous broad-spectrum antibiotics as rapidly as possible and certainly within one hour. Activated protein C (APC) is a vitamin K dependent serine protease that is an anticoagulant and is also cytoprotective and anti-inflammatory. APC (24 mg/kg/hour infusion for 96 hours) decreased mortality (APC 25% vs placebo 31%, relative risk 0.81P=0.005) and improved organ dysfunction in patients at high risk of death (e.g. APACHE II >25 [APC 31% vs placebo 44%]). APC is not recommended to treat surgical patients who have one organ system dysfunction. In 2006, the European regulatory authority indicated that there must be another randomized placebo-controlled trial of APC to further establish efficacy as assessed by mortality reduction. Vasopressin is a key stress hormone in response to hypotension. The VASST

  8. Current surgical management of carotid body tumors.

    Science.gov (United States)

    Davila, Victor J; Chang, James M; Stone, William M; Fowl, Richard J; Bower, Thomas C; Hinni, Michael L; Money, Samuel R

    2016-12-01

    Carotid body tumors (CBTs) are rare. Management guidelines may include genetic testing for succinate dehydrogenase (SDH) mutations. We performed an institutional review of the surgical management of CBT. A retrospective analysis (1994-2015) of CBT excisions at our institution was performed. Data obtained included demographics, genetic testing (if performed), intraoperative details, postoperative morbidity, and long-term outcomes. Data from the first CBT excision were included in patients with bilateral tumors. Genetic testing was routinely offered in patients with a family history of CBT or multiple paragangliomas. A total of 183 CBTs (124 female [67.7%]) were excised. A neck mass was present in 106 patients (57.9%), 24 patients (12.1%) presented with tenderness or neck pain, and 3 (1.6%) presented with cranial nerve dysfunction. Computed tomography (57.9%) or magnetic resonance imaging (51.3%) were the most commonly used imaging modalities. Preoperative angiography was performed in 73 patients (39.8%), and 62 of them (84.5%) underwent embolization or internal carotid balloon occlusion testing, or both. Mean tumor diameter was 3.2 cm (range, 0.6-7.2 cm). There were 71 (38.8%), 75 (41%), and 37 (20.2%) Shamblin type 1, 2, and 3 tumors, respectively. Average operating time was 224 minutes (range, 52-696 minutes). Average blood loss was 143.9 mL (range, 10-2000 mL). Arterial reconstruction with an interposition graft was required in 10, and patch angioplasty was performed in four. Cranial nerve injury was permanent in 10 (5.5%), and the rate of stroke was 1% (n = 2). A total of 382 lymph nodes were excised, and all were benign. There were no deaths ≤30 days. Only one patient presented with malignant disease 2 years after CBT excision, and this patient did not undergo genetic testing. Thirty-four (18.6%) had a family history of CBT. SDH testing was performed in 18 patients, and 17 tested positive. Positive genetic testing had a correlation with earlier age

  9. Current Pharmacological Management of Gastroesophageal Reflux Disease

    Directory of Open Access Journals (Sweden)

    Yao-Kuang Wang

    2013-01-01

    Full Text Available Gastroesophageal reflux disease (GERD, a common disorder with troublesome symptoms caused by reflux of gastric contents into the esophagus, has adverse impact on quality of life. A variety of medications have been used in GERD treatment, and acid suppression therapy is the mainstay of treatment for GERD. Although proton pump inhibitor is the most potent acid suppressant and provides good efficacy in esophagitis healing and symptom relief, about one-third of patients with GERD still have persistent symptoms with poor response to standard dose PPI. Antacids, alginate, histamine type-2 receptor antagonists, and prokinetic agents are usually used as add-on therapy to PPI in clinical practice. Development of novel therapeutic agents has focused on the underlying mechanisms of GERD, such as transient lower esophageal sphincter relaxation, motility disorder, mucosal protection, and esophageal hypersensitivity. Newer formulations of PPI with faster and longer duration of action and potassium-competitive acid blocker, a newer acid suppressant, have also been investigated in clinical trials. In this review, we summarize the current and developing therapeutic agents for GERD treatment.

  10. Sustainable urban regime adjustments

    DEFF Research Database (Denmark)

    Quitzau, Maj-Britt; Jensen, Jens Stissing; Elle, Morten

    2013-01-01

    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 directs...... attention to the transformative implications of conscious strategic maneuvering by incumbent regime actors, when confronting regime structurations. This article provides insight to processes of regime enactment performed by local governments by applying a flow-oriented perspective on regime dynamics...

  11. E-waste: Environmental Problems and Current Management

    National Research Council Canada - National Science Library

    D. Aktsoglou; K. Angelakoglou; G. Gaidajis

    2010-01-01

    ..., 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...

  12. Cancer of the cervix: current management and new approaches.

    Science.gov (United States)

    Shivnani, Anand T; Rimel, B J; Schink, Julian; Small, William

    2006-11-01

    This article summarizes the current management of patients with newly diagnosed cervical cancer. The topics range from the management of early-stage disease to the phase III randomized studies that have established the current standard of care for patients with locally advanced cancer of the cervix. New approaches to combined-modality therapy with the goal of improving outcomes and decreasing complications are also described.

  13. Current state management of the consumer capital of domestic enterprises

    OpenAIRE

    E.O. Golysheva

    2010-01-01

    In the article the analysis of the current state of management by consumer business capital is carried out. It is based on three components: system of communications with consumers and external subjects, the history of relationship with them and the database about partners; portfolio management of trade marks (brands); the.

  14. E-waste: Environmental Problems and Current Management

    Directory of Open Access Journals (Sweden)

    D. Aktsoglou

    2010-01-01

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

  15. Current Issues for Higher Education Information Resources Management.

    Science.gov (United States)

    CAUSE/EFFECT, 1995

    1995-01-01

    Current issues that are important for the future of information resources management in higher education are presented. They include: integrating planning for information resources within institution-wide strategic planning; reengineering fundamental services; change management; distributed computing support; networking; the changing communication…

  16. Current state management of the consumer capital of domestic enterprises

    Directory of Open Access Journals (Sweden)

    E.O. Golysheva

    2010-12-01

    Full Text Available In the article the analysis of the current state of management by consumer business capital is carried out. It is based on three components: system of communications with consumers and external subjects, the history of relationship with them and the database about partners; portfolio management of trade marks (brands; the.

  17. Field-driven domain wall motion under a bias current in the creep and flow regimes in Pt/[CoSiB/Pt]N nanowires.

    Science.gov (United States)

    Choi, Y H; Yoshimura, Y; Kim, K-J; Lee, K; Kim, T W; Ono, T; You, C-Y; Jung, M H

    2016-03-31

    The dynamics of magnetic domain wall (DW) in perpendicular magnetic anisotropy Pt/[CoSiB/Pt]N nanowires was studied by measuring the DW velocity under a magnetic field (H) and an electric current (J) in two extreme regimes of DW creep and flow. Two important findings are addressed. One is that the field-driven DW velocity increases with increasing N in the flow regime, whereas the trend is inverted in the creep regime. The other is that the sign of spin current-induced effective field is gradually reversed with increasing N in both DW creep and flow regimes. To reveal the underlying mechanism of new findings, we performed further experiment and micromagnetic simulation, from which we found that the observed phenomena can be explained by the combined effect of the DW anisotropy, Dzyaloshinskii-Moriya interaction, spin-Hall effect, and spin-transfer torques. Our results shed light on the mechanism of DW dynamics in novel amorphous PMA nanowires, so that this work may open a path to utilize the amorphous PMA in emerging DW-based spintronic devices.

  18. Sustainability in facilities management: an overview of current research

    DEFF Research Database (Denmark)

    Nielsen, Susanne Balslev; Sarasoja, Anna-Liisa; Ramskov Galamba, Kirsten

    2016-01-01

    the emerging sub-discipline of sustainable facilities management (SFM) on research, an overview of current studies is needed. The purpose of this literature review is to provide exactly this overview. Design/methodology/approach: This article identifies and examines current research studies on SFM through...... indicated that the current research varies in focus, methodology and application of theory, and it was concluded that the current research primary addresses environmental sustainability, whereas the current research which takes an integrated strategic approach to SFM is limited. The article includes lists...... of reviewed journals and articles to support the further development of SFM in research and practice. Research limitations/implications: The literature review includes literature from 2007 to 2012, to manage the analytical process within the project period. However, with the current categorisation...

  19. Natural flood risk management in flashy headwater catchments: managing runoff peaks, timing, water quality and sediment regimes

    Science.gov (United States)

    Wilkinson, Mark; Addy, Steve; Ghimire, Sohan; Kenyon, Wendy; Nicholson, Alex; Quinn, Paul; Stutter, Marc; Watson, Helen

    2013-04-01

    catchments are known for their rapid runoff generation and have downstream local communities at risk of flash flooding. In Bowmont, NFM measures are currently being put in place to restore river bars and to store water more effectively on the flood plains during these flashy events. For example, Apex engineered wood structure in the river channel and riparian zones are designed to trap sediment and log bank protection structures are being installed to stop bank erosion. Tree planting in the catchment is also taking place. In the Belford catchment storage ponds and woody debris have been installed over the past five years to help to reduce the flood risk to the village of Belford. A dense instrumentation network has provided data for analysis and modelling which shows evidence of local scale flood peak reductions along with the collection of large amounts of sediment. A modelling study carried out (using a pond network model) during an intense summer storm showed that 30 small scale pond features used in sequence could reduce the flood peak by ~35% at the local scale. Findings show that managing surface runoff and local ditch flow at local scale headwater catchments is a cost effective way of managing flashy catchment for flood risk and sediment control. Working with catchment stakeholders is vital. Information given by the local community post flooding has been useful in placing NFM measures throughout the catchments. Involving the local communities in these projects and giving them access to the data and model outputs has helped to develop these projects further.

  20. Management Regimes, Property Rights, and Forest Biodiversity in Nepal and India

    Science.gov (United States)

    Nagendra, Harini; Gokhale, Yogesh

    2008-05-01

    This article compares a range of initiatives aimed at involving people in the management of forest resources in Nepal and India. In Nepal, we focus on three categories of state-initiated programs: community forestry, the parks’ buffer zone program, and leasehold forestry. In the southern Indian state of Karnataka, we study the state-initiated Joint Forest Planning and Management program along with older institutions of leaf manure forests ( Soppina betta) and historical sacred forests ( Kans). We conclude that state-initiated approaches to involving communities have been limited, at best, promote standardized and relatively inflexible management practices, and lead to partial improvement in biodiversity and people’s livelihoods. When management is initiated and owned by the community, as in the case of sacred groves in India, and when other conditions are appropriate, communities can have the opportunity to demonstrate their capacity for putting effective and adaptive conservation practices in place.

  1. Reassuring livelihood functions of the forests to their dependents: Adoption of collaborative forest management system over Joint forest management regime in India

    Directory of Open Access Journals (Sweden)

    Narendra Kumar Bhatia

    2013-12-01

    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.

  2. Anesthesia information management systems marketplace and current vendors.

    Science.gov (United States)

    Stonemetz, Jerry

    2011-09-01

    This article addresses the brief history of anesthesia information management systems (AIMS) and discusses the vendors that currently market AIMS. The current market penetration based on the information provided by these vendors is presented and the rationale for the purchase of AIMS is discussed. The considerations to be evaluated when making a vendor selection are also discussed. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. Governance Regime Factors Conducive to Innovation Uptake in Urban Water Management: Experiences from Europe

    Directory of Open Access Journals (Sweden)

    Josselin Rouillard

    2016-10-01

    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.

  4. Current concepts in wound management and wound healing products.

    Science.gov (United States)

    Davidson, Jacqueline R

    2015-05-01

    Current concepts in wound management are summarized. The emphasis is on selection of the contact layer of the bandage to promote a moist wound environment. Selection of an appropriate contact layer is based on the stage of wound healing and the amount of wound exudate. The contact layer can be used to promote autolytic debridement and enhance wound healing.

  5. Current knowledge and attitudes: Russian olive biology, ecology and management

    Science.gov (United States)

    Sharlene E. Sing; Kevin J. Delaney

    2016-01-01

    The primary goals of a two-day Russian olive symposium held in February 2014 were to disseminate current knowledge and identify data gaps regarding Russian olive biology and ecology, distributions, integrated management, and to ascertain the feasibility and acceptance of a proposed program for classical biological control of Russian olive. The symposium was...

  6. Current Standards in the Management of Cerebral Metastases

    Directory of Open Access Journals (Sweden)

    Pablo Goetz

    2012-01-01

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

  7. Management and prevention of neonatal anemia: current evidence and guidelines.

    Science.gov (United States)

    von Lindern, Jeannette S; Lopriore, Enrico

    2014-04-01

    Neonatal anemia is a common disorder, particularly in (very) preterm neonates. Management of neonatal anemia is based principally on red blood cell (RBC) transfusion. Although the use of blood products is nowadays widespread in neonatal medicine, evidence on the potential benefit is extremely limited. Recent studies suggest that RBC transfusions in newborns may be associated with an increased risk for necrotizing enterocolitis, transfer of infectious agents and negative effects on neurodevelopmental outcome. Whether the benefits of RBC transfusions outweigh the risks is controversial and requires further studies. In this review, we summarize the current evidence on the management of neonatal anemia and compare the various international guidelines. In addition, we discuss the various strategies to prevent neonatal anemia and reduce the need for RBC transfusions and discuss important trials currently enrolling patients to improve the management in neonatal anemia.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    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...... 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...... episode of silent AF was documented, without recommending further investigations. The results of this survey have confirmed that there is currently no consensus regarding the screening and management of patients with silent AF and that clinical practice is not always consistent with the few existing...

  9. The Assimilation and Retention of Carbon in Upland Heath Plant Communities Typical of Contrasting Management Regimes: A 13C Tracer Study

    Directory of Open Access Journals (Sweden)

    Samuel L. O. Quin

    2013-01-01

    Full Text Available Upland heath is an extensive habitat in the UK and is currently managed for a range of objectives: agricultural grazing, sporting interests, and biodiversity conservation. Increasingly land management will also have to address the provision of the ecosystem service of carbon sequestration (transfer of CO2 from the atmosphere into long-lived pools for storage. This study investigates carbon sequestration in Calluna- and Nardus-dominated upland heath vegetation communities in NE Scotland, which typically occurs as a result of low and high intensity management (grazing and burning regimes, respectively. A 13CO2 tracer experiment compared the rate of carbon assimilation and the retention of assimilated carbon over six weeks during the growing season between these two communities. There was no difference in 13CO2 uptake between Calluna- or Nardus-dominated vegetation communities and they both retained over 40% of the assimilated 13C after six weeks. The 13C retained was mostly held in Calluna leaf and stem tissue in the Calluna-dominated community and in graminoid leaves in the Nardus-dominated community. Consideration of the strategies of the dominant species and the attributes of the tissues in which 13C was retained suggests that Calluna-dominated vegetation may be of greater benefit to carbon sequestration in the longer term.

  10. Marek's disease in local chicken strains of Ethiopia reared under confined management regime in central Ethiopia

    NARCIS (Netherlands)

    Duguma, R.; Yami, A.; Dana, N.; Hassen, H.H.; Esatu, W.

    2005-01-01

    The prevalence, clinical and pathological manifestations and extent of mortality due to Marek’s disease (MD) was investigated from November 2003 to January 2004 among indigenous chickens of Ethiopia reared under confined management at the Debre Zeit Agricultural Research Center, central Ethiopia.

  11. Compensation in Flood Risk Management with a Focus on Shifts in Compensation Regimes Regarding Prevention, Mitigation and Disaster Management

    NARCIS (Netherlands)

    van Doorn - Hoekveld, Willemijn

    2014-01-01

    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 compensatio

  12. Nationwide trends in the current management of desmoid (aggressive) fibromatosis.

    Science.gov (United States)

    Eastley, N C; Hennig, I M; Esler, C P; Ashford, R U

    2015-06-01

    The optimal management of desmoid fibromatosis remains unclear, leading to significant variability in patient management. To assess this problem, the current approach of clinicians managing this complex condition in the UK was investigated. A hypothetical case of intramuscular limb girdle desmoid fibromatosis in a fit 65-year-old patient was devised. Surgical and non-surgical oncology members of the British Sarcoma Group were questioned on how they would manage this case in three scenarios: primary disease with function-sparing surgery possible, primary disease with neurovascular involvement and disease recurrence after a previous R0 resection. Initial management, management of symptomatic disease progression, follow-up preferences and any differences in respondents' management choices in a younger case were investigated. The responses from 14 sarcoma surgeons and 23 oncologists (14 clinical, nine medical) were analysed. Desmoid fibromatosis management is generally shared by surgeons and oncologists within sarcoma multidisciplinary teams in the UK. Variation exists in the chosen initial management of primary desmoid fibromatosis in the UK, with function-sparing surgery possible (observation 51%, resection 51%), primary desmoid fibromatosis with neurovascular involvement (hormone therapy with non-steroidal anti-inflammatory drugs 51%, radiotherapy 27%, observation 22%) and for cases of desmoid fibromatosis recurrence (radiotherapy 41%, hormone therapy and non-steroidal anti-inflammatory drugs 27%, observation 24%). There was a clear preference of surgical resection of symptomatic disease progression in cases of primary desmoid fibromatosis without neurovascular involvement (60%). By contrast, radiotherapy was the preferred treatment for progression in cases with neurovascular involvement (47%) or cases of recurrence after a previous R0 resection (34%). Clinical follow-up was selected 3 months after intervention in 68% of scenarios. Follow-up imaging was selected 3

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

    Directory of Open Access Journals (Sweden)

    Lingegowda PB

    2014-07-01

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

  14. Influence of management regime and harvest date on the forage quality of rangelands plants: the importance of dry matter content.

    Science.gov (United States)

    Bumb, Iris; Garnier, Eric; Bastianelli, Denis; Richarte, Jean; Bonnal, Laurent; Kazakou, Elena

    2016-01-01

    In spite of their recognized ecological value, relatively little is known about the nutritional value of species-rich rangelands for herbivores. We investigated the sources of variation in dry matter digestibility (DMD), neutral detergent fibre content (NDF) and nitrogen concentration (NC) in plants from species-rich Mediterranean rangelands in southern France, and tested whether the dry matter content (DMC) was a good predictor of the forage quality of different plant parts. Sixteen plant species with contrasting growth forms (rosette, tussock, extensive and stemmed-herb) were studied, representative of two management regimes imposed in these rangelands: (i) fertilization and intensive grazing and (ii) non-fertilization and moderate grazing. Among the 16 plant species, four species were found in both treatments, allowing us to assess the intraspecific variability in forage quality and DMC across the treatments. The components of nutritional value (DMD, NDF and NC) as well as the DMC of leaves, stems and reproductive plant parts, were assessed at the beginning of the growing season and at peak standing biomass. All components of nutritional value and DMC were affected by species growth form: rosettes had higher DMD and NC than tussocks; the reverse being found for NDF and DMC. As the season progressed, DMD and NC of the different plant parts decreased while NDF and DMC increased for all species. DMC was negatively related to DMD and NC and positively to NDF, regardless of the source of variation (species, harvest date, management regime or plant part). Path analysis indicated that NDF was the main determinant of DMD. Better assessment of forage quality in species-rich systems requires consideration of their growth form composition. DMC of all plant parts, which is closely related to NDF, emerged as a good predictor and easily measured trait to estimate DMD in these species-rich systems. Published by Oxford University Press on behalf of the Annals of Botany Company.

  15. Phenotypic variation of Lotus corniculatus L. natural populations in relation to habitat type and management regimes

    Directory of Open Access Journals (Sweden)

    Giagourta Panagiota

    2015-01-01

    Full Text Available Lotus corniculatus is a highly diverse legume with good adaptability to different soil and climatic conditions. The objective of this research was to estimate the phenotypic diversity of individual L. corniculatus plants growing under two different habitat types with different grazing management. The collection of plant material was conducted in four forested and four open grassland sites in northern Greece. Plants from open grassland had significantly lower leaf area, leaf perimeter, leaf length, leaf width and internode length compared to those from the forest. This morphological differentiation could be contributed to by differences in grazing intensity. Plants from open grasslands had significantly higher total phenols and condensed tannins, but lower crude protein content compared to those from the forest. Environmental factors in association with grazing management are the main contributors to the highly divergent concentrations of phenols, tannins and condensed tannins.

  16. Agricultural adaptation to water scarcity in the Sri Lankan dry zone: A comparison of two water managment regimes

    Science.gov (United States)

    Burchfield, E. K.

    2014-12-01

    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.

  17. The late 1980s regime shift in the ecosystem of Tsushima warm current in the Japan/East Sea: Evidence from historical data and possible mechanisms

    Science.gov (United States)

    Tian, Yongjun; Kidokoro, Hideaki; Watanabe, Tatsuro; Iguchi, Naoki

    2008-05-01

    A climatic regime shift, an abrupt change from cooling to warming in the Japan/East Sea (JES), particularly in the Tsushima warm current (TWC) region, occurred in the late 1980s. The ecosystem of the JES responded strongly to the changing thermal regime. Many, but not all biological components of the ecosystem, spanning from plankton to predatory fishes, and including both warm-water pelagic and cold-water demersal species responded to this late 1980s climatic regime shift in the JES. Diatom abundance (cell number) in spring from a monitoring line located in the central part of JES showed decadal variations with a step change from positive to negative anomalies in 1991. Zooplankton biomass in spring and autumn was high in the 1970s, declined during the 1980s, and returned to higher, but quite variable levels during the 1990s. Japanese sardine catch increased after 1974 to its peak level in 1989 and then declined dramatically to 1974 levels by 1997 with step changes in 1979 and 1994. Conversely, catches of other small pelagic species such as Japanese anchovy and common squid, and several higher-trophic fishes, such as yellowtail and tunas increased markedly in the 1990s compared to the early-mid 1980s. Step changes were detected in these pelagic species during 1989-1992. Catch of demersal species (crab, pink shrimp, Pacific cod and walleye pollock) were high during most of the 1970-1980s, but declined at various times in the late 1980s to generally low catches in the 1990s. Detailed analysis of the demersal fish assemblage composition, abundance and distribution indicated a shift in the late 1980s with several years lag in the time of change. Cold-water species (e.g., walleye pollock, Pacific cod) decreased in abundance and the regions in which their abundances remained high became greatly reduced in extent. Conversely, warm-water species (e.g., pointhead flounder, shotted halibut) increased in abundance and/or extended their spatial range (as indicated by trawl

  18. Individual Performance Management: A Review of Current Practices

    Directory of Open Access Journals (Sweden)

    Ian O’ Boyle

    2013-05-01

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

  19. Deregulating 'the rural'; threatening land management regime. Experiences of space in the Tuscan countryside

    CERN Document Server

    Orsini, Stefano

    2011-01-01

    In this research the relationships between landownership and the use of rural land are investigated and analyzed through an empirical study, conducted in Tuscany, which was based on interviews with landowners. Through the development of farmers' typologies, the results highlight a general process of decoupling form land, which appears through disinvestments in farming activity and changing the intended uses of rural land and buildings. The dynamic of liberalization (and urbanization) of rural space arises challenges to the future of land management system, which seems to be going to suffer a radical restructuring. Another relevant and connected issue emerges by this case study, that is the volatility of rural land development practices.

  20. A Study on Current Status of Detection Technology and Establishment of National Detection Regime against Nuclear/Radiological Terrorism

    Energy Technology Data Exchange (ETDEWEB)

    Kwak, Sung Woo; Jang, Sung Soon; Lee, Joung Hoon; Yoo, Ho Sik [Korea Institute of Nuclear Non-proliferation and Control, Daejeon (Korea, Republic of)

    2009-09-15

    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.

  1. Compensation in Flood Risk Management with a Focus on Shifts in Compensation Regimes Regarding Prevention, Mitigation and Disaster Management

    Directory of Open Access Journals (Sweden)

    Willemijn van Doorn-Hoekveld

    2014-05-01

    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.

  2. Asthma in children: gaps between current management and best practice.

    Science.gov (United States)

    Haby, M M; Powell, C V E; Oberklaid, F; Waters, E B; Robertson, C F

    2002-06-01

    To determine the extent to which steps three to six of the Australian six-step asthma management plan are being implemented in the community and to identify barriers to the adoption of best practice asthma management. A cross-sectional descriptive study was conducted at the Royal Children's Hospital and Sunshine Hospital, Melbourne. Two hundred and thirty-one 2-5-year old children who visited the emergency department for asthma were enrolled in the study. Main outcome measures were frequency of asthma management practices and barriers, as measured by parent-completed questionnaire. Gaps: 51% of parents do not feel they have enough information about asthma triggers, more than 60% of children with persistent or frequent episodic asthma are not using regular preventive medication, 48% do not have a written action plan, 39% have not had their asthma reviewed in the last 6 months, and 38% of parents do not feel that they have enough information about their child's asthma. Areas where current practice was close to best practice: 83% of doctors had talked to parents about what causes or 'triggers' their child's asthma, less than 1% of children are using puffers without a spacer, 83% of parents who had an action plan used it for the current visit to the emergency department. Large gaps still exist between current management and best practice in this group of emergency department attenders. Improvements in asthma management could be achieved if the child's asthma doctor requested review visits for asthma, provided an action plan and followed best practice in relation to asthma medications.

  3. Current Evidence on Atypical Odontalgia: Diagnosis and Clinical Management

    OpenAIRE

    Yoshihiro Abiko; Hirofumi Matsuoka; Itsuo Chiba; Akira Toyofuku

    2012-01-01

    Patients with atypical odontalgia (AO) complain of medically unexplained toothache. No evidence-based diagnostic criteria or treatment guidelines are yet available. The present paper addresses seven clinical questions about AO based on current knowledge in the literature and discusses diagnostic criteria and guidelines for treatment and management. The questions are (i) What is the prevalence of AO in the community? (ii) What psychological problems are experienced by patients with AO? (iii) A...

  4. Current Concepts in the Management of Rheumatoid Hand

    Directory of Open Access Journals (Sweden)

    Umile Giuseppe Longo

    2015-01-01

    Full Text Available Rheumatoid arthritis (RA is a chronic inflammatory disease caused by a T cell-driven autoimmune process, which majorly involves the diarthrodial joints. It affects 1% of the US population, and approximately 70% of patients with RA develop pathologies of the hand, especially of the metacarpophalangeal joints (MCP. Furthermore, also the extensor and flexor tendons of the fingers are frequently involved. The first line of treatment should be conservative. Three general classes of drugs are currently available for RA: nonsteroidal anti-inflammatory agents (NSAIDs, corticosteroids, and disease modifying antirheumatic drugs (DMARDs. Encouraging results have been obtained using DMARDs. However, when severe deformities occur or when patients are unresponsive to medical management and injections therapy, surgical intervention should be performed to relieve pain and restore function. Several surgical options have been described for the management of MCP joint deformities, including soft tissue procedures, arthrodesis, and prosthetic replacement. Tendons ruptures are generally managed with tendon transfer surgery, while different surgical procedures are available to treat fingers deformities. The aim of the present review is to report the current knowledge in the management of MCP joint deformities, as well as tendons damage and fingers deformities, in patients with RA.

  5. Collective action in the management of a tropical dry forest ecosystem: effects of Mexico's property rights regime.

    Science.gov (United States)

    Schroeder, Natalia Mariel; Castillo, Alicia

    2013-04-01

    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.

  6. Collective Action in the Management of a Tropical Dry Forest Ecosystem: Effects of Mexico's Property Rights Regime

    Science.gov (United States)

    Schroeder, Natalia Mariel; Castillo, Alicia

    2013-04-01

    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.

  7. Managing hytrosavirus infections in Glossina pallidipes colonies: feeding regime affects the prevalence of salivary gland hypertrophy syndrome.

    Directory of Open Access Journals (Sweden)

    Adly M M Abd-Alla

    Full Text Available Many species of tsetse flies are infected by a virus that causes salivary gland hypertrophy (SGH syndrome and the virus isolated from Glossina pallidipes (GpSGHV has recently been sequenced. Flies with SGH have a reduced fecundity and fertility. Due to the deleterious impact of SGHV on G. pallidipes colonies, several approaches were investigated to develop a virus management strategy. Horizontal virus transmission is the major cause of the high prevalence of the GpSGHV in tsetse colonies. Implementation of a "clean feeding" regime (fresh blood offered to each set of flies so that there is only one feed per membrane, instead of the regular feeding regime (several successive feeds per membrane, was among the proposed approaches to reduce GpSGHV infections. However, due to the absence of disposable feeding equipment (feeding trays and silicone membranes, the implementation of a clean feeding approach remains economically difficult. We developed a new clean feeding approach applicable to large-scale tsetse production facilities using existing resources. The results indicate that implementing this approach is feasible and leads to a significant reduction in virus load from 10(9 virus copies in regular colonies to an average of 10(2.5 and eliminates the SGH syndrome from clean feeding colonies by28 months post implementation of this approach. The clean feeding approach also reduced the virus load from an average of 10(8 virus copy numbers to an average of 10(3 virus copies and SGH prevalence of 10% to 4% in flies fed after the clean fed colony. Taken together, these data indicate that the clean feeding approach is applicable in large-scale G. pallidipes production facilities and eliminates the deleterious effects of the virus and the SGH syndrome in these colonies.

  8. Waste management in Greenland: current situation and challenges

    DEFF Research Database (Denmark)

    Eisted, Rasmus; Christensen, Thomas Højlund

    2011-01-01

    Waste management in Greenland (56 000 inhabitants) is characterized by landfilling, incineration and export to Denmark of small quantities of metals and hazardous waste. The annual amount of waste is estimated to about 50 000 tons but actual data are scarce. Data on the waste composition is basic...... are small and equipped with only moderate flue gas cleaning technology. This report summarizes the current waste management situation in Greenland and identifies important challenges in improving the waste management.......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 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...

  9. Management of asthma: the current US and European guidelines.

    Science.gov (United States)

    Reddy, Ashwini P; Gupta, Meera R

    2014-01-01

    Asthma management guidelines aim to improve the implementation of current knowledge into daily clinical practice by establishing a consensus of scientific practices for the management of asthma. Initial guidelines were based on consensus of expert opinion in order to employ a severity-based classification system as a guide to treatment. However, advances in asthma research led to the development of evidence-based guidelines and a major paradigm shift to control-based asthma management. Control-based management is central to the published guidelines developed by The National Heart, Lung, and Blood Institute (NHLBI), The Global Initiative for Asthma (GINA), and The British Thoracic Society (BTS), each one using the same volume of evidence but emphasizing aspects particular to their specific patient populations and socioeconomic needs. This chapter summarizes the evolution of these guidelines and summarizes the key points and evidence used in the recommendations for the assessment, monitoring, and management of asthma in all ages, with particular emphasis on the NHLBI guidelines.

  10. Can current moisture responses predict soil CO2 efflux under altered precipitation regimes? A synthesis of manipulation experiments

    DEFF Research Database (Denmark)

    Vicca, S.; Bahn, M.; Estiarte, M.

    2014-01-01

    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 on extrapolation of current relationships between ecosystem processes ...

  11. Can current moisture responses predict soil CO2 efflux under altered precipitation regimes? A synthesis of manipulation experiments

    DEFF Research Database (Denmark)

    Vicca, S.; Bahn, M.; Estiarte, M.;

    2014-01-01

    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 on extrapolation of current relationships between ecosystem processes ...

  12. Can current moisture responses predict soil CO2 efflux under altered precipitation regimes? A synthesis of manipulation experiments

    NARCIS (Netherlands)

    Vicca, S.; Bahn, M.; Estiarte, M.; van Loon, E.E.; Vargas, R.; Alberti, G.; Ambus, P.; Arlain, M.A.; Beier, C.; Bentley, L.P.; Borken, W.; Buchmann, N.; Collins, S.L.; De Dato, G.; Dukes, J.S.; Escolar, C.; Fay, P.; Guidolotti, G.; Hanson, P.J.; Kahmen, A.; Kröel-Dulay, G.; Ladreiter-Knauss, T.; Larsen, K.S.; Lellei-Kovacs, E.; Lebrija-Trejos, E.; Maestre, F.T.; Marhan, S.; Marshall, M.; Meir, P.; Miao, Y.; Muhr, J.; Niklaus, P.A.; Ogaya, R.; Peñuelas, J.; Poll, C.; Rustad, L.E.; Savage, K.; Schindlbacher, A.; Schmidt, I.K.; Smith, A.R.; Scotta, E.D.; Suseela, V.; Tietema, A.; Van Gestel, N.; Van Straaten, O.; Wan, S.; Weber, U.; Janssens, I.A.

    2014-01-01

    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 on extrapolation of current relationships between ecosystem processes and

  13. Current state and prospects of carbon management in high latitudes of Northern Eurasia

    Science.gov (United States)

    Schepaschenko, Dmitry; Shvidenko, Anatoly

    2010-05-01

    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

  14. Studies of challenge in lower hybrid current drive capability at high density regime in experimental advanced superconducting tokamak

    Science.gov (United States)

    Ding, B. J.; Li, M. H.; Li, Y. C.; Wang, M.; Liu, F. K.; Shan, J. F.; Li, J. G.; Wan, B. N.; Wan

    2017-02-01

    Aiming at a fusion reactor, two issues must be solved for the lower hybrid current drive (LHCD), namely good lower hybrid wave (LHW)-plasma coupling and effective current drive at high density. For this goal, efforts have been made to improve LHW-plasma coupling and current drive capability at high density in experimental advanced superconducting tokamak (EAST). LHW-plasma coupling is improved by means of local gas puffing and gas puffing from the electron side is taken as a routine way for EAST to operate with LHCD. Studies of high density experiments suggest that low recycling and high lower hybrid (LH) frequency are preferred for LHCD experiments at high density, consistent with previous results in other machines. With the combination of 2.45 GHz and 4.6 GHz LH waves, a repeatable high confinement mode plasma with maximum density up to 19~\\text{m}-3$ was obtained by LHCD in EAST. In addition, in the first stage of LHCD cyclic operation, an alternative candidate for more economical fusion reactors has been demonstrated in EAST and further work will be continued.

  15. Comparative performance of annual and perennial energy cropping systems under different management regimes

    Energy Technology Data Exchange (ETDEWEB)

    Boehmel, Ute Constanze

    2007-07-18

    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.)

  16. Exploiting Soil-Management Strategies for Climate Mitigation in the European Union: Maximizing "Win-Win" Solutions across Policy Regimes

    Directory of Open Access Journals (Sweden)

    Christian Bugge. Henriksen

    2011-12-01

    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.

  17. Breast cancer pain management - A review of current & novel therapies

    Directory of Open Access Journals (Sweden)

    Aanchal Satija

    2014-01-01

    Full Text Available Breast cancer is one of the most prevalent cancers amongst women in the world. Unfortunately, even after adequate treatment, some patients experience severe pain either due to disease progression or due to treatment related side effects. The persistent pain causes a negative physical and psychosocial impact on patients′ lives. Current rational pain management is patient-centred and requires a thorough psychological assessment. Usually adequate analgesia is achieved by adopting the WHO′s three step analgesic ladder. As the disease progresses, the pain experienced by the patient also increases. This necessitates the administration of opioids and adjuvant analgesics to the breast cancer patients experiencing severe pain. However, opioid use is associated with intolerable side effects like constipation, nausea, vomiting, fear of dependence, and tolerance. Concomitant medications are required to combat these unacceptable side effects. Adjuvant analgesics need to be added to provide adequate and satisfactory analgesia. These factors worsen the psychological state of patients and deteriorate their quality of life. Hence, there is a need to develop therapeutic modalities to provide adequate analgesia with minimum side effects. This review article focuses on the current treatments available for cancer pain management, their limitations, and novel targets and non-pharmacological measures under investigation which have the potential to produce a radical change in pain management measures for the breast cancer patients.

  18. Comparative performance of annual and perennial energy cropping systems under different management regimes

    Energy Technology Data Exchange (ETDEWEB)

    Boehmel, Ute Constanze

    2007-07-18

    management on quality parameters and (iv) environmentally benign crop rotation systems. Differently mat

  19. Mobile applications for obesity and weight management: current market characteristics.

    Science.gov (United States)

    Nikolaou, C K; Lean, M E J

    2017-01-01

    Mobile-Health (mHealth) is the fastest-developing eHealth sector, with over 100 000 health applications (apps) currently available. Overweight/obesity is a problem of wide public concern that is potentially treatable/preventable through mHealth. This study describes the current weight-management app-market. Five app stores (Apple, Google, Amazon, Windows and Blackberry) in UK, US, Russia, Japan and Germany, Italy, France, China, Australia and Canada were searched for keywords: 'weight', 'calorie', 'weight-loss', 'slimming', 'diet', 'dietitian' and 'overweight' in January/February 2016 using App-Annie software. The 10 most downloaded apps in the lifetime of an app were recorded. Developers' lists and the app descriptions were searched to identify any professional input with keywords 'professional', 'dietitian' and 'nutritionist'. A total of 28 905 relevant apps were identified as follows: Apple iTunes=8559 (4634, 54% paid), Google Play=1762 (597, 33.9% paid), Amazon App=13569 (4821, 35.5% paid), Windows=2419 (819, 17% paid) and Blackberry=2596 (940, 36% paid). The 28 905 identified apps focused mainly on physical activity (34%), diet (31%), and recording/monitoring of exercise, calorie intake and body weight (23%). Only 17 apps (0.05%) were developed with identifiable professional input. Apps on weight management are widely available and very popular but currently lack professional content expertise. Encouraging app development based on evidence-based online approaches would assure content quality, allowing healthcare professionals to recommend their use.

  20. Current Soil Nutrient Status of Intensively Managed Greenhouses

    Institute of Scientific and Technical Information of China (English)

    HU Yun-Cai; SONG Zhi-Wen; LU Wen-Long; C.POSCHENRIEDER; U.SCHMIDHALTER

    2012-01-01

    Nine districts covering the main greenhouse vegetable areas in Tianjin Municipality of the North China Plain were selected for the soil investigation in 2010 to survey the current soil nutrient status (soil available N,P and K),acidification and salinization due to excessive input of fertilizers in greenhouses in Tianjin. The study showed that,in particular,soil available P content increased with the age of greenhouses.In contrast,our results did not reveal higher K accumulation and lowered pH in the greenhouse soils compared with cultivation in open fields.Over-fertilization,causing high NO3- accumulation,most likely resulted in salinity problems in the greenhouses.Ninety percent of the investigated greenhouse soils had electrical conductivity values of saturated paste extracts of 2-10 d S m-1,which might affect the yields of vegetable crops like green bean,pepper,cabbage,carrot,eggplant,lettuce,spinach,celery,cucumber and tomato. The findings of our survey of the current fertility and salinity problems in greenhouse soils suggest that there is an urgent need to improve the farmers' practices and strategies in fertilization management in greenhouses of China.Because education and the agricultural technical extension services may play a more important role in avoiding overuse of fertilizers,we suggest that current nutrient management practices should be improved in the near future through training of local farmers in farmers' schools and through strengthening the agricultural extension services with practical techniques.

  1. Current strategies for endoscopic management of acute cholangitis.

    Science.gov (United States)

    Isayama, Hiroyuki; Yasuda, Ichiro; Tan, Damien

    2017-04-01

    At the pancreatobiliary session of Endoscopic Forum Japan (EFJ) 2016, current strategies for the endoscopic management of acute cholangitis were discussed. The topics consisted of two major parts, namely endoscopic management of acute cholangitis caused by common bile duct stones (CBDS) and biliary stent occlusion. Endoscopists from nine Japanese high-volume centers along with two overseas centers participated in the questionnaires and discussion. Strategies for management of cholangitis due to CBDS were agreed upon, and the clinical guideline of acute cholangitis (Tokyo guidelines 2013) was accepted. The best timing for drainage in Grade 2 (moderate) cholangitis urgent or early (strategies differed according to the stricture location (distal or hilar) and stent type initially placed (Covered or uncovered metal stent). Strategies for management of cholangitis caused by CBD stones are well established according to the TG13. More evidence is required before further recommendations can be made with regards to cholangitis due to stent occlusion. We aim to clarify this in the near future with questionnaires and consensus from experts. © 2017 The Authors. Digestive Endoscopy © 2017 Japan Gastroenterological Endoscopy Society.

  2. Current concepts in the management of shoulder instability

    Directory of Open Access Journals (Sweden)

    Suresh Srinivasan

    2017-01-01

    Full Text Available Shoulder instability ranges from subtle instability to frank dislocation. Our understanding on the subject is getting better. Patient lifestyle, increased awareness/expectations, better availability of information, improved imaging modalities, and increased awareness about the previously less known concepts in instability all add to the challenges of managing the problem. History and clinical examination without over reliance on imaging remain essential. We used Embase, PubMed, Medline, CINAHL, Cochrane Library, Scottish Intercollegiate Guidelines Network and Google Scholar search for published literature in English. We used various combinations of the keywords, namely, human shoulder instability, sports injuries, dislocation, surgery, latarjet, glenohumeral, glenoid, and arthroscopy from 1980 to March 2017. The systematic search captured 310 publications. After applying initial exclusion criteria, 41 abstracts were assessed for eligibility. Of these, we selected 20 full-text articles with the majority of focus primarily on surgical management of traumatic shoulder instability. A tailor-made approach for the management of the individual patient is essential and should involve shared decision making. In this article, we have tried to simplify and present the current evidence in the management of traumatic shoulder instability, particularly in sportsperson.

  3. Current investigation and management of patients with syncope

    DEFF Research Database (Denmark)

    Dagres, Nikolaos; Bongiorni, Maria Grazia; Dobreanu, Dan

    2013-01-01

    for neurally mediated syncope. Physical manoeuvres were the most widely (93%) applied standard treatment for this syncope form. The results of this survey suggest that there are significant differences in the management of patients with syncope across Europe, specifically with respect to hospitalization rates......The aim of this European Heart Rhythm Association (EHRA) survey was to provide an insight into the current practice of work-up and management of patients with syncope among members of the EHRA electrophysiology research network. Responses were received from 43 centres. The majority of respondents...... (74%) had no specific syncope unit and only 42% used a standardized assessment protocol or algorithm. Hospitalization rates varied from 10% to 25% (56% of the centres) to >50% (21% of the centres). The leading reasons for hospitalization were features suggesting arrhythmogenic syncope (85...

  4. Macroeconomic regimes

    NARCIS (Netherlands)

    Baele, L.T.M.; Bekaert, G.R.J.; Cho, S.; Inghelbrecht, K.; Moreno, A.

    2015-01-01

    A New-Keynesian macro-model is estimated accommodating regime-switching behavior in monetary policy and macro-shocks. A key to our estimation strategy is the use of survey-based expectations for inflation and output. Output and inflation shocks shift to the low volatility regime around 1985 and 1990

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

    Science.gov (United States)

    2009-09-21

    Managing the Services Supply Chain in the Department of Defense: Empirical Study of the Current Management Practices in the Army 21 September...Managing the Services Supply Chain in the Department of Defense: Empirical Study of the Current Management Practices in the Army 5a. CONTRACT NUMBER 5b...Service Supply Chain , Services Acquisition, Service Lifecycle, Contract Management, Project Management, Program Management = = ^Åèìáëáíáçå=oÉëÉ~êÅÜ

  6. Riparian plant community structure in a managed hydrological regime. University of Wyoming National Park Service Research Center Annual Report

    Science.gov (United States)

    Mellman-Brown, Sabine; Roberts, Dave; Pugesek, Bruce H.

    2008-01-01

    The hydrology of the Snake River in Grand Teton National Park is partly determined by releases from Jackson Lake Dam. The dam was first built in 1908 and became part of the National Park system when GTNP was expanded to include most of Jackson Hole. Completion of the present structure of Jackson Lake Dam occurred in 1917 and resulted in an increase above the natural level of Jackson Lake of 11.9 m. The Bureau of Reclamation (BOR) manages the dam and sets discharge schedules, primarily to meet agricultural needs, and to a lesser extent the needs of recreational river use. Major changes to the hydrological regime of the Snake River include lower than natural peak releases, decrease in frequency of extreme flood events , and unusually high flows from July to September. In addition , peak releases prior to 1957 were not synchronized with spring runoff but shifted to July or early August. Changes in inundation frequencies of floodplains , inundation duration and timing of peak flows have profound effects on the extent and composition of the riparian zone.

  7. Managing reservoir sedimentation by venting turbidity currents:A review

    Institute of Scientific and Technical Information of China (English)

    Sabine Chamoun; Giovanni De Cesare; Anton J. Schleiss

    2016-01-01

    Reservoir sedimentation is an issue that dam operators are increasingly facing as dams are aging. Not only does it reduce a reservoir's capacity but it also affects its outlet structures such as bottom outlets and powerhouse intakes. Sedimentation may also impoverish downstream ecosystems. For these reasons, several strategies for sediment management are being investigated and applied worldwide. Among these methods, venting of turbidity currents reaching the dam can be very beneficial and economical. This measure helps in preserving a certain continuity of sediment transport in rivers obstructed by dams. However, several practical but also theoretical challenges hamper this technique, rendering its use less common and its aspects rela-tively unknown. The present paper aims to gather the actual state-of-the-art concerning turbidity currents venting and to present an outlook for future development and research in this field.

  8. [Management of stroke in sub-Saharan Africa: current issues].

    Science.gov (United States)

    Adoukonou, T A; Vallat, J-M; Joubert, J; Macian, F; Kabore, R; Magy, L; Houinato, D; Preux, P-M

    2010-11-01

    In sub-Saharan Africa, stroke is likely to present an increasingly important public health problem with a larger relative share of overall morbidity and mortality. Overall, sub-Saharan Health Care is characterized by a lack of human resources, lack of facilities for special investigations, and especially an absence of specific programs addressing the prevention of cardiovascular conditions. Current data on the epidemiology of stroke in sub-Saharan Africa, although sparse and fragmentary, indicate a comparatively high incidence of cerebral hemorrhage associated with high blood pressure, while ischemic stroke in black Africans still appears to be related primarily to small artery disease, HIV infection, and sickle cell disease. With urbanization, the role of large-vessel atherosclerosis is increasing. It is thus essential to coordinate government funding, health care professionals and development agencies to address this rising health problem. Access to health care needs to be better structured, and screening programs should be developed in order to identify and treat vascular risk factors. Improved training of health care professionals is also required in the areas of prevention, diagnosis and management of stroke. Implementation of best-practice recommendations for the management of stroke adapted to the specificities and resources of African countries would help rationalize the scarce resources currently available. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  9. Current-voltage characteristics of quantum-point contacts in the closed-channel regime: Transforming the bias voltage into an energy scale

    DEFF Research Database (Denmark)

    Gloos, K.; Utko, P.; Aagesen, M.;

    2006-01-01

    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...... analysis is based on a single scaling factor, extracted from the experimental I(V) characteristics. For both polarities, this scaling factor transforms the change of bias voltage into a change of electron energy. The latter is determined with respect to the top of the potential barrier of the contact....... 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...

  10. The current role of thiazolidinediones in diabetes management.

    Science.gov (United States)

    Rizos, Christos V; Kei, Anastazia; Elisaf, Moses S

    2016-08-01

    Among the epidemics of modern time, type 2 diabetes mellitus (T2DM) is one of the main contributors to overall morbidity as well as mortality. A number of different treatment options are available for the management of diabetes. Among them thiazolidinediones (TZDs) is an interesting drug class since it does not target the result of T2DM, i.e., hyperglycemia but rather some of the core mechanisms of the disease. Indeed, glitazones increase insulin sensitivity by activating the peroxisome proliferator-activated receptor γ, which plays an important role in regulating various metabolic parameters. Although TZDs have an established efficacy in T2DM treatment, their usage during the past years was questioned following the emergence of some alarming data regarding their safety and especially the cardiovascular safety of rosiglitazone. As a result, there is often some skepticism about the current role of TZDs in T2DM management. This mainly affects rosiglitazone even leading to its withdrawal from several markets in contrast to pioglitazone, which has shown a beneficial cardiovascular profile. A comprehensive assessment of the benefit-to-risk ratio of TZDs is required in order to better understand the place of these drugs in T2DM management.

  11. Preoperative management of children with esophageal atresia: current perspectives

    Directory of Open Access Journals (Sweden)

    Parolini F

    2017-01-01

    Full Text Available Filippo Parolini,1 Anna Lavinia Bulotta,1 Sonia Battaglia,1 Daniele Alberti1,2 1Department of Pediatric Surgery, “Spedali Civili” Children’s Hospital, 2Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy Abstract: Esophageal atresia remains one of the most challenging congenital anomalies of the newborn. In recent years, because of the advances in prenatal diagnosis, neonatal critical care, and surgical procedures, overall outcomes have improved substantially, including for premature children. Nowadays, most of the research is focused on medium- and long-term morbidity, with particular reference to respiratory and gastroesophageal problems; the high frequency of late sequelae in esophageal atresia warrants regular and multidisciplinary checkups throughout adulthood. Surprisingly, there are few studies on the impact of prenatal diagnosis and there is continuing debate over the prenatal and preoperative management of these complex patients. In this review, we analyze the literature surrounding current knowledge on the management of newborns affected by esophageal atresia, focusing on prenatal management and preoperative assessment. Keywords: prenatal diagnosis, esophageal atresia, tracheoesophageal fistula, ultrasound scan, tracheobronchoscopy

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

    Science.gov (United States)

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

    2009-12-01

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

  13. Current Research and Management of Ovarian Cancer in China

    Institute of Scientific and Technical Information of China (English)

    GUMeijiao; SHIWei

    2002-01-01

    Ovarian cancer is ne of the most lethal malignant tumors in China,represents the third most common cancer after cervical cancer and endometrial cancer,and the first leading cause of death from hynaecological cancers.Due to the lack of effective screening strategies and the absence of symptoms in early-stage of disease,over 70% of patients present at an advanced stage.Despite the advances in surgical techniques and conventional chemotheraphy,the prognosis of ovarian cancer has not been improved significantly,and indeed the long-term survival for patients with advanced disease does not exceed 20%.The aetiology of ovarian cancer temains poorly understood.In China,the major focus of research is to clarify the mechanism underlying ovarian cancer,develop more effective life-saving diagnostic and therapeutic measures,and undertake more population-based studies.This article summarizes current research,diagnosis and management of ovarian cancer in China.

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

    Science.gov (United States)

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

    2003-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Sultan Al-Shaqsi

    2016-02-01

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

  16. Current concepts in the management of complex elbow trauma.

    Science.gov (United States)

    Morrey, B F

    2009-06-01

    Complex instability of the elbow, also known as fracture dislocation of the elbow, is one of the most challenging injuries of the musculoskeletal system. A clear understanding of the biomechanics of the joint with special focus on the relative contributions of the articular components and the ligamentous constraints is critical to the proper management of these injuries. The accurate recognition and implications of associated injuries offers a rationale for approaching these difficult problems by appropriately addressing the elements of the trauma. Further, doing so in a timely fashion enhances the outcome. Currently, even the most devastating of injuries are felt to have a more favourable prognosis than was present in the past if the principles contained herein are followed.

  17. Cutaneous Scar Prevention and Management: Overview of current therapies.

    Science.gov (United States)

    Al-Shaqsi, Sultan; Al-Bulushi, Taimoor

    2016-02-01

    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.

  18. Current concepts in the management of patellar instability

    Directory of Open Access Journals (Sweden)

    Michael S Laidlaw

    2017-01-01

    Full Text Available Patellar instability is a common presenting clinical entity in the field of orthopedics. This not only can occur from baseline morphologic variability within the patellofemoral articulation and alignment, but also from traumatic injury. While conservative management is many times employed early in the treatment course, symptomatic patellar instability can persist. This article reviews the available indexed published literature regarding patellar instability. Given the debilitating nature of this condition and the long term sequelae that can evolve from its lack of adequate recognition and treatment, this article details the most current methods in the evaluation of this entity as well as reviews the most up-to-date surgical treatment regimens that are available to address this condition.

  19. The Pathophysiology, Diagnosis and Current Management of Acute Compartment Syndrome

    Science.gov (United States)

    Donaldson, James; Haddad, Behrooz; Khan, Wasim S

    2014-01-01

    Acute compartment syndrome (ACS) is a surgical emergency warranting prompt evaluation and treatment. It can occur with any elevation in interstitial pressure in a closed osseo-fascial compartment. Resultant ischaemic damage may be irreversible within six hours and can result in long-term morbidity and even death. The diagnosis is largely clinical with the classical description of ‘pain out of proportion to the injury’. Compartment pressure monitors can be a helpful adjunct where the diagnosis is in doubt. Initial treatment is with the removal of any constricting dressings or casts, avoiding hypotension and optimizing tissue perfusion by keeping the limb at heart level. If symptoms persist, definitive treatment is necessary with timely surgical decompression of all the involved compartments. This article reviews the pathophysiology, diagnosis and current management of ACS. PMID:25067973

  20. Acute Compartment Syndrome of the Limbs: Current Concepts and Management

    Science.gov (United States)

    Mabvuure, Nigel Tapiwa; Malahias, Marco; Hindocha, Sandip; Khan, Wasim; Juma, Ali

    2012-01-01

    Acute compartment syndrome (ACS) of the limb refers to a constellation of symptoms, which occur following a rise in the pressure inside a limb muscle compartment. A failure or delay in recognising ACS almost invariably results in adverse outcomes for patients. Unrecognised ACS can leave patients with nonviable limbs requiring amputation and can also be life–threatening. Several clinical features indicate ACS. Where diagnosis is unclear there are several techniques for measuring intracompartmental pressure described in this review. As early diagnosis and fasciotomy are known to be the best determinants of good outcomes, it is important that surgeons are aware of the features that make this diagnosis likely. This clinical review discusses current knowledge on the relevant clinical anatomy, aetiology, pathophysiology, risk factors, clinical features, diagnostic procedures and management of an acute presentation of compartment syndrome. PMID:23248724

  1. Flecainide: Current status and perspectives in arrhythmia management

    Institute of Scientific and Technical Information of China (English)

    George; K; Andrikopoulos; Sokratis; Pastromas; Stylianos; Tzeis

    2015-01-01

    Flecainide acetate is a class IC antiarrhythmic agent and its clinical efficacy has been confirmed by the results of several clinical trials. Nowadays, flecainide is recommended as one of the first line therapies for pharmacological conversion as well as maintenance of sinus rhythm in patients with atrial fibrillation and/or supraventricular tachycardias. Based on the Cardiac Arrhythmia Suppression Trial study results, flecainide is not recommended in patients with structural heart disease due to high proarrhythmic risk. Recent data support the role of flecainide in preventing ventricular tachyarrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia associated both with ryanodine receptor and calsequestrin mutations. We herein review the current clinical data related to flecainide use in clinical practice and some concerns about its role in the management of patients with coronary artery disease.

  2. Bariatric emergencies: current evidence and strategies of management

    Science.gov (United States)

    2013-01-01

    Background The demand for bariatric surgery is increasing and the postoperative complications are seen more frequently. The aim of this paper is to review the current outcomes of bariatric surgery emergencies and to formulate a pathway of safe management. Methods The PubMed and Google search for English literatures relevant to emergencies of bariatric surgery was made, 6358 articles were found and 90 papers were selected based on relevance, power of the study, recent papers and laparoscopic workload. The pooled data was collected from these articles that were addressing the complications and emergency treatment of bariatric patients. 830,998 patients were included in this review. Results Bariatric emergencies were increasingly seen in the Accident and Emergency departments, the serious outcomes were reported following complex operations like gastric bypass but also after gastric band and the causes were technical errors, suboptimal evaluation, failure of effective communication with bariatric teams who performed the initial operation, patients factors, and delay in the presentation. The mortality ranged from 0.14%-2.2% and increased for revisional surgery to 6.5% (p = 0.002). Inspite of this, mortality following bariatric surgery is still less than that of control group of obese patients (p = value 0.01). Conclusions Most mortality and catastrophic outcomes following bariatric surgery are preventable. The awareness of bariatric emergencies and its effective management are the gold standards for best outcomes. An algorithm is suggested and needs further evaluation. PMID:24373182

  3. Immunotherapy in the management of melanoma: current status

    Directory of Open Access Journals (Sweden)

    Alston D

    2013-02-01

    Full Text Available Dylan Alston,1 Jerry D Brewer21Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL, 2Mayo Clinic, Rochester, MN, USAAbstract: As the rate of melanoma continues to increase, so does the need for more effective and durable therapies. Despite considerable research, the management of advanced disease remains challenging. Numerous therapies are being investigated, many of which aim at upregulating the immune system's innate ability to attack the tumor. Cytotoxic T lymphocyte antigen 4 antibodies are immune stimulants that act as negative regulators of the immune system by modifying an antitumor T-cell response. Ipilimumab, one such cytotoxic T lymphocyte antigen 4 antibody, and vemurafenib, a BRAF competitive inhibitor, were approved as first-line therapies in 2011 due to improved survival rates versus standard chemotherapy. Allovectin-7 is a lipid plasmid that encodes for major histone compatibility complex DNA sequences. It has led to increases in cytotoxic T-cell production, which subsequently attacks the tumor. OncoVEX, an oncolytic herpes virus, and PV-10, a chemoablative agent, have yielded promising results in metastatic lesions and have demonstrated a unique "bystandarder" phenomenon. In this paper we review the basics of melanoma from the pathophysiology, risk factors, signs, diagnostic approaches, and current status of immunologic management of melanoma.Keywords: melanoma, immunotherapy, ipilimumab, vemurafenib, OncoVEX, Allovectin-7

  4. Diagnosis and management of microscopic colitis: current perspectives

    Science.gov (United States)

    Bohr, Johan; Wickbom, Anna; Hegedus, Agnes; Nyhlin, Nils; Hultgren Hörnquist, Elisabeth; Tysk, Curt

    2014-01-01

    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 microscopic colitis. PMID:25170275

  5. The presentation, pathology, and current management strategies of cutaneous metastasis

    Directory of Open Access Journals (Sweden)

    Christina Yin Bin Wong

    2013-01-01

    Full Text Available Skin metastases are rare in the routine clinical practice of dermatology, but are of major clinical significance because they usually indicate advanced disease. We reviewed the literature on skin metastasis regarding recent trends in clinical presentation and diagnosis of the most common cutaneous lesions. An extensive literature review was conducted using PubMed from May 26, 2011 to July 16, 2013 relating cutaneous metastases. Articles chosen for reference were queried with the following prompts: "Cutaneous metastases", "clinical presentation", "histological features", and "immunohistochemistry". Further searches included "treatment" and "management" options for "metastatic breast", "metastatic colorectal", "metastatic melanoma", "metastatic lung", and "hematologic cancers." We also reviewed the literature on the current management of melanoma as a model for all cutaneous metastatic disease. Our own clinical findings are presented and compared to the literature. Additionally, we highlight the most useful immunohistochemical studies that aid in diagnoses. Several novel therapies and combination therapies such as electrochemotherapy, vemurafenib, and imiquimod will be discussed for palliative treatment of cancers that have been found to improve cutaneous lesions. We review these notable findings and developments regarding skin metastases for the general dermatologist.

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

    Directory of Open Access Journals (Sweden)

    Jordan N

    2016-03-01

    Full Text Available Natasha Jordan,1 David D’Cruz2 1Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, 2Louise Coote Lupus Unit, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, UK Abstract: 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. Keywords: hydroxychloroquine, mycophenolate mofetil, azathioprine, cyclophosphamide, rituximab, belimumab

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

    Science.gov (United States)

    Jordan, Natasha; D'Cruz, David

    2016-01-01

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

  8. Current Evidence on Atypical Odontalgia: Diagnosis and Clinical Management

    Directory of Open Access Journals (Sweden)

    Yoshihiro Abiko

    2012-01-01

    Full Text Available Patients with atypical odontalgia (AO complain of medically unexplained toothache. No evidence-based diagnostic criteria or treatment guidelines are yet available. The present paper addresses seven clinical questions about AO based on current knowledge in the literature and discusses diagnostic criteria and guidelines for treatment and management. The questions are (i What is the prevalence of AO in the community?\t(ii What psychological problems are experienced by patients with AO? (iii Are there any comorbidities of AO? (iv Is local anesthesia effective for the relief of pain in AO? (v Are there any characteristic symptoms of AO other than spontaneous pain? (vi Are antidepressants effective for treatment of AO? (vii Are anticonvulsants effective for treatment of AO? Our literature search provided answers for these questions; however, there is insufficient evidence-based data to establish guidelines for the diagnosis and treatment of AO. Overall, some diagnostic criteria for neuropathic pain and persistent dentoalveolar pain disorder may be applied to AO patients. The patient's psychogenic background should always be considered in the treatment and/or management of AO. The clinicians may need to treat AO patients using Patient-Oriented Evidence that Matters approach.

  9. Current Evidence on Atypical Odontalgia: Diagnosis and Clinical Management

    Science.gov (United States)

    Abiko, Yoshihiro; Matsuoka, Hirofumi; Chiba, Itsuo; Toyofuku, Akira

    2012-01-01

    Patients with atypical odontalgia (AO) complain of medically unexplained toothache. No evidence-based diagnostic criteria or treatment guidelines are yet available. The present paper addresses seven clinical questions about AO based on current knowledge in the literature and discusses diagnostic criteria and guidelines for treatment and management. The questions are (i) What is the prevalence of AO in the community? (ii) What psychological problems are experienced by patients with AO? (iii) Are there any comorbidities of AO? (iv) Is local anesthesia effective for the relief of pain in AO? (v) Are there any characteristic symptoms of AO other than spontaneous pain? (vi) Are antidepressants effective for treatment of AO? (vii) Are anticonvulsants effective for treatment of AO? Our literature search provided answers for these questions; however, there is insufficient evidence-based data to establish guidelines for the diagnosis and treatment of AO. Overall, some diagnostic criteria for neuropathic pain and persistent dentoalveolar pain disorder may be applied to AO patients. The patient's psychogenic background should always be considered in the treatment and/or management of AO. The clinicians may need to treat AO patients using Patient-Oriented Evidence that Matters approach. PMID:22844283

  10. Clinical utility of ivabradine in cardiovascular disease management: current status

    Directory of Open Access Journals (Sweden)

    Rosano GMC

    2014-08-01

    Full Text Available Giuseppe MC Rosano,1,2 Cristiana Vitale,1,2 Ilaria Spoletini,1 Maurizio Volterrani11Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy; 2Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK Abstract: Ivabradine is a selective antagonist of the funny channels with anti-anginal and anti-ischemic properties, approved for the treatment of coronary artery disease (CAD and heart failure (HF. It provides pure heart rate reduction, reducing the diastolic depolarization slope, without altering hemodynamic parameters. This review summarizes the current knowledge on the efficacy of ivabradine in patients with cardiovascular diseases, with a particular focus on its role in the clinical management of patients with CAD and HF. There is consistent evidence that ivabradine is effective in reducing angina pectoris symptoms and myocardial ischemia. At approved doses ivabradine is safe, improves exercise tolerance, and reduces heart rate. Available data from clinical trials support its use in the management of patients with stable CAD and chronic HF. Recent studies have cast doubt on the safety of non-approved high doses of ivabradine for the treatment of patients with CAD and without clinical HF, but have shown no concerns on the doses approved for clinical use. Keywords: ivabradine, coronary artery disease, heart failure, angina pectoris, exercise performance

  11. Therapeutic Management of Familial Hypercholesterolemia: Current and Emerging Drug Therapies.

    Science.gov (United States)

    Patel, Roshni S; Scopelliti, Emily M; Savelloni, Julie

    2015-12-01

    Familial hypercholesterolemia (FH) is a genetic disorder characterized by significantly elevated low-density lipoprotein cholesterol (LDL-C) concentrations that result from mutations of the LDL receptor, apolipoprotein B (apo B-100), and proprotein convertase subtilisin/kexin type 9 (PCSK9). Early and aggressive treatment can prevent premature atherosclerotic cardiovascular disease in these high-risk patients. Given that the cardiovascular consequences of FH are similar to typical hypercholesterolemia, traditional therapies are utilized to decrease LDL-C levels. Patients with FH should receive statins as first-line treatment; high-potency statins at high doses are often required. Despite the use of statins, additional treatments are often necessary to achieve appropriate LDL-C lowering in this patient population. Novel drug therapies that target the pathophysiologic defects of the condition are continuously emerging. Contemporary therapies including mipomersen (Kynamro, Genzyme), an oligonucleotide inhibitor of apo B-100 synthesis; lomitapide (Juxtapid, Aegerion), a microsomal triglyceride transfer protein inhibitor; and alirocumab (Praluent, Sanofi-Aventis/Regeneron) and evolocumab (Repatha, Amgen), PCSK9 inhibitors, are currently approved by the U.S. Food and Drug Administration for use in FH. This review highlights traditional as well as emerging contemporary therapies with supporting clinical data to evaluate current recommendations and discuss the future direction of FH management.

  12. Challenges of Environmental Management Accounting - Current Accounting Practices

    National Research Council Canada - National Science Library

    Prof. Ph.D. Gheorghe Popescu; Prof. Ph.D. Adriana Popescu; Univ. Junior Assistant, PhD Attendant Cristina Raluca Popescu

    2008-01-01

    ...).Environmental Management Accounting is a relatively new tool in environmental management definedas the identification, collection, estimation, analysis, internal reporting, and use of materials...

  13. Impacts of extensive driftnet fishery and late 1990s climate regime shift on dominant epipelagic nekton in the Transition Region and Subtropical Frontal Zone: Implications for fishery management

    Science.gov (United States)

    Ichii, T.; Nishikawa, H.; Igarashi, H.; Okamura, H.; Mahapatra, K.; Sakai, M.; Wakabayashi, T.; Inagake, D.; Okada, Y.

    2017-01-01

    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.

  14. Hepatocellular carcinoma:current management and recent advances

    Institute of Scientific and Technical Information of China (English)

    Wan-Yee Lau; Eric C. H. Lai

    2008-01-01

    BACKGROUND:Hepatocellular carcinoma (HCC) is a major health problem worldwide. It is the iffth most common cancer in the world, and the third most common cause of cancer-related death. Without speciifc treatment, the prognosis is very poor. The goal of management is"cancer control"-a reduction in its incidence and mortality as well as an improvement in the quality of life of patients with HCC and their families. This article aims to review the current management of HCC and its recent advances. DATA SOURCES:A MEDLINE database search was performed to identify relevant article using the keywords"hepatocellular carcinoma", "hepatectomy", "liver transplantation", and"local ablative therapy". Additional papers and book chapters were identiifed by a manual search of the references from the key articles. RESULTS:Liver resection and liver transplantation remain the options that give the best chance of a cure. Recent evidence suggests that local ablative therapy may offer comparable survival results in patients with small HCC, and preserved liver function. Transarterial chemoembolization (TACE) is the most promising palliative modality for unresectable HCC, but other techniques, such as transarterial radioembolization (TARE), and local ablative therapy, have also shown comparable results. CONCLUSIONS:Early diagnosis of HCC remains a key goal in improving the prognosis of patients. During the last two decades, operative mortality and surgical outcome of liver resection and liver transplantation for HCC have improved. Progress also has been made in multi-modality therapy which can increase the chance of survival and improve the quality of life for patients with advanced HCC.

  15. Soil aggregation and aggregate associated organic carbon and total nitrogen under long-term contrasting soil management regimes in loess soil

    Institute of Scientific and Technical Information of China (English)

    XIE Jun-yu; XU Ming-gang; Qiangjiu Ciren; YANG Yang; ZHANG Shu-lan; SUN Ben-hua; YANG Xue-yun

    2015-01-01

    This study investigated the effects of three contrasting soil management regimes and different nutrient treatments on the distribution of water-stable aggregates (>2, 1–2, 0.5–1, 0.25–0.5, and 0.25 mm) and mean weight diameter (MWD) at 0–10 and 10–20 cm soil horizons compared with Cropping, whereas Falow yielded lower values of above two parameters. Abandonment increased SOC and TN contents in al aggregate sizes by 17–62%and 6–60%, respectively, at 0–10 cm soil layer compared with Cropping. Conversely, Falow decreased SOC and TN contents in al aggregates by 7–27% and 7–25%, respectively. Nevertheless, the three soil management regimes presented similar SOC contents in al aggregates at 10–20 cm soil horizon. Only Cropping showed higher TN content in >0.5 mm aggregates than the two other regimes. Consequently, Abandonment enhanced the partitioning proportions of SOC and TN in >1 mm macro-aggregates, and Falow promoted these proportions in micro-aggregates compared with Cropping. Under Cropping, long-term fertilization did not affect the distribution of aggregates and MWD values compared with those under CK, except for NPK treatment. Fertilizer treatments enhanced SOC and TN contents in aggregates at al tested soil depths. However, fertilization did not affect the partitioning proportions of SOC and TN contents in al aggregates compared with CK. Comprehensive results showed that different soil management regimes generated varied patterns of SOC and TN sequestration in loess soil. Abandonment enhanced soil aggregation and sequestered high amounts of SOC and TN in macro-aggregates. Long-term amendment of organic manure integrated with NPK maintained soil aggregate stability and improved SOC and TN sequestration in al aggregates in loess soil subjected to dryland farming.

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

    Science.gov (United States)

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

    2016-04-01

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

  17. Optimal management of multiple sclerosis during pregnancy: current perspectives

    Directory of Open Access Journals (Sweden)

    Borisow N

    2014-08-01

    Full Text Available Nadja Borisow, Friedemann Paul, Jan DörrNeuroCure Clinical Research Center and Clinical and Experimental Research Center for Multiple Sclerosis, Charité – Universitätsmedizin Berlin, Berlin, GermanyAbstract: Multiple sclerosis (MS is a common inflammatory demyelinating disorder of the central nervous system. It frequently affects females in their reproductive phase of life. Therefore, family planning, pregnancy, and breastfeeding are important issues in the management of MS, particularly with respect to counseling and drug treatment. This paper reviews currently available data on the outcome of pregnancies in MS patients and the influence of pregnancy on the course of the disease. We give an update on the use of various disease-modifying MS drugs during pregnancy and breastfeeding. In addition to established therapies such as interferon-β, glatiramer acetate, natalizumab, and fingolimod, we also discuss the state of knowledge about new agents such as dimethyl fumarate, teriflunomide, and alemtuzumab in the context of pregnancy and breastfeeding.Keywords: multiple sclerosis, pregnancy, lactation, disease-modifying therapy

  18. Current Approach to the Evaluation and Management of Microscopic Colitis.

    Science.gov (United States)

    Cotter, Thomas G; Pardi, Darrell S

    2017-02-01

    Microscopic colitis is a common cause of chronic watery diarrhea, particularly in the elderly. The accompanying symptoms, which include abdominal pain and fatigue, can markedly impair patients' quality of life. Diagnosis is based upon characteristic histologic findings of the colonic mucosa. This review focuses on the current approach to evaluation and management of patients with microscopic colitis. Although the incidence of microscopic colitis has been increasing over time, recent epidemiological studies show stabilization at 21.0-24.7 cases per 100,000 person-years. Recent research has further expanded our knowledge of the underlying pathophysiology and emphasized the entity of drug-induced microscopic colitis and the association with celiac disease. Two recent randomized studies have confirmed the effectiveness of oral budesonide for both induction and maintenance treatment of microscopic colitis and is now endorsed by the American Gastroenterological Association as first-line treatment. The incidence of microscopic colitis has stabilized at just over 20 cases per 100,000 person-years. Celiac disease and drug-induced microscopic colitis should be considered in all patients diagnosed with microscopic colitis. There are a number of treatments available for patients with microscopic colitis; however, budesonide is the only option well studied in controlled trials and is effective for both induction and maintenance treatment.

  19. Para-phenylenediamine allergy: current perspectives on diagnosis and management

    Directory of Open Access Journals (Sweden)

    Mukkanna KS

    2017-01-01

    Full Text Available Krishna Sumanth Mukkanna,1 Natalie M Stone,2 John R Ingram3 1Dermatology Department, Abertawe Bro Morgannwg University Health Board, Swansea, 2Dermatology Department, Aneurin Bevan University Health Board, Newport, 3Division of Infection and Immunity, Cardiff University, Cardiff, UK Abstract: Para-phenylenediamine (PPD is the commonest and most well-known component of hair dyes. Oxidative hair dyes and dark henna temporary tattoos contain PPD. Individuals may be sensitized to PPD by temporary henna tattooing in addition to dyeing their hair. PPD allergy can cause severe reactions and may result in complications. In recent years, frequency of positive patch test reactions to PPD has been increasing. Cross-sensitization to other contact allergens may occur, in particular to other hair dye components. Hairdressers are at a high risk for PPD allergy and require counseling regarding techniques to minimize exposure and protective measures while handling hair dye. We focus this review on the current perspectives of diagnosis and management of PPD allergy. Keywords: para-phenylenediamine, patch test, hair dye

  20. Diagnosis, antenatal surveillance and management of prolonged pregnancy: current perspectives.

    Science.gov (United States)

    Vitale, S G; Marilli, I; Rapisarda, A M; Iapichino, V; Stancanelli, F; Cianci, A

    2015-08-01

    Prolonged pregnancy is defined as a pregnancy that extends beyond 42 weeks of gestation (294 days) from the first day of the last normal menstrual period. An accurate estimation of the 'natural' incidence of prolonged pregnancy would require meticulous early pregnancy dating. The use of ultrasound to establish gestational age reduces the number of pregnancies that are classified as prolonged. Prolonged pregnancy is associated with an increased perinatal mortality and morbidity in pregnancies which appear to be otherwise low risk. Postterm births are easily preventable by intervening to deliver with the use of induction of labor. Thus, this potentially problematic condition deserves further attention and careful consideration. The focus of this article is to review and challenge some current concepts surrounding the diagnosis and management of prolonged pregnancy. We outline how to identify those women with prolonged pregnancy and which is the appropriate moment to start monitoring the fetal wellbeing. Finally we address the question of benefits and hazards of induction of labor strategies.

  1. Current Concepts of Oxygen Management in Retinopathy of Prematurity

    Directory of Open Access Journals (Sweden)

    Leah A Owen

    2014-01-01

    Full Text Available Retinopathy of prematurity (ROP is a potentially blinding disorder in premature infants. The underlying pathophysiology is incompletely understood, limiting the prevention and treatment of this devastating condition. Current therapies are directed toward management of aberrant neovascularization thought to result from retinal ischemia in the developing preterm retina. The molecular mediators important for development of retinal ischemia and subsequent neovascular pathology are not fully understood. However, oxygen has been shown to be a key mediator of disease and the oxygen environment for preterm infants has been extensively studied. Despite this, the optimal oxygen environment for preterm infants remains unclear and recent works seeking to clarify this relationship demonstrate somewhat disparate findings. These data further substantiate that ROP is a complex disease with multifactorial etiology including genetic and environmental factors. Therefore, while environmental factors such as oxygen are important to our understanding of the disease process and care of preterm infants, identification of the molecular mediators downstream of oxygen which are necessary for development of ROP pathology will be critical to improve prevention, diagnosis and treatment strategies.

  2. Targeted temperature management: Current evidence and practices in critical care

    Directory of Open Access Journals (Sweden)

    Saurabh Saigal

    2015-01-01

    Full Text Available Targeted temperature management (TTM in today′s modern era, especially in intensive care units represents a promising multifaceted therapy for a variety of conditions. Though hypothermia is being used since Hippocratic era, the renewed interest of late has been since early 21 st century. There have been multiple advancements in this field and varieties of cooling devices are available at present. TTM requires careful titration of its depth, duration and rewarming as it is associated with side-effects. The purpose of this review is to find out the best evidence-based clinical practice criteria of therapeutic hypothermia in critical care settings. TTM is an unique therapeutic modality for salvaging neurological tissue viability in critically ill patients viz. Post-cardiac arrest, traumatic brain injury (TBI, meningitis, acute liver failure and stroke. TTM is standard of care in post-cardiac arrest situations; there has been a lot of controversy of late regarding temperature ranges to be used for the same. In patients with TBI, it reduces intracranial pressure, but has not shown any favorable neurologic outcome. Hypothermia is generally accepted treatment for hypoxic ischemic encephalopathy in newborns. The current available technology to induce and maintain hypothermia allows for precise temperature control. Future studies should focus on optimizing hypothermic treatment to full benefit of our patients and its application in other clinical scenarios.

  3. Desmoplastic Small Round Cell Tumor: Current Management and Recent Findings

    Directory of Open Access Journals (Sweden)

    Armelle Dufresne

    2012-01-01

    Full Text Available Desmoplastic small round cell tumor (DSRCT is a rare and highly aggressive mesenchymal tumor that develops in the abdominal cavity of young men adults. Patients typically present with symptoms of abdominal sarcomatosis. Diagnosis is based on histological analysis of biopsies which typically show small round blue cells in nests separated by an abundant desmoplastic stroma. DSRCT is associated with a unique chromosomal translocation t(11:22 (p 13; q 12 that involves the EWSR1 and WT1 genes. The prognosis is particularly poor; median survival ranges from 17 to 25 months, largely due to the presentation of the majority of patients with metastatic disease. Management of DSRCT remains challenging and current schemes lack a significant cure rate despite the use of aggressive treatments such as polychemotherapy, debulking surgery and whole abdominal radiation. Several methods are being evaluated to improve survival: addition of chemotherapy and targeted therapies to standard neoadjuvant protocol, completion of surgical resection with HIPEC, postoperative IMRT, treatment of hepatic metastases with [90Y]Yttrium microsphere liver embolization.

  4. Regimes of justification

    NARCIS (Netherlands)

    Arts, Irma; Buijs, A.E.; Verschoor, G.M.

    2017-01-01

    Legitimacy of environmental management and policies is an important topic in environmental research. Based on the notion of ‘regimes of justification’, we aim to analyse the dynamics in argumentations used to legitimize and de-legitimize Dutch nature conservation practices. Contrary to prior

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

    Directory of Open Access Journals (Sweden)

    Klajn-Tatić Vesna

    2011-01-01

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

  6. Case Management in Community Corrections: Current Status and Future Directions

    Science.gov (United States)

    Day, Andrew; Hardcastle, Lesley; Birgden, Astrid

    2012-01-01

    Case management is commonly regarded as the foundation of effective service provision across a wide range of human service settings. This article considers the case management that is offered to clients of community corrections, identifying the distinctive features of case management in this particular setting, and reviewing the empirical evidence…

  7. Shifts in dynamic regime of an invasive lady beetle are linked to the invasion and insecticidal management of its prey

    NARCIS (Netherlands)

    Bahlai, C.A.; Werf, van der W.; O'Neal, M.; Hemerik, L.; Landis, D.A.

    2015-01-01

    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 s

  8. Challenges of Environmental Management Accounting ?- Current Accounting Practices

    OpenAIRE

    Prof. Ph. D. Gheorghe Popescu; Prof. Ph.D . Adriana Popescu; Univ.Junior Assistant, PhD Attendant Cristina Raluca Popescu

    2008-01-01

    The goal of our paper is to reduce some of the international confusion generated on such an important topic by providing a general framework and set of definitions for Environmental Management Accounting (EMA). Environmental Management Accounting is a relatively new tool in environmental management defined as the identification, collection, estimation, analysis, internal reporting, and use of materials and energy flow information, environmental cost information, and other cost information for...

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

    OpenAIRE

    ANDREEA PAULA DUMITRU

    2011-01-01

    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...

  10. Acute urinary retention and the difficult catheterization: current emergency management.

    Science.gov (United States)

    Sliwinski, Ania; D'Arcy, Frank T; Sultana, Ron; Lawrentschuk, Nathan

    2016-04-01

    Acute urinary retention (AUR) is a common presentation to emergency departments. This article updates the reader on the appropriate management, investigations and guidelines for AUR. It looks at the mechanism of normal micturition and describes the theories of AUR. It outlines urethral catheterization techniques for difficult cases, reviews suprapubic catheterization procedures and describes the management of AUR in polytrauma. Although emergency management is by bladder drainage, key points in the history and examination may expose significant, latent pathologies.

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

    Directory of Open Access Journals (Sweden)

    ANDREEA PAULA DUMITRU

    2011-04-01

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

  12. Integration of woodland caribou habitat management and forest management in northern Ontario - current status and issues

    Directory of Open Access Journals (Sweden)

    Ted (E.R Armstrong

    1998-03-01

    Full Text Available Woodland caribou {Rangifer tarandus caribou range across northern Ontario, occurring in both the Hudson Bay Lowlands and the Boreal Forest. Woodland caribou extend south well into the merchantable forest, occurring in licensed and/or actively managed Forest Management Units (FMU's across the province. Caribou range has gradually but continuously receded northward over the past century. Since the early 1990's, the Ontario Ministry of Natural Resources (OMNR has been developing and implementing a woodland caribou habitat management strategy in northwestern Ontario. The purpose of the caribou habitat strategy is to maintain woodland caribou occupancy of currently occupied range in northwestern Ontario. Long-term caribou habitat needs and predator-prey dynamics form the basis of this strategy, which requires the development of a landscape-level caribou habitat mosaic across the region within caribou range. This represents a significant change from traditional forest management approaches, which were based partially upon moose (Alces alces habitat management principles. A number of issues and concerns regarding implications of caribou management to the forest industry are being addressed, including short-term and long-term reductions in wood supply and wood quality, and increased access costs. Other related concerns include the ability to regenerate forests to pre-harvest stand conditions, remote tourism concerns, implications for moose populations, and required information on caribou biology and habitat. The forest industry and other stakeholders have been actively involved with the OMNR in attempting to address these concerns, so that caribou habitat requirements are met while ensuring the maintenance of a viable timber industry, other forest uses and the forest ecosystem.

  13. Current Approaches Regarding the Knowledge Management Impact on SMEs Performance

    Directory of Open Access Journals (Sweden)

    Ionela Carmen RIZEA (PIRNEA

    2011-12-01

    Full Text Available Managing knowledge is a critical capability for small to medium-sized enterprises (SMEs to master because it helps them leverage their most critical resource. Organizational knowledge is the most salient resource at the disposal of SMEs in terms of availability, access, and depth. Successful SMEs are those who can leverage their knowledge in an effective and efficient manner, so as to make up for deficiencies in traditional resources, like land, labor, and capital. The purpose of this article is to identify the knowledge management impact on SMEs performance and to compare knowledge management in SMEs with knowledge management in large companies. The research discovered that SMEs do not manage knowledge the same way as larger organizations.

  14. Regimes internacionais

    OpenAIRE

    Meireles, André Bezerra

    2004-01-01

    Dissertação (mestraddo) - Universidade Federal de Santa Catarina, Centro de Ciências Jurídicas. Programa de Pós-Graduação em Direito. Qual o papel dos regimes internacionais com relação ao comportamento dos agentes das relações internacionais contemporâneas, em especial, o Estado? Dentro das negociações de uma esfera internacional caracterizada por uma forte interdependência econômica, verificada a existência de múltiplos canais de conexões entre as sociedades, e uma tendência contínua p...

  15. Time-resolved magneto-optical imaging of Y{sub 1}Ba{sub 2}Cu{sub 3}O{sub 7-{delta}} thin films in high-frequency AC current regime

    Energy Technology Data Exchange (ETDEWEB)

    Lucarelli, A [Department of Applied Science, College of William and Mary, Williamsburg, VA 23187-8795 (United States); Luepke, G [Department of Applied Science, College of William and Mary, Williamsburg, VA 23187-8795 (United States); Haugan, T J [Air Force Research Laboratory, Wright-Patterson AFB, OH 45433-7919 (United States); Levin, G A [Air Force Research Laboratory, Wright-Patterson AFB, OH 45433-7919 (United States); Barnes, P N [Air Force Research Laboratory, Wright-Patterson AFB, OH 45433-7919 (United States)

    2006-06-15

    We present a time-resolved magneto-optical (MO) imaging study of high-temperature superconductor (HTS) in a high-frequency alternating current (AC) regime. The evolution of the magnetic flux density distribution in YBa{sub 2}Cu{sub 3}O{sub 7-{delta}} (YBCO) thin film samples is studied as a function of the phase of the applied AC current. A quantitative analysis of the data shows that the maxima of the AC current density is shifted from the edges further inside the sample, which may be caused by the higher self-induced field in that region. This technique can be used to study magnetic flux evolution in HTS films and coated conductors in the high-frequency current regime.

  16. Prognostics and Health Management of Wind Turbines: Current Status and Future Opportunities

    Energy Technology Data Exchange (ETDEWEB)

    Sheng, Shuangwen

    2016-10-04

    This presentation was given at the 2016 Annual Conference of the Prognostics and Health Management Society. It covers the current status and challenges and opportunities of prognostics and health management of wind turbines.

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

    Directory of Open Access Journals (Sweden)

    Prof. Ph.D. Gheorghe Popescu

    2008-12-01

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

  18. Current problems in the management of marine fisheries.

    Science.gov (United States)

    Beddington, J R; Agnew, D J; Clark, C W

    2007-06-22

    The public perception of fisheries is that they are in crisis and have been for some time. Numerous scientific and popular articles have pointed to the failures of fisheries management that have caused this crisis. These are widely accepted to be overcapacity in fishing fleets, a failure to take the ecosystem effects of fishing into account, and a failure to enforce unpalatable but necessary reductions in fishing effort on fishing fleets and communities. However, the claims of some analysts that there is an inevitable decline in the status of fisheries is, we believe, incorrect. There have been successes in fisheries management, and we argue that the tools for appropriate management exist. Unfortunately, they have not been implemented widely. Our analysis suggests that management authorities need to develop legally enforceable and tested harvest strategies, coupled with appropriate rights-based incentives to the fishing community, for the future of fisheries to be better than their past.

  19. Current treatment options for the management of esophageal cancer

    Directory of Open Access Journals (Sweden)

    Mawhinney MR

    2012-11-01

    Full Text Available Mark R Mawhinney, Robert E GlasgowDepartment of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USAAbstract: In recent years, esophageal cancer characteristics and management options have evolved significantly. There has been a sharp increase in the frequency of esophageal adenocarcinoma and a decline in the frequency of squamous cell carcinoma. A more comprehensive understanding of prognostic factors influencing outcome has also been developed. This has led to more management options for esophageal cancer at all stages than ever before. A multidisciplinary, team approach to management in a high volume center is the preferred approach. Each patient should be individually assessed based on type of cancer, local or regional involvement, and his or her own functional status to determine an appropriate treatment regimen. This review will discuss management of esophageal cancer relative to disease progression and patient functional status.Keywords: esophageal adenocarcinoma, squamous cell carcinoma, treatment regimen, disease progression, patient functional status

  20. Current Credit Risk Management Practices in Chinese Banking Industry

    OpenAIRE

    Zheng, Hao

    2008-01-01

    ABSTRACT Bank loans can be characterized as the engine of the Chinese economy as the economy is almost financed by bank loans. As a result, Credit risk management in Chinese banks is not only the issue to those banks, but it is also essential to the stability of the whole economy. Inadequate credit risk management practices can create an unforeseeable disaster to China in the future, especially with a significant increase in credit expansion. In the last decade, the government has tried ha...

  1. Current practice in out-of-hospital cardiac arrest management

    DEFF Research Database (Denmark)

    Proclemer, Alessandro; Dobreanu, Dan; Pison, Laurent

    2012-01-01

    AIMS: The purpose of this EP wire is to examine clinical practice in the field of out-of-hospital cardiac arrest (OHCA) management, with special focus on in-hospital diagnostic and therapeutic strategies. METHODS AND RESULTS: Fifty-three European centres, all members of the EHRA-EP Research network...... management strategy, including coronary angiography/PCI and implantable cardioverter defibrillator therapy, while therapeutic hypothermia appears to be underused....

  2. Current Concepts in the Management of Postoperative Nausea and Vomiting

    Directory of Open Access Journals (Sweden)

    S. Chatterjee

    2011-01-01

    Full Text Available Postoperative nausea and vomiting (PONV are still common following surgery. This is not only distressing to the patient, but increases costs. The thorough understanding of the mechanism of nausea and vomiting and a careful assessment of risk factors provide a rationale for appropriate management of PONV. Strategy to reduce baseline risk and the adoption of a multimodal approach will most likely ensure success in the management of PONV.

  3. Management of opioid addiction with buprenorphine: French history and current management

    Directory of Open Access Journals (Sweden)

    Poloméni P

    2014-03-01

    pathophysiologic mechanisms of the disease, better knowledge of the pharmacology of opioid substitution treatments, and clear definition of short-, medium- and long-term treatment objectives. Data related to the management of opioid addiction by general practitioners in France have been published in 2005. Since then, the context has changed, other drugs were launched on the market such as generics of buprenorphine, methadone capsule, and Suboxone. Thus, an update seems necessary. This paper provides a description of opioid addiction management objectives and treatment modalities for general practitioners, based on currently available knowledge. Keywords: opioid addiction, withdrawal, opioid substitution treatment, buprenorphine, naloxone, general medicine

  4. Resilience of river flow regimes.

    Science.gov (United States)

    Botter, Gianluca; Basso, Stefano; Rodriguez-Iturbe, Ignacio; Rinaldo, Andrea

    2013-08-06

    Landscape and climate alterations foreshadow global-scale shifts of river flow regimes. However, a theory that identifies the range of foreseen impacts on streamflows resulting from inhomogeneous forcings and sensitivity gradients across diverse regimes is lacking. Here, we derive a measurable index embedding climate and landscape attributes (the ratio of the mean interarrival of streamflow-producing rainfall events and the mean catchment response time) that discriminates erratic regimes with enhanced intraseasonal streamflow variability from persistent regimes endowed with regular flow patterns. Theoretical and empirical data show that erratic hydrological regimes typical of rivers with low mean discharges are resilient in that they hold a reduced sensitivity to climate fluctuations. The distinction between erratic and persistent regimes provides a robust framework for characterizing the hydrology of freshwater ecosystems and improving water management strategies in times of global change.

  5. World Nonproliferation Regime

    Institute of Scientific and Technical Information of China (English)

    Ouyang Liping; Wu Xingzuo

    2007-01-01

    2006 witnessed an intense struggle between nuclear proliferation and nonproliferation. Iran's nuclear issue and North Korea's nuclear test have cast a deep shadow over the current international nonproliferation regime. The international contest for civil nuclear development became especially fierce as global energy prices went up. Such a situation , to some extent, accelerated the pace of nuclear proliferation. Furthermore, the existing international nonproliferation regime, based upon the Nuclear Nonproliferation Treaty (NPT), was affected by loopholes, and the U.S. failed in its ambition to unite other forces to mend fences. The international community needs to come up with a comprehensive and long-term strategy to meet the demand for an effective future nonproliferation regime in a healthy nuclear order.

  6. Thinkings of Management Regime of Basin Water Resources in France%法国流域水资源管理的模式及启示

    Institute of Scientific and Technical Information of China (English)

    寇怀忠

    2015-01-01

    In France, drinking water supply network is accessible to 90%inhabitants,and 95%domestic waste water is treated. The modern regime of water resources management with natural hydrologic basin as unit in France has yielded gained good results and it has important impacts on management mode of water resources and aquatic environment in Europe. By presenting and analyzing management experiences of Loire-Bretagne basin water resources, this paper is aimed to provide clear insights into modern management regime of France basin water resources, and is expected to be helpful to management reforming and sustainable development of basin water resources in China.%在法国,99%的居民都能用上供水管网的水,95%的生活污水得到处理.法国以水文自然流域为基本单元的现代水资源管理模式,取得了非常好的效果,其成功经验对欧盟水资源水环境的管理模式产生了很大影响.旨在通过介绍和分析卢瓦尔—布列塔尼流域水资源管理实践,了解法国流域水资源管理的模式,以期为我国流域水资源的管理改革和可持续发展提供有益借鉴.

  7. Grade 4 renal injury: current trend of management and

    Directory of Open Access Journals (Sweden)

    Ho Yiu Ming

    2011-04-01

    Full Text Available 【Abstract】The management of blunt renal trauma has been evolving. The past management largely based on American Association for Surgery of Trauma (AAST grading system, i.e. necessitated a computed tomography (CT scan. Although the CT scan use is increasing and becomes the standardized mode of investigation, AAST grading no longer plays the sole role in the decision of surgical interventions. Two case reports of blunt renal trauma managed successfully by conservative methods are presented. Case one was an 18 year-old boy who had a fall when riding a motorbike at 20 km/h with a helmet and full protective equipments. He was landed by his left flank onto a rock. Contrast abdominal CT revealed a 4 cm, grade III splenic tear and a grade IV left kidney injury with large perirenal haematoma. His international severity score (ISS was 34. He was managed conservatively with bed rest and frequent serum haemoglobin monitoring. Subsequent CT with delayed contrast revealed stable perirenal haematoma with urine extravasation which was consistent with a grade IV renal injury. Case two was a 40 year-old male who had a motor bike accident on a racetrack when he was driving at 80 to 100 km/h, wearing a helmet. He lost control and hit onto the sidewall of the racetrack. Contrast abdominal CT revealed a grade IV left renal injury with a large urine extravasation. His renal injury was managed conservatively with interval delayed phase CT of the abdomen. A repeat CT on abdomen was performed five months after the initial injury which revealed no residual urinoma. In this study, moreover, a review of the literature to the management of blunt renal trauma was conducted to demonstrate the trend of increasing conservative management of such traumas. Extra radiological parameters may guide future decision making. However, the applicability of data may be limited until randomized trials are available. Key words: Renal trauma; International classification of diseases

  8. [Modern airway management--current concepts for more patient safety].

    Science.gov (United States)

    Timmermann, Arnd

    2009-04-01

    Effective and safe airway management is one of the core skills among anaesthesiologists and all physicians involved in acute care medicine. However, failure in airway management is still the most frequent single incidence with the highest impact on patient's morbidity and mortality known from closed claims analyses. The anaesthesiologist has to manage the airway in elective patients providing a high level of safety with as little airway injury and interference with the cardio-vascular system as possible. Clinical competence also includes the management of the expected and unexpected difficult airway in different clinical environments. Therefore, it is the anaesthesiologist's responsibility not only to educate and train younger residents, but also all kinds of medical personnel involved in airway management, e.g. emergency physicians, intensive care therapists or paramedics. Modern airway devices, strategies and educational considerations must fulfill these sometimes diverse and large range requirements. Supraglottic airway devices will be used more often in the daily clinical routine. This is not only due the multiple advantages of these devices compared to the tracheal tube, but also because of the new features of some supraglottic airways, which separate the airway from the gastric track and give information of the pharyngeal position. For the event of a difficult airway, new airway devices and concepts should be trained and applied in daily practice.

  9. The current state of personal training: managers' perspectives.

    Science.gov (United States)

    Melton, Deana I; Dail, Teresa K; Katula, Jeffrey A; Mustian, Karen M

    2010-11-01

    Fitness managers play an integral role in the day-to-day operation of the facilities in which they work. One of the most critical responsibilities is that of hiring, training, and supervising personal trainers. Research studies have identified a number of qualities and competencies that an effective exercise leader is required to have, but there is little scholarly work addressing managers' attitudes surrounding the performance of personal trainers. Using focus group methodology, managers of personal trainers were recruited to provide viewpoints related to desirable qualities of personal trainers and opinions regarding certification and academic preparation. Responses of the participants were transcribed, coded, and analyzed for themes. Two global themes, Selection Rationale and Negative Characteristics, emerged. Selection Rationale consisted of qualities that influence a manager's decision to hire a particular trainer (e.g., physique, education, social skills). Negative characteristics referred to qualities considered unethical or unprofessional (e.g., sexual comments, misuse of power) and the consequences of those behaviors (e.g., loss of clients, potential for litigation). The results suggest that undergraduate exercise science programs devote additional time toward the development of the affective qualities of future fitness trainers. Managers also recommended licensure for employees.

  10. Pediatric airway management: current practices and future directions.

    Science.gov (United States)

    Sunder, Rani A; Haile, Dawit T; Farrell, Patrick T; Sharma, Anshuman

    2012-10-01

    Management of a pediatric airway can be a challenge, especially for the non-pediatric anesthesiologists. Structured algorithms for an unexpected difficult pediatric airway have been missing so far. A recent step wise algorithm, based on the Difficult Airway society (DAS) adult protocol, is a step in the right direction. There have been some exciting advances in development of pediatric extra-glottic devices for maintaining ventilation, and introduction of pediatric versions of new 'non line of sight' laryngoscopes and optical stylets. The exact role of these devices in routine and emergent situations is still evolving. Recent advances in simulation technology has become a valuable tool in imparting psychomotor and procedural skills to trainees and allied healthcare workers. Moving toward the goal of eliminating serious adverse events during the management of routine and difficult pediatric airway, authors propose that institutions develop a dedicated Difficult Airway Service comprising of a team of experts in advanced airway management. © 2012 Blackwell Publishing Ltd.

  11. Employee Internet management: current business practices and outcomes.

    Science.gov (United States)

    Case, Carl J; Young, Kimberly S

    2002-08-01

    This paper empirically examines emergent business practices that attempt to reduce and control employee Internet misuse and abuse. Over a 6-month period, 52 web-administered surveys were collected. Respondents ranged from human resource managers to company presidents. Data were stored in a database management system and analyzed utilizing statistical measures. Monitoring efforts and policy development issues are examined against critical incidents of employee Internet abuse. The analysis also includes a rank ordering of the types of Internet applications that were perceived as most problematic or abused. Types of applications abused include electronic mail, adult web sites, online gaming, chat rooms, stock trading, and so on. Moreover, company size and years online are examined. Overall, this research will assist organizations in implementing effective corporate initiatives to improve employee Internet management practices.

  12. Current concepts in the management of Clostridium tetani infection.

    Science.gov (United States)

    Brook, Itzhak

    2008-06-01

    This review summarizes the microbiology, management and prevention of tetanus. Tetanus is an acute toxemic illness caused by Clostridium tetani infection at a laceration or break in the skin. It can also occur as a complication of burns, puerperal infections, umbilical stumps (tetanus neonatorum) and surgical-site infection. Tetanus is an intoxication, manifested mostly by neuromuscular dysfunction, caused by tetanal exotoxin (tetanospasmin), a potent exotoxin produced by C. tetani. It starts with tonic spasms of the skeletal muscles and is followed by paroxysmal contractions. The muscle stiffness initially involves the jaw (lockjaw) and neck and later becomes generalized. Treatment goals include interrupting the production of toxin, neutralizating the unbound toxin, controlling muscle spasms, managing dysautonomia and appropriate supportive management. Specific therapy includes intramuscular administration of tetanus immunoglobulin to neutralize circulating toxin before it binds to neuronal cell membranes. The disease can be prevented by immunization with tetanal toxoid and appropriate wound care.

  13. Current concepts in the management of disseminated intravascular coagulation.

    Science.gov (United States)

    Thachil, Jecko; Toh, Cheng Hock

    2012-04-01

    Disseminated Intravascular Coagulation is a clinicopathological syndrome where widespread intravascular coagulation occurs in response to an inciting process. The pathophysiology for this disorder is complex with an important role for thrombin, the central regulator of the coagulation process. Since the clinical spectrum of DIC is variable due to its dynamic nature, the laboratory diagnosis should ideally be not based on a single marker or an isolated set of results. The treatment should primary focus on the management of the underlying triggering condition with blood products used as resuscitative measures. Newer therapeutic modalities have been recently tried with success although the management of DIC still remains a major challenge.

  14. Talent management : Current theories and future research directions

    NARCIS (Netherlands)

    Al Ariss, A.; Cascio, W.F.; Paauwe, J.

    2014-01-01

    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.

  15. A review of the current literature on management of halitosis.

    NARCIS (Netherlands)

    Broek, A.M. van den; Feenstra, L.; Baat, C. de

    2008-01-01

    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 me

  16. A review of the current literature on management of halitosis.

    NARCIS (Netherlands)

    Broek, A.M. van den; Feenstra, L.; Baat, C. de

    2008-01-01

    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

  17. Management and employee control in current industrial work

    DEFF Research Database (Denmark)

    Holt, Helle; Hvid, Helge

    2014-01-01

    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...

  18. Managing Current Complexity: Critical Energy Infrastructure Failures in North America

    Directory of Open Access Journals (Sweden)

    Colin MacDonald

    2012-04-01

    Full Text Available

    This paper applies the competing theories of High Reliability Organizations (HRO and Normal Accidents Theory (NAT, two competing views of risk management in highly-complex and tightly-coupled systems, in analyzing the 1998 Ice Storm and the 2003 Blackout to examine vulnerabilities in North America’s critical energy infrastructure (CEI. Inferences are then made by highlighting the similarities and differences in the two cases, which are then used to draw lessons for public managers regarding the protection of CEIs.

     

    As CEIs are highly-complex and tightly-coupled systems, failures stemming from complex and uncertain risks are inevitable. There is an increasingly low tolerance for failure in energy infrastructure because society’s critical infrastructures have become increasingly interdependent. Public managers must regulate CEIs in order to ensure an emphasis is placed on safety and security while also finding ways to reduce unnecessary complexities. It is through the adoption of such measures that public managers will aid in minimizing the cascading effects of inevitable failures.

     

  19. The Current Role of Endourologic Management of Renal Transplantation Complications

    Directory of Open Access Journals (Sweden)

    Brian D. Duty

    2013-01-01

    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.

  20. Current Challenges in Higher Education Administration and Management

    Science.gov (United States)

    Baldwin, Jon F.

    2009-01-01

    UK higher education has a proud tradition stretching back centuries, with St. Andrews almost 600 years old, and teaching having existed at Oxford for more than 900 years. There is no reason why universities established more recently should not demonstrate similar longevity. The management of stakeholders has always been central to the successful…

  1. Current Challenges in Higher Education Administration and Management

    Science.gov (United States)

    Baldwin, Jon F.

    2009-01-01

    UK higher education has a proud tradition stretching back centuries, with St. Andrews almost 600 years old, and teaching having existed at Oxford for more than 900 years. There is no reason why universities established more recently should not demonstrate similar longevity. The management of stakeholders has always been central to the successful…

  2. [Current management of nonvariceal upper gastrointestinal bleeding in Spain].

    Science.gov (United States)

    Pérez Aisa, Angeles; Nuevo, Javier; López Morante, Anibal Alejandro; González Galilea, Angel; Martin de Argila, Carlos; Aviñoa Arreal, David; Feu, Faust; Borda Celaya, Fernando; Gisbert, Javier P; Pérez Roldan, Francisco; Gonzalvo Sorribes, José Manuel; Palazón Azorín, José María; Ponce Romero, Marta; Castro Fernández, Manuel; Catalina Rodriguez, M Vega; Gallego Montañés, Sonia; Calvet, Xavier; Rodrigo Saez, Luis; Montoro Huguet, Miguel; González Méndez, Yanira; Sierra Hernández, Angel; Sánchez Hernández, Eloy; Dominguez Muñoz, Enrique; Pérez Cuadrado, Enrique; Muñoz, Maria; Lanas, Angel

    2012-01-01

    Mortality related to nonvariceal upper gastrointestinal bleeding (NVUGIB) has not changed. More information is needed to improve the management of this entity. The aims of this study were: a) to determine the characteristics of bleeding episodes, b) to describe the clinical approaches routinely used in NVUGIB, and c) to identify adverse outcomes related to endoscopic or medical treatments in Spain. The European survey of nonvariceal upper GI bleeding (ENERGiB) was an observational, retrospective cohort study on NVUGIB with endoscopic evaluation carried out across Europe. The present study focused on Spanish patients in the ENERGiB study. The patients were managed according to routine care. The mean and standard deviation were calculated for quantitative variables and absolute and relative frequencies were calculated for categorical variables. Patients (n=403) were mostly men (71%), with a mean age of 65 years, and co-morbidities (62.5%). Most of the patients were managed by gastroenterologists (57.1%) or internal medicine teams (25.1%). A proton pump inhibitor was used empirically in 80% before endoscopy. Bleeding persistence occurred in 6.4% and recurrence in 6.7%. The mortality rate at 30 days was 3.5%. This study contributes to the characterization of Spanish patients and NVUGIB episodes in a real clinical setting and identifies the routine management of this entity, which is in line with the standards proposed by recent clinical practice guidelines. A notable finding was that age and the number of comorbidities in NVUGIB patients were increasing. These factors could explain the persistent mortality rate, despite the evident advances in the management of this entity. Copyright © 2011 Elsevier España, S.L. y AEEH y AEG. All rights reserved.

  3. Comparison of pollen gene flow among four European beech (Fagus sylvatica L.) populations characterized by different management regimes

    NARCIS (Netherlands)

    Piotti, A.; Leonardi, S.; Buiteveld, J.; Geburek, T.; Gerber, S.; Kramer, K.; Vettori, C.; Vendramin, G.G.

    2012-01-01

    The study of the dispersal capability of a species can provide essential information for the management and conservation of its genetic variability. Comparison of gene flow rates among populations characterized by different management and evolutionary histories allows one to decipher the role of fac

  4. Resilience, Regime Shifts, and Guided Transition under Climate Change: Examining the Practical Difficulties of Managing Continually Changing Systems

    Directory of Open Access Journals (Sweden)

    Brenda B. Lin

    2013-03-01

    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.

  5. Current treatment options for management of anal intraepithelial neoplasia

    Science.gov (United States)

    Weis, Stephen E

    2013-01-01

    inflammatory response. Successful treatment requires adherence to a regime that is uncomfortable at best and at worst painful. Topical treatments can be successful in motivated adherent patients willing to accept these side effects. PMID:23788834

  6. Contrasting effects of managed opening regimes on water quality in two intermittently closed and open coastal lakes

    Science.gov (United States)

    Schallenberg, M.; Larned, S. T.; Hayward, S.; Arbuckle, C.

    2010-03-01

    Intermittently closed and open lakes and lagoons (ICOLLs) are shallow barrier lakes which are intermittently connected to the sea and experience saline intrusions. Many ICOLLs are mechanically opened to prevent flooding of surrounding agricultural and urban land and to flush water of poor quality. In this study, the effects of modified opening regimes (frequency and duration of barrier openings and closures) on water quality and phytoplankton in two New Zealand ICOLLs were investigated over a number of opening/closure cycles. Water quality in Lake Ellesmere (Te Waihora) responded weakly to both opening and closing events, indicating that sea-ICOLL exchange did not markedly improve water quality. Conversely, water quality in Waituna Lagoon responded rapidly to barrier openings; water level decreased to near sea level within days of opening and subsequent seawater exchange resulted in rapid decreases in nitrate and chlorophyll a concentrations. The closure of Waituna Lagoon resulted in rapid rise in water level and a pulse of nitrate and phosphorus in the water column and phytoplankton chlorophyll a concentrations increased with increasing closed-period duration. Based on data on the underwater light climate and nutrient dynamics, phytoplankton in Lake Ellesmere was probably light-limited, whereas phytoplankton in Waituna Lagoon was rarely light-limited, and appeared to be predominately P-limited. The marked differences in responses of Lake Ellesmere and Waituna Lagoon to barrier openings and closures reflected differences in ICOLL water levels and morphological characteristics, which dictated the degree of tidal flushing when the barriers were open. The inter-ICOLL differences observed in this study indicate that unless the effects of ICOLL openings/closures on phytoplankton and nutrient dynamics are understood, changes to ICOLL opening regimes may have unintended consequences for the water quality and ecology of these systems.

  7. Acute Aortic Syndromes: Update in Current Medical Management.

    Science.gov (United States)

    Morris, Jacqueline H; Mix, Doran; Cameron, Scott J

    2017-04-01

    Advances in medical therapy and non-surgical percutaneous options to manage the specter of acute aortic syndromes have improved both patient morbidity and mortality. There are key features in the patient history and initial exam which physicians should be attuned to in order to diagnose acute aortic syndromes such as aortic dissection, penetrating aortic ulcer, and intramural hematoma. Once recognized, early initiation of the appropriate pharmacologic therapy is important, and further appreciating the limitations of such therapy before considering a surgical approach is critical to improve patient outcomes. For the undifferentiated patient with acute aortic dissection presenting to facilities who do not routinely manage this condition, adding pharmacologic agents in the correct sequence assures the best chance for a satisfactory outcome.

  8. Current Chemotherapeutic Management of Patients with Gestational Trophoblastic Neoplasia

    Directory of Open Access Journals (Sweden)

    Taymaa May

    2011-01-01

    Full Text Available Gestational trophoblastic neoplasia (GTN describes a heterogeneous group of interrelated lesions that arise from abnormal proliferation of placental trophoblasts. GTN lesions are histologically distinct, malignant lesions that include invasive hydatidiform mole, choriocarcinoma, placental site trophoblastic tumor (PSTT and epithelioid trophoblastic tumor (ETT. GTN tumors are generally highly responsive to chemotherapy. Early stage GTN disease is often cured with single-agent chemotherapy. In contrast, advanced stage disease requires multiagent combination chemotherapeutic regimens to achieve a cure. Various adjuvant surgical procedures can be helpful to treat women with GTN. Patients require careful followup after completing treatment and recurrent disease should be aggressively managed. Women with a history of GTN are at increased risk of subsequent GTN, hence future pregnancies require careful monitoring to ensure normal gestational development. This article will review the workup, management and followup of women with all stages of GTN as well as with recurrent disease.

  9. Current Management Strategy for Active Surveillance in Prostate Cancer.

    Science.gov (United States)

    Syed, Jamil S; Javier-Desloges, Juan; Tatzel, Stephanie; Bhagat, Ansh; Nguyen, Kevin A; Hwang, Kevin; Kim, Sarah; Sprenkle, Preston C

    2017-02-01

    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.

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

    Science.gov (United States)

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

    2016-01-01

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

  11. Aquatic Plant Management Program current status and seasonal workplan

    Energy Technology Data Exchange (ETDEWEB)

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

    1993-07-01

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

  12. Current clinical management strategies for benign prostatic hyperplasia

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xiang-hua

    2008-01-01

    @@ This article summarizes the major new findings on clinical management for benign prostatic hyperplasia (BPH) that were presented at the annual meeting of the American Urological Association (AUA) in May 2008.The management of symptomatic BPH has been changed significantly over the last decade in response to the availability of new treatment options.Prior to the 1980s,open prostatectomy was the only widely accepted intervention for BPH.Since then,the advent of new medical therapies for BPH and the introduction of a range of minimally invasive therapies have provided for men with lower urinary tract symptoms (LUTS) secondary to BPH.1 In this year's AUA meeting,several new findings were reported in the filed of BPH which involved epidemiology,clinical progression,drug therapy and new technologies in surgical therapy of BPH.

  13. Current trends in the management of acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Srinivasan Paramasivam

    2015-01-01

    Full Text Available Stroke is the leading cause of disability and most of the cases are those of ischemic stroke. Management strategies especially for large vessel occlusive stroke have undergone a significant change in the recent years that include widespread use of thrombolytic medications followed by endovascular clot removal. For successful treatment by endovascular thrombectomy, the important factors are patient selection based on clinical criterion including age, time of onset, premorbid clinical condition, co-morbidities, National Institute of Health Stroke Scale, and imaging criterion including computed tomography (CT head, CT angiogram and CT perfusion. Patients presenting within 4.5 hours of onset are considered for intravenous (IV recombinant tissue plasminogen activator treatment. Mechanical clot retrieval devices have evolved over the past decade. The Mechanical Embolus Removal in Cerebral Ischemia device was approved first followed by the penumbra revascularization system. They have proven in various studies to improve recanalization with acceptable rates of symptomatic intra-cerebral hemorrhage. Introduction of stent retrievers has led to a new era in the interventional management of acute ischemic stroke (AIS. Recent trials namely MRCLEAN, ESCAPE, SWIFT PRIMEs, and EXTEND-IA have used the stent retriever predominantly and have shown unequivocal benefit in the outcome at 90 days for AIS patients with large vessel occlusion. More recently, a new catheter namely 5 MAX ACE was introduced along with improvement in the suction device. This has led to a direct aspiration first pass technique resulting in faster recanalization. Advancements in the endovascular management of AIS with large vessel occlusion have resulted in a paradigm shift in the way this disease is managed. Improvements in patient selection using clinical and imaging criterion along with technical and technological advancements in mechanical thrombectomy have made possible a significantly

  14. Current trends in the management of acute ischemic stroke.

    Science.gov (United States)

    Paramasivam, Srinivasan

    2015-01-01

    Stroke is the leading cause of disability and most of the cases are those of ischemic stroke. Management strategies especially for large vessel occlusive stroke have undergone a significant change in the recent years that include widespread use of thrombolytic medications followed by endovascular clot removal. For successful treatment by endovascular thrombectomy, the important factors are patient selection based on clinical criterion including age, time of onset, premorbid clinical condition, co-morbidities, National Institute of Health Stroke Scale, and imaging criterion including computed tomography (CT) head, CT angiogram and CT perfusion. Patients presenting within 4.5 hours of onset are considered for intravenous (IV) recombinant tissue plasminogen activator treatment. Mechanical clot retrieval devices have evolved over the past decade. The Mechanical Embolus Removal in Cerebral Ischemia device was approved first followed by the penumbra revascularization system. They have proven in various studies to improve recanalization with acceptable rates of symptomatic intra-cerebral hemorrhage. Introduction of stent retrievers has led to a new era in the interventional management of acute ischemic stroke (AIS). Recent trials namely MRCLEAN, ESCAPE, SWIFT PRIMEs, and EXTEND-IA have used the stent retriever predominantly and have shown unequivocal benefit in the outcome at 90 days for AIS patients with large vessel occlusion. More recently, a new catheter namely 5 MAX ACE was introduced along with improvement in the suction device. This has led to a direct aspiration first pass technique resulting in faster recanalization. Advancements in the endovascular management of AIS with large vessel occlusion have resulted in a paradigm shift in the way this disease is managed. Improvements in patient selection using clinical and imaging criterion along with technical and technological advancements in mechanical thrombectomy have made possible a significantly improved outcome

  15. Current debate in the oncologic management of rectal cancer.

    Science.gov (United States)

    Millard, Trish; Kunk, Paul R; Ramsdale, Erika; Rahma, Osama E

    2016-10-15

    Despite the considerable amount of research in the field, the management of locally advanced rectal cancer remains a subject to debate. To date, effective treatment centers on surgical resection with the standard approach of total mesorectal resection. Radiation therapy and chemotherapy have been incorporated in order to decrease local and systemic recurrence. While it is accepted that a multimodality treatment regimen is indicated, there remains significant debate for how best to accomplish this in regards to order, dosing, and choice of agents. Preoperative radiation is the standard of care, yet remains debated with the option for chemoradiation, short course radiation, and even ongoing studies looking at the possibility of leaving radiation out altogether. Chemotherapy was traditionally incorporated in the adjuvant setting, but recent reports suggest the possibility of improved efficacy and tolerance when given upfront. In this review, the major studies in the management of locally advanced rectal cancer will be discussed. In addition, future directions will be considered such as the role of immunotherapy and ongoing trials looking at timing of chemotherapy, inclusion of radiation, and non-operative management.

  16. CURRENT METHODS OF MANAGEMENT OF INTEGRATED CORPORATE STRUCTURES

    Directory of Open Access Journals (Sweden)

    Makarevich O. A.

    2016-09-01

    Full Text Available The article summarizes the results of a study devoted to the solution of actual problems of management of corporate integrated structures. Among the significant scientific results are presented: methods of evaluating the development of corporate integrated structures of the agro-industrial sector operating in the absence of a legislative base; substantiation of actual problems of management of corporate integrated structures on the example of a typical representative of this sector of the economy and developed a multi-tasking method of system analysis, directions for solving the identified problems; methods and models of design of control system corporate integrated structures and alternative options for organizational structures, their evaluation based on the use of methods of mass service theory and the choice of variant by criterion the average time of document management system; developed the organizational-economic mechanism of strategic planning and a set of interrelated models obtained using the method of systemic-cognitive analysis, which allows on the basis of the accumulated information on the activities of the organizations included in the corporate integrated structures to obtain the predicted values of the system indices when setting the target value of one of them; methods of control of the chain of value creation, allows us to develop structures of integrated systems with allocation in them of financial and material flows, and improved models for assessing effectiveness and calculating the parameters of technologically complete industrial chain and optimization model of the volume of material flow

  17. Smartphone applications to aid weight loss and management: current perspectives.

    Science.gov (United States)

    Sutton, Elizabeth F; Redman, Leanne M

    2016-01-01

    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.

  18. Current migraine management – patient acceptability and future approaches

    Directory of Open Access Journals (Sweden)

    Jean Schoenen

    2008-10-01

    Full Text Available Arnaud Fumal, Jean SchoenenDepartments of Neurology and Functional Neuroanatomy, Headache Research Unit, University of Liège, BelgiumAbstract: Despite its high prevalence and individual as well as societal burden, migraine remains underdiagnosed and undertreated. In recent years, the options for the management of migraine patients have greatly expanded. A number of drugs belonging to various pharmacological classes and deliverable by several routes are now available both for the acute and the preventive treatments of migraine. Nevertheless, disability and satisfaction remain low in many subjects because treatments are not accessible, not optimized, not effective, or simply not tolerated. There is thus still considerable room for better education, for more efficient therapies and for greater support from national health systems. In spite of useful internationally accepted guidelines, anti-migraine treatment has to be individually tailored to each patient taking into account the migraine subtype, the ensuing disability, the patient’s previous history and present expectations, and the co-morbid disorders. In this article we will summarize the phenotypic presentations of migraine and review recommendations for acute and preventive treatment, highlighting recent advances which are relevant for clinical practice in terms of both diagnosis and management.Keywords: migraine, disability, acute treatment, preventive treatment, management

  19. Airway Management of the Cardiac Surgical Patients: Current Perspective

    Science.gov (United States)

    Choudhury, Arindam; Gupta, Nishkarsh; Magoon, Rohan; Kapoor, Poonam Malhotra

    2017-01-01

    The difficult airway (DA) is a common problem encountered in patients undergoing cardiac surgery. However, the challenge is not only just establishment of airway but also maintaining a definitive airway for the safe conduct of cardiopulmonary bypass from initiation to weaning after surgical correction or palliation, de-airing of cardiac chambers. This review describes the management of the DA in a cardiac theater environment. The primary aims are recognition of DA both anatomical and physiological, necessary preparations for (and management of) difficult intubation and extubation. All patients undergoing cardiac surgery should initially be considered as having potentially DA as many of them have poor physiologic reserve. Making the cardiac surgical theater environment conducive to DA management is as essential as it is to deal with low cardiac output syndrome or acute heart failure. Tube obstruction and/or displacement should be suspected in case of a new onset ventilation problem, especially in the recovery unit. Cardiac anesthesiologists are often challenged with DA while inducing general endotracheal anesthesia. They ought to be familiar with the DA algorithms and possess skill for using the latest airway adjuncts. PMID:28074820

  20. Current status of managing diabetes mellitus in Korea.

    Science.gov (United States)

    Ha, Kyoung Hwa; Kim, Dae Jung

    2016-09-01

    Diabetes mellitus is an increasing global health problem. Guidelines for diabetic care recommend management of lifestyle and risk factors (glucose, blood pressure, and cholesterol), as well as regular screening for complications associated with treatment of the conditions related to diabetes. The prevalence of diabetes increased from 8.6% to 11.0% from 2001 to 2013. According to the diabetes fact sheet 2015, the proportion of patients with diabetes treated with antihypertensive medications increased from 56.0% to 62.5% from 2006 to 2013, and 49.5% of those with diabetes were being treated with lipid-lowering medications in 2013, a 1.8-fold increase since 2006. According to the 2014 Korea National Health and Nutrition Examination Survey data, 45.6% of patients with diabetes achieved a hemoglobin A1c level of lipoprotein cholesterol 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.

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

    Science.gov (United States)

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

    2010-01-01

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

  2. Book Review: Current Issues in International Human Resource Management and Strategy Research

    DEFF Research Database (Denmark)

    Gretzinger, Susanne

    2009-01-01

    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....

  3. Book Review: Current Issues in International Human Resource Management and Strategy Research

    DEFF Research Database (Denmark)

    Gretzinger, Susanne

    2009-01-01

    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....

  4. Current nutritional approaches in managing autism spectrum disorder: A review.

    Science.gov (United States)

    Cekici, Hande; Sanlier, Nevin

    2017-08-01

    The link between nutrition and autism spectrum disorder (ASD), which is a complex developmental disorder manifesting itself in significant delays or deviation in interaction and communication, has provided a fresh point of view and signals that nutrition may have a role in the aetiology of ASD, as well as play an active role in treatment by alleviating symptoms. In this review study aimed at evaluating, with scientific and concrete proof, the current medical nutrition implementations on ASD, existing medical nutrition therapies have been addressed and their effects on ASD symptoms have been discussed in light of current research. We reviewed articles regarding the medical nutritional therapy of autism on current nutritional approaches selected from PubMed, Science Direct, EBSCO, and databases about autism and nutrition. The research put forward that in individuals with ASD, while gluten-free/casein-free and ketogenic diets, camel milk, curcumin, probiotics, and fermentable foods can play a role in alleviating ASD symptoms, consumption of sugar, additives, pesticides, genetically modified organisms, inorganic processed foods, and hard-to-digest starches may aggravate symptoms. Further prospective controlled trials with large sample sizes are needed before recommendations can be made regarding the ideal ASD diet. This review emphasizes the value of identifying current nutritional approaches specific to individuals with ASD and integrating their effects on symptoms to the conversation and presents suggestions for future research designed to identify medical nutrition therapies targeting this population to better understand the link between ASD and nutrition.

  5. Disturbingly Weak: The Current State of Financial Management Education in Library and Information Science Curricula

    Science.gov (United States)

    Burger, Robert H.; Kaufman, Paula T.; Atkinson, Amy L.

    2015-01-01

    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…

  6. Disturbingly Weak: The Current State of Financial Management Education in Library and Information Science Curricula

    Science.gov (United States)

    Burger, Robert H.; Kaufman, Paula T.; Atkinson, Amy L.

    2015-01-01

    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…

  7. Current treatment options for management of anal intraepithelial neoplasia

    Directory of Open Access Journals (Sweden)

    Weis SE

    2013-06-01

    -fluorouracil or imiquimod. Topical therapies have the advantage of being nonsurgical and are well suited for treating widespread multifocal disease. Topical treatments have the disadvantage of requiring extended treatment courses and causing a symptomatic inflammatory response. Successful treatment requires adherence to a regime that is uncomfortable at best and at worst painful. Topical treatments can be successful in motivated adherent patients willing to accept these side effects. Keywords: human papilloma virus, anal dysplasia, anal cancer, high-resolution anoscopy, infrared coagulation, perianal dermatosis

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

    Directory of Open Access Journals (Sweden)

    Elena Monti

    2010-08-01

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

  9. Smartphone applications to aid weight loss and management: current perspectives

    Directory of Open Access Journals (Sweden)

    Sutton EF

    2016-07-01

    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

  10. Current concepts in the management of necrotizing fasciitis

    Directory of Open Access Journals (Sweden)

    Evangelos P. Misiakos

    2014-09-01

    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.

  11. The current municipal solid waste management situation in Tibet.

    Science.gov (United States)

    Jiang, Jianguo; Lou, Zhiying; Ng, Silo; Luobu, Ciren; Ji, Duo

    2009-03-01

    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.

  12. LOCAL ANAESTHETIC SYSTEMIC TOXICITY: CURRENT CONCEPTS AND MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Lakshmi

    2014-03-01

    Full Text Available Local anesthetics are one of the most commonly used drugs in the field of medicine. Local anesthetics are widely used to induce anesthesia and analgesia for surgical procedures and pain management. Local an aesthetic systemic toxicity (LAST is a rare but potentially fatal complication of regional anesthesia and has been recognized and reported since the late1800s. This narrative review summarizes the pharmacology of local anesthetics, clinical manifestations of systemic toxicity associated with these agents, necessary preventive measures and recent treatment strategies

  13. [Dyslipidemia management with medical nutrition therapy: current status and perspectives].

    Science.gov (United States)

    Sucato, Vincenzo; Triolo, Oreste Fabio; Bronte, Enrico; Trovato, Rosaria Linda; Tona, Giuseppe Riccardo; Novo, Salvatore

    2013-09-01

    In Italy, patients with dyslipidemia account for 15-20% of the adult population with major healthcare and socio-economic impact. According to the ESC/EAS guidelines for the management of dyslipidemias, desirable cholesterol and triglyceride levels can be achieved with a synergy between drug treatment and adequate diet therapy. However, what diets should be adopted? In this review article, different types of dietary treatments are compared, with a special focus on diet education. The new scientific frontier of nutrigenetics is also discussed.

  14. Mooren′s ulcer : Current concepts in management

    Directory of Open Access Journals (Sweden)

    Sangwan Virender

    1997-01-01

    Full Text Available Mooren′s ulcer is strictly a peripheral ulcerative keratitis (PUK with no associated scleritis. It occurs completely in absence of any diagnosable systemic disorder that could be responsible for the progressive destruction of the cornea. The aetiology of Mooren′s ulcer remains uncertain. However, recent studies indicate that it is an autoimmune disease directed against a specific target molecule in the corneal stroma, probably triggered in genetically susceptible individuals by one of several possible provocateurs. Advances have been made in the management of this disease. Immunosuppressive therapy has been shown increasingly successful in patients unresponsive to conventional treatment and in bilateral progressive destructive ocular disease.

  15. Management of Hypertensive patient in the Dental Office - Current Concepts

    Directory of Open Access Journals (Sweden)

    T Maheswaran

    2006-01-01

    Full Text Available Dental patients with a significant medical condition like hypertension are more likely to be encountered in the dental office. Those with very high blood pressure are at great risk for acute medical problems while receiving dental treatment. Adverse oral effects and drug interactions of antihypertensive medications further indicates special considerations for the hypertensive patient. This article highlights the recent advances in the dental management of hypertension. It is important for the dentist to be aware of hypertension in relation to the practice of dentistry.

  16. Kawasaki disease: current aspects on aetiopathogenesis and therapeutic management.

    Science.gov (United States)

    Alexoudi, Iliana; Kanakis, Meletios; Kapsimali, Violetta; Vaiopoulos, George

    2011-07-01

    Kawasaki disease (KD) is a vasculitis that affects mainly children of 6 months to 4 years old. It is important to be early recognised so as to limit the inflammatory cascade that may lead to aneurysmatic dilatations of coronary arteries. The causative agent of KD has not been still indentified and the aetiopathogenetic theories are based on epidemiologic, laboratory and histological data. The management of the disease is divided according to the clinical stage and patients' follow up should be continued for years after the disease onset. The exact period is determined by the risk level of the KD.

  17. Current and new thinking in the management of comorbid insomnia.

    Science.gov (United States)

    Neubauer, David N

    2009-02-01

    Insomnia occurs predominantly in conjunction with a medical or psychiatric illness. New thinking regarding the treatment of comorbid insomnia has moved the field away from practices that called for treating the comorbid condition to resolve the coexisting insomnia to one in which the insomnia is treated as a separate condition. Although 10 medications currently are approved by the US Food and Drug Administration for the treatment of insomnia, only 2, eszopiclone and zolpidem, have been evaluated for efficacy in patients with chronic comorbid insomnia. Studies suggest clear benefits in comorbid insomnia. Nonpharmacologic treatments, such as cognitive behavioral therapy, sleep hygiene, and relaxation training, have also been investigated for comorbid insomnia, with studies suggesting these approaches may be effective either alone or in conjunction with medications. While behavioral issues should be optimized, clinicians need to customize treatments for patients with comorbid insomnia based on coexisting medical and psychiatric morbidities, age, medical history, current medications, and lifestyle issues.

  18. Current medical and surgical management of Raynaud's syndrome.

    Science.gov (United States)

    Landry, Gregory J

    2013-06-01

    Raynaud's syndrome (RS) is characterized by episodic digital ischemia induced by cold or emotional stress. Pathophysiologic mechanisms include temporary vasospasm and fixed digital artery obstruction. A number of pharmacologic and invasive therapies have been studied to treat RS symptoms; however, there are no specific treatments that are currently approved by the U.S. Food and Drug Administration specifically for RS. Of the available pharmacologic agents, calcium-channel blockers remain the preferred initial treatment for vasospastic RS, although many vasodilators have been studied and found to be efficacious. Vasodilators are less effective in treating digital artery obstruction, and no treatments have been found to be universally beneficial, although the phosphodiesterase V inhibitors have been gaining in popularity. Invasive therapies may have a role in selective cases. In this review, the current evidence of treatment for RS is summarized. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  19. The Dynamics of Social Capital and Conflict Management in Multiple Resource Regimes: A Case of the Southwestern Highlands of Uganda

    Directory of Open Access Journals (Sweden)

    Pascal C. Sanginga

    2007-06-01

    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

  20. Current challenges in the diagnosis and management of fever.

    Science.gov (United States)

    Sherman, Joshua M; Sood, Sunil K

    2012-06-01

    We review recommendations from recent publications on the management of fever with antipyretics, the classification and diagnosis of fevers of unknown origin (FUO), and the evaluation of fever in infants under 90 days of age. Anxiety about fever persists in the population, while the toxicity of antipyretics is an increasing concern. The numerous opportunities for overdosing with antipyretics have been emphasized by the American Academy of Pediatrics (AAP). The practice of alternating acetaminophen and ibuprofen has limited value. Nonclassic FUO and pseudo-FUO are as important to consider as true FUO, and clinicians should become familiar with the variety of periodic fever syndromes. The clinical utility of low-risk criteria to identify febrile infants at low risk for serious bacterial infection (SBI) was demonstrated in a systematic review of studies. Pediatricians should spend more time educating parents about fever and antipyretic use. Not all persistent fever is FUO, and testing should be targeted to the child's clinical condition. Existing low-risk criteria should be used to identify febrile infants who can be managed without extensive work-up and antibiotics. Adherence to evidence-based recommendations will lessen the morbidity and mortality associated with febrile illnesses in children.

  1. A review of current progress in acquired cholesteatoma management.

    Science.gov (United States)

    Kuo, Chin-Lung; Liao, Wen-Huei; Shiao, An-Suey

    2015-12-01

    The aim of this study was to review recent advances in the management of acquired cholesteatoma. All papers referring to acquired cholesteatoma management were identified in Medline via OVID (1948 to December 2013), PubMed (to December 2013), and Cochrane Library (to December 2013). A total of 86 papers were included in the review. Cholesteatoma surgery can be approached using either a canal wall up (CWU) or canal wall down (CWD) mastoidectomy with or without reconstruction of the middle ear cleft. In recent decades, a variety of surgical modifications have been developed including various "synthesis" techniques that combine the merits of CWU and CWD. The application of transcanal endoscopy has also recently gained popularity; however, difficulties associated with this approach remain, such as the need for one-handed surgery, the inability to provide continuous irrigation/suction, and limitations regarding endoscopic accessibility to the mastoid cavity. Additionally, several recent studies have reported successes in the application of laser-assisted cholesteatoma surgery, which overcomes the conflicting goals of eradicating disease and the preservation of hearing. Nevertheless, the risk of residual disease remains a challenge. Each of the techniques examined in this study presents pros and cons regarding final outcomes, such that any pronouncements regarding the superiority of one technique over another cannot yet be made. Flexibility in the selection of surgical methods according to the context of individual cases is essential in optimizing the outcomes.

  2. Current Trends in the Management of Difficult Urinary Catheterizations

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    Paul A Willette

    2012-12-01

    Full Text Available Routine urinary catheter placement may cause trauma and poses a risk of infection. Male catheterization, in particular, can be difficult, especially in patients with enlarged prostate glands or other potentially obstructive conditions in the lower urinary tract. Solutions to problematic urinary catheterization are not well known and when difficult catheterization occurs, the risk of failed catheterization and concomitant complications increase. Repeated and unsuccessful attempts at urinary catheterization induce stress and pain for the patient, injury to the urethra, potential urethral stricture requiring surgical reconstruction, and problematic subsequent catheterization. Improper insertion of catheters also can significantly increase healthcare costs due to added days of hospitalization, increased interventions, and increased complexity of follow-up evaluations. Improved techniques for catheter placement are essential for all healthcare personnel involved in the management of the patient with acute urinary retention, including attending emergency physicians who often are the first physicians to encounter such patients. Best practice methods for blind catheter placement are summarized in this review. In addition, for progressive clinical practice, an algorithm for the management of difficult urinary catheterizations that incorporates technology enabling direct visualization of the urethra during catheter insertion is presented. This algorithm will aid healthcare personnel in decision making and has the potential to improve quality of care of patients.

  3. Managers' perceptions of radiographers' skills: current and future needs.

    Science.gov (United States)

    Akroyd, D; Wold, B

    1996-01-01

    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.

  4. [Effects of different straw-returning regimes on soil organic carbon and carbon pool management index in Guanzhong Plain, Northwest China].

    Science.gov (United States)

    Li, Shuo; Li, You-bing; Wang, Shu-juan; Shi, Jiang-lan; Tian, Xiao-hong

    2015-04-01

    A four-year (2008-2012) field experiment was conducted to investigate the effects of different straw-returning regimes on soil total organic carbon (TOC), labile organic carbon (LOC) and the ratio of LOC to TOC (LOC/TOC) as well as TOC stock (SCS) and soil carbon pool management index (CPMI) in a farmland with maize-wheat double cropping system in Guanzhong Plain area, Shaanxi Province, China. The results indicated that soil TOC and LOC contents and SCS were significantly increased when wheat or maize straw was returned to field, and the increasing extent showed the rising order as follows: double straw-returning > single straw-returning > no straw-returning. Compared to no straw returning, a significant increase of TOC and LOC contents and SCS was found in the treatment of wheat straw chopping retention combined with maize straw chopping subsoiling retention (WC-MM), and CPMI of WC-MM was significantly higher than in the other treatments in 0-20 cm soil layer. Compared to no wheat straw returning, soil CPMIs in 0-10 cm and 10-20 cm soil layer increased by 19.1% and 67.9% for the wheat straw chopping returning treatment, and by 22.6% and 32.4% for the maize straw chopping subsoiling treatment, respectively. Correlation analysis showed that soil CPMI was a more effective index reflecting the sequestration of soil organic carbon in 0-30 cm soil layer than the ratio of LOC to TOC. This study thus suggested that WC-MM regime is the best straw-returning regime for soil organic carbon sequestration.

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

    Science.gov (United States)

    Chatterjee, Sudesna; Davies, Melanie J

    2015-11-01

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

  6. Nutrient sources and dynamics in a mediterranean fluvial regime (Ebro river, NE Spain) and their implications for water management

    Science.gov (United States)

    Torrecilla, Néstor J.; Galve, Jorge P.; Zaera, Lidia G.; Retamar, Javier F.; Álvarez, Alejandro N. A.

    2005-03-01

    Nonpoint source and point source nutrient loads (N, PO 4-P, COD) to the Ebro River in its central sector were estimated using hydrogeological and socioeconomical data. Their impacts on eutrophication and nutrient dynamics in the river were analyzed through a review of the public administration's historical data and the interpretation of two sampling profiles in September 02 (low flows season) and April 03 (high flows season). A marked seasonality was found in nutrient concentrations, nutrient loads and eutrophication indicators (O 2, Turbidity), appearing symptoms of eutrophication during the summer related to both NPS and PS Nutrient loads within the study area. Agricultural NPS account for 64% of NO 3 loads generated within the study area while urban and industrial PS are responsible of 88% PO 4-P and 71% COD loads. Biological reactions within the river ecosystem (including denitrification in the most eutrophic branches) were found to be a key factor in nutrient content and dynamics. Improvements in urban and industrial wastewater treatment facilities, land use planning and restoration of river-side wetlands, seem to be adequate policies for the improvement of the nutrient water quality in the studied sector of the Ebro River. Flow and temperature seasonality related to Mediterranean fluvial regime imposes significant limitations to nutrient PS in order to accomplish the combined approach proposed in European Water Framework Directive (WFD), based upon Emission Limit Values (ELV) and Environmental Quality Standards (EQS).

  7. Comparison of pollen gene flow among four European beech (Fagus sylvatica L.) populations characterized by different management regimes.

    Science.gov (United States)

    Piotti, A; Leonardi, S; Buiteveld, J; Geburek, T; Gerber, S; Kramer, K; Vettori, C; Vendramin, G G

    2012-03-01

    The study of the dispersal capability of a species can provide essential information for the management and conservation of its genetic variability. Comparison of gene flow rates among populations characterized by different management and evolutionary histories allows one to decipher the role of factors such as isolation and tree density on gene movements. We used two paternity analysis approaches and different strategies to handle the possible presence of genotyping errors to obtain robust estimates of pollen flow in four European beech (Fagus sylvatica L.) populations from Austria and France. In each country one of the two plots is located in an unmanaged forest; the other plots are managed with a shelterwood system and inside a colonization area (in Austria and France, respectively). The two paternity analysis approaches provided almost identical estimates of gene flow. In general, we found high pollen immigration (~75% of pollen from outside), with the exception of the plot from a highly isolated forest remnant (~50%). In the two unmanaged plots, the average within-population pollen dispersal distances (from 80 to 184 m) were higher than previously estimated for beech. From the comparison between the Austrian managed and unmanaged plots, that are only 500 m apart, we found no evidence that either gene flow or reproductive success distributions were significantly altered by forest management. The investigated phenotypic traits (crown area, height, diameter and flowering phenology) were not significantly related with male reproductive success. Shelterwood seems to have an effect on the distribution of within-population pollen dispersal distances. In the managed plot, pollen dispersal distances were shorter, possibly because adult tree density is three-fold (163 versus 57 trees per hectare) with respect to the unmanaged one.

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

    Directory of Open Access Journals (Sweden)

    Lamba Gurpreet

    2012-06-01

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

  9. Current Concepts in the Intensive Care Management of Neurosurgical Patients

    Directory of Open Access Journals (Sweden)

    G S Umamaheswara Rao

    2008-01-01

    Full Text Available There have been some major conceptual changes in the approach to patients with both traumatic and nontraumatic cerebral injury, in recent years. These changes have their basis in a better understanding of the cerebral pathophysi-ology and availability of some recent monitors of cerebral function. Both traditional and modern therapeutic innova-tions are being subjected to extensive investigation. Evidence-based guidelines are now available for the management of traumatic brain injury. Increasing emphasis is being laid on monitoring not only intracranial pressure and cerebral perfusion pressure, but also cerebral blood flow, oxygenation and metabolism. Alternative osmotherapeutic choices are being explored. With a large pool of high quality evidence, more focused and precise therapeutic innovations are likely to emerge in near future.

  10. Management and Employee Control in Current Industrial Work

    Directory of Open Access Journals (Sweden)

    Helle Holt

    2014-09-01

    Full Text Available 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 and “labor process theory.”

  11. Current approach in diagnosis and management of anterior uveitis

    Directory of Open Access Journals (Sweden)

    Agrawal Rupesh

    2010-01-01

    Full Text Available Uveitis is composed of a diverse group of disease entities, which in total has been estimated to cause approximately 10% of blindness. Uveitis is broadly classified into anterior, intermediate, posterior and panuveitis based on the anatomical involvement of the eye. Anterior uveitis is, however, the commonest form of uveitis with varying incidences reported in worldwide literature. Anterior uveitis can be very benign to present with but often can lead to severe morbidity if not treated appropriately. The present article will assist ophthalmologists in accurately diagnosing anterior uveitis, improving the quality of care rendered to patients with anterior uveitis, minimizing the adverse effects of anterior uveitis, developing a decision-making strategy for management of patients at risk of permanent visual loss from anterior uveitis, informing and educating patients and other healthcare practitioners about the visual complications, risk factors, and treatment options associated with anterior uveitis.

  12. Current concepts in the management of cardiogenic shock

    Directory of Open Access Journals (Sweden)

    Trohman RG

    2014-07-01

    Full Text Available Richard G TrohmanCardiology, Electrophysiology, Arrhythmia and Pacemaker Service, Department of Medicine, Rush University Medical Center, Chicago, IL, USAAbstract: Cardiogenic shock most commonly results from myocardial infarction and is associated with mortality rates ranging from 40% to 50%. Early revascularization improves mortality. Mechanical complications of myocardial infarction require surgical intervention. Medical, device and mechanical therapies may improve hemodynamics, but are not associated with improvement in short term survival. Massive pulmonary embolism may also result in cardiogenic shock. Prevention of fatal RV failure requires treatment that will result in rapid restoration of flow through the occluded pulmonary arteries. This review summarizes these and other clinical entities that may result in cardiogenic shock with an emphasis placed on a guideline-based approach to their management.Keywords: myocardial infarction, revascularization, mechanical complications, surgery, pulmonary embolism

  13. Juvenile arthritis: current concepts in terminology, etiopathogenesis, diagnosis, and management.

    Science.gov (United States)

    Abramowicz, S; Kim, S; Prahalad, S; Chouinard, A F; Kaban, L B

    2016-07-01

    The latest change in terminology from juvenile rheumatoid arthritis (JRA) to juvenile idiopathic arthritis (JIA), established by the International League of Associations for Rheumatology (ILAR), has resulted in some confusion for OMFS and other treating clinicians. JIA comprises a group of systemic inflammatory diseases that result in the destruction of hard and soft tissues in a single or multiple joints. In a significant number of patients, one or both temporomandibular joints (TMJ) are also involved. TMJ disease may be accompanied by pain, swelling, and limitation of motion, as well as mandibular retrognathism, open bite, and asymmetry. The purpose of this article is to provide a review, for the oral and maxillofacial surgeon, of the terminology, etiopathogenesis, diagnosis, and management of children with JIA.

  14. Current trends in the management of Graves' disease

    Energy Technology Data Exchange (ETDEWEB)

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

    1990-06-01

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

  15. Childhood food allergies: current diagnosis, treatment, and management strategies.

    Science.gov (United States)

    Gupta, Ruchi S; Dyer, Ashley A; Jain, Namrita; Greenhawt, Matthew J

    2013-05-01

    Food allergy is a growing public health concern in the United States that affects an estimated 8% of children. Food allergy is defined as an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a specific food. Nearly 40% of children with food allergy have a history of severe reactions that if not treated immediately with proper medication can lead to hospitalization or even death. The National Institute of Allergy and Infectious Diseases (NIAID) convened an expert panel in 2010 to develop guidelines outlining evidence-based practices in diagnosing and managing food allergy. The purpose of this review is to aid clinicians in translating the NIAID guidelines into primary care practice and includes the following content domains: (1) the definition and mechanism of childhood food allergy, (2) differences between food allergy and food intolerance, (3) the epidemiology of childhood food allergy in the United States, (4) best practices derived from the NIAID guidelines focused on primary care clinicians' management of childhood food allergy, (5) emerging food allergy treatments, and (6) future directions in food allergy research and practice. Articles focused on childhood food allergy were considered for inclusion in this review. Studies were restricted to the English language and to those published within the past 40 years. A cross-listed combination of the following words, phrases, and MeSH terms was searched in PubMed and Google Scholar to identify relevant articles: food allergy, food hypersensitivity, child, pediatric, prevalence, and epidemiology. Additional sources were identified through the bibliographies of the retrieved articles.

  16. Current Trends on Lean Management – A review

    Directory of Open Access Journals (Sweden)

    M. Shabeena Begam

    2013-12-01

    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.

  17. Quantifying stream thermal regimes at management-pertinent scales: combining thermal infrared and stationary stream temperature data in a novel modeling framework.

    Science.gov (United States)

    Vatland, Shane J.; Gresswell, Robert E.; Poole, Geoffrey C.

    2015-01-01

    Accurately quantifying stream thermal regimes can be challenging because stream temperatures are often spatially and temporally heterogeneous. In this study, we present a novel modeling framework that combines stream temperature data sets that are continuous in either space or time. Specifically, we merged the fine spatial resolution of thermal infrared (TIR) imagery with hourly data from 10 stationary temperature loggers in a 100 km portion of the Big Hole River, MT, USA. This combination allowed us to estimate summer thermal conditions at a relatively fine spatial resolution (every 100 m of stream length) over a large extent of stream (100 km of stream) during during the warmest part of the summer. Rigorous evaluation, including internal validation, external validation with spatially continuous instream temperature measurements collected from a Langrangian frame of reference, and sensitivity analyses, suggests the model was capable of accurately estimating longitudinal patterns in summer stream temperatures for this system Results revealed considerable spatial and temporal heterogeneity in summer stream temperatures and highlighted the value of assessing thermal regimes at relatively fine spatial and temporal scales. Preserving spatial and temporal variability and structure in abiotic stream data provides a critical foundation for understanding the dynamic, multiscale habitat needs of mobile stream organisms. Similarly, enhanced understanding of spatial and temporal variation in dynamic water quality attributes, including temporal sequence and spatial arrangement, can guide strategic placement of monitoring equipment that will subsequently capture variation in environmental conditions directly pertinent to research and management objectives.

  18. Management of keloids and hypertrophic scars: current and emerging options

    Directory of Open Access Journals (Sweden)

    Gauglitz GG

    2013-04-01

    Full Text Available Gerd G GauglitzDepartment of Dermatology and Allergy, Ludwig-Maximilian University, Munich, GermanyAbstract: In the context of growing aesthetic awareness, a rising number of patients feel disappointed with their scars and are frequently seeking help for functional and aesthetic improvement. However, excessive scarring following surgery or trauma remains difficult to improve despite a plethora of advocated treatment strategies as frequently observed in daily clinical routine. It is thus still preferable to prevent scarring by minimizing risk factors as much as possible. Hence, it remains crucial for the physician to be aware of basic knowledge of healing mechanisms and skin anatomy, as well as an appreciation of suture material and wound closure techniques to minimize the risk of postoperative scarring. Next to existing, well known prophylactic and therapeutic strategies for the improvement of excessive scarring, this article discusses emerging techniques such as intralesional cryotherapy, intralesional 5-fluorouracil, interferon, and bleomycin. Some of them have been successfully tested in well-designed trials and already have extended or may extend the current spectrum of excessive scar treatment in the near future. Innovative options such as imiquimod 5% cream, photodynamic therapy, or botulinum toxin A may also be of certain importance; however, the data currently available is too contradictory for definite recommendations.Keywords: intralesional cryotherapy, lasers, triamcinolone acetonide, TGF-β

  19. Eosinophilic esophagitis: current perspectives from diagnosis to management.

    Science.gov (United States)

    Moawad, Fouad J; Cheng, Edaire; Schoepfer, Alain; Al-Haddad, Sahar; Bellizzi, Andrew M; Dawson, Heather; El-Zimaity, Hala; Guindi, Maha; Penagini, Roberto; Safrooneva, Ekaterina; Chehade, Mirna

    2016-09-01

    Eosinophilic esophagitis (EoE) is a chronic antigen-mediated immune disease of the esophagus characterized by symptoms related to esophageal dysfunction, as well as significant esophageal eosinophilia. Although dense eosinophilia is the hallmark of EoE, other characteristic histologic features have been described that may help distinguish EoE from other competing diagnoses, although none are specific to EoE. One or more foods and, at times, environmental allergens trigger EoE. Left untreated, esophageal inflammation in EoE may lead to esophageal remodeling and stricture formation. Symptoms in EoE vary with age, as they relate to the progression of the disease from an inflammatory to a fibrostenotic phenotype over time. There are currently no U.S. Food and Drug Administration-approved therapies for EoE. Current options include various dietary-restriction therapies, topical corticosteroids, and esophageal dilations. Several emerging therapies aiming at restoring the esophageal barrier function or targeting various inflammatory cells or their mediators are under investigation.

  20. Current management options for latent tuberculosis: a review

    Directory of Open Access Journals (Sweden)

    Norton BL

    2012-11-01

    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

  1. Pharmacotherapy for uveitis: current management and emerging therapy

    Science.gov (United States)

    Barry, Robert J; Nguyen, Quan Dong; Lee, Richard W; Murray, Philip I; Denniston, Alastair K

    2014-01-01

    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

  2. Current and emerging therapy for the management of vitiligo

    Directory of Open Access Journals (Sweden)

    Alicia Cecile Borderé

    2009-03-01

    Full Text Available Alicia Cecile Borderé, Jo Lambert, Nanny van GeelUniversity Hospital of Ghent, Department of Dermatology, Ghent, BelgiumAbstract: Vitiligo is an acquired cutaneous disorder of pigmentation, with an incidence of 0.5% to 2% worldwide. There are three major hypotheses for the pathogenesis of vitiligo that are not exclusive of each other: biochemical/cytotoxic, neural and autoimmune. Recent data provide strong evidence supporting an autoimmune pathogenesis of vitiligo. As vitiligo can have a major effect on quality of life, treatment can be considered and should preferably begin early when the disease is active. Current treatment modalities are directed towards stopping progression of the disease and achieving repigmentation. Therapies include corticosteroids, topical immunomodulators, photo(chemotherapy, surgery, combination therapies and depigmentation of normally pigmented skin. Topical class 3 corticosteroids can be used for localized vitiligo. The use of topical immunomodulators (TIMs in vitiligo seems to be equally effective as topical steroids, especially when used in the face and neck region. In photo(chemotherapy, narrowband ultraviolet-B therapy (NB-UVB seems to be superior to psoralen ultraviolet-A therapy (PUVA and broadband UVB. In surgical techniques, split-thickness grafting and epidermal blister grafting were shown to be effective methods, although the non-cultured epidermal suspension technique has many advantages and seems to be a promising development. Depigmentation therapy can be considered if vitiligo affects more than 60% to 80% of the body. Complementary therapies such as Polypodium leucotomos show promising results in combination with UVB therapy. No causative treatment for vitiligo is currently available. More randomized controlled trials on the treatment of vitiligo are necessary.Keywords: vitiligo, non-surgical treatment, surgical treatment

  3. Current status of endoscopic management for nonvariceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Kawamura, Takuji; Yasuda, Kenjiro; Morikawa, Soichiro; Itonaga, Masahiro; Nakajima, Masatsugu

    2010-07-01

    Endoscopic hemostasis is widely performed for nonvariceal upper gastrointestinal (UGI) bleeding. As the aged Japanese population rapidly increases, the number of patients experiencing complications increases. The aim of this study was to evaluate the recent results of endoscopic hemostasis for nonvariceal UGI bleeding. A retrospective analysis of patients who underwent endoscopic procedures for nonvariceal UGI bleeding was performed. We performed 223 endoscopic procedures on 217 patients between January 1995 and July 2000, and 238 endoscopic procedures on 236 patients between January 2006 and September 2009 at the Kyoto Second Red Cross Hospital. We divided the patients into the 1995-2000 group and the 2006-2009 group. Patient characteristics, hemostasis methods chosen, rates of temporary hemostasis and rebleeding, and mortality were analyzed. There were many serious and actively bleeding cases in the 2006-2009 group (P < 0.001). The endoclip method and intravenous proton pump inhibitor were mainly used in the 2006-2009 group compared with the drug-injection method and intravenous H2 receptor antagonist in the 1995-2000 group (P < 0.001). Through these treatments, the two groups were able to obtain similar treatment outcomes. Through the progress of endoscopic management we obtained similar satisfactory results in the 2006-2009 group, which had multiple complicated cases, compared to the 1995-2000 group.

  4. Craniofacial fibrous dysplasia - A review of current management techniques

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    Yadavalli Guruprasad

    2012-01-01

    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.

  5. Clinical management of achalasia: current state of the art

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    Krill JT

    2016-04-01

    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

  6. Hyperthyroidism in Graves disease. Current trends in management and diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Haibach, H.

    1976-06-01

    The radioimmunoassay for T/sub 3/ is now widely available and is a useful diagnostic tool for hyperthyroidism, especially in T/sub 3/-thyrotoxicosis. It is an essential tool in the management of hyperthyroidism that persists after treatment with normal T/sub 4/ serum levels or, in euthyroid cases, with low T/sub 4/ serum levels. In these conditions, it reflects the metabolic state more accurately than serum levels of T/sub 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/sub 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.

  7. Analysis of umbu (Spondias tuberosa Arruda (Anacardiaceae)) in different landscape management regimes: a process of incipient domestication?

    Science.gov (United States)

    Lins Neto, Ernani Machado de Freitas; Peroni, Nivaldo; Maranhão, Christine Maria Carneiro; Maciel, Maria Inês Sucupira; de Albuquerque, Ulysses Paulino

    2012-07-01

    Plant domestication is an evolutionary process guided by human groups who modify the landscape for their needs. The objective of this study was to evaluate the phenotypic variations between populations of Spondias tuberosa Arruda (umbuzeiro) when subjected to different local landscape management strategies. The influence of the landscape management system on these populations was evaluated in five identified regional units (mountains, base of mountains, pastures, cultivated areas and home gardens). Ten individuals were randomly selected from each region and subjected to morphological and chemical fruit analysis. The diversity index, based on Simpson's index, was determined for the different populations. We then evaluated the morphological differences between the individual fruits from the distinct landscape areas. We observed no significant differences in morphological diversity between the areas studied. Our data suggest that the umbuzeiro specimens in this region may be in the process of incipient domestication.

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

    LENUS (Irish Health Repository)

    Dolan, Eamon

    2013-11-28

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

  9. [Refractory ascites and dilutional hyponatremia: current management and new aquaretics].

    Science.gov (United States)

    Torre Delgadillo, Aldo

    2005-01-01

    Ascites is the most common complication of cirrhosis and is associated with 50% mortality at 2 years if patients do not receive orthotopic liver transplantation. Recently the International Ascites Club defined ascites into three groups: In grade I ascites fluid is detected only by ultrasound; in grade II, ascites is moderate with symmetrical distention of the abdomen; and in Grade 3 ascites is large or tense with marked abdominal distention. About 10% of patients with ascites are refractory to treatment with diuretics. In refractory ascites, patients do not respond to highest doses of diuretics (spironolactone 400 mg/day and furosemide 160 mg/ day) or develop side effects (hyperkalemia, hyponatremia, hepatic encephalopathy, or renal failure) that prohibit their use. Patients may be treated either by repeated large volume paracentesis plus albumin or transjugular intrahepatic portosystemic shunts (TIPS). Dilutional hyponatremia in cirrhotic patients is defined as serum sodium < or = 130 mEq/L in the presence of an expanded extracellular fluid volume, as indicated by the presence of ascites and/or edema. This complication of cirrhotic patients with ascites has recently gained attention given that several reports indicate that when serum sodium concentration is combined with the Model for End-Stage liver disease (MELD) it improves the prognostic accuracy of MELD score in patients awaiting orthotopic liver transplant (OLT). The first step in the management of dilutional hyponatremia is fluid restriction and discontinuation of diuretics. Water restriction at 1,000 mL/day helps prevent the progressive decrease in serum sodium concentration but usually does not correct hyponatremia in most cases. Actually are developing drugs that are active orally and act by selectively antagonizing the specific receptors (V2 receptor) of arginine vasopressin. These agents act in the distal collecting ducts of the kidneys, by increasing solute free water excretion and, thus, improving

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

    Directory of Open Access Journals (Sweden)

    Pompili M

    2012-12-01

    techniques have more rapid remission and relapse less frequently than patients treated only pharmacologically.Keywords: schizophrenia, support management, nonpharmacological treatment, cognitive behavioral therapy

  11. Hepatocellular carcinoma: natural history, current management, and emerging tools

    Directory of Open Access Journals (Sweden)

    Tinkle CL

    2012-07-01

    Full Text Available Christopher L Tinkle, Daphne Haas-KoganDepartment of Radiation Oncology, University of California, San Francisco, CA, USAAbstract: Hepatocellular carcinoma (HCC is the most common primary liver tumor and represents the third-leading cause of cancer-related death in the world. The incidence of HCC continues to increase worldwide, with a unique geographic, age, and sex distribution. The most important risk factor associated with HCC is liver cirrhosis, with the majority of cases caused by chronic infection with hepatitis B (HBV and C (HCV viruses and alcohol abuse, although nonalcoholic fatty liver disease is emerging as an increasingly important cause. Primary prevention in the form of HBV vaccination has led to a significant decrease in HBV-related HCC, and initiation of antiviral therapy appears to reduce the incidence of HCC in patients with chronic HBV or HCV infection. Additionally, the use of ultrasonography enables the early detection of small liver tumors and forms the backbone of recommended surveillance programs for patients at high risk for the development of HCC. Cross-sectional imaging studies, including computed tomography and magnetic resonance imaging, represent further noninvasive techniques that are increasingly employed to diagnose HCC in patients with cirrhosis. The mainstay of potentially curative therapy includes surgery – either resection or liver transplantation. However, most patients are ineligible for surgery, because of either advanced disease or underlying liver dysfunction, and are managed with locoregional and/or systemic therapies. Randomized controlled trials have demonstrated a survival benefit with both local therapies, either ablation or embolization, and systemic therapy in the form of the multikinase inhibitor sorafenib. Despite this, median survival remains poor and recurrence rates significant. Further advances in our understanding of the molecular pathogenesis of HCC hold promise in improving the

  12. 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

    Energy Technology Data Exchange (ETDEWEB)

    Buvat, F

    2005-07-01

    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)

  13. Implications of future disturbance regimes on the carbon balance of Canada's managed forest (2010-2100)

    Energy Technology Data Exchange (ETDEWEB)

    Metsaranta, J.M.; Kurz, W.A.; Neilson, E.T.; Stinson, G. (Natural Resources Canada, Canadian Forest Service, Pacific Forestry Centre, Victoria, BC (Canada))

    2010-11-15

    Recent increases in fire and insect disturbances have contributed to a transition of Canada's managed forest carbon balance from sink to source. Further increases in area burned could contribute positive feedback to climate change. We made probabilistic forecasts of the recovery of C sinks in Canada's managed forest between 2010 and 2100 under two assumptions about future area burned by wildfire: (1) no increase relative to levels observed in the last half of the 20th century and (2) linear increases by a factor of two or four (depending on region) from 2010 to 2100. Recovery of strong C sinks in Canada's managed forest will be delayed until at least the 2030s because of insect outbreaks, even if predicted increases in area annually burned do not occur. After 2050, our simulations project an annual probability of a sink near 70% with no increase in area burned and 35% with increasing area burned. All simulations project a cumulative C source from 2010-2100, even if annual area burned does not increase. If the sink strength of terrestrial ecosystems is reduced because of increasing natural disturbances, then it will become more difficult to achieve global atmospheric CO{sub 2} stabilization targets.

  14. Managing inflammatory bowel disease in pregnancy: current perspectives

    Directory of Open Access Journals (Sweden)

    Pinder M

    2016-10-01

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

  15. Selected aspects of the current management of myositis.

    Science.gov (United States)

    Lilleker, James; Murphy, Sean; Cooper, Robert

    2016-08-01

    The idiopathic inflammatory myopathies (IIM) are a rare and heterogeneous group of acquired autoimmune muscle disorders, often referred to as 'myositis'. Clinical assessment, together with muscle biopsy findings and autoantibody status are key factors to consider when making a diagnosis of IIM, and in stratification of the 'IIM spectrum' into disease subgroups. Treatment stratified according to serotype (and in the future, likely also genotype) is increasingly being used to take account of the heterogeneity within the IIM spectrum. Subgroup classification is also important in terms of monitoring for complications, such as malignancy and interstitial lung disease. Disease monitoring should include the use of standardized tools such as the IMACS disease activity outcome measures. Other tools such as muscle MRI can be useful in identifying areas of active muscle inflammation. Treatment outcomes in IIM remain unsatisfactory. The evidence base to guide treatment decisions is remarkably limited. In addition to muscle inflammation, a number of noninflammatory cell-mediated mechanisms may contribute to weakness and disability, and for which no specific treatments are currently available.

  16. Managing pediatric hepatitis C: current and emerging treatment options

    Directory of Open Access Journals (Sweden)

    Wikrom Karnsakul

    2009-08-01

    Full Text Available Wikrom Karnsakul, Mary Kay Alford, Kathleen B SchwarzPediatric Liver Center, Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins School of Medicine, Baltimore, MD, USAAbstract: Since 1992, the maternal–fetal route of transmission has become the dominant route for acquisition of hepatitis C (HCV infection by children. With increasing knowledge of antiviral treatment for HCV infection, the main goal of therapy is to achieve a sustained virological response (SVR as defined by undetectable serum HCV RNA by polymerase chain reaction assay six months after cessation of therapy. In young children, interferon therapy is more effective than in adults with chronic HCV infection (CHC. Although children clearly have a milder degree of liver pathology, data have indicated that hepatic inflammation from HCV infection can progress to fibrosis or cirrhosis in children. Hepatocellular carcinoma has been reported in adolescents with CHC. In this article, recent improvements in therapy of children with CHC and in the clinical development of new emerging drugs with potential use in children will be reviewed.Keywords: chronic hepatitis C, children, current therapy, pegylated interferon

  17. Current management and treatment of cerebral vasospasm complicating SAH.

    Science.gov (United States)

    Kühn, Anna Luisa; Balami, Joyce Saleh; Grunwald, Iris Quasar

    2013-03-01

    Cerebral vasospasm is a common and serious complication of aneurysmal subarachnoid haemorrhage. Despite the improvements in treatment of aneurysmal subarachnoid haemorrhage (aSAH), cerebral vasospasm complicating aSAH has remained the main cause of morbidity and mortality. Subarachnoid haemorrhage (SAH)-induced vasospasm is a complex entity caused by vasculopathy, impaired autoregulation, and hypovolaemia, causing a regional reduction of cerebral brain perfusion which can then induce ischaemia. Cerebral vasospasm can present either asymptomatically detected only radiologically or symptomatically (delayed ischaemic neurologic deficit). The various diagnostic approaches include the use of transcranial doppler, digital subtraction angiography and multimodal computed tomography (CT) and magnetic resonance (MR) techniques. Although digital subtraction angiography is usually the gold standard for the diagnosis of cerebral vasospam, transcranial doppler is commonly the first-screening method for the detection of cerebral vasospam. The treatment of subarachnoid haemorrhage -induced vasospasm include the use of both medical and endovascular therapy. The aim of this review is to discuss the various current therapeutic options and future perspective measures for reducing cerebral vasospasm induced stroke after SAH.

  18. Dietary intervention in the management of phenylketonuria: current perspectives

    Directory of Open Access Journals (Sweden)

    Rocha JC

    2016-12-01

    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

  19. Current Trends, Evaluation, and Management of Pediatric Nephrolithiasis.

    Science.gov (United States)

    Hernandez, Joel D; Ellison, Jonathan S; Lendvay, Thomas S

    2015-10-01

    The incidence of pediatric nephrolithiasis has been steadily increasing for the past several decades, with a concomitant concerning increase in health care costs and burden to children with this disease. Recent population-based studies have also demonstrated a change in the current trends of pediatric nephrolithiasis that is characterized by a significant increase in the number of girls now being affected. While changes in diet and lifestyle, obesity prevalence, and even imaging practices have been proposed to contribute to the recent increase in pediatric nephrolithiasis, a definite underlying cause remains elusive. This situation is complicated by the fact that, unlike in adults, the trends occurring in pediatric nephrolithiasis have not been studied rigorously, which contributes to the paucity of data in children. The level of concern with the increasing incidence is raised by factors unique to pediatric nephrolithiasis that could expose an affected child to more complications. Factors such as variable clinical presentation, high recurrence of kidney stones associated with abnormalities of metabolism and the urinary tract, and the possible presence of rare genetic kidney stone diseases would require physicians to comprehensively evaluate patients presenting with kidney stones. The goal of evaluation is to identify modifiable risk factors and abnormalities for which targeted therapy can be prescribed. The goals of medical and surgical treatments are to eliminate the burden of kidney stones and prevent recurrence while simultaneously minimizing complications from interventions. Patients at high risk may benefit from a specialized kidney stone clinic staffed by a pediatric nephrologist, urologist, dietitian, and clinical nurse. Such a multidisciplinary clinic can help provide the medical and surgical support needed for patients at high risk and offer key opportunities to learn more about pediatric nephrolithiasis, thereby fueling the much-needed research in this

  20. Risk management of seasonal influenza during pregnancy: current perspectives

    Science.gov (United States)

    Yudin, Mark H

    2014-01-01

    Influenza poses unique risks to pregnant women, who are particularly susceptible to morbidity and mortality. Historically, pregnant women have been overrepresented among patients with severe illness and complications from influenza, and have been more likely to require hospitalization and intensive care unit admission. An increased risk of adverse outcomes is also present for fetuses/neonates born to women affected by influenza during pregnancy. These risks to mothers and babies have been observed during both nonpandemic and pandemic influenza seasons. During the H1N1 influenza pandemic of 2009–2010, pregnant women were more likely to be hospitalized or admitted to intensive care units, and were at higher risk of death compared to nonpregnant adults. Vaccination remains the most effective intervention to prevent severe illness, and antiviral medications are an important adjunct to ameliorate disease when it occurs. Unfortunately, despite national guidelines recommending universal vaccination for women who are pregnant during influenza season, actual vaccination rates do not achieve desired targets among pregnant women. Pregnant women are also sometimes reluctant to use antiviral medications during pregnancy. Some of the barriers to use of vaccines and medications during pregnancy are a lack of knowledge of recommendations and of safety data. By improving knowledge and understanding of influenza and vaccination recommendations, vaccine acceptance rates among pregnant women can be improved. Currently, the appropriate use of vaccination and antiviral medications is the best line of defense against influenza and its sequelae among pregnant women, and strategies to increase acceptance are crucial. This article will review the importance of influenza in pregnancy, and discuss vaccination and antiviral medications for pregnant women. PMID:25114593

  1. PCSK9 inhibitors in the current management of atherosclerosis.

    Science.gov (United States)

    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.

  2. Current concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era.

    Science.gov (United States)

    Esposito, Ciro; Escolino, Maria; Turrà, Francesco; Roberti, Agnese; Cerulo, Mariapina; Farina, Alessandra; Caiazzo, Simona; Cortese, Giuseppe; Servillo, Giuseppe; Settimi, Alessandro

    2016-08-01

    The surgical repair of inguinal hernia and hydrocele is one of the most common operations performed in pediatric surgery practice. This article reviews current concepts in the management of inguinal hernia and hydrocele based on the recent literature and the authors׳ experience. We describe the principles of clinical assessment and anesthetic management of children undergoing repair of inguinal hernia, underlining the differences between an inguinal approach and minimally invasive surgery (MIS). Other points discussed include the current management of particular aspects of these pathologies such as bilateral hernias; contralateral patency of the peritoneal processus vaginalis; hernias in premature infants; direct, femoral, and other rare hernias; and the management of incarcerated or recurrent hernias. In addition, the authors discuss the role of laparoscopy in the surgical treatment of an inguinal hernia and hydrocele, emphasizing that the current use of MIS in pediatric patients has completely changed the management of pediatric inguinal hernias. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Restoring Summer Base Flow under a Decentralized Water Management Regime: Constraints, Opportunities, and Outcomes in Mediterranean-Climate California

    Directory of Open Access Journals (Sweden)

    Matthew J. Deitch

    2017-01-01

    Full Text Available Seasonal rainfall dynamics in Mediterranean-climate coastal California place pressures on humans and aquatic ecosystems. Without rainfall during summer, residents and land managers commonly turn to streams and adjacent shallow aquifers to meet domestic, irrigation, and recreational water needs, often depleting the water necessary to support stream biota. The potential for adverse ecological impacts within this coupled natural-human system has led to interest in restoring summer base flow (especially for federally protected steelhead and coho salmon, which depend on flow through the summer dry season for juvenile survival through methods such as reducing dry-season water abstractions. Characterizing constraints and opportunities has proven useful for planning streamflow restoration in Mediterranean-climate coastal California. Biophysical parameters such as ample rainfall and very low summer discharge are critical considerations, but institutional parameters are equally important: regional management practices and state laws can inhibit streamflow restoration, and implementation is dependent on interrelationships among residents, agency staff, and other stakeholders (which we term the egosystem within each watershed. Additionally, while watershed-scale spatial analysis and field-based evaluations provided a solid foundation for exploring streamflow restoration needs, adaptation based on information from local stakeholders was often essential for prioritizing projects and understanding whether projects will have their intended benefits.

  4. Arctic lake physical processes and regimes with implications for winter water availability and management in the national petroleum reserve alaska

    Science.gov (United States)

    Jones, Benjamin M.; Arp, C.D.; Hinkel, Kenneth M.; Beck, R.A.; Schmutz, J.A.; Winston, B.

    2009-01-01

    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 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.

  5. Regional economic effects of current and proposed management alternatives for Sand Lake National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This report first provides a description of the local community and economy near Sand Lake NWR. An analysis of current and proposed management strategies that could...

  6. Diagnosis and management of chronic pancreatitis: current knowledge.

    Science.gov (United States)

    Ammann, Rudolf W

    2006-03-18

    This paper reviews the current literature on chronic pancreatitis (CP). Despite marked progress in diagnostic tools, predominately imaging methods, no consensus has been reached on the nomenclature of CP, ie diagnosis, classification, staging, pathomechanisms of pain and its optimal treatment. A major problem is that no single reliable diagnostic test exists for early-stage CP except histopathology (rarely available). This stage is characterised typically by recurrent acute pancreatitis +/- necrosis (eg pseudocysts). Acute pancreatitis is a well-defined condition caused in 80% of cases by gallstones or alcohol abuse. Alcoholic pancreatitis, in contrast to biliary pancreatitis, progresses to CP in the majority of patients. However, a definite CP-diagnosis is often delayed because progressive dysfunction and/or calcification, the clinical markers of CP, develop on average 5 years from disease onset. The progression rate is variable and depends on several factors eg aetiology, smoking, continued alcohol abuse. Repeated function testing eg by the faecal elastase test, is the best alternative for histology to monitor progression (or non-progression) of suspected (probable) to definite CP. The pathomechanism of pain in CP is multifactorial and data from different series are hardly comparable mainly because insufficient data of the various variables ie diagnosis, classification, staging of CP, pain pattern and presumptive pain cause, are provided. Pain in CP is rarely intractable except in the presence of cancer, opiate addiction or extra-pancreatic pain causes. Local complications like pseudocysts or obstructive cholestasis are the most common causes of severe persistent pain which can be relieved promptly by an appropriate drainage procedure. Notably, partial to complete pain relief is a common feature in 50-80% of patients with late-stage CP irrespective of surgery and about 50% of CP-patients never need surgery (or endoscopic intervention). The spontaneous "burn

  7. State-and-transition simulation modeling to compare outcomes of alternative management scenarios under two natural disturbance regimes in a forested landscape in northeastern Wisconsin, USA

    Directory of Open Access Journals (Sweden)

    Amanda Swearingen

    2015-07-01

    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.

  8. Inorganic and Hazardous Solid Waste Management: Current Status and Challenges for Indonesia

    NARCIS (Netherlands)

    Aprilia, A.; Tezuka, T.; Spaargaren, G.

    2013-01-01

    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.

  9. Inorganic and Hazardous Solid Waste Management: Current Status and Challenges for Indonesia

    NARCIS (Netherlands)

    Aprilia, A.; Tezuka, T.; Spaargaren, G.

    2013-01-01

    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.

  10. The current waste generation and management trends in South Africa: A Review

    CSIR Research Space (South Africa)

    Nkosi, N

    2013-04-01

    Full Text Available This paper, a continuation and expansion of the work of Muzenda et al, 2012 [1] 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...

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

    Science.gov (United States)

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

    2014-09-01

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

  12. Landscape management of fire and grazing regimes alters the fine-scale habitat utilisation by feral cats.

    Directory of Open Access Journals (Sweden)

    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.

  13. Landscape management of fire and grazing regimes alters the fine-scale habitat utilisation by feral cats.

    Science.gov (United States)

    McGregor, Hugh W; Legge, Sarah; Jones, Menna E; Johnson, Christopher N

    2014-01-01

    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.

  14. The impacts of climate change and environmental management policies on the trophic regimes in the Mediterranean Sea: Scenario analyses

    Science.gov (United States)

    Lazzari, P.; Mattia, G.; Solidoro, C.; Salon, S.; Crise, A.; Zavatarelli, M.; Oddo, P.; Vichi, M.

    2014-07-01

    The impacts of climate change and environmental management policies on the Mediterranean Sea were analyzed in multi-annual simulations of carbon cycling in a planktonic ecosystem model. The modeling system is based on a high-resolution coupled physical-biogeochemical ocean model that is off-line and forced by medium-resolution global climate simulations and by estimates of continental and river inputs of freshwater and nutrients. The simulations span the periods 1990-2000 and 2090-2100, assuming the IPCC SRES A1B scenario of climatic change at the end of the century. The effects of three different options on land use, mediated through rivers, are also considered. All scenarios indicate that the increase in temperature fuels an increase in metabolic rates. The gross primary production increases approximately 5% over the present-day figures, but the changes in productivity rates are compensated by augmented community respiration rates, so the net community production is stable with respect to present-day figures. The 21st century simulations are characterized by a reduction in the system biomass and by an enhanced accumulation of semi-labile dissolved organic matter. The largest changes in organic carbon production occur close to rivers, where the influence of changes in future nutrient is higher.

  15. Evaluation of the Effect of Non-Current Fixed Assets on Profitability and Asset Management Efficiency

    Science.gov (United States)

    Lubyanaya, Alexandra V.; Izmailov, Airat M.; Nikulina, Ekaterina Y.; Shaposhnikov, Vladislav A.

    2016-01-01

    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…

  16. Supply regimes in fisheries

    DEFF Research Database (Denmark)

    Nielsen, Max

    2006-01-01

    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......-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...... recruitment. The implications are that the effects on supply following from e.g. trade liberalisation and reductions of subsidies are small in several and probably most fisheries worldwide. Keywords: backward-bending supply, regulated open access, regulated restricted access, mesh size regulation, Beverton...

  17. Opportunities for Process-Based Management of Rivers Below Water Diversions: Exploring and Exploiting Coupled Alteration of Flow and Sediment Regimes

    Science.gov (United States)

    Kibler, K. M.; Alipour, M.

    2015-12-01

    In mountainous, rural catchments throughout the world, small to medium-sized rivers are being developed for diversion hydropower. Previous study indicates that in the absence of careful management, consequences to rivers downstream of diversion hydropower dams can be severe. However, patterns of hydrologic alteration below diversion hydropower dams have not been well described. In addition, diversion hydropower projects typically require some form of sediment management to maintain relatively small impoundments at diversion sites. Investigation of principal coupled processes, notably flow and sediment dynamics, in the context of alteration by diversion schemes may elucidate potential for working with natural processes to mitigate consequences to rivers. This analysis characterizes hydrologic alteration by diversion hydropower dams, investigating flows below 31 diversion dams. Diversion for hydropower production generated distinctive signatures of hydrologic alteration in sample rivers. For instance, flow signals were characterized by reduced low to moderate flows and steep transitions between low and high stages. In a number of rivers, small floods were reduced in number and size. However, effect to magnitude and timing of large floods was minimal across all rivers investigated. Sediments were stored in impoundments and released in pulses annually through lower sediment gates. The hydrologic signatures observed were strongly linked to diversion designs and may be transferable to other rivers developed with similar infrastructure. Understanding characteristic flow alterations due to diversion hydropower, in combination with cycles of sediment storage and release, may inform management practices for simultaneously maintaining reservoirs and downstream channels. In particular, investigating altered flood magnitudes and frequencies in the context of geomorphic work may indicate potential for maintaining natural hydrogeomorphic processes. Detailed study of sediment

  18. Exploitation rates of two benthic resources across management regimes in central Chile: Evidence of illegal fishing in artisanal fisheries operating in open access areas.

    Science.gov (United States)

    Andreu-Cazenave, Miguel; Subida, Maria Dulce; Fernandez, Miriam

    2017-01-01

    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.

  19. A legacy of divergent fishery management regimes and the resilience of rainbow and cutthroat trout populations in Lake Crescent, Olympic National Park, Washington

    Science.gov (United States)

    Brenkman, Samuel J.; Duda, Jeffrey J.; Kennedy, Philip R.; Baker, Bruce M.

    2014-01-01

    As a means to increase visitation, early fisheries management in the National Park Service (NPS) promoted sport harvest and hatchery supplementation. Today, NPS management objectives focus on the preservation of native fish. We summarized management regimes of Olympic National Park's Lake Crescent, which included decades of liberal sport harvest and hatchery releases of 14.3 million salmonids. Notably, nonnative species failed to persist in the lake. Complementary analyses of annual redd counts (1989–2012) and genetics data delineated three sympatric trout (one rainbow; two cutthroat) populations that exhibited distinct spatial and temporal spawning patterns, variable emergence timings, and genetic distinctiveness. Allacustrine rainbow trout spawned in the lake outlet from January to May. Cutthroat trout spawned in the major inlet tributary (Barnes Creek) from February to June and in the outlet river (Lyre) from September to March, an unusual timing for coastal cutthroat trout. Redd counts for each species were initially low (rainbow = mean 89; range 37–159; cutthroat = mean 93; range 18–180), and significantly increased for rainbow trout (mean 306; range 254–352) after implementation of catch-and-release regulations. Rainbow and cutthroat trout reached maximum sizes of 10.4 kg and 5.4 kg, respectively, and are among the largest throughout their native ranges. Morphometric analyses revealed interspecific differences but no intraspecific differences between the two cutthroat populations. Genetic analyses identified three distinct populations and low levels (9–17%) of interspecific hybridization. Lake Crescent rainbow trout were genetically divergent from 24 nearby Oncorhynchus mykiss populations, and represented a unique evolutionary legacy worthy of protection. The indigenous and geographically isolated Lake Crescent trout populations were resilient to overharvest and potential interactions with introduced fish species.

  20. Regional economic effects of current and proposed management alternatives for Arrowwood National Wildlife Refuge

    Science.gov (United States)

    Koontz, Lynne; Lambert, Heather

    2005-01-01

    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.

  1. Regional economic effects of current and proposed management alternatives for Sand Lake National Wildlife Refuge

    Science.gov (United States)

    Koontz, Lynne; Lambert, Heather

    2005-01-01

    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.

  2. Developing a Knowledge Management Framework to Assist With Current USMC Information Management Practices

    Science.gov (United States)

    2010-09-01

    23 Figure 8. AFKN Build Learning Communities (from AFMC Briefing...the goals. Figure 8. AFKN Build Learning Communities (from AFMC Briefing, 2001) 41 HQ AFMC/A5BK provides expertise in management of information

  3. A review of current knowledge on toxic benthic freshwater cyanobacteria--ecology, toxin production and risk management.

    Science.gov (United States)

    Catherine, Quiblier; Susanna, Wood; Isidora, Echenique-Subiabre; Mark, Heath; Aurélie, Villeneuve; Jean-François, Humbert

    2013-10-01

    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.

  4. Time-Resolved Magneto-Optical Imaging of Y1Ba2Cu3O7-delta Thin Films in High-Frequency AC Current Regime (Postprint)

    Science.gov (United States)

    2012-02-01

    ΘF=αB laser pulseAC time φ Figure 1. Schematic diagram of the time-resolved MO imaging setup. time-resolved imaging, we use a Q- switched Nd:YLF diode...controlled power source in order to obtain time-resolved MO images of the current flow in the sample. We use a 6 µm thick epitaxial grown ferrite ...the AC current. Ultimately the time resolution achievable with this method will be limited to sub-nanoseconds by the magnetization switching time of the

  5. 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

    Directory of Open Access Journals (Sweden)

    Narcisa G. Pricope

    2015-07-01

    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.

  6. Current indications and role of surgery in the management of sigmoid diverticulitis

    Institute of Scientific and Technical Information of China (English)

    Luca; Stocchi

    2010-01-01

    Sigmoid diverticulitis is a common disease which carries both a significant morbidity and a societal economic burden.This review article analyzes the current data regarding management of sigmoid diverticulitis in its variable clinical presentations.Wide-spectrum antibiotics are the standard of care for uncomplicated diverticulitis.Recently published data indicate that sigmoid diverticulitis does not mandate surgical management after the second episode of uncomplicated disease as previously recommended.Rathe...

  7. Water Utility Management Strategies in Turkey: The current situation and the challenges

    Science.gov (United States)

    Alp, E.; Aksoy, M. N.; Koçer, B.

    2013-12-01

    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

  8. A review on current status of municipal solid waste management in India.

    Science.gov (United States)

    Gupta, Neha; Yadav, Krishna Kumar; Kumar, Vinit

    2015-11-01

    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.

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

    Directory of Open Access Journals (Sweden)

    AMALIA VENERA TODORUŢ

    2011-06-01

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

  10. The difficulties of the Chinese and Indian exchange rate regimes

    Directory of Open Access Journals (Sweden)

    Ila Patnaik

    2009-06-01

    Full Text Available China and India have both sought control over the exchange rate in order to maintain export competitiveness, manage current account balance, and pursue independent monetary policy. In this paper, we examine structural change in the Chinese and Indian de facto exchange rate regimes, focusing on the period from 1998 to 2007. With increasing capital account openness, exchange rate inflexibility has been associated with significant monetary policy distortions. In both countries, the short-term rate expressed in real terms dropped, and achieved very low values, in the unprecedented business cycle expansion of the early 2000s. In the Indian case, difficulties of sterilisation led to a modification of the exchange rate regime, moving towards greater flexibility. In China, in contrast, the exchange rate regime did not change.

  11. GIBSI: an integrated modelling system for watershed management – sample applications and current developments

    Directory of Open Access Journals (Sweden)

    A. N. Rousseau

    2007-11-01

    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.

  12. Management of urinary tract infections: historical perspective and current strategies: Part 2--Modern management.

    Science.gov (United States)

    Nickel, J Curtis

    2005-01-01

    An understanding of the microbial origin of infectious diseases and the introduction of antimicrobial therapy stimulated more advances in the management of urinary tract infections (UTIs) in the 20th century than had occurred in the previous 5 centuries. Numerous resources were used to collect the information described in this review. Medical texts from the 19th and 20th century contain information regarding the traditional contemporary treatment of UTI during those eras. Early volumes of the Journal of Urology from the beginning of the 20th century describe the first attempts at chemotherapy for UTI. MEDLINE searches were used to collect appropriate information after 1969. Modern medical journals and modern medical texts were used to collect information on antimicrobial therapy since the late 1960s through today. Numerous advances in the diagnosis and management of UTI were made during the 20th century. Advances in microbiological and chemical assays have facilitated the development of historical uroscopy into modern day urinalysis and culture techniques, which are the cornerstone of UTI diagnosis. Imaging technologies, including x-ray, ultrasound, nuclear imaging, magnetic resonance and computerized tomography, have been particularly helpful in the diagnosis of complicated or recurrent UTIs. Major innovations in nonpharmacological therapy include noninvasive shock wave lithotripsy and percutaneous drainage of kidney abscesses. The most profound advance in UTI management during the 20th century was the discovery of antimicrobial agents. Nitrofurantoin was the first truly effective and safe antimicrobial therapy for UTI but its spectrum of activity is limited. Broad use of amoxicillin (and other beta-lactams) after its introduction in the 1970s led to the development of resistance to this antimicrobial, prompting a gradual change to trimethoprim/sulfamethoxazole (TMP/SMX) as first line therapy for UTI. However, wide use of TMP/SMX also resulted in the progressive

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

    Directory of Open Access Journals (Sweden)

    Nico Schutte

    2015-03-01

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

  14. Current trends in pharmacy benefit designs: a threat to disease management in chronic complex diseases.

    Science.gov (United States)

    Owens, Gary; Emons, Matthew F; Christian-Herman, Jennifer; Lawless, Grant

    2007-04-01

    With a focus on those patients who are candidates for treatment with biologic agents, we review the impact that current pharmacy benefit trends have on patients with chronic complex diseases and how they affect opportunities for disease management in this unique patient population. Dramatic increases in health care costs have led to a variety of strategies to manage cost. Many of these strategies either limit access to care or increase the patient's responsibility for choosing and paying for care, especially for medications. These strategies have a disproportionate impact on patients with chronic complex diseases, particularly those who require the use of biologic medications. A fundamental prerequisite of disease management has been coverage of disease-modifying therapies. If current pharmacy benefit trends continue, unintended consequences will likely occur including lost opportunities for disease management. Current pharmacy benefit trends could adversely impact disease management, particularly for patients requiring the use of biologic agents. Health plans should consider innovative benefit designs that reflect an appropriate level of cost sharing across all key stake-holders, ensuring appropriate access to needed therapies. Additional research is needed to clarify the value of newer approaches to therapies or benefit design changes.

  15. Z-pinch driven hohlraums design for the 100 nanoseconds current time scale; Conception de cavites radiatives chauffees par plasma de striction magnetique en regime 100ns

    Energy Technology Data Exchange (ETDEWEB)

    Hamann, F

    2003-12-15

    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)

  16. Women in Management: Analysis of Selected Data from the Current Population Survey. Report to Congressional Requesters.

    Science.gov (United States)

    Robertson, Robert E.

    The key characteristics, representation, and salaries of women in management versus those of their male counterparts were examined through an analysis of Current Population Survey data collected in March 1995 and 2000. The study focused on the following 10 industries: communications; public administration; business and repair services;…

  17. A review of current guidelines for the management of Helicobacter pylori infection in children and adolescents

    OpenAIRE

    Jones, Nicola L.

    2004-01-01

    Helicobacter pylori infection is acquired in childhood and plays a causative role in chronic gastritis, peptic ulcer disease and the development of gastric cancer. The present review focuses on recent advances in the management of H pylori infection in children and provides an update of current Canadian guidelines regarding clinical sequelae, diagnosis and treatment.

  18. Regional economic impacts of current and proposed management alternatives for Charles M. Russell National Wildlife Refuge

    Science.gov (United States)

    Koontz, Lynne; Sexton, Natalie; Ishizaki, Asuka; Ritten, John

    2013-01-01

    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:

  19. Utilization management in radiology, part 1: rationale, history, and current status.

    Science.gov (United States)

    Duszak, Richard; Berlin, Jonathan W

    2012-10-01

    Previous growth in the utilization of medical imaging has led to numerous efforts to reduce associated spending. Although these have historically been directed toward unit cost reductions, recent interest has emerged by various stakeholders in curbing inappropriate utilization. Radiology benefits managers have widespread market penetration and have been promoted largely by the payer community as effective mechanisms to curb increases in imaging volume. The provider community has tended to favor real-time order entry decision support systems. These have demonstrated comparable effectiveness to radiology benefits managers in early projects but currently have only limited market penetration. In this first of a two-part series, the rationale for the development of utilization management programs will be discussed and their history and current status reviewed. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  20. Current industrial practice of managing risks in product development project portfolios

    DEFF Research Database (Denmark)

    Weng, R.; Oehmen, Josef; Ben-Daya, M.

    2013-01-01

    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...... influences them. The objective of this paper is two-fold: First, based on a literature review and industry focus group discussions, we introduce a new model for describing portfolio-level risks. It consists of three types of risks (escalated risks, common cause risks, and cascading risks) based on 9 types...... of interdependencies in PD project portfolios (Technology, Budget, Objectives and Requirements, Infrastructure and Equipment, Skillset and Human Resources, Process and Schedule, Supplier, Legal and Regulatory, and finally Market and Customer). Second, we investigate how risk management on the portfolio level...

  1. CURRENT TRENDS FOR DEVELOPMENT AND IMPROVEMENT OF THE ORGANIZATIONAL STRUCTURES IN MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Angel Doraliyski

    2017-03-01

    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.

  2. Is current medical education adequately preparing future physicians to manage concussion: an initial evaluation.

    Science.gov (United States)

    Donaworth, Michael A; Grandhi, Ravi K; Logan, Kelsey; Gubanich, Paul J; Myer, Gregory D

    2016-01-01

    In 2010, there were 2.5 million hospitalizations, emergency room visits, or deaths associated with concussions in the United States.[1] Knowledge deficits exist among physicians regarding concussion management, which can lead to severe repercussions, including poor patient outcomes, poor patient satisfaction, and potential medical-legal issues. While concussion is a prevalent condition evaluated in the medical field, medical students continue to have a knowledge deficit regarding concussion diagnosis, prognosis, medical management, and return to play guidelines. Medical students from a mid-western medical school completed a survey on concussion diagnosis, prognosis, medical management, and return to play guidelines. The response rate was 40%. The data suggests that the vast majority of medical students are able to define concussion; however, most reported never having a lecture dedicated to concussion during medical school and also lacked clinical experience with acute concussion and post-concussive syndrome. There are clear areas of deficiency as noted by the inability of students to correctly identify symptoms and appropriate management of concussion. The current study indicates that at an individual, mid-western, top 50 medical school, current medical trainees may not be adequately educated to identify and manage concussion. Future research is warranted to determine the optimal guidelines to educate future physicians as it pertains to concussion diagnosis, management, prognosis, and return to play guidelines.

  3. Sexual behavior and male volatile compounds in wild and mass-reared strains of the Mexican fruit fly Anastrepha ludens (Diptera: Tephritidae) held under different colony management regimes.

    Science.gov (United States)

    Bosa, Carlos Felipe; Cruz-López, Leopoldo; Zepeda-Cisneros, Cristina Silvia; Valle-Mora, Javier; Guillén-Navarro, Karina; Liedo, Pablo

    2016-02-01

    We compared the calling and mating behavior and volatile release of wild males Anastrepha ludens (Loew) with males from 4 mass-reared strains: (i) a standard mass-reared colony (control), (ii) a genetic sexing strain (Tap-7), (iii) a colony started from males selected on their survival and mating competitiveness abilities (selected), and (iv) a hybrid colony started by crossing wild males with control females. Selected and wild males were more competitive, achieving more matings under field cage conditions. Mass-reared strains showed higher percentages of pheromone calling males under field conditions except for Tap-7 males, which showed the highest percentages of pheromone calling males under laboratory cage conditions. For mature males of all strains, field-cage calling behavior increased during the last hour before sunset, with almost a 2 fold increase exhibited by wild males during the last half hour. The highest peak mating activity of the 4 mass-reared strains occurred 30 min earlier than for wild males. By means of solid phase microextraction (SPME) plus gas chromatography-mass spectrometry (GC-MS), the composition of volatiles released by males was analyzed and quantified. Wild males emitted significantly less amounts of (E,E)-α-farnesene but emitted significantly more amounts of (E,E)-suspensolide as they aged than mass-reared males. Within the 4 mass-reared strains, Tap-7 released significantly more amounts of (E,E)-α-farnesene and hybrid more of (E,E)-suspensolide. Differences in chemical composition could be explained by the intrinsic characteristics of the strains and the colony management regimes. Characterization of calling behavior and age changes of volatile composition between wild and mass-reared strains could explain the differences in mating competitiveness and may be useful for optimizing the sterile insect technique in A. ludens. © 2014 Institute of Zoology, Chinese Academy of Sciences.

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

    Science.gov (United States)

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

    2012-11-01

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

  5. Mineralogy of Holocene Sediments from the Southwestern Black Sea Shelf (Turkey) in Relation to Provenance, Sea-level and Current Regimes

    Institute of Scientific and Technical Information of China (English)

    Emel BAYHAN; Mustafa ERG(I)N; Abidin TEMEL; Seref KESK(I)N

    2005-01-01

    Grain size and mineral composition of core sediments were used to investigate influences of various terrestrial and marine conditions,which have prevailed on the southwestern Black Sea shelf during the Holocene.Siliciclastic mud with small amounts of sand and gravel from nearby coastal hinterland is the principal sediment type,whereas sediments deposited near the shelf edge and the (I)stanbul Strait and off the Duru Lake (a paleo-river mouth)constitued large quantities of sand and gravel of both biogenic and terrigenic origin.Variable amounts of aragonite,1 nm-micas,quartz,feldspars,calcite and dolomite constitute the dominant non-clay minerals in bulk sediments.The clay mineral assemblage in the < 2 μm fraction is made up of smectite,illite,kaolinite and chlorite.Aragonite and calcite are mainly derived from benthic accumulations,whereas feldspars (mainly plagioclase) and smectite reflect magmaticvolcanic provenance and the distribution of 1 nm-micas and chlorite correlate with nearby metamorphic sources onland.Nevertheless,grain size and mineral distribution generally indicate a combination of effects of wind and wave climate,longshore and offshore cyclonic currents,changing sea-level stands and nearby source rock and morphological conditions.It is also suggested that at least part of clay minerals could be derived from the northwesterly Danube River input.

  6. ESTIMATION OF LEAF AREA INDEX IN OPEN-CANOPY PONDEROSA PINE FORESTS AT DIFFERENT SUCCESSIONAL STAGES AND MANAGEMENT REGIMES IN OREGON. (R828309)

    Science.gov (United States)

    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...

  7. Offshore produced water management: A review of current practice and challenges in harsh/Arctic environments.

    Science.gov (United States)

    Zheng, Jisi; Chen, Bing; Thanyamanta, Worakanok; Hawboldt, Kelly; Zhang, Baiyu; Liu, Bo

    2016-03-15

    Increasing offshore oil and gas exploration and development in harsh/Arctic environments require more effective offshore produced water management, as these environments are much more sensitive to changes in water quality than more temperate climates. However, the number and scope of studies of offshore produced water management in harsh/Arctic environments are limited. This paper reviews the current state of offshore produced water management, impacts, and policies, as well as the vulnerability, implications and operational challenges in harsh/Arctic environments. The findings show that the primary contaminant(s) of concern are contained in both the dissolved oil and the dispersed oil. The application of emerging technologies that can tackle this issue is significantly limited by the challenges of offshore operations in harsh/Arctic environments. Therefore, there is a need to develop more efficient and suitable management systems since more stringent policies are being implemented due to the increased vulnerability of harsh/Arctic environments.

  8. The blunt liver trauma: Review of current diagnostic and management strategies

    Directory of Open Access Journals (Sweden)

    Doklestic Krstina

    2013-12-01

    Full Text Available The liver is one of the most commonly injured organs in blunt abdominal trauma. Major liver trauma in polytraumatic patients accounts for significant morbidity and mortality. Therapeutic options for blunt hepatic trauma include both non-operative and operative management. Hemodynamic status, not the grade of the injury, should dictate the management. CT scan of the abdomen and pelvis is a standard diagnostic modality in hemodynamically stable trauma patients. Recent advancements in imaging studies and enhanced critical care strategies have shifted the paradigm for the management of liver injuries. Nonoperative management of both low- and high-grade injuries can be successful in hemodynamically stable patients. Direct suture of bleeding vessels, vascular isolation of the liver, and damage control surgery have improved outcomes in the hemodynamically unstable patients. We have reviewed current position in the treatment of blunt hepatic trau

  9. Translational Science Project Team Managers: Qualitative Insights and Implications from Current and Previous Postdoctoral Experiences.

    Science.gov (United States)

    Wooten, Kevin C; Dann, Sara M; Finnerty, Celeste C; Kotarba, Joseph A

    2014-07-01

    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.

  10. The perfect ash-storm: large-scale Pyroclastic Density Current experiments reveal highly mobile, self-fluidising and air-cushioned flow transport regime

    Science.gov (United States)

    Lube, G.; Cronin, S. J.; Breard, E.; Valentine, G.; Bursik, M. I.; Hort, M. K.; Freundt, A.

    2013-12-01

    We report on the first systematic series of large-scale Pyroclastic Density Current (PDC) experiments using the New Zealand PDC Generator, a novel international research facility in Physical Volcanology recently commissioned at Massey University. Repeatable highly energetic and hot PDCs are synthesized by the controlled ';eruption column-collapse' of up to 3500 kg of homogenously aerated Taupo ignimbrite material from a 15 m-elevated hopper onto an instrumented inclined flume. At discharge rates between 250-1300 kg/s and low- to moderate gas injection rates (yielding initial solids concentration of 15-70 vol%) channelized gas-particle mixture flows life-scaled to dense PDCs can be generated. The flow fronts of the currents reach velocities of up to 9.5 m/s over their first 12 m of travel and rapidly develop strong vertical density stratification. The PDCs typically form a highly mobile, surge that also laterally escapes the flume boundaries. Depending on the PDC starting conditions underflows with 1-45 vol% solids concentration are formed, while the upper surge contains <<1 vol.% solids. A characteristic feature of the underflow is the occurrence of 'ignitive' front breakouts, producing jetted lobes that accelerate outward from the flow front, initially forming a lobe-cleft structure, followed by segregation downslope into multiple flow pulses. Depending on initial solids concentration and discharge rate, stratified, dune-bedded and inversely graded bedforms are created whose thicknesses are remarkably uniform along the medial to distal runout path characterising highly mobile flow runout. Along with high-speed video footage we present time-series data of basal arrays of load- and gas-pore pressure transducers to characterise the mobile dense underflows. Data shows that the PDCs are comprised of a turbulent coarse-grained and air-ingesting front with particle-solids concentrations of 1-5 vol%. The front shows a brief phase of negative pore pressure due to the

  11. Cancer pain management in China: current status and practice implications based on the ACHEON survey.

    Science.gov (United States)

    Xia, Zhongjun

    2017-01-01

    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. 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. 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%). Knowledge of cancer pain management should be strengthened among physicians. Quantitative pain assessment and principle-based pain management should be combined to achieve pain relief. Misconceptions about opioids in patients and physicians and poor report about pain should be

  12. A Conceptual Analysis of Current Trends in the Evolution of Risk Management Process

    Directory of Open Access Journals (Sweden)

    Monika Wieczorek-Kosmala

    2013-11-01

    Full Text Available Purpose of the article: The traditional idea of risk management is continually evolving as it enjoys growing popularity in corporations. The paper reviews the risk management procedure within the traditional concept and then identifies and discusses the main trends currently observed within the organisation and implementation of this procedure. Scientific aim: The paper aims at identyfing and describing the currently observed trends in the evolution of risk management process. To achieve this, it aims at comparative analysis of solutions within traditional risk management concept and the ideas underpinning the current process of risk management standardisation. It also aims at reviewing the validity of clasiffication of risk treatment techniques. Methodology/methods: The paper represents a conceptual analysis of the current state of affairs and uses the method of comparative analysis and deduction based on the literature review and the lecture of standardisation documents. As a viewpoint paper, it represents au-thor’s own ideas and findings. Findings: The two main trends of risk management evolution should be idetified. The first one is related with strategic dimension of risk management as this procedure is often promoted as an integrated concept. It springs from the regulations of standardisation procedures which aim at unifying the terminology and set of activities from practitioners’ perspective. The second direction of risk management concept evolution is observed within the development of risk financing techniques due to the innovations observed within traditional risk retention and trasfer solutions, as a result of continuous convergence of insurance and capital markets. Conclusions: (limits, implications etc The risk management process is constantly evolving toward the strategic dimension as the risk perception changes, concerning both the downside and upside of risk. However, the standards follow similar sequence of

  13. The Indus basin in the framework of current and future water resources management

    Science.gov (United States)

    Laghari, A. N.; Vanham, D.; Rauch, W.

    2012-04-01

    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

  14. The Indus basin in the framework of current and future water resources management

    Directory of Open Access Journals (Sweden)

    A. N. Laghari

    2012-04-01

    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

  15. Power Management Based Current Control Technique for Photovoltaic-Battery Assisted Wind-Hydro Hybrid System

    Science.gov (United States)

    Ram Prabhakar, J.; Ragavan, K.

    2013-07-01

    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.

  16. Current Situation of the Solid Waste Management in Gjirokastra Region: Problems and Challenges for the Future

    Directory of Open Access Journals (Sweden)

    ORNELA ÇUÇI

    2016-03-01

    Full Text Available The system of collecting waste and the current situation in their management is the main objective of this paper, to help the local government for sustainable waste management in the district of Gjirokastra. Through this study it was possible the provision of a database for the management of actual waste at the regional level, an analysis of actual system of waste management, the criteria necessary for managing them through an approach of sustainable development environmental, economic and social. Geographical space, which is the objective of this study is Gjirokastra district, consisting of three districts and currently, according to the new territorial division of 6 municipalities. To provide data on the current situation of waste used the data of municipalities and communes under the old territorial division. Processing of this database, the most important qualities and characteristics of the area are classified into 6 new municipalities functioning. Also they have interviewed over 250 employees and stakeholders the respective municipalities, and are inventoried evidence on policy practices and technologies used. They were examined waste prevention policies at national, regional and local enforcement practices, and based on general descriptions of available activities to prevent / reuse / recycling has prepared a detailed SWOT analyze. With SWOT analysis and data arising from it the results of this study suggest measures for the sustainable management of waste in the district of Gjirokastra, because the waste generated is collected without any prior sorting and no recycling process for hazardous waste appliances (batteries, etc. together with them even hospital waste. Disposal of waste from communities and municipalities realized using plastic bags or not, but without any preliminary separation according to their content or without taking into consideration all the resource sharing and protection from further urbanization

  17. Can Public Managers Make Their Welfare Organizations Adapt to the New Performance Landscape Shaped by the Current Austerity?

    DEFF Research Database (Denmark)

    Pedersen, John Storm; Aagaard, Peter

    2014-01-01

    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....

  18. Screening California Current fishery management scenarios using the Atlantis end-to-end ecosystem model

    Science.gov (United States)

    Kaplan, Isaac C.; Horne, Peter J.; Levin, Phillip S.

    2012-09-01

    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

  19. [Current quality management situation and administration countermeasure study of enterprises marketing corneal contact lens].

    Science.gov (United States)

    Liu, Yungui; Yao, Ying; Shangguan, Shihao; Gu, Qun; Gao, Wuming; Chen, Yaoshui

    2014-05-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Serdar YARLIKAŞ

    2015-09-01

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

  1. Framing of regimes and transition strategies

    DEFF Research Database (Denmark)

    Jensen, Jens Stissing

    2012-01-01

    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...

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

    Science.gov (United States)

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

    2017-07-08

    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.

  3. Physical Activity in Clinical Pediatric Weight Management Programs: Current Practices and Recommendations.

    Science.gov (United States)

    Kist, Christopher; Gier, Amanda; Tucker, Jared; Barbieri, Teresa F; Johnson-Branch, Sonya; Moore, Lindy; Picard, Sarah; Lukasiewicz, Gloria; Coleman, Nailah

    2016-11-01

    Physical activity (PA) is essential for youth weight management. FOCUS on a Fitter Future (FFF), a group of health care professionals from 25 children's hospitals, sponsored by the Children's Hospital Association, examined current care practices for overweight and obese youth with the goal of building consensus on outcome measurements and quality improvement for pediatric weight management programs (WMPs). WMPs completed a survey regarding PA practices, including testing, assessment and intervention. Consistency in general treatment practices was noted with variability in implementation. All programs included PA assessment and counseling. A majority of programs measured aerobic fitness, and more than half evaluated muscular fitness. Most offered group exercise sessions. Programs differed in availability of resources, assessment tools, interventions and outcome measures. Based on current practice and research, the FFF PA subgroup recommends key components for inclusion in a pediatric WMP: exercise testing, body composition assessment, PA and sedentary behaviors measures, individual exercise counseling, and group exercise programming. © The Author(s) 2015.

  4. Capital Finance Decisions for project managers - A reflection on current methods

    Directory of Open Access Journals (Sweden)

    C. Scheepers

    2003-12-01

    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.

  5. THE DUAL CONTROL – A REQUIREMENT OF THE CURRENT BANK MANAGEMENT

    Directory of Open Access Journals (Sweden)

    ALINA MATIȘ

    2014-10-01

    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.

  6. Current Management of Low Risk Differentiated Thyroid Cancer and Papillary Microcarcinoma.

    Science.gov (United States)

    Tarasova, V D; Tuttle, R M

    2017-01-10

    Each year, the proportion of thyroid cancer patients presenting with low risk disease is increasing. Moreover, the definition of low risk thyroid cancer is expanding and several histological subtypes beyond papillary microcarcinomas are now classified as low risk disease. This shift in the landscape of thyroid cancer presentation is forcing clinicians to critically re-evaluate whether or not traditional management paradigms that were effective in treating intermediate and high risk disease are applicable to these low risk patients. Here we review the definition of low risk disease, examine the various histological subtypes that are considered low risk in the 2015 American Thyroid Association guidelines for the management of thyroid nodules and thyroid cancer, and review our current approach to the management of these low risk tumours.

  7. Current strategies for the prevention and management of central line-associated bloodstream infections

    Directory of Open Access Journals (Sweden)

    Zhuolin Han

    2010-11-01

    Full Text Available Zhuolin Han, Stephen Y Liang, Jonas MarschallDivision of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, MO, USAAbstract: Central venous catheters are an invaluable tool for diagnostic and therapeutic purposes in today’s medicine, but their use can be complicated by bloodstream infections (BSIs. While evidence-based preventive measures are disseminated by infection control associations, the optimal management of established central line-associated BSIs has been summarized in infectious diseases guidelines. We prepared an overview of the state-of-the-art of prevention and management of central line-associated BSIs and included topics such as the role of antibiotic-coated catheters, the role of catheter removal in the management, and a review of currently used antibiotic compounds and the duration of treatment.Keywords: central venous catheters, bloodstream infections, guidelines, prevention

  8. Current status of managing food allergies in schools in Seoul, Korea.

    Science.gov (United States)

    Kim, Soyoung; Yoon, Jihyun; Kwon, Sooyoun; Kim, Jihyun; Han, Youngshin

    2012-12-01

    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.

  9. Waste management in the Irkutsk Region, Siberia, Russia: Environmental assessment of current practice focusing on landfilling

    DEFF Research Database (Denmark)

    Starostina, Vlada; Damgaard, Anders; Rechberger, Helmut

    2014-01-01

    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...... years, the LCA modelling showed that introduction of a new and modern landfill with gas and leachate collection could improve the performance of the waste management system significantly. Collection of landfill gas and utilization for 30 years for electricity production (gas turbine) would reduce...

  10. Manifesto for the current understanding and management of traumatic brain injury-induced hypopituitarism

    DEFF Research Database (Denmark)

    Tanriverdi, F; Agha, A; Aimaretti, G

    2011-01-01

    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....

  11. Manifesto for the current understanding and management of traumatic brain injury-induced hypopituitarism.

    LENUS (Irish Health Repository)

    Tanriverdi, F

    2011-01-01

    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.

  12. Individual Monitoring and Occupational Dose Record Management in China: History, Current Status and Perspectives.

    Science.gov (United States)

    Wang, Hong-Bo; Yu, Hai-Tao; Sun, Quan-Fu

    2016-06-03

    This review paper presents an overview of individual monitoring, as well as the national dose register and dose record management of radiation workers in China. Progress has recently been made on the individual monitoring of radiation workers. A critical analysis of current status and problems in individual monitoring is also presented and necessary future research on individual monitoring, such as the monitoring technology in the form of the ring dosimeters and eye lens dosimeters, is suggested.

  13. Care of the patient with interstitial cystitis: current theories and management.

    Science.gov (United States)

    Burrell, M; Hurm, R

    1999-02-01

    Interstitial cystitis is a disease process that has only come into focus over recent years. Researchers are looking for a cause of this painful and frustrating disorder of the bladder, but currently, only theories exist. Nurses must understand the pathophysiology of the disease and the dysfunction of the bladder to educate and assist the patient in the management of this chronic process. This report provides the nurse with information and education on the symptoms, pathophysiology, nursing diagnoses, and potential treatment modalities.

  14. Current State and Issues of Logistics Cost Accounting and Management in Malaysia

    OpenAIRE

    Zakariah, Sahidah; Pyeman, Jaafar

    2013-01-01

    Background: Logistics cost is an important factor affecting the competitiveness on both macro (national) and micro level (firms). Logistics cost indicates the performance of logistics industry, efficiency level and its competitiveness. Research Problem: Despite of its significance, current state of logistics cost accounting and management in Malaysia has not properly addressed and the issues surround logistics cost measurement remains incoherent. Aim of research: The purpose o...

  15. Critical report of current fisheries management measures implemented for the North Sea mixed demersal fisheries

    DEFF Research Database (Denmark)

    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 sup...... to distinguish specific effects and impacts of each individual measures implemented. Accordingly, it is also very difficult to make scientific management evaluation and advice associated to the individual measures......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....... The prevailing management system and principle has been landing quotas (TAC, Total Allowable Catch) mainly based on the EU principle of relative stability in the international sharing of the TAC. Also, general effort limitations and technical measures are set for the EU and Norwegian fisheries on top of the TAC...

  16. Current Trends in the Management of Phyllodes Tumors of the Breast

    Science.gov (United States)

    Adesoye, Taiwo; Neuman, Heather B; Wilke, Lee G; Schumacher, Jessica R; Steiman, Jennifer; Greenberg, Caprice C

    2016-01-01

    Introduction National Comprehensive Cancer Network (NCCN) guidelines recommend wide excision without axillary staging to treat phyllodes tumors of the breast. Without prospective trials to guide management, NCCN also recommends consideration of radiation therapy (XRT). We describe current patterns of care for the multidisciplinary management of phyllodes tumors. Methods Using Surveillance, Epidemiology and End Results Program (SEER) data, we identified women diagnosed with phyllodes tumors between 2000 and 2012 who underwent surgical therapy. Trends in breast conserving surgery (BCS), nodal sampling and XRT were assessed using the Cochrane-Armitage test. Multivariable logistic regression was used to identify factors associated with treatment. Results Of 1,238 patients, 56.9% underwent BCS and 23.6% underwent nodal sampling (10.5% after BCS vs 40.9% after mastectomy). After surgery, 15.4% received adjuvant XRT (BCS, 12.9% and mastectomy, 18.8%). XRT utilization increased significantly over the study period (BCS, p=tumors. Nodal sampling was also associated with older age, larger tumor size and receipt of mastectomy. Receipt of XRT was associated with later year of diagnosis, larger tumors and nodal assessment. Conclusion Over time, an increasing number of women received XRT after surgical management of phyllodes tumor, and one in four women underwent nodal sampling. While some of this practice can be attributed to concern about more advanced disease in the absence of strong data, there may be an educational gap regarding current guidelines and appropriate management. PMID:27334214

  17. Recent changes (1973-2014 versus 1903-1972) in the flow regime of the Lower Paraná River and current fluvial pollution warnings in its Delta Biosphere Reserve.

    Science.gov (United States)

    Puig, Alba; Olguín Salinas, Héctor F; Borús, Juan A

    2016-06-01

    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

  18. Recent changes (1973-2014 versus 1903-1972) in the flow regime of the Lower Paraná River and current fluvial pollution warnings in its Delta Biosphere Reserve

    Science.gov (United States)

    Puig, Alba; Olguín Salinas, Héctor F.; Borús, Juan A.

    2016-06-01

    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 slightly

  19. Current Controversies in Diagnosis and Management of Cleft Palate and Velopharyngeal Insufficiency

    Directory of Open Access Journals (Sweden)

    Pablo Antonio Ysunza

    2015-01-01

    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.

  20. Current Controversies in Diagnosis and Management of Cleft Palate and Velopharyngeal Insufficiency

    Science.gov (United States)

    Ysunza, Pablo Antonio; Repetto, Gabriela M.; Pamplona, Maria Carmen; Calderon, Juan F.; Shaheen, Kenneth; Chaiyasate, Konkgrit; Rontal, Matthew

    2015-01-01

    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

  1. Comparative evaluation of different strengths of electrical current in the management of dentinal hypersensitivity

    Directory of Open Access Journals (Sweden)

    Sandhu Sharn

    2010-01-01

    Full Text Available Background : Dentinal hypersensitivity is a commonly occurring but less understood and poorly managed problem of the teeth. Iontophoresis is a technique wherein desensitizing agents can be transferred under electrical pressure into the tooth structure to manage hypersensitivity. Aim : The purpose of present study is to compare the effect of different strengths of electrical current used for varying lengths of time, keeping the electrical dosage constant with the iontophoretic unit in the management of dentinal hypersensitivity. Materials and Methods : This study was conducted among the patients attending the Periodontal Department of the Government Dental College and Hospital, Patiala, Punjab, specifically complaining of tooth hypersensitivity. The Verbal Rating Scale (VRS was used to record scores pre-, during, and post-treatment. Ten percent SrCl2 solution was applied with an iontophoretic unit. Three applications were performed at weekly intervals, up to the second week, using the same electric current dosage. The data compiled was statistically analyzed. Results : A remarkable reduction in dentinal hypersensitivity to both air blast and cold water stimuli was noted at the end of two months after iontophoresis with each current group / method, namely, I (0.25 mA for 4 minutes, II (0.5 mA for 2 minutes, and III (1 mA for 1 minute. However, the differences in effectiveness / improvement within the three current groups during the entire duration of the study were found to be statistically insignificant. Conclusion : Within the limits of this study, it could be implied that for relieving hypersensitivity, iontophoresis for all three current groups was almost equally effective, and it was found that repeated applications (up to three gave good relief. Iontophoresis was found to be effective and safe.

  2. History of the current understanding and management of tethered spinal cord.

    Science.gov (United States)

    Safavi-Abbasi, Sam; Mapstone, Timothy B; Archer, Jacob B; Wilson, Christopher; Theodore, Nicholas; Spetzler, Robert F; Preul, Mark C

    2016-07-01

    An understanding of the underlying pathophysiology of tethered cord syndrome (TCS) and modern management strategies have only developed within the past few decades. Current understanding of this entity first began with the understanding and management of spina bifida; this later led to the gradual recognition of spina bifida occulta and the symptoms associated with tethering of the filum terminale. In the 17th century, Dutch anatomists provided the first descriptions and initiated surgical management efforts for spina bifida. In the 19th century, the term "spina bifida occulta" was coined and various presentations of spinal dysraphism were appreciated. The association of urinary, cutaneous, and skeletal abnormalities with spinal dysraphism was recognized in the 20th century. Early in the 20th century, some physicians began to suspect that traction on the conus medullaris caused myelodysplasia-related symptoms and that prophylactic surgical management could prevent the occurrence of clinical manifestations. It was not, however, until later in the 20th century that the term "tethered spinal cord" and the modern management of TCS were introduced. This gradual advancement in understanding at a time before the development of modern imaging modalities illustrates how, over the centuries, anatomists, pathologists, neurologists, and surgeons used clinical examination, a high level of suspicion, and interest in the subtle and overt clinical appearances of spinal dysraphism and TCS to advance understanding of pathophysiology, clinical appearance, and treatment of this entity. With the availability of modern imaging, spinal dysraphism can now be diagnosed and treated as early as the intrauterine stage.

  3. Environmental assessment of waste management in Greenland: current practice and potential future developments.

    Science.gov (United States)

    Eisted, Rasmus; Christensen, Thomas H

    2013-05-01

    The majority of the waste in Greenland is disposed of in open dumps or incinerated in simple small-scale incinerators. There are relatively few environmental regulations that control the emissions of leachate, landfill gas and/or flue gases from incineration. Only some scrap metal and hazardous waste are collected separately and exported to Europe. The impacts from the current waste management system were modelled from a life-cycle perspective using the LCA-waste model EASEWASTE. Impacts with regard to global warming, acidification, etc. are small (a few hundred person-equivalents (PE) for a system serving 56 000 inhabitants), but significant environmental loads are caused by air emissions from the incinerators and leachate from the landfills. Several alternative management scenarios were modelled and results show that increased use of incineration, full utilization of the heat production for district heating and separation of hazardous waste probably could improve Greenland's waste management system. Segregation of recyclable materials as paper, cardboard and biowaste will do little to environmentally improve the waste management system due to loss of energy recovery from incineration and the long transport of the recyclables to markets. Export of waste to Denmark for incineration at modern waste incinerators with advanced flue gas cleaning could also be considered as a means to achieve better environmental performance of the waste management system.

  4. Prognostics and Health Management of Wind Turbines: Current Status and Future Opportunities

    Energy Technology Data Exchange (ETDEWEB)

    Sheng, Shuangwen

    2015-12-14

    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.

  5. Methods for Management of Innovation Activity Risks in the Current Conditions

    Directory of Open Access Journals (Sweden)

    Pysmak Viktoriia O.

    2016-03-01

    Full Text Available The article considers theoretical foundations of management of innovation activity risks. Relevance of the selected topic of research in connection with both volatile external environment and crisis developments in the country's economy has been substantiated. A semantic analysis of the concept of «risk» has been done, showing the presence of both positive and negative sides of risk situations. A scheme for enterprise management in the light of implementing innovation activity has been elaborated. An improved classification of innovation activity has been provided, creating the opportunity to focus on identifying risks in the process of allocating a specific direction of innovation activity. The main stages of identification and analysis of risks of innovation activity has been allocated. Methods for management of innovation activity risks in the current conditions have been developed. A concept of «system for management of innovation activity risks» has been formulated, its major features for enterprise has been outlined. The main requirements for a system for management of innovation activity risks have been allocated.

  6. The Current Role of Carotid Duplex Ultrasonography in the Management of Carotid Atherosclerosis: Foundations and Advances

    Directory of Open Access Journals (Sweden)

    Kelly R. Byrnes

    2012-01-01

    Full Text Available The management of atherosclerotic carotid occlusive disease for stroke prevention has entered a time of dramatic change. Improvements in medical management have begun to challenge traditional interventional approaches to asymptomatic carotid stenosis. Simultaneously, carotid artery stenting (CAS has emerged as an alternative to carotid endarterectomy (CE. Finally, multiple factors beyond degree of stenosis and symptom status now mitigate clinical decision making. These factors include brain perfusion, plaque morphology, and patency of intracranial collaterals (circle of Willis. With all of these changes, it seems prudent to review the role of carotid duplex ultrasonography in the management of atherosclerotic carotid occlusive disease for stroke prevention. Carotid duplex ultrasonography (CDU for initial and serial imaging of the carotid bifurcation remains an essential component in the management of carotid bifurcation disease. However, correlative axial imaging modalities (computer tomographic angiography (CTA and contrast-enhanced magnetic resonance angiography (CE-MRA increasingly aid in the assessment of individual stroke risk and are important in treatment decisions. The purpose of this paper is twofold: (1 to discuss foundations and advances in CDU and (2 to evaluate the current role of CDU, in light of other imaging modalities, in the clinical management of carotid atherosclerosis.

  7. Current and emerging management options for patients with Morquio A syndrome.

    Science.gov (United States)

    Algahim, Mohamed F; Almassi, G Hossein

    2013-01-01

    Morquio A syndrome is a lysosomal storage disease associated with mucopolysaccharidosis. It is caused by a deficiency of the lysosomal enzyme, N-acetylgalactosamine-6-sulfate sulfatase, which leads to accumulation of keratan sulfate and condroitin-6 sulfate in multiple organs. Patients present with multisystemic complications involving the musculoskeletal, respiratory, cardiovascular, and digestive systems. Presently, there is no definitive cure, and current management options are palliative. Enzyme replacement therapy and hematopoietic stem cell therapy have been proven effective in certain lysosomal storage diseases, and current investigations are underway to evaluate the effectiveness of these therapies and others for the treatment of Morquio A syndrome. This review discusses the current and emerging treatment options for Morquio A syndrome, citing examples of the treatment of other mucopolysaccharidoses.

  8. Current and emerging management options for patients with Morquio A syndrome

    Directory of Open Access Journals (Sweden)

    Algahim MF

    2013-02-01

    Full Text Available Mohamed F Algahim, G Hossein AlmassiDivision of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USAAbstract: Morquio A syndrome is a lysosomal storage disease associated with mucopolysaccharidosis. It is caused by a deficiency of the lysosomal enzyme, N-acetylgalactosamine-6-sulfate sulfatase, which leads to accumulation of keratan sulfate and condroitin-6 sulfate in multiple organs. Patients present with multisystemic complications involving the musculoskeletal, respiratory, cardiovascular, and digestive systems. Presently, there is no definitive cure, and current management options are palliative. Enzyme replacement therapy and hematopoietic stem cell therapy have been proven effective in certain lysosomal storage diseases, and current investigations are underway to evaluate the effectiveness of these therapies and others for the treatment of Morquio A syndrome. This review discusses the current and emerging treatment options for Morquio A syndrome, citing examples of the treatment of other mucopolysaccharidoses.Keywords: lysosomal, storage disease, mucopolysaccharidosis

  9. Design document for the Surface Currents Data Base (SCDB) Management System (SCDBMS), version 1.0

    Science.gov (United States)

    Krisnnamagaru, Ramesh; Cesario, Cheryl; Foster, M. S.; Das, Vishnumohan

    1994-01-01

    The Surface Currents Database Management System (SCDBMS) provides access to the Surface Currents Data Base (SCDB) which is maintained by the Naval Oceanographic Office (NAVOCEANO). The SCDBMS incorporates database technology in providing seamless access to surface current data. The SCDBMS is an interactive software application with a graphical user interface (GUI) that supports user control of SCDBMS functional capabilities. The purpose of this document is to define and describe the structural framework and logistical design of the software components/units which are integrated into the major computer software configuration item (CSCI) identified as the SCDBMS, Version 1.0. The preliminary design is based on functional specifications and requirements identified in the governing Statement of Work prepared by the Naval Oceanographic Office (NAVOCEANO) and distributed as a request for proposal by the National Aeronautics and Space Administration (NASA).

  10. Assessing and Managing the Current and Future Pest Risk from Water Hyacinth, (Eichhornia crassipes), an Invasive Aquatic Plant Threatening the Environment and Water Security

    Science.gov (United States)

    Brunel, Sarah

    2016-01-01

    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. PMID:27513336

  11. Current management of intracerebral haemorrhage in China: a national, multi-centre, hospital register study

    Directory of Open Access Journals (Sweden)

    Heeley Emma L

    2011-01-01

    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.

  12. Extra-abdominal desmoid fibromatosis: A review of management, current guidance and unanswered questions.

    Science.gov (United States)

    Eastley, N; McCulloch, T; Esler, C; Hennig, I; Fairbairn, J; Gronchi, A; Ashford, R

    2016-07-01

    Extra abdominal desmoid fibromatosis is a complex condition with many recognised treatments including active observation, hormonal therapy, chemotherapy, radiotherapy and surgical resection. There is large variation in the natural history of individual desmoid tumours, with some cases progressing aggressively and others regressing spontaneously when observed alone. This combined with an absence of accurate clinical predictors of a desmoid tumour's behaviour has led to difficulties in identifying which patients would benefit most from aggressive treatment, and which could be adequately managed with a policy of active observation alone. This review explores the aetiology and common presentation of extra-abdominal desmoid fibromatosis including the condition's histopathological, clinical and radiological characteristics. The current evidence for potential predictors of desmoid tumour behaviour is also reviewed, along with the indications and evidence for the multitude of treatments available. We also summarise the published guidelines that are currently available for oncologists and surgeons managing extra-abdominal desmoid fibromatosis, and highlight some of the unanswered questions that need to be addressed to optimise the management of this condition. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Current management for word finding difficulties by speech-language therapists in South African remedial schools.

    Science.gov (United States)

    de Rauville, Ingrid; Chetty, Sandhya; Pahl, Jenny

    2006-01-01

    Word finding difficulties frequently found in learners with language learning difficulties (Casby, 1992) are an integral part of Speech-Language Therapists' management role when working with learning disabled children. This study investigated current management for word finding difficulties by 70 Speech-Language Therapists in South African remedial schools. A descriptive survey design using a quantitative and qualitative approach was used. A questionnaire and follow-up focus group discussion were used to collect data. Results highlighted the use of the Renfrew Word Finding Scale (Renfrew, 1972, 1995) as the most frequently used formal assessment tool. Language sample analysis and discourse analysis were the most frequently used informal assessment procedures. Formal intervention programmes were generally not used. Phonetic, phonemic or phonological cueing were the most frequently used therapeutic strategies. The authors note strengths and raise concerns about current management for word finding difficulties in South African remedial schools, particularly in terms of bilingualism. Opportunities are highlighted regarding the development of assessment and intervention measures relevant to the diverse learning disabled population in South Africa.

  14. Pulmonary hypertension in adults with congenital heart disease and Eisenmenger syndrome: current advanced management strategies.

    Science.gov (United States)

    D'Alto, Michele; Diller, Gerhard-Paul

    2014-09-01

    The presence of pulmonary arterial hypertension (PAH) increases morbidity and reduces survival in patients with congenital heart disease (CHD). PAH-CHD is a heterogeneous condition, depending on the type of the underlying defect and previous repair strategies. There is growing evidence of the benefits of PAH-specific therapy in the PAH-CHD population, but despite recent advances mortality rates remain relatively high. In the last years, an increasing focus has been placed on patients with PAH-CHD and net left-to-right shunt. Currently, there are limited data to guide the management of these patients and uncertainty on the cut-off values for eventual defect closure. Pregnancy conveys significant risks in PAH-CHD patients: appropriate counselling and care, including psychological support and a multidisciplinary team, should be part of the routine management of women with PAH-CHD of reproductive age. Some subgroups, such as patients with Down's syndrome, Fontan circulation and 'segmental' pulmonary hypertension, present particular challenges in terms of management and therapy. The current review focuses on contemporary treatment strategies in PAH-CHD patients with particular emphasis on challenging patient groups and conditions.

  15. Current state of sludge production, management, treatment and disposal in China.

    Science.gov (United States)

    Yang, Guang; Zhang, Guangming; Wang, Hongchen

    2015-07-01

    Large amount of sludge has been a great trouble and raised significant concerns in China. This paper reviewed the current situation of sludge production, management, treatment and disposal in China. Total sludge production in China had an average annual growth of 13% from 2007 to 2013, and 6.25 million tons dry solids was produced in 2013. Per Capita sludge production in China is lower than that in developed countries. However, sludge management is poor in China. Administrative agents of sludge are not in accordance with each other. Laws and regulations of sludge management are incomplete and sometimes unrealistic. As to sludge treatment and disposal, many technical routes have been applied in China. Thickening, conditioning, and dewatering are three most used treatment methods, while application ratios of stabilization and drying are low in China. More than 80% of sludge is disposed by improper dumping in China. Regarding proper disposal, sanitary landfill is the commonest, followed by land application, incineration and building materials. According to the overall situation of China, "thickening-anaerobic digestion-dewatering-land application" is the priority technical route of sludge treatment and disposal. Good changes, current challenges and future perspectives of this technical route in China were analyzed and discussed in details.

  16. Management of tinnitus in English NHS audiology departments: an evaluation of current practice.

    Science.gov (United States)

    Hoare, Derek J; Gander, Phillip E; Collins, Luke; Smith, Sandra; Hall, Deborah A

    2012-04-01

    In 2009, the UK Department of Health formalized recommended National Health Service practices for the management of tinnitus from primary care onwards. It is timely therefore to evaluate the perceived practicality, utility and impact of those guidelines in the context of current practice. We surveyed current practice by posting a 36-item questionnaire to all audiology and hearing therapy staff that we were able to identify as being involved in tinnitus patient care in England. In total, 138 out of 351 clinicians responded (39% response rate). The findings indicate a consensus opinion that management should be tailored to individual symptom profiles but that there is little standardization of assessment procedures or tools in use. While the lack of standardized practice might provide flexibility to meet local demand, it has drawbacks. It makes it difficult to ascertain key standards of best practice, it complicates the process of clinical audit, it implies unequal patient access to care, and it limits the implementation of translational research outcomes. We recommend that core elements of practice should be standardized, including use of a validated tinnitus questionnaires and an agreed pathway for decision making to better understand the rationale for management strategies offered. © 2010 Blackwell Publishing Ltd.

  17. Current and emerging strategies in the management of venous thromboembolism: benefit-risk assessment of dabigatran.

    Science.gov (United States)

    Fanola, Christina L

    2015-01-01

    Venous thromboembolism (VTE) is a disease state that carries significant morbidity and mortality, and is a known cause of preventable death in hospitalized and orthopedic surgical patients. There are many identifiable risk factors for VTE, yet up to half of VTE incident cases have no identifiable risk factor and carry a high likelihood of recurrence, which may warrant extended therapy. For many years, parenteral unfractionated heparin, low-molecular weight heparin, fondaparinux, and oral vitamin K antagonists (VKAs) have been the standard of care in VTE management. However, limitations in current drug therapy options have led to suboptimal treatment, so there has been a need for rapid-onset, fixed-dosing novel oral anticoagulants in both VTE treatment and prophylaxis. Oral VKAs have historically been challenging to use in clinical practice, with their narrow therapeutic range, unpredictable dose responsiveness, and many drug-drug and drug-food interactions. As such, there has also been a need for novel anticoagulant therapies with fewer limitations, which has recently been met. Dabigatran etexilate is a fixed-dose oral direct thrombin inhibitor available for use in acute and extended treatment of VTE, as well as prophylaxis in high-risk orthopedic surgical patients. In this review, the risks and overall benefits of dabigatran in VTE management are addressed, with special emphasis on clinical trial data and their application to general clinical practice and special patient populations. Current and emerging therapies in the management of VTE and monitoring of dabigatran anticoagulant-effect reversal are also discussed.

  18. Current status of solid waste management in small island developing states: A review

    Energy Technology Data Exchange (ETDEWEB)

    Mohee, Romeela [University of Mauritius, Réduit (Mauritius); Mauthoor, Sumayya, E-mail: sumayya.mauthoor@umail.uom.ac.mu [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)

    2015-09-15

    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

  19. "Dry mouth" from the perspective of traditional Persian medicine and comparison with current management.

    Science.gov (United States)

    Heydarirad, Ghazaleh; Choopani, Rasool

    2015-04-01

    Xerostomia is a common problem, particularly in an elderly population, with a range of causes that affect important aspects of life, such as chewing, swallowing, and speaking. Xerostomia has been explained in traditional medicine throughout history. Traditional Persian medicine, with more than 4000 years of history, consists of the sum total of all the knowledge and practices used in diagnosis, prevention, and exclusion in Iran from ancient times to the present. Based on leading Persian medical manuscripts, the current study focuses on the medieval concept of xerostomia as an important general disorder to review the aetiology of xerostomia and xerostomia types, the control and treatment of xerostomia by lifestyle modification, and medicinal plants for xerostomia suppression according to the theory and practice of traditional Persian medicine. Xerostomia was treated with 3 major approaches in traditional Persian medicine: lifestyle modification, simple single herbal remedies, and compound medicines. It appears that all the factors that cause xerostomia in current studies can be described by using the theories of traditional Persian medicine; furthermore, therapies aimed at both medicines (current and traditional) focus on protecting salivary glands and salivary flow. As a conclution while current managements of xerostomia are still inadequate and traditional approaches have found experimental support over the centuries, some of these traditional treatments may still be useful to current medicine as alternative medicine.

  20. Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss

    Science.gov (United States)

    Ramhamadany, Eamon; Modi, Chetan S

    2016-01-01

    The management of recurrent anterior gleno-humeral joint instability is challenging in the presence of bone loss. It is often seen in young athletic patients and dislocations related to epileptic seizures and may involve glenoid bone deficiency, humeral bone deficiency or combined bipolar lesions. It is critical to accurately identify and assess the amount and position of bone loss in order to select the most appropriate treatment and reduce the risk of recurrent instability after surgery. The current literature suggests that coracoid and iliac crest bone block transfers are reliable for treating glenoid defects. The treatment of humeral defects is more controversial, however, although good early results have been reported after arthroscopic Remplissage for small defects. Larger humeral defects may require complex reconstruction or partial resurfacing. There is currently very limited evidence to support treatment strategies when dealing with bipolar lesions. The aim of this review is to summarise the current evidence regarding the best imaging modalities and treatment strategies in managing this complex problem relating particularly to contact athletes and dislocations related to epileptic seizures. PMID:27335809

  1. Managing the services supply chain in the Department of Defense: an empirical study of current management practices / by Aruna U. Apte, Uday M. Apte, and Rene G. Rendon.

    OpenAIRE

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

    2009-01-01

    This paper presents the results of our ongoing research on the management of services acquisition in the Department of Defense. In this empirical study we developed and used a web-based survey to collect data on the acquisition strategy, procurement methods, and contract types used at Air Force and Navy installations. Specifically, we studied the current management practices in such areas as life cycle approach, project management, organization/management structure, and training provided to s...

  2. Big Data and Big Data Management (BDM with current Technologies –Review

    Directory of Open Access Journals (Sweden)

    Atul S

    2017-04-01

    Full Text Available The emerging phenomenon called ―Big Data‖ is pushing numerous changes in businesses and several other organizations, Domains, Fields, areas etc. Many of them are struggling just to manage the massive data sets. Big data management is about two things - ―Big data‖ and ―Data Management‖ and these terms work together to achieve business and technology goals as well. In previous few years data generation have tremendously enhanced due to digitization of data. Day by day new computer tools and technologies for transmission of data among several computers through Internet is been increasing. It‗s relevance and importance in the context of applicability, usefulness for decision making, performance improvement etc in all areas have emerged very fast to be relevant in today‗s era. Big data management also has numerous challenges and common complexities include low organizational maturity relative to big data, weak business support, and the need to learn new technology approaches. This paper will discuss the impacts of Big Data and issues related to data management using current technologies

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

    Science.gov (United States)

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

    2013-01-01

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

  4. An Overview of Current Screening and Management Approaches for Prostate Cancer.

    Science.gov (United States)

    Akram, Omar N; Mushtaq, Gohar; Kamal, Mohammad Amjad

    2015-01-01

    Prostate cancer is the fourth leading cause of mortality in Australian men. The prevalence and incidence is increasing in both developed and developing nations, thus there is a need for better screening and management of this disorder. While there is no direct known cause of prostate cancer, management is largely focused on early detection and treatment strategies. Of particular concern is advanced prostate cancer which can manifest as castrate resistant prostate cancer characterized by therapy resistance. This short review outlines the global epidemiology of prostate cancer, clinical manifestations, risk factors, current screening strategies including first line clinical screening as well as the use of circulating biomarkers, and treatment of prostate cancer through mainstream therapeutics as well as the cutting edge peptide and nano-technology based therapeutics that are being implemented or in the process of development to overcome therapeutic obstacles in the treatment of prostate cancer.

  5. Current practice with regard to short-term incentive schemes for middle managers

    Directory of Open Access Journals (Sweden)

    Chrisilla Grigoiadis

    2007-01-01

    Full Text Available This study aimed to determine what the current practice is with regard to short-term incentive schemes for middle managers. This was done by means of a quantitative study through a structured research survey completed by a sample of forty-eight organisations. The design elements, performance measures and payout practices of the various schemes in use were surveyed, as well as the participants’ view on the perceived effectiveness of their short-term incentive schemes. Evidence shows that the majority of organisations have a short-term incentive scheme in place for middle managers, and that the type of scheme used in most of the organisations is a performance-related bonus scheme, introduced mainly to drive business performance and reward superior performance.

  6. Current status of retrograde intrarenal surgery for management of nephrolithiasis in children

    Directory of Open Access Journals (Sweden)

    Yaser El-Hout

    2010-01-01

    Full Text Available Purpose : To review the current status of retrograde intrarenal surgery (RIRS for renal stones in children focusing on its indications, outcomes and success in the management of nephrolithiasis. Materials and Methods : Between 1988 and 2009, a comprehensive PubMed/MEDLINE literature review on RIRS was conducted. Results : The available literature is limited and heterogeneous, skewed by favorable results on ureteral stone outcomes. However, recent case series report outcomes comparable to time-honored modalities: percutaneous nephrolithotomy and shock wave lithotripsy. Concerns about urinary tract damage are not substantiated by the yet available intermediate-term follow-up. Conclusions : RIRS seems to be an effective modality in pediatric nephrolithiasis management. However, long-term outcomes and comparative prospective randomized studies are awaited.

  7. Australian general practitioners’ current practice for chronic kidney disease (CKD detection and management

    Directory of Open Access Journals (Sweden)

    Marie Ludlow

    2017-06-01

    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

  8. Current concepts in the management of bacterial skin infections in children

    Directory of Open Access Journals (Sweden)

    Palit Aparna

    2010-01-01

    Full Text Available Bacterial skin infections in children vary widely clinically, starting from mild superficial folliculitis to deep necrotizing fasciitis. The causative organisms are mostly Staphylococcus aureus and Streptococcus, with occasional involvement of Gram-negative organisms. Treatment of even the milder forms of bacterial skin infections is of importance because of the long-term morbidity associated with them. However, because of global emergence of resistant strains of bacteria, treatment of these conditions is becoming increasingly difficult. The current antibacterial resistance patterns in organisms causing skin and soft tissue infections and the problems encountered in their management in children have been discussed.

  9. CURRENT STATUS AND PROSPECTS OF MANAGEMENT IN AGRARIAN SECTOR THE STAVROPOL REGION

    Directory of Open Access Journals (Sweden)

    Mamaev I. I.

    2013-11-01

    Full Text Available Currently, when solving the problem of greening it is addressed to the technical and technological capabilities. These means can achieve some improvement of the environment in a particular region, but they are not enough to solve the problem of pollution in the whole country and the world. The problem in general can be solved only through an integrated analysis of the set of economic and ecological processes, which makes it possible not only to improve the development, but also to manage the process of impacts on the environment itself

  10. Evaluation and Management of Hepatic Encephalopathy: Current Status and Future Directions.

    Science.gov (United States)

    Suraweera, Duminda; Sundaram, Vinay; Saab, Sammy

    2016-07-15

    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.

  11. Managing Bias Leakage Currents and High Data Rates in the BABAR Silicon Vertex Tracker

    CERN Document Server

    Garra-Tico, J; Bondioli, M; Bruinsma, M; Curry, S; Kirkby, D; Burke, S; Callahan, D; Campagnari, C; Cunha, A; Hale, D; Kyre, S; Richman, J; Beck, T; Eisner, A M; Kroseberg, J; Lockman, W S; Nesom, G; Seiden, A; Spradlin, P; Winstrom, L; Brown, D; Dardin, S; Goozen, F; Kerth, L T; Lynch, G; Roe, N A; Anderson, J; Chen, C; Lae, C K; Roberts, D; Simi, G; Tuggle, J; Lazzaro, A; Lombardo, V; Palombo, F; Ratti, L; Angelini, C; Batignani, G; Bettarini, S; Bosi, F; Bucci, F; Calderini, G; Carpinelli, M; Ceccanti, M; Cenci, R; Cervelli, A; Forti, F; Giorgi, M A; Lusiani, A; Mammini, P; Manfredi, P F; Marchiori, G; Mazur, M; Morganti, M; Morsani, F; Neri, N; Paoloni, E; Profeti, A; Rama, M; Rizzo, G; Walsh, J; Elmer, P; Long, O; Charles, E; Perazzo, A; Burchat, P; Edwards, A J; Miyashita, T S; Majewski, S; Petersen, B A; Bona, M; Bianchi, F; Gamba, D; Trapani, P; Bomben, M; Bosisio, L; Cartaro, C; Dittongo, S; Lanceri, L; Vitale, L; Azzolini, V; Lopez-March, N; Gao, Y Y; Gritsan, A V; Guo, Z J

    2008-01-01

    The silicon vertex tracker at the BABAR experiment is the primary device used in measuring the distance between B0 and meson decay vertices for the extraction of CP asymmetries. It consists of five layers of double-sided, AC-coupled silicon modules, read out by custom integrated circuits. It has run well consistently for eight years. I report on three years of experience in managing problematic bias leakage currents in the fourth layer. In addition, I report on recent success in decreasing the data acquisition time by reducing the readout window.

  12. [Management in nursing in the current state impoverishment of working conditions].

    Science.gov (United States)

    Bellato, Roseney; Pereira, Wilza Rocha

    2004-01-01

    This study aims to provide reflection points on the nursing management process in the current state impoverishment financial conditions facing nursing work in a public health service in the State of Mato Grosso. We used the concepts of vulnerability, user rights and ethic to seek to understand how these concepts can broaden the view of citizenship in the search for better health care conditions for the users and workers in the institution studied. The blatant impoverishment of conditions that was detected point to the need for more awareness raising all levels where we think about, carry out and submit ourselves to the health care Nursing, working conditions, nursing ethics.

  13. Management of obstetric postpartum hemorrhage: a national service evaluation of current practice in the UK

    Directory of Open Access Journals (Sweden)

    Al Wattar BH

    2017-01-01

    Full Text Available Bassel H Al Wattar,1,* Jennifer A Tamblyn,2,* William Parry-Smith,2,* Mathew Prior,3,* Helen Van Der Nelson4,* On behalf of UK Audit and Research trainee Collaborative in Obstetrics and Gynaecology (UKARCOG 1Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK; 2Institute of Metabolism and Systems Research (IMSR, University of Birmingham, Birmingham, UK; 3Division of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK; 4Academic Centre for Women’s Health, North Bristol NHS Trust, Bristol, UK *UKARCOG Background: Postpartum hemorrhage (PPH continues to be one of the major causes of maternal mortality and morbidity in obstetrics. Variations in practice often lead to adverse maternity outcomes following PPH. Our objective was to assess the current practice in managing PPH in the UK.Methods: We performed a national multicenter prospective service evaluation study over one calendar month and compared the current performance to national standards for managing PPH. We used a standardized data collection tool and collected data on patients’ demographics, incidence of PPH, estimated blood loss (EBL, prophylactic and treatment measures, onset of labor, and mode of delivery.Results: We collected data from 98 obstetric units, including 3663 cases of primary PPH. Fifty percent of cases were minor PPH (EBL 500–1000 mL, n=1900/3613, 52.6% and the remaining were moderate PPH (EBL >1000 to <2000 mL, n=1424/3613, 39.4% and severe PPH (EBL >2000 mL, n=289/3613, 8%. The majority of women received active management of the third stage of labor (3504/3613, 97% most commonly with Syntometrine intramuscular (1479/3613, 40.9%. More than half required one additional uterotonic agent (2364/3613, 65.4% most commonly with Syntocinon intravenous infusion (1155/2364, 48.8%. There was a poor involvement of consultant obstetricians and anesthetists in

  14. Medication therapy management services in North Carolina community pharmacies: current practice patterns and projected demand.

    Science.gov (United States)

    Hansen, Richard A; Roth, Mary T; Brouwer, Emily S; Herndon, Susan; Christensen, Dale B

    2006-01-01

    To evaluate the types of cognitive services offered and the number of patients being served in community pharmacies, determine the number of pharmacies that plan to offer medication therapy management (MTM) services under the Medicare Part D prescription drug benefit, and assess whether current and expected practices will meet the potential needs of enrollees. Cross-sectional study. North Carolina in January 2005. 1,593 community pharmacy managers. Survey using a Web-based tool. Provision of cognitive services and number of patients for whom services are provided. A total of 262 (16%) pharmacy managers provided usable responses. Approximately 42% of respondents (n = 110) indicated that they provide some type of cognitive service. Comprehensive MTM services, or services consistent with the professionwide consensus definition, were provided by 31% of respondents (n = 81). Independent pharmacies were more likely to offer some type of service compared with chain pharmacies (58% versus 31%, respectively; P Pharmacy managers with a doctor of pharmacy degree were less likely than pharmacy managers with a bachelor's degree to offer services in their pharmacies (P = .02), and pharmacies with pharmacists on staff who had received certificate training were more likely to offer cognitive services (P = .03). Of all respondents, 28% (n = 73) indicated that they planned to offer MTM services under the Medicare Part D prescription drug benefit. Comparing these results with those of a 1999 survey of North Carolina pharmacists that used some of the same items, the percentage of community pharmacies that provide cognitive services has increased in the intervening years but remains low. Among the services being offered in 2005, most were focused on patient education and training, coordinating and integrating care, and medication regimen reviews. Implementation of MTM services under the Medicare Part D prescription drug benefit should hasten the development and offering of these

  15. Management of blunt extracranial traumatic cerebrovascular injury: a multidisciplinary survey of current practice

    Directory of Open Access Journals (Sweden)

    Cava Luis P

    2011-04-01

    Full Text Available Abstract Background Extracranial traumatic cerebrovascular injury (TCVI is present in 1-3% of all blunt force trauma patients. Although options for the management of patients with these lesions include anticoagulation, antiplatelet agents, and endovascular treatment, the optimal management strategy for patients with these lesions is not yet established. Objective Multidisciplinary survey of clinicians about current management of TCVI. Methods A six-item multiple-choice survey was sent by electronic mail to a total of 11,784 neurosurgeons, trauma surgeons, stroke neurologists, and interventional radiologists. The survey included questions about their choice of imaging, medical management, and the use of endovascular techniques. Survey responses were analyzed according to stated specialty. Results Seven hundred eighty-five (6.7% responses were received. Overall, a total of 325 (42.8% respondents favored anticoagulation (heparin and/or warfarin, 247 (32.5% favored antiplatelet drugs, 130 (17.1% preferred both anticoagulation and antiplatelet drugs, and 57 (7.5% preferred stenting and/or embolization. Anticoagulation was the most commonly preferred treatment among vascular surgeons (56.9%, neurologists (50.2% and neurosurgeons (40.7%, whereas antiplatelet agents were the most common preferred treatment among trauma surgeons (41.5%. Overall, 158 (20.7% of respondents recommended treatment of asymptomatic dissections and traumatic aneurysms, 211 (27.7% did not recommend it, and 39.4% recommended endovascular treatment only if there is worsening of the lesion on follow-up imaging. Conclusions These data demonstrate the wide variability of physicians' management of traumatic cerebrovascular injury, both on an individual basis, and between specialties. These findings underscore the need for multicenter, randomized trials in this field.

  16. Measuring autocratic regime stability

    Directory of Open Access Journals (Sweden)

    Joseph Wright

    2016-01-01

    Full Text Available Researchers measure regime stability in autocratic contexts using a variety of data sources that capture distinct concepts. Often this research uses concepts developed for the study of democratic politics, such as leadership change or institutionalized authority, to construct measures of regime breakdown in non-democratic contexts. This article assesses whether the measure a researcher chooses influences the results they obtain by examining data on executive leadership, political authority, and autocratic regimes. We illustrate the conceptual differences between these variables by extending recent studies in the literature on the political consequences of non-tax revenue and unearned foreign income.

  17. Exchange rate regime choice

    Directory of Open Access Journals (Sweden)

    Beker Emilija

    2006-01-01

    Full Text Available The choice of an adequate exchange rate regime proves to be a highly sensitive field within which the economic authorities present and confirm themselves. The advantages and disadvantages of fixed and flexible exchange rate regimes, which have been quite relativized from the conventional point of view, together with simultaneous, but not synchronized effects of structural and external factors, remain permanently questioned throughout a complex process of exchange rate regime decision making. The paper reflects the attempt of critical identification of the key exchange rate performances with emphasis on continuous non-uniformity and (uncertainty of shelf life of a relevant choice.

  18. A review of the current status of endoluminal therapy as a primary approach to obesity management.

    Science.gov (United States)

    Majumder, Shounak; Birk, John

    2013-07-01

    Gastroenterologists are expected to play a pivotal role in the management of the global obesity epidemic in coming years as novel endoscopic approaches become more widely available, safe, and effective. This review focuses on the recent advances in the field of endoluminal therapy as a primary approach to obesity management with the aim of providing the interventional endoscopist an overview of currently available evidence along with an insight into upcoming devices and techniques. The intragastric balloon appears to be safe and effective in the short term, especially as a bridge to bariatric surgery. Although early trials support the safety and feasibility of endoscopic gastroplasty, it is technically demanding and staple-line dehiscence continues to be a problem. Moreover, with ongoing technical innovations, most devices that have been used in published trials are no longer manufactured and results of studies using newer endoscopic suturing systems are currently awaited. The duodenojejunal bypass sleeve mimics the physiology of intestinal bypass and shares the metabolic advantages of intestinal diversion. A high rate of premature device withdrawal has been its major limiting factor. Therapeutic endoscopy may be the next paradigm of bariatric care. Combining restrictive and barrier endoscopic techniques can potentially improve efficacy and should be evaluated in the setting of appropriate clinical trials.

  19. Decompression illness secondary to occupational diving: recommended management based current legistation and practice in Malaysia.

    Science.gov (United States)

    Rozali, A; Khairuddin, H; Sherina, M S; Zin, B Mohd; Sulaiman, A

    2008-06-01

    Occupational divers are exposed to hazards which contribute to the risk of developing decompression illnesses (DCI). DCI consists of Type I decompression sickness (DCS), Type II DCS and arterial gas embolism (AGE), developed from formation of bubbles in the tissues or circulation as a result of inadequate elimination of inert gas (nitrogen) after a dive. In Malaysia, DCI is one of the significant contributions to mortality and permanent residual morbidity in diving accidents. This is a case of a diver who suffered from Type II DCS with neurological complications due to an occupational diving activity. This article mentions the clinical management of the case and makes several recommendations based on current legislations and practise implemented in Malaysia in order to educate medical and health practitioners on the current management of DCI from the occupational perspective. By following these recommendations, hopefully diving accidents mainly DCI and its sequalae among occupational divers can be minimized and prevented, while divers who become injured receive the proper compensation for their disabilities.

  20. A Survey on Current Practice of Management of Early Onset Neonatal Sepsis.

    Science.gov (United States)

    Dey, A C; Hossain, M I; Afroze, S; Dey, S K; Mannan, M A; Shahidullah, M

    2016-04-01

    It was a survey type of cross sectional study where the participants were from different teaching/referral hospital across the country and was done to gather information regarding current practice of management of neonatal sepsis among paediatricians and neonatologists and was conducted on the spot during a national conference of Bangladesh Perinatal Society in December 2013. Specialists in neonatology, paediatrics, and some other disciplines working in different institutes across the country were requested to respond. Out of 150 physicians, 92 (61.33%) were neonatologists. Physicians suspected early onset neonatal sepsis (EONS) when there is history suggestive of prolonged rupture of membrane (74.77%), prolonged labour (9.33%), chorioamnionitis (7.33%) and maternal fever (2%). Clinical sepsis is found commonly (53.33%) which is later proved by laboratory evidences such as Hb%, TC, DC PBF (peripheral blood film), C-reactive protein, chest X-ray etc. Injection Ampicillin and Gentamycin are still the first choice of antibiotics (61.3%). Preferred route was intravenous (95.3%). Antibiotics were given for 7-10 days by most of the physicians (48.77%). However there is lack of uniformity among the participants in regard to taking decision about antibiotics, the choice of first line and the subsequent options of antibiotics. So, neonatal sepsis is the most important cause of neonatal mortality in the community. Therefore a standard protocolized approach for diagnosis and management of Early Onset Neonatal Sepsis may prove critical which is currently not in practice uniformly.

  1. Current perspectives on biomedical waste management: Rules, conventions and treatment technologies

    Directory of Open Access Journals (Sweden)

    Malini R Capoor

    2017-01-01

    Full Text Available Unregulated biomedical waste management (BMWM is a public health problem. This has posed a grave threat to not only human health and safety but also to the environment for the current and future generations. Safe and reliable methods for handling of biomedical waste (BMW are of paramount importance. Effective BMWM is not only a legal necessity but also a social responsibility. This article reviews the current perspectives on BMWM and rules, conventions and the treatment technologies used worldwide. BMWM should ideally be the subject of a national strategy with dedicated infrastructure, cradle-to-grave legislation, competent regulatory authority and trained personnel. Improving the management of biomedical waste begins with waste minimisation. These standards, norms and rules on BMWM in a country regulate the disposal of various categories of BMW to ensure the safety of the health-care workers, patients, public and environment. Furthermore, developing models for the monitoring of hospital health-care waste practices and research into non-burn eco-friendly sustainable technologies, recycling and polyvinyl chloride-free devices will go in long way for safe carbon environment. Globally, greater research in BMWM is warranted to understand its growing field of public health importance.

  2. Current perspectives for management of acute respiratory insufficiency in premature infants with acute respiratory syndrome.

    Science.gov (United States)

    Chen, Peng; Zhang, Ying; Li, Long-Yun

    2014-09-01

    Current perspectives for management of acute respiratory insufficiency in premature infants with acute respiratory syndrome and the pathology of acute respiratory insufficiency in the preterm infant, including the current therapy modalities on disposition are presented. Since the therapeutical challenge and primary clinical goal are to normalize ventilation ratio and lung perfusion, when respiratory insufficiency occurs, it is very important to introduce the respiratory support as soon possible, in order to reduce development of pulmonary cyanosis and edema, and intrapulmonary or intracardial shunts. A characteristic respiratory instability that reflects through fluctuations in gas exchange and ventilation is often present in premature infants. Adapting the respiratory support on a continuous basis to the infant's needs is challenging and not always effective. Although a large number of ventilation strategies for the neonate are available, there is a need for additional consensus on management of acute respiratory distress syndrome in pediatric population lately redefined by Berlin definition criteria, in order to efficiently apply various modes of respiratory support in daily pediatrician clinical use.

  3. Lower GI bleeding: a review of current management, controversies and advances.

    Science.gov (United States)

    Moss, Andrew J; Tuffaha, Hussein; Malik, Arshad

    2016-02-01

    Lower gastrointestinal (GI) bleeding is defined as bleeding distal to the ligament of Treitz. In the UK, it represents approximately 3 % of all surgical referrals to the hospital. This review aims to provide review of the current evidence regarding the management of this condition. Literature was searched using Medline, Pubmed, and Cochrane for relevant evidence by two researchers. This was conducted in a manner that enabled a narrative review of the evidence covering the aetiology, clinical assessment and management options of continuously bleeding patients. The majority of patients with acute lower GI bleeding can be treated conservatively. In cases where ongoing bleeding occurs, colonoscopy is still the first line of investigation and treatment. Failure of endoscopy and persistent instability warrant angiography, possibly preceded by CT angiography and proceeding to superselective embolisation. Failure of embolisation warrants surgical intervention. There are still many unanswered questions. In particular, the development of a more reliable predictive tool for mortality, rebleeding and requirement for surgery needs to be the ultimate priority. There are a small number of encouraging developments on combination therapy with regard to angiography, endoscopy and surgery. Additionally, the increasing use of haemostatic agents provides an additional tool for the management of bleeding endoscopically in difficult situations.

  4. Current trends and controversies in the management of patients with splenic flexure tumours

    Directory of Open Access Journals (Sweden)

    Chan DS

    2013-03-01

    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.

  5. Managing Lymphoma with Non-FDG Radiotracers: Current Clinical and Preclinical Applications

    Directory of Open Access Journals (Sweden)

    Fan-Lin Kong

    2013-01-01

    Full Text Available Nuclear medicine imaging modalities such as positron emission tomography (PET and single-photon emission computed tomography (SPECT have played a prominent role in lymphoma management. PET with [18F]Fluoro-2-deoxy-D-glucose (FDG is the most commonly used tool for lymphoma imaging. However, FDG-PET has several limitations that give the false positive or false negative diagnosis of lymphoma. Therefore, development of new radiotracers with higher sensitivity, specificity, and different uptake mechanism is in great demand in the management of lymphoma. This paper reviews non-FDG radiopharmaceuticals that have been applied for PET and SPECT imaging in patients with different types of lymphoma, with attention to diagnosis, staging, therapy response assessment, and surveillance for disease relapse. In addition, we introduce three radiolabeled anti-CD20 antibodies for radioimmunotherapy, which is another important arm for lymphoma treatment and management. Finally, the relatively promising radiotracers that are currently under preclinical development are also discussed in this paper.

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

    Science.gov (United States)

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

    2015-01-01

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

  7. [Security Management in Clinical Laboratory Departments and Facilities: Current Status and Issues].

    Science.gov (United States)

    Ishida, Haku; Nakamura, Junji; Yoshida, Hiroshi; Koike, Masaru; Inoue, Yuji

    2014-11-01

    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.

  8. Regimes, Non-State Actors and the State System: A 'Structurational' Regime Model

    NARCIS (Netherlands)

    Arts, B.J.M.

    2000-01-01

    Regime analysis has become a popular approach in International Relations theory and in international policy studies. However, current regime models exhibit some shortcomings with regard to (1) addressing non-state actors, and in particular nongovernmental organizations (NGOs), (2) the balancing of

  9. Regimes, Non-State Actors and the State System: A 'Structurational' Regime Model

    NARCIS (Netherlands)

    Arts, B.J.M.

    2000-01-01

    Regime analysis has become a popular approach in International Relations theory and in international policy studies. However, current regime models exhibit some shortcomings with regard to (1) addressing non-state actors, and in particular nongovernmental organizations (NGOs), (2) the balancing of a

  10. Current antimicrobial usage for the management of neutropenic fever in Korea: a nationwide survey.

    Science.gov (United States)

    Choi, Su-Mi; Park, Sun Hee; Lee, Dong-Gun; Choi, Jung-Hyun; Yoo, Jin-Hong; Shin, Wan-Shik

    2008-12-01

    A nationwide questionnaire-based survey was performed to evaluate the current clinical practices for the management of neutropenic fever in hematology units and hematopoietic stem cell transplantation (HSCT) centers throughout Korea. A 86.9% response rate was obtained from a total of 46 doctors and practical policies of the 33 sites were analysed. Approximately 42.4% and 84.8% of the sites responded that they used oral fluoroquinolone as prophylaxis for neutropenic patients receiving chemotherapy and HSCT, respectively. Additionally, 42.4% of the sites responded that they used antifungal prophylaxis in the chemotherapy groups whereas 90.9% of the sites responded that they used antifungal prophylaxis in HSCT recipients. Approximately half of the responding sites prescribed combination regimen with 3rd or 4th cephalosporin plus aminoglycoside as a first-line therapy. Most of the sites considered persistent fever for 2-4 days or aggravated clinical symptoms for 1-2 days as failure of the first-line regimen, and they changed antibiotics to second-line regimens that varied widely among the sites. Twenty-seven sites (84.4%) responded that they considered adding an antifungal agent when fever persisted for 5-7 days despite antibacterial therapy. Amphotericin B deoxycholate was preferred as a first-line antifungal, which was probably due to the limitations of the national health insurance system. The role of oral antibiotics in the management of neutropenic fever still accounted for a small portion. To the best of our knowledge, this survey is the first report to examine the practical policies currently in place for the management of neutropenic fever in Korea and the results of this survey may help to establish a Korean guideline in the future.

  11. The sustainable management and protection of forests: analysis of the current position globally.

    Science.gov (United States)

    Freer-Smith, Peter; Carnus, Jean-Michel

    2008-06-01

    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

  12. Current status of radiation therapy. Evidence-based medicine (EBM) of radiation therapy. Current management of patients with esophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nemoto, Kenji [Tohoku Univ., Sendai (Japan). School of Medicine

    2002-03-01

    The best management for small mucosal esophageal cancer is generally endoscopic mucosal resection. However, for submucosal cancer and extensive mucosal caner, either radical surgery or radiation seems to be an equally efficacious option. Radiation therapy concurrent with chemotherapy is more effective than radiation therapy alone for patients with unresectable esophageal cancer. The key drugs are cisplatin and 5-fluorouracil. However, for patients with poor performance status or for aged patients, radiation therapy alone is still a choice of treatment. Surgery has generally been indicated for patients with resectable esophageal cancer. However, outcomes of concurrent chemoradiation therapy may be comparable with those of surgery. Therefore, a prospective randomized study should be performed to determine the best management for patients with resectable esophageal cancer. The usefulness of intra-cavitary irradiation for esophageal cancer has not been clarified. A prospective randomized trial with a large number of patients is necessary to determine the effectiveness of intra-cavitary irradiation. The best management for patients with loco-regionally recurrent esophageal cancer after surgery has not been determined. Intensive therapy should be considered if the site of recurrence is limited and the time interval from surgery to recurrence is long. Chemotherapy is essential in the management of patients with small cell esophageal cancer. However, the best local therapy has not been determined. (author)

  13. Assessing The Current Status Of Solid Waste Management Of Gondar Town Ethiopia

    Directory of Open Access Journals (Sweden)

    Mohammed Gedefaw

    2015-08-01

    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.

  14. Review of the current management of upper urinary tract injuries by the EAU Trauma Guidelines Panel.

    Science.gov (United States)

    Serafetinides, Efraim; Kitrey, Noam D; Djakovic, Nenad; Kuehhas, Franklin E; Lumen, Nicolaas; Sharma, Davendra M; Summerton, Duncan J

    2015-05-01

    The most recent European Association of Urology (EAU) guidelines on urological trauma were published in 2014. To present a summary of the 2014 version of the EAU guidelines on upper urinary tract injuries with the emphasis upon diagnosis and treatment. The EAU trauma guidelines panel reviewed literature by a Medline search on upper urinary tract injuries; publication dates up to December 2013 were accepted. The focus was on newer publications and reviews, although older key references could be included. A full version of the guidelines is available in print and online. Blunt trauma is the main cause of renal injuries. The preferred diagnostic modality of renal trauma is computed tomography (CT) scan. Conservative management is the best approach in stable patients. Angiography and selective embolisation are the first-line treatments. Surgical exploration is primarily for the control of haemorrhage (which may necessitate nephrectomy) and renal salvage. Urinary extravasation is managed with endourologic or percutaneous techniques. Complications may require additional imaging or interventions. Follow-up is focused on renal function and blood pressure. Penetrating trauma is the main cause of noniatrogenic ureteral injuries. The diagnosis is often made by CT scanning or at laparotomy, and the mainstay of treatment is open repair. The type of repair depends upon the severity and location of the injury. Renal injuries are best managed conservatively or with minimally invasive techniques. Preservation of renal units is feasible in most cases. This review, performed by the EAU trauma guidelines panel, summarises the current management of upper urinary tract injuries. Patients with trauma benefit from being accurately diagnosed and treated appropriately, according to the nature and severity of their injury. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  15. Current trends in management of men with lower urinary tract symptoms and benign prostatic hyperplasia.

    Science.gov (United States)

    Holtgrewe, H L

    1998-04-01

    Management of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) has been central to urology for decades. The urologic community has increasingly come to realize that many men with LUTS do not have prostate enlargement and do not need their prostates debulked surgically. Of all the factors that have emerged to alter the trends associated with management of LUTS and BPH, none has had more impact than the advent of medical therapy. The selective, long-acting, alpha1-blocking agents terazosin, doxazosin, and tamsulosin have become most popular because of their specificity in the urinary tract, reduced side effects, and simplicity of dosage. In addition, finasteride, a 5-alpha-reductase inhibitor, was found to be effective in men with prostates of > or = 40 g. Furthermore, the larger the prostate at baseline, the greater the efficacy of finasteride on symptom relief and flow rate improvement. In addition to medical therapy, an array of device therapies has emerged in the management of LUTS and BPH. Laser prostatectomy is the oldest of the device therapies and includes transurethral vaporization of the prostate (VLAP), transurethral evaporation of the prostate (TUEP), and transurethral interstitial laser prostatectomy (TILP). Studies report beneficial outcomes approaching those achieved with transurethral resection of the prostate (TURP) with less morbidity and a shorter hospital stay. Common diseases contribute the most to national healthcare expenditures. The management of LUTS and BPH are such disorders and result in the expenditure of vast healthcare resources worldwide. The surgical strategies have an established record of outcomes documenting their potential for symptom relief and the avoidance of future complications. Medical and device therapies, although currently promising and attractive, therefore must prove comparable durability.

  16. Current status of solid waste management in small island developing states: A review.

    Science.gov (United States)

    Mohee, Romeela; Mauthoor, Sumayya; Bundhoo, Zumar M A; Somaroo, Geeta; Soobhany, Nuhaa; Gunasee, Sanjana

    2015-09-01

    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.

  17. Current Management of Penile Fracture: An Up-to-Date Systematic Review.

    Science.gov (United States)

    Falcone, Marco; Garaffa, Giulio; Castiglione, Fabio; Ralph, David J

    2017-09-02

    Because of the low incidence of penile fracture, many aspects of the diagnostic process and of the surgical and functional outcomes are rarely reported. To systematically review the current literature on the surgical management of penile fracture, focusing on etiology, diagnosis, functional outcomes, and postoperative complications. The present review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration standards for systematic reviews. A systematic search for the terms penile fracture, fracture of penis, trauma of penis, rupture of corpora cavernosa, and immediate management of penile fracture was been carried out in the PubMed, EMBASE, Cochrane, SCOPUS, and Science Citation Index databases. Etiology of penile fracture, clinical presentation, types of radiologic investigations and their accuracy, surgical approach, suture material used for tunica repair, timing of surgical exploration, intraoperative findings, surgical complications, and functional outcomes. The total number of patients analyzed was 438, and the patients' an average age was 36 years. The most frequent reported cause of penile fracture was sexual intercourse (80% of cases). The most common finding at examination was a penile hematoma (97.5%). Although operator dependent, in experienced hands, ultrasonography was found to be a useful tool in confirming the location of the albuginea tear and identifying the presence of any concomitant urethral injury, helping the surgeon to choose the best surgical approach. Early surgical repair of a penile fracture was found to be a safe procedure, although long-term complications are not uncommon. Tertiary referral centers that managed a larger number of cases seemed to obtain more satisfactory long-term results with a significantly smaller number of complications. A low incidence of postoperative complications and full satisfactory functional outcomes are reported when early repair is

  18. Quantifying the fire regime distributions for severity in Yosemite National Park, California, USA

    Science.gov (United States)

    Thode, Andrea E.; van Wagtendonk, Jan W.; Miller, Jay D.; Quinn, James F.

    2011-01-01

    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.

  19. 75 FR 32982 - Notice of Intent To Request Extension From the Office of Management and Budget of a Currently...

    Science.gov (United States)

    2010-06-10

    ... Federal Aviation Administration Notice of Intent To Request Extension From the Office of Management and... Airmen for the Operation of Light-Sport Aircraft AGENCY: Federal Aviation Administration (FAA), DOT... request ] the Office of Management and Budget (OMB) to approve a current information collection. This...

  20. International Experiences with Different Monetary Policy Regimes

    OpenAIRE

    Mishkin, Frederic S.

    1999-01-01

    In recent years a growing consensus has emerged for price stability as the overriding, long-run goal of monetary policy. However, despite this consensus, the following question still remains: how should monetary policy be conducted to achieve the price stability goal? This paper examines the experience with different monetary policy regimes currently in use in a number of countries to shed light on this question. A central feature of all of the monetary regimes discussed here is the ise of a ...