WorldWideScience

Sample records for environmental management long-term

  1. Environmental Management Long-Term Stewardship Transition Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Kristofferson, Keith

    2001-11-01

    Long-term stewardship consists of those actions necessary to maintain and demonstrate continued protection of human health and the environment after the completion of facility cleanup. Long-term stewardship is administered and overseen by the U.S. Department of Energy Environmental Management Office of Science and Technology. This report describes the background of long-term stewardship and gives general guidance about considerations when ownership and/or responsibility of a site should be transferred to a long-term stewardship program. This guidance document will assist the U.S. Department of Energy in: (a) ensuring that the long-term stewardship program leads transition planning with respect to facility and site areas, and (b) describing the classes and types of criteria and data required to initiate transition for areas and sites where the facility mission has ended and cleanup is complete.

  2. Environmental and other evaluations of alternatives for long-term management of stored INEL transuranic waste

    Energy Technology Data Exchange (ETDEWEB)

    1979-02-01

    This study identifies, develops, and evaluates, in a preliminary manner, alternatives for long-term management of TRU waste stored at the Radioactive Waste Management Complex (RWMC) at the INEL. The evaluations concern waste currently at the RWMC and waste expected to be received by the beginning of the year 1985. The effects of waste that might be received after that date are addressed in an appendix. The technology required for managing the waste, the environmental effects, the risks to the public, the radiological and nonradiological hazards to workers, and the estimated costs are discussed.

  3. Final Long-Term Management and Storage of Elemental Mercury Environmental Impact Statement Volume1

    Energy Technology Data Exchange (ETDEWEB)

    2011-01-01

    Pursuant to the Mercury Export Ban Act of 2008 (P.L. 110-414), DOE was directed to designate a facility or facilities for the long-term management and storage of elemental mercury generated within the United States. Therefore, DOE has analyzed the storage of up to 10,000 metric tons (11,000 tons) of elemental mercury in a facility(ies) constructed and operated in accordance with the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act (74 FR 31723).DOE prepared this Final Mercury Storage EIS in accordance with the National Environmental Policy Act of 1969 (NEPA), as amended (42 U.S.C. 4321 et seq.), the Council on Environmental Quality (CEQ) implementing regulations (40 CFR 1500–1508), and DOE’s NEPA implementing procedures (10 CFR 1021) to evaluate reasonable alternatives for a facility(ies) for the long-term management and storage of elemental mercury. This Final Mercury Storage EIS analyzes the potential environmental, human health, and socioeconomic impacts of elemental mercury storage at seven candidate locations:Grand Junction Disposal Site near Grand Junction, Colorado; Hanford Site near Richland, Washington; Hawthorne Army Depot near Hawthorne, Nevada; Idaho National Laboratory near Idaho Falls, Idaho;Kansas City Plant in Kansas City, Missouri; Savannah River Site near Aiken, South Carolina; and Waste Control Specialists, LLC, site near Andrews, Texas. As required by CEQ NEPA regulations, the No Action Alternative was also analyzed as a basis for comparison. DOE intends to decide (1) where to locate the elemental mercury storage facility(ies) and (2) whether to use existing buildings, new buildings, or a combination of existing and new buildings. DOE’s Preferred Alternative for the long-term management and storage of mercury is the Waste Control Specialists, LLC, site near Andrews, Texas.

  4. Final Long-Term Management and Storage of Elemental Mercury Environmental Impact Statement Volume 2

    Energy Technology Data Exchange (ETDEWEB)

    2011-01-01

    Pursuant to the Mercury Export Ban Act of 2008 (P.L. 110-414), DOE was directed to designate a facility or facilities for the long-term management and storage of elemental mercury generated within the United States. Therefore, DOE has analyzed the storage of up to 10,000 metric tons (11,000 tons) of elemental mercury in a facility(ies) constructed and operated in accordance with the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act (74 FR 31723). DOE prepared this Final Mercury Storage EIS in accordance with the National Environmental Policy Act of 1969 (NEPA), as amended (42 U.S.C. 4321 et seq.), the Council on Environmental Quality (CEQ) implementing regulations (40 CFR 1500–1508), and DOE’s NEPA implementing procedures (10 CFR 1021) to evaluate reasonable alternatives for a facility(ies) for the long-term management and storage of elemental mercury. This Final Mercury Storage EIS analyzes the potential environmental, human health, and socioeconomic impacts of elemental mercury storage at seven candidate locations: Grand Junction Disposal Site near Grand Junction, Colorado; Hanford Site near Richland, Washington; Hawthorne Army Depot near Hawthorne, Nevada; Idaho National Laboratory near Idaho Falls, Idaho; Kansas City Plant in Kansas City, Missouri; Savannah River Site near Aiken, South Carolina; and Waste Control Specialists, LLC, site near Andrews, Texas. As required by CEQ NEPA regulations, the No Action Alternative was also analyzed as a basis for comparison. DOE intends to decide (1) where to locate the elemental mercury storage facility(ies) and (2) whether to use existing buildings, new buildings, or a combination of existing and new buildings. DOE’s Preferred Alternative for the long-term management and storage of mercury is the Waste Control Specialists, LLC, site near Andrews, Texas.

  5. Long-Term Biological Monitoring of an Impaired Stream: Synthesis and Environmental Management Implications

    Science.gov (United States)

    Peterson, Mark J.; Efroymson, Rebecca A.; Adams, S. Marshall

    2011-06-01

    The long-term ecological recovery of an impaired stream in response to an industrial facility's pollution abatement actions and the implications of the biological monitoring effort to environmental management is the subject of this special issue of Environmental Management. This final article focuses on the synthesis of the biological monitoring program's components and methods, the efficacy of various biological monitoring techniques to environmental management, and the lessons learned from the program that might be applicable to the design and application of other programs. The focus of the 25-year program has been on East Fork Poplar Creek, an ecologically impaired stream in Oak Ridge, Tennessee with varied and complex stressors from a Department of Energy facility in its headwaters. Major components of the long-term program included testing and monitoring of invertebrate and fish toxicity, bioindicators of fish health, fish contaminant accumulation, and instream communities (including periphyton, benthic macroinvertebrate, and fish). Key parallel components of the program include water chemistry sampling and data management. Multiple lines of evidence suggested positive ecological responses during three major pollution abatement periods. Based on this case study and the related literature, effective environmental management of impaired streams starts with program design that is consistent across space and time, but also adaptable to changing conditions. The biological monitoring approaches used for the program provided a strong basis for assessments of recovery from remedial actions, and the likely causes of impairment. This case study provides a unique application of multidisciplinary and quantitative techniques to address multiple and complex regulatory and programmatic goals, environmental stressors, and remedial actions.

  6. Workshop proceedings: Developing the scientific basis for long-term land management of the Idaho National Engineering and Environmental Laboratory

    Energy Technology Data Exchange (ETDEWEB)

    Sperber, T.D.; Reynolds, T.D. [eds.] [Environmental Science and Research Foundation, Inc., Idaho Falls, ID (United States); Breckenridge, R.P. [ed.] [Lockheed Martin Idaho Technologies Co., Idaho Falls, ID (United States)

    1998-03-01

    Responses to a survey on the INEEL Comprehensive Facility and Land Use Plan (US DOE 1996a) indicated the need for additional discussion on environmental resources, disturbance, and land use issues on the Idaho National Engineering and Environmental Laboratory (INEEL). As a result, in September 1997, a workshop evaluated the existing scientific basis and determined future data needs for long-term land management on the INEEL. This INEEL Long-Term Land Management Workshop examined existing data on biotic, abiotic, and heritage resources and how these resources have been impacted by disturbance activities of the INEEL. Information gained from this workshop will help guide land and facility use decisions, identify data gaps, and focus future research efforts. This report summarizes background information on the INEEL and its long-term land use planning efforts, presentations and discussions at the workshop, and the existing data available at the INEEL. In this document, recommendations for future INEEL land use planning, research efforts, and future workshops are presented. The authors emphasize these are not policy statements, but comments and suggestions made by scientists and others participating in the workshop. Several appendices covering land use disturbance, legal drivers, land use assumptions and workshop participant comments, workshop participants and contributors, and the workshop agenda are also included.

  7. Final Long-Term Management and Storage of Elemental Mercury Environmental Impact Statement Summary and Guide for Stakeholders

    Energy Technology Data Exchange (ETDEWEB)

    2011-01-01

    Pursuant to the Mercury Export Ban Act of 2008 (P.L. 110-414), DOE was directed to designate a facility or facilities for the long-term management and storage of elemental mercury generated within the United States. Therefore, DOE has analyzed the storage of up to 10,000 metric tons (11,000 tons) of elemental mercury in a facility(ies) constructed and operated in accordance with the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act (74 FR 31723). DOE prepared this Final Mercury Storage EIS in accordance with the National Environmental Policy Act of 1969 (NEPA), as amended (42 U.S.C. 4321 et seq.), the Council on Environmental Quality (CEQ) implementing regulations (40 CFR 1500–1508), and DOE’s NEPA implementing procedures (10 CFR 1021) to evaluate reasonable alternatives for a facility(ies) for the long-term management and storage of elemental mercury. This Final Mercury Storage EIS analyzes the potential environmental, human health, and socioeconomic impacts of elemental mercury storage at seven candidate locations: Grand Junction Disposal Site near Grand Junction, Colorado; Hanford Site near Richland, Washington; Hawthorne Army Depot near Hawthorne, Nevada; Idaho National Laboratory near Idaho Falls, Idaho; Kansas City Plant in Kansas City, Missouri; Savannah River Site near Aiken, South Carolina; and Waste Control Specialists, LLC, site near Andrews, Texas. As required by CEQ NEPA regulations, the No Action Alternative was also analyzed as a basis for comparison. DOE intends to decide (1) where to locate the elemental mercury storage facility(ies) and (2) whether to use existing buildings, new buildings, or a combination of existing and new buildings. DOE’s Preferred Alternative for the long-term management and storage of mercury is the Waste Control Specialists, LLC, site near Andrews, Texas.

  8. Environmental management: integrating ecological evaluation, remediation, restoration, natural resource damage assessment and long-term stewardship on contaminated lands.

    Science.gov (United States)

    Burger, Joanna

    2008-08-01

    Ecological evaluation is essential for remediation, restoration, and Natural Resource Damage Assessment (NRDA), and forms the basis for many management practices. These include determining status and trends of biological, physical, or chemical/radiological conditions, conducting environmental impact assessments, performing remedial actions should remediation fail, managing ecosystems and wildlife, and assessing the efficacy of remediation, restoration, and long-term stewardship. The objective of this paper is to explore the meanings of these assessments, examine the relationships among them, and suggest methods of integration that will move environmental management forward. While remediation, restoration, and NRDA, among others, are often conducted separately, it is important to integrate them for contaminated land where the risks to ecoreceptors (including humans) can be high, and the potential damage to functioning ecosystems great. Ecological evaluations can range from inventories of local plants and animals, determinations of reproductive success of particular species, levels of contaminants in organisms, kinds and levels of effects, and environmental impact assessments, to very formal ecological risk assessments for a chemical or other stressor. Such evaluations can range from the individual species to populations, communities, ecosystems or the landscape scale. Ecological evaluations serve as the basis for making decisions about the levels and kinds of remediation, the levels and kinds of restoration possible, and the degree and kinds of natural resource injuries that have occurred because of contamination. Many different disciplines are involved in ecological evaluation, including biologists, conservationists, foresters, restoration ecologists, ecological engineers, economists, hydrologist, and geologists. Since ecological evaluation forms the basis for so many different types of environmental management, it seems reasonable to integrate management options

  9. Sandia National Laboratories performance assessment methodology for long-term environmental programs : the history of nuclear waste management.

    Energy Technology Data Exchange (ETDEWEB)

    Marietta, Melvin Gary; Anderson, D. Richard; Bonano, Evaristo J.; Meacham, Paul Gregory (Raytheon Ktech, Albuquerque, NM)

    2011-11-01

    Sandia National Laboratories (SNL) is the world leader in the development of the detailed science underpinning the application of a probabilistic risk assessment methodology, referred to in this report as performance assessment (PA), for (1) understanding and forecasting the long-term behavior of a radioactive waste disposal system, (2) estimating the ability of the disposal system and its various components to isolate the waste, (3) developing regulations, (4) implementing programs to estimate the safety that the system can afford to individuals and to the environment, and (5) demonstrating compliance with the attendant regulatory requirements. This report documents the evolution of the SNL PA methodology from inception in the mid-1970s, summarizing major SNL PA applications including: the Subseabed Disposal Project PAs for high-level radioactive waste; the Waste Isolation Pilot Plant PAs for disposal of defense transuranic waste; the Yucca Mountain Project total system PAs for deep geologic disposal of spent nuclear fuel and high-level radioactive waste; PAs for the Greater Confinement Borehole Disposal boreholes at the Nevada National Security Site; and PA evaluations for disposal of high-level wastes and Department of Energy spent nuclear fuels stored at Idaho National Laboratory. In addition, the report summarizes smaller PA programs for long-term cover systems implemented for the Monticello, Utah, mill-tailings repository; a PA for the SNL Mixed Waste Landfill in support of environmental restoration; PA support for radioactive waste management efforts in Egypt, Iraq, and Taiwan; and, most recently, PAs for analysis of alternative high-level radioactive waste disposal strategies including repositories deep borehole disposal and geologic repositories in shale and granite. Finally, this report summarizes the extension of the PA methodology for radioactive waste disposal toward development of an enhanced PA system for carbon sequestration and storage systems

  10. A Strategy and Case Study Example for Designing and Implementing Environmental Long-Term Monitoring at Legacy Management Sites

    Energy Technology Data Exchange (ETDEWEB)

    Earl D. Mattson; Roelof J. Versteeg; Mark Ankeny; Gail Heath; Alex Richardson

    2004-04-01

    Environmental monitoring objectives of site owners, regulators, consultants, and scientists typically share the common elements of (1) cost management, (2) risk management, and (3) information management (Figure 1). Many site owners focus on minimizing monitoring costs while regulators typically focus on risk and regulatory compliance. Scientists and consultants typically provide information management in the form of spreadsheets with extracted information provided in reports to other users. This common piecemeal approach upon individual focus on elements of the monitoring objectives, rather than the common objective of minimizing cost and risk using site information, results in missed opportunities for cost savings, environmental protection, and improved understanding of site performance.

  11. Environmental evaluation of alternatives for long-term management of Defense high-level radioactive wastes at the Idaho Chemical Processing Plant

    Energy Technology Data Exchange (ETDEWEB)

    1982-09-01

    The U.S. Department of Energy (DOE) is considering the selection of a strategy for the long-term management of the defense high-level wastes at the Idaho Chemical Processing Plant (ICPP). This report describes the environmental impacts of alternative strategies. These alternative strategies include leaving the calcine in its present form at the Idaho National Engineering Laboratory (INEL), or retrieving and modifying the calcine to a more durable waste form and disposing of it either at the INEL or in an offsite repository. This report addresses only the alternatives for a program to manage the high-level waste generated at the ICPP. 24 figures, 60 tables.

  12. Long-term environmental behaviour of radionuclides

    Energy Technology Data Exchange (ETDEWEB)

    Brechignac, F.; Moberg, L.; Suomela, M

    2000-04-01

    The radioactive pollution of the environment results from the atmospheric nuclear weapons testing (during the mid-years of twentieth century), from the development of the civilian nuclear industry and from accidents such as Chernobyl. Assessing the resulting radiation that humans might receive requires a good understanding of the long-term behaviour of radionuclides in the environment. This document reports on a joint European effort to advance this understanding, 3 multinational projects have been coordinated: PEACE, EPORA and LANDSCAPE. This report proposes an overview of the results obtained and they are presented in 6 different themes: (i) redistribution in the soil-plant system, (ii) modelling, (iii) countermeasures, (iv) runoff (v) spatial variations, and (vi) dose assessment. The long term behaviour of the radionuclides {sup 137}Cs, {sup 90}Sr and {sup 239-240}Pu is studied through various approaches, these approaches range from in-situ experiments designed to exploit past contamination events to laboratory simulations. A broad scope of different ecosystems ranging from arctic and boreal regions down to mediterranean ones has been considered. (A.C.)

  13. Sensors for environmental monitoring and long-term environmental stewardship.

    Energy Technology Data Exchange (ETDEWEB)

    Miller, David Russell; Robinson, Alex Lockwood; Ho, Clifford Kuofei; Davis, Mary Jo (Science Applications International Corporation, Albuquerque, NM)

    2004-09-01

    This report surveys the needs associated with environmental monitoring and long-term environmental stewardship. Emerging sensor technologies are reviewed to identify compatible technologies for various environmental monitoring applications. The contaminants that are considered in this report are grouped into the following categories: (1) metals, (2) radioisotopes, (3) volatile organic compounds, and (4) biological contaminants. Regulatory drivers are evaluated for different applications (e.g., drinking water, storm water, pretreatment, and air emissions), and sensor requirements are derived from these regulatory metrics. Sensor capabilities are then summarized according to contaminant type, and the applicability of the different sensors to various environmental monitoring applications is discussed.

  14. The long-term consequences of anaesthetic management | Sessler ...

    African Journals Online (AJOL)

    The long-term consequences of anaesthesia were not seriously considered until relatively recently. There is increasing evidence that some intraoperative anaesthetic management decisions have long-term consequences, and that others might as well. Keywords: long-term consequences; anaesthetic management ...

  15. Long-Term Impact of Service Learning in Environmental Studies

    Science.gov (United States)

    MacFall, Janet

    2012-01-01

    Long-term impacts from a senior course in Environmental Studies were evaluated by a survey of program graduates (36 respondents, 50% response rate) who had participated in the course over an 8-year permiod. Each year, the Senior Seminar used a service-learning pedagogy with a different environmentally focused project ranging from web resource…

  16. Science and society: the role of long-term studies in environmental stewardship

    Science.gov (United States)

    Charles T. Driscoll; Kathleen F. Lambert; F. Stuart Chapin; David J. Nowak; Thomas A. Spies; Frederick J. Swanson; David B. Kittredge; Clarisse M. Hart

    2012-01-01

    Long-term research should play a crucial role in addressing grand challenges in environmental stewardship. We examine the efforts of five Long Term Ecological Research Network sites to enhance policy, management, and conservation decisions for forest ecosystems. In these case studies, we explore the approaches used to inform policy on atmospheric deposition, public...

  17. Community Solutions for Stormwater Management: A Guide for Voluntary Long-Term Planning

    Science.gov (United States)

    This draft guide describes how to develop a comprehensive long-term community stormwater plan that integrates stormwater management with communities’ broader plans for economic development, infrastructure investment and environmental compliance.

  18. Method for Water Management Considering Long-term Probabilistic Forecasts

    Science.gov (United States)

    Hwang, J.; Kang, J.; Suh, A. S.

    2015-12-01

    This research is aimed at predicting the monthly inflow of the Andong-dam basin in South Korea using long-term probabilistic forecasts to apply long-term forecasts to water management. Forecasted Cumulative Distribution Functions (CDFs) of monthly precipitation are plotted by combining the range of monthly precipitation based on proper Probability Density Function (PDF) in past data with probabilistic forecasts in each category. Ensembles of inflow are estimated by entering generated ensembles of precipitation based on the CDFs into the 'abcd' water budget model. The bias and RMSE between averages in past data and observed inflow are compared to them in forecasted ensembles. In our results, the bias and RMSE of average precipitation in the forecasted ensemble are bigger than in past data, whereas the average inflow in the forecasted ensemble is smaller than in past data. This result could be used for reference data to apply long-term forecasts to water management, because of the limit in the number of forecasted data for verification and differences between the Andong-dam basin and the forecasted regions. This research has significance by suggesting a method of applying probabilistic information in climate variables from long-term forecasts to water management in Korea. Original data of a climate model, which produces long-term probabilistic forecasts should be verified directly as input data of a water budget model in the future, so that a more scientific response in water management against uncertainty of climate change could be reached.

  19. The long-term consequences of anaesthetic management

    African Journals Online (AJOL)

    management might influence long-term outcomes. The distinction being made here is between the classical definition of anaesthetic complications, which is restricted to the immediate perioperative period, perhaps extending to a few days after surgery, and the potential effects of anaesthetic management on events weeks, ...

  20. Issues for the long term management of radioactive waste

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, T.; Schieber, C. [CEPN, 92 - Fontenay-aux-Roses (France); Lavelle, S. [ICAM, 59 - Lille (France)

    2006-07-01

    High-level radioactive waste are currently managed in interim storage installations, providing an adequate protection of the public and the workers for the short term period. However, the long-term persistence of the radioactivity of the waste gives a new timescale dimension, never experimented by the society for the development of protection systems. In the framework of the European Commission research project 'COWAM-2' (COmmunity WAste Management) dedicated to the governance of radioactive waste management, the issues of 'long term governance' have been addressed by exploring the elements which can contribute to a better integration of the technical and societal time dimensions, taking into account technical, ethical, economic and organizational considerations. The originality of this project is to address the various issues within working groups involving stakeholders from different origins and European countries together with a research team. After a discussion on the time dimensions to be taken into account from the technical and societal perspective, this paper presents, mainly based on the findings of the COWAM-2 project, a brief analysis of the ethical criteria to be considered when future generations are concerned as well as some performance criteria regarding long term governance. Finally, it proposes a discussion on the interest for the radiation protection experts to engage a process with stakeholders concerned by radioactive waste management in order to favour the emergence of a sustainable management responding to the issues at stake and including radiation protection considerations for long term periods. (authors)

  1. Reflectance-based detection for long term environmental monitoring

    Directory of Open Access Journals (Sweden)

    Brandy J. Johnson

    2017-06-01

    Full Text Available Here, the potential of colorimetric sensors utilizing porphyrin indicators for long term environmental monitoring is demonstrated. Prototype devices based on commercial color sensing chips (six per device were combined with in-house developed algorithms for data analysis. The devices are intended to provide real-time sensing of threats. An initial outdoor data set was collected using prototype devices with occasional spiked exposure to targets. This data was supported by similar data collected in a controlled indoor environment. Weaknesses in the noted performance of the devices during these experiments were addressed through altering device parameters, algorithm parameters, and array element composition. Additional outdoor data sets totaling 1,616 h and indoor data sets totaling 728 h were collected in support of assessing these changes to the system configuration. The optimized system provided receiver operating characteristics (ROC of specificity 0.97 and sensitivity 1.0.

  2. Roundtable on Long-Term Management In The Cleanup of Contaminated Sites

    Energy Technology Data Exchange (ETDEWEB)

    Aimee Houghton

    2002-06-28

    The Center for Public Environmental Oversight (CPEO) convened a roundtable in Washington, DC on June 28, 2002 to discuss innovative approaches to long-term management in the cleanup of contaminated property. Twenty participants attended the meeting, including representatives of federal agencies, local government, state regulatory agencies, environmental organizations, and thinking tanks, as well as private consultants with experience in site remediation and redevelopment.

  3. Metyrapone for Long-Term Medical Management of Cushing's Syndrome

    Science.gov (United States)

    Traina, Andrea N.; Farr, Ashley; Malik, Ritu; Bingham, Robert J.

    2013-01-01

    Cushing's syndrome is characterized by any cause of excess cortisol in the blood and produces many physiologic consequences. Left untreated, Cushing's is associated with significant morbidity and mortality. Seventy percent of endogenous cases of Cushing's syndrome are secondary to a pituitary tumor; because of this, the primary mode of management is surgical resection of the tumor. Should hypercortisolism persist following surgical resection, further treatment options are limited. Metyrapone is an orphan medication that is often used in the diagnosis of the disease and occasionally for short-term treatment prior to surgery. Long-term treatment with metyrapone is usually discouraged due to the contradictory increase in ACTH production, acne, hirsutism, hyperkalemia, edema, and other mineralocorticoid effects. We present a patient with refractory Cushing's syndrome successfully treated for nearly 6 years with metyrapone with minimal adverse effects. This orphan medication may be a viable long-term treatment option for this difficult disease. PMID:24416602

  4. Long-term surgical-orthodontic management of hemimandibular hyperplasia.

    Science.gov (United States)

    Bennett, Samuel C; Goonewardene, Mithran S

    2016-05-01

    Hemimandibular hyperplasia (HH), also known as hemimandibular hypertrophy, is characterised by excessive unilateral three-dimensional growth of the mandible after birth. Vertical unilateral elongation of the mandible becomes clinically evident as a rare form of vertical facial asymmetry. Aberrant growth of the facial skeleton affects the developing dentition and the dental compensatory mechanism is usually unable to maintain optimal occlusal relationships. The resulting malocclusion is effectively managed by combined surgical-orthodontic care to address the facial, skeletal and dental problems that confront clinicians. Orthodontists are advised to assess patients with HH during the post-treatment retention stage for continuing mandibular growth and assess the stability of treatment outcomes with long-term follow-up and records as required. To present a case of hemimandibular hyperplasia treated successfully by combined surgical-orthodontic care and evaluated for stability over a seven-year follow-up period. Surgical-orthodontic management was accomplished in four stages: 1) pre-surgical orthodontic; 21 surgical; 3) post-surgical orthodontic; and 4) post-treatment orthodontic retention. Complete orthodontic records, including extra- and intra-oral photographs, study models, and cephalograms plus panoramic radiographs were taken at the pretreatment, post-treatment, and seven-year orthodontic retention time-points. Facial, skeletal and dental goals were achieved in the three planes of space and the long-term stability of the treatment results was shown during a post-treatment orthodontic retention period of seven years. Hemimandibular hyperplasia is a true growth anomaly which may be managed effectively. Clinicians may expect successful long-term correction and stability by utilising a comprehensive surgical-orthodontic treatment approach.

  5. Long Term Fur Management Plan : Seney National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The Seney NWR Furbearer Management Plan directs the management and regulation of trapping. The furbearer management program directly supports the environmental...

  6. Acute and long-term management of food allergy

    DEFF Research Database (Denmark)

    de Silva, D; Geromi, M; Panesar, S S

    2014-01-01

    BACKGROUND: Allergic reactions to food can have serious consequences. This systematic review summarizes evidence about the immediate management of reactions and longer-term approaches to minimize adverse impacts. METHODS: Seven bibliographic databases were searched from their inception to September...... 30, 2012, for systematic reviews, randomized controlled trials, quasi-randomized controlled trials, controlled clinical trials, controlled before-and-after and interrupted time series studies. Experts were consulted for additional studies. There was no language or geographic restrictions. Two...... management for non-life-threatening reactions. H1-antihistamines may be of benefit, but this evidence was in part derived from studies on those with cross-reactive birch pollen allergy. Regarding long-term management, avoiding the allergenic food or substituting an alternative was commonly recommended...

  7. The essential value of long-term experimental data for hydrology and water management

    Science.gov (United States)

    Tetzlaff, Doerthe; Carey, Sean K.; McNamara, James P.; Laudon, Hjalmar; Soulsby, Chris

    2017-04-01

    Observations and data from long-term experimental watersheds are the foundation of hydrology as a geoscience. They allow us to benchmark process understanding, observe trends and natural cycles, and are prerequisites for testing predictive models. Long-term experimental watersheds also are places where new measurement technologies are developed. These studies offer a crucial evidence base for understanding and managing the provision of clean water supplies, predicting and mitigating the effects of floods, and protecting ecosystem services provided by rivers and wetlands. They also show how to manage land and water in an integrated, sustainable way that reduces environmental and economic costs.

  8. Long-term condition management: health professionals' perspectives.

    Science.gov (United States)

    Ashworth, Natasha; Thompson, Shona

    2011-03-01

    Long-term conditions (LTCs) are the leading cause of morbidity and mortality in New Zealand. The burden upon patients and health care services to manage these conditions has prompted calls for primary care to lead the way in early diagnosis and coordination of LTC care. The purpose of this study was to investigate the perspectives of health professionals in a geographically-isolated region of New Zealand regarding current levels of LTC management to provide direction for future service development. Semi-structured, face-to-face interviews conducted in 2009 with 10 purposively sampled health professionals in the primary care field, including four general practitioners, four nurses and two management team personnel, all practising in a regional District Health Board. The resultant data were analysed using a general inductive thematic approach. Three main themes were identified by the health professionals as being key issues pertaining to the management of LTCs. These are discussed as issues pertaining to management, information and communication and leadership. The results showed that LTC management is rated as highly important by health care professionals who are aware of the need to change current delivery methods to improve client outcomes. All those interviewed highlighted issues related to funding as being a significant barrier to implementing innovations in LTC management, including nurse-led services. Plans to develop integrated family health centres, information technology systems and increased collaboration between clinicians were hailed as potential solutions to improving LTC management.

  9. Cost accounting in long term construction project management

    Directory of Open Access Journals (Sweden)

    Sabrina Versteg

    2017-09-01

    Full Text Available The aim of this study is to analyze the particularities that involve accounting and ways to control the revenue and costs of long-term engineering projects, in accordance with the accounting practices established by Technical Publication No. 17 (CPC 17. In order to achieve the research objectives, we performed a case study with a qualitative and quantitative approach through the collection of data and evidence from management reports and semi-structured interviews with two project coordinators and the accountant for the company that is the focus of the study. The results showed that the company under review applies accounting practices, according to the guideline of the CPC 17, in accounting for construction contracts, and achieves cost and revenue controls of these projects through project management and accounting control.

  10. Hypertension: diagnosis, acute antihypertension therapy, and long-term management.

    Science.gov (United States)

    Porsche, R

    1995-11-01

    Hypertension remains a major modifiable risk factor for coronary heart disease, cerebrovascular disease, peripheral vascular disease, and renal disease. Although great strides have been made in increasing patient awareness, lifestyle changes, and compliance with treatment protocols, hypertensive emergencies and hypertensive urgencies remain a major concern. Unless treated promptly, irreversible target organ damage will ensue. Therefore, patients with acutely elevated blood pressure, regardless of cause, must be evaluated expeditiously, and appropriate treatment must be initiated. Nurses must be able to assess and monitor patients and their progress and recognize signs and symptoms of complications related to hypertension. Once blood pressure control has been achieved, nurses initiate patient education. However, long-term management must not only include blood pressure monitoring and patient education, but also emphasize lifestyle changes.

  11. Maintenance of Lost Weight and Long-Term Management of Obesity.

    Science.gov (United States)

    Hall, Kevin D; Kahan, Scott

    2018-01-01

    Weight loss can be achieved through a variety of modalities, but long-term maintenance of lost weight is much more challenging. Obesity interventions typically result in early weight loss followed by a weight plateau and progressive regain. This review describes current understanding of the biological, behavioral, and environmental factors driving this near-ubiquitous body weight trajectory and the implications for long-term weight management. Treatment of obesity requires ongoing clinical attention and weight maintenance-specific counseling to support sustainable healthful behaviors and positive weight regulation. Published by Elsevier Inc.

  12. Beyond the short term : transportation asset management for long-term sustainability, accountability and performance

    Science.gov (United States)

    2010-01-01

    Transportation Asset Management (TAM) has long been recognized as a sound, long-term approach to managing infrastructure. It provides decision makers with a rational, long-term systematic process for making difficult and complex decisions about how t...

  13. [Outsourcing in long-term care: a risk management approach].

    Science.gov (United States)

    Guimarães, Cristina Machado; Carvalho, José Crespo de

    2012-05-01

    This article seeks to investigate outsourcing decisions in supply chain management of healthcare organizations, namely the motives and constraints behind the decision, the selection criteria for activities to be outsourced to third parties, the type of possible agreements, and the impact of this decision on the organization per se. A case study of the start-up phase of a Long-term Care unit with an innovative approach and high levels of customization was conducted to understand the outsourcing process in a start-up context (not in the standard context of organizational change) and a risk evaluation matrix was created for outsourcing activities in order to define and implement a performance monitoring process. This study seeks to understand how to evaluate and assess the risks of an outsourcing strategy and proposes a monitoring model using risk management tools. It was shown that the risk management approach can be a solution for monitoring outsourcing in the organizational start-up phase. Conclusions concerning dissatisfaction with the results of outsourcing strategies adopted are also presented.

  14. Ecosystem and human health assessment to define environmental management strategies: The case of long-term human impacts on an Arctic lake.

    Science.gov (United States)

    Moiseenko, T I; Voinov, A A; Megorsky, V V; Gashkina, N A; Kudriavtseva, L P; Vandish, O I; Sharov, A N; Sharova, Yu; Koroleva, I N

    2006-10-01

    There are rich deposits of mineral and fossil natural resources in the Arctic, which make this region very attractive for extracting industries. Their operations have immediate and vast consequences for ecological systems, which are particularly vulnerable in this region. We are developing a management strategy for Arctic watersheds impacted by industrial production. The case study is Lake Imandra watershed (Murmansk oblast, Russia) that has exceptionally high levels of economic development and large numbers of people living there. We track the impacts of toxic pollution on ecosystem health and then--human health. Three periods are identified: (a) natural, pre-industrial state; (b) disturbed, under rapid economic development; and (c) partial recovery, during recent economic meltdown. The ecosystem is shown to transform into a qualitatively new state, which is still different from the original natural state, even after toxic loadings have substantially decreased. Fish disease where analyzed to produce and integral evaluation of ecosystem health. Accumulation of heavy metals in fish is correlated with etiology of many diseases. Dose-effect relationships are between integral water quality indices and ecosystem health indicators clearly demonstrates that existing water quality standards adopted in Russia are inadequate for Arctic regions. Health was also poor for people drinking water from the Lake. Transport of heavy metals from drinking water, into human organs, and their effect on liver and kidney diseases shows the close connection between ecosystem and human health. A management system is outlined that is based on feedback from indices of ecosystem and human health and control over economic production and/or the amount of toxic loading produced. We argue that prospects for implementation of such a system are quite bleak at this time, and that more likely we will see a continued depopulation of these Northern regions.

  15. Long-term endoscopic management for primary recurrent pyogenic cholangitis

    Directory of Open Access Journals (Sweden)

    James L Buxbaum

    2014-01-01

    Full Text Available Background: Primary recurrent pyogenic cholangitis (RPC is characterized by relentless suppurative cholangitis in those with a suspected parasitic injury of the biliary tree. Prior work has demonstrated that the infections recur following "definitive" biliary surgery and long-term percutaneous biliary catheters are poorly tolerated. The aim of this study was to assess whether scheduled surveillance endoscopic retrograde cholangiopancreatography (ERCP prevents cholangitis in those with RPC. Materials and Methods: Following initial biliary decompression and stone clearance, patients with RPC were offered serial ERCP every 3-6 months to remove accumulating stony debris and to dilate incipient strictures. Review of a large series managed using this approach at the University of California, San Francisco Medical Center was performed. The principle outcome was the development of acute cholangitis requiring hospitalization and whether the episode occurred, while the RPC patient was in compliance with endoscopic surveillance recommendations. Results: Over a period of 10 years, 66 patients with primary RPC were managed for RPC at the University of California, San Francisco. The patients were comprised primarily of first-generation immigrants from Asia though one-quarter had migrated from Latin America and Russia. Episodes of cholangitis were significantly less likely to occur in those undergoing surveillance biliary endoscopy than in those who were not (odds ratio 5.3; P = 0.005 . The mean follow-up was 36.1 months. Conclusions: Serial endoscopic treatment of RPC may be used to systematically clear biliary debris and decreases the risk of cholangitis requiring hospitalization. It represents a reasonable initial management strategy for these patients. Surgery and percutaneous management may also be required, but are best performed as part of a multidisciplinary approach.

  16. Management of complications in long-term LVAD support.

    Science.gov (United States)

    Schweiger, Martin; Vierecke, Juliane; Potapov, Evgenij; Krabatsch, Thomas

    2013-06-25

    Management of complications in long-term LVAD support like aortic regurgitation, progressive decline of right ventricular function, or pump thrombosis are challenging.
 After 2.5 years on a HeartMate II left ventricular assist device (LVAD) a 59-year-old patient was admitted to hospital due to severe hemolysis caused by a partial occlusion and thrombosis caused by a shift of the LVAD inflow cannula towards the lateral wall of the left ventricle (LV). Preoperative assessment revealed additional severe aortic regurgitation and impaired right ventricular (RV) function (severe tricuspid regurgitation, RV ejection fraction 25%, central venous pressure 14 mmHg). After LVAD device exchange and aortic valve replacement (AVR) RV failure occurred and a temporary right ventricular assist device (RVAD) was employed. RVAD explantation was feasible 21 days after surgery. The patient was discharged to a rehabilitation center.
 In this case, LVAD exchange with concomitant AVR and temporary RVAD efforts saved the patient's life and restored a good quality of life.

  17. Diagnosis, management, and long-term outcomes of rectovaginal endometriosis

    Directory of Open Access Journals (Sweden)

    Moawad NS

    2013-11-01

    Full Text Available Nash S Moawad,1 Andrea Caplin21Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Florida, 2University of Florida College of Medicine, Gainesville, FL, USAAbstract: Rectovaginal endometriosis is the most severe form of endometriosis. Clinically, it presents with a number of symptoms including chronic pelvic pain, dysmenorrhea, deep dyspareunia, dyschezia, and rectal bleeding. The gold standard for diagnosis is laparoscopy with histological confirmation; however, there are a number of options for presurgical diagnosis, including clinical examination, transvaginal/transrectal ultrasound, magnetic resonance imagining, colonoscopy, and computed tomography colonography. Treatment can be medical or surgical. Medical therapies include birth control pills, oral progestins, gonadotropin-releasing hormone agonists, danazol, and injectable progestins. Analgesics are often used as well. Surgery improves up to 70% of symptoms. Surgery is either ablative or excisional, and is conducted via transvaginal, laparoscopic, laparotomy, or combined approaches. Common surgical techniques involve shaving of the superficial rectal lesion, laparoscopic anterior discoid resection, and low anterior bowel resection and reanastomosis. Outcomes are generally favorable, but postoperative complications may include intra-abdominal bleeding, anastomotic leaks, rectovaginal fistulas, strictures, chronic constipation, and the need for reoperation. Recurrence of rectal endometriosis is a possibility as well. Other outcomes are improved pain-related symptoms and fertility. Long-term outcomes vary according to the management strategy used. This review will provide the most recent approaches and techniques for the diagnosis and treatment of rectovaginal endometriosis.Keywords: pelvic pain, dyspareunia, bowel resection, endometriosis, rectovaginal

  18. Environmental prices in the long term; Miljoepriser paa lang sikt

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-12-31

    Economic analyses may undervalue important long-time environmental impacts of economic activities if the calculated price of the impacts are wrong. This report discusses how one may estimate the future calculated price of some environmental services. The term environmental service denotes something the presence or absence of which has an impact on the environment that can be valued. Thus, puffins, NOx emissions and suspended dust are all environmental services. The calculated price of an environmental service is the price used in socio-economic benefit-cost analyses. A calculation method is proposed and evaluated by application to such diverse environmental services as the stock of puffins, impregnated wood, NOx emissions and suspended dust. None of these services are priced in the market. The proposed method can be used to estimate the future prices of environmental services that are not priced in the market. The most important difficulties experienced with the method have been (1) how to find data for the increase in the supply of environmental services and (2) how to define environmental services in a satisfactory way. 29 refs., 5 figs., 6 tabs.

  19. Osteoporosis management among residents living in long-term care.

    Science.gov (United States)

    Giangregorio, L M; Jantzi, M; Papaioannou, A; Hirdes, J; Maxwell, C J; Poss, J W

    2009-09-01

    Fractures in long-term care (LTC) residents have substantial economic and human costs. Osteoporosis management in residents with fractures or osteoporosis is low, and certain subgroups are less likely to receive therapy, e.g., those with >5 comorbidities, dementia, and wheelchair use. Many LTC residents who are at risk of fracture are not receiving optimal osteoporosis management. The objective of this study was to describe the prevalence and predictors of osteoporosis management among LTC residents with osteoporosis or fractures. In a retrospective study, LTC residents of 17 facilities in Ontario and Manitoba, Canada were investigated. The participants were 65+ years old with osteoporosis, history of hip fracture, or recent fracture. Comprehensive assessments were conducted by trained nurse assessors between June 2005 and June 2006 using a standardized instrument, known as the Resident Assessment Instrument 2.0. Among residents (n = 525) with osteoporosis or fractures, 177 (34%) had had a recent fall. Bisphosphonate use was reported in 199 (38%) residents, calcitonin use in six (1%), and raloxifene use in six (1%). Calcium and vitamin D supplementation were reported in 140 (27%) residents. Fifty-four (10.3%) residents were on a bisphosphonate but were not taking vitamin D or multivitamin. Variables negatively associated with osteoporosis therapy [OR (95% CI)]: six or more comorbidities [0.46 (0.28-0.77), p = 0.028], wheelchair use [0.62 (0.40-0.95), p = 0.003], cognitive impairment [0.71 (0.55-0.92), p = 0.009], depression [0.54 (0.34-0.87), p = 0.01], swallowing difficulties [0.99 (0.988-0.999), p = 0.034] or Manitoba residence [0.47 (0.28-0.78), p = 0.004]. Prescription of 10+ medications was positively associated with therapy [3.34 (2.32-4.84), p Osteoporosis management is not optimal among residents at risk of future fracture. Identifying at-risk subgroups of residents that are not receiving therapy may facilitate closing the osteoporosis care gap.

  20. Digital health system for personalised COPD long-term management.

    Science.gov (United States)

    Velardo, Carmelo; Shah, Syed Ahmar; Gibson, Oliver; Clifford, Gari; Heneghan, Carl; Rutter, Heather; Farmer, Andrew; Tarassenko, Lionel

    2017-02-20

    Recent telehealth studies have demonstrated minor impact on patients affected by long-term conditions. The use of technology does not guarantee the compliance required for sustained collection of high-quality symptom and physiological data. Remote monitoring alone is not sufficient for successful disease management. A patient-centred design approach is needed in order to allow the personalisation of interventions and encourage the completion of daily self-management tasks. A digital health system was designed to support patients suffering from chronic obstructive pulmonary disease in self-managing their condition. The system includes a mobile application running on a consumer tablet personal computer and a secure backend server accessible to the health professionals in charge of patient management. The patient daily routine included the completion of an adaptive, electronic symptom diary on the tablet, and the measurement of oxygen saturation via a wireless pulse oximeter. The design of the system was based on a patient-centred design approach, informed by patient workshops. One hundred and ten patients in the intervention arm of a randomised controlled trial were subsequently given the tablet computer and pulse oximeter for a 12-month period. Patients were encouraged, but not mandated, to use the digital health system daily. The average used was 6.0 times a week by all those who participated in the full trial. Three months after enrolment, patients were able to complete their symptom diary and oxygen saturation measurement in less than 1 m 40s (96% of symptom diaries). Custom algorithms, based on the self-monitoring data collected during the first 50 days of use, were developed to personalise alert thresholds. Strategies and tools aimed at refining a digital health intervention require iterative use to enable convergence on an optimal, usable design. 'Continuous improvement' allowed feedback from users to have an immediate impact on the design of the system (e

  1. Summary of the engineering analysis report for the long-term management of depleted uranium hexafluoride

    Energy Technology Data Exchange (ETDEWEB)

    Dubrin, J.W., Rahm-Crites, L.

    1997-09-01

    The Department of Energy (DOE) is reviewing ideas for the long-term management and use of its depleted uranium hexafluoride. DOE owns about 560,000 metric tons (over a billion pounds) of depleted uranium hexafluoride. This material is contained in steel cylinders located in storage yards near Paducah, Kentucky; Portsmouth, Ohio; and at the East Tennessee Technology Park (formerly the K-25 Site) in Oak Ridge, Tennessee. On November 10, 1994, DOE announced its new Depleted Uranium Hexafluoride Management Program by issuing a Request for Recommendations and an Advance Notice of Intent in the Federal Register (59 FR 56324 and 56325). The first part of this program consists of engineering, costs and environmental impact studies. Part one will conclude with the selection of a long-term management plan or strategy. Part two will carry out the selected strategy.

  2. Osteoporosis Diagnosis and Management in Long-Term Care Facility.

    Science.gov (United States)

    Aguilar, Erwin A; Barry, Sean D; Cefalu, Charles A; Abdo, Abir; Hudson, William P; Campbell, James S; Reske, Thomas M; Bonafede, Machaon; Wilson, Kathleen; Stolshek, Bradley S; Paoli, Carly J; Tran, Nguyet; Cheng, Lung-I

    2015-11-01

    Contemporary estimates of the prevalence of diagnosed osteoporosis among long-term care facility residents are limited. This chart review collected data between April 1, 2012 and August 31, 2013 for adult (age ≥ 30 years) residents of 11 long-term care facilities affiliated with the Louisiana State University Health Sciences Center in the New Orleans metropolitan area. Data (demographics; comorbidities; osteoporosis diagnosis, risk factors, diagnostic assessments, treatments; fracture history; fall risk; activities of daily living) were summarized. Data for residents with and without diagnosed osteoporosis were compared using χ tests and t tests. The study included 746 residents (69% women, mean [SD] age: 76.3 [13.9] years, median length of stay approximately 18.5 months). An osteoporosis diagnosis was recorded for 132 residents (18%), 30% of whom received a pharmacologic osteoporosis therapy. Fewer than 2% of residents had bone mineral density assessments; 10% had previous fracture. Calcium and vitamin D use was more prevalent in residents with diagnosed osteoporosis compared with other residents (calcium: 49% versus 12%, vitamin D: 52% versus 28%; both P assessed residents had a high fall risk. Activities of daily living were similarly limited regardless of osteoporosis status. The prevalence of diagnosed osteoporosis was higher than previously reported for long-term care residents, but lower than epidemiologic estimates of osteoporosis prevalence for the noninstitutional U.S. In our sample, osteoporosis diagnostic testing was rare and treatment rates were low. Our results suggest that osteoporosis may be underdiagnosed and undertreated in long-term care settings.

  3. Managing Osteoporosis Patients after Long-Term Bisphosphonate Treatment

    Science.gov (United States)

    Adler, Robert A.; Fuleihan, Ghada El-Hajj; Bauer, Douglas C.; Camacho, Pauline M.; Clarke, Bart L.; Clines, Gregory A.; Compston, Juliet E.; Drake, Matthew T.; Edwards, Beatrice J.; Favus, Murray J.; Greenspan, Susan L.; McKinney, Ross; Pignolo, Robert J.; Sellmeyer, Deborah E.

    2016-01-01

    Bisphosphonates (BPs) are the most commonly used medications for osteoporosis, but optimal duration of therapy is unknown. This ASBMR report provides guidance on BP therapy duration with a risk benefit perspective. Two trials provided evidence for long-term BP use. In the Fracture Intervention Trial Long-term Extension (FLEX), postmenopausal women receiving alendronate for 10 years had fewer clinical vertebral fractures than those switched to placebo after 5 years. In the HORIZON extension, women who received 6 annual infusions of zoledronic acid had fewer morphometric vertebral fractures compared with those switched to placebo after 3 years. Low hip T-score between −2 and −2.5 in FLEX and below −2.5 in HORIZON extension predicted a beneficial response to continued therapy. Hence, the Task Force suggests that after 5 years of oral BP or 3 years of intravenous BP, women should be reassessed. Women with previous major osteoporotic fracture, those who fracture on therapy, or others at high risk should generally continue therapy for up to 10 years (oral) or 6 years (intravenous), with periodic risk-benefit evaluation. Older women, those with a low hip T-score or high fracture risk score are considered high risk. The risk of osteonecrosis of the jaw and atypical femoral fracture increases with BP therapy duration, but such rare events are far outweighed by fracture risk reduction with BPs in high risk patients. For women not at high fracture risk after 3–5 years of BP treatment, a drug holiday of 2–3 years can be considered, with periodic reassessment. The algorithm provided for long term BP use is based on limited evidence in mostly Caucasian postmenopausal women and only for vertebral fracture reduction. It is probably applicable to men and patients with glucocorticoid-induced osteoporosis, with some adaptations. It is unlikely that future osteoporosis trials will provide data for formulating definitive recommendations. PMID:26350171

  4. Ethical issues in long-term psychiatric management.

    Science.gov (United States)

    Dickenson, D

    1997-10-01

    Two general ethical problems in psychiatry are thrown into sharp relief by long term care. This article discusses each in turn, in the context of two anonymised case studies from actual clinical practice. First, previous mental health legislation soothed doubts about patients' refusal of consent by incorporating time limits on involuntary treatment. When these are absent, as in the provisions for long term care which have recently come into force, the justification for compulsory treatment and supervision becomes more obviously problematic. Second, Anglo-American law does not normally allow the preventive detention of someone who may be dangerous but has not actually committed any crime. The justification for detaining a possibly dangerous user of mental health services without his or her consent can only be based on risk assessment, but this raises issues of moral luck. Is the psychiatrist who decides not to take out a supervision order for a possibly dangerous patient with an initial psychotic diagnosis morally at fault if that person harms someone in the community, or himself? Or is the psychiatrist merely unlucky?

  5. The inbuilt long-term unfeasibility of environmental flows when disregarding riparian vegetation requirements

    Science.gov (United States)

    Rivaes, R.; Boavida, I.; Santos, J. M.; Pinheiro, A. N.; Ferreira, M. T.

    2015-10-01

    Environmental flows remain biased towards the traditional fish biological group and ignore the inter-annual flow variability that rules longer species life cycles, thus disregarding the long-term perspective of the riverine ecosystem. Incorporating riparian vegetation requirements into environmental flows could bring an important contribute to fill in this gap. The long-term after-effects of this shortcoming on the biological communities downstream of dams were never estimated before. We address this concern by evaluating the effects of environmental flow regimes disregarding riparian vegetation in the long-term perspective of the fluvial ecosystem. To achieve that purpose, the riparian vegetation evolution was modeled considering its structural response to a decade of different environmental flows, and the fish habitat availability was assessed for each of the resulting riparian habitat scenarios. We demonstrate that fish habitat availability changes accordingly to the long-term structural adjustments that riparian habitat endure following river regulation. Environmental flow regimes considering only aquatic biota become obsolete in few years due to the change of the habitat premises in which they were based on and, therefore, are unsustainable in the long run. Therefore, considering riparian vegetation requirements on environmental flows is mandatory to assure the effectiveness of those in the long-term perspective of the fluvial ecosystem.

  6. STRATEGIC MANAGEMENT AS LONG TERM SURVIVAL INSTRUMENT OF BUSINESS COMPANY

    OpenAIRE

    Silineviča, Irēna

    2009-01-01

    Theoretical aspects in Strategic management of small business enterprises is analysed. Research of small enterprise management in the Latgale region is performed with the aim to do an analyses of how small business enterprises, which have survived in economic crises conditions, use strategic management opportunities. Findings have clarified the main factors which influence business management in a changing business environment in small business companies.

  7. Long-Term Soil Experiments: A Key to Managing Earth's Rapidly Changing Critical Zones

    Science.gov (United States)

    Richter, D., Jr.

    2014-12-01

    In a few decades, managers of Earth's Critical Zones (biota, humans, land, and water) will be challenged to double food and fiber production and diminish adverse effects of management on the wider environment. To meet these challenges, an array of scientific approaches is being used to increase understanding of Critical Zone functioning and evolution, and one amongst these approaches needs to be long-term soil field studies to move us beyond black boxing the belowground Critical Zone, i.e., to further understanding of processes driving changes in the soil environment. Long-term soil experiments (LTSEs) provide direct observations of soil change and functioning across time scales of decades, data critical for biological, biogeochemical, and environmental assessments of sustainability; for predictions of soil fertility, productivity, and soil-environment interactions; and for developing models at a wide range of temporal and spatial scales. Unfortunately, LTSEs globally are not in a good state, and they take years to mature, are vulnerable to loss, and even today remain to be fully inventoried. Of the 250 LTSEs in a web-based network, results demonstrate that soils and belowground Critical Zones are highly dynamic and responsive to human management. The objective of this study is to review the contemporary state of LTSEs and consider how they contribute to three open questions: (1) can soils sustain a doubling of food production in the coming decades without further impinging on the wider environment, (2) how do soils interact with the global C cycle, and (3) how can soil management establish greater control over nutrient cycling. While LTSEs produce significant data and perspectives for all three questions, there is on-going need and opportunity for reviews of the long-term soil-research base, for establishment of an efficiently run network of LTSEs aimed at sustainability and improving management control over C and nutrient cycling, and for research teams that

  8. Exploring project management as a practical solution to long-term care service.

    Science.gov (United States)

    Su, Chun-Hsien; Yeh, Nai-Ching

    2008-01-01

    The main purpose of this study is to explore the project management methodology as a practical solution for the field of long-term care management. This research was conducted by gathering data from reviewed literature and written documents. The conclusion suggests that project management methodology is applicable for long-term care service implementation. Moreover, the project management methodology discussed in this article could be applied to other Medicare practices to prove its validity in the future.

  9. Costs of quality management systems in long-term care organizations: an exploration.

    NARCIS (Netherlands)

    Wagner, C.; Merode, G.G. van; Oort, M. van

    2003-01-01

    The article describes a method for measuring and reporting the costs of quality management in 11 long-term care organizations (nursing homes, home health care organizations, and homes for the elderly) and a national survey in 489 organizations providing long-term care. Site visits and a

  10. Publication of sensor data in the long-term environmental sub-observatory TERENO Northeast

    Science.gov (United States)

    Stender, Vivien; Ulbricht, Damian; Klump, Jens

    2017-04-01

    Terrestrial Environmental Observatories (TERENO) is an interdisciplinary and long-term research project spanning an Earth observation network across Germany. It includes four test sites within Germany from the North German lowlands to the Bavarian Alps and is operated by six research centers of the Helmholtz Association. TERENO Northeast is one of the sub-observatories of TERENO and is operated by the German Research Centre for Geosciences GFZ in Potsdam. This observatory investigates geoecological processes in the northeastern lowland of Germany by collecting large amounts of environmentally relevant data. The success of long-term projects like TERENO depends on well-organized data management, data exchange between the partners involved and on the availability of the captured data. Data discovery and dissemination are facilitated not only through data portals of the regional TERENO observatories but also through a common spatial data infrastructure TEODOOR (TEreno Online Data repOsitORry). TEODOOR bundles the data provided by the different web services of the single observatories and provides tools for data discovery, visualization and data access. The TERENO Northeast data infrastructure integrates data from more than 200 instruments and makes data available through standard web services. TEODOOR accesses the OGC Sensor Web Enablement (SWE) interfaces offered by the regional observatories. In addition to the SWE interface, TERENO Northeast also publishes time series of environmental sensor data through the DOI registration service at GFZ Potsdam. This service uses the DataCite infrastructure to make research data citable and is able to keep and disseminate metadata popular to the geosciences [1]. The metadata required by DataCite are created in an automated process by extracting information from the SWE SensorML metadata. The GFZ data management tool kit panMetaDocs is used to manage and archive file based datasets and to register Digital Object Identifiers (DOI

  11. Intermittent catheterisation for long-term bladder management.

    Science.gov (United States)

    Prieto, Jacqui; Murphy, Catherine L; Moore, Katherine N; Fader, Mandy

    2014-09-10

    , mean differences and 95% confidence intervals were calculated for each outcome. Because of trial heterogeneity, it was not always possible to combine data to give an overall estimate of treatment effect. Thirty-one trials met the inclusion criteria, including 13 RCTs and 18 cross-over trials. Most were small (less than 60 participants completed), although five trials had more than 100 participants. There was considerable variation in length of follow-up and definitions of UTI. Participant dropout was a problem for several trials, particularly where there was long-term follow-up to measure incidence of UTI. Fifteen trials were more than 10 years old and focused mainly on comparing different catheterisation techniques (e.g. single versus multiple-use) on clinical outcomes whereas, several more recent trials have focused on comparing different types of catheter designs or materials, especially coatings, and user preference. It was not possible to combine data from some trials owing to variations in the catheters tested and in particular the catheter coatings. Where there were data, confidence intervals around estimates were wide and hence clinically important differences in UTI and other outcomes could neither be identified nor reliably ruled out. No study assessed cost-effectiveness. Despite a total of 31 trials, there is still no convincing evidence that the incidence of UTI is affected by use of aseptic or clean technique, coated or uncoated catheters, single (sterile) or multiple-use (clean) catheters, self-catheterisation or catheterisation by others, or by any other strategy. Results from user-reported outcomes varied. The current research evidence is weak and design issues are significant. More well-designed trials are strongly recommended. Such trials should include analysis of cost-effectiveness because there are likely to be substantial differences associated with the use of different catheter designs, catheterisation techniques and strategies.

  12. WITHDRAWN: Intermittent catheterisation for long-term bladder management.

    Science.gov (United States)

    Prieto, Jacqui; Murphy, Catherine L; Moore, Katherine N; Fader, Mandy

    2017-08-08

    , mean differences and 95% confidence intervals were calculated for each outcome. Because of trial heterogeneity, it was not always possible to combine data to give an overall estimate of treatment effect. Thirty-one trials met the inclusion criteria, including 13 RCTs and 18 cross-over trials. Most were small (less than 60 participants completed), although five trials had more than 100 participants. There was considerable variation in length of follow-up and definitions of UTI. Participant dropout was a problem for several trials, particularly where there was long-term follow-up to measure incidence of UTI. Fifteen trials were more than 10 years old and focused mainly on comparing different catheterisation techniques (e.g. single versus multiple-use) on clinical outcomes whereas, several more recent trials have focused on comparing different types of catheter designs or materials, especially coatings, and user preference. It was not possible to combine data from some trials owing to variations in the catheters tested and in particular the catheter coatings. Where there were data, confidence intervals around estimates were wide and hence clinically important differences in UTI and other outcomes could neither be identified nor reliably ruled out. No study assessed cost-effectiveness. Despite a total of 31 trials, there is still no convincing evidence that the incidence of UTI is affected by use of aseptic or clean technique, coated or uncoated catheters, single (sterile) or multiple-use (clean) catheters, self-catheterisation or catheterisation by others, or by any other strategy. Results from user-reported outcomes varied. The current research evidence is weak and design issues are significant. More well-designed trials are strongly recommended. Such trials should include analysis of cost-effectiveness because there are likely to be substantial differences associated with the use of different catheter designs, catheterisation techniques and strategies.

  13. Consol structures its management for long-term leadership

    Energy Technology Data Exchange (ETDEWEB)

    Merritt, P.; Sanda, A.; Sprouls, M.

    1988-10-01

    This is a profile of Consolidation Coal which is the second largest coal producer in US. A business strategy has led to the development of a strong management team, to acquisitions and development of new mines, to increased miner productivity and use of innovative mining technologies, and to the application of well-planned, aggressive coal marketing strategies. 23 figs., 4 tabs.

  14. The role of universities in managing Long Term Athlete ...

    African Journals Online (AJOL)

    The differential layering of the development phases relates to the socialisation process (into and through sport) which underpins the elite sport participation trajectory. The study reports on the role of a public residential South African university in managing the optimal development of elite student-athletes in field disciplines ...

  15. Case managers speak out: responding to depression in community long-term care.

    Science.gov (United States)

    Munson, Michelle; Proctor, Enola; Morrow-Howell, Nancy; Fedoravicius, Nicole; Ware, Norma

    2007-08-01

    This study sought to understand how case managers in one publicly funded health and social service system, community long-term care, understand and address depression among their clients. Four focus groups with a total of 18 case managers were conducted. Case managers were asked a series of questions about their perspectives on the recognition and treatment of depression, including subthreshold depression, in community long-term care. Case managers perceived addressing depression as complex because of competing demands. Furthermore, case managers perceived conflict between their current role and what it would take to expand their role to include addressing depression. Case managers suggested that in order to successfully improve the detection and treatment of depression in community long-term care, systemic changes, such as increased support and training, may be necessary, along with a shift in the professional role of case managers.

  16. Regional Sustainable Environmental Management

    Science.gov (United States)

    Regional sustainable environmental management is an interdisciplinary effort to develop a sufficient understanding of the interactions between ecosystems, the economy, law, and technology to formulate effective long-term management strategies on a regional scale. Regional sustai...

  17. Assessing climate change and socio-economic uncertainties in long term management of water resources

    Science.gov (United States)

    Jahanshahi, Golnaz; Dawson, Richard; Walsh, Claire; Birkinshaw, Stephen; Glenis, Vassilis

    2015-04-01

    Long term management of water resources is challenging for decision makers given the range of uncertainties that exist. Such uncertainties are a function of long term drivers of change, such as climate, environmental loadings, demography, land use and other socio economic drivers. Impacts of climate change on frequency of extreme events such as drought make it a serious threat to water resources and water security. The release of probabilistic climate information, such as the UKCP09 scenarios, provides improved understanding of some uncertainties in climate models. This has motivated a more rigorous approach to dealing with other uncertainties in order to understand the sensitivity of investment decisions to future uncertainty and identify adaptation options that are as far as possible robust. We have developed and coupled a system of models that includes a weather generator, simulations of catchment hydrology, demand for water and the water resource system. This integrated model has been applied in the Thames catchment which supplies the city of London, UK. This region is one of the driest in the UK and hence sensitive to water availability. In addition, it is one of the fastest growing parts of the UK and plays an important economic role. Key uncertainties in long term water resources in the Thames catchment, many of which result from earth system processes, are identified and quantified. The implications of these uncertainties are explored using a combination of uncertainty analysis and sensitivity testing. The analysis shows considerable uncertainty in future rainfall, river flow and consequently water resource. For example, results indicate that by the 2050s, low flow (Q95) in the Thames catchment will range from -44 to +9% compared with the control scenario (1970s). Consequently, by the 2050s the average number of drought days are expected to increase 4-6 times relative to the 1970s. Uncertainties associated with urban growth increase these risks further

  18. Environmental and genetic preconditioning for long-term anoxia responses requires AMPK in Caenorhabditis elegans.

    Directory of Open Access Journals (Sweden)

    Bobby L LaRue

    2011-02-01

    Full Text Available Preconditioning environments or therapeutics, to suppress the cellular damage associated with severe oxygen deprivation, is of interest to our understanding of diseases associated with oxygen deprivation. Wildtype C. elegans exposed to anoxia enter into a state of suspended animation in which energy-requiring processes reversibly arrest. C. elegans at all developmental stages survive 24-hours of anoxia exposure however, the ability of adult hermaphrodites to survive three days of anoxia significantly decreases. Mutations in the insulin-like signaling receptor (daf-2 and LIN-12/Notch (glp-1 lead to an enhanced long-term anoxia survival phenotype.In this study we show that the combined growth environment of 25°C and a diet of HT115 E. coli will precondition adult hermaphrodites to survive long-term anoxia; many of these survivors have normal movement after anoxia treatment. Animals fed the drug metformin, which induces a dietary-restriction like state in animals and activates AMPK in mammalian cell culture, have a higher survival rate when exposed to long-term anoxia. Mutations in genes encoding components of AMPK (aak-2, aakb-1, aakb-2, aakg-2 suppress the environmentally and genetically induced long-term anoxia survival phenotype. We further determine that there is a correlation between the animals that survive long-term anoxia and increased levels of carminic acid staining, which is a fluorescent dye that incorporates in with carbohydrates such as glycogen.We conclude that small changes in growth conditions such as increased temperature and food source can influence the physiology of the animal thus affecting the responses to stress such as anoxia. Furthermore, this supports the idea that metformin should be further investigated as a therapeutic tool for treatment of oxygen-deprived tissues. Finally, the capacity for an animal to survive long bouts of severe oxygen deprivation is likely dependent on specific subunits of the heterotrimeric

  19. Perinatal management and long-term cardiac outcome in fetal arrhythmia

    NARCIS (Netherlands)

    Hahurij, Nathan D.; Blom, Nico A.; Lopriore, Enrico; Aziz, Mohammad I.; Nagel, Helene T.; Rozendaal, Lieke; Vandenbussche, Frank P. H. A.

    2011-01-01

    cardiac arrhythmias are commonly observed in the fetus, however, may have major consequences for fetal development and post natal life. to evaluate the perinatal management and cardiac outcome of fetuses with tachy- or bradyarrhythmia. perinatal management, outcome and long-term cardiac follow-up

  20. The long-term prospects of citizens managing urban green space

    NARCIS (Netherlands)

    Mattijssen, T.J.M.; Jagt, van der Alexander P.N.; Buijs, A.E.; Elands, B.H.M.; Erlwein, S.; Lafortezza, R.

    2017-01-01

    This paper discusses the long-term management or ‘place-keeping’ of urban green space by citizens and highlights enabling and constraining factors that play a crucial role in this continuity. While authorities have historically been in charge of managing public green spaces, there is an increased

  1. Long-term electroencephalographic monitoring for diagnosis and management of seizures.

    Science.gov (United States)

    Lagerlund, T D; Cascino, G D; Cicora, K M; Sharbrough, F W

    1996-10-01

    Long-term electroencephalographic (EEG) monitoring is the process of recording an EEG for a prolonged period in order to document epileptic seizures or other episodic disturbances of neurologic function. Indications for long-term EEG monitoring include diagnosis of a seizure disorder (epilepsy), classification of seizure types in patients with epilepsy, and localization of the epileptogenic region of the brain. Methods used for long-term EEG monitoring include prolonged analog or digital EEG, prolonged analog or digital ambulatory EEG, and prolonged analog or digital video-EEG monitoring with telemetry. Each of these methods has distinct advantages and disadvantages, particularly relative to storage, retrieval, and manipulation of data. Long-term EEG monitoring is useful in the management of patients with epilepsy and in the diagnosis of a seizure disorder. For most patients, inpatient long-term EEG monitoring is best performed in a specialized epilepsy-monitoring unit, which can provide a safe environment and both educational and psychosocial support. The choice of the most appropriate method of long-term monitoring for a specific clinical situation is best made by an epileptologist or a neurologist at an epilepsy center.

  2. Environmental bonds and the challenge of long-term carbon sequestration.

    Science.gov (United States)

    Gerard, David; Wilson, Elizabeth J

    2009-02-01

    The potential to capture carbon from industrial sources and dispose of it for the long-term, known as carbon capture and sequestration (CCS), is widely recognized as an important option to reduce atmospheric carbon dioxide emissions. Specifically, CCS has the potential to provide emissions cuts sufficient to stabilize greenhouse gas levels, while still allowing for the continued use of fossil fuels. In addition, CCS is both technologically-feasible and commercially viable compared with alternatives with the same emissions profile. Although the concept appears to be solid from a technical perspective, initial public perceptions of the technology are uncertain. Moreover, little attention has been paid to developing an understanding of the social and political institutional infrastructure necessary to implement CCS projects. In this paper we explore a particularly dicey issue--how to ensure adequate long-term monitoring and maintenance of the carbon sequestration sites. Bonding mechanisms have been suggested as a potential mechanism to reduce these problems (where bonding refers to financial instruments used to ensure regulatory or contractual commitments). Such mechanisms have been successfully applied in a number of settings (e.g., to ensure court appearances, completion of construction projects, and payment of taxes). The paper examines the use of bonding to address environmental problems and looks at its possible application to nascent CCS projects. We also present evidence on the use of bonding for other projects involving deep underground injection of materials for the purpose of long-term storage or disposal.

  3. What factors influence the effectiveness of financial incentives on long-term natural resource management practice change?

    Directory of Open Access Journals (Sweden)

    Emma Swann

    2016-12-01

    Full Text Available Financial incentives are used by natural resource management organisations to encourage landholders to adopt sustainable practices where the outcomes on a farm scale may be negative or marginal. There is a growing body of research aimed at understanding why landholders do or do not agree to participate in financial incentive programs, however research that considers when and how financial incentives work to bring about long-term behaviour change is relatively immature. The purpose of this review is to answer the question ‘What factors influence the effectiveness of financial incentives on long-term natural resource management practice change?’ In synthesising the evidence, it was found that there are numerous characteristics of the practice change itself, along with the program design and implementation, which are important to understand long-term behaviour change. These include whether inexpensive maintenance or long-term funding is available; whether the changes are relatively simple to sustain; whether the program involves structural changes; whether there is land use rigidity; and whether the changes have resulting environmental benefits that are highly observable. Additionally, it is advisable for programs that use financial incentives to include the following program features: ongoing extension support and a focus on building relationship and trust; flexibility in how the practice change is applied; active landholder involvement from planning to evaluation; and contract length that is appropriate for the complexity of the NRM practice. These characteristics can be used to guide policy makers in their natural resource management investment decisions. There is a clear need for greatly increased monitoring and evaluation of existing programs, both during the program and after its conclusion, in order to more fully understand its long-term impacts and ultimate effectiveness. Finally, landholders undertaking a practice change generally

  4. The value of long-term environmental monitoring programs: an Ohio River case study.

    Science.gov (United States)

    Lohner, Timothy W; Dixon, Douglas A

    2013-11-01

    As a subset of environmental monitoring, fish sampling programs have been an important part of assessing the potential impacts of water withdrawals and effluent discharges on fish populations for many years. New environmental regulations often require that adverse environmental impacts to fish populations be minimized. Without long-term field data, population evaluations may incorrectly indicate adverse impacts where none exist or no impact where one is likely to occur. Several electric utility companies have funded the Ohio River Ecological Research Program, which has been in existence for over 40 years and consists of fish, habitat, and water quality studies at multiple power plant sites on the mainstem Ohio River. Sampling includes seasonal night-time electrofishing and daytime beach seining at three upstream and three downstream locations near each plant. The long-term nature of the program allows for the establishment of aquatic community indices to support evaluations of technology performance, the collaborative development of compliance metrics, and the assessment of fish population trends. Studies have concluded that the Ohio River fish community has improved in response to better water quality and that power plant fish entrainment and impingement and thermal discharges have had little or no measureable impact. Through collaboration and the use of long-term data, $6.3 million in monitoring costs have been saved during recent fish impingement studies. The ability to access a multiyear fish abundance database, with its associated data on age, growth, and fecundity, improves the quality of such evaluations and reduces the need for extensive field sampling at individual locations.

  5. Quality indicators for the acute and long-term management of anaphylaxis

    DEFF Research Database (Denmark)

    Dhami, Sangeeta; Sheikh, Aadam; Muraro, Antonella

    2017-01-01

    ) and long-term (n = 27) management of anaphylaxis. The majority of indicators were developed through expert consensus with relatively few of these having been formally piloted or tested to demonstrate that they could discriminate between variations in practice and/or that they were sensitive to change...

  6. Impact and contributors to cost of managing long term conditions in ...

    African Journals Online (AJOL)

    Journal of Community Medicine and Primary Health Care ... This study assessed the contributors to cost and financial implications for patients being managed for hypertension and/or diabetes in a tertiary hospital in Nigeria. Method: ... Keywords: Cost Of Care, Long Term Conditions, Hypertension, Diabetes, Access, Nigeria ...

  7. Development of applicating probabilistic long-term forecasts into water management

    Science.gov (United States)

    Hwang, Jin; Ryoo, Kyongsik; Suh, Aesook

    2016-04-01

    This research shows development of applicating probabilistic long-term forecasts into water management. Forecasted Cumulative Distribution Functions (CDFs) of monthly precipitation are plotted by combining the range of monthly precipitation based on proper Probability Density Function (PDF) in past data with probabilistic forecasts in each category. Ensembles of inflow are estimated by entering generated ensembles of precipitation based on the CDFs into the 'abcd' water budget model. The bias and RMSE between averages in past data and observed inflow are compared to them in forecasted ensembles. In our results, the bias and RMSE of average precipitation in the forecasted ensemble are bigger than in past data, whereas the average inflow in the forecasted ensemble is smaller than in past data. This result could be used for reference data to apply long-term forecasts to water management, because of the limit in the number of forecasted data for verification and differences between the Andong-dam basin and the forecasted regions. This research has significance by suggesting a method of applying probabilistic information in climate variables from long-term forecasts to water management in Korea. Original data of a climate model, which produces long-term probabilistic forecasts should be verified directly as input data of a water budget model in the future, so that a more scientific response in water management against uncertainty of climate change could be reached.

  8. Long-term sustainability in the management of acid mine drainage ...

    African Journals Online (AJOL)

    2013-08-14

    Aug 14, 2013 ... Review. Long-term sustainability in the management of acid mine drainage wastewaters – development of the Rhodes BioSURE Process. Peter Rose*. Rhodes University, PO Box 480, Grahamstown, 6140, South Africa. Abstract. The decanting of flooded gold mines threatens water supply on the ...

  9. Creature comforts: personal communities, pets and the work of managing a long-term condition.

    Science.gov (United States)

    Brooks, Helen L; Rogers, Anne; Kapadia, Dharmi; Pilgrim, Jack; Reeves, David; Vassilev, Ivaylo

    2013-06-01

    To explore in the context of peoples' personal social networks, the contribution that pets make to 'the work' associated with the management of long-term conditions. Mixed methods survey with nested parallel qualitative study; 300 participants were drawn from diabetes and chronic heart disease registers of General Practices across Greater Manchester in the North West of England. Notions of 'work' were used to describe the illness and everyday activities associated with chronic illness. Nineteen percent of participants identified at least one pet within their network. Pets contributed mostly to managing emotions (emotional work), to enhancing a sense of self identity (biographical work) and to a lesser extent practical tasks (everyday work). There were indicators that pets mediated relationships for people living with a long-term condition through very weak ties with others in domestic and community settings. The findings suggest that pets have unique qualities and are not simply substitutes for human relationships in long-term condition management. The study has potential implications for furthering a social contextual analysis of chronic illness, the understanding of relationships, and the meaning and the role of companion animals in long-term condition management.

  10. Long-term complications of JJ stent and its management: A 5 years review

    Directory of Open Access Journals (Sweden)

    Rajendra Prasad Ray

    2015-01-01

    Conclusions: JJ stent related long-term complications are not uncommon and are usually seen after 6 months of indwelling time. Endourological procedure should be the initial approach with a high success rate. Coordinated use multimodality and technology helps in management of difficult cases. Open surgery is rarely required. Prevention of the complication by judicious use and early removal is the cornerstone.

  11. Elucidating the apparent maize tolerance to weed competition in long-term organically managed systems

    NARCIS (Netherlands)

    Ryan, M.R.; Mortensen, D.A.; Bastiaans, L.; Teasdale, J.R.; Mirsky, S.B.; Curran, W.S.; Seidel, R.

    2010-01-01

    In a long-term cropping systems trial comparing organically and conventionally managed systems, organic maize production sustained crop yields equal to conventional methods despite higher weed levels. In 2005 and 2006, an experiment nested within the trial was conducted to gain insight into this

  12. Management considerations in the care of elderly heart failure patients in long-term care facilities.

    Science.gov (United States)

    Heckman, George A; Boscart, Veronique M; McKelvie, Robert S

    2014-07-01

    Heart failure, a condition that affects up to 20% of older persons residing in long-term care facilities, is an important cause of morbidity, health service utilization and death. Effective and interprofessional heart failure care processes could potentially improve care, outcomes and quality of life and delay decline or hospital admission. This article reviews the clinical aspects of heart failure, and the challenges to the diagnosis and management of this condition in long-term care residents who are frail and are affected by multiple comorbidities.

  13. Potentials, Limitations and Applications of long-term and mobile ad-hoc Wireless Sensor Networks for Environmental Monitoring

    Science.gov (United States)

    Bumberger, Jan; Mollenhauer, Hannes; Lapteva, Yulia; Hutschenreuther, Tino; Toepfer, Hannes; Dietrich, Peter

    2014-05-01

    To characterize environmental systems it is necessary to identify and describe processes with suitable methods. Environmental systems are often characterized by their high heterogeneity, so individual measurements for their complete representation are often not sufficient. The application of wireless sensor networks in terrestrial and aquatic ecosystems offer significant benefits as a better consideration of the local test conditions becomes possible. This can be essential for the monitoring of heterogeneous environmental systems. Significant advantages in the application of mobile ad-hoc wireless sensor networks are their self-organizing behavior, resulting in a major reduction in installation and operation costs and time. In addition, a point measurement with a sensor is significantly improved by measuring at several points. It is also possible to perform analog and digital signal processing and computation on the basis of the measured data close to the sensor. Hence, a significant reduction of the data to be transmitted can be achieved which leads to a better energy management of sensor nodes. Furthermore, their localization via satellite, the miniaturization of the nodes and long-term energy self-sufficiency are current topics under investigation. The possibilities and limitations of the applicability of wireless sensor networks for long-term and mobile environmental monitoring are presented. A concepts and realization example are given in the field of micrometeorology and soil parameters for the interaction of biotic and abiotic processes .This long term monitoring is part of the Global Change Experimental Facility (GCEF), a large field-based experimental platform to assess the effects of climate change on ecosystem functions and processes under different land-use scenarios. Furthermore a mobile ad-hoc sensor network is presented for the monitoring of water induced mass wasting processes.

  14. Long term rehabilitation management and outcome of anti-NMDA receptor encephalitis: case reports.

    Science.gov (United States)

    Bach, Laura J

    2014-01-01

    Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an auto immune-disorder. It is a life threatening condition that typically presents with viral illness, headaches, severe psychiatric symptoms, seizures, behavioural changes, decreasing levels of unconsciousness and progressive unresponsiveness, cognitive impairment, abnormal movements (e.g., dyskinesia), ataxia and hypoventilation. This paper describes the long term outcome and rehabilitation management of patients with NMDAR encephalitis and highlights the diverse outcome of this condition and the unique and individual long term management needs associated with this disorder. This is a case report study of three different patients with NMDAR encephalitis. All three cases are young women, two of whom presented with ovarian teratoma. Patient KH is the most impaired and was resident in a slow stream rehabilitation care home and presented with challenging behaviour. Patients RM and OA both lived in the community and presented with similar anxieties but diverse levels of cognition and motivation. A review of the literature is provided summarizing the disorder, interventions, management and challenges of this varied and complex condition. Standard neuropsychological tests and questionnaires to assess community integration (BICRO-39), quality of life (QOLIBRI-OS) and mood (HADS) were administered. Positive outcomes were achieved for all three patients using a variety of interventions which included behavioural management, family psycho-education and an integrated holistic multi-disciplinary team community approach. Memory and executive deficits were persistent in the long term and severity of impairments showed wide variability between patients. Emotional distress and behavioural difficulties were prominent and persistent and had a pronounced impact on rehabilitation. Continence issues were also a major factor impacting on the rehabilitation. Long term integrated and multi-disciplinary input by a variety of

  15. Norovirus Disease in Older Adults Living in Long-Term Care Facilities: Strategies for Management.

    Science.gov (United States)

    Chen, Yingxi; Hall, Aron J; Kirk, Martyn D

    2017-01-01

    Noroviruses are the most common cause of gastroenteritis outbreaks in long-term care facility (LTCFs). This review summarizes the most up-to-date knowledge on norovirus infection in LTCFs with the aim of identifying potential strategies for management. LTCF residents are at greater risk of norovirus infection. Early identification of norovirus infection and prompt initiation of appropriate supportive therapy are required to reduce morbidity and mortality. Measures to prevent outbreaks and reduce the risk of norovirus infection in LTCFs include timely diagnosis and implementation of infection control interventions to limit virus transmission. Current guidelines for prevention and control are based on generic principles of infection control. Real-time reverse transcription-quantitative polymerase chain reaction assays have been the gold standard for the rapid and sensitive detection of noroviruses. With the recent breakthroughs of human norovirus in vitro culture, doors are now opened to evaluate the efficacy of environmental disinfectants and hand hygiene options. Additionally, development of licensed vaccines against noroviruses may provide another important tool for infection prevention among high-risk individuals.

  16. Nonparametric Monitoring for Geotechnical Structures Subject to Long-Term Environmental Change

    Directory of Open Access Journals (Sweden)

    Hae-Bum Yun

    2011-01-01

    Full Text Available A nonparametric, data-driven methodology of monitoring for geotechnical structures subject to long-term environmental change is discussed. Avoiding physical assumptions or excessive simplification of the monitored structures, the nonparametric monitoring methodology presented in this paper provides reliable performance-related information particularly when the collection of sensor data is limited. For the validation of the nonparametric methodology, a field case study was performed using a full-scale retaining wall, which had been monitored for three years using three tilt gauges. Using the very limited sensor data, it is demonstrated that important performance-related information, such as drainage performance and sensor damage, could be disentangled from significant daily, seasonal and multiyear environmental variations. Extensive literature review on recent developments of parametric and nonparametric data processing techniques for geotechnical applications is also presented.

  17. Reducing soil phosphorus fertility brings potential long-term environmental gains: A UK analysis

    Science.gov (United States)

    Withers, Paul J. A.; Hodgkinson, Robin A.; Rollett, Alison; Dyer, Chris; Dils, Rachael; Collins, Adrian L.; Bilsborrow, Paul E.; Bailey, Geoff; Sylvester-Bradley, Roger

    2017-05-01

    Soil phosphorus (P) fertility arising from historic P inputs is a major driver of P mobilisation in agricultural runoff and increases the risk of aquatic eutrophication. To determine the environmental benefit of lowering soil P fertility, a meta-analysis of the relationship between soil test P (measured as Olsen-P) and P concentrations in agricultural drainflow and surface runoff in mostly UK soils was undertaken in relation to current eutrophication control targets (30-35 µg P L-1). At agronomic-optimum Olsen P (16-25 mg kg-1), concentrations of soluble reactive P (SRP), total dissolved P (TDP), total P (TP) and sediment-P (SS-P) in runoff were predicted by linear regression analysis to vary between 24 and 183 µg L-1, 38 and 315 µg L-1, 0.2 and 9.6 mg L-1, and 0.31 and 3.2 g kg-1, respectively. Concentrations of SRP and TDP in runoff were much more sensitive to changes in Olsen-P than were TP and SS-P concentrations, which confirms that separate strategies are required for mitigating the mobilisation of dissolved and particulate P forms. As the main driver of eutrophication, SRP concentrations in runoff were reduced on average by 60 µg L-1 (71%) by lowering soil Olsen-P from optimum (25 mg kg-1) to 10 mg kg-1. At Olsen-P concentrations below 12 mg kg-1, dissolved hydrolysable P (largely organic) became the dominant form of soluble P transported. We concluded that maintaining agronomic-optimum Olsen-P could still pose a eutrophication risk, and that a greater research focus on reducing critical soil test P through innovative agro-engineering of soils, crops and fertilisers would give long-term benefits in reducing the endemic eutrophication risk arising from legacy soil P. Soil P testing should become compulsory in priority catchments suffering, or sensitive to, eutrophication to ensure soil P reserves are fully accounted for as part of good fertiliser and manure management.

  18. Decision analysis to support development of the Glen Canyon Dam long-term experimental and management plan

    Science.gov (United States)

    Runge, Michael C.; LaGory, Kirk E.; Russell, Kendra; Balsom, Janet R.; Butler, R. Alan; Coggins,, Lewis G.; Grantz, Katrina A.; Hayse, John; Hlohowskyj, Ihor; Korman, Josh; May, James E.; O'Rourke, Daniel J.; Poch, Leslie A.; Prairie, James R.; VanKuiken, Jack C.; Van Lonkhuyzen, Robert A.; Varyu, David R.; Verhaaren, Bruce T.; Veselka, Thomas D.; Williams, Nicholas T.; Wuthrich, Kelsey K.; Yackulic, Charles B.; Billerbeck, Robert P.; Knowles, Glen W.

    2016-01-07

    The U.S. Geological Survey, in cooperation with the Bureau of Reclamation, National Park Service, and Argonne National Laboratory, completed a decision analysis to use in the evaluation of alternatives in the Environmental Impact Statement concerning the long-term management of water releases from Glen Canyon Dam and associated management activities. Two primary decision analysis methods, multicriteria decision analysis and the expected value of information, were used to evaluate the alternative strategies against the resource goals and to evaluate the influence of uncertainty.

  19. Development of nuclear fuel cycle technologies - bases of long-term provision of fuel and environmental safety of nuclear power

    Energy Technology Data Exchange (ETDEWEB)

    Solonin, M.I.; Polyakov, A.S.; Zakharkin, B.S.; Smelov, V.S.; Nenarokomov, E.A.; Mukhin, I.V. [SSC, RF, A.A. Bochvar ALL-Russia Research Institute of Inorganic Materials, Moscow (Russian Federation)

    2000-07-01

    To-day nuclear power is one of the options, however, to-morrow it may become the main source of the energy, thus, providing for the stable economic development for the long time to come. The availability of the large-scale nuclear power in the foreseeable future is governed by not only the safe operation of nuclear power plants (NPP) but also by the environmentally safe management of spent nuclear fuel, radioactive waste conditioning and long-term storage. More emphasis is to be placed to the closing of the fuel cycle in view of substantial quantities of spent nuclear fuel arisings. The once-through fuel cycle that is cost effective at the moment cannot be considered to be environmentally safe even for the middle term since the substantial build-up of spent nuclear fuel containing thousands of tons Pu will require the resolution of the safe management problem in the nearest future and is absolutely unjustified in terms of moral ethics as a transfer of the responsibility to future generations. The minimization of radioactive waste arisings and its radioactivity is only feasible with the closed fuel cycle put into practice and some actinides and long-lived fission radionuclides burnt out. The key issues in providing the environmentally safe fuel cycle are efficient processes of producing fuel for NPP, radionuclide after-burning included, a long-term spent nuclear fuel storage and reprocessing as well as radioactive waste management. The paper deals with the problems inherent in producing fuel for NPP with a view for the closed fuel cycle. Also discussed are options of the fuel cycle, its effectiveness and environmental safety with improvements in technologies of spent nuclear fuel reprocessing and long-lived radionuclide partitioning. (authors)

  20. Nurses' perception and comfort level with diabetes management practices in long-term care.

    Science.gov (United States)

    Agarwal, Gina; Sherifali, Diana; Kaasalainen, Sharon; Dolovich, Lisa; Akhtar-Danesh, Noori

    2014-10-01

    Increasing numbers of elderly people in long-term care have diabetes mellitus. We explored nurses' perceptions and level of comfort with current diabetes management of patients in long-term care. A mixed-methods approach using a cross-sectional survey design, including both quantitative and open-ended questions, was used. The licensed nurses employed in 9 long-term care homes in southwestern Ontario were surveyed. The survey explored nurses' comfort with managing diabetes, detecting hypoglycemia and hyperglycemia, glucose monitoring guidelines, and insulin administration and training. Of 301 nurses invited (130 registered nurses [RNs], 171 registered practical nurses [RPNs]), 165 nurses (77 RNs and 88 RPNs) responded (165 of 280, 59% response rate). Nurses were female (93.3%); their mean age was 45.3 years (SD 11.7). Most noted that the medication administration system and guidelines regarding diabetes management were adequate; RPNs were more comfortable administering insulin than RNs (p=0.048). The findings suggest RNs and RPNs have different comfort levels and perceptions of diabetes management. Copyright © 2014 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  1. Mount St. Helens Long-Term Sediment Management Plan for Flood Risk Reduction

    Science.gov (United States)

    2010-06-01

    SRS, staged SRS, and dredging – were to be evaluated during continuing planning and engineering. Provided below is the Syllabus from the 1985...2.2 shows the layout of one set of grade control structures. Figure 2.2 Example Layout of One Set of Grade Control Structures Mount St...orientation of the 2-dimensional grid layout . Figure 1. Lower Cowlitz Model Mesh Mount St. Helens Long-Term Sediment Management Plan Progress Report

  2. Individuals’ long term use of cognitive behavioural skills to manage their depression: a qualitative study

    OpenAIRE

    French, Lydia R.M.; Thomas, Laura; Campbell, John; Kuyken, Willem; Lewis, Glyn; Williams, Chris; Wiles, Nicola J.; Turner, Katrina M.

    2017-01-01

    Background: Cognitive Behavioural Therapy (CBT) aims to teach people skills to help them self-manage their depression. Trial evidence shows that CBT is an effective treatment for depression and individuals may experience benefits long-term. However, there is little research about individuals’ continued use of CBT skills once treatment has finished. Aims: To explore whether individuals who had attended at least 12 sessions of CBT continued to use and value the CBT skills they had learnt during...

  3. Anaphylaxis management plans for the acute and long-term management of anaphylaxis: a systematic review.

    Science.gov (United States)

    Nurmatov, Ulugbek; Worth, Allison; Sheikh, Aziz

    2008-08-01

    Anaphylaxis management plans (AMPs) are increasingly advocated to improve outcomes and reduce the risk of recurrence in persons with anaphylaxis. A recent systematic review investigating their effectiveness failed to identify any randomized controlled trial evidence to guide clinical decision making. We sought to identify and describe available AMPs, assess their acceptability and likely effectiveness, and understand potential facilitators and barriers to their use. We performed a systematic review of published, unpublished, and ongoing epidemiologic and qualitative studies, searching 13 international databases and contacting an international panel of anaphylaxis experts. Studies were critically appraised using established international criteria and thematically synthesized. Nineteen of 789 potentially eligible studies identified satisfied our inclusion criteria. A number of AMPs exist, and other than agreement on the central importance of early administration of self-administered epinephrine, there is a range of perspectives on what should be included. AMPs are acceptable to patients/caregivers and might considerably reduce the risk of recurrence. This latter finding needs to be interpreted with caution given the substantial risk of bias in the limited number of intervention studies conducted. Access to specialists, problems with follow-up, and indemnity considerations relating to emergency administration of epinephrine in schools are important structural barriers to their wider use. There are currently no universally accepted AMPs. The available evidence to support use of self-management plans is encouraging but is, in comparison with other long-term conditions, such as asthma, extremely weak. The effectiveness and cost-effectiveness of AMPs need to be formally evaluated.

  4. Long-term cost-effectiveness of disease management in systolic heart failure.

    Science.gov (United States)

    Miller, George; Randolph, Stephen; Forkner, Emma; Smith, Brad; Galbreath, Autumn Dawn

    2009-01-01

    Although congestive heart failure (CHF) is a primary target for disease management programs, previous studies have generated mixed results regarding the effectiveness and cost savings of disease management when applied to CHF. We estimated the long-term impact of systolic heart failure disease management from the results of an 18-month clinical trial. We used data generated from the trial (starting population distributions, resource utilization, mortality rates, and transition probabilities) in a Markov model to project results of continuing the disease management program for the patients' lifetimes. Outputs included distribution of illness severity, mortality, resource consumption, and the cost of resources consumed. Both cost and effectiveness were discounted at a rate of 3% per year. Cost-effectiveness was computed as cost per quality-adjusted life year (QALY) gained. Model results were validated against trial data and indicated that, over their lifetimes, patients experienced a lifespan extension of 51 days. Combined discounted lifetime program and medical costs were $4850 higher in the disease management group than the control group, but the program had a favorable long-term discounted cost-effectiveness of $43,650/QALY. These results are robust to assumptions regarding mortality rates, the impact of aging on the cost of care, the discount rate, utility values, and the targeted population. Estimation of the clinical benefits and financial burden of disease management can be enhanced by model-based analyses to project costs and effectiveness. Our results suggest that disease management of heart failure patients can be cost-effective over the long term.

  5. Challenges Experienced by School Managers in the Nkangala District, Mpumalanga, Regarding the Provision of Long Term Leadership

    Science.gov (United States)

    van Niekerk, E. J.

    2012-01-01

    The long term leadership task of creating favourable circumstances for followers to excel are discussed in this article using narratives supplied by education managers in schools of the Nkangala District in Mpumalanga Province. Thereby deficiencies in the long term leadership proficiency of these managers are identified with a view to be able to…

  6. Long-term environmental assessment of waste from PyroGreen system

    Energy Technology Data Exchange (ETDEWEB)

    Ju, Heejae; Hahm, Inhye; Sohn, Sungjune; Hwang, Il-Soon [Seoul National University, Gwanak-ro, Gwanak-gu, Seoul, 151-742 (Korea, Republic of)

    2016-07-01

    We have conducted a long-term environmental assessment of a geological repository for Intermediate Level Wastes (ILW) arising from PyroGreen processes that has been developed to decontaminate all HLW from the pyrochemical partitioning of spent nuclear fuels (SNF). PyroGreen process has been designed so that final ILW can meet conservative acceptance criteria such as one established for the Waste Isolation Pilot Plant (WIPP) in U.S.A. The nuclide inventory of final vitrified PyroGreen waste is calculated using ORIGEN 2.1 based on the design decontamination factor of PyroGreen processes applied to 18,171 metric tons of PWR SNF with 45 GWD/MTU burnup. Using GoldSim model, the environmental impact of ILW upon geological disposal at an intermediate depth. Among radioactive nuclides, Ra{sup 226}, Rn{sup 222} and Sn{sup 126} are identified as key contributors to radiological dose for general public. The environmental impact of PyroGreen wastes satisfies the Korean dose limit of 0.1 mSv/year with sufficiently high margin. Sensitivity studies have shown that the predicted dose can vary significantly by distribution coefficient of Ra{sup 226} and Rn{sup 222}, solubility limit of Se{sup 79}. (authors)

  7. Long-Term Assessment of Critical Radionuclides and Associated Environmental Media at the Savannah River Site

    Energy Technology Data Exchange (ETDEWEB)

    Jannik, G. T.; Baker, R. A.; Lee, P. L.; Eddy, T. P.; Blount, G. C.; Whitney, G. R.

    2012-11-06

    During the operational history of the Savannah River Site (SRS), many different radionuclides have been released from site facilities. However, only a relatively small number of the released radionuclides have been significant contributors to doses and risks to the public. At SRS dose and risk assessments indicate tritium oxide in air and surface water, and Cs-137 in fish and deer have been, and continue to be, the critical radionuclides and pathways. In this assessment, indepth statistical analyses of the long-term trends of tritium oxide in atmospheric and surface water releases and Cs-137 concentrations in fish and deer are provided. Correlations also are provided with 1) operational changes and improvements, 2) geopolitical events (Cold War cessation), and 3) recent environmental remediation projects and decommissioning of excess facilities. For example, environmental remediation of the F- and H-Area Seepage Basins and the Solid Waste Disposal Facility have resulted in a measurable impact on the tritium oxide flux to the onsite Fourmile Branch stream. Airborne releases of tritium oxide have been greatly affected by operational improvements and the end of the Cold War in 1991. However, the effects of SRS environmental remediation activities and ongoing tritium operations on tritium concentrations in the environment are measurable and documented in this assessment. Controlled hunts of deer and feral hogs are conducted at SRS for approximately six weeks each year. Before any harvested animal is released to a hunter, SRS personnel perform a field analysis for Cs-137 concentrations to ensure the hunter's dose does not exceed the SRS administrative game limit of 0.22 millisievert (22 mrem). However, most of the Cs-137 found in SRS onsite deer is not from site operations but is from nuclear weapons testing fallout from the 1950's and early 1960's. This legacy source term is trended in the SRS deer, and an assessment of the ''effective'' half-life of Cs-137 in deer

  8. Performance management: an aspirin or a long-term cure. [Public power industry

    Energy Technology Data Exchange (ETDEWEB)

    Sherron, B.

    The public power industry is suffering from a headache brought about by several challenges to the way they have traditionally operated. Performance management is one of the long-term approaches it can use to identify its problems, suggest solutions, and provide feedback systems to evaluate results of the solutions put into action. The term performance management has specific meaning for those concerned with productivity matters. Dr Scott Sink, director of the Virginia Productivity Center, offers this textbook definition: In general, there are at least seven distinct, although not necessarily mutually exclusive, measures of organizational system performance. They are: effectiveness, efficiency, quality, profitability (benefit/burden), productivity, quality of work life, and innovation.

  9. Long-term stewardship of the environmental legacy at restored sites within the Department of Energy nuclear weapons complex.

    Science.gov (United States)

    Wells, James R; Spitz, Henry B

    2003-11-01

    It is readily apparent, as the Department of Energy Office of Environmental Management proceeds in remediating its vast network of contaminated nuclear weapons facilities, that final cleanup at many facilities will not be performed to a level allowing unrestricted use of the facility. Instead, these facilities must rely on engineering, administrative, and institutional controls to ensure the level of cleanup performed at the site remains adequately protective of public health and the environment. In order for these controls to remain effective, however, a plan for long-term stewardship of these sites must be developed that is approved by the U.S. Congress. Although this sounds simple enough for the present, serious questions remain regarding how best to implement a program of stewardship to ensure its effectiveness over time, particularly for sites with residual contamination of radionuclides with half-lives on the order of thousands of years. Individual facilities have attempted to answer these questions at the site-specific level. However, the complexities of the issues require federal support and oversight to ensure the programs implemented at each of the facilities are consistent and effective. The Department of Energy recently submitted a report to Congress outlining the extent of long-term stewardship needs at each of its facilities. As a result, the time is ripe for forward thinking Congressional action to address the relevant issues and ensure the remedy of long-term stewardship successfully carries out its intended purpose and remains protective of public health and the environment. The regulatory elements necessary for the stewardship program to succeed can only be implemented through the plenary powers of the U.S. Congress.

  10. Environmental change drives long-term recruitment and growth variation in an estuarine fish.

    Science.gov (United States)

    Morrongiello, John R; Walsh, Chris T; Gray, Charles A; Stocks, Jerom R; Crook, David A

    2014-06-01

    How individuals respond to environmental change determines the strength and direction of biological processes like recruitment and growth that underpin population productivity. Ascertaining the relative importance of environmental factors can, however, be difficult given the numerous mechanisms through which they affect individuals. This is especially true in dynamic and complex estuarine environments. Here, we develop long-term otolith-based indices of recruitment and growth for estuary perch Percalates colonorum (Bemm River, Australia), to explore the importance of intrinsic (individual, demographic) and extrinsic (hydrologic, climatic, density-dependent) factors in driving estuarine fish productivity. Analyses involved a novel zero-inflated specification of catch curve regression and mixed effects modelling. The 39 years of recruitment and 46 years of growth data, spanning a period of environmental change including severe drought, displayed considerable inter-annual variation. Recruitment success was strongly related to high freshwater inflows during the spawning season, suggesting that these conditions act as spawning cues for adults and potentially provide favourable conditions for larvae. Individuals displayed age-dependent growth, with highest rates observed at younger ages in years characterized by warm temperatures, and to a lesser degree, greater magnitude base inflow conditions. We detected systematic among-year-class growth differences, but these were not attributable to year class strength, suggesting that environmental conditions experienced by individuals as juveniles can have long-lasting effects of greater importance to population productivity than density-dependent growth responses. The primacy of temperature in driving growth variation highlights that under-appreciated climatic variation can affect estuarine fish productivity through direct physiological and indirect food web mechanisms. We predict that climatic warming will promote individual

  11. Towards Support for Long-Term Digital Preservation in Product Life Cycle Management

    Directory of Open Access Journals (Sweden)

    Wolfgang Wilkes

    2011-03-01

    Full Text Available Important legal and economic motivations exist for the design and engineering industry to address and integrate digital long-term preservation into product life cycle management (PLM. Investigations revealed that it is not sufficient to archive only the product design data which is created in early PLM phases, but preservation is needed for data that is produced during the entire product lifecycle including early and late phases. Data that is relevant for preservation consists of requirements analysis documents, design rationale, data that reflects experiences during product operation and also metadata like social collaboration context. In addition, also the engineering environment itself that contains specific versions of all tools and services is a candidate for preservation. This paper takes a closer look at engineering preservation use case scenarios as well as PLM characteristics and workflows that are relevant for long-term preservation. Resulting requirements for a long-term preservation system lead to an OAIS (Open Archival Information System based system architecture and a proposed preservation service interface that respects the needs of the engineering industry.

  12. Simulating long-term effectiveness and efficiency of management scenarios for an invasive grass

    Science.gov (United States)

    Jarnevich, Catherine S.; Holcombe, Tracy R.; Cullinane Thomas, Catherine; Frid, Leonardo; Olsson, Aaryn D.

    2015-01-01

    Resource managers are often faced with trade-offs in allocating limited resources to manage plant invasions. These decisions must often be made with uncertainty about the location of infestations, their rate of spread and effectiveness of management actions. Landscape level simulation tools such as state-and-transition simulation models (STSMs) can be used to evaluate the potential long term consequences of alternative management strategies and help identify those strategies that make efficient use of resources. We analyzed alternative management scenarios for African buffelgrass (Pennisetum ciliare syn. Cenchrus ciliaris) at Ironwood Forest National Monument, Arizona using a spatially explicit STSM implemented in the Tool for Exploratory Landscape Scenario Analyses (TELSA). Buffelgrass is an invasive grass that is spreading rapidly in the Sonoran Desert, affecting multiple habitats and jurisdictions. This invasion is creating a novel fire risk and transforming natural ecosystems. The model used in this application incorporates buffelgrass dispersal and establishment and management actions and effectiveness including inventory, treatment and post-treatment maintenance. We simulated 11 alternative scenarios developed in consultation with buffelgrass managers and other stakeholders. The scenarios vary according to the total budget allocated for management and the allocation of that budget between different kinds of management actions. Scenario results suggest that to achieve an actual reduction and stabilization of buffelgrass populations, management unconstrained by fiscal restrictions and across all jurisdictions and private lands is required; without broad and aggressive management, buffelgrass populations are expected to increase over time. However, results also suggest that large upfront investments can achieve control results that require relatively minimal spending in the future. Investing the necessary funds upfront to control the invasion results in the most

  13. Simulating long-term effectiveness and efficiency of management scenarios for an invasive grass

    Directory of Open Access Journals (Sweden)

    Catherine S. Jarnevich

    2015-05-01

    Full Text Available Resource managers are often faced with trade-offs in allocating limited resources to manage plant invasions. These decisions must often be made with uncertainty about the location of infestations, their rate of spread and effectiveness of management actions. Landscape level simulation tools such as state-and-transition simulation models (STSMs can be used to evaluate the potential long term consequences of alternative management strategies and help identify those strategies that make efficient use of resources. We analyzed alternative management scenarios for African buffelgrass (Pennisetum ciliare syn. Cenchrus ciliaris at Ironwood Forest National Monument, Arizona using a spatially explicit STSM implemented in the Tool for Exploratory Landscape Scenario Analyses (TELSA. Buffelgrass is an invasive grass that is spreading rapidly in the Sonoran Desert, affecting multiple habitats and jurisdictions. This invasion is creating a novel fire risk and transforming natural ecosystems. The model used in this application incorporates buffelgrass dispersal and establishment and management actions and effectiveness including inventory, treatment and post-treatment maintenance. We simulated 11 alternative scenarios developed in consultation with buffelgrass managers and other stakeholders. The scenarios vary according to the total budget allocated for management and the allocation of that budget between different kinds of management actions. Scenario results suggest that to achieve an actual reduction and stabilization of buffelgrass populations, management unconstrained by fiscal restrictions and across all jurisdictions and private lands is required; without broad and aggressive management, buffelgrass populations are expected to increase over time. However, results also suggest that large upfront investments can achieve control results that require relatively minimal spending in the future. Investing the necessary funds upfront to control the invasion

  14. Long-Term Information Management (LTIM) of Safeguards Data at Repositories: Phase II

    Energy Technology Data Exchange (ETDEWEB)

    Haddal, Risa N. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2016-10-01

    One of the challenges of implementing safeguards for geological repositories will be the long-term preservation of safeguards-related data for 100 years or more. While most countries considering the construction and operation of such facilities agree that safeguards information should be preserved, there are gaps with respect to standardized requirements, guidelines, timescales, and approaches. This study analyzes those gaps and explores research to clarify stakeholder needs, identify current policies, approaches, best practices and international standards, and explores existing safeguards information management infrastructure. The study also attempts to clarify what a safeguards data classification system might look like, how long data should be retained, and how information should be exchanged between stakeholders at different phases of a repository’s life cycle. The analysis produced a variety of recommendations on what information to preserve, how to preserve it, where to store it, retention options and how to exchange information in the long term. Key findings include the use of the globally recognized international records management standard, ISO15489, for guidance on the development of information management systems, and the development of a Key Information File (KIF). The KIF could be used to identify only the most relevant, high-level safeguards information and the history of decision making about the repository. The study also suggests implementing on-site and off-site records storage in digital and physical form; developing a safeguards data classification system; long-term records retention with periodic reviews every 5 to 10 years during each phase of the repository life cycle; and establishing transition procedures well in advance so that data shepherds and records officers can transfer information with incoming facility managers effectively and efficiently. These and other recommendations are further analyzed in this study.

  15. The long-term environmental impacts of the Mount Polley mine tailings spill, British Columbia, Canada

    Science.gov (United States)

    Byrne, Patrick; Hudson-Edwards, Karen; Macklin, Mark; Brewer, Paul; Bird, Graham; Williams, Richard

    2015-04-01

    On the 4th August 2014 a tailings impoundment failure at the Mount Polley gold and copper mine in British Columbia, Canada, released approximately 25 million m3 of solid and liquid waste into Hazeltine Creek, Quesnel Lake and Polley Lake. The sheer volume of the tailings released caused Haseltine Creek channel to expand from 2m to over 25m in width and Polley Lake water level to rise by 1.7m. The spill also removed trees in a 900 km2 corridor either side of Hazeltine Creek. Local residents and government officials have expressed serious concerns regarding the potential long-term effects on regional biodiversity, water security and to the livelihoods of First Nation communities. Among impoundment failures, the Mount Polley disaster is unique in that the solid tailings contain an unusual mixture of metal contaminants (arsenic, copper, gold, manganese, nickel, lead, vanadium). As particulate matter is the principal carrier of metal contaminants, the spilled tailings may reside in the regional soils and sediments for 1000s of years serving as a secondary source of pollution. The environmental risk posed by the spilled tailings is compounded by the location of the spill in a mountainous forested catchment, affected by severe winters with prominent spring snow melts that have the potential to remobilise very large quantities of spilled tailings. No data currently exist on the short- to long-term behaviour of these tailings in soils and sediments and the effects of the clean-up operations on their behaviour in this type of river environment. In this study, we adopt a multidisciplinary approach to determine the environmental and geomorphological impacts of the tailings spill. We have two specific objectives. (1) The physicochemical speciation and geochemical stability of spilled tailings will be characterised in surface and hyporheic sediments using bulk chemistry, mineralogical (XRD and SEM) and speciation methods (sequential extractions, electron microprobe analysis, XAS

  16. Earnings Management of Firms Reporting Long Term Debt: An Alternative Method

    Directory of Open Access Journals (Sweden)

    Yulius Jogi Christiawan

    2014-01-01

    Full Text Available This study aims to apply an alternative detection model to prove that the earnings management will be occured when a company has long-term debts as well as the pressure of operating income. Generally, the literature study of earnings management indicates that the detection of earnings management can be grouped into two objectives, 1] to find variables for detecting earnings management (accruals, real activity and classification shifting and 2] to use some advanced statistical or mathematical models to detect earnings management. This study applies a quantitative approach using secondary data of financial statements. The study was conducted on 50 companies with the largest market capitalization, 50 of the most active companies based on trading volume, 50 of the most active companies based on the value of trade and 50 of the most active companies by frequency trading. All of them are 200  public company (listed in the Indonesia Stock Exchange-ID based on IDX statistical report 2013. The results of this study are expected to provide a new method to detect earnings management and its application in the context of positive accounting theory (PAT. The results of the study proves that the model is able to detect earnings management by utilizing foreign exchange transaction losses and use these models to support PAT (particularly on debt covenant hypothesis. These results contribute that earnings management can be done by using the foreign exchange gain / loss. However, the limitation of this study is the model has not been able to capture the phenomenon of earnings management if a company does not report any long-term debt nor foreign exchange gain/ loss.

  17. 75 FR 20582 - Record of Decision: Final Environmental Impact Statement for Decommissioning and/or Long-Term...

    Science.gov (United States)

    2010-04-20

    ... of Decision: Final Environmental Impact Statement for Decommissioning and/or Long-Term Stewardship at...) to examine the ] potential environmental impacts of the range of reasonable alternatives to meet DOE... spent nuclear fuel at WNYNSC from 1966 to 1972 under an Atomic Energy Commission license. Fuel...

  18. From Sky to Archive: Long Term Management of Sky Survey Data

    Science.gov (United States)

    Darch, Peter T.; Sands, Ashley E.; Borgman, Christine; Golshan, Milena S.; Traweek, Sharon

    2017-01-01

    Sky survey data may remain scientifically valuable long beyond the end of a survey’s operational period, both for continuing inquiry and for calibrating and testing instruments for subsequent generations of surveys. Astronomy infrastructure has many stakeholders, including those concerned with data management. Research libraries are increasingly partnering with scholars to sustain access to data.The Sloan Digital Sky Survey (SDSS) was among the first major scientific projects to partner with libraries in this way, embarking on a data transfer process with two university libraries. We report on a qualitative case study of this process.Ideally, long-term sustainability of sky survey data would be a key part of planning and construction, but rarely does this occur. Teams are under pressure to deliver a project on time and on budget that produces high-quality data during its operational period, leaving few resources available to plan long-term data management. The difficulty of planning is further compounded by the complexity of predicting circumstances and needs of the astronomy community in future decades. SDSS team members regarded libraries, long-lived institutions concerned with access to scholarship, as a potential solution to long-term data sustainability.As the SDSS data transfer was the first of this scale attempted - 160 TB of data - astronomers and library staff were faced with scoping the range of activities involved. They spent two years planning this five-year process. While successful overall as demonstration projects, the libraries encountered many obstacles. We found all parties experienced difficulty in articulating their notions of “scientific data,” “archiving,” “serving,” and “providing access” to the datasets. Activities and interpretations of the data transfer process varied by institutional motivations for participation and by available infrastructure. We conclude several, rather than a single, “library solutions” for long-term

  19. Diabetes MILES--Australia (management and impact for long-term empowerment and success)

    DEFF Research Database (Denmark)

    Speight, Jane; Browne, Jessica L; Holmes-Truscott, Elizabeth

    2012-01-01

    BACKGROUND: Successful management of diabetes requires attention to the behavioural, psychological and social aspects of this progressive condition. The Diabetes MILES (Management and Impact for Long-term Empowerment and Success) Study is an international collaborative. Diabetes MILES......--Australia, the first Diabetes MILES initiative to be undertaken, was a national survey of adults living with type 1 or type 2 diabetes in Australia. The aim of this study was to gather data that will provide insights into how Australians manage their diabetes, the support they receive and the impact of diabetes...... on their lives, as well as to use the data to validate new diabetes outcome measures. METHODS/DESIGN: The survey was designed to include a core set of self-report measures, as well as modules specific to diabetes type or management regimens. Other measures or items were included in only half of the surveys...

  20. Grand Challenges for Biological and Environmental Research: A Long-Term Vision

    Energy Technology Data Exchange (ETDEWEB)

    Arkin, A.; Baliga, N.; Braam, J.; Church, G.; Collins, J; ; Cottingham, R.; Ecker, J.; Gerstein, M.; Gilna, P.; Greenberg, J.; Handelsman, J.; Hubbard, S.; Joachimiak, A.; Liao, J.; Looger, L.; Meyerowitz, E.; Mjolness, E.; Petsko, G.; Sayler, G.; Simpson, M.; Stacey, G.; Sussman, M.; Tiedje, J.; Bader, D.; Cessi, P.; Collins, W.; Denning, S.; Dickinson, R.; Easterling, D.; Edmonds, J.; Feddema, J.; Field, C.; Fridlind, A.; Fung, I.; Held, I.; Jackson, R.; Janetos, A.; Large, W.; Leinen, M.; Leung, R.; Long, S.; Mace, G.; Masiello, C.; Meehl, G.; Ort, D.; Otto-Bliesner, B.; Penner, J.; Prather, M.; Randall, D.; Rasch, P.; Schneider, E.; Shugart, H.; Thornton, P.; Washington, W.; Wildung, R.; Wiscombe, W.; Zak, D.; Zhang, M.; Bielicki, J.; Buford, M.; Cleland, E.; Dale, V.; Duke, C.; Ehleringer, J.; Hecht, A.; Kammen, D.; Marland, G.; Pataki, D.; Riley, M. Robertson, P.; Hubbard, S.

    2010-12-01

    outcomes and behaviors of complex biological and environmental systems, leading to robust solutions for DOE missions and strategic goals. In March 2010, the Biological and Environmental Research Advisory Committee held the Grand Challenges for Biological and Environmental Research: A Long-Term Vision workshop to identify scientific opportunities and grand challenges for BER science in the coming decades and to develop an overall strategy for drafting a long-term vision for BER. Key workshop goals included: (1) Identifying the greatest scientific challenges in biology, climate, and the environment that DOE will face over a 20-year time horizon. (2) Describing how BER should be positioned to address those challenges. (3) Determining the new and innovative tools needed to advance BER science. (4) Suggesting how the workforce of the future should be trained in integrative system science. This report lays out grand research challenges for BER - in biological systems, climate, energy sustainability, computing, and education and workforce training - that can put society on a path to achieve the scientific evidence and predictive understanding needed to inform decision making and planning to address future energy needs, climate change, water availability, and land use.

  1. New Tools for Preservation: Assessing Long-Term Environmental Effects on Library and Archives Collections.

    Science.gov (United States)

    Reilly, James M.; And Others

    A new method was developed by the Image Permanence Institute for monitoring the effects of dynamic environmental conditions on organic materials in order to make it easier to manage the preservation of library and archives collections. This new approach to preservation management applies to the many types of scholarly resources for which research…

  2. Towards sustainable groundwater use: Setting long-term goals, backcasting, and managing adaptively

    Science.gov (United States)

    Gleeson, T.; Alley, W.M.; Allen, D.M.; Sophocleous, M.A.; Zhou, Y.; Taniguchi, M.; Vandersteen, J.

    2012-01-01

    The sustainability of crucial earth resources, such as groundwater, is a critical issue. We consider groundwater sustainability a value-driven process of intra- and intergenerational equity that balances the environment, society, and economy. Synthesizing hydrogeological science and current sustainability concepts, we emphasize three sustainability approaches: setting multigenerational sustainability goals, backcasting, and managing adaptively. As most aquifer problems are long-term problems, we propose that multigenerational goals (50 to 100 years) for water quantity and quality that acknowledge the connections between groundwater, surface water, and ecosystems be set for many aquifers. The goals should be set by a watershed- or aquifer-based community in an inclusive and participatory manner. Policies for shorter time horizons should be developed by backcasting, and measures implemented through adaptive management to achieve the long-term goals. Two case histories illustrate the importance and complexity of a multigenerational perspective and adaptive management. These approaches could transform aquifer depletion and contamination to more sustainable groundwater use, providing groundwater for current and future generations while protecting ecological integrity and resilience. ?? 2011, The Author(s). Ground Water ?? 2011, National Ground Water Association.

  3. Soil aggregation and aggregating agents as affected by long term contrasting management of an Anthrosol.

    Science.gov (United States)

    Zhang, Shulan; Wang, Renjie; Yang, Xueyun; Sun, Benhua; Li, Qinghui

    2016-12-13

    Soil aggregation was studied in a 21-year experiment conducted on an Anthrosol. The soil management regimes consisted of cropland abandonment, bare fallow without vegetation and cropping system. The cropping system was combined with the following nutrient management treatments: control (CONTROL, no nutrient input); nitrogen, phosphorus and potassium (NPK); straw plus NPK (SNPK); and manure (M) plus NPK (MNPK). Compared with the CONTROL treatment, the abandonment treatment significantly increased the formation of large soil macroaggregates (>2 mm) and consequently improved the stability of aggregates in the surface soil layer due to enhancement of hyphal length and of soil organic matter content. However, in response to long-term bare fallow treatment aggregate stability was low, as were the levels of aggregating agents. Long term fertilization significantly redistributed macroaggregates; this could be mainly ascribed to soil organic matter contributing to the formation of 0.5-2 mm classes of aggregates and a decrease in the formation of the >2 mm class of aggregates, especially in the MNPK treatment. Overall, hyphae represented a major aggregating agent in both of the systems tested, while soil organic compounds played significantly different roles in stabilizing aggregates in Anthrosol when the cropping system and the soil management regimes were compared.

  4. Integrated system for long-term radioactive waste management in the UK

    Energy Technology Data Exchange (ETDEWEB)

    Dalton, J.; Wisbey, S. [United Kingdom Nirex Ltd., Curie Avenue, Harwell, Didcot, Oxfordshire (United Kingdom)

    2003-07-01

    Since the failure of Nirex application to build a Rock Characterisation Facility near Sellafield in 1997, Nirex has been applying lessons learnt from that failure. Some of the issues involved are generic and relate to the process by which legitimate authority can be gained for government policy development, the structure of the nuclear industry and the behaviour of institutions. Transparency must be central to the culture of organisations attempting to win public acceptance. In the UK, the Department for Environment, Food and Rural Affairs (DEFRA) have started a consultation process - stage one completed in March 2002 - to consult about the safe management of radioactive waste. Nirex has modified its approach to long-term waste management, using a concept of phased (stepwise and reversible) geological disposal. Nirex also provides waste producers with advice on, and endorsement of, the packaging and transport of wastes. Through these examples, this paper will demonstrate how Nirex is providing an integrated approach to the long-term management of radioactive wastes in the UK. (orig.)

  5. Development and appraisal of long-term adaptation pathways for managing heat-risk in London

    Directory of Open Access Journals (Sweden)

    Ashley Kingsborough

    2017-01-01

    Full Text Available The risk of residential overheating and mortality is increasing due to the effects of global warming and the urban heat island effect and needs to be addressed through climate change adaptation. ‘Adaptation pathways’ have become widely recognised as an adaptation planning approach, but they have not been utilised for long-term planning for city-scale urban heat risk management. This paper applies adaptation pathway methodology to urban heat risk management. We use spatially coherent downscaled probabilistic climate change projections that account for changes in urban-land cover and the urban heat island to appraise adaptation pathways and inform long-term adaptation planning. We demonstrate that adaptation strategies focusing solely on urban greening or building level adaptation based on current best practice are unlikely to cope with the increasing levels of risk. Air-conditioning may play a growing role in managing heat-risk; however, increasing air-conditioning will exacerbate the urban heat island and further increase the risks of overheating.

  6. Risks and management of long-term corticosteroid use in chronic rhinosinusitis.

    Science.gov (United States)

    Campbell, Raewyn G

    2018-02-01

    The purpose of this review is to provide an update on the use and risks of long-term corticosteroids in the management of chronic rhinosinusitis (CRS). Long-term use of systemic corticosteroids is not indicated in the management of CRS due to the associated side effects and potential complications. Therefore, recent research has focused on the safety and efficacy of topical corticosteroid, particularly second-generation corticosteroids, and their modes of administration. Second-generation corticosteroids are more potent and have less systemic bioavailability than their first-generation counterparts. However, caution must be taken with concomitant use of more than two types of corticosteroids (topical, systemic, inhaled etc.) and also with their dosage and frequency of administration to avoid adrenal suppression, growth suppression in children, elevated intraocular pressure or epistaxis. Research is ongoing into therapies that may reduce corticosteroid resistance which has been demonstrated in some nasal polyps. Corticosteroids play an essential role in the management of CRS; however, use must be tailored to the patient-specific disease and requires ongoing review and regular reevaluation by their physician.

  7. Soil aggregation and aggregating agents as affected by long term contrasting management of an Anthrosol

    Science.gov (United States)

    Zhang, Shulan; Wang, Renjie; Yang, Xueyun; Sun, Benhua; Li, Qinghui

    2016-12-01

    Soil aggregation was studied in a 21-year experiment conducted on an Anthrosol. The soil management regimes consisted of cropland abandonment, bare fallow without vegetation and cropping system. The cropping system was combined with the following nutrient management treatments: control (CONTROL, no nutrient input); nitrogen, phosphorus and potassium (NPK); straw plus NPK (SNPK); and manure (M) plus NPK (MNPK). Compared with the CONTROL treatment, the abandonment treatment significantly increased the formation of large soil macroaggregates (>2 mm) and consequently improved the stability of aggregates in the surface soil layer due to enhancement of hyphal length and of soil organic matter content. However, in response to long-term bare fallow treatment aggregate stability was low, as were the levels of aggregating agents. Long term fertilization significantly redistributed macroaggregates; this could be mainly ascribed to soil organic matter contributing to the formation of 0.5-2 mm classes of aggregates and a decrease in the formation of the >2 mm class of aggregates, especially in the MNPK treatment. Overall, hyphae represented a major aggregating agent in both of the systems tested, while soil organic compounds played significantly different roles in stabilizing aggregates in Anthrosol when the cropping system and the soil management regimes were compared.

  8. Developing and analyzing long-term fuel management strategies for an advanced Small Modular PWR

    Energy Technology Data Exchange (ETDEWEB)

    Hedayat, Afshin, E-mail: ahedayat@aeoi.org.ir

    2017-03-15

    Highlights: • Comprehensive introduction and supplementary concepts as a review paper. • Developing an integrated long-term fuel management strategy for a SMR. • High reliable 3-D core modeling over fuel pins against the traditional LRM. • Verifying the expert rules of large PWRs for an advanced small PWR. • Investigating large numbers of safety parameters coherently. - Abstract: In this paper, long-term fuel management (FM) strategies are introduced and analyzed for a new advanced Pressurized Light Water Reactor (PWR) type of Small Modular Reactors (SMRs). The FM strategies are developed to be safe and practical for implementation as much as possible. Safety performances, economy of fuel, and Quality Assurance (QA) of periodic equilibrium conditions are chosen as the main goals. Flattening power density distribution over fuel pins is the major method to ensure safety performance; also maximum energy output or permissible discharging burn up indicates economy of fuel fabrication costs. Burn up effects from BOC to EOC have been traced, studied, and highly visualized in both of transport lattice cell calculations and diffusion core calculations. Long-term characteristics are searched to gain periodical equilibrium characteristics. They are fissile changes, neutron spectrum, refueling pattern, fuel cycle length, core excess reactivity, average, and maximum burn up of discharged fuels, radial Power Peaking Factors (PPF), total PPF, radial and axial power distributions, batch effects, and enrichment effects for fine regulations. Traditional linear reactivity model have been successfully simulated and adapted via fine core and burn up calculations. Effects of high burnable neutron poison and soluble boron are analyzed. Different numbers of batches via different refueling patterns have been studied and visualized. Expert rules for large type PWRs have been influenced and well tested throughout accurate equilibrium core calculations.

  9. Total energy management for nursing homes and other long-term care institutions

    Energy Technology Data Exchange (ETDEWEB)

    1977-01-01

    The purpose of this publication is to provide the basic instruction needed to implement the most effective form of energy conservation--Total Energy Management, or TEM--in your long-term care facility. The effort required is worthwhile for many different reasons: TEM is self-paying; TEM promotes energy conservation without negative impact on health care services; and energy costs will continue to escalate. Following the introductory chapter, chapters are titled: Understanding Energy Consumption; Initiating a Total Energy Management Program; Developing Energy Consumption Data; Conducting the Facility Survey; Developing and Implementing the Basic Plan; Communication and Motivation; Monitoring Your Program and Keeping It Effective; and Guidelines for Energy Conservation. Two appendices furnish information on building information for TEM and sources of information for energy management. (MCW)

  10. A data management proposal to connect in a hierarchical way nodes of the Spanish Long Term Ecological Research (LTER) network

    Science.gov (United States)

    Fuentes, Daniel; Pérez-Luque, Antonio J.; Bonet García, Francisco J.; Moreno-LLorca, Ricardo A.; Sánchez-Cano, Francisco M.; Suárez-Muñoz, María

    2017-04-01

    another has no infrastructure to maintain their data (The Arid Iberian South East LTSER Platform). The last one (Environmental Information Network of Andalusia-REDIAM) acts as the coordinator, providing physical and logical support to other nodes and also gathers and distributes the information "uphill" to the rest of the network (LTER Europe and ILTER). The development of the network has been divided in three stages. First, existing resources and data management requirements are identified in each node. Second, the necessary software tools and interoperable standards to manage and exchange the data have been selected, installed and configured in each participant. Finally, once the network has been set up completely, it is expected to expand it all over Spain with new nodes and its connection to others LTER and similar networks. This research has been funded by ADAPTAMED (Protection of key ecosystem services by adaptive management of Climate Change endangered Mediterranean socioecosystems) Life EU project, Sierra Nevada Global Change Observatory (LTER-site) and eLTER (Integrated European Long Term Ecosystem & Socio-Ecological Research Infrastructure).

  11. Plan for the long term environmental assessment of geopressured resource development in the Louisiana Gulf Coast Region

    Energy Technology Data Exchange (ETDEWEB)

    Newchurch, E.J.; Bryan, C.F.; Harrison, D.P.; Muller, R.A.; Wilcox, R.E.; Bachman, A.L.; Newman, J.P.; Cunningham, K.J.; Hilding, R.K.; Rehage, J.A.

    1978-07-15

    Results of research to develop a plan for the long-term environmental assessment of geopressured/geothermal resource development in the Louisiana Gulf Coast region are reported. An overall view of the environmental issues facing decision-makers in the area of geopressured resource development is presented, along with a plan for monitoring potential environmental impacts. Separate assessments and plans are presented for geological effects, air and water quality, ecosystem quality, and socioeconomic and cultural considerations. (JGB)

  12. Long-term effects of soil management practices on selected indicators of chemical soil quality

    Directory of Open Access Journals (Sweden)

    Alicja Pecio

    2016-06-01

    Full Text Available The study was conducted in scope of Catch-C project “Compatibility of agricultural management practices and types of farming in the EU to enhance climate change mitigation and soil health” (7FP, realized in 2012–2014 by the consortium of partners from 10 European countries (http://www.catch-c.eu. This work reports the effects of soil management practices – under different soil and climatic conditions – on the selected soil chemical quality indicators, based on the analysis of data extracted from literature on long term experiments (LTEs in Europe, as well as from LTEs held by the Catch-C consortium partners. The dataset related to soil chemical quality indicators consisted of 1044 records and referred to 59 long-term trials. The following indicators of chemical soil quality were analyzed: pH, N total content, N total stock, C:N ratio, N mineral content, P and K availability. They are the most frequently used indicators in the European literature on long-term experiments collected in the Catch-C project database. Soil organic carbon, however, the most important indicator was not presented here, due to it was covered by a separate study on indicators for climate change mitigation. The indicators were analyzed using their response ratio (RR to a management practice. For a given treatment (management practice, this ratio was calculated as the quotient between the indicator value obtained in the treatment, and the indicator value in the reference treatment. The examples were: rotation (with cereals, with legume crops, with tuber or root crops, with grassland vs. adequate monoculture, catch/cover crops vs. no catch/cover crops, no-tillage and no-inversion tillage vs. conventional tillage, mineral fertilization vs. no fertilization, organic fertilization (compost, farmyard manure, slurry vs. mineral fertilization at the same available nitrogen input, crop residue incorporation vs. removal. All tested practices influenced soil chemical quality

  13. The long-term functional outcome of type II odontoid fractures managed non-operatively.

    LENUS (Irish Health Repository)

    Butler, J S

    2010-10-01

    Odontoid fractures currently account for 9-15% of all adult cervical spine fractures, with type II fractures accounting for the majority of these injuries. Despite recent advances in internal fixation techniques, the management of type II fractures still remains controversial with advocates still supporting non-rigid immobilization as the definitive treatment of these injuries. At the NSIU, over an 11-year period between 1 July 1996 and 30 June 2006, 66 patients (n = 66) were treated by external immobilization for type II odontoid fractures. The medical records, radiographs and CT scans of all patients identified were reviewed. Clinical follow-up evaluation was performed using the Cervical Spine Outcomes Questionnaire (CSOQ). The objectives of this study were to evaluate the long-term functional outcome of patients suffering isolated type II odontoid fractures managed non-operatively and to correlate patient age and device type with clinical and functional outcome. Of the 66 patients, there were 42 males and 24 females (M:F = 1.75:1) managed non-operatively for type II odontoid fractures. The mean follow-up time was 66 months. Advancing age was highly correlated with poorer long-term functional outcomes when assessing neck pain (r = 0.19, P = 0.1219), shoulder and arm pain (r = 0.41, P = 0.0007), physical symptoms (r = 0.25, P = 0.472), functional disability (r = 0.24, P = 0.0476) and psychological distress (r = 0.41, P = 0.0007). Patients >65 years displayed a higher rate of pseudoarthrosis (21.43 vs. 1.92%) and established non-union (7.14 vs. 0%) than patients <65 years. The non-operative management of type II odontoid fractures is an effective and satisfactory method of treating type II odontoid fractures, particularly those of a stable nature. However, patients of advancing age have been demonstrated to have significantly poorer functional outcomes in the long term. This may be linked to higher rates of non-union.

  14. The role of the National Bison Range in the long-term management of Federal bison herds

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Proposal for "The role of the National Bison Range in the long-term management of Federal bison herds" project created by the Texas Agricultural Experiment Station...

  15. Time management and leadership styles: an empirical study of long-term health care administrators.

    Science.gov (United States)

    Hartley, H J; Kramer, J A

    1991-01-01

    Is there a relationship between the type of leadership style employed by long-term health care administrators and the effective use and management of time? This paper describes a 1989 study of 188 administrators of skilled nursing facilities and intermediate care facilities in Connecticut. Two self-rating instruments were employed: the Executive Time Management Inventory (Hartley, Kramer, et al.) and the LEAD-Self instrument (Hersey and Blanchard). Four hypotheses were tested at the .05 level of significance to examine relationships among time management, leadership style, size of facility, administrator experience, and cost factors. Statistical procedures included Pearson Product-Moment correlations, analysis of variance, t-tests, and partial correlations. Results of the study included (1) time management effectiveness increased as administrators gained more experience; (2) no significant relationship existed between type of leadership style and time management effectiveness; (3) women administrators perceived themselves as significantly more effective time managers than men did; (4) most health care administrators employed the same primary leadership style: "selling," which is defined as high relationship/high task; and (5) institutional size was not related to the time management effectiveness of the administrator. The findings have implications for pre-service and in-service training and for future studies in health administration education.

  16. Gastric bypass patients' goal-strategy-monitoring networks for long-term dietary management.

    Science.gov (United States)

    Lynch, Amanda; Bisogni, Carole A

    2014-10-01

    Following gastric bypass surgery, patients must make dramatic dietary changes, but little is known about patients' perspectives on long-term dietary management after this surgery. This grounded theory, qualitative study sought to advance conceptual understanding of food choice by examining how gastric bypass patients constructed personal food systems to guide food and eating behaviors 12 months post-surgery. Two in-depth interviews were conducted with each of 16 adults, purposively sampled from bariatric support groups. Using constant comparative analysis of verbatim interview transcripts, researchers identified participants' goal-strategy-monitoring networks representing how participants used specific food and eating behaviors towards their main goals of: Weight Management, Overall Health, Avoiding Negative Reactions to Eating, and Integrating Dietary Changes with Daily Life. Linked to each main goal was a hierarchy of intermediary goals, strategies, and tactics. Participants used monitoring behaviors to assess strategy effectiveness towards goal achievement. Individuals' Weight Management networks were compared to uncover similarities and differences among strategy use and monitoring methods among those who maintained weight loss and those who regained weight. The complex, multilevel goal-strategy-monitoring networks identified illustrate the "work" involved in constructing new personal food systems after surgery, as well as advance understanding of strategies as a component of people's personal food systems. These findings provide researchers and practitioners with insight into the long-term dietary issues that gastric bypass patients face and a potential method for representing how people relate deliberate dietary behaviors to their goals. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Long-term mountain tundra composition's responses to grazing pressure in the context of environmental changes

    Science.gov (United States)

    Saccone, Patrick; Pyykkonen, Tuija; Eskelinen, Anu; Virtanen, Risto

    2013-04-01

    exclosure, where the absence of grazing pressure in non-disadvantageous conditions allowed the dominance of V. myrtillus which also led to a low diversity level largely composed by vascular plants. Our long-term exclosure study shows that grazing is a driver of Arctic tundra plant composition, as, at least equally strong, as environmental conditions (snow duration, soil moisture). Our results highlighted that the interaction of these two major drivers could lead, depending on local conditions, to alternative plant community states. These states could be diverse in terms of plant morphology, functional traits and chemistry. Finally such changes in plant communities could induce changes in interaction and feedback between biotic and abiotic compartments of the ecosystem. Key-words: Alternative stable states; Competitive dominated communities; Habitat filtering; Niche differentiation; Species Abundance Distribution

  18. Assessing long-term sustainable environmental impacts of agri-environment schemes on land use

    DEFF Research Database (Denmark)

    Vesterager, Jens Peter; Teilmann, Kasper; Vejre, Henrik

    2012-01-01

    , and indicators of the environmental state at farm level. In a Danish test case, agricultural practices at twenty-five farms in two groundwater protection zones were assessed. Data was collected from databases, registers, maps and interviews with farmers. The index was calculated for 1996/7 and 2006/7 to track......The lack of generic methods to assess the environmental consequences of agricultural practices and the lack of consensus on monitoring and evaluation of environmental, agricultural and socio-economic effects of agri-environment schemes (AES) in EU Member States call for better evaluation methods....... It is important to consider the robustness of each indicator: to assess whether changes will occur over time; whether changes are linked to management practices or external factors; and whether data are available up to date. Indicators dependent upon uptake data from agri-environmental schemes should be used...

  19. Management of occlusion and thrombosis associated with long-term indwelling central venous catheters

    Science.gov (United States)

    Baskin, Jacquelyn L.; Pui, Ching-Hon; Reiss, Ulrike; Wilimas, Judith A.; Metzger, Monika L.; Ribeiro, Raul C.; Howard, Scott C.

    2010-01-01

    Long-term central venous catheters (CVC) facilitate care for patients with chronic illnesses, but catheter occlusions and catheter-related thrombosis (CRT) are common complications. This review summarizes management of CVC and CRT. Mechanical CVC occlusions require cause-specific therapy; whereas, thrombotic occlusions usually resolve with thrombolytic therapy, such as alteplase. Prophylaxis with thrombolytic flushes may decrease CVC infections and CRT, but confirmatory studies and cost-effectiveness analysis are needed. Risk factors for CRT include previous catheter infections, malposition of the catheter tip, and prothrombotic states. CRT can lead to catheter infection, pulmonary embolism, and post-thrombotic syndrome. CRT is diagnosed primarily using Doppler ultrasound or venography and treated with anticoagulation for 6 weeks to a year, depending on the extent of the thrombus, response to initial therapy, and whether thrombophilic factors persist. Prevention of CRT includes proper positioning of the CVC and prevention of infections; anticoagulation prophylaxis is not recommended at present. PMID:19595350

  20. Multidisciplinary management and long-term follow-up of mesiodens: a case report.

    Science.gov (United States)

    Cogulu, Dilsah; Yetkiner, Enver; Akay, Cemal; Seckin, Ozlem; Alpoz, Riza

    2008-01-01

    Supernumerary teeth are relatively common in the oral cavity and are characterized by an excessive number of teeth. The term "mesiodens" refers to a supernumerary tooth located in the midline of the maxilla between the central incisors. Mesiodens may cause a variety of pathological complications such as impaction of the maxillary central incisors, tooth retention or delayed eruption of the permanent incisors, crowding, eruption within the nasal cavity, formation of diastema, intraoral infection, root anomaly, root resorption of adjacent teeth and cyst formation accompanied by bone destruction. Therefore it is recommended to follow-up with regular radiographic examination. Early diagnosis minimizes treatment needs and prevents associated complications. The present case, followed for 7 years, presented bilateral mesiodens resulting in delayed eruption of the permanent incisors and emphasizes the importance of multidisciplinary management and long-term follow-up.

  1. Long-term management of a hydroelectric multireservoir system under uncertainty using the progressive hedging algorithm

    Science.gov (United States)

    Carpentier, P.-L.; Gendreau, M.; Bastin, F.

    2013-05-01

    Among the numerous methods proposed over the past decades for solving reservoir management problems, only a few are applicable on high-dimensional reservoir systems (HDRSs). The progressive hedging algorithm (PHA) was rarely used for managing reservoir systems, but this method is a promising alternative to conventionally used methods for managing HDRSs (e.g., the stochastic dual dynamic programming). The PHA is especially well suited when a new stochastic optimization model must be built upon an existing deterministic optimization model (DOM). In such case, scenario subproblems can be resolved using an existing DOM with minor modifications. In previous studies, the PHA was rarely used and only tested on problems covering short-range planning horizons (2 months with six time periods) where a small number of nonanticipativity constraints (NACs) must be satisfied. Large reservoirs often need to be managed over a much longer planning horizon (1-5 years) containing many tens of time periods. In such case, convergence becomes much more difficult to achieve because of the larger number of NACs to be satisfied. Finding a nonanticipative solution becomes particularly difficult when the input scenarios differ drastically. In this study, we demonstrate the applicability of the PHA for managing HDRSs over long-term (more than a year) horizons in highly uncertain decision environments. We apply the PHA on Hydro-Québec's reservoir system over a 92 week (period) horizon. We analyze the performance of the PHA for different penalty parameter values. Deterministic solutions are compared to stochastic solutions.

  2. Understanding long-term variations in an elephant piosphere effect to manage impacts.

    Directory of Open Access Journals (Sweden)

    Marietjie Landman

    Full Text Available Surface water availability is a key driver of elephant impacts on biological diversity. Thus, understanding the spatio-temporal variations of these impacts in relation to water is critical to their management. However, elephant piosphere effects (i.e. the radial pattern of attenuating impact are poorly described, with few long-term quantitative studies. Our understanding is further confounded by the complexity of systems with elephant (i.e. fenced, multiple water points, seasonal water availability, varying population densities that likely limit the use of conceptual models to predict these impacts. Using 31 years of data on shrub structure in the succulent thickets of the Addo Elephant National Park, South Africa, we tested elephant effects at a single water point. Shrub structure showed a clear sigmoid response with distance from water, declining at both the upper and lower limits of sampling. Adjacent to water, this decline caused a roughly 300-m radial expansion of the grass-dominated habitats that replace shrub communities. Despite the clear relationship between shrub structure and ecological functioning in thicket, the extent of elephant effects varied between these features with distance from water. Moreover, these patterns co-varied with other confounding variables (e.g. the location of neighboring water points, which limits our ability to predict such effects in the absence of long-term data. We predict that elephant have the ability to cause severe transformation in succulent thicket habitats with abundant water supply and elevated elephant numbers. However, these piosphere effects are complex, suggesting that a more integrated understanding of elephant impacts on ecological heterogeneity may be required before water availability is used as a tool to manage impacts. We caution against the establishment of water points in novel succulent thicket habitats, and advocate a significant reduction in water provisioning at our study site

  3. Understanding long-term variations in an elephant piosphere effect to manage impacts.

    Science.gov (United States)

    Landman, Marietjie; Schoeman, David S; Hall-Martin, Anthony J; Kerley, Graham I H

    2012-01-01

    Surface water availability is a key driver of elephant impacts on biological diversity. Thus, understanding the spatio-temporal variations of these impacts in relation to water is critical to their management. However, elephant piosphere effects (i.e. the radial pattern of attenuating impact) are poorly described, with few long-term quantitative studies. Our understanding is further confounded by the complexity of systems with elephant (i.e. fenced, multiple water points, seasonal water availability, varying population densities) that likely limit the use of conceptual models to predict these impacts. Using 31 years of data on shrub structure in the succulent thickets of the Addo Elephant National Park, South Africa, we tested elephant effects at a single water point. Shrub structure showed a clear sigmoid response with distance from water, declining at both the upper and lower limits of sampling. Adjacent to water, this decline caused a roughly 300-m radial expansion of the grass-dominated habitats that replace shrub communities. Despite the clear relationship between shrub structure and ecological functioning in thicket, the extent of elephant effects varied between these features with distance from water. Moreover, these patterns co-varied with other confounding variables (e.g. the location of neighboring water points), which limits our ability to predict such effects in the absence of long-term data. We predict that elephant have the ability to cause severe transformation in succulent thicket habitats with abundant water supply and elevated elephant numbers. However, these piosphere effects are complex, suggesting that a more integrated understanding of elephant impacts on ecological heterogeneity may be required before water availability is used as a tool to manage impacts. We caution against the establishment of water points in novel succulent thicket habitats, and advocate a significant reduction in water provisioning at our study site, albeit with greater

  4. Peptide-based anti-PCSK9 vaccines - an approach for long-term LDLc management.

    Directory of Open Access Journals (Sweden)

    Gergana Galabova

    Full Text Available Low Density Lipoprotein (LDL hypercholesterolemia, and its associated cardiovascular diseases, are some of the leading causes of death worldwide. The ability of proprotein convertase subtilisin/kexin 9 (PCSK9 to modulate circulating LDL cholesterol (LDLc concentrations made it a very attractive target for LDLc management. To date, the most advanced approaches for PCSK9 inhibition are monoclonal antibody (mAb therapies. Although shown to lower LDLc significantly, mAbs face functional limitations because of their relatively short in vivo half-lives necessitating frequent administration. Here, we evaluated the long-term efficacy and safety of PCSK9-specific active vaccines in different preclinical models.PCSK9 peptide-based vaccines were successfully selected by our proprietary technology. To test their efficacy, wild-type (wt mice, Ldlr+/- mice, and rats were immunized with highly immunogenic vaccine candidates. Vaccines induced generation of high-affine PCSK9-specific antibodies in all species. Group mean total cholesterol (TC concentration was reduced by up to 30%, and LDLc up to 50% in treated animals. Moreover, the PCSK9 vaccine-induced humoral immune response persisted for up to one year in mice, and reduced cholesterol levels significantly throughout the study. Finally, the vaccines were well tolerated in all species tested.Peptide-based anti-PCSK9 vaccines induce the generation of antibodies that are persistent, high-affine, and functional for up to one year. They are powerful and safe tools for long-term LDLc management, and thus may represent a novel therapeutic approach for the prevention and/or treatment of LDL hypercholesterolemia-related cardiovascular diseases in humans.

  5. Sevilleta Long-Term Ecological Research Program: Measuring ecosystem reponses to environmental change

    Science.gov (United States)

    Robert R. Parmenter

    1999-01-01

    The purpose of this paper is to describe the research program of the Sevilleta Long-Term Ecological Research Program (LTER) at the University of New Mexico. Details and data for each of the research topics described can be found in the Sevilleta LTER Internet Homepage (http://sev.lternet.edu/).

  6. The strategic skills of business continuity managers: putting business continuity management into corporate long-term planning.

    Science.gov (United States)

    Wong, Wei Ning Zechariah

    2009-11-01

    Despite its rapid development in the last two decades, business continuity management (BCM) as a discipline and a profession is still regarded by many as an operational entity of management. Two main issues are discussed in this paper: the role of BCM in strategic management and the strategic skills of business continuity managers. These issues are crucial as they represent the role of BCM in high-level corporate management. The paper discusses the importance of BCM in the long-term planning of organisational success and the preservation of future competitiveness. Finally, salient points that underpin the importance of its role in sustaining organisational performance are addressed.

  7. Pain Management in Long-Term Care Communities: A Quality Improvement Initiative.

    Science.gov (United States)

    Reid, Manney C; O'Neil, Kevin W; Dancy, JaNeen; Berry, Carolyn A; Stowell, Stephanie A

    2015-02-01

    Pain is underrecognized and undertreated in the long-term care (LTC) setting. To improve the management of pain for LTC residents, the authors implemented a quality improvement (QI) initiative at one LTC facility. They conducted a needs assessment to identify areas for improvement and designed a 2-hour educational workshop for facility staff and local clinicians. Participants were asked to complete a survey before and after the workshop, which showed significant improvement in their knowledge of pain management and confidence in their ability to recognize and manage residents' pain. To measure the effectiveness of the QI initiative, the authors performed a chart review at baseline and at 3 and 8 months after the workshop and evaluated relevant indicators of adequate pain assessment and management. The post-workshop chart reviews showed significant improvement in how consistently employees documented pain characteristics (ie, location, intensity, duration) in resident charts and in their use of targeted pain assessments for residents with cognitive dysfunction. The proportion of charts that included a documented plan for pain assessment was high at baseline and remained stable throughout the study. Overall, the findings suggest a QI initiative is an effective way to improve pain care practices in the LTC setting.

  8. Hellsgate Winter Range Mitigation Project; Long-term Management Plan, Project Report 1993, Final Draft.

    Energy Technology Data Exchange (ETDEWEB)

    Berger, Matthew T.

    1994-01-01

    A study was conducted on the Hellsgate Winter Range Mitigation Project area, a 4,943 acre ranch purchased for mitigating some habitat losses associated with the original construction of Grand Coulee Dam and innundation of habitat by Lake Roosevelt. A Habitat Evaluation Procedure (HEP) study was used to determine habitat quality and quantity baseline data and future projections. Target species used in the study were sharp-tailed grouse (Tympanuchus phasianellus), mule deer (Odocoileus hemoinus), mink (Mustela vison), spotted sandpiper (Actiius colchicus), bobcat (Felis reufs), blue grouse (Dendragapus obscurus), and mourning dove (Zenaida macroura). From field data collected, limiting life values or HSI's (Habitat Suitability Index's) for each indicator species was determined for existing habitats on project lands. From this data a long term management plan was developed. This report is designed to provide guidance for the management of project lands in relation to the habitat cover types discussed and the indicator species used to evaluate these cover types. In addition, the plan discusses management actions, habitat enhancements, and tools that will be used to enhance, protect and restore habitats to desired conditions. Through planned management actions biodiversity and vegetative structure can be optimized over time to reduce or eliminate, limiting HSI values for selected wildlife on project lands.

  9. Establishing Long Term Data Management Research Priorities via a Data Decadal Survey

    Science.gov (United States)

    Wilson, A.; Uhlir, P.; Meyer, C. B.; Robinson, E.

    2013-12-01

    We live in a time of unprecedented collection of and access to scientific data. Improvements in sensor technologies and modeling capabilities are constantly producing new data sources. Data sets are being used for unexpected purposes far from their point of origin, as research spans projects, discipline domains, and temporal and geographic boundaries. The nature of science is evolving, with more open science, open publications, and changes to the nature of peer review and data "publication". Data-intensive, or computational science, has been identified as a new research paradigm. There is recognition that the creation of a data set can be a contribution to science deserving of recognition comparable to other scientific publications. Federally funded projects are generally expected to make their data open and accessible to everyone. In this dynamic environment, scientific progress is ever more dependent on good data management practices and policies. Yet current data management and stewardship practices are insufficient. Data sets created at great, and often public, expense are at risk of being lost for technological or organizational reasons. Insufficient documentation and understanding of data can mean that the data are used incorrectly or not at all. Scientific results are being scrutinized and questioned, and occasionally retracted due to problems in data management. The volume of data is greatly increasing while funding for data management is meager and generally must be found within existing budgets. Many federal government agencies, including NASA, USGS, NOAA and NSF are already making efforts to address data management issues. Executive memos and directives give substantial impetus to those efforts, such as the May 9 Executive Order directing agencies to implement Open Data Policy requirements and regularly report their progress. However, these distributed efforts risk duplicating effort, lack a unifying, long-term strategic vision, and too often work in

  10. On becoming a coach: a pilot intervention study with managers in long-term care.

    Science.gov (United States)

    Cummings, Greta; Mallidou, Anastasia A; Masaoud, Elmabrok; Kumbamu, Ashok; Schalm, Corinne; Spence Laschinger, Heather K; Estabrooks, Carole A

    2014-01-01

    Health care leaders have called for the development of communication and leadership skills to improve manager-employee relationships, employee job satisfaction, quality care, and work environments. The aim of the study reported here was to pilot how a 2-day coaching workshop ("Coaching for Impressive CARE") conducted as a leadership development strategy influenced frontline care managers' coaching practices in residential long-term care (LTC) settings. We had four objectives: (a) to identify managers' perceptions of their role as a coach of employee performance in LTC facilities, (b) to understand managers' intentions to coach employee performance, (c) to examine opportunities and factors that contributed to or challenged implementation of workshop coaching skills in daily leadership/management practice, and (d) to examine managers' reports of using coaching practices and employee responses after the workshop. We used an exploratory/descriptive design involving pre-/post-workshop surveys, e-mail reminders, and focus groups to examine participation of 21 LTC managers in a 2-day coaching workshop and their use of coaching practices in the workplace. Focus group findings provided examples of how participants used their coaching skills in practice (e.g., communicating empathy) and how staff responded. Factors contributing to and challenging implementation of these coaching skills in the workplace were identified. Attitudes and intentions to be a coach increased significantly, and some coaching skills were used more frequently after the workshop, specifically planning for performance change with employees. The coaching workshop was feasible to implement, well received by participants, influenced their willingness to become coaches, and had some noted impact on their use of coaching behaviors in the workplace. Coaching skills by managers to improve staff performance with residents in LTC facilities can be learned.

  11. Management of severe chronic pain with tapentadol prolonged release - long-term data from pain specialists.

    Science.gov (United States)

    Strick, Volker

    2014-10-01

    Clinical trials have documented the efficacy and good tolerability of tapentadol prolonged released (PR) for severe chronic pain. This study investigated routine long-term administration by pain specialists. The effectiveness analysis included prospective data collected over a 3 month period (cohort I, n = 1457, mean age 61.2 ± 13 years) and over a 12 month period (cohort II, n = 588, 60.1 ± 13.2 years) regarding previous and concomitant analgesic treatment, tapentadol dosage, pain intensity, sleep and quality of life parameters, and tolerability. Most patients (>77%) had suffered from severe chronic pain for ≥2 years with low back pain the main pain diagnosis (82%); 91% had already received analgesic long-term treatment prior to initiation of tapentadol therapy (42% of those received strong opioids). After 3 month tapentadol treatment, cohort I had experienced a mean pain reduction of 2.4 points (from 6.8 ± 1.6 at baseline) and improvements of 2.1 points in quality of sleep (from 5.8 ± 2.5) and quality of life (from 6.5 ± 2; all p ≤ 0.001). The 12 month tapentadol treatment (cohort II) reduced the mean pain intensity by 3.2 points from 6.7 ± 1.6 at baseline (NRS-11; p ≤ 0.001); 57% of the patients experienced clinically relevant pain relief of ≥50%. At end of observation, 92% attained either their intended pain reduction and/or an additional individual treatment target, both predefined at start of tapentadol therapy. This was accompanied by a significant reduction in pain-related impairments in daily activities and an improvement in quality of life (all p ≤ 0.001). Most frequent side-effects were nausea (6.3% of patients) and dizziness (3.8%) for cohort I, and nausea (1.5%) and constipation (1.2%) for cohort II. Tapentadol PR is effective and well tolerated and can be considered an alternative to classical strong opioids in long-term chronic pain therapy. The study lacks a control group; assessment under

  12. Mobile phone messaging for facilitating self-management of long-term illnesses.

    Science.gov (United States)

    de Jongh, Thyra; Gurol-Urganci, Ipek; Vodopivec-Jamsek, Vlasta; Car, Josip; Atun, Rifat

    2012-12-12

    Long-term illnesses affect a significant proportion of the population in developed and developing countries. Mobile phone messaging applications, such as Short Message Service (SMS) and Multimedia Message Service (MMS), may present convenient, cost-effective ways of supporting self-management and improving patients' self-efficacy skills through, for instance, medication reminders, therapy adjustments or supportive messages. To assess the effects of mobile phone messaging applications designed to facilitate self-management of long-term illnesses, in terms of impact on health outcomes and patients' capacity to self-manage their condition. Secondary objectives include assessment of: user evaluation of the intervention; health service utilisation and costs; and possible risks and harms associated with the intervention. We searched the Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library 2009, Issue 2), MEDLINE (OvidSP) (January 1993 to June 2009), EMBASE (OvidSP) (January 1993 to June 2009), PsycINFO (OvidSP) (January 1993 to June 2009), CINAHL (EbscoHOST) (January 1993 to June 2009), LILACS (January 1993 to June 2009) and African Health Anthology (January 1993 to June 2009).We also reviewed grey literature (including trial registers) and reference lists of articles. We included randomised controlled trials (RCTs), quasi-randomised controlled trials (QRCTs), controlled before-after (CBA) studies, or interrupted time series (ITS) studies with at least three time points before and after the intervention. We selected only studies where it was possible to assess the effects of mobile phone messaging independent of other technologies or interventions. Two review authors independently assessed all studies against the inclusion criteria, with any disagreements resolved by a third review author. Study design features, characteristics of target populations, interventions and controls, and results data were extracted by two review authors and confirmed by

  13. Jackson bison herd long term management plan and environmental assessment

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Free-ranging bison (Bison bison) were reintroduced to Jackson Hole from the Jackson Hole Wildlife Park in Grand Teton National Park in 1969. By March 1996, the herd...

  14. Dietary self-monitoring and long-term success with weight management.

    Science.gov (United States)

    Peterson, Ninoska D; Middleton, Kathryn R; Nackers, Lisa M; Medina, Kristen E; Milsom, Vanessa A; Perri, Michael G

    2014-09-01

    To examine the contributions of frequency, consistency, and comprehensiveness of dietary self-monitoring to long-term weight change. Participants included 220 obese women (mean ± SD, age = 59.3 ± 6.1 years; BMI = 36.8 ± 4.9 kg/m(2) ) who achieved a mean weight loss of -10.39 ± 5.28% from baseline during 6 months of behavioral treatment and regained 2.30 ± 7.28% during a 12-month extended-care period. The contributions of cumulative frequency of self-monitoring (total number of food records), consistency across time (number of weeks with ≥3 records), and comprehensiveness of information recorded were examined as predictors of weight regain in a hierarchical linear regression analysis. The mediating role of adherence to daily caloric intake goals was tested using a bootstrapping analysis. The association between high total frequency of self-monitoring and reduced weight regain was moderated by weekly consistency of self-monitoring, P = 0.004; increased frequency produced beneficial effects on weight change only when coupled with high consistency (>3 days/week). There was no impact of comprehensiveness on weight change, P > 0.05. The favorable effect of high frequency/high consistency self-monitoring on weight change was partially mediated by participants' success in meeting daily caloric intake goals (P self-monitoring improves long-term success in weight management. © 2014 The Obesity Society.

  15. A long-term perspective on anthropogenic activities and management strategies in a prairie wetland

    Science.gov (United States)

    Hobbs, J. M.; Hobbs, W.; LaFrancois, T.; Edlund, M.; Theissen, K. M.; Zimmer, K.; Hanson, M.

    2012-12-01

    Multiple stressors to shallow lake/wetland ecosystems have the ability to control the relative stability of alternative states (clear, macrophyte-dominated or turbid, algal dominated). As a consequence, the use of remedial biomanipulations to induce trophic cascades and shift a turbid lake to a clear state is often only a temporary solution. Here we show the instability of short-term manipulations in the shallow Lake Christina (a Class V wetland in the prairie ecoregion of western Minnesota, USA) is governed by the long-term state following a regime shift in the lake. During the modern, managed period of the lake, three top-down manipulations (fish kills) were undertaken inducing temporary (5-10 years) unstable clear-water states. Paleoecological remains of diatoms, along with proxies of primary production (total chlorophyll a and total organic carbon accumulation rate) and trophic state (total P) from sediment records clearly show a single regime shift in the lake during the early 1950s; following this shift, the functioning of the lake ecosystem is dominated by a persistent turbid state. We find that multiple stressors contributed to the regime shift. First, the lake began to eutrophy (from agricultural land use and/or increased waterfowl populations), leading to a dramatic increase in primary production. Soon after, the construction of a dam in 1936 effectively doubled the depth of the lake, compounded by increases in regional humidity; this resulted in an increase in planktivorous and benthivorous fish reducing phytoplankton grazers. These factors further conspired to increase the stability of a turbid regime during the modern managed period, such that switches to a clear-water state were inherently unstable and the lake consistently returned to a turbid state. We conclude that while top-down manipulations have had measurable impacts on the lake state, they have not been effective in providing a return to an ecosystem similar to the stable historical period

  16. Transforming long-term care pain management in north america: the policy-clinical interface.

    Science.gov (United States)

    Hadjistavropoulos, Thomas; Marchildon, Gregory P; Fine, Perry G; Herr, Keela; Palley, Howard A; Kaasalainen, Sharon; Béland, François

    2009-04-01

    The undertreatment of pain in older adults who reside in long-term care (LTC) facilities has been well documented, leading to clinical guideline development and professional educational programs designed to foster better pain assessment and management in this population. Despite these efforts, little improvement has occurred, and we postulate that focused attention to public policy and cost implications of systemic change is required to create positive pain-related outcomes. Our goal was to outline feasible and cost-effective clinical and public policy recommendations designed to address the undermanagement of pain in LTC facilities. We arranged a 2-day consensus meeting of prominent United States and Canadian pain and public policy experts. An initial document describing the problem of pain undermanagement in LTC was developed and circulated prior to the meeting. Participants were also asked to respond to a list of relevant questions before arriving. Following formal presentations of a variety of proposals and extensive discussion among clinicians and policy experts, a set of recommendations was developed. We outline key elements of a transformational model of pain management in LTC for the United States and Canada. Consistent with previously formulated clinical guidelines but with attention to readily implementable public policy change in both countries, this transformational model of LTC has important implications for LTC managers and policy makers as well as major quality of life implications for LTC residents.

  17. Individuals' Long Term Use of Cognitive Behavioural Skills to Manage their Depression: A Qualitative Study.

    Science.gov (United States)

    French, Lydia R M; Thomas, Laura; Campbell, John; Kuyken, Willem; Lewis, Glyn; Williams, Chris; Wiles, Nicola J; Turner, Katrina M

    2017-01-01

    Cognitive Behavioural Therapy (CBT) aims to teach people skills to help them self-manage their depression. Trial evidence shows that CBT is an effective treatment for depression and individuals may experience benefits long-term. However, there is little research about individuals' continued use of CBT skills once treatment has finished. To explore whether individuals who had attended at least 12 sessions of CBT continued to use and value the CBT skills they had learnt during therapy. Semi-structured interviews were held with participants from the CoBalT trial who had received CBT, approximately 4 years earlier. Interviews were audio-recorded, transcribed and analysed thematically. 20 participants were interviewed. Analysis of the interviews suggested that individuals who viewed CBT as a learning process, at the time of treatment, recalled and used specific skills to manage their depression once treatment had finished. In contrast, individuals who viewed CBT only as an opportunity to talk about their problems did not appear to utilize any of the CBT skills they had been taught and reported struggling to manage their depression once treatment had ended. Our findings suggest individuals may value and use CBT skills if they engage with CBT as a learning opportunity at the time of treatment. Our findings underline the importance of the educational model in CBT and the need to emphasize this to individuals receiving treatment.

  18. Evaluation of the Management of Severe Trauma Kidney Injury and Long Term Renal Function in Children.

    Science.gov (United States)

    Overs, Camille; Teklali, Youssef; Boillot, Bernard; Poncet, Delphine; Rabattu, Pierre-Yves; Robert, Yohan; Piolat, Christian

    2018-02-17

    To evaluate the management and long term renal function with DMSA scintigraphy in pediatric severe traumatic kidney injury (STKI) grade IV (STKI IV) and V (STKI V) at the trauma center of Grenoble Teaching Hospital. This is a single-center observational retrospective study between 2004 and 2014. All children under the age of 15 managed at the Grenoble teaching Hospital for a STKI IV or V were included. The trauma grade was radiologically diagnosed on arrival at hospital, using the classification of the American Association for Surgery of Trauma. The management followed the algorithm in effect in the establishment. The assessment of the renal function was performed by a DMSA scintigraphy after at least 6 months from the injury. 21 children were managed for a STKI (16 STKI IV and 5 STKI V). The diagnosis was initially made by an ultrasonography (8 cases) or a CT-scan (13 cases). A child with STKI IV underwent a nephrectomy on day 6 of the trauma. Eleven children needed a therapeutic procedure (3 embolizations, 4 double J stents, 1 arterial stent, 1 peritoneal lavage for a splenic hemoperitoneum, 4 pleural drainages). A DMSA scintigraphy was performed in 15 patients to assess the function of the injured kidney: 11/16 STKI IV with an average of 39.4%, and 17% for the 4/5 STKI V analyzed. among the 21 children managed for a STKI IV or V, 11 required a therapeutic procedure, one of them a nephrectomy. The DMSA scintigraphy performed after at least 6 months from the trauma, found an injured renal function at 39.4% for the 11/16 SKI IV analyzed, and 17% for the 4/5 SKI V analyzed, which confirms the currently conservative management. IV TYPE OF STUDY: original article, retrospective observational study.

  19. Implementing a balanced scorecard as a strategic management tool in a long-term care organization.

    Science.gov (United States)

    Schalm, Corinne

    2008-01-01

    The Capital Care Group, the largest public sector continuing care organization in Canada, had no ready access to information on its own performance and therefore was limited in its pursuit of evidence-informed decision-making. To remedy this, it was decided to introduce a balanced scorecard. A literature review was conducted together with interviews with 10 other health care organizations which had implemented balanced scorecards. With this information, a workshop was held that resulted in a framework and about 120 potential indicators. Subsequently the number of indicators was reduced to 29, using pre-determined criteria. Development of a corporate balanced scorecard facilitated executive strategic thinking and clarified the organization's strategic direction. In parallel, scorecards were developed at the level of care centres. These had a common core of indicators, plus some site-specific ones. Development of the corporate scorecard took three years and an additional six months for the care centre scorecards. A formal implementation plan has been accepted by the executive team. Key to this is communicating to staff the role of scorecards for strategic management and not just performance measurement. Traditional thinking needs to change from a short-term operational focus to long-term strategy. In addition, champions need to be identified in each care centre and they need to be networked together. Finally, the scorecard is being integrated into existing operational management as a routine component together with resources to support its use. The balanced scorecard has focused on its role as a strategic management tool. The indicators and dimensions need to be customized to the organization. Senior management must be seen to be driving its introduction. It is worth spending sufficient time developing and implementing a scorecard rather than trying to rush its introduction. The scorecard needs to be integrated with existing management processes and sufficient

  20. Hypertension management in the oldest old: Findings from a large long-term care facility.

    Science.gov (United States)

    Schwinn, Susan; McKay, Robin; Dinkel, Shirley; Mansfield, Bobbe; Da Cunha, Brooke Faria; Cummins, Savanna; Brunin, Krystal

    2017-03-01

    The purpose of this quality improvement project was to evaluate hypertension (HTN) management in patients 80 years of age and older who reside in a large, long-term care (LTC) facility. A retrospective chart audit was conducted on 75 charts of patients 80 years of age and older and who had a diagnosis of HTN. Using the 2011 American College of Cardiology Foundation/American Heart Association (ACCF/AHA) Expert Consensus Document on Management of Hypertension in the Elderly as a guide, blood pressure readings, significant comorbidities, and antihypertensive medication utilization were analyzed. LTC residents in this sample were often not treated according to expert recommendations. Specifically, analysis revealed overtreatment of uncomplicated HTN and undertreatment of those with comorbid conditions. Additionally, those with diabetes mellitus and chronic kidney disease were infrequently prescribed ace inhibitors/angiotensin receptor blockers, as recommended. Utilizing evidence-based practice (EBP) guidelines affords the best avenue for providing safe and effective treatment of HTN. While expert recommendations are available, researchers seldom recruit frail elders in LTC facilities into treatment investigations. In the absence of population-specific EBP guidelines, nurse practitioners must rely on expert opinion and diagnostic reasoning to individualize HTN treatment to this unique and vulnerable population. ©2016 American Association of Nurse Practitioners.

  1. The impact of worker health on long term care: implications for nursing managers.

    Science.gov (United States)

    Letvak, Susan; Ruhm, Christopher J

    2010-01-01

    Long-term care (LTC) facilities face many challenges, including retention of qualified and caring staff and maintaining high-quality care. In 2008, the Institute of Medicine (IOM)(1) reported widespread consensus that there are insufficient numbers of competent licensed and direct care staff to manage, supervise, and deliver high-quality care to the elderly population. Although examples of excellence in nursing home care exist, average quality of care has remained persistently low,(2) and little progress has been made to improve safety in LTC.(3) The Nursing Home Reform Act (which was included in the 1987 Omnibus Budget Reconciliation Act) mandates minimum staffing levels in Medicare and Medicaid certified LTC facilities. Although research has documented the importance of adequate staffing for quality of care, little attention has been placed on the productivity of staff and how this may impact care. The purpose of this article is to discuss the issue of worker presenteeism (reduced productivity due to health problems) and how this may be affecting quality of resident care. Strategies for nurse managers to recognize and address presenteeism are also discussed. Copyright (c) 2010 Mosby, Inc. All rights reserved.

  2. Enhancing patient-provider communication for long-term post-stroke spasticity management.

    Science.gov (United States)

    Sunnerhagen, K S; Francisco, G E

    2013-11-01

    Stroke is a major public health concern, with estimated 16 million people worldwide experiencing first-time strokes each year, a number that is expected to rise. Two-thirds of those experiencing a stroke are younger than 70 years of age. Stroke is a leading cause of disability in adults as a result of major sequelae that include spasticity, cognitive impairment, paresis, and depression. Disabling spasticity, defined as spasticity severe enough to require intervention, occurs in 4% of stroke survivors within 1 year of first-time stroke. The aim of this report is to focus instead on a discussion of patient-provider communication, and its role in post-stroke spasticity (PSS) rehabilitation within the context of patient-centered health care. A discussion based on a review of the literature, mainly since 2000. Problems within communication are identified and suggestion to enhance communication are proposed thus improving patient-centered goal setting/goal achievement for the effective management of spasticity rehabilitation. These are as follows: (i) involving family members, (ii) educating patients and family members on stroke and rehabilitation, and (iii) establishing a common definition for long-term goals. Increased communication among physicians, patients, and payers may bridge some of the gaps and increase the effectiveness of PSS rehabilitation and management. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Integrated, long term, sustainable, cost effective biosolids management at a large Canadian wastewater treatment facility

    Energy Technology Data Exchange (ETDEWEB)

    LeBlance, R.J.; Allain, C.J.; Laughton, P.J.; Henry, J.G.

    2003-07-01

    The Greater Moncton Sewerage Commission's 115 000 m{sup 3}/d advanced, chemically assisted primary wastewater treatment facility located in New Brunswick, Canada, has developed an integrated, long term, sustainable, cost effective programme for the management and beneficial utilization of biosolids from lime stabilized raw sludge. The paper overviews biosolids production, lime stabilization, conveyance, and odour control followed by an indepth discussion of the wastewater sludge as a resource programme, namely: composting, mine site reclamation, landfill cover, land application for agricultural use, tree farming, sod farm base as a soil enrichment, topsoil manufacturing. The paper also addresses the issues of metals, pathogens, organic compounds, the quality control program along with the regulatory requirements. Biosolids capital and operating costs are presented. Research results on removal of metals from primary sludge using a unique biological process known as BIOSOL as developed by the University of Toronto, Canada to remove metals and destroy pathogens are presented. The paper also discusses an ongoing cooperative research project with the Universite de Moncton where various mixtures of plant biosolids are composted with low quality soil. Integration, approach to sustainability and ''cumulative effects'' as part of the overall biosolids management strategy is also discussed. (author)

  4. Eurosafe 2006 radioactive waste management: long term safety requirements and societal expectations

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2006-07-01

    The EUROSAFE Forum is part of the EUROSAFE approach, which consists of two further elements: the EUROSAFE Tribune and the EUROSAFE web site. The general aim of EUROSAFE is to contribute to fostering the convergence of technical nuclear safety practices in a broad European context. This is done by providing technical safety and research organisations, safety authorities, power utilities, the rest of the industry and non-governmental organisations mainly from the European Union and East-European countries, and international organisations with a platform for the presentation of recent analyses and R and D in the field of nuclear safety, to share experiences, exchange technical and scientific opinions, and conduct debates on key issues in the fields of nuclear safety and radiation protection. The EUROSAFE Forum 2006 focuses on 'Radioactive Waste Management: Long Term Safety Requirements and Societal Expectations' from the point of view of the authorities, TSOs and industry and presents the latest work in nuclear installation safety and research, waste management, radiation safety as well as nuclear material and nuclear facilities security carried out by GRS, IRSN, AVN and their partners in the European Union, Switzerland and Eastern Europe. A high level of nuclear safety is a priority for Europe. The technical safety organisations play an important role in contributing to that objective through appropriate approaches to major safety issues as part of their assessments and research activities. The challenges to nuclear safety are international. Changes in underlying technologies such as instrumentation and control, the impact of electricity market deregulation, demands for improved safety and safety management, the ageing of nuclear facilities, waste management, maintaining and improving scientific and technical knowledge, and the need for greater transparency - these are all issues where the value of an international approach is gaining increasing recognition

  5. Long-term variability and environmental control of the carbon cycle in an oak-dominated temperate forest

    Science.gov (United States)

    Jing Xie; Jiquan Chen; Ge Sun; Housen Chu; Asko Noormets; Zutao Ouyang; Ranjeet John; Shiqiang Wan; Wenbin Guan

    2014-01-01

    Our understanding of the long-term carbon (C) cycle of temperate deciduous forests and its sensitivity to climate variability is limited due to the large temporal dynamics of C fluxes. The goal of the study was to quantify the effects of environmental variables on the C balance in a 70-year-old mixed-oak woodland forest over a 7-year period in northwest Ohio, USA. The...

  6. Impact of coastal management practice on long-term foredune behaviour

    Science.gov (United States)

    Wijnberg, Kathelijne M.; Bochev-van der Burgh, Lisette M.

    2010-05-01

    Coastal dunes located in densely populated areas provide various services to man, such as protection against flooding during storm surges, recreation, and nature conservation. As a result, man will interfere with the natural dynamics of coastal dunes if these negatively affect these functions. For example, local storm erosion of the foredune will reduce the safety level of dunes as flooding defence, or the resulting steep dune front can be perceived as a public safety issue (collapse). Usually, the applied management interventions aim at restoring the pre-storm situation. As such they result in an increased recovery rate from an erosional event as compared to post-storm recovery rates occurring without human intervention. The above raises the question whether the usually localized and intermittent human interventions will actually interfere with the long term evolution of the foredune area. And if so, whether these short term management interventions can turn out to be detrimental to the persistence of these functions in the long run. Especially for the flooding defence functionality this is of importance, as we can expect natural drivers of coastal behaviour, such as storm climatology and mean sea level stand, to change over the next century. To increase insight in the above issues we performed a case study on the behaviour of managed foredunes along the Holland coast (The Netherlands). Information on the morphologic behaviour was extracted by EOF-analysis from a 40 year data set (1965-2004) of annual, high-resolution elevation surveys of the subaerial part of coastal profile along about 90 km of coastline. Information on the applied dune management during this period was retrieved from documents as well as from interviews with coastal managers with long-term involvement in the actual dune maintenance practice in the studied area. It appeared that during the studied period the coastal management policy changed from being essentially reactive in nature to being pro

  7. Social Environmental Moderators of Long-term Functional Outcomes of Early Childhood Brain Injury.

    Science.gov (United States)

    Wade, Shari L; Zhang, Nanhua; Yeates, Keith Owen; Stancin, Terry; Taylor, H Gerry

    2016-04-01

    Pediatric traumatic brain injury (TBI) contributes to impairments in behavior and academic performance. However, the long-term effects of early childhood TBI on functioning across settings remain poorly understood. To examine the long-term functional outcomes of early childhood TBI relative to early childhood orthopedic injuries (OIs). We also examine the moderating role of the social environment as defined by parent report and observational measures of family functioning, parenting practices, and home environment. A prospective, longitudinal, observational cohort study conducted at each child's home, school, and hospital, including 3 children's hospitals and 1 general hospital in the Midwest. Patients were enrolled in the initial study between January 2003 and October 2006. Follow-ups were completed between January 2010 and April 2015. Fifty-eight children who sustained a TBI (67% of original enrolled cohort) and 72 children who sustained an OI (61% of the original enrolled cohort) were prospectively followed up from shortly after injury (between the ages of 3 and 7 years at enrollment) to an average of 6.7 years after injury, with assessments occurring at multiple points. Long-term functional outcomes in everyday settings, as assessed through the Child and Adolescent Functional Assessment Scale (CAFAS). Of the 130 children included, the median age for those with OIs was 11.72 years and 11.97, 12.21, and 11.72 years for those with complicated mild, moderate, and severe TBIs, respectively. Children with moderate and severe TBI were rated as having more functional impairments in multiple domains than those with OIs (P Children with complicated mild TBI had greater impairments in school (odds ratio = 2.93; 95% CI = 1.10-7.82) and with thinking (odds ratio = 15.72; 95% CI = 3.31-74.73) than those with OIs. Functional impairments in children with TBI were more pronounced among children from families with higher levels of permissive (mean CAFAS of 49.71, 35.74, 58

  8. Management of Charcot–Marie–Tooth disease: improving long-term care with a multidisciplinary approach

    Directory of Open Access Journals (Sweden)

    McCorquodale D

    2016-01-01

    Full Text Available Donald McCorquodale, Evan M Pucillo, Nicholas E Johnson Department of Neurology, Eccles Institute of Human Genetics, University of Utah, Salt Lake City, UT, USA Abstract: Charcot–Marie–Tooth (CMT disease is the most common inherited neuropathy and one of the most common inherited diseases in humans. The diagnosis of CMT is traditionally made by the neurologic specialist, yet the optimal management of CMT patients includes genetic counselors, physical and occupational therapists, physiatrists, orthotists, mental health providers, and community resources. Rapidly developing genetic discoveries and novel gene discovery techniques continue to add a growing number of genetic subtypes of CMT. The first large clinical natural history and therapeutic trials have added to our knowledge of each CMT subtype and revealed how CMT impacts patient quality of life. In this review, we discuss several important trends in CMT research factors that will require a collaborative multidisciplinary approach. These include the development of large multicenter patient registries, standardized clinical instruments to assess disease progression and disability, and increasing recognition and use of patient-reported outcome measures. These developments will continue to guide strategies in long-term multidisciplinary efforts to maintain quality of life and preserve functionality in CMT patients. Keywords: rehabilitation, genetic diagnosis, patient quality of life, inherited neuropathies, hereditary motor and sensory neuropathies, longitudinal care 

  9. Long-Term Metal Retention Performance of Media Filter Drains for Stormwater Management

    Directory of Open Access Journals (Sweden)

    Agathe Thomas

    2015-03-01

    Full Text Available Stormwater runoff, a substantial source of nonpoint pollution, can be treated using Best Management Practices (BMPs, such as the Media Filter Drain (MFD. An MFD is a trench filled with an engineered media mix, usually with a grass overlay, that receives runoff from the paved roadway next to it. The MFD was shown to remove dissolved metals (zinc and copper, typical pollutants from vehicles and urban areas, which might negatively impact aquatic species in receiving waters, but its long-term effectiveness was not known. Existing media filter mixes of different ages were collected from two different sites in the Pacific Northwest of the United States. Columns made with these media mixes received concentrated copper and zinc loading to simulate accelerated aging for estimated total lifespans from 14 to 22 years of copper and zinc loading, with little or no decrease in sorption. Throughout the aging process, some columns were subjected to performance testing with higher levels of typical runoff concentrations and average concentration decreases from influent to effluent were found to be greater than 90% for both copper and zinc. Based on this study, the MFD’s lifespan for zinc and copper treatment is significantly greater than the initial ten-year estimate.

  10. Acute hepatic porphyrias: Recommendations for evaluation and long-term management.

    Science.gov (United States)

    Balwani, Manisha; Wang, Bruce; Anderson, Karl E; Bloomer, Joseph R; Bissell, D Montgomery; Bonkovsky, Herbert L; Phillips, John D; Desnick, Robert J

    2017-10-01

    The acute hepatic porphyrias are a group of four inherited disorders, each resulting from a deficiency in the activity of a specific enzyme in the heme biosynthetic pathway. These disorders present clinically with acute neurovisceral symptoms which may be sporadic or recurrent and, when severe, can be life-threatening. The diagnosis is often missed or delayed as the clinical features resemble other more common medical conditions. There are four major subgroups: symptomatic patients with sporadic attacks (Porphyrias Consortium of the National Institutes of Health's Rare Diseases Clinical Research Network, which consists of expert centers in the clinical management of these disorders, has formulated these recommendations. These recommendations are based on the literature, ongoing natural history studies, and extensive clinical experience. Initial assessments should include diagnostic confirmation by biochemical testing, subsequent genetic testing to determine the specific acute hepatic porphyria, and a complete medical history and physical examination. Newly diagnosed patients should be counseled about avoiding known precipitating factors. The frequency of follow-up depends on the clinical subgroup, with close monitoring of patients with recurrent attacks who may require treatment modifications as well as those with clinical complications. Comprehensive care should include subspecialist referrals when needed. Annual assessments include biochemical testing and monitoring for long-term complications. These guidelines provide a framework for monitoring patients with acute hepatic porphyrias to ensure optimal outcomes. (Hepatology 2017;66:1314-1322). © 2017 by the American Association for the Study of Liver Diseases.

  11. Integrating Long-Term Avian Studies with Planning and Adaptive Management: Department of Energy Lands as a Case Study.

    Energy Technology Data Exchange (ETDEWEB)

    Burger, J.

    2000-10-01

    Long-term bio-monitoring of avian communities have been initiated, but they often lack a management component. Integration of the managers needs at an early stage is suggested as a means to increase the use of the data. Variation in community structure is important in understanding impacts. In addition, reference site must be carefully selected.

  12. Are we missing the boat? Current uses of long-term biological monitoring data in the evaluation and management of marine protected areas.

    Science.gov (United States)

    Addison, P F E; Flander, L B; Cook, C N

    2015-02-01

    Protected area management agencies are increasingly using management effectiveness evaluation (MEE) to better understand, learn from and improve conservation efforts around the globe. Outcome assessment is the final stage of MEE, where conservation outcomes are measured to determine whether management objectives are being achieved. When quantitative monitoring data are available, best-practice examples of outcome assessments demonstrate that data should be assessed against quantitative condition categories. Such assessments enable more transparent and repeatable integration of monitoring data into MEE, which can promote evidence-based management and improve public accountability and reporting. We interviewed key informants from marine protected area (MPA) management agencies to investigate how scientific data sources, especially long-term biological monitoring data, are currently informing conservation management. Our study revealed that even when long-term monitoring results are available, management agencies are not using them for quantitative condition assessment in MEE. Instead, many agencies conduct qualitative condition assessments, where monitoring results are interpreted using expert judgment only. Whilst we found substantial evidence for the use of long-term monitoring data in the evidence-based management of MPAs, MEE is rarely the sole mechanism that facilitates the knowledge transfer of scientific evidence to management action. This suggests that the first goal of MEE (to enable environmental accountability and reporting) is being achieved, but the second and arguably more important goal of facilitating evidence-based management is not. Given that many MEE approaches are in their infancy, recommendations are made to assist management agencies realize the full potential of long-term quantitative monitoring data for protected area evaluation and evidence-based management. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Analysing long-term changes of everyday life in an environmental perspective

    DEFF Research Database (Denmark)

    Røpke, Inge

    2004-01-01

    time of 35 years. In spite of technologically induced reductions in the average environmental impact of each monetary unit spent on consumption, it is hard to keep up with the quantitative increase and, in particular, to cope with accumulated problems like the greenhouse effect and to make room...... for increasing consumption in developing countries. This problem of ever increasing quantities of consumption ought to be placed high on the sustainable development agenda, and it calls for research on the dynamics behind the growth to improve the possibilities for curbing it. A real challenge in relation...... to this issue is that the increases in consumption are imperceptible and that most people in the industrialized countries are preoccupied with managing their everyday lives and do not experience that they live in any kind of extreme luxury. Some years ago I wrote a paper dealing with this issue in general terms...

  14. Management of acute sigmoid volvulus: short- and long-term results.

    Science.gov (United States)

    Bruzzi, M; Lefèvre, J H; Desaint, B; Nion-Larmurier, I; Bennis, M; Chafai, N; Tiret, E; Parc, Y

    2015-10-01

    The best form of prophylactic management of a decompressed sigmoid volvulus (SV) is controversial especially in the elderly. We have studied our experience with this condition to assess the short- and long-term results of SV management. All patients treated for SV in our department between 2003 and 2013 were retrospectively included. Emergency decompression was attempted in all patients in whom there was no sign of peritonitis. Planned surgical resection was the procedure of choice in young patients. Percutaneous endoscopic colopexy (PEC) was used in high surgical risk patients. There were 65 patients (45 males) of median age 71.5 (24-99) years. Non-surgical reduction was performed in 62 with a success rate of 95% (59/62). Recurrence after initial decompression was 67% at a median follow-up of 5 (1-14) years. A prophylactic surgical resection was performed with primary anastomosis in 33 patients. There were no deaths and the major morbidity rate was 6%. At a mean follow-up of 62 months, only 1 (3%) patient had had a recurrence (at 130 months). PEC was performed in six patients of median age 90 (84-99) years and with a median American Society of Anesthesiologists score of 4. Complications included local site infection (n = 2), pain (n = 1) and abdominal wall bleeding (n = 1). After a median follow-up of 2 (1-4) years, three patients died from medical causes and one recurrence occurred 13 months after removal of the PEC tube. Prophylactic treatment after initial decompression of SV results in a low rate of recurrence. Planned sigmoid resection is safe and effective. In frail elderly patients, PEC is satisfactory. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

  15. Long-term population dynamics of a managed burrowing owl colony

    Science.gov (United States)

    Barclay, John H.; Korfanta, Nicole M.; Kauffman, Matthew J.

    2011-01-01

    We analyzed the population dynamics of a burrowing owl (Athene cunicularia) colony at Mineta San Jose International Airport in San Jose, California, USA from 1990-2007. This colony was managed by using artificial burrows to reduce the occurrence of nesting owls along runways and within major airport improvement projects during the study period. We estimated annual reproduction in natural and artificial burrows and age-specific survival rates with mark-recapture techniques, and we estimated the relative contribution of these vital rates to population dynamics using a life table response experiment. The breeding colony showed 2 distinct periods of change: high population growth from 7 nesting pairs in 1991 to 40 pairs in 2002 and population decline to 17 pairs in 2007. Reproduction was highly variable: annual nesting success (pairs that raised =1 young) averaged 79% and ranged from 36% to 100%, whereas fecundity averaged 3.36 juveniles/pair and ranged from 1.43 juveniles/pair to 4.54 juveniles/pair. We estimated annual adult survival at 0.710 during the period of colony increase from 1996 to 2001 and 0.465 during decline from 2002 to 2007, but there was no change in annual survival of juveniles between the 2 time periods. Long-term population growth rate (lambda) estimated from average vital rates was lambdaa=1.072 with lambdai=1.288 during colony increase and lambdad=0.921 (DELTA lambda=0.368) during decline. A life table response experiment showed that change in adult survival rate during increasing and declining phases explained more than twice the variation in growth rate than other vital rates. Our findings suggest that management and conservation of declining burrowing owl populations should address factors that influence adult survival.

  16. The Earth Education Program Sunship™ Earth: A Mixed Methods Study of the Long-Term Influence on Environmental Attitudes and Actions

    Science.gov (United States)

    Bires, Nancy K.

    2013-01-01

    There have been a limited number of studies on the short-term influence of environmental and earth education programs, however, not much information is available about the long-term influence of these programs on participants' environmental attitudes and actions. This mixed methods study explores the long-term influence of the earth education…

  17. Current Status of the United Kingdom Programme for Long-Term Radioactive Waste Management

    Energy Technology Data Exchange (ETDEWEB)

    Murray, C. H.; Hooper, A. J.; Mathieson, J.

    2002-02-27

    In 1997, the UK programme for the deep disposal of radioactive waste was ''stopped dead in its tracks'' with the refusal by the Secretary of State for the Environment to allow Nirex to go ahead with its plans for an underground Rock Characterisation Facility at Sellafield in north-west England. Since that time a House of Lords' Select Committee has held an inquiry into what went wrong and what the way ahead should be. In addition, Nirex and the nuclear industry players have also been analyzing the past with a view to learning from the experience in taking things forward. In Nirex's view this is essentially an ethical issue; the waste exists and we should deal with it in this generation. Three areas need to be better addressed if a successful program of management of the nation's radioactive waste is to be achieved: the process of how policy development and implementation can be achieved; the structure of the nuclear industry and its relationship to the waste management organization; and the behavior of the players in their interaction with stakeholders. All three are underpinned by the need for transparency. In recognition that developing a policy for managing radioactive waste has to be achieved with the support of all stakeholders, the Government instigated a consultation exercise in September 2001. The initial phase of this initiative is essentially a consultation about consultation and is intended to decide on how the next stages of a six year policy development program should be addressed. In addition to this exercise, the Government is undertaking a fundamental review of the structuring of the United Kingdom Atomic Energy Authority (UKAEA) and British Nuclear Fuels plc (BNFL). They are both shareholders in Nirex and in November 2001 the Government announced the setting up of a Liabilities Management Authority (LMA) to manage the long-term nuclear liabilities that are publicly owned, particularly through those organizations

  18. Biogeochemical Cycling and Environmental Stability of Pu Relevant to Long-Term Stewardship of DOE Sites

    Energy Technology Data Exchange (ETDEWEB)

    Francis, Arokiasamy J.; Santschi, Peter H.; Honeyman, Bruce D.

    2005-06-01

    The overall objective of this proposed research is to understand the biogeochemical cycling of Pu in environments of interest to long-term DOE stewardship issues. Central to Pu cycling (transport initiation to immobilization) is the role of microorganisms. The hypothesis underlying this proposal is that microbial activity is the causative agent in initiating the mobilization of Pu in near-surface environments: through the transformation of Pu associated with solid phases, production of extracellular polymeric substances (EPS) carrier phases, and the creation of microenvironments. Also, microbial processes are central to the immobilization of Pu species, through the metabolism of organically complexed Pu species and Pu associated with extracellular carrier phases and the creation of environments favorable for Pu transport retardation.

  19. Biogeochemical Cycling and Environmental Stability of Pu Relevant to Long-Term Stewardship of DOE Sites

    Energy Technology Data Exchange (ETDEWEB)

    Honeyman, Bruce D.; Francis, A.J.; Gillow, Jeffrey B.; Dodge, Cleveland J.; Santschi, Peter H.; Chin-Chang Hung; Diaz, Angelique; Tinnacher, Ruth; Roberts, Kimberly; Schwehr, Kathy

    2006-04-05

    The overall objective of this research is to understand the biogeochemical cycling of Pu in environments of interest to long-term DOE stewardship issues. Central to Pu cycling (transport initiation and immobilization) is the role of microorganisms. The hypothesis underlying this work is that microbial activity is the causative agent in initiating the mobilization of Pu in near-surface environments: through the transformation of Pu associated with solid phases, production of extracellular polymeric substances (EPS) carrier phases and the creation of microenvironments. Also, microbial processes are central to the immobilization of Pu species, through the metabolism of organically complexed Pu species and Pu associated with extracellular carrier phases and the creation of environments favorable for Pu transport retardation.

  20. Automated telephone communication systems for preventive healthcare and management of long-term conditions.

    Science.gov (United States)

    Posadzki, Pawel; Mastellos, Nikolaos; Ryan, Rebecca; Gunn, Laura H; Felix, Lambert M; Pappas, Yannis; Gagnon, Marie-Pierre; Julious, Steven A; Xiang, Liming; Oldenburg, Brian; Car, Josip

    2016-12-14

    Automated telephone communication systems (ATCS) can deliver voice messages and collect health-related information from patients using either their telephone's touch-tone keypad or voice recognition software. ATCS can supplement or replace telephone contact between health professionals and patients. There are four different types of ATCS: unidirectional (one-way, non-interactive voice communication), interactive voice response (IVR) systems, ATCS with additional functions such as access to an expert to request advice (ATCS Plus) and multimodal ATCS, where the calls are delivered as part of a multicomponent intervention. To assess the effects of ATCS for preventing disease and managing long-term conditions on behavioural change, clinical, process, cognitive, patient-centred and adverse outcomes. We searched 10 electronic databases (the Cochrane Central Register of Controlled Trials; MEDLINE; Embase; PsycINFO; CINAHL; Global Health; WHOLIS; LILACS; Web of Science; and ASSIA); three grey literature sources (Dissertation Abstracts, Index to Theses, Australasian Digital Theses); and two trial registries (www.controlled-trials.com; www.clinicaltrials.gov) for papers published between 1980 and June 2015. Randomised, cluster- and quasi-randomised trials, interrupted time series and controlled before-and-after studies comparing ATCS interventions, with any control or another ATCS type were eligible for inclusion. Studies in all settings, for all consumers/carers, in any preventive healthcare or long term condition management role were eligible. We used standard Cochrane methods to select and extract data and to appraise eligible studies. We included 132 trials (N = 4,669,689). Studies spanned across several clinical areas, assessing many comparisons based on evaluation of different ATCS types and variable comparison groups. Forty-one studies evaluated ATCS for delivering preventive healthcare, 84 for managing long-term conditions, and seven studies for appointment reminders

  1. Depleted Uranium Hexafluoride Management Program. The technology assessment report for the long-term management of depleted uranium hexafluoride. Volume 2

    Energy Technology Data Exchange (ETDEWEB)

    Zoller, J.N.; Rosen, R.S.; Holliday, M.A. [and others

    1995-06-30

    With the publication of a Request for Recommendations and Advance Notice of Intent in the November 10, 1994 Federal Register, the Department of Energy initiated a program to assess alternative strategies for the long-term management or use of depleted uranium hexafluoride. This Request was made to help ensure that, by seeking as many recommendations as possible, Department management considers reasonable options in the long-range management strategy. The Depleted Uranium Hexafluoride Management Program consists of three major program elements: Engineering Analysis, Cost Analysis, and an Environmental Impact Statement. This Technology Assessment Report is the first part of the Engineering Analysis Project, and assesses recommendations from interested persons, industry, and Government agencies for potential uses for the depleted uranium hexafluoride stored at the gaseous diffusion plants in Paducah, Kentucky, and Portsmouth, Ohio, and at the Oak Ridge Reservation in Tennessee. Technologies that could facilitate the long-term management of this material are also assessed. The purpose of the Technology Assessment Report is to present the results of the evaluation of these recommendations. Department management will decide which recommendations will receive further study and evaluation.

  2. Depleted Uranium Hexafluoride Management Program. The technology assessment report for the long-term management of depleted uranium hexafluoride. Volume 1

    Energy Technology Data Exchange (ETDEWEB)

    Zoller, J.N.; Rosen, R.S.; Holliday, M.A. [and others

    1995-06-30

    With the publication of a Request for Recommendations and Advance Notice of Intent in the November 10, 1994 Federal Register, the Department of Energy initiated a program to assess alternative strategies for the long-term management or use of depleted uranium hexafluoride. This Request was made to help ensure that, by seeking as many recommendations as possible, Department management considers reasonable options in the long-range management strategy. The Depleted Uranium Hexafluoride Management Program consists of three major program elements: Engineering Analysis, Cost Analysis, and an Environmental Impact Statement. This Technology Assessment Report is the first part of the Engineering Analysis Project, and assesses recommendations from interested persons, industry, and Government agencies for potential uses for the depleted uranium hexafluoride stored at the gaseous diffusion plants in Paducah, Kentucky, and Portsmouth, Ohio, and at the Oak Ridge Reservation in Tennessee. Technologies that could facilitate the long-term management of this material are also assessed. The purpose of the Technology Assessment Report is to present the results of the evaluation of these recommendations. Department management will decide which recommendations will receive further study and evaluation. These Appendices contain the Federal Register Notice, comments on evaluation factors, independent technical reviewers resumes, independent technical reviewers manual, and technology information packages.

  3. Importance of considering riparian vegetation requirements for the long-term efficiency of environmental flows in aquatic microhabitats

    Science.gov (United States)

    Rivaes, Rui; Boavida, Isabel; Santos, José M.; Pinheiro, António N.; Ferreira, Teresa

    2017-11-01

    Environmental flows remain biased toward the traditional biological group of fish species. Consequently, these flows ignore the inter-annual flow variability that rules species with longer lifecycles and therefore disregard the long-term perspective of the riverine ecosystem. We analyzed the importance of considering riparian requirements for the long-term efficiency of environmental flows. For that analysis, we modeled the riparian vegetation development for a decade facing different environmental flows in two case studies. Next, we assessed the corresponding fish habitat availability of three common fish species in each of the resulting riparian landscape scenarios. Modeling results demonstrated that the environmental flows disregarding riparian vegetation requirements promoted riparian degradation, particularly vegetation encroachment. Such circumstance altered the hydraulic characteristics of the river channel where flow depths and velocities underwent local changes of up to 10 cm and 40 cm s-1, respectively. Accordingly, after a decade of this flow regime, the available habitat area for the considered fish species experienced modifications of up to 110 % when compared to the natural habitat. In turn, environmental flows regarding riparian vegetation requirements were able to maintain riparian vegetation near natural standards, thereby preserving the hydraulic characteristics of the river channel and sustaining the fish habitat close to the natural condition. As a result, fish habitat availability never changed more than 17 % from the natural habitat.

  4. Importance of considering riparian vegetation requirements for the long-term efficiency of environmental flows in aquatic microhabitats

    Directory of Open Access Journals (Sweden)

    R. Rivaes

    2017-11-01

    Full Text Available Environmental flows remain biased toward the traditional biological group of fish species. Consequently, these flows ignore the inter-annual flow variability that rules species with longer lifecycles and therefore disregard the long-term perspective of the riverine ecosystem. We analyzed the importance of considering riparian requirements for the long-term efficiency of environmental flows. For that analysis, we modeled the riparian vegetation development for a decade facing different environmental flows in two case studies. Next, we assessed the corresponding fish habitat availability of three common fish species in each of the resulting riparian landscape scenarios. Modeling results demonstrated that the environmental flows disregarding riparian vegetation requirements promoted riparian degradation, particularly vegetation encroachment. Such circumstance altered the hydraulic characteristics of the river channel where flow depths and velocities underwent local changes of up to 10 cm and 40 cm s−1, respectively. Accordingly, after a decade of this flow regime, the available habitat area for the considered fish species experienced modifications of up to 110 % when compared to the natural habitat. In turn, environmental flows regarding riparian vegetation requirements were able to maintain riparian vegetation near natural standards, thereby preserving the hydraulic characteristics of the river channel and sustaining the fish habitat close to the natural condition. As a result, fish habitat availability never changed more than 17 % from the natural habitat.

  5. Minimizing the regrets of long-term urban floodplain management decisions under deeply uncertain climate change

    Science.gov (United States)

    Hecht, J. S.; Kirshen, P. H.; Vogel, R. M.

    2016-12-01

    Making long-term floodplain management decisions under uncertain climate change is a major urban planning challenge of the 21stcentury. To support these efforts, we introduce a screening-level optimization model that identifies adaptation portfolios by minimizing the regrets associated with their flood-control and damage costs under different climate change trajectories that are deeply uncertain, i.e. have probabilities that cannot be specified plausibly. This mixed integer program explicitly considers the coupled damage-reduction impacts of different floodwall designs and property-scale investments (first-floor elevation, wet floodproofing of basements, permanent retreat and insurance), recommends implementation schedules, and assesses impacts to stakeholders residing in three types of homes. An application to a stylized municipality illuminates many nonlinear system dynamics stemming from large fixed capital costs, infrastructure design thresholds, and discharge-depth-damage relationships. If stakeholders tolerate mild damage, floodwalls that fully protect a community from large design events are less cost-effective than portfolios featuring both smaller floodwalls and property-scale measures. Potential losses of property tax revenue from permanent retreat motivate municipal property-tax initiatives for adaptation financing. Yet, insurance incentives for first-floor elevation may discourage locally financed floodwalls, in turn making lower-income residents more vulnerable to severe flooding. A budget constraint analysis underscores the benefits of flexible floodwall designs with low incremental expansion costs while near-optimal solutions demonstrate the scheduling flexibility of many property-scale measures. Finally, an equity analysis shows the importance of evaluating the overpayment and under-design regrets of recommended adaptation portfolios for each stakeholder and contrasts them to single-scenario model results.

  6. Assessment of a novel alder biorefinery concept to meet demands of economic feasibility, energy production and long term environmental sustainability

    DEFF Research Database (Denmark)

    Thomsen, Tobias; Ahrenfeldt, Jesper; Thomsen, Sune Tjalfe

    2013-01-01

    A biorefinery concept based on alder tree plantations on degenerated soil is developed to comply with indicators of economic feasibility, fossil fuel depletion concerns, and long term sustainability issues. The potential performance of feedstock and biorefinery has been assessed through a literat......A biorefinery concept based on alder tree plantations on degenerated soil is developed to comply with indicators of economic feasibility, fossil fuel depletion concerns, and long term sustainability issues. The potential performance of feedstock and biorefinery has been assessed through...... a literature study and by using a method developed during the study for first hand assessment and comparison of biorefinery system characteristics. The management of an average alder plantation in a 6-year coppicing system was found to fixate atmospheric nitrogen to the soil in yearly rates between 50 and 200...

  7. Long-term lesser prairie-chicken nest ecology in response to grassland management

    Science.gov (United States)

    Fritts, Sarah R.; Grisham, Blake A.; Haukos, David A.; Boal, Clint W.; Patten, Michael; Wolfe, Don H.; Dixon, Charles; Cox, Robert D.; Heck, Willard R.

    2016-01-01

    Long-term population and range declines from habitat loss and fragmentation caused the lesser prairie-chicken (Tympanuchus pallidicinctus) to be a species of concern throughout its range. Current lesser prairie-chicken range in New Mexico and Texas is partially restricted to sand shinnery oak (Quercus havardii; hereafter shinnery oak) prairies, on which cattle grazing is the main socioeconomic driver for private landowners. Cattle producers within shinnery oak prairies often focus land management on shrub eradication using the herbicide tebuthiuron to promote grass production for forage; however, herbicide application alone, and in combination with grazing, may affect nest site selection and nest survival of lesser prairie-chickens through the reduction of shinnery oak and native grasses. We used a controlled, paired, completely randomized design study to assess the influence of grazing and tebuthiuron application and their combined use on nest site selection and nest survival from 2001 to 2010 in Roosevelt County, New Mexico, USA at 2 spatial scales (i.e., treatment and microhabitat) in 4 treatments: tebuthiuron with grazing, tebuthiuron without grazing, no tebuthiuron with grazing, and a control of no tebuthiuron and no grazing. Grazing treatment was a short-duration system in which plots were grazed once during the dormant season and once during the growing season. Stocking rate was calculated each season based on measured forage production and applied to remove ≤25% of available herbaceous material per season. At the treatment scale, we compared nest site selection among treatments using 1-way χ2 tests and nest survival among treatments using a priori candidate nest survival models in Program MARK. At the microhabitat scale, we identified important habitat predictors of nest site selection and nest survival using logistic regression and a priori candidate nest survival models in Program MARK, respectively. Females typically used treatments as expected and

  8. The Effectiveness of Self-Management Mobile Phone and Tablet Apps in Long-term Condition Management: A Systematic Review.

    Science.gov (United States)

    Whitehead, Lisa; Seaton, Philippa

    2016-05-16

    Long-term conditions and their concomitant management place considerable pressure on patients, communities, and health care systems worldwide. International clinical guidelines on the majority of long-term conditions recommend the inclusion of self-management programs in routine management. Self-management programs have been associated with improved health outcomes; however, the successful and sustainable transfer of research programs into clinical practice has been inconsistent. Recent developments in mobile technology, such as mobile phone and tablet computer apps, could help in developing a platform for the delivery of self-management interventions that are adaptable, of low cost, and easily accessible. We conducted a systematic review to assess the effectiveness of mobile phone and tablet apps in self-management of key symptoms of long-term conditions. We searched PubMed, Embase, EBSCO databases, the Cochrane Library, and The Joanna Briggs Institute Library for randomized controlled trials that assessed the effectiveness of mobile phone and tablet apps in self-management of diabetes mellitus, cardiovascular disease, and chronic lung diseases from 2005-2016. We searched registers of current and ongoing trials, as well as the gray literature. We then checked the reference lists of all primary studies and review papers for additional references. The last search was run in February 2016. Of the 9 papers we reviewed, 6 of the interventions demonstrated a statistically significant improvement in the primary measure of clinical outcome. Where the intervention comprised an app only, 3 studies demonstrated a statistically significant improvement. Interventions to address diabetes mellitus (5/9) were the most common, followed by chronic lung disease (3/9) and cardiovascular disease (1/9). A total of 3 studies included multiple intervention groups using permutations of an intervention involving an app. The duration of the intervention ranged from 6 weeks to 1 year, and

  9. Management Development Training; Multiple Measurement of Its Effect When Used to Increase the Impact of a Long Term Motivational Program.

    Science.gov (United States)

    Camealy, John Bremer

    This field investigation applied multiple measures to determine effects of management development training when used to increase the benefits from a long term motivational program. Two experimental groups and a control group were used. Instruments applied included the Miner Sentence Completion Scale, the Leadership Opinion Questionnaire (LOQ), and…

  10. Meso level influences on long term condition self-management: stakeholder accounts of commonalities and differences across six European countries

    NARCIS (Netherlands)

    Rogers, A.; Vassilev, I.; Pumar, M.J.; Todorova, E.; Portillo, M.C.; Foss, C.; Koetsenruijter, J.; Ratsika, N.; Serrano, M.; Knutsen, I.A.; Wensing, M.J.; Roukova, P.; Patelarou, E.; Kennedy, A.; Lionis, C.

    2015-01-01

    BACKGROUND: European countries are increasingly adopting systems of self -care support (SMS) for long term conditions which focus on enhancing individual, competencies, skills, behaviour and lifestyle changes. To date the focus of policy for engendering greater self- management in the population has

  11. Social Network Type and Long-Term Condition Management Support: A Cross-Sectional Study in Six European Countries

    NARCIS (Netherlands)

    Vassilev, I.; Rogers, A.; Kennedy, A.; Wensing, M.; Koetsenruijter, J.; Orlando, R.; Portillo, M.C.; Culliford, D.

    2016-01-01

    BACKGROUND: Network types and characteristics have been linked to the capacity of inter-personal environments to mobilise and share resources. The aim of this paper is to examine personal network types in relation to long-term condition management in order to identify the properties of network types

  12. An integrated modelling framework to assess long-term impacts of water management strategies steering soil subsidence in peatlands

    NARCIS (Netherlands)

    van Hardeveld, H. A.; Driessen, P. P.J.; Schot, P. P.; Wassen, M. J.

    2017-01-01

    Around the world many peatlands are managed unsustainably. Drainage of the peat causes soil subsidence and a range of negative societal impacts. Integrated strategies are required to ensure more sustainable long-term settings, based on impact assessment models that simulate the interrelated dynamics

  13. Nonsurgical Outpatient Therapies for the Management of Female Stress Urinary Incontinence: Long-Term Effectiveness and Durability

    Directory of Open Access Journals (Sweden)

    G. Willy Davila

    2011-01-01

    Results. Thirty-two clinical trial reports were included. Prospective long-term studies of pelvic floor rehabilitation were limited but indicated significant improvements with treatment adherence for at least 12 months. Poor initial tolerability with duloxetine resulted in substantial discontinuation. Most patients receiving transurethral radiofrequency collagen denaturation or urethral bulking agents reported significant long-term improvements, generally good tolerability, and safety. Conclusions. Conservative therapy is an appropriate initial approach for female SUI, but if therapy fails, radiofrequency collagen denaturation or bulking agents may be an attractive intermediate management step or alternative to surgery.

  14. Effects of Relocation and Individual and Environmental Factors on the Long-Term Stress Levels in Captive Chimpanzees (Pan troglodytes): Monitoring Hair Cortisol and Behaviors.

    Science.gov (United States)

    Yamanashi, Yumi; Teramoto, Migaku; Morimura, Naruki; Hirata, Satoshi; Inoue-Murayama, Miho; Idani, Gen'ichi

    2016-01-01

    Understanding the factors associated with the long-term stress levels of captive animals is important from the view of animal welfare. In this study, we investigated the effects of relocation in addition to individual and environmental factors related to social management on long-term stress level in group-living captive chimpanzees by examining behaviors and hair cortisol (HC). Specifically, we conducted two studies. The first compared changes in HC levels before and after the relocation of 8 chimpanzees (Study 1) and the second examined the relationship between individual and environmental factors and individual HC levels in 58 chimpanzees living in Kumamoto Sanctuary (KS), Kyoto University (Study 2). We hypothesized that relocation, social situation, sex, and early rearing conditions, would affect the HC levels of captive chimpanzees. We cut arm hair from chimpanzees and extracted and assayed cortisol with an enzyme immunoassay. Aggressive behaviors were recorded ad libitum by keepers using a daily behavior monitoring sheet developed for this study. The results of Study 1 indicate that HC levels increased during the first year after relocation to the new environment and then decreased during the second year. We observed individual differences in reactions to relocation and hypothesized that social factors may mediate these changes. In Study 2, we found that the standardized rate of receiving aggression, rearing history, sex, and group formation had a significant influence on mean HC levels. Relocation status was not a significant factor, but mean HC level was positively correlated with the rate of receiving aggression. Mean HC levels were higher in males than in females, and the association between aggressive interactions and HC levels differed by sex. These results suggest that, although relocation can affect long-term stress level, individuals' experiences of aggression and sex may be more important contributors to long-term stress than relocation alone.

  15. Effects of Relocation and Individual and Environmental Factors on the Long-Term Stress Levels in Captive Chimpanzees (Pan troglodytes: Monitoring Hair Cortisol and Behaviors.

    Directory of Open Access Journals (Sweden)

    Yumi Yamanashi

    Full Text Available Understanding the factors associated with the long-term stress levels of captive animals is important from the view of animal welfare. In this study, we investigated the effects of relocation in addition to individual and environmental factors related to social management on long-term stress level in group-living captive chimpanzees by examining behaviors and hair cortisol (HC. Specifically, we conducted two studies. The first compared changes in HC levels before and after the relocation of 8 chimpanzees (Study 1 and the second examined the relationship between individual and environmental factors and individual HC levels in 58 chimpanzees living in Kumamoto Sanctuary (KS, Kyoto University (Study 2. We hypothesized that relocation, social situation, sex, and early rearing conditions, would affect the HC levels of captive chimpanzees. We cut arm hair from chimpanzees and extracted and assayed cortisol with an enzyme immunoassay. Aggressive behaviors were recorded ad libitum by keepers using a daily behavior monitoring sheet developed for this study. The results of Study 1 indicate that HC levels increased during the first year after relocation to the new environment and then decreased during the second year. We observed individual differences in reactions to relocation and hypothesized that social factors may mediate these changes. In Study 2, we found that the standardized rate of receiving aggression, rearing history, sex, and group formation had a significant influence on mean HC levels. Relocation status was not a significant factor, but mean HC level was positively correlated with the rate of receiving aggression. Mean HC levels were higher in males than in females, and the association between aggressive interactions and HC levels differed by sex. These results suggest that, although relocation can affect long-term stress level, individuals' experiences of aggression and sex may be more important contributors to long-term stress than

  16. Long-term soil changes from forest harvesting and residue management in the northern Rocky Mountains

    Science.gov (United States)

    Woongsoon Jang; Deborah S. Page-Dumroese; Christopher R. Keyes

    2016-01-01

    Soil changes associated with forest harvesting, differing utilization levels, and post-harvest prescribed burning were determined using an empirical study to investigate the long-term impacts on soil physical and chemical properties at Coram Experimental Forest in northwestern Montana. In 1974, two replications of three regeneration cuttings (shelterwood,...

  17. Long-term response of the mamane forest to feral herbivore management on Mauna Kea, Hawaii

    Science.gov (United States)

    E. Reddy; D. H. Van Vuren; P. G. Scowcroft; J. B. Kauffman; L. Perry

    2012-01-01

    Seven exclosure sites located on Mauna Kea, Hawaii and established in the 1960s and 70s were sampled to characterize long-term response of the mamane (Sophora chrysophylla) forest to protection from feral sheep grazing, and to assess impacts of non-native plant species and recurrent sheep presence on forest recovery. The forest provides essential...

  18. Long-term Outdoor Recreation Participation Projections for Public Land Management Agencies.

    Science.gov (United States)

    Hof, John G.; Kaiser, H. Fred

    1983-01-01

    A theoretical structure for projecting long-term outdoor recreation demand is presented and demonstrated, using data from an outdoor recreation survey by the United States Department of Interior. Since the availability of opportunities seems to influence participation significantly, future planning should take into account supply-demand…

  19. Estimation of long-term environmental inventory factors associated with land application of sewage sludge

    DEFF Research Database (Denmark)

    Bruun, Sander; Yoshida, Hiroko; Nielsen, Martin P.

    2016-01-01

    techniques. Subsequently, 100 year model simulations were used to provide emission factors as well as harvest and carbon sequestration factors (collectively called environmental inventory factors) under a variety of environmental conditions. Environmental inventory factors were calculated under both high.......18 to 0.55. The average carbon sequestration factor across the different environmental conditions ranged from 0.03 to 0.05 for the different sludge types. In conclusion, the approach using an agro-ecosystem model to estimate inventory factors associated with land application of sludge under varying...

  20. Meso level influences on long term condition self-management: stakeholder accounts of commonalities and differences across six European countries.

    Science.gov (United States)

    Rogers, Anne; Vassilev, Ivaylo; Pumar, Maria J Jesús; Todorova, Elka; Portillo, Mari Carmen; Foss, Christina; Koetsenruijter, Jan; Ratsika, Nikoleta; Serrano, Manuel; Knutsen, Ingrid A Ruud; Wensing, Michel; Roukova, Poli; Patelarou, Evridiki; Kennedy, Anne; Lionis, Christos

    2015-07-08

    European countries are increasingly adopting systems of self -care support (SMS) for long term conditions which focus on enhancing individual, competencies, skills, behaviour and lifestyle changes. To date the focus of policy for engendering greater self- management in the population has been focused in the main on the actions and motivations of individuals. Less attention has been paid to how the broader influences relevant to SMS policy and practice such as those related to food production, distribution and consumption and the structural aspects and economics relating to physical exercise and governance of health care delivery systems might be implicated in the populations ability to self- manage. This study aimed to identify key informants operating with knowledge of both policy and practice related to SMS in order to explore how these influences are seen to impact on the self-management support environment for diabetes type 2. Ninety semi-structured interviews were conducted with key stakeholder informants in Bulgaria, Spain, Greece, Norway, Netherlands and UK. Interviews were transcribed and analysed using thematic and textual analysis. Stakeholders in the six countries identified a range of influences which shaped diabetes self-management (SM). The infrastructure and culture for supporting self- management practice is viewed as driven by political decision-makers, the socio-economic and policy environment, and the ethos and delivery of chronic illness management in formal health care systems. Three key themes emerged during the analysis of data. These were 1) social environmental influences on diabetes self-management 2) reluctance or inability of policy makers to regulate processes and environments related to chronic illness management 3) the focus of healthcare system governance and gaps in provision of self-management support (SMS). Nuances in the salience and content of these themes between partner countries related to the presence and articulation of

  1. Evolving 'self'-management: exploring the role of social network typologies on individual long-term condition management.

    Science.gov (United States)

    Morris, Rebecca L; Kennedy, Anne; Sanders, Caroline

    2016-10-01

    Whilst there has been a focus on the importance of social support for managing long-term conditions, there has been little specific focus on the characteristics of social networks that shape self-management. Policy emphasis is placed on individual responsibility for self-care, and this influences commissioning of health-care services. Assumptions are often made by policymakers about accessibility and preference for support and the influence of the social context on chronic illness management. To examine the social networks of individuals with long-term conditions and identify how the characteristics of their composition influences support needs. Thirty participants completed initial face-to-face in-depth interviews, telephone follow-ups and final face-to-face interviews in the north-west of England. A longitudinal qualitative design was used to elicit the subtle changes in relationships over a year. The findings suggest that the relationships which constitute a social network influence perceived support needs and attitudes to self-management. The amalgamation of relationships was characterized into three network typologies (family focused, friend focused or health-care professional focused) according to which types of relationships were dominant. In the absence of support, accounts highlighted a small number of substitutes who could provide support at times of critical need. This study challenges the notion of 'self'-management as an individual construct as many of the practices of illness management involved the support and/or negotiation of roles with others. By examining the nuances of relationships, this study has highlighted the tacit boundaries of practical and emotional support provision. © 2015 The Authors. Health Expectations published by John Wiley & Sons Ltd.

  2. Long-Term Condition Self-Management Support in Online Communities: A Meta-Synthesis of Qualitative Papers.

    Science.gov (United States)

    Allen, Chris; Vassilev, Ivaylo; Kennedy, Anne; Rogers, Anne

    2016-03-10

    Recent years have seen an exponential increase in people with long-term conditions using the Internet for information and support. Prior research has examined support for long-term condition self-management through the provision of illness, everyday, and emotional work in the context of traditional offline communities. However, less is known about how communities hosted in digital spaces contribute through the creation of social ties and the mobilization of an online illness "workforce." The aim was to understand the negotiation of long-term condition illness work in patient online communities and how such work may assist the self-management of long-term conditions in daily life. A systematic search of qualitative papers was undertaken using various online databases for articles published since 2004. A total of 21 papers met the inclusion criteria of using qualitative methods and examined the use of peer-led online communities for those with a long-term condition. A qualitative meta-synthesis was undertaken and the review followed a line of argument synthesis. The main themes identified in relation to the negotiation of self-management support were (1) redressing offline experiential information and knowledge deficits, (2) the influence of modeling and learning behaviors from others on self-management, (3) engagement that validates illness and negates offline frustrations, (4) tie formation and community building, (5) narrative expression and cathartic release, and (6) dissociative anonymity and invisibility. These translated into a line of argument synthesis in which four network mechanisms for self-management support in patient online communities were identified. These were (1) collective knowledge and identification through lived experience; (2) support, information, and engagement through readily accessible gifting relationships; (3) sociability that extends beyond illness; and (4) online disinhibition as a facilitator in the negotiation of self-management

  3. LONG-TERM OUTCOMES OF RADIAL OPTIC NEUROTOMY FOR MANAGEMENT OF OPTIC DISK PIT MACULOPATHY.

    Science.gov (United States)

    Karacorlu, Murat; Sayman Muslubas, Isil; Hocaoglu, Mumin; Ozdemir, Hakan; Arf, Serra; Uysal, Omer

    2016-12-01

    To evaluate the long-term outcomes of radial optic neurotomy (RON) in patients with optic disk pit maculopathy and to compare the functional and anatomical outcomes of pars plana vitrectomy (PPV) with temporal side single RON versus PPV without RON. This retrospective study included 15 eyes of 15 consecutive patients who had surgery for optic disk pit maculopathy. Patients were followed for 12 to 115 months after surgery. Anatomical and functional results were evaluated with optical coherence tomography, MP-1 microperimetry in the central 20°, and measurement of best-corrected visual acuity. Descriptive statistical methods, Friedman chi-square test, post hoc Dunn test, Mann-Whitney test, Wilcoxon signed-rank test, and Fisher's exact test were used to determine the best-corrected visual acuity and MP-1 microperimetry differences between time points and to compare the results between the two treatment groups. Two male and 5 female patients with a mean age 23.3 ± 8.7 (±standard error) years at presentation had PPV and silicone oil or gas tamponade with RON. Best-corrected visual acuity did not deteriorate after the operation in any of the eyes, and improved in 6 (86%) eyes (3 ± 2 lines). After surgery, complete resolution of fluid in the central macula was observed in 6 (86%) eyes. Five male and 3 female patients with a mean age 28.2 ± 8.2 years at presentation had PPV, posterior vitreous detachment, with or without juxtapapillary laser treatment, and silicone oil or gas tamponade. Best-corrected visual acuity did not deteriorate after the operation in any of the eyes, and improved in 5 (62.5%) eyes (2 ± 0.7 lines). After surgery, fluid in the central macula resolved completely in 4 (50%) eyes. Pars plana vitrectomy with temporal side, single RON seems to be an effective method of managing optic disk pit maculopathy. The anatomical and functional improvements, without additional treatment or complication during the follow-up period, indicate that RON might be an

  4. Generalized lymphatic malformation with chylothorax: long-term management of a highly morbid condition in a pediatric patient.

    Science.gov (United States)

    Chen, Wendy; Adams, Denise; Patel, Manish; Gupta, Anita; Dasgupta, Roshni

    2013-03-01

    Generalized lymphatic malformation (GLM) often causes chylothorax, which can be a highly morbid condition. Chylothorax in a pediatric patient with a lymphangiogenic disorder may be especially resistant to therapy, requiring more aggressive measures. We discuss the complex ongoing long-term management of a pediatric patient with GLM who presented with massive, persistent left chylothorax, which resolved by surgical ligation of the thoracic duct and medical management. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. SEARCH: Study of Environmental Arctic Change--A System-scale, Cross-disciplinary, Long-term Arctic Research Program

    Science.gov (United States)

    Wiggins, H. V.; Schlosser, P.; Fox, S. E.

    2009-12-01

    The Study of Environmental Arctic Change (SEARCH) is a multi-agency effort to observe, understand, and guide responses to changes in the changing arctic system. Under the SEARCH program, guided by the Science Steering Committee (SSC), the Observing, Understanding, and Responding to Change panels, and the Interagency Program Management Committee (IPMC), scientists with a variety of expertise work together to achieve goals of the program. Over 150 projects and activities contribute to SEARCH implementation. The Observing Change component is underway through the NSF’s Arctic Observing Network (AON), NOAA-sponsored atmospheric and sea ice observations, and other relevant national and international efforts, including the EU-sponsored Developing Arctic Modeling and Observing Capabilities for Long-term Environmental Studies (DAMOCLES) Program. The Understanding Change component of SEARCH consists of modeling and analysis efforts, including the Sea Ice Outlook project, an international effort to provide a community-wide summary of the expected September arctic sea ice minimum. The Understanding Change component also has strong linkages to programs such as the NSF Arctic System Science (ARCSS) Program. The Responding to Change element will be launched through stakeholder-focused research and applications addressing social and economic concerns. As a national program under the International Study of Arctic Change (ISAC), SEARCH is working to expand international connections. The State of the Arctic Conference (soa.arcus.org), to be held 16-19 March 2010 in Miami, will be a milestone activity of SEARCH and will provide an international forum for discussion of future research directions aimed toward a better understanding of the arctic system and its trajectory. SEARCH is sponsored by eight U.S. agencies that comprise the IPMC, including: the National Science Foundation (NSF), the National Oceanic and Atmospheric Administration (NOAA), the National Aeronautics and Space

  6. Relationship between soil aggregate strength, shape and porosity for soils under different long-term management

    DEFF Research Database (Denmark)

    Munkholm, Lars Juhl; Heck, Richard J; Deen, Bill

    2016-01-01

    aggregate and bulk soil properties. The objectives of this study were to quantify the long-term effect of rotation and tillage on aggregate shape, strength and pore characteristics, to evaluate the influence of aggregate shape and pore characteristics on aggregate strength and soil friability...... and to correlate aggregate properties to bulk soil properties. Soil core samples were taken in spring 2010 from the long-term rotation and tillage trial (initiated in 1980) at the University of Guelph, Canada. The rotations includedwere continuous corn (R1) and a diverse rotation (R6), and the tillage treatments...... of the aggregateswere determined using image analysis with 40 μm voxel size. Subsequently, aggregate tensile strength was determined in an indirect tension test. Rotation had a more pronounced effect than tillage treatment on the different aggregate properties. The diverse rotation resulted in higher aggregate total...

  7. A Collaborative Long-Term Project: Early Childhood Education, Environmental Education, and Landscape Architecture.

    Science.gov (United States)

    Luera, Gail R.; Hong, Seong B.

    2003-01-01

    Describes how the common guiding principles of environment, representation, and collaboration in the disciplines of environmental education, early childhood education, and landscape architecture provided the foundation for a school-based garden project. Shows how the gardening activities and integration of the three philosophies helped to enhance…

  8. Long-term no-tillage and organic input management enhanced the diversity and stability of soil microbial community.

    Science.gov (United States)

    Wang, Yi; Li, Chunyue; Tu, Cong; Hoyt, Greg D; DeForest, Jared L; Hu, Shuijin

    2017-12-31

    Intensive tillage and high inputs of chemicals are frequently used in conventional agriculture management, which critically depresses soil properties and causes soil erosion and nonpoint source pollution. Conservation practices, such as no-tillage and organic farming, have potential to enhance soil health. However, the long-term impact of no-tillage and organic practices on soil microbial diversity and community structure has not been fully understood, particularly in humid, warm climate regions such as the southeast USA. We hypothesized that organic inputs will lead to greater microbial diversity and a more stable microbial community, and that the combination of no-tillage and organic inputs will maximize soil microbial diversity. We conducted a long-term experiment in the southern Appalachian mountains of North Carolina, USA to test these hypotheses. The results showed that soil microbial diversity and community structure diverged under different management regimes after long term continuous treatments. Organic input dominated the effect of management practices on soil microbial properties, although no-tillage practice also exerted significant impacts. Both no-tillage and organic inputs significantly promoted soil microbial diversity and community stability. The combination of no-tillage and organic management increased soil microbial diversity over the conventional tillage and led to a microbial community structure more similar to the one in an adjacent grassland. These results indicate that effective management through reducing tillage and increasing organic C inputs can enhance soil microbial diversity and community stability. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Local government involvement in long term resource planning for community energy systems. Demand side management

    Energy Technology Data Exchange (ETDEWEB)

    1992-03-01

    A program was developed to coordinate governmental, research, utility, and business energy savings efforts, and to evaluate future potential actions, based on actual field data obtained during the implementation of Phase I of the State Resource Plan. This has lead to the establishment of a state conservation and energy efficiency fund for the purpose of establishing a DSM Program. By taking a state wide perspective on resource planning, additional savings, including environmental benefits, can be achieved through further conservation and demand management. This effort has already blossomed into a state directive for DSM programs for the natural gas industry.

  10. Social Network Type and Long-Term Condition Management Support: A Cross-Sectional Study in Six European Countries.

    Science.gov (United States)

    Vassilev, Ivaylo; Rogers, Anne; Kennedy, Anne; Wensing, Michel; Koetsenruijter, Jan; Orlando, Rosanna; Portillo, Maria Carmen; Culliford, David

    2016-01-01

    Network types and characteristics have been linked to the capacity of inter-personal environments to mobilise and share resources. The aim of this paper is to examine personal network types in relation to long-term condition management in order to identify the properties of network types most likely to provide support for those with a long-term condition. A cross-sectional observational survey of people with type 2 diabetes using interviews and questionnaires was conducted between April and October 2013 in six European countries: Greece, Spain, Bulgaria, Norway, United Kingdom, and Netherlands. 1862 people with predominantly lower socio-economic status were recruited from each country. We used k-means clustering analysis to derive the network types, and one-way analysis of variance and multivariate logistic regression analysis to explore the relationship between network type socio-economic characteristics, self-management monitoring and skills, well-being, and network member work. Five network types of people with long-term conditions were identified: restricted, minimal family, family, weak ties, and diverse. Restricted network types represented those with the poorest self-management skills and were associated with limited support from social network members. Restricted networks were associated with poor indicators across self-management capacity, network support, and well-being. Diverse networks were associated with more enhanced self-management skills amongst those with a long-term condition and high level of emotional support. It was the three network types which had a large number of network members (diverse, weak ties, and family) where healthcare utilisation was most likely to correspond to existing health needs. Our findings suggest that type of increased social involvement is linked to greater self-management capacity and potentially lower formal health care costs indicating that diverse networks constitute the optimal network type as a policy in terms of

  11. Long-term prospects for the environmental profile of advanced sugar cane ethanol.

    Science.gov (United States)

    da Silva, Cinthia R U; Franco, Henrique Coutinho Junqueira; Junqueira, Tassia Lopes; van Oers, Lauran; van der Voet, Ester; Seabra, Joaquim E A

    2014-10-21

    This work assessed the environmental impacts of the production and use of 1 MJ of hydrous ethanol (E100) in Brazil in prospective scenarios (2020-2030), considering the deployment of technologies currently under development and better agricultural practices. The life cycle assessment technique was employed using the CML method for the life cycle impact assessment and the Monte Carlo method for the uncertainty analysis. Abiotic depletion, global warming, human toxicity, ecotoxicity, photochemical oxidation, acidification, and eutrophication were the environmental impacts categories analyzed. Results indicate that the proposed improvements (especially no-til farming-scenarios s2 and s4) would lead to environmental benefits in prospective scenarios compared to the current ethanol production (scenario s0). Combined first and second generation ethanol production (scenarios s3 and s4) would require less agricultural land but would not perform better than the projected first generation ethanol, although the uncertainties are relatively high. The best use of 1 ha of sugar cane was also assessed, considering the displacement of the conventional products by ethanol and electricity. No-til practices combined with the production of first generation ethanol and electricity (scenario s2) would lead to the largest mitigation effects for global warming and abiotic depletion. For the remaining categories, emissions would not be mitigated with the utilization of the sugar cane products. However, this conclusion is sensitive to the displaced electricity sources.

  12. Connecting local support: A qualitative study exploring the role of voluntary organisations in long-term condition management.

    Science.gov (United States)

    Morris, Rebecca; Kirk, Susan; Kennedy, Anne; Vassilev, Ivaylo; Mathieson, Amy; Jeffries, Mark; Blickem, Christian; Brooks, Helen; Sanders, Caroline; Rogers, Anne

    2015-06-01

    To examine the role of community groups to support people living with long-term conditions and the organisational factors that influence this role. Thirty-three semi-structured interviews were conducted with voluntary group organisers purposefully sampled in Greater Manchester from a local database of community groups. Interviews explored the organisations role in supporting people living with a long-term condition, their social networks and the origins of the groups. Respondents' construed their role in supporting individual capacity for management either explicitly (e.g. providing exercise) or implicitly (e.g. emotional support). This role was influenced by a combination of group ideology, funding and social networks. Analysis highlights the role of the non-clinical setting, the social support provided within the group, as well as organisational processes that influenced their capacity to support people living with long-term conditions. By examining the organisation of voluntary groups, this study highlights the way in which they may support or constrain access to an extended range of support for people with long-term conditions. This paper has implications for commissioning of services by the health service from the third sector because of the differing ideological perspectives and limited operational capacity. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  13. [Long-term therapeutic effects of whole lung lavage in the management of silicosis].

    Science.gov (United States)

    Zhang, Ying-ming; Zhang, Hai-tao; Wang, Cai-ying; Wang, Wei; Wu, Jing; Wang, Chun

    2012-09-01

    To investigate the long-term therapeutic effect of whole lung lavage (WLL) in the treatment of silicosis. A total of 70 patients with silicosis were randomly and equally divided into WLL group and control group based on chest X-ray, silicosis staging, age, and working age of dust exposure. Comparative analysis was performed to evaluate the long-term therapeutic effect of WLL. Moreover, 157 patients with silicosis treated by WLL were subject to long-term follow-up. Two years after treatment, the cough, expectoration, and asthma improvement rates of the WLL group were 62.5% , 75.0% , and 81.8%, respectively, significantly higher than those (24.0%, 23.8%, and 26.3%) of the control group (P 0.05), while the control group showed significant decrease in FVC and FEV1 after treatment (P 0.05). 22 cases of accelerated silicosis in the WLL group had significantly higher no change rate than the control group with respect to chest X-ray (75.0% vs. 30.0%; 58.3% vs. 20.0%). The WLL group had lower progression rate (2 years of treatment) and significant progression rate (4 years after treatment) than the control group (16.7% vs. 50.0%, P silicosis stage was, the less FVC decreased. Follow-up of 108 cases treated by WLL showed that the lower silicosis stage was, the higher no change rate was, according to the chest X-ray findings 2 ∼ 3, 4 ∼ 5, and 6 ∼ 7 years after treatment and that there were significant differences in no change rate between stages II and III silicosis groups and stages 0+ and I silicosis groups (P silicosis, especially for early silicosis and accelerated silicosis. However, WLL should be used cautiously in the treatment of advanced silicosis.

  14. Monitoring the Long-Term Effectiveness of Integrated Safety Management System (ISMS) Implementation Through Use of a Performance Dashboard Process

    Energy Technology Data Exchange (ETDEWEB)

    Michael D. Kinney and William D. Barrick

    2008-09-01

    This session will examine a method developed by Federal and Contractor personnel at the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office (NNSA/NSO) to examine long-term maintenance of DOE Integrated Safety Management System (ISMS) criteria, including safety culture attributes, as well as identification of process improvement opportunities. This process was initially developed in the summer of 2000 and has since been expanded to recognize the importance of safety culture attributes, and associated safety culture elements, as defined in DOE M 450.4-1, “Integrated Safety Management System Manual.” This process has proven to significantly enhance collective awareness of the importance of long-term ISMS implementation as well as support commitments by NNSA/NSO personnel to examine the continued effectiveness of ISMS processes.

  15. Drastic changes in aquatic bacterial populations from the Cuatro Cienegas Basin (Mexico) in response to long-term environmental stress.

    Science.gov (United States)

    Pajares, Silvia; Eguiarte, Luis E; Bonilla-Rosso, German; Souza, Valeria

    2013-12-01

    Understanding the changes of aquatic microbial community composition in response to changes in temperature and ultraviolet irradiation is relevant for predicting biogeochemical modifications in the functioning of natural microbial communities under global climate change scenarios. Herein we investigate shifts in the bacterioplankton composition in response to long-term changes in temperature and UV radiation. For this purpose, 15 mesocosms were seeded with composite aquatic microbial communities from natural pools within the Cuatro Cienegas Basin (Mexican Chihuahuan desert) and were subject to different temperatures and UV conditions. 16S rRNA gene clone libraries were obtained from water samples at the mid-point (4 months) and the end of the experiment (8 months). An increase in bacterial diversity over time was found in the treatment of constant temperature and UV protection, which suggests that stable environments promote the establishment of complex and diverse bacterial community. Drastic changes in the phylogenetic bacterioplankton composition and structure were observed in response to fluctuating temperature and increasing UV radiation and temperature. Fluctuating temperature induced the largest decrease of bacterial richness during the experiment, indicating that frequent temperature changes drive the reduction in abundance of several species, most notably autotrophs. The long-term impact of these environmental stresses reduced diversity and selected for generalist aquatic bacterial populations, such as Porphyrobacter. These changes at the community level occur at an ecological time scale, suggesting that under global warming scenarios cascade effects on the food web are possible if the microbial diversity is modified.

  16. Meso level influences on long term condition self-management: stakeholder accounts of commonalities and differences across six European countries

    OpenAIRE

    Rogers, A; Vassilev, I; Pumar, M.J.; Todorova, E.; Portillo, M.C.; Foss, C; Koetsenruijter, J.; Ratsika, N; Serrano, M.; Knutsen, I.A.; Wensing, M.J.; Roukova, P.; Patelarou, E; Kennedy, A; Lionis, C.

    2015-01-01

    Background European countries are increasingly adopting systems of self –care support (SMS) for long term conditions which focus on enhancing individual, competencies, skills, behaviour and lifestyle changes. To date the focus of policy for engendering greater self- management in the population has been focused in the main on the actions and motivations of individuals. Less attention has been paid to how the broader influences relevant to SMS policy and practice such as tho...

  17. A long-term environmental sensor network in a glacial environment: challenges and results

    Science.gov (United States)

    Martinez, K.; Hart, J. K.; Basford, P. J.; Gong, X.; Edwards, L.; Pethica, C.; Glacsweb Team

    2011-12-01

    We report the findings from wireless environmental sensor network installed at Skalafellsjökull, Iceland, which has now been deployed for three years. The scientific aim of the project was to use a sensor network to better understand subglacial processes in order to investigate the response of glaciers to climate change. The engineering aim was to produce a working environmental sensor network which could operate in a very challenging environment. The sensor network comprised: 1. Wireless subglacial probes which monitored the subglacial environment for 2 years. They were able to show the nature of the subglacial environment, in particular the occurrence of stick-slip motion. 2. Base Station on the glacier surface, collecting probe data, as well as GPS and weather data for 3 years. 3. Reference Station close to the glacier, collecting GPS and weather data for 2 years 4. Automatic web-data harvesting of weather, GPS recordings and web cams. A combination of this data allowed us to interpret glacier dynamics over the period, while evaluating the performance of the sensor network under extreme conditions. This paper will report on the most recent deployments which include; long range WiFi alongside GPRS backup for communications off-site, Python scripting of base station power-sensitive behaviour, adaptive sampling based on energy availability and trials of the Contiki operating system in the new custom wireless sensor nodes. Additional data streams have also been established by equipping the base station with geophones and putting a full weather station at the reference station. Further enhancements that have been made include moving further into the glacier in order to experience faster flows.

  18. Management of adrenocortical insufficiency with continuous subcutaneous hydrocortisone infusion: long-term experience in three patients.

    Science.gov (United States)

    Khanna, A; Khurana, R; Kyriacou, A; Davies, R; Ray, D W

    2015-01-01

    To assess continuous subcutaneous hydrocortisone infusion (CSHI) in patients with adrenocortical insufficiency (AI) and difficulties with oral replacement. Three patients with AI and frequent hospital admissions attributed to adrenal crises were treated with CSHI, which was delivered via a continuous subcutaneous infusion. All three patients preferred CSHI and remained on it long term, which permitted prolonged follow-up analysis. All three patients reported symptomatic improvement, and in two cases, reduced hospital admission rates and inpatient stay lengths were observed. The cost of hospital admissions and overall treatment was reduced in all cases. CSHI offers a practical and acceptable alternative to oral replacement in a subset of patients with AI. The cost of initiating and maintaining the pump is offset in the long term by reduced frequency and duration of emergency admissions. CSHI can therefore be considered in a select group of patients who are resistant to treatment with conventional oral glucocorticoids. Continuous subcutaneous infusion of cortisol is a viable alternative in patients unable to take oral steroids.Patient acceptability was high, with three out of three patients preferring to remain on pump treatment.Hospital admissions were reduced in response to pump therapy, which compensated for the increased treatment cost.The daily dosage of hydrocortisone can be reduced by using pump therapy.

  19. Environmental Effects on Long Term Displacement Data of Woven Fabric Webbings Under Constant Load for Inflatable Structures

    Science.gov (United States)

    Kenner, WInfred S.; Jones, Thomas C.; Doggett, William R.; Duncan, Quinton; Plant, James

    2015-01-01

    An experimental study of the effects of environmental temperature and humidity conditions on long-term creep displacement data of high strength Kevlar and VectranTM woven fabric webbings under constant load for inflatable structures is presented. The restraint layer of an inflatable structure for long-duration space exploration missions is designed to bear load and consists of an assembly of high strength webbings. Long-term creep displacement data of webbings can be utilized by designers to validate service life parameters of restraint layers of inflatable structures. Five groups of high-strength webbings were researched over a two year period. Each group had a unique webbing length, load rating, applied load, and test period. The five groups consisted of 1.) 6K Vectran webbings loaded to 49% ultimate tensile strength (UTS), 2.) 6K Vectran webbings loaded to 55% UTS, 3.) 12.5K Vectran webbings loaded to 22% UTS, 4.) 6K Kevlar webbings loaded to 40% and 43% UTS, and 5.) 6K Kevlar webbings loaded to 48% UTS. Results show that all webbing groups exhibit the initial two stages of three of a typical creep curve of an elastic material. Results also show that webbings exhibit unique local wave patterns over the duration of the test period. Data indicate that the local pattern is primarily generated by daily variations in relative humidity values within the test facility. Data indicate that after a three to six month period, where webbings reach a steady-state creep condition, an annual sinusoidal displacement pattern is exhibited, primarily due to variations in annual mean temperature values. Data indicates that variations in daily temperature values and annual mean humidity values have limited secondary effects on creep displacement behavior. Results show that webbings in groups 2 and 5 do not exhibit well defined annual displacement patterns because the magnitude of the applied loads cause large deformations, and data indicate that material yielding within a webbing

  20. Growth in Biofuels Markets: Long Term Environmental and Socioeconomic Impacts (Final Report)

    Energy Technology Data Exchange (ETDEWEB)

    Seth D. Meyer; Nicholas Kalaitzandonakes

    2010-12-02

    Over the last several years increasing energy and petroleum prices have propelled biofuels and the feedstocks used to produce them, to the forefront of alternative energy production. This growth has increased the linkages between energy and agricultural markets and these changes around the world are having a significant effect on agricultural markets as biofuels begin to play a more substantial role in meeting the world's energy needs. Biofuels are alternatively seen as a means to reduce carbon emissions, increase energy independence, support rural development and to raise farm income. However, concern has arisen that the new demand for traditional commodities or alternative commodities which compete for land can lead to higher food prices and the environmental effects from expanding crop acreage may result in uncertain changes in carbon emissions as land is converted both in the US and abroad. While a number of studies examine changes in land use and consumption from changes in biofuels policies many lack effective policy representation or complete coverage of land types which may be diverted in to energy feedstock production. Many of these biofuels and renewable energy induced land use changes are likely to occur in developing countries with at-risk consumers and on environmentally sensitive lands. Our research has improved the well known FAPRI-MU modeling system which represents US agricultural markets and policies in great detail and added a new model of land use and commodity markets for major commodity producers, consumers and trade dependent and food insecure countries as well as a rest of the world aggregate. The international modules include traditional annual crop lands and include perennial crop land, pasture land, forest land and other land uses from which land may be drawn in to biofuels or renewable energy feedstock production. Changes in calorie consumption in food insecure countries from changes in renewable energy policy can also be examined

  1. Environmental factors affecting long-term stabilization of radon suppression covers for uranium mill tailings

    Energy Technology Data Exchange (ETDEWEB)

    Young, J.K.; Long, L.W.; Reis, J.W.

    1982-04-01

    Pacific Northwest Laboratory is investigating the use of a rock armoring blanket (riprap) to mitigate wind and water erosion of an earthen radon suppression cover applied to uranium mill tailings. To help determine design stresses for the tailings piles, environmental parameters are characterized for the five active uranium-producing regions on a site-specific basis. Only conventional uranium mills that are currently operating or that are scheduled to open in the mid 1980s are considered. Available data indicate that flooding has the most potential for disrupting a tailings pile. The arid regions of the Wyoming Basins and the Colorado Plateau are subject to brief storms of high intensity. The Texas Gulf Coast has the highest potential for extreme precipitation from hurricane-related storms. Wind data indicate average wind speeds from 3 to 6 m/sec for the sites, but extremes of 40 m/sec can be expected. Tornado risks range from low to moderate. The Colorado Plateau has the highest seismic potential, with maximum acceleration caused by earthquakes ranging from 0.2 to 0.4 g. Any direct effect from volcanic eruption is negligible, as all mills are located 90 km or more from an igneous or hydrothermal system.

  2. Environmental medicine, part three: long-term effects of chronic low-dose mercury exposure.

    Science.gov (United States)

    Crinnion, W J

    2000-06-01

    Mercury is ubiquitous in the environment, and in our mouths in the form of "silver" amalgams. Once introduced to the body through food or vapor, mercury is rapidly absorbed and accumulates in several tissues, leading to increased oxidative damage, mitochondrial dysfunction, and cell death. Mercury primarily affects neurological tissue, resulting in numerous neurological symptoms, and also affects the kidneys and the immune system. It causes increased production of free radicals and decreases the availability of antioxidants. It also has devastating effects on the glutathione content of the body, giving rise to the possibility of increased retention of other environmental toxins. Fortunately, effective tests are available to help distinguish those individuals who are excessively burdened with mercury, and to monitor them during treatment. Therapies for assisting the reduction of a mercury load include the use of 2,3-dimercaptosuccinic acid (DMSA) and 2,3-dimercato-1-propanesulfonic acid (DMPS). Additional supplementation to assist in the removal of mercury and to reduce its adverse effects is discussed.

  3. Impact of environmental factors on PADC radon detector sensitivity during long term storage

    Science.gov (United States)

    Wasikiewicz, J. M.

    2018-01-01

    A broad set of data on poly-allyl diglycol carbonate (PADC) exposure to various environmental conditions has been collected for a period of 1 year in order to study the aging effect on the sensitivity to radon detection. Aging is a phenomenon that occurs during long PADC storage resulting in a loss of sensitivity and/or creation of false tracks. Conditions under investigation were storages under pure nitrogen or air atmospheres, in water solutions of different pHs, in a range of temperatures, humidity and exposure to UV, gamma and neutron radiations. It was found that PADC strongly responds to some external conditions through physical changes in the polymer material; for example, etching of UV exposed detectors led to 10% loss of their thickness and the removal of the tracks layer. Performance of detectors was compared with a control that was the sensitivity of detectors from the same sheet at the time of primary calibration - within 1 month of each sheet being manufactured. Substantial difference in performance was found between storage under pure, dry nitrogen and in the presence of water. The former preserves PADC radon detection properties for the period of one year without noticeable change. The latter, on the other hand significantly reduces its performance even after 3 months' storage. It was also established that storage under low temperature is not a suitable means to preserve PADC sensitivity to radon detection due to significant loss in the detector sensitivity.

  4. Long-term effects of environmental endocrine disruptors on reproductive physiology and behavior

    Directory of Open Access Journals (Sweden)

    Heather B Patisaul

    2009-06-01

    Full Text Available It is well established that, over the course of development, hormones shape the vertebrate brain such that sex specific physiology and behaviors emerge. Much of this occurs in discrete developmental windows that span gestation through the prenatal period, although it is now becoming clear that at least some of this process continues through puberty. Perturbation of this developmental progression can permanently alter the capacity for reproductive success. Wildlife studies have revealed that exposure to endocrine disrupting compounds (EDCs, either naturally occurring or man made, can profoundly alter reproductive physiology and ultimately impact entire populations. Laboratory studies in rodents and other species have elucidated some of the mechanisms by which this occurs and strongly indicate that humans are also vulnerable to disruption. Use of hormonally active compounds in human medicine has also unfortunately revealed that the developing fetus can be exposed to and affected by endocrine disruptors, and that it might take decades for adverse effects to manifest. Research within the field of environmental endocrine disruption has also contributed to the general understanding of how early life experiences can alter reproductive physiology and behavior through non-genomic, epigenetic mechanisms such as DNA methylation and histone acetylation. These types of effects have the potential to impact future generations if the germ line is affected. This review provides an overview of how exposure to EDCs, particularly those that interfere with estrogen action, impacts reproductive physiology and behaviors in vertebrates.

  5. Palaeoflood and floodplain records from Spain: Evidence for long-term climate variability and environmental changes

    Science.gov (United States)

    Benito, G.; Thorndycraft, V. R.; Rico, M.; Sánchez-Moya, Y.; Sopeña, A.

    2008-10-01

    Palaeoflood chronologies from seven Spanish river basins and floodplain aggradation chronologies from thirteen rivers are analysed. These fluvial records were divided in to two sub-sets, namely Atlantic (10 ka record) and Mediterranean (3 ka record) river basins, which represent distinct modern hydroclimatic conditions. In Atlantic basins floods result from intense, widespread rainfalls associated with Atlantic frontal systems transported by westerly airflow. Mediterranean river flooding is related to heavy rainfall induced by mesoscale convective systems (MCSs) during autumn months. Evidence from radiocarbon dates in slackwater flood deposits shows six periods of flood clusters at 10,750-10,240; 9550-9130; 4820-4440; 2865-2350; 960-790; and 520-290 cal BP. Despite the different flood-producing weather conditions in Atlantic and Mediterranean rivers, the radiocarbon sample clusters overlap and indicate changes in large-scale atmospheric circulation and climatic conditions in the Iberian Peninsula. Comparison with proxy records of mean temperature for the Northern Hemisphere demonstrates a relationship between the period of slackwater flood deposition and cold climatic phases (e.g. the 2650 yr BP climatic event or AD 1590-1650 period of the Little Ice Age). Radiocarbon dates from aggraded floodplain sediments were clustered at 2710-2320, 2000-1830, and 910-500 cal BP. The first cluster period is in phase with the timing of slackwater deposition, whereas the third (910-500 cal BP) occurs in between two periods of increased flood frequency as indicated by the palaeoflood and documentary flood records. It is argued that the 910-500 cal BP floodplain aggradation period reflects the first post-Roman evidence of environmental change related to generalised land-use changes at the catchment scale, which produced high sediment load transported to overbank areas during high flows.

  6. Legacy phosphorus accumulation and management in the global context: insights from long-term analysis of major river basins

    Science.gov (United States)

    Powers, S. M.; Burt, T. P.; Chan, N. I.; Elser, J. J.; Haygarth, P. M.; Howden, N. J. K.; Jarvie, H. P.; Peterson, H. M.; Shen, J.; Worrall, F.; Sharpley, A. N.

    2014-12-01

    Phosphorus (P) is closely linked to major societal concerns including food security and water quality, and human activities strongly control the modern global P cycle. Current knowledge of the P cycle includes many insights about relatively short-term processes, but a long-term and landscape-level view may be needed to understand P status and optimize P management towards P sustainability. We reconstructed long-term (>40 years) P mass balances and rates of P accumulation in three major river basins where excess P pollution is demanding improvements in P management at local, national, and international levels. We focus on: Maumee River Basin, a major source of agricultural P to Lake Erie, the southernmost and shallowest of the Laurentian Great Lakes; Thames River Basin, where fluxes of effluent P from the London, England metropolitan area have declined following improvements in wastewater treatment; Yangtze (Changjiang) River Basin, the largest in China, which is undergoing rapid economic development. The Maumee and Thames are intensively monitored, and show long-term declines in basin P inputs that represent a step towards P sustainability. However, river P outputs have been slower to decline, consistent with the hypothesis that legacy P is mobilizing from soils or from within the river network. Published data on the Yangtze indicate the P flux from land to water has clearly increased with industrialization and population growth. Historical trajectories of P accumulation and depletion in major river basins are providing new understanding about the long-term impacts of P management, including watershed P legacies and response times, that may inform future policy towards local, national, and global P sustainability.

  7. Dynamics and management of silver fir stand in Tuscany: a review of long-term research

    Directory of Open Access Journals (Sweden)

    Bianchi L

    2008-05-01

    Full Text Available The paper aims to outline the guidelines for the management of silver fir stands in Tuscan Apennines, according to a review of research activities carried out by the Silviculture Institute of Florence, nowadays Department of Forest Environmental Technologies (DISTAF, from 1960 up to today. The study cases are placed in the Vallombrosa Forest Reserve (province of Florence, in the National Park of Foreste Casentinesi Monte Falterona e Campigna (province of Arezzo and in Amiata Mountain (province of Siena. The main research activities concern different issues linked to the dynamics of silver fir stands: 1 ecology of natural regeneration, 2 stands dynamics in time, 3 sapling growth rates in relation with different canopy cover, 4 impact of wildlife on regeneration storey, 5 forest typology according to vegetation dynamics. As regards management aspects, the decrease of the importance of silver fir pure stands for timber production, as well as the increase of their role from naturalistic, recreation and landscape point of view, encourage close-to-nature sylviculture interventions aimed to promote stand dynamics towards mixed forest. Selective cuttings are proposed in order to progressively reduce the tree canopy cover and to favour the growth of regeneration layer. Nevertheless, wherever silver fir artificial stands play an important role from an historical point of view, the conservation of pure stand by means of clear cutting and artificial regeneration is recommended. Finally, the paper outlines the necessity to face the interactions between forest regeneration and wild ungulate populations, which currently represents one of the most dramatic problems of sustainable management.

  8. Induced damage in Carrara Marble as a result of long-term low-magnitude environmental stresses

    Science.gov (United States)

    Voigtlaender, Anne; Leith, Kerry; Krautblatter, Michael; Walter, Jens M.

    2015-04-01

    Damage of intact rock is commonly driven by the interaction of long-term low-magnitude external environmental stresses in combination with surface chemistry, rather than short-term loading in excess of intact rock strength. In order to determine the contribution of environmental stresses to the propagation of micro- and macroscopic fractures under natural environmental conditions we undertook long-term three-point bending tests on large size Carrara Marble specimens. The interaction of mechanical stresses induced by external loading and corrosive conditions (e.g. the presence of water) at the tip of a pre-existing crack is termed stress corrosion. We investigate stress corrosion below saw cut notches in wet and dry samples of Carrara Marble (M1-5, each 10cm x 10cm x 110cm). These were pre-loaded to about 66% of their assumed ultimate strength (determined by the fracture toughness (Kic) calculated for the crack tip). Two marble beams (M1, M3) were initially loaded to 22% and three (M2, M4, M5) to 55% of Kic. CaC03 saturated water was continuously dripped in the notch of samples --M1-4 to create corrosive conditions, while M5 was kept dry. After a three-week bedding period, loading on sample M1 was increased to 55%, M2 and M5 to 77% and M3 and M4 to 85% of Kic respectively. The tests were interrupted prior to failure of the specimens in order to allow the assessment of the crack-tip structure. During the testing period we used classical strain gages and acoustic emission sensors to measure strain and elastic stress changes through coda wave interferometry. Temperature and humidity were monitored and the outflowing fluid was collected for future analysis, throughout. The effect of induced damage on residual intrinsic stresses was evaluated using neutron diffraction on the SALSA instrument at the Institute Laue-Langevin (ILL, Grenoble, France), while texture measurements were undertaken using the X-ray goniometer at the Geoscience Center, University Göttingen, and

  9. Managing Heart Failure in Long-Term Care: Recommendations from an Interprofessional Stakeholder Consultation.

    Science.gov (United States)

    Heckman, George A; Boscart, Veronique M; D'Elia, Teresa; Kelley, Mary Lou; Kaasalainen, Sharon; McAiney, Carrie A; van der Horst, Mary-Lou; McKelvie, Robert S

    2016-12-01

    Heart failure (HF) affects up to 20 per cent of residents in long-term care (LTC) and is associated with substantial morbidity, mortality, and health service utilization. Our study objective was to formulate recommendations on implementing HF care processes in LTC. A three-phase and iterative stakeholder consultation process, guided by expert panel input, was employed to develop recommendations on implementing care processes for HF in LTC. This article presents the results of the third phase, which consisted of a series of interdisciplinary workshops. We developed 17 recommendations. Key elements of these recommendations focus on improving interprofessional communication and improving HF-related knowledge among all LTC stakeholders. Engaging frontline staff, including personal support workers, was stated as an essential component of all recommendations. System-level recommendations include improving communication between LTC homes and acute care and other external health service providers, and developing facility-wide interventions to reduce dietary sodium intake and increase physical activity.

  10. Long-term intensive management increased carbon occluded in phytolith (PhytOC) in bamboo forest soils.

    Science.gov (United States)

    Huang, Zhang-ting; Li, Yong-fu; Jiang, Pei-kun; Chang, Scott X; Song, Zhao-liang; Liu, Juan; Zhou, Guo-mo

    2014-01-08

    Carbon (C) occluded in phytolith (PhytOC) is highly stable at millennium scale and its accumulation in soils can help increase long-term C sequestration. Here, we report that soil PhytOC storage significantly increased with increasing duration under intensive management (mulching and fertilization) in Lei bamboo (Phyllostachys praecox) plantations. The PhytOC storage in 0-40 cm soil layer in bamboo plantations increased by 217 Mg C ha(-1), 20 years after being converted from paddy fields. The PhytOC accumulated at 79 kg C ha(-1) yr(-1), a rate far exceeding the global mean long-term soil C accumulation rate of 24 kg C ha(-1) yr(-1) reported in the literature. Approximately 86% of the increased PhytOC came from the large amount of mulch applied. Our data clearly demonstrate the decadal scale management effect on PhytOC accumulation, suggesting that heavy mulching is a potential method for increasing long-term organic C storage in soils for mitigating global climate change.

  11. Long-term effects of early life exposure to environmental estrogens on ovarian function: Role of epigenetics

    Science.gov (United States)

    Cruz, Gonzalo; Foster, Warren; Paredes, Alfonso; Yi, Kun Don; Uzumcu, Mehmet

    2014-01-01

    Estrogens play an important role in development and function of the brain and reproductive tract. Accordingly, it is thought that developmental exposure to environmental estrogens can disrupt neural and reproductive tract development potentially resulting in long-term alterations in neurobehavior and reproductive function. Many chemicals have been shown to have estrogenic activity whereas others affect estrogen production and turnover resulting in disruption of estrogen signaling pathways. However, these mechanisms and the concentrations required to induce these effects cannot account for the myriad adverse effects of environmental toxicants on estrogen sensitive target tissues. Hence, alternative mechanisms are thought to underlie the adverse effects documented in experimental animal models and thus could be important to human health. In this review, the epigenetic regulation of gene expression is explored as a potential target of environmental toxicants including estrogenic chemicals. We suggest that toxicant-induced changes in epigenetic signatures are important mechanisms underlying disruption of ovarian follicular development. In addition, we discuss how exposure to environmental estrogens during early life can alter gene expression through effects on epigenetic control potentially leading to permanent changes in ovarian physiology. PMID:25040227

  12. Long-term safety and efficacy of insulin degludec in the management of type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Thuillier P

    2015-10-01

    Full Text Available Philippe Thuillier,1 Zarrin Alavi,2 Véronique Kerlan1 1Department of Endocrinology, Diabetology and Metabolic Diseases, 2French Institute of Health and Medical Research CIC 1412, Medical University Hospital of Brest La Cavale Blanche, Brest, France Abstract: Insulin degludec (IDeg is a novel antiglycemic agent belonging to the therapeutic class of ultra-long duration basal insulin analogs. Its half-life and duration of action are 25 hours and 42 hours, respectively. This pharmacodynamic profile leads to a strict dosing schedule, ie, IDeg is injected at the same time each day to ensure optimal biological action and consistent glycemic control. According to the literature, IDeg provides glycemic control and nocturnal hypoglycemia reduction comparable with other long-acting analogs in type 2 diabetes mellitus. The risk of severe hypoglycemic episodes seems also to be reduced when using IDeg therapy; however, long-term follow-up is warranted for monitoring of possible but relatively infrequent adverse events. IDeg is also available in combination with aspart insulin and with liraglutide. The above preparations have been approved by the European Medicines Agency and other national health authorities. In 2012, the US Food and Drug Administration asked for a complementary study on IDeg-associated cardiovascular risk. Future prospective evaluation of large cohorts of patients with type 2 diabetes mellitus treated with IDeg, with long-term follow-up, can provide further relevant information on the safety of IDeg therapy. Keywords: degludec insulin, hypoglycemia, HbA1c, safety, type 2 diabetes mellitus, basal insulin analog

  13. Long-term non-invasive ventilation to manage persistent ventilatory failure after COPD exacerbation.

    Science.gov (United States)

    Oscroft, Nicholas S; Quinnell, Timothy G; Shneerson, John M; Smith, Ian E

    2010-07-01

    Patients with ventilatory failure at discharge from hospital following an exacerbation of COPD (ECOPD) have increased work of breathing and reduced inspiratory muscle strength compared with those with a normal arterial carbon dioxide tension (PaCO(2)). They also have a significantly worse prognosis. Long-term non-invasive positive pressure ventilation (NIPPV) may offer a treatment strategy but benefits have not been established. We examined the outcomes of 35 patients, with a PaCO(2) >7.5 kPa and normal pH, following hospital admission with an ECOPD. Patients were initiated on long-term NIPPV. Our aims were to establish if NIPPV was tolerated and to describe the effects on ventilatory parameters. Daytime arterial blood gases and nocturnal ventilatory parameters improved significantly on NIPPV. Diurnal PaO(2), self-ventilating, rose from (mean (SD)) 7.3 (1.8) to 8.1 (0.9) kPa (P = 0.005) and PaCO(2) fell from 8.8 (1.3) to 7.3 (0.8) kPa (P

  14. Ascending aortic origin of a branch pulmonary artery--surgical management and long-term outcome.

    Science.gov (United States)

    Peng, Edward W K; Shanmugam, Ganesh; Macarthur, Kenneth J D; Pollock, James C S

    2004-10-01

    Ascending aortic origin of a branch pulmonary artery (AOPA, hemitruncus arteriosus) is a rare congenital malformation. While there have been isolated case reports, larger series, relating to long-term outcomes following surgery are few. This article analyses the surgical results of a series of nine patients, over a period of 29 years. Between 1974 and 2003, nine patients [neonates, 6; infants, 3; male, 5; female, 4] were operated on for AOPA. Median age at presentation was 14 days (range birth to 231 days). Six [corrected] patients (group 1) had associated simple lesions like patent ductus arteriosus or right aortic arch. Three patients (group 2) had complex lesions with right ventricular outflow tract obstruction. One patient (group 2) had DiGeorge syndrome. All patients except group 2 presented with congestive cardiac failure and, in addition one had pre-operative coronary ischemia. Diagnosis was established by angiocardiography in two patients and by echocardiography in seven [corrected] The median age at operation was 28 days (range 7-365). Follow-up period ranged from 7 months to 20.5 years (median 9 years). All nine patients had an anomalous right pulmonary artery (RPA) arising from the proximal ascending aorta, while the left branch was of right ventricular origin. All had evidence of pulmonary hypertension or elevated right ventricular pressure pre-operatively. There was no operative mortality. Of eight patients who had direct anastomosis of the RPA to the main pulmonary artery, one required patch enlargement and another required stenting of an anastomotic stenosis. One patient had a RV-RPA conduit, which required replacement 8, 13, and 14 years later. At follow-up, all patients were alive. All patients in group 1 had normal haemodynamic function and were in NYHA class I. In group 2, all were in NYHA class II with evidence of right ventricular hypertrophy. Four patients had post-operative ventilation-perfusion scans which showed satisfactory perfusion to

  15. Model-Based Analysis of the Long-Term Effects of Fertilization Management on Cropland Soil Acidification.

    Science.gov (United States)

    Zeng, Mufan; de Vries, Wim; Bonten, Luc T C; Zhu, Qichao; Hao, Tianxiang; Liu, Xuejun; Xu, Minggang; Shi, Xiaojun; Zhang, Fusuo; Shen, Jianbo

    2017-04-04

    Agricultural soil acidification in China is known to be caused by the over-application of nitrogen (N) fertilizers, but the long-term impacts of different fertilization practices on intensive cropland soil acidification are largely unknown. Here, we further developed the soil acidification model VSD+ for intensive agricultural systems and validated it against observed data from three long-term fertilization experiments in China. The model simulated well the changes in soil pH and base saturation over the last 20 years. The validated model was adopted to quantify the contribution of N and base cation (BC) fluxes to soil acidification. The net NO3(-) leaching and NO4(+)input accounted for 80% of the proton production under N application, whereas one-third of acid was produced by BC uptake when N was not applied. The simulated long-term (1990-2050) effects of different fertilizations on soil acidification showed that balanced N application combined with manure application avoids reduction of both soil pH and base saturation, while application of calcium nitrate and liming increases these two soil properties. Reducing NH4(+) input and NO3(-) leaching by optimizing N management and increasing BC inputs by manure application thus already seem to be effective approaches to mitigating soil acidification in intensive cropland systems.

  16. Management of kyphoscoliosis patients with respiratory failure in the intensive care unit and during long term follow up

    Directory of Open Access Journals (Sweden)

    Adıgüzel Nalan

    2012-09-01

    Full Text Available Abstract Background We aimed to evaluate the ICU management and long-term outcomes of kyphoscoliosis patients with respiratory failure. Methods A retrospective observational cohort study was performed in a respiratory ICU and outpatient clinic from 2002–2011. We enrolled all kyphoscoliosis patients admitted to the ICU and followed-up at regular intervals after discharge. Reasons for acute respiratory failure (ARF, ICU data, mortality, length of ICU stay and outpatient clinic data, non-invasive ventilation (NIV device settings, and compliance were recorded. NIV failure in the ICU and the long term effect of NIV on pulmonary performance were analyzed. Results Sixty-two consecutive ICU kyphoscoliosis patients with ARF were enrolled in the study. NIV was initially applied to 55 patients, 11 (20% patients were intubated, and the majority had sepsis and septic shock (p  Conclusions We strongly discourage the use of NIV in the case of septic shock in ICU kyphoscoliosis patients with ARF. Pulmonary performance improved with NIV during long term follow up.

  17. Management of nucleus loss into the vitreous: long term follow up in 63 patients

    Science.gov (United States)

    Romero-Aroca, Pedro; Fernández-Ballart, Juan; Méndez-Marín, Isabel; Salvat-Serra, Merce; Baget-Bernaldiz, Marc; Buil-Calvo, Jose A

    2007-01-01

    Background: The aim of present study is to determine the long-term results of patients who undergo pars plana vitrectomy after retained nucleus into the vitreous. Setting: Service of Ophthalmology, Hospital Universitari St Joan, Reus (Barcelona), Spain. Methods: Retrospective, noncomparative, consecutive case series. Medical records were reviewed of all patients who underwent pars plana vitrectomy for retained nucleus into the vitreous after complicated cataract surgery, over a 9-year period between August 1, 1997 and July 31, 2005. Result: The incidence of retained lens fragments was 0.57% (63 patients), the postoperative visual acuity was higher than 20/40 in 59.60% and fell to 48.93% by the end of the study, and was related to the presence of CME and retinal detachment. The CME appeared in 31.91% of the patients and was related to preoperative uveitis an corneal edema. In the group of patients on whom the vitrectomy was performed at the time of cataract complication, visual acuity was higher than 20/40 in 77.77%, and no one developed secondary glaucoma or uveitis. Conclusion: Being retrospective, our study was not result conclusive. Despite the initial good results of these patients after PPV surgery, follow-up should be accurate and over a long period of time in order to minimize postoperative complications such as retinal detachment, retinal breaks, secondary glaucoma and CME. PMID:19668529

  18. Management of sexual disorders in long-term of craniocerebral injury within the complex neurorehabilitatione

    Directory of Open Access Journals (Sweden)

    B. G. Dranitsyna

    2015-01-01

    Full Text Available The article describes the importance of the problem of consequences of traumatic brain injury. The study included men with long-term consequences of traumatic brain injury with sexual dysfunction. The study used sexological, psychopathological, psychometric, statistical techniques and additional methods. All patients were divided into three groups depending on the time of the injury. All rehabilitation aimed at restoring lost functions, taking into account the identified sexual dysfunction symptoms. Drug therapy, psychotherapy, logotherapy, massage, physiotherapy effects, acupuncture is used in rehabilitation. Symptomatic treatment was aimed at correcting the underlying psychopathology (affective disorders, asthenic conditions, seizures. Much attention is paid to the psychotherapeutic work, because traumatic brain injury not only leads to a change in the functioning of the human, but also entails a number of social, communication problems, resulting in developing family and sexual disharmony. The basic stages of therapy, taking into account the peculiarities of social functioning, relationships, sexual function of patients and their sexual constitution. The results of evaluation of the effectiveness of the therapy in the study group compared with the control group of patients who were not receiving specific therapy. 

  19. [Long-term care in Europe. Challenges and strategies in nursing staff management].

    Science.gov (United States)

    Kuhlmann, E; Larsen, C

    2013-08-01

    Across Europe, long-term care (LTC) is one of the most challenging areas of social policy. Despite a growing awareness of the problems and improved data, current institutional reforms are an ineffective response to demographic change. This article aims to provide an overview of the challenges of future nursing and care staff in LTC in Europe, and to discuss the German case in a wider European context. We focus on the nursing workforce and on the link between current and prospective analyses on the demand and offer of LTC services and LTC professionals/nursing staff. We draw on a secondary analysis of the literature and public statistics, especially OECD data. The European comparison shows a high variation in the future demand for LTC. In Germany, a number of problematic trends create a negative scenario: the growing demand for LTC meets with a decrease in nursing staff on the supply side. We conclude by suggesting intervention strategies that may reduce this negative scenario.

  20. Incorporating Oracle on-line space management with long-term archival technology

    Science.gov (United States)

    Moran, Steven M.; Zak, Victor J.

    1996-01-01

    The storage requirements of today's organizations are exploding. As computers continue to escalate in processing power, applications grow in complexity and data files grow in size and in number. As a result, organizations are forced to procure more and more megabytes of storage space. This paper focuses on how to expand the storage capacity of a Very Large Database (VLDB) cost-effectively within a Oracle7 data warehouse system by integrating long term archival storage sub-systems with traditional magnetic media. The Oracle architecture described in this paper was based on an actual proof of concept for a customer looking to store archived data on optical disks yet still have access to this data without user intervention. The customer had a requirement to maintain 10 years worth of data on-line. Data less than a year old still had the potential to be updated thus will reside on conventional magnetic disks. Data older than a year will be considered archived and will be placed on optical disks. The ability to archive data to optical disk and still have access to that data provides the system a means to retain large amounts of data that is readily accessible yet significantly reduces the cost of total system storage. Therefore, the cost benefits of archival storage devices can be incorporated into the Oracle storage medium and I/O subsystem without loosing any of the functionality of transaction processing, yet at the same time providing an organization access to all their data.

  1. Electrolyte management for effective long-term electro-osmotic transport in low-permeability soils.

    Science.gov (United States)

    Cherepy, Nerine J; Wildenschild, Dorthe

    2003-07-01

    Electro-osmosis, a coupled-flow phenomenon in which an applied electrical potential gradient drives water flow, may be used to induce water flow through fine-grained sediments. Test cell measurements of electro-osmotic transport in clayey cores extracted from the 27-31 m depth range of the Lawrence Livermore National Laboratory site indicate the importance of pH control within the anode and cathode reservoirs. In our first experiment, pH was not controlled. As a result, carbonate precipitation and metals precipitation occurred near the cathode end of the core, with acidification near the anode. The combination of these acid and base reactions led to the decline of electro-osmotic flow by a factor of 2 in less than one pore volume. In a second experiment, long-term water transport (>21 pore volumes) at stable electro-osmotic conductivity (k(eo) approximately 1 x 10(-9) m2/s-V) was effected with anode reservoir pH > 8, and cathode reservoir pH chlorine gas reacting with trace organics. The chloroform was transported electro-osmotically to the cathode, without measurable loss to adsorption, volatilization, or degradation.

  2. Long-Term Effect of Different Carbon Management Strategies on Water Flow and Related Processes for Three Loamy Soils

    DEFF Research Database (Denmark)

    Vendelboe, Anders Lindblad; Schjønning, Per; de Jonge, Lis Wollesen

    2013-01-01

    flow patterns showed a rapid breakthrough of irrigation water but only little or negligible effect in reducing the risk of colloid loss and chemicals leaching from the root zone, despite 20 to 30 years of different management strategies with this aim. Previous studies reported in the literature have...... emphasized high SOC contents and grass ley soils to significantly reduce nonequilibrium water flow. Our results thus indicate the need for more effective management options than those addressed in this study....... on preferential flow and loss of colloids during heavy irrigation events. The field sites were all under long-term management and therefore represent up to 30 years of pairwise different management strategies. One field in each field pair was managed with a more C-repleting strategy (HighC) than the other (Low...

  3. Solid pseudopapillary neoplasm of the pancreas: Management and long-term outcome.

    Science.gov (United States)

    Lubezky, N; Papoulas, M; Lessing, Y; Gitstein, G; Brazowski, E; Nachmany, I; Lahat, G; Goykhman, Y; Ben-Yehuda, A; Nakache, R; Klausner, J M

    2017-06-01

    Solid pseudopapillary neoplasm (SPN) of pancreas is a rare pancreatic neoplasm with a low metastatic potential. Our aim was to study the clinical-pathological characteristics, and long-term outcome of this tumor. Rretrospective single center study of patients operated for SPN of pancreas. Clinical and pathological data were collected. From 1995 to 2016, 1320 patients underwent pancreatic resection. SPN was confirmed in 32 cases (2.46%), including 29 (90.6%) female and three (9.4%) male, with a mean age of 28.4 ± 12.2 years. SPN was the most common pathology among female patients under age of 40 (72.4%). Abdominal pain was the most frequent presenting symptom (48%), whereas none of the patients presented with jaundice. Mean tumor diameter was 5.9 cm (range, 0.9-14 cm). All patients underwent margin-negative surgical resection. Two patients demonstrated gross malignant features, including liver metastases at presentation (n = 1), and adjacent organ and vascular invasion (n = 1). Microscopic malignant features were present in thirteen patients (40.6%). Recurrence occurred in the retroperitoneal lymph nodes (n = 1, 7 years post resection) and in the liver (n = 2, 1 and 5 years post resection). Mean follow-up was 49.2 months (range, 1-228 months). Five and 10-year disease-free survival was 96.5% and 89.6% respectively. SPNs are low-grade tumors with a good prognosis. Margin-negative surgical resection is curative in most patients. However, almost 15% of patients demonstrate malignant features including invasion of adjacent organs or metastatic disease. Patients with malignant disease are still expected to have long survival, and aggressive surgical approach is advocated. Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  4. Chiari pelvic osteotomy in the management of developmental hip dysplasia: a long term follow-up.

    Science.gov (United States)

    Rozkydal, Z; Kovanda, M

    2003-01-01

    Developmental hip dysplasia in adults causes several anatomical changes which can lead to premature and progressive secondary osteoarthritis. The principle of Chiari osteotomy is the medialisation of the subluxated femoral head. This improves the biomechanics of the hip. The goal of the study was to assess the long term results of Chiari innominate osteotomy. The authors evaluated 130 hips after Chiari ostetomy from 230 patients operated on in the sears 1969-1985 at the Ist Orthopaedic Department of St. Anna University Hospital in Brno, Czech Republic. The mean follow-up was 22.3 years (15-30) and there were 125 women and 5 men. The average age at the time of the procedure was 29 years (15-52). We assessed the Harris hip score, daily activities, the length of the improvement after the procedure and asked the patients if they would undergo again the same procedure. We also assessed the CE angle, the Sharp angle, AHI index, the CCD angle, the Shenton's line, Crowe type of dysplasia, the shape of the femoral head and Kellgren-Lawrence grades of the osteoarthritis. There were 5 types of hip dysplasia in the study: coxa valga subluxans, coxa valga luxans, coxa plana brevis, coxa magna and severe deformity of the femoral head. There were 26 cases of hip dysplasia alone, 87 cases of hip dysplasia with a subluxation of the femoral head and 13 cases of dysplasia with a false acetabulum. We searched for the factors influencing the end results. We measured the medial shift of the distal pelvic fragment and the level of the osteotomy. The mean nmedial shift of the distal fragment was 22 mm e.g. 48.6%. There was a correct level of the osteotomy in 113 patients. Radiological features improved: the CE angle (-12 degrees to +37.2 degrees), the Sharp angle (48 degrees to 41 degrees), AHI index (51 to 96.3%). The Harris hip score improved from 42 points to 67.5 points an average. 65 patients have been satisfied with the procedure, 49 were partialy satisfied and 16 were not satisfied

  5. Forest management for mitigation and adaptation: insights from long-term silvicultural experiments

    Science.gov (United States)

    Anthony W. D' Amato; John B. Bradford; Shawn Fraver; Brian J. Palik

    2011-01-01

    Developing management strategies for addressing global climate change has become an increasingly important issue influencing forest management around the globe. Currently, management approaches are being proposed that intend to (1) mitigate climate change by enhancing forest carbon stores and (2) foster adaptation by maintaining compositionally and structurally complex...

  6. Multiple long-term trends and trend reversals dominate environmental conditions in a man-made freshwater reservoir.

    Science.gov (United States)

    Znachor, Petr; Nedoma, Jiří; Hejzlar, Josef; Seďa, Jaromír; Kopáček, Jiří; Boukal, David; Mrkvička, Tomáš

    2017-12-12

    Man-made reservoirs are common across the world and provide a wide range of ecological services. Environmental conditions in riverine reservoirs are affected by the changing climate, catchment-wide processes and manipulations with the water level, and water abstraction from the reservoir. Long-term trends of environmental conditions in reservoirs thus reflect a wider range of drivers in comparison to lakes, which makes the understanding of reservoir dynamics more challenging. We analysed a 32-year time series of 36 environmental variables characterising weather, land use in the catchment, reservoir hydrochemistry, hydrology and light availability in the small, canyon-shaped Římov Reservoir in the Czech Republic to detect underlying trends, trend reversals and regime shifts. To do so, we fitted linear and piecewise linear regression and a regime shift model to the time series of mean annual values of each variable and to principal components produced by Principal Component Analysis. Models were weighted and ranked using Akaike information criterion and the model selection approach. Most environmental variables exhibited temporal changes that included time-varying trends and trend reversals. For instance, dissolved organic carbon showed a linear increasing trend while nitrate concentration or conductivity exemplified trend reversal. All trend reversals and cessations of temporal trends in reservoir hydrochemistry (except total phosphorus concentrations) occurred in the late 1980s and during 1990s as a consequence of dramatic socioeconomic changes. After a series of heavy rains in the late 1990s, an administrative decision to increase the flood-retention volume of the reservoir resulted in a significant regime shift in reservoir hydraulic conditions in 1999. Our analyses also highlight the utility of the model selection framework, based on relatively simple extensions of linear regression, to describe temporal trends in reservoir characteristics. This approach can

  7. Mathematical models for long-term management of a hydroelectric power production network. Modeles mathematiques pour la gestion a long terme d'un reseau de production hydro-electrique

    Energy Technology Data Exchange (ETDEWEB)

    Bouchard, H.

    1993-08-01

    The problem of long-term (5-20 y) management of an electric power producing network where hydroelectric power dominates is analyzed. The various aspects of a computerized system used to aid in the management of a network of hydroelectric reservoirs are studied as well as the different mathematical models which are applicable. An aggregate model is first considered in which the problem of water management in the reservoirs, the key problem in long-term planning, is handled by replacing multiple stocks of water in multiple reservoirs by a single imaginary reservoir. Two aggregation studies are performed: the first examining the hypothesis of independence between the water level in a reservoir and the production factor of the downstream plant, and the second in which the production factor varies with the level of the upstream reservoir. The function of sales profit is then examined in a study of the optimization of short-term profit. Long term management decisions are subsequently studied using discrete stochastic dynamic programming. The matrix-based ARMA model is used to simulate natural inputs to the reservoirs. Four cases of ARMA models are considered: stationary univariant, periodic univariant, stationary multivariant and periodic multivariant. 49 refs., 2 tabs.

  8. Both column fractures of the acetabulum: epidemiology, operative management and long-term-results.

    Science.gov (United States)

    Gänsslen, A; Frink, M; Hildebrand, F; Krettek, C

    2012-01-01

    occued in only 17.5% of these patients. A joint failure was present in 25.4%. In this group, a joint failure was significantly more likely to be present with an additional lesion of the femoral head and severe primary articular fracture displacement. In contrast to other acetabular fracture types, both column fractures show worser results regarding joint reconstruction, and functional and radiological long-term results. The optimal results can be achieved with anatomic joint reconstruction.

  9. The Biggest Loser Thinks Long-Term: Recency as a Predictor of Success in Weight Management

    OpenAIRE

    Gilly eKoritzky; Chantelle eRice; Camille eDieterle; Antoine eBechara

    2015-01-01

    Only a minority of participants in behavioral weight management lose weight significantly. The ability to predict who is likely to benefit from weight management can improve the efficiency of obesity treatment. Identifying predictors of weight loss can also reveal potential ways to improve existing treatments. We propose a neuro-psychological model that is focused on recency: the reliance on recent information at the expense of time-distant information. Forty-four weight-management patients c...

  10. The problem of the long-term management of nuclear wastes; Le probleme de la gestion a long terme des dechets nucleaires

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-07-01

    The law from December 30, 1991, precisely defines 3 axes of researches for the management of high level and long-lived radioactive wastes: separation/transmutation, surface storage and underground disposal. A global evaluation report about these researches is to be supplied in 2006 by the French government to the Parliament. A first synthesis of the knowledge gained after 14 years of research has led the national commission of the public debate (CNDP) to organize a national debate about the general options of management of high-level and long-lived radioactive wastes before the 2006 date line. The debate comprises 4 public hearings (September 2005: Bar-le-Duc, Saint-Dizier, Pont-du-Gard, Cherbourg), 12 round-tables (October and November 2005: Paris, Joinville, Caen, Nancy, Marseille), a synthesis meeting (December 2005, Dunkerque) and a closing meeting (January 2006, Lyon). This document is the proceedings of the synthesis meeting of Dunkerque. It comprises an introduction which recalls the stakes and modalities of the debate, followed by a talk from the president of the national association of local commissions for nuclear activities information (ANCLI), and three synthesis talks from the particular commission of the public debate, the ministry of industry, and the committee of experts and counter-experts. These proceedings end with some questions and answers with the public. A slide presentation by B. Dessus about the progresses made in the debate on nuclear wastes management is attached to the document. (J.S.)

  11. Long-term Strategic Planning for a Resilient Metro Colombo: An Economic Case for Wetland Conservation and Management

    Science.gov (United States)

    Rozenberg, J.

    2015-12-01

    Colombo faces recurrent floods that threaten its long-term economic development. Its urban wetlands have been identified by local agencies as a critical component of its flood reduction system, but they have declined rapidly in recent years due to continuous infilling, unmanaged land development and dredging to create lakes. In collaboration with government agencies, NGOs and local universities, the World Bank has carried out a Robust Decision Making analysis to examine the value of Colombo urban wetlands, both in the short-term and long-term, and identify what are the most viable strategies available to increase the city's flood resilience in an unclear future (in terms of climate change and patterns of urban development). This has involved the use of numerous hydrological and socio-economic scenarios as well as the evaluation of some wetlands benefits, like ecosystem services, wastewater treatment, or recreational services. The analysis has determined that if all urban wetlands across the Colombo catchment were lost, in some scenarios the metropolitan area would have to cope with an annual average flood loss of approximately 1% of Colombo GDP in the near future. For long-term strategies, trade-offs between urban development, lake creation and wetland conservation were analyzed and it was concluded that an active management of urban wetlands was the lowest regret option. Finally, the analysis also revealed that in the future, with climate change and fast urban development, wetlands will not be sufficient to protect Colombo against severe floods. Pro-active urban planning and land-use management are therefore necessary, both to protect existing wetlands and to reduce future exposure. The use of many different scenarios, the consideration of several policy options, and the open participatory process ensured policy-makers' buy-in and lead to the decision to actively protect urban wetlands in Colombo.

  12. Long-term efficacy and safety of otilonium bromide in the management of irritable bowel syndrome: a literature review.

    Science.gov (United States)

    Triantafillidis, John K; Malgarinos, George

    2014-01-01

    Irritable bowel syndrome (IBS) is a very common functional gastrointestinal disorder characterized by abdominal pain or discomfort and altered bowel habits. The disease affects a large part of the world population. The clinical course is mostly characterized by a cyclic recurrence of symptoms. Therefore, IBS patients should receive, as an initial therapeutic approach, a short course of treatment, and long-term treatment should be reserved for those patients with recurrent symptoms. The available clinical trials show that significant improvement of the symptoms over placebo could be achieved with various drugs, although this improvement is frequently time dependent and with high relapse rates after the cessation of the treatment. In a proportion of patients, clinically obvious relapse could appear long after stopping the treatment. Some of the available pharmacologic agents, including otilonium bromide (OB), are able to significantly prolong the time to the appearance of relapse, compared with placebo. As a consequence, some authors suggest that a cyclic treatment could be of benefit. Antispasmodic drugs have been used for many years in an effort to control the symptoms of IBS. OB is a poorly absorbed spasmolytic drug, exerting significantly greater control of the symptoms of IBS compared with placebo. Recent data suggest that the drug could effectively be used for the long-term management of patients with IBS. The aim of this review is to provide the reader with an evidence-based overview of the efficacy and tolerability of OB in the long-term management of IBS patients, based on the results of the clinical trials published so far.

  13. Long-term data archiving

    Energy Technology Data Exchange (ETDEWEB)

    Moore, David Steven [Los Alamos National Laboratory

    2009-01-01

    Long term data archiving has much value for chemists, not only to retain access to research and product development records, but also to enable new developments and new discoveries. There are some recent regulatory requirements (e.g., FDA 21 CFR Part 11), but good science and good business both benefit regardless. A particular example of the benefits of and need for long term data archiving is the management of data from spectroscopic laboratory instruments. The sheer amount of spectroscopic data is increasing at a scary rate, and the pressures to archive come from the expense to create the data (or recreate it if it is lost) as well as its high information content. The goal of long-term data archiving is to save and organize instrument data files as well as any needed meta data (such as sample ID, LIMS information, operator, date, time, instrument conditions, sample type, excitation details, environmental parameters, etc.). This editorial explores the issues involved in long-term data archiving using the example of Raman spectral databases. There are at present several such databases, including common data format libraries and proprietary libraries. However, such databases and libraries should ultimately satisfy stringent criteria for long term data archiving, including readability for long times into the future, robustness to changes in computer hardware and operating systems, and use of public domain data formats. The latter criterion implies the data format should be platform independent and the tools to create the data format should be easily and publicly obtainable or developable. Several examples of attempts at spectral libraries exist, such as the ASTM ANDI format, and the JCAMP-DX format. On the other hand, proprietary library spectra can be exchanged and manipulated using proprietary tools. As the above examples have deficiencies according to the three long term data archiving criteria, Extensible Markup Language (XML; a product of the World Wide Web

  14. Long-term management of scalp psoriasis: perspectives from the International Psoriasis Council

    NARCIS (Netherlands)

    Kragballe, K.; Menter, A.; Lebwohl, M.; Tebbey, P.W.; Kerkhof, P.C.M. van de

    2013-01-01

    The scalp is a well-known predilection site for psoriasis. Epidemiological data on the various manifestations of scalp psoriasis as well as on its therapeutic management are sparse. The understanding of the natural course of scalp psoriasis is relevant for its therapeutic management. In over 25% of

  15. Perinatal management and long-term cardiac outcome in fetal arrhythmia

    NARCIS (Netherlands)

    Hahurij, N.D.; Blom, N.A.; Lopriore, E.; Aziz, M.I.; Nagel, H.T.; Rozendaal, L.; Vandenbussche, F.P.H.A.

    2011-01-01

    BACKGROUND: cardiac arrhythmias are commonly observed in the fetus, however, may have major consequences for fetal development and post natal life. AIMS: to evaluate the perinatal management and cardiac outcome of fetuses with tachy- or bradyarrhythmia. STUDY DESIGN: perinatal management, outcome

  16. Long-term effects of grazing management and buffer strips on soil erosion from pastures

    Science.gov (United States)

    High grazing pressure can lead to soil erosion in pastures by compacting soil and increasing runoff and sediment delivery to waterways. Limited information exists on the effects of grazing management and best management practices (BMPs), such as buffer strips, on soil erosion from pastures. The obje...

  17. RANGE RAM: a long-term planning method for managing grazing lands

    Science.gov (United States)

    Henricus C. Jansen

    1976-01-01

    Range RAM (Resource Allocation Method) is a computerized planning method designed to assist range managers in developing and selecting alternatives in spatial and temporal allocation of resources. The technique is applicable at the frest or district management levels, or their equivalents. Range RAM can help formulate plans that maximize the production of range outputs...

  18. Total pancreatectomy and islet autotransplantation in children for chronic pancreatitis: indication, surgical techniques, postoperative management, and long-term outcomes.

    Science.gov (United States)

    Chinnakotla, Srinath; Bellin, Melena D; Schwarzenberg, Sarah J; Radosevich, David M; Cook, Marie; Dunn, Ty B; Beilman, Gregory J; Freeman, Martin L; Balamurugan, A N; Wilhelm, Josh; Bland, Barbara; Jimenez-Vega, Jose M; Hering, Bernhard J; Vickers, Selwyn M; Pruett, Timothy L; Sutherland, David E R

    2014-07-01

    Describe the surgical technique, complications, and long-term outcomes of total pancreatectomy and islet autotransplantation (TP-IAT) in a large series of pediatric patients. Surgical management of childhood pancreatitis is not clear; partial resection or drainage procedures often provide transient pain relief, but long-term recurrence is common due to the diffuse involvement of the pancreas. Total pancreatectomy (TP) removes the source of the pain, whereas islet autotransplantation (IAT) potentially can prevent or minimize TP-related diabetes. Retrospective review of 75 children undergoing TP-IAT for chronic pancreatitis who had failed medical, endoscopic, or surgical treatment between 1989 and 2012. Pancreatitis pain and the severity of pain statistically improved in 90% of patients after TP-IAT (P total IEQ (100,000) (P = 0.004) were associated with insulin independence. By multivariate analysis, 3 factors were associated with insulin independence after TP-IAT: (1) male sex, (2) lower body surface area, and (3) higher total IEQ per kilogram body weight. Total IEQ (100,000) was the single factor most strongly associated with insulin independence (odds ratio = 2.62; P Total pancreatectomy and islet autotransplantation provides sustained pain relief and improved quality of life. The β-cell function is dependent on islet yield. Total pancreatectomy and islet autotransplantation is an effective therapy for children with painful pancreatitis that failed medical and/or endoscopic management.

  19. An approach to design long-term monitoring and evaluation frameworks in multi-actor systems--a case in water management.

    Science.gov (United States)

    Hermans, Leon M; Naber, Arienne C; Enserink, Bert

    2012-11-01

    Learning-by-doing and adaptive management require careful monitoring and evaluation of the outcomes of environmental policies and programs under implementation. Selecting relevant indicators is difficult, especially when monitoring over a longer period of time. Further challenges arise when policies are developed as a collaborative effort among multiple actors. This paper discusses an approach to design frameworks for long-term monitoring and evaluation in multi-actor systems. It uses Dynamic Actor Network Analysis (DANA) as an actor-sensitive method to reconstruct program theories. This is combined with elements of assumption-based planning to identify critical assumptions and associated indicators to incorporate the dynamic aspects related to long-term monitoring. An application of this approach is described for a case of water management in the Netherlands. Here, mapping multiple perspectives and identifying critical assumptions helped to broaden the scope of monitoring in important ways. Identifying associated indicators and expectations on their development in response to policy implementation proved more difficult. From this case, it can be concluded that the approach is feasible, useful, but also demanding. However, with continuing trends of networked governance and adaptive management, additional efforts to reflect these trends in monitoring and evaluation, through this and similar approaches, are needed. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. Polar lessons learned: long-term management based on shared threats in Arctic and Antarctic environments

    NARCIS (Netherlands)

    Bennett, J.R.; Shaw, J.D.; Terauds, A.; Smol, J.P.; Aerts, R.; Bergstrom, D.M.; Blais, J.M.; Cheung, W.W.L.; Chown, S.L.; Lea, M.-A.; Nielsen, U.N.; Pauly, D.; Reimer, K.J.; Riddle, M.J.; Snape, I.; Stark, J.S.; Tulloch, V.J.; Possingham, H.P.

    2015-01-01

    The Arctic and Antarctic polar regions are subject to multiple environmental threats, arising from both local and ex-situ human activities. We review the major threats to polar ecosystems including the principal stressor, climate change, which interacts with and exacerbates other threats such as

  1. Long-term effects of best management practices on crop yield and nitrogen surplus

    NARCIS (Netherlands)

    Zavattaro, Laura; Costamagna, Chiara; Grignani, Carlo; Bechini, Luca; Spiegel, Adelheid; Lehtinen, Taru; Guzmán, Gema; Krüger, Janine; D’Pose, Tommy; Pecio, Alicja; Evert, van F.K.; Berge, ten H.F.M.

    2015-01-01

    Inherent in the concept of good agricultural practice (BMP) is that it improves resource use efficiency, mitigates environmental impact or increases farm profitability. However, it is usually impossible to achieve all the objectives, and trade-offs need to be accepted, such as a reduction in

  2. Environmental legacy of an underground gas well blowout: long-term effects of gas and brine leakage on groundwater quality

    Science.gov (United States)

    Schout, Gilian; Hartog, Niels; Majid Hassanizadeh, S.; Griffioen, Jasper

    2017-04-01

    research sheds new light on the long-term effects of natural gas and brine leakage on groundwater quality, which is considered one of the main environmental hazards related to hydraulic fracturing and unconventional gas production in general. Notably, it shows that the anaerobic oxidation of methane may play a major role in containing the effects of uncontrolled gas migration from reservoirs to shallow aquifers.

  3. Obesity: Risk factors, complications, and strategies for sustainable long-term weight management.

    Science.gov (United States)

    Fruh, Sharon M

    2017-10-01

    The aims of this article are to review the effects of obesity on health and well-being and the evidence indicating they can be ameliorated by weight loss, and consider weight-management strategies that may help patients achieve and maintain weight loss. Narrative review based on literature searches of PubMed up to May 2016 with no date limits imposed. Search included terms such as "obesity," "overweight," "weight loss," "comorbidity," "diabetes," cardiovascular," "cancer," "depression," "management," and "intervention." Over one third of U.S. adults have obesity. Obesity is associated with a range of comorbidities, including diabetes, cardiovascular disease, obstructive sleep apnea, and cancer; however, modest weight loss in the 5%-10% range, and above, can significantly improve health-related outcomes. Many individuals struggle to maintain weight loss, although strategies such as realistic goal-setting and increased consultation frequency can greatly improve the success of weight-management programs. Nurse practitioners have key roles in establishing weight-loss targets, providing motivation and support, and implementing weight-loss programs. With their in-depth understanding of the research in the field of obesity and weight management, nurse practitioners are well placed to effect meaningful changes in weight-management strategies deployed in clinical practice. ©2017 American Association of Nurse Practitioners.

  4. Probability, management, and long-term outcomes of biliary complications after hepatic artery thrombosis in liver transplant recipients.

    Science.gov (United States)

    Fujiki, Masato; Hashimoto, Koji; Palaios, Emmanouil; Quintini, Cristiano; Aucejo, Federico N; Uso, Teresa Diago; Eghtesad, Bijan; Miller, Charles M

    2017-11-01

    Hepatic artery thrombosis after liver transplantation is a devastating complication associated with ischemic cholangiopathy that can occur even after successful revascularization. This study explores long-term outcomes after hepatic artery thrombosis in adult liver transplantation recipients, focusing on the probability, risk factors, and resolution of ischemic cholangiopathy. A retrospective chart review of 1,783 consecutive adult liver transplantations performed between 1995 and 2014 identified 44 cases of hepatic artery thrombosis (2.6%); 10 patients underwent immediate retransplantation, and 34 patients received nontransplant treatments, involving revascularization (n = 19) or expectant nonrevascularization management (n = 15). The 1-year graft survival after nontransplant treatment was favorable (82%); however, 16 of the 34 patients who received a nontransplant treatment developed ischemic cholangiopathy and required long-term biliary intervention. A Cox regression model showed that increased serum transaminase and bilirubin levels at the time of hepatic artery thrombosis diagnosis, but not nonrevascularization treatment versus revascularization, were risk factors for the development of ischemic cholangiopathy. Ischemic cholangiopathy in revascularized grafts was less extensive with a greater likelihood of resolution within 5-years than that in nonrevascularized grafts (100% vs 17%). Most liver abscesses without signs of liver failure also were reversible. Salvage retransplantation after a nontransplant treatment was performed in 8 patients with a 1-year survival rate equivalent to immediate retransplantation (88% vs 80%). Selective nontransplant treatments for hepatic artery thrombosis resulted in favorable graft survival. Biliary intervention can resolve liver abscess and ischemic cholangiopathy that developed in revascularized grafts in the long-term; salvage retransplantation should be considered for ischemic cholangiopathy in nonrevascularized grafts

  5. Enabling synthesis of spatially and temporally diverse data collected from environmental sensors within the Long Term Ecological Research Network

    Science.gov (United States)

    Vande Castle, J. R.; Servilla, M. S.; San Gil, I.; Michener, B. K.; Waide, R. B.; Scuderi, L. A.

    2006-12-01

    The Network Office (LNO) of the 26 site Long Term Ecological Research Network (LTER) is involved in the design and implementation of cyberinfrastructure (CI) that will support and enable synthesis of spatially and temporally diverse sets of environmental sensor data. Funded by the NSF, the LTER and LNO are driven to provide a methodology and a CI that enables researchers, and ultimately society, to share and exploit integrated current and historical observations from sensor data representing twenty-five years of environmental observatory experience for purposes of projecting trends and patterns that will provide knowledge about the our changing ecosystems. An example of this includes the "Biophony Grid Portal", which provides researchers direct access to environmental acoustic data. This project involves aggregation of streaming acoustic data from field microphones sent by Internet to a staging server at Michigan State University. Metadata for the acoustic files are stored at the LNO for discovery and access purposes using the LTER Metacat, a metadata catalog and Internet accessible data repository. An application portal developed with the National Center for Supercomputer Applications (NCSA) integrate these data for analysis and synthesis using high-performance computers located at NCSA. Collaborations with the USGS National Biological Information Infrastructure (NBII) disseminates such information by sharing metadata standards and content within the NBII clearinghouse system a channel to the broader research community. Working with the NBII, the LTER Network has adopted the Ecological Metadata Language (EML) for data documentation. Conforming to FGDC standards, EML supports discovery of these data through both the LTER Metacat and the NBII data search capabilities developed by the Oak Ridge National Laboratory Distributed Active Archive Center (ORNL DAAC) for Biogeochemical Dynamics. The (LNO) maintains a rich archive of historical remote sensing data, documented

  6. Evaluation of Neglected Idiopathic Ctev Managed by Ligamentotaxis Using Jess: A Long-Term Followup

    Directory of Open Access Journals (Sweden)

    Ajai Singh

    2011-01-01

    Full Text Available Background. This study was conducted with the aim of evaluating the role of Ligamentotaxis in the management of neglected clubfeet managed by ligamentotaxis using Joshi's External Stabilisation System (JESS. Method & Material. Total 20 subjects (28 feet were studied, which were corrected by differential ligamentotaxis using JESS. All were evaluated clinically, radiologically, podogrammically, and by Catterall Pirani Scoring System, both before and after the correction. Results. Severity of the deformities and clinical correction was assessed by Pirani score. All patients achieved good clinical results as per Pirani score, which was statistically significant. Radiological evaluation showed that all subjects achieved the normal range of values. The pre- and postcorrection difference in FBA was statistically significant. Conclusion. Differential distraction by fixator for the correction of neglected idiopathic CTEV is an effective and patient-friendly method of management.

  7. Packaging sensing cells in spores for long-term preservation of sensors: a tool for biomedical and environmental analysis.

    Science.gov (United States)

    Date, Amol; Pasini, Patrizia; Sangal, Abhishek; Daunert, Sylvia

    2010-07-15

    Whole-cell sensing systems have successfully been employed for detection of various biologically and environmentally important analytes. A limitation to their use for on-field analysis is the paucity of preservation methods for long-term storage and transport. For that, we have previously developed spore-based genetically engineered whole-cell sensing systems that are able not only to maintain the activity of the sensing cells but also to preserve it for long periods of time in normal and extreme environmental conditions. Herein, we have employed these spore-based sensing systems for analysis of real samples, such as blood serum and freshwater. Spores were able to germinate in the presence of the sample matrix, and the minimum time required for the spores to germinate and generate vegetative sensing cells able to elicit a measurable response to target analytes resulted to be around 2 h. Of the two spore-based sensing systems selected to detect model analytes in real samples, one was able to detect arsenic concentrations as low as 1 x 10(-7) M in freshwater and serum samples, and the other one could sense down to 1 x 10(-6) M of zinc in serum. The analysis of human serum samples from healthy subjects for their zinc content proved the viability of spore-based sensing systems. The complete assays, including spore germination and analyte detection, were performed in 2.5 h or less for arsenic and zinc. Furthermore, the assay is inexpensive and simple to carry out and offers unique advantages for the incorporation of the spore-based sensing systems into portable analytical platforms, such as microfluidic devices, to be employed for on-site analysis.

  8. Long term results of early density management of a third growth redwood stand

    Science.gov (United States)

    Lynn A. Webb; John-Pascal Berrill; James L. Lindquist

    2017-01-01

    Precommercial or early thinning of regenerating redwood forests can support management objectives including maximizing yield, forest structure restoration, and promoting carbon sequestration. We present data collected over 30 years following a precommercial thinning (PCT) in a 19 year-old naturally regenerated and planted coast redwood (Sequoia sempervirens ...

  9. The Biggest Loser Thinks Long-Term: Recency as a Predictor of Success in Weight Management

    Directory of Open Access Journals (Sweden)

    Gilly eKoritzky

    2015-12-01

    Full Text Available Only a minority of participants in behavioral weight management lose weight significantly. The ability to predict who is likely to benefit from weight management can improve the efficiency of obesity treatment. Identifying predictors of weight loss can also reveal potential ways to improve existing treatments. We propose a neuro-psychological model that is focused on recency: the reliance on recent information at the expense of time-distant information. Forty-four weight-management patients completed a decision-making task and their recency level was estimated by a mathematical model. Impulsivity and risk-taking were also measured for comparison. Weight loss was measured in the end of the 16-week intervention. Consistent with our hypothesis, successful dieters (n=12 had lower recency scores than unsuccessful ones (n=32; p=0.006. Successful and unsuccessful dieters were similar in their demographics, intelligence, risk taking, impulsivity, and delay of gratification. We conclude that dieters who process time-distant information in their decision making are more likely to lose weight than those who are high in recency. We argue that having low recency facilitates future-oriented thinking, and thereby contributes to behavior change treatment adherence. Our findings underline the importance of choosing the right treatment for every individual, and outline a way to improve weight-management processes for more patients.

  10. Effects of long-term forest management on a regional avifauna

    Science.gov (United States)

    John C. Kilgo; Kathleen E. Franzreb; Sidney A. Gauthreaux; Karl V. Miller; Brian R. Chapman

    2000-01-01

    We compared breeding bird populations on and off of the Savannah River Site, SC, to determine whether management practices have affected abundance and composition of the resident avifauna. We assessed relative abundance by comparing Breeding Bird Survey (BBS) data from six routes off the Savannah River Site with three surrogate routes generated using point-count data...

  11. Long-term strategies for flood risk management: scenario definition and strategic alternative design

    NARCIS (Netherlands)

    Bruijn, de K.; Klijn, F.; McGahey, C.; Mens, M.; Wolfert, H.P.

    2008-01-01

    This report reviews some mainstream existing methods of scenario development and use, as well as experiences with the design and assessment of strategic alternatives for flood risk management. Next, a procedure and methods are proposed and discussed. Thirdly, the procedure and methods are tried on

  12. Climate change and long-term fire management impacts on Australian savannas.

    Science.gov (United States)

    Scheiter, Simon; Higgins, Steven I; Beringer, Jason; Hutley, Lindsay B

    2015-02-01

    Tropical savannas cover a large proportion of the Earth's land surface and many people are dependent on the ecosystem services that savannas supply. Their sustainable management is crucial. Owing to the complexity of savanna vegetation dynamics, climate change and land use impacts on savannas are highly uncertain. We used a dynamic vegetation model, the adaptive dynamic global vegetation model (aDGVM), to project how climate change and fire management might influence future vegetation in northern Australian savannas. Under future climate conditions, vegetation can store more carbon than under ambient conditions. Changes in rainfall seasonality influence future carbon storage but do not turn vegetation into a carbon source, suggesting that CO₂ fertilization is the main driver of vegetation change. The application of prescribed fires with varying return intervals and burning season influences vegetation and fire impacts. Carbon sequestration is maximized with early dry season fires and long fire return intervals, while grass productivity is maximized with late dry season fires and intermediate fire return intervals. The study has implications for management policy across Australian savannas because it identifies how fire management strategies may influence grazing yield, carbon sequestration and greenhouse gas emissions. This knowledge is crucial to maintaining important ecosystem services of Australian savannas. © 2014 The Authors. New Phytologist © 2014 New Phytologist Trust.

  13. Acute and long-term management of food allergy: systematic review

    NARCIS (Netherlands)

    de Silva, D.; Geromi, M.; Panesar, S. S.; Muraro, A.; Werfel, T.; Hoffmann-Sommergruber, K.; Roberts, G.; Cardona, V.; Dubois, A. E. J.; Halken, S.; Host, A.; Poulsen, L. K.; van Ree, R.; Vlieg-Boerstra, B. J.; Agache, I.; Sheikh, A.; Akdis, C. A.; Alvarez, R.; Beyer, K.; Bindslev-Jensen, C.; Demoly, P.; Eigenmann, P.; Fernandez Rivas, M.; Lack, G.; Marchisotto, M. J.; Niggemann, B.; Nilsson, C.; Papadopoulos, N.; Skypala, I.; Worm, M.

    2014-01-01

    Allergic reactions to food can have serious consequences. This systematic review summarizes evidence about the immediate management of reactions and longer-term approaches to minimize adverse impacts. Seven bibliographic databases were searched from their inception to September 30, 2012, for

  14. Acute and long-term management of food allergy : systematic review

    NARCIS (Netherlands)

    de Silva, D.; Geromi, M.; Panesar, S. S.; Muraro, A.; Werfel, T.; Hoffmann-Sommergruber, K.; Roberts, G.; Cardona, V.; Dubois, A. E. J.; Halken, S.; Host, A.; Poulsen, L. K.; Van Ree, R.; Vlieg-Boerstra, B. J.; Agache, I.; Sheikh, A.

    BackgroundAllergic reactions to food can have serious consequences. This systematic review summarizes evidence about the immediate management of reactions and longer-term approaches to minimize adverse impacts. MethodsSeven bibliographic databases were searched from their inception to September 30,

  15. The Biggest Loser Thinks Long-Term: Recency as a Predictor of Success in Weight Management.

    Science.gov (United States)

    Koritzky, Gilly; Rice, Chantelle; Dieterle, Camille; Bechara, Antoine

    2015-01-01

    Only a minority of participants in behavioral weight management lose weight significantly. The ability to predict who is likely to benefit from weight management can improve the efficiency of obesity treatment. Identifying predictors of weight loss can also reveal potential ways to improve existing treatments. We propose a neuro-psychological model that is focused on recency: the reliance on recent information at the expense of time-distant information. Forty-four weight-management patients completed a decision-making task and their recency level was estimated by a mathematical model. Impulsivity and risk-taking were also measured for comparison. Weight loss was measured in the end of the 16-week intervention. Consistent with our hypothesis, successful dieters (n = 12) had lower recency scores than unsuccessful ones (n = 32; p = 0.006). Successful and unsuccessful dieters were similar in their demographics, intelligence, risk taking, impulsivity, and delay of gratification. We conclude that dieters who process time-distant information in their decision making are more likely to lose weight than those who are high in recency. We argue that having low recency facilitates future-oriented thinking, and thereby contributes to behavior change treatment adherence. Our findings underline the importance of choosing the right treatment for every individual, and outline a way to improve weight-management processes for more patients.

  16. Antiobesity Pharmacotherapy for Patients with Type 2 Diabetes: Focus on Long-Term Management

    OpenAIRE

    Jeon, Won Seon; Park, Cheol-Young

    2014-01-01

    Type 2 diabetes and obesity have a complex relationship; obesity is linked to insulin resistance, the precursor to type 2 diabetes. The management of obesity is an important method to delay onset of diabetes and improve the glycemic durability of antidiabetic agents. However, insulin and some of the oral hypoglycemic agents used to treat diabetes cause significant weight gain, and it is difficult for patients with diabetes to reduce and maintain their weight by life-style changes alone. Thus,...

  17. Contact lens fitting and long-term management for the Boston keratoprosthesis.

    Science.gov (United States)

    Nau, Amy C; Drexler, Scott; Dhaliwal, Deepinder K; Mah, Francis; Raju, Leela; Deschler, Emily

    2014-05-01

    To examine the types of contact lenses used as bandage lenses in the postoperative management of patients with Boston type 1 keratoprosthesis (K-Pro). We examined the lens parameters, the number of trial lenses used to achieve successful fit, and lens replacement schedule. The strategies to achieving a successful fit in these complex patients are reviewed. This was a single-center, retrospective chart review of patients who had undergone implantation of the Boston keratoprosthesis in 1 or more eyes from January 2006 to December 2011. Patients included male and female subjects aged 18 years or older who had been fit with bandage contact lenses as part of their postoperative management. Twenty-two eyes of 15 patients met the criteria for this review. The age range was 30 to 90 years. There were eight men and seven women. The average number of lenses to achieve a successful fit varied from 1 to 8, with an average of 2.22 trial lenses used per patient. By 6 months after the surgery, 12 K-Pro eyes showed visual acuity of 20/200 or better, with 7 of those eyes attaining better than 20/80 best-corrected Snellen distance acuity. Our results show that it is often necessary to use custom contact lenses for K-Pro patients. Management of poor tear film quality, protein deposition, inflammation, lens replacement schedule, and antibiotic resistance are related considerations.

  18. Antiobesity pharmacotherapy for patients with type 2 diabetes: focus on long-term management.

    Science.gov (United States)

    Jeon, Won Seon; Park, Cheol Young

    2014-12-29

    Type 2 diabetes and obesity have a complex relationship; obesity is linked to insulin resistance, the precursor to type 2 diabetes. The management of obesity is an important method to delay onset of diabetes and improve the glycemic durability of antidiabetic agents. However, insulin and some of the oral hypoglycemic agents used to treat diabetes cause significant weight gain, and it is difficult for patients with diabetes to reduce and maintain their weight by life-style changes alone. Thus, antiobesity medications or bariatric surgery may be a necessary adjunct for certain obese patients with diabetes. In 2012, the U.S. Food and Drug Administration (FDA) approved lorcaserin and phentermine/topiramate extended-release for the management of chronic weight, and approval for naltrexone/bupropion sustained-release as an adjunct to exercise and reduced caloric intake followed in 2014. Liraglutide is pending FDA approval for antiobesity drug. Here we review the efficacy of approved and new promising drugs for the management of obesity.

  19. Antiobesity Pharmacotherapy for Patients with Type 2 Diabetes: Focus on Long-Term Management

    Directory of Open Access Journals (Sweden)

    Won Seon Jeon

    2014-12-01

    Full Text Available Type 2 diabetes and obesity have a complex relationship; obesity is linked to insulin resistance, the precursor to type 2 diabetes. The management of obesity is an important method to delay onset of diabetes and improve the glycemic durability of antidiabetic agents. However, insulin and some of the oral hypoglycemic agents used to treat diabetes cause significant weight gain, and it is difficult for patients with diabetes to reduce and maintain their weight by life-style changes alone. Thus, antiobesity medications or bariatric surgery may be a necessary adjunct for certain obese patients with diabetes. In 2012, the U.S. Food and Drug Administration (FDA approved lorcaserin and phentermine/topiramate extended-release for the management of chronic weight, and approval for naltrexone/bupropion sustained-release as an adjunct to exercise and reduced caloric intake followed in 2014. Liraglutide is pending FDA approval for antiobesity drug. Here we review the efficacy of approved and new promising drugs for the management of obesity.

  20. Engaging aboriginal peoples in Canada's plan for the long-term management of used nuclear fuel

    Energy Technology Data Exchange (ETDEWEB)

    Patton, P. [Nuclear Waste Management Organization, Toronto, ON (Canada)

    2011-07-01

    The interests and concerns of Aboriginal peoples are integral to development and implementation of Canada's plans for the long-term management of used nuclear fuel. The Nuclear Waste Management Organization (NWMO) has an ongoing statutory obligation and a commitment to active and meaningful participation with Aboriginal peoples. The organization has worked with Aboriginal organizations and individuals to develop long-term engagement and dialogue processes that respect traditional Aboriginal practices, culture, protocols and approaches to decision-making. Aboriginal peoples were significant participants in the 2003-2005 study that resulted in the recommendation for Adaptive Phased Management (APM). After the Canadian government agreed to proceed with APM, Aboriginal peoples provided valuable input into development of the process for selecting a site for a deep geological repository (DGR) for the long-term management of Canada's used nuclear fuel. The involvement of Aboriginal stakeholders continues to be important as Canada moves into the siting process. Engagement of Aboriginal peoples is guided by principles that respond to the unique interests, perspectives and culture of Aboriginal peoples. These principles recognize and honour the special relationship that Aboriginal peoples have with the natural environment, their unique stewardship responsibilities, and the fact that Aboriginal peoples are holders of Aboriginal Traditional Knowledge (ATK), which brings value to planning processes. The NWMO has been working with Aboriginal Elders and others to learn about ATK and to interweave this knowledge into its work. ATK includes important knowledge about the land, ecology and intergenerational decision-making. The NWMO and Aboriginal peoples have given life to engagement principles and the wisdom of ATK by collaboratively developing a number of programs including agreements with national, regional and local Aboriginal organizations. Additionally, the NWMO has

  1. Short-Term and Long-Term Technology Needs/Matching Status at Idaho National Engineering and Environmental Laboratory

    Energy Technology Data Exchange (ETDEWEB)

    S. L. Claggett

    1999-12-01

    This report identifies potential technology deployment opportunities for the Environmental Management (EM) programs at the Idaho National Engineering and Environmental Laboratory (INEEL). The focus is on identifying candidates for Accelerated Site Technology Deployment (ASTD) proposals within the Environmental Restoration and Waste Management areas. The 86 technology needs on the Site Technology Coordination Group list were verified in the field. Six additional needs were found, and one listed need was no longer required. Potential technology matches were identified and then investigated for applicability, maturity, cost, and performance. Where promising, information on the technologies was provided to INEEL managers for evaluation. Eleven potential ASTD projected were identified, seven for near-term application and four for application within the next five years.

  2. Cloud2IR: Infrared thermography and environmental sensors integrated in an autonomoussystem for long term monitoring of structures

    Science.gov (United States)

    Crinière, Antoine; Dumoulin, Jean; Mevel, Laurent; Andrade-Barroso, Guillermo

    2016-04-01

    Since late 2014, the project Cloud2SM aims to develop a robust information system able to assess the long term monitoring of civil engineering structures as well as interfacing various sensors and data. Cloud2SM address three main goals, the management of distributed data and sensors network, the asynchronous processing of the data through network and the local management of the sensors themselves [1]. Integrated to this project Cloud2IR is an autonomous sensor system dedicated to the long term monitoring of infrastructures. Past experimentations have shown the need as well as usefulness of such system [2]. Before Cloud2IR an initially laboratory oriented system was used, which implied heavy operating system to be used [3]. Based on such system Cloud2IR has benefited of the experimental knowledge acquired to redefine a lighter architecture based on generics standards, more appropriated to autonomous operations on field and which can be later included in a wide distributed architecture such as Cloud2SM. The sensor system can be divided in two parts. The sensor side, this part is mainly composed by the various sensors drivers themselves as the infrared camera, the weather station or the pyranometers and their different fixed configurations. In our case, as infrared camera are slightly different than other kind of sensors, the system implement in addition an RTSP server which can be used to set up the FOV as well as other measurement parameter considerations. The second part can be seen as the data side, which is common to all sensors. It instantiate through a generic interface all the sensors and control the data access loop (not the requesting). This side of the system is weakly coupled (see data coupling) with the sensor side. It can be seen as a general framework able to aggregate any sensor data, type or size and automatically encapsulate them in various generic data format as HDF5 or cloud data as OGC SWE standard. This whole part is also responsible of the

  3. Solid Waste Management Units And Areas Of Concern Annual Long-Term Monitoring & Maintenance Report For Calendar Year 2016.

    Energy Technology Data Exchange (ETDEWEB)

    Dotson, Patrick Wells [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Little, Bonnie Colleen [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2017-02-01

    Long-term controls were maintained at 21 Solid Waste Management Units (SWMUs) and Areas of Concern (AOCs) in accordance with the requirements of the “Long-Term Monitoring and Maintenance Plan for SWMUs and AOCs Granted Corrective Action Complete with Controls” in Attachment M of the Resource Conservation and Recovery Act Facility Operating Permit, which took effect February 26, 2015. Maintenance and controls at these SWMUs and AOCs are described and documented in this report. Conditions requiring maintenance or repair activities were not identified for any of the inspected SWMUs or AOCs. Based upon the inspections performed and site conditions observed, the administrative and physical institutional controls in place at the SWMUs and AOCs are effectively providing continued protection of human health and the environment. This report does not present monitoring and maintenance activities for SWMU 76, the Mixed Waste Landfill; those activities adhere to the approved MWL LTMM Plan, Section 4.8.1 requiring a separate annual report which will be submitted to the NMED by June 30, 2017.

  4. Efficacy of a conservative weight loss program in the long-term management of chronic upper airway obstruction.

    Science.gov (United States)

    Case, Ryan C; Schweinfurth, John

    2009-01-01

    Objective. Obesity is a significant contributor to oxygen demand and dynamic airway obstruction. The objective of the current study is to determine the long-term success of conservative measures directed toward weight reduction on airway management without respect to specific airway disease etiology. Methods. Patients with chronic airway obstruction secondary anatomic lesions or obstructive sleep apnea were recruited and followed prospectively. Demographics, initial and final weights, diagnosis, and followup information were recorded. Patients were referred to a registered dietician, provided counseling, and started on a weight-loss regimen. Outcome measures were change in body mass index (BMI) and rate of decannulation from weight loss alone. Results. Of fourteen patients, ten remained tracheostomy-dependent and four had high-grade lesions with the potential for improvement in oxygen demand and dynamic airway collapse with weight loss. The mean follow up period was 25 months. The mean change in BMI was an increase of 1.4 kg/m(2) per patient. Conclusions. Conservative measures alone were not effective in achieving weight reduction in the population studied. This may be due to comorbid disease and poor compliance. The promise of decannulation was an insufficient independent motivator for weight loss in this study. Although the theoretical benefits of weight loss support its continued recommendation, the long-term success rate of conservative measures is low. More aggressive facilitated interventions including pharmacotherapy or bariatric surgery should be considered early in the course of treating airway disease complicated by obesity.

  5. The impact of meticulous management for hepatic artery thrombosis on long-term outcome after pediatric living donor liver transplantation.

    Science.gov (United States)

    Uchida, Yoichiro; Sakamoto, Seisuke; Egawa, Hiroto; Ogawa, Kohei; Ogura, Yasuhiro; Taira, Kaoru; Kasahara, Mureo; Uryuhara, Kenji; Takada, Yasutsugu; Kamiyama, Yasuo; Tanaka, Koichi; Uemoto, Shinji

    2009-01-01

    To analyze the risk factors in the development of hepatic artery thrombosis (HAT) and assess the impact of our perioperative management for HAT on the long-term outcome after pediatric living donor liver transplantation (LDLT), we reviewed 382 patients under 12 yr of age who underwent 403 LDLT from January 1996 to December 2005. One- and 10-yr patient survival rates were 78% and 78% in the patients with HAT (27 patients; 6.7%), and 84% and 76% in the patients without HAT, respectively (p = n.s.). Univariate analysis showed gender (female), body weight (lower), and graft-to-recipient weight ratio (higher) were significant risk factors in the patients with HAT (p ultrasound signal loss of the hepatic artery (HA) accompanied by an increase of liver enzymes underwent thrombectomy and reanastomosis (S-group, n = 13), and patients with a weak HA signal underwent anticoagulant therapy (M-group, n = 13). One patient underwent re-LDLT. One- and five-yr patient survival rates were 83% and 83% in the S-group, and 77% and 77% in the M-group (p = n.s.). The incidence of biliary complications in the S-group (58%) was significantly higher than that of the M-group (15%). For a successful long-term outcome, the early detection of HAT and prompt medical and surgical intervention are crucial to minimize the insult of HAT.

  6. Long-term opioid contract use for chronic pain management in primary care practice. A five year experience.

    Science.gov (United States)

    Hariharan, Jaishree; Lamb, Geoffrey C; Neuner, Joan M

    2007-04-01

    The use of opioid medications to manage chronic pain is complex and challenging, especially in primary care settings. Medication contracts are increasingly being used to monitor patient adherence, but little is known about the long-term outcomes of such contracts. To describe the long-term outcomes of a medication contract agreement for patients receiving opioid medications in a primary care setting. Retrospective cohort study. All patients placed on a contract for opioid medication between 1998 and 2003 in an academic General Internal Medicine teaching clinic. Demographics, diagnoses, opiates prescribed, urine drug screens, and reasons for contract cancellation were recorded. The association of physician contract cancellation with patient factors and medication types were examined using the Chi-square test and multivariate logistic regression. A total of 330 patients constituting 4% of the clinic population were placed on contracts during the study period. Seventy percent were on indigent care programs. The majority had low back pain (38%) or fibromyalgia (23%). Contracts were discontinued in 37%. Only 17% were cancelled for substance abuse and noncompliance. Twenty percent discontinued contract voluntarily. Urine toxicology screens were obtained in 42% of patients of whom 38% were positive for illicit substances. Over 60% of patients adhered to the contract agreement for opioids with a median follow-up of 22.5 months. Our experience provides insight into establishing a systematic approach to opioid administration and monitoring in primary care practices. A more structured drug testing strategy is needed to identify nonadherent patients.

  7. Evaluation of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care: a qualitative study

    National Research Council Canada - National Science Library

    Roets-Merken, L.M; Vernooij-Dassen, M.J.F.J; Zuidema, S.U; Dees, M.K; Hermsen, P.G; Kempen, G.I; Graff, M.J.L

    2016-01-01

    OBJECTIVES: To gain insights into the process of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care, and into the...

  8. The role of the Ft. Niobrara Wildlife Refuge and Sullys Hill Wildlife Preserve in the long-term management of Federal bison herds

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Proposal for "The role of the Ft. Niobrara Wildlife Refuge and Sullys Hill Wildlife Preserve in the long-term management of Federal bison herds" project created by...

  9. Long-Term Management Strategy for Dredged Material Disposal for Naval Facilities at Pearl Harbor, Hawaii Phase III - Analysis of Alternatives and Development of an LTMS

    National Research Council Canada - National Science Library

    Palermo, Michael

    2000-01-01

    This report documents Phase III of a three-phase study to develop a Long-Term Management Study for disposal of dredged material unsuitable for ocean disposal from Pearl Harbor Naval Complex for the next 30 years...

  10. Managing the cryogenic systems of SCUBA-2 for long term operation

    Science.gov (United States)

    Cookson, Jamie L.; Bintley, Dan

    2016-07-01

    SCUBA-2 has been operational on JCMT producing excellent science for almost 5 years. We describe the strategy and methods that we have evolved to keep one of the world's first "dry dilution refrigerators" and the other cryogenic systems working effectively at the summit of Mauna Kea, keeping the instrument functioning at peak efficiency for extended periods (over 12 months at a time), with minimum downtime. We discuss new plans to reduce day-to-day operational costs and to add remote management of the gas handling systems, as we look to the future and envisage another ten years of SCUBA-2 science.

  11. Long-term grassland management effects on soil Phosphorus status on rewetted Histosols

    Science.gov (United States)

    Heller, Sebastian; Müller, Jürgen; Kayser, Manfred

    2017-04-01

    Since the Neolithic Period, the cultivation of wetlands has played a significant role for the settlement of Humans northwest Germany. A continuing drainage of the wetlands over the centuries and an intensified soil cultivation during the last decades has caused irreversible peat degradation and led to fundamental changes in the landscape. Nowadays, almost 70 % of the 4345 km2 peatland of Lower Saxony is altered by agriculture. For the revitalization of wetland ecosystems, permanent rewetting is an integral component to preserve the functions of organic soils and achieve resilient, speciesrich wetlands. However, permanent rewetting measures are not always feasible. In our study area at the Osterfeiner Moor, a fen located in the Dümmer lowlands near Osnabrück, intensive forage cropping areas were converted into extensive permanent grasslands accompanied by temporary rewetting during winter. This management practice combined with zero fertilization and a low mowing and grazing intensity aims at mitigating mineralisation of peat layers and creating a habitat for endangered meadow bird species. In this semi-natural ecosystem soil phosphorus (P) dynamics play a crucial role. However, longterm research results on P availability of degraded and rewetted fens are still lacking. Thus, we investigated the interaction of different grassland uses and P dynamics in the soil. We described P depletion of the topsoil over a time scale of 17 years after the implementation of restoration measures. Our study site comprises of 180 ha protected grassland divided into 52 management plots. According to the management system, we divided the plots into meadows, pastures and combinations of cutting and grazing. The soils in our study area can be characterised as drained organic soils, WRB: Rheic Sapric Histosols (Drainic), with drastic degradation properties through moorsh forming processes. Plant-available P (double lactate extraction method: PDL) was analysed from representative topsoil

  12. Shared care across the interface between primary and specialty care in management of long term conditions.

    Science.gov (United States)

    Smith, Susan M; Cousins, Gráinne; Clyne, Barbara; Allwright, Shane; O'Dowd, Tom

    2017-02-23

    Shared care has been used in the management of many chronic conditions with the assumption that it delivers better care than primary or specialty care alone; however, little is known about the effectiveness of shared care. To determine the effectiveness of shared care health service interventions designed to improve the management of chronic disease across the primary/specialty care interface. This is an update of a previously published review.Secondary questions include the following:1. Which shared care interventions or portions of shared care interventions are most effective?2. What do the most effective systems have in common? We searched MEDLINE, Embase and the Cochrane Library to 12 October 2015. One review author performed the initial abstract screen; then two review authors independently screened and selected studies for inclusion. We considered randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after studies (CBAs) and interrupted time series analyses (ITS) evaluating the effectiveness of shared care interventions for people with chronic conditions in primary care and community settings. The intervention was compared with usual care in that setting. Two review authors independently extracted data from the included studies, evaluated study quality and judged the certainty of the evidence using the GRADE approach. We conducted a meta-analysis of results when possible and carried out a narrative synthesis of the remainder of the results. We presented the results in a 'Summary of findings' table, using a tabular format to show effect sizes for all outcome types. We identified 42 studies of shared care interventions for chronic disease management (N = 18,859), 39 of which were RCTs, two CBAs and one an NRCT. Of these 42 studies, 41 examined complex multi-faceted interventions and lasted from six to 24 months. Overall, our confidence in results regarding the effectiveness of interventions ranged from moderate to high

  13. [Analysis on long-term compliance of anticoagulation treatment and demands of disease management in patients with atrial fibrillation].

    Science.gov (United States)

    Zuo, Hui-juan; Su, Jiang-lian; Lin, Yun; Zeng, Zhe-chun; Wang, Jin-wen

    2010-08-24

    To analyze the long-term compliance of oral anticoagulant therapy and the demands of disease management in patient with atrial fibrillation (AF). Inpatients with AF taking warfarin were collected from Department of Internal Medicine from January 1 to December 31, 2008. Inpatients from departments of surgery, ophthalmology, otorhinolaryngology, dermatology and pediatrics and those on a previous warfarin therapy were excluded. The data of patient profiles, medical history and anticoagulant treatment were collected from electronic medical record. And the status of anticoagulant treatment one year later and demands of disease management were inquired by telephone. A total of 268 AF patients received a telephone survey. Among them, 145 patients (54.1%) continued taking warfarin. Gender, age, type of AF, duration of AF and history of ischemic stroke was not significantly associated with the compliance of anticoagulant treatment. The odds ratio was 1.74 (95%CI: 0.67-4.47), 0.87 (95%CI: 0.30-2.53), 1.59 (95%CI: 0.35-1.09), 1.09 (95%CI: 0.61-1.93) and 0.44 (95%CI: 0.12-1.60) respectively. Among patients on warfarin, INR was monitored monthly in 88 patients (60.7%) and 70 patients (48.3%) had an INR value of 2.0-3.0. Among 123 withdrawal patients, 88 patients (71.5%) terminated treatment within 6 month. The common reasons included patient ignorance about long-term anticoagulant treatment (35.0%) and switching to aspirin because of a poor effect (24.4%). About 80% of patients wished to obtain instructions about INR monitoring and adjustment of drug dosage. Among them, 196/268 patients (73.1%) wished for a regular follow-up. And 176/196 patients (89.8%) opted for a telephone follow-up and 150/176 patients (85.2%) wanted to receive monthly instructions. The compliance of anticoagulation treatment and the target-meeting proportion of INR value are relative low. And the common reasons of withdrawal are patient ignorance about long-term anticoagulant treatment and switching to

  14. Environmental Education Supports Conservation Action by Increasing the Immediate and Long-Term Environmental Knowledge of Children in West Africa

    Science.gov (United States)

    Grúnová, Markéta; Brandlová, Karolína; Svitálek, Jan; Hejcmanová, Pavla

    2017-01-01

    Local communities play a key role in the sustainability of any conservation program. We evaluated the impact of an environmental education program for school children in the surroundings of the Delta du Saloum Biosphere reserve (Senegal) dedicated to the conservation of African charismatic fauna with the critically endangered Western Derby eland…

  15. Using Long-Term Removal Data to Manage a Crown-of-Thorns Starfish Population

    Directory of Open Access Journals (Sweden)

    Masako Nakamura

    2016-11-01

    Full Text Available Background: Removal programs are effective strategies for short-term management of Crown-of-Thorns Starfish (Acanthaster spp. populations, especially on a small scale. However, management programs are costly, and, in order to be effective, they must be based on local Acanthaster spp. population dynamics. We have developed simple models to predict the annual number of removable A. cf. solaris along the Onna coast of western central Okinawa Island, where chronic outbreaks have continued for several decades. Methods: The Onna coastal area was divided into five sectors, and annual abundance of small A. cf. solaris individuals was used to predict the total number of removable individuals of a cohort in each sector. Three models were developed, based on size class data collected by the Onna Village Fisheries Cooperative (OVFC for 2003–2015, according to possible patterns of recruitment and adult occurrence. Using the best-fit models selected for each of the five sectors, the number of individuals that potentially escaped removal was calculated. Results: Best-fit models were likely to differ among the five sectors instead of small differences in the coefficients of determination. The models predict differences in the number of residual starfish among sectors; the northernmost sector was predicted to have a high number of residuals and the potential density of A. cf. solaris in the sector exceeded the outbreak criterion. Conclusions: These results suggest how to allocate resources to reduce the population of A. cf. solaris along the Onna coast in 2016. The OVFC implemented a control program for A. cf. solaris based on three model predictions.

  16. Long-term changes in nutrient availability after prescribed fire management in a Mediterranean soil

    Science.gov (United States)

    Alcañiz, Meritxell; Outeiro, Luis; Francos, Marcos; Farguell, Joaquim; Úbeda, Xavier

    2016-04-01

    The study area is located in the Tivissa Ranges (NE Iberian Peninsula) and the slope is ~35%, at 615 m.a.s.l. The natural vegetation before prescribed fire was composed of the three stratums in which trees (1% of the plot) were Pinus halepensis, shrubs were Ulex parviflorus, Cistus albidus, Rosmarinus officinallis, Erica multiflora and Quercus coccifera (75% of the plot), and herbs (24%) manly composed of Brachypodium retusum. The firemen had two main forest management objectives with the prescribed fire that was carried out on April 2002: (1) to change the dominance from Ulex to Cistus which is less flammable specie, and which would (2) permit the livestock into this area. Nine years after the prescribed fire our study plot was burned again with a low severity fire to manage the accumulation of vegetation. The aim of this study is a) to see the evolution of nutrient availability in the soil during 13 years since the first prescribed fire, and b) to evaluate the use of prescribed fire as a forest management tool. We have five sampling moments: (1) before the first prescribed fire; (2) after; (3) one year after; (4) three years after and (5) thirteen years after. Within the study area was placed a sampling plot with a rectangular 4×18 m structure. The study was carried out with 30 unstructured soil samples which were air-dried and passed through a 2 mm sieve. After that, fine material was prepared to measure different chemicals parameters of soil studied: soil pH [1:2.5], electrical conductivity [1:2.5], potassium, calcium and magnesium. The results show that, while pH is stable during the period studied, electrical conductivity increased after the prescribed fire as it was expected. However, thirteen years after the first prescribed fire the value (167 μS/cm) was markedly lower than before the prescribed fire (326 μS/cm). Changes in nutrient availability depend on the cation valence. Divalent cations (calcium and magnesium) decreased just after the prescribed

  17. Time to rethink long-term rehabilitation management of stroke patients.

    Science.gov (United States)

    Teasell, Robert; Mehta, Swati; Pereira, Shelialah; McIntyre, Amanda; Janzen, Shannon; Allen, Laura; Lobo, Liane; Viana, Ricardo

    2012-01-01

    It has long been assumed that stroke patients plateau in their recovery within 3 to 6 months of their stroke, and evidence for rehabilitation during the chronic stage is limited. As a consequence, rehabilitation resources for the management of chronic stroke are minimal. The primary objective was to identify randomized controlled trials (RCTs) across the continuum of stroke rehabilitation for interventions initiated 6 months or more following the onset of stroke. The secondary objective was to determine whether treatments provided post 6 moths are effective in improving outcomes among stroke survivors. Multiple databases were used to identify all RCTs published from 1970 to June 2012 in English language where the stroke interventions were initiated more than 6 months after the onset of the stroke. Data abstraction was performed using standardized data abstraction form that included general citation information, study participant characteristics, methodology, outcomes accessed, and overall findings. The results of our analysis revealed 339 RCTs. The mean number of subjects per study was 73. Two hundred fifty-six RCTs were related to motor recovery, 39 to cognitive function, and only 19 to psychosocial issues and community reintegration. The majority of the RCT s demonstrated a significant positive benefit. There is a robust evidence-base for stroke rehabilitation interventions in chronic stroke. This research synthesis reveals a paradox, whereby an impressive evidence-base contrasts with the limited optimism and resources available for rehabilitation in chronic stroke.

  18. Long-Term Management of Complications of Retinal Artery Macroaneurysms with Intravitreal Aflibercept Injection

    Directory of Open Access Journals (Sweden)

    Kamal Kishore

    2016-09-01

    Full Text Available Purpose: To report the 1-year follow-up results of intravitreal aflibercept injection (IAI for the management of complications of retinal artery macroaneurysms (RAM. Methods: A retrospective, noncomparative, interventional case series of 4 eyes of 4 patients (all female, aged 68–91 years, 3 treatment naive treated with IAI 2 mg for complications of RAM [macular edema (ME 2, submacular hemorrhage (SMH 1, and vitreous hemorrhage (VH 1] was conducted. Baseline parameters consisted of complete ocular examination, medical history, best-corrected Snellen VA, fundus photography, IVFA and SD OCT, unless precluded by VH (1. All patients completed ≥1 year follow-up. Results: Baseline VA was hand motions in the eye with SMH (31 mm2 area and 1,478 μm thickness; 20/40 and 20/100 with ME (CST 390 and 337 μm, respectively, and 20/200 in the eye with VH. At 1 month, both patients with ME showed resolution of ME with CST <300 μm with improvement in VA which was maintained through 1 year. VH resolved in one eye at 1 month with no recurrence after 1 year. The eye with SMH developed macular scar and had counting fingers vision at 1 year. Thrombosis of RAM was noted in all eyes and hairpin-like remodeling of artery in one. No eye required repeat injection or laser. Conclusion: ME and VH from RAM were effectively treated with IAI. However, the eye with thick SMH had poor visual outcome despite thrombosis of RAM. Single IAI provided effective therapy for complications of RAM with excellent anatomical and visual results in each eye, except one with thick SMH, and merits further study.

  19. Long-Term Outcomes of the Boston Type I Keratoprosthesis in the Management of Corneal Limbal Stem Cell Deficiency.

    Science.gov (United States)

    Aravena, Carolina; Bozkurt, Tahir Kansu; Yu, Fei; Aldave, Anthony J

    2016-09-01

    To report the long-term outcomes of the Boston type I keratoprosthesis (KPro) in the management of limbal stem cell deficiency (LSCD). Retrospective review of KPro procedures performed by a single surgeon from May 1, 2004, to January 1, 2015. One hundred seventy-three KPro procedures were performed in 149 eyes, including 68 in 54 eyes with LSCD. Glaucoma (48% vs. 82%, P keratoprosthesis implantation results in a significant improvement in CDVA in the majority of eyes with LSCD through 5 years after surgery, with better visual outcomes than eyes without LSCD. Although several postoperative complications are more common in LSCD, sight-threatening complications such as endophthalmitis and retinal detachment are not. Additionally, there is no difference in the retention failure rate in eyes with and without LSCD, although a larger number of procedures with longer follow-up will be needed to determine retention outcomes more than 5 years after surgery.

  20. Design and operation of an anaerobic digester for waste management and fuel generation during long term lunar mission

    Science.gov (United States)

    Dhoble, Abhishek S.; Pullammanappallil, Pratap C.

    2014-10-01

    Waste treatment and management for manned long term exploratory missions to moon will be a challenge due to longer mission duration. The present study investigated appropriate digester technologies that could be used on the base. The effect of stirring, operation temperature, organic loading rate and reactor design on the methane production rate and methane yield was studied. For the same duration of digestion, the unmixed digester produced 20-50% more methane than mixed system. Two-stage design which separated the soluble components from the solids and treated them separately had more rapid kinetics than one stage system, producing the target methane potential in one-half the retention time than the one stage system. The two stage system degraded 6% more solids than the single stage system. The two stage design formed the basis of a prototype digester sized for a four-person crew during one year exploratory lunar mission.

  1. A long-term follow up study of a birth cohort of boxer dogs in The Netherlands : genetic and environmental risk factors for diseases

    NARCIS (Netherlands)

    Hagen, Marjan Antonia Elisabeth van

    2004-01-01

    This thesis describes the long-term follow up of a birth cohort of boxer dogs to study disease incidence, mortality, as well as genetic and environmental risk factors in a purebred dog population in The Netherlands. During the last decades, both the number of genetic disorders and the disease rate

  2. The Management of Long-Term Sickness Absence in Large Public Sector Healthcare Organisations: A Realist Evaluation Using Mixed Methods.

    Science.gov (United States)

    Higgins, Angela; O'Halloran, Peter; Porter, Sam

    2015-09-01

    The success of measures to reduce long-term sickness absence (LTSA) in public sector organisations is contingent on organisational context. This realist evaluation investigates how interventions interact with context to influence successful management of LTSA. Multi-method case study in three Health and Social Care Trusts in Northern Ireland comprising realist literature review, semi-structured interviews (61 participants), Process-Mapping and feedback meetings (59 participants), observation of training, analysis of documents. Important activities included early intervention; workplace-based occupational rehabilitation; robust sickness absence policies with clear trigger points for action. Used appropriately, in a context of good interpersonal and interdepartmental communication and shared goals, these are able to increase the motivation of staff to return to work. Line managers are encouraged to take a proactive approach when senior managers provide support and accountability. Hindering factors: delayed intervention; inconsistent implementation of policy and procedure; lack of resources; organisational complexity; stakeholders misunderstanding each other's goals and motives. Different mechanisms have the potential to encourage common motivations for earlier return from LTSA, such as employees feeling that they have the support of their line manager to return to work and having the confidence to do so. Line managers' proactively engage when they have confidence in the support of seniors and in their own ability to address LTSA. Fostering these motivations calls for a thoughtful, diagnostic process, taking into account the contextual factors (and whether they can be modified) and considering how a given intervention can be used to trigger the appropriate mechanisms.

  3. Between Participation and Collective Action—From Occasional Liaisons towards Long-Term Co-Management for Urban Resilience

    Directory of Open Access Journals (Sweden)

    Elisabeth Schauppenlehner-Kloyber

    2016-07-01

    Full Text Available For resilience building, cities need to foster learning and innovation processes among all actors in order to develop transformative capacities of urban governance regimes to manage extraordinary situations as well as continuous change. A close collaboration of urban governmental actors and citizens is, therefore, of high importance. This paper explores two different discourses on urban governance: participation and self-organized collective action for the management of the commons. Both address the involvement of citizens into governance, albeit from different perspectives: on the one hand from the viewpoint of the government, selectively handing some of its power over to citizens, on the other hand from the perspective of citizens who self-organize for a collective management of urban commons. Based on experiences in the Austrian city of Korneuburg, it is argued that the collective action literature may help overcome some of the self-criticisms and shortcomings of the participation discourse. More specifically, Elinor Ostrom’s design principles for the management of the commons provide valuable input to overcome restrictions in thinking about citizen participation and to effectively design institutions for long-term urban co-management.

  4. Life Cycle Management Considerations of Remotely Sensed Geospatial Data and Documentation for Long Term Preservation

    Science.gov (United States)

    Khayat, Mohammad G.; Kempler, Steven J.

    2015-01-01

    As geospatial missions age, one of the challenges for the usability of data is the availability of relevant and updated metadata with sufficient documentation that can be used by future generations of users to gain knowledge from the original data. Given that remote sensing data undergo many intermediate processing steps, for example, an understanding of the exact algorithms employed and the quality of that data produced, could be key considerations for these users. As interest in global climate data is increasing, documentation about older data, their origins, and provenance are valuable to first time users attempting to perform historical climate research or comparative analysis of global change. Incomplete or missing documentation could be what stands in the way of a new researcher attempting to use the data. Therefore, preservation of documentation and related metadata is sometimes just as critical as the preservation of the original observational data. The Goddard Earth Sciences - Data and Information Service Center (GES DISC), a NASA Earth science Distributed Active Archive Center (DAAC), that falls under the management structure of the Earth Science Data and Information System (ESDIS), is actively pursuing the preservation of all necessary artifacts needed by future users. In this paper we will detail the data custodial planning and the data lifecycle process developed for content preservation, our implementation of a Preservation System to safeguard documents and associated artifacts from legacy (older) missions, as well as detail lessons learned regarding access rights and confidentiality of information issues. We also elaborate on key points that made our preservation effort successful; the primary points being: the drafting of a governing baseline for historical data preservation from satellite missions, and using the historical baseline as a guide to content filtering of what documents to preserve. The Preservation System currently archives

  5. Effect of different agronomic management practices on greenhouse gas emissions and nutrient cycling in a long-term field trial

    Science.gov (United States)

    Koal, Philipp; Schilling, Rolf; Gerl, Georg; Pritsch, Karin; Munch, Jean Charles

    2015-04-01

    In order to achieve a reduction of greenhouse gas emissions, modern agronomic management practices need to be established. Therefore, to assess the effect of different farming practices on greenhouse gas emissions, reliable data are required. The experiment covers and compares two main aspects of agricultural management for a better implementation of sustainable land use. The focus lies on the determination and interpretation of greenhouse gas emissions, however, regarding in each case a different agricultural management system, namely an organic farming system and an integrated farming system where the effect of diverse tillage systems and fertilisation practices are observed. In addition, with analysis of the alterable biological, physical and chemical soil properties a link between the impact of different management systems on greenhouse gas emissions and the observed cycle of matter in the soil, especially the nitrogen and carbon cycle, will be enabled. Measurements have been carried out on long-term field trials at the Research Farm Scheyern located in a Tertiary hilly landscape approximately 40 km north of Munich (South Germany). The long-term field trials of the organic and integrated farming system were started in 1992. Since then parcels of land (each around 0.2-0.4 ha) with a particular interior plot set-up have been conducted with the same crop rotation, tillage and fertilisation practice referring to organic and integrated farming management. Thus, the management impacts on the soil of more than 20 years are being examined. Fluxes of CH4, N2O and CO2 have been monitored since 2007 for the integrated farming system trial and since 2012 for the organic farming system trial using an automated system which consists of chambers (0.4 m2 area) with a motor-driven lid, an automated gas sampling unit, an on-line gas chromatographic analysis system, and a control and data logging unit. Precipitation and temperature data have been observed for each experimental

  6. Modelling crop yield, soil organic C and P under variable long-term fertilizer management in China

    Science.gov (United States)

    Zhang, Jie; Xu, Guang; Xu, Minggang; Balkovič, Juraj; Azevedo, Ligia B.; Skalský, Rastislav; Wang, Jinzhou; Yu, Chaoqing

    2016-04-01

    Phosphorus (P) is a major limiting nutrient for plant growth. P, as a nonrenewable resource and the controlling factor of aquatic entrophication, is critical for food security and human future, and concerns sustainable resource use and environmental impacts. It is thus essential to find an integrated and effective approach to optimize phosphorus fertilizer application in the agro-ecosystem while maintaining crop yield and minimizing environmental risk. Crop P models have been used to simulate plant-soil interactions but are rarely validated with scattered long-term fertilizer control field experiments. We employed a process-based model named Environmental Policy Integrated Climate model (EPIC) to simulate grain yield, soil organic carbon (SOC) and soil available P based upon 8 field experiments in China with 11 years dataset, representing the typical Chinese soil types and agro-ecosystems of different regions. 4 treatments, including N, P, and K fertilizer (NPK), no fertilizer (CK), N and K fertilizer (NK) and N, P, K and manure (NPKM) were measured and modelled. A series of sensitivity tests were conducted to analyze the sensitivity of grain yields and soil available P to sequential fertilizer rates in typical humid, normal and drought years. Our results indicated that the EPIC model showed a significant agreement for simulating grain yields with R2=0.72, index of agreement (d)=0.87, modeling efficiency (EF)=0.68, pmanagement practices.

  7. Management of Tuberous Breast Deformities: Review of Long-term Outcomes and Patient Satisfaction with BREAST-Q.

    Science.gov (United States)

    Tenna, Stefania; Cagli, Barbara; Brunetti, Beniamino; Barone, Mauro; Persichetti, Paolo

    2017-12-01

    The treatment of a tuberous breast deformity has changed over the years, with a large variety of procedures described. However, maintaining a long-lasting breast contour is an ongoing challenge. The aim of this study was to evaluate the long-term results of tuberous breast corrections, focusing on the incidence of secondary procedures and patient satisfaction. Forty-six patients who underwent correction of a tuberous breast deformity from 2000 through 2013 were considered. Age, degree of deformity, asymmetry, BMI, pregnancy, first surgical technique used, complications and further surgical procedures were evaluated. Statistical analysis was conducted to identify predicting factors for multiple procedures. Patient satisfaction was evaluated with BREAST-Q. Eighty-eight breasts were treated: 57 breasts underwent implant-based corrections, whereas 31 breasts underwent autologous procedures. A multi-step procedure was initially planned in 7 breasts only, and 41 breasts underwent secondary procedures: 33 out of 53 breasts (62.3%) were re-operated in the implant-based group, whereas 8 out of 28 breasts (28.6%) were re-operated in the autologous group. Statistical analysis showed a correlation between the number of procedures and young age (P = 0.0253) and between the number of procedures and the primary surgical technique (P = 0.0132). The BREAST-Q evaluation suggested that patient satisfaction was comparable. The question of time is one of the main issues in breast surgery. The management of tuberous breast deformities requires a customized strategy considering all parameters to improve the longevity of the result in the long term. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  8. Chiari-like malformation with syringomyelia in the Cavalier King Charles spaniel: long-term outcome after surgical management.

    Science.gov (United States)

    Rusbridge, Clare

    2007-07-01

    To evaluate long-term success of cranial cervical decompression for management of canine Chiari-like malformation with syringomyelia (CM/SM). Retrospective clinical study. Cavalier King Charles spaniels (n=15). After diagnosis by magnetic resonance imaging (MRI) dogs had cranial cervical decompression with durotomy. Seven dogs had the durotomy patched with biocompatible collagen matrix. Clinical outcome was monitored for >12 months. All dogs either improved (80%) or were unchanged (20%) postoperatively. Postoperative MRI in 6 dogs revealed persistence of syringomyelia. Seven dogs (47%) subsequently deteriorated, 0.2-2.3 years after surgery (mean, 1.3 years) and 2 dogs were eventually euthanatized as a consequence. Twelve dogs were still alive, 1-6.5 years after surgery (mean, 2.5 years). Cranial cervical decompression surgery is associated with low mortality and morbidity, and results in clinical improvement in most dogs. The procedure seemingly does not result in syrinx collapse and resolution. Clinical improvement may not be sustained and some dogs can be expected to deteriorate. Cranial cervical decompression surgery may have a role in management of CM/SM. In dogs with severe pain, it can improve quality of life for several years; however, it does not appear to adequately address the primary cause of syringomyelia. Further prospective study is needed to better understand the pathogenesis and treatment of this disorder. Because this condition causes neuropathic pain but does not necessarily result in euthanasia more information is needed on appropriate pain management for these patients.

  9. Dietary and Behavioral Adjustments to Manage Bowel Dysfunction After Surgery in Long-Term Colorectal Cancer Survviors

    Science.gov (United States)

    Sun, Virginia; Grant, Marcia; Wendel, Christopher S.; McMullen, Carmit K.; Bulkley, Joanna E.; Altschuler, Andrea; Ramirez, Michelle; Baldwin, Carol M.; Herrinton, Lisa J.; Hornbrook, Mark C.; Krouse, Robert S.

    2015-01-01

    BACKGROUND Bowel dysfunction is a known complication of colorectal cancer (CRC) surgery. Poor bowel control has a detrimental impact on survivors’ health-related quality of life (HRQOL). This analysis describes the dietary and behavioral adjustments used by CRC survivors to manage bowel dysfunction and compares adjustments used by survivors with permanent ostomy to those with anastomosis. METHODS This mixed-methods analysis included pooled data from several studies that assessed HRQOL in CRC survivors. In all studies, CRC survivors with or without permanent ostomies (N=856) were surveyed using the City of Hope Quality of Life Colorectal Cancer tool. Dietary adjustments were compared by ostomy status and by overall HRQOL score (high versus low). Qualitative data from 13 focus groups and 30 interviews were analyzed to explore specific strategies used by survivors to manage bowel dysfunction. RESULTS CRC survivors made substantial, permanent dietary and behavioral adjustments after surgery, regardless of ostomy status. Survivors who took longer after surgery to become comfortable with their diet or regain their appetite were more likely to report worse HRQOL. Adjustments to control bowel function were divided into four major strategies: dietary adjustments, behavioral adjustments, exercise, and medication use. CONCLUSIONS CRC survivors struggled with unpredictable bowel function and may fail to find a set of management strategies to achieve regularity. Understanding the myriad adjustments used by CRC survivors may lead to evidence-based interventions to foster positive adjustments after surgery and through long-term survivorship. PMID:26159443

  10. Long-Term Mechanical Ventilation.

    Science.gov (United States)

    Sahetya, Sarina; Allgood, Sarah; Gay, Peter C; Lechtzin, Noah

    2016-12-01

    Although precise numbers are difficult to obtain, the population of patients receiving long-term ventilation has increased over the last 20 years, and includes patients with chronic lung diseases, neuromuscular diseases, spinal cord injury, and children with complex disorders. This article reviews the equipment and logistics involved with ventilation outside of the hospital. Discussed are common locations for long-term ventilation, airway and secretion management, and many of the potential challenges faced by individuals on long-term ventilation. Published by Elsevier Inc.

  11. The clinical effectiveness and cost-effectiveness of long-term weight management schemes for adults: a systematic review.

    Science.gov (United States)

    Loveman, E; Frampton, G K; Shepherd, J; Picot, J; Cooper, K; Bryant, J; Welch, K; Clegg, A

    2011-01-01

    To assess the long-term clinical effectiveness and cost-effectiveness of multicomponent weight management schemes for adults in terms of weight loss and maintenance of weight loss. Bibliographic databases were searched from inception to December 2009, including the Cochrane Library, MEDLINE (Ovid), EMBASE (Ovid), and MEDLINE In-Process & Other Non-Indexed Citations. Bibliographies of related papers were screened, key conferences and symposia were searched and experts were contacted to identify additional published and unpublished references. For the clinical effectiveness review, two reviewers independently screened titles and abstracts for eligibility. Inclusion criteria were applied to the full text of retrieved papers by one reviewer and checked by a second reviewer using a pre-piloted inclusion flow chart. The studies were long-term randomised controlled trials (RCTs) of adult participants who were classified by body mass index as overweight or obese. Interventions were multicomponent weight management programmes (including diet, physical activity and behaviour change strategies) that assessed weight measures. Programmes that involved the use of over-the-counter medicines licensed in the UK were also eligible. For the cost-effectiveness review two reviewers independently screened studies for inclusion. Cost-effectiveness, cost-utility, cost-benefit or cost-consequence analyses were eligible. Data were extracted using a standardised and pre-piloted data extraction form. The quality of included studies was assessed using standard criteria. Studies were synthesised through a narrative review with full tabulation of results. A total of 3358 references were identified, of which 12 were included in the clinical effectiveness review. Five RCTs compared multicomponent interventions with non-active comparator groups. In general, weight loss appeared to be greater in the intervention groups than in the comparator groups. Two RCTs compared multicomponent interventions

  12. An intervention to promote patient participation and self-management in long term conditions: development and feasibility testing

    Directory of Open Access Journals (Sweden)

    Chew-Graham Carolyn

    2010-07-01

    Full Text Available Abstract Background There is worldwide interest in managing the global burden of long-term conditions. Current health policy places emphasis on self-management and supporting patient participation as ways of improving patient outcomes and reducing costs. However, achieving genuine participation is difficult. This paper describes the development of an intervention designed to promote participation in the consultation and facilitate self-management in long-term conditions. In line with current guidance on the development of complex interventions, our aim was to develop and refine the initial intervention using qualitative methods, prior to more formal evaluation. Methods We based the intervention on published evidence on effective ways of improving participation. The intervention was developed, piloted and evaluated using a range of qualitative methods. Firstly, focus groups with stakeholders (5 patients and 3 clinicians were held to introduce the prototype and elucidate how it could be improved. Then individual 'think aloud' and qualitative interviews (n = 10 were used to explore how patients responded to and understood the form and provide further refinement. Results The literature highlighted that effective methods of increasing participation include the use of patient reported outcome measures and values clarification exercises. The intervention (called PRISMS integrated these processes, using a structured form which required patients to identify problems, rate their magnitude and identify their priority. PRISMS was well received by patients and professionals. In the individual qualitative interviews the main themes that emerged from the data related to (a the content of the PRISMS (b the process of completing PRISMS and how it could be operationalised in practice and (c the outcomes of completing PRISMS for the patient. A number of different functions of PRISMS were identified by patients including its use as an aide-memoire, to provide a

  13. Palaeolithic use of fossil combustible linked to singular environmental conditions : the long term el Kowm record (Syria).

    Science.gov (United States)

    Courty, M.-A.; Le Tensorer, J.-M.; Boëda, E.; Muhesen, S.; Alsakhel, E.; Wegmüller, F.

    2012-04-01

    Identifying the adaptation of hunter-gatherer communities to particular situations that provided natural resources is a major concern for multidisciplinary team studying archaeological contexts. This challenge is illustrated in the desertic El Kowm basin in central Syria by data from Hummal and El Kowm Paleolithic sites. The sites form prominent mounds at artesian springs resulting from recurrent episodes of lacustrine, limnic and aeolian sedimentation in pseudo-karstic depressions. The few meter sequences provide semi-continuous succession of archaeological levels from the Oldest Palaeolithic (Oldowan) to the early Neolithic period. This long term continuity of occupation is partly due to attracting conditions due to the profusion of water from epithermal artesian wells during periods of high water recharge. In addition, we document here the unique potential of this endoreic basin to have accumulated singular fossil combustible of high energy value during particular environmental episodes. The latter are represented by the recurrence of distinctive black organogenic facies showing a contrasting micro stratification formed of interlayered grey calcareous silty clay, dark brown organic rich clay and dull orange clay. Spatial excavation has shown the unique preservation of Palaeolithic occupation surfaces in association to the microstratified facies. High resolution sampling and multi-proxy analysis have allowed explaining the formation of the microstratified facies from rapid changes of environmental conditions in response to contrasting fluctuations of atmospheric dust loading, precipitation events, rainwater quality and evapotranspiration. Organogenic microfacies formed at different time periods share common compositional assemblage and structural behaviour: occurrence of exotic fine sand-sized debris formed of metal-rich carbonaceous components with polymer, fine charcoal, vitrous carbon, carbon fibres, and exotic rock clasts with a metal-rich carbonaceous

  14. Long-Term Managed Aquifer Recharge in a Saline-Water Aquifer as a Critical Component of an Integrated Water Scheme in Southwestern Florida, USA

    Directory of Open Access Journals (Sweden)

    Thomas M. Missimer

    2017-10-01

    Full Text Available Managed Aquifer Recharge (MAR systems can be used within the context of integrated water management to create solutions to multiple objectives. Southwestern Florida is faced with severe environmental problems associated with the wet season discharge of excessive quantities of surface water containing high concentrations of nutrients into the Caloosahatchee River Estuary and a future water supply shortage. A 150,000 m3/day MAR system is proposed as an economic solution to solve part of the environmental and water supply issues. Groundwater modeling has demonstrated that the injection of about 150,000 m3/day into the Avon Park High Permeable Zone will result in the creation of a 1000 m wide plume of fresh and brackish-water (due to mixing extending across the water short area over a 10-year period. The operational cost of the MAR injection system would be less than $0.106/m3 and the environmental benefits would alone more than cover this cost in the long term. In addition, the future unit water supply cost to the consumer would be reduced from $1 to $1.25/m3 to $0.45 to $0.65/m3.

  15. Long-Term Stewardship Baseline Report and Transition Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Kristofferson, Keith

    2001-11-01

    Long-term stewardship consists of those actions necessary to maintain and demonstrate continued protection of human health and the environment after facility cleanup is complete. As the Department of Energy’s (DOE) lead laboratory for environmental management programs, the Idaho National Engineering and Environmental Laboratory (INEEL) administers DOE’s long-term stewardship science and technology efforts. The INEEL provides DOE with technical, and scientific expertise needed to oversee its long-term environmental management obligations complexwide. Long-term stewardship is administered and overseen by the Environmental Management Office of Science and Technology. The INEEL Long-Term Stewardship Program is currently developing the management structures and plans to complete INEEL-specific, long-term stewardship obligations. This guidance document (1) assists in ensuring that the program leads transition planning for the INEEL with respect to facility and site areas and (2) describes the classes and types of criteria and data required to initiate transition for areas and sites where the facility mission has ended and cleanup is complete. Additionally, this document summarizes current information on INEEL facilities, structures, and release sites likely to enter long-term stewardship at the completion of DOE’s cleanup mission. This document is not intended to function as a discrete checklist or local procedure to determine readiness to transition. It is an overarching document meant as guidance in implementing specific transition procedures. Several documents formed the foundation upon which this guidance was developed. Principal among these documents was the Long-Term Stewardship Draft Technical Baseline; A Report to Congress on Long-Term Stewardship, Volumes I and II; Infrastructure Long-Range Plan; Comprehensive Facility Land Use Plan; INEEL End-State Plan; and INEEL Institutional Plan.

  16. Long-Term Outcome of Interdisciplinary Management of Patients with Duchenne Muscular Dystrophy Receiving Daily Glucocorticoid Treatment.

    Science.gov (United States)

    Wong, Brenda L; Rybalsky, Irina; Shellenbarger, Karen C; Tian, Cuixia; McMahon, Mary A; Rutter, Meilan M; Sawnani, Hemant; Jefferies, John L

    2017-03-01

    To evaluate clinical outcomes and steroid side effects in a cohort of patients with Duchenne muscular dystrophy (DMD) treated with long-term daily glucocorticoid therapy. Although daily glucocorticoid therapy has been shown to extend ambulatory function in DMD, less frequent dosing is often used because of side effect concerns. Retrospective study of 97 patients with DMD aged 10 to gastrointestinal symptoms, behavior, hypertrichosis, and need for medication interventions. For 13- to 16-year-old patients, 40% could rise from the floor and 50% could perform the 30-foot run test. Forced vital capacity for the entire cohort was well preserved. Thirteen percent of younger (10- to 20 degrees). Eighty-six percent had normal weight velocities; 30% had no increased facial fullness; 72% had short stature; and 19% had asymptomatic cataracts. Asymptomatic spine compression deformities were noted in 76% and long bone fractures in 30%. One patient stopped glucocorticoid because of behavioral concerns. With evidence for improved outcomes and manageable side effects, we recommend use of daily glucocorticoid therapy for patients with DMD with anticipatory management of side effects and a coordinated interdisciplinary care approach. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Increasing the Frequency and Timeliness of Pain Assessment and Management in Long-Term Care: Knowledge Transfer and Sustained Implementation

    Directory of Open Access Journals (Sweden)

    Thomas Hadjistavropoulos

    2016-01-01

    Full Text Available Background. Although feasible protocols for pain assessment and management in long-term care (LTC have been developed, these have not been implemented on a large-scale basis. Objective. To implement a program of regular pain assessment in two LTC facilities, using implementation science principles, and to evaluate the process and success of doing so. Methods. The implementation protocol included a pain assessment workshop and the establishment of a nurse Pain Champion. Quality indicators were tracked before and after implementation. Focus groups and interviews with staff were also conducted. Results. The implementation effort was successful in increasing and regularizing pain assessments. This was sustained during the follow-up period. Staff members reported enthusiasm about the protocol at baseline and positive results following its implementation. Despite the success in increasing assessments, we did not identify changes in the percentages of patients reported as having moderate-to-severe pain. Discussion. It is our hope that our feasibility demonstration will encourage more facilities to improve their pain assessment/management practices. Conclusions. It is feasible to implement regular and systematic pain assessment in LTC. Future research should focus on ensuring effective clinical practices in response to assessment results, and determination of longer-term sustainability.

  18. Conceptualisation of the 'good' self-manager: A qualitative investigation of stakeholder views on the self-management of long-term health conditions.

    Science.gov (United States)

    Ellis, J; Boger, E; Latter, S; Kennedy, A; Jones, F; Foster, C; Demain, S

    2017-03-01

    Healthcare policy in developed countries has, in recent years, promoted self-management among people with long-term conditions. Such policies are underpinned by neoliberal philosophy, as seen in the promotion of greater individual responsibility for health through increased support for self-management. Yet still little is known about how self-management is understood by commissioners of healthcare services, healthcare professionals, people with long-term conditions and family care-givers. The evidence presented here is drawn from a two-year study, which investigated how self-management is conceptualised by these stakeholder groups. Conducted in the UK between 2013 and 2015, this study focused on three exemplar long-term conditions, stroke, diabetes and colorectal cancer, to explore the issue. Semi-structured interviews and focus groups were carried out with 174 participants (97 patients, 35 family care-givers, 20 healthcare professionals and 22 commissioners). The data is used to demonstrate how self-management is framed in terms of what it means to be a 'good' self-manager. The 'good' self-manager is an individual who is remoralised; thus taking responsibility for their health; is knowledgeable and uses this to manage risks; and, is 'active' in using information to make informed decisions regarding health and social wellbeing. This paper examines the conceptualisation of the 'good' self-manager. It demonstrates how the remoralised, knowledgeable and active elements are inextricably linked, that is, how action is knowledge applied and how morality underlies all action of the 'good' self-manager. Through unpicking the 'good' self-manager the problems of neoliberalism are also revealed and addressed here. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Multi-configuration electromagnetic induction measurements at long term agricultural test sites in Germany with different fertilizer and irrigation managements

    Science.gov (United States)

    Kaufmann, Manuela Sarah; von Hebel, Christian; Brogi, Cosimo; Baumecker, Michael; Döring, Thomas; Amelung, Wulf; Vereecken, Harry; van der Kruk, Jan

    2017-04-01

    Electromagnetic induction (EMI) data are often being used to investigate large scale soil properties including clay content, soil water content, and salinity changes for a wide range of applications. For agricultural sites, different management practices such as organic/mineral fertilization, tillage, and/or irrigation are important when interpreting the measured apparent electrical conductivity (ECa). Here, we present EMI data recorded at two long term field experiment (LTFE) agricultural test sites in Thyrow near Berlin (Germany), where different long term fertilizer and irrigation management practices were applied. We used two fixed-boom multi-coil EMI instruments that simultaneously measure over nine different depths of investigation (DOI), recording information ranging between the very shallow (0-0.25 m) ploughing zone including the organic matter and the surface soil (A-Horizon) down to the relatively deep (0-2.7 m) subsoil (B-Horizon) or even substratum (C-Horizon). At both test sites, the prevailing sandy to silty sand in the A- and B-Horizon is underlain by a glacial till C-Horizon resulting in generally low ECa values between 0.5 and 5 mS/m. At one test site, a "static nutrient deficiency experiment" is performed since 1937, where organic fertilizer (farm yard manure) and mineral fertilizers (nitrogen-phosphate-potassium (NPK) and liming) are applied at specific grids. Comparing the fertilizer application grid to the measured EMI data, the lowest ECa values coincide to unfertilized grids whereas the ECa values increase with liming, farm yard manure, and NPK. The visually observed correlation between ECa and the liming treatment was possibly due to the increased pH of the soil, because the fertilizer application increases ion contents that increase the soil electrical conductivity. At the second test site, a "Static Irrigation and Fertilizer Experiment" is conducted, where next to the fertilizer treatment (farm yard manure and nitrogen) part of the field

  20. Long-term management changes topsoil and subsoil organic carbon and nitrogen dynamics in a temperate agricultural system.

    Science.gov (United States)

    Gregory, A S; Dungait, J A J; Watts, C W; Bol, R; Dixon, E R; White, R P; Whitmore, A P

    2016-07-01

    Soil organic carbon (SOC) and nitrogen (N) contents are controlled partly by plant inputs that can be manipulated in agricultural systems. Although SOC and N pools occur mainly in the topsoil (upper 0.30 m), there are often substantial pools in the subsoil that are commonly assumed to be stable. We tested the hypothesis that contrasting long-term management systems change the dynamics of SOC and N in the topsoil and subsoil (to 0.75 m) under temperate conditions. We used an established field experiment in the UK where control grassland was changed to arable (59 years before) and bare fallow (49 years before) systems. Losses of SOC and N were 65 and 61% under arable and 78 and 74% under fallow, respectively, in the upper 0.15 m when compared with the grass land soil, whereas at 0.3-0.6-m depth losses under arable and fallow were 41 and 22% and 52 and 35%, respectively. The stable isotopes (13)C and (15)N showed the effects of different treatments. Concentrations of long-chain n-alkanes C27, C29 and C31 were greater in soil under grass than under arable and fallow. The dynamics of SOC and N changed in both topsoil and subsoil on a decadal time-scale because of changes in the balance between inputs and turnover in perennial and annual systems. Isotopic and geochemical analyses suggested that fresh inputs and decomposition processes occur in the subsoil. There is a need to monitor and predict long-term changes in soil properties in the whole soil profile if soil is to be managed sustainably. Land-use change affects soil organic carbon and nitrogen, but usually the topsoil only is considered.Grassland cultivated to arable and fallow lost 13-78% SOC and N to 0.6 m depth within decades.Isotopic and biomarker analyses suggested changes in delivery and turnover of plant-derived inputs.The full soil profile must be considered to assess soil quality and sustainability.

  1. Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association.

    Science.gov (United States)

    Munshi, Medha N; Florez, Hermes; Huang, Elbert S; Kalyani, Rita R; Mupanomunda, Maria; Pandya, Naushira; Swift, Carrie S; Taveira, Tracey H; Haas, Linda B

    2016-02-01

    Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly

  2. Environmental Management

    DEFF Research Database (Denmark)

    Lehmann, Martin

    The doctoral research project is co-financed by DUCED-I&UA and is part of a joint effort of Thai, Malay, South African and Danish universities to conduct collaborative research on the overarching theme "Environmental Management: Globalisation and Industrial Governance in Developing Countries......". The PhD project is expected to conclude ultimo 2005. Environmental management and cleaner production (CP) are both internationally recognised as tools for minimising environmental impacts of production or services. However, several studies have shown that especially SMEs, which probably amount to more...... than 90 percent of the total number of enterprises, are experiencing a vast number of both external and internal barriers towards the implementation of preventative environmental measures. In general, SMEs are therefore not introducing such improvements to the same extents as larger companies are...

  3. Patient Safety Policy in Long-Term Care: A Research Protocol to Assess Executive WalkRounds to Improve Management of Early Warning Signs for Patient Safety.

    Science.gov (United States)

    van Dusseldorp, Loes; Hamers, Hub; van Achterberg, Theo; Schoonhoven, Lisette

    2014-07-15

    At many hospitals and long-term care organizations (such as nursing homes), executive board members have a responsibility to manage patient safety. Executive WalkRounds offer an opportunity for boards to build a trusting relationship with professionals and seem useful as a leadership tool to pick up on soft signals, which are indirect signals or early warnings that something is wrong. Because the majority of the research on WalkRounds has been performed in hospitals, it is unknown how board members of long-term care organizations develop their patient safety policy. Also, it is not clear if these board members use soft signals as a leadership tool and, if so, how this influences their patient safety policies. The objective of this study is to explore the added value and the feasibility of WalkRounds for patient safety management in long-term care. This study also aims to identify how executive board members of long-term care organizations manage patient safety and to describe the characteristics of boards. An explorative before-and-after study was conducted between April 2012 and February 2014 in 13 long-term care organizations in the Netherlands. After implementing the intervention in 6 organizations, data from 72 WalkRounds were gathered by observation and a reporting form. Before and after the intervention period, data collection included interviews, questionnaires, and studying reports of the executive boards. A mixed-method analysis is performed using descriptive statistics, t tests, and content analysis. Results are expected to be ready in mid 2014. It is a challenge to keep track of ongoing development and implementation of patient safety management tools in long-term care. By performing this study in cooperation with the participating long-term care organizations, insight into the potential added value and the feasibility of this method will increase.

  4. Responses of bacterial and archaeal ammonia oxidizers to soil organic and fertilizer amendments under long-term management

    Energy Technology Data Exchange (ETDEWEB)

    Wessen, E.; Nyberg, K.; Jansson, J.K.; Hallin, S.

    2010-05-01

    Ammonia-oxidizing bacteria (AOB) and ammonia-oxidizing archaea (AOA) co-exist in soil, but their relative distribution may vary depending on the environmental conditions. Effects of changes in soil organic matter and nutrient content on the AOB and AOA are poorly understood. Our aim was to compare effects of long-term soil organic matter depletion and amendments with labile (straw) and more recalcitrant (peat) organic matter, with and without easily plant-available nitrogen, on the activities, abundances and community structures of AOB and AOA. Soil was sampled from a long-term field site in Sweden that was established in 1956. The potential ammonia oxidation rates, the AOB and AOA amoA gene abundances and the community structures of both groups based on T-RFLP of amoA genes were determined. Straw amendment during 50 years had not altered any of the measured soil parameters, while the addition of peat resulted in a significant increase of soil organic carbon as well as a decrease in pH. Nitrogen fertilization alone resulted in a small decrease in soil pH, organic carbon and total nitrogen, but an increase in primary production. Type and amount of organic matter had an impact on the AOB and AOA community structures and the AOA abundance. Our findings confirmed that AOA are abundant in soil, but showed that under certain conditions the AOB dominate, suggesting niche differentiation between the two groups at the field site. The large differences in potential rates between treatments correlated to the AOA community size, indicating that they were functionally more important in the nitrification process than the AOB. The AOA abundance was positively related to addition of labile organic carbon, which supports the idea that AOA could have alternative growth strategies using organic carbon. The AOB community size varied little in contrast to that of the AOA. This indicates that the bacterial ammonia oxidizers as a group have a greater ecophysiological diversity and

  5. Exploring physiotherapists' experiences of implementing a cognitive behavioural approach for managing low back pain and identifying barriers to long-term implementation.

    Science.gov (United States)

    Richmond, Helen; Hall, Amanda M; Hansen, Zara; Williamson, Esther; Davies, David; Lamb, Sarah E

    2017-06-01

    Our objectives were two-fold: (i) to describe physiotherapists' experiences of implementing a cognitive behavioural approach (CBA) for managing low back pain (LBP) after completing an extensive online training course (iBeST), and (ii) to identify how iBeST could be enhanced to support long-term implementation before scale up for widespread use. We conducted semi-structured interviews with 11 physiotherapists from six National Health Service departments in the Midlands, Oxfordshire and Derbyshire. Questions centred on (i) using iBeST to support implementation, (ii) what barriers they encountered to implementation and (iii) what of information or resources they required to support sustained implementation. Interviews were transcribed and thematically analysed using NVivo. Themes were categorised using the Theoretical Domains Framework (TDF). Evidence-based techniques were identified using the behaviour change technique taxonomy to target relevant TDF domains. Three themes emerged from interviews: anxieties about using a CBA, experiences of implementing a CBA, and sustainability for future implementation of a CBA. Themes crossed multiple TDF domains and indicated concerns with knowledge, beliefs about capabilities and consequences, social and professional roles, social influences, emotion, and environmental context and resources. We identified evidence-based strategies that may support sustainable implementation of a CBA for LBP in a physiotherapy setting. This study highlighted potential challenges for physiotherapists in the provision of evidence-based LBP care within the current UK NHS. Using the TDF provided the foundation to develop a tailored, evidence-based, implementation intervention to support long term use of a CBA by physiotherapists managing LBP within UK NHS outpatient departments. Copyright © 2017 Chartered Society of Physiotherapy. All rights reserved.

  6. GMDPtoolbox: A Matlab library for designing spatial management policies. Application to the long-term collective management of an airborne disease.

    Science.gov (United States)

    Cros, Marie-Josée; Aubertot, Jean-Noël; Peyrard, Nathalie; Sabbadin, Régis

    2017-01-01

    Designing management policies in ecology and agroecology is complex. Several components must be managed together while they strongly interact spatially. Decision choices must be made under uncertainty on the results of the actions and on the system dynamics. Furthermore, the objectives pursued when managing ecological systems or agroecosystems are usually long term objectives, such as biodiversity conservation or sustainable crop production. The framework of Graph-Based Markov Decision Processes (GMDP) is well adapted to the qualitative modeling of such problems of sequential decision under uncertainty. Spatial interactions are easily modeled and integrated control policies (combining several action levers) can be designed through optimization. The provided policies are adaptive, meaning that management actions are decided at each time step (for instance yearly) and the chosen actions depend on the current system state. This framework has already been successfully applied to forest management and invasive species management. However, up to now, no "easy-to-use" implementation of this framework was available. We present GMDPtoolbox, a Matlab toolbox which can be used both for the design of new management policies and for comparing policies by simulation. We provide an illustration of the use of the toolbox on a realistic crop disease management problem: the design of long term management policy of blackleg of canola using an optimal combination of three possible cultural levers. This example shows how GMDPtoolbox can be used as a tool to support expert thinking.

  7. GMDPtoolbox: A Matlab library for designing spatial management policies. Application to the long-term collective management of an airborne disease

    Science.gov (United States)

    Aubertot, Jean-Noël; Peyrard, Nathalie; Sabbadin, Régis

    2017-01-01

    Designing management policies in ecology and agroecology is complex. Several components must be managed together while they strongly interact spatially. Decision choices must be made under uncertainty on the results of the actions and on the system dynamics. Furthermore, the objectives pursued when managing ecological systems or agroecosystems are usually long term objectives, such as biodiversity conservation or sustainable crop production. The framework of Graph-Based Markov Decision Processes (GMDP) is well adapted to the qualitative modeling of such problems of sequential decision under uncertainty. Spatial interactions are easily modeled and integrated control policies (combining several action levers) can be designed through optimization. The provided policies are adaptive, meaning that management actions are decided at each time step (for instance yearly) and the chosen actions depend on the current system state. This framework has already been successfully applied to forest management and invasive species management. However, up to now, no “easy-to-use” implementation of this framework was available. We present GMDPtoolbox, a Matlab toolbox which can be used both for the design of new management policies and for comparing policies by simulation. We provide an illustration of the use of the toolbox on a realistic crop disease management problem: the design of long term management policy of blackleg of canola using an optimal combination of three possible cultural levers. This example shows how GMDPtoolbox can be used as a tool to support expert thinking. PMID:28982151

  8. Combined management of retroperitoneal sarcoma with dose intensification radiotherapy and resection: Long-term results of a prospective trial.

    LENUS (Irish Health Repository)

    Smith, Myles J F

    2014-01-07

    Late failure is a challenging problem following resection of retroperitoneal sarcoma (RPS). We investigated the effects of preoperative XRT plus dose escalation with early postoperative brachytherapy (BT) on long-term survival and recurrence in RPS.

  9. Long-term engagement with a mobile self-management system for people with type 2 diabetes.

    Science.gov (United States)

    Tatara, Naoe; Arsand, Eirik; Skrøvseth, Stein Olav; Hartvigsen, Gunnar

    2013-03-27

    In a growing number of intervention studies, mobile phones are used to support self-management of people with Type 2 diabetes mellitus (T2DM). However, it is difficult to establish knowledge about factors associated with intervention effects, due to considerable differences in research designs and outcome measures as well as a lack of detailed information about participants' engagement with the intervention tool. To contribute toward accumulating knowledge about factors associated with usage and usability of a mobile self-management application over time through a thorough analysis of multiple types of investigation on each participant's engagement. The Few Touch application is a mobile-phone-based self-management tool for patients with T2DM. Twelve patients with T2DM who have been actively involved in the system design used the Few Touch application in a real-life setting from September 2008 until October 2009. During this period, questionnaires and semistructured interviews were conducted. Recorded data were analyzed to investigate usage trends and patterns. Transcripts from interviews were thematically analyzed, and the results were further analyzed in relation to the questionnaire answers and the usage trends and patterns. The Few Touch application served as a flexible learning tool for the participants, responsive to their spontaneous needs, as well as supporting regular self-monitoring. A significantly decreasing (Plearning materials, especially about foods. Many grounded design implications were identified through a thorough analysis of results from multiple types of investigations obtained through a year-long field trial of the Few Touch application. The study showed the importance and value of involving patient-users in a long-term trial of a tool to identify factors influencing usage and usability over time. In addition, the study confirmed the importance of detailed analyses of each participant's usage of the provided tool for better understanding of

  10. Soil Biological Activity Contributing to Phosphorus Availability in Vertisols under Long-Term Organic and Conventional Agricultural Management.

    Science.gov (United States)

    Bhat, Nisar A; Riar, Amritbir; Ramesh, Aketi; Iqbal, Sanjeeda; Sharma, Mahaveer P; Sharma, Sanjay K; Bhullar, Gurbir S

    2017-01-01

    Mobilization of unavailable phosphorus (P) to plant available P is a prerequisite to sustain crop productivity. Although most of the agricultural soils have sufficient amounts of phosphorus, low availability of native soil P remains a key limiting factor to increasing crop productivity. Solubilization and mineralization of applied and native P to plant available form is mediated through a number of biological and biochemical processes that are strongly influenced by soil carbon/organic matter, besides other biotic and abiotic factors. Soils rich in organic matter are expected to have higher P availability potentially due to higher biological activity. In conventional agricultural systems mineral fertilizers are used to supply P for plant growth, whereas organic systems largely rely on inputs of organic origin. The soils under organic management are supposed to be biologically more active and thus possess a higher capability to mobilize native or applied P. In this study we compared biological activity in soil of a long-term farming systems comparison field trial in vertisols under a subtropical (semi-arid) environment. Soil samples were collected from plots under 7 years of organic and conventional management at five different time points in soybean (Glycine max) -wheat (Triticum aestivum) crop sequence including the crop growth stages of reproductive significance. Upon analysis of various soil biological properties such as dehydrogenase, β-glucosidase, acid and alkaline phosphatase activities, microbial respiration, substrate induced respiration, soil microbial biomass carbon, organically managed soils were found to be biologically more active particularly at R2 stage in soybean and panicle initiation stage in wheat. We also determined the synergies between these biological parameters by using the methodology of principle component analysis. At all sampling points, P availability in organic and conventional systems was comparable. Our findings clearly indicate

  11. Soil Biological Activity Contributing to Phosphorus Availability in Vertisols under Long-Term Organic and Conventional Agricultural Management

    Science.gov (United States)

    Bhat, Nisar A.; Riar, Amritbir; Ramesh, Aketi; Iqbal, Sanjeeda; Sharma, Mahaveer P.; Sharma, Sanjay K.; Bhullar, Gurbir S.

    2017-01-01

    Mobilization of unavailable phosphorus (P) to plant available P is a prerequisite to sustain crop productivity. Although most of the agricultural soils have sufficient amounts of phosphorus, low availability of native soil P remains a key limiting factor to increasing crop productivity. Solubilization and mineralization of applied and native P to plant available form is mediated through a number of biological and biochemical processes that are strongly influenced by soil carbon/organic matter, besides other biotic and abiotic factors. Soils rich in organic matter are expected to have higher P availability potentially due to higher biological activity. In conventional agricultural systems mineral fertilizers are used to supply P for plant growth, whereas organic systems largely rely on inputs of organic origin. The soils under organic management are supposed to be biologically more active and thus possess a higher capability to mobilize native or applied P. In this study we compared biological activity in soil of a long-term farming systems comparison field trial in vertisols under a subtropical (semi-arid) environment. Soil samples were collected from plots under 7 years of organic and conventional management at five different time points in soybean (Glycine max) -wheat (Triticum aestivum) crop sequence including the crop growth stages of reproductive significance. Upon analysis of various soil biological properties such as dehydrogenase, β-glucosidase, acid and alkaline phosphatase activities, microbial respiration, substrate induced respiration, soil microbial biomass carbon, organically managed soils were found to be biologically more active particularly at R2 stage in soybean and panicle initiation stage in wheat. We also determined the synergies between these biological parameters by using the methodology of principle component analysis. At all sampling points, P availability in organic and conventional systems was comparable. Our findings clearly indicate

  12. Clinical characteristics, management and long-term outcome of suspected rapid eye movement sleep behaviour disorder in 14 dogs.

    Science.gov (United States)

    Schubert, T A; Chidester, R M; Chrisman, C L

    2011-02-01

    To describe the clinical characteristics, management and long-term outcome in dogs with suspected rapid eye movement sleep behaviour disorder. Medical records and video recordings of 14 dogs with suspected rapid eye movement sleep behaviour disorder were reviewed and the owners were contacted via telephone or email for further information. Clinical signs included episodes of violent limb movements, howling, barking, growling, chewing, or biting during sleep. Episodes occurred at night and during daytime naps. The age at onset ranged from 8 weeks to 7·5 years with a median of 6 years but 64% of dogs were one year or less. There was no apparent sex or breed predisposition. Rapid eye movement sleep behaviour disorder events were reduced in severity and frequency in 78% of the dogs treated with 40 mg/kg/day oral potassium bromide. One dog was euthanized within 3 months of the onset of signs because of their severity. The duration of the disorder in the 13 surviving dogs ranged from 1·5 to 9 years. None of the dogs spontaneously recovered. Rapid eye movement sleep behaviour disorder is suspected to occur in dogs, as it does in human beings. It causes concern to the owners and disrupts the home environment. Unlike human beings, rapid eye movement sleep behaviour disorder of dogs often has a juvenile onset. © 2011 British Small Animal Veterinary Association.

  13. [Multiple Salvage Radiotherapies for Metachronous Lymph Node Metastasis from Gastric Cancer Contributed to Long-Term Management of Disease].

    Science.gov (United States)

    Hori, Naoto; Kagawa, Shunsuke; Kikuchi, Satoru; Kuroda, Shinji; Watanabe, Megumi; Sakamoto, Shuichi; Kagawa, Tetsuya; Kuwada, Kazuya; Kubota, Tetsushi; Kishimoto, Hiroyuki; Nishizaki, Masahiko; Katayama, Norihisa; Fujiwara, Toshiyoshi

    2017-02-01

    A 70-year-old man who underwent gastrectomy for Stage III C gastric cancer developed lymph node(LN)metastasis posterior to the pancreatic head 3 years after the radical surgery.He was first treated with radiotherapy(RT)followed by chemotherapy.The irradiated tumor regressed completely.However, the cancer relapsed in a single para-aortic LN and he was treated with RT to the lesion followed by chemotherapy.Although it completely regressed, later, lung metastasis was observed.The lung lesions were well suppressed by switching to docetaxel; however, the cancer relapsed again in a mediastinal LN, and it was not responsive to docetaxel.The growing mediastinal lesion was irradiated again, which resulted in stable disease.The patient has been treated for 4 years and 7 months with all lesions being well-managed, and chemotherapy is being continued.Recurrent gastric cancer after surgery tends to present as multiple lesions; therefore, the principle therapy is systemic chemotherapy and RT is unlikely to be suitable.However, especially in cases of a solitary lesion that is chemo-resistant, RT could be an optimal option and contribute to long-term survival even in patients with recurrent gastric cancer.

  14. Long-term cost-effectiveness of home versus clinic-based management of chronic heart failure: the WHICH? study.

    Science.gov (United States)

    Maru, Shoko; Byrnes, Joshua M; Carrington, Melinda J; Stewart, Simon; Scuffham, Paul A

    2017-04-01

    The cost-effectiveness of a heart failure management intervention can be further informed by incorporating the expected benefits and costs of future survival. This study compared the long-term costs per quality-adjusted life year (QALY) gained from home-based (HBI) vs specialist clinic-based intervention (CBI) among elderly patients (mean age = 71 years) with heart failure discharged home (mean intervention duration = 12 months). Cost-utility analysis was conducted from a government-funded health system perspective. A Markov cohort model was used to simulate disease progression over 15 years based on initial data from a randomized clinical trial (the WHICH? study). Time-dependent hazard functions were modeled using the Weibull function, and this was compared against an alternative model where the hazard was assumed to be constant over time. Deterministic and probabilistic sensitivity analyses were conducted to identify the key drivers of cost-effectiveness and quantify uncertainty in the results. During the trial, mortality was the highest within 30 days of discharge and decreased thereafter in both groups, although the declining rate of mortality was slower in CBI than HBI. At 15 years (extrapolated), HBI was associated with slightly better health outcomes (mean of 0.59 QALYs gained) and mean additional costs of AU$13,876 per patient. The incremental cost-utility ratio and the incremental net monetary benefit (vs CBI) were AU$23,352 per QALY gained and AU$15,835, respectively. The uncertainty was driven by variability in the costs and probabilities of readmissions. Probabilistic sensitivity analysis showed HBI had a 68% probability of being cost-effective at a willingness-to-pay threshold of AU$50,000 per QALY. Compared with CBI (outpatient specialized HF clinic-based intervention), HBI (home-based predominantly, but not exclusively) could potentially be cost-effective over the long-term in elderly patients with heart failure at a willingness-to-pay threshold of

  15. Environmental controls on spatial patterns in the long-term persistence of giant kelp in central California

    Science.gov (United States)

    Young, Mary Alida; Cavanaugh, Kyle C.; Bell, Tom W.; Raimondi, Peter T.; Edwards, Christopher A.; Drake, Patrick T.; Erikson, Li H.; Storlazzi, Curt

    2016-01-01

    As marine management is moving towards the practice of protecting static areas, it is 44 important to make sure protected areas capture and protect persistent populations. Rocky reefs in 45 many temperate areas worldwide serve as habitat for canopy forming macroalgae and these 46 structure forming species of kelps (order Laminariales) often serve as important habitat for a great 47 diversity of species. Macrocystis pyrifera is the most common canopy forming kelp species found 48 along the coast of California but the distribution and abundance of M. pyrifera varies in space and 49 time. The purpose of this study is to determine what environmental parameters are correlated with 50 the spatial and temporal persistence of M. pyrifera along the central coast of California and how 51 well those environmental parameters can be used to predict areas where M. pyrifera is more likely 52 to persist. Nine environmental variables considered in this study included depth of the seafloor, 53 structure of the rocky reef, proportion of rocky reef, size of kelp patch, biomass of kelp within a 54 patch, distance from the edge of a kelp patch, sea surface temperature, wave orbital velocities, and 55 population connectivity of individual kelp patches. Using a generalized linear mixed effects model 56 (GLMM), the persistence of M. pyrifera was significantly associated with seven of the nine 57 variables considered: depth, complexity of the rocky reef, proportion of rock, patch biomass, 58 distance from the edge of a patch, population connectivity, and wave-orbital velocities. These 59 seven environmental variables were then used to predict the persistence of kelp across the central 60 coast and these predictions were compared to a reserved dataset of M. pyrifera persistence, which 61 was not used in the creation of the GLMM. The environmental variables were shown to accurately 62 predict the persistence of M. pyrifera within the central coast of California (r = 0.71, P<0.001). 63 Because

  16. Respiratory care year in review 2011: long-term oxygen therapy, pulmonary rehabilitation, airway management, acute lung injury, education, and management.

    Science.gov (United States)

    Dunne, Patrick J; Macintyre, Neil R; Schmidt, Ulrich H; Haas, Carl F; Jones-Boggs Rye, Kathy; Kauffman, Garry W; Hess, Dean R

    2012-04-01

    For the busy clinician, educator, or manager, it is becoming an increasing challenge to filter the literature to what is relevant to one's practice and then update one's practice based on the current evidence. The purpose of this paper is to review the recent literature related to long-term oxygen therapy, pulmonary rehabilitation, airway management, acute lung injury and acute respiratory distress syndrome, respiratory care education, and respiratory care management. These topics were chosen and reviewed in a manner that is most likely to have interest to the readers of Respiratory Care.

  17. The National Wind Erosion Research Network: Building a standardized long-term data resource for aeolian research, modeling and land management

    Science.gov (United States)

    Webb, Nicholas P.; Herrick, Jeffrey E.; Van Zee, Justin W.; Courtright, Ericha M.; Hugenholtz, Christopher H.; Zobeck, Ted M.; Okin, Gregory S.; Barchyn, Thomas E.; Billings, Benjamin J.; Boyd, Robert; Clingan, Scott D.; Cooper, Brad F.; Duniway, Michael C.; Derner, Justin D.; Fox, Fred A.; Havstad, Kris M.; Heilman, Philip; LaPlante, Valerie; Ludwig, Noel A.; Metz, Loretta J.; Nearing, Mark A.; Norfleet, M. Lee; Pierson, Frederick B.; Sanderson, Matt A.; Sharratt, Brenton S.; Steiner, Jean L.; Tatarko, John; Tedela, Negussie H.; Toledo, David; Unnasch, Robert S.; Van Pelt, R. Scott; Wagner, Larry

    2016-09-01

    The National Wind Erosion Research Network was established in 2014 as a collaborative effort led by the United States Department of Agriculture's Agricultural Research Service and Natural Resources Conservation Service, and the United States Department of the Interior's Bureau of Land Management, to address the need for a long-term research program to meet critical challenges in wind erosion research and management in the United States. The Network has three aims: (1) provide data to support understanding of basic aeolian processes across land use types, land cover types, and management practices, (2) support development and application of models to assess wind erosion and dust emission and their impacts on human and environmental systems, and (3) encourage collaboration among the aeolian research community and resource managers for the transfer of wind erosion technologies. The Network currently consists of thirteen intensively instrumented sites providing measurements of aeolian sediment transport rates, meteorological conditions, and soil and vegetation properties that influence wind erosion. Network sites are located across rangelands, croplands, and deserts of the western US.

  18. Talking about depression: a qualitative study of barriers to managing depression in people with long term conditions in primary care

    Directory of Open Access Journals (Sweden)

    Cherrington Andrea

    2011-03-01

    Full Text Available Abstract Background The risk of depression is increased in people with long term conditions (LTCs and is associated with poorer patient outcomes for both the depressive illness and the LTC, but often remains undetected and poorly managed. The aim of this study was to identify and explore barriers to detecting and managing depression in primary care in people with two exemplar LTCs: diabetes and coronary heart disease (CHD. Methods Qualitative in-depth interviews were conducted with 19 healthcare professionals drawn predominately from primary care, along with 7 service users and 3 carers (n = 29. One focus group was then held with a set of 6 healthcare professionals and a set of 7 service users and 1 carer (n = 14. Interviews and the focus group were digitally recorded, transcribed verbatim, and analysed independently. The two data sets were then inspected for commonalities using a constant comparative method, leading to a final thematic framework used in this paper. Results Barriers to detecting and managing depression in people with LTCs in primary care exist: i when practitioners in partnership with patients conceptualise depression as a common and understandable response to the losses associated with LTCs - depression in the presence of LTCs is normalised, militating against its recognition and treatment; ii where highly performanced managed consultations under the terms of the Quality and Outcomes Framework encourage reductionist approaches to case-finding in people with CHD and diabetes, and iii where there is uncertainty among practitioners about how to negotiate labels for depression in people with LTCs in ways that might facilitate shared understanding and future management. Conclusion Depression was often normalised in the presence of LTCs, obviating rather than facilitating further assessment and management. Furthermore, structural constraints imposed by the QOF encouraged reductionist approaches to case-finding for depression in

  19. Predictors of Short- and Long-Term Attrition From the Parents as Agents of Change Randomized Controlled Trial for Managing Pediatric Obesity.

    Science.gov (United States)

    Spence, Nicholas D; Newton, Amanda S; Keaschuk, Rachel A; Ambler, Kathryn A; Jetha, Mary M; Holt, Nicholas L; Rosychuk, Rhonda J; Spence, John C; Sharma, Arya M; Ball, Geoff D C

    Attrition in pediatric weight management is a substantial problem. This study examined factors associated with short- and long-term attrition from a lifestyle and behavioral intervention for parents of children with overweight or obesity. Fifty-two families with children ages 6 to 12 years old and body mass index at or above the 85th percentile participated in a randomized controlled trial focused on parents, comparing parent-based cognitive behavioral therapy with parent-based psychoeducation for pediatric weight management. We examined program attrition using two clinical phases of the intervention: short-term and long-term attrition, modeled using the general linear model. Predictors included intervention type, child/parent weight status, sociodemographic factors, and health of the family system. Higher self-assessed health of the family system was associated with lower short-term attrition; higher percentage of intervention sessions attended by parents was associated with lower long-term attrition. Different variables were significant in our short- and long-term models. Attrition might best be conceptualized based on short- and long-term phases of clinical, parent-based interventions for pediatric weight management. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  20. Long term fluctuations of groundwater mine pollution in a sulfide mining district with dry Mediterranean climate: Implications for water resources management and remediation.

    Science.gov (United States)

    Caraballo, Manuel A; Macías, Francisco; Nieto, José Miguel; Ayora, Carlos

    2016-01-01

    Water resources management and restoration strategies, and subsequently ecological and human life quality, are highly influenced by the presence of short and long term cycles affecting the intensity of a targeted pollution. On this respect, a typical acid mine drainage (AMD) groundwater from a sulfide mining district with dry Mediterranean climate (Iberian Pyrite Belt, SW Spain) was studied to unravel the effect of long term weather changes in water flow rate and metal pollutants concentration. Three well differentiated polluting stages were observed and the specific geochemical, mineralogical and hydrological processes involved (pyrite and enclosing rocks dissolution, evaporitic salts precipitation-redisolution and pluviometric long term fluctuations) were discussed. Evidencing the importance of including longer background monitoring stage in AMD management and restoration strategies, the present study strongly advise a minimum 5-years period of AMD continuous monitoring previous to the design of any AMD remediation system in regions with dry Mediterranean climate. Copyright © 2015 Elsevier B.V. All rights reserved.

  1. Stakeholder-led science: engaging resource managers to identify science needs for long-term management of floodplain conservation lands

    Science.gov (United States)

    Bouska, Kristin L.; Lindner, Garth; Paukert, Craig; Jacobson, Robert B.

    2016-01-01

    Floodplains pose challenges to managers of conservation lands because of constantly changing interactions with their rivers. Although scientific knowledge and understanding of the dynamics and drivers of river-floodplain systems can provide guidance to floodplain managers, the scientific process often occurs in isolation from management. Further, communication barriers between scientists and managers can be obstacles to appropriate application of scientific knowledge. With the coproduction of science in mind, our objectives were the following: (1) to document management priorities of floodplain conservation lands, and (2) identify science needs required to better manage the identified management priorities under nonstationary conditions, i.e., climate change, through stakeholder queries and interactions. We conducted an online survey with 80 resource managers of floodplain conservation lands along the Upper and Middle Mississippi River and Lower Missouri River, USA, to evaluate management priority, management intensity, and available scientific information for management objectives and conservation targets. Management objectives with the least information available relative to priority included controlling invasive species, maintaining respectful relationships with neighbors, and managing native, nongame species. Conservation targets with the least information available to manage relative to management priority included pollinators, marsh birds, reptiles, and shore birds. A follow-up workshop and survey focused on clarifying science needs to achieve management objectives under nonstationary conditions. Managers agreed that metrics of inundation, including depth and extent of inundation, and frequency, duration, and timing of inundation would be the most useful metrics for management of floodplain conservation lands with multiple objectives. This assessment provides guidance for developing relevant and accessible science products to inform management of highly

  2. Spatiotemporal variation of long-term drought propensity through reliability-resilience-vulnerability based Drought Management Index

    Science.gov (United States)

    Chanda, Kironmala; Maity, Rajib; Sharma, Ashish; Mehrotra, Rajeshwar

    2014-10-01

    This paper characterizes the long-term, spatiotemporal variation of drought propensity through a newly proposed, namely Drought Management Index (DMI), and explores its predictability in order to assess the future drought propensity and adapt drought management policies for a location. The DMI was developed using the reliability-resilience-vulnerability (RRV) rationale commonly used in water resources systems analysis, under the assumption that depletion of soil moisture across a vertical soil column is equivalent to the operation of a water supply reservoir, and that drought should be managed not simply using a measure of system reliability, but should also take into account the readiness of the system to bounce back from drought to a normal state. Considering India as a test bed, 5 year long monthly gridded (0.5° Lat × 0.5° Lon) soil moisture data are used to compute the RRV at each grid location falling within the study domain. The Permanent Wilting Point (PWP) is used as the threshold, indicative of transition into water stress. The association between resilience and vulnerability is then characterized through their joint probability distribution ascertained using Plackett copula models for four broad soil types across India. The joint cumulative distribution functions (CDF) of resilience and vulnerability form the basis for estimating the DMI as a five-yearly time series at each grid location assessed. The status of DMI over the past 50 years indicate that drought propensity is consistently low toward northern and north eastern parts of India but higher in the western part of peninsular India. Based on the observed past behavior of DMI series on a climatological time scale, a DMI prediction model comprising deterministic and stochastic components is developed. The predictability of DMI for a lead time of 5 years is found to vary across India, with a Pearson correlation coefficient between observed and predicted DMI above 0.6 over most of the study area

  3. Analysis of the Long-term Meteorological Data at Kori Nuclear Power Plant for Environmental Impact Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Park, Kihyun; Min, Byung-Il; Kim, Sora; Suh, Kyung-Suk [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2015-05-15

    For the past four years, relatively clear regular patterns were found in terms of wind and atmospheric stability. Wind direction, which is a very essential component for atmospheric dispersion, shows a strong seasonal dependency. We analyzed the long-term meteorological data collected since 1997 at the Kori nuclear power plant. The annual wind tendency shows irregular patterns before 2009. However, for the past four years, clear regular patterns are found in terms of the wind and atmospheric stabilities. Especially, the main wind direction, which is a very essential component for an atmospheric dispersion, shows a strong dependency on the season. During spring and summer, south-west and south-southwest winds are the main winds, whereas north-northeast wind dominates during fall and winter. The annual wind is strongly affected by that of winter.

  4. Long-Term Outcome of Intravitreal Bevacizumab Followed by Ahmed Valve Implantation in the Management of Neovascular Glaucoma.

    Science.gov (United States)

    Tailor, Rajen; Kinsella, Matt T; Clarke, Jonathan C

    2017-10-09

    To report the outcome of intravitreal Bevacizumab followed by Ahmed valve implantation in the management of neovascular glaucoma in a patient group with extended follow-up. The records of 16 patients (18 eyes) with neovascular glaucoma refractory to medical therapy who presented to a single surgeon between 2006-2008 were reviewed. Patients received pan-retinal photocoagulation and then intravitreal Bevacizumab followed by Ahmed valve implantation. The main outcome measures were: control of IOP (with or without additional medication), visual acuity (VA) and failure (IOP >21 mmHg or AGV. The mean pre-operative IOP was 37.1 mmHg (±13.4) on 3.2 (±0.87) medications. Of the 18 eyes, 14 eyes (78%) were treated with AGV alone and 4 eyes (22%) with AGV combined with cataract extraction. Sixteen eyes (89%) received mitomycin C treatment intraoperatively. Post-operatively, the mean follow-up period was 63 months (24-84). At final follow-up, the success rate was 50% (33.3% complete, 16.7% qualified) with a mean IOP of 18.1 mmHg (±9.5) on a mean number of 1.5 (±1.6) medications. The failure rate was 50%, with five eyes (27.8%) not meeting the IOP criteria for success (of these, three eyes required additional surgery to lower the IOP) and five eyes (22.2%) lost light perception. Intravitreal Bevacizumab followed by AGV offers long-term control of IOP without additional surgical intervention in the majority of cases.

  5. Which metastasis management allows long-term survival of synchronous solitary M1b non-small cell lung cancer?

    Science.gov (United States)

    Mordant, Pierre; Arame, Alex; De Dominicis, Florence; Pricopi, Ciprian; Foucault, Christophe; Dujon, Antoine; Le Pimpec-Barthes, Françoise; Riquet, Marc

    2012-03-01

    OBJECTIVES; Patients with extrathoracic synchronous solitary metastasis and non-small cell lung cancer (NSCLC) are rare. The effectiveness of both tumour sites resection is difficult to evaluate because of the high variability among clinical studies. We reviewed our experience regarding the management and prognosis of these patients. The charts of 4668 patients who underwent lung cancer surgery from 1983 to 2006 were retrospectively reviewed. We analysed the epidemiology, treatment, pathology and prognostic characteristics of those with extrathoracic synchronous solitary metastasis amenable to lung cancer surgery on a curative intend. There were 94 patients (sex ratio M/F 3.2/1, mean age 56 years). Surgery included pneumonectomy (n = 27), lobectomy (n = 65) and exploratory thoracotomy (n = 2). Pathology revealed adenocarcinomas (n = 57), squamous cell carcinoma (n = 20), large cell carcinoma (n = 14) and other NSCLC histology (n = 3). Lymphatic extension was N0 (n = 46), N1 (n = 17) and N2 (n = 31). Metastasis involved the brain (n = 57), adrenal gland (n = 12), bone (n = 14), liver (n = 5) and skin (n = 6). Sixty-nine metastases were resected. Five-year survival rate was 16% (median 13 months). Induction therapy, adenocarcinoma, N0 staging and lobectomy were criteria of better prognosis, but metastasis resection was not. These results suggest that extrathoracic synchronous solitary metastasis of pN0 adenocarcinoma may achieve long-term survival in the case of lung resection with or without metastasis resection. This pattern may reflect a specific tumour biology whose solitary metastasis benefits both from surgical or non-surgical treatment.

  6. Impacts of weather on long-term patterns of plant richness and diversity vary with location and management.

    Science.gov (United States)

    Jonas, Jayne L; Buhl, Deborah A; Symstad, Amy J

    2015-09-01

    Better understanding the influence of precipitation and temperature on plant assemblages is needed to predict the effects of climate change. Many studies have examined the relationship between plant productivity and weather (primarily precipitation), but few have directly assessed the relationship between plant richness or diversity and weather despite their increased use as metrics of ecosystem condition. We focus on the grasslands of central North America, which are characterized by high temporal climatic variability. Over the next 100 years, these grasslands are predicted to experience further increased variability in growing season precipitation, as well as increased temperatures, due to global climate change. We assess the portion of interannual variability of richness and diversity explained by weather, how relationships between these metrics and weather vary among plant assemblages, and which aspects of weather best explain temporal variability. We used an information-theoretic approach to assess relationships between long-term plant richness and diversity patterns and a priori weather covariates using six data sets from four grasslands. Weather explained up to 49% and 63% of interannual variability in total plant species richness and diversity, respectively. However, richness and diversity responses to specific weather variables varied both among sites and among experimental treatments within sites. In general, we found many instances in which temperature was of equal or greater importance as precipitation, as well as evidence of the importance of lagged effects and precipitation or temperature variability. Although precipitation has been shown to be a key driver of productivity in grasslands, our results indicate that increasing temperatures alone, without substantial changes in precipitation patterns, could have measurable effects on Great Plains grassland plant assemblages and biodiversity metrics. Our results also suggest that richness and diversity

  7. Long-Term Engagement With a Mobile Self-Management System for People With Type 2 Diabetes

    Science.gov (United States)

    Årsand, Eirik; Skrøvseth, Stein Olav; Hartvigsen, Gunnar

    2013-01-01

    involved. The following factors were identified as associated with usability and/or usage over time: Integration with everyday life; automation; balance between accuracy and meaningfulness of data with manual entry; intuitive and informative feedback; and rich learning materials, especially about foods. Conclusion Many grounded design implications were identified through a thorough analysis of results from multiple types of investigations obtained through a year-long field trial of the Few Touch application. The study showed the importance and value of involving patient-users in a long-term trial of a tool to identify factors influencing usage and usability over time. In addition, the study confirmed the importance of detailed analyses of each participant’s usage of the provided tool for better understanding of participants’ engagement over time. PMID:25100649

  8. Long-term modeling of the forest-grassland ecotone in the French Alps: implications for land management and conservation.

    Science.gov (United States)

    Carlson, Bradley Z; Renaud, Julien; Biron, Pierre Eymard; Choler, Philippe

    2014-07-01

    Understanding decadal-scale land-cover changes has the potential to inform current conservation policies. European mountain landscapes that include numerous protected areas provide a unique opportunity to weigh the long-term influences of land-use practices and climate on forest-grassland ecotone dynamics. Aerial photographs from four dates (1948, 1978, 1993, and 2009) were used to quantify the extent of forest and grassland cover at 5-m resolution across a 150-km2 area in a protected area of the southwestern French Alps. The study area included a grazed zone and a nongrazed zone that was abandoned during the 1970s. We estimated time series of a forestation index (FI) and analyzed the effects of elevation and grazing on FI using a hierarchical linear mixed effect model. Forest extent (composed primarily of mountain pine, Pinus uncinata) expanded from 50.6 km2 in 1948 to 85.5 km2 in 2009, i.e., a 23% increase in relative cover at the expense of grassland communities. Over the sixty-year period, the treeline rose by 118 m, from 1564 to 1682 m. Rapid forest expansion within the nongrazed zone followed the cessation of logging activities and was likely accelerated by climate warming during the 1980s. Within the grazed zone, the maintained presence of sheep did not fully counteract mountain pine expansion and led to highly contrasting rates of land-cover change based on the location of shepherds' cabins and water sources. Projections of FI for 2030 showed remnant patches of intensively used grasslands interspersed in a densely forested matrix. Our analysis of mountain land-cover dynamics provided strong evidence for forest encroachment into grassland habitat despite consistent grazing pressure. This pattern may be attributed to the disappearance of traditional land-use practices such as shrub burning and removal. Our findings prompt land managers to reconsider their initial conservation priority (i.e., the protection of a renowned mountain pine forest) and to implement

  9. Management of women with human papillomavirus persistence: long-term follow-up of a randomized clinical trial.

    Science.gov (United States)

    Elfgren, Kristina; Elfström, K Miriam; Naucler, Pontus; Arnheim-Dahlström, Lisen; Dillner, Joakim

    2017-03-01

    Introduction of human papillomavirus-based screening is ongoing in many countries, given its higher sensitivity and longer-lasting protection compared with cytology-based screening. However, optimal clinical management of human papillomavirus-positive but cytology-negative women is unclear, and additional studies with clinical follow-up are warranted. The aim of the current study was to investigate the long-term outcomes of the clinical management used in a double-blind, randomized clinical trial of human papillomavirus screening conducted in the context of the routine, organized screening program in Sweden. Among 12,527 women aged 32-38 years enrolled in the trial, we followed up the 195 women who attended the colposcopy screening who were cytologically normal but persistently human papillomavirus positive (at least 12 months later; median, 19 months) in the human papillomavirus testing arm (n = 100) or were randomly selected from the control arm (n = 95). Women in the human papillomavirus testing arm were followed up with repeated human papillomavirus testing, cytologies, and colposcopies if persistently human papillomavirus-positive without cervical intraepithelial neoplasia grade 2 or worse. A similar number of random colposcopies and tests were carried out in the control arm. Women were followed up over 13 years for the main outcome measures: cumulative incidence of cervical intraepithelial neoplasia grade 2 or worse and cervical intraepithelial neoplasia grade 3 or worse. Among women who continued to attend and had continuous human papillomavirus persistence, all (40 of 40, 100% [95% confidence interval, 91-100%]) developed cervical intraepithelial neoplasia grade 2 or worse. There were no cases among women who cleared their human papillomavirus persistence (0 of 35, 0% (95% confidence interval, 0-10%) (P < .001). Among women who had had human papillomavirus persistence but did not continue with repeated human papillomavirus tests (unknown persistence

  10. Long-Term Study of Children With ROME III Functional Gastrointestinal Disorders Managed Symptomatically in a Biopsychosocial Model.

    Science.gov (United States)

    Madani, Shailender; Parikh, Suchi; Madani, Rohit S; Krasaelap, Amornluck

    2017-04-01

    Our study evaluated progression of and identified potential factors contributing to outcomes of ROME III defined-functional gastrointestinal disorders (FGIDs) in children treated symptomatically in a biopsychosocial model of care with a long-term follow-up. We performed a retrospective review of pediatric patients who were diagnosed with ROME III defined-FGIDs including functional abdominal pain, functional dyspepsia, irritable bowel syndrome and abdominal migraine. Patients were managed symptomatically in a biopsychosocial model of care from the time of initial diagnosis. Demographics, management, progression and response to treatment assessed as complete, partial, and no improvement were reviewed. Two hundred fifty-eight patients were included with mean age of 10.6 years, female 55.4%, mean number of encounters 3.3 visits, and mean follow-up was 18.7 months (range 2 - 59, SD 15.8). Diagnoses were functional abdominal pain 45%, irritable bowel syndrome 20.9%, multiple 13.2%, functional dyspepsia 12.8%, and abdominal migraine 8.1%. Investigations were performed in most patients: laboratory studies in 93.4% (non-contributory abnormal 23.6%), imaging studies in 45.3% (non-contributory abnormal 5%) and endoscopies in 43.0% (non-contributory abnormal 1.2%). Treatment included medication in 93.7%, and surgery in 1.9% (normal pathology). There were new functional gastrointestinal diagnosis in 11.6%, evolution of FGIDs, from one to another in 12.0%, and recurrence found in 35.7% of patients. There were 60.1% patients in the complete improvement group (CIG) and 39.1% in the partial/no improvement group (PIG/NIG). No statistical difference was found between CIG and PIG/NIG regarding demographics or evaluation. PIG/NIG had more encounters (mean 3.63 vs. 3.11; P = 0.03), had non-contributory lab abnormalities (34.4% vs. 20.0%; P = 0.01), needed more endoscopies (52.4% vs. 36.8%; P = 0.02), required more treatment changes (mean 1.41 vs. 0.81; P biopsychosocial model of care is

  11. The National Wind Erosion Research Network: Building a standardized long-term data resource for aeolian research, modeling and land management

    Science.gov (United States)

    Webb, Nicholas P.; Herrick, Jeffrey E.; Van Zee, Justin W; Courtright, Ericha M; Hugenholtz, Ted M; Zobeck, Ted M; Okin, Gregory S.; Barchyn, Thomas E; Billings, Benjamin J; Boyd, Robert A.; Clingan, Scott D; Cooper, Brad F; Duniway, Michael C.; Derner, Justin D.; Fox, Fred A; Havstad, Kris M.; Heilman, Philip; LaPlante, Valerie; Ludwig, Noel A; Metz, Loretta J; Nearing, Mark A; Norfleet, M Lee; Pierson, Frederick B; Sanderson, Matt A; Sharrat, Brenton S; Steiner, Jean L; Tatarko, John; Tedela, Negussie H; Todelo, David; Unnasch, Robert S; Van Pelt, R Scott; Wagner, Larry

    2016-01-01

    The National Wind Erosion Research Network was established in 2014 as a collaborative effort led by the United States Department of Agriculture’s Agricultural Research Service and Natural Resources Conservation Service, and the United States Department of the Interior’s Bureau of Land Management, to address the need for a long-term research program to meet critical challenges in wind erosion research and management in the United States. The Network has three aims: (1) provide data to support understanding of basic aeolian processes across land use types, land cover types, and management practices, (2) support development and application of models to assess wind erosion and dust emission and their impacts on human and environmental systems, and (3) encourage collaboration among the aeolian research community and resource managers for the transfer of wind erosion technologies. The Network currently consists of thirteen intensively instrumented sites providing measurements of aeolian sediment transport rates, meteorological conditions, and soil and vegetation properties that influence wind erosion. Network sites are located across rangelands, croplands, and deserts of the western US. In support of Network activities, http://winderosionnetwork.org was developed as a portal for information about the Network, providing site descriptions, measurement protocols, and data visualization tools to facilitate collaboration with scientists and managers interested in the Network and accessing Network products. The Network provides a mechanism for engaging national and international partners in a wind erosion research program that addresses the need for improved understanding and prediction of aeolian processes across complex and diverse land use types and management practices.

  12. Patient Safety Policy in Long-Term Care: A Research Protocol to Assess Executive WalkRounds to Improve Management of Early Warning Signs for Patient Safety

    NARCIS (Netherlands)

    Dusseldorp, L. van; Hamers, H.; Achterberg, T. van; Schoonhoven, L.

    2014-01-01

    BACKGROUND: At many hospitals and long-term care organizations (such as nursing homes), executive board members have a responsibility to manage patient safety. Executive WalkRounds offer an opportunity for boards to build a trusting relationship with professionals and seem useful as a leadership

  13. Evaluation of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care: a qualitative study

    NARCIS (Netherlands)

    Roets-Merken, L.M.; Vernooij-Dassen, M.J.F.J.; Zuidema, S.U.; Dees, M.K.; Hermsen, P.G.; Kempen, G.I.; Graff, M.J.L.

    2016-01-01

    OBJECTIVES: To gain insights into the process of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care, and into the factors that contributed to these changes in their perceptions. DESIGN: Qualitative study

  14. Evaluation of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care : a qualitative study

    NARCIS (Netherlands)

    Roets-Merken, Lieve M.; Vernooij-Dassen, Myrra J. F. J.; Zuidema, Sytse U.; Dees, Marianne K.; Hermsen, Pieter G. J. M.; Kempen, Gertrudis I. J. M.; Graff, Maud J. L.

    2016-01-01

    Objectives: To gain insights into the process of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care, and into the factors that contributed to these changes in their perceptions. Design: Qualitative study

  15. Kamp K’aana, a 2-week residential weight management summer camp, shows long-term improvement in body mass index z scores

    Science.gov (United States)

    Long-term effects of Kamp K'aana, a 2-week residential weight management camp, on body mass index (BMI) measures were evaluated on 71 of 108 (66%) obese youth 10 to 14 years of age. Measures were obtained at 11-month study follow-up (n=38) or extracted from medical record (n=33). Compared with basel...

  16. Short- and Long-Term Theory-Based Predictors of Physical Activity in Women Who Participated in a Weight-Management Program

    Science.gov (United States)

    Wasserkampf, A.; Silva, M. N.; Santos, I. C.; Carraça, E. V.; Meis, J. J. M.; Kremers, S. P. J.; Teixeira, P. J.

    2014-01-01

    This study analyzed psychosocial predictors of the Theory of Planned Behavior (TPB) and Self-Determination Theory (SDT) and evaluated their associations with short- and long-term moderate plus vigorous physical activity (MVPA) and lifestyle physical activity (PA) outcomes in women who underwent a weight-management program. 221 participants (age…

  17. Implementation of Medicaid Managed Long-Term Services and Supports for Adults with Intellectual And/Or Developmental Disabilities in Kansas

    Science.gov (United States)

    Williamson, Heather J.; Perkins, Elizabeth A.; Levin, Bruce L.; Baldwin, Julie A.; Lulinski, Amie; Armstrong, Mary I.; Massey, Oliver T.

    2017-01-01

    Many adults with intellectual and/or developmental disabilities (IDD) can access health and long-term services and supports (LTSS) through Medicaid. States are reforming their Medicaid LTSS programs from a fee-for-service model to a Medicaid managed LTSS (MLTSS) approach, anticipating improved quality of care and reduced costs, although there is…

  18. Impact of chronic kidney disease on long-term ischemic and bleeding outcomes in medically managed patients with acute coronary syndromes

    DEFF Research Database (Denmark)

    Melloni, Chiara; Cornel, Jan H; Hafley, Gail

    2016-01-01

    AIMS: We aimed to study the relationship of chronic kidney disease stages with long-term ischemic and bleeding outcomes in medically managed acute coronary syndrome patients and the influence of more potent antiplatelet therapies on platelet reactivity by chronic kidney disease stage. METHODS AND...

  19. Similar long-term survival of consecutive in-hospital and out-of-hospital cardiac arrest patients treated with targeted temperature management

    DEFF Research Database (Denmark)

    Engsig, Magaly; Søholm, Helle; Folke, Fredrik

    2016-01-01

    OBJECTIVE: The long-term survival of in-hospital cardiac arrest (IHCA) patients treated with targeted temperature management (TTM) is poorly described. The aim of this study was to compare the outcomes of consecutive IHCA with out-of-hospital cardiac arrest (OHCA) patients treated with TTM. DESIGN...... SETTING AND PATIENTS: Retrospectively collected data on all consecutive adult patients treated with TTM at a university tertiary heart center between 2005 and 2011 were analyzed. MEASUREMENTS: Primary endpoints were survival to hospital discharge and long-term survival. Secondary endpoint was neurological...

  20. Commissioning of self-management support for people with long-term conditions: an exploration of commissioning aspirations and processes.

    Science.gov (United States)

    Reidy, Claire; Kennedy, Anne; Pope, Catherine; Ballinger, Claire; Vassilev, Ivo; Rogers, Anne

    2016-07-15

    To explore how self-management support (SMS) is considered and conceptualised by Clinical Commissioning Groups (CCGs) and whether this is reflected in strategic planning and commissioning. SMS is an essential element of long-term condition (LTC) management and CCGs are responsible for commissioning services that are coordinated, integrated and link into patient's everyday lives. This focus provides a good test and exemplar for how commissioners communicate with their local population to find out what they need. A multisite, quasi-ethnographic exploration of 9 CCGs. National Health Service (NHS) CCGs in southern England, representing varied socioeconomic status, practice sizes and rural and urban areas. Content analysis of CCG forward plans for mention of SMS. Semistructured interviews with commissioners (n=10) explored understanding of SMS and analysed thematically. The practice of commissioning explored through the observations of Service User Researchers (n=5) attending Governing Body meetings (n=10, 30 hours). Observations illuminate the relative absence of SMS and gateways to active engagement with patient and public voices. Content analysis of plans point to tensions between local aspirations and those identified by NHS England for empowering patients by enhancing SMS services ('person-centred', whole systems). Interview data highlight disparities in the process of translating the forward plans into practice. Commissioners reference SMS as a priority yet details of local initiatives are notably absent with austerity (cost-containment) and nationally measured biomedical outcomes taking precedence. Commissioners conceptualise locally sensitive SMS as a means to improve health and reduce service use, but structural and financial constraints result in prioritisation of nationally driven outcome measures and payments relating to biomedical targets. Ultimately, there is little evidence of local needs driving SMS in CCGs. CCGs need to focus more on early strategic

  1. Long-term monitoring for conservation management: Lessons from a case study integrating remote sensing and field approaches in floodplain forests.

    Science.gov (United States)

    Rodríguez-González, Patricia María; Albuquerque, António; Martínez-Almarza, Miguel; Díaz-Delgado, Ricardo

    2017-11-01

    Implementing long-term monitoring programs that effectively inform conservation plans is a top priority in environmental management. In floodplain forests, historical pressures interplay with the complex multiscale dynamics of fluvial systems and require integrative approaches to pinpoint drivers for their deterioration and ecosystem services loss. Combining a conceptual framework such as the Driver-Pressure-State-Impact-Response (DPSIR) with the development of valid biological indicators can contribute to the analysis of the driving forces and their effects on the ecosystem in order to formulate coordinated conservation measures. In the present study, we evaluate the initial results of a decade (2004-2014) of floodplain forest monitoring. We adopted the DPSIR framework to summarize the main drivers in land use and environmental change, analyzed the effects on biological indicators of foundation trees and compared the consistency of the main drivers and their effects at two spatial scales. The monitoring program was conducted in one of the largest and best preserved floodplain forests in SW Europe located within Doñana National Park (Spain) which is dominated by Salix atrocinerea and Fraxinus angustifolia. The program combined field (in situ) surveys on a network of permanent plots with several remote sensing sources. The accuracy obtained in spectral classifications allowed shifts in species cover across the whole forest to be detected and assessed. However, remote sensing did not reflect the ecological status of forest populations. The field survey revealed a general decline in Salix populations, especially in the first five years of sampling -a factor probably associated with a lag effect from past human impact on the hydrology of the catchment and recent extreme climatic episodes (drought). In spite of much reduced seed regeneration, a resprouting strategy allows long-lived Salix individuals to persist in complex spatial dynamics. This suggests the beginning

  2. Reframing long-term controversies in transboundary river management. The intermediate role of puzzling and powering in tackling wicked problems

    NARCIS (Netherlands)

    Warner, Jeroen F.; Buuren, van A.

    2016-01-01

    In this paper we analyze how the process of visioning about 'wicked' long-term policy issues developed as a result of co-evolving processes of "framing", "puzzling" and "powering". In this article we discuss a case of cross-border joint visioning on multi-purpose land use planning in a

  3. Long-term avian research at the San Joaquin Experimental Range: recommendations for monitoring and managing oak woodlands

    Science.gov (United States)

    Kathryn L. Purcell

    2011-01-01

    Experimental forests and ranges are living laboratories that provide opportunities for conducting scientific research and transferring research results to partners and stakeholders. They are invaluable for their long-term data and capacity to foster collaborative, interdisciplinary research. The San Joaquin Experimental Range (SJER) was established to develop...

  4. Managing competition in the countryside: Non-profit and for-profit perceptions of long-term care in rural Ontario.

    Science.gov (United States)

    Skinner, Mark W; Rosenberg, Mark W

    2006-12-01

    This paper contributes to the current debates surrounding private delivery of health care services by addressing the distinctive challenges, constraints and opportunities facing for-profit and non-profit providers of long-term care in rural and small town settings. It focuses on the empirical case of Ontario, Canada where extensive restructuring of long-term care, under the rubric of managed competition, has been underway since the mid-1990s. In-depth interviews with 72 representatives from local governments, public health institutions and authorities, for-profit and non-profit organisations, and community groups during July 2003 to December 2003 form the platform for a qualitative analysis of the implications of managed competition as it relates to the provision of long-term care in the countryside. The results suggest that the introduction and implementation of managed competition has accentuated the problems of service provision in rural communities, and that the long-standing issues of caregiving in rural situations transcend the differences, perceived or otherwise, between for-profit and non-profit provision. Understanding the implications of market-oriented long-term care restructuring initiatives for providers, and their clients, in rural situations requires a re-focussing of research beyond the for- versus non-profit dichotomy.

  5. The northernmost coral frontier of the Maldives: The coral reefs of Ihavandippolu Atoll under long-term environmental change.

    Science.gov (United States)

    Tkachenko, Konstantin S

    2012-12-01

    Ihavandippolu, the northernmost atoll of the Maldives, experienced severe coral bleaching and mortality in 1998 followed by several bleaching episodes in the last decade. Coral cover in the 11 study sites surveyed in July-December of 2011 in the 3-5 m depth range varied from 1.7 to 51%. Reefs of the islands located in the center of Ihavandippolu lagoon have exhibited a very low coral recovery since 1998 and remain mostly degraded 12 years after the impact. At the same time, some reefs, especially in the inner part of the eastern ring of the atoll, demonstrate a high coral cover (>40%) with a dominance of branching Acropora that is known to be one of the coral genera that is most susceptible to thermal stress. The last severe bleaching event in 2010 resulted in high coral mortality in some sites of the atoll. Differences in coral mortality rates and proportion between "susceptible" and "resistant" taxa in study sites are apparently related to long-term adaptation and local hydrological features that can mitigate thermal impacts. Abundant herbivorous fish observed in the atoll prevent coral overgrowth by macroalgae even on degraded reefs. Despite the frequent influence of temperature anomalies and having less geomorphologic refuges for coral survivals than other larger Maldivian atolls, a major part of observed coral communities in Ihavandippolu Atoll exhibits high resilience and potential for further acclimatization to a changing environment. Copyright © 2012 Elsevier Ltd. All rights reserved.

  6. Long-term increases in young-of-the-year growth of Arctic cisco Coregonus autumnalis and environmental influences.

    Science.gov (United States)

    von Biela, V R; Zimmerman, C E; Moulton, L L

    2011-01-01

    Arctic cisco Coregonus autumnalis young-of-year (YOY) growth was used as a proxy to examine the long-term response of a high-latitude fish population to changing climate from 1978 to 2004. YOY growth increased over time (r² = 0·29) and was correlated with monthly averages of the Arctic oscillation index, air temperature, east wind speed, sea-ice concentration and river discharge with and without time lags. Overall, the most prevalent correlates to YOY growth were sea-ice concentration lagged 1 year (significant correlations in 7 months; r² = 0·14-0·31) and Mackenzie River discharge lagged 2 years (significant correlations in 8 months; r² = 0·13-0·50). The results suggest that decreased sea-ice concentrations and increased river discharge fuel primary production and that life cycles of prey species linking increased primary production to fish growth are responsible for the time lag. Oceanographic studies also suggest that sea ice concentration and fluvial inputs from the Mackenzie River are key factors influencing productivity in the Beaufort Sea. Future research should assess the possible mechanism relating sea ice concentration and river discharge to productivity at upper trophic levels. Journal of Fish Biology © 2010 The Fisheries Society of the British Isles. No claim to original US government works.

  7. Long-term impacts of extensification of grassland management on biodiversity and productivity in upland areas. A review

    OpenAIRE

    Marriott, Carol; Fothergill, Michael; Jeangros, Bernard; Scotton, Michele; Louault, Frédérique

    2004-01-01

    International audience; Modern rural policies that incorporate agricultural and environmental aims within the broader framework of sustainable rural development are being formulated to address the problem of declines in grassland biodiversity and the destruction of sensitive landscapes and habitats in Europe. Extensification is the process of reducing fertiliser inputs, management intensity and stocking rates, and is central to these sustainable rural policies. However, research in the Less F...

  8. Analysis of social recognition and disposal time for the long-term management scenario of high-level waste

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kang Myong; Jeong, Jin Yeop; Ha, Gyu Man [Korea Energy Technology and Emergency Management Institute, Seoul (Korea, Republic of)

    2009-02-15

    Recently, the need of high-level radioactive waste policy including spent fuel management becomes serious due to the rapid increase in oil price, the nationalism of natural resources, and the environmental issues such as Tokyo protocol. Also, the policy should be established urgently to prepare the saturation of on-site storage capacity of spent fuel, the revision of 'Agreement for Cooperation-Concerning Civil Uses of Atomic Energy' between Korea and US, the anxiety for nuclear weapon proliferation, and R and D to reduce the amount of waste to be disposed. In this study, we performed case study of US, Japan, Canada and Finland, which have special laws and plans/roadmaps for high-level waste management, to draw the policy requirements to be considered in HLW management. Also, we reviewed social conflict issues experienced in our society, and summarized the factors affecting the political and social environment. These policy requirements and factors summarized in this study should be considered seriously in the process for public consensus and the policy making regarding HLW management. Finally, the following 4 action items were drawn to manage HLW successfully : - Continuous and systematic R and D activities to obtain reliable management technology - Promoting companies having specialty in HLW management - Nurturing experts and workforce - Drive the public consensus process

  9. Environmental Management vitrification activities

    Energy Technology Data Exchange (ETDEWEB)

    Krumrine, P.H. [Waste Policy Institute, Gaithersburg, MD (United States)

    1996-05-01

    Both the Mixed Waste and Landfill Stabilization Focus Areas as part of the Office of Technology Development efforts within the Department of Energy`s (DOE) Environmental Management (EM) Division have been developing various vitrification technologies as a treatment approach for the large quantities of transuranic (TRU), TRU mixed and Mixed Low Level Wastes that are stored in either landfills or above ground storage facilities. The technologies being developed include joule heated, plasma torch, plasma arc, induction, microwave, combustion, molten metal, and in situ methods. There are related efforts going into development glass, ceramic, and slag waste form windows of opportunity for the diverse quantities of heterogeneous wastes needing treatment. These studies look at both processing parameters, and long term performance parameters as a function of composition to assure that developed technologies have the right chemistry for success.

  10. Long-term collections

    CERN Multimedia

    Collectes à long terme

    2007-01-01

    The Committee of the Long Term Collections (CLT) asks for your attention for the following message from a young Peruvian scientist, following the earthquake which devastated part of her country a month ago.

  11. Fire and vegetation history on Santa Rosa Island, Channel Islands, and long-term environmental change in southern California

    Science.gov (United States)

    Starratt, Scott W.; Pinter, N.; Anderson, Robert S.; Jass, R.B.

    2009-01-01

    The long-term history of vegetation and fire was investigated at two locations – Soledad Pond (275 m; from ca. 12 000 cal. a BP) and Abalone Rocks Marsh (0 m; from ca. 7000 cal. a BP) – on Santa Rosa Island, situated off the coast of southern California. A coastal conifer forest covered highlands of Santa Rosa during the last glacial, but by ca. 11 800 cal. a BP Pinus stands, coastal sage scrub and grassland replaced the forest as the climate warmed. The early Holocene became increasingly drier, particularly after ca. 9150 cal. a BP, as the pond dried frequently, and coastal sage scrub covered the nearby hillslopes. By ca. 6900 cal. a BP grasslands recovered at both sites. Pollen of wetland plants became prominent at Soledad Pond after ca. 4500 cal. a BP, and at Abalone Rocks Marsh after ca. 3465 cal. a BP. Diatoms suggest freshening of the Abalone Rocks Marsh somewhat later, probably by additional runoff from the highlands. Introduction of non-native species by ranchers occurred subsequent to AD 1850. Charcoal influx is high early in the record, but declines during the early Holocene when minimal biomass suggests extended drought. A general increase occurs after ca. 7000 cal. a BP, and especially after ca. 4500 cal. a BP. The Holocene pattern closely resembles population levels constructed from the archaeological record, and suggests a potential influence by humans on the fire regime of the islands, particularly during the late Holocene.

  12. A long term (1667-1860) perspective on impacts of fishing and environmental variability on fisheries for herring, eel, and whitefish in the Limfjord, Denmark

    DEFF Research Database (Denmark)

    Poulsen, B.; Holm, P.; MacKenzie, Brian

    2007-01-01

    This investigation reconstructs the development of major fisheries for her-ring, eel and whitefish in the Limfjord estuary, Denmark ca. 1667-1860, and then evaluates how their long-term dynamics have been influenced by some key fishery and environmental developments. The commercially most important...... fishery was for herring, Clupea harengus, which spawned in the Limfjord. This fishery underwent large changes in these centuries. High landings occurred in two periods in the early 18th and again in the early 19th centuries, when 4000-8000 metric tonnes were caught annually. In 1830, the fishery collapsed...

  13. Environmental Life Cycle Assessment of long-term organic rice production in a Subtropical area of China

    DEFF Research Database (Denmark)

    Xueqing, He; Qiao, Yuhui; Liang, Long

    2018-01-01

    conversion and compare it to conventional rice (CR) in subtropical China. The life cycle assessment (LCA) method was used to assess environmental impact of rice production systems with regard to nine environmental impact categories: Non-renewable Energy Depletion (NED), Water Depletion (WD), Land Occupation......Organic farming is considered as a promising solution for reducing the environmental burden related to agricultural practices. China is one of the top-five countries with the largest organic area in the world and produces a major part of the world's organic rice. Rice cultivation causes...... a considerable environmental impact and changing from conventional to organic rice cultivation might therefore have a potentially great impact. Meanwhile, it takes time for the organic farming systems to reach a new steady state after conversion to organic. Thus, the environmental profile of the organic products...

  14. Fluoroscopically guided caudal epidural steroid injection for management of degenerative lumbar spinal stenosis: short-term and long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Joon Woo; Myung, Jae Sung; Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Seong Nam, Gyeongi-do (Korea); Park, Kun Woo; Yeom, Jin S. [Seoul National University Bundang Hospital, Department of Orthopaedic Surgery, Seong Nam, Gyeongi-do (Korea); Kim, Ki-Jeong; Kim, Hyun-Jib [Seoul National University Bundang Hospital, Department of Neurosurgery, Seong Nam, Gyeongi-do (Korea)

    2010-07-15

    To evaluate the short-term and long-term effects of fluoroscopically guided caudal epidural steroid injection (ESI) for the management of degenerative lumbar spinal stenosis (DLSS) and to analyze outcome predictors. All patients who underwent caudal ESI in 2006 for DLSS were included in the study. Response was based on chart documentation (aggravated, no change, slightly improved, much improved, no pain). In June 2009 telephone interviews were conducted, using formatted questions including the North American Spine Society (NASS) patient satisfaction scale. For short-term and long-term effects, age difference was evaluated by the Mann-Whitney U test, and gender, duration of symptoms, level of DLSS, spondylolisthesis, and previous operations were evaluated by Fisher's exact test. Two hundred and sixteen patients (male: female = 75:141; mean age 69.2 years; range 48{proportional_to}91 years) were included in the study. Improvements (slightly improved, much improved, no pain) were seen in 185 patients (85.6%) after an initial caudal ESI and in 189 patients (87.5%) after a series of caudal ESIs. Half of the patients (89/179, 49.8%) replied positively to the NASS patient satisfaction scale (1 or 2). There were no significant outcome predictors for either the short-term or the long-term responses. Fluoroscopically guided caudal ESI was effective for the management of DLSS (especially central canal stenosis) with excellent short-term and good long-term results, without significant outcome predictors. (orig.)

  15. Managing treatment fatigue in patients with multiple sclerosis on long-term therapy: the role of multiple sclerosis nurses

    Directory of Open Access Journals (Sweden)

    Crawford A

    2014-08-01

    Full Text Available Ann Crawford, Sally Jewell,* Holly Mara, Laura McCatty, Regina Pelfrey The Lash Group; Frisco, TX, USA *Sally Jewell is now retired Abstract: This article discusses the many ways that nurses can address the factors that lead to treatment fatigue in patients with multiple sclerosis (MS on long-term disease-modifying therapy, ultimately helping to preserve the patient’s health and quality of life. Patients with MS on long-term therapy may suffer from treatment fatigue and poor adherence due to a variety of different factors, including difficulties with injections, anxiety/depression, financial problems, and inaccurate beliefs about the MS disease process. Because MS nurses have regular interactions with patients, they are ideally situated to help patients cope with these and other factors that may limit adherence. Keywords: multiple sclerosis, disease-modifying therapy, injection, nurse

  16. Retrospective evaluation of the long-term outcome of non-surgical management of 74 dogs with clinical hip dysplasia.

    Science.gov (United States)

    Farrell, M; Clements, D N; Mellor, D; Gemmill, T; Clarke, S P; Arnott, J L; Bennett, D; Carmichael, S

    2007-04-14

    The long-term outcome for dogs treated non-surgically for clinical signs of canine hip dysplasia were evaluated retrospectively; 74 dogs were evaluated by a postal questionnaire sent to their owners, and 24 of these were also evaluated by a veterinary clinical examination. A total of 11 outcome variables were evaluated. Depending on the variable assessed, between 31 (41.9 per cent) and 49 (66.2 per cent) of the dogs remained clinically affected according to their owner's assessment, and between 17 (70.8 per cent) and 23 (95.8 per cent) of the 24 dogs had abnormalities attributed to hip osteoarthritis according to the veterinary assessment. Orthopaedic abnormalities other than hip dysplasia affected 17 of the 24 dogs. Long-term medications had been prescribed for the treatment of clinical signs associated with hip dysplasia in 41 of the 74 dogs.

  17. Surgical Treatment of Spinal Dural Arteriovenous Fistula: Management and Long-Term Outcome in a Single-Center Series.

    Science.gov (United States)

    Schuss, Patrick; Daher, Frederick H; Greschus, Susanne; Vatter, Hartmut; Güresir, Erdem

    2015-06-01

    To perform a retrospective chart review of surgically treated patients with spinal dural arteriovenous fistula (SDAVF), a rare disease but the most common vascular malformation of the spine, focusing on clinical characteristics and functional outcome during long-term follow-up. Between June 1990 and April 2012, 29 patients with SDAVFs were treated surgically in a single institution. Patient characteristics, time from onset of symptoms to treatment, radiologic features, treatment-related complications, and functional outcome were analyzed. Outcome was assessed according to the Aminoff-Logue scale during follow-up. Results of magnetic resonance imaging scans performed during long-term follow-up were correlated with functional outcome. There were 3 female (10%) and 26 male (90%) patients with SDAVFs treated surgically. Mean age was 61 years ± 11. Location of the fistula was at the thoracic level in 20 patients (69%), at the lumbar level in 8 patients (28%), and at the sacral level in 1 patient (3%). Mean postoperative Aminoff-Logue scale scores regarding gait and micturition improved after treatment compared with preoperatively (P = 0.02; P = 0.03). After surgical treatment, 22 patients (76%) achieved improvement in neurologic symptoms. In 6 patients (21%), neurologic status was the same as preoperatively. In 1 patient (3%), neurologic status worsened. Medullary signal alteration of diagnostic magnetic resonance imaging scans did not correlate with functional outcome (P = 0.2). Mean follow-up time was 63 months ± 55. All SDAVFs were treated in a single session without recurrence during the long-term follow-up period. Surgical treatment of SDAVFs is safe and effective and leads to an improvement of neurologic symptoms in most patients. Surgical treatment of SDAVFs also provides long-term stability. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Educational Needs of Health Care Providers Working in Long-Term Care Facilities with Regard to Pain Management

    Directory of Open Access Journals (Sweden)

    Yannick Tousignant-Laflamme

    2012-01-01

    Full Text Available BACKGROUND: The prevalence of chronic pain ranges from 40% to 80% in long-term care facilities (LTCF, with the highest proportion being found among older adults and residents with dementia. Unfortunately, pain in older adults is underdiagnosed, undertreated, inadequately treated or not treated at all. A solution to this problem would be to provide effective and innovative interdisciplinary continuing education to health care providers (HCPs.

  19. Exploring Long-Term Impact of Grazing Management on Land Degradation in the Socio-Ecological System of Asteroussia Mountains, Greece

    Directory of Open Access Journals (Sweden)

    Costas Kosmas

    2015-07-01

    Full Text Available The socio-ecological system dominated by pastureland in the Asteroussia Mountains (Crete, Greece was analyzed over a long time interval (1945–2010 to identify the most relevant system’s characteristics and changes. Vegetation cover and land-uses have been quantified by analyzing aerial photographs exploring the whole study period. Soil characteristics have been assessed by carrying out an extensive field survey for the last reference year (2010 and by estimating the average soil loss for the past period using the PESERA soil erosion model validated by field measurements. Based on environmental, social and economic attributes, three major periods characterizing the socio-ecological system of Asteroussia Mountains have been distinguished. During the first and second period, the land was satisfactorily managed with moderate–low soil erosion rates despite the adverse (prevailing soil, topographic and climate conditions for vegetation growth. The third time interval featured a rapid growth in the livestock density causing increased soil erosion rates, loss in plant productivity, and a generalized over-exploitation of natural resources. As a consequence, the desertification process has significantly increased in the last period. The analysis of the long-term evolution of socio-ecological system provided evidence to understand the main drivers of land degradation and to recommend mitigation policies specifically addressing Mediterranean pastureland.

  20. A long-term comparison of the influence of organic and conventional crop management practices on the content of the glycoalkaloid α-tomatine in tomatoes.

    Science.gov (United States)

    Koh, Eunmi; Kaffka, Stephen; Mitchell, Alyson E

    2013-05-01

    α-Tomatine, synthesized by Lycopersicon and some Solanum species, is a steroidal glycoalkaloid which functions to protect against pathogens and insects. Although glycoalkaloids are generally considered toxic, α-tomatine appears to be well tolerated in humans. α-Tomatine has numerous potential health benefits including the ability to inhibit cancer cell growth in in vitro studies. α-Tomatine is influenced by numerous agronomic factors including fertilization and nitrogen availability. Herein, the levels of α-tomatine were compared in dried tomato samples (Lycopersicon esculentum L. cv. Halley 3155) produced in organic and conventional cropping systems that had been archived over the period from 1994 to 2004 from the Long Term Research on Agricultural Systems project (LTRAS) at UC Davis. The α-tomatine levels of tomatoes in both cropping systems ranged from 4.29 to 111.85 µg g(-1) dry weight. Mean levels of α-tomatine were significantly higher in the organically grown tomatoes than conventional ones (P organic management system, α-tomatine content was also significantly (P organically produced tomatoes had higher average α-tomatine content than their conventional counterpart over the 10-year study. Significant annual variability in the α-tomatine content in tomatoes was also observed and suggests that environmental factors, external to nitrogen fertilization, influence α-tomatine content in tomatoes. © 2012 Society of Chemical Industry.

  1. Coordination of short-term and long-term mitigation measures of hydro-meteorological risks: the importance of establishing a link between emergency management and spatial planning

    Science.gov (United States)

    Prenger-Berninghoff, Kathrin; Cortes, V. Juliette; Aye, Zar Chi; Sprague, Teresa

    2013-04-01

    The management of natural hazards involves, as generally known, the four stages of the risk management cycle: Prevention, preparedness, response and recovery. Accordingly, the mitigation of disasters can be performed in terms of short-term and long-term purposes. Whereas emergency management or civil protection helps to strengthen a community's capacity to be better prepared for natural hazards and to better respond in case a disaster strikes, thus addressing the short-term perspective, spatial planning serves long-term planning goals and can therefore implement long-term prevention measures. A purposefully applied risk mitigation strategy requires coordination of short-term and long-term mitigation measures and thus an effective coordination of emergency management and spatial planning. Several actors are involved in risk management and should consequently be linked throughout the whole risk management cycle. However, these actors, partly because of a historically fragmented administrative system, are hardly connected to each other, with spatial planning only having a negligible role compared to other actors1, a problem to which Young (2002) referred to as the "problem of interplay". In contrast, information transfer and decision-taking happen at the same time and are not coordinated among different actors. This applies to the prevention and preparedness phase as well as to the recovery phase, which basically constitutes the prevention phase for the next disaster2. Since investments in both risk prevention and emergency preparedness and response are considered necessary, a better coordination of the two approaches is required. In this regard, Decision Support Systems (DSS) can be useful in order to provide support in the decision-making aspect of risk management. The research work currently undertaken examines the problem of interplay in the four case study areas of the Marie Curie ITN, CHANGES3. The link between different risk management actors will be explored

  2. Social networks, work and network-based resources for the management of long-term conditions: a framework and study protocol for developing self-care support

    Directory of Open Access Journals (Sweden)

    Kapadia Dharmi

    2011-05-01

    Full Text Available Abstract Background Increasing the effective targeting and promotion of self-care support for long-term conditions requires more of a focus on patient contexts and networks. The aim of this paper is to describe how within a programme of research and implementation, social networks are viewed as being centrally involved in the mobilisation and deployment of resources in the management of a chronic condition. This forms the basis of a novel approach to understanding, designing, and implementing new forms of self-management support. Methods Drawing on evidence syntheses about social networks and capital and the role of information in self-management, we build on four conceptual approaches to inform the design of our research on the implementation of self-care support for people with long-term conditions. Our approach takes into consideration the form and content of social networks, notions of chronic illness work, normalisation process theory (NPT, and the whole systems informing self-management engagement (WISE approach to self-care support. Discussion The translation and implementation of a self-care agenda in contemporary health and social context needs to acknowledge and incorporate the resources and networks operating in patients' domestic and social environments and everyday lives. The latter compliments the focus on healthcare settings for developing and delivering self-care support by viewing communities and networks, as well as people suffering from long-term conditions, as a key means of support for managing long-term conditions. By focusing on patient work and social-network provision, our aim is to open up a second frontier in implementation research, to translate knowledge into better chronic illness management, and to shift the emphasis towards support that takes place outside formal health services.

  3. Social networks, work and network-based resources for the management of long-term conditions: a framework and study protocol for developing self-care support.

    Science.gov (United States)

    Rogers, Anne; Vassilev, Ivaylo; Sanders, Caroline; Kirk, Susan; Chew-Graham, Carolyn; Kennedy, Anne; Protheroe, Joanne; Bower, Peter; Blickem, Christian; Reeves, David; Kapadia, Dharmi; Brooks, Helen; Fullwood, Catherine; Richardson, Gerry

    2011-05-29

    Increasing the effective targeting and promotion of self-care support for long-term conditions requires more of a focus on patient contexts and networks. The aim of this paper is to describe how within a programme of research and implementation, social networks are viewed as being centrally involved in the mobilisation and deployment of resources in the management of a chronic condition. This forms the basis of a novel approach to understanding, designing, and implementing new forms of self-management support. Drawing on evidence syntheses about social networks and capital and the role of information in self-management, we build on four conceptual approaches to inform the design of our research on the implementation of self-care support for people with long-term conditions. Our approach takes into consideration the form and content of social networks, notions of chronic illness work, normalisation process theory (NPT), and the whole systems informing self-management engagement (WISE) approach to self-care support. The translation and implementation of a self-care agenda in contemporary health and social context needs to acknowledge and incorporate the resources and networks operating in patients' domestic and social environments and everyday lives. The latter compliments the focus on healthcare settings for developing and delivering self-care support by viewing communities and networks, as well as people suffering from long-term conditions, as a key means of support for managing long-term conditions. By focusing on patient work and social-network provision, our aim is to open up a second frontier in implementation research, to translate knowledge into better chronic illness management, and to shift the emphasis towards support that takes place outside formal health services.

  4. 75 FR 41575 - Notice of Intent To Prepare an Environmental Impact Statement for a Long-Term Landscape...

    Science.gov (United States)

    2010-07-16

    ... CFR parts 1500 through 1508, The Valles Caldera Preservation Act, Public Law 106-248, NEPA Procedures...) which includes mechanical treatments, prescribed burning, management of lightning caused wildland fires... acres of forest and grassland ecosystems over a 10-year period. The management of lightning caused fires...

  5. Earthworm Populations in Savannas of the Orinoco Basin. A Review of Studies in Long-Term Agricultural-Managed and Protected Ecosystems

    Directory of Open Access Journals (Sweden)

    Danilo López-Hernández

    2012-04-01

    Full Text Available Earthworm biomass and production in savannas are limited by seasonal precipitation and the lack of organic and nutrient resources; I hypothesize that after a long-term protection of savanna from fire and agricultural activities drastic changes in the physical and chemical characteristics of the soil occur with a concomitant increase in earthworm abundance and activities. Similar changes might occur after a long-term fertilization of savannas with manure. This review article considers the earthworm communities and other soil quality indices in Trachypogon savannas of the Orinoco Basin in an organic agricultural forestal savanna (OAFS amended with compost over forty years in Puerto Ayacucho, Venezuela, and in an Experimental Station long-term protected (PS from fire and cattle raising from more than four decades in Central Llanos, Venezuela, comparison is made with results from similar savannas. Long-term additions of organic manure or a long protection have induced significant changes in the soil physical and chemical properties of the natural savanna (NS soils that induce a significant increase in the density and biomass of earthworm populations. On the other hand, the protection of the savanna promotes an improvement in the physical and chemical properties of the soil, which favors an increase in the density and biomass of earthworms in the PS compared with the NS subjected to recurrent burning and grazing. The results emphasize the importance of appropriate organic matter management and the relevance of earthworms in such agroecosystems.

  6. Multivariate and phylogenetic analyses assessing the response of bacterial mat communities from an ancient oligotrophic aquatic ecosystem to different scenarios of long-term environmental disturbance.

    Directory of Open Access Journals (Sweden)

    Silvia Pajares

    Full Text Available Understanding the response of bacterial communities to environmental change is extremely important in predicting the effect of biogeochemical modifications in ecosystem functioning. The Cuatro Cienegas Basin is an ancient oasis in the Mexican Chihuahuan desert that hosts a wide diversity of microbial mats and stromatolites that have survived in extremely oligotrophic pools with nearly constant conditions. However, thus far, the response of these unique microbial communities to long-term environmental disturbances remains unexplored. We therefore studied the compositional stability of these bacterial mat communities by using a replicated (3x mesocosm experiment: a Control; b Fluct: fluctuating temperature; c 40C: increase to 40 ºC; d UVplus: artificial increase in UV radiation; and f UVmin: UV radiation protection. In order to observe the changes in biodiversity, we obtained 16S rRNA gene clone libraries from microbial mats at the end of the experiment (eight months and analyzed them using multivariate and phylogenetic tools. Sequences were assigned to 13 major lineages, among which Cyanobacteria (38.8% and Alphaproteobacteria (25.5% were the most abundant. The less extreme treatments (Control and UVmin had a more similar composition and distribution of the phylogenetic groups with the natural pools than the most extreme treatments (Fluct, 40C, and UVplus, which showed drastic changes in the community composition and structure, indicating a different community response to each environmental disturbance. An increase in bacterial diversity was found in the UVmin treatment, suggesting that protected environments promote the establishment of complex bacterial communities, while stressful environments reduce diversity and increase the dominance of a few Cyanobacterial OTUs (mainly Leptolyngbya sp through environmental filtering. Mesocosm experiments using complex bacterial communities, along with multivariate and phylogenetic analyses of molecular

  7. Multivariate and phylogenetic analyses assessing the response of bacterial mat communities from an ancient oligotrophic aquatic ecosystem to different scenarios of long-term environmental disturbance.

    Science.gov (United States)

    Pajares, Silvia; Souza, Valeria; Eguiarte, Luis E

    2015-01-01

    Understanding the response of bacterial communities to environmental change is extremely important in predicting the effect of biogeochemical modifications in ecosystem functioning. The Cuatro Cienegas Basin is an ancient oasis in the Mexican Chihuahuan desert that hosts a wide diversity of microbial mats and stromatolites that have survived in extremely oligotrophic pools with nearly constant conditions. However, thus far, the response of these unique microbial communities to long-term environmental disturbances remains unexplored. We therefore studied the compositional stability of these bacterial mat communities by using a replicated (3x) mesocosm experiment: a) Control; b) Fluct: fluctuating temperature; c) 40C: increase to 40 ºC; d) UVplus: artificial increase in UV radiation; and f) UVmin: UV radiation protection. In order to observe the changes in biodiversity, we obtained 16S rRNA gene clone libraries from microbial mats at the end of the experiment (eight months) and analyzed them using multivariate and phylogenetic tools. Sequences were assigned to 13 major lineages, among which Cyanobacteria (38.8%) and Alphaproteobacteria (25.5%) were the most abundant. The less extreme treatments (Control and UVmin) had a more similar composition and distribution of the phylogenetic groups with the natural pools than the most extreme treatments (Fluct, 40C, and UVplus), which showed drastic changes in the community composition and structure, indicating a different community response to each environmental disturbance. An increase in bacterial diversity was found in the UVmin treatment, suggesting that protected environments promote the establishment of complex bacterial communities, while stressful environments reduce diversity and increase the dominance of a few Cyanobacterial OTUs (mainly Leptolyngbya sp) through environmental filtering. Mesocosm experiments using complex bacterial communities, along with multivariate and phylogenetic analyses of molecular data, can

  8. Long-term effects of wildfire on greater sage-grouse - integrating population and ecosystem concepts for management in the Great Basin

    Science.gov (United States)

    Coates, Peter S.; Ricca, Mark A.; Prochazka, Brian G.; Doherty, Kevin E.; Brooks, Matthew L.; Casazza, Michael L.

    2015-09-10

    Greater sage-grouse (Centrocercus urophasianus; hereinafter, sage-grouse) are a sagebrush obligate species that has declined concomitantly with the loss and fragmentation of sagebrush ecosystems across most of its geographical range. The species currently is listed as a candidate for federal protection under the Endangered Species Act (ESA). Increasing wildfire frequency and changing climate frequently are identified as two environmental drivers that contribute to the decline of sage-grouse populations, yet few studies have rigorously quantified their effects on sage-grouse populations across broad spatial scales and long time periods. To help inform a threat assessment within the Great Basin for listing sage-grouse in 2015 under the ESA, we conducted an extensive analysis of wildfire and climatic effects on sage-grouse population growth derived from 30 years of lek-count data collected across the hydrographic Great Basin of Western North America. Annual (1984–2013) patterns of wildfire were derived from an extensive dataset of remotely sensed 30-meter imagery and precipitation derived from locally downscaled spatially explicit data. In the sagebrush ecosystem, underlying soil conditions also contribute strongly to variation in resilience to disturbance and resistance to plant community changes (R&R). Thus, we developed predictions from models of post-wildfire recovery and chronic effects of wildfire based on three spatially explicit R&R classes derived from soil moisture and temperature regimes. We found evidence of an interaction between the effects of wildfire (chronically affected burned area within 5 kilometers of a lek) and climatic conditions (spring through fall precipitation) after accounting for a consistent density-dependent effect. Specifically, burned areas near leks nullifies population growth that normally follows years with relatively high precipitation. In models, this effect results in long-term population declines for sage-grouse despite cyclic

  9. Satellite-driven predictions of animal migrations in response to short and long-term environmental change

    Science.gov (United States)

    Beck, P. S.; Bohrer, G.; Wethington, S.; Bartlam-Brooks, H. L.; Powers, D. R.; Goetz, S. J.; Graham, C. H.

    2012-12-01

    Animal migrations have evolved in response to spatio-temporal heterogeneity in resources, habitats, predation, and competition. Their reliance on disjunct habitats makes migratory animals potentially more vulnerable to extreme climate events or phenological changes at other trophic levels. The advent of affordable satellite-based tracking technology has revolutionized the study of animal movement in the past two decades. Understanding internal and external drivers of migratory behavior, and how they interact, is critical for migration ecology to move beyond solely the measurement and description of organism-level movement and to predict how environmental change might affect migrations. To achieve this, it is necessary to not only measure animals' movement but also their reliance on prevailing external, i.e. environmental, conditions prior to, and during migration. An increasingly wide array of satellite and model-derived gridded data sets that map environmental conditions at regular temporal intervals are now readily accessible because of standardized processing and data formats, as well as a variety of online portals that provide host data archives and/or on-demand processing free-of-charge. While they are often of coarser spatial resolution, these data can overcome many limitations of in situ measurements with regard to spatial extent and temporal frequency. We demonstrate the use of global gridded environmental time-series in the study of animal migrations through case studies. First we show how inter-annual weather variation in wintering habitats affects migratory behavior of broad-tailed hummingbirds and investigate how it carries over to their reproductive success and survival in summer habitats. To do so, we use vegetation indices as proxies of resource availability, and the NCEP Climate Forecast System Reanalysis (CFSR) to map known physiological constraints on the birds. Secondly, we investigated the effects of long as well as short-term variations in

  10. Long-term outcomes for women versus men with unstable angina/non-ST-segment elevation myocardial infarction managed medically without revascularization

    DEFF Research Database (Denmark)

    Clemmensen, Peter; Roe, Matthew T; Hochman, Judith S

    2015-01-01

    -term ischemic and bleeding outcomes and platelet reactivity for medically managed ACS patients randomized to prasugrel versus clopidogrel plus aspirin. METHODS: Data from 9,326 patients enrolled in TRILOGY ACS were analyzed to determine differences in long-term ischemic and bleeding outcomes between women (n......-cause mortality (12.2% vs 11.7%; P = .88), and Global Use of Strategies to Open Occluded Arteries severe/life-threatening/moderate bleeding (3.8% vs 2.8%; P = .74) through 30 months were similar in women versus men. After adjustment, women had significantly lower risk for ischemic outcomes and all-cause mortality....... There were no sex-specific, treatment-related differences in 30-day platelet reactivity. CONCLUSIONS: Long-term ischemic and bleeding outcomes in medically managed ACS patients were similar for women versus men, as was treatment-related platelet reactivity. Women had a higher baseline risk profile and, after...

  11. Environmental Burkholderia cenocepacia Strain Enhances Fitness by Serial Passages during Long-Term Chronic Airways Infection in Mice

    Directory of Open Access Journals (Sweden)

    Alessandra Bragonzi

    2017-11-01

    Full Text Available Burkholderia cenocepacia is an important opportunistic pathogen in cystic fibrosis (CF patients, and has also been isolated from natural environments. In previous work, we explored the virulence and pathogenic potential of environmental B. cenocepacia strains and demonstrated that they do not differ from clinical strains in some pathogenic traits. Here, we investigated the ability of the environmental B. cenocepacia Mex1 strain, isolated from the maize rhizosphere, to persist and increase its virulence after serial passages in a mouse model of chronic infection. B. cenocepacia Mex1 strain, belonging to the recA lineage IIIA, was embedded in agar beads and challenged into the lung of C57Bl/6 mice. The mice were sacrificed after 28 days from infection and their lungs were tested for bacterial loads. Agar beads containing the pool of B. cenocepacia colonies from the four sequential passages were used to infect the mice. The environmental B. cenocepacia strain showed a low incidence of chronic infection after the first passage; after the second, third and fourth passages in mice, its ability to establish chronic infection increased significantly and progressively up to 100%. Colonial morphology analysis and genetic profiling of the Mex1-derived clones recovered after the fourth passage from infected mice revealed that they were indistinguishable from the challenged strain both at phenotypic and genetic level. By testing the virulence of single clones in the Galleria mellonella infection model, we found that two Mex1-derived clones significantly increased their pathogenicity compared to the parental Mex1 strain and behaved similarly to the clinical and epidemic B. cenocepacia LMG16656T. Our findings suggest that serial passages of the environmental B. cenocepacia Mex1 strain in mice resulted in an increased ability to determine chronic lung infection and the appearance of clonal variants with increased virulence in non-vertebrate hosts.

  12. Geologic processes in the RWMC area, Idaho National Engineering Laboratory: Implications for long term stability and soil erosion at the radioactive waste management complex

    Energy Technology Data Exchange (ETDEWEB)

    Hackett, W.R.; Tullis, J.A.; Smith, R.P. [and others

    1995-09-01

    The Radioactive Waste Management Complex (RWMC) is the disposal and storage facility for low-level radioactive waste at the Idaho National Engineering Laboratory (INEL). Transuranic waste and mixed wastes were also disposed at the RWMC until 1970. It is located in the southwestern part of the INEL about 80 km west of Idaho Falls, Idaho. The INEL occupies a portion of the Eastern Snake River Plain (ESRP), a low-relief, basalt, and sediment-floored basin within the northern Rocky Mountains and northeastern Basin and Range Province. It is a cool and semiarid, sagebrush steppe desert characterized by irregular, rolling terrain. The RWMC began disposal of INEL-generated wastes in 1952, and since 1954, wastes have been accepted from other Federal facilities. Much of the waste is buried in shallow trenches, pits, and soil vaults. Until about 1970, trenches and pits were excavated to the basalt surface, leaving no sediments between the waste and the top of the basalt. Since 1970, a layer of sediment (about 1 m) has been left between the waste and the basalt. The United States Department of Energy (DOE) has developed regulations specific to radioactive-waste disposal, including environmental standards and performance objectives. The regulation applicable to all DOE facilities is DOE Order 5820.2A (Radioactive Waste Management). An important consideration for the performance assessment of the RWMC is the long-term geomorphic stability of the site. Several investigators have identified geologic processes and events that could disrupt a radioactive waste disposal facility. Examples of these {open_quotes}geomorphic hazards{close_quotes} include changes in stream discharge, sediment load, and base level, which may result from climate change, tectonic processes, or magmatic processes. In the performance assessment, these hazards are incorporated into scenarios that may affect the future performance of the RWMC.

  13. Long-Term Weight-Loss Maintenance by a Meal Replacement Based Weight Management Program in Primary Care

    Directory of Open Access Journals (Sweden)

    Renate Kruschitz

    2017-04-01

    Full Text Available Objective: Structured obesity treatment programs at primary care level are becoming increasingly important. However, evidence from current treatment approaches in the long term is lacking. In view of this fact we evaluated a standardized, meal replacement-based weight loss program (myLINE®; AENGUS, Graz, Austria according to the currently applicable guidelines. Methods: Data of overweight and obese individuals (n = 70 who participated at least 36 months in the program were analyzed. Data were collected at baseline (T0 as well as after 1, 3, 6, 12, 24, and 36 (T1-T36 months. Body composition was measured by conventional anthropometry and bioelectrical impedance analysis. Results: Compared to T0, a maximum weight, BMI, fat mass, absolute body cell mass (BCM reduction and an increase of relative BCM could be seen at T6. Subsequently, the findings reveal a significant reduction of body weight and body fat and a satisfying development of body cell mass during the observation period of 36 months. Conclusion: The evaluated program complies with national and international guidelines for the therapy of obesity in adults and is efficient and meaningful for a long-term therapeutic use in primary care..

  14. Long-term safety, efficacy, and patient acceptability of teriparatide in the management of glucocorticoid-induced osteoporosis

    Directory of Open Access Journals (Sweden)

    Dore RK

    2013-05-01

    Full Text Available Robin K DoreDavid Geffen School of Medicine, University of California, Los Angeles, CA, USAAbstract: Glucocorticoids are commonly prescribed medications to treat multiple diseases across many medical specialties. One of the most common yet largely unappreciated side effect of glucocorticoid use is increased risk of fracture. Many different therapies are indicated to prevent and treat this condition; many guidelines exist that suggest appropriate use of both glucocorticoids and the medications approved to prevent this common side effect of glucocorticoid therapy. Nevertheless, 30%–50% of patients on long-term glucocorticoid therapy sustain a fracture. Teriparatide, recombinant human parathyroid hormone (1–34, is a daily self-injectable therapy for 24 months approved for use in patients taking long-term glucocorticoids. Teriparatide has been shown to increase bone mineral density and reduce vertebral fracture risk in glucocorticoid-treated patients. Glucocorticoids have many adverse effects on bone that teriparatide has been shown to prevent or negate. Given the fact that preventive therapy for glucocorticoid-induced osteoporosis is often not prescribed, one wonders whether a daily self-injectable therapy for this condition would be prescribed by physicians and accepted by patients. This article reviews the epidemiology, pathophysiology, treatment, guidelines, and persistence data (when available for patients with glucocorticoid-induced osteoporosis treated with teriparatide.Keywords: glucocorticoid-induced osteoporosis, teriparatide, anabolic, PTH, parathyroid hormone

  15. A method for long-term environmental monitoring; Een methodiek voor milieu-monitoring op de lange termijn

    Energy Technology Data Exchange (ETDEWEB)

    Van Bochove, J. [Afdeling Beleidcyclus en Milieumonitoring, Provincie Zeeland, Middelburg (Netherlands)

    2005-07-01

    An overview is given of the activities of the Dutch Province Zeeland to develop a method for environmental monitoring which follows methodologies used on an international level in order to make use of a clear method and improve the transparency of the monitoring. The basis was formed by the DPSIR-model (Driving forces, Pressure, State, Impact and Response), developed by the OECD and in use at the European Environment Agency (EEA) [Dutch] Vele organisaties houden zich op een of andere manier bezig met milieumonitoring. De manieren waarop dat gebeurt verschillen van elkaar. De helderheid en doorzichtigheid van de gebruikte systematiek voor de organisaties zelf en voor derden is eveneens nogal variabel. In de provincie Zeeland is actie ondernomen om qua systematiek aan te sluiten bij datgene wat op internationaal niveau is ontwikkeld en om milieumonitoring zo duidelijk en transparant mogelijk te maken. Deze bijdrage zet uiteen waarom en hoe dat is gebeurd en wat die inspanning heeft opgeleverd. In navolging van de Organisatie voor Economische Samenwerking en Ontwikkeling (OESO) werd bij die monitoring vaak het DPSIR model (Driving forces, Pressure, State, Impact en Response indicatoren). Inmiddels zijn dergelijke indicatorenstelsels en de bijbehorende gegevensverzameling en -bewerking ontwikkeld op Europees niveau (zie de jaarlijkse publicaties van het European Environmental Agency onder de titel Environmental Signals) en ook op nationaal niveau (zie in Nederland de Milieubalansen en aanverwante publicaties). Op provinciaal en lokaal niveau worden eveneens veel milieu(beleids)gegevens verzameld maar de afstemming op de bovengenoemde indicatorstelsels en op de eigen beleidsdoelen laat nog (veel) te wensen over (zie Milieubalans 2004)

  16. Long-term ongoing impact of arsenic contamination on the environmental compartments of a former mining-metallurgy area.

    Science.gov (United States)

    González-Fernández, B; Rodríguez-Valdés, E; Boente, C; Menéndez-Casares, E; Fernández-Braña, A; Gallego, J R

    2018-01-01

    Arsenic and mercury are potentially toxic elements of concern for soil, surficial and ground waters, and sediments. In this work various geochemical and hydrogeological tools were used to study a paradigmatic case of the combined effects of the abandonment of Hg- and As-rich waste on these environmental compartments. Continuous weathering of over 40years has promoted As and Hg soil pollution (thousands of ppm) in the surroundings of a former Hg mining-metallurgy site and affected the water quality of a nearby river and shallow groundwater. In particular, the high availability of As both in soils and waste was identified as one of the main determinants of contaminant distribution, whereas the impact of Hg was found to be minor, which is explained by lower mobility. Furthermore, potential additional sources of pollution (coal mining, high natural backgrounds, etc.) discharging into the study river were revealed less significant than the contaminants generated in the Hg-mining area. The transport and deposition of pollutants within the water cycle has also affected several kilometres downstream of the release areas and the chemistry of stream sediments. Overall, the environmental compartments studies held considerable concentrations of Hg and As, as remarkably revealed by the average contaminant load released in the river (several tons of As per year) and the accumulation of toxic elements in sediments (enrichment factors of As and Hg above 35). Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Long-Term Collections

    CERN Multimedia

    Comité des collectes à long terme

    2011-01-01

    It is the time of the year when our fireman colleagues go around the laboratory for their traditional calendars sale. A part of the money of the sales will be donated in favour of the long-term collections. We hope that you will welcome them warmly.

  18. Long-term environmental correlates of invasion by Lantana camara (Verbenaceae) in a seasonally dry tropical forest.

    Science.gov (United States)

    Ramaswami, Geetha; Sukumar, Raman

    2013-01-01

    Invasive species, local plant communities and invaded ecosystems change over space and time. Quantifying this change may lead to a better understanding of the ecology and the effective management of invasive species. We used data on density of the highly invasive shrub Lantana camara (lantana) for the period 1990-2008 from a 50 ha permanent plot in a seasonally dry tropical forest of Mudumalai in southern India. We used a cumulative link mixed-effects regression approach to model the transition of lantana from one qualitative density state to another as a function of biotic factors such as indicators of competition from local species (lantana itself, perennial grasses, invasive Chromolaena odorata, the native shrub Helicteres isora and basal area of native trees) and abiotic factors such as fire frequency, inter-annual variability of rainfall and relative soil moisture. The density of lantana increased substantially during the study period. Lantana density was negatively associated with the density of H. isora, positively associated with basal area of native trees, but not affected by the presence of grasses or other invasive species. In the absence of fire, lantana density increased with increasing rainfall. When fires occurred, transitions to higher densities occurred at low rainfall values. In drier regions, lantana changed from low to high density as rainfall increased while in wetter regions of the plot, lantana persisted in the dense category irrespective of rainfall. Lantana seems to effectively utilize resources distributed in space and time to its advantage, thus outcompeting local species and maintaining a population that is not yet self-limiting. High-risk areas and years could potentially be identified based on inferences from this study for facilitating management of lantana in tropical dry forests.

  19. Long-term environmental correlates of invasion by Lantana camara (Verbenaceae in a seasonally dry tropical forest.

    Directory of Open Access Journals (Sweden)

    Geetha Ramaswami

    Full Text Available Invasive species, local plant communities and invaded ecosystems change over space and time. Quantifying this change may lead to a better understanding of the ecology and the effective management of invasive species. We used data on density of the highly invasive shrub Lantana camara (lantana for the period 1990-2008 from a 50 ha permanent plot in a seasonally dry tropical forest of Mudumalai in southern India. We used a cumulative link mixed-effects regression approach to model the transition of lantana from one qualitative density state to another as a function of biotic factors such as indicators of competition from local species (lantana itself, perennial grasses, invasive Chromolaena odorata, the native shrub Helicteres isora and basal area of native trees and abiotic factors such as fire frequency, inter-annual variability of rainfall and relative soil moisture. The density of lantana increased substantially during the study period. Lantana density was negatively associated with the density of H. isora, positively associated with basal area of native trees, but not affected by the presence of grasses or other invasive species. In the absence of fire, lantana density increased with increasing rainfall. When fires occurred, transitions to higher densities occurred at low rainfall values. In drier regions, lantana changed from low to high density as rainfall increased while in wetter regions of the plot, lantana persisted in the dense category irrespective of rainfall. Lantana seems to effectively utilize resources distributed in space and time to its advantage, thus outcompeting local species and maintaining a population that is not yet self-limiting. High-risk areas and years could potentially be identified based on inferences from this study for facilitating management of lantana in tropical dry forests.

  20. Microbial lipid and amino sugar responses to long-term simulated global environmental changes in a California annual grassland

    Directory of Open Access Journals (Sweden)

    Chao eLIANG

    2015-05-01

    Full Text Available Global environmental change is predicted to have major consequences for carbon cycling and the functioning of soil ecosystems. However, we have limited knowledge about its impacts on the microorganisms, which act as a valve between carbon sequestered in soils versus released into the atmosphere. In this study we examined microbial response to continuous 9-year manipulation of three global change factors (elevated CO2, warming, and nitrogen deposition, singly and in combination using two methods: lipid and amino sugar biomarkers at the Jasper Ridge Global Change Experiment (JRGCE. The two methods yielded important distinctions. There were limited microbial lipid differences, but many significant effects for microbial amino sugars. We found that CO2 was not a direct factor influencing soil carbon and major amino sugar pools, but had a positive impact on bacterial-derived muramic acid. Likewise, warming and nitrogen deposition appeared to enrich residues specific to bacteria despite an overall depletion in total amino sugars. The results indicate that elevated CO2, warming, and nitrogen deposition all appeared to increase bacterial-derived residues, but this accumulation effect was far offset by a corresponding decline in fungal residues. The sensitivity of microbial residue biomarker amino sugars to warming and nitrogen deposition may have implications for our predictions of global change impacts on soil stored carbon.

  1. Long term evolution of coastal morphology and global change

    NARCIS (Netherlands)

    Capobianco, M.; De Vriend, H.J.; Nicholls, R.J.; Stive, M.J.F.

    1993-01-01

    Long-term prediction of sediment transport and of morphological behaviour in the coastal zone, in response to human interference or to change in environmental conditions (collectively global change) is an increasingly important issue in coastal zone management, especially in relation to the needs

  2. Future electricity generation: An economic and environmental life cycle perspective on near-, mid- and long-term technology options and policy implications

    Science.gov (United States)

    Bergerson, Joule Andrea

    This thesis evaluates the cost and environmental tradeoffs of current and future electricity generation options from a life cycle perspective. Policy and technology options are considered for each critical time horizon (near-, mid-, and long-term). The framework developed for this analysis is a hybrid life cycle analysis which integrates several models and frameworks including process and input-output life cycle analysis, an integrated environmental control model, social costing, forecasting and future energy scenario analysis. The near-term analysis shows that several recent LCA studies of electricity options have contributed to our understanding of the technologies available and their relative environmental impacts. Several promising options could satisfy our electricity demands. Other options remain unproven or too costly to encourage investment in the near term but show promise for future use (e.g. photovoltaic, fuel cells). Public concerns could impede the use of some desirable technologies (e.g. hydro, nuclear). Finally, less tangible issues such as intermittency of some renewable technologies, social equity and visual and land use impacts, while difficult to quantify, must be considered in the investment decision process. In the mid-term analysis, this thesis explores alternative methods for transport of coal energy. A hybrid life cycle analysis is critical for evaluating the cost, efficiency and environmental tradeoffs of the entire system. If a small amount of additional coal is to be shipped, current rail infrastructure should be used where possible. If entirely new infrastructure is required, the mine mouth generation options are cheaper but have increased environmental impact due to the increased generation required to compensate for transmission line losses. Gasifying the coal to produce methane also shows promise in terms of lowering environmental emissions. The long-term analysis focuses on the implications of a high coal use future. This scenario

  3. Analysis of Bending Strength of Resin Mortars That Are at Risk of Long-Term Exposure to Environmental Corrosives

    Science.gov (United States)

    Debska, Bernardeta; Licholai, Lech

    2017-12-01

    The results of the article are part of an extensive research on new building materials including cement-free polymer composites where the binder is epoxy resin modified with glycolyzates obtained from poly (ethylene terephthalate) waste (PET). The investigation conducted con-firmed that there is a possibility of using waste materials in the production of mortar. Since they have always been an environmental problem, their utilization will help to apply the principles of sustainable development in the processes of obtaining new materials. The article discusses the results of a study of flexural strength of polymer mortars. Mortar specimens modified with propylene glycol and PET waste based glycolyzate were exposed to a 10% NaCl solution and their strength parameters were then examined after one month, six months and twelve months of immersion in this aggressive medium. The same characteristics were also determined for specimens that were not exposed to the NaCl solution. The results were presented as the trend function. The sections of the curve corresponding to the particular periods of exposure in aggressive medium vary in shape. Due to this, an attempt was made to adjust the spline function to the experimental data. The composites obtained show a deterioration in their strength properties which grows with the extension of their exposure to a corrosive medium. However, the chemical corrosion resistance of the mortars under investigation can be considered very good as it is still much higher than that of conventional cement mortars. Even after a year exposure to a corrosive substance, the mortars obtained still show high mean flexural strength values which equal about 30 MPa.

  4. Patterns of forest composition and their long term environmental drivers in the tropical dry forest transition zone of southern Africa

    Directory of Open Access Journals (Sweden)

    Vera De Cauwer

    2016-09-01

    Full Text Available Background Tropical dry forests cover less than 13 % of the world’s tropical forests and their area and biodiversity are declining. In southern Africa, the major threat is increasing population pressure, while drought caused by climate change is a potential threat in the drier transition zones to shrub land. Monitoring climate change impacts in these transition zones is difficult as there is inadequate information on forest composition to allow disentanglement from other environmental drivers. Methods This study combined historical and modern forest inventories covering an area of 21,000 km2 in a transition zone in Namibia and Angola to distinguish late succession tree communities, to understand their dependence on site factors, and to detect trends in the forest composition over the last 40 years. Results The woodlands were dominated by six tree species that represented 84 % of the total basal area and can be referred to as Baikiaea - Pterocarpus woodlands. A boosted regression tree analysis revealed that late succession tree communities are primarily determined by climate and topography. The Schinziophyton rautanenii and Baikiaea plurijuga communities are common on slightly inclined dune or valley slopes and had the highest basal area (5.5 – 6.2 m2 ha−1. The Burkea africana - Guibourtia coleosperma and Pterocarpus angolensis – Dialium englerianum communities are typical for the sandy plateaux and have a higher proportion of smaller stems caused by a higher fire frequency. A decrease in overall basal area or a trend of increasing domination by the more drought and cold resilient B. africana community was not confirmed by the historical data, but there were significant decreases in basal area for Ochna pulchra and the valuable fruit tree D. englerianum. Conclusions The slope communities are more sheltered from fire, frost and drought but are more susceptible to human expansion. The community with the important timber tree P

  5. Assessing the environmental impacts of cropping systems and cover crops : Life cycle assessment of FAST, a long-term arable farming field experiment

    NARCIS (Netherlands)

    Prechsl, U E; Wittwer, R; van der Heijden, M.G.A.|info:eu-repo/dai/nl/240923901; Luscher, G; Jeanneret, P; Nemecek, T

    2017-01-01

    To reduce environmental impacts of cropping systems, various management strategies are being discussed. Longterm field experiments are particularly suitable to directly compare different management strategies and to perform a comprehensive impact assessment. To identify the key drivers of several

  6. Prediction of fish catch in the Danube River based on long-term variability in environmental parameters and catch statistics.

    Science.gov (United States)

    Smederevac-Lalić, Marija M; Kalauzi, Aleksandar J; Regner, Slobodan B; Lenhardt, Mirjana B; Naunovic, Zorana Z; Hegediš, Aleksandar E

    2017-12-31

    The effects of physical factors on fish catch in the Serbian part of the Danube River were studied for period of six decades. The data on total catch for the Danube River from river kilometre 845 to river kilometre 1433 were collected from Statistical Office of the Republic of Serbia, while water level and water temperature data were collected from 16 water gauge stations along the investigated part of the Danube River for the period 1948-2009. Cross-correlation functions have been used to analyse the functional connection between Danube water level, water temperature and fish catch while ARMA model which combines cyclic (deterministic) and random (stochastic) components of the analysed sequences was used for the forecasts. The cross-correlation function showed negative correlation between water level and temperature as well as between water temperature and catch and positive correlation between water level and catch. The Danube water level and catch were coherent at the periods of 2.06, 4.13, 6.2, 10.33, 20.66years, while the cross correlation function between these time series did not show phase lag. The results of reconstruction and forecast of water level, temperature, and catch of fish in the Danube River, obtained by summing the cyclic and stochastic components, was used for the forecast till 2029. In 2016, seven years after, the initial forecasts were made, validity of the model was checked by obtaining data for water temperature, water level and fish catch in the Danube River for the period 2010-2015. Model gave the best prediction for water temperature; average standard error was 1.6 times higher for predicted value than for model value while for fish catch and water level they were 1.96 and 4.97, respectively. Methods used in this work could be powerful tool for prediction of fish catch and serve as the basis for better fisheries management. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Mobile Phone and Tablet Apps to Support Young People's Management of Their Physical Long-Term Conditions: A Systematic Review Protocol.

    Science.gov (United States)

    Majeed-Ariss, Rabiya; Hall, Andrew G; McDonagh, Janet; Fallon, Deborah; Swallow, Veronica

    2015-04-07

    The prevalence of long-term or chronic conditions that limit activity and reduce quality of life in young people aged 10-24 years is rising. This group has distinct health care needs and requires tailored support strategies to facilitate increasing personal responsibility for the management of their condition wherever possible, as they mature. Mobile phone and tablet mobile technologies featuring software program apps are already well used by young people for social networking or gaming. They have also been utilized in health care to support personal condition management, using condition-specific and patient-tailored software. Such apps have much potential, and there is an emerging body of literature on their use in a health context making this review timely. The objective of this paper is to develop a systematic review protocol focused on identifying and assessing the effectiveness of mobile phone and tablet apps that support young people's management of their chronic conditions. The search strategy will include a combination of standardized indexed search terms and free-text terms related to the key concepts of young people; long-term conditions and mobile technology. Peer-reviewed journal articles published from 2003 that meet the inclusion and exclusion criteria will be identified through searching the generated hits from 5 bibliographical databases. Two independent reviewers will screen the titles and abstracts to determine which articles focus on testing interventions identified as a mobile phone or tablet apps, and that have been designed and delivered to support the management of long-term conditions in young people aged 10-24 years. Data extraction and quality assessment tools will be used to facilitate consistent analysis and synthesis. It is anticipated that several studies will meet the selection criteria but that these are likely to be heterogeneous in terms of study design, reported outcomes, follow-up times, participants' age, and health condition

  8. VISIONARY THINKER: LEADERSHIP AND MANAGEMENT IN WORKS OF MARY P. FOLLETT – LONG-TERM PERSPECTIVE IN THE COMPANIES OF THE REPUBLIC OF SERBIA

    Directory of Open Access Journals (Sweden)

    Srdjan Nikezic

    2014-06-01

    Full Text Available In her lectures, Mary P. Follett pointed to key moments of leadership, management, group membership, coordination and participation as relevant elements for the exploration of human relations that are of interest today in the same way as they were eighty years ago. Model of thinking applied by Mary P. Follett is deeply linked to current strong needs for the creation of leadership and management professions that are linked to changes and long term strategic goals of big companies and world economy as a whole.

  9. Manage Short-term Flood Events and Long-term Water Needs via Reservoir Operation: A Risk Analysis Study

    Science.gov (United States)

    Cheng, W.; Hsu, N.; Wei, C.; Cheng, W.

    2010-12-01

    This study proposes a methodology to assess the risk of the water shortage during a drought period and the risk of the downstream over-levee flows during a flood period based on the reservoir operation rules for flood control. These rules are defined by upper limits (or flood control storage zone).Through a Monte Carlo simulation, a series of hydrographs are generated to represent the reservoir inflow during a flood period based on historic typhoon events. This series of generated hydrographs are then applied to a reservoir flood operation simulation model. The simulation model calculates the water levels of reservoir at the end of a flood period and the reservoir release during the typhoon the events. Reservoir release is used to calculate the water level at downstream control locations for evaluation of a short-term over-levee risk. The ending water level of the reservoir is used as the initial condition for a water distribution optimization model that evaluates drought conditions for long-term water supply. By applying risk analysis, an assessment is made on the risk of both the water shortage during a drought and over-levee flows during flooding seasons. Based on the results of the risk analysis, we evaluate the relationship among upper-limit sets, shortage risk, and over-levee risk and also provide reservoir operation suggestions based on the risk evaluation.

  10. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association.

    Science.gov (United States)

    McCrindle, Brian W; Rowley, Anne H; Newburger, Jane W; Burns, Jane C; Bolger, Anne F; Gewitz, Michael; Baker, Annette L; Jackson, Mary Anne; Takahashi, Masato; Shah, Pinak B; Kobayashi, Tohru; Wu, Mei-Hwan; Saji, Tsutomu T; Pahl, Elfriede

    2017-04-25

    Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and long-term outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances. © 2017 American Heart Association, Inc.

  11. Evaluation of nurses’ changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care: a qualitative study

    Science.gov (United States)

    Roets-Merken, Lieve M; Vernooij-Dassen, Myrra J F J; Zuidema, Sytse U; Dees, Marianne K; Hermsen, Pieter G J M; Kempen, Gertrudis I J M; Graff, Maud J L

    2016-01-01

    Objectives To gain insights into the process of nurses’ changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care, and into the factors that contributed to these changes in their perceptions. Design Qualitative study alongside a cluster randomised controlled trial. Setting 17 long-term care homes spread across the Netherlands. Participants 34 licensed practical nurses supporting 54 dual sensory impaired older adults. Intervention A 5-month training programme designed to enable nurses to support the self-management of dual sensory impaired older adults in long-term care. Primary outcomes Nurses’ perceptions on relevance and feasibility of the self-management programme collected from nurses’ semistructured coaching diaries over the 5-month training and intervention period, as well as from trainers’ reports. Results Nurses’ initial negative perceptions on relevance and feasibility of the intervention changed to positive as nurses better understood the concept of autonomy. Through interactions with older adults and by self-evaluations of the effect of their behaviour, nurses discovered that their usual care conflicted with client autonomy. From that moment, nurses felt encouraged to adapt their behaviour to the older adults’ autonomy needs. However, nurses’ initial unfamiliarity with conversation techniques required a longer exploration period than planned. Once client autonomy was understood, nurses recommended expanding the intervention as a generic approach to all their clients, whether dual sensory impaired or not. Conclusions Longitudinal data collection enabled exploration of nurses’ changes in perceptions when moving towards self-management support. The training programme stimulated nurses to go beyond ‘protocol thinking’, discovering client autonomy and exploring the need for their own behavioural adaptations. Educational programmes for practical nurses should offer

  12. An assessment of the long-term environmental impacts of reusing alkaline clay on coal refuse piles with a dynamic solute transport model at a watershed scale

    Science.gov (United States)

    Xu, Y.; Liang, X.; Davis, T. W.; Patterson, J.; Jaw, F. K.; Koranchie-Boah, P.

    2011-12-01

    Coal refuse piles play a significant role in producing acid mining drainage (AMD) that deteriorates water quality at a watershed scale. The waste produced from coal refuse piles results in a decrease of the pH value in soil water and river flow. Metal compounds, such as ferric and ferrous solutions, are also continuously released from the coal pile due to the extensive and complicated chemical reactions in the acidic environment. Alkaline clay, a byproduct of alumina refining process, has a high residual pH in the material. If the alkaline clay is used innovatively with the coal mine refuse, the problems associated with each (e.g., high and low pH values) are likely to be effectively resolved. In addition, the solubility of the sulfur and iron will be reduced significantly. This will effectively eliminate the AMD problem at the coal refuse pile and improve the water quality at the watershed scale. This study investigates the long-term impacts of the combined mixture (i.e., alkaline clay + coal refuse) on the environment (e.g., in the soil column and in the river system) through systematic modeling simulations in a combination with field measurements. In particular, a dynamic solute transport model that accounts for processes of the pyrite oxidation, oxygen diffusion, absorption, desorption, and advection is developed and is coupled with the Distributed Hydrology Soil and Vegetation Model (DHSVM) to assess the environmental impacts at the watershed scale. The model-simulated sulfur and iron concentrations are compared with field observations and the long-term impacts of the combined mixture (i.e., alkaline clay + coal refuse) on the environment are investigated. This study paves the way for monitoring and assessing the impacts of the reuse of the alkaline clay and refuse mixture on the environment at a watershed scale.

  13. Patient outcome after surgical management of the spinal accessory nerve injury: A long-term follow-up study

    Directory of Open Access Journals (Sweden)

    Harry Göransson

    2016-04-01

    Full Text Available Objectives: A lesion in the spinal accessory nerve is typically iatrogenic: related to lymph node biopsy or excision. This injury may cause paralysis of the trapezius muscle and thus result in a characteristic group of symptoms and signs, including depression and winging of the scapula, drooped shoulder, reduced shoulder abduction, and pain. The elements evaluated in this long-term follow-up study include range of shoulder motion, pain, patients’ satisfaction, delay of surgery, surgical procedure, occupational status, functional outcome, and other clinical findings. Methods: We reviewed the medical records of a consecutive 37 patients (11 men and 26 women having surgery to correct spinal accessory nerve injury. Neurolysis was the procedure in 24 cases, direct nerve repair for 9 patients, and nerve grafting for 4. Time elapsed between the injury and the surgical operation ranged from 2 to 120 months. The patients were interviewed and clinically examined after an average of 10.2 years postoperatively. Results: The mean active range of movement of the shoulder improved at abduction 44° (43% in neurolysis, 59° (71% in direct nerve repair, and 30° (22% in nerve-grafting patients. No or only slight atrophy of the trapezius muscle was observable in 75%, 44%, and 50%, and no or controllable pain was observable in 63%, 56%, and 50%. Restriction of shoulder abduction preceded deterioration of shoulder flexion. Patients’ overall dissatisfaction with the state of their upper extremity was associated with pain, lower strength in shoulder movements, and occupational problems. Conclusion: We recommend avoiding unnecessary delay in the exploration of the spinal accessory nerve, if a neural lesion is suspected.

  14. Participation in voluntary and community organisations in the United Kingdom and the influences on the self-management of long-term conditions.

    Science.gov (United States)

    Jeffries, Mark; Mathieson, Amy; Kennedy, Anne; Kirk, Susan; Morris, Rebecca; Blickem, Christian; Vassilev, Ivalyo; Rogers, Anne

    2015-05-01

    Voluntary and community organisations (VCOs) have health benefits for those who attend and are viewed as having the potential to support long-term condition management. However, existing community-level understandings of participation do not explain the involvement with VCOs at an individual level, or the nature of support, which may elicit health benefits. Framing active participation as 'doing and experiencing', the aim of this qualitative study was to explore why people with long-term vascular conditions join VCOs, maintain their membership and what prevents participation. Twenty participants, self-diagnosed as having diabetes, chronic heart disease or chronic kidney disease, were purposefully sampled and recruited from a range of VCOs in the North West of England identified from a mapping of local organisations. In semi-structured interviews, we explored the nature of their participation. Analysis was thematic and iterative involving a continual reflection on the data. People gave various reasons for joining groups. These included health and well-being, the need for social contact and pursuing a particular hobby. Barriers to participation included temporal and spatial barriers and those associated with group dynamics. Members maintained their membership on the basis of an identity and sense of belonging to the group, developing close relationships within it and the availability of support and trust. Participants joined community groups often in response to a health-related event. Our findings demonstrate the ways in which the social contact associated with continued participation in VCOs is seen as helping with long-term condition management. Interventions designed at improving chronic illness management might usefully consider the role of VCOs. © 2014 John Wiley & Sons Ltd.

  15. First-line managers' views of the long-term effects of clinical supervision: how does clinical supervision support and develop leadership in health care?

    Science.gov (United States)

    Hyrkäs, Kristiina; Appelqvist-Schmidlechner, Kaija; Kivimäki, Kirsti

    2005-05-01

    There have recently been several organizational changes that have challenged nursing managers in the Finnish health care system. First-line managers need support in their work because of organizational changes and scarce economic resources. One of these supportive measures is clinical supervision. A group of first-line managers in a Finnish University hospital participated in a 2-year clinical supervision intervention in 1999-2000. The managers' perceptions of the clinical supervision were followed up twice during the intervention and 1 year after (2001). The aim of this study is to describe how the first-line managers saw the future effects of the clinical supervision intervention 1 year after its termination. At the beginning of the intervention, the number of participating nursing managers was 32. The number of respondents in this study 1 year (2001) after the clinical supervision was 11. Data was collected using empathy-based stories, which involved writing short essays. The respondents received orientation and a script to assist them in the writing of essays. The stories were analysed qualitatively by categorizing the responses by themes. The managers deemed that clinical supervision had, in the 3-year time frame, positive long-term effects on their leadership and communication skills, the desire for self-development, self-knowledge and coping. Managers believed that in the long run, clinical supervision would provide them with a broader perspective on work and would enhance the use of clinical supervision as a supportive measure among co-workers. First-line managers expect clinical supervision to have long-term positive effects on their work and coping. Empathy-based stories, as a method, were found suited to studies, which aim to obtaining future-oriented knowledge.

  16. Meeting current and future conservation challenges through the synthesis of long-term silviculture and range management research

    Science.gov (United States)

    Mary Beth Adams; Joe NcNeel; Carlos. Rodriguez-Franco

    2010-01-01

    The Experimental Forests and Ranges (EFRs) of the Forest Service, U.S. Department of Agriculture were established to represent major forest vegetation types of the United States, to provide guidelines for management of those forests and ranges, and to serve as "outdoor classrooms" for land managers to learn how to better manage their forests. Research data...

  17. Long term fish assemblages as units of management in a temperate estuary (Rio de La Plata - SW Atlantic Ocean

    Directory of Open Access Journals (Sweden)

    María Inés Lorenzo

    2011-03-01

    Full Text Available Demersal fish assemblages from trawl surveys in the Rio de la Plata estuary and its inner continental shelf were analyzed from 1975 to 1995. The first two factors of Principal Component Analysis explained 48% of the variance in species distribution, and they are consistent with the results of a cluster analysis. The analysis indicated the existence of three spatially and temporally distinct fish assemblages: internal and external estuarine and inner continental shelf (Uruguayan coastal assemblages. These assemblages were persistent considering the environmental characteristics and their species composition. Despite the changes registered in the species density during the period surveyed, the fish assemblages tend to persist over time. It was demonstrated that the assemblages can be considered as open systems and that there exists a reciprocal flow of organisms between adjacent associations. However, each assemblage showed high spatial and temporal persistence in accordance with the environmental characteristics of the system analyzed. Therefore, and according to the multispecies fisheries operating in the system, each assemblage defined could be considered a unit of management.Foram analisadas as associações dos peixes demersais provenientes de arrastos de prospecção no estuário do Rio de la Plata e sua plataforma interna no período de 1975 a 1995. Os dois primeiros fatores da Análise de Componentes Principais explicaram 48% da variância na distribuição das espécies sendo consistentes com os resultados da análise de agrupamento. Os resultados mostraram a existência de três associações de peixes espacial e temporalmente distintas: uruguaia costeira, estuarina externa e estuarina interna. Essas associações foram consistentes quanto às características ambientais e de composição de espécies. A despeito das mudanças registradas na densidade das espécies ao longo do período analisado, as associações de peixes foram

  18. Effect of short-term versus long-term grassland management and seasonal variation in organic and conventional dairy farming on the composition of bulk tank milk

    DEFF Research Database (Denmark)

    Adler, S A; Jensen, Søren Krogh; Govasmark, E

    2013-01-01

    Bulk tank milk from 28 dairy farms was sampled every second month for 2 yr to assess the effects of grassland management, production system and season on milk fatty acid (FA) composition, concentrations of fat-soluble vitamins, Se, and milk sensory quality. Grassland management varied in terms...... of time since establishment. Short-term grassland management (SG) was defined as establishment or reseeding every fourth year or more often, and long-term grassland management (LG) was defined as less frequent establishment or reseeding. Fourteen organic (ORG) dairy farms with either short-term or long...... feeding periods had potential health benefits due to FA composition. In contrast, the higher milk-fat proportions of saturated FA in milk from ORG farms may be perceived as negative for human health....

  19. The connection between long-term and short-term risk management strategies: examples from land-use planning and emergency management in four European case studies

    Science.gov (United States)

    Prenger-Berninghoff, K.; Cortes, V. J.; Sprague, T.; Aye, Z. C.; Greiving, S.; Głowacki, W.; Sterlacchini, S.

    2014-04-01

    The need for continuous adaptation to complex and unforeseen events requires enhancing the links between planning and preparedness phases to reduce future risks in the most efficient way. In this context, the legal-administrative and cultural context has to be taken into account. This is why four case study areas of the CHANGES1 project (Nehoiu Valley in Romania, Ubaye Valley in France, Val Canale in Italy, and Wieprzówka catchment in Poland) serve as examples to highlight currently implemented risk management strategies for land-use planning and emergency preparedness. The strategies described in this paper were identified by means of exploratory and informal interviews in each study site. Results reveal that a dearth or, in very few cases, a weak link exists between spatial planners and emergency managers. Management strategies could benefit from formally intensifying coordination and cooperation between emergency services and spatial planning authorities. Moreover, limited financial funds urge for a more efficient use of resources and better coordination towards long-term activities. The research indicates potential benefits to establishing or, in some cases, strengthening this link and provides suggestions for further development in the form of information and decision support systems as a key connection point. Aside from the existent information systems for emergency management, it was found that a common platform, which integrates involvement of these and other relevant actors could enhance this connection and address expressed stakeholder needs. 1 Marie Curie ITN CHANGES - Changing Hydro-meteorological Risks as Analyzed by a New Generation of European Scientists.

  20. SERDP and ESTCP Workshop on Research and Development Needs for Long-Term Management of Contaminated Sediments

    Science.gov (United States)

    2012-10-01

    is being developed by the Society of Environmental Toxicology and Chemistry (SETAC) through its Pelleston Workshop series. The product from the... stormwater discharge. Recontamination from off-site sources can slow or even reverse recovery. In most urban and industrial harbors and rivers...Chemical in Aquatic Ecosystems. Environmental Toxicology and Chemistry , 23(10): 2343-2355. Burton, G.A., D.B. Chadwick, G. Rosen and M. Greenberg

  1. Long-term efficacy of excimer laser in situ keratomileusis in the management of children with high anisometropic amblyopia.

    Science.gov (United States)

    Lin, Xiao-Ming; Yan, Xiao-He; Wang, Zheng; Yang, Bin; Chen, Qi-Wen; Su, Jin-Ai; Ye, Xue-Lian

    2009-04-05

    Children with anisometropic amblyopia are often noncompliant with traditional treatment including spectacules and contact lenses. This study was to evaluate the long-term efficacy of excimer laser in situ keratomileusis (LASIK) for children with high anisometropic amblyopia. A retrospective analysis of 24 children with high unilateral anisometropic amblyopia, who underwent LASIK during the period between August 2000 and September 2005 in our hospital, was conducted. The mean age of these children was (7.4 +/- 1.9) years (range 5 - 14 years) and the mean follow-up period was (33.3 +/- 14.2) months (range 18.5 - 74.2 months). After LASIK, visual acuity, refraction and far or near stereoacuity were analyzed. Near stereoacuity was measured by the random-dot butterfly stereogram and the pre-school random-dot stereogram, while far stereoacuity was measured by the synoptophore with Yan's random-dot stereogram. Mean preoperative uncorrected visual acuity was 0.06 +/- 0.05, while mean postoperative uncorrected visual acuity was elevated to 0.43 +/- 0.33. Mean preoperative best-corrected visual acuity was 0.26 +/- 0.22, while mean postoperative best-corrected visual acuity was elevated to 0.67 +/- 0.40. For patients with myopic anisometropia, preoperative mean spherical equivalent refraction was (-8.01 +/- 2.70) D while postoperative value significantly reduced to (-1.32 +/- 2.47) D. For patients with hyperopic anisometropia, preoperative mean spherical equivalent refraction was (+7.35 +/- 1.55) D while postoperative value significantly reduced to (+3.30 +/- 0.86) D. These results demonstrated that there was statistical difference in these parameters between preoperative and postoperative tests. At the last follow-up, 20 patients had near stereoacuity, and the mean near stereoacuities measured by the random-dot butterfly stereogram and the preschool random-dot stereogram were (149.00 +/- 152.93)'' and (201.05 +/- 235.94)'', respectively. In contrast, 11 patients had far

  2. Long-Term Collections

    CERN Multimedia

    Staff Association

    2016-01-01

    45 years helping in developing countries! CERN personnel have been helping the least fortunate people on the planet since 1971. How? With the Long-Term Collections! Dear Colleagues, The Staff Association’s Long-Term Collections (LTC) Committee is delighted to share this important milestone in the life of our Laboratory with you. Indeed, whilst the name of CERN is known worldwide for scientific discoveries, it also shines in the many humanitarian projects which have been supported by the LTC since 1971. Several schools and clinics, far and wide, carry its logo... Over the past 45 years, 74 projects have been supported (9 of which are still ongoing). This all came from a group of colleagues who wanted to share a little of what life offered them here at CERN, in this haven of mutual understanding, peace and security, with those who were less fortunate elsewhere. Thus, the LTC were born... Since then, we have worked as a team to maintain the dream of these visionaries, with the help of regular donat...

  3. Long-Term Collection

    CERN Multimedia

    Staff Association

    2016-01-01

    Dear Colleagues, As previously announced in Echo (No. 254), your delegates took action to draw attention to the projects of the Long-Term Collections (LTC), the humanitarian body of the CERN Staff Association. On Tuesday, 11 October, at noon, small Z-Cards were widely distributed at the entrances of CERN restaurants and we thank you all for your interest. We hope to have achieved an important part of our goal, which was to inform you, convince you and find new supporters among you. We will find out in the next few days! An exhibition of the LTC was also set up in the Main Building for the entire week. The Staff Association wants to celebrate the occasion of the Long-Term Collection’s 45th anniversary at CERN because, ever since 1971, CERN personnel have showed great support in helping the least fortunate people on the planet in a variety of ways according to their needs. On a regular basis, joint fundraising appeals are made with the Directorate to help the victims of natural disasters around th...

  4. Collectes à long terme

    CERN Multimedia

    Collectes à long terme

    2014-01-01

    En cette fin d’année 2014 qui approche à grands pas, le Comité des Collectes à Long Terme remercie chaleureusement ses fidèles donatrices et donateurs réguliers pour leurs contributions à nos actions en faveur des plus démunis de notre planète. C’est très important, pour notre Comité, de pouvoir compter sur l’appui assidu que vous nous apportez. Depuis plus de 40 ans maintenant, le modèle des CLT est basé principalement sur des actions à long terme (soit une aide pendant 4-5 ans par projet, mais plus parfois selon les circonstances), et sa planification demande une grande régularité de ses soutiens financiers. Grand MERCI à vous ! D’autres dons nous parviennent au cours de l’année, et ils sont aussi les bienvenus. En particulier, nous tenons à remercier...

  5. Long-term international impacts of nature-oriented forest management on European forests - an assessment with the EFISCEN model

    NARCIS (Netherlands)

    Nabuurs, G.J.; Goede, de D.M.; Michie, B.; Schelhaas, M.J.; Wesseling, J.G.

    2002-01-01

    Forest management in Europe is changing towards a multi-functional approach in which the role of nature conservation and wood production are given equal prominence. This nature-oriented forest management will result in a very different European forest in 50-100 years time, changing felling options

  6. An analysis of the long-term variation in stream water quality for three upland catchments at Loch Dee (Galloway, S.W. Scotland under contrasting land management

    Directory of Open Access Journals (Sweden)

    S. J. Langan

    2004-01-01

    Full Text Available A long term record of water chemistry, consisting of twenty years of weekly spot samples, from three sub-catchments draining into a loch and the loch outflow in Galloway, S.W. Scotland have been analysed. The analysis undertaken consisted of a three component statistical trend model. The technique allows the identification of long-term, seasonal and short-term trends, as well as differentiation between base flow and high flow responses. The land usage in the three sub-catchments is moorland, forest and forest plus lime. The results show that, since the mid-1980s, there has been a gradual decline in stream-water sulphate of the same order as reductions in the deposition of non-marine sulphate. Superimposed on this trend are somewhat random but considerable perturbations to this decline, caused by sea-salt deposition. There is no evidence of changes in surface water nitrate concentrations. The influence of different land management is evident in the sulphate, nitrate and pH data, whilst variations in calcium concentrations are also a product of differences in hydrological routing and the impact of sea-salt episodes. Keywords: trend analysis, acid deposition, land management, water quality, sea-salts, Galloway, S.W. Scotland

  7. Stability of Cacopsylla pyricola (Hemiptera: Psyllidae Populations in Pacific Northwest Pear Orchards Managed with Long-Term Mating Disruption for Cydia pomonella (Lepidoptera: Tortricidae

    Directory of Open Access Journals (Sweden)

    Kaushalya G. Amarasekare

    2017-09-01

    Full Text Available This study focused on conservation biological control of pear psylla, Cacopsylla pyricola, in the Pacific Northwest, USA. We hypothesized that insecticides applied against the primary insect pest, codling moth Cydia pomonella, negatively impact natural enemies of pear psylla, thus causing outbreaks of this secondary pest. Hence, the objective of this study was to understand how codling moth management influences the abundance of pear psylla and its natural enemy complex in pear orchards managed under long-term codling moth mating disruption programs. We conducted this study within a pear orchard that had previously been under seasonal mating disruption for codling moth for eight years. We replicated two treatments, “natural enemy disrupt” (application of two combination sprays of spinetoram plus chlorantraniliprole timed against first-generation codling moth and “natural enemy non-disrupt” four times in the orchard. Field sampling of psylla and natural enemies (i.e., lacewings, coccinellids, spiders, Campylomma verbasci, syrphid flies, earwigs revealed that pear psylla populations remained well below treatment thresholds all season despite the reduced abundance of key pear psylla natural enemies in the natural enemy disrupt plots compared with the non-disrupt treatment. We speculate that pear psylla are difficult to disrupt when pear orchards are under long-term codling moth disruption.

  8. Impact of Managers' Coaching Conversations on Staff Knowledge Use and Performance in Long-Term Care Settings.

    Science.gov (United States)

    Cummings, Greta G; Hewko, Sarah J; Wang, Mengzhe; Wong, Carol A; Laschinger, Heather K Spence; Estabrooks, Carole A

    2017-07-29

    Extended lifespans and complex resident care needs have amplified resource demands on nursing homes. Nurse managers play an important role in staff job satisfaction, research use, and resident outcomes. Coaching skills, developed through leadership skill-building, have been shown to be of value in nursing. To test a theoretical model of nursing home staff perceptions of their work context, their managers' use of coaching conversations, and their use of instrumental, conceptual and persuasive research. Using a two-group crossover design, 33 managers employed in seven Canadian nursing homes were invited to attend a 2-day coaching development workshop. Survey data were collected from managers and staff at three time points; we analyzed staff data (n = 333), collected after managers had completed the workshop. We used structural equation modeling to test our theoretical model of contextual characteristics as causal variables, managers' characteristics, and coaching behaviors as mediating variables and staff use of research, job satisfaction, and burnout as outcome variables. The theoretical model fit the data well (χ2 = 58, df = 43, p = .06) indicating no significant differences between data and model-implied matrices. Resonant leadership (a relational approach to influencing change) had the strongest significant relationship with manager support, which in turn influenced frequency of coaching conversations. Coaching conversations had a positive, non-significant relationship with staff persuasive use of research, which in turn significantly increased instrumental research use. Importantly, coaching conversations were significantly, negatively related to job satisfaction. Our findings add to growing research exploring the role of context and leadership in influencing job satisfaction and use of research by healthcare practitioners. One-on-one coaching conversations may be difficult for staff not used to participating in such conversations. Resonant leadership, as

  9. The contribution of social networks to the health and self-management of patients with long-term conditions: a longitudinal study.

    Directory of Open Access Journals (Sweden)

    David Reeves

    Full Text Available Evidence for the effectiveness of patient education programmes in changing individual self-management behaviour is equivocal. More distal elements of personal social relationships and the availability of social capital at the community level may be key to the mobilisation of resources needed for long-term condition self-management to be effective.To determine how the social networks of people with long-term conditions (diabetes and heart disease are associated with health-related outcomes and changes in outcomes over time.Patients with chronic heart disease (CHD or diabetes (n = 300 randomly selected from the disease registers of 19 GP practices in the North West of England. Data on personal social networks collected using a postal questionnaire, alongside face-to-face interviewing. Follow-up at 12 months via postal questionnaire using a self-report grid for network members identified at baseline.Multiple regression analysis of relationships between health status, self-management and health-economics outcomes, and characteristics of patients' social networks.Findings indicated that: (1 social involvement with a wider variety of people and groups supports personal self-management and physical and mental well-being; (2 support work undertaken by personal networks expands in accordance with health needs helping people to cope with their condition; (3 network support substitutes for formal care and can produce substantial saving in traditional health service utilisation costs. Health service costs were significantly (p<0.01 reduced for patients receiving greater levels of illness work through their networks.Support for self-management which achieves desirable policy outcomes should be construed less as an individualised set of actions and behaviour and more as a social network phenomenon. This study shows the need for a greater focus on harnessing and sustaining the capacity of networks and the importance of social involvement with community

  10. Understanding the use of strategic intelligence as a strategic management tool in the long-term insurance industry in South Africa

    Directory of Open Access Journals (Sweden)

    René Pellissier

    2011-03-01

    Full Text Available The purpose of this research paper was to explore the extent to which strategic intelligence is utilised within the South African long-term insurance industry and whether it could be used to identify opportunities or threats within the global environment to remain competitive, create greater innovation, and corporate advantage.The paper obtained the qualitative views and opinions of strategic decision makers, on an executive managerial level within the South African long-term insurance industry, on their organisations use of strategic intelligence. It was found that there are marked differences in the conformity and usage of strategic intelligence and its components between the organisations surveyed, with a measurable difference between large and small organisations. It is, however, generally viewed that the use of a strategic intelligence framework could greatly enhance decision-making.Data collection for the research undertaken was limited to the 82 long-term insurance companies, which were registered with the South African Financial Services Board. More specifically the focus was on the organisations listed on the Johannesburg Securities Exchange within the Life Assurance sector, within which a final response rate of 36.1% was achieved, including the 100% response rate from the six listed organisations.By understanding the extent to which strategic intelligence is utilised in the South African longterminsurance industry, and the benefits or problems that are experienced by implementing and using strategic intelligence as an input to the strategic management process we can comprehend the value that strategic intelligence adds in the decision making process. The originality of this work concludes in the identification and utilisation of the most important factors of a strategic intelligence framework that will greatly enhance global corporate decisionmakingand result in competitive advantage and constant innovation within the South African

  11. Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer.

    Science.gov (United States)

    Hanlon, Peter; Daines, Luke; Campbell, Christine; McKinstry, Brian; Weller, David; Pinnock, Hilary

    2017-05-17

    Self-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions. The objectives of this metareview were to (1) assess the impact of telehealth interventions to support self-management on disease control and health care utilization, and (2) identify components of telehealth support and their impact on disease control and the process of self-management. Our goal was to synthesise evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support. We performed a metareview (a systematic review of systematic reviews) of randomized controlled trials (RCTs) of telehealth interventions to support self-management in 6 exemplar long-term conditions. We searched 7 databases for reviews published from January 2000 to May 2016 and screened identified studies against eligibility criteria. We weighted reviews by quality (revised A Measurement Tool to Assess Systematic Reviews), size, and relevance. We then combined our results in a narrative synthesis and using harvest plots. We included 53 systematic reviews, comprising 232 unique RCTs. Reviews concerned diabetes (type 1: n=6; type 2, n=11; mixed, n=19), heart failure (n=9), asthma (n=8), COPD (n=8), and cancer (n=3). Findings varied between and within disease areas. The highest-weighted reviews showed that blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes, and that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and of components of successful

  12. Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer

    Science.gov (United States)

    Hanlon, Peter; Daines, Luke; Campbell, Christine; McKinstry, Brian; Weller, David

    2017-01-01

    Background Self-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions. Objective The objectives of this metareview were to (1) assess the impact of telehealth interventions to support self-management on disease control and health care utilization, and (2) identify components of telehealth support and their impact on disease control and the process of self-management. Our goal was to synthesise evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support. Methods We performed a metareview (a systematic review of systematic reviews) of randomized controlled trials (RCTs) of telehealth interventions to support self-management in 6 exemplar long-term conditions. We searched 7 databases for reviews published from January 2000 to May 2016 and screened identified studies against eligibility criteria. We weighted reviews by quality (revised A Measurement Tool to Assess Systematic Reviews), size, and relevance. We then combined our results in a narrative synthesis and using harvest plots. Results We included 53 systematic reviews, comprising 232 unique RCTs. Reviews concerned diabetes (type 1: n=6; type 2, n=11; mixed, n=19), heart failure (n=9), asthma (n=8), COPD (n=8), and cancer (n=3). Findings varied between and within disease areas. The highest-weighted reviews showed that blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes, and that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and

  13. Long Term Physiologic and Behavioural Effects of Housing Density and Environmental Resource Provision for Adult Male and Female Sprague Dawley Rats

    Directory of Open Access Journals (Sweden)

    Christopher J. Pinelli

    2017-06-01

    Full Text Available There is considerable interest in refining laboratory rodent environments to promote animal well-being, as well as research reproducibility. Few studies have evaluated the long term impact of enhancing rodent environments with resources and additional cagemates. To that end, male and female Sprague Dawley (SD rats were housed singly (n = 8/sex, in pairs (n = 16/sex, or in groups of four (n = 16/sex for five months. Single and paired rats were housed in standard cages with a nylon chew toy, while group-housed rats were kept in double-wide cages with two PVC shelters and a nylon chew toy and were provided with food enrichment three times weekly. Animal behaviour, tests of anxiety (open field, elevated plus maze, and thermal nociception, and aspects of animal physiology (fecal corticoid levels, body weight, weekly food consumption, organ weights, and cerebral stress signaling peptide and receptor mRNA levels were measured. Significant differences were noted, primarily in behavioural data, with sustained positive social interactions and engagement with environmental resources noted throughout the study. These results suggest that modest enhancements in the environment of both male and female SD rats may be beneficial to their well-being, while introducing minimal variation in other aspects of behavioural or physiologic responses.

  14. Traffic density as a surrogate measure of environmental exposures in studies of air pollution health effects: Long-term mortality in a cohort of US veterans

    Science.gov (United States)

    Lipfert, F. W.; Wyzga, R. E.; Baty, J. D.; Miller, J. P.

    Vehicular traffic is an ubiquitous source of air pollution in developed nations, yet relatively few epidemiology studies have considered its long-term health effects. This paper uses an areal measure of traffic density as a surrogate index of exposure to vehicular traffic. We present associations between county-level traffic density (annual vehicle-km traveled km -2), ambient air quality, and mortality in a cohort of about 70,000 male US veterans (the Washington University-EPRI Veterans Cohort) who were enrolled in 1976 and followed through 2001. Traffic density is seen to be a significant and robust predictor of survival in this cohort, more so than ambient air quality, with the possible exception of ozone. Stronger effects of traffic density are seen in the counties that have ambient air quality monitoring data, which also tend to have higher levels of traffic density. These proportional-hazard modeling results indicate only modest changes in traffic-related mortality risks over time, from 1976-2001, despite the decline in regulated tailpipe emissions per vehicle since the mid-1970s. This suggests that other environmental effects may be involved, such as particles from brake, tire, and road wear, traffic noise, psychological stress, and spatial gradients in socioeconomic status.

  15. Long-term influence of alternative forest management treatments on total ecosystem and wood product carbon storage

    Science.gov (United States)

    Joshua J. Puhlick; Aaron R. Weiskittel; Ivan J. Fernandez; Shawn Fraver; Laura S. Kenefic; Robert S. Seymour; Randall K. Kolka; Lindsey E. Rustad; John C. Brissette

    2016-01-01

    Developing strategies for reducing atmospheric CO2 is one of the foremost challenges facing natural resource professionals today. The goal of this study was to evaluate total ecosystem and harvested wood product carbon (C) stocks among alternative forest management treatments (selection cutting, shelterwood cutting, commercial clearcutting, and...

  16. Long Term Effects of a Staff Development Programme on Effective Instruction and Classroom Management for Teachers in Multigrade Classes.

    Science.gov (United States)

    Veenman, Simon; Raemaekers, Jan

    1995-01-01

    Presents the findings of a six-year staff development program for multigrade teachers. Discovers a significant increase in the time on task levels of the pupils and the instructional and classroom management skills of the teachers. Discusses the implications of, and problems with, the study. (MJP)

  17. ETHICAL ASPECTS OF ENVIRONMENTAL MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Cîrstea Ştefan-Dragoş

    2013-07-01

    Full Text Available The purpose of this article is to outline the main economical and social benefits that can be obtained by adopting an ethical attitude of the organisations which use a performant environmental management. From the idea that the human being is the master of nature, it was passed to the view according to which the human being must ensure a balance between consumption and the use of resources. In order to achieve our goal we identified the factors that lead to long term or even permanent destructive effects over the environment and we briefly present the reasons for which the organizations adopt and implement environmental management systems. Also, the difficulties encountered in implementing environmental strategies have been briefly enumerated and the competitive and economic advantages that can be achieved by adopting an efficient environmental management and the main reasons that grant to the environmental management a special significance were exposed. This theoretical paper emphasizes the importance of the adoption by organizations of a "green behavior" and reveals correlations between sustainability, economic growth and environmental performance in organizations. The analysis of the ethical aspects of environmental management shows the links that can be created between the development of an ethical culture of organizations and the achievement of the environmental excellence. The research provides an overview of the concept of environmental ethics and encloses it within the scope of environmental management. Someone needs to explain why an increasing number of organizations, both large and small, are setting up environmental management systems, making environmental investments and reducing risks over and beyond legal requirements, even when the benefits are not at all obvious, even in the long run. Also, this paper provides some practical examples of organizations environmental problems and points out how these organizations adapted their

  18. Late presentation of an anomalous left coronary artery from the pulmonary artery treated with conservative surgical management with long-term cardiac magnetic resonance imaging follow-up

    Directory of Open Access Journals (Sweden)

    Pishoy Gouda

    2017-02-01

    Full Text Available Anomalous origin of the left coronary artery from the pulmonary artery is rare congenital abnormality that most commonly presents in childhood and is associated with a high mortality. In the elderly, patients may present acutely with arrhythmias or signs of ischemia or with vague chronic presentations of shortness of breath and fatigue. In the high-risk elderly population, it is unclear as to whether conservative surgical management by means of suture ligation of the left coronary artery is associated with positive long-term outcomes. We present a case of a 69-year-old patient diagnosed with anomalous origin of the left coronary artery from the pulmonary artery, which was treated with conservative surgical management and followed up for 15 years with cardiovascular magnetic resonance imaging, with positive outcomes.

  19. Long-term oncologic outcomes after fertility-sparing management using oral progestin for young women with endometrial cancer (KGOG 2002).

    Science.gov (United States)

    Park, Jeong-Yeol; Kim, Dae-Yeon; Kim, Jong-Hyeok; Kim, Yong-Man; Kim, Kyu-Rae; Kim, Young-Tak; Seong, Seok Ju; Kim, Tae-Jin; Kim, Jae Weon; Kim, Seok Mo; Bae, Duk-Soo; Nam, Joo-Hyun

    2013-03-01

    To analyse the long-term oncologic outcomes of a fertility-sparing management using oral progestin in young women with endometrial cancer. We analysed 148 patients (age≤40 years) with stage IA, grade 1, endometrioid adenocarcinoma of the uterus who underwent fertility-sparing management using daily oral medroxyprogesterone acetate (MPA) or megestrol acetate (MA). 115 (77.7%) showed complete response (CR) to progestin treatment, and 35 (30.4%) of them experienced recurrence after median follow-up time of 66 months. The 5-year recurrence-free survival was 68% (95% confidence interval [CI], 58.5-76.9%). However, 33 patients (22.3%) who failed to achieve CR underwent definitive surgical management, and no one had recurrence after median follow-up time of 41 months. During progestin treatment and at the time of recurrence, no patient showed clinical progression of disease over stage IA. Body mass index (BMI) ≥25 kg/m(2) was the only significant factor associated with a failure to achieve CR (odds ratio [OR], 3.00; 95% CI, 1.35-6.66; P=0.007). Upon multivariate analysis, BMI≥25 kg/m(2) (OR, 2.14; 95% CI, 1.06-4.31; P=0.033) was significantly associated with a higher risk of recurrence and the use of MPA (compared to MA) (OR, 0.44; 95% CI, 0.22-0.88; P=0.021), maintenance treatment (OR, 0.22; 95% CI, 0.05-0.94; P=0.042) and pregnancy (OR, 0.25; 95% CI, 0.11-0.56; P=0.001) were significantly associated with a lower risk of recurrence. Fertility-sparing management was highly effective and safe. BMI<25 kg/m(2), MPA (compared to MA), maintenance treatment and pregnancy were associated with higher possibility of long-term success. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. Why less may be more: a mixed methods study of the work and relatedness of 'weak ties' in supporting long-term condition self-management.

    Science.gov (United States)

    Rogers, Anne; Brooks, Helen; Vassilev, Ivaylo; Kennedy, Anne; Blickem, Christian; Reeves, David

    2014-02-13

    The distribution of the roles and responsibilities of long-term condition management (LTCM) outside of formal health services implicates a wide set of relationships and activities of involvement. Yet, compared to studies of professional implementation, patient systems of implementation remain under-investigated. The aim of this paper is to explore the work, meaning and function attributed to 'weaker' ties relative to other more bonding relationships in order to identify the place of these within a context of systems of support for long-term conditions. This is a mixed methods survey with nested qualitative study. A total of 300 people from deprived areas in the North West of England with chronic illnesses took part in a survey conducted in 2010 to 2011. A concentric circles diagram was used as a research tool with which participants identified 2,544 network members who contributed to illness management. Notions of 'work' were used to describe activities associated with chronic illness and to identify how weaker ties are included and perceived to be involved through social network members (SNM) contributions. The results provide an articulation of how SNMs are substantially involved in weak tie illness management. Weaker ties constituted 16.1% of network membership involved in illness work. The amount of work undertaken was similar but less than that of stronger ties. Weaker ties appeared more durable and less liable to loss over time than stronger ties. The qualitative accounts suggested that weak ties enabled the moral positioning of the self-managing 'self' and acted on the basis of a strong sense of reciprocity. Weak ties act as an acceptable bridge between a sense of personal agency and control and the need for external support because it is possible to construct a sense of moral acceptability through reciprocal exchange. Access to weak tie resources needs to be taken into account when considering the ways in which systems of health implementation for chronic

  1. Impact of chronic kidney disease on long-term ischemic and bleeding outcomes in medically managed patients with acute coronary syndromes: Insights from the TRILOGY ACS Trial.

    Science.gov (United States)

    Melloni, Chiara; Cornel, Jan H; Hafley, Gail; Neely, Megan L; Clemmensen, Peter; Zamoryakhin, Dmitry; Prabhakaran, Dorairaj; White, Harvey D; Fox, Keith Aa; Ohman, E Magnus; Armstrong, Paul W; Roe, Matthew T

    2016-10-01

    We aimed to study the relationship of chronic kidney disease stages with long-term ischemic and bleeding outcomes in medically managed acute coronary syndrome patients and the influence of more potent antiplatelet therapies on platelet reactivity by chronic kidney disease stage. We estimated creatinine clearance for 8953 medically managed acute coronary syndrome patients enrolled in the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes trial. Patients were classified by chronic kidney disease stage: normal renal function/mild (creatinine clearance >60 mL/min); moderate (creatinine clearance 30-60 mL/min); severe (creatinine clearance chronic kidney disease stage and treatment allocation (prasugrel vs. clopidogrel) within each stage. Adjusted hazard ratios (95% confidence intervals) for moderate and for severe chronic kidney disease vs. normal/mild chronic kidney disease were estimated. Platelet reactivity at 30 days was assessed in a subset of patients (n = 1947). The majority of patients were in the normal/mild chronic kidney disease group (67%), followed by moderate chronic kidney disease (29%) and severe chronic kidney disease (4%). The incidence of ischemic and bleeding outcomes increased sharply across chronic kidney disease stages and no significant treatment interactions were observed. The adjusted risk of the primary end point increased across chronic kidney disease stages (moderate vs. normal/mild: hazard ratio 1.26; 95% confidence interval 1.09-1.46; severe vs. normal/mild: hazard ratio 1.60; 95% confidence interval 1.25-2.04). Platelet reactivity was lower in patients treated with prasugrel compared with clopidogrel, across all three chronic kidney disease stages. Among medically managed acute coronary syndrome patients, the long-term risks of ischemic and bleeding outcomes increased markedly with worse chronic kidney disease stages. Despite lower platelet reactivity of prasugrel compared with

  2. Evaluation of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care: a qualitative study.

    Science.gov (United States)

    Roets-Merken, Lieve M; Vernooij-Dassen, Myrra J F J; Zuidema, Sytse U; Dees, Marianne K; Hermsen, Pieter G J M; Kempen, Gertrudis I J M; Graff, Maud J L

    2016-11-17

    To gain insights into the process of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care, and into the factors that contributed to these changes in their perceptions. Qualitative study alongside a cluster randomised controlled trial. 17 long-term care homes spread across the Netherlands. 34 licensed practical nurses supporting 54 dual sensory impaired older adults. A 5-month training programme designed to enable nurses to support the self-management of dual sensory impaired older adults in long-term care. Nurses' perceptions on relevance and feasibility of the self-management programme collected from nurses' semistructured coaching diaries over the 5-month training and intervention period, as well as from trainers' reports. Nurses' initial negative perceptions on relevance and feasibility of the intervention changed to positive as nurses better understood the concept of autonomy. Through interactions with older adults and by self-evaluations of the effect of their behaviour, nurses discovered that their usual care conflicted with client autonomy. From that moment, nurses felt encouraged to adapt their behaviour to the older adults' autonomy needs. However, nurses' initial unfamiliarity with conversation techniques required a longer exploration period than planned. Once client autonomy was understood, nurses recommended expanding the intervention as a generic approach to all their clients, whether dual sensory impaired or not. Longitudinal data collection enabled exploration of nurses' changes in perceptions when moving towards self-management support. The training programme stimulated nurses to go beyond 'protocol thinking', discovering client autonomy and exploring the need for their own behavioural adaptations. Educational programmes for practical nurses should offer more longitudinal coaching of autonomy supportive conversational skills. Intervention programming should

  3. Risk Assessment and Management for Long-Term Storage of CO2 in Geologic Formations — United States Department of Energy R&D

    Directory of Open Access Journals (Sweden)

    Dawn Deel

    2007-02-01

    Full Text Available Concern about increasing atmospheric concentrations of carbon dioxide (CO2 and other greenhouse gases (GHG and their impact on the earth's climate has grown significantly over the last decade. Many countries, including the United States, wrestle with balancing economic development and meeting critical near-term environmental goals while minimizing long-term environmental risks. One promising solution to the buildup of GHGs in the atmosphere, being pursued by the U.S. Department of Energy's (DOE National Energy Technology Laboratory (NETL and its industrial and academic partners, is carbon sequestration—a process of permanent storage of CO2 emissions in underground geologic formations, thus avoiding CO2 release to the atmosphere. This option looks particularly attractive for point source emissions of GHGs, such as fossil fuel fired power plants. CO2 would be captured, transported to a sequestration site, and injected into an appropriate geologic formation. However, sequestration in geologic formations cannot achieve a significant role in reducing GHG emissions unless it is acceptable to stakeholders, regulators, and the general public, i.e., unless the risks involved are judged to be acceptable. One tool that can be used to achieve acceptance of geologic sequestration of CO2 is risk assessment, which is a proven method to objectively manage hazards in facilities such as oil and natural gas fields, pipelines, refineries, and chemical plants. Although probabilistic risk assessment (PRA has been applied in many areas, its application to geologic CO2 sequestration is still in its infancy. The most significant risk from geologic carbon sequestration is leakage of CO2. Two types of CO2 releases are possible—atmospheric and subsurface. High concentrations of CO2 caused by a release to the atmosphere would pose health risks to humans and animals, and any leakage of CO2 back into the atmosphere negates the effort expended to sequester the CO2

  4. 78 FR 7450 - Final Environmental Impact Statement for Protecting and Restoring Native Ecosystems by Managing...

    Science.gov (United States)

    2013-02-01

    ... National Park Service Final Environmental Impact Statement for Protecting and Restoring Native Ecosystems... a Final Environmental Impact Statement for Protecting and Restoring Native Ecosystems by Managing... a manner that supports long-term ecosystem protection, supports natural ecosystem recovery and...

  5. Is there an association between external cardioversions and long-term mortality and morbidity? Insights from the Atrial Fibrillation Follow-up Investigation of Rhythm Management study.

    Science.gov (United States)

    Elayi, Claude S; Whitbeck, Matthew G; Charnigo, Richard; Shah, Jignesh; Macaulay, Tracy E; Morales, Gustavo; Gurley, John C; Kakavand, Bahram; Thal, Sergio; Ching, Chi Keong; Khaykin, Yaariv; Verma, Atul; Barrett, Conor; Bai, Rong; Di Biase, Luigi; Patwardhan, Abhijit; Moliterno, David J; Natale, Andrea

    2011-08-01

    Cardiac electric therapies effectively terminate tachyarrhythmias. Recent data suggest a possible increase in long-term mortality associated with implantable cardioverter-defibrillator shocks. Little is known about the association between external cardioversion episodes (ECVe) and long-term mortality. We sought to assess the safety of repeated ECVe with regard to cardiovascular mortality and morbidity. We analyzed the data of the 4060 patients from the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial. In particular, associations of ECVe with all-cause mortality, cardiovascular mortality, and hospitalizations after ECVe were studied. Over an average follow-up of 3.5 years, 660 (16.3%) patients died, 331 (8.2%) from cardiovascular causes. A total of 207 (5.1%) and 1697 (41.8%) patients had low ejection fraction and nonparoxysmal atrial fibrillation, respectively; 2460 patients received no ECVe, whereas 1600 experienced ≥ 1 ECVe. Death occurred in 412 (16.7%), 196 (16.5%), 39 (13.5%), and 13 (10.4%) of patients with 0, 1, 2, and ≥ 3 ECVe, respectively. There was no significant association between ECVe and mortality within any of the 4 subgroups defined by ejection fraction and atrial fibrillation type, although myocardial infarction, coronary artery bypass graft, and digoxin were significantly associated with death (estimated hazard ratios, 1.65, 1.59, and 1.62, respectively; P Digoxin, myocardial infarction, and coronary artery bypass graft were significantly associated with mortality.

  6. Understanding the use of strategic intelligence as a strategic management tool in the long-term insurance industry in South Africa

    Directory of Open Access Journals (Sweden)

    René Pellissier

    2011-10-01

    The paper obtained the qualitative views and opinions of strategic decision makers, on an executive managerial level within the South African long-term insurance industry, on their organisations use of strategic intelligence. It was found that there are marked differences in the conformity and usage of strategic intelligence and its components between the organisations surveyed, with a measurable difference between large and small organisations. It is, however, generally viewed that the use of a strategic intelligence framework could greatly enhance decision-making. Data collection for the research undertaken was limited to the 82 long-term insurance companies, which were registered with the South African Financial Services Board. More specifically the focus was on the organisations listed on the Johannesburg Securities Exchange within the Life Assurance sector, within which a final response rate of 36.1% was achieved, including the 100% response rate from the six listed organisations. By understanding the extent to which strategic intelligence is utilised in the South African longterminsurance industry, and the benefits or problems that are experienced by implementing and using strategic intelligence as an input to the strategic management process we can comprehend the value that strategic intelligence adds in the decision making process. The originality of this work concludes in the identification and utilisation of the most important factors of a strategic intelligence framework that will greatly enhance global corporate decisionmakingand result in competitive advantage and constant innovation within the South African business environment.

  7. The potential to mitigate global warming with no-tillage management is only realized when practised in the long term

    OpenAIRE

    Six, J; Ogle, S M; Breidt, F J; Conant, R T; Mosier, A R; Paustian, K

    2004-01-01

    No-tillage (NT) management has been promoted as a practice capable of offsetting greenhouse gas (GHG) emissions because of its ability to sequester carbon in soils. However, true mitigation is only possible if the overall impact of NT adoption reduces the net global warming potential (GWP) determined by fluxes of the three major biogenic GHGs (i.e. CO2, N2O, and CH4). We compiled all available data of soil-derived GHG emission comparisons between conventional tilled (CT) and NT systems for hu...

  8. Charcot spinal arthropathy: an increasing long-term sequel after spinal cord injury with no straightforward management.

    Science.gov (United States)

    Grassner, Lukas; Geuther, Martina; Mach, Orpheus; Bühren, Volker; Vastmans, Jan; Maier, Doris

    2015-01-01

    Charcot spinal arthropathy (CSA) is most likely increasing in patients suffering from consequences of spinal cord injury. We want to highlight initial symptoms, certain risk factors and perioperative complications of this condition. A single center retrospective case series in a specialized Center for Spinal Cord Injuries, BG Trauma Center Murnau, Germany highlighting the potential obstacles in the management of Charcot spine. We describe four female paraplegic patients (mean age: 50.75 years; range: 42-67), who developed Charcot spinal arthropathies. The mean age at the time of the accident was 21.5 years (3-35), the time lag after the accident before CSA was developed and finally diagnosed was on average 29.5 years (17-39) and the mean follow-up period was 39.5 months (6-73). Patient histories, initial symptoms, risk factors as well as the management and postoperative complications are provided. Charcot spine is an important potential sequel of spinal cord injury, which can lead to significant disability and spinal emergencies in affected individuals. More studies are needed to provide better recommendations for spine surgeons. Conservative treatment is an option. Posterior fixation alone does not seem to be sufficient.

  9. LONG TERM COLLECTIONS

    CERN Multimedia

    STAFF ASSOCIATION

    2010-01-01

    ACKNOWLEDGMENTS The Long-Term Collections (CLT) committee would like to warmly thank its faithful donors who, year after year, support our actions all over the world. Without you, all this would not be possible. We would like to thank, in particular, the CERN Firemen’s Association who donated 5000 CHF in the spring thanks to the sale of their traditional calendar, and the generosity of the CERN community. A huge thank you to the firemen for their devotion to our cause. And thank you to all those who have opened their door, their heart, and their purses! Similarly, we warmly thank the CERN Yoga Club once again for its wonderful donation of 2000 CHF we recently received. We would also like to tell you that all our projects are running well. Just to remind you, we are currently supporting the activities of the «Réflexe-Partage» Association in Mali; the training centre of «Education et Développement» in Abomey, Benin; and the orphanage and ...

  10. Social scientist on board in long-term management of high level and/or long-lived radioactive waste in Belgium

    Energy Technology Data Exchange (ETDEWEB)

    Parotte, C. [Spiral Research Center, Department of Political Sciences, Faculty of Law, University of Liege (Belgium)

    2013-07-01

    In Belgium, the long-term management of radioactive waste is under the exclusive competence of the Belgian Agency for Radioactive Waste and Enriched Fissile Materials (knew as ONDRAF/NIRAS). Unlike low-level waste, no institutional policy has yet been formally approved for the long-term management of high level and/or long-lived radioactive waste (knew as B and C waste). In this context, ONDRAF/NIRAS considers the public and stakeholders' participation as an essential factor in the formulation of an effective and legitimate policy. This is why it has decided to integrate them in different ways during the elaboration of the Waste Plan (ONDRAF/NIRAS-document containing guidelines to make a principled policy decision about nuclear waste management). To do so, social scientists have been regularly mobilized either as external evaluators, follow-up committee members, or participatory observants. Hence, the Waste Plan is only the first step in a long decision-making process. For a PhD student under contract with ONDRAF/NIRAS, this mandate consists of thinking out a way to construct an inter-organizational innovative communication system that would be participative, transparent and embedded in a long-term perspective, thus integrating all the further legal steps to take throughout the decision-making process. In this regard, two paradoxical constraints must be taken into account: on the one hand, my own influence on the legal decision-making process should remain limited, because of a series of constraints, lock-ins and previous decisions which have to be respected; on the other hand, ONDRAF/NIRAS expects the research conclusions to be policy relevant and useful. In this paper, the purpose is twofold. Firstly, the issues raised by this policy mandate is an opportunity to question the per-formative dimensions of the social scientist in the decision-making process and, more specifically, to have a reflexive view on our position as PhD Student. Secondly, assuming the

  11. The long-term outcomes of interventions for the management of attention-deficit hyperactivity disorder in children and adolescents: a systematic review of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Parker J

    2013-09-01

    Full Text Available Jack Parker,1 Gill Wales,2 Nevyne Chalhoub,1 Val Harpin2 1Child and Adolescent Mental Health Service, Sheffield Children’s NHS Foundation Trust, Sheffield, UK; 2Paediatric Neurodisability, Ryegate Children’s Centre, Sheffield Children’s NHS Foundation Trust, Sheffield, UK Purpose: To systematically identify and review the currently available evidence on the long-term outcomes of recommended attention-deficit hyperactivity disorder (ADHD interventions following randomized controlled trials with children and young people. Method: A systematic search was conducted to identify trials >1 year in length using the following databases: CINAHL (January 1982– July 2012, MEDLINE (Ovid and Cambridge Scientific Abstracts [CSA], Psych info, Science Direct (Elsevier, and Cochrane Library. Hand searches of key journals in the subject, book chapters, and conference proceedings were also carried out. Relevant papers were critically appraised using the Cochrane risk of bias tool. Results: Eight controlled trials were identified as being relevant, of duration ranging from 1 year to 8 years (at follow up. The total number of participants in the studies was 1,057, of whom 579 (54.7% were from one cohort and included 26 different outcome measures. Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions, and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months. However, the effect size may decrease beyond this period. Conclusion: This review has highlighted the paucity and limitations of the evidence investigating the long-term outcomes of recommended interventions for managing ADHD symptoms. There is little evidence to suggest that the effects observed over the relatively short term are maintained throughout longer periods of impairment. Furthermore, much of the existing evidence examining effectiveness beyond 12 months does not

  12. Incorporating patient preferences in the management of multiple long-term conditions: is this a role for clinical practice guidelines?

    Directory of Open Access Journals (Sweden)

    Charlotte E. Young

    2015-11-01

    Full Text Available Background: Clinical practice guidelines provide an evidence-based approach to managing single chronic conditions, but their applicability to multiple conditions has been actively debated. Incorporating patient-preference recommendations and involving consumers in guideline development may enhance their applicability, but further understanding is needed. Objectives: To assess guidelines that include recommendations for comorbid conditions to determine the extent to which they incorporate patient-preference recommendations; use consumer-engagement processes during development, and, if so, whether these processes produce more patient-preference recommendations; and meet standard quality criteria, particularly in relation to stakeholder involvement. Design: A review of Australian guidelines published from 2006 to 2014 that incorporated recommendations for managing comorbid conditions in primary care. Document analysis of guidelines examined the presence of patient-preference recommendations and the consumer-engagement processes used. The Appraisal of Guidelines for Research and Evaluation instrument was used to assess guideline quality. Results: Thirteen guidelines were reviewed. Twelve included at least one core patient-preference recommendation. Ten used consumer-engagement processes, including participation in development groups (seven guidelines and reviewing drafts (ten guidelines. More extensive consumer engagement was generally linked to greater incorporation of patient-preference recommendations. Overall quality of guidelines was mixed, particularly in relation to stakeholder involvement. Conclusions: Guidelines do incorporate some patient-preference recommendations, but more explicit acknowledgement is required. Consumer-engagement processes used during guideline development have the potential to assist in identifying patient preferences, but further research is needed. Clarification of the consumer role and investment in consumer training

  13. Institutionalization and Organizational Long-term Success

    Directory of Open Access Journals (Sweden)

    Denise L. Fleck

    2007-05-01

    Full Text Available Institutionalization processes have an ambivalent effect on organizational long-term success. Even though they foster organizational stability and permanence, they also bring about rigidity and resistance to change. As a result, successful organizations are likely to lose their competitive advantage over time. The paper addresses this issue through the investigation of the institutionalization processes of two long-lived companies: General Electric, a firm that has been a long-term success and its rival, Westinghouse, which was broken up after eleven decades of existence. The longitudinal, multilevel analysis of firms and industry has identified two different modes of organizational institutionalization. The reactive mode gives rise to rigidity and change resistance, much like institutional theory predicts; the proactive mode, on the other hand, neutralizes those negative effects of institutionalization processes. In the reactive mode, structure predominates. In the proactive mode, agency plays a major role in organizational institutionalization, and in managing the organization’s relations with the environment, clearly contributing to environmental institutionalization.

  14. Soil zinc and cadmium availability and uptake by wheat (Triticum aestivum L.) as affected by long-term organic matter management

    Science.gov (United States)

    Grüter, Roman; Costerousse, Benjamin; Mayer, Jochen; Mäder, Paul; Thonar, Cécile; Frossard, Emmanuel; Schulin, Rainer; Tandy, Susan

    2017-04-01

    Zinc (Zn) deficiency is a widespread problem in human mineral nutrition. It is mainly caused by imbalanced diets with low contents of bioavailable Zn. This is in particular a problem in populations depending on cereals such as wheat (Triticum aestivum L.) as a major source of this essential micronutrient element. Increasing Zn concentrations in wheat grains (biofortification) is therefore an important challenge. At the same time, increased uptake of the toxic heavy metal cadmium (Cd) must be prevented. Agronomic practises influence soil properties such as pH and soil organic carbon and thus also have an indirect effect on phytoavailable soil Zn and Cd concentrations and the uptake of these metals by wheat in addition to direct inputs with fertilizers and other amendments. This study investigated the effects of long-term organic matter management on the phytoavailability of soil Zn and Cd and their uptake by wheat on plots of two Swiss long-term field trials. In one trial (DOK), a farming system comparison trial established in 1978, we compared plots under conventional management with mineral fertilization either in combination or not with farmyard manure application to plots under biodynamic organic management and control plots with no fertilizer application. In the second trial (ZOFE), established in 1949, we compared different fertilizer regimes on conventionally managed plots, including plots with application of mineral fertilizers only, farmyard manure, or compost and control plots with no fertilizer application. Soil physico-chemical and biological properties were determined at the beginning of the growing season. Soil Zn and Cd availabilities were assessed by the Diffusive Gradients in Thin Films (DGT) method and by DTPA extraction before and after wheat cultivation. Additionally, various wheat yield components and element concentrations in shoots and grains were measured at harvest. In the ZOFE trial, soil Zn and Cd concentrations were lowest in the mineral

  15. Profiling Patients’ Healthcare Needs to Support Integrated, Person-Centered Models for Long-Term Disease Management (Profile: Research Design

    Directory of Open Access Journals (Sweden)

    Arianne MJ Elissen

    2016-04-01

    Full Text Available Background: This article presents the design of PROFILe, a study investigating which (biomedical and non-(biomedical patient characteristics should guide more tailored chronic care. Based on this insight, the project aims to develop and validate ‘patient profiles’ that can be used in practice to determine optimal treatment strategies for subgroups of chronically ill with similar healthcare needs and preferences. Methods/Design: PROFILe is a practice-based research comprising four phases. The project focuses on patients with type 2 diabetes. During the first study phase, patient profiles are drafted based on a systematic literature research, latent class growth modeling, and expert collaboration. In phase 2, the profiles are validated from a clinical, patient-related and statistical perspective. Phase 3 involves a discrete choice experiment to gain insight into the patient preferences that exist per profile. In phase 4, the results from all analyses are integrated and recommendations formulated on which patient characteristics should guide tailored chronic care. Discussion: PROFILe is an innovative study which uses a uniquely holistic approach to assess the healthcare needs and preferences of chronically ill. The patient profiles resulting from this project must be tested in practice to investigate the effects of tailored management on patient experience, population health and costs.

  16. Long-Term Urban Growth and Land Use Efficiency in Southern Europe: Implications for Sustainable Land Management

    Directory of Open Access Journals (Sweden)

    Marco Zitti

    2015-03-01

    Full Text Available The present study illustrates a multidimensional analysis of an indicator of urban land use efficiency (per-capita built-up area, LUE in mainland Attica, a Mediterranean urban region, along different expansion waves (1960–2010: compaction and densification in the 1960s, dispersed growth along the coasts and on Athens’ fringe in the 1970s, fringe consolidation in the 1980s, moderate re-polarization and discontinuous expansion in the 1990s and sprawl in remote areas in the 2000s. The non-linear trend in LUE (a continuous increase up to the 1980s and a moderate decrease in 1990 and 2000 preceding the rise observed over the last decade reflects Athens’ expansion waves. A total of 23 indicators were collected by decade for each municipality of the study area with the aim of identifying the drivers of land use efficiency. In 1960, municipalities with low efficiency in the use of land were concentrated on both coastal areas and Athens’ fringe, while in 2010, the lowest efficiency rate was observed in the most remote, rural areas. Typical urban functions (e.g., mixed land uses, multiple-use buildings, vertical profile are the variables most associated with high efficiency in the use of land. Policies for sustainable land management should consider local and regional factors shaping land use efficiency promoting self-contained expansion and more tightly protecting rural and remote land from dispersed urbanization. LUE is a promising indicator reflecting the increased complexity of growth patterns and may anticipate future urban trends.

  17. Clinical Pattern and Acute and Long-term Management of Hereditary Angioedema Due to C1-Esterase Inhibitor Deficiency.

    Science.gov (United States)

    Gómez-Traseira, C; Pérez-Fernández, E; López-Serrano, M C; García-Ara, M C; Pedrosa, M; López-Trascasa, M; Caballero, T

    2015-01-01

    Hereditary angioedema due to C1-esterase inhibitor deficiency (HAE-C1-INH) is a life-threatening disease. To describe the clinical characteristics and management of patients with HAE-C1-INH during routine clinical practice. An observational, retrospective study was performed in patients with HAE-C1-INH. Demographic, clinical, and analytical data were collected from 2 periods: period A (October 2009-September 2010) and period B (October 2007-September 2009). We studied 112 patients with HAE-C1-INH (57.1% females). Age at onset of symptoms was 14.4 years (lower in patients who had experienced attacks in the previous year). In period B (n=87), 62.1% of patients presented at least 1 edema attack (median, 3.5 attacks/patient/2 years), and 19.1% of attacks were treated. In period A (n=77), 58.4% of patients were on maintenance therapy. Stanozolol was the most widely used drug (48.9%), with a mean weekly dose of 6.7 mg. At least 1 attack was recorded in 72.7% of patients (median, 3.0 attacks/patient/year), and 31.5% of the attacks were treated. Treatment of acute attacks increased by 12.4%. Age at onset of symptoms is associated with clinical expression of disease. The higher age at onset of symptoms, the fewer number of attacks per patient and year, and the lower dose of attenuated androgens necessary to control the disease than in other series lead us to hypothesize that HAE-C1-INH could have a less severe expression in Spain. Acute attacks seem to be treated increasingly often.

  18. Pan-Britain, mixed-methods study of multidisciplinary teams teaching parents to manage children's long-term kidney conditions at home: Study protocol

    Directory of Open Access Journals (Sweden)

    Swallow Veronica M

    2012-02-01

    Full Text Available Abstract Background Care of children and young people (children with long-term kidney conditions is usually managed by multidisciplinary teams. Published guidance recommends that whenever possible children with long-term conditions remain at home, meaning parents may be responsible for performing the majority of clinical care-giving. Multidisciplinary team members, therefore, spend considerable time promoting parents' learning about care-delivery and monitoring care-giving. However, this parent-educative aspect of clinicians' role is rarely articulated in the literature so little evidence exists to inform professionals' parent-teaching interventions. Methods/Design This ongoing study addresses this issue using a combination of quantitative and qualitative methods involving the twelve children's kidney units in England, Scotland and Wales. Phase I involves a survey of multidisciplinary team members' parent-teaching interventions using: i A telephone-administered questionnaire to determine: the numbers of professionals from different disciplines in each team, the information/skills individual professionals relay to parents and the teaching strategies/interventions they use. Data will be managed using SPSS to produce descriptive statistics ii Digitally-recorded, qualitative group or individual interviews with multidisciplinary team members to explore their accounts of the parent-teaching component of their role. Interviews will be transcribed anonymously and analysed using Framework Technique. Sampling criteria will be derived from analysis to identify one/two unit(s for subsequent in-depth study Phase II involves six prospective, ethnographic case-studies of professional-parent interactions during parent-teaching encounters. Parents of six children with a long-term kidney condition will be purposively sampled according to their child's age, diagnosis, ethnicity and the clinical care-giving required; snowball sampling will identify the

  19. Pan-Britain, mixed-methods study of multidisciplinary teams teaching parents to manage children's long-term kidney conditions at home: study protocol.

    Science.gov (United States)

    Swallow, Veronica M; Allen, Davina; Williams, Julian; Smith, Trish; Crosier, Jean; Lambert, Heather; Qizalbash, Leila; Wirz, Lucy; Webb, Nicholas J A

    2012-02-14

    Care of children and young people (children) with long-term kidney conditions is usually managed by multidisciplinary teams. Published guidance recommends that whenever possible children with long-term conditions remain at home, meaning parents may be responsible for performing the majority of clinical care-giving. Multidisciplinary team members, therefore, spend considerable time promoting parents' learning about care-delivery and monitoring care-giving. However, this parent-educative aspect of clinicians' role is rarely articulated in the literature so little evidence exists to inform professionals' parent-teaching interventions. This ongoing study addresses this issue using a combination of quantitative and qualitative methods involving the twelve children's kidney units in England, Scotland and Wales. Phase I involves a survey of multidisciplinary team members' parent-teaching interventions using:i) A telephone-administered questionnaire to determine: the numbers of professionals from different disciplines in each team, the information/skills individual professionals relay to parents and the teaching strategies/interventions they use. Data will be managed using SPSS to produce descriptive statisticsii) Digitally-recorded, qualitative group or individual interviews with multidisciplinary team members to explore their accounts of the parent-teaching component of their role. Interviews will be transcribed anonymously and analysed using Framework Technique. Sampling criteria will be derived from analysis to identify one/two unit(s) for subsequent in-depth studyPhase II involves six prospective, ethnographic case-studies of professional-parent interactions during parent-teaching encounters. Parents of six children with a long-term kidney condition will be purposively sampled according to their child's age, diagnosis, ethnicity and the clinical care-giving required; snowball sampling will identify the professionals involved in each case-study. Participants will

  20. Kamp K'aana, a 2-Week Residential Weight Management Summer Camp, Shows Long-Term Improvement in Body Mass Index z Scores.

    Science.gov (United States)

    Farhat, Alicia Elena; Sharma, Shreela; Abrams, Stephanie H; Wong, William W; Barlow, Sarah E

    2016-03-01

    Long-term effects of Kamp K'aana, a 2-week residential weight management camp, on body mass index (BMI) measures were evaluated on 71 of 108 (66%) obese youth 10 to 14 years of age. Measures were obtained at 11-month study follow-up (n = 38) or extracted from medical record (n = 33). Compared with baseline, BMI increased (P < 0.001), but both BMI percentile and BMI z score decreased (98.7 ± 1.0 to 97.3 ± 6.7 and 2.34 ± 0.30 to 2.23 ± 0.34, P < 0.001). A decrease in BMI z score of ≥0.2 units was seen in 27% of the participants (P < 0.001). The short program has sustained effect.

  1. Kootenai River Wildlife Habitat Enhancement Project : Long-term Bighorn Sheep/Mule Deer Winter and Spring Habitat Improvement Project : Wildlife Mitigation Project, Libby Dam, Montana : Management Plan.

    Energy Technology Data Exchange (ETDEWEB)

    Yde, Chis

    1990-06-01

    The Libby hydroelectric project, located on the Kootenai River in northwestern Montana, resulted in several impacts to the wildlife communities which occupied the habitats inundated by Lake Koocanusa. Montana Department of Fish, Wildlife and Parks, in cooperation with the other management agencies, developed an impact assessment and a wildlife and wildlife habitat mitigation plan for the Libby hydroelectric facility. In response to the mitigation plan, Bonneville Power Administration funded a cooperative project between the Kootenai National Forest and Montana Department of Fish, Wildlife and Parks to develop a long-term habitat enhancement plan for the bighorn sheep and mule deer winter and spring ranges adjacent to Lake Koocanusa. The project goal is to rehabilitate 3372 acres of bighorn sheep and 16,321 acres of mule deer winter and spring ranges on Kootenai National Forest lands adjacent to Lake Koocanusa and to monitor and evaluate the effects of implementing this habitat enhancement work. 2 refs.

  2. Effect of short-term versus long-term grassland management and seasonal variation in organic and conventional dairy farming on the composition of bulk tank milk.

    Science.gov (United States)

    Adler, S A; Jensen, S K; Govasmark, E; Steinshamn, H

    2013-09-01

    Bulk tank milk from 28 dairy farms was sampled every second month for 2 yr to assess the effects of grassland management, production system and season on milk fatty acid (FA) composition, concentrations of fat-soluble vitamins, Se, and milk sensory quality. Grassland management varied in terms of time since establishment. Short-term grassland management (SG) was defined as establishment or reseeding every fourth year or more often, and long-term grassland management (LG) was defined as less frequent establishment or reseeding. Fourteen organic (ORG) dairy farms with either short-term or long-term grassland management were paired with 14 conventional (CON) farms with respect to grassland management. Within ORG farms, SG farms differed from LG farms in herbage botanical composition, but not in concentrate FA concentrations, dry matter intake, or milk yield. Within CON farms, herbage composition, concentrate FA concentrations, dry matter intake, and milk yield showed no or insignificant variations. The ORG farms differed from CON farms in herbage botanical composition, concentrate FA concentrations, concentrate intake, and milk yield. Compared with ORG-LG farms, ORG-SG farms produced milk fat with higher proportions of C10:0 and C12:0 associated with higher herbage proportions of legumes (Fabaceae) and lower proportions of other dicotyledon families. Compared with milk from CON farms, milk fat from ORG farms had higher proportions of most saturated FA and all n-3 FA, but lower proportions of C18:0 and C18:1 cis-9 associated with higher forage proportion and differences in concentrations of FA in concentrates. Compared with the outdoor-feeding periods, the indoor feeding periods yielded milk fat with higher proportions of most short-chain and medium-chain FA and lower proportions of most C18-FA associated with grazing and higher forage proportions. Milk concentrations of α-tocopherol and β-carotene were lower during the grazing periods. Inclusion of fishmeal in

  3. Temporal variability of CO2 and N2O emissions in an agricultural long-term field trial regarding effects of different management practices and extreme weather effects

    Science.gov (United States)

    Koal, Philipp; Schilling, Rolf; Gerl, Georg; Pritsch, Karin; Munch, Jean Charles

    2016-04-01

    In order to achieve a reduction of greenhouse gas emissions, modern agronomic management practices need to be established. Therefore, to assess the effect of different farming practices on greenhouse gas emissions, reliable data are required. The experiment covers and compares main aspects of agricultural management for a better implementation of sustainable land use. The focus lies on the determination and interpretation of greenhouse gas emissions, where the effects of diverse tillage systems and fertilisation practices of an integrated farming system as well as the impacts of extreme weather conditions are observed. In addition, with analysis of the alterable biological, physical and chemical soil properties a link between the impact of different management systems on greenhouse gas emissions and the observed cycle of matter in the soil, especially the nitrogen and carbon cycle, is enabled. Measurements have been carried out on long-term field trials at the Research Farm Scheyern located in a Tertiary hilly landscape approximately 40 km north of Munich (South Germany). The long-term integrated farming system trial was started in 1992. Since then parcels of land (each around 0.2-0.4 ha) with a particular interior plot set-up have been conducted with the same crop rotation, tillage and fertilisation practice referring to integrated farming management. Thus, the management impacts on the soil of more than 20 years have been examined. Fluxes of CH4, N2O and CO2 have been monitored since 2007 for the integrated farming system trial using an automated system which consists of chambers (0.4 m2 area) with a motor-driven lid, an automated gas sampling unit, an on-line gas chromatographic analysis system, and a control and data logging unit. Precipitation and temperature data have been observed for the experimental field to include weather effects. The main outcomes are the analysis of temporal and spatial dynamics of greenhouse gas emissions influenced by management

  4. Modulation of metallothionein and metal partitioning in liver and kidney of Solea senegalensis after long-term acclimation to two environmental temperatures

    Energy Technology Data Exchange (ETDEWEB)

    Siscar, R.; Torreblanca, A.; Ramo, J. del [Departamento Biología Funcional y Antropología Física, Universitat de València, Dr. Moliner 50 Burjassot, 46100 València (Spain); Solé, M., E-mail: msole@icm.csic.es [Institut de Ciencies del Mar (ICM-CSIC), Passeig marítim de la Barceloneta 37-49, 08003 Barcelona (Spain)

    2014-07-15

    Juveniles of Solea senegalensis were fed with commercial pellets under controlled conditions at two environmental Mediterranean temperatures (15 and 20 °C) for two months. After this period, the accumulation of essential and non-essential metals and metallothionein (MT) levels was measured in liver and kidney by inductively coupled plasma mass spectrometry (ICP-MS) and pulse polarography, respectively. The bioaccumulation factor (BAF) for selected metals in both tissues was calculated in relation to levels present in the feed. Tissue partitioning (liver/kidney) and molar ratios, considering the metal protective mechanisms: MT and Selenium (Se), were included for evaluating the detoxification capacity of each tissue. Ag, Cd, Cu and Mn were preferentially accumulated in the liver whereas Co, Fe, Hg, Se and Zn were found in larger concentrations in the kidney, and higher temperature enhanced the accumulation of some of them, but not all. MT content in liver, but not in kidney, was also influenced by temperature changes and by length of exposure. The BAF revealed that Cu was taken up mainly by the liver whereas Se was efficiently taken up by both tissues. The high molar ratios of MT and most metals denoted the kidney's remarkable spare capacity for metal detoxification through MT binding. Moreover, the potential protective role of Se was also more evident in kidney as a higher Se:Cd and Se:Ag molar ratios were reached in this organ. In contrast to other fish, the storage of Cd in kidney was particularly low. - Highlights: • Long-term increases in temperature entailed changes in MT and metal content in liver. • The liver is the preferred storage organ for most metals. • Se assimilation from feed results in a high BAF in the liver and kidney. • MT/metal and Se/metal are higher in kidney than in liver for most metals, except Cd.

  5. Long-term evolution of fish communities in European mountainous rivers: past log driving effects, river management and species introduction (Salzach River, Danube).

    Science.gov (United States)

    Haidvogl, Gertrud; Pont, Didier; Dolak, Horst; Hohensinner, Severin

    Using historical sources from the turn of the 19th to the 20th century, we investigated the long-term evolution of the fish community in a mountainous river network and the influence of different human uses and management measures. Within the alpine Salzach catchment, historical presence was reconstructed for 26 fish species, abundance classes for 19 species. Due to channelization, flood protection and dam erections, the spatial distribution of fish species was reduced during the 20th century. Many rheophilic and eurytopic fish species historically inhabited river reaches along a wide longitudinal profile and were present in more upstream river reaches than nowadays. The decrease of species diversity in the headwater sections is a consequence of lost lateral connectivity. Strongest effects are reported for sensitive species requiring different habitat types during their life cycles (especially pike, nase, Danube salmon). One of the most important shifts from the historical fish community to the present one reflects the deliberate introduction of fish species for fisheries. Rainbow trout and brook trout, absent from the historical fish assemblage, today represent up to 29 % of the total number of fish occurrences. In contrast, log driving, one of the most common historical pressures in European mountainous rivers, did not show significant negative effects on the past fish ecological situation. This result strongly differs from the impacts of log driving and deforestation demonstrated for recent times, and could be related to the change in log driving practices during the 20th century and to the high societal value of fish before the industrialization period along with other historical pressures affecting fish in rivers without log driving. In general, our results can be valid for a large number of European mountainous rivers. They highlight the usefulness of such detailed historical studies for our understanding of the long-term evolution of fish communities and

  6. Surgical management of congenital intrahepatic bile duct dilatation, Caroli's disease and syndrome: long-term results of the French Association of Surgery Multicenter Study.

    Science.gov (United States)

    Mabrut, Jean-Yves; Kianmanesh, Reza; Nuzzo, Gennaro; Castaing, Denis; Boudjema, Karim; Létoublon, Christian; Adham, Mustapha; Ducerf, Christian; Pruvot, François-René; Meurisse, Nicolas; Cherqui, Daniel; Azoulay, Daniel; Capussotti, Lorenzo; Lerut, Jan; Reding, Raymond; Mentha, Gilles; Roux, Adeline; Gigot, Jean-François

    2013-11-01

    To assess clinical presentation and long-term results of surgical management of congenital intrahepatic bile duct dilatation (IHBDD) (Caroli disease and syndrome) in a multicenter setting. Congenital IHBDD predisposes to biliary stasis, resulting in intrahepatic lithiasis, septic complications, and cholangiocarcinoma. Although liver resection (LR) is considered to be the treatment of choice for unilobar disease extent into the liver, the management of bilobar disease and/or associated congenital hepatic fibrosis remains challenging. From 1978 to 2011, a total of 155 patients (median age: 55.7 years) were enrolled from 26 centers. Bilobar disease, Caroli syndrome, liver atrophy, and intrahepatic stones were encountered in 31.0%, 19.4%, 27.7%, and 48.4% of patients, respectively. A complete resection of congenital intrahepatic bile ducts was achieved in 90.5% of the 148 patients who underwent surgery. Postoperative mortality was nil after anatomical LR (n = 111) and 10.7% after liver transplantation (LT) (n = 28). Grade 3 or higher postoperative morbidity occurred in 15.3% of patients after LR and 39.3% after LT. After a median follow-up of 35 months, the 5-year overall survival rate was 88.5% (88.7% after LT), and the Mayo Clinic score was considered as excellent or good in 86.0% of patients. The 1-year survival rate was 33.3% for the 8 patients (5.2%) who presented with coexistent cholangiocarcinoma. LR for unilobar and LT for diffuse bilobar congenital IHBDD complicated with cholangitis and/or portal hypertension achieved excellent long-term patient outcomes and survival. Because of the bad prognosis of cholangiocarcinoma and the sizeable morbidity-mortality after LT, timely indication for surgical treatment is of major importance.

  7. High environmental ammonia exposure has developmental-stage specific and long-term consequences on the cortisol stress response in zebrafish.

    Science.gov (United States)

    Williams, Tegan A; Bonham, Luke A; Bernier, Nicholas J

    2017-12-01

    The capacity for early life environmental stressors to induce programming effects on the endocrine stress response in fish is largely unknown. In this study we determined the effects of high environmental ammonia (HEA) exposure on the stress response in larval zebrafish, assessed the tolerance of embryonic and larval stages to HEA, and evaluated whether early life HEA exposure has long-term consequences on the cortisol response to a novel stressor. Exposure to 500-2000μM NH 4 Cl for 16h did not affect the gene expression of corticotropin-releasing factor (CRF) system components in 1day post-fertilization (dpf) embryos, but differentially increased crfa, crfb and CRF binding protein (crfbp) expression and stimulated both dose- and time-dependent increases in the whole body cortisol of 5dpf larvae. Pre-acclimation to HEA at 1dpf did not affect the cortisol response to a subsequent NH 4 Cl exposure at 5dpf. In contrast, pre-acclimation to HEA at 5dpf caused a small but significant reduction in the cortisol response to a second NH 4 Cl exposure at 10dpf. While continuous exposure to 500-2000μM NH 4 Cl between 0 and 5dpf had a modest effect on mean survival time, exposure to 400-1000μM NH 4 Cl between 10 and 14dpf decreased mean survival time in a dose-dependent manner. Moreover, pre-acclimation to HEA at 5dpf significantly decreased the risk of mortality to continuous NH 4 Cl exposure between 10 and 14dpf. Finally, while HEA at 1dpf did not affect the cortisol stress response to a novel vortex stressor at 5dpf, the same HEA treatment at 5dpf abolished vortex stressor-induced increases in whole body cortisol at 10 and 60dpf. Together these results show that the impact of HEA on the cortisol stress response during development is life-stage specific and closely linked to ammonia tolerance. Further, we demonstrate that HEA exposure at the larval stage can have persistent effects on the capacity to respond to stressors in later life. Copyright © 2017 Elsevier Inc. All

  8. Carbon sequestration in croplands is mainly driven by management leading to increased net primary production - evidence from long-term field experiments in Northern Europe

    Science.gov (United States)

    Kätterer, Thomas; Bolinder, Martin Anders; Börjesson, Gunnar; Kirchmann, Holger; Poeplau, Christopher

    2014-05-01

    Sustainable intensification of agriculture in regions with high production potential is a prerequisite for providing services for an increasing human population, not only food, animal feed, fiber and biofuel but also to promote biodiversity and the beauty of landscapes. We investigated the effect of different management practices on soil fertility and carbon sequestration in long-term experiments, mainly from Northern Europe. In addition, a meta-analysis on the effect of catch crops was conducted. Improved management of croplands was found to be a win-win strategy resulting in both increased soil fertility and carbon sequestration. We quantified the effect of different management practices such as N fertilization, organic amendments, catch crops and ley-arable rotations versus continuous annual cropping systems on soil carbon stocks. Increasing net primary productivity (NPP) was found to be the main driver for higher soil carbon storage. Mineral N fertilization increased soil carbon stocks by 1-2 kg C ha-1 for each kg of N applied to cropland. Ley-arable rotations, being a combination of annual and perennial crops, are expected to have C stocks intermediate between those of continuous grass- and croplands. A summary of data from 15 long-term sites showed that on average 0.5 Mg ha-1 yr-1 (range 0.3 to 1.1; median 0.4 Mg ha-1 yr-1) more carbon was retained in soils in ley-arable compared to exclusively annual systems, depending on species composition, management, soil depth and the duration of the studies. The annual C accumulation rate for catch crops determined in the meta-analysis was well within that range (0.32±0.08 Mg C ha-1 yr-1). Retention factors calculated for straw, manure, sawdust, peat, sewage sludge and composted household waste varied widely in a decadal time scale. Retention of root and rhizodeposit carbon was higher than for above-ground crop residues. We conclude that NPP is the major driver for C sequestration and emphasize that increased soil

  9. Long-term monitoring of high-elevation white pine communities in Pacific West Region National Parks

    Science.gov (United States)

    Shawn T. McKinney; Tom Rodhouse; Les Chow; Penelope Latham; Daniel Sarr; Lisa Garrett; Linda Mutch

    2011-01-01

    National Park Service Inventory and Monitoring (I&M) networks conduct long-term monitoring to provide park managers information on the status and trends in key biological and environmental attributes (Vital Signs). Here we present an overview of a collaborative approach to long-term monitoring of high-elevation white pine forest dynamics among three Pacific West...

  10. Long-Term Ownership by Industrial Foundations

    DEFF Research Database (Denmark)

    Børsting, Christa Winther; Kuhn, Johan Moritz; Poulsen, Thomas

    2016-01-01

    in several respects. Foundations hold on to their shares for longer. Foundation-owned companies replace managers less frequently. They have more conservative capital structures with less leverage. Their companies survive longer. Their business decisions appear to be more long term. This paper supports...... in Denmark. Industrial foundations are independent legal entities without owners or members typically with the dual objective of preserving the company and using excess profits for charity. We use a unique Danish data set to examine the governance of foundation-owned companies. We show that they are long-term......Short-termism has become a serious concern for businesses and policy makers and this has inspired a search for governance arrangement to promote long term decision making. In this paper we study a particularly long-term ownership structure, which is fairly common in Northern Europe, particularly...

  11. Surgical management of medium and large petroclival meningiomas: a single institution's experience of 199 cases with long-term follow-up.

    Science.gov (United States)

    Li, Da; Tang, Jie; Ren, Cong; Wu, Zhen; Zhang, Li-Wei; Zhang, Jun-Ting

    2016-03-01

    Petroclival meningiomas (PCMs) were once regarded as 'inoperable' due to their complex anatomy and limited surgical exposure. This study aimed to evaluate the long-term outcomes of surgically treated PCMs larger than 2 cm. A series of 199 consecutive patients (137 females, 68.8 %) with PCMs larger than 2 cm from between 1993 and 2003 were included. The clinical charts, radiographs, and follow-ups were evaluated. Gross total resection (GTR) was achieved in 111 (55.8 %) patients, subtotal resection (STR) in 65, and partial resection (PR) in 23. Cranial nerve dysfunctions were the most common complications and occurred in 133 (66.8 %) cases. The surgical mortality was 2.0 %. The Karnofsky Performance Scale (KPS) scores significantly decreased 1 month after the operations (preoperative KPS = 76.8 and postoperative KPS = 64.8; p = 0.011, Paired-samples t test). Long-term follow-ups were obtained in 142 patients, the follow-up duration was 171.6 months, and the most recent KPS was 83.2. Permanent morbidities remained in 24 patients (18.9 %). Multivariate analysis revealed that brainstem edema and tumors larger than 4 cm in diameter were independent risk factors in terms of outcomes (KPS Pearson χ (2) test). Gamma Knife radiosurgery for the remnants exhibited good tumor control. Favorable outcomes and low mortality were achieved with the microsurgical management of medium and large PCMs; however, the rates of cranial nerves dysfunction remained high. Radically aggressive resection might not be judicious in terms of postoperative morbidity. The preoperative evaluations and intraoperative findings were informative regarding the outcomes. The low follow-up rate likely compromised our findings, and additional consecutive studies were required.

  12. Value and innovation of direct-acting antivirals: long-term health outcomes of the strategic plan for the management of hepatitis C in Spain.

    Science.gov (United States)

    Turnes, Juan; Domínguez-Hernández, Raquel; Casado, Miguel Ángel

    2017-12-01

    To assess the long-term healthcare costs and health outcomes in association with the access to new direct-acting antivirals (DAAs), during the first year of the National Strategic Plan for Chronic Hepatitis C (SPCHC) in patients with chronic hepatitis C (CHC) in Spain. A decision tree and a lifetime Markov model were developed to simulate the natural history, morbidity, and mortality of a cohort of 51,900 patients with CHC before (pre-DAA strategy) and after (post-DAA strategy) access to DAAs, following SPCHC approval. The percentage of patients treated, transition probabilities, disease management costs, health state utility values, sustained virologic response rates and treatment costs were obtained from the literature and published data from Spain. The results were expressed in terms of costs (€, 2016), quality-adjusted life years (QALYs) and prevention of clinical events, with an annual discount rate of 3%. The post-DAA strategy would prevent 8,667 cases of decompensated cirrhosis, 5,471 cases of hepatocellular carcinoma, 1,137 liver transplants and 9,608 liver-related deaths. The cohort of 51,900 patients would require investments of 1,606 and 1,230 million euros with the post-DAA and pre-DAA strategies, respectively. This would produce 819,674 and 665,703 QALYs. The use of new DAA-based treatments in CHC patients during the first year after the implementation of the SPCHC significantly reduced long-term morbidity and mortality and increased quality of life; demonstrating that this plan is an efficient use of public health resources.

  13. Short- to long-term results of Ahmed glaucoma valve in the management of elevated intraocular pressure in patients with pediatric uveitis.

    Science.gov (United States)

    Eksioglu, Umit; Yakin, Mehmet; Sungur, Gulten; Satana, Banu; Demirok, Gulizar; Balta, Ozgur; Ornek, Firdevs

    2017-06-01

    The aim of this study was to evaluate the long-term outcome of Ahmed glaucoma valve (AGV) implant for elevated intraocular pressure (IOP) in pediatric patients with uveitis. This was a retrospective chart review. The study included 16 eyes (11 children) with uveitis. Success was defined as having IOP between 6 and 21 mm Hg with (qualified success) or without (complete success) antiglaucoma medications and without the need for further glaucoma or tube extraction surgery. Mean age of patients at the time of AGV implantation was 14.19 ± 3.25 years. AGV implantation was the first glaucoma surgical procedure in 12 eyes (75%). Average postoperative follow-up period was 64.46 ± 33.56 months. Mean preoperative IOP was 33.50 ± 7.30 mm Hg versus 12.69 ± 3.20 mm Hg at the last follow-up visit (p AGV implantation in 1 eye. The cumulative probability of complete success was 68.8% at 6 months, 56.3% at 12 months, 49.2% at 36 months, 42.2% at 48 months, and 35.2% at 84 months, and the cumulative probability of eyes without complication was 75.0% at 6 months, 66.7% at 24 months, 58.3% at 36 months, 48.6% at 48 months and 24.3% at 108 months based on Kaplan-Meier survival analysis. Although AGV implant is an effective choice in the management of elevated IOP in pediatric uveitis, antiglaucoma medications are frequently needed for control of IOP. Tube exposure is an important complication in the long term. Differential diagnosis between relapse of uveitis and endophthalmitis is important in patients who received AGV implantation. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  14. Integrating care for people with mental illness: the Care Programme Approach in England and its implications for long-term conditions management

    Directory of Open Access Journals (Sweden)

    Nick Goodwin

    2010-03-01

    Full Text Available Introduction: This policy paper considers what the long-term conditions policies in England and other countries could learn from the experience of the Care Programme Approach (CPA. The CPA was introduced in England in April 1991 as the statutory framework for people requiring support in the community for more severe and enduring mental health problems. The CPA approach is an example of a long-standing 'care co-ordination' model that seeks to develop individualised care plans and then attempt to integrate care for patients from a range of providers. Policy description: The CPA experience is highly relevant to both the English and international debates on the future of long-term conditions management where the agenda has focused on developing co-ordinated care planning and delivery between health and social care; to prioritise upstream interventions that promote health and wellbeing; and to provide for a more personalised service. Conclusion: This review of the CPA experience suggests that there is the potential for better care integration for those patients with multiple or complex needs where a strategy of personalised care planning and pro-active care co-ordination is provided. However, such models will not reach their full potential unless a number of preconditions are met including: clear eligibility criteria; standardised measures of service quality; a mix of governance and incentives to hold providers accountable for such quality; and genuine patient involvement in their own care plans. Implications: Investment and professional support to the role of the care co-ordinator is particularly crucial. Care co-ordinators require the requisite skills and competencies to act as a  care professional  to the patient as well as to have the power to exert authority among other care professionals to ensure multidisciplinary care plans are implemented successfully. Attention to inter-professional practice, culture, leadership and organisational

  15. Integrating care for people with mental illness: the Care Programme Approach in England and its implications for long-term conditions management

    Directory of Open Access Journals (Sweden)

    Nick Goodwin

    2010-03-01

    Full Text Available Introduction: This policy paper considers what the long-term conditions policies in England and other countries could learn from the experience of the Care Programme Approach (CPA. The CPA was introduced in England in April 1991 as the statutory framework for people requiring support in the community for more severe and enduring mental health problems. The CPA approach is an example of a long-standing 'care co-ordination' model that seeks to develop individualised care plans and then attempt to integrate care for patients from a range of providers.Policy description: The CPA experience is highly relevant to both the English and international debates on the future of long-term conditions management where the agenda has focused on developing co-ordinated care planning and delivery between health and social care; to prioritise upstream interventions that promote health and wellbeing; and to provide for a more personalised service.Conclusion: This review of the CPA experience suggests that there is the potential for better care integration for those patients with multiple or complex needs where a strategy of personalised care planning and pro-active care co-ordination is provided. However, such models will not reach their full potential unless a number of preconditions are met including: clear eligibility criteria; standardised measures of service quality; a mix of governance and incentives to hold providers accountable for such quality; and genuine patient involvement in their own care plans.Implications: Investment and professional support to the role of the care co-ordinator is particularly crucial. Care co-ordinators require the requisite skills and competencies to act as a  care professional  to the patient as well as to have the power to exert authority among other care professionals to ensure multidisciplinary care plans are implemented successfully. Attention to inter-professional practice, culture, leadership and organisational

  16. Environmental technology foresight : New horizons for technology management

    NARCIS (Netherlands)

    Den Hond, Frank; Groenewegen, Peter

    1996-01-01

    Decision-making in corporate technology management and government technology policy is increasingly influenced by the environmental impact of technologies. Technology foresight (TF) and environmental impact assessment (EIA) are analyzed with regard to the roles they can play in developing long-term

  17. Why less may be more: a mixed methods study of the work and relatedness of ‘weak ties’ in supporting long-term condition self-management

    Science.gov (United States)

    2014-01-01

    Background The distribution of the roles and responsibilities of long-term condition management (LTCM) outside of formal health services implicates a wide set of relationships and activities of involvement. Yet, compared to studies of professional implementation, patient systems of implementation remain under-investigated. The aim of this paper is to explore the work, meaning and function attributed to ‘weaker’ ties relative to other more bonding relationships in order to identify the place of these within a context of systems of support for long-term conditions. Methods This is a mixed methods survey with nested qualitative study. A total of 300 people from deprived areas in the North West of England with chronic illnesses took part in a survey conducted in 2010 to 2011. A concentric circles diagram was used as a research tool with which participants identified 2,544 network members who contributed to illness management. Notions of ‘work’ were used to describe activities associated with chronic illness and to identify how weaker ties are included and perceived to be involved through social network members (SNM) contributions. Results The results provide an articulation of how SNMs are substantially involved in weak tie illness management. Weaker ties constituted 16.1% of network membership involved in illness work. The amount of work undertaken was similar but less than that of stronger ties. Weaker ties appeared more durable and less liable to loss over time than stronger ties. The qualitative accounts suggested that weak ties enabled the moral positioning of the self-managing ‘self’ and acted on the basis of a strong sense of reciprocity. Conclusions Weak ties act as an acceptable bridge between a sense of personal agency and control and the need for external support because it is possible to construct a sense of moral acceptability through reciprocal exchange. Access to weak tie resources needs to be taken into account when considering the ways in

  18. Case management of individuals with long-term conditions by community matrons: report of qualitative findings of a mixed method evaluation.

    Science.gov (United States)

    Randall, Sue; Daly, Guy; Thunhurst, Colin; Mills, Natalie; Guest, David A; Barker, Annette

    2014-01-01

    To consider findings from a study that evaluated case management of individuals with long-term conditions (LTCs) by a community matron (CM) service. The paper highlights issues related to the implementation of a new role and the impact this had on the experience of care across hospital and community settings for patients and their carers. The introduction of the role of CM was intended to increase effective management of patients with complex comorbid LTCs through the introduction of case management, thereby reducing unplanned hospital admissions. The overall methodological approach was one of mixed methods. This paper reports the qualitative findings from CMs (n = 15); patients (n = 13); family carers (n = 8); and secondary care staff who interface with the CM service (n = 7). Data were collected between October 2009 and May 2010. A thematic analysis resulted in the identification of four themes: (1) visibility; (2) interpersonal relationships; (3) leadership; and (4) systems/professional boundaries. Patients enjoyed being seen as a whole and family carers appreciated the coordination aspect of the role. Difficulties arose from the limited understanding of the CM role and from a lack of a shared vision across healthcare professionals concerning the role and its goals.

  19. Stressors in Teens with Type 1 Diabetes and Their Parents: Immediate and Long-Term Implications for Transition to Self-Management.

    Science.gov (United States)

    Ersig, Anne L; Tsalikian, Eva; Coffey, Julie; Williams, Janet K

    2016-01-01

    Teens with Type 1 diabetes and their parents experience every day and illness-related stress; however, understanding of how these stressors relate to the transition to adulthood is limited. The purpose of this study was to identify stressors of teens with Type 1 diabetes (T1DM) and their parents related to the impending transition to adulthood. This study used open-ended questions to identify every day and illness-related stressors among 15 teens with T1DM and 25 parents seen in one pediatric diabetes clinic. Qualitative descriptive analysis identified themes in interview transcripts. The primary teen stressor related to impending transition centered on ineffective self-management, often when they were taking over responsibility for T1DM management. Parents' concerns included immediate and long-term negative outcomes of teen self-management as well as financial resources and health insurance for the teen. Teens and parents both expressed specific concerns about outcomes and prevention of nocturnal hypoglycemia, and identified uncertainties related to teen health and diabetes-focused health care when no longer living in the parent's home. Teens with Type 1 diabetes and their parents understand that independent teen self-management is a component of transition to adulthood, but worry about teen self-management outcomes. Concerns specific to health care transition included health insurance, T1DM resources, and teens' abilities to handle new situations. Identifying current and future self-management concerns of individuals and families can facilitate targeted education and interventions to support successful transition to adulthood. Copyright © 2016 Elsevier Inc. All rights reserved.