Sample records for dialysis develop strategies

  1. Patients in assisted automated peritoneal dialysis develop strategies for selfcare

    Holch, Kirsten

    Henderson's areas of need and Dorothea Orem's self - care theory combined with problems and symptoms in End Stage Renal Disease (ESRD) patients. Results The results showed that patients in their own home improve their self-care capacity in the period between three and six months after starting AAPD......  Patients in Assisted Automated Peritoneal Dialysis develop strategies for self-care Background: Since 2000 a model for Assisted Automated Peritoneal Dialysis (AAPD) in the patients own home has been developed at Aarhus University Hospital, Skejby. The patient group consists of physically...

  2. Patients in assisted automated peritoneal dialysis develop strategies for self-care

    Holch, Kirsten


      Background Since 2000, a model for Assisted Automated Peritoneal Dialysis (aAPD) for patients in their own home needing chronic dialysis treatment has been developed at Aarhus University Hospital, Skejby, Denmark. The patient group consists of physically or mentally frail elderly who cannot...

  3. Alternative dialysis strategies with icodextrin.

    Panzer, Sarah E; Teitelbaum, Isaac


    Proper volume management continues to be a major challenge in patients requiring renal replacement therapy. In patients performing peritoneal dialysis the introduction of icodextrin represented a major advance in this effort. Recent studies have demonstrated a potential role for the use of novel dialysis strategies employing icodextrin to further enhance ultrafiltration and to improve cardiac indices in patients with ultrafiltration failure. These alternative strategies include the use of icodextrin in non-traditional patient populations (low transporters), the simultaneous use of glucose-based and icodextrin solutions in combination, and the use of icodextrin twice daily rather than for just a single dwell. This paper will briefly review the current status of these alternative dialysis strategies with icodextrin. In addition, the potential role for icodextrin to decrease postoperative adhesions will be discussed as well. Copyright © 2012 S. Karger AG, Basel.

  4. Peritoneal dialysis in developing countries.

    Nayak, K S; Prabhu, M V; Sinoj, K A; Subhramanyam, S V; Sridhar, G


    Peritoneal dialysis (PD) is acknowledged worldwide as a well-accepted form of renal replacement therapy (RRT) for end-stage renal disease (ESRD). Ideally, PD should be the preferred modality of RRT for ESRD in developing countries due to its many inherent advantages. Some of these are cost savings (especially if PD fluids are manufactured locally or in a neighboring country), superior rehabilitation and quality of life (QOL), home-based therapy even in rural settings, avoidance of hospital based treatment and the need for expensive machinery, and freedom from serious infections (hepatitis B and C). However, this is not the ground reality, due to certain preconceived notions of the health care givers and governmental agencies in these countries. With an inexplicable stagnation or decline of PD numbers in the developed world, the future of PD will depend on its popularization in Latin America and in Asia especially countries such as China and India, with a combined population of 2.5 billion and the two fastest growing economies worldwide. A holistic approach to tackle the issues in the developing countries, which may vary from region to region, is critical in popularizing PD and establishing PD as the first-choice RRT for ESRD. At our center, we have been pursuing a 'PD first' policy and promoting PD as the therapy of choice for various situations in the management of renal failure. We use certain novel strategies, which we hope can help PD centers in other developing countries working under similar constraints. The success of a PD program depends on a multitude of factors that are interlinked and inseparable. Each program needs to identify its strengths, special circumstances, and deficiencies, and then to strategize accordingly. Ultimately, teamwork is the 'mantra' for a successful outcome, the patient being central to all endeavors. A belief and a passion for PD are the fountainhead and cornerstone on which to build a quality PD program.

  5. Strategies for preserving residual renal function in peritoneal dialysis patients.

    Nongnuch, Arkom; Assanatham, Montira; Panorchan, Kwanpeemai; Davenport, Andrew


    Although there have been many advancements in the treatment of patients with chronic kidney disease (CKD) over the last 50 years, in terms of reducing cardiovascular risk, mortality remains unacceptably high, particularly for those patients who progress to stage 5 CKD and initiate dialysis (CKD5d). As mortality risk increases exponentially with progressive CKD stage, the question arises as to whether preservation of residual renal function once dialysis has been initiated can reduce mortality risk. Observational studies to date have reported an association between even small amounts of residual renal function and improved patient survival and quality of life. Dialysis therapies predominantly provide clearance for small water-soluble solutes, volume and acid-base control, but cannot reproduce the metabolic functions of the kidney. As such, protein-bound solutes, advanced glycosylation end-products, middle molecules and other azotaemic toxins accumulate over time in the anuric CKD5d patient. Apart from avoiding potential nephrotoxic insults, observational and interventional trials have suggested that a number of interventions and treatments may potentially reduce the progression of earlier stages of CKD, including targeted blood pressure control, reducing proteinuria and dietary intervention using combinations of protein restriction with keto acid supplementation. However, many interventions which have been proven to be effective in the general population have not been equally effective in the CKD5d patient, and so the question arises as to whether these treatment options are equally applicable to CKD5d patients. As strategies to help preserve residual renal function in CKD5d patients are not well established, we have reviewed the evidence for preserving or losing residual renal function in peritoneal dialysis patients, as urine collections are routinely collected, whereas few centres regularly collect urine from haemodialysis patients, and haemodialysis dialysis

  6. Strategies to improve clinical outcomes in peritoneal dialysis patients: delivered dose and membrane transport.

    Churchill, D N


    For patients with end-stage renal disease treated with peritoneal dialysis, prospective cohort studies using multivariate statistical analysis have shown an association between greater urea clearance and a decreased relative risk for death. The recommended weekly Kt/V for urea is 2.0, with the corresponding creatinine clearance (CrCl) of 60 L/1.73 m2. This is considered adequate dialysis but fails to define optimum urea and CrCl targets. The assumption that renal and peritoneal clearances are equivalent has been challenged by circumstantial data and is probably untenable. The relative importance of these clearances requires definition. The suggestion that CrCl is a more important indicator of adequacy of dialysis is confounded by association with renal, rather than peritoneal, clearance and perhaps by the early referral and initiation of dialysis. Recent reports have shown an association between increased peritoneal membrane transport and an increased relative risk for technique failure and/or death. Patients with higher peritoneal transport should have greater clearance of urea and creatinine and better clinical outcomes. Possible explanations for this apparent contradiction include the adverse effects of increased glucose absorption, malnutrition, and fluid overload, the latter caused by decreased ultrafiltration. Available data suggest an important role for the failure of ultrafiltration among patients treated with continuous ambulatory peritoneal dialysis (CAPD). Strategies to improve the clearance of urea and creatinine include the preservation of residual renal function and increased peritoneal clearance. Loss of residual renal function may be delayed by the avoidance of nephrotoxic drugs and angiographic dye. Peritoneal clearance can be enhanced by a combination of increased volume and frequency of peritoneal dialysis cycles. Ultrafiltration failure, but not protein loss, can be addressed with shorter cycles with nocturnal peritoneal dialysis. Development of

  7. Evaluating Infection Prevention Strategies in Out-Patient Dialysis Units Using Agent-Based Modeling.

    Joanna R Wares

    Full Text Available Patients receiving chronic hemodialysis (CHD are among the most vulnerable to infections caused by multidrug-resistant organisms (MDRO, which are associated with high rates of morbidity and mortality. Current guidelines to reduce transmission of MDRO in the out-patient dialysis unit are targeted at patients considered to be high-risk for transmitting these organisms: those with infected skin wounds not contained by a dressing, or those with fecal incontinence or uncontrolled diarrhea. Here, we hypothesize that targeting patients receiving antimicrobial treatment would more effectively reduce transmission and acquisition of MDRO. We also hypothesize that environmental contamination plays a role in the dissemination of MDRO in the dialysis unit. To address our hypotheses, we built an agent-based model to simulate different treatment strategies in a dialysis unit. Our results suggest that reducing antimicrobial treatment, either by reducing the number of patients receiving treatment or by reducing the duration of the treatment, markedly reduces overall colonization rates and also the levels of environmental contamination in the dialysis unit. Our results also suggest that improving the environmental decontamination efficacy between patient dialysis treatments is an effective method for reducing colonization and contamination rates. These findings have important implications for the development and implementation of future infection prevention strategies.

  8. Optimal choice of dialysis access for chronic kidney disease patients: developing a life plan for dialysis access.

    Lok, Charmaine E; Davidson, Ingemar


    Patient-focused dialysis modality and access selection requires a coordinated teamwork approach that emphasizes chronic kidney disease care to be a continuum of care. Individualized and detailed patient history and examination are the mainstays of dialysis modality and access selection. Preoperative vessel mapping by duplex Doppler ultrasonography can be a useful supplementary investigation to the history and physical examination to determine the optimal dialysis access type and site. Dialysis access modality and choice considers many patient factors that can be aided by a clinical risk score, asking key clinical questions, surgical expert opinion, and a multidisciplinary approach to individualized patient care. In many situations, a lifelong access utilization strategy prioritizes peritoneal dialysis as the first dialysis modality followed by appropriately planned hemodialysis. The goal of an integrated patient-focused approach is to achieve complication-free access to help patients achieve their life goals on and off dialysis. Copyright © 2012. Published by Elsevier Inc.

  9. Development and evaluation of a retroperitoneal dialysis porcine model.

    Okhunov, Zhamshid; Yoon, Renai; Perez Lanzac, Alberto; Sgroi, Michael; Lau, Wei Ling; Del Junco, Michael; Ordon, Michael; Drysch, Austin; Hwang, Christina; Vernez, Simone L; Fujitani, Roy; Kabutey, Nii-Kabu; Kalantar-Zadeh, Kamyar; Landman, Jaime


    We attempted to create a surgical model to evaluate the retroperitoneal space for the ability to transfer solutes through the retroperitoneal membrane. Our dual objectives were to develop a technique to assess the feasibility of retroperitoneal dialysis (RPD) in a porcine model. We incorporated two 35-kg Yorkshire pigs for this pilot study. In the first animal, we clamped renal vessels laparoscopically. In the second animal, we embolized renal arteries. In both animals, we dilated the retroperitoneal space bilaterally and deployed dialysis catheters. We measured serum creatinine (Cr), urea, and electrolytes at baseline 6 hours before the dialysis and every 4 hours after. We successfully created retroperitoneal spaces bilaterally and deployed dialysis catheters in both animals. In the first animal, dialysate and plasma Cr ratio (D/P) on the left and right side were 0.43 and 0.3, respectively. Cr clearance by 40 minutes of dialysis treatment was 6.3 mL/min. The ratio of dialysate glucose at 4 hours dwell time to dialysate glucose at 0 dwell time (D/D0) for left/rights sides were 0.02 and 0.02, respectively. kt/Vurea was 0.43. In the second animal, D/P Cr for left/right sides were 0.34 and 0.33, respectively. kt/Vurea was 0.17. We euthanized the pigs due to fluid collection in the peritoneal space and rapid increase of serum Cr, urea, and electrolytes. We demonstrated the feasibility of creation of a functionally anephric porcine model with successful development of retroperitoneal spaces using balloon inflation. Notwithstanding minimal clearance and limited diffusion capacity in this experiment, additional studies are needed to examine potential use of retroperitoneal space for peritoneal dialysis.

  10. Iron Treatment Strategies in Dialysis-Dependent CKD.

    Pandey, Richa; Daloul, Reem; Coyne, Daniel W


    Iron deficiency is common in patients on chronic dialysis, and most require iron-replacement therapy. In addition to absolute iron deficiency, many patients have functional iron deficiency as shown by a suboptimal response to the use of erythropoietin-stimulating agents. Both absolute and functional iron-deficiency anemia have been shown to respond to intravenous (IV) iron replacement. Although parenteral iron is an efficacious method and superior to standard doses of oral iron in patients on hemodialysis, there are ongoing safety concerns about repeated exposure potentially enhancing infection risk and cardiovascular disease. Each IV iron product is composed of an iron core with a carbohydrate shell. The avidity of iron binding and the type of carbohydrate shell play roles in the safe maximal dose and the frequency and severity of acute infusion reactions. All IV iron products are taken up into the reticuloendothelial system where the shell is metabolized and the iron is stored within tissue ferritin or exported to circulating transferrin. IV iron can be given as large intermittent doses (loading therapy) or in smaller doses at frequent intervals (maintenance dosing regimen). Limited trial data and observational data suggest that a maintenance dosing regimen is more efficacious and possibly safer than loading therapy. There is no consensus regarding the preferred method of iron repletion in patients on peritoneal dialysis, although small studies comparing oral and parenteral iron regimens in these patients have shown the latter to be more efficacious. Use of IV iron in virtually all hemodialysis and many peritoneal dialysis patients remains the standard of care.

  11. Dialysis cultures.

    Pörtner, R; Märkl, H


    Dialysis techniques are discussed as a means for effective removal of low-molecular-mass components from fermentation broth to reach high cell density. Reactor systems and process strategies, the relevant properties of membranes and examples for high-density fermentation with dialysis, and problems related to scale-up are addressed. The dialysis technique has turned out to be very efficient and reliable for obtaining high cell densities. As in dialysis processes the membranes are not perfused, membrane clogging is not a problem as it is for micro- and ultrafiltration. By applying a "nutrient-split" feeding strategy, the loss of nutrients can be avoided and the medium is used very efficiently. The potential of dialysis cultures is demonstrated on the laboratory scale in a membrane dialysis reactor with an integrated membrane and in reactor systems with an external dialysis loop. In dialysis cultures with different microorganisms (Staphylococci, Escherichia coli, extremophilic microorganisms, Lactobacilli) the cell densities achieved were up to 30 times higher than those of other fermentation methods. The technique enables high cell densities to be attained without time-consuming medium optimization. For animal cell cultures the concept of a fixed bed coupled with dialysis proved to be very effective.

  12. Dialysis and Quality of Dialysate in Southeast Asian Developing Countries

    Tomotaka Naramura


    Full Text Available Background: The number of dialysis patients has been increasing in Southeast Asia, but statistical data about these patients and on the quality of dialysates in Southeast Asian dialysis facilities are still imprecise. For this study, dialysis-related statistical data were collected in Southeast Asia. Methods: A survey of the quality of dialysates was carried out at 4 dialysis facilities in Vietnam and Cambodia. The dialysis patient survey included the numbers of dialysis facilities and patients receiving dialysis, a ranking of underlying diseases causing the initiation of dialysis, the number of patients receiving hemodialysis (HD/on-line hemodiafiltration/continuous ambulatory peritoneal dialysis, the number of HD monitoring devices installed, the cost of each session of dialysis (in USD, the percentage of out-of-pocket payments, and the 1-year survival rates of the dialysis patients (in percent. The dialysate survey covered the endotoxin (ET level and bacterial count in tap water, in water filtered through a reverse osmosis system and in dialysate. Results: In each of the countries, the most frequent reason for the initiation of dialysis is diabetes mellitus. HD is usually carried out according to the ‘reuse' principle. The 1-year survival rates are 70% in Myanmar and about 90% in the Philippines and Malaysia. The ET levels in standard dialysates were satisfactory at 2 facilities. The bacterial counts in dialysates were not acceptable at any of the facilities investigated. Conclusion: There is an urgent need to teach medical workers involved in dialysis how to prepare sterile and ET-free dialysates.

  13. Dialysis modalities as risk factors in the development of atherosclerosis

    Damjanović Tatjana


    Full Text Available Introduction Atherosclerosis is a major risk factor for increased cardiovascular morbidity and mortality in dialysis patients. First clinical symptoms are usually associated with initial atherosclerotic changes of blood vessels. The aim of this study was ultrasound evaluation of intimae media thickness (IMT of carotid arteries in dialysis patients and its correlation with certain risk factors. Patients and methods IMT was measured in 45 dialysis patients with no signs of cardiovascular diseases:15 continuous ambulatory peritoneal dialysis (CAPD patients, 30 haemodialysis (HD patients and in 20 healthy controls. IMT was correlated with certain risk factors for atherosclerosis (general parameters - age, gender, duration of dialysis cause of renal diseases, parameters of nutrition, parameters of calcium and phosphorus metabolism, lipid parameters, blood pressure and smoking. Results The mean carotid artery IMT was significantly higher in dialysis patients than in the control group (p<0.05. In addition, the mean IMT was statistically significantly higher in PD than in HD patients (p<0.05. In CAPD patients there was a significant correlation between IMT and total and LDL cholesterol. In the second group (HD patients IMT was significantly correlated with diastolic blood pressure, BMI and smoking. Conclusion Although atherosclerotic cardiovascular disease may not manifest in dialysis patients, IMT of carotid arteries significantly increases. Major risk factors affecting IMT are lipid disturbances in patients on peritoneal dialysis and hypertension, obesity and smoking in HD patients.

  14. Identifying cost management strategies in dialysis clinics: sustainable savings with positive outcomes.

    West, Timothy D; Gupta, Mahendra; Balas, E Andrew; West, David A


    To examine whether cost management strategies are used in a revenue-constrained environment without compromising clinical effectiveness. Cross-sectional analysis of monthly cost and acuity-adjusted hospitalization data. This research included longitudinal regression analyses involving 10 years of data, 1990 through 1999, from each of 6 dialysis centers. Two sets of regression models were used: one set examined cost interactions and cost trends (P management strategies were examined: (1) selective reductions in targeted cost categories, (2) cost reductions through improved efficiencies, (3) cost avoidance by shifting responsibilities to external parties, and (4) uniform reductions across all cost categories. Managers appeared to have limited opportunity to selectively or uniformly reduce costs because of cost "stickiness" and minimal resource substitutability. Improvements in operational efficiencies and cost shifting to external parties occurred. Over time, however, realized efficiencies increased at a decreasing rate, whereas cost shifting actually declined. Contrary to prior hospital studies, these results indicate significant economies of scale. No statistical correlation was found to indicate that the physician/clinic management teams' use of cost reduction strategies affected acuity-adjusted hospitalizations of dialysis patients. Strategic models that include both financial and outcomes data can enable healthcare managers to predict both positive and negative results of cost management proposals. These models can help identify aspects of an organization's cost structure that affect sustainable cost savings: cost stickiness, cost substitutability, institutional experience, realized operational improvements, and economies of scale.

  15. Wernicke's encephalopathy that developed during the introduction period of peritoneal dialysis.

    Nakashima, Yuko; Ito, Kenji; Nakashima, Hitoshi; Shirakawa, Aki; Abe, Yasuhiro; Ogahara, Satoru; Sasatomi, Yoshie; Yasunaga, Tomoe; Ifuku, Masakazu; Tsugawa, Jun; Tsuboi, Yoshio; Saito, Takao


    A 43-year-old man was admitted with end-stage renal disease caused by IgA nephropathy, and was treated with maintenance peritoneal dialysis. The patient developed general fatigue and appetite loss, and his symptoms were gradually aggravated by depression. After approximately 2 months on dialysis, the patient presented with altered consciousness and ophthalmoplegia. Wernicke's encephalopathy was diagnosed based on the presence of classic symptoms and the findings on magnetic resonance imaging. Thiamine replacement therapy was immediately initiated. The patient recovered from most of his neurological symptoms; however, the sequela of Korsakoff syndrome remained. A marginal thiamine deficiency in combination with predisposing factors must be considered when treating dialysis patients.

  16. Technical characterization of dialysis fluid flow of newly developed dialyzers using mass transfer correlation equations.

    Kunikata, Satoru; Fukuda, Makoto; Yamamoto, Ken-ichiro; Yagi, Yutaka; Matsuda, Masato; Sakai, Kiyotaka


    Dialysis fluid flow and mass transfer rate of newly developed dialyzers were evaluated using mass transfer correlation equations of dialysis fluid-side film coefficient. Aqueous creatinine clearance and overall mass transfer coefficient for APS-15S (Asahi Kasei Kuraray) as a conventional dialyzer, and APS-15SA (Asahi Kasei Kuraray), PES-150Salpha (Nipro), FPX140 (Fresenius), and CS-1.6U (Toray) as newly developed dialyzers were obtained at a blood-side flow rate (QB) of 200 ml/min, dialysis fluid-side flow rates (QD) of 200-800 ml/min and a net filtration rate (QF) of 0 ml/min. Mass transfer correlation equations between Sherwood number (Sh) containing dialysis fluid-side mass transfer film coefficient and Reynolds number (Re) were formed for each dialyzer. The exponents of Re were 0.62 for APS-15S whereas approximately 0.5 for the newly developed dialyzers. The dialysis fluid-side mass transfer film coefficients of the newly developed dialyzers were higher than those of the conventional dialyzer. Based on the mass transfer correlation equations, introduction of short taper, full baffle of dialyzer jacket and further wave-shaped hollow fiber improves the dialysis fluid flow of the newly developed dialyzers.

  17. Strategy Development in Organisations

    Sørensen, Lene


    " as used in practice and literature. Emphasis is put on how the term is related to the problem, the organisation, the strategy process and the practical way of methodologically developing the strategy. Finally, alternative strategy developing perspectives are presented.......There exist certain ambiguities with the converging fields of information technology and organisational strategy development. The term "IT strategy" has evolved and reflects in some respects this confusion. This paper discusses some of the ambiguities and difficulties of the term "IT strategy...

  18. Strategy Development in Organisations

    Sørensen, Lene


    There exist certain ambiguities with the converging fields of information technology and organisational strategy development. The term "IT strategy" has evolved and reflects in some respects this confusion. This paper discusses some of the ambiguities and difficulties of the term "IT strategy......" as used in practice and literature. Emphasis is put on how the term is related to the problem, the organisation, the strategy process and the practical way of methodologically developing the strategy. Finally, alternative strategy developing perspectives are presented....

  19. Critical Care Dialysis System


    Organon Teknika Corporation's REDY 2000 dialysis machine employs technology originally developed under NASA contract by Marquardt Corporation. The chemical process developed during the project could be applied to removing toxic waste from used dialysis fluid. This discovery led to the development of a kidney dialysis machine using "sorbent" dialysis, a method of removing urea from human blood by treating a dialysate solution. The process saves electricity and, because the need for a continuous water supply is eliminated, the patient has greater freedom.

  20. Why does three times per week hemodialysis provide inadequate dialysis for children?

    Fischbach, Michel; Zaloszyc, Ariane; Laetitia, Higel; Menouer, Soraya; Terzic, Joelle


    The duration of chronic conventional dialysis is a risk factor in children, both in terms of growth retardation and cardiovascular morbidity and mortality. Therefore, we need to develop alternative strategies, such as preemptive kidney transplantation and/or more intensive dialysis prescription. Indeed, conventional hemodialysis could be improved in all children by the use of high permeable membrane and ultrapure dialysis fluids (having very low endotoxin levels); by the addition of a convective dialysis dose to the urea diffusion dialysis dose (Kt/Vurea), i.e., hemodiafiltration; moreover, by the preservation of cardiovascular morphology and function (optimized blood pressure control); and also by the prescription of more frequent/longer dialysis sessions.

  1. A Rare Case of Pediatric Nosocomial Liver Abscess Developing During Dialysis Therapy



    Full Text Available Introduction Liver abscess developing during hospital stay in pediatric patients on dialysis for acute kidney injury has been previously unreported. Impaired immunity, prolonged use of antibiotics, diabetes and malnutrition predispose to liver abscess in chronic hemodialysis patients. Case Presentation We reported a case of liver abscess developing in a 6-year-old boy admitted with sepsis and multiorgan dysfunction syndrome including acute kidney injury. He received peritoneal and subsequently hemodialysis, as he did not improve on peritoneal dialysis. He developed fever while on hemodialysis, which was due to a liver abscess developing during the course of hospital stay. The abscess was in the right lobe of the liver with a volume of 40 mL. Staphylococcus aureus is the leading cause of pyogenic liver abscesses in children and infection acquired from hospital. The patient received vancomycin and responded well with complete resolution and did not require any drainage procedure. He may have acquired bacteremia during dialysis with subsequent hepatic seeding. Conclusions Though rare, liver abscess may develop even in patients undergoing short-term dialysis therapy. Liver abscess is a medical emergency and if not treated promptly may lead to significant mortality. Invasive therapeutic procedures, like drainage is associated with further risk of complications. Therefore, a high index of suspicion should be kept when evaluating a patient who develops unexplained fever while being on hemodialysis. Early medical intervention through appropriate antibiotics can significantly reduce the morbidity and mortality. Strict infection control policies should be followed to prevent such nosocomial infections.

  2. Creativity and Strategy Development

    Sørensen, Lene Tolstrup; Vidal, Rene Victor Valqui

    This paper focus on how creative thinking, processes and methods can support the strategy development and planning process in organisations. First, several fundamental concepts related to both strategy development and planning are stipulated. In addition, the concept of living organisation...... will be discussed as well as the interaction between strategy and creativity. Then, methodological ideas to support the strategy making process are presented enhancing the use of creative methods and tools. Finally, a case study related to the development of a strategy for organisational development using...... creativity tools is discussed....

  3. Low GDP Solution and Glucose-Sparing Strategies for Peritoneal Dialysis.

    Szeto, Cheuk Chun; Johnson, David W


    Long-term exposure to a high glucose concentration in conventional peritoneal dialysis (PD) solution has a number of direct and indirect (via glucose degradation products [GDP]) detrimental effects on the peritoneal membrane, as well as systemic metabolism. Glucose- or GDP-sparing strategies often are hypothesized to confer clinical benefits to PD patients. Icodextrin (glucose polymer) solution improves peritoneal ultrafiltration and reduces the risk of fluid overload, but these beneficial effects are probably the result of better fluid removal rather than being glucose sparing. Although frequently used for glucose sparing, the role of amino acid-based solution in this regard has not been tested thoroughly. When glucose-free solutions are used in a combination regimen, published studies showed that glycemic control was improved significantly in diabetic PD patients, and there probably are beneficial effects on peritoneal function. However, the long-term effects of glucose-free solutions, used either alone or as a combination regimen, require further studies. On the other hand, neutral pH-low GDP fluids have been shown convincingly to preserve residual renal function and urine volume. The cost effectiveness of these solutions supports the regular use of neutral pH-low GDP solutions. Nevertheless, further studies are required to determine whether neutral pH-low GDP solutions exert beneficial effects on patient-level outcomes, such as peritonitis, technique survival, and patient survival. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Aquaporin-1: new developments and perspectives for peritoneal dialysis.

    Devuyst, Olivier; Yool, Andrea J


    Peritoneal dialysis involves diffusive and convective transport and osmosis through the highly vascularized peritoneal membrane. Several lines of evidence have demonstrated that the water channel aquaporin-1 (AQP1) corresponds to the ultrasmall pore predicted by the model of peritoneal transport. Proof-of-principle studies have shown that upregulation of the expression of AQP1 in peritoneal capillaries results in increased water permeability and ultrafiltration, without affecting the osmotic gradient or small solute permeability. Conversely, studies in Aqp1 mice have shown that haplo-insufficiency for AQP1 results in significant attenuation of water transport. Recent studies have demonstrated that AQP1 is involved in the migration of different cell types, including endothelial cells. In parallel, chemical screening has identified lead compounds that could act as antagonists or agonists of AQPs, with description of putative binding sites and potential mechanisms of gating the water channel. By modulating water transport, these pharmacological agents could have clinically relevant effects in targeting specific tissues or disease states.


    Shakhshir Ghassan


    Full Text Available The positioning strategy has suffered serious changes in the last few decades, being influenced by the rapid development of competition and the growing focus on specific traits belonging to the market, to the consumer or to the product. The purpose of this paper is to present the developments of theoretical positioning strategies and the orientation from more simple, product oriented strategies, to ones more oriented towards the client and with a briefer period of time. The world is moving in a much faster pace than in the past, thanks to communication development so companies are obliged to adopt more specific strategies in order for them to be effective. This essay represents a literary review presenting a documentary research within the scientific articles and strategy and positioning books. The paper begins with the analysis of company strategies and the marketing strategies in general. The first author to group the product positioning strategies is Porter with his three generic strategies. Following the development of brands and because of the lack of competitiveness in the simple generic positioning strategies, this paper has also presented the newer positioning strategies proposed by Kotler, Treacy & Wiersema, and also more complex ones such as Bowman's Strategy Clock and Blankson and Kalafatis positioning strategy based on the type of the consumer. The fast expansion of local brands in all categories has led to mistakes in positioning strategies, categories also presented in the current essay. The results of this study show that new positioning strategies are more and more based on the consumer and market segments and on the product specification - which have also evolved in the last decades. Adaptability to fast changes in the competitive market will represent the future positioning strategies.

  6. Implementing Sustainable Development Strategies

    Zhang Cuiying


    China's national sustainable development strategies were drafted under the guidance of Deng Xiaoping's theory on socialist construction with Chinese distinguishing features and, the theory and practice of sustainable development has further enriched and perfected Deng Xiaoping's theory. An in-depth study of Deng Xiaoping's theory is significant if we are to accurately understand our sustainable development program and how to best implement the strategies.

  7. Recent Development on Home Peritoneal Dialysis in Hainan Province



    Objective:In order to experience and contrast incidence rate of intection peritonitis. Exit-site infection,lunnitis, patients re cover one's works,still living survival and withdraw rate from CAPD in particular on home PD of Subtropical Zone of China. Method:134 cases patients PD with CRF were from January 1,1981 to February 1998. We used three kinds of device and dialysate to complete CAPD. 134 patients into three groups according to PD device and form. Group Ⅰ: Non o-set 74 cases. Pat to use bottled dialysate/bag dialysate infusion abdominal cavity made by general emulsion tube/or once emulsion tube for CAPD. Group Ⅱ: 60 cases. Made by the o-set(Baxter H. Itd. USA).Group Ⅲ:45 cases. Made by o-set for on home PD. Result: The occur rate of infection peritonitis in Ⅰ,Ⅱ,Ⅲ Group were one/11.17,94.87 and 121.80 patient months. The infec tion rate of exit-site in Ⅰ,Ⅱ,Ⅲ Group were 18.91%,6.66%,6.66%. The lunnitis incidence rate in Ⅰ,Ⅱ,Ⅲ Group were 8.1%, 3.33%, and 4.44%, respectively. The patients recover one's works in group Ⅰ almost come to nought, group Ⅱ 30% and 45.6% in group Ⅲ. Survival still living: Group Ⅰ 12.83. Group Ⅱ≥23.25. Group Ⅲ≥27 months and among them ≥36 months 7 cases (15.55%).About withdraw:Group Ⅰ average 2%/year. Group Ⅱ and Group Ⅲ 1.4%/year. The death rate of average year in Ⅰ and Ⅱ Group patients were 2.66% lower than of HD death rate 10%. Conclusion: o-set it's indeed a device of develop of PD and home PD, because the o-set able to most limit lower occur rate of intection peritonitis especially fit into home PD subtropical zone area.

  8. Avionics advanced development strategy

    Dyer, D.


    Discussed here is the problem of how to put together an integrated, phased, and affordable avionics advanced development program that links and applies to operational, evolving, and developing programs/vehicles, as well as those in the planning phases. Collecting technology needs from individual programs/vehicles and proposed technology items from individual developers usually results in a mismatch and something that is unaffordable. A strategy to address this problem is outlined with task definitions which will lead to avionics advanced development items that will fit within an overall framework, prioritized to support budgeting, and support the scope of NASA space transportations needs.

  9. Russia's Development Strategy


    @@ Acomplex process characterizes the evolvement of Russia's development strategy from general and ambiguous to specific and clear. In the immediate post-independence days, former President Boris Yeltsin's zeal for wholesale leaning to and meshing with the West only ended up in the loss of initiative and national assertiveness. Since his assumption of office, President Vladimir Putin came up with a "national resurgence strategy" aimed at economic rejuvenation for recovery of the country's status as a big power by proceeding from its current post-Soviet weakened conditions. This pragmatic popular approach is generally believed to have a rosy future ahead.Even so it would still be a bumpy, uphill path, replete with challenges due to trammels of domestic opposition and resentment or obstruction from the West. In addressing these issues under international limelight, after briefly reviewing Russia's post-independence trajectory, this article will focus on President Putin's "strong national strategy" and do some crystal ball gazing for its future.

  10. New Developments in Peritoneal Fibroblast Biology: Implications for Inflammation and Fibrosis in Peritoneal Dialysis

    Janusz Witowski


    Full Text Available Uraemia and long-term peritoneal dialysis (PD can lead to fibrotic thickening of the peritoneal membrane, which may limit its dialytic function. Peritoneal fibrosis is associated with the appearance of myofibroblasts and expansion of extracellular matrix. The extent of contribution of resident peritoneal fibroblasts to these changes is a matter of debate. Recent studies point to a significant heterogeneity and complexity of the peritoneal fibroblast population. Here, we review recent developments in peritoneal fibroblast biology and summarize the current knowledge on the involvement of peritoneal fibroblasts in peritoneal inflammation and fibrosis.

  11. American Cotton Development Strategy


    The 30th International Cotton Conference took place March 24 - 27 in the historic city of Bremen,Germany this year.Worldwide high-ranking experts from cotton production, trade,spinning,weaving and some other fields of textile industries gathered together in the Bremen Town Hall.Allen A.Terhaar,Executive Director of Cotton Council International(CCI), Washington,presented a speech on the future development strategy of American cotton industry,and the development schedule in Chinese market.In the following part,let’s share his opinions and foresighted views.

  12. Development of a symptom assessment instrument for chronic hemodialysis patients: the Dialysis Symptom Index.

    Weisbord, Steven D; Fried, Linda F; Arnold, Robert M; Rotondi, Armando J; Fine, Michael J; Levenson, David J; Switzer, Galen E


    Little is known about the prevalence, severity, or impact of symptoms in hemodialysis patients because of the lack of a validated symptom assessment instrument. We systematically developed an index to assess physical and emotional symptom burden in this patient population. We employed four steps in the generation of this index: a review of dialysis quality-of-life instruments, three focus groups, experts' content validity assessment, and test-retest reliability measurement. Seventy-five symptoms were identified. Of these, 46 appeared in > or = 4 of the instruments/focus groups and were considered for inclusion. Twelve were grouped into other symptom constructs and experts judged four of the remaining items not to be pertinent, leaving 30 items in the new index. Overall kappa statistic was 0.48+/-0.22. These steps allowed the systematic development of a 30-item symptom assessment index for hemodialysis patients. Additional reliability and validity testing is needed prior to its widespread use.

  13. Strategies for Sustainable Energy Development

    Meyer, Niels I


    The paper analyses international strategies for establishing a sustainable energy development. Proposals are given for mitigation of global warming.......The paper analyses international strategies for establishing a sustainable energy development. Proposals are given for mitigation of global warming....

  14. Strategies for Sustainable Energy Development

    Meyer, Niels I


    The paper analyses international strategies for establishing a sustainable energy development. Proposals are given for mitigation of global warming.......The paper analyses international strategies for establishing a sustainable energy development. Proposals are given for mitigation of global warming....

  15. Strategies for planning the optimal dialysis access for an individual patient.

    Drew, David A; Lok, Charmaine E


    Achieving functioning vascular access in hemodialysis patients remains challenging. Current guidelines recommend creating arteriovenous fistulas (AVFs) as the initial form of vascular access and are primarily based on outdated, observational data. Determining the optimal access for each individual patient is, therefore, of great interest. Multiple recent studies suggest that certain subgroups of patients may benefit from alternative forms of vascular access. In particular, the elderly and patients with limited life-expectancy may be less likely to benefit from an AVF first approach. These patients may be more likely to die before benefiting from an AVF and are more likely to experience primary failure of an AVF. If these factors are considered, arteriovenous grafts, and in some cases central venous catheters, become a valid alternative form of vascular access. Patients may also have strong opinions about each type of vascular access, leading to a preference for alternative forms of access. A patient-centered approach to the choice of dialysis access that incorporates a balance between recent evidence from the literature and patient preferences may be preferred to the current fistula first focus in vascular access choice.

  16. Newly Developed Neutralized pH Icodextrin Dialysis Fluid: Nonclinical Evaluation.

    Yamaguchi, Naoya; Miyamoto, Keiichi; Murata, Tomohiro; Ishikawa, Eiji; Horiuchi, Takashi


    A two-compartment system (NICOPELIQ; NICO, Terumo Co., Tokyo, Japan) has recently been developed to neutralize icodextrin peritoneal dialysis fluid (PDF). In this study, a nonclinical evaluation of NICO was carried out to evaluate biocompatibility as well as water transport ability. Glucose degradation products (GDPs) in the icodextrin PDFs were analyzed via high-performance liquid chromatography (HPLC). The cell viability of human peritoneal mesothelial cells derived from peritoneal dialysis effluent (PDE-HPMCs) was evaluated as well as the amount of lactate dehydrogenase (LDH) released after exposure to different PDFs (NICO and EXTRANEAL [EX, Baxter Healthcare Corp., Chicago, IL, USA]) and neutralized pH glucose PDF MIDPELIQ 250 (M250, Terumo). The water transport ability of NICO, EX, and M250 was tested using dialysis tube membranes with various pore sizes: 1, 2, 6-8, and 12-16 kDa. Although cell viability decreased by 30% after 30 min exposure to NICO, it was maintained for 6 h while a significant decrease was observed after 6 h exposure to EX. However, following adjustment of the pH to the same pre-exposure pH value, there was no significant difference in cell viability within the same pH group despite a doubling of the difference in the total amount of GDPs (44.6 ± 8.6 µM in NICO and 91.9 ± 9.5 µM in EX, respectively). In contrast, a significant decrease in cell viability was observed when the pH decreased to less than pH 6. Levels of released LDH, a cytotoxic marker, were within 5% after a 6-h exposure of NICO to PDE-HPMCs. There was no significant difference in water transport ability represented as overall osmotic gradients between NICO and EX. In conclusion, neutralization of icodextrin PDF is beneficial for maintaining cell viability and minimizing LDH release while water transport ability is comparable to the conventional icodextrin PDF. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  17. Peritoneal Dialysis

    Peritoneal dialysis Overview By Mayo Clinic Staff Peritoneal dialysis (per-ih-toe-NEE-ul die-AL-uh-sis) is a way to remove waste products from your blood when your kidneys can no longer do the job adequately. A cleansing fluid flows through a tube (catheter) into part of your abdomen and filters waste ...

  18. Development and Psychometric Properties of the Dialysis Module of the WHOQOL-BREF Taiwan Version

    Shu-Chang Yang


    Conclusion: Besides broader coverage than the core WHOQOL-BREF(TW, the dialysis module of the WHOQOL-BREF(TW is a valid, reliable and sensitive QOL instrument for the assessment of HD patients in Taiwan.

  19. Developing a glocalisation strategy

    Hollensen, Svend; Schimmelpfennig, Christian


    while exploiting the benefits of global integration. The challenge is to balance the local knowledge with global reach. In the case of Persil Abaya Shampoo (for the Middle East market) and Persil Black Gel (for the European market), Henkel chose a strategy that successfully benefitted from...... the ‘economies of scope’ in the purchasing department as well as in production and packaging. But by using an adapted product communication, plus individualised packaging designs, product positionings and marketing communications for the two regions, Henkel honoured the cultural heteroge-neity of its target...... markets and used Persil Abayas’ particular significance in the Arab world to its advantage. The results document that it has been possible for Henkel’s Persil to gain competitive advantages in terms of higher market shares, with the ‘glocalisation strategy’ in the (Middle East) liquid detergent market....


    Vaduva Maria


    Full Text Available Regional development policies in the EU Member States have included tools whoseimportance varied from one country to another. Can be identified by negative incentives forregional development policy towards location in crowded areas or control over the location,the reallocation of economic activities in national territory, creation of adequateinfrastructure, measures to enhance development, financial incentives granted toenterprises. Sustainable business development, rehabilitation of social infrastructure,including social housing and improved social services. Improved regional and localtransportation are key areas of intervention rehabilitation and upgrading of county roads,city streets, including road construction and rehabilitation of belt.

  1. Strategies of Regional Development Management

    Bogdan Włodarczyk


    Full Text Available In the process of strategic planning the strategy of development as well as applications realizing it are formulated. Planning is the basis for preparing and taking decisions referring to principles, trends and the pace of far-reaching development. Elaboration of the strategy of regional development management is the undertaking of large scale complexity. It comprises decisions referring to development perspectives, formulating purposes and determining (choice the methods of their realization, analysis of social and political conditions, collecting and processing the information. Conditioning of defining the strategy has a versatile character. None of the above-mentioned areas can be regarded as less important. The purpose of this study is to attempt to identify basic problems of forming the strategy of regional development management. The study contains a brief description of planning regional development on the basis of the literature of the subject, and then empirical verification of the accepted hypothesis. Considerations and based upon them conclusions can be useful in working out the strategy of regional development management.

  2. Development of a flexible dialysis pore water sampler placement system: easy handling and related error sources

    Stephan Hilgert


    Full Text Available Investigations in the context of greenhouse gas production measurements in sub-tropical reservoirs brought up the necessity to survey the in situ pore water gas and ion concentrations at many positions within a relatively short time. As several sediment cores were taken, the interest in analyzing the pore water at the same time and at the same positions forced us to develop a cost- and time saving method for the placement of dialysis pore water samplers (DPS. General prerequisites were the ability to place several DPS per day, within a flexible depth range of up to 40 m and with a low cost budget. To meet these requirements, a DPS placing system (DPSPS was developed, which would allow the precise placement of DPS in water with a depth of up to 40 m and assessing the biases of on-board measurements and possible methodological improvements. The DPSPS was transported to Brazil and tested in a measurement campaign for 10 days. The measurements were carried out during two campaigns in December 2012 and March 2013 in the Capivari Reservoir north-east of Curitiba in the State of Paraná. The system worked properly and several DPS could be placed from a 5 m class aluminum boat. The placement was performed with high accuracy regarding the positioning as well as the penetration depth of the DPS. After the recovery of the DPS, the possible biases during sampling were analyzed. Possible back-diffusion was investigated, taking oxygen concentration as one representative parameter for estimation of the sample behavior. Laboratory as well as field results showed that special care has to be taken to minimize the influence of diffusion processes during post-recovery sampling. The results also suggested that the used membranes are affected by clogging which is likely to influence the diffusion times of various ions and gases. It can be stated that the DPSPS was developed successfully as the demands in terms of handling as well as monitoring efficiency and sample

  3. Increased rate of force development and neuromuscular activity after high-load resistance training in patients undergoing dialysis

    Molsted, Stig; Andersen, Jesper L.; Eidemak, Inge


    AimThe aim of this study was to investigate the effects of high-load resistance training on the rate of force development and neuromuscular function in patients undergoing dialysis. MethodsTwenty-nine patients were tested before and after 16 weeks of resistance training. The rate of force...... development was tested using the Good Strength dynamometer chair. Muscle strength and neuromuscular function in the m. Vastus lateralis was estimated using electromyography in a one repetition maximum test during dynamic knee extension and during a 20s isometric knee extension with 50% of the one repetition...

  4. Maldives Low Carbon Development Strategy

    Fenhann, Jørgen Villy; Ramlau, Marianne

    This report presents the findings of a study for low carbon development strategy for Maldives. The study was implemented under the Memorandum of Understanding between the Ministry of Environment and Energy (MEE), Maldives and URC and was financed by Danida, Denmark’s development aid agency under...

  5. Arterial calcifications at the hand: Normal development and its course in patients on maintenance dialysis

    Fischer, E.


    Normally, the arterial calcifications at the hand progress form proximal to distal and do not reach the fingers in the 8th decade. In patients on maintenance dialysis the arterial calcifications begin earlier and do not progress with age. The most severe arterial calcifications occur in patients with renal failure caused by diabetic nephropathy. Prognostically arterial calcifications in the finger-metacarpal region are an unfavourable sign.

  6. [The issue of dialysis withdrawal and palliative cares. A 3-year retrospective study carried out at Grenoble university teaching hospital development of a decision-making tool].

    Jarrin, Guillemette; Maurizi-Balzan, Jocelyne; Laval, Guillemette


    Dialysis-related constraints encourage questioning about discontinuation of treatment. In France, the 04/22/2005 law, related to patients' rights and end-of-life issues, defines bounds to treatment withdrawal, authorizing it in specific conditions, to avoid foolish obstinacy. Shortly before the publication of this law, a study has been conducted at Grenoble University Teaching Hospital, involving 31 patients followed by the dialysis service and the palliative care service, in order to analyse the circumstances in which withdrawals from dialysis happen. These patients were old and their general condition was very poor. After initiation of the questioning, treatment was removed in older patients and in those who had been dialysed for short time, which suggests they may have poor adaption to the treatment. No dialysis withdrawal was ever decided without the patient consent or without his nearest and dearest consent. After multidisciplinary discussions, a decision-making tool for dialysis withdrawal has been developed, with a view to be a starting point in the thinking process, for each decision to be adapted to each situation. This tool emphasizes the importance of time and collegial consultation in the decision-making process. It points out to that the decision lies with the referent nephrologist. After withdrawing dialysis, palliative cares must be implemented, since stopping the treatment does not mean stopping cares.

  7. Peritoneal dialysis and inflammation.

    Velloso, Marina Souza Silva; Otoni, Alba; de Paula Sabino, Adriano; de Castro, Whocely Victor; Pinto, Sérgio Wyton Lima; Marinho, Maria Aparecida Silva; Rios, Danyelle Romana Alves


    Peritoneal dialysis (PD) is a kidney replacement therapy for end stage renal disease (ESRD) patients. Despite being a lifesaving treatment, the rate of mortality in patients under PD is elevated, mainly due to the chronic peritoneal dysfunction which is characterized by inflammation, peritoneal fibrosis and neoangiogenesis. The inflammatory process is trigged and modulated by the type of the peritoneal dialysis solutions (PDSs) used during PD. Currently, different PDSs are commercially available: (i) the conventional solutions; (ii) solutions of neutral pH containing low concentration of glucose degradation products (GDPs); (iii) solutions with icodextrin; and (iv) solutions containing taurine. Therefore, the aim of this review is to describe the different types of peritoneal dialysis solutions used during PD and their relationship with systemic and intraperitoneal inflammation. Some studies suggested that solutions of neutral pH containing low concentration of GDPs, icodextrin and taurine have better biocompatibility and lower influence on the inflammatory process compared to the conventional one. On the other hand, the studies, in general, were performed with a small population and for a short period of time. Therefore, further well-designed and -controlled clinical trials with larger number of individuals are required in order to better understand the role of different peritoneal dialysis solution types in the development of inflammation in patients with chronic peritoneal dialysis. Accordingly, studies that are more well-designed, well-controlled and with a larger number of patients are needed to explain and define the role of different types of PDS in the inflammation development in patients with chronic peritoneal dialysis.

  8. Four Styles of Strategy Development

    Idenburg, P.J.


    When considering the number of movements, schools and wars of position, the professional field of strategic management would appear to be maturing. Four views of the strategy development process can be distinguished: rational planning, planning as a guided learning process, planning on the basis of

  9. Forward osmosis process for dialysis fluid regeneration.

    Talaat, Khaled Mohamed


    In a preliminary experiment, 38% of the spent dialysis fluid water was reclaimed by a forward osmosis process through a cellulose triacetate membrane. The simplicity of forward osmosis and its minimal external energy requirements may allow the construction of a small bulk device that can reclaim a considerable portion of the water used in the patient's dialysis process. For developing an acceptable ambulatory dialysis system, decreasing the bulk of the fluid and equipment carried on the patient is essential. Forward osmosis may feasibly be used for dialysis fluid regeneration in ambulatory dialysis systems.

  10. Antibody response to HBV vaccination on dialysis does not correlate with the development of deNovo anti-HLA antibodies after renal transplantation.

    Kauke, Teresa; Link, Maximilian; Rentsch, Markus; Stangl, Manfred; Guba, Markus; Andrassy, Joachim; Werner, Jens; Meiser, Bruno; Fischereder, Michael; Habicht, Antje


    Response to Hepatitis B virus (HBV) vaccination can be diminished in some (50-80%) but not all dialysis patients. We hypothesized, that the response to vaccination on dialysis may correlate with the development of anti-HLA antibodies after renal transplantation and might therefore be a valuable parameter to predict alloresponses. The response to HBV vaccination on dialysis and the development of deNovo anti-HLA antibodies post-transplant was analyzed in 188 non-immunized renal transplant recipients. The response to HBV vaccination was evaluated by measuring the anti-HBs titer at time of transplantation. Anti-HLA antibodies post-transplant were monitored by serial measurements by means of Luminex. Acute rejection episodes, graft loss and renal dysfunction were assessed within a median follow-up of 5.5years. One hundred and forty-one patients (75%) exhibited an adequate immune response to HBV vaccination on dialysis. Vaccine responder (R) and none responder (NR) did not differ with respect to age, gender and BMI, while R spend significantly more time on dialysis before transplantation (4.58±3.35 vs 3.23±2.55 years, p=0.033). More NR developed deNovo anti-HLA antibodies (27.7 vs 22.7%, p=0.554) and donor-specific anti-HLA antibodies (23.4 vs 14.2%, p=0.173) in comparison to R. Accordingly, the number of acute rejections was higher in NR as compared to R (36.1 vs 24.1%, p=0.130) while graft survival was similar in both groups. Contrary to our hypothesis antibody response to HBV vaccination on dialysis does not predict the development of anti-HLA antibodies post transplant. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Skills Development and Transfer Strategy

    Mutshena, M.T.; Nkuna, K.K. [Pebble Bed Modular Reactor Pty (Ltd), P O Box 9394, Centurion, 0046 (South Africa); South African Young Nuclear Professionals Society (South Africa); Thugwane, S.J. [South African Young Nuclear Professionals Society (South Africa); Rasweswe, M.A. [South African Young Nuclear Professionals Society (South Africa); Nuclear Energy Cooperation of South Africa, P O Box 582, PRETORIA 0001 (South Africa)


    South Africa as a developing country is faced with numerous challenges amongst them is the shortage of skills in the working environment. Skills shortage has been aggravated by the retirement of the ageing skilled workforce and emigration of most experienced professionals to first world countries. Some professionals once they acquire the experience they opt out for a consultative business. This leaves a gap or void in the industries which can results into poor performance and quality, lessening of business standards and loosing competition. This challenge need to be attended to, because it will lead to hiring of consultants in most jobs or having many young and less experienced professionals and new graduates filling these gaps. The South African Young Nuclear Professionals Society (SAYNPS) has developed a strategic plan to serve as a guideline on how these challenges mentioned above can be addressed [1]. The proposed strategy will be aligned with skills development in the line of work and should get support from the nuclear Industry. Young professionals and recent graduates are the most affected people who lack skills and shall benefit from these programmes. In order for skill development and transfer to be accomplished there should be a Skill Development and Transfer Strategy and procedures to be followed. (authors)

  12. Design and development of an impedimetric-based system for the remote monitoring of home-based dialysis patients.

    Montalibet, Amalric; Arkouche, Walid; Bogónez Franco, Paco; Bonnet, Stéphane; Clarion, Antoine; Delhomme, Georges; Géhin, Claudine; Gharbi, Sadok; Guillemaud, Régis; Jallon, Pierre; Massot, Bertrand; Pham, Pascale; Ribbe-Cornet, Eva; McAdams, Eric


    A key clinical challenge is to determine the desired 'dry weight' of a patient in order to terminate the dialysis procedure at the optimal moment and thus avoid the effects of over- and under-hydration. It has been found that the effects of haemodialysis on patients can be conveniently monitored using whole-body bioimpedance measurements. The identified need of assessing the hydrational status of patients undergoing haemodialysis at home gave rise to the present Dialydom (DIALYse à DOMicile) project. The aim of the project is to develop a convenient miniaturised impedance monitoring device for localised measurements (on the calf) in order to estimate an impedimetric hydrational index of the home-based patient, and to transmit this and other parameters to a remote clinical site. Many challenges must be overcome to develop a robust and valid home-based device. Some of these are presented in the paper.

  13. 腹膜透析病人残余肾功能及其保护策略研究进展%Research progress on residual renal function of peritoneal dialysis patients and its protection strategies

    方慧苹; 刘琼玲; 赵瑞; 黎列娥


    阐述了残余肾功能的作用,从积极控制腹膜透析病人的原发病、做好容量控制、保证蛋白质及能量摄入、避免使用肾毒性药物、选择合适的透析液和透析剂量方面综述了残余肾功能保护策略研究进展.%It expounded the role of residual renal function,and reviewed the research progress on residual renal function protection strategies from the aspects of actively controlling primary disease of peritoneal dialysis patients, good capacity control, ensuring the intake of protein and energy, a-voiding the use of nephrotoxic drugs, selecting the appropriate dialysis fluid and the dose of dialysis.


    Borma Afrodita


    Full Text Available Third year PhD candidate at the University of Oradea, under the guidance of Professor Mrs. Alina Bădulescu in the doctoral research project entitled: "Doctoral studies and Ph.D. candidates for competitive research on a knowledge based society", a co-financed project by the European Social Fund through the Sectoral Operational Program for Human Resources Development 2007 - 2013, Priority Axis 1. "Education and training in support for growth and development of a knowledge based society" I chose to present this subject in order to demonstrate the connection that exists between tourism and development. Having as research topic "Tourism and development in the Euro regional context” I dedicated a subchapter of this thesis in presenting tourism as a development strategy. Thus we have analysed a series of specialised papers encountered at national and international level in order to achieve a synthesis about the addressed topic. Authors like Sharpley and Telfer (2002 found that the specialised literature in the tourism domain contains few articles on the relationship between tourism and development despite the fact that tourism remains an important area of the economic policy regarding development in most regions of the world. Writings on tourism, that debate development, are often written in terms of the impact of tourism on the environment in which it unfolds. Following statistical data collected on Faits saillants OMT du tourisme, 2011 Edition I found that indeed tourism is an important element in the development strategies. The research methodology that was used consisted in documentation from the specialised literature and the site in order to gather representative data on the evolution of international tourism for the 1950-2010 period, also highlighting the potential success of tourism in the economic development. For this study to be more representative I

  15. Urgent peritoneal dialysis or hemodialysis catheter dialysis.

    Lok, Charmaine E


    Worldwide, there is a steady incident rate of patients with end-stage kidney disease (ESKD) who require renal replacement therapy. Of these patients, approximately one-third have an "unplanned" or "urgent" start to dialysis. This can be a very challenging situation where patients have either not had adequate time for education and decision making regarding dialysis modality and appropriate dialysis access, or a decision was made and plans were altered due to unforeseen circumstances. Despite such unplanned starts, clinicians must still consider the patient's ESKD "life-plan", which includes the best initial dialysis modality and access to suit the patient's individual goals and their medical, social, logistic, and facility circumstances. This paper will discuss the considerations of peritoneal dialysis and a peritoneal dialysis catheter access and hemodialysis and central venous catheter access in patients who require an urgent start to dialysis.

  16. Association of coping strategies with mortality and health-related quality of life in hemodialysis patients: The Japan Dialysis Outcomes and Practice Patterns Study.

    Niihata, Kakuya; Fukuma, Shingo; Akizawa, Tadao; Fukuhara, Shunichi


    Hemodialysis patients are exposed to disease- and treatment-related stresses, and use various coping strategies to deal with these stresses. Although some studies have reported the association of coping strategies with mortality or health-related quality of life (QOL) in some populations, the effect of coping strategies on clinical outcomes in hemodialysis patients remains unclear. We investigated the association in a longitudinal design among Japanese hemodialysis patients. We examined Japanese hemodialysis patients who participated in the Dialysis Outcomes and Practice Patterns Study (DOPPS) IV, which was conducted between 2009 and 2012. The exposure variable was stress coping strategy, as assessed using subscales in Coping Strategies Inventory Short Form: problem-focused engagement, problem-focused disengagement, emotion-focused engagement, and emotion-focused disengagement. Hazard ratios were estimated using Cox proportional hazard model for all-cause mortality and mean differences for change in health-related QOL in 1 year were estimated using a regression model. Among 1,354 patients, only problem-focused engagement was significantly associated with longer survival; other subscales were not associated with all-cause mortality after adjustment for potential confounding factors. In terms of health-related QOL, the subscale of problem-focused engagement was also associated with improvement in physical functioning and mental health among 1,045 patients. Emotion-focused disengagement was associated with deterioration in mental health, but not with change in physical functioning. The other subscales were not associated with change in physical functioning or mental health. Among hemodialysis patients, "problem-focused engagement" coping strategies were associated with longer survival and also with improvement in physical functioning and mental health. To achieve greater longevity and improve QOL in hemodialysis patients under ongoing stresses, problem

  17. Green dialysis: the environmental challenges ahead.

    Agar, John W M


    The US Environmental Protection Agency Resource Conservation website begins: "Natural resource and energy conservation is achieved by managing materials more efficiently--reduce, reuse, recycle," yet healthcare agencies have been slow to heed and practice this simple message. In dialysis practice, notable for a recurrent, per capita resource consumption and waste generation profile second to none in healthcare, efforts to: (1) minimize water use and wastage; (2) consider strategies to reduce power consumption and/or use alternative power options; (3) develop optimal waste management and reusable material recycling programs; (4) design smart buildings that work with and for their environment; (5) establish research programs that explore environmental practice; all have been largely ignored by mainstream nephrology. Some countries are doing far better than others. In the United Kingdom and some European jurisdictions, exceptional recent progress has been made to develop, adopt, and coordinate eco-practice within dialysis programs. These programs set an example for others to follow. Elsewhere, progress has been piecemeal, at best. This review explores the current extent of "green" or eco-dialysis practices. While noting where progress has been made, it also suggests potential new research avenues to develop and follow. One thing seems certain: as global efforts to combat climate change and carbon generation accelerate, the environmental impact of dialysis practice will come under increasing regulatory focus. It is far preferable for the sector to take proactive steps, rather than to await the heavy hand of government or administration to force reluctant and costly compliance on the un-prepared.

  18. Dissolved organic nitrogen measurement using dialysis pretreatment.

    Lee, Wontae; Westerhoff, Paul


    Dissolved organic nitrogen (DON) is important for ecological and engineering researches. Quantification of low DON concentrations in waters with elevated dissolved inorganic nitrogen (DIN) using existing methods is inaccurate. In this study, a dialysis-based pretreatment technique was optimized and adopted to reduce the interference from DIN to the quantification of DON in natural water. A cellulose ester dialysis tube (nominal molecular weight cutoff = 100 Da) was used in batch and continuous-flow dialysis steps with model compounds, natural organic matter isolates, and bulk waters to develop a dialysis pretreatment approach that selectively reduces DIN from solutions containing DON. By reducing DIN concentrations, propagation of analytical variance in total dissolved nitrogen (TDN) and DIN species concentrations allows more accurate determination of DON (DON = TDN - NO3 - NO2- - NH3/NH4+). Dialysis for 24 h against continuously flowing distilled water reduced DIN species by 70%. With dialysis pretreatment, DON recoveries of more than 95% were obtained for surface water and finished drinking water, but wastewater experienced a slight loss (approximately 10%) of DON possibly due to the adsorption of organics onto the dialysis membrane, permeation of low molecular weight fractions, or biodegradation. Dialysis experiments using surface water spiked with different DIN/TDN ratios concluded that dialysis pretreatment leads to more accurate DON determination than no dialysis when DIN/TDN ratios exceed 0.6 mg of N/mg of N.

  19. Strategies in cancer vaccines development.

    Cunto-Amesty, Gina; Monzavi-Karbassi, Behjatolah; Luo, Ping; Jousheghany, Fariba; Kieber-Emmons, Thomas


    The recent definition of tumour-specific immunity in cancer patients and the identification of tumour-associated antigens have generated renewed enthusiasm for the application of immune-based therapies for the treatment of malignancies. Recent developments in cancer vaccines have also been based on an improved understanding of the cellular interactions required to induce a specific anti-tumour immune response. Consequently, a number of cancer vaccines have entered clinical trials. Targeting broad-spectrum tumour-associated antigens has emerged as a strategy to lower the risk of tumour escape due to the loss of specific nominal antigen. Amongst the most challenging of tumour-associated antigens to which to target in active specific immunotherapy applications are carbohydrate antigens. As carbohydrates are intrinsically T-cell-independent antigens, more novel approaches are perhaps needed to drive specific-T-cell-dependent immune responses to carbohydrate antigens. In this context peptide mimetics of core structures of tumour-associated carbohydrate antigens might be developed to augment immune responses to these broad-spectrum antigens.

  20. Fully automated dialysis system based on the central dialysis fluid delivery system.

    Kawanishi, Hideki; Moriishi, Misaki; Sato, Takashi; Taoka, Masahiro


    The fully automated dialysis system (FADS) was developed as an improvement over previous patient monitors used in the treatment of hemodialysis, with the aim of standardizing and promoting labor-saving in such treatment. This system uses backfiltration dialysis fluid to perform priming, blood rinse back and rapid fluid replenishment, and causes guiding of blood into the dialyzer by the drainage pump for ultrafiltration. This requires that the dialysis fluid used be purified to a high level. The central dialysis fluid delivery system (CDDS) combines the process of the creation and supply of dialysis water and dialysis fluid to achieve a level of purity equivalent with ultrapure dialysis fluid. FADS has the further advantages of greater efficiency and streamlined operation, reducing human error and the risk of infection without requiring the storage or disposal of normal saline solution. The simplification of hemodialysis allows for greater frequency of dialysis or extended dialysis, enabling treatment to be provided in line with the patient's particular situation. FADS thus markedly improves the reliability, safety and standardization of dialysis procedures while ensuring labor-saving in these procedures, making it of particular utility for institutions dealing with dialysis on a large scale.

  1. Organisational IT Strategy Development using GDSS

    Sørensen, Lene


    IT strategy development in organisations is a complex task for which there is an immediate need for methodological support to be able to make satisfying decisions. Group Decision Support Systems (GDSS) is one line of supporting the process of group decision making and supporting IT strategy...... to support development of organisational IT strategies....

  2. [Natural history of HBV in dialysis population].

    Fabrizi, F; Martin, P; Lunghi, G; Ponticelli, C


    Dialysis patients remain at risk of acquiring hepatitis B virus (HBV) infection. The issue of the natural history of HBV among patients undergoing long-term dialysis remains unclear. Assessing the natural history of hepatitis B in patients on maintenance dialysis is problematic because of the unique characteristics of this population: serum aminotransferase activity is lower in dialysis patients compared with patients without renal disease; also, chronic hepatitis B has an insidious and prolonged natural history, and the competing mortality from complications of end-stage renal disease may obscure the long-term consequences of hepatitis B. HBV-related liver disease frequently runs an asymptomatic course in dialysis patients and the liver-related mortality in this population is very low; thus, the prognosis for chronic HBV infection in dialysis patients has been reported as benign. However, the frequency of liver cancer in dialysis patients appears higher than that observed in the general population, this has been related to a greater exposure to HBV/HCV. Cirrhosis is not a frequent comorbid condition in the dialysis population of industrialised countries, but the death rate for dialysis patients with cirrhosis is 35% higher than for those without it. In addition, it has been observed that liver disease remains a significant cause of mortality among HbsAg-positive carriers on dialysis in developing countries. The low viral load measured in dialysis patients with persistent HBsAg carriage could be accounted for by the relatively benign course of HBV-related liver disease in this population. Prospective clinical trials are under way to better define the virological features of HBV in the dialysis population.

  3. Developing Children's Classroom Listening Strategies.

    Brent, Rebecca; Anderson, Patricia


    Argues that classroom activities offer excellent opportunities for students to become listeners. Discusses how teachers can model good listening, teach skill and strategy lessons, and provide meaningful reasons for listening. (SR)

  4. Dialysis Facility Compare

    U.S. Department of Health & Human Services — Dialysis Facility Compare helps you find detailed information about Medicare-certified dialysis facilities. You can compare the services and the quality of care that...

  5. Literacy: Development and Teaching Strategies.

    Orme, Liz; Masson, Susan

    This paper seeks to provide teachers with a sampling of before, during, and after reading strategies that are appropriate for use in K-12 classrooms. The paper first discusses diagnostic assessment methods in the classroom and presents activities which provide samples of informal diagnostic assessment. It then outlines some "before reading"…

  6. Dialysate as food as an option for automated peritoneal dialysis

    Tjiong, Hoey Lan; Swart, Roel; Berg, Willem; Fieren, Marien


    textabstractProtein-energy malnutrition is frequently found in dialysis patients. Many factors play a role in its development including deficient nutrient intake as a result of anorexia. Peritoneal dialysis (PD) solutions containing a mixture of amino acids and glucose in an appropriate ratio could serve as a source of food. The authors of this article found that such a dialysis solution when administered to fasting patients who were on nightly automated peritoneal dialysis (APD), as part of ...

  7. [The DIALYSIS AMICA project].

    Marchionni, B


    The denominated Plan "DIALYSIS FRIEND" organized in the region March in the 1998, has seen involved almost all the centers of Dialysis of the region. He has the purpose of furnish the sanitary operators the tools for face the varied strife-torn situations in first person and emotional that they present themselves in an U.O. to "high tension" like result be the Dialysis and the "particularity" personality of whom affection from chronic uraemia comes subjected to dialysis. Besides through the identification of a "profile of fitness" furnishes data on the compliance of the person dialyzed or in pre-dialysis to the different techniques of dialysis. The share of the doctor, of a chief ward, and of any nurses of the U.O. of Nefro/Dialysis of Fano to such plan has resulted to be a very significance experience. The participants to the course tell their experience.

  8. Epidemiology and aetiology of dialysis-treated end-stage kidney disease in Libya

    Alashek Wiam A


    Full Text Available Abstract Background The extent and the distribution of end stage kidney disease (ESKD in Libya have not been reported despite provision of dialysis over 4 decades. This study aimed to develop the first comprehensive description of the epidemiology of dialysis-treated ESKD in Libya. Methods Structured demographic and clinical data were obtained regarding all adult patients treated at all maintenance dialysis facilities (n=39 in Libya from May to September 2009. Subsequently data were collected prospectively on all new patients who started dialysis from September 2009 to August 2010. Population estimates were obtained from the Libyan national statistics department. The age and gender breakdown of the population in each region was obtained from mid-2009 population estimates based on 2006 census data. Results The prevalence of dialysis-treated ESKD was 624 per million population (pmp. 85% of prevalent patients were aged Conclusions Libya has a relatively high prevalence and incidence of dialysis-treated ESKD. As the country prepares to redevelop its healthcare system it is hoped that these data will guide strategies for the prevention of CKD and planning for the provision of renal replacement therapy.

  9. Epidemiology and aetiology of dialysis-treated end-stage kidney disease in Libya.

    Alashek, Wiam A; McIntyre, Christopher W; Taal, Maarten W


    The extent and the distribution of end stage kidney disease (ESKD) in Libya have not been reported despite provision of dialysis over 4 decades. This study aimed to develop the first comprehensive description of the epidemiology of dialysis-treated ESKD in Libya. Structured demographic and clinical data were obtained regarding all adult patients treated at all maintenance dialysis facilities (n=39) in Libya from May to September 2009. Subsequently data were collected prospectively on all new patients who started dialysis from September 2009 to August 2010. Population estimates were obtained from the Libyan national statistics department. The age and gender breakdown of the population in each region was obtained from mid-2009 population estimates based on 2006 census data. The prevalence of dialysis-treated ESKD was 624 per million population (pmp). 85% of prevalent patients were aged Libya has a relatively high prevalence and incidence of dialysis-treated ESKD. As the country prepares to redevelop its healthcare system it is hoped that these data will guide strategies for the prevention of CKD and planning for the provision of renal replacement therapy.

  10. [Continuous ambulatory peritoneal dialysis: the perfect dialysis?].

    Marichal, J F


    Among the dialysis method, Continuous Ambulatory Peritoneal Dialysis (CAPD) is considered as simple, efficient, economical and giving autonomy to the patient. After more than ten year using Continuous Ambulatory Peritoneal Dialysis, results are evaluated. The method remains simple, but the obvious simplicity demands a strict medical control. It is efficient, but the hope in anemia and osteodystrophy correction is not confirmed. It offers more freedom but with a lot of restraints: the dietary restriction must be followed and there is only relative moving autonomia. It is economical, but the costs with the use of disconnectable systems which reduce morbidity, bring it near to the home hemodialysis.

  11. Labor development strategy in the bag industry

    Dyah Maya Nihayah


    Full Text Available The research aims to formulate strategies for improving the labor competencies in the bag industry in Kudus Regency. The data comprise business players, which will be analyzed using the Strength, Weaknesses, Opportunities, and Threats (SWOT analysis. The results reveal that the proper strategy for improving employment in the bag industry is growth and build strategy. Growth and development strategy are intensive actions undertaken through the development of labor competencies to improve the quality of output. It can be made with creating learning resources by designing methods and trainings refer to the Competency Based Training (CBT.

  12. Management Strategies for Ecocities of Sustainable Development

    Zhao Linan; Yang Bolin; Xu Mingzhi


    Building ecocities becomes an objective requirement for sustainable development. This article discusses the relationship between sustainable development and sustainable urban development.On the basis of discussing the sigificance of sustainable urban development and that of an eco-city from different perspectives, it suggests several management strategies for developing an eco-city, a desirable sustainable urban model.

  13. Success rates for product development strategies in new drug development.

    Dahlin, E; Nelson, G M; Haynes, M; Sargeant, F


    While research has examined the likelihood that drugs progress across phases of clinical trials, no research to date has examined the types of product development strategies that are the most likely to be successful in clinical trials. This research seeks to identify the strategies that are most likely to reach the market-those generated using a novel product development strategy or strategies that combine a company's expertise with both drugs and indications, which we call combined experience strategies. We evaluate the success of product development strategies in the drug development process for a sample of 2562 clinical trials completed by 406 US pharmaceutical companies. To identify product development strategies, we coded each clinical trial according to whether it consisted of an indication or a drug that was new to the firm. Accordingly, a clinical trial that consists of both an indication and a drug that were both new to the firm represents a novel product development strategy; indication experience is a product development strategy that consists of an indication that a firm had tested previously in a clinical trial, but with a drug that was new to the firm; drug experience is a product development strategy that consists of a drug that the firm had prior experience testing in clinical trials, but with an indication that was new to the firm; combined experience consists of both a drug and an indication that the firm had experience testing in clinical trials. Success rates for product development strategies across clinical phases were calculated for the clinical trials in our sample. Combined experience strategies had the highest success rate. More than three and a half percent (0·036) of the trials that combined experience with drugs and indications eventually reached the market. The next most successful strategy is drug experience (0·025) with novel strategies trailing closely (0·024). Indication experience strategies are the least successful (0·008

  14. Organisational IT Strategy Development using GDSS

    Sørensen, Lene


    IT strategy development in organisations is a complex task for which there is an immediate need for methodological support to be able to make satisfying decisions. Group Decision Support Systems (GDSS) is one line of supporting the process of group decision making and supporting IT strategy...... development. This paper discusses the features of GDSSs in terms of a broad definition, and a focus on how it supports and makes impact on group decision making. For illustrating reasons, an existing GDSS is presented: the Strategic ADvisor, STRAD. STRAD is presented and it is showed how this GDSs can be used...... to support development of organisational IT strategies....

  15. Guidance of technical management of dialysis water and dialysis fluid for the Japan Association for Clinical Engineering Technologists.

    Kawasaki, Tadayuki; Uchino, Junji; Shinoda, Toshio; Kawanishi, Hideki


    There has been remarkable medical and technological progress in Japanese dialysis therapy where more than 270 thousand patients had been treated with dialysis by the end of 2007. Clinical engineering technologists have played an important role not only in the safety treatment but also in the technological development of dialysis therapy. It is very important to supply pure dialysis fluid for both the efficacy and the safety of hemodialysis in which high permeable dialysis membranes are used. The Japanese Society for Dialysis Therapy recently issued the standard for bacterial management of fluids for hemodialysis and related therapies according to the International Organization for Standardization (ISO)/DIS 23500. In order to achieve the standard, the management of dialysis water treatment is important as well as the role of clinical engineering technologists in daily dialysis practice. Purification is defined as no contamination by chemical substances and/or microorganisms and its components. The purification consists of the design and the system structure of the water treatment equipment and dialysis fluid-supplying equipment, and the operation and management of the equipment. The guideline aims to show the minimum standard and the management method of the water treatment system and dialysis fluid-supplying equipment in order to perform hemodialysis safely. They should outline safer dialysis by the management of purification of dialysis fluid.

  16. Using a genetic, observational study as a strategy to estimate the potential cost-effectiveness of pharmacological CCR5 blockade in dialysis patients

    Muntinghe, Friso L. H.; Vegter, Stefan; Verduijn, Marion; Boeschoten, Elisabeth W.; Dekker, Friedo W.; Navis, Gerjan; Postma, Maarten


    Background and objective Randomized clinical trials are expensive and time consuming. Therefore, strategies are needed to prioritise tracks for drug development. Genetic association studies may provide such a strategy by considering the differences between genotypes as a proxy for a natural, lifelon

  17. How to develop vocabulary learning strategies



    @@ Due to limited class time,students will not be able to learn all the vocabulary simply from class teaching.Thus we need to help students develop items vocabulary learning strategies so that they can effectively acquire more vocabulary on their own,especially outside the class.Below are some strategies.

  18. Developing IEC Strategies for Population Programmes.

    Cohen, Sylvie I.


    Proposes a systematic and stepwise approach to the design of population information, education, and communication (IEC) strategies. Clarifies the role of IEC in population programs, details methodological steps to follow in IEC strategy development, and identifies types of research and sources of data needed. (MDH)

  19. Developing IEC Strategies for Population Programmes.

    Cohen, Sylvie I.


    Proposes a systematic and stepwise approach to the design of population information, education, and communication (IEC) strategies. Clarifies the role of IEC in population programs, details methodological steps to follow in IEC strategy development, and identifies types of research and sources of data needed. (MDH)

  20. [Dialysis and ecology: can we do better in the future?].

    Vuignier, Y; Pruijm, M; Jarrayah, F; Burnier, M


    Development of dialysis has saved the lives of many patients. However, haemodialysis and peritoneal dialysis are very demanding in resources such as water and electricity, and generate a large amount of waste. In this article, we will review the environmental aspects of dialysis. Different solutions will be discussed, such as recycling of water discharged during reverse osmosis, the integration of solar energy, recycling of waste plastics, and the use of other techniques such as sorbent dialysis. In a world where natural resources are precious and where global warming is a major problem, it is important that not only dialysis, but all branches of medicine become more attentive to ecology.

  1. Social Farming Rural Development Strategy

    Adrian Gheorghe ZUGRAVU


    Full Text Available The paper follows two main objectives: to understand farmers’ perception and image of social services and to identify communication levers in order to improve the perceived image of social farming. Orientations in terms of communication are product-focused and aim at enhancing the reputation of social farming consequently with impact on rural development. This paper conducted a questionnaire survey of Romanian farmers’ perception toward social agricultural. The empirical study indicated that farmers shown different awareness to social farming.

  2. Effectiveness of peritonaeal dialysis

    Jovanović Nataša


    Full Text Available Introduction. In the last few years, an increasing number of patients suffering from terminal renal disease of various leading causes was treated with renal replacement therapy. Peritonaeal dialysis involves an exchange of water and solutes between blood in the peritonaeal capillaries and dialysate in the peritonaeal cavum throughout the peritonaeum. Effective dialysis treatment should provide good quality of life, decrease the number of physical complaints, and bring the incidence of morbidity and mortality closer to the incidence of morbidity and mortality in the healthy population. Aim. The aim of this study was the evaluation of peritonaeal transport characteristics and dialysis effectiveness in 58 patients affected by terminal renal disease who underwent peritonaeal dialysis treatment during August 2003 at the Clinic of Nephrology of the Clinical Centre of Serbia. Method. We examined 30 male and 28 female patients, with an average age of 52 years (range 26 to 78 years. The average duration of peritoneal dialysis treatment was 20 months (ranging from 2 to 66 months, and the end-stage renal failure was caused by different leading disease in our patients. We applied different dialysis modalities: continuous ambulatory peritonaeal dialysis (CAPD with three to five 2- or 3-litre exchanges daily, cyclic peritonaeal dialysis (CCPD, intermittent peritonaeal dialysis (IPD, or automatic peritonaeal dialysis (APD, according to the transport characteristics of the peritonaeal membrane, the residual renal function (RRF, and the clinical status of the patients, in order to perform adequate depuration as suggested by the new international criteria. A peritonaeal equilibrium test (PET was performed according to the new international advice; urea and creatinine clearances (Kt/V and Ccr as well as RRF were calculated using the internationally suggested formulas. Results. Most of our patients received effective dialysis treatment, thanks to the modulation of

  3. Developing & Optimizing a Logical Sourcing Strategy

    Lee S Scheible; Chris Bodurow; Karin Daun


      In order to optimize the benefit of the sourcing strategy and ensure delivery of the portfolio, a logical operational process flow must be developed and implemented consistently across all study...


    D. B. Smirnov


    Full Text Available Article tasks: defi ne main approaches to business development strategy formation. Methodology: methodological basis includes systemic, replication and dialectic general scientifi c approaches. Results: it is established that the activity approach as a leading methodology of strategy development assumes correlation between the activity category and the concepts: needs, interests, incentives, goals, refl ection (evaluation, and self-development. Systemic approach assumes to consider strategy as a system having a defi nite structure and interconnections within the system components. Conclusions/relevance: for Russian businesses the main goal in the management system is not a prompt response to current environmental changes, but formation of a strategic vision of the business’ future, elaboration of a fl exible and viable development strategy, to foresee tactical and strategic threats for the business activity, to remove them timely, as well as to use strategic management ideas in practice for sustainable growth.

  5. Students’ Learning Strategies for Developing Speaking Ability

    Sofyan A. Gani; Dian Fajrina; Rizaldy Hanifa


    This study was done to study the learning strategies used by both low and high performance speaking students in developing their speaking skills as well as the differences between the learning strategies used by both groups of learners. The reason for conducting this research was the fact that the competency of many students in speaking English was still considered unsatisfactory in Banda Aceh. We postulated that one aspect involved in the process of developing speaking skills was the learnin...

  6. Strategy for Developing Local Chicken

    Sofjan Iskandar


    Full Text Available Chicken industry in Indonesia offer jobs for people in the village areas . The balance in development industry of selected and local chicken has to be anticipated as there has been threat of reducing importation of grand parent stock of selected chicken due to global avian influenza . In the mean time, high appreciation to the local chicken has been shown by the existence of local chicken farms in the size of business scale . For local chicken business, the government has been built programs, projects, and infrastructures, although the programs and projects were dropped scattered in to several institutions, which were end up with less significant impact to the people. Therefore, it is the time that the government should put more efforts to integrate various sources . focusing in enhancing local chicken industry .

  7. Prodrug Strategy in Drug Development

    Hajnal Kelemen


    Full Text Available Prodrugs are chemically modified derivatives introduced in therapy due to their advantageous physico-chemical properties (greater stability, improved solubility, increased permeability, used in inactive form. Biological effect is exerted by the active derivatives formed in organism through chemical transformation (biotransformation. Currently, 10% of pharmaceutical products are used as prodrugs, nearly half of them being converted to active form by hydrolysis, mainly by ester hydrolysis. The use of prodrugs aims to improve the bioavailability of compounds in order to resolve some unfavorable characteristics and to reduce first-pass metabolism. Other objectives are to increase drug absorption, to extend duration of action or to achieve a better tissue/organ selective transport in case of non-oral drug delivery forms. Prodrugs can be characterized by chemical structure, activation mechanism or through the presence of certain functional groups suitable for their preparation. Currently we distinguish in therapy traditional prodrugs prepared by chemical derivatisation, bioprecursors and targeted delivery systems. The present article is a review regarding the introduction and applications of prodrug design in various areas of drug development.

  8. Sectoral sustainable development strategies : self assessment guide


    This guide has been produced as part of Sustainable Development Commission's work with business sectors, the Department for Trade and Industry and the Department for Environment, Food and Rural Affairs to encourage the development of sectoral strategies for sustainable development. Publisher PDF

  9. Medical nutrition therapy in chronic kidney disease; from dialysis to transplant: A case report

    Gabriela Leal-Escobar


    Full Text Available Chronic kidney disease has direct implications in nutritional status, causing anorexia and muscular catabolism. These situations are frequent in kidney renal replacement therapy in which nutritional disorders and inflammatory mechanisms associated with therapy often lead to the development of protein-energy wasting. Nutrition therapy has shown an adequate therapeutic strategy to prevent and treat metabolic alterations, reducing surgical and nutritional complication risks in kidney transplantation patients. The current case reports nutritional intervention on a continuous ambulatory peritoneal dialysis patient who was subsequently prescribed to automatic peritoneal dialysis and, finally, kidney transplant from a living donor.

  10. [Report on chronic dialysis in France in 2016].

    Société Francophone de Néphrologie Dialyse Et Transplantation


    The report on dialysis in France in 2016 from the French Speaking Society of Nephrology Dialysis and Transplantation (SFNDT) provides an exhaustive and documented inventory on dialysis in France. It underlines the organizations that are important in 2016 to maintain a high quality dialysis. Several measures are proposed to maintain and improve the care of dialysis in France: (1) The regulation of dialysis treatment in France must be maintained; (2) a burden of care indicator is proposed to ensure that patients requiring the most care are treated in the centers. Proposals are also made to stimulate peritoneal dialysis offers, (3) to improve the calculation of the cost of dialysis and warn against lower reimbursement rates of dialysis, (4) to reduce transport costs by minimizing transport by ambulance (5). The SFNDT recalls recent recommendations concerning access to the renal transplant waiting list, are recalled; (6) as well as recommendations that require waiting until clinical signs are present to start dialysis (7). The SFNDT makes the proposal to set up advanced renal failure units. These units are expected to develop care that is not supported today: consultation with a nurse, a dietician, a social worker or psychologist, palliative care, and coordination (8). Finally, the financial and human resources for pediatric dialysis should be maintained. Copyright © 2017. Published by Elsevier Masson SAS.

  11. Reducing staff turnover: a case study of dialysis facilities.

    Tai, T W; Robinson, C D


    A multivariate logistic analysis of 42 Texas dialysis facilities indicated that younger, white, short tenure, an LVN/LPN, with less support from family and friends for emotional concerns, and less supervisor support significantly increased the likelihood of turnover (p staff turnover of these dialysis facilities increases costs and impedes the delivery of quality patient care. Managerial strategies to increase staff retention are suggested.

  12. The development of the Swiss Adaptation Strategy

    Hohmann, R.; Köllner-Heck, P.; Probst, T.


    In summer 2009, the Federal Council mandated the Departement of the Environment, Transport, Energy and Communication (DETEC) to develop a Swiss adaptation strategy. This strategy aims to coordinate the efforts of all federal departments involved in adaptation, and to provide them with the necessary basic information. For the development of the Swiss adaptation strategy the following principles are fundamental. (1.) The strategy aims to achieve the overarching objectives of harnessing the opportunities that climate change presents, minimizing the risks of climate change to people and assets, and to increases the adaptive capacity of all resources. (2) The strategy is based on the most recent scientific knowledge about climate change and climate change impacts. (3.) It is based in on a sound and comprehensive analysis of climate change risks. (4.) It includes strategic goals for the sectors that are most vulnerable to climate change, i.e., water management, biodiversity management, agriculture, forestry, natural hazard prevention, health care, energy generation, tourism, land use. (5.) It thoroughly analyzes the interfaces between the sectoral strategies in order solve existing conflicts and profit form existing synergies. The Swiss Adaptation Strategy will be completed and submitted to the Federal Council by the End of 2011.

  13. A Development Strategy for Marine Leisure Infrastructure

    Institute, Marine


    In July 1999 the Marine Institute published an Investment Strategy for the Water-based Tourism and Leisure Sector in Ireland 2000-2006. The strategy recommended a programme of investment aimed at; (1) the provision of new infrastructure and facilities strategically positioned around the coastline (2) the development of high quality integrated clusters of water-based tourism and leisure activities which would attract overseas and local visitors. These recommendations were incorporated into the...

  14. Optimizing Infant Development: Strategies for Day Care.

    Chambliss, Catherine

    This guide for infant day care providers examines the importance of early experience for brain development and strategies for providing optimal infant care. The introduction discusses the current devaluation of day care and idealization of maternal care and identifies benefits of quality day care experience for intellectual development, sleep…


    History recalls that during the period in question, Nigerians especially the Rivers man ... Strategies for the Development of Tourism and Theatre Industries in Nigeria .... that in planning for tourism, national or state development plans should be .... in the evolution of modern drama and modern traditional theatre and drama in ...

  16. Achieving more frequent and longer dialysis for the majority: wearable dialysis and implantable artificial kidney devices.

    Fissell, William H; Roy, Shuvo; Davenport, Andrew


    The long-term survival for many chronic kidney failure patients who remain treated by dialysis in economically advanced countries remains similar to that of those with solid-organ malignancy, despite a disproportionate amount of health-care expenditure. As such, the current paradigm of three times weekly in-center hemodialysis for 4 h or shorter sessions needs to change to improve patient outcomes. Although more frequent and longer dialysis sessions have been reported to improve cardiovascular risk surrogates and short-term outcomes, these options are only practically available to a very small fraction of the total dialysis population. As such, radically new approaches are required to improve patient outcomes and quality of life for the majority of dialysis patients. Currently, two different approaches are being developed, wearable devices based on current dialysis techniques and more futuristic implantable devices modeled on the natural nephron.


    Andrei-Cosmin GLODEANU


    Full Text Available The objective of this study is to explore the Europe 2020 development strategy, from Romania, trough qualitative methods and the corelation analysis trough quantitative methods of the European Funds present in Romania in the period 2007-2010 with the strategy's indicators. From the indicators presented by the European Uniun for the Europe 2020 development strategy,t the following indicators were chosen: "Total expenses for Research and Development as % of GDP", "Renewable energy share of the total energy consumption", "Early school leavers rate" and an alaysis of the correlation with the "Total available allocated budget of the European Union financed projects, arithmetic mean per project" indicator, using Pearson's correlation coefficient and determining also the algebraic average, range, absolute deviation, mean absolute deviation, standard deviation, skewness and kurtosis.

  18. Self-management support for peritoneal dialysis patients.

    Sarian, Mari; Brault, Diane; Perreault, Nathalie


    The increasing prevalence of chronic illnesses and kidney disease, in particular, makes it necessary to adopt new approaches towards their management (Wagner, 1998). Evidence suggests that promoting self-management improves the health status of peritoneal dialysis (PD) patients, as they manage upwards of 90% of their own care. Patients who are unable to self-manage suffer from various complications. This project proposes an intervention aimed at improving self-management skills among PD patients. To promote self-management in peritoneal dialysis patients. This is achieved through the following objectives: (a) develop an algorithm that can improve patients' ability to solve the specific problem of fluid balance maintenance, (b) develop an educational session for patients on how to use the algorithm, and (c) develop an implementation strategy in collaboration with the PD nurse. Three measures evaluate the effectiveness of the intervention. First, a telephone call log shows that participating patients call the clinic less to inquire about fluid balance maintenance. Next, a pre- and post-intervention knowledge test measures definite knowledge increase. Finally, a Patient Satisfaction Questionnaire reveals overall satisfaction with the intervention. This project, which proved beneficial to our patient population, could be duplicated in other clinics. The algorithm "How do I choose a dialysis bag" and the slides of the educational sessions can be shared with PD nurses across the country for the benefit of PD patients.

  19. Service-oriented product development strategies

    Tan, Adrian Ronald

    . Here PSS are understood on three levels in relation to design: 1. PSS solution – a system of integrated products and services that companies develop and deliver to customers. 2. PSS development – the integrated design processes and development activities that result in PSS solutions. 3. PSS approaches...... community, service-oriented approaches that embrace this change of business focus from individual products to total integrated customer solutions are termed Product/Service-Systems (PSS). The research in this thesis addresses the systematic design and development of PSS solutions in manufacturing firms...... in understanding and structuring the development task related to PSS approaches. - PSS approaches require companies to coordinate their business strategy with their development competencies, product strategy and service offerings in close collaboration with customers and other external partners. These findings...

  20. Development Strategy 0f Local Food Diversification

    Imelda Imelda


    Full Text Available The purpose of this research is to develop strategies that can be applied in the development of local food diversification in West Kalimantan. The data used are primary data and secondary data. Variables examined included internal factors (strengths and weaknesses and external factors (opportunities and threats in the development of local food diversification in West Kalimantan. Data analysis were conducted in qualitative descriptive to describe the pattern of food consumption in West Kalimantan and continued with a SWOT analysis to carry out the development strategy of the local food diversification in West Kalimantan. The analysis result showed that the strategy for the development of local food diversification in West Kalimantan is SO strategy (Strengths - Opportunities those are: 1 the increase in synergy between the government and the micro, small and medium enterprises for the development of local food products, 2 the utilization of communications and market information system in improving the marketing of local food products on micro, small and medium enterprises, and 3 the utilization of unutilized agricultural land to improve the quality and quantity of local food products.

  1. Strategy development management of Multimodal Transport Network

    Nesterova Natalia S.


    Full Text Available The article gives a brief overview of works on the development of transport infrastructure for multimodal transportation and integration of Russian transport system into the international transport corridors. The technology for control of the strategy, that changes shape and capacity of Multi-modal Transport Network (MTN, is considered as part of the methodology for designing and development of MTN. This technology allows to carry out strategic and operational management of the strategy implementation based on the use of the balanced scorecard.

  2. Renewable energy strategies for sustainable development

    Lund, Henrik


    This paper discusses the perspective of renewable energy (wind, solar, wave and biomass) in the making of strategies for a sustainable development. Such strategies typically involve three major technological changes: energy savings on the demand side, efficiency improvements in the energy...... on the case of Denmark, this paper discusses the problems and perspectives of converting present energy systems into a 100 percent renewable energy system. The conclusion is that such development will be possible. The necessary renewable energy sources are present, if further technological improvements...

  3. Sustainable development strategy based on GIS

    Vognimary, Marie Odette; Liu, Yanfang; Xu, Feng


    The key problem for implementation of the sustainable development is to design the strategy and policy which incorporates the environmental impacts. This paper puts forward a new model based on GIS of ecological environment protection and sustainable development based on estimating and assessment. The environmental carrying capacity and developing intensity of studied area are analyzed, the ecological security and the level of sustainable development are evaluated, and also the constraints are discussed. According to this analysis, the range of Lichuan is divided into four regions. On the foundation of distinctive characteristics of each area, the designation of the industrial development and environment protection have been ensured; after that, the environmental impact of the given strategies has been identified and predicted; finally, several mitigation measures are suggested.

  4. Strategies for successful software development risk management

    Marija Boban


    Full Text Available Nowadays, software is becoming a major part of enterprise business. Software development is activity connected with advanced technology and high level of knowledge. Risks on software development projects must be successfully mitigated to produce successful software systems. Lack of a defined approach to risk management is one of the common causes for project failures. To improve project chances for success, this work investigates common risk impact areas to perceive a foundation that can be used to define a common approach to software risk management. Based on typical risk impact areas on software development projects, we propose three risk management strategies suitable for a broad area of enterprises and software development projects with different amounts of connected risks. Proposed strategies define activities that should be performed for successful risk management, the one that will enable software development projects to perceive risks as soon as possible and to solve problems connected with risk materialization. We also propose a risk-based approach to software development planning and risk management as attempts to address and retire the highest impact risks as early as possible in the development process. Proposed strategies should improve risk management on software development projects and help create a successful software solution.

  5. Timing of dialysis initiation in the geriatric population: toward a patient-centered approach.

    Treit, Kathryn; Lam, Daniel; O'Hare, Ann M


    Over the last 10-15 years, the incidence of treated end-stage renal disease (ESRD) among older adults has increased and dialysis is being initiated at progressively higher levels of estimated glomerular filtration rate (eGFR). Average life expectancy after dialysis initiation among older adults is quite limited, and many experience an escalation of care and loss of independence after starting dialysis. Available data suggest that treatment decisions about dialysis initiation in older adults in the United States are guided more by system- than by patient-level factors. Stronger efforts are thus needed to ensure that treatment decisions for older adults with advanced kidney disease are optimally aligned with their goals and preferences. There is growing interest in more conservative approaches to the management of advanced kidney disease in older patients who prefer not to initiate dialysis and those for whom the harms of dialysis are expected to outweigh the benefits. A number of small single center studies, mostly from the United Kingdom report similar survival among the subset of older adults with a high burden of comorbidity treated with dialysis vs. those managed conservatively. However, the incidence of treated ESRD in older US adults is several-fold higher than in the United Kingdom, despite a similar prevalence of chronic kidney disease, suggesting large differences in the social, cultural, and economic context in which dialysis treatment decisions unfold. Thus, efforts may be needed to adapt conservative care models developed outside the United States to optimally meet the needs of US patients. More flexible approaches toward dialysis prescription and better integration of treatment decisions about conservative care with those related to modality selection will likely be helpful in meeting the needs of individual patients. Regardless of the chosen treatment strategy, time can often be a critical ally in centering care on what matters most to the patient, and

  6. Developing Communicative Strategies and Grammar Exercises.

    Drozdzial, Krystyna

    Procedures used in foreign language teaching are discussed from the point of view of developing communicative strategies in students. Literature on communicative competence is reviewed and the implications for foreign language instruction are discussed. It is shown that: (1) from the very beginning of language instruction, the classroom setting,…

  7. New product development and product launch strategies

    Filiz Bozkurt Bekoğlu; Ahu Ergen


    In today’s highly competitive environment, a balanced product portfolio, success in new product development and product launch are important factors for the sustainability of organizations. The aim of the study is to reveal the right product launch steps for the companies through theory and case study. In the study, new product development and product launch strategies are first investigated theoretically. Afterwards, a successful product series launch case from cosmetics sector is analyzed. ...

  8. Impact of advanced dialysis technology on the prevalence of dialysis-related amyloidosis in long-term maintenance dialysis patients.

    Schiffl, Helmut


    Dialysis-related amyloidosis (DRA) is a unique type of amyloidosis (beta-2 microglobulin) predominantly in end-stage renal disease. Its clinical manifestations add to increased morbidity and reduced quality of life. There seems to be a relative risk reduction in DRA manifestations when hemodialysis (HD) patients are treated with advanced HD technology, but changes of the course of DRA are uncertain. The aim of our investigation was to evaluate the prevalence and severity of carpal tunnel syndrome (CTS) in long-term dialysis patients receiving either conventional or high-flux, online-produced ultrapure dialysis fluid. The cross-sectional study included 147 HD patients (at least 10 years). The definitive diagnosis of CTS was made histologically or by the coexistence of CTS with other radiological DRA manifestations (bone cysts, arthropathies). The two HD patient groups did not differ significantly in age at start of HD, gender, major co-morbid diseases, anuria, and dialysis vintage. The conventional HD group had significantly higher circulating beta-2 microglobulin and C-reactive protein (CRP) levels. The prevalence of DRA was 68% for the conventional HD group and 28% for the advanced HD group. Duration of dialysis treatment was the only significant risk factor for the development of clinical DRA manifestations in both study groups, but CTS, bone cysts, or arthropathies occurred significantly earlier in conventional HD patients. The prevalence and severity of DRA have decreased with advances in dialysis technology during the last two decades, although its occurrence is simply delayed.

  9. Developing Invention Strategies in Collaborative Writing



    "Invention" refers to the process writers use to search for, discover, create, or "invent"material for a piece of writing. For many students, one of the most frustrating obstacles to effective and productive writing is to get ideas before turning them into a paper. They often complain that it takes them a long time to think of something to say and find that they run out of things to say very quickly. Therefore developing effective invention strategies should be an important part of writing class. In this article, some effective invention strategies are proposed in the framework of collaborative learning. Meanwhile, someimportant factors that need to be considered are explained.


    Indah Eko Suryani


    Full Text Available The objective of this study was to formulate a development strategy in order to maintain the existence of Batik Tulis Rolla Junior. The study used a case study approach with Rumah Batik Tulis Rolla Junior as the research object. The data were analyzed by a value chain approach to determine the internal and external conditions influencing the existence of the Batik Tulis Rolla Junior. Furthermore, this study also used the analysis of Internal Factor Evaluation (IFE, External Factor Evaluation (EFE, Internal-External (IE Matrix, SWOT, dan Quantitative Strategic Planning Matrix (QSPM to create the development strategy. The results show that the strategies that can be recommended to Rolla Junior include 1 increasing the capital by Kredit Usaha Rakyat (KUR program, 2 conductiong expansions to other regencies, 3 creating a website/blog  to promote and perform business transactions, 4 increasing the frequency in joining exhibitions or EXPO both in regional and national levels, 5 conducting researches to solve the problem of coloring which requires sun rays, 6 conducting cooperations with raw material suppliers (backward integration, and 7 finding alternative suppliers of raw materials especially from the areas closer to Jember district.Keywords: development strategy, batik tulis Rolla Junior, SWOT, QSPMABSTRAKPenelitian ini bertujuan merumuskan strategi pengembangan sehingga dapat menjaga eksistensi Batik Tulis Rolla Junior. Penelitian menggunakan pendekatan studi kasus dengan Rolla Junior sebagai objek penelitiannya. Data dianalisis dengan pendekatan rantai nilai untuk mengetahui kondisi internal dan eksternal yang berpengaruh terhadap Batik Tulis kemudian menggunakan analisis Internal Factor Evaluation (IFE, External Factor Evaluation (EFE, Internal-External (IE Matrix, SWOT, dan Quantitative Strategic Planning Matrix (QSPM untuk menyusun strategi pengembangan Batik Tulis Rolla Junior. Hasil penelitian menunjukkan bahwa strategi-straegi prioritas

  11. Dialysis Facility Compare Data

    U.S. Department of Health & Human Services — These are the official datasets used on the Dialysis Facility Compare Website provided by the Centers for Medicare and Medicaid Services. These data...

  12. [The contribution of dialysis and laboratoristic methods for the control of phosphates].

    Bolasco, Piergiorgio


    Prevention and correction of hyperphosphatemia is the first main goal of CKD-MBD management. Therefore, special attention is required to prevent a positive phosphate balance. In addition to a careful use of phosphate binders and dietary, phosphate control is needed to optimize the control of phosphate balance. In well-nourished patients is necessary to provide an optimal dialysis removal schedule. A solution could be the increase of the number of dialysis sessions per week and to carry out longer dialysis session strategies. Nevertheless, many patients have a high phosphate (P) intake linked to the high dietary protein requirement of dialysis patients, hence the use of intestinal P binders is mandatory to reduce P net intestinal absorption. Unfortunately the phosphate molecule must be considered as a medium molecular toxin. Nowadays it remains difficult to remove with modern dialysis strategies and ones clearance is still dependent on dialysis time. The best solutions are: hemodiafiltration with high-volume reinfusion, daily dialysis, long dialysis and modern peritoneal dialysis. Today, this scheduled strategies are difficult because of logistic and cost problems. However the milestone will be an adequate nutrition surveillance, especially with nursing collaboration toward dialysis treatments. This strategy should start in outpatient pre-dialysis ambulatory.

  13. Developing the ontological foundations of a terminological system for end-stage diseases, organ failure, dialysis and transplantation.

    Jacquelinet, Christian; Burgun, Anita; Delamarre, Denis; Strang, Nigel; Djabbour, Sami; Boutin, Bernard; Le Beux, Pierre


    The Etablissement français des Greffes (EfG) is a state agency dealing with Public Health issues related to organ, tissue and cell transplantation in France. The evaluation of organ retrieval and transplantation activities, one of its missions, is supported by a national information system (EfG-IS). The EfG-IS is moving towards a new n-tier architecture comprising a terminology server for end-stage diseases, organ failure, dialysis and transplantation (EfG-TS). Following a preliminary audit of the existing coding system and in order to facilitate data recording, to improve the quality of information, to assume compatibility with terminological existing standards and to allow semantic interoperability with other local, national or international registries, a specific work has been conducted on the thesauri to integrate within the EfG-TS. In this paper focusing on the server's content rather than the container, we report first the functional and cognitive requirements that resulted from the preliminary audit. We then describe the methodological approach used to build the terminological server on "sound ontological foundations". We performed the semantic analysis of existing medical terms to set up disease description frame-like structures. These diseases description frames consist of a limited set of nosological discriminating slots such as etiology, semiology, pathology, evolution and associated diseases. Each relevant medical term is thus associated to a concept defined and inserted within a hierarchy according to disease description frame resulting from the semantic analysis. Last, because this terminological server is shared by various transplant and dialysis centers to record patient data at different time point, contextualization of terms appeared as one of the functional requirements. We will also point out various contexts for medical terms and how they have been taken into account.

  14. Countermeasures of Implementing Sustainable Development Strategy in Shandong, China

    Cui Jianhai


    This paper set forth the goals of implementing sustainable development strategy in Shandong Province guided by the view of scientific development of being people oriented, comprehensive,coordinated and sustainable. Based on the target of sustainable development strategy in Shandong province this paper discusses the main tasks in the sustainable development strategy Countermeasures for sustainable development strategy in Shandong province are put forward.

  15. Phosphate control in dialysis

    Cupisti A; Gallieni M; Rizzo MA; Caria S; Meola M; Bolasco P


    Adamasco Cupisti,1 Maurizio Gallieni,2 Maria Antonietta Rizzo,2 Stefania Caria,3 Mario Meola,4 Piergiorgio Bolasco31Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; 2Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy; 3Territorial Department of Nephrology and Dialysis, ASL Cagliari, Italy; 4Sant'Anna School of Advanced Studies, University of Pisa, Pisa, ItalyAbstract: Prevention and correction of hyperphosphatemia is a major goal ...

  16. Dialysis provision in Malaysia.

    Lim, T O; Lee, D G; Zaki, M


    We determined the provision for dialysis treatment in Malaysia. There were 181 dialysis centres as at 1st June 1999 (161 Haemodialysis (HD) and 20 Continuous Ambulatory Peritoneal Dialysis (CAPD) centres), providing treatment for 5614 patients. This is equivalent to an estimated prevalence rate of 253 patients per million population (pmp) and new dialysis acceptance rate of 49 patients pmp. Dialysis facilities were widely distributed throughout the country though rather unevenly among states. Penang, Selangor/KL, Malacca led with number of dialysis patients pmp ranging from 417 to 480. Kelantan and Sabah had the lowest provision with 51 and 64 patients pmp respectively. There were more centres and HD capacity in the private sector while the Non-Government Organisation and public sectors had about the same capacity. However the public sector had more patients on account of availability of CAPD and home HD services, as well as low HD capacity to patient ratio. The number ofcentres, HD capacity and patients have increased rapidly especially since 1991; the estimated growth rates were 16.5 centres/year, 658 capacity/year, and 392 patients/year respectively. There was also a trend toward increasing over-capacity in the private and NGO sectors. In conclusion, the level of dialysis provision is increasing, indicating increasing accessibility of dialysis treatment in Malaysia. Over-capacity is a concern in the private and NGO sectors. Thus funding agencies should be encouraged to source provision from those sectors. The public sector still has the crucial role of providing for under-served areas in the country.

  17. Using Sustainable Development as a Competitive Strategy

    Spearman, Pat

    Sustainable development reduces construction waste by 43%, generating 50% cost savings. Residential construction executives lacking adequate knowledge regarding the benefits of sustainable development practices are at a competitive disadvantage. Drawing from the diffusion of innovation theory, the purpose of this qualitative case study was to explore knowledge acquisition within the bounds of sustainable residential construction. The purposive sample size of 11 executive decision makers fulfilled the sample size requirements and enabled the extraction of meaningful data. Participants were members of the National Home Builders Association and had experience of a minimum of 5 years in residential construction. The research question addressed how to improve knowledge acquisition relating to the cost benefits of building green homes and increase the adoption rate of sustainable development among residential builders. Data were collected via semistructured telephone interviews, field observation, and document analysis. Transcribed data were validated via respondent validation, coded into 5 initial categories aligned to the focus of the research, then reduced to 3 interlocking themes of environment, competitive advantage, and marketing. Recommendations include developing comprehensive public policies, horizontal and vertical communications networks, and green banks to capitalize sustainable development programs to improve the diffusion of green innovation as a competitive advantage strategy. Business leaders could benefit from this data by integrating sustainable development practices into their business processes. Sustainable development reduces operational costs, increases competitive advantage for builders, and reduces greenhouse gas emissions. Implications for social change increase energy independence through conservation and developing a legislative policy template for comprehensive energy strategies. A comprehensive energy strategy promotes economic development

  18. Initiation of dialysis.

    Hakim, R M; Lazarus, J M


    The decision to initiate dialysis in a patient with progressive renal disease often depends on the physician's assessment of the patient's subjective symptoms of uremia. There is an increasing need to identify objective criteria for such a decision. Recent evidence suggests that malnutrition at the initiation of dialysis is a strong predictor of subsequent increased relative risk of death on dialysis. In this context, the role of prescribed protein restriction as well as the influence of the progression of renal disease on spontaneous dietary protein intake is examined. It is proposed that the indices of malnutrition such as progressive weight loss, serum albumin levels below 4.0 g/dL, serum transferrin levels below 200 mg/dL, and spontaneous dietary protein intake (using 24-hr urinary nitrogen measurement) below 0.8 to 0.7 g/kg per day be considered as objective criteria for the initiation of dialysis. Studies that have examined the role of "early" versus "late" dialysis have consistently shown a better outcome in the patients starting dialysis early. Other studies also suggest that early referral to nephrologists results in improved morbidity and mortality as well as hospitalization costs. An adequate vascular access, as well as social and psychological preparation of the patient, is an important early step in the process.


    S. P. Burlankov


    Full Text Available Relevance of the topic of the study is that the conflicting tendencies of economic development, the need to consider a variety of factors internal and external environment in a changing operating environment in the paramount problem of providing concept enterprises as concept distributed in time. Variety of factors that influence the activity of enterprises, the ambiguity estimates of their effect, often lack the possibility of their accounting and forecasting, the complication of the problem to identify the interdependence of external and internal parameters of management lead to serious negative consequences, and often to the destruction of production and the economic system. This raises the need to develop new approaches and management techniques the intra interaction, based on the use of tools of market relations and the transformation of the elements of the market at the enterprise level. Insufficiently complete theoretical study concept issues, lack of models, diagrams, algorithms for the formation mechanism of industrial relations on the principles of intra-enterprise, ensuring longevity economic enterprises by integrating and mobilizing intra-building, deter-mined the choice of the research topic. Strategy - an integrated model of action designed to achieve the objectives of the enterprise. Content of the strategy is a set of decision rules used to determine the main directions of activity. In the literature on strategic planning, there are two opposing views on the understanding of the strategy. In the first case the strategy - it is a concrete long-term plan to achieve a certain goal, and develop a strategy - it is the process of finding a purpose and making long-term plan. This approach is based on the fact that all the emerging changes are predictable, occur-ring in the environment of the processes are deterministic and amenable to complete control and management. At the same time, both within the organization and outside it there

  20. Request Strategy Development in Iranian Study Abroaders

    Hassan Rasouli Khorshidi


    Full Text Available This longitudinal study empirically investigated the development of request strategies in Iranian study abroaders. More specifically, this study aimed at exploring if length of stay in L2 context impacts learners’ number and type of strategies. To this end, 72 students who registered in a six month study abroad program and 60 native speakers from U.S. Britain, Australia, and Canada agreed to participate in the present study. The learners in this investigation were tested at three phases. In the first phase, the study abroad (SA group was given a Discourse Completion Task (DCT at the beginning of the program as a pre-test. Three months later the same test was administered to the learners as post-test 1 and subsequently at the end of the program once again the test was given to the learners as post-test 2 in order to measure their achievement after three and six months sojourn. The native speakers were also asked to fill the DCT in order to compare the learners’ responses to the native speakers’. Finally, through comparing the learners’ performances in pre-test and post-tests with each other and with the native speakers’, it was found out that first, majority of learners and native speakers used conventionally indirect strategies in their request utterances, second, the number of strategies used by the students steadily increased over time from pre-test to the first and second post-test and third, the type of request strategies used by learners changed to be native like at the end of their sojourn.Keywords: interlanguage pragmatics, pragmatic competence, request strategies, speech acts, study abroad

  1. Strategies in Developing Agropolitan Areas in Indonesia

    Laelatul Farhanah


    Full Text Available Agropolitan program, so far, has not been widely acknowledged by public. Various facilities have not been optimally utilized due to their functions as there are only limited parties aware upon this program. Developing agropolitan areas through superior horticultural commodities development has not increased farmers’ exchange rate. Gaps between planning and implementation in developing agropolitan areas encourage a research with the goal of strategies in developing agropolitan areas in Rojonoto of Wonosobo district. Type of this research is a quantitative description. Primary and secondary data are used. The primary data are taken from 18 key-person agropolitan stakeholders. Priorities in developing Agropolitan areas in Rojonoto of Wonosobo district may be obtained through sequences of priority by improving human resources and technologies, the provision of production inputs, infrastructures, policies, and institutions. This study suggests that local government pay more attention to develop human resources and technologies, without disregarding to the other criteria.

  2. Sodium Balance During Extra Corporeal Dialysis

    Locatelli Francesco


    Full Text Available In order to reduce intradialytic and interdialytic morbidity, it is important to obtain a zero sodium balance at the end of each dialysis session. This can be achieved by matching exactly the interdialytic sodium and water intake with the intradialytic sodium and water removal. A positive sodium balance can be obtained by using hypernatric dialysis or "sodium ramping" or convective techniques. While reducing the intradialytic side effects (hypotension, cramps, nausea, vomiting, these methods may increase the interdialytic side effects (thirst, weight gain, hypertension and pulmonary edema. Given the highly variable amounts of sodium introduced during the interdialytic periods, the use of sodium-conductivity kinetic models allows removing exactly the amount of sodium accumulated in the interdialytic period. This strategy may be advantageous towards cardiovascular stability in patients prone to dialysis hypotension.

  3. Central station market development strategies for photovoltaics


    Federal market development strategies designed to accelerate the market penetration of central station applications of photovoltaic energy system are analyzed. Since no specific goals were set for the commercialization of central station applications, strategic principles are explored which, when coupled with specific objectives for central stations, can produce a market development implementation plan. The study includes (1) background information on the National Photovoltaic Program, photovoltaic technology, and central stations; (2) a brief market assessment; (3) a discussion of the viewpoints of the electric utility industry with respect to solar energy; (4) a discussion of commercialization issues; and (5) strategy principles. It is recommended that a set of specific goals and objectives be defined for the photovoltaic central station program, and that these goals and objectives evolve into an implementation plan that identifies the appropriate federal role.

  4. Systems strategies for developing industrial microbial strains

    Lee, Sang Yup; Kim, Hyun Uk


    Industrial strain development requires system-wide engineering and optimization of cellular metabolism while considering industrially relevant fermentation and recovery processes. It can be conceptualized as several strategies, which may be implemented in an iterative fashion and in different...... performance under industrial fermentation conditions. These challenges can be overcome by taking systems approaches through the use of state-of-the-art tools of systems biology, synthetic biology and evolutionary engineering in the context of industrial bioprocess. Major systems metabolic engineering...

  5. Private Sector Development: Sector Strategy (2004)

    Inter-American Development Bank


    This Strategy provides a roadmap for the IDB Group intended to strategically focus its private sector development activities. Its objective is to deepen and complement the essential role of the private sector in promoting economic growth and generating income by creating jobs that contribute to sustained poverty reduction. The IDB Group can support governments in providing public goods, regulating markets, promoting positive externalities, overcoming market failures, and building consensus on...

  6. Peritoneal Dialysis in Diabetics: There Is Room for More

    P. Cotovio


    Full Text Available End stage renal disease diabetic patients suffer from worse clinical outcomes under dialysis-independently of modality. Peritoneal dialysis offers them the advantages of home therapy while sparing their frail vascular capital and preserving residual renal function. Other benefits and potential risks deserve discussion. Predialysis intervention with early nephrology referral, patient education, and multidisciplinary support are recommended. Skilled and updated peritoneal dialysis protocols must be prescribed to assure better survival. Optimized volume control, glucose-sparing peritoneal dialysis regimens, and elective use of icodextrin are key therapy strategies. Nutritional evaluation and support, preferential use of low-glucose degradation products solutions, and prescription of renin-angiotensin-aldosterone system acting drugs should also be part of the panel to improve diabetic care under peritoneal dialysis.

  7. Developing IEC strategies for population programmes.

    Cohen, S I


    The thrust of this article is to define terms of IEC, IEC strategies, the stepwise planning process for IEC, data requirements, the ideational change process, and the need for situational and institutional analysis. A chart provided an at-a-glance perspective on the 11 steps in IEC strategic planning for as many specific target groups as needed. The steps are to state the goals, select and prioritize the target audience, describe the target audience,, determine the IEC activities, outline appropriate messages, identify communication channels, identify managerial and organizational strategies, calculate the amount of resources required, identify a realistic time frame, and evaluate critical factors and obstacles. IEC goals are to contribute to solving a problem or supporting an issue, which involved attitudinal and/or behavioral changes. Many strategies are possible. The common weaknesses are the lack of priorities, the view of targets as a mass audience, a lack in support for population strategies, a lack of integration with family planning or specific population sectors, a lack of integration of up-to-data research findings on population programs, vague or difficult-to-measure objectives, reliance on printed media, and sporadic assessment of personnel needs. THe levels of strategy are identified as follows: 1) national and multisectoral, 2) national and sectoral specific, and 3) project specific. Traditional sociocultural research and KAP surveys are not sufficient to provide an understanding of the target audience. There must be an understanding of the stages of individual change: unaware, aware, concerned, information seeking, learning, motivated to change, initial behavior change, sustained behavior change, and adoption or refusal of behavior change. Beliefs must be distinguished from attitudes in measurement. Changes in beliefs may involve correction of misinformation; attitude change requires a motivational approach. Behavior may be determined by other

  8. Dialysis access, infections, and hospitalisations in unplanned dialysis start patients

    Machowska, Anna; Alscher, Mark Dominik; Vanga, Satyanarayana Reddy


    Introduction: Unplanned dialysis start (UPS) associates with worse clinical outcomes, higher utilisation of healthcare resources, lower chances to select dialysis modality and UPS patients typically commenced in-centre haemodialysis (HD) with central venous catheter (CVC). We evaluated patient ou...


    Vharessa Aknesia


    Full Text Available Specialty coffee is a coffee of premium quality that has been made through various stages of post-harvest processing and strictly controlled to produce distinctive taste of origins. PT Sinar Mayang Lestari is one of the companies that currently produce and develop specialty coffee type, Arabica Java Preanger. The objectives of the study are to examine competitive advantages and develop an alternative strategy that need to be done by PT Sinar Mayang Lestari for their business development. The research methods used are value chain analysis and VRIO framework to explore competitive advantage owned by the company. The result shows the company currently has a temporary competitive advantage of the technological resources and reputation. By using SWOT-AHP technique, the alternative strategies that can be done by company are as follows: 1 increasing the production of natural and honey coffee  type; 2 building coffee center in plantation site for sharing knowledge and innovation media to the farmers; 3 improving the competency of human resource in plantation, post harvest, and promoting area; 4 building management system gradually 5 forwarding integration by building roast and ground coffee business; and 6 maximizing the ability of the land and human resources through research and development.Keywords: competitive advantage, specialty coffee, SWOT-AHP, value chain, VRIOABSTRAKKopi special merupakan kopi dengan kualitas premium yang sudah melalui berbagai tahapan pengolahan pascapanen yang diawasi dengan ketat sehingga menghasilkan cita rasa yang khas sesuai dengan daerah asalnya. PT Sinar Mayang Lestari adalah salah satu perusahaan yang saatini memproduksi dan mengembangkan kopi spesial jenis Arabika Java Preanger. Tujuan dari penelitian ini adalah menganalisis keunggulan bersaing yang dimiliki dan mengembangkan alternative strategi yang perlu dilakukanoleh PT Sinar Mayang Lestari untuk pengembangan usahanya. Penelitian ini menggunakan analisis rantai

  10. Testing Strategies for Model-Based Development

    Heimdahl, Mats P. E.; Whalen, Mike; Rajan, Ajitha; Miller, Steven P.


    This report presents an approach for testing artifacts generated in a model-based development process. This approach divides the traditional testing process into two parts: requirements-based testing (validation testing) which determines whether the model implements the high-level requirements and model-based testing (conformance testing) which determines whether the code generated from a model is behaviorally equivalent to the model. The goals of the two processes differ significantly and this report explores suitable testing metrics and automation strategies for each. To support requirements-based testing, we define novel objective requirements coverage metrics similar to existing specification and code coverage metrics. For model-based testing, we briefly describe automation strategies and examine the fault-finding capability of different structural coverage metrics using tests automatically generated from the model.

  11. Human Resource Development Strategies: The Malaysian Scenario

    Haslinda Abdullah


    Full Text Available The socio-economic development of Malaysia is greatly influenced by human resources activities in both the private and public sectors. But the private sector, particularly the industrial sector is the key player for the country’s economic growth. In acknowledging human resources importance in this sector, the country’s developmental plans developed thrusts that support the development of human resources to become skilled, creative and innovative. This article examines the concepts and nature of human resource development (HRD at the national level in Malaysia. In examining HRD from the national perspective, a review of documentary evidence from relevant Governmental reports and documents was utilised. The plans, policies, strategies, roles and responsibilities in HRD at the national level were discussed.

  12. Quality of Life and Self-Efficacy in Three Dialysis Modalities: Incenter Hemodialysis, Home Hemodialysis, and Home Peritoneal Dialysis.

    Wright, Linda S; Wilson, Linda


    Previous research has demonstrated improved outcomes for patients on dialysis who have better quality of life and self-efficacy, but has focused almost exclusively on those receiving hemodialysis. The goal of this study was to describe the quality of life and self-efficacy of patients receiving incenter hemodialysis versus those receiving a home dialysis modality (hemodialysis or peritoneal dialysis). The study utilized a correlational cross-sectional design and quota sampling methods. Participants were recruited from outpatient dialysis facilities and included 77 community dwelling adult patients who had been on dialysis for at least six months. Quality of life was measured using the Kidney Disease Quality of Life instrument, and self-efficacy was measured using the Strategies Used by People to Promote Health instrument. Findings suggest equal outcomes between treatment groups, with no contraindication to the use of home therapies.

  13. Dengue vaccine development: strategies and challenges.

    Ramakrishnan, Lakshmy; Pillai, Madhavan Radhakrishna; Nair, Radhakrishnan R


    Infection with dengue virus may result in dengue fever or a more severe outcome, such as dengue hemorrhagic syndrome/shock. Dengue virus infection poses a threat to endemic regions for four reasons: the presence of four serotypes, each with the ability to cause a similar disease outcome, including fatality; difficulties related to vector control; the lack of specific treatment; and the nonavailability of a suitable vaccine. Vaccine development is considered challenging due to the severity of the disease observed in individuals who have acquired dengue-specific immunity, either passively or actively. Therefore, the presence of vaccine-induced immunity against a particular serotype may prime an individual to severe disease on exposure to dengue virus. Vaccine development strategies include live attenuated vaccines, chimeric, DNA-based, subunit, and inactivated vaccines. Each of the candidates is in various stages of preclinical and clinical development. Issues pertaining to selection pressures, viral interaction, and safety still need to be evaluated in order to induce a complete protective immune response against all four serotypes. This review highlights the various strategies that have been employed in vaccine development, and identifies the obstacles to producing a safe and effective vaccine.

  14. Phosphate control in dialysis

    Cupisti A


    Full Text Available Adamasco Cupisti,1 Maurizio Gallieni,2 Maria Antonietta Rizzo,2 Stefania Caria,3 Mario Meola,4 Piergiorgio Bolasco31Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; 2Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy; 3Territorial Department of Nephrology and Dialysis, ASL Cagliari, Italy; 4Sant'Anna School of Advanced Studies, University of Pisa, Pisa, ItalyAbstract: Prevention and correction of hyperphosphatemia is a major goal of chronic kidney disease–mineral and bone disorder (CKD–MBD management, achievable through avoidance of a positive phosphate balance. To this aim, optimal dialysis removal, careful use of phosphate binders, and dietary phosphate control are needed to optimize the control of phosphate balance in well-nourished patients on a standard three-times-a-week hemodialysis schedule. Using a mixed diffusive–convective hemodialysis tecniques, and increasing the number and/or the duration of dialysis tecniques are all measures able to enhance phosphorus (P mass removal through dialysis. However, dialytic removal does not equal the high P intake linked to the high dietary protein requirement of dialysis patients; hence, the use of intestinal P binders is mandatory to reduce P net intestinal absorption. Unfortunately, even a large dose of P binders is able to bind approximately 200–300 mg of P on a daily basis, so it is evident that their efficacy is limited in the case of an uncontrolled dietary P load. Hence, limitation of dietary P intake is needed to reach the goal of neutral phosphate balance in dialysis, coupled to an adequate protein intake. To this aim, patients should be informed and educated to avoid foods that are naturally rich in phosphate and also processed food with P-containing preservatives. In addition, patients should preferentially choose food with a low P-to-protein ratio. For example, patients could choose egg white or protein from a vegetable source

  15. Developing A Strategy to Enact Lean

    Nicola Morrey


    Full Text Available This paper explains the strategy employed by a case study company to implement lean across the business, and to reflect on the success of this approach so other companies may consider this learning and how it might be useful to them. The strategy to enact lean in the case study company was based on creating a number of standard tools/ways of working. These tools can be considered to be standardised work for key aspects of the construction process that the company undertakes. The aim of the tools was to ensure that critical tasks would be carried out to the correct standard (quality, time, cost, health and safety every time, across the business. Achievement of this is expected to lead to improved performance and elimination of variation (waste. To implement this strategy of using standardised work to eliminate variation and lead to improved performance, a step-by-step process was developed to create the tools/standardised work. The paper describes the process that was undertaken and how it aimed to not only produce a number of tools/standardised work, but also to involve people and managers from across the business such that lean philosophy and thinking might also begin to become embedded. The paper will firstly explain, with reference to the relevant literature, how and why the strategy to implement standardised work was chosen, the process that was defined to develop the standardised work, and what happened when that process was put into practice. The findings of the paper show that whilst the completed tools delivered business benefits, the development of the tools did not follow the planned process. The paper discusses how people within the business responded to this strategy and how the process had to be continuously adapted to cope with the current business environment and path dependencies, further evidencing that lean implementations need to be tailored to suit the needs of the individual firm, rather than there being a one size fits all

  16. 腹膜透析超滤衰竭的诊治策略%Strategy of diagnosis and treatment for ultrafiltration failure of peritoneal dialysis

    倪兆慧; 金海姣


    Ultrafiltration failure is a common complication and an important cause of peritoneal dialysis failure.Ultrafiltration failure is defined as that the net ultrafiltration volume is less than 400 ml after a 4-hour dwell with 4.25% dextrose dialysis solution.According to its pathophysiological mechanisms,the ultrafiltration failure has been divided into 4 types:type 1 ultrafiltration failure is caused by increase of effective peritoneal surface area;type 2 ultrafiltration failure is caused by decrease of osmotic conductance to glucose;type 3 ultrafiltration failure is caused by decrease of effective peritoneal surface area;and type 4 ultrafiltration failure is caused by absorbance of a lot of water through the peritoneal lymphatic system or local tissue gap.Beneficial methods to prevent and treat ultrafiltration failure include rational use of high glucose dialysate,effective prevention and treatment of peritoneal dialysis-related peritonitis,protection of residual renal function,appropriate use of biocompatible dialysates,and application of drugs to improve peritoneal damage and fibrosis.%超滤衰竭是腹膜透析常见的并发症,是导致腹膜透析失败的重要原因之一。超滤衰竭定义为4.25%葡萄糖透析液留腹4 h 后超滤量<400 ml。超滤衰竭根据病理生理机制分为4种类型:Ⅰ型超滤衰竭由于有效腹膜表面积增加导致,Ⅱ型超滤衰竭由于葡萄糖渗透转导作用下降导致,Ⅲ型超滤衰竭由于腹膜有效表面积减少导致,Ⅳ型超滤衰竭由于通过腹腔淋巴系统或局部组织间隙吸收大量水分导致。避免过度使用高浓度葡萄糖透析液、有效防治腹膜透析相关腹膜炎、保护残肾功能、选用生物相容性好的透析液、使用改善腹膜损伤和纤维化药物等是防治超滤衰竭的有益方法。

  17. Dialysis centers -- what to expect

    ... F (38.0°C) The arm where your catheter is placed swells and the hand on that side feels cold Your hand gets ... kidneys - dialysis centers; Dialysis - what to expect; Renal replacement therapy - ...


    Yuri N. Lapygin


    Full Text Available Currently, the process of strategic analysis andstrategy development process from a methodological point of view, there are separate from each other.At least, it is not clear why perform an analysis ofwhat happened in the past, if we are going to designsomething that does not exist yet? There are methods for the formation of the image of the future andbuild a strategically important targets. Of which thenbuilds up the development strategy of the organization. The paper shows the relationship betweenthese processes. The article discusses aspects of creative thinking and a set of factors that determinethe strategic decisions, as well as the relationshipof the process of analysis and synthesis. The research methodology is based on systems theory andmethods of strategic management. The research results can be used in the strategic development ofsocio-economic systems of various types and forms.

  19. The role of OR in strategy development

    T.J. Ormerod


    Full Text Available Reflecting on the experiences of applying OR approaches in a variety of contexts, the paper draws attention to some of the ways that OR can be brought to bear on strategic issues. Perhaps most frequently the strategic contribution derives from projects aimed at operational issues which have strategic implications. The paper argues that OR practitioners cannot expect to be given a role in strategy questions as of right, nor is there an "OR solution" to strategic questions. However, many OR scientists do have the skills, approaches and methods that can be usefully deployed, if they develop the confidence to do so.

  20. Another strategy to assess sustainable development

    Chen Yunfeng; Lu Genfa


    The goal of sustainable development is to preserve sustainability and simultaneously prevent catastrophe in a man-land system. However, almost all the existing approaches to assessing sustainable development are to measure the sustainability, namely appraise from the obverse side of the sustainable development. So it seems necessary to attack the same task on the reverse, namely to measure the possibility of catastrophe. In this paper, with a case study of Tianjin,China, we employ catastrophe theory and models to integrate Tianjin's sustainable development indicators, and then deduce the catastrophe risk index (CRI) to present the level of catastrophic possibility in the city. Applying catastrophe theory is a new strategy to assess sustainable development and shows great practical significance, especially for those developing regions or countries, who always give more priority to their economy and therefore have more obligation to make sure whether their social economic activities might bring forth any ecological environment catastrophe. Besides,being both qualitative and quantitative, the approach could be employed to explore not only static characteristics but also dynamic mechanism of man-land system. Although our work is only a maiden attempt and still calls for further effort to improve it, the case study of Tianjin in this paper would assure us the great promising future to apply catastrophe theory to sustainable development modeling.

  1. Kidney Dialysis Patients Discover New Hope through ABE Program.

    Amonette, Linda; And Others

    A program was developed to provide adult basic education (ABE) to kidney patients while they are receiving dialysis treatment. The program, which relies on an individualized learning approach, involved the coordinated efforts of the following parties: West Virginia Dialysis Facilities, Inc.; the Charleston Renal Group; and the Kanawha County Adult…

  2. Dialysate as food as an option for automated peritoneal dialysis

    H.L. Tjiong (Hoey Lan); R. Swart (Roel); J.W.O. van den Berg (Willem); M.W.J.A. Fieren (Marien)


    textabstractProtein-energy malnutrition is frequently found in dialysis patients. Many factors play a role in its development including deficient nutrient intake as a result of anorexia. Peritoneal dialysis (PD) solutions containing a mixture of amino acids and glucose in an appropriate ratio could

  3. A peritoneal dialysis patient with osmotic demyelination syndrome

    Hing Ming Cheng


    Full Text Available A peritoneal dialysis patient with cirrhosis presented with drowsiness, vomiting, and mild hyponatremia. Despite no active correction of hyponatremia, she developed convulsion and quadriplegia. Magnetic resonance imaging of the brain showed changes of osmotic demyelination syndrome. This case illustrates that osmotic demyelination syndrome may occur in peritoneal dialysis without rapid correction of hyponatremia.

  4. Phosphate control in dialysis.

    Cupisti, Adamasco; Gallieni, Maurizio; Rizzo, Maria Antonietta; Caria, Stefania; Meola, Mario; Bolasco, Piergiorgio


    Prevention and correction of hyperphosphatemia is a major goal of chronic kidney disease-mineral and bone disorder (CKD-MBD) management, achievable through avoidance of a positive phosphate balance. To this aim, optimal dialysis removal, careful use of phosphate binders, and dietary phosphate control are needed to optimize the control of phosphate balance in well-nourished patients on a standard three-times-a-week hemodialysis schedule. Using a mixed diffusive-convective hemodialysis tecniques, and increasing the number and/or the duration of dialysis tecniques are all measures able to enhance phosphorus (P) mass removal through dialysis. However, dialytic removal does not equal the high P intake linked to the high dietary protein requirement of dialysis patients; hence, the use of intestinal P binders is mandatory to reduce P net intestinal absorption. Unfortunately, even a large dose of P binders is able to bind approximately 200-300 mg of P on a daily basis, so it is evident that their efficacy is limited in the case of an uncontrolled dietary P load. Hence, limitation of dietary P intake is needed to reach the goal of neutral phosphate balance in dialysis, coupled to an adequate protein intake. To this aim, patients should be informed and educated to avoid foods that are naturally rich in phosphate and also processed food with P-containing preservatives. In addition, patients should preferentially choose food with a low P-to-protein ratio. For example, patients could choose egg white or protein from a vegetable source. Finally, boiling should be the preferred cooking procedure, because it induces food demineralization, including phosphate loss. The integrated approach outlined in this article should be actively adapted as a therapeutic alliance by clinicians, dieticians, and patients for an effective control of phosphate balance in dialysis patients.

  5. Electricity from biomass: A development strategy


    The purpose of this document is to review the current status of biomass power technology and to evaluate the future directions for development that could significantly enhance the contribution of biomass power to U.S. production of electricity. This document reviews the basic principles of biomass electric systems, the previous contributions of industry and the National Biomass Energy Programs to technology development, and the options for future technology development. It discusses the market for biomass electric technology and future needs for electric power production to help establish a market-oriented development strategy. It projects trends in the performance and cost of the technology and examines the changing dynamics of the power generation market place to evaluate specific opportunities for biomass power development. In a separate document, the Biomass Power Program Five Year R&D Plan, the details of schedules, funding, and roles of participating R&D organizations within the R&D program funded by the U.S. Department of Energy (DOE) are presented. In evaluating the future directions for research and development, two cases are examined.

  6. Strategies for greater impact in developing countries.

    Bailey, C


    Effective AIDS education programs are needed to prevent AIDS. They must integrate HIV/AIDS messages into basic health care services and adapted them to cultural norms and values. They should eliminate the mystery surrounding human sexuality. Effective AIDS education programs must examine control of communicable diseases and the relationship between gender issues and effective health care treatment. The infrastructure and resources to direct vertical HIV/AIDS programs generally do not exist in developing countries. All too often senior professionals accept positions in these vertical programs, which limits their ability to lobby for integrated HIV/AIDS programs. Donor organizations should make sure that all projects which they support have an AIDS component and work with other organizations to ensure that prevention and control of sexually transmitted diseases (STD)/HIV/AIDS is completely integrated into health care delivery services. All health workers should undergo AIDS prevention and control training. Supervisors should make sure that subordinates practice AIDS control. Benefit packages should not be offered to attract health workers. Just because nationals may make up an information, education, and communication (IEC) program does not mean that they will adapt the program to cultural values. Donors must provide appropriate educational strategies and programs to developing countries. Social change evolves from the culture. Health care workers must help find culturally appropriate education strategies. IEC has not reached its objectives in prevention and control of STDs. Communication mechanisms that allow human sexuality to be a subject of every day discussion without causing embarrassment, uneasiness, and outrage are needed.

  7. Bioorthogonal chemistry: strategies and recent development

    Ramil, Carlo P.; Lin, Qing


    The use of covalent chemistry to track biomolecules in their native environment—a focus of bioorthogonal chemistry—has received considerable interests recently among chemical biologists and organic chemists alike. To facilitate wider adoption of bioorthogonal chemistry in biomedical research, a central effort in the last few years has been focused on the optimization of a few known bioorthogonal reactions, particularly with respective to reaction kinetics improvement, novel genetic encoding systems, and fluorogenic reactions for bioimaging. During these optimizations, three strategies have emerged, including the use of ring strain for substrate activation in the cycloaddition reactions, the discovery of new ligands and privileged substrates for accelerated metal-catalysed reactions, and the design of substrates with pre-fluorophore structures for rapid “turn-on” fluorescence after selective bioorthogonal reactions. In addition, new bioorthogonal reactions based on either modified or completely unprecedented reactant pairs have been reported. Finally, increasing attention has been directed toward the development of mutually exclusive bioorthogonal reactions and their applications in multiple labeling of a biomolecule in cell culture. In this feature article, we wish to present the recent progress in bioorthogonal reactions through the selected examples that highlight the above-mentioned strategies. Considering increasing sophistication in bioorthogonal chemistry development, we strive to project several exciting opportunities where bioorthogonal chemistry can make a unique contribution to biology in near future. PMID:24145483

  8. Course strategies for clinical nurse leader development.

    Gerard, Sally; Grossman, Sheila; Godfrey, Marjorie


    The scope of the clinical nurse leader (CNL) is evolving in practice across the country. The preparation of this pivotal role in a complex healthcare environment has prompted the collaboration of nurse academics, nurse administrators, and clinicians to design unique educational experiences to maximize best practice. Knowledge attained regarding healthcare improvement and patient safety must not only be theoretical, but personal and application focused. Utilizing the American Association of Colleges of Nursing's CNL white paper and published resources faculty developed a clinical leadership course focused on active learning and reflection. Students explore concepts of improvement and quality related to business models of high functioning organizations including healthcare. Three key components of the course are described in detail; "quality is personal", executive interviews and the "5P" clinical microsystems assessment. Evaluation outcomes are discussed. Course content and innovative teaching/learning strategies for CNL are shared which may support the growth of CNL program development nationally.

  9. Dialysis for undocumented immigrants in the United States.

    Rodriguez, Rudolph A


    The United States offers near-universal coverage for treatment of ESRD. Undocumented immigrants with ESRD are the only subset of patients not covered under a national strategy. There are 2 divergent dialysis treatment strategies offered to undocumented immigrants in the United States, emergent dialysis and chronic outpatient dialysis. Emergent dialysis, offering dialysis only when urgent indications exist, is the treatment strategy in certain states. Differing interpretations of Emergency Medicaid statute by the courts and state and federal government have resulted in the geographic disparity in treatment strategies for undocumented immigrants with ESRD. The Patient Protection and Affordable Care Act of 2010 ignored the health care of undocumented immigrants and will not provide relief to undocumented patients with catastrophic illness like ESRD, cancer, or traumatic brain injuries. The difficult patient and provider decisions are explored in this review. The Renal Physicians Association Position Statement on uncompensated renal-related care for noncitizens is an excellent starting point for a framework to address this ethical dilemma. The practice of "emergent dialysis" will hopefully be found unacceptable in the future because of the fact that it is not cost effective, ethical, or humane. Published by Elsevier Inc.


    A. I. Khorev


    Full Text Available Summary. In the beginning of the article is defined a rational sequence of the consideration of the nature of the strategy of a company development, included into an integrated structure. Further the article describes the following items separately: "a strategy", "a development of a company", and "an integrational structure", applying them to companies included to the integrated structure; separating them from a strategy of development of an autonomous company. The article defines functions which such strategy must define, taking into consideration the nature of the strategy of the company development, included into an integrated structure. Next, the article defines six steps which describe a sequence of development of the strategy of the company development, included into an integrated structure. The analysis which is defined in the article allows determining a complete definition of essence of the strategy of the company development, included into an integrated structure. The article also defines a place of the strategy of development into the hierarchical structure of the strategies. The strategy of the company development, included into an integrated structure (as well as the strategy of development of an autonomous company -- is a competition strategy, and it separates "strategy of leadership for costs", “differentiation strategy”, and “strategy of focusing for costs”. Also authors are analyzed the strategy of the cost optimization. According to the complex definition of the strategy, and the strategy's place inside the hierarchical structure, the article defines functions which corporate, competitive, and functional strategies execute during the management of companies inside an integrational structure. The article presents characteristics of applied strategic decisions at different levels of all three types of strategies. The article's researches allow companies included to the integrated structure define their place inside the

  11. Association of dialysis with the risks of cancers.

    Ming Yen Lin

    Full Text Available To increase the survival span after dialysis in patients with end-stage renal disease (ESRD, identifying specific cancer risks is crucial in the cancer screening of these patients. The aim of this study was to investigate the risks of various cancers in an incident dialysis group in comparison with a non-dialysis group.We conducted a nationwide cohort study by using data from the Taiwan National Health Insurance Research Database. Patients who initially received long-term dialysis between January 1997 and December 2004, were selected and defined as the dialysis group and were matched with the non-dialysis patients (control group according to age, sex, and index year. Competing risk analysis was used to estimate cumulative incidence and subdistribution hazard ratios (SHRs of the first cancer occurrence.After consideration for the competing risk of mortality, the dialysis group showed a significantly higher 7-year cancer incidence rate than did the control group (6.4%; 95% confidence interval [CI], 6.0%-6.7% vs 1.7%; 95% CI, 1.4%-2.1%; P <0.001.The modified Cox proportional hazard model revealed that the dialysis group had significantly association with increased risks for all cancers (SHR, 3.43; 95% CI, 3.02-3.88. The risk of cancers was dominated in younger and female patients. Specific cancer risks were significantly higher in the dialysis group particularly in the development of oral, colorectal, liver, blood, breast, renal, upper urinary tract, and bladder cancer than in the control group. Multivariable stratified analyses confirmed the association between long-term dialysis and cancer in all subgroups of patients.Dialysis is associated with a higher risk of cancer in patients with ESRD. However, cancer screening in ESRD population should be a selective approach, based on individual patient health condition and life expectancy.

  12. Private Sector Development Strategy: Fostering Development through the Private Sector

    Inter-American Development Bank


    This strategy document, which was expanded and edited based on comments received through the two periods of the public consultation process, lays out a diagnosis of the key challenges facing development through the private sector and proposes five general areas for IDB intervention. Given the integrated nature of the Bank's work with the private sector, an exclusive relationship does not exist between the PSDS and a single Bank department. Rather, close collaboration among both public sector/...

  13. Strategies for Developing China's Software Industry

    Mingzhi Li


    Full Text Available The software industry is deemed an ideal target for a developing country to integrate into the world information and communications technology (ICT market. On the one hand the industry is labor intensive, and the developing countries have a large labor surplus; on the other hand, it is a worldwide trend for developed countries to outsource a vast amount of low-end, software-related tasks to the low-cost countries and regions, which fits into some developing countries’ caliber nicely. India has often been cited as the role model for a developing country to tap into the world software market for its continuous success in the software export sector. In comparison, China’s software industry is still negligible in the world despite its sustained high economic growth rate since the economic reform took off in the late 1970s.This paper aims at examining strategies for developing China’s software industry. We use India as a reference because of the similarities of the two countries’ stages of economic development and the clear divergence in their ICT structures and development paths. Although the language barrier has often been singled out as the major obstacle for China’s software exports, we believe the major reasons for its underdevelopment can be ascribed to the following factors. On the national level, the government attention has been skewed toward the hardware sector in the ICT industry, and there is no clear national vision for the strategic direction for the software industry.On the industry and ªrm level, software development has been regarded as the art of individual creativity rather than an engineering process. As a result, the importance of quality and standards, the two important critical factors in software development, have been largely neglected. Perhaps an even more fundamental factor lies in the deeply rooted notion that software is an attachment to the hardware and should be a free product. The lack of intellectual

  14. Strategies for Local Low-Carbon Development

    Zhou, Nan [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Price, Lynn [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Fridley, David [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Ohshita, Stephanie [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Khanna, Nina [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Min, Hu [Energy Foundation China, Beijing (China); Xiulian, Hu [Energy Research Inst., Beijing (China)


    Cities around the world are implementing policies and programs with the goal to reduce greenhouse gas emissions, as well as save energy, reduce costs, and protect the local, regional, and global environment. In China, low-carbon development is a key element of the 12th Five Year Plan. Pilot low-carbon development zones have been initiated in five provinces and eight cities and many other locations around China also want to pursue a low-carbon development pathway. This booklet provides information for government officials, policy makers, program designers and implementers, provincial and city planners, and others who want an overview of the key options available for low-carbon development at local level. These Strategies for Local Low-Carbon Development draw from successful experiences from around the world. Information is provided for low-carbon actions that can be taken in the sectors of (1) Industry, (2) Buildings and Appliances, (3) Electric Power, (4) Consumption and Waste Management, (5) Transportation and Urban Form, and (6) Agriculture and Forestry. A description of each policy is provided along with information on the stakeholders involved in implementation, the conditions for successful implementation, the expected energy and carbon savings, and the policy cost-effectiveness. Case studies show how each policy has been implemented somewhere around the world. While there are many low-carbon options available for local implementation, this booklet aims to provide guidance on those that have been most successful, that have the largest impact, and that are cost-effective in order to support low-carbon development efforts in Chinese cities.

  15. [Incremental peritoneal dialysis - yes].

    Neri, Loris


    The incremental modality at the start of peritoneal dialysis (Incr-DP) is implicit in the definition of adequacy, which is expressed as the sum of dialysis clearance and renal clearance.Theoretically, it is possible to demonstrate that with a glomerular filtration rate at the start of dialysis of 6 mL/min, the minimum Kt/V target of 1.70 indicated by the current guidelines is easily exceeded with both 2-exchange of CAPD (incremental CAPD) and APD of 3 or 4 weekly sessions (Incr-APD), with a daytime icodextrin dwell. The GSDP (Peritoneal Dialysis Study Group) census data suggest that Incr-DP favors the choice of peritoneal dialysis. Although limited to a few studies with a relatively small number of patients, data show that Incr- CAPD is associated with a better quality of life, the achievement of Kt/V targets, and satisfactory ultrafiltration. The clearance of medium molecules is equivalent in Incr-DP and full-dose PD as it depends on the duration of the dwell and not on the number of exchanges. The maintenance of body weight, protein intake and peritoneal permeability may be explained by the lower glucose load with Incr-DP. The preservation of residual renal function is similar to that recorded with full-dose PD, while the peritonitis rate seems to be lower. The favorable results reported in the literature and the indications of the most recent guidelines about the importance of reducing the exposure to glucose to a minimum and safeguarding the patient's quality of life in our opinion further justify the use of Incr-DP.

  16. Development Strategies in Papua Economic Democracy

    Muhamad Ismail


    Full Text Available Based economic development aims to increase community participation in various development activities, especially in the economic field. Populist both economic development by exploiting the potential of Micro Small Medium Enterprises has not made a significant impact to the welfare of society. The purpose of the study to see how far the populist economic development in Papua, and formulate a strategy based economic development in the province of Papua. Using SWOT the analysis, using primary and secondary data. The results showed populist economic development in Papua province could not be implemented to the fullest because it is affected by several drawbacks and other technical constraints such as shortage of working capital, equipment is still modest, the quality and quantity of the product is low, the difficulty of access to markets and weak entrepreneurial spirit, especially for community / indigenous people of Papua economic actors. Based economic development can be done by utilizing the role of micro and medium-sized businesses and cooperatives / KUD because people could easily be involved in both the economic container. Based economic development can be done by: Increasing the quality and quantity of local products to compete with regional and international markets, giving stimulant fund for venture capital for the economic actors of the people by utilizing funds OTSUS, and the state budget, Improved HR agriculture through private sector support (partners’ business and capital of banking institutions. To overcome the weaknesses in the development of community economy, it can be done through: Boosting qualities SDM economic actors people through non-formal education / training, education and ongoing training for facilitators, provision of venture capital and agricultural equipment by utilizing appropriate technology (TTG, increasing the role of Micro, Small and Medium Enterprises and co-operatives to all districts / cities, utilization of

  17. Wearable impedance monitoring system for dialysis patients.

    Bonnet, S; Bourgerette, A; Gharbi, S; Rubeck, C; Arkouche, W; Massot, B; McAdams, E; Montalibet, A; Jallon, P


    This paper describes the development and the validation of a prototype wearable miniaturized impedance monitoring system for remote monitoring in home-based dialysis patients. This device is intended to assess the hydration status of dialysis patients using calf impedance measurements. The system is based on the low-power AD8302 component. The impedance calibration procedure is described together with the Cole parameter estimation and the hydric volume estimation. Results are given on a test cell to validate the design and on preliminary calf measurements showing Cole parameter variations during hemodialysis.

  18. Response to the National Career Development Strategy Green Paper

    Australian Journal of Career Development, 2012


    The National Career Development Strategy Green Paper paper proposes a strategy that is committed to these principles: (1) quality through Career Industry Council of Australia (CICA) benchmarking, quality frameworks and processes and as a risk management strategy; (2) lifetime access to career development services; (3) development of career…

  19. Strategies to Enhance Rehabilitation After Acute Kidney Injury in the Developing World

    Samuel A. Silver


    Full Text Available Acute kidney injury (AKI is independently associated with new-onset chronic kidney disease (CKD, end-stage kidney disease, cardiovascular disease, and all-cause mortality. However, only a minority of patients receive follow-up care after an episode of AKI in the developing world, and the optimal strategies to promote rehabilitation after AKI are ill-defined. On this background, a working group of the 18th Acute Dialysis Quality Initiative applied the consensus-building process informed by a PubMed review of English-language articles to address questions related to rehabilitation after AKI. The consensus statements propose that all patients should be offered follow-up within 3 months of an AKI episode, with more intense follow-up (e.g., <1 month considered based on patient risk factors, characteristics of the AKI event, and the degree of kidney recovery. Patients should be monitored for renal and nonrenal events post-AKI, and we suggest that the minimum level of monitoring consist of an assessment of kidney function and proteinuria within 3 months of the AKI episode. Care should be individualized for higher risk patients, particularly patients who are still dialysis dependent, to promote renal recovery. Although evidence-based treatments for survivors of AKI are lacking and some outcomes may not be modifiable, we recommend simple interventions such as lifestyle changes, medication reconciliation, blood pressure control, and education, including the documentation of AKI in the patient’s medical record. In conclusion, survivors of AKI represent a high-risk population, and these consensus statements should provide clinicians with guidance on the care of patients after an episode of AKI.

  20. Ormen Lange subsea development strategy and execution

    Hogmoen, K. [Norsk Hydro, Oslo (Norway)


    Ormen Lange is the largest natural gas field in development on the Norwegian continental shelf. This paper discussed Norsk Hydro's Ormen Lange development strategy and execution. Several illustrations of the Ormen Lange project were presented, including the field layout and the main challenges of working in deep water. Other challenges involve environmental conditions; long distance control; and hydrate prevention. Several components of the project were presented, including the xmas tree handling system; choke module; control system; large bore tie-in system; in-line tee system; and free spans in pipeline design. Other topics that were presented and illustrated included the feasibility of pipeline design; design optimization with installation contractors; design optimization between intervention methods; positioning; dredging with spiders; excavation with jetprops; ploughing; rock installation; and trenching. The installation of thirty inch pipelines and umbilical lines in shallow and deep water were also discussed and illustrated. The presentation concluded with a discussion of lessons learned subsea. These included early definition of operational requirements; close monitoring of interface work between contractors; professional change management; and thorough testing onshore prior to installation. Securing vessel capacity and timely start-up were among the lessons learned for marine operations. figs.

  1. Population and Strategy Development in Buffaloes

    Lisa Praharani


    Full Text Available Buffalo is a potential large ruminant that its contribution in national program on beef self sufficiency has been unrecognized in Indonesia. In rural community, buffalo has similar functions as cattle, it is used as draught animal, meat (beef producer, saving, milk producer, sacrificial ritual animal to social status. The peak of buffalo population was on 1925, 3.227 million heads in Java and 1.10 million in outside Java. The centers of cattle production sites for national program of self sufficiency on beef were formly as noted the centers of buffalo production. The introduction of Bali cattle to those former buffalo centers particularly in outside of Java depressed buffalo population and then dominated by Bali cattle. Then Bali cattle were noted to be the major beef animal supplier beside buffalo to the centers of consumers for domestic and export. This article aims to discuss the depleting buffalo population and to formulate development strategy. Historical approaches system and critical evaluation population, SWOT (strength, weaknesses, opportunity and threat analysis were used as tools for analyzing. Two case studies on herd survival from Banten indicated depleting population of buffalo. Despite low reproductive profile, strategic diseases and farmers’ institution needed to be optimized on services. Understanding criticizing on ecological habitats in the potential regions, the need of spatial planning for its development, zoning program for strategic diseases free, reproductive problems and village institution are the important areas of improvement for buffalo development in supporting beef self sufficiency and the welfare of rural people with their buffalo in sustainable beef production.

  2. Developing a positive organisational culture using a management development strategy.

    Williams, Harry


    This paper evaluates a management development program, which was piloted at Albury Base Hospital during 2001 for nurse managers. The program uses quantitative assessments of participants using a lifestyle inventory tool and enables managers to identify opportunities and strategies to assist them to become more effective managers. The program also helps identify management "blind spots" and increased awareness of the effect of management's behaviour on team efficiency. The program was evaluated as being relevant to managers from any health discipline and was a means by which workplace culture and behaviour could be improved.

  3. Dialysis Free Protocol for Some End Stage Renal Disease Patients (Khosroshahi Protocol)

    Hamid Tayebi Khosroshahi; Kamyar Kalantar-zadeh


    Background: The number of patients with End Stage Renal Disease (ESRD) is growing annually around the world. Provision of renal replacement therapy in the form of dialysis and transplant is relatively expensive. Recent studies have shown no survival benefit of early initiation of dialysis. Given recent outcome data of the timing of dialysis treatment and the expenses and logistics of hemodialysis procedure have stimulated research on alternative strategies. The aim of this study is to int...

  4. [Assisted peritoneal dialysis].

    Klarić, Dragan; Prkačin, Ingrid


    According to the National Registry of Renal Replacement Therapy (RRT), the incidence of chronic kidney disease (end-stage renal disease) and the need of RRT have declined in the last decade renal. One of the reasons for this tendency certainly is transplantation as the best choice. However, transplant procedure has limitations in elderly patients due to the number of comorbidities. This study was designed as retrospective analysis of outcomes in patients treated with peritoneal dialysis for a period of eleven years. Patients were divided into those who had been assisted or unassisted. Out of 100 patients treated with peritoneal dialysis (PD), 77 completed the treatment, including 26 assisted and 51 unassisted patients. Peritonitis was recorded in 20 assisted and 26 unassisted patients. Peritonitis was more common in unassisted patients, who were more frequently lost from PD. Assisted PD could be a good and safe choice of RRT in this special group of patients.

  5. [Should dialysis be for all? Yes indeed!].

    Panzetta, G; Grignetti, M; Toigo, G


    our clinical knowledge, it is difficult to conceive of a true motive to not dialyze a patient--whether very elderly or any other patient in critical conditions--except in situations of futility or the impossibility to attain a reasonable quality of life. Thus, the true nature of the debate regarding the indications or the limits of dialysis in developed countries is not economic, technical nor clinical, but ethical. The challenge for the Nephrologist is to balance the need to alleviate human suffering and the institutional support that society can offer, which is the "bottom line" which unifies dialysis for the very elderly with every other therapy which prolongs life in tenuous conditions.

  6. Developing Children's Language Learner Strategies at Primary School

    Kirsch, Claudine


    This article discusses the strategy repertoires and strategy development of six English children who learned foreign languages at primary school. My study differs from mainstream research, in that it focuses on young children and on the development of their strategies, draws on sociocultural theory and uses ethnographic methods. My findings show…

  7. Developing Children's Language Learner Strategies at Primary School

    Kirsch, Claudine


    This article discusses the strategy repertoires and strategy development of six English children who learned foreign languages at primary school. My study differs from mainstream research, in that it focuses on young children and on the development of their strategies, draws on sociocultural theory and uses ethnographic methods. My findings show…

  8. [Maintaining residual renal function in patients on dialysis].

    Ryckelynck, Jean-Philippe; Goffin, Éric; Verger, Christian


    There are evidences supporting a positive impact of renal residual function (RRF) on survival and quality of life of dialysis patients. Many strategies are available in clinical practices to maintain RRF. Hemodiafiltration seems to be better that conventional hemodialysis and similar to peritoneal dialysis. Arterial hypotension in hemodialysis or dehydration in peritoneal dialysis are deleterious in terms of preservation of RRF. Loop diuretics increase urine volume and natriuresis, not RRF. Radiocontrast and aminoglycosides may be used safely. The benefits of ACE inhibitors and angiotensin II receptor blockers are debated but have positive effect on blood pressure control and cardiac function. Neither biocompatible solutions nor the modality of peritoneal dialysis have demonstrated benefits on RRF. Copyright © 2013 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  9. Trace elements in dialysis.

    Filler, Guido; Felder, Sarah


    In end-stage chronic kidney disease (CKD), pediatric nephrologists must consider the homeostasis of the multiple water-soluble ions that are influenced by renal replacement therapy (RRT). While certain ions such as potassium and calcium are closely monitored, little is known about the handling of trace elements in pediatric dialysis. RRT may lead to accumulation of toxic trace elements, either due to insufficient elimination or due to contamination, or to excessive removal of essential trace elements. However, trace elements are not routinely monitored in dialysis patients and no mechanism for these deficits or toxicities has been established. This review summarizes the handling of trace elements, with particular attention to pediatric data. The best data describe lead and indicate that there is a higher prevalence of elevated lead (Pb, atomic number 82) levels in children on RRT when compared to adults. Lead is particularly toxic in neurodevelopment and lead levels should therefore be monitored. Monitoring of zinc (Zn, atomic number 30) and selenium (Se, atomic number 34) may be indicated in the monitoring of all pediatric dialysis patients to reduce morbidity from deficiency. Prospective studies evaluating the impact of abnormal trace elements and the possible therapeutic value of intervention are required.

  10. Renal Dialysis and its Financing.

    Borelli, Marisa; Paul, David P; Skiba, Michaeline


    The incidence of end-stage renal disease (ESRD) and its associated comorbidities such as diabetes and hypertension continue to increase as the population ages. As most ESRD patients qualify for Medicare coverage, the U.S. government initiated reforms of the payment system for dialysis facilities in an effort to decrease expenditures associated with ESRD reimbursement. The effects of reduced reimbursement rates, bundled payment options, and quality incentives on the current dialysis system, including kidney dialysis units, physicians, and patients, are examined.

  11. Peritoneal Dialysis Dose and Adequacy

    ... salt, and other minerals dissolved in water, called dialysis solution, is placed in a person's abdominal cavity through a catheter. The body's peritoneal membrane enclosing the digestive organs ...

  12. Treatment Methods for Kidney Failure: Peritoneal Dialysis

    ... During an exchange, you can read, talk, watch television, or sleep. Usually, you change the dialysis solution at least ... During an exchange, you can read, talk, watch television, or sleep. Dialysis Solution Dialysis solution comes in 1.5-, ...

  13. Beyond the Horizon: Developing Future Airpower Strategy


    realize the unintended consequences, second and third order effects, and the adaptive nature of enemy creativ - ity. The prewar airpower thinkers...airpower strategy. While SAC was prohibited from conducting its unlimited nuclear bombard- ment strategy, it was content with defending the bipolar ...bombing operations in a global context of bipolar strategic competition with the Soviet Union. Given the initial context of what the United States

  14. Ecotourism Development Strategy Of Wera Nature Recreation Park (NRP

    Poppy Oktadiyani


    Full Text Available The Wera Nature Recreation Park (NRP sustainable nature tourism development requires multi-stakeholder synergy and robust potential resources management, it is necessary to development strategy for an effective conservation area management. The purpose of this study: 1 Knowing the aspects tourism supply of Wera NRP, 2 Knowing the aspects tourism demand of Wera NRP, 3 Analyzing the nature tourism development strategy of NRP Wera, and 4 Knowing the types of nature tourism that can be developed in the NRP Wera. The data analysis method was involves tourism supply-demand analysis and development strategy. Development strategy was located on cell-1 (1,09; 1,33 in Grand Strategy Matrix, meaning that it supports aggressive strategy, i.e. intensive promotion on certain segments especially students and people of age 7 - 35. Based on those results, the development of tourisms are nature panorama, nature phenomenon, wildlife observation, hiking, education and conservation, outbond, religious, and rural tourisms.

  15. Investigating product development strategy in beverage industry using factor analysis

    Naser Azad


    Full Text Available Selecting a product development strategy that is associated with the company's current service or product innovation, based on customers’ needs and changing environment, plays an important role in increasing demand, increasing market share, increasing sales and profits. Therefore, it is important to extract effective variables associated with product development to improve performance measurement of firms. This paper investigates important factors influencing product development strategies using factor analysis. The proposed model of this paper investigates 36 factors and, using factor analysis, we extract six most influential factors including information sharing, intelligence information, exposure strategy, differentiation, research and development strategy and market survey. The first strategy, partnership, includes five sub-factor including product development partnership, partnership with foreign firms, customers’ perception from competitors’ products, Customer involvement in product development, inter-agency coordination, customer-oriented approach to innovation and transmission of product development change where inter-agency coordination has been considered the most important factor. Internal strengths are the most influential factors impacting the second strategy, intelligence information. The third factor, introducing strategy, introducing strategy, includes four sub criteria and consumer buying behavior is the most influencing factor. Differentiation is the next important factor with five components where knowledge and expertise in product innovation is the most important one. Research and development strategy with four sub-criteria where reducing product development cycle plays the most influential factor and finally, market survey strategy is the last important factor with three factors and finding new market plays the most important role.

  16. The development of dialysis from Dialysis Outcomes and Practice Patterns Study%从透析预后与实践研究(DOPPS)的结果看透析未来发展

    孟建中; 刘雷; 李丹丹


    1 DOPPS背景 自1997年美国国家肾脏基金会(National Kidney Foundation,NKF)公布了有关终末期肾衰竭(End stage renal disease,ESRD)透析治疗和慢性肾脏疾病(Chronic kidney disease,CKD)的K/DOQI指南(Dialysis Outcomes Quality Initiative,DOQI)以来,至今已先后公布了“2000年慢性肾衰竭营养治疗临床实践指南”、“2001年慢性肾衰竭贫血的治疗、腹膜透析充分性、血液透析充分性和血管通路临床实践指南更新”、“2003年CKD临床实践指南”、“2003年CKD中血脂异常的处理临床实践指南”、“2003年CKD中骨代谢异常和疾病的处理临床实践指南”和“2004年CKD中高血压和降压药物的临床实践指南”,

  17. Vascular Endothelial Cell Injury Is an Important Factor in the Development of Encapsulating Peritoneal Sclerosis in Long-Term Peritoneal Dialysis Patients.

    Mitsuhiro Tawada

    Full Text Available Encapsulating peritoneal sclerosis (EPS is a rare but serious and life-threatening complication of peritoneal dialysis (PD. However, the precise pathogenesis remains unclear; in addition, predictors and early diagnostic biomarkers for EPS have not yet to be established.Eighty-three peritoneal membrane samples taken at catheter removal were examined to identify pathological characteristics of chronic peritoneal deterioration, which promotes EPS in patients undergoing long-term PD treatment with low occurrence of peritonitis.According to univariable logistic regression analysis of the pathological findings, thickness of the peritoneal membrane (P = 0.045, new membrane formation score (P = 0.006, ratio of luminal diameter to vessel diameter (L/V ratio, P<0.001, presence of CD31-negative vessels (P = 0.021, fibrin deposition (P<0.001, and collagen volume fraction (P = 0.018 were associated with EPS development. In analyses of samples with and without EPS matched for PD treatment period, non-diabetes, and PD solution, univariable analysis identified L/V ratio (per 0.1 increase: odds ratio (OR 0.44, P = 0.003 and fibrin deposition (OR 6.35, P = 0.027 as the factors associated with EPS. L/V ratio was lower in patients with fibrin exudation than in patients without fibrin exudation.These findings suggest that damage to vascular endothelial cells, as represented by low L/V ratio, could be a predictive finding for the development of EPS, particularly in long-term PD patients unaffected by peritonitis.

  18. The possible impact of dialysis modality on cognitive function in chronic dialysis patients.

    Radić, J; Ljutić, D; Radić, M; Kovaĉić, V; Sain, M; Curković, K Dodig


    Chronic kidney disease (CKD) is a growing public health problem. Individuals in all stages of CKD are at higher risk for development of cognitive impairment and this may be a major determinant in their quality of life (QOL). The prevalence of cognitive deficits is particularly high in subjects with end-stage renal disease (ESRD). While it is sufficiently well documented that ESRD is linked with a change in cognitive function, little is known about the influence of different dialysis modalities on cognitive function. The effect of dialysis modality on risk of cognitive impairment is unclear. Some data suggest that patients with ESRD treated with chronic ambulatory peritoneal dialysis (CAPD) had consistently better cognitive function than patients treated with haemodialysis (HD). We concluded that the previously observed apparent difference between two modalities of dialysis treatments resulted either from very low dialysis delivery or comparison with poorly matched controls. Regarding these data from previous studies we hypothesised that well-dialysed, well-nourished and medically stable HD patients had no cognitive dysfunction in comparison with well-dialysed, well-nourished, medically stable and demographically matched CAPD patients. Also, future studies are needed to differentiate between modality as a risk factor from the factors contributing to selection bias among patients choosing CAPD over HD.

  19. Amyloidosis associated with dialysis. Dialyseassoziierte Amyloidosteopathie - radiologische Aspekte

    Schadmand, S.; Klose, K.J. (Mainz Univ. (Germany, F.R.). Inst. fuer Klinische Strahlenkunde); Wandel, E. (Mainz Univ. (Germany, F.R.). 1. Medizinische Klinik und Poliklinik)


    Amongst the complications of dialysis, amyloid osteopathy is getting increasingly significant. It is due to deposition of {beta}2-microglobulin. To determine the incidence and time of development of this complication, the skeletal radiographs of 185 patients undergoing dialysis, some for up to ten years, were analysed retrospectively. In about 10% of patients, the presence of {beta}2-microglobulin osteopathy may be expected. The radiological features, sites of predilection and differential diagnosis of amyloid osteopathy and of other skeletal changes due to dialysis are discussed. (orig.).

  20. Nature-Inspired Design: Strategies for Sustainable Product Development

    De Pauw, I.C.


    Product designers can apply different strategies, methods, and tools for sustainable product development. Nature-Inspired Design Strategies (NIDS) offer designers a distinct class of strategies that use ‘nature’ as a guiding source of knowledge and inspiration for addressing sustainability. Biomimic

  1. Nature-Inspired Design: Strategies for Sustainable Product Development

    De Pauw, I.C.


    Product designers can apply different strategies, methods, and tools for sustainable product development. Nature-Inspired Design Strategies (NIDS) offer designers a distinct class of strategies that use ‘nature’ as a guiding source of knowledge and inspiration for addressing

  2. Nature-Inspired Design: Strategies for Sustainable Product Development

    De Pauw, I.C.


    Product designers can apply different strategies, methods, and tools for sustainable product development. Nature-Inspired Design Strategies (NIDS) offer designers a distinct class of strategies that use ‘nature’ as a guiding source of knowledge and inspiration for addressing sustainability. Biomimic

  3. The effect of outpatient dialysis global budget cap on healthcare utilization by end-stage renal disease patients.

    Chang, Ray-E; Hsieh, Chi-Jeng; Myrtle, Robert C


    Controlling the cost of chronic diseases remains one of the vexing problems of developed and developing nations alike. Taiwan, faced with rapidly escalating healthcare costs associated with End Stage Renal Disease (ESRD) services utilization, imposed an outpatient dialysis global budget (ODBG) on outpatient dialysis care. This study, using a before and after study design with a comparison group, assessed the impact of this policy innovation on outpatient, inpatient and emergency room utilization. Using a difference in difference (DID) strategy and the generalized estimating equation (GEE) approach, this study found providers responded to these changes through cost reduction and revenue enhancement strategies. This study extends our understanding of provider responses to changes in reimbursement policies that target one segment of the continuum of care required by chronic disease patients.

  4. Bimodal Solutions or Twice-Daily Icodextrin to Enhance Ultrafiltration in Peritoneal Dialysis Patients

    Dousdampanis, Periklis; Trigka, Konstantina; Bargman, Joanne M.


    The efficacy and safety of icodextrin has been well established. In this paper, we will discuss the pharmacokinetics and biocompatibility of icodextrin and its clinical effect on fluid management in peritoneal dialysis patients. Novel strategies for its prescription for peritoneal dialysis patients with inadequate ultrafiltration are reviewed. PMID:23365749

  5. Bimodal Solutions or Twice-Daily Icodextrin to Enhance Ultrafiltration in Peritoneal Dialysis Patients

    Periklis Dousdampanis


    Full Text Available The efficacy and safety of icodextrin has been well established. In this paper, we will discuss the pharmacokinetics and biocompatibility of icodextrin and its clinical effect on fluid management in peritoneal dialysis patients. Novel strategies for its prescription for peritoneal dialysis patients with inadequate ultrafiltration are reviewed.

  6. Industrial symbiosis as sustainable development strategy

    Verguts, Veerle; Dessein, Joost; Dewulf, Art; Lauwers, Ludwig; Werkman, Renate; Termeer, C.J.A.M.


    Industrial symbiosis (IS) is the coordination of energy and material flows among geographically proximate firms to increase economic performance while reducing environmental impact. Although IS is gaining popularity as a sustainability strategy, implementation is proving difficult. In an attempt

  7. Industrial symbiosis as sustainable development strategy

    Verguts, Veerle; Dessein, Joost; Dewulf, Art; Lauwers, Ludwig; Werkman, Renate; Termeer, C.J.A.M.


    Industrial symbiosis (IS) is the coordination of energy and material flows among geographically proximate firms to increase economic performance while reducing environmental impact. Although IS is gaining popularity as a sustainability strategy, implementation is proving difficult. In an attempt

  8. Developing Marketing Strategies for University Teaching Hospitals.

    Fink, Daniel J.


    University teaching hospitals face increasing competition from community hospitals, expanding regulation of health care, consumerism, and a declining urban population base. New marketing strategies are seen as ways in which teaching hospitals can achieve better relationships with institutions, practitioners, and surrounding communities and…

  9. Metabolic alterations in dialysis patients

    Drechsler, Christiane


    Assessing metabolic risk in dialysis patients, three main aspects are important: a) the pathophysiologic effects of metabolic disturbances as known from the general population are unlikely to completely reverse once patients reach dialysis. b) Specific additional problems related to chronic kidney d

  10. Metabolic alterations in dialysis patients

    Drechsler, Christiane


    Assessing metabolic risk in dialysis patients, three main aspects are important: a) the pathophysiologic effects of metabolic disturbances as known from the general population are unlikely to completely reverse once patients reach dialysis. b) Specific additional problems related to chronic kidney

  11. Determinants of survival in patients receiving dialysis in Libya.

    Alashek, Wiam A; McIntyre, Christopher W; Taal, Maarten W


    Maintenance dialysis is associated with reduced survival when compared with the general population. In Libya, information about outcomes on dialysis is scarce. This study, therefore, aimed to provide the first comprehensive analysis of survival in Libyan dialysis patients. This prospective multicenter study included all patients in Libya who had been receiving dialysis for >90 days in June 2009. Sociodemographic and clinical data were collected upon enrollment and survival status after 1 year was determined. Two thousand two hundred seventy-three patients in 38 dialysis centers were followed up for 1 year. The majority were receiving hemodialysis (98.8%). Sixty-seven patients were censored due to renal transplantation, and 46 patients were lost to follow-up. Thus, 2159 patients were followed up for 1 year. Four hundred fifty-eight deaths occurred, (crude annual mortality rate of 21.2%). Of these, 31% were due to ischemic heart disease, 16% cerebrovascular accidents, and 16% due to infection. Annual mortality rate was 0% to 70% in different dialysis centers. Best survival was in age group 25 to 34 years. Binary logistic regression analysis identified age at onset of dialysis, physical dependency, diabetes, and predialysis urea as independent determinants of increased mortality. Patients receiving dialysis in Libya have a crude 1-year mortality rate similar to most developed countries, but the mean age of the dialysis population is much lower, and this outcome is thus relatively poor. As in most countries, cardiovascular disease and infection were the most common causes of death. Variation in mortality rates between different centers suggests that survival could be improved by promoting standardization of best practice.

  12. Prescription and practice of dialysis in Australia, 1988.

    Disney, A P


    Facilities for provision of treatment of end-stage renal failure with hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) are available in many centers, most of which are government-funded. Medicare provides free treatment for all patients. There are no specific criteria for determining a patient's acceptance for dialysis treatment: age, quality of life, and capacity for independent living are important factors. The usual HD prescription is three dialysis periods weekly, hollow-fiber dialyzer, 1.0-1.2 m2 surface area, for 4 to 5 hours, with blood flow rate 250 mL/min and acetate-based dialysate flow rate 500 mL/min. Reuse of the dialyzer is common, but many units practice single use to reduce the expense and time necessary for processing the dialyzer and the risks of formalin exposure. There is only limited use of hemofiltration, or highly efficient dialyzers for shortened hours at higher blood flow rates. The choice of dialysis prescription is influenced by the physician's preference for the patient to be treated at home or in a self-care center with limited assistance. CAPD is preferred for home dialysis, especially for elderly or diabetic patients. There is no personal financial incentive to the physician to favor any particular form of dialysis. The costs of dialysis do influence the provision and prescription of treatment, causing the reuse of dialyzers and the limited use of bicarbonate-based HD and highly permeable dialyzers. Nevertheless, adequate dialysis should be available to all patients, and noncompliance with prescribed dialysis is infrequent. Quality-assurance programs have been developed both for nursing and medical care.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Sewage sludge disposal strategies for sustainable development.

    Kacprzak, Małgorzata; Neczaj, Ewa; Fijałkowski, Krzysztof; Grobelak, Anna; Grosser, Anna; Worwag, Małgorzata; Rorat, Agnieszka; Brattebo, Helge; Almås, Åsgeir; Singh, Bal Ram


    The main objective of the present review is to compare the existing sewage sludge management solutions in terms of their environmental sustainability. The most commonly used strategies, that include treatment and disposal has been favored within the present state-of-art, considering existing legislation (at European and national level), characterization, ecotoxicology, waste management and actual routs used currently in particular European countries. Selected decision making tools, namely End-of-waste criteria and Life Cycle Assessment has been proposed in order to appropriately assess the possible environmental, economic and technical evaluation of different systems. Therefore, some basic criteria for the best suitable option selection has been described, in the circular economy "from waste to resources" sense. The importance of sewage sludge as a valuable source of matter and energy has been appreciated, as well as a potential risk related to the application of those strategies.

  14. H1N1 in dialysis units: Prevention and management

    Karkar Ayman


    Full Text Available Dialysis patients are at increased risk of contracting influenza A H1N1 and deve-loping serious illness. Increasing the awareness of dialysis patients and continuous education and training of medical staff on early recognition and management of influenza A H1N1 can help in saving the life of patients. Antiviral drugs and influenza vaccines are effective in providing ade-quate immunity in dialysis patients with strict implementation of infection control policies and procedures can help in preventing and controlling the dissemination of influenza A H1N1 in dia-lysis units. We report a case of a patient who presented with HINI influenza and developed acute kidney injury during his hospitalization and his course with disease.

  15. Non-ketotic hyperosmolar diabetic pre-coma due to pancreatitis in a boy on continuous ambulatory peritoneal dialysis.

    Emder, P J; Howard, N J; Rosenberg, A R


    An unusual case of diabetes secondary to acute pancreatitis in a boy with end-stage renal failure receiving continuous ambulatory peritoneal dialysis (CAPD) is described. A hyperglycaemic, hyperosmolar pre-coma developed, aggravated by associated hypercalcaemia. The glucose content of the dialysis fluid contributed to the hyperglycaemia, which settled as the pancreatitis resolved and lower glucose concentration dialysis fluid was used. Our experience suggests that pancreatic dysfunction should be considered where significant hyperglycaemia occurs during peritoneal dialysis.

  16. Self-Regulated Strategy Development Revisited: Teaching Writing Strategies to Struggling Writers.

    Graham, Steve; Harris, Karen R.; Troia, Gary A.


    This article examines the development of the Self-Regulated Strategy Development Model for teaching writing strategies and self-regulation procedures to students with writing difficulties. It describes how the model operates, and examines its effectiveness. It also highlights how the model has been used to respond to variations in settings and…

  17. A CO2-strategy for BTC [Belgian Development Agency

    Bailly, J. [Prospect C and S, Brussels (Belgium); Hanekamp, E. [Partners for Innovation, Amsterdam (Netherlands)


    The CO2 footprint is determined the CO2 strategy is developed for the Belgian Technical Cooperation (BTC). BTC is the Belgian agency for development cooperation, and finances development projects in 23 partner countries. The CO2 footprint covered BTC's activities in 2007 in all their offices worldwide. Footprint and strategy were finalised and adopted by the Executive Board at the end of 2008. Meanwhile, the BTC began with the introduction of the proposed strategy. Partners for Innovation and Prospect were asked to support the introduction of the strategy and to determine the CO2 footprint of 2008.

  18. Faculty development strategies at the Danish engineering

    Kolmos, Anette; Vinther, Ole


    The article describes the structure of engineering educations in Denmark, the staff development centres and the formal requirements to staff development.......The article describes the structure of engineering educations in Denmark, the staff development centres and the formal requirements to staff development....

  19. Dialysis vintage, body composition, and survival in peritoneal dialysis patients.

    Avram, Morrell M; Mittman, Neal; Fein, Paul A; Agahiu, Samuel; Hartman, William; Chattopadhyay, Neil; Matza, Betty


    The relationship between dialysis vintage (length of time on dialysis), body composition, and survival has been reported in hemodialysis patients. In the present study, we examined the association ofdialysis vintage with body composition and survival in peritoneal dialysis (PD) patients. At enrollment, body composition in 65 PD patients was determined by bioelectrical impedance analysis. Patients (mean age at enrollment: 54 years) were followed for up to 11 years maximum. At enrollment, the mean, median, and maximum dialysis vintages were 51, 34, and 261 months respectively. After adjusting for age, race, sex, and diabetes status, dialysis vintage was indirectly correlated (partial correlation coefficients) with body weight (r = -0.40, p = 0.001), body mass index (r = -0.40, p = 0.002), body surface area (r = -0.39, p = 0.002), body cell mass (r = -0.39, p = 0.002), total body fat weight (r = -0.30, p = 0.02), and fat percentage of body weight (r = -0.31, p = 0.018), and directly correlated with extracellular mass to body cell mass ratio (r = 0.27, p = 0.039). The observed cumulative survival was significantly higher (p = 0.007) in patients with a dialysis vintage at enrollment of 35 months or less, than in patients with dialysis vintage at enrollment of more than 35 months. In the multivariate Cox regression analysis, adjusting for age, race, sex, and diabetes, dialysis vintage at enrollment remained an independent predictor of mortality (relative risk: 1.010; p = 0.002). Increase in relative risk of death with increasing dialysis vintage may be partly explained by the association of vintage with unfavorable changes in body composition and the nutrition status of patients over time.

  20. Testosterone deficiency in dialysis patients: Difference between dialysis techniques.

    Cigarrán, Secundino; Coronel, Francisco; Florit, Enrique; Calviño, Jesús; Villa, Juan; Gonzalez Tabares, Lourdes; Herrero, José Antonio; Carrero, Juan Jesús

    Testosterone deficiency is a prevalent condition in male patients with chronic kidney disease. However, it is not known whether the type of renal replacement therapy has an impact on testosterone deficiency that accompanies loss of renal function. The cross-sectional study enrolled 79 prevalent male patients on dialysis; 43 on haemodialysis (HD) and 36 on peritoneal dialysis (PD). The median age was 69 years and 31.6% were diabetics. Endogenous testosterone levels were measured by immunoluminescence assay (normal range 3-10.5ng/ml), while nutritional/inflammatory markers, bone and mineral metabolism markers, anaemia, type of dialysis technique and time on dialysis were also assessed. Body composition was evaluated by bioimpedance vector analysis and bioimpedance spectroscopy. Testosterone deficiency was defined as levels below 3ng/ml. Mean testosterone levels were 8.81±6.61ng/ml. Testosterone deficiency affected 39.5% of HD patients and only 5.6% of PD patients. In the univariate analysis, testosterone levels were directly correlated with type of dialysis technique (HD) (Rho Spearman 0.366; P<.001) and time on dialysis (Rho -0.412; P=.036) and only with the HD technique in the multivariate analysis. No other significant correlations were found. Circulating testosterone levels in men on dialysis were independently associated with HD technique. It can be concluded that a new factor -namely the dialysis technique- may be associated with falling testosterone levels and the associated loss of muscle mass and inflammation. Further studies are needed to establish whether the dialysis technique itself triggers testosterone elimination. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  1. Developing green supply chain management strategies: A taxonomic approach

    Michael Mutingi


    Full Text Available Purpose: The objective of this research is to explore the empirical green supply chain activities found in literature, and to develop a taxonomic framework that can be used for formulating appropriate strategies for green supply chains, based on characteristic dimensions for the green supply chain. Design/methodology/approach: The taxonomic framework is developed through (i analysis of green supply chain activities found in existing empirical work or case studies recorded in literature, (ii identification of key dimensions that influence green supply chain management strategies, and (iii development of a taxonomic scheme for selecting or developing green strategies. Findings: The paper finds that this study yielded: a set of three characteristic dimensions that influence strategic green supply chain management, and a guided structured approach selecting appropriate green strategies, providing managerial insights. Research limitations/implications: This paper shows that future work includes development of specific performance management indices according to the taxonomy of green strategies developed in this study. Practical implications: This research provided a practical guided approach that enhances appropriate formulation of green strategies for green supply chain management, while providing sound managerial insights for the supply chain decision maker. The choice of supply chain strategy directly impacts the overall environmental, economic and operations performance of the supply chain. Originality/value: This study presents to supply chain decision makers a new taxonomic framework that simplifies and enhances the formulation of green strategies, and to researchers a comparative understanding of various strategies applicable to green supply chains.

  2. Formal and Integrated Strategies for Competence Development in SMEs

    Kock, Henrik; Ellstrom, Per-Erik


    Purpose: The purpose of this paper is to increase understanding of the relationships among the workplace as a learning environment, strategies for competence development used by SMEs and learning outcomes. Specifically, there is a focus on a distinction between formal and integrated strategies for competence development, the conditions under which…

  3. A Tool for the Development of Robot Control Strategies

    Luiz Carlos Figueiredo


    Full Text Available In this paper we report as the development of a tool in to develop and set control strategies as a fast and easy way. Additionally, a tricycle robot with two traction motors was built to test the strategies produced with the tool. Experimental tests have shown an advantage in the use of such tool.

  4. Understanding MBA Consumer Needs and the Development of Marketing Strategy

    Dailey, Lynn; Anderson, Murphy; Ingenito, Cristina; Duffy, David; Krimm, Paul; Thomson, Scott


    The need to develop marketing strategies in higher education is evident. In order to develop effective strategies, marketers must understand the basic needs that their product fulfills. Exploratory research was utilized to identify and better understand the needs that motivate consumers to pursue an MBA degree. This paper emphasizes the importance…

  5. Understanding MBA Consumer Needs and the Development of Marketing Strategy

    Dailey, Lynn; Anderson, Murphy; Ingenito, Cristina; Duffy, David; Krimm, Paul; Thomson, Scott


    The need to develop marketing strategies in higher education is evident. In order to develop effective strategies, marketers must understand the basic needs that their product fulfills. Exploratory research was utilized to identify and better understand the needs that motivate consumers to pursue an MBA degree. This paper emphasizes the importance…

  6. Creative tourism as a strategy for regional development and cultural ...

    Creative tourism as a strategy for regional development and cultural heritage ... local communities could contribute to making a shift in regional development, ... as the enabler of the processes of cultural enrichment and acculturation through a ...

  7. Nuclear Cryogenic Propulsion Stage Affordable Development Strategy

    Doughty, Glen E.; Gerrish, H. P.; Kenny, R. J.


    The development of nuclear power for space use in nuclear thermal propulsion (NTP) systems will involve significant expenditures of funds and require major technology development efforts. The development effort must be economically viable yet sufficient to validate the systems designed. Efforts are underway within the National Aeronautics and Space Administration's (NASA) Nuclear Cryogenic Propulsion Stage Project (NCPS) to study what a viable program would entail. The study will produce an integrated schedule, cost estimate and technology development plan. This will include the evaluation of various options for test facilities, types of testing and use of the engine, components, and technology developed. A "Human Rating" approach will also be developed and factored into the schedule, budget and technology development approach.

  8. [Oxidative stress in patients on regular hemodialysis and peritoneal dialysis].

    Vostálová, J; Galandáková, A; Strebl, P; Zadražil, J


    Hemodialysis and peritoneal dialysis are methods of blood purification, which partially replaced excretory renal function in patients with chronic renal failure, which was depleted regime, dietary and pharmaco-therapeutic remedy, and who are not eligible for kidney transplantation. Both two methods are accompanied by increased oxidative stress. In peritoneal dialysis particularly the composition of dialysis solution contributes to oxidative stress. In extracorporeal hemodialysis the oxidative stress is associated with the character of hemodialysis membranes, non-specific loss of low molecular weight antioxidants, activation of leukocytes (oxidative burst), feroteraphy, supplementation with low molecular weight antioxidants and other factors. To improve and maintain the quality of life of dialysis patients, the continuous monitoring of oxidative stress-related parameters as non-traditional risk factors for cardiovascular complications development is suitable.

  9. Developing Business School Strategies: A Practitioner-Oriented Conceptualization

    Daniel Seelhofer


    Full Text Available This conceptual paper examines the rationale for strategic planning in business schools and outlines an applied strategy development and controlling process that has been in use at a major Swiss business school for several years, contributing to a significant strengthening of the school's strategic position. It explains the strategy hierarchy and the strategy planning cycle, describes how to conduct a consistent strategic situation analysis, and details how to develop and manage a coherent strategy at all levels (normative, strategic, tactical, and operational, including type, nature, and structure of the corresponding documents.

  10. MNC Strategies and Linkage Effects in Developing Countries

    Hansen, Michael Wendelboe; Pedersen, Torben; Petersen, Bent


    . It is hypothesized that compared to investments undertaken by MNCs following strategies of global integration, investments of MNCs pursuing local responsiveness create more jobs but imply less job upgrading in developing countries. The hypotheses are tested on a sample of Danish MNCs with extensive investments......The paper addresses the question of which implications MNC strategies have to FDI linkage effects in developing countries. Two contrasting MNC strategies reflecting an integration-responsiveness dichotomy are scrutinized as to their job effects on local linkage partners in developing countries...... in developing countries....

  11. [Focusing on peritoneal dialysis adequacy].

    Issad, Belkacem; Durand, Pierre-Yves; Siohan, Pascale; Goffin, Eric; Cridlig, Joëlle; Jean, Guillaume; Ryckelynck, Jean-Philippe; Arkouche, W; Bourdenx, J-P; Cridlig, J; Dallaporta, B; Fessy, H; Fischbach, M; Giaime, P; Goffin, E; Issad, B; Jean, G; Joly, D; Mercadal, L; Poux, J-M; Ryckelynck, J-P; Siohan, P; Souid, M; Toledano, D; Verger, C; Vigeral, P; Uzan, M


    The optimal method to assess the adequacy of peritoneal dialysis therapies is controversial. Today, the adequacy must not be considered as a number or a concept assessed only by two parameters (total KT/V urea and total solute clearance) but defined by many more items. In the absence of data, based on theoretical considerations, the reanalysis of the CANUSA study showed that renal kidney function, rather than peritoneal clearance, was associated with improved survival. Residual renal function is considered as a major predictor factor of cardiovascular mortality. Results of this reanalysis were supported by the adequacy data in ADEMEX, EAPOS and ANZDATA studies. Therefore, clinical assessment plays a major role in PD adequacy. The management of fluid balance, the regular monitoring of malnutrition, the control of mineral metabolism and particularly the glucose load, considered as the "corner-stone" of the system, are the main points to be considered in the adequacy of PD patients. The essential goal is to minimize glucose load by glucose-sparing strategies in order to reduce the neoangiogenesis of the peritoneal membrane. Copyright © 2013. Published by Elsevier SAS.

  12. [Exploration of ultrafiltration failure in peritoneal dialysis].

    Bellavia, Salvatore; Coche, Emmanuel; Goffin, Eric


    Ultrafiltration failure (UFF) is a common complication of peritoneal dialysis (PD). It may be due to a technical problem (PD catheter obstruction or migration, peritoneal leaks or intraperitoneal adhesions) or because of a peritoneal membrane alteration (hyperpermeability, aquaporin dysfunction, peritoneal sclerosis or enhanced lymphatic reabsorption). We, here, present the case of a patient who developed several consecutive PD complications that eventually led to UFF. We also present an algorithm, which may help clinicians to establish a precise etiological diagnosis of UFF.

  13. Strategies of Integrated Rural Development Adopted by ...

    unique firstlady

    development designed to improve life at the local community level as much .... problems of co- ordination, lack of trained or professional workers, flexibility .... be attained, but it is being stressed in development literature that for rural ... the habit of belonging and self-reliance (Lele, 1975). Lately .... Esusu groups/banks. Fig.

  14. Peritoneal dialysis in Asia.

    Cheng, I K


    The socioeconomic status of Asian countries is diverse, and government reimbursement policies for treatment of patients suffering from end-stage renal disease (ESRD) vary greatly from one country to another. Both of these factors have a major impact not only on the choice of treatment for ESRD but also on the utilization of peritoneal dialysis (PD) in this region. Based on the data collected from 11 representative Asian countries, several observations can be made. First, the treatment rates for ESRD in these countries correlated closely with their gross domestic product (GDP) per capita income. Second, the PD utilization rate appeared to have a biphasic relationship with the GDP per capita income and treatment rate, in that countries with the highest and the lowest treatment rates tended to have lower PD utilization rates, whereas countries with modest treatment rates tended to have higher PD utilization rates. The reason for low PD utilization in countries with the highest treatment rates differs from that in countries with low treatment rates. In the former, because of full government reimbursement, there is little physician incentive to introduce PD as an alternative form of ESRD treatment to in-center hemodialysis (HD), whereas in the latter, the complete lack of government reimbursement prevents the introduction of PD as a form of treatment. This pattern is likely to change in the future because, of the 11 countries surveyed, all except Thailand have recorded a growth rate which is higher for PD than HD over the last three years. The rate of utilization of different PD systems varies greatly among different Asian countries. Automated PD has yet to gain popularity in Asia. Conventional straight-line systems remain the dominant PD systems in use in Hong Kong, Korea, Thailand, and the Philippines, while in Malaysia and Singapore UV germicidal connection devices are most popular. However, in all these countries there has been a progressive shift over the last

  15. Transportation energy strategy: Project {number_sign}5 of the Hawaii Energy Strategy Development Program



    This study was prepared for the State Department of Business, Economic Development and Tourism (DBEDT) as part of the Hawaii Energy Strategy program. Authority and responsibility for energy planning activities, such as the Hawaii Energy Strategy, rests with the State Energy Resources Coordinator, who is the Director of DBEDT. Hawaii Energy Strategy Study No. 5, Transportation Energy Strategy Development, was prepared to: collect and synthesize information on the present and future use of energy in Hawaii`s transportation sector, examine the potential of energy conservation to affect future energy demand; analyze the possibility of satisfying a portion of the state`s future transportation energy demand through alternative fuels; and recommend a program targeting energy use in the state`s transportation sector to help achieve state goals. The analyses and conclusions of this report should be assessed in relation to the other Hawaii Energy Strategy Studies in developing a comprehensive state energy program. 56 figs., 87 tabs.

  16. Alloy development for irradiation performance: program strategy

    Bloom, E. E.; Stiegler, J. O.; Wiffen, F. W.; Dalder, E. N.C.; Reuther, T. C.; Gold, R. E.; Holmes, J. J.; Kummer, D. L.; Nolfi, F. V.


    The objective of the Alloy Development for Irradiation Performance Program is the development of structural materials for use in the first wall and blanket region of fusion reactors. The goal of the program is a material that will survive an exposure of 40 MWyr/m/sup 2/ at a temperature which will allow use of a liquid-H/sub 2/O heat transport system. Although the ultimate aim of the program is development of materials for commercial reactors by the end of this century, activities are organized to provide materials data for the relatively low performance interim machines that will precede commercial reactors.

  17. Rice industrial economy and its development strategy

    Qing Xianguo


    On the basis of the analysis of the present situation of food grain and rice production in China,countering the beginning tendency to neglect rice production because of rice grain structural surplus and low market price after China's agriculture entering the new development stage,this paper putsforward the concept of rice industrial economy,explains its attribute,connotation,key factors,etc,forms the basic idea of developing the rice industrial economy,and suggests some strategic measures such as regionalized layout of rice production, develop the rice industrial economy.

  18. Developing a Strategy Menu for Community-Level Obesity Prevention.

    Spahr, Christopher; Wells, Alexandra; Christens, Brian D; Pollard, Ethen; LaGro, James; Morales, Alfonso; Dennis, Samuel; Hilgendorf, Amy; Meinen, Amy; Korth, Amy; Gaddis, Jennifer; Schoeller, Dale; Tomayko, Emily J; Carrel, Aaron; Adams, Alexandra


    Childhood obesity is a complex problem influenced by policies, systems, and environments across multiple settings. The prevention of childhood obesity requires changes across a range of community settings. To describe the development of an obesity prevention strategy menu that incorporates effective policy, systems, and environmental changes for reducing and preventing childhood obesity, and which offers the flexibility to consider local community needs and capacity. We describe the development of a strategy menu and some of the challenges of this process. We then elaborate on how communities will interact with the strategy menu and the development of a website to facilitate this interaction. No single discipline has all of the expertise needed to identify strategies for childhood obesity prevention. Therefore, a multidisciplinary team of researchers and practitioners reviewed evidence and organized a menu that assists communities in choosing complementary strategies tailored for efficacy in specific community settings. The strategies will eventually be part of a web-based point of access that complements the foundational relationships built between communities, researchers, and practitioners. The strategy menu is comprised of a set of effective approaches that communities can use to develop tailored, context-specific health interventions. By developing a framework to engage communities in the selection and implementation of multi-setting obesity prevention strategies, we aim to create and sustain momentum toward a long-term reduction in obesity in Wisconsin children.

  19. Alzheimer's disease drug development: translational neuroscience strategies.

    Cummings, Jeffrey L; Banks, Sarah J; Gary, Ronald K; Kinney, Jefferson W; Lombardo, Joseph M; Walsh, Ryan R; Zhong, Kate


    Alzheimer's disease (AD) is an urgent public health challenge that is rapidly approaching epidemic proportions. New therapies that defer or prevent the onset, delay the decline, or improve the symptoms are urgently needed. All phase 3 drug development programs for disease-modifying agents have failed thus far. New approaches to drug development are needed. Translational neuroscience focuses on the linkages between basic neuroscience and the development of new diagnostic and therapeutic products that will improve the lives of patients or prevent the occurrence of brain disorders. Translational neuroscience includes new preclinical models that may better predict human efficacy and safety, improved clinical trial designs and outcomes that will accelerate drug development, and the use of biomarkers to more rapidly provide information regarding the effects of drugs on the underlying disease biology. Early translational research is complemented by later stage translational approaches regarding how best to use evidence to impact clinical practice and to assess the influence of new treatments on the public health. Funding of translational research is evolving with an increased emphasis on academic and NIH involvement in drug development. Translational neuroscience provides a framework for advancing development of new therapies for AD patients.

  20. Investigating product development strategy in beverage industry using factor analysis

    Naser Azad; Seyed Mohsen Seyed Aliakbar; Seyed Foad Zarifi; Somayeh Hozouri


    Selecting a product development strategy that is associated with the company's current service or product innovation, based on customers’ needs and changing environment, plays an important role in increasing demand, increasing market share, increasing sales and profits. Therefore, it is important to extract effective variables associated with product development to improve performance measurement of firms. This paper investigates important factors influencing product development strategies us...

  1. How to make the development strategies for digital city

    刘琳; 黄英


    Digital City has emerged gradually with the development of a global economy and global information. How to make development strategies for Digital City is becoming an important topic that deserves deeper re search in both theory and practice. This paper mainly analyzes the connation of Digital City and the principles of developing strategies for Digital City. The conclusions of this paper can supply fundamental ideas and instruc tions for Digital City construction.

  2. Ecotourism Development Strategy Of Wera Nature Recreation Park (NRP)

    Poppy Oktadiyani; Helwinsyah Helwinsyah; Iwanuddin Iwanuddin


    The Wera Nature Recreation Park (NRP) sustainable nature tourism development requires multi-stakeholder synergy and robust potential resources management, it is necessary to development strategy for an effective conservation area management. The purpose of this study: 1) Knowing the aspects tourism supply of Wera NRP, 2) Knowing the aspects tourism demand of Wera NRP, 3) Analyzing the nature tourism development strategy of NRP Wera, and 4) Knowing the types of nature tourism that can be devel...

  3. Biofeedback-driven dialysis: where are we?

    Santoro, Antonio; Ferramosca, Emiliana; Mancini, Elena


    interactions between the actuators and the controlled variable. In these cases, more sophisticated control systems are needed, which must be capable of identifying the behavior of the process, and continuously update information data while the control is on. These complex systems are called adaptive controllers. In dialysis, over the last few years, it has been relatively easy to realize some biofeedback systems since a series of sensors have been developed for online monitoring. Three biofeedback devices are routinely used with the aim of improving the cardiovascular instability, one of the main problems limiting the tolerance to treatment by the patient and the quality of HD in itself - the first is the biofeedback control of blood volume, the second is the biofeedback control of thermal balance, and the third is the biofeedback control of blood pressure.

  4. China's Energy Security Strategy for Sustainable Development


    In recent years, soaring energy consumption is posing a huge potential threat to China's energy security. China has rich coal resources, but most of the coal is mainly burned directly with low efficiency. Thus oil and gas plays a comparatively important role in national economic development. However domestic oil and gas cannot meet the need of economic development. To solve this problem, China would continue to import oil and gas from petroleum producing countries, especially from the Middle East. The dependence on oil import increases year after year and the sources of supply are concentrated in a few countries, which results in the insecurity of energy supply. Therefore, China should optimize its energy structure, improve energy efficiency, increase the geographic diversity of oil supply, build oil reserve bases, and develop new energies actively.

  5. National Strategies for Public Library Development

    Kann-Christensen, Nanna


    by The Danish Agency for Libraries and Media, and The Swedish Arts Council, who both administer development grants to public libraries. The paper identifies both differences and similarities in both the means to (the political agendas) and the objectives of governmental influence in the libraries.......The economic rationale of New Public Management (NPM) is used in both Sweden and Denmark in order to employ the national cultural policies in local development projects. The paper discusses two different organizational models that are used in order for the national level to be able to exercise...... policies on the local level are discussed. according to the national goals and cultural policies for libraries. This is done in order to point towards a possible relationship between the political means and ends regarding library development. The two models to be discussed are the systems practiced...

  6. National Strategies for Public Library Development

    Kann-Christensen, Nanna


    policies on the local level are discussed. according to the national goals and cultural policies for libraries. This is done in order to point towards a possible relationship between the political means and ends regarding library development. The two models to be discussed are the systems practiced...... by The Danish Agency for Libraries and Media, and The Swedish Arts Council, who both administer development grants to public libraries. The paper identifies both differences and similarities in both the means to (the political agendas) and the objectives of governmental influence in the libraries....

  7. Management Strategies and Economic Development in Ghana

    Kuada, John


    Ghana has experienced a tumultuous political and economic history since its independence in 1957. But today it is among the handful of African nations that showcase the dreams and aspirations of Sub-Sahara Africa. In 2011 it achieved an impressive economic growth rate of 14.6 per cent and ranked...... development models just like other SSA countries. It has also followed many other African countries in embracing private enterprise development as a model for growth. This volume of the dissertation draws on three decades of research I have conducted into enterprise formation and management in the country...

  8. Characterization of alternative FBR development strategies

    Boegel, A.J.; Clausen, M.J.


    Near-term decisions regarding the nature and place of the FBR development program must be made. This study is part of a larger program designed to provide the Department of Energy (DOE) with imformation that can be used to make strategic programmatic decisions. The focus of this report is the description of alternative approaches for developing the FBR and the quantification of the duration and cost of each alternative. The time frames of the alternative approaches are investigated in companion reports (White 1981 and Fraley 1981). The results of these analyses will be described in a summary report (Burnham et al. 1981).

  9. Self-Regulated Strategy Development for Students with Learning Disabilities

    Lienemann, Torri Ortiz; Reid, Robert


    Self-Regulated Strategy Development (SRSD) is a well-established, thoroughly validated instructional model. In this article, we discuss the rationale and steps for implementing it. We also provide practical information for use in teaching and evaluating strategy instruction. This article is intended to guide teacher educators as they help future…

  10. Self-Regulated Strategy Development for Students with Writing Difficulties

    Mason, Linda H.; Harris, Karen R.; Graham, Steve


    Students with writing difficulties often struggle with the planning, composing, and revising skills required for effective writing. Fortunately, researchers have documented that explicit, interactive, scaffolded development of powerful composing strategies and strategies for self-regulating the writing process, as in Self-Regulated Strategy…


    Nataliya BYKOVA


    Full Text Available The role of strategy of public-private partnerships development through information is examined. The informational nature measures, the implementation of which help to promote Ukrainian innovative products on foreign markets, are identified. The urgency of implementing the strategy of public-private partnerships to intensify foreign trade with innovative products in crisis period is substantiated.

  12. Corruption in Education Sector Development: A Suggestion for Anticipatory Strategy.

    Tanaka, Shinichiro


    Proposes an anticipatory strategy that will help protect education sector development from corruption. The strategy, which may exist as a "hidden agenda" within a project, focuses on diagnosing rather than redressing a system thought to be corrupt, adopting prevention rather than punishment, informal rather than formal approaches, and…

  13. Purchasing strategy development: A multi-level review

    Hesping, Frank Henrik; Schiele, Holger


    Is it reasonable to speak of ‘the’ purchasing strategy, or do different hierarchical levels of analysis need to be distinguished? A fragmented research field and a diverse set of understandings (including misunderstandings) of the scope of strategy development at various levels of analysis make a th

  14. Purchasing strategy development: A multi-level review

    Hesping, Frank; Schiele, Holger


    Is it reasonable to speak of ‘the’ purchasing strategy, or do different hierarchical levels of analysis need to be distinguished? A fragmented research field and a diverse set of understandings (including misunderstandings) of the scope of strategy development at various levels of analysis make a

  15. Developing a Scale for Quality of Using Learning Strategies

    Tasci, Guntay; Yurdugul, Halil


    This study aims to develop a measurement tool to measure the quality of using learning strategies. First, the quality of using learning strategies was described based on the literature. The 32 items in the 5-point Likert scale were then administered to 320 prospective teachers, and they were analysed with exploratory factor analysis using…

  16. Critical Review of Language Learning Strategies in EFL Development



    This article is a critical review of the development of language learning strategies (LLS) in EFL. It reviews the theoretical framework of language learning strategies and empirical research. Based on the review,it critically discusses the implications and limitations of the framework and research behind the construction of the theory.

  17. Critical Review of Language Learning Strategies in EFL Development



    This article is a critical review of the development of language learning strategies(LLS) in EFL. It reviews the theoretical framework of language learning strategies and empirical research. Based on the review,it critically discusses the implications and limitations of the framework and research behind the construction of the theory.

  18. Strategy and business development practices in Danish constrution industry SMEs

    Thuesen, Christian Langhoff; Koch, Christian; Nielsen, Jesper Salling


    The paper presents a qualitative study of strategy and business development practices in Small and Medium Sizes Enterprises (SME) in the Danish construction industry. Theoretically the paper draws upon theories on how strategy is developed and practiced as in integrated part of everyday management...... development represents an important but unacknowledged practice for innovation of the building industry and suggests that strategy processes should be facilitated and subject to more detailed research in order to escape the present unhealthy market practices in the construction industry....... the companies compete on their overhead rather than their ability to reduce production cost and create value. (2) the companies have a reactive practice towards development, where they try to follow the development in the market rather than shaping their own market. (3) their approach towards strategy...

  19. Dialysis and transplantation in Sudan.

    Suliman, S M; Beliela, M H; Hamza, H


    In this report we present the current status of the renal replacement therapy in Sudan. Sudan is a large country with 30 million inhabitants. Peritoneal Dialysis was started in 1968, while hemodialysis was started in 1973. At present, there are only 16 hemodialysis machines serving 56 patients in two centers in Sudan. There are also 15 peritoneal dialysis beds for 70 intermittent peritoneal dialysis patients in three centers. Continuous ambulatory peritoneal dialysis is not being practiced in Sudan. The first renal transplant was in 1974, and till now more than 30 transplants have been performed in two transplant centers. All the transplants have been from living donors. The scholars of Islam in Sudan oppose to donation from cadavers. There are 200 renal transplant patients being followed up in Sudan and the majority had their renal transplants abroad. We conclude that there is a tremendous shortage of renal services in Sudan. There are more efforts being made to improve these services.

  20. [Peritoneal dialysis today and tomorrow].

    Grangier, Jean-Pierre


    Peritoneal dialysis was first used in the 1980s. Less well-known than haemodialysis, it represents an important treatment option for elderly patients at home. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  1. Overhydration prevalence in peritoneal dialysis – A 2 year longitudinal analysis1

    Pedro Ventura Aguiar


    Conclusions: Peritoneal dialysis maintenance without increasing volume status, nor major deleterious corporal composition trends, is feasible under careful therapy strategies. Longitudinal application of BIA may be a useful clinical tool to evaluate adequacy beyond Kt/V.

  2. Overhydration prevalence in peritoneal dialysis – A 2 year longitudinal analysis

    Pedro Ventura Aguiar


    Conclusions: Peritoneal dialysis maintenance without increasing volume status, nor major deleterious corporal composition trends, is feasible under careful therapy strategies. Longitudinal application of BIA may be a useful clinical tool to evaluate adequacy beyond Kt/V.

  3. Response to the National Career Development Strategy Green Paper

    Australian Journal of Career Development, 2012


    The Career Development Association of Australia (CDAA) congratulates the Commonwealth Government on the development of the National Career Development Strategy Green Paper. This is a timely and important document that provides a framework to demonstrate the central contribution that career development services play in supporting individuals,…

  4. Response to the National Career Development Strategy Green Paper

    Australian Journal of Career Development, 2012


    The Career Development Association of Australia (CDAA) congratulates the Commonwealth Government on the development of the National Career Development Strategy Green Paper. This is a timely and important document that provides a framework to demonstrate the central contribution that career development services play in supporting individuals,…

  5. Career Development Strategies for Japanese Immigrant Teachers

    Okamura, Yasuko; Miller, Judi


    Many career development theories recognise that the relationship between people and their environment constantly changes through historical and socio-political influences. Such theories emphasise the importance of systematic interpretations and general cultural influences on meaning-making. While such a view of meaning-making is important, we…

  6. Cheyenne-Laramie County Economic Development Strategy


    Chamber of Commerce John Etchepare Warren Livestock Co. Shirley Francis Laramie County Commissioner Nancy Gire Economic Development Planner, Cheyenne...Eagle Reeves & Company Investments Jeff Ketcham John Rogers Laramie County Commissioner Rogers, Wolf & Blythe Mike Lane Dean Run Lane & Associates...Dorn, Director of Planning Mountain Bell Memorial Hospital Fred Baggs, General Manager Joe Dougherty Fleiscli Oil Yellowstone Neighborhood

  7. Developing the Competitive Organization: Interventions and Strategies.

    Beer, Michael; Walton, Elise


    Discusses how a competitive environment has given rise to a paradigmatic transformation in how corporations organize and manage people. Discusses the following topics: (1) the field of organization development; (2) how corporations transform their culture; (3) the role of effective change leaders; and (4) the role of the consultant. (JS)

  8. Orphan drug: Development trends and strategies.

    Sharma, Aarti; Jacob, Abraham; Tandon, Manas; Kumar, Dushyant


    The growth of pharma industries has slowed in recent years because of various reasons such as patent expiries, generic competition, drying pipelines, and increasingly stringent regulatory guidelines. Many blockbuster drugs will loose their exclusivity in next 5 years. Therefore, the current economic situation plus the huge generic competition shifted the focus of pharmaceutical companies from the essential medicines to the new business model - niche busters, also called orphan drugs. Orphan drugs may help pharma companies to reduce the impact of revenue loss caused by patent expiries of blockbuster drugs. The new business model of orphan drugs could offer an integrated healthcare solution that enables pharma companies to develop newer areas of therapeutics, diagnosis, treatment, monitoring, and patient support. Incentives for drug development provided by governments, as well as support from the FDA and EU Commission in special protocols, are a further boost for the companies developing orphan drugs. Although there may still be challenges ahead for the pharmaceutical industry, orphan drugs seem to offer the key to recovery and stability within the market. In our study, we have compared the policies and orphan drug incentives worldwide alongwith the challenges faced by the pharmaceutical companies. Recent developments are seen in orphan drug approval, the various drugs in orphan drug pipeline, and the future prospectives for orphan drugs and diseases.

  9. Dialysis disequilibrium leading to posterior reversible encephalopathy syndrome in chronic renal failure.

    Sengupta, Pratim; Biswas, Sumanta


    Dialysis disequilibrium syndrome is a neurological adverse effect of acute hemodialysis in advanced uremic patients. Dialysis disequilibrium has a wide spectrum of clinical manifestations starting from subtle uneasiness, confusion, to florid and complex life threatening neurological deficit. In this case study, we present a patient who developed sudden cortical blindness following hemodialysis due to posterior reversible encephalopathy, which is a rare presentation of dialysis disequilibrium syndrome.

  10. Measuring residual renal function in dialysis patients: can we dispense with 24-hour urine collections?

    Davenport, Andrew


    Residual renal function is associated with improved survival and quality of life for dialysis patients. Whereas residual renal function is monitored in peritoneal dialysis patients, many hemodialysis centers simply concentrate on achieving dialyzer urea clearance targets. Accurately quantifying residual renal function from urine collections is arduous. Thus, there is a clinical need to develop alternative methods of assessing residual renal function based on serum testing, especially for patients receiving less than thrice weekly dialysis.

  11. [Interests of advanced systematic evaluation of dialysis session].

    Galland, Roula; Hallonet, Patrick; Pachot, Monique; Combe, Corinne; Schoenfelder, Isabelle; Caillette Beaudoin, Agnès


    In order to rationalize the cost of care for dialysis patients in Centre, regulatory authorities urge establishments to favor the orientation of the patients in Medical Dialysis Unit where the medical presence is not permanent. This involves clinical skills for nurses in the conduct of the dialysis session. Faced with this changing work patterns, we present two security tools of the dialysis session. The first is a "check-list", simple, quick and easy to use, it enables secure connection phase of the patient. It was quickly integrated practice of all professionals. The second tool developed is a combination of indicators "DEAUP" for Pain, Purification, Blood access, Ultrafiltration and other Problems for assessing the quality of the course of the dialysis session. The aim is to reduce the occurrence of adverse events, the DEAUP rating certain criteria depending on the occurrence of incidents, from 0 to 2, 2 corresponding to the appearance of an incident having required the call of the doctor and constitute a precious tool of evaluation of the session for all the professionals. All nurses have joined the practice of evaluation, 98% of the realized sessions are informed and quoted; 8.4% of sessions required call nephrologists before or at the connection. The evaluation at the end of dialysis session found 15% of the sessions listed 2. Calls have resulted in an adjustment to the prescription of the sessions.

  12. Environmental Protection and Sustainable Development Strategy

    Brasoveanu Florica


    Since 1970 after scientific discoveries about the ozone hole humanity began to reconsider the environment. Environmental messages had different intensities depending on their sources Scientific messages proved the harshest, the political ones had a powerful declarative impact, but the administrative apparatus, both worldwide and local didn't turn very perceptive. Towards the implementation of actions to protect the environment and sustainable development economic and social factors intervened...

  13. Harnessing Biomechanics to Develop Cartilage Regeneration Strategies

    Athanasiou, KA; Responte, DJ; Brown, WE; Hu, JC


    Copyright © 2015 by ASME. As this review was prepared specifically for the American Society of Mechanical Engineers H.R. Lissner Medal, it primarily discusses work toward cartilage regeneration performed in Dr. Kyriacos A. Athanasiou's laboratory over the past 25 years. The prevalence and severity of degeneration of articular cartilage, a tissue whose main function is largely biomechanical, have motivated the development of cartilage tissue engineering approaches informed by biomechanics. Thi...

  14. Effects of exercise therapy during dialysis for elderly patients undergoing maintenance dialysis

    Chigira, Yusuke; Oda, Takahiro; Izumi, Masataka; Yoshimura, Tukasa


    [Purpose] Exercise therapy during dialysis is currently being recommended since it is easy for patients to follow and results in high participation rates. In this study, this therapy was performed for elderly patients undergoing maintenance dialysis, and its effects were examined. [Subjects and Methods] Seven elderly patients (age: 70.6 ± 4.4) with chronic renal failure, who were able to perform exercises during maintenance dialysis, received the exercise therapy 2 or 3 times weekly for 3 months. Lower-limb muscle strength as well as the standardized dialysis dose (Kt/V) was measured before and after intervention. The patients were also evaluated using the 30-sec chair stand test (CS-30), the World Health Organization QOL Assessment 26 (WHO-QOL26), and a questionnaire. [Results] The lower-limb muscle strength and circumference, CS-30 score, and Kt/V values improved after intervention, but the difference was not significant. Significant differences were observed only in the WHO-QOL26 score. [Conclusion] The outcome was particularly favorable in terms of the quality of life (QOL). Based on the results from the questionnaire, the higher QOL may be due to the patients’ development of a positive attitude toward these activities. Although there were no significant differences, the values for the other criteria also improved, thereby supporting the effectiveness of exercise therapy to maintain or improve the patients’ motor functions and activity daily living (ADL) ability. PMID:28210031

  15. Entropy of uremia and dialysis technology.

    Ronco, Claudio


    The second law of thermodynamics applies with local exceptions to patient history and therapy interventions. Living things preserve their low level of entropy throughout time because they receive energy from their surroundings in the form of food. They gain their order at the expense of disordering the nutrients they consume. Death is the thermodynamically favored state: it represents a large increase in entropy as molecular structure yields to chaos. The kidney is an organ dissipating large amounts of energy to maintain the level of entropy of the organism as low as possible. Diseases, and in particular uremia, represent conditions of rapid increase in entropy. Therapeutic strategies are oriented towards a reduction in entropy or at least a decrease in the speed of entropy increase. Uremia is a process accelerating the trend towards randomness and disorder (increase in entropy). Dialysis is a factor external to the patient that tends to reduce the level of entropy caused by kidney disease. Since entropy can only increase in closed systems, energy and work must be spent to limit the entropy of uremia. This energy should be adapted to the system (patient) and be specifically oriented and personalized. This includes a multidimensional effort to achieve an adequate dialysis that goes beyond small molecular weight solute clearance. It includes a biological plan for recovery of homeostasis and a strategy towards long-term rehabilitation of the patient. Such objectives can be achieved with a combination of technology and innovation to answer specific questions that are still present after 60 years of dialysis history. This change in the individual bioentropy may represent a local exception to natural trends as the patient could be considered an isolated universe responding to the classic laws of thermodynamics.

  16. Bacterial otitis media: current vaccine development strategies.

    Cripps, Allan W; Kyd, Jennelle


    Otitis media is the most common reason for children less than 5 years of age to visit a medical practitioner. Whilst the disease rarely results in death, there is significant associated morbidity. The most common complication is loss of hearing at a critical stage of the development of speech, language and cognitive abilities in children. The cause and pathogenesis of otitis media is multifactorial. Among the contributing factors, the single most important are viral and bacterial infections. Infection with respiratory syncytial virus, influenza viruses, para-influenza viruses, enteroviruses and adenovirus are most commonly associated with acute and chronic otitis media. Streptococcus pneumoniae, non-typeable Haemophilus influenzae and Moraxella catarrhalis are the most commonly isolated bacteria from the middle ears of children with otitis media. Treatment of otitis media has largely relied on the administration of antimicrobials and surgical intervention. However, attention has recently focused on the development of a vaccine. For a vaccine to be effective against bacterial otitis media, it must, at the very least, contain antigens that induce a protective immune response in the middle ear against the three most common infecting bacteria. Whilst over the past decade there has been significant progress in the development of vaccines against invasive S. pneumoniae disease, these vaccines are less efficacious for otitis media. The search for candidate vaccine antigens for non-typeable H. influenzae are well advanced whilst less progress has been made for M. catarrhalis. No human studies have been conducted for non-typeable H. influenzae or M. catarrhalis and the concept of a tribacterial vaccine remains to be tested in animal models. Only when vaccine antigens are determined and an understanding of the immune responses induced in the middle ear by infection and immunization is gained will the formulation of a tribacterial vaccine against otitis media be possible.

  17. Dialysis cultures with immobilized hybridoma cells for effective production of monoclonal antibodies

    Pörtner, Ralf; Lüdemann, Ines; Märkl, Herbert


    An industrial scale reactor concept for continuous cultivation of immobilized animal cells (e.g. hybridoma cells) in a radial-flow fixed bed is presented, where low molecular weight metabolites are removed via dialysis membrane and high molecular products (e.g. monoclonal antibodies) are enriched. In a new “nutrient-split” feeding strategy concentrated medium is fed directly to the fixed bed unit, whereas a buffer solution is used as dialysis fluid. This feeding strategy was investigated in a...


    Tantri Wijayanti


    Full Text Available This research was aimed to identify the agrotourism potential in Jember Regency, to identify the condition of internal and external environment of Sukorambi Botanic Garden. The research used the Importance Performance Analysis (IPA method to find out the level of the visitors’ interest and satisfaction. For the internal and external analyses, the Internal Factor Evaluation (IFE method, the External Factor Evaluation (EFE method,  Strength Weakness Opportunity and Threat (SWOT and the Analytic Hierarchy Process (AHP were used to determine the strategies for marketing Sukorambi Botanic Garden. Three resource persons were used by purposive sampling technique. Thirty respondents were used for analytical level of interest by distributing questionnaires to visitors. The results of the research showed that the priorities of marketing Sukorambi Botanic Garden were 1 the strategy to maximize the concept of recreation while studying  such as crop cultivation and animal farming, 2 the strategy to increase the number of outbound games, 3 the strategy to coordinate intensively with stakeholders for improvement and sustainable development, 4 the strategy to get a loan from  a financial institution to increase capital, 5 the strategy to optimize promotion activities, (6  the strategy to improve the quality of community services through improved performance and transportation facilities, 7 the strategy to improve the quality of services through trainings for the employees to improve the company’s management system, 8 the strategy to realize facility development on the remainder of the land  accompanied by improvement of existing facilities, and 9 the strategy to optimize online promotion activities.    Keywords: Agrotourism, marketing development strategy, Sukorambi Botanic Garden, AHP, SWOT

  19. Framework for Creating a Smart Growth Economic Development Strategy

    This step-by-step guide can help small and mid-sized cities, particularly those that have limited population growth, areas of disinvestment, and/or a struggling economy, build a place-based economic development strategy.

  20. Human Capital Development: A Strategy for Moving Nigeria into the ...

    Human Capital Development: A Strategy for Moving Nigeria into the ... Countries without abundant resources have been excelling because of the emphasis on ... building because she has not been treating education as a priority sector.

  1. Water-Permeable Dialysis Membranes for Multi-Layered Micro Dialysis System

    Naoya eTo


    Full Text Available This paper presents the development of water-permeable dialysis membranes that are suitable for an implantable microdialysis system that does not use dialysis fluid. We developed a microdialysis system integrating microfluidic channels and nanoporous filtering membranes made of polyethersulfone (PES, aiming at a fully implantable system that drastically improves the quality of life of patients. Simplicity of the total system is crucial for the implantable dialysis system, where the pumps and storage tanks for the dialysis fluid pose problems. Hence, we focus on hemofiltration, which does not require the dialysis fluid but water-permeable membranes. We investigated the water-permeability of the PES membrane with respect to the concentrations of the PES, the additives, and the solvents in the casting solution. Sufficiently water-permeable membranes were found through in vitro experiments using whole bovine blood. The filtrate was verified to have the concentrations of low-molecular-weight molecules, such as sodium, potassium, urea, and creatinine, while proteins, such as albumin, were successfully blocked by the membrane. We conducted in vivo experiments using rats, where the system was connected to the femoral artery and jugular vein. The filtrate was successfully collected without any leakage of blood inside the system and it did not contain albumin but low-molecular-weight molecules whose concentrations were identical to those of the blood. The rat model with renal failure showed 100% increase of creatinine in 5 h, while rats connected to the system showed only a 7.4% increase, which verified the effectiveness of the proposed microdialysis system.


    Shirley Gregor


    Full Text Available This paper addresses the question of how virtual organizations that yield strategic advantage are formed. The study uses grounded theory to investigate the organizational processes and structure that facilitate the formation of a successful virtual organization. We present a case study of one virtual organization, a university in Australia, which has gained strategic advantage from alliances supported by information and communication technologies (ICT. The university is now the fastest growing university in Australia in terms of international student enrolments. The case study suggests that this commercial success is based on responsiveness to environmental conditions and organizational factors that include a long history as a distance education provider (an early form of virtualization, sophisticated information communication technologies, and a culture of innovation and risk-taking. The development processes observed included evolutionary growth, decisive actions and management leadership at opportune moments, and examples of technological and entrepreneurial innovations led by individuals. Significant decision making occurred outside formal strategic planning processes.

  3. Sustainable Energy Development Strategy in China

    LU Guang-yao; WANG Jing; LI Zhan


    Energy and electrical power is very important in economy and society. China has faced an increasingly serious energy shortage in the past decade. On the other hand, energy consumption and power generation, releasing carbon dioxide and other gaseous emissions from fossil fuels, may pollute the environment. Nuclear power, as an alternative energy source, would reduce these gaseous emissions. Both global warming and sustainable energy supply can be solved to some extent by the application of nuclear power. In the aspects of regaining economic advantages, environmental protection, the security and reliability of energy, nuclear power has an obvious superiority. In this paper, we present the energy status in quo of China, and discuss ways to realize the sustainable development of energy and power.


    Dewi Marbawati


    Full Text Available ABSTRAKPenyakit demam Dengue endemik di lebih dari 100 negara di dunia. Obat anti virus Dengue efektif belum ditemukan danpengendalian vektor dinilai kurang efektif, sehingga diperlukan upaya pencegahan dengan vaksinasi. Vaksin Dengue yangideal adalah murah, mencakup 4 serotipe, efektif dalam memberikan kekebalan, cukup diberikan sekali seumur hidup, aman,memberi kekebalan jangka panjang, stabil dalam penyimpanan dan stabil secara genetis (tidak bermutasi. Beberapakandidat vaksin yang telah dan sedang dikembangkan oleh para peneliti di seluruh dunia adalah tetravalent live attenuatedvaccine, vaksin Chimera (ChimeriVax, vaksin subunit dan vaksin DNA. Vaksin Dengue dipandang sebagai pendekatan yangefektif dan berkesinambungan dalam mengendalikan penyakit Dengue. Tahun 2003 telah terbentuk Pediatric DengueVaccine Initiative (PDVI, yaitu sebuah konsorsium internasional yang bergerak dalam advokasi untuk meyakinkanmasyarakat internasional akan penting dan mendesaknya vaksin Dengue. Konsorsium vaksin Dengue Indonesia saat iniberupaya mengembangkan vaksin Dengue dengan menggunakan strain virus lokal.Kata kunci: Dengue, virus, vaksinABSTRACTDengue fever is endemic in more than 100 countries in the world. The effective dengue antiviral drug has not been found yet,and vector control is considered less effective. Prevention program by vaccination is needed. An ideal dengue vaccine shouldbe inexpensive, covering four serotypes (tetravalent, effective in providing immunity, given once a lifetime, safe, stable instorage and genetically. Several vaccine candidates have been and are being developed included attenuated tetravalentvaccine, ChimeriVax, sub- unit vaccines and DNA vaccines. Dengue vaccine is seen as an effective and sustainable approachto controll Dengue infection. In 2003, Pediatric Dengue Vaccine Initiative (PDVI has been formed as an internationalconsortium involved in advocacy to convince the international community about the essence and urgency

  5. Characteristics of Strategies in Product/Service-System Development

    Tan, Adrian; McAloone, Timothy Charles


    The underlying principle in Product/Service-Systems (PSS) strategy is to shift from business based on the value of the transfer of product ownership and responsibility, to business based on the value of utility of the product and services. This paper identifies characteristics of various strategies...... that may be applied in PSS development. PSS concepts created in projects by third year Design & Innovation students at the Technical University of Denmark (DTU) working with product-life oriented design approaches were reviewed, and the strategies developed were analysed. This identification and mapping...

  6. Recycling: key component of a sustainable development strategy

    Clapham, M. [Natural Resources Canada, Mineral and Metal Policy Branch, Ottawa, ON (Canada)


    Challenges facing the recycling industry in Canada and elsewhere, some tools, standards and methods that are used to address these challenges and examples of how sustainable development strategies are being incorporated into the corporate business plans of the recycling industry are discussed. Support of senior management, commitment of resources and recognition that implementation of recycling strategies may take several years, are identified as some of the prerequisites to successful implementation of sustainable development strategies. The role government plays in encouraging the changing awareness by industry of the need for balancing environmental, economic and social needs are also reviewed. 10 refs.

  7. Satisfaction with care in peritoneal dialysis patients.

    Kirchgessner, J; Perera-Chang, M; Klinkner, G; Soley, I; Marcelli, D; Arkossy, O; Stopper, A; Kimmel, P L


    Patient satisfaction is an important aspect of dialysis care, only recently evaluated in clinical studies. We developed a tool to assess peritoneal dialysis (PD) customer satisfaction, and sought to evaluate and validate the Customer Satisfaction Questionnaire (CSQ), quantifying PD patient satisfaction. The CSQ included questions regarding administrative issues, Delivery Service, PD Training, Handling Requests, and transportation. The study was performed using interviews in all Hungarian Fresenius Medical Care dialysis centers offering PD. CSQ results were compared with psychosocial measures to identify if patient satisfaction was associated with perception of social support and illness burden, or depression. We assessed CSQ internal consistency and validity. Factor analysis explored potential underlying dimensions of the CSQ. One hundred and thirty-three patients treated with PD for end-stage renal disease for more than 3 months were interviewed. The CSQ had high internal consistency. There was high patient satisfaction with customer service. PD patient satisfaction scores correlated with quality of life (QOL) and social support measures, but not with medical or demographic factors, or depressive affect. The CSQ is a reliable tool to assess PD customer satisfaction. PD patient satisfaction is associated with perception of QOL. Efforts to improve customer satisfaction may improve PD patients' quantity as well as QOL.

  8. Nephrologists' professional ethics in dialysis practices.

    Ozar, David T; Kristensen, Cynthia; Fadem, Stephen Z; Blaser, Robert; Singer, Dale; Moss, Alvin H


    Although the number of incidents is unknown, professional quality-oriented renal organizations have become aware of an increased number of complaints regarding nephrologists who approach patients with the purpose of influencing patients to change nephrologists or dialysis facilities (hereinafter referred to as patient solicitation). This development prompted the Forum of ESRD Networks and the Renal Physicians Association to publish a policy statement on professionalism and ethics in medical practice as these concepts relate to patient solicitation. Also common but not new is the practice of nephrologists trying to recruit their own patients to a new dialysis unit in which they have a financial interest. This paper presents two illustrative cases and provides an ethical framework for analyzing patient solicitation and physician conflict of interest. This work concludes that, in the absence of objective data that medical treatment is better elsewhere, nephrologists who attempt to influence patients to change nephrologists or dialysis facilities fall short of accepted ethical standards pertaining to professional conduct, particularly with regard to the physician-patient relationship, informed consent, continuity of care, and conflict of interest.




    Full Text Available The concept of innovations embraces everything that is connected with creation and application of new knowledge in order to win competitive advantage. A traditional approach applied by organizational and management sciences are not enough to explain and manage the development of enterprises as well as that of cities, regions and countries. According to a new approach to innovativeness, creation of innovations depends on a complex/system approach. A phenomenon of particular importance is the approach to network pro-innovation structures from the urban and regional point of view. What makes a network work is a mutual relation between actors who have same rights to access and participate in the network. The whole system must be perceived by every actor. Simultaneously, every actor is partially responsible for the whole. The nature of networking can be understood as a differentiated system of relations (particularly personal ones inside the network. Tolerance and trust are other foundations of information flow and information return.

  10. Cybersecurity Strategy in Developing Nations: A Jamaica Case Study

    Newmeyer, Kevin Patrick


    Developing nations have been slow to develop and implement cybersecurity strategies despite a growing threat to governance and public security arising from an increased dependency on Internet-connected systems in the developing world and rising cybercrime. Using a neorealist theoretical framework that draws from Gilpin and Waltz, this qualitative…

  11. Strategies for development of clean energy in China

    Yang Zhen; Zhang Hongliang


    A development framework of clean energy in China is put forward based on core development strategy,technology support,and policy and laws support.In this framework,the priority development and strategic backup of clean energy are defined,and the technology support and policy and laws support are also presented.

  12. Cybersecurity Strategy in Developing Nations: A Jamaica Case Study

    Newmeyer, Kevin Patrick


    Developing nations have been slow to develop and implement cybersecurity strategies despite a growing threat to governance and public security arising from an increased dependency on Internet-connected systems in the developing world and rising cybercrime. Using a neorealist theoretical framework that draws from Gilpin and Waltz, this qualitative…

  13. Views of Canadian patients on or nearing dialysis and their caregivers: a thematic analysis.

    Barnieh, Lianne; King-Shier, Kathryn; Hemmelgarn, Brenda; Laupacis, Andreas; Manns, Liam; Manns, Braden


    Quality of life of patients receiving dialysis has been rated as poor. To synthesize the views of Canadian patients on or nearing dialysis, and those who care for them. Secondary analysis of a survey, distributed through dialysis centres, social media and the Kidney Foundation of Canada. Pan-Canadian convenience sample. Patients, their caregivers and health-care providers. Text responses to open-ended questions on topics relevant to end-stage renal disease. Statements related to needs, beliefs or feelings were identified, and were analysed by thematic content analysis. A total of 544 relevant statements from 189 respondents were included for the thematic content analysis. Four descriptive themes were identified through the content analysis: gaining knowledge, maintaining quality of life, sustaining psychosocial wellbeing and ensuring appropriate care. Respondents primarily identified a need for more information, better communication, increased psychosocial and financial support for patients and their families and a strong desire to maintain their previous lifestyle. Convenience sample; questions were originally asked with a different intent (to identify patient-important research issues). Patients on or nearing dialysis and their caregivers identified four major themes, gaining knowledge, maintaining quality of life, sustaining psychosocial wellbeing and ensuring appropriate care, several of which could be addressed by the health care system without requiring significant resources. These include the development of patient materials and resources, or sharing of existing resources across Canadian renal programs, along with adopting better communication strategies. Other concerns, such as the need for increased psychosocial and financial support, require consideration by health care funders.


    José G. Vargas-Hernández


    Full Text Available The aim of this paper is to analyze a competitiveness strategy based on sustainability to lead the way to a model of responsible and competitive development. The analysis takes as its starting point the assumption that the maturity of a sustainable business strategy positively affects competitiveness. The used method is the critical analysis. Among other results of this analysis concludes that the current business strategy seeks a system ecologically appropriate, economically viable and socially fair to reach sustainable equilibrium. This strategy based on sustainability must be promoted by the institutions and strengthened by the capabilities and resources that each company counts on to develop advantages to foster the overall development and achieve the maximization of benefits from the tangible and intangible perspectives

  15. The economic considerations of patients and caregivers in choice of dialysis modality

    Howard, Kirsten; Tong, Allison; Palmer, Suetonia C.; Marshall, Mark R.; Morton, Rachael L.


    Abstract Introduction Broader adoption of home dialysis could lead to considerable cost savings for health services. Globally, however, uptake remains low. The aim of this study was to describe patient and caregiver perspectives of the economic considerations that influence dialysis modality choice, and elicit policy‐relevant recommendations. Methods Semistructured interviews with predialysis or dialysis patients and their caregivers, at three hospitals in New Zealand. Interview transcripts were analyzed thematically. Findings 43 patients and 9 caregivers (total n = 52) participated. The three themes related to economic considerations were: (i) productivity losses associated with changes in employment; (ii) the need for personal subsidization of home dialysis expenses; and (iii) the role of socio‐economic disadvantage as a barrier to home dialysis. Patients weighed the flexibility of home dialysis which allowed them to remain employed, against time required for training and out‐of‐pocket costs. Patients saw the lack of reimbursement of home dialysis costs as unjust and suggested that reimbursement would incentivize home dialysis uptake. Social disadvantage was a barrier to home dialysis as patients’ housing was often unsuitable; they could not afford the additional treatment costs. Home hemodialysis was considered to have the highest out‐of‐pocket costs and was sometimes avoided for this reason. Discussion Our data suggests that economic considerations underpin the choices patients make about dialysis treatments, however these are rarely reported. To promote home dialysis, strategies to improve employment retention and housing, and to minimize out‐of‐pocket costs, need to be addressed directly by healthcare providers and payers. PMID:27196634

  16. Development Strategy for Mobilecommunications Market in Chinese Rural Area

    Zhang, Liwei; Zhang, Yanjun; Xu, Liying; Li, Daoliang

    Based on full analysis of rural mobile communication market, in order to explore mobile operators in rural areas of information services for sustainable development model, this paper presents three different aspects, including rural mobile communications market demand, the rural market for mobile communications business model and development strategies for rural mobile communications market research business. It supplies some valuable references for operators to develop rural users rapidly, develop the rural market effectively and to get access to develop a broad space.

  17. Models, measurement, and strategies in developing critical-thinking skills.

    Brunt, Barbara A


    Health care professionals must use critical-thinking skills to solve increasingly complex problems. Educators need to help nurses develop their critical-thinking skills to maintain and enhance their competence. This article reviews various models of critical thinking, as well as methods used to evaluate critical thinking. Specific educational strategies to develop nurses' critical-thinking skills are discussed. Additional research studies are needed to determine how the process of nursing practice can nurture and develop critical-thinking skills, and which strategies are most effective in developing and evaluating critical thinking.

  18. Tidal peritoneal dialysis: preliminary experience.

    Flanigan, M J; Doyle, C; Lim, V S; Ullrich, G


    To determine the feasibility of home tidal peritoneal dialysis (TPD) and to assess whether eight hours of TPD can achieve uremia control and urea removal equal to that of continuous cycling peritoneal dialysis (CCPD). An open enrollment pilot study. The Home Dialysis Training Center of the University of Iowa Hospitals and Clinics, a tertiary care teaching hospital. Nine patients experienced with CCPD and living 80 km to 280 km from the dialysis center began TPD, because they wished to decrease their dialysis time. Following baseline measurements, each patient was taught to perform TPD. TPD consisted of an initial fill volume of 40 mL/kg, a residual volume approximately 20 mL/kg, and tidal exchanges of 10 to 20 mL/kg to achieve the desired hourly flow rate. Clinic assessments took place every four to six weeks, and prescriptions were subsequently altered to attain urea removal equal to that of CCPD. Patient interviews were used to determine TPD acceptance. Prior to each clinic visit, dialysate effluent volume and dialysis duration were recorded, and a sterile sample of the effluent was obtained for urea, creatinine, and total nitrogen measurement. Urea and creatinine clearances increased with dialysate flow. Dialysate nonurea nitrogen was 3.0 +/- 0.2 mmol/kg/D and changed minimally with increasing dialysate volumes. Eight hours of TPD (initial fill: 40 mL/kg; residual volume: 20 mL/kg; tidal inflow: 20 mL/kg) with hourly tidal flow exceeding 40 mL/kg/hr and no daytime volume achieved urea removal equal to that of the patient's prior CCPD prescription. TPD can provide dialysis equal to that of CCPD within a shorter amount of time (eight vs ten hours), but uses a greater volume of dialysate (16.0 L for TPD vs 9.5 L for CCPD).


    I. V. Cheryomushkina


    Full Text Available Summary. The article describes the factors of the crisis, the sustainability of investment and shows the role of investment strategies in the current economic conditions. The authors have disclosed features to ensure the crisis-stability of firms based on the use of different types of investment strategies to basic, which, first of all, should include a strategy of expansion and diversification, stabilization and reconstruction, renovation and development of innovations. The introduction of the practice of formation of the investment policy will achieve high rates of economic growth and support the competitiveness of firms. Investment policy is a part of the overall financial strategy of the enterprise, is to select and implement the most effective forms of investment to ensure high rates of development and constant growth of the market value. With it, the company implements its ability to anticipation of long-term economic trends and adapt to them. The complexity of the investment activities is largely due to the peculiarities of the organizational and economic situation of enterprises. The investment strategy is subject to the basic strategy of economic development of the enterprise. The positive results of the investment strategy, manifested in the form of increasing the economic potential of the company, its mobilization for achieving a qualitatively new level of development are the basis for increasing the crisis-stability. Revealed the decisive role of innovation to ensure sustainable development of the enterprise. Innovation potential allows to form the necessary basis of early detection of problems in the sustainable development of the company. Ensuring sustainable development of the enterprise on the basis of the formation and use of innovative potential in practice can reasonably review the strategic guidelines for innovation activities and the economic effect, expressed in the sustainable development and effective functioning.

  20. 不同心态类型的老年腹膜透析患者的心理健康教育对策%Mental health education strategies of elderly patients with peritoneal dialysis of different type of mood

    蔡坤; 董雅梦; 苏红梅


    作为终末期肾衰竭患者的一种有效替代疗法,腹膜透析在临床已成为有效治疗终末期肾衰竭的措施之一。老年肾衰竭患者的体质差,血流动力学不稳定,不适宜肾移植,临床常采用腹膜透析进行肾脏替代治疗。腹膜透析可有效清除尿毒症毒素,提高患者的生活质量,延长患者的生命,因此研究影响腹膜透析患者生存期的相关因素,对进一步提高腹膜透析疗效,改善尿毒症患者的生存质量有重要意义。本研究通过对不同心态类型的老年腹膜透析患者的心理健康教育对策的观察与分析,提出针对性强的心理健康教育方式能降低老年腹膜透析患者的住院率及减少并发症。%As an effective replacement therapy for patients with end-stage renal failure,peritoneal dialysis becomes one of the effective treatment of end-stage renal failure.The constitution of elderly patients with renal failure is poor with hemodynamic instability, therefore patients is not suitable for kidney transplantation, clinical often uses peritoneal dialysis in renal replacement therapy. Peritoneal dialysis can effectively remove the uremic toxins,improve the life qual-ity of patients,prolong life of patients,therefore study the related factors influencing the peritoneal dialysis patient surial has an important significance for further improving the quality of peritoneal dialysis curative effect,improving the sur-vival of patients with uremia.The study puts forward that the proper psychological health education could reduce the hospitalization rate and complications of old patients with peritoneal dialysis through the observation and analysis of psychological health education countermeasure for elderly patients with peritoneal dialysis of different type of mood.

  1. Renal cell carcinoma co-existent with other renal disease: clinico-pathological features in pre-dialysis patients and those receiving dialysis or renal transplantation.

    Peces, Ramón; Martínez-Ara, Jorge; Miguel, José Luis; Arrieta, Javier; Costero, Olga; Górriz, José Luis; Picazo, Mari-Luz; Fresno, Manuel


    Patients on chronic dialysis are prone to developing acquired cystic kidney disease (ACKD), which may lead to the development of renal cell carcinoma (RCC). The risk factors for the development of RCC so far have not been determined in pre-dialysis patients with co-existent renal disease. The aim of this study was to evaluate the clinico-pathological features of RCC in pre-dialysis patients with associated renal diseases or in those undergoing chronic dialysis and renal transplantation. We studied 32 kidneys from 31 patients with RCC and associated renal diseases. Of those, 18 kidneys were from 17 patients not on renal replacement therapy (RRT) when diagnosed with RCC; 14 patients received dialysis or dialysis followed by renal transplantation. Several clinico-pathological features were analysed and compared between the two groups. Overall, there was a preponderance of males (75%); nephrosclerosis was the predominant co-existent disease (31%). The median intervals from renal disease to RCC in the dialysis and transplanted groups were significantly longer than in the pre-dialysis group (15.8+/-1.1 vs 2.4+/-0.7 years, P<0.0001). In contrast to pre-dialysis RCC, the dialysis and transplant RCC groups had greater frequency of ACKD (100 vs 28%, P<0.0001), papillary type RCC (43 vs 11%, P<0.05) and multifocal tumours (43 vs 5%, P<0.05). At the end of the study, 71% of dialysis and transplanted patients and 72% of pre-dialysis patients were alive. ACKD develops in dialysis patients, as it does in those with renal disease prior to RRT. The duration of renal disease, rather than the dialysis procedure itself, appears to be the main determinant of ACKD and RCC. The RCC occurring in patients with ACKD and prolonged RRT is more frequently of the papillary type and multifocal than the RCC occurring in patients with no or few acquired cysts and a short history of renal disease. Long-term outcomes did not differ between the two groups.

  2. SSBRP User Operations Facility (UOF) Overview and Development Strategy

    Picinich, Lou; Stone, Thom; Sun, Charles; Windrem, May; Givens, John J. (Technical Monitor)


    This paper will present the Space Station Biological Research Project (SSBRP) User Operations Facility (UOF) architecture and development strategy. A major element of the UOF at NASA Ames Research Center, the Communication and Data System (CDS) will be the primary focus of the discussions. CDS operational, telescience, security, and development objectives will be discussed along with CDS implementation strategy. The implementation strategy discussions will include: Object Oriented Analysis & Design, System & Software Prototyping, and Technology Utilization. A CDS design overview that includes: CDS Context Diagram, CDS Architecture, Object Models, Use Cases, and User Interfaces will also be presented. CDS development brings together "cutting edge" technologies and techniques such as: object oriented development, network security, multimedia networking, web-based data distribution, JAVA, and graphical user interfaces. Use of these "cutting edge" technologies and techniques translates directly to lower development and operations costs.

  3. Model strategy for village development in the Czech Republic

    Ladislav ROLÍNEK


    Full Text Available The model strategies discussed in this article represent different ways of possible village development in the Czech Republic. We used typologies of strategies from business strategic management for their definition. Twenty municipalities, where structured interviews were carried out with their mayors, were chosen randomly from among 100 villages where a questionnaire survey was conducted in 2012 (Faltová Leitmanová, et al., 2012. Based on the qualitative analysis of the structured interview summaries, eight model strategies were ascertained. These include integration strategy, service differentiation, spending cuts, usage of municipal property, stabilization of village population, business support, fundraising, and identification of the inhabitants with the village (village pride. The most commonly applied model strategy is integration, followed by village population stabilization.

  4. Human Resource Development Issues in the Implementation of the Western China Development Strategy

    Xiao, Mingzheng


    This paper systematically illustrates the value and role of human resource development in the implementation of the Western China development strategy. It analyzes in details some current human resource issues constraining the implementation of the Western China development strategy and those on the sustainable development process of economic…

  5. Pediatric Chronic Dialysis in Brazil: Epidemiology and Regional Inequalities.

    Tulio Konstantyner

    Full Text Available There are few reports in the literature estimating the epidemiologic characteristics of pediatric chronic dialysis. These patients have impaired physical growth, high number of comorbidities and great need for continuous attention of specialized services with high demand for complex and costly procedures.The aim of this study was to estimate the incidence and prevalence rates and describe the characteristics of children and adolescents undergoing chronic dialysis treatment in a Brazilian demographic health survey.A cross-sectional study was performed in a representative sample of dialysis centers (nc = 239 that was established from the 2011 Brazilian Nephrology Society Census (Nc = 708. We collected data encompassing the five Brazilian macro-regions. We analyzed the data from all patients under 19 years of age. The sample population consisted of 643 children and adolescents who were on chronic dialysis program anytime in 2012. Data collection was carried out in the dialysis services by means of patients' records reviews and personal interviews with the centers' leaders.We estimated that there were a total of 1,283 pediatric patients on chronic dialysis treatment in Brazil, resulting in a prevalence of 20.0 cases per million age-related population (pmarp (95% CI: 14.8-25.3 and an incidence of 6.6 cases pmarp in 2012 (95% CI: 4.8-8.4. The South region had the highest prevalence and incidence rates of patients under dialysis therapy, 27.7 (95% CI: 7.3-48.1 and 11.0 (95% CI: 2.8-19.3 cases pmarp, respectively; the lowest prevalence and incidence rates were found in the North-Midwest region, 13.8 (95% CI: 6.2-21.4, and in the Northeast region, 3.8 (95% CI: 1.4-6.3 cases pmarp, respectively.Brazil has an overall low prevalence of children on chronic dialysis treatment, figuring near the rates from others countries with same socioeconomic profile. There are substantial differences among regions related to pediatric chronic dialysis treatment. Joint

  6. Survival influencing factors and the interventional strategy in patients with peritoneal dialysis%影响腹膜透析生存的因素及干预策略

    阳晓; 余学清


    腹膜透析(PD)是终末期肾脏疾病(ESRD)的主要替代治疗方法之一.心血管疾病(CVD)是PD患者死亡的主要原因.慢性肾脏病(CKD)患者存在非传统的、自身疾病特有的心血管危险因素,包括贫血、矿物质代谢紊乱、炎症和氧化应激状态及蛋白质能量消耗,这些都与CKD增加的全因死亡率和心血管疾病死亡率相关.提高PD患者长期生存率的策略包括纠正传统与非传统的心血管危险因素,如血压、血糖、血脂控制,戒烟,纠正贫血、钙磷代谢紊乱,纠正炎症和氧化应激及蛋白质能量消耗,同时必须高度重视PD患者存在的可纠正的影响生存的因素,如残余肾功能、腹膜完整性和PD中心规模.%Peritoneal dialysis (PD) is one of renal replacement therapeutics for patients with end-stage renal disease (ESRD).PD patients mainly died of cardiovascular disease.Patients with chronic kidney disease (CKD) have risks of cardiovascular disorders,which are non-traditional and related to the disease itself,including anemia,mineral metabolic disturbance,inflammation,oxidative stress,and protein energy wasting.These factors are correlated with the increased mortality of all causes as well as cardiovascular causes.Strategies to improve the long-term survivals of these patients include:managing of traditional and non-traditional cardiovascular factors such as blood pressure,blood glucose,blood lipid,smoking,anemia and calcium-phosphorus metabolic disturbance;and decreasing inflammation,oxidation stress and protein energy wasting.Meanwhile,high attention should be paid to the survival influencing factors that can be corrected such as residual renal function,peritoneal integrity and size of PD centers.

  7. The dialysis catheter and infectious peritonitis in intermittent peritoneal dialysis

    Kolmos, Hans Jørn; Hemmeløff Andersen, Karl Erik; Hansen, Lise


    118 episodes of infectious peritonitis registered among 156 patients treated with intermittent peritoneal dialysis over a 5-yr period were analysed with special reference to potential routes of infection associated with the dialysis catheter. Peritonitis was randomly distributed among the patients......, and the change of keeping free of peritonitis declined exponentially with time. The main factor determining the individual number of episodes was the total space of time, in which a patient had been wearing a dialysis catheter, whereas the number of catheter disconnections played no significant role. A relative...... preponderance of cases due to Enterobacteriaceae was noted within the first week after catheter implantation. In contrast with this, peritonitis with skin microorganisms was not associated with the implantation of catheters....

  8. Cryptococcosis in HIV-negative Patients with Renal Dialysis: A Retrospective Analysis of Pooled Cases.

    Hong, Nan; Chen, Min; Fang, Wenjie; Al-Hatmi, Abdullah M S; Boekhout, Teun; Xu, Jianping; Zhang, Lei; Liu, Jia; Pan, Weihua; Liao, Wanqing


    Cryptococcosis is a lethal fungal infection mainly caused by Cryptococcus neoformans/C. gattii species. Currently, our understanding of cryptococcosis episodes in HIV-negative patients during renal dialysis remains scarce and fragmented. Here, we performed an analysis of pooled cases to systemically summarize the epidemiology and clinical characteristics of cryptococcosis among HIV-negative patients with renal dialysis. Using pooled data from our hospital and studies identified in four medical databases, 18 cases were identified and analyzed. The median duration time of renal dialysis for peritoneal renal dialysis and hemodialysis cases was 8 months and 36 months, respectively. Several non-neoformans/gattii species were identified among the renal dialysis recipients with cryptococcosis, particularly Cryptococcus laurentii and Cryptococcus albidus, which share similar clinical manifestations as those caused by C. neoformans and C. gattii. Our analyses suggest that physicians should consider the possibility of the occurrence of cryptococcosis among renal dialysis recipients even when cryptococcal antigen test result is negative. The timely removal of the catheter is crucial for peritoneal dialysis patients with cryptococcosis. In addition, there is a need for optimized antifungal treatment strategy in renal dialysis recipients with cryptococcal infections.

  9. Anemia in peritoneal dialysis patients

    Laušević Mirjana


    Full Text Available A normocytic normochromic anemia is one of the first signs of renal failure. Since anemia increases morbidity and mortality, its elimination is one of the essential objectives of the treatment. Human recombinant erythropoietin (rHuEPO has changed the therapeutical approach to anemia. The aim of the present study was to compare efficacy of anemia correction in peritoneal dialysis patients depending on treatment and dialysis modality. The study is the retrospective analysis of 64 patients who presented to our Clinic in 2003. Eighteen (28.13% patients were treated with rHuEPO, 14 (28% underwent continuous ambulatory peritoneal dialysis (CAPD, 2 (100% - automated peritoneal dialysis (APD and 2 (33.3% - intermittent peritoneal dialysis (IPD. Mean hemoglobin level was 98.6±17.82 g/l in patients treated with rHuEPO versus 98.81±15.14 g/I in patients without rHuEPO treatment. Erythropoietin requirements were 3392.85±1211.77 IU/week. AII patients received iron supplementation during rHuEPO therapy. Mean serum ferritin levels were 463.41 ±360 μg/l. Transferrin saturation (TSAT was 0.35±0.16%. No difference of serum iron and TSAT levels was found between CAPD and IPD patients. The degree of anemia significantly differed between CAPD and IPD patients. A total of 17.11% of PD patients were given blood transfusions, most frequently during the first three months after the onset of dialysis. Our conclusion is that the number of patients receiving rHuEPO should be increased, as 50% of our patients should be substituted, while only 28% are being treated. As 50% of patients receiving rHuEPO failed to reach target Hgb levels, higher EPO doses should be considered. Iron stores should be continuously monitored, particularly in patients receiving rHuEPO, since iron deficiency is an important problem for patients undergoing peritoneal dialysis, especially during erythropoietin therapy. Oral iron supplementation is satisfactory in the majority of patients, and

  10. Two New Strategies for Developing Loop Invariants and Their Applications



    The loop invariants take a very important role in the design,proof and derivation of the algorithmic program.We point out the limitations of the taditional standard strategy for developing loop invariants.and propose two new strategies for proving the existing algorithmic program and developing new ones.The strategies ure recurrence as vehicle and integrate some effective methods of designing algorithms,e.g.Dynamic Porgramming,Greedy and Divide-Conquer,into the recurrence relation of problem solving sequence.This lets us get straightforward an approach for solving a variety of complicated problems,and makes the standard proof and formal derivation of their algorithmic programs possible.We show the method and advantages of applying the strategies with several typical nontivial examples.




    Full Text Available The aim of this paper is to analyze a competitiveness strategy based on sustainability to lead the way to a model ofresponsible and competitive development. The analysis takes as its starting point the assumption that the maturity of asustainable business strategy positively affects competitiveness. The used method is the critical analysis. Amongother results of this analysis concludes that the current business strategy seeks a system ecologically appropriate,economically viable and socially fair to reach sustainable equilibrium. This strategy based on sustainability must bepromoted by the institutions and strengthened by the capabilities and resources that each company counts on todevelop advantages to foster the overall development and achieve the maximization of benefits from the tangible andintangible perspectives.

  12. Strategies for Designing and Developing Services for Manufacturing Firms

    Tan, Adrian Ronald; Matzen, Detlef; McAloone, Tim C.


    Product/service-systems (PSS) are in effect an approach to designing integrated products and services with a focus on both customer- and product life cycleactivities . Literature offers a range of service-oriented design strategies from product-oriented DfX approaches to more customer......-oriented approaches such as integrated solutions and service design. These design strategies are mapped out in relation to how applicable they are to different types of services. Case studies from two industrial companies are used to confront the existing literature in order to improve understanding of how...... manufacturing companies may align their product and service development activities with their business strategies....

  13. Faculty development and mentorship using selected online asynchronous teaching strategies.

    Vitale, Anne T


    The use of distance learning continues to improve accessibility to nursing education programs, yet online teaching remains an intimidating experience for novice educators. An emerging role in professional faculty development is the online educator, who serves as a mentor for novice faculty. This article presents the necessary elements to plan, organize, and manage asynchronous online courses, especially for novice educators and online faculty mentors. Course engagement and faculty-student online communication strategies are explored using examples. Threaded discussion strategies for engaging students in active, collaborative learning are discussed using specific examples. A threaded discussion grading rubric is included. Strategies to sustain interactive learning and evaluate student learning using examples are offered.

  14. Developing a promotional strategy: important questions for social marketing.

    Thackeray, Rosemary; Neiger, Brad L; Hanson, Carl L


    Health practitioners often use the terms marketing and promotion interchangeably. Yet, promotion is just one element of an overall marketing strategy. To realize the greatest impact there must be a combination of all the marketing components, including product, price, place, and promotion. The purpose of this article is to clarify the role of promotion and describe key elements of developing a promotional strategy within the broader context of a social marketing initiative.

  15. Learning Strategies Used by College Freshmen in Developing English Proficiency



    Full Text Available - The main objective of this study was to determine the learning strategies used by College Freshmen to enhance the development of English language proficiency; and to find out the extent of using them along phonology, vocabulary and grammar. The survey-results served as the basis of devising an instructional tool that would offer more learning techniques and ways that would enhance further the development of English proficiency. The descriptive method of research was applied. Survey questionnaires of two parts were used. Part 1 was a diagnostic test in English focused on phonology, vocabulary and grammar. Part 2 was an inventory of English Language learning strategies that emphasized reading and study skills, which also determined the extent of using them along the three (3 elements of English. The research venue was Camarines Sur State Agricultural College where 255 College Freshmen served as respondents. The statistical tools used were score interval, weighted mean, averaging and ranking systems. Results showed that the College freshmen are moderately proficient both on vocabulary and grammar but are hardly proficient on phonology. Varied learning strategies on reading and studying exercises are frequently used by the respondents in developing English proficiency. The extent or frequency of using learning strategies along the English language elements revealed that the respondents moderately used target learning strategies along phonology while they frequently used said strategies along vocabulary and grammar elements of English language.”Language Strategies for Better English Proficiency” was devised to offer more learning ways and techniques that would enhance English proficiency development. The teaching tool entitled “Language Strategies for Better English Proficiency” was found valid to be used in the curriculum.


    Jin Hui; Ge Anlin


    With the rapid development of electronics and the growing demand for higher vehicle performance,intelligent shift technology is becoming increasingly important,and it promises to be a developing trend in vehicle automatic transmissions.A new simulation model is presented,which includes engine,powertrain,tire and vehicle dynamics models.Based on the model,simulation experiments are conducted to investigate the slope shift strategy.The data and conclusions obtained from the simulations are valuable contributions to the development of an intelligent slope shift strategy.

  17. An Analytic Framework to Support E.Learning Strategy Development

    Marshall, Stephen J.


    Purpose: The purpose of this paper is to discuss and demonstrate the relevance of a new conceptual framework for leading and managing the development of learning and teaching to e.learning strategy development. Design/methodology/approach: After reviewing and discussing the research literature on e.learning in higher education institutions from…


    A. Kryvokon


    Full Text Available Research of strategy and prospects of Ukrainian automobile motor industry development has been done: the measures of public policy, which must be realized for the development of national automobile industry, a car production volume and expected working place in motor industry under state support have been described.

  19. Coping Strategies and the Development of Psychological Resilience

    Booth, Jessie W.; Neill, James T.


    This paper describes psychological theory about stress, coping, and psychological resilience, and considers how coping strategies can help develop resilience in the context of outdoor education. Outdoor education programs often aim to develop psychological resilience through structured challenging and reflective experiences. Use of coping…

  20. Academic Professional Development Strategies to Facilitate Educational Changes in Universities

    Gonzalez Alonso, Gloria Amparo


    This qualitative within-case study explored how planned educational change in universities can be facilitated through academic professional development strategies. Thus this study attempted to shed some light on the dynamics of educational planned change in universities and their implications for academic professional development of faculty. The…

  1. Criteria for method selection and process design of a technical development strategy

    Joseph-Malherbe, S


    Full Text Available Building on previous work by the author, the intention of the study is to collate what is available on developing a technical development strategy framework. The technical development strategy is foreseen to include a development strategy, a...

  2. Depression Often Untreated in Dialysis Patients

    ... page: Depression Often Untreated in Dialysis Patients Sometimes it's the ... 26, 2017 THURSDAY, Jan. 26, 2017 (HealthDay News) -- Depression is common among kidney failure patients undergoing dialysis. ...

  3. Dialysis: MedlinePlus Health Topic

    ... Filtering Dialysis Myths from Facts (National Kidney Foundation) Hemodialysis Catheters: How to Keep Yours Working Well (National Kidney ... Thrombotic complications and tip position of transjugular chronic dialysis catheter... Article: Clinical emergency treatment of 68 critical patients ...

  4. 42 CFR 414.316 - Payment for physician services to patients in training for self-dialysis and home dialysis.


    ... training for self-dialysis and home dialysis. 414.316 Section 414.316 Public Health CENTERS FOR MEDICARE... Payment for physician services to patients in training for self-dialysis and home dialysis. (a) For each... for self-dialysis and home dialysis. (b) CMS determines the amount on the basis of program...

  5. Causes Analysis and Nursing Strategies of Patients with Peritoneal Dialysis and Peritonitis%腹膜透析患者并发腹腔感染的原因分析及护理对策

    陈娟娟; 石国霞; 张晓萍


    目的 分析腹膜透析患者发生腹腔感染的环节及其发生的相关影响因素,为临床预防和减少腹腔感染的发生提供依据,并提出相应的护理干预措施.方法 回顾性调查第二军医大学长征医院自2011年1-12月共300例腹膜透析患者(共腹透3368个月)腹腔感染发生的原因.结果 300例维持性腹膜透析患者共发生腹腔感染55例次,感染发生率为18.3%.结论 腹膜透析患者腹腔感染发生率高,应针对腹腔感染发生的原因加以预防,采取提高患者依从性、积极治疗原发病、预防呼吸道及肠道感染、加强宣教和随访等措施,以提高透析疗效,改善患者的生活质量.%Objective To analyze the causes of intra-abdominal infection and its related factors in peritoneal dialysis patients, so as to provide evidence for the prevention of clinical abdominal infection and reduction of peritonitis, and to give the corresponding nursing interventions. Methods A retrospective survey was conducted in 300 peritoneal dialysis patients(Peritoneal dialysis 3368)between January and December 2011 on the causes of intra-abdominal infection. Results Totally 55 intra-abdominal infections occurred in 300 maintenance peritoneal dialysis patients. The incidence of intra-abdominal infection is 18. 3%. Conclusion Peritoneal dialysis patients have a higher incidence of peritoneal infection. It's important for us to improve dialysis efficacy and life quality as long as we prevent the abdominal infection according to the causes, take actions to improve compliance behavior,aggressively treat the primary disease,prevent respiratory and intestinal infections and strengthen the education and follow-up.

  6. The development strategy of financial and innovative technologies

    R.V. Lavrov


    Full Text Available The aim of the article. The aim of the article is to define and to estimate the forming of expediency of the development strategy of financial and innovative technologies in the context of modern economic space realities.The results of the analysis. The growing importance of the financial sector in the contemporary economic space, as well as rapid changes in it, generates a need for financial innovative technologies. Development strategy of financial and innovative technologies is always associated with the current state of the financial system, its existent technical, technological and financial base. Therefore, the strategy of financial and innovative technologies will be considered the system of long-term goals and means of achieving them, implemented in the financial activity. Financial innovative technologies strategy includes two aspects: 1 management of the introduction of technical and technological innovations; 2the process of constant changes in the financial sector according to the environment change. Thus, theessence of the development strategy of financial innovative technologies is to target business entities (including banks to application new and more efficient technologies, services and organizational structures. In other words, to put the problem of profitability, flexibility and adaptability increasing in the financial market.The development expediency of the financial and innovative technologies is determined by such criteria: concordance with the amount of capital that can be directed to the financial activity; efficiency or concordance of the results and the real costs of achieving them; distinctness in terms of achieving the aim; the optimal combination of expected achievement the necessary profitability and possible risks and uncertainty in the future period; concordance of planned financial technologies with general economic conditions of the environment. Choosing the basic strategy of financial innovative technologies

  7. Roles in the strategy of innovative development formation

    Vita Iukhymenko


    Full Text Available The article presents the results of evaluation the roles in strategies innovative development formation at engineering enterprises. The aim of the article is to analyze the roles of participants forming process innovation development strategies of engineering enterprises, provided for the implementation of management , information , production, financial , marketing , logistics and quality management business processes. Steps involving interaction with certain circle of people who play in this process, certain roles were studied to analyze the formation of innovation development strategies. The research is based on the author's approach , which was called the "processing". Each of the roles were considered separately and the place of each in their totality were determined. The author examined the distribution of roles in the implementation process of ERP-systems at the enterprise from the idea inception to project implementation and its financing.

  8. Role of metacognitive processes in developing learning strategies

    Mirkov Snežana I.


    Full Text Available Within the context of effects that findings in the domain of cognitive psychology produce on the improvement of learning process in teaching, the results for examinations on student learning strategies and some of their implications were analyzed. Diverse methods for the operationalization of strategies, both cognitive and metacognitive, applied by students are featured. It is demonstrated that engagement of metacognitive processes is of crucial importance, firstly for developing efficient learning strategies and then for achieving better quality outcomes of educational process. Metacognition is treated in some studies as a process parallel to cognition and accordingly, distinction is made between cognitive and metacognitive learning strategies. But metacognitive processes are also often treated as intrinsic factors acting in the process of developing and using cognitive strategies in learning and they determine features and quality of those strategies and their effects. Some prospects for further intervening trends in the process of teaching are presented using the findings. It is emphasized that influence exerted by social environment i.e. school setting where the process of learning is going on can not be disregarded.

  9. Development Strategy of Sugarcane Industry in Guangdong Province

    CHEN Yue-gui; WU Jian-tao; YANG Jun-xian; LI Qi-wei; XIE Jing; PAN Fang-yin; WU Wen-long; LIU Fu-ye; DENG Hai-hua; QI Yong-wen


    Guangdong Province is one of the main producing areas of sugarcane in China, and one of China’s three regions with dominant advantage in sugarcane, having good basis and conditions for developing sugarcane industry. In this research, using the SWOT-AHP method, we set 20 assessment indicators (such as the regions with dominant advantage in sugarcane, huge demand for domestic sugar, increased production costs and backward system of sugarcane), to analyze the development strategy of sugarcane industry in Guangdong Province, from strengths, weaknesses, opportunities and challenges of sugarcane industrial development in Guangdong Province. The results show that in order to promote the development of sugarcane industry in Guangdong Province, it is necessary to adopt the SO development strategy (relying on its own strengths and using favorable external environment), to achieve the rapid development.

  10. A study on the science instructional strategy to develop metacognition

    Kinoshita, Hiroyoshi

    The aims of this study are to reveal the actual condition of metacognition of elementary schoolchildren and junior high school students in observation/experiment activities, and to elaborate the instructional strategy to develop metacognition of elementary schoolchildren and junior high school students. In order to achieve the aim of this study, a questionnaire survey was conducted comprising 14 items for elementary schoolchildren and junior high school students. The instructional strategy was elaborated based on the result of metacognition of elementary schoolchildren and junior high school students. The elaborated instructional strategy adopted five methods, as follows: (1) instruction of the self-control strategies, (2) bulletining the learning plan, (3) improvement of questioning techniques, (4) utilization of flash cards, (5) devising worksheets.

  11. Conditions and strategies for integrating ergonomics into product development

    Broberg, Ole


    Ergonomics considerations at the stage of product development in industry is a major strategy for prevention of work-related injuries and illnesses among employees at the time of manufacture of new products. This study elucidates some important conditions and possibilities for integrating...... such considerations during the product development process. Special attention is paid to the role of design and production engineers. Based on different understandings of the product development process four approaches to integration of ergonomics are outlined....

  12. Development and monitoring of a novel monoclonal antibody purification strategy

    Capito, Florian


    The studies presented in the cumulative part of this thesis illustrate the different steps to develop a polymer-driven antibody purification process. These peer-reviewed reports show in detail fundamental research, additional method development useful in the development of such a purification process as well as implementation of the final process. A strategy for analyzing copolymers, synthesized by a lab in house, was implemented with particular emphasis on copolymer composition analysis. Thi...

  13. Increasing loyalty to breastfeeding: investigating a product development strategy.

    Parkinson, Joy; Russell-Bennett, Rebekah; Previte, Josephine


    This article demonstrates how social marketing insights were used to influence women's loyalty to breastfeeding. The article reports on a social marketing campaign undertaken by the Australian Breastfeeding Association and a government health department, which used a product development strategy in order to increase breastfeeding loyalty. Seeking new approaches to support breastfeeding behaviors is critical and timely, because while initiation rates of breastfeeding are high in developed countries such as the United Kingdom, Australia, Canada, and the United States, duration rates are significantly lower. Results indicate that a product- focused strategy influences pregnant women's loyalty to exclusively breastfeeding.

  14. Evolution of technology for automated peritoneal dialysis.

    Ronco, Claudio; Amerling, Richard; Dell'aquila, Roberto; Rodighiero, Maria Pia; Di Loreto, Pierluigi


    Automated peritoneal dialysis (APD) is important for the further penetration of PD in the dialysis marketplace. Long dwell, equilibration PD (CAPD) has limited applicability in many patients due to inadequate solute clearance or fast membrane transport characteristics. Providing large volumes of dialysate over circumscribed hours is highly labor intensive without an automated system. Early attempts at APD were crude but effective in reducing labor, which was generally provided by nursing staff. Later evolution of PD technology has been greatly accelerated by the microchip, and by miniaturization of components. Current generation machines allow individualized fill volumes, variable tidal volumes and additional daytime automated exchanges, teledialysis, memorized delivery control, and full portability. The ideal machine should not only be able to perform all treatment schedules, but it should also optimize the performance of a selected treatment strategy. Biocompatible solutions, improved osmotic agents, and sorbent technology are all adaptable to APD. The eventual evolution toward continuous flow PD will resolve many of the current problems with both CAPD and APD.

  15. A Qualitative Assessment of Mismatch Between Dialysis Modality Selection and Initiation.

    Ziolkowski, Susan; Liebman, Scott


    At our institution, we have noted that end-stage renal disease patients choosing a home dialysis modality after education often initiate renal replacement therapy with in-center hemodialysis (HD) instead. We interviewed 24 such patients (23 choosing peritoneal dialysis [PD], one choosing home HD) to determine reasons for this mismatch. The most common reasons cited for not starting home dialysis were: lack of confidence/concerns about complications, lack of space or home-related issues, a feeling of insufficient education, and perceived medical or social contraindications. We propose several potential strategies to help patients start with their preferred modality.

  16. Desenvolvimento e avaliação da esterilidade de sistema de diálise peritoneal pediátrico fechado Development and assessment of sterility of a closed-system pediatric peritoneal dialysis

    Ana Paula Pereira Biazi


    Full Text Available OBJETIVO: Desenvolver um sistema de diálise peritoneal pediátrico totalmente fechado, de fácil manejo e avaliar o nível de garantia de esterilidade. MÉTODOS: No período de fevereiro a dezembro de 2008, foi idealizado e desenvolvido junto ao Setor de Bioengenharia da Braile Biomédica Indústria, Comércio e Representações S/A® um sistema de diálise peritoneal pediátrico fechado. Foram construídos 20 sistemas submetidos a testes quanto à garantia do nível de esterilidade, sendo divididos em grupo A (n=10, utilizando-se teste de esterilidade, e B (n=10, penetração do gás óxido de etileno. RESULTADOS: No grupo A, o teste de esterilidade foi negativo para a proliferação de bactérias e fungos em 14 dias, em todos os sistemas. No grupo B, o teste de penetração de gás demonstrou que houve penetração de gás em todos os pontos avaliados. CONCLUSÃO: Foi possível desenvolver um novo sistema de diálise peritoneal pediátrico fechado de fácil manuseio e garantir sua esterilização.OBJECTIVE: To develop an easy-handling totally closed pediatric peritoneal dialysis system and assess the sterility assurance level. METHODS: From February to December 2008 was designed and developed a closed-system pediatric peritoneal dialysis at the Bioengineering Division of Braile Biomédica Indústria, Comércio e Representações S/A®. Twenty systems were manufactured and submitted to sterility assurance level testing, and were divided into Group A (10 - using the sterility test - and B (10 - ethylene oxide gas penetration. RESULTS: In Group A, the sterility test was negative for bacteria and fungi proliferation within 14 days in all systems. In Group B, the gas penetration test showed that there was gas penetration in all points assessed. CONCLUSIONS: It was possible to develop a new easy-handling closed-system pediatric peritoneal dialysis and ensure its sterility.

  17. Developing mobile educational apps: development strategies, tools and business models

    Serena Pastore

    Full Text Available The mobile world is a growing and evolving market in all its aspects from hardware, networks, operating systems and applications. Mobile applications or apps are becoming the new frontier of software development, since actual digital users use mobile devi ...


    Anas M. Fauzi


    Full Text Available Kampung Vannamei as shrimp cluster is being developed since 2004 by PT CP Prima, tbk Surabaya through Shrimp Culture Health Management transformation technology to several traditional farmers in Gresik, Lamongan, Tuban, and Madura areas. The research objectives aims to identify and mapping of stakeholder, to analyze interaction of stakeholders, to formulate strategy from internal and external environment factors and to set priority on strategy to develop sustainable and competitive shrimp cluster in the Kampung vannamei. Primary data was collected through stakeholders’ discussion forums, questionnaires, and interviews with relevant actors. Observations to the business unit also performed to determine the production and business conditions, particularly in capturing information about the threat and challenges. While the secondary data is used in policy documents national and local area statistics, and relevant literature. Analyses were performed by using the SRI International cluster pyramid, diamond porter’s analysis, SWOT and Matrix TOWS analysis, and analytical hierarchy process. Analyses were performed by the methods discussed in qualitative and descriptive. There are 7 strategies could be implemented to develop sustainable and competitive shrimp cluster. However, it is recommended to implement the strategy base on priority, which the first priority is strategy to improve linkages between businesses in the upstream and downstream industries into multi stakeholders’ platform in shrimp industry.Keywords: Shrimp, Cluster, Competitiveness, Diamond Porter, SWOT Analysis, AHP

  19. Effective strategies for development of thermal heavy oil field facilities

    Davis, Ken; Lehnert-Thiel, Gunter [IMV Projects (Canada)


    In thermal heavy oil, a significant part of the capital has to be invested in field facilities and therefore strategies have to be implemented to optimize these costs. Field facilities consist of pipelines, earthworks and production pads whose purpose is to connect an oilsands reservoir to a central processing facility. This paper, presented by IMV Projects, a leading company in the thermal heavy oil field, highlights strategies to manage field facility lifecycle cost. Upfront planning should be done and the development of field facilities should be thought of as a long term infrastructure program rather than a stand-alone project. In addition, templates should be developed to save money and repeatability should be implemented to obtain a better prediction of the program's costs. The strategies presented herein allow major savings over the program's life by implementing an improved schedule and allowing refinements all along the program's course.

  20. Intermittent Oral Versus Intravenous Alfacalcidol in Dialysis Patients

    Mitwalli Ahmed


    Full Text Available Patients with end-stage renal failure (ESRF on maintenance dialysis, commonly develop secondary hyperparathyroidism and renal osteodystrophy (ROD. Alfacalcidol, taken orally or administered intravenously, is known to reverse these complications. In this study, 19 ESRF patients, who were on dialysis (13 on hemodialysis and six on peritoneal dialysis for longer than six months and having serum parathormone levels at least four times normal and serum calcium less than 2.1 mmol/L, were randomly allocated to treatment with oral or intravenous (i.v. alfacalcidol for a period of 12 months. There were six patients on hemodialysis (HD and three on peritoneal dialysis (PD in the oral treatment group while in the i.v. group there were seven patients on HD and three on PD. Clinical and serial biochemical assessments showed no statistically significant difference between the orally- and i.v.-treated patients in terms of suppressing secondary hyperparathyroidism and osteodystrophy. However, patients with features of mild ROD on bone histology, had more satisfactory changes in biochemistry when compared to others. Our results further support the use of intermittent oral alfacalcidol in ESRF patients because of its cost effectiveness, ease of administration and convenience, especially for peritoneal dialysis patients.

  1. How to Develop Reading Strategies in Extensive Reading



    Extensive reading demands readers to read in quantity for general, overall meaning, and for information. Learners are supposed to know how to choose appropriate reading tactics in accordance with different reading purposes. This paper mainly proposes some effective strategies to develop learners' reading skills and competency.

  2. Participatory Development Strategies for Open Source Content Management Systems

    Panke, Stefanie; Kohls, Christian; Gaiser, Birgit


    Stefanie Panke, Christian Kohls, and Birgit Gaiser maintain that effective strategies for the development of educational technology can only arise when the process is understood, analyzed, and assessed as a social phenomenon, and when the experience of users is integrated within the design process. To illustrate, they describe the early…

  3. Strategies Used by Superintendents in Developing Leadership Teams

    Morse, Michelle M.


    The purpose of this study was to determine the strategies public school superintendents across the nation use to develop executive leadership teams. Extensive research has been conducted in private for profit and medical settings, however relatively little research on leading teams has been conducted in the public education sector. Research based…

  4. Developing Reading-Writing Connections: Strategies from "The Reading Teacher."

    Rasinski, Timothy V., Ed.; Padak, Nancy D., Ed.; Church, Brenda Weible, Ed.; Fawcett, Gay, Ed.; Hendershot, Judith, Ed.; Henry, Justina M., Ed.; Moss, Barbara G., Ed.; Peck, Jacqueline K., Ed.; Pryor, Elizabeth, Ed.; Roskos, Kathleen A., Ed.

    Using literature in the classroom yields rewards. Literature for children is being recognized as increasingly important in children's literacy development. The ideas, resources, and activities offered in this collection of 43 articles published in "The Reading Teacher" from 1993 to 1999 provide strategies that are engaging and effective for all…

  5. Vocabulary Developing Strategies Applied to Individuals with Hearing Impairments

    Karasu, Guzin; Girgin, Umit; Uzuner, Yildiz; Kaya, Zehranur


    The general purpose of this research was to investigate the strategies utilized for vocabulary development of ten individuals (first year college students) in Graphic Art Department, School for The Handicapped, Anadolu University with hearing impairment. The reflective and cyclical data were consisted of videotape recordings of the actual lessons,…

  6. Developing Reading-Writing Connections: Strategies from "The Reading Teacher."

    Rasinski, Timothy V., Ed.; Padak, Nancy D., Ed.; Church, Brenda Weible, Ed.; Fawcett, Gay, Ed.; Hendershot, Judith, Ed.; Henry, Justina M., Ed.; Moss, Barbara G., Ed.; Peck, Jacqueline K., Ed.; Pryor, Elizabeth, Ed.; Roskos, Kathleen A., Ed.

    Using literature in the classroom yields rewards. Literature for children is being recognized as increasingly important in children's literacy development. The ideas, resources, and activities offered in this collection of 43 articles published in "The Reading Teacher" from 1993 to 1999 provide strategies that are engaging and effective…

  7. Modeling Coherent Strategies for the Sustainable Development Goals

    Walsh, B.; Obersteiner, M.; Herrero, M.; Riahi, K.; Fritz, S.; van Vuuren, D.; Havlik, P.


    The Sustainable Development Goals (SDGs) call for a comprehensive new approach to development rooted in planetary boundaries, equity and inclusivity. Societies have largely responded to this call with siloed strategies capable of making progress on selected subsets of these goals. However, agendas crafted specifically to alleviate poverty, hunger, deforestation, biodiversity loss, or other ills may doom the SDG agenda, as policies and strategies designed to accomplish one or several goals can impede and in some cases reverse progress toward others at national, regional, and global levels. We adopt a comprehensive modeling approach to understand the basis for tradeoffs among environmental conservation initiatives (goals 13-15) and food prices (goal 2). We show that such tradeoffs are manifestations of policy-driven pressure in land (i.e. agricultural and environmental) systems. By reducing total land system pressure, Sustainable Consumption and Production (SCP, goal 12) policies minimize tradeoffs and should therefore be regarded as necessary conditions for achieving multiple SDGs. SDG strategies constructed around SCP policies escape problem-shifting, which has long placed global development and conservation agendas at odds. We expect that this and future systems analyses will allow policymakers to negotiate tradeoffs and exploit synergies as they assemble sustainable development strategies equal in scope to the ambition of the SDGs.

  8. Developing Relevant Teaching Strategies during In-Service Training

    Borghi, Lidia; De Ambrosis, Anna; Mascheretti, Paolo


    The research reported here focuses on links between teachers' comprehension of the underlying physics and their development of educational strategies for classroom work during in-service training. It deals with the teaching of hydrostatics, a topic considered particularly interesting by teachers. Starting from the analysis of simple experiments…

  9. State Sector Strategies: The New Workforce Development in the USA

    Lakes, Richard D.


    Neoliberal governments consider global business competitiveness to be thwarted by costly bureaucratic regulation and programme duplication. In an effort to downsize the costs of operating a state, the governors now streamline job training functions via a coordinated workforce and economic development effort known as sector strategies, with…

  10. FEMP Fiscal Year 1999 ESPC Business Strategy Development Summary Report

    Mcmordie, Katherine; Hunt, W. D.


    This report summarizes the objectives, activities, products, and recommendations of the ESPC Business Strategy Development project. The objective of this project was to assist DOE FEMP in defining the potential Federal sector market for FEMP-offered alternative financing services with a focus on Super-Energy Savings Performance Contracts (Super-ESPCs).

  11. Development of Fraction Comparison Strategies: A Latent Transition Analysis.

    Rinne, Luke F; Ye, Ai; Jordan, Nancy C


    The present study investigated the development of fraction comparison strategies through a longitudinal analysis of children's responses to a fraction comparison task in 4th through 6th grades (N = 394). Participants were asked to choose the larger value for 24 fraction pairs blocked by fraction type. Latent class analysis of performance over item blocks showed that most children initially exhibited a "whole number bias," indicating that larger numbers in numerators and denominators produce larger fraction values. However, some children instead chose fractions with smaller numerators and denominators, demonstrating a partial understanding that smaller numbers can yield larger fractions. Latent transition analysis showed that most children eventually adopted normative comparison strategies. Children who exhibited a partial understanding by choosing fractions with smaller numbers were more likely to adopt normative comparison strategies earlier than those with larger number biases. Controlling for general math achievement and other cognitive abilities, whole number line estimation accuracy predicted the probability of transitioning to normative comparison strategies. Exploratory factor analyses showed that over time, children appeared to increasingly represent fractions as discrete magnitudes when simpler strategies were unavailable. These results support the integrated theory of numerical development, which posits that an understanding of numbers as magnitudes unifies the process of learning whole numbers and fractions. The findings contrast with conceptual change theories, which propose that children must move from a view of numbers as counting units to a new view that accommodates fractions to overcome whole number bias. (PsycINFO Database Record

  12. Nutritional assessment of elderly patients on dialysis: pitfalls and potentials for practice.

    Rodrigues, Juliana; Cuppari, Lilian; Campbell, Katrina L; Avesani, Carla Maria


    The chronic kidney disease (CKD) population is aging. Currently a high percentage of patients treated on dialysis are older than 65 years. As patients get older, several conditions contribute to the development of malnutrition, namely protein energy wasting (PEW), which may be compounded by nutritional disturbances associated with CKD and from the dialysis procedure. Therefore, elderly patients on dialysis are vulnerable to the development of PEW and awareness of the identification and subsequent management of nutritional status is of importance. In clinical practice, the nutritional assessment of patients on dialysis usually includes methods to assess PEW, such as the subjective global assessment, the malnutrition inflammation score, and anthropometric and laboratory parameters. Studies investigating measures of nutritional status specifically tailored to the elderly on dialysis are scarce. Therefore, the same methods and cutoffs used for the general adult population on dialysis are applied to the elderly. Considering this scenario, the aim of this review is to discuss specific considerations for nutritional assessment of elderly patients on dialysis addressing specific shortcomings on the interpretation of markers, in addition to providing clinical practice guidance to assess the nutritional status of elderly patients on dialysis.

  13. Phosphorus balance with daily dialysis.

    Kooienga, Laura


    Hyperphosphatemia is an almost universal finding in patients with end-stage renal disease and is associated with increased all-cause mortality, cardiovascular mortality, and vascular calcification. These associations have raised the question of whether reducing phosphorus levels could result in improved survival. In light of the recent findings that increased per-session dialysis dose, as assessed by urea kinetics, did not result in improved survival, the definition of adequacy of dialysis should be re-evaluated and consideration given to alternative markers. Two alternatives to conventional thrice weekly dialysis (CHD) are nocturnal hemodialysis (NHD) and short daily hemodialysis (SDHD). The elimination kinetics of phosphorus as they relate to these alternative daily dialysis schedules and the clinical implications of overall phosphorus balance are discussed here. The total weekly phosphorus removal with NHD is more than twice that removed by CHD (4985 mg/week +/- 1827 mg vs. 2347 mg/week +/- 697 mg) and this is associated with a significantly lower average serum phosphorous (4.0 mg/dl vs. 6.5 mg/dl). In spite of the observed increase in protein and phosphorus intake seen in patients on SDHD, phosphate binder requirements and serum phosphorus levels are generally stable to decrease although this effect is strongly dependent on the frequency and overall treatment time.

  14. Pulmonary hypertension in dialysis patients.

    Kosmadakis, George; Aguilera, Didier; Carceles, Odette; Da Costa Correia, Enrique; Boletis, Ioannis


    Pulmonary hypertension in end-stage renal disease patients is associated with significantly increased morbidity and mortality. The prevalence of pulmonary hypertension in dialysis patients is relatively high and varies in different studies from 17% to 49.53% depending on the mode of dialysis and other selection factors, such as the presence of other cardiovascular comorbidities. The etiopathogenic mechanisms that have been studied in relatively small studies mainly include arteriovenous fistula-induced increased cardiac output, which cannot be accomodated by, the spacious under normal conditions pulmonary circulation. Additionally, pulmonary vessels show signs of endothelial dysfunction, dysregulation of vascular tone due to an imbalance in vasoactive substances, and local as well as systemic inflammation. It is also believed that microbubbles escaping from the dialysis circuit can trigger vasoconstriction and vascular sclerosis. The non-specific therapeutic options that proved to be beneficial in pulmonary artery pressure reduction are endothelin inhibitors, phosphodiesterase inhibitor sildenafil, and vasodilatory prostaglandins in various forms. The specific modes of treatment are renal transplantation, size reduction or closure of high-flow arteriovenous fistulas, and transfer from hemodialysis to peritoneal dialysis-a modality that is associated with a lesser prevalence of pulmonary hypertension.

  15. Managing scientists leadership strategies in research and development

    Sapienza, Alice M


    Managing Scientists Leadership Strategies in Research and Development Alice M. Sapienza "I found ...this book to be exciting ...Speaking as someone who has spent 30 years grappling with these issues, I certainly would be a customer." -Robert I. Taber, PhD Senior Vice President of Research & Development Synaptic Pharmaceutical Corporation In today's climate of enormous scientific and technologic competition, it is more crucial than ever that scientists involved in research and development be managed well. Often trained as individual researchers, scientists can find integration into teams difficult. Managers, from both scientific and nonscientific backgrounds, who are responsible for these teams frequently find effective team building a long and challenging process. Managing Scientists offers strategies for fostering communication and collaboration among scientists. It shows how to build cohesive, productive, and focused teams to succeed in the competitive research and development marketplace. This book wil...

  16. Patient-Centered Dialysis Care: Depression, Pain, and Quality of Life.

    Weisbord, Steven D


    Remarkable advancements have been made in the provision of chronic dialysis therapy since its inception decades ago. A series of studies inform current dialysis dosing recommendations, while advancements in strategies to treat mineral and bone disease, acid-base and electrolyte disturbances, and anemia have facilitated the management of these well-recognized complications of ESRD. The collective result has been a model of chronic dialysis care focused principally on the achievement of metabolic and dialysis-related targets. In fact, guidelines such as the Kidney Disease Outcomes Quality Initiative put forth by the National Kidney Foundation recommend metrics that characterize successful dialysis care, including the attainment of specific solute clearance targets; maintenance of hemoglobin, calcium, phosphorous, and parathyroid hormone levels within target ranges; and the preferred use of primary arteriovenous fistulae for vascular access. This focus on serologic and dialysis-specific outcomes has helped renal providers manage the biochemical effects related to the loss of kidney function and has reduced ESRD-related morbidity and mortality. Yet, absent from this model of care is an emphasis on the treatment of bothersome symptoms and the impact of such treatment on quality of life (QOL). Among the many symptoms that affect patients on chronic dialysis, depression and pain are particularly common, strongly associated with decrements in QOL, and potentially treatable. This review discusses key research findings and unanswered questions pertaining to the prevalence, significance, and treatment of depression and pain and the effect of such treatment on QOL in patients dependent on chronic dialysis, with the broad goal of incorporating symptom management strategies into a paradigm of patient-centered dialysis care. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

  17. [New dialysis therapy modalities: what role do they play in the hemodialysis patient's outcome?].

    Mandolfo, S; Imbasciati, E


    Many studies have been devoted to investigating new techniques and new dialysis strategies aimed at achieving adequate removal of "uremic toxins". Conversely, few studies focus on the effect of different dialysis techniques on long-term outcome, including large series and with adequate follow-up. Dialysis dose, membrane biocompatibility and permeability, convective techniques, and the number and duration of dialysis sessions have all been considered as potentially related to patient outcome. The available data from the literature clearly show a significant relationship between the urea kinetic model based dialysis delivered and long-term patient outcome. A significant positive correlation between survival and Kt/V up to 1.3 per session in patients treated three times a week with standard low flux cellulosic dialyzers has been shown. Many studies have shown an effect of high flux membranes on the appearance of symptoms related to dialysis amyloidosis. It is likely that such an effect is further enhanced by convective or mixed techniques. The role of these techniques in patient survival is suggested by some studies, but should be confirmed in larger series. The use of techniques suitable for ultra-pure dialysis fluids are mandatory whenever high permeability membranes are used. Treatment schedules which include long dialysis sessions or an increased number of sessions such as daily dialysis, seem to be beneficial for the control of hypertension or hyperphosphatemia. However, their role on patient survival has not yet been clearly assessed. Together with the choice of the best strategy, great attention should be paid to other factors known to be related to patient outcome, such as early patient referral, and the type and efficiency of vascular access.

  18. Suitable Strategies for the Development of Sahoolan Watery Cave Geotourism

    H Nouri; N. Moradi Hovasin; M. Khoshnazar


    Extended abstract1-IntroductionToday, tourism is one of the largest and most beneficial industries in the world and in many countries it is used as a development strategy. Geotourism or geological tourism is emerging as a new global phenomenon. It is a form of natural area tourism that specifically focuses on geology and landscape. Because of appropriate planning and recognizing advantages and limitations, this kind of tourism can play an important role in the national development and diversi...

  19. Developing green supply chain management strategies: A taxonomic approach

    Michael Mutingi


    Purpose: The objective of this research is to explore the empirical green supply chain activities found in literature, and to develop a taxonomic framework that can be used for formulating appropriate strategies for green supply chains, based on characteristic dimensions for the green supply chain. Design/methodology/approach: The taxonomic framework is developed through (i) analysis of green supply chain activities found in existing empirical work or case studies recorded in literature, (ii)...

  20. Purification of dialysis fluid: historical background and perspective.

    Ledebo, Ingrid


    When dialysis became a chronic therapy, certain clinical symptoms could be connected to the fluid quality and some form of water treatment had to be introduced. The required equipment was empirically developed and consisted of sedimentation filters, carbon filters and softeners. In the mid-1970s the toxic effect of aluminum accumulation was discovered and led to the introduction of reverse osmosis modules. When these components - prefilters, softeners and RO modules - are properly maintained, they produce water of a quality that should meet modern standards. However, the water quality could be ruined by bacterial contamination from the distribution pipes, unless the entire flow path is hygienically designed and frequently disinfected. The quality of the concentrate is also important, especially the bicarbonate component which is prone to bacterial growth. The extent of the microbiological burden in water and dialysis fluid has been brought to the attention of the dialysis community through new and sensitive detection and quantification methods for bacteria and endotoxin.

  1. Game Development as Didactic Strategy for Biochemistry Teaching

    G. G. Hornink


    It is well known that students and teachers have difficulties in learning and teaching Biochemistry due to its abstract and interconnected contents. This work proposes a didactic strategy in order to facilitate teaching and learning process in Biochemistry. The strategy was implemented with biological science undergraduate students. At first, the students were divided into groups with a specific topic to develop a game. During the semester, problem based learning cases, online activities like...

  2. Developing competitive marketing and sales strategy for HS-Eden

    Dragusha, Cajup


    Start-ups are faced with variety of challenges and uncertainty therefore comprehensive marketing and sales strategy must be in place to make sure that limited resources are spend wisely in order to minimize uncertainty and pave a path that would lead to successful business. HS Eden is a new-start-up venture created in Lappeenranta University of Technology with an ambition to develop AMB systems for commercial use. The aim of this study was to build a marketing and sales strategy to help HS-Ed...

  3. A Patient on Peritoneal Dialysis with Refractory Volume Overload


    The management of volume in patients with diabetes on peritoneal dialysis is affected by several factors, including the degree of residual renal function, peritoneal membrane small-solute transport, salt and water intake, blood sugar control, comorbidity, and nutritional status. It requires sequential evaluation of volume status and adjustment of the peritoneal dialysis prescription on the basis of assessments of membrane function and alterations in urine volume. Steps should be taken to preserve residual renal function for as long as possible. Ultimately, in patients who have become anuric and have developed ultrafiltration failure, timely transfer to hemodialysis may be necessary, requiring discussion and planning with the patient. PMID:26185264

  4. Epidemiology, diagnosis and management of hypertension among patients on chronic dialysis.

    Georgianos, Panagiotis I; Agarwal, Rajiv


    The diagnosis and management of hypertension among patients on chronic dialysis is challenging. Routine peridialytic blood pressure recordings are unable to accurately diagnose hypertension and stratify cardiovascular risk. By contrast, blood pressure recordings taken outside the dialysis setting exhibit clear prognostic associations with survival and might facilitate the diagnosis and long-term management of hypertension. Once accurately diagnosed, management of hypertension in individuals on chronic dialysis should initially involve non-pharmacological strategies to control volume overload. Accordingly, first-line strategies should focus on achieving dry weight, individualizing dialysate sodium concentrations and ensuring dialysis sessions are at least 4 h in duration. If blood pressure remains unresponsive to volume management strategies, pharmacological treatment is required. The choice of appropriate antihypertensive regimen should be individualized taking into account the efficacy, safety, and pharmacokinetic properties of the antihypertensive medications as well as any comorbid conditions and the overall risk profile of the patient. In contrast to their effects in the general hypertensive population, emerging evidence suggests that β-blockers might offer the greatest cardioprotection in hypertensive patients on dialysis. In this Review, we discuss estimates of the epidemiology of hypertension in the dialysis population as well as the challenges in diagnosing and managing hypertension among these patients.

  5. Reproductive strategy, sexual development and attraction to facial characteristics.

    Cornwell, R Elisabeth; Law Smith, Miriam J; Boothroyd, Lynda G; Moore, Fhionna R; Davis, Hasker P; Stirrat, Michael; Tiddeman, Bernard; Perrett, David I


    Sexual reproduction strategies vary both between and within species in the level of investment in offspring. Life-history theories suggest that the rate of sexual maturation is critically linked to reproductive strategy, with high investment being associated with few offspring and delayed maturation. For humans, age of puberty and age of first sex are two developmental milestones that have been associated with reproductive strategies. Stress during early development can retard or accelerate sexual maturation and reproduction. Early age of menarche is associated with absence of younger siblings, absence of a father figure during early life and increased weight. Father absence during early life is also associated with early marriage, pregnancy and divorce. Choice of partner characteristics is critical to successful implementation of sexual strategies. It has been suggested that sexually dimorphic traits (including those evident in the face) signal high-quality immune function and reproductive status. Masculinity in males has also been associated with low investment in mate and offspring. Thus, women's reproductive strategy should be matched to the probability of male investment, hence to male masculinity. Our review leads us to predict associations between the rate of sexual maturation and adult preferences for facial characteristics (enhanced sexual dimorphism and attractiveness). We find for men, engaging in sex at an early age is related to an increased preference for feminized female faces. Similarly, for women, the earlier the age of first sex the greater the preference for masculinity in opposite-sex faces. When we controlled sexual dimorphism in male faces, the speed of sexual development in women was not associated with differences in preference for male facial attractiveness. These developmental influences on partner choice were not mediated by self-rated attractiveness or parental relationships. We conclude that individuals assort in preferences based on

  6. Surveillance and Monitoring of Dialysis Access

    Lalathaksha Kumbar


    Full Text Available Vascular access is the lifeline of a hemodialysis patient. Currently arteriovenous fistula and graft are considered the permanent options for vascular access. Monitoring and surveillance of vascular access are an integral part of the care of hemodialysis patient. Although different techniques and methods are available for identifying access dysfunction, the scientific evidence for the optimal methodology is lacking. A small number of randomized controlled trials have been performed evaluating different surveillance techniques. We performed a study of the recent literature published in the PUBMED, to review the scientific evidence on different methodologies currently being used for surveillance and monitoring and their impact on the care of the dialysis access. The limited randomized studies especially involving fistulae and small sample size of the published studies with conflicting results highlight the need for a larger multicentered randomized study with hard clinical end points to evaluate the optimal surveillance strategy for both fistula and graft.

  7. The Northern Philippine Sea: A Bioregional Development Communication Strategy

    Marivic G. Pajaro


    Full Text Available The Philippine marine management challenge requires a scaled up ecosystem approach to the biodiversity-based bioregional level used in marine spatial planning. The related communication challenge is being addressed by a currently informal consortium that includes non-government organizations, local government units, as well as state colleges and universities. The evolving communication strategy described here is focused upon considerations that include local government mandates, status of marine development, provinceby- province assessment of coastal economies, cultural relevance, academic programming, and the need for national inputs on counterpart funding. The current work provides a possible model for Philippine application in all marine bioregions. The concept of the bioregional approach was systematically advocated across one bioregion, the Northern Philippine Sea. The Philippine strategy of development communication was used as a template to promote the development of a bioregional approach by establishing an initial level of participation involving the provincial governments as well as the state universities and colleges.

  8. Cognitive impact of social stress and coping strategy throughout development.

    Snyder, Kevin P; Barry, Mark; Valentino, Rita J


    Stress experience during adolescence has been linked to the development of psychiatric disorders in adulthood, many of which are associated with impairments in prefrontal cortex function. The current study was designed to determine the immediate and enduring effects of repeated social stress on a prefrontal cortex-dependent cognitive task. Early adolescent (P28), mid-adolescent (P42), and adult (P70) rats were exposed to resident-intruder stress for 5 days and tested in an operant strategy-shifting task (OSST) during the following week or several weeks later during adulthood. Engagement of prefrontal cortical neurons during the task was assessed by expression of the immediate early gene, c-fos. Social stress during adolescence had no immediate effects on task performance, but impaired strategy-shifting in adulthood, whereas social stress that occurred during adulthood had no effect. The cognitive impairment produced by adolescent social stress was most pronounced in rats with a passive coping strategy. Notably, strategy-shifting performance was positively correlated with medial prefrontal cortical c-fos in adulthood but not in adolescence, suggesting that the task engages different brain regions in adolescents compared to adults. Adolescent social stress produces a protracted impairment in prefrontal cortex-mediated cognition that is related to coping strategy. This impairment may be selectively expressed in adulthood because prefrontal cortical activity is integral to task performance at this age but not during adolescence.

  9. Mobile learning: a workforce development strategy for nurse supervisors.

    Mather, Carey; Cummings, Elizabeth


    Digital technology provides opportunities for using mobile learning strategies in healthcare environments. To realise the vision of the National Workforce Development Strategy there needs to be innovation of health professionals to further develop knowledge and skills of clinical supervisors to access and gain an understanding of the value of mobile learning at the workplace. The use of digital technology by clinical supervisors was explored in 2012 as part of a teaching development grant to evaluate the use of Web 2.0 technology to develop a community of practice about clinical supervision. Prior to developing the virtual network of clinical supervisors, feedback about the use of Web 2.0 technology by clinicians was sought via an online survey. Over 90% of respondents used social media, 85% understood what a blog and wiki were and approximately half of the respondents used smart phones. More than one-third indicated they would participate in a virtual community of practice and would like to receive information about clinical facilitation at least once per week. Findings indicate both inhibitors and opportunities for workforce development within healthcare environments that need to be addressed. Support of graduate-ready nurses can be achieved through an integrated outlook that enables health professionals within organisations to undertake mobile learning in situ. A flexible and collaborative approach to continuing professional development within organisations could enhance practice development and could positively impact on workforce development.

  10. PVC-piping promotes growth of Ralstonia pickettii in dialysis water treatment facilities.

    Dombrowsky, Matthias; Kirschner, Alexander; Sommer, Regina


    Biofilms forming inside dialysis water treatment systems are one of the main sources of microbiological contamination. Among the bacteria found in biofilms, Ralstonia pickettii is frequently encountered in dialysis water treatment systems and has been shown to develop extreme oligotrophic talents. In Austria, R. pickettii was exclusively detected in high numbers in dialysis water treatment facilities equipped with chlorinated polyvinyl chloride (PVC-C) piping. In this laboratory study it was shown that PVC-C effectively promotes growth of R. pickettii biofilms, while residual organic carbon in purified dialysis water is sufficient for promoting substantial growth of planktic R. pickettii. This provides evidence that PVC-C is an unsuitable material for piping in dialysis water treatment systems.

  11. Incorporating patient travel times in decisions about size and location of dialysis facilities.

    Eben-Chaime, M; Pliskin, J S


    This report demonstrates the power and usefulness of mathematical optimization as a decision support tool in the medical services industry by presenting an application to dialysis service planning. Models to predict the number of dialysis beds in a given region are usually population-based. Dialysis planners and providers have found a need to accommodate sparsely populated regions by making some allowance for patient travel times. A formal approach to incorporating travel times into dialysis planning, based on the formulation and solution of a mixed-integer programming model, is presented. The development of a method for dialysis planning serves as a platform to demonstrate the use of integer programming to support decision making. Major modeling principles are presented; output interpretation and sensitivity analysis are illustrated by examples; and computational requirements are discussed.

  12. Strategies for the development of CBM gas industry in China

    Fuyuan Mu


    Full Text Available Since the environment for the CBM development in China has been changing in recent years, it is necessary to re-consider the relevant strategies. Through investigations, surveys, geologic assessment, strategic decision-making and other techniques, the strategies for CBM development in China were discussed in respect to present situations, opportunities, challenges, proved reserves, producing reserves, strategic principles, strategic countermeasures, time-spatial allocation of strategies, risk assessments, and elimination of relevant risks. Some research results were obtained. Firstly, still in its initial development stage with fast growth, the CBM industry in China has made outstanding achievements in six aspects and also faces challenges in six aspects. Secondly, strategic focus can be summarized as constructing six CBM production bases in Qinshui, Eastern margin of Ordos Basin, Southwest China, Changqing, Northwest China, and Northeast China, respectively, according to the principles of “steadily developing middle-high rank coals, accelerating the development of low-rank coals and strengthening the comprehensive utilization of mining gas wells”. It is expected that the producing reserves and peak-production rate will be 3–4 trillion m3 and 35–45 billion m3/a, respectively. Thirdly, major strategic risks in CBM development in China include low productivities of individual wells, improper understandings of geologic conditions, decline in investments and lack of technical reserves. To eliminate these risks, it is necessary to reinforce work in the following five aspects, namely, strengthening comprehensive exploration and development of coal-bearing formations, creating favorable environments for the development of private oil companies, expanding spaces for the growth of technical service companies, conducting more researches for the development of innovative technologies in more areas and intensifying law enforcement.

  13. Game Development as Didactic Strategy for Biochemistry Teaching

    G.G. Hornink


    Full Text Available It is well known that students and teachers have difficulties in learning and teaching Biochemistry due to its abstract and interconnected contents. This work proposes a didactic strategy in order to facilitate teaching and learning process in Biochemistry. The strategy was implemented with biological science undergraduate students. At first, the students were divided into groups with a specific topic to develop a game. During the semester, problem based learning cases, online activities like crossword puzzle, essay questions and educational softwares were used to present the content of each topic. The groups were oriented in classroom and online, to choose and organize contents and create ways to approach them in games. At the end of the course the groups played each other games, which were evaluated by teacher and students following some criteria like: creativity, content organization, interdisciplinarity, proposal coherence, instructions clarity, specific content. The game elaboration contributed to the development of social and cognitive functions, such as teamwork and troubleshooting, providing an interesting perspective to the student about knowledge construction process. The strategy showed up students' creativity and ability to reorganize their knowledge to a different education level. In an overview, the results indicate that the proposed didactic strategy is an effective way to enhance learning and to motivate students into Biochemistry topics.

  14. Ecto-5' -Nucleotidase CD73 (NT5E), vitamin D receptor and FGF23 gene polymorphisms may play a role in the development of calcific uremic arteriolopathy in dialysis patients – Data from the German Calciphylaxis Registry

    Brandenburg, Vincent; Haun, Margot; Kollerits, Barbara; Kronenberg, Florian; Ketteler, Markus; Wanner, Christoph


    Introduction Calciphylaxis/calcific uremic arteriolopathy affects mainly end-stage kidney disease patients but is also associated with malignant disorders such as myeloma, melanoma and breast cancer. Genetic risk factors of calciphylaxis have never been studied before. Methods We investigated 10 target genes using a tagging SNP approach: the genes encoding CD73/ ecto-5'-nucleotidase (purinergic pathway), Matrix Gla protein, Fetuin A, Bone Gla protein, VKORC1 (all related to intrinsic calcification inhibition), calcium-sensing receptor, FGF23, Klotho, vitamin D receptor, stanniocalcin 1 (all related to CKD-MBD). 144 dialysis patients from the German calciphylaxis registry were compared with 370 dialysis patients without history of CUA. Genotyping was performed using iPLEX Gold MassARRAY(Sequenom, San Diego, USA), KASP genotyping chemistry (LGC, Teddington, Middlesex, UK) or sequencing. Statistical analysis comprised logistic regression analysis with adjustment for age and sex. Results 165 SNPs were finally analyzed and 6 SNPs were associated with higher probability for calciphylaxis (OR>1) in our cohort. Nine SNPs of three genes (CD73, FGF23 and Vitamin D receptor) reached nominal significance (p< 0.05), but did not reach statistical significance after correction for multiple testing. Of the CD73 gene, rs4431401 (OR = 1.71, 95%CI 1.08–2.17, p = 0.023) and rs9444348 (OR = 1.48, 95% CI 1.11–1.97, p = 0.008) were associated with a higher probability for CUA. Of the FGF23 and VDR genes, rs7310492, rs11063118, rs13312747 and rs17882106 were associated with a higher probability for CUA. Conclusion Polymorphisms in the genes encoding CD73, vitamin D receptor and FGF23 may play a role in calciphylaxis development. Although our study is the largest genetic study on calciphylaxis, it is limited by the low sample sizes. It therefore requires replication in other cohorts if available. PMID:28212442

  15. Timing for Removal of Peritoneal Dialysis Catheters in Pediatric Renal Transplant Patients.

    Melek, Engin; Baskın, Esra; Gülleroğlu, Kaan Savaş; Kırnap, Mahir; Moray, Gökhan; Haberal, Mehmet


    Peritoneal dialysis, the preferred long-term renal replacement modality in the pediatric population, can also be used during the post transplant period. Although it is well known that peritonitis or other complications may occur related to the peritoneal dialysis catheter, less is known about complications related to the peritoneal dialysis during the posttransplant period. Our objective was to evaluate the complications related to use of a peritoneal dialysis catheter during the posttransplant period and to determine the optimum time for removal of the peritoneal dialysis catheter. We retrospectively analyzed 33 chronic peritoneal dialysis patients. Pretransplant and posttransplant demographics and clinical and laboratory data for each patient were recorded, including incidence of peritonitis and incidence of peritoneal dialysis catheter requirement after transplant. Mean age of patients at transplant was 12.8 ± 4.0 years (range, 3.5-18.0 y). Mean catheter removal time was 81.1 ± 36.2 days (range, 22.0-152.0 d). The peritoneal dialysis catheter was used in 6 of 33 patients (18.2%); none of these patients developed peritonitis. In contrast, 2 of the 27 patients who did not use the peritoneal dialysis catheter developed peritonitis. Our data suggest that the need for catheter use occurs predominantly during the first month, and infectious complications usually happen later. Previously, the trend was to not remove the peritoneal dialysis catheter at the time of transplant. However, in light of recent literature and our present study, we recommend that the time of catheter removal should be modified and decided for each patient on an individual basis.

  16. Estimating residual kidney function in dialysis patients without urine collection.

    Shafi, Tariq; Michels, Wieneke M; Levey, Andrew S; Inker, Lesley A; Dekker, Friedo W; Krediet, Raymond T; Hoekstra, Tiny; Schwartz, George J; Eckfeldt, John H; Coresh, Josef


    Residual kidney function contributes substantially to solute clearance in dialysis patients but cannot be assessed without urine collection. We used serum filtration markers to develop dialysis-specific equations to estimate urinary urea clearance without the need for urine collection. In our development cohort, we measured 24-hour urine clearances under close supervision in 44 patients and validated these equations in 826 patients from the Netherlands Cooperative Study on the Adequacy of Dialysis. For the development and validation cohorts, median urinary urea clearance was 2.6 and 2.4 ml/min, respectively. During the 24-hour visit in the development cohort, serum β-trace protein concentrations remained in steady state but concentrations of all other markers increased. In the validation cohort, bias (median measured minus estimated clearance) was low for all equations. Precision was significantly better for β-trace protein and β2-microglobulin equations and the accuracy was significantly greater for β-trace protein, β2-microglobulin, and cystatin C equations, compared with the urea plus creatinine equation. Area under the receiver operator characteristic curve for detecting measured urinary urea clearance by equation-estimated urinary urea clearance (both 2 ml/min or more) were 0.821, 0.850, and 0.796 for β-trace protein, β2-microglobulin, and cystatin C equations, respectively; significantly greater than the 0.663 for the urea plus creatinine equation. Thus, residual renal function can be estimated in dialysis patients without urine collections.


    I. L. Kuchma


    Full Text Available In the effect prognosis of dialysis a possible adjustment of the modified potential death risk factors of patients who are on renal replacement therapy by hemodialysis techniques are discussed. The conclusions about the possibility of modern dialysis techniques to effectively influence on arterial hypertension of patients with chronic kidney disease stage 5 - D and the need for further study in order to develop treatment standards using mathematical models for individualised dialysis programs.

  18. Potential Role of Vegetarianism on Nutritional and Cardiovascular Status in Taiwanese Dialysis Patients: A Case-Control Study

    Shih-Hsiang Ou; Mei-Yin Chen; Chien-Wei Huang; Nai-Ching Chen; Chien-Hsing Wu; Chih-Yang Hsu; Kang-Ju Chou; Po-Tsang Lee; Hua-Chang Fang; Chien-Liang Chen


    Background & Objectives Cardiovascular disease remains the most common cause of death for patients on chronic dialysis. End stage renal disease patients undergoing dialysis imposed to reduce phosphorus intake, which likely contributes to development of vegetarian diet behaviors. Vegetarian diets are often lower in protein content, in contradiction to the recommendation that a high protein diet is followed by patients undergoing dialysis. The purpose of the study was to investigate the effects...

  19. [Health from the municipality: a strategy for development].

    Sotelo, J M; Rocabado, F


    Taking into account some aspects of the evolution of the health-illness concept, and considering that health depends on four elements--human biology, environment, life styles and health promotion with emphasis on well-being--the intersectorial action, the participation of the population in their own health care and the reorientation of services through the development of local health systems, are evaluated. At the same time mention is made of the importance of the decentralization process and the district's participation in the democratization of the civilian life. Considering all these aspects, the possibility of implementing the healthy district strategy as an alternative and facilitating form of development and well being and as a way to distribute health more equitably, is proposed. To increment the effects of this strategy, support for the creation of a regional movement of healthy districts is suggested.


    Sorokozheryev V. V.


    Full Text Available The round table of "anti-crisis strategy of regional development: myth or reality?", initiated and organized with the active participation of Financial University under the Government of the Russian Federation, the Ministry of economy of Krasnodar region, the Fund of "research and education initiatives of Kuban" was devoted to the problems of formation of viable development strategies, competitive system of management of economy of regions in modern conditions of the resource and investment restrictions, the drop in living standards of the bulk of the population and the overall stagnation of the economy. Almost all speakers, who represented Moscow, SaintPetersburg, a wide range of regions of Russia, and also coming from abroad, critically assessed the situation in the regional office and offered their recommendations on organization of an effective regional policy

  1. Developing and implementing the community nursing research strategy for Wales.

    Kenkre, Joyce; Wallace, Carolyn; Davies, Robyn; Bale, Sue; Thomas, Sue


    In order to obtain the best patient outcomes in community nursing, practice needs to be underpinned by robust research-based evidence. This article describes a Community Nursing Research Strategy developed and implemented in Wales to provide the nursing profession with the evidence to support future organisational and professional change in achieving excellence in the community. This was developed in partnership with education, research, health services, workforce planning and Government using consensus methodology (specifically, a nominal group technique). Consequently, the process was inclusive and included three steps: escalating presentation of ideas, topic debate and topic rating. The result was a strategy with four implementation strands, including a virtual network, research portfolio, application to practice and leadership.

  2. [The development of public health strategy with the purpose to develop human capital].

    Babenko, A I; Bravve, Iu I; Tomchuk, A L; Babenko, E A


    The article substantiates the necessity to develop public health strategy considering the processes of demographic, social, economic progression of society. The core issue in these conditions is human capital and its component--health capital as an integral reflection of different characteristics of population. The definitions of these notions in a social hygienic aspect are presented. The main stages of development of the health strategy such as formation of strategic planning elements, human capital valuation, population health and health capital losses, evaluation of potential demand in medical technologies, medical organizational measures implementation and their input into development of human capital are considered. These positions are supported as determinants of effectiveness of health strategy.

  3. Telecommunication companies strategy depending on their stage of development

    G. I. Tamoshina


    Full Text Available Telecommunication branch has an especial function in the economic of the country, because it major function is ensuring of the society's needs in information transmission. Depending on the companies' development degree on the market and also on the presence of the powerful local rival on the territory, the operator corresponds with definite group. The central strategy 4P (product, price, promotion, place adopts to the tasks which are actual for the concrete group.

  4. A Strategy for the Development of Macromolecular Nonlinear Optical Materials


    obsolete. SECURITY CLASSIFICATION OF THIS PAGE STRATEGY FOR THE DEVELOPMENT OF MACROMOLECULAR NONLINEAR OPTICAL MATERIALS Braja K. Mandala , Jan-Chan...materials is significantly different from the conventional inorganic NLO materials. The extent of second order (quadratic) NLO effect such as a criterion of paramount importance for a large second order electro-optic effect in organic materials 8 ,9 . The most common approach to obtain

  5. Developing an equitable and sustainable mobility strategy for Havana

    Warren, James; Morris, Emily; Enoch, Marcus; Padilla Magdaleno, Idalmis; Parra Arias, Zunilda; Guanche, Julia


    The particular political, economic and social conditions of the state of Cuba, in the Caribbean, have created unique possibilities for the development of a sustainable transport system in its capital city, Havana. This paper reports on the outcomes of a project to identify the possibilities and priorities for a long-term strategy for equitable and sustainable mobility for Havana. This involved almost 100 participants from Cuba and the UK in the 12 months from June 2013.\\ud \\ud Overall, the st...

  6. Analytical Concept: Development of a Multinational Information Strategy


    home of refugees because the UNHCR already has a resourced programme in place. THEME: "Acceptance of the Coalition" (Understanding of Coalition aims...gender or sex of a person. Page 61 of 106 UNCLASSIFIED FOR PUBLIC RELEASE – Development of a Multinational Information Strategy – MNIOE Analytical...constructive dialogue between all sides. − We are encouraging the local communities to accept refugees /IDPs on a temporary basis. We will support

  7. Human Sustainable Development in the Context of Europa 2020 Strategy

    Alina-Mihaela Ion


    Full Text Available Human development is a constant concern at European level. Thus, various programs have been proposed with the main objective of developing skills of citizens and informing them about training courses as part of lifelong learning and of employment in the labour market. The article highlights the evolution of European Union through the investments in human capital. The objective of this paper is represented by the analysis of the impact of sustainable human development through trans-disciplinary and inter-disciplinary education in the context of the European Union strategy proposed for the following period up to 2020. Europe 2020 represents a strategic plan for European Union development until 2020, having as main objective raising the standard of living and the quality of life for European citizens. Europe 2020 strategy promotes a new vision for the economy of European Union. For the following period until 2020 there is a major concern for creating favourable conditions for development of a sustainable intelligent economy that promotes inclusion. Some of the main activities with a major impact on creating such conditions are investments in education, research and innovation. The article analyses the current and recent past years’ situation in terms of sustainable development from educational and economic perspectives at European Union level. The analysis was done based on Eurostat data, using specific statistical methods.

  8. Maintenance of employment on dialysis.

    Rasgon, S; James-Rogers, A; Chemleski, B; Ledezma, M; Mercado, L; Besario, M; Trivedi, J; Miller, M; Dee, L; Pryor, L; Yeoh, H


    This article describes the components of a multidisciplinary effort focused on promoting, among other goals, continued employment during end-stage renal disease (ESRD) treatment. The education and guidance of the patient begin during the pre-ESRD period, intensify through dialysis treatment, and continue even through posttransplantation follow-up. Such focused programs support patients in retaining their usual lifestyle, staying in their current jobs where possible, and maximizing self-esteem and quality of life.

  9. Intraperitoneal pressure in peritoneal dialysis.

    Pérez Díaz, Vicente; Sanz Ballesteros, Sandra; Hernández García, Esther; Descalzo Casado, Elena; Herguedas Callejo, Irene; Ferrer Perales, Cristina


    The measure of intraperitoneal pressure in peritoneal dialysis is easy and provides clear therapeutic benefits. However it is measured only rarely in adult peritoneal dialysis units. This review aims to disseminate the usefulness of measuring intraperitoneal pressure. This measurement is performed in supine before initiating the drain of a manual exchange with "Y" system, by raising the drain bag and measuring from the mid-axillary line the height of the liquid column that rises from the patient. With typical values of 10-16 cmH2O, intraperitoneal pressure should never exceed 18 cmH2O. With basal values that depend on body mass index, it increases 1-3 cmH2O/L of intraperitoneal volume, and varies with posture and physical activity. Its increase causes discomfort, sleep and breathing disturbances, and has been linked to the occurrence of leaks, hernias, hydrothorax, gastro-esophageal reflux and enteric peritonitis. Less known and valued is its ability to decrease the effectiveness of dialysis significantly counteracting ultrafiltration and decreasing solute clearance to a smaller degree. Because of its easy measurement and potential utility, should be monitored in case of ultrafiltration failure to rule out its eventual contribution in some patients. Although not yet mentioned in the clinical practice guidelines for PD, its clear benefits justify its inclusion among the periodic measurements to consider for prescribing and monitoring peritoneal dialysis. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  10. Evaluation of Bacteriological and Chemical Quality of Dialysis Water and Fluid in Isfahan, Central Iran



    Full Text Available Background: Chemical and microbial quality of water used in hemodialysis play key roles in a number of dialysis-related complications. In order to avoid the complications and to guarantee safety and health of patients therefore, vigorous control of water quality is essential. The objective of present study was to investigate the chemical and bacteriological characteristics of water used in dialysis centers of five hospitals in Isfahan, central Iran.Methods: A total of 30 water samples from the input of dialysis purification system and dialysis water were analyzed for chemical parameters. Heterotrophic plate count and endotoxin concentration of drinking water, dialysis water and dialysis fluid of 40 machines were also monitored over a 5-month period in 2011-2012.Results: Concentration of the determined chemicals (copper, zinc, sulfate, fluoride, chloramines and free chlorine did not exceed the recommended concentration by the Association for the Advancement of Medical Instrumentation (AAMI exclude lead, nitrate, aluminum and calcium. Furthermore, the magnesium; cadmium and chromium concentration exceeded the maximum level in some centers. No contamination with heterotrophic bacteria was observed in all samples, while the AMMI standard for endotoxin level in dialysis fluid (<2 EU/ml was achieved in 95% of samples.Conclusion: Dialysis water and fluid failed to meet the all chemical and bacteriological requirements for hemodialysis. To minimize the risk of contaminants for hemodialysis patients therefore, a water quality management program including monitoring, maintenance and development of water treatment system in hemodialysis centers is extremely important. In addition, an appropriate disinfection program is needed to guarantee better control of bacterial growth and biofilm formation. Keywords: Dialysis water, Dialysis fluid, Chemical quality, Endotoxin, Heterotrophic bacteria 

  11. Prophylactic dialysis in non-dialysis-dependent patients with renal failure after CABG

    Roghayyeh Borji


    Conclusion: According the results of this study, prophylactic dialysis, before conduct-ing CABG, does not have any significant effect on mortality and other complications. The only exception is lung complications in non-dialysis-dependent patients with renal failure.

  12. [Guidelines for quality management of dialysis solutions].

    Pérez García, R; González Parra, E; Ceballos, F; Escallada Cotero, R; Gómez-Reino, Ma I; Martín-Rabadán, P; Pérez García, A; Ramírez Chamond, R; Sobrino, P E; Solozábal, C


    A Best Practice Guideline about Dialysis fluid purity has been developed under the leadership of the Spanish Society of Nephrology. The Guideline has established recommendations for standards for preparing dialysate: water, concentrates and hemodialysis proportioning systems. The Guideline was based on the European pharmacopoeia, the Real Farmacopea Española, the AAMI Standards and Recommended Practices, European Best Practice Guidelines for Haemodialysis (Section IV), literature reviews, according to their level of evidence, and the opinion of the expert spanish group. Two levels of quality of water were defined: purified water and high purified water (Ultra pure) and for dialysate: standard dialysate and ultra pure dialysate. Regular use of ultra pure dialysate is necessary for hemofiltration and hemodiafiltration on-line and desirable for high-flux hemodialysis to prevent and delay the occurrence of complications: inflammation, malnutrition, anemia and amyloidosis. Water, concentrates and dialysate quality requirements are defined as maximum allowable contaminant levels: chemicals (1.1.2), microbial and endotoxins: [table: see text] Monitoring frequency, maintenance and corrective actions were specified. Methods of sampling and analysis were described in appendix (Anexos). For microbiological monitoring, TSA or R2A medium are recommended, incubated during 5 days at a temperature of 30-35 degrees C. The dialysate quality assurance process involves all dialysis staff members and requires strict protocols. The physician in charge of hemodialysis has the ultimate responsibility for dialysate quality. All suggestions and questions about this Guideline are wellcome to

  13. Biocompatible Peritoneal Dialysis Fluids: Clinical Outcomes

    Yeoungjee Cho


    Full Text Available Peritoneal dialysis (PD is a preferred home dialysis modality and has a number of added advantages including improved initial patient survival and cost effectiveness over haemodialysis. Despite these benefits, uptake of PD remains relatively low, especially in developed countries. Wider implementation of PD is compromised by higher technique failure from infections (e.g., PD peritonitis and ultrafiltration failure. These are inevitable consequences of peritoneal injury, which is thought to result primarily from continuous exposure to PD fluids that are characterised by their “unphysiologic” composition. In order to overcome these barriers, a number of more biocompatible PD fluids, with neutral pH, low glucose degradation product content, and bicarbonate buffer have been manufactured over the past two decades. Several preclinical studies have demonstrated their benefit in terms of improvement in host cell defence, peritoneal membrane integrity, and cytokine profile. This paper aims to review randomised controlled trials assessing the use of biocompatible PD fluids and their effect on clinical outcomes.

  14. The developing strategy of Chinese magnesium and magnesium alloy

    ZUO; Tie-yong; DU; Wen-bo


    The status and developing strategy of Chinese magnesium industry are summarized in the present paper. The output and export of Chinese magnesium ingot have rapidly increased in the recent ten years, but the magnesium products with high value, such as the wrought magnesium alloys, and their applications are insufficient. Chinese magnesium industry should develop toward the direction of large scale, specialization and collectivization in the future. The enterprises should enhance the level of management and reinforce the international competing ability with the help of governmental policies.

  15. Strategy for the development of the eel fishery in Ireland

    Moriarty, C.


    In the course of a reply to a Parliamentary Question on eel in February 1997, the Minister stated that ‘there is considerable potential for development of the fishery and an integrated development strategy plan is being formulated’. The Marine Institute and other bodies were asked by the Department of the Marine to prepare a submission. The material which follows is based on the author’s work as a biologist, first in the fisheries service of the Government and, subsequently in the Marine Inst...

  16. Developing a Comprehensive Search Strategy for Evidence Based Systematic Reviews

    Sekhar Thadiparthi


    Full Text Available Objective ‐ Within the health care field it becomes ever more critical to conduct systematic reviews of the research literature to guide programmatic activities, policy‐making decisions, and future research. Conducting systematic reviews requires a comprehensive search of behavioural, social, and policy research to identify relevant literature. As a result, the validity of the systematic review findings and recommendations is partly a function of the quality of the systematic search of the literature. Therefore, a carefully thought out and organized plan for developing and testing a comprehensive search strategy should be followed. This paper uses the HIV/AIDS prevention literature to provide a framework for developing, testing, and conducting a comprehensive search strategy looking beyond RCTs.Methods ‐ Comprehensive search strategies, including automated and manual search techniques, were developed, tested, and implemented to locate published and unpublished citations in order to build a database of HIV/AIDS and sexually transmitted diseases (STD literature. The search incorporated various automated and manual search methods to decrease the chance of missing pertinent information. The automated search was implemented in MEDLINE, EMBASE,PsycINFO, Sociological Abstracts and AIDSLINE. These searches utilized both index terms as well as keywords including truncation, proximity, and phrases. The manual search method includes physically examining journals (hand searching, reference list checks, and researching key authors.Results ‐ Using automated and manual search components, the search strategy retrieved 17,493 articles about prevention of HIV/AIDS and STDs for the years 1988‐2005. The automated search found 91%, and the manual search contributed 9% of the articles reporting on HIV/AIDS or STD interventions with behavioural/biologic outcomes. Among the citations located with automated searches, 48% were found in only one database (20

  17. Horizontal integration in the development strategy of mining companies

    Jan Kudełko


    Full Text Available Integration strategy is one option in the development of mining companies and is implemented through a connection of either processes or economic entities which operate or may operate separately. Usually this strategy is carried out by companies that occupy a very strong competitive position. Considering its direction, it may be horizontal or vertical. Horizontal integration strategy stems from a desire to increase market share by an entrepreneur or create a new company based on common know-how and combined operational processes. It can be realized in an external dimension through a merger or takeover, as well as in the internal dimension based on its own resources. The external dimension is based on capital or contractual integration of a company with external economic entities performing related or conglomerate activity. The targets of such integration have a resource, a market effectiveness, or a competence nature. In the case of mining companies, it covers all important activity areas, including geology, mining, processing, environmental protection, and waste management, and is carried out with due diligence. In the internal dimension, the strategy of horizontal integration consists in consolidating the strategic targets of all business units around the company’s (corporation’s targets. The authors focused on two trends most relevant to pursuing a horizontal integration strategy, including increasing the company’s flexibility and undertaking joint activities. Flexibility consists in the potential ability of the company to adapt quickly to changed environment conditions. Joint activity includes co-operation of its respective units in terms of products, markets, and functions.

  18. The development scale of learning strategies used in piano lesson

    Özlem Kılınçer


    Full Text Available The aim of this study is to develop a valid and reliable measurement tool to designate the learning strategies exploited during the piano lesson by the answers of the students studying at the departments of music education. The sampling group is composed of 372 students of 5 music education departments around Turkey at second, third and fourth grades between 2010 and 2011. The scale which is developed for the study is based on the classification of the learning strategies by Weinstein and Meyer (1986. The phrases in the scale are determined via the essays of the students and screening of the literature. The hypothesis that each item is evaluating the related psychological formation is tested by confirmative factor analysis. The scale is made up of 5 sub-dimensions and 66 items. The factorial weights of items in the scale takes place between 0.452 and 0.802. The reliability coefficient for the scale (Cronbach alpha as a whole was 0.955. The confidence coefficients for sub-scales were determined as 0.940, 0.888, 0.858, 0.884 and 0.867. The results of the study suggests that this scale may help determining and assess the aplication levels of learning strategies exploited during the piano lesson and organizing the teaching and learning environment this direction.

  19. Recombinant vaccines and the development of new vaccine strategies.

    Nascimento, I P; Leite, L C C


    Vaccines were initially developed on an empirical basis, relying mostly on attenuation or inactivation of pathogens. Advances in immunology, molecular biology, biochemistry, genomics, and proteomics have added new perspectives to the vaccinology field. The use of recombinant proteins allows the targeting of immune responses focused against few protective antigens. There are a variety of expression systems with different advantages, allowing the production of large quantities of proteins depending on the required characteristics. Live recombinant bacteria or viral vectors effectively stimulate the immune system as in natural infections and have intrinsic adjuvant properties. DNA vaccines, which consist of non-replicating plasmids, can induce strong long-term cellular immune responses. Prime-boost strategies combine different antigen delivery systems to broaden the immune response. In general, all of these strategies have shown advantages and disadvantages, and their use will depend on the knowledge of the mechanisms of infection of the target pathogen and of the immune response required for protection. In this review, we discuss some of the major breakthroughs that have been achieved using recombinant vaccine technologies, as well as new approaches and strategies for vaccine development, including potential shortcomings and risks.

  20. Cyanobacterial Biofuels: Strategies and Developments on Network and Modeling.

    Klanchui, Amornpan; Raethong, Nachon; Prommeenate, Peerada; Vongsangnak, Wanwipa; Meechai, Asawin

    Cyanobacteria, the phototrophic microorganisms, have attracted much attention recently as a promising source for environmentally sustainable biofuels production. However, barriers for commercial markets of cyanobacteria-based biofuels concern the economic feasibility. Miscellaneous strategies for improving the production performance of cyanobacteria have thus been developed. Among these, the simple ad hoc strategies resulting in failure to optimize fully cell growth coupled with desired product yield are explored. With the advancement of genomics and systems biology, a new paradigm toward systems metabolic engineering has been recognized. In particular, a genome-scale metabolic network reconstruction and modeling is a crucial systems-based tool for whole-cell-wide investigation and prediction. In this review, the cyanobacterial genome-scale metabolic models, which offer a system-level understanding of cyanobacterial metabolism, are described. The main process of metabolic network reconstruction and modeling of cyanobacteria are summarized. Strategies and developments on genome-scale network and modeling through the systems metabolic engineering approach are advanced and employed for efficient cyanobacterial-based biofuels production.

  1. Recombinant vaccines and the development of new vaccine strategies

    I.P. Nascimento


    Full Text Available Vaccines were initially developed on an empirical basis, relying mostly on attenuation or inactivation of pathogens. Advances in immunology, molecular biology, biochemistry, genomics, and proteomics have added new perspectives to the vaccinology field. The use of recombinant proteins allows the targeting of immune responses focused against few protective antigens. There are a variety of expression systems with different advantages, allowing the production of large quantities of proteins depending on the required characteristics. Live recombinant bacteria or viral vectors effectively stimulate the immune system as in natural infections and have intrinsic adjuvant properties. DNA vaccines, which consist of non-replicating plasmids, can induce strong long-term cellular immune responses. Prime-boost strategies combine different antigen delivery systems to broaden the immune response. In general, all of these strategies have shown advantages and disadvantages, and their use will depend on the knowledge of the mechanisms of infection of the target pathogen and of the immune response required for protection. In this review, we discuss some of the major breakthroughs that have been achieved using recombinant vaccine technologies, as well as new approaches and strategies for vaccine development, including potential shortcomings and risks.

  2. Recombinant vaccines and the development of new vaccine strategies

    Nascimento, I.P.; Leite, L.C.C. [Centro de Biotecnologia, Instituto Butantan, São Paulo, SP (Brazil)


    Vaccines were initially developed on an empirical basis, relying mostly on attenuation or inactivation of pathogens. Advances in immunology, molecular biology, biochemistry, genomics, and proteomics have added new perspectives to the vaccinology field. The use of recombinant proteins allows the targeting of immune responses focused against few protective antigens. There are a variety of expression systems with different advantages, allowing the production of large quantities of proteins depending on the required characteristics. Live recombinant bacteria or viral vectors effectively stimulate the immune system as in natural infections and have intrinsic adjuvant properties. DNA vaccines, which consist of non-replicating plasmids, can induce strong long-term cellular immune responses. Prime-boost strategies combine different antigen delivery systems to broaden the immune response. In general, all of these strategies have shown advantages and disadvantages, and their use will depend on the knowledge of the mechanisms of infection of the target pathogen and of the immune response required for protection. In this review, we discuss some of the major breakthroughs that have been achieved using recombinant vaccine technologies, as well as new approaches and strategies for vaccine development, including potential shortcomings and risks.

  3. Community development strategies codification (physical - spatial using smart growth approaches

    Hamid Majedi


    Full Text Available Urban management structure in recent decades, associated with features and constraints such as nonparticipatory, focus, system of scheduling, planning top-down, bureaucratic and politicization of the urban development process lacks practical commitment to the principles and applications urban development programs. Hence, it has paused the management strategies developed to resolve these issues and problems at the micro level and neighborhoods. However, despite years of planning, today's cities are growing sporadically. In the past decades, a large amount of agricultural land, gardens and green spaces around the city in order to grow the city is dedicated to building and the day following cities and have been moving more and more toward scattering phenomena and the increasing use of private cars fueled by the fragmentation and is involved on environment quality degradation. Urban Village, new-urbanism, sustainable development, smart growth and the increasing development of all new concepts and approaches that the today's urban problems and uncontrolled expansion of urban areas and put up a new way of development in open areas of the old, the potential uses, increased density and….and each one is complement each loan different from the experiences and achievements of former approaches. the methodology is this research we try that new approaches are presented in the discussion of urban development and smart growth theory as the main approach to explain the research is and concepts developed and compression is needed to analyze and eventually the criticisms and pudding on smart growth and enumerate the benefits of local sustainable development strategies will be described.

  4. A conceptual approach to the development of motivational strategies.

    Wong, J; Wong, S; Mensah, L L


    Teachers in both general and professional education are well aware of the importance of motivation as the basis of effective teaching. Heidgerken maintains that a major problem that faces nursing educators is to select the right type of motivation and to know how to effect motivation. The authors propose a conceptual model for developing strategies to deal with motivational problems. This model is an application of Vroom's value/expectancy theory and Rotter's social learning theory, and is based on the premise that nursing faculty are in strategic positions to enhance student motivation for learning by manipulating variables that are believed to influence motivation. These suggested strategies include: enhancing student's need value by rewarding them with rewards that they value the most; increasing student's perceptions of a strong link between performance and rewards; providing students with consistent and clear role perceptions; improving student satisfaction towards learning.

  5. Future Development Strategies for S Group Based on SWOT Analysis

    Guohui; QI; Ligen; CHEN


    In recent years,the real estate development enterprises are facing the gradually increased government’s macro-control,and the increasingly fierce market competition,so it is very imperative to timely adjust and change the enterprises’ development strategies to adapt to the new development situation.With S Group as the study object,we use SWOT analysis to analyze the company’s internal and external environment,study the current situation of the company and the existing problems,and clearly point out the opportunities and challenges facing the company.Finally we put forth some targeted strategic recommendations,in order to provide a reference for the development of S Group.

  6. International trends and strategies in educational development at universities

    James Wisdom


    Full Text Available This article considers four areas of educational development work which may become more significant in the future. The range and quality of professional development for teaching in higher education has expanded in many countries, the investment in academic frameworks of outcomes, credits and standards has yet to be exploited, the research into student learning is both productive and challenging to existing structures, and the practice of educational development is becoming more extensive – for example, practitioners are now expected to contribute to institutional strategy as much as to provide support for individual lecturers. The article notes significant changes in assumptions about the relations between students, their teachers and their courses, the need for revised approaches to assessment, and the importance of the professional development of the program leader and team to support the modernization of higher education.

  7. Protein binding studies with radiolabeled compounds containing radiochemical impurities. Equilibrium dialysis versus dialysis rate determination

    Honoré, B


    The influence of radiochemical impurities in dialysis experiments with high-affinity ligands is investigated. Albumin binding of labeled decanoate (97% pure) is studied by two dialysis techniques. It is shown that equilibrium dialysis is very sensitive to the presence of impurities resulting...

  8. Recovery of renal function in dialysis patients

    Patlovany Matthew


    Full Text Available Abstract Background Although recovery of renal functions in dialysis dependent patients is estimated to be greater than 1%, there are no indicators that actually suggest such revival of renal function. Residual renal function in dialysis patients is unreliable and seldom followed. Therefore renal recovery (RR in dialysis dependent patients may remain unnoticed. We present a group of dialysis dependent patients who regained their renal functions. The aim of this project is to determine any indicators that may identify the recovery of renal functions in dialysis dependent patients. Methods All the discharges from the chronic dialysis facilities were identified. Among these discharges deaths, transplants, voluntary withdrawals and transfers either to another modality or another dialysis facility were excluded in order to isolate the patients with RR. The dialysis flow sheets and medical records of these patients were subsequently reviewed. Results Eight patients with a mean age of 53.8 ± 6.7 years (± SEM were found to have RR. Dialysis was initiated due to uremic symptoms in 6 patients and fluid overload in the remaining two. The patients remained dialysis dependent for 11.1 ± 4.2 months. All these patients had good urine output and 7 had symptoms related to dialysis. Their mean pre-initiation creatinine and BUN levels were 5.21 ± 0.6 mg/dl and 72.12 ± 11.12 mg/dl, respectively. Upon discontinuation, they remained dialysis free for 19.75 ± 5.97 months. The mean creatinine and BUN levels after cessation of dialysis were 2.85 ± 0.57 mg/dl and 29.62 ± 5.26 mg/dl, respectively, while the mean creatinine clearance calculated by 24-hour urine collection was 29.75 ± 4.78 ml/min. One patient died due to HIV complications. One patient resumed dialysis after nine months. Remaining continue to enjoy a dialysis free life. Conclusion RR must be considered in patients with good urine output and unresolved acute renal failure. Dialysis intolerance may be

  9. The use of peritoneal dialysis in newborns

    Stojanović Vesna


    Full Text Available Introduction. Acute renal failure is a common complication in critically ill newborn infants. The therapy of acute renal failure is conservative and etiological. Patients not responding to this kind of therapy require peritoneal dialysis. Material and methods. This retrospective study included 6 newborn infants undergoing peritoneal dialysis during the period from January 2004 to June 2006, at the Nephrology Department of the Institute of Child and Youth Health Care in Novi Sad. All patients presented with complications of acute renal failure including hypercalemia and uremic encephalopathy. Results. Complete restoration of kidney function was evident in four patients on peritoneal dialysis. Three patients are still alive, but in one patient acute renal failure progressed to chronic renal failure. One patient died in the third month of life due to multiple organ dysfunction, after just two days of dialysis. Several complications were reported: intra-abdominal hemorrhage, dialysate leakage, peritonitis and dialysis catheter obstruction. Discussion. Periotoneal dialysis catheter placement is a great problem due to the size of the newborn. If it is estimated that it will be a long-lasting dialysis, Tenckhoff catheter is recommended. In very low birth weight newborn infants, in poor overall condition, general anesthesia is too risky, and acute peritoneal dialysis catheter should be placed (i.v. cannula, venous catheter. Conclusion. Peritoneal dialysis is the method of choice in newborns with acute renal failure, and it is used in the treatment of neonatal asphyxia till the restoration of kidney function is achieved. .

  10. [The specific nutritionnal care in peritoneal dialysis].

    Castrale, Cindy; Azar, Raymond; Piquet, Marie-Astrid; Lobbedez, Thierry


    Protein energy wasting is a major complication in peritoneal dialysis. It is leading to a poor quality of life and increasing mortality. Diagnosis must be early, according to criteria defined by the International society of renal nutrition and metabolism. It is necessary to appropriate the diagnostic tools with dialysis method. The nutritional care is difficult in peritoneal dialysis. Indeed, studies are limited and practical nutrition is complex. In this point of view, we propose to treat guidelines for protein energy wasting, in peritoneal dialysis patients. Copyright © 2016 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  11. Strategies for developing a culture of mentoring in postdoctoral periodontology.

    Hempton, Timothy J; Drakos, Dimitrios; Likhari, Vikram; Hanley, James B; Johnson, Lonnie; Levi, Paul; Griffin, Terrence J


    Dental education in the United States and Canada is currently experiencing a crisis with respect to faculty recruitment and retention. The major reasons for the status of dental and specialty education are lower salaries and lack of interest. To make up for this deficit in the specialty of periodontology, our current educators need to utilize strategies targeted towards an existing potential teaching resource: the postdoctoral students in periodontology. The intent of this article is to review the current crisis in dental faculty recruitment and retention, show how it affects the specialty of periodontics, and describe how creating a culture of mentoring may facilitate more engagement of periodontal residents in the teaching process during their postdoctoral training. The strategies utilized to develop a culture of mentoring in the Department of Periodontology at Tufts University are presented. They include methodologies to develop and enhance residents' mentoring skills, thereby helping to compensate for the shortage of periodontists involved in academics. Measurement of the mentoring strategy is presented from data obtained from an online survey of third-year predoctoral students' perceptions of their interaction with residents as their clinical instructors. Moreover, the numbers of program alumni engaged in teaching prior to and after the mentoring program was initiated are also presented as an outcome of the mentoring program. Developing a culture of mentoring in postdoctoral periodontology programs can be an important tool to enable individuals to become more involved in the process of teaching and mentoring during their postdoctoral training. This outcome could ameliorate the deficit of periodontists engaged as formal educators. Moreover, development and expansion of a culture of mentoring in a periodontolgy program may encourage recent graduates to become more involved in teaching subsequent to graduation.

  12. 45 CFR 1336.64 - Development of goals and strategies: Responsibilities of the Loan Administrator.


    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Development of goals and strategies... Loan Fund Demonstration Project § 1336.64 Development of goals and strategies: Responsibilities of the... the basis for the development of an organizational strategy and operating plan. The RLF strategies...

  13. Predicting mortality in patients with diabetes starting dialysis.

    Merel van Diepen

    Full Text Available BACKGROUND: While some prediction models have been developed for diabetic populations, prediction rules for mortality in diabetic dialysis patients are still lacking. Therefore, the objective of this study was to identify predictors for 1-year mortality in diabetic dialysis patients and use these results to develop a prediction model. METHODS: Data were used from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD, a multicenter, prospective cohort study in which incident patients with end stage renal disease (ESRD were monitored until transplantation or death. For the present analysis, patients with DM at baseline were included. A prediction algorithm for 1-year all-cause mortality was developed through multivariate logistic regression. Candidate predictors were selected based on literature and clinical expertise. The final model was constructed through backward selection. The model's predictive performance, measured by calibration and discrimination, was assessed and internally validated through bootstrapping. RESULTS: A total of 394 patients were available for statistical analysis; 82 (21% patients died within one year after baseline (3 months after starting dialysis therapy. The final prediction model contained seven predictors; age, smoking, history of macrovascular complications, duration of diabetes mellitus, Karnofsky scale, serum albumin and hemoglobin level. Predictive performance was good, as shown by the c-statistic of 0.810. Internal validation showed a slightly lower, but still adequate performance. Sensitivity analyses showed stability of results. CONCLUSIONS: A prediction model containing seven predictors has been identified in order to predict 1-year mortality for diabetic incident dialysis patients. Predictive performance of the model was good. Before implementing the model in clinical practice, for example for counseling patients regarding their prognosis, external validation is necessary.

  14. Systematic Procedure for Integrated Process Operation: Reverse Electro-Enhanced Dialysis (REED) during Lactic Acid Fermentation

    Prado Rubio, Oscar Andres; Jørgensen, Sten Bay; Jonsson, Gunnar Eigil


    The integration of lactic acid fermentation and Reverse Electro-Enhanced Dialysis (REED) is investigated based upon previously developed mathematical models. A goal driven process and operation design procedure is proposed and partially investigated. The conceptual analysis of the processes...

  15. Suitable Strategies for the Development of Sahoolan Watery Cave Geotourism

    H. Nouri


    Full Text Available Extended abstract1-IntroductionToday, tourism is one of the largest and most beneficial industries in the world and in many countries it is used as a development strategy. Geotourism or geological tourism is emerging as a new global phenomenon. It is a form of natural area tourism that specifically focuses on geology and landscape. Because of appropriate planning and recognizing advantages and limitations, this kind of tourism can play an important role in the national development and diversification of local economy. There is a wide variety of caves in Iran, including calcareous (karst, salt, ancient and human-made caves which Sahoolan is one of the most important of them. Though Sahoolan has a great range of potentials for geotourism development, geotourism is just emerging and taking its first developmental steps. So these questions arise: What are the potentialities and limitations of Geotourism development in this region? Which strategies are required for developing this type of tourism and following national and regional development?2. Theoretical Bases Geotourism is a new phenomenon in tourism industry. It is defined as tourism activity pertaining to geology and geomorphology, and the natural resources of landscape, landforms, fossil beds, rocks and minerals, with an emphasis on appreciating the processes that are creating and have created such features. Geotourism’s first definition appeared after 1990s. An early definition of geotourism was made by Thomas Hose. He specifically focused on geology and geomorphologic sites. The goal of geotourism is to maintain the character of place. It is not just travelling to undisturbed natural areas or to centers of human activity but travelling to destinations where nature and humans come together to produce a working landscape. The focus is to encourage visitation to an area by visitors who value the same working landscapes valued by the residents. Ideally, geotourism can be beneficial for both

  16. The costs of HIV prevention strategies in developing countries.

    Söderlund, N; Lavis, J; Broomberg, J; Mills, A


    Since many evaluations of HIV (human immunodeficiency virus) prevention programmes do not include data on costs, a preliminary analysis of the costs and outputs of a sample of HIV prevention projects was attempted. Case studies, representing six broad HIV prevention strategies in developing countries with differing levels of per capita gross domestic product, were sought on the basis of availability of data and potential generalizability. The six prevention strategies studied were mass media campaigns, peer education programmes, sexually transmitted disease treatment, condom social marketing, safe blood provision, and needle exchange/bleach provision programmes. Financial cost data were abstracted from published studies or were obtained directly from project coordinators. Although estimates of cost-effectiveness were not made, calculations of the relative cost per common process measure of output were compared. Condom distribution costs ranged from US$ 0.02 to 0.70 per condom distributed, and costs of strategies involving personal educational input ranged from US$ 0.15 to 12.59 per contact.

  17. Nuclear thermal propulsion test facility requirements and development strategy

    Allen, George C.; Warren, John; Clark, J. S.


    The Nuclear Thermal Propulsion (NTP) subpanel of the Space Nuclear Propulsion Test Facilities Panel evaluated facility requirements and strategies for nuclear thermal propulsion systems development. High pressure, solid core concepts were considered as the baseline for the evaluation, with low pressure concepts an alternative. The work of the NTP subpanel revealed that a wealth of facilities already exists to support NTP development, and that only a few new facilities must be constructed. Some modifications to existing facilities will be required. Present funding emphasis should be on long-lead-time items for the major new ground test facility complex and on facilities supporting nuclear fuel development, hot hydrogen flow test facilities, and low power critical facilities.

  18. Strategies for Development of Shaanxi’s Agricultural Insurance Industry


    This paper introduces current situations of agricultural insurance market in Shaanxi Province. It is indicated that development of Shaanxi’s agricultural insurance industry is faced with following difficulties. First, risks of agricultural production are various, occurrence frequency is high and losses are great. Second, effective supply of commercial insurance companies for agriculture is seriously inadequate. Third, farmers’ demand for agricultural insurance is restricted by many factors. Fourth, government support for agricultural insurance is not generous. Then, it puts forward strategies for development of agricultural insurance in Shaanxi Province. These include: encourage commercial insurance companies to actively enter agricultural insurance market; establish perfect agricultural reinsurance system; strengthen propaganda of agricultural insurance and speed up agricultural industrialization; enhance policy support for agricultural insurance to promote its development.

  19. Development strategy research of low-carbon tourist city

    Dong, Xiaohong


    Construction of low-carbon tourist city has become a strategic choice for the development of city construction in our country, becoming the direction and goal of future city development in China. In this paper, the development strategy of low-carbon tourist city is put forward from the aspects of building low-carbon tourism culture, strengthening and perfecting the relevant rules and regulations, establishing and perfecting the decision-making management mechanism of low-carbon tourist city construction, establishing accurate, timely, efficient and comprehensive ecological environment monitoring and supervision network, building economical resource utilization system, strengthening science and technology supporting of low-carbon city construction, establishing low-carbon tourism scenic spot, low-carbon community or low-carbon demonstration area, etc.

  20. Development strategies in design and process planning quality assurance context

    J. Duda


    Full Text Available According to the new development strategies, the product development focuses on as much as possible parallel execution of alldevelopment related product life cycle phases, thus creating CE (Concurrent Engineering approach. Its further extension is CEE (CrossEnterprises Engineering approach incorporating the relations between business and engineering activities, so securing also the access tothe resources of cooperating enterprises. Computer integration of product phases can be viewed as functional, informational and complexintegration. The process planning quality is assured on the design and technological process planning stage with the use of methods andsystems processing the data from the other product development phases. The paper presents the methods and systems for design andprocess planning quality assurance in the product life cycle as well as the possibility for the implementation of the presented productdevelopment phases.

  1. Nuclear thermal propulsion test facility requirements and development strategy

    Allen, George C.; Clark, John S.; Warren, John; Perkins, David R.; Martinell, John


    The Nuclear Thermal Propulsion (NTP) subpanel of the Space Nuclear Propulsion Test Facilities Panel evaluated facility requirements and strategies for nuclear thermal propulsion systems development. High pressure, solid core concepts were considered as the baseline for the evaluation, with low pressure concepts an alternative. The work of the NTP subpanel revealed that a wealth of facilities already exists to support NTP development, and that only a few new facilities must be constructed. Some modifications to existing facilities will be required. Present funding emphasis should be on long-lead-time items for the major new ground test facility complex and on facilities supporting nuclear fuel development, hot hydrogen flow test facilities, and low power critical facilities.

  2. Rambutan Commodity Development Strategy as Regional Potential Product

    Amin Pujiati


    Full Text Available The potential product of a region needs to be developed in order to improve the social welfare. Commonly, at harvest time, there is abundant horticulture commodity. Unluckily, the price of the commodity drops significantly. In other words, it costs extremely cheap. The purpose of research is analyzing the internal and external factors and determining an appropriate strategy for developing rambutan in Central Java, especially at Gunungpati District, Semarang, Central Java Province. The primary data of this research is obtained from 58 rambutan farmers that have been interviewed and have filled out the questionnaire forms. The secondary data is taken from the Central Bureau of Statistics, the monograph of the village and the internet by implementing the literature study method. Then, SWOT analysis is implemented for analizing the data. The internal factors that become the strengths are fertilized land for rambutan to grow and the farmers’ hereditary experiences in cultivating rambutan. Further, the lack of absorbing power of knowledge and technologies and the low existence of rambutan business are the weaknesses. Next, the external factor that becomes opportunity is the continuous increasing market demand, while the threat is the young generations having no interest in rambutan business. Finally, the stability (hold and maintain strategy should be implemented for developing rambutan business


    Camelia MĂNESCU


    Full Text Available In this paper, the authors conducted a study on the economic development of Timiş County, as well as its SWOT analysis. The paper concludes with the Development Strategy of Timiş County, the main conclusions drawn from the conducted researches and bibliographical references. Within the paper, there are presented theoretical aspects related to rural area concept, followed by the physical- geographical characteristics of Timiş County. Throughout the paper, there are analyzed the existing demographic aspects found in Timiş County. The end part of the paper represents a translation in statistical terms of the main economic phenomena which are recorded in Timiş County. There are references made towards agriculture, forestry, industry, services, trade, tourism, as economic activities carried out in Timis County. Following these researches, at the end part of the paper, the authors have compiled a SWOT analysis of Timiş County, proposing in the same time a strategy for its development.

  4. Rambutan Commodity Development Strategy as Regional Potential Product

    Amin Pujiati


    Full Text Available The potential product of a region needs to be developed in order to improve the social welfare. Commonly, at harvest time, there is abundant horticulture commodity. Unluckily, the price of the commodity drops significantly. In other words, it costs  extremely cheap. The purpose of research is analyzing the internal and external factors and determining an appropriate strategy for developing rambutan in Central Java, especially at Gunungpati District, Semarang, Central Java Province. The primary data of this research is obtained from 58 rambutan farmers that have been interviewed and have filled out the questionnaire forms. The secondary data is taken from the Central Bureau of Statistics, the monograph of the village and the internet by implementing the literature study method. Then, SWOT analysis is implemented for analizing the data. The internal factors that become the strengths are fertilized land for rambutan to grow and the farmers’ hereditary experiences in cultivating rambutan. Further, the lack of absorbing power of knowledge and technologies and the low existence of rambutan business are the weaknesses. Next, the external factor that becomes opportunity is the continuous increasing market demand, while the threat is the young generations having no interest in rambutan business. Finally, the stability (hold and maintain strategy should be implemented for developing rambutan business

  5. Measuring, managing, and improving quality in the end-stage renal disease treatment setting: peritoneal dialysis.

    Nissenson, A R


    Peritoneal dialysis is now performed as an end-stage renal disease modality in nearly 70,000 patients worldwide. The use of this modality varies widely from less than 5% of all end-stage renal disease patients in Japan to over 95% of patients in Mexico. In addition to medical and psychosocial factors, modality selection involves many other factors, including financial reimbursement, educational deficiencies, resource availability, social mores, and cultural habits. Survival on chronic peritoneal dialysis is similar to that on hemodialysis, although older diabetic patients on peritoneal dialysis may have a higher mortality rate. Hospitalizations and transfer off modality are more common in patients on chronic peritoneal dialysis compared with patients on hemodialysis. The important factors contributing to outcome in patients on chronic peritoneal dialysis are unknown. Results of the Baxter Best-Demonstrated Practice Program suggest that process of care has a strong impact on outcome, at least in retention of patients on chronic peritoneal dialysis. Quality of life is another outcome that has been poorly assessed in chronic peritoneal dialysis patients. Available studies suffer from a lack of standardization of instruments used, no control groups, no random patient allocation to modalities, and short-term, small population groups. When chronic peritoneal dialysis and hemodialysis are compared, subjective quality of life is generally higher with chronic peritoneal dialysis. For objective quality of life, the balance of studies favor hemodialysis. It is clear that there is a dearth of information available on many aspects of delivery of chronic peritoneal dialysis. Future research should target patient factors that are important in morbidity and mortality with chronic peritoneal dialysis, facility factors ("process of care") that are important in morbidity and mortality with chronic peritoneal dialysis, quality of life in chronic peritoneal dialysis patients, and how

  6. Affordable Development and Qualification Strategy for Nuclear Thermal Propulsion

    Gerrish, Harold P., Jr.; Doughty, Glen E.; Bhattacharyya, Samit K.


    A number of recent assessments have confirmed the results of several earlier studies that Nuclear Thermal Propulsion (NTP) is a leading technology for human exploration of Mars. It is generally acknowledged that NTP provides the best prospects for the transportation of humans to Mars in the 2030's. Its high Isp coupled with the high thrusts achievable, allow reasonable trip times, thereby alleviating concerns about space radiation and "claustrophobia" effects. NASA has embarked on the latest phase of the development of NTP systems, and is adopting an affordable approach in response to the pressure of the times. The affordable strategy is built on maximizing the use of the large NTP technology base developed in the 1950's and 60's. The fact that the NTP engines were actually demonstrated to work as planned, is a great risk reduction feature in its development. The strategy utilizes non-nuclear testing to the fullest extent possible, and uses focused nuclear tests for the essential qualification and certification tests. The perceived cost risk of conducting the ground tests is being addressed by considering novel testing approaches. This includes the use of boreholes to contain radioactive effluents, and use of fuel with very high retention capability for fission products. The use of prototype flight tests is being considered as final steps in the development prior to undertaking human flight missions. In addition to the technical issues, plans are being prepared to address the institutional and political issues that need to be considered in this major venture. While the development and deployment of NTP system is not expected to be cheap, the value of the system will be very high, and amortized over the many missions that it enables and enhances, the imputed costs will be very reasonable. Using the approach outlined, NASA and its partners, currently the DOE, and subsequently industry, have a good chance of creating a sustained development program leading to human

  7. Neurophysiological indices of strategy development and skill acquisition.

    Smith, M E; McEvoy, L K; Gevins, A


    In order to examine neurophysiological changes associated with the development of cognitive and visuomotor strategies and skills, spectral features of the EEG were measured as participants learned to perform new tasks. In one experiment eight individuals practiced working memory tasks that required development of either spatial or verbal rehearsal and updating strategies. In a second experiment six individuals practiced a video game with a difficult visuomotor tracking component. The alpha rhythm, which is attenuated by functional cortical activation, was affected by task practice. In both experiments, a lower-frequency, centrally distributed alpha component increased between practice sessions in a task-independent fashion, reflecting an overall decrease in the extent of cortical activation after practice. A second, higher-frequency, posterior component of the alpha rhythm displayed task-specific practice effects. Practice in the verbal working memory task resulted in an increase of this signal over right posterior regions, an effect not seen after practice with the spatial working memory task or with the video game. This between-task difference presumably reflects a continued involvement of the posterior region of the right hemisphere in tasks that invoke visuospatial processes. This finding thus provides neurophysiological evidence for the formation of a task-specific neurocognitive strategy. In the second experiment a third component of the alpha rhythm, localized over somatomotor cortex, was enhanced in conjunction with acquisition of tracking skill. These alpha band results suggest that cortical regions not necessary for task performance become less active as skills develop. In both experiments the frontal midline (Fm) theta rhythm also displayed increases over the course of test sessions. This signal is associated with states of focused concentration, and its enhancement might reflect the conscious control over attention associated with maintenance of a task

  8. Research on Design Optimization Strategy in Virtual Product Development

    潘军; 韩帮军; 范秀敏; 马登哲


    Simulation and optimization are the key points of virtual product development (VPD). Traditional engineering simulation software and optimization methods are inadequate to analyze the optimization problems because of its computational inefficiency. A systematic design optimization strategy by using statistical methods and mathematical optimization technologies is proposed. This method extends the design of experiments (DOE) and the simulation metamodel technologies. Metamodels are built to in place of detailed simulation codes based on effectively DOE, and then be linked to optimization routines for fast analysis, or serve as a bridge for integrating simulation software across different domains. A design optimization of composite material structure is used to demonstrate the newly introduced methodology.

  9. Tissue engineering strategies to study cartilage development, degeneration and regeneration.

    Bhattacharjee, Maumita; Coburn, Jeannine; Centola, Matteo; Murab, Sumit; Barbero, Andrea; Kaplan, David L; Martin, Ivan; Ghosh, Sourabh


    Cartilage tissue engineering has primarily focused on the generation of grafts to repair cartilage defects due to traumatic injury and disease. However engineered cartilage tissues have also a strong scientific value as advanced 3D culture models. Here we first describe key aspects of embryonic chondrogenesis and possible cell sources/culture systems for in vitro cartilage generation. We then review how a tissue engineering approach has been and could be further exploited to investigate different aspects of cartilage development and degeneration. The generated knowledge is expected to inform new cartilage regeneration strategies, beyond a classical tissue engineering paradigm.

  10. The Impact of a Strategies-Based Instruction on Iranian EAP Students’ Reading Strategy Use: Developing Strategic EAP Readers

    Seyyed Hossein Kashef


    Full Text Available Underperformance of students in EAP reading comprehension has been an issue of concern for teachers, syllabus designers, and curriculum developers in general and for EAP practitioners in particular. In spite of the fact that considerable efforts have been made to improve reading comprehension of students through strategies instruction over past decades, EAP students however have not benefited much from learning strategies. Thus, this study intended to investigate the impact of a Strategies-Based Instruction (SBI on undergraduate students’ reading strategy use in an EAP context. Taking an instructional model from strategies taxonomy of Oxford (1990; 2001, it was assumed that in contrast to conventional EAP reading methods, SBI would be more effective in encouraging reading strategy use and as a result developing reading comprehension of EAP students through encouraging the use of effective strategies and skills. To do so, 80 freshman undergraduate students were chosen as the participants of this study who were in two intact classes. After administration of a pre-test, treatment (22 sessions, 2 sessions per week, and a post-test, the collected data was analyzed using t-test to examine the effect of the proposed method of instruction. The results of the analysis showed that the teaching intervention had a significant effect on students’ reading strategy use. The findings have implications for teachers encouraging effective reading comprehension instruction through the use of strategies in EAP teaching contexts. Keywords: Strategies-based instruction; EAP; learning strategies; reading strategies; reading comprehension

  11. Severe venous neointimal hyperplasia prior to dialysis access surgery

    Lee, Timmy; Chauhan, Vibha; Krishnamoorthy, Mahesh; Wang, Yang; Arend, Lois; Mistry, Meenakshi J.; El-Khatib, Mahmoud; Banerjee, Rupak; Munda, Rino; Roy-Chaudhury, Prabir


    Background. Venous neointimal hyperplasia is the most common cause of arteriovenous (AV) fistula and graft dysfunction following dialysis access surgery. However, the pathogenetic impact of pre-existing venous neointimal hyperplasia at the time of AV access creation on final clinical success is currently unknown in the setting of advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. The aim of this study was to perform a detailed histological, morphometric, and immunohistochemical analysis of vein specimens in advanced CKD and ESRD patients collected at the time of new vascular access placement. Methods. Vein samples from 12 patients were collected at the time of AV access creation near the site of AV anastomosis. Histological, immunohistochemistry and morphometric studies were performed on these vein samples. Results. Examination of the tissue specimens obtained at the time of surgery showed neointimal hyperplasia in 10 of 12 specimens, ranging from minimal to very severe. The majority of cells within the neointima were myofibroblasts with a minority of contractile smooth muscle cells present. Conclusion. Our work represents a detailed description of the morphometric and cellular phenotypic lesions present in the veins of CKD and ESRD patients, prior to dialysis access placement. These studies (i) suggest the future possibility of a new predictive marker (pre-existing venous neointimal hyperplasia) for AV dialysis access dysfunction and (ii) open the door for the future development of novel local therapies for optimization of the venous substrate on which the dialysis access is created. PMID:21220751

  12. Strategies to support human oocyte development in vitro.

    Telfer, Evelyn E; McLaughlin, Marie


    Many young cancer patients are now being given the option to store ovarian cortical biopsies before undergoing potentially damaging chemo- or radiotherapy. This tissue mainly contains large numbers of immature primordial follicles. Currently the only option to restore fertility using this tissue is by transplantation which may not be a viable option for all patients. Greater options to realise the potential of this tissue to restore fertility could be achieved by the development of in vitro systems that support oocyte development. The ability to develop human oocytes from the most immature stages of follicles (primordial) through to maturation and fertilisation in vitro would revolutionise fertility preservation practice. This has been achieved in mouse where in vitro grown (IVG) oocytes from primordial follicles have resulted in the production of live offspring. However, developing IVG systems to support complete development of human oocytes has been more difficult because of differences in scale of timing and size. Our lab has been working on a multi-step culture system to support growth and development of bo-vine and human oocytes from primordial through to fully grown, using fresh and cryopreserved ovarian cortical tissue. This review outlines the approaches being taken to obtain complete in vitro development of human oocytes and strategies for assessing the health and viability of IVG oocytes.

  13. Evaluation of Bacteriological and Chemical Quality of Dialysis Water and Fluid in Isfahan, Central Iran



    Background: Chemical and microbial quality of water used in hemodialysis play key roles in a number of dialysis-related complications. In order to avoid the complications and to guarantee safety and health of patients therefore, vigorous control of water quality is essential. The objective of present study was to investigate the chemical and bacteriological characteristics of water used in dialysis centers of five hospitals in Isfahan, central Iran. Methods: A total of 30 water samples from the input of dialysis purification system and dialysis water were analyzed for chemical parameters. Heterotrophic plate count and endotoxin concentration of drinking water, dialysis water and dialysis fluid of 40 machines were also monitored over a 5-month period in 2011–2012. Results: Concentration of the determined chemicals (copper, zinc, sulfate, fluoride, chloramines and free chlorine) did not exceed the recommended concentration by the Association for the Advancement of Medical Instrumentation (AAMI) exclude lead, nitrate, aluminum and calcium. Furthermore, the magnesium; cadmium and chromium concentration exceeded the maximum level in some centers. No contamination with heterotrophic bacteria was observed in all samples, while the AMMI standard for endotoxin level in dialysis fluid (water and fluid failed to meet the all chemical and bacteriological requirements for hemodialysis. To minimize the risk of contaminants for hemodialysis patients therefore, a water quality management program including monitoring, maintenance and development of water treatment system in hemodialysis centers is extremely important. In addition, an appropriate disinfection program is needed to guarantee better control of bacterial growth and biofilm formation. PMID:27398338

  14. Epidemiologic trends in chronic renal replacement therapy over forty years: A Swiss dialysis experience

    Lehmann Petra


    Full Text Available Abstract Background Long term longitudinal data are scarce on epidemiological characteristics and patient outcomes in patients on maintenance dialysis, especially in Switzerland. We examined changes in epidemiology of patients undergoing renal replacement therapy by either hemodialysis or peritoneal dialysis over four decades. Methods Single center retrospective study including all patients which initiated dialysis treatment for ESRD between 1970 and 2008. Analyses were performed for subgroups according to dialysis vintage, based on stratification into quartiles of date of first treatment. A multivariate model predicting death and survival time, using time-dependent Cox regression, was developed. Results 964 patients were investigated. Incident mean age progressively increased from 48 ± 14 to 64 ± 15 years from 1st to 4th quartile (p  Discussion We document an increase of a predominantly elderly incident and prevalent dialysis population, with progressively shortened survival after initiation of renal replacement over four decades, and, nevertheless, a prolonged lifespan. Analysis of the data is limited by lack of information on comorbidity in the study population. Conclusions Survival in patients on renal replacement therapy seems to be affected not only by medical and technical advances in dialysis therapy, but may mostly reflect progressively lower mortality of individuals with cardiovascular and metabolic complications, as well as a policy of accepting older and polymorbid patients for dialysis in more recent times. This is relevant to make demographic predictions in face of the ESRD epidemic nephrologists and policy makers are facing in industrialized countries.

  15. Toward the Development of an Integrated Global Observing Strategy

    Charles, Leslie Bermann


    In the current environment of stagnant or shrinking budgets for space research and exploration, nations can no longer afford to develop costly systems in a vacuum. Greater coordination of existing and planned systems, both among space agencies and between the space agencies and user communities, will enable the maximization of global investments in all areas of space-related research. In this manner, a group of space agencies has embarked on an initiative to link their activities in Earth observation with complementary observation programs. The goal of this initiative is to develop a comprehensive strategy for enhanced levels of support to scientific, operational and research communities. The space agencies, through the Committee on Earth Observation Satellites (CEOS), have embraced the concept of an Integrated Global Observing Strategy (IGOS), primarily in fulfillment of their own set of objectives and to derive greater benefit from both operating and planned Earth observing systems. Through working together, CEOS agencies are in a position to plan their Earth observation projects with the minimum of unnecessary overlap and to devise joint strategies for addressing serious gaps in their observation capabilities. Ultimately, an IGOS should be the joint product of all groups involved in the collection and analysis of both space-based and in-situ data. CEOS is actively seeking IGOS -related partnerships with the Global Climate, Global Ocean and Global Terrestrial Observing Systems, their intergovernmental Sponsors, the International Group of Funding Agencies for Global Change Research, and other scientific and user organizations including the International Geosphere-Biosphere Programme and the World Climate Research Programme.

  16. Toward the Development of an Integrated Global Observing Strategy

    Charles, Leslie Bermann


    In the current environment of stagnant or shrinking budgets for space research and exploration, nations can no longer afford to develop costly systems in a vacuum. Greater coordination of existing and planned systems, both among space agencies and between the space agencies and user communities, will enable the maximization of global investments in all areas of space-related research. In this manner, a group of space agencies has embarked on an initiative to link their activities in Earth observation with complementary observation programs. The goal of this initiative is to develop a comprehensive strategy for enhanced levels of support to scientific, operational and research communities. The space agencies, through the Committee on Earth Observation Satellites (CEOS), have embraced the concept of an Integrated Global Observing Strategy (IGOS), primarily in fulfillment of their own set of objectives and to derive greater benefit from both operating and planned Earth observing systems. Through working together, CEOS agencies are in a position to plan their Earth observation projects with the minimum of unnecessary overlap and to devise joint strategies for addressing serious gaps in their observation capabilities. Ultimately, an IGOS should be the joint product of all groups involved in the collection and analysis of both space-based and in-situ data. CEOS is actively seeking IGOS -related partnerships with the Global Climate, Global Ocean and Global Terrestrial Observing Systems, their intergovernmental Sponsors, the International Group of Funding Agencies for Global Change Research, and other scientific and user organizations including the International Geosphere-Biosphere Programme and the World Climate Research Programme.

  17. Strategies and challenges for safe injection practice in developing countries.

    Gyawali, Sudesh; Rathore, Devendra Singh; Shankar, P Ravi; Kumar, Kc Vikash


    Injection is one of the important health care procedures used globally to administer drugs. Its unsafe use can transmit various blood borne pathogens. This article aims to review the history and status of injection practices, its importance, interventions and the challenges for safe injection practice in developing countries. The history of injections started with the discovery of syringe in the early nineteenth century. Safe injection practice in developed countries was initiated in the early twentieth century but has not received adequate attention in developing countries. The establishment of "Safe Injection Global Network (SIGN)" was an milestone towards safe injection practice globally. In developing countries, people perceive injection as a powerful healing tool and do not hesitate to pay more for injections. Unsafe disposal and reuse of contaminated syringe is common. Ensuring safe injection practice is one of the greatest challenges for healthcare system in developing countries. To address the problem, interventions with active involvement of a number of stakeholders is essential. A combination of educational, managerial and regulatory strategies is found to be effective and economically viable. Rational and safe use of injections can save many lives but unsafe practice threatens life. Safe injection practice is crucial in developing countries. Evidence based interventions, with honest commitment and participation from the service provider, recipient and community with aid of policy makers are required to ensure safe injection practice.

  18. Formation of Strategy of Efficient Development of Cruise Tourism

    Lohunova Natalia A.


    Full Text Available The article presents conceptualisation of basic provisions on formation of strategy of efficient development of cruise tourism in Ukraine. Based on the study of problems of the cruise sector development, the article identifies the main goal and structures relevant tasks, justifies main reference points and strategic priorities of development of the cruise industry, specifies principles, mechanisms and expected results of realisation of the designated strategic course. The article states that efficient development of cruise tourism requires creation of an effective system of regulatory and legal, organisational, scientific and methodical, financial and information support. The article offers methodical recommendations on preparation of statistical reports and submission of statistical information about the state and development of the cruise market to the bodies of state statistics, which would allow identification of its quantitative and qualitative parameters, carry out monitoring of the process of creation of the cruise tourist product, analyse practical consequences of measures on stimulation and regulation of the cruise sphere and assess results of realisation of priority directions of strategic development.

  19. Assessing of Dialysis Adequacy in Patients under Hemodialysis in Dialysis Department of Ekbatan Hospital in Hamadan

    E. Nadi


    Full Text Available Determining reduction proportion of blood urea in patients under hemodialysis in dialysis department of Ekbatan hospital and comparison between obtained results and standard scales. This study was descriptive, cross - Sectional. In this study the number of 100 patient under dialysis in were evaluated and their blood samples were accumitated before and after dialysis and were transferred to the laboratory. Results were calculated by BUN formula, meanwhile the other parameters as, the time of dialysis, speed of blood circulation, percentage of filter clearance, patient weight before and after dialysis, blood pressure before and after dialysis, also evaluated and registered. To consider the obtained results from BUN calculations we found out that 10% of individuals have URR 65%. In that the results are in accord with standard scales, and revealed adequate dialysis. About 34% were near accepted range (55%-64%. The rest of individuals about 56% were lower than accepted URR.

  20. COMSATCOM service technical baseline strategy development approach using PPBW concept

    Nguyen, Tien M.; Guillen, Andy T.


    This paper presents an innovative approach to develop a Commercial Satellite Communications (COMSATCOM) service Technical Baseline (TB) and associated Program Baseline (PB) strategy using Portable Pool Bandwidth (PPBW) concept. The concept involves trading of the purchased commercial transponders' Bandwidths (BWs) with existing commercial satellites' bandwidths participated in a "designated pool bandwidth"3 according to agreed terms and conditions. Space Missile Systems Center (SMC) has been implementing the Better Buying Power (BBP 3.0) directive4 and recommending the System Program Offices (SPO) to own the Program and Technical Baseline (PTB) [1, 2] for the development of flexible acquisition strategy and achieving affordability and increased in competition. This paper defines and describes the critical PTB parameters and associated requirements that are important to the government SPO for "owning" an affordable COMSATCOM services contract using PPBW trading concept. The paper describes a step-by-step approach to optimally perform the PPBW trading to meet DoD and its stakeholders (i) affordability requirement, and (ii) fixed and variable bandwidth requirements by optimizing communications performance, cost and PPBW accessibility in terms of Quality of Services (QoS), Bandwidth Sharing Ratio (BSR), Committed Information Rate (CIR), Burstable Information Rate (BIR), Transponder equivalent bandwidth (TPE) and transponder Net Presence Value (NPV). The affordable optimal solution that meets variable bandwidth requirements will consider the operating and trading terms and conditions described in the Fair Access Policy (FAP).

  1. The "phosphorus pyramid": a visual tool for dietary phosphate management in dialysis and CKD patients.

    D'Alessandro, Claudia; Piccoli, Giorgina B; Cupisti, Adamasco


    Phosphorus retention plays a pivotal role in the onset of mineral and bone disorders (MBD) in chronic kidney disease (CKD). Phosphorus retention commonly occurs as a result of net intestinal absorption exceeding renal excretion or dialysis removal. The dietary phosphorus load is crucial since the early stages of CKD, throughout the whole course of the disease, up to dialysis-dependent end-stage renal disease.Agreement exits regarding the need for dietary phosphate control, but it is quite challenging in the real-life setting. Effective strategies to control dietary phosphorus intake include restricting phosphorus-rich foods, preferring phosphorus sourced from plant origin, boiling as the preferred cooking procedure and avoiding foods with phosphorus-containing additives. Nutritional education is crucial in this regard.Based on the existing literature, we developed the "phosphorus pyramid", namely a novel, visual, user-friendly tool for the nutritional education of patients and health-care professionals. The pyramid consists of six levels in which foods are arranged on the basis of their phosphorus content, phosphorus to protein ratio and phosphorus bioavailability. Each has a colored edge (from green to red) that corresponds to recommended intake frequency, ranging from "unrestricted" to "avoid as much as possible".The aim of the phosphorus pyramid is to support dietary counseling in order to reduce the phosphorus load, a crucial aspect of integrated CKD-MBD management.

  2. How to successfully achieve salt restriction in dialysis patients? What are the outcomes?

    Ok, Ercan


    Despite the fact that dietary salt restriction is the most logical measure to prevent accumulation of salt and water in patients without renal function, it is not applied in most dialysis centers. In this review, the reasons for this unlucky development are analyzed. First, it appears that many dialysis patients are slightly overhydrated, but this is often not noticed and, if so, the deleterious effects in the long run are not appreciated. These consist not only of 'drug-resistant' hypertension, but also dilatation of the cardiac compartments leading to preventable cardiovascular events. Second, there are practical reasons why salt restriction is neglected. It is very difficult to buy salt-poor food. Salt consumption is an addiction, which can be overcome, but time and efforts are needed to achieve that. Suggestions are made how to reach that goal. Finally, examples are given how cardiac damage (often considered irreversible) can be improved or even cured by a 'volume control' strategy, whose crucial part is serious salt restriction.

  3. ROS homeostasis during development: an evolutionary conserved strategy.

    Schippers, Jos H M; Nguyen, Hung M; Lu, Dandan; Schmidt, Romy; Mueller-Roeber, Bernd


    The balance between cellular proliferation and differentiation is a key aspect of development in multicellular organisms. Recent studies on Arabidopsis roots revealed distinct roles for different reactive oxygen species (ROS) in these processes. Modulation of the balance between ROS in proliferating cells and elongating cells is controlled at least in part at the transcriptional level. The effect of ROS on proliferation and differentiation is not specific for plants but appears to be conserved between prokaryotic and eukaryotic life forms. The ways in which ROS is received and how it affects cellular functioning is discussed from an evolutionary point of view. The different redox-sensing mechanisms that evolved ultimately result in the activation of gene regulatory networks that control cellular fate and decision-making. This review highlights the potential common origin of ROS sensing, indicating that organisms evolved similar strategies for utilizing ROS during development, and discusses ROS as an ancient universal developmental regulator.

  4. [Strategies for pharmaceutical research and development. II. Generic drugs].

    Kuchar, M


    When the patent protection is terminated, the original registered-mark preparation becomes a generic drug, which results in a decrease in its price as compared with the original pharmaceutical. The effects of changes in price relation are discussed from the viewpoint of the generic firms and the manufacturers of original preparations. The differences in the insurance system and legislative regulations of the registration of generic preparations can markedly the size influence of the share of generic drugs in the total consumption of drugs. The future development of generic drugs from a general viewpoint is discussed in relation to the contemporary extensive expiration of patent protection of drugs. The hitherto results are summed up and the topics for the present strategy of the development of generic drugs in the Research Institute for Pharmacy and Biochemistry, or in the Czech Republic, respectively are discussed.

  5. Polymeric nanotherapeutics: clinical development and advances in stealth functionalization strategies

    Hu, Che-Ming J.; Fang, Ronnie H.; Luk, Brian T.; Zhang, Liangfang


    Long-circulating polymeric nanotherapeutics have garnered increasing interest in research and in the clinic owing to their ability to improve the solubility and pharmacokinetics of therapeutic cargoes. Modulation of carrier properties promises more effective drug localization at the disease sites and can lead to enhanced drug safety and efficacy. In the present review, we highlight the current development of polymeric nanotherapeutics in the clinic. In light of the importance of stealth properties in therapeutic nanoparticles, we also review the advances in stealth functionalization strategies and examine the performance of different stealth polymers in the literature. In addition, we discuss the recent development of biologically inspired ``self'' nanoparticles, which present a differing stealth concept from conventional approaches.

  6. [Immigrants and dialysis: a survey in Piedmont].

    Forneris, Giacomo; Boero, Roberto; Massara, Carlo; Quarello, Francesco


    The number of immigrants has been rapidly increasing in Italy in the last decade, with potentially profound effects on the national health care system. Yet, few data are available on the clinical and demographic features of these subjects, or on their need for nephrological care and dialysis treatment. A survey was conducted in 19 dialysis facilities of Piedmont (a northwestern Italian region) about immigrants on chronic dialysis treatment. Data on native country, administrative position, clinical and dialysis aspects were anonymously collected. Overall, 93 immigrant dialysis patients coming from 24 foreign countries were registered. Most of them were young (mean age 46∓14 years) and on extracorporeal treatment (87%); late referral (38%) or starting dialysis in emergency (17%) were common modalities of presentation. Glomerular (33%) or unknown (31%) nephropathies were the most representative causes of end stage renal disease. No difference in incidence of HCV, HBV and HIV compared with native Italian patients was observed. Notably, more than 50% of the immigrant patients had low-level knowledge of Italian. As regards administrative position, 69% were regular foreign citizens, 19% were temporary foreign workers, and 9% had a residence permit. Our survey confirms the existence of a young immigrant population on dialysis in Piedmont, whose social and relational problems are more challenging than clinical aspects and call for new organizational models to manage this growing population on dialysis.

  7. Research and Development Strategies in the Semiconductor Industry

    Bowling, Allen


    In the 21st Century semiconductor industry, there is a critical balance between internally funded semiconductor research and development (R) and externally funded R. External R may include jointly-funded research collaborations/partnerships with other device manufacturers, jointly-funded consortia-based R, and individually-funded research programs at universities and other contract research locations. Each of these approaches has merits and each has costs. There is a critical balance between keeping the internal research and development pipeline filled and keeping it from being overspent. To meet both competitive schedule and cost goals, a semiconductor device manufacturer must decide on a model for selection of internal versus external R. Today, one of the most critical decisions is whether or not to do semiconductor research and development on 300 mm silicon wafers. Equipment suppliers are doing first development on 300 mm equipment. So, for the device manufacturer, there is a balance between the cost of doing development on 300 mm wafers and the development time schedule driven by equipment availability. In the face of these cost and schedule elements, device manufacturers are looking to consortia such as SEMATECH, SRC, and SRC MARCO for early development and screening of new materials and device structure approaches. This also causes much more close development collaboration between device manufacturer and equipment supplier. Many device manufacturers are also making use of direct contract research with universities and other contract-research organizations, such as IMEC, LETI, and other government-funded research organizations around the world. To get the most out of these external research interactions, the company must develop a strategy for management and technology integration of external R.

  8. Word Reading Strategy Development of Deaf and Hard-of-Hearing Preschoolers

    Burke, Victoria


    Siegler's (1996) overlapping waves model of strategy development applied to reading posits that children use multiple strategies to read words from the earliest stage of reading development, that these strategies coexist over a long period of time, and that experience results in gradual change in the strategies children use and the…

  9. Theoretic-methodological approaches to determine the content and classification of innovation-investment development strategies

    Gerashenkova Tatyana


    Full Text Available The article states the necessity to form an innovation-investment strategy of enterprise development, offers an approach to its classification, determines the place of this strategy in a corporatewide strategy, gives the methodology of formation and the realization form of the innovation-investment development strategy.

  10. An assessment of survival among Korean elderly patients initiating dialysis: a national population-based study.

    Shina Lee

    Full Text Available BACKGROUND: Although the proportion of the elderly patients with incident end-stage renal disease (ESRD patients has been increasing in Korea, there has been a lack of information on outcomes of dialysis treatment. This study aimed to assess the survival rate and to elucidate predictors for all-cause mortality among elderly Korean patients initiating dialysis. METHODS: We analyzed 11,301 patients (6,138 men aged 65 years or older who had initiated dialysis from 2005 to 2008 and had followed up (median, 37.8 months; range, 3-84 months. Baseline demographics, comorbidities and mortality data were obtained using the database from the Health Insurance Review & Assessment Service. RESULTS: The unadjusted 5-year survival rate was 37.6% for all elderly dialysis patients, and the rate decreased with increasing age categories; 45.9% (65∼69, 37.5% (70∼74, 28.4% (75∼79, 24.1% (80∼84, and 13.7% (≥85 years. The multivariate Cox proportional hazard model revealed that age, sex, dialysis modality, the type of insurance, and comorbidities such as diabetes mellitus, myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, chronic pulmonary disease, hemiparesis, liver disease, and any malignancy were independent predictors for mortality. In addition, survival rate was significantly higher in patients on hemodialysis compared to patients on peritoneal dialysis during the whole follow-up period in the intention-to-treat analysis. CONCLUSIONS: Survival rate was significantly associated with age, sex, and various comorbidities in Korean elderly patients initiating dialysis. The results of our study can help to provide relevant guidance on the individualization strategy in elderly ESRD patients requiring dialysis.

  11. Regional sustainable development strategy for the Athabasca oil sands

    Braat, T.; Barrett, R. [Alberta Environment, Edmonton, AB (Canada)


    This paper describes the efforts by Alberta Environment to implement a regional sustainable development strategy for the oil sands industry. Alberta Environment gathers the views from industry, government, First Nations and non-governmental organizations on issues regarding cumulative environmental impacts and sustainable industrial development in Alberta's Athabasca oil sands area. This mandate is carried out through a multi-stakeholder partnership initiative called the Cumulative Environmental Management Association (CEMA). CEMA develops environmental management tools, guidelines and objectives to address environmental issues such as acid deposition, trace air pollutants and surface water quality. The NOx/SO{sub 2} Working Group and the Trace Metal and Air Contaminants Working Group of CEMA address air emissions issues. Their recommendations are referred to the appropriate regulatory agency for implementation. The Lakeland Industry and Community Association (LICA) was created in response to expansion of oil and gas production in the Cold Lake area. LICA is a not-for-profit organization that addresses the concerns of residents living near the Lakeland area to ensure that development is conducted in an environmentally responsible manner. The organization is developing regional environmental monitoring programs for soil, air and water. tabs., figs.

  12. The new Medicare PPS and home dialysis.

    Curtis, Jim; Schatell, Dori


    Overall, we believe that bundling of payments to dialysis facilities is positive for home dialysis. The incentive for higher utilization of home therapies comes down to the fact that, with treatments for all modalities being paid at the same rate, providers will see that home modalities cost less than facility-based treatments. The adjustment for home training treatments is certainly helpful, but it is not incentive enough on its own. From our perspective, one of the biggest financial incentives for home dialysis and more frequent dialysis therapies is that these patients are statistically known to spend less time in the hospital, over time costing taxpayers and the ESRD Program less money. We will continue to encourage CMS to consider the overall cost implications of more frequent dialysis. We are hopeful that when hospitalization costs are accounted for, CMS will do even more to encourage the use of these modalities.

  13. Update on dialysis economics in the UK.

    Sharif, Adnan; Baboolal, Keshwar


    The burgeoning population of patients requiring renal replacement therapy contributes a disproportionate strain on National Health Service resources. Although renal transplantation is the preferred treatment modality for patients with established renal failure, achieving both clinical and financial advantages, limitations to organ donation and clinical comorbidities will leave a significant proportion of patients with established renal failure requiring expensive dialysis therapy in the form of either hemodialysis or peritoneal dialysis. An understanding of dialysis economics is essential for both healthcare providers and clinical leaders to establish clinically efficient and cost-effective treatment modalities that maximize service provision. In light of changes to the provision of healthcare funds in the form of "Payment by Results," it is imperative for UK renal units to adopt clinically effective and financially accountable dialysis programs. This article explores the role of dialysis economics and implications for UK renal replacement therapy programs.

  14. YES Africa: Geoscience Projects for Development (GPD) (Strategy and Process)

    Barich, A.; Nkhonjera, E.; Venus, J.; Gonzales, L. M.


    For various reasons, Earth Science in Africa has been acareer path that has not been promoted or a preferred option. In January 2011, the YES Network in Africa launched the Network in Africa through a symposium. This took place at the University of Johannesburg, in conjunction with the Colloquium of Africa Geology in January 2011. The Symposium brought together young geoscientists from all regions of Africa to talk about their geoscience research that focused on geohazards and professional development within the African continent. The YES Africa Symposium also aimed to improve the participation of students in African geosciences issues and to also discuss how geoscience education in Africa can be promoted to attract more students to choose a career in the profession. The YES Africa Symposium resulted in ambitious short/long term projects. Symposium participants agreed unanimously that spreading awareness throughout the society about geological hazards, climate change, water management strategies and sustainable development remains a priority. As a direct result local projects are being developed by the YES Network's African National Chapters to develop a long-term geoscience taskforce within the continent. These projects will be developed by implementing student chapters in universities and strengthening the ties with local geoscience organizations and governments. Many YES Network African National Chapters have already taken the lead in developing their local projects, and some have been very successful in their efforts. Collaboration with the various YES Network National Chapters will be critical in developing a geo-hazard portal which links regional organizations and institutions together. This will help to disseminate geo-information more efficiently, and also to develop the next generation of young African geoscience students and early-career professionals. This presentation will detail a variety of innovative outreach methods used to connect with the public

  15. 13 CFR 303.7 - Requirements for Comprehensive Economic Development Strategies.


    ... Economic Development Strategies. 303.7 Section 303.7 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE PLANNING INVESTMENTS AND COMPREHENSIVE ECONOMIC DEVELOPMENT STRATEGIES § 303.7 Requirements for Comprehensive Economic Development Strategies. (a) General. CEDS are designed...

  16. Suggestions on the development strategy of shale gas in China

    Dazhong Dong


    Full Text Available From the aspects of shale gas resource condition, main exploration and development progress, important breakthrough in key technologies and equipment, this paper systematically summarized and analyzed current situation of shale gas development in China and pointed out five big challenges such as misunderstandings, lower implementation degree and higher economic uncertainty of shale gas resource, and still no breakthrough in exploration and development core technologies and equipment for shale gas buried depth more than 3500 m, higher cost and other non-technical factors that restrict the development pace. Aiming at the above challenges, we put forward five suggestions to promote the shale gas development in China: (1 Make strategies and set goals according to our national conditions and exploration and development stages. That is, make sure to realize shale gas annual production of 20 × 109 m3, and strives to reach 30 × 109 m3. (2 Attach importance to the research of accumulation and enrichment geological theory and exploration & development key engineering technologies for lower production and lower pressure marine shale gas reservoir, and at the same time orderly promote the construction of non-marine shale gas exploration & development demonstration areas. (3 The government should introduce further policies and set special innovation funds to support the companies to carry out research and development of related technologies and equipment, especially to strengthen the research and development of technology, equipment and process for shale gas bellow 3500 m in order to achieve breakthrough in deep shale gas. (4 Continue to promote the geological theory, innovation in technology and management, and strengthen cost control on drilling, fracturing and the whole process in order to realize efficient, economic and scale development of China's shale gas. (5 Reform the mining rights management system, establish information platform of shale

  17. Cluster strategies in the regional economy development: legal aspects

    Irina V. Mikheeva


    Full Text Available Objective to study the state of legal support of the cluster strategies implementation to identify the problems and possible directions for improving the legal support of cluster development in the regions. Methods systemic structuralfunctional induction and deduction analysis and synthesis formal legal. Results the paper formulates the definition of cluster as a form of cooperative interaction of organizations interacting in some economic sphere due to functional dependence complementing each other and reinforcing the competitive advantages of individual companies. The hypothesis is proposed that the organizational and management structure of clusters should be unified and obtain normative fixation so that the same type of bodies including executive bodies and the structure of the different clusters deliberative specialized organizations organizationcoordinator etc. had similar competence and position in the management hierarchy. Scientific novelty following the most general conception of a cluster as interacting institutions in a specific area one can see that the lack of clarity in the legal support of the clusters functioning does not allow to determine the status of authoritative and nonauthoritative subjects of economic activities their organizationallegal forms and the procedure of their interaction. Practical significance the identified problems of legal support of the cluster strategies implementation can help in the improvement of state regulation of cluster relations in the regions and their implementation.

  18. Adaptive building envelopes, component development as well as implementation strategies

    Tillmann Klein


    Full Text Available The papers in this issue of JFDE discuss the potential of adaptive building envelopes, component development as well as implementation strategies. The applied practice paper demonstrates decision strategies behind the adaptive sun shading system of the Al-Bahr Towers. Additivity in building envelopes is not only a strategy to fulfil the growing demands for energy efficient buildings and comfort but has great architectural implications as well. In general it asks for more complex components as well as control strategies. But complexity also means costs and risks, and we need to discuss the means and effects. This discussion in particular is very interesting because here science and practice meet. The Journal of Facade Design and Engineering JFDE will actively follow and stimulate by providing high quality contributions. Four of the paper contributions have their origins in the Conference ‘Facades 2014’, held in November 2014 in Lucerne. The contributions have been carefully selected and have been subjected to the regular double blind review process of the journal. We want to thank Prof. Dr. Andres Luible for the help in making this issue happen. We are proud that JFDE is the scientific partner for a number of conferences such as ‘The Future Envelope’ Conference on Building Envelopes held yearly in Delft (NL or Bath (UK, the ICAE International Congress on Architectural Envelopes in San Sebastian (ES and the above mentioned conference ‘Facades’ in Lucerne (CH and Detmold (D. Our latest partner is the ICBEST 2017 - International Conference on Building Envelope Systems and Technologies in Istanbul. The growing number of partners indicates the relevance of JFDE for our growing discipline and will assure the continuity of the journal. Facade Design and Engineering is a peer reviewed, open access journal, funded by The Netherlands Organisation for Scientific Research NWO ( We see ‘open access’ as the future publishing model

  19. The Evolution of Industrial Development Strategy up to China's Entry into the WTO



    Changes in China's industrial development strategy undertaken prior to its entry into the WTO centered on strategies for foreign trade, foreign capital utilization, and industry structure. The foreign trade strategy tended to involve a shift from the importsubstitution strategy adopted before the reforms of 1978 to an export-oriented strategy, mainly still one of preferential export promotion. Strategy with regard to foreign capital utilization changed from restricting foreign capital to encouraging foreign capital.

  20. Clinical and pharmacoeconomic profile of lanthanum carbonate treatment of hyperphosphataemia in chronic renal dialysis patients

    Mario Eandi


    Hyperphosphatemia is recognized as a principal mineral disorder in chronic kidney disease (CKD) that leads to the development of secondary hyperparathyroidism. Approximately 70% of patients with end-stage renal disease (ESRD) and dialysis have hyperphosphataemia, which is associated with renal osteodystrophy, metastatic calcification and increased mortality and morbidity. Despite dietary restriction and dialysis, most patients will require a phosphate-binding agent to treat this condition.Lan...

  1. Severe “sweet” pleural effusion in a continuous ambulatory peritoneal dialysis patient


    Introduction: Hydrothorax is a rare complication of continuous ambulatory peritoneal dialysis (CAPD) which can progress quickly to cause acute respiratory distress. Case presentation: We present a 76 year-old female with a past medical history significant for end-stage renal disease (ESRD) on daily home peritoneal dialysis for 2 years presented to the hospital from home with shortness of breath at rest and cough for 2 days prior to admission. She developed severe respiratory distress and h...

  2. Severe cutaneous hypersensitivity to icodextrin in a continuous ambulatory peritoneal dialysis patient.

    Lee, Sang Hun; Park, Hyeong Cheon; Sim, Soung Rok; Chung, Soo Jin; Kim, Ki Joong; Park, Woo Il; Hong, Soon Won; Ha, Sung Kyu


    Icodextrin, a glucose polymer, is widely used as an alternative to glucose as the osmotic agent in peritoneal dialysis (PD). We describe a case of a continuous ambulatory peritoneal dialysis patient who developed severe cutaneous hypersensitivity after initiation of icodextrin PD solution. Erythematous skin lesions gradually disappeared after discontinuation of icodextrin PD solution. Although the safety and efficacy of icodextrin PD solution is well documented, clinicians should be mindful of the possibility of severe adverse cutaneous reactions to icodextrin PD solution.

  3. Strategies for Sustainable Urban Development and Urban-Rural Linkages

    Nilsson, Kjell; Nielsen, Thomas Alexander Sick; Aalbers, Carmen;


    the population has grown by only 33%. In the PLUREL project - an integrated project within the EU’s 6th Research Framework Programme - more than 100 researchers from 15 countries analysed the impacts of urban land consumption at a pan-European level and, through six European and one Chinese case studies......An important driving force behind urban expansion is the growth of the urban population. But for Europe, this is not a sufficient explanation. The major trend is that European cities have become much less compact. Since the mid-1950s European cities have expanded on average by 78%, whereas......, identified how land use conflicts and the pressure towards peri- urban areas can be strategically managed in different development and regulatory contexts. To summarise, the following strategies were identified as important steps towards more sustainable urban-rural futures: (i) better coordination...

  4. Development of open access in China: strategies, practices, challenges

    Dr Xiaolin Zhang


    Full Text Available China's rapid growth in scientific R&D in recent years provides solid evidence for the country's innovation-driven development strategy, but also puts increasing demand on open access (OA to publicly funded research results. This article looks at ways in which the Chinese government, funders, research and library communities are all rising to this challenge, and at future challenges still to be met. As a major scientific publishing country with its estimated 5,000 STM journals, China's place in the international OA publishing scene is considered in detail, with the author concluding that he believes open access to publicly funded research in China will soon become the accepted norm, as all levels of scientific policymakers fulfil their political, professional and international responsibilities, to the benefit of Chinese research and society.

  5. A strategy for PACS development using introductory team software process

    Martinez-Martinez, A.; Nunyez-Gaona, M. A.; Jimenez-Alaniz, J. R.; Munyoz de Cote, J. E.; Chavez-Avelar, N.; Delgado-Esquerra, R. E.; Gutierrez-Martinez, J.


    A PACS development requires to fill the needs of a specific imagenology area in a hospital and, as consequence, the amount of requirements associated to a PACS implicate a great complexity. This can be observed through methods that allow the size and complexity of a PACS software system to be quantified and measured, by analyzing the user requirements and interactions with other systems to be realized. When a PACS development is proposed, it can be difficult to actually launch the development project since a lot of time may be invested in defining the initial activities to be performed. In this work a model to address the complexity of a PACS development is proposed, and a strategy to divide the different tasks involved is defined. The model can offer an estimation about the effort to be spent. To face the problem, a correct planning and schedule can be defined. The model was obtained applying the first steps of the introductory Team Software Process (TSPi) methodology, and was represented using Unified Modelling Language activity diagrams. The model shows the different activities that have to be realized during the PACS development, and also the products that are generated once activities are accomplished. Another main aspect is a dependence view which shows the synchronization and dependence between tasks. This allows the possible sequences of activities to be visualized, and to be planned across different cycles. According to the TSPi, in each planned cycle a testable version of a PACS specific application should to be produced and the combination of the products, obtained through the different cycles should produce a final software system. With the model presented in this work, PACS developers can have a clear idea about the involved tasks and can schedule the work to accomplish specific PACS applications. A case study was conducted at the "Centro Nacional de Rehabilitacion" (National Rehabilitation Center)in Mexico City, using the proposed model.

  6. Issues in developing a mitigation strategy for Bangladesh

    Asaduzzaman, M. [Bangladesh Institute of Development Studies, Dhaka (Bangladesh)


    Bangladesh, it is by now well-known, is at the receiving end, in the literal sense of the term, of the global climate change and its potential impacts. She contributes very little to the current global emission of greenhouse gases (GHGs). The Emission Inventory under the present umbrella project, Bangladesh Climate Change Study (BCCS), has found that her annual emission of carbon has been only 3.99 mn metric tons per year. An earlier study arrived at exactly the same figure. The figures for estimated release of methane is far less firm. The estimated methane emission in 1990 could be anywhere between 1 million and 6 million metric tons. In any case the total emission is unlikely to be more than one-half of one percent of the global total. On the other hand, however, she faces specter of widespread and more frequent floods, more frequent droughts, cyclones and above all sea-level rise (SLR) which may inundate a substantial part of the country all of these bringing in immeasurable misery and destitution and loss of income, employment and growth. One would expect that in such a situation, Bangladesh`s basic concern should be to prepare an appropriate adaptation strategy. This is already a major policy concern of the Government. There is, however, an increasing realization that Bangladesh should as well emphasize an appropriate mitigation strategy (MS). There may be at least three reasons why this should be so. The first is that she is a signatory of the Framework Convention on Climate Change. The second is that in the medium, if not short term she expects major growth due to a developing economy. Third is that Bangladesh depends primarily on fossil fuel imports for energy, and will become a larger source with further development.

  7. Affordable Development and Qualification Strategy for Nuclear Thermal Propulsion

    Gerrish, Harold P., Jr.; Doughty, Glen E.; Bhattacharyya, Samit K.


    Nuclear Thermal Propulsion (NTP) is a concept which uses a nuclear reactor to heat a propellant to high temperatures without combustion and can achieve significantly greater specific impulse than chemical engines. NTP has been considered many times for human and cargo missions beyond low earth orbit. A lot of development and technical maturation of NTP components took place during the Rover/NERVA program of the 60's and early 70's. Other NTP programs and studies followed attempting to further mature the NTP concept and identify a champion customer willing to devote the funds and support the development schedule to a demonstration mission. Budgetary constraints require the use of an affordable development and qualification strategy that takes into account all the previous work performed on NTP to construct an existing database, and include lessons learned and past guidelines followed. Current guidelines and standards NASA uses for human rating chemical rocket engines is referenced. The long lead items for NTP development involve the fuel elements of the reactor and ground testing the engine system, subsystem, and components. Other considerations which greatly impact the development plans includes the National Space Policy, National Environmental Policy Act, Presidential Directive/National Security Council Memorandum #25 (Scientific or Technological Experiments with Possible Large-Scale Adverse Environmental Effects and Launch of Nuclear Systems into Space), and Safeguards and Security. Ground testing will utilize non-nuclear test capabilities to help down select components and subsystems before testing in a nuclear environment to save time and cost. Existing test facilities with minor modifications will be considered to the maximum extent practical. New facilities will be designed to meet minimum requirements. Engine and test facility requirements are based on the driving mission requirements with added factors of safety for better assurance and reliability


    Agung Suryawan Wiranatha


    Full Text Available Ecotourism Destination of Tangkahan is located at the edge of Gunung Leuser National Park, within the Sub-regency of Batang Serangan, Regency of Langkat, Province of North Sumatera, Indonesia. The Ecotourism Destination of Tangkahan relies upon a distinctive tourist attraction, namely elephant trekking that is undertaken along the edge of the river and in the Gunung Leuser National Park (GLNP, as well as the diversity of flora and fauna available at the GLNP. There are many activities can be undertaken by visitors at this destination, such as: elephant trekking, wildlife watching at the GLNP, trekking at the edge of Buluh river and come back by swimming wearing life jacket, tubing (traditional rafting and canoeing at Batang Serangan river, swimming at Buluh river, camping and outbound activities at the camping ground, village tour at sub-village of Kuala Buluh, and traditional massage (pijat / kusuk by local therapist. The research was undertaken to develop strategies which could be used as guidance in managing and developing this ecotourism destination. The proposed strategies were based upon the results of SWOT analysis. Data were assembled from the visitors’ survey, focus group discussions and workshop involving tourism stakeholders and several interested groups. Based upon the analysis of existing tourist attractions offered at the Ecotourism Destination of Tangkahan, it could be said that the nature based tourist attractions were considered to be interesting up to very interesting. The uniqueness of elephant jungle trekking in the GLNP was the tourism icon of the Ecotourism Destination of Tangkahan. Camping ground, plant nursery, and agriculture plantation were potential to be promoted as tourist attractions at the Ecotourism Destination of Tangkahan.\tBased upon the results of SWOT analysis of the Ecotourism Destination of Tangkahan, several strategies could be recommended for ecotourism development at Tangkahan, namely, to maintain the

  9. Regional Evolution Features and Coordinated Development Strategies for Northeast China

    MEI Lin; XU Xiaopo; CHEN Mingxiu


    Northeast China, as the most important production base of agriculture, forestry, and livestock-breeding as well as the old industrial base in the whole country, has been playing a key role in the construction and development of China's economy. However, after the policy of reform and open-up was taken in China, the economic development speed and efficiency of this area have turned to be evidently lower than those of coastal area and the national average level as paper firstly reviews the spatial and temporal features of the regional evolution of this area so as to unveil the profound ploration into the status quo of this region and its forming causes by analyzing its economy gross, industrial structure,product structure, regional eco-categories, etc. At the end of the paper, the authors put forward the basic coordinated development strategies for Northeast China, namely we can revitalize this area by means of adjustment of economic structure, regional coordination, planning urban and rural areas as a whole, institutional innovation, etc.

  10. Strategies for developing biostatistics resources in an academic health center.

    Welty, Leah J; Carter, Rickey E; Finkelstein, Dianne M; Harrell, Frank E; Lindsell, Christopher J; Macaluso, Maurizio; Mazumdar, Madhu; Nietert, Paul J; Oster, Robert A; Pollock, Brad H; Roberson, Paula K; Ware, James H


    Biostatistics--the application of statistics to understanding health and biology-provides powerful tools for developing research questions, designing studies, refining measurements, analyzing data, and interpreting findings. Biostatistics plays an important role in health-related research, yet biostatistics resources are often fragmented, ad hoc, or oversubscribed within academic health centers (AHCs). Given the increasing complexity and quantity of health-related data, the emphasis on accelerating clinical and translational science, and the importance of conducting reproducible research, the need for the thoughtful development of biostatistics resources within AHCs is growing.In this article, the authors identify strategies for developing biostatistics resources in three areas: (1) recruiting and retaining biostatisticians, (2) efficiently using biostatistics resources, and (3) improving biostatistical contributions to science. AHCs should consider these three domains in building strong biostatistics resources, which they can leverage to support a broad spectrum of research. For each of the three domains, the authors describe the advantages and disadvantages of AHCs creating centralized biostatistics units rather than dispersing such resources across clinical departments or other research units. They also address the challenges that biostatisticians face in contributing to research without sacrificing their individual professional growth or the trajectory of their research teams. The authors ultimately recommend that AHCs create centralized biostatistics units because this approach offers distinct advantages both to investigators who collaborate with biostatisticians as well as to the biostatisticians themselves, and it is better suited to accomplish the research and education missions of AHCs.

  11. Empowering Young Writers with Disabilities: The Impact of Teaching a Writing Strategy Using Self-Regulated Strategy Development

    Leakan, Christe S.


    The purpose of this study was to investigate the impact of implementing the Self-Regulated Strategy Development (SRSD) model of instruction to teach students with special needs to use a planning strategy. Single-subject design was used. The three participants were elementary students from a small suburban school in southern New Jersey. The…

  12. Empowering Young Writers with Disabilities: The Impact of Teaching a Writing Strategy Using Self-Regulated Strategy Development

    Leakan, Christe S.


    The purpose of this study was to investigate the impact of implementing the Self-Regulated Strategy Development (SRSD) model of instruction to teach students with special needs to use a planning strategy. Single-subject design was used. The three participants were elementary students from a small suburban school in southern New Jersey. The…

  13. Dialysis

    ... chap 132. Tolkoff-Rubin N. Treatment of irreversible renal failure. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 24th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 133. Review Date 12/30/2014 Updated by: Deepak Sudheendra, ...

  14. Preclinical assessment of adjunctive tPA and DNase for peritoneal dialysis associated peritonitis.

    Amanda L McGuire

    Full Text Available A major complication of peritoneal dialysis is the development of peritonitis, which is associated with reduced technique and patient survival. The inflammatory response elicited by infection results in a fibrin and debris-rich environment within the peritoneal cavity, which may reduce the effectiveness of antimicrobial agents and predispose to recurrence or relapse of infection. Strategies to enhance responses to antimicrobial agents therefore have the potential to improve patient outcomes. This study presents pre-clinical data describing the compatibility of tPA and DNase in combination with antimicrobial agents used for the treatment of PD peritonitis. tPA and DNase were stable in standard dialysate solution and in the presence of antimicrobial agents, and were safe when given intraperitoneally in a mouse model with no evidence of local or systemic toxicity. Adjunctive tPA and DNase may have a role in the management of patients presenting with PD peritonitis.

  15. 21 CFR 876.5630 - Peritoneal dialysis system and accessories.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Peritoneal dialysis system and accessories. 876... Peritoneal dialysis system and accessories. (a) Identification. (1) A peritoneal dialysis system and... peritoneal dialysis, a source of dialysate, and, in some cases, a water purification mechanism. After...

  16. Dialysis search filters for PubMed, Ovid MEDLINE, and Embase databases.

    Iansavichus, Arthur V; Haynes, R Brian; Lee, Christopher W C; Wilczynski, Nancy L; McKibbon, Ann; Shariff, Salimah Z; Blake, Peter G; Lindsay, Robert M; Garg, Amit X


    Physicians frequently search bibliographic databases, such as MEDLINE via PubMed, for best evidence for patient care. The objective of this study was to develop and test search filters to help physicians efficiently retrieve literature related to dialysis (hemodialysis or peritoneal dialysis) from all other articles indexed in PubMed, Ovid MEDLINE, and Embase. A diagnostic test assessment framework was used to develop and test robust dialysis filters. The reference standard was a manual review of the full texts of 22,992 articles from 39 journals to determine whether each article contained dialysis information. Next, 1,623,728 unique search filters were developed, and their ability to retrieve relevant articles was evaluated. The high-performance dialysis filters consisted of up to 65 search terms in combination. These terms included the words "dialy" (truncated), "uremic," "catheters," and "renal transplant wait list." These filters reached peak sensitivities of 98.6% and specificities of 98.5%. The filters' performance remained robust in an independent validation subset of articles. These empirically derived and validated high-performance search filters should enable physicians to effectively retrieve dialysis information from PubMed, Ovid MEDLINE, and Embase.

  17. Dialysis Search Filters for PubMed, Ovid MEDLINE, and Embase Databases

    Iansavichus, Arthur V.; Haynes, R. Brian; Lee, Christopher W.C.; Wilczynski, Nancy L.; McKibbon, Ann; Shariff, Salimah Z.; Blake, Peter G.; Lindsay, Robert M.


    Summary Background and objectives Physicians frequently search bibliographic databases, such as MEDLINE via PubMed, for best evidence for patient care. The objective of this study was to develop and test search filters to help physicians efficiently retrieve literature related to dialysis (hemodialysis or peritoneal dialysis) from all other articles indexed in PubMed, Ovid MEDLINE, and Embase. Design, setting, participants, & measurements A diagnostic test assessment framework was used to develop and test robust dialysis filters. The reference standard was a manual review of the full texts of 22,992 articles from 39 journals to determine whether each article contained dialysis information. Next, 1,623,728 unique search filters were developed, and their ability to retrieve relevant articles was evaluated. Results The high-performance dialysis filters consisted of up to 65 search terms in combination. These terms included the words “dialy” (truncated), “uremic,” “catheters,” and “renal transplant wait list.” These filters reached peak sensitivities of 98.6% and specificities of 98.5%. The filters’ performance remained robust in an independent validation subset of articles. Conclusions These empirically derived and validated high-performance search filters should enable physicians to effectively retrieve dialysis information from PubMed, Ovid MEDLINE, and Embase. PMID:22917701

  18. 76 FR 37119 - Development of Best Practices for Community Health Needs Assessment and Implementation Strategy...


    ... health needs assessment (CHNA) and implementation strategy/plan development and execution. HHS/CDC is... strategy development and execution for improved community health outcomes. These best practices are... accreditation standards, current practices in CHNA, implementation strategy/plan development and execution, and...

  19. Exploring the Interconnectedness among Strategy Development, Shared Mental Models, Organisational Learning and Organisational Change

    Malan, Renee


    The cognitive psychological processes related to learning and change behaviour are factors that impact on organisational strategy development. Strategy development is dependent on strategic thinking that is reciprocally influenced by shared mental models, organisational learning and organisational change. Although strategy development, shared…

  20. Exploring the Interconnectedness among Strategy Development, Shared Mental Models, Organisational Learning and Organisational Change

    Malan, Renee


    The cognitive psychological processes related to learning and change behaviour are factors that impact on organisational strategy development. Strategy development is dependent on strategic thinking that is reciprocally influenced by shared mental models, organisational learning and organisational change. Although strategy development, shared…

  1. General strategy for development of fuel cell technology in Denmark; Overordnet strategi for udvikling af braendselscelleteknologi i Danmark



    This strategy memo on fuel cell technology R and D is prepared by the Danish Energy Authority, Elkraft System and Eltra. The objective of the strategy process is to ensure that publicly funded research is efficient and coordinated with commercial development efforts, and, furthermore, in line with societal objectives for energy related R and D. The first strategy phase focused on establishing an updated overview of Danish R and D regarding fuel cells and evaluation of the perspectives for future use. In the second phase the strategy for fuel cell technology presented in this memo was prepared. The strategy is general and includes two tracks, 'Solid Oxide Fuel Cells' (SOFC) and 'Proton Exchange Membrane Fuel Cells' (PEMFC). A general strategy for publicly funded fuel cell projects should contribute to establish overview and targeting throughout the programme in order to ensure the best possible coordination and efficient use of R and D investments. (BA)

  2. The atrial fibrillation conundrum in dialysis patients.

    De Vriese, An S; Caluwé, Rogier; Raggi, Paolo


    The burden of atrial fibrillation (AF) and the risk of stroke are high in dialysis patients. The decision to use anticoagulation rests heavily on effective risk stratification. Because both the pathophysiology of the disease and the response to therapy differ in dialysis, data from the general population cannot be extrapolated. The effect of vitamin K antagonists (VKAs) on the risk of stroke in dialysis patients with AF has not been studied in randomized trials. The available observational data provide contradictory results, reflecting differences in the degree of residual confounding, quality of international normalized ratio control, and stroke characterization. Dialysis patients have a high baseline bleeding risk. It remains unclear to what extent VKAs affect the overall bleeding propensity, but they may significantly increase the risk of intracerebral hemorrhage. Vascular calcifications are extremely prevalent in dialysis patients and independently associated with an adverse outcome. Vitamin K antagonists inhibit the activity of key anticalcifying proteins and may thus compound the risk of vascular calcification progression in dialysis. In the absence of evidence-based guidelines for anticoagulation in dialysis patients with AF, we provide recommendations to assist clinicians in individualized risk stratification. We further propose that new oral anticoagulants may have a better benefit-risk profile in dialysis patients than VKA, provided appropriate dose reductions are made. New oral anticoagulant may yield more on-target anticoagulation, reduce the risk of intracerebral bleeding, and not interfere with vascular calcification biology. Clinical trials with new oral anticoagulant in dialysis patients are eagerly awaited, to reveal whether these assumptions can be confirmed.

  3. A New Strategy for Developing Vs30 Maps

    Wald, D. J.; McWhirter, L.; Thompson, E.; Hering, A. S.


    Despite obvious limitations as a proxy for site amplification, the use of time-averaged shear-wave velocity over the top 30 m (Vs30) is useful and widely practiced, most notably through its use as an explanatory variable in ground motion prediction equations (and thus hazard maps and ShakeMaps, among other applications). Local, regional, and global Vs30 maps thus have diverse and fundamental uses in earthquake and engineering seismology. An additional advantage of Vs30 measurements (rather than more complex frequency-dependent, site amplification characterizations), and perhaps one of the reasons it is so widely in use, is the ability to extrapolate Vs30 point observations to maps and thus to apply the limited existing data to important regional hazard mapping applications. It is this advantage upon which we expand in this study. Two common existing Vs30 mapping approaches, geology- and topographic-slope-based proxies, are attractive in that both are available in many areas of the world and can thus be applied over wide regions. Yet, although derived from or aimed to be consistent with observed Vs30 values, a limiting aspect of these current state-of-the-art Vs30 mapping strategies is that these approaches fail to directly incorporate the Vs30 observations back into the map. Likewise, predictive models typically fail to accommodate significant new Vs30 data as they become available even if they show trends that deviate from the default trend models. As such, we have developed a strategy for developing Vs30 maps that uses a hierarchical approach, where the baseline model is derived from topographic slope because it is available globally, yet geological maps and Vs30 observations contribute where available. Using the abundant measured Vs30 values in Taiwan as an example, we analyze Vs30 versus slope per geologic unit and observe minor trends that indicate potential interaction of geologic and slope terms. We then regress Vs30 for the geologic Vs30 medians

  4. Strategy Developed for Selecting Optimal Sensors for Monitoring Engine Health


    Sensor indications during rocket engine operation are the primary means of assessing engine performance and health. Effective selection and location of sensors in the operating engine environment enables accurate real-time condition monitoring and rapid engine controller response to mitigate critical fault conditions. These capabilities are crucial to ensure crew safety and mission success. Effective sensor selection also facilitates postflight condition assessment, which contributes to efficient engine maintenance and reduced operating costs. Under the Next Generation Launch Technology program, the NASA Glenn Research Center, in partnership with Rocketdyne Propulsion and Power, has developed a model-based procedure for systematically selecting an optimal sensor suite for assessing rocket engine system health. This optimization process is termed the systematic sensor selection strategy. Engine health management (EHM) systems generally employ multiple diagnostic procedures including data validation, anomaly detection, fault-isolation, and information fusion. The effectiveness of each diagnostic component is affected by the quality, availability, and compatibility of sensor data. Therefore systematic sensor selection is an enabling technology for EHM. Information in three categories is required by the systematic sensor selection strategy. The first category consists of targeted engine fault information; including the description and estimated risk-reduction factor for each identified fault. Risk-reduction factors are used to define and rank the potential merit of timely fault diagnoses. The second category is composed of candidate sensor information; including type, location, and estimated variance in normal operation. The final category includes the definition of fault scenarios characteristic of each targeted engine fault. These scenarios are defined in terms of engine model hardware parameters. Values of these parameters define engine simulations that generate

  5. Being-in-dialysis: The experience of the machine-body for home dialysis users.

    Shaw, Rhonda


    New Zealand leads the world in rates of home dialysis use, yet little is known about the experience of home dialysis from the patient's perspective. This article contributes to the literature on the self-care of dialysis patients by examining the relevance of the concept of the machine-body and cyborg embodiment for the lived experience of people with end-stage renal failure. The article, which presents a discussion of 24 in-depth interviews undertaken between 2009 and 2012, shows that although dialysis therapy is disruptive of being and time, study participants experience home dialysis in terms of flexibility, control and independence. While they do not use the term machine-body as a descriptor, the concept resonates with felt experience. Data also indicate that positive experience of home dialysis is relative to socio-economic positioning and the lived relation of patients to others, necessitating further research to examine these factors. © The Author(s) 2014.

  6. Collagen markers in peritoneal dialysis patients

    Graff, J; Joffe, P; Fugleberg, S


    (PICP), aminoterminal propeptide of type III procollagen (PIIINP), and carboxyterminal telopeptide of type I collagen (ICTP)] were studied in 19 nondiabetic peritoneal dialysis patients. The absence of correlation between the mass appearance rates of the markers and the duration of dialysis treatment...... as well as the number of peritonitis episodes supports the concept that peritoneal dialysis does not cause persistent changes in the deposition and degradation rates of collagen. A correlation between the D/Pcreatinine 4 hr and the PICP mass appearance rates was found. Since it is unlikely...

  7. Setting priorities for waste management strategies in developing countries.

    Brunner, Paul H; Fellner, Johann


    This study aimed to determine whether the waste management systems, that are presently applied in affluent countries are appropriate solutions for waste management in less developed regions. For this purpose, three cities (Vienna, Damascus and Dhaka) which differ greatly in their gross domestic product and waste management were compared. The criteria for evaluation were economic parameters, and indicators as to whether the goals of waste management (protection of human health and the environment, the conservation of resources) were reached. Based on case studies, it was found that for regions spending 1-10 Euro capita(-1) year(-1) for waste management, the 'waste hierarchy' of prevention, recycling and disposal is not an appropriate strategy. In such regions, the improvement of disposal systems (complete collection, upgrading to sanitary landfilling) is the most cost-effective method to reach the objectives of solid waste management. Concepts that are widely applied in developed countries such as incineration and mechanical waste treatment are not suitable methods to reach waste management goals in countries where people cannot spend more than 10 Euro per person for the collection, treatment and disposal of their waste. It is recommended that each region first determines its economic capacity for waste management and then designs its waste management system according to this capacity and the goals of waste management.

  8. Development of a Space Weather Strategy in Mexico

    Gonzalez-Esparza, A.; De la Luz, V.; Corona-Romero, P.; Mejia-Ambriz, J. C.; Sergeeva, M. A.; Romero-Hernandez, E.; González, L. X.; Aguilar-Rodriguez, E.


    The Mexican Space Weather Service (SCIESMEX) ( initiated in October 2014 and it is operated by the Geophysics Institute at the National Autonomous University of Mexico (UNAM). The SCIESMEX observational capabilities combines a network of different ground instruments covering solar, interplanetary, geomagnetic, and ionospheric observations. The service became a Regional Warning Center (RWC) of the International Space Environment Services (ISES) in June 2015 and participates representing Mexico in the Interprogamme Coordination Team on Space Weather (ICTSW) of the Word Meteorological Organization (WMO) and the Space Weather expert group of the UNCOUPUOS. We report the progress in developing a space weather strategy in Mexico. The plan includes: (1) to strengthen regional observational capabilities to monitor ionospheric and geomagnetic disturbances; (2) to develope of an early warning alert within the national civil protection system; (3) to study the vulnerability of critical technological systems in the country towards intense or extreme space weather events; and (4) to desing national policies to prepare the reaction of the guverment to space weather hazards.

  9. Development of Relocation Strategies Regarding Eruption Hazard in Mount Merapi

    Rosdiana Puji Lestari


    Full Text Available The research was conducted to answer a questions: 1 how the relocation of the current strategy was carried out by the government 2 the problems that arise in the relocation which has yet to be resolved, 3 how the good concept of relocation so that these problems can be minimized. The research methodology used in this study combined quantitative and qualitative methods. Qualitative methods are used to explain the empirical facts that exist in each of these conditions in the relocation settlements. SWOT analysis is used to provide an overview of the strengths, weaknesses, opportunities and threats in the relocation of victims of Merapi. Information, facts and issues that arise in the study will be described, explained and analyzed primarily for the impact of residential relocation on social and economic life of the community. Relocation concept of the economic aspects of community empowerment efforts should be made related to community economic recovery after a change in livelihood. In addition, the potential of community mapping needs to be done by the government to be optimized and developed. From the aspect of government settlements seek to transfer ownership of land in the new settlement which may be the property of the citizens so that citizens obtain legal certainty while occupying the new settlement. The social aspects of the development potential of relocating residents and making it as a tourist village, residents need to support that relocation is no longer a newcomer, they have the same rights and obligations with citizens of another.

  10. Developing Canada`s climate change strategy : electricity sector table

    Castellan, A. [Ontario Hydro, Toronto, ON (Canada)


    Canada`s climate change strategy has been the focus of extensive consultation processes whose objective is to provide recommendations to federal and provincial ministers by the end of 1999. They are also designed to study the impact, the cost and the benefits of implementation of the Kyoto Protocol and to develop immediate actions to provide early reductions in CO{sub 2} emissions. The development of long-term actions that will result in sustained greenhouse gas (GHG) reductions is also on the agenda. The role of the Electricity Sector Table is to determine the contribution of GHG emissions by power generation, transmission and distribution elements as well as by electricity and cogeneration industries. The contribution of GHG emissions by renewable energy is also being studied. One of the recommended early actions is that the federal government should include solution gas as a qualifying fuel in Class 43.1 of the Income Tax Act to provide incentives to produce electricity from waste solution gas in fossil fuel production. Natural Resources Canada predicts that GHG emissions from the electricity sector will have increased from 94 MT in 1990 to 146 MT by 2020. The current sources of power generation in Canada are as follows: hydroelectric (65 per cent), nuclear (15 per cent), coal (15 per cent), and other (5 per cent).

  11. Strategy for development of the Polish electricity sector

    Dybowski, J. [Polish Power Grid Co., Warsaw (Poland)


    This paper represents the strategy for development of the Polish Electricity Sector dealing with specific problems which are common for all of East Central Europe. In 1990 Poland adopted a restructuring program for the entire energy sector. Very ambitious plans were changed several times but still the main direction of change was preserved. The most difficult period of transformation is featured by several contradictions which have to be balanced. Electricity prices should increase in order to cover the modernization and development program but the society is not able to take this burden in such a short time. Furthermore the new environment protection standards force the growth of capital investment program which sooner or later has to be transferred through the electricity prices. New economic mechanisms have to be introduced to the electricity sector to replace the old ones noneffective, centrally planned. This process has to follow slow management changes. Also, introduction of new electricity market is limited by those constraints. However, this process of change would not be possible without parallel governmental initiation like preparation of new energy law and regulatory frames.

  12. Film: a strategy for the development of thinking

    Luz Marina Rodríguez Romero


    Full Text Available The present project, developed in 2009, is framed in the Pedagogical Innovations research line of the Education Masters Program of Universidad Pedagógica y Tecnológica de Colombia.The main objective was to design and apply a strategy in order to break the dogmatic image of thinking in university students, through the use of film. This action research project with a socio-critical approach, is grounded in theoretical and conceptual references concerning educational innovation, film-thinking and image-notion. Moreover, this pedagogical innovation was carried out using a pilot test as data analysis tool. It was concluded that film is a meaningful instrument for the development of thinking, given that students work with concepts and images. Critical thinking and reflection were the result of this educational innovation, which allowed students a deeper comprehension regarding the world, nature and the human being.One of the most important aspects achieved was that students were able to link real life with the fictional problems shown in the films, relationship between teacher and students also became stronger.

  13. Dialysis technicians' perception of certification.

    Williams, Helen F; Garbin, Margery


    The Nephrology Nursing Certification Commission initiated this research project to study the viewpoint of dialysis technicians regarding the value of certification. A national convenience sample was obtained using both paper-and-pencil and online forms of the survey instrument. Demographic characteristics were obtained concerning age, race, ethnicity, education, and future employment planning. Technicians' primary work settings, the roles they fill, and the types of certification they hold are described. Incentives offered by employers are considered to explore how they contribute to job satisfaction. Understanding the perceptions of technicians regarding the benefits of certification and the limitations of workplace incentives should enable employers to improve their recruitment and retention programs. Information obtained may offer a baseline for future observations of the characteristics of these significant and essential contributors to the nephrology workforce.

  14. Strategy for Self-Centered Development from the Perspective of an Historical Analysis of Development

    Alfredo Pérez Sánchez


    Full Text Available After acknowledging the three phases of historical analysis of development, and especially considering the research work done in the last twenty-five years by the Germans Dieter Sengcheus and Ulrich Mezel, the author presents the principle elements of a self-centered development strategy which highlights the following perspectives:dissociation, economic restructuring, and the new forms of an international division of labor among Third World economies.This document calls into question the underlying operation of the conventional theory of development and its current policy, which call for the increasing integration of the Third World in the world market as a means of going beyond development as it is commonly understood. Though being an integral element in the theory of self-centereddevelopment, temporary dissociation from the world market is proposed. The justification for the strategy of dissociation, excepting the recourse to some historical and paradigmatic reflections sketched by Friedrich List, has kept itself, of necessity, to the global and abstract level. This position is nothing, however, but a most direct analytical result deduced fromthe principle theoretical beginnings and the empirical observations of both the Theory of Dependence and Peripheral Capitalism. Although the review vents its criticism on (and mainly questions the practicality of the aforesaid conception, a more penetratingunderstanding of what the wager for such a strategy entails is found. Thus, the notion of self-centered development influences and gives impulse to a most extensive ideologicallymarked debate about the alternative conceptions of development.

  15. Anxiety disorders in dialysis patients

    Novaković Milan


    Full Text Available Introduction. Anxiety, as a primary symptom, includes all conditions of indefinite fear and psychic disorders dominated by fear. All dialysis patients suffer from anxiety as an independent phenomenon, or as part of another disease. Material and Methods. This study included 753 patients on chronic hemodialysis in Bosnia and Herzegovina (B&H in the period 1999-2004. The patients were divided into two groups: the first group included 348 patients with Balkan Endemic Nephropathy (BEN, and the control group included 405 patients with other diagnoses causing renal insufficiency (N18. The study was designed as a comparative cross sectional study, and patients were tested using questionnaires assessing anxiety, depression and general mental health status. Statistical analysis was done using standard descriptive and analytical methods. Results. Socio-demographic data showed highly significant differences between BEN and N18 in relation to place of residence (urban/rural (c2 = 23.970 p<0.01; in the incidence of renal comorbidity (c2 = 23.970 p<0.01; familial renal comorbidity (c2 = 23.970 p<0.01; and migrations (c2 = 4.874 p<0.01. Beck Anxiety Inventory Scores were highly significantly different between the two groups p<0.001, in regard to the incidence and variables. Hamilton Depression Rating Scale demonstrated a group significance p<0.001, and variables pointed to somatization, general anxiety and depression. This was confirmed by mini-mental state examination pointing to generalmental weakness. Conclusion. Anxiety appeared in all tested dialysis patients. It may be independent, somatized as part of another mental disorder or reinforced by a cognitive damage. Structured anxiety and depression result in pre-suicidal risk. .

  16. Hemodialysis Reliable Outflow (HeRO) device in end-stage dialysis access: a decision analysis model.

    Dageforde, Leigh Anne; Bream, Peter R; Moore, Derek E


    The Hemodialysis Reliable Outflow (HeRO) dialysis access device is a permanent tunneled dialysis graft connected to a central venous catheter and is used in patients with end-stage dialysis access (ESDA) issues secondary to central venous stenosis. The safety and effectiveness of the HeRO device has previously been proven, but no study thus far has compared the cost of its use with tunneled dialysis catheters (TDCs) and thigh grafts in patients with ESDA. A decision analytic model was developed to simulate outcomes for patients with ESDA undergoing placement of a HeRO dialysis access device, TDC, or thigh graft. Outcomes of interest were infection, thrombosis, and ischemic events. Baseline values, ranges, and costs were determined from a systematic review of the literature. Total costs were based on 1 year of post-procedure outcomes. Sensitivity analyses were conducted to test model strength. The HeRO dialysis access device is the least costly dialysis access with an average 1-year cost of $6521. The 1-year cost for a TDC was $8477. A thigh graft accounted for $9567 in a 1-year time period. The HeRO dialysis access device is the least costly method of ESDA. The primary determinants of cost in this model are infection in TDCs and leg ischemia necessitating amputation in thigh grafts. Further study is necessary to incorporate patient preference and quality of life into the model. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Epidemiology and mortality of liver abscess in end-stage renal disease dialysis patients: Taiwan national cohort study.

    Chon-Seng Hong

    Full Text Available BACKGROUND AND OBJECTIVES: To determine the incidence rates and mortality of liver abscess in ESRD patients on dialysis. DESIGN SETTING PARTICIPANTS & MEASUREMENTS: Using Taiwan's National Health Insurance Research Database, we collected data from all ESRD patients who initiated dialysis between 2000 and 2006. Patients were followed until death, end of dialysis, or December 31, 2008. Predictors of liver abscess and mortality were identified using Cox models. RESULTS: Of the 53,249 incident dialysis patients identified, 447 were diagnosed as having liver abscesses during the follow-up period (224/100,000 person-years. The cumulative incidence rate of liver abscess was 0.3%, 1.1%, and 1.5% at 1 year, 5 years, and 7 years, respectively. Elderly patients and patients on peritoneal dialysis had higher incidence rates. The baseline comorbidities of diabetes mellitus, polycystic kidney disease, malignancy, chronic liver disease, biliary tract disease, or alcoholism predicted development of liver abscess. Overall in-hospital mortality was 10.1%. CONCLUSIONS: The incidence of liver abscess is high among ESRD dialysis patients. In addition to the well known risk factors of liver abscess, two other important risk factors, peritoneal dialysis and polycystic kidney disease, were found to predict liver abscess in ESRD dialysis patients.

  18. Reconsidering the Lack of Urea Toxicity in Dialysis Patients.

    Massy, Ziad A; Pietrement, Christine; Touré, Fatouma


    Urea is an old uremic toxin which has been used for many years as a global biomarker of CKD severity and dialysis adequacy. Old studies were not in favor of its role as a causal factor in the pathogenesis of complications associated with the uremic state. However, recent experimental and clinical evidence is compatible with both direct and indirect toxicity of urea, particularly via the deleterious actions of urea-derived carbamylated molecules. Further studies are clearly needed to explore the potential relevance of urea-related CKD complications for patient management, in particular the place of new therapeutic strategies to prevent urea toxicity.

  19. Strength in Ways: Finding Creativity in Routine Strategy Development


    national projects but always made time to mentor by answering my strategy questions. Dr. Tom Mann at the Library of Congress was selfless in his help...very diverse educational backgrounds. On my left is a music major. On my right is an astrophysics engineer. As such, like fingerprints...approach, calling it the “nexus of ideas and practices.”28 Grandmaster of strategy theory, Thomas Schelling, stressed an ID approach to strategy. In his

  20. Physical Activity in Patients Treated With Peritoneal Dialysis

    Thangarasa, Tharshika; Imtiaz, Rameez; Hiremath, Swapnil; Zimmerman, Deborah


    Background: Patients with chronic diseases are known to benefit from exercise. Despite a lack of compelling evidence, patients with end-stage kidney disease treated with peritoneal dialysis are often discouraged from participating in exercise programs that include resistance training due to concerns about the development of hernias and leaks. The actual effects of physical activity with or without structured exercise programs for these patients remain unclear. The purpose of this study is to more completely define the risks and benefits of physical activity in the end-stage kidney disease population treated with peritoneal dialysis. Methods/design: We will conduct a systematic review examining the effects of physical activity on end-stage kidney disease patients treated with peritoneal dialysis. For the purposes of this review, exercise will be considered a purposive subcategory of physical activity. The primary objective is to determine if physical activity in this patient population is associated with improvements in mental health, physical functioning, fatigue and quality of life and if there is an increase in adverse outcomes. With the help of a skilled librarian, we will search MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials for randomized trials and observational studies. We will include adult end-stage kidney disease patients treated with peritoneal dialysis that have participated in an exercise training program or had their level of physical activity assessed directly or by self-report. The study must include an assessment of the association between physical activity and one of our primary or secondary outcomes measures. We will report study quality using the Cochrane Risk of Bias Assessment Tool for randomized controlled trials and the Newcastle–Ottawa Scale for observational studies. Quality across studies will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The

  1. Pasteurella Species Peritoneal Dialysis-Associated Peritonitis: Household Pets as a Risk Factor

    Philippe Guillaume Poliquin


    Full Text Available BACKGROUND: Pasteurella species are Gram-negative coccobacilli that are a part of the normal oropharyngeal flora of numerous domestic animals. They have been recognized as a rare but significant cause of peritonitis in patients undergoing peritoneal dialysis (PD. A consensus about management strategies for PD-associated peritonitis caused by Pasteurella species currently does not exist.

  2. Information society development through ICT market strategies Albania versus other developing countries

    Kordha Tolica, Ermelinda; Gorica, Klodiana


    ​This book examines the relationship between information society and information communication technology (ICT) markets, while evaluating the ICT impact on Albanian society and its economy. It offers insights on the country's information society development and compares it to other nations. The book begins with a general introduction to information society and efforts that can be used for ICT strategy. It then takes a look at ICT as an industrial sector and uncovers the importance for a strong ICT infrastructure management. Using this background information, the book finally explores the growing information society and ICT sector found in Albania. It measures the information society being created, and compares it to other countries in South Eastern Europe. Next the authors introduce a theoretical model for ICT driven development, focusing on ICT innovation and investment as factors that can affect the ICT market. These factors have also taken into account for strategy development in the national and industr...

  3. Increased peritoneal permeability at peritoneal dialysis initiation is a potential cardiovascular risk in patients using biocompatible peritoneal dialysis solution

    Hamasaki, Yoshifumi; Doi, Kent; Tanaka, Mototsugu; Kume, Haruki; Ishibashi, Yoshitaka; Enomoto, Yutaka; Fujita, Toshiro; Homma, Yukio; Nangaku, Masaomi; Noiri, Eisei


    Background Cardiovascular disease is a frequent cause of death in peritoneal dialysis patients. Biocompatible peritoneal dialysis solutions with neutral pH have been anticipated to reduce cardiovascular disease more than conventional peritoneal dialysis solutions with low pH, but it remains unclear which factors at peritoneal dialysis initiation increase cardiovascular risk in patients using biocompatible peritoneal dialysis solutions. This study was undertaken to investigate which clinical f...

  4. Tuberculous peritonitis in a child undergoing continuous ambulatory peritoneal dialysis.

    Tsai, T C; Hsu, J C; Chou, L H; Lee, M L


    We present a 13-year-old girl with Arnold-Chiari syndrome and uremia secondary to neurogenic bladder. She had been treated with continuous ambulatory peritoneal dialysis (CAPD) for 13 months prior to the development of peritonitis. The patient demonstrated no improvement with a 3-day therapy of intraperitoneal vancomycin and netilmicin. Meanwhile, smear of centrifuged dialysate revealed acid fast bacilli on two occasions. We, then, started anti-TB therapy with oral isoniazid (INAH), rifampin and ethambutal. The symptoms subsided within three days. In the first week, the patient lost her peritoneal ultrafiltration and needed daytime automatic peritoneal dialysis. At the last follow-up examination, 12 months after treatment, she remained well on standard CAPD.

  5. Treatment of refractory hemodialysis ascites with maintenance peritoneal dialysis.

    Ing, T S; Daugirdas, J T; Popli, S; Kheirbek, A O; Humayun, H M; Gandhi, V C; Chapa, S M


    In 5 patients who were receiving maintenance hemodialysis, ascites developed that was refractory to treatment by ultrafiltration during hemodialysis. Use of sequential isolated ultrafiltration and hemodialysis therapy either precipitated side effects or else required prolongation of total treatment time which the patients declined to accept. In 4 of the patients, ascites was believed to be primarily responsible for severe, progressive cachexia. Maintenance peritoneal dialysis was instituted in all patients, and abdominal fluid was removed gradually, over a period of 2 to 3 days. Ascites resolved promptly in each case. Three patients noted a dramatic improvement in appetite after relief of abdominal distension. Follow-up periods ranged from 6 to 4 1/2 years. Our results suggest that maintenance peritoneal dialysis can successfully control hemodialysis ascites.

  6. Laughter and humor therapy in dialysis.

    Bennett, Paul N; Parsons, Trisha; Ben-Moshe, Ros; Weinberg, Melissa; Neal, Merv; Gilbert, Karen; Rawson, Helen; Ockerby, Cherene; Finlay, Paul; Hutchinson, Alison


    Laughter and humor therapy have been used in health care to achieve physiological and psychological health-related benefits. The application of these therapies to the dialysis context remains unclear. This paper reviews the evidence related to laughter and humor therapy as a medical therapy relevant to the dialysis patient population. Studies from other groups such as children, the elderly, and persons with mental health, cancer, and other chronic conditions are included to inform potential applications of laughter therapy to the dialysis population. Therapeutic interventions could range from humorous videos, stories, laughter clowns through to raucous simulated laughter and Laughter Yoga. The effect of laughter and humor on depression, anxiety, pain, immunity, fatigue, sleep quality, respiratory function and blood glucose may have applications to the dialysis context and require further research.

  7. Are Diuretics Underutilized in Dialysis Patients?

    Trinh, Emilie; Bargman, Joanne M


    While oral diuretics are commonly used in patients with chronic kidney disease for the management of volume and blood pressure, they are often discontinued upon initiation of dialysis. We suggest that diuretics are considerably underutilized in peritoneal dialysis and haemodialysis patients despite numerous potential benefits and few side effects. Moreover, when diuretics are used, optimal doses are not always prescribed. In peritoneal dialysis, the use of diuretics can improve volume status and minimize the need for higher glucose-containing solutions. In patients on haemodialysis, diuretics can help lessen interdialytic weight gain, resulting in decreased ultrafiltration rates and fewer episodes of intradialytic hypotension. This paper will review the mechanism of action of diuretics in patients with renal insufficiency, quantify the risk of side effects and elaborate on the potential advantages of diuretic use in peritoneal dialysis and hemodialysis patients with residual kidney function.

  8. ToxCast HTS Assay Development and Retrofitting: Strategies ...

    A presentation to EC JRC partners on new ToxCast HTS assay methods and strategies to address current limitations to HTS methods Slide presentation to EC JRC partners on new ToxCast HTS assay methods and strategies to address current limitations to HTS methods.

  9. How Graphic Novels Support Reading Comprehension Strategy Development in Children

    Brenna, Beverley


    This qualitative case study explored the relationship between comprehension strategies and graphic novels in one Grade 4 classroom, utilising children as informants. The primary research questions related to children's applications of metacognitive reading comprehension strategies as well as the potential for graphic novels to support the…

  10. Limitations for a Successful Army Leader Development Strategy


    concepts that provide cohesion and focus. Second, 9James Brian Quinn, "Strategies for Change," in Readings in the Strategy Process, ed. Henry Mintzberg Henry Mintzberg and James Brian Quinn, 3-10. Upper Saddle River, N.J.: Prentice Hall, 1998. Schifferle, Peter J. America’s School for War: Fort

  11. Developing a Publication Containing Elementary Teachers' Successful Mathematics Instruction Strategies.

    Syster, Susan M.

    Mathematics teachers are trained to assess students' abilities and instruction needs. Many teachers use creative teaching strategies, games, and various media to meet those needs. Teachers, though, are constantly searching for instructional strategies, time savers, games, materials, and other ways to improve teaching in mathematics classrooms.…

  12. Enhancing Vocabulary Development and Reading Comprehension through Metacognitive Strategies

    Cubukcu, Feryal


    This article presents a study of the teacher trainees in an English department who have received instruction in metacognitive awareness for reading comprehension. Metacognition or "thinking about thinking" involves the awareness and regulation of thinking processes. Metacognitive strategies are those strategies which require students to…

  13. How Graphic Novels Support Reading Comprehension Strategy Development in Children

    Brenna, Beverley


    This qualitative case study explored the relationship between comprehension strategies and graphic novels in one Grade 4 classroom, utilising children as informants. The primary research questions related to children's applications of metacognitive reading comprehension strategies as well as the potential for graphic novels to support the…

  14. Developing an Integrated Design Strategy for Chip Layout Optimization

    Wits, Wessel Willems; Jauregui Becker, Juan Manuel; van Vliet, Frank Edward; te Riele, G.J.


    This paper presents an integrated design strategy for chip layout optimization. The strategy couples both electric and thermal aspects during the conceptual design phase to improve chip performances; thermal management being one of the major topics. The layout of the chip circuitry is optimized acco


    Carmen IORDACHE


    Full Text Available Along time, towns have proven to be landmarks in travelling, meaning that either their endowment has ben used as halt places during travels, or by the architecture of their buildings and assemblies, monuments, sculptures and bas-reliefs which have been used to decorate squares, public and private places, elements of decorative art, landscape painting, whereas the attractions they shelter have themselves proven to be some highly appreciated tourist destinations.Towns’ growth and modernization on one hand and the manifold of their supplies on the other have led along time to the emergence of a typical tourism form which is urban tourism. Along with travels’ increase, this form of tourism has aquired more and more substance, as it now benefits from the features of a distinct form of travelling with very diverse motivations. Taking account of the need to adapt towns to tourists’ demands, this paper attempts to clarify certain aspects related to the contents, specificity and materialization ways of urban tourism as well as to adopt certain urban tourism development strategies.

  16. Developing Primary Intervention Strategies to Prevent Allergic Disease.

    Rueter, Kristina; Haynes, Aveni; Prescott, Susan L


    Allergic diseases are a major cause of morbidity in the developed world, now affecting up to 40 % of the population with no evidence that this is abating. If anything, the prevalence of early onset allergic diseases such as eczema and food allergy appears to be still increasing. This is almost certainly due to the changing modern environment and lifestyle factors, acting to promote immune dysfunction through early perturbations in immune maturation, immune tolerance and regulation. This early propensity to inflammation may also have implications for the rising risk of other inflammatory non-communicable diseases (NCDs) later in life. Identifying risk factors and pathways for preventing early onset immune disease like allergy is likely to have benefits for many aspects of human health, particularly as many NCDs share similar risk factors. This review focuses on recent advances in primary intervention strategies for promoting early immune health and preventing allergic disease, highlighting the current evidence-based guidelines where applicable and areas requiring further investigation.

  17. Market Structure in the Context of Developing Competitive Strategy

    Algirdas Krivka


    Full Text Available The abstract deals with the application of positioning strategies under the conditions of classical market structures. It is discovered that the assumptions of pure competition leave no space for M. Porter’s generic cost leadership and differentiation strategies to be applied. The enterprise’s actions, influencing five competitive forces and implementing generic strategies, are reasonable under the conditions of imperfect competition market structures. The game theory models, applied to oligopoly, indicate the close interaction of enterprises and interdependence of their strategic decisions: cost reduction and differentiation strategies not only increase the profit of the enterprise, implementing the strategy, but by affecting market price and residual demand decrease the competitor’s profit.Article in Lithuanian

  18. Using tunneled femoral vein catheters for "urgent start" dialysis patients: a preliminary report.

    Hingwala, Jay; Bhola, Cynthia; Lok, Charmaine E


    Multiple benefits of arteriovenous fistulas (AVF) and arteriovenous grafts (AVGs) exist over catheters. As part of a strategy to preserve thoracic venous sites and reduce internal jugular (IJ) vein catheter use, we inserted tunneled femoral vein catheters in incident "urgent start" dialysis patients while facilitating a more appropriate definitive dialysis access. "Urgent start" dialysis patients between January 15, 2013 and January 15, 2014 who required chronic dialysis, and did not have prior modality and vascular access plans, had tunneled femoral vein catheters inserted. We determined the femoral vein catheter associated infections rates, thrombosis, and subsequent dialysis access. Eligible patients were surveyed on their femoral vein catheter experience. Twenty-two femoral vein catheters were inserted without complications. Subsequently, one catheter required intraluminal thrombolytic locking, while all other catheters maintained blood flow greater than 300 ml/min. There were no catheter-related infections (exit site infection or bacteremia). Six patients continued to use their tunneled catheter at report end, one transitioned to peritoneal dialysis, thirteen to an arteriovenous graft, and two to a fistula. One patient received a tunneled IJ vein catheter. Of the patients who completed the vascular access survey, all indicated satisfaction with their access and that they had minimal complaints of bruising, bleeding, or swelling at their access sites. Pain/discomfort at the exit site was the primary complaint, but they did not find it interfered with activities of daily living. Femoral vein tunneled catheters appear to be a safe, well tolerated, and effective temporary access in urgent start dialysis patients while they await more appropriate long-term access.

  19. Developing Hydrogeological Site Characterization Strategies based on Human Health Risk

    de Barros, F.; Rubin, Y.; Maxwell, R. M.


    In order to provide better sustainable groundwater quality management and minimize the impact of contamination in humans, improved understanding and quantification of the interaction between hydrogeological models, geological site information and human health are needed. Considering the joint influence of these components in the overall human health risk assessment and the corresponding sources of uncertainty aid decision makers to better allocate resources in data acquisition campaigns. This is important to (1) achieve remediation goals in a cost-effective manner, (2) protect human health and (3) keep water supplies clean in order to keep with quality standards. Such task is challenging since a full characterization of the subsurface is unfeasible due to financial and technological constraints. In addition, human exposure and physiological response to contamination are subject to uncertainty and variability. Normally, sampling strategies are developed with the goal of reducing uncertainty, but less often they are developed in the context of their impacts on the overall system uncertainty. Therefore, quantifying the impact from each of these components (hydrogeological, behavioral and physiological) in final human health risk prediction can provide guidance for decision makers to best allocate resources towards minimal prediction uncertainty. In this presentation, a multi-component human health risk-based framework is presented which allows decision makers to set priorities through an information entropy-based visualization tool. Results highlight the role of characteristic length-scales characterizing flow and transport in determining data needs within an integrated hydrogeological-health framework. Conditions where uncertainty reduction in human health risk predictions may benefit from better understanding of the health component, as opposed to a more detailed hydrogeological characterization, are also discussed. Finally, results illustrate how different dose

  20. Pleuroperitoneal Leak Complicating Peritoneal Dialysis: A Case Series

    C. Kennedy


    Full Text Available Pressure related complications such as abdominal wall hernias occur with relative frequency in patients on peritoneal dialysis. Less frequently, a transudative pleural effusion containing dialysate can develop. This phenomenon appears to be due to increased intra-abdominal pressure in the setting of congenital or acquired diaphragmatic defects. We report three cases of pleuroperitoneal leak that occurred within a nine-month period at our institution. We review the literature on this topic, and discuss management options. The pleural effusion resolved in one patient following drainage of the peritoneum and a switch to haemodialysis. One patient required emergency thoracocentesis. The third patient developed a complex effusion requiring surgical intervention. The three cases highlight the variability of this condition in terms of timing, symptoms and management. The diagnosis of a pleuroperitoneal leak is an important one as it is managed very differently to most transudative pleural effusions seen in this patient population. Surgical repair may be necessary in those patients who wish to resume peritoneal dialysis, or in those patients with complex effusions. Pleuroperitoneal leak should be considered in the differential diagnosis of a pleural effusion, particularly a right-sided effusion, in a patient on peritoneal dialysis.